Planning management Flashcards
How would you calculate PRN/”as needed” dose of opioids?
1/6 of total daily dose of opioids
give PRN option of every 4-6 hours
Acute management of STEMI
- ABC, O2 on non-rebreath if low sats (caution COPD)
- Ix to confirm Dx (ECG)
- aspirin 300mg PO + ticagrelor 180mg
- morphine 5-10mg IV + cyclizine 50mg IV
- GTN spray/tablet
- Primary PCI or thrombolysis
- beta-blocker, bisoprolol 2.5mg PO (CI LV failure or asthma)
- transfer to CCU
describe MONA BASH
management of ACS
MONA BASH (morphine, oxygen, nitrates, aspirin, beta-blocker, ACEi, statin, heparin)
- statin high dose - all ACS pt e.g. atorvastatin 80mg PO
- ACEi - if indicated by BP
- heparin - for all non-ST MI
acute management of NSTEMI
- A-E, oxgen
- Ix + Dx
- aspirin 300mg
- morphine 5-10mg IV + cyclizine 50mg IV
- GTN spray/tablet
- clopidogrel 300mg oral or LMW heparin (tinzapari)/fondaparinex 2.5mg OD SC
- beta-blocker (bisoprolol 2.5mg, CI LV failure, asthma)
- transfer to CCU
management of acute left ventricular failure
- A-E, oxgen
- Ix + Dx
- sit patient up
- morphine 5-10mg IV + cyclizine 50mg IV
- GTN spray/tablet
- fruosemide 40-80mg IV (repeat as required/tolerated)
- inadequate response isosorbide dinitrate infusion + CPAP
- transfer to CCU
management of tachycardia w/ haemodynamic compromise?
- signs - shock, syncope, MI, HF
- DC cardioversion
- amiodarone given alongside, if successful need 900mg amiodarone/24 hours
management of broad QRS tachycardia in haemodynamically stable patient
- irregular
- AF with BBB - treat as narrow
- pre-excited AF - amiodarone
- polymorphic VT (torsades) - magensium sulphate 2g over 10 minutes
- regular
- VT - amiodarone 300mg IV over 20-60mins, 900mg/24hr after
- previously confirmed SVT + BBB - adenosine
management of narrow QRS tachycardia in stable patient
- irregular
- likely AF - rate control beta-blocker, diltiazem
- if evidence of HF consider digoxin or amiodarone
- likely AF - rate control beta-blocker, diltiazem
- regular
- vagal manoeuvres
- adenosine 6mg IV, repeat 12mg if no success (up to 2)
- failure - consider atrial flutter (beta-blocker to rate control)
acute management of anaphylaxis
- A-E, oxygen
- History, examination, Ix
- Remove cause (e.g. drug or transfusion)
- Adrenaline 500 micrograms (mcg) of 1:1000 IM
- Chlorphenamine 10mg IV
- Hydrocortisone 200mg IV
- Salbutamol nebuliser if wheeze
- Amend drug chart allergies as required
acute management of pneumonia
- A-E
- high flow oxygen
- antibiotics
- paracetamol if fever/pain
- if low BP or tachy - IV fluids
acute management of PE
- A-E
- High flow O2
- Morphine 5-10mg IV + Cyclizine 50mg IV
- LMWH e.g. tinzaparin 175 units/kg SC daily
- If low BP → fluids, contact ICU, consider thrombolysis
acute managemnet of GI bleed
8 C’s
- A-E + oxygen
- Cannula x 2
- Catheter + strict fluid monitoring
- Crystalloid bolus
- Cross-match 6 units
- Correct clotting abnormalities
- If PT/APTT > 1.5 normal range give FFP
- If warfarin give prothrombin complex
- If platelets < 50 and active bleeding - transfuse platelets
- Camera - Endoscopy
- Culprits → Stop trigger drugs - NSAIDs, aspirin, warfarin, heparin
- Call surgeons is severe
management of hypoglyacemia
BM < 3 mmol/L
- can eat - sugar rich snack (juice, biscuit)
- unable to eat (drowsy/vomiting) - 100mL 20% glucose or 50mL 50% glucose IV
- unable to eat and no cannula - IM glucagon 1mg
- less effective in malnourished + alcoholics (no glycogen stores)
summary of HTN management in GP
describe the steps in managing HTN
- step 1 - monotherapy
- ACEi/ARB - HTN + T2DM; < 55 not AC
- CCB - > 55 or AC without T2DM
- step 2 - dual therapy
- ACEi/ARB + CCB or thiazide like diuretic
- CCB + ACEi/ARB or thiazide like diuretic
- step 3 - triple therapy
- ACEi/ARB + CCB + thiazide diuretic
- step 4
- low dose spironolactone if serum K + < 4/5
- alpha or beta blocker if serum K+ > 4.5
what are the BP targets?
- < 80 years - clinic < 140/90
- > 80 years - clinic < 150/90
what are the methods of cardioversion?
- electrical (DC)
- pharmacological
- flecanide - no structural heart defect
- amiodarone - structural heart defect
summarise management of AF
- stroke prevention (CHADS VASC and HAS BLED determine anticoagulation requirement)
- Control heart rate or rhythm
- Rhythm control
- < 48 hours onset of AF if young/symptomatic AF/1st episode/AF due to treated precipitant
- Cardioversion
- Electrical (DC)
- Pharmacological - flecanide (no structural heart disease); amiodarone (structural heart disease)
- Rate control
- > 48 hours
- Bisoprolol or CCB e.g. diltiazem
- Depends on CI
- Dual therapy - any of beta-blocker, digoxin or diltiazem
- Rhythm control
what are contraindications for atenolol
hypotension, bradycardia, asthma, acute heart failure
contarindications for CCB
hypotension, bradycardia, peripheral oedema
summarise the management of Crohn’s
- Inducing remission
- Prednisolone 20-40mg PO oral
- Severe - hydrocortisone 100-500mg TDS/QDS or as required IV
- IV fluids, NBM, antibiotics
- If rectal disease give rectal hydrocortisone as well
- Maintaining remission Azathioprine
- Must check TPMT levels prior to initiating drug, if low start on lower dose
- Methotrexate - if absent TPMT
what is last line of RA treatment? indication for it?
TNF alpha inhibitors e.g. infliximab
failure to respond to 2 DMARDS
for stool softeners give:
- example:
- CI:
- information:
for stool softeners give:
- example: docusate sodium (stimulant at high doses), arachis oil (rectally)
- CI: arachis oil if nut allergy
- information: good for impaction, reduced gut motility
for bulking agents give:
- example:
- CI:
- information:
for bulking agents give:
- example: isphagula hulk
- CI: faecal impaction
- information: can take days to develop effect
for stimulant laxatives give:
- example:
- CI:
- information:
for stimulant laxatives give:
- example: senna, bisacodyl
- CI: bisacodyl - acute abdomen
- information: can exacerbate abdominal cramps
for osmotic laxatives give:
- example:
- CI:
- information:
for osmotic laxatives give:
- example: lactulose, phosphate enema
- CI: phosphate enema - acute abdomen, IBD
- information: can exacerbate bloating
management of chronic diarrhoea
Loperamide 2mg PO 3 hourly
codeine 30mg oral up to 6 hourly
management of insomnia (PSA exam purpose)
- 7.5mg zopliclone OD night for adults
- 3.75mg zopiclone OD night for elderly
