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Medication and Health

Medication and Health. Anne Liu Pharmacy Doctor, Registered Pharmacist CVS Pharmacist October 6, 2007 . Outline. Health Management - Diet, Exercise, Stress Management, and Medication Medication (Drugs) – evidence based medicines, treatment guidelines, and top 20 prescription drugs

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Medication and Health

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  1. Medication and Health Anne Liu Pharmacy Doctor, Registered Pharmacist CVS PharmacistOctober 6, 2007

  2. Outline • Health Management - Diet, Exercise, Stress Management, and Medication • Medication (Drugs) – evidence based medicines, treatment guidelines, and top 20 prescription drugs • Risk Factors for Cardio-Vascular Disease (CVD) – the leading cause of death in US and developed countries • Drugs - used for diabetes, high cholesterol, and hypertension • Drug Interactions • Drug Side Effects

  3. Health - Diet • Reduce salt intake • Reduce fat intake • Have balanced diet – “rainbow” food

  4. Health - Exercise • There are 1,440 minutes in every day. Schedule 30 of them for physical activity! • The best exercise is the one that you will do. • Walking is an aerobic and weight-bearing exercise, so it is good for your heart and helps prevent osteoporosis.

  5. Health – Stress Management • Consequences of Stress • An Epidemic Disease • A Silent Killer • Stress Free Management • Meditation • Laugh Out Loud • Play Soothing Music • Think Happy Things • Take a Short Walk • Slow/Deep Breaths • Relax Body (Before/After Bed)

  6. Top 20 Prescription Drugs 30Metformin Diabetes

  7. Cardio-Vascular Diseases (CVD) • No. 1 cause of death in men and women • More than 900,000 deaths annually in the United States alone • CVD – including • Coronary heart disease (CHD) • Stroke • Peripheral vascular disease

  8. Artherosclorosis - Blockages in Blood Vessel

  9. Artherosclorosis - Blockages in Blood Vessel …

  10. Risk Factors of CVS • Smoking • Stress • Hypertension • Diet • Dyslipidemia • Physical inactivity • Obesity • Diabetes mellitus (considered a coronary heat disease risk equivalent)

  11. Calculate Bob’s 10-Year Risk of Suffering CVD (Heart Attack/Stroke) • Age: 59 years • Total cholesterol (TC): 234 mg/dl • HDL (good Cholesterol): 36 mg/dl • Treatment for high blood pressure: 148/94 • Smoking history: a smoker • Triglyceride (TG): 205 mg/dl Using the attached Framingham Score Chart His 10-Year Risk = _________ %

  12. 10-Year Risk for CVD - Framingham Score

  13. Prevalence of Diabetes 1994 2004

  14. Diabetes • Affects 20.8 million people in the U.S. (7%) • 6th leading cause of death - 65% of deaths due to heart disease and stroke • Leading cause of blindness, renal failure, and non-traumatic lower-extremity amputations

  15. Diabetes - Types

  16. Diabetes - Diagnosis

  17. Diabetes – Goal of Therapy • Diet • Exercise • Medication

  18. Glipizide Glipizide XL Glyburide Glyburide, micronized Glimeperide Acetohexamide Chlorpropamide Tolazamide Tolbutamide Repaglinide Nateglinide Acarbose Miglitol Metformin XR Metformin/Glyburide Metformin/Glipizide Pioglitazone Rosiglitazone Sitagliptin Sitagliptin/Metformin Rosiglitazone/Metformin Rosiglitazone/Glimeperie Pioglitazone/Metformin Pioglitazone/Glimeperide Exenatide (Byetta™) Pramlintide (Symlin) Insulin Regular insulin NPH insulin Regular 70/30 Regular 50/50 Insulin Lispro Lispro 75/25 Lispro 50/50 Insulin Aspart Aspart 70/30 Insulin Glulisine Insulin Glargine Insulin Detemir Inhaled insulin Drugs to Treat Diabetes

  19. High Cholesterol • Affects 65 million US adults • Independent risk factor for CHD CHD #1 killer in the US • Total cholesterol (TC) >200 mg/dL • LDL (Bad) >130 mg/dL • HDL (Good) <40 mg/dL

  20. Drugs to Treat High Cholesterol

  21. Drugs to Treat High Cholesterol …

  22. LDL Cholesterol Goals and Cut Points for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories

  23. Take Home Points • High total cholesterol, high LDL (bad), low HDL (good), and possible high triglyceride are linked to the risk of heart attack and possible stroke. • Medications (Lipitor, zocor, pravachol…..) used to treat cholesterol reduces the risks of heart attack and over all deaths • Statins (Lipitor, zocor, pravachol..) are the drugs of choice for high cholesterol

  24. High Blood Pressure (BP)

  25. Treatment Guidelines for High BP(JNC7) * Optimize dosages or add additional drugs until goal blood pressure is achieved.

  26. Drugs to Treat High BP

  27. Drugs to Treat High BP …

  28. Drug Interactions • Diazepam – Lexapro = increase CNS side effects (drowsiness, dizziness, headache) • Flagyl – Lexapro = Flagyl (3A4 inhibitor) may increase the effect of lexapro (3A4 Substrate) • Grape fruit juice (a 3A4 inhibitor), it will affect the drug level which is metabolized by 3A4 (an enzyme). • Flagyl – Alcohol = Increase flushing (red face) • Skelaxin – Alcohol = increase CNS side effects (drowsiness, dizziness, headache)

  29. Drugs – Narrow Therapeutic Index

  30. Questions ?

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