YEAR 4 NOTES Flashcards
ecoli
gram negative rod (haemolytic uraemic syndrome)
staph
gram positive coccus
strep
gram positive coccus
neisseria
gram negative coccus
moraxella
gram negative coccus
Actinomycetes
gram positive rod
bacillus cereus / anthrax
gram positive rod
clostridium
gram positive rod
diphtheria
gram positive rod
Listeria
gram positive rod
pseudomonas
gram negative rod
h/influenzae
gram negative rod
salmonella
gram negative rod
shigella
gram negative rod
campylobacter
gram negative rod
Ca125
Ovarian cancer
Ca 19-9
Pancreatic
Ca15-3
Breast cancer
PSA
prostate carcinoma
Alpha fetoprotein
HCC / teratoma
Carcinoembryonic antigen CEA
Colorectal
S100
Melanoma / schwannoma
Bombesin
SCLC / gastric cancer / neruoblastoma
Raised h-bCG + raised AFP
Nonseminomas testicular cancer
Raised b-hCG and normal AFP
Seminoma testicular cancer
things that can raise a Ca 125
○ Cervical adenocarcinoma ○ Endometrial carcinoma ○ Fallopian tube cancer ○ Heart failure ○ Hypothyroidism ○ Liver cirrhosis with severe necrosis ○ Non-Hodgkin’s lymphoma ○Pleural effusion
Conns syndrome
Low K+ and Normal/ high Na+
Addisons
Hyperkalaemia metabolic acidosis
Cushing’s disease
Hypokalaemic metabolic alkalosis
Ix findings in SIADH
U+E = hyponatraemiaUrinary sodium / osmolaltiy will be HIGHSerum osmolality = LOWBUT EUOVOLEMIC –> normal BP + skin turgor etc
How slow should you replace sodium in SIADH and why
10 mmol/l per 24 hoursto prevent central pontine myelinolysis
SIADH causes mnemonic
S - surgeryI - intracranial –> infection (meningitis) / CVAA - Alveolar –> malignancy / pus (atypical pneu or TB)D - Drugs –> thiazide diuretics, carbamazepine, vincristine, cyclophosphamide, antipsychotics, SSRIs, NSAIDSsH - Head injury
FLuid restriction in SIADH
500-1000ml
Oxycodone generally causes compared to morphine
less sedation / vomiting / pruitus than morphine BUT more constipation
oral codeine to oral morphine conversion
divide by 10
oral tramadol to oral morphine conversion
divide by 10
oral morphine to oral oxycodone conversion
divide by 1.5 (to 2 but bnf says 1.5)
transdermal fetanyl 12 mcg patch equals
approx 30mg oral morphine daily
transdermal buprenoprhine 10 mcg patch equals
approx 24mg oral morphine daily
when increasing dose of opiods - next dose should be increased by
30-50%
for metastatic bone pain strong opiods PLUS
bisphopshonates / radio / denosumab may be used
breakthrough dose of morphine is
1/6th the daily dose
all pts prescribe dopioid should be coprescribed a
laxative
opioids in CKD
use w caution:- oxycodone preferred in palliative pts with mild-mod pain- if renal impairment severe , alfentanil / buprenorphine / fentanyl preffered
when prescribed an opioid if they get nausea
advise it is often transient –> if persists offer an antiemetic
when prescribed an opioid if they get nausea
advise it is often transient –> if persists offer an antiemetic
CAP in alcoholics
klebsiella –> (klepSTELLA)
most common cause of CAP
strep pneumoniae
CAP assoc w erythema multiforme / haemolytic anaemia / ITP and diagnosed by serology
Mycoplasma pneumonia
CAP assoc w lymphopenia and hyponatraemia, recently holdica (or AC units) and diagnosed by urinary antigen
