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PHAY0010 > Special Patient Groups [completed] > Flashcards

Special Patient Groups [completed] Flashcards

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1
Q

What are some special patient groups?

A

Patients with:
Asthma
Diabetes
Kidney, Liver and Cardiovascular disease
and more…

Athletes
Pregnant people
Elderly
Children

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2
Q

What advice is there regarding giving medicines to pregnant patients?

A

Give as few medicines as possible at the lowest effective doses for as short a duration as possible

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3
Q

Are herbal medicines a safer alternative to conventional medicines?

A

NO - less regulation/ evidence for use in pregnancy and constituents may be toxic, have pharmacological activity or be contaminated.

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4
Q

When do medicines pose the greatest risk during a pregnancy?

A

3-11 weeks - risk of teratogenicity
Trimester 2 and 3 - there is still a risk to growth, functional development and toxicity

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5
Q

What can medications given short before term or during labour do?

A

Have adverse effects on labour and the neonate after delivery

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6
Q

What needs to be considered when supplying medication to women who are breastfeeding?

A

Does the medication pass into milk and how much - look at pH and lipid solubility?
Will this be harmful to the baby?
Will medicines affect supply of milk and what are the consequences of this - what alternatives may be given?
Will the medication affect the babies ability to suckle?
- Sedatives/codeine can affect suckling ability of baby –> cannot feed so effect on nutrition

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7
Q

When medicines are not contraindicated it is important that they are:

A

Taken after feeds wherever possible

At the lowest effective dose

Shortest duration of treatment possible

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8
Q

What are some common conditions that pregnant women may ask a pharmacy about?

A

Nausea and Vomiting
Pain and Fever
Coughs and colds
Threadworm
Headlice
Heartburn and Indigestion
Constipation
Haemorrhoids
Diarrhoea
Cystitis
Fungal Infections
Dermatitis
Hayfever and allergies
Conjunctivitis
Anti-malarials

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9
Q

What may the GP prescribe in women suffering from nausea and vomiting during pregnancy?

A

Antiemetics such as cyclizine or promethazine BUT only if ESSSENTIAL

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10
Q

What is available over the counter for women suffering from nausea and vomiting during pregnancy?

A

NOTHING

DO NOT GIVE TRAVEL SICKNESS MEDICINES

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11
Q

What is some self-care advice that can be given to women suffering from nausea and vomiting during pregnancy

A

Having a drink and a ginger biscuit before getting out of bed as ginger can help with nausea
Wearing travel BANDS used to prevent travel sickness
Maintaining hydration if vomiting

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12
Q

What can be provided to women suffering from pain and fever during pregnancy?

A

PARACETAMOL AT LOWEST EFFECTIVE DOSE AND SHORTEST DURATION

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13
Q

Are NSAIDs recommended during pregnancy?

A

Should be avoided, especially in the third trimester

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14
Q

What effect can aspirin and ibuprofen have during pregnancy especially in the third trimester?

A

Aspirin can impair platelet function
Aspirin and Ibuprofen can affect onset and duration of labour

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15
Q

What can be given to breastfeeding women who are experiencing pain?

A

Paracetamol and Ibuprofen

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16
Q

Why is OTC aspirin not allowed to be taken by breastfeeding women?

A

can pass through milk and cause Reye’s syndrome in the baby

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17
Q

What is reyes syndrome?

A

A condition that causes swelling in the liver and brain

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18
Q

Aspirin 75mg may be taken by breastfeeding women under what condition?

A

Prescribed by the GP and no other contraindications

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19
Q

What non-drug advice may be given to pregnant women experiencing back pain?

A

exercising in water
massage therapy

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20
Q

Why are many cough and cold medicines not used in pregnant or breastfeeding women?

A

They usually contain suppressants, expectorants and decongestants which are not licensed in pregnancy and breastfeeding?

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21
Q

What could be recommended to a patient with a cough or cold who is pregnant or breastfeeding?

A

Can take paracetamol for fever.
Use of steam inhalation, saline and nasal sprays, and NON MEDICATED glycerin pastilles to lubricate the throat
Make sure they are drinking plenty of fluids

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22
Q

What is the role of pseudoephedrine in cough and cold medicines?

A

Decongestant

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23
Q

What effect can pseudoephedrine have on breast milk?

A

Reduces breast milk production

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24
Q

What effect can codeine have if taken during breastfeeding?

