Pantoprazole Protonix

Pantoprazole Protonix
Pantoprazole Protonix
Nexium GenericEsomeprazole is in a class of drugs called proton pump inhibitors PPIs which block the production of acid by the stomach. Other drugs in the same class include omeprazole Prilosec lansoprazole Prevacid rabeprazole Aciphex and pantoprazole Protonix. Chemically esomeprazole is very similar to omeprazole. Proton pump inhibitors are used for the treatment of conditions such as stomach and duodenal ulcers gastroesophageal reflux disease GERD and the Zollinger-Ellison syndrome which all are caused by stomach acid. Esomeprazole like other proton-pump inhibitors blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme the production of acid is decreased and this allows the stomach and esophagus to heal. Esomeprazole was approved by the FDA in February 2001.

how to use
For GERD 20 or 40 mg of esomeprazole is given once daily for 4-8 weeks.

For the treatment of H. pylori 40 mg is administered once daily in combination with amoxicillin and clarithromycin for 10 days.

Esomeprazole capsules should be administered one hour before meals swallowed whole and should not be crushed or chewed. Patients with difficulty swallowing can open the capsule and mix the pellets with applesauce. The applesauce should not be hot and the pellets should not be chewed or crushed.

side effects
Esomeprazole like other PPIs is well-tolerated. The most common side effects are diarrhea nausea vomiting headaches rash and dizziness. Nervousness abnormal heartbeat muscle pain weakness leg cramps and water retention occur infrequently.

interaction
Esomeprazole potentially can increase the concentration in blood of diazepam Valium by decreasing the elimination of diazepam in the liver. Esomeprazole may have fewer drug interactions than omeprazole.

Multiple sclerosis

Multiple sclerosis (MS) is a chronic sensory and motor disorder of variable presentation due to loss of myelin from the nerve cells in the central nervous system. The cause of multiple sclerosis is patchy deterioration of the myelin sheaths of nerve tracts in the brain and spinal cord and in the optic nerve which leads to the deterioration of nerve function. Other probable causes are: genetic, infectious and autoimmune factors.

Onset is usually between 20 and 40. The incidence is higher in women and in high altitude places. The disease is precipitated by fatigue, emotional stress, pregnancy or viral respiratory infection.

The presenting manifestation is mainly due to irregular, intermittent or progressive impairment of sensory or motor function such as the following: hyperesthesia (increased sensitivity to pain), paresthesias (“pins and needles” sensation or tingling sensation), visual disturbances, dysequilibrium, muscular weakness, spasticity, unsteadiness, tremors, nystagmus (rapid, jerky oscillating rhythmic eye movements), diplopia (double vision) and disturbances of swallowing or bladder function.

Physical examination findings focuses on the neurologic examination which reveals typically diffuse and highly variable hyperesthesia or anesthesia, irregularly distributed muscle weakness with spasticity, hypereflexia or increased in deep tendon reflexes, positive Babinski reflex, impaired or abnormal superficial reflexes, ataxia, uncoordinated speech, tremors, nystagmus, and temporal pallor of the optic disks followed by optic atrophy, visual field defects, and emotional lability.

Diagnostic test include lumbar puncture or spinal tap which may show moderate lymphocytosis and elevation of immune globulins including oligoclonal IgG globulins (antibody to myelin) not found in serum. The electroencephalogram (EEG) may show nonspecific abnormalities. Magnetic resonance imaging (MRI) of the brain and spinal cord shows multiple patchy lesions. Visual evoked potential testing may corroborate the diagnosis.

The disease is highly unpredictable. Four patterns are distinguished: relapsing remitting, primary progressive, secondary progressive and progressive relapsing. Presenting symptoms often remit for months or years. Typically the disease progresses gradually, with remissions and exacerbations and eventually produces some disability. Relapses may be triggered by excessive fatigue.

Treatment management include: increased rest, particularly during periods of heightened symptoms. Adrenocortical steroids often mitigate neurologic impairment particularly during acute relapses. Physical therapy and muscle relaxants are helpful in dealing with muscle weakness and spasm. Immunotherapy, plasmapharesis, and synthetic myelin protein are among the treatments currently being evaluated. Psychotherapy may be necessary.

