Management Flashcards
Disease name
Management
Type I Diabetes
Aim for a HbA1c goal of less than 6.5%. Combination of insulin, diet, exercise regulation and monitoring of blood glucose. Yearly screening for BP, eGFR, lipids, smoking, funduscope, foot check, urinary protein.
Type II Diabetes
Aims are to remove symptoms of uncontrolled diabetes, avoid emergencies, reduce risk developement, early detection, avoid adverse effect on QofL
Diabetic retinopathy
Laser therapy can be used to cauterize areas of microhaemorrage
HIV
HAART, antiretroviral, supportive care (counselling…) treat any symptoms. General medical checkups often.
Sepsis
Sepsis 6: high flow oxygen, take blood, give broad spectrum antibiotics, give IV fluids, measure lactate and haemoglobin, measure hours lay urine output.
Varicella
Antiviral therapy not routinely given for children. In adults, aciclovir or valaciclovir first line antivirals.
Shingles
VZ immunoglobulin, aciclovir
Encephalitis
Supportive treatement and aetiology targeted antiviral/Anti-microbial.
Ebola infection
No treatement works very well. Convalescent plasma can maybe help. rVSV-EBOV vaccine exists and 100% effective in ring distribution
Cellulitis
Systemic antibiotic with MRSA cover like Vancomyocin IV
Gall stone disease
Laparoscopic Cholecystectomy
Pancreatitis
Endoscopic retrograde cholangiopancreatography
(look at pancreatic duct and get rid of stones). Oxygen, iv fluids, analgesia, antibiotics, NGT.
Appendicities
Appendicectomy
Upper GI Bleeding
Get support of critical care team. Give fluids. Stop offending drugs, give plasma, correct clotting, platelet transfusion, consider antibiotics.Non variceal: PPI. Variceal: Terlipressin (like vasopressin). Endoscoping bimodal (2) intervention (clipping, banding, injections, burning vessel).
Diverticular disease
Haartman’s proceudre, antibiotics, fibre rich diet.
IBD (Crohn’s disease)
- Steroids/ antibiotics (short term only). Followed by immunosuppressants, biologics (antiTNF, anti0integrin, IL23&IL12 and oral nutrition with supplements quite good but bad taste. Last resort treatment is Surgery.
IBD (Ulcerative Colitis)
- Initial treatment include steroids, aminosaliculates (5-ASA, mesalazine). 2. second line give immunosupressants like thiopurines, methotrexate, ciclosorine. 3. give biologics like anti-tnf, anti-integrin. JAK inhibitors (tofacitinib). Last resort is surgery (20%)
Coeliac disease
Only treatment available is a strict gluten free diet. Duodenal biopsy is performed and is very sensitive for disease.
Alcoholic hepatitis
Prednisolone,
Tuberculosis
Rifampicin + isoniazid (6-12 months) + pyrazinamide (2months) _ ethambutol (1-2 months). In resistant TB, consider other antibiotics.
Meningitis
Immediate broad spectrum antimicrobials should be given, then focused once culture results are back. An adjunctive corticosteroid (dexamethosone) may be given
Osteoarthritis
Local analgesia, exercise, intra-articular corticosteroids, knee replacement surgery if very bad.
Psoriatic arthritis
first line moisterizer, then topical corticosteroid, vit D analogues. Then phototherapy, then methotrexate, acitrecin, ciclosporin, fumaric acid. Then 3rd line is biologics. Criteria for biologic is severe psoriasis, failed standard treatement,
Rheumatoid arthritis
Anti-inflammatory treatments: NSAIDs, then DMARDs (traditional then biologics then targeted biologics) then steroids for flare ups. Anti-tnfa antibody treatement biologics gold standard (some humanised versions)
Systemic lupus erythematosus
Aim is to achieve remission while minimizing drug related toxicity. Drugs escalating: Hydroxychloroquine (for patients with mild symptoms) ,corticosteroids short course for flareups, azothiopine, micofenalate, methotrexate, belimumab (apoptosis of autoreactive b cells)
Systemic sclerosis
Early: low dose steroids, immunosuppressives. Late: symptomatic control and BP control
Raynaud’s
Keep warm, ca channel blocker, prostacyclin injection
Antiphospholipid syndrome
Strokes/TIAs primarily, anticoagulation treatement of choice. Primarily organic brain symptoms like headache psychosis ect. immunosupression treatment. In obstetrics, heparin and aspirin. Warfarin in patients which have had thrombosis.
Atopic dermatitis (Eczema)
Initial emollients, then topical steroids/ calcineurin inhibitors alternatives, then systemic steroids (prednisolone) or phototherapy. Last line is methotrexate, cliclosporin, azathioprine, biologics (dulipumab is good. IL4-IL13 inhibitor).
IgA nephropathy (main cause of glomerulonephritis)
Blood pressure control is most important, immunosupression may be benificial in some cases.
Nephrotic syndrome
Diuretics (be cautious of hypovolaemia), ACE inhibitors (good for kidneys), anticoagulation (increased risk of VTE), statin (cholesterol)
Minimal change disease (cause of nephrotic syndrome)
Steroids and sometimes orhter immunosuppression
Membranous nephropaty (cause of nephrotic syndrome)
Immunosupression
Urinary Tract Infection
Antibiotics.(based on culture results). Continuous prophylaxis or self-start antibiotic can be given for recurrent. Trimethoprin first line in females. INcreased fluid intake, general hygiene. Cranberry juice good for prophylaxis. Topical estrogens