Legionella pneumophila
how to work out anion gap
(Na + K) - (Cl + HCO3)
normal anion gap
10-18 mmol/L
Causes of normal anion gap mneumonic
HARDASS
HARDASS stands for
H- hyperalimentationA - AddisonsR- Renal tubular acidosisD - diarrhoeaA - AcetazolamideS - SpirinolactoneS- saline infusion
Mnemonic for raised anion gap metabolic acidosis
A CAT MUDPILES
A CAT MUDPILES
A- AspirinC - Cyanide, carbon monoxideA - Alcoholic ketoacidosisT - TolueneM - Methanol, metforminU - UraemiaD - Diabetic ketoacidosisP - Phenformin, pyroglutamic acid, paraldehyde, propylene glycol, paracetamolI - Iron, isoniazidL - Lactate (numerous causes)E - Ethanol, ethylene glycolS - Salicylates
alpha 1 agonist
decongestant e.g. phenylephrine / oxymetazoline
alpha 2 agonist
glaucoma Tx e.g. topical brimonidine
alpha antagonist
BPH - tamsulosinHTN - doxazosin
beta 1 agonists
inotropes e.g. dobutamine
beta 1 blockers
non selective + selective bblockers e..g atenolol / bisoprolol
beta 2 agonists
bronchodilators e.g. salbutamol
b 2 antagonists
nonselective bblockers e.g. propanolol / labetalol
dopamine agonists
parkinsons disease - ropiniroleprolactinoma
dopamine antagonists
antipsychotics - haloperidolantiemetics - metoclopramide / domperidone
GABA agonist
benzodiapines baclofen
GABA antagonists
flumazenil - reversal of benzos
histamine 1 antagonists
antihistamines e.g. loratidine
histamine 2 antagonists
antacids - ranitidine
muscarininc agonist
glaucoma e.g. pilocarpine
muscarinic antagonist
atropine - bradycardiabronchodilator - ipatroprium bromide / tiotropiumurge incontinence - oxybutinin
nicotonic agonist
nicotinevareniciline - used for smoking cessationdepolarising muscle relaxant = suxamethonium
nicotonic antagonist
nondepolarising muscle relaxants - atracurium
oxycotin agonist
inducing labour - syntocinon
oxycotin antagonist
tocolysis e.g. atosiban
serotinin agonist
triptans e.g. zolmitriptan
serotinin antagonists
antiemetics - ondasteron
MEN1 syndrome
the 3 Ps- parathyroid ( hyper due to parathyroid hyperplasia)- pituitary - pancreas –> insulinoma / gastrinoma
MEN1 genetics
MEN1 gene
most common presentation of MEN1
hypercalcaemia
MEN2a syndrome
Medullary thyroid cancer AND the 2Ps- parathyroid- phaechromocytoma
Men2b syndrome
Medullary thyrpoid cancer and 1 P- phaechromocytomas(+ marfanoid body habitus and neuromas)
MEN2a genetic component
RET oncogene
MEN2b genetic component
RET oncogene
genetics in Lynch syndrome
Mismatch repair gene defect - MHS1/2
FAP genetics
APC mutation
liver mets usually come from
colorectal cancer
SCLC is a
central lung cancer (not in apices)
type of lung cancer seen more often in nonsmokers
adenocarcinoma
pernicious anaemia predisposes to
gastric cancer
right sided murmur heard best on
inspiration
Left sided murmur heard best on
expiration
holo/pansystolic
mitral / tricuspid regurg (high pitched and blowing)VSD (harsh)
aortic stenosis
ejection systoliclouder on expiration
pulmonary stenosis
ejection systoliclouder on inspiration
late systolic
mitral valve prolapse
aortic regurg
early diastolic high-pitched and ‘blowing’ in character)
mitral stenosis
mid-late diastolicrumbling in character
.
