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OSCE Exam Flashcards

1
Q

What is ALT a measure of

A

Liver function, raised ALT indicates liver disease

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2
Q

What is AST a measure of?

A

Liver function, raised ALT indicates liver disease

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3
Q

What is ALKP (alkaline phosphatase? a measure of

A

liver function, raised ALKP indicates liver disease

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4
Q

what is GGT a measure pf

A

liver function, raised GGT indicates liver disease and is especially common in alcoholics

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5
Q

what is bilirubin a measure of

A

liver function, raised bilirubin indicates liver disease,

bile may accumulate and make the person yellow (jaundice)

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6
Q

what can prothrombin time be used as a measure of

A

liver function, raised prothrombin time indicates liver disease

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7
Q

what is albumin a measure of

A

liver function, LOWER albumin indicates liver disease (this is beacause albumin is made in the liver)

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8
Q

What is the requirement for high extraction ratio drugs?

A

Er>0.7

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9
Q

What is the requirement for low extraction ratio drugs?

A

ER<0.3

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10
Q

what it is the requirement for intermediate extraction ratio drugs/

A

ER 0.3-0.7

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11
Q

what is special about phenytoin?

A

it has non-linear pharmacokinetics

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12
Q

how do you calculate DOSE RATE for phenytoin?

A

DR = (Vmax X Cssav)/(km+Cssav)

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13
Q

how do you calculate Cssav for phenytoin

A

CssAv= (KmXDr)/(Vmax-DR)

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14
Q

how to you calculate clearance for phenytoin

A

(Vmax)/(Km+Cssav)

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15
Q

how to you calculate T1/2

A

0.693XV/Vmax (x km+Css)

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16
Q

is propranolol a selective or non selective beta blocker

A

non selectiv

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17
Q

Name some non selective beta blockers

A

atenolol/bisoprolol/metoprolol

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18
Q

How long to copies of private prescriptions need to be retained for from the last date of supply?

A

2 years

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19
Q

how to private prescriptions for CDs need to be written

A

PPCD(1) with all the same requirements on it

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20
Q

name all the private prescription writing requirements

A

1) signature of the prescriber
2) date (valid within 28days)
3) prescribers adress (must be within UK)
4) dose
5) formulation
6) strength (only if product available in more than one strength)
7) total quantity (needs to be in both words and figs, total number of dosage units)
8) quantity must not exceed 30days treatmnet
9) name of patient
10) address of patient

If written by a dentist (for dental treatment only) must be present
Installment direction with appropriate wording if required

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21
Q

does the dose of medicine for a private prescription need to be written in words and figs

A

no

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22
Q

does the strength of medicine for a private prescription need to be written in words and figs

A

no

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23
Q

does the quantity of medicine for a private prescription need to be written in words and figs

A

yes (and must not exceed 30days treatment

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24
Q

do Sch2 CDs need to fulfil the special writing requirements

A

yes

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25
Q

do Sch3 CDs need to fulfil the special writing requirements

A

yes

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26
Q 
do Sch4(1) CDs need to fulfil the special writing requirements
(CD benz pom)
A

no

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27
Q 
do Sch4(II) CDs need to fulfil the special writing requirements
Cd Anab POM
A

no

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28
Q

do Sch5 CDs need to fulfil the special writing requirements

A

no

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29
Q

how long are rx for Sch. 2/3/4 drugs valid for?

A

28 days (from 21/3/18 on the day of the OSCE)

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30
Q

how long are rx for school 6 drugs valid for

A

6 months like normal prescriptions (18/10/17)

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31
Q

can EEA and swiss prescribers legally prescribe SCH. 2/3 drugs?

A

no

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32
Q

are the prescriptions for Sch. 2 or 3 drugs repeatable?

A

no

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33
Q

are the prescriptions for Sch.4/5 drugs repeatable?

A

yes

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34
Q

are emergency supplies of Sch2 drugs allowed

A

no

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35
Q

are emergency supplies of sch 3 drugs allowed

A

no,

EXEPT phenobarbitone for epileps

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36
Q

are requisitions necessary for CDs

A

for Sch2 and Sch3 only

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37
Q

what Schedule drugs require safe custody

A

Sch2

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38
Q

do Sch2 drugs need to be in CD cabinet?

