Week 1 and 2--Notes Flashcards
1
Q
what are the components of whole blood
A
packed red cells
platelets
frozen plasma and cryoprecipitate
(FP can also be further separated into immunoglobulins, albumin, factor concentrates)
2
Q
what is cryoprecipitate
A
plasma enriched in fibrinogen, vWF, but deficient in other factors
3
Q
indications for pRBC transfusion
A
- symptomatic anemia
- severe acute anemia with signs and symptoms or ongoing bleeding
- significant obstetric or traumatic hemorrhage
- as per anesthesiologist comfort
4
Q
contraindiations for pRBC transfusion
A
not generally used for:
- compensated patients with chronic anemia
- patients with iron deficiency anemia
- asymptomatic anemia
- mild anemia of any cause
5
Q
indications for platelet transfusion
A
thrombocytopenia or dysfunctional platelets and bleeding (or bleeding risk)
6
Q
contraindications for platelet transfusion
A
useless in ITP
dangerous in TTP, HUS, HITT, DIC/MAHA
7
Q
indications for plasma transfusion
A
- factor replacement (i.e best for urgent multifactor replacement) i.e vitamin K deficiency, warfarin overdose, DIC, liver failure
- coagulopathy NYD in a preoperative patient
(3. trauma)
8
Q
contraindications for plasma transfusion
A
not generally used for single factor replacement
9
Q
indications for cryoprecipitate transfusion
A
fibribogen replacement
10
Q
contraindications for cryoprecipitate transfusion
A
should not be used for haemophilia A in Canada
11
Q
when should patients with the following platelet count be transfused?
more than 100
A
never
12
Q
when should patients with the following platelet count be transfused?
50-100
A
patients who are actively bleeding
neurosurgery patients preoperatively
13
Q
when should patients with the following platelet count be transfused?
10-50
A
preoperative patients
other patients at high risk for bleeding
14
Q
when should patients with the following platelet count be transfused?
less than 10
A
basically everyone
15
Q
why should you NOT transfuse platelets in ITP
A
transfusion is USELESS because transfused platelets will be destroyed as fast as the patients own platelets are destroyed therefore no increase in platelet count
16
Q
why should you NOT transfuse platelets in TTP, DIC etc
A
transfusion is DANGEROUS because platelets are pathologically activated in the circulation before being cleared by the spleen–> can cause pathological thrombosis–> adding more platelets increases this risk
17
Q
what is the overarching theme for who needs transfusion
A
when you need higher oxygen capacity in the patient
18
Q
when should you transfuse the patient with the following HgB value?
100 or above
A
no transfusions
19
Q
when should you transfuse the patient with the following HgB value?
less than or equal to 80
A
consider for post surgical, the stable hospitalized patient with cardiac disease, and SYMPTOMS OF ANEMIA
20
Q
when should you transfuse the patient with the following HgB value?
less than 70
A
consider for adult ICU patient who is stable
pediatric ICU patient who is stable
21
Q
when is platelet transfusion dangerous
A
TTP
DIC
HUS
HITT
22
Q
should you use plasma for fluid resuscitation
A
no
23
Q
what are 3 indications for plasma replacement
A
liver failure with multifactor deficiency
DIC
trauma induced coagulopathy
24
Q
is plasma the product of choice for urgent warfarin reversal
A
no
but can still be used if dont have access to prothrombin complex concentrate (“octoplex”)
25
which blood group is the universal donor
O
no A or B antigens on the RBCs
26
which blood group is the universal recipient
group AB
no antibodies to RBC antigens
27
what are the Rh antigens
D, C, c, E, c
Rh antibodies can be involved in hemolytic transfusion reactions (usually caused DELAYED HEMOLYTIC transfusion reactions)
patients only develop anti-D antibodies if they are without D and have been exposed to D+ cells ie through pregnancy or transfusion
28
which is the most common blood group
O
| then A, then B, then AB is most rare
29
