W/S 3 + 4

Question 1

What is polypharmacy? Why does it occur?

Answer 1

when a person is taking 5 or more regular medications

occurs due to
- prescribing being the most common healthcare intervention.
- initiation of medicines increasing whilst stopping therapy is limited.

Question 2

What is the difference between appropriate and inappropriate polypharmacy?

Answer 2

appropriate
- when practitioners combine best available evidence and clinical judgement with the patient’s values and preferences, along with an assessment of what is realistic for that individual

inappropriate
- when multiple medicines are prescribed without considering patients’ wishes or ability to take the medicine, where intended benefits are not realised, and where risks of adverse drug reactions (ADRs) and negative outcomes are high

Question 3

What is the prescribing cascade?

Answer 3

occurs when patients have been prescribed medicines to treat the side effects of other medicines, rather than stopping the offending medicine.

Question 4

What are essential medicines?

Answer 4

medicines which are
- fulfilling replacement function
= levothyroxine

• preventing rapid symptomatic decline
  = treatment for Parkinson’s disease or heart failure medications

Question 5

Why are older, frailer patients more vulnerable to ADRs?

Answer 5

due to
- age related changes and pathologies
= changes in cognitive function

• co-morbidity of chronic conditions
• changes in pharmacokinetics and pharmacodynamics
  = renal elimination of medicine is reduced
  = increased sensitivity to certain medicines such as benzodiazepines and opioids

Question 6

What is the difference between hidden and overt non-adherence?

Answer 6

hidden non-adherence
- non-adherence is hidden from medical

overt non-adherence
- medical professionals are aware of non-adherence

Question 7

What is the mechanism of action of tramadol? Why is it not a preferred analgesic?

Answer 7

exists as a racemic mixture consisting of two pharmacologically active enantiomers
- blocks the reuptake of monoamines (serotonin and noradrenaline)
- binds weakly to mu-opioid receptors (agonist), blocking the transmission of pain signals (inhibiting nociceptive signalling) to the brain.

tramadol is a dirty drug as it can bind to many different targets/receptors and has many side effects

Question 8

What is fraility? What are signs of fraility?

Answer 8

increased vulnerability resulting from aging-related physiological decline

signs of fraility
- weight loss, exhaustion, low physical activity, slowness and weakness

Question 9

What are the different routes of giving intravenous medicines? How can they be given?

Answer 9

direct intravenous injection
- administration of a small volume of drug solution into an entry port sited in a vein.

intravenous infusion
- involves IV administration over a longer period often using larger volumes.

they may be given via peripheral or central veins
- peripheral = usually inserted in the hand or arm
- central = are inserted into larger veins such as the superior vena cava

Question 10

What are the types of peripheral intravenous access?

Answer 10

cannula (Venflon)
- cannula is inserted into a vein in the hand or arm and is for short-term use (days)

midline intravenous catheter
- long peripheral intravenous line generally inserted into an arm vein, but the tip of the catheter sits some distance away from where it enters the patient
- requires less frequent site change and is less prone to causing phlebitis

Question 11

What is phlebitis?

Answer 11

inflammation of a vein near the surface of the skin.

Question 12

What are the types of central intravenous access?

Answer 12

short term access
- achieved by a multi-lumen central line with separate lumens running the length of the catheter

longer term access
- peripherally inserted central catheter (PICC)
= is intended to stay in place for long periods (months)

• totally implantable devices (portacath)
  = are implanted beneath the skin somewhere on the chest wall in a pocket of skin
• tunnelled and cuffed central catheter (Hickman line)
  = inserted into the body at a site on the chest wall and is tunnelled under the skin until it reaches the neck

Question 13

What are the advantages of central administration over peripheral?

Answer 13

irritant or vasoconstrictive drugs can be given more safely because of the wide diameter of the vein and the faster blood flow

Question 14

Why do administration lines need to be flushed? When should flushing occur?

Answer 14

to prevent potentially incompatible drugs from mixing and to prevent the line from blocking

intravenous lines must be flushed before and after the administration of medicine

should also occur at the end of surgical procedures to ensure that peri-operative medicines such as anaesthetics are not left in the line when the patient returns to the ward.

Question 15

What are infusion devices? How do they work?

Answer 15

an ‘infusion device’ is used to propel the drug from its container (i.e., infusion bag, syringe, or bottle) to the patient.

fall into 2 groups; those that use gravity and those that use an electromechanical pump

Question 16

What is extravasation? What is its effects?

Answer 16

occurs when a medicine leaks from a blood vessel and causes injury to the surrounding tissue

adverse consequence depends on whether the medicine is classed as
- an irritant, meaning it can cause inflammation but not necrosis
- a vesicant, which means it can cause irritation, vascular ulceration, and necrosis

if a non-irritant medicine leaks from a blood vessel this is called infiltration.

Question 17

What kind of medicines cannot be crushed for administration through a nasogastric tube?

Answer 17

not all medicines may be crushed, and these include modified release or enteric coated tablets and cytotoxic agents (methotrexate)