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Year 3 - GP > SLA 7 - Health Promotion > Flashcards

SLA 7 - Health Promotion Flashcards

1
Q

What is the stages of change model?

A
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2
Q

What is the behaviour change wheel?

A

Helps to understand behaviour change at the individual, community and population levels.

It can be used by clinicians to help identify and address barriers to behaviour change with individual patients. It can also be used to help develop public health interventions.

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3
Q

What are the current UK guidelines for alcohol consumption?

A

Men and women are advised not to drink more than 14 units per week on a regular basis.

If a person regularly drinks as much as 14 units per week, drinking should be spread across at least 3 days.

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4
Q

Give some examples of drugs that have significant interactions with alcohol consumption.

A

Opioids and sedatives may interact with alcohol to cause respiratory depression, which can be fatal.

NSAIDs may interact with alcohol to increase the risk of peptic ulceration and GORD.

Anticoagulants (e.g. warfarin) may interact with alcohol, inducing CYP enzymes and thus causing anticoagulant to reach hypotherapeutic levels, increasing the risk of clots.

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5
Q

What is harmful drinking?

A

A pattern of alcohol consumption causing health problems directly related to alcohol (e.g. depression, acute pancreatitis).

In the long term, harmful drinkers may go on to develop hypertension, liver cirrhosis, heart disease or some types of cancer.

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6
Q

What is alcohol dependance?

A

Characterised by craving and tolerance with alcohol and continued drinking in spite of harmful consequences.

Alcohol dependence has also been associated with increased criminal activity and domestic violence.

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7
Q

Suggest some screening tools for alcohol dependence.

A

CAGE questionnaire can be used to screen for alcohol dependence. Note a score > 2 should prompt further investigation.

CKS also recommends AUDIT questionnaire for further exploration.

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8
Q

Outline the management of a patient with alcohol dependence.

A

Encouraging the patient to achieve abstinence is the end goal. This may however begin by encouraging the patient to slowly reduce their alcohol consumption to a moderate level, then to little, then none.

Practical strategies to help reduce alcohol consumption may include:

  • recognising and avoiding high-risk situations for drinking
  • recognising personal cues for drinking (e.g. stress or being alone)
  • drinking a soft drink for every alcoholic drink
  • trying alternative coping activities to drinking (e.g. exercising, reading, exploring other interests)
  • keeping a drinking diary and asking close contacts for help

Note a patient with alcohol dependence is required by law to inform the DVLA.

Note a patient with alcohol dependence should NOT go cold turkey, as this increases the risk of severe alcohol withdrawal (e.g. seizures).

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9
Q

Which psychological interventions may be available for a patient with severe alcohol dependence?

A
  • cognitive behavioural therapies focused on alcohol-related problems.
  • social network and environment based therapies (e.g. AA)
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10
Q

What are the symptoms of alcohol withdrawal?

A

Mild: hypertension, tachycardia, anorexia, anxiety, insomnia, irritability, headache, fine tremor.

Moderate: worsening mild symptoms plus agitation and coarse tremor.

Severe: worsening moderate symptoms plus confusion, tonic-clonic seizures, hallucinations or hyperthermia.

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11
Q

Which medications can be used to help with alcohol withdrawal?

A

A long-acting benzodiazepine (e.g. diazepam) can be used to attenuate alcohol withdrawal symptoms.

Over 7-10 days follow a dose reduction regime to zero.

Note pts with mild alcohol withdrawal symptoms will not need specific medical intervention.

Note acamprosate is a medication used that can sustain abstinence from alcohol.

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12
Q

When would you consider referring someone who is alcohol dependent for:

a) psychological intervention

b) assisted alcohol withdrawal

A

a) high-risk drinkers or those with moderate alcohol dependence

b) people drinking over 15 units/day OR score >20 on AUDIT questionnaire.

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13
Q

What is Wernicke-Korsakoff syndrome (WKS)?

A

A spectrum of disease resulting from thiamine deficiency, usually related to alcohol abuse.

