Tailings Dams: Causes of Failure and Proposals to Avoid Them
Lifestyle Failure To Avoid Med Use
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Transcript of Lifestyle Failure To Avoid Med Use
Presented by: Lynda Pardo, Jorge Garcia, Rosa Garcia
Pharm.D. Candidates 2010
OUTLINE
Introduction to Lifestyle Modifications
Overview of Hypertension Disease
Overview of Diabetes Mellitus
Lifestyle Modifications for Hypertension
Lifestyle Modifications for Diabetes Mellitus
DID YOU KNOW…?
~133 million people in the U.S have at
least one chronic condition
U.S spends ~ $1.5 trillion on chronic
conditions annually
U.S is the number one drug market
worldwide
INTRODUCTION
Chronic conditions affect the national
economy and our patient's health
Lifestyle modifications prevent most of
these conditions
Lifestyle modifications may be use in the
management of chronic conditions
LIMITATIONS
Difficulties achieving a new lifestyle
Difficulties maintaining new lifestyle
for long terms
BENEFITS
Low cost
Safety profile
Benefits seen rapidly
Enhance medication efficacy
Decrease incidence of complications
Decrease the need for Pharmacotherapy
LIFESTYLE MODIFICATIONS
Prevention and management
Dyslipidemia
Gastroesophageal reflux disease
(GERD)
Obesity
Hypertension (HTN)
Diabetes Mellitus (DM)
HYPERTENSION
HYPERTENSION (HTN)
Defined as consistently elevated blood
pressure (BP)
Multifactorial etiology
Primary or Essential Hypertension
(Unknown)
Secondary Hypertension
CLASSIFICATION
CLASSIFICATION SBP mmHg DBP mmHg
Normal < 120 and - < 80
Pre-hypertension 120 – 139 or - 80 -89
Hypertension Stage 1 140 – 159 or - 90 - 99
Hypertension Stage 2 ≥ 160 or - ≥ 100
SBP = Systolic Blood Pressure
DBP = Diastolic Blood Pressure
EPIDEMIOLOGY
Most common primary diagnosis in
America
~ 50 million Americans have high BP that
needs some type of treatment
Lifetime risk of developing hypertension
between 55 – 65 years old is > 90 %
Continuous relationship between BP and
risk of cardiovascular events
PATHOPHYSIOLOGY
A variety of systems and mechanisms
involved:
Renin Angiotensin Aldosterone System
(RAAS)
Nervous System Regulation
Peripheral and Vascular mechanisms
Oxidative Stress
CLINICAL PRESENTATION
Most patients present with no symptoms
Severe symptoms occur as a result of
organ damage
Heart
Brain
Retinopathy
Peripheral arterial disease
Chronic Kidney Disease (CKD)
GOALS OF THERAPY
BP <140/90 mmHg for most patients
BP <130/80 mmHg for patients with
diabetes or chronic kidney disease
TREATMENT
Pharmacotherapy
Non-pharmacotherapy
DIABETES MELLITUS
DIABETES MELLITUS (DM)
Chronic condition
Defined as elevated blood glucose
(sugar) levels
Inadequate insulin secretion or insulin
action
CLASSIFICATION
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Gestational Diabetes Mellitus
EPIDEMIOLOGY
~ 20.8 million Americans have DM
Type 2 Diabetes accounts for 90 – 95%
Elderly 65 - 74 years old have greater
incidence
Hyperglycemia (high blood glucose levels)
is a strong risk factor for cardiovascular
disease
PATHOPHYSIOLOGY
Metabolic disorder resulting from
deficiencies at multiple organ sites
Insulin resistance in muscle and adipose
tissue
Decreased insulin secretion by pancreas
Excessive hepatic glucose production
Inadequate glucagon secretion
CLINICAL PRESENTATION
Polyuria (excessive urine)
Polydipsia (excessive thirst)
Unexplained weight loss
Fatigue
Blurred vision
Dehydration
COMPLICATIONS
Microvascular Complications
Nephropathy
Peripheral neuropathy
Retinopathy
Impotence
Macrovascular Complications
Cardiovascular disease
Stroke
Peripheral vascular disease
GOALS OF THERAPY
According to the American Diabetes Association
70 – 130 mg/dL fasting and preprandial
<180 mg/dL postprandial
Glycosylated hemoglobin (A1C) < 7%
As close as possible to < 6% (normal) without significant hypoglycemia
TREATMENT
Pharmacotherapy
Insulin
Non-pharmacotherapy
HYPETENSION: Lifestyle Modifications
HTN: Lifestyle Modifications
What We’re Up Against
Larger portions at fast food restaurants
Little to no availability of healthy food in
schools and jobs
High cost of healthy food
High amounts of sodium in processed
foods
Efficient physical education programs
lacking in schools
HTN: Lifestyle Modifications
Reduction of BP can be achieved by losing
as little as 10 pounds (4.5 kg)
1,600 mg sodium DASH diet = single
antihypertensive drug
Multiple lifestyle modifications ideal
HTN: Lifestyle Modifications
Quit smoking!
