By H. Hassan. Texas A&M University.
Concurrent administration of contraception may be needed during griseofulvin therapy fucidin 10 gm visa. The 5-fluorouracil is has fungicidal activity against dermatophytes and has been then metabolized to products that interfere with the synthesis used primarily for topical treatment of ringworm infections of fungal RNA and DNA generic fucidin 10gm without a prescription. Flucytosine has little activity and oral treatment of onychomycosis (fungal infection of against molds or dimorphic fungi and is mainly used for yeast nails) fucidin 10gm on line. It has significant activity against Candida and after drug therapy is stopped generic fucidin 10gm with mastercard, because of the time required Cryptococcus neoformans organisms. It is most often used Candida, Aspergillus, and possibly other fungal organisms, in combination with amphotericin B to treat systemic can- terbinafine is being evaluated for possible use in invasive didiasis and cryptococcal meningitis. If high doses of amphotericin B are tabolism reduces bioavailability to approximately 40%. Levels in CSF reach 60% to Common effects with oral use are headache, diarrhea, and 80% of serum levels. Oral drug may also cause skin reactions CHAPTER 40 ANTIFUNGAL DRUGS 605 and liver failure with long-term therapy of onychomycosis. Planning/Goals Hepatotoxicity is uncommon, but has occurred in people with and without preexisting liver disease and has led to The client will: liver transplant or death. Terbinafine is not recommended • Take or receive systemic antifungal drugs as prescribed for patients with chronic or active liver disease and serum • Apply topical drugs accurately aminotransferases (ALT and AST) should be checked before • Act to prevent recurrence of fungal infection starting the drug. Superficial in- Assessment fections (eg, ringworm) are highly contagious and can be spread by sharing towels and hairbrushes. Specific signs and symptoms mycoses are not usually considered contagious. Some lesions are room and request regular cleaning and inspection of air- moist; others are dry and scaling. For outpatients, assist lesions are likely to occur in perineal and intertriginous to identify and avoid areas of potential exposure (eg, soil areas. They are usually moist, inflamed, pruritic areas with contaminated by chicken, bird, or bat droppings; areas papules, vesicles, and pustules. Oral lesions are white where buildings are being razed, constructed, or reno- patches that adhere to the buccal mucosa. If exposure is unavoidable, instruct to spray areas causes a cheesy vaginal discharge, burning, and itching. For clients at risk of ex- causes chills and fever, myalgia, arthralgia, and prostration. Severe histoplasmosis may to intertriginous areas to help prevent irritation and can- also cause fever, anemia, enlarged spleen and liver, didal growth. In clients with AIDS or other immunosup- • For clients with systemic fungal infections, monitor res- pressant disorders, it often involves the central nervous piratory, cardiovascular, and neurologic status at least system (CNS) and produces mental status changes, every 8 hours. Provide comfort measures and medications headache, dizziness, and neck stiffness. Nodules and ulcers • Observe for relief of symptoms for which an antifungal also may develop in local lymphatic channels and nodes. The infection can spread to other parts of the body in • Interview outpatients regarding their compliance with immunocompromised clients. Nursing Diagnoses • Risk for Injury related to fungal infection Nursing Notes: Apply Your Knowledge • Deficient Knowledge: Prevention of fungal infection; accurate drug usage • Noncompliance related to the need for long-term therapy Harold Johnson has oral candidiasis and is being treated with • Risk for Injury: Adverse drug effects with systemic anti- nystatin 5 cc, S & S, after meals and at bedtime. What nursing fungal drugs considerations are important to ensure therapeutic effect? For example, aspergillus organisms, which can be in the ✔ Wash applicator with mild soap and rinse thoroughly air, dust, soil, and other environments, can cause serious after each use. To minimize exposure, you should avoid ✔ Avoid sexual intercourse while using the drug. However, do not take with antacids or towels, hairbrushes, or other personal items. Recurrent infections may in- ✔ With itraconazole capsules, take after a full meal for dicate inadequate treatment, reinfection, or a bacterial best absorption. With the oral suspension, take on an infection (for which an antifungal drug is not effective), empy stomach, usually by swishing in the mouth and and a different treatment may be needed. These may be signs of liver Self-Administration damage or other adverse drug effects.
