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Counselling stations - OSCE Flashcards

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1
Q

What type of risk factors is it important to elicit when counselling for bisphosphonates

A

osteoporosis risk factors including smoking, alcohol, steroid use and being post-menopause.

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2
Q

How do bisphosphonates work

A

They work by slowing down the process of bone breakdown by osteoclasts, whilst allowing osteoblasts to continue enhancing bone density(Prevent thinning of bones)

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3
Q

How often is alendronic acid taken

A

Once a week(tablet) - Same day each week

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4
Q

How should alendronic acid be taken

A

Should be taken with a large glass of water, and the patient should not consume any food or drink, other than water, for 2 hours after taking it.

Advise the patient to sit upright for 30 mins after taking the tablet as alendronic acid can cause oesophageal irritation, ulceration and in some cases strictures.

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5
Q

Advice regarding missed tablets - alendronic acid

A

If the patient misses a tablet, they should take it as soon as they remember. They should not take 2 tablets in one day.

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6
Q

How long do bisphosphonates take for effect and how often is this reviewed

A

Roughly 6 months for the bisphosphonate to take effect

Annually reviewed

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7
Q

Side effects of bisphosphonates

A

Oseophageal irritation
abdominal pain, nausea, gastrointestinal upset and joint/muscle pain

Osteonecrosis of jaw(should attend annual dental checks)

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8
Q

Which medications should not be taken with bisphosphonates

A

OTC painkillers(ibuprofen) - can worsen oesophageal irritation

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9
Q

Lifestyle advice when on bisphosphonates

A

Diet and exercise
Weight-bearing exercises
High calcium foods(dairy, leafy greens)
Smoking cessation

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10
Q

What type of risk factors is it important to elicit when counselling for statins

A

CVS history/risk factors - smoking, HTN, sedentary lifestyle

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11
Q

Tool used to assess need for statins

A

QRISK - 10-year risk of CVD over the age of 40

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12
Q

What are statins

A

Statins are a group of lipid-lowering drugs used to reduce the risk of atherosclerosis and related CVD events.

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13
Q

How do statins work

A

Work by inhibiting a key enzyme in the liver, HMG-CoA reductase, causing a decrease in hepatic synthesis of cholesterol.

Increases the expression of hepatic cholesterol receptors, increasing uptake of low-density lipoprotein (LDL) from the blood to the liver, resulting in a fall in plasma cholesterol(reduces production of new cholesterol and clears bad cholesterol)

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14
Q

What might patients with raised triglyceride concentrations require

A

Fibrate in addition to a statin

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15
Q

How often are statins taken

A

OD - at night with consistent timing

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16
Q

Advice regarding missed tablets - statins

A

If the patient misses a tablet, they should take it as soon as they remember. They should not take two tablets in one day.

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17
Q

monitoring treatment of statins

A

Pre-treatment cholesterol levels

LFTs

Another blood test within 3 months of starting treatment and again at 12 months to monitor effectiveness

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18
Q

Side effects of statins

A 
Myalgia/cramps/tenderness 
Muscle toxicity 
Nausea
Constipation 
Diarrhea
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19
Q

Key statin interactions

A

Grapefruit
Antibiotics
Immunosuppressants
Fibrates

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20
Q

Lifestyle advice while on statins

A

Physical activity(moderate intensity of 30 mins at least 5 days a week)
Healthy foods
Smoking and alcohol cessation

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21
Q

How is clozapine taken

A

Clozapine comes in tablet form, a liquid option and more recently an orodispersible form.

It is not currently available in depot form.

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22
Q

Why is it important not to miss a dose of clozapine

A

Clozapine is prescribed at a low dose to start off with and this is titrated up over a period of several weeks. It is important that doses are not missed. This is because if clozapine is not taken for more than 48 hours the titration process needs to start again

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23
Q

Advantages of clozapine

A

Studies have shown that approximately six out of ten people with treatment-resistant schizophrenia will benefit from taking clozapine.

There is also research that demonstrated clozapine is superior to olanzapine when preventing suicide attempts in patients with schizophrenia and schizoaffective disorder

