Week 30

In our last Patient Care 2 session, we discussed the musculoskeletal and integumentary systems.

This week, we face the following body organs:

• Eyes
• Ears
• Nose
• Pharynx (throat)

Eye – (Karu or Whatu)

The adult eye is a sphere that is approximately 2.5 cm in diameter. Each eye is located within the protective sockets of the skull, known as eye sockets or orbits. The eyes are the sensory organs responsible for vision.

Structure

For a small part of the body, the anatomy and structure of the eye is fairly complex and has many parts. As some of these are well known to us, test your knowledge of each part's function before expanding the label to see if there’s any information that’s new to you.

As you can see, although there are many parts that make up the eye, essentially, the eye is a camera. At the front of this camera, we have the lens and cornea that capture passing images and project them onto the retina at the back of the eye. There, photoreceptors convert them into electrical signals and send them along the optic nerve to the brain.

Watch: How the Eye Works Animation […] (3:22 minutes)

Mātakitaki, watch this animation that explains how the eye works and the disorders of near and far-sightedness and then complete the activity that follows to summarise your understanding of these disorders.

Tears

Tears are a clear, saline fluid produced by the lacrimal glands above each eye. Tears keep the eye moist and lubricated and clean the eye of debris. They also provide an antibacterial action and form a smooth, regular surface on the eye, preventing distortion of light.

In other parts of the body, the blood vessels transport oxygen via the blood, but as the cornea is transparent, it has no blood vessels to supply the oxygen. Instead, the cornea receives oxygen from the air that dissolves in tears.

Tears are continuously produced, and excess tears, along with debris and waste products, are drained through small openings called puncta located in the inner corners of the upper and lower eyelids. From the puncta, tears travel through the lacrimal canals into the lacrimal sac, into the nasolacrimal duct, and into the nasal cavity. A blockage can occur at any point in the tear drainage system. When that happens, tears do not drain properly. Symptoms may include watery eyes and increasing risk of eye infection and inflammation.

Fun/sad fact: As far as we can tell, humans are the only creatures that cry from feeling (emotional tears). We also don’t know why we cry from emotion, as there is no physiological benefit. (Bryson, 2019).

Here, you can see what is happening in the eye when the tear duct is blocked.

Ears, Nose and Throat (ENT)

The ears, nose and throat are connected by the eustachian tube and therefore treated as one medical specialty known as ‘ENT’ (this may be another acronym to add to your glossary!).

The eustachian tube is located in the middle ear, connecting it to the nasopharynx, the upper part of the throat (pharynx) behind the nasal cavity.

Functions

The eustachian tube’s functions are to:

• Equalise air pressure on both sides of the eardrum. This is crucial for maintaining optimal conditions in the middle ear for hearing. Swallowing, yawning, or chewing helps open the eustachian tube, allowing air to flow in or out and equalise pressure.
• Drain off fluid from the middle ear to the throat. This drainage helps prevent fluid build-up, reducing the risk of ear infections.
• Prevent pathogens or fluid from entering the middle ear from the throat.

Now, let’s explore each component that makes up the ENT speciality. You will be familiar with much of this content from your previous learning.

Ears (Taringa)

1. Scapha
2. Helix
3. Temporal muscle
4. Temporal bone
5. External acoustic meatus (Ear canal)
6. Malieus
7. Stapes
8. Semicircular canals
9. Cochlea
10. Vestibular nerve
11. Cochlear nerve
12. Eustachian tube
13. Tympanic cavity
14. Incus
15. Tympanic membrane (Eardrum)
16. Cartilage
17. Auricular lobule (Earlobe)
18. Concha
19. Antihelix
20. Triangular fossa

The ear is the sensory organ responsible for hearing and maintaining balance. This amazing organ consists of three main parts: outer, middle and inner ear.

Let’s explore these three main parts and discover common disorders that can impact them.

Outer ear

The outer ear includes the visible portion called the pinna or auricle and the ear canal.

• The pinna helps collect sound waves and directs them into the ear canal.
• The ear canal is a tube that extends to the eardrum.

Fun fact: Although our outer ears all function in the same way, they are distinctive, like our fingerprints. They appear to be entirely unique to each person! (Bryson, 2019).

