This document provides guidance on screening for cholesterol levels in a community pharmacy setting. It defines cholesterol and hyperlipidemia, outlines who should be screened and how frequently. The summary describes the equipment needed for screening including a photometer, lancing device, test strips, and control solutions. Step-by-step instructions are given for calibrating the photometer, collecting a blood sample via finger prick, running the test strip, and interpreting results. Normal cholesterol ranges are provided along with factors that can influence accuracy.
Importance of enzymes : The two aminotransferases that are checked are the alanine aminotransferase (ALT or SGPT) and aspartate aminotransferase (AST or SGOT). These liver enzymes form a major constituent of the liver cells. They are present in lesser concentration in the muscle cells.
Essential drug concept and rational use of medicinesPravin Prasad
Many medical students are unheard of the Essential Medicine List. This has been mentioned in very small sections in various textbooks that are in use in Nepal. The discussion on this topic is a must among medical and nursing students, as well as anyone related to field of Medicine
Chapter 7_Health Screening Services in Community Pharmacy.pptxVinayGaikwad14
Introduction,
Scope and importance of various health screening services - for routine monitoring of patients,
Early detection,
And referral of undiagnosed cases
Etiopathogenesis and pharmacotherapy of DIPDs
a. the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects).
It is also called as complete blood picture/complete blood count(CBP/CBC)
The FBC assesses several different parameters and can provide a great deal of information.
The red cell variables will determine whether or not the patient is anaemic. If anaemia is present the MCV is likely to provide clues as to the cause of the anaemia.
The white cells are often raised in infection neutrophilia in bacterial infections and lymphocytosis in viral (but not always so).
Platelets (size or number) may be abnormal either as a direct effect of underlying blood disease.
Importance of enzymes : The two aminotransferases that are checked are the alanine aminotransferase (ALT or SGPT) and aspartate aminotransferase (AST or SGOT). These liver enzymes form a major constituent of the liver cells. They are present in lesser concentration in the muscle cells.
Essential drug concept and rational use of medicinesPravin Prasad
Many medical students are unheard of the Essential Medicine List. This has been mentioned in very small sections in various textbooks that are in use in Nepal. The discussion on this topic is a must among medical and nursing students, as well as anyone related to field of Medicine
Chapter 7_Health Screening Services in Community Pharmacy.pptxVinayGaikwad14
Introduction,
Scope and importance of various health screening services - for routine monitoring of patients,
Early detection,
And referral of undiagnosed cases
Etiopathogenesis and pharmacotherapy of DIPDs
a. the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects).
It is also called as complete blood picture/complete blood count(CBP/CBC)
The FBC assesses several different parameters and can provide a great deal of information.
The red cell variables will determine whether or not the patient is anaemic. If anaemia is present the MCV is likely to provide clues as to the cause of the anaemia.
The white cells are often raised in infection neutrophilia in bacterial infections and lymphocytosis in viral (but not always so).
Platelets (size or number) may be abnormal either as a direct effect of underlying blood disease.
Pharmacist role in the community and new aspects of pharmacy professionNabil El-Hady
my lecture with my young SAMPSian friends
"Pharmacist role in the community "
In a prepration to a huge campaign aiming to raise the people apperception and to correct some wrong conception about pharmacists
Interpretation and Clinical Significance of some Clinical Laboratory Tests - ...Bigin Gyawali
Certainly, clinical laboratory tests play a crucial role in assessing the function and health of various organ systems in the body. Let's discuss the clinical significance of some common laboratory tests for each of the mentioned systems:
1. **Cardiovascular System:**
- **Complete Blood Count (CBC):** Evaluating red blood cell count, hemoglobin, and hematocrit levels can help identify anemia, which may contribute to cardiovascular issues.
- **Lipid Profile:** Measures cholesterol levels (LDL, HDL, and total cholesterol), triglycerides, and can help assess the risk of atherosclerosis and cardiovascular disease.
2. **Endocrine System:**
- **Thyroid Function Tests (TFTs):** TSH, T3, and T4 levels are assessed to diagnose thyroid disorders. An imbalance in thyroid hormones can affect metabolism and cardiovascular function.
- **Hemoglobin A1c (HbA1c):** Monitors long-term glucose control and is essential in managing diabetes, a condition that can impact multiple organ systems, including the cardiovascular and renal systems.
3. **Gastrointestinal System:**
- **Liver Function Tests (LFTs):** Assess the health of the liver by measuring enzymes (ALT, AST, ALP), bilirubin, and proteins. Abnormalities may indicate liver disease or dysfunction.
- **Stool Tests (e.g., fecal occult blood):** Detects blood in the stool, which may indicate gastrointestinal bleeding or conditions such as colorectal cancer.
