Exam 3 Self-Care

• Accuracy: _________, how close to the _________ (test vs _________, test vs _________ of disease)

• Precision: _________, how close each reading is _________, _________ or _________

validity, actual value, gold standard, presence/absence, reliability, to the next, repeatability, reproducibility

• True Positive (TP): tests are _________ (_________ accurate and/or precise)

• True Negative (TN): tests are _________ (_________ accurate and/or precise)

• False Positive (FP): tests are _________ (_________ accurate and/or precise)

• False Negative (FN): tests are _________ (_________ accurate and/or precise)

always correct, is, always correct, is, subject to error, is not, subject to error, is not

Sensitivity: (Number of people _________ disease that test _________) / (Total number of people _________ disease)

• Formula: _________

Specificity: (Number of people _________ disease that test _________) / (Total number of people _________ disease)

• Formula: _________

with, positive, with, TP / (TP + FN), without, negative, without, TN / (TN + FP)

Positive Prediction Value (PPV): Number of people _________ disease that test _________ / Total number of people that test _________

• Formula: _________

Negative Prediction Value (NPV): Number of people _________ disease that test _________ / Total number of people that test _________

• Formula: _________

with, positive, positive, TP / (TP + FP), without, negative, negative, TN / (TN + FN)

250 people in a population of 1000 have a particular disease. A test can correctly find 200 of the 250 affected people. This same test also identifies 100 of the healthy people as having the disease. Find the sensitivity, specificity, PPV, and NPV of this test.

• Positive w/condition → _________

• Negative w/condition → _________

• Positive w/o condition → _________

• Negative w/o condition → _________

• Test’s Sensitivity = _________

• Test’s Specificity = _________

• PPV = _________

• NPV = _________

200, 50, 100, 650, 80.0%, 86.7%, 66.7%, 92.9%

• Pregnancy Detection Kits

  • Detects _________ (hCG) in the _________

  • Hormone produced by placenta _________ fertilization of ovum

  • Generally detectable in urine _________ weeks after conception 

  • hCG _________ in concentration during pregnancy

  • Max levels at ~__ weeks post-conception

  • Presence of hCG in _________ is diagnostic for pregnancy

  • Pregnancy cannot be detected _________ implantation/fertilization

  • Several tests allow for testing before missed period

human chorionic gonadotropic hormone, urine, after, 1-2, increases, 6, urine, before

• Urinary Ovulation Tests

  • Goal: determine _________ ovulation will occur to _________ time sexual intercourse

  • Ovulation occurs ~_________ hours _________ surge

  • To maximize the chance of pregnancy, intercourse should occur within __ hours

when, better, 24-48, after, 24

• Detection of Fertility

  • Testing start determined by patient’s _________

    • Use average cycle length over past __ cycles

    • If 3–4 day variation in cycle, use _________ cycle length

  • Women should begin testing _________ days prior to their expected ovulation date (~mid-cycle)

cycle length, 3, shortest, 2-4

• Basal Thermometer

  • Utilizes a thermometer designed to measure _________

  • A _________ in temperature signals that ovulation has occurred (ranges from __°F to __°F)

  • Ex. Digital Thermometer

    • Can deliver results in _________

    • Some monitor a _________ of temperature readings

    • May require _________

  • Ex. Digital Sensors

    • Can store _________

    • Predict cycle _________ and _________ by memory

    • Types: _________, _________, _________, _________

basal temperature, rise, 0.4, 1, under a minute, multitude, calibration, cycle information, duration, ovulation, skin patch, armband, wristband, ring

• Fecal Occult Blood Tests (FOBT)

  • FOBT identify hidden _________ in _________

  • Main use: help to screen for _________ (CRC)

    • _________ years of age

    • Positive _________

    • _________

    • _________

    • _________ (_________ fiber, _________ fat)

  • FOBT can also detect the presence of various _________

    • Active _________

    • _________

    • Anal _________

    • _________

    • _________ of medications

• Guaiac-based

• Toilet tests (analyzes toilet tank water for the presence of blood)