what do we get concerned about with transfusions in female patients
hemolytic disease of the newborn is more common than hemolytic transfusion reactions--> get concerned about giving Rh compatible cells to female patients
30
list some of the other antigen families
```
duffy
kidd
kell
MNS
lutheran
lewis
```
all have antigens from these families on our RBCs, only develop antibodies if transfused or pregnant
in general these are less clinically significant than ABO or Rh
31
why do we do pretransfusion testing
ensures the right product for the right patient
prefer to give ABO and Rh matched RBCs whenever possible
32
what are the pretransfusion tests
group, screen, crossmatch
33
what is the screen pretransfusion test
AB screen
negative--> no antibodies against AB antigens
positive--> there are antibodies to antigens--> must do extended antibody panel to determine which
34
what is the group pretransfusion test
ABO/Rh group
35
what is the crossmatch pretransfusion test
checking the unit against the patient to ensure compatibility
trying to match any antigens on the unit's RBCs with any anti-RBC antibodies in the patients serum
electronic crossmatch--> group compatibility check, performed if no clinically significant Ab in patient
full ("wet") crossmatch--> mix patient serum unit RBCs to show there is no Ab-Ag reaction
36
how long does the group and screen take
30 min
37
how long does the electronic crosmatch take
15 min
38
how long does the antibody panel take
2-3 hours
39
how long does the wet crossmatch take
20-30 min
40
when do you order a group and screen
order for ANYONE who gets a transfusion or if patient MIGHT need a transfusion
41
what does ordering a crossmatch mean
asking for RBCs to be set aside specifically for this patient
need to specify number of unit of RBCs
units are set aside in separate fridge, labelled with patients name, would be immediately available if needed
order if patient will likely need transfusion in next couple days
42
what do you need to write when you order blood
component, volume, rate, other (consent, age, volume status, CV status, reasons for transfusion)
43
what are the standard durations for RBCs, platelets, plasma, cryo
RBC--3-4h per unit
platelets--1-2hours per dose
plasma 1-2h per unit
cryo--just run it in
44
max duration for any transfusion
4 hours
45
what should you do if you need blood in an emergency
communicate clinical urgency to transfusion medicine lab
allows TML staff to better prioritize testing
sometimes better to give blood NOW that is "probably safe" then wait and give "almost definitely safe" blood later
1st choice--group specific blood that has been crossmatched
2nd choice--group specific blood not crossmatched
3rd choice--O- blood not crossmatched (Rh negative especially important for women of childbearing age, can provide O+ for men and post menopausal women in emergencies)
46
what does ABO incompatibility cause in transfusion med
acute hemolytic transfusion reaction (AHTR)
one of two leading causes of death related to transfusion
47
in which patients do you need to be careful about volume overload with transfusion
older age
infants
hx CV disease
*consider PROPHYLACTIC DIURETIC
48
what is the risk of the following transfusion reaction?
| any reaction to RBC transfusion
0.6%
| severe is 0.04%
49
what is the risk of the following transfusion reaction?
| overall reaction to platelet transfusion
11%
| severe is 0.1%
50
what is the risk of the following transfusion reaction?
| urticaria
1/100 transfusions
51
what is the risk of the following transfusion reaction?
| anaphylaxis
1/1600 transfusions
52
what is the risk of the following transfusion reaction?
| fever
1/300 transfusions (febrile non hemolytic transfusion reaction)
53
what is the risk of the following transfusion reaction?
| TRALI (transfusion related acute lung injury) or bacterial sepsis
1/10 000 transfusions
54
what is the risk of the following transfusion reaction?
| wrong blood transfused
1/14000
55
what is the risk of the following transfusion reaction?
