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4th Year - Management > CCC - Primary Care > Flashcards

CCC - Primary Care Flashcards

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1
Q

Asthma - Management

A

1) Salbutamol
2) ICS (200mg)

3) LABA
- benefit = continue
- some benefit, continue and increase ICS to 800mg
- no benefit - stop, increase ICS, trial LTRA

4) ICS to 2000

5) Oral prednisolone
- Refer

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2
Q

Asthma Review

A
  • Smoking cessation
  • Inhaler technique
  • Symptom control (compliance)
  • Admissions
  • Exacerbations
  • Flu jab and PCV
  • Mood
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3
Q

Acute AF - Unstable

A

DC Cardioversion

Medical cardioversion: Amiodarone

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4
Q

Acute AF - Stable

A

Rate control:

  • Bisoprolol 2.5mg
  • Verapamil 40-120mg/8 hours

Anticoagulation with LMWH

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5
Q

Chronic AF - Rate control

A

Beta blocker

  • Atenolol
  • Not in asthma

Rate limiting calcium channel blocker

  • Verapamil/diltazem
  • Not in HF

Digoxin
- Only if sedentary life style

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6
Q

Chronic AF - Rhythm Control

A

ECHO

  • No structural abnormality - flecainide
  • Structural abnormality - amiodarone
  • Surgical ablation
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7
Q

Stable Angina - 1st Line

A 
Beta blocker 
- Bisoprolol 2.5mg
OR 
Rate limiting Calcium channel blocker 
- Diltiazem/verapamil

Long Acting mononitrate

  • Isosorbide mononitrate
  • May become tolerant

GTN Spray/sublingual tablet
- Symptom relief

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8
Q

Stable Angina - Secondary Prevention

A
  • Aspirin 75mg
  • ACEi if diabetic
  • Statin/hypertensive

Revascularisation

  • CABG
  • PCI (single vessel disease)
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9
Q

Stable Angina - Review

A

6 months - 1 year

  • Symptoms (rest, exercise, duration)
  • CVD risk
  • Modifiable risk factors
  • Medication r/v

SCREEN: Heart failure and depression

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10
Q

Q RISK 2 - Who?

A

Assess every 5 years

  • > 40 years
  • First degree relative with premature CVD or familial hyperlipidaemia
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11
Q

CVD - Modifiable risk factors

A
  • Diet
  • Smoking
  • Stress
  • Exercise
  • Alcohol
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12
Q

CVD - Primary Prevention

A

> 10% in 10 years
- Atorvastatin 20mg

BP

  • ACEi if diabetic
  • Follow ACD rule
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13
Q

CHA2DS2VASC

A 
Congestive heart failure
Hypertension
Age >75 (2) 65-74 (1)
Diabetes
Stroke/TIA/VTE
Vascular disease (MI, angina, peripheral vasc. disease)
Sex (Female = 1)

ANTICOAGULATE

  • Men @ 1+
  • Women @ 2+
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14
Q

HASBLED

A 
Hypertension >160
Abnormal renal (1), liver (1)
Stroke
Bleeding history
Labile INR
Elderly (>65)
Drugs
- Alcohol (8U/week) 
- NSAIDs/anti platelet
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15
Q

COPD - FEV >50% (mild-mod)

A

SABA,
SABA + LABA,
Combohaler (ICS/LABA) + LAMA

OR

SAMA
LAMA
COMBOHALER + LAMA

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16
Q

COPD - FEV <50% (severe)

A

SABA
SABA + COMBOHALER
COMBO-HALER + LAMA

or

SAMA
LAMA
COMBOHALER + LAMA

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17
Q

COPD - Extra Management

A

STOP SMOKING!!

Rescue Pack

  • Prednisolone 30mg 7 days
  • Amoxicillin 500mg 5 days
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18
Q

COPD - Review

A

6M (severe), 1Y (mild-mod)

  • Mood
  • Smoking cessation
  • Inhaler Technique
  • O2 sats, BMI
  • Medication
  • Exacerbations, admissions
  • Flu jab/PCV
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19
Q

CKD - Stages

A

1) >90 (normal)
2) 60-89
3a) 45-59
3b) 30-44
4) 15-29
5) <15

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20
Q

CKD - Stage 1-2 Management

A
  • Annual monitoring
  • ACEi
  • CV risk
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21
Q

CKD - Stage 3a and 3b Management

A
  • CVS Risk
  • Investigate proteinuria, haematuria, declining eGFR, young age
  • Decrease use of nephrotoxic drugs
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22
Q

CKD - Stage 4 Management

A
  • Urgent referral

- Medication review if eGFR <30

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23
Q

Diabetes - Education

A
  • Vaccinations
  • Exercise (increase insulin sensitivity)
  • Smoking cessation
  • Work (if on insulin, no army, machinery, driving)
  • Diet
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24
Q

