Medicine Flashcards
What is Wilson’s disease?
- Autosomal recessive
- ATP7B gene on chromosome 13
- Leads to increased copper deposition in tissues
Features of Wilson’s disease?
- Hepatitis
- Cirrhosis
- Kayser fleischer rings
- Asterixis
- Chorea
- Dementia
- Neurological: basal ganglia degeneration
Management of Wilsons disease: investigation and treatment
Investigation
- slit lamp investigation
- [caeruloplasmin] decreased
- [serum copper] decreased
- 24hr urinary copper excretion increased
- genetic analysis of ATP7B gene
Treatment
- Penicillamine (chelates copper)
Angina Pectoris treatment algorithm
1st Line: BB or CCB
- BB –> atenolol?
- CCB –> verampril, diltiazem
NOT BB IF ASTHMATIC.
2nd Line: Long acting nitrates
- Nicorandil
- Ivabrandine
NOTE:
- do not combine non-dihydropyridines with beta blocker due to bradycardia risk
Type 2 diabetes management algorithm 1st line
Assess CVD Risk
NO –> metformin
YES –> metformin (establish first then add) + SGLT2 inhibitor (-flozin)
If metformin contraindicated:
+ CVD risk –> SGLT2i monotherapy
- CVD risk –> DPP4i (-liptin) or pioglitazone or sulfonylurea
If metformin not tolerated due to GI side effects what can it be switched to:
switch to modified release metformin
2nd Line T2DM management algorithm
If not CVD risk
- add either (DPP4i, pioglitazone, sulfonylurea or SGLT2i) w/ metformin
- if still not managed add another one from the list
OR insulin based Tx
Then switch one drug for GLP-1 mimetic if BMI > 35 or insulin will have occupational complications
If CVD risk or QRISK > 10%
- Add SGLT-2i
Hypertension targets in diabetes
The same
UNDER 80
- 140/90 (clinic)
- 135/85 (home)
Over 80
- 150/90 (clinic)
- 145/85 (home)
Management of HTN in diabetes
1st Line
- ACEi
——> (-pril)
- OR ARB (preferred in Afro-Caribbean descent)
——> (-sartan)
PRIMARY PREVENTION
- atorvastatin 20mg
——> consider increasing to 80 if HDL not fallen by 40%
Secondary prevention
- atorvastatin 80mg OD
What is syringomyelia?
collection of CSF in spinal cord
