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Management Flashcards

1
Q

SNAP Protocol

A

Smoking
Refer to Quitline
Few options – NRT, Varenicline

Nutrition
Overall – Mediterranean Diet
Inc intake of vegetables, Fruits and wholegrain
Low in salt
Dec. Red meat – Inc Fish
Dec Saturated fat like butter
Inc. Unsaturated fat like olive oil

Alcohol
Cut down alcohol intake
No safe level of drinking
Keep Alc <10 SD/wks, <4SD on one sitting.
2 Alcohol free days

Physical Activity and Weight
At least 150 mins, mod-high intensity exercise per week
Weight Management
BMI <25
WC <94 in Men, <80 in Female

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2
Q

Hyperlipidemia Mx

A
  1. r/o Sec Cause - DM, TFT, KFT
  2. Pharmacologic Management - Aus Risk Calculator
    - If High we start Statins - Atorvastatin
    - Aim at TC <4, LDL & TG <2, HDL >1
  3. Non-pharma - SNAP Protocol
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3
Q

How to Use Automated BP Device

A
  1. Calibrated BP Device
  2. Cuff should be 80% Length and 40% Width of the Arm Circumference
  3. Put Cuff in Bare Arm w/out thick Clothing
  4. Place Cuff above the elbow, Midpoint of the cuff should be at the midpoint of the arm.
  5. Tighten the Cuff in a way that you can slip 1-2 finger in between.
  6. Make sure the tubes fall in front of elbow - Sensor
  7. Place your arm on the desk and Relax
  8. Press the start button
  9. Record and Write down both Numbers
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4
Q

Secondary Hypertension Inv.

A

TFT
Abdominal Ultrasound/ Doppler
2D Echo
Saliva
Urine ACR/ eGFR
Urine Metaneprine
Aldosterone/Renin Ratio
XX
Sleep Studies

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5
Q

Aortic Abdominal Aneurysm Mx

A

Non-Pharma - SNAP
Meds - Statins, Anti-HTN (ACEi), Aspirin
Surgery if - >5.5cm(M), >1cm/yr, w/Sx
F/U - Depends on Size, USD at least 2yr
Family f/u - ~65 y/o USD for Screening
Notify Driving Authorities
- Untreated AAA - Conditional License
- >5cm No driving

Assess other blood tubes in the body
Do Investigations

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6
Q

Hypertensive Urgency Criteria & Mx

A

Criteria - >~180/110 + Symptoms
Refer to ED
Inv. r/o Endorgan Damage
Meds - Captopril 12.5 SD
Treat HTN - Initiate Meds
SNAP

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7
Q

HTN Emergency Criteria & Mx

A

Criteria - >~220/140
Refer to ED
Inv. r/o Endorgan Damage
Meds - Captopril 12.5 SD
Treat HTN - Initiate Meds
SNAP

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8
Q

OCP Induced HTN Mx

A

Stop OCPs, Use other Methods
Monitor BP
Investigations - TRACKPADS
SNAP

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9
Q

Diabetes Mx

A

Investigation (End-Organ Damage)
- Eyes, Legs, Heart, Kidney
Pharma - Metformin
Non-Pharma
- SNAP Protocol
- Activity - >5mmol BSL before exercise, Carry Jelly Bean Always
- Hypoglycemia - Rule of 15s
- Weight Loss - ~7%
BSL Monitoring
Referrals - Podiatrist, Diabetic Educator, Ophtha, Nephro
Inform DLA (if w/ Meds)
Sick Day Management

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10
Q

Glucometer Procedure

A

Wash hands and Prepare Equip (4)
Check Strip Due Date and Put in Glucometer. Turn On
Lancet to the Lancing Pen. Prime
Prick the Side of Finger. Wait for Results
Band Aid and Clean Area
Record Findings. Done before BF and 2 hours after meals

