NP Practice - the whole thing

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1. DERM

1.1. Tinea

1.2. Dermatitis

1.3. Parasites

1.4. HSV

1.5. Acne

1.6. Miscellaneous Skin Drugs

1.6.1. Keratolytic Drugs

1.6.1.1. Retinoic Acid - Vit A acid - Derivatives

1.6.1.1.1. Tretinoin

1.6.1.1.2. Antineoplastic Agents

1.6.1.2. Trichloroacetic Acid

1.6.2. Benzoyl Peroxide

1.6.3. Topical Steroids

1.6.3.1. Hydrocortisone 0.5 - 1% - low potency

1.6.3.2. Hydrocortisone valerate 0.2% - intermediate potency

1.6.3.3. Betamethasone Diproprionate 0.5% - high potency

1.6.4. Hydroxyzine

2. Reumatologic/MSK

2.1. Musculoskeletal Complaints

2.1.1. Shoulder Exam

2.1.1.1. Standing

2.1.1.1.1. Inspect

2.1.1.1.2. Active ROM

2.1.1.1.3. strength

2.1.1.1.4. Reflexes

2.1.1.1.5. palpation

2.1.1.1.6. Sulcus sign

2.1.1.1.7. neer's test - of impingement of supraspinadous tendon

2.1.1.1.8. hawkins test - of impingement of supraspinadous tendon

2.1.1.1.9. acromioclavicular compression test

2.1.1.1.10. test biceps tendon / yurgasons test

2.1.1.1.11. adson's test for thoracic outlet syndrome

2.1.1.1.12. apprehension test

2.1.2. Foot exam

2.1.2.1. Inspect

2.1.2.1.1. inspect from back - look for how many toes you can see. more than 2 is getting too many

2.1.2.2. halux valgus

2.1.2.3. Mortons neuroma

2.1.2.4. achiles tendon rupture

2.1.2.4.1. thompson's test

2.1.2.5. Palpation for tenderness (most important)

2.1.2.5.1. 2nd metatarsal most common for stress #

2.1.2.5.2. Plantar Fasciatis

2.1.2.5.3. chronic heel pain syndrome

2.1.2.5.4. Midfoot - Lisfranc's Joint

2.1.2.5.5. Ottawa Ankle Rules

2.1.2.6. Passive ROM

2.1.3. Joint above/joint below

2.1.3.1. valgus force - applied to lateral side of joint leading to ie: genu Valgum [knock-kneed] distal part angled out)

2.1.3.1.1. Varus force - force applied to medial side of joint (leading to ie: genu VARum[ bow legged] distal part angled in)

2.1.4. Elbow exam

2.1.4.1. inspect

2.1.4.1.1. "carrying angle (greater than women"

2.1.4.1.2. active ROM

2.1.4.1.3. palpation

2.1.4.2. lateral epicondylitis "tennis elbow"

