Consent and drug counselling Flashcards
How do you consent for a bronchoscopy?
Preparation: 4h clear fluids, 2h NBM. Do clotting test and stop aspirin/ warfarin 1 week before.
During: Can use midazolam as a sedative and lignocaine gel for airways
After procedure: No E+D for 2h as throat is numb . No driving, alcohol or heavy machinery for 24h and get picked up with sedative.
Arrange F/U.
Risks:
Sore throat.
Haemoptysis next day if biopsy
Lung collapse
Consent for an OGD?
Before: 8h no fluids before
4h before NBM
Stop anatcids 2 w before
During: Midaxzolam as sedative and lidocaine spray with continuous suction, air is passed through which may make you feel full/ gassy
After: No alcohol, driving or heavy machinery for 24 h and someone picks you up with sedative
F/U with GP
Risks: Perforation (will get pain, high temperature, breathing difficulties - may be able to mix with just abx, may need surgery) Bleeding Infection sore throat
Consent for Colonoscopy
Before: 3d no bran 1d before clear fluids only 4h before NBM Laxative Sachets morning and night before
During: Midazolam sedative Pain relief - IV or gas and air Takes 30-45 mins of actual scoping Air passed through scope which may make you feel bloated and like you need to go to the toilet
After:
Are taken to a recovery room since have been given sedative
No driving, alcohol, heavy machinery, get picked up for sedation
F/U 2-3 weeks for results of biopsy
Risks: Perforation, bleeding, infection, abdominal pain, failure to complete procedure
Red flag sx: Excessive PR bleeding, temperture
Consent for cystoscopy?
Before:
NBM for 2h
During: May have sedative or anaesthesia
anaesthetic jelly used
After:
No alcohol, driving, heavy machinery, need pick up if sedative
Risks: Bleeding Infection Mild pain with urination haematuria if biopsy
Consent for chest drain?
Done under local anaesthetic
Insertion of plastic tube to collect fluid content in chest
Is diagnostic (sample sent to lab) and therapetuic
Drain bottle is kept under bed to allow to drain
Risks: Bleeding, infection, pain, risk of lung damage
Investigations would ask for: pH, protein, LDH, gram stain. MCS
Consent for lumbar puncture?
Use local anaesthetic
Needle inserted into space between vertebrae of back, goes in about 1-2cm, very small amount of the fluid that surrounds the spinal cord is collected which will be sent to the lab. Will need to lie flat for 4 hrs after to stop CSF leak and subsequent headache.
Risks: bleeding, infection, meningitis, CSF leak
Investigations would ask for from sample: MCS, cell count, glucose, protein, PCR
Consent for blood transfusion?
Benefits: Relieves symptoms and stops damage to organs from anaemia, allows quicker recovery
Risks: 1 in 10,000
Reactions (allergies, anaphylaxis - monitored during to deal with this quickly)
Build up of fluid causing SOB
Infection (low due to our screening, 1 in a million chance)
Formation of antibodies
Can get delayed reactions (Delayed haemolytic reaction, graft versus host, infections)
During: small sample of blood needs to be taken before to check blood group, this will be tested in the lab, a cannula is then put in your arm, you will have your details checked many times to check this is the right match for you. It usually takes 2-4 h to tranfuse the blood, vitals will be monitored during.
Consent for NGT?
CI: Basal skull #
Process: Measure distance first, Lubricate tip NGT, insert horizontally, give water to keep swallowing
Consent for NGT?
CI: Basal skull #
Process: Measure distance first, Lubricate tip NGT, insert horizontally, give water to keep swallowing if no risk of aspiration, once reach desired length fix with dressing.