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11
Q

Gonorrhea Mx

A

Ceftriaxone + Azithromycin
Contact Tracing and Notify DOH from last 2 months
No sex for 7 days
No sex with partners from last 2 months
Test of Cure at 2 weeks
Re-Test at 3 months
Safe Sex - Condom, Partner, Avoid High Risk
Reading Material - Drama in Down Under

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12
Q

Chlamydia Mx

A

Doxycycline
Contact Tracing and Notify DOH last 6 months
Notification of the Lab
No sex with partners from last 6 months
No sex for 7 days
No Test of Cure
Re-Test at 3 months
Safe Sex - Condom, Partner, Avoid High Risk
Reading Material - Drama in Down Under

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13
Q

Gonorrhea + Chlamydia Mx

A

Ceftriaxone + Doxycycline
Contact Tracing and Notify DOH
No sex for 7 days
No sex with partners from last 6 months
Test of Cure at 2 weeks (Gono)
Re-Test at 3 months
Safe Sex - Condom, Partner, Avoid High Risk
Reading Material - Drama in Down Under

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14
Q

MSM Advice Mx

A

Explain STI’s
Safe Sex Advice
STI Test - Every 3 Months
HIV PrEP
- Step 1 - Checking if eligible
- Step 2 – Confirm HIV Status and KFT
- Step 3 – STI Screening
- Step 4 – Prescribing PrEP
- Step 5 – Ongoing Monitoring

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15
Q

STI Tests

A

Gonorrhea and Chlamydia - Swab and First Pass Urine
Syphilis - VDRL
Hepatitis B - Hepatitis Titer
HIV - Serology

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16
Q

Warfarin Counselling

A

Warfarin Desc, INR
Result Interpret – 2-3,
Schedule – How to take it, INR Test – Everyday once ok, Every month
Complications - if <2 - Clot, if >3 – Bleed
Interactions
– Other Meds, OTC, Herbal,
– Diet, Leafy (Dec), Grapefruit (Inc),
– Alcohol, Sickness
Missed Dose - <4h Take, >4h Skip, Never Double
4R’s

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17
Q

NOAC Counselling

A

Condition - Anti-Coagulant, CHADSVasc, Thombosis
M - NOAC
A - No Regular Testing, No Bridging, Fast Effect, Less Interaction
D - Does not have antidote, CI in CKD, Mech Valve, Mitral Stenosis, SE Bleeding
D - Taken Everyday at the same time frame, Never Double Dose

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18
Q

Steps in changing from Warfarin to NOACs

A

Stop Warfarin
INR everyday
Start if INR <2.5

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19
Q

Pre-Op Management

A

Before
Bleeding Risk - Procedure and HASBLED
- Low - Cont Warfarin
- High - Stop Warfarin 5 days before
Clotting Risk - Conditions and CHADVasc
- Low - No Bridging
- High - Bridging Therapy, Enoxaparin start if INR <2 (Stop 6 hrs before)
Antibiotics if (+) Mechanical Heart Valve

After Surgery
Enoxaparin - Start 6 hours
Warfarin - After 24 hours
Stop Enox once everything is under control

20
Q

Time need to stop Meds before Surgery?
Warfarin, NOACs, Metformin, SGLT (Flozin)

A

Warfarin - 5 days
NOAC’s - Depends on KFT 1-3 days
Metformin - On the Day
SGLT- 3 days Prior

21
Q

DVT Mx Counselling

A

Condition, Clinic Presnt, Complication – DVT, COSTVMPF, PE & Post Thrombotic Synd
Management – NOACs, Warfarin
Advantage & Indications
– NOACs – No monitoring, Fast Effect No Bridging Req, Less interaction,
– Warfarin – Regular Monitoring, Slow need Warfarin, More interaction
Disadvantage – Risk, S/E, & CI
– NOACs – Cannot be used in CKD, Mechanical Valves
– Warfarin – Regular Monitoring, Slow need Warfarin, More interaction, CI in Pregnant
– SE of Anticoags – Bleeding, Pain,
Dose and Duration – Taken Everyday at the same timeframe, Never Double Dose