learn it bitch xoxox
head bobbing is a sign of
aortic regurg
Mitral stenosis is typically caused by
rheumatic fever
acute relapse Mx
high dose steroids for 5 days to shorten course(don’t affect degree of recovery just length of flare)
Indications for DMARDs
- relapsing remitting disease + 2 relapses in past 2 years + ablte to walk 100m unaided- secondary progressive disease + 2 relapses in past 2 yrs + able to walk 10 (aided/unaided)
Natalizumab
- monoclonal antibody –> antagonises integrin on surface of leukocytes- inhibit migration of leucocytes across endothelium into blood brain barrier- used first line (best evidence base) - given IV
Ocrelizumab
- humanised antibody CD20 monoclonal antibody- often used first line too- given IV
fingolimod
- S1P receptor modulator- prevents lymphocytes leaving lymph nodes- oral forms available
Mx of fatigue
- amantadine- other options = mindfulness / CBT
Spaciticity Mx
- baclofen and gabapentin first line- physio is important
Bladder dysfunction Mx
- in form of urgency / incontinence / overflow- get USS to assess bladder emptying- if signic residual volume = intermittent self catheterization- if no signif residual volume = anticholinergics
HLA-B27
ankylosing spondylititsreactive arthritis
HLA-DQ2/8
coeliac disease
HLA-A3
haemochromatosiss
HLA-DR2
narcolepsygoodpastures syndrome
HLA-DR3
dermatitis herperitiformissjorgens syndromeprimary billiary cirrhosis
HLA-DR4
T1DMRA
Anti-Jo1
Polymyositis and dermatomyositis
Anti centromere
limited systemic sclerosis - aka CREST
Anti-Scl-70
diffuse systemic sclerosis
Anti-Ro
Sjorgens
Anti-RNA polymerase III
nonspecific for systemic sclerosis- more a marker of renal involvement
antihistone
drug induced lupus
ANA
SLE
ANCA
various vasculitises
AMA
PBC
Ank spond MX
DMARDs found not to be useful –> form NSAIDs skip straight to biologics like etanercept / infliximab
etanercept and infliximab are Egs of
tnf alpha blockers
cANCA
granulomatosis w polyangiitis
granulomatosis w polyangiitis Fx
ent stuff (sinusitis etc) + resp + kidney
amoxicillin
rash if have glandular fever
Co-amoxiclav
cholestasis
flucloxacillin
cholestasis –>wks after use
Erythromycin
long QTGI upset
Ciprofloxacin
Lowers seizure thresholdTendonitis
Metronadizaole
Reaction following alcohol ingestion
Doxycycline
photosensitivity and N+V
Trimethoprim
Rashes, including photosensitivityPruritusSuppression of haematopoiesis
gentamicin
ototoxicitiy and nephrotoxcitiy
Hep A presents as
- flu like Sx- RUQ pain- tender hepatomegaly- deranged LFTs
Metoclopramide
Dopamine (D2) receptor antagonists should be used in palliative care for nausea and vomiting that is due to gastric dysmotility and stasis
Levomepromazine
broad-spectrum anti-emetic useful for mechanical obstruction, and for persistent nausea and vomiting uncontrolled by other anti-emetics
Ondanestron
serotonin antagonist anti-emetic which is used for nausea and vomiting related to chemotherapy and radiotherapy as well as for post-operative nausea and vomiting
for migraine nausea
metoclopramide –> gastric stasis
how to work out alcohol units
volume (ml) * ABV / 1,000
Clarithromycin contrindicated w
STATINS –> increased risk of rhabdomyolysis
CML causes
M -assive splenomegaly
CLL causes
L - lymphadenopathy
metformin titration
slowly! leave at least 1 wk between change of dose
if someone bad GI SE w metformin
try MR before swapping
osmotic laxatives MOA
increase amount of fluid in bowel –> therefore soften stool
Osmotic laxatives e.g.
lactulose / movicol
Stimulant laxatives MOA
stimulate bowel to contract –> thus expel faeces
Stimulant laxatives e.g.
senna / picosulphate
Bulk forming laxatives MOA
help stool retain water and thereby soften stool
Bulk forming e.g.
Ispaghula husk
Rectal meds e.g.
glycerin supppository (stimulant)phosphate enema (stimulant)
Pts w chronic constipation will benefit from
stool softening laxative (movicol / lactulose) but may need glycerin suppositories initially n rectal stool
Pts w post op ileus / opiod induced constipation / soft stool will benefit from
stimulant laxatives e.g. senna or picosulphate
prophylactic laxatives should be given to
pts w opiod analgesia –> esp elderly (stimulant laxative)
Used to determine the need to anticoagulate a patient in atrial fibrillation
CHA2DS2-VASc
Prognostic score for risk stratifying patients who’ve had a suspected TIA
ABCD2
HF severity score
NYHA
Measure of disease activity in rheumatoid arthritis
DAS28
A scoring system used to assess the severity of liver cirrhosis
Child-Pugh classification
DVT Risk
Wells score
cognitive impairment assessment
MMSE
MH scoring
HAD / PHQ9 / GAD7
Alcohol screening tools
AUDIT / CAGE / FAST
Prognosis of pneumonia
CURB65
assess of suspected OSA
Epworth sleepiness scale
Prostate Sx scoring
IPSS
Prognositc indicator of prosate cancer
Gleason score
Risk of pressure sore assessment
Waterloo score
10 yr risk of osteoporotic related fracture
FRAX
Acute pancreatitis scoring
Ranson criteria
Malnutrition screening
MUST
Infective endocarditis
Modified dukes criteria
ovarian cancer risk
Risk of malignancy index-Ca125 number + menopausal (1=pre/3= post) + USS score depending on number of Fx(0 = none , 1=1 , 3= 2+ features)
ECOG status
deciedes how well pt is –> deciede between active and passive
Grade mitotic rate of cancer cells (how quick it is growing)
Ki-67 index
measures disability or dependence in activities of daily living in stroke patients
Barthel index
Cyanide Mx
Hydroxycobalamin + sodium nitrite/thiosulphate
Carbon monoxide Mx
100% O2
Iron overload
Desferrioxamine
Digoxin tox Mx
DIgoxin specific antibody fragments ( digibind)
Organophosphate (insecticide) poisoning
Atropine
Methanol poisoning
fomepizole / ethanol PLUS haemodialysis
Ethylene glycol Mx
Fomepizole / haemodialysis
BBlocker OD
bradycardia = atropineresistant cases = glucagon
Lithium toxicity
mild mod = volume resus w salinesevere = haemodialysis?sometimes sodium bicarb?
