Responding to Symptoms - CNS

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  • Created by: LBCW0502
  • Created on: 24-11-18 16:08
Outline the RTS consultation framework
Scene setting, information gathering, problem identification, actions and solutions, closing, consultation behaviours - important to listen to patient's answers and promote self-care/sign-posting
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What is motion sickness?
Disagreement exists between visually perceived movement and the vestibular system's sense of movement
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What are the types of motion sickness?
Sea, car, air and train
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Describe the epidemiology of motion sickness
More common in women than men. Uncommon in children under 12. Most common age between 2 and 12. Highest incidence at 12, then reducing. After 21, declines with age. Women more susceptible during menstruation and pregnancy
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What are the muscarinic effects of motion sickness?
Nausea and vomiting, dizziness, headache, increases salivation, general malaise/drowsiness, pallor, sweating, yawning, hyperventilation, gastric motility reduced, digestion impaired
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Describe features of differential diagnosis for motion sickness
Nausea and vomiting occur in a wide range of conditions but symptoms of motion sickness are usually associated with travel. Patients always ask for advice on prevention rather than treatment. Mal de barquement syndrome. Labyrinthitis
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Describe features of hyoscine hydrobromide
Naturally occurring alkaloid. Anticholigeric. Most effect, short acting, more antimuscarinic side effects than antihistamines. 0.15-0.3 micrograms. 1 tablet every 6 hrs PRN, also comes as patches (over age of 10)
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Describe features of 1st generation H1-antagonists (antihistamines)
Anti-allergic/antipruritic/antitussive/anti-muscarinic effects (anti-emetic and sedation). Sedating antihistamines slightly less effective but better tolerated than hyoscine. Compound selected based on anti-emetic properties/length of action/effects
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Describe features of 2nd generation H1-antagonists (antihistamines)
Lower lipid solubility (doesn't cross BBB), have little or no central activity, no value for motion sickness
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Give examples of antihistamines
Cinnarizine, meclozine and promethazine (hydrochloride, teoclate - acts longer)
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What are the side effects of hyoscine and antihistamines?
Drug mouth, blurred vision, urinary retention, constipation, sedation
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What are the cautions and contra-indications for motion sickness?
Avoid glaucoma/prostatic hypertrophy, alcohol, pregnancy/breast-feeding. Caution in elderly, patients with epilepsy or CVD, increase sedation/anti-muscarinic actions of other drugs e.g. antidepressants, antipsychotics, PD drugs
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What are the self-care tips for motion sickness?
Avoid heavy meals/pungent odours/alcohol, look outside window/stay away from engine/below deck/back of bus, in air travel try to sit by the wing, sit in passenger seat, listen to radio, don't read (pregnancy - ginger/acupressure wristbands)
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What is insomnia?
A sleep disorder where sufferer finds it difficult to fall and/or stay asleep - can affect mood, lifestyle, work, health risks
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Outline the sleep cycle (circadian rhythm)
Interim between consciousness and sleep. Heart rate slows, brain does less complicated tasks. Body makes repairs. Body temperature and BP decreases. Increase eye movement, heart rate, breathing, BP and temperature
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State features of the epidemiology of insomnia
More common in women, age. Melatonin/serotonin/dopamine levels affect sleep, mood and dreams. (Mental Health Foundation - 1/3 of adults in the UK may suffer insomnia)
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What are the symptoms of insomnia?
Difficulty sleeping, waking up often during the night, difficult to get back to sleep. Waking up too early in the morning. Feeling tired upon waking. Significant impairment of daytime functioning (fatigue, mood, concentration, irritability)
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What are the signs of sleep deprivation? (1)
Decreased communications, performance deterioration, poor concentration/easy distraction. Poor cognitive assimilation and memory. Poor mood/inappropriate behaviour. Greater risk-taking behaviour. Inability to make necessary adjustments
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What are the signs of sleep deprivation? (2)
Increased caffeine intake, increase sickness/sickness absence
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How is insomnia classified by type?
Primary insomnia - sleep problems not directly associated with illness. Secondary insomnia - due to health condition e.g. asthma, depression, medicines etc.
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How is insomnia classified by duration?
Transient (2/3 days e.g. jet lag). Short term/acute (1-4 weeks). Long term/chronic (at least 3 nights per week for 4+ weeks) - Pharmacy treats transient (referral for chronic insomnia)
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What are the causes of insomnia?
Medical/psychiatric (e.g. dementia, bipolar etc.). Iatrogenic (alcohol, caffeine etc.), psychosocial (jet lag, poor sleep hygiene etc.)
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What are the self-care tips for insomnia?
Good sleep hygiene, sleep diary, apps to track sleep. Eat 2-3 hours before sleep. Avoid caffeine/alcohol. Exercise, breathing techniques. Medication. Bedroom environment (e.g. mattress, temperature, avoid TV etc.)
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Describe features of diphenhydramine hydrochloride
Sedative/anti-muscarinic effects. OTC (for 16+ years), short term use, combination products for insomnia due to pain (paracetamol)
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Describe features of promethazine hydrochloride
Marked sedative properties, hangover drowsiness, 16+ years, short term use only
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What are the cautions for insomnia?
Consider patients taking POMs containing caffeine/stimulants. Interactions with other medicines (antihistamines interact with alcohol/sedative effect). Prolonged sedative effects of antihistamines. Short term use of antihistamine based sleep aids
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What are the herbal products used to treat insomnia?
Hops, valerian, passion flower, Jamaica dogwood, wild lettuce. Evidence of activity/effectiveness from in vitro/animal studies - little clinical evidence
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What is jet lag?
Occurs when your body clock is disrupted after crossing time zones
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What are the symptoms of jet lag?
Fatigue, irritability, disturbed/wakeful nights, poor concentration/memory, being less co-ordinated than normal, dehydration, change in bowel habits, poor appetite, nausea/digestion
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What are the methods to prevent jet lag?
Adjust sleeping pattern beforehand, rest during flight, adjust watch to new time zone, eat light meals, take regular walks during flight, keep hydrated, jet lag treatment if needed, avoid drinking alcohol, avoid junk food/fizzy drinks, avoid coffee
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What are the causes of epidemiology for snoring?
Overeating, lack of exercise, obesity, alcohol consumption, smoking, sleeping position, allergy, nasal stuffiness, breathing through mouth, small or collapsing nostrils (occurs more in men)
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What are the anti-snoring aids?
Nasal strips/sprays, acupressure ring, oral vestibular guards
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What are the self-care tips for snoring?
Change sleep position, lose weight, avoid alcohol, practice good sleep hygiene practice, open nasal passages, change pillows, hydration
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Other cards in this set

Card 2

Front

What is motion sickness?

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Disagreement exists between visually perceived movement and the vestibular system's sense of movement

Card 3

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What are the types of motion sickness?

Back

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Card 4

Front

Describe the epidemiology of motion sickness

Back

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Card 5

Front

What are the muscarinic effects of motion sickness?

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