| fatal hemolytic reaction
1/600 000
56
HIV risk
1/21 million
"more likely to die of a lightening strike in Canada then get HIV from a transfusion
that means human error is more likely to cause problems than the actual blood product
57
what are the types of transfusion reactions
acute vs delayed
immune vs non immune
58
what are the acute transfusion reactions
anything within 24 hours
usually bacterial infections
59
what are the delayed transfusion reactions
after 24 hours
often viral
60
what should you think of or rule out in a patient who has received a transfusion and is showing the following symptom:
urticaria or itching
anaphylaxis or allergic
61
what should you think of or rule out in a patient who has received a transfusion and is showing the following symptom:
fever
febrile non hemolytic
acute hemolytic
TRALI (tho usually presents more with SOB than fever)
sepsis
62
what should you think of or rule out in a patient who has received a transfusion and is showing the following symptom:
hypotension
anaphylaxis
AHTR
septic shock
less likely is TRALI
63
what should you think of or rule out in a patient who has received a transfusion and is showing the following symptom:
anxiety, pain, red urine
AHTR
*there are historical accounts of patients saying "something feels wrong" while getting a transfusion and they end up having AHTR
64
what should you think of or rule out in a patient who has received a transfusion and is showing the following symptom:
SOB or hypoxia
transfusion associated circulatory overload
TRALI
transfusion associated dyspnea
*signs of common and non severe reactions overlap with life threatening ones so ASSUME THE WORST
65
what should you do if you suspect a transfusion reaction
1. STOP the transfusion
2. GO TO THE PATIENT--cannot manage a transfusion reaction over the phone--> dont transfuse in the middle of the night because then you wont have help if theres a problem
66
when should you suspect bacterial contamination or transfusion associated sepsis
fever above 39 + sx like hypotension, tachy, nausea, vomiting, dyspnea, temp unresponsive to Rx
more likely associated with PLATELETS than RBCs
do NOT restart transfusion
tell the lab to culture the bag but also do blood cx on patient and start broad spectrum abx
67
when should you suspect febrile nonhemolytic transfusion reaction
no clinical consequence but must rule out other causes
do NOT restart transfusion
(may also be fever unrelated to transfusion)
68
when should you suspect AHTR
fever + hypotension + hemoglobinuria/emia (from lysed RBCs) + vomiting + bleeding from puncture sites
sx--chills, feeling of apprehension etc
almost always due to ABO incompatibility and usually results from failure in patient ID or lab process
less likely due to mechanism or thermal injury to RBCs prior to or during transfusion
69
how do you manage AHTR
1. STOP transfusion, REMOVE the bag
2. assess vitals, give IV fluid support
3. CALL SENIOR RESIDENT OR STAFF ASAP--do not manage this alone as a junior as patients often end up in ICU
4. confirm patient identity
5. send blood sample down ASAP
6. treat hypotension and prevent ATN--crystalloid at 3L/m2 daily
70
when should you suspect TRALI
generally present with SOB but should also consider bronchospasm, TACO
71
when should you suspect TACO
non productive cough, dyspnea, tachy, pulm edema, hypertension, raised JVP
must prevent in at risk patients
72
What are the two different scales used for EBM
1. levels A-D
| 2. Levels I-V
73
what do each of the levels A-D represent for EBM
A--> consistent randomized, controlled trial, cohort, "all or none" trials; clinical decision rule validated in different populations
B--> consistent, retrospective cohort, exploratory cohort, ecological studies, outcomes research, case control studies or extrapolations of level A studies
C--> case series or extrapolations from level B studies
D--> expert opinion without explicit critical appraisal or based on physiology, bench research or first principles
74
what do the levels I-V represent for looking at EBM
I--> evidence is based on RCTs or meta analyses of such trials of adequate size to ensure a low risk of incorporating false positive or false negative data
II--> evidence is based on RCTs that are too small to provide level I evidence --may show either positive trends that are not statistically significant or no trends and are associated with a high risk of false negative results
III--> evidence is based on non randomized controlled or cohort studies, case series, case control studies or cross sectional studies
IV--> evidence is based on the opinion of respected authorities or expert committees as indicated in published consensus conferences or guidelines
V--> evidence is based on the opinions of those who have written and reviewed the guidelines, based on their experience, knowledge of the relevant literature and discussion with their peers
75
what are the two types of overall study design
experimental vs observational
76
describe experimental study design
randomized controlled trials (randomization equalizes confounders) --> RCTs can have tests of significance (i.e p values)
offers cause and effect information
can also include meta analyses or systematic reviews--> can look at combined odds ratios and relative risk
77
describe observational study design
observational studies do NOT answer questions based on cause and effect, they can show ASSOCIATIONS however
have increased biases relative to experimental designs
78
what is bias in study design
any systematic error in the design, conduct or analysis of a study that results in a mistaken estimate of an exposure's effect on the risk of disease
i.e selection bias, information bias, confounding
79
how is a cohort study designed
looks at exposure--> disease (retrospective or prospective)
two or more groups are assembled that differ based on exposure
you then follow individuals and monitor outcomes --> i.e follow exposed and non exposed individuals and monitor outcomes
(vs ecological studies that look at group level exposure and outcomes)
80
how is a case control study designed
looks at disease--> exposure
identify people with a disease and look back for the exposure
i.e do all individuals with cancer (case) have the same exposure as those without cancer (control)
81
how are cross sectional studies designed
exposure and disease are measured together at one point in time in a group
informs prevalence
82
how are case series studies designed
multiple cases
meant to inform regarding disease and exposure (i.e SARS)
83
how do you evaluate new diagnostic tests
"new" diagnostic tests need to be assessed against an alternative/ "the gold standard"
multiple summary measures can be easily calculated by creating a 2x2 table of results from both the new and the gold standard test
i.e "gold standard" along the top, with + and - results and "new" test along the side with + and - results
AB
CD
where A is + for both tests, B is - gold standard, + new, C is + for gold and - new, and D is - for both
then calculate sensitivity and specificity
84
what is sensitivity
of those with the disease (according to the gold standard test) how many tested positive in the new test
85
what is specificity
of those without the disease in the gold standard test, how many tested negative in the new test
86
how do you calculate prevalence
A+C/(A+B+C+D)
87
how do you calculate sensitivity
true positive/(true positive + false negative)
A/A+C
88
how do you calculate specificity
true negative/(true negative + false positive)
D/B+D
89
what is a likelihood ratio and how do you calculate it
LR+ tells you how much the odds of the disease increase when a test is positive
= sensitivity/(1-specificity)
LR- tells you how much the odds of the disease decrease when a test is negative
= (1-sensitivity)/specificity
90
how do you calculate pre test odds
prevalence/(1-prevalence)
91
how do you calculate pre test probability
pre test odds / (pre test odds +1)
92
what is another way to determine pre and post test odds
likelihood ratio normograms
93
how do you evaluate a new treatment/therapy?
