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Specialties > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is clinical reasoning?

A

The process by which clinicians collect, analyse and interpret information to make an accurate diagnosis/develop a plan of action

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2
Q

How often is diagnosis incorrect?

A

10-15% of the time

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3
Q

Where can clincial reasoning go wrong?

A 
Knowledge
Fail to think laterally – generate enough diagnoses
Fail to appreciate the patient’s agenda
Close down differential too soon
Generate inappropriate working diagnosis
Cognitive bias
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4
Q

Give an example of a surgical sieve?

A

I VINDICATE AID

Inflammatory
Vascular
Infectious  
Neoplastic
Degenerative 
Idiopathic
Congenital 
Autoimmune
Traumatic
Endocrine and metabolic
Allergic
Iatrogenic
Drugs
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5
Q

What is occams razor?

A

The answer that requires the fewest assumptions is usually the correct one

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6
Q

What is sutton’s law?

A

The most obvious answer should be considered first

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7
Q

What is anchoring?

A

Tendency to fail to adjust initial impression in light of later information

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8
Q

What is availability in relation to diagnosis?

A

Judge diagnosis as being more likely if readily comes to mind. Common things are common.

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9
Q

What is confirmation bias in diagnosis?

A

Tendency to give preferential attention to confirming evidence for a diagnosis rather than disconfirming evidence

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10
Q

What is diagnosis momentum?

A

Once diagnostic label becomes attached to patient it tends to stick

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11
Q

What is the framing effect in diagnosis?

A

How diagnosticians see things be strongly influenced by how they have been framed by other individuals

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12
Q

What is overconfidence bias in diagnosis?

A

Tendency to believe we know more than we do acting on incomplete information, intuitions or hunches

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13
Q

What is premature closure in diagnosis?

A

Accepting a diagnosis before it has been fully verified

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14
Q

What is search satisfying in diagnosis?

A

Call off search once something is found, missing for example 2nd fracture, co-morbidities and co-ingestants in poisoning etc

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15
Q

What is triage cueing in diagnosis?

A

Patient triaged in a particular direction cues their subsequent management

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16
Q

What defines complementary and alternative medicine?

A

A broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system

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17
Q

List some examples of complementary/alternative medicine?

A 
Herbal medicine
Homeopathy
Acupuncture
Anthroposophic medicine
Aromatherapy
Ayuveda
Chiropractic
Hypnosis
Meditation
Naturopathy
Osteopathy
Reflexology
Reiki
Shiatsu
Yoga
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18
Q

What are some potential concerns of complementary therapies?

A 
Implausibility of most therapies
Lack of evidence for benefit
Lack of safety data
Evidence of harm
Adverse Effects / Herb-Drug Interactions
Unqualified practitioners / Missed diagnoses
Stopping conventional medicine
Cost-effectiveness?
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19
Q

What are the functions of the MHRA?

A
  • Ensures that human medicines meet acceptable standards on safety quality and efficacy
  • Ensures that the sometimes difficult balance between safety and effectiveness is achieved.
20
Q

What is pharmacovigilance?

A

The process involving detection, assessment, understanding and prevention of adverse drug reactions (ADRs).

21
Q

What is the main method for post-marketing drug surveillance in the UK?

A

Yellow Card scheme

22
Q

What information is collected by the MHRA Yellow Card Scheme?

A
  • Side effects (ADRs)
  • Medical device adverse incidents
  • Defective medicines
  • Counterfeit/fake medicines or medical devices
  • Safety concerns
23
Q

What should be reported by healthcare professionals on the yellow card system?

A

All suspected ADRs to

  • New drug on market and black triangle drug
  • Children (Mostly off license)
  • Serious ADRs for established drugs and vaccines, e.g. anaphylaxis, events that have led to significant harm, those which are fatal.
24
Q

What pieces of information need to be included in a yellow card report?

A
  • The side effects
  • Information about person experiencing side effect
  • Name of medicine
  • Your name and full address
25
Q

What does unlicensed mean for prescribing?

