What should I prescribe? Flashcards
Primary hypertension with type 2 diabetes
Primary hypertension without diabetes, <55 and not black
1- ACEi or ARB
2- ACEi or ARB + CCB or thiazide-like diuretic
3- ACEi or ARB + CCB + thiazide-like diuretic
+offer lifestyle advice
use clinical judgement for pts with frailty or multimorbidity
Primary hypertension without diabetes and >55
Primary hypertension without diabetes and black
1- CCB
2- CCB + ACEi or ARB or thiazide-like diuretic
3- ACEi or ARB + CCB + thiazide-like diuretic
+offer lifestyle advice
use clinical judgement for pts with frailty or multimorbidity
Step 4 treatment of resistant hypertension (if BP not controlled on optimal tolerated doses)
If the person is already taking three antihypertensive drugs and blood pressure is not controlled (resistant hypertension), consider adding spironolactone if blood potassium level is 4.5 mmol/L or lower.
Monitor renal function and sodium and potassium within a month of commencing treatment and repeat as needed.
Alpha and beta blockers should be considered instead if high [K+]
Chronic HF
(aims: reduction in symptoms, managed increase in exercise tolerance, address comorbidities (arrhthymias, hyperlipidemia, diabetes) increase quality of life and slow progression of HF)
Correct underlying cause e.g. valve repair/angioplasty
Non-pharm: reduce salt and liquid intake , avoid salt substitutes as can cause hyperK
Pharm: Diuretics e.g. furosemide
HFpEF
Offer Diuretics e.g. furosemide
Offer personalised exercise based cardiac rehabilitation programme
HFrEF
Offer diuretics e.g. furosemide
Offer ACEi (or ARB if intolerant) and BB
an MRA e.g. spiranolactone
Acute HF
IV nitrates, sympathetic ionotropes
H. pylori
Triple therapy:
PPI (e.g. omeprazole) and two antibiotics (typically metronidazole and tetracycline)
Leicester guidelines are clarithromycin and amoxyxillin/metronidazole if penicillin allergic
Asthma first line
Step 1: SABA e.g. salbutamol “reliever”
Step 2: Low-dose inhaled corticosteroids “preventer”
Acute, severe and life-threatening asthma
O2
High dose nebulised B2 agonist (salbutamol)
Nebulised ipratropium bromide
Oral steroids e.g. prednisolone
Consider i.v. aminophylline if life threatening and no success with above
Wolff-Parkinson-White Syndrome
Flecainide
(Amiodarone)
Avoid AV node blocking drugs as can cause VF
T2DM
1st line - Metformin
Arterial thrombi
Rich in platelets so anti-platelet therapy (low in fibrin, usually form at site of atherosclerosis)
Secondary prevention post MI
Lifestyle modifications - diet, exercise smoking cessation
Cardiac rehab
Medical:
- ACEi e.g. Ramipril 10mg (improves cardiac remodelling of heart, reduces BP)
- Duel anti-platelet: aspirin (lifelong) + clopidogrel (12 months)
- Beta blocker e.g. Bisoprolol 5mg (prevents arrhythmia and lowers BP)
- Statin e.g. altorvastatin 80mg
Acute exacerbation of COPD
Nebulised salbutamol and/or ipratropium
Air driven if hypercapnic/acidotic
Oral steroids
Antibiotics
Benign paroxysmal positional vertigo
Epley manoeuvre to treat - shifts crystals away from stereocillia
Presents with vertigo only
Short lived episodes (seconds) triggered by movement of head
Dix-Hallpike test to diagnose
Meniere’s disease
Symptomatic control with:
- prochlorperazine, which helps relieve severe nausea and vomiting
- antihistamines, which help relieve mild nausea, vomiting and vertigo
Vertigo, hearing loss and tinnitus (typically unilateral)
Also aural fullness, N&V
Longer lasting symptoms - 30 mins up to 24 hrs)
Recurrent episodes and hearing may deteriorate over time
Thought to be due to increased fluid pressure in inner ear but not fully understood
Central retinal artery occlusion
Ocular massage - try to dislodge thrombus but not strong evidence it works
Sudden painless loss of vision in one eye developing over seconds - due to embolus causing occlusion
Cherry red spot (macula - thinner so well perfused choroid shows through) on fundoscopy - pale retina due to ischemia (pallor)
Open-angle glaucoma
Prostaglandin analogue eye drops (e.g. latanoprost), may need surgery
Chronic - most common
Trabecular network deteriorates with age
Mainly asymptomatic - picked up on routine eye tests
Increased IOP -> optic disk cupping
Gradual loss of peripheral vision
Optic nerve damage secondary to raised IOP
Closed-angle glaucoma
Drugs to reduce IOP then surgery
Acute - less common
Narrowing of the iridocorneal angle
Ophthalmological emergency -> sight threatening
Acutely painful red eye, irregular oval-shaped pupil (fixed), blurring of vision, halo’s around lights (due to corneal oedema), N&V
AF
Rate control to slow conduction through AV node and reduce HR
1st line - Bisoprolol
Verapamil if asthma
Rhythm control to keep in normal rhythm
- Sotalol
- Flecainide
Ectopic beats (aka atrial tachy)
1st line - Bisoprolol
Ca channel blockers if asthmatic
Sinus tachy
1st line - Ivabradine - no drop in blood pressure
2nd - Bisoprolol
Verapamil if asthma
Intestinal volvulus
Surgery - emergency
Sigmoid colon most commonly affected but also seen in caecum
Increased in children with intestinal malrotation -> improper anchoring of intestines to posterior abdo wall
When colon twists around mesentry
Coffee bean sign in sigmoid
Caused by: constipation, high fibre diet
S&L bowel obstruction
CT abdo and pelvis
Ventricular Tachy
Without haemodynamic instability (/low risk) - IV Amiodarone
High risk - DC Cardioversion
Torsades de pointes
IV magnesium sulphate
High risk bradycardia
IV atropine
Supraventricular tachy
1- Valsalva manoeuvre (blow through tube)
2- Carotid sinus massage
3- IV Adenosine or verapamil
4 - DC cardioversion
Sinus tachy
Propranolol or bisoprolol
Stress urinary incontinence
Duloxetine
(combined seratonin and NA uptake inhibitor - increases storage phase)
Urge urinary incontinence
1st line - Oxybutynin (Muscularinic anticholineric)
Alternative - Mirabegron (Beta-3 adrenoceptor agonist)
