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27 NSAIDs
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27 NSAIDs
Author: Mark Parkinson RPh: President AFC CE
Credit Hours 1 - Approximate time required: 60 min.
Educational Goal:
To provide Adult Foster Care providers with information that will help them understand and utilize the Non-steroidal Anti-inflammatory Drug class of medication.
Educational Objectives:
Procedure:
Disclaimer
The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.
27 NSAIDs
Did you know that there were 27 different drugs in the NSAID class of medications? That doesn’t include combination drugs, so the number of NSAID-containing meds is actually much higher. NSAID stands for Non-Steroidal Anti-Inflammatory Drug. They are among the most commonly used drugs for pain killing in the world today (aspirin is included in this group). They can be used to kill pain, reduce fever, and reduce swelling due to inflammation. Many find NSAIDs have advantages other painkillers do not. NSAIDs are not addicting like narcotics, and they reduce inflammation (acetaminophen and opiates do not), which helps in the healing process.
List of NSAIDs
Aspirin (Anacin, Ascriptin, Bayer, Bufferin, Ecotrin, Excedrin)
Choline and magnesium salicylates (CMT, Tricosal, Trilisate)
Choline salicylate (Arthropan)
Celecoxib (Celebrex)
Diclofenac potassium (Cataflam)
Diclofenac sodium (Voltaren, Voltaren XR)
Diclofenac sodium with misoprostol (Arthrotec)
Diflunisal (Dolobid)
Etodolac (Lodine, Lodine XL)
Fenoprofen calcium (Nalfon)
Flurbiprofen (Ansaid)
Ibuprofen (Advil, Motrin, Motrin IB, Nuprin)
Indomethacin (Indocin, Indocin SR)
Ketoprofen (Actron, Orudis, Orudis KT, Oruvail)
Magnesium salicylate (Arthritab, Bayer Select, Doan's Pills, Magan, Mobidin, Mobogesic)
Meclofenamate sodium (Meclomen)
Mefenamic acid (Ponstel)
Meloxicam (Mobic)
Nabumetone (Relafen)
Naproxen (Naprosyn, Naprelan*)
Naproxen sodium (Aleve, Anaprox)
Oxaprozin (Daypro)
Piroxicam (Feldene)
Salsalate (Amigesic, Anaflex 750, Disalcid, Marthritic, Mono-Gesic, Salflex, Salsitab)
Sodium salicylate (various generics)
Sulindac (Clinoril)
Tolmetin sodium (Tolectin)
NSAID use accounts for a major portion of both prescription and over-the counter pain-relieving efforts in modern medicine. But lately there has been some bad press about the harmful effects of NSAIDs. In fact, the FDA recently issued new consumer alerts and required manufacturers to increase their warning labels on all NSAID products sold in the United States. So what’s the deal? Are they safe or unsafe to use? This CE course will answer some of those questions.
How NSAIDs Work
To truly understand NSAIDs, you must first start with what pain is. Pain is a very complex subject. For a greater understanding, see my other CEs. At its simplest, pain is the brain’s warning system that damage is being done to the body. When the cells in the body are harmed or ruptured, certain chemicals are released into the surrounding area. They in turn trigger other cells that release additional triggering chemicals that start a cascade of protecting reaction from the body. Nerve signals are sent to the brain; swelling starts to wall off of the damaged area, and fever sometimes start to occur as an additional warning signal and as a protection to kill off certain heat-sensitive opportunistic infections. This is an over-simplification of a complex reaction that is still not fully understood. The important thing to remember is this is a chemical cascade reaction, like a domino chain that branches out to trigger specific responses from the body.
Narcotics and acetaminophen block the reaction farther down the domino chain closer to the brain. NSAIDs block the domino chain closer to its start by inhibiting an enzyme called the cyclooxygenase or Cox for short. That’s how NSAIDs reduce inflammation while other painkillers do not. So far we have identified two types of Cox enzymes, Cox1 and Cox2. They are responsible for converting arachadonic acid into prostaglandins. Prostaglandins, in turn, branch out to warning signals, protective mechanisms, and restorative healing processes pathways.
Some of you might be thinking “Whoa up there, partner, you’re getting’ a bit deep for me!” You’re probably right. I did get a little pharmacologically carried away there. So let’s ratchet it back a bit and just say NSAIDs stop prostaglandin from being produced, which in turn leads to the desired effects and some undesired side effects.
Side Effects
There are multiple kinds of prostaglandins used throughout the body for various purposes. If you reduce the production of prostaglandins, naturally you’ll affect all the processes they are involved with. As a result, NSAID use could lead to side effects. To be clear, not all NSAIDs’ side effects are tied to prostaglandins and not all are well understood. The most common side effects, though, are connected to the prostaglandins or the cox enzymes.
GI Tract Side Effects
The gastrointestinal (GI) tract dissolves the food we eat with a soup of powerful enzymes and acids. What keeps this combination from dissolving the GI tract lining is a mucus layer that insulates us from our digestive juices. As you can imagine, that mucous layer has to be constantly replaced. Unfortunately for NSAID users, prostaglandins play a major role in renewing of the protective mucous layer. If the protective process is disrupted long enough, ulcers appear, which lead to bleeding into the GI tract.
