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Schizophrenia is the most common psychotic disorder, Psychotic behavior ranges from total inactivity to extreme agitation and combativeness. At high doses, spironolactone produces teratogenic effects in laboratory animals; thus it should not be used during pregnancy. The relationship between heat illness, exertional rhabdomyolysis, and malignant hyperthermia. This increase in gallbladder disease has not been seen with other fibric acid agents, but drugs in this class are generally not used in patients with preexisting gallbladder or biliary disease. From what you learned in Chapter 19, what are the primary indications for the drugs selective for beta1-adrenergic receptors Ipratropium is much less effective than the beta2 agonists at preventing exercise-induced bronchospasm. Particular care with ambulation is required because bradykinesia and rigidity may increase the risk of falls. Anesthesia occurs in 6 to 12 minutes and can last up to 90 minutes if epinephrine is added to the injection. The ability to treat arthritis without adverse effects caused excitement throughout the medical field in the 1990s, and the three drugs originally in this class were widely prescribed. Most anti-inflammatory agents are nonspecific; that is, whether the inflammation is caused by an injury, autoimmune disease, or allergy, the drug will exhibit the same inhibitory actions. Off-label indications include use as a uterine relaxant to aid in the extraction of a retained placenta and for pain associated with anal fissures or hemorrhoids. Assess diverse patients frequently to ensure optimal therapeutic effects and minimize adverse effects. Lifespan and Diversity Considerations: Monitor cardiac status in the older adult receiving pseudoephedrine. Quinupristin-dalfopristin (Synercid): Approved in 1999, quinupristin-dalfopristin is a fixed-dose bacteriocidal combination used for therapy of life-threatening E. Anidulafungin, the newest drug in this class, was approved in 2006 for candidemia and other systemic Candida infections. Proper treatment, however, can reduce or completely eliminate seizures in many patients. Until this most recent illness, he had started efforts toward a healthier lifestyle and weight reduction. This drug contains a black box warning that permanent vision loss can occur during therapy. Apply the nursing process to care for patients receiving pharmcotherapy for viral infections. The nurse must educate the patient and family to maintain strict adherence to the pharmacotherapy regimen. Some health care providers prescribe adefovir in combination with lamivudine to discourage the development of resistant strains. If pharmacotherapy is initiated, the drug of choice is benzimidazole, a medication that is only available in Brazil. Unrelated to its anti-infective properties, demeclocycline is the only drug in this class that has the ability to stimulate urine flow by blocking the reabsorption of water in the distal renal tubule. Administration of levodopa directly leads to increased biosynthesis of dopamine within the nerve terminals. Lifespan and Diversity Considerations: Because the drug may cause drowsiness, dizziness, or ataxia, use special caution in administering it to the older adult who is at increased risk of falls. These include thinking difficulties, decreased attentiveness or ability to concentrate, and significant learning and memory problems. Text messages were preprogrammed to arrive at specific times before the medication was due and the patient had to respond with an affirmative message. Phagocytes have proteins on their surface that allow them to recognize cells and cellular components that are "non-self. When administered orally, the drug is not absorbed and 100% is recovered in the feces. Saturated fats are the building blocks that the liver uses for making cholesterol. Certain antihypertensive classes cause a higher incidence of adverse effects and are generally prescribed when primary agents do not produce a satisfactory response. Dystonia may occur secondary to other neurologic Two Faces of Botox Botox (botulinum toxin type A) has received tremendous media attention as public figures confess to using, or are suspected of using, the drug to reduce the appearance of aging.

