Social science Flashcards
Analgesia in pregnancy
- Paracetaml is safe throughout pregnancy
- NSAID’s i.e. ibuprofen shouldn’t be used in the third trimester
- Codeine is the weak opioid of choice in pregnancy, best not to use opioids in the end of pregnancy as can cause neonatal respiratory depression
- Avoid analgesic doses of aspirin in the last few weeks of pregnancy can be teratogenic
- Try and avoid opioids in the first trimester
High quality patient information
RCOG patient information, NHS Choices or patient information which has achieved the Information Standard
Vulnerable people
- Pregnant women
- LGBT people
- Long term unemployed or precarious work
- Prisoners
- Drug or alcohol dependency
- Non English speakers
- Homeless people
- Children
- BAME ethnicity
- Disabled people
- Migrants, refugees, asylum seekers
- Chronic physical/mental illness
- Malnourished
- Elderly people
- Sex workers
Symptoms of physical abuse
Cuts, scrapes and bruises, wounds, fractures, lost teeth, sexually transmitted diseases, unwanted pregnancy. Also non-specific symptoms like GI problems, gynaecological problems, chronic pain and seizures.
Symptoms of social abuse
financial dependence on partner, impact on work, isolation from support networks, homelessness, impact on ability to parent child, impact on ability to make decisions, abuser attends appointments so harder to disclose.
Symptoms of psychological abuse
emotional distress (low self esteem), depression, anxiety, suicide, self harm, PTSD, alcohol and substance abuse, eating and sleep disorders.
Treatment for Hyperemesis Gravidarum
- Fluid replacement therapy
- Potassium chloride as excessive vomiting is likely to cause hypokalaemix
- Anti-emetic medications such as cyclizine (first line), metoclopramide or prochlorperazine. Ondansetron or domperidone may be used in severe cases.
- Thiamine and folic acid to prevent development of Wernicke’s encephalopathy
- Antacids to relieve epigastric pain
- Thromboembolic (TED) stockings and low molecular weight heparin as there is increased risk of venous thromboembolism.
Epithelial ovarian tumours
- Originate from the epithelium which lines the fimbria of the fallopian tubes or the ovaries
- Epithelial tumours are partially cystic, and the cysts can contain fluid
- The initial metastatic spread typically involves the peritoneal cavity, with seeding particularly affecting the bladder, paracolic gutters and the diaphragm
- Around 90% of ovarian cancers are epithelial ovarian tumours.
Germ cell tumours (ovarian)
- Originate from the germ cells in the embryonic gonad
- These tumours typically grow rapidly and spread predominantly via the lymphatic route
- Germ cell tumours most commonly arise in young women, which is atypical for most cases of ovarian cancer
- Tumour markers include alpha-fetoprotein and sometimes beta human chorionic gonadotrophin (B-HCG).
Sex cord stromal tumours (ovarian)
- Originate from connective tissue
- They are rare, making up less than 5% of all ovarian tumours. They are malignant tumours, but are much less aggressive than epithelial tumours
- Additionally, ovarian cancer can be secondary to another cancer elsewhere, which has metastasised to the ovary. A Krukenberg tumour refers to a “signet ring” sub-type of tumour, typically gastrointestinal in origin, which has metastasised to the ovary.
What happens if the women trying to conceive is not immune to rubella And alcohol consumption when trying to conceive
Give the vaccine then wait one month before trying to conceive
No more than 2 units per week for women
No more than 3/4 units per week for men
When is the OGGT done and the anti-D injections given
OGGT: Ideally 26 weeks (24-28)
Anti-D: 28 and 34 weeks
When are women screened for anaemia
Booking bloods
28 week gestation
Pre-eclampsia medication
- In critical care for severe pre-eclampsia: IV hydralazine
- For mother: Enalapril (1st line), Nifedipine or amlodipine (1st line in African/Caribbean)
- Eclampsia: Magnesium sulfate IV, Hydralazine IV
Antibiotics given in maternal sepsis
Pipercillin + tazobactam
OR
Amoxicillin + clindamycin + gentamycin
MBRRACE UK
Where all stillbirths are reported to
Helps increase mother and babies health through confidential enquiries
Stillbirth medication
Suppress lactation- Dopamine agonists i.e. cabergoline
Induction of labour- oral mifepristone and vaginal/oral misoprostol
Approaches to reducing prescribing error
- Expanding professional roles: use more pharmacists
- Education roles: prescribing safety assessment introduced to the MBBS course
- Using computerised roles: prescribing mostly done online, integrated into patients medical records
Medication error definition
Medication errors are any incident where there has been an error in the process of: prescribing, dispensing, preparing, administering, monitoring or providing medicines advice regardless of whether any harm occurred or was possible.
