GIN Exam 1

Lansoprazole brand

Prevacid

Lansoprazole class

PPI

Lansoprazole MOA

Inhibits gastric parietal cell hydrogen-potassium ATPase

Lansoprazole side effects

Headache, diarrhea, abdominal pain, nausea, flatulence, long term use can lead to osteoporosis

Lansoprazole dose

15-20 mg PO qD

Lansoprazole contraindications

Dexlansoprazole brand

Dexilant

Dexlansoprazole class

PPI

Dexlansoprazole MOA

Inhibits gastric parietal cell hydrogen-potassium ATPase

Dexlansoprazole side effects

Headache, diarrhea, abdominal pain, nausea, flatulence, increased risk of osteoporosis

Dexlansoprazole dose

Initial: 60 mg PO qD, maintenance: 30 mg PO qD

Dexlansoprazole contraindications

Pantoprazole brand

Protonix

Pantoprazole class

PPI

Pantoprazole MOA

Inhibits gastric parietal cell hydrogen-potassium ATPase

Pantoprazole side effects

Diarrhea, headache, abdominal pain, nausea, flatulence, dizziness, vertigo, myalgia, long term use causes bone loss

Pantoprazole dose

20 mg PO/IV qD

Omeprazole brand

Prilosec

Omeprazole class

PPI

Omeprazole MOA

Inhibits gastric parietal cell hydrogen-potassium ATPase

Omeprazole side effects

Diarrhea, headache, abdominal pain, nausea, flatulence, dizziness, rash, upper respiratory infection, long term use causes bone loss

Omeprazole dose

20 mg PO qD

Esomeprazole brand

Nexium

Esomeprazole class

PPI

Esomeprazole MOA

Inhibits gastric parietal cell hydrogen-potassium ATPase

Esomeprazole side effects

Diarrhea, headache, abdominal pain, nausea, vomiting, flatulence, dizziness, long term use causes bone loss

Esomeprazole dose

20-40 mg PO qD

Famotidine brand

Pepcid

Famotidine class

H2 antagonist

Famotidine MOA

Antagonizes H2 histamine receptors

Famotidine side effects

Dizziness, headache, taste changes, constipation, diarrhea

Famotidine dose

20-40 mg PO qD

Ibuprofen brand

Advil, Motrin

Ibuprofen class

NSAID

Ibuprofen MOA

Inhibits COX, reducing prostaglandin and thromboxane synthesis

Ibuprofen side effects

Dyspepsia, nausea, abdominal pain, constipation, headache, drowsiness, photosensitivity

Ibuprofen dose

300-800 mg TID or QID

Ibuprofen contraindications

ASA/NSAID induced asthma, 2nd/3rd trimester of pregnancy, CABG surgery

Ibuprofen BBW

May increase risk of CV thrombotic events, may increase risk of fatal GI events such as GI bleed, ulceration, proliferation

Meloxicam brand

Mobic

Meloxicam class

NSAID

Meloxicam MOA

Inhibits COX, reducing prostaglandin and thromboxane synthesis

Meloxicam side effects

Dyspepsia, nausea, abdominal pain, dizziness, headache, rash, contipation, edema, GI bleed

Meloxicam dose

7.5-15 mg PO qD

Meloxicam contraindications

ASA/NSAID allergy, 2nd/3rd trimester of pregnancy

Meloxicam BBW

May increase risk of CV thrombotic events, may increase risk of fatal GI events such as GI bleed, ulceration, and proliferation

Naproxen brand

Naprosyn, Naprelan

Naproxen class

NSAID

Naproxen MOA

Inhibits COX, reducing prostaglandin and thromboxane synthesis

Naproxen side effects

Dyspepsia, nausea, abdominal pain, constipation, drowsiness, photosensitivity, GI bleed

Naproxen dose

IR/DR: 250-500 mg PO q12h, ER: 750-1000 mg PO qD

Naproxen contraindications

ASA/NSAID induced asthma, 2nd/3rd trimester of pregnancy, CABG surgery

Naproxen BBW

May increase risk of CV thrombotic events, may increase risk of fatal GI events such as GI bleeds, ulceration, and proliferation

Celecoxib brand

Celebrex

Celecoxib class

NSAID

Celecoxib MOA

Selectively inhibits COX-2, reducing prostaglandin synthesis

Celecoxib side effects

Headache, diarrhea, nausea, vomiting, peripheral edema, photosensitivity, GI bleed

