Guidelines for Management of Chronic Conditions

Transcription

1 Guidelines for Management of Chronic Conditions 1. DIABETES: If you have high blood sugar or Diabetes, the following are recommended: Goals to prevent progression of diabetes and reducing complications of diabetes: Discuss with your provider for specific recommendation. Fasting finger-stick blood glucose: 80 to 120 (checked 3 to 5 times weekly if at goal) Non-fasting finger-stick blood sugar: below 180 (checked 3 to 5 times weekly if at goal) Glycohemoglobin or Hemoglobin A1c goal of less than 7% (checked yearly if at goal) Blood pressure goal of <130/85 mm Hg Fasting Bad cholesterol or LDL cholesterol goal of: o less than 70 gm/dl if positive for Coronary Heart Disease or previous heart attack o less than 100 gm/dl if positive for diabetes Follow a low refined carbohydrate diet Maintaining a regimen of moderate physical activities 5 times a week Body Mass Index (height-to-weight ratio) of 25% or less. If interested in losing weight, go to Important diabetic screenings tests: Discuss with your provider for specific recommendation. Peripheral Vascular Disease check for peripheral circulation of the feet Neuropathy check for sensation and nerve damage using a monofilament examination Retinopathy check for glaucoma and retinal eye examination by an Optometrist or an Ophthalmologist (at least once a year) Nephropathy check for urine protein (urine micro-albumin) and decreased filtration of the kidneys using urine and blood test (serum creatinine) at least 1 to 2 times a year Useful Medications to prevent complications of diabetes: Discuss with your provider for specific recommendation. ACE inhibitors Angiotensin Receptor Blockers (ARB) Cholesterol-lowering agents such as statins Fibrates Insulin and oral blood glucose-lowering agents Useful Tests to monitor if you have diabetes: Discuss appropriateness and frequency of these tests with your provider. Hemoglobin A1c or glycohemoglobin Metabolic Panel Urine Microalbumin Fasting Lipid panel Helpful Specialists to manage diabetes and minimize complications of diabetes: Endocrinologist Optometrist Ophthalmologist Nephrologist Cardiologist Podiatrist Diabetic educator. Self-referral is available at

2 2. HYPERTENSION: If you have High Blood Pressure, the following are recommended: Goals to keep your blood pressure under control and prevent complications of hypertension: Blood pressure target of <130/85 mm Heart-friendly diet Fasting Bad cholesterol or LDL cholesterol goal of: o less than 70 gm/dl if positive for Coronary Heart Disease or previous heart attack o less than 100 gm/dl if positive for diabetes o less than 130 gm/dl if no other co-morbid conditions Low protein diet Low salt diet Maintaining a regimen of moderate physical activities 5 times a week Stress reduction techniques Body Mass Index (Height-to-weight ratio) of 25% or less. If interested in losing weight, go to Diuretics ACE inhibitors Angiotensin-Receptor Blockers (ARB) Beta-blockers Calcium-channel blockers Cholesterol-lowering agents if cholesterol is high Blood glucose-lowering agents if diabetic Metabolic Panel Fasting lipid profile Liver function tests Thyroid function test, Uric acid Urine analysis Helpful Specialists to manage hypertension and minimize complications of hypertension: Nephrologist Cardiologist

3 3. CHRONIC KIDNEY DISEASE (CKD): If you have Chronic Kidney Disease (CKD) due to presence of protein in your urine or decrease filtering ability of your kidneys, the following are recommended: Goals to preserve your kidney function and health: Blood pressure target of <130/85 mm Heart-friendly diet Fasting Bad cholesterol or LDL cholesterol goal of: o less than 70 gm/dl if positive for Coronary Heart Disease or previous heart attack o less than 100 gm/dl if positive for diabetes o less than 130 gm/dl if no other co-morbid conditions Low protein diet Low salt diet Avoiding use of NSAIDs (Ibuprofens, Advils, Motrin, Alleve, Naproxen) Maintaining a regimen of moderate physical activities 5 times a week Body Mass Index (Height-to-weight ratio) of 25% or less. If interested in losing weight, go to Stress reduction techniques ACE inhibitors Angiotensin Receptor Blockers (ARB) Diuretics Cholesterol-lowering agents if cholesterol is high glucose-lowering agents if diabetic Medications or drugs to avoid: Non-steroidal anti-inflammatory drugs such as ibuprofens (Advil, Motrin), naproxen (Alleve, Naprosyn Metabolic Panel Urine Microalbumin and other urine studies Complete Blood Count (CBC) Kidney ultrasound Helpful Specialists to manage CKD and minimize complications of CKD: Nephrologist

