By W. Stejnar. Waldorf College.
Allergic reactions cheap kamagra soft 100 mg without a prescription, With cephalosporins buy kamagra soft 100 mg online, ask clients if they have ever taken one including fatal anaphylactic shock, have occurred with of the drugs, as far as they know, and whether they ever had skin tests and after negative skin tests. Naming a few cephalosporins is positive, desensitization can be accomplished by giv- (eg, Ceclor, Keﬂex, Rocephin, Suprax) may help the client ing gradually increasing doses of penicillin. Because anaphylactic shock may occur with adminis- Nursing Diagnoses tration of the penicillins, especially by parenteral • Risk for Injury: Hypersensitivity reactions with penicillins routes, emergency drugs and equipment must be read- or cephalosporins ily available. Treatment may require parenteral epi- • Risk for Injury: Renal impairment with cephalosporins nephrine, oxygen, and insertion of an endotracheal or • Deﬁcient Knowledge: Correct home care administration tracheostomy tube if laryngeal edema occurs. With penicillins, penicillin G or amoxicillin is the niques to minimize tissue irritation drug of choice in many infections; an antipseudomonal peni- 520 SECTION 6 DRUGS USED TO TREAT INFECTIONS CLIENT TEACHING GUIDELINES Oral Penicillins General Considerations Self- or Caregiver Administration ✔ Do not take any penicillin if you have ever had an allergic ✔ Take most penicillins on an empty stomach, 1 hour be- reaction to penicillin with which you had difﬁculty breath- fore or 2 hours after a meal. However, some people call a Augmentin can be taken without regard to meals. Drug effectiveness depends on maintaining temperature or after 2 weeks if refrigerated. They are also used for treatment of intra- antistaphylococcal penicillin is indicated in staphylococcal abdominal infections such as pelvic inflammatory disease, infections. Antistaphylococcal drugs of choice are nafcillin diverticulitis, penetrating wounds of the abdomen, and other for IV use and dicloxacillin for oral use. They may also be used alone for sistant to ﬁrst- and second-generation cephalosporins. They treatment of infections caused by susceptible organisms in are often used in the treatment of infections caused by E. Cefazolin (Kefzol) is a frequently used parenteral obacteriaceae, especially when the infections occur in body agent. It reaches a higher serum concentration, is more protein sites not readily reached by other drugs (eg, CSF, bone) and bound, and has a slower rate of elimination than other ﬁrst- in clients with immunosuppression. These factors prolong serum half-life, so ce- against many Pseudomonas strains, these drugs should not be fazolin can be given less frequently. Cefazolin may also be used alone in treating pseudomonal infections because drug administered IM. Second-generation cephalosporins are also often used for Fourth-generation drugs are most useful in serious gram- surgical prophylaxis, especially for gynecologic and col- negative infections, especially infections caused by organisms resistant to third-generation drugs. Cefepime has the same in- dications for use as ceftazidime, a third-generation drug. Nursing Notes: Apply Your Knowledge Route of Administration and Dosage Ellen Driver is admitted to the emergency department with celluli- Choice of route and dosage depends largely on the serious- tis in her left leg. Cefotetan (a second-generation cephalosporin) ness of the infection being treated. Before administering this med- beta-lactam antibacterials are usually given IV in large doses. Ten minutes maintain therapeutic blood levels because the kidneys rapidly after the IV cefotetan starts to infuse, Ms. She appears ﬂushed and her throat feels tight and serious infections and for long-term prophylaxis of rheumatic itchy. Her respiratory rate is slightly elevated at 24 breaths per fever; the IM route is rarely used in hospitalized clients but minute, but you do not see any rash.
