By X. Hauke. South Dakota State University.
Lately keflex 250mg low cost, totoxicity is associated with plasma levels of <120 mcg/mL at she has been feeling weak and tired keflex 750mg with mastercard. She has also experienced dizziness when getting up from bed trusted 750 mg keflex, and today she fainted buy keflex 750mg mastercard. She 4 hours after ingestion or <30 mcg/mL at 12 hours after inges- asks you if this could be related to the medications she is taking tion. With blood levels >300 mcg/mL at 4 hours after inges- and what she should do. CHAPTER 7 ANALGESIC–ANTIPYRETIC–ANTI-INFLAMMATORY AND RELATED DRUGS 117 ability of joint structures). Clients who continue to have se- the drug has several advantages over opioid analgesics, vere pain and functional impairment despite medical treat- bleeding and hematomas may occur. Use of Acetaminophen, Aspirin, Rheumatoid Arthritis (RA) and Other NSAIDs in Cancer Pain Acetaminophen may relieve pain; aspirin or another NSAID may relieve pain and inﬂammation. Aspirin is effective but Cancer often produces chronic pain from tumor invasion of many people are unable to tolerate the adverse effects asso- tissues or complications of treatment (chemotherapy, surgery, ciated with anti-inﬂammatory doses. As with acute pain, these drugs prevent sensiti- dosage usually ranges between 2 and 6 g daily but should be zation of peripheral pain receptors by inhibiting prostaglandin individualized to relieve symptoms, maintain therapeutic sa- formation. They are especially effective for pain associated licylate blood levels, and minimize adverse effects. For mild pain, acetaminophen or an ple who cannot take aspirin, another NSAID may be given. NSAID may be used alone; for moderate to severe pain, these For those who cannot take aspirin or a nonselective NSAID drugs may be continued and a opioid analgesic added. Non- because of gastric irritation, peptic ulcer disease, bleeding opioid and opioid analgesics can be given together or alter- disorders, or other contraindications, a selective COX-2 in- nated; a combination of analgesics is often needed to provide hibitor NSAID may be preferred. Aspirin is contraindicated for the client re- in larger, anti-inﬂammatory doses for RA, rather than the ceiving chemotherapy that depresses the bone marrow be- smaller, analgesic doses given for OA. Second-line drugs, for moderate or severe RA, include cor- ticosteroids and immunosuppressants (see Chap. The goal of treatment with corticosteroids is to relieve symptoms; Use of Acetaminophen, Aspirin, the goal with immunosuppressants is to relieve symptoms and and Other NSAIDs in Children also slow tissue damage (so-called disease-modifying effects). Both groups of drugs may cause serious adverse effects, Acetaminophen is usually the drug of choice for pain or fever including greatly increased susceptibility to infection. Children seem less susceptible to liver toxicity Methotrexate (MTX), which is also used in cancer chemother- than adults, apparently because they form less of the toxic apy, is given in smaller doses for RA. However, MTX has disease-modifying effects or just improves symp- there is a risk of overdose and hepatotoxicity because aceta- toms and quality of life. About 75% of clients have a beneﬁ- minophen is a very common ingredient in OTC cold, ﬂu, cial response, with improvement usually evident within 4 to fever, and pain remedies. An overdose can occur with large 8 weeks (ie, less morning stiffness, pain, joint edema, and doses of one product or smaller amounts of several different fatigue). In addition, toxicity has occurred when parents or Three newer immunosuppressants used to treat RA are caregivers have given the liquid concentration intended for etanercept (Enbrel), inﬂiximab (Remicade), and leﬂunomide children to infants. Clinical improvement usually occurs within a few not be given interchangeably. For 3 days before surgery; nabumetone and piroxicam have children with juvenile rheumatoid arthritis, aspirin, ibupro- long half-lives and must be discontinued approximately fen, naproxen, or tolmetin may be given. After surgery, especially after rela- for use and dosages have not been established for most of the tively minor procedures, such as dental extractions and epi- other drugs. Numerous medications have been used for prophylaxis, including aspirin (650 mg bid) and Acetaminophen is usually safe in recommended doses unless NSAIDs (ibuprofen 300 to 600 mg tid; ketoprofen 50 to 75 mg liver damage is present or the person is a chronic alcohol bid or tid; naproxen 250 to 750 mg daily or 250 mg tid). Aspirin is usually safe in the small doses prescribed for used to prevent migraine associated with menses, they should prevention of myocardial infarction and stroke (antiplatelet be started approximately 1 week before and continued through effects). Aspirin and other NSAIDs are probably safe in ther- the menstrual period.