A

yes

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39
Q

do Sch3 drugs need to be in CD cabinet?

A

only some (buprenorphine and temazepam)

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40
Q

do Sch4 and Sch5 drugs need to be in CD cabinet?

A

no

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41
Q

name the requirements of CD register

A
  • entries made on the day or the day following supply
  • bound book (not loose leaf) or computer special system
  • separate pages for each form and strength
  • record Q recieved and who from
  • record name and address of patient
  • record name and address of prescriber
  • quantity
  • date of suppy
  • must be an indelible entry and mistakes must not be scored out or deleted
  • best practice to keep a running balances
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42
Q

what are the important parts that must be included in instalment directions

A
  • amount of medicine per installment

- duration of time between each instalment

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43
Q

how does dopamine work?

A

Serotonin antagonist activity (5-HT2A) receptors to relive the negative symptoms

Weak dopamine D2 agonist (D2) to receive the positive symptoms

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44
Q

what kind of S/e does dopamine have compared to typical antipsychotics

A

Less associated extrapyramidal/ movement side effects than the typical antipsychotics that mainly exert their action by being dopamine antagonists

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45
Q

why is monitoring required

A

it causes neutropenia/agranulocytosis which is dangerous as it is an abnormally low level of neutrophils which causes the patient to be more susceptible to infection

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46
Q

when is the greatest risk of neutropenia/agranulocytosis in cloxapine

A

the first 18 weeks

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47
Q

name some dose related s/e of clozapine

A 
hypotension
tachychardia
constipation
hypersalivation
(effect of smoking, number of cigarettes smoked)
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48
Q

does clozapine prolong QT itnerval

A

yes

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49
Q

what is important about clozapine and smoking

A

smoking while taking clozapine causes reduced clozapine levels in the blood, this means that higher doses are required to

this is because tobacco smoke contains hydrocarbons that increase the activity of hepatic CYP enzymes that metabolise clozapine, thus reducing clozapine levels in the blood

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50
Q

how would you deal with a patient who takes clozapine and then stops smoking

A

Take clozapine before pt stops smoking (trough levels, in the morning before the next dose)

Take clozapine level one week after stop smoking nd look for any dose dependent side effects)
Reduce fose to approx 75% of pre-quit dose

take plasma levels one week after new dose is stable

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51
Q

BENZODIAZEPINES

How long is the duration of action of MIDAZOLAM

A

SHORT

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52
Q

BENZODIAZEPINES

How long is the duration of action of TEMAZEPAM

A

INTERMEDIATE

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53
Q

BENZODIAZEPINES

How long is the duration of action of LORAZEPAM

A

INTERMEDIATE

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54
Q

BENZODIAZEPINES

How long is the duration of action of DIAZEPAM

A

LONG

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55
Q

what are some important counselling points to mention to a patient taking antidepressants

A

Depression is caused by a deficiency in chemicals in the brains called monoamines, antidepressants work to increase the amount of monoamines in the brain (for example serotonin) so that there are more monoamines in the brain for neurotransmission therefore alleviating the depression

  • most will take more than 2 weeks to start working

initially symptoms may be worse but they will go away as the medicine starts to work

need to take the antidepressant every day and dont miss any doses

even after you feel better and not depressed it is important to keep taking the antidepressants until the doctor tells you to stop or your depression could come back if you stop taking them too early (normally prescribed them for 6 to 12 weeks after symptoms have subsided)

when you have to stop taking them then the dose will be reduced gradually and not suddenly as this can be bad for you, generally there is a reduction of 25% every 4 weeks

avoid taking grapefruit juice when taking sertraline

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56
Q

why are SSRI’s good antidepressants

A

they are safe in overdose

lowest potential withdrawal effects

less side effects than any other antidepressant as they only act on the serotonergic system (bind with significantly less affinity to H/Ach/ nor-adrenaline receptors than TCA’s)

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57
Q

why is ketamine different from other antidepressants

A

as only a SINGLE DOSE can provide rapid next day releif from major depression

(antidepressant effect in very low doses <10X the dose than required for anaesthetic properties)