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Recall from Chapter 24 that antipsychotic drugs act through a blockade of dopamine receptors. Although not calcineurin inhibitors, everolimus, sirolimus, and temsirolimus are immunosuppressants similar to tacrolimus and are also described next. Intense diuresis may cause significant electrolyte imbalances, especially hyponatremia. Rash and pruritus are common adverse effects, and these may appear 1 to 2 weeks after therapy has begun. Her parents have already left for work, and they trust her to check with you, the nurse who lives next door, before taking any medication. Since the discovery of streptokinase, the first drug in this class, there have been several subsequent generations of thrombolytics. Patient and Family Education: Take this medication exactly as instructed, and do not discontinue it without consulting the health care provider because seizures may result. Sulfadiazine carries a black box warning that it should be discontinued at the first sign of a skin rash due to the possibility for Stevens-Johnson syndrome. To be most effective, therapy should begin before joint damage has occurred, usually prior to age 2. Patients should be advised to see their health care provider if symptoms worsen, or if they do not resolve during prophylactic therapy, because this may be a sign of a more serious infection. A number of chemicals, insect stings, foods, and some therapeutic drugs can cause this widespread release of histamine from mast cells if the person has an allergy to these substances. Lens changes have occurred during quetiapine use; thus it is recommended for baseline and 6-month eye examinations to be conducted. Dandelion Description: the common dandelion, Taraxacum officinale, is found worldwide and is considered a weed by homeowners and gardeners; however, this plant has both culinary and medicinal uses. There is a high incidence of contact dermatitis, related to the preservatives found in some of the formulations. It should also be understood that it is the bacteria that become resistant, not the patient. Some patients have normal insight and do understand that their experiences are not based on reality. The nurse would include in the care plan to monitor the client for which adverse effect Decreased blood pressure the client states, "I always put my nitroglycerin patch in the same place so I do not forget to take it off. Precautions and contraindications: There are few absolute contraindications for the use of vaccines. Use special caution when administering this drug to the older adult who may be at greater risk for developing thrombosis due to age-related vascular changes. Immature renal function or declines in renal function make these populations more susceptible to adverse effects. Topical lidocaine should not be applied to seriously damaged skin from trauma, burns, or eczema. Insomnia has multiple causes and often presents secondary to an underlying disorder. Other signs of neurotoxicity include paresthesias, muscle twitching, and seizures. Epilepsy, however, is a diverse disease that includes nearly 20 different seizure disorders, only some of which involve convulsions. Opium is one of the oldest known natural remedies; it has been used to relieve pain for thousands of years. Signs and symptoms include elevation in the liver enzyme levels, jaundice, fatigue, anorexia, fever, dull abdominal pain, nausea, and vomiting. Basiliximab (Simulect) and daclizumab is given to prevent the acute rejection of kidney transplants. Mechanism of Action: Like other azoles, fluconazole acts by interfering with the synthesis of ergosterol. The questions raised by the approval of a "race-based drug" have advanced the era of pharmacogenomics.

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Bipolar disorder, once known as manic-depression, is a common and serious psychiatric disorder. Asymptomatic elevations of serum aminotransferase levels are common during therapy. An otic suspension (Ciprodex otic) is a combination of ciprofloxacin and dexamethasone to treat acute otitis media and acute otitis externa in children ages 6 months and older. Approximately 30% of patients are hospitalized during the acute phase of hepatitis infection. Caffeine increases the secretion of gastric acid; therefore, patients who have peptic ulcer disease should limit their caffeine intake. The cure rate for onychomycosis is 50% to 70%, which is higher than that for griseofulvin. Minerals are held together by ionic bonds and dissociate or ionize when placed in water. Use of the vaginal gel may lead to vaginal candidiasis in more than 10% of patients. The potassium channel blockers are a small but diverse class of drugs that have very important applications to the treatment of dysrhythmias. Common adverse effects are typical of other drugs in this class: somnolence, akathisia, nausea, agitation, and parkinsonism. These guidelines are updated regularly as research determines optimum strategies for pain management. Anti-infectives that belong to the same chemical class have close structural similarities and usually share similar antibacterial properties and adverse effects. An episode of narcolepsy may last from a few seconds to about 30 minutes and the disorder may start anytime between ages 5 and 50. Because electrolytes are lost due to normal excretory functions, they must be replaced by adequate intake, otherwise electrolyte imbalances will result, as shown in Table 36. It is only used when other therapies have failed to produce satisfactory outcomes. Immediately report febrile seizures, changes in behavior, or changes in level of consciousness to the health care provider. Diazepam (Valium) is a drug in this class that acts centrally to relax skeletal muscle. Lifespan and Diversity