From The Treatment of 105 Cases of Pediatric Enuresis with Acupuncture by Gao Jie-yin 10 gm fucidin for sale, Hu Bei Zhong Yi Za Zhi (Hubei Journal of Chinese Medicine) purchase fucidin 10 gm online, 1992 fucidin 10gm for sale, #5 purchase fucidin 10 gm on line, p. The patients were between 5-10 years old in 56 cases, between 10-14 years old in 43 cases, and more than 14 years old in six cases. These cases of enuresis were often accompanied by poor appetite, a lusterless facial complexion, and decreased essence- spirit. Compared to other children their age, these children had a lower body weight. Treatment method: The main points consisted of: Chinese Research on the Treatment of Pediatric Enuresis 121 Guan Yuan (CV 4) Qi Hai (CV 6) San Yin Jiao (Sp 6) Auxiliary points included: Shen Shu (Bl 23) Zhong Ji (CV 3) Zu San Li (St 36) Two to four points were chosen each time and these points were alternated. Hand stimulation was applied to the points, and the needles were retained for 20 minutes. The patient received two treatments each week, and 2-4 treatments equaled one course. Study outcomes: After 1-2 courses of treatment, 76 cases were cured, 29 cases improved, and two cases did not improve. From The Treatment of 53 Cases of Pediatric Enuresis Using Bai Hui (GV 20) & Pattern Discrimination by Dong Wen- yi & Wu Chao, Liao Ning Zhong Yi Za Zhi (Liaoning Journal of Chinese Medicine), 1995, #9, p. Eighteen cases were less than five years old, 27 cases were between 6-10 years old, and eight cases were between 11-14 years old. The Chinese medical pattern discrimina- tion was heart-kidney yang vacuity in 38 cases and spleen-lung qi vacuity in 15 cases. Treatment method: Bai Hui (GV 20) was the main point used in this protocol. If there was heart-kidney yang vacuity, the following points were added bilaterally: Shen Shu (Bl 23), Tai Xi (Ki 3), Shen Men (Ht 7), and 122 Treating Pediatric Bed-wetting with Acupuncture & Chinese Medicine Guan Yuan (CV 4). If there was spleen-lung qi vacuity, then San Yin Jiao (Sp 6), Zu San Li (St 36), Nei Guan (Per 6), and Qi Hai (CV 6) were added. The even supplementing-even draining method of stimulation was used on all these points except for Bai Hui which was supplemented. Needles were retained for 15 minutes and stimulated three times during this period. One treatment was given per day, and 10 treat- ments equaled one course. The least number of courses a patient was treated was one, and the most was four courses of treatment. Study outcomes: The following table shows the comparative outcome between those manifesting different patterns. RESULTS HEART-KIDNEY YANG SPLEEN-LUNG QI TOTAL NUMBER VACUITY PATTERN(%) VACUITY PATTERN(%) OF CASES (%) Cured 27 (52. Due to these functions, Bai Hui is an important addition to acupuncture and tuina protocols when treating enuresis. From The Treatment of 83 Cases of Pediatric Enuresis with Acupuncture by Xu Guang-li & Cui Da-ming, Ji Lin Zhong Yi Yao (Jilin Chinese Medicine & Medicinals), 1994, #4, p. All children were between the ages of 4-18 years old, with an average age of 7. The course of Chinese Research on the Treatment of Pediatric Enuresis 123 disease was as short as one year and as long as 11 years, with an average length of 3. Enuresis occurred 2-3 times per day in 21 cases, one time a day in 36 cases, two times a week in 17 cases, and an indefinite number of times in nine cases. Treatment method: Acupuncture points used in this protocol consisted of: Qu Gu (CV 2) Heng Gu (Ki 11) Qi Hai (CV 6) Tai Xi (Ki 3) Supplementation method was used with medium stimulation on all points except Tai Xi which was drained with strong stimulation. All points were stimulated until an aching or distention was felt, and it was recommended that the patient empty their bladder before having the treatment. The treatment was given one time per day, and 10 times equaled one course of treatment. From The Use of Acupuncture on the Yin & Yang Spring Vessels in the Treatment of 32 Cases of Pediatric Enuresis by Zhang Hui-ping, An Hui Zhong Yi Xue Yuan Bao (Academic Journal of the Anhui College of Chinese Medicine), 2000, #4, p.