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58
Q

when does serotonin syndrome occur

A

using two medicines that affect the serotonergic system

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59
Q

what is generalised epilepsy

A 
seizure affects both sides of the brain
"arising within and rapidly engaging bilaterally distributed networks"
tonic
clonic
tonic clonic
absence
atonic
myoclonic
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60
Q

what is focal epilepsy

A 
seizure only affects one side of the brain (originating within networks limited only to one hemisphere of the brain)
aura 
motor
autonomic
awareness/responsivness
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61
Q

what is status epilepticus

A

medical emergency in which epileptic fits follow one another without recovery of consciousness between them
have long term consequences due to neuronal alteration and can result in death

can start because of mechanisms that lead to normally prolonged seizures or faulty mechanisms that are normally responsible for seizure termination

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62
Q

what is first line for generalised seizures

A

sodium valproate

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63
Q

what is first line for absence seizures

A

ethosuxamide

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64
Q

what is first line for status epilepticus

A

midazolam

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65
Q

what is first line for focal seizures

A

lamotrignine

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66
Q

name some ergot derived dopamine agonists

A

bromocriptine
carbegoline
pergolide

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67
Q

name some non-ergot derived dopamine agonists

A

apomorphine, pramipexole, ropinirole,rotigotine

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68
Q

why are ergot derived drugs bad

A

as they cause heart and lung fibrosis and also damage to the heart valces

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69
Q

in simmer (carbidopa and levodopa) which bit does what

A

carbidopa is the dopamine decarboxylase inhibitor
levodopa is the dopamine metabolic precursor

carbidopa inhibit the Ddc enzymes that would metabolise the levodopa before it reaches the brain (cross BBB)

carbidopa doesnt cross BBB

all the levodopa reaches the brain in the levodopa form leaving it all to be metabolised to dopamine in the brain (Not the periphery)

increase plasma half life of levodopa
75% lower dose required to achieve the same therapeutic effects
less s/e of peripheral dopamine (cardiac conduction abnormalities, tachycardia, hypotension, nausea, headache, bradycardia, anxiety

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70
Q

why can you not stop taking levodopa suddenly

A

risk of neuroleptic malignancy syndrome

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71
Q

why is it important that patients are compliant with their anti epileptic drugs>

A 
NEGATIVE EFFECTS OF POOR EPILEPSY CONTROL
worsening seizure control
major morbidity
physical injury
neuronal damage
may loose driving liscence
may not be able to go to school or work
72
Q

what is SUDEP

A

sudden unexpected death in epilepsy

risk factors include
- young
poor compliance with AEDs
male
having a seizure during sleep
having severe seizures
73
Q

what antiepilepdic drugs are enzyme inducers and how does this affect contraceptives

A

Carbemazepine
phenobarbital
phenytoin

Oxcarbazepine
Topirimate
Permapanel

induce liver enzymes that metabolise the hormones in the COC pill , pill may be ineffective, need more oestrogen in the Pill
Even at higher doses may still not be effective
If you bleed between periods suggests that ineffective

74
Q

what methods of contraception are still good if taking enzyme inducing AED’s such as carbamazepine, phenytoin, phenobarbital

A

intrauterine devices/ intrauterine systems as the morning is released straight into the womb and doesnt need to go around the rest of the body first (but there is a risk that the lady will have a seizure while the coil is being fitted)

contraceptive injections are ok aswell (e.g. Depo proverb as the hormone is broken down in the blood rather in the liver )

need to take double the dose of EHC
barrier

progesterone implants/contraceptive patches/vaginal ring are effected by enzyme inducing AEDs

75
Q

what methods of contraception are still good if taking non enzyme inducing AED’s such as gabapentin, pregabalin, sodium valproate

A

any method

76
Q

what are important considerations to make regarding lamotragine and contraception?

