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
Not troubled by breathlessness except on strenuous exercise
Short of breath when hurrying or walking up a slight hill
Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
Stops for breath after about 100 m or after a few minutes on the level
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