Treatment for all diseases Flashcards
1
Q
How is osteoarthritis treated?
A
1st line:
- Topical analgesics, (NSAID’s such as diclofenac)
- Corticosteroid injections
- Exercise (increases joint lubrication, therefore decreasing pain).
2nd line:
- Paracetamol + all above.
If pain persists despite multiple treatment modalities, or patient has severe disability:
- Surgery
2
Q
How is rheumatoid arthritis treated?
A
1st line:
- DMARD such as methotrexate or hydroxychloroquine (unless pregnant or planning pregnancy).
- Corticosteroid such as prednisolone. Usually administered via interarticular injection.
- NSAIDS such as ibuprofen, diclofenac, naproxen.
IF SEVERE:
- Consider biological agent such as infliximab (TNF-a inhibitor).
3
Q
What treatment is given for osteoporosis?
A
1st line:
- Calcium and vitamin D supplementation.
- Biphosphonates (such as alendronic acid).
2nd line:
- Denosumab. This is a RANK ligand inhibitor.
- Oestrogen can be given to women whose oestrogen is low.
4
Q
What is the treatment for osteomalacia?
A
1st line:
- Calciferol (source of vitamin D)
AND
- Calcium carbonate/calcium citrate (source of calcium).
5
Q
What is the treatment for a patient with SLE?
A
- Avoid sunlight and smoking
- Give hydroxychloroquine (1st line)
- Give NSAIDs and corticosteroids to treat the arthralgia.
- If symptoms severe, prescribe immumnosuppresives (e.g. rituximab).
6
Q
How is gout treated?
A
For an acute attack:
- NSAIDs, Corticosteroids
- Colchicine (if NSAIDs are not tolerated).
For recurring gout:
- Long term treatment with allopurinol (xanthine oxidase inhibitor).
7
Q
What is the treatment for pseudogout?
A
If joint accessible to injection:
- Steroid injection + paracetamol
If joint inaccessible to injection:
- NSAIDs + paracetamol
For polyarticular pseudogout:
- NSAIDs (1st line)
- Systemic steroids (2nd line)
8
Q
What is the treatment given for ankylosing spondylitis?
A
1st line:
- Physiotherapy
- NSAIDS (naproxen)
If 2 NSAIDS fail to control pain/stiffness, 2nd line:
- TNF-a inhibitor (infliximab).
9
Q
What is the treatment for psoriatic arthritis?
A
If disease is limited:
- NSAIDS (naproxen)
- Physiotherapy
- Corticosteroid injections
If disease is progressive:
- SAME AS ABOVE
- PLUS DMARD (e.g. methotrexate).
10
Q
What is the treatment for reactive arthritis?
A
For symptomatic relief:
- NSAIDs (e.g. naproxen)
- Corticosteroid injections (e.g. prednisolone)
For persistent or recurrent reactive arthritis:
- DMARD (sulfasalazine).
- ANTIBIOTICS NOT INDICATED UNLESS THERE IS AN ACTIVE GU OR GI INFECTION STILL.
11
Q
What is the treatment for septic arthritis?
A
If there is systemic involvement:
- Follow local sepsis guidance (e.g. SEPSIS-6).
If there is no systemic involvement:
- Pathogen targeted antibiotics (e.g. amoxicillin) + joint aspiration (to remove infectious fluids.) IMMEDIATELY AFTER JOINT ASPIRATION FOR CULTURE HAS BEEN OBTAINED.
If the joint is prosthetic, consider surgery.
Consider analgesia (NSAIDS/paracetamol) to manage the pain.
12
Q
What is the treatment for osteomyelitis?
A
- Antibiotic therapy (flucloxacillin 1st line)
- Consider surgery if bone continues to deteriorate.
13
Q
What is the treatment for unstable angina?
What is the treatment for stable angina?
A
UNSTABLE ANGINA
1st line: DEFINITELY - Aspirin (Anti-platelet) - P2Y12 inhibitor (clopidogrel) CONSIDER - GTN (Nitrate) - Morphine (opiate analgesic) - Anti-emetic (metoclopramide) - CABG
STABLE ANGINA
1st line: DEFINITELY - Beta Blocker (Bisoprolol, Verapamil) - GTN (Nitrate) - Continue dual anti-platelet therapy (Aspirin + clopidogrel) - Discuss lifestyle changes (healthy diet, lowering alcohol intake, stop smoking etc.) CONSIDER - ACEI (ramapril) - Statins (lower cholesterol)
14
Q
What is the treatment for a myocardial infarction?
A
STEMI and NSTEMI
1st Line:
- Aspirin
- PCI (Percutaneous coronary intervention) within 120 mins.
- NOTE: IF A PATIENT IS GOING TO HAVE PCI, DO NOT START HEPARIN (ANTICOAGULATION) AS THIS WILL BE STARTED BY THE SURGICAL TEAM IN THEATRE. DO START DUAL ANTIPLATELET THERAPY (ASPIRIN + PRASUGREL).
