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My General Practise > Oxford handbook summary > Flashcards

Oxford handbook summary Flashcards

1
Q

Weight loss DDx

A

GIT: malabsorption, malnutrition, dieting
Chronic: hyperthyroidism, DM, HF, RD, COPD, degenerative neurological, TB/HIV
Malignancy
Psychiatric: depression, dementia, anorexia

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2
Q

BMI ranges

A
  • Healthy: 18.5- 24.9
  • Overweight: 25- 29.9
  • Obese: 30- 39.9 (35- 39.9 – OBESITY II)
  • Morbidly Obese: ≥40
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3
Q

Meds to stop smoking

A

• Nicotine replacement therapy: continue for 3months, gradually decrease over 2 weeks
o Contraindicated: post MI, stroke or TIA, arrhythmia
• Bupropion: 150mg od for 3 days, then 150mg bd for 7-9weeks- start 1 week before intended quit day
o Contraindicated: epilepsy, eating disorders, bipolar disorders
• Varenicline 0.5mg od for 3days, 0.5mg bd 4d, 1mg bd 11/52- started 1 week before intended quit day
Contraindicated: Caution in Psychiatric illness

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4
Q

Recommended levels of alcohol

A

Men <21 u/ weekly

Women <14 u/weekly

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5
Q

Alcohol assessment

A

FBC( MCV),

LFT( GGT, AST, bilirubin), USS shows fatty liver/ cirrhosis

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6
Q

Alcoholic management

A

o Community alcohol team, self-help organization
o Detoxification with chlordiazepoxide 1/52

Vitamin B supplements: mild 10-25mg/d; severe 200-300mg/d

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7
Q

Insomnia drugs

A

Benzodiazepines (temazepam), zolpidem,
zopiclone,
low dose TCA (amitriptyline) when severe, disabling or distress

SE: amnesia and daytime somnolence

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8
Q

Mental state examination

A

• Appearance and behavior: self- neglect, malnutrition, eye contact, movement, agitation, aggression
• Speech
• Mood
• Thinking: form, content, flow, possession
• Perception: illusions, hallucinations, pseudohallucinations
• Cognition
Insight on their illness, the effects and need for treatment

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9
Q

Cognitive behavior therapy

A
  1. Behavioral therapy: systematic desensitization + anxiety reducing measures
  2. Cognitive therapy: focus on thoughts and reasoning behind assumptions that lead to abnormal reactions
     Patient learns to recognize negative thinking patterns- can teach them ways to challenge cognitive errors
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10
Q

Panic attack Sx

A

PANICS”
• Palpitations, paresthesias
• Abdominal distress
• Nausea
• Intense fear of dying or losing control, light-headedness
• Chest pain, chills, chocking, disconnetedness
• Sweating, shaking, SOB

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11
Q

panic attack tx

A 
1.	SSRI (paroxetine, citalopram): start at low dose and increase – review in 2,4, 6, 12 weeks. Continue for ≥6mo
     OR 
2.	TCA (imipramine, clomipramine) 
     OR
3.	Non-drug treatment
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12
Q

anxiety drug tx

A

SSRI (sertraline 50-150mg od)

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13
Q

Anxiety psychological Symptoms

A 
Fearful anticipation 
Irritability, restlessness 
Sensitive to noise, poor concentrate 
Worrying thoughts, obsessions 
Insomnia, nightmares 
Depression, depersonalization, fear of losing control/ dying
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14
Q

Anxiety Physical symptoms

A 
Dry mouth 
Headache, epigastric pain, tinnitus 
Tremor, tinnitus, parasthesiae, dizziness
Difficulty swallowing
Frequent loose motions/ flatulence 
Frequency/ urgency of micturition 
SOB, chest pain, palpitations 
Sexual dysfunction, menstrual problems
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15
Q

Somatization disorder

A 
Starts <30
multiple organ system complaints
4 pain, 
2 GI, 
1 sexual, 
1 pseudoneurological
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16
Q

Agrophobia:

A

onset 20-40years.
Crowds, being far from home, situtations where difficult to escape lead to panic attacks, fear of fainting, loss of control

SSRI, MAOI, TCA

17
Q

PTSD

A

last >1 month and start anytime after event
• Intrusive recollections: thoughts, nightmares, flashbacks
• Avoidant behavior
• Increased arousal: anxiety, irritability, vigilance, insomnia and decreased concentration
• Numbing of emotions

18
Q

Depression screening

A

Past month have you been bothered by feeling down, depressed or hopeless?