4. **Hematologic System:**
- **Coagulation Panel (PT, aPTT, INR):** Evaluates the blood's clotting ability. Abnormalities may suggest bleeding disorders or an increased risk of thrombosis.
- **Complete Blood Count (CBC):** Assesses the cellular components of blood, including red and white blood cells and platelets, helping to diagnose anemias, infections, and blood disorders.
5. **Renal System:**
- **Blood Urea Nitrogen (BUN) and Creatinine:** Evaluate kidney function. Elevated levels may indicate impaired renal function, suggesting acute or chronic kidney disease.
- **Urinalysis:** Examines urine for abnormalities such as protein, blood, or glucose, providing insights into kidney and urinary tract health.
6. **Respiratory System:**
- **Arterial Blood Gas (ABG) Analysis:** Assesses oxygen and carbon dioxide levels in the blood, helping diagnose respiratory and metabolic disorders.
- **Pulmonary Function Tests (PFTs):** Measures lung function, aiding in the diagnosis and monitoring of conditions such as asthma or chronic obstructive pulmonary disease (COPD).
Interpretation of these tests requires a comprehensive understanding of the patient's medical history and clinical presentation. Abnormal results can guide further diagnostic investigations and help healthcare professionals develop appropriate treatment plans. Regular monitoring of these parameters is vital for managing chronic conditions and preventing complications.
A blood glucose test measures the level of glucose (sugar) in your blood. The test can involve a finger prick or a blood draw from your vein. Healthcare providers most commonly use blood glucose tests to screen for Type 2 diabetes, which is a common condition.
HEALTH SCREENING SERVICES IN COMMUNITY PHARMACY .pptxLipanjali Badhei
Content:
INTRODUCTION
SCOPE
IMPORTANCE OF HEALTH SCREENING
SUCCESS OF HEALTH SCREENING
TYPES OF HEALTH SCREENING
ROUTINE Monitoring OF PATIENT
EARLY DISEASE DETECTION
SOME DISEASE AND THEIR HEALTH SCREENING SERVICE
Diabetes Mellitus: DR L H Hiranandani Hospital, MumbaiKrishna Singh
A group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.
Visit: https://www.hiranandanihospital.org/
A case report of Adrenal cushing's syndrome , presented with a typical dermatological lesions , seen in endocrinology outpatient clinic in zagazig university hospitals, Egypt
CholesLo shows clinical significance in
helping reduce plasma cholesterol and
homocysteine levels and therefore affects
favourably the risk of subsequent development
of cardiovascular disease. Furthermore, our
findings suggest that the dose required to cause
such improvements in plasma lipid profile is
safe enough to be considered for use in general
population.
3. Objectives
After this practical experience, you will be able to provide the
answers to the following questions:
WHAT is a cholesterol-screening test?
WHO should have their cholesterol tested checked?
HOW frequent should cholesterol be screened?
WHAT is the importance of a cholesterol screening test?
WHAT are the normal (reference) values of a cholesterol
screening test?
WHAT are the precautions that need to be taken by a pharmacist
(operator) and by the subject (patient/volunteer)?
HOW reliable are the results of a cholesterol screening test?
WHAT factors can affect the screening results?
4. Hyperlipideamia (HLD)
Definition:
Hyperlipideamia is a term used to describe all
conditions characterized by high cholesterol
levels
Characterized by an increase in blood conc. of 1
/ > types of lipids (fats) in the blood (e.g.
cholesterol, cholesterol esters, triglycerides,
phospholipids)
One of the main causes of:
Atherosclerosis
Coronary heart disease
5. Drugs that give rise to drug-
induced HLD
Thiazide diuretics (LDL and total CHOL (TC)
increase)
Certain β-blockers (TG increase and HDL decreases)
Progestins (TC increases)
Glucocorticoids (TC increases)
Anabolic steroids (TC increases and HDL decreases)
Cyclosporine (TG and LDL increases)
Isotretinoin (TG increases and HDL decreases)
Large amounts of alcohol (TG increases)
Oestrogen in oral contraceptives
6. Other factors that give rise to HLD
Very high KJ diet
Diet rich in (unsaturated) fats
Diet rich in cholesterol
Very low fibre diet
Lack of exercises
Smoking
Moderate / high alcohol abuse
High androgen levels (men > premenopausal
women)
7. Determination & screening of
cholesterol
Determined in a:
Clinical environment (e.g. blood taken and TG is
determined)
Community Pharmacy (screening for CHOL)
Clinical environment
Blood is drawn and lipoprotein / full lipogram (incl. TG)
be determined
Blood drawn after 12 hrs of fasting and 24 hrs of
alcohol avoidance
8. Determination & screening of
cholesterol
Community pharmacy (Screening for CHOL)
CHOL is screened
Only total CHOL is determined
Units: mmol/L; mg/100 ml/ mg/dl (1 mmol =
387 mg)
Total CHOL represented as:
Desired
Moderately high
Seriously high
Above is linked to age
9. Determination & screening of
cholesterol
Other application locations:
Doctor’s offices
Medical clinics
Homes
Field Hospitals
10. Which persons’ total CHOL should be
tested?
