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The drug is nearly always used in combination with ribavirin because this increases the effectiveness of therapy. Broad-spectrum antibiotics are more likely to cause superinfections because they kill many microbial species, which sometimes includes host flora. Describe how the pharmacotherapy of tuberculosis differs from that of bacterial infections. Furthermore, withdrawal symptoms from this drug are generally mild and its onset may be delayed 1 to 2 weeks. A third difference in therapy is that antimycobacterial drugs are used extensively for preventing the disease, in addition to treating active infections. Sulfacetamide (Cetamide, Others) is available as a solution to treat conjunctivitis and other ocular infections. Felbamate (Felbatol): Approved in 1993, felbamate is an oral agent that is effective against most types of seizures. The iminostilbenes are a small class of two drugs that have important applications to seizure management. These agents are used when the anxiety or sleep disorder is severe or when the condition is unresponsive to nonpharmacologic therapies. They have the ability not only to correct dysrhythmias, but also to worsen or even create new dysrhythmias. Like the treatment of major depression, nonadherence with drug therapy is a serious problem in patients with bipolar disorder. When therapy is discontinued, doses of the cholinesterase inhibitors should be tapered gradually. Lamotrigine is one of the preferred drugs for managing epilepsy in pregnant women. It is important that disinfecting agents with heavy metal content not be used to disinfect the skin prior to the insertion of the epidural catheter because these have been associated with swelling and edema. For example, administration of a sympathomimetic will shrink the nasal mucosa, relieving nasal stuffiness associated with the common cold. All have analgesic properties: They are widely prescribed to treat patients with mild to moderate pain. Lifespan and Diversity Considerations: Supervise young children over 5 years of age to ensure the appropriate use of the inhaler. Polio Pathophysiology: Poliomyelitis was the leading cause of permanent disability in the era just prior to vaccines. The body, therefore, does not lose potassium, as is the case with the thiazide and loop diuretics. High doses of dandelion should be discouraged due to potential interactions with prescription medications. As with other lipid-lowering drugs, maximum therapeutic effects may take a month or longer to achieve. The process of hemostasis, however, is a positive feedback mechanism in which small amounts of clotting lead to additional clotting. Giving other drugs that affect acetylcholine release, such as anesthetics or neuromuscular blockers (see Chapter 30), can result in profound apnea and prolonged muscle paralysis. From a pharmacologic perspective, one of the most important nonspecific defenses is inflammation. In cases where penicillin G is the only effective antibiotic in a patient with a known allergy to the drug, penicillin may be given via a desensitization procedure whereby the dose begins very small and gradually increases. The drug is well tolerated, with nausea, vomiting, and diarrhea being the most common adverse effects. The pump consists of a small metal disk that is surgically placed under the skin at the waistline. Approximately 90% of patients who have narcolepsy experience cataplexy, a bilateral loss of muscle tone and emotion. Various reproductive abnormalities have been reported with systemic azoles, including menstrual irregularities, gynecomastia in males, and drops in plasma testosterone levels. Although not a controlled substance, carisoprodol can cause physical dependence and has been abused by recreational drug users.
