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Musculoskeletal System > Pharmacology ,patient safety, patient perspective and professionalism > Flashcards

Pharmacology ,patient safety, patient perspective and professionalism Flashcards

1
Q

What are the two functions of steroids?

A
  • Regulation of membrane fluidity

- Acting as signalling molecules > hormones

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2
Q

What are the two branches of steroids?

A
  1. Corticosteroids (mineralocorticoids and glucocorticoids)

2. Sex hormones (oestrogen, androgens and progesterone)

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3
Q

Where are sex hormones produced?

A
  • The gonads (reproductive system)
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4
Q

Where are corticosteroids produced?

A

The adrenal glands

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5
Q

What does glucocorticoids do and name an example

A

Example: Cortisol

  • Affects carbohydrate, fat and protein metabolism (e.g increasing blood glucose by gluconeogenesis
  • Supress the immune system (e.g by preventing phagocytosis
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6
Q

What does mineralocorticoids do and name an example

A

Example: aldosterone

  • affects water balance
  • increases blood volume by promoting the reabsorption of sodium and water? promoting excretion of potassium
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7
Q

Name 5 side effects of taking steroids therapeutically for a long time

A
  • Hair thinning
  • Moon face
  • Acne
  • Bruising
  • Psychosis
  • Decreased skin thickness
  • Muscle wastage
  • Osteoporosis
  • Peptic ulcer
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8
Q

Name some therapeutic uses of steroids

A
  • reduce inflammation

- suppress immune system

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9
Q

What conditions are steroids used for?

A
  • Crohns disease
  • COPD
  • Asthma
  • Gout
  • Sciatica
  • Inflammatory arthritis
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10
Q

What is a steroid

A

It is a hormone

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11
Q

What does the neuroendocrine system do?

A

System that uses both the nervous and endocrine components to release signalling molecules into the blood and they regulate the synthesis of steroid hormones in the body

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12
Q

Name one of the neuroendocrine systems

A

HPA axis
“The HPA axis refers to a complex set of interactions and
feedback loops between the hypothalamus, pituitary and adrenal
glands. This system regulates the body’s response to stress,
immune function, energy expenditure, mood, emotions and libido”

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13
Q

Describe the pathway of steroids

A

Steroid hormones are transported in the
blood by being bound to to carrier proteins
eg albumin.
The steroid hormone then frees itself of its
carrier protein and passes passively into the
cell cytoplasm, where the hormone either:
(two pathways)
1) Binds to an intracellular receptor in the
cytoplasm then relocates to the nucleus.
2) Passes into the nucleus and then binds to
a nuclear located receptor.
Either way the hormone-receptor complex
formed, binds to elements (eg promoters) on
the DNA and acts as a transcription factor.
Turning the expression of a gene on or off
and causing a change eg production of a
protein.

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14
Q

What are the effects of nicotine on the autonomic nervous system

A
  • reduces the parasympathetic pathway (associated with rest, slow heart and digestion )
  • increases the sympathetic pathway which is associated with increased heart rate
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15
Q

Name 3 effects of nicotine on the whole organism:

A
  • increase heart rate
  • increased cardiac contractiatility
  • increased blood pressure
  • decreased skin temperature
  • mobilisation of blood sugar
  • arousal or relaxation
  • bad breath
  • smokers cough
  • stained teeth
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16
Q

Name 3 effects of nicotine at a cellular level

A
  • increased synthesis and release of hormones
  • activation of tyrosine hydroxylase enzyme
  • activation of several transcription factors
  • induction of heat shock proteins
  • effects on apoptosis
  • induction of sister chromatid exchange
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17
Q

How does nicotine increase heart rate

A

Once it is absorbed into the blood stream it stimulates the adrenal gland to produce epinephrine (adrenaline) which increases heart rate, blood pressure and cardiac contractility

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18
Q

Nicotine also stimulates the production of ……….. (1) ………

A
  1. Dopamine (controls brains pleasure centre)
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19
Q

What is nicotine broken down into and where does this happen

A
  • it is metabolised in the liver within 1-2 hours into COTININE
  • 50% Of nicotine gets excreted in urine
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20
Q

Name 3 conditions nicotine is a risk factor for:

A

Coronary heart disease
Lung cancer
Abnormal foetal development
Peripheral vascular disease(hypertension)

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21
Q

Name the three enzymes that breaks down alcohol

A
  • Catalase
  • Alcohol dehydrogenase
  • Cytochrome P-45 isoenzymes
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22
Q

How many people have chronic alcoholism in the western world

A

5% to 10%

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23
Q

Why do chronic alcoholics develop a tolerance?

