Medicine (5) Flashcards
Management of status epilepticus
- Rectal diazepam / buccal midazolam
- IV lorazepam
- IV phenytoin (phenobarbital if already on regular phenytoin)
- Anaesthesia (propofol / thiopental sodium)
Treatment of generalised tonic-clonic seizures
Generalised tonic-clonic seizures
- sodium valproate
- second line: lamotrigine, carbamazepine
Treatment of absence seizures
Absence seizures (Petit mal)
- sodium valproate or ethosuximide
*sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy
DO NOT use carbamazepine → it may exaggerate absence seizures
Treatment of myoclonic seiures
Myoclonic seizures
- sodium valproate
- second line: clonazepam, lamotrigine
DO NOT USE carbamazepine → it may exacerbate myoclonic seizures
Treatment of focal seizures
Focal seizures
- carbamazepine or lamotrigine
- second line: levetiracetam, oxcarbazepine or sodium valproate
SEs of sodium valproate

SEs of carbamazepine

seizure vs syncope

A 43 year old male with known epilepsy is being withdrawn from his
AED under the care of his neurologist. During this period, he suffers a tonic-clonic seizure.
What does the DVLA state in this case?
- Cannot drive for at least 6 months + goes back on previous AED
- He can start driving once he goes back to his previous AED – has to be seizure-free for 6 months after going back to his previous AED
DVLA and epilepsy guidance

The differential diagnosis for ‘tired all the time’

Red flags for an adult with ‘tiredness’
- unintentional weight loss (5% of body weight in 6–12 months)
- Lymphadenopathy suggestive of malignancy
- Other symptoms and signs of malignancy, such as haemoptysis, dysphagia, rectal bleeding, breast lump, or postmenopausal bleeding
- Localizing/focal neurological signs
Blood tests for patient presenting with ‘tiredness’
- Full blood count
- Erythrocyte sedimentation rate or C-reactive protein
- Renal and liver function tests
- Thyroid stimulating hormone
- Random blood glucose or HbA1c
- IgA tissue transglutaminase (for coeliac disease)
Type 1 vs Type 2 Diabetes Mellitus

Microvascular and macrovascular complications of diabetes

What to look for an examination of a diabetic patient?

What to look/examine for on diabetic foot examination?

Values diagnostic of diabetes mellitus

Values of pre-diabetes and diabetes glucose

Conservative management of T2DM
- Lifestyle management (diet, exercise, smoking cessation, reduce alcohol consumption)
- Education about the condition
- Offer structured group education programme (DESMOND: Diabetes Education for Self-Management for Ongoing and Newly Diagnosed)
- Monitor for complications (inform about annual screening for retinopathy, foot problems, nephropathy and cardiovascular risk factors)
Medical management of T2DM (other than hypoglycaemic agents)
- Lipid modification – ither atorvastatin 20mg for primary prevention if QRISK2 >10% or >85 or atorvastatin 80mg for secondary prevention of cardiovascular disease
- Blood Pressure – ACE inhibitor is first line for all patients with diabetes diagnosed with hypertension (if African/Caribbean – prescribe concurrent diuretic or calcium channel blocker)
Steps in hypoglycaemic agents selection for T2DM

Metformin
- class
- MoA
- SEs
(Biguanide)
Metformin
MoA: Reduces the rate of gluconeogenesis and
increases insulin sensitivity
*Does not affect insulin secretion or cause
hypoglycaemia or predispose to weight
gain
Side effects: Diarrhoea
Gliclazide
- class
- MoA
- SEs
(Sulfonylureas)
Gliclazide, Tolbutamide, Glibenclamide
MoA: Act on beta cells to promote insulin
secretion in response to glucose and other secretagogues
*Ineffective in patients with no remaining
beta cell function
Side effects: Promote weight gain, risk of
hypoglycaemia