Public Health Exam 2

Match the following terms with its definitions

1 - health disparity

2 - health inequity

3 - health equity

a. the attainment of the highest level of health for all people

b. difference in health-related outcomes between groups

c. differences in health status or distribution of health resources

1. b

2. c

3. a

When is health equity achieved?

when every person can attain his or her full health potential and no one is disadvantaged from achieving this potential regardless of social position or circumstances.

Select all that apply - List populations identified as being affected by health disparities.

a. racial and ethnic minority groups

b. upper class

c. socioeconomically disadvantaged populations

d. underserved rural populations

e. religious minorities

f. sexual and gender majorities

g. persons with disabilities

h. sexual and gender minorities

a racial and minority groups

c. socioeconomically disadvantaged populations

d. underserved rural populations

e. religious minorities

f. sexual and gender minorities

g. persons with disabilities

Select all that apply - Factors that contribute to development of health disparities.

a. race or ethnicity

b. socioeconomic status

c. religion

d. gender

e. mental health status

f. cognitive, sensory, or physical abilities

g. sexual orientation

h. geographic location

all of the above

Select three reasons of why are health disparities is a concern for public health?

a. they impact overall health of a nation

b. makes profit to US health care system

c. does not align with definition of public health nor population health.

d. costly to US healthcare system

a. they impact overall health of a nation

c. does not align with definition of public health nor population health.

d. costly to US healthcare system

How is descriptive and analytic epidemiology used in health disparities?

- helps to describe, develop hypotheses, and identify methods to address disparities.

(Remember: descriptive asks the what, when, where, and who while analytic asks the why and how)

How is surveillance used in health disparities?

- helps to discover and monitor differences in outcomes. Also helps to determine if differences are minimizing or if they cease to exist.

Match the following goals of healthy people to its year:

1. 2000

2. 2010

3. 2020

4. 2030

a. eliminate health disparities

b. eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well being of all

c. achieve health equity, eliminate disparities, improve health

d. reduce health disparities

1. d

2. a

3. c

4. b

Which of the following states the Healthy People 2030?

a. eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well being of all

b. achieve health equity, eliminate disparities, improve health

c. eliminate health disparities

d. reduce health disparities

a. eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well being of all

Healthy People are measured in ______ year intervals

10

Place the following processes of surveillance in order:

- data dissemination

- data analysis

- link to action

- data collection

- data interpretation

1. data collection

2. data analysis

3. data interpretation

4. data dissemination

5. link to action

Match the following terms with its definitions:

1. culture

2. cultural competence

3. cultural sensitivity

4. cultural humility

5. linguistic competence

a. Providing readily available, culturally appropriate oral and written languages services to limited English proficiency (LEP) members through such means as bilingual/bicultural staff, trained medical interpreters, and qualified translators.

b. A lifelong commitment to self-evaluation and critique, to redressing power imbalances and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations

c. Knowing that cultural similarities and differences exist without assigning value to those differences

d. An integrated pattern of human behavior that includes thoughts, communications, languages, practices, beliefs,

e. Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system,

1. d

2. e

3. c

4. b

5. a

How can culture influence health?

Culture influences how illness and symptoms are recognized/interpreted and to what they are attributed, and when should health services be used.

True or False: the purpose of having an awareness of culture in health care is to change the patient’s culture.

False, it is to help providers be aware of the influence of culture and understand how to best meet the health needs of a patient when their culture can help or hinder healthcare delivery. This improves patient-provider communication.

Place the following different stages of cultural competence continuum to its definitions.

1. cultural destructiveness

2. cultural incapacity

3. cultural blindness

4. cultural pre-competence

5. cultural competence

6. cultural proficiency

a. viewing and treating everyone the same

b. demonstrate an acceptance and respect for cultural differences

c. awareness of areas of growth to respond effectively to diverse populations

d. not being able to respond effectively to cultural groups

e. talks about what destroys a cultural group

f. hold culture in high esteem

1. e

2. d

3. a

4. c

5. b

6. f

You are a pharmacy technician working in a local pharmacy. A patient comes in to pick up his medications. The patient does not speak English. You overhear another technician saying, "I can't help him, no one here speaks his language."

