1. Ch. 6 Hypertension and the Health Belief Model
Group 1 - Jaslyn Adams, Cherise Cassell, Maria Hernandez, Jason Moore, Jayme Rentz, Mackenzy Volmy
PHA 4724 Health Care & Behavior Section 301
Ch. 5- Hypertension
October 25, 2011
Ch. 6 Hypertension and the Health Belief Model

2. Hypertension Statistics
32% of U.S. adults had high blood pressure in 2002.
31% of American adults has pre-hypertension in 2002
Higher than normal blood pressure, but not yet in the hypertension range.
Raises your risk for high blood pressure.
In 2010, high blood pressure will cost the United States $76.6 billion in health care services, medications, and missed days of work.

3. Risk Factors Stress or Anxiety Family history of hypertension
Race – African-Americans
Diet – Excessive salt or fat
Drug Use – Smoking, Alcohol
Medications – Pain medication, Decongestants, etc.
Medical Conditions – Diabetes, Obesity

4. Symptoms No signs or symptoms for hypertension
Severe(Malignant) hypertension
Nosebleeds
Severe headaches
Nausea and vomiting
Changes in vision

5. Treatment
Usually combines preventative lifestyle modifications with one or more antihypertensive drugs
Can be managed with medications such as Lopressor®, Ativan®, Toprol®, and Cardura® among others.

6. Prevention Hypertension can be prevented by: Exercising regularly
Reducing alcohol intake
Dietary Approach to Stop Hypertension (DASH)
Increases fruits and vegetables, Limits fat and sodium
Check your blood pressure regularly.
Manage other medical conditions

7. Complications
When hypertension is left untreated or not well controlled the following conditions can develop:
Heart
Myocardial infarction
Congestive heart failure
Angina Pectoris
Vascular Disease
Brain
Stroke
Dementia
Vision Problems
Chronic kidney disease

8. Ch 7 Dyslipidemia?
Definition: Increased blood lipid levels and lipoprotein concentrations.
Caused by:
Environmental
Genetic
Pathologic risk factors
A disorder of lipoprotein metabolism, including lipoprotein overproduction or deficiency.
May be manifested by elevation of the total cholesterol, the "bad" low-density lipoprotein (LDL) cholesterol and the triglyceride concentrations, and a decrease in the "good" high-density lipoprotein (HDL) cholesterol concentration in the blood.
Causes may be primary (genetic) or secondary.
Diagnosis is by measuring plasma levels of total cholesterol, TGs, and individual lipoproteins.

9. Dyslipidemia The major blood lipids involve:
Cholesterol- vital & needed component for maintaining normal physiologic functioning
Triglycerides- consist of glycerol esterfied with 3 fatty acids and are the main constituents of stored energy. Present in blood plasma and form plasma lipids when associated with cholesterol.
Phospholipids- essential for cholesterol and triglyceride transportation in the serum in the form of lipoproteins.
Elevated lipoprotein concentrations contribute to dyslipidemia.
Excess triglycerides in plasma is called hypertriglyceridemia. It is linked to the occurrence of coronary artery disease in some people. Elevated triglycerides may be a consequence of other disease, such as untreated diabetes mellitus.
Triglycerides are the chemical form in which most fat exists in food as well as in the body. They're also present in blood plasma and, in association with cholesterol, form the plasma lipids. 
Triglycerides in plasma are derived from fats eaten in foods or made in the body from other energy sources like carbohydrates.