A

lamotragine is a non enzyme inducing AED
it doesnt reduce the effectiveness of the Pill but there is evidence that the pill lowers lamotragine levels int he blood :-(

this could reduce seizure control and lead to seizures happening

77
Q

when is ECT used to treat depression

A

used to treat severe life threatening depression who haven’t responded to other therapies including medication

78
Q

what do you need to ensure a patient taking an opioid has

A

laxative
antiemetic
breakthrough (1/10- 1/6 of total dose)

79
Q

what act is involved in covert administration of medicines

A

Adults with incapacity (scotland) act (2000)

80
Q

what is covert administration of medicines

A

administration of medicine to a patient in such a way that it is discussed or hidden so that they dont know they are taking it and aren’t consenting to taking it (e.g crushingand tablet and putting it in tea or hiding it in a cake)

81
Q

what considerations need to be made before covert administration is allowed

A

must never be given to a patient who is competent and capable of deciding to take treatment or not themselves

multidisciplinary decision must be made and all practitioners directly or indirectly involved in the administration of covert medicine must be included in the discussion/decision and ALWAYS EXPERT GUIDANCE FROM THE PHARMACIST

family/ welfare proxy must be included too

82
Q

what gene is associated with CML

A

Chromasome 22 (philadelphia chromasome)

83
Q

how is targeted therapy used to treat CML

A

CML is a type of blood cancer
Forms bad BCR-ABL genes (oncogenic) that turn normal cells into cancerous CML cells
BCR-ABL is translated into a very active tyrosine kinase
Need to eliminate the BCR-CBL gene/Ph Chromasome

IMATINIB (gleevec) is a tyrosine kinase inhibitor that targets only the BCR-ABL genes in CML

84
Q

what is rheumatoid arthritis

A

autoimmune disease that causes inflammation and stiffness in the joints
symmetrical
progressive loss of bone density

85
Q

how is Rheumatoid arthritis treated

A

lowest possible dose of NSAID
+
DMARD (methotrexate or sulfasalazine)

86
Q

how is disease severity in rheumatoid arthritis assessed

A

DAS28 score

  • number of swollen joints out of 28
  • number of inflamed joints out of 28
  • ERS blood test
  • global assessment of health

good score is: <2.6 ( remission)

alright sore is : <3.2 (low disease activity)

bad score is : >5.1 (high disease activity, patient in a lot of pain)

87
Q

what is osteoarthritis

A

caused by dammage

causes inflammation and damage asymmetrically

88
Q

how do you treat an acute attack go gout

A

NSAID (continue for 48hrs after attack resolved)
+ PPI

or colcicine
or intra-articualr corticosteroids

dont start allopurinol now but dont stop if already established on these drugs

89
Q

what is chronic gout treatment

A

allopurinol
febuxostat

initially gout attack amy occur when you start taking them or just after , dont stop taking them though, (co-prescribe NSAID +ppi for at least one month

life long treatment

90
Q

what is an important counselling point to make to a patient starting methotrexate or sulfasalazine

A

they wont start working immediately

will take 12 weeks

91
Q

why do you take folic acid when taking methotrexate

A

methotrexate lowers the levels of folate in the body
take folic acid to prevent a folate deficiency
also because of this it helps to prevent methotrexate side effects

92
Q

what are the important considerations to remember for NSAIDS

A
  • no NSAID is any better than any other one for any other condtion

BUT all NSAIDS aren’t equal in terms of GI adverse effect risk
Low dose ibuprofen poses the least risk (<400mg)

PPIs are best for preventing NSAID induced ulcers

All NSAIDS (less so naproxen) show tendencies towards higher CV rates but this needs to be contextualised for the patient

93
Q

what are some counselling points to make to a patient starting on methotrexate

A
  • clarify dose
    only take ONCE WEEKLY NEEVER ONCE A DAY

dont take NSAIDS or aspirin
must speak to doctor if planning to become pregnant or you find out you are pregnant because it will destroy your baby
stop taking if find out you are pregnant

take on the same day each week for ease take methotrexate on a monday and folic acid on a frday

you take folic acid as methotrexate lowers the folic acid levels in your body so to prevent folate deficiency you take folic acid on a different day from the folic acid

do a new DAS28 score and ESR test every 4 weeks to see if the methotrexate is working nd whether dose can be decreased or if it needs to be increased

