Safe prescribing 2 Flashcards
COPD severity scale in re to % of FEV1
Patient with: T2DM, COPD and HTN
What’s the target BP?
140/80
- With diabetes alone and no microvascular or macrovascular complications target BP is 140/80
- With CKD, Proteinuria, retinopathy etc this would reduce to 130/80
Pt with T2DM, COPD and HTN
Has had a productive cough & increased breathlessness for 5 days. On examination, he has coarse crackles to the base of his left lung on auscultation, a moderate polyphonic wheeze elsewhere & the following observations
Obs as follows on the picture
What do you do as a GP?
Call an ambulance 999 as he needs urgent hospital admission due to suspected sepsis
*even if CURB 65 is only 1, but if sepsis is suspected -> hospital admission is required
Patient with COPD, HTN and T2DM (on dual therapy)
What’s HbA1C target?
53 mmol/mol
- if pt on dual therapy for their sugar - target is 53
- step up in treatment if 58 mmol/mol
CURB 65 sore of 1
What antibiotics are adviced by PanMersey?
Amoxicillin AND Clarithromycin, or doxycycline
Classification of CKD
(according to eGFR and albumin: creatinine ratio)
CURB 65 score of 0; what antibiotics are adviced by PanMersey?
either amoxicillin or clarithromycin or doxycycline
What medication increases the risk of non-fatal pneumonia in COPD?
Seretide
What’s target BP in pt:
Diabetes with signs of micro or macrovascular disease aim for the lower blood pressure target
130/80
You review a patient who has had diarrhoea and vomiting. Looking at his records you see they have Diabetes Mellitus Type II and Heart Failure.
Thinking about the risk of Acute Kidney Injury, which medication would be the most appropriate to continue?
Metformine
Amlodipine
Ramipril
Furosemide
Naproxen
Amlodipine is CCB and is the only one out of this list that does not cause/ increase AKI
A 74 year old lady attends Accident and Emergency feeling breathless, complaining of a productive cough for the last 2 weeks. She is otherwise well in herself.
Her observations include a respiratory rate of 24/min, Oxygen saturations in room air of 94%, a pulse rate of 88/min and a blood pressure 100/74 mmHg.
What other marker do you need to complete her CURB-65 score?
Blood urea
What blood test would be most helpful in deciding if a patient presenting with chest infection symptoms requires antibiotic?
CRP
- no antibiotic if it’s <20
- consider delayed prescription if it’s 20-100
- immediate antibiotic if it’s over 100
A lady presents with chest infection symptoms. Excluding respiratory disease and immunosuppression, what two co-morbidities, if present, would increase your likelihood of prescribing an antibiotic?
- Diabetes Mellitus
- Congestive Heart Failure
What are the benefits of delayed antibiotic prescription?
- Reduced antibiotic resistance - around 40% of patients don’t use the delayed prescription
- Reduced consultation rates in General Practice
- A cost saving for the NHS
- Reduced complications from antibiotic usage, e.g. Clostrium difficile infection
What (acute cardiac) condition binge drinking increase risk of?
AF
Can we give bisoprolol and verapamil together?
No. Do not combine VERAPAMIL with beta blockers
As verapamil is rate-limiting CCB -> together with other drugs it beings HR down extremely
*other CCB (non-rate limiting) e.g. Amlodipine can be combined with b- blockers
What can Metronidazole do to Warfarin?
Metronidazole is an inhibitor of P450 -> will inhibit the metabolism of other drugs (e.g. Warfarin) -> potentially levels of warfarin will raise/ become toxic