10. Statistics CHD is the number 1 cause of death in the US
It is reported than nearly 1million Americans experience CHD event annually in which 40% are fatal
One of the major risk factors is hyperlipidemia
Approx 18% American have blood cholesterol levels that are too high

11. Risk Factors for Dyslipidemia
Chronic Heart Disease (CHD)
Diabetes mellitus
Metabolic Syndrome
Severe or poorly controlled CHD factors
Latricia starts talking

12. Primary Factors Contributing to Dyslipidemia
Single or multiple gene mutations
Overproduction or defective clearance of TG and LDL cholesterol
Underproduction or excessive clearance of HDL

13. Secondary Factors Contributing to Dyslipidemia
Sedentary lifestyle
Excessive dietary intake of saturated fat, cholesterol, and trans fat (processed foods).
Diabetes mellitus
Alcohol overuse
Chronic kidney disease
Hypothyroidism
Biliary cirrhosis

14. Disease Prevention & Treatment (Nutrition)
Lifestyle changes can involve diet and exercise.
Dietary changes include:
Decreasing intake of saturated fats and cholesterol.
Increasing the proportion of dietary fiber, and complex carbohydrates.
Maintaining ideal body weight. .
Metabolic syndrome is a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes.[1] It affects one in five people, and prevalence increases with age. Some studies estimate the prevalence in the USA to be up to 25% of the population.[2]

15. Disease Prevention & Treatment Cont…
If the patient has high blood pressure, first step is to lower LDL cholesterol.
Second step is to manage risk factors for metabolic syndrome & other lipid risk factors

16. Program Adherence Recommendations
Make sure the patient has a clear understanding of therapeutic life changes.
Contact the patient weekly for the first 4 weeks of the program & then monthly thereafter.
Set achievable goals.
Assess dietary intake.
Identify specific barriers to lifestyle changes.
Design a program that is reasonable, gradual, and easily implemented.

17. Chapter 8 Coronary Heart Disease
Jake Shouppe
Ashley Andrews
Fantasia Wilburn
Group #3
Shantoria Easton
Kaitlin Hudson
Saurabh Narkhede
November 1, 2011

18. Overview of Coronary Heart Disease
Coronary Heart Disease (CHD), also called ischemic heart disease, is a complex disease process that ultimately results in an imbalance in the amount of oxygen that is available to supply the heart compared to the demand that the heart requires to function properly

19. Prevalence of CHD
In 2002, 13 million Americans had CHD, 7.1 million of who had experienced an MI.
White males have the highest incidence of CHD (8.9%) followed by black females (7.5%), black males (7.4%). Mexican-American males (5.6%), white females (5.4%), and Mexican-American females (4.3%).

20. Prevalence of CHD cont.
Approximately 700,000 Americans would have new coronary attack and that 500,000 would have a recurrent attack was estimated for 2005.
Average age to experience a first heart attack for American males is 66 years old and for American females is 71 years old.

21. Prevalence of CHD cont.
In 2002, CHD caused 1 out of every 5 deaths in the United States.
CHD is the single largest killer if American males and females and increasing.

22. Economic Costs
In 2005, it was estimated that the direct and indirect costs associated with CHD was $142 billion.

23. Environmental Risk Factors Leading to CHD
Smoking
Hypertension
High total cholesterol
High LDL cholesterol
Low HDL cholesterol
High triglycerides
Diabetes mellitus
Obesity or overweight
Physical inactivity
Emotional stress
Male gender
Increasing age
Family history of CHD
High lipoprotein
High homocystiene

24. CHD Prevention and Treatment
Strategies for preventing CHD are approached in two ways, depending on the status of the patient.
Primary prevention strategies
Secondary prevention strategies
Many of the prevention strategies are similar with respect to lifestyle modification
Drug therapy differs between primary and secondary prevention

25. Primary CHD Prevention
Pharmacist and healthcare providers can encourage patients to participate in primary prevention strategies.
Excess body weight can lead to diseases that can also increase CHD risk, such as hypertension, dyslipidemia, type 2 diabetes mellitus, and stroke. Weight-loss programs and activities, even at modest levels, have been shown to decrease the risk for these diseases therefore decrease the risk for CHD.
Nutrition plays an important role not only in weight loss but also in controlling other risk factors for CHD such as hypertension and dyslipidemia

26. Primary CHD Prevention cont.
Eating plans that consist of whole grains, fruits, and vegetables and that are high in fiber, calcium, and potassium and low in saturated fat and cholesterol are associated with decrease risk for CHD.
Physical inactivity is an independent risk factor for CVD but can also contribute to increasing the incidence of other diseases as type 2 diabetes, hypertension, dyslipidemia, and obesity. Increasing the physical activity and fitness levels of individuals decrease the risk for CHD.

