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Has mouth purchase dulcolax 5mg with amex treatment resistant anxiety, constipation cheap dulcolax online visa treatment mastitis, nausea and vomiting buy discount dulcolax 5mg on line symptoms zika virus, hypotension, tachy- CNS depressant and anticholinergic effects. With nefazodone, observe for: (1) CNS effects—anxiety, drowsiness, dizziness, headache, insomnia (2) GI effects—nausea, vomiting, diarrhea, dry mouth, anorexia, constipation (3) Cardiovascular effect—orthostatic hypotension (4) Hepatic effect—liver failure (anorexia, nausea, vomit- ing, abdominal pain, dark urine, jaundice) g. With lithium, observe for: Most clients who take lithium experience adverse effects. Symp- (1) Metallic taste, hand tremors, nausea, polyuria, poly- toms listed in (1) are common, occur at therapeutic serum drug dipsia, diarrhea, muscular weakness, fatigue, edema, and levels (0. Nausea may be decreased by (2) More severe nausea and diarrhea, vomiting, ataxia, in- giving lithium with meals. Propranolol (Inderal), 20–120 mg coordination, dizziness, slurred speech, blurred vision, tin- daily, may be given to control tremors. Severe adverse effects may nitus, muscle twitching and tremors, increased muscle tone be managed by decreasing lithium dosage, omitting a few doses, or discontinuing the drug temporarily. Drugs that increase effects of SSRIs: Drug interactions with the SSRIs vary with individual drugs. The reaction, attributed to excess serotonin and called the sero- tonin syndrome, may cause hyperthermia, muscle spasm, agita- tion, delirium, and coma. To avoid this reaction, an SSRI should not be started for at least 2 weeks after an MAOI is discontinued, and an MAOI should not be started for at least 2 weeks after an SSRI has been discontinued (5 weeks with fluoxetine, because of its long half-life). Drugs that decrease effects of SSRIs: (1) Carbamazepine, phenytoin, rifampin These drugs induce liver enzymes that accelerate the metabolism of the SSRIs. Drugs that increase the effects of mirtazapine, nefazodone, and venlafaxine: (1) MAOIs See SSRIs, above. These drugs and MAOIs should not be given concurrently or close together because serious and fatal reac- tions have occurred. Mirtazapine should be stopped at least 14 days and nefazodone or venlafaxine at least 7 days before start- ing an MAOI, and an MAOI should be stopped at least 14 days be- fore starting mirtazapine, nefazodone or venlafaxine. Drugs that increase effects of TCAs: (1) Antiarrhythmics (eg, quinidine, disopyramide, pro- Additive effects on cardiac conduction, increasing risk of heart cainamide) block (2) Antihistamines, atropine, and other drugs with anti- Additive anticholinergic effects (eg, dry mouth, blurred vision, cholinergic effects urinary retention, constipation) (3) Antihypertensives Additive hypotension (4) Cimetidine Increases risks of toxicity by decreasing hepatic metabolism and increasing blood levels of TCAs (5) CNS depressants (eg, alcohol, benzodiazepine anti- Additive sedation and CNS depression anxiety and hypnotic agents, opioid analgesics) (6) MAOIs TCAs should not be given with MAOIs or within 2 weeks after an MAOI drug; hyperpyrexia, convulsions, and death have occurred with concurrent use. Drugs that decrease effects of TCAs: (1) Carbamazepine, phenytoin, rifampin, nicotine (cigarette These drugs induce drug-metabolizing enzymes in the liver, which smoking) increases the rate of TCA metabolism and elimination from the body. Drugs that increase effects of MAOIs: (1) Anticholinergic drugs (eg, atropine, antipsychotic agents, Additive anticholinergic effects TCAs) (2) Adrenergic agents (eg, epinephrine, phenylephrine), Hypertensive crisis and stroke may occur. Drugs that increase effects of lithium: (1) Angiotensin-converting enzyme inhibitors (eg, captopril) Decrease renal clearance of lithium and thus increase serum lithium levels and risks of toxicity. These drugs also may precipitate a manic episode and increase risks of hypothyroidism. Drugs that decrease effects of lithium: (1) Acetazolamide, sodium chloride (in excessive amounts), Increase excretion of lithium drugs with a high sodium content (eg, ticarcillin), theo- phylline 3. When a client begins antidepressant drug therapy, why they can be forgotten or taken away with the food tray. In this sit- is it important to explain that relief of depression may uation, special care should be taken to supervise all medications. The risk for this increases as the antidepressant drugs may they be minimized? What is the advantage of giving a TCA at bedtime rather tions as you watch. For a client taking an MAOI, what information would you provide for preventing a hypertensive crisis? How do the newer drugs, mirtazapine, nefazodone, and venlafaxine, compare with the SSRIs in terms of adverse effects and adverse drug–drug interactions?