Patients with a personal history of CV disease
Should there be a family history of CV disease – esp. in patients <
50 years
Children, should there be a family history of hyperlipoproteinemia
Should there be evidence of DM, hypertension, serious obesity (BMI
> 30), gout / smoking
Women: 35-59 years of age with two/> risk factors* (*smoking,
hypertension, obesity, DM, family history of CV disease &
hypercholesterolemia)
Men 35-59 years of age with one risk factor*
Men: 20-34 years and 60-69 years of age, with 2/> risk factors*
Adults > 20 years of age – non fasting CHOL screen done once
every 5 years
11. Patient factors which influence TC
levels
Posture/position of patient
Food and alcohol ingestion
Physical activity
Recent cardiac conditions
Pregnancy
Gender
Age
Trauma/infection
Biological (‘time of the day’) variation
12. Patient factors which influence TC
levels
Posture/position of patient
TC increases in the standing position
Determinations done in the same position (sitting)
Sitting for at least 5 min. prior to test, so that the effect
can be stabilized
Food and alcohol ingestion
TC can be determined without patient fasting
Dietary cholesterol will cause a small/insignificant
increase in TC
Alcohol ingestion will give rise to a modest decrease in
TC
Physical activity
Strenuous physical activity 24 hrs prior to the
screening lowers TG levels
Above influences TC levels
13. Patient factors which influence TC
levels
Recent cardiac conditions
TC levels decrease sign. following a MI (for various days, until
about 8 weeks)
CHOL levels can also decrease following cardiac catheterization
Pregnancy
TC increases by 20 to 35%
Gender
After puberty: HDL levels are lower in men than women
TG and VLDL levels are higher in men than women
After puberty: Oestrogen lowers LDL levels and increase HDL
(women)
Androgens increase LDL and decreases HDL (men)
During menstruation: TC lower during luteal phase than other
stages of the menstrual cycle
14. Patient factors which influence TC
levels
Age
Birth to six months: plasma levels rise rapidly
Childhood: plasma CHOL levels stay reasonably
constant
After puberty: plasma CHOL rises
Adulthood: plasma CHOL reaches a peak:
men: 50 to 60 yrs of age
women: 60 to 70 yrs of age
Trauma/infection
Trauma: CHOL levels decrease by 40% and remain
lowered for 5 to 6 weeks after the event
Infection (bacterial / viral)/bad pain/operation: CHOL
levels are lowered and remain lowered for 8 weeks
after such events
15. Patient factors which influence TC levels
Biological (‘time of the day’) variation
During the day: TC variation of 2 to 3% during
the day
Seasonal variation: TC levels lower in summer
than winter
16. Cholesterol screening done in a
Community Pharmacy
Items needed:
Reflex photometer (e.g. GCT meter)
Finger pricking apparatus / lancing
device
Lancets
Reagent test strips (glucose,
cholesterol, triglycerides)
Control solutions
18. Cholesterol screening done in a
Community Pharmacy
Calibration
Calibration with a code strip serves to
adjust the meter to a specific characteristics
of the CHOL / GLUC / TG test strips used
Code strips are wrapped individually in the
pack of test strips purchased
(!! Storage of the test strip in its wrapping
and not in the test-strip vial – print on the
code strip may impair the test strip quality
and lead to erroneous results !!)
Calibration must take place when:
The meter is switched on for the first
time
Whenever new test strips are used
21. Cholesterol screening done in a
Community Pharmacy
Measurement procedures
STEP 1: Wash and dry
hands thoroughly. Rinse with
clear water before
commencing measurement
(!! TG measurements – all
creams and many soap
products e.g. shower gels,
shampoos) contain fat –
leads to false results !!)
STEP 2: Prepare lancing
device
Select penetration depth
(e.g. ‘soft skin’ hands vs.