22
Q

COPD Mx

A

C – Confirm diagnosis – X-ray, Spirometry, ABG r/o CVD
O – Optimize Lung Function
- Steps in Meds, Nutrition and Diet
- Chest Physiotherapy
P – Prevent deterioration (Worsening)
- Stop Smoking
- Vaccines
D – Develop Support and Plan
- Pulmonary Rehab
X - eXacerbation
- Steroids - Flare Ups
- Antibiotics - If w/change in CCVO of Sputum

23
Q

COPD Medications, Step Ladder

A

Step 1 - SABA
Step 2 – Add LABA
Step 3 – LABA + LAMA
Step 4 – LABA + LAMA + ICS (Depends)

24
Q

Osteopenia Mx

A

Garvan Calculator
High Risk - Meds
- Alendronate - Oral Meds, Daily 5 years Max, SE - Nausea, Vomiting
- Denosumab - Injections, Every 6 Months, Can get Worse if Lost to ff up
Ca Supplements - Diet if not able, Meds
Vit D Supplements
Non pharma - Exercise and Diet, Sun Exposure, Alcohol and Smoking

25
Asthma Treatment
Step 1 - SABA Step 2 - SABA + LD ICS Step 3 - SABA + LD ICS (+ LABA or Montelukast (Pedia)) Step 4 - SABA + MD ICS + LABA 3 Months of Control Before Stepping Down
26
Fall Reduction Strategies
Refer to Fall Clinic Physiotherapist - Balance and Exercise Occupation Therapist - Home Review Podiatrist Vision and Hearing Assessment Medication Review
27
General Fracture Care
Pain Relievers Elevate, Ice - Reduce Swelling Avoid Getting the Cast Wet Maintain the Cast Clean If Itchy Avoid putting things in the Cast Use Hair blower in Cool Mode Still Move your Fingers
28
Fracture Mx in Elderly
General Fracture Care Redflags (Compartment Sx) Physiotherapist Osteoporosis Mx Fall Reduction Strategies
29
Prostate CA Mx
Surgery - Keyhole Surgery - After Tx - Need to monitor PSA - SE - Erectile Dysfunction, Retrograde Ejaculation Radiotherapy or Brachytherapy Hormonal Tx - Meds or Testicular Surgery Wait & Watch - Gleason =< 6, >70 y/o
30
IBD Mx
Inflammatory Bowel Disease Meds - Steroids - Sulfasalazine, - Methotrexate - Surgery if no Response Non-pharma - Investigations - TB, Hepatitis - Vaccinations - Influenza and Pneumoccocal - More Regular Monitoring (Colonoscopy) - UC
31
Hemochromatosis Mx
Test Primary Family Member - if (+) - Iron Studies - Ferritin, Transferrin Saturation = High - Genetic Studies - C282Y, H63D -- 2 C282Y - Test wife -- 1 C282Y or 2 H63D - No need follow up -- 1C282Y AND 1 H63D - Iron Lvl every 2-3 yrs Management - Life long blood donation - Every week until normal then every 2-3 months - Deferroxamine Tablets - If Iron Storage is lowered before organ damage = Normal Life-expectancy Avoid - Alcohol, Vit. C
32
Alcoholic SN Mx
Immediate - Refer to Neuro - Nerve Conduction Studies - Gabapentin - If Problematic - Thiamine Long-Term - Cessation of Alcohol - Podiatrist - Fall Prevention Mx
33
Alzheimer's Disease Mx
Referral - Aged Care Assessment - Asses what level of support he needs - Social Worker Visit few times a day or - Nursing Home Investigation - TFT, BSL, B12, LFT, KUB Meds - Donepizil Reduce Risk - Mood (SSRI), Med Review, Vision and Hearing Check Advance Care Planning Healthy Lifestyle Driving Notification Support Group - Dementia Australia
34
Private Driver License Mx (1st Episode)
