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NICE guidelines Flashcards

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1
Q

ASTHMA: how can you use PEFR to diagnose?

A

PEFR improves after administration of a SABA

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2
Q

ASTHMA - adult: first line treatment (symptom relief)

A

SABA

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3
Q

ASTHMA - adult: first line treatment + prevention

A

SABA + low-dose ICS

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4
Q

ASTHMA - adult: next step from SABA + low-dose ICS

A

+ LTRA

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5
Q

ASTHMA - adult: next step from SABA + low-dose ICS + LTRA

A

+ LABA (keep or take away LTRA)

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6
Q

ASTHMA - adult: next step from SABA + low-dose ICS + LTRA + LABA

A

incorporate MART routine

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7
Q

ASTHMA - adult: next step from SABA + low-dose ICS + LTRA + LABA (MART routine)

A

increase ICS to medium dose

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8
Q

ASTHMA - adult: next step from SABA + med-dose ICS + LTRA + LABA (+/-MART routine)

A

increase ICS to high dose

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9
Q

ASTHMA - adult: next step from SABA + high-dose ICS + LTRA + LABA (+/-MART routine)

A

+ 4th drug theophylline/oral beta agonist/anti-muscarinic

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10
Q

ASTHMA - adult: next step from SABA + high-dose ICS + LTRA + LABA (+/-MART routine OR 4th drug)

A

oral corticosteroid (also keep high dose ICS)

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11
Q

ASTHMA - 5-16yo: first line treatment (symptom relief)

A

SABA

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12
Q

ASTHMA - 5-16yo: next step from SABA + paed low dose ICS

A

+ LTRA

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13
Q

ASTHMA - 5-16yo: next step from SABA + paed low dose ICS + LTRA

A

+ LABA (consider stopping LTRA)

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14
Q

ASTHMA - 5-16yo: next step from SABA + paed low dose ICS + LABA (+ LTRA)

A

incorporate MART routine

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15
Q

ASTHMA - 5-16yo: next step from SABA + paed low dose ICS + LABA (+ LTRA; +/- MART routine)

A

increase to medium dose ICS

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16
Q

ASTHMA - 5-16yo: next step from SABA + paed med dose ICS + LABA (+ LTRA; +/- MART routine)

A

refer to specialist paed clinic + consider increasing to high dose ICS

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17
Q

ASTHMA - 5-16yo: next step from SABA + paed med dose ICS + LABA (+ LTRA; +/- MART routine)

A

refer to specialist paed clinic + consider increasing to high dose ICS

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18
Q

ASTHMA - <5yo: first line treatment (symptom relief)

A

SABA

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19
Q

ASTHMA - <5yo: first line treatment with maintenance therapy

A

SABA + 8-week trial of paed mod-dose ICS

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20
Q

ASTHMA - <5yo: after 8 week paed mod-dose ICS trial if symptoms recur within 4 weeks

A

low dose ICS and SABA

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21
Q

ASTHMA - <5yo: after 8 week paed mod-dose ICS trial if symptoms recur within & after 4 weeks

A

med dose ICS and SABA

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22
Q

COPD FVC <0.7, FEV1 >80%

mild, mod, severe, v severe?

A

mild

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23
Q

COPD FVC <0.7, FEV1 50-79%

mild, mod, severe, v severe?

A

moderate

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24
Q

COPD FVC <0.7, FEV1 30-49%

mild, mod, severe, v severe?