Common Disorder - Otitis Externa (Swimmer's Ear)

This infection or inflammation of the ear canal is often caused by water exposure, leading to pain, swelling, and sometimes discharge.

Middle ear

The middle ear is located behind the eardrum, the tympanic membrane. It contains three small bones called the ossicles:

1. malleus (hammer)
2. incus (anvil)
3. stapes (stirrup).

These bones amplify and transmit sound vibrations from the eardrum to the inner ear.

The middle ear is connected to the back of the throat by the eustachian tube, which helps equalise air pressure.

Common Disorder - Otitis Media

This infection or inflammation of the middle ear is commonly seen in children. It can cause ear pain, fluid build-up, and potential hearing loss.

Inner ear

The inner ear consists of the cochlea and the vestibular system.

• The cochlea contains the nerves responsible for hearing and contains fluid-filled channels lined with hair cells that convert sound vibrations into electrical signals sent to the brain.
• The vestibular system, located in the inner ear, is essential for balance and spatial orientation.

Common Disorder - Meniere's Disease

A disorder of the inner ear characterised by vertigo, hearing loss, tinnitus (ringing in the ears), and a feeling of fullness or pressure.

Nose (Ihu)

The nose is the body’s primary organ of smell. It also functions as part of the body’s respiratory system. The nose consists of external and internal components.

As you read about the following components, refer to the illustrations to visualise their location and relation to the other components.

External components

• The nasal bone, cartilage, and fat define the shape of your nose and house the nostrils.
• Nostrils (nares) are the visible openings at the base of the nose through which air enters.
• The septum is a combination of bone and cartilage along the centre of the nose that divides it into two nasal cavities.

Internal components

• Each nostril leads to a nasal cavity. This is where breathed-in air is filtered by cilia, hair-like structures inside the nostrils, before entering your lungs. Each nasal cavity is lined with mucus membranes and respiratory (epithelium) cells.
• Nasal conchae (turbinates) are three bony shelves on each side of the nasal cavity that help filter, humidify, and direct airflow.
• The olfactory region is in the upper part of the nasal cavity, containing olfactory receptors for the sense of smell.
• The nasal sinuses are air-filled cavities within the bones surrounding the nasal cavity. These sinuses are:
  • Frontal: Located in the forehead.
  • Maxillary: Situated in the cheekbones.
  • Ethmoid: Found between the eyes.
  • Sphenoid: Located behind the ethmoid sinuses.

Functions

The key functions of the nose are:

• Breathing: The nose is the primary passage for inhaling and exhaling air. It filters, warms, and humidifies the air as it enters the respiratory system.
• Smelling (Olfaction): The olfactory region in the upper part of the nasal cavity contains olfactory receptors, allowing the nose to detect and identify various odours.   
  • Fun Fact: Although humans all have 350 – 400 types of receptors, only about half of these are common to all people. This means we don’t smell the same things (Bryson, 2019).
• Air filtration: Nose hairs and mucus help trap particles, dust, and pathogens in the air, preventing them from reaching the lungs.
• Humidification: The nasal mucous membranes add moisture to the air, preventing the respiratory tract from drying out and maintaining optimal conditions for lung function.
• Voice resonance: The nasal passages contribute to the resonance of the voice, influencing speech and sound production.

Common disorders

Common disorders of the nose include:

Deviated septum

A shift in the nasal septum (the cartilage dividing the nostrils) that can cause nasal congestion and difficulty breathing.

Allergic Rhinitis

An allergic reaction that causes sneezing, itching, congestion, and a runny nose.

Pharynx | throat (korokoro)

The throat, also known as the pharynx, is a muscular tube at the back of the mouth and nasal cavity, connecting it to the oesophagus and larynx. You will remember this image from previous content, as this is a crucial part of the digestive and respiratory systems.

Structure

The throat is divided into three parts:

1. Nasopharynx
2. Oropharynx
3. Laryngopharynx (also known as hypopharynx).

Expand the labels to find out more about each of these parts.

Functions

The functions of the pharynx are:

• Air passage: The pharynx acts as a common pathway for air, connecting the nasal cavity and mouth to the trachea. It allows air to pass from the upper respiratory system into the lower respiratory system.
• Swallowing: Muscles in the pharynx contract to propel food from the mouth into the oesophagus, preventing it from entering the windpipe (trachea).
• Speech and sound production: The pharynx contributes to speech and sound production by resonating and modifying the sound waves produced by the vocal cords in the larynx.
• Immune function: The tonsils, located in the pharynx, are part of the immune system. They help protect against infections by trapping and fighting bacteria and viruses.