TCA OD Mx
IV bicarb = reduce risk of seizure / arrhythmias
Benzo OD Mx
Flumenazil (risk of seizure w this so often managed supportively only)
Opiod OD Mx
Naloxone
Salicyate OD Mx
Urinary alkilization w IV bicarbhaemodialysis
paracetamol OD presenting 8-24 hrs later taken more than _____ to treat w NAC, before plasma levels
150mg/kg
Dabigatran MOA
direct thrombin(factor IIa) inhibitor
Dabigatran excretion + antidote
maj renal + idarucizumab
RIvaroxaban MOA
Direct factor Xa inhibitor
RIvaroxaban excretion + antidote
Maj liver + andexanet alpha (but it ain’t gr8)
Apixaban MOA
Direct factor Xa inhibitor
Apixaban excretion + antidote
Maj faecal + andexanet alpha (not gr8 tho)
aplastic crisis has
low reticulocytes
Sequestration crisis has
high reticulocytes
FAB classification is for
AML –> shows what Fx seen on blood film
JAK2 mutation
polycythaemia rubra vera
Philadelphia chromosome
t(9:22)
ALL gentics
philadelphia chromosome
Auer rods suggest
APML
APML genetics
t(14:17)
Down syndrome is assoc w
ALL
smear / smudge cells indicative of
CLL
RIchters transformatio
CLL to a high grade lymphoma
ALL blood film shows
blast cells
CML genetics
philadelphia chromosome t(9:22)
AML blood film
blast cells and Auer rods
Lymph node biopsy hodgkin lymphoma
Reed-sternburg cells
Reed sternburg cells are
abnormally large B cells that have multiple nuclei that have nucleoli
CML Tx
Imatinib = tyrosine kinase inhibitor
Type 1 hypersensitivity
IgE mediated - mast cells
Type 2 hypersensitivity
IgG and IgM antibodies
Type 2 hypersensitivity e.g.
blood transfusion reaction / haemolytic disease of newborn / goodpastures syndrome
Type 3 hypersensitivity e.g.
RA / farmers lung
Type 3 hypersensitivity
Antibody-antigen complexes
Type IV hypersensitivity
T cell mediated
Type IV hypersensitivity
Nickel and gold / mantoux test / GVHD
incubation period of malaria
1-4 wks
IV Tx of mod-severe malaria
artensuate + quinine
How to get a diagnosis of malaria
- malaria blood film (sent in EDTA bottle)3 samples over 3 days to catch in 48hr life cycle of the parasite
whats the worst malaria
palmodium falciprum
Malaria prophylaxis options
progunail and atovaquonemefloquinedoxycycline
Proguanil and atovaquone as malaria prophylaxis
AKA MALARONE- Taken daily 2 days before, during and 1 week after being in endemic area- Most expensive (around £1 per tablet)- Best side effect profile
Mefloquine as malaria prophylaxis
- Taken once weekly 2 weeks before, during and 4 weeks after being in endemic area- Can cause bad dreams and rarely psychotic disorders or seizures
Doxycycline as malaria prophylaxis
- Taken daily 2 days before, during and 4 weeks after being in endemic area- Broad-spectrum antibiotic therefore it causes side effects like diarrhoea and thrush- Makes patients sensitive to the sun causing a rash and sunburn
MRSA carrier Tx
nose: mupirocin 2% in white soft paraffin, tds for 5 daysskin: chlorhexidine gluconate, od for 5 days. Apply all over but particularly to the axilla, groin and perineum
how to MRSA screening
charcoal swabsnasal swab and skin lesions or woundsthe swab should be wiped around the inside rim of a patient’s nose for 5 secondsthe microbiology form must be labelled ‘MRSA screen’
who should be screened for MRSA
all elective and emergency admissions
Ix for syphilis
(serological tests!!!)NON TREPONMONAL TESTS- not specific for syphilis, therefore may result in false positives- based upon the reactivity of serum from infected patients to a cardiolipin-cholesterol-lecithin antigen- assesses the quantity of antibodies being produced- becomes negative after treatment- examples include: rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL)TREPONMONAL SPEIFIC TESTS- more complex and expensive but specific for syphilis- qualitative only and are reported as ‘reactive’ or ‘non-reactive’- examples include: TP-EIA (T. pallidum enzyme immunoassay), TPHA (T. pallidum HaemAgglutination test)