Check local guidance but generally is aspirate pH <5.5 is fine –> if can’t get aspirate then lie on left for 30 mins and retry. Otherwise CXR which must show NGT passing vertically down the oesophagus until the diaphragm, does not follow bronchi, tip NGT visible 10cm beyond gastro-oesophageal junction
Summarise SSRI counselling
Action: Antidepressants alter balance of chemicals in brain, alters levels of serotonin
Timeline: OD
How taken: Tablet
Length: stop 3-6 months after feel better
Effects: 4-6 weeks
Tests: None
Important Side effects: GI, headache, drowsy, anxiety at first, ED
Complications/ CI: Suicide risk - need review in 2 weeks of starting
Summarise Methotrexate counselling
Action: DMARD which suppresses inflammation and immune system
Timeline: Once weekly with folic acid
How taken: Tablet/ infection
Length: Long-term
Effects start: 4-6 months
Tests: FBC, LFT, UE at start, 2 weeks until established then every 2-3 months
Important SE: alopecia, headaches, GI distrubance, myelosuppression so beware anaemia, bleeding/ brusing/ infections
Complications: myelosuppression, liver toxicity (careful alcohol), pulmonary toxicity
CI: Pregnancy (male too), hepatic impairment, breast feeding, infections, immunodeficiency
Supplementary advice: Need annual flu jab, no NSAIDs
Summarise Lithium counselling
Action: mood stabiliser
Timeline: OD
How taken: tablet/ syrup
Length: lifelong usually
Effects start: 1-2 weeks
Tests: FBC, UE, TFT at start and every 6m+ bHCG, ECG baseline. lithium levels every week until stable then every 3m
Effects: GI, fine tremor, thirst, polyuria, wt gain
CI: pregnant, breast feeding, cardiac disease, significant renal impairment, addisons
Complications: lithium toxicity (dysarthria, dizzy, coarse tremor, ataxia, muscle twitch, speech/ vision problems, N+V+D)
Renal toxicity
diabetes insipidus
hypothyroidism
Supplementary advice: brand lithium is important
Summarise atypical antipsychotics
Action: blocks receptors in brain
Time: OD tablet or depot 2-4 weeks
How taken: tablet/ depot
Length: long term
Effect taken after: days/ weeks
Tests: LFT, ECG
Important SE: anti-dopaminergic (tardive dyskinesia, tremor, movement disorder); anti-cholinergic (constipation, dry mouth); anti-histamine (wt gain, dizzy); QT prolongation; gynaecomastia ; ED
CI: liver failure, phaeochromocytoma, need advice in pregnancy
Complications: liver failure, NMS (high fever and rigid muscles), agranulocytosis
Summarise Levodopa counselling
Action: Replaces dopamine in brain which helps with rigidity and slow movements
Time: 3-4 times daily with food
How taken: PO
Length: As long as it works effectively
Effect taken after: Straight away
Tests: None
Important SE: Psychosis, N+V, dyskinesia - can use domperidone and selegiline to help with this
CI: glaucoma
Summarise bisphosphonates counselling
Action: Prevents the bone from being broken down and helps rebuild new bone
Time taken: once weekly
How taken: tablet, wait at least 30 minutes before food and stay upright
Length: long term but can eventually try a bisphosphonates holiday
Tests: dental check up
Important SE: heartburn, GI SE
CI: pregnancy, stomach ulcers, dysphagia, severe renal impairment
Complications: osteonecrosis of the jaw, atypical #s, oeseophageal irritation
Summarise Warfarin counselling
Action: Thins the blood by blocking vitamin K
Time taken: OD, same time every day
How taken: Tablet
Length: 3/6 months for DVT, 6 months for PE, lifelong AF
Effect starts: 2-3 days
Tests: INR needs to be taken regularly
Important SE: Bleeding (look out for bruises, epistaxis, haematuria, bleeding gums, dark stools etc); N+V+D; interactswith CYP450 drugs and steroids
CI: pregnancy, haemorrhagic stroke, ORBIT score high, surgery
Supplementary advice: Carefu alcohol binges, NSAIDs, keep diet the same. Need yellow anticoagulant book, tell doctors you’re on warfarin as has lots of interactions and before surgery!!, dont double up on warfarin doses
