Planning management Flashcards
Doses in STEMI/ NSTEMI / acute LVF:
a) aspirin
b) clopidogrel
c) morphine
d) beta blocker
e) furosemide
f) metoclopramide
a) 300mg chewed/dispersed
b) 300mg oral
c) 5-10mg IV
d) atenolol 5mg (unless asthma/LVF)
e) 40-80mg IV
f) 10mg IV
What drug is used if there is an inadequate response to furosemide in LVF?
Isosorbide dinitrate
What is the a) first line treatment b) second line treatment, if there are adverse features in adult tachycardia (i.e. shock, syncope, MI, heart failure)
a) Synchronized DC shock (up to 3 attempts)
b) amiodarone 300mg IV over 10-20 minutes, followed by amiodarone infusion
Tachycardia with narrow QRS and irregular rhythm?
Probably fast AF
Tachycardia with narrow QRS and regular rhythm?
Probable re-entry paroxysmal SVT
Drug management of a) atrial fibrillation b) re-entry paroxysmal SVT
a) beta-blocker or diltiazem; digoxin/amiodarone if evidence of heart failure
b) vagal manouvres; adenosine 6mg IV (then 12mg, then 12mg)
Drug doses in anaphylaxis:
a) adrenaline
b) chlorphenamine
c) hydrocortisone
a) 500 micrograms of 1:1000 IM
b) 10mg IV
c) 200mg IV
CURB-65 score?
Confusion Urea > 7.5 Respiratory rate > 30 Blood pressure < 90 Over 65 years of age
CURB score for a) mild b) moderate c) severe CAP?
a) 0-1 b) 2 c) 3 or greater
Antibiotic choices for a) mild/moderate b) severe CAP?
a) oral/IV amoxicillin/doxycycline if pen-allergic, 5 days therapy
b) co-amoxiclav IV + doxycycline PO, 7 days therapy
GI haemorrhage treatment:
a) if prolonged PT/aPTT more than 1.5x normal range
b) if prolonged PT/aPTT due to warfarin
c) if thrombocytopenia (<50x10^9) and actively bleeding
a) fresh frozen plasma
b) prothrombin complex (i.e. beriplex)
c) platelet transfusion
Management of suspected bacterial meningitis (3)
Ceftriaxone 2g IV + Dexamethasone 10mg + Amoxicillin 2g IV if old or immunocompromised
Complications of AKI? (3)
Fluid overload, hyperkalaemia, acidosis
Management of DKA/HONK? (3)
IV fluids, sliding scale insulin, monitor BM potassium and pH
When do NICE recommend starting treatment for hypertension?
If BP >180/95, or 135/85 if existing vascular disease or hypertensive organ damage
NICE treatment algorithm for hypertension? Step 1 Step 2 Step 3 Step 4
Step 1- if under 55 years, ACE inhibitor or ARB. If over 55, or black patients of any age, Calcium channel blocker
Step 2- A + C
Step 3- A + C + D (thiazide Diuretic)
Step 4- A + C + D plus either alpha blocker, beta blocker, further diuretic
CHADSVASC score interpretation? (3)
0- aspirin 75mg daily
1- aspirin or wafarin
2 or more- warfarin
Rate control in Atrial fibrillation? (3)
Beta blocker or rate limiting calcium blocker. Digoxin if required or beta-blockers/calcium blockers contraindicated
First line stable angina management? (3)
GTN spray as required
Secondary prevention - aspirin, statin, hypertension treatment
Beta-blocker/calcium blocker
What is used in stable angina if beta blocker/calcium blocker (either as mono- or dual therapy) fails to control symptoms?
Monotherapy with either nicorandil or long acting nitrate (e.g. isosorbide mononitrate)
Asthma management guidelines? Step 1 Step 2 Step 3 Step 4 Step 5
1- SABA as required
2- SABA + inhaled steroid
3- initial add-on therapy. Add LABA. If no response/inadequate response to LABA, increase steroid. If no response to LABA consider other therapies e.g. leukotriene antagonist
4- Consider increasing inhaled steroid, addition of a fourth drug e.g. B2 agonist tablet
5- add daily steroid tablet
First-line treatment for Parkinsons?
a) normal circumstances
b) mild Parkinsons where patient is concerned about the finite period of benefit from levodopa
a) Co-beneldopa or co-careldopa (i.e. levodopa combined with peripheral decarboxylase inhibitor)
b) dopamine agonist e.g. ropinirole
Treatment options for constipation: examples of
a) stool softener
b) bulking agent
c) stimulant (2)
d) osmotic (2)
a) docusate sodium
b) isphaghula husk
c) senna, bisacodyl
d) lactulose, phosphate enema
In the case of faecal impaction, what laxative would be useful and what would be contraindicated?
Docusate is useful as it is a stool softener; ispaghula is contraindicated as it is a bulking agent
