Increased incidence of C.diff with use of PPIs

In the hospital setting we see most, if not all patients on some sort of stomach ulcer prophylaxis. The most common medication seen inpatient for this is Pantoprazole, the trade name being Protonix. The problem that arises with over-utilizing Proton Pump Inhibitor’s(PPIs) is the associated increased incidence of Clostridium difficile colitis infections in patients. PPIs work by reducing the amount of acid in the stomach.

Clostridium difficile also known as C.diff is an infection caused by the disruption of normal healthy bacteria in the colon. Symptoms include frequent diarrhea, stomach pain and fever. C.diff is transmittable from person to person by spores. Patients who have been diagnosed with C.diff are placed on Contact precautions. Contact precautions include wearing protective equipment which are gowns and gloves. Hand washing pre and post care of all patients is another way of reducing infections.

According to the FDA, a diagnosis of C.diff should be considered when a patient who is on a PPI has diarrhea that does not improve. The treatment for C.diff includes oral antibiotics such as Vancomycin. The indications of this finding to healthcare is significant. There has been a over-utilization of PPIs for patients in the hospital setting. If the patient does not have a history of ulcer disease or acid reflux then these medications should not be used in them. This decreases their risk of contracting C.diff and saves the hospitals thousands as well. 

Chronic Heart Failure Pharmacotherapy

The goal in managing a patient with heart failure is to maximize quality of life, minimize symptoms, prevent hospitalizations, slow disease progression, and prolong survival.

Heart Failure Symptoms Include:

Pharmacotherapy

Loop Diuretics

Agents: Furosemide, Bumetanide, Torsemide, and Ethacrynic acid

Mechanism of Action: Block sodium and chloride reabsorption in the ascending loop of Henle. Cause decreased renal vascular resistance and increased renal blood flow. Assists in fluid removal.

Therapeutic effects: Provides symptomatic relief of fluid overload, improves exercise tolerance, and prevents hospitalization.

Furosemide is the most commonly used. Bumetanide and torsemide are much more potent than furosemide. Ethacrynic acid is rarely used due to its adverse effects.

Angiotensin-Converting Enzyme Inhibitors (ACE)

Agents: Captopril, Enalapril, Fosinopril, Lisinopril, Perindopril, Quinopril, Ramipril, and Trandolapril

Mechanism of Action: Prevent the conversion of Angiotensin I to Angiotensin II by blocking the enzyme ACE.

Therapeutic Effects: Proven to reduce mortality, slowing progression, preventing hospitalization, and provides symptomatic improvement. Reduces peripheral vascular resistance without reflexively increasing cardiac output, heart rate, or contractility.

Angiotensin Receptor Blockers (ARB)

Agents: Candesartan, Losartan, and Valsartan

Mechanism of Action: Inhibits Angiotensin II receptors.

Therapeutic Effects: Can be considered in patients who are intolerant of ACE inhibitors. Same therapeutic effects as an ACE inhibitor. Produce arteriolar and venous dilation and block aldosterone secretion, lowering blood pressure and decreasing salt and water retention.

Beta-Adrenergic Blockers

Agents: Bisoprolol, Carvedilol, and Metoprolol succinate

Mechanism of Action: Reduce both resting and exercise heart rate, cardiac output, and both systolic and diastolic blood pressure; reduce sympathetic outflow from the CNS and suppress renin release from the kidneys; agents that block alpha-receptors or increase nitric oxide reduce peripheral vascular resistance

Therapeutic Effects: Long-term benefits of inhibiting the effects of the sympathetic nervous system. Reduces blood pressure primarily by decreasing cardiac output.

Aldosterone Antagonists

Agents: Sprinolactone, Eplerenone

Mechanism of Action: Suppression of Aldosterone

Therapeutic Effects: Shown to reduce all-cause mortality in patients with moderate to moderately severe heart failure.

Sprinolactone is a direct antagonist of aldosterone, thereby preventing salt retention, myocardial hypertrophy, and hypokalemia. Eplerenone is a competitive antagonist of aldosterone at mineralcorticoid receptors. Eplerenone has a lower incidence of endocrine-related side effects compared to sprinolactone.

Digoxin

Mechanism of Action: Inotropic action is the result of an increased cytoplasmic calcium concentration that enhances the contractility of cardiac muscle.

Therapeutic Effect: Improve symptoms and reduce hospitalization.

Isosorbide Dinitrate and Hydralazine

Mechanism of Action: ISDN is a venous vasodilator and Hydralazine is an arterial vasodilator. ISDN also delivers nitric oxide. Hydralazine has antioxidant properties while eliminate the need for nitrate free-interval with ISDN.

Therapeutic Effects: Reduces all-cause mortality and is recommended in African Americans with moderate to moderately severe heart failure receiving standard heart failure therapy.

Gestational Trophoblastic Disease

Gestational Trophoblastic Disease (GTD) is a group of conditions which involve an abnormal growth of cells in a woman’s uterus. These abnormal cells arise from the tissue that would have become the placenta during pregnancy. Below is a case study of a patient presenting with gestational trophoblastic disease and the pathophysiology that accompanies this disease. Enjoy !

Children of the Genetically Modified Corn

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Recently I have become interested in the Non-Genetically Modified Organism movement. Watching numerous Netflix documentaries on the topic and researching the issue has made me realize there is very little awareness of this issue.

Genetically Modified Organisms known as GMOs include the alteration of DNA of our food supply. This includes many common food sources such as tomatoes,corn, soy, etc. which are pretty much all ingredients in many of our pantry items. Monsanto is the leading corporation producing these GMO seeds and stocking supermarket shelves with these foods.

According to the Center for Food Safety, “Currently, up to 92% of U.S. corn is genetically engineered (GE), as are 94% of soybeans and 94% of cotton (cottonseed oil is often used in food products). It has been estimated that upwards of 75% of processed foods on supermarket shelves – from soda to soup, crackers to condiments – contain genetically engineered ingredients.”

The DNA alteration in these foods include the insertion of Roundup. Yes, that is right the weed and grass killer many of us use to maintain our lawns. This is so that the crops become weed resistant and survive the harvest to produce more corn. It is all about the money honey. European countries have banned the use of GMOs completely. When will the U.S. wake up to this ongoing real threat?

Many health concerns have come up with the use of GMOs. A researcher in France named Séralini conducted a study of the health affects of GMOs on rats who were fed it for 2 years. Monsanto, the big kahuna in the GMO world conducted the same study prior to Séralini but for only 90 days. Séralini’s study showed that 90-day tests commonly done on GMO foods are not long enough to see long-term effects like cancer, organ damage, and premature death. The first tumors only appeared 4-7 months into the study.

Labeling of foods have been a big issue that many people want. In the U.S. legislation is trying to pass the DARK Act (Deny Americans the Right to Know). This is where no labeling is required for any food put out for consumers. People should have a choice of what kind of food they feed their children by being able to identify GMO vs. Non-GMO foods. When grocery shopping one must look for the Non-GMO project verified label.

Image result for non gmo project verified

Many chronic health problems arise from what we eat. We must become more conscious and aware of what we are putting into our bodies and feeding our children. First thing is spreading awareness and education of this issue. If you are interested in learning more watch a documentary on Netflix called GMO OMG.