Several of the NSAIDs are week acids themselves, which only compounds the problem. Drug manufacturers have tried to reduce this problem by coating their product (enteric coated aspirin) or adding buffers that help balance the acidic effect (buffered aspirin). These help the acid problem, but the reduced prostaglandin problem still remains.
Fortunately for most NSAID users, significant GI problems never develop if directions are followed. Under normal conditions, prostaglandin production is continuously being turned on and off as the body needs them in a process called homeostasis. So the body can handle short-term or minor interruption in prostaglandin production. Where GI problems occur the most is with prolonged use or higher doses of NSAIDs. That is one reason that OTC NSAIDs warn never to exceed 10 days of therapy without consulting a doctor.
There is one NSAID that is different than all the rest. Celecoxib (Celebrex) primarily affects only the Cox2 enzyme. This enables Celebrex to avoid most of the serious GI tract problems that are rooted in the blockage of the Cox1 enzyme. Unfortunately blocking only the Cox2 enzyme leads to possible cardiovascular side effects.
Cardiovascular Side Effects
A less common but more serious side effect of NSAID use involves how prostaglandins are used by the body in the cardiovascular system. There are Cox1 enzymes located in blood cells called platelets. They are involved in the beginning of the blood clotting process. Cox2 enzymes are found in the lining of blood vessel walls and are involved in unsticking platelets (reduces clotting) and relaxing or dilating blood vessels, which drops blood pressure. If you start messing around with blood clotting or blood pressure, seriously bad things can happen. NSAID use could lead to heart attack, stroke, high blood pressure, kidney problems, liver problems, and anemia.
It is important to note that some of these side effects aren’t always a problem. Sometimes side effects can actually be used to help a patient. Low-dose aspirin prevents blood clotting and can be used to prevent strokes and heart attacks.
Allergy and Breathing Problems
In my pharmacy career, I have found that you can find someone who is allergic to just about anything. Those who are allergic to NSAIDs have an over-reactive protection response of inflammation when NSAID are taken. If they have serious swelling in their lungs, life- threatening breathing problems can occur. This reaction is of particular concern to asthma suffers or others who already have breathing problems. It turns out that approximately 10 to 20 percent of adults with asthma have sensitivity to aspirin or other NSAIDs. Those numbers lead many doctors to say that all asthma sufferers should not take NSAIDs because you can never tell when an allergy will start to develop.
Other Side Effects Concerns
Each drug has its own side effect profile, and it is up to the care provider to read the warning literature that comes with each bottle. Other side effects that could occur include:
You might be starting to freak out about now, saying, “I’ll never touch an NSAID again.” Time for a reality check. The vast major of NSAID users will never develop any serious health problems. You have taken an aspirin or ibuprofen yourself in the past and lived to tell the tale. Even the FDA still allows for NSAIDs to be sold to anyone OTC (over the counter). If you follow the directions and are aware of the warning signs, no major problems will likely occur.
But people don’t always follow instructions and read the warnings, not even health professionals. That has led the FDA to require prominently placed warnings on NSAID containers called black box warnings. They also require pharmacists to hand out an extra Medication Guide with all NSAID prescriptions. In essence, the FDA is saying that really serious problems can occur so pay attention when using NSAIDs.
Caregiver Issues
Paying Attention
Speaking of paying attention, that’s your job as a caregiver. Pay attention to the drug info provided with each drug. Pay attention to how the drug is supposed to act. Pay attention to the side effects that can occur. What it really boils down to is knowing what the normal condition is for your residents and taking note of any changes that occur when they take their medicine.
According to the FDA’s Medication Guide that is supposed to be handed out with each prescription, NSAID caregivers should watch for the following warning symptoms.
Stop your NSAID medicine and call your healthcare provider right away if you have any of the following symptoms.
Staying Alert
One of the major challenges of any medical practice today is how can any care provider keep an alert watch on the important details when they are repeated over and over and over again. It is a natural human tendency to ignore repetitive tasks that don’t change. It happens to doctors, pharmacists, nurses, and it will happen to you.
Here are a couple of facts about NSAID use that might help you keep alert to your patients’ safety.
Pregnancy and Breast Feeding
To be complete in this article about warnings, some NSAIDs can cross the placental barrier and enter into breast milk. Interfering with the Cox enzymes of a baby can cause serious issues. NSAID medicines should not be used by pregnant women late in their pregnancy, and mothers should consult with their doctor or pharmacist about NSAID use while breastfeeding, even OTC NSAIDs.
Herbals
Some herbal products contain NSAID or NSAID-like chemicals. Not all herbals are well studied, and we just don’t know all the details yet. The smart thing to do is if the herbal says it’s for pain relief- monitor it like an NSAID.
