By Q. Bradley. University of Maryland University College. 2018.
Thus order famvir 250mg online, you should consult a blood levels and more normal body metabolism buy 250mg famvir with amex. These adverse effects result from excessive remedies famvir 250mg without a prescription, cold remedies buy famvir 250mg on-line, decongestants). In addition, stimulation and may indicate that drug dosage or intake you should avoid the herb ephedra (also called ma huang of other stimulants needs to be reduced. Specific factors include Drug Selection the following: Levothyroxine is the drug of choice for thyroid hormone re- 1. Dosage must be individualized to approximate the placement because of uniform potency, once-daily dosing, amount of thyroid hormone needed to make up the and low cost. The goal of treatment with levothyroxine is to deficit in endogenous hormone production. Dosage is CLIENT TEACHING GUIDELINES Propylthiouracil or Methimazole General Considerations Self-Administration ✔ These drugs are sometimes called antithyroid drugs be- ✔ Take at regular intervals around the clock, usually every cause they are given to decrease the production of thyroid 8 hours. Some drugs contain iodide, which can in- ✔ crease the likelihood of goiter and the risk of adverse restrict amounts of seafood or iodized salt. These effects from excessive doses of iodide (eg, some cough sources of iodide may need to be reduced or omitted dur- syrups, asthma medications, and multivitamins may con- ing antithyroid drug therapy. CHAPTER 25 THYROID AND ANTITHYROID DRUGS 361 gradually increased at approximately 2-week intervals drug before starting thyroid replacement. Thyroid hormones until symptoms are relieved and a normal serum TSH increase tissue metabolism and tissue demands for adreno- level (0. Infants requiring thyroid hormone replacement need relatively large doses. After thyroid drugs are started, Antithyroid Drugs the maintenance dosage is determined by periodic radioimmunoassay of serum thyroxine levels and by Dosage Factors periodic radiographs to follow bone development. Clients who are elderly or have cardiovascular disease until a euthyroid state is reached, usually in 6 to 8 weeks. A require cautious treatment because of a high risk of ad- maintenance dose, in the smallest amount that prevents recur- verse effects on the cardiovascular system. Thus, they rent symptoms of hyperthyroidism, is then given for 1 year or are given smaller initial doses and smaller increments longer. Dosage should be decreased if the thyroid gland en- at longer intervals than younger adults. Hypothyroidism and the Metabolism Duration of Antithyroid Therapy of Other Drugs No clear-cut guidelines exist regarding duration of antithyroid Changes in the rate of body metabolism affect the metabolism drug therapy because exacerbations and remissions occur. Most drugs given to a client with hypothy- It is usually continued until the client is euthyroid for 6 to roidism have a prolonged effect because drug metabolism in 12 months. Diagnostic tests to evaluate thyroid function or the liver is delayed and the glomerular filtration rate of the kid- a trial withdrawal then may be implemented to determine neys is decreased. Also, drug absorption from the intestine or whether the client is likely to remain euthyroid without further a parenteral injection site may be slowed. If the drug is to be discontinued, this is usually of many other drugs should be reduced, including digoxin and done gradually over weeks or months. In addition, people with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs. However, when Iodine preparations and thioamide antithyroid drugs are con- necessary, they are given very cautiously and in dosages of traindicated during pregnancy because they can lead to goiter approximately one third to one half the usual dose. Once thyroid replacement therapy is started and stabilized, Hyperthyroidism and the Metabolism the client becomes euthyroid, has a normal rate of metabo- of Other Drugs lism, and can tolerate usual doses of most drugs if other influ- encing factors are not present. On the other hand, excessive Treatment of hyperthyroidism changes the rate of body me- doses of thyroid drugs may produce hyperthyroidism and a tabolism, including the rate of metabolism of many drugs. In this instance, larger During the hyperthyroid state, drug metabolism may be very doses of most other drugs are necessary to produce the same rapid, and higher doses of most drugs may be necessary to effects. Rather than increasing dosage of other drugs, how- achieve therapeutic results. When the client becomes euthy- ever, dosage of thyroid drugs should be reduced so the client roid, the rate of drug metabolism is decreased. Duration of Replacement Therapy Iodine Ingestion and Hyperthyroidism Thyroid replacement therapy in the client with hypo- thyroidism is lifelong. Medical supervision is needed fre- Iodine is present in foods (especially seafood) and in contrast quently during early treatment and at least annually after the dyes used for gallbladder and other radiologic procedures.
