OSCE communication skills Flashcards
Drugs requiring counselling
SSRIs
A: Alter the balance of some of the chemicals in the brain. Mainly affect a neurotransmitter called serotonin. An altered balance of serotonin and other neurotransmitters if thought to play a part in causing depression.
T: Once daily
H: Tablet
L: 3-6 months after feeling better
E: 4-6 weeks
T: N/A
I: GI (diarrhoea, nausea, vomiting, appetite changes, weight changes), headaches, drowsiness, worsening of symptoms at first, withdrawal
C: CIs: suicide risk (-> refer)
S: www.mind.org
Drugs requiring counselling
Methotrexate
A: Disease-modifying drug which has both reduced inflammation and suppresses the immune system. Early use improves outcomes and symptoms.
T: Once weekly with folic acid at another time. Build the dose up slowly.
H: Usually tablet. Injection is available.
L: Long-term
E: 4-6 months
T: FBCs, LFTs, U&Es. Before starting, then every 2 weeks until stable, then every 2-3 months.
I: Alopecia, headaches, GI disturbance. MYELOSUPPRESSION - attend A&E if infection, unexpected bleeding or bruising, anaemia
C: Myelosuppression, liver toxicity, pulmonary toxicity (let know if SOB)
CIs: Pregnancy (including male), hepatic impairment, breast-feeding, active infection, immunodeficiency
S: No NSAIDs/aspirin, get the annual flu jab, arthritisresearch.org.uk
Drugs requiring counselling
Lithium
A: Mood stabiliser. Exact mechanism unknown. Thought to enter cells and interfere with neurotransmitters release and second messenger systems.
T: Once or twice daily, depends on brand
H: Tablet, capsule or syrup
L: Lifelong usually, if works. Regular psych reviews.
E: 1-2 weeks
T: Before starting: FBC, U&Es, TFTs, betaHCG, ECG.
Check lithium levels after 5 days, then every week until stable for 4 weeks, then every 3 months. Check TFTs, U&Es, calcium every 6 months.
I: GI (abdo pain, nausea), fine tremor, metallic taste, thirsy, polyuria, weight gain, oedema
Toxicity: anorexia, dizziness, vomiting, dysarthria, diarrhoea, ataxia, muscle twitching, coarse tremor
C: Toxicity, diabetes insipidus, hypothyroidism
C: 1st trimester, breast-feeding, cardiac disease, significant renal failure, addisons, low sodium diets, untreated hypothyroidism
S: www.bipolar.org.uk
Drugs requiring counselling
Atypical anti-psychotics
A: Schizophrenia is caused by over-activity of the chemicals in transmission of messages in the brain. Olanzapine works by blocking receptors in brain that are involved with transmitting these messages between nerve cells.
T: Tablet daily or depot injection every 2-4 weeks (upper arm, buttocks, upper thigh)
H: Tablet or depot, start at small dose and build up over week or 2. Dose adjusted depending on persons response.
L: Long-term. Tell a doctor if planning a pregnancy.
E: Days-weeks
T: Occasional LFTs
I: Anti-dopaminergic (tardive dyskinesia, tremor etc), anti-cholinergic (constipation, dry mouth), Anti-histaminergic (weight gain, dizziness, drowsiness), Anti-adrenergic (hypotension)
C: Neuroleptic malignant syndrome (high fever and muscle rigidity), agranulocytosis (swelling of mouth, throat or rash), withdrawal
CIs: liver failure, phaeochromocytoma, caution in epilepsy, parkinsons, DM, glaucoma, heart, prostate, kidney problems, pregnancy
S: www.rethink.org
Drugs requiring counselling
Levodopa
A: Levodopa works to replace some of the dopamine in your brain that it is no longer able to make. Will help reduce symptoms, in particular the rigidity and slow movements. Given with carbidopa (inhibits peripheral levodopa degeneration)
T: 3-4 times daily with food (reduces nausea)
H: Tablet, with carbidopa
L: For as long as it works effectively. After 5 years most people suffer from end dose deterioration (works for shorter time) and on-off effect (fluctuate between severe parkinsonism and repetitive involuntary movements)
E: Fast-acting
T: N/A
I: Psychosis, N+V, dyskinesia, postural hypotension
BUT other drugs help these, e.g. domperidone and selegiline (MAO inhibitor)
C: End-dose deterioration, on-off effects
CIs: Glaucoma
S: Parkinsons.org.uk
Drugs requiring counselling
Bipshosphonates
A: Prevents bones from being broken down and helps to rebuild new bone. Remember lifestyle factors can also help with this - exercise, stop smoking, eat well.
T: Once weekly or smaller dose daily
H: Swallow tablet with full glass of water, take at least 30 mins before food/anything other than water, be upright for 30 mins after swallowing
L: Long-term
E: N/A
T: Dental check-up before starting then regularly (risk of jaw osteonecrosis)
I: Headache, heartburn, bloating, indigestion, GI (diarrhoea, constipation, black stools, abdo pain),
C: Osteonecrosis of the jaw
CIs: Pregnancy, dysphagia, stomach ulcers, severe renal impairment
S: www.Nos.org.uk
Drugs requiring counselling
Warfarin
A: Thins the blood. Blocks Vitamin K - the vitamin used by the body to make proteins that cause the blood to clot.
T: OD (usually evening)
H: Tablets - different colours for different strengths
L: 3 months for DVT, 6 months for PE, Lifelong for AF
E: 2-3 days
T: Start 5 mg for 4 days then test INR on days 5 and 8, adjusting dose accordingly. Start concomitantly with LMWH if immediate effect is required. Regular INR checks by anti-coag clinic.