- Opioid analgesia IV (Morphine)
- Metoclopramide (anti-emetic)
FOLLOWING THE MI:
- Continue dual antiplatelet therapy (Aspirin + Prasugrel/clopidogrel)
- Start/continue B-blocker (Bisoprolol). If patient contra-indicated, start CCB (Amlodipine).
- ACEI (ramipril)
- Statin (atorvastatin)
- Lifestyle changes (cardiac rehab).
15
Q
What is the treatment for chronic heart failure?
A
1st line:
- Ramapril (ACEI)
- Lifestyle changes (Lower sodium intake, reasonable fluid intake, exercise).
- Bisoprolol (B-blocker).
- IF FLUID RETENTION OCCURING furosemide (loop diuretic).
16
Q
What is the treatment for the different types of acute heart failure and how does it work?
A
CARDIOGENIC SHOCK (<90mmHg systolic, hypotensive):
1st line:
- Treat underlying cause (Infection, tamponade, PE, MI etc.)
- Give O2 if needed hypoxic
- Refer to specialist
HYPERTENSIVE CRISIS: 1st line: - Treat underlying cause (MI, angina, tachycardia etc.) - Loop diuretic (furosemide) - GTN for vasodilation. - Refer to specialist
HAEMODYNAMICALLY STABLE:
1st line:
- Treat underlying cause
- Refer to specialist
17
Q
What are the treatments for dilated cardiomyopathy?
A
- Bed rest (reduce demand on heart).
- Loop (Furosemide) and thiazide diuretics (loop diuretics are more potent than thiazide diuretics). These are used to reduce treat any oedema and lower blood pressure, to reduce strain on the heart.
- ACEI (ramapril). Used to lower blood pressure.
- Beta blockers (bisoprolol). Block the effects of epinephrine, otherwise known as adrenaline. This reduces blood pressure.
- Potentially an ICD can be implanted surgically. (Used to manage arrhythmia, by sending an electrical impulse if heart rhythm becomes abnormal.)
18
Q
What are the common treatments for hypertrophic cardiomyopathy?
A
1st line:
- B-blocker (atenolol/bisoprolol - inhibits action of epinephrine)
- Calcium channel blockers such as amlodipine. (allow cardiomyocytes to relax, due to suppression of calcium influx.) ONLY USE IF B BLOCKER NOT EFFECTIVE/TOLERATED.
- Prevention of sudden death. An implanted cardioverter defibrillator (ICD) may be inserted to control any arrhythmias that occur. Or amiodarone as a pharmacological cardioverter.
- Severe hypertrophic cardiomyopathy. Treated with septal myectomy. Involves removal of excess septal myocardium to restore heart volume.
19
Q
What treatment is given to patients with arrythmogenic right ventricular cardiomyopathy?
A
STANDARD HEART FAILURE MEDICATIONS:
- Beta blockers (bisoprolol), even for asymptomatic patients.
- ICD for high risk patients.
- Heart transplant given to patients with refractory disease (heart not responding to the standard treatments).
20
Q
What are the treatment options for hypertension?
A
- Offer lifestyle advice.
Drug therapy
If the patient has any of the following:
- type 2 diabetes
- is under 55 BUT NOT BLACK/AFRO-CARRIBEAN.
- 1st line is ACEi (ramipril)
- If not tolerated (e.g. due to cough) give an ARB (e.g. olmesartan).
- 2nd line is add in a CCB (a.g. amlodipine) OR a thiazide-like diuretic (a.g. metolazone).
If the patient is any of the following:
- Aged over 55 and no type 2 diabetes
- Black/Afro-carribbean any age with no type 2 diabetes
- 1st line is CCB (e.g. amlodipine).
- If not tolerated (e.g. due to oedema) offer a thiazide-like diuretic (e.g. metolazone).
- 2nd line is add ACEI (ramipril) or ARB (olmesartan) or thiazide-like diuretic (metolazone).
IF THERE IS AN UNDERLYING CAUSE AIM TO TREAT THIS.
21
Q
What are the treatment options for atrial fibrillation?
A
Control the arrhythmia. 2 components:
Rate control
- B-blockers such as bisoprolol (1st line).
- CCB such as verapamil (1st line.
- Both if needed (2nd line).
Rhythm control
- Cardioversion (can be done with electrical pads or antiarrhythmatic drugs such as adenosine).
- Thromboprophylaxis to prevent strokes (anticoagulants, warfarin, aspirin).
If there is an underlying cause, aim to treat this.
22
Q
What treatments are offered for the different types of heart block?
A
1st degree:
- None needed
2nd degree (mobitz I AND II):
- Monitor
- Atropine (if presenting acutely).
- Potentially needs a pacemaker.
3rd degree:
- If issue is with His bundle, atropine (1st line) or pacemaker (2nd line).
- If issue is Purkinje fibres, permanent pacemaker.
23
Q
What are the treatment options for SVT?
A
If haemodynamically unstable:
- Cardioversion. Should try synchronised cardioversion (electrical pads) before trying anti-arrhymthic, drug based cardioversion.
If haemodynamically stable:
- Antiarrhythmatic drugs (1st line) such as adenosine.
