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PHAR10400 - The Public > Sem 1 > Flashcards

Sem 1 Flashcards

1
Q

What is the epicardium of the heart

A

Outside layer of the heart -
Layer is the parietal pericardium
Connective tissue layer

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2
Q

What is the myocardium of the heart

A

Middle layer of the heart -

Mostly cardiac muscle

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3
Q

What is the endocardium of the heart

A

Inner layer of the heart -

Endothelium

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4
Q

Atrioventricular valves

A

Between the atria and ventricles
Bicuspid and mitral valve (left)
Tricuspid valve (right)

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5
Q

Semilunar valve

A

Between ventricle and artery
Pulmonary semilunar valve
Aortic semilunar valve

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6
Q

Chordae tendineae

A

Valves open as blood is pumped through held in place by chordate tendineae
Close to prevent back flow

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7
Q

Operation of the AV valves

A

1) blood returning to the heart fills atria ,putting pressure against atrioventricular valves; the av valves are forced open
2) atria contract, forcing additional blood into ventricles
3) ventricles contract forcing blood against av valve cusp
4) av valves close
5) chordae tendineae tighten, preventing valve flaps from everting into atria

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8
Q

Operation of the semilunar valves

A

1) as ventricles contract and intraventricular pressure rises, blood is pushed up against semilunar valves, forcing them open
2) as ventricles relax, and intraventricular pressure falls, blood flows back from arteries, filling the cusp of semilunar valves and forcing them to close

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9
Q

Cardiac output ( and how to calculate it)

A

CO = heart rate (HR) X stroke volume (SV)

Amount of blood pumped by each side of the heart in one minute

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10
Q

Sinoatrial node (right atrium)

A

Heart pacemaker

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11
Q

Stroke volume ( and how to calculate it)

A

Stroke volume = volume of blood pumped by each ventricle in one contraction

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12
Q

Drug therapy for the cardiovascular treat what conditions

A
  • angina
  • heart attack
  • high blood pressure
  • high cholesterol
  • congestive heart failure
  • rhythm disorders
  • vascular problems
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13
Q

Angina medication

A

Nitrates
Beta blockers
Calcium channel blockers
- relieve pain and prevent attacks of angina

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14
Q

High blood pressure medication

A

May require treatment with one or more drugs
Vasodilator
Diuretics
Angiotensin converting enzyme inhibitors

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15
Q

Congestive heart failure medication

A

Treated with medication that increase myocardial contractions.

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16
Q

Rhythm disorder medication

A

Treated with medications that normalise the heart rate by affecting the nervous system that controls heart rate

  • beta blockers
  • calcium channel blockers
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17
Q

What is heart disease

A

Disease that affects the heart and blood vessels mainly related to atherosclerosis.

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18
Q

What is atherosclerosis

A

Build up of plaque (cholesterol) in artery walls

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19
Q

Risk factors of atherosclerosis

A

Diet, sedentary, hypertension, tobacco, diabetes, obesity, blood lipids, male

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20
Q

Results of atherosclerosis

A
  • hypertension
  • angina
  • myocardial infractions
  • heart failure
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21
Q

Cause of Hypertension

A

Exact cause is not known in most patients.

  • increased sympathetic activity and sodium overload increase blood pressure
  • renal disease
  • smoking , high BMI , and increased sodium consumption contribute to hypertension
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22
Q

Stable ischemic heart disease

A
  • Characterised by transient myocardial ischemia

- mostly commonly caused by obstruction of the coronary arteries by atheromatous plaque

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23
Q

Ischemic heart disease

A
  • ischemic heart disease is a condition in which there is an adequate supply of blood and oxygen to a portion of myocardium
  • typically occurs when there is an imbalance between myocardial oxygen supple and demand
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24
Q

