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OSCE > Station 5 > Flashcards

Station 5 Flashcards

1
Q

HTN Treatment
- AB/CD therapy

A

<55 & Caucasian - ACE-I first line
- then give CCB or Diuretic if not properly controlled

> 55 or ethnic - CCB
- then give ACE-I or ARB if worsens

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2
Q

Secondary HTN Prevention

A
  • atorvastatin 40-80mg (4mmol/L aim), regardless of BP
  • check LFT’s because they affect liver function
  • lifestyle advice - smoking, drinking, exercise diet
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3
Q

Exacerbating Drugs for HTN

A

NSAID’s , Oestrogens , Sympathomimetics , corticosteroids , high sodium drugs

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4
Q

ACS
- Angina

A

1 - BB 1st line bisoprolol (if intolerable then rate limiting CCB)
- add amlodipine if symptoms poorly controlled by BB

  1. sublingual GTN tablets or spray
    - morning and afternoon
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5
Q

ACE Inhibitor

Beta Blockers

Calcium Channel Blocker

A

BB
S/E : fatigue , dizziness , impotence
atenolol - coldness in hands and feet

CCB
S/E - oedema , dizziness , nausea

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6
Q

Secondary Prevention after MI

A
  1. Dual Anti-Platelet
    - Aspirin 75mg
    - Ticagrelor 90mg BD
  2. Beta Blocker (1yr to lifelong)
  3. ACE-I
  4. High dose statin (atorvastatin 40-80mg)
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7
Q

HF Treatment

  • Diuretic
  • ACE-I
  • BB
A

Diuretic
- furosemide to remove fluid surrounding lungs

ACE-I
- enalapril 20mg daily

BB
- bisoprolol

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8
Q

HF Treatment
- Sacubitril/Valsartan

A
  • must have at least 1 hospitalisation in last year + ejection fraction <35%
  • need to stop ACE-I treatment at least 36hrs before starting
  • 49mg/51mg 2x daily
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9
Q

Anti-Arrhythmic Drug Classes

A

Class 1
- sodium channel blockers slows down uptake on ECG slowing depolarisation
1b - lignocaine 1c - flecanide

Class 2
- B Blocker reduces upstroke and prolongs refractory
- atenolol

Class 3
- prolong action potential upstroke & refractory
- amiodarone (can cause hyperthyroidism)

Class 4
- calcium channel blocker
- verapamil
- impairs impulse propagation by blocking cc in AV and SA

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10
Q

Diabetes

A

Type 1
- body doesn’t produce insulin
- insulin injections/infusions

Type 2
- body insulin resistance
- anti-diabetic drugs. start with 1 unless very symptomatic
- do not stop agents until at triple therapy

Symptoms
- vascular damage, increased infections, tiredness, unexplained weight loss (type 1) , blurred vision
- due to high glucose in urine , high chance of thrush/UTI

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11
Q

Diabetes Glucose Testing

A

Fasting Glucose
- no food/drink for 8-10hr
- fasting glucose plasma level should be 3.9-5.5mmol/L
- diabetic range is >7mmol/L

Random Glucose
- any value of 11.1mmol/L or above is diabetic

Oral Glucose Test
- patient fasts for 8hrs
- glucose plasma measured immediately before 75mg glucose dissolved in water. and then 2hrs after drink

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12
Q

HBA1c

A
  • used to diagnose type 2 diabetes

gives level of glucose over last 3-4month
- 48mmol/L or over is type 2 diabetic

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13
Q

Metformin

A
  • inhibits gluconeogenesis
  • 1st line anti-diabetic, no weight gain or hypoglycaemia

S/E - GI upset, B12 deficiency

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14
Q

Sulfonylureas
- used when metformin has s/e

A

stimulates insulin secretion from pancreatic cells

  • includes glipizide and glicizide
  • 2nd line

S/E - weight gain, hypoglycaemia , hypotension

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15
Q

SGLT-2

A
  • 3rd line
  • decreases HBA1c
  • used when patient has diabetes + CVD

S/E - genital infection, polyurea, weight loss, BP loss

Contra - monitor very closely if with furosemide

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16
Q

Thiazolidinediones (glitazones)

  • insulin sensitisers
A

Pioglitazone
- only oral tablet in its class
- exacerbates AF

Useful in renal failure as a substitute for metformin

Other drugs in this class are injection only

S/E - weight gain , low risk hypoglycaemia
Contra - HF , fractures , haematuria

17
Q

Diabetes Treatment

DPP4 Inhibitors (gliptins)

A

DPP4 - increase insulin release and decrease glucagon
- used instead of TZD if weight gain problem or HF