2.1.5. Knee

2.1.5.1. ottawa knee rules

2.2. Sprains

2.3. Strains

2.4. Osteoporosis

2.4.1. full BC Guidline

2.5. Musckuloskeletal Treatment

2.5.1. Back pain

2.5.1.1. acute

2.5.1.2. chronic

2.5.1.3. analgesics

2.5.1.3.1. narcotics

2.5.1.3.2. NSAIDs

2.5.1.3.3. Acetaminophen

2.5.1.4. muscle relaxants

2.5.1.5. non-pharm treatment

2.5.2. Osteoperosis

2.5.2.1. anti catabolic agents - Bisphosphonates 1st line

2.5.2.1.1. alendronate

2.5.3. Rheumatoid Arthritis

2.5.3.1. non biologic DMARDs

2.5.3.1.1. hydroxychloroquine only for mild RA

2.5.4. Gout

2.5.4.1. Acute

2.5.4.1.1. colchicine

2.5.4.1.2. NSAIDs

2.5.4.1.3. glucocorticoids

2.5.4.2. chronic

2.5.4.2.1. allopurinol

2.5.5. fibromyalgia

2.5.5.1. TCAs

2.5.5.1.1. TCA type muscle relaxant

2.5.5.1.2. Cyclobenzaprine

2.5.5.2. Amitriptyline

2.5.6. Polymyalgia Rheumatica

2.5.6.1. 1st line high dose corticosteroid

2.6. SEADS

2.6.1. swelling

2.6.2. erythema/echymosis

2.6.3. atrophy/asymetry

2.6.4. deformity

2.6.5. skin changes

2.7. Arthritis & Joint Pain

2.7.1. Infectious Arthritis

2.7.2. Systemic Rheumatic Disease

2.7.2.1. Rheumatoid Arthritis

2.7.2.2. Myopathy

2.7.2.2.1. Polymyositis

2.7.2.2.2. Dermatomyositis

2.7.2.3. Connective Tissue Diseases

2.7.2.3.1. Systemic Lupus Erythmatosis

2.7.2.3.2. sjogrens disease

2.7.2.3.3. scleroderma

2.7.3. Spondyloarthropathies

2.7.4. Crystal Induced Arthropathy

2.7.5. Degenerative

2.7.6. Vasculitis

2.7.7. Endocrine

2.7.8. Neoplasia

2.8. Vitamin D

2.8.1. Patient Handout

3. GU

3.1. STI

3.1.1. STIs

3.1.1.1. Common STIs with genital ulcers

3.1.1.1.1. Syphilis

3.1.1.1.2. Lymphogranuloma venereum (LGV)

3.1.1.1.3. Herpes

3.1.1.2. Genital Warts

3.1.1.2.1. Human Papiloma Virus (HPV)

3.1.1.3. Tx Algorithm for Vaginitis/cervicitis

3.1.1.3.1. common STI causing Vaginal Discharge

3.1.1.3.2. for men

3.1.1.3.3. Common STI causing urethritis and cervicitis

3.1.1.4. Pelvic Inflammatory Disease

3.2. Urinary Conditions

3.2.1. UTI

3.2.1.1. complcated

3.2.1.2. uncomplicated

3.2.1.2.1. first line

3.2.1.2.2. second line

3.2.1.3. Pyelonephritits

3.2.2. BPH

3.2.2.1. Alpha1 adrenergic blockers

3.2.2.1.1. "...osins"

3.2.2.2. 5 - alpha reductase inhibitors

3.2.2.2.1. Finasteride

3.2.2.2.2. best for treating large prostates

3.2.2.2.3. targeted effect to prostate so, low side effects and DDI

3.2.2.2.4. blocks testosterone conversion to dihydrotestosterone --> less stimulation, prostate shrinks

3.2.2.3. Phosphodiesterase Inhibitors

3.2.2.3.1. Tadalafil

3.2.3. urinary incontinence

3.2.3.1. Incontinence in Children

3.2.4. erectile dysfunction

3.2.4.1. Phosphdiesterase inhibitors

3.2.4.1.1. Sildenafil

4. Renal

4.1. Chronic Kidney Disease

4.1.1. CKD BC Guidlines

5. Endocrine

5.1. DM

5.1.1. Diabetes

5.1.1.1. Type I

5.1.1.2. Type II

5.1.1.2.1. what HBA1C do you start treatment?

