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GP Phase 2A > Session 1-5 > Flashcards

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

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2
Q

green FP10?

A

GP’s

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3
Q

FP10D - yellow

A

dentists

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4
Q

FP10MDA - blue

A

used for drugs such as methadone

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5
Q

FP10P. PN, SP or CN - purple or green

A

used by prescribers such as nurses or pharmacists

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6
Q

What should be included in an FP10 prescription?

A
  1. prescribers signature
  2. prescriber’s address
  3. a number to identify the prescriber
  4. date of signature
  5. patient’s details
  6. info about the product supplied
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7
Q

oral?

A

PO

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8
Q

intravenous

A

IV

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9
Q

Rectal?

A

PR

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10
Q

Subcutaneous

A

SC

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11
Q

Intramuscular

A

IM

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12
Q

Intra-nasal

A

IN

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13
Q

Topical

A

top

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14
Q

sublingual

A

SL

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15
Q

inhaled

A

inh

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16
Q

nebulised

A

neb

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17
Q

how are the 8 week immunisations administered?

A

IM

but rotavirus is administered PO

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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
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19
Q

what are the different routes of administration for paracetamol in any age?

A

PO, PR, IV

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20
Q

Who are involved in child health surveillance?

A

Health visitors + midwifery staff

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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
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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
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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
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24
Q

8 week baby check includes?

A
  1. maternal + newborn history
  2. weight
  3. colour, cry, posture, tone
  4. head size, shape, fontanelle
  5. skin colour, bruising, birthmarks, vernix
  6. Face: appearance, asymmetry, trauma, nose
  7. Eyes, ears, mouth
    8; Neck + clavicles
    etc
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25
Q

What is the mechanism of action of naproxen?

A
  • NSAID
  • inhibits cyclo-oxygenase 2 (COX-2)
  • arachidonic acid —-> prostaglandins + thromboxane
    COX
  • thus analgesic
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26
Q

What contra-indications are there to using NSAIDS?

A
  • GI bleeding + ulceration
  • severe heart failure
  • renal failure
  • dehydration
  • may be allergic to aspirin
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27
Q

Why should we avoid giving NSAIDs to patients with asthma?

A
  • bronchospasm

- asthmatics w. chronic rhinitis or a history of nasal polyps are at a greater risk

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28
Q

How do NSAIDs cause renal dysfunction?

A
  • biosynthesis of prostaglandins (for maintenance of renal medullary blood flow) is inhibited
  • after many months: acute interstitial nephritis –> renal impairment
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29
Q

pharmacological management of osteoarthritis?

A
  • 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
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30
Q

Non-pharmacological management of osteoarthritis?

A
  • 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
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31
Q

Analgesic ladder?

A

more for acute pain
step 1: non-opioid analgesics
step 2: mild opioids e.g. codeine
step 3: strong opioids e.g morphine, fentanyl

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32
Q

effect of pain on QOL

A
  • family relations
  • sexual activity
  • depression
  • recreational activities
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33
Q

assessment of ADLs (activities of daily living)

A

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
Q

adverse effects of opioids

A
  • constipation
  • N+V
  • drowsiness
    in larger doses:
  • resp depression
  • hypotension
35
Q

how is metformin excreted/

A
  • by active tubular excretion

- excreted unchanged in the urine

36
Q

Half-life?

A

the time required for the serum concentration of the drug to decrease by 50%

37
Q

what precautions do you need to take if a patient on metformin is undergoing a radiological investigation with IV contrast?

A
  • 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
Q

in what way can a prescription be altered to mitigate the effects of reduced renal function (metformin)

A
  • 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
Q

NHS health check?

A
  • 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
Q

CVD risk assessment?

A

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
Q

Diagnosis of diabetes

A 
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
Q

Risk factors of T2 diabetes

A
  • obesity
  • sedentary lifestyle
  • family history + genetics
  • increasing age
  • high BP + cholesterol
43
Q

Management of T2 diabetes

A 
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
Q

What’s involved in a diabetic review?

A
  • diabetics undergo a review annually
  • reviews blood glu control
  • issues, advice
  • injection sites checked, depression, sexual dysfunction
  • eye + foot examination
45
Q

Complications of diabetes

A
  • blindness
  • CV disease
  • Heart attacks
  • Stroke
  • Kidney failure
  • Amputations
  • Sexual problems
  • Nerve damage
46
Q

Type 1 Diabetes features

A
  • younger, lean, N.European
  • HLA-DR3/4
  • autoimmune
  • ketonuria
  • insulin deficiency +/- ketoacidosis
  • Always needs insulin
  • C-peptide disappears
47
Q

Type 2 Diabetes features

A
  • older, overweight, Asian African
  • partial insulin deficiency initially +/- hyperosmolar state
  • need insulin when B cells fail over time
  • C-peptide persists
48
Q

What class is Ramipril

A

ACEi

49
Q

What is the mechanism of action of Ramipril

A
  • 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
Q

When should the renal function be monitored if using an ACEi?

