Clinical skills

Question 1

What are the risks of O2 administration with patients with COPD?

Answer 1

Supplemental O2 removes a COPD patient’s hypoxic (low level of oxygen) respiratory drive causing hypoventilation which causes higher carbon dioxide levels, apnea (pauses in breathing), and ultimately respiratory failure.

Question 2

What are GSL medicines?

Answer 2

General Sales Medicines do not need pharmacist supervision and can be bought from supermarkets

Question 3

What are P medicines?

Answer 3

Pharmacy medicines are sold under pharmacist supervision

Question 4

What are POM medicines?

Answer 4

Prescription Only Medicines must be prescribed by a doctor, dentist or another qualified health professional

Question 5

What are controlled drugs?

Answer 5

Drugs which are tightly regulated by the government in relation to their production, use, handling, storage and distribution. Include opioids, stimulants, depressants, hallucinogens and anabolic steroids

Question 6

What are the classes as laid out by the misuse of drugs act?

Answer 6

Class A: No therapeutic value, highly addictive (Heroin, methadone, cocaine, crack cocaine, MDMA, mushrooms, crystal meth)

Class B: Highly addictive (Amphetamines, barbiturates, cannabis, dihydrocodeine)

Class C: Minor stimulants and depressants (Benzodiazepines, tramadol, midazolam, steroids, subutex)

Question 7

When can class B drugs be reclassified as class A?

Answer 7

When they have been prepared for injection

Question 8

When are codeine and morphine classified as schedule 5?

Answer 8

In concentrations less than 0.2%

Question 9

What is a PGD?

Answer 9

A Patient Group Direction provides a legal framework that allows some registered health professionals to supply and/or administer specified medicines to a pre defined group of patients without them having to see a prescriber

Question 10

What is a controlled drugs register?

Answer 10

A record of any schedule 1 or CD containing schedule 2 substances received or supplied by a pharmacy

Question 11

What defines hazardous waste?

Answer 11

Sharps
Cytotoxic substances (kills living things)
Cytostatic medicines (arrests growth of living things)
Clinical waste

Question 12

What are the 3 main routes of drug administration?

Answer 12

Enteral: Absorbed through the GI tract
Percutaneous: Absorbed through the skin
Parenteral: And other route

Question 13

What are some advantages and disadvantages of intranasal drug administration?

Answer 13

-High mucosal permeability
-Fast absorption due to highly vascularised subepithilial tissue
-Avoids first pass
-Not limited by vomiting
-Not very invasive
-Can be self administered

-Limited to small volumes
-Mucociliary action
-Can be impaired by illness/injury
-Chronic use may cause damage

Question 14

What are the benefits of giving drugs via inhalation?

Answer 14

Smaller required dose and reduced side effects

Question 15

How many litres of O2 for a nebulising mask?

Answer 15

6-8L

Question 16

What is the absorption speed of subcutaneous injections?

Answer 16

Very slowly

Question 17

Where is the dorsogluteal IM injection site?

Answer 17

Upper outer quadrant of the buttocks (gluteus maximus muscle)

Question 18

Where is the ventrogluteal site for IM injections?

Answer 18

Side of the hip (Gluteus medius muscle)

Question 19

What hand position is used for ventrogluteal injections?

Answer 19

Heel of the hand on the greater trochanter, index finger on the anterior superior iliac spine

Question 20

What are some pros and cons of IV injection?

Answer 20

Pros:
Immediate effects
More suitable for large volumes
No absorption needed
Suitable for unconscious patients
Avoids first pass

Cons:
Aseptic technique is essential
Painful and costly
Short duration of action (supporting equipment needed for longer periods e.g. drips)
Self medication not possible

Question 21

What are some contradictions for cannulation?

Answer 21

Local infection, burns or compromised skin at insertion site
Deep vein thrombosis or trauma on affected limb
Arteriovenous Fistula

Question 22

What are the trans mucosal drug administration routes?

Answer 22

Intranasal, buccal, sublingual and rectal

Question 23

What are some advantages and disadvantages of buccal and sublingual drug administration?

Answer 23

-Rapid onset
-Avoids first pass
-Non invasive
-Can be self administered
-Suitable for patients with swallowing difficulties or even unconscious patients

-Limited to small doses
-Difficulty in keeping drug on site
-Not very suitable for bad tasting drugs

Question 24

What are some advantages and disadvantages of rectal drug administration?

Answer 24

-Avoids first pass
-Doesn’t cause vomiting
-Suitable for pre-surgery
-Prolonged drug action
-Can be self administered

-Patient comfort
-Placement too high will cause fast pass metabolism
-Can trigger deification reaction

Question 25

What’s the rate of BVM ventilations on a patient who is not breathing?

Answer 25

Once every 6 seconds

Question 26

When giving neb salbutamol to a patient with COPD how long do you administer for?

Answer 26

6 min on 6 min off

Question 27

What is the maximum number of puff on a patients own inhaler you can encourage them to take?

Answer 27

10 puffs, 2 at a time

Question 28

What is the correct order for iGel insertion?

Answer 28

Laryngoscopy
iGel
Right angle connection
Filter
Capnography
BVM

Question 29

What should you do the check an iGel inserted correctly?

Answer 29

Check C02
Ausculte chest and stomach on ventilation

Question 30

If an iGel is inserted incorrectly what should you do before re-attempting?

Answer 30

Re-oxygenate