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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