Cardiology + Resp Flashcards
What is the low dose ICS for adults and kids
beclomethasone 100-250mg BD
beclomethasone 50 - 100mg BD ‘Clenil’
What is the FIRST escalation in management of asthma
(3 Ts prior)
- LTRA + r/v in 4-8weeks
- LABA (Salmeterol or fomterol fumarate)
—-> combo with ICS as MART is beclome + forneterol
whats is mod dose ICS (adults + then kids)
beclometasone 300-500mcg BD
150-200mcg BD
what should high dose steroids also have (>600mcg BD)
referral
via pMDI + space
what is the rule with reducing therapy
In asthma ICS
reduced 25-50% every 3 months
what is the diagnostic criteria for COPD post bronchodilator spirometry
FEV1/FVC <0.7
what are some features of asthma/steroid responsiveness
Past history of asthma/atopy.
Significant symptom variability (based on history or tests: >400ml in FEV1/>20% in serial PEFRs).
Higher blood eosinophil count (NICE doesn’t specify a number but GOLD suggests >300/microL) .
treat for exacerbation
30mg pred 5 days
amox/doxy/clarith
what is the severity of FEV1 30-49%
3 = severe
what is the MRC breathless score needed rehab
3 = can’t keep up with peers on flat
5 is breathless at AODL
What are the regimen for those without asthma features
LABA + LAMA
- glycopyromiun + fometerol
- tiotropium + cladetal
What are the regimen for those with asthma features
LABA + ICS
- fluticasone propionate + salmterol (seritde)
- budeonsonide + fometerol (syncort)
triple therapy (trimbow pMDI)
- option after
theophylline
risk of regular ssteroids in copd
sepsis + VTE
fracture
- consider bone protection if >3 course of oral sted a year
indications for LTO
<30% FEV1
02 stats 92%
cyanosis, polycythenia
what should be done on annual review for COPD
- FEV1/FVC
- BMI
- MRC score (5)
- sats if severe
What level is reduced EF
HFrEF <40%
- normal is >50%
what level of BNP should trigger assessment within 2 weeks
> 2000
400-2000 = sepcailist assessment within 6 weeks (after echo)
what level of NY may require medical support/fit for fly prior
3 + 4 (medical support travelling)
when should you weight in HF
on waking, after voiding, before eating
- report 2kg within 24-72hrs
what is the mainstay of tx in HFrEF
ACE/ARB - low + slow, 2weeks bloods
BB (bisoprolol, nebivolol, carvediol)- aim pulse 60
- if overloaded dieuritcs
- afro/caribean = hydrazaine (high BP)
- Spirnolocatone if still symptomatic (NOT CKD >4 or K >5)
- SGLT2, ANRI, Invabrine if tachycarry
HFpEF mx
control BP, ischaemia, arrythmia, valve
no prognostic benefit with acei, BP
what is a risk of Bendroflumethiazide
diabetes
- indapamide
option to swap if peripehral oedema on amolpidine
felodipine
stage 1 hypertension
- when give drugs
135-149 / 85-94
- <80 + CVD/Diabetes/Renal disease
- QRISK >10
If not = lifestyle review
Stage 2 hypertension
150 / 90
HTN in pregnancy management
labeletol/nifedipine/methydopa + 75mg aspirin from 12 weeks
target BP 135/85 then 140/90 after birth
choice of HTN drug in <55yr or T2DM
ACE (ARB if black + diabetic)
> 55 or African (not diabetic) for HTN
CCB
2nd line add on option for HTN
- especially with HTN with HF + oedema
thiazide-like diuretic ‘Indapamide’
4th agent
<4.5 = add spironolactone (check U+Es within 1 month)
>4.5 - add alpha/BB
looking at routine referral then
- also if <40, seocndary
what are the BP targets
<140/90 (135/85 at home) if <80yrs
over 80 add 10 to sysotlic
Indications for primary prevention
- atorvastatin 20mg
QRisk >10% or >85
T1DM if >40yrs, 10yr diagnosis, nephropathy
CKD (eGFR <60) if <30 need to d/w renal
FHC
what is the targets (after 3m)
guidelines for LFTs
target >40% reduction in non-hdl
(Total choletserol minus HDL)
LFTs only if x3 upper normal limits
secondary prevention dose
aim for non-hdl
80mg
<2.5, if > think abouth inclusican (injection) or ezetimbibe
conditions that cause dyslipidemia
excess alochol, diabetes, hypoothyroid, liver disease, nephrotic syndrome
what level of chol should you refer
what level of simon broom criteria inidcate FHC
TC >9 or non-hdl >7.5
chol >7.5 or LDL >4.9
with mutation or tendon xanthomas or 1/2 relative
when to stop statins
3m before preg
avoid grapefruit juice
Alt rise >3
triglycerides rpt after fasting if 10-20
what drugs could cause
thiazide, non-selctive BB, unopposed estrogens
rehab drugs post ACS
DVLA rules
Statin (80mg, 20mg if ckd)
Antiplatelts - apsirin life, 12m of ticgrelol or clop, prasugrel (if had PCI)
BB - 12months, longer if reduced LV ejection fraction (rate limiting CCB if CI dilitiazem, verapamil)
ACEi - titrate max tolerated
annual HBA1c if raised Glucose
spiro if LVSD
1 weeks after PCI
6 week if lorry driver
uncertain of angina - what can you refer for
rapid access chest pain clinic - excerise/stree ECHO
- CT-coronary angiogram
What are the three typical symptoms for a diagnosis of angina
constricting discomfort
brought on by exertion
relieved by GTN/Rest
what is prinzmetal angina
occurs at rest due to spasm
- amlopdine or nifedepine good
what is cardiac syndrome X
microvessel disease
what are the principes of angina treatment
- 2nd prevention
- symptoms relief
- when refer
Aspirin ( + clop if recent MI or CVA)
Atrovastatin
ACEi
GTN and BB
- alternative is CCB (Nifedipine, Amlodipine, felodipine) caution/CI dilteazam or verapamil (esp HF)
if BB + CCB together not effectibe
considering ISMN, nicrandil (ulcer), ivabardaine, ranaolazine
what AVN blocks require referral
second degree type 2 - as PR constantly long with drop beats
third degree - noassications
what red flags of an arrythmia history require referral (4)
DVLA rules
palpitations during exercise
syncope
FHx of cardiac death
2 or 3rd HB
stop driving till controlled for 4 weeks
what drugs are CI in WPW (AVRT)
digoxin or verapamil
what are increases the bleeding risk in AF (orbit)
etoh
antiplatete therapy
NSAIDs, SSRI
uncontrolled BP
anaemia
poor INR control
what needs warfarin rather DOAC
mitral stenosis, mechanical valve, low creat, antiphopslid syndrome, left atrial appendice
who do you consider rhythm control with AF
(cardioversion, second line is left atrial ablation)
- would use bb for about 3m after
within 48hours onset - d/w specialist ?CV
younger pt with normal heart - reversible trigger, HF that causes AF
choices for rate control aiming pulse <110pbm
BB
rate limiting CCB (dilitazine or verapamil - mono)
if little exercise, digoxin
2nd line is dual BB/dilitiazem/dig (dig prefered if LVEF <40%)
What increases Long QT risk
Erythromycin/clari, amitriptyline, citalopram, seratline, antipsychotics, amiodraone, terfodenaine, ondasteron
Triglycerides >21 action
Assess if due to alcohol intake or poor glycaemic control
If not then refer for specialist review (pancreatis risk)
