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Pharmacy Year 4 > Global Health > Flashcards

Global Health Flashcards

1
Q

How many people are infected with soil transmitted helminth?

A

1.5-2 billion

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2
Q

Where are helminth infections most common?

A

Sub-Saharan Africa, Americas, China and east Asia

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3
Q

Where are the most important helminth infections?

A

Intestinal nematodes:
Roundworm (ascaris lumbarcoides)
Whipworm (trchuris trichuira)
Hookworms (Neactor)

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4
Q

What is the standard treatment of ascarids?

A

Mebendazole (500mg) or albendazole (400mg)

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5
Q

How does mebendazole work?

A

Inhibit mitochondrial ATP production and also binds irreversibly to tubulin, disrupting the cytoskeleton.

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6
Q

What is piperazine?

A

Common pet anti-worm preparation

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7
Q

How does piperazine work?

A

Blocks the worm’s neuromuscular junction in response to acetylcholine, leading to flaccid paralysis.

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8
Q

What key condition can be caused by hookworms? How?

A

Hookworms ingest blood.
They also move around the gut leaving bleeding lesions.
The chief result of hookworm infection is therefore iron-deficient anaemia.

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9
Q

Where is whipworm most common?

A

Warmer areas of the world, especially in Asia.

Africa and South America are also affected

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10
Q

What are filarial worms?

A

Tissue nematodes whose larvae are transmitted via mosquito bites

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11
Q

Where are filarial most common?

A

The tropical belt

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12
Q

What is the standard treatment of filarial worms?

A

Ivermectin single dose, repeated after 6 and 12 months

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13
Q

How does ivermectin work?

A

Ivermectin works by inhibiting the g-aminobutyric acid – associated chloride channel of the nematode, resulting in muscle paralysis.

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14
Q

What is schistosomiasis?

A

Worm infection via skin penetration

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15
Q

Where is schistosomiasis found?

A

Africa and the Far East

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16
Q

What is the treatment for schistosomiasis?

A

Praziquantel

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17
Q

How does praziquantel work?

A

Causes a massive increase in permeability of the fluke’s muscles to mono- and di-valent cations, especially Ca2+
Massive influx of calcium ions results in spastic paralysis

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18
Q

What are the two most relevant types of flatworm?

A

Taenia saginata, the beef tapeworm, is much more common than T. solium, the pork tapeworm

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19
Q

What is first line treatment for tapeworms?

A

Niclosamide

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20
Q

How does Niclosamide work?

A

Inhibits oxidative phosphorylation in worm mitochondria

Eventually, the worm cannot resist proteolysis in the human gut

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21
Q

How many children die yearly due to pneumonia?

A

1.1 million under 5s

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22
Q

What is the pneumonia treatment rate for children?

A

30% of children receive antibiotics they need

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23
Q

Where is pneumonia most common?

A

South Asia and Sub-Saharan Africa but occurs everywhere

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24
Q

What are the 3 most common causative organisms of pneumonia?

A

Streptococcus pneumoniae
Haemophilus influenzae B
Respiratory syncytial virus
(Pneumocystis jiroveci in infants with HIV)

