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PSA > PSA- common conditions > Flashcards

PSA- common conditions Flashcards

1
Q

management of chronic asthma

A

1) SABA eg salbutamol
2) Inhaled corticosteroid
3) LTRA-montelukast
4) LABA-eg salmeterol (stop LTRA if not helping)
5) MART- maintenance and release therapy- ICS plus fast acting LABA
6) theophyline/ tiotropium

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2
Q

side effects of salbutamol/ SABA

A

hypokalaemia

arrhythmia, tremor, palpitations, headache

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3
Q

drugs not to prescribe in asthma

A

NSAIDs- bronchospasm

betablockers-

adenosine (also CI in COPD)

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4
Q

management of acute asthma

A

1) Oxygen
2) SABA
3) Steroid- oral pred/ IV hydrocortisone
4) Nubuslied ipratropium bromide
5) magnesium sulphate
6) IV aminophyline

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5
Q

loading dose of aminophyline in acute asthma?

A

5mg/kg SLOW IV injection over at least 20 mins

available in 25mg/ml ampules

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6
Q

target plasma concentration of aminophyline

when to measure aminiphylline concs?

A

10-20 micrograms/mL

measure 18 hours after starting treatment or sooner if concerns about toxicity

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7
Q

Management of chronic COPD

A

Stop smoking, flu vaccine and pneumococcal vaccine, pulmonary rehabilitation

1) SAMA (ipratropium bromide) / SABA (salbutamol)
2) determine whether asthmatic features and steroid responsive

NO ASTHMATIC FEATURES/ NOT STEROID RESPONSIVE

3) LABA +LAMA (tiotropium), (stop SAMA)
4) ICS

STERIOD RESPOSIVE/ ASTHMATIC

3) LABA+ ICS- fostair, symbicort, seretide
4) LABA+ LAMA+ ICS (stop SAMA)

prolonged or frequent infective exacerbations:
prophylactic azithromycin

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8
Q

management of exacerbation of COPD

A

AT HOME

1) Prednisolone 30mg once daily for 7-14 days
2) Regular inhalers or home nebulisers
3) Antibiotics if there is evidence of infection

IN HOSPITAL

1) Nebulised SABA/ SAMA
2) IV/PO steroids
3) antibiotics- amoxicillin/ doxycyline
4) physio
5) IV aminophylline
6) NIV
7) intubation and ventilation

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9
Q

Target saturations for COPD

A

88-92%

Venturi 28% mask, 4L, until blood gases can be measured to determine of retaining CO2

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10
Q

Management of angina

A

ACUTE

  • GTN (glyceryl trinitrate)
  • repeat after 5 mins, call ambulance if pain still present after another 5 mins

LONG TERM
1)betablocker- atenolol/ bisoprolol
(CCB eg verapimil if CI)
2) BB + CCB (long acting nitrate eg ivabridine if either CI)

SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE

  • lifestyle
  • low dose aspirin and statin if atherosclerotic disease
  • ACE-I if diabetes
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11
Q

acute management of unstable angina/ NSTEMI

A

MONA ABC

  • morphine 5-10mg IV
  • oxygen if desaturating <96%
  • GTN
  • Asprin 300mg

ABC

  • Anticoagulant- LMWH eg enoxaparin 1mg/kg BD
  • Betablocker- continued indefinitely (verapimil/diltaziem if CI)
  • Clopidogrel

GRACE Score-
PCI if high risk (NEVER THROMBOLYSIS)

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12
Q

Secondary prevention of ACS

A

6As

Aspirin 75mg OD
Another antiplatelet- clopidogrel/ticagrelor for 12 months
Atorvostatin 80mg OD
ACE-I- ramipril
Atenolol
Aldosterone antagonist if clinical heart failure

plus lifestyle changes

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13
Q

acute management of STEMI

A

MONA

PCI if available <90 mins after diagnosis + LMWH
or
Thrombolysis if not available- streptokinase+ LMHW

A(2)BC
-Anticoagulant (LMWH) +ACE-I (continued for 5-6 weeks)
-Betablocker
-Clopidogrel
D- diabetes- monitor for hyperglycaemia
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14
Q

Management of Gastro-oesophageal reflux disease (GORD)

A
  • lifestyle changes
  • PPI (lansoprazole)
  • if no response after 4-8 weeks–> H2 receptor antagonist (ranitidine)
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15
Q

