Clinical Pharmacology Flashcards
What is the definition of complimentary alternative medicine?
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
Give some examples of CAM
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
What are the concerns regarding the use of CAM?
- 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 ?
Why do people use CAM?
- 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
Why do healthcare professionals recommend CAM?
- Patient demand
- Placebo effect
- Genuine belief in it
- Experience
- Feel good factor in terminal illness/distressing hospital experiences
- Use CAM themselves
Why is using CAM potentially dangerous in pregnancy?
- No safety or efficacy data
- Teratogenesis
- Fetogenesis
- Drug-herb interactions
What are the issues regarding the safety of herbal medicines?
- Contamination, adulteration and misidentification
- Variation between labelled content and actual content
- Serious toxic effects
- Lack of data
- Drug-herb interactions
What are the issues regarding the safety of homeopathy?
- Missed diagnosis
- Inappropriate treatment
- Adulteration
What are the issues regarding the safety of acupuncture?
Infection Pneumothorax Pneumopericardium Organ puncture Cardiac Tamponade
Why can aromatherapy be harmful?
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
Which agency regulates the licensing of medicines in the UK and what do they ensure?
- MHRSA
- Ensure that human medicines meet acceptable standards on safety, quality and efficacy
Other than licensing the medicine what else do the MHRA do?
- Clinical trial authorisation
- Product licence (must be renewed every 5 yrs and new data analysed)
- Company license: manufacturing and wholesaler dealer licenses
What is pharmacovigilance?
The process involving detection, assessment, understanding and prevention of adverse drug reactions e.g. Yellow Card Scheme
What does the Yellow Card Scheme collect information on?
- Side effects/ADRs
- Medical device adverse effects
- Defective medicines
- Counterfeit/fake medicines or medical devices
- Safety concerns e.g. for e-cigarettes
Give three ways in which a drug which is not licensed can be used?
- 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
How can medicines be classified?
- Prescription only medicines (POM)
- Pharmacy medicines (P)
- General Sales List (GSL)
What are the general prescription requirements (Primary care)?
- 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
What are the prescription requirements for controlled drugs?
- Schedules 2,3, and 4 limited to 30 day supply
- Specify formulation and strength
- Specify dose
- Total amount in words and figures
What are the general principles for prescription chart?
- 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
What is osmolarity?
The measure of solute concentration per unit
What is the definition of osmolality?
The measure of solute concentration per unit mass of solvent
What is tonicity?
The measure of the osmotic pressure gradient between two solutions
How is the fluid in the body distributed?
- 2/3 (28L) Intracellular
- 1/3 (14L) Extracellular
What is the osmolality inside and outside of the cell?
285-290 mOsm/kg
