Management Flashcards
Bronchiectasis
- Physical training
- Postural drainage
- Antibiotics for exacerbations
- Bronchodilators
- Immunisations
- Surgery in selected cases
angina
- all patients should receive aspirin and statin in absence of contraindications
- gtn to abort acute attacks
1st line
- beta blocker or rate limiting calcium channel blocker
2nd line
- increase monotherapy to maximum dose
3rd line
- add the other, use dihydropyridine instead
- if patient cannot tolerate this, then consider long acting nitrate, ivabradine, nicorandil or ranolozine
only add 3rd drug if patient awaiting assessment for pci or cabg
copd; stable
general management
- smoking cessation
- annual influenza vaccine
- one off pneumococcal vaccine
1st line = saba or sama
2nd line
- fev1 >50% = laba or lama
- fev1 <50% = laba + ics, or lama
for patients with persistent exacerbations or breathlessness
- if taking laba then switch to laba+ics combination inhalers
- otherwise give lama and laba+ics combination inhaler
consider oral theophylline for those who cannot tolerate inhaled therapy
consider mucolytics
cor pulmonale
- treat oedema with loop diuretics
- consider ltot
asthma; stable
- saba + low dose ics
- add laba
if no response to laba
- stop laba and increase steroid to medium dose
if some response to laba
- keep laba and increase steroid to medium dose
- also consider keeping current dosage and trialling ltra, theophylline or lama
next step is consider trials of
- increasing ics to high dose
- addition of fourth drug
- referral to specialist care
next step
- consider regular oral steroids
hypertension
1st line
- ace inhibitor for under 55
- calcium channel blocker for over 55 or black
2nd line
- add the other
3rd line
- add thiazide diuretic
4th line
- if potassium less than or equal to 4.5, spironolactone
- if potassium greater than 4.5, increase dose of thiazide diuretic
5th line
- consider alpha/beta blocker
diabetes mellitus type 2
- lifestyle modification and risk factor optimisation
1st line
- metformin
if hba1c greater than 58 add one of
- sulfonylurea
- pioglitazone
- gliptin
- sglt-2 inhibitor
if hba1c still greater than 58 add one to make triple therapy
consider insulin
if triple therapy not effective/not tolerated/is contraindicated and bmi is greater than 35
- consider adding glp-1 mimetic
heart failure
- 1st line = ace inhibitor and beta-blocker; increase to max before adding more drugs
- 2nd line = aldosterone antagonist, arb or hydralazine + nitrate
if symptoms persist
- cardiac resynchronisation therapy
- digoxin; inotropic effect, strongly indicated if co-existent af
diuretics should be offered for fluid overload
annual influenza vaccine
one off pneumococcal vaccine; booster every 5 years for;
- apslenia
- splenic dysfunction
- ckd
crohn’s disease
- stop smoking
inducing remission
- 1st line = glucocorticoids
- 2nd line = 5-asa eg mesalazine
- azathioprine/mercaptopurine may be used as add on therapy (not on their own)
refractory disease or fistulating crohns
- infliximab added
maintaining remission
- 1st line = azathioprine or mercaptopurine
- 2nd line = methotrexate
- mesalazine should be considered if the patient has had previous surgery
around 80% of crohns patients will eventually have surgery
ulcerative colitis
- mild: < 4 stools/day, only a small amount of blood
- moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
- severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
inducing remission
- rectal aminosalicylates or steroids for distal colitis
- oral aminosalicylates
- 2nd line = oral prednisolone
- severe colitis requires in hospital iv steroids
maintaining remission
- oral aminosalicylates eg mesalazine
- azathioprine and mercaptopurine
generalised tonic-clonic seizures
1st line
- sodium valproate
2nd line
- lamotrigine
- carbamazepine
partial seizures
1st line
- carbamazepine
2nd line
- lamotrigine
- sodium valproate
myoclonic seizures
1st line
- sodium valproate
2nd line
- clonazepam
- lamotrigine
absence seizures
1st line
- sodium valproate
- ethosuxemide