24
Q
What is the treatment for BBB?
A
- Treat underlying cause (if possible)
- Treat symptoms (Blood pressure, cardiac failure etc.)
- Potentially pacemaker.
25
What are the treatment options for aortic aneurysm?
- Surgical repair (immediate if ruptured).
| - If unruptured, consider insertion of supportive stent.
26
How is aortic dissection treated?
- Surgical repair (either open or stentgraft).
27
What is the treatment for peripheral vascular disease?
- Antiplatelet therapy (aspirin + clopidogrel)
- Lifestyle modification
To manage claudication:
- consider use of cilostazol (another antiplatelet).
In the event of acute limb ischaemia:
- Urgent revascularisation if possible, or urgent amputation.
28
What is the treatment for pericarditis?
1st line:
- NSAIDS (aspirin)
- PPI (omeprazole) to protect the gastric mucosa from high doses of NSAIDs.
Colchicine (unless TB is suspected cause).
TREAT UNDERLYING CAUSE
29
What is the treatment for septic hypovolaemic shock?
Don't wait for investigations to confirm diagnosis:
- ABC's
- Broad spectrum antibiotics.
- IV fluids.
- Vasopressors (such as vasopressin) to increase BP.
30
What is the treatment for type 1 DM?
1st line:
- Basal-bolus insulin
- Pre-meal insulin IF NEEDED
- Metformin (a biguanide) IF NEEDED.
31
What is the treatment for type 2 DM?
- First line: Diet and exercise changes.
- If no change, prescribe metformin (biguanide).
- Add SGLT2 inhibitor if CV risk is high (canagliflozin)
- Potentially use sulfonylurea (glimepiride) if metformin not tolerated.
- Give aspirin (non-selective COX inhibitor) or clopidogrel (P2Y12 antagonist) to reduce risk of CVD. Both aspirin and clopidogrel are antiplatelet drugs.
32
What are the potential treatments for Grave's disease?
- Antithyroid drugs (carbimazole usually, else propylthiouracil). These will be taken in one of two ways:
- Block and replace. Prolonged treatment using the drug, along with levothyroxine to replace the lost thyroid hormone.
- Titration. Gradual reduction in the dose of anti-thyroid, until the naturally produced thyoid hormones are at the right level again.
- Also give a B blocker (atenolol or propanolol) to treat symptoms such as tachycardia, tremor and anxiety. If contraindicated give CCB (verapamil).
- Thyoidectomy (partial or complete)
- Radioactive iodine. Taken up by thyroid, and will subsequently kill some of the thyroid, reducing hormone production.
33
What treatments are available for Hashimoto's disease?
- Thyroid hormone replacement (levothyroxine).
| - Resection of obstructive goitre to relieve symptoms (dyspnoea and dysphagia.)
34
What treatments are given for primary and secondary hypothyroidism?
Primary - Thyroid hormone replacement therapy (Levothyroxine), and potential resection of the obstructive goitre.
Secondary - Still give thyroid hormone replacement (levothyroxine) but also treat the underlying cause.
Transient - Will often resolve on its own. If due to treatment withdrawal, consider restarting treatment/ re-establishing a higher dose.
35
What are the treatment options for thyroid cancer?
- Total thyroidectomy
- Radioactive iodine administration.
- External radiotherapy. (Palliative care to reduce symptoms).
- Prophylactic central lymph node dissection (a preventative measure to reduce chance of cancer spreading).
36
How is Cushing's syndrome treated?
- For tumours, surgical removal. This is first line for all types of Cushing syndrome where it is possible.
- Otherwise, cortisol synthesis inhibition. (Drugs include metyrapone and ketoconazole).
37
What are the treatment options for acromegaly?
- Transsphenoidal resection surgery (removal of pituitary tumour). IF POSSIBLE THIS IS 1ST LINE.
- IF SURGERY NOT POSSIBLE SOMATOSTATIN ANALOGUES ARE FIRST LINE (Again, somatostatin inhibits GH production). 2 examples of SSA are Octreotide and Ianreotide.
- Dopamine agonists (Bind to D2 receptors and restrict GH secretion). Often given as dual therapy with SSAs. Usually bromocriptine
2nd line:
- GH receptor antagonists (Due to -ve feedback loops, suppress GH secretion) For example, pegvisomant.
38
What are the treatment options for Conn's syndrome?
For an adenoma:
- Surgical removal
For adrenal hyperplasia:
- Aldosterone antagonist (usually spironolactone).
39
What is the treatment for Addison's disease?
- Hormone replacement (hydrocortisone) and mineralocorticoid (fludrocortisone).
40
What is an adrenal crisis and how is it treated?
- Acute medical emergency caused by a lack of cortisol.
- IV hydrocortisone immediately if suspected.
- Saline for hypotension/ dehydration if required. If glucose is low, 5% dextrose.
- Treat underlying cause if possible.
41
What is the treatment for secondary adrenal insufficiency?
- Hormone replacement (just hydrocortisone, as aldosterone has not been affected).
