week 1 Flashcards
what is a fit note for?
- free of charge
- statement for fitness to work advising either
a) not fit for work
b) you may be fit for work taking account certain pieces of advice
when does a fit note need to be issued
when an individual has been off work for more than 7 days
can altered hours be stated as a request for a patient issued with a fit note
yes
palliative management of anorexia
dexamethasone
palliative management of pruritus
cholestyramine
palliative trx muscle spasms
baclofen
palliative trx insomnia
temazepam
palliative trx hiccups
metoclopramide
palliative trx dyspnoea
morphine
palliative trx restlessness
haloperidol
palliative trx excessive resp secretions
hyoscine hydrobramide
palliative trx capillary bleeding
tranexamic acid
4 basic principles of end of life care
- autonomy
- beneficience
- non maleficence
- justice
time definition of end of life
person likely to die within next 12 months
1st line management of delirium tremens
oral lorazepam
presentation of delerium tremens
tachycardia, HTN, pyrexia
when does delerium tremens occur
1-2 days following cessation of alcohol
other signs of alcohol withdrawal
- n+v
- headache
- tremors
- extreme sweating
- hallucinations
- agitation/anxiety
during what period is alcohol withdrawal symptoms worst
first 48 hours
peak incidence of alcohol withdrawal seizures
36 hours
peak incidence of delirium tremens
48-72 hours
symptoms of delirium tremens
- seizures
- hallucinations
- coarse tremor
- confusion
- fever
- tachycardia
cause of wernicke’s encephalopathy
thiamine deficiency
offer thiamine to…. (4)
- those at high risk of wernickes encephalopathy
- are malnourished
- decompensated liver disease
- in acute withdrawal
2 supplementations during alcohol withdrawal
thiamine + folic acid
why is folic acid required in alcohol withdrawal
alcohol affects the bodys ability to absorb folate
where is alcohol detoxification carried out
undertaken by specialist community alcohol services
- in patient, or
- close supervision at home
treatment for alcohol withdrawal
benzodiazepine regimen: chloorodiazepoxide
therapy for alcohol dependancy (4)
- self help groups: AA
- 12 step facilitation therapy
- CBT
- family therapy
4 medications for alcohol dependancy
- acamprosate
- disulfiram
- naltrexone
- nalmefene
mechanism of acamprostate and how long advised course
- weak NDMA antagonist
- 6 months course
promotes abstinence if you are concerned you may have a relapse
Disulfiram
mechanism of disulfiram
prevents you drinking by causing an unpleasant reaction when you do drink
- nausea
- chest pain
- vomiting
- dizziness
what must you warn patients about when starting disulfiram
May have reaction to other alcohol containing things such as perfume, mouthwash, aftershave
blocks opioid receptos
- Naltrexone
- Nalmefene
lower back pain red flags (6)
- age <20
- age >50
- hx previous malignancy
- night pain
- hx trauma
- weight loss
- fever
gradual onset of unilateral/bilateral pain with numbness, weakness; worse on walking.
- pain resolves sitting down
- diagnosed by MRI
spinal stenosis
causes of spinal stenosis (3)
- tumour
- disc prolapse
- degenerative changes
Management of disc herniation/prolapse
- NSAIDs
- PPI protection
- exercise programme
- manual therapy
- epidural injections of local anaesthesia + steroids
what tool do GPs use as a prognostic questionnaire to help identify modifiable risk factors for back pain
STarT tool
presentation of lumbar muscle sprain/strain
- muscle spasms on movement
- lasting < 30 minutes
- aggravated by movement
- usually lasts 2-4 weeks
- saddle anaesthesia
- urinary/faecal incontinence
- bilateral sciatics
cauda equina
spinal cord compression presentation
- gradual onset
- aching night pain
- localised spinal tenderness
- worse with coughing/straining
infection e.g. spinal epidural abscess
- fever
- TB
- recent UTI
- HIV infection/immunosuppressed
causes of lumbar spinal stenosis
- tumour
- disc prolapse
- degen changes
easier to walk uphill than downhill
lumbar spinal stenosis
management of lumbar spinal stenosis
- laminectomy
common side effects of Metformin
- Abdo pain
- anorexia
- diarrhoea
- nausea
- taste disturbances
- vomiting
rarer side effect of metformin
decreased B12 absorption