Common disorders

Common disorders of the throat include:

Tonsillitis

Inflammation of the tonsils, often causing throat pain and difficulty swallowing.

Throat infections

Infections caused by bacteria or viruses lead to symptoms like pain, swelling, and difficulty swallowing.

Summary

Ka pai mai hoki, that’s fantastic! You've successfully delved into the study of the eye and ENT.

As a pharmacy technician, your role involves offering advice and care to patients with health issues connected to these body systems. A solid understanding of human anatomy, particularly in these areas, is crucial for your role in providing effective support and assistance to those seeking pharmaceutical guidance.

Another week of Patient Care 2 is now complete! Treat yourself to a well-deserved break before tackling this week’s Anatomy and Physiology.

Kia ora, welcome to this session where we pick up where we continue to explore the pancreas and the endocrine disorder of diabetes.

Diabetes

Understanding diabetes is essential for pharmacy technicians so that they can provide informed, safe and empathetic care. According to the Ministry of Health (2022), over 250,000 people in New Zealand have been diagnosed with diabetes, most with type 2.

Diabetes in Aotearoa

Take a look at this infographic from Diabetes New Zealand to see the extent to which diabetes impacts the Aotearoa New Zealand population.

As you can see, the impact of diabetes on Kiwis is huge and set to keep rising.

Pancreas review

During previous learning of Anatomy and Physiology, our focus was on the endocrine function of the pancreas. Before delving into the discussion of diabetes disorders, it is highly recommended that you return to this section to refresh your knowledge.

Use this link to revisit last week's learning: Week 29. Use the keyboard shortcut CTRL + F | Command + F and search ‘Pancreas’ to find the content.

Types of diabetes

There are different types of diabetes, each with its own complications and ways to manage them, and generally different pathologies.

Type 2 diabetes (Mate huka)

Let’s take a deeper dive into Type 2 diabetes.

Watch: 1a Diabetes – Overview & Symptoms (4:26 minutes)

Mātakitaki mai, watch here to see a simple overview of type 2 diabetes and hear people with diabetes talking about how the disorder has affected them.

Watch: Understanding Type 2 Diabetes (3:45 minutes)

Mātakitaki this video for a more in-depth look at the physiology of type 2 diabetes.

Monitoring and managing diabetes

Blood glucose monitoring

Monitoring blood glucose is a cornerstone of diabetes management. Blood glucose levels reflect the amount of sugar in the bloodstream, and maintaining these levels within a target range is crucial for people with diabetes.

As pharmacy technicians, you'll encounter various tools and devices for blood glucose monitoring, ranging from glucose meters to continuous glucose monitoring (CGM) systems. Patients rely on accurate readings to make real-time adjustments to their diabetes management plans.

HbA1c testing

As well as daily glucose monitoring, HbA1c testing provides a valuable long-term perspective on blood sugar control. Haemoglobin A1c (HbA1c) is a measure of average blood glucose levels over the past two to three months. This test is used to diagnose type 2 diabetes and to check the blood glucose levels of people with type 2 diabetes.

HbA1c results guide healthcare providers in adjusting treatment plans, setting blood sugar targets, and preventing the onset of diabetes-related complications.

Read this Healthify webpage on the HbA1c test: HbA1c test – monitoring type 2 diabetes.

Make sure to watch the video clip on the page that discusses the role of HbA1c testing in reducing complications from diabetes.

Oral hypoglycaemics

In the previous tūmahi (activity), you looked at lifestyle changes as the first line, no-pharmacological (non-medicine) treatment for type 2 diabetes. If this is not successful in reducing blood sugar levels, then pharmacological treatments will be introduced in addition to continuing with lifestyle changes.

Metformin

When it comes to pharmacological treatments, the first line of treatment is oral hypoglycaemic medications such as metformin. Metformin belongs to the class of medications known as biguanides.

