self care exam 1

What is self care and what does it involve?

it is the diagnosis, treatment and prevention of one’s own illness

it involves full spectrum of care: prevention, wellness stratgeties, diagnosis, screening, measures for treatment and relief

PPCP with self care

Collect, Asses, Plan, Implement, Follow up

QuEST

Quickly assess

Establish self care appropriatness

Suggest care

Talk to patient

SCHOLAR-MAC

Symptoms

Characteristics

History

Onset

Location

Aggravating Factors

Remitting Factors

Medications

Allergies

Conditions

Exclusion for self treatment

is symptom is beyond scope, health status, history, nonprescription is not indicated, previous failure with nonprescription drugs

Refer patients when

too severe symptoms, minor but persistant and not identifiable, repeatedly returned, pharmacist is in doubt about the condition

Type 1 Diabetes Risk factors

genetic, autoimmune, white race, environmental factors

Type 2 Diabetes risk factors

non modifiable: age>35, race(other than white), fam hx, hx of gestational diabetes, PCOS

modifiable: obese(>25kg/m2), no activity, HTN(>130/80), dyslipidemia, prediabetes, smoking, MASLD

What are the complications with diabetes

Heart disese, neuropathy, retinopathy, CKD, stroke

emerging: cancer, liver disease, infections, cognitive/functioning ability

Preventative measures for diabetes complications

routine exams, glucose monitoring, skin/dental/eye care, BP management

Treatment goals for adults with diabetes? A1c, BP, Lipids, smoking

ADA:

<7% for most adults

preprandial: 80-130mg/dL

2-hr postprandial: <180mg/dL

AACE

<6.5%

<110mg/dL prepran

<140 post pran

BP:<130/80

Lipids: treatment and stating dose based on risk stat

smoking cessation

Ketone testing indications

indicated for poor glycemic control in patients who are prone to elevated ketone levels

• acute illnes, BG>240mg/dL, symptoms of DKA(fruity breath, klussmaul breathing, thirst)

ketone testing methods

urine

• inexpensive, eh accuracy, positive test: if test trip changes after dip

blood

• expensive, accurate, postive test >0.6mmol/L

CGMs perals

monitors glucose levels 1-5 min

helps reduce hypoglycemic events, lowers A1c, quick detection, and help see trends in glucose levels and habits

T1DM dosing and insulin

need both bolos and basal

0.3-0.5units/kg

50% bolus, and 50% basal

1 unit covers 10-15 grams of carb

T2DM dosing and insulin

start with basal first, then add others

0.5-1.2units/kg

1 unit = 0.1mL

Insulin Injection Devices advantages

Ease of use, dexterity, convenience, easy/accurate dosing, privacy

Insulin Injection Devices disadvantages

units per pen/vial, varying exp. dates, limited units per admin, cost

Which injection site has good absorption?

lower abdomen

pick one and dont switch

Factors influencing insulin absorption?

location: Abdomen > arm > thigh > buttock

depth: IV > IM > SQ

IV is avoided tho

increase: Exercise, Massaging the injection site

decrease: Cold skin temperature, Smoking

Hypoglycemia symptoms + treatment

sweating, trembling, Tachycardia/Palpitations, Confusion/Tiredness

Treatment: Rule of 15

give 15g of carbs, if its still less than <60 after 15 min, give 15g more carbs

equivalent: 3 tsp on sugar, 4 ounces of juice, 5-6lifesavers or 8 ounces of milk

Indications for aspirin for diabetes

if hx of ASCD

or if none

70<x>50—> ASCVD risk factor(HTN, DysLd, smoking, CKD,fam hx)

Where do infants get their macronutrients from?

Carbs: mainly lactose

Protein: whey and caseinate salts

Fat: Linolenic acid (omega-3 fatty acid), Linoleic acid (omega-6 fatty acid)

Breastfeeding recommendations

untl 4-12 months of age, atleasy 6 months when possible

if stopped before 12 months, make sure to give iron fortified milk and NOT cows milk

Breastfeeding Warnings and Contraindications

CIs:

• Lactation suppressors: bromocriptine

• Chemotherapy: cyclophosphamide, doxorubicin, methotrexate

• Immunosuppressives: leflunomide, cyclosporine

• Ergotamine, lithium, phenindione, and generally drugs of abuse

Not recommended if uncontrolled HIV or infants with galactosemia

Infant formula indications

Substitute—> when cant breastfeed or CI to it

Supplment—> Infants who inadequately gain weight

Polymeric vs Monomeric Formulas

Polymeric→ standard, protein remains intact, need fully functioning GI tract to digest

Monomeric→ for abnormal GI tracts, Proteins are partially or fully hydrolyzed

Gerber Good Start® Indication + components

Infants with intolerance (not allergy) to milk- based formulas

Lactose + Partially hydrolyzed whey, vegetable oils

Similac® Total Comfort/ Sensitive Indication + components

Both: Infants with lactose malabsorption or intolerance

Sensitive: + fussiness and gas

Both components: Milk protein isolate (whey + casein), vegetable oil

Comfort: Corn syrup solids

Sensitive Corn syrup solids + Lactose free but contains sucrose and corn maltodextrin

Enfamil® Gentlease Indication + components

Infants with fussiness and gas

Partially hydrolyzed whey, lactose, vegetable oil

Goat milk indication + components + supplements

Intolerance to cow’s milk

Lactose, Whey +/- casein, Medium and short chain fatty acids

Requires iron, vitamin D and folic acid supplementation

Soy-Based Formulas Indications + CIs

Lactose deficiency or intolerance

Galactosemia

Cow's milk protein allergy

Vegetarians

preterm babies, CF babies, Prevention of colic or allergy or if developed protein induced enterocolitis

Sucrase-Isomaltase Deficiency recommendation

Similac® Soy Isomil OR Enfamil® ProSobee

bc sucrose free

Who should receive premature formula + what is different in it?

