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Management Flashcards

1
Q

What does 1% mean in drug calculation?

A

1g in 100ml (1mg in 1ml) or 1g in 100g

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2
Q

What does 1 in 1000 mean for concentration?

A

1g in 1000ml - for anaphlaxis

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3
Q

What does 1 in 10,000 mean in concentration?

A

1g in 10,000ml - for cardiopulmonary resuscitation

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4
Q

What are the two first-line management drugs for heart failure?

A

Beta blockers and ace inhibitors

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5
Q

What time are ace inhibitors given?

A

Evening due to risk of postural hypotension

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6
Q

What is the drug for rate control in new-onset AF?

A

Verapamil HYDROCHLORIDE or beta blockers (not sotolol)

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7
Q

What is a side-effect of carbamazepine?

A

SIADH

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8
Q

Which anti-epileptic is safer in pregnancy?

A

Lamotrigine

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9
Q

What is levetiracetam associated with?

A

Anxiety/depression is a side-effect

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10
Q

When should metformin be avoided?

A

When creatinine is over 150 or eGFR less than 30

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11
Q

At what BP do you give lifestyle advice?

A

135/85

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12
Q

At whart BP do you treat?

A

If BP>150/95 or 135/95 with the following features

> 80 with clinic BP 150/95
<80 with target organ damage, cardiovascular or renal disease, diabetes or 10 year CVD risk >10%

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13
Q

What is the treatment firstline for hypertension for someone with type 2 diabetes?

A

ACE inhibitor or ARB

Next line, add a calcium channel blocker or thiazide-like diuretic

Next line add the other one.

Finally, consider expert advice or low-dose spironolactone or alpha-blocker or beta-blocker depending on potassium levels

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14
Q

What is the firstline treatment for hypertension for someone under 55 and not of black african or african-caribbean family origin

A

ACE inhibitor or ARB

Next line, add a calcium channel blocker or thiazide-like diuretic

Next line add the other one.

Finally, consider expert advice or low-dose spironolactone or alpha-blocker or beta-blocker depending on potassium levels

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15
Q

What is the firstline hypertension treatment for someone aged over 55 or of black african or african-caribbean origin?

A

Calcium channel blockers

Next line, add an ACE inhibitor or ARB or or thiazide-like diuretic

Next line add the other one.

Finally, consider expert advice or low-dose spironolactone or alpha-blocker or beta-blocker depending on potassium levels

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16
Q

What is the treatment pathway for heart failure?

A

ACE inhibitor plus beta blocker
ARB, e.g. candesartan if intoleant of ACE inhibitor
If intolerant of ARB, use hydralazine or nitrate
If inadequate, increase doses as tolerated
If inadequate, add aldosterone receptor antagonist, e.g. spironolactone
If inadequate, specialist assessment.

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17
Q

What does the CHA2DS2-VASc score indicate?

A

Risk of stroke.
1 point means consider anticoagulation in men using apixaban, dabigatran etc or a vitamin K antagonist (warfarin).
2 points are required for women

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18
Q

What does the HASBLED score indicate?

A

Bleeding risk for anticoagulation in AF.
0 is low risk
1-2 is low-moderate risk
>3 is high risk of major bleeding

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19
Q

When would you do rhythm control for AF?

A

Less than 48 hours onset if young or asymptomatic AF or AF due to treated precipitant

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20
Q

How would you do rhythm control for AF?

A

Electrical cardioversion or flecanide (if no structural heart disease) or amiodarone (if structural heart disease)

Consider anticoagulation if high risk of reoccurance in 48 hour presentation period or if high risk of clots

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21
Q

When should you do rate control in AF?

A

When presentation is after 48 hours

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22
Q

How should you do rate control in AF?

A

Either beta blocker or calcium channel blocker (diltiazem)

If monotherapy does not work, consider combination therapy with a beta blocker, ditiazem, or digoxin

Digoxin should only be considered in non-paroxysmal AF if the person is sedentary. Amiodarone should NOT be used for long term rate control

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23
Q

How would you tell the difference between stable angina and ACS?

A

If sweaty or vomiting, likely STEMI or NSTEMI
If occurs on exertion/emotion and ceases in 15 min, likely stable angina
If occurs at rest and lasts more than 15 min, then likely ACS.
Response to GTN spray - if resolves the pain, likely angina

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24
Q

What drugs are required for the management of stable angina?

