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Finals > Management > Flashcards

Management Flashcards

1
Q

STEMI Management

A
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2
Q

NSTEMI Management

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3
Q

Acute LV Failure Management

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4
Q

Tachycardia >125bp, + shock Management

A

Amiodarone 300mg IV over 20-20mins

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5
Q

Anaphylaxis Management

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6
Q

Acute Exacerbation Asthma/COPD

A

Add ABx if infective exacerbation

In COPD, hypoxia will kill a lot faster than hypercapnia –> In acute setting, apply high flow then review after an ABG.

If patient not in per-arrest, 28% O2 safer with ABG 30min later to assess affect

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7
Q

Pneumonia Management

A
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8
Q

Pulmonary Embolism Management

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9
Q

Bacterial meningitis Management

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A GP will usually give patients 1.2g benzylpenicillin if there is any suspicion of meningitis.

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10
Q

Status Epilepticus

A

Ensure airway is patent, recovery position with O2

Status Epilepticus: Seizure lasting more than 30 mins

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11
Q

Stroke Management

A

If CT shows haemorrhage of any type, refer to neurosurgery, do not give aspirin or thrombolysis

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12
Q

DKA Management

A
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13
Q

Hypoglycaemia (BM glucose <3 mmol/L) Management

A

If patient can eat –> sugar rick snack e.g. orange juice, biscuits

If unable to eat (drowsy/vomiting) –> IV glucose 100ml 20% glucose)

Unable to eat and no cannula –> IM glucagon 1mg

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14
Q

Hypertension Management

A

Lifestyle advice to those with BP > 135/85

Anti-Hypertensives if BP>150/95 or >135/58 + over 8-, CV or renal disease, Diabetes

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15
Q

Target Blood pressure on treatment?

A

<80yo = aim for <140/90 at clinic

> 80yo = add 10 to systolic values

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16
Q

Chronic Heart Failure Management

A
  • ACEi + B-blocker.
    If intolerant of ACEi use ARB
    If intolerant of ARB use hydralazine or nitrate
  • If inadequate, increase dose as tolerated
  • If still inadequate add aldosterone receptor antagonist e.g. spironolactone
17
Q

AF Management

A

2 Aims of treatment: Prevent stroke + control rhythm and rate of the heart

Rate control: B-blocker + CCB

18
Q

Stroke Prevention - using CHA2DS2-VASc Score

A 
Congestive Heart failure 
Hypertension
Age > 75 (2 points)
Diabetes Mellituse 
Stroke TIA previous  (2 points)
Vascular disease (Peripheral arterial disease or IHD)
Age 65-74
Sex (female)

Score = 0 –> may not require anticoagulation

1 = consider antigoagulation in men –> DOAC

2 or more = Anticoagulation in men and women –> consider bleeding risk (HAS-BLED)

19
Q

Bleeding Risk for anticoagulation in AF - Using HAS-BLED score

A

Hypertension - uncontrolled BP

Abnormal renal function (cr >200/transplant/dialysis. Abnormal liver function (cirrhosis or bilirubin 2x normal, AST/ALT/ALP >3xnormal)

Stroke

Bleeding tendency

Labile INR

Elderly >65yo

Drugs (concomitat aspirin or NSAIDs) or alcohol

0 = low risk bleeding, strongly consider anticoag

1-2 = low-mod risk - consider anticoag

> 3 = high risk - alternatives to anticoags to be considered

20
Q

stable angina management

A

GTN spray PRN for symptomatic relief

secondary prev: aspirin, statin, CV RF modification

1 anti-anginal drug: b-blocker, CCB

21
Q

COPD Management

A

1) Offer smoking cessation
Offer pneumococcal + influenza vaccinations
Offer pulmonary rehab if indicated
Co-develop personalised self-management plan

2) INHALED THERAPIES: SABA/SAMA

3) No asthmatic features: LABA + LAMA
If symptoms still impacting QOL/experiencing exacerbations: LABA + LAMA + ICS