27. Primary CHD Prevention cont.
Working with “healthy” patients to avoid risk factors for CHD is at the heart of primary prevention and is an area that all healthcare providers, including pharmacist, should spend more time doing.
Helping patients maintain physical activity and normal levels of blood pressure, blood lipids, and blood glucose are important concepts in the prevention of diseases.

28. Secondary CHD Prevention
Approximately 70% of deaths from CHD and one half of MIs occur in patients with previously established CHD.
Instituting strategies for secondary CHD prevention is major opportunity to reduce the risk for cardiovascular disease.
The Pharmacist’s role in the secondary prevention of patients with CHD who have not yet attended a cardiac rehabilitation program is to encourage such participation and help monitor drug therapy associated with the disease

29. Behavior Therapy
Strategies to enhance program adherence for patients risk for CHD and for those who currently have CHD largely focus around patient education.
Most individuals who do not currently have CHD do not understand the importance of implementing strategies such as lifestyle modification.
Spreading the word about primary disease prevention can be a part of every healthcare providers’ responsibilities.
Pharmacist can support both primary and secondary CHD prevention by educating patients about their importance

30. Nutrition and CHD
The goal is to adopt the necessary dietary changes to decrease the risk for CHD.
The dietary recommendation primarily focus on the promoting health and reducing risk for CHD and other chronic diseases by lowering low-density lipoprotein cholesterol (LDL) and blood pressure.
Lowering the LDL cholesterol through dietary modifications can most successfully be accomplished by reaching the dietary intake of saturated of saturated fats, trans fatty acids, and cholesterol.
The overarching themes are to rat fewer calories, be more physically active, and make wiser food choices.

31. Dietary Recommendations for Patients with CHD
Nutrient
Recommendation
Total calories
Balance calorie intake with expenditure to obtain appropriate body weight
Carbohydrates
50-60% of total calorie intake
Fiber
20-30 g/day
Protein
Around 15% of total calorie intake
Monounsaturated fat
Up to 20% of total calorie intake
Polyunsaturated fat
Less than 7% of total calorie intake
Total fat
25-35% of total calorie intake
Dietary cholesterol
Less than 200 mg/day

32. Physical Activity and CHD
It is well established that regular amounts of aerobic physical produce cardiovascular changes that increase exercise capacity, endurance, and muscular strength.
Regular exercise also prevents the incidence of CHD and helps to decrease the symptoms associated with cardiovascular disease.
Exercise can decrease the risk for and aid in controlling chronic diseases that can lead to CHD such as obesity, type 2 diabetes, hypertension, and dyslipidemia ,as well as other diseases such as osteoporosis. Depression, breast cancer, and colon cancer.

33. Physical Activity and CHD cont.
The studies have shown that individuals who participate in physical activity generally experience a CHD rate that is half of sedentary individuals.
Individuals should engage in 30 minutes or more a day of moderate intensity physical activity on most(preferably all) days of the week.
Patients with existing CHD should perform exercise under supervision of cardiac rehabilitation facility as these patients may pose additional risks while exercising compared with individuals without CHD.

