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CSP2 Flashcards

1
Q

Locus of control

A

Expectancy that rewards are controlled by external forces or one’s own behaviour (internal vs. external)

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2
Q

Health belief model

A

action is a function of perceived likelihood of illness, seriousness, costs and benefits of action

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3
Q

Self efficacy

A

belief in ability to success, task specific

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4
Q

States of change

A 
Pre contemplation (happy with status quo)
Contemplation (think about change)
Preparation
Action
Maintenance or Relapse
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5
Q

What extent of obesity is associated with increased all cause mortality?

A

> 34

Not Grade 1 obesity 30-35

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6
Q

Basal metabolic rate for women

A

1200-1600 kCal per day

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7
Q

Total energy expenditure for most women

A

2000-2500

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8
Q

Strategies of behaviour modification

A 
Self monitoring
stimulus control
goal setting
cognitive restructuring
incentives
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9
Q

Successful slimming Recommendations

A

Diet and activity
400 kcal/day activity
Eat 5 times
Weigh 1 a week

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10
Q

Physical activity recommendation

A

30 minutes moderate activity on 5 or more days a week
Up to an hour/day to prevent obesity
Up to 90 minutes/day to maintain weight reduction

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11
Q

Who can have orlistat Rx (Xenical) - one you prescribe?

A
  • 12 years or older
  • BMI >30
  • BMI>37 with HTN, diabetes, dyslipidemia
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12
Q

Orlistat Rx (Xenical) dosage

A

120mg

With fat containing meals

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13
Q

Orlistat OTC (Alli) dosage - over the counter.

A

18 years
reduced calorie and low fat diet needed as well
60mg with fat containing meals
£12 per week

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14
Q

Orlistat effectiveness

A

Meta analysis shows weight change at 12 months compared to placebo

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15
Q

Side effects of orlistat

A
  • diarrhea
  • steatorrhea
  • minimised by maintaining strict low fat diet
  • reduce intake of fat soluble vitamins = multivitamins for 2 weeks
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16
Q

Atkins diet

A

Max 20g of carbs/day

Protein and fat

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17
Q

Appetite Suppressants

A 
Methylcellulose
Amphetamine derivatives
Sibutramine (SSRI derivative)
Rimonabant (cannabis antagonist)
GLP1 agonist = liraglutide, daily subcut injection, feel fuller and satisfied, reduces speed of stomach emptying, nausea and vomit, thyroid tumours, pancreatitis
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18
Q

Malabsoprtion inducers

A

Orlistat
Acarbose
SGLT2 inhibitors

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19
Q

Metabolic stimulants

A

Thyroxine

Beta-agonists

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20
Q

Gastric surgery

A

BMI 40 or above or 35 or above with comorbidities
Gastric Bypass = Roux en Y, restrictive and malabsoprtive (changed gut hormones)
LAP BAND = restrictive

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21
Q

Product licence

A

Marketing Authorisation

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22
Q

Off label

A

Use/route outside licensed indication

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23
Q

Liability

A

None to prescriber if

  • correct diagnosis
  • correct medicine choice
  • patient warned of potential adverse effects
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24
Q