A

Because they metabolise alcohol at a higher rate than normal

24
Q

Name the toxic effects resulting from ethanol metabolism

A
  1. Alcohol oxidation causes a decrease in NAD+ which is required for fatty acid oxidation in the liver > causes fat accumulation in the liver
  2. Alcohol may cause release of endotoxin which is a product of gram-negative bacteria > stimulates TNF and other cytokines which causes cell injury.
25
Q

Name some of the condition chronic alcoholism can cause:

A
  • Cirrhosis and alcohol hepatitis
  • Massive bleeding from gastritis etc.
  • Neurological effects: Thiamine deficiency is common in chronic alcoholics – can cause cerebral atrophy, cerebellar degeneration, and optic neuropathy
  • Cardiovascular effects: injuries to the myocardium can cause dilated congestive cardiomyopathy (thinned heart muscle), can also cause hypertension
  • Pancreatitis
  • Alcohol consumption during pregnancy can cause foetal alcohol syndrome > consists of facial abnormalities in the new born, growth retardation etc.
  • Carcinogenesis
26
Q

Name some effects on acute alcoholism

A
    • Mainly affects the CNS as alcohol is a depressant that first affects the subcortical structures that modulate the cerebral cortex activity.
  • headaches
  • nausea/diarrhoea
27
Q

What is a never event?

A

An event that never should have happened in first place

28
Q

Name an example of an never event

A

Overdose of insulin due to abbreviations

  • falls from poorly restricted windows
  • retained foreign object post procedure
29
Q

What does the never event framework state?

A

States that some never events should and can be avoided if the available preventative measures have been implemented

30
Q

What is patient safety

A

Action of preventing avoidable harm and the general principles of patient safety aims to maximise the things that go right and minimising the things that go wrong for patients

31
Q

Why was the WHO checklist developed?

A

It was developed in order to decrease errors of adverse events and increase teamwork and communication in surgery - due to the checklist there has been a reduction to morbidities and mortalities

32
Q

Antibiotics can be used to kill bacteria and not viruses. TRUE OR FALSE

A

TRUE - antibiotics only work for bacterial infections as viruses and bacteria have different mechanisms of replicating and surviving > viruses replicate in cells

33
Q

What are the key principles of non- pharmacological pain management

A 
	Educate pt
	Promote self-management
	Improve function
	Improve QoL
	Control pain
34
Q

What are the uses of hydrotherapy?

A

o Muscle relaxation
o Reduction in weight bearing
o Movement improves range of movement
o Education about their disease and exercise to reduce symptoms

35
Q

What are the uses of splints

A

o Temporary rest and support
o Protect during daily function and sleep
o Can be permanent- orthoses (splint)
 Reduce instability
 Reduce excessive abnormal movement e.g. hyper-mobility
 Good for severely disabled pets who can’t have surgery

36
Q

What is hydrotherapy?

A

y is a therapeutic whole-body treatment that involves moving and exercising in water; essentially physiotherapy in a pool.

37
Q

What are the uses of physiotherapy?

A

o Provide exercises to strengthen muscles and compensate for loss of function due to their disease or treatment e.g. surgery.
o Allows pt to function more independently
o May reduce pain and slow disease progression

38
Q

What are the uses of mobility and daily living aids?

A

o Provide independence
o Include raised toilet seat, shower instead of a bath, thick handled cutlery etc
o Provided by OT

39
Q

What do self - help and coping strategies include?

A
  • Understand their chronic pain
  • Acceptance
  • Plans to manage flares and LT to manage degeneration
  • Yoga and relaxation
  • Avoidance of exacerbating actions
  • Education and open discussion about the disease to alter perspectives.
  • Reduction of maladaptive pain behaviour and catastrophising.
  • Distraction techniques
  • Increase social support
40
Q

……. and …….. are other non- pharmacological pain managements

A

Weight control and Surgery

41
Q

Why is weight control useful?

A
  • Obesity worsens pain due to increased mechanical strain.
  • Is a risk factor for many arthritis’ namely OA
  • Education must be provided
  • BMI should be in 20-25g/m2 range
  • May need advice from GP, referral to a dietician or to a physiotherapist.
42
Q

Why is surgery useful?

