Disease Management 3

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laurajane.price
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87325
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Disease Management 3
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2011-05-24 19:04:49
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Disease management
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Disease management 3 module flashcards
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  1. What does PQRST stand for in terms of pain assessment?
    • Provokes
    • Quality
    • Radiation
    • Severity
    • Time
  2. Which drugs does pain caused by renal colic respond well to?
    NSAIDs
  3. Cautions and Contraindications of NSAIDs
    • Caution in elderly - lowest dose for shortest time possible
    • Contraindicated in previous or active gastric ulceration
    • Cox-2 contraindicated in active gastric ulceration
    • Cautioned in hepatic impairment - lowest dose shortest time, avoid in severe disease
    • Advised avoid in pregnancy unless benefit outweighs risk, Avoid in third trimester
    • Cautioned in breast feeding
    • Cautioned in renal impairment - lowest dose for shortest time and monitor renal function - avoid if possible
    • Cautioned in cardiac impairment due to renal imparment risk
    • Contraindicated in severe heart failure
    • COX-2's contraindicated/cautioned in cardiac problems
    • Contraindicated in coagulation defects - inc risk thrombus
    • Other drugs and disease states
    • Contraindicated in allergy to aspirin or NSAIDs
  4. Side effects of NSAIDs
    • Gastric disturbance
    • Hypersensitivity
    • Headache
    • Dizziness/drowsiness
    • Nervousness/depression
    • Worsening of asthma
    • Blood disorders
    • Renal failure
    • Hepatic damage
    • Fluid retention
  5. Key principle of opioid use
    Carefully titrate dose against desired effect
  6. Most commonly used opiates
    • Morphine
    • Fentanyl
    • Oxycodone
    • Codeine
    • Tramadol
  7. Predictable problems with opioids
    • Elderly - challenge high doses
    • Children and babies
    • Respiratory disease
    • Renal failure
    • Head injury - monitor
    • Addiction
    • Acute on chronic pain
  8. Advantages of patient controlled analgesia (PCA)
    • Patient is in control
    • Fast onset
    • Reduce side effects
    • Reduction in nursing time administering drugs
  9. Disadvantages of Patient controlled analgesia (PCA)
    • Dexterity
    • Understanding
    • Safety - relatives should never administer
  10. Opioid side effects
    • Nausea and vomiting
    • Constipation
    • Drowsiness/sedation
    • Dry mouth
    • Pruritus
    • Urinary retention
    • Hallucinations
    • Euphoria
  11. Opioid cautions and contraindications
    • Cautioned in impared respiratory function and asthma
    • Avoid in COPD
    • Cautioned in hypotension
    • Reduced dose recommended in the elderly
    • Cautioned in myasthenia gravis, hypertrophy, obstructive bowel disorders, biliary disease and convulsive disorders
    • Contraindicated in acute respiratory depression
    • Contraindicated in raised intercranial pressure and head injury and comatose patients
    • Avoid or reduce dose in hepatic impairment
    • Avoid or reduce dose in renal impairment
  12. Which drugs are used for epidural anaesthesia?
    Combo of opioid and local anaesthetic

    • Diamorphine
    • Fentanyl
    • Bupivicaine
    • Levobupivicaine
  13. Epidural anaesthesia cannot be used in...
    • patients with clotting irregularities
    • allergy to the drugs used
    • severe arthritis or spinal deformity
    • infection (in the back)
  14. Advantages of epidural anaesthesia
    • Better pain relief
    • If correctly placed all central pain can be blocked
    • Patients able to mobilise
    • Reduces many opioid side effects
  15. Side effects and complications of epidural anaesthesia
    • Inability to pass urine
    • Itching
    • N&V
    • Backache
    • Headache
    • Respiratory depression
    • Infection
  16. What drugs are used when "stepping down" from epidural anaesthesia?
    Oral opioids - morphine, oxycodone
  17. When are corticosteroids used for pain relief?
    Cancer, head and neck surgery
  18. Psychological symptoms of anxiety
    • Fearful anticipation
    • Irritability
    • Poor concentration
    • Restlessness
    • Sensitivity to noise
    • Disturbed sleep
    • Poor memory
  19. Physical symptoms of anxiety
    • Dry mouth
    • Difficulty swallowing
    • Wind
    • Loose motions
    • Tinitus
    • Blurred vision
    • Dizziness
    • Constricted chest/difficulty inhaling/overbreathing
    • Palpitations/heart pain/missed beats/neck throbbing
    • Increased micturation
    • Lack of libido/impotence
    • Muscular tension
    • Panic attacks
  20. Panic disorder NICE guidance
    Psychological therapy

    • Pharmacological therapy:
    • SSRI
    • 2nd line tricyclics: clomipramine, imipramine
    • (12 week trial for 6m then taper off)
  21. Generalised Anxiety Disorder NICE guidance
    • Immediate treatment
    • Support/information/problem solving
    • Benzodiazepines 2-4 weeks max
    • Sedating antihistamines (unlicensed)
    • Longer term care:
    • Psychological therapy
    • SSRI - start low dose
    • SNRI: venlafaxine 75mg/day, duloxetine 30mg/day (max 120mg/day)
    • Pregabalin 150mg/day (max 600mg/day)
    • Specialists: atypical antipsychotics
    • Monitoring: side effects and medication effectiveness 2,4,6,12 weeks
  22. Benzodiazepine mode of action
    Act on GABA receptors - agonists
  23. Benzodiazepines can mask...
    depression
  24. Long half life benzodiazepines
    • Diazepam
    • Alprazolam
    • Chlordiazepoxide
    • Clobazam
  25. Short half life benzodiazepines
    • Lorazepam
    • Oxazepam
  26. Most addictive benzodiazepine
    Lorazepam
  27. Benzodiazepine side effects
    • Drowsiness
    • Lightheadednes
    • Confusion
    • Ataxia
    • Amnesia
    • Paroxodical increase in aggression
    • Dependence with pronounced withdrawal syndrome
    • Headache
    • Vertigo
    • Hypotension
    • Salivation changes
    • Gastric changes
    • Rash
    • Visual disturbances
    • Libido changes
    • Urinary retention
    • Blood disorders
    • Jaundice
    • Apnoea
  28. Symptoms of benzodiazepine dependence/toxicity
    • Unsteadiness of gait
    • Disarthria
    • Drowsiness
    • Nystagmus
  29. Benzodiazepine withdrawal symptoms
    • Insomnia
    • Tremor
    • Anxiety
    • Restlessness
    • Tinnitus
    • Perceptual disturbances
    • Convulsions
    • Appetite disturbance
    • Weight loss
    • Sweating
    • Confusion
    • Toxic psychosis
  30. How to stop benzodiazepines
    • Switch to long acting diazepam - equivalence tables
    • Reduce dose by 2mg/fortnight
    • If symptoms occur maintain dose until improved
    • Reduce dose in smaller steps
    • Avoid other drug use if possible
  31. Beta blockers can be used to treat anxiety
    True - physical symptoms only
  32. Buspirone in anxiety
    • Short term use
    • 5HT receptors
    • Response takes up to 2 weeks
    • Side effects:
    • N&V
    • dizziness/lightheaded
    • headache
    • nervousness/excitement
  33. Prolonged action hypnotics with "hangover effects" the next day
    • Nitrazepam,
    • flunitrazepam,
    • flurazepam,
    • diazepam
  34. Short acting hypnotics with little chance of "hangover effects"
    • Loprazolam
    • lormetazepam,
    • temazpam

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