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131 Cards in this Set
- Front
- Back
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Define the goals of Healthy People 2010.
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1. Increase quality and years of life
2. Eliminate health disparities |
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Identify the Leading Health Indicators.
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Physical activity
Overweight & obesity Tobacco use Substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality Immunization Access to health care |
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What is preventive healthcare?
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Healthcare that focuses on the health of individuals and defined populations in order to protect, promote, and maintain health and well-being and prevent disease, disability, and premature death.
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List the determinants of health.
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Genetics
Social circumstances Environmental exposure Health care Behavioral patterns |
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Which of the following determinants of health contributes the MOST to premature death?
Behavioral patterns Genetics Health care Social circumstances |
Behavioral patterns
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Describe the role of the pharmacist in preventive healthcare.
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-Advocacy
Brochures, education materials Risk assessment quizzes Demonstrate use of various devices -Facilitation Sponsor screenings/health fairs Ask other healthcare professionals to provide services -Provision Health screenings Disease state management Immunizations |
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What are the Five Stages of the Transtheoretical Model of Behavior Change?
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Precontemplation
Contemplation Preparation Action Maintenance |
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What are some factors that contribute to relapse?
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Emotional distress
Social pressure Guilt and self-blame for lapses or one-time slips Overconfidence Frequent temptation Desire for immediate gratification |
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How would you help a patient prevent a relapse?
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Understand a ‘slip’ or a ‘lapse’ versus a ‘relapse’.
Identify the high-risk situations that make them vulnerable. See lapses as learning experiences. Have a plan, in the event of a lapse, to go back to the new behavior regimen without feeling guilty. |
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How would you calculate body mass index (BMI)?
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[weight (pounds) / height (inches2)] X 703
[weight (kg) / height (m2)] |
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What are the BMI Classifications?
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Underweight < 18.5 kg/m2
Normal 18.5-24.9 kg/m2 Overweight 25-29.9 kg/m2 Obesity Class I 30-34.9 kg/m2 Obesity Class II 35-39.9 kg/m2 Extreme Obesity ≥ 40 kg/m2 |
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What would be considered a high risk waist circumference? M/F?
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Men > 102 cm (> 40 in)
Women > 88 cm (> 35 in) |
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What are the Components of Physical Activity?
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Warm-up
Stretching activities Aerobic conditioning Resistance training Cool-down |
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List the macronutrients and their RDI.
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Recommended total carbohydrate intake for adults = 45-65% of total daily calories
Recommended total protein intake for adults = 10-35% of total daily calories Recommended total fat intake for adults = 20-35% of total daily calories |
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What is considered healthy weightloss?
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A 10% reduction in total body weight over 6 months
Suggested rate of loss = 0.5-2 pounds/week A calorie deficit of 500-1000 kcals/day will result in an approximate 1-2 pounds of weight loss per week |
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Identify the 5 major components of MyPyramid and the general recommendations to meet the needs of a 2,000 calorie diet
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Grains: 6oz
Veg: 2.5 cups Fruits: 2 cups Milk: 3 cups Meat: 5.5oz |
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List the symptoms of nicotine withdrawal.
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Depression
Insomnia Irritability/frustration/anger Anxiety Difficulty concentrating Restlessness Increased appetite/weight gain Decreased heart rate Cravings* |
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NICOTINE PHARMACODYNAMICS (How does it effect the body)
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-Cardiovascular system
vasoconstriction -Central nervous system Pleasure, Arousal, Anxiety relief -Other Appetite suppression Increased metabolic rate |
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What are the 5A's?
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Ask: about tobacco use
Advise: tobacco users to quit Assess: readiness to attempt quitting Assist: with quit attempt Arrange: Follow-up care |
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What are some non-pharm ways to quit smoking?
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-Cold turkey: Just do it!