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Sympathomimetics cause vasoconstriction, immediately raising cerebral, coronary, and systemic blood pressure. Implementation Interventions and (Rationales) Ensuring therapeutic effects: Patient-Centered Care Teach the patient, family, or caregiver how to monitor the pulse and blood pressure. Hypertension increases afterload, forcing the heart to work harder to pump blood to the tissues. Rivastigmine is contraindicated in patients with hypersensitivity to rivastigmine or carbamate. Serum flecainide levels should be monitored, especially in patients with renal or hepatic impairment, and maintained between 0. The effectiveness of the vaccine in producing immunity in adults declines with age. Persons reporting egg allergy have a very low risk of allergic reaction but it is recommended that these patients be observed for 90 minutes following immunization. Continue to reorient the patient to surroundings frequently in the postoperative period. Often, patients begin anticoagulation therapy with heparin and are switched to warfarin when their condition stabilizes. Orphenadrine (Banflex, Myophen, Norflex): Orphenadrine is an older drug that was approved in 1959. The implementation of the ketogenic diet can produce positive effects in some patients by decreasing seizure activity. This may be accomplished by directly replacing dopamine, decreasing the breakdown of dopamine, increasing the release of dopamine from neurons, or activating dopamine receptors. Phenytoin increases the metabolism of corticosteroids, warfarin, and oral contraceptives, thus rendering these drugs less effective. This is mostly because of the emergence of numerous streptomycin-resistant strains of M. Neurotransmitters such as serotonin, norepinephrine, and endogenous opioids (endorphins and enkephalins) inhibit pain transmission. Patient and Family Education: Take this medication exactly as instructed, and do not discontinue it without consulting the health care provider because seizures may result. A specific class of drugs, the thrombolytics, has been developed to dissolve lifethreatening clots. As therapy continues with loop diuretics, some patients become less responsive, a phenomenon known as diuretic resistance. The cilia have a wavelike motion that "sweeps" the pathogens and particulate matter upward toward the oropharynx, where they are swallowed when a person coughs or clears the throat. This includes immunocompromised patients, long-term care residents, health care workers, and close personal contacts of high-risk patients. Ideally, nondrug strategies should be tried before additional medications are added to the drug regimen. Used as adjunctive therapy for patients who have allergies and severe, persistent asthma. Leukotrienes are associated with inflammation and are responsible for some of the sneezing, nasal itching, and congestion characteristic of allergic rhinitis. These drugs cause a number of dermal reactions ranging from urticaria to photosensitivity and exfoliative dermatitis. It is also approved to supplement anesthesia produced by lowpotency drugs such as nitrous oxide. Electrolytes are essential to many body functions, including nerve conduction, membrane permeability, muscle contraction, water balance, and bone growth and remodeling. Hydromorphone produces less nausea but more orthostatic hypotension than morphine. Drugs that may increase pramipexole levels include levodopa, cimetidine, ranitidine, diltiazem, verapamil, and quinidine.
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This drug is pregnancy category B; the category changes to D if used in high doses or close to term. The implementation of hydrotherapy increases blood circulation to the site of the muscle spasm in an effort to relieve pain. Isosorbide mononitrate (Imdur, Ismo, Monoket): Approved in 1991, isosorbide mononitrate is an active, long-acting metabolite of isosorbide dinitrate. The answer to this is highly individualized, but the most common answer is for the lifetime of the patient. Asymptomatic bacteriuria is present in 30% to 50% of older adults, and such widespread therapy would promote the emergence of resistant strains. Imbalances may occur in any or all electrolytes, causing symptoms such as tachycardia, dysrhythmias, nausea, and vomiting. Thiabendazole (Mintezol): Like mebendazole and albendazole, this drug belongs to the benzimidazole chemical class. Drug Interactions: Oral anticoagulants, including warfarin or heparin, may potentiate lepirudin activity. As stress reduction techniques, they may be useful for migraine prevention, especially by improving sleep quality. Because these medications have a brief half-life and are rapidly destroyed in the blood, stopping the infusion normally results in the rapid termination of adverse effects. From what you learned in Chapter 43, compare and contrast the humoral and cell-mediated responses to an antigen. To be most effective, therapy should begin before joint damage has occurred, usually prior to age 2. Reserpine is only prescribed when patients are unable to tolerate safer antihypertensives. Contraindications/Precautions: Diazepam should not be administered to patients with depressed vital signs, those in shock, or those with acute alcohol intoxication. They offer the advantage of not causing dependence, although their use is often limited by their anticholinergic adverse effects. The animal forms antibodies against the human immune cells, which can be collected and purified. The functions of endogenous albumin are to maintain plasma osmotic pressure and to bind certain substances traveling through the blood, including fatty acids, hormones, enzymes, and a substantial number of drug molecules. If both humans and bacteria conduct continuous protein synthesis, why are antibiotics that inhibit protein synthesis not also toxic to human cells The answer lies in differences in the structures of the bacterial and human ribosomes. Patients with limited income or who do not have health insurance are at high risk for not purchasing the drugs after receiving a prescription. The supply of blood products depends on human donors and may require careful crossmatching to ensure compatibility between the donor and the recipient. Drugs Similar to Alteplase (Activase) Other thrombolytics include reteplase, streptokinase, and tenecteplase. The client who is receiving bumetanide (Bumex) is instructed to watch for symptoms associated with electrolyte imbalances. An otic suspension (Ciprodex otic) is a combination of ciprofloxacin and dexamethasone to treat acute otitis media and acute otitis externa in children ages 6 months and older. The spectrum of activity of daptomycin includes a wide variety of gram-positive pathogens. Occurring in both men and women, symptoms include dysuria and increased voiding urgency and frequency.
