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Year 3 GP > Health promotion > Flashcards

Health promotion Flashcards

1
Q

Recommended units of alcohol per week

A

14 units per week spread across at least 3 days

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2
Q

1 unit of alcohol

A

= 10ml of ethanol (pure alcohol) - amount average adult can process per hour

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3
Q

Gin, rum, vodka, whisky, sambuca and tequila shot units

A

1.4 units

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4
Q

Wine glass

A

2.1 - 3 units

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5
Q

Tips for decreasing alcohol intake

A 
Set a limit or budget 
Cut down with a friend 
Alternate with water 
Use a small glass or put less in
Lower strength 
Days without
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6
Q

Consequences of alcohol abuse

A

Alcohol fatty liver disease leading to cirrhotic liver failure
Associated with depression, self-harm and suicide
Disrupts sleep pattern
Affects judgement and actions - irrational and aggressive
Accidents resulting in inury
Unprotected sex and risky behaviours
Cardiomegaly

Can cause:

  • stroke - brain damage
  • Heart disease
  • Mouth, throat and breast cancer
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7
Q

Binge drinking

A

8 units in 1 session for men and 6 for women

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8
Q

Risk of drinking whilst pregnant

A

Fetal alcohol syndrome - physical, mental and developmental disorders

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9
Q

How does alcohol affect people that are old and people taking medication

A

People on a certain medication and elderly have decreased liver function so alcohol will have greater effects as metabolised slower

Alcohol may interact with medication e.g.

  • NSAIDs
  • Opiods
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10
Q

Mx of alcohol abuse

A
  • refer to an alcohol addiction clinic
  • alcohol detoxification programme
  • CBT
  • Social network and environment-based therapies
  • Behavioural couple therapies

Pharmacological:
- Disulfiram - inhibits aldehyde dehydrogenase causing a build-up of acetyl aldehyde which causes hangover symptoms

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11
Q

Risks of IVDU

A 
DVT
Sepsis 
Immunocompromised 
HIV 
TB
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12
Q

Management of drug abuse

A
  • Vaccinations against hepatitis B and tetanus
  • Overdose prevention training and take-home naloxone
  • Contraception - refer to a sexual health service
  • Refer to drug addiction clinic
  • whether maintenance therapy or detoxification is most appropriate
  • opioid substitution therapy
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13
Q

Presentation of alcohol misuse

A 
Smell of alcohol 
Dilated facial capillaries - flushed 
Bloodshot eyes 
Hand tremor 
Raised GGT
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14
Q

Alcohol withdrawal symptoms

A 
Seizures 
Delirium tremens
Sweating 
Tremor 
Tachycardia 
Palpitations
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15
Q

Wernicke’s encephalopathy presentation

A 
Confusion 
Ataxia 
Eye paraylsis - opthalmoplegia 
Memory disturbance 
Hypothermia 
Hypotension 
Coma
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16
Q

Treatment of Wernicke’s encephalopathy

A

Parenteral thiamine

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17
Q

DVLA

A

People who are dependent on alcohol should be advised that they are required by law to notify the DVLA and will be required to surrender their driving license for a period.

Pt must inform the DVLA of use of heroin, morphine, buprenorphine, or methadone - will lead to refusal/surrendering of driving licence.

18
Q

When to refer to hospital for alcohol

A

Urgent

  • signs of seizure, delirium tremens in alcohol withdrawal
  • Wernicke’s encephalopathy
19
Q

Alcohol investigation

A

AUDIT - alcohol use disorders identification test
1- 7 - low risk
8 - 15 - hazardous
16 - 19 - harmful

AUDIT-C if limited time
- full AUDIT should be given if score 5+

SADQ- Severity of Alcohol Dependence Questionnaire

  • mild — 15
  • moderate — 15–30
  • severe — 31+
20
Q

Suspected opiod dependency

A

Opioid intoxification:

  • Pupil constriction
  • itching
  • sedation and somnolence, - hypotension and slower pulse + hypoventilation

Certain features:
Psychiatric history - overdoses, depression, psychosis.