  • Ensure it’s free of _________, _________

  • Flush toilet _________ prior to testing

• Surface _________

• _________ GI bleeds

• Fecal immunochemical-based

  • _________ antibody test (human hemoglobin)

  •  “_________” blood

  • _________ bleeds

blood, stool, colorectal cancer, 45-75, family history, intestinal polyps, IBD, diet, low, high, GI disorders, ulcers, Crohn’s Disease, fissures, hemorrhoids, overuse, cleansers, deodorizers, twice, bleeding, lower, stool wipe, matrix, upper GI

• HIV Home Test

  • Determines if HIV is present in the _________

    • Detects HIV _________ (_________) or _________ (_________)

    • May take between _________ to _________ for AB development

  • At-home tests (_________)

    • Detects HIV-1/2 AB’s

    • Sensitivity ___%

    • Specificity ___%

    • Results available _________

    • Swab upper and lower _________ once

    • After collection, place in test tube, mixed with reagent

    • Results available in __ minutes (invalid after __ min)

  • Mail-in tests (_________)

    • Detects HIV-1/2 ABs ± (_________)

    • _________ antigen

    • Accuracy ≥ ___%

    • Register product with company

    • Perform _________ in usual manner

    • Mailed to testing facility after collection

    • Results available in _________ days

blood, antibodies, AB, antigens, P24, 3 weeks, 6 months, saliva, 92, 99.98, in-home, gums, 20, 40, blood, more or less, P24, 99, fingerstick, 2-7

KNOW IMAGE

• Pregnancy Detection Kits

  • If testing on the _________ of missed period

    • Accuracy is generally ~90%

  • If testing _________ after a missed period

    • Accuracy is generally ~97%

  • Majority of home pregnancy tests are advertised as being “99% _________”

    • Individual methods of testing may _________ accuracy

first day, one week, accurate, reduce

• Urinary Ovulation Tests

  • Most kits detect a surge in _________ (_________)

  • Hormone secreted by _________

  • Helps _________ develop and mature

  • Some kits also detect _________ (E3G)

  • Rises and falls similar to _________ pattern

luteinizing hormone, LH, anterior pituitary gland, ovarian follicles, estrone-3-glucuronide, LH

• Detection of Fertility

  • LH surge shown through change in _________ or _________, _________ (smiley face)

  • Positive result means ovulation should begin in _________ days

  • 5 and 10-day kits are available with _________ monitoring showing _________ predictability:

    • 5-day kit: __% predictability

    • 10-day kit: __% predictability

  • Positive test: Result line is _________ color or _________ than control

  • Negative test: Baseline _________ in urine; will not show positive result until ~__ to __ mIU are detected

  • Digital test sets LH reference range

  • Surpassing reference range generates _________ result

  • Some tests a smiley face indicates a _________ result

color, color intensity, indicator, 1-2, longer, greater, 80, 95, same, darker, LH, 25, 40, positive, positive

• Basal Thermometer

  • Temperature may be taken _________, _________, or _________; use same location for _________

  • Temperature must be taken each _________

  • Women should have intercourse _________ after temperature increase is noted

orally, rectally, vaginally, accuracy, morning before arising from bed, as soon as possible

• Fecal Occult Blood Tests (FOBT)

• _________-based

  • Test toilet water _________ to testing stool sample

  • Place test pad in water and observe for _________ coloring

  • Use another toilet if color change occurs

  • Place test pad in toilet bowel _________ bowel movement

  • Appearance of _________ color after __ min is a positive result

  • Repeat the test for the next __ bowel movements 

  • If all results are negative, perform QA check of test pads using chemical package

• _________-based

  • Retain small amount of stool on toilet paper _________ bowel movement

  • Collect stool sample using wand from collection tube and screw back in place, shake

  • Apply 3 drops from collection tube into testing well, read results in __ minutes

  • A red line at “__” indicates the test is _________, a red line at “__” indicates a _________ test result

