10 Complex patients Flashcards Preview

Clinical > 10 Complex patients > Flashcards

Flashcards in 10 Complex patients Deck (15):

what is the difference between co and multi morbidity

Multi-morbidity is generally considered to be the presence of more than one long-term condition;
Co-morbidity is a long-term condition that exists in the presence of another long-term condition.


STEMI +Heart Failure+ Depression

antudepressants in CV disease - drug srug interactions
aspirin + SSRIs is bleed risk
PPIs + SSRI cause low sodium in the lederly


AF + Hypothyroid or Hyperthyroid

Amioderone - thyroid effects.
If hypo then treat,
if hyper stop amiodarone

OR is AF caused by the hyperthyoidism/overtreatment of hypothyroidism?


Hypertension + Diabetes + STEMI

Managment of diabetes in acute illness
beta blockers mask hypos


Asthma + Heart failure

beta agonist v beta blockers

use a cardio selective beta blocker, you may still need to up the step of asthma treatment


COPD + UC / Crohn’s

increased steroid requirements - cushings?

Smoking is protective in UC but bad for COPD



can they use inhalers


Parkinson's Disease + Dementia

conflicting pharmacology -treating one worsens the other. Consider what patient needs treating more


Diabetes + Neuropathic pain + Depression

TCA use higher depression dose and hope it works for pain. Caution they may end up on both.


Diabetes + Heart failure + CKD

dose adjustment nightmare


Osteoporosis + CKD

must use activated vitamin D.
Benifits vs risks or treatment


Diabetes + Idiopathic thrombocythaemia (↑platelets) + Leg ulcers

Ulcer the side effect of treatment for IT or consquence of poor diabetes control


Hypertension + AF + Risk of falls

Anticoagulation vs risk associated with falling.

Benefit v risk.


10 steps so appropriate prescribing

Indication for drug
Is it working?
Correct dose?
Clear directions?
Can the patient use it?
Interactions – drug/drug?
Interactions – drug /disease?
Duplication of pharmacology?
Course? Or long term?
Value for money?


Continuation of medicines questions

is the drug still needed?
has the condition changed?
can the pt continue to benifit?
has the evidence changed?
is the drug being used to treat an itraogenic problem?
what are the ethical issues of withholding care
would discontinuation cause problems?