Conclusion
Modern medicine has found the pain-relieving, fever-reducing, and anti-inflammatory effects of NSAID are so useful that it has developed and marketed over 27 different kinds. Non-Steroidal Anti-Inflammatory medications are so common that caregivers will probably deal with them one way or another every single day of their foster care career. Even so, NSAID use is so common the FDA has warned that serious sometimes life-threatening events can occur. Caregivers should note that the more their residents use NSAIDs, the more likely these ill effects can occur. That makes continued vigilant monitoring all that more important to keep clients healthy and happy.
As always, good luck in your caregiving
Mark Parkinson RPh
References:
1. Nonsteroidal anti-inflammatory drug. Wikipedia the Free Encyclopedia. Sep. 25 2015 https://en.wikipedia.org/wiki/Nonsteroidal_anti-inflammatory_drug
2. NSAID (List of non-steroidal anti-inflammatories) http://cdn.dupagemedicalgroup.com/userfiles/file/patientForms/nsaid-list.pdf
3. R. Morgan Griffin, Pain Relief: How NSAIDs Work. Arthritis Health Center, WebMD http://www.webmd.com/arthritis/features/pain-relief-how-nsaids-work
4. Non-Steroidal Anti-Inflammatory Drugs (NSAID)-Oral MedicineNet http://www.medicinenet.com/nonsteroidal_anti-inflammatory_drugs_nsaid/article.htm `
5. FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. U.S. Food and Drug Administration Jul 9 2015
http://www.fda.gov/Drugs/DrugSafety/ucm451800.htm
6. Medication Guide for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) U.S. Food and Drug Administration. August 2007 www.fda.gov/downloads/Drugs/DrugSafety/ucm089162.pdf
7. NSAIDs and Cardiovascular Risk Explained, According to Studies from the Perelman School of Medicine. Penn Medicine, University of Pennsylvania Health System. May 2 2012 www.uphs.upenn.edu/news/News_Releases/2012/05/risk
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Obesity Therapy - A New Perspective
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Obesity Therapy - A New Perspective
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Obesity Therapy - A New Perspective
Author: Mark Parkinson RPh: President AFC-CE.com
Credit Hours 1.5 - Approximate time required: 90 min.
Educational Goal:
To give Adult Foster Care providers an update perspective on the management of obesity.
Educational Objectives:
Procedure:
1. Read the course materials. 2. Click on exam portal [Take Exam]. 3. If you have not done so yet fill in Register form (username must be the name you want on your CE certificate). 4. Log in 5. Take exam. 6. Click on [Show Results] when done and follow the instructions that appear. 7. A score of 70% or better is considered passing and a Certificate of Completion will be generated for your records.
Disclaimer
The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.
Obesity Therapy - A New Perspective
Throughout the history of mankind, there have been individuals so overweight that it seriously affects their health and wellbeing. Because weight gain in the general populace has always been a matter of choice, it is commonly believed that extremely overweight individuals must have chosen to be that way as well. All that changed in June 2013 when the American Medical Association recognized obesity as a disease state and recommended several medical therapies to treat it. As part of the health care team, adult foster care providers must now recognize obesity as a disease and learn their role in its treatment.
What Is Obesity?
How a word is defined has a tremendous effect on how it is used. Traditionally, obesity has been defined as an abnormal amount of body fat that is at least 20 percent more than an individual’s ideal body weight. That is an extremely basic definition and only defines what obesity looks like, not what it actually is. A more useful definition of obesity is: a multifactorial disease state that leads to an excessive accumulation of body fat that exceeds 20 percent or more the ideal body weight of a patient. This places emphasis on the causes, not the outcome
Causes of Obesity
Obesity is actually a very complex and not-fully-understood condition that leads to being harmfully overweight. At its most basic analysis, weight gain is derived from eating more calories than needed. The excess is converted to fats and stored in adipose cells for later use. If this process continues without the stored fats being used, then a disproportionately large amount of adipose tissue is created and obesity occurs. Why the process continues into the unhealthy state of obesity is not fully understood and is probably caused by many factors.
Contributing Factors That Lead to Obesity
Research is being conducted on the causes of obesity, and new discoveries contribute to our understanding of the disease. While not all causes have been discovered, it is clear is that each obesity sufferer has his or her own collection of contributing factors that lead to being extremely overweight. Some factors are under the patient’s control and some are not.
Voluntary Factors
Diet- There is a lot of controversy about which collection of foods leads to obesity. High-calorie and high-fat-content foods certainly are more easily converted into excess fat than others. But a diet is more than a collection of foods. Diets are formed under the influence of many factors. To truly understand a person’s diet, you must look at the whole person and what motivates them and not just the foods they select. For example, the selection of a deep fried food diet may be the result of cultural influences rather than personal choice based on taste preferences. In such cases, culture is a contributing factor that causes obesity.
Sedentary Lifestyle- An obesity-causing lifestyle is characterized by a lot of sitting and little physical exercise. It is a self-perpetuating contributing factor. The more obese the patient is, the more sedentary they become.