5.1.1.2.2. Biguanides

5.1.1.2.3. Sulfonylurea

5.1.1.3. Insulins

5.1.1.3.1. bolus/prandial

5.1.1.3.2. basal

5.1.1.3.3. premixed

5.1.1.4. acarbose

5.1.1.5. pioglitazone

5.2. Thyroid Disease

5.2.1. Thyroid

5.2.1.1. Thyroid

5.2.1.1.1. no screening asymptomatic pts

5.2.1.2. Hypothyroid

5.2.1.2.1. levothyroxine

5.2.1.3. hyperthyroid

5.3. Obesity

5.3.1. BC Guidline

6. OSCE PROCESS

6.1. 2 min to write reminders in booklet

6.1.1. 2 min to read instructions

6.1.1.1. 10 min for test

6.1.1.2. Evaluation

6.1.1.2.1. To do for all scenarios

7. HEENT

7.1. Allergies

7.2. Pharyngitis

7.3. Otitis

7.3.1. Otitis Externa OE

7.3.1.1. Staph Aureus & Psuedomonas most common

7.3.1.2. tender tragus and auricle

7.3.1.2.1. erythema & edema in external canal

7.3.1.3. Malignant Otitis Externa

7.3.1.3.1. Most common in older pts

7.3.1.4. management

7.3.1.4.1. gently remove debri from canal

7.3.2. Otitis Media OM

7.4. Rhinitis

7.4.1. Rhinitis

7.4.1.1. Allergic Rhinitis

7.4.1.2. Infectious Rhinitis

7.4.1.3. Nonallergic/noninfectious Rhinitis

7.4.1.3.1. Occupational Rhinitis

7.4.1.3.2. Drug induced Rhinitis

7.4.1.3.3. Hormonal Rhinitis

7.4.1.3.4. Rhinitis if the elderly (senile)

7.4.1.3.5. NARES (nonallergic rhinitis with nasal eosinophilia syndrome

7.4.1.3.6. smoking rhinitis

7.4.1.3.7. Idiopathic rhinitis (IR)

8. PAIN

8.1. Acute Pain

8.2. Chronic Non Cancer Pain

8.3. Cancer Pain

8.4. Pain

8.4.1. narcotics

8.4.1.1. codeine

8.4.1.2. tramadol

8.4.2. NSAIDs

8.4.2.1. ketorolac

8.4.3. Acetaminophen

8.4.4. GABA

8.4.4.1. gabapentin

8.4.5. Chronic pain

8.4.6. acute pain

9. GI

9.1. GI

9.1.1. Acute Abdomen

9.1.2. Diarrhea

9.1.2.1. Osmotic

9.1.2.2. Secretion

9.1.2.3. Inflammation

9.1.2.4. Motility

9.1.2.5. Anal Sphincter Control

9.1.3. Dyspepsia and peptic ulcers

9.1.4. Appendicitis

9.1.4.1. Mcburney's point tenderness

9.1.4.1.1. RLQ (over appendix)

9.1.4.2. Rovsig's sign

9.1.4.2.1. Press deeply in LLQ and quickly release

9.1.4.3. psoas sign

9.1.4.3.1. Flexion of Psoas muscle

9.1.4.4. obturator sign

9.1.4.4.1. stretch the obturator muscle

9.1.5. Cholecystitis

9.1.5.1. Murphy's Sign

9.1.5.1.1. hook left thumb under right costal margin (where gall bladder is

9.1.5.2. Risk for Cholecystitis

9.1.5.2.1. ABCDEF

9.1.6. Ascites

9.1.6.1. Fluid wave test

9.1.6.2. assess shifting dullness to percussion

9.2. GERD

9.2.1. GERD

9.2.1.1. Treatment

9.2.1.2. lifestyle mods

9.2.1.3. PPI x 4-8 weeks

9.2.1.3.1. Chronic if still symptomatic

9.2.1.3.2. R/O H. Pylori infection

9.3. esophagitis

9.4. Abd Pain

9.4.1. IBS

9.4.1.1. IBS

9.4.1.1.1. ALARM FEATURES

9.5. Dyspepsia

9.5.1. Peptic Ulcer Disease

9.5.1.1. H. Pylori testing/treatment

9.5.1.1.1. Chronic Dyspepsia

9.5.1.1.2. triple therapy

9.5.1.1.3. qudruple therapy

9.5.1.2. must stop ABX 4 weeks, bismuth 2 weeks, PPI and H2 blockers 1 week before Urea Breath Test

9.6. IBD

9.6.1. Crohns Disease

9.6.2. Ulcerative Colitis

9.7. N&V

9.7.1. N&V in Pregnancy

9.8. constipation

9.8.1. non pharm measures

9.8.1.1. increase dietary fibre

9.8.1.1.1. bulk forming agents

9.8.1.1.2. Psylium

9.8.2. reduce and treat causal factors

9.8.3. watch for constipating med

9.9. Diarrhea

9.9.1. acute Diarrhea - ? why

9.9.1.1. Infectious Diarrhea?

9.9.1.1.1. antibiotic associated diarrhea?

