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clinical bs Flashcards

1
Q

who is aspririn permitted for

A

adults and children over 16

300mg to 900mg every 4-6 hours
max 4g

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2
Q

why is aspirin not for those under 16

A

not recommended

reyes syndrome

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3
Q

nuromol

A

ibuprofen 200mg

paracetamol 500mg

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4
Q

anadin

A

paracetamol 200
aspirin 300
caffeine 45mg

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5
Q

co-codamol

A

oparacetamol

codiene

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6
Q

Co-dydramol

A

paracetamol

dihydrocodeine

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7
Q

MHRA asdbice for pain killers containing codeine and dihdrocodeine

A

tighter measures for the sale of products containing codeine and dihydrocodeine because of the risk of overuse and addiction

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8
Q

back pain brought on by

A

soft tissue injury from twisting or lifting

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9
Q

spreading of back pain

A

pain may radiate to buttocl o thigh

restig movement and causing the patient to adopt a posture leaning forward or to the side

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10
Q

tx of back pain

A

analgesia
rest
heat
physiotherapy

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11
Q

lifestyle advice for back pain

A

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

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12
Q

when to refer back pain

A

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

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13
Q

when to reger injuries

A 
severe pan
severe swelling
numbness
limb unable to bear weight
swelling occurs in old injury
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14
Q

tx of injuries. rice

A

rest
ice
compression
elavation

oral analgesic

  • paracetamol
  • nsaids and aspirin

to[pical analgesics
topical rubeficants

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15
Q

dental pain. signs and symptoms

A 
dental abscess
dental caries
pericornitis
dry socket
gingical recession
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16
Q

types of primary ehadache

A

migrane w or w/out aura
tension type headache
cluster and otehr trigemical autonomic

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17
Q

types of tension type head headache

A

infrequent episodic tension type headache
frequent episodic tension type headache
chronic tension type headache

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18
Q

migraine symtpoms

A 
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)

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19
Q

tx of headaches

A

nsaids and aspirin

paracetamol

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20
Q

tx of migraines

A 
nsaids and aspiorin
paracetamol
compound analgesics
sumatriptan
prochlorperazine
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21
Q

sumatriptan

A

constrict cerbral arteries

coutneract cranaial vasodilat

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22
Q

dose of sumatriptan

A

one 50mg tablet

second dose taken after minimin of two hours

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23
Q

tension type headache

A

pericrainial muscle contraction
pain often at base of skull but can be over top of head
bilateral
ddull pain

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24
Q

what can tensiion type ehacache be triggered by

A

tension anxiety fatigue

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25
Q

cluster headache

A

affects mainly men

male to female ratio 6;1

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26
Q

secondary headache

A

headache attributed to other conditions such as :
neck trauma
craninal or cerviacal vascular disorder
infection

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27
Q

neuralgias and other headaches

A

central and primary facial pain

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28
Q

headache red flag

A

sudden or severe onset of headache
headache with stiff neck or rash
headache with n and v
unresponsive to analgesics

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29
Q

who pain ladder

A

simple analgesic

opioid suitable for mild pain+ simple analgesic

opioid suitable for severe pain + simple analgesic

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30
Q

options for gastroprotection

A

h2 receptor antagonist
misoprostol
proteon pump inhibitor

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31
Q

oral nsaid prescribing for healthy young adults

A

low dose ibuprofen

1200mg/ day

consider prescrbibing ppi with nsaid to reduce risk of adverse GI effects

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32
Q

topical nsaids contraindication

A

pregneant woemn

dont use oral and topical nsaid

not to be applied to broken skin, mucouus memerbane or near the eyes

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33
Q

opioid induced constipation tx

A

non pahramcologucal approaches

laxatives

peripherally restricted opioid antagoist

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34
Q

initiating oral morphine for pain

A

pain assessment inclusing analgesia
determine opioid erquirement
calculate 24 hour requirement
convert to modified release formulation

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35
Q

converting to alternative opioid

A

determine 24 hour requirement

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36
Q

patient controlled analgesia

A

iv or sc administration

is a method by which the patient controls the amount of pain medicine (analgesia) they receive.

