Week 7 Flashcards
(44 cards)
what should all patients be asked regardless of how much they smoke?
asked about their interest in quitting assessed if they are nicotine dependant, offer appropriate pharmacotherapy advised to quit offered referral to proactive telephone callback cessation service
smoking cessation guidelines?
ask and assess assess nicotine dependance by asking: - minutes till first cigarette after waking? - how many cigarettes a day? - withdrawal symptoms/ cravings in previous quit attempts?
some symptoms of nicotine withdrawal?
irritability insomnia anxiety poor concentration dysphoria/ depressed
NRT clinical suitability?
everyone, including CVD
varenicline clinical suitability?
not for children not in pregnancy not in people with psychiatric disorder decrease dose in renal impairment
bupropion clinical suitability?
not for current/ past seizures do not mix with drugs that lower seizure threshold not in concurrent monoamine oxidase inhibitors
moa of dependance and withdrawal of opiates?
increased mu opioid receptor internalization and degradation decreased officiation of u-opioid signal transduction hyper activation of adenylyl cyclase signalling = enhanced GABA release and increased gene transcription via activation of transcription factors
onset/ duration of withdrawal for opiates?
heroin onset= 8-24 hrs, duration= 4-10 days methadone onset = 12-48 hrs, duration= 10-20 days
withdrawal scale for opiates?
COWS, SOWS
substitution therapies for opiates?
clonidine buprenorphine methdone
opiate substitution: AIMS
decreased spread of BBV decrease injection related harms decrease crime rates improve engagement in tx
how does naloxone help with constripation?
binds to u opioid receptors in the gut
risk of opiates?
OD, respiratory depression, miscarriage risk in withdrawal, IVDU related harms leukoencephalopathy (smoked heroin)
risk mitigation of opiates?
avoid use in chronic pain lowest dose for shortest time avoid combination with other CNS depressants
which drug class can kill in intoxication and withdrawal?
benzodiazepines
withdrawal scale used for benzos?
CIWA-B
onset and duration of withdrawal for benzos?
short acting:1-2 days; 2-7 days long acting: 2-4 weeks; 2-8 weeks
what is common mucosal immune system?
priming of lymphocytes i none mucosal tissue can induce protective immunity at other mucosal surfaces important in vaccine development
which lymphocytes are found in the GALT?
gamma-delta T cells CD8 alpha/beta T ell CD8 alpha/alpha T cells
function of J chain?
attaches poly-Ig receptor and is responsible for transporting both IgA and IgM across epithelial surfaces into lumen
what is oral tolerance?
a state of systemic hypo responsiveness induced by feeding protein
how does an immune response cause MS?
T cells recognize myelin epitopes and activate macrophages to damage myelin by phagocytosis cytokines and toxic mediators released by T cells, microglia and macrophages cause myelin damage autoantibodies through binding to myelin and activating complement facilitate phagocytosis mediated by macrophages
effects of estrogen and progesterone on immune response?
estrogen stimulates immune response progesterone dampens immune response
how are NKC involved FRT?
host defence, implantation and pregnancy