-Unassisted tapering (fading) -Assisted tapering -Formal cessation programs -Aversion therapy -Acupuncture therapy -Hypnotherapy -Massage therapy |
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List the Disease Outcomes Resulting from Hypertension
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1. Brain (stroke, transient ischemic attack, dementia)
2. Eyes (retinopathy) 3 Heart (left ventricular hypertrophy, angina or myocardial infarction, heart failure) 4. Kidney (chronic kidney disease) 5. Peripheral vasculature (peripheral arterial disease) |
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List the complications of DB
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CVD (heart disease, stroke)
Blindness (retinopathy) Kidney disease (nephropathy) Amputations (neuropathy) Dental caries Complications with pregnancy |
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Classification of Blood Pressure
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Normal < 120
Prehypertension 120-139 Hypertension Stage 1 140-159 Stage 2 >160 |
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List the Goal BP values
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1. Most Patients: < 140/90 mm Hg
2. Patients with Diabetes: <130/80 mm Hg 3. Patients with Chronic Kidney Disease: < 130/80 mm Hg |
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Identify the Risk Factors for HTN
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Genetics
Obesity Sodium consumption |
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How would you Decrease SBP Resulting from Lifestyle Modifications
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Weight loss 5-20 mm Hg
DASH diet 8-14 mm Hg Decrease sodium intake 2-8 mm Hg Physical activity 4-9 mm Hg Moderate alcohol consumption 2-4 mm Hg |
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List the Risk Factors for Dyslipidemia
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Genetics
Physical inactivity Cigarette smoking Excess alcohol intake Diabetes mellitus Hypothyroidism Kidney disease |
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Risk Factors for Cancer
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Genetics
Tobacco use Environmental exposures Obesity -Colon -Breast -Endometrial -Kidney -Esophagus |
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Lab values for FPG and RPG in normal patients vs. DB patients.
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Diabetes FPG >126 RPG>200
Normal FPG 70-100 RPG<140 |
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List some risk factors for osteoperosis
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Family history
Physical inactivity Smoking Low calcium & vitamin D intake Advanced age Female gender Caucasian or Asian Small stature Low body weight (< 125 lbs) Postmenopausal |
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Pathophysiology of Heartburn
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-Dec. resting tone of LES
-Impaired esophageal clearance -Inc. intra-abdominal pressure -Inc. mucosal resistance |
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What are some lifestyle modifications to prevent heartburn?
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Weight loss
Elevation of the head of the bed Eating smaller meals Avoidance of eating within 3 hr prior to sleep Avoidance of exacerbating foods, medications, and alcohol Smoking cessation |
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Which medications can cause heartburn?
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Aspirin
(NSAIDs) e.g. ibuprofen Iron Potassium Bisphosphonates e.g. alendronate |
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Pharmacologic therapy for heartburn
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Antacids
Histamine2 (H2)-receptor antagonists Proton pump inhibitors (PPIs) |
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Which antacid has the potential to give black tongue/stool?
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Bismuth subsalicylate
Pepto-Bismol® |
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Describe the MOA for antacids.
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MOA: Act as buffering agents in the esophagus, stomach, and duodenum .
Cations interact with Cl-, anions interact with H+ to form H20 Inc. stomach pH |
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Onset/duration of antacids?
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Fast onset, short duration
Onset < 5 min Liquid faster than tablets Duration = 20-30 min Food may prolong duration |
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Administration Considerations of antacids?
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Take at onset of symptoms
Should not be used regularly for more than 2 wk Separate by ≥ 2 hr from other medications May bind to and Dec. absorption of medications Dosed multiple times a day Do not exceed product-specific maximum daily dose |
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MOA of H2 antagonists?
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MOA: Inhibit histamine2 receptor-mediated acid secretion
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Onset/duration of H2 antagonists?
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Onset = 30-45 min; Duration = 4-10 hr
Cimetidine is shortest acting |
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Which medication can possibly dec. libido, impotence, and cause gynecomastia?
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Cimetidine
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Adverse effects of H2 antagonists?
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Headache, diarrhea, constipation, thrombocytopenia
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Administration Considerations for H2 antagonists?
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May be used at onset of symptoms or 30 min – 1 hr before meal when heartburn is anticipated
Should not use more than twice daily Refer to health care provider if used for more than 2 wk |
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When would PPI's be used?
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Used for treatment of frequent heartburn in patients with symptoms ≥ 2 days/week or for patients who do not respond to OTC H2 antagonists
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MOA for PPI?
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MOA: Inhibit H+/K+ ATPase pump (proton pump) in parietal cell → Dec. acid secretion
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Onset/duration PPI?
