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Co-morbidity Exam > Lectures > Flashcards

Lectures Flashcards

1
Q

how many health boards are in NHS scoltand?

A

14 geographical health boards
7 special health boards (e.g. NES or HIS)

all of them are accountable to scottish ministers (even the ones that aren’t geographical locations)

there is an annual accountable meeting for each of the health boards

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2
Q

what is the responsibility for each of the geographical health boards?

A

Each health board is responsible for the protection and improvements of their populations health and for the delivery of frontline health care services

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3
Q

what is the scottish governments aim for 2020

A

that by 2020 everyone is able to live longer and healthier lives at home or in a home setting
Health care system has…

integrated health and social care

focus on prevention/anticipiation

supported self management

if hospital admission is required (because patient cannot be treated in the comity) then day case treatment become the normal (reduce hospital stays and prevent if possible)

whatever the setting, care is always provided to the highest standards of quality and safety

person/patient at the centre of all decisions

focus to try and get patients back to their home as soon as appropriate

minimal risk of re-admission

implementation of a quality strategy
required actions to improve efficiency and achieve financial stability

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4
Q

what is the Public Bodies (Joint Working) (Scotland) Act 2004 for?

A

Orgnaisaiton designed to bring multidisciplinary groups together within a locality

Form health and social care partnerships (31 across Scotland)

Can be totally joint partnerships or one (health or social) can be identified as taking the lead (if this is the case then subject to interrogation scrutiny to ensure that both parties are still working together)

Bringing together healthcare and social care to get the best possible result for the patient , work out the best devision of functions, coordinate visits to the patient and improve integration between health can social care

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5
Q

what are the 5 points involved in prescription for excellence?

A

vision

patient centred pharmaceutical care and medicines

safety in pharmaceutical care and medicines

effectiveness of pharmaceutical care and medicines (make best use of pharmacists knowledge)

making it happen- infrastructure to deliver pharmacueitcl care

a vision and action plan for the right pharmaceutical care through integrated partnerships and innovation

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6
Q

what are the 9 commitments for achieving excellence in pharmaceutical care

A

increasing access of pharmacy as a first port of call

integrating pharmacists

creating conditions to transform pharmacy services

providing resources to support the safer use of medicines

improving the pharmaceutical care of patients in care homes and patients being cared for in their own homes

enhancing access to pharmaceutical care in remote and rural communities

building the clinical capacity and capability of the pharmaceutical work force

optimising the use of digital information, data and technologies

planning for sustainable pharmaceutical care in scotland

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7
Q

what does CMS dO

A

chronic medication service

  • facilitate shifting of balance of care
  • improve multidisciplinary and collaborative working
  • minimise the duplication of effort
  • establish a framework to improve monitoring and continuity of care
  • improve the efficiency of information transfer
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8
Q

who are “high risk patients” as according to SIGN

A

patients >50yrs is care homes

patients >75 years on multiple medications

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9
Q

what medicines are especially high risk

A 
NSAIDS
anticholinergics
sedatives
analgesics
anti-psychotics
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10
Q

what are the aims of a medication revieq

A

structured clinical examination of a patients medication…

optimising the impact of their medicine

minimising the number of medicine related problems

reducing waste

(also helps to improve health outcomes)

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11
Q

please state the 7 steps of medication review

A

1) Identify aims and objectives of drug therapy
2) Identify essential drug therapy
3) Does the patient take any unnecessary drug therapy?
4) Are the therapeutic objectives being achieved?
5) is the patient at risk of ADRs
6) is the drug therapy cost effective?
7) is the patient willing and able to take drug therapy as intended?

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12
Q

what is the differnence between adherence and compliance

A

ADHERENCE presumes that the patient is in agreement with the recommendation and the taking of the medicines

COMPLIANCE implies patient passivity

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13
Q

What factors influence adherence with medication

A 
Age
Culture
Religion
Cognition
Physical
Visual
Compliated medication regimes
Understanding/motivation
Illness
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14
Q

What factors can cause unintentional non-adherence, will a compliance aid help in this situation?