Considerations: Monitor older adults for bleeding more frequently because normal hepatic changes related to aging may prolong the action of the drug and increase the risk of bleeding. Vancomycin acts by preventing the formation of peptide chains that are used in the construction of the cell wall. Upon further assessment and conversation, she states that her mother died of breast cancer when she was young. Valganciclovir (Valcyte): Approved in 2001, valganciclovir is a prodrug that is rapidly converted to ganciclovir after absorption. Although they have the ability to produce deep anesthesia, they produce little analgesia and are usually used in combination with nitrous oxide and opioids as part of balanced anesthesia. Flurazepam (Dalmane): Chlordiazepoxide is a long-acting benzodiazepine that has been available for almost 50 years. These drugs have other actions, however, that are unexplained by the sodium channel mechanism, including analgesic, anticholinergic, antidysrhythmic, antidepressant, and sedative effects. As a final step, the viral enzyme protease cleaves some of the larger proteins to smaller, functional forms. A cluster of complaints known as irritative voiding symptoms accompanies cystitis. In most cases the risk of rhabdomyolysis, which may be fatal, outweighs the potential benefits of combined statin and gemfibrozil therapy. The provider should be notified if fever remains present after 3 days or if increasing signs of infection are present. If a significant area is involved, vasodilation from histamine may cause hypotension and reflex tachycardia. The nurse teaches the client that which type of over-thecounter cough preparation is not effective on coughs associated with the common cold and allergic rhinitis Pseudoephedrine An older adult man informs the nurse that he is taking diphenhydramine (Benadryl) to reduce seasonal allergy symptoms.

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Phase 2: During phase 2, a plateau is reached in which depolarization is maintained. Through this selective action, these pathogens can be killed, or their growth severely hampered, without any major effects on human cells. Through osmosis, water moves from areas of low solute concentration (low osmolality), to areas of high solute concentration (high osmolality). This chapter will examine medications used to enhance the functions of erythrocytes, leukocytes, and platelets. This is because the merozoites grow and rupture erythrocytes on a regular time schedule. Leukotriene modifiers reduce inflammation by either blocking the enzyme that controls leukotriene synthesis or by blocking leukotriene receptors. Sinus bradycardia generally does not require treatment unless the patient is experiencing syncope or dizziness due to lack of sufficient blood flow to the brain, or if the heart rate fails to increase during periods of exertion. It is interesting to note that restriction of dietary cholesterol alone will not result in a significant reduction in blood cholesterol levels. Some theories have proposed that antidepressant medications actually increase the risk of suicide. Thrombolytics are nonspecific and have a very narrow margin of safety between dissolving "normal" and "abnormal" clots. Many people with schizophrenia demonstrate all of these symptoms at some time during their illness, whereas others exhibit only one or two. The appearance of a new infection while receiving anti-infective therapy is highly suspicious of a superinfection. In addition, high levels of bicarbonate ion passing through the kidney tubules increase potassium secretion, which could lead to hypokalemia. Common adverse effects include rash, headache, alopecia, chills, anorexia, and anemia. Concurrent administration of verapamil with buspirone can triple the plasma concentration of buspirone. Should a pathogen be clever enough to escape surveillance in a lymph node, it is then faced with passing through dozens, and sometimes hundreds, more lymph nodes in the lymphatic system. Contraindications/Precautions: Patients with suspected sensitivity to cobalt should receive an intradermal test dose because they may experience allergic reactions or anaphylaxis to the drug. Therapeutic Effects and Uses: Sodium chloride is administered for hyponatremia when serum levels fall below 130 mEq/L. The incidence of ototoxicity with torsemide is very low, and the risk of hypokalemia is less than that of other drugs in this class. It is also used to assist in the diagnosis of coronary artery disease of dysrhythmias in patients who are unable to undergo a cardiac exercise stress test. They are also used to treat the tremor and extrapyramidal adverse effects from conventional antipsychotic drugs. The drug is administered for treating and preventing excessive bleeding events such as acute trauma or surgery. The patient explains that most of the time, her neighbor will pick up prescriptions for her. Administration of naloxone will reduce some, but not all, of the symptoms of tramadol overdose and may precipitate convulsions. This relationship holds true whether the twins were raised together or separately. Not all people are able to acetylate isoniazid at the same rate because of genetic differences in the activity of acetyltransferase, the hepatic enzyme that performs this action. In contrast, neuropathic pain is caused by injury or irritation to nerve tissue and typically is described as burning, shooting, or numbing pain. The client is admitted to the emergency department with severe central nervous system depression. A second example is high intraocular pressure caused by excess fluid accumulation in the eye (glaucoma). After the clot is successfully dissolved with the thrombolytic, anticoagulant therapy with an anticoagulant is initiated to prevent the reformation of clots.

