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Specialities > Clinical Pharmacology > Flashcards

Clinical Pharmacology Flashcards

1
Q

What is the definition of complimentary alternative medicine?

A

a broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system

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2
Q

Give some examples of CAM

A 
Herbal medicine
Homeopathy
Acupuncture
Anthroposophic medicine
Aromatherapy
Ayuveda
Chiropractice
Hypnosis
Meditation
Naturopathy
Osteopathy
Reflexology
Shiatsu
Yoga
Chinese medicine
Vitamins and minerals
Massage
Nutraceutical
Acupressure
Spiritual healing/prayer
Alexander technique
Applied kinesiology
Autogenic training
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3
Q

What are the concerns regarding the use of CAM?

A
  • Implausibility of most therapies
  • Lack of evidence and safety data
  • Evidence of harm
  • Adverse effects/herb-drug interactions
  • Unqualified practitioners/missed diagnoses
  • Stopping conventional medicine
  • Cost effectiveness ?
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4
Q

Why do people use CAM?

A
  • Think its safe, natural and harmless
  • Don’t see any distinction
  • Dissatisfaction with conventional medicine
  • Side effects
  • Lack of effective treatments
  • Chronic symptoms
  • Hype
  • Holistic
  • Promote health
  • Relatives use CAM
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5
Q

Why do healthcare professionals recommend CAM?

A
  • Patient demand
  • Placebo effect
  • Genuine belief in it
  • Experience
  • Feel good factor in terminal illness/distressing hospital experiences
  • Use CAM themselves
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6
Q

Why is using CAM potentially dangerous in pregnancy?

A
  • No safety or efficacy data
  • Teratogenesis
  • Fetogenesis
  • Drug-herb interactions
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7
Q

What are the issues regarding the safety of herbal medicines?

A
  • Contamination, adulteration and misidentification
  • Variation between labelled content and actual content
  • Serious toxic effects
  • Lack of data
  • Drug-herb interactions
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8
Q

What are the issues regarding the safety of homeopathy?

A
  • Missed diagnosis
  • Inappropriate treatment
  • Adulteration
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9
Q

What are the issues regarding the safety of acupuncture?

A 
Infection
Pneumothorax
Pneumopericardium
Organ puncture
Cardiac Tamponade
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10
Q

Why can aromatherapy be harmful?

A

Skin irritation
Photosensitivity
Headaches and fatigue
Insomnia
Origanum, sage, savory, thyme and wintergreen are not safe for home use
Bronchial spasm
Abortifacient - need avoided during pregnancy

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11
Q

Which agency regulates the licensing of medicines in the UK and what do they ensure?

A
  • MHRSA

- Ensure that human medicines meet acceptable standards on safety, quality and efficacy

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12
Q

Other than licensing the medicine what else do the MHRA do?

A
  • Clinical trial authorisation
  • Product licence (must be renewed every 5 yrs and new data analysed)
  • Company license: manufacturing and wholesaler dealer licenses
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13
Q

What is pharmacovigilance?

A

The process involving detection, assessment, understanding and prevention of adverse drug reactions e.g. Yellow Card Scheme

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14
Q

What does the Yellow Card Scheme collect information on?

A
  • Side effects/ADRs
  • Medical device adverse effects
  • Defective medicines
  • Counterfeit/fake medicines or medical devices
  • Safety concerns e.g. for e-cigarettes
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15
Q

Give three ways in which a drug which is not licensed can be used?

A
  • Unlicensed: no marketing authorisation
  • Offlabel: licensed but prescribed outwith the terms of marketing authorisation
  • Specials: special formulation of medicines made for clinical reasons when an existing formulation of an available licensed product is not suitable for the patient
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16
Q

How can medicines be classified?

A
  • Prescription only medicines (POM)
  • Pharmacy medicines (P)
  • General Sales List (GSL)
17
Q

What are the general prescription requirements (Primary care)?

A
  • Name and address of patient
  • Age if patient is under 12
  • Drug name, formulation, dose, frequency and quantity
  • Signed and dated
  • Type of prescriber and address
18
Q

What are the prescription requirements for controlled drugs?

A
  • Schedules 2,3, and 4 limited to 30 day supply
  • Specify formulation and strength
  • Specify dose
  • Total amount in words and figures
19
Q

What are the general principles for prescription chart?

A
  • All patients must have a PAR
  • Use permanent black ink
  • Legible: block capitals
  • Max of 2 PARs at a time
  • Use 24hr clock
  • Don’t use dittos
  • Sign for each medicine and print name
  • Route of administration
  • Generic prescribing unless clinically significant (beclometasone inhalers, ciclosporin etc.)
  • Insulin by brand
20
Q

What is osmolarity?

A

The measure of solute concentration per unit

21
Q

What is the definition of osmolality?

A

The measure of solute concentration per unit mass of solvent

22
Q

What is tonicity?

A

The measure of the osmotic pressure gradient between two solutions

23
Q

How is the fluid in the body distributed?

A
  • 2/3 (28L) Intracellular

- 1/3 (14L) Extracellular

24
Q

What is the osmolality inside and outside of the cell?

A

285-290 mOsm/kg

25
Q

What are the daily requirements for water and solutes?

A
  • Water: 25-30ml/kg/day
  • Sodium: 1mmol/kg/day
  • Potassium: 1mmol/kg/day
  • Glucose: 50-100g/day
26
Q

What are the R’s of fluids?

A
  • Resus
  • Routine maintenance
  • Replacement
  • Redistribution
  • Reassessment
27
Q

When should dextrose be used and when should it not?

A
  • Useful in Chronic Dehydration and hypernatraemia

- Not useful in resus and low albumin

28
Q

When should crystalloids be used and when should they not?

A
  • Useful in acute dehydration, AKI and resus

- Not useful in long term maintenance and hypernatraemic patients

29
Q

When should plasma expanders be used and when should they not?

A
  • Useful: liver patients and intra-operatively

- Not useful in much else

30
Q

What are the most common causes of adverse events?

A
  • Surgery
  • Complications from drug treatment
  • Therapeutic mishaps
  • Diagnostic errors
31
Q

Which patients are most at risk of adverse events?

A
  • Patients undergoing cardiothoracic/vascular/neuro surgery
  • Those with complex conditions
  • Patients in A&E
  • Those with inexperienced doctors
  • Older patients
32
Q

What factors can increase the risk of medication errors?

A
  • More rapid throughput of patients
  • New drug developments
  • Increasing complexity of medical care
  • Increased specialisation
  • Increased use of medications
  • Sicker and older patients
33
Q

What are the people related causes of medication incidents?

A

Fatigue, hunger, concentration, stress, distraction, lack of training, lack of access to information and other factors (alcohol, drugs, illness etc.)

34
Q

Where do the majority of errors occur?

A

Prescribing and administering

35
Q

What are the common prescribing errors?

A

Wrong drug, wrong dose, inappropriate units, poor prescriptions, drug interactions, omission, wrong route, calculation errors, infusions with not enough details, once weekly drugs and multiple dose changes

36
Q

What is the role of the Scottish Medicines Consortium?

A

Primary role is to make decisions on the cost effectiveness of new/existing pharmaceutical products in respect of their use in NHS Scotland

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