GP

Question 1

Why does depression and anxiety matter in chronic disease and why is it challanging?

Answer 1

It matters because it is very common (more common in people with chronic disease), it is associated with non-compliance and poor outcomes.
It is challenging because there is lots of symptom overlap and high risk of polypharmacy

Question 2

Define multimorbidity and polypharmacy

Answer 2

• Multimorbidity is 2+ conditions.
• Polypharmacy is being on 5-10+ drugs

Question 3

What are the determinants of multimorbidity?

Answer 3

Social - Socioeconomic, psychosocial and behavioural determinants.
Biological - aging and inflammation

Question 4

What is supportive self management? and how can you encourage it?

Answer 4

Supporting a patient to build skills, behavior’s and capacity to live well and manage their long term condition. Do via agenda setting, goal setting and action planning and goal follow up. Positive affirmations

Question 5

What are the social determinants that can affect health?

Answer 5

Conditions people are born into, grow, live, work and age

Question 6

What is a better alternative for BMI?

Answer 6

Edmonton Obesity Staging System (EOSS)

Question 7

What is pharmacodynamics?
Pharmacokinetics

Answer 7

• What the drug does to the body,
• What the body does to the drug

Question 8

How is bioavailability expressed and what is it effected by?

Answer 8

• Expressed as F, it is affected by drug factors, absorption of drug which can be affected by gastric pH or health of GI tract, first pass metabolism.
• Grapefruit juice may increase bioavailability

Question 9

What is clearence?

Answer 9

The volume of plasma cleared of drug per unit time

Question 10

What is half life?

Answer 10

Time required for serum plasma concentration to decrease by half. It is determined by the clearance and volume of distribution

Question 11

How can age affect pharmacokinetics

Answer 11

With age there is a decrease in body water and an increase in body fat, so serum levels of water soluble drugs may increase (due to the decreased volume of distribution) and the half life of fat soluble drugs is increased.
Absorption remains relatively the same and the affects on first pass metabolism can vary

Question 12

How can age affect the liver

Answer 12

Oxidative metabolism via CYP450 system decreases so there is decrease clearance of drugs

Question 13

How can you accurately measure drug excretion by kidneys?

Answer 13

Cr Cl (crockroft and Gault)

Question 14

How can age affect pharmacodynamics?

Answer 14

• Effects of alcohol, opiates, sedatives and theophylline are increased.
• Effects to beta blockers are decreased

Question 15

What are some common drug interactions?

Answer 15

• Statins and clarithromycin,
• Verapamil and beta blockers,
• Warfarin and aspirin,
• Ace inhibitors increase the hypoglycaemic affect of sulfonylureas.

Question 16

What is the prescribing cascade?

Answer 16

When you prescribe a drug to treat the side effects of another drug

Question 17

What are the affects of renal disease on pharmacodynamics and pharmacokinetics

Answer 17

pharmacodynamics - Altered sensitivity to the drug and increased adverse effects.
Pharmacokinetics - Decreased elimination, decreased protein binding and decreased hepatic metabolism
Summary - Prolonged elimination so increase the dosing interval

Question 18

Why is protein binding affected in renal disease?

Answer 18

• Renal failure leads to acid retention so acidic drugs become less bound to albumin and therefore the amount of free drug is increased

Question 19

What drugs must be stoped in renal disease?

Answer 19

Metformin and NSAIDs. Caution with ACE inhibitors and reduce the dose of many others

Question 20

What are the affects of hepatic impairment on pharmacokinetics and pharmacodynamics?

Answer 20

Pharmacokinetics - First pass metabolism is affected, activation of prodrugs is affected, decreased protein binding and decreased elimination.
Pharmacodynamics - altered sensitivity to drugs
Summary - Slower rate of enzyme metabolism (increased bioavailability and half life) so lower dose and increase dosing interval)

Question 21

What are high extraction drugs?

Answer 21

Drugs which are metabolized at high rates by the liver. They can be affected by changes in blood flow. Liver disease may cause big peaks in these drugs
Eg, morphine, verapamil.

Question 22

What are low extraction drugs?

Answer 22

Drugs which are metabolized by the liver at low rates, eg theophylline. Longer half life in liver disease

Question 23

How can congestive cardiac failure affect drugs?

Answer 23

• \Reduce absorption, reduced hepatic metabolism, and reduced renal elimination

Question 24

What is frailty?

Answer 24

Gradual loss of physiological reserve and higher risk of decompensating

Question 25

What can impact immigrants access to healthcare?

Answer 25

• ## Residence, social networks, legal status, health literacy, discrimination, financial security,