COX-2 INHIBITORS
Aspirin and Bextra don't mix
[black small square] Caution your patients who take the COX-2 inhibitor valdecoxib (Bextra) that combining it with aspirin may increase the risk of blood clots that could lead to a heart attack or stroke.
In December 2004, the Food and Drug Administration added a warning to valdecoxib that patients who undergo heart-bypass surgery shouldn't use it. Evidence suggested a threefold increase in the risk for heart attack and stroke in bypass patients who took valdecoxib. A similar COX-2 inhibitor, celecoxib (Celebrex), was linked in late 2004 to an increased risk of heart attack. Another COX-2 inhibitor, rofecoxib (Vioxx) was pulled from the market because of concerns about increased heart attack and stroke risk.
Because many patients who are at higher risk of heart disease are on low-dose aspirin therapy, they should know about the danger of mixing aspirin and COX-2 inhibitors.
ASTHMA AND PREGNANCY
Treatments are safe-and necessary
[black small square] Managing asthma in pregnant patients can be a challenge. About a third of women with mild asthma have worsening symptoms when they become pregnant. When a mom-to-be has trouble breathing, the baby also has difficulty getting enough oxygen.
The health care provider will need to tailor an appropriate medical treatment for asthma and the conditions that often occur with it, like allergic rhinitis, gastroesophageal reflux disease, and sinusitis. The good news is that many of the drugs used for treating asthma symptoms and other associated conditions have shown a high degree of safety when used in pregnancy.
Urge your pregnant patient to take her asthma symptoms seriously, limit her exposure to substances that trigger asthma exacerbations, and seek medical treatment immediately.
DIET AND EXERCISE
Couch potatoes not recommended
[black small square] In the just-released "Dietary Guidelines for Americans 2005," the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) provide science-based advice to promote health and reduce risks for major chronic diseases through diet and physical activity. Among the recommendations: engaging in 60 to 90 minutes of moderate to vigorous exercise daily to maintain or lose weight; eating more fruits, vegetables, and whole grains; limiting sodium intake to about a teaspoon a day; and limiting consumption of added sugar, saturated and trans fats (trans fats are liquid fats that are made solid for incorporation in food, such as shortening or margarine), cholesterol, and alcohol.
The guidelines suggest that nutrient needs should be met primarily through food consumption. In certain cases, fortified foods and dietary supplements may be useful sources of one or more nutrients that may not be otherwise consumed in recommended amounts. For example, people over age 50 should take vitamin B12 in its crystalline form through fortified foods or supplements; and older adults, people with dark skin, and people exposed to insufficient sunlight should consume extra vitamin D in fortified foods or supplements.
The entire document is available online at http://www.health.gov/dietaryguidelines/dga2005/document/. LPN
DEMENTIA
Weight loss may predict dementia
[black small square] According to a study in the January 2005 issue of the Archives of Neurology, significant weight loss may be an early sign of dementia in older patients. In many study participants, the weight loss occurred over a 2- to 4-year period before a clinical diagnosis of dementia was made.
You should watch for weight loss in your older patients; with nutritional support, it may be prevented or minimized if caught early. Poor nutrition and overall frailty put your patients at increased risk for falls, poor wound healing, and increased dependence on help for activities of daily living.
DID YOU KNOW?
[black small square] Nurses are tops. In a recent Gallup survey ranking various professions, 79% of the participants rated nurses "high" or "very high" for honesty and ethics. In fact, nurses have ranked at or near the top of the list since being added in 1999. Who's bringing up the rear? Lawyers (18%), members of Congress (10%), advertising practitioners (10%), and car salespeople (9%).