Misc Med Flashcards
1
Q
Insomnia: Pathophysiology
A
- Physiology:
- The older you get, the less sleep you need
- Medical and psychiatric disorders
- Drugs that cause sleep disturbance
- Recognize depression
- Lots of little complaints, anxiety
- Depression is one of those disease that uses everybody elses symptoms. Sleeping, can’t sleep, not interested in doing anything, backpain, no appetite, headache,
- Sleep hygiene
- OTC sedative profiles
2
Q
Sleep Disturbance Etiology: Medical, Psyche, Misc.
A
- Medical
- Arthritis*
- Pain*
- CHF
- lots of pillow, feel like being strangled
- GERD*
- if eating late, non adherant to acid reflux disease
- Asthma, COPD
- allergic to pillows/air ducts
- BPH*
- Diabetes
- Hyperglycemia, pee in night
- Hypoglycemia, wake up
- RLS
- restless leg syndrome
- OSA*
- obstructive sleep apnea
- obesity (neck circ., waist to hip ratio), craniofacial or upper airway abnormality, FH, smoker, DM
- Hypertension, male, overweight, big neck
- Psyche
- Anxiety*
- Depression*
- anxious, complain about little things
- Bipolar disorder
- Psychosis
- Substance abuse
- Misc.
- Shift work
- Shift work
3
Q
Insomia: Causative Drugs
A
- Alcohol
- short half-life, wake up, rebound
- Antidepressants
- Antihypertensives
- Nicotine
- Stimulants
- Steroids
- hungry, talk alot, not sleep
- prednisone
- Theophylline
4
Q
Sleep Hygiene
A
- Don’t go to bed if you are not sleepy.
- Bed is for intimacy and sleeping
- If you’re not sleeping get up
- Don’t watch clock
- Don’t take daytime naps
- Don’t take caffeine after supper
- Caution with stimulants in evening
- Establish regular pattern
5
Q
OTC Sedatives
A
- Best chance of taking something to put you to sleep, diphenhydramine, some daytime sedation might occur
- Not the greatest OTC choices, for a night or two they are fine.
- Antihistamines
- Diphenhydramine
- This patient, not good to recommend because prostate worse, age (oldsters can fall and then die)
- Anticholinergic side effects
- Acute narrow glaucoma
- Cognitive effects
- 1st generation antihistamines, benadryl, unisom, etc.
- Melatonin
- Not very effective
- Some people are melatonin defficient, made in pineal gland, will help melatonin deficient people
- May help track back to cycle for travelers, getting back to cycle faster is better than sliding in slowly
- Not overnight
- Very safe
- Alcohol
- rebound
- short half-life and wake up
- sleep disturbance later
- Valerian
- Go to sleep 1 min earlier
- L-tryptophan
- Not on market because of eosiophil myophalgia syndrome deaths
- Other herbals (passion flower, etc.)
- Not effective
6
Q
Exclusions for OTC Sleeper
A
- Frequent nocturnal awakenings or terminal sleep disorder
- Chronic : more than 3 weeks, nightly
- Secondary to medical or psychiatric disorders
*
7
Q
Drowsiness/Fatigue
A
- Get more sleep
- Reinforce sleep hygiene
- Treat underlying cause
- Caffeine
- Physiological effects:
- Adverse effects:
- addictive, headaches
8
Q
7 Reasons Why Coffee is good for you
A
- Makes you smarter
- Burns fat and improves physical performance
- Lowers risk of diabetes
- Lowers risk for Parkinson’s, Alzhiemer’s.
