Chronic Medical Conditions and Pharmacological Challenges - Assignment Example

CHRONIC MEDICAL CONDITIONS AND PHARMACOLOGICAL CHALLENGES Chronic medical conditions and pharmacological challenges 1. Briefly discuss at least three key reasons why chronic medical conditions have a significant effect on health care service provision in the pre-hospital setting. Chronic medical conditions are those ailments that persist for at least six months and the most common include cancer, asthma, HIV, diabetes mellitus, stroke, cardiovascular disease and musculoskeletal conditions. Chronic disease management enables general practitioners to plan and also coordinate healthcare for patients with chronic conditions (AU., 2013).The plan will also incorporate other healthcare provides or specialists in case a multidisciplinary team based approach is necessary. Other healthcare providers include occupational therapists, psychiatrists, cardiologists, neurologists or other specialists depending on the chronic medical condition. Chronic disease management will ensure a successful and structured delivery of health care. Secondly chronic conditions increase the cost of healthcare and a patient must cover the extra costs that are not covered by medical insurance. This may be a hindrance to the delivery of comprehensive healthcare. Third, chronic conditions predispose patients to other complicated and opportunistic diseases. Chronic medical conditions manifest in critically ill patients will affect the decision to administer intensive care unit, decisions on the type and intensity of intensive care unit treatment options as well as outcomes (Esper and Martin, 2011). Due consideration must be made in the management of these patients to prevent further complications, organ dysfunction and the onset of opportunistic diseases. 2. Identify two comorbidities H.I.V and tuberculosis and discuss:1) how they interact 2) how they affect the care provision for that person. The comorbidity of human immunodeficiency virus and tuberculosis is a major public health concern. The co-infection association is interactive, reciprocal and synergetic, interactive and impacts significantly with the progression of these two pathologies (Neves et al., 2012). Individuals with HIV have an immune-compromised system and are highly susceptible to opportunistic infections such as tuberculosis. According to statistics by the World Health Organization (WHO), of the 1.4 million who are HIV positive, about 0.5 million individuals are going to die of tuberculosis. People living with HIV are highly predisposed (a HIV positive individual is 25 more times vulnerable to tuberculosis than a HIV negative individual) to Mycobacterium tuberculosis infection in places where TB is prevalent. In addition, the risk of death in an individual co-infected with HIV and TB is twice as high as in a HIV positive individual without TB. After the onset of active TB disease, the individual experiences a very rapid and severe compromise of the immunological system. In most cases, HIV positive individuals have been known to die of TB among other AIDS-related opportunistic infections (AOI). The patients also develop severe liver injury and later die due to intolerance to multiple drug regimens (anti-retroviral therapy and TB medication) as well as adverse drug interactions (Kantipong et al., 2012). 2) How they affect the care provision for that person. The treatment options for HIV positive individuals with active TB disease or LTBI (latent TB infection) is comprehensive antibiotic therapy for 9-12 months. The treatment is usually longer when the patient takes anti-retroviral medicine. The treatment for both chronic diseases is a challenge and there are many risks such as liver damage. Patients should be closely monitored to check for side effects arising from combination of HIV and TB medication. The patient should faithfully take the medication as drug resistance is fatal (AIDS.GOV., 2013). Multidrug-resistant TB (MDR TB) occurs as result of resistance to 2 of the most effective anti-TB drugs i.e. rifampin and isoniazid. Treatment of MDR TB is very difficult. Extensively Drug-Resistant Tuberculosis (XDR TB) occurs when a patient is resistant to the most effective first-line and second-line drugs. Patients with XDR TB have less effective treatment options and usually have poor treatment outcomes. Generally, there are adverse drug interactions between TB medication and anti-HIV drugs. HIV drugs comprise of non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors undergo adverse drug interactions with rifampicin. Most doctors recommend a delay of HIV treatment until TB is under control. In some cases, the patient may need to cease or change anti-retroviral medication when he/she develops TB while taking the medicine. Overall treatment of TB and HIV is complicated and a unique approach is taken to suit every patient. 3. Discuss the systemic factors and the pulmonary factors that contribute to impaired functional capacity in chronic obstructive pulmonary disease (COPD). Chronic obstructive pulmonary disease is characterized by a severe reversible airflow limitation and it is a progressive condition linked to abnormal inflammatory response of the lungs as well as cigarette smoke, and other noxious gases/particles. The clinical manifestation and pathological mechanisms of COPD include airway remodeling and pulmonary inflammation. Systematic manifestations of chronic obstructive pulmonary disease include cardiovascular comorbidities, muscle dysfunction, cachexia, anemia, systemic inflammation, osteoporosis, anxiety and clinical depression. Chronic comorbidities affect health outcomes in patients with COPD, including mortality. In fact, the majority of patients with COPD die of non-respiratory disorders such as cardiovascular diseases or cancer (Tcakova, 2010). Systemic factors contribute to impaired functional capacity in chronic pulmonary disease (COPD). VEGF (vascular endothelial growth factor) is a cytokine with lethal angiogenic properties and it is responsible in enhancing vascular permeability as well as modulating thrombogenicity. According to analysis on lung tissue on patients with COPD, expression of VFGF is postulated to play a significant role in the pathogenesis of the