Angina pectoris

A
  • chest pain because of episodic myocardial ischemia

- most common manifestation of the ischemic heart disease

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25
Q

Myocardial infraction

A

Heart cells deprived of blood/oxygen

Caused by complete blockage of one of the coronary arteries

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26
Q

Treatment of hypertension

A 
Thiazides diuretics 
Beta blockers 
ACE inhibitors 
Angiotensin 
Calcium channel blockers
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27
Q

How do Thiazide diuretics work

A

Inhibit sodium reabsorption in the kidney
Increase sodium excretion and uridine volume
Dilates arterioles

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28
Q

How do beta blockers work

A
  • block beta adrenoreceptors in the body
  • stimulation of the beta receptors in the heat increases the force of contraction
  • overall effect = increased cardia output, vascular resistance and sodium + water retention
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29
Q

How do ACE inhibitors work

A
  • Competitively inhibit the formation of angiotensin II from angiotensin I
  • very good at constricting veins
  • promotes aldosterone release
  • reduces blood pressure
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30
Q

How do Calcium channel blockers

A
  • reduce calcium ion influx into the heart
  • reduce calcium ion influx in the heart conducting
  • reduced the hearts contractility
  • reduces the electrical impulses in the heart
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31
Q

Special considerations when providing cardiovascular disease medication

A
  • pregnancy
  • elderly
  • diabetes
  • renal disease
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32
Q

What is the NHS health check

A

The NHS health check is a national risk assessment and management program.
Used to reduce risk, can prevent and delay the onset of vascular disease.
The service targets 40-74 year olds.

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33
Q

Vascular diseases that the NHS health check targets

A
  • coronary heart disease
  • stroke
  • diabetes
  • kidney disease
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34
Q

Fixed factors that cause vascular diseases

A

Age, sex and family history

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35
Q

Modifiable factors that cause vascular diseases

A
  • smoking
  • physical inactivity and a sedentary lifestyle
  • high blood pressure
  • raised cholesterol levels
  • obesity
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36
Q

How nicotine causes harm

A

Increases in heart rate

Increase in blood pressure

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37
Q

Affects of cigarettes on the body

A

Tar - principle source of carcinogens in cigarette smoke
Carbon monoxide - reduces oxygen-carrying capacity of the blood
Oxidant gases - increase the tendency of the blood to clot

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38
Q

Diseases caused from smoking

A
  • respiratory tract diseases
  • influenza
  • tuberculosis
  • periodontitis
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39
Q

What are the main aims of the stop smoking service

A
  • to improve access to and choice of stop smoking services
  • to assist in the delivery of the public service agreement
  • to reduce smoking related illnesses and deaths by helping people to give up smoking
  • to improve the health of the population by reducing exposure to passive smoke
40
Q

What happens during the consultation for a patient who wishes to stop smoking through the smoking cessation service

A

Initial assessment should include :

  • an assessment of the persons readiness to make a quit attempt
  • an assessment of the persons willingness to use appropriate treatment

Consultation should include :

  • a CO test
  • description of the effects of passive smoking on children and adults
  • explanation of the benefits of quitting smoking
  • describe what a typical treatment program might look like
  • conclude with an agreement on the shower treatment pathway
41
Q

How does smoking affect children and babies

A

Children and babies who live in a. Home where there is a smoke:

  • are more prone to asthma, and ear, nose and chest infections
  • have an increase risk of dying from cot death
  • more likely than average to become smokers themselves
  • they do less well at reading and reasoning skills compared
42
Q

Why is smoking harmful in pregnancy

A

Higher risk of:

  • having a miscarriage
  • having a pregnancy which does not develop in the normal place
  • slow growth of the baby
  • premature labor
  • bleeding towards the end of the pregnancy
43
Q

State the immediate benefits of stopping smoking

A

Improved circulation, lower blood pressure and heart rate, and better oxygen levels

44
Q

State two formulations of NRT that can be obtained via a PGD

A

Gum: release nicotine by chewing until taste becomes strong
Adv - discrete and mimics high level when smoking
Disadv- some people do not like the taste

Patch: worn for 16 or 24hrs a day
Adv - discrete
Disadv - does not mimic the highs of smoking

45
Q

Define respiration and the function of the respiratory system

A

The interchange of gases between an organism and the medium in which it lives. Respiratory system allows animals to move oxygen (needed for cellular respiration) into body tissues and remove carbon dioxide from cells.