Wernicke’s encephalopathy describes a classic triad of symptoms:

  1. Mental confusion
  2. Ataxia
  3. Ophthalmoplegia

Korsakoff’s syndrome is a late manifestation of Wernicke’s encephalopathy if it is inadequately treated. This can lead to coma and death.

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14
Q

What is the correlation between WKS and alcohol misuse?

A

Chronic alcohol misuse results in liver cirrhosis, which limits the absorption of thiamine and its respective metabolism to Vitamin B1.

This interferes with numerous cellular functions and can affect the thalamus, hypothalamus and mammillary bodies in the brain.

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15
Q

How is Wernicke’s encephalopathy treated?

A

Prophylactic oral thiamine prescribed to patients with severe alcohol dependence.

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16
Q

Give some long-term risks of excessive alcohol consumption.

A
  • cancer (e.g. mouth, throat, breast)
  • strokes
  • heart disease
  • liver disease
  • diabetes
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17
Q

Give some short-term risks of excessive alcohol consumption.

A
  • alcohol-provoked accidents resulting in injury
  • misjudging risky situations
  • losing self-control
  • alcohol poisoning
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18
Q

What drinking advice should be given to pregnant women?

A

Encourage patient to abstain from drinking during pregnancy, as alcohol may harm the baby (e.g. fetal alcohol syndrome).

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19
Q

What effects can alcohol have upon a foetus?

A

Fetal alcohol syndrome:

  • restricted growth
  • facial abnormalities
  • learning and behaviour disorders
20
Q

What are the benefits of smoking cessation?

A
  • reduces risk of smoking-related diseases (e.g. lung cancer, COPD)
  • increases life expectancy
21
Q

What are some withdrawal symptoms of smoking cessation?

A
  • irritability
  • depression
  • restlessness
  • increased appetite and weight gain
  • nicotine cravings
22
Q

What are the risks of smoking during pregnancy?

A
  • maternal DVT and pre-eclampsia
  • preterm birth
  • placenta praevia
  • ectopic pregnancy
  • miscarriage
  • infant mortality and stillbirth
  • birth defects (e.g. cleft lip)

If a patient discloses that they are smoking while pregnant, you should advise the patients of the risks

23
Q

Outline NICE guidance on very brief advice (VBA) for smoking cessation.

A

VBA is given in less than 30 seconds.

  • ask about current and past smoking behaviour
  • provide verbal and written information on the risks of smoking and the benefits of stopping smoking
  • advise the options for quitting smoking including behavioural support, medication and e-cigarettes
  • refer the person to their local stop smoking service (if they wish to stop smoking)
24
Q

How can a patient who does not wish to stop smoking be managed?

A

Offer a harm-reduction approach to smoking:

  • stopping smoking, but continuing to use nicotine replacement therapy (NRT)
  • cutting down before stopping smoking, with or without NRT
25
Q

Which treatment options are available for a person who wishes to cease smoking?

A
  • NHS Stop Smoking Service
  • nicotine replacement therapy (NRT)
  • bupropion
  • varenicline
26
Q

Describe the NHS stop smoking service.

A

NHS provides local stop smoking services, that increase the chances of quitting for good (3x more likely to stop smoking).

They offer one-to-one and group stop smoking sessions that give advice and make it easy and affordable to get stop smoking treatments (e.g. NRT).

27
Q

NRT is available in a choice of formats, including:

A
  • gum
  • inhalator
  • lozenge
  • nasal spray
  • oral spray
  • sublingual tablet
  • transdermal patch (available in 16hr and 23hr preparations)
28
Q

Suggest common side effects to NRT.

A
  • headache
  • dizziness
  • nausea
  • vomiting
  • rash
29
Q

Can NRT be used in pregnancy and breastfeeding?

A

Yes - however smoking cessation without NRT should be tried first.

30
Q

Outline the role of bupropion in smoking cessation.

A

Acts as a selective dopamine and noradrenaline re-uptake inhibitor, working directly on the brain pathways involved in addiction and withdrawal.

Note bupropion should be avoided in women who are pregnant or breastfeeding.

31
Q

Outline the role of varenicline in smoking cessation.