it takes up to 12 weeks to work

tell Dr if notice sore throat or blood dycrasias

94
Q

what happens to following medicines in PEG tubes

phenytoin
carbemazepine
diazepam

A

bind to the tube as they are hydrophobic and the tube is hydrophobic too

flush
administer with large volume of water

95
Q

what happens to following medicines in PEG tubes

acidic drugs
chlorphenamine
promethiazine
HCL salt
mallets
A

interact with feed and cause a blockage
- denature proteins and cause them to precipitate out and cause a blockage

dilute and flush

96
Q

what happens to the following medicines in PEG tubes:

phenytoin
ciprofloxacin
warfarin
fluoroquinolones

A

interact with the feed causing reduced absorption,
the drug complexes with the metal ions in the feed and therefore it cannot be absorpbed

flush before and after
be aware of feed patterns and stop feed 2 hrs before and after drug administrtation

97
Q

what important consideration is needed for the following drugs when administered as a PEG tube

penicillin
tetracyclines

A

administration in resect to food
be aware of feeding pattern

continuous feeding not allowed
NJ sube not allowed as stomach is by-passed
intermittent or bolus is better

98
Q

what are the 6 hallmarks of cancer

A 
Angiogenesis
Evading apoptosis
Insensitivity to anti-growth signals
Self-sufficiency in growth signals
Limitless replicative potential
Tissue invasion and metastasis
99
Q

how to medicines that prevent grout attacks work?

A

lower uric acid

100
Q

what is co-prescribed with allopurinol or fexubustat and for how long?

A

low dose NSAID or calcimine

for 6-12 months

101
Q

how does allopurinol work?

A

It is an xanthine oxidase inhibitor
it blocks the xanthine oxidase enzyme that allows the conversion of oxypurines to uric acid
therefore decreasing uric acid production
(it is a build-up or uric acid that causes gout attacks)

102
Q

what medicines can cause gout

A

thiazide like diuretics (eg bendroflumethiazide)

103
Q

what non-pharmacological advice can you offer someone with gout

A

loose weight
eat a healthy diet
do exercise (but dont do intense jumping or exercise that could cause damage to the joint)
have at least 2 alcohol free days per week
drink plenty of water (2/L per day)
stop smoking
take Vit C supplements

dont eat a lot of sea food or red leat
dont binge drink or drink >14 units per week
dont eat very sugary things or full fat dairy products

104
Q

can you give aspirin to treat a gout attack

A

NO
salicylic acid will worsen the flare up as its excretion is preferred by the body over the uric acid so salicylic acid will be excreted out and uric acid will accumulate

105
Q

what advice could you offer for palliative care patients and mouth care/ treatment for sore moutn

A 
moist gauze sqabs
saliva stimulant sweeties
artificial saliva (NOT glandosane)
sugar free chewing gum
suck on frozen fruit
suck on ice cubes
ensure lips are moisturised
drink small frequent sips of cool water
use fluoride mouth wash
106
Q

what are important symptoms to look out for in a patient taking TKI’s that would indicate toxicity

A

keritis (hand rash)

107
Q

how are the BCR/ABL cells detected in CML

A

PCR (rather than FISH)

108
Q

what is personalised therapy in breast cancer

A

breast cancer biopsies sent to the lab –> stained for presence of receptor proteins–> results indicate whether the tumour has oestrogen receptors (ER+) or perception receptors (HR+) or both and this dictates treatment

109
Q

what treatments can be used fo ER+ breast cancer>

A

tamoxifen

110
Q

what treatments can be used for HR+ breast cancer?

A

Herceptin/tratuzumab

111
Q

what is triple negative breast cancer

A

ER-
PR-
HR2-

112
Q

what national screening programmes are in place

A

breast cancer

bowel cancer

113
Q

what things should you monitor your moles for for melanoma (skin cancer)

A 
Assymetry
Border (irrecular)
Colour (uneven)
Diameter (wider than a pencil)
Evolving (changing in any way)

Keep an eye on it and take pictures with a ruler next to it for reference
Go and see a dermatologist
Remember always keep skin protected from the sun and dont use sun-beds or anything like that

114
Q

is their a national screening programme for melanoma

A

no

115
Q

is there a national screening programme or prostate cancer

A

no
(if there was one then would look for PSA prostate specific antigen) however this leads to risk of overdiagnosis and over treatment

high PSA can be a sign of cancer but can also be high because of other prostate conditions that aren’t cancer for example benign growths or infection
PSA test alone doesn’t diagnose prostate cancer

