PSA- common conditions Flashcards
management of chronic asthma
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
side effects of salbutamol/ SABA
hypokalaemia
arrhythmia, tremor, palpitations, headache
drugs not to prescribe in asthma
NSAIDs- bronchospasm
betablockers-
adenosine (also CI in COPD)
management of acute asthma
1) Oxygen
2) SABA
3) Steroid- oral pred/ IV hydrocortisone
4) Nubuslied ipratropium bromide
5) magnesium sulphate
6) IV aminophyline
loading dose of aminophyline in acute asthma?
5mg/kg SLOW IV injection over at least 20 mins
available in 25mg/ml ampules
target plasma concentration of aminophyline
when to measure aminiphylline concs?
10-20 micrograms/mL
measure 18 hours after starting treatment or sooner if concerns about toxicity
Management of chronic COPD
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
management of exacerbation of COPD
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
Target saturations for COPD
88-92%
Venturi 28% mask, 4L, until blood gases can be measured to determine of retaining CO2
Management of angina
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
acute management of unstable angina/ NSTEMI
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)
Secondary prevention of ACS
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
acute management of STEMI
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
Management of Gastro-oesophageal reflux disease (GORD)
- lifestyle changes
- PPI (lansoprazole)
- if no response after 4-8 weeks–> H2 receptor antagonist (ranitidine)
1st line medical treatment of depression
SSRI eg citalopram, fluoxetine, sertraline
1st line medicial management of anxiety
SSRI- sertraline
Management of urge incontinence
-antimuscarinic- oxybutynin/ tolterodine
-bladder retraining
(mirabegron if concern about antimuscarinic effects in frail older women)
management of stress incontinence
- pelvic floor training
- surgical procedures
- duloxetine only if other measures have failed
Management of hypertension
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
Management of UTI
trimethoprim/ nitrofurantoin
pregnant women- nitrofurantoin/ amoxicillin
pyelonephritis- ciprofloxacin/ cefalexin
Management of pulmonary oedema
Stop IV fluids
Sit up, oxygen if desaturating
Diuretic- IV furosemide 40mg STAT
Monitor fluid balance, U+Es, bloods, daily weight
management of Crohn’s disease
inducing remission:
1st line- steroids (oral pred/ IV hydrocortisone)
2nd line- azothiaprine, methotrexate, infliximab
maintaining remission:
1st line: azothiaprine
management of ulcerative coliitis
flare
- aminosalicylate
- IV steroids if severe
maintenance
- aminosalicylate
- azothiaprine
Management of Parkinson’s disease
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
Medical management of alzheimers disease
acetylcholinesterase (AChE) inhibitors:
donepezil
rivastigmine
galantamine
management of anaphylaxis
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
DKA management
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
drug management of shingles
aciclovir
Empirical antibiotics for community acquired pneumonia
CURB 0-1: amoxicillin 500mg TDS/ doxycycline 200mg PO
CURB 2: amoxicillin + clarithromycin PO/ IV
CURB >3: co-amoxiclav + clarithromycin IV
management of pulmonary embolism
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
acne management
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
management of croup
one dose oral dexamethasone (0.15mg/kg)
emergency treatment: oxygen and adrenaline
management of ear infections
otitis externa- flucoxacillin
otitis media- amoxicillin
epiglottitis management
secure airway
IV antibiotics- cefotaxime/ ceftriaxone
dexamethasone