A

forgetfullness
dexterity issues
confusion
dementia

Yes a compliance aid may help

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15
Q

What factors can cause intentional non-adherence, will a compliance aid help in this situation?

A

Mental health
avoidance of side effects
belief that the medication isn’t working
belief system

A compliance aid will not help if it is these issues that are causing the non-compliance

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16
Q

What happens if patient has poor health literacy

A

poorer health outcomes

patient wait until they are more unwell before seeking help

harder to access the service they need

harder to understand labelling or directions

less able to communicate with HCPs

Less able to take part in decisions about their own health

Less likely/ableto engage in health promotion activities (flu-jab or breast cancer screening)

higher rates of avoidable and emergency admissions

higher risk of hospitalisaion

longer in-patients stays

difficulty managing their own health and their family

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17
Q

What are the problems associated with use of MCAs

A

Evidence supporting MCA interventions as increasing adherence is inconclusive

Lack of evidence for general benefit of MCA

Use is service driven not person centred

High Risk

Lack of evidence of barrier properties/ medicine stability/ interactions between medicines in the MCA

IF person also takes Prn medicines too then there is a risk of the patient having to take multiple medicine administration systems (if other ones aren’t suitable for conclusion)

Product licence is revoked when remove medicine for OP so the pharmacist is responsible

De-skilling of the patient, lack of patient choice and emoweremnet (should first conduct a medication review to establish the issues resulting in poor compliance)

patient choice is comprimised (doesnt automatically improve compliance)

non adherence soul be a prompt for review, not automatic blister pack!

pharmacist are professionally responsible if something goes wrong

sustainability? high workload and workforce pressure for community and hospital services

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18
Q

what is aspiration pneumonia

A

Pulmonary aspiration is when you inhale food, stomach acid, or saliva into your lungs.

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19
Q

what different types of stroke are there?

A

ischemic or haemorrhage

Ischemic can either be thrombotic or caused by emboli

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20
Q

what is the FAST acronym for stroke

A

Face
Arms
Speect
Time

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21
Q

what is a thrombotic stroke

A

a type of ischemic stroke where a thrombus forms at the site in one of the arteries that supplies blood to the brain

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22
Q

what is an embolic stroke

A

a type of ischemic stroke that occurs when a blood clot that has formed elsewhere in the body travels to the brain via the blood stream and it lodges in an artery, blocking the flow of blood causing a stroke

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23
Q

what is a common cause of embolic strokes

A

atrial fibrillation

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24
Q

how does arrhythmia cause an an embolic stroke

A

atrial beats are irregular (although peripheral pulse may be normal due to regular ventricular beats maintaining a reasonable cardiac output)

spamming atria only pumps out a tiny bit of blood into the ventricle each time it contracts therefore the rest of the blood pools and in the atria and starts to coagulate

every now and again the heart/atria will revert to sinus rhythym, the blood clot that has formed in the atria is forced out into the ventricles, it then travels through the aorta to the brain and causes an embolic stroke due to occlusion of blood flow

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25
Q

what is a TIA

A

sometimes thought of as a mini stroke, a temporary occlusion of blood flow
risk factor for a full stroke

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26
Q

what is a cerebral heamorrhage

A

a type of haemorrhage stroke caused by an artery in the brain bursting and causing localised bleeding in the surrounding tissues
the bleeding kills brain cells

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27
Q

what are some modifiable risk factors for a stokr

A 
smoking
drug use
hypertension
diabetes
high cholesterol
atrial fibrillation
alcohol
diet/exercise
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28
Q

what are some non-modifiable risk factors for stokr

A

age
sex (jemals)
race
PFO

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29
Q

can hypo perfusion case a stroke?

