Question

I was always under the impression that it was a competitive, non-selective antagonist at the muscarinic M₁, M₂, M₃, M₄ and M₅ receptors (parasympatholytic action). I can't seem to find any evidence that suggests that is is a non-competitive antagonist at those receptors.

hey bud hows tings?have a wee question if yeh can spare a sec.

for a patient who is hypoglycaemic. also at high cardiovascular risk ...what treatment plan would you give? also what targets would you give?

Appreciate if you could make a stab at it.mind boggled.

Hypoglycaemic?

For the CV risk I would advise simvastatin 40 mg PO ON, aiming to reduce TC by 33% regardless of initial cholesterol level (monitor for myopathy and LFTs).

Is the pt chronically or acutely hypoglycaemic - what's the HbA_1c and random blood glucose level?

What is the pt's blood pressure? Consider starting a dihydropyridine CCB or an ACE inhibitor to reduce blood pressure depending on age and race (target BP < 130/80 mmHg).

How are things going anyway? Back to uni yet?

youre right its strange, he should have hyperglycaemic risk , she just said the patient would have CVD risk mustve been hyper then. whats PO ON? tc= total cholesterol ah.

7.5% hba1c so slightly hyper? no glucose level given. his bp is 152/94 which is high so yeh.

it asks should ted start blood glucose lowering theraphy immediately and what is the most appropriate treatment for him? so give them metforming and have a target of 6.5% right? keep monitoring. consider dual theraphy with acarbose and then if targets still arent met consider insulin and intensify until becomes lower. the metformin suits him because hes obese BMi=31

for people who are hyperglycaemic the trick is to give them more insulin right? is the Basal-bolus regimen / multiple daily injection therapy best for these patients?
if hes hypoglycaemic you give him less insulin or encourage him to stabilise his eating patterns? what regimen or therapy suits a patient with hypoglycaemia on occasion?
if he cant stabilise his eating patterns he needs i.e. work lifestyle busy etc you give him here is the insulin pump therapy right? as he can take extra insulin easily when eating.



Im getting on alright. these exams are fecking me over though. overwhelmed if Im honest. this heart/diabetes/pain pharmacology module is v. difficult coupled with Law and our first OSCE's and this is gonna be a tough tough exam period. you well yourself?

PO = per os (by mouth), ON = omne nocte (every night).

HbA_1C is on the high end of normal, would consider advising on diet/lifestyle changes to reduce it. Not necessary at the moment though, as the Pt has presented with hypoglycaemia.

If Pt is hypoglycaemic, you wouldn't start antihyperglycaemic therapy until it has returned back to base line levels.

If Pt is under 55 or non-Afro Caribbean, start ramipril 1.25 mg PO ON (titrate dose to 10 mg max until HTN controlled). If Pt is over 55 or Afro-Caribbean, start amlodipine 5 mg PO OD (titrate dose to 10 mg max until HTN controlled).

Acarbose is ****ing useless - consider using a sulfonylurea like glipizide instead. First line (drug-wise, anyway) is metformin though, especially in the obese. Only start drugs after a 6 week trial of diet / exercise modification.

Yeah, exam prep is going okay. First exam in just over 2 weeks, so kind of nervous, but I'm making progress with revision.

where do you get this info?!:O brilliant help.thanks a mill man!love the acarbose part haha.

Im sure youll be grand.that response says it all.you know your stuff.best of luck manXD and thanks again!