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PSA > Chapter 4 - Chronic > Flashcards

Chapter 4 - Chronic Flashcards

Planning Management

1
Q

At what level do you treat hypertension?

A

> 150/95mmHg

If existing/high risk of stroke, IHD, PVD or if evidence of hypertensive organ damage - CKD, retinopathy, LVH or intracerebral bleed
>135/85mmHg

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2
Q

Target BPs for those on antihypertensives

A

<80 Clinic - <140/85
Home - <135/85
>80 Clinic - <150/85
Home - <145/85

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3
Q

Draw out the treatment diagram for antihypertensives

A

Over 55/Afro caribbean - C
Under 55 - A

A + C

A + C + D

A + C + D + (other diuretic, beta blocker, alpha blocker)

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4
Q

Chronic management: Heart failure

A
  1. ACEi + Beta blocker
  2. Increase dose as tolerated
  3. Mild - add ARB (candesartan)
    Mod/sev+afro caribbean - add hydralazine + isosorbide mononitrate
    Mod/sev other patients - add spironolactone
ACEi
ARB if ACEi not tolerated
Hydralazine + isosorbide mononitrate if neither ARB nor ACEi tolerated
Beta blocker - start low and go slow
Spironolactone
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5
Q

Chronic management: Stable angina

A
  1. GTN spray PRN
  2. Beta blocker +/- CCB
    Inadequate control - add isosorbide mononitrate or nicorandil
    Inadequate control - PCI/CABG
  3. Secondary prevention - aspirin + statin
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6
Q

Stable angina - symptom control

A

GTN spray PRN

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7
Q

Stable angina - anti-anginal

A

Beta blocker +/- CCB
increase dose
add isosorbide mononitrate or nicorandil
PCI/CABG

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8
Q

Stable angina - secondary prevention

A

Aspirin + statin

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9
Q

Chronic management - 3 areas of AF management

A
  1. Rhythm control
  2. Rate control
  3. Stroke prevention
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10
Q

AF - how do you see if they require stroke prevention and what are the results?

A 
CHADSVAS
Congestive HF
Hypertension
Age >75 (2)
Diabetes
Stroke or TIA before (2)
Vascular disease - PAD/IHD
Age (65-74)
Sex (female)

0 (or 1 if female) - NO ANTICOAGULATION
1 (if male) = condiser antiplatelet or anticoagulant: aspirin OR warfarin
2 or more = anticoagulation - warfarin - aim for INR 2.5

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11
Q

Who do you cardiovert in AF? (5)

What does the cardioversion involve?

A
  1. Young
  2. First episode
  3. Symptomatic
  4. Reversible cause

IF IT HAS BEEN LESS THAN 48 HOURS
If not, they require anticoagulation

Electrical
Pharmacological - Amioderone 5mg/kg IV over 20-120 minutes

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12
Q

Asthma - Step 0

A

Monitored initiation of treatment with LOW DOSE ICS

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13
Q

Asthma - Step 1

A

Regular preventer - LOW DOSE ICS

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14
Q

Asthma - Step 2

A

Initial add-on - add inhaled LABA - usually in a combination inhaler like fostair or seretide

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15
Q

Asthma - Step 3

A

Additional add-on

No response to LABA - stop LABA, increase ICS to MEDIUM DOSE

LABA benefit:
1. Continue LABA, increase ICS to MEDIUM DOSE
or
2. Continue LABA, continue ICS, add (theophylline, montelukast, LAMA)

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16
Q

Asthma - Step 4

A
  1. Increase ICS to HIGH DOSE
    or
  2. Trial 4th drug (theophylline, montelukast, LAMA, Beta agonist tablet)
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17
Q

Asthma - Step 5

A

Continued oral steroids

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18
Q

When should you consider moving up the asthma management ladder?

A

Using SABA 3 or more times a week for relief of symptoms

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19
Q

Draw out COPD guidelines

A

SABA or SAMA PRN

exacerbations: no asthmatic features or no steroid responsiveness
add LABA + LAMA

exacerbations: asthmatic features or steroid responsiveness:
add LABA + ICS

persistent exacerbations: asthmatic features or steroid responsiveness:
triple therapyLABA + LAMA + ICS

20
Q

What should diabetics have checked annually to monitor nephropathy? Results mean what?