4) Asthmatic features/responds to steroids: LABA + ICS
If symptoms still impactinf QOL/Exacerbations : LABA + LAMA + ICS

22
Q

Asthma Management

A
23
Q

Type 2 Diabetes: Blood Glucose lowering therapy

A
24
Q

Parkinson’s First line Management

A

Co-beneldopa or co-careldopa

unless very mild disease: Ropinirole (Dopamine agonist) or rasagiline (MAOI)

25
Q

Epilepsy Management

Myoclonic Seizures
Tonic seizures
All other focal seizures
Absence seizures
Generalised tonic clonic seizures
A

Myoclonic Seizures : Valproate (M), Levetiracetam (F)

Tonic seizures: Valproate (M), Lamotrigine (F)

All other focal seizures: Carbamazepine or lamotrigine

Absence seizures: Ethosuximide or valproate

Generalised tonic clonic seizures: Valproate (M), Lamotrigine (F)

26
Q

Lamotrigine SEs

A

Rash, rarely Stevens-Johnson syndrome

27
Q

Carbamazepine SEs

A 
Rash
Dysarthria
Ataxia
Nystagmus
Hyponatraemia
28
Q

Phenytoin SEs

A

Ataxia
Periph. neuropathy
gum hyperplasia
hepatotoxicity

29
Q

sodium valproate SEs

A

Tremor
teratogenicity
weight gain

30
Q

Levetiracetam

A

Fatigue
mood disorders
agitation

31
Q

which anti-epileptics cause a rash

A

Lamotrigine

Carbemazepine

32
Q

Alzheimer’s disease management

A

Mild/Mod: AChEi –> Donepezil, rivastigmine, galantamine

Mod/Sev: NMDA antag –> Memantine

33
Q 
Crohns Management
Inducing Remission (treating a flare)
A

Mild flare: Prednisolone
Severe flare: Hydrocortisone + supportive care
if rectal disease, use rectal hydrocortisone too

34
Q 
Crohns management:
Maintaining remission (preventing a flare)
A

Azathioprine

Check TPMT levels before starting (Azathioprine is a pro drug, metabolised by the liver, the metabolite is inactivated by TPMT - thiopurine S-methyl transferase)

10% pop has low TPMT activity which would lead to abnormal accumulation of metabolites, increasing liver and bone marrow toxicity.

If TPMT is low = lower dose azathioprine
If TPMT is deficient/absent offer methotrexate

35
Q

Rheumatoid Arthritis Management

A

Methotrexate + additional DMARDs

During a flare: Short term glucocorticoids e.g. IM methylprednisolone 80mg,
short term NSAIDs with PPI protection, reinstate DMARDs if dose previously reduced

IF failure to respond to 2 DMARSs + severely active RA –> TNF alpha inhibs e.g. Infliximab

36
Q

Constipation Management

A

Never give a laxative if there is evidence of obstruction

Stool Softener: Arachis oil/Docusate - good for faecal impaction or reduced gut motility

Bulking agents: Isphagula husk - good for reduced gut motility, can take days to cause effect - do not use in faecal impaction

Stimulant laxatives: Senna/Bisacodyl. - may exacerbate abdo cramps

Osmotic laxatives: Lactulose phosphate enema = CI in IBD. may exacerbate bloating

37
Q

Diarrhoea management

A

Most common cause is GI infection (Norovirus and C diff). Removal of infectious agents should not be intentionally inhibited by drugs.

Chronic diarrhoea (proven to be non-infectious) = Loperamide or Codeine (also provides pain relief

38
Q

Insomnia management

A

Corticosteroids can cause insomnia - give in the AM

Deal with any modifiable aspects e.g. noise in hospital first.

Beware elderly can become drowsy and incr risk of falls

Zopiclone 7.5mg PO nightly / 3.5mg nightly in elderly

Finals (8 decks)

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