A

Varenicline is a nicotinic receptor agonist, alleviating symptoms of craving and withdrawal.

It also reduces the rewarding and reinforcing effects of smoking by preventing nicotine binding to the receptors.

Note varenicline is unavailable until further notice (NICE, 2022).

32
Q

How safe are vaping devices based upon current evidence (2022)?

A

In the UK, e-cigarettes are tightly regulated for safety and quality. They are not completely risk free, but carry a small fraction of the risk of cigarettes.

The liquid and vapour contain some potentially harmful chemicals also found in cigarette smoke, but at much lower levels.

There have been instances of e-cigarettes exploding or catching fire.

Note that e-cigarettes are not available from the NHS on prescription.

33
Q

Give the BMI ranges of a person who is:

a) healthy weight
b) overweight
c) obesity (I)
d) obesity (II)
e) obesity (III)

A

a) 18.5 - 24.9 kg/m2
b) 25.0 - 29.9 kg/m2
c) 30.0 - 34.9 kg/m2
d) 35.0 - 39.9 kg/m2
e) >40.0 kg/m2

34
Q

What is the recommended daily calorie intake for:

a) male
b) female

A

a) 2500kCal
b) 2000kCal

35
Q

Give some risk factors for obesity.

A
  • excessive food and drink consumption
  • physical inactivity
  • low self-esteem and eating ‘comfort foods’
  • genetic factors
  • PCOS
  • Cushing’s syndrome
  • hypothyroidism
  • medications
36
Q

Obesity is associated with which risks?

A
  • type 2 diabetes mellitus
  • coronary heart disease
  • hypertension / stroke
  • asthma
  • depression
  • cancer
  • GORD
  • reproductive problems
  • osteoarthritis and mechanical back pain
  • breathlessness
  • obstructive sleep apnoea

Note that life expectancy is reduced by up to 10 years in people who are obese.

37
Q

What dietary advice can be given to a person when managing weight?

A

Advise the person to eat a nutritionally balanced diet:
- five portions of fruit and vegetables
- meals based on starchy food (e.g. bread, pasta, rice)
- moderate amounts of milk and dairy (low fat)
- moderate amounts of protein-rich foods (e.g. meat, fish, eggs, beans)

Also advise the person to reduce consumption of foods high in fat, sugar and salt, and cook with methods that reduce fat (e.g. grilling or steaming).

Can also recommend the person reduces alcohol intake.

38
Q

Diets that are recommended for sustainable weight loss are:

A
  • those with a max 600kCal/day deficit
  • reduce calories by lowering the fat content

Do NOT recommend very-low-calorie diets to manage obesity

39
Q

What advice can be given on physical activity when managing weight?

A
  • reduce amount of time being inactive
  • do at least 30 minutes of moderate exercise on 5 days a week (e.g. gardening, brisk walking, cycling)

Advise the patient that they should continue exercising even if it does not lead to weight loss, as exercise has its own health benefits.

40
Q

Which medications can be used to help manage obesity and when is its use indicated?

A

Orlistat can be used to interfere with the digestion of fats (lipase inhibitor), helping to reduce weight.

Orlistat can be prescribed if lifestyle and dietary modifications have been unsuccessful in achieving weight loss and the person is obese.

41
Q

Give the three broad groups of agents that have the potential for misuse.

A
  1. Illegal drugs (ie. those that are regulated by law)
  2. Legal highs (ie. psychoactive substances not regulated by law)
  3. Prescription only medicines
42
Q

Give 5 examples of illegal drugs.

A
  • cocaine
  • ecstasy
  • marijuana
  • heroin
  • LSD
43
Q

Which agents are most commonly abused in adults?

A

Heroin

44
Q

Which agents are most commonly abused in children under the age of 18 years?

A

Alcohol and marijuana

45
Q

Which blood-borne infections are drug misusers at particular risk of?

A
  • hepatitis B (21%)
  • hepatitis C (50%)
  • HIV (3%)

Particular risk if using injectable drugs.

Year 3 - GP (17 decks)

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