Interpretation & Clinical Decision Making Flashcards
What is clinical decision making? (1)
Balance of experience, awareness, knowledge and information gathering using appropriate assessment tools.
What are the core skills of clinical decision making? (7)
Pattern recognition (learning from experience)
Critical Thinking (removing emotions from our reasoning)
Communication skills: Active listening (listen to patients, what they say/don’t say)
Evidence based approaches
Teamwork
Sharing
Reflections
State the process of clinical decision making. (4)
Using cues and gathering and analysing patient data systematically.
Making judgments
Making decisions
Evaluating outcomes
How would you gather information as part of clinical decision making? (7)
What do you need to know?:
- Patient details
- PC
- HPC
- PMH
- Drug Hx and allergies
- Clinical tests results
Analyse, identify pharmaceutical problems.
Explain how you would be making judgements as part of the clinical decision making process. (4)
Is an antibiotic/steroid indicated?
Tx duration?
Interactions?
Existing medications?
Explain how to make decisions as part of clinical decision making. (3)
Which ABx?
- Penicillin allergic
- Macrolide/doxycycline.
Tx Duration
Implications for other medications:
- Drug interactions
Explain the process of evaluating outcomes as part of clinical decision making. (5)
How will the outcome be evaluated?
- Safety netting
- Tx failure
- Signposting
- Preventative care
What is the risk associated with Tramadol and SSRI antidepressants? (5)
Serotonin syndrome = increased seizure risk.
Serotonin syndrome develops when levels of 5-HT increases in the CNS.
Tramadol inhibits 5-HT reuptake and SSRI causing increase in 5-HT levels.
Combination should be avoided or used with caution.
Can increase GI bleeding in risk.
What are the s/s of 5-HT syndrome? (3)
Change in mental status
Autonomic hyperactivity (tachycardia, diarrhoea)
Neuromuscular abnormalities (hyperreflexia)
What is the normal range of lithium? (1)
0.4-1mmol/L
(Check non-compliance or dose alteration if ineffective)
What monitoring is considered for Lithium? (1)
TFTs as it can cause thyroid disorders.
Checked at least 6 months.
What important counselling points is given to patients taking Lithium? (4)
Narrow therapeutic index drug:
- Toxic levels = > 1.5mmol/L
Regular monitoring
Maintain adequate fluid intake (dehydration reduces renal blood flow = reduced renal excretion)
Avoid dietary changes which reduce or increase Na intake (lithium toxicity is made worse by Na depletion.)
What are the common interactions of Lithium? (2)
Drugs affecting renal excretion (NSAIDs, ACEi, Diuretics.)
Drugs which may cause Na depletion (Thiazide diuretics)
What are the monitoring requirements of Olanzapine? (5)
ECG
Glucose/lipids
Weight
BP
What does the QT represent? (1)
Duration of activation and recovery of the ventricular myocardium.
What is the reference range of QT interval? (1)
0.33-0.44 seconds
What does it mean if QT interval is > 0.44 seconds? (1)
Marker of myocardial electrical instability - QT prolongation interval is associated with possible development of ventricular arrhythmia, syncope and sudden death.
What are the risk factors of QT prolongation? (2)
Antipsychotics
Patients with pre-existing QT prolongation.
What is the general framework of clinical decision making? (8)
Seek patient’s participation
Help your patient
Assess patient’s values and preference.
Reach a decision
Evaluate patient’s decision
Reflect on decision made.
Ensure adequate monitoring, follow up and support are in place.
Be prepared to review your decision at a later date.