116
Q

what is the national screening programme for breast cancer

A

mammogram to detect breast cancer (can identify tumours that are too small to feel)

every woman 50-70 invited fr screening every 3 yrs if registered with a GP in scotland

117
Q

what are some risk factors for breast cancer

A 
inherited risk (BRACA or BRACA2 gene in the family)
excessive alcohol consumption
being overweight
HRT (unopposed estrogen)
having 1st period at young age
older age at menopause
never being pregnant
118
Q

what is screening for bowel cancer

A

home testing kit
sent to everyone in scotland between ages of 50-74 every 2 years
easy
take 2 samples of poo on 3 separate occasions then seal up and send away in the post
look for small amount of blood invisible to the human eye

if get a normal result then this is good as there has been no blood found, dont have to do anything else just do another test in 2 years

if get an unclear result then this means that there has been a little amount of blood found but this is normally fine and doesnt automatically mean you have bowel cancer
asked to do the test again
may need to a have a colonoscopy to be sure

119
Q

what is the purpose of screening

A

screening can help detect cancer at earlier stage when it is easier to treat

120
Q

what notes should someone taking break through paint relief make

A

how often they need to take pain relief
if there are any activities that make pain worse or better
if there are any times of the day that pain is worse

121
Q

what is ESR a marker of

A

erythrocyte sedimentation rate
a non-specific blood marker of inflammation
used within DAS28 as a marker to assess diseases severity in RA

122
Q

how often is DAS28 score taken

A

every 4 weeks in early stages of disease/management

123
Q

when can a biologic medicine be introduced in RA treatmnet

A

if you have tried at least 2 DMARDs first
they are expensive
they work best alongside another DMARD
need to have had high disease activity (at least 5.1 on at least two occasions)

e.g end up on steroid + methotrexate + infliximab

124
Q

should steroids be used as long term therapy

A

no as they cause adrenosuppression and adverse effects

patients should be informed of risks and given steroid treatment card

125
Q

how is chemotherapy dosed

A

BODY SURFACE AREA

in practice dose banded based on weight (this makes it safer and easier as it is impractical to administer specifically calculated doses to every single patient)

126
Q

what tests should be conducted before chemotherapy is commenced?

A 
Full blood count
urea
LFT
creatine
ECHO (if chemo medicines are cariotoxic e.g. anthracyclines)

so you can determine renal and hepatic baseline

127
Q

what counselling should be done with patient before administering chemotherapyy

A 
how it will be adminsitered
how long will treatment last for
how it will affect their daily living/quality of life during treatment 
side effects
risks
potential benefits
128
Q

how is chemotherapy adminsitered

A

IV peripheral line

max syringe size is 50ml

129
Q

what labels should be put on chemotherapy medicines

A 
name
1of 2 etc
drug
dose 
expiry
storage conditions
cytotoxic
130
Q

what should be started before the chemotherapy

A

anti-emetic (e.g ondansetron)

131
Q

what does palliative care offer

A

relief from pain
relief from other symptoms
support for the patint
support for the family

132
Q

what do palliative care pharmacies have to have1

A

maintain stock of speciaslist medications at all times
offer advice and support
offer courier service
attend training day annually
provide out of hours supply of the special medicines

133
Q

how often should oral care be provided to palliative care patients suffering with mouth issues

A

every 4 hours

134
Q

what are some signs of poor glycaemic control

A 
sudden weight loss or weight gain
always thirsty 
wounds that dont heal quickly
increasing UTI/ infections
frequent need to urinate
signs of retinopathy
135
Q

what is ketoacidosis

A

hewn a person has a very high blood sugar and not enough insulin
because there isn’t enough insulin the body canny use sugar as a fuel so instead it starts to break down fat and use that instead
fruity smelling breath

136
Q

what is the BP aim for diabetics

A

130/80

lower than non-diabetics as they are at a higher risk of CV events already

137
Q

what advice should be given to someone taking insulin

A

to always have a fast acting form of glucose available at all times
e.g dextrose tablets, glucose contains sweeties (eg jelly babies) glucose containing drinks (eg full fat coca-cola or fruit juice)