Neurological disorder

Neurologic disorders encompass areas that cover, among other things, hereditary and congenital pathologies, demyelinating and degenerative disorders, infections, and neoplasms. Major neurological conditions include the following: headache disorders such as migraine, cluster headache and tension headache (the most common) ; epilepsy and seizure disorders; neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease, Lou Gehrig's disease and ataxia; cerebrovascular diseases such as transient ischemic attacks (TIA) and cerebrovascular accidents (CVA) also known as strokes or brain attack which is either ischemic or hemorrhagic in nature; sleep disorders (insomnia); cerebral palsy (CP), a non-progressive disorder of voluntary and posture control; CNS infections such as encephalitis, meningitis and peripheral neuritis; brain abscess; herpetic meningoencephalitis, aspergilloma and cerebral hydatic cyst ; PNS infections , such as tetanus and botulism; neoplasms such as glioblastoma multiforme which is the most malignant brain tumor, spinal cord tumors, peripheral nerves tumor (acoustic neuroma); movement disorders such as Parkinson's disease, chorea, hemiballismus, tic disorder, and Gilles de la Tourette syndrome; CNS demyelinating disease such as multiple sclerosis, and of the peripheral nervous system, such as Guillain-Barr� syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) ; spinal cord disorders e.g. tumors, infections, trauma, malformations such as myelocele, meningomyelocele, myelomeningocele; peripheral nerve disorders like Bell palsy (CN VII) and carpal tunnel syndrome (CTS) involving the median nerve, myopathy and neuromuscular junctions problem (e.g. myasthenia gravis); traumatic injuries to the brain, spinal cord and peripheral nerves ; altered mental status, encephalopathy, stupor and coma ; lastly, any speech and language disorders (expressive or receptive aphasia).

A complete neurological examination entails the neurologist to first review the patient's medical history with special focus to the present condition prior to a neurological exam. Generally, the exam tests cranial nerves, level of consciousness, motor strength, coordination, deep tendon reflexes and sensation. Additional mental status examination may be needed to assess cognitive function in psychiatric, geriatric and even in a healthy aged patient to uncover early signs of dementia. Findings of the neurologic exam help the neurologist determine if the problem is indeed in the nervous system. Further tests like the lumbar puncture also known as spinal tap may be needed to confirm a diagnosis or find a specific treatment.

Mouth diseases

The following are the list of some mouth diseases encountered in clinical practice: The candidiasis also known as the oral thrush or moniliasis is caused by growth of yeast cells. The causative agent is candida albicans. It is characterized as whitish plaques in the oral cavity seen most commonly in immunocompromised patients (e.g. acquired immunodeficiency syndrome or AIDS; severe combined immunodeficiency (SCID); diGeorge syndrome, a thymic hypoplasia) and also seen in those patients on prolonged inhalational steroids like in asthmatic patients who failed to wash their mouth every after steroid use.

Isolated inflammatory mouth diseases include: cheilitis or cheilosis; gingivostomatitis; aphthous stomatitis; laryngitis; tonsillopharyngitis and diphtheria. Cheilitis or cheilosis means inflammation of the lips such as in vitamin deficiency. Gingivostomatitis is an inflammatory condition of the gums and mouth which is most likely due to poor oral hygiene. Aphthous stomatitis is mouth ulcers, caused either by mechanical injury to the oral mucosa or due to some vitamin deficiency.

Throat infections like tonsillopharyngitis is commonly due to streptococcus termed as “strep throat”; common during cold or winter months and may spread to the entire members of the household. Although between a bacterium and a virus, the most common cause of sore throat is still viral in origin. However, recurrent bouts of strep throat may lead to serious complications such as acute rheumatic fever, rheumatic heart disease, subacute bacterial endocarditis (leading to a valvular heart problem). Furthermore, a hypertrophic tonsil also known as “kissing tonsils” due to recurrent tonsillitis may cause loud snoring and decrease air inflow during sleep leading to a condition known as obstructive sleep apnea. In this case, tonsillectomy is advisable to prevent nocturnal hypoxemia. Vocal cord infections also called laryngitis may also be due to viruses or bacteria. Laryngitis may be preceded by a tonsillopharyngeal infection which is left untreated hence, descending towards the voice box resulting to hoarseness or even loss of voice. A more serious throat infection is the highly contagious, diphtheria. This is a severe throat infection characterized with markedly swollen tonsils or adenoids, pharynx with exudates formation and cervical lymphadenopathy more common in infants and children. This is caused by corynebacterium diphtheriae but can be treated successfully with antibiotics. Immunization with DPT vaccine may give protection to a child because of antibody formation against the bacteria.

A surgical mouth disease is the congenital problem of incomplete fusion of the hard and soft palate or the mouth’s roof either with or without involving the lips is known as cleft palate or cleft lip. This condition is surgically corrected ideally before the child learns how to speak to avoid speech defects. In surgical repair, the “rule of 10s” ideally is followed which means surgery can be performed if the pediatric patient is around 10 pounds in weight, as early as 10 months’ old and with a hemoglobin of at least 10 mg/dl.

