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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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    :: Saturday, September 06, 2003 ::

    antihistamines

    astemizole (hismanal)
    azatadine maleate (optimine)

    azelastine hydrochloride (astelin)
    brompheniramine maleate (dimetane)
    cetirizine hydrochloride (zyrtec)
    chlorpheniramine maleate (aller-chlor, chlor-trimeton)
    clemastine fumarate (tavist)
    cyprophetadine hydrochloride (periactin)
    dexchlorpheniramine maleate (polaramine)
    diphenhydramine (benadryl)
    doxylamine succinate (unisom)
    fexofenadine (allegra)
    loratadine (claritin)
    methyldilazine hydrochloride (tacaryl)
    phenindamine tartrate (nolahist)
    pyrilamine maleate (nisaval)
    tripelennamine citrate or hydrochloride (PBZ-SR)
    triprolidine hydrochloride (myidil)


    description

    called histamine antagonists or h1 receptor blockers, these medications compete with histamine for receptor sites, thus preventing a histamine response.
    when the h1 receptor is stimulated, the extravascular muscles, including those lining the nasal cavity are constricted.
    decrease nasopharyngeal secretions by blocking the h1 receptor and decrease nasal itching that causes sneezing
    used for the comon cold, rhinitis, nausea and vomiting, motion sickness, uriticaria and as sleep aid
    can cause central nervous system depression if taken with alcohol, narcotics, barbituates, or hypnotics
    used with caution in clients with chronic obstructive pulmonary disease because of their drying effect
    diphenhydramine (benadryl) has an anticholinergic effect and shuold be avoided in clients with narrow angle glaucoma

    side effects

    drowsiness and fatigue
    dizziness
    urinary retention
    blurred vision
    wheezing
    constipation
    dry mouth
    GI irritation
    hypotension
    hearing disturbances
    photosensitivity
    nervousness and irritability
    confusion
    nightmares



    implementation

    monitor vital signs
    monitor for signs of urinary dysfunction
    administer with food or milk
    avoid subcutaneous injection and administer intramuscular injection in a large muscle if the IM route is prescribed
    insturct the client to avoid hazardous activities, alcohol and other CNS depressants
    instruct the client taking medication for motion sickness to take the medication 30 minutes before the event, and then before meals and at bedtime during the event.
    instruct the client to suck on hard candy or ice chips for dry mouth.

    :: Sindhu's Medical News @ 5:35 PM [+]

    ...
    nasal decongestants

    oxymetazoline hydrochloride (afrin)
    phenylephrine HCL (neo-synephrine)
    phenylpropranolamine hydrochloride (dimetapp)
    pseudoephedrine hydrochloride (sudafed)
    xylometazoline hydrochloride (otrivin)


    description

    stimulate the alpha-adrenergic receptors, thus producing vasoconstriction of the capillaries within the nasal mucosa
    shrink nasal mucosaal membranes and reduce fluid secretions
    used for allergic rhinitis, hay fever, and acute coryza (profuse nasal discharge)
    contraindicated or used in caution with clients with hypertension, cardiac disease, hyperthyroidism, and diabetes mellitus
    nasal decongestants can cause tolerance and rebound nasal congestion (vasodilation) caused by irritation of the nasal mucosa and should not be used for more than 48 hours.

    side effects

    frequent use of decongestants, especially nasal sprays or drops can result in tolerance and irritation of the nasal mucosa
    nervousness
    restlessness
    hypertension
    hyperglycemia

    implementation

    assess teh client for exisiting medical orders
    assess the client for cardiac dysrhythmias
    monitor blood glucose levels
    instruct the clients to avoid caffeine in large amounts because it can increase restlessness and palpitations
    instruct the client in the importance of limiting the use of nasal sprays and drops.

    :: Sindhu's Medical News @ 5:06 PM [+]

    ...
    expectorants and mucolytic agents

    expectorants

    guaifenesin (glycerylguaiacolate)

    mucolytic

    acetylcysteine (mucomyst)

    description


    loosen bronchial secretions so that they can be eliminated without coughing
    used for dry, unproductive cough and to stimulate bronchial secretions
    mucolytic agents with dextromethorphan should not be used with clients with COPD because they suppress the cough
    acetylcysteine (mucomyst) can increase airway resistance and should not be used in clients with asthma.

    side effects

    GI irritation
    skin rash
    oropharyngeal irritation


    implementation

    instruct the client to take medication with a full glass of water to loosen mucusinstruct the client to maintain an adequate fluid intake
    encourage the clietn to cough and deep breath
    acetylcysteine (mucomyst), administered by nebulization, should not be mixed together with another medication
    if acetylcysteine is administered with a bronchodilator, the bronchodilator should be administered 5 minutes before the acetylcysteine.
    monitor for side effects of acetylcysteine such as nausea and vomiting, stomatitis, and runny nose.

