Public Health Final Flashcards
What percent of deaths each year are associated with infectious diseases worldwide?
25%
What is an emerging infectious disease?
Outbreak of a previously unknown disease
OR
Outbreak of a known disease whose incidence in humans significantly increases or threatens to increase in the near future
What is a re-emerging infectious disease?
A disease that has reappeared after a significant decline in incidence
What was the World Health Organization’s take on infectious diseases in 2007?
“Infectious diseases are emerging at an unprecedented rate”
Since the 1970’s how many infectious diseases have been discovered?
> 40
(mostly viruses)
What 4 factors contribute to the rapid and global spread of infectious diseases?
-International Travel
-Living in densely populated areas
-Intimate human contact
-Close contact with wild animals
What does SARS-CoV-2 stand for?
Severe Acute Respiratory Syndrome- Coronavirus- 2
What kind of virus of COVID-19?
Single-strand enveloped RNA virus
What percent of COVID-19 deaths in the US were made up of people age > 65?
80%
What percent of COVID-19 deaths in the US were made up of people with comorbidities?
94%
What is the affect of race on those hospitalized for COVID-19?
Blacks, Native Americans, and Hispanics are hospitalized at greater rates
What is the main way that COVID-19 is transmitted?
Respiratory droplets
How soon may viral shedding of COVID-19 appear before symptoms?
1-2 days
What is the mean incubation period of COVID-19?
5-6 days (range 2-12 days)
In mild to moderate COVID-19 infections, how long does the patient remain infectious?
No longer than 10 days after symptom onset
How long do severely immunocompromised patients or those with severe-critical illness remain infectious with COVID-19?
No longer than 20 days after symptom onset
What occurs in Stage I (Early Infection) of COVID-19 disease progression?
Viral response phase
What medications should be used to treat Stage I (early infection) of COVID-19 disease progression?
Use antivirals
(does not make sense to use steroids since the inflammatory response phase has not started yet)
What clinical SIGNS and SYMPTOMS are present during Stage I (Early Infection) of COVID-19 Disease Progression?
Symptoms:
–Mild constitutional symptoms
–Fever
–Dry Cough
Signs:
–Lymphopenia
What occurs in Stage II (Pulmonary Phase) of COVID-19 disease progression?
Both viral response phase and host inflammatory response phase
What are the clinical SYMPTOMS and SIGNS of Stage II (Pulmonary Phase) of COVID-19 disease progression?
Symptoms:
–Shortness of breath without (IIa) and with hypoxia (IIb)
Signs:
–Abnormal chest imaging
–Transaminitis
–Low-normal procalcitonin
What happens in Stage III (Hyperinflammation Phase) of COVID-19 disease progression?
Host inflammatory response phase
What medications should be used to treat Stage III (Hyperinflammation Phase) of COVID-19 disease progression?
Give anti-inflammatories (steroids)
-Does not make sense to give antivirals since viral-response phase is over
What clinical SIGNS and SYMPTOMS may appear during Stage III (Hyperinflammation Phase) of COVID-19 disease progression?
Symptoms:
–ARDS (acute respiratory distress syndrome)
–SIRS/Shock
–Cardiac Failure
Signs:
–Elevated inflammatory markers
–Troponin, NT-proBNP elevation
Among BOTH hospitalized critically ill and non-critically ill but severe (SpO2 < or = 94%) patients with COVID-19, what is the recommended treatment?
Dexamethasone (6mg IV/PO for 10 days)
**glucocorticoid
What is the recommended treatment for hospitalized patients with mild-to-moderate COVID-19 without hypoxemia that require supplemental oxygen? (SpO2 > 94%)
DO NOT USE GLUCOCORTICOIDS
(no dexamethasone, not beneficial)
If a patient with COVID-19 is not on oxygen do they need dexamethasone?
NO
What did the RECOVERY trial show?
Dexamethasone does not have an effect in COVID-19 patients who are not on oxygen
(do not have inflammation)
For patients hospitalized with progressive severe or critical COVID-19 with elevated markers of systemic inflammation, what medication should be used to treat them?