46
Q

What are the 4 parts of the respiratory system

A
  • trachea
  • bronchi
  • bronchioles
  • alveoli
47
Q

Describe how respiration takes place in humans

A

During inhalation - the diaphragm and intercostal muscles contract

During exhalation - these muscles relax.the diaphragm domes upwards

48
Q

Describe how gas exchange occurs in humans

A

Air entering the lungs contains more oxygen and less carbon dioxide than the blood that flows in the pulmonary capillaries.
Hemoglobin binds to oxygen that diffuse into the bloodstream.

49
Q

Name 3 diseases of the lung and how they can affect respiration

A

Emphysema: smoking can lead to emphysema - alveoli become dry and brittle and eventually rupture

Cystic fibrosis: inherited disorder where mucus becomes to thick and sticky

Pneumonia: infection causes the lungs’ air sacs (alveoli) to become inflamed and fill up with fluid or pus

50
Q

Role of cilia and mucus in health and disease

A

Goblet cells- mucus secreting cells lining trachea, bronchi and bronchioles to trap foreign particles

Cilia - hair like structures that sweep the foreign particles up towards the mouth

51
Q

How does smoking lead to lung cancer

A

Inhaled smoke contains :

  • CO2, which affects the CO2 gradient
  • carcinogenic particles that can trigger tumors
  • toxic nicotine which paralyzes cilia which clean the lungs
52
Q

Factors leading to respiratory diseases

A
  • smoking
  • air pollution
  • hereditary
  • male sex
  • age
53
Q

How does smoking contribute to emphysema

A
  • it destroys lung tissue which is the cause of obstruction

- causes inflammation and irritation of airways

54
Q

Treatment of respiratory diseases

A
  • bronchodilators: drugs which help relieve coughing, shortness of breath and breathing problems by relaxing constricted airways
  • inhaled steroids: corticosteroid drugs inhaled as aerosol sprays reduce inflammation and may help relieve shortness of breath
  • antibiotics: appropriate for bacterial infections such as bronchitis
55
Q

Treatment of asthma

A

No cure for asthma can only be managed:

  • avoiding triggers or reducing exposure to triggers
  • using medication to control symptoms
56
Q

What is COPD and what type of medications are used to treat it

A

Chronic obstructive pulmonary disease - type of obstructive lung disease characterized by long-term breathing problems and poor airflow.

Treatment -

  • smoking cessation counseling and recommend PCV and flu vaccine
  • high dose inhaled corticosteroids or oral corticosteroid
  • symptoms may be relieved by short acting beta 2 agonist
57
Q

The role of WHO in health promotion

A
  • Focus on primary health care to improve access to quality essential service
  • train the health workforce and advise on labour policies
  • improve monitoring, data and information
58
Q

What are the 4 key commitments set out in the Bangkok charter for health promotion

A

The four key commitments are to make the promotion of health:

central to the global development agenda
a core responsibility for all of government
a key focus of communities and civil society
a requirement for good corporate practice.

59
Q

Public health three domains

A
  • health improvements : monitoring the public’s health, educating the public
  • improving services : evaluating health services, planning new health services
  • health protection : protecting the public. From dangers
60
Q

What is health education

A

Covers all aspects of activities seeking to improve health of individuals and community includes:

  • health education
  • environmental changes
  • legislative change
  • health promotion is making healthier choices easer choices
61
Q

Describe the pharmacist contribution to public health

A

3 levels of services:

Essential - all pharmacies:

  • provide opportunistic advice health living pharmacy
  • pharmacies will participate in 6 campaigns
  • undertake prescription linked interventions