  • Immunochemical tests have no _________ constraints

  • Immunochemical tests have higher _________ 0.42–0.94 vs. 0.13–1 with Guaiac-based, with comparable _________ 0.4–1 vs. 0.69–0.99 with Guaiac-based

  • Immunochemical tests are more _________ for malignant neoplasia than benign neoplasia, and overall have a higher _________ for advanced malignant neoplasia

  • Despite superiority of immunochemical tests, guaiac tests are still _________ due to _________ morbidity from CRC

Guaiac, prior, blue, after, blue/green, 2, 2, fecal immunochemical, after, 5, C, functioning properly, T, positive, food/supplement, sensitivity, specificity, sensitive, sensitivity, recommended, reduced

• HIV Home Test

  • __ general home testing kits are available

  • HIV blood tests

    • Some combine with _________ testing

    • Positive samples _________ and _________

    • Results reviewed and/or patient consulted by _________

    • Results available on secure online platform

    • Treatment options may also be provided 

  • Risk factors for HIV

    • _________ who have sex with _________ (_________)

    • _________ sex with _________ individuals

    • Greater than __ sexual partner since _________ HIV test

    • Sharing _________ for injection drug use

    • Exchanging sex for _________

    • Having been diagnosed or treated for _________, _________, and/or _________

    • Having sex with persons who match the criteria above or persons who have an undisclosed sexual past

  •  Consider _________ since _________ infection

  •  Consider retesting if initial test is _________

2, STI, re-screened, confirmed, medical expert, Men, Men, MSM, anal/vaginal, HIV infected, 1, last, syringes/needles, drugs/money, sexually transmitted diseases, hepatitis, tuberculosis, time, possible, negative

• Pregnancy Detection Kits

  • False Positive: 

    • Previous _________ within __ weeks

    • _________ interval within __ weeks

    • Use of _________ medications

  • False Test: 

    • _________ testing/_________ hCG

    • _________ hCG produced: _________, _________ pregnancies (~500,000 mIU/mL)

miscarriage, 8, postpartum, 8, fertility, early, low, excess, cancers, multi-embryo

• Detection of Fertility

  • False Positives

    • _________ medications

    • _________

    • _________

    • Polycystic ovarian syndrome (_________)

    • Past _________ (< _ months)

  • False Negatives

    • _________ too _________ to detect

    • Testing too _________ or too _________ in cycle

    • Naturally _________ surge

Fertility, oral contraceptives, perimenopause, PCOS, pregnancy, 2, LH concentration, low, early, late, short LH

• Basal Thermometry

  • Measuring basal temperature is a simple method of detecting _________

  • Recording and interpreting results may be _________

  • Changes in _________ may occur due to many factors (EMFI)

    • _________

    • _________

    • _________

    • _________

  • Eating, drinking, talking, etc should be _________ until after measurement is taken

ovulation, difficult, temperature, emotions, movement, fever, infections, delayed

• Fecal Occult Blood Tests (FOBT) for CRC

  • False Positives

    • Other medical conditions associated with _________

    • _________, _________, _________

    • Consumption of (_________ tests only):

      • _________ vegetables

      • Foods with high levels of _________

      • _________

      • Vitamin __, __

    • Using _________ (_________ tests only)

  • False Negatives

    • No _________ present

bleed risk, NSAIDs, aspirin, corticosteroids, guaiac, green, peroxidase, red meat, C, Fe, toilet bowl cleaners, guaiac, active bleeding

• HIV Home Testing

  • Blood tests

    • Laboratory _________

    • Insufficient amount of _________ on testing card

    • Insufficient levels of _________ and/or _________ present

      • _________ since _________

      • _________

  • Saliva Tests

    • Swabbing top/lower gum _________

    • _________, _________, or using _________ (__ min before use)

  • Presence of _________, _________

error, blood, AB, antigen, time, infection, immunosuppression, more than 1 time, eating, drinking, oral care products, 30, dentures, retainers

• Pregnancy

  • Consider waiting at least one week after the date of the _________ for testing

  • Test the _________ morning's urine or limit fluid intake _________ hours prior to testing at other times

  • If test is negative, test again in _________ if menstruation has not yet begun

  • Refer to physician if test is positive

  • Discontinue select medications

    • _________

    • Category D, X (B? C?)