MHRA

A

Medicines and Healthcare Products Regulatory Agency

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25
Classification of Medicinal Products
General Sale List Pharmacy Only medicines Prescription Only medicines Controlled Drugs
26
Prescription Only Medicines
To anyone except injections Injections if purpose of saving life Midwives, chiropodists, opticians, paramedics, practititoners direct
27
FP10s
GP prescriptions
28
FP14
Dentist prescriptions
29
FP10MDA-SS
Addict prescriptions
30
OM
On-in the morning:at night
31
PRN
When required
32
SOS
If neccessary
33
Black List
Indigestion remedies Analgesics Hypnotics & Anxiolytics (not available on NHS)
34
Supplementary prescribing
Voluntary prescribing partnership Between independent prescriber and supplementary prescriber Agreed patient specific clinical management plan with patient agreement
35
BAN
British Approved Name
36
Most commonly implicated medications in adults
Antiplatelets Diuretics NSAIDs Anticoagulants
37
NPSA
National Patient Safety Agency
38
Clinical Trial Positives
No confounding No bias Gives correlation
39
Define pharmacodynamics
Relationship between drug level and effect | 'what drug does to body'
40
Hysteresis
Relationship between drug concentrations and effect is not direct
41
Counter clockwise hysteresis
``` Sensitisation of receptors Delay of drug to site of effect Agonist metabolite generation Slow receptor kinetics Time dependent protein binding ```
42
Clockwise hysteresis
``` Tolerance of receptors Feedback regulation Time dependent protein binding Antagonist metabolite generation Disequilibrium between arterial and venous concentration ```
43
Drug targets
Enzymes Ion channels Ion carriers/transporters Receptors
44
Affinity
How avidly drug binds to receptor Low Kd = high affinity = low conc of ligand to bind half of receptors - determined by strength of receptor-ligand interaction
45
Receptor Ligand Interaction
Electrostatic (common) Hydrophillic Covalent (least common)
46
Selectivity
Drugs ability to preferentially binding to certain receptors
47
Specificity
Number of different mechanisms involved In drug action
48
Potency
Conc. (EC50) or dose (ED50) of drug required to produce 50% of drugs maximal effect
49
Median inhibitory concentration
IC50 | Concentration of an antagonist that reduces a specified response to 50% of the maximal possible effect
50
Efficacy
max effect (Emax) of a drug
51
Full agonist
Maximal response by occupying all or fraction of receptors
52
Partial agonist
Less than max response even when drug occupies all of receptors
53
Antagonist
Affinity but no efficacy
54
Inverse agonists
Agent which binds to same receptor as agonist but induces pharmacological response opposite to that agonist
55
Competitive antagonist
Reversibily binds to receptors as agonist but without activating receptor so competes for same binding site
56
Non comp antagonist
Reduces magnitude of max response attained by any amount of agonist
57
Allosteric modulator
Indirectly influences effects of an agonist | conformational change from binding to distinct site
58
Positive allosteric modulator
induces amplification of agonist
59
negative allosteric modulator
Reduces effects of agonist
60
Other antagonism types
Chemical Physiologic Pharmacokinetic
61
biological therapies
Engineered macromolecule products like protein and nucleic acid based drugs Antagonists More specific and high potency/efficacy
62
Pharmacokinetics
Description and prediction of time course of drugs in the body Quantitative study of ADME
63
Bioavailability
Fraction of unchanged drug that is absorbed intact and reaches the site of measurement
64
Vd
Volume of distribution | = amount in body/conc in plasma
65
Metabolism
Phase 1 = catabolic, P450 enzymes | Phase 2= anabollic
66
Cytochrome P450
Haeme co-factor In mitochondria and ER activity varies
67
First pass metabolism
- before reaches site of measurement | - gut wall or liver
68
Elimination pathways
``` kidney hepatoiliary lungs saliva tears sweat other secretions ```
69
1st order elimination
rate of elimination/metabolism proportionate to drug conc.
70
0 order elimination
constant rate of drug eliminated/metabolised
71
Half Life Rules
3.3 half lives to 90% steady state | 5 half lives to <5% of initial conc.
72
Clearance
``` Total = renal + hepatic + other Links drug conc. to rate of elimination Volume per unit time Clearance of organ = organ blood flow x extraction ratio of organ total = (F x Dose)/AUC ```
73
What do pre-contemplators need?
Information
74
What do those wanting to change need?