Differentiate between H1 and H2 receptor antagonists in Rochelle buy keflex 250mg mastercard, NY: The Medical Letter buy 500mg keflex overnight delivery, Inc discount keflex 750mg. Journal of the American Pharmaceutical Association trusted keflex 500mg, 43(3), vent or treat allergic disorders? Discuss the advantages and disadvantages of piratory disorders and symptoms. Critical Thinking Scenario New parents bring their 5-month-old into the clinic with symptoms of a cold. The mother states her daughter has a slight fever, a runny nose, and a cough. The baby has had difﬁculty sleeping and has been keeping the mother awake with her fussing. Reﬂect on: Worries and concerns new parents are likely to have about their sick infant. How nasal stufﬁness may affect smaller anatomic structures of the infant. OVERVIEW membranes of the nose and throat become more inﬂamed, other common symptoms include cough, increased nasal con- The drugs discussed in this chapter are used to treat upper gestion and drainage, sore throat, hoarseness, headache, and respiratory disorders and symptoms such as the common general malaise. Colds can be caused by many types of virus, cold, sinusitis, nasal congestion, cough, and excessive secre- most often the rhinovirus. Some of these diverse drugs are discussed more exten- fected people, mainly from nasal mucosa, can result in rapid sively in other chapters; they are discussed here in relation to spread to other people. The major mode of transmission is contamination of skin or environmental surfaces. The infected person, with viruses on the hands from contact with nasal secretions (eg, sneezing, THE COMMON COLD coughing), touches various objects (eg, doorknobs, faucet handles, telephones). The uninfected person touches these The common cold, a viral infection of the upper respiratory contaminated surfaces with the fingers and then transfers tract, is the most common respiratory tract infection. A cold often begins with dry, stuffy Cold viruses can survive for several hours on the skin and feelings in the nose and throat, an increased amount of clear hard surfaces, such as wood and plastic. As the mucous airborne spread from sneezing and coughing, but this source 728 CHAPTER 49 NASAL DECONGESTANTS, ANTITUSSIVES, AND COLD REMEDIES 729 is considered secondary. Once the viruses gain entry, the in- pharyngitis) and chronic obstructive pulmonary dis- cubation period is about 5 days, the most contagious period eases (eg, emphysema, chronic bronchitis). Because of the way cold viruses are duction or decreased ability to cough or otherwise re- spread, frequent and thorough handwashing (by both infected move secretions from the respiratory tract. Secretions and uninfected people) is the most important protective and may seriously impair respiration by obstructing airways preventive measure. Secretions also may cause atelectasis (a condition in which part of the lung is airless and col- SINUSITIS lapses) by blocking air ﬂow, and they may cause or ag- gravate infections by supporting bacterial growth. Sinusitis is inﬂammation of the paranasal sinuses, air cells Respiratory disorders characterized by retention of se- that connect with the nasal cavity and are lined by similar mu- cretions include inﬂuenza, pneumonia, upper respiratory cosa. As in other parts of the respiratory tract, ciliated mucous infections, acute and chronic bronchitis, emphysema, and membranes help move ﬂuid and microorganisms out of the acute attacks of asthma. This movement becomes predispose to secretion retention include immobility, impaired when sinus openings are blocked by nasal swelling, debilitation, cigarette smoking, and postoperative status. Symptoms may include moderate to severe headache, ten- DRUGS FOR RESPIRATORY derness or pain in the affected sinus area, and fever. DISORDERS Numerous drugs are available and widely used to treat the COMMON SIGNS AND SYMPTOMS symptoms of respiratory disorders. Many are nonprescription OF RESPIRATORY DISORDERS drugs and can be obtained alone or in combination products. Available products include nasal decongestants, antitussives, • Nasal congestion is manifested by obstructed nasal and expectorants. It is a prominent symptom of the common cold and rhinitis (including allergic rhinitis; see Chap. Nasal Decongestants Nasal congestion results from dilation of the blood ves- sels in the nasal mucosa and engorgement of the mu- Nasal decongestants are used to relieve nasal obstruction and cous membranes with blood.
