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Summary Global Health, Pharmacotherapy and Communication
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SummaryGlobal Health, Pharmacotherapy and communication
Lecture 1: Global health (Taxis)
Climate change: greatest global health threat
Global health strives to improve health worldwide emphasizing transnational health issues.
Threats of global health: life-threatening heat, spread of infectious diseases, lack of stable
health care systems, communicable diseases/infectious diseases and noncommunicable
diseases
Green pharmacy: reducing the negative impact of the health care sector and reducing drug
pollution are a priority
Healthcare sector’s climate footprint is equivalent to 4.4% of global net emissions, and
equivalent to annual greenhouse gas emissions from 514 coal-fired power
plants(koolcentrales). If the health sector were a country, it would be the fifth-largest emitter
on the planet
Make drug production more sustainable by changing the way drugs are synthesized in
industry. e.g. Reduce the number of steps in the process of synthesizing medicines or
replace chemical substances in the synthesis of medicines with enzymes
COVID-19
● respiratory infection
● Symptoms ranging from mild common cold-like illness to severe viral
pneumonia(longontsteking) with potentially fatal acute respiratory distress syndrome
● Complications of severe disease: Multi-organ failure, septic shock(BP drops), blood
clots
● Long term complication: Long COVID
Determine risk to die from a (COVID-19) infection:
● Crude mortality rate: dividing the number of deaths from the disease by the total
population
● The case fatality rate (CFR) is the number of confirmed deaths divided by the
number of confirmed cases
● Infection fatality rate (IFR) is the number of deaths from a disease divided by the
total number of cases.
The global outbreak of COVID-19 had a big (negative) impact on achieving a healthier world.
(mental health impact, health inequalities, overburdened healthcare systems)
Fragile and vulnerable settings: At least 22% of the global population has no access to basic
care because of drought, famine, conflict, and population displacement(vluchtelingen).
In some coountries they have weak primarily health care, Dysfunctional health systems,
Lack of childhood vaccination, malnutrition of children
,Communicable diseases (Infectious diseases) that form a global health threat:
● Global influenza pandemic
● Dengue: viral infection caused by the dengue virus, transmitted through mosquito,
causes flu-like symptoms (20% with severe dengue die)
● HIV/AIDS: 1 million die every year
● Ebola and other high-threat pathogens
● Antimicrobial resistance
Noncommunicable diseases(often long-term or chronic conditions that develop over time
and are influenced by a combination of genetic, environmental, and lifestyle factors) which
form a global health threat: Diabetes, cancer, heart disease and dementia
Most mortality is caused by noncommunicable diseases.
Communicable diseases and non communicable diseases remain a challenge.
Reducing the number of deaths caused by communicable diseases, maternal and perinatal
deaths(during pregnancy, childbirth, in first 28 days after childbirth), malnutrition-> Progress
of reducing especially in children under 5 years of age.
In the netherlands low dead threats for children/new born in comparison with other countries
in the world
Sustainable development goals (SDG): sustainable development goals on health and
wellbeing. It is a call to action to end poverty, protect the planet and ensure that all people
enjoy peace and prosperity by 2030.
Lecture 2 Pharmacotherapy (Taxis)
Pharmacodynamics: Biochemical, cellular, and physiological effects of drugs and their
mechanisms of action. Effects of drugs often due to interaction with drug receptors or drug
targets.
Metoprolol is a selective β₁ blocker
An individual’s response to a drug depends on Age, Gender, Pharmacogenetics, Organ
function, Co-morbidities(two or more medical conditions simultaneously.) and Co-
medication.
Drug interactions may occur when patients take more than one prescribed drug or use over-
the-counter medications, vitamins, and other “natural” supplements in addition to prescribed
medicines or have unusual diets. Consequence is failure of therapy or toxicity.