A

yes, as it cases an increased risk of coagulation (but this is rare)

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30
Q

what steps are needed in acute stroke care

A

1) admit to a stoke unit
2) imaging
3) assess swallow
4) assess medicines (stop everything)
5) thrombolysis using TPA (alteplase)
6) 24 hours after thrombolysis put on high dose aspirin 300mg for 2 weeks
7) after 2 weeks stop the aspirin and start clopidogrel 75mg per day

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31
Q

name the steps of secondary stroke prevention

A 
A (antiplatlets)
B (blood pressure)
C (cholesterol)
D(diabetes)
E (exercise and lifestyle)
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32
Q

what additional step is required if a patient that has had a stroke also has AF

A

anticoagulant e.g warfarin or DOAC

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33
Q

what is used to assess stroke risk in patients with AF

A

CHADS2 or CHA2DS2VAS

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34
Q

what is the CHADS2 score

A 
CHF (1)
Hypertension (1)
Age >75 (1)
Diabetes (1)
Stroke (2)

Score >2 means anticoagulation is necessary

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35
Q

wat is the CHA2DS2VAS score?

A 
CHF -1
Hypertension -1
Age >75 -2
Diabetes -1
Stroke/TIA -2
Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque) -1
Age (64-75)-1
Sex (female)-1

Score >2 means anticoagulation is necessary

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36
Q

what its the calgary-cambridge approach to assessing a patients medicines?

A 
initiating session
gathering informaion
physical exam (if appropriate)
explanation and planning
closing the session
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37
Q

what is drug testing

A 
quantitative
test targeted specifically at a specific drug or dug class can can detect substances only when present at above cut-off levels
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38
Q

what is drug screening?

A

qualatative immune assay test to distinguish specimens that test negative for a drug or metabolite from positive specimens

Drug screening is often the initial test and theyn they do drug confirmatory test to identify and quantify the presence of a specific drug

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39
Q

what is test SENSITIVITY

A

proportion of positive results a testing method correctly identifies

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40
Q

what is SPECIFICITY

A

proportion of negative results a testing method correctly identifies

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41
Q

what is limit of detection

A

lowest amount of analyte in a sample that can be detected but not necessarily quantified

42
Q

what is the limit of quantification?

A

lowest amount of analyte in a sample that can be quantified with suitable precision and accuracy

43
Q

what is the window of detection

A

length of time a substance or their metabolite can be detected in a biological matrix

44
Q

what factors affect the window of detection

A

chemical properties of the substance that is being detected

individual metabolism and excretion rates

route of administration, frequency of use, amount of use of the drug that is being tested for

sensitivity and specificity of the test

cut off concentration

biological specimen thats ued

patient health, weight, gender, fluid intake etc.

45
Q

what is the window of detection foe breath

A

mins

46
Q

what is the window of detection for blood

A

mins

47
Q

what is the window of detection for oral fluid

A

mins- hours

48
Q

what is the window of detection for urin

A

mins-weeeks

49
Q

what is the window of detection for sweat

A

hours-days

50
Q

what is the window of detection for hair

A

days-years

51
Q

what is the window of detection for meconium

A

weeks-months

52
Q

what is a point of care test

A

a test that is conducted where the sample is collected (for example in the doctors room)
quickly reveal the test results (not quantitive only qualitative)
positive POCT should be followed up by lab test especially if legal ramifications fro the patient will results from the findings

53
Q

what is a specimen validity test

A

determines whether a sample specimen has been diluted, adulterated, or substituted to obtain a negative result

54
Q

how is the validity of urine tested

A

labs always preform a pH and creatinine test on urine sables
compare creatinine level and reflex specific gravity with sample and normal characteristics for urine
check for common aduleterants

55
Q

what is adulteration/substitution or dilution of tests

A

diluting the samples to the point that the drug is below the cut off concentration to achieve a negative test result

consuming larger than normal volumes of water
taking diuretics
adding water from toilet or tap

56
Q

what are the two types of renal failure

A

acute and chronic

57
Q

what are the different types of acute renal failure

A

pre-renal renal failure
intra renal renal failure
post-renal renal failure

58
Q

what is pre-renal renal failure

A

reduction in renal perfusion due to fluid loss, blood loss, reduced BP due to chock, cardiac failure
can be caused by prostaglandin inhibition by NSAIDS etc

remember : REDUCITON IN RENAL PERFUSION LEADING TO ACUTE ONSET RENAL FIALURE

59
Q

what is intra-renal renal fialur

A

damage to kidney in some way

damage to renal tubules (e.g. nephrotoxicity by aminogllycoside antibiotics)

interstitial nephritis (caused by penicillins)

glomerulonephritis

60
Q

what is post renal renal fialure

A

urinary tract obstruction (kidney stones, thrombosis, tumours), back pressure causes damage to the kidneys