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Onset = 2-3 hr; Duration = 12-24 hr
Complete relief may take 1-4 days |
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Adverse effects PPI's?
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Diarrhea, constipation, headache
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Administration considerations PPI's?
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Should be taken once daily x 14 days
Should be taken 30 min before meal (preferably breakfast) Inhibits only active proton pumps Do not crush |
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Strain Vs. Sprain
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Sprain: Injury to a ligament caused by joint overextension
Ligaments: Connect bone to bone Strain: Injury to a muscle or tendon caused by improper use or overuse Tendons : Attach muscles to bone |
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RICE??
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-Rest injured area
-Ice: In 10-min increments 3-4 times/day x 12-24 hr -Apply compression to injured area with elasticized bandage -Elevate the injured area at or above the level of the heart |
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When should heat be applied to an injury?
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Can be used if pain is non-inflammatory. It may Dec. pain by Inc. blood flow to area
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When is SC inappropriate for pain mgmt?
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Severe pain
Duration of pain > 2 weeks intensity of changing character of pain Pelvic or abdominal pain Excluding dysmenorrhea N/V, fever or other S/S infection Suspected fracture Pregnancy ≤ 7 years of age |
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What is normal body temp? Fever?
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Normal oral temperature = 95.9°-99.5°F
Typically 98.6°F Fever Oral temperature > 100°F (37.8°C) |
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Sites of temperature measurement ?
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Oral
Rectal -Typically 0.5°-1°F higher than oral Axillary -Typically 0.5°-1°F lower than oral Tympanic -Typically 0.5°-1°F higher than oral |
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Temp. Conversions?
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°F = (9/5 x °C) + 32
°C = 5/9 (°F – 32) |
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S/S of fever?
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Headache
Diaphoresis Malaise Chills Tachycardia Irritability Myalgia |
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Which pain OTC med has no GI irritation?
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Acetaminophen
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Properties of Acetaminophen?
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Analgesic (for mild-moderate pain)
Antipyretic Has NO anti-inflammatory effects |
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Which OTC Product can be used prevention and treatment of various cardiovascular diseases (e.g. myocardial infarction, stroke)?
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Asprin: used for its antiplatelet effects
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which OTC product has the potential to increase risk of Reye’s syndrome?
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Asprin
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Properties of Asprin?
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Analgesic
Anti-inflammatory Antipyretic Antiplatelet |
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Causes of Fever?
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Infection
Cancer Dehydration Tissue damage Surgery Stroke Medications |
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Max dose of tylenol?
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Maximum daily adult dose = 4000 mg (2000 mg if pre-existing liver disease)
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Types of Salicylates?
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Acetylated = Aspirin
-Inhibit platelet aggregation Nonacetylated = Magnesium salicylate (Doan’s Extra Strength®) -Do not inhibit platelet aggregation |
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MOA Asprin?
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MOA: Inhibits both forms of the enzyme, cyclooxygenase (COX-1 and COX-2)
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Asprin max dose
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4000 mg/day (adults)
Be careful of aspirin in other OTC products |
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Drug interactions - Asprin?
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Patients on warfarin should not use aspirin unless recommended by health care provider (Inc. risk of bleeding)
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Adverse affects- Asprin?
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Gastric ulceration/bleeding
Bleeding |
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Properties- NSAIDs?
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Analgesic
Anti-inflammatory Antipyretic Antiplatelet (reversible) -Not used for this effect (vs. aspirin) |
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NSAID max dosage?
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Ibuprofen = 1200 mg/day
Naproxen = 660 mg/day |
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NSAID's drug interactions?
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-Inc. risk of bleeding with warfarin
-May Dec. effects of antihypertensive agents |
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NSAID's adverse affects?
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Gastric irritation/ulceration/bleeding
Dyspepsia, heartburn, nausea, anorexia Bleeding Fluid retention May Inc. risk of cardiovascular and cerebrovascular events (e.g. myocardial infarction, stroke) |
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What are some combination products for headaches?