Preterm infants (born <36 weeks gestational age) weighing less than 2-3 kg

less lactose, more protein, vitamins(A,D,E), other stuff

Casein Hydrolysate Based Formula indication

Infants sensitive to intact milk proteins

Casein Hydrolysate Base Formula Pregestimil® and Alimentum® indication

Malabsorption

• Short-bowel syndrome

• CF

• Bilary atresia

• Fat malabsorption

• Chronic diarrhea

• Food allergies

Iron-fortified

Casein Hydrolysate Base Formula

Portagen® Indication

Infants unable to absorb/digest fat

• Fat malabsorption

• Intestinal lymphatic anomalies

• Chronic liver disease

Casein Hydrolysate Base Formula

Nutramigen® indication

Only indicated for infants with food allergies

Amino Acid Based Formulas Indications

Extreme milk protein allergy

Extreme soy allergy

Extreme food allergies

Modular Nutrient Components Products: Carbs, Protein, Fat, Carb + Fat, Protein + Fat, DHA/ARA

Carbs: Polycal®

Protein: Beneprotein®, Complete and Essential Amino Acid Mix, Liquid Protein Fortifier, Procel®

Fat: Liquigen®, MCT Oil, Microlipid®

Carb + Fat: Duocal®

Protein + Fat: Benecalorie®

DHA/ARA: Enfamil® DHA & ARA Supplement

Ashwaganda indication + DDIs

reduces anxiety, stress and may improve insomnia (possibly effective)

DDIs: Antidiabetes drugs, Thyroid Hormones

Level of Evidence for Drug Drug Interactions (A,B,C,D)

A: high quality data for the DDI

B: study but its not that great for DDI

C: consensus and expert opinion DDI

D: anecdotal, in vitro, Theoretical based evidence

Vitamin D indication + DDIs

builds up bone and supports muscle, Osteoporosis, Deficiencies

DDIs: Atorvastatin, Diltiazem, Verapamil

St John’s wort indication + DDIs

Mild to Moderate Depression Symptoms, Menopause symptoms

DDIs: (B level)Contraceptives, Omeprazole, Warfarin, Imatinib(A)

Prebiotics moa, benefits, clinical applications

“Food for your Good Bacteria”

Non-digestible fibers that act as food to foster a favorable environment for beneficial bacteria to grow

Benefits: decreases constipation, reduce triglycerides, better absorption of calcium and magnesium

good for ppl on low fiber diets and to support metabolic/ immune health

Probiotics moa, benefits, clinical applications

“Good Bacteria for your Gut”

Live, beneficial bacteria that can improve gut health

Reduce colonization caused by pathogenic organisms

Benefits: induce production of cytokines, enhance antiviral activity, Inhibit pathogens

Indications: IBD, Eczema, DM, IBS, infection

Protein supplements products and how its different

Whey concentrate: higher levels of fat, lactose and carbs; cheapest

Whey isolate: leanest powder >90, amino acid profile, lactose and fat free

Whey hydrosalate: predigested 80-90% protein content

Caffeine info + safety concerns + counseling

CNS stimulant (preggo should avoid)

100% F

basically restlessness, heart stuff

400mg or less is safe

Insomnia clinical presentation

difficulty sleeping, unusual or troublesome dreams, > 30 mins to fall asleep, < 7 hours of sleep per night

chronic: >3months with >3 times per week

Moisturizer vs Hydrocortisone

Moisturizer are maintenance/barrier therapy, hydrocortisone treats inflammation and flare of AD

Common Moisturizer Ingredients

Humectants: draw water into the strateum corneum

Emollients: Fills spaces between skin cells and soften skin

Occulsives: reduce transepidermal water loss

How is a shampoo used?

Massage into scalp and leave on for 3-5 min; use daily for 1 week and then 2-3x weekly for a couple weeks, followed by once weekly

Dandruff treatment

non medicated shampoo—> cytostatic agents(zinc, sulfide)→ ketoconzole, coal-tar shampoo

Contact dermatitis vs allergic + treatment

contact: caused by an irritating substance (hx of repeated exposure)

treat with removing irritant, the soothe and repair the skin barrier

allergic: caused by skin reaction to an antigen

remove allergen, hydrocortisone, calamine lotion

Diaper Dermitis treatment

Zinc oxide active ingredient

Pharmacological Treatments of Urushiol

topical steroids for the inflammation

oral antihistamines for helping sleep at night

how to apply skin protectants

apply a thick layer and dont rub it all in