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4th Year - Management > CCC - Primary Care > Flashcards

CCC - Primary Care Flashcards

1
Q

Asthma - Management

A

1) Salbutamol
2) ICS (200mg)

3) LABA
- benefit = continue
- some benefit, continue and increase ICS to 800mg
- no benefit - stop, increase ICS, trial LTRA

4) ICS to 2000

5) Oral prednisolone
- Refer

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2
Q

Asthma Review

A
  • Smoking cessation
  • Inhaler technique
  • Symptom control (compliance)
  • Admissions
  • Exacerbations
  • Flu jab and PCV
  • Mood
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3
Q

Acute AF - Unstable

A

DC Cardioversion

Medical cardioversion: Amiodarone

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4
Q

Acute AF - Stable

A

Rate control:

  • Bisoprolol 2.5mg
  • Verapamil 40-120mg/8 hours

Anticoagulation with LMWH

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5
Q

Chronic AF - Rate control

A

Beta blocker

  • Atenolol
  • Not in asthma

Rate limiting calcium channel blocker

  • Verapamil/diltazem
  • Not in HF

Digoxin
- Only if sedentary life style

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6
Q

Chronic AF - Rhythm Control

A

ECHO

  • No structural abnormality - flecainide
  • Structural abnormality - amiodarone
  • Surgical ablation
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7
Q

Stable Angina - 1st Line

A 
Beta blocker 
- Bisoprolol 2.5mg
OR 
Rate limiting Calcium channel blocker 
- Diltiazem/verapamil

Long Acting mononitrate

  • Isosorbide mononitrate
  • May become tolerant

GTN Spray/sublingual tablet
- Symptom relief

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8
Q

Stable Angina - Secondary Prevention

A
  • Aspirin 75mg
  • ACEi if diabetic
  • Statin/hypertensive

Revascularisation

  • CABG
  • PCI (single vessel disease)
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9
Q

Stable Angina - Review

A

6 months - 1 year

  • Symptoms (rest, exercise, duration)
  • CVD risk
  • Modifiable risk factors
  • Medication r/v

SCREEN: Heart failure and depression

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10
Q

Q RISK 2 - Who?

A

Assess every 5 years

  • > 40 years
  • First degree relative with premature CVD or familial hyperlipidaemia
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11
Q

CVD - Modifiable risk factors

A
  • Diet
  • Smoking
  • Stress
  • Exercise
  • Alcohol
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12
Q

CVD - Primary Prevention

A

> 10% in 10 years
- Atorvastatin 20mg

BP

  • ACEi if diabetic
  • Follow ACD rule
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13
Q

CHA2DS2VASC

A 
Congestive heart failure
Hypertension
Age >75 (2) 65-74 (1)
Diabetes
Stroke/TIA/VTE
Vascular disease (MI, angina, peripheral vasc. disease)
Sex (Female = 1)

ANTICOAGULATE

  • Men @ 1+
  • Women @ 2+
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14
Q

HASBLED

A 
Hypertension >160
Abnormal renal (1), liver (1)
Stroke
Bleeding history
Labile INR
Elderly (>65)
Drugs
- Alcohol (8U/week) 
- NSAIDs/anti platelet
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15
Q

COPD - FEV >50% (mild-mod)

A

SABA,
SABA + LABA,
Combohaler (ICS/LABA) + LAMA

OR

SAMA
LAMA
COMBOHALER + LAMA

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16
Q

COPD - FEV <50% (severe)

A

SABA
SABA + COMBOHALER
COMBO-HALER + LAMA

or

SAMA
LAMA
COMBOHALER + LAMA

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17
Q

COPD - Extra Management

A

STOP SMOKING!!

Rescue Pack

  • Prednisolone 30mg 7 days
  • Amoxicillin 500mg 5 days
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18
Q

COPD - Review

A

6M (severe), 1Y (mild-mod)

  • Mood
  • Smoking cessation
  • Inhaler Technique
  • O2 sats, BMI
  • Medication
  • Exacerbations, admissions
  • Flu jab/PCV
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19
Q

CKD - Stages

A

1) >90 (normal)
2) 60-89
3a) 45-59
3b) 30-44
4) 15-29
5) <15

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20
Q

CKD - Stage 1-2 Management

A
  • Annual monitoring
  • ACEi
  • CV risk
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21
Q

CKD - Stage 3a and 3b Management

A
  • CVS Risk
  • Investigate proteinuria, haematuria, declining eGFR, young age
  • Decrease use of nephrotoxic drugs
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22
Q

CKD - Stage 4 Management

A
  • Urgent referral

- Medication review if eGFR <30

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23
Q

Diabetes - Education

A
  • Vaccinations
  • Exercise (increase insulin sensitivity)
  • Smoking cessation
  • Work (if on insulin, no army, machinery, driving)
  • Diet
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24
Q

Diabetes - Therapy

A

Diet and lifestyle for 3 months

If HbA1c >6.5% = Metformin

> 7.5% - Dual therapy
- Metformin + one other

> 7.5% - Triple therapy
- Metformin + sulphonylurea + DDPIV/pioglitazone

Still >7.5%

  • Insulin
  • Aim for HbA1c <7.0
25
Q

Diabetes - Therapy (Metformin contraindicated)

A

DPPIV/Sulphonylurea/pioglitazone

Duel therapy - combo of any two

Insulin (aim <7.0%)

26
Q

Metformin

A

Biguanide

  • Increases insulin sensitivity,
  • Decreases gluconeogenesis

GOOD - Weightloss, no hypos
BAD - GI disturbance, can give MR preparation

DO NOT USE IN eGFR <30

27
Q

Sulphonylureas (Gliclazide)

