Lecture 21: Home testing & Monitoring Devices Flashcards

Question

FOBT

Answer 1

● Utilizes a pseudo-peroxidase reaction using a chromagen that turns blue-green when oxidized by hemoglobin ● Blue green = positive test ● Test relies on fecal blood from stool will be left in the toilet bowl after a bowel movement

Answer 2

● Uses antibodies to detect human hemoglobin protein in stool ● Test reacts to part of hemoglobin protein found in red blood cells ● Stool is sampled from toilet tissue after a bowel movement

Answer 3

● Other GI conditions that cause bleeding: ○ Ulcers, Crohn’s disease, colitis, diverticulitis, anal fissures, hemorrhoids ● Menstruation → wait to take the test ● Certain medications: ASA, NSAIDs, steroids, rectally administered ○ Ideally meds should be avoided for 2-3 days before ● Toilet bowl cleaners?

Answer 4

● Increase dietary fiber intake for several days before testing ○ Roughage may stimulate bleeding from lesions ● Perform the test on 3 consecutive bowel movements ○ Cancerous lesions may bleed intermittently ● Some prescription medications may cause bleeding; consult with a healthcare provider before discontinuing

Answer 5

● Remove toilet tank cleansers or deodorizers, and flush toilet twice before testing. ● Keep test pads in original foil pouch until time of testing. ● Before testing, use one test pad to perform a water quality check. Hold the pad by its corners and drop it into the toilet bowl. If any trace of blue appears in the cross-shaped area when the pad is placed in the toilet water, use another toilet to complete the testing. Perform this water quality check on the second toilet as well. ● Immediately after a bowel movement, place a pad in the toilet bowl, printed side up. After 2 minutes, check for the appearance of a blue cross on the test pad (positive result). ● If color changes differ from the blue cross, discard the pad and repeat the test after the next bowel movement. ● Repeat the test on the next two bowel movements

Answer 6

● After a bowel movement, wipe the anal area as normal, and retain a small amount of stool on toilet paper. ● Unscrew cap/wand from buffer tube. ● Collect a small sample of stool onto the grooves of the buffer tube cap/wand. ● Return cap to tube and screw tightly. Shake tube for 3 seconds. Unscrew smaller clear cap at top of tube. ● Apply 3 drops from tube to sample well. ● Read results after 5 minutes. There should be a red line at “C,” which indicates the test is working. A positive test will also have a line at “T.” Do not read results if 10 minutes has elapsed

Answer 7

○ Start screening for colon cancer at 50 years old and screen every 5-10 years (high risk start at age 40-45) ○ USPSTF recommends FOBT, sigmoidoscopy, or colonoscopy ○ American College of Gastroenterology recommends colonoscopy (more sensitive) ○ American Cancer society recommends FOBT annually, colonoscopy every 10 years

Answer 8

does not diagnose a specific disease ○ Test indicates that there is any bleeding in the GI tract ○ If positive → visit healthcare provider for full workup

Answer 9

A. Sensitivity

Answer 10

Used for more frequent cholesterol screenings ○ Hypercholesterolemia is a chronic condition ○ Monitoring can help promote adherence to lifestyle and medication regimens

Answer 11

Some allow measurement at home ○ Others allow collection at home with a measurement by a lab ○ Efficacy rates vary…

Answer 12

CholesTrak ○ First Track ○ Cardiochek (also a professional version of this)

Answer 13

``` ● Good finger stick technique required ○ Hanging drops of blood required ○ Collection must be fairly quick ○ Avoid “milking” the finger ● Avoid vitamin C >500mg before the test ● High/abnormal test results should follow up with provider ```

Answer 14

→ LDL, HDL, triglycerides

Answer 15

``` ● Lead to 8-10 million HCP visits annually ● Symptoms: ○ Painful urination ○ Urinary urgency ○ Blood in urine ○ Lower abdominal pain/discomfort ```

