7947662
Descripción
Fichas por Ashutosh Kumar, actualizado hace más de 1 año
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Creado por Ashutosh Kumar
hace más de 7 años
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| Pregunta | Respuesta |
| General explanation plan: | General explanation plan: Negotiate a mutually acceptable way forward and check understanding and acceptance. Assess the patient’s start point and main questions. Organize the explanation into sections using signposting. Check the patient’s understanding and encourage questions regularly. Layout management options and determine patient’s preferences. Negotiate a mutually acceptable way forward. |
| Explanation points expanded (WCHHPWOL): | Explanation points expanded (WCHHPWOL) What does it do/How it works? Check for allergy, contraindications and cautions. How to take it-how often, with/without food, when. How long for-type of medication, acute vs chronic, drug tolerance, review of efficacy, drug abuse. Precautions-e.g sunlight, reflux, drugs, food(s) to avoid (grapefruit juice/alcohol/broccoli) What to look for (common annoying/serious side effects?) Ongoing monitoring requirements Drug level Drug efficacy Side effects Long term side effects, if relevant. |
| The frequency of adverse effects: | The frequency of adverse effects: Description Frequency Very common >1 in 10 Common 1 in 100-1 in 10 Uncommon 1 in 1000-1 in 100 Rare 1 in 10,000-1 in 1000 Very rare <1 in 10,000 Also reported Frequency is unknown |
| Considerations to make before prescribing a drug: | Considerations to make before prescribing a drug: Bad reactions: allergy/previous reaction Baby, Breast feeding and Gender (fertility/sex hormone issues) Bad organs: Liver, kidney and heart (prolonged QT) Biological differences: funny syndromes and age Other medications (including OTC)- interactions Mode of delivery, including taste Side effects Cost |
| Antihypertensives for people with uncomplicated hypertension: | Antihypertensives for people with uncomplicated hypertension: Management is individualized based on cardiovascular risk (CVR) and other co-morbidities. If stage 1 hypertension (140-159/90-99) assess for): Target organ damage 5 yr CVR > 15% Diabetes Renal disease (CKD) Other high risk disease Routine investigations: HbA1c Electrolytes and urea, eGFR Lipids Urinalysis, ACR/PCR |
| Treat to target: | Treat to target: Target blood pressures individualized according to age and the presence of co-morbidities: Age Target BP >80 <150/90 <80 <140/90 <80 and CKD, diabetes or CHD <130/80 |
| Lifestyle changes: | Lifestyle changes: With stage 1 hypertension and no sign of end organ damage, it is usual to try these for the first 6-12 months before adding in medication: Lifestyle change Target Eat healthy and reduce salt intake DASH diet Exercise regularly 30 mins of heart beat rising activity, 4-7 x week Lose weight if needed Limit alcohol 2/day (M) 1/day (F) Stopping smoking reduces CVR but doesn’t have a significant effect on recorded blood pressure readings. |
| Medication choices: | Medication choices: Influenced by presence of comorbidities and other findings. Uncomplicated hypertension with no end organ damage or DM: Young <55 years STEP 1: ACEi/ARB if cough of ACEi STEP 2: ACEi/ARB and either BB or CCB STEP 3: ACEi/ARB + CCB + Diuretic Old >55 years or African/Caribbean descent STEP 1: CCB or diuretic STEP 2: Same as young If diabetic or end organ damage: ACEi first line Consider BB if IHD or HF or AF If PVD consider ACEi or CCB Resistant hypertension: Reconsider secondary causes, check patient adherence and lifestyle measures, reduce meds that may increase BP. Else further diuretics, B or alpha blockers. *In Females or reproductive avoid A, use B or C. |
| Patient funding codes: YJAO 134 Z | Patient funding codes: YJAO Y= under 6 years old J=6-17 A=18 and over O=contraceptives 134 1=community services card 3=No CSC 4=PHO or eligible person/eligible prescriber Z z=High user health card |
| Basics: Prescriber details Patient details Legible Name and strength of medicine Dose and frequency of dose Period to supply or quantity to supply Label Signed and dated | Basics: Prescriber details Full name, address, tel.number, NZMC number (for doctors) Patient details Title, full name, if under 13 need d.o.b (weight may be useful), NHI number, (consider allergies) Legible And in indelible ink Name and strength of medicine Generic name- or stipulate either alternative or underline brand name Dose and frequency of dose Period to supply or quantity to supply Total amount Label Extra instructions, warnings for patient Signed and dated By the prescriber |
| Hand written scripts are required for controlled drugs: | Hand written scripts are required for controlled drugs: Morphine, methadone, oxycodone, pethidine, fentanyl (but not tramadol, codeine, DHC) Methylphenidate, dexamphetamine 30 days max, close control, 7 day window |
| Abbreviations: In the morning Night time Before meals After meals With meals Twice a day Three times a day Four times a day Every four hours Every six hours Immediately As required If necessary Supply Five days One week Two months | Abbreviations: In the morning mane Night time nocte Before meals ac After meals pc With meals c Twice a day Bd, 2 x daily Three times a day Tds, 3 x daily Four times a day Qds, 4 x daily Every four hours qqh Every six hours q6h Immediately Stat As required prn If necessary sos Supply mitte Five days 5/7 One week 1/52 Two months 2/12 |
| Defining hypertension: Stage one (mild) Stage two (moderate) Severe Isolated systolic Isolated diastolic | Defining hypertension: Stage one (mild) ≥140/90 Stage two (moderate) ≥160/100 Severe ≥180 SBP, ≥110 DBP Isolated systolic ≥160 SBP, <90 DBP Isolated diastolic ≥90 DBP, <140 SBP |
| In clinic if a patient has stage one hypertension: | In clinic if a patient has stage one hypertension: Confirm a diagnosis of hypertension. Assess CVR Determine if any end organ damage has occurred. Detect any causes of secondary hypertension. Confirming a diagnosis of hypertension: Ambulatory monitoring. Gold standard; 24 hr BP monitoring; half hourly during day and hourly at night. White coat hypertension. Defined as difference of >20/10 between clinic and daytime out of clinic measurements. Masked hypertension. Out of clinic BP readings higher than in clinic. Suspect in people with high normal clinic or normal BP readings in patient with asymptomatic organ damage or high CVR. Home blood measure monitoring. Alternative to ambulatory. More accurate assessment of likelihood of end organ damage. Whilst seated with back and arm support. 2 consecutive measurements in the morning and evening for at least 4 days. Disregard 1st day and average from rest. |
| Investigating for end organ damage and co-morbidities: | Investigating for end organ damage and co-morbidities: Kidneys, heart and diabtetes: Urinalysis for proteinuria and haematuria. Quantify urinary protein with ACR or PCR Blood sample for eGFR, urea and electrolytes. Lipids and HbA1c. Ophthalmoscopic examination ECG for cardiomegaly Sleep study if sleep apnoea |
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