Summarise Levothyroxine
Action: Increase hormone in body that thyroid usually makes
Time taken: OD
How taken: tablet
Length: lifelong
Effects start: few weeks later
Tests: TFT every 2-3 months until stable and after that annually
Important SE: Usually none as replacing a hormone but if become hyperthyroid may get N+V+D, heat intolerance, palpitations/ hypothyroid sx
Summarise statin counselling
Action: stops the liver making cholestrol which predisposes to clots in blood
Time taken: OD at night
How taken: tablet
Length: lifelong
Effects start: decreases the risk over the years
Tests: LFTs at start, 3m and 12m
Important SE: muscle pains, N+V+D
CI: pregnancy
Complications: Rhabdomyolysis
Supplementary advice: Avoid grapefruit juice and clarithromycin
Summarise Metformin Counselling
Action: Lowers blood glucose by increasing sensitivity to insulin
Time taken: OD with meal
How taken: Tablet
Length: Lifelong if works
Tests: U+Es before starting and then annually
Important SE: GI distubances
CI: Renal impairment, low BMI, ketoacisosis, stop before general anaesthetic
Complications: Lactic acidosis
Summarise Iron tablet counselling
Action: Replaces body’s store of iron which is needed to make blood cells
Time taken: OD-TDS, with food
How taken: Tablet
Length: usually 4 months
Effects start: 3-4 weeks
Tests: FBC in 3-4 weeks
Important SE: GI irritation (N+V+D, dark stools), tablets taste bad
Explain inhaler technique
Explain that inhalers are to relax the tubes in the lungs, they need to reach quite deep down so need to stay in lungs as long as possible. Explain when to use and that 2 puffs should be taken.
1) remove mouthpiece
2) shake cannister
3) breathe all the way out
4) form a tight seal with mouth around mouthpiece
5) take a deep breath in and press firmly down on the cannister
6) breathe in for as long as you can
7) hold your breath for 10s then breathe out normally
8) repeat
Summarise HRT counselling
Action: replacess oestrogen and progesterone which have gone down with menopause which will help reduce hot flushes, vaginal dryness, OP, CVD
Time: OD
How taken: gel, cream, PO or patch - patch if VTE risk, combined if have uterus, cyclical if perimenopausal and continous if menopausal
Length: as long as symptoms need controlling
CI: breast cancer, PV bleed, breast feeding, VTE
Supplementary advice: contraception needed until 1 yr post final period
Summarise COCP counselling
Action: stop you from getting pregnant by stopping periods and thickening mucus of womb to stop sperm entering, also improves PMS and reduces risk of ovarian and endometrial cancer
Time: OD, same time every day, 21 days on, 7 days off
How taken: PO (also have depot proverra, patch, coil and implant)
Length: As long as wish not to be pregnant
Effects start: After 7 days unless taken in day 1-5 of period cycle
Tests: BP check
Important SE: headaches, sore breasts, low mood, low libido, breakthrough bleeding, skin changes, raised BP, blood clots
CI: VTE, breast cancer, pregnant, migraine with aura, 35+ smoking 15+ cigarettes a day; relative = BMI 35+
Complications: cervical cancer, breast cancer
Supplementary advice: 99% effective if taken correctly Does not protect against STIs Retake if D+V Stop before surgery (4 weeks) May interact with abx Missed pill rules: If miss one take another on same day, if miss two still take the other and then if there are less than 7 pills in the pack do not take your break and use condoms for 7 days. If there are over 7 use condoms for 7 days and still have your withdrawal bleed
Summarise steroid counselling
Action: Reduce inflammation
Time: OD
How taken: PO
Length: depends
Important SE: wt gain, skin thinning, acne, mood change, proximal myopathy
CI: NSAIDs
Complications: peptic ulcers, htn, infections, OP, DM, cataracts
Supplementary advice: Sick day rules, dont suddenly stop
Need bisphosphonates and PPI, NSAID CI