Societal Influences- A person’s motivations cannot be understood without looking at the society they live in. We live in a consumer society in which appetites and desires are boisterously catered to. It is so easy to be swept along the societal current of labor- saving convenience and instant gratification. Appetite control is certainly a lot harder today than in times past.
Food as Therapy- Food or the pleasure we get from food can become a maladaptive response to the stresses of life. We eat because we’re bored, or we eat to unwind from a stressful day. In such cases, the lack of coping skills is the cause of obesity more than the food itself.
Involuntary Factors
Genetics- The genes a person is born with play a significant role in fat accumulation. Genetics influences how appetite is regulated, controls the metabolic rate, sets the homeostasis mechanisms (keeping things the same even if it’s unhealthily heavy), and produces the control mechanisms of the body, including fat-controlling hormones.
Mental Health- Motivations, appetites, and even metabolic rates can be influenced by mental health issues. For example, depression leads to obesity in several ways.
Medication Side Effects- Drugs can have unintended effects on the body and its metabolism that can contribute to weight gain. Medications that can lead to weight gain include older antidepressants, antihistamines, beta blockers, antipsychotics, corticosteroids, certain diabetic drugs, anti-seizure and mood stabilizers.
Other Diseases- Diseases can alter the way our bodies operate, and some effects can lead to excessive weight gain. Hypothyroidism, polycystic ovarian disorder, Cushing’s disease, and uncontrolled diabetes are among the conditions that can contribute to obesity.
Getting a Clearer Picture of Obesity
It should be clear by now that obesity is much more complex than just choosing to eat more than you burn off. It usually is a collection of contributing factors, many of which are lifelong concerns. Just choosing to lose weight is too simplistic an approach and will ultimately fail to be sustainable in the long run. Those who think that the problem will go away once the weight is gone are doomed to disappointment and failure. The weight will come back because the underlying causes where never addressed. Obesity must be viewed as a disease state that has to be actively managed throughout a patient’s life.
Therapy
There is no cure for obesity, but it can be effectively managed. It will be a lifelong struggle but well worth the effort. When managed properly, the emphasis will change from how a person looks to how healthy a person is. Those who can effectively manage their weight will significantly reduce the incidence and severity of type 2 diabetes, heart disease, sleep apnea, arthritis, high blood pressure, gallstones, hernias, heartburn/GERD, skin disorders, and infections. In addition, mental health problems can be reduced with the removal of the negative self-image that obesity inspires. Ultimately it is more productive and sustainable to concentrate on how healthy a patient is not just how thin they are.
How Much Weight to Lose
Getting down to a patient’s ideal weight maybe the ultimate goal, but significant health benefits can be achieved with even a modest weight reduction. Weight loss research has determined that fat associated with vital organs is among the first fat stores to be reduced. So in weight reduction, any weight loss can be beneficial. Recent studies have shown that with a 5-10 percent drop in weight can result in a drop in blood pressure, lower levels of cholesterol, reduction of heart disease, and increased control of blood glucose.
Where to Start
Assessment of the attitudes, motivations, and understanding of all those involved is the first step in therapy. Any successful weight loss plan starts with forming the proper attitude for the patient and caregivers and disregarding false or misleading perceptions.
Properly educating the patient and caregiver is the next step. More effective weight loss efforts stem from a more complete understanding of what obesity really is. A better understanding can lead to more realistic expectations and more achievable goal setting. This resetting of understanding should also extend to the social network and family members of the patient.
In short, obesity management starts with asking questions and searching the answers for misconceptions. Then follow up by educating to change false perceptions. This process should continue throughout the course of therapy.
How Fast Should the Weight Come Off
Rapid weight loss goals are counterproductive. The emphasis of such efforts is on how the patient looks not how healthy they are becoming. They may be very encouraging to the patient but harder to achieve and maintain thus ultimately discouraging to the patient. The National Heart Lung and Blood Institute has recommended the following:
For Adults
•Try to lose 5 to 10 percent of your current weight over six months. This will lower your risk for coronary heart disease (CHD) and other conditions.
•The best way to lose weight is slowly. A weight loss of one to two pounds a week is doable, safe, and will help you keep off the weight. It also will give you the time to make new, healthy lifestyle changes.
•If you've lost 10 percent of your body weight, have kept it off for six months, and are still overweight or obese, you may want to consider further weight loss.
For Children and Teens
•If your child is overweight or at risk for overweight or obesity, the goal is to maintain his or her current weight and to focus on eating healthy and being physically active. This should be part of a family effort to make lifestyle changes.
•If your child is overweight or obese and has a health condition related to overweight or obesity, your doctor may refer you to a pediatric obesity treatment center. ”
Source -http://www.nhlbi.nih.gov/health/health-topics/topics/obe/treatment
How to Lose the Weight
There are thousands of ways to lose weight but most are ineffective at managing obesity. The hallmark of truly effective obesity management addresses the multifactorial causes of the disease.
Effective weight control involves combining multiple techniques and strategies, including dietary management, sustainable physical activity, behavior modification, medications, and even surgery.