Tocilizumab *in addition to the standard of care (steroids) rather than just the standard of care alone
If tocilizumab is not available for the treatment of COVID-19 patients, what medication can be used instead?
Sarilumab (+ the standard of care which is steroids)
**this is a conditional recommendation, very low evidence
What are the characteristics of the Hyperinflammation Phase of COVID-19?
-Cytokine storm
-Elevations in proinflammatory cytokines
-Multi organ dysfunction
What is the mechanism of action of Tocilizumab?
Humanized monoclonal antibody against the human IL-6 receptor
What is the history of approval of Remdesivir (Veklury)?
-Emergency Use Authorization put in place on May 1, 2020 for patients with severe disease
-Expanded EUA to treat all hospitalized patients (regardless of severity)
-FDA approved October 2020
What is the mechanism of action of Remdesivir (Veklury)?
Interferes with viral RNA-dependent RNA polymerase
-Delayed chain termination of viral RNA transcription
(interferes with viral replication)
What was Remdesivir (Veklury) initially developed to treat?
Ebola (failed)
What is one important safety issue with Remdesivir regarding liver function?
AST/ALT have been shown to increase with multiple doses of Remdesivir
What is sulfobutylether-beta cyclodextrin (SBECD) and how does it relate to the safety of remdesivir?
SBECD is a vehicle required for Remdesivir to be soluble
-If too much SBECD accumulates, it can be toxic
(not much is present in Remdesivir, whether this drug can cause kidney disease is up for debate)
When should Remdesivir be used to treat COVID-19 patients?
-Patients with mild-to-moderate COVID-19 at high risk for progression to severe disease treat WITHIN 7 DAYS OF SYMPTOM ONSET
-Patients on supplemental oxygen but no mechanical ventilation or ECMO, treat FOR 5 DAYS
-Hospitalized patients with severe COVID-19 (use Remdesivir as opposed to no antiviral)
When should Remdesivir NOT be used?
Patients with COVID-19 on invasive ventilation and/or ECMO
What did the ACTT-1 Study show?
Use of Remdesivir in patients hospitalized with COVID-19 decreased time to recovery and mortality vs placebo
-Also showed that Remdesivir has no effect on patients receiving mechanical ventilation or ECMO
When should Nirmatrelvir/Ritonavir (Paxlovid) be given for patients with COVID-19?
Ambulatory patients with mild-to-moderate COVID-19 at high risk for progression to severe disease
INITIATE WITHIN 5 DAYS OF SYMPTOM ONSET
When should Molnupiravir (Lagevrio)be initiated in patients with COVID-19?
Ambulatory patients with mild-to-moderate COVID-19 at high risk for progression to severe disease WHO HAVE NO OTHER TREATMENT OPTIONS
*Initiate WITHIN 5 DAYS of symptom onset
What virus causes Monkeypox (M-Pox) and what family of viruses is it in?
Caused by monkeypox virus
In the same family of viruses as variola virus which causes smallpox
True or False: M-Pox is rarely fatal
True
What is the suspected route of transmission of M-Pox?
Largely transmitted through sexual close contact
(mostly seen in homosexual males)
What is the only drug we need to know for this exam that treats M-Pox?
Tecovirimat (TPOXX)
**this drug is approved for small-pox, since M-Pox is in the same family it is treated the same
What is the #1 reported infectious disease in the US?
Chlamydia
What gender is more likely to be diagnosed with chlamydia?
Females
–more likely to be screened
Which gender is more likely to experience symptoms from chlamydia?
Males are more likely to experience symptoms even though they are less likely to be screened and diagnosed
*Females are often asymptomatic
What is the #2 most reported infectious disease in the US?
Gonorrhea
What drugs are used to treat gonorrhea?
-Ciprofloxacin
-Tetracycline
-Penicillin
-Azithromycin
-Cefixime
-Ceftriaxone
Rank the drugs used to treat gonorrhea in order of the drug with the MOST RESISTANCE to the LEAST RESISTANCE (demonstrated by the bacteria)
MOST: Ciprofloxacin
Tetracycline
Penicillin
Azithromycin
Cefixime
LEAST: Ceftriaxone
True or False: Rates of syphilis are decreasing
FALSE, the disease is out of control
What is the recommended medication to treat Chlamydia?
