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taz year 3 gp > Long term conditions > Flashcards

Long term conditions Flashcards

1
Q

How is t2 diabetes diagnosed? (3)

A
  • 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
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2
Q

How is t2 diabetes managed initially

A
  • refferal to DESMOND
  • manage lifestyle
  • screen for complications
  • consider starting metformin
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3
Q

What lifestyle advice would you give to someone with t2 diabetes?

A
  • 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
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4
Q

What complications need to be screened for in t2 diabetes?

A
  • depression and anxiety
  • NEUROPATHY: erectile dysfunction, neuropathic pain, gastroparesis (delayed empyting of stomach)
  • retinopathy
  • diabetic foot ulcers and neuropathy
  • nephropathy
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5
Q

What are the HbA1c targets for t2 diabetes?

A
  • Aim for less that 48/6.5% in those not on meds

- 53/7% in those on meds

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6
Q

What are the options for the first intensification of medical treatment for t2 diabetes?

A

metfomin + DDP4 inhibitor (gliptin), pioglitazone or sulphonylurea (gliclazide)

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7
Q

What monitoring is needed for those with t2 diabetes?

A
  • renal monitoring (u&es annually)
  • serum lipids
  • TFTs (initally and annually)
  • eye
  • neuropathy
  • feet
  • blood pressure
  • BMI
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8
Q

How is COPD diagnosed?

A

Symptoms (breathless, chronic cough, sputum production, wheeze, frequent bronchitis)
+
Non reversible obstruction on spirometry
Usually w/ smoking history

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9
Q

What medications can be offered for COPD?

A
  • 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
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10
Q

When should you refer someone with COPD?

A
  • 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
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11
Q

How is COPD staged?

A

by FEV1: 1= 80%, 2= 50-79%, 3= 30-49%, 4= <30%

by breathlessness: MRC score

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12
Q

Give 4 complications of COPD

A
  • cor polmonale
  • pneumothorax
  • resp failure
  • arrhythmias (esp AF)
  • infection
  • depression
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13
Q

What is the definition of good asthma control? (7 criteria)

A
  • 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
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14
Q

When may metformin not be used first line in t2 diabetes?

A

GFR below 30

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15
Q

when should poiglitazones not be offered? (4)

A

heart failure
hepatic impairmenent
DKA
history of bladder cancer

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16
Q

What are problems with sulphonylureas?

A
  • hypoglycaemia
  • weight gain
  • liver dysfunction
  • GI upset
    generally DDP4 and glitazones are used before then now due to weight gain and hypo risk
17
Q

What is 1st and second line antihypertensive used in diabetes?

A

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

18
Q

What medications should be prescribed for stable angina? (5)

A
  • 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
19
Q

what advice should you give someone about when they get the angina attacks

A
  • 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
20
Q

When should you refer someone with angina?

A
  • 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
21
Q

How should hypertension be diagnosed?

A

home blood pressure monitoring or 24hr bp monitor with average >140/90

22
Q

How should hypertension be investigated to look for organ damage and secondary causes?

A
  • 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
23
Q

what lifestyle advice is important to give in hypertension? (3 bigguns)

A
  • reduce stress- mindfullness apps
  • exercise
  • stop smoking
24
Q

What antihypetensive drugs should be avoided in pregnancy?

A

ARB and ACEi

should use labetalol, methyldopa or nifedipine instead

25
Q

What are the common renal causes of secondary hypertension? (5)

A
  • 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)
26
Q

Give 2 vascular causes of hypertension?

A
  • coarctation of aorta (upper limb hypertension, varies between arms, weak femoral pulses)
  • renal artery stenosis
27
Q

Give 6 endocrine causes of hypertension?

A
  • primary hyperaldosteronism (high K+ & Na+, alklasosis, tetany, muscle weakness, nocturia)
  • phaeochromocytoma
  • cushings
  • acromegaly
  • hypothyroidism (usually increases diastolic BP)
  • hyperthyroidism (usually increase systolic BP)
28
Q

What drugs can cause hypertension

A
  • alcohol
  • ciclosporin
  • cocaine
  • steroids (cortico and anabolic)
  • erythropoetin
  • leflunomide
  • liquorice
  • NDAIDs
  • venlafaxine
29
Q

How should heart failure be managed?

A
  • 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
30
Q

When should stage 1 htn be treated?

A

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
31
Q

give 3 lifestyle interventions to reduce blood pressure

A
  • increase exercise
  • reduce stress
  • reduce caffine
  • reduce alcohol
  • reduce sodium in diet
  • stop smoking

taz year 3 gp (12 decks)

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