Which of the following most likely characterizes this situation on the cultural competence continuum?

A. Cultural Destructiveness

B. Cultural Incapacity

C. Cultural Blindness

D. Cultural Pre-Competence

E. Cultural Competence

F. Cultural Proficiency

B. Cultural Incapacity

You are a pharmacy technician working in a local pharmacy. It is the week after New Year's day. You are aware that many of your patients observe the Daniel Fast. Therefore, you make a note to ask your patients with diabetes if they plan on fasting and counseling them on managing their blood glucose during this time.

Which of the following most likely characterizes this situation on the cultural competence continuum?

A. Cultural Destructiveness

B. Cultural Incapacity

C. Cultural Blindness

D. Cultural Pre-Competence

E. Cultural Competence

F. Cultural Proficiency

E. Cultural Competence

Core Functions at Government Levels

- Federal

- State

- Local

- Federal: public health surveillance; policies, CLAS Standards; Federal grants and resources

- State: state surveillance; policy development; state grants and resources

- Local: surveillance and reports; local policies; resources

Describe how the governmental core functions apply to promoting cultural competency

- National and Federal Level: Policy Development (CLAS Standards) —> support a more consistent and comprehensive approach to cultural and linguistic competence in healthcare.

- National and Federal Level: Assurance and Surveillance.

Surveillance: conducting and supporting research related to cultural competence using surveillance data

Assurance: tool books and guides from CDC and HRSA promote culturally competent care.

Describe the purpose of cultural competence assessments

To help bring an awareness to an individual or organization of areas of strength and improvement regarding cross-cultural interactions

Describe the CLAS standards

Developed to support a more consistent and comprehensive approach to cultural and linguistic competence in healthcare

Goal: to eliminate racial and ethnic disparities and improve health outcomes for all Americans

Identify the 4 theme areas addressed in the CLAS standards

1. Principal Standard

2. Governance, Leadership and Workforce

3. Communication and Language Assistance

4. Engagement, Continuous Improvement, and Accountability

Health Promotion

Health promotion is the process of enabling people to increase control over, and to improve, their health

Disease Prevention

Population based and individual based interventions for primary and secondary prevention

Explain the goal of health promotion and disease prevention.

To help people make healthy choices and prevent chronic diseases, and promote health and wellness.

Select all that apply: Behaviors addressed with health promotion and disease prevention.

a. eating well

b. staying idle

c. physical activity

d. tobacco use

e. alcohol use/misuse

f. eating what we want

g. health screenings

a. Eating Well

c. Physical Activity

d. Tobacco Use

e. Alcohol use/misuse

g. Health Screenings

Place the following 4 domains addressed by the National Center for Chronic Disease Prevention and Health Promotion to its domain:

1. Domain 1:

2. Domain 2:

3. Domain 3:

4. Domain 4:

a. Environmental Approaches

b. Community Programs Linked to Clinical Services

c. Epidemiology and Surveillance

d. Health Care System Interventions

1. c. Domain 1: Epidemiology and Surveillance

2. a. Domain 2: Environmental Approaches

3. d. Domain 3: Health Care System Interventions

4. b. Domain 4: Community Programs Linked to Clinical Services

Explain the ecological framework.

Relationship between living organisms and their environment. It includes intrapersonal (biological) and interpersonal (social) which are prime levels of influence for pharmacists. There is also organization, community, and policy.

Place the following tiers in order from top to bottom in the health impact pyramid framework.

• addresses social determinants of health

• interventions that are done once or infrequently

• ongoing clinical interventions

• counseling and education interventions

• involves making health the default choice

1. counseling and education interventions

2. ongoing clinical interventions

3. interventions that are done once or infrequently

4. involves making health the default choice

5. addresses social determinants of health

Which of the 5-tiers involve pharmacists?

The first 3

Compare and contrast the ecological framework and the 5-tier health impact pyramid framework.