A

No market authorisation

26
Q

What does off-label mean in prescribing?

A

Licensed but prescribed outwith the terms of marketing authorisation

27
Q

What does specials mean in prescribing?

A

Special formulations of medicines made for clinical reasons when an existing formulation of an available licensed product is not suitable for patient = unlicensed

28
Q

What are the expectations of the GMC in regards to unlicensed medicines?

A
  • Carefully consider any treatment you prescribe

- Be able to justify decisions and actions when prescribing , administering and managing medicines

29
Q

What are the classifications of medicines according to the human medicines regulations 2012?

A

Prescription only medicines (POM)

Over the counter (OTC - includes pharmacy and general sales list medicines)

30
Q

List some examples of appropriate practitioners for prescription only medicines

A
  • Doctor
  • Dentist
  • Supplementary prescriber
  • Nurse independent prescriber
  • Pharmacist independent prescriber
31
Q

Give some examples of controlled drugs?

A
  • Opiates

- Temazepan, tramadol

32
Q

What type of medical errors can occur in healthcare?

A

-Cognitive errors vs Technical errors

  • Surgical errors
  • Complications from drug treatment
  • Therapeutic mishaps
  • Diagnostic errors
33
Q

Which patients are most at risk of medical error?

A
  • Those undergoing cardiothoracic surgery, vascular surgery, or neurosurgery
  • Those with complex conditions
  • Those in the emergency room
  • Those looked after by inexperienced doctors
  • Older patients
34
Q

What factors may increase the rate of medication errors?

A
  • More rapid throughput of patients
  • New drug developments, extending medicines into new areas
  • Increasing complexity of medical care
  • Increased specialisation
  • Increased use of medicines generally
  • Sicker and older patients, more vulnerable to adverse effects
35
Q

List some human factors that cause medication incidents?

A 
Fatigue
Hunger
Concentration
Stress
Distraction
Lack of training
Lack of access to information (not timely)
Other factors (Alcohol, drugs, illness)
36
Q

What are some common types of prescribing errors?

A 
Wrong drug (e.g. drugs that sound alike)
Wrong dose 
Inappropriate Units
Poor/illegible prescriptions
Failure to take account of drug interactions
Omission
Wrong route/multiple routes (IV/SC?PO)
Calculation errors (important in Paediatrics)
Poor cross referencing etc
37
Q

What are the 5Rs in safe prescribing?

A 
Right Patient
Right Drug
Right Dose
Right Route 
Right Time
38
Q

What is the function of the commission on human medicines (CHM)?

A

Advises Ministers on matters relating to human medicinal products

Advises Licensing Authority (LA)

Considers representations by an applicant or MA holder

Promotes collection and investigation of information relating to adverse Drug Reactions to human medicines

39
Q

What is the purpose of the Scottish Medicines Consortium?

A

To make decisions on the cost effectiveness of

new/existing pharmaceutical products in respect of their use in NHS Scotland

40
Q

What is an end of life medicine?

A

A medicine used to treat a condition at a stage
that usually leads to death within 3 years with
currently available treatments

41
Q

What is an orphan medicine?

A

A medicine with EMA designated orphan status

(ie conditions affecting fewer than 2,500 people in a population of 5 million

42
Q

Why does use of herbal medicines matter in pregnant women?

A
  • No safety or efficacy data
  • Teratogenesis
  • Fetogenesis
  • Drug-Herb Interactions
43
Q

What are some safety concerns with herbal remedies?

A
  • Contamination, adulteration and misidentification of herbal remedies.
  • Variation between the content of products
  • Serious toxic effects
  • Lack of data.
  • Drug-herb interactions are a major concern
44
Q

What is the general principle of homeopathy?

A

Like cures like

  • Uses dilution levels
  • Water memory
45
Q

What are some potential serious problems with acupuncture?

A

Infection
Pneumothorax
Pneumopericardium
Organ puncture

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