Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Prescribing - PSA > Chronic management > Flashcards

Chronic management Flashcards

1
Q

How do we manage hypertension?

A

Treat if ambulatory BP > 150/95

OR BP >135/85 if:

  • >80 years
  • <80 years
    • Diabetes
    • Renal disease, CVD, Qrisk >20%
    • Target organ damage

Target BP: <135/85 mmhg ambulatory

if >80 years targer: <145/85 mmhg ambulatory

Treatment: A= ACEi, C=CCB, D=Thiazide like diuretic

  1. A if >55, C if <55 or black/african/caribbean of any age
  2. A + C
  3. A + C + D
  4. Reistant add further diuretic e.g. spironolactone or higher dose of thiazide like diuretic
    1. or alpha or beta blocker if further diuretic therapy is not tolerated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do we manage chronic heart failure?

A
  1. ACE i (or ARB) + Beta blocker
  2. Increase dose if inadequate as tolerated
  3. Add Diuretic
  4. Add aldosterone antagonist - spironolactone
  5. Hydralazine and isosorbide mononitrate
  6. Digoxin - last line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do we manage AF?

A

Rate control if >65 year or Hx of IHD/structural heart disease

  • If asthma
    • Verapamil 40-120 mg TDS (dont use with beta blockers)
    • Diltiazem MR 120mg - most commonly used but not liscensed
  • No asthma
    • Atenolol 50-100mg once a day
    • if HF consider bisoprolol
  • Digoxin if HF (only works in sedantry)
  • If still not controlled - rhythm control

Rhythm control: Young/symptomatic AF/first episode of AF/ AF due to precipitant

  • >48 hours
    • Haemodynamicall unstable - DC conversion without delay for anticoagulation
    • Stable then anticoagulate (LMWH) + rate control for 4 weeks before DC conversion
  • <48 hours and stable
    • No structural heart disease: Flecanide
    • Amiodarone

Paroxysmal AF

  • Permanent rhythm control + ‘pill in the pocket’ - flecanide PRN
    • only if good BP and no past LV dysfunction
    • Flecanide prolongs QT and VT if structural disease or hypokalaemia
    • Beware of use with furosemide/thiazide as they deplete K+
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the thromboprophalytic requirements for AF?

A

CHA2DS2-Vasc score

  • Congestive HF or LHF
  • HTN
  • Age>75 = 2 points
  • Diabetes mellitus
  • Stroke or TIA before = 2 points
  • Vascular disease
  • Age 65-74
  • Sex (female)

0 = aspirin 75mg daily

1 = aspirin or warfarin (INR 2.5)

2 = Warfarin (INR 2.5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do we manage stable angina?

A
  1. Aspirin 75mg +
  2. Beta blocker or CCB +
  3. Cholesterol - statin +
  4. Disease modifying - GTN spray

If not better add one of:

  1. CCB or Beta blocker
  2. long acting nitrate - isosorbide mononitrate
  3. Potassium channel activatpr
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do we manage chronic asthma?

A

See image

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do we manage chronic COPD?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 4 main components of diabetes management?

A
  1. Education and dietary/exercise advice
  2. CV risk factor management
    1. Aspirin 75mg daily if any significant CV risk factors (or over age 50 in T2DM)
    2. Simvastatin 20-40mg daily if any significant CV risk factor (or over age 40 in T2DM)
  3. Annual review of complications
    1. Albumn-creatinine ratio
      1. Diabetic nephropathy
      2. Predictor of CVD disease if ACR>_3 and needs ACEi
  4. Blood glucose lowering therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the blood glucose lowering therapies in T1DM and T2DM?

A

T1DM

  • Start with insulin!

T2DM

  1. Metformin (HbA1c <58)
    1. Cannot be used in renal failure (eGFR <30, creatinine >150), go straight to Gliclazide
    2. GI effects (diarrhoea), Lactic acidosis
  2. Add a Sulfonylurea (Gliclazide) IF HbA1c >58
    1. Target HbA1c is now 53 due t hypo risk
    2. Disadvantages: Hypoglycaemia, hyponatraemia, weight gain
    3. Take with breakfast
  3. Add another drug if HbA1c remains consistently >58 or not tolerant of gliclazide/metformin
    1. Beta cells deteriorate with time and so sulphonyureas become less effectiv
    2. Thiazolidinediones
      1. Safe in renal impairment
    3. SGLT-2 inhibitors (Gliflozins)
      1. Weight loss, reno&cardio protective
      2. UTI, Thrush
      3. Can get ketones
    4. GLP-1 agonists (exenatide)
      1. GI symptoms, N&V very common
      2. Weight loss
      3. Contraindicated in heart failure
    5. DPP-2 inhibitors
      1. Inhibits GLP-1 breakdown
  4. Insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do we manage parkinson’s disease?

A

Side effects of all - hypotension, hallucinations, fatigue, nausea

Early/young

  • Dopamine agonists
    • Ropinirole, pramiprexole
    • Useful also if acutely nil-by-mouth as can be given as patches
    • Delusions, disinhibition, diplopia, dyspnoea, fibrosis (cardiac and pulmonary), sudden onset sleep
  • MAO-Bi-degraded to amphetamines. Stops dopamine degradation. Alternative to DA

Gold standard

  • Co-careldopa: levodopa + carbidopa
  • Levodopa
    • On-off symptoms:
      • on - dyskinesias at the begining of therapies
      • off - sx worsen at the end of those
    • Dyskenesia, freezing, end-of dose
    • Tx GI with domperidone. Schixophenic sx
  • Reduces levodopa degradation - Carbidopa COMTi

Late stages

  • COMTi(-capone)
  • Amantadine - add if dyskinesia with L-dopa

Orange urine? - entacapone (COMTi)

Livedo reticularis? - Amantadine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do we manage epilepsy?

A

Remember, epilepsy means two or more seizures; most first seizures are not treated with anti-epileptic drugs.

  • Generalised tonic-clonic: sodium valporate; Lamotrigine if female of child-bearing potential
  • Myoclonic: Valporate or levetiracetam or topiramate. Lamotrigine exacerbates
  • Partial (focal): Carbamazepine or lamotrigine
  • Absence: Ethosuximide or valporate or lamotrigine. DO NOT use phenytoin.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the common side-effects of the following antiepileptic drugs?

  1. Lamotrigine
  2. Carbamazepine
  3. Phenytoin
  4. Sodium Valporate
A
  1. Rash, rarely Stevens-Johnson syndrome
  2. Rash, dysarthria, ataxia, nystagmus, hyponatremia
  3. Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity
  4. Tremor, teratogenicity, tubby (weight gain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do we manage Alzheimer’s disease?

A

If mild/moderate dementia then treat with acetylcholinesterase (AChE) inhibitors. However, note the following

  • Treatment may only be started by specialist doctors
  • There are three liscenced drugs: donepezil, rivastigmine and galantamine

If moderate/severe dementia then treat with NMDA antagonist (memantine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do we manage Crohn’s disease?

A
  1. Inducing remission
    1. Mild flare - 30mg prednisolone OD
    2. Severe flare - 100mg hydrocortisone IV QDS
  2. Mantain remission
    1. Azathioprine - must check TPMT levels
      1. If low consider methotrexate instead
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do we manage Rheumatoid arthritis?

A
  • Methotrexate + another DMARD (sulfasalazine/hydroxychloroquine) + short term steroid
  • If inadequate, then TNF-inhibitors: Etanercept, infliximab, adalimumab
  • Rituximab

Flare

  • IM methylpredisolone 80mg
  • NSAIDs ibuprofen 400mg TDS + lansoprazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly

Prescribing - PSA (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions