US health final exam - Chronic and Genetic Diseases Flashcards
Chronic Disease
what is the mission?
to do this, what must we do
which is harder to prevent, chronic disease, or infectious disease
Another mission of public health is to prevent premature death and disability
In order to prevent disease, you have to understand it
More difficult with chronic disease than infectious disease - because typically infectious disease has a life span but chronic diseases last for a long time or a life
type 2 diabetes, obesity can go away
Chronic degenerative diseases
what diseases are the most common and the most preventable
is it cheap to treat
what does prevention require
Cardiovascular disease, stroke, cancer, diabetes are among the most common chronic diseases and are also the most preventable
Most common and costly of all health problems
Prevention of these diseases requires understanding of the causes which are more complex than those of acute diseases
Also requires understanding of risk factors for the diseases
Most often occur from diagnosis to death and are progressive and are not curable
Chronic degenerative diseases
In most cases, no single pathogen
Have multiple causes making it hard to recognize significant risk factors and establish preventive measures
Often have a gradual onset providing the advantage of early detection - gives advantage to detect early to implement interventions early in the disease and minimize impact of disease
Allows for secondary prevention: interventions early in the disease process that can mitigate its impact
Research aimed at understanding chronic diseases
Biomedical – conducted by NIH and its institutes. The growth of NIH reflects concern about chronic diseases
Biomedical research/laboratory research involves studies of animals as models or stand-ins for human subjects
Challenges of using animal models include ethical issues, cost, similarity of animal models and humans, ability to extrapolate results to humans, differences in genetic regulation, anatomical differences, variety of pathophysiological mechanisms, differences between species, differences in responses to drugs
Research aimed at understanding chronic diseases
Epidemiologic
Utilizes prospective and retrospective cohort studies as well as case-control studies
The Burden of chronic diseases
The leading cause of death and disability
Cause 7 out of 10 deaths per year - financial impact on country and healthcare system
Cardiovascular, cancer, and stroke account for more than 50% of all deaths yearly
More than 75% of healthcare costs are spent on chronic diseases
Risk factors terms
Term for factors linked with specific health problems
Determinants of disease
– scientifically established factors that relate directly to the level of a health problem.
As the level of the determinant changes the severity of the health problem changes.
These are the risk factors most closely associated with the disease.
- if for HTN: smoking, poor diet, salt intake, no exercise – these cause the disease
Direct Contributing Factors
– scientifically identified factors that affect the level of the determinant
sooo determinants of disease determines how severe the disease is and the driect contributing factors are factors that heighten your chances of getting the disease
Risk Factors for chronic disease
What are modifiable risk factors?- behaviors that lead to the development or maintenance of chronic disease
What are non-modifiable risk factors? - factors that cannot be changed like age and sex
Chronic disease prevention
Primary prevention - lifestyle changes to prevent the disease
- usually refers to healthy lifestyle choices to prevent the development of risk factors. Primary prevention deals with delaying or preventing the onset of cardiovascular disease
- what they do every day
Secondary prevention - early detection of the disease to stop progression
- relies on early detection of the disease process and the application of interventions to prevent the progression of the disease
- going to PCP for physical, or to draw blood, or a lipid panel, chemotherapy
Four common causes of chronic disease
Four Common Causes of Chronic Disease
Four modifiable health risk behaviors:
—lack of physical activity
— poor nutrition
— tobacco use
— excessive alcohol consumption
are responsible for much of the illness, suffering, and early death related to chronic diseases.
Cardiovascular disease
Includes 2 of the 3 leading causes of death in the United States: heart disease and stroke
Risk increases with age (not a modifiable risk factor, cannot do anything about age)
Incidence is higher in men than women
Incidence is higher in blacks than in whites
any room for modification: nope
Determinants of cardiovascular disease
what relates directly to the level of the health problem and are the most closely related risk factors - related to the level of CVD
- Atherosclerosis
- Smoking
- Lipid disorders
- Diabetes (type 2 mostly)
- Hypertension
- Obesity
Example of direct contributing factors
Determinant is hypertension
Direct contributing factors:
- Obesity
- Smoking
- Lack of exercise
- Stress
- Dietary salt
will not have to know what is a direct contributing factor or modifiable risks
Hypertension
Normal, pre-hypertension, hypertension
Modifiable risk factors: diet, exercise, smoking, tobacco
Non-modifiable risk factors: age, sex,
Primary prevention
- eating a healthy diet
- exercise
- not smoking
- no tobacco
- no alcohol
Secondary prevention
- screening for it
Role of the Pharmacist
- most of the patients will have this disorder
Hyperlipidemia
Normal total cholesterol, LDL, HDL
Factors that affect cholesterol (Direct contributing factors) include:
- Diet
- Exercise
- Alcohol consumption
- Smoking
- Genetic predisposition
HTN is also modified thru
- diet
- exercise
- alcohol
- smoking
Hyperlipidemia and lipid disorders
Modifiable risk factors
Non-modifiable risk factors
Primary prevention
Secondary prevention
Role of the pharmacist
Atherosclerosis
Often referred to as the hardening of the arteries