Advanced - accredited pharmacies :

  • medicine use review (MUR)
  • new medicine service (NMS)

Enhanced - local services :
- drug misuse services

62
Q

What is drug tolerance

A

Reduction or loss of the normal response to a substance

63
Q

What is drug abuse

A

Persistent or sporadic excessive use inconsistent with or unrelated to acceptable medical practice

64
Q

What is psychological and physical drug dependence

A

Psychological - a feeling of satisfaction and psychic drive that requires periodic or continuous administration of the drug to produce pleasure or avoid discomfort

Physical - intensive physical disturbances that occur when administration is suspended

65
Q

Describe the pattern of drug misuse

A

Stage 1 - experimentation
Stage 2 - recreational use
Stage 3 - problematic use
Stage 4 - addiction

66
Q

What are the main reasons people misuses drugs

A
  • peer pressure
  • rebellion
  • combat depression
  • overcome shyness, anxiety, lack of confidence
  • feel good, high, exhilarated, euphoria, rush
67
Q

Described the factors which affect the desired effects

A
  • route of administration:
  • swallowed
  • injected
  • sniffed
  • smoke
  • type of drug misuse:
  • psychotic
  • stimulants
  • depressant
  • hallucinogen
68
Q

Risks of using heroin

A
  • physical dependence leading to crime
  • overdose
  • HIV infection
  • hepatitis infection
  • bacterial infection
  • damaged veins
69
Q

What 3 areas should be covered when giving advice to drug misusers

A
  1. Preparation of drugs for injection
  2. Advice on injection site
  3. Advice on injection techniques
70
Q

Needle exchange scheme

A

Community pharmacist can supply sterile injecting equipment to drug misuses as part of drug treatment services

71
Q

Describe the symptoms of chlamydia

A

Asymptotic 70% of women and 50 %

Suspected symptoms in women:

  • increased vaginal discharge
  • post-coital or intermenstrual

Suspected symptoms in men:

  • dysuria
  • reactive arthritis
72
Q

Why are chlamydia screening programs are important

A

It offers free opportunistic testing, treatment and partner management and prevention to sexually active young men and women under the age of 25.
Goals are to:
Prevent and control chlamydia
Reduce onward transmission
Prevent the consequences of untreated infection

73
Q

What patients are suitable for chlamydia treatment in a pharmacy

A

Pharmacies can provide chlamydia testing kits to people under the of 25.

74
Q

What are minor ailments

A

Minor ailments are defined as ‘common or self-limiting or uncomplicated conditions, which can be diagnosed and managed without medical intervention’

75
Q

What are the key aims and intended service outcomes of the minor ailment service

A
  • to improve primary, urgent and emergency care capacity by reducing the workload of those providers related to minor ailments
  • to provide evidence based care in line with local and national guidelines
76
Q

Who Is eligible to receive treatment via the minor ailments service

A

A. Local access - any patient registered with a GP practice in the PCO area can present in the pharmacy and access the scheme
B.voucher - people need a voucher to access the scheme. The management of the voucher will need to be determined locally
C.Referral - where people may be referred from another health care team member

77
Q

What is bowel cancer

A

Bowel cancer is the name most commonly given to any cancer of the large bowel
Bowel referred to as the colon and the back passage

78
Q

Signs and symptoms of bowel cancer

A
  • bleeding from the bottom or blood in your faces with no obvious reason
  • changes in your bowel habits
  • losing weight
  • extreme tiredness
79
Q

How do you reduce the risk of bowel cancer

A
  • get screened
  • eat a healthy high-fibre diet
  • engage in regular physical activity
  • don’t smoke
  • drink alcohol moderation
80
Q

Screening for bowel cancer

A

The test aims to find tiny amount of blood in your poo that cannot be seen with the naked eye

81
Q

Key drug interactions associated with azithromycin

A
  • warfarin: occasionally and unpredictably, the effects of warfarin may be markedly increased by macrolipids
  • statins
  • cyclosporin
  • Colchicine
82
Q

Describe the purpose of the QRISK calculator

A

QRISK®3 is the recommended formal risk assessment tool to assess CVD risk for the primary prevention of CVD in people up to and including the age of 84 years.

