1
Q
What is the epicardium of the heart
A
Outside layer of the heart -
Layer is the parietal pericardium
Connective tissue layer
2
Q
What is the myocardium of the heart
A
Middle layer of the heart -
Mostly cardiac muscle
3
Q
What is the endocardium of the heart
A
Inner layer of the heart -
Endothelium
4
Q
Atrioventricular valves
A
Between the atria and ventricles
Bicuspid and mitral valve (left)
Tricuspid valve (right)
5
Q
Semilunar valve
A
Between ventricle and artery
Pulmonary semilunar valve
Aortic semilunar valve
6
Q
Chordae tendineae
A
Valves open as blood is pumped through held in place by chordate tendineae
Close to prevent back flow
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
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
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
10
Q
Sinoatrial node (right atrium)
A
Heart pacemaker
11
Q
Stroke volume ( and how to calculate it)
A
Stroke volume = volume of blood pumped by each ventricle in one contraction
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
13
Q
Angina medication
A
Nitrates
Beta blockers
Calcium channel blockers
- relieve pain and prevent attacks of angina
14
Q
High blood pressure medication
A
May require treatment with one or more drugs
Vasodilator
Diuretics
Angiotensin converting enzyme inhibitors
15
Q
Congestive heart failure medication
A
Treated with medication that increase myocardial contractions.
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
17
Q
What is heart disease
A
Disease that affects the heart and blood vessels mainly related to atherosclerosis.
18
Q
What is atherosclerosis
A
Build up of plaque (cholesterol) in artery walls
19
Q
Risk factors of atherosclerosis
A
Diet, sedentary, hypertension, tobacco, diabetes, obesity, blood lipids, male
20
Q
Results of atherosclerosis
A
- hypertension
- angina
- myocardial infractions
- heart failure
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
22
Q
Stable ischemic heart disease
A
- Characterised by transient myocardial ischemia
- mostly commonly caused by obstruction of the coronary arteries by atheromatous plaque
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
24
Q
Angina pectoris
A
- chest pain because of episodic myocardial ischemia
- most common manifestation of the ischemic heart disease
25
Myocardial infraction
Heart cells deprived of blood/oxygen
| Caused by complete blockage of one of the coronary arteries
26
Treatment of hypertension
```
Thiazides diuretics
Beta blockers
ACE inhibitors
Angiotensin
Calcium channel blockers
```
27
How do Thiazide diuretics work
Inhibit sodium reabsorption in the kidney
Increase sodium excretion and uridine volume
Dilates arterioles
28
How do beta blockers work
- 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
29
How do ACE inhibitors work
- Competitively inhibit the formation of angiotensin II from angiotensin I
- very good at constricting veins
- promotes aldosterone release
- reduces blood pressure
30
How do Calcium channel blockers
- 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
31
Special considerations when providing cardiovascular disease medication
- pregnancy
- elderly
- diabetes
- renal disease
32
What is the NHS health check
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.
