Chapter 4 - Planning Management Flashcards by David Wheeler

Analgesia + antiemetic choice for STEMI/NSTEMI/acute LVF?

Morphine 5-10mg IV + cyclizine 50mg IV

How well did you know this?

Not at all

Perfectly

Anti-clot drugs for NSTEMI?

Clopidogrel 300mg PO + LMWH or Fondaparinux 2.5mg OD s/c

How well did you know this?

Not at all

Perfectly

Drug to give for STEMI/NSTEMI to decrease heart workload?

Beta-blocker e.g. bisoprolol 2.5mg PO

How well did you know this?

Not at all

Perfectly

Short-term reliever drug to consider in heart patients?

GTN spray/tablet

How well did you know this?

Not at all

Perfectly

Main drugs to use in tachycardia situations?

Unstable - amiodarone after 3 sync DC shocks
Irregular + broad QRS = mag sulph (amiodarone if pre-excited AF)
Regular + broad QRS = amiodarone (adenosine if SVT with bundle branch block)
Regular + narrow QRS = adenosine after vagal maneouvres
Irregular + narrow QRS = rate/rhythm control with beta-blocker or diltiazem

How well did you know this?

Not at all

Perfectly

Anaphylaxis emergency treatment algorithm?

ABC + 15L O2 by non-rebreather
Remove cause
Adrenaline 0.5mg 1:1000 IM
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV

How well did you know this?

Not at all

Perfectly

Acute exacerbation of asthma treatment algorithm?

ABC + 100% O2 by non-rebreather
Salbutamol 5mg nebuliser
Moderate = prednisolone 40-50mg PO
Severe/LTing = hydrocortisone 100mg IV
Ipratropium 500mcg nebuliser
If LTing - add aminophylline

How well did you know this?

Not at all

Perfectly

Pulmonary embolism treatment algorithm?

ABC + high-flow oxygen
Morphine 5-10mg IV + cyclizine 50mg IV
LMWH e.g. tinzaparin 175 units/kg SC OD
If unstable then thrombolysis with alteplase

How well did you know this?

Not at all

Perfectly

Acute GI bleed treatment algorithm?

ABC + O2 15L by non-rebreather
2 large bore cannulae + catheter
Crystalloid bolus + cross-match 6 units blood
Endoscopy
Stop culprit drugs

How well did you know this?

Not at all

Perfectly

Bacterial meningitis treatment algorithm?

1.2g IM benzylpenicillin if primary care (600mg if child)
4-10mg dexamethasone IV (unless immunocompromise/septicaemia)
LP (+/- CT head)
2g cefotaxime IV, add 2g ampicillin IV if immunocompromised/>55

How well did you know this?

Not at all

Perfectly

Seizures/status epilepticus treatment algorithm?

ABC + put patient in recovery position
IV lorazepam/diazepam or buccal midazolam
If still fitting after 5 min then repeat benzo
If still fitting after 5 min then phenytoin IV
If still fitting after 5 min then propofol + intubation

How well did you know this?

Not at all

Perfectly

Stroke treatment algorithm?

ABC + CT head
<4.5 hours = thrombolysis +/- thrombectomy if available
Aspirin 300mg once haemorrhage excluded

How well did you know this?

Not at all

Perfectly

Fluids in DKA?

IV fluids
- 1L saline stat
- 1L over 1 hour
- 1L over 2 hours
- 1L over 4 hours
- 1L over 8 hours

How well did you know this?

Not at all

Perfectly

Example of insulin regimen in DKA?

50 units Actrapid in 50ml 0.9% saline infused at 0.1 units/kg/hour

How well did you know this?

Not at all

Perfectly

Glucose + potassium rules in DKA treatment?

Potassium - if 4-5.5mmol/L = add 20mmol KCl to IV fluids, if <4 = add 40 mmol KCl to IV fluids (take this with a pinch of salt (haha) because passmed says 40 mmol if in normal range and more than this if below 3.5)
Glucose - once <14 mmol/L then add 10% dextrose at 125ml/hr

How well did you know this?

Not at all

Perfectly

Monitoring requirements in DKA?

Cap glucose + ketones hourly, VBG 2-hourly

How well did you know this?

Not at all

Perfectly

Ketone and venous bicarb target reduction rates in DKA treatment?

Ketones = >0.5mmol/L/hr
HCO3- = >3mmol/L/hr

How well did you know this?

Not at all

Perfectly

Osmolarity threshold for HHS?

> 340 mmol/L

How well did you know this?

Not at all

Perfectly

Calculation for serum osmolarity?

2x(Na + K) + urea + glucose

How well did you know this?

Not at all

Perfectly

Hypoglycaemia treatment?

If able to eat = sugar-rich snack or glucose gel
If unable = 20% glucose 100ml IV
If no cannula and can’t eat = IM glucagon (only if you have to)

AKI acute management principles?

