Week 12: Clinical Decision Making Flashcards
What is clinical decision making? (1)
Being able to use various resources and possess experience/knowledge to help you make a good decision in order to provide safe care.
What essential skills do you need to make a reasonable decision? (4)
Info. gathering and knowledge
Evidence based + critical thinking (reflecting on experience)
Good communication
Team Working
What information do we need to know when performing a thorough history taking? (6)
- Patient details
- Presenting Complaint (PC)
- Hx presenting complaint (HPC)
- Past Medical History (PMH)
- Drug Hx and allergies
- Biochemistry/clinical test results.
What is a pharmaceutical problem? (2)
Related to a medical issue.
Appropriate/optimal treatment of a disease state.
- Prophylaxis
- Symptom control
- Risk/benefit decisions
How do we know it’s a pharmaceutical issue? (3)
Consider:
- S/s of px
- What do the test results show? (Abnormalities?)
- Is there any add. info. needed?
What are the possible solutions for a pharmaceutical problem? (6)
Review current tx:
- Rationalise (deprescribe?)
- Correct dose, frequency/timings
- Duration
- Interaction/C/i.
- Environment
What factors do you need to consider when making a decision? (4)
- Patient safety (paramount)
- Conjunction with patient/team
- Document accurately and clearly
- Explain and justify reasons for actions.
What is the main interaction between citalopram and tramadol? (1)
Tramadol + SSRI antidepressant = Serotonin syndrome (increases seizure threshold)
Explain the interaction between Citalopram and Tramadol. (1)
Tramadol + SSRI antidepressants inhibits serotonin reuptake = Increases serotonin (5HT) levels.
What is Serotonin syndrome? (1)
Levels of 5HT increases in the CNS.
What are the signs and symptoms of serotonin syndrome?
- Changes in mental state.
- Autonomic hyperactivity (tachycardia, diarrhoea )
- Neuromuscular abnormalities (hyperreflexia)
Explain the appropriate actions to take for SSRI + NSAIDS and SSRI + Tramadol.
SSRI + Tramadol = avoided or use with caution
SSRI + NSAIDs = Increases GI bleeding risk (okay for short-term, not for long-term)
What is the reference range for Lithium? (1)
0.4-1mmol/L
If the patient’s lithium levels are low, what actions should be taken? (2)
- Check compliance.
- If compliant, dose change.
Why does a patient prescribed lithium need their thyroid function testing regularly? (2)
Lithium can induce thyroid disorders = TFTs checked every 6 months.
What counselling should a px prescribed lithium receive? (3)
- Regular monitoring is considered = TFTs every 6 months etc.
- Maintain adequate fluid intake (dehydration = reduces renal blood flow. Hence reduces renal excretion)
- Avoid diet changes which can reduced or increase sodium intake. (Lithium toxicity worsens on low sodium)
Why is Lithium a high risk drug? (2)
- Lithium is a narrow therapeutic index drug (high risk drug)
What lithium level is considered toxic? (1)
> 1.5mmol/L
What drugs can interact with lithium? (2)
Affects renal function (ACEI, Diuretics, NSAIDs)
Can cause sodium depletion (Thiazide diuretics)
What does the QT interval in an ECG represent? (1)
Duration of activation and recovery of ventricular myocardium.
What is the normal range for the QT interval? (1)
0.33-0.44 sec
What does a QT interval of > 0.44 sec indicate? (1)
Myocardial electrical instability - QT prolongation
What are the possible complications for QT prolongation? (3)
- Ventricular Arrhythmias
- Syncope
- Sudden Death
What types of drugs can cause QT prolongation? (3)
- Antipsychotic drugs
- Citalopram/Escitalopram
- Opioids (Methadone)
What is shared decision making? (1)
Patient is involved in the decision making process.
What does shared decision making comprise of? (3)
Risks, monitoring and informing px.
Giving info.
Listening to patient.
What do you always need to do when it comes to making decisions? (3)
Reflect on decision made
Ensure adequate monitoring, follow-up and support is in place.
Be prepared to review your decision at a later date.