- Try to taper off the hydrocortisone if condition improves.
42
What is the treatment for hyperkalaemia?
- Restriction of dietary potassium.
| - Loop diuretics.
43
What is the treatment for hypokalaemia?
Treat underlying cause
- Withdrawal of harmful medication.
- Increase dietary potassium/ give a potassium supplement if required.
- Check magnesium levels, as these are closely related.
44
What treatment is given to patients with syndrome of inappropriate ADH secretion?
1st line:
- Reduce fluid intake.
- Treat underlying cause.
2nd line or if disease is more severe:
- Tolvaptan (ADH receptor antagonist).
45
What is the treatment of DI?
Central DI:
- Desmopressin
Nephrogenic DI:
- Treat underlying cause (often renal disease)
- Maintain adequate fluid intake to prevent dehydration.
- Can use hydrochlorothiazide or sodium restriction in diet to reduce urine output.
46
What is the treatment for primary hyperparathyroidism?
MANAGEMENT OF HYPERCALCAEMIA
- Surgical removal of adenoma.
- If surgery unsuccessful or rejected, give cinacalcet (a calcimimetic, that will decrease PTH levels).
- If osteoporosis is present, consider bisphosphonates (alendronic acid).
47
What is the treatment for secondary hyperparathyroidism?
- Vit D and calcium supplementation always (calcium needed as the PTH secretion is driven by hypocalcaemia).
- If malabsorption related, treat the GI cause.
- If CKD related, treat the CKD.
48
What is the treatment for severe secondary/tertiary hyperparathyroidism?
- Partial or total parathyroidectomy with close calcium monitoring afterwards.
49
What is the treatment for hypoparathyroidism?
- Calcium
| - Calcitrol (biologically active form of vitamin D, so doesn't require PTH to be activated.)
50
What is the treatment for COPD?
For stable COPD:
1st line:
- Stop smoking
- Pulmonary rehabilitation
- SABA (salbutamol)
```
2nd line:
- Combination therapy.
- LAMA (tiotropium) + LABA (salmeterol).
OR
- LABA (salmeterol) + ICS (ciclesonide).
```
3rd line:
- Combination therapy.
- LAMA (tiotropium) + LABA (salmeterol) + ICS (ciclesonide).
For severe/unstable COPD:
- Consider long-term oxygen therapy.
- Be careful this doesn't cause respiratory depression.
51
What are the treatment options for asthma?
1) SABA (salbutamol) for reliever treatment. 1st line
2) INHALED CORTICOSTEROIDS (ciclesonide) for maintinence therapy. 2nd line
3) LEUKOTRINE RECEPTOR ANTAGONIST (montelukast). 3rd line OR introduce a LABA (salmeterol).
52
What treatment is given for rhinitis?
1st line:
- Avoidance of allergens (if possible).
- Intranasal corticosteroid (beclometasone or budesonide)
- Anti-histamines.
53
What are the treatment options for bronchiectasis?
- Stop smoking (reduces further deterioration)
- Physiotherapy (Airway clearance exercises)
Medication:
- Antibiotics to treat infection. Amoxicillin is 1st line until susceptibility data available.
- SABA (salbutamol) especially if bronchiectasis concurrent with COPD/asthma.
- Surgery. Lobectomy of the lobe affected by the bronchiectasis. (more uncommon now).
54
What are the potential treatments for cystic fibrosis?
FOR ONGOING RESPIRATORY DISEASE:
1st line:
- Chest physio (2 times a day).
- Bronchodilators. Salbutamol (SABA) is 1st line.
- Mucolytic (dornase alfa and hypertonic saline inhaled).
- Inhaled tobramycin (prophylactic antibiotics) if patient has chronic infection with Pseudomonas aeruginosa.
- Anti-inflammatories. Azithromycin is 1st line.
- Inhaled corticosteroids e.g. ciclesonide.
FOR ONGOING GI DISEASE WITH PANCREATIC INSUFFICIENCY:
- Pancreatic enzyme replacement (pancreatin)
- H2 antagonist (famotidine) or PPI (omeprazole)
55
What are the treatment options for pleural mesothelioma?
- Surgical (resection if possible)
- Chemo (if unresectable)
- Radio (uncommon, but can relieve pain).
56
What are the treatment options for lung carcinoma?
- Gold standard is curative surgery. Not always possible.
- Chemotherapy
- Radiotherapy
57
What is the treatment for a PE?
If PE suspected and haemodynamically unstable and/or hypoxic:
- Resuscitate
- High-flow oxygen
When PE confirmed:
- Heparin
- Thrombolysis (e.g. altepase)
After PE:
- Continue long term anticoagulation (e.g. warfarin)
58
What treatment is given for pneumonia?
Treatment depends on severity:
- Antibiotics to clear infection (1st line amoxicillin, if penicillin allergy cefuroxime).
- If severe, admit to hospital and consider oxygen and analgesia.
59
What is the treatment for TB?
- Isoniazid (anti-TB drug) + rifampicin (antibiotic) for 6 months.
- Pyrazinamide and ethambutol for 2 months.