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24
Q

Common side effects of clozapine

A 
Sedation(consider night time dosing) 
Constipation 
Tachycardia 
Weight gain 
Hypersalivation 
BP changes 
Hyperglycaemia
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25
Rare/serious side effects of clozapine
Agranulocytosis Lowers seizure threshold Cardiac complications(myocarditis/cardiomyopathy)
26
Baseline ix for clozapine
``` ECG Blood pressure and pulse Calculation of body mass index (BMI) FBC, U&Es, LFTs, prolactin, HbA1c and lipids Baseline tropi ```
27
Clozapine monitoring
Weekly FBC in first 18 weeks Fortnightly after 18 weeks and then monthly after one year
28
What can cause plasma clozapine levels to change
Levels of clozapine can rise significantly with the reduction and cessation of cigarette smoking
29
How is levothyroxine taken
at least 30 minutes before breakfast. This is because food and coffee can reduce the absorption of levothyroxine Once a day tablet
30
Missed dose - levothyroxine
If they forget to take a dose, advise them to take it as soon as they remember but to avoid double dosing.
31
Monitoring in levothyroxine therapy
TFTs 2-3 weeks after initiation of treatment, tweaking levothyroxine dose as required 2-3 monthly intervals after a dose change Annually once thyroid hormone levels are within the normal range and stable
32
Side effects from excessive dose of levothyroxine
Heat intolerance Weight loss Insomnia Fine tremor
33
Side effects from inadequate dose of levothyroxine
``` Cold intolerance Weight gain Low mood Constipation Dry skin ```
34
What are the three main types of emergency contraception
The copper intrauterine device, EllaOne® which is a 30mg ulipristal acetate tablet, also known as “the morning after pill” Levonelle® which is a 1500mg levonorgestrel tablet, also known as “the morning after pill”, “plan B”, or “one-step”
35
Aspects of sexual history that should be asked about prior to emergency contraception
Consensual sex LMP Safeguarding Screening for STIs
36
How does levonelle work
Levonelle® works by inhibiting ovulation for around 5 days.
37
When can levonelle be taken
72 hours of UPSI Longer the delay, the less effective it is
38
How effective is levonelle
Less effective than Ella one Not effective after ovulation
39
Side effects of levonelle and risks
Nausea/vomiting Delayed/early menses Double dose in patients with BMI of 26 or above Would need to taken a second dose if vomit within 3 hrs of taking tablet
40
Advantages of levonelle
Generally safe | Can use with ongoing contraception
41
How does ellaone work
Ulipristal acetate works by delaying ovulation for around 5 days
42
When can ellaone be taken
120 hrs or 5 days of UPSI
43
What can ellaone effectiveness be affected by
rendered less effective by progestogen hormones, and as such should not be taken in a 7 day period following progestogen use
44
Risk and side effects of Ellaone
nausea, vomiting, and a delayed or early menses if a patient vomits within 3 hours of taking ellaOne®, they will need to repeat the dose Not suitable in patients with severe asthma
45
What is the copper IUD
a small T-shaped plastic and copper device which is inserted into the womb during a small procedure
46
How does copper IUD work in contraception
Fertilisation inhibition occurs through direct toxicity effects of the copper on both ovum and sperm. This toxic effect prevents pregnancy
47
When can copper IUD be used for contraception
up to 5 days, (120 hours) after unprotected sex; or within 5 days of the earliest expected date of ovulation
48
How long should copper iUD be left in place for contraception
the copper IUD should remain in situ ideally for 21 days. It can be left in place for up to 10 years to provide ongoing contraceptive protection.
49
When should patients be advised to take pregnancy test after emergency contraception
3 weeks after UPSI
50
Disadvantages of copper IUD
Infection, expulsion, perforation, ectopic pregnancy
51
How does methotrexate work
Disease modifying agent which reduces inflammation and suppresses the immune system
52
How is methotrexate taken
Tablet usually Injection also available Once weekly with folic acid at another time. Build up dose slowly
53
Length of methotrexate treatment
Long term
54
Time it takes for methotrexate to take effect
4-6 months
55
Methotrexate monitoring
FBC, LFTs and U&Es Before starting, then every 2 weeks and then every 2-3 months
56
side effects of methotrexate
Alopecia Headaches GI disturbance Infection Unexpected bleeding/bruising Anaemia
57
Complications of methotrexate
Myelosuppression Liver toxicity Pulmonary toxicity(inform if SOB)
58
Methotrexate contraindications
``` Pregnancy(including male) Hepatic impairment Breast feeding Active infection Immunodeficiency ```
59
Supplementary advice for methotrexate
No NSAIDs/Aspirin Annual flu jab Arthritisresearch.org.uk
60
How do SSRIs work
Alter balance of some of chemicals in the brain. SSRI affect a chemical called serotonin. An altered balance of serotonin and other chemicals is thought to play a part in depression
61
How should SSRIs be taken
Once daily | Tablet
62
When should SSRIs be stopped normally
3-6 months after feeling better(taper)
63
How long do SSRIs take to show effect
4-6 weeks
64
Important side effects of SSRIs
``` GI(diarrhoea, nausea, vomiting) Appetite and weight change Headache Drowsiness Anxiety(first 2 weeks) ``` Withdrawal
65
SSRI contraindications
Suicide risk | Past psychiatric illness
66
How does lithium work
Mood stabiliser Each mechanism unknown
67
How is lithium taken
Once or twice daily Tablet, capsule or syrup Lifelong usually(if works) with regular psych review
68
How long does it take for lithium to take effect
1-2 weeks
69
Tests for lithium therapy
FBC, U&Es, TFTs, beta HCG, ECG
70
How often should lithium be checked
After 5 days | Then every week until stable for 4 weeks, then every 3 months
71
Lithium side effects
GI(Nausea) Metallic taste Fine tremor Water symptoms(thirst)
72
Lithium toxicity symptoms
GI Neuromuscular(dysarthria, dizziness) Others(drowsiness, apathy)
73
Complications of lithium therapy
Renal toxicity Nephrogenic diabetes insipidus Hypothyroidism
74
Lithium contraindications
``` 1st trimester preg Breast feeding Cardiac disease Significant renal disease Addison's ```

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