34. Physical Activity Recommendations for patients with CHD
Exercise
Recommendation
Goals
Decrease risk for CHD and CVD
Decrease risk factors for CHD and CVD such as elevated blood pressure, insulin resistance and glucose intolerance, elevated triglyceride concentrations, low HDL-C concentrations, obesity, stroke, myocardial function
Increase exercise peak workload and endurance
Type
Aerobic exercises such as walking, jogging, running, cycling, or individual aerobic exercise preference
Resistance running can be adjunctive to aerobic exercises
Intensity
Moderate-intensity endurance activity
Duration
30 minutes or more continuous or intermittent exercise per day
Frequency
Most, preferably all, days of week
Lifestyle activity
Increase overall daily activity through the duration of activities of daily living

35. Ch 9 Cancer Group 9 Andria Frazier Shanice Waller Tosha Brown
Chinelo Okany
Alvin Llanos
Chapter 15
Novemeber 15, 2011

36. What is Cancer
Cancer is characterized as an uncontrolled growth and spread of abnormal cells
Most are categorized by their development such as
Carcinoma
Leukemia
Lymphoma
Sarcoma

37. Prevalence Cancer is the 2nd most common cause of death in the US
Cancer accounted for 564,000 death is 2006
The most commonly diagnosed types
Prostate
Breast
Lung
Colon

38. Risk of Cancer Men Women Developing cancer 46% Dying from cancer 24%

39. Now we will turn our attention to the number of new cancers anticipated in the US this year. It is estimated that almost 1.6 million new cases of cancer will be diagnosed in The most common cancers are prostate in men and breast in women; lung and colorectal cancers are the second and third most common cancers in both men and in women.

40. Risk Factors Genetics Environmental Occupational Medication
DES, diethylstilbestrol and cervical cancer
Lifestyle activity factors
Ex: Lifestyle:
tobacco use, dietary factors, physical inactivity, obesity, overconsumption of alcohol, etc.
Enviro:
UV radiation, viruses, ionizing radiation, secondhand smoke
Occupational:
Asbestos, aniline dye, benzene, Cr, Ni, vinyl chloride
Medications:
Alkylating agents, azathioprine, estrogens, diethylstilbestrol, etc.
DES (diethylstilbestrol): DES may increase the risk of a rare form of cervical cancer in daughters exposed to this drug before birth. DES was given to some pregnant women in the United States between about 1940 and (It is no longer given to pregnant women.)

41. Pathophysiology Normal Cell Mutation Transformation and proliferation
Disruption of normal cell division
Oncogenes and Proto-oncogenes
Damage tumor-suppressor genes
Transformation and proliferation
Cancer occurs as a consequence of exposure to one of the risk factors.
A normal cell is transformed as a result of an event that mutates the cell’s DNA. Damage can cause the development of oncogenes which lead to the development of cancer. Oncogenes develop from proto-oncogenes that control many cell-signaling pathways. Damage can also lead to the malfunction of tumor suppressor genes whose job it is to suppress abnormal cell division or growth, leading to cancer.

42. Prevention and Treatment
Genetic predisposition
Lifestyle modifications
Smoking 30% of cancer deaths annually
Physical inactivity, obesity, improper nutrition 30% of cancer deaths
Treatment and
recommended
adherence programs
Those genetically predisposed must be especially vigilant and avoid risk factors (enviro, occupational, etc.). Lifestyle modifications include physical activity, proper nutrition, healthy weight, and abstaining from overdrinking and smoking (smoking is “the single-most significant modifiable risk factor for cancer”).
Adherence programs recommend a multiple strategy approach including setting goals, self-monitoring, identifying barriers, and designing easily implemented programs
Refer to the diagram on the right. The next three slides will further elaborate on the effects of weight, diet, and physical activity

43. Weight
Obesity results from a diet high in saturated fats and inactivity
It is linked to
Risk of endometrial cancer
High estrogens levels
Polycystic ovary syndrome (PCOS)
Postmenopausal women
Primary source of estrogens is from the conversion of androgens to estrogens within adipose tissue.