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The mechanism by which diuretics increase the excretion of water and electrolytes, specifically where and how the kidney is affected, differs among the various classes of diuretics. The most common adverse effects are orthostatic hypotension, dizziness, and headache. Ropivacaine (Naropin): Ropivacaine is a newer local anesthetic agent approved in 1996 that is used in epidural anesthesia and postoperative pain management. Bipolar disorder, once known as manic-depression, is a common and serious psychiatric disorder. Blockade of beta-adrenergic receptors in the heart causes bradycardia, which may not be well tolerated in patients with preexisting cardiac disease, and hypotension may cause dizziness and possible fainting. Parenteral lidocaine is administered to treat life-threatening ventricular dysrhythmias (see Chapter 40). Alcohol use during abacavir therapy should be avoided, because blood levels of the antiretroviral can increase as much as 40%. The first drug developed in the penicillinase-resistant class, called methicillin, was removed from the U. For terminal cancer pain, obtain instructions from the oncologist or hospice provider on any dose restrictions. Its longer duration has the potential to extend drowsiness into the morning hours. The species of pathogenic fungi that attack hosts with healthy immune defenses are often distinct from those that infect immunocompromised patients. Ascariasis: Ascariasis, caused by the roundworm Ascaris lumbricoides, is the most common helminth disease worldwide, affecting more than 1. If a patient does not respond to these agents with relaxation or sleep, it indicates a serious underlying psychiatric or medical condition that requires further assessment by behavioral specialists. The alpha2 agonists have a tendency to cause excessive sedation, dizziness, and orthostatic hypotension, which can be especially troublesome in older adults. Although safer alternatives have since been discovered, quinine is still used for chloroquine-resistant Plasmodia, in combination with other antimalarials. Apply the nursing process to care for patients receiving pharmacotherapy for angina and myocardial infarction. H1-receptor antagonists, also called antihistamines, are drugs that selectively block histamine from reaching its H1 receptors, thus alleviating allergic symptoms. The half-lives of the statins vary from 20 hours (rosuvastatin) to less than an hour (fluvastatin). Apply the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system. Worsening symptoms of depression must be reported immediately because these may indicate that the drug is not working or that the patient is not compliant with pharmacotherapy. The beta-lactamase inhibitors are ineffective when used alone and therefore are always used in fixed combination formulations with other drugs. He is very supportive of her and understanding of her feelings of resentment but does not realize that she is experiencing anxiety and insomnia. Patients with paranoia may feel that drug therapy is a plot by others to poison them and keep them from thinking clearly. Severe diarrhea, especially containing mucus, blood, or pus, or decreased urine output should be reported immediately. First, immediate treatment is indicated because the consequences of infection can be serious or fatal. Patients should increase their amount of dietary potassium, and potassium supplements may be prescribed. Caution should be used in treating patients with serious renal impairment: Dosage should be reduced. Without fibrinogen, 488 a nucleus, a single erythrocyte hemopoiesis, 486 can carry as many as one billion hemostasis, 487 molecules of oxygen. Most effective when taken before symptoms develop, fexofenadine reduces the severity of nasal congestion, sneezing, and tearing of the eyes.