61
Q

what is chronic renal failur

A

chronic progression of renal fialure over weeks or months (symptoms initially start to appear when eGFR <30ml/min)

62
Q

what is drug tolerance

A

pharmacological phenomenon where identical doses of a drug gradually produce decreasing levels of effect
higher doses of drug are required to produce the same level of effect

63
Q

what is drug dependence

A

results from chronic use of a drug that has produced tolerance and adverse physical symptoms (withdrawal) occur from sudden discontinuation or rapid dose reduction of the drug

64
Q

what is addiction

A

compulsive and repetitive use of a drug often at potentially harmful doses
tolerance and physical dependence may develop as a reults

65
Q

how can you prevent hydrolysis

A

exclude moisture from the formulation (by including as little water in the formulation as possible)

protect the product from moisture , pH, heat (using appropriate containers)

store in appropriate places (fridge, dry areas)

use by dates to ensure no decomposition has occurred)

66
Q

how do you prevent autoxidation?

A

exclude oxygen from blister packs

protect from light using opaque containers

use optimum pH

use a cheating agent (EDTA) to suppress heavy metals for example copper, that will accelerate autooxidation

use an antioxidant (to “mop up” any free radicals that can also contribute to autooxidaiton)

67
Q

draw a fishbone diagram for why medicines have to be stored under specific conditions

A 
time
moisture
light
air
temperature  
---> unstable drug product 
production
distrubution
storage
68
Q

what factors need to be considered when deciding whether covert administration is suitable for a patient

A

adults with incapacity (scotland) act 2000

benefit for patient
least restrictive
take patients wishes into account
consultation with others (should be a team decision and family involved too)

69
Q

what is the remit of the MHRA

A

to ensure medicines, medical devices and blood products for transfusion meet the applicable standards for safety, quality and efficacy

70
Q

what do the MHRA do to fulfil their remit

A

ensure medicines supply chains are safe and secure

promote international standardisation

help to educate public and HCP on risks

do inspections of manufacturers, wholesale dealers, clinical trial sites, laboratories

inspections can be routine, product related or triggered

71
Q

what are the 3 possible results of a MHRA inspection

A

critical
major
other

72
Q

what does the EMA do

A

european medicines agency

established to harmonise different national legislation between countries in the europe
central procedure for liscencing medicines across the EU

73
Q

who are the FDA

A

american regulators

74
Q

name some of the MHRA licences that you can get

A 
marketing authorisation
wholeslae
dealer
importer 
active substances (manufacture, distribute, import)
broker registration
clinical trial autohrisaion
manufacture liscence
parallel imports liscnec
brokers liscence
specials liscence
registration of homeopathic medicines and traditional herbal medicines THR
75
Q

what information does the product lisence for a medicine include?

A 
indications
dose
formulation
safety issues (side effects and contraindications)
storage and stability information
76
Q

what is a manufacturer/importer lisence

A

a lisence to manufacture and/or assemble licensed medicinal products (including export to a country outside the EEA)

77
Q

what is a manufacturer special lisence

A

lisence to manufacture unlicensed medicines ‘specials” that are for a named patient

78
Q

what is a manufacturer lisence for IMP

A

licence to manufacture investigational medicinal products for use in clinical trials

79
Q

what is a manufacturer licence exempt ATMP

A

licence to manufacture exempt advanced therapy medicinal products on a non-routine basis for UK hospitals

80
Q

what do specials manufacturers have to operate to

A

have to operate under a manufacturers specials liscnce

have to operate to GMP and have QMS and QC but they do not need a QP to release the finished product

81
Q

what is a parallel import lisence

A

a licence to import the exact same medicinal products from the EU to the UK
simple
standard
complex

82
Q

what is the role of the QP

A

no batch product is released for sale or supply prior to certification by a QP that the product is in accordance with the requirements of the relevant authorisation

samedi on the site licence and manufacture licence
expected to be operationally familiar with the site (although they may not be there full time)

83
Q

do all steps of the supply chain need a QP?

