Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Medication/Intervention | Criteria for Initiation |
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Antihypertensive Therapy |
Systolic blood pressure consistently >160 mmHg and/or diastolic blood pressure consistently >90 mmHg.
In diabetic patients: systolic blood pressure >140 mmHg and/or diastolic blood pressure >90 mmHg. |
Beta-Blocker or Calcium Channel Blocker | For stable angina. |
Appropriate Beta-Blocker | For stable systolic heart failure. |
ACE Inhibitor | For systolic heart failure and/or documented coronary artery disease. |
Statins |
Discussion for initiation with patients who have:
- Known coronary heart disease. - QRISK >10%. - Diabetes (Type 1 or 2). - Chronic kidney disease (CKD) with eGFR <60 mL/min/1.73m². Consider in patients aged ≥85 years. First-line: Atorvastatin. |
Lifestyle Advice for Cardiovascular Disease Prevention |
- Smoking Cessation: Offer support, advice, and referral to local services.
- Diet: Standard healthy eating advice. - Physical Activity: Encourage at least 150 minutes of moderate-intensity exercise weekly. - Alcohol: Advise ≤14 units per week for both men and women. - Psychosocial Factors: Interventions may include group counselling, cognitive behavioral therapy, stress management, meditation, or yoga. |
Antiplatelet Therapy | One of Aspirin, Clopidogrel, Prasugrel, or Ticagrelor for documented coronary, cerebral, or peripheral vascular disease. |
Anticoagulation |
For atrial fibrillation:
- Use CHA2DS2-VASc and HAS-BLED scores to assess risk and benefit. - Offer anticoagulation if CHA2DS2-VASc score ≥2 (≥1 for males). - Options: Warfarin or Direct Oral Anticoagulant (DOAC). |
Regular Inhaled Beta-2 Agonist or Antimuscarinic Bronchodilator | For mild to moderate COPD (e.g., ipratropium, aclidinium). |
Regular Inhaled Corticosteroid |
For moderate to severe asthma or COPD (FEV₁ <50% predicted and repeated exacerbations requiring oral corticosteroids).
Provide a steroid warning card for high-dose corticosteroids. |
Long-Term Oxygen Therapy (LTOT) | For chronic hypoxaemia with documented SaO₂ <92%. |
Self-Management Plan |
Include a "rescue pack" of antibiotics and oral corticosteroids for patients at risk of exacerbations.
Provide advice on when to use the pack. |
Spacer Device | For patients using high-dose inhaled corticosteroids or those with poor technique using metered-dose inhalers. |
New Medications | Only after checking the patient's inhaler technique and compliance with existing medications. |
Pulmonary Rehabilitation | Offer to all appropriate patients with moderate to severe COPD, including those recently hospitalized for an acute exacerbation. |