9.9.1.1.2. Metronizadole

9.9.1.1.3. Vancomycin

9.9.1.2. Viral?

9.9.1.3. Bacterial?

9.9.1.4. O&P?

9.10. antacids

9.10.1. magnesium and aluminum hydroxide

9.11. H2 antagonists

9.11.1. Ranitidine

9.12. PPIs

9.12.1. omeprazole

10. Pediatrics

10.1. Piaget's stages of Development

10.2. Erickson

11. Geriatrics

11.1. Frailty

11.1.1. Full BC Guidline Frailty

12. OB/Gyn/sexuality

12.1. OB / GYN

12.1.1. Contraceptives

12.1.1.1. Combined hormonal contraceptives (COCs)

12.1.1.1.1. ring

12.1.1.1.2. Evra patch

12.1.2. Menopause

12.1.2.1. HRT

12.1.2.1.1. Estrogen

12.1.2.1.2. Progesterone

12.1.3. Primary amenorrhea

12.1.4. Polycystic ovarian syndrome

12.1.5. endometriosis

12.2. Menstruation and Related Problems

12.2.1. Dysmenorrhea

12.2.1.1. NSAIDs

12.2.2. Amenorrhea

12.2.3. oligomenorrhoea

12.2.4. polymenorrhea

12.2.5. hypomenorrhea

12.2.6. Menorrhagia

12.2.7. metrorrhagia

12.2.8. menometrorrhagia

12.2.9. intermenstrual bleeding

12.3. Sexuality

12.3.1. Sexual History 5 P's

13. Diagnostic Testing

13.1. Diagnostic Testing

13.1.1. Laboratory

13.1.1.1. BC Medical Services Plan Payment Schedule

13.1.2. Medical Imaging

13.1.2.1. X- rays

13.1.2.2. ultrasound

13.1.2.3. CT

13.1.2.4. Miscellaneous

13.1.3. Objectives of Diagnostic Tests

13.1.3.1. facilitate diagnosis in a sick pt

13.1.3.2. give prognostic info for pt with a disease

13.1.3.3. screen for sub clinical symptoms in pt with enough risk factors

13.1.3.4. monitor therapy

13.1.4. Questions to ask about each test

13.1.4.1. Why am I considering this test?

13.1.4.2. What question is this test meant to answer?

13.1.4.3. can this test answer my question?

13.1.4.4. do benefits of testing outweigh risks?

13.1.4.5. does the benefit outweigh the cost?

13.1.5. How to decide to use a test?

13.1.5.1. PRE TEST PROBABILITY

13.1.5.1.1. Liklihood Ratios (LR)

13.1.5.2. CLINICAL DECISION RULES (CDR) help set Pre test probabilities for various problems and provide screening tests

13.1.5.2.1. Examples

13.1.5.3. According to Bayesian principles, the pretest odds of disease multiplied by the likelihood ratio gives the post-test odds of disease

13.1.6. Diagnostic and Procedural Codes (ICD9)

14. Oncology

14.1. Oncology Pharm

14.1.1. methotrexate

14.1.2. warfarin

14.1.3. tamoxifen

14.2. Breast CA

14.2.1. BC Guidlines

14.3. Colorectal CA

14.3.1. BC Guidlines Colorectal CA

14.4. Palliative Care

14.4.1. BC Guidline Paliative

15. Respiratory

15.1. Asthma

15.1.1. Asthma BC guidlines Summary

15.2. Pneumonia

15.2.1. 60-80% caused by Strep pneumoniae

15.2.1.1. atypical pneumonia caused by other organisms like influenza, mycoplasma, chlamydia

15.2.1.1.1. young adults more succeptible to atypical pneumonia

15.2.2. LRT infection

15.3. Chronic Cough

15.4. COPD

15.4.1. mild/moderate COPD

15.4.2. Bronchitis

15.4.2.1. Viruses most common cause

15.4.2.1.1. influenza A&B, parainfluenza, RSV, carona, adenovirus

15.4.2.2. usually resolves in <6wks in healthy

15.4.2.3. cough with normal VS and absence of other resp findings of consolidation are very suggestive