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After 2 to 4 weeks, there is usually improvement in mood, socialization, and the ability to provide self-care. Herbal/Food: No food interactions have been reported, but there are several possible interactions with herbal products. There is no standard dosage; however, some manufacturers are beginning to report dose by the percentage of hypericin in the extract. There are several different formulations of diltiazem and not all are approved for the same indications (see Table 33. It is also approved for influenza chemoprophylaxis in patients ages 12 months or older. Beta-Adrenergic Blockers Beta blockers have the ability to slow heart rate, decrease contractility, and reduce blood pressure. Secondly, depolarization releases large amounts of calcium ions stored inside the cell in structures called sarcoplasmic reticula. In addition, several antibiotics are effective when used in combination with an antimalarial. At the low doses needed for cough suppression, codeine does not produce the serious adverse effects characteristic of morphine. These therapies are sometimes postponed until the acute depressive symptoms have improved. Virtually anything that changes the homeostatic environment of brain neurons has the potential to cause seizures, thus complicating the diagnosis and treatment of epilepsy. If the motor cortex is affected, jerky, rhythmic contractions of a specific muscle group are noted. These anti-insomnia benzodiazepines are administered as hypnotics to induce sleep. Meclizine (Antivert) and dimenhydrinate (Dramamine) are the two most common antihistamines used for this purpose. Apply the nursing process to care for patients receiving pharmacotherapy for fungal infections. Because this drug is not absorbed systemically, it does not carry the same black box warnings as other aminoglycosides. Patient and Family Education: Immediately report chest pain (angina) to the health care provider should it occur during the infusion. Patients with generalized septicemia, inflammation, or sepsis should not be injected with procaine. Only 50% to 70% of patients will respond favorably to nifurtimox therapy, indicating a need for additional drugs for this infection. Decreasing the heart rate and contractility also reduces cardiac output and lowers systemic blood pressure. Two drugs in this class, ardeparin (Normiflo) and danaparoid (Orgaran), have been discontinued in the United States. The first purified alkaloid, ergotamine (Ergostat), was isolated from the ergot fungus in 1920, although the actions of the ergot alkaloids had been known for thousands of years. Because rare incidences of liver injury have been reported, patients with elevated hepatic enzymes or symptoms such as jaundice, nausea, vomiting, or anorexia should immediately discontinue the drug. It may also offer protection against kernicterus, a toxic accumulation of bilirubin in infants that causes brain injury. Cephalosporins are contraindicated, however, for patients who have experienced anaphylaxis following penicillin exposure. Those who are pregnant or immunosuppressed, however, require pharmacotherapy because the disease can cause significant morbidity in these populations. The major hepatic metabolite of the drug, N-acetyl procainamide, also has antidysrhythmic activity.

