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Primary Care Cheat Sheet by

Primary care top conditions/diseases/etc

HYPERT­ENSION

Symptoms
Questions
Headaches, dizziness, tinnitus, blurred vision, epistaxis, chest discom­fort, palpit­ations, nervou­sness, fatigue
Does patient check blood pressure at home? What numbers are they getting? What are the highest and lowest numbers? How often are their numbers super high?
Compli­cations
Any symptoms of HTN?
HF, CAD, MI, A Fib, aortic dissec­tion, PAD, athero­scl­erosis, stroke, CKD, hypert­ensive nephro­scl­erosis, retino­pathy
What medica­tion(s) is the patient taking? Dose? How many times a day? How many days per week does the patient forget­/does not have time to take their medica­tion?
Risk Factors
Obesity, diabetes, smoking, excessive alcoho­l/c­aff­eine, high sodium diet, physical inacti­vity, stress
Labs
CBC, creati­nine, eGFR, BMP

HYPERT­ENSION: MEDICA­TIONS

ACEIs (lisin­opril, enalapril)
Thiazide diuretics (HCTZ)
First-line for patients with DM, renal disease, ischaemic heart disease, and HF
Side effects: hypoka­laemia, hypona­tra­emia, increased glucose and choles­terol
Side effects: dry cough, hyperk­alaemia
___
Adverse effects: angioedema - STOP IMMEDI­ATELY
___
ARBs (losartan, valsartan)
Dihydr­opy­ridine CCB (amlod­ipine, nifedi­pine)
First-line for patients with DM, renal disease, ischaemic heart disease, and HF
Avoid in patients with HFrEF
Side effects: hyperk­alaemia
Side effects: oedema, nausea, flushing, HA, GERD, gingival hyperp­lasia
Nondih­ydr­opy­ridine CCB (dilti­azem, verapamil)
Beta blockers (propr­anolol, metopr­olol)
Side effects: bradyc­ardia, AV block, consti­pation, hyperp­rol­act­inaemia (verap­amil)
Second­-line therapy; used as primary drug in patients with HF, A Fib, ischaemic heart disease
 
Side effects: bronch­oco­nst­riction with non-ca­rdi­ose­lective beta blockers, increased TG
Many others, but these are the main ones that you are most likely to see in clinic.

DIABETES TYPE II

Symptoms
Questions
Polyuria, polydi­psia, polyph­agia, vision changes, poor wound healing, numbness, tingling, consti­pation
Does pt check their blood sugars at home? When? What are their morning numbers (before eating)? Numbers during the day?
Labs
Highest and lowest blood sugars? How often? Any sympto­matic low blood sugars?
A1c (every 3-6 months), BMP (renal function and electr­oly­tes), LFTs, lipids, urine microa­lb/cr
If on insulin, how many units with which type of insulin? How often do they forget/are too busy to take their insulin?
Look For
Numbness, tingling, etc? Vision changes?
Statin therapy regard­less, ASCVD assessment for high-i­nte­nsity statin
Have they seen an eye doctor in the past year?
Last ophtha­lmology exam, podiatry
Physical Exam
Foot exam, acanthosis nigricans