    :: Sindhu's Medical News @ 4:48 PM [+]

    ...
    antitussives

    narcotics

    codeine, codeine phosphate, codeine sulfate, hydrocodone bitartrate (hycodan)

    nonnarcotics

    dextromethrophan hydrochloride (benylin, robitussin DM)
    diphenhydramine hydrochloride (benadryl, benylin cough syrup)


    description

    act on the cough control center in the medulla to suppress the cough reflex
    used for a cough that is nonproductive and irritating

    side effects

    dizziness, drowsiness, sedation
    GI irritation
    nausea
    dry mouth
    constipation
    respiratory depression


    implementation

    instruct the client that if the cough lasts longer than 1 week and a fever or rash occurs, the physician should be notified.
    encourage the clietn to take adequate fluids with the medication
    encourage the clietn to sleep with the head of the bed elevated
    instruct the clietn to avoid hazardous activities
    note that drug dependency can occur
    avoid administration to the client with a head injury or post operative cranial surgery
    avoid administration to the client using narcotics, sedatives, barbituates, or antidepressants, because CNS depression can occur
    instruct the client to avoid the use of alcohol.

    :: Sindhu's Medical News @ 4:22 PM [+]

    ...
    narcotic agonist

    naloxone hydrochloride (narcan)


    description

    reverses respiratory depression in narcotic overdose
    avoid use in nonnarcotic respiratory depression

    side effects

    CNS depression,
    nausea, vomiting
    tremors
    sweating
    increased blood pressure
    tachycardia


    implementation

    assess vital signs, especially respirations
    have oxygen and resuscitative equipment available during administration

    use of an inhaler

    client instructions

    if two different inhaled medications are prescribed, and one of the medicaton contains a glucocorticoid (corticosteroid), administer the bronchodilator first and the corticosoteroid second.
    wait 5 minutes after the bronchodilator before inhaling the corticosteroid.

    tuberculosis medications

    descripiton


    the most effective method for treating the disease and preventing transmission
    treatment of identified lesions depends on whehter the individual has active disease or has been exposed to the disease
    treatment is difficult because the bacterium has a waxy substance on the capsule, which makes penetration and destruction difficult.
    the use of a multiple medication regimen destroys organisms as quickly as possilbe and minimizes teh emergence of medications to which the organism is susceptible.
    individuals with active TB are treated for 6 to 9 months; however, clients with human immunodeficiency virus (HIV) infection will be treated for a longer period.
    after the infected individual has received the medication for 2 to 3 weeks, the risk of transmission is greatly reduced.
    most clients have negative sputum cultures after 3 months with compliance to medication therapy
    individuals who have been exposed to active TB are treated with preventive isoniazid for 6 to 9 months upto 1 year.

    first or second line medications

    first line medications provide the most effective antituberculosis activity
    second line medications are used in combination with first line medications but are more toxic
    current infecting organisms are proving resistant to standard first line medications and the resistant organisms develop becuase the individuals with the disease fail to complete the course of treatment; surviving bacteria adiapt to the medication and becoem resistant
    multidrug therapies are instituted because of the persistent organisms.

    multidrug resistant tuberculosis (MDR-TB)

    occurs when a client receiving two medications (first line and second line medications) discontinues one of teh medications without the physician's knowledge.
    the client briefly experiences some response from teh single medication, but then large numbers of resistant organisms begin to grow
    the client, infectious again, transmits the drug resistant organism to other individuals
    as this event is repeated, an organism develops that is resistant to many of the first line tuberculosis medications.


