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2A content- Sameera > **GP** > Flashcards

**GP** Flashcards

1
Q

what is polypharmacy

A

use of multiple medications (usually 5+)

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2
Q

what is concordance

A

patients and healthcare workers work together to effectively plan treatment

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3
Q

what are reasons for low concordance (3)

A

forgetfulness/ age, no understanding of meds, med accessibility (cost)

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4
Q

what is green prescribing

A

health professionals direct patients to nature-based activities

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5
Q

what is blue prescribing

A

health professionals direct patients to wetland-based activities

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6
Q

why might green and blue prescribing not be important to patients (2)

A

may have social anxiety, may not understand why they need it

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7
Q

when is the postnatal mother and new born check done?

A

6-8 weeks after birth

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8
Q

what is done in a baby’s 6-8 week physical exam 4

A

look at eyes, heart, hips and whether the males testicles have descended

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9
Q

what can assess for post-natal depression in new mothers

A

patient healthcare questionnaire 9 (PHQ9)

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10
Q

why is a weight check done for in a postnatal check

A

there is a risk of developing obesity if the weight is retained

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11
Q

what three things are discussed for the future in a postnatal mothers gp appt

A

scheduling cervical screening
discuss contraception
weight check

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12
Q

what is checked/ asked about in a postnatal mother check

A
  1. period/ vaginal discharge
  2. issues with waste secretion or sex
  3. check stitches if present
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13
Q

what 4 things happen during the newborn check at birth

A

Apgar score check
physical exam
heel prick
hearing screening

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14
Q

what does the apgar score check cover? (5)

A

skin color, heart rate, reflexes, muscle tone, breathing

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15
Q

when is the heel prick done and what does it test for

A

5-8 days
cystic fibrosis
congenital hyperthyroidism

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16
Q

when is the newborn physical exam done

A

72 hours then at 6-8 weeks

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17
Q

what do growth charts measure and what should cause concern

A

track baby’s length/ height and weight
concerns when plots do not remain within a similar centile

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18
Q

what does the ASQ questionnaire look at (5) and when is this done (2)

A

9 months and 2 years
monitors diet, activity, movement, speech and sleep

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19
Q

what is included in the 6 in 1 vaccination

A

diptheria, tetanus, pertussis (whooping cough), polio, Hib disease, Heb B

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20
Q

when is the 6 in 1 vaccination given (3)

A

8 weeks
12 weeks
16 weeks

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21
Q

what are the three categories of signs of depression

A

psychological, physical, social

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22
Q

psychological signs of depression (5)

A

low self esteem, no motivation, feeling hopeless, anxious, thoughts of harming

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23
Q

physical signs of depression (4)

A

reduced sleep, unexplained aches, lack of energy, slower movements/ speech

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24
Q

social signs of depression (2)