E-mails are sent immediately order famvir 250mg line, so there is no time for the false feedback loop to come into effect generic 250 mg famvir amex. No doubt this will change famvir 250mg sale, and some e-mails will start to be as boring as other types of writing generic 250mg famvir. Embargo A notice put on a press release requesting that publication of the news is delayed until a certain date and time. Some public relations advisers overdo it, putting on artificial embargoes: these are likely to be broken. Emphasis Many people embark on a false and gimmicky quest to give emphasis. Thus they will put words in CAPITAL LETTERS, or in bold type or in italics. This may work in small 46 EMPHASIS doses: it can be effective to use italics to emphasize one word, as here, but if you use it for more than a word or two it becomes difficult to read, according to a number of studies (see research on writing). Putting something into a box is also a bad solution: the evidence suggests that people tend to notice boxes, but ignore what goes in them. The best solution is to order your words in such a way that the natural cadences will emphasize the words and phrases you wish to emphasize. We read in certain ways, which gives us key positions to exploit, in particular the start and the end of a sentence, paragraph or piece of writing. If you want to emphasize a single word, put it at the end of the sentence. If you want to emphasize a sentence, place it at the beginning or end of your writing (see first sentence; final sentence). English English is not one language, but several, all of which are developing in different ways. Use the version that is most appro- priate to your target audience (see evidence-based writing). 0 It is important for those traumatized in this way to realize that they have moved on and should no longer be writing to please their teachers (see audience; false feedback loop). Enthusiasm Be wary of those who wax lyrical about how much they enjoy writing; most rational people hate it. Those who argue otherwise are either fooling themselves (and boring their audi- ences), or lying. If you have defined carefully your target audience, 47 THE A–Z OF MEDICAL WRITING then the type of writing you need is the type of writing that has worked for that audience in the past. If writing for a journal, follow the style of that journal; if writing for a newspaper, follow the style of that newspaper; if writing a report for a committee, then follow the style of reports that have been previously accepted. Instead of arguing endlessly whether to use jargon, or pompous initial capitals, or split infini- tives, or the passive voice, look at the evidence of what your target audience prefers. This approach will save hours of argument and stress (see negotiating changes). This is probably because much of their writing has been dominated by the unnatural act of sitting examinations – taking a couple of hours to regurgitate previously memorized information. We all need to move on: treat writing not as a measure of goodness or cleverness or niceness, but as a powerful tool of communication (see effective writing). Exclamation marks Most people insist that they should be used only to signal an exclamation and not to signal a weak joke. After many years repeating this advice (but ignoring it in my own writing! The purpose of writing reports is to make recommendations and provide evidence in favour of implementing them. The goal of the executive summary, on the other hand, is to sell the recommendations to the busy decision-makers. It should be shorter (rarely more than a single page), written in a more accessible language (see readability scores), and use the more reader-friendly inverted triangle structure. Contributors and authors have a right to be dealt with promptly and openly.
Appropriate questions include • Color changes and skin rashes are more difficult to detect • When and where did the skin rash appear? The illumination provided by overbed lights or flash- • Etiologic factors buy generic famvir 250 mg line. In many instances generic 250mg famvir with mastercard, appropriate treat- lights is inadequate for most purposes generic famvir 250 mg with amex. Some etiologic fac- • Some skin rashes may be visible on oral mucous tors include the following: membranes discount famvir 250mg with visa. CHAPTER 66 DRUGS USED IN DERMATOLOGIC CONDITIONS 957 • Petechiae are not visible on dark brown or black skin, • Liberal use of lubricating creams, lotions, and oils. Bath but they may be visible on oral mucous membranes or oils, which usually contain mineral oil or lanolin oil and the conjunctiva. Creams and cially those with chronic disorders, feel self-conscious lotions may be applied several times daily. In clients Nursing Diagnoses at high risk for development of pressure ulcers, major • Disturbed Body Image related to visible skin lesions preventive measures include frequent changes of position • Anxiety related to potential for permanent scarring or dis- and correct lifting techniques. Various pressure-relieving figurement devices (eg, special beds and mattresses) also are useful. Although controlled amounts of UV Planning/Goals light are beneficial in some dermatologic disorders (ie, acne, The client will: psoriasis), excessive amounts cause wrinkling, dryness, and • Apply topical drugs correctly malignancies. If prolonged exposure is necessary, protec- • Experience relief of symptoms tive clothing and sunscreen lotions decrease skin damage. Water or • Avoid scarring and disfigurement when possible normal saline may be used alone or with additives, such • Be encouraged to express concerns about acute and chronic as colloidal oatmeal (Aveeno) or baking soda. A cool en- body image changes vironment also tends to decrease pruritus. For severe itching, a systemic antihistamine may be • Use general measures to promote health and increase resis- needed. Have the client sub- stitute nonirritating soaps or cleaning supplies for irritat- PRINCIPLES OF THERAPY ing ones; use hypoallergenic jewelry and cosmetics if indicated; wear cotton clothing if indicated. Scratch- General treatment goals for many skin disorders are to relieve ing relieves itching only if it is strong enough to damage symptoms (eg, dryness, pruritus, inflammation, infection), the skin and serve as a counterirritant. Skin damaged or eradicate or improve lesions, promote healing and repair, re- disrupted by scratching is susceptible to invasion by path- store skin integrity, and prevent recurrence. Thus, dry skin may lead to seri- often depend on the condition being treated. Measures to decrease skin dryness include the following: General Aspects of Dermatologic • Alternating complete and partial baths. For example, Drug Therapy the client may alternate a shower or tub bath with a sponge bath (of face, hands, underarms, and perineal 1. Warm water, mild soaps, and patting dry are multiple agents used concurrently or sequentially. For severe skin conditions, a dermatologist is best qual- bing with a towel have drying effects on the skin. Acne is not caused ✔ Severe dermatologic disorders should be treated by a by dirt, washing does not improve acne, and vigorous dermatologist. There ✔ Promote healthy skin by a balanced diet, personal hygiene is also no evidence that acne is caused by eating choco- measures, avoiding excessive exposure to sunlight, avoid- late or other foods. Recommendations for managing acne ing skin injuries, and lubricating dry skin. Healthy skin is include using non–acne-producing cosmetics, moisturiz- less susceptible to inflammation, infections, and other dis- ers, and sunscreens; washing and bathing with a gentle, orders. It also heals more rapidly when disorders or in- nonirritating cleanser (eg, Dove or Purpose bar); and avoid- juries occur. It is very im- temic medications (eg, oral antihistamines, antibiotics portant to not give up or stop treatment prematurely. There is a wide array of topical products, both National Psoriasis Foundation (NPF) prescription and over-the-counter.