Doxycycline
What are two alternative medications to treat Chlamydia?
Azithromycin
Levofloxacin
What is the recommended medication to treat uncomplicated gonococcal infections of the cervix, urethra, or rectum?
Ceftriaxone
**if a chlamydia infection has not been ruled out, treat for chlamydia with doxycycline
Why is doxycycline the preferred agent for chlamydia infections?
It is useful for all potential sites of infection
What is the preferred medication for every stage of syphilis?
Penicillin
technically: benzathine penicillin
If penicillin is unavailable for syphilis treatment what medication should be used instead?
Doxycycline
What medication should be used in pregnant patients with syphilis?
Penicillin (the answer is always penicillin)
*only medication that protects both mom and baby
What was Alexander Fleming’s warning after he discovered penicillin?
The public will demand the use of penicillin and then the microbes will become resistant to it and people will die
What is intrinsic resistance?
An organism is and has always been resistant to a given antibiotic (not developed over time)
What are some possible mechanisms by which an organism can be intrinsically resistant?
Absence of target site, bacterial cell impermeability
What is acquired resistance?
Organisms initially susceptible to a drug become resistant
How can acquired resistance occur?
-A change in bacterial DNA (mutation)
-Acquisition of new DNA (chromosomal or extrachromosomal)
What are the 3 genetic exchange routes that can cause resistance in bacteria?
-Conjugation
-Transduction
-Transformation
What is conjugation?
(in regard to bacterial genetic exchange/resistance)
Direct contact or mating via sex pili
**most common
What is transduction?
(in regard to bacterial genetic exchange/resistance)
Genes are transferred between bacteria by bacteriophages (viruses)
What is transformation?
(in regard to bacterial genetic exchange/resistance)
The transfer or uptake of “free floating” DNA from the environment
-This DNA is integrated into the host DNA
What enzymes produced by bacteria allow them to be resistant through “enzymatic inactivation”?
B-lactamases
Aminoglycoside-modifying enzymes
What mechanisms can be used by a bacteria to cause bacterial resistance through “alteration of target site”?
PBPs
Cell wall precursors
Ribosomes
DNA gyrase/topoisomerase
What mechanisms can be use by a bacteria to cause bacterial resistance through “altered permeability of bacterial cell”?
Efflux pumps
Porin changes
What are the most urgent antibiotic resistance threats in the US?
Carbapenem-resistant Acinetobacter
Carbapenem-resistant Enterobacterales
What are serious antibiotic resistance threats in the US?
ESBL-producing enterobacterales
Multidrug-resistant Pseudomonas aeruginosa
Drug resistant tuberculosis
What are the most important Carbapenemases?
(the drugs with the most concerning antibiotic resistance in the US)
KPC- Klebsiella pneumoniae carbapenemase
NDM- New Delhi metallo-B-lactamase
OXA-type- Oxacillinase
What gene is causing Colistin resistance?
MCR-1 gene
-Encodes for resistance to colistin, located on plasmid and can be transferred to other bacteria
What is a major concern with gram-negative bacteria?
They may become resistance to every available antibiotic
(are able to use multiple different resistance pathways)
How does Cefiderocol (Fetroja) work?
“Trojan horse” siderophone cephalosporin
-Catechol group on cephalosporin chelates iron and takes it up into the cell via normal iron uptake channels
-Dissociates to release active drug
-Stable to clinically-relevant B-lactamases
(basically: attaches to iron which the organism needs and brings it in)
What is Cefiderocol (Fetroja) used for?
In vitro activity against multidrug resistant Pseudomonas aeruginosa and Acinetobacter baumannii
What steps can be taken to preserve the function of antibiotics?