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None of the solutions should be used after the expiration date because drug decomposition is likely discount dulcolax 5mg mastercard symptoms 7. Give parenteral antimicrobial solutions alone; do not mix To avoid chemical and physical incompatibilities that may cause with any other drug in a syringe or intravenous (IV) solution cheap dulcolax online amex treatment zap. Give intramuscular (IM) antimicrobials deeply into large To decrease tissue irritation muscle masses (preferably gluteal muscles) purchase dulcolax toronto medications lisinopril, and rotate injec- tion sites. For IV administration, use dilute solutions, give direct in- Most antimicrobials that are given IV can be given by intermittent jections slowly and intermittent infusions over 30 to 60 min. Although instructions vary with specific drugs, most re- After infusions, flush the IV tubing with at least 10 mL of IV constituted drugs can be further diluted with 50 to 100 mL of IV solution. For children, check references about individual drugs fluid (D W, NS, D -1⁄ % or D -1⁄ % NaCl). Dilution and slow ad- 5 5 4 5 2 to avoid excessive concentrations and excessive fluids. Flushing ensures that the entire dose is given and prevents contact between drugs in the tubing. With local infections, observe for decreased redness, Signs and symptoms of inflammation and infection usually sub- edema, heat, and pain. With systemic infections, observe for decreased fever and regardless of the cause, local manifestations vary with the type or white blood cell count, increased appetite, and reports of feel- location of the infection. With wound infections, observe for decreased signs of local inflammation and decreased drainage. With respiratory infections, observe for decreased dyspnea, coughing, and secretions. With urinary tract infections, observe for decreased ur- gency, frequency, and dysuria. If urinalysis is done, check the laboratory report for decreased bacteria and white blood cells. Hypersensitivity Reactions are more likely to occur in those with previous hyper- sensitivity reactions and those with a history of allergy, asthma, or hay fever. Anaphylaxis may occur with oral administration but is more likely with parenteral administration and may occur within 5 to 30 min of injection. Superinfection Superinfection is a new or secondary infection that occurs during antimicrobial therapy of a primary infection. Superinfections are common and potentially serious because responsible microorgan- isms are often drug-resistant staphylococci, gram-negative organ- isms (eg, Pseudomonas aeruginosa), or fungi (eg, Candida). These and other antibiotics suppress normal bacterial flora and allow the over- growth of Clostridium difficile. The organism produces a toxin that kills mucosal cells and produces superficial ulcerations that are visible with sigmoidoscopy. Discontinuing the drug and giving metronidazole or oral vancomycin are curative measures. Phlebitis at IV sites; pain at IM sites Many antimicrobial parenteral solutions are irritating to body tissues. Nausea and vomiting These often occur with oral antimicrobials, probably from irritation of gastric mucosa. Diarrhea Commonly occurs, caused by irritation of gastrointestinal mu- cosa and changes in intestinal bacterial flora; and may range from mild to severe.

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Check the sites of insulin injection for at- blood sugar control appears better than it actually is discount dulcolax 5 mg mastercard medicine allergic reaction. Check the Nursing Diagnoses lower leg for brown spots; these are caused by small • Ineffective Tissue Perfusion best buy for dulcolax medications for osteoporosis, peripheral trusted dulcolax 5mg medicine that makes you throw up, related to athero- hemorrhages into the skin and may indicate widespread sclerosis and vascular impairment changes in the blood vessels. Therefore, inspect the feet for calluses, treatment 394 SECTION 4 DRUGS AFFECTING THE ENDOCRINE SYSTEM • Anxiety: Managing a chronic illness, finger sticks, insulin and families to observe for these conditions and report injections their occurrence. Have the client ob- • Deficient Knowledge: Disease process and management; serve the following safeguards: avoid going barefoot, to administration and effects of antidiabetic drugs; inter- prevent trauma to the feet; wear correctly fitted shoes; relationships among diet, exercise, and antidiabetic drugs; wash the feet daily with warm water, dry well, inspect for and management of hypoglycemia, sick days, and other any lesions or pressure areas, and apply lanolin if the skin complications is dry; wear cotton or wool socks because they are more absorbent than synthetic materials; cut toenails straight Planning/Goals across and only after the feet have been soaked in warm the client will: water and washed thoroughly. Teach the client to avoid • Learn self-care activities use of hot water bottles or electric heating pads, cutting • Manage drug therapy to prevent or minimize hypo- toenails if vision is impaired, use of strong antiseptics on glycemia and other adverse effects the feet, and cutting corns or calluses. Also teach the • Develop a consistent pattern of diet and exercise client to report any lesions on the feet to the physician. Interventions Evaluation Use nondrug measures to improve control of diabetes and • Check blood sugar reports regularly for normal or ab- to help prevent complications. Self- monitoring of blood glucose levels allows the client to see Goals of Therapy the effects of diet, exercise, and hypoglycemic medications on blood glucose levels and may promote compliance. For most clients, the goals of treatment are to maintain blood Several products are available for home glucose mon- glucose at normal or near-normal levels; promote normal me- itoring. All involve obtaining a drop of capillary blood tabolism