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Women who are pregnant or who may become pregnant within the first 3 months after vaccination should return to the health care provider for follow-up. Therapeutic Effects and Uses: Approved in 1996 for the treatment of allergic rhinitis, fexofenadine is a second-generation H1-receptor antagonist with an effectiveness that is equivalent to that of diphenhydramine. For malarial prophylaxis, it is combined with pyrimethamine and marketed as Fansidar. The drug should be taken on an empty stomach, because food reduces its bioavailability. Patient and Family Education: Report the following symptoms to the health care provider: difficulty breathing, changes in urination (other than brown discoloration), chest pain, cough, numbness or tingling of fingers or toes, vision changes, unusual bleeding, yellowing of skin, or light-colored stools. The drug acts by blocking serotonin reuptake and by demonstrating partial agonist action at serotonin receptors. Certain populations of patients, however, are treated when asymptomatic bacteriuria is discovered. When the loop diuretics block this symporter, sodium and chloride are prevented from being reabsorbed, and diuresis is increased. The use of specific adjuvant analgesics and their doses are often guided by experience, rather than controlled clinical trials, and the majority of these drugs are prescribed offlabel for their analgesic effects. Opium is one of the oldest known natural remedies; it has been used to relieve pain for thousands of years. A detailed discussion of benzodiazepines is found in Chapter 26, along with a prototype feature for diazepam. Primary metabolism Primary excretion Onset of action Duration of action Adverse Effects: Nifedipine is well tolerated and serious adverse effects are not common. It is a prodrug that is metabolized by hepatic enzymes to its active form, ramiprilat. Chemical mediators of inflammation include histamine, leukotrienes, bradykinin, complement, and prostaglandins. A maintenance phase follows, typically with azole antifungals taken once weekly (fluconazole) or once monthly (itraconazole) for 6 months. Adults, however, may receive a booster vaccine (Tdap if they are anticipating contact with patients with pertussis. To be of benefit in reducing high serum cholesterol, nutritionists recommend a daily intake of plant sterols of 2 to 3 grams. During the time a fibrin clot is forming, the surrounding damaged tissue secretes anticoagulant chemicals that limit the spread of the clot to the area of injury. The final formed elements of the blood are thrombocytes or platelets, which are actually fragments of larger cells called megakaryocytes. They are indicated for short-term therapy of insomnia, approximately 4 weeks, although in clinical practice they may be used for longer periods. Provide additional health care referrals as required for a support group, counseling, or respite care. Nurses serve essential roles in providing education about this disorder to their patients and stressing the importance of adherence. It is believed that a pathogen, such as a latent virus, may trigger an abnormal autoimmune response in patients who are genetically susceptible. Consciousness is retained during the seizure, although the patient may express amnesia about the event. Evidence: Research has shown that omega-3 fatty acids may reduce the incidence of cardiovascular disease. Preventive treatment is recommended for headaches that occur three or more times a month. Patient and Family Education: Maintain strict adherence to the established drug regimen and do not change the drug dosage without the approval of the health care provider. For some infections, treatment delays of just a few hours or days can lead to poorer patient prognosis and even death. The nurse should teach that local health authorities should be contacted if the diarrhea worsens, is accompanied by severe abdominal pain or fever, or if blood is present in the stool.