THIS TREATMENT IS THE SAME FOR BOTH ACTIVE TB AND DORMANT TB IF THE PATIENT IS AT RISK OF TB ACTIVATION.
60
What is the treatment for flu?
If symptomatic (A and B):
- Paracetamol
- Bed rest
- Fluids
61
What is the treatment for sarcoidosis?
- If there is no pulmonary infiltration, no treatment is needed.
- If there is respiratory infiltration, prescribe corticosteroids (e.g. prednisolone).
62
What is the treatment for idiopathic pulmonary fibrosis?
If disease ongoing:
- pirfenidone (a pyridone - 1st line).
- Lung transplant (2nd line)
If an exacerbation:
- High dose prednisolone (1st line)
63
What is the treatment for pulmonary hypertension?
Treat underlying cause if possible. Otherwise:
- Trial of CCB
- Lifestyle changes
- Warfarin (anticoagulation)
Consider a diuretic (furosemide)
64
What are the treatment options for urinary tract stones?
- NSAIDS (1st line is diclofenac or ibuprofen) for the pain. Potentially use IV paracetamol (2nd line) or IV steroids (3rd line) if pain doesn't get better.
- If stones are smaller (<5mm), observe and allow stones to pass naturally. ENSURE PATIENT REMAINS WELL HYDRATED.
- If stones are larger, consider extracorporeal shockwave lithotripsy (ESWL) to break the stone down and allow passage.
- Can use utereroscopy + laser to break down stones too.
- Percutaneous nephrolithonomy (PCNL) can be used for larger stones. It is a form of keyhole surgery through the patients lumbar region.
- IF THERE ARE SIGNS OF SEPSIS, administer DRAINAGE as this can be life threatening. ALSO START URGENT ANTIBIOTIC THERAPY
65
What is the treatment for AKI?
- Treat the underlying cause.
- Check for any nephrotoxic drugs the patient may be taking.
- Consider loop diuretics (furosemide) if appropriate, and under specialist advice.
66
What is the treatment for CKD?
1st line:
- Antihypertensives to try and prevent further damage (ACEI ramipril or ARB e.g. losartan).
- Statins (such as simvastatin) to reduce chance of developing dyslipidaemia.
Next steps:
- If severe (stage 5), consider dialysis or ideally a kidney transplant.
67
How is BPH treated?
NO SYMPTOMS:
- Watch and wait
FOR THOSE WITH SYMPTOMS NOT SUITABLE FOR SURGERY:
- Doxazosin (alpha blocker)
- Finasteride (5-a-reductase inhibitor)
IF SUITABLE FOR SURGERY:
- Transurethral resection of prostate (GS)
- Open prostatectomy if transurethral surgery not an option.
68
What is the treatment for pyelonephritis (acute)?
- Antibiotics (ciprofloxacin or co-amoxiclav).
- When urine culture comes back, change antibiotics if necessary.
- Consider paracetamol for analgesia (not NSAIDs as these can cause AKI).
69
What is the treatment for cystitis?
- 3 Days of trimethoprim OR 5 days of nitrofurantoin.
| - Phenazopyridine to relieve dysuria.
70
What is the treatment for prostatitis?
- Quinolone antibiotics (Ciprofloxacin) 1st line.
| - Ibuprofen (NSAID) for analgesia.
71
What is the treatment for urethritis?
- For gonococcal urethritis, ceftriaxone (cephalosporin).
| - For non-gonococcal uteritis, doxycycline or azithromycin.
72
What are the treatments for GORD?
1st line:
- Usually conservative. This includes lifestyle management, such as weight loss, avoidance of alcohol where possible, stopping smoking.
- PPI's for 1 month.
2nd line:
- H2 antagonist (such as ranitidine or famotidine - H2 antagonists usually end in "-idine")
GOLD STANDARD:
- Anti-reflux surgery. Rarely carried out in practice.
73
What are the treatment options for Mallory-Weiss tears?
- Tear tends to rapidly (within 24 hours) heal on its own.
IF LARGER TEAR:
- ABC + resuscitate (provide oxygen, open airways, correct fluid losses).
- Blood transfusion if required. (hypovolemic shock)
- Give PPI or anti-emetic depending on symptoms (nausea/vomiting. Use PPI to reduce acidity of fluids reaching the tear).
- Identify and plan modification to any co-morbidities.
74
What are the potential treatment options for oesophageal-gastric varices?
IF SMALL WAIT AND MONITOR WITH ANNUAL ENDOCSCOPY.
IF MEDIUM:
- Diagnostic endoscopy
- Non-selective B-blocker (eg. propanolol).
IF AN ACUTE VARICEAL BLEED:
1st - ABC + resuscitate (Provide oxygen, open airways, treat potential shock).
2nd - Urgent endoscopy
3rd - Calculate Rockall score. Assesses how severe an upper GI bleed is.
- Provide terlipressin (1st line drug). This will reduce the dilation of the splanchnic blood vessels, reducing blood flow to the hepatic system and subsequently reducing bleeding.