Community programs: Preventing
Hypertension
Employing culturally sensitive
educational messages
Lifestyle support services
Cardiovascular risk-factor screening and
referral programs
DASH Diet: Daily Calories
DASH Diet: Sodium Intake
DASH Diet
Tips to reduce sodium intake
Buy low or reduced sodium foods whenever possible
Limit cured foods (bacon or ham)
Cook rice or pasta without salt (avoid instant mixes)
Rinse canned goods such as tuna and beans to remove some salt
Use spices instead of salt
DASH Diet
Tips on getting started
Baby steps
Initiate or add one more fruit or
vegetable to every meal
Meat should NOT be the focus of the
meal, just another part of it
Snack on fruits or other products which
are low in fat, sodium, and calories
DIABETES: Lifestyle Modifications
DM: Lifestyle Modifications
Diet
Exercise
DM: Lifestyle Modifications
Diet
Become educated on the types of foods
that help lower or maintain blood glucose
at healthy levels
DM: Lifestyle Modifications
Manage carbohydrate intake by:
Plate Method
Carbohydrate Counting
Glycemic Index
DM: Lifestyle Modifications
How to manage the holidays
If cooking, plan menu ahead of time
Include festive, but healthy foods
Watch your portions!
DM: Lifestyle Modifications
Exercise
Know the reasons!
Strive to incorporate exercise into
everyday activities
Find what motivates you
For more strenuous physical activities,
always consult your physician
beforehand
REFERENCES
1. http://www.diabetes.org/about-diabetes.jsp
2. http://www.diabetes.org/food-nutrition-lifestyle/lifestyle-prevention.jsp
3. http://www.fightchronicdisease.org/news/pfcd/pr10022007.cfm
4. Chicago Tribune ONLINE Web Site. Available at: http://newsblogs.chicagotribune.com/triage/2008/06/death-rates-plu.html. Accessed September 22, 2009.
5. Partnership to Fight Chronic Disease ONLINE Web Site. Available at: http://www.fightchronicdisease.org/news/pfcd/pr10022007.cfm. Accessed September 22, 2009.
6. CNN Money ONLINE Web Site. Available at: http://money.cnn.com/2008/04/15/news/companies/IMS/index.htm?postversion=2008041511. Accessed September 22, 2009.
REFERENCES
7. American Association of Clinical Endocrinologist Medical
Guidelines for Clinical Practice for Management of Diabetes
Mellitus. Endocrine Practice 2007; 13:3-12.
8. Nathan D, Buse J, Davidson Mayer et al. Management of
Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the
initiation and Adjustment of Therapy. Diabetes Care 2006; 29 (8):
1963 – 1969.
9. American Diabetes Association. Standards of medical care in
diabetes. Diabetes Care 2008; 31 (suppl 1) s12 – s44.
10. DiPiro JT, Talbert RL, Hayes PE, et al. Pharmacotherapy: A
Pathophysiologic Approach. 6th ed. New York, NY: McGraw Hill;
2005.