Psychosocial

Question 1

Discuss “financial stressors”?

Answer 1

Hx:

• Employment
• Pension
• Other sources of income
• Total income
• Cost of living
• Cost of meds
• Cost of appointments

Rx:

• Social worker: pensions, disability support services
• Rationalise meds
• Rationalise appointments

Question 2

How would you approach smoking cessation?

Answer 2

Brief motivational advice
Telephone counselling and quitlines
Self-help materials

First line:

• Nicotine replacement therapy
• Varenicline (nicotinic ACh receptor agonist): Most effective monotherapy. 12 week course. Nausea, neuropsychiatric SEs.
• Bupropion SR (dopamine and norad reuptake inhibitor): Good in chronic disease and depression. 8 week course. Headache, insomnia, dry mouth.

Second line:
- Nortriptyline: 12 week course. SE dry mouth, constipation, nausea, sedation, headaches, risk of arrhythmias in those with heart disease.