of carbohydrate, fat, and protein; prevent acute and from a finger with a sterile lancet. The blood is placed on long-term complications; and prevent hypoglycemic episodes. The There is strong evidence that strict control of blood sugar amount of blood glucose can be read with various ma- delays the onset and slows progression of complications of di- chines (eg, glucometers). In addition to glycemic control, other measures can be • Test urine for ketones when the client is sick, when blood used to help prevent end-stage renal disease. Administration glucose levels are above 200 mg/dL, and when episodes of angiotensin-converting enzyme (ACE) inhibitors (eg, cap- of nocturnal hypoglycemia are suspected. Also teach topril) has protective effects on the kidneys in both type 1 and clients and family members to test urine when indicated. Although ACE inhibitors are also used in the treat- by observing for signs and symptoms of urinary tract ment of hypertension, their ability to delay nephropathy seems infection, peripheral vascular disease, vision changes, to be independent of antihypertensive effects. Teach clients sures to preserve renal function include effective treatment of CHAPTER 27 ANTIDIABETIC DRUGS 395 CLIENT TEACHING GUIDELINES Antidiabetic Drugs General Considerations If you take acarbose (Precose) or miglitol (Glyset) along ✔ Wear or carry diabetic identification (eg, a Medic-Alert neck- with insulin, glimepiride (Amaryl), glipizide (Glucotrol), lace or bracelet) at all times, to aid treatment if needed. Few other diseases require as much adap- glucose (or glucagon) for treatment. Sucrose (table sugar) tation in activities of daily living, and you must be well and other oral carbohydrates do not relieve hypoglycemia informed to control the disease, minimize complications, because the presence of acarbose or miglitol prevents and achieve an optimal quality of life. Although much in- their digestion and absorption from the gastrointestinal formation is available from health care providers (physi- (GI) tract. If American Diabetes Association you take insulin, glucagon should be available in the 1660 Duke St. Alexandria, VA 22314 ✔ the best way to prevent, delay, or decrease the severity 1-800-ADA-DISC of diabetes complications is to maintain blood sugar at Other measures include ✔ In general, a consistent schedule of diet, exercise, and regular visits to health care providers, preferably a team medication produces the best control of blood sugar lev- of specialists in diabetes care; regular vision and glau- els and the least risk of complications. In addition, if you ✔ Diet, weight control, and exercise are extremely impor- have hypertension, treatment can help prevent heart tant in managing diabetes. Exercise helps body tissues use insulin better, counter drugs unless these are discussed with the physi- which means that glucose moves out of the bloodstream cian treating the diabetes because adverse reactions and and into muscles and other body tissues.

Most important buy 5 mg dulcolax with visa treatment 7th feb bournemouth, this term enlists the patient in inspecting his or her life to find the variables that may be triggering or even causing the symptoms buy cheap dulcolax 5mg on-line 97140 treatment code. Several colleagues have suggested that the clinical methods de- scribed here need a unifying name buy 5mg dulcolax amex medicine clipart. They tell me this will help others use, explore, and test the interventions. The mainstay of PDR as a method is enlisting and directing patients to uncover the causes of their symptoms. The physician remains a coach on the sidelines and, through the use of unspecified language and other techniques, calls on the mind of the patient to re-collect lost or unknown associations that lie behind the symptoms. The details of the PDR methods are presented in the case reports and in Chapter 20. A nurse and physician rolled a patient in a wheelchair into the bottom of the amphitheater. A white-haired fiftyish-appearing woman in a bath- robe and nightgown sat slumped to one side of the wheelchair. She struggled to raise her head from its dangling position but could not. The rows of seats of the amphitheater slanted upward in an acute angle for nearly two stories. Students sitting in the top rows looked almost directly down into the pit below. William King, professor of physiology, stood at the bottom of this well with the patient and her physician. King had just finished his lecture on the biochemistry of the neuromuscular junction. Approaching the end of our physiology course and nearly at the end of our first year of medical school, we were seeing our first patient. During the first year of medical school, all the focus is on the normal human body—its anatomy, tissues, organs, physiology, and biochemistry. So natu- rally, as the courses went by, we became more and more interested in seeing live patients—more accurately, we were hungry for clini- cal contact. Riven had a busy practice of internal medicine in the community and was widely known as an excellent physician. A Phi Beta Kappa key dangled from a small gold chain that ran from one vest pocket to another. Tere was a trace of a Canadian accent as he spoke in a soft but distinct voice. Gladys Goode to the class and told us this pitiful woman had myasthenia gravis. Goode had agreed to omit one dose of her medicines so we could see how she appeared untreated. The woman made a feeble effort to smile with an ever-so-slight move- ment of the corners of her mouth; she made a hoarse whispery sound when she tried to speak. She could not move her legs or arms, could not raise her head, could not completely open her eyes. She could barely swallow and could not speak, at least in a voice we could hear. It was more as if she raised her head a fraction of an inch and then let go as her head wobbled a few times on her chest.

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