Nursing Process • Participate in school or community programs to inform children kamagra soft 100 mg otc, parents discount 100mg kamagra soft amex, coaches, athletic trainers, and others of Assessment the risks of inappropriate use of androgens, anabolic steroids, and related dietary supplements. Before drug therapy is started, clients need a thorough his- tory and physical examination. Evaluation • Assess for conditions in which androgens are used (eg, de- • Interview and observe for compliance with instructions ﬁciency states). These may be elevated by retention of sodium and water with resultant PRINCIPLES OF THERAPY edema, especially in clients with congestive heart failure. Duration of Therapy • For children, check x-ray reports of bone growth status ini- tially and approximately every 6 months while the drugs Drug therapy with androgens may be short or long term, are being taken. Nursing Diagnoses Effects of Androgens and Anabolic • Disturbed Body Image related to masculinizing effects Steroids on Other Drugs and menstrual irregularities • Deficient Knowledge: Physiologic and psychological Androgens may increase effects of cyclosporine and warfarin, consequences of overuse and abuse of the drugs to enhance apparently by slowing their metabolism and increasing their athletic performance concentrations in the blood. These combinations should be 430 SECTION 4 DRUGS AFFECTING THE ENDOCRINE SYSTEM CLIENT TEACHING GUIDELINES Androgens General Considerations ✔ Place the tablet between the cheek and gum and ✔ Take the drugs only if prescribed and as prescribed. Rotate sites, with 7 days between appli- ✔ Practice frequent and thorough skin cleansing to de- cations to a site. Wash hands after application and allow sites to ✔ For buccal preparations: dry before dressing. However, if required, serum creatinine and Use in Children cyclosporine levels should be monitored with cyclosporine and prothrombin time or international normalized ratio (INR) with The main indication for use of androgens is for boys with es- warfarin. Because the drugs cause epiphyseal Androgens also increase effects of sulfonylurea anti- closure, hands and wrists should be x-rayed every 6 months diabetic drugs. If required, smaller doses of sulfonylureas may be needed, Stimulation of skeletal growth continues for approximately blood glucose levels should be monitored closely, and clients 6 months after drug therapy is stopped. Danazol in- occurs (precocious sexual development, enlarged penis), the hibits metabolism of carbamazepine and increases risks of drug should be stopped. Scrupulous skin care and other antiacne treatment may be needed, especially in adolescent boys. Use in Older Adults Nursing Notes: Ethical/Legal Dilemma The main indication for use of androgens is a deﬁciency state in men. Older adults often have hypertension and other cardio- After you discussed the dangers of using anabolic steroids with the vascular disorders that may be aggravated by the sodium and wrestling team, one of the young second-string players comes to water retention associated with androgens and anabolic you to discuss his friend. In men, the drugs may increase prostate size and in- wrestlers on the team and he suspects that his dramatic athletic im- terfere with urination, increase risk of prostatic cancer, and provement over the last year has been because he has used ana- cause excessive sexual stimulation and priapism. Androgens and anabolic steroids are contraindicated in clients Reﬂect on: with preexisting liver disease. Drug-induced jaundice is reversible when the solve how he might handle the situation? CHAPTER 29 ANDROGENS AND ANABOLIC STEROIDS 431 NURSING Androgens and Anabolic Steroids ACTIONS NURSING ACTIONS RATIONALE/EXPLANATION 1. Give intramuscular preparations of testosterone, other an- drogens and anabolic steroids deeply, preferably in the gluteal muscle. With transdermal systems: Correct site selection and application are necessary for therapeu- tic effects. Clients may prefer self-applica- abdomen, once daily, preferably in the morning. Skin should be clean, dry, and intact; hands should be washed after application; and showering and swimming should be avoided for at least 1 hour and preferably 4 to 6 hours after application.
Dronabinol discount kamagra soft 100mg with mastercard, a formulation of characterized by psychological effects and hallucinations ∆-9-THC discount kamagra soft 100mg visa, is used to treat nausea and vomiting associated with that may recur days, weeks, or months after the drug is anticancer drugs and to stimulate appetite in patients with taken), and possible chromosomal damage resulting in birth acquired immunodeﬁciency syndrome (AIDS). It is usually taken by adolescents and ization of marijuana for medical uses. However, clinicians young adults, often at dance parties called raves, and its use state that such usage is no more effective than available legal is reportedly increasing. These effects occur within an hour after oral ingestion and last 6 to 8 hours. Marijuana Dependence Although users apparently think this is a safe drug, evi- Tolerance and psychological dependence do not usually de- dence indicates it is extremely dangerous. Adverse effects in- velop with occasional use but may occur with chronic use; clude cardiac dysrhythmias, coma, dehydration, delirium, physical dependence rarely occurs. There is no speciﬁc treat- hypertension, hyperthermia, hyponatremia, rhabdomyolysis, ment other than abstinence. Even without these life-threatening adverse effects, drug use is usually followed by several days of de- Hallucinogens pression, sadness, low energy, and a decreased ability to feel emotions or pleasure. Early cause mood changes, anxiety, distorted sensory perceptions, effects include spasmodic jerking, involuntary jaw clench- hallucinations, delusions, depersonalization, pupil dilation, ing, and teeth grinding. Long-term or permanent changes elevated body temperature, and elevated blood pressure. MDMA floods the brain with high of lysergic acid, a compound in ergot and some varieties of amounts of serotonin, which is important in emotion, mood, morning glory seeds. As a result, repeated use of MDMA may lead BOX 15–4 EFFECTS OF MARIJUANA Central Nervous System Effects people; possibly increased risk of mouth, throat, and lung cancer Impaired memory; perceptual and sensory distortions; disturbances (some known carcinogens are much higher in marijuana smoke in time perception; mood