-Establish a US database for use
-Restrict use in agriculture
-Prevent selected nosocomial infections
-Promote antimicrobial stewardship
-Promote new diagnostic use and emphasize point-of-care molecular methods
-Reduce FDA antibiotic barrier
-Facilitate public-private partnerships for antibiotic development
What are the goals of antimicrobial stewardship?
Optimize clinical outcomes while minimizing unintended consequences of antimicrobial use
Reduce healthcare costs without adversely impacting quality of care
What is Public Health Policy?
The laws, actions, and decisions implemented within society in order to promote wellness and ensure specific health goals are met
What are examples of public health policies?
Medicare
(relates to issue of aging population and healthcare costs)
Policies limiting smoking in public places, limiting tobacco sale to 21 and older
(relates to issue of tobacco use)
Increasing the availability of naloxone and research funding
(relates to opioid epidemic)
What are some examples of Public Health Organizations?
Federal Agencies
State and Local Agencies
International Agencies
National Organizations
State Organizations
Local Organizations
What was the first public health service (under the U.S. Department of Health and Human Services) to give pharmacists prescribing status?
Indian Health Service
How many operating divisions are there in the US Department of Health and Human Services?
12
What is the largest payer for healthcare in the US?
Center for Medicare and Medicaid Services (CMS)
What are the requirements for Medicare eligibility?
65 years old or older
OR
Have a disability
OR
Have End Stage Renal Disease
What is the focus of the US Public Health Service Commissioned Corps?
Delivering the nation’s public health promotion and disease prevention programs and advancing public health
Who oversees the US Public Health Service Comissioned Corps?
The US surgeon general
Where does the US Public Health Service Comissioned Corps serve?
Across federal government agencies
What are the six subject matters associated with the Indiana Governor’s Public Health Review Commission?
-Governance, Infrastructure, Services
-Public Health Funding
-Workforce
-Data and Information integration
-Emergency preparedness
-Child and adolescent health
Where does the Indiana Governor’s Public Health Review Commission get its recommendations from?
A multidisciplinary group
What is the main purpose of the Indiana Family and Social Services Administration (FSSA)?
Healthcare and social services funding
-Want to dismantle long-standing inequity through deliberate human services system improvements
Who oversees Medicaid in Indiana?
Indiana Family and Social Services Administration (FSSA)
How has the pandemic affected Medicaid enrollment?
During the pandemic the state could not remove anyone from Medicaid even if they did not meet requirements
-this caused the enrollment levels for Medicaid to skyrocket
-now eligibility must be reviewed for everyone
Who does the World Health Organization affect?
The United Nations
What organization is the leader in global public health efforts?
World Health Organization
What are the 4 factors to implementing public health policy?
-Legislation
-Regulations/rules
-Agency action
-Public attention/awareness
What are the main ways that pharmacists can contribute to Public Health?
-Preventive care
-Chronic disease state management
-COVID-19 vaccine doses
*88.9% of Americans live within 5 miles of a pharmacy
What does the Public Readiness and Emergency Preparedness Act (PREP Act) do?
Authorizes HHS secretary to issue declarations
What does a standing order do?
Enables provision of certain services/medications by a single prescriber
What are the 4 categories of prescribing done by pharmacists?
Patient-Specific CPA (collaborative practice agreement)
Population-specific CPA
Statewide protocol
Unrestricted/categorical
In Indiana, what ages of patients may a pharmacist immunize without a prescription?
11 years +
What are social determinants of health?
Conditions in which people are born, grow, live, work, and age including the health system
Ex: health care access and quality, neighborhood and built environment, social and community context, economic stability, education access and quality
What shapes social determinants of health?
Distribution of:
-money
-power
-resources
at global, national, and local levels
What is allosteric load?
The “wear and tear” on the body that accumulates as an individual is exposed to repeated or chronic stress
What is allostasis?
A mechanism of regulation in which the body anticipates and adjusts its energy use according to environmental demands and stress
What are health disparities?
Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions existing between specific population groups in the US
What are health care disparities?
Differences in access to or availability of facilities and services that exist among specific population groups in the US
What two factors contribute to the creation of disparities?
-Social determinants of health
-Vulnerable populations
What are safety net organizations?
