Health promotion Flashcards
Recommended units of alcohol per week
14 units per week spread across at least 3 days
1 unit of alcohol
= 10ml of ethanol (pure alcohol) - amount average adult can process per hour
Gin, rum, vodka, whisky, sambuca and tequila shot units
1.4 units
Wine glass
2.1 - 3 units
Tips for decreasing alcohol intake
Set a limit or budget Cut down with a friend Alternate with water Use a small glass or put less in Lower strength Days without
Consequences of alcohol abuse
Alcohol fatty liver disease leading to cirrhotic liver failure
Associated with depression, self-harm and suicide
Disrupts sleep pattern
Affects judgement and actions - irrational and aggressive
Accidents resulting in inury
Unprotected sex and risky behaviours
Cardiomegaly
Can cause:
- stroke - brain damage
- Heart disease
- Mouth, throat and breast cancer
Binge drinking
8 units in 1 session for men and 6 for women
Risk of drinking whilst pregnant
Fetal alcohol syndrome - physical, mental and developmental disorders
How does alcohol affect people that are old and people taking medication
People on a certain medication and elderly have decreased liver function so alcohol will have greater effects as metabolised slower
Alcohol may interact with medication e.g.
- NSAIDs
- Opiods
Mx of alcohol abuse
- refer to an alcohol addiction clinic
- alcohol detoxification programme
- CBT
- Social network and environment-based therapies
- Behavioural couple therapies
Pharmacological:
- Disulfiram - inhibits aldehyde dehydrogenase causing a build-up of acetyl aldehyde which causes hangover symptoms
Risks of IVDU
DVT Sepsis Immunocompromised HIV TB
Management of drug abuse
- Vaccinations against hepatitis B and tetanus
- Overdose prevention training and take-home naloxone
- Contraception - refer to a sexual health service
- Refer to drug addiction clinic
- whether maintenance therapy or detoxification is most appropriate
- opioid substitution therapy
Presentation of alcohol misuse
Smell of alcohol Dilated facial capillaries - flushed Bloodshot eyes Hand tremor Raised GGT
Alcohol withdrawal symptoms
Seizures Delirium tremens Sweating Tremor Tachycardia Palpitations
Wernicke’s encephalopathy presentation
Confusion Ataxia Eye paraylsis - opthalmoplegia Memory disturbance Hypothermia Hypotension Coma
Treatment of Wernicke’s encephalopathy
Parenteral thiamine
DVLA
People who are dependent on alcohol should be advised that they are required by law to notify the DVLA and will be required to surrender their driving license for a period.
Pt must inform the DVLA of use of heroin, morphine, buprenorphine, or methadone - will lead to refusal/surrendering of driving licence.
When to refer to hospital for alcohol
Urgent
- signs of seizure, delirium tremens in alcohol withdrawal
- Wernicke’s encephalopathy
Alcohol investigation
AUDIT - alcohol use disorders identification test
1- 7 - low risk
8 - 15 - hazardous
16 - 19 - harmful
AUDIT-C if limited time
- full AUDIT should be given if score 5+
SADQ- Severity of Alcohol Dependence Questionnaire
- mild — 15
- moderate — 15–30
- severe — 31+
Suspected opiod dependency
Opioid intoxification:
- Pupil constriction
- itching
- sedation and somnolence, - hypotension and slower pulse + hypoventilation
Certain features:
Psychiatric history - overdoses, depression, psychosis.
Social history — family problems, unemployment, accommodation issues, financial problems.
Physical examination
- poor nutrition
- dental caries
- Signs of neglect
- needle tracks
- skin abscess and signs of drug intoxication or withdrawal.
Acute substance withdrawal syndrome
Watering eyes Rhinorrhoea Yawning Sneezing Cool and clammy skin Dilated pupils Cough. Abdominal cramps, nausea, vomiting, diarrhoea. Tremor Sleep disorder, restlessness Anxiety and irritability, Hypertension
Investigations for opiod misuse
- Urine analysis drug screen
- Mouth swab tests
- Possible hepatitis testing (serology)
- HIV testing
- Bloods - LFTs
When should substitution therapy be offered
- Opioids are being taken on a regular basis, usually daily.
- Convincing evidence of current dependence.
- Initial assessment clearly indicative
- Pt can comply with the prescribing regimen.
- Pt not receiving an opioid prescription for management of dependence from another clinician.
- LFTs
Substitution therapy for opioid dependence
1st line - Methadone
- more effective in retaining people in treatment
- more suitable for people who use large amounts of heroin
Buprenorphine + naloxone pill - reduced risk of fatal overdose
Buprenorphine injection- administered by a health care professional
Stop using heroin completely
high-dose methadone or buprenorphine
If a person misses doses of methadone or buprenorphine
Do not take extra
Find out why
BMI categories
Under 18.5 - underweight 18.5 - 24.9 - good weight 25 - 29.9 - overweight 30 - 35- obese 35+ - morbidly obese
Waist circumference
Men - 94 cm +
(90cm + for Asian men)
Women - 80 cm +
Indicates an increased risk of obesity-related health problems.
Mx of obesity
Conservative:
- diet modification
- exercise
- CBT
Pharmacological:
- orlistat
Surgery
- bariatric surgery - BMI 40+
Diet recommendations
Men - 2500 kcal
Women - 2000 kcal
5 food groups:
- carbohydrates - 38%
- meat - 12 %
- dairy - 8%
- fats - 1%
- Fruits and veg - 40%
Exercise guidelines
150 minutes - moderate intensity activity a week
or
75 minutes of vigorous intensity activity a week
Smoking cessation mx
- referral to local smoking cessation service
- nicotine replacement therapy
- e-cigarettes
- Medication: varenicline or bupropion
Nicotine dependence
How many cigarettes they smoke per day?
How soon after waking they smoke their first cigarette?
Nicotine replacement therapy
16 hour patch
24 hour patch
When to start varenicline or bupropion
Started 7-14 days before the quit date
Varenicline - 12 weeks course
Bupropion - 7 - 9 wks course
Carbon monoxide test
Measure the carbon monoxide (CO) level 4 weeks after quitting.
A CO level of 10 ppm or less suggests the person is a non-smoker.
Cycle of change
- Pre contemplation
- Contemplation
- Preperation
- Action
- Maintenance
- Relapse
POMC
Planning
Opportunity
Motivation
Capability
Bupropion contraindication
Under 18 Pregnant Epileptic Eating disorder Bipolar
Weight loss
Reduce calorie intake to 600 kcal below daily requirement to sustain weight loss of 0.5 - 1 kg per week