confusion screen blood tests
Full blood countCRPU&EsBone profileB12 & FolateThyroid function testsGlucoseLFTsCoagulation/INR
confusion screen imaging
ct head
metformin SE
diarrhoea and abdo pain
metformin class
biguanide
metformin MOA
increase insulin sensitivity and decrease liver glucose production
pioglitazone class
thiazidiolines
pioglitazone SE
weight gain , fluid retention, BLADDER CANCER
pioglitazone MOA
increase insulin sensitivity and decrease liver glucose
gliclazide class
sulphonurea
gliclazide MOA
increase insulin release
Gliclazide SE
weight gain, HYPOS
sitagliptin class
DPP4 inhibitor
Sitagliptin MOA
increases incretins (which inhibit glucagon storage)
Sitagliptin SE
GI upset weight neutral
empagliflozin MOA
makes you wee out glucose
empagliflozin class
SGLT2 inhib
Empagliflozin SE
UTI / thrush, wloss
Exanatide MOA
incretin mimetic
Exanatide class
GLP1 mimetic
Exanatide SE
Wloss! but INJECTABLE
causes of liver cirrhosis
-alcoholic liver disease-nonalcoholic liver disease-hep b -hep c
monitoring of cirrhosis for HCC
6 monthly USS and AFP levels
first line for assessing NAFLD
ELF –> enhanced liver fibrosismeasures 3 markers to grade severity of cirrhosis
USS appearance in fibrosis
- Nodularity of the surface of the liver- “corkscrew” appearance to the arteries with increased flow as they compensate for reduced portal flow- Enlarged portal vein with reduced flow- Ascites- Splenomegaly
Screening for high risk of fibrosis
Fibro scan = transient elastography- measures elasticity using sound waves- retesting every 2 yrs in those w high risk
Those considered high risk for liver fibrosis
- Hepatitis C- Heavy alcohol drinkers (men drinking > 50 units or women drinking > 35 units per week)- Diagnosed alcoholic liver disease- Non alcoholic fatty liver disease and evidence of fibrosis on the ELF blood test- Chronic hepatitis B (although they suggest yearly for hep B)
endoscopy use in liver cirrhosis
assess any varices w portal HTNshould be done every 3 yrs
Whats in the child pugh score
BilirubinAlbumin INRAscitesencephalopathy
WHat is the MELD score
to be done every 6 months in pts w compensated cirrhosisto assess requirement for dialysisuses bilirubin, creatinine, INR and sodiumGives a 3 mnth mortality –> guides transplant refferal
Mx of ascites
Low sodium dietspirinolactoneParacentesis (ascitic tap or ascitic drain)Prophylactic antibiotics against SBP (ciprofloxacin or norfloxacin) in patients with less than 15g/litre of protein in the ascitic fluidConsider TIPS procedure in refractory ascitesConsider transplantation in refractory ascites
Mx of hepatic encephalopathy
- Laxatives (i.e. lactulose) promote the excretion of ammonia, aim is 2-3 soft motions daily, may require enemas initially- Abx reduce number of intestinal bacteria producing ammonia, Rifaximin is useful as it is poorly absorbed so stays in the GI tractNutritional support –>may need nasogastric feeding
WHat is the MELD score
to be done every 6 months in pts w compensated cirrhosisto assess requirement for dialysisuses bilirubin, creatinine, INR and sodiumGives a 3 mnth mortality –> guides transplant refferal
Sx of hypercalcaemia
- Renal stones- Painful bones- Abdominal groans refers to symptoms of constipation, nausea and vomiting- Psychiatric moans refers to symptoms of fatigue, depression and psychosis
Primary hyperthyroidism is caused by
uncontrolled parathyroid hormone produced directly by a tumour of the parathyroid glands
Mx of primary hyperparathyroid
surgical removal of tumour
Secondary hyperparaythoid is caused by