4 4. HYPERLIPIDEMIA/ HYPERCHOLESTEROLEMIA: If you have high cholesterol, the following are recommended: Fasting Bad cholesterol or LDL cholesterol goal of: less than 70 gm/dl if positive for Coronary Heart Disease or previous heart attack less than 100 gm/dl if positive for diabetes less than 130 gm/dl if no other co-morbid conditions Following a heart-friendly diet Blood pressure target of <130/85 mm Hg Maintaining a regimen of moderate physical activities 5 times a week Stress reduction techniques Cholesterol-lowering agents if cholesterol is high Blood glucose-lowering agents if diabetic Blood-pressure lowering agent if blood pressure is high Fasting Lipid profile Lipoprotein analysis Helpful Specialists to manage hyperlipidemia and minimize complications of hyperlipidemia: Cardiologist Endocrinologist

5 5. HYPERTRIGLICERIDEMIA: If you have high triglyceride level, the following are recommended: Fasting Triglyceride level of less than 200 gm/dl Fasting Bad cholesterol or LDL cholesterol goal of: less than 70 gm/dl if positive for Coronary Heart Disease or previous heart attack less than 100 gm/dl if positive for diabetes less than 130 gm/dl if no other co-morbid conditions Follow heart-friendly diet Blood pressure target of <130/85 mm Hg Stress reduction techniques Fibrates or other triglyveride-lowering agents Cholesterol-lowering agents if cholesterol is high Blood glucose-lowering agents if diabetic Blood-pressure lowering agent if blood pressure is high Fasting Lipid profile Thyroid function test Lipoprotein analysis Helpful Specialists to manage hyperlipidemia and minimize complications of hyperlipidemia: Cardiologist Endocrinologist

6 6. If you have known heart disease (Coronary Artery Disease, Atherosclerosis) or previous heart attack, the following are recommended: Blood pressure target of <130/85 mm Hg Bad cholesterol or Low Density Lipoprotein (LDL) cholesterol goal of <70 gm/ dl Heart-friendly diet Low saturated fat diet Low salt diet Maintaining a regimen of moderate physical activities 5 times a week Stress reduction techniques Body Mass Index (Height-to-weight ratio) of 25% or less. If interested in losing weight, go to Anti-platelets such as Aspirin or Plavix Cholesterol-lowering agents such as statins Blood-pressure lowering agent such as beta-blockers, ACE-inhibitors, ARBs, Diuretics, Nitroglycerine, Amiodarone Blood glucose-lowering agents if diabetic Fasting Lipid profile Liver Function Test if on cholesterol-lowering agent Exercise or chemical stress test Echocardiogram Helpful Specialists to manage atherosclerosis and minimize complications of atherosclerosis: Cardiologist Cardiovascular surgeon Diabetic educator

7 7. If you have Congestive Heart Failure (CHF) or history of CHF, the following are recommended: Blood pressure target of <130/85 mm Hg Bad cholesterol or Low Density Lipoprotein (LDL) cholesterol goal of <70 gm/ dl Heart-friendly diet Low saturated fat diet Low salt diet Maintaining a regimen of moderate physical activities 5 times a week Stress reduction techniques Body Mass Index (Height-to-weight ratio) of 25% or less. If interested in losing weight, go to Aspirin or Plavix Cholesterol-lowering agents Blood-pressure lowering agent such as beta-blockers, ACE-inhibitors, Angiotensin-receptor blockers (ARBs), Diuretics, Digoxin, Nitroglycerine, Amiodarone Blood glucose-lowering agents if diabetic Comprehensive Metabolic Panel Fasting Lipid profile BNP Liver Function Test if on cholesterol-lowering agent Thyroid Function Test Chest x-ray Exercise or chemical stress test EKG Echocardiogram Helpful Specialists to manage heart failure and minimize complications of heart failure: Cardiologist Cardiovascular surgeon Nephrologist