- Good for your liver
- Decrease risk of dying
- Loaded with nutrients and antioxidants
9
Q
Caffeine: Physiolgic and Adverse Effects
A
- Physiologic effects
- Bronchodilator
- CNS stimulant
- Incr. gastric acid & pepsin
- Incr. renin
- Incr. metabolic rate
- Incr. blood glucose
- Incr. cortisol
- Decr. LES tone
- Diuretic
- Adverse Effects
- Cardiovascular (BP, P)
- Psychiatric
- (anxiety, panic)
- Fertility
- Pregnancy
10
Q
Obesity: Class Notes
A
- Obesity
- Patient knows that he needs to lose weight
- Exercise and diet, fruits
- Burn more than taking in, how to do it is the question,
- Set reasonable goal, 0.5-1 pounds a week, maybe 2 lbs a week in the beginning
- Support groups, family/friends, weightwatchers,
- Gadgets: Pedometer, Fitbit, use smartphone, make practical suggestions
- Smaller plates
11
Q
Treatment of Obesity
A
- Behavior modification
- Dietary
- 2200-3000 – male/1800-2800-female Kcal/day to maintain a 30 year old in temperate climate
- Nobody can maintain on 1000 Kcal/day
- Exercise
- Drugs
- sibutramine (no longer),orlistat, phentermine, diethylpropion, buproprion, topiramate
- Liposuction
- Bariatric Surgery
- BMI >40; BMI >35 with co-morbidities
12
Q
Tobacco Use: Addictions
A
- Give clear cut, unambiguous advice “Single most powerful thing to preserve quality and quantity of life”
- Nurse who continually goes back to it.
- Cigarettes will never get back to the pharmacy. Would you sell cigarettes to a patient. Don’t do it.
- Physical: take away drug and get withdrawls, need to maintain a blood level, crabiness, tachycardia, headache, bitchiness, blood level dependent
- A lot of people have this
- Overcome in a couple of days
- Psychological: goes to brain, bathed with dopamine, (pleasure, fun, enjoyment), very addictive and powerful
- Virtually everybody has this
- Cravings, I wish I had
- Hardest to over come
- Takes months to overcome
- Behavioral: in a ritual
- Triggers
- Modality needs to match the type of addiction that the person has
- Hospital woman addiction: behavioral (always shopping for cigarettes), psychological (craving), not physical
- Nurse woman addiction: behavioral and psychogical, not much physical
- How do you figure out physical addition
- Use fagersome scale
- 2 questions: when do you smoke cigarette (in first 30 min) and how many to do you smoke (more than 20)
- 2 pts is physically addicted
13
Q
5 A’s
A
- Ask
- Advise
- Assess
- Assist
- Arrange
- Not counseling technique
- A way to manage smoking
- Manage smoking on a constant basis
- Knowing if a person smokes is probably one of the most important vital signs
- Flag profiles for smoking
- So can have an opportunity to ask them
- Can’t help anybody that you don’t know
- Advice: your blood-pressure could be better if you didn’t smoke
- Clear cut unambiguity advice
- I’d like to quit but I can’t, can swoop in for asses
- Figure out the type of addiction
- Assist, pick the best NRT
- Arrange for followup
14
Q
Smoking Schpiel
A
- History:
- Positives and negatives of smoking
- Motivation for quitting
- Past quit attempts
- PMH, risk factors
- Fagerstrom Score
- Decide who is ready to change
- Ask to come back
- Are they contemplative, if not, don’t waste your time
- Go to ask and advice
- Ask what they like about smoking? A lot of people have a hard time coming up with positives. Don’t like about it smell, kisses, expensive, teeth. Bring up all their health problems
- Have you ever quit before? How long? What did you use? Did it work?
- Cover medical problems and risk factors
- Calculate Fagerstrom Score
- More when angry
- Activities associated with smoking
- When wake up
15
Q
Smoking Quit Plan
A
- Plan:
- Quit Date:
- A couple weeks out so can get psyched, pick a significant date so they can keep track of it
- Enroll support (including 877-270-STOP)
- Smoke Log
- date, time, activity, rate how important (1-10)
- Less than 5, skip that cig
- 8-10, behavioral trigger that need to be careful around
- Pharmacotherapy:
-
bupropion (physical and psychological)
- 1 tablet a day, after 3 days to 1 twice day, can still smoke until quit day, 3 months
-
bupropion (physical and psychological)
- Gimmick
- detail car, start bank account, dry cleaners etc.
- Follow-up:
- phone call on quit date;
- visit @ 2 weeks post quit date
*