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37
Q

epidural opioids

A

alternatice to patient controlled analgesia

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38
Q

csi

A

continuous subcutaneous infusion

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39
Q

indication of contrinuous subcutaneous infusion

A

unable to take medicines by mouth
bowel obstruction
patient does not wish to take regular medication by mouth

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40
Q

monitoring of opioid therapy

A 
pulse
bp
respiratory rate
pain
oxygen saturation
opioid usage/ side effects
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41
Q

naloxone

A

opioid antagonist

higher affinity for receptor than agonist

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42
Q

tramadol

A

mu opioid reeptor agonist

inhibit noradrenaline uptake and 5-ht release

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43
Q

tricyclic antidepressant

A

emitriptyline and nortriptylune

inhibit neuronal reuptake of noradernaline and serotonin

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44
Q

antiepileptic drugs

A

block votlage gated sodium channels

effective in certain neuropathic pain syndromes

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45
Q

gabapentin and pregabalin

A

prevent voltage dependent calcium channel activation in dorsal horn neyrines
does not affect voltage gated na channels

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46
Q

lidocaine 5% medicated plaster

A

licensed for PHN (Postherpetic neuralgia (PHN) is nerve pain which occurs due to damage to a peripheral nerve)

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47
Q

what is pain

A

unpleasant and sensory and emotional experieince associated with actual or potential tissue damage or described in terms of such damage

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48
Q

perception, emotion and loclaisation of pain

A

perception-it hurts
emotion-it botehrs me
lcoalisation-its my leg

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49
Q

what changes pain

A

movment
weight bearing
isometric contraction
pressure

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50
Q

what else changes pain

A 
anxiety
stress
attention/distractuion
mood
tablets
51
Q

muscoskeletal pain

A

pain arising froma disease processes affecting bone, joints, tendon, muscle and spine

52
Q

neuropathic pain

A

pain caused by lesion or disease of the somatosensory nervous system

53
Q

chronic primary pain

A

pain without probable muscoskeletal origin

54
Q

measuring the pain of knee osteoarthiritis

A

quesitonaire

quantitaive sensory testing

brain imaging

55
Q

amount of medicaiton is not a measure of pain severity

A

use lecture recording to elaborate

56
Q

intermittent and constant oa pain scale

A

constant -continous acting

intermittent-severe but transcient

57
Q

pain catastophising

A

important mediator of chronic pain

says stuff that are only negative about the pain

58
Q

painDETECT

A

neuropathic screening questionnaire

59
Q

pain assessment in children, dementia and in those unable to communicate

A 
observation
-facial expression
verbalization
body movement
changes in interpersonal interaction
changes in activity patterns and routine
60
Q

fmri and back pain

A

neuroimaging provides evidence of structural and functional brain changes in the majority of chronic pain syndromes

61
Q

fmri and pain catastrophising scale

A

high pcs-predicts higher pain intensitu, disability, reduced treatment efficacy, persistent opioid use

62
Q

somateosensory genotype

A

centalised pain processing system

driven and modulated by neurotransmitters and their receptors

modulated by complex system of inflammatory cytokines and growth factors

63
Q

sensory phenotype

A

asdaasd

64
Q

asdasdasd

A

asdasd

65
Q

asdasd

A

asdasds

66
Q

back pain trajectories

A

track back pain pts qst (quantitative sensory testing)changes after stimuli over time

67
Q

who are back pain trajectories abnormal in

A

those with early life stress

e.g. childhood absue, physical stress

68
Q

clinical significance of back pain trajectories

A

predict at risk individuals

normalsise the somatosensory changes

69
Q

intervention and treatment to pain

A

self management, improving udnerstanding, expectations,self effucacy, resiliance

physical therapies
pain management programmes
medicaitons
procedures

70
Q

procedures used in intervention of pain

A

injections
surgery
neuromodulation

71
Q

diagnostic invasive procedures

A

medial branch blocks

injection to the medial nerve

72
Q

how are the values of the interventions calculated

A

outcomes/values

73
Q

high value outcomes

A

epidural for disc protrusion reduces need for surgery

74
Q

low value outcomes

A

many interventions get no or temporary pain relief

relatively high cost

75
Q

STarT back screening

A

designed to help clinicians produce an indexs of modifiable risk factis

used to stratify patients to matched treatment

76
Q

what medications not to use in lower back pain

A

paracetamol

opioid except weak opioids +- paracetamol for acute LBP

amityptyline

spnial flusion

77
Q

what to do in lower back pain

A

nsaids

exercise

manual therapy alongside exercise

psychological tx alongside exercise

promote and facilitate return to work or normal activities of daily living

78
Q

what factors to consider when thinkign about interbentions in relation to lower back pain

A

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

79
Q

the role of placebo in pain management

A

changing perspective

RCT data for OA

clincial relebrance

80
Q

what can expectations in a drug affect its effectiveness

A

exxpectation can reverse drug effect

81
Q

patient practitioner interaction

A

negative words can increase pain

82
Q

sham

A

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

83
Q

nocebo

A

detrimental effect on health produced by psychological or psychosomatic factors such as negative expectations of treatment or prognosis.