The buildup of plaque (composed of fat and cholesterol, blood cells, and clotting factors)
Plaques build up and break off causing stroke and myocardial infarction
Factors that contribute (Direct contributing factors) include
- Smoking
- Hypertension
- Obesity
- Hypertension
- Bacterial infection being studied as a contributor
Atherosclerosis
Modifiable risk factors
Non-modifiable risk factors
Primary prevention
Secondary prevention
Role of the pharmacist
Cancer
Normal cells are turned cancerous through a mutation in the DNA
Mutated cells reproduce rapidly and transmit the mutation to daughter cells
Errors occur in the DNA that is copied leading to further mutations and abnormalities
During the formation of a tumor, there may be overstimulation of the growth of blood vessels leading to metastasizing
Mutations caused by chemicals, viruses, radiation, hormones
Diets high in fat content are associated with cancer as well
Has surpassed heart disease as the leading cause of death among Americans less than 85 years of age
DNA can only take so many hits leading to mutation and tumors
Cancer in men
The three most common cancers among men include:
Prostate cancer:
Lung cancer:
Colorectal cancer:
Cancer in men
The leading causes of cancer death among men are:
Lung cancer:
Prostate cancer:
Liver cancer:
Colorectal cancer:
Cancer in women
The three most common cancers among women include:
1 - Breast cancer:
2- Lung cancer:
3- Colorectal cancer
Cancer in Women
The leading causes of cancer death among women are:
1- Lung cancer:
2- Breast cancer:
3- Colorectal cancer: have routine screening
for both men and women, lung is not as common but lung is the most deadly
Cancer
Primary Prevention – avoid exposure to agents known to cause cell mutations:
Chemicals and minerals associated with lung and other cancers (smoking)
Viruses such as HPV associated with cervical cancer, Hepatitis B associated with liver cancer
Radiation (sun and ionizing radiation, radon gas) associated with skin cancer, leukemia and others
Primary cancer prevention
Don’t smoke or use tobacco products or second-hand smoking
Limit alcohol consumption
Limit exposure to UV rays from the sun and artificial sources
Eat a diet rich in fruits and vegetables and low in fat and processed foods
Maintain a healthy weight
Be physically active
Have regular routine screenings and medical care
Cancer
Secondary Prevention
- screening for disease
Role of the Pharmacist
- as more kits are given, the more role the RPh will have
Diabetes
Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action or both
There are four types of diabetes: Type 1 (DM1), Type 2 (DM2), Pre-diabetes and gestational diabetes
Type 1 Diabetes – There is an autoimmune attack on the islet beta cells of the pancreas destroying a significant number of these cells. The pancreas cannot make adequate amounts of insulin and hyperglycemia occurs.
Type 2 Diabetes – Begins with insulin resistance in adipose, liver and muscle tissue. As the disease progresses insulin secretion also declines. (↑insulin resistance, ↓insulin production)
Diabetes
In adults, DM2 accounts for 90 to 95% of diagnosed diabetes.
The risk of developing Type 2 diabetes increases with age.
There is a strongly correlated genetic component in the development of Type 2 diabetes.
Risk factors for developing Type 2 diabetes include:
Age - a non-modifiable risk factor
Obesity
Sedentary lifestyle
Chronic pancreatitis
Ethnicity (Native Americans, African Americans, Asians, Pacific Islanders, Alaskans)
Co-morbidities such as hypertension, hyperlipidemia
Genetic predisposition
Complications of diabetes
Heart disease and stroke.
High blood pressure
Kidney disease
Neuropathy
Amputation
Blindness
Depression
Diabetes
Type 1 - insulin prevention
Primary prevention - none
Secondary prevention - decrease the impact of disease
Role of the Pharmacist
Diabetes
Type 2
Primary prevention
- diet
- just like HTN :)
Secondary prevention
- Screening
Role of the pharmacist
Other chronic diseases
Mental Illness
Alzheimer’s disease and dementia
Arthritis
Chron’s disease
Obesity
Primary Prevention
Secondary Prevention
Role of the Pharmacist
The burden of chronic disease
On the individual with the disease
- may have anxiety about it
- financially
- taking meds correctly
- change in insurance
On the public health system
On the healthcare system as a whole
On caregivers and families
side note:
- epilepsy will not be a focus of PH initiatives because there are not a lot of modifiable risk factors
- PH interventions on diseases that have the most modifiable risks
Congenital defects or disease
3 to 4% of newborns have a major abnormality identified at birth
Up to 7.5% of children diagnosed with a congenital defect by age 6
Major cause of death and disability in infants and children
don’t memorize % but just know many children are born with defects
Congenital defects or disease
This may be caused by:
- Injury during birth
- Mother’s exposure to infectious disease or toxic substances during pregnancy. Mother’s behavior: smoking, alcohol, heavy metals
- Genetics from parents
Environmental teratogens
Teratogens – environmental agents that can cause birth defects and/or cancer generally through mutations in DNA
Includes
- Infectious diseases
- Teratogenic drugs
- Environmental chemicals
- Alcohol
Genetic diseases
Many chronic diseases have some evidence of genetic predisposition
this is why we need to pay attention to family history – Detailed past medical history and family history are essential health information
Prediction and Prevention of Birth Defects and Genetic Diseases
Genetic screening
Prenatal testing
Detailed PMH of birth mother and father
Prenatal health measures
- healthcare before delivery of baby
Education
Role of the pharmacist?
Ethical Issues and Genetic Diseases
Infant screening for diseases
Pre-natal screening for diseases
Parent screening for disease carriers
RPh PCP
a lot of information has to do with the collection of info
assessment of patient
plan put in place to address the issue
implement the plan
monitor how effective the plan was