Gastro problems

A peptic ulcer is a sore on the lining of the stomach, which is the beginning of the small intestine. Peptic ulcers are common; as many as 1 in 10 Americans develops an ulcer sometime in his or her life. One cause of peptic ulcer is bacterial infection, but some ulcers are caused by long-term use of NSAIDs, like aspirin and ibuprofen. In a very few cases, cancerous tumors in the stomach or pancreas can cause ulcers. Unlike a common misconception, peptic ulcers are not caused by stress or eating spicy food, but these can make ulcers worse.

Abdominal discomfort is the most common symptom of an ulcer. This pain is usually a dull, gnawing ache; comes and goes for several days or weeks; occurs 2 to 3 hours after a meal; occurs in the middle of the night (when the stomach is empty); is relieved by eating; or is relieved by antacid medications. Some other symptoms include; weight loss; poor appetite; bloating; burping; nausea; and vomiting.

Call your doctor immediately if you experience sharp, sudden, persistent stomach pain; bloody or black stools; or bloody vomit or vomit that looks like coffee grounds; They could be signs of a serious problem, like perforation, a break in a blood vessel, or an obstruction.

Treatment usually involves a combination of antibiotics, acid suppressors, and stomach protectors.

Reflux Esophagitis

Reflux Esophagitis is an inflammation of the esophagus caused by a failure of the valve between the esophagus and the stomach that prevents the back flow of gastric juices. Inflammation occurs when the exposure to stomach contents is prolonged and the stomach juices refluxed have a high acid and pepsin content.

Heartburn is the characteristic symptom. Other symptoms are a feeling of food coming back into the mouth, a feeling of delay in food going down and discomfort associated with swallowing. Treatment should consider lifestyle factors, the consideration of drug treatment, and perhaps even surgery.

Anal Fissure

An anal fissure is a small tear or cut in the skin lining the anus, which causes pain, and/or bleeding. The typical symptoms of an anal fissure are extreme pain during defecation and red blood streaking the stool.

A hard, dry bowel movement can cause a tear in the anal lining, resulting in a fissure. Other causes of a fissure include diarrhea and inflammation of the area. An acute fissure is managed with treatments and over 90% will heal without surgery. Bowel habits are improved with a high fiber diet, fiber supplements, stool softeners, and plenty of fluids to avoid constipation and promote soft stools. Warm baths for 10-20 minutes several times each day are soothing and promote relaxation of the anal muscles. Occasionally, special medicated creams may be recommended. A fissure lasting longer than one month may require additional treatment.

Pharmacy PD pathway

Pharmacists play a key role in the care of patients with cancer across the continuum of care. Pharmacists practise in a variety of settings including medical oncology, haematology, palliative care and cytotoxic preparation services. In the page below, find out how some Australian pharmacists have developed their careers in these different settings and access professional development opportunities that are available through a range of avenues, including workplace-based learning, self-directed learning, workshops and seminars, short courses, professional networks, conferences and postgraduate qualifications.


Why use the PLAN resource?

This section of Cancer Learning is designed to help health professionals plan and implement an individualised professional development plan. The website provides information and resources to help in your role as:

    * an individual health practitioner, keeping you up to date with latest treatments and evidence-based practice
    * a member of a team of professionals contributing to the care of cancer patients
    * a member of a health care system that is working to achieve specific service delivery outcomes.

Who should use the PLAN resource?

This section of Cancer Learning will be useful for individual health professionals who are seeking guidance or direction in:

    * developing a professional development plan
    * identifying suitable learning activities and support.

It will be particularly helpful if you are new to cancer care or are thinking about moving into this area of practice.
Using the PLAN resource

The PLAN resource contains general information about how to develop a professional development plan that:

    * is relevant to all disciplines
    * outlines the key steps involved in completing and implementing a professional development plan
    * provides links to relevant resources and websites

Clinical Research Professional

Clinical research is a fundamental component of cancer care, providing new and improved approaches to the management of this broad range of diseases. Clinical research may focus on a range of areas, including diagnosis, treatment, follow–up and psychosocial care.

People working in clinical research come from a range of backgrounds – both clinical and non-clinical – and may work in a variety of settings, including hospitals, academic institutions and industry. Roles may be part–time or full–time. Key roles include:

    * Clinical research nurses
    * Research assistants
    * Data managers
    * Non–clinical project managers (may include clinical research associates, study coordinators, study managers and research managers)
    * Data systems developers
    * Regulatory affairs specialists
    * Health economists
    * Audit and review – Quality control management and auditors
    * Drug safety or pharmacovigilence.

Find out how some Australian professionals have developed their careers in these different settings. Your professional development needs will vary depending on your background and the role you are undertaking. Professional development opportunities related to clinical research are available through a range of avenues, including workplace–based learning, self–directed learning, workshops and seminars, short courses, professional networks, conferences and postgraduate qualifications. If you work in a large unit, you may have access to formal training programs through your place of work. If you are in a smaller unit or you are a single coordinator in a hospital setting, you may need to source activities outside your organisation.