Year 3 Pharmacology pt.2

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  • Created by: evepoag
  • Created on: 20-09-23 19:02
What are the 2 types of adverse drug reactions?
Type A - "Augmented"
Type B - "Bizzare"
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What is a type A augmented adverse drug reaction?
A predictable reaction, that is dose-dependent, common, with a low mortality rate, and can be managed by reducing the dose
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What is a type B bizarre adverse drug reaction?
A reaction that is unpredictable, not obviously dose-dependant, uncommon, with a high mortality rate, and can be managed only be continuing therapy
ie: anaphylaxis
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What is the prescribing cascade?
When an adverse reaction occurs due to medication and this is mistaken as a new medical condition, for which further medicine is then prescribed
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What is the scheme called to report adverse side effects/reactions?
Yellowcard scheme
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What is a STOPP/START criteria in general terms?
It the evidence-based criteria used to review medication regimens in elderly people
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What does the STOPP criteria acronym stand for?
Screening Tool of Older Persons' potentially inappropriate Prescriptions
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What is the aim of the STOPP criteria?
To reduce the incidence of medicine-related adverse events from potentially inappropriate prescribing and polypharmacy
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What does the START criteria acronym stand for?
Screening Tool to Alert to Right Treatment
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What is the aim of the START criteria?
Used to prevent omissions of indicated, appropriate medicines in older patients with specific conditions
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When is it especially important for prescriptions to be reviewed regularly?
Elderly patients, those receiving more medications, those with more diseases
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What does the NO TEARS tool acronym stand for?
Need
Open questions
Tests
Evidence
Adverse events
Risk reduction or prevention
Simplification/switches
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How often should patients attend a medicine review with their GP?
Annually
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What is it called when a prescriber stops or reduces medications, with the aim of eliminating problematic polypharmacy?
Deprescribing
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What is the generally accepted definition of a complex drug?
Uncommon products, often in atypical dosage forms
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What are biological products?
Biologics are products that come from a variety of natural sources,
ie: vaccines, blood products
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Give an example of a challenge posed by complex drug processing?
Aseptic manufacturing
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What are the 4 TYPES of complex drugs? Give one example of each of them
1. Products with complex active ingredients, ie: chemo

2. Complex routes of delivery, ie: intratumoural drugs
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What are the 4 TYPES of complex drugs? Give one example of each of them
pt.2
3. Complex dosage forms/formulations, ie: extended-release injectables

4. Complex drug-device combination products, ie: auto-injectors
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What are the 4 broad categories of complex drug products?
1. Solubilisation and bioavailability enhancement techniques = insoluble drugs with limited bioavailability

2. Drug-eluting systems = when a natural substances helps to deliver the drug, ie: depot injections
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What are the 4 broad categories of complex drug products?
pt.2
3. Sterile products

4. Highly potent APIs/controlled substances = potent APIs, such as cancer treatments, enable effective treatment with lower doses
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What is a VAD?
a Vascular Access Devices
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What are the 2 different types of VADs?
Peripheral venous access devices, and central venous access devices
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What 3 things is the chosen type of VAD dependent on?
1. Clinical need of the patient
2. Type of IV therapy needed
3. Anticipated length of therapy
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What is a PVC? Describe it
Peripheral Venous Catheter