Patients receive medications appropriate to their clinical needs, in doses that meet their own
individual requirements, for an adequate period of time, and at the lowest cost to them and
their community
Pharmacotherapy is the use of medicine for
prevention of diseases and treatment of diseases and
symptoms
Lecture 3 Pain treatment (Balogh)
Pain is always subjective
,Types of pain
based on time/persistence:
● acute pain
● (subacute pain)
● chronic pain: pain persisting beyond 6-12 weeks: usually transition from acute to
chronic pain
Based on pathophysiology
● nociceptive pain: actual or potential damage to tissues. Range of musculoskeletal
and visceral(internal organs) conditions that involve inflammatory, ischemic,
infectious, or mechanical/compressive injury
● neuropathic pain: maladaptive response to damage or disease of the somatosensory
nervous system->NSAIDs are less likely to work in this pain state
● nociplastic pain: pain that is not fully explained by tissue injury (nociceptive pain) or
nerve injury or disease (neuropathic pain)
It’s important to assess pain symptoms and the type of pain but it is big challenge because
of complexity of different pain syndromes and the subjectivity(person's personal and
individual experience, interpretation) Examples:
● body diagram map: know where and how much pain
● use of different pain scales(how much the pain is affecting e.g. mood, sleep)->most
used
● special questionnaires for different diseases
Therapy of pain
Non-pharmacologic therapy
● physical therapy
● psychological therapy (when depression and pain coexist use this therapy)
● other: spinal manipulation->manual adjustments to the spine (adverse events),
acupuncture(insertion of needles into specific points on body to relief pain), etc.
➢ usually the evidence supporting their effectiveness is limited!
Pharmacologic therapy
● pain pathways: ascending pathway and descending pathway:
○ ascending: different mediators(bradykinin, serotonin) are released->bind to
nociceptive receptors->nociceptive signals from periphery are then
transmitted via sensory nerve fibers, primarily A-delta(fast, acute
and sharp pain signals) and C fibers(slow, chronic and dull pain
signals), via spinal cord to somatosensory cortex in CNS where
the perception of pain occurs.
○ descending: The descending pain pathway originates from higher
brain centers and sends signals down to the spinal cord. These
signals can modulate the transmission of pain signals from the
periphery to the brain and inhibit the ascending pathway. Which is
caused by opioids.
Primary sensitization: increased sensitivity of nociceptive neurons in response
to tissue damage or injury.
Opioids act on both ascending and descending pathways by binding to opioid
receptors, providing analgesia(verdoving)
, Placebo effect:
● improves patient reported outcomes
● doesn’t treat underlying diseases.
● Placebo is unpredictable and hard to measure.
● Some symptoms are especially sensitive to placebo effects (e.g. pain, depression).
● There is a big increase in the past decades in placebo use.
● placebo effect goes down overtime so not persistent effect.
● Endogenous opioids are involved in producing placebo-induced analgesia
WHO ladder:
Principles:
● Preferably orally (alternative administration sc
(subcutaneous injections) / plaster(gips)
● Fixed intake-times
● Work according to the ladder
● Individual setting(taking personal factors into account)
● Pain monitoring
On the who pain ladder, the NSAIDs are on place 1
4.cancer pain->strongest opioids (intramuscular (IM),
subcutaneous (SC), and intravenous (IV) routes)
NSAIDs (non-steroidal anti-inflammatory drugs)
The prevalence of NSAID use in patients over 65 years old in the general practice setting is
90%->so insanely common
Therapeutic effects:
● analgesic (pain-killing)
○ good in conditions with mild or moderate pain
○ role of PGE2: PGE2 causes sensitization of pain receptors and the promotion
of inflammation->inhibiting PGE2 synthesis->reduces pain and inflammation.
○ NSAIDs generally not addictive, no resp. depression and no euphoria
● antipyretic (fever-reducing)
○ When body encounters infection or inflammatory process, immune cells such
as phagocytes release pyrogens, including IL-1-> stimulates production of
prostaglandins(PGE2), in hypothalamus, which is responsible for regulating
body temperature. PGE2 increase activate cAMP->increase in the body's
thermoregulatory set point in hypothalamus->fever
○ no effect on normal body heat only target the elevated temperature
associated with fever
● anti-inflammatory effects
○ PG decrease (PGE1, PGE2)
■ ->vasodilation, oedema,
permeability and pain all
decreases.
■ ->cartilage damage (because of
decreased blood flow)
COX enzyme: responsible for formation of
prostaglandins.
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