33
Vascular diseases that the NHS health check targets
- coronary heart disease
- stroke
- diabetes
- kidney disease
34
Fixed factors that cause vascular diseases
Age, sex and family history
35
Modifiable factors that cause vascular diseases
- smoking
- physical inactivity and a sedentary lifestyle
- high blood pressure
- raised cholesterol levels
- obesity
36
How nicotine causes harm
Increases in heart rate
| Increase in blood pressure
37
Affects of cigarettes on the body
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
38
Diseases caused from smoking
- respiratory tract diseases
- influenza
- tuberculosis
- periodontitis
39
What are the main aims of the stop smoking service
- 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
What happens during the consultation for a patient who wishes to stop smoking through the smoking cessation service
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
How does smoking affect children and babies
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
Why is smoking harmful in pregnancy
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
State the immediate benefits of stopping smoking
Improved circulation, lower blood pressure and heart rate, and better oxygen levels
44
State two formulations of NRT that can be obtained via a PGD
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
Define respiration and the function of the respiratory system
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
What are the 4 parts of the respiratory system
- trachea
- bronchi
- bronchioles
- alveoli
47
Describe how respiration takes place in humans
During inhalation - the diaphragm and intercostal muscles contract
During exhalation - these muscles relax.the diaphragm domes upwards
48
Describe how gas exchange occurs in humans
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
Name 3 diseases of the lung and how they can affect respiration
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
Role of cilia and mucus in health and disease
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
How does smoking lead to lung cancer
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
Factors leading to respiratory diseases
- smoking
- air pollution
- hereditary
- male sex
- age
53
How does smoking contribute to emphysema
- it destroys lung tissue which is the cause of obstruction
| - causes inflammation and irritation of airways
54
Treatment of respiratory diseases
- 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
Treatment of asthma
No cure for asthma can only be managed:
- avoiding triggers or reducing exposure to triggers
- using medication to control symptoms
56
What is COPD and what type of medications are used to treat it
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
The role of WHO in health promotion
- 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
What are the 4 key commitments set out in the Bangkok charter for health promotion
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
Public health three domains
- 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
What is health education
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
Describe the pharmacist contribution to public health
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
What is drug tolerance
Reduction or loss of the normal response to a substance
63
What is drug abuse
Persistent or sporadic excessive use inconsistent with or unrelated to acceptable medical practice
64
What is psychological and physical drug dependence
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
Describe the pattern of drug misuse
Stage 1 - experimentation
Stage 2 - recreational use
Stage 3 - problematic use
Stage 4 - addiction
66
What are the main reasons people misuses drugs
- peer pressure
- rebellion
- combat depression
- overcome shyness, anxiety, lack of confidence
- feel good, high, exhilarated, euphoria, rush
67
Described the factors which affect the desired effects
- route of administration:
- swallowed
- injected
- sniffed
- smoke
- type of drug misuse:
- psychotic
- stimulants
- depressant
- hallucinogen
68
Risks of using heroin
- physical dependence leading to crime
- overdose
- HIV infection
- hepatitis infection
- bacterial infection
- damaged veins
69
What 3 areas should be covered when giving advice to drug misusers
1. Preparation of drugs for injection
2. Advice on injection site
3. Advice on injection techniques
70
Needle exchange scheme
Community pharmacist can supply sterile injecting equipment to drug misuses as part of drug treatment services
71
Describe the symptoms of chlamydia
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
Why are chlamydia screening programs are important
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
What patients are suitable for chlamydia treatment in a pharmacy
Pharmacies can provide chlamydia testing kits to people under the of 25.
74
What are minor ailments
Minor ailments are defined as ‘common or self-limiting or uncomplicated conditions, which can be diagnosed and managed without medical intervention’
75
What are the key aims and intended service outcomes of the minor ailment service
- 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
Who Is eligible to receive treatment via the minor ailments service
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
What is bowel cancer
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
Signs and symptoms of bowel cancer
- bleeding from the bottom or blood in your faces with no obvious reason
- changes in your bowel habits
- losing weight
- extreme tiredness
79
How do you reduce the risk of bowel cancer
- get screened
- eat a healthy high-fibre diet
- engage in regular physical activity
- don’t smoke
- drink alcohol moderation
80
Screening for bowel cancer
The test aims to find tiny amount of blood in your poo that cannot be seen with the naked eye
81
Key drug interactions associated with azithromycin
- warfarin: occasionally and unpredictably, the effects of warfarin may be markedly increased by macrolipids
- statins
- cyclosporin
- Colchicine
82
Describe the purpose of the QRISK calculator
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
What drug interactions are associated with statins
- 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
What drug interactions are associated with azithromycin
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
Describe the role of the pharmacist in community
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
pharmacists in general practice
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
What is compliance
To do what the doctor orders
88
What is adherence
When the patient’s behaviour coincides with the clinical prescription
89
Techniques used to measure adherence
Direct methods:
•Measure drug concentration in body fluids
•Observation
```
Indirect methods;
•Tablet counts
•Electronic monitors
•Interview patients
•Dispensing records
```
90
Types of non-adherence
1. Intentional
•Patients deliberately do not take their medicine as prescribed
2. Non-intentional
•Patients unintentionally don’t take their medicine as prescribed
91
What is concordance
* 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
How to improve adherence
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
self care
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
Role of the pharmacist in self care
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
Self medication
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
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PHAR10400 - The Public
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