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Planning Management Flashcards

1
Q

What do you give to a patient who has had a STEMI or NSTEMI?

A 
O2 (if req)
Aspirin 300mg PO
Clopidogrel 300mg (can give Prasugrel 60mg or Ticagrelor 180mg)
Morphine 5-10mg IV
\+ metoclopramide 10mg IV
GTN spray/tablet (not if hypotensive)
Primary PCI (preferred) or thrombolysis
5mg Atenolol
Transfer to CCU
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2
Q

What drugs are given for the long term management of a STEMI?

A
  • Statin
  • Beta-blocker
  • ACE Inhibitor
  • Combination of Aspirin, Clopidogrel, Ticagrelor, Prasugrel, Warfarin
  • GTN
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3
Q

How is acute left ventricular failure managed?

A

A-E
Sit patient up
Morphine 5-10mg IV + Metoclopramide 10mg IV
GTN spray/tablet
Furosemide 40-80mg IV
Isosorbide dinitrate infusion if inadequate response
Transfer to CCU

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4
Q

What drugs should be given in anaphylaxis?

A

Adrenaline 500 micrograms (1:1000) IM
Chlorphenamine 10mg IV
Hydrocortisone 200mg IV

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5
Q

How would you manage a patient with tachycardia who has adverse features?

A

Synchronised DC shock (upto 3 attempts)

Amiodarone 300mg IV over 10-20 mins and repeat shock then amiodarone 900mg IV over 24 hr

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6
Q

What features of tachycardia would you classify as adverse

A

Shock
Syncope
Myocardial ischaemia
Heart failure

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7
Q

How would an irregular broad complex tachycardia be managed?

A

SEEK HELP

  • If AF with bundle branch block - treat as narrow complex (vagal manoevres, adenosine 6mg IV)
  • Pre-excited AF - consider amiodarone
  • Polymorphic VT - magnesium 2g over 10mins
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8
Q

How would you manage a regular broad complex tachycardia?

A

VT - amiodarone 300mg IV over 20-60 mins then 900mg over 24 hr

SVT plus bundle branch block - adenosine

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9
Q

How would you manage a regular narrow complex tachycardia?

A

Vagal manoevres

Adenosine 6mg IV rapid bolus

  • if unsuccessful give 12mg IV bolus
  • if unsuccessful again give further 12mg IV bolus

Monitor ECG continuously

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10
Q

If the regular narrow complex tachycardia doesn’t return to sinus rhythm following vagal manoeuvres and adenosine, what is the likely cause and how is it managed?

A

Atrial flutter

Control rate - beta blocker

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11
Q

How is an irregular narrow complex tachycardia managed?

A

Beta blocker or diltiazem

If evidence of heart failure, consider digoxin or amiodarone

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12
Q

How is acute asthma managed?

A
  • 100% O2 via non rebreather mask
  • Salbutamol 5mg nebuliser
  • Hydrocortisone 100mg IV (severe/life-threatening) or Prednisolone 40-50mg PO
  • Ipratropium bromide (500 micrograms nebuliser)
  • Theophylline if life threatening
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13
Q

How is an acute exacerbation of COPD managed?

A

Similar to asthma but:

  • Abx if infective
  • Use high-flow O2 with care - use then review after ABG
  • 28% O2 sage starter
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14
Q

How are pneumothoraces managed?

A

Secondary: Chest drain if >2cm or SOB or >50yo

Tension - Emergency aspiration then chest drain

Primary:
<2cm rim and no SOB - discharge and follow up in 4 wks
>2cm rim or SOB - aspirate –> aspirate –>drain

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15
Q

What is the mnemonic used to decide whether pneumonia requires inpatient treatment?

A 
CURB-65
Confusion
Urea >7mmol/L
Resp rate >30
BP <90 systolic
Age>65yo
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16
Q

How is pneumonia managed?

A

High flow o2
IV Abx - amoxicillin or co-amoxiclav
Paracetamol
IV fluids - low BP or raised HR

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17
Q

How is a pulmonary embolus managed?

A

High flow o2
Morphine 5-10mg IV and metoclopramide 10mg IV
LMWH - tinzaparin 175 units/kg SC
If low BP - IV gelofusine –> noradrenaline –> thrombolysis

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18
Q

What would you give in a GI bleed?

A
  • High flow o2
  • Catheter
  • Crystalloid (0.9% NaCl) if BP normal/high, Colloid (gelofusine) if BP low
  • X Match 6 units of blood
  • Correct clotting abnormalities
  • Endoscopy
  • Stop drugs - NSAID’s, aspirin, warfarin, heparin
  • Surgeons
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19
Q

How would you correct clotting abnormalities in a GI bleed

A
  • if PT/aPTT >1.5x normal give FFP (or prothrombin complex if due to warfarin)
  • platelets <50 and actively bleeding - give platelet transfusion
20
Q

How is bacterial meningitis managed?

A
  • High flow O2
  • IV fluids
  • Dexamethasone IV
  • LP (+/-CT head)
  • 2g cefotaxime IV (give pre LP if having CT head or prolonged LP)
  • Consider ITU

Can also give 1.2g benzylpenicillin

21
Q

How are seizures managed?

