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General practice > Counselling stations - OSCE > Flashcards

Counselling stations - OSCE Flashcards

1
Q

What type of risk factors is it important to elicit when counselling for bisphosphonates

A

osteoporosis risk factors including smoking, alcohol, steroid use and being post-menopause.

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2
Q

How do bisphosphonates work

A

They work by slowing down the process of bone breakdown by osteoclasts, whilst allowing osteoblasts to continue enhancing bone density(Prevent thinning of bones)

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3
Q

How often is alendronic acid taken

A

Once a week(tablet) - Same day each week

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4
Q

How should alendronic acid be taken

A

Should be taken with a large glass of water, and the patient should not consume any food or drink, other than water, for 2 hours after taking it.

Advise the patient to sit upright for 30 mins after taking the tablet as alendronic acid can cause oesophageal irritation, ulceration and in some cases strictures.

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5
Q

Advice regarding missed tablets - alendronic acid

A

If the patient misses a tablet, they should take it as soon as they remember. They should not take 2 tablets in one day.

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6
Q

How long do bisphosphonates take for effect and how often is this reviewed

A

Roughly 6 months for the bisphosphonate to take effect

Annually reviewed

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7
Q

Side effects of bisphosphonates

A

Oseophageal irritation
abdominal pain, nausea, gastrointestinal upset and joint/muscle pain

Osteonecrosis of jaw(should attend annual dental checks)

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8
Q

Which medications should not be taken with bisphosphonates

A

OTC painkillers(ibuprofen) - can worsen oesophageal irritation

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9
Q

Lifestyle advice when on bisphosphonates

A

Diet and exercise
Weight-bearing exercises
High calcium foods(dairy, leafy greens)
Smoking cessation

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10
Q

What type of risk factors is it important to elicit when counselling for statins

A

CVS history/risk factors - smoking, HTN, sedentary lifestyle

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11
Q

Tool used to assess need for statins

A

QRISK - 10-year risk of CVD over the age of 40

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12
Q

What are statins

A

Statins are a group of lipid-lowering drugs used to reduce the risk of atherosclerosis and related CVD events.

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13
Q

How do statins work

A

Work by inhibiting a key enzyme in the liver, HMG-CoA reductase, causing a decrease in hepatic synthesis of cholesterol.

Increases the expression of hepatic cholesterol receptors, increasing uptake of low-density lipoprotein (LDL) from the blood to the liver, resulting in a fall in plasma cholesterol(reduces production of new cholesterol and clears bad cholesterol)

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14
Q

What might patients with raised triglyceride concentrations require

A

Fibrate in addition to a statin

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15
Q

How often are statins taken

A

OD - at night with consistent timing

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16
Q

Advice regarding missed tablets - statins

A

If the patient misses a tablet, they should take it as soon as they remember. They should not take two tablets in one day.

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17
Q

monitoring treatment of statins

A

Pre-treatment cholesterol levels

LFTs

Another blood test within 3 months of starting treatment and again at 12 months to monitor effectiveness

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18
Q

Side effects of statins

A 
Myalgia/cramps/tenderness 
Muscle toxicity 
Nausea
Constipation 
Diarrhea
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19
Q

Key statin interactions

A

Grapefruit
Antibiotics
Immunosuppressants
Fibrates

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20
Q

Lifestyle advice while on statins

A

Physical activity(moderate intensity of 30 mins at least 5 days a week)
Healthy foods
Smoking and alcohol cessation

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21
Q

How is clozapine taken

A

Clozapine comes in tablet form, a liquid option and more recently an orodispersible form.

It is not currently available in depot form.

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22
Q

Why is it important not to miss a dose of clozapine

A

Clozapine is prescribed at a low dose to start off with and this is titrated up over a period of several weeks. It is important that doses are not missed. This is because if clozapine is not taken for more than 48 hours the titration process needs to start again

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23
Q

Advantages of clozapine

A

Studies have shown that approximately six out of ten people with treatment-resistant schizophrenia will benefit from taking clozapine.

There is also research that demonstrated clozapine is superior to olanzapine when preventing suicide attempts in patients with schizophrenia and schizoaffective disorder

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24
Q

Common side effects of clozapine

A 
Sedation(consider night time dosing) 
Constipation 
Tachycardia 
Weight gain 
Hypersalivation 
BP changes 
Hyperglycaemia
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25
Q

Rare/serious side effects of clozapine

A

Agranulocytosis
Lowers seizure threshold
Cardiac complications(myocarditis/cardiomyopathy)

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26
Q

Baseline ix for clozapine

A 
ECG
Blood pressure and pulse
Calculation of body mass index (BMI)
FBC, U&Es, LFTs, prolactin, HbA1c and lipids 
Baseline tropi
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27
Q

Clozapine monitoring

A

Weekly FBC in first 18 weeks

Fortnightly after 18 weeks and then monthly after one year

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28
Q

What can cause plasma clozapine levels to change

A

Levels of clozapine can rise significantly with the reduction and cessation of cigarette smoking

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29
Q

How is levothyroxine taken

A

at least 30 minutes before breakfast. This is because food and coffee can reduce the absorption of levothyroxine

Once a day tablet

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30
Q

Missed dose - levothyroxine

A

If they forget to take a dose, advise them to take it as soon as they remember but to avoid double dosing.

