Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

who are “high risk patients” as according to SIGN

A

patients >50yrs is care homes

patients >75 years on multiple medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what medicines are especially high risk

A 
NSAIDS
anticholinergics
sedatives
analgesics
anti-psychotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What factors influence adherence with medication

A 
Age
Culture
Religion
Cognition
Physical
Visual
Compliated medication regimes
Understanding/motivation
Illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is aspiration pneumonia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what different types of stroke are there?

A

ischemic or haemorrhage

Ischemic can either be thrombotic or caused by emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the FAST acronym for stroke

A

Face
Arms
Speect
Time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is a common cause of embolic strokes

A

atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what is a TIA
sometimes thought of as a mini stroke, a temporary occlusion of blood flow risk factor for a full stroke
26
what is a cerebral heamorrhage
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
27
what are some modifiable risk factors for a stokr
``` smoking drug use hypertension diabetes high cholesterol atrial fibrillation alcohol diet/exercise ```
28
what are some non-modifiable risk factors for stokr
age sex (jemals) race PFO
29
can hypo perfusion case a stroke?
yes, as it cases an increased risk of coagulation (but this is rare)
30
what steps are needed in acute stroke care
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
31
name the steps of secondary stroke prevention
``` A (antiplatlets) B (blood pressure) C (cholesterol) D(diabetes) E (exercise and lifestyle) ```
32
what additional step is required if a patient that has had a stroke also has AF
anticoagulant e.g warfarin or DOAC
33
what is used to assess stroke risk in patients with AF
CHADS2 or CHA2DS2VAS
34
what is the CHADS2 score
``` CHF (1) Hypertension (1) Age >75 (1) Diabetes (1) Stroke (2) ``` Score >2 means anticoagulation is necessary
35
wat is the CHA2DS2VAS score?
``` 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
36
what its the calgary-cambridge approach to assessing a patients medicines?
``` initiating session gathering informaion physical exam (if appropriate) explanation and planning closing the session ```
37
what is drug testing
``` quantitative test targeted specifically at a specific drug or dug class can can detect substances only when present at above cut-off levels ```
38
what is drug screening?
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
39
what is test SENSITIVITY
proportion of positive results a testing method correctly identifies
40
what is SPECIFICITY
proportion of negative results a testing method correctly identifies
41
what is limit of detection
lowest amount of analyte in a sample that can be detected but not necessarily quantified
42
what is the limit of quantification?
lowest amount of analyte in a sample that can be quantified with suitable precision and accuracy
43
what is the window of detection
length of time a substance or their metabolite can be detected in a biological matrix
44
what factors affect the window of detection
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
what is the window of detection foe breath
mins
46
what is the window of detection for blood
mins
47
what is the window of detection for oral fluid
mins- hours
48
what is the window of detection for urin
mins-weeeks
49
what is the window of detection for sweat
hours-days
50
what is the window of detection for hair
days-years
51
what is the window of detection for meconium
weeks-months
52
what is a point of care test
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
what is a specimen validity test
determines whether a sample specimen has been diluted, adulterated, or substituted to obtain a negative result
54
how is the validity of urine tested
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
what is adulteration/substitution or dilution of tests
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
what are the two types of renal failure
acute and chronic
57
what are the different types of acute renal failure
pre-renal renal failure intra renal renal failure post-renal renal failure
58
what is pre-renal renal failure
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
what is intra-renal renal fialur
damage to kidney in some way damage to renal tubules (e.g. nephrotoxicity by aminogllycoside antibiotics) interstitial nephritis (caused by penicillins) glomerulonephritis
60
what is post renal renal fialure
urinary tract obstruction (kidney stones, thrombosis, tumours), back pressure causes damage to the kidneys
61
what is chronic renal failur
chronic progression of renal fialure over weeks or months (symptoms initially start to appear when eGFR <30ml/min)
62
what is drug tolerance
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
what is drug dependence
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
what is addiction
compulsive and repetitive use of a drug often at potentially harmful doses tolerance and physical dependence may develop as a reults
65
how can you prevent hydrolysis
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
how do you prevent autoxidation?
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
draw a fishbone diagram for why medicines have to be stored under specific conditions
``` time moisture light air temperature ---> unstable drug product production distrubution storage ```
68
what factors need to be considered when deciding whether covert administration is suitable for a patient
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
what is the remit of the MHRA
to ensure medicines, medical devices and blood products for transfusion meet the applicable standards for safety, quality and efficacy
70
what do the MHRA do to fulfil their remit
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
what are the 3 possible results of a MHRA inspection
critical major other
72
what does the EMA do
european medicines agency established to harmonise different national legislation between countries in the europe central procedure for liscencing medicines across the EU
73
who are the FDA
american regulators
74
name some of the MHRA licences that you can get
``` 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
what information does the product lisence for a medicine include?
``` indications dose formulation safety issues (side effects and contraindications) storage and stability information ```
76
what is a manufacturer/importer lisence
a lisence to manufacture and/or assemble licensed medicinal products (including export to a country outside the EEA)
77
what is a manufacturer special lisence
lisence to manufacture unlicensed medicines 'specials" that are for a named patient
78
what is a manufacturer lisence for IMP
licence to manufacture investigational medicinal products for use in clinical trials
79
what is a manufacturer licence exempt ATMP
licence to manufacture exempt advanced therapy medicinal products on a non-routine basis for UK hospitals
80
what do specials manufacturers have to operate to
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
what is a parallel import lisence
a licence to import the exact same medicinal products from the EU to the UK simple standard complex
82
what is the role of the QP
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
do all steps of the supply chain need a QP?
all stages except brokers wholesale distributors specials
84
what is an unliscenced medicine
a medicine that hasn't been approved by the relevant medical authority for the treatment of a specific disease state
85
what do the MHRA check for in a product to grant it a marketing authorisation
quality efficacy safety
86
what different types of unliscnecded medicines are there
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
are unlicensed medicines and off label the same
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
what legislations allow for the use of unlicensed mediciens
Legislation 65/65/EEC | S11344/1994
89
what is the decision heirarchy for using unlicensed medicines?
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
explain the process of manufacturing specials in NHS scotlant
``` 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
what is the definition of a carer
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
how many unpaid carers are there estimated to be in scotland
over 750,000 | doing unpaid work worth more than £10.3 billion
93
how can being a carer affect the carer themselves
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
what government legislations are in place for carers
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
what HSCP support is available for carers
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
how can pharmacies support carers
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
what are pharmacokinetic drug interactions
interactions involving how drugs are absorbed, distrubuted, metabolised or excreted (affect ADME processes) (there will be a change in drug level)
98
what are pharmacodynamic drug interactions
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
how do you calculate log D for acids
Log D = Log P + Funionised F(unionised) acid = 1/(1+10)pH-pKa
100
how do you calculate log D for based
Log D = Log P + Funionised F(unionised) bases = 1/(1+10)pKa-pH

Co-morbidity Exam (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions