What lifestyle modifications do you recommend for CF?
What lifestyle modifications do you recommend for CF?It is crucial to educate and reassure CF. Perhaps if he understood how his choices affect the discomfort he is having, he would be more likely to adhere to the suggested treatment plan. Gastroesophageal reflux disease (GERD) can be prevented and cured by making straightforward lifestyle and dietary modifications (Cao et. al, 2019). First of all, I would recommend CF consider eliminating his nightly intake of wine as alcohol decreases lower esophageal sphincter (LES) tone; thus allowing for the contents of the stomach to flow back into the esophagus (Woo & Robinson, 2017). Additionally, eating smaller meals, and avoiding caffeine, chocolate, peppermint, and fatty foods can help prevent the acid reflux (Smith, 2018). Furthermore, I would inform CF that his choice to stop smoking was advantageous to his overall health. In relation to GERD, smoking inhibits the production of saliva causing a reduction of saliva in the mouth/throat; saliva helps to counteract the acidity of gastric secretions, thus avoiding smoking is best (Smith, 2018).
Describe a rational drug choice for this patient. Be specific regarding what factors you would consider. Include pharmacokinetic and dynamic considerations for the pharmacological choices made. Also consider interactions and side effects.The entire class of proton pump inhibitors (PPI) are approved for treatment of GERD since they decrease gastric acid by over 90% (Woo & Robinson, 2017). Omeprazole (Prilosec) 20mg capsule by mouth once daily for a trial period of 4 weeks would be my rational drug choice for CF. Due to his age, negative physical exam, and the fact that he does not take daily medications, omeprazole would not interact with any current medications or put him at a concerning risk for osteoporosis. The benefits of omeprazole include rapid absorption of less than one hour and peak effect within 2 hours (Lexicomp, 2017). I would inform CF about common side effects such as dizziness, headaches, skin rash, constipation, diarrhea, flatulence, and nausea/vomiting (Lexicomp, 2017).
What counseling points about this medication do you give CF?First of all, I would tell CF I wish to see him back in four weeks to discuss his potential experience with side effects, symptom relief including his being awakened at night with symptoms. Should he report his symptoms are controlled during the day and reappear before bed, I would consider adding either a second dose of omeprazole daily or an H2 receptor antagonist before bed (Woo & Robinson, 2017). It is important for CF to understand the efficiency of omeprazole is greatly decreased if not taken on an empty stomach (Lexicomp 2017). Adherence to taking PPI is crucial to attain the optimal gastric acid secretion; therefore, I would reinforce how important it is to stay consistent with his medication regimen (Smith, 2018).
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