While such aids have been shown to be to the need for extraction of teeth for orthodon- effective in plaque control with minimum damage tic purposes generic 10 gm fucidin, has resulted in clinicians decid- if used correctly cheap fucidin 10gm with amex, they are generally prescribed ing on a case-by-case basis without any clinical guidelines generic 10gm fucidin free shipping. In particular the use of chlorhexidene in the Currently the lack of high-quality research within chemical control of plaques has widely been dentistry generic fucidin 10 gm visa, namely the lack of RCTs, has impeded advocated, particularly in acute phases and in the identification of best dental practice and preventing post-surgical infection. There is however widespread is a tendency for it to stain (extrinsic) teeth. In recognition of these problems and concerted more recent times the addition of antimicrobial efforts to undertake more collaborative high- agents to dentifrices to aid plaque control has quality research that can inform policies and become commonplace. Stjernsward J, Stanley K, Eddy D, Tsechkovski M, als have concluded that non-surgical periodontal Sobin L, Koza I, Notaney KH. National cancer 206 TEXTBOOK OF CLINICAL TRIALS control programs and setting priorities. McDaniel TF, Miller DL, Jones RM, Davis MS, the United States: estimates from the NHANES Russell CM. Int J Adult Orthodont Orthognat Surg brushing proficiency on plaque removal. Validity issues in split- different levels of carbohydrate intake on caries mouth trials. Oral Health Surveys: the efficacy of 2 electric toothbrushes in plaque Basic Methods, 4th edn. Problems and proposals for supervised chlorhexidine mouthrinses on untreated recording gingivitis and plaque. Periodontal disease in preg- resin-modified glass ionomer cement and amalgam nancy. A blind caries and plaque formation by the chloromethyl analogue of fluorosis prevalence study of school-children in Victamine C. Chapel Hill: University of North Carolina dentifrices to arrest root carious lesions. JDental preventive effect of sugar-substituted chewing Educ (1997) 61: 37–46. Commun Dent retention and the effect on caries of fissure Oral Epidemiol (2001) 29: 175–82. Commun Dent Oral Epidemiol (2001) 29: Chichester, UK: John Wiley & Sons (1983). Design principles and efficacy of 1100, 1700, 2200, and 2800 ppm statistical considerations in periodontal clinical fluoride ion in a sodium fluoride dentifrice over trials. In: Kalberg J, Tsang K, eds, Intro- with the atraumatic restorative treatment approach duction to Clinical Trials. Searching for answers to clinical lar overdentures compared with complete dentures; questions: finding evidence on the Internet. Some aspects (SLA) implants: a prospective split-mouth com- of data analysis in dentistry. Development and evalua- depth in patients responding differently to peri- tion of the Oral Health Impact Profile. Gilthorpe MS, Griffiths GS, Maddick IH, Zamzuri trials: a description for the clinician. Hierarchical Linear between form and substance in orthodontic clin- Models: Applications and Data Analysis Methods. Acta Odontol Scand (1976) 34: Searching for answers to clinical questions: how 405–8. Int Dental J (2001) Critical appraisal of the dental literature: papers 51: 408–12. Tresaure ET, Chestnutt IG, Whiting P, McDon- Critical appraisal of the dental literature: papers agh M, Kleijnen J.
