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Phase 3b AE > GP & Palliative care > Flashcards

GP & Palliative care Flashcards

1
Q

What are the DAMN drugs?

A 
Drugs that may cause AKI
Diuretics
ACE inhibitors
Metformin
NSAIDs
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2
Q

What is the curb65 score?

A 
Confusion
Urea
Resp rate (normal approx.12-20)
BP
>65 yrs
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3
Q

What should you not take at the same time as a macrolide? (clarithro/erythromycin)

A

Statin

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4
Q

What is repeat prescribing?

A

System to allow patient to collect prescriptions for ongoing medication without seeing a doctor every time

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5
Q

What is the NO TEARS tool?

A 
Used for medication review:
Need and indication
Open questions
Tests and monitoring
Evidence and guidlines
Adverse events
Risk reduction or prevention
Simplification and swatches
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6
Q

What interacts with iron tablets?

A

Vit D and calcium tablets because calcium binds with iron in the stomach and neither of them are absorbed

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7
Q

Why is someone on apixaban?

A

DVT, AF or rate problem

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8
Q

What blood test should you do if a patient is on ACE inhibitors?

A

U+Es once a year

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9
Q

What is Rozex gel used for?

A

Rosacea (metronidazole gel)

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10
Q

How can amlodipine effect rosacea?

A

It makes it worse, because amlodipine is a vasodilator

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11
Q

What is Priadel?

A

Lithium - trade name - mood stabiliser

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12
Q

What antibiotics can cause C.diff in the community?

A

Ciprofloxacin
Cephalosporins
Co-amoxiclav

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13
Q

What are the five functions of the kidney

A 
Fluid balance,
Waste excretion,
Vitamin D metabolism 
Produces erythropoietin
Acid-Base regulation
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14
Q

What is creatinine?

A

Waste production of muscle metabolism
Purely excreted by kidneys
Longstanding measure of kidney function

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15
Q

What is the problem with a urine dipstick/positive of albumin:creatinine ratio?

A

It is concentration so can be affected by dehydration, whereas albumin:creatinine should be a constant

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16
Q

What is microabuminuria?

A

30-300mg/24h

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17
Q

Where on the tongue do you normally bite in a tonic clonic seizure?

A

The sides rather than the tip

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18
Q

What can raise the troponin?

A

Severe sepsis, hypotension, MI and PE

19
Q

What are the causes of learning disabilities?

A

Genetic factors
Maternal alcohol, drugs and tobacco during pregnancy
Pregnancy complications
Environmental toxins

20
Q

How can you think of what may cause nausea and vomiting in palliative care?

A

Three Bs……..
Bowels: mucositis, constipation, infection, gastric stasis, bowel obstruction
Brain: Less likely in this case but breast cancer can spread to the brain so in advance disease or unresolved nausea – think about CT Head. - Raised intracranial pressure
Biochemical: medications, hypercalcaemia, hypomagnesaemia, uraemia, infection

21
Q

What is the sanctity of life?

A

The moral status of persons
The right to life and the Human Rights Act
The intrinsic value of life

22
Q

What’s the difference between killing and letting die?

A

Killing concerns the direct causation of another’s death, whereas letting die is about avoiding any intervention so disease can take its course

23
Q

How does paracetamol work?

A

Inhibits prostaglandins

24
Q

Would you give patients with kidney failure paracetamol?

A

Yep, no problems there

25
Q

What do you need to check when giving paracetamol?

A 
Liver impairment
Severe cachexia (severe wasting) (less than 50kg = max 500mg QDS)
26
Q

What do you need to check when giving NSAIDs?

A

Renal and platelet count
Contraindications: GI bleeding or ulcer history, asthma (can trigger an attack)
Concurrent medications: warfarin, digoxin, steroids

27
Q

What are some weak opioids?

A

Codeine
Dihydrocodeine
Tramadol

28
Q

What is a problem with weak opioids?

A

All have a “ceiling effect” on analgesia so if not effective, replace with a strong opioid rather than add to weak opioids

29
Q

What are some generic strong opioids?

A 
Morphine
Oxycodone
Fentanyl
Buprenorphine
Diamorphine
30
Q

What are some palliative care specialist strong opioids?

A

Hydromorphone
Alfentanil
Methadone
Ketamine

31
Q

What are the benefits of diamorphine?

A

Increased pre-load and it lasts for longer

32
Q

What should you consider before starting a strong opioid?

A 
Have they tried them before?
Need to prescribe any medications for side effects?
Co-morbidies
Age and frailty
Renal Function
Patient concerns
Adherence
Are they driving?
33
Q

What is background pain?

A

Pain at rest

34
Q

What is breakthrough pain?

A

Transient exacerbation

Can be predictable such as movement or unpredictable

35
Q

What type of pain are modified release morphine and oxycodone used for?

A

Background pain

36
Q

What type of pain are immediate release morphine and oxycodone used for?

A

Breakthrough pain

37
Q

What are some examples of modified release morphine?

A

MST (tablet)

Zomorph (capsule)

38
Q

What are some examples of immediate release morphine?

A

Oramorph (liquid)

Sevredol (tablet)

39
Q

What are some examples of modified release oxycodone?

A

Oxycontin

40
Q

What are some examples of immediate release oxycodone?

A

Oxynorm (liquid or capsule)

41
Q

What would you prescribe in order to counteract opioid side effects?

A

Stimulant laxatives

PRN antiemetic

42
Q

What are the common opioid side effects?

A 
Constipation 
Nausea 
Sedation
Dry mouth 
*Nausea and drowsiness often improve after the first week or so, constipation remains and need a stimulant laxative*
43
Q

What are the rarer but more serious opioid side effects?

A

Allergy
Respiratory depression
Pruritus

44
Q

What are the indications for fentanyl patches?

A

Stable opioid responsive pain
Intolerable side effects
Oral route difficulties: Compliance or dysphagia
Renal impairment

Phase 3b AE (4 decks)

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