138
Q

how is diabetes managed in pregnancy

A

take folic acid (pre-conception and 1st trimester)
metformin is ok
most diabetic ladies will have a healthy baby
can be of a higher birth weight which may make labour difficult
at a higher risk of misscarriage

139
Q

what factors does a disease need to have for a screening test to be used

A 
prevlaant
delectable from early stages
treatable
suitable exam/test
facilites for diagnosis and treatment

test must acceptable for the general population
not harmful or painful
relatively quick and easy

140
Q

why may a patient be receiving enteral feeding

A

dysphagia (because of stroke, parkinson’s, motor neurone disease etc)

partial intestinal failure (because of IBD)

psychological problems (depression, anorexia)

141
Q

what is continuous enteric feeding

A

slow rate of feeding over 24 hours

142
Q

what is cyclic enteric feedinc

A

continuous feed over 8-20 hours

can be done over night

143
Q

what is bolus enteric feedin

A

mimic eating patterns

4-6 times a day

144
Q

what is intermittent feeding

A

simular to bolus but with longer periods of feeding

145
Q

what medicines should be stopped on ‘sick days’

A 
ACE inhibitors
ARBs
NSAIDS
diureitcs
metformin

restart 24-48 hours after sickness diarrhoea has stopped

146
Q

what is an ADR

A

an unwanted/undestirable effect from a medicine that occurs during normal clinical use

147
Q

what factors need to be considered when deciding whether adverse event has been caused by a drug or not

A

Timing
Recovery
Independent evidence
Predictability

timing:
does the event stop when the drug is stopped
does the event start again when the drug is re-started
is it dose dependent

148
Q

what are the types of ADR

A

A (augmented) dose dependent and predictable from known pharmacology

B (bizarre) unpredictable, not dose dependent, often dangerous/ rare/ fatal

C (chronic) because of prolonged treatments

D (delayed) occurs after years of treatment, years later on

E (end to use) occurs when you stop takingbthe drug

T (teratogenic)

149
Q

are ACE inhibitor good for your kidneys

A

yes they are renally protective when your renal function is good
( they have been shown effective in preventing or at least slowing progression of renal disease in patients with diabetes by interfering with the renin angiotensin system , they also lower the intraglomerular pressure)
they are also cardio protective (good for your heart)

but they shouldn’t be used in renal impairment

150
Q

what side effect is more common in patients with renal impairment

A

hyperkalaemia

151
Q

what diuretics cause hyperkalaemia

A

potassium sparing ones
spironolactone
amilioride
eplerenone

152
Q

what diuretics cause hypokalaemia

A

thiazide
thiazide like
loop

depends on duration of action and potency
risk greater with thiazide like rather than loop

153
Q

what medicines are used for rate control

A

flecanide

amilioride

154
Q

what medicines are used for hythrym control

A

calcium channel blockers
dilttiazem
verapamil
beta blockers

155
Q

what is used to estimate stroke risk in AF

A

CHA2DSVASC

Congestive heart failure (1)
Hypertension (1)
Age >75 (2)
Diabetes
Stroke/TIA/Thromboembolism (2)
Age 65-74 (1)
Sex female (1)
156
Q

what classes of drugs are the highest likelihood to cause falls in elderly people

A

drugs that work on the brain

drugs that work on the heart and circulation (reduces HR or BP)

157
Q

generally what effect of medicines can cause old people to fall over

A 
sedation
hypo. glycaemia
confusion
vestibular damage
orthostatic hypotension
impaired postular stabiltiy
hypothermia
dehydration
visual impairment
drug induced parkinson's diseae
158
Q

what are the bad consequences of old people falling ocer

A 
fractures (especially femur and hip)
soft tissue ijuries
haematoma
condusion
social consequences (loss of independence, loss of mobility, limited social activity)
sudden ageing
hospitalisation
immobilisation
disability
death
159
Q

why can reduced blood pressure cause falls inelderley peopel

A

maintaining consciousness and an upright posture requires adequate blood supply to the brain which requires adequate pulse and blood pressure

in elderly people BP<110mmHg is associated with an increased risk of falls

160
Q

are drug levels changed in pharmacokinetic interactions

A

yes

161
Q

are drug levels change in pharmacodynamic interactions

A

no

162
Q

when is an oral syringe used

A

when the volume that needs to be adminsitered is not devisable by 5 or 2.5 ml

163
Q

what is an unlicensed medicie

A

a medicine that doesnt have a marketing authorisation in the UK for the indication that it is being used for
means that there is no evidence for efficacy or safety in treating this condition