These drugs are usually ordered and methods of using data in performing calculations order keflex 500 mg free shipping. Milliequivalents express the ionic ac- The most commonly used system of measurement is the met- tivity of a drug generic keflex 500mg without prescription. Drugs such as potassium chloride are ordered ric system keflex 250mg on-line, in which the meter is used for linear measure purchase keflex 500mg otc, the and labeled in the number of milliequivalents per dose, tablet, gram for weight, and the liter for volume. The apothecary system, now obsolete and rarely used, has units called grains, minims, drams, ounces, pounds, pints, Mathematical Calculations and quarts. The household system, with units of drops, tea- spoons, tablespoons, and cups, is infrequently used in health Most drug orders and labels are expressed in metric units of care agencies but may be used at home. If the amount speciﬁed in the order is the same alent measurements within and among these systems. Equiv- as that on the drug label, no calculations are required, and alents are approximate. For example, if A few drugs are ordered and measured in terms of units the order reads ibuprofen 400 mg PO and the drug label or milliequivalents (mEq). Units express biologic activity in reads ibuprofen 400 mg per tablet, it is clear that one tablet is to be given. What happens if the order calls for a 400-mg dose and 200-mg tablets are available? The question is, How many TABLE 3–3 Equivalents 200-mg tablets are needed to give a dose of 400 mg? This is a simple example that also can be 1 mL = 1 cc = 15 or 16 minims = 15 or 16 drops used to illustrate mathematical calculations. This problem 4 or 5 mL = 1 ﬂuid dram = 1 tsp can be solved by several acceptable methods; the following 60 or 65 mg = 1 gr 30 or 32 mg = 1/2 gr formula is presented because of its relative simplicity for stu- 30 g = 30 mL = 1 oz = 2 tbsp dents lacking a more familiar method. V = unit (one tablet, here) CHAPTER 3 ADMINISTERING MEDICATIONS 35 400 mg X ablett 3. Order: 4 mg IV = Label: 10 mg/mL 200 mg 1 tablet Cross multiply: 4 mg X mL = 200X = 400 10 mg 1 mL 10X = 4 400 X = = 2 tablets 200 4 X = = 04. The desired or ordered dose and the available or label dose 10,000X = 5000 must be in the same units of measurement. Using the equiva- 5000 lents (ie, 1 g = 1000 mg) listed in Table 3–2, an equation can X = = 05. Each has advantages, disadvan- tages, indications for use, and speciﬁc techniques of admin- The same procedure and formula can be used to calculate istration (Table 3–4). The term parenteral refers to any route portions of tablets or dosages of liquids. These are illustrated other than gastrointestinal (enteral), but is commonly used to in the following problems: indicate SC, IM, and IV injections. General char- Label: 50-mg tablet acteristics are described below; speciﬁc considerations for the intravenous route are described in Box 3–2. Order: 25 mg IM containers with rubber stoppers through which a sterile needle Label: 50 mg in 1 cc can be inserted for withdrawing medication. Single-dose vials usually do not contain a preservative and must be discarded 25 mg X cc after a dose is withdrawn; multiple-dose vials contain a preser- = 50 mg 1 cc vative and may be reused if aseptic technique is maintained. Ampules are sealed glass containers, the tops of which 50X = 25 must be broken off to allow insertion of a needle and with- 25 drawal of the medication. Intramuscular (IM) • May be used for several drugs • A relatively small amount of drug It is very important to use injection—injection of • Drug absorption is rapid be- (up to 3 mL) can be given anatomic landmarks when drugs into selected cause muscle tissue has an • Risks of damage to blood vessels selecting IM injection sites. Effects may cause systemic adverse effects lungs, eyes, or nose; may last several days and the (eg, beta blocker eye drops, used to and by insertion under patches are usually convenient treat glaucoma, can cause bradycar- the tongue (sublingual), for clients. CHAPTER 3 ADMINISTERING MEDICATIONS 37 BOX 3–2 PRINCIPLES AND TECHNIQUES WITH IV DRUG THERAPY Methods lumen of the vein is recommended. This allows good blood IV injection or IV push is the direct injection of a medication ﬂow and rapidly dilutes drug solutions as they enter the vein. The drug may be injected through an injection This, in turn, prevents high drug concentrations and risks of site on IV tubing or an intermittent infusion device. Also, once a catheter is inserted, it is very impor- push medications should be injected slowly. Rapid injection should generally be avoided be- risks of thrombophlebitis and infection.
