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 are the three general treatment goals for alcohol dependence?
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 lunch 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
What are the recommendations of the eatwell guide?
- Fruit and veg should make up to a 1/3 of our diet
What are the NHS guidelines on exercising age 19-64?
Range of CVS and strengthening exercises
What should a person’s waist circumference be?
- Higher than this at risk of heart disease, Type 2 DM, cancer stroke
- Measure midway between hips and bottom of the ribs whilst breathing out naturally
What groups of people are at risk of drug misuse?
- People who go to nightclubs and festivals
- Gyms
Those who are in multiple at risk groups and theose who are regularly excessively consuming another substance, e.g alcohol, are particularly at risk
How can you approach patients who are at risk of drug misuse to help prevent misuse before it occurs?
- Discuss patients mental and physical health, and their employment, social, personal circumstances to identify if at risk and ask if they have taken a drug before
- Give children at risk skills training such as listening, conflict resolution, identifying and managing stress
- Provide information to people in lots of different formats
What are some questions you should ask a patient who is using drugs?
- Ask what type/method of administration, quantity and frequency
- If patient has acute chest pain and is young, acute psychosis or mood/sleep disorders ask about the possibility of drug missus
What are brief interventions?
- Technique to initiate unhealthy behaviour change such as drug misuse
- During routine appointments provide info to people taking drugs about reducing exposure to blood-borne viruses both through injections and sexually. Offer testing for viruses.
- Provide info about 12 step services such as NA and Cocaine Anon and if they need help making first contact, e.g transport, help them
Apart from self help with support groups, what are some psychosocial interventions a GP can do for a person who is misusing drugs?
- Contingency Management: rewarding positive behaviours, e.g privileges like take home methadone if drug free negative test or £10 vouchers for TB, HIV/HEPB testing
- Behavioural Couple’s Therapy: if patient’s partner is non drug misusing. 12 weekly sessions
- CBT and psychodynamic therapy
What are some harm reduction techniques for drug misusers?
- Needle exchange schemes: to reduce blood-borne viruses
- Drug consumption rooms: less chances of OD and crime
- Drug testing in clubs
Tell patient if going to use drugs do not take them alone and always tell someone what you have taken. Crush, Dab and Wait with pills. Do not share needles.
When might opioid substitution be considered?
- Heroin and opioid addicts found from history taking e.g cravings, withdrawal symptoms etc
- Take urinalysis or mouth swab before prescribing methadone or bupronorphine
- Also check LFTs at initial assessment as both substitution drugs undergo most metabolism in the liver. Don’t wait for results to prescribe if well
What is the recommended first line drug for opioid substitution? What is it’s mechanism of action, side effects and require monitoring?
Methadone oral solution is a long acting full opioid agonist
- Start low go slow to avoid overdose. Observe for few hours after first dose to check for OD as due to long acting can take a while to see OD
- Consider splitting dose
- Can cause asthma exacerbations, drowsiness, galactorrhoea, dry eye, long QT syndrome
Apart from methadone what other drug can be used for opioid substitution therapy?
Buprenorphine sublingual or injectable as it has less drowsiness as it is a partial opioid agonist/antagonist
Review dose every 3 months and check injection sites
Can cause anxiety, back pain, chills, ECG abnormalities, insomnia, constipation, syncope, N+V. Cannot be used if have renal insufficiency
What is the screening tool for depression?
PHQ9 score
Normal 1-4
Mild 5-9
Moderate 10-14
Moderately severe 15-19
Severe 20-27
What are the different CKD stages?
What is a FRAMES intervention?
Used to help with problem drinkers