A
  • 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
Q

What is ACEi cough?

A

a chronic cough due to accumulation of kinins in the lung e.g. bradykinin

52
Q

How common is ACEi cough?

A

10-30% of patients taking ACEi
F>M
can occur after many months of treatment

53
Q

Why do Afro-Carribean patients respond less well to ACEi?

A
  • they have low renin essential hypertension

- where the renin-angiotensin system is contributing little to their hypertension

54
Q

Differential diagnosis of chest pain?

A
  • constricting discomfort in front of chest, neck, shoulders, jaws or arms
  • precipitated by physical exertion
  • relieved by rest or GTN
55
Q

Risk factors of ischaemic heart disease?

A
  • family history
  • increasing age
  • smoking
  • high levels of LDL
  • obesity/sedentary lifestyle
  • hypertension
56
Q

Management of acute MI

A
  • 999
  • Book a PCI
  • Aspirin 300g
  • Morphine
  • If hypoxic: O2 + nitrates
57
Q

Secondary prevention post MI?

A
  • BB
  • ACE-I (don’t work for Afro-Carribeans because they lack renin)
  • Clopidogrel
  • Aspirin
  • Statins
  • Modification of risk factors
58
Q

Pathophysiology of MI?

A

Atherosclerosis –> plaque rupture –> platelet aggregation –> thrombosis formation –> ischaemia + infarction –> necrosis of cells –> permanent heart muscle damage + ACS

59
Q

the young lady has episodes of severe diarrhoea, how would you advise her regarding contraception for any young lady?

A
  • 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
Q

other options other than the combined oral contraceptive pill?

A
  • progesterone only pill
  • contraceptive patch
  • vaginal ring
  • contraceptive injection
  • contraceptive implant
  • intra-uterine device
61
Q

what needs to be considered when choosing type of contraception?

A
  • 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
Q

how does the combined oral contraceptive pill prevent pregnancy?

A
  • 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
Q

How does loperamide work?

A
  • 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
Q

History assessment of diarrhoea

A
  • onset
  • freq
  • amount
  • consistency
  • blood
  • mucus/pus
  • fever
  • recent travel
  • diet
  • exposure to pets/cattle
  • associated symptoms: abdo pain, nausea, vomiting
  • medications
65
Q

physical examination of diarrhoea

A
  • 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
Q

Differential diagnosis of diarrhoea

A
  • 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
Q

Investigations with a patient with chronic diarrhoea

A

> 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
Q

Management of irritable bowel syndrome

A 
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
Q

Management of Crohn’s disease (IBD)

A
  • 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
Q

Management of Coeliac disease

A
  • gluten free diet

- nutritional supplement as required

71
Q

features of Crohn’s disease (IBD)

A
  • 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
Q

Features of Ulcerative Colitis

A
  • Continuous inflammation
  • Mucosal inflammation
  • only affects the colon
  • smoking decreases risk
  • autoimmune
  • gut bac release sulphide –> acute inflammation
  • young women
73
Q

Management of UC

A
  • anti-inflammatories
  • Mesalazine (5-ASA)
  • steroids
  • IV hydrocortisone
  • ciclosporin (immunosuppressant)
  • surgery
74
Q

what is the mechanism of action of methotrexate

A
  • 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
Q

Why is folic acid given to patient on methotrexate?

A
  • to counteract the folate-antagonist action of methotrexate

- it reduces the toxic effects + improves continuation of therapy + compliance

76
Q

when is folic acid given to patients on methotrexate?

A
  • 5mg once weekly, not on the same day as methotrexate

- if given on the same day, the effectiveness of methotrexate would be reduced

77
Q

how can you monitor the patients for adverse drug reactions? (methotrexate)

A
  • FBC, renal, LFT before starting methotrexate
  • repeated evert 1-2 weeks until therapy stabilised
  • thereafter every 2-3 months
78
Q

History taking in muscoskeletal conditions

A
  1. current symptoms
  2. acute or chronic?
  3. involvement of other symptoms
  4. impact of the disease on the person’s life
79
Q

pharmacological management of rheumatoid arthritis

A
  • NSAIDs
  • corticosteroids
  • 2x DMARDs (1 being methotrexate)
  • biological agents
80
Q

non-pharmacological management of rheumatoid arthritis

A
  • physio, OT, psychological services + podiatry
  • exercise
  • transcutaneous electrical nerve stimulation
81
Q

monitoring patients on DMARDs/ immunosuppression

A
  • blood dyscrasias + liver cirrhosis
  • FBC + LFT every 1-2 weeks until therapy stabilised
  • thereafter every 2-3 months

GP Phase 2A (1 decks)

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