Misuse and Health Promotion Quiz PDF

Sympathiomimetics Similar chemical structure to amfetamines (stimulants) Enhance release of endogenous noradrenaline. (ά β agonists- (++ heart rate and blood pressure, elevate mood and decrease appetite) Used as decongestants = vasoconstriction of (nasal) blood vessels- able to breathe easier Inter...

Sympathiomimetics Similar chemical structure to amfetamines (stimulants) Enhance release of endogenous noradrenaline. (ά β agonists- (++ heart rate and blood pressure, elevate mood and decrease appetite) Used as decongestants = vasoconstriction of (nasal) blood vessels- able to breathe easier International Olympic Committee ban on ephedrine products. Large packs of pseudoephedrine & ephedrine replaced by smaller packs of 720mg (the equivalent of 12 tablets or capsules of 60 mg or 24 tablets or capsules of 30mg) One pack per customer - sales should be carried out by a pharmacist Analgesics Highest volume of OTC sales. Misuse can lead to Some contain chronic headaches, caffeine or medication overuse antihistamines headache (MOH) (withdrawal / (prevalence of MOH tolerance problems) likely to 1% to 2%) Non opioid Abuse: Most analgesics: aspirin, problematic with ibuprofen (subtle products containing reinforcing effects at opioids e.g codeine high doses- (esp those on OST) paracetamol is toxic at high dose) All packs now contain warning- 3- day max use, highlight potential of Opioids Mainly codeine, dihydrocodeine and loperamide agonists at mu receptors- (analgesia, bradycardia, cough suppression, euphoria, miosis, dependence, reduced GI motility, respiratory depression, sedation) Synergistic effect with GABA agonists (alcohol, BZs, z hypnotics) Therapeutic effect is via active metabolites of codeine – morphine, hydrocodone, hydromorphone and morphine – 6- glucuronide Dependent on CYP2D6, 3A4 which is person dependent (genetic polymorphism) and functionality of the P-glycoprotein pump which prevents certain drugs from penetrating the BBB. Loperamide is antidiarrheal- less CNS effect at therapeutic dose ,need to take supratherapeutic Antihistamines Sedating antihistamines (in large doses) can produce Diphenhydramine = mild euphoria – Chlorphenamine = cough suppressant dissociative effect rash/itch caused by & sleep aid antimuscarinic properties Particularly popular Cyclizine = travel Promethazine = amongst opiate drug sickness travel sickness users, in large quantities Elderly - ++falls, + can substitute or +anticholinergic enhance effect of burden (often illicit drugs inadvertent use) Antitussives cough is stimulated by irritation of respiratory To supress [dry irritating] DMD metabolite mucosa- due to cough i.e inhibit the (dextrophan) has similar contamination/infection, medullary cough centre: action to PCP (NMDA protective mechanism- Dextromethorphan (pro receptor agonist)- Main encourage or supress the drug) & pholcodine. effects: dissociative, cough. euphoria, hallucinations. Tolerance & dependence (tachycardia, hypertension, psychosis, mania) - usual CYP 2D6 polymorphism doses = 300mg daily dependent (highest recorded = 2880mg for up to 5 yrs) Laxatives Stimulant laxatives - Intension is to  common amongst calorific impact of food To change or alter by preventing individuals with eating body image /shape absorption – (not so as disorders (Anorexia nutrients/calories Nervosa / Bulimia) already removed) Adverse effects of laxative abuse: chronic diarrhoea, dehydration, Products: Ex Lax, hypotension, Dulco-lax, Senokot tachycardia, (sennosides choc or hypokalaemia (muscle tablets) weakness), reduced weight, bone loss, seizures, stroke, death Treatment NHS geared towards other addiction (alcohol, opioids) – lack of understanding, resources, services ‘Cold turkey’ – sudden stop or by reducing doses External support (online forums, Narcotics Anonymous, OverCount & Codeine Free Websites form a confirmatory role i.e reassurance that it is a problem and others are similarly affected. Charities. Atherosclerosis Risk Factors Detection? Atherosclerosis is typically asymptomatic! It is most often found after it manifests itself as a heart attack or stroke Measure of LDL within the blood as a predictor Measure blood pressure as a predictor 20% of events occur in individuals with no major risk factors LDL – (low-density lipoprotein or ‘Bad cholesterol’. This forms plaques. Plaques will form with age regardless of the person. Cholesterol is a surrogate marker for CVD. Prevalence of Risk Factors in