Practical advice and guidance
75
What do those trying and failing need?
Specialist treatment
76
most to least intensive ways of changing behaviours
Specialist treatments - durg clinics, obesity treatments Doctor advice Health promotion
77
ways of changing behaviours, in order of having largest population impact to smallest
health promotion doctor advice specialist treatment
78
Obesity - strength of drive, effort required, target pop., efficacy of supportive meds
Strong strength Substantial effort target - well motivated, varied resources and barriers Limited supportive meds
79
Most valuable complication of obesity that by treating obesity would be economically effective?
DIABETES
80
Define NEAT
non exercise activities - fidgeting
81
Resting metabolic rate
- increases with muscle mass - declines with age - declines during restriction of energy intake (diet)
82
Approaches to changing behaviour
Behaviour Diet Medical
83
Behaviour Modification Requirements
Goals - specific and realistic Plan of action Manageable slow changes
84
Strategies of obesity behaviour modifications
Self Monitoring Stimulus Control Goal Setting - 5% weight loss over 6M, 1lb a week Cognitive Restructuring
85
Dietary Interventions
Quack cures Fad diets FAT AND SUGAR About eating less not really about food groups
86
Problem with fat
High calories but least satiating nutrient unlike protein
87
Order of calorie content of food groups
Fat Alcohol Protein & Carbs Fibre
88
Who gets pharmacotherapy obesity treatment?
- if BMI 27-29.9 + co-morbidities | - or higher BMI
89
Who gets obesity surgery?
- BMI 35-39.9 + co-morbidities | - >40
90
New obesity drugs
Semaglutide Lorcaserine phentermine Topiramate
91
What does orlistat do?
- blocks absorption from gut of 1/3 fat which is eaten - if too much eaten there is oily leakage, flatulence, diarrhoea - teaches people which foods contain fat = behavioural so then when stop taking tablets stopping eating fats should stay with you
92
Reasons for initiation and maintenance of smoking?
``` Initiation = social Maintenance = pharmacological ```
93
What is addiction a product of?
Person + drug + circumstances
94
Peak Seeker
- seeking for peak effect of smoking vs Heavy smoker - not very trough and peak life, don't let it drop as get withdrawal/restless Only a level of nicotine you can tolerate as it makes you sick
95
Nicotine
- stimulant - increases HR - stops boredom - immediate reward - neuroadaptation, dopaminergic, ACH receptor density - discomfort at low levels and high - illusion of positive effect as get rid of restlessness when don't have it - other chemicals also play a role in smoke - nicotine hunger when conc deplete in brain or during other stress - nucleus accumbens
96
Smoking risk vs benefit
- higher stress until post quit - social, less bored, enjoy - weight loss - increased vigilance but lower performance
97
How to assess a smoker's dependence?
- best = time to first cig in the morning (under half hour then dependent, serious if 5 mins) - CO in expired breaths - not how many cigs or types
98
How long is smoking withdrawal?
4 weeks Help is with these symptoms IRRITABILITY worse in heavier smokers difficulty concentrating <2 weeks LT urges to smokes but less and less frequent Rarer = night time waking, constipation, mouth ulcers, RTI, gum bleeding, lower pain threshold, productive cough
99
Average weight gain post smoking quitting
5-6kg
100
Signs of smokers post quit
``` HR drop adrenaline and cortisol drop tremor drop increased skin temp. decreased metabolism of caffeine and other drugs ```
101
What effects smoke cessation success?
Heavy smokers Depression Urge to smoke
102
Clinical advice smoking
Drugs for withdrawal Reassurance and explain Advise against early dieting regarding weight gain
103
Adaptive Immunity Features
- vast diversity of cell types - clonal expansion - danger of autoimmunity - B and T lymphocytes
104
Innate Immunity Features
- no autoimmunity - no clonal expansion - neutrophils/monocytes/eosinophils/mast cells - all cells of one kind
105
B vs T lymphocytes
mature in bone marrow vs thymus B have antibody as receptor T only recognised when presented on cell surface
106
Clonal deletion of B lymphocytes
- in bone marrow - If an antigen engages with antibody - antibody expressed as IgM - if T dependent, in LN after activation during expansion and mutations
107
Outer domain of HLA
2 alpha helices on beta pleated sheet | - antigen between helices
108
HLA function
``` present peptide antigens to T lymphocytes Endogenous on class 1 to CD8 T lymph Exogenous on class 2 to CD4 ```