Seizure Free for 6 months Started Treatment for 6 months Address RF - Alcohol, Sleep, Drugs, Medications Inform Driving Authority (If 1st time) Follow Up
35
Methotrexate Preparation
Vaccination Folic Acid Supplement FBE, LFT
36
Palliative Care
PEPSI COLA P - Physical Symptoms - Pain Meds, Stop Non-Essential E - Emotion - Provide Support and Expectations of the Difficult situation P - Personal - Religious Need S - Social Support - Center Link & Social Worker I - Information and Communication - Schedule a consult with Consultant C - Control - Respect Advance Directive O - Out of hours L - Late A - Afterwards
37
Epistaxis Management - Step Wise
Squeeze Nose 10-15 mins, Leaning forward, Head Slightly Tilted Forward If stops - Check Vessel - Anestetic Spray then Apply Silver Nitrate If stops - Vessel Not visualized - Use Merocel + Oral Ab If it dosen't help - Refer to ENT and insert Foley Catheter then Inflate Stop Nasal Steroid Change to Anti-Histamine
38
Rheumatiod Arthritis Mx
MTX or DMARDS Steroid Short Course NSAIDS for Pain Prior to Start - Vaccinations, Folic Acid Supplement, FBE & LFT Non-Pharma - Physiotherapist, OT, Excercise Physiologist, Psychologist Lifestyle Change Goal of treatment - Symptom Free, Control Symptoms, AOD
39
Delirium Mx
Usually Multi Factorial Treat Underlying Cause (ex.) - Hyponatremia - Restrict Fluids, PNSS if Severe - Hypoxia - Give oxygen Do Further Investigations Supportive Treatment - Familiar Environment - Family Members, One Nurse, - Room Quiet Well lit, Normal Temperature - Calendar and Clock - Regular Communication - Safe Environment Haloperidol or Olanzapine - If High Risk of Harm
40
Diltiazem, Statin, Interaction Mx
Diltiazem - If for HTN - Change to another class - If for CHF - Liase with Cardio
41
Temazepam Dependence Mx
Taper Dose Change to Long acting Taper 10-25% dose every 1-2 weeks Arrange daily pick up
42
HTN Mx (Medication)
First Line Medications ACEi/ARB (Perindopril) - Ad: Protects the Kidneys - SE: Dry Cough, Inc. K, Drop in Kidney Func. - Dis: Need to check KFT after 2 weeks -- Cont. if eGFR change is <25% - CI - Pregnancy, Angioedema, Hyperkalemia, Bilateral RAS CCB (Amlodipine) - SE: Swelling of the leg Thiazides - SE: Postural Hypotension, Frequency of Urination, Drops K - Dis: Interacts with other Medication - CI - Gout
43
Peripheral Arterial Disease
Inv - USD Doppler, CT Angiogram, Metabolic Panel Manage Risk Factors Pharma - ACEi, Cholesterol, Aspirin (If has B-Block - Change) Non-Pharma - SNAP - Exercise Physiotherapist - Podiatrist - Monitor Ulcers Surgery - ABI <0.3-0.4 - Vascular Surgeon
44
HTN Mx (Steps)
Step 1 - First line Drug + Lifestlye Step 2 - Add 2nd Drug Step 3 - Increase dose of 1 drug before inc the 2nd drug Step 4 - Max 1st and 2nd Drug + 3rd Drug Step 5 - Refer to Specialist Give 3 months before stepping up
45
HTN Investigations
Check 2ndary HTN - TRACKPADS Check Complications - Kidneys - eGFR, Urine ACR - Heart - 12L ECG, 2D Echo - PAD - Ankle Brachial Index Check Metabolic Panel - FBS - Lipid Profile - BUA

Counselling (4 decks)

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