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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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    :: Tuesday, September 09, 2003 ::

    peripheral vasodilators

    alpha adrenergic blocker

    tolazoline (priscoline) http://www.drugs.com/xq/cfm/pageid_0/htm_001658/tgid_41/type_pros/bn_Priscoline/micrpro_medex/qx/index.htm

    beta-adrenergic agonist

    isoxsuprine (vasodilan) http://www.drugs.com/xq/cfm/pageID_0/htm_001359/type_pros/bn_Vasodilan/micrpro_medex/qx/index.htm


    direct acting peripheral vasodilator

    ergoloid mesylate (hydergine) http://www.healthsquare.com/newrx/hyd1198.htm


    alpha blocker

    doxazosin mesylate (cardura) http://www.pfizer.com/download/uspi_cardura.pdf

    prazosin hydrochloride (minipress) http://www.pharmacynetworkgroup.com/i/minipress-indications-dosage.htm
    terazosin hydrochloride (hytrin) http://www.rxabbott.com/pdf/hytrin.PDF

    calcium channel blocker

    nifedipine (procardia) http://www.pfizer.com/download