-Providers that organize and deliver health care and other services to uninsured, Medicaid, and vulnerable patients
*Won’t turn people away
*Fill in gaps
*Free or fees are on a sliding scale
How are safety net organizations financed?
-Federal/state funds
-Foundations/charities
-Private donors
-Sliding scale revenues
-Third-party (ex: medicaid/medicare, etc)
What are the types of safety net providers?
-Federally qualified health center (FQHC)
-FQHC look alike
-Free clinic
-Street medicine
-Disproportionate share hospital
What is a Federally Qualified Health Center (FQHC)?
Organizations that receive federal funding from the Health Resources and Services Administration (HRSA)
*have to apply and be approved
What are the requirements FQHCs?
Location: medically underserved area
Services: primary care/preventive care
Community board: mostly from community being served
Fees: Sliding scale or waived if unable to pay
Ongoing quality assurance program
Governing board of directors
What are some possible characteristics of a medically underserved area?
Decreased primary care providers
Increased infant mortality
Increased poverty
Increased elderly population
What are hospital safety nets?
Public/Disproportionate-Share Hospitals (DSH)
-A disproportionate number of patients served are low-income/uninsured
-States receive funds to cover the costs of these hospitals
What are 4 ways to make medications more accessible for uninsured/low-income patients?
340B Drug Pricing programs
Medication Samples
Patient Assistance Programs
Discounted Prescription Programs Sponsored by Pharmacies
What are Patient Assistance Programs?
Programs sponsored by manufacturers to provide medications to underserved individuals
-Referred to as PAPs or MAPs
-Eligibility criteria and drug availability vary
-Both brand and generic drugs available
-Discount cards/coupons available
What are the advantages of medication samples?
-Able to try new medication before filling
-No cost to clinic or patient
-Can be used as “bridge” until insurance starts
What are the disadvantages of medication samples?
-Promote compliance but discourage use of more appropriate meds (other meds)
-Sustainability concerns
What are 2 strategies to reduce dietary energy intake?
Option 1:
Women: around 1200-1500 calories per day
Men: around 1500-1800 calories per day
Option 2:
Decrease by 500-750 calories per day OR 30% of total
How many calories does a person need per day?
10-18 calories/pound/day
What amount of cal/lb are used for weight loss?
10 cal/lb
What amount of cal/lb are used for maintenance?
15 cal/lb
What amount of cal/lb are used for weight gain?
20cal/lb
Which of the following provides the highest amount of calories per gram of food:
Protein
Alcohol
Carbohydrates
Fat
Fat
How many calories/gram are there in protein?
4 calories/gram
How many calories/gram are there in fat?
9 calories/gram
How many calories/gram are there in carbohydrates?
4 calories/gram
What are the 3 macronutrients?
-Protein
-Fat
-Carbohydrates
What is the glycemic index?
A measure of how quickly blood sugar levels rise after eating a particular type of food
*estimates how much each gram of available carbohydrates raises blood glucose following consumption of food relative to consumption of pure glucose
What is the glycemic index of glucose?
100
What is the equation for available carbohydrates?
Available CHO= Total CHO (g) - Fiber (g)
What does a high-glycemic index indicate?
Releases energy quickly
-makes you feel hungry sooner
-causes you to eat more
What does a low-glycemic index indicate?
Releases energy slower
-makes you feel fuller longer
-causes you to eat less
How often/much should a person eat per day?
Recommended to eat 6 low calorie meals per day
What are some ways to make the food groups healthier?
Vegetables: Vary your veggies, go green
Fruits: Want whole and fresh
Protein: Want lean
Grains: Make half whole
Dairy: Low fat
What are empty calories?
Calories from solid fats or added sugars
-add calories but few nutrients
What are solid fats?
Fats that are solid at room temperature
-ex: butter, shortening, beef fat
*Often added in processed foods
What are added sugars?
Sugars and syrups added to processed foods and beverages
What is the goal amount of exercise to get per day?
30 minutes of moderate-intensity activity
(gradually increase to reach this goal)
What percent of adults do not meet the guidelines for aerobic and muscle-strengthening activities?