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Some contain analgesic + caffeine
-Produce synergistic analgesic effect Some contain analgesic + pseudoephedrine -Sinus headache |
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Situations in Which Self-Care is Inappropriate (Pain/Fever)
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Children >6 months of age with rectal temperature ≥ 104°F (or equivalent)
Children < 6 months of age with rectal temperature ≥ 101°F (or equivalent) S/S of infection Respiratory distress Immunosuppressed Head trauma, stroke Children with history of seizures |
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Antihistamines-sedation levels?
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Sedating
Diphenhydramine Less sedating Chlorpheniramine Cetirizine Nonsedating Loratadine |
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Cold- S/S?
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Sore throat
Nasal congestion Rhinorrhea Sneezing |
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Nonpharmacological Treatment-Cold?
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Inc. Fluid intake
Adequate rest Use of humidifers/steamy showers Saline gargle/nasal irrigation Prevent the spread -Hand washing -Covering mouth when coughing/sneezing |
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Treatment for sore throat?
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Local Anesthetics
Active ingredients:Benzocaine, Dyclonine HCl |
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How long would you use Intranasal decongestants? Why?
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Only use for 3-5 days, Prolonged use can result in rebound congestion
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List some intranasal decongestants
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Phenylephrine
Naphazoline Tetrahydrozoline Oxymetazoline |
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What are some Systemic Decongestants? Adverse Affects?
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Products
-Pseudoephedrine -Phenylephrine CNS stimulation -Restlessness/Insomnia -Anxiety Cardiovascular stimulation -Inc. BP, Tachycardia -Palpitations -Arrhythmias |
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Allergic Rhinitis - S/S?
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Symptoms
Watery eyes Itchy nose, eyes, throat Sneezing Rhinorrhea Nasal congestion Postnasal drip Signs “Allergic shiners” “Allergic crease” “Allergic gape” |
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Which OTC product is effective in preventing allergies?
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Cromolyn Sodium
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Non-Pharmacologic treatment for cough?
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Nonmedicated lozenges
Use of humidifers/steamy showers Hydration |
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What is the treatment for nonproductive cough?
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Systemic Antitussives: Dextromethorphan
Topical Antitussives: Camphor, Menthol |
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What is the treatment for productive cough?
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Protussives (Expectorants): Guaifenesin
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What are the types of laxatives?
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Bulk forming
Emollient Lubricant Saline Hyperosmotic Stimulant |
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CAM??
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Complementary & alternative medicine
Treatments used in addition to or instead of conventional medicine Includes: dietary supplements, acupuncture, homeopathy, biofeedback |
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Proposed use of Glucosamine/Chondroitin?
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Shown to reduce pain and joint stiffness, Osteoarthritis.
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Which product should you avoid in patients with a shellfish allergy?
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Glucosamine/Chondroitin
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Echinacea-proposed use?
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Immune stimulant to prevent & treat common cold
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Ginkgo Biloba-proposed uses?
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Alzheimer’s disease
Vascular dementias Intermittent claudication Tinnitus |
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Adverse Rxn of Ginkgo, Garlic and Fish oils?
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May increase risk of bleeding in patients taking anticoagulant or antiplatelet therapy (also avoid ginseng:effects unpredictable)
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Ginseng-Proposed uses? Types?
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Mental & physical stress
Improve immune function Improve energy Three types American Asian (Panax) Siberian |
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Which herbal use should be limited to < 3 months?
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Ginseng
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Used for BPH?
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Saw Palmetto
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Product used for Heart disease & Hypertriglyceridemia?
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Fish Oils
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Used for Mild to moderate depression
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St. John's Wort
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Drug interactions-St. John's wort?
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Many drug interactions
All antidepressants, HIV medications, oral contraceptives, antiseizure medications, anticoagulants |
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Proposed uses of Garlic?
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Hyperlipidemia
Hypertension Prevention of atherosclerosis |
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Product causes N/V, heartburn, bad breath, body odor
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Garlic
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What is Melatonin and its proposed uses?
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Hormone that control circadian rhythm and sleep-wake cycle
Proposed Uses Treatment of insomnia “Jet lag” |
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Discuss the role of DSHEA in regards to labeling of dietary supplements?