Patients with Coronary Heart Disease Relative Risks of Future MI among Apparently Healthy Middle-Aged Men: Physician’s Health Study Lipoprotein(a) Homocysteine Total Cholesterol Fibrinogen tPA Antigen TC:HDL-C hs-CRP hs-CRP + TC/HDL-C 0 1.0 2.0 4.0 6.0 Relative Risk for Future MI Ridker PM. Ann Intern Med 1999;130:933-937. Proportion of People in Scotland with any Cardiovascular Condition by Age and Deprivation Source: Scottish Health Survey 2019 Role of the Pharmacist in Health Education/ Promotion What is the role of the pharmacist? Managing conditions such as blood pressure, asthma, diabetes etc Understanding illness Understanding medications Compliance Developing community relationship – nurses, dentists, this forms a structure that ppl rely on  Health- Minor Illness- Major disease progression healthy onset of advanced disability person symptoms symptoms death (reversible) (not reversible ) Primary Secondary Tertiary prevention prevention prevention screening rehabilitation case finding early prevention The Ottawa Charter (WHO 1986) The Ottawa Charter for Health Promotion provided a further impetus to an emerging modern health promotion movement. Definition: “Health promotion is the process of enabling people to increase control over, and to improve their health”. Ottawa Charter for Health Promotion. WHO, Geneva,1986 Over the last 25 years, the Ottawa Charter has been highly influential, constant point of reference for those involved in promoting health: http://www.who.int/healthpromotion/en/ Health Promotion 3 basic strategies: “empowering, mediating, and advocacy” 5 key themes: 1. Build healthy public policy 2. Create supportive environments 3. Strengthen community action 4. Develop personal skills 5. Reorientation of health services Definitions of health Health as “absence of disease” Medical model of health Can be traced back as far as the ancient Greeks Health as “well being” Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO 1948) Health as “a resource” Health is a resource for everyday life, not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capabilities (Ottawa Charter for Health Promotion. WHO, Geneva, Factors that influence health The factors which influence health are: multiple and interactive both within and outside an individual’s control (loci of control) modifiable or non-modifiable Health promotion is fundamentally concerned with action and advocacy to address the full range of potentially Modifiable determinants of health: not only those which are related to the actions of individuals (health behaviours and lifestyles) but also factors such education, employment and working conditions and the physical environments. Non-modifiable determinants of health: biology and genetics. Models for health and illness behaviour Level of theory Model or theory Individual Biological models Motivation theory Cognitive dissonance Health Belief Model Stages of Change Model Family/friends Social Learning Theory Theory of Reasoned Action Social Network Theory Community Social Capital Theory Communication of Innovations National/Society Normative models Culture-based models Economic/legal models Health belief model For a person to take action he/she must: believe they are susceptible believe the health problem is serious believe that the advantages of taking action outweigh the disadvantages A trigger may be needed to encourage the person to act Dahlgren and Whitehead (1991) Illustration of the wider determinants of health, identifying layers which influence health from individual to societal to global. Used to flag inequalities in health, identifying socio-economic, cultural and environmental factors which affect health. Identifies the need for structural interventions to impact on the causes. Changing Your Health Behaviour Change depends on the individual. Identify what is most important to you or what poses the most immediate threat to health. Examples: Diet Relationships Stress management (Uni workload vs. life) Safe sex Drug and alcohol use Exercise Tobacco use  Factors that Influence Behaviour Change Predisposing factors Knowledge, beliefs, and attitudes based on life experiences, as well as gender, age, race, and socioeconomic background Enabling factors Skills and abilities, available resources; can be positive or negative Reinforcing factors Presence or absence of support, encouragement or discouragement from those around you Percentage of respondents who smoke by Scottish Index of Multiple Deprivation ?