‘hard skin’ hands)
22. Cholesterol screening done in a
Community Pharmacy
Measurement procedures
STEP 3: Switch on
apparatus
Word CHOL / GLUC / TG
appears
Corresponding code no.,
time, and date appears
When word CODE
appears, the apparatus is
ready for measurements
STEP 4: Remove the test
strip from its wrapping. Close
vial immediately
23. Cholesterol screening done in a
Community Pharmacy
Measurement procedures
STEP 5: Cover flap and insert test
trip into slot in the direction of the
arrow making sure that it is inserted
as far as it can go
Test strip successfully read:
two beeps
name the test strip inserted e.g.
either CHOL or GLUC or TG will
be displayed
CODE stops blinking and EV.0
begins to blink:
Test strip incorrectly read:
Error messages appear e.g. E-1
, E-2 or OFF
Act according to procedures
stipulated in the booklet
24. Cholesterol screening done in a
Community Pharmacy
STEP 6: Open flap
EV.O blinks on display together with
measurement time: 180 sec (max) for
TG (reaction time = 174 sec)
STEP 7: Rub and kneed a fingertip to
facilitate the withdrawal and application
of blood
STEP 8: Prick the massaged place on
the fingertip with the lancing device
26. Cholesterol screening done in a
Community Pharmacy
STEP 9:
Cover yellow test field completely
with blood (otherwise falsely low
results will be measured)
If too little blood is applied, do
not rub it in or apply second drip,
repeat the measurement with a
fresh test strip
Allow hanging blood drop to form
without applying too much
pressure
Carefully drop blood to yellow
test field on top of strip without
touching top of strip
27. Cholesterol screening done in a
Community Pharmacy
STEP 9 (cont.):
If too little blood is applied, do not rub it in or apply second drip,
repeat the measurement with a fresh test strip
29. Cholesterol screening done in a
Community Pharmacy
STEP 11: Meter counts down in seconds to 0.
Last four sec is heard at the end of the
measurement followed by a long beep
Measured value (in mg/dl or mmol/l)
appears on the display and EV.O blinks
Measured values only within certain
ranges:
CHOL 150 – 300 mg/dl (3.88 - 7.76
mmol/l)
Blood GLC 20 – 600 mg/dl (1.1 – 33.3
mmol/l)
TG 70 – 600 mg/dl (0.80 – 6.86
mmol/l)
Above the ranges : HI shown
Below the ranges: LO shown (also
when too little blood is used)
Open flap. Remove test strip
Close flap and switch meter off
32. Heart Foundation recommendations
SA Heart Foundation recommends the following classification
for TC levels:
<5.0 mmol/L – Desirable
5-6.5 mmol/L – Moderate risk
6.5-7.8 mmol/L – High Risk
>7.8 mmol/L – Very high risk
Recommended that > 1 test be done for confirmation
(esp. moderate/high TC)
TC screening can be done – fasting/non-fasting
conditions
33. Factors influencing the accuracy of
results
Factors influencing the accuracy of results
Instrumental factors
Sampling
Quality control procedures
Instrumental factors
Apparatus of Community Pharmacies compare well with
apparatus in Clinical environments
Comparing results: variation from 1 to 5% (Community Pharmacy
results lower than standard operating laboratories results
34. Factors influencing the accuracy of
results
Sampling
Has a strong influence on the accuracy of results
Personnel have to be trained in the correct procedures
Results of finger pricking sample vary about 4% from the
venous puncture sample
!! Finger should not be ‘milked’ at all – blood will then
mix with the ECF and result in giving falsely low
CHOL levels
Capillary tube should not be pushed into the finger
35. Factors influencing the accuracy of
results
Quality control procedures
Standing correct quality SOP should be adhered to at all
times
Accuracy of the sample should be evaluated through the
test of std solutions with a known CHOL level
Should be done weekly / after 100 tests (which ever
comes first)
Records should be kept of the results and carefully
studied
Analyzers that do not comply with ≈ 5% or < standard
precision, should be removed from service until repaired
Comparing: venous puncture sample of same patient
(screen test done in a Community Pharmacy) vs.
laboratory (clinical setting)
Optical system of the apparatus should be cleaned with
70% alcohol
Should not be used within 15 min. after the cleaning
procedure
Instruction manual should be strictly adhered to
36. References
Davies, A, Blakeley, AGH and Kidd, C. Human Physiology. McGraw-
Hill:Boston, Massachusetts
Griesel, MS. Primary screening and monitoring services for
pharmacists. PSSA Publications: Potchefstroom, Chapter 2, pp. 48-61
Internet resources:
http://www.diavant.com/diavant/CMSFront.html?pgid=3,1,5,0
http://www.diavant.com/diavant/CMSFront.html?pgid=1,3,9,1
http://www.roche-diagnostics.com/products_services/accutrend_gct.html
SAMF, 9h edition, Section on Serum lipid-modifying agents
37. Hands on screening of cholesterol levels in
blood plasma using photometers
38. Hands on screening of cholesterol levels in
blood plasma using photometers
DE 519 CE S522
CE
302B
TA N309
VA
520C