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The incubation period in adults is approximately 4 weeks, while in children the asymptomatic period may last decades. The purpose of this chapter is to present the fundamental principles that apply to the pharmacotherapy of infectious diseases. The bronchial tree ends in microscopic sacs called alveoli, which have no smooth muscle and inflate like balloons during inspiration. In some manner, the normal generation or conduction of the electrical impulse, or action potential, across the myocardium has been altered. For dosing and additional information on the antianxiety and antiseizure actions of benzodiazepines, the student should refer to Chapters 22 and 26, respectively. Clofazimine (Lamprene): Clofazimine is a drug that exhibits selective activity toward mycobacteria. When later faced with the actual bacterial infection, the immune system will remember the protein-based toxin and respond rapidly by producing antibodies to neutralize it. Like chlorzoxazone, metaxalone may cause liver injury and is contraindicated in patients with hepatic impairment. Perhaps the best example of the use of this form of biotechnology is for the development of the hepatitis B immunization. Short-acting agents have a rapid onset of action, usually several minutes, so they are effective in terminating an acute asthma attack. Patients with renal impairment should receive lower doses of digoxin, because the drug is excreted by this route. Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children. The drug produces significant anticholinergic effects and orthostatic hypotension; thus it is not a first-line drug for depression. Concurrent use of allopurinol with azathioprine can result in a large increase in azathioprine activity and hematologic toxicity. Pergolide (Permax) is a dopamine agonist that was discontinued in the United States due to the possible development of valvular heart disease. The infusion of an alkalinizing agent will create an alkaline filtrate in the kidney tubule, a perfect environment for ionization of an acidic drug like aspirin. Symptoms become worse near the end of the cycle because the concentration of the drug has fallen below the therapeutic level. Black Box Warning: the nonliposomal form of this drug should only be used for patients with a progressive and potentially life-threatening fungal infection. Actions and adverse effects are the same as those of other inhaled corticosteroids. Other important hemodynamic factors affecting the myocardial oxygen supply include changes in blood volume. In herpes zoster management, famciclovir shortens healing time from 7 to 5 days, and reduces pain. The anticoagulant effect of warfarin may be increased if given concurrently with cefazolin. Caution must also be used if the patient is taking lithium because fluoxetine may increase plasma levels of the drug. Newer drugs, without new tests to detect them initially, are on the horizon, and the race against cheating in sports continues. Delusions sometimes are religious in nature, with the individual believing he is a higher power, or a messenger of a higher power. Similarly, clonidine (Catapres) is an adrenergic antagonist that can block the autonomic symptoms that accompany anxiety. This action is used to advantage in the treatment of two conditions where fluid has accumulated in extravascular spaces. Mechanism of Action: During the hepatic conversion of ammonium chloride to urea, Cl and H are formed. Pharmacotherapy is not indicated for all helminthic infections because some are self-limiting and the adult parasites die without reinfecting the host. Although the cholinesterase inhibitors improve all three domains, their effectiveness is modest at best.

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With less blood for the ventricles to pump, myocardial oxygen demand is decreased. Contraindications/Precautions: There are many contraindications to using aldesleukin, and a thorough baseline assessment of health status is required. Although they are chemically different from each other, diltiazem (Cardizem, Dilacor, Tiazac) and verapamil (Calan, Isoptin, Verelan) have quite similar pharmacologic properties and may be grouped together as nondihydropyridines. If the patient or family so chooses, notify the provider so that appropriate alternatives may be considered. Administration of the diuretic furosemide (Lasix) can significantly increase the urinary excretion of potassium within 5 to 15 minutes. Verapamil also dilates the coronary arteries, an action that is important when the drug is used to treat angina. Although the immune system provides elaborate defenses against microbial invaders, there are times when the body defenses become overwhelmed by an infection. Doxycycline is recommended as an alternative to ciprofloxacin for the prophylactic treatment of Bacillus anthracis (anthrax). This effect is dose related, may be unilateral or bilateral, and is usually reversible when therapy is discontinued. However, Carol claims that she has abstained from substance abuse for the past 5 years. Some health care providers recommend initiating therapy with two drugs to ensure an adequate response. Chlorzoxazone is hepatotoxic and should not be used in patients with liver impairment. The risk of patients developing type 2 diabetes mellitus is greater with the use of olanzapine than with other atypical agents. Recombinant technology vaccines: Modern biologic techniques have allowed the development of vaccines that include partial organisms or proteins that are generated in the laboratory. A client who is taking methylphenidate (Concerta, Metadate, Ritalin) for attention deficit/hyperactivity disorder reports having insomnia. These types of dysrhythmias require pharmacologic intervention, as discussed in Chapter 40. Illicit users may "doctor shop" and obtain opioids from different prescribers then sell the pills for profit. Researchers are also beginning to investigate the link between unusual episodes of exertional heat illness and exertional rhabdomyolysis, that is, heat illness occurring in mild weather or associated with muscle breakdown (rhabdomyolysis). Mechanism of Action: Carbamazepine inhibits sodium channels, blocking the repetitive, sustained firing of neurons that is characteristic of epilepsy. Like dextromethorphan the effectiveness of benzonatate in treating acute cough has not been clearly established. If C&S testing confirms that an infection is caused by a single species of microbe, antibiotic therapy is usually begun with one drug. The neuromuscular blocking agents are very dangerous; the diaphragm and intercostal muscles are paralyzed and breathing requires a mechanical ventilator. It is also found in higher incidence in patients with chronic obstructive pulmonary disease. A simple classification is to group endorphins, 432 types of pain as either acute or gate control theory, 431 chronic. Intermediate-duration beta 2 agonists last approximately 8 hours, whereas long-acting agents last up to 12 hours. Prevention of relapse: Patients who acquire an acute malaria infection will almost always experience subsequent attacks unless drugs are given to eliminate dormant P. Since thromboembolic disease can be life threatening, therapy is often begun by administering anticoagulants parenterally to achieve the most rapid onset of action. For some infections, a laxative is given 2 hours after treatment, to remove all parts of the worm and its eggs.