It is the most prescribed oral hypoglycaemic. Its action is to lower blood glucose. It does this in two ways:

1. Decreasing the amount of glucose released from the liver where it is stored.
2. Making the cells more sensitive to the effects of the insulin the body produces, which enables more glucose to be absorbed into the cells from the bloodstream.

Metformin acts in the presence of naturally occurring insulin, so it is only effective if the pancreas is still producing some insulin.

Gliclazide

Another oral hypoglycaemic medication is Gliclazide, which belongs to the class of medications known as sulfonylureas. They are currently considered third or fourth-line treatment options in the management of type 2 diabetes and are prescribed when symptoms persist despite the use of metformin with other blood-glucose-lowering therapy and attempts at dietary modification.

Sulfonylureas, like biguanides, act mainly by increasing insulin production and are, therefore, only effective when the pancreas is able to produce some insulin still. Over time, they can also increase insulin sensitivity.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors

Another class of oral hypoglycaemic that you may come across in the pharmacy are sodium-glucose co-transporter 2 (SGLT2) inhibitors.

These medications work by inhibiting the reabsorption of glucose in the kidneys, leading to increased urinary excretion of glucose and, consequently, lowering blood glucose levels.

An example of this class of medication is empagliflozin. It may be used on its own or in combination with other blood glucose-lowering treatments.

There are other classes of oral hypoglycaemics that you may wish to discuss with your pharmacy colleagues.

Hypoglycaemic attacks

Consider this - how might an oral hypoglycaemic medication cause a hypoglycaemic attack?

Challenge yourself to take a minute to reflect on your learnings before expanding the answer.

How did you go? If your answer was incorrect, ask yourself if you understand the correct answer. If it’s not sinking in yet, no fear! Take a break to refresh your brain, and then test yourself to answer the question again.

Treatments for type 2 diabetes: Insulin

Patients with type 1 diabetes always need insulin therapy since their pancreas doesn't produce insulin due to an autoimmune reaction that destroys insulin-producing beta cells.

In certain instances, patients with type 2 diabetes may also need insulin therapy as their condition advances or if their pancreas's insulin production decreases over time.

The route of administration for insulin is subcutaneous, which means that insulin is injected into the fatty tissue just beneath the skin.

Insulin cannot be given in an oral form as it degrades in the stomach, making it ineffective.

Injection sites

The most common injection sites include the abdomen, thigh, and upper arm. The choice of injection site can depend on individual preferences, the specific insulin regimen, and recommendations from healthcare providers. It's important for individuals with diabetes to rotate injection sites to avoid developing lumps or changes in the fatty tissue under the skin.

Injection methods

Subcutaneous insulin injections can be delivered using various methods, providing flexibility and options for individuals managing diabetes.

Complete the next activity to view three of the most common methods.

Watch: What is an insulin pump? (2:30 minutes)

This video demonstrates how an insulin pump is attached and operates. As you watch, consider the benefits of this injection method and who it might be suitable for.

Types of insulin

There are different types of insulin, each with a different onset, peak and duration of action.

Click on the (+) symbol for a reminder of these terms.

Let's look at five different categories of insulin. They are:

1. Rapid-acting insulin
2. Short-acting insulin
3. Immediate-acting insulin
4. Long-acting insulin
5. Pre-mixed insulin

Hoake tatou, let’s go!

Rapid-acting insulin

This type of insulin is often used to manage mealtime spikes in blood sugar levels.

Onset: Rapid-acting insulin starts working quickly, typically within 15 minutes after injection.
Peak: Its peak effectiveness occurs about 1 to 2 hours after injection.
Duration: Its effects last for about 3 to 4 hours.
Dosing: The frequency of dosing may be multiple times per day, depending on the number of meals and snacks eaten.

Examples

Product		Drug	Onset, peak, duration	Presentation	Appearance
NovoRapid		Insulin Aspart	Onset: 10 - 20 minutes Peak: 1 - 3 hours Duration: 3 - 5 hours Suitable: IV, SC infusion via pump, or injection.	3ml penfill 10 ml vial	Clear
Apidra		Insulin Glulisine	Onset: 15 minutes Peak: 60 minutes Duration: 2 - 4 hours Not suitable: IV Suitable: SC pump, or injection.	3ml penfill 10 ml vial	Clear
Apidra Solostar				Prefilled disposable pen	Clear
Humalog		Insuline Lispro	Onset: 15 minutes Peak: 30 - 70 minutes Duration: 2 - 5 hours Suitable: IV, infusion pump, or injection.	3ml penfill 10 ml vial	Clear

Short-acting insulin

Short-acting insulin is commonly used to cover blood sugar increases related to meals.