The aim Prevention in the modern biological sense of treatment is the re-establishment of balance; frequently refers to an immunological mecha- once balance is re-established cheap 250mg famvir mastercard, either naturally or nism through which the individual becomes more through herbal intervention discount famvir 250 mg visa, well-being will be resistant to future attacks of similar pathologi- re-established purchase 250 mg famvir amex. Chinese medicine is often the control of adverse Clinical trials for Chinese medicine or herbal symptoms generic 250mg famvir visa. The ultimate goal is maintaining the medicine therefore could follow the line of well-being of the biological system. The aeti- thought for scientific planning on data collection ological consideration is therefore not directed and subsequent data meta-analysis. However, the towards the actual cause of the disease (of which pre-treatment data would be confined mainly to the herbal expert has no idea), but a general symptomatology. Other parameters would carry conceptual state of the biological balance of the little weight for the herbal expert; but could human bodily functions. The ancient healers cor- still be included for more scientific knowledge related this conceptual state with the Taoist phi- in clinical trials. Any loss of balance GENERAL CONSIDERATIONS FOR CLINICAL led to ailment and disease. TRIALS ON HERBS The aim of treatment is therefore to main- tain the balance. Yin and Yang includes other In the modern scientific world, only up-to-date contrasting opposing forces like cold and heat, methodologies should be adopted. The set of COMPLEMENTARY MEDICINE 67 common methodologies for conducting clinical and metabolic pathways before clinical tests be trials on modern medicine has been logical, conducted. What is the chemistry of specific useful and has made wonderful contributions to herbs? What are the pathways of action and the clinical testing of new drugs and new meth- metabolic degradation? A lot of work of data and the use of statistics have revealed has been done in the past 50 years on this basic the trustworthiness of certain accumulated expe- understanding and not much has come out. Each rience, while at the same time the fallacies of and every herb contains so much complicated some even well accepted and widely practised chemistry that many years of research might methods. Actually at least four The common methodology of random selec- hundred herbs are popular and possess records tion, blinding and placebo control, followed by of therapeutic action and impressive efficacy. In the demand thorough knowledge on just this popular design of the trial, good clinical practice should proportion of herbs is not practical, not to speak be the aim. However, due to the nature of the of the less commonly used extra one to two herbs, which come from different origins and thousand varieties. Strictly encounter situations where basic principles that speaking, since herbs are agricultural products, cannot be strictly kept. The sites of production have THE OLD APPROACHES different weather, different soil contents, and the methods of plantation are also different. At the The herbal experts fervently respect case reports moment, maybe over 50% of popular Chinese and anecdotal reports, particularly when results herbs are produced on special farms in China. Once good demands that environmental and nurturing proce- results are known to be possible, the expert could dures be uniformly ensured. Procedures include try to achieve equally good results by wisely soil care, watering, fertilisers, pest prevention and manipulating the varieties of treatment. When such procedures are not uniform In this chapter, we do not endorse this and there are no means to ensure a common prac- traditional approach. We do want to apply modern tice, good agricultural practice is not possible. These different After all, the development of this system of species may have different detailed chemical con- healing depends solely on anecdotal analysis. Herbal experts have extensive experience Good clinical practice insists that the pre- and knowledge about some special correlations scribed drug for the clinical trial should be between the effectiveness of particular herbs and thoroughly known and uniform. Some commonly used herbal preparations for clinical trials faces diffi- herbs are even labelled jointly with the best sites culties of thorough technical knowledge and uni- of production. That is why we could not be sat- When we consider the other 50% of herbs that isfied with records on efficacy alone, but should are only available from the wilderness, i. States have openly endorsed the approach of Putting together what we have discussed, to accepting traditional methods of healing as safe strictly insist on good clinical practice in clinical measures and then putting them to proper clini- cal trials. Indeed in the practical effective means of pain control started in 1998.