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
RA + 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?
Can the patient use it?
Interactions – drug/drug?
Interactions – drug /disease?
Duplication of pharmacology?
Course? Or long term?
Value for money?