A

if seizure >5 mins:
- IV lorazepam 2-4mg or Buccal midazolam 10mg or Diazepam 10mg IV

  • Repeat after 10 mins
  • Inform anaesthetist
  • Give phenytoin infusion if no response in 25 mins
  • Intubate and RSI with propofol, midazolam or thiopental sodium
22
Q

How is an ischaemic stroke managed?

A

<80 and <4.5hr - consider thrombolysis with alteplase

Aspirin 300mg PO

Transfer to stroke unit

23
Q

What long term treatment is recommended for ischaemic stroke?

A

Clopidogrel
can consider dipyridamole + aspirin

Atorvastatin 40-80mg 48hrs after event
Target BP <130/90 - not beta blockers unless indicated by other condition
Lifestyle factor modification

24
Q

When should hypertension be treated?

A

Ambulatory/home BP of :

  • > 155/95 or
  • > 135/85 + existing/high risk vascular disease or hypertensive organ damage (intracerebral bleed, CKD, left ventricular hypertrophy or retinopathy)
25
Q

What is the target blood pressure on treatment?

A

<80yo - <140/85 at clinic or <135/85 at home

> 80yo - add 10mmHg to systolic values

26
Q

What is the management algorithm for hypertension?

A

Stage 1:
<55 - A
>55 or afro-caribbean - C

Stage 2 = A+C
Stage 3 = A+C+D
Resistant = A+C+D+ B blocker/alpha blocker or spironolactone (depend on K+)

A - ACEi/ARB
C - Ca2+ blocker - amlodipine
D - Thiazide like diuretic

27
Q

How is chronic heart failure managed?

A

1: ACE inhibitor + Beta blocker
2: Aldosterone antagonist (depend on K+ level)
3: Initiated by specialist - ivabradine/candesartan/hydralazine etc.

28
Q

What are the parts of the CHA2DS2-VASc score?

A 
Congestive Heart Failure
Hypertension
Age >75 = 2
Diabetes
Stroke/TIA = 2
Vascular disease
Age >65 = 1
Sex - female = 1
29
Q

How is CHA2DSVASc used to determine management for atrial fibrillation?

A

0 - no treatment req. (must do transthoracic echo to rule out valvular disease)
1 - males consider anticoagulation, females no treatment
2+ - anticoagulate

It is recommended that DOAC’s are used for anti-coagulation now

30
Q

Which patients with atrial fibrillation req. rhythm control and how is it established?

A
  • young
  • symptomatic AF
  • first episode
  • AF due to precipitant

Cardioversion either electrical or chemical (amiodarone 5mg/kg IV over 20-120 mins)

Patient req. anti-coagulation if more than 48hr since onset

31
Q

Which patients with atrial fibrillation req. rate control and how is this established?

A

Everyone with HR >90

1 Beta-Blocker (propranolol 10mg 6 hourly
2 Rate limiting Ca2+ blocker - diltiazem 120mg OD

Digoxin can be added or used 1st line if Beta blocker and CI contraindicated - load then start at 62.5-125mg daily

32
Q

What medication is prescribed for stable angina?

A 
GTN spray PRN
Secondary prevention:
- aspirin
- statin
- CVS modification
- beta blocker or ca2+ blocker
33
Q

What are the common side effects of Lamotrigine?

A

Rash

Stevens Johnson Syndrome - rare

34
Q

What are the common side effects of carbamazepine?

A 
Rash
Dysarthria
Ataxia
Nystagmus
Hyponatraemia
agranulocytosis
35
Q

What are the common side effects of phenytoin?

A

Ataxia
Peripheral Neuropathy
Gum hyperplasia
Hepatotoxicity

36
Q

What are the common side effects of sodium valproate?

A

Tremor
Teratogenicity
Tubby - weight gain

37
Q

What is important to be aware of with azathioprine prescription?

A

Pro-drug which becomes 6-mercaptopurine. This is metabolised by TPMT.

10% of population have reduced TPMT activity so can have high 6-MT with normal azathioprine dose.

Increased risk of liver and bone marrow toxicity

Must check TPMT levels before starting. If low, consider methotrexate instead

38
Q

How is pyrexia treated?

A

Paracetamol - max 4g/day

39
Q

Give an example of a stool softener

A

Sodium decussate

Arachis oil

40
Q

Give an example of a bulking agent for constipation

A

Isphagula husk

CI - faecal impaction and colonic atony

41
Q

Give an example of a stimulant laxative

A

Senna

Bisacodyl - CI in acute abdomen

42
Q

Give an example of an osmotic laxative

A

Lactulose

Phosphate enema - CI in acute abdomen

43
Q

What is the commonest cause for Diarrhoea?

A

GI infection - norovirus or C Diff

44
Q

How should chronic diarrhoea be managed?

A

Loperamide 2mg PO 3 hourly

Codeine 30mg PO QDS

Only used if confirmed non-infectious cause with stool cultures and microscopy

45
Q

How is insomnia managed?

A

Ensure drugs that prevent sleep are given in the morning - corticosteroids

Try to avoid hypnotics where possible - can cause dizziness and drowsiness leading to falls

Zopiclone 7.5mg PO or 3.75mg PO in elderly

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