    :: Sindhu's Medical News @ 4:05 PM [+]

    ...
    :: Friday, September 05, 2003 ::
    first line medications for TB continued

    isoniazid

    description


    bactericidal
    inhibitis synthesis of mycolic acids and acts to kill actively growing organisms in the extracellular environment
    inhibits growth of dormant organisms in the macrophages and caseating granulomas
    active only during cell division
    used in combination with other antitubercular medications

    contraindications and cautions

    contraindicated in clients with hypersensitivity or with acute liver disease
    use in caution in cilents with chronic liver disease or renal impairment
    used in cuation with clients taking niacin, nicotinic acid
    used in caution with clients taking hepatotoxic medications because the risk for hepatotoxicity increases
    isoniazid may increase the risk of toxicity for carbamazepine (tegretol) and phenytoin (dilantin)
    isoniazid may decrease ketoconazole (nizoral) concentrations


    side effects

    hypersensitivity reactions
    peripheral neuritis
    neurotoxicity
    hepatotoxicity
    pyridoxine (vitaminb6) deficiency
    irritation at injection site with IM administration
    nausea and vomiting
    dry mouth
    dizziness
    hyperglycemia
    increased liver function tests
    hepatitis


    implementation

    assess for hypersensitivity
    assess for hepatic dysfunction
    assess for sensitivity to niacin, nicotinic acid
    monitor for liver function tests
    monitor for signs of hepatitis, such as anorexia, nausea, vomiting, weakness, fatigue, dark urine, jaundice, if these symptoms persists, withhold the medication and notify the physician.
    monitor for bleeding, tingling, numbness
    assess mental status
    monitor for visual changes and notify the physician if they occur
    assess for dizziness and initiate safety precautions
    monitor complete blood count and blood glucose levels
    administer 1 hour before and 2 hours after a meal because food may delay absorption
    administer atleast one hour before antacids especially those antacids that contain aluminum

    client education

    instruct the client not to skip doses and to take medication for the full length of the prescribed therapy
    instruct teh client not to take any other medication without consulting the physician.
    advise the client about the importance of follow up visits, vision testing and laboratory tests.
    instruct the client to avoid alcohol
    advise the client to take medication on an empty stomach with 8 ounces of water 1 hour before or 2 hours after meals and to avoid taking antacids with the medication
    instruct the clietn to avoid tyramine containing foods because they may cause a skin reaction such as red and itching skin, a pounding heart beat, light headedness, a hot or clammy feeling, or a headache, if these reactions occur, notify the physician
    instruct the client in the signs of neurotoxicity, hepatitis, and hepatotoxicity
    instruct the client to noitify the physician if signs of neurotoxicity, hepatitis, and hepatotoxicity or visual changes occur.

    rifampin (rifadin)

    description

    inhibits bacterial synthesis
    binds to DNA dependent RNA polymerase and blocks RNA transciption
    used in conjunction with atleast one other antitubercular medication

    Contraindications and Cautions

    contraindicated in clients with hypersensitivity
    use with caution in clients with hepatic dysfunction or alcoholism
    use of alcohol or hepatotoxic medications may increase the risk of hepatotoxicity
    decrease the effects of several medications including oral anticoagulants, oral hypoglycemics, chloramphenicol, digoxin, disopyramide phosphate (norpace), mexiletine (mexitil), quinidine polygalacturonate (cardioquin), tocainide hydrochloride (tonocard), fluconazole (diflucan), methadone hydrochloride (dolophine), phenytoin (dilantin), and verapamil hydrochloride (calan)

    side effects

    hypersensitivity reaction including fever, chills, shivering, headache, muscle and bone pain, and dyspnea
    heartburn
    nausea, vomiting, diarrhea
    increased liver function tests
    hepatotoxicity and hepatitis
    increased uric acid levels
    blood dyscrasias
    colitis

    implementation


    assess for hypersensitivity
    evaluate CBC, uric acid, and liver function tests
    assess for signs of hepatitis, and if they occur, withhold the medication and notify the physician
    monitor stools for signs of colitis
    monitor mental status
    assess for visual changes

    client education

    instruct teh client not to skip doses and to take medication for the full length of the prescirbed therapy
    instruct the client not to take any other medication without consulting the physician
    advise teh client of teh importance of follow up phyisician visits and laboratory tests
    instruct the client to avoid alcohol
    advise the client to take medication on an empty stomach with 8 oz of water 1 hour before or 2 hours after meals and to avoid taking antacids with the medication
    instruct the client that urine, feces sweat and tears will be red-orange in color and that soft contact lenses can become permanently discolored.
    insturct teh client to notify physician if jaundice develops or if weakness, nausea, fatigue, vomiting, sore throat, fever, or unusal bleeding occurs.

