By X. Deckard. California State University, Channel Islands.
Increasingly cheap 25mg zoloft, highly active dation may change in the future zoloft 100mg low cost, because acarbose purchase 25mg zoloft overnight delivery, antiretroviral therapy (HAART) is being used for pregnant miglitol discount zoloft 25 mg mastercard, and metformin are thought to have little risk women. Glyburide has been used in some women a nucleoside reverse transcriptase inhibitor (eg, zidovudine, after 11 weeks of gestation. However, its use is not rec- lamivudine, or didansoine), a non-nucleoside reverse tran- ommended during the last few weeks of pregnancy. Women with HIV infection or AIDS should be encour- • Insulin is the antidiabetic drug of choice during preg- aged to avoid pregnancy. Human insulin should be used because it is least Urinary tract infections commonly occur during preg- likely to cause an allergic response. Because insulin re- nancy and may include asymptomatic bacteriuria, cystitis, quirements vary according to the stage of pregnancy, and pyelonephritis. It is should be treated in pregnant women because of its associa- especially important that sufﬁcient insulin is given to tion with cystitis and pyelonephritis. Uncontrolled acidosis is uria and UTIs are also associated with increased preterm likely to interfere with neurologic development of the deliveries and low birth weights. At the same time, careful dietary control and other and nitrofurantoin are commonly used drugs. Poor asthma control time, termination of the pregnancy reverses the diabeto- during pregnancy is considered more detrimental to a fetus genic hormonal changes and decreases insulin require- than treatment with available drugs. Commonly used drugs include orally inhaled beta2 ag- on frequent measurements of blood glucose. Once the onists (eg, albuterol or metaproterenol) and anti-inﬂammatory insulin requirement is stabilized, the client may be able agents (eg, cromolyn or beclomethasone). CHAPTER 67 DRUG USE DURING PREGNANCY AND LACTATION 973 Hypertension Nursing Notes: Ethical/Legal Dilemma Chronic hypertension (hypertension beginning before con- ception or up to 20 weeks of pregnancy) is associated with increased maternal and fetal risks. Thus, appropriate manage- As a nursing student, you are assigned to a unit where abortions ment is mandatory. Your religious and family upbringing has taught avoiding excessive weight gain, sodium restriction, increased you that abortion is an immoral act. Do you have a right to refuse to participate in an experience involving abortion as a student? If drug therapy is required, so, how might you approach your instructor about this issue? Alternatives include labetalol and other beta blockers, cloni- dine, hydralazine, isradipine, nifedipine, and prazosin. With beta blockers, fetal and neonatal bradycardia, hypotension, hypoglycemia, and respiratory depression have been re- ABORTIFACIENTS ported. As a result, some authorities recommend avoiding the drugs during the ﬁrst trimester and stopping them 2 to 3 days Abortion is the termination of pregnancy before 20 weeks. Medical Opinions seem divided on the use of angiotensin-converting abortion may be induced by prostaglandins and an antiproges- enzyme (ACE) inhibitors. Some sources say the drugs are tin (Drugs at a Glance: Abortifacients, Prostaglandins, To- contraindicated during pregnancy; others say they can be colytics, and Oxytocics). Prostaglandins may be used to used during the first trimester but should then be discontin- terminate pregnancy during the second trimester. The reproductive system, prostaglandins E and F are found in same effects would probably occur with angiotensin II the ovaries, myometrium, and menstrual ﬂuid. They stimulate receptor blockers (ARBs), because they also act on the uterine contraction and are probably important in initiating and renin–angiotensin system. Drug preparations of Although diuretics are commonly used in the treatment of prostaglandins are capable of inducing labor at any time dur- hypertension, they should not be given during pregnancy. Misoprostol, a prostaglandin developed to They decrease blood volume, cardiac output, and blood pres- prevent nonsteroidal anti-inﬂammatory drug–induced gastric sure and may cause ﬂuid and electrolyte imbalances, all of ulcers (see Chap. Mifepristone is a progesterone antagonist used to termi- Seizure Disorders nate pregnancy during the first trimester. A prostaglandin is given approximately 48 hours after the mifepristone to Although antiepileptic drugs (AEDs) are known teratogens, augment uterine contractions and ensure expulsion of the they must often be taken during pregnancy because seizures conceptus. Despite the usually good outcomes, the incidence of birth defects is 2 to TOCOLYTICS 3 times higher in fetuses exposed to AEDs than in those not exposed.
