Non-communicable Disease

Question 1

Choice of med for dyslipidaemia

Answer 1

Predominant hypercholesterolaemia -> statin, simvastatin 10mg nocte (= HMGCoA reductase inhibitor)
Mixed hyperlipidaemia-> statin or fibrate
Predominant hypertriglyceridemia -> fibrate , bezafibrate 400mg po daily
Patient on ARVs -> fibrate (ARVs up the TG level)

Question 2

Which patients with dyslipidaemia should be referred

Answer 2

Those with suspected familial hypercholesterolaemia

Suspected severe familial dyslipidaemia

Question 3

When to use meds in HPT

Answer 3

SBP >140/ DBP >90 despite lifestyle changes

Question 4

Definition of mild, moderate and severe HPT

Answer 4

Mild: 140-159/90-99; 180/110

Question 5

Management of mild hypertension

Answer 5

Lifestyle change for 3-6/12 -> no change -> single med:
Low dose thiazide (hydrochlorothiazide 12.5mg daily)

Start on med immediately if >3 risk factors, TOD or assoc clinical condition

Question 6

Management of moderate HPT

Answer 6

Lifestyle changes
2 meds after trial lifestyle changes (or immediately, if risk factors, TOD or assoc condition)
A. Hydrochlorothiazide
+ B. ACE inhibitor (enalapril 10mg daily)
Or C. CCB (amlodipine 5 mg daily)

Start this regimen if mild HPT target not reached in 1/12
If mod target not reached in 1/12 add either ACE-I or CCB (whichever wasn’t used initially)
If target still not reached, add B-blocker (atenolol 50mg daily)
If still no effect, increase all to max doses

Question 7

Dyslipidaemia indications for rx

Answer 7

CVS: to reduce risk of CVS event; all px with clinical CVS disease need a statin
Non-CVS: MC complication is acute pancreatitis ; px with severe hypertriglyceridemia (fasting TG>10)

Question 8

Indications for insulin

Answer 8

Inability to control HGT with oral meds
Temp use for major stress
Severe kidney or liver disease
Pregnancy

Question 9

Types of insulin

Answer 9

Short-acting: regular human insulin; onset 30min, peak 2-5 hours, duration 5-8 hours
Intermediate-acting: neutral protamine hagedom (NPH)= isophane 8u at night. Add-on therapy. Onset 1-3 hours, peak 6-12 hours, duration 16-24 hours
Substitution therapy: biphasic insulin, 30/70 NPH/regular human insulin. 2/3 in morning, 1/3 in evening. Onset 30 min, peak 2-12 hours, duration 16-24
Basal bonus insulin (basal intermediate acting, bolus is short acting): 50/50 dose of 0.6u/kg

Question 10

Management of diabetes

Answer 10

1st line: metformin 500mg po bd upped to 850 with lifestyle and diet change
2nd line: sulphonylurea - glibenclamide 2.5mg po daily upped to 15, or glimepiride 1mg po daily upped to 4
3rd line: insulin

Question 11

Management of stable angina

Answer 11

Nitrates
B-blocker
CCB

Question 12

Management of ACS

Answer 12

MONA- morphine, O2, nitrates, aspirin
Thrombolysis - streptokinase
Anticoagulation - heparin (UFH or LMWH)

Total drug mx: morphine, statin, reperfusion, nitrates, ACE-I, B-blockers, anti-PLT (aspirin and clopidogrel)