Ecological framework is more about increasing positive interactions to better motivate healthy habits while the 5-tier health impact pyramid framework are tiers of how it best impacts behavior change. The lower tiers have greater impact on population (addressing social determinants of health)

Health care providers have been working to ensure that all patients have foot exams. There are new posters and videos in the waiting rooms and exam rooms that explain the purpose of diabetic foot exams. When patients check in to their appointment, they are asked when was their last foot exam. After the medical assistants check the patient’s vitals, they instruct the patient to remove their shoes and socks. At the end of the visit, the medical assistant returns to train the patient how to check and care for their feet at home.

Which framework is used in this example?

Ecological framework

Describe the pharmacist's role in the ecological and 5-tier health impact frameworks.

In ecological: pharmacists have a role in intrapersonal and interpersonal.

In 5-tier: pharmacists have a role in counseling and education interventions, ongoing clinical interventions, interventions that are done once or infrequently.

List the 3 components to be included in health education.

1. Awareness of relationship to health

2. Development of skills to act on awareness

3. Ability to use information correctly

Place the 10 steps required to plan and execute health promotion education initiatives in order.

• elicit reactions from the intended audience

• gather and review existing materials

• create criteria for choosing health promotion materials

• determine mode of delivery

• determine focus and intended audience

• determine the need for the initiative and educational materials

• understand the intended audience

• develop and implement a plan for dissemination

• create a mechanism for periodic review and modification

• identify and engage key community partners

1. determine the need for the initiative and educational materials

2. identify and engage key community partners

3. determine the focus and intended audience

4. understand the intended audience

5. determine the mode of delivery

6. create criteria for choosing health promotion materials

7. gather and review existing materials

8. elicit reactions from the intended audience

9. develop and implement a plan for dissemination

10. create a mechanism for periodic review and modification

BMI formula and steps

BMI = lbs/in² x 703

Waist circumference that is associated with increased risk of type 2 diabetes in men and women

>/= 40 inches in men and >/= 35 inches in women

Identify disease states and risk factors associated with overweight and obesity.

increased risk of type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease

Classify a patient into the National Institutes of Health (NIH) weight category according to BMI.

Describe initial and long-term goals of weight management

Initially patient would go on a diet but if BMI is alot higher, they would be on medications that assist with management.

Evaluate non-pharmacologic and pharmacologic treatment options available for weight loss and maintenance.

Non-pharmacologic: diet, physical activity, behavioral modifications, implantable medical devices (such as vBloc and ReShape), bariatric surgery.

Pharmacologic: (below)

Prescription: Orlistat, Phentermine/Topiramate ER, Naltrexone/Bupropion ER, Liraglutide and Semaglutide, Tirzepatide, Cellulose and citric acid, lorcaserin, phentermine, diethylpropion

OTC: ephedra, bitter orange and country mallow, guarana, chitosan, starch blockers

Generic of Alli and Xenical

Orlistat

Trade names for Orlistat

Xenical (Rx) and Alli (OTC)

MOA of Orlistat

• inhibits gastrointestinal lipases

• prevents enzymes from hydrolyzing dietary fat into free fatty acids, this decreases absorption of dietary fats, leads to reduced caloric intake.

Proper administration of Orlistat

by mouth, take while eating with meals that contains fat either during or up to 1 hour after the meal.

Contraindications of Orlistat

chronic malabsorption syndrome or cholestasis

Precautions of Orlistat

• If meal contains too much fat it increases GI side effects

• Use with caution in patients that have history of kidney stones.