THE ULTIMATE NEW YORK BODY PLAN EXERCISE PROGRAM 73 TLFeBOOK PUSH-UPS TO T-STANDS A buy generic keflex 250mg. Come into a push-up posi- tion with your palms on the floor under your shoulders and the balls of your feet on the ﬂoor keflex 250 mg lowest price. Bend your elbows out to the side as you lower your face and chest toward the floor cheap keflex 500mg online. Once your face is hovering just above the ﬂoor buy cheap keflex 250mg on-line, exhale as you push back up. Rotate your torso to the left, placing your right leg and foot on top of your left and lifting your right arm toward the ceiling. You should now be balanced on your left palm and the outer edge of your left foot. Your abs should be tight, your tailbone slightly tucked, and your waist and your body straight, reaching up toward the ceiling. Lower back into a push-up position, repeating a push-up with your right leg raised and then a T-stand with your left arm raised. Continue alternating legs and arms for a total of ten push-ups and five T-stands on each side. Take a large step sideways with your right leg, bringing your right knee in toward your chest and then over to the right in one continu- ous motion. As soon as your right foot touches the ground, bring your knee back into your chest and complete a side kick, kicking your right heel out to the side into the stomach of an imaginary opponent (or jaw if that imaginary person is height compromised). Repeat with a sumo lunge and side kick with your left leg and another frog jump. Continue alternating right to left until you have completed ten lunges on each side and 20 frog jumps. THE ULTIMATE NEW YORK BODY PLAN EXERCISE PROGRAM 75 TLFeBOOK JUMP SQUATS A. Tap your heels together and then bring your feet apart before you land on your heels, rolling forward onto your toes. Take a large step back with your right foot, planting and then lowering your body until both legs are bent in right angles. I find this brings more focus to the glutes and the hips, making it a more effective exercise. Lift your right foot, bringing your right knee in toward your chest, and then launch a front kick into the stomach of an imag- inary opponent standing directly in front of you. Complete 15 lunges with front kicks with the right leg and then repeat on the left side. Then return to the jump squats, and complete one set each of jump squats and reverse lunges with a side kick. From a seated position on your stability ball, walk your feet forward and slide your torso down the ball until you come into a bench press position with your upper back and head against the ball, knees bent 90 degrees, and feet on the ground. Grasp a dumbbell in each hand with your arms extended toward the ceiling from your chest. Once your arms are parallel with the ﬂoor with your palms facing up, bring your arms in a semicircle down toward your hips, all the while keeping your arms parallel to the ﬂoor. Bend your elbows and squeeze your hands together above your navel, as if you are hug- ging your arms around a large oak tree with your palms facing each other. Remain in the bench press position on the sta- bility ball, and proceed to the next exercise. From your bench press position on the stabili- ty ball, bend your elbows out to the sides with a dumbbell in each hand. Rotate your hands so your palms are facing in the direction of your head. As you extend your arms, rotate your hands so your palms are facing your feet. As you lower your arms, rotate your hands back to the starting position. From your bench press position on the ball, grasp a dumbbell in each hand and bend your right elbow just over your head toward the ﬂoor. Keeping your right elbow bent, lower your right hand toward the ﬂoor behind your head and rest at about ear level.