PVCs are temporary plastic catheters in a peripheral vein to allow bolus injections, infusions, drug transfusions and medicine administrations
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What are the other common names for PVCs?
IVs, cannulas, venflons, drips
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Is a PVC short-term or long-term?
Short-term, usually when access is only needed for up to 10 days
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What type of medicine solutions are allowed to be used for PVCs?
Ones that do not damage the veins
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When would you use a yellow PVC?
Fragile veins, elderly, paediatric patients
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When would you use a blue PVC?
Chemo infusions, patients with small veins, paediatric patients
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What would you use a pink PVC?
Multi-purpose IV, medications, hydration, routine therapies
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When would you use a green PVC?
Blood transfusions, or large volume infusions
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When would you use a grey PVC?
Trauma, surgery, multiple large-volume infusions
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When would you use an orange PVC?
In massive trauma situations
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What is a midline catheter?
A temporary catheter inserted into a peripheral vein, very similar to a PICC but it is slightly shorter
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When are midline catheters used?
Typically for access up to 30 days, when patients are requiring multiple PVC insertions, or require extended-term IV access
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What does a PICC stand for?
a Peripherally Inserted Central Catheter
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What is a PICC?
Catheter inserted into a vein in the upper arm and is then advanced until tip is placed into the lower superior vena cava (SVC) or right atrium
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Is a PICC a peripheral or central VAD?
It is a central VAD that is inserted peripherally
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When should a PICC be used?
For mid-long term access during extended IV therapy, such as cytotoxic chemotherapy
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How long can a PICC be used for?
It can be used for many days, months, and sometimes up to a year or more
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What are the 4 types of PICC?
Valved, non-valved, single lumen, or multi-lumen
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Why would a multi-lumen PICC be used?
When more than one activities need to take place during the same procedure, ie: administration of nutrition, blood products, or therapeutic drugs
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What is the difference between a midline and a PICC line?
A midline is used as a peripheral line only. It is not a central line or PICC line
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What is a CVC?
a Central Venous Catheter
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What are the 2 different types of CVCs?
1. non-tunnelled central venous catheter (CVC)
2. tunnelled central venous catheter (tCVC)
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What are the 2 common access points a CVC is inserted into?
Subclavian vein, and internal jugular vein
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Describe a non-tunnelled CVC
Inserted directly into a large central vein near the heart, in the neck, chest or groin.
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What are other names for non-tunnelled CVCs?
CVC, Quinn or central line
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When would a non-tunnelled CVC be used?
In acutely unwell patient, ie: for aggressive fluid resuscitation and central venous pressure monitoring
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Is a non-tunnelled CVC long or short-term?
Short-term central VAD, it can be used for up to 29 days
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What are the 2 types of non-tunnelled CVCs?
Single or multi-lumen
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Describe a tunnelled CVC
It is sited with the tip in a large central vein in the neck, chest or groin, ending in a vein near the heart.

It is tunnelled to exit the skin surface at a distant point from the entry vein
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When are tunnelled CVCs used?
For long-term use from weeks to years, and for IV therapy, such as chemo
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What do some tunnelled CVCs have to prevent migration of the catheter and act as a barrier to reduce risk of bloodstream infections?
Cuffs
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What are the 4 types of tCVCs?
valved, non-valved, single lumen, or multi-lumen
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What is a dialysis central venous catheter?
A central VAD that is inserted into a large central vein to administer renal dialysis
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What is special about dialysis CVCs?
They have an access lumen and a return lumen to facilitate the flow of blood for renal dialysis treatment
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What is a implanted port or a 'Portacath'?
A small medical device that is placed under the skin, made up of a long catheter into a large veins near the heart, and plastic port which is inserted in the chest and attached to the catheter. A small needle is put into the port through your skin to give
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Are portacaths short-term or long-term?
Long-term vascular access
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When are portacaths used?
They allow repeated access to the venous system for the parenteral delivery of medications, etc.
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When should VADs be allowed to stay in situ and when should they be removed?
VADs can stay in longer than the manufacturer's recommended dwell time if there is a clinical indication and there are no signs of phlebitis or infection.

They should be removed for phlebitis, infection, or when no longer clinically indicated
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When should a VAD be checked and inspected?
Any time the catheter is being accessed. If it is not being used, it should be checked at least once daily
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What kind of ANTT approach is taken for VAD insertions?
A surgical ANTT approach should be used for complicated procedures with many key parts/cites and a critical aseptic filed, including sterile dressing packs, sterile gloves, and sterile drapes
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How can you prevent VAD complications and adverse events?
Practitioner education, careful insertion technique, adherence to ANTT principles, regular observation, securing the device appropriately, regular flushing to ensure latency, rotation of all lumens to reduce occlusion risk, removing immediately when it is
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What is the dwell time for peripheral venous catheters (PVCs)?
up to 10 days
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What is the dwell time for midlines?
up to 30 days, or for the duration of treatment in the larger ones
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What is the dwell time for tunnelled CVCs?
Long-term (weeks to years)
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What is the dwell time for non-tunnelled CVCs?
Short-term, up to 29 days
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What is the dwell time for implanted portacaths?
Long-term
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Other cards in this set

Card 2

Front

What is a type A augmented adverse drug reaction?

Back

A predictable reaction, that is dose-dependent, common, with a low mortality rate, and can be managed by reducing the dose

Card 3

Front

What is a type B bizarre adverse drug reaction?

Back

Preview of the front of card 3

Card 4

Front

What is the prescribing cascade?

Back

Preview of the front of card 4

Card 5

Front

What is the scheme called to report adverse side effects/reactions?

Back

Preview of the front of card 5
View more cards

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