Session 1-5 Flashcards
1
Q
What is the FP10?
A
a prescription that can be issued by GP’s, nurses + pharmacist prescribers, supplementary prescribers or hospital doctors in England
2
Q
green FP10?
A
GP’s
3
Q
FP10D - yellow
A
dentists
4
Q
FP10MDA - blue
A
used for drugs such as methadone
5
Q
FP10P. PN, SP or CN - purple or green
A
used by prescribers such as nurses or pharmacists
6
Q
What should be included in an FP10 prescription?
A
- prescribers signature
- prescriber’s address
- a number to identify the prescriber
- date of signature
- patient’s details
- info about the product supplied
7
Q
oral?
A
PO
8
Q
intravenous
A
IV
9
Q
Rectal?
A
PR
10
Q
Subcutaneous
A
SC
11
Q
Intramuscular
A
IM
12
Q
Intra-nasal
A
IN
13
Q
Topical
A
top
14
Q
sublingual
A
SL
15
Q
inhaled
A
inh
16
Q
nebulised
A
neb
17
Q
how are the 8 week immunisations administered?
A
IM
but rotavirus is administered PO
18
Q
what vaccines are administered in the 8 week immunisation?
A
5 in 1 vaccine: 1. Diphtheria 2. Tetanus 3. Whooping cough 4. Polio 5. Haemophilus influenza type B \+ Pneumococcal, Rotavirus, Men B vaccine
19
Q
what are the different routes of administration for paracetamol in any age?
A
PO, PR, IV
20
Q
Who are involved in child health surveillance?
A
Health visitors + midwifery staff
21
Q
what is the role of a health visitor?
A
- works w/ families to give pre-school age children the best possible start in life
- supports parents in bringing up their young children
- assesses a child’s growth + development needs of young children
22
Q
what is the role of midwifery staff?
A
- supports the woman and her family throughout the childbearing process
- trained in assisting w/ childbirth
- helps partners adjust to parental role during first few weeks after birth
- assists w/ health check-ups during pregnancy
- provides full antenatal care: classes, clinical examinations, screening
23
Q
What is the red book / PCHR?
A
- medical info about child from 0-4yrs:
1. child, family + birth details
2. immunisations
3. screening + routine reviews
4. growth charts
24
Q
8 week baby check includes?
A
- maternal + newborn history
- weight
- colour, cry, posture, tone
- head size, shape, fontanelle
- skin colour, bruising, birthmarks, vernix
- Face: appearance, asymmetry, trauma, nose
- Eyes, ears, mouth
8; Neck + clavicles
etc
25
What is the mechanism of action of naproxen?
- NSAID
- inhibits cyclo-oxygenase 2 (COX-2)
- arachidonic acid ----> prostaglandins + thromboxane
COX
- thus analgesic
26
What contra-indications are there to using NSAIDS?
- GI bleeding + ulceration
- severe heart failure
- renal failure
- dehydration
- may be allergic to aspirin
27
Why should we avoid giving NSAIDs to patients with asthma?
- bronchospasm
| - asthmatics w. chronic rhinitis or a history of nasal polyps are at a greater risk
28
How do NSAIDs cause renal dysfunction?
- biosynthesis of prostaglandins (for maintenance of renal medullary blood flow) is inhibited
- after many months: acute interstitial nephritis --> renal impairment
29
pharmacological management of osteoarthritis?
- paracetamol at first
- NSAIDs
- opioids - codeine, tramadol, dihydrocodeine
- Capsaicin cream - blocks nerves that send pain messages in the treated area
- Steroids injections for short term relief
- PRP: platelet rich plasma to repair damaged tissue using patient's own healing platelets
30
Non-pharmacological management of osteoarthritis?
- exercise
- losing weight
- transcutaneous electrical nerve stiulation
- hot or cold packs
- physiotherapy
- footwear, cane, splint
- surgery:
arthroplasty - joint replacement therapy
arthrodesis - fuses joint in a permanent position
osteotomy - adding/removing a small section of bone
31
Analgesic ladder?
more for acute pain
step 1: non-opioid analgesics
step 2: mild opioids e.g. codeine
step 3: strong opioids e.g morphine, fentanyl
32
effect of pain on QOL
- family relations
- sexual activity
- depression
- recreational activities
33
assessment of ADLs (activities of daily living)
a series of basic activities performed by individuals on a daily basis necessary for independent living at home
1) personal hygiene - bathing, grooming, nail + oral care
2) dressing
3) eating
4) maintaining continence
5) transferring/motility
34
adverse effects of opioids
- constipation
- N+V
- drowsiness
in larger doses:
- resp depression
- hypotension
35
how is metformin excreted/
- by active tubular excretion
| - excreted unchanged in the urine
36
Half-life?
the time required for the serum concentration of the drug to decrease by 50%
37
what precautions do you need to take if a patient on metformin is undergoing a radiological investigation with IV contrast?
