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  • [::..archive..::]
    07/20/2003 - 07/27/2003 07/27/2003 - 08/03/2003 08/03/2003 - 08/10/2003 08/10/2003 - 08/17/2003 08/24/2003 - 08/31/2003 08/31/2003 - 09/07/2003 09/07/2003 - 09/14/2003 09/14/2003 - 09/21/2003 09/21/2003 - 09/28/2003 11/09/2003 - 11/16/2003 03/21/2004 - 03/28/2004
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    :: Thursday, August 28, 2003 ::

    second line medications for TB

    capreomycin sulfate (capastat sulfate)


    description

    mechanism of action is unknown
    used to treat MDR-TB when significant resistance to other medications is expected
    must be given by the IM route

    contraindications and cautions

    the risk of nephrotoxicity, ototoxicity and neuromuscular blockade is increased with the use of aminoglycosides or loop diuretics.
    use with caution in clients with renal insufficiency, acoustic nerve impairment, hepatic disorder, myasthenia gravis, and parkinsonism.
    do not administer to client receiving streptomycin

    side effects


    nephrotoxicity
    ototoxicity
    neuromuscular blockade


    implementation

    perform baseline audiometric testing
    assess renal, hepatic and electrolyte levels before administration
    monitor I&O
    reconstituted medication may be stored for 48 hours at room temperature
    administer deep IM in large muscle mass
    rotate injection sites
    observe injection site for redness, excessive bleeding, and inflammation

    client education

    instruct the client not to perform tasks that require mental alertness
    instruct the client to report any hearing loss, balance disturbances, respiratory difficulty, weakness or signs of hypersensitivity reactions

    kanamycin (kantrex)

    description


    an aminoglycoside antibiotic that is used in conjunction with at least one other antitubercular injection
    bactericidal, because of receptor binding action, interfering with protein synthesis in susceptible microorganisms.

    contraindications and cautions

    contraindicated in clients with with hypersensitivity, neuromuscular disorders, or eighth cranial nerve damage
    use with caution in the elderly, in neonates because of renal insufficiency and immaturity, and in young infants because it may cause CNS depression.
    the risk of toxicity increases when taken with other aminoglycosides, or nephrotoxic or ototoxic-producing medications.


    side effects

    hypersensitivity
    pain and irritation at the injection site
    nephrotoxicity as evidenced by increased blood urea nitrogen and serum creatinine
    ototoxcity as evidenced by tinnitus, dizziness, ringing/roaring in the ears, and reduced hearing
    neurotoxicity as evidenced by headache, dizziness, lethargy, tremors, and visual disturbances
    superinfections


    implementation

    assess for hypersensitivity
    monitor for ototoxic, neurotoxic, and nephrotoxic reactions
    monitor liver and renal function tests
    obtain baseline audiometric test and repeat every one to two months because the medication impairs the eigth cranial nerve
    assess hearing acuity
    monitor for visual changes
    assess hydration status and maintain adequate hydration during therapy.
    monitor I &O
    assess urinalysis
    monitor for superinfection

    client education

    instruct the client not to skip doses and to take medication for the full length of the prescribed therapy.
    instruct the client not to take any other medication without consulting the physician.
    advise the client of the importance of follow up physician visits and laboratory tests
    instruct the client to notify the physician if hearing loss, changes in vision, or urinary problems occur.

    ethionamide (trecator-SC)

    description

    mechanism of action is unknown
    used to treat MDR-TB when signficant resistance to other medications is expected.

    contraindications and cautions

    contraindications in clients with hypersensitivity
    use with caution in clients with diabetes mellitus or renal dysfunction


    side effects

    anorexia, nausea and vomiting
    metallic taste in the mouth
    orthostatic hypotension
    jaundice
    mental changes
    peripheral neuritis
    rash


    implementation

    assess liver and renal function tests
    monitor glucose levels in teh client with diabetes mellitus
    administer pyridoxine as prescribed to reduce the risk of neurotoxcity.

    client education

    instruct the client to take medication with food or meals to minimize GI irriation.
    instruct the client to change positions slowly.
    instruct the client to report signs of a rash, which canprogress to exfoliative dermatitis if the medication is not discontinued.
    instruct the client to avoid alcohol
    instruct the clietn to report any sign of jaundice and other side effects of the medication if they occur.

    aminosalicylate sodium (Tubasal)

    description


    inhibits folic acid metabolism in mycobacteria
    used to treat MDR-TB when significant resistance to other medications is expected.

    contraindications and cautions

    contraindicated with hypersensitivity to aminosalicylates, salicylates or compounds containing para-aminophenyl group.

    side effects

    hypersensitivity
    bitter taste in the mouth
    GI tract irritation
    exfoliative dermatitis
    blood dyscrasias
    crystalluria
    changes in thyroid function


    implementation

    assess for hypersensitivity
    offer clear water to rinse the mouth, chewing gum, or hard candy to alleviate the bitter taste.
    encourage fluid intake to prevent crystalluria
    monitor I&O


    client education

    instruct the client to discard teh medication if a purplish brown discoloration occurs.
    instruct the client that urine may turn red on contact with hypochlorite bleach if bleach was used to clean a toilet.
    instruct the client not to take aspirin or over the counter medications without the physicians approval.inform the client with diabetes mellitus that a false positive test may occur in glucose monitoring
    instruct teh clietn to report signs of blood dyscrasia such as sore throat or mouth, malaise, fatigue, bruising or bleeding.