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Atovaquone-proguanil (Malarone): the fixed-dose combination drug Malarone was approved in 2000 for the prevention and treatment of malaria. The electrical shock momentarily stops all electrical impulses in the heart, both normal and abnormal. Single-dose or short-course therapy is often preferred for patient convenience and to maximize adherence. Instead of increasing the dosage, a different antipsychotic drug may be substituted. The cure rate for onychomycosis is 50% to 70%, which is higher than that for griseofulvin. The nasal spray formulation of ipratropium was approved in 1995 for the symptomatic relief of rhinorrhea associated with the common cold and perennial rhinitis. In most cases, the benefits of treating pregnant women who have major depression with fluoxetine are greater than the potential risks to the neonate. Because heparin is derived from animal sources, hypersensitivity reactions are possible. This not only extends the anesthetic duration but it also prevents the anesthetic from reaching the circulation too quickly, which could cause systemic toxicity. Seraphina Alvarez, age 55, is an elementary school teacher who has planned on retiring at the end of this academic year. Two atypical antidepressants are used for anxiety disorders: Duloxetine (Cymbalta). Some of the newer antifungals may be used for superficial, subcutaneous, or systemic infections. A positive urine culture, with or without urinary tract symptoms, is an indication for removal of the catheter (if feasible) and initiation of pharmacotherapy. As nephrons "die," however, the remaining healthy ones have the ability to compensate by increasing their filtration capacity. Choices for prophylaxis include administration of antibiotics at low doses either on a daily or three-times-per-week schedule. It is more selective for aldosterone receptors and has a very low incidence of endocrine-related adverse effects. Concurrent administration of verapamil with buspirone can triple the plasma concentration of buspirone. Joint and muscle pain, diarrhea, rash, and pain at the infusion site are common adverse effects. Each lymph node serves as a minifilter, removing up to 99% of the foreign agents entering the node. A rapid, regular heartbeat in which the atria may beat 250 to 350 times per minute. Ticagrelor (Brilinta): Approved in 2011, ticagrelor is a new coagulation modifier indicated to reduce the risk of thromboembolic events in patients with acute coronary syndrome. Anxiolytics such as buspirone (BuSpar) or benzodiazepines are used to control anxiety. Explain the importance of patient drug adherence in the pharmacotherapy of psychoses. These drugs act by very different mechanisms than tramadol and are much less frequently prescribed. The target for this pathogen is the lymph nodes, and infants have mild symptoms, such as low-grade fever. Verapamil also dilates the coronary arteries, an action that is important when the drug is used to treat angina.
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Tachydysrhythmias are disorders exhibiting a heart rate greater than 100 beats/minute. The fibrin strands form an insoluble web over the injured area to stop blood loss. Antibacterial drugs that inhibit this high rate of protein metabolism can either kill the bacterial cell or slow its replication rate. She also has guilt feelings that she did not do all she could or should have done to raise her daughter to be a responsible parent. This results in diminished mucus production and edema, thus reducing airway obstruction. Abnormally low numbers of platelets, or thrombocytopenia, can result in serious delays in blood clotting. Platelets have an affinity for the damaged vessel: They become sticky and adhere to each other and to the injured area. Contraindications/Precautions: Potassium chloride is contraindicated in patients with hyperkalemia, systemic acidosis, severe dehydration, extensive tissue breakdown as in severe burns, or adrenal insufficiency. In those with healthy immune systems, the primary infection lasts a few weeks and then subsides. Like other benzodiazepines tolerance develops to their therapeutic effects, and all have the potential for physical and psychological dependence. The macrolides are preferred drugs for the prophylaxis of recurring rheumatic fever in patients who are allergic to penicillins. A black box warning states that antithymocyte globulin should only be used by physicians experienced in immunosuppressive therapy. Prophylactic dosing begins 1 week before entering an endemic area and continues for 4 weeks after leaving. Therapeutic Effects and Uses: Procaine is used for spinal, epidural, and peripheral nerve blocks through injection or infiltration. Signs and symptoms such as bradycardia, nausea and vomiting, anorexia, visual changes, depression, changes in level of consciousness, fatigue, dizziness, or syncope should be reported. Drugs Similar to Zolpidem (Ambien, Edluar) Other drugs in this category include buspirone, eszopiclone, ramelteon, and zaleplon. Drugs Similar to Ciprofloxacin (Cipro) Other fluoroquinolones include besifloxacin, gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin. Because of their broad spectrum, superinfections due to Candida albicans are relatively common. To circumvent major problems with mobility or posture, administration of botulinum toxin is often limited to the small muscle groups. The second-generation, or atypical, antipsychotics have become preferred drugs for the pharmacotherapy of severe mental illness. The female adult worm, which can grow to over 40 cm in length, lays as many as 240,000 eggs daily, which enter the feces. The potency of inhalation anesthetics is described by the minimum alveolar concentration: the concentration of drug vapor in the alveoli that prevents a motor response in 50% of subjects when exposed to a painful stimulus. The drug has only a 3-hour half-life and therefore must be administered several times daily. It has the ability to reduce the nausea and vomiting adverse effects of opioids and produces sedation by reducing anxiety and motor activity. Blood dyscrasias such as leukopenia, agranulocytosis, and aplastic anemia are rare, though serious, adverse effects. Concurrent use of atenolol with other antihypertensives may result in additive hypotension. Because atorvastatin is not excreted by the kidneys, no adjustment in dosage is necessary in patients with renal impairment. The drug delays digestion, increases smooth muscle tone in the intestinal tract, and slows peristalsis in the colon, leading to constipation. Pseudomembranous colitis is an additional rare, though serious, severe adverse effect. Upon further assessment and conversation, she states that her mother died of breast cancer when she was young. This involves an initial or induction phase of therapy during which the actively dividing mycobacterial cells are killed, and a continuation phase in which the remaining dormant mycobacteria are eliminated. The length of protection has been shown to be 5 to 8 years, although it is predicted that antibody levels may provide protection for 20 years or longer.