A

Sedation of the infant
Effect on suckling ability
Constipation

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25
Why do pregnant women commonly have heartburn?
Pressure of baby against stomach and hormonal changes. It is more common in the later stages as the baby gets heavier.
26
What medications can be given to treat heartburn in pregnant women?
Alginates such as gaviscon but they require caution
27
Why do alginates require caution in pregnancy?
High in sodium if patient is predisposed to a high BP can lead to pre-eclampsia or eclampsia
28
What effect may aluminium based alginates have in pregnancy?
Can aggravate constipation
29
Can PPIs be recommended OTC in pregnancy?
No - omeprazole MIGHT be allowed but check product licensing and SmPC first
30
What is the recommended treatment for heartburn and indigestion in pregnant women?
Lifestyle and diet changes before drug treatment - avoiding trigger foods -propping up upper body when sleeping -smaller meals - try to not eat 3 hours before bed - Drink plenty of fluid
31
What is the recommended treatment for constipation in pregnant and breastfeeding women?
First make changes to diet such as increasing fibre and sorbitol intake then if ineffective use drug treatment
32
What drug treatment is okay for constipation in pregnant and breastfeeding women?
Bulk forming (fybogel) and osmotic (lactulose) laxatives ONLY if dietary changes have been ineffective
33
Why are stimulant laxatives like Senna, docusate and bisacodyl not reccomended OTC in pregnancy?
They stimulate smooth muscle - uterus is made up of smooth muscle causing contractions.
34
Why are stimulant laxatives like Senna, docusate and bisacodyl not reccomended OTC in breastfeeding?
The baby can get colic and diarrhoea due to peristaltic activity if in breast milk
35
Why is it important for breastfeeding mothers to drink plenty of fluid?
A lot of their fluid intake is used to make milk so it is important they stay hydrated
36
Why are haemorrhoids so common in pregnancy?
Pregnant women likely to be constipated and there is pressure on the blood vessels in the anus and rectum due to the baby
37
When do symptoms of haemorrhoids resolve in pregnancy?
after baby is delivered
38
What products are not licensed for OTC use in pregnancy for the treatment of haemmorhoids?
Hydrocortisone
39
In general should haemorrhoids in pregnancy be treated OTC?
No. Patient should be referred to the GP if this is their first time having haemmorhoids and if symptoms are very painful or severe
40
What lifestyle advice could be given for treating haemorrhoids in pregnancy?
Dietary advice - increase fibre and sorbitol - drink plenty of water Discourage straining such as lifting heavy loads
41
What is the first line treatment for headlice in pregnancy and breastfeeding?
Dimethicone 4% (Hedrin) (HEDRIN IS FIRST LINE IN ALL PATIENT GROUPS) Wet combing with conditioner regularly
42
What is the first line treatment for THREADWORM in pregnancy and breastfeeding?
STRICT HYGIENE RULES ONLY FOR 4 -6 WEEKS Washing hands thoroughly with soap and warm water Keep fingernails short and avoid biting nails or scratching around the anus. Shower every morning to remove eggs from skin Change bed linen and nightwear daily Do not shake out clothing or bed linen as this will distribute eggs. Wash and dry clothing or bed linen in a hot cycle Thoroughly dust and vacuum and clean bathroom.
43
Can we give OTC products such as piperazine and mebendazole (OVEX) to treat threadworm in pregnant and breastfeeding women?
NO
44
Are chloramphenicol and propamidine isetionate licensed for OTC supply in treating conjunctivitis in pregnant and breastfeeding women?
NO
45
What can be recommended to pregnant and breastfeeding women who have conjunctivitis?
Boil water and add salt to make a sterile saline solution to clean the eye with
46
what should be done if a pregnant or breastfeeding woman presents with cystitis?
Refer to GP
47
Why does pregnancy increase the risk of fungal infections - especially vaginal thrush?
Hormonal changes make it easier for fungi to stick to the epithelium
48
Are OTC antifungals reccomended in pregnancy?
No
49
When can clotrimazole be given to treat fungal infection in pregnancy?
When prescribed by the GP if ESSENTIAL
50
What fungal infection is common in infants and then can affect breastfeeding mothers?
Oral thrush
51
Which product is licensed OTC to give to infants experiencing oral thrush?
Miconazole gel for infants OVER 4 MONTHS can be applied to mother's nipple
52
What is the treatment for eczema/dermatitis in pregnant or breastfeeding individuals?
Emollients
53
Is Hydrocortisone 1% licensed to be given OTC in pregnancy?
NO
54
What is the recommended treatment for diarrhoea in pregnancy and breastfeeding?