84
Q

adherence to plavebo in modifying outcomes

A

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

85
Q

optimising contextual response in patient care

A

positive, professional, unhurried consultations

full holistic patient assessment

elicit abd address concerns

individualised education, risk factors, outcomes, treatment

involve patient in management decisions

86
Q

cost eddectiveness and good patietn education

A

good patietne education and assessment takes time

cost effective long term

87
Q

2 ways controlled drugs are classified

A

misuse of drugs act 1971

misuse of drugs regulations 2001

88
Q

misuse of drugs act 1971

A

primary purpose to prevent the misuse of ‘controlled drugs’

89
Q

how does the misuse of drugs act prevent the misuse of controlled drugs

A

prohibiting posession, supply , manufacture, import and export

exceot as allowed by the regulations or licence from the secretary of state

90
Q

class of drugs and penalties

A

drugs classified according to their potential harmfulness and the class determines penalties for drug offences under the act

91
Q

misuse of drugs regulations 2001

A

controls applied to their legitimate use

classified on the basis of several factros

92
Q

5 schedules

A 
schedule 1-cd lic
schedule 2-cd pom
schedule -cd no register pom
schedule 4
schedule 5-cd inv pom
93
Q

schedule 4 split into

A

part 1-CD benz

aprt 2: cd anab-anabloic steroid and hrowth hormones

94
Q

possessions

A

unlawful to be in possessions of CDs orther than in schedule 5 unless permitted

95
Q

who can permit the possessions of controlled drugs

A

home office license
legally prescribed
member of a aclass of person specified in the regulations e.g. practictioner, pharmacists

96
Q

safe custody

A

scehdule 2 and 4 must be kept in a locked safe, cabinet or room

97
Q

exemptions of schdule 2 and 3s that are exempted from teh safe custody

A

scedule 2-quinabarbitone

schedule 3- many exemptions
applies to temzaepam, diethylproprion, brupernorphine

98
Q

prescription requreiemnt for drugs in schedule 2 and 3

A 
acquainted witht he prescriber signature
data
address
dose
total quantity
quantity prescribed
instalment
99
Q

collection of schedule 2 cds

A

legal requirement to ascertain who is collecting

  • patient or representative
  • healthcare professional

good practise to obtain signature from person collcting
instalment prescription

100
Q

controlled drug requisition

A

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)

101
Q

midwife supply order

A

registered midwiffe authorised to possess and administer diamorphine, morphine and pethidine in her own right

102
Q

what must a widwife supply order contain

A 
name of midwife
occupation
name of person to whom cd administered
purpose for which drug required
total quantitiy
authorising signature
103
Q

record keeping (controleld rug register)

A

electronic or handwritten form

schedules 1 and 2

for controlled drugs received

  • date
  • name and address
  • quantity received
104
Q

variation of controlled drug registers

A

different part of register for each class, strength and formulation

entered chonologically
entered promptly
indelible

105
Q

sativex. controlled drugs registered

A

cannabinoid extract

keep records of supply and receipt

106
Q

destruciton of controlled drugs. sc 2, 3 4 (pt1)

A

denaturing prior to denaturing

107
Q

destruction of sch 2. exprired pharmacy stock

A

destroyed in the prescnence of an authorised witness

108
Q

destruction of ech3. expired pharmacy stock

A

destruction does not need to be witnessed. but good practise for another memeber of staff to witness and record

109
Q

destruction of controlled drugs. patient returned drugs

A

sch 2 cd destroyed without authorised witness

110
Q

accountant officer

A

role in ensure safe and appropriate and effective manageent of cds within organization

111
Q

supply to misusers

A

specialiset prescribers

doctors require home office license to prescribve cocaiane, diamorphine

non licensed doctors should refer to specilaist treatment centers

112
Q

medicinal cannabis

A

cannabis based products for medicinal use rescheduled as sch 2

must be prescribed by specialist

113
Q

new psychoactive substances

A

legal highs

114
Q

psychoactive substance act 2016

A

being (a) capable of producing a psychoactive effect in a persons who consume it and (b) is not an exempted substance

115
Q

psychoactive effect is

A

stimulating or depressing the cns

affects metnal functioning or emotional state

116
Q

tension between health and commercial aims

A

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

117
Q

promotion and marketing of oxycontin, commerical tirumph public health tragedy

A

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

118
Q

effects on interactions between physicians and thepharmaceuticdal industry and effects on knowledge, attitudes and behavior

A

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

119
Q

common problems with referencing in adverts

A

cited refernces are inconsistent witht eh advertising claim

120
Q

how to evaluate drug company adverts

A

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

121
Q

ABPI

A

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

122
Q

pharmaceutical industry.research

A

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

123
Q

the erpidemiology of industry sponseored researc

A

research found that trials supported by parhamceutical industry were about 3 times mroe likely to report in favour of the experimental therapy

124
Q

why does epidemiology happen

A

little evidece that its due to poorer methodological quality of industry sponsored research

pain (6 decks)

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