Diet
Long-term dietary management is an essential part of obesity therapy. How and why foods are selected, what foods are consumed, and how much is eaten are all important elements of therapy. The long-term goal is to change food from a cause of obesity to a therapeutic tool for greater health. Diets that decrease caloric intake must be able to maintain nutritional values or healthy outcomes will be compromised.
Experts suggest that a negative 500- 1,000 calories difference between what is consumed and what is burned off through activity will help achieve the goal of one-two pounds of weight loss per week.
Physical Activity
Physical activity is an important part of obesity therapy and essential to achieving and maintaining good health. Increased exercise will at first increase weight reduction but taper off as therapy progresses. Despite this, many of the health benefits achieved by increased activity will not reduce over time. There will always be therapeutic benefits to increased activity even if no weight is lost. Increased activity is good for the heart, increases bone mass, maintains balance and coordination, and reduces stress. Increased physical activity can be achieved in everyday routines such as walking instead of riding, doing chores manually instead of using a machine, and gardening. Exercise routines are effective therapy but should be done with caution so they don’t cause harm.
A basic guideline for how much activity to achieve is 30-45 minutes of moderate exercise a day, three to five times a week. Long-term fat stores are most effectively reduced with more than 45 minutes of exercise.
Behavior Modification
Behavior modification is more than just making correct choices. It is rearranging mental thought patterns. Regardless of the cause, obesity sufferers have developed a set mental pattern that helps them cope with the condition. Many of these mental actions actually reinforce obesity-causing choices and thus become maladaptive. If the mental actions occur enough, they become automatic responses without much conscious thought. In certain mental actions involving pleasure, the brain can actually “rewire” its self to always try to get pleasure even if the result is harmful. This is one way to describe addiction: a maladaptive automatic response to pleasure that overrides the choices we make.
Fortunately the mind is changeable. We can consciously override automatic mental responses. If continued long enough, we can “rewire” the brain for the better, but it takes time for that to happen. It takes more than making a few right choices for a couple of months. It is a long-term process that must be maintained in order to rearrange our automatic responses. Changing a single thought is immediate; changing an automatic response (habits) may take years.
The process of behavioral modification can be supported and reinforced by caregivers. Maladaptive responses can be explained for what they really are. Good choices can be praised so that patients can have pleasurable reinforcing responses. Proper education can replace incorrect conceptions, and successful weight loss methodology can replace ineffective short-term thinking. Most importantly, caregivers can help change patients’ thoughts of trying to “cure” obesity by becoming thin to managing obesity to become healthy.
 |
Medications
There is no pill for the ill of obesity. Medications can only modify certain contributing factors that lead to being overweight. They can only be used to support overall weight loss efforts.
Medications approved for weight loss:
|
Name |
Action |
|
sibutramine (Meridia) |
Helps increased satiation (i.e., fullness) No longer marketed in the US because of the possibility of dangerous side effects |
|
orlistat (Xenical)—(Alli) |
Blocks the absorption of about one-third of the fat contained in a meal. |
|
lorcaserin (Belviq) |
Promotes satiation |
|
Liraglutide (Saxenda) |
Involved in appetite regulation |
|
phentermine and extended-release topiramate (Qsymia). |
Suppresses hunger and controls appetite |
|
phentermine (Fastin) |
Suppresses hunger |
Medications not approved for but can contribute to weight loss:
|
Drug Class |
Action |
|
Thyroid replacements |
Increases the metabolic rate of the body |
|
Diabetes Medications |
Corrects improper glucose and fat metabolisms caused by diabetes that contribute to weight gain |
|
Anti-depressants |
Controls the overeating and sedentary lifestyle caused by depression |
|
Anti-seizure |
Weight loss side effect |
Herbals and OTC Remedies
There are numerous products claiming to have weight loss properties, but few have been scientifically verified. They may have some use as a support therapy as prescribed by a doctor. For example, caffeine increases the metabolism in the short term.
Surgery
Bariatric surgery is a type of surgical procedure that alters the upper digestive tract. It differs from liposuction surgery, which removes fat through suction (not commonly used as weight loss therapy) in that it alters the way food is digested.
Weight loss is achieved by severely restricting how much food can be taken in and or rerouting ingested food so that a portion of it is not digested and taken into the blood stream.
Two common examples of bariatric surgery are:
1. Gastroplasty- A constricting band is placed around the stomach or staples are inserted to create a small pouch at the top of the stomach. This severely restricts the amount of food that can be taken in at any one time.
2. Gastric Bypass- A small pouch is created at the top of the stomach by stapling off the rest of the stomach. The pouch is then connected to the far end of the small intestine thus bypassing the areas where most of the food calories are absorbed.
Bariatric surgery is very successful at rapid weight loss and retaining reduced weight over the long run. It is not a cure for obesity, though, and comes with many restricting aspects. It requires a surgical specialist, is expensive, requires lifelong follow ups with the doctor, alters the way a persons can interact with others through food (example holiday dinners and other social events), and comes with many serious surgical and post-surgical risks. It is usually reserved for the extremely obese (100 pounds over ideal weight) who have attempted and failed at other therapies.