- risk of lactic acidosis
- serum creatinine must be measured within the preceding month
- if creatine normal + <100ml contrast administered = no special precaution required
- if >100ml contrast = Metformin withheld for 48 hrs prior to the contrast
- if raised creatine + requires contrast = metformin withheld for 48 hrs prior + post contrast + serum creatine measured prior to restarting metformin
38
in what way can a prescription be altered to mitigate the effects of reduced renal function (metformin)
- drugs predominantly excreted unchanged in the urine may require dose adjustment in renal impairment
- particularly important for drugs w/ a narrow therapeutic index
- so either reduce the dose or lengthen the dosing interval or both
- some drugs less effective in renal impairment so should be substituted
39
NHS health check?
- a health check up for adults in England aged 40-74
- designed to spot early signs of:
stroke
kidney disease
heart disease
T2diabetes
dementia
40
CVD risk assessment?
QRISK2 assessment tool assesses the 10 year risk of developing CVD. You need:
age, sex, ethnicity, postcode, smoking status, selected medical + family history
BP, BMI
total cholesterol
- repeat assessment every 5 years
41
Diagnosis of diabetes
```
Symptoms of hyperglycaemia:
- polyuria
- polydipsia
- unexplained weight loss
- visual blurring
- genital thrush
- lethargy
AND
- Raised venous glu once:
Fasting >7 or random >11.1
OR
- Raised venous glu twice
fasting or random
or
OGTT >11.1
```
HbA1C > 48
pre diabetes >42
42
Risk factors of T2 diabetes
- obesity
- sedentary lifestyle
- family history + genetics
- increasing age
- high BP + cholesterol
43
Management of T2 diabetes
```
1st line
- lifestyle + dietary changes
- BP control: Ramipril
- Hyperlipidaemia control: Statins
2nd line
- Biguanide e.g. PO Metformin
- SE: lactic acidosis, anorexia, nausea, diarrhoea
if HbA1c >53:
- Sulfonylurea e.g. PO Gliclazide
- opens channels in B cells so more insulin produced
if at 6 months HbA1c >57:
- insulin e.g. isophane insulin/long-acting analogue
- or a glitazone .g. oral Pioglitazone
```
44
What's involved in a diabetic review?
- diabetics undergo a review annually
- reviews blood glu control
- issues, advice
- injection sites checked, depression, sexual dysfunction
- eye + foot examination
45
Complications of diabetes
- blindness
- CV disease
- Heart attacks
- Stroke
- Kidney failure
- Amputations
- Sexual problems
- Nerve damage
46
Type 1 Diabetes features
- younger, lean, N.European
- HLA-DR3/4
- autoimmune
- ketonuria
- insulin deficiency +/- ketoacidosis
- Always needs insulin
- C-peptide disappears
47
Type 2 Diabetes features
- older, overweight, Asian African
- partial insulin deficiency initially +/- hyperosmolar state
- need insulin when B cells fail over time
- C-peptide persists
48
What class is Ramipril
ACEi
49
What is the mechanism of action of Ramipril
- ACEi
- Angiotensin 1 (inactive)----> Angiotensin II (potent vasoconstrictor) ----> release of aldosterone
- thus less angiotensin II produced
- ACEi causes vasodilation, K+ retention, inhibition of salt + H20 retention
50
When should the renal function be monitored if using an ACEi?
- before starting ACEi
+2-4 weeks after any increase in dose
+ periodically during treatment
- esp if there's pre-existing renal impairment as hyperkalaemia can occur
51
What is ACEi cough?
a chronic cough due to accumulation of kinins in the lung e.g. bradykinin
52
How common is ACEi cough?
10-30% of patients taking ACEi
F>M
can occur after many months of treatment
53
Why do Afro-Carribean patients respond less well to ACEi?
- they have low renin essential hypertension
| - where the renin-angiotensin system is contributing little to their hypertension
54
Differential diagnosis of chest pain?
- constricting discomfort in front of chest, neck, shoulders, jaws or arms
- precipitated by physical exertion
- relieved by rest or GTN
55
Risk factors of ischaemic heart disease?
- family history
- increasing age
- smoking
- high levels of LDL
- obesity/sedentary lifestyle
- hypertension
56
Management of acute MI
- 999
- Book a PCI
- Aspirin 300g
- Morphine
- If hypoxic: O2 + nitrates
57
Secondary prevention post MI?
- BB
- ACE-I (don't work for Afro-Carribeans because they lack renin)
- Clopidogrel
- Aspirin
- Statins
- Modification of risk factors
58
Pathophysiology of MI?
Atherosclerosis --> plaque rupture --> platelet aggregation --> thrombosis formation --> ischaemia + infarction --> necrosis of cells --> permanent heart muscle damage + ACS
59
the young lady has episodes of severe diarrhoea, how would you advise her regarding contraception for any young lady?
- count severe diarrhoea as though she has missed her pills on those days
- needs to take additional contraceptive precautions for the following 7 days
60
other options other than the combined oral contraceptive pill?
