13.10.10 GP notes

Antihistamines

• First-generation (sedating)

  • Diphenhydramine

  • Chlorphenamine

• Second-generation

  • Loratadine

  • Cetirizine

• Third-generation

  • Levocetirizine

  • Fexofenadine

Mirtazapine

• • Noradrenergic and specific serotonergic antidepressant (NaSSA)

• Primary use is the treatment of major depressive disorder and other mood disorders

  • Also useful in anxiety, panic, PTSD, insomnia..

• Comparable efficacy and tolerability to SSRIs and SNRIs

• Side effects:

  • Somnolence (54%)

  • Weight gain (≥7% weight gain, only in paediatrics is this very common − incidence=49%)

  • Dry mouth (25%)

  • Increased appetite (17%)

  • Constipation (13%)

Dr MCQ Bravado

• Dr - define risk

  • Justify why they are on a CTG

• M - movements

• C - contractions

  • Are there any and how often

• Q - quality

  • How good is the trace, is there lots of loss of contact? can you read it?

• Bra - baseline rate

• V - variability

  • Should be between 5 and 15bpm

• A - accelerations

  • A rise of 15bpm or more for more than 15 seconds - a good sign

• D - decelerations

  • A drop of 15bpm or more for more than 15seconds

• O - overall and plan

Asthma review questions

• • Difficulty sleeping due to symptoms

  • Day symptoms

  • Exercise tolerance

MRCP dyspnoea scale

1. Not troubled by breathlessness except on strenuous exercise

2. Short of breath when hurrying or walking up a slight hill

3. Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace

4. Stops for breath after about 100 m or after a few minutes on the level

5. Too breathless to leave the house, or breathless when dressing or undressing

Heart failure (EF<40%) - Medications

• ACE-i/ARB reduce mortality and morbidity in patients with heart failure and left ventricular systolic dysfunction

• β-blockers reduce mortality and morbidity in patients with heart failure and left ventricular systolic dysfunction

  • β-blockers specifically shown to reduce mortality and morbidity in HF with LVSD are carvedilol, metoprolol, bisoprolol