Communication & pharmacology Flashcards
How do you describe statin therapy?
Gauge understanding of cholesterol and statins
Cholesterol is a type of fat in your blood, eaten and created by your liver
Different types (goof HDL and bad LDL)
Too much LDL increases risk of stroke and heart disease
Diet changes (less fat and eggs), increased exercise and losing weight may help
Statins are the main medication, reducing cholesterol by reducing amount created by the liver
Pill taken once daily, at night, lifelong
Reduces risk of heart disease and stroke and can shrink plaques in coronary arteries
SE: myalgia, muscle breakdown and deranged liver function, n & v & d
Leaflet & summarise
How do you describe inhaler technique?
Establish understanding of asthma and inhalers
Medication directly to airways
MDI same dose every time, spacers improve results
Shake, cap off
Breathe out, seal lips around inhaler
Start breathing in and press button
Breathe in deep and hard for as long as you can, hold for 10 secs
Breathe out normally and repeat whole process
Demonstrate, get pt to perform it and correct mistakes
How do you counsel someone about warfarin?
Check understanding of why they need it and what it does
Decreases clotting and increases INR
Taken once daily, doses may vary depending on INR measured from blood test
INR and doses all recorded in yellow book
In clinic the nurse may adjust dose depending on INR
1st few days a higher ‘loading’ dose will be given
SE: bleeding, alopecia, d&v&n, jaundice
Seek medical help if excessive bruising, nose bleeds, haematuria, bleeding gums
Reduce alcohol and green veg consumption, keep it steady
Avoid contact sports
Avoid pregnancy (teratogenic)
Read all drug info carefully before taking new drug as may interact
Do not double dose if you miss it, or stop taking it without advice from Dr
May need to inform dentist etc, wear medic alert bracelet?
How do you counsel someone about HRT?
Establish understanding of menopause and HRT
HRT replaces natural oestrogen and progesterone that the body stops producing at menopause
Pro’s: reduced hot flushes, reduced vaginal dryness and atrophy, postpones osteoporosis, protects against CV disease and ovarian ca
con’s: breast cancer, endometrial cancer, DVT
C/I: breast cancer, PV bleeding, breastfeeding, DVT/PE
Comes in pill, cream, pessary
Contraception should be continued until 1 month after last period
ICE
How effective is the COCP?
Over 99% with perfect use
91% with average use
Who can’t take COCP?
Pregnant Within 21 days of delivery BMI>35 Age >35 and smoker Sickle cell PV bleeding Severe liver disease HTN Migraine with aura Hx or FH of DVT/PE
Benefits of COCP
Makes periods regular and lighter
Decreased risk of ovarian and endometrial cancer
Risks of COCP
DVT/PE
Breast and cervical cancer
Nausea, headache, sore breasts, tired, change in sex drive, mood and skin changes
What do you do if you miss a COC pill?
If missed pill <12hrs take missed pill and continue as normal (even if this means 2 pills on one day)
If missed pill>12hrs or 2 pills then take 1 pill as soon as you remember
If more than 7 days of pills left, use extra protection for 7 days, allow 7 day bleed then start next pack as normal
If less than 7 days left, use extra protection for 7 days and start next pack without break
How do you approach a consultation about starting prednisolone tablets for RA?
Establish knowledge, whether taken before
Other meds, NSAID use, allergies
Steroids are anti-inflammatory drugs, reduce swelling and pain but have many SE
SE: peptic ulcers, gastritis, osteoporosis, infection, HTN, diabetes
Other SE: skin thinning, weight gain, mood change, stretch marks, muscle weakness
To minimise SE monitor BP, sugar etc
Give Ca and Vit D and PPI
Avoid NSAIDs and notify doctor if stomach pain or vomit blood
Low dose and reduce it slowly, but likely to be long term, oral OD
Can’t stop suddenly due to own steroid production needs to catch up (addisonian crisis)
When writing a variable rate insulin infusion, what key details need to be included?
50 units actrapid in 49.5ml fluid
0.9% saline if BM>15, 5% dextrose if BM<15
1unit/ml
Include 20mmol KCL in 1L fluid bags but write ‘no more than 40mmol KCl per 24hrs’
If BM<3.9 or >20 call doctor