Celecoxib dose

100-200 mg PO qD or BID

Celecoxib contraindications

Hypersensitivity to sulfonamides, 2nd/3rd trimester of pregnancy

Celecoxib BBW

May increase risk of CV thrombotic events, may increase risk of fatal GI events such as GI bleed, ulceration, proliferation

Diclofenac brand

Voltaren, Cambia, Catafiam

Diclofenac class

NSAID

Diclofenac MOA

Inhibits COX, reducing prostaglandin and thromboxane synthesis

Diclofenac side effects

Dyspepsia, vomiting, headache, dizziness, rash, drowsiness, fluid retention, GI bleed

Diclofenac dose

DR: 50 mg PO BID or TID, ER: 100 mg PO qD

Diclofenac contraindications

ASA/NSAID allergy, 2nd/3rd trimester of pregnancy

Diclofenac BBW

May increase risk of CV thrombotic events, may increase risk of fatal GI events such as GI bleed, ulceration, and proliferation

Ketorolac brand

Toradol, Sprix

Ketorolac class

NSAID

Ketorolac MOA

Inhibits COX, reducing prostaglandin and thromboxane synthesis

Ketorolac side effects

GI bleed, perforation, ulcer, dyspepsia, nausea, abdominal pain, constipation, headache, drowsiness, photosensitivity

Ketorolac dose

10 mg PO q4-6h PRN

Ketorolac contraindications

Major surgery post-op, ASA/NSAID induced asthma, epidural or intrathecal use, CABG surgery

Ketorolac BBW

May increase risk of CV thrombotic events, may increase risk of fatal GI events such as GI bleed, ulceration, and proliferation; oral: up to 5 days treatment and only after parenteral use

True or false. Optimal nutrition is only relevant in critically ill patients

False. Relevant in all environments including inpatient and outpatient as nutrition can be treatment for conditions

True or false. We can tell a patient’s nutritional status exclusively from appearance

False

How should we incorporate nutritional screening into patient care?

Routine patient screening with quick, simple, noninvasive way to identify risk factors in the general population

What are some risk factors for abnormal nutrition?

Recent and unintended weight loss, medications, medical conditions, diet and exercise history

How will we take a more thorough and detailed nutritional assessment compared to a screening?

Nutrition focused history, physical exam, anthropometric measurements, lab assessment

What do we look for with a nutrition focused history?

Nutrition intake, dietary habits, underlying pathology with nutritional impact, end-organ effects (weight changes), GI surgical history, medications, family history, alcohol or drug use, pregnancy status

How can medications impact nutritional status?

Either directly or indirectly, indirect being side effects such as N/V

What do we examine with a nutrition focused physical exam?

Vital signs, hair, skin, nails, eyes, nose, mouth, neck, abdomen, musculoskeletal system

What are some examples of anthropometric measurements?

Weight, height, waist circumference, head circumference, wrist circumference

What lab assessments do we do to examine nutritional status?

Visceral proteins, nitrogen balance study, immune function test

What are the visceral proteins?

Albumin, prealbumin, transferrin

What does nitrogen balance study analyze and when do we utilize it?

Examines protein intake compared to protein use, generally only used with long term TPN use to ensure nutritional needs are being met

What are some immune function tests we perform to analyze nutritional status?

Total lymphocyte count, delayed cutaneous hypersensitivity

Define malnutrition

Consequence of nutrient imbalance either undernutrition or overnutrition

What are the 3 categories of malnutrition?

Starvation-associated malnutrition, chronic disease related malnutrition, acute disease/injury related malnutrition

What are some examples of deficiencies a person can have?

Protein, energy, single nutrient

What are risk factors for malnutrition?

Unintended weight loss, chronic/acute illness, socioeconomic factors, substance use, medications, absorption issues

What are some medications that can contribute to malnutrition?

Stimulants, chemo, antacids, sulfasalazine, metformin

How do stimulants cause malnutrition?

Weight loss is secondary to decreased appetite

How does chemo cause malnutrition?

Weight loss secondary to N/V/diarrhea, also possible nutritional deficiencies

How do antacids cause malnutrition?

Thiamine deficiency

How does sulfasalazine cause malnutrition?

Folate deficiency

How does metformin cause malnutrition?

Vitamin B12 and folate deficiency

What is starvation associated malnutrition?

Malnutrition resulting from prolonged inadequate intake, absorption, or utilization of protein and energy

What are some causes of starvation associated malnutrition?

Inadequate food supply, anorexia, depression, malabsorptive syndromes

What is the general class of disease that chronic disease related malnutrition is related to?

Inflammatory