CKD or vit D deficiencyparathyroid glands reacts to the low serum calcium by excreting more parathyroid hormone –> Over time the hyperplasia cos need to produce more PTH to keep calcium right
Labs in secondary hyperparathyroid
-Ca = low/normal-PTH = high
what causes tertiary parathyroid
secondary for long time –> permanent hyperplasiawhen initial cause of secondary fixed PTH remains highmeans hypercalcaemia
The rule of Es is
Excessive PTH results in excessive phosphate excretion
upper zone fibrosis
CHARTSC - Coal worker’s pneumoconiosisH - Histiocytosis/ hypersensitivity pneumonitisA - Ankylosing spondylitisR - RadiationT - TuberculosisS - Silicosis/sarcoidosis
recommended weekly intake
14 units
spread drinking over
3 days if going up to 14 units
14 units is equal to
6 normal strength beersor 10 small glasses of low percentage wine
steps of cxr
Airway: trachea, carina, bronchi and hilar structuresBreathing: lungs and pleuraCardiac: heart size and bordersDiaphragm: including assessment of costophrenic anglesEverything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas
RIPE stands for
rotation –> spinous process in line w vertebral bodies AND clavicle equidistant from spinous processInspiration –> 5-6 anterior ribs, lung apices, both costophrenic angles and the lateral rib edges should be visible.Projection –> AP or PA (if shoulderblades in chest = AP)Exposure –> vertebrae visible behind heart
Sail sign
L Lower lobe collapse
things to say in A of CXR
trachea –> central?carina + bronchi –> (does NG tube disect carina)hilar region –> any adenopathy / symmetrical / enlargement?
things to say in B of CXR
lung fieldspleura
things to say in C of CXR
size - cardiothoracici ratio of less than 0.5borders - reduction in definition suggests consolidation
things to say in D of CXR
free gascostophrenic angles
things to say in E of CXR
aortic knucle / aortopulmonary window bonessoft tissuestubes / valves / pacemakers
Abdo xray approach
Exposure + projectionB - bowel and other organsb - bonesc - calcification
B(ow) for AXR
small bowel –> valvulae conniventes obstruction = coiled spring appearancelarge bowel = haustradilated?sigmoid = coffee beancaecal = looks like foetus3/6/9 rule - small / large / caecumriglers sign = double walled = pneumopertioneum
Fx of IBD on AXR
Thumbprinting: mucosal thickening of the haustra due to inflammation and oedema causing them to appear like thumbprints projecting into the lumen (wall of whiter bit looks poked in)Lead-pipe (featureless) colon: loss of normal haustral markings secondary to chronic colitisToxic megacolon: colonic dilatation without obstruction associated with colitis.
B(on) Fx of AXR
RibsLumbar vertebraeSacrumCoccyxPelvisProximal femursSclerotic / lytic lesions!!!Fractures
C Fx on AXR
Calcified gallstones in the right upper quadrantRenal stones/staghorn calculiPancreatic calcificationVascular calcificationCostochondral calcificationContrast (e.g. following a barium meal)Surgical clipsJewellery
for ?NOF fracture imaging
XRAY AP pelvisXRAP R/L lateral hip
confusion imaging clinical details
“to rule out reversible cause”
Mx of pulmonary fibrosis
O2/rehab/morphinepirfinedone –> antifibrotic and antiinflammNintedanib –>monocolonal antibody targeting TKI nausea + photosensitivity
OA Mx
up the pain ladderoral paracetamol + topical ibuprofenopioids arent effective against chronic pain + cause tolerancejoint replacement can be sought after
angina baseline Mx
GTN aspirin statin
Angina first line
either BBlocker or CCB (pt choice)
if monotherapy don’t work add both together but
NEVER BBLOCKER W VERAPAMIL
third line
long acting nitrate / nicorandil / ivabradine BUT ONLY whilst waiting for CABG or PCI
calcineurin inhibitors
ciclosporin or tacrolimus
antimetabolite immunospuresion
mycophenolate mofetil / azaithioprine