A
  • Increases production of insulin

GOOD - Rapid improvement, good if low eGFR
BAD - Weight gain, hypos

28
Q

Pioglitazone

A
  • Increases insulin sensitivity
  • Preserves beta cell function

CONTRAINDICATIONS

  • Heart failure
  • Bladder Ca
29
Q

DPP-IV Inhibitors (sitagliptin)

A
  • Inhibits DPP-IV (which breaks down incretin)

Increase Incretin = increases insulin, decreases gluconeogenesis

30
Q

SGLT-2 (dapaglifozin)

A
  • Reduce glucose transporter on proximal tubule
  • More glucose lost in urine

BAD - polyuria, polydipsia, UTIs, Candida

31
Q

Statins - Primary Prevention

A

Atorvastatin 20mg

  • QRISK2 >10%
  • T1DM - >40 years or diabetes >10 years
  • T2DM >10% qrisk
  • CKD
32
Q

Statins - Secondary Prevention Dose

A

Atorvastatin 80mg (20mg in CKD)

33
Q

Statins - Monitoring

A
  • ALT/AST at 3M and 12M

- Cholesterol at 3M (aim for 40% reduction in HDL)

34
Q

Hypertension - Diagnosis

A

Measure BP in both arms

  • > 140/90 measure again
  • Ambulatory/home monitoring to confirm
35
Q

Hypertension - Exam and Investigations

A
  • Fundus
  • 12 Lead ECG
  • Urine (ACR and haematuria)

Bloods

  • Glucose
  • UEs + eGFR
  • LFTs
  • Lipids
36
Q

Hypertension - Staging

A

1 ) 135-150/ 85-90

2) >150/>90
3) >180/>110

37
Q

Hypertension - Who to treat?

A

> 80 years and stage 1

Stage 2 and above

38
Q

ACD Rule

A

<55 years

  • ACEi
  • ACEi + Ca2+ Channel blocker
  • ACEi + Ca2+ Channel Blocker + Thiazide diuretic

> 55 years/afro carribean

  • Ca2+ Channel blocker
  • Ca2+ Channel blocker + ACEi (or ARB if afrocarribean)
  • Ca2+ Channel Blocker + ACEi/ARB + Thiazide diuretic

Resistant
- Add another diuretic/beta blocker

39
Q

Epilepsy - General Seizures

A
  • Absence
  • Tonic clonic (LOC, post ictal)
  • Myoclonic (drop to ground)
  • Atonic (fall, no LOC)
40
Q

Epilepsy - Focal seizures

A
  • Simple, no LOC
  • Complex, post ictal, impaired awareness
  • Focal -> generalised
41
Q

Epilepsy - DVLA

A

Car
- 1 year fit free

HGV
One off - 5 years, no meds
Multiple - 10 years, no meds

42
Q

Epilepsy - Safety

A
  • Showers not baths
  • Do not swim alone
  • No climbing
  • Medic alert bracelet
43
Q

Epilepsy - Drugs

A

Carbamezepine
- P450 inducer

Sodium Valproate

  • Teratogenic
  • p450 inhibitor

Phenytoin
- P450 inducer

Lamotrigine
- Safe in pregnancy

44
Q

Heart Failure - Investigations

A

Previous MI
- ECHO in 2 weeks

No prior MI - BNP
>400 = ECHO 2 weeks
100-400 - ECHO 6 weeks
<100 - unlikely, reconsider Dx

45
Q

NYHA Scoring

A

1 - no limitation
2 - comfortable at rest, SOB on exertion
3 - ordinary activity limited
4- SOB at rest

46
Q

HF - 1st line

A 
Beta blocker (bisoprolol)
ACEi (Ramipril)
Loop Diuretic (furusomide 40mg)
47
Q

HF - 2nd Line

A 
Aldosterone antagonis (sprinolactone)
ARB (valsartan)
48
Q

HF - Further management

A
  • Cardiac rehab

- Implantable cardio defic in LV failure

49
Q

Bamford Classification

A
  1. unilateral hemiparesis/sensory loss of face arm and leg
  2. homonymous heminopia
  3. higher cognitive dysfunction
50
Q

TACs and PACs

A

TACS

  • All 3 present
  • middle cerebral and anterior cerebral

PACS
- 2 of 3 present

51
Q

LACS

A

Lacunar - internal capsule, thalamus and basal ganglia

  • unilateral deficit of arm/leg/face
  • ataxic hemiparesis
  • pure sensory stroke
52
Q

POCS

A
  • cerebellar/brainstem syndrome
  • LOC
  • Isolated homonymous heminopia
53
Q

Thrombolysis

A

CT showing infarct

  • <4.5 hours
  • <3 hours if over 80 years

Do CT 24 hours later to exclude haemorrhagic transformation of infarct

54
Q

Thrombolysis contraindicated

A

300mg aspirin stat and for 2 weeks

- Clopidogrel 75mg OD lifelong

55
Q

ABCD2 Score

A

Age >60

BP <140/90

Clinical

  • Weakness (2)
  • Speech disturbance (1)
  • Other (0)

Duration

  • > 60 (2)
  • 10-59 (1)
  • <10 (0)

Diabetes

56
Q

TIA Management (based on score)

A 
>4 = TIA clinic in 24 hours
<3 = TIA clinic in 1 week

Regardless 24hours:

  • AF
  • Warfarin
  • Crescendo TIA
57
Q

TIA - Investigations

A

ECG to rule out AF

58
Q

Stroke - Secondary prevention

A
  • Clopidogrel 75mg
  • Atorvastatin 80mg (start 24 hours post)
  • Diet and lifestyle advice
  • ACEi according to ACD rule
59
Q

Stroke - DVLA

A

Do not drive for 1 month

NEVER if neglect/visual field defect

4th Year - Management (11 decks)

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