DIABETES TYPE II: TREATMENT

Metformin
Sulpho­nyl­ureas
Enhances effect of insulin. Weight loss.
Glyburide, glimep­iride, glipizide
Side effects: lactic acidosis, GI complaints (only when first starting, D/C), decreased B12 absorption
Increase insulin secretion
Contra­ind­ica­tion: CKD w/ GFR <30
Side effects: risk of hypogl­yca­emia, weight gain, agranu­loc­ytosis, haemolysis
_____
Contra­ind­ica­tions: CV comorb­idity, obesity, severe renal/­liver failure
SGLT-2 Inhibitors
Meglit­inides
Canagl­ifl­ozin, dapagl­ifl­ozin, empagl­iflozin
Nategl­inide, repagl­inide
Increases glucose excretion with urine
Increases insulin secretion
Side effects: genital yeast infections and UTI, polyuria and dehydr­ation, DKACon­tra­ind­ica­tion: CKD, recurrent UTIs
Side effects: risk of hypogl­yca­emia, weight gain
Contra­ind­ica­tion: CKD, recurrent UTIs
Contra­ind­ica­tion: severe liver failure
DPP-4 Inhibitors
GLP-1 Agonists
Saxagl­iptin, sitagl­iptin
Exenatide, liragl­utide
Inhibits GLP-1 degrad­ation
Stimulates GLP-1 receptors
Side effects: GI sx, pancre­atitis, URI, headache, dizziness, oedema
Side effects: pancre­atitis, possible pancreatic cancer, nausea
Contra­ind­ica­tion: liver failure, moderate to severe renal failure
Contra­ind­ica­tions: pre-ex­isting, sx GI motility disorders
_____
______
_____
______
Rapid Acting Insulin
Long-A­cting Insulin
Lispro, aspart, glulisine
Glargine, detemir, degludec
Onset: 5-15 min, Peak: 1 hr, Duration: 3-4 hrs
Onset: 1-4 hrs, Duration: 24 hrs
Before meals
Once daily
Adverse Effects of Insulin
Hypogl­yca­emia, weight gain, lipody­str­ophy, hypoka­laemia, oedema, pain/e­rythema at injection site
 

CORONARY ARTERY DISEASE

Symptoms
Questions
Angina: Retros­ternal chest pain/p­ressure that may radiate to the L arm, neck, jaw, or back. Pain is not affected by body position or breathing. No chest wall tender­ness. Dyspnea, dizziness, palpit­ations, diapho­resis, n/v, syncope
Has patient had chest pain since last visit? Is it occuring more often or stable? Does nitro help relieve pain?
Stable angina: chest pain/sx reprod­uci­ble­/pr­edi­ctable, subside with rest or nitrog­lyc­erin.
Any hospit­ali­sations since last visit?
Things to Check For
Medication compli­ance?
ASCVD score, new ECGs, stress tests, ECHO, CT angio, coronary artery calcium (CAC) scoring, cardiac cathet­eri­sations
Any of the other symptoms besides chest pain?
Revasc­ula­ris­ation - PCI or CABG
If they follow with cardio­logy, when was the last time they were seen?
Secondary Prevention
Smoking cessation, increased physical activity, lifelonf antipl­atelet therapy with aspiring or clopid­ogrel, treat comorb­idi­ties, lipid-­low­ering therapy

CORONARY ARTERY DISEASE: TREATMENT

Anti-a­nginal Drugs
Antipl­atelet Agents
First-­line: beta-b­lockers
Recomm­ended for all patients
Second­-line: CCBs, nitrates, ranolazine
Aspirin, clopid­ogrel
ACEIs or ARBs
Revasc­ula­ris­ation
In patients who also have HTN, DM, LVEF 40% or <, CKD
CABG
Lisino­pril, ramipril. Losartan, valsartan.
PCI

COPD & TREATMENT

Symptoms
Compli­cations
Cough, dyspnea, fatigue, hyperv­ent­ilation
Chronic respir­atory failure, R HF (cor pulmon­ale), secondary sponta­neous pneumo­thorax
Physical Exam
Treatment
Accessory muscle use, barrel chest, decreased breath sounds, end-ex­pir­atory wheezing and/or prolonged expira­tion, rhonch­i/c­rac­kles, cyanosis, tachyc­ardia, JVD, oedema, nail clubbing
Short-­acting beta agonists: salbutamol
Labs
Long-a­cting beta agonists: salmeterol
CBC
Short-­acting muscarinic antago­nists: ipratr­opium bromide
Things To Look For
Long-a­cting muscarinic antago­nists: tiotropium bromide
PFT: FEV1 and FEV1/FVC
Inhaled cortic­ost­eroids: budeso­nide, flutic­asone
CXR, chest CT
Pulmon­ology clinic notes
Questions: How often they use albuterol inhaler? Any hospit­ali­sations due to COPD exacer­bation since last visit? If on O2, when do they use it? How has their COPD been - stable, worse? Have they used their steroids (pills) since the last visit (if they have them, some have to prevent exacer­bat­ions)?