15.4.2.4. consider CAP and pertussis

15.4.2.5. treatment

15.4.2.5.1. rest

16. Neuro

16.1. parkinsons disease

16.1.1. levodopa/carbodopa

16.1.2. NMDA receptor blocker

16.1.2.1. amantadine

16.1.3. COMT blocker

16.1.3.1. entacapone

16.1.4. MAOIs

16.1.4.1. Selegiline

16.2. Headache

16.2.1. Migraine

16.2.1.1. abortive agents

16.2.1.1.1. sumatriptan

16.2.1.1.2. ergotamines

16.2.1.1.3. what not to use with peds

16.2.1.1.4. Metoclopramide

16.2.1.2. suppressive/prophylactic agents

16.2.1.2.1. CCBs

16.2.1.2.2. TCAs

16.2.1.2.3. BBs

16.2.1.2.4. what to avoid in peds

16.2.1.3. analgesics

16.2.1.3.1. NSAIDs

16.2.1.3.2. acetaminaphen

16.3. Dizziness

16.4. Bells Palsy

16.4.1. cause of 50% of unilateral LMN facial paralysis

16.4.1.1. some correlation with HSV

16.4.1.1.1. often triggered by something - often URTI

16.4.2. Sparing Forehead muscles suggests UMN lesion instead of Bells Palsy (LMN)

16.4.2.1. quick onset 2-5 days compared to other etiologies

16.4.2.1.1. post auricular pain

16.4.3. Treatment

16.4.3.1. protection of the unclosing eye

16.4.3.1.1. patch at night

16.4.3.2. better prognosis if not full paralysis

16.4.3.2.1. 80-85% recover in 6 months

16.4.3.3. High dose steroids for a week then tapper

16.4.3.3.1. antivirals

16.5. Trigeminal Neuralgia

16.5.1. 2 types of TN

16.5.1.1. TN1/ Primary Classic

16.5.1.1.1. most caused by vascular compression

16.5.1.2. TN2/ Secondary - trigeminal neuropathy

16.5.2. Diagnosed mainly on clinical presentation and lack of other cause

16.5.2.1. immediate referral if ophthalmic involvement

16.5.2.1.1. Usually unilateral

16.5.3. Treatment

16.5.3.1. First Line - Anticonvulsants

16.5.3.1.1. Carbamazepine

16.5.4. Often a symptom of MS

16.5.4.1. Treatment with some success using Misoprostol (NSAID)

16.6. Crancial Nerves

16.6.1. Oh Oh Oh, Tiny Tits Are Fun And Give Virgins Awkward Hips

16.6.1.1. Oh-1

16.6.1.1.1. Olfactory

16.6.1.2. Oh-2

16.6.1.2.1. Optic

16.6.1.3. Oh-3

16.6.1.3.1. oculomotor

16.6.1.4. Tiny-4

16.6.1.4.1. Trochlear

16.6.1.5. Tits-5

16.6.1.5.1. Trigeminal

16.6.1.6. Are-6

16.6.1.6.1. Abductens

16.6.1.7. Fun-7

16.6.1.7.1. Facial

16.6.1.8. And-8

16.6.1.8.1. Auditory

16.6.1.9. Give-9

16.6.1.9.1. glossopharyngeal

16.6.1.10. Virgins-10

16.6.1.10.1. Vagus

16.6.1.11. Awkward-11

16.6.1.11.1. Accessory (spinal accessory)

16.6.1.12. Hips-12

16.6.1.12.1. Hypoglosal

16.6.2. Sensory Nerve

16.6.3. Motor Nerve

16.6.4. Sensory Nerves, Motor Nerves or Both

16.6.4.1. Some Say Marry Money, But My Brother Says Big Brains Matter Most

16.7. Dementia

16.7.1. primary treatment

16.7.2. non pharm treatment

16.7.3. cholinesterase inhibitors

16.7.3.1. Donepezil

16.7.3.2. Galantamine

16.7.4. NMDA receptor blockers

16.7.4.1. mementine

16.8. siezures

16.8.1. non-pharm treatment

16.8.1.1. avoid ETOH, Stimulants, stress

16.8.1.2. get enough sleep

16.8.1.3. yoga

16.8.2. pharm depends on type of seizure

16.8.2.1. phenytoin

16.8.2.2. carbamazepine

16.8.2.3. valproic acid

16.8.2.4. phenobarbitol