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When faced with adverse conditions, some protozoa can form protective capsules called cysts that allow the organism to survive in harsh environments in a dormant state for prolonged time periods. Increase bicarbonate and mucus production to protect the stomach mucosa from acid Renal protection. It is a prodrug that is metabolized to its active form, moexiprilat, by hepatic enzymes. Because of its toxicity, serum levels of cycloserine are measured frequently during therapy, with normal levels ranging from 25 to 35 mcg/mL. If the baby is of proper gestational age, delivery is the treatment of choice for eclampsia. Tetracycline is usually considered bacteriostatic, although it can be bacteriocidal at high concentrations. Removing the patch at night, when cardiac workload is lessened helps avoid possible anginal attacks during the daytime when workload is greater. A first-dose effect may occur with a significant drop in blood pressure with the first few doses. The bite of another Anopheles mosquito can pick up the merozoites from infected human blood, and the cycle begins anew. Serious infections may occur secondary to immunosuppression, and latent herpes or varicella infections may become reactivated during azathioprine therapy. Allergy testing can help pinpoint the particular allergens responsible for the symptoms and help direct a treatment plan that includes avoiding allergens that cause the symptoms and treating the symptoms. Cardiovascular adverse effects include transient atrial dysrhythmias, sinus tachycardia, vasodilation, and peripheral edema. The traditional treatment for bipolar disorder is lithium carbonate (Eskalith), a mood stabilizer prescribed as monotherapy or in combination with other drugs. Patient and Family Education: Clean the mouthpiece at least weekly by removing the drug canister and running warm water through the top and bottom, shaking out excess water, and allowing to air dry. Drugs Similar to Chlorpromazine Similar drugs include fluphenazine, perphenazine, prochlorperazine, thioridazine, and trifluoperazine. Certain complex partial seizures can cause unusual symptoms that are sometimes mistaken for psychosis. Alpha-adrenergic agonists should be used with caution in patients with prostatic enlargement, because these drugs increase smooth muscle activity in the prostate gland and may diminish urinary outflow (see Chapter 74). Rather than treat with high doses of opioids, several adjuvant analgesics have been found to be effective at relieving neuropathic pain. Describe the exchange of fluids that occurs among the different fluid compartments in the body. Ocular herpes causes a painful, inflamed lesion on the eyelid or surface of the eye. The drug can produce erections and is approved to treat erectile dysfunction in some countries (but not in the United States). The traditional drug for onychomycosis has been griseofulvin (Fulvicin), but this drug has a narrow spectrum of activity. These drugs change the rate of excretion of specific electrolytes, most importantly sodium and chloride. Plasma protein fraction (Plasmanate) is another albumin product that contains 83% albumin and 17% plasma globulins. Explain why the actions of the beta1-adrenergic antagonists are similar to those of the calcium channel blockers. Nonadherence: Patients with serious mental illness have a very high nonadherence rate. This latent phase of the infection may last only a few weeks, or it may continue for decades. The majority of drugs and their metabolites travel through the urinary system producing little or no effect on the renal tubular cells or the other parts of the kidney. Make position changes slowly when moving from a lying to a standing position to prevent dizziness and possible fainting.