A

severe

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25
COPD FVC <0.7, FEV1 <30% | mild, mod, severe, v severe?
v severe
26
MRC dyspnoea scale 1 = not troubled by breathlessness OR too breathless to leave house?
not troubled by breathlessness
27
MRC dyspnoea scale 5 = not troubled by breathlessness OR too breathless to leave house?
too breathless to leave house
28
name 2 lifestyle management things for COPD
smoking cessation vaccinations pulmonary rehab
29
COPD - inhaled meds - step-up if no improvement FEV1 >/=50% (already on SABA/SAMA + LABA)
LABA + ICS
30
COPD - inhaled meds - short acting relief
SABA salbutamol or | SAMA ipatropium bromide
31
COPD - inhaled meds - long acting if FEV 1 >/=50%
LABA (salmeterol) or LAMA (tiotropium bromide) | remove SAMA if using LAMA
32
COPD - inhaled meds - long acting if FEV 1 <50%
LABA + ICS combi inhaler or LAMA
33
COPD - inhaled meds - second line if no improvement for both FEV1 measurements
LABA + ICS combo AND LAMA
34
COPD - combined inhaled and oral therapy
beta-2 agonist + theophylline OR | anticholinergic + theophylline
35
COPD - if chronic cough
mucolytic (carbocristine)
36
COPD - abx for purulent sputum
amoxicillin doxycycline erythromycin
37
COPD - when would you give PO corticosteroids?
increased dyspnoea or reduced ADLs
38
DM classic triad
polyuria polydipsia weight loss
39
DM2 - HbA1c target if not on hypoglycaemics
<48
40
DM2 - HbA1c target if on hypoglycaemics
53
41
DM1 routes of insulin
SC injections - short acting before meals, long acting in the evening SC pump - continuous/regular
42
DM2 - first line meds
metformin
43
DM2 - metformin SEs
reduced appetite + weight, cardio protective, reduced risk of hypo
44
DM2 - metformin CI
cannot be used if eGFR <30
45
DM2 - what to add to metformin if HbA1c >58
DPP4 (sitagliptin) OR sulfonylurea (gliclazide) OR pioglitazone
46
DM2 - out of sitagliptin, gliclazide and pioglitazone, which is best in kidney impairment?
sitagliptin
47
DM2 - sulfonylurea SEs
increased weight, increased risk of hypo
48
DM2 - pioglotazone CIs
HF, DKA, bladder ca, haematuria
49
DM2 - third line treatment
metformin + sulfonylurea + DPP4(sitagliptin)/pioglitazone
50
DM2 - 4th line treatment
insulin
51
DM2 - if metformin resistant...
skip metformin and use one of the other adjuncts
52
DM2 - when to measure HbA1c
3 monthly until stable then 6 monthly
53
DM2 - non glycaemic treatments
statin (reduce CVD risk) | antihypertensives if >140/90
54
DM2 - annual check
``` weight + BMI serum creatinine BP smoking HbA1c cholesterol urinary ACR eye exam foot exam ```
55
DM - microalbuminuria - ACR ratio over ?
>3 | + urine dip + for protein
56
DM - microalbuminuria management
ACE-i or ARB even if BP normal - protects kidneys
57
CHD - what type of angina? | induced by effort, relieved by rest
stable
58
CHD - what type of angina? | caused by coronary artery spasm
variant
59
CHD - what type of angina? | increasing in freq or severity, after minimal exertion/at rest, high risk of MI
unstable/crescendo
60
CHD - what type of angina? | precipitated by lying flat
decubitus
61
QRISK2 score - what does it calculate?
10 year risk of having MI or stroke (based on RFs and demographics)
62
CHD - step 0 - symptom relief
inhaled GTN
63
CHD - step 1 - regular medicines
BB or CHB amlodipine, felodipine OR diltiazem + verapamil (rate limiting)
64
CHD - step 2 - monotherapy
long acting nitrate (isorbide mononitrate) | specific anti-angina drugs (ivabrandine, nicorandil, ranolazine)
65
CHD - when step 2 monotherapy insufficient
combine with BB or CCB | then can add GTN
66
CHD - secondary prevention in stable angina
aspirin 75mg to all statin to all ace-i if also have DM
67
CHD - secondary prevention after an MI
``` BRA-AC bisoprolol ramipril aspirin atorvostatin clopidogrel ```
68
HF - investigations
BNP echo ECG CXR
69
HF - acute management
diuretics - frusemide or bendroflumethiazide if already on loop do not offer opiates or nitrates
70
HF - first line chronic management
ACE-i and BB ARB if ACE-i intolerant hydralazine + nitrate if afro-caribbean
71
HF - second line chronic management
aldosterone antagonist (spironolactone), ARB or hydralazine + nitrate OR sacubitril valsartan
72
HF - 3rd line management
digoxin or ivabradine | implantable cardiac defib
73
investigation in suspected AF
ambulatory ECG
74