A

GTN spray as required
Secondary prevention: aspirin, statin, risk factor modification
One anti-anginal drug and dependent on contraindications, beta blocker (contraindications hypotension, bradykinesia and acute heart failure) or calcium channel blocker (contraindications, hypotension, bradycardia, and peripheral oedema)

If one anti-anginal drug isn’t working, increase dose and then add the other.

If this doesn’t work, add a long acting nitrate e.g. isosorbide mononitrate or potassium channel activator, e.g. nicorandil.

If uncontrolled on two anti anginal drugs, refer for urgent revascularisation therap (percutaneous coronary intervention (PCI) or coronary artery bypass graft).

Even if controlled on medication, refer regularly for consideration of revascularisation.

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25
Q

What drugs can be used to reduce cigarette craving?

A

Bupropion or varenicline

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26
Q

What are the treatment steps for chronic asthma?

A
  1. Short acting B2 agonist as required with low dose inhaled corticosteroid
  2. Add inhaled long acting beta 2 agonist (e.g. salmeterol)
  3. Consider increasing inhaled corticosteroid to a medium dose OR adding a leukotriene receptor antagonist (montelukast or zafirlukast).

If no response to LABA, consider stopping it.

  1. Refer to specialist care.
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27
Q

What should be annually reviewed for diabetics?

A

Albumin-creatinine ratio

ACR > 3 indicates microalbuminuria and a need for an ACE inhibitor for cardiovascular and renal protection

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28
Q

What is the cardiovascular management in diabetes?

A

Aspirin 75mg daily if any significant risk factors (or aged over 50 in T2DM)

Atorvastatin 20mg daily if any significant CV risk factor (or over age 40 in T2DM)

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29
Q

What is pioglitazone associated with?

A

Increased risk of heart failure, bladder cancer, and bone fracture. Age is a particular risk factor

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30
Q

What is a severe complication associated with SGLT-2 inhibitors? e.g. canagliflozin, dapagliflozin or empagliflozin?

A

Serious DKA, even at near normal levels of blood glucose. Test for ketones

31
Q

When should GLP-1 mimetic therapy be continued?

A

If there is a beneficial metabolic response (reduction of HbA1c by at least 11 and weight loss of at least 3% of initial body weight in 6 months)

32
Q

What is the first line treatment for T2DM? When is it given?

A

Metformin 500mg OD given when HbA1c is over 48 mmol/mol

The target HbA1c is then 48mmol/mol

33
Q

What is the second line treatment for T2DM? When is it given?

A

When HbA1c rises to 58 mmol/mol

Consider dual therapy with:
methformin and a DPP-4i (gliptin)
metformin and pioglitazone
metformin and a sulphonyurea
metformin and a SGLT-2i

Aim for a HbA1c of 53 mmol/mol

34
Q

What is the third line treatment for T2DM?

A

Triple therapy with:
metformin, a DPP-4i (gliptin) and an SU
metformin, pioglitaxone and a SU
metformin, pioglitaone, or an SU and an SGLT-2i

Insulin

Aim for a level of 53

35
Q

What is given firstline when metformin is contraindiated for T2DM?

A

Aim for 48 (or 53 on a SU)

Consider a DPP-4i, pioglitazone, or a SU
an SGLT-2i instead of a DPP-4i if an SU or pioglitazone is not appropriate

36
Q

If metformin is contraindicated, what is treatment for first intensification?

A

When HbA1c rises to 58, consider dual therapy with:
A DPP-4i and pioglitazone
a DPP-4i and an SU
pioglitazone and an SU

Aim for 53

If none of this works, consider insulin

37
Q

What should be given first-line for Parkinsons?

A

Co-beneldopa or co-careldopa

38
Q

What should be given first-line in Parkinsons for a very mild case if there are concerns about the finite period of benefit from levodopa?

A

A dopamine agonist, suh as ropinirole or monoamine oxidase inhibitor such as rasagiline may be appropriate

39
Q

What drug should be offered for myoclonic seizures?

A

Valproate for men

Levetiracetam for women

40
Q

What drug should be offered for tonic seizures?

A

Valproate for men

Lamotrigine for women

41
Q

What drug should be offered for all other focal seizures?

A

Carbamazepine or lamotrigine

42
Q

What drug should be given for absence seizures?

A

Ethosuximide or valproate

43
Q

What drug should be given for generalised tonic clonic seizures?

A

Valproate for men

Lamotrigine for women

44
Q

When would valproate not be used?

A

In girls or women unless alternatives are unsuitable and the conditions of the pregnancy prevention programme are met

45
Q

What is the firstline treatment for mild alzhemier’s disease?