use relative risk reduction, absolute risk ratios and number needed to treat to discuss the measurement of a treatment effect
also use a 2x2 table for a therapeutic intervention
have outcome along the top, with + and -
have therapy along the side, with control and treatment
+ -
control a . b
treatment . c . d
outcome rate control = a/a+b
outcome rate tx = c/c+d
94
what is relative risk reduction
the difference in outcomes between the treatment and control groups expressed as a proportion of the outcome rate in the control
calculate control event ratio and treatment event ratio then express as a proportion
```
CER = a/a+b
EER = c/c+d
```
RRR = CER-EER/CER
or--> relative risk = EER/CER
and RRR = 1-relative risk
95
what is absolute risk reduction and how do you calculate it
absolute risk reduction is the arithmetic difference in. outcome rates
CER-EER
96
what is the number needed to treat and how do you calculate it
useful way to quantify the effects of an intervention
| = 1/ARR
97
define epidemiology
the study of patterns of health and illness and associated factors at the population level
98
define clinical epidemiology
patient level research, examines intervention effect on individual patient outcome
99
define incidence
rate of occurrences of new cases--> measure of RISK of developing some new condition within a specified time frame
100
define prevalence
measure of the total number of cases of disease in a population --> how widespread is the disease?
101
define pain
unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
102
define nociceptive pain
initiated by stimulation of nociceptors which are peripheral nerve fibres (A delta and C fibres) that respond only to stimuli approaching or exceeding harmful intensity
103
define central sensitization
increased response to stimulation that is mediated by amplification of signaling in the CNS
104
examples of conditions causing:
| acute nociceptive pain
fracture, burns, surgery
105
examples of conditions causing:
| acute neuropathic pain
lacerated nerve, herpes zoster
106
examples of conditions causing:
| chronic nociceptive pain
arthritis, headaches, back pain
107
examples of conditions causing:
| chronic neuropathic pain
amputation, post herpetic neuralgia, stroke/SCI
108
how do you test for allodynia
cotton swab against skin
109
how do people usually describe:
| somatic nociceptive pain
```
throbbing
aching
sharp
gnawing
constant
```
(i.e burn, sprained ankle)
110
how do people usually describe:
| visceral nociceptive pain
```
dull
cramping
squeezing
deep
aching
```
i.e bowel obstruction
111
how do people usually describe:
| neuropathic pain
burning, shooting, tingling, electric, decreased sensation
i.e GBS, diabetic neuralgia
112
describe the process of peripheral sensitization
injury--> release of proinflammatory mediators (bradykinin, substance P, prostaglandins, serotonin etc) and site of injury --> reduces threshold for activation of nociceptors
nociceptors are thus stimulated to fire--> activates immune cells and sympathetic terminals to release further pain generating substances--> positive feedback to increase nociceptive input to spinal cord
113
how does peripheral pain sensitization manifest
wheal and flare response--> erythema, swelling, warmth
114
what is primary hyperalgesia
pain and sensitivity of normal tissue surrounding injury and injury site itself
115
what is the purpose of primary hyperalgesia
to protect and heal
is adaptive
decreases as injury heals
116
describe the process of central sensitization
describes the increased response to stimulation that is mediated by amplification of signalling in the CNS
alterations in the excitability of spinal cord neurons to a variety of normal inputs following peripheral tissue damage or irradiation
mediators include chemicals released from central terminals of primary afferents like substance P, NMDA receptors etc
facilitates pain transmission, prolong stimulus, widens field of pain
117
how does central pain sensitization manifest
secondary hyperalgesia--> increased response to a painful stimulus
signalling is via sensitized A delta and C fibres
118
list physical agents that can be used to treat pain
```
thermotherapy
hydrotherapy
electrotherapy
light therapy