A

neglecting interest, avoiding socialising with friends

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25
what two assessments/ questionnaires can be done for depression
becks depression index patient health questionnaire 9
26
what does SSRI stand for and explain how it works
selective serotonin reuptake inhibitor blocks reuptake of serotonin into neurone which causes more serotonin to be available as a neurotransmitter
27
what does SNRI stand for and explain how it works
serotonin-noradrenaline re-uptake inhibitors block reuptake of serotonin and noradrenaline back into presynaptic cells which causes more serotonin and noradrenaline to be available as a neurotransmitter
28
what does TCA stand for and explain how it works
tricyclic antidepressants block reuptake of serotonin and noradrenaline back into presynaptic cells which causes more serotonin and noradrenaline to be available as a neurotransmitter
29
give an example of SSRI
citalopram
30
give an example of SNRI
duloxetine
31
given an example of a TCA
amytriptyline
32
where are SGLT2 inhibtors, DPP4 inhibtors, sulfonylurea and metformin metabolised and excreted
all metabolised in liver except for metformin which is metabolised in the kidney all are excreted in the urine
33
what are the risk factors for atrial fibrillation (5)
age, hypertension, alcohol, obesity, family history
34
causes of atrial fibrillation (5)
SMITH sepsis mitral valve stenosis or rgurgitation ischaemic heart disease thyrotoxicosis hypertension
35
what are the two tests for atrial fibrillation
ECG= gold standard blood tests
36
explain what is the purpose of blood tests for atrial fibrillation
detect non-cardiac factors eg anaemia or renal impairment
37
what are the two main asssessments to determine atrial fibrillation treatment
CHA2DS2-VAsc and ORBIT score
38
what is CHA2DS2-VAsc and what does it indicate
uses a 0-9 point system to identify the risk of stroke in AF patients eg hypertension, previous stroke anything over 2 is considered high risk and requires an anticoagulant
39
what is the ORBIT score and what does it indicate
products the bleeding risk of patients on anticoagulants for AF uses a 0-7 point system to identify the risk of stroke in AF patients eg bleeding history, haemoglobin levels etc anything from 4-7 is high risk
40
what is the treatment if there is a high risk CHA2DS2-VAsc and high risk ORBIT score
no anticoagulant prescribed as risk of bleeding
41
two methods to calculate rate from an ECG and what types of rhythms can they be used for
1. box method- for regular and irregular rhythms 300 divided by the number of boxes between two consecutive R waves 2. R wave method- for regular rhythms only count the number of QRS complexes in a 6 second strip (30 large boxes) and x 10
42
what 4 things should be noted to see if there is regular rhythm in an ECG
-> is the R-R rhythm is consistent or not: defines if it is regular or irregular -> is the QRS complex normal (0.12 seconds- 3 small boxes), wide or narrow -> r there sinus P waves? positive P waves deflection in Lead II, negative in aVR and all P waves followed by a QRS complex -> is the P-R interval 0.12-0.2 seconds (3-5 small squares) and is the case for all P-R intervals
43
what does each part of the PQRST wave represent in an ECG
P wave= atrial depolorisation PR interval= contraction of atria and conduction from SAN to AVN Q= depolarisation of inter ventricular septum R= depolorisation of most of the ventricles S= depolorisation of the base of the ventricles QRS complex= ventricle depolarisation and atrial depolarisation ST interval= ventricular contraction T wave= ventricular depolarisation
44
what are the ecg changes for atrial fibrillation (3)
-> irregularly irregular pulse -> narrow QRS (less than 0.12s) -> no p waves, instead there r fibrillatory waves
45
what are the ecg changes for atrial flutter (2)
-> f wave ‘saw tooth’ pattern -> often with a 2:1 block (2 p waves for every QRS complex)
46
what are the ecg changes for 1st degree heart block (2)
PR interval prolongation (200ms +) every P followed by QRS
47
what is the ecg change for 2nd degree heart block Mobitx type I
PR prolongation until a QRS is dropped (PR progressively elongates)
48
what are the ecg changes for 2nd degree heart block Mobitx type II
PR interval is consistently prolonged (not progressive) with random dropped QRS
49
what are the ecg changes for 3rd degree/ complete heart block (2)
AV dissociation (complete heart block so atria and ventricles beat independantly of each other p waves never related to the QRS complex
50
what class of drug is mesalazine and when is it prescribed
aminosalicylate IBS
51
mechanism of action of mesalazine
decreases prostaglandin synthesis to decrease the inflammatory response
52
what is the medication given for flare ups of IBS and what class is each
mebeverine- antispasmodic loperamide- antidiarrhoeal
53
what is a stoma and the two types
opening on abdomen that can be connected to the digestive or urinary system to allow urine or faeces to be diverted out of the body. can be permanent or temporary
54
name two aspects of stoma care
change regularly, clean skin with warm water before changing
55
what are the consequences of stomas 2
social anxiety body consciousness
56
what are the three otomy types and explain where each's opening is
colosctomy- opening in colon ileostomy- opening in ileum urostomy- opening in ureters
57
what are nephrogenic drugs 6
NSAIDs ACE inhibitors ARBs gentamicin rifampicin diuretics iodine based contrast media if used within past week GAINAR
58
how are NSAIDs, ACEi and ARBs nephrotoxic
decrease GFR by causing vasoconstriction of afferent and vasodilation of efferent arterioles
59
how is gentamicin nephrotixic
toxic to epithelial cells in proximal convoluted tubule
60
how is NSAIDs and rifampicin nephrotoxic
cause inflammation of interstitium of kidney
61
when is renal replacement therapy given
when patients are non responsive to medication
62
what things to consider when women are taking contraceptives 2
will be able to take everyday comfort when inserting devices
63
what do doctors consider when recommending contraceptives
medical history (eg clots) does she want future kids
64
2 pros 3 cons of renal transplant
+better survival rate +better quality of life. -lifelong immunosuppressants -risk of rejection -long waiting list
65
what is haemodialysis 1 pro and 1 con
Dialysis machine uses counter current flow with blood and dialysate (diffusion dependant ) +dialysis free days -diet and fluid restriction
66
what is peritoneal dialysis, 1 pro 1 con
Dialysate is pumped into peritoneal cavity and left for several hours then is removed +at home -risk of peritonitis
67
what is haemofiltration and 1 pro and 1 con
Dialysis machine uses a counter current flow with blood and dialysate and removes solute from body, replacing it with clean fluid (convection dependant). +better control of hypertension and fluid levels -expensive replacement fluid
68
what are the lifestyle changes that can be done for BPH 2 how can urinary flow be maintained in large BPHs 1
lifestyle changes: reduce alcohol and caffeine, reduce water intake before bed catheters to maintain urinary flow
69
investigation for PBH and what is PSA produced by
PSA test- (prostate specific test) protein produced by normal and cancerous prostate cells
70
conditions for a PSA test
requires no heavy exercise or ejaculation in past 24 hours and no prostate biopsy within past 6 weeks
71
when is PSA raised/ lowered (3,1)
raised with: 1. exercise 2. age 3. larger prostate lowered with: 1. obesity
72
what is the specificity of PSA testing and give an example
not specific enough to be used in a screening programme to diagnose early prostatic cancer (3/4 men with raised PSA won’t have cancer and 1/7 with normal psa have prostate cancer
73
risk factors for prostate cancer 3
black, family history, age
74
What group of drugs do all epilepsy treatment drugs belong to
anti epileptic
75
are AEDs okay with 1. contraception and 2. pregnancy
1. affects how effective implants/ the pill are so natural barrier contraception is recommended 2. higher risk of baby born with birth defect
76
triggers for epilepsy 4
non adherence with medication stress alcohol flashing lights
77
mechanism of action of sodium valproate
GABA agonist
78
mechanism of action of carbamazepine
blocks sodium gated channels which inhibits release of glutamate
79
side effect of sodium valproate and carbamazepine 2
GI distress dry mouth
80
diagnosis for epilepsy
2 or more unprovoked seizures occurring less than 24 hours apart

2A content- Sameera (21 decks)

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