Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Antihypertensive therapy | where systolic blood pressure consistently above 160 mmHg and/ or diastolic blood pressure consistently above 90 mmHg. or If diabetic, if systolic blood pressure above 140 mmHg and/ or diastolic blood pressure above 90 mmHg. |
Beta-blocker or Calcium channel blocker | for stable angina. |
Appropriate beta-blocker | with stable systolic heart failure. |
ACE inhibitor | with systolic heart failure and/or documented coronary artery disease. |
Statin discussion with patients with known coronary heart disease, | QRISK greater than 10%, diabetes type 1 or 2, or CKD with eGFR less than 60 min/1.73m², consider for 85 years or over. Use Atorvastatin first line. |
Lifestyle advice for prevention of cardiovascular disease: |
Smoking cessation - offer support, advice and referral to local services to all patients who smoke.? Diet and supplements -standard healthy eating advice.? Physical Exercise - advise patients to aim to be active daily (at least 150 minutes moderate-intensity exercise over a week). Alcohol - advise no more than 14 units per week for both men and women.? Psychosocial factors -interventions may include group counselling, cognitive behavioural therapy, stress management programmes, meditation/yoga. |
Antiplatelet therapy | (one of Aspirin, Clopidogrel, Prasugrel or Ticagrelor) with a documented history of coronary, cerebral or peripheral vascular disease. |
Anticoagulation | for atrial fibrillation, using the CHA2DS2-Vasc and HAS-BLED score and discuss the risk and benefit with the patient. Offer anticoagulation to people with a CHA2DS2-Vasc score of 2 or above (1 or above for males), taking bleeding risk into account. Anticoagulation can be either Warfarin or a DOAC. |
Regular inhaled Beta-2 agonist or antimuscarinic bronchodilator | (e.g. ipratropium, aclidinium) for mild to moderate COPD. |
Regular inhaled corticosteroid | for moderate-severe asthma or COPD (where FEV1 less than 50% of predicted value and repeated exacerbations requiring treatment with oral corticosteroids). Give a steroid warning card for high doses. |
Long term oxygen therapy (LTOT) | with documented chronic hypoxaemia - SaO₂ less than 92%. |
A self-management plan | including a course of antibiotics and oral corticosteroid tablets to keep at home (rescue pack), where patients are at risk of exacerbations and including advice on when to use them. |
A spacer device | for patients using high dose inhaled corticosteroids or if poor technique with metered dose inhalers. |
New medications | only after checking technique and compliance with existing inhalers. |
Pulmonary rehabilitation | should be available to all appropriate people with moderate-severe COPD, including those who have had a recent hospitalisation for an acute exacerbation. |