31
Q

Monitoring in levothyroxine therapy

A

TFTs

2-3 weeks after initiation of treatment, tweaking levothyroxine dose as required
2-3 monthly intervals after a dose change
Annually once thyroid hormone levels are within the normal range and stable

32
Q

Side effects from excessive dose of levothyroxine

A

Heat intolerance
Weight loss
Insomnia
Fine tremor

33
Q

Side effects from inadequate dose of levothyroxine

A 
Cold intolerance
Weight gain
Low mood
Constipation
Dry skin
34
Q

What are the three main types of emergency contraception

A

The copper intrauterine device,

EllaOne® which is a 30mg ulipristal acetate tablet, also known as “the morning after pill”

Levonelle® which is a 1500mg levonorgestrel tablet, also known as “the morning after pill”, “plan B”, or “one-step”

35
Q

Aspects of sexual history that should be asked about prior to emergency contraception

A

Consensual sex
LMP
Safeguarding
Screening for STIs

36
Q

How does levonelle work

A

Levonelle® works by inhibiting ovulation for around 5 days.

37
Q

When can levonelle be taken

A

72 hours of UPSI

Longer the delay, the less effective it is

38
Q

How effective is levonelle

A

Less effective than Ella one

Not effective after ovulation

39
Q

Side effects of levonelle and risks

A

Nausea/vomiting
Delayed/early menses
Double dose in patients with BMI of 26 or above

Would need to taken a second dose if vomit within 3 hrs of taking tablet

40
Q

Advantages of levonelle

A

Generally safe

Can use with ongoing contraception

41
Q

How does ellaone work

A

Ulipristal acetate works by delaying ovulation for around 5 days

42
Q

When can ellaone be taken

A

120 hrs or 5 days of UPSI

43
Q

What can ellaone effectiveness be affected by

A

rendered less effective by progestogen hormones, and as such should not be taken in a 7 day period following progestogen use

44
Q

Risk and side effects of Ellaone

A

nausea, vomiting, and a delayed or early menses

if a patient vomits within 3 hours of taking ellaOne®, they will need to repeat the dose

Not suitable in patients with severe asthma

45
Q

What is the copper IUD

A

a small T-shaped plastic and copper device which is inserted into the womb during a small procedure

46
Q

How does copper IUD work in contraception

A

Fertilisation inhibition occurs through direct toxicity effects of the copper on both ovum and sperm. This toxic effect prevents pregnancy

47
Q

When can copper IUD be used for contraception

A

up to 5 days, (120 hours) after unprotected sex; or within 5 days of the earliest expected date of ovulation

48
Q

How long should copper iUD be left in place for contraception

A

the copper IUD should remain in situ ideally for 21 days. It can be left in place for up to 10 years to provide ongoing contraceptive protection.

49
Q

When should patients be advised to take pregnancy test after emergency contraception

A

3 weeks after UPSI

50
Q

Disadvantages of copper IUD

A

Infection, expulsion, perforation, ectopic pregnancy

51
Q

How does methotrexate work

A

Disease modifying agent which reduces inflammation and suppresses the immune system

52
Q

How is methotrexate taken

A

Tablet usually
Injection also available

Once weekly with folic acid at another time. Build up dose slowly

53
Q

Length of methotrexate treatment

A

Long term

54
Q

Time it takes for methotrexate to take effect

A

4-6 months

55
Q

Methotrexate monitoring

A

FBC, LFTs and U&Es

Before starting, then every 2 weeks and then every 2-3 months

56
Q

side effects of methotrexate

A

Alopecia
Headaches
GI disturbance

Infection
Unexpected bleeding/bruising
Anaemia

57
Q

Complications of methotrexate

A

Myelosuppression
Liver toxicity
Pulmonary toxicity(inform if SOB)

58
Q

Methotrexate contraindications

A 
Pregnancy(including male) 
Hepatic impairment 
Breast feeding 
Active infection 
Immunodeficiency
59
Q

Supplementary advice for methotrexate

A

No NSAIDs/Aspirin
Annual flu jab
Arthritisresearch.org.uk

60
Q

How do SSRIs work

A

Alter balance of some of chemicals in the brain.

SSRI affect a chemical called serotonin. An altered balance of serotonin and other chemicals is thought to play a part in depression

61
Q

How should SSRIs be taken

A

Once daily

Tablet

62
Q

When should SSRIs be stopped normally

A

3-6 months after feeling better(taper)

63
Q

How long do SSRIs take to show effect

A

4-6 weeks

64
Q

Important side effects of SSRIs

A 
GI(diarrhoea, nausea, vomiting) 
Appetite and weight change 
Headache 
Drowsiness 
Anxiety(first 2 weeks)

Withdrawal

65
Q

SSRI contraindications

A

Suicide risk

Past psychiatric illness

66
Q

How does lithium work

A

Mood stabiliser

Each mechanism unknown

67
Q

How is lithium taken

A

Once or twice daily
Tablet, capsule or syrup
Lifelong usually(if works) with regular psych review

68
Q

How long does it take for lithium to take effect

A

1-2 weeks

69
Q

Tests for lithium therapy

A

FBC, U&Es, TFTs, beta HCG, ECG

70
Q

How often should lithium be checked

A

After 5 days

Then every week until stable for 4 weeks, then every 3 months

71
Q

Lithium side effects

A

GI(Nausea)
Metallic taste
Fine tremor
Water symptoms(thirst)

72
Q

Lithium toxicity symptoms

A

GI
Neuromuscular(dysarthria, dizziness)
Others(drowsiness, apathy)

73
Q

Complications of lithium therapy

A

Renal toxicity
Nephrogenic diabetes insipidus
Hypothyroidism

74
Q

Lithium contraindications

A 
1st trimester preg 
Breast feeding 
Cardiac disease 
Significant renal disease 
Addison's

General practice (26 decks)

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