Lifestyle Advice and Simple Procedures Flashcards
What is the biggest cause of preventable disease and premature death in the UK?
Smoking!
What diseases in smoking implicated in?
Premature death, cancers (resp, oesophageal, bladder, kidney, stomach, pancrease, myeloid leukameia), pneumonia, CVA, AAs, CHD, peptic ulcers, angina, PVD, asthma, miscarriage, prematurity, low birth weight, the list goes on.
What hsould be done if someone tells their GP (or any HCP) that they smoke?
Advise them to try and stop and provide information about the best way to do this and help facilitate smoking cessation
Where can a smoker be referred to to help them stop smoking?
A stop smoking clinic!!
What are the NICE-recommended pharmacological smoking cessation tools?
- Nicotine replacement therapy
- Varenicline
- Bupropion
If varenicline or bupropion are prescribed, what condition are they prescribed under?
That the patient makes a commitment to stop smoking on or before a particular date. A prescription should run until only 2 weeks post this date.
How long should someone use nicotine replacement before their agreed stop smoking date?
2 weeks
How long should someone use varenicline or bupropion before their agreed stop smoking date?
3-4 weeks
Can nicotine replacement therapy, bupropion and varenicline be offered together in any combination?
No!
What form can nicotin replacement therapy come in? Which ones work better?
Pathces, gum, nasal spray, mouth spray, inhalation cartidge, lozenges, sublingual tablets.
None of them are more effective than any other, however high dose patches or gum are more effective if the patient smokes more than 10 per day.
How is the efficacy of nicotine replacement therapy most improved?
Use alongside behavioural therapies to break patterns of smoking in lifestyle.
What is bupropion?
An atypical antidepressant used in smoking cessation - it is a nin-competative nicotine receptor agonist.
When is bupropion contraindicated?
- Pregnancy
- Breast feeding
- Hx of bipolar
- Patients under 18
What is Varenicline?
An alpha-4, beta-2 nicotinic ACh receptor partial agonist used in smoking cessation.
When is Varenicline contraindicated?
- Pregnancy
- Under 18s
- History of psychiatric problems as risk of suicidal thoughts and behaviours.
Who needs to be notified if someone has a condition which may affect their ability to drive?
The DVLA
Whose responsibility is it to tell the DVLA if someone cannot drive due to a medical condition?
The patient/driver, but it is the responsibility of the doctor to inform a patient when this is the case.
What does the GMC say about informing the DVLA?
It is the doctors responsibility to inform the DVLA if the patient fails to act.
What are the common conditions that patients need to inform the DVLA about?
- Epileptic events
- Attack of giddiness, fainting, or blackout
- Severe learning disability
- Pacemaker/implanted defib device
- Diabetes with risk of hypos
- Parkinson’s
- Dementia
- Stroke/TIA
- Brain surgery or trauma
- Severe psychiatric ilness
- Visual problems in both eyes
- Deoendance on alcohol or substances
Following a single TIA, how long should someone abstain from driving?
One month
Following a TIA witha history of frquent or recurrent TIAs, how long should a patient abstain from driving?
3 months at least attack free
Do all patients with Parkinson’s get their driving liscence taken away?
No - only if there is significant disability or variable motor function
What are the factors that need to be considered when assessing someones fitness to fly?
- Mild hypoxia and lower air pressure in cabin
- Immobility
- Ability to adopt brace position
- Physical and mental ability to cope with travel
- Medical condition that may affect people around them
What is the risk of developing a DVT following a long haul flight (4+ hours)?
It doubles compared to baseline.
What causes increase risk of DVT on long haul flights?
Immobilisation
How can people be advised to avoid DVT on long haul flights?
- Adequate hydration
- Exercise calves
- Get up from seat regularly
- Avoid excess alcohol
- Avoid tight-fitting socks or stockings
- Use of graduating compression stockings
What is the advice given regarding flying during pregnancy?
- No flying past 36 weeks if uncomplicated singleton, or 32 weeks for multiple pregnancy.
- Increased risk of DVT - take appropriate precautions
- No risk of exposure of foetus to radiation unless flying multiple times per week
What is the advice for newborns flying?
- If born at tern, can fly at equivalent of 41 weeks,
- If born preterm, have oxygen available for signs of respiratory distress
A patient has had abdominal surgery. How long until they can fly?
10 days at least
A patient with a colostomy bag wants to fly. Do they need to do anything extra?
Use a larger colostomy bag as intestinal distension will occur, causing increaseed foecal output.
Where can a patient check to see if they can fly?
BA website has list of guidelines of minimal time to wait before flying (although different airlines may have different policies)
A patient who has had TB is concerned about flying. What can you tell them?
If they have had adequate treatment and are non-infectious as confirmed by 2 negative sputum smears, they can fly.
