clinical bs Flashcards
who is aspririn permitted for
adults and children over 16
300mg to 900mg every 4-6 hours
max 4g
why is aspirin not for those under 16
not recommended
reyes syndrome
nuromol
ibuprofen 200mg
paracetamol 500mg
anadin
paracetamol 200
aspirin 300
caffeine 45mg
co-codamol
oparacetamol
codiene
Co-dydramol
paracetamol
dihydrocodeine
MHRA asdbice for pain killers containing codeine and dihdrocodeine
tighter measures for the sale of products containing codeine and dihydrocodeine because of the risk of overuse and addiction
back pain brought on by
soft tissue injury from twisting or lifting
spreading of back pain
pain may radiate to buttocl o thigh
restig movement and causing the patient to adopt a posture leaning forward or to the side
tx of back pain
analgesia
rest
heat
physiotherapy
lifestyle advice for back pain
avoid bending or stopping, lifting or sitting on low chairs, allow time for back to recover
backpain rarely assocated with serious illness therefore self limiting
when to refer back pain
not related to movement
associated with symptoms of illness
associated with neurolopgical symtpoms eg tingling or numbness
unresponnsive to 7 day tx with otc products
when to reger injuries
severe pan severe swelling numbness limb unable to bear weight swelling occurs in old injury
tx of injuries. rice
rest
ice
compression
elavation
oral analgesic
- paracetamol
- nsaids and aspirin
to[pical analgesics
topical rubeficants
dental pain. signs and symptoms
dental abscess dental caries pericornitis dry socket gingical recession
types of primary ehadache
migrane w or w/out aura
tension type headache
cluster and otehr trigemical autonomic
types of tension type head headache
infrequent episodic tension type headache
frequent episodic tension type headache
chronic tension type headache
migraine symtpoms
at least two of throbbing or pulsating pain severe intensity pain unilateral pain worsen by movement
at least one of
n and/or v
photophobia and photonophobia (loud noises)
tx of headaches
nsaids and aspirin
paracetamol
tx of migraines
nsaids and aspiorin paracetamol compound analgesics sumatriptan prochlorperazine
sumatriptan
constrict cerbral arteries
coutneract cranaial vasodilat
dose of sumatriptan
one 50mg tablet
second dose taken after minimin of two hours
tension type headache
pericrainial muscle contraction
pain often at base of skull but can be over top of head
bilateral
ddull pain
what can tensiion type ehacache be triggered by
tension anxiety fatigue
cluster headache
affects mainly men
male to female ratio 6;1
secondary headache
headache attributed to other conditions such as :
neck trauma
craninal or cerviacal vascular disorder
infection
neuralgias and other headaches
central and primary facial pain
headache red flag
sudden or severe onset of headache
headache with stiff neck or rash
headache with n and v
unresponsive to analgesics
who pain ladder
simple analgesic
opioid suitable for mild pain+ simple analgesic
opioid suitable for severe pain + simple analgesic
options for gastroprotection
h2 receptor antagonist
misoprostol
proteon pump inhibitor
oral nsaid prescribing for healthy young adults
low dose ibuprofen
1200mg/ day
consider prescrbibing ppi with nsaid to reduce risk of adverse GI effects
topical nsaids contraindication
pregneant woemn
dont use oral and topical nsaid
not to be applied to broken skin, mucouus memerbane or near the eyes
opioid induced constipation tx
non pahramcologucal approaches
laxatives
peripherally restricted opioid antagoist
initiating oral morphine for pain
pain assessment inclusing analgesia
determine opioid erquirement
calculate 24 hour requirement
convert to modified release formulation
converting to alternative opioid
determine 24 hour requirement
patient controlled analgesia
iv or sc administration
is a method by which the patient controls the amount of pain medicine (analgesia) they receive.