Onset: Short-acting insulin begins to work within 30 minutes after injection.
Peak: The peak effect occurs 2 to 3 hours later.
Duration: Its duration of action is around 3 to 6 hours.
Dosing: The frequency of dosing may be multiple times per day, often before main meals.

Examples

Product		Drug	Onset, peak, duration	Presentation	Appearance
Actripid		Insulin Neutral (soluble)	Onset: ≤ ½ hour Peak: 1 - 3 hours Duration: 8 hours Suitable: IV, IMI, SC injection	3ml penfill 10 ml vial	Clear
Humulin R		Insulin Neutral (soluble)	Onset: 30 - 60 minutes Peak: 2 – 4 hours Duration: 8 - 12 hours Suitable: IV, SC injection	3ml penfill 10 ml vial	Clear

Intermediate-acting insulin

This type of insulin is often used to provide a basal (background) level of insulin over a more extended period.

Onset: Intermediate-acting insulin has a slower onset, usually starting within 2 to 4 hours after injection.
Peak: Occurs around 4 to 12 hours after injection.
Duration: It can last up to 18 hours or more.
Dosing: The frequency of dosing is typically once or twice a day, depending on the specific insulin regimen.

Examples

Product		Drug	Onset, peak, duration	Presentation	Appearance
Humulin NPH		Insulin Isophane	Onset: 1-2 hours Peak: 4-12 hours Duration: 15-24 hours Not suitable: IV, IM infusion pump	3ml penfill 10 ml vial	Cloudy suspension
Protophane		Insulin Isophane	Onset: ≤ 1.5 hours Peak: 4 – 12 hours Duration: ≤ 24 hours Not suitable: IV, IM infusion pump	3ml penfill 10 ml vial	Cloudy suspension

Long-acting insulin

Long-acting insulin is used to maintain a consistent background level of insulin throughout the day and night.

Onset and duration: Slow and steady release, providing a basal level of insulin over an extended period, often up to 24 hours.
Peak: It typically doesn't have a pronounced peak.
Dosing: The frequency of dosing is usually once a day, although some individuals may require twice-daily dosing.

Examples

Product		Drug	Onset, peak, duration	Presentation	Appearance
Lantas		Insulin Glargine	Onset: 1.1 hours Peak: None Duration: 24 hours Suitable: SC injection only Not suitable: IV, IM infusion pump	3ml penfill 10 ml vial	Clear
Lantus Solostar				SoloStar prefilled disposable pen	Clear
Levemir		Insulin Detemir (rys)	Onset: ≤ 1.5 hours Peak: 4 – 12 hours Duration: ≤ 24 hours Not suitable: IV, IM infusion pump	prefilled disposable device	Clear

Pre-mixed insulin

Pre-mixed insulin contains a combination of short-acting or rapid-acting insulin with intermediate-acting insulin.

This type of insulin is convenient for some individuals, as it provides both mealtime coverage and a basal insulin component in one injection. Pre-mixed insulin is available in different ratios to accommodate individual insulin needs.

Dosing: The frequency of dosing can vary but is often once to three times per day, depending on the specific product and the individual's meal and insulin needs.

Examples:

• NovoMix 30 FlexPen
• PenMix 30, PenMix 40, PenMix 50
• Humulin 30/70
• Mixtard 30
• Humalog Mix 25, Humalog Mix 50

Test your knowledge

There was a bit to absorb there! Complete this four-question quiz to check (and aid) your retention.

Supporting patients

Pharmacy technicians play a crucial role in diabetes management by assisting patients in various aspects of their medication and overall care. They contribute to diabetes management in many ways, including accurate and timely dispensing of diabetes medications, including insulin and oral medications.

They also provide education and information to patients on proper medication usage, storage, potential side effects, adherence to prescribed treatment plans and support better understanding and self-management.

This completes our exploration of the endocrine system. You have now completed your Anatomy and Physiology learning for another week. Good work, he pukumahi koe, you are a hard worker for getting through!