please respond to each discussion post with apa references Thank you!
Discuss the recommendations of JNC-7 and JNC-8, with regard to health outcomes and practice implications.
High blood pressure continues to be a major health concern increasing morbidity and mortality. Untreated or chronically high blood pressure can lead to other health conditions such as stroke, heart failure, and kidney problems. In 2003 the Joint National Committee issued its seventh report (JNC-7) on research-based guidelines on the prevention, detection, evaluation, and treatment of hypertension (HTN) which became the gold standard for treating HTN for the next decade. The JNC-7 defined HTN as a sustained blood pressure reading of greater than 140/90 (Adams & Holland, 2017).
Fast forward to 2013 and the JNC-8 revised the HTN guidelines. The parameter of >140/90 was the same, however, the research showed that not all patients with a sustained blood pressure of >140/90 needed to be started on anti-HTN medications. Patients who did not have diabetes or chronic kidney disease could be allowed to go as high as 150/90 before anti-HTN medications would be started. Another big change with the JNC-8 was no longer using bet-adrenergic blockers as the first-line medications for the treatment of HTN. First-line medications are now ACE inhibitors, ARBs, CCBs, and thiazide diuretics. These medications are more effective and cause fewer adverse effects for most patients (Adams & Holland, 2017).
Adams, M. P., Holland, N., & Urban, C. Q. (2017). Pharmacology for nurses. A
pathophysiologic approach. (5th ed.). Pearson Education.
https://online.vitalsource.com/books/9780134255378
It’s always interesting to think how much of our bodies are affected by blood pressure. You essentially listed all the major body systems that can be affected. I got curious and found that even the GI tract can be affected by hypertension as well. I’m not talking about portal hypertension that causes those esophageal varicies, but rather some studies have found a correlation between blood pressure and gut bacteria. The pathophysiology is long and involves many acronyms, but the short of it is that dietary fiber is broken down by specific gut bacteria and when that gut bacteria is changed for whatever reason, it begins a complex chain reaction of chemical signals that cause essential hypertension in the vascular system (Richards et al., 2017). Imagine if implications from this are actually significant? Could you envision JNC-9 to include pro-biotics as a recommendation to treat high blood pressure?
Richards, E. M., Pepine, C. J., Raizada, M. K., & Kim, S. (2017). The Gut, Its Microbiome, and Hypertension.
Current hypertension reports,
19(4), 36. https://doi.org/10.1007/s11906-017-0734-1
Discuss medications to treat GERD. What specifically should patients be taught about these medications to prevent adverse side effects?
Prescription medications to treat GERD include proton pump inhibitors (PPI) and H2 receptor antagonists. Common PPIs include esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole. It is common to have headaches, nausea, rash, dizziness, and diarrhea. Patient’s taking these medications long-term are at increased risk of osteoporosis-related fractures because of interference with calcium absorption so calcium supplements are recommended. Patients should take PPIs 20-30 minutes before the first major meal of the day since the proton pump is activated by food. These medications block acid production and allow the esophagus to heal. The patient should not drink alcohol because alcohol can aggravate the stomach mucosa and decrease the efficacy of the medication. (Adams & Holland, 2017)
Medications to reduce acid production include histamine blockers (h-2 receptor antagonists). These medications include cimetidine, famotidine, and nizatidine. Adverse effects include diarrhea, constipation, headache, fatigue, and dry mouth. The patient should not take antacids along with h2 receptor antagonists because the absorption of the H2 receptor antagonist will be decreased (Adams & Holland, 2017).
Adams, M. P., Holland, N., & Urban, C. Q. (2017). Pharmacology for nurses. A
pathophysiologic approach. (5th ed.). Pearson Education.
https://online.vitalsource.com/books/9780134255378
I’m going to play devil’s advocate and drop Targownik et al’s (2017) assumption that long term use of PPI’s doesn’t actually cause bone fractures related to osteoporosis. In an emperical article, they used bone density studies to evaluate 104 subjects (half on PPI and half not) to find no actual significant correlation between PPI and decreased bone densities. With this said, I’m guilty of stating the same information as you that PPI’s lead to osteo. Many of the recent articles found regarding this topic are literature reviews which leads to the notion that more research needs to be done. Imagine if this is actually true? If so, how much of the supplement market was actually skewed by nursing recommendations?
Targownik, L. E., Goertzen, A. L., Luo, Y., & Leslie, W. D. (2017). Long-Term Proton Pump Inhibitor Use Is Not Associated With Changes in Bone Strength and Structure.
The American journal of gastroenterology,
112(1), 95–101. https://doi.org/10.1038/ajg.2016.481
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