Oral rehydration sachets if the specific product is licensed?
55
If diarrhoea in pregnancy and breastfeeding has lasted over 2-3 days the appropriate action would be to....
REFER
56
Is an amtimotility drug such as loperamide reccomended to treat diarrhoea in pregnancy and breastfeeding?
NO
57
True of false. Rhinitis can be aggravated by pregnancy.
True
58
What is the first line treatment for hayfever and allergic rhinitis in pregnancy and breastfeeding?
Allergen avoidance
59
What are some examples of barrier treatments for hayfever and allergic rhinitis in pregnancy and breastfeeding? How do these work?
Vaseline, Prevalin, Haymax Coat the nasal mucosa to trap the allergen so it cannot get to receptors
60
True or false. Both sedating and non-sedating antihistamines should be avoided in pregnancy and breastfeeding.
True Should be avoided unless prescribed
61
Can topical cromoglicate and antihistamines always be given in pregnancy and breastfeeding?
can be considered - would have to check specific product licensing and SPC
62
Should pregnant women avoid overseas travel if possible?
Yes
63
What antimalarials can be given to pregnant women who have to travel overseas?
Chloroquine and proguanil in areas with P.falciparum species. BUT ONLY ON PRESCRIPTION
64
What should be prescribed alongside proguanil in pregnant women?
Folic acid
65
How does age affect risk of ADRs?
Higher risk as we get older due to changes in physiology and metabolism and excretion of drug.
66
How does age affect risk of certain diseases?
Increase in age - increase risk of certain disease states so symptoms presented in a pharmacy may have more sinister underlying cause
67
Why is constipation more common in the elderly?
Slowed down gut motility
68
What effect can long term use of a stimulant laxative have?
Lazy gut - gut becomes use to being stimulated by drug so usual reflexes stop working?
69
What is the referral time for diarrhoea in an adults vs an older person?
Adult is 72 hours. Old person is 48 hours Higher risk of dehydration
70
What should you do if a person over 55 presents with recent dyspepsia for the first time?
Refer - higher risk of ulcers, bleeds and gastric cancer
71
What can sedating histamines cause in older patients?
Sedating histamines such as chlorphenamine and promethazine can have stronger effects and can cause falls and confusion
72
Which antihistamine should be avoided in people over the age of 65?
Acrivastine (Benadryl)
73
What analgesic is generally okay for use in older patients?
Paracetamol. but should check if they are taking any other paracetamol containing products.
74
There is a greater risk of gastric ulceration in older people when taking....
NSAIDs
75
What should we check for in older patients before supplying NSAIDs?
Cardiovascular disease History of gastrointestinal disorders
76
What cause of pain is common in older patients?
Falls
77
What should we do if an older patient presents with symptoms of cystitis in a community pharmacy and why?
Refer as it is more likely for the cystitis to develop into AKI/CKD.
77
What age group are topical antifungals (e.g. clotrimazole) not licensed in for the treatment of vaginal thrush?
Over 60 - would need to be referred
78
What are some symptoms of pyelonephritis (kidney infection)
Soreness in the lower back Haematuria Fever
79
Cold and flu medicines containing which ingredients should not be used in children under six?
nasal decongestants expectorants antitussives (cough suppressants) antihistamines
80
When are antihistamines okay to be used in children under six?
Allergies relief of itching such as in chickenpox
81
What do cough syrups for children contain and what do these do?
Demulsants which moisturise the throat. THEY DO NOT SUPPRESS COuGH
82
What is the reccomended treatment for children under six with cold and flu symptoms?
Paracetamol Ibuprofen Vicks Olbas oil (3 months +)
83
For children aged 6-12 years old cough and cold medicines continuing antitussives, suppressants, antihistamines, expectorants and decongestants are to be used for a maximum of how many days?
5 DAYS
84
Hydrocortisone cream is only licensed to be sold OTC for children over what age?
10 years
85
Which products for constipation are licensed OTC for use in children?
Lactulose and califig
86
Which products for constipation does the OTC licensing vary for use in children?
Senna and stimulant laxatives
87
Oral rehydration sachets such as dioralyte can be provided to children over...
2 years old
88
Give an example of an antispasmodic. Are these licensed to be given to children under the age of six.
Buscopan - tablets not licensed in children under 6 years old
89
What should be done if a child under 2 needs to be treated with mebendazole?
Refer to nurse or GP
90
What age group is chloramphenicol eye drops licensed in?
