Chapter 4 - Planning Management Flashcards
Analgesia + antiemetic choice for STEMI/NSTEMI/acute LVF?
Morphine 5-10mg IV + cyclizine 50mg IV
Anti-clot drugs for NSTEMI?
Clopidogrel 300mg PO + LMWH or Fondaparinux 2.5mg OD s/c
Drug to give for STEMI/NSTEMI to decrease heart workload?
Beta-blocker e.g. bisoprolol 2.5mg PO
Short-term reliever drug to consider in heart patients?
GTN spray/tablet
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
Anaphylaxis emergency treatment algorithm?
ABC + 15L O2 by non-rebreather
Remove cause
Adrenaline 0.5mg 1:1000 IM
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV
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
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
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
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
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
Stroke treatment algorithm?
ABC + CT head
<4.5 hours = thrombolysis +/- thrombectomy if available
Aspirin 300mg once haemorrhage excluded
Fluids in DKA?
IV fluids
- 1L saline stat
- 1L over 1 hour
- 1L over 2 hours
- 1L over 4 hours
- 1L over 8 hours
Example of insulin regimen in DKA?
50 units Actrapid in 50ml 0.9% saline infused at 0.1 units/kg/hour
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
Monitoring requirements in DKA?
Cap glucose + ketones hourly, VBG 2-hourly
Ketone and venous bicarb target reduction rates in DKA treatment?
Ketones = >0.5mmol/L/hr
HCO3- = >3mmol/L/hr
Osmolarity threshold for HHS?
> 340 mmol/L
Calculation for serum osmolarity?
2x(Na + K) + urea + glucose
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