44. Diet Rich fruits and vegetables diet Vitamin recommendations
Vegetarians
Vitamin recommendations
Multi-vitamin pill
Vitamin E (400 IU daily)
Has both a cancer reducing as well as a heart protective effect.
Fruits and vegetable seem to confer a cancer protective effect
Vegetarians tend to get less of certain types of cancers.
Multi-vitamin pill is probably good nutritional insurance.
Vitamin E is very difficult to get through dietary means and it seems to confer both a cancer reducing as well as a heart protective effect.

45. Physical activity
Exercise should be a PRIORITY throughout your treatment and recovery
improves quality of life
reduces fatigue
increases physical functioning.
Exercise can improve mental health
improve self-image
decreases stress and anxiety
gives you a sense of control over cancer.

46. Chapter 10: Peripheral Arterial Disease
Section 301
Group 5
Latrice Wilson
Trevena Favors
Amethyst Smith
Amber Balbosa
Donnie Ray Johnson
Monica Nicola
November 8, 2011

47. What is Peripheral Arterial Disease (pad)?
Also known as
Atherosclerosis of the Lower Extremity Arteries
Peripheral Vascular Disease
Lower Extremity Arterial Disease
Narrowing of the arteries as a result of plaque formation
A systemic disease
Traditionally diagnosed as the presence of lower extremity pain with exertion, often called claudication, absent or markedly diminished pulses on physical examination

48. Symptoms May Be Asymptomatic Claudication
Painful cramping in your hip, thigh or calf muscles after activity, such as walking or climbing stairs
Leg numbness or weakness
Hair loss or slower hair growth on your feet and legs
No pulse or a weak pulse in your legs or feet
Sores on your toes, feet or legs that won't heal

49. Prevalence
PAD: 3.9% of men and 3.3% of women between the ages of 55 to 64 years and 65 to 74 years respectively
Claudication: 1.9% of men and 0.8% of women
20% of people have PAD by 75 years of age

50. Risk Factors
Age- 40 and older
Gender
Family History
Racial Background

51. Modifiable Risks Factors
Smoking
Diabetes
Dyslipidemia
Hypertension
Physical Inactivity

52. Risks for Patients with PAD
Cardiovascular Disease
Myocardial Infarction
4x greater than people without PAD
Stroke
2-3x greater risk than those without Pad
85% have coronary heart disease
60% have cerebrovascular disease
Carotid Artery Stenosis

53. Behavior Changes Relevant to Pad
Exercise
Aerobic, such as walking, jogging, running, or cycling
At least 30 minutes of continuous or intermittent activity
Proper Nutrition
Balance caloric intake with expenditure to obtain appropriate body weight
Carbohydrates: 50-60% of caloric intake
Fiber: 20-30g/day
Protein: 15% of total caloric intake
Total Fat: 25-35% of total caloric intake

54. Primary Prevention
Patients who do not have PAD, but possess risk factors for the disease
Strategies:
Smoking cessation programs (for smokers)
Weight loss programs
Nutrition regiments

55. Secondary prevention Patients who currently have PAD
Strategies include:
Smoking cessation programs (for smokers)
Weight loss programs
Nutrition regiments
Drug Regiments
Blood glucose, blood pressure, and blood lipid management

56. Prevention: Program Adherence Recommendations
Ensure patient’s understanding of PAD and prevention components
Multiple adherence strategies work better than a single approach
Weekly contact with patients for the first weeks, and then continually assess monthly progress
Set achievable goals to manage and prevent PAD

57. Complications Critical Limb Ischemia Stroke Heart Attack
This condition begins as open sores that don't heal, an injury, or an infection of your feet or legs. Critical limb ischemia (CLI) occurs when such injuries or infections progress and can cause tissue death (gangrene), sometimes requiring amputation of the affected limb.
Stroke
Heart Attack

58. Treatment Exercise Proper Nutrition Medications Angioplasty
Anti-hypertensives
Lipid lowering drugs
Diabetes therapies
Smoking Cessation
Anti-platelet drugs
Angioplasty
Bypass Surgery
Thrombolytic Surgery