    cycloserine (seromycin)

    description

    intereferes with cell wall biosynthesis
    used to treat MDR-TB when significant resistance to other medications is expected.

    contraindications and cautions

    use of alcohol or ethionamide increases the risk of seizures
    use with caution in clients with epilepsy, depression, severe anxiety, psychosis, renal insufficiency or the client who uses alcohol.



    side effects


    hypersensitivity
    CNS reactions
    neurotoxicity
    seizures
    heart failures
    headaches
    vertigo
    altered level of conscioiusness
    irritability, nervousness, anxiety
    confusion
    mood changes, depression, thoughts of suicide


    implementation

    monitor LOC
    monitor for changes in mental status and thought processes
    monitor renal and hepatic function tests
    monitor serum drug level to avoid the risk of neurotoxicity; peak concentrations, measured 2 hours after dosing, should be 25 to 35 mcg/ml

    client education

    instruct the client to take the medication after meals to prevent GI upset
    instruct the client to avoid alcohol
    instruct the clietn to report signs of a rash or signs of CNS Toxicity
    instruct the client to avoid driving or performing tasks that require alertness until the reaction to the medication has been determined.
    advise the clietn of the need for serum drug levels weekly; as prescribed.

    :: Sindhu's Medical News @ 2:35 AM [+]

    ...
    :: Monday, August 25, 2003 ::
    laxatives

    bulk forming laxativesmethylcellulose (Citrucel)
    calcium polycarbophil (fibercon)

    psyllium hydrophilic mucilloid (metamucil, fiberall, konsyl, serutan, modane bulk)>

    description of bulk forming laxatives

    absorb water into the feces and increase bulk to produce large and soft stools.
    for short term use.
    contraindicated in bowel obstruction

    side effects

    GI disturbances
    dehydration
    electrolyte imbalance
    dependency with chronic use


    stimulant cathartics

    bisacodyl (dulcolax)
    cascara sagrade
    castor oil emulsified (neoloid)

    phenolphythalein (ex-lax)
    senna concentrate (senexon, senna-gen)


    description of stimulant cathartics

    stimulate motility of large intestine.

    biscodyl (dulcolax): do not administer within 60 minutes of an antacid or millk.

    cascara (castor oil): administer with juice, produces results in 2 to 6 hours.
    saline cathartics

    glycerine suppositories (senokot)
    lactulose (chronulac)
    magnesium citrate (Citroma)
    magnesium sulfate (epsom salt)
    sodium phosphate (fleet phospho soda)
    magnesium hydroxide (milk of magnesia)
    potassium bitrate and sodium bicarbonate (coe-two)



    description of saline cathartics

    attract water into the large intestine to produce bulk.
    stimulate peristalsis.
    acheive results in 2 to 6 hours.

    stool softeners

    docusate calcium (surfak)
    docusate sodium (colace)
    docusate with casanthranol (peri-colace)


    description of stool softners

    inhibit absorption of water so fecal mass remains large and soft.
    used to avoid straining.

    lubricant

    mineral oil


    description of lubricants

    act to control the feces
    ease the strain of passing stool
    lessen irriation with hemorrhoids
    mineral oil:- can cause lipid pneumonia if accidently aspirated
    interferes with absorption of fat soluble vitamins A, D, E, and K

    medications to control diarrhea

    opioid and related medications

    codeine phosphate; codeine sulfate
    difenoxin with atropine (motofen)
    diphenoxylate hydrochloride with atropine (lomotil)
    loperamide hydrochloride (immodium)
    tincture of opium

    description of opioids


    decrease intestinal motility and peristalsis
    when poisons, infections, or bacterial toxins are the cause of the diarrhea, opioids worsen the condition by delaying the elimination of toxins.
    tincture of opium has an unpleasant taste and can be diluted with 15 to 30 ml of water for administration

    other antidiarrheals

    bismuth subsalicylate (pepto-bismol)
    kaolin and pectin (kao-spen, kapectolin)
    somatostatin analog
    octreotide (sandostatin)

    antispasmodics


    dicyclomine hydrochloride (antispas)
    dicyclomine hydrochloride (bentyl)


    side effects

    constipation
    rash
    euphoria
    dizziness
    drowsiness
    headache
    nausea and weakness


    :: Sindhu's Medical News @ 11:44 PM [+]

    ...
    medications to treat hepatic encephalopathy

    lactulose (cephulac)
    neomycin (mycifradin)

    lactulose

    reduces ammonia levels
    improves protein tolerance in clients with advanced hepatic cirrhosis.
    lowers the colonic ph from 7 to 5; this acidification pulls ammonia into the bowel to be excreted in the feces, thus lowering the ammonia level.
    administered orally in the form of a syrup.