80%
What percent of adolescents do not do enough aerobic physical activity to meet the guidelines?
80%
What is considered “moderate physical activity”?
Activity that burns 3.5 to 7 kcal/min
-Results in achieving 60-73% of peak heart rate (for majority of exercise period)
What is considered “vigorous physical activity”?
Activity that burns more than 7kcal/min
-Results in achieving 74-88% of peak heart rate (for majority of exercise period)
What is the equation for peak heart rate?
PKR= 220-age (yrs)
When is prescription drug therapy indicated for weight loss?
BMI > or = 30
OR
BMI > or = 27 with other risk factors (hypertension, diabetes, dyslipidemia, etc)
AND
Did not lose weight OR maintain weight loss with comprehensive lifestyle intervention
What are the requirements for a patient to have to be considered for weight loss surgery?
-Severe clinical obesity
-BMI > or = 40 OR BMI > or = 35 with coexisting conditions
-Done after other methods have failed
True or False: Lifelong surveillance is required after weight-loss surgery
Trye
What are some important factors of gastric bypass surgery?
-Reduced gastric volume to 15-30mL
-Restricts food intake and nutrient malabsorption
-Food bypasses the upper GI tract
What are some important factors of sleeve gastrectomy?
80-85% of stomach is removed
-Reduces gastric volume to tube or banana shaped pouch
-Restricts food intake
-Irreversible
What types of medications should not be used in patients with a history of weight loss surgery?
Enteric-coated and sustained release formulations need to be converted to immediate release because of shortened intestinal transit time
What portion of adults in the US are described as either overweight or obese?
3 in 4 adults
What percent of adults in the US are overweight?
31.1%
What percent of adults in the US are obese?
42.5%
What percent of adults in the US are severely obese?
9%
What BMI indicates “overweight”?
25-29.9
What BMI indicates “obese”?
30 and above
Which of the following types of fat has been implicated as being most harmful due to increased inflammation, release of free fatty acids, etc?:
Peripheral fat
Subcutaneous fat
Visceral fat
Cellulite
Visceral Fat
Which location of fat is associated with higher risks?: Waist or Hips
Fat in the waist
Excess fat in the abdomen is linked to what?
-Hypertension
-Diabetes
-Early heart disease
-Certain cancers
Men and Women of what waist sizes are considered to be at “high risk”?
Women: >35 inches
Men: > 40 inches
What are adipocytes?
-Secreted by fat cells
-Secrete both pro-inflammatory and anti-inflammatory factors
-Regulate energy metabolism, altered in obese patients
Which gut hormone causes an increase in the peripheral effect on food intake?
Ghrelin
What is non-sickness?
Simply surviving
-NOT in a healthy state of living
What is the #1 contributing factor to obesity?
Behavioral factors
What are all of the contributing factors to obesity?
-Behavioral factors
-Genetics
-The busy world today (long hours and sedentary lifestyle)
-No breakfast
-High glycemic index carbohydrates
-Refined/added sugars
-Processed foods
What percent of patients successfully maintain their weight loss for 1-5 years?
20%
What are the 3 phases of weight changes?
- Active weight loss
- Transition
- Weight management
True or False: Obesity is a chronic disease
True
Which of the macronutrients results in the greatest rise in insulin levels?
A. Protein
B. Fat
C. Carbohydrates
C. Carbohydrates
How does Leptin affect energy balance?
Long-term satiety
-Leads to decreased food intake
-Leads to weight loss
How does Grehlin affect energy balance?
Short-term satiety
-Leads to increased food intake
-Leads to weight gain
What is a “trigger” event?
An event that creates the desire to lose weight
*medical triggers result in more significant weight loss and better maintenance
What is structural tension?
The difference between the weight we are at currently (where we are) and the weight we want to be at (where we want to be)
What is Fundamental Choice?
Defines our state of being
ex: I choose to have optimal health
What are Primary Choices?
Defines our health goal
ex: I will maintain a healthy weight
What are Secondary Choices?
