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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
Q

What is the most key prevention method for pneumonia in less economically developed countries?

A

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

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26
Q

What is first line for pneumonia?

A

Amoxicillin (clarithromycin)

Erythromycin in pregnancy

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27
Q

What prophylaxis is current to HIV-positive infants to prevent pneumonia?

A

Co-trimoxazole

28
Q

What is RSV?

A

Viral pneumonia- respiratory syncytial virus

29
Q

How many people die yearly due to fungal infections?

A

1.6 million

30
Q

Approximately what proportion of HIV deaths are due to fungal infection?

A

50%

31
Q

What 7 medications did GAFFI campaign to be added to the WHO essential medicines list?

A 
Griseofulvin
Fluconazole
Amphotericin B
Flucytosine
Itraconazole
Voriconazole
Topical natamycin for fungal keratitis
32
Q

Where is histoplasmosis most common?

A

The Americas

33
Q

What is the key problem with chronic pulmonary aspergillosis?

A

Mimics TB after infection

34
Q

What is the prevalence of fungal asthma?

A

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
Q

What are the common modifiable factors underlying major NCDs?

A 
Tobacco
Harmful use of alcohol
Unhealthy diet
Insufficient physical activity
Raised BP
Raised BG
High cholesterol
Obesity
36
Q

What is the estimated prevalence and mortality of cancer? 2018

A

An estimated 17 million new cancer cases (excluding non-melanoma skin cancer) and 9.5 million cancer death

37
Q

What is the most common kind of cancer?

A

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
Q

How has cancer survival improved in the UK?

A

Half of the people diagnosed with cancer in the UK, now survive their disease for at least 5 years

39
Q

What are the 6 types of cancer therapy?

A 
Surgery
Hormone therapy
Radiation
Chemotherapy
Immunotherapy
Targeted therapy
40
Q

What are the 3 types of cancer drugs directly interacting with DNA?

A

Alkylating agents
Metal complexes
Intercalating agents

41
Q

What is the aim of direct drug induced DNA damage or alteration in cancer?

A

Prevention of nucleic acid synthesis by inhibiting one or more of the enzymes involved in synthesis

42
Q

What is the difference between adjuvant and neoadjuvant cancer therapy?

A

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
Q

What are the 6 hallmarks of cancer?

A

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
Q

What are the 6 elements of cancer control in Africa?

A 
Cancer intelligence units
Tobacco control
Early diagnosis and prevention
Cure the curable
Palliative care
Training and education
45
Q

What is the most stark difference in life expectancy in the world?

A

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
Q

What is the estimated proportion of deaths associated with CVD?

A

30% in 2013

47
Q

How many people in the UK are living with CVD?

A

2.3 mil with CHD
>600,000 with HF
1.1 mil with AF

48
Q

What proportion of hospital in patient episodes in the UK are due to CVD?

A
  1. 1% male

6. 3% females

49
Q

How much is spent per year by NHS England on CVD?

A

£6.8 billion

50
Q

How many deaths per year occur due to RTAs?

A

1.25 million (within 30 days of the accident)

51
Q

What was the highest cause of death in 15-29 year olds in 2012?

A

RTAs

52
Q

Where has the highest RTA death rates?

A

Africa (26.6)

53
Q

Describe the prevalence of TB.

A

10.4 mil cases and 1.8 mil deaths in 2015

95% of deaths in LICs

54
Q

Which 6 countries account for the most TB deaths? What proportion is this?

A

60%

China, India, Indonesia, Nigeria, Pakistan and South Africa

55
Q

How many TB cases were drug resistant in 2015?

A

480,000

56
Q

What is first line treatment for TB?

A

Isoniazid but not used as monotherapy

57
Q

What are the 5 options for treatment in TB?

A 
Isoniazid
Rifampicin
Streptomycin
Ethambutol
Pyrazinamide
58
Q

What is indicated in multi drug resistant TB?

A

Add streptomycin

59
Q

What is indicated in extensively drug resistant TB?

A

Add fluoroquinolone or cycloserine

60
Q

Describe the structure of mycobacterium.

A

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
Q

How does streptomycin work?

A

Active transport into bacterial cells, inhibits protein synthesis via binding to ribosome

62
Q

How does isoniazid work?

A

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
Q

How does rifamycin work?

A

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
Q

How does ethambutol work?

A

Inhibits formation of mycobacterial cell wall
Inhibits synthesis of arabinogalactan by inhibitng arabinosyl transferase
Increased permeability of cell wall

65
Q

How does Pyrazinamide work?

A

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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