NPS rotating term 2 Flashcards
what are the 3 common nutritional haematinic deficiencies?
iron, folate and vitamin B12
what are some causes of nutritional haematinic deficiencies?
Pregnancy, growth spurts, menorrhagia, poor dietary intake, haemolysis, active bleeding, coeliac disease, crohn’s disease, adverse drug effects
in iron replacement therapies- which is preferred, oral iron or parenteral iron?
oral iron. Parenteral iron is reserved for more severe cases
what improves the absorption of iron?
Vitamin C
What are some SE of iron preparations?
GIT disturbances such as abdominal pain, constipation, diarrhoea, black discolouration of faeces
what should we combine with iron when treating for iron deficiency anaemia?
Folate
why must B12 be given BEFORE folate if B12 is required?
If folate is given first, can precipitate subacute degeneration of the spinal cord
what is Ferro F?
Ferrous fumarate and folic acid
after treating iron deficiency anaemia appropriately, how best might we measure the patient’s iron levels?
Ferritin levels
In patients with proteinuria >1 g/day (with or without diabetes), the recommended BP target is ?
125/75
Mr Reynolds is a 60-year-old man with heart failure and hypertension. Which antihypertensive agents are NOT recommended in patients with heart failure?
In heart failure or significantly impaired left ventricular function there is a risk of further depression of cardiac function with calcium channel blockers. The risk is greatest risk with verapamil, then diltiazem. There is less risk with dihydropyridines channel blockers but they should be used with caution.
50-75% of patients with hypertension will not achieve BP targets on monotherapy. Which of the following are recommended combinations of antihypertensive agents?
Ace inhibitor + calcium channel blocker
Three months after commencing methadone treatment Sasha tells her methadone prescriber that that she has started doctor shopping for Panadeine Forte (paracetamol 500 mg and codeine phosphate 30 mg) again. The most appropriate next step is:
Relapse to opioid misuse warrants review of current treatment and often suggests inadequate therapy and may be resolved by dose increase of opioid substitution therapy.
Buprenorphine may cause precipitated withdrawal if dosed soon after a full opioid agonist in a dependent patient because
B/c of high affinity at the mu receptor. Buprenorphine may displace the full agonist from the receptor, and with only partial efficacy, the net effect is withdrawal.
Methadone and buprenorphine are used in maintenance treatment of opioid dependence because both medications:
Long half-life allows for once daily supervised administration
what is the goal of opioid substitution therapy?
to minimise potentially harmful illicit, prescription or OTC medication misuse.
how is dose of methadone usually managed?
Methadone is usually initiated at a dose of 20-30 mg daily and titrated upward until withdrawal symptoms and cravings are suppressed.
how is methadone and buprenorphine metabolised?
hepatic metabolism. hence alter dosage with hepatic impairment
can we write a discharge prescription for methadone?
no. Can only be prescribed by an authorised prescriber of methadone
SE of OTC therapy?
sedation, constipation, nausea and sweating.
Patients should abstain from alcohol while their dose is being titrated as the risk of toxicity is greater with the combination. Patients should also be cautioned about using NSAIDS and other OTC products
what must we think about the long term side effects/consequences of hypnotic medication such as temazepam?
Long-term use of hypnotic medicines leads to tolerance, dependence and potential harm from adverse effects and drug interactions.
Tolerance to the hypnotic effects of benzodiazepines develops rapidly, sometimes after only a few days of regular use.
The risk of dependence increases with dose and duration of treatment. It is more pronounced in patients receiving long-term therapy and/or high dosage
what is the preferred dosing method for hypnotic therapy?
If a hypnotic medicine is required, limit use to the shortest time possible (
what are some non pharmacological methods to address insomnia?
- Sleep hygiene
- Relaxation therapy
- sleep restriction therapy
- cognitive behavioural therapy
first line approach to insomnia?
non pharmacological methods
common withdrawal symptoms for benzodiazepines?
Common withdrawal symptoms include sweating, feeling ill, dizziness, blurred vision, irritability, lack of concentration, feeling anxious, depression and sleeplessness. Intermittent use may be indicated for severe long standing disorders not relieved by non-drug measures.
Minimise potential harms of hypnotic medicines by engaging the patient in managing sleep difficulties.
The risk of falls is also a concern, particularly for older patients.
when is rivaroxaban indicated for VTE prophylaxis prior to surgery?
Rivaroxaban is an oral anticoagulant approved for VTE prophylaxis after elective total hip or total knee replacement.
It is not approved for abdominal surgery.
how we monitor a patient who is on clexane for VTE prophylaxis?
platelets Hb wound site clinical manifestations of bleeding renal function
triple therapy for H pylori?
PPI and 2 x antibiotics
PPI + amoxycillin and clarithromycin
what do we call drugs delivered by the rectum?
suppository