MANAGEMENT AFTER BLEED:
- Non-selective B blocker (propanolol).
- Consider endoscopic band ligation (Insertion of a constrictive band around the varices, to mechanically constrict them).
75
What are the potential treatment options for peptic ulcers?
1st line:
- STOP NSAIDS
- Stop smoking
- PPI for 4 weeks (omeprazole).
IF H. PYLORI IS CAUSE:
- Triple therapy is used (PPI + 2 antibiotics is 1st line - usually clarithromycin, amoxicilin, and omeprazole (the PPI))
ANOTHER ENDOSCOPY IN 6 WEEKS. If not healed, biopsy to check for malignancy.
76
What treatment is given for gastritis?
IF MILD:
- Encourage fluid intake
- Small, light, non-fatty meals.
- Anti-motility agents (CONTRAINDICATED IF INFECTIVE CAUSE).
IF MODERATE - SEVERE:
- Stop NSAIDS and aspirin.
- Give PPI (omeprazole 1st line) or H2 antagonist (famotidine 2nd line).
IF H. PYLORI SUSPECTED CAUSE:
- Triple therapy (PPI + 2 antibiotics - omeprazole, amoxicillin and clarithromycin).
IF CAMPYLOBACTER CAUSE:
- May cause neurological symptoms.
- Neuro symptoms + gastritis = campylobacter (usually).
77
What treatment is offered to patients with gastropathy?
- PPI (reduce acidity in GI tract).
| - Removal of causative agent (often reduce NSAID use).
78
What are the treatment options for scleroderma (systemic sclerosis)?
- NO DEFINITIVE CURE. TREAT SYMPTOMS (E.g tamponade treated with prednisolone - a corticosteroid).
79
What are the potential treatments for achalasia?
AIM IS TO RELAX THE MUSCLES OF THE OESOPHAGUS, ESPECIALLY THE LOS.
1st line:
- Nitrates (isosorbide dinitrate orally) where surgery is not an option, to open up the blood vessels and promote blood flow.
- POTENTIALLY USE A CCB (verapamil)
2nd line:
- Botox may be an option for patients too, to try and reduce unwanted contraction of the smooth muscle cells in the oesophagus.
GOLD STANDARD:
- Surgical division of lower oesophageal sphincter, or endoscopic balloon dilatation of the oesophagus.
80
What is the treatment for coeliac disease?
- Gluten-free diet
| - Nutritional supplementation as required (ergocalciferol for Vit. D2, and calcium carbonate for Ca2+)
81
What is the treatment for ulcerative colitis?
MILD CASES:
1st line - 5-Aminosalicyclic acid (most commonly mesalazine) to be applied topically.
MODERATE-SEVERE cases:
1st line: biological agents (e.g. infliximab)
2nd line: oral corticosteroids (prednisolone) may be used.
SEVERE/UNTREATED:
- Potential to perform surgical resection (colectomy).
82
What is the treatment for Crohn's disease?
- Stop smoking (Exacerbates the disease).
- Corticosteroids (to induce remission).
- Thiopurines such as azathioprine (To maintain remission - but these have relatively severe side effects as they are a form of immunosuppressant).
- If remission was achieved through a TNF-a inhibitor (infliximab), continue with that.
83
What is the treatment for IBS?
Lifestyle modification:
- Lots of fluids
- More fibre with diarrhoea, less with constipation.
Pharmaceutical:
- Laxatives for constipation.
- Antidiarrhoeals for diarrhoea (e.g. loperamide).
84
What are the potential treatments for oesophageal cancer?
- Gastrectomy (partial or total) + chemotherapy.
85
What is the treatment for colorectal cancer?
- Surgery, ideally with end to end anastomosis. Can fit a stoma bag if this is not possible.
- Chemotherapy alongside this.
86
What are the potential treatment options for appendicitis?
- Gold standard is appendectomy.
| - In patients not suitable for surgery, paracetamol + antibiotics.
87
What is the treatment for mechanical intestinal obstruction?
- Fluid replacement
- Analgesia
- Nasogastric decompression
- Consider surgery to correct the blockage.
88
What treatment is usually given for functional intestinal obstruction?
Usually treatment is conservative:
- Fluid replacement
- Analgesia (PRN)
- Intestinal decompression with a nasogastric tube
89
What is the treatment of diverticular disease?
- For asymptomatic diverticular disease, increase fibre.
- For diverticulitis, antibiotics (amoxicillin 1st line).
- Analgesics (paracetamol).
- Consider surgical resection for patients with frequent attacks of diverticulitis.
90
What treatment can be given for a TIA?
1st line:
- Aspirin (COX-1 and 2 inhibitor - an antiplatelet).
- If intolerant, give clopidogrel (P2Y12 inhibitor - alternative antiplatelet).
After TIA has been confirmed:
- High-intensity statin.(Atorvastatin).
91
What is the treatment for an ischaemic stroke?
When suspected:
- ABC's
- Admit to stroke unit.
When confirmed:
- Glasgow coma score (GCS)
- Monitor blood glucose. Administer insulin as required.