Side effects of Orlistat

soft stools diarrhea, oily spotting, fecal urgency, decreased absoprtion of fat soluble vitamins

Monitoring parameters of Orlistat

BMI, calorie and fat intake, serum glucose in patients with diabetes, thyroid function tests in patients with thyroid disease, liver enzymes in patients with signs/symptoms of liver disease

Generic name of Qsymia

Phentermine/Topiramate ER

Trade name for Phentermine/Topiramate ER

Qsymia

MOA of Phentermine/Topiramate ER

• Phentermine induces central norepinephrine and dopamine transmission —> suppresses appetite

• Topiramate MOA is unsure, but helps increase satiety

Proper administration of Phentermine/Topiramate ER

• Take in AM to reduce insomnia

• If discontinued, taper dose to prevent seizures

Contraindications for Phentermine/Topiramate ER

pregnancy, glaucoma, hyperthyroidism, and use of MAOIs within 14 days

Precautions for Phentermine/Topiramate ER

• increase in HR, suicidal behavior and ideation, mood and sleep disorders, metabolic acidosis, elevated SCr can cause hypoglycemia

Side effects for Phentermine/Topiramate ER

tachycardia, paresthesia, taste changes insomnia, constipation, dry mouth

Monitoring parameters for Phentermine/Topiramate ER

• BMI, calorie and fat intake, blood glucose in patients with diabetes, pregnancy, depression, or suicidal thoughts, mood or sleep disorders, HR

• dicontinue if 5% weight loss is not achieved by 3 months at max dose.

Generic name for Contrave

naltrexone/bupropion ER

Trade name for naltrexone/bupropion ER

Contrave

MOA of naltrexone/bupropion ER

• pure opioid antagonist

• bupropion is a weak inhibitor of neuronal reuptake of dopamine and NE

• decrease appetite by reducing reactivity to food cues and improvement in dysregulation of eating control

Proper administration of naltrexone/bupropion ER

• do not take with high-fat meal

• take 1 tablet in the morning in week 1, increase to twice a day for week 2, increase to two in the morning and 1 at night for week 3, and then week 4 take two tablets twice a day

Contraindications for naltrexone/bupropion ER

hypersensitivity, use of other bupropion like drugs, use of other opioids, uncontrolled HTN, seizure disorder or history, eating disorders, pregnancy

Precautions for naltrexone/bupropion ER

watch for renal impairment

• no dose adjustments for mild renal impairment

• max dose 1 tablet twice a day if pt has moderate-severe renal impairment

• discontinue if pt has severe impairment

• pt with liver impairment, max dose of 1 a day

Side effects of naltrexone/bupropion ER

headache, n&v, tachycardia, HTN, acute opioid withdrawal, seizures

Discuss safety and/or efficacy concerns related to the use of noradrenergic agents and alternative therapies for weight loss.

N&V, headache, insomnia, HTN, acute opioid withdrawal, seizures

Monitoring parameters for naltrexone/bupropion ER

BMI, calorie and fat intake, serum glucose in patients with diabetes, CBC, depression/suicidal thoughts, serotonin syndrome or valvular heart disease

Generic name for Saxenda

liraglutide

Trade name for liraglutide

Saxenda

MOA of liraglutide

GLP-1 agonist —> suppresses appetite by delaying gastric emptying, increases glucose-dependent insulin release, decrease glucagon secretion

Proper administration of liraglutide

subcutneous, start at 0.6 mg then increase by 0.6 each week until it reaches 3 mg

Contraindications for liraglutide

history in personal/fam of medullary thyroid carcinoma or MEN-2 syndrome, pregnancy

Precautions for liraglutide

thyroid C-cell tumors, acute pancreatitis, hypoglycemia, HR increase, renal impairment, depression/suicidal, acute gallbladder disease

Side effects from liraglutide

nausea, hypoglycemia, vomiting, headache, decrease appetite, fatigue

Monitoring parameters of liraglutide

BMI, calorie and fat intake, serum glucose in pts with diabetes, CBC, depression/suicidal thoughts, SCr, HR, signs/symptoms of pancreatitis or gallbladder disease

Bariatric surgery is reserved for patients with BMI >/= ?

40 or 35 with comorbidities

Pharmacotherapy is considered for patients with BMI >/= ?

30 or 27-30 with comorbidities

Pharmacotherapy may be discontinued If how much % of weight loss didn’t occur after how many weeks of max dose therapy with phe/top or bup/nal?

12, 5%

Pharmacotherapy may be discontinued If how much % of weight loss didn’t occur after how many weeks of max dose therapy with liraglutide?

16, 4%