AF - acute management
cardioversion | flecainide or amiodarone
75
AF - management - anti-coagulation
CHADSVASC or HASBLED if anti-coag warfarin or NOAC
76
AF - management - rate control
beta blocker or rate limiting CCB digoxin if sedentary next stage is to combine 2 of the above
77
AF - management - rhythm control
only if rate control has been unsuccessful | cardioversion + amiodarone
78
score for stroke prevention in AF
``` CHA2DS2VASC stroke risk based on congestive heart failure HF age diabetes stroke sex (female) vascular disease if score >/= 7 = 10% stroke risk ```
79
score for predicting risk of bleed on anti-coags in AF
hasbled
80
FAST screen for stroke
face arms legs TIME TO CALL 999 muvafuka
81
acute stroke management - thrombolysis
alteplase thrombolysis in <4.5hrs
82
acute stroke management - pharmacological
antiplatelets aspirin 300mg for 2 weeks then clopidogrel 75mg long term warfarin if AF
83
acute stroke management - possible surgical interventions
carotid artery imaging <1 week to see if there is carotid artery narrowing carotid endarectomy
84
stroke management longterm
clopidogrel 75mg warfarin if AF statin
85
score for TIA
``` ABCD2 age BP clinical features (unilateral weakness or speech disturbance) duration of symptoms ```
86
TIA - ABCD2 score meanings
``` >/= 4 - urgent 24hr see neurologist <4 - 1 week referral ALSO hospitalise if... persistant signs/sx <45yo crescendo TIA patient has AF ```
87
TIA - management
ABCD2 score >/=4 (or <45, crescendo or AF) aspirin 300mg & urgent neurologist appt in 24hrs ABCD2 score <4 aspirin 300mg within 1 week
88
DVLA rules post stroke or TIA
1 month
89
what classification system used for stroke
oxford
90
CKD investigations
creatinine based eGFR urine ACR renal USS + biopsy
91
CKD - microalbuminaemia
raised ACR
92
CKD - stages
``` 1 = eGFR >90 (review annually) 2 = 60-90 (review annually) 3 = 30-60 (review 6 monthly) 4 = 15-30 (review 3 monthly) 5 (end stage) = <15 (review 6 weekly) ```
93
CKD - managment
``` BP control (aim <140) ACE-I or ARB ```
94
CKD - end stage management
haemodialysis / some form of dialysis
95
CKD - prevention of CVD
statin | antiplatelet (apixiban or warfarin)
96
epilepsy - initial investigation for all
ECG
97
epilepsy - when to start treatment
after diagnosis confirmed (usually 2nd seizure)
98
epilepsy - absent/tonic clonic or atonic management
sodium val | lamotrigine
99
epilepsy - myoclonic management
sodium valproate | leviteracetam, topiramate
100
epilepsy - focal management
carbamazepine | lamotrigine
101
epilepsy - non-pharma management
surgery vagal stimulation ketogenic diet deep brain stimulation
102
epilepsy - coming off anti-epileptics
wean down over 3 months
103
epilepsy - annual review
seizures medications bloods lifestyle/eduction
104
epilepsy - DVLA
can drive car/bike if seizure free for over a year | can drive lorry/bus if seizure free for 10 years
105
epilepsy - sodium val side effects
weight gain, N+V
106
epilepsy - lamotrigine side effects
anti-cholinergic
107
epilepsy - carbemazapine side effects
headache, blurred vision, dizzy drowsy ataxic
108
HT - diagnosis
blood pressure in GP | ambulatory blood pressure
109
HT - score for risk of cardiac event
qrisk2 | % risk of heart attack or stroke in 10 years
110
HT - first line management - non-pharmacological
lifestyle and diet
111
HT - first line - pharmacological
<55yo ACE-i (ARB if not tolerated) >55 or afro-caribbiean CCB (thiazide diuretic if not tolerated)
112
HT - second line pharma treatment
ACE-i + CCB
113
HT - third line pharma treatment
ACE-i + CCB + thiazide diuretic
114
HT - 4th line pharma treatment
add: a blocker (tamusolin) diuretic (spironolactone or indapamide) beta blocker
115
HT - ACE-i side effets
postural HT dry cough can't use in pregnancy
116
HT - ARB Side effects
dizzy | can't use in pregnancy/breast feeding
117
HT - CCB side effects
ankle oedema headaches palpitations N+V
118
HT - thiazides side effects
hypokalaemia | headache
119
HT - K+ sparing diuretics side effects
gynaecomastia impotence menstrual irregular
120
HT - annual review
BP, weight, height BMI | medicines
121
COPD - exacerbation management in the community
oral prednisolone for 2 weeks | abx if needed
122
COPD - what is in a rescue pack?
corticosteriods, bronchodilator, abx

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