- Monitor signs of ICP. Refer to neurosurgery as required.
1st line medication:
- Altepase (thrombolytic agent).
- Administer aspirin (or clopidogrel if aspirin is not tolerated) WHEN STROKE IS CONFIRMED TO BE ISCHAEMIC AND NOT HAEMORRHAGIC.
92
What is the treatment for a patient with a haemorrhagic stroke?
- Urgent referral to stroke unit.
- After haemorrhagic has been confirmed, urgent reversal of any anticoagulation medication being given.
- WARFARIN CAN BE REVERSED USING VIT. K.
93
What is the treatment for a subarachnoid haemorrhage?
- Bed rest
- ABC's
- Keep assessing Glasgow Coma Score.
Drugs:
- Give nimodipine (A CCB).
- Consider analgesia (such as paracetamol or codeine).
- Consider stopping and reversing anticoagulation (such as warfarin, reverse with K+).
- 50% of subarachnoid haemorrhage patients will die in hospital.
94
What is the treatment for a subdural haemorrhage?
- ABC's
- Glasgow Coma Score.
Drugs:
- Prophylactic anti-epileptics (levetiracetam).
- Reversal of anticoagulation (Stop warfarin, give vit. K+)
- Reduce the ICP (surgery if possible, mannitol can be given to help reduce ICP).
95
What is the treatment for an extradural haemorrhage?
- Surgical drainage of the blood to reduce ICP.
| - Consider mannitol in low dose to reduce ICP.
96
What are the treatment options for epilepsy?
1st line:
- Avoidance of triggers
- AED (anti-epileptic drugs) such as sodium valproate, lamotrigine, carbamazepine or phenytoin.
- Consider use of diazepam for seizure control.
97
What are the treatment options for Parkinson's disease?
1st line:
- carbidopa (decarboxylase inhibitor) AND levidopa (CNS agent) in the same pill. Often called L-DOPA.
2nd line:
- Ropinirole (dopamine agonist).
98
What are the treatment options for migraine?
- Sometimes will pass in sleep.
If moderate:
- Painkillers (Paracetamol/NSAIDs)
If severe:
- Serotonin agonist (such as triptan) will suppress the inflammation causing the migraine.
- Ensure patient stays hydrated and consider anti-emetics if they are feeling nauseas.
99
What is the treatment for MS?
For an acute relapse:
- Methylprednisolone (Short course of steroids).
For relapsing-remitting MS:
- Use immunomodulators: B-interferon or immunosuppressants (e.g. rituximab).
100
How is myasthenia gravis treated?
1st line:
- Anti-cholinesterase (pyridostigmine).
If severe:
- Immunosuppressant drugs (such as azathioprine).
If there is a myasthenia crisis:
- Intubation/ventilation
- Plasma exchange (removes autoantibodies, reducing the autoimmune response).
101
What treatments are available for MND?
1st line:
- Sodium channel blockers (e.g. Riluzole)
If struggling with muscle spasticity:
- Baclofen (a skeletal muscle relaxant).
102
What is the treatment for bacterial meningitis?
When suspected:
- ABC
- Corticosteroids (dexamethasone)
- Empirical antibiotics (cefotaxime)
After cultures arrive back, choose more pathogen specific antibiotics.
103
What is the treatment for viral meningitis?
When suspected:
- treat with empirical antibiotics until viral cause has been confirmed (cefotaxime).
When confirmed:
- ABCs
- Analgesics (Ibuprofen/paracetamol)
If viral meningitis is recurrent:
- Consider specialist referral for antibiotics.
104
What is the treatment for encephalitis?
- ABCs
- Immediate start on aciclovir as soon as viral encephalitis is suspected. This is because most of the time it is due to HSV, and aciclovir is an antiviral for herpes.
- Make antiviral therapy more specific when the exact viral cause has been established.
- If ICP elevated, give steroids and mannitol.
105
What is the treatment for shingles?
- Famciclovir (antiviral) 1st line.
- Aciclovir (antiviral) 2nd line.
- Analgesia as required (NSAID/paracetamol for moderate, oxycodone opiate for severe).
106
What are the therapeutic options for a brain tumour?
- Surgery (removal or biopsy)
| - Radiotherapy or chemotherapy.
107
What is the treatment for giant cell arteritis?
- Administer high dose prednisolone IMMEDIATELY, even before diagnosis confirmation.
- Specialist may consider use of methotrexate if the patient is high risk/experiencing a relapse of giant cell arteritis.
108
What is the treatment for cluster headaches?
ONGOING MANAGEMENT:
- CCB (1st line) such as verapamil.
- Lithium (2nd line).
ACUTE ATTACK MANAGEMENT:
- Subcutaneous sumatriptan (a triptan) and high flow oxygen.
109
What is the treatment for a tension headache?
Simple analgesics for an acute attack (aspirin/paracetamol/ibuprofen).
For chronic headache (>7 days per month), consider using low dose antidepressants such as amitriptyline (tricyclic antidepressant).
110
What is the treatment for acute ascending cholangitis?