CKD

Risk Factors
Treatment
DMII, HTN, obesity, advanced age, substance use, AKI
Diet
Aetiology
Avoidance of nephro­toxic substa­nces: NSAIDs, antifu­ngal, antibi­otics, antivirals
Diabetic nephro­pathy, hypert­ensive nephro­pathy, glomer­ulo­nep­hritis, PKD, analgesic misuse, amyloi­dosis
Control underlying condition and comorb­idities
Labs
Haemod­ialysis
CBC, BMP (Cr, BUN), PT, PTT, bleeding time, lipid panel, blood pH, eGFR, urinal­ysis, urine microa­lb/cr
Compli­cations
 
CKD-mi­neral and bone disorder, secondary hyperp­ara­thy­roi­dism, anaemia, ESRD
 

CONGESTIVE HEART FAILURE

Symptoms
Lifestyle Modifi­cations
Nocturia, fatigue, tachyc­ardia, dyspnea, orthopnea, PND, peripheral oedema
Exercise, cessation of smokin­g/E­tOH­/re­cre­ational drugs, weight loss, immuni­sations
Physical Exam
Diet and fluid restri­ction
S3/S4 gallop, pulsus alternans, bilateral basilar crackles, displaced apical heart beat, peripheral pitting oedema, JVD, hepato­jugular reflux
Self-m­oni­toring and symptom recogn­ition (if pt gains > 4-5 lbs within 3 days -> fluid overlo­aded)
Labs
Drugs to Avoid
CBC, BMP, LFTs, lipid panel
Most antiar­rhy­thmic drugs, CCB (except amlodi­pine), NSAIDs, thiazo­lid­ine­diones
Know baseline BNP
Look For
Echo - ejection fraction, valvular dysfun­ction
CXR - cardiac silhou­ette, pulmonary congestion
ECG - LVH
Cardiac MRI, L heart cath/a­ngio, R heart cath

CONGESTIVE HEART FAILURE: TREATMENT

ACEIs
Aldost­erone Antago­nists
Enalapril, lisinopril
Spiron­ola­ctone, eplerenone
Every patient with HFrEF
Class II-IV and LVEF <35%
ARBs
Monitor for hyperk­alaemia
Losartan, valsartan
Loop Diuretics and Thiazide Diuretics
Beta Blockers
Loop: furose­mide, torsemide
Carved­ilol, metoprolol
Thiazide: HCTZ, metola­zone, chlort­hal­idone
Add once patient is stable on ACEI/ARB and no decomp­ensated
To treat volume overload

CIRRHOSIS

Symptoms
Things to Look Out For
Often asympt­omatic
Child-Pugh score and MELD score every 6 months along with labs
Fatigue, pruritus, yellowing of skin or eyes, n/v, increased abdomen size, gyneco­mastia, hypogo­nadism
HCC screening (q6 months)
Physical Exam
Compli­cations
Jaundice, telang­iec­tasia, caput medusae, palmar erythema, hepato­megaly, spleno­megaly, ascites, asterixis
Portal HTN, ascites, sponta­neous bacterial perito­nitis, oesoph­ageal variceal haemor­rhage, coagul­opathy, hepatic enceph­alo­pathy, hepato­renal syndrome, hepato­pul­monary syndrome, HCC, portal vein thrombosis
Labs
Treatment
CBC, LFTs, alk phos, ammonia, PT/INR, albumin
Treat underlying condition, avoid hepato­toxic substances (EtOH, NSAIDs), routine vaccines
Imaging
Non-se­lective beta blockers (propr­anolol) to lower portal HTN and prevent variceal bleeding
US, CT scan
Spiron­ola­ctone and furosemide for ascites and oedema
Aetiology is extensive: alcohol use, medica­tions, aflatoxin, hepatitis, primary biliary cirrhosis, primary sclerosing cholan­gitis, parasitic infect­ions, non-al­coholic steato­hep­atitis, haemoc­hro­mat­osis, Wilson disease, alpha-1 antitr­ypsin defici­ency, glycogen storage disease, CF, Budd-C­hiari syndrome
   
 

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  • Published: 1st December, 2021
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