During last month, have you often been bothered by having little interest or pleasure in doing things?

19
Q

Depression Biophychosocial Assessment (BPA)

A
  • Current symptoms- nature, onset, duration, severity
  • Phx depression or mood elevation
  • Fhx of mental illness
  • Relationship qualities, living conditions, social support, financial worries
  • Alcohol/ substance use
  • Suicidal ideation
  • Treatment options and if any previous tx
20
Q

Depression Sx

> 50% of time in past two weeks

SIG E CAPS

A
  • Depressed mood
  • Sleep disturbances
  • Loss of interest- anhedonia
  • Guilt or feeling of worthlessness
  • Loss of energy
  • Loss of concentration
  • Appetite/ weight changes
  • Psychomotor retardation or agitation
  • Suicidal ideation
21
Q

Suicide risk

SAD PERSONS

A 
•	Sex: male 
•	Age: teenager or elderly 
•	Depression 
•	Previous attempt 
•	Ethanol or drug use 
•	Loss of rational thiknig 
•	Sickness 
•	Organized plan 
•	No spouse – divorced/ widowed/ single 
Social support lacking
22
Q

Depression Tx

A 
SSRI
SNRI
TCA
Mirtazapine
Reboxetine
MAOI
23
Q

SSRI:

A

fluoxetine 20mg od, citalopram 20-40mg od, sertraline 50-150mg od
• First line, safer in overdose, more compliant
• SE: short term increased anxiety, GI symptoms- dyspepsia common. (+ PPI if >60- GI bleed risk)
• Elderly have risk of hyponateamia
• Fluoxetine: only tx for kids

24
Q

SNRI:

A

venlafaxine 37.5mg bd, duloxetine 60mg od

• Avoid if uncontrolled HT, contraindicated in arrhythmia

25
Q

TCA:

A

lofepramine 70mg od/ db/ tds, trazodone 150-300mg daily
• Titrate dose up
• SE: drowsiness, dry mouth, blurry vision, constipation, urinary retention, sweating, arrhythmia
• Caution in CVD, prostate hypertrophy, raised intraocular P (risk of acute glaucoma)

26
Q

Mirtazapine 15-45 mg nocte

A
  • Presynaptic a2- adrenoreceptor antagonist increase central noradrenergic and serotonergic NT
  • SE: sedation initially and weight gain
27
Q

Reboxetine 4-6mg bd

A
  • Selective inhibitor of NA reuptake

* Not recommended in elderly

28
Q

MAOIs: phenelzine 15mg tds

A

• Only initiated in specialist setting
• Diet specifid: only fresh food, avoid game, alcohol, foods with tyramine (Cheese, pickled herring, beans pods, merat, year, soya beans)  cause high BP  headache
Cant start other antidepressants until stopped for 2 week

29
Q

Follow up for depression meds

A
  • Every 1-2 weeks until stable assessing response, compliance, SE, suicide risk
  • Continue for 4-6 weeks before saying treatment failed and another 2-4 if partial response
  • Continue for at least 6monoth. 12 months if elderly/ GAD and 2 years if recurrent depression
30
Q

BP

A

• If ≥140/90: measure again, if not on medications do ambulatory BP monitoring or home BPM
• If ≥180 systolic or ≥110 diastolic: start antihypertensives without waiting for ABPM/ HBPM
Refer same day if you suspect accelerated HT (± papilloedema ± retinal haemorrhage) or Pheochromocytoma

My General Practise (8 decks)

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