  • Recommend _________ supplementation

missed period, first, 4-6, 1 week, Teratogenic, folic acid

• Detection of Fertility

  • Collect urine sample in the _________

    • LH surge starts in the _________

    • Concentration of urine is _________

  • Start testing _________ days prior to expected _________

  • Lie testing device on flat surface and wait up to __ min before reading results

  •  Discontinue testing once _________ is detected

AM, morning, greater, 2-4, ovulation date, 5, LH surge

• Basal Thermometer

  • Consistently use one location for temperature taking to ensure _________

  • Take temperature readings at the _________ time each _________

  • Do not _________ while taking temperature

  • Do not _________, _________, or _________ for __ minutes before taking temperature

  • An _________ in temperature indicates that _________ has occurred

accuracy, same, morning, move, eat, drink, talk, 30, increase, ovulation

• Fecal Occult Blood Tests (FOBT)

  • Do not test when _________

  • Increase _________ intake _________ days prior to testing

  • Perform/complete __ consecutive tests to increase _________ detection rates, even if first __ results are negative

  • Avoid _________, _________ for _________ days prior to testing to limit _________ from other sources

  • Avoid eating _________, _________ vegetables, _________ 2 to 3 days prior to testing (_________ tests)

  • Avoid the use of toilet bowl cleansers or deodorizers prior to testing (_________ tests)

actively bleeding, fiber, 2-3, 3, positive, 2, NSAIDs, aspirin, 2-3, bleeding, red meat, green, Iron/Vitamin C, guaiac, guaiac

• HIV Home Testing

  • Recommend simplistic and straightforward tests

  • Recommend tests with a _________ to verify _________ and _________

  • Refer patients with _________ issues for tests that require a _________ sample

  • Ensure proper _________ for _________ tests, if ocular disability ask someone else to read test

control, functioning, accuracy, clotting, blood, lighting, color changing

Signs and Symptoms of Allergic Rhinitis

Ocular symptoms

• _________, _________ eyes

• _________ eyes

• _________ eyelids

• _________ discharge

Nasal Symptoms (PPRC)

• _________ sneezing (sudden, intense)

• _________ (_________) nose/palate

• _________

• Nasal _________

Systemic symptoms (CiFIM)

• _________

• _________

• _________

• _________

red, irritated, itchy, puffy, watery, paroxysmal, Pruritius, itchy, rhinorrhea, congestion, cognitive impairment, fatigue, irritability, malaise

KNOW IMAGE

KNOW IMAGE

Exclusion Criteria

• Children <__ years

• _________ or _________ women

• Symptoms of _________

• Symptoms of _________, _________, _________, or other infection

• Symptoms of undiagnosed or uncontrolled _________ (e.g., wheezing, shortness of breath), _________, or other _________ respiratory disorder

12, pregnant, lactating, nonallergic rhinitis, otitis media, sinusitis, bronchitis, asthma, COPD, lower

Nonpharmacologic Interventions for Allergic Rhinitis

Allergen Avoidance Measures

• House Dust Mites

• Pollen

• Mold (_________)

• Cockroaches

• Pollutants (_________)

Nasal Wetting Agents

• Relieve nasal mucosal _________ and _________

• Process also aids in the removal of _________, _________, or _________ mucus from the nose

• Nasal wetting agents (e.g., _________, _________, _________ spras, gels)

• No significant adverse effects have been noted with use of nasal wetting agents

lower household humidity, air quality, irritation, dryness, dried, encrusted, thick, saline, propylene, polyethylene glycol

More Nonpharmacologic Interventions for Allergic Rhinitis

Nasal Irrigation Agents

• Nasal irrigation with _________ (isotonic or hypertonic) delivered using a syringe or Neti pot

• It is used to hold _________ (saline solution) what is poured into one nostril and drained out of the other nostril, Mild _________ or _________