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Prohibits “disease claims”
Permit “structure/function claims” |
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Thiamine (B1) deficiency
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Polyneuropathy, Beriberi
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Dermatitis, Diarrhea, Dementia
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Niacin (B3) Deficiency
(nicotinamide) |
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Which vitamin has Flushing (vasodilating effects)
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B3 niacin
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Folic acid (folate) deficiency
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Folic acid deficiency anemia
Mouth sores Diarrhea |
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High doses of this vitamin inhibit prolactin.
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Pyridoxine (B6)
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Cyanocobalamin (B12) deficiency
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B12 deficiency anemia
Neurologic changes Smooth, red tongue |
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Oral lesions, Peripheral neuropathy, Convulsions are caused due to a deficiency in________.
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Pyridoxine (B6)
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_______is necessary for myocardial
function, nerve cell function, and carbohydrate metabolism |
Thiamine (B1)
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Vit. E deficiency?
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Peripheral neuropathy
Muscle weakness Hemolytic anemia |
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How would you prevent sun induced skin disorders?
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Avoid sun exposure
Wear sun-protective clothing and hats Use sunscreen |
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Discuss Sun protection factor (SPF)
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↑ SPF = ↑ sunburn protection
Ex: SPF 6: If it normally takes 60 minutes of sun exposure for a person to develop a sunburn, with SPF 6 it will take 6 times as long (6 X 60min = 6 hours) to develop the same sunburn |
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List the categories of SPF
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SPF 2-11: minimal protection
SPF 11-29: moderate protection SPF 30+: high protection3 |
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What is Tinea Pedis? S/S?
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Athlete’s foot
Signs/symptoms: Scaling or cracking between toes, malodor, itching, burning, stinging |
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What is Tinea corporis? S/S?
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Ringworm
Signs/symptoms: Circular, erythematous scaly area Itching |
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What is Tinea Cruris? S/S?
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Jock itch
Signs/symptoms Lesions are slightly elevated and erythematous Pruritus Occurs bilaterally, spares the penis and scrotum |
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What are some pharmacological treatments for fungal infections(Athlete’s foot, jock itch, and ringworm)?
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Butenafine (Lotrimin Ultra®)
Clotrimazole (Cruex®) Miconazole (Micatin®, Desenex®, Cruex®) Terbinafine (Desenex®) Tolnaftate (Tinactin®, Aftate®) Undecylenates (Cruex®) |
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Non-pharm therapy for pediculosis?
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Use of a lice comb to remove nits
Avoid direct physical contact with infected people Clothing and bedding should be washed in hot water and dried in a dryer Carpets should be vacuumed Body lice is treated with good hygiene |
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Which medication for treatment of Pediculosis requires only 1 treatment?
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Permethrin
Product: Nix |
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What are the types of contact dermatitis? What differentiates them?
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Irritant contact dermatitis (ICD)
-Inflammatory reaction is caused by irritant exposure -Ex: occupational chemicals (detergents, fiberglass, wood dust) Allergic contact dermatitis (ACD) -Inflammatory reaction is caused by allergen exposure -Ex: poison ivy |
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What is the general treatment for contact dermatitis?
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Remove offending agents
Wash area to reduce immune response Localized, mild rash Not weeping → topical lotions and ointments Large rash (not affecting the eyes or genitals) Astringent compresses and bath treatments |
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Which pharm-therapy promotes drying of weeping dermatitis?
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Astringents
Aluminum acetate (Burow’s solution), zinc oxide, zinc acetate, sodium bicarbonate, calamine, witch hazel |
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Nonpharmacologic therapy for Xerosis?
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Apply lotions/creams after showering
Increase room humidity Drink plenty of water |
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General rules regarding treatment of Xerosis?
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“If it is wet, dry it.”
Solutions, gels “If it is dry, wet it.” Creams/lotions Ointments |
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What type of condom would you recommend for someone with a latex allergy?
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Polyurethane
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What hormone do menopause tests detect?
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Detects FSH levels in the urine
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What hormone do Ovulation tests detect?
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Detects LH levels in the urine
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What hormone do home pregnancy tests look for?
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hCG: diagnostic indicator of pregnancy
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What can give a false positive during home ovulation tests?
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False-positive
-Medications that promote ovulation (menotropins),Repronex -Menopause -PCOS |