16.9. Comparing MS, ALS and Musculo dystrophy

16.10. Temporal/Giant Cell Arteritis

17. Hematologic

17.1. Anemia

17.1.1. Anemias

17.1.1.1. Iron Deficiency Anemia

17.1.1.1.1. patient teaching

17.1.1.2. Megaloblastic Anemias

17.1.1.2.1. Folate deficient

17.1.1.2.2. B12 deficient

17.1.1.3. sickle cell anemia

18. LEGEND

18.1. NP CAN TREAT INDEPENDANTLY

18.2. NO - NP CAN'T TREAT

18.3. NP CAN CO-MANAGE

18.4. NP CAN PRESCRIBE

18.5. NP CAN CONTINUE PRESCRIPTION ONLY

18.6. NP CAN NOT PRESCRIBE

18.7. Not safe in pregnancy

18.8. probably not safe in pregnancy

18.9. probably safe in pregnancy

19. Infectious Disease

19.1. Pharmacology of ID

19.1.1. Infectious Diseases

19.1.1.1. Antiviral Drugs

19.1.1.1.1. Acyclovir

19.1.1.2. Anti parasitic drugs

19.1.1.2.1. Permethrin

19.1.1.3. Antifungals

19.1.1.3.1. Clotrimazole - Canesten

19.1.1.3.2. Ketoconazole

19.1.1.3.3. fluconazole

19.1.1.4. Mechanisms for antibiotic resistance

19.1.1.5. Antibiotic Toxicities

19.1.1.6. Interactions with warfarin

19.1.1.7. Allergic Reactions

19.1.1.8. Atypical Bacteria and their diseases

19.1.1.9. Antibiotics for Atypical Bacteria

19.1.1.10. Infections

19.1.1.10.1. Respiratory Infections

19.1.1.10.2. Skin Infections

19.1.1.10.3. Eye Infections

19.1.1.10.4. Ear infections

19.1.1.10.5. Nasal Infections

19.1.1.10.6. Throat infections

19.1.1.10.7. Eye infections

19.1.1.11. Anaerobic Bacteria

19.1.1.12. Mechanisms of Antibiotics

19.1.1.13. add these to the map: Gentamicin (opthalmic anti-­infective) Timolol (beta blocker antiglaucoma agent) Ciprofloxacin otic solution (otic anti-­infective) Benzocaine antipyrine-­glycerine (otic analgesic) Acetic acid otic solutions Loratadine (2nd generation antihistamine) Chlorpheneramine Diphenhydramine Pseudoephedrine (decongestant, look also at phenylephrine) Codeine phosphate (antitussive) Guaifenesin (expectorant) Intranasal steroids (Fluticosone and betamethasone) Cromolyn (mast cell stabilizer) Ketotifen (opthalmic antihistamine + mast cell stabilizer) Ketorolac (ophthalmic NSAID)

19.1.1.14. Highly Resistant Gram Neg Bacteria

19.1.1.14.1. Antibiotics for highly resistant Gram Neg Bacteria

19.1.1.15. Oral Antibiotics against CA - MRSA

19.1.1.16. Preferred Antibiotic for serious Gram + Infections

19.1.1.17. Antibiotic Classes

19.1.1.17.1. Miscellaneous Antibiotics

19.1.1.17.2. macrolides

19.1.1.17.3. penicillins

19.1.1.17.4. cephalosporins

19.1.1.17.5. flouroquinolones

19.1.1.17.6. sulpha

19.1.1.17.7. Tetracyclines

19.1.1.17.8. aminoglycosides

19.1.1.17.9. Metronidazole

19.1.1.18. Infectious Disease Common Etiologies

19.2. Immunization

19.2.1. Which are live attenuated vaccines?

19.2.2. Basic immunization schedule first year of life

19.2.3. Schedule and reccomendations

19.2.3.1. MMR

19.2.3.2. Hep A

19.2.3.3. Hep B

19.2.3.4. Varicella

19.2.3.5. HPV

19.2.3.6. tetanus

19.2.3.7. influenza

19.2.3.7.1. antivirals

19.3. HIV

19.3.1. drugs in pregnancy?

19.3.2. Protease Inhibitors (PI)

19.3.2.1. ritonavir

19.3.3. nucleoside Reverse transcriptase inhibitor (NRTI)