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For example, tinea capitis is an infection of the scalp, and tinea pedis is an infection of the feet. Mechanism of Action: Spironolactone acts by inhibiting the actions of aldosterone in the distal tubule and collecting ducts of the nephron. Although not usually painful, the curling is progressive and can restrict motion and use of the hand. To ensure that this client does not experience adverse effects related to the acetylation process, both and will be monitored frequently. These areas, known as ectopic foci or ectopic pacemakers, may send impulses across the myocardium that competes with those from the normal conduction pathway. A first-dose effect may occur with a significant drop in blood pressure with the first few doses. The skeletal muscle relaxants used as surgical adjuncts are presented in Chapter 18. A major advantage of oxcarbazepine over carbamazepine is that drug interactions Mechanism of Action: Ethosuximide depresses the motor cortex by delaying the calcium influx into the neuron. Serious adverse effects may occur if the drugs are not used properly; therefore, these patients will require frequent assessment and monitoring to ensure that the goal of normal coagulation is being achieved, without serious adverse events. For patients not taking long-term control therapy, select the treatment step based on severity. I try to spend my nights at the shelter, but it is sometimes too crowded and I sleep on the street. Mesoridazine (Serentil), thiethylperazine (Torecan), and promazine (Sparine) are firstgeneration phenothiazines that have been discontinued in the United States. In patients with healthy immune systems, the disease is self-limiting and no antiprotozoan drugs are necessary. Many practitioners routinely prescribe pyridoxine during isoniazid therapy to prevent the development of peripheral neuropathy. Cardio: Heart rate regular without murmurs; blood pressure 118/74 mmHg; all pulses present equal and strong in all extremities; no respiratory distress-regular, clear, breath sounds; audible bowel sounds in all four quadrants. Pharmacotherapy with nephrotoxic drugs can also lead to either acute or chronic renal failure. Like the loop diuretics, thiazides can increase serum levels of uric acid, although this is only clinically significant in patients with a history of gout. Each plasma cell is capable of manufacturing antibodies at an astounding rate, as many as 2,000 antibodies each second. Rifampin increases the metabolism of fluconazole; thus, the dose of fluconazole may need to be increased to maintain therapeutic plasma levels. In 2007, Tindamax was approved to treat bacterial vaginosis, the most common vaginal infection in the United States. Parkinsonism induced by antipsychotic drugs may include tremor, loss of fine motor skills, muscle rigidity, stooped posture, and a shuffling gait. In most cases, anti-infectives are given when there is clear evidence of infection. Mechanically ventilated patients may receive lorazepam infusions to manage excessive anxiety and agitation that are characteristic of being connected to this device. Oral vitamin B12 formulations are available primarily as vitamin supplementation, although they are only effective in patients who have sufficient amounts of intrinsic factor and normal absorption in the small intestine. Because there are only six unique drug classes of antiretroviral agents, this option is not always possible. Patient and Family Education: Avoid vaccinations while receiving treatment with this drug and for 3 months after completion of treatment. It is not effective at treating symptoms of shingles or postherpetic neuralgia once they develop. When possible, warfarin should be discontinued or the dosage lowered before dental or elective surgical procedures. Because the drug inhibits the synthesis of sterols, including testosterone, ketoconazole has been used to treat advanced prostate cancer, although this is not a U.
