wk2- history taking Flashcards
format for pain history
NILDOCART
N-nature
I-intensity
L-location
D-duration
O-onset
C-complicating factors
A-aggreviating factors
R- relieveing factors
T- treatment
why is it so important to conduct an effective medical history taking
to determine
-the need for drug or non drug intervention (QUM)- for example maybe theres an interaction thats causing issues and there’s no need to add more or it can be conservatively treated with the same outcomes
- potential drug-disease interactions that might make the condition worse
- potential drug-drug interactions that will interact with current medication making things worse
format for condition history
oldcarts
O = onset
L = location/radiation
D = duration
C = character
A = aggravating factors
R = relieving factors
T = timing
S = severity
PAKASPO
Prescription only meds
Adherence
Knowledge
Allergies
Side effects
Phamarcy medicines
OTC medicines
CHIPES
Creams, lotions, gels
Herbal
Inhalers
Patches
Ear drops/nasal drops
Suppositories
CRIBS
Contraception
Recreational drugs
Internet purchased drugs
Borrowed medication
Substances other (tobacco, alcohol)
clinical features of diabetics
retinopathy- basement membrane thickening of blood vessels causing swelling and leakage (non proliferative and proliferative types)
nephropathy- hyperglycameia causes basement membrane thickening of kidney blood vessels which causes scarring (glomerulosclerosis) reducing GFR
neuropathy- hyperglycameia weakenes the walls of the small blood vessels (capillaries) which are responsible for supplying nerves with oxygen and nutrients
hypoglycaemia- typically due to insulin use and not eating enough, exercising alot or drinking too much alcohol
clinical features of hypothyroidism
bradycardia
weight gain
hair loss
dry skin
cold intolerence
clinical fetures of hyperthyroidism
irritable
sweating
heat intolerence
weight loss
palpitations
goitre
tremors
tachycardia
myxoedema
bulging eyes (graves disease)
OA radiological findings
subchondral bone sclerosis
uneven joint space narrowing
bone cysts
osteophytes
clinical features of gout
red
hot
swollen
joint
unable to walk during attack
tophi when chronic (10 years)
what to be aware of with athletes
- supplements and interactions
- banned substances- MIMS
- autoimmune conditions?
things to consider for diabetes
- Renal function/ blood pressure be able to tolerate medications like NSAIDs and antibiotics?
- safe level for HBA1C?
things to consider for RA
- likely taking DMARD and other medications, are there interactions?
- immunosuppression
things to consider for hypertension
- antihypertensives - reduces BP, risk of falls, medication interactions(NSAID)
things to consider for hypercholesterolaemia
- likely to be on a statin- could there be a drug interaction with the CYP450 system in liver
- side effects because of medications- leg pains
high risk groups include and whats the concern with the pop
pregnancy- malformation
lactation- malformation
children- systemic toxicity
edlerly- systemic toxicity
renal imapirment- systemic toxicity/acute renal failure
hepatic imapirment- systemic toxicity
history of drug allergy- anaphylaxis
common drugs to avoid in pregnancy as they lead to malformations
- tetracycline- antibiotic (stained bone/teeth)
- warfarin- anticoagulant (impaired brain development)
- thalidomide (impaired limb development)
- methotrexate- DMARD (many)
- first trimester NSAID/aspirin exposure/LA
what drugs on the pod formulary are categorised for pregnancy?
cephalospirins -CAT A
NSAIDS- CAT C
benzodiazepines- CAT C
what is polyharmacy
5 or more medications daily
risks of polypharmacy
- falls/fractures
- memory/cognitive impairment
- mortality/hospital
- drug interactions
- burden of patient- cost, schedule, visits to practitioners
weight gain is a common ADR with what medicines
- antipsychotics
- TCA
- insulins
- sulfonylureas
joint stiffness is a common ADR with what medicines
- antithyroid drugs
- aromatase inhibitors
- MAO-I
musculoskeletal pain is a common ADR in what medicines
- bisphosphonates
- DPP4 inhibitors
peripheral neuropathy is a common and RARE ADR is what medicines
- leflunomide
- oxaliplatin
rare in
1. statins
2. colchicine
patient presents for treatment and has mild dementia. what strategies could you use to obtain a full medication list
- Ask family/carers
- list of medications from GP or pharmacist
- open ended and close ended questions (be specific- any eye drops, inhalers , etc)
why are elderly more of a concern with pharmacotherapeutic management
- adherence
- polypharmacy (multiple comorbidities and complementary medicines)
- pharmacokinetic/dynamic changes with age (renal function, hepatic function, cardiovascular function- systemic toxicity. cognitive decline- adherence)
identify and explain risk factors for multimorbidity
multimorbidiity- multiple disease conditions
risk factors:
- age
-polypharmacy (duplication, incorrect prescribing)
-social demographics (ethnicity, location/access, diet/ lifestyle)
what are the concerns with multimorbidity with prescribing
polypharmacy
cost
adherence
drug - disease interactions
drug- drug interactions
duplications in prescribition
what are other causes of polypharmacy
self medications- OTC
prescriber error (over prescribing, inappropriate duration, missed medications)
whats the challenge with pain in someone who has clinical depression
modulatory pathways of pain
depression causes a reduction in neurotransmitters serotonin which is responsible for inhibiting pain signals in the spinal cord therefore, they are less resistant to the sensation of pain
if the nature of the pain is neuropathic and chronic it could be helpful to prescribe low dose antidepressants .- beyond our scope of practice, refer
what do you need to be aware of when diagnosing a patient that could potentially result in you prescribing more medicatons
that the diagnosis/symptoms are not side effects or adverse drug reactions from current medications they are taking
eg
leg pain while on a statin