19.3.3.1. 1st Generation

19.3.3.1.1. zodovudine / AZT

19.3.3.1.2. NON-nucleoside REverse Transcriptase Inhibitors (NNRTI)

20. Cardiovascular

20.1. HTN

20.1.1. HTN Guidlines

20.1.1.1. Primary HTN

20.1.1.1.1. treat to <140/90

20.1.1.1.2. diabetic treat to <130/80

20.1.1.1.3. 80yr+ treat carefully SBP 150 is ok

20.1.2. hepatojugular reflux sign

20.2. Dyslipidemia

20.3. CV Disease

20.4. PVD

20.4.1. Peripheral Vascular Tests

20.4.1.1. Allens Test

20.4.1.1.1. occlude both ulnar and radial arteries till hand goes white

20.4.1.2. Pallor Leg Raise Test

20.4.1.2.1. raise both legs to 60deg x 1 minute

20.4.1.3. Trendelenberg Test

20.4.1.3.1. lay supine, raise legs to 90 deg for to empty venous system

20.5. Cardiovascular drug classes

20.5.1. Diuretics

20.5.1.1. Thiazide Diuretics

20.5.1.2. Loop Diuretics

20.5.1.3. Potassium Sparing Diuretics

20.5.2. Vasodilators

20.5.2.1. Renin Angiotensin System Blockers

20.5.2.1.1. ACE inhibitors

20.5.2.1.2. Angiotensin Receptor Blockers

20.5.3. Antiplatelet Drugs

20.5.3.1. ASA

20.5.3.2. Clopidogrel

20.5.4. antithrombotic

20.5.4.1. Warfarin - Coumadin

20.5.4.2. Dabigatran

20.5.5. Cardioinhibitory Drugs

20.5.5.1. Alpha bockers

20.5.5.1.1. Clonidine

20.5.5.1.2. Methydopa

20.5.5.2. Calcium Channel Blockers

20.5.5.2.1. Dihydropyridine CCB - for HTN not ischemic disease

20.5.5.2.2. Non-Dihydropyridine CCB

20.5.5.3. Beta Blockers

20.5.5.3.1. Cardioselective Beta Blockers

20.5.5.3.2. non-cardioselective Beta Blocker

21. Mental Health

21.1. Anxiety

21.1.1. anxiety Pharm

21.1.1.1. First line

21.1.1.1.1. SNRI

21.1.1.1.2. SSRI

21.1.1.2. second line/ adjunct

21.1.1.2.1. TCA

21.1.1.2.2. Benzodiazepines

21.1.1.2.3. MOAI

21.2. Depression

21.2.1. Depression Pharm

21.2.1.1. SSRIs

21.2.1.1.1. Citalopram

21.2.1.2. SNRIs

21.2.1.2.1. venlafaxine

21.2.1.3. single vs Dual action

21.2.1.4. TCAs 2nd line

21.2.1.4.1. amatriptyline

21.2.1.5. MAOIs - 3rd line

21.2.1.5.1. phenelzine

21.2.1.5.2. meclobemide

21.2.1.6. atypical antidepressants

21.2.1.6.1. bupropion

21.2.1.6.2. Trazodone

21.2.1.7. which are safer

21.2.1.7.1. citalopram for SSRIs

21.2.1.7.2. Bupropion for atypicals and TCAs

21.2.1.7.3. venlafaxine for SNRIs because it has been around longer

21.2.1.7.4. NO MAOs, too many DDI and small therapeutic window.

21.2.1.8. which are less sedating

21.2.1.8.1. most of the SSRIs, SNRIs and bupropion

21.2.1.9. SIGECAPS - for depression

21.2.1.9.1. Sleep

21.2.1.9.2. Interest

21.2.1.9.3. Guilt

21.2.1.9.4. Energy

21.2.1.9.5. Concentration

21.2.1.9.6. Appetite

21.2.1.9.7. Psychomotor

21.2.1.9.8. Suicide

21.2.1.10. DIG FAST - for mania

21.2.1.10.1. Distractable

21.3. Suicide

21.3.1. SADPERSONS

21.3.1.1. sex (male)

21.3.1.1.1. age (>60yrs)

21.4. Pharmacologics

21.4.1. Psychiatric disorders

21.4.1.1. Bipolar Depression

21.4.1.1.1. Mood Stabilizers

21.4.1.1.2. Bipolar I - manic

21.4.1.1.3. Bipolar II - depression with no full mania

21.4.1.1.4. Bipolar not otherwise specified

21.4.1.2. Depression

21.4.1.2.1. SSRIs

21.4.1.2.2. SNRIs

21.4.1.2.3. single vs Dual action

21.4.1.2.4. TCAs 2nd line

21.4.1.2.5. MAOIs - 3rd line

21.4.1.2.6. atypical antidepressants

21.4.1.2.7. which are safer

21.4.1.2.8. which are less sedating

21.4.1.3. anxiety

21.4.1.3.1. First line

21.4.1.3.2. second line/ adjunct

21.4.1.4. what drugs are worse to overdose on?

21.4.1.4.1. TCAs because of narrow therapuetic window

21.4.1.5. what drugs are worse to withdraw from?

21.4.1.5.1. Benzodiazepines

21.4.1.5.2. SNRIs

21.4.1.5.3. ETOH

21.4.1.6. antipsychotics

21.4.1.6.1. First Generation

21.4.1.6.2. second generation / atypical

21.4.1.7. ADHD

21.4.1.7.1. methylphenidate

21.5. Sleep Disturbances

21.5.1. BC Guidline on insomnia/hypersomnia/parsomnias

21.5.1.1. Sleep Hygiene/diary handout

21.6. Addictions

21.6.1. Alcohol Abuse

21.6.1.1. BC Guidlines