GP & Palliative care Flashcards
What are the DAMN drugs?
Drugs that may cause AKI Diuretics ACE inhibitors Metformin NSAIDs
What is the curb65 score?
Confusion Urea Resp rate (normal approx.12-20) BP >65 yrs
What should you not take at the same time as a macrolide? (clarithro/erythromycin)
Statin
What is repeat prescribing?
System to allow patient to collect prescriptions for ongoing medication without seeing a doctor every time
What is the NO TEARS tool?
Used for medication review: Need and indication Open questions Tests and monitoring Evidence and guidlines Adverse events Risk reduction or prevention Simplification and swatches
What interacts with iron tablets?
Vit D and calcium tablets because calcium binds with iron in the stomach and neither of them are absorbed
Why is someone on apixaban?
DVT, AF or rate problem
What blood test should you do if a patient is on ACE inhibitors?
U+Es once a year
What is Rozex gel used for?
Rosacea (metronidazole gel)
How can amlodipine effect rosacea?
It makes it worse, because amlodipine is a vasodilator
What is Priadel?
Lithium - trade name - mood stabiliser
What antibiotics can cause C.diff in the community?
Ciprofloxacin
Cephalosporins
Co-amoxiclav
What are the five functions of the kidney
Fluid balance, Waste excretion, Vitamin D metabolism Produces erythropoietin Acid-Base regulation
What is creatinine?
Waste production of muscle metabolism
Purely excreted by kidneys
Longstanding measure of kidney function
What is the problem with a urine dipstick/positive of albumin:creatinine ratio?
It is concentration so can be affected by dehydration, whereas albumin:creatinine should be a constant
What is microabuminuria?
30-300mg/24h
Where on the tongue do you normally bite in a tonic clonic seizure?
The sides rather than the tip
What can raise the troponin?
Severe sepsis, hypotension, MI and PE
What are the causes of learning disabilities?
Genetic factors
Maternal alcohol, drugs and tobacco during pregnancy
Pregnancy complications
Environmental toxins
How can you think of what may cause nausea and vomiting in palliative care?
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
What is the sanctity of life?
The moral status of persons
The right to life and the Human Rights Act
The intrinsic value of life
What’s the difference between killing and letting die?
Killing concerns the direct causation of another’s death, whereas letting die is about avoiding any intervention so disease can take its course
How does paracetamol work?
Inhibits prostaglandins
Would you give patients with kidney failure paracetamol?
Yep, no problems there
What do you need to check when giving paracetamol?
Liver impairment Severe cachexia (severe wasting) (less than 50kg = max 500mg QDS)
What do you need to check when giving NSAIDs?
Renal and platelet count
Contraindications: GI bleeding or ulcer history, asthma (can trigger an attack)
Concurrent medications: warfarin, digoxin, steroids
What are some weak opioids?
Codeine
Dihydrocodeine
Tramadol
What is a problem with weak opioids?
All have a “ceiling effect” on analgesia so if not effective, replace with a strong opioid rather than add to weak opioids
What are some generic strong opioids?
Morphine Oxycodone Fentanyl Buprenorphine Diamorphine
What are some palliative care specialist strong opioids?
Hydromorphone
Alfentanil
Methadone
Ketamine
What are the benefits of diamorphine?
Increased pre-load and it lasts for longer
What should you consider before starting a strong opioid?
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?
What is background pain?
Pain at rest
What is breakthrough pain?
Transient exacerbation
Can be predictable such as movement or unpredictable
What type of pain are modified release morphine and oxycodone used for?
Background pain
What type of pain are immediate release morphine and oxycodone used for?
Breakthrough pain
What are some examples of modified release morphine?
MST (tablet)
Zomorph (capsule)
What are some examples of immediate release morphine?
Oramorph (liquid)
Sevredol (tablet)
What are some examples of modified release oxycodone?
Oxycontin
What are some examples of immediate release oxycodone?
Oxynorm (liquid or capsule)
What would you prescribe in order to counteract opioid side effects?
Stimulant laxatives
PRN antiemetic
What are the common opioid side effects?
Constipation Nausea Sedation Dry mouth *Nausea and drowsiness often improve after the first week or so, constipation remains and need a stimulant laxative*
What are the rarer but more serious opioid side effects?
Allergy
Respiratory depression
Pruritus
What are the indications for fentanyl patches?
Stable opioid responsive pain
Intolerable side effects
Oral route difficulties: Compliance or dysphagia
Renal impairment