Cannula + catheter with strict fluid monitoring
IV fluids = 500ml stat, then 1L 4hrly

When can ACEi’s + ARBs not be used for hypertension?

Pregnancy (check guidelines)

Chronic heart failure treatment algorithm?

ACEi + BB
Spironolactone
Sacubitril valsartan, digoxin, ivabradine

Consider ARB if ACEi no good, hydralazine/nitrate if ARB also no good

HASBLED score + categories

Hypertension
Abnormal renal/liver function
Stroke
Bleeding tendency/predisposition
Labile INR
Elderly (>65)
Drugs (aspirin, NSAIDs, alcohol)

0 = low risk, strongly consider anticoagulation
1-2 = low-moderate risk, consider anticoagulation
3+ = high risk, consider alternatives to anticoagulation

Rhythm control for AF? (who and how?)

Who - if <48 hours and young/symptomatic AF/first episode/due to reversible or treated precipitant How - cardioversion - electrical or pharmacological with Flecanide (no structural HD) or amiodarone (structural HD)

Rate control for AF? (who and how?)

Who - if >48 hours How - BB or CCB (rate-limiting), combi therapy if ineffective

When to test with troponin and high-sensitivity troponin?

Troponin - 12 hours after HS trop - 6 hours after

Stable angina medical management?

Symptomatic relief = GTN spray PRN Secondary prevention = aspirin, statin Anti-angina drug(s) = BB or CCB, then both, then long-acting nitrate or nicorandil

4 key elements to diabetes management?

Education + dietary/exercise advice CVD management - aspirin 75mg, statin 20mg Annual review of complications - use albumin-creatinine ratio Blood glucose-lowering therapy

Key medical management point to remember in diabetes? (non-glucose related)

ACE inhibitor if ACR is ≥3 mg/mmol !!!

Medical management of Parkinson's?

Co-beneldopa or co-careldopa (levodopa + peripheral dopa decarboxylase inhibitor, benserazide or carbidopa) If specifically concerned about finite period of benefit from levodopa = dopamine agonist (ropinirole) or MAO inhibitor (rasagiline)

Medical management of epilepsy? (prevention)

Absence = ethosuximide Focal = lamotrigine, levetiracetam, carbamazepine Generalised = valproate (males) lamotrigine (females) Myoclonic = valproate (males), levetiracetam (females) Tonic/atonic = valproate (males), lamotrigine (females)

Rash, rarely SJS - which anti-epileptic drug?

Lamotrigine

Rash, dysarthria, ataxia, nystagmus, hyponatraemia - which anti-epileptic drug?

Carbamazepine

Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity - which anti-epileptic drug?

Phenytoin

Tremor, teratogenicity, weight gain - which anti-epileptic drug?

Sodium valproate

Fatigue, mood disorders, agitation - which anti-epileptic drug?

Levetiracetam

Alzheimer's medical management?

Mild - acetylcholinesterase inhibitor - donepezil, rivastigmine, galantamine Moderate/severe - memantine (NMDA antagonist)

Crohn's, remission induction?

Mild flare - prednisolone 20-40mg PO OD Severe - hydrocortisone 100-500mg IV TDS/QDS (or as required, check BNF) If rectal disease then use rectal hydrocortisone too

Crohn's, remission maintenance?

Azathioprine or 6-mercaptopurine If TPMT levels low = low dose azathioprine If TPMT levels absent = methotrexate

Rheumatoid arthritis medical management?

Methotrexate Flare = short-term steroids + NSAIDs = IM methylprednisolone 80mg, PO ibuprofen 400mg 8hrly + lansoprazole If refractory to 2 DMARDs = TNF-alpha inhibitor (infliximab)

Fever medical management?

Paracetamol - max 4g in 24 hours

Constipation medical management? (short-term constipation + opioid-induced constipation + chronic constipation)

1st = bulk-forming laxative 2nd = hard stools = osmotic laxative, soft but not passing = stimulant laxative Opioid-induced = osmotic + stimulant. AVOID bulk-forming Chronic = as for short-term (same principles, start with BFing, then osmotic if hard or stimulant if not passing)

Bulk-forming, osmotic, and stimulant laxatives?

Bulk-forming = isphagula husk Osmotic = lactulose or phosphate enema Stimulant = Senna or bisacodyl

Contraindications to each type of laxative?

To ALL = obstruction BFing = faecal impaction Osmotic = acute abdomen, IBD (both phosphate enema) Stimulant = acute abdomen (bisacodyl)

Main side effects of laxatives?

BFing = takes days to develop effect Osmotic = bloating Stimulant = abdo cramps

Chronic diarrhoea medical management? (chronic bc in acute the diarrhoea is a method of pathogen removal so shouldn't be inhibited)

Loperamide 2mg PO 3hrly OR Codeine 30mg PO 6hrly

Insomnia medical management?

Zopiclone 7.5mg nightly PO (3.75mg in elderly) - remember risk of fall here