Clinical skills Flashcards
What are the risks of O2 administration with patients with COPD?
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.
What are GSL medicines?
General Sales Medicines do not need pharmacist supervision and can be bought from supermarkets
What are P medicines?
Pharmacy medicines are sold under pharmacist supervision
What are POM medicines?
Prescription Only Medicines must be prescribed by a doctor, dentist or another qualified health professional
What are controlled drugs?
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
What are the classes as laid out by the misuse of drugs act?
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)
When can class B drugs be reclassified as class A?
When they have been prepared for injection
When are codeine and morphine classified as schedule 5?
In concentrations less than 0.2%
What is a PGD?
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
What is a controlled drugs register?
A record of any schedule 1 or CD containing schedule 2 substances received or supplied by a pharmacy
What defines hazardous waste?
Sharps
Cytotoxic substances (kills living things)
Cytostatic medicines (arrests growth of living things)
Clinical waste
What are the 3 main routes of drug administration?
Enteral: Absorbed through the GI tract
Percutaneous: Absorbed through the skin
Parenteral: And other route
What are some advantages and disadvantages of intranasal drug administration?
-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
What are the benefits of giving drugs via inhalation?
Smaller required dose and reduced side effects
How many litres of O2 for a nebulising mask?
6-8L
What is the absorption speed of subcutaneous injections?
Very slowly
Where is the dorsogluteal IM injection site?
Upper outer quadrant of the buttocks (gluteus maximus muscle)
Where is the ventrogluteal site for IM injections?
Side of the hip (Gluteus medius muscle)
What hand position is used for ventrogluteal injections?
Heel of the hand on the greater trochanter, index finger on the anterior superior iliac spine
What are some pros and cons of IV injection?
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
What are some contradictions for cannulation?
Local infection, burns or compromised skin at insertion site
Deep vein thrombosis or trauma on affected limb
Arteriovenous Fistula
What are the trans mucosal drug administration routes?
Intranasal, buccal, sublingual and rectal
What are some advantages and disadvantages of buccal and sublingual drug administration?
-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
What are some advantages and disadvantages of rectal drug administration?
-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
What’s the rate of BVM ventilations on a patient who is not breathing?
Once every 6 seconds
When giving neb salbutamol to a patient with COPD how long do you administer for?
6 min on 6 min off
What is the maximum number of puff on a patients own inhaler you can encourage them to take?
10 puffs, 2 at a time
What is the correct order for iGel insertion?
Laryngoscopy
iGel
Right angle connection
Filter
Capnography
BVM
What should you do the check an iGel inserted correctly?
Check C02
Ausculte chest and stomach on ventilation
If an iGel is inserted incorrectly what should you do before re-attempting?
Re-oxygenate
