GP Flashcards
step1 management of patients ≥ 12 years with newly diagnosed asthma
a low-dose inhaled corticosteroid (ICS)/formoterol combination inhaler to be taken as needed for symptom relief
this is termed anti-inflammatory reliever (AIR) therapy
what is tx in patients ≥ 12 years with newly diagnosed asthma if patient presents highly symptomatic (for example, regular nocturnal waking) or with a severe exacerbation?
start treatment with low-dose MART (maintenance and reliever therapy, see below)
treat the acute symptoms as appropriate (e.g. a course of oral corticosteroids may be indicated)
step 2 management of patients ≥ 12 years with newly diagnosed asthma
a low-dose MART
MART describes using an inhaled corticosteroid (ICS)/formoterol combination inhaler for daily maintenance therapy and the relief of symptoms as needed, i.e. regularly and as required
step 3 management of patients ≥ 12 years with newly diagnosed asthma
a moderate-dose MART
step 4 management of patients ≥ 12 years with newly diagnosed asthma
check the fractional exhaled nitric oxide (FeNO) level if available, and the blood eosinophil count NICE
if either of these is raised, refer to a specialist in asthma care
if neither FeNO nor eosinophil count is raised, consider a trial of either a leukotriene receptor antagonist (LTRA) or a long-acting muscarinic receptor antagonist (LAMA) used in addition to moderate-dose MART
if control has not improved, stop the LTRA or LAMA and start a trial of the alternative medicine (LTRA or LAMA)
step 5 management of patients ≥ 12 years with newly diagnosed asthma
refer people to a specialist in asthma care when asthma is not controlled despite treatment with moderate-dose MART, and trials of an LTRA and a LAMA
Sulfonylureas - side-effects
hypoglycaemia, weight gain and hyponatraemia
meds causing hyperkalaemia
ACE inhibitors
angiotensin II receptor blockers
spironolactone
heparin
ciclosporin
amiloride
most common s/e of metformin
GI disturbance
meds causing bradycardia
verapamil
amiodarone
diltiazem
ivabradine
meds causing lethargy/drowsiness
antipsychotics
tricyclic antidepressants
beta-blockers
carbamazepine
chlorpheniramine
phenytoin
Lethargy, weight gain, cold intolerance?
- hypothyroidism
Second degree heart block (Mobitz II)
an ECG shows a constant PR interval but the P wave is often not followed by a QRS complex
Second degree heart block (Mobitz I)
an ECG shows progressive prolongation of the PR interval until a dropped beat occurs
Metformin - contraindicated by
CKD (eGFR < 30ml/min/1.73m2)
Insulin - side-effects
hypoglycaemia, weight gain and lipodystrophy
COPD general mx?
COPD - 1st line mx?
a short-acting beta2-agonist (SABA) or short-acting muscarinic antagonist (SAMA)
COPD - for patients who remain breathless or have exacerbations despite using short-acting bronchodilators?
is the patient has ‘asthmatic features/features suggesting steroid responsiveness’
how do you determine whether a patient has asthmatic/steroid responsive features?
COPD mx if No asthmatic features/features suggesting steroid responsiveness
add a long-acting beta2-agonist (LABA) + long-acting muscarinic antagonist (LAMA)
if already taking a SAMA, discontinue and switch to a SABA
COPD mx if Asthmatic features/features suggesting steroid responsiveness
COPD - when is oral theophylline given?
COPD - prophylactic abx?
COPD - short course oral steroids when?
COPD - cor pulmonale features + mx?
Factors which may improve survival in patients with stable COPD?
what inflammatory marker is raised in subacute thyroiditis?
ESR
exacerbating factors of psoriasis?
trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids
what are indications for verapamil?
Angina, hypertension, arrhythmias
Highly negatively inotropic
Should not be given with beta-blockers as may cause heart block
s/e and cautions for verapamil?
Heart failure, constipation, hypotension, bradycardia, flushing
indications for diltizaem?
Angina, hypertension
Less negatively inotropic than verapamil but caution should still be exercised when patients have heart failure or are taking beta-blockers
s/e and cautions for diltiazem?
Hypotension, bradycardia, heart failure, ankle swelling
indications for Nifedipine, amlodipine, felodipine
(dihydropyridines)?
Hypertension, angina, Raynaud’s
Affects the peripheral vascular smooth muscle more than the myocardium and therefore do not result in worsening of heart failure but may therefore cause ankle swelling
Shorter acting dihydropyridines (e.g. nifedipine) cause peripheral vasodilation which may result in reflex tachycardia
s/e and cautions for Nifedipine, amlodipine, felodipine
(dihydropyridines)?
Flushing, headache, ankle swelling
complete heart block ECG?
The ECG shows no association between the P waves and QRS complexes - complete heart block
what is this?
Treponema pallidum
what is seen on scan of thyroid in subacute thyroiditis?
Globally reduced uptake on iodine-131 scan
what does coxsackie virus cause?
hand, foot, mouth disease
meds causing impaired glucose tolerance?
antipsychotics
thiazides
ciclosporin
loop diuretics
corticosteroids
moderate asthma features?
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm
severe asthma features?
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
life-threatening asthma features?
PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
clinic BP in <80yo?
140/90 mmHg
clinic BP in >80yo?
150/90 mmHg
ABPM / HBPM in <80yo?
135/85 mmHg
ABPM / HBPM in >80yo?
145/85 mmHg
features of secondary syphilis?
painless, warty lesions on the genitalia
rash on palms and soles
buccal ulceration
condylomata lata
features of dengue fever?
Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller
pneumonia caused by what is assoc with cold sores?
strep pneumoniae
features of PDA?
left subclavicular thrill
continuous ‘machinery’ murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat
how does myxoedema coma present?
Myxoedema coma typically presents with confusion and hypothermia.
which anaesthetic agent may result in adrenal suppression?
Etomidate
features of lithium toxicity?
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
pulsus paradoxes can be a feature in what level of asthma?
severe asthma