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25
What is the most key prevention method for pneumonia in less economically developed countries?
Exclusive breast feeding up to 6 months is recommended Ensures that the baby is adequately and appropriately nourished A child who is exclusively breast fed is not getting contaminated water, protects infant
26
What is first line for pneumonia?
Amoxicillin (clarithromycin) | Erythromycin in pregnancy
27
What prophylaxis is current to HIV-positive infants to prevent pneumonia?
Co-trimoxazole
28
What is RSV?
Viral pneumonia- respiratory syncytial virus
29
How many people die yearly due to fungal infections?
1.6 million
30
Approximately what proportion of HIV deaths are due to fungal infection?
50%
31
What 7 medications did GAFFI campaign to be added to the WHO essential medicines list?
``` Griseofulvin Fluconazole Amphotericin B Flucytosine Itraconazole Voriconazole Topical natamycin for fungal keratitis ```
32
Where is histoplasmosis most common?
The Americas
33
What is the key problem with chronic pulmonary aspergillosis?
Mimics TB after infection
34
What is the prevalence of fungal asthma?
Affects mostly adults Allergic bronchopulmonary aspergillosis affects 2.5% of asthmatics (5mil) Severe asthma with fungal sensitisation affects 50% of severe asthmatics (3.5-15mil) Responsive to itraconazole
35
What are the common modifiable factors underlying major NCDs?
``` Tobacco Harmful use of alcohol Unhealthy diet Insufficient physical activity Raised BP Raised BG High cholesterol Obesity ```
36
What is the estimated prevalence and mortality of cancer? 2018
An estimated 17 million new cancer cases (excluding non-melanoma skin cancer) and 9.5 million cancer death
37
What is the most common kind of cancer?
Lung cancer is the most commonly diagnosed cancer (11.6%) and the leading cause of cancer death (18.4%), closely followed by breast cancer
38
How has cancer survival improved in the UK?
Half of the people diagnosed with cancer in the UK, now survive their disease for at least 5 years
39
What are the 6 types of cancer therapy?
``` Surgery Hormone therapy Radiation Chemotherapy Immunotherapy Targeted therapy ```
40
What are the 3 types of cancer drugs directly interacting with DNA?
Alkylating agents Metal complexes Intercalating agents
41
What is the aim of direct drug induced DNA damage or alteration in cancer?
Prevention of nucleic acid synthesis by inhibiting one or more of the enzymes involved in synthesis
42
What is the difference between adjuvant and neoadjuvant cancer therapy?
Adjuvant (after) This is given following local treatment of disease with radiotherapy or surgery to treat disseminated disease and help prevent local recurrence. Neoadjuvant (before) Treatment given before treatment with surgery or radiotherapy with the intent of shrinking or debulking the tumour.
43
What are the 6 hallmarks of cancer?
Self sufficiency in proliferative growth signals Insensitivity to growth inhibitory signals Evasion of apoptosis Acquisition of limitless replicative potential Induction of angiogenesis Induction of invasion and metastasis
44
What are the 6 elements of cancer control in Africa?
``` Cancer intelligence units Tobacco control Early diagnosis and prevention Cure the curable Palliative care Training and education ```
45
What is the most stark difference in life expectancy in the world?
36 year gap in life expectancy between countries A child born in Malawi can expect to live for only 47 years while a child born in Japan could live for as long as 83 years
46
What is the estimated proportion of deaths associated with CVD?
30% in 2013
47
How many people in the UK are living with CVD?
2.3 mil with CHD >600,000 with HF 1.1 mil with AF
48
What proportion of hospital in patient episodes in the UK are due to CVD?
10. 1% male | 6. 3% females
49
How much is spent per year by NHS England on CVD?
£6.8 billion
50
How many deaths per year occur due to RTAs?
1.25 million (within 30 days of the accident)
51
What was the highest cause of death in 15-29 year olds in 2012?
RTAs
52
Where has the highest RTA death rates?
Africa (26.6)
53
Describe the prevalence of TB.
10.4 mil cases and 1.8 mil deaths in 2015 | 95% of deaths in LICs
54
Which 6 countries account for the most TB deaths? What proportion is this?
60% | China, India, Indonesia, Nigeria, Pakistan and South Africa
55
How many TB cases were drug resistant in 2015?
480,000
56
What is first line treatment for TB?
Isoniazid but not used as monotherapy
57
What are the 5 options for treatment in TB?
``` Isoniazid Rifampicin Streptomycin Ethambutol Pyrazinamide ```
58
What is indicated in multi drug resistant TB?
Add streptomycin
59
What is indicated in extensively drug resistant TB?
Add fluoroquinolone or cycloserine
60
Describe the structure of mycobacterium.
Very slow growing due to the need to develop thick waxy impermeable c ell wall barrier Cell wall is rich in mycolic acids, long chain branched fatty acids and is very hydrophobic
61
How does streptomycin work?
Active transport into bacterial cells, inhibits protein synthesis via binding to ribosome
62
How does isoniazid work?
Isonicotinamide prodrug, resembles cofactor NADH Inhibits biosynthesis of mycolic acids needed in the cell wall Inhibits fatty acid desaturase enzyme Highly active against rapidly dividing TB, only bacteriostatic with dormant organisms
63
How does rifamycin work?
Highly specific for inhibition of abcterisal RNA polymerase Bind to beta subunit of huge enzyme Allow nucleotide dimers to form but bind in the nucelotide binding site, prevent arrival of third nucleotide
64
How does ethambutol work?
Inhibits formation of mycobacterial cell wall Inhibits synthesis of arabinogalactan by inhibitng arabinosyl transferase Increased permeability of cell wall
65
How does Pyrazinamide work?
Prodrug of pirazinoic acid in M. tuberculosis by pyrazinamidase Thought to inhibit fatty acid synthase 1

Pharmacy Year 4 (3 decks)

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