A

AlbuminCreatinineRatio - >3mg/mmol = give ACEi

21
Q

What should diabetics be on to avoid CV risks?

A

Statin

22
Q

What is the target HbA1c in type 2 diabetics?

A

<48mmol/mol

23
Q

Type 2 diabetes drug regime if overweight + creatinine <150

A
  1. standard release metformin 500mg then increase slowly to reduce GI SEs
  2. If GI SEs - modified release metformin 500mg then increase slowly
  3. metformin + gliclazide
    metformin + sitagliptin
    metformin + pioglitazone
    metformin + empaglifozin
  4. metformin + gliclazide + sitagliptin
    metformin + gliclazide + pioglitazone
  5. insulin
24
Q

What is the most common first line drug for Parkinson’s?

A

Co-careldopa

Levodopa + carbidopa

(also co-beneldopa - levodopa + benserazide)

25
Q

What are 2 alternative drug groups and examples in Parkinson’s and who would you consider giving it to?

A

Dompamine AGONISTS
rotigotine, ropinirole, pramipexole

MAO-B inhibitors - selegiline, rasagiline

Consider giving these to patients with mild symptoms whose quality of life is not really that affected.
Also if concerned about finite period of benefit from levodopa

26
Q

Drug of choice in epilepsy: focal seizures

A

Carbamazepine or lamotrigine

27
Q

Drug of choice in epilepsy: tonic clonic

A

Sodium valproate

28
Q

Drug of choice in epilepsy: absence

A

Sodium valproate or ethosuximide

29
Q

Drug of choice in epilepsy: myoclonic

A

Sodium valproate

30
Q

Drug of choice in epilepsy: tonic/atonic

A

Sodium valproate

31
Q

What is the drug group of choice & examples for

mild/moderate Alzheimer’s?

A

Achesterase inhibs

Rivastigmine, donepezil, galantamine

32
Q

What is the drug group of choice & examples for

moderate/severe Alzheimer’s?

A

NMDA antagonists

Memantine

33
Q

What would you use to induce remission in Crohn’s in

a) mild
b) severe

A

a) prednisolone 30mg PO OD

b) hydrocortisone 500mg IV 6 hourly

34
Q

What 3 drugs would you use to maintain remission in Crohn’s?

A

1) Steroids
2) Azathioprine/mercaptopurine - IF TPMT deficient, methotrexate
3) Infliximab

35
Q

What is a definite contraindication to a certain drug used to treat IBD and why? which drug? alternative?

A

Azathioprine, mercaptopurine
TPMT deficiency
Liver and bone marrow toxicity
Methotrexate alternative

36
Q

If diarrhoea is non-infective, what would you treat it with?

A

Loperamide or codeine

37
Q

Stool softeners (2) - what are they good for? Contraindications?

A

Docusate sodium
Arachis oil (PR)
Good for impaction
Arachis oil - nut allergy

38
Q

Bulking agents (1) - problem? Contraindications?

A

Isphagula hulk
Can take days to work
Impaction, colonic atony

39
Q

Stimulants (2) - problem? Contraindications?

A

Senna
Bisacodyl
May exacerbate cramps
Bisacodyl - acute abdomen

40
Q

Osmotic laxatives (2) - problem? Contraindications?

A

Lactulose
Phosphate enema
May exacerbate bloating
Phosphate - acute abdomen

41
Q

First line treatment for insomnia

A

Zopiclone

42
Q

What is the standard treatment for rheumatoid arthritis?

A

Methotrexate + DMARD (hydroxychloroquine or sulfasalazine)

43
Q

2 DMARDs you might use in treatment of RA

A

Hydroxychloroquine, sulfasalazine

44
Q

What would you use to treat flare ups of RA?

A

short term glucocorticoids - IM methylprednisolone

NSAIDs - ibu + lansoprazole

45
Q

What would you use to treat RA that fails to respond to 2 DMARDs?

A

Infliximab (TNFa inhibitor)

PSA (9 decks)

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