8 8. If you have Chronic or Paroxysmal Atrial Fibrillation, the following are recommended: Therapeutic blood level (PT/INR) if on anticoagulation (Warfarin) Blood pressure target of <130/85 mm Hg Bad cholesterol or Low Density Lipoprotein (LDL) cholesterol goal of <70 gm/ dl if positive for Coronary Artery Disease Heart-friendly diet Low saturated fat diet Low salt diet Stress reduction techniques Warfarin Aspirin or Plavix if indicated Cholesterol-lowering agents Blood-pressure lowering agent such as beta-blockers, ACE-inhibitors or ARBs Diuretics, Nitroglycerine, Amiodarone Blood glucose-lowering agents if diabetic Fasting Metabolic Panel Fasting Lipid profile Liver Function Test if on cholesterol-lowering agent Thyroid Function Test Exercise or chemical stress test EKG Echocardiogram Helpful Specialists to manage atrial fibrillation and minimize complications of atrial fibrillation: Cardiologist Cardiologist Electrophysiologist

9 9. If you have Peripheral Vascular Disease (PVD)or atherosclerosis of peripheral arteries, the following are recommended: Blood pressure target of <130/85 mm Hg Bad cholesterol or Low Density Lipoprotein (LDL) cholesterol goal of <70 gm/ dl Heart-friendly diet Low saturated fat diet Low salt diet Stress reduction techniques Aspirin or Plavix Cholesterol-lowering agents Blood-pressure lowering agent such as beta-blockers, ACE-inhibitors or ARBs if hypertensive Diuretics, Nitroglycerine, Amiodarone if positive for heart failure Blood glucose-lowering agents if diabetic Fasting Lipid profile Liver Function Test if on cholesterol-lowering agent Ankle-Brachial Index (ABI) Arterial Doppler Ultrasound Exercise or chemical stress test Echocardiogram Helpful Specialists to manage PVD and minimize complications of PVD: Cardiologist Cardiovascular surgeon

10 10. If you have had a stroke or other vascular disease, the following are recommended: Blood pressure target of <135/85 mm Hg Bad cholesterol or Low Density Lipoprotein (LDL) cholesterol goal of <70 gm/ dl Heart-friendly diet Low saturated fat diet Low salt diet Stress reduction techniques Aspirin or Plavix Cholesterol-lowering agents Blood-pressure lowering agent such as beta-blockers, ACE-inhibitors or ARBs if hypertensive Diuretics, Nitroglycerine, Amiodarone if positive for heart failure Blood glucose-lowering agents if diabetic Fasting Lipid profile Liver Function Test if on cholesterol-lowering agent Ankle-Brachial Index (ABI) Arterial Doppler Exercise or chemical stress test Echocardiogram Helpful Specialists to manage Stroke and minimize complications of Stroke: Neurologist Cardiovascular surgeon Physical Therapist, Occupational Therapist, Speech Therapist

11 11. Thyroid Disease: If you have Hypothyroidism or under-active thyroid disease, the following are recommended: Appropriate use of prescribed medication Thyroid-replacement medication Thyroid function test every 6 to 12 months if under control Helpful Specialists to manage hypothyroidism and minimize complications of hypothyroidism: Endocrinologist 12. Thyroid disease: If you have Hyperthyroidism or over-active thyroid disease, the following are recommended: Appropriate use of prescribed medication Maintenance medications Beta-blockers Thyroid function tests Thyroid ultrasound or thyroid scan Thyroid biopsy if indicated Helpful Specialists to manage hyperthyroidism and minimize complications of hyperthyroidism: Endocrinologist Surgeon if surgery is needed Interventional Radiologist

12 13. If you have chronic gout or frequent attacks of gout, the following are recommended: Prevention of chronic damage to joints from frequent gout attacks Diet low in purines Adequate intake of water Moderation or reduction of alcohol consumption Appropriate use of prescribed medication Medications for treatment of acute gouty attack Prophylactic medications to prevent acute gouty attacks Uric acid level Helpful Specialists to manage gout and minimize complications of gout: Rheumatologist Podiatrist Orthopedist Endocrinologist

13 14. If you have Anemia or low red blood cell count, the following are recommended: Look for the source or explanation for the presence of anemia Maintenance of red blood count based on the causes of anemia Useful Medications depending on the specific causes of anemia: Iron replacement therapy Complete Blood Count Iron studies Vitamin B12 and Folic acid levels Urinalysis Stool for occult blood Pelvic exam and pelvic ultrasound Upper Endoscopy (EGD) Colonoscopy Helpful Specialists to manage anemia and minimize complications of anemia: Gastroenterologist Hematologist Gynecologist (for female patients)