Diabetes - Therapy

Study These Flashcards
A

Diet and lifestyle for 3 months

If HbA1c >6.5% = Metformin

> 7.5% - Dual therapy
- Metformin + one other

> 7.5% - Triple therapy
- Metformin + sulphonylurea + DDPIV/pioglitazone

Still >7.5%

  • Insulin
  • Aim for HbA1c <7.0
25
Diabetes - Therapy (Metformin contraindicated)
DPPIV/Sulphonylurea/pioglitazone Duel therapy - combo of any two Insulin (aim <7.0%)
26
Metformin
Biguanide - Increases insulin sensitivity, - Decreases gluconeogenesis GOOD - Weightloss, no hypos BAD - GI disturbance, can give MR preparation DO NOT USE IN eGFR <30
27
Sulphonylureas (Gliclazide)
- Increases production of insulin GOOD - Rapid improvement, good if low eGFR BAD - Weight gain, hypos
28
Pioglitazone
- Increases insulin sensitivity - Preserves beta cell function CONTRAINDICATIONS - Heart failure - Bladder Ca
29
DPP-IV Inhibitors (sitagliptin)
- Inhibits DPP-IV (which breaks down incretin) Increase Incretin = increases insulin, decreases gluconeogenesis
30
SGLT-2 (dapaglifozin)
- Reduce glucose transporter on proximal tubule - More glucose lost in urine BAD - polyuria, polydipsia, UTIs, Candida
31
Statins - Primary Prevention
Atorvastatin 20mg - QRISK2 >10% - T1DM - >40 years or diabetes >10 years - T2DM >10% qrisk - CKD
32
Statins - Secondary Prevention Dose
Atorvastatin 80mg (20mg in CKD)
33
Statins - Monitoring
- ALT/AST at 3M and 12M | - Cholesterol at 3M (aim for 40% reduction in HDL)
34
Hypertension - Diagnosis
Measure BP in both arms - >140/90 measure again - Ambulatory/home monitoring to confirm
35
Hypertension - Exam and Investigations
- Fundus - 12 Lead ECG - Urine (ACR and haematuria) Bloods - Glucose - UEs + eGFR - LFTs - Lipids
36
Hypertension - Staging
1 ) 135-150/ 85-90 2) >150/>90 3) >180/>110
37
Hypertension - Who to treat?
>80 years and stage 1 Stage 2 and above
38
ACD Rule
<55 years - ACEi - ACEi + Ca2+ Channel blocker - ACEi + Ca2+ Channel Blocker + Thiazide diuretic >55 years/afro carribean - Ca2+ Channel blocker - Ca2+ Channel blocker + ACEi (or ARB if afrocarribean) - Ca2+ Channel Blocker + ACEi/ARB + Thiazide diuretic Resistant - Add another diuretic/beta blocker
39
Epilepsy - General Seizures
- Absence - Tonic clonic (LOC, post ictal) - Myoclonic (drop to ground) - Atonic (fall, no LOC)
40
Epilepsy - Focal seizures
- Simple, no LOC - Complex, post ictal, impaired awareness - Focal -> generalised
41
Epilepsy - DVLA
Car - 1 year fit free HGV One off - 5 years, no meds Multiple - 10 years, no meds
42
Epilepsy - Safety
- Showers not baths - Do not swim alone - No climbing - Medic alert bracelet
43
Epilepsy - Drugs
Carbamezepine - P450 inducer Sodium Valproate - Teratogenic - p450 inhibitor Phenytoin - P450 inducer Lamotrigine - Safe in pregnancy
44
Heart Failure - Investigations
Previous MI - ECHO in 2 weeks No prior MI - BNP >400 = ECHO 2 weeks 100-400 - ECHO 6 weeks <100 - unlikely, reconsider Dx
45
NYHA Scoring
1 - no limitation 2 - comfortable at rest, SOB on exertion 3 - ordinary activity limited 4- SOB at rest
46
HF - 1st line
``` Beta blocker (bisoprolol) ACEi (Ramipril) Loop Diuretic (furusomide 40mg) ```
47
HF - 2nd Line
``` Aldosterone antagonis (sprinolactone) ARB (valsartan) ```
48
HF - Further management
- Cardiac rehab | - Implantable cardio defic in LV failure
49
Bamford Classification
1. unilateral hemiparesis/sensory loss of face arm and leg 2. homonymous heminopia 3. higher cognitive dysfunction
50
TACs and PACs
TACS - All 3 present - middle cerebral and anterior cerebral PACS - 2 of 3 present
51
LACS
Lacunar - internal capsule, thalamus and basal ganglia - unilateral deficit of arm/leg/face - ataxic hemiparesis - pure sensory stroke
52
POCS
- cerebellar/brainstem syndrome - LOC - Isolated homonymous heminopia
53
Thrombolysis
CT showing infarct - <4.5 hours - <3 hours if over 80 years Do CT 24 hours later to exclude haemorrhagic transformation of infarct
54
Thrombolysis contraindicated
300mg aspirin stat and for 2 weeks | - Clopidogrel 75mg OD lifelong
55
ABCD2 Score
Age >60 BP <140/90 Clinical - Weakness (2) - Speech disturbance (1) - Other (0) Duration - >60 (2) - 10-59 (1) - <10 (0) Diabetes
56
TIA Management (based on score)
``` >4 = TIA clinic in 24 hours <3 = TIA clinic in 1 week ``` Regardless 24hours: - AF - Warfarin - Crescendo TIA
57
TIA - Investigations
ECG to rule out AF
58
Stroke - Secondary prevention
- Clopidogrel 75mg - Atorvastatin 80mg (start 24 hours post) - Diet and lifestyle advice - ACEi according to ACD rule
59
Stroke - DVLA
Do not drive for 1 month NEVER if neglect/visual field defect

4th Year - Management (11 decks)

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