Interviews are not the time to make a fashion statement: the more acceptable you appear to the interviewee buy 50 mg zoloft amex, the more likely you will be to get good quality informa- tion order zoloft 100mg free shipping. This is the time to set any ground rules (see off the record; non-attributable information) buy generic zoloft 25 mg line. These should be negotiated before you start rather than when the questions start getting difficult order zoloft 100 mg free shipping. Keep the interviewee on track, 65 THE A–Z OF MEDICAL WRITING though sometimes desperate measures may be needed, such as knocking over a glass of water. Using a tape recorder will free you to concentrate on the business in hand – though keep some written notes as well, just in case there is a systems failure. Interviewees will often ask to see a copy of what you have written before it is published. The danger with this is that they will try to get rid of their bright, clear quotes and try to put back their posh overcoat (see putting on the posh overcoat). On the other hand, passing your copy to them will probably pick up one or two errors of fact. Use your discretion: a sensible compromise is to read what you have written over the phone. In that way they can pick up errors but will have no time to fiddle with the style. Wherever possible go through the information as soon as the interview is over. When you come to write, you should be in a position to take out of it, from memory, what you need. Avoid where possible writing up transcripts: this takes up huge amounts of time. The test of a good interviewer is not what the interviewee thinks, but the quality of the information elicited, or the liveliness of the quotes. Introductions Many people believe that the role of the first part of a piece of writing is to introduce the reader to what you are going to say so that the reader can decide whether or not to become involved. This probably stems from school essays and has a slightly old-fashioned feel to it. Intro This is the term used by journalists to describe the first sentence of a news story. It is based on the assumption that your best chance of being read is to put your finest information into the first sentence. Once you have done that, you can put in all the qualifying information, in order of importance. The occasional (or perhaps more than occasional, depending on the papers you buy) lapses into extremity should not distract from the fact that this is a sensible approach, and we should adopt it for many types of writing up to about 400 words – particularly letters, e- mails and executive summaries (see marketing). Much of what we call jargon today is actually a technical language that has a precise meaning for fellow professionals, but is mean- ingless to outsiders. All have meanings within their group and are useful because they can describe complex notions and ideas in a simple way. The difficulty comes when these terms are used inappropriately to the wrong audiences. Jargon (as opposed to gobbledegook) has proliferated because of the increasing tendency to write one document for a number of different audiences (see effective writing), or even for the wrong audience (see false feedback loop). The answer is not to get rid of all 67 THE A–Z OF MEDICAL WRITING these uncommon words completely, but to make sure that we use the right language for our audience. Jokes It is difficult to make these work in the unforgiving black and white of the printed word. Journalese Doctors often use this word as a general term of abuse for vulgar and sensational writing.
If the contents are not mixed well every time a dose is given buy 100 mg zoloft fast delivery, the liquid vehicle will be given initially buy zoloft 50 mg free shipping, and the concentrated drug will be given later discount zoloft 25mg free shipping. That is order 100 mg zoloft fast delivery, underdosage will occur at ﬁrst, and little if any therapeutic beneﬁt will result. Over- dosage will follow, and the risks of serious toxicity are greatly in- creased. Calibrated medication cups or measuring teaspoons or tablespoons are acceptable. Regular household teaspoons and tablespoons used for eating and serving are not acceptable because sizes vary widely. Rapid administration must be avoided be- piggybacked into a primary IV line, the primary IV solu- cause it may produce myocardial depression, hypotension, cardiac tion must be normal saline or the line must be ﬂushed with arrhythmias, and even cardiac arrest. To give carbamazepine and phenytoin suspensions by naso- Absorption is slow and decreased, possibly because of drug ad- gastric (NG) feeding tube, dilute with an equal amount of herence to the NG tube. Dilution and tube irrigation decrease such water, and rinse the NG tube before and after administration. To give oxcarbazepine suspension, use the 10-mL oral dos- For accurate measurement and a reminder that the suspension is ing syringe provided by the manufacturer with each bottle. The suspension is stored at room temperature Also check expiration date. When the drug is given on a long-term basis to prevent Therapeutic effects begin later with antiseizure drugs than with seizures, observe for a decrease in or absence of seizure activity. Optimum therapeutic beneﬁts of phenytoin occur approximately 7–10 days after drug therapy is started. When the drug is given to stop an acute convulsive seizure, IV lorazepam is the drug of choice for controlling an acute seizure activity usually slows or stops within a few minutes. Central nervous system (CNS) effects—ataxia, dizziness, These effects are common, especially during the ﬁrst week or two drowsiness, double vision of drug therapy. Gastrointestinal effects—anorexia, nausea, vomiting These common effects of oral drugs can be reduced by taking the drugs with food or a full glass of water. Hypersensitivity reactions—often manifested by skin dis- These may occur with almost all the antiseizure drugs. Some are orders such as rash, urticaria, exfoliative dermatitis, Stevens- mild; some are potentially serious but rare. These skin reactions Johnson syndrome (a severe reaction accompanied by headache, are usually sufﬁcient reason to discontinue the drug. About arthralgia, and other symptoms in addition to skin lesions) 25–30% of patients with allergic reactions to carbamazepine are likely to be allergic to oxcarbazepine. Blood dyscrasias—anemia, leukopenia, thrombocytopenia, Most antiseizure drugs decrease blood levels of folic acid, which agranulocytosis may progress to megaloblastic anemia. The other disorders indi- cate bone marrow depression and are potentially life threatening. They do not usually occur with phenytoin, but may infrequently occur with most other antiseizure drugs. Respiratory depression This is not likely to be a significant adverse reaction except when a depressant drug, such as lorazepam, is given IV to control acute seizures, such as status epilepticus. Even then, respiratory de- pression can be minimized by avoiding overdosage and rapid administration. Liver damage—hepatitis symptoms, jaundice, abnormal Hepatic damage may occur with phenytoin, and fatal hepatotox- liver function test results icity has been reported with valproic acid. Gingival hyperplasia Occurs often with phenytoin, especially in children. Hypocalcemia May occur when antiseizure drugs are taken in high doses and over long periods (continued) CHAPTER 11 ANTISEIZURE DRUGS 199 NURSING ACTIONS RATIONALE/EXPLANATION i. Hyponatremia May occur with carbamazepine and oxcarbazepine, especially if taken concurrently with sodium-losing diuretics (eg, furosemide, hydrochlorothiazide). Usually transient and levels return to nor- mal with ﬂuid restriction or dose reduction. Lymphadenopathy resembling malignant lymphoma This reaction has occurred with several antiseizure drugs, most often with phenytoin.