Antihypertensive therapy where systolic blood pressure consistently above 160 mmHg and/ or diastolic blood pressure consistently above 90 mmHg. or If diabetic, if systolic blood pressure above 140 mmHg and/ or diastolic blood pressure above 90 mmHg.
Beta-blocker or Calcium channel blocker for stable angina.
Appropriate beta-blocker with stable systolic heart failure.
with systolic heart failure and/or documented coronary artery disease.
Statin discussion with patients with known coronary heart disease, QRISK greater than 10%, diabetes type 1 or 2, or CKD with eGFR less than 60 min/1.73m2, consider for 85 years or over . Use Atorvastatin first line.
Lifestyle advice for prevention of cardiovascular disease:
Smoking cessation - offer support, advice and referral to local services to all patients who smoke.?
Diet and supplements -standard healthy eating advice.?
Physical Exercise - advise patients to aim to be active daily (at least 150 minutes moderate-intensity exercise over a week).
Alcohol - advise no more than 14 units per week for both men and women.?
Psychosocial factors -interventions may include group counselling, cognitive behavioural therapy, stress management programmes, meditation/yoga.
Antiplatelet therapy (one of Aspirin, Clopidogrel, Prasugrel or Ticagrelor) with a documented history of coronary, cerebral or peripheral vascular disease.
Anticoagulation for atrial fibrillation, using the CHA2DS2-Vasc and HAS-BLED score and discuss the risk and benefit with the patient. Offer anticoagulation to people with a CHA2DS2-Vasc score of 2 or above (1 or above for males), taking bleeding risk into account. Anticoagulation can be either Warfarin or a NOAC.
Regular inhaled Beta-2 agonist or antimuscarinic bronchodilator (e.g. ipratropium, aclidinium) for mild to moderate COPD.
Regular inhaled corticosteroid for moderate-severe asthma or COPD (where FEV1 less than 50% of predicted value and repeated exacerbations requiring treatment with oral corticosteroids). Give a steroid warning card for high doses.
Long term oxygen therapy (LTOT) with documented chronic hypoxaemia - SaO2 less than 92%.
A self-management plan including a course of antibiotics and oral corticosteroid tablets to keep at home (rescue pack), where patients are at risk of exacerbations and including advice on when to use them.
A spacer device for patients using high dose inhaled corticosteroids or if poor technique with metered dose inhalers.
New medications only after checking technique and compliance with existing inhalers.
Plmonary rehabilitation should be available to all appropriate people with moderate-severe COPD, including those who have had a recent hospitalisation for an acute exacerbation.
|MEDICAL DISCLAIMER:The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd|
Polypharmacy Start Criteria
| About | Anaesthetics and Critical Care | Anatomy | Basic Science | Biochemistry | Cardiology | Cases | Clinical Cases | Crib | Dentistry | Dermatology | Differentials | Drugs | ENT | Electrocardiogram | Embryology | Emergency Medicine | Endocrinology | Ethics | Foundation Doctors | Gastroenterology | General Information | General Practice | Genetics | Geriatric Medicine | Guidelines | Haematology | Hepatology | Immunology | Infectious Disease | Infectious Diseases | Infographic | Investigations | Lists | Microbiology | Miscellaneous | Nephrology | Neuroanatomy | Neurology | Nutrition | OSCE | Obstetrics Gynaecology | Oncology | Ophthalmology | Oral Medicine | Paediatrics | Palliative | Pathology | Pharmacology | Physiology | Procedures | Psychiatry | Radiology | Research | Respiratory | Resuscitation | Rheumatology | Statistics | Stroke | Surgery | Surgical | Toxicology | Trauma and Orthopaedics | Twitter | Urology | Version Jan 2023