A

• Reduce pain, restore/maintain function, reduce damage, improve QoL
• Main procedures include:
o Osteotomy- cutting bone to alter joint mechanics (e.g. reduce damage in OA)
o Arthroplasty
o Arthrodesis- joint fusion
o Incision and drainage- e.g. for septic arthritis to prevent joint damage when Abx alone doesn’t work
o Surgical fixation of fractures
• MDT approach is needed to managing pts pre/post-op
• Surgery is usually a last resort management option due to the potential to harm the pt.
• Criteria is dependent on:
o General health, extent of disease, QoL, ability to mobilise
o Risk of surgery, risk of anaesthesia, post-op complications
o Motivation, social support, environment

43
Q

What is patient safety?

A

The prevention of avoidable harm- whether by an error or an omission (failure to do the right thing)

44
Q

How can patients come to harm?

A

• Never events- events that should have never been allowed to happen. E.g.
o Wrong-site surgery
o Wrong implants
o Foreign object left in a body cavity e.g. swabs
o Wrong Medx given/ wrong route
o Overdose

45
Q

What are the main causes of never events?

A

o Personal task related
o Situational
o Organisational

46
Q

How can never events be addressed?

A
  • Clear policy that is stuck to
  • Checklists e.g. WHO surgical checklist
  • Continuation training and GMC revalidation
  • Duty of candour
  • Looking to best practice and NICE guidelines
  • Ensuring continuity of care
  • Applying critical thinking
  • Owning up to mistakes and learning from them
  • Practice within your competency
  • Seek help and advice from colleagues and seniors
47
Q

What are causes of medication error?

A

o patient factors
-can’t take the medication: swallowing, dexterity, eyesight. etc
-taking over the counter medications aswell and not informing the doctor or nurse
-renal/ liver/ metabolic diseases
-compliance with taking
o system factors
-poor knowledge/ ignorance of drug interactions or side effects
-human error (dose calculation - especially with younger patients)
-poor communication to patient
-wrong drug
-wrong route
-wrong dose frequency
-repeat prescription errors - not stopping a drug at end of course
-not monitoring if drug works or if there is any toxic side effects

48
Q

What is the human error theory

A

When unintended errors occurs because the prescriber fails to complete the prescription correctly

49
Q

How do you respond to a human error?

A

o the first duty is to protect the patient’s safety
o this involves a clinical review and taking any steps to reduce harm
o patients should always be informed if they have been exposed to potential harm
o reporting errors is useful because others can learn from the experience and take the opportunity to reflect on how a similar incident might be avoidable in the future

50
Q

How can you reduce and identify errors done by prescribers

A
  • medications that have severe side effects should be regulated
  • adequate training above a certain level should be required before you can carry out tasks
  • multiple checkpoints to make sure no mistakes are made and continually carried on
51
Q

How can you deal with a medical error

A

o gather evidence - what actually happened? - non-judgemental discussion (avoid blame culture)
o provide support to those involved
o what could have been done differently? what needs to change? were protocols followed? “training needs” identified as a result?
o clear documentation of learning points. usually, minutes of a significant event meeting where doctors and HCP who are involved meet with those who were not and have an open discussion
o in complaints where something has gone wrong, its best to be honest and open from the outset with patients or relatives; apologise, give evidence of learning from mistakes

52
Q

What is the demography of people with chronic pain

A
  • older patients
  • developing countries
  • work that involves high levels of stress
  • people that come from deprived areas
53
Q

What are some clinical factors associated with chronic pain? `

A
  • weight
  • genetics
  • mental health
  • co-morbidities
  • pain
54
Q

What investigations can be carried out for chronic pain?

A
  • MRI: useful for nerve root or peripheral nerve damage check
  • Blood tests: only helpful with peripheral neuropathy and genetical testing for inherited disorders
  • Quantitative sensory testing: tests abnormalities of fine touch (slightly touching with a cotton wool), hyperalgesia (increased sensitivity to pain by using a pin prick) and thermal sensation
  • Nerve conduction studies: measures the speed of conduction as well as identifying nerve damage and its location
    5. Nerve blocks
    6. Pain scoring systems
55
Q

How can chronic pain be managed?

A

First a biopsychological assessment should be carried out

  1. Supported self- management: e,g increasing activity levels, relaxation etc.
  2. Physical therapies
  3. Pharmacological therapies e.g paracetamol, nsaids, opiods, ketamine, gabapentin etc.
  4. Psychological therapies e.g CBT
  5. Stimulation therapies e.g acupuncture

Musculoskeletal System (14 decks)

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