- progesterone only pill
- contraceptive patch
- vaginal ring
- contraceptive injection
- contraceptive implant
- intra-uterine device
61
what needs to be considered when choosing type of contraception?
- remembering everyday
- STI's?
- comfortable inserting contraceptives vaginally
- current periods and effect it will have
- medical history - drug interaction
- weight, smoke
- pregnant in future
62
how does the combined oral contraceptive pill prevent pregnancy?
- it contains artificial oestrogen + progesterone
- -ve feedback on hypothalamus
- inhibition of LH + FSH (gonadotropins) release
- prevents the mid cycle rise of LH which triggers ovulations
- ovulation suppressed
- thinner endometrium --> prevents likelihood of an egg implanting successfully
- cervical mucus becomes thicker --> more difficult for sperm to reach an egg
63
How does loperamide work?
- opioid-receptor agonist
- reduces GI tract motility
- this increases the time material stays in the intestine
- allowing more water to be absorbed from the faecal matter
64
History assessment of diarrhoea
- onset
- freq
- amount
- consistency
- blood
- mucus/pus
- fever
- recent travel
- diet
- exposure to pets/cattle
- associated symptoms: abdo pain, nausea, vomiting
- medications
65
physical examination of diarrhoea
- general appearance of the patient
- pulse
- skin turgor
- mucous membranes appear dry?
- capillary refill time (usually >3 sec but may be increased in dehydration)
- BP
- Orthostatic changes
- Abdo examinations
66
Differential diagnosis of diarrhoea
- stool examination:
- watery: functional, villous adenoma
- mucoid: IBS, Crohn's disease
- bloody mucoid: ulcerative colitis, diverticulitis
- steatorrhea: Crohn's disease, celiac disease, DM, cystic fibrosis
67
Investigations with a patient with chronic diarrhoea
>3 loss stools/day for > 4 weeks
- FBC + TFT
- if <45 + diarrhoea + typical symptoms of functional bowel disorder + -ve in above inx = IBS
- if >45 --> colonic inx
68
Management of irritable bowel syndrome
```
Mild
- education + reassurance
- low FODMAP diet (avoid food that aren't easily broken down by gut)
Moderate
- antispasmodics for pain
- laxatives for constipation
- anti-motility agents for diarrhoea
- CBT + hypnotherapy
Severe
- MDT approach, referral to specialist pain treatment centres
- Tri-cyclic anti-depressants
```
69
Management of Crohn's disease (IBD)
- smoking cessation
- anti-inflammatories
- mild attacks: Prednisolone
- severe: hydrocortisone
- 5-ASA analogues (mesalazin)
- corticosteroids
- surgery doesn't cure since inflammation can occur anywhere along GI tract
70
Management of Coeliac disease
- gluten free diet
| - nutritional supplement as required
71
features of Crohn's disease (IBD)
- Granulomas
- Transmural inflammation
- Skip lesions (scattered) inflammation
- cobble stone appearance
- smoking increases risk
- frameshift mutation in NOD2 gene
- immune destruction of cell in GI tract
- ileum + colon most common
72
Features of Ulcerative Colitis
- Continuous inflammation
- Mucosal inflammation
- only affects the colon
- smoking decreases risk
- autoimmune
- gut bac release sulphide --> acute inflammation
- young women
73
Management of UC
- anti-inflammatories
- Mesalazine (5-ASA)
- steroids
- IV hydrocortisone
- ciclosporin (immunosuppressant)
- surgery
74
what is the mechanism of action of methotrexate
- folic acid is required for synthesis of thymidylate (a pyrimidine) + purine nucleotides
- and thus for DNA synthesis
- Methotrexate is a v.slowly reversible competitive inhibitor of dihydrofolate reductase (DHFR)
- thus, methotrexate prevents nucleic acid synthesis + causes cell death
75
Why is folic acid given to patient on methotrexate?
- to counteract the folate-antagonist action of methotrexate
| - it reduces the toxic effects + improves continuation of therapy + compliance
76
when is folic acid given to patients on methotrexate?
- 5mg once weekly, not on the same day as methotrexate
| - if given on the same day, the effectiveness of methotrexate would be reduced
77
how can you monitor the patients for adverse drug reactions? (methotrexate)
- FBC, renal, LFT before starting methotrexate
- repeated evert 1-2 weeks until therapy stabilised
- thereafter every 2-3 months
78
History taking in muscoskeletal conditions
1. current symptoms
2. acute or chronic?
3. involvement of other symptoms
4. impact of the disease on the person's life
79
pharmacological management of rheumatoid arthritis
- NSAIDs
- corticosteroids
- 2x DMARDs (1 being methotrexate)
- biological agents
80
non-pharmacological management of rheumatoid arthritis
- physio, OT, psychological services + podiatry
- exercise
- transcutaneous electrical nerve stimulation
81
monitoring patients on DMARDs/ immunosuppression
- blood dyscrasias + liver cirrhosis
- FBC + LFT every 1-2 weeks until therapy stabilised
- thereafter every 2-3 months
