case 2 - health & illness behaviour Flashcards
What is the acronym used for the possible reasons for pathophysiological symptoms?
‘AVINDICATEDPIF’
What are the 6 parts/steps in taking a history?
Sequence of events, Symptom analysis, associated symptoms, patient perspective, background medical information, personal and social history
What class of drug is codeine?
Opiate
What is codeine used as?
An analgesic, decreasing pain perception
What is the mechanism of action of codeine?
An agonist of mu-opioid receptors, which are involved in the transmission of pain.
What are the key side effects of codeine?
Drowsiness, sedation, respiratory depression, nausea, vomiting, constipation
What are the GI side effects of codeine?
Nausea, vomiting, constipation
What class of drug is diclofenac?
NSAID - non-steroidal anti-inflammatory drug)
What is diclofenac used for?
Reduce pain & inflammation
What is the mechanism of action of diclofenac?
Binds to and inhibits COX-1 and COX-2 to block the production of prostaglandin, which is involved in inflammation
What are the GI side effects of diclofenac?
Nausea, vomiting, diarrhoea
What is the key difference between the action of diclofenac and the action of codeine?
Diclofenac reduces inflammatory pain, while codeine decreases pain perception
What are the key personal perspectives of the doctor and patient in the doctor-patient relationship?
knowledge, experiences, ideas, priorities, attitudes, opinions
What are some of the societal factors that contribute to health behaviours?
Advertising, accessibility, stigma, cost, education, socioeconomic status, cultural values, religion
What are the 4 pillars of medical ethics?
Beneficence, non-maleficence, autonomy, justice
What is beneficence?
To act in the best interest of the patient
What is non-maleficence?
To do no harm to the patient
What is autonomy?
The patient’s right to choose or decline treatment
What is justice?
Fairness and equity in the distribution and delivery of treatment
What are the 3 parts of the ‘spirit of Motivational Interviewing’?
Collaborative, Honouring autonomy, evocative
What are the core principles of Motivational Interviewing?
OARS: Open questions, affirmation, reflective listening, summarising
What are the 6 stages of change in Motivational Interviewing?
Pre contemplation, Contemplation, Determination, Action, Maintenance, Recurrence
What causes nausea/vomiting in a patient taking morphine?
Morphine, and other opioids, act on chemoreceptors in the CTZ (chemoreceptor trigger zone) in the medulla oblongata. Morphine also inhibits gut motility, causing nausea & vomiting.
What is the name for the ‘vomiting centre’ in the medulla oblongata?
CTZ - chemoreceptor trigger zone
What causes nausea/vomiting in a patient in cardiogenic shock?
Decreased blood flow to the GI tract slows digestion. The ischemic byproducts of damaged cardiomyocytes can trigger nausea and vomiting also.
What causes nausea/vomiting in a patient receiving cytotoxic chemotherapeutic drugs?
Drugs trigger the release of substance P from neurons which acts on NK1 receptors in the brain, triggering vomiting. Cell damage in GI tract can also cause it.
What causes nausea/vomiting in a patient who has witnessed a horrifying event?
Adrenaline can decrease gut motility, and the vasovagal response leads to hypotension and nausea
What causes nausea/vomiting in a patient who is in her first trimester of pregnancy?
HCG, a hormone produced by the placenta, can trigger nausea. High progesterone can slow gastric motility. Increased sensitivity of CTZ in the brain
What are antiemetic drugs?
Medications used to prevent nausea and vomiting symptoms
What are the 3 key antiemetic drugs studied?
Metoclopramide, domperidone, cyclizine
What is the mechanism of action of metaclopramide?
Antagonises dopamine-2 receptors in the CTZ to decrease sensitivity of nerves between GI tract and CTZ.
What is the mechanism of action of domperidone?
Antagonises dopamine-2 and dopamine-3 receptors in the CTZ to decrease the sensitivity of nerves between the GI tract and vomiting centre.
What is the mechanism of action of cyclizine?
Antagonises H1 histamine receptors to inhibit nausea and vomiting
What is the action of metaclopramide?
anti-emetic
What is the action of domperidone?
anti-emetic
What is the action of cyclizine?
anti-emetic