• Safe for _________ and _________

• Only use _________, _________, or _________ tap water (that is brought to room temperature)

• Rinse device after each use and let air dry

• Do not share device

Allergic Conjunctivitis

• _________

• Applying _________ to the eyes _________x daily

warm saline, salt water, stinging, burning, children, pregnant women, distilled, sterile, boiled, artificial tears, cold compresses, 3-4

Intranasal Corticosteroid (INC)

• Most effective treatment for most symptoms of _________ (_________ weeks for full therapeutic effect)

• MOA: _________ multiple cell _________, and stop the “allergic cascade” → decrease _________

• ADEs: Nasal _________, _________, _________, and _________

• _________ Doses → headache, dizziness, nausea, and vomiting

• Long-term use → changes in _________, _________, _________, increased risk of _________, and _________ in children

allergic rhinitis, 1-2, inhibit, mediators, inflammation, discomfort, sneezing, cough, pharyngitis, high, vision, glaucoma, cataracts, infection, growth inhibition

These medications are exampled of _________.

Intranasal Corticosteroid (INC)

Systemic Antihistamines (AH)

• Systemic antihistamines are used to relieve symptoms of _________, _________, and _________

• _________ onset of action and _________ ability to achieve full benefits

• MOA: compete with _________ at central and peripheral _________ receptor sites. _________ the _________ interaction and subsequent mediator _________

• Decreased _________, _________, _________, and _________

• Decreased _________ in CNS

• Increased _________

• Decreased _________ and _________ impairment

• Increased _________

sneezing, rhinorrhea, itching, quick, quick, histamine, H1, prevents, histamine-receptor, release, inflammation, itching, sneezing, rhinorrhea, neurotransmission, sedation, cognitive, psychomotor, appetite

1st Gen Anithistimines

• _________ antihistamines are highly _________ molecules that readily cross the _________

• Very _________, readily _________, and relatively _________

• Exposure to risks of _________ effects and should be used with caution

• Duration of action is _________ (dosing q___h dosing)

• ADEs: _________ (sleepy), anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation), _________ impairment

• CIs: _________ or _________ + _________

sedating, lipophilic, BBB, effective, available, inexpensive, anticholinergic, short, 4-6, somnolence, cognitive, newborns, premature infants, lactating women

1st Gen Anithistimines

• Precautions: 

  • Narrow-angle _________

  • Acute _________

  • Stenosing (blocking) _________

  • Symptomatic _________ (enlargement, BPH)

  • _________ neck and pyloroduodenal obstruction

  • Concomitant use of _________ (e.g., rasagiline, selegiline, hydrazine, isocarboxazid)

  • Patients with _________ respiratory tract diseases (e.g., emphysema, chronic bronchitis, asthma)

  • People whose activities require _________

  • _________

  • _________ (sensitive to light)

glaucoma, asthma exacerbation, peptic ulcer, benign prostatic hyperplasia, bladder, MAO inhibitors, lower, mental alertness, elderly, photosensitizing

These medications are examples of _________.

1st Gen Antihistamines

2nd Gen Antihistimines

• Second generation AH are considered _________ sedating than first generation AH and generally _________ over first generation AH based of _________ and _________

  • _________ readily cross the BBB

  • Peripherally _________

• Chemical class differences make it reasonable to suggest _________ to a different class

• ADEs: _________ can still be seen in certain second-generation AH

• Least Sedating: _________ + _________

• Moderately Sedating: _________ + _________

• Most Sedating: _________

less, preferred, safety, efficacy, Do not, selective, switching, somnolence, Loratadine, Fexofenadine, Cetirizine, Levocetirizine, 1st Gen AH

These medications are examples of _________.