109
MHC define
- cluster of genes which encode molecules in antigen presentation - HLA region
110
HLA define
Human Leukocyte Antigen | Genes and the molecules they encode
111
Class I loci
HLA-A, B, C Encoded at A, B, C locus 2 of each
112
Class II loci
HLA-DP, DQ, DR alleles | 2 of each
113
Allele number
Number after locus letter A*02:01:02:11 First pair = cross reactive group Second pair = difference in amino acid sequence Third pair = silent polymoprhisms in exons Fourth pair = polymorph in introns
114
What do APCs express
both class I and II
115
Define haplotype
Team of alleles encoded on short section of 1 chromosome. Inherited from 1 parent and passed on intact if short enough otherwise crossovers
116
Transplant terms
``` Auto = given back to same person Iso = between 2 identical twins Allo = between 2 members of same species Hetero/xeno = different species ```
117
Kidney transplants
Allografts = antibody/T lymph rejection AB against = ABO T lymphocytes = HLA + peptide
118
Types of rejection in kidney transplants
Hyperacute Rejection = mins to 4 days, complement Acute = 5 days - 3 months, antibody, T lymphocyte Chronic rejection = antibody or T lymphocyte, infection
119
How to avoid rejection
- do not if recipient has AB against donor HLA molecules - match donor and recipient for HLA alleles - use antirejection therapy - perform a cross match between donor cells and recip serum - screen all patients - avoid sensitisation = blood transfusion, pregnancy, previous graft
120
Antirejection therapy
- must be taken except if identical twin - prednisolone - azathioprime/mycophenolate - tacrolimus/ciclosporine - monoclonal ABs
121
Bone Marrow Transplant
T lymphocyte mediated all No need for cross matching of serum screening Host vs graft disease & graft vs host
122
How to prevent HvG and GvH
autografts use in allografts T lymphocyte may be depleted Antirejection therapy
123
Type 1 hypersensitivity
IgE mediated Histamine release from mast cells/basophils Always allergic Hayfever, asthma, anaphylactic shock
124
Type 2 hypersensitivity
IgG & IgM mediated Complement & phagocytosis Autoimmune haemolytic anaemia, thrombocytopenia, myasthenia gravis, Goodpastures, pemphigus
125
Type 3 hypersensitivity
Immune complexes Autoimmune/allergic/antimicrobial Extrinsic allergic alveolitis Vasculitis, glomerulonephritis, arthritis
126
Type 4 hypersensitivity
``` Activated T lymphocytes Granulomas = CD4, macrophages Without granuloma = CD8 Antimicrobial = TB, hep B, allergy, nickel sensitivity, coeliac Autoimmune = sarcoid ```
127
Type 5 hypersensitivity
ABs Stimulate rather than destroying target Graves
128
HA B27
Ank Spon RA Colitic arthritis Psoriatic Arthritis
129
Cw6
Psoriasis
130
DQ2 & DQ8
Coeliac disease
131
DQ8 & DQ2
T1D
132
DQ6
MS
133
DR4
RA
134
Eaton-Lambert Syndrome
Autoantibody to presynaptic Ca2+ in NMJ = weakness | Small cell lung cancer
135
Auto-immune haemolytic anaemia
Autoantibodies to red cells Destruction by complement system and phagocytes Some AB act in warm and cold
136
Causes of autoimmune haemolytic anaemia
Infections = syphilis, mycoplasma, EBv, virsus Neoplasms = CLL, lymphoma Autoimmune disease = SLE, RA, UC, PSS Drugs = penicillin, methyl dopa
137
Autoimmune thrombocytopenia
``` Idiopathic thrombocytopenic purpura SLE CLL Lymphoma Drugs = AB, co-trimoxazole ```
138
Coeliac disease
- inflammatory disease - steatorrhoea, bloating, malabsorption - villous atrophy, deepened crypts, ulcers, lamina propria infiltrate, intra-epithelial lymphocytes
139
Autoantibodies
``` IgA Antibodies Anti-transglutaminase antibodies Anti endomysial antibodies Anti reticulin antibodies Anti Gliadin antibodies ```
140
Gluten Coeliac
Alpha -gliadin - resistant to digestion in lumen of bowel
141
Transglutaminase
tTG enzyme removes side chain amino group from glutamines converting them to glutamate engaged when alpha gliadin leak into lamina propria and become deamidated Bind to class II HLA Activates T lymph which secrete cytokines = changes = villous atrophy, crypt enlargement
142
HLA in coeliac
DQ2 and DQ8
143
Role of IgA autoantibodies in coeliac?
Do not activate complement or opsonise for phagocytosis | May contribute by trapping antigen or block tTG action
144
Coeliac RF
European Females x 2 Severity varies Infancy but often later
145
Other coeliac features
dermatitis herpetiformis
146
Other coeliac features
dermatitis herpetiformis
147
IM contraindicated in who?
Haemophillia
148
Max volume of IM vs subcut
5ml vs 2ml

CSP1 (20 decks)

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