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

    ...
    first line medications for TB

    ethambutol (myambutal)

    description


    bacteriostatic
    interferes with cell metabolism and multiplication by inhibiting one or more metabolites in teh susceptible organism
    inhibits bacterial RNA synthesis
    active only during cell division
    is slow acting and must be used in combintation with other bactericidal agents

    Contraindications and cautions

    contraindicated in clients with hypersensitivity, optic neuritis, and in children under 13 years old.
    use in caution in clients with renal dysfunction, gout, ocular defects, diabetic retinopathy, cataracts, and ocular inflammatory conditions
    use in caution in clients taking neurotoxic medications as the risk of neurotoxicity increases.

    side effects

    hypersensitivity reactions
    anorexia, nausea, vomiting
    dizziness
    malaise
    mental confusion

    joint pain
    dermatitis
    optic neuritis
    peripheral neuritis
    thrombocytopenia
    increased uric acid levels
    anaphylactoid reaction


    implementation

    assess for hypersensitivity
    evaluate results of CBC, uric acid, renal andl iver dysfunction tests
    obtain baseline visual acuity and color discrimination, especially to the color green
    administer once every 24 hours and administer with food to decrease gastrointestinal upset
    monitor input and output and for adequate renal function
    assess mental status
    monitor for dizziness and initiate safety precautions
    assess for peripheral neuritis (numbness, tingling, or burning of teh extremities) and if it occurs, notify the physician.

    client education

    inform the client that he or she can prevent nausea related to the medication by taking the daily dose at bedtime, or to take prescribed antinausea medications
    instruct the client not to skip doses and to take the 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 visits, vision testing, and laboratory tests.
    instruct the client to notify the physician immediately if any visual problems occur; if a rash, swelling or joint pain, or numbness or tingling occurs, or if burning in the hands or feet occurs.

    streptomycin

    description


    an aminoglycoside antibiotic that is used in conjunction with atleast one other antitubercular medication
    bactericidal, because of receptor binding action, interfereing with protein synthesis in susceptible organisms.

    contraindications and cautions

    contraindicated in clients with hypersensitivity, myasthenia gravis, parkinsonism, or eighth cranial nerve damage
    use with caution in the elderly, in neonates because of renal sufficiency and immaturity and in young infants because the medication may cause CNS depression.
    the risk of toxicity increases when taken with other aminoglycosides or nephrotoxic or ototoxic producing medications.


    side effects

    hypersensitivity
    visual changes
    increased liver function and renal function tests
    peripheral neuritis such as burning of the face or mouth.>

    implementation

    assess for hypersensitivity
    monitor liver and renal function tests
    monitor for ototoxic, neurotoxic, and nephrotoxic reactions
    obtain baseline audiometric tests and repeat every 1 to 2 months because the medication impairs the eighth cranial nerve
    assess hearing activity
    monitor for visual changes
    assess hydration status and maintain adequate hydration during therapy
    monitor I and O
    assess urinalysis
    monitor for signs of peripheral neuritis

    side effects of streptomycin

    nephrotoxicity

    changes in urine output
    increased thirst
    decreased appetite
    nausea, vomiting


    vestibular ototoxicity

    dizziness
    clumsiness
    unsteadiness



    neurotoxicity

    muscle numbness
    tingling
    twitching
    seizures


    auditory ototoxicity

    ringing in the ears
    loss of hearing
    a full feeling in the ears


    client education

    instruct teh 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 physician if hearing loss, changes in vision and urinary problems occur.

    pyrazinamide

    description


    exact mechanism of action is unknown
    may be bacteriostatic and bactericidal depending on its concentration at the infection site and susceptibility of infecting organism
    used in conjuction with atleast one other antitubercular medication after failure or ineffectiveness of the primary medications occurs


    contraindications and cautions

    contraindicated in clients with hypersensitivity
    use with caution in clients with diabetes mellitus, renal impairment, gout and in children
    may decrease the effects of allopurinol (zyloprim), colchicine, sulfinpyrazone (anturane)
    cross senstivity is possible with isoniazid (INH), ethionamide (trecator-sc), or niacin, and nicotinic acid (nicobid)


    side effects

    increases liver function and uric acid levels
    arthralgia, myalgia
    photosensitivity
    hepatotoxicity
    thrombocytopenia


    implementation

    assess for hypersensitivity
    evaluate CBC, liver function tests, and uric acid levels
    observe for hepatotoxic effects, and if they occur, withhold the medication, and notify the physician
    assess for painful or swollen joints
    evaluate blood glucose levels because diabetes mellitus may be difficult to control while on medication.

    client education

    instruct the client to take the medication with food to reduce GI distress
    instruct the client to avoid sunlight or ultraviolet light until photosensitivity is determined.
    instruct the client to notifiy physician if any side effect occur
    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

    :: Sindhu's Medical News @ 9:47 PM [+]

    ...

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