Answer 16

Reasons for testing: ○ Early detection ○ Confirmation of cure

Answer 17

``` ● Available as Azo Strips, store brands ● Detects nitrate (reduction product of gram negative bacteria) and leukocyte esterase (enzyme specific to WBCs) ● Sensitivity of 68-90% ```

Answer 18

• Vegetarian diet ○ Tetracycline ○ Vitamin C (within 10 hours)

Answer 19

○ Those who share needles or syringes ○ Sexual intercourse with someone infected with HIV ○ Blood transfusion between 1978 and 1985 ○ Born to a mother infected with HIV

Answer 20

○ Blood sample + mail to lab | ○ Saliva test + result at home (OraQuick® )

Answer 21

○ May take between 3 weeks to 6 months to appear after exposure

Answer 22

● Remove the test tube from packaging, pop it open, and insert it into the holder. Hold the test tube upright to avoid spilling the liquid that is inside. ● Remove the test stick from packaging. Do not touch the test pad. ● Swipe the test pad along upper and lower gums. Swipe each gum only once. ● Insert the test stick into the test tube with the test window facing forward. Start timing. ● Read the test result in the test window at 20 minutes. After 40 minutes, the results may be invalid. ● The test kit provides guidelines for how to read the results and what the results mean. One line at C is negative. A line at C and T is positive. ● Note that counseling on performing the test is available 24 hours a day from the company

Answer 23

● Using alcohol, clean the fingertip chosen for puncture. Allow alcohol to dry. ● Prick the cleaned fingertip using the lancet provided, and place a few drops of blood on the blood specimen card. Fill the circle on the card completely to ensure a readable test. Examine the back of the card to ensure that the blood soaked through. If it did not, place more blood on the front of the card. If a second fingerstick is needed, use the second lancet provided in the kit. ● Allow the card to air dry for 30 minutes; place the sample in the specimen return pouch, and seal the pouch in the prepaid and addressed shipping package. Be sure that the processing laboratory receives the specimen within 10 days of sampling. ● To obtain the results, call the manufacturer’s toll-free number 3–7 business days after mailing the specimen, depending on which test kit was used. ● Note that counseling is available 24 hours a day, for both negative and positive results, and counseling is included in the cost of the testing unit.

Answer 24

● Hepatitis C induces liver damage by causing hepatic cell necrosis and inflammation → fibrosis, cirrhosis, carcinoma ● Most common blood borne pathogen in the U.S.

Answer 25

○ Use of injectable drugs ○ Receipt of clotting factors before 1987 ○ Blood transfusion, long term hemodialysis or organ transplant prior to 1992 ○ Sexual intercourse with multiple partners ○ Born to mother infected with HCV

Answer 26

○ Screening recommended for all adults born between 1945 and 1965

Answer 27

● Tests for ANTIBODIES ○ May take 6 months for HCV antibodies to develop after exposure ● Positive tests should be referred to HCP

Answer 28

● Register the PIN (personal identification number) with the manufacturer by calling the provided tollfree telephone number and following the automated directions. ● Remain seated during the testing process to prevent falling if dizziness occurs. ● Before starting the test, wash your hands thoroughly with soap and warm water, and then dry them. ● Date the blood sample card. ● Lance the side of one of your middle fingers. ● Apply a sufficient number of blood drops until both the front and back of the circular area on the testing card are saturated. ● Allow the sample to dry at least 30 minutes before sealing it in the pouch and mailing it. ● Within 4–10 business days after mailing the sample, call the toll-free number provided, using the PIN to access the test results. Test results are available for up to 1 year. ● Note that counseling is included in the cost of the testing unit and is available 24 hours a day, for both negative and positive results

Answer 29

``` ● Various tests on the market ○ Most are send away ○ Some have a home option first, then send away confirmation ○ May test for 1 drug or many ● Different collection techniques ○ Urine ○ Hair ● Tests are only qualitative- yes/no (not amount or route of administration) ● False positives: ○ Decongestants, DXM, antidiarrheals, cough medicine with codeine ```

Answer 30

● 32% of Americans over 20 have hypertension ● Home blood pressure monitoring can be used in screening and monitoring ○ “White coat syndrome” ○ Regular monitoring ○ Promotes medication, lifestyle adherence ● Monitors built for arms, wrist, finger ○ Finger are generally considered inaccurate ○ Wrist may be more accurate in individuals who are obese