1st line:
- Fluid resuscitation.
- Potentially oxygen required.
- Antibiotic therapy (to clear the infection) Give IV until adequate biliary drainage has been achieved.
- Clear the obstruction (e.g. the gall stone) using ERCP.
111
What is the treatment for sclerosing cholangitis?
MANAGE THE SYMPTOMS OF DECREASED LIVER FUNCTION:
- Rifampicin to reduce itching (puritis).
- Ca2+ and Vit. D supplementation for osteopenia.
- Immunosuppression if autoimmune hepatitis.
- ERCP can be used to dilate the strictures.
WHEN END-STAGE LIVER DISEASE/LIVER FAILURE REACHED:
- Liver transplant.
112
What is the treatment for liver failure?
- Treat symptoms (e.g. diuretics for ascites).
| - If failure is severe, consider liver transplant.
113
What is the treatment for acute pancreatitis?
- Fluid resuscitation
- Oxygen
- Analgesia (NSAIDs)
- IV antibiotics (if infection suspected).
- DO NOT MAKE NIL BY MOUTH IF UNNEEDED.
114
What is the treatment for chronic pancreatitis?
- Stop alcohol intake and stop smoking (1st line)
- Analgesia. Paracetamol or NSAIDs (1st line)
- Pancreatic enzyme replacement therapy - pancreatin (1st line)
- If really bad, consider surgical intervention.
115
What is the treatment for alcoholic liver disease?
- Alcohol abstinence and smoking cessation.
- Nutritional support.
- Corticosteroids (prednisolone) to control inflammation if there is no renal failure.
116
What is the treatment for iron deficiency anaemia?
- Iron salts orally (1st line)
| - If persistent/severe, give iron IV or perform a RBC transfusion.
117
What is the treatment for pernicious anaemia?
- Give hydroxocobalamin, a B12 analogue (1st line)
| - If there are neuro symptoms, refer to neurology/haematology.
118
What is the treatment for folate-deficiency anaemia?
- Folic acid supplementation.
- Folate should be taken while trying to conceive and for the first 12 weeks of pregnancy to reduce risks of neural tube defects.
119
What is the treatment for haemolytic anaemia?
- Folate and iron supplementation.
- Corticosteroid (prednisolone) if autoimmune (Coomb's positive) is 1st line.
- Consider corticosteroids for non-autoimmune haemolytic anaemia too.
- Plasma exchange for patients with thrombotic thrombocytopenic purpura
120
What is the treatment for sickle cell anaemia?
- Anaphylactic penicillin until 5 years old (children). Because they are at substantially increased risk of invasive pneumococcal infection.
- Hydroxycarbamide. Manages the pain.
- Potentially blood transfusion.
- Bone marrow stem cell transfusion if disease severe - still a very new treatment.
121
What is the treatment for multiple myeloma?
Chemotherapy (Bortezomib + dexamethasone is 1st line for patients illegible for high dose chemo + stem cell transplant).
- Stem cell transplant (if illegible).
- Offer zoledronic acid to prevent bone disease (1st line).
122
What is the treatment for fibromyalgia?
- 1st line is amitriptyline (tricyclic antidepressant) to manage the pain.
- Evidence that opioids help is limited.
- Education, exercise, CBT when improvements with pharmacological therapy has been established.
123
What is the treatment for a DVT?
Until DVT confirmed/ruled out:
- apixaban (1st line)
- If not tolerated, offer LMWH (2nd line).
When confirmed:
- Continue apixaban
- Encourage mobilisation as soon as possible.
- Compression stockings.
124
What is the treatment for ALL?
Chemotherapy:
- Prednisolone (corticosteroid) AND cyclophosphamide (immunosuppressant) AND vincristine (alkaloid chemo drug) AND doxorubicin (anthracycline antibiotic).
- Potentially use methotrexate (antimetabolite immunosuppressant) depending on type of AML.
125
What is the treatment for CLL?
If asymptomatic, watch and wait.
When symptomatic:
- Chemotherapy.
CLL is incurable.
126
What is the treatment for AML?
- Chemotherapy
| - For severe/relapsing AML, consider stem cell transplant.
127
What is the treatment for CML?
If in chronic stage, 1st line is imatinib (tyrosine kinase inhibitor).
When blast phase/acute phase reached, chemotherapy is 1st line.
128
What is the treatment for non-Hodgkins lymphoma?
- Chemotherapy + radiotherapy.
129
What is the treatment for Hodgkin's lymphoma?
- Radio + chemo (often doxorubicin).
As disease progresses, treatment will be made more aggressive.
130
What is the treatment for malaria?
If infection is with plasmodium falciparum:
- Quinine sulfate + doxycycline (as will usually be resistant to chloroquine).
- Chloroquine phopshate if not resistant.
If malaria infection is caused by another pathogen:
- Chloroquine is first line.
131
What is the treatment for thalassaemia?
- If iron too high: desferrioxamine
- Blood transfusions if required.
IF THALASSAEMIA SEVERE, USE BONE MARROW TRANSPLANT!