epidural opioids
alternatice to patient controlled analgesia
csi
continuous subcutaneous infusion
indication of contrinuous subcutaneous infusion
unable to take medicines by mouth
bowel obstruction
patient does not wish to take regular medication by mouth
monitoring of opioid therapy
pulse bp respiratory rate pain oxygen saturation opioid usage/ side effects
naloxone
opioid antagonist
higher affinity for receptor than agonist
tramadol
mu opioid reeptor agonist
inhibit noradrenaline uptake and 5-ht release
tricyclic antidepressant
emitriptyline and nortriptylune
inhibit neuronal reuptake of noradernaline and serotonin
antiepileptic drugs
block votlage gated sodium channels
effective in certain neuropathic pain syndromes
gabapentin and pregabalin
prevent voltage dependent calcium channel activation in dorsal horn neyrines
does not affect voltage gated na channels
lidocaine 5% medicated plaster
licensed for PHN (Postherpetic neuralgia (PHN) is nerve pain which occurs due to damage to a peripheral nerve)
what is pain
unpleasant and sensory and emotional experieince associated with actual or potential tissue damage or described in terms of such damage
perception, emotion and loclaisation of pain
perception-it hurts
emotion-it botehrs me
lcoalisation-its my leg
what changes pain
movment
weight bearing
isometric contraction
pressure
what else changes pain
anxiety stress attention/distractuion mood tablets
muscoskeletal pain
pain arising froma disease processes affecting bone, joints, tendon, muscle and spine
neuropathic pain
pain caused by lesion or disease of the somatosensory nervous system
chronic primary pain
pain without probable muscoskeletal origin
measuring the pain of knee osteoarthiritis
quesitonaire
quantitaive sensory testing
brain imaging
amount of medicaiton is not a measure of pain severity
use lecture recording to elaborate
intermittent and constant oa pain scale
constant -continous acting
intermittent-severe but transcient
pain catastophising
important mediator of chronic pain
says stuff that are only negative about the pain
painDETECT
neuropathic screening questionnaire
pain assessment in children, dementia and in those unable to communicate
observation -facial expression verbalization body movement changes in interpersonal interaction changes in activity patterns and routine
fmri and back pain
neuroimaging provides evidence of structural and functional brain changes in the majority of chronic pain syndromes
fmri and pain catastrophising scale
high pcs-predicts higher pain intensitu, disability, reduced treatment efficacy, persistent opioid use
somateosensory genotype
centalised pain processing system
driven and modulated by neurotransmitters and their receptors
modulated by complex system of inflammatory cytokines and growth factors
sensory phenotype
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back pain trajectories
track back pain pts qst (quantitative sensory testing)changes after stimuli over time
who are back pain trajectories abnormal in
those with early life stress
e.g. childhood absue, physical stress
clinical significance of back pain trajectories
predict at risk individuals
normalsise the somatosensory changes
intervention and treatment to pain
self management, improving udnerstanding, expectations,self effucacy, resiliance
physical therapies
pain management programmes
medicaitons
procedures
procedures used in intervention of pain
injections
surgery
neuromodulation
diagnostic invasive procedures
medial branch blocks
injection to the medial nerve
how are the values of the interventions calculated
outcomes/values
high value outcomes
epidural for disc protrusion reduces need for surgery
low value outcomes
many interventions get no or temporary pain relief
relatively high cost
STarT back screening
designed to help clinicians produce an indexs of modifiable risk factis
used to stratify patients to matched treatment
what medications not to use in lower back pain
paracetamol
opioid except weak opioids +- paracetamol for acute LBP
amityptyline
spnial flusion
what to do in lower back pain
nsaids
exercise
manual therapy alongside exercise
psychological tx alongside exercise
promote and facilitate return to work or normal activities of daily living
what factors to consider when thinkign about interbentions in relation to lower back pain
changes in pain account for relatively little or no variance in outcomes
pain relief is not necessary for patient satisfaction
aim is to improve QoL according tp patient values
the role of placebo in pain management
changing perspective
RCT data for OA
clincial relebrance
what can expectations in a drug affect its effectiveness
exxpectation can reverse drug effect
patient practitioner interaction
negative words can increase pain
sham
Sham surgery (placebo surgery) is a faked surgical intervention that omits the step thought to be therapeutically necessary. In clinical trials of surgical interventions, sham surgery is an important scientific control
nocebo
detrimental effect on health produced by psychological or psychosomatic factors such as negative expectations of treatment or prognosis.