164
Q

what is a special medication

A

a medicine that is specially manufactured for a named patient and is manufactured by a company that is a holder of a MHRA specials licence (MS)
it is an unlicensed medicine in this formulation
often it is a medication act isn’t routlinley given in this formulation
the marketing authorisation doesnt have a MA (it is unlicensed)

165
Q

what is a martketing authorisation

A

HMR (2012) states that a medicine placed int eh marker t in the UK needs to hold a marketing authorisation
this means that the medicine has been approved bt the european commission or the MHRA and meets appropriate standards of efficacy, quality and safety

166
Q

what responsibility does the pharmacist hold int eh supply of unliscenced medicines

A

the pharmacist has professional responsibility as the purchaser of the unlicensed medicine

167
Q

what three things are required for covert administrationt o be allwed

A

patient doesnt have capacity
treatment is deemed necessary and that this is the least restrictive option for the patient
there is a best interest meeting

168
Q

what is an early access programme?

A

ethical/compliant/ controlled access of a medicine to patients that has undergone clinical trials but isn’t commercially available yet
advantages are that they are made available to the patients at a reduced cost
earlier access
compassionate use, patient will benefit
life extension (often used in palliative situation)

disadvantage is the results aren’t published

169
Q

what do you have to go through to get unliscenced mediciens

A

scottish drug tarriff
if listed in part 7 of the drug tarrif then this is the maximum money health board will pay including out of pocket costs

if not listed in part 7 of the drug tarriff then this means that authorisation is needed from the health board
get a ref. code from the health board and write this on the prescription

170
Q

what are some advantages of guidelien

A

improve quality of care
improve health outcomes
improve promotion of interventions of proven value
empower the patient as they can look up the guidelines
standardise treatment across the country seen as fair

171
Q

what are some disadvantages of guidelines

A

not individualised
guidelines based on the condition as a single disease, often in reality they are a co-morbidity
many different gudliens for a single condition may have conflicting ideas

172
Q

what are the requirements for a vet presctiption

A

name/address/telephone no/qualification and signature of the prescriber

name/ and address of owner

identity and species of the animal (and address if different)

date

name, Q, dosage instructions of the medicine (as directed unacceptable)

any necessary warnings and withdrawal period if there needs tp be time before the animal can be eaten

if appropriate stamens highlighting that the medicines has been prescribed under the veterinary cascade

if CD needs to be “prescribed for an animal under my care”

173
Q

what does the veterinary cascade allo

A

supply of medicines that aren’t licences for animals (although if there is a MHRA listened formulation available for that animal than that needs to be used first)

174
Q

EXPLAINT HE veterinary cascade

A

supply licenced veterinary medicine for that species

when the above isn’t available consider an existing veterinary medicine with UK licence for another species or another condition

when the above isn’t available consider listened human medicine or an EU licencesd veterinary medicine

when the above isn’t available then extemporaneous prepation

175
Q

veterinary labelling must include (unless already on box0

A 
usual labelling details+ ...
name of veterinary surgeon
name and address of owner
identification and species of the animal (buttons the rabbit(
for animal treatment only
176
Q

how long to records of veterinary medicines have to be kept for

A

5 yrs

name of medicien
date of receipt or supply
batch number
quantity
name and address of supplier or recipient
177
Q

what records need to be kept of CDs

A

PURCHASED
date supply was recieved
name and address of the supplier
quantity

SUPPLIED
date supplied
name and address of person supplied
details of authority to prescribe (doctor)
q supplied
person collecting and their name (if a HCP their name and address)
whether proof of ID was requrested
whether ID was provided 
running balance

Class Test (2 decks)

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