US health final exam - Chronic and Genetic Diseases

Question 1

Chronic Disease

what is the mission?

to do this, what must we do

which is harder to prevent, chronic disease, or infectious disease

Answer 1

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

Question 2

Chronic degenerative diseases

what diseases are the most common and the most preventable

is it cheap to treat

what does prevention require

Answer 2

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

Question 3

Chronic degenerative diseases

Answer 3

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

Question 4

Research aimed at understanding chronic diseases

Answer 4

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

Question 5

Research aimed at understanding chronic diseases

Answer 5

Epidemiologic

Utilizes prospective and retrospective cohort studies as well as case-control studies

Question 6

The Burden of chronic diseases

Answer 6

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

Question 7

Risk factors terms

Answer 7

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

Question 8

Risk Factors for chronic disease

Answer 8

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

Question 9

Chronic disease prevention

Answer 9

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

Question 10

Four common causes of chronic disease

Answer 10

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.

Question 11

Cardiovascular disease

Answer 11

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

Question 12

Determinants of cardiovascular disease

Answer 12

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

Question 13

Example of direct contributing factors

Answer 13

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

Question 14

Hypertension

Answer 14

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

Question 15

Hyperlipidemia

Answer 15

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

Question 16

Hyperlipidemia and lipid disorders

Answer 16

Modifiable risk factors
Non-modifiable risk factors
Primary prevention
Secondary prevention
Role of the pharmacist

Question 17

Atherosclerosis

Answer 17

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

Question 18

Atherosclerosis

Answer 18

Modifiable risk factors
Non-modifiable risk factors
Primary prevention
Secondary prevention
Role of the pharmacist

Question 19

Cancer

Answer 19

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

Question 20

Cancer in men

Answer 20

The three most common cancers among men include:
Prostate cancer:

Lung cancer:

Colorectal cancer:

Question 21

Cancer in men

Answer 21

The leading causes of cancer death among men are:
Lung cancer:

Prostate cancer:

Liver cancer:

Colorectal cancer:

Question 22

Cancer in women

Answer 22

The three most common cancers among women include:
1 - Breast cancer:

2- Lung cancer:

3- Colorectal cancer

Question 23

Cancer in Women

Answer 23

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

Question 24

Cancer

Answer 24

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

Question 25

Primary cancer prevention

Answer 25

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

Question 26

Cancer

Answer 26

Secondary Prevention
- screening for disease

Role of the Pharmacist
- as more kits are given, the more role the RPh will have

Question 27

Diabetes

Answer 27

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)

Question 28

Diabetes

Answer 28

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

Question 29

Complications of diabetes

Answer 29

Heart disease and stroke.

High blood pressure

Kidney disease

Neuropathy

Amputation

Blindness

Depression

Question 30

Diabetes

Answer 30

Type 1 - insulin prevention

Primary prevention - none

Secondary prevention - decrease the impact of disease

Role of the Pharmacist

Question 31

Diabetes

Answer 31

Type 2
Primary prevention
- diet
- just like HTN :)

Secondary prevention
- Screening

Role of the pharmacist

Question 32

Other chronic diseases

Answer 32

Mental Illness

Alzheimer’s disease and dementia

Arthritis

Chron’s disease

Obesity
Primary Prevention
Secondary Prevention
Role of the Pharmacist

Question 33

The burden of chronic disease

Answer 33

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

Question 34

Congenital defects or disease

Answer 34

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

Question 35

Congenital defects or disease

Answer 35

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

Question 36

Environmental teratogens

Answer 36

Teratogens – environmental agents that can cause birth defects and/or cancer generally through mutations in DNA

Includes
- Infectious diseases
- Teratogenic drugs
- Environmental chemicals
- Alcohol

Question 37

Genetic diseases

Answer 37

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

Question 38

Prediction and Prevention of Birth Defects and Genetic Diseases

Answer 38

Genetic screening

Prenatal testing

Detailed PMH of birth mother and father

Prenatal health measures
- healthcare before delivery of baby

Education

Role of the pharmacist?

Question 39

Ethical Issues and Genetic Diseases

Answer 39

Infant screening for diseases

Pre-natal screening for diseases

Parent screening for disease carriers

Question 40

RPh PCP

Answer 40

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