2nd Gen Antihistamines

Azelastine Hydrochloride 0.15% (Astepro)

• June 2021 _________ to _________

• Approved for OTC use in ≥__years old

• Indicated for allergic rhinitis

• MOA: _________ receptor antagonist that blocks _________ of histamine from cells involved in allergic response

• OTC dosing

  • Ages 6-11: __ spray in each nostril BID

  • Ages 12+: __ sprays in each nostril _________ or __ sprays in each nostril _________

• SEs: _________ or _________ irritation, _________, _________ or _________, _________, _________, _________, _________ taste, _________, _________

Astepro, Rx, OTC, 6, H1, release, 1, BID, 1-2, BID, 2, QD, nose, throat, sneezing, burning, stinging, drowsiness, headache, cough, bitter, dry mouth, nosebleed

Mast Cell Stabilizers

• Cromolyn Sodium (_________)

  • MOA: _________ agent that stabilizes mast cells, thereby _________ mediator release

• Dosing:

  • > 2 years of age: __ spray in each nostril _________ times daily at regular interval

  • Initial drug of choice in _________ and _________ (less systemic absorption)

  • ADEs: _________, _________ and _________

NasalCrom, anti-inflammatory, preventing, 1, 3-6, pregnant women, breastfeeding, sneezing, nasal stinging, burning

Combo Products

• Adv: _________, Improve patient _________, One med for variety of _________

• Disadv: Difficult to recommend for patients with _________, Additional medications to the regimen may increase _________, Taking potentially _________ medications

simple dosing, adherence, symptoms, coexisting medical conditions, ADEs, unnecessary

These medications are examples of _________.

Combo Products for Allergic Rhinitis

Allergic Conjunctivitis

• Ketotifen Fumarate

  • Indicated for allergic conjunctivitis in those __ years of age and _________

  • Dosing: one drop into affected eye(s); _________ dosing

  • MOA: _________ histamine H1 antagonist that exerts its effects by inhibiting release of histamine from mast cells

  • SEs: _________, _________, change in _________, eye _________

• Pheniramine

  • Used in combination with _________; indicated for allergic conjunctivitis in those __ years of age and _________

  • Dosing: 1-2 drops into affected eye(s); up to _________

  • MOA: _________ histamine H1 antagonist that exerts its effects by inhibiting release of histamine from mast cells

  • SEs: _________, eye _________

• Olopatadine

  • July 2020 now OTC for __ years and _________

  • Indicated for allergic conjunctivitis

  • MOA: _________ histamine H1 antagonist that exerts its effects by inhibiting release of histamine from mast cells

  • 0.2% & 0.7%: One drop in each eye _________

  • 0.1% available as well _________ dosing

  • SEs: headache, blurred vision, change in taste, eye irritation

3, older, BID, selective, headache, blurred vision, taste, irritation, naphazoline, 3, older, QID, non-selective, blurred vision, irritation, 2, older, selective, QD, BID

KNOW IMAGE

KNOW

Counseling for INCs

• Before use:

  • _________ gently and remove cap

  • _________ the pump in the air for the first time it is used OR when you have not used it for awhile

• Using the spray:

  • _________ your nostrils

  • _________ one nostril

  • Start to breathe in through nose, while pressing firmly and quickly down

    • Repeat for other nostril

  • Breath out through your mouth

  • Wipe clean

  • Do not _________ after

shake, prime, clear, close, blow your nose

Counseling for AH

• Patients with _________ allergic rhinitis should initiate _________ before being exposed to known allergens

• _________ allergic rhinitis should take _________ on a _________

intermittent, therapy, persistent, antihistamines, regular basis

Counseling for Mast Cell Stabalizers

• _________ for therapeutic effect

• _________ for maximal therapeutic benefit

3-7 days, 2-4 weeks

Counseling for Decongestants

• _________-term use (no more than _________)

short, 5 days

FOLLOW-UP

• Assess in _________

• Monitor if symptoms are improved, under control

• Monitor for adverse drugs reactions

• If nonadherent, educate patient to continue therapy, assess in _________

• Refer to PCP:

  • If symptoms have worsened during treatment

  • Self-care measures do not improve symptoms after _________

  • S/sx of _________ develop

3-4 days, 1-4 weeks, 1-2 weeks, bacterial infection