Management Flashcards
STEMI Management
NSTEMI Management
Acute LV Failure Management
Tachycardia >125bp, + shock Management
Amiodarone 300mg IV over 20-20mins
Anaphylaxis Management
Acute Exacerbation Asthma/COPD
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
Pneumonia Management
Pulmonary Embolism Management
Bacterial meningitis Management
A GP will usually give patients 1.2g benzylpenicillin if there is any suspicion of meningitis.
Status Epilepticus
Ensure airway is patent, recovery position with O2
Status Epilepticus: Seizure lasting more than 30 mins
Stroke Management
If CT shows haemorrhage of any type, refer to neurosurgery, do not give aspirin or thrombolysis
DKA Management
Hypoglycaemia (BM glucose <3 mmol/L) Management
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
Hypertension Management
Lifestyle advice to those with BP > 135/85
Anti-Hypertensives if BP>150/95 or >135/58 + over 8-, CV or renal disease, Diabetes
Target Blood pressure on treatment?
<80yo = aim for <140/90 at clinic
> 80yo = add 10 to systolic values
Chronic Heart Failure Management
- 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
AF Management
2 Aims of treatment: Prevent stroke + control rhythm and rate of the heart
Rate control: B-blocker + CCB
Stroke Prevention - using CHA2DS2-VASc Score
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)
Bleeding Risk for anticoagulation in AF - Using HAS-BLED score
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
stable angina management
GTN spray PRN for symptomatic relief
secondary prev: aspirin, statin, CV RF modification
1 anti-anginal drug: b-blocker, CCB
COPD Management
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
Asthma Management
Type 2 Diabetes: Blood Glucose lowering therapy
Parkinson’s First line Management
Co-beneldopa or co-careldopa
unless very mild disease: Ropinirole (Dopamine agonist) or rasagiline (MAOI)
Epilepsy Management
Myoclonic Seizures Tonic seizures All other focal seizures Absence seizures Generalised tonic clonic seizures
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)
Lamotrigine SEs
Rash, rarely Stevens-Johnson syndrome
Carbamazepine SEs
Rash Dysarthria Ataxia Nystagmus Hyponatraemia
Phenytoin SEs
Ataxia
Periph. neuropathy
gum hyperplasia
hepatotoxicity
sodium valproate SEs
Tremor
teratogenicity
weight gain
Levetiracetam
Fatigue
mood disorders
agitation
which anti-epileptics cause a rash
Lamotrigine
Carbemazepine
Alzheimer’s disease management
Mild/Mod: AChEi –> Donepezil, rivastigmine, galantamine
Mod/Sev: NMDA antag –> Memantine
Crohns Management Inducing Remission (treating a flare)
Mild flare: Prednisolone
Severe flare: Hydrocortisone + supportive care
if rectal disease, use rectal hydrocortisone too
Crohns management: Maintaining remission (preventing a flare)
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
Rheumatoid Arthritis Management
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
Constipation Management
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
Diarrhoea management
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
Insomnia management
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