14 15. If you have a lung condition known as COPD (Emphysema or Chronic Bronchitis), the following are recommended: Smoking cessation if currently smokes Reduce exposure to second-hand smoke and other factors that cause COPD exacerbation Yearly Influenza vaccination Pneumococcal vaccination after age 60 an/or one-time booster at age 65 Inhaled corticosteroids Oral corticosteroids (Prednisone) Inhaled Beta2-agonist such as Albuterol (short-acting) Inhaled Beta2-agonist (long-acting) Inhaled Anticholinergic agents (Ipratropium or Spiriva) Nebulized Albuterol and anticholinergic solutions Theophylline or Aminophylline Oxygen Antibiotics if indicated Spirometry or Pulmonary Function Test Chest xray Helpful Specialists to manage COPD and minimize complications of COPD: Pulmonologist Pulmonary Rehabilitation Specialist Allergist

15 16. If you have Asthma with frequent exacerbations, the following are recommended: Smoking cessation if currently smokes Reduce or avoid exposure to second-hand smoke Reduce or avoid exposure to allergens and irritants Regular use of prescribed medication Regular use of peak flow meters to self-monitor at home Yearly Influenza vaccination Pneumococcal vaccination after age 60 an/or one-time booster at age 65 Inhaled corticosteroids Oral corticosteroids Inhaled Beta2-agonist (short-acting such as Albuterol, Ventolin, Proventil) Inhaled Beta2-agonist (long-acting such as Salmeterol or Serevent) Combination inhaler Advair Inhaled anticholinergic agents (Ipratropium or Spiriva) Leukotriene inhibitors Nedocromil sodium Theophylline or Aminophylline Nebulized Beta2 agonists and anticholinergics Oxygen Spirometry or Pulmonary Function Test Chest x-ray Categories of Asthma: Mild intermittent asthma daytime symptoms are less than 2 times a week; nighttime symptoms are less than 2 times per month. Mild persistent daytime symptoms are 2 times or more per week but less than 1 per day; nighttime symptoms more than 2 per month. Moderate persistent daily symptoms; nighttime symptoms more than 1 per week. Daily use of short-acting inhaled albuterol. Exacerbations occur 2 or more times a week. Severe Persistent continuous symptoms with frequent nighttime symptoms and frequent exacerbations. Helpful Specialists to manage Asthma and minimize complications of Asthma: Pulmonologist Pulmonary Rehabilitation Specialist Allergist

16 17. If you have Osteopenia ( or mild thinning of your bone) or Osteoporosis (moderate to severe thinning of your bone), the following are recommended: Smoking cessation if currently smokes Regular use of prescribed medication Falls prevention Alendronate Boniva Evista Calcium 1500 mg daily Vitamin D to 5000 units daily In-office Ankle Bone Density test DEXA Scan Thyroid Function Test Serum calcium and Parathyroid hormone level Vitamin D level(25 hydroxy vitamin D) Helpful Specialists to manage Osteopenia and minimize complications of Osteopenia: Endocrinologist Rheumatologist

17 18. If you have Major Depression, the following are recommended: Regular use of prescribed anti-depressant medication. Do not stop or adjust the dose of your medication without first consulting with your doctor or provider Professional counseling and therapy Reduction in alcohol use Anti-depressants such as SSRI, SNRI, Bupropion Complete Blood Count Thyroid Function Test Helpful Specialists to manage Depression and minimize complications of Depression: Psychiatrist Therapist

18 19. If you have Anxiety Disorder, the following are recommended: Regular use of prescribed anti-anxiety medication. Do not stop or adjust the dose of your medication without first consulting with your doctor or provider Professional counseling and therapy Moderation and reduction in alcohol use Anti-depressants such as SSRI Short term use of benzodiazepines Complete Blood Count Thyroid Function Test Helpful Specialists to manage Anxiety and minimize complications of Anxiety: Psychiatrist Therapist

19 20. If you have Dementia or are a care-giver for someone with Dementia, the following are recommended: Regular use of prescribed medication. Do not stop or adjust the dose of your medication without first consulting with your doctor or provider. Maintain a regimen of physical activities several times a week Moderation and reduction in alcohol use Education and support for care-givers Donezepil, etc Metabolic Panel Thyroid Function Test Complete Blood Cell Count (CBC) Serologic Test for Syphillis (STS or RPR) Vitamin B12 and Folate level CT scan or MRI of the brain Helpful Specialists to manage Dementia and minimize complications of Dementia: Geriatric specialist Neurologist Neuro-Psychiatrist