I: Bleeding - tell doc is any unusual bleeding - dark stools, cuts taking longer to heal, bruising
CIs: Pregnancy! Hemorrhagic stroke, significant bleeding. Caution in high risk of falls.
S: Avoid liver, spinach, cranberry juice, alcohol binges, NSAIDs, aspirin, given anticoagulation book.
Drugs requiring counselling
Levothyroxine
A: Synthetic version of the normal hormone produced by the thyroid - thyroxine. Brings thyroxine levels back up to normal.
T: OD before breakfast
H: Tablet
L: Lifelong
E: Few weeks
T: Start test dose then review in 2-3 weeks. TSH every 2-3 months. When TSH stable, check annually.
I: Rare when thyroxin dose stable. May be hyperthyroid symptoms (vom, diarrhoea, headache, palps, heat intolerance)
C: N/A
S: Free prescriptions for everything if taking levothyroxine.
Drugs requiring counselling
Statin
A: Stops the lvier from making cholesterol. Cholesterol is one of the things that predisposes to artery problems and can cause heart disease, stroke or kidney disease. Also important to address other RFs.
T: OD in evening
H: Tablet
L: Lifelong
E: Decreases risk over many years
T: Review in 4 weeks. Then every 6 months. LFTs before starting, at 3 months and at 12 months.
I: Muscle pain, hair loss, itching
C: Rhabdomyolysis
CIs: Pregnancy
S: Avoid grapefruit. www.bhf.org.uk. Also important to address other CVS RFs.
Drugs requiring counselling
Metformin
A: Increases sensitivity of cells to insulin, so the body makes better use of the lower insulin levels.
T: OD with breakfast (may be BD)
H: Tablet with or immediately after a meal, same time each day.
L: Lifelong if works
E: -
T: U&Es before starting
I: Nausea, diarrhoea, abdo pain, weight loss
C: Lactic acidosis
CIs: renal impariment, ketoacidosis, low BMI, must not be taken on day of and 2 days after GA or XR contrast media (increased lack acidosis risk)
S: If miss a dose, take as soon as remember unless it is very close to next dose
Drugs requiring counselling
Iron tablets
A: Replaces the body stores of iron. Important because it is needed to make RBCs.
T: 1-3 times daily depending on brand
H: Works best if taken on an empty stomach but most take with food as iron can irritate the stomach. Tablet.
L: 4 months (3-4 weeks for Hb to normalise and 3 additional months to replenish stores)
E: 3-4 weeks
T: Hb in 3-4 weeks
I: GI irritation, coloured stools, tastes bad
C: N/A
S: N/A
Inhaler technique
Gathering info
- how much do they know about condition
- how much do they know about the different inhalers
Inhaler technique
Types of inhalers and uses
BLUE
BLUE
- Salbutamol
- E.g. evohaler, reliever
- Used during an attack to relieve symptoms
- May be used with a spacer
- SEs: tachycardia, tremor
Inhaler technique
Types of inhalers and uses
BROWN
BROWN
- Steroid inhaler
- Morning and night every day to prevent an attack
- Rinse mouth afterward
- May be used with a spacer
- SEs: dry mouth, hoarse voice, thrush
Inhaler technique
Types of inhalers and uses
Dry powder inhalers
- Used as a reliever of preventer as indicated
- Different uses depending on the type
- Typically click to activate then breathe in quickly and deeply, hold for 10 seconds
- Not used in < 6 yrs (need quick breath)
- Easier to use
- Better for environment
- SEs depends on drug inside
Inhaler technique
Initial explanation
- Explain type of inhaler, it’s purpose and when to use
- Inhaler contains a set dose of mediciation
- Aim is to get it all the way down into the lungs
- Drug released by pressing canister or twisting/clicking device - demonstrate!
Inhaler technique
Steps
- Check date of expiration
- Shake vigorously
- Remove cap and check inside is clean
- Stand or sit up straight
- Hold inhaler upright with index finger on top and thumb on bottom
- Breathe out completely
- Seal mouth around mouthpiece
- Simultaneously press firmly on canister and breath in slowly and deeply (aim for back of throat, not tongue)
- Hold breath for 10 seconds or as long as possible
- Breathe out slowly
- Replace cap
- Repeat after 1 min if required
Inhaler technique
Demo and observsation
- Demonstrate it yourself
- With different placebo inhaler, ask patient to demo
- Observe and correct any mistakes
- Get patient to repeat until correct
Inhaler technique
Other advice
- Seek emergency help if symptoms are severe/not relieved
- See GP/specialist nurse if SEs or using reliever more than 3 times a week
- Ask if any questions or concerns
Inhaler technique
Spacer device steps
- Assemble spacer
- Shake inhaler and remove cap
- Attach to spacer
- Breathe out
- Seal mouth around spacer
- Press on canister to release drug
- Breathe in slowly and deeply for 3-5 seconds then hold for 10 seconds (alternatively take 5 normal breaths in and out through mouth)
- Repeat if required after 30 secs
- If device whistles - breathing in too quickly
Inhaler technique
Looking after spacer
- Wash spacer with warm water and soap
- Always leave to drip dry
- Replace every 6-12 months
Operation-specific risks
Gastrectomy
- Dumping syndrome
- Malasbsorption
- Peptic ulcers/gastric cancer
- Blind loop syndrome
- Abdo fullness
Operation-specific risks
Small and large bowel ops
- Ileus
- Anastomotic leaks
- Stoma restraction
- Intra-abdo collections
- Pre-sacral plexus damage
- Adhesions/intestinal obstruction
- Damage to other local structures, e.g. kidneys
Operation-specific risks
Cholecystectomy
- Common bile duct injury/bile leak