adherence to plavebo in modifying outcomes
antibiotic px follwing chemotherapy
non aderes to plcebos twice the infectionr ate as adhereres
chlorpromazine for schizophrenia. non adherers to placebo twice relapse as adherers
optimising contextual response in patient care
positive, professional, unhurried consultations
full holistic patient assessment
elicit abd address concerns
individualised education, risk factors, outcomes, treatment
involve patient in management decisions
cost eddectiveness and good patietn education
good patietne education and assessment takes time
cost effective long term
2 ways controlled drugs are classified
misuse of drugs act 1971
misuse of drugs regulations 2001
misuse of drugs act 1971
primary purpose to prevent the misuse of ‘controlled drugs’
how does the misuse of drugs act prevent the misuse of controlled drugs
prohibiting posession, supply , manufacture, import and export
exceot as allowed by the regulations or licence from the secretary of state
class of drugs and penalties
drugs classified according to their potential harmfulness and the class determines penalties for drug offences under the act
misuse of drugs regulations 2001
controls applied to their legitimate use
classified on the basis of several factros
5 schedules
schedule 1-cd lic schedule 2-cd pom schedule -cd no register pom schedule 4 schedule 5-cd inv pom
schedule 4 split into
part 1-CD benz
aprt 2: cd anab-anabloic steroid and hrowth hormones
possessions
unlawful to be in possessions of CDs orther than in schedule 5 unless permitted
who can permit the possessions of controlled drugs
home office license
legally prescribed
member of a aclass of person specified in the regulations e.g. practictioner, pharmacists
safe custody
scehdule 2 and 4 must be kept in a locked safe, cabinet or room
exemptions of schdule 2 and 3s that are exempted from teh safe custody
scedule 2-quinabarbitone
schedule 3- many exemptions
applies to temzaepam, diethylproprion, brupernorphine
prescription requreiemnt for drugs in schedule 2 and 3
acquainted witht he prescriber signature data address dose total quantity quantity prescribed instalment
collection of schedule 2 cds
legal requirement to ascertain who is collecting
- patient or representative
- healthcare professional
good practise to obtain signature from person collcting
instalment prescription
controlled drug requisition
required for supply of sc 2 or 4 cd
must be processed
-marked with suppliers name and address of receipt
-copied, retained for 2 years
sent to nhs agency (ppd)
midwife supply order
registered midwiffe authorised to possess and administer diamorphine, morphine and pethidine in her own right
what must a widwife supply order contain
name of midwife occupation name of person to whom cd administered purpose for which drug required total quantitiy authorising signature
record keeping (controleld rug register)
electronic or handwritten form
schedules 1 and 2
for controlled drugs received
- date
- name and address
- quantity received
variation of controlled drug registers
different part of register for each class, strength and formulation
entered chonologically
entered promptly
indelible
sativex. controlled drugs registered
cannabinoid extract
keep records of supply and receipt
destruciton of controlled drugs. sc 2, 3 4 (pt1)
denaturing prior to denaturing
destruction of sch 2. exprired pharmacy stock
destroyed in the prescnence of an authorised witness
destruction of ech3. expired pharmacy stock
destruction does not need to be witnessed. but good practise for another memeber of staff to witness and record
destruction of controlled drugs. patient returned drugs
sch 2 cd destroyed without authorised witness
accountant officer
role in ensure safe and appropriate and effective manageent of cds within organization
supply to misusers
specialiset prescribers
doctors require home office license to prescribve cocaiane, diamorphine
non licensed doctors should refer to specilaist treatment centers
medicinal cannabis
cannabis based products for medicinal use rescheduled as sch 2
must be prescribed by specialist
new psychoactive substances
legal highs
psychoactive substance act 2016
being (a) capable of producing a psychoactive effect in a persons who consume it and (b) is not an exempted substance
psychoactive effect is
stimulating or depressing the cns
affects metnal functioning or emotional state
tension between health and commercial aims
conflict between goals of manufacturers and the social, medical and econiomic needs of providers and the public to select and use drugs in the most rational way
promotion and marketing of oxycontin, commerical tirumph public health tragedy
massive investment in development of key opinion leaders
use of sophisticted marketing data to influence prescribing
distribution of branded promotional items to health care professionals
effects on interactions between physicians and thepharmaceuticdal industry and effects on knowledge, attitudes and behavior
continuing education funding increased the likelihood of presccribing sponsor’s products
frequent cotnact with sale representatives associated with higher prescribing costs and more rapid prescriptions of new medicines and less prescribing of generics
common problems with referencing in adverts
cited refernces are inconsistent witht eh advertising claim
how to evaluate drug company adverts
do citations contain all the information necessary to identidy references
are all referenced cited rerievable including those to ‘data on file’
are referencees of high metholodogical quality
ABPI
2006 code of practise for pharamceutical industry onw orking with patient groups
enforces that pahramceutical company sponsorship must be clearly, fairly and prominently displayed on any projects meterials, publications, meeting papers
pharmaceutical industry.research
industry sponsored research generates extreem reactions
P has a primary responsibility to generate profits for shareholders
it can and does use a varierty of techniques to present the findings of research to health professionals
the erpidemiology of industry sponseored researc
research found that trials supported by parhamceutical industry were about 3 times mroe likely to report in favour of the experimental therapy
why does epidemiology happen
little evidece that its due to poorer methodological quality of industry sponsored research