Social history — family problems, unemployment, accommodation issues, financial problems.

Physical examination

  • poor nutrition
  • dental caries
  • Signs of neglect
  • needle tracks
  • skin abscess and signs of drug intoxication or withdrawal.
21
Q

Acute substance withdrawal syndrome

A 
Watering eyes
Rhinorrhoea
Yawning
Sneezing
Cool and clammy skin
Dilated pupils
Cough.
Abdominal cramps, nausea, vomiting, diarrhoea.
Tremor
Sleep disorder, restlessness
Anxiety and irritability, Hypertension
22
Q

Investigations for opiod misuse

A
  • Urine analysis drug screen
  • Mouth swab tests
  • Possible hepatitis testing (serology)
  • HIV testing
  • Bloods - LFTs
23
Q

When should substitution therapy be offered

A
  • Opioids are being taken on a regular basis, usually daily.
  • Convincing evidence of current dependence.
  • Initial assessment clearly indicative
  • Pt can comply with the prescribing regimen.
  • Pt not receiving an opioid prescription for management of dependence from another clinician.
  • LFTs
24
Q

Substitution therapy for opioid dependence

A

1st line - Methadone

  • more effective in retaining people in treatment
  • more suitable for people who use large amounts of heroin

Buprenorphine + naloxone pill - reduced risk of fatal overdose

Buprenorphine injection- administered by a health care professional

25
Q

Stop using heroin completely

A

high-dose methadone or buprenorphine

26
Q

If a person misses doses of methadone or buprenorphine

A

Do not take extra

Find out why

27
Q

BMI categories

A 
Under 18.5 - underweight 
18.5 - 24.9 - good weight 
25 - 29.9 - overweight 
30 - 35- obese 
35+ - morbidly obese
28
Q

Waist circumference

A

Men - 94 cm +
(90cm + for Asian men)

Women - 80 cm +

Indicates an increased risk of obesity-related health problems.

29
Q

Mx of obesity

A

Conservative:

  • diet modification
  • exercise
  • CBT

Pharmacological:
- orlistat
Surgery
- bariatric surgery - BMI 40+

30
Q

Diet recommendations

A

Men - 2500 kcal
Women - 2000 kcal

5 food groups:

  • carbohydrates - 38%
  • meat - 12 %
  • dairy - 8%
  • fats - 1%
  • Fruits and veg - 40%
31
Q

Exercise guidelines

A

150 minutes - moderate intensity activity a week
or

75 minutes of vigorous intensity activity a week

32
Q

Smoking cessation mx

A
  • referral to local smoking cessation service
  • nicotine replacement therapy
  • e-cigarettes
  • Medication: varenicline or bupropion
33
Q

Nicotine dependence

A

How many cigarettes they smoke per day?

How soon after waking they smoke their first cigarette?

34
Q

Nicotine replacement therapy

A

16 hour patch

24 hour patch

35
Q

When to start varenicline or bupropion

A

Started 7-14 days before the quit date

Varenicline - 12 weeks course
Bupropion - 7 - 9 wks course

36
Q

Carbon monoxide test

A

Measure the carbon monoxide (CO) level 4 weeks after quitting.
A CO level of 10 ppm or less suggests the person is a non-smoker.

37
Q

Cycle of change

A
  1. Pre contemplation
  2. Contemplation
  3. Preperation
  4. Action
  5. Maintenance
  6. Relapse
38
Q

POMC

A

Planning
Opportunity
Motivation
Capability

39
Q

Bupropion contraindication

A 
Under 18 
Pregnant 
Epileptic 
Eating disorder 
Bipolar
40
Q

Weight loss

A

Reduce calorie intake to 600 kcal below daily requirement to sustain weight loss of 0.5 - 1 kg per week

Year 3 GP (20 decks)

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