1st line medical treatment of depression

A

SSRI eg citalopram, fluoxetine, sertraline

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16
Q

1st line medicial management of anxiety

A

SSRI- sertraline

17
Q

Management of urge incontinence

A

-antimuscarinic- oxybutynin/ tolterodine
-bladder retraining
(mirabegron if concern about antimuscarinic effects in frail older women)

18
Q

management of stress incontinence

A
  • pelvic floor training
  • surgical procedures
  • duloxetine only if other measures have failed
19
Q

Management of hypertension

A

WHITE <55 or T2DM ANY AGE or RACE
1)ACE-I
2)ACE-I + CCB
3ACE-I +CCB+ thiazide diuretic

BLACK/ WHITE >55

1) CCB
2) CCB+ thiazide diuretic
3) CCB +thiazide diuretic + ACE-I

20
Q

Management of UTI

A

trimethoprim/ nitrofurantoin

pregnant women- nitrofurantoin/ amoxicillin

pyelonephritis- ciprofloxacin/ cefalexin

21
Q

Management of pulmonary oedema

A

Stop IV fluids
Sit up, oxygen if desaturating
Diuretic- IV furosemide 40mg STAT
Monitor fluid balance, U+Es, bloods, daily weight

22
Q

management of Crohn’s disease

A

inducing remission:
1st line- steroids (oral pred/ IV hydrocortisone)
2nd line- azothiaprine, methotrexate, infliximab

maintaining remission:
1st line: azothiaprine

23
Q

management of ulcerative coliitis

A

flare

  • aminosalicylate
  • IV steroids if severe

maintenance

  • aminosalicylate
  • azothiaprine
24
Q

Management of Parkinson’s disease

A

if motor symptoms affecting QoL
-levodopa

if not affecting QoL, choice of:

  • ropinirole: non-ergot-derived dopamine-receptor agonist
  • rasagiline: monoamine-oxidase-B inhibitors
  • levodopa
25
Q

Medical management of alzheimers disease

A

acetylcholinesterase (AChE) inhibitors:
donepezil
rivastigmine
galantamine

26
Q

management of anaphylaxis

A

500 micrograms adrenaline IM 0.5mls- 1 in 1000
-repeat after 5 mins if no better

oxygen
IV fluid challenge 500-1000mls

chlorphenamine (antihistamine) 10mg IM/IV slowly
Hydrocortisone 200mg im/IV slowly

27
Q

DKA management

A

1) fluid resus- 500ml 0.9% NaCL over 10-15 mins
2) Repeat, add potassium if hypokalaemic
3) Fixed rate insulin infusion- 0.1units/kg/hr, diluted with NaCL- 1 unit/ml
4) Monitor blood ketones, glucose, potassium
5) once blood glucose <14mmol/L- add in glucose 10%
6) continue with insulin infusion until blood ketone <0.3, pH >7.3 and patient can eat and drink–> give SC fast acting insulin and meal

28
Q

drug management of shingles

A

aciclovir

29
Q

Empirical antibiotics for community acquired pneumonia

A

CURB 0-1: amoxicillin 500mg TDS/ doxycycline 200mg PO

CURB 2: amoxicillin + clarithromycin PO/ IV

CURB >3: co-amoxiclav + clarithromycin IV

30
Q

management of pulmonary embolism

A

prophylaxis in hospital: LMWH eg enoxaparin

management:
1)Wells score- >4(likely)–> CTPA for diagnosis
(V/Q scan if renal impairment/ contrast allergy)
<4 (unlikely)–> D-Dimer
2) Treatment dose LMWH
3)oxygen
4)Switch to long term anti-coagulation (warfarin/ NOAC/ LMWH)
5)thrombolysis if massive PE

31
Q

acne management

A

1) topical benzyl peroxide
2) topical retinoid- adapalene
3) Topical antibiotic- clindamycin
4) atelaic acid
5) Oral antibiotic- tetracycline eg doxycycline
6) Oral contraceptive pill
7) oral retinoid- isotrenin

32
Q

management of croup

A

one dose oral dexamethasone (0.15mg/kg)

emergency treatment: oxygen and adrenaline

33
Q

management of ear infections

A

otitis externa- flucoxacillin

otitis media- amoxicillin

34
Q

epiglottitis management

A

secure airway
IV antibiotics- cefotaxime/ ceftriaxone
dexamethasone

PSA (1 decks)

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