83
Q

What drug interactions are associated with statins

A
  • Warfarin/courmarins : Statins may affect coumarin anticoagulation and increase the risk of haemorrhagic events
  • Fibrates : The use of fibrates alone is occasionally associated with myopathy; use with statins may increase this risk
  • Ezetimibe : Ezetimibe has no pharmacokinetic interaction with statins. However, ezetimibe alone is associated with a risk of myopathy and an additive risk with statins cannot be ruled out
84
Q

What drug interactions are associated with azithromycin

A

Colchicine - Azithromycin is predicted to increase the exposure to colchicine. Manufacturer advises avoid P-glycoprotein inhibitors or adjust colchicine dose

Digoxin - Azithromycin increases the concentration of digoxin. Manufacturer advises monitor digoxin concentration

Edoxaban - Azithromycin is predicted to slightly increase the exposure to edoxaban. Manufacturer makes no recommendation

85
Q

Describe the role of the pharmacist in community

A

community pharmacist your job would be all about helping patients and the public, assessing their conditions and making decisions about which medicines they should take. You’ll be involved in dispensing medicines and offering your patients advice

86
Q

pharmacists in general practice

A

Role of pharmacist : Prescription requests
•Medication queries
•Make cost saving changes
•Order routine bloods •Conduct medication reviews

Career pathway : pre reg -> junior pharmacist-> senior pharmacist

87
Q

What is compliance

A

To do what the doctor orders

88
Q

What is adherence

A

When the patient’s behaviour coincides with the clinical prescription

89
Q

Techniques used to measure adherence

A

Direct methods:
•Measure drug concentration in body fluids
•Observation

Indirect methods;
•Tablet counts
•Electronic monitors
•Interview patients
•Dispensing records
90
Q

Types of non-adherence

A
  1. Intentional
    •Patients deliberately do not take their medicine as prescribed
  2. Non-intentional
    •Patients unintentionally don’t take their medicine as prescribed
91
Q

What is concordance

A
  • the prescriber and patient negotiate as equals to agree a plan of treatment
  • Agreement between patient and health care professional that respects the beliefs and wishes of the patient in determining whether, when and how medicines are to be taken
92
Q

How to improve adherence

A

Simplify dosage regimen:
Use combination products
•Co-codamol - contains codeine & paracetamol
•Co-amilozide - contains amiloride & hydrochorothiazide
Change formulation - Use modified release products
•Diclofenac 25mg three times a day
•75mg SR – take one daily
Change drug - to a once daily drug
•Captoptil – three times a day, ramipril – once daily

93
Q

self care

A

What it is :
Self care is what people do for themselves to establish and maintain health, prevent and deal with illness

Why it is important :
Over 15 million people in England with longer term health needs – growing number, ageing population
Wasted resources due to less focus on patient support and encouragement to take control of condition
People with long term conditions are experts in themselves and how their condition affects them and their lives

Benefits :
visits to GPs could decrease by up to 40%
visits to outpatient clinics could decrease by up to 17%
visits to A&E units could decrease by up to 50%

94
Q

Role of the pharmacist in self care

A

Provide advice to people, including carers, requesting help with the treatment of minor illness and long-term conditions, including general information and advice on how to manage illness

95
Q

Self medication

A

One element of self care
Selection and use of medicines by individuals to treat self recognised illnesses or symptoms

Maintain health and prevent illness
•Treatment of condition
•Treatment in addition to professionally prescribed medication

Influences on self medication
•Lowering of sickness absence
•Increase POM to P
•Increase medication availability
•Advertising and the INTERNET

PHAR10400 - The Public (2 decks)

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