Chronic Management Recap

Question 1

COPD

or
-
-
-
-

Answer 1

pO2 of < 7.3 kPa

oe

pO2 of 7.3 - 8 kPa AND one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension

Question 3

Epilepsy - Sodium Valproate
MOA
Who?
Adverse Effects: (8)

Answer 3

Epilepsy - Sodium Valproate
MOA - increase GABA
Who? Males - Gen tonic clonic / myoclonic and atonic and second line absence
Adverse Effects:
teratotrogenic!
increase apetite and weight gain
alopecia
cytochrome p450 inhibtor
hepatitis
thrombocytopenia
pancreatitis
ataxia

Question 4

Epilepsy - Carbamezapine
MOA
Who?
Adverse Effects: (6)

Answer 4

Epilepsy - Carbamezapine
MOA - binds to Na+ inc. refractory period
Who? second line focal seizures
Adverse Effects:
SIADH (increase ADH)
dizzy/ ataxia
drowsy
agranulocytosis
diplopia/ double vision

Question 5

Epilepsy - Lamotrigine
MOA
Who?
cant give it route via?
Adverse Effects: (1)

Answer 5

Epilepsy - Lamotrigine
MOA- Na+ channel blocker
Who? gen female and focal
cant give it IV!
Adverse Effects:
steven-johnson syndrome (therefore titrate v slowly)

Question 6

Epilepsy - Phenytoin
MOA
Who?
Adverse Effects: (9) some rogue ones in there

Answer 6

Epilepsy - Phenytoin
MOA - binds to Na+ inc. refractory period
Who? palliative patients with brain tumour
Adverse Effects:
1. Cyt p450 INDUCER!
2. dizzy / ataxia
3. drowsy
4. gingval hyperplasia
5. hirutism
6. peripheral neuropathy
7. vit D def
8. lymphadenopathy
9. weight gain

Question 7

Stable Angina

Investigations
Bedside -
Bloods -
Imaging -

Management

Conservative

Medical
- Everyone gets (3)
First line:
Second Line:
Third line: (4)

Surgical
1.
vs
2.

Answer 7

Investigations
Bedside - ECG, full obs, CV exam
Bloods - Trop, FBC (anaemia), TFT (hyper can cause)
Imaging
1. CT coronary angiography (if CKD or allergic to contrast then its CI)
2. Stress echo or MRI wall dysfunction imaging
3. Invasive CT coronary angiography

Management

Conservative
- smoking cessation
- increase exercise
- decrease weight
- control comorbid (HTN, HbA1c, Hyperlipid)
- decrease fatty diet

Medical
- Everyone gets (3)
1. GTN (999 if >3 puffs doesnt subside)
2. statin
3. aspirin 75mg

First line: B-bloker or rate limiting CCB (verapamil/ dilitazem)

Second Line: B-block AND long acting CCB(amlodipine or modified release nifedapine - this is to prevent severe bradycardia/ third degree heart block)

Third line: (4) add one whilst they wait for surgery
- Ivabridine (HCN channel blocker)
- Long acting Nitrite
- Nicorandil (K+ causing vasodilator)
- Ranolazine

Surgical
1. PCI - cheaper, less invasive, better recovery, less chance of stroke
vs
2. CABG (indications is symp + 3 vessel disease or signif left vessel stenosis)
- better outcomes for diabetics, 3 vessels and >65yo
- less chance of re-occurrence procedure