manipulation and mobilization
traction
massage
acupuncture
```
119
what are the goals of physical agents to treat pain
resolve inflammation
activate temporary analgesia
change nerve conduction
provide counter-irritant
modify muscle tone and collagen extensibility
modify CNS
120
what are two interventions that can be used for sympathetically mediated pain
i.e complex regional pain syndrome
can use sympathetic nerve blocks or bier blocks
can use IV infusions of lidocaine or ketamine
121
where should the ETT be placed on CXR
at least 3 cm above the carina
122
when should you use CT with contrast
inflammation
neoplastic
vascular
traumatic pathology
123
what are you seeing when you describe "ground glass opacity" on CXR
increased density that does NOT obscure vessels
can also be seen in CT
124
what does ground glass opacity on CXR or CT indicate
active disease--interstitial and alveolar process
i.e PE, PCP, ARDS, hypersensitivity pneumonitis, drug induced, pulmonary edema
125
what are you seeing when you describe consolidation on CXR
increased density that DOES obscure vessels
usually pneumonia
if at R heart border, likely a right middle lobe process
if at LV border, likely a L lingular process
126
when should you use MRI
superior to CT for soft tissue characterization
primarily a staging modality in the chest
127
what is the first line imaging for the heart
U/S
can also localize pleural effusions
128
what heart structure sits against the sternum in CXR lateral view
R ventricle
129
how do you assess the following aspect of a CXR:
| technique and quality
rotation--> spinous processes should be equidistant between the medial heads of the clavicles
inspiration--> dome of the right hemidiaphragm below or at the R 10th interspace
exposure--> lower thoracic disc spaces should be seen behind the heart
130
how do you assess the following aspect of a CXR:
| chest wall and soft tissues
cervical ribs can be associated with thoracic outlet
131
how do you assess the following aspect of a CXR:
| abdo
look for free air
132
how do you assess the following aspect of a CXR:
| diaphragm
look for clear edges/effusion
133
what do you see on CXR in:
| subcutaneous emphysema
see muscle fibrils of pec major because the air is between them
lucent axilla
134
what do you see on CXR in:
| hydropneumothorax
gas and effusion in pleural space
135
what do you see on CXR in:
| cavitating lesion
fissure is moved superiorly because of loss of volume
ddx TB, lung malignancy
136
what do you see on CXR in:
| reactivation of TB
fibronodularity in apices of the lung
137
how do you diagnose tension pneumo
clinically
elevated JVP
decreased breath sounds
hyperresonance
trachea toward opposite side
138
treatment of tension pneumo
emergency decompression with angiocatheter into the 2nd intercostal space at the MCL
can also do tube thoracostomy at 5th or 6th rib along midaxillary line
139
what is the mainstay of cardiac imaging
TTE
provides anatomic and functional info
can measure degree of regurg, volume of compartments, wall motion, motion of heart valves, congenital defects, ejection fraction etc
140
when do you use nuclear medicine in cardiac imaging
for functional assessment
MIBI scans--> asses myocardial viability/ischemia
141
what is the best non-invasive test to exclude or detect CAD
CT angio
| if high probability of CAD then go straight to coronary angio in the cath lab
142
how does cardiac MRI compare to TTE and nuclear med scans
better than U/S for motion and EF
better than MIBI for ischemia /viability
143
what conditions are associated with pectus excavatum
marfans
mitral valve prolapse
ehlers danlos
144
what conditions are associated with pectus carinatum
congenital abnormalities like VSD, downs
145
what do you see on CXR in: pulmonary edema
cephalization of blood flow
kerley B lines
airspace edema
pleural effusion
146
when should you consider a trach for someone who is intubated
if need airway support or ventilation for over 1-3 weeks
147
what are thoracostomy tubes
placed into pleural space to drain fluid (pus, blood) or air (pneumothorax)
all about patient position--> if the patient is supine, the air will be anterior and fluid posterior
148
where do you place an NG for decompression? for feeding?
