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Round Up Email August 2019

NICE have updated their guidance relating to antihypertensive treatment in the postpartum period and suggested enalapril as first line treatment; however if a woman is of black African or Caribbean family origin then nifedipine or amlodipine should instead be first line treatment – the justification behind this update has been reflected in GPnotebook. Other topics covered in this "Round Up" include the circumstances where combined T3 and T4 is indicated for treatment of hypothyroidism (basically very rarely, but I have had patients ask me about this); the use of Coronary Artery Calcium Score (CACS) and how it can help with assessment of cardiovascular; and the third in a series about knee joint injections by Dr Elspeth Wise and Dr Alan Walker on behalf of the Primary Care Rheumatology and Musculoskeletal Medicine Society – Annual Conference November 14th to 16th 2019 and much more…

  • Question 1

    NICE have updated their guidance relating to management of hypertension in pregnancy. There is now very specific guidance relating to management of antihypertensive treatment in the postpartum with enalapril or nifedipine being the antihypertensive of choice. This change in guidance is detailed on GPnotebook.: Hypertension in pregnancy - antihypertensive treatment during the postnatal period, including during breastfeeding (gestational hypertension)

    1) Which statement regarding management of gestational hypertension in the postnatal period is true?

  • Question 2

    When is combined therapy with T3 and T4 indicated? Is there a "conversion" rate when calculating dose of T4 versus T3? Who should initiate treatment with T3? All of these queries are answered on GPnotebook: Comparison of T3 and T4

    2) Which statement regarding use of T3 in hypothyroidism is true?

  • Question 3

    Non-contrast cardiac computed tomography (CT) has become an established diagnostic tool in clinical practice and the Coronary Artery Calcium Score (CACS) is a measure of atheromatous plaque burden in the coronary vasculature. The significance of the CACS in assessing cardiovascular risk is highlighted in GPnotebook: Coronary artery calcium score (CACS)

    3) Which statement regarding CACS is true?

  • Question 4

    Scalp psoriasis is a common presenting problem for the busy GP to manage and has been updated on GPnotebook. This update reflects the diagnostic uncertainty when the presentation is that of pityriasis amiantacea (when there is thick, adherent scale extending up the hair shaft).: Scalp psoriasis

    4) Which statement regarding pityriasis amiantacea is true?

  • Question 5

    HPV update – reflects the changes in the guidance for HPV vaccination from September 2019.: HPV vaccine

    5) Which statement regarding the HPV vaccine is true?

  • Question 6

    Switching from one form of contraception to another – what are the criteria for excluding pregnancy if considering change in (or starting) contraception. These are reflected on GPnotebook Note - In addition to the conditions mentioned, health professionals should also consider whether a woman is at risk of becoming pregnant as a result of UPSI within the last 7 days: Criteria for excluding pregnancy if considering change in (or starting) contraception

    6) Which is a criteria for excluding pregnancy when starting contraception (adapted from UK Selected Practice Recommendations for Contraceptive Use)

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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