Chapter 4 - Chronic Flashcards
Planning Management (45 cards)
At what level do you treat hypertension?
> 150/95mmHg
If existing/high risk of stroke, IHD, PVD or if evidence of hypertensive organ damage - CKD, retinopathy, LVH or intracerebral bleed
>135/85mmHg
Target BPs for those on antihypertensives
<80 Clinic - <140/85
Home - <135/85
>80 Clinic - <150/85
Home - <145/85
Draw out the treatment diagram for antihypertensives
Over 55/Afro caribbean - C
Under 55 - A
A + C
A + C + D
A + C + D + (other diuretic, beta blocker, alpha blocker)
Chronic management: Heart failure
- ACEi + Beta blocker
- Increase dose as tolerated
- Mild - add ARB (candesartan)
Mod/sev+afro caribbean - add hydralazine + isosorbide mononitrate
Mod/sev other patients - add spironolactone
ACEi ARB if ACEi not tolerated Hydralazine + isosorbide mononitrate if neither ARB nor ACEi tolerated Beta blocker - start low and go slow Spironolactone
Chronic management: Stable angina
- GTN spray PRN
- Beta blocker +/- CCB
Inadequate control - add isosorbide mononitrate or nicorandil
Inadequate control - PCI/CABG - Secondary prevention - aspirin + statin
Stable angina - symptom control
GTN spray PRN
Stable angina - anti-anginal
Beta blocker +/- CCB
increase dose
add isosorbide mononitrate or nicorandil
PCI/CABG
Stable angina - secondary prevention
Aspirin + statin
Chronic management - 3 areas of AF management
- Rhythm control
- Rate control
- Stroke prevention
AF - how do you see if they require stroke prevention and what are the results?
CHADSVAS Congestive HF Hypertension Age >75 (2) Diabetes Stroke or TIA before (2) Vascular disease - PAD/IHD Age (65-74) Sex (female)
0 (or 1 if female) - NO ANTICOAGULATION
1 (if male) = condiser antiplatelet or anticoagulant: aspirin OR warfarin
2 or more = anticoagulation - warfarin - aim for INR 2.5
Who do you cardiovert in AF? (5)
What does the cardioversion involve?
- Young
- First episode
- Symptomatic
- Reversible cause
IF IT HAS BEEN LESS THAN 48 HOURS
If not, they require anticoagulation
Electrical
Pharmacological - Amioderone 5mg/kg IV over 20-120 minutes
Asthma - Step 0
Monitored initiation of treatment with LOW DOSE ICS
Asthma - Step 1
Regular preventer - LOW DOSE ICS
Asthma - Step 2
Initial add-on - add inhaled LABA - usually in a combination inhaler like fostair or seretide
Asthma - Step 3
Additional add-on
No response to LABA - stop LABA, increase ICS to MEDIUM DOSE
LABA benefit:
1. Continue LABA, increase ICS to MEDIUM DOSE
or
2. Continue LABA, continue ICS, add (theophylline, montelukast, LAMA)
Asthma - Step 4
- Increase ICS to HIGH DOSE
or - Trial 4th drug (theophylline, montelukast, LAMA, Beta agonist tablet)
Asthma - Step 5
Continued oral steroids
When should you consider moving up the asthma management ladder?
Using SABA 3 or more times a week for relief of symptoms
Draw out COPD guidelines
SABA or SAMA PRN
exacerbations: no asthmatic features or no steroid responsiveness
add LABA + LAMA
exacerbations: asthmatic features or steroid responsiveness:
add LABA + ICS
persistent exacerbations: asthmatic features or steroid responsiveness:
triple therapyLABA + LAMA + ICS
What should diabetics have checked annually to monitor nephropathy? Results mean what?
AlbuminCreatinineRatio - >3mg/mmol = give ACEi
What should diabetics be on to avoid CV risks?
Statin
What is the target HbA1c in type 2 diabetics?
<48mmol/mol
Type 2 diabetes drug regime if overweight + creatinine <150
- standard release metformin 500mg then increase slowly to reduce GI SEs
- If GI SEs - modified release metformin 500mg then increase slowly
- metformin + gliclazide
metformin + sitagliptin
metformin + pioglitazone
metformin + empaglifozin - metformin + gliclazide + sitagliptin
metformin + gliclazide + pioglitazone - insulin
What is the most common first line drug for Parkinson’s?
Co-careldopa
Levodopa + carbidopa
(also co-beneldopa - levodopa + benserazide)
