Long term conditions Flashcards
How is t2 diabetes diagnosed? (3)
- random blood glucose > 11.1 or fasting >7 w/ symptom>7 + 2x fasting >7 w/out symptoms
- HbA1c >48 or 6.5%
- plasma glucose >11.1 two hrs after oral glucose tolerance test
How is t2 diabetes managed initially
- refferal to DESMOND
- manage lifestyle
- screen for complications
- consider starting metformin
What lifestyle advice would you give to someone with t2 diabetes?
- DIET: lots of fibre, low GI food, low fat diary, oily fish, reduce kcals and alcohol
- WEIGHT: aim for 5-10% loss initially
- EXERCISE: at least 150 mins of moderate intensity exercise a week
- SMOKING: stop smoking service refferal
What complications need to be screened for in t2 diabetes?
- depression and anxiety
- NEUROPATHY: erectile dysfunction, neuropathic pain, gastroparesis (delayed empyting of stomach)
- retinopathy
- diabetic foot ulcers and neuropathy
- nephropathy
What are the HbA1c targets for t2 diabetes?
- Aim for less that 48/6.5% in those not on meds
- 53/7% in those on meds
What are the options for the first intensification of medical treatment for t2 diabetes?
metfomin + DDP4 inhibitor (gliptin), pioglitazone or sulphonylurea (gliclazide)
What monitoring is needed for those with t2 diabetes?
- renal monitoring (u&es annually)
- serum lipids
- TFTs (initally and annually)
- eye
- neuropathy
- feet
- blood pressure
- BMI
How is COPD diagnosed?
Symptoms (breathless, chronic cough, sputum production, wheeze, frequent bronchitis)
+
Non reversible obstruction on spirometry
Usually w/ smoking history
What medications can be offered for COPD?
- Salbutamol or ipratropium bromide (SAMA)
- then LABA (fometerol)
- or LAMA tiotropium
- or combination of LABA plus ICS (fostair)
- then fostair + LAMA
- long term oxygen is last step
When should you refer someone with COPD?
- haemoptysis (rule out cancer)
- uncertain diagnosis
- severe or worsening COPD (FEV1<30% predicted)
- cor pulmonale suspected
- age <40
- frequent infections (to exclude bronchiectasis)
- for O2 therapy, sugery or long term oral steroids
How is COPD staged?
by FEV1: 1= 80%, 2= 50-79%, 3= 30-49%, 4= <30%
by breathlessness: MRC score
Give 4 complications of COPD
- cor polmonale
- pneumothorax
- resp failure
- arrhythmias (esp AF)
- infection
- depression
What is the definition of good asthma control? (7 criteria)
- no day symptoms
- no night wakening due to symptoms
- no need for rescue meds
- no asthma attacks
- no limitations on physical activity
- normal lung function
- no side effects from meds
When may metformin not be used first line in t2 diabetes?
GFR below 30
when should poiglitazones not be offered? (4)
heart failure
hepatic impairmenent
DKA
history of bladder cancer
What are problems with sulphonylureas?
- hypoglycaemia
- weight gain
- liver dysfunction
- GI upset
generally DDP4 and glitazones are used before then now due to weight gain and hypo risk
What is 1st and second line antihypertensive used in diabetes?
ACEi regardless of age, ACEi + CCB if african/ caribbean
CCB first line if possibility of becoming pregnant
Second line for all is ACEi + CCB or diuretic
What medications should be prescribed for stable angina? (5)
- Glycerol trinitrate (GTN) spray
- Beta blocker or CCB 1st line to reduce symptoms
- Long acting nitrate (isosorbide mononitrate) if CCB/ BB contraindicated or not tolerated
- Low dose aspirin (75mg)
- statin should be offered
what advice should you give someone about when they get the angina attacks
- stop what theyre doing and rest
- take GTN spray/ tablets
- take 2nd dose after 5 mins if pain not eased
- call 999 if pain not eased 5 mins after 2nd dose or earlier if pain intensifying or person is unwell
When should you refer someone with angina?
- urgent admission if its unstable
- stable angina should be reffered immediately if: previous MI, CABG, PCI, ECG abnormal, AF, heart failure, murmer
- other indications: doubt over diagnosis, severe risk factors or strong FHx
How should hypertension be diagnosed?
home blood pressure monitoring or 24hr bp monitor with average >135/85
How should hypertension be investigated to look for organ damage and secondary causes?
- 12 lead ECG to asses cardiac function and detect LVH
- urine dip for haematuria (kidneys)
- ACR of urine (kidneys)
- plasma glucose and hba1c (diabetes)
- U&Es, creatinine, eGFR (adrenal disease, CKD)
- refer to specialist if signs suggesting secondary cause or organ damage
what lifestyle advice is important to give in hypertension? (3 bigguns)
- reduce stress- mindfullness apps
- exercise
- stop smoking
What antihypetensive drugs should be avoided in pregnancy?
ARB and ACEi
should use labetalol, methyldopa or nifedipine instead
What are the common renal causes of secondary hypertension? (5)
- chronic pyelonephritis (often detected unexpectantly on USS)
- diabetic nephropahy (microalbuminurea or proteinuria)
- glomerularnephritis (microscopic haematuria)
- Polycystic kidney disease (abdo or flank mass, microscopic haematuria, FHx)
- obstructive uropathy (abdo or flank mass)
- RCC (haematuria, loin pain, loin mass but often asymptomatic)
Give 2 vascular causes of hypertension?
- coarctation of aorta (upper limb hypertension, varies between arms, weak femoral pulses)
- renal artery stenosis
Give 6 endocrine causes of hypertension?
- primary hyperaldosteronism (high K+ & Na+, alklasosis, tetany, muscle weakness, nocturia)
- phaeochromocytoma
- cushings
- acromegaly
- hypothyroidism (usually increases diastolic BP)
- hyperthyroidism (usually increase systolic BP)
What drugs can cause hypertension
- alcohol
- ciclosporin
- cocaine
- steroids (cortico and anabolic)
- erythropoetin
- leflunomide
- liquorice
- NDAIDs
- venlafaxine
How should heart failure be managed?
- Give loop diruetic to reduce fluid overload
- if systolic: give ACEi and beta blocker one at a time
- referral (if still symptomatic despite ACEi and BB in systolic and in all diastolic)
- antiplatelet if indicated
- statin if high Qrisk
- depression and anxiety screen
- supervised exercise rehab
- flu vaccine
- dietary advice if high BMI
When should stage 1 htn be treated?
Under 80 and one of:
- qrisk >20%
- evidence of end organ damage
- established cvd
- renal disease
- diabetes
- if stage 1 and age <40 consider refferal for investigation of secondary causes
give 3 lifestyle interventions to reduce blood pressure
- increase exercise
- reduce stress
- reduce caffine
- reduce alcohol
- reduce sodium in diet
- stop smoking