Caregiver Factors in Obesity Management
Obesity is a serious impediment to the health and contentment of the residents under your care. Diet and lifestyle choices have a major influence on the disease and are a major focus of therapy. There is no other member of the health care team that has greater day-to- day influence on these factors than adult foster care providers. With the right perspective about obesity as a disease, practicing good everyday caregiving techniques and maintaining contact with the rest of the care team, obesity can be successfully managed.
Proper Perspectives
Caregivers must remember that:
Important Weight Loss Topics
Homeostasis- The body is built to remain the same. There are powerful metabolic mechanisms that work hard to keep the body within a range of behaviors that it normally operates under. When the resident loses weight, the body will fight to retain the weight. Some of these metabolic mechanisms are long-term processes that are designed to regain weight once it’s lost. Studies have shown that obese patients commonly regain weight that is lost.
Caregivers can help fight these trends by adopting a lifelong attitude of disease management, focusing on health outcomes and continuing efforts even if some weight is regained.
Maladaptive Behaviors- Each obese patient has developed behaviors that enable them to cope with the stress of being overweight. Many are maladaptive responses that only perpetuate the condition. In addition, it is a normal human trait to resist change. Short-term choices to change activities can easily be overridden by long-term habits and entrenched attitudes.
Caregivers can help by educating the patient to replace misconceptions with accurate facts. Help the resident find new ways of coping that do not involve eating more food. Ensure doctor’s orders are followed even when the resident resists. Support the development of new habits and generously apply large amounts of patience.
Childhood Obesity- The goal of obesity management changes in adolescents and children from weight loss to reduced rate of weight gain. In essence, you’re attempting to help the child to grow out of being overweight.
Caregivers can use the same overall weight loss therapies used in adult therapies.
At the present, orlistat is the only medication approved for weight loss in adolescents.
Helpful Caregiver Tips
Weight Loss Terminology
Conclusion
Weight loss in extremely overweight individuals has change dramatically with the realization that obesity is a multifactorial disease state and not just a consequence of a lifestyle choice. With this realization the goals of therapy have changed from a onetime event of dieting to become thin to a more comprehensive long-term management of contributing factors that have led to obesity. Being healthy has replaced being thin as the ultimate goal of therapy.
Caregivers can contribute significantly to therapeutic efforts by helping their residents maintain a proper diet, reduce sedentary lifestyle choices, and support weight loss efforts through a variety of ways. Changing the emphasis of therapy from being thin to being healthy will greatly contribute to the wellbeing of those suffering from obesity.
As always, good luck in your caregiving efforts
Mark Parkinson RPh
References:
1. Osama Hamdy, MD, PhD. Obesity Treatment & Management. Medscape.co. Aug. 25 2015 http://emedicine.medscape.com/article/123702-treatment
2. Robert Kushner, MD, Jennifer Costello, PharmD, BCPS, BC-ADM. The Pharmacist's Role in Obesity Management: A Long-term Commitment to Improving Overall Health. PowerPak CE Oct. 10 2013
http://www.powerpak.com/course/content/109485
3. Obesity Treatment. University of California San Francisco Medical Center http://www.ucsfhealth.org/conditions/obesity/treatment.html
4. How Are Overweight and Obesity Treated? National Heart Blood and Lung Institute. National Institutes of Health. Jul 12 2013 http://www.nhlbi.nih.gov/health/health-topics/topics/obe/treatment
5. Gary D Foster, Angela P Makris, Brooke A Bailer. Behavioral treatment of obesity. American Journal of Clinical Nutrition, American Society for Clinical Nutrition. Am J Clin Nutr July 2005 vol. 82 no. 1 230S-235S
http://ajcn.nutrition.org/content/82/1/230S.full
6. Anthony N. Fabricatore, PhD, Thomas A. Wadden, PhD. Treatment of Obesity: An Overview. Clinical Diabetes, American Diabetes Association, Clinical Diabetes April 2003 vol. 21 no. 2 67-72
http://clinical.diabetesjournals.org/content/21/2/67.full
7. The Practical Guide Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Heart Blood and Lung Institute. National Institutes of Health. NIH Publication Number 00-4084 October 2000
https://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.pdf
8. Obesity. Medical Dictionary The Free Dictionary by Farlex http://medical-dictionary.thefreedictionary.com/obesity
9. Leigh Anderson, PharmD.,Can Prescription Drugs Cause Weight Gain? Drugs.com Feb. 24 2014 http://www.drugs.com/article/weight-gain.html
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Caregiver Refresher-
Fire Prevention and Emergency Planning
Test Questions
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Caregiver Refresher
Fire Prevention and Emergency Planning
Test Questions
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Caregiver Refresher- Fire Prevention and Emergency Planning
Author: Mark Parkinson RPh: President AFC CE
Credit Hours 1.5 - Approximate time required: 90 min.
