Third year revision Flashcards
What is the blood pressure target in pregnancy?
150/90
or 140/90 if they have diabetes, CKD etc.
What is the BP target in elderly?
150/90
What is the BP target in diabetes?
130/80
What is stage 2 hypertension defined as?
160/100
What antihypertensives are suitable in pregnancy?
Labetolol, methyl dopa and nifedipine
What is the target cholesterol level?
Total cholesterol <5mmol/L
Are statins appropriate for use in pregnancy?
NO
Outline the secondary prevention of angina
75mg Aspirin
80mg Atorvastain
ACEI
Short-acting nitrate (GTN spray) and BB/CCB
What is the difference between acute and chronic pain?
Chronic pain lasts over 3-6 months
How can we assess pain?
Verbal rating scale, numeric rating scale (1-10), visual
Outline the WHO analgesic ladder
Step 1. - NSAIDs, Paracetamol, Aspirin
Step 2 - weak opioids (codeine, oxycodone, tramadol)
Step 3- strong opioids (morphine, fentanyl)
If NSAIDs are CI then what is a suitable alternative?
Weak opioid
What dose of morphine should an opioid naieve patient be initiated on?
20-30mg
What dose of morphine should a non opoid naive patient be started on?
30-40mg
If a patient cannot tolerate morphine, what should be given instead?
Consider giving oxycodone
How should break through pain be managed?
Give 1/10th to 1/6th of the total daily dose
How should morphine doses be titrated?
Increments of morphine should not exceed 1/3 to 1/2 of the total daily dose every 24 hours.
How can VTE risk be reduced in a patient taking COC with planned surgery?
NICE advises stopping oestrogen containing pill 4 weeks before elective surgery.
What EHC is best for patients overweight?
If oral then Ulipristal is more efficacous. However IUD is most effective
Who can we not use the cockcroft gault equation for?
Should not be used in patients with extensive burns of those with fluid overload - HEART FAILURE
If a patient is taking an ACEi and they are vomiting/diarrhoea what advice would you give them?
Stop taking ACEI until better, need to maintain hydration
What is ACR test?
Albumin:creatine ratio - used to test for proteinurea and therefore kidney failure
If ACR is >3mg/mmol then it is regarded as clinically important.
What ACR value is regarded as clinically important in terms of kidney failure?
ACR >3mg/mmol
How should pain be managed in someone with liver impairment?
Paracetamol is preferred
NSAIDs increase bleeding risk
Opioids increase sedation and constipation so can worsen encephalopathy
PPI and broad spec antibiotics increase the risk of what?
C.diff
How should C.diff be managed?
Important to stop all unnecessary antibiotcs
Fluid and electrolyte replacemnet
Metronidazole or vancomycin
What pharmacogical agents can be used to manage diabetes in pregnancy?
Metformin and insulin.
All other oral agents should be stopped.
What dose of folic acid is advised in pregnant diabetics?
Should have the higher dose - 5mg.
Are BB safe for the management of symptom control in hyperthyroidism if the patient is diabetic?
Safe for short term use
What anti asthmatic drug should not be started in pregnancy?
Leukotriene antagonists.
If patient is already taking and it is considered essential then they can continue.
Opioid induced constipation should be treated with what?
Avoid bulk forming laxatives. Treat using stimulant or osmotic.
Constipation that has failed to be treated with diet and lifestyle should be treated with what type of laxative?
1st line - bulk forming (unless opioid induced) e.g. isphagula husk
2nd line - Osmotic, macrogels and then lactulose
3rd - stimulant e.g. senna, docusate