A

Acetylcholinesterase inhibitors - donepezil, rivastigmine, galantamine

Memantine for more moderate/severe dementia

46
Q

How should a crohn’s disease flare be treated?

A

20-40mg prednisolone orally

If severe, hydrocortisone 100-150mg three to four times daily IV and supportive care (i.e. antibiotics, fluids, nil by mouth)

if rectal disease, use rectal hydrocortisone too for mild or severe

47
Q

What are the risks associated with azathioprine?

A

Liver and bone marrow toxicity if there is low TPMT activity (10% population)

48
Q

What is azathioprine used to treat?

A

Used for maintaining remission of crohn’s disease

49
Q

What should be checked before starting azathioprine?

A

TPMT levels.
If low, start at a lower dose
If absent, use methotrexate

50
Q

What are the fundamentals of COPD care?

A

Offer treatment and support to stop smoking
Offer flu and pneumococcal vaccinations
Offer pulmonary rehabilitation if indicated
Optimise treatment for comorbidities
Co-develop a personalised self-management plan

51
Q

When should inhaled therapies be started in COPD?

A

To relieve SOB and exercise limitation and when other interventions have been offered

52
Q

What is the first line treatment for COPD?

A

SABA or SAMA (ipratropium) PRN

53
Q

What is added in COPD secondline if asthmatic features?

A

Consider LABA and ICS (salmeterol and Beclometasone DIPROPIONATE)

If day-to-day symptoms severely affecting life or 1 severe or 2 moderate exacerbations within a year, offer LABA, LAMA AND ICS.

54
Q

What is added in COPD secondline if no asthmatic features:

A

Offer LABA and LAMA

Then consider LABA, LAMA and ICS if symptoms adversely affecting day-day life or 1 severe or 2 modeate exacerbations a year

55
Q

What are asthmatic features in COPD?

A

Previous asthma diagnosis
Atopy
High eosinophil count
Substantial variation in FEV1 over time (400ml at least)
Substantial diurnal variation in peak expiratory flow (at least 20%)

56
Q

What is the firstline treatment by specialists for rheumatoid arthritis?

A

Methotrexate

57
Q

What is the second-line treatment by specialists for rhemuatoid arthritis?

A

DMARDs

58
Q

What is appropriate treatment during a rheumatoid arthritis flare?

A

Short-term glucocorticoids, e.g. IM methylprednisolone 80mg
Short term NSAIDs e.g. ibuprofen 400mg 8 hourly with gastro-protection (e.g. lansoprazole)
Re-instate DMARDs if dose previously reduced

59
Q

How do you manage rheumatoid arthritis after failure to respond to DMARDs?

A

After failure to respond to 2 DMARDs, severely active rheumatoid arthritis may be managed with TNF-a inhibitors, e.g. infliximab.

60
Q

Treatment for fever

A

Paracetamol 1g QDS maximum 4 gram in 24 hour

61
Q

How should diarrhoea be managed?

A

If infectious, do not intentionally inhibit diarrhoea by drugs

If chronic and non-infective, may treat with loperamide or codeine

62
Q

How should insomnia be managed?

A

Optimise other factors, such as giving corticosteroids in the morning (they prevent sleep)

Be aware of risks of giving hypnotics, particularly in elderly.

Zopiclone 7.5mg oral nightly in adults. (3.75 mg nightly in elderly)

63
Q

Give 2 examples of stool softeners

A 
Docustate sodium (though stimulant at higher doses)
Arachis oil (rectal)
64
Q

What are stool softeners good for?

A

Faecal impaction and reduced gut motility

65
Q

What is the contraindication to arachis oil?

A

Nut allergy

66
Q

Give one example of a bulking agent

A

Isphagula husk

67
Q

What is a negative of bulking agents?

A

Can take days to develop effect

68
Q

What are the contraindications to bulking agents?

A

Faecal impaction
Colonic atony
Reduced gut motility

69
Q

Give 2 examples of stimulant laxatives

A

Senna

Bisacodyl

70
Q

What is a negative of stimulant laxaties?

A

May exacerbate stomach cramps

71
Q

What is a contraindication of bisacodyl?

A

Acute abdomen

72
Q

Give 2 examples of osmotic laxatives

A

Lactulose

Phosphate enema

73
Q

What is a negative of an osmotic laxative?

A

May exacerbate bloating

74
Q

When are phosphate enemas contraindicated?

A

Inflammatory bowel disease

Acute abdomen

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