GP 2 Flashcards
What are the mainstays of treatment for drug abuse?
Reduce harm to user, friends/ family and society
Improve access to healthcare
Reduce overdoses
Reduce rates of Blood Borne Viruses
Stabilize lifestyle
Reduce crime
What is the ICD criteria for Drug dependence?
Compulsion to take
Difficulties controlling substance taking behaviour
Physiological withdrawal state
Evidence of tolerance
Neglect of other duties
Continual use despite evidence of harm
How do you diagnosis an opioid addiction?
History of drug use
2 drug screens separated by five days apart
Observation of objective opioid withdrawal using Clinical Opioid Withdrawal Scale (COWS)
List two drugs that can be prescribed in GP to reduce opioid addiction:
Methadone
- stored in tissues and released activating opioid receptors
Buprenorphine
- Sublingual tablet
- Partial opioid receptor agonist
Give 4 reasons why supervision of methadone and buprenorphine is important:
Done in first 3 months always.
- avoids disruption
- Improves retention of treatment
- reduces overdose (i.e. if drunk as well)
- Builds patient-pharmacist relationship
What things do you want to establish in a consultation about illegal drug use?
Assess drug dependency
Ask about other drug use
Ask about alcohol
Check for physical health
Establish mental health and any red flags
Establish use of drugs/ safety/ sharing of needles
Safe guarding for children
What are some of the additional exclusions of homelessness?
Disrupted family life (Poverty/ abuse)
Poor education
Poverty
Violence
Addiction
Mental health problems
Risky relationships
What are the signs of dehydration specific in a child?
Mild:
- Weight loss 3-5%
Moderate:
- Irritable
- Sunken fontanelle
- Pale
Severe:
- Weight loss >10%
- Depressed fontanelle
What are the medications that can be used for smoking cessation?
Varenicline
- partial nicotine receptor agonist
Bupropion
- epinephrine, dopamine re-uptake inhibitor
*both are contraindicated in pregnancy
How is smoking in pregnancy managed?
All women who smoke or smoked within 2 weeks should have carbon monoxide testing
- it can be hard to admit
CBT is first line
Nicotine replacement is 2nd
In a patient presenting with fatigue, what are the red flags?
Significant weight loss
Lymphadenopathy
Focal neurological signs
Systemic signs of cancer
Systemic signs of inflammatory disease
Sleep apnea
Signs of cardiovascular disease
What is the term for a set of symptoms in which no underlying physical cause can be found?
Medically Unexplained Physical Symptoms (MUPS)
In someone with/ signs of IBS, what symptoms would indicate for further investigation?
- what initial investigations would be conducted in GP?
Rectal bleeding Unintentional weight loss Family history of ovarian cancer Family history of bowel cancer Onset >60 years
FBC
ESR/ CRP
Coeliac screen
CEA
Give two examples of DDP-4 inhibitors and how are they administered to the patient?
Sitagliptin
Vidagliptin
Subcut injection
Name a grading scale used to assess the effect COPD has on the life of someone:
MRC Score
I - not troubled by breathlessness
II - Short of breath when walking up a hill
III - Walks slower than peers, has to stop for breath
IV - Stops for breath every 100m
V - Too breathless to leave house