Answer 31

● Choose a correct cuff size ○ May impact reading by 20-30mmHg ○ Use a wrist cuff if large enough cuff is not available ● Wrist cuffs must be held at heart level ○ Rest arm on a table/pillow to get to correct height

Answer 32

Detect RNA Polymerase chain reaction (PCR) test is a type of NAAT

Answer 33

Sent to labs

Answer 34

Highly sensitive and specific

Answer 35

Detect pieces of protein from the virus → high level of virus in sample is needed

Answer 36

Sample applied to test strip or cartridge

Answer 37

Moderate to high sensitivity, | high specificity

Answer 38

10-15 minutes

Answer 39

● NAAT tests have high sensitivity ○ Important to minimize false negatives to limit the spread of COVID ● Despite high specificity of antigen tests, false positives are possible ○ Especially in communities where the prevalence of infection is low ○ In general, the lower the prevalence of infection in the community, the higher the proportion of false positive test results

Answer 40

○ Register kit, collect sample using nasal swab, ship sample to lab, access results online 1-2 days after sample is received

Answer 41

○ Most sensitive | ○ Usually does not need to be repeated to confirm results

Answer 42

○ Expensive → ~$125 ○ Longer turnaround time ○ A positive NAAT diagnostic test should not be repeated within 90 days, since people may continue to have detectable RNA after risk of transmission has passed

Answer 43

``` ● Antigen tests ● Directions: ○ Swab nose, perform test, analyze results in 15 minutes ● Age 2 and up with or without symptoms ○ Test twice within 3 days ```

Answer 44

○ Not as expensive → ~$25 ○ Short turnaround time ○ Comparable performance to NAAT tests in symptomatic people

Answer 45

Less sensitive especially among asymptomatic people | ○ May need confirmatory testing

Answer 46

● NAAT tests are considered the gold standard ● PCR tests are usually required for travel ● Antigen tests are preferred for surveillance testing ○ Sensitivity may not be as important as frequency of testing

Answer 47

○ Antigen or NAAT test 3-5 days after potential exposure

Answer 48

Antigen and NAAT have comparable sensitivity when viral load in the specimen is high and the person is most likely to be contagious

Answer 49

``` ● Alcohol screening tests ● Visiderm (mole changes) ● Breast self-examination aid ● Vaginal pH test ● Tobacco/Nicotine exposure test ● Paternity test ● Menopause test ● Strep A test ● Home electrocardiogram monitor ```

Answer 50

● Offer counseling to patients who purchase these products ● Be available to answer questions ● Familiarize yourself with local resources ○ Planned Parenthood ○ Free/low-cost clinics ○ Urgent care facilities

Answer 51

● Centers for Medicare & Medicaid Services (CMS) regulates human laboratory testing through the Clinical Laboratory Improvement Amendments (CLIA) ● Objective = ensure qualified laboratory testing through lab certification ● If lab testing is being provided then the a lab must be CLIA certified!

Answer 52

○ The FDA decides which tests are waived ○ Must meet criteria of “simple laboratory examinations and procedures that have an insignificant risk of an erroneous result” ○ MUST observe and follow package directions from the manufacturer (i.e. individuals must be familiar with and trained in administering these tests) ○ These tests can be completed in a non-lab setting (pharmacy, doctor’s office, clinic)

Answer 53

○ A1C test ○ CardioCheck (lipid/glucose) ○ Strep test ○ Influenza test

Answer 54

● In 39 states, a pharmacist may administer CLIA-waived tests by obtaining a waiver certificate for their pharmacy ● In NYS, a pharmacist may NOT operate a CLIA waived lab ○ However, they can be employed by that lab to administer tests under a qualified director - but they are not doing this as a pharmacist, they are doing it as a trained employee

Answer 55

● April 8, 2020: Health and Human Services (federal agency) authorized pharmacists to order and administer COVID-19 tests authorized by the FDA ● April 25, 2020: NYS Executive order allowing pharmacists to order/administer COVID-19 tests

Lecture 21: Home testing & Monitoring Devices Flashcards

(80 cards)