When CBC indicates excessive leukopenia or thrombocytopenia fucidin 10gm sale, Older adults are at risk for a wide range of cancers buy fucidin 10gm lowest price. In addition purchase 10 gm fucidin mastercard, exposure during pregnancy increases risks of fetal abnormalities purchase 10 gm fucidin, ectopic pregnancy, and sponta- You are working on an oncology unit and have recently become certified to administer antineoplastic medications. Guidelines to avoid adverse effects include new study that documents significant cancer with contact expo- the following: sure to a new antineoplastic agent. Avoid contact with solutions for injection by wearing gloves, eye protectors, and protective clothing (eg, dis- Reflect on: posable, liquid-impermeable gowns). If handling a powder form of a drug, wear a mask to medication if he or she feels it poses a personal health risk? CHAPTER 64 DRUGS USED IN ONCOLOGIC DISORDERS 929 effects, they should not be denied the potential benefits of • Mercaptopurine should be given in smaller doses chemotherapy on the basis of age alone. For example, older adults are more sensi- use in clients with impaired renal function may lead to tive to the neurotoxic effects of vincristine and need reduced accumulation of toxic amounts or additional renal dam- dosages of some drugs (eg, cyclophosphamide, MTX) if age. If significant renal impair- monitored; serum creatinine level is not a reliable indicator ment occurs, the drug should be discontinued or re- of renal function in older adults because of their decreased duced in dosage until renal function improves. In clients who receive high doses for treatment of os- teosarcoma, MTX may cause renal damage leading to acute renal failure. Nephrotoxicity is attributed to precip- Use in Renal Impairment itation of MTX and a metabolite in renal tubules. Renal impairment may be reduced by monitoring renal function Some antineoplastic drugs are nephrotoxic (eg, cisplatin, MTX) closely, ensuring adequate hydration, alkalinizing the and many are excreted through the kidneys. Hospital- function should be monitored carefully during therapy and ization is recommended for the first course of treatment. Asparaginase often causes azotemia reliable because these clients are often in catabolic states char- (eg, increased BUN); acute renal failure and fatal renal in- acterized by increased production of creatinine from break- sufficiency have been reported. Bleomycin is rarely associated down of skeletal muscle and other proteins. Renal effects of with nephrotoxicity but its elimination half-life is prolonged in selected drugs are as follows: clients with a CrCl of less than 35 mL/minute. Cytarabine is • Carmustine and lomustine are associated with azotemia detoxified mainly by the liver. However, clients with renal im- and renal failure, usually with long-term IV administra- pairment may have more CNS-related adverse effects, and tion and large cumulative doses. Gemcitabine should be used • Cisplatin is nephrotoxic, and acute overdosage can with caution, although it has not been studied in clients with cause renal failure. Mild proteinuria and hematuria with repeated doses, cisplatin is given at 3- or 4-week were commonly reported during clinical trials, and hemolytic- intervals and renal function tests (eg, serum creatinine, uremic syndrome (HUS) was reported in a few clients. HUS blood urea nitrogen [BUN]) and serum electrolytes may be manifested by anemia, indications of blood cell break- (eg, sodium, potassium, calcium) are measured before down (eg, elevated bilirubin and reticulocyte counts), and renal each course of therapy. The drug should be stopped immediately if HUS lowed to return to normal before another dose is given. Nephrotoxicity may be reduced by the use of amifostine or IV hydration and mannitol. Some antineoplastic drugs are hepatotoxic and many are me- • Ifosfamide may increase BUN and serum creatinine, tabolized in the liver. In the presence of impaired hepatic but its major effect on the urinary tract is hemorrhagic function, risks of further impairment or accumulation of toxic cystitis, manifested by hematuria. Dosage reduction is needed with duced by the use of mesna, vigorous hydration, and de- some drugs and hepatic function should be monitored with laying drug administration if a predose urinalysis shows most. No dosage reduction is recommended indicate decreased ability to metabolize drugs. Clients with with mild impairment (CrCl 40 to 60 mL/minute), and metastatic cancer often have impaired liver function. He- • Melphalan should be reduced in dosage when given patic effects of these and selected other drugs are as follows: IV, to reduce accumulation and increased bone marrow • Asparaginase is hepatotoxic in most clients and may toxicity.