alteration; restlessness; depersonaliza- than in tobacco smoke). Miscellaneous Effects Cardiovascular Effects Constipation, decreased libido, thirst, decreased intraocular pressure. Hypertension; bradycardia; peripheral vasoconstriction; orthostatic hypotension and tachycardia at high doses. Respiratory Effects Irritation and cellular changes in bronchial mucosa; bronchospasm; impaired gas exchange; aspergillosis in immunocompromised CHAPTER 15 SUBSTANCE ABUSE DISORDERS 247 to depression, insomnia, memory impairment, and low energy or passivity. Nursing Notes: Ethical/Legal Dilemma In addition to adverse effects of MDMA, users also need to be concerned about the actual product they are taking. Collins is admitted There have been numerous reports of other drugs (eg, LSD, for cirrhosis after an acute drinking episode. You overhear a methamphetamine, ketamine, or phencyclidine [PCP]) being coworker stating, in a very judgmental tone, This is the third time sold as ecstasy. All of these drugs may have serious adverse she has been admitted for her drinking, and it is the taxpayers that effects as well. It is very hard for me even to go in the room MDMA is not thought to cause dependence or with- and take care of her. Emergency treatment of MDMA abuse Reﬂect on: usually involves decreasing the high body temperature, re- • What are your feelings about caring for someone who abuses placing fluids and electrolytes, and monitoring for cardio- drugs or alcohol? Phencyclidine (PCP) produces excitement, delirium, hallu- Volatile Solvents (Inhalants) cinations, and other profound psychological and physiologic effects, including a state of intoxication similar to that produced These drugs include acetone, toluene, and gasoline. These by alcohol; altered sensory perceptions; impaired thought solvents may be constituents of some types of glue, plastic processes; impaired motor skills; psychotic reactions; sedation cements, aerosol sprays, and other products. Some general in- and analgesia; nystagmus and diplopia; and pressor effects that halation anesthetics, such as nitrous oxide, have also been can cause hypertensive crisis, cerebral hemorrhage, convul- abused to the point of dependence. Death from overdose also has occurred often abused by preadolescents and adolescents who squeeze as a result of respiratory depression. Bizarre murders, suicides, glue into a plastic bag, for example, and sniff the fumes.
This has the of cortisol is determined as a balance between added advantage over drug plasma concentrations production and elimination (with a half-life of that it accounts for differences in potency in about 1 order kamagra soft 100 mg amex. We therefore need to study a done by negative feedback on the HPA axis) kamagra soft 100 mg lowest price. The cortisol levels in plasma have It is important to state at this point that we a diurnal rhythm which is very pronounced, so do not study endogenous cortisol levels because the most appropriate study to do is to give they themselves represent a dangerous side- repeated doses of the GCS until a new steady effect. The most useful variable to study is RESPIRATORY 385 the area under the curve for those 24 hours. In steady state, when there is a 24-hour periodicity, Mean 95% Conﬁdence Treatment ratio (%) limits p this is proportional to the amount produced during 24 hours. This result does not tell much about how the Example: Comparison of Plasma Cortisol drugs compare. To do that we can ﬁt parallel Dose–Response Curves non-linear dose–response curves to the mean effect data, adjusting for precision by using a We want to compare two inhaled steroids (with weighted non-linear regression. Each treatment period obtain that the relative dose potency is estimated consists of 4 days, and there was a washout to be 3. Each steroid was given in estimated to be about four times more potent than three doses: 200, 400 and 1000 µg b. Or put in other words: to achieve the Blood samples were measured every second hour same average depression in cortisol, we can use during the last 24 hours in each treatment period a four times larger dose of A than of B. The effect of the fact that the study is open We cannot extrapolate these results to patients is hard to assess. There is a basic difference between a of the drugs is associated with more stress than healthy volunteer and an asthmatic – the latter the administration of the other, this might bias has an ongoing inﬂammatory process. However, this seems unlikely, and that the dynamic system regulating cortisol is doing the study open has the beneﬁt that fewer disturbed (compared to healthy) and we can inhalations are required on each occasion. So a typical patient might have a It is done on the logarithm of the concentrations larger ED50 than a typical healthy volunteer. By with standard factors for a crossover study: sub- the same token we can expect different patients ject, treatment and period. Estimated dose–response mean value curves for treatments A (to the right) and B (to the left) and in healthy volunteers, i. Thus the to claim that the relative effect of two GCS, pivotal conﬁrmatory trials for the airway diseases as measured by the potency ratio, ρ, should asthma, COPD and rhinitis are parallel group, differ between patients and healthy volunteers, or diary card studies typically spanning from a between different categories of patients for that month up to a year. If such differences turn out to be the case, the reason must be that the systemic dose differs Asthma Trials between healthy volunteers and patients, and For asthma the typical study length for an efﬁcacy then, most likely, between patients of different study seems to be 3 months, though occasionally degrees of severity in their disease. As already discussed, there is a continuous scale of severity of each of PHASE III STUDIES the respiratory diseases. The severity of asthma can be classiﬁed into a few groups, each of which DOCUMENTING EFFICACY AND SAFETY has its recommended medical treatment. Both the classiﬁcation and the recommended treatment Most drugs for obstructive airway diseases are are, like the disease under study, somewhat given for maintenance treatment, and the main varying with time. The following classiﬁcation point to document is the level of disease control is meant only to be indicative on what type of of the proposed treatment. FEV1 in how much oral steroids can be spared by tak- percent of predicted normal should be ≥ 80%.