disease (Valipour et al., 2008). There is evidence that links COPD with chronic inflammatory response in lung parenchyma and airways. According to histopathologic studies, patients with COPD have elevated levels of CD8+ T cells and macrophages in lung parenchyma and the peripheral airways and this can be linked to latent adenoviral infection (Barnes and Celli, 2009). Analysis of induced sputum from COPD patients revealed that they have elevated levels of tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8), crucial mediators in the mobilization of neutrophils (Vernooy et al., 2002). Moreover, high levels of neutrophil granule proteins have been found in the bronchoalveolar lavage fluid and induced sputum from individuals with advanced COPD. Chronic local inflammation of lungs and systemic inflammation has been exhibited in patients with COPD and acute exacerbations. In addition high levels of sTNF-R75 and sTNF-R55 are significantly high in the circulation of individuals with COPD. Systemic inflammatory response is critical to quality of life as muscle wasting and weight loss is associated with systemic inflammation. Systemic hypoxia is postulated to triggering the activation of the TNF-α system in individuals with COPD (Vernooy et al., 2002). 4. Briefly define iatrogenic disease. Iatrogenic disease is defined as adverse drug reactions and complications triggered by non-drug medical interventions. It can also be defined as a disease triggered by drugs prescribed by a doctor after a surgical or medical procedure, environmental event (defective equipment, fall etc.) and unauthorized prescription. With respect to prescribed medication, it excludes non-medical intervention and intentional overdose. “However, it has to be kept in mind that, by definition, an adverse drug reaction differs from an adverse drug event, in that the former is an outcome attributable to a drug, whereas the latter, while associated with medication intake, is not necessarily so” (Permpongkosol, 2011). Consider three risk factors associated with iatrogenic disease the consequences of those risk factors, and their prevention in the older person. Risk factors of iatrogenic disease among the elderly include: multiple chronic diseases, drug induced iatrogenic disease, hospitalization, multiple physicians (misdiagnosis arising from under-treatment or overtreatment), surgical or medical procedures. Adverse drug events in elderly persons arise due to an increased incidence of disease/pathologies coupled with the numerous drugs administered on a long-term basis. Indeed, “Multiple medications (polypharmacy) that transform the elderly into living “chemistry sets” are probably the most ubiquitous threats for iatrogenic disease (Permpongkosol, 2011). This results in kidney and liver dysfunction as well as changes in plasma protein levels (e.g. hypoalbuminemia). An increased incidence of chronic diseases among the elderly increases the risk of health complications arising from adverse drug effects. For instance, nonsteroidal anti-inflammatory drugs used to treat arthritis trigger chronic gastritis, coronary artery disease or heart failure. In the elderly, iatrogenic disease leads to traumatizing social and psychomotor consequences. In many cases, the patient may become independent on another person for all activities. Confusion arising from medical intervention leads to confusion during forensic investigation and postmortem examination. “Chattopadhyay and Pal reported a rare case in which the iatrogenic injuries produced by a medical practitioner during the course of treatment of a case of suicidal hanging resulted in suspicion being raised as to the nature of the death”(Permpongkosol, 2011). Prevention of iatrogenic disease begins with identification of elderly individuals at high risk and minimization of medication. Routine medical check-ups will lead to early diagnosis and treatment of illness, and effective management of chronic illness. Most iatrogenic diseases are preventable. Primary prevention is a strategy to stop the onset of iatrogenic disease by eliminating or reducing risk factors. Secondary prevention entails treatment of iatrogenic disease in the early stages after diagnosis before functional losses or symptoms occur. This greatly minimizes mortality and morbidity. Tertiary prevention is effective management of an existing iatrogenic disease in order to avoid its progression and further functional loss (Permpongkosol, 2011). References AIDS.GOV. (2013). Tuberculosis and HIV. [online]. Assessed 18 April, 2013. http://aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/potential-related-health- problems/tuberculosis/ AU.(2013). Chronic Disease Management (CDM) Medicare Items. [online]. Assessed 18 April, 2013. http://www.health.gov.au/internet/main/publishing.nsf/content/mbsprimarycare- chronicdiseasemanagement Barnes,P.J. and Celli, B.R.(2009).Systemic manifestations and comorbidities of COPD. Eur Respir J. 33:1165-85. Esper, A.M. and Martin, G.S.(2011). The impact of comorbid [corrected] conditions on critical illness. Crit Care Med. 39(12):2728-2735. Kantipong, P., Murakami, K., Moolphate, S., Aung, M.N. and Tamada, N.(2012). Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai, Northern Thailand. HIV AIDS (Auckl). 4: 159–168. Neves, A.S., Canini, S.R.M., Reis, R.K., Santos, C.B. and Gir, E.(2012). Aids and tuberculosis: co-infection from the perspective of the quality of life of patients. Rev. esc. enferm. 46 (3):1-13.  Permpongkosol, S. (2011). Iatrogenic disease in the elderly: risk factors, consequences, and prevention. Clinical Interventions in Aging. 6:77-82. Tcakova, R. (2010). Systemic Inflammation in Chronic Obstructive Pulmonary Disease. Mediators of Inflammation. 10:1-11. Valipour, A., Schreder,M., Wolzt, M., Saliba, S., Kapiotis, S., Eickhoff and Burghuber, O.C.(2008). Circulating vascular endothelial growth factor and systemic inflammatory markers in patients with stable and exacerbated chronic obstructive pulmonary disease. Clinical Science. 115:225-232. Vernooy, J.H., Küçükaycan, M., Jacobs,J.A., Chavannes,N.H., Buurman,W.A., Dentener, M.A.and Wouters, E.F.(2002). Local and Systemic Inflammation in Patients with Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine. 166(9): 1219-1224. Read More