18
Q

Aims Of Asthma Treatment

  • normal lung function >80% predicted PEFR
A
  • if 6 months or more. consider reduce ICS therapy
  • no daytime symptoms
  • no night-time awakening
  • no need for rescue medication
  • no asthma attacks
  • no limitations on activity or exercise
19
Q

Asthma Management - Adults

Stage 4: refer to specialist

Fluticasone - most potent ICS

A

suspected : SABA while monitoring

Stage 1: SABA + low dose ICS (budesonide)

Stage 2: SABA + low dose ICS + LABA (salmeterol)
- use combined ICS/LABA inhaler (fostair)

Stage 3: SABA +increase ICS and/or add Montelukast (phosphodiesterase inhibitor to inhibit leukotrienes)
- continue with LABA unless having no effect

20
Q

Asthma Management Children

  • stage 4 specialist care
A

suspected : SABA

Stage 1: SABA + very low ICS

Stage 2 : SABA + very low ICS
- if >5 add LABA serevent , , if <5 add montelukast

Stage 3 : SABA + increased ICS (inc puffs to 2)
- if >5 add LABA serevent , , if <5 add montelukast

21
Q

FEV1 & FVC

  • FEV1 <0.8 means COPD
  • FEV1/FVC <0.7means COPD
A

FEV1 - forced exhalation of breath in 1 second

FEV1/VC Ratio - FEV1 divided by max amount of breath that CAN be exhaled in one breath

  • stage 1: FEV1 50 - 79%
  • stage 2: FEV1 33 - 50%
  • stage 3: FEV1 <33%
22
Q

COPD Exacerbation Management

A
  1. Bronchodilators nebulised with air (not oxygen)
    - SABA (with SAMA if severe)
    - theophylline not recommended bc S/E
  2. Steroids
    - prednisolone 30-40mg 5-7 days

IF BACTERIAL
- give oxygen to 88-92%
- amox 500mg 3x day / doxy 200mg then 100mg daily

23
Q

Severe Asthma Treatment

  • PEFR 33-50
  • HR >110
  • Pulse >25/min
A

refer to hospital

  1. air nebulised SABA (+ SAMA if needed)
  2. oxygen via venturi 40-60%
  3. oral corticosteroid Prednisolone 40-50mg
  4. if bacterial then amox 500mg 8hrs daily
24
Q

Diabetes Injections

A

Novorapid - rapid acting
Humalog - rapid acting
Humulin S - short acting

Humulin I - medium acting

Levemir & Lantis - long acting 18-26hrs
Tresiba - long acting 40hrs

25
Q

Diabetes Insulin Management

  • Type 1 , children
A

Insulin Therapies

  1. Basal Bolus
    - rapid acting before each meal
    - intermediate/long acting once daily

2.continous SC insulin infusion
- constant short acting insulin
- extra bolus short acting activated by patient at meal times

  1. 1,2,3 injections of short + intermediate acting mixed injections
26
Q

Diabetic Insulin Management

  • Type 2
A

if triple anti-diabetic therapy not working

  1. Basal injection once or twice daily of Long or Intermediate acting Insulin
  2. basal bolus SA before meals can be given if symptoms worsen
27
Q

Inhaler Treatments

  • SABA’s & LABA’s
A

SABA’s
- Salbutamol (100mcg, 200mcg) pMDI
- Easyhaler (100mcg, 200mcg) DPI
- Ventolin (200mcg) DPI - strongest
- bricanyl

LABAs
- serevent (salmeterol)
- Foradil (formeterol)

28
Q

Inhaler Treatments

  • ICS & LABA/ICS Combos
A

ICS
- Clenil (beclomethasone) 100mcg 2 puffs 2x daily
- pulmicort (budesonide)
- QVAR 50mcg / 100mcg 2 puffs 2x daily (PMDI)

Combos
Fostair - pMDI
Symbicort - pMDI or DPI

29
Q

DPI Technique

  • accuhaler
  • turbohaler
  • easyhaler
  • autohaler
A
  1. open inhaler and breathe out away from it
  2. create a seal over mouthpiece and breathe in deeply and steadily
  3. remove inhaler from mouth and hold for 5-10sec then breathe out slowly
30
Q

pMDI Technique

  • clenil
  • ventolin
A
  1. prime inhaler by spraying away from you in the air
  2. shake the inhaler, breathe out away from the inhaler and remove the lid
  3. create a seal and start breathing in before pressing the button and inhale slowly
  4. hold for 5-10sec and then breathe out slowly
31
Q

COPD MANAGEMENT

A

MRC 0-1
- give SABA inhaler for symptomatic

MRC 2-3
- LAMA/LABA Combo Anora Elipta

Exacerbation
- SABA nebulised with air
- Prednisolone 30mg for 5days
- Amox 500mg 3x daily for 5 days if infectious

OSCE (2 decks)

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