Educational Goal:
To supplement caregivers knowledge of disaster planning and home fire control.
Educational Objectives:
1. Discuss what is involved in disaster planning
2. List what is in a 72 hour kit
3. Enumerate the three aspects of disaster planning
4. Teach about the attributes of a house fire.
5. Tell about how to prevent house fires
Procedure:
1. Read the course materials. 2. Click on exam portal [Take Exam]. 3. If you have not done so yet fill in Register form (username must be the name you want on your CE certificate). 4. Log in 5. Take exam. 6. Click on [Show Results] when done and follow the instructions that appear. 7. A score of 70% or better is considered passing and a Certificate of Completion will be generated for your records.
Disclaimer
The information presented in this activity is not meant to serve as a guideline for care home management. All procedures and planning discussed or suggested in this article should be only used by care providers after consultant with local emergency preparation officials. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication.
Caregiver Refresher- Fire Prevention and Emergency Planning
Each year in the U.S., more than 2,500 people die and 12,600 are injured in home fires, with direct property loss due to home fires estimated at $7.3 billion annually. Add to that floods, hurricanes, ice storms, power outages, etc. Stay in business long enough, and you’ll most likely have to face an emergency or two. Unlike disaster planning for other businesses (where they just send every home), care homes have to remain open and functioning. To do that, you must develop a plan and practice it to be able to stay open in times of crisis.
This CE is not intended to replace, supplant or supersede existing AFC basic training. It is written as a continuing education article, intended to add to and refresh in the mind of the reader about certain aspects of the topics written about. This article does not cover all required information as set forth by the State of Oregon. If you need the complete basic training on these subjects please refer to the approved sources.
Emergency Planning
By law, planning and preventing disasters are part of the care home’s operation. Most care homes don’t have the resources that big skilled-nursing facilities have, so you have to use your head instead of your wallet to be prepared. With a little bit of thinking and some ingenuity, you can have a pretty good plan in place for common disasters that could come your way.
Let’s see, what does a care home absolutely need to stay open for a couple of days during a catastrophe. Well, there’s the house. Let’s start with that. There are times when you might have to evacuate the entire home. Flood, fire next door, train full of toxic gas wrecks nearby, these and other events could force you to empty the home.
Do you have enough vehicles, wheel chairs, and the like to get everyone out of the home? Where would you go? Local church, other care home, hospital, or local school would do. Do you need to ask permission to show up there or are you just going to pop up and say, Hi? You might want to get that permission in writing. People get kind of forgetful during a crisis. When you’re on your way out the door, you might also want to bring a cell phone with a charger and the list of emergency phone numbers for your clients. Don’t forget to call the case workers and all the others. You know, all the people who are going to want to know where your clients are once you leave.
You are also going to want to bring your 72-hour emergency kit. “What is that,” you say? I’m glad you asked. A 72-hour kit is all the essential supplies you need to survive for, you guessed it, 72 hours. You can buy one for each of your residents or make them yourself. Back packs or an action packer plastic tote are usually the container of choice. You should include the following:
I have listed several items that can be stored but will expire over time. I would suggest a yearly inspection of the kits. Pay attention to the water, food, and first aid supplies. You’ll want to air out the sleeping bags every couple of years too. If you buy a 72-hour kit, you are still going to have to inspect it for outdates and usability. The kit is not going to be much use if don’t know what’s in it and how to use it. They are not made for care homes, so you’ll still have to consider things like adult diapers, medicine, and patient records.
OK, what else does your care home need to plan for in order to operate in an emergency? Power, or more specifically the lack thereof. In operating my adult foster care homes I have had to go without electricity a couple of times. When the power goes out, you are going to have to compensate for the lack of it in:
If handled correctly, loss of power can actually be a fun experience for your residents, like camping without having to go to the campground. Proper planning and the right employee attitudes will be needed to make it fun.
We have talked about what is needed to keep a care home open and functioning during an emergency. The most important resource, by far, is a well-trained, prepared, and flexible staff. Emergencies come in all shapes and sizes. There is no way to plan for all contingencies. What is actually needed is someone to take charge, who can think on their feet and cooperate with others in what needs to be done.
In general, emergency preparedness has three aspects, recognizing, general plan of reacting, reacting to what happens.
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What is the emergency? ____________________________ |
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Do you need to call 911? |
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Is it safer to stay or go? |
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Flee |
Stay indoors |
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How long will you be gone?
Short time ___ Overnight ___ Where are you going? _______________________________ |
Do you need to call anyone? Case workers, family, emergency responders, extra employees
Who is to call? _______________
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What resources do you need? |
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Flee Stay |
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Cell phone and charger ___ Patient records and MARs ___ Medications ___ Medical equipment /supplies ___ 72-hour kit ___ Bedding Yes ___ No ___ Kitchen equipment Yes ___ No ___ Camping equipment Yes ___ No ___ |
Breathing filter masks ___ Camp stove/ grill ___ Portable heaters ___ Fireplace fire ___ Extra blankets ___ Portable lights ___ Entertainment items ___ Land Line/ cell phone ___ |
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Who is in charge of what? |
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Flee Stay |
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Residents preparations
Resident transportation
Equipment/ supplies
Communications/ Calling
First Aid
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Residents preparations
Resident transportation
Equipment/ supplies
Communications/ Calling
First Aid
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Care homes should periodically review their disaster plans and customize them to meet the needs of their ever-changing resident population. Practice the plan so that everyone will know what to do when things go crazy and thinking clearly will become harder to do.