The day-to-day actions we take to achieve our primary choices
ex: I will go to the pool 3 days per week
What 3 factors are associated with weight regain?
-Dietary inhibition
-Decrease in physical activity
-Depression
What are the predictors of success?
(Use the acronym BE SLIM)
Breakfast
Exercise
Support
Low-fat meals every 3 hours
Individual plan
Monitor progress
What are the benefits of the mediterranean diet?
Decreased risk of death from cancer + heart disease
Reduced incidence of Parkinson’s disease and Alzheimer’s
Participants that kept their weight off for at least 2 years had what % chance of not gaining it back?
50%
Is it better to incorporate “cheat” days into your diet, or maintain consistent eating across the week?
It is better to maintain consistent eating patterns
How long does it take for the body to register satiety?
15-20 minutes
What is the recommended fiber target per day?
25-50 grams/day
True or False: Most Americans reach their daily fiber target
FALSE
The recommended daily fiber target is 25-50 g/day
*Most Americans consume 16g/day
What are the requirements for a patient to be considered a candidate for weight loss pharmacotherapy?
BMI > or = 30 kg/m^2
OR
BMI > or = 27 kg/m^2 with other risk factors AND did not lose/maintain weight loss with lifestyle intervention (<5% loss in 3-6 months)
What is the initial weight loss goal for a patient in the first 6 months of starting pharmacotherapy?
5-10% decrease of initial weight in six months
What are the goals of weight-loss related pharmacotherapy?
-Reduce body weight
-Maintain body weight
-Prevent weight gain
-Improve obesity-related conditions
When should an initial follow-up be conducted after starting weight-loss pharmacotherapy?
Every month for first 3 months of therapy
After 3 months of being on weight-loss pharmacotherapy (all initial follow-ups completed) how often should future follow-ups occur?
Every 3 months
What drug class offers a short-term weight loss treatment option?
CNS Stimulants
What is the mechanism of action of CNS stimulants?
Increase concentrations of norepinephrine to stimulate receptors in the hypothalamus
-Results in appetite suppression
What medications are CNS stimulants?
-Phentermine
-Phendimetrazine
-Benzphetamine
Diethylpropion
What is the mechanism of action of Orlistat?
Lipase inhibitor
-Reversibly inhibits gastric and pancreatic lipases which are integral in the absorption of long-chain triglycerides
-Decrease absorption of dietary fats by 30%
-Minimally absorbed, not systemic
What are the 2 brand names of Orlistat?
Xenical + Alli
If a meal is missed or does not contain fat should Orlistat be taken?
No
What 2 considerations should be taken into account with Orlistat?
-Suggested for patients with cardiovascular disease
-Recommend that patients take a standard multivitamin with this medication
What are the common adverse reactions to Orlistat?
-GI effects (oily spotting, pain, gas, fecal urgency, fatty stools, increased defecation, etc)
-Decreased absorption of fat-soluble vitamins
What are the contraindications of Orlistat?
-Pregnancy
-Chronic malabsorption syndrome
-Cholestasis
What is the mechanism of action of Phentermine/Topiramate ER?
Sympathomimetic amine/ Anticonvulsant
Phentermine:
-Stimulates hypothalamus to release norepinephrine which stimulates satiety
Topiramate:
-Weight loss mechanism unknown
At 12 weeks of taking phentermine/topiramate er, what needs to be accessed?
If 5% of baseline weight has not been lost after 12 weeks, discontinue use of phentermine/ topiramate er GRADUALLY
How do we define Global Health?
Using the term global health equity:
-A borderless pursuit of improving health for populations around the world
What is PEPFAR?
The US president’s emergency plan for AIDS relief
-Created in 2003
What is the leading cause of death and disability globally?
Non-communicable diseases (NCDs)
What is the goal of COVAX?
Ensures equitable access to COVID-19 tests, treatment, and vaccines
What are some important considerations with copay cards?
-Supplied by manufacturers to reduce the insurance copay with commercial/private insurance
-Cover brand not generic products
-Temporary solution
CANNOT USE WITH GOVERNMENT FUNDED INSURANCE