A

all stages except

brokers
wholesale distributors
specials

84
Q

what is an unliscenced medicine

A

a medicine that hasn’t been approved by the relevant medical authority for the treatment of a specific disease state

85
Q

what do the MHRA check for in a product to grant it a marketing authorisation

A

quality
efficacy
safety

86
Q

what different types of unliscnecded medicines are there

A

products that have been administered to patients under terms of a clinical trial (not yet liscenced, early access included in this category)

products that are licensed in other countries but not in the UK

products that are manufactured under the terms of a manufacturers specials license

Products manufactured under Reg4 of HMR 2012

repackaged/overlaelled medicines

87
Q

are unlicensed medicines and off label the same

A

no, unlicensed medicines have no marketing authorisation in the UK

off-label medicines is the use of a product that has a marketing authorisation in the UK but you are using it for an indication which it has no marketing authorisation for/ is not listed in its SPC
(licensed medication used outwit the terms of its marketing authorisation)

88
Q

what legislations allow for the use of unlicensed mediciens

A

Legislation 65/65/EEC

S11344/1994

89
Q

what is the decision heirarchy for using unlicensed medicines?

A

licensed medicine within the UK

licensed medicine used off label

imported medicinal product with a license in its country of origin

specially manufactured unlicensed product (special)

extemporaneous preparation

90
Q

explain the process of manufacturing specials in NHS scotlant

A 
Request
Formulation
Process development
Validation
Documentation
Manufacture
Packaging/labelling
QC (as appropriate)
Release (Product release)
Storage
Distribution to customer for administration to named patient
91
Q

what is the definition of a carer

A

a carer is someone who, without payment provides help and support to a partner, child, relative, friend or neighbour who could not manage without their help

the person that is recieving care could need help because of age, physical or mental illness, addiction or disability

92
Q

how many unpaid carers are there estimated to be in scotland

A

over 750,000

doing unpaid work worth more than £10.3 billion

93
Q

how can being a carer affect the carer themselves

A

sinificant impact on carers mental and physical health
especially young carers, it may affect their studies or make them feel that they cannot go out and socialise with their friends and have to care instead

adult carers may need to give up their employment or career to care

may be able to access support

94
Q

what government legislations are in place for carers

A

carers (scotland) act 2016

determines carers that are eligible for support
carers must be involved in the planning of care services for the person they are caring for
also must be involved in discharge planning for the person they are caring for

95
Q

what HSCP support is available for carers

A

glasgow city health and social care partnership

prepare an adult carer support plan
prepare a young carers statement
emergency and future planning, support etc

96
Q

how can pharmacies support carers

A

form professional relationships

be understanding

pro-active in informing the carers about pharmacy services that may be helpful for them (flu jag, CMS, doxette box deliveries

provide information for a local carer centre

discuss medicines and side effects (carer and patient will need to sign a consent form that provides clarity and security to the pharmacy re. information sharing, this needs to be signed before the pharmacy can discuss things with the carer

communicate with other healthcare professionals (hespecially helpful in hospital discharge and admissions)

be relialble, a trustworthy place where carers know the will get excellent service

can help alleviate stress through good organisation, flexibility and communication

valuable source of support and service precision

medicines adherence information

97
Q

what are pharmacokinetic drug interactions

A

interactions involving how drugs are absorbed, distrubuted, metabolised or excreted (affect ADME processes)

(there will be a change in drug level)

98
Q

what are pharmacodynamic drug interactions

A

interactions where the effect of drug A is altered by the presence of drug B without affecting its pharmacokinetics

(there will be no change in drug level)

99
Q

how do you calculate log D for acids

A

Log D = Log P + Funionised

F(unionised) acid = 1/(1+10)pH-pKa

100
Q

how do you calculate log D for based

A

Log D = Log P + Funionised

F(unionised) bases = 1/(1+10)pKa-pH

Co-morbidity Exam (18 decks)

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