Treatment of unstable angina: The role of platelet inhibitors signs of bleeding order keflex 750 mg with amex. Outpatient treatment of deep vein throm- bosis: Translating clinical trials into practice purchase keflex 500mg on line. Before giving anticoagulants purchase keflex 250mg free shipping, it is important to ing of low-molecular-weight heparins in special populations keflex 750mg line. Pharma- check lab work (activated partial thromboplastin time for heparin, cotherapy, 21(2), 218–234. Philadelphia: may have interfered with the synthesis of vitamin K in the intes- Lippincott Williams & Wilkins. Because no signs of bleeding have been noted, he or she ology: Concepts of altered health states, 6th ed. What are the major functions of the endothelium, platelets, North American Nursing Diagnosis Association. Nursing diagnoses: and coagulation factors in hemostasis and thrombosis? Review of the action, onset and duration of action, and method of ad- Fifth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy: Outpatient management for adults. List interventions to protect clients from anticoagulant- Skidmore-Roth, L. When is it appropriate to use protamine sulfate as an after hospitalization for deep-venous thrombosis. Describe dyslipidemic drugs in terms of mecha- nism of action, indications for use, major ad- verse effects, and nursing process implications. Critical Thinking Scenario During a routine physical examination, 26-year-old William Halls is diagnosed with dyslipidemia. His father died at 46 years of age of a massive myocardial infarction (MI). He responds by asking, Does this mean I am going to die young like my dad? Ways to explain the signiﬁcance of laboratory values (cholesterol, low-density lipoproteins, high-density lipoproteins, triglycerides). OVERVIEW stroke, peripheral vascular disease, and death (see Chapters 53 and 57). It is a systemic disease characterized by lesions in Dyslipidemic drugs are used in the management of clients the endothelial lining of arteries throughout the body. These with elevated blood lipids, a major risk factor for atheroscle- lesions (called fatty plaques or atheromas) start with injury rosis and vascular disorders such as coronary artery disease, to the endothelium and involve progressive accumulation of strokes, and peripheral arterial insufﬁciency. These drugs lipids (eg, cholesterol), vascular smooth muscle cells, have proven efﬁcacy and are being used increasingly to re- macrophages, lymphocytes, and connective tissue proteins. As the lesions develop and enlarge, they pro- and types of blood lipid disorders. Severely impaired blood flow leads to damage or death of tissue supplied by the artery. Clinical manifesta- Atherosclerosis is a major cause of ischemic heart disease tions vary according to the arteries involved and the extent (eg, angina pectoris, myocardial infarction), heart failure, of vessel obstruction. Each lipoprotein contains cholesterol, Blood lipids, which include cholesterol, phospholipids, and phospholipid, and triglyceride bound to protein. The lipopro- triglycerides, are derived from the diet or synthesized by the teins vary in density and amounts of lipid and protein. Most cholesterol is found in body cells, sity is determined mainly by the amount of protein, which is where it is a component of cell membranes and performs other more dense than fat. The lipoproteins are differentiated ac- testes, cholesterol is required for the synthesis of steroid hor- cording to these properties, which can be measured in the mones (eg, cortisol, estrogen, progesterone, and testosterone).