    neomycin (mycidradin)

    reduces teh number of colonic bacteria that normally convert urea and amino acids into ammonia
    adminstered orally or via nasogastric tube
    used with caution in clients with kidney impairment.

    pancreatic enzyme replacements

    pancreatin (creon)
    pancrelipase (cotazym, pancreas, viokase)

    used to supplement or replace pancreatic enzymes.
    taken meals with a snack (food helps to buffer the stomach acid)
    a high fiber diet may increase the efficacy of the medication
    side effects include abdominal cramps, or pain, nausea and diarrhea.
    products that contain calcium carbonate or magnesium hydroxide interfere with the action of the medication

    antiemetics

    commonly administered antiemetics

    diphenidol hydrochloride (Vontrol)
    dolasteron mesylate (Anzemet)
    dronabinol (marinol)
    granisetron (kytril)
    hydroxine hydrochloride (atarax)
    hydroxine pamoate (vistaril)
    meclizine hydrochloride (antivert)

    metoclopramide (reglan)
    ondansetron (Zofran)
    promethazine hydrochloride (phenergan)
    thiethylperazine malate (torecon)
    trimethobenzamide hydrochloride (Tigan)
    prochlorperazine (Compazine)


    medications used to control vomiting
    the choice of the antiemetic is determined by the cause of the nausea and diarrhea.
    monitor for drowsiness and protect the client from injury.
    monitor vital signs and input and output
    limit odors in the client's room when the client is nauseated and or vomiting
    limit oral intake to clear liquids when the client is nauseated or vomiting

    :: Sindhu's Medical News @ 2:44 AM [+]

    ...
    :: Sunday, August 24, 2003 ::
    Bile Acid Sequestrants

    cholestyramine (questran, prevalite)
    colestipol (colestid)


    description of bile acid sequestrants

    used to treat pruritis associated with biliary disease
    acts by absorbing and combining with instestinal bile salts, which are then secreted in the feces, preventing intestinal reabsorption
    may be used cautiously in the treatment of hypercholesterolemia in adults.
    used cautiously in clients with bowel obstruction or severe constipation because of the adverse GI effects.
    taste and palatability are often reasons for noncompliance and can be improved by the use of flavored products or mixing the medication with various juices.
    stool softners and other sources of fibers can be used to abate the GI side effects

    side effects

    constipation
    bloating
    flatulence
    nausea
    fecal impaction and intestinal obstruction
    exacerbation of hemorroids
    hypoprothrombinemia
    decreased vitamin absorption

    medications for cholelithiaisis

    chenodiol (chenix)
    monoctanoin (moctanin)
    ursodiol ( Actigall)


    chenodiol (chenix)

    decreases cholesterol production, lowering content of bile, thus facilitates dissolution of gallstones
    can cause diarrhea and possible hepatoxicity
    baseline liver function studies should be performed
    client should be instructed to contact the physician if abdominal pain, sudden right upper quadrant, nausea or vomiting occurs.
    administer with food and milk
    avoid aluminium containing antacids

    Ursodiol (actigall)

    a naturally occuring bile salt
    suppresses hepatic synthesis and secretion of cholesterol and inhibitis intestinal absorption
    requires months of therapy for dissolution of gallstone to occur
    ultrasound images are obtained within 6 months to determine effectiveness of therapy.
    clients should be instructed to report nausea, vomiting, diarrhea, or rash to the physician
    administer with food or milk
    avoid aluminum containing antacids

    monoctanoin (moctanin)

    used when stones made of calcium are resistant to dissolution by oral chenodiol
    administered through a T tube, nasal biliary catheter or percutaneous transhepatic catheter.
    effective only when in contact witht he stone
    major side effects include diarrhea, nausea, and abdominal pain.

    :: Sindhu's Medical News @ 10:55 PM [+]

    ...

    proton pump inhibitors

    omeprazole (prilosec)
    lansoprazole (prevacid)


    description of proton pump inhibitors

    supress gastric acid secretion
    used with active ulcer diseasem, erosive esophagitis and pathological hypersecretory conditions
    <strong>contraindicated in hypersensitivity
    common side effects include headache, nausea, vomiting, diarrhea, and abdominal pain.

    gastrointestinal stimulants
    bethanecol chloride (urecholine, Duvoid)
    metoclopramide (reglan)
    neostigmine methylsulfate (prostigmin)
    description of gastrointestinal stimulants

    stimulates motility of the upper GI tract and increases the rate of gastric emptying without stimulating gastric, biliary, or pancreatic secretions
    used for gastroesophageal reflux
    may cause restlessness, drowsiness, extrapyramidal reactions, dizziness, insomnia, headaches
    contraindicated in clients with sensitivity.

    contraindicated in clients with mechanical obstruction, perforation, or GI hemorrhage
    can precipitate hypertensive crisis in clients with phechromocytoma.
    safety in pregnancy is not established.
    reglan can cause parkinson like reactions and if this occurs this medication is discontinued
    anticholingerics and narcotic analgesics antagonize the effects of metoclopramide (reglan)alcohol, sedatives, cyclosporine (sandimmune) and tranquilizers produce an additive effect.

    :: Sindhu's Medical News @ 10:30 PM [+]

    ...

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