from 2 years and over
91
Why is lidocaine gel used in children and is this use first line for this condition?
Used for teething and not first line. Only used if teething ring and massaging the gum have failed.
92
What was the change in classification for lidocaine gels for teething?
GSL --> P
93
When should children be referred if they have had diarrhoea?
aged under 1 = 1 day aged under 3 = over 2 days older than 3 = 3 days
94
Why should parents take care administering medicines if there is more than one child in the house taking the same medication?
Dose may vary based on ages and weight
95
What are some common long term conditions that can be aggravated by OTC medicines?
Respiratory conditions Cardiovascular Conditions Diabetes Epilepsy Renal and Hepatic Glaucoma Prostate Hypertrophy
96
What analgesia should be avoided in patients with congestive heart failure and why?
NSAIDs as they cause sodium and water retention
97
Why should NSAIDs be avoided in patients taking warfarin, anticoagulants, and anti-platelets especially if over 65?
Can affect clotting
98
What two NSAIDs have the highest risk of thrombotic events?
Diclofenac High doses of ibuprofen
99
Which NSAID has a generally lower thrombotic risk?
Naproxen
100
What migraine treatment is contraindicated in patients with 3 CVS factors, hypertension, previous heart attack, ischaemic heart disease and angina?
Sumatriptan
101
What can be given to patients with CVD if they have migraines?
Refer if very bad or recommend Paracaetamol Co-codamol Migraleve
102
What can happen if minoxidil reaches the bloodstream after application?
Lowers blood pressure
103
Which cardiovascular condition is minoxidil not to be used in?
Hypertension
104
What should be done if a patient would like minoxidil and they have a CVS condition?
refer to GP
105
When is sildenafil contraindicated?
If taking nitrates including poppers When sexual activity is INADVISABLE - recent MI, Stroke, unstable angina or severe heart failure Severe hepatic impairment Hypotension (less than 90/50)
106
What needs to be looked out for in diabetic patients?
Medicines that affect glucose levels Slowed healing Signs that diabetes is not controlled Comorbidities Sick day rules
107
What are some medicines not reccomended in patients with epilepsy?
Sumatriptan - CONTRAINDICATED Piperazine (for threadworm but not commercially available anymore) HIGH DOSES of antihistamines
108
What medicines should we avoid/use with caution in RENAL impairment?
Sumatriptan Piperazine Cystitis products high in potassium Products high in sodium (alginates, effervescent tablets) NSAIDS (can impact sodium and fluids) Sympathimometics/Decongestants (can cause vasoconstriction and increase pressure in renal blood vessels)
109
What medicines should we avoid/use with caution in HEPATIC impairment?
Sumatriptan NSAIDs (may have clotting changes in severe impairment) Piperazine
110
What medicines should we avoid/use with caution in GLAUCOMA?
Antimuscarinics: Antihistamines Hyoscine Analgesia for headaches : headaches may indicate glaucoma getting worse Sympathimometics = vasoconstriction increases IOP
111
What medicines should we avoid/use with caution in PROSTATE HYPERTROPHY?
Antihistamines Hyoscine Sympathimometics
112
Why may sports athletes use drugs?
Therapeutic use for medical conditions Performance enhancement Social and recreational use
113
Drug testing carried out by sports athletes can detect...
all medicinal products
114
What substances are prohibited all the time in and out of sports competitions?
Non-approved substances Anabolic agents Peptide hormones, growth factors and related products, mimetics Beta 2 agonists Hormone and metabolic modulators Diuretics and masking agents - help hide or flush out illegal substances
115
What substances are prohibited during sports competitions?
All of the substances that are prohibited all the time as well as Stimulants Narcotics Cannabinoids Glucocorticoids
116
What substances may be prohibited in particular sports?
Alcohol - due to safety reasons such as in motorsports or archery Beta-blockers - need for steady hand in archery
117
What resource can be used to check if licensed medicines are allowed in and out of competitions?
Global drug reference online
118
What are some commonly used supplements by athletes?
Carbohydrate drinks Protein supplements Amino acids Vitamin Supplements Glucosamine Nutritional ergogenic supplements: creatine, caffeine, sodium bicarbonate and sodium citrate
119
As there is an increasing availability of commonly used supplements, there is a risk of....
supplements being laced.
120
What is the role of Informed Sport?
Testing batches of supplements for prohibited substances.

PHAY0010 (27 decks)

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