decompression--antrum
feeding--proximal small bowel (post pyloric)
149
what is the reason for inserting a CVC
measure central venous pressure, administer large volumes of fluid, or admin medications
150
where is the ideal position for a CVC
distal SVC--> in the proximal RA
*arrhythmias can be triggered if in RA/RV
151
what is a swan ganz catheter
measures PCWP --allows differentiation of causes of edema
152
where is the ideal location of a swan ganz catheter
R or L pulmonary artery "within the mediastinal shadow"
*going too far can cause infarction or vessel rupture
153
where are cannabinoids found
in the resins produced by the marijuana plant
154
what are cannabinoids
a family of complex molecules (both synthetic and natural) that bind to cannabinoid receptors in the brain and on immune cells
155
name the exogenous cannabinoids
1. THC
2. cannabidiol (CBD)
3. nabilone--synthetic cannabinoid
156
what is THC
main PSYCHOACTIVE compound derived from marijuana
percentage of THC depends on the strain of the plant and growing conditions
157
what is CBD
NOT psychoactive
thought to have other medicinal properties like anti-cancer, anti-inflammatory etc
158
name the endogenous cannabinoids
1. anandamide (AEA)
2. 2-arachnidonyl glycerol (2-AG)
3. palmitoyl ethanolamide (PEA)
AEA and 2-AG are the most common endogenous forms and are found throughout the brain
they are synthesized from membrane phospholipids and act locally at the synaptic junction then are degraded
159
name the 3 cannabinoid receptors
1. CB1
2. CB2
3. ?CB3
160
what does CB1 do
found widely in the CNS and also in parts of the PNS
NOT found around the respiratory centres of the CNS
161
what does CB2 do
found mostly on immune cells like mast cells, macrophages, microglia and astrocytes
162
what do cannabinoids do?
act on the presynaptic terminal to decrease the excitability of the presynaptic neuron--> "synaptic circuit breaker"
modulate neuronal activity at multiple points;
- spinal cord level
- subcortical brain level
- cortical brain level
- peripheral nerve level
163
how quickly are smoked cannabinoids absorbed
rapidly diffuse into the blood stream and enter the CNS within minutes
ingested are much less bioavailable (25-30%) due to first pass metabolism by liver --> need 0.5-2 hours longer for onset of effect with ingested
once in the bloodstream, are widely distributed as they are very lipid soluble
164
what is nabilone
synthetic cannabinoid that comes in a PO capsule
very potent CB1 agonist
currently approved for chemo induced nausea and vomiting
also shown positive results in studies on pain control in fibromyalgia
NOT detected in UDS
poor street value
expensive to buy but covered by MSP
165
what is dronabinol
rx cannabinoid
synthetic THC
PO capsule
approved for chemo related nausea and vomiting and HIV/AIDS anorexia
166
what is sativex
THC/CBD oral mucosal spray
formulated to improve mucosal absorption but can still take 1 hour to onset
dosing highly variable between patients and thus must self titrate dose
approved for MS neuropathic pain and cancer related pain
have shown some benefit in improving sleep and RA pain
very expensive
167
other than N/V and pain, what are some other conditions that are being researched as benefitting from cannabinoids?
epilepsy
chronic non cancer pain (arthritis, fibromyalgia)
neuro disorders (ALS, MS, dystonia)
asthma
anxiety, PTSD, depression
168
how effective is smoked marijuana in the treatment of HIV related peripheral neuropathy
NNT 3.6 for 30% reduction in pain
169
what dose is recommended of cannabis for chronic non cancer pain
1g/day
170
cardiac SEs of cannabis
tachy (?related to vasodilation)
postural hypotension
palpitations
vasodilation (red eyes, flushing)
increased risk of MI within 1 hour of use
171
respiratory SEs of cannabis
COPD/bronchitis
lung infections
upper airway CA
172
contraindications for cannabinoids
personal history of psychosis
unstable cardiac disease
schizophrenia
relative contraindication--> family hx of psychosis
173
why do we advice youth to avoid cannabis
can cause functional and structural changes in the developing brain leading to damage
174
what is the position of the CMA on cannabis use
"insufficient scientific evidence available to support the use of marijuana for clinical purposes"
i.e not enough info on dosing, interactions, overall risk and benefits
CMA encourages further rigorous research into clinical use of marijuana
