10 Complex patients

Question 1

what is the difference between co and multi morbidity

Answer 1

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.

Question 2

STEMI +Heart Failure+ Depression

Answer 2

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

Question 3

AF + Hypothyroid or Hyperthyroid

Answer 3

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

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

Question 4

Hypertension + Diabetes + STEMI

Answer 4

Managment of diabetes in acute illness

beta blockers mask hypos

Question 5

Asthma + Heart failure

Answer 5

beta agonist v beta blockers

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

Question 6

COPD + UC / Crohn’s

Answer 6

increased steroid requirements - cushings?

Smoking is protective in UC but bad for COPD

Question 7

RA + COPD

Answer 7

can they use inhalers

Question 8

Parkinson’s Disease + Dementia

Answer 8

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

Question 9

Diabetes + Neuropathic pain + Depression

Answer 9

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

Question 10

Diabetes + Heart failure + CKD

Answer 10

dose adjustment nightmare

Question 11

Osteoporosis + CKD

Answer 11

must use activated vitamin D.

Benifits vs risks or treatment

Question 12

Diabetes + Idiopathic thrombocythaemia (↑platelets) + Leg ulcers

Answer 12

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

Question 13

Hypertension + AF + Risk of falls

Answer 13

Anticoagulation vs risk associated with falling.

Benefit v risk.

Question 14

10 steps so appropriate prescribing

Answer 14

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?

Question 15

Continuation of medicines questions

Answer 15

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?