GP Flashcards
asthma bronchodialator improvement diagnosis
imrpovement in FEV1 of 12% or more
asthma FEV1
<80%
asthma FEV1:FVC
<0.7
what age can you use peak flow and diagnose asthma
> 5
PERF diary over 4 week improvement diagnosis
> 20% variability is positive
who cant you use HBA1C with?
T1DM
chidden
pregnancy
Metformin
Incr sensitivity to glucose
GI: N&V, lactic acidosis
Sulphonylurea
e.g. gliclazide – incr production of insulin - SE: hypo’s – DVLA
DPP-IV inhibibitor = gliptins
e.g. sitagliptin – incr incretin which stimates insulin – SE: pancreatitis
SGLT-2 inhibitor EG Gliflozin
E.g. gliflozin – Na/glucose transporter stop absorbing glucose so wee it out
SE: UTI, Thrush, diabetic symptoms, hypoglycaemic/dka risk
Thiazolidenedione = Glitazone
e.g. Pioglitazone – prevserves B cell function – can’t use if PMHx, SE: weight gain
Triple therapy/ insulin
DKA presentation
Nausea, Vomiting, Abdominal pain, Decreased conscious level, ‘Pear drop’ smell,
DKA diagnosis
Blood glucose >11mmol/L (or known diabetes)
Blood Ketones >3mmol/L or urinary >2+
Venous pH <7.3 or venous bicarb <15
HHS syx
Thirst, polyuria, freq, tired, vomiting, SOB
HHS diagnosis
BM > 30 mmol, Plasma osmolarity >340
HHS treatment
ABCDE –> 1L 0.9% saline over 30 mins, sliding scale of insulin
Qrisk
Percentage risk of CVD event over the next 10 years
Use in people aged 40-85 every 5 years (prevention)
>10% risk = atorvastatin 20mg (80mg if previous CHD/DM/ACS symptoms)
Statin tests, SE and CI
LFTs before starting stains (& @ 3m + 12m) + cholesterol levels (aim <5mmol)
SEs: Headache, GI disturbance, muscle aches, myopathy, rhabdomyolysis
CI: pregnancy, erythromycin/other Cyt p450 inhibitors (AO DEVICES)
Stable angina diagnosis
clinical, exercise ECG (ST depression, T wave inversion)
stable angina treatment
B blocker/CCB + GTN for symptom relief
Long acting nitrate e.g. ivabradine
Secondary prevention:
Antiplatelet (aspirin 75mg), statin, ACEi + lifestyle advice
Surgery: revascularisation stents (PTCA)/CABG – coronary artery bypass graft
NSTEMI treatment
BATMAN
B – Beta blockers unless contraindicated
• A – Aspirin 300mg stat dos
• T – Ticagrelor 180mg stat dose (clopidogrel 300mg is an alternative)
• M – Morphine titrated to control pain
• A – Anticoagulant: Low Molecular Weight Heparin (LMWH) at treatment dose (e.g. enoxaparin 1mg/kg twice daily for 2-8 days) or fondaparinux 2.5mg SC
• N – Nitrates (e.g. GTN) to relieve coronary artery spasm
MI complications - DREAD
D – Death
R – Rupture of the heart septum or papillary muscles
E – “Edema” (Heart Failure)
A – Arrhythmia and Aneurysm
D – Dressler’s Syndrome
It usually occurs around 2-3 weeks after an MI. It is caused by a localised immune response and causes pericarditis
secondary prevention MI
6 As
+ lifestyle too
Aspirin 75mg once daily
Another antiplatelet: e.g. clopidogrel or ticagrelor for up to 12 months
Atorvastatin 80mg once daily
ACE inhibitors (e.g. ramipril titrated as tolerated to 10mg once daily)
Atenolol (or other beta blocker titrated as high as tolerated)
Aldosterone antagonist for those with clinical heart failure (i.e. eplerenone titrated to 50mg once daily
HF treatment
ABAL
ACE inhibitor (e.g. ramipril titrated as tolerated up to 10mg once daily)
Beta Blocker (e.g. bisoprolol titrated as tolerated up to 10mg once daily)
Aldosterone antagonist when symptoms not controlled with A and B (spironolactone or eplerenone) (2nd line add on)
Loop diuretics improves symptoms (e.g. furosemide 40mg once daily)
Measure U&Es
CKD Definition
eGFR <60 on 2 occasions 90 days apart
eg over 3 months
CKD management
- ACE INHIBITOR <140 OR <130 Systolic f DM
- Atorvastatin 20mg (Primary prevention of CVD)
- Lifestyle changes: Exercise, maintain a healthy weight and stop smoking. Special dietary advice about phosphate, sodium, potassium and water intake
Optimise Diabetic control - Oral sodium bicarbonate to treat metabolic acidosis
- Iron supplementation and erythropoietin to treat anaemia
- Vitamin D to treat renal bone disease
- Dialysis in end stage renal failure
- Renal transplant in end stage renal failure
CKD complications and management
Hypertension –> ACEi (monitor K+)
Anaemia -> Iron supplementation and erythropoietin
Renal Bone Disease –> Vitamin D
Dialysis in end stage renal failure
Renal transplant in end stage renal failure