Fire!
Beside power outages, fire is probably the most prevalent and, by far, the most serious threat that care homes face on an ongoing basis. I have saved writing about fire until last and will cover it in the most detail.
I don’t think it would be too far off the mark to say that today we live in the equivalent of a box of matches. One spark at the wrong place and the whole house will go up in flames literally in a matter of minutes. According to a study done by a fire safety department, a 12x16 foot room could experience a flashover fire in as little as 166 seconds.
Fortunately, most care home owners and employees have never experienced a really bad house fire. Usually the only thing care providers know of fire is what they see on TV and movies, not exactly the best sources of information. The basic characteristics of fire are quite different than what is generally presented in the mass media.
Learning about fire
Fire is fast. A fire starts small but, within 30 second it can grow till it’s out of control. Our reaction time needs to be even faster than the fire. Ironically, the very items that fill our houses with comfort and convenience are extremely flammable, reducing the amount of time we get to react. If you factor in the time it takes to discover the fire, your effective reaction time is reduced to where literally every second counts. What it boils down to is -do what is absolutely necessary to save lives, leaving possessions and property behind. Even time for heroism is only within the first few seconds after the fire discovery.
Fire is HOT-
Heat rises. During a fire, the temperature at floor level could be 100 degrees while at eye level it measures 600 degrees. Heat kills, hot air can scorch lungs, melt clothes and jewelry to your skin. A fire can get so hot that everything in a room ignites all at once in what’s called a flashover.
Fire is dark-
Home fires produce thick black smoke, filling rooms with darkness. If you or your residents wake up to a room full of smoke, things will get confusing and disoriented very quickly. It would not be uncommon to lose your way in a house you have lived in for years.
Fire is deadly in more ways than one-
Smoke and toxic fumes kill more people than flames do. Fire uses up oxygen as it grows. Breathing fumes and the lack of oxygen can make you disoriented. There might not be time for you to even find out what’s going on. The odorless, colorless fumes of a fire can lull you into a deep sleep before the flames even reach your door. You or your residents might not wake up in time to escape.
Only when you know and respect the true nature of fire can you begin to react in survivable ways.
Reacting to fires
Fire prevention tips for care homes
Reaction times must be very fast, even at night. You only get fast if you practice. Take practice fire drills seriously. It’s part of being professional.
At this point, your home has already been inspected and approved by the fire marshal, so let’s cover the items that happen after inspections.
In 2010, the American Red Cross responded to more than 63,000 home fires - that’s one every eight minutes! But unlike other disasters, most home fires can be prevented. Be professional and pay attention to the details, then fires won’t start in the first place. Practice, practice, practice – just do it. It saves lives.
Conclusion
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In-home care providers accept an unusually large amount of responsibility for the welfare of those in their charge. By letting them come to your home, you are promising to take care of them no matter what happens. They are counting on you to save them in case of emergency. Be prepared, be knowledgeable, be professional, and be responsible.
As always, good luck in your caregiving efforts.
Mark Parkinson RPh
References:
1. Home Fire Safety Checklist. National Fire Protection Association. http://www.hackettstown.net/doc/home-fire-safety-checklist.pdf
2. Home Fires. Ready.Go, FEMA, 4/3/13. http://www.ready.gov/fires
3. Home Fire Prevention and Safety Tips. US Fire administartion FEMA,7/19/13. http://www.usfa.fema.gov/citizens/home_fire_prev/
4. Myths vs Facts. Fire Sprinkler Initiative, National Fire Protection Association
http://www.firesprinklerinitiative.org/resources/fact-sheets/myths-vs-facts.aspx
5. Planning and responding to workplace emergencies, OSHA Fact Sheet. Occupation Safetyand Health Administration, OSHA.
https://www.osha.gov/OshDoc/data_General_Facts/factsheet-workplaceevergencies.pdf
6. Emergency Preparedness. National Safety Counsel http://www.nsc.org/safety_home/EmergencyPreparedness/Pages/EmergencyPreparedness.aspx
7. Emergency Preparedness, Merit Badge pamphlet. Boy Scouts of America http://www.troop1043.org/books/eprep.pdf
9. Home Fire Prevention. Liberty Mutual Insurance http://www.libertymutual.com/home-insurance/tools-resources/home-fire-prevention
10. Ki Mae Heussner,. With Modern Furnishing, Homes Burn Faster. ABC News, Good Morning America.2/2/11
http://abcnews.go.com/Technology/modern-furnishing-homes-burn-faster/story?id=12806666
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