9 - Health Promotion Flashcards
What is the stages of change model?
What is the behaviour change wheel?
Can identify whether groups of people are not changing their behaviour due to capability, opportunity or motivation and then target public intervention at that
What are the current guidelines in the UK to alcohol consumption?
- 14 units over at least 3 days with several alcohol free days a week
- If pregnant no alcohol and if trying to concieve partner should be drinking less than 14 units a week to improve sperm quality
- Units are ABV X Volume
What are some drugs that elderly people may take that you should be careful when drinking alcohol with?
Opioids and Sedatives (e.g diazepam): can cause respiratory depression which can be fatal
NSAIDS: stomach ulcers and heartburn
Anticoagulants (e.g warfarin): can increase their metabolism so more at risk of bleeding
What is the difference between alcohol dependence and harmful drinking?
What are some screening tools for alcohol dependence?
- CAGE (score over 2 should prompt more investigation)
- AUDIT (out of 40)
- SADQ to measure severity of alcohol dependence
What is used to treat alcohol dependence, and what are the goals of this treatment?
1st line - Abstinence
2nd line - Moderation
3rd line - Risk reduction
- Do motivational interviewing
- Blood tests to look for any physical problems
- Arrange psychological intervention e.g CBT for at least 12 weeks
- Consider in-patient withdrawal if on over 30 units per day
What are some drug regimes that can be used for alcohol withdrawal?
- Benzodiazepines e.g diazepam/lorazepam over 7-10 days to help with withdrawals
- Do not give large amounts at once due to risk of OD
- After successful withdrawal prescribe acamprosate, naltrexone or disulfiram with psychological intervention to stop relapse
When would you consider referring someone who is alcohol dependent for psychological intervention and for assisted alcohol withdrawal?
Psychological:
- high risk drinkers and those with moderate alcohol dependence
Assisted alcohol withdrawal:
- people drinking over 15 units a day and/or score more than 20 on the AUDIT.
- should have 2-4 meetings per week and consist of a drug regimine and psychological support inc motivational interviewing
What is the cause of Wernicke’s encephalopathy and Korsakoff syndrome?
- Vit B1/Thiamine deficiency
- Thiamine is stored in the liver and makes thiamine pyrophosphate synthase that is involved in glucose metabolism.
- Alcohol causes cirrhosis, stops absorption of thiamine and stops conversion of thiamine to active form
How does Wernicke’s encephalopathy and Korsakoff syndrome present and how is it diagnosed?
If untreated can lead to coma or death
Dx
- Clinical features
- FBC, LFTs, Thiamine levels
- MRI for degeneration of the mamillary bodies
How is Wernickes encephalopathy treated?
- Prophylatic oral thiamine given to high risk of alcohol dependence
- If suspect Wernicke’s give parenteral thiamine for 5 days then oral thiamine
What are the withdrawal symptoms with stopping drinking?
What are the benefits of stopping smoking and what are the withdrawal symptoms?
Do VBA at every appointment
Benefits:
- 20 minutes: pulse rate returns to normal
- 8 hours: CO in the blood will half
- 48 hours: All CO gone, sense of taste and smell back
- 1 year: risk of heart attack will have halved compared with a smoker
- 10 years: risk of death from lung cancer will have halved compared to a smoker
What management can a GP give to a person who wants to stop smoking?
- Ask about triggers and habits then
Non-pharmacological:
- Referral to NHS Stop Smoking services (website)
- If referral declined offer practical advice, advise to stop abruptly, offer drug treatment with NRT and Varenicline being most effective
- Review 2 weeks after stopping smoking and measure CO level at 4 weeks
Pharmacological: (done by smoking service)
- NRT e.g gym, inhaler, transfermal patch
- Buproprion/Zyban (D and NA reuptake inhibitor) and stop smoking after 7-14 days
- Varenicline/Champix (nicotone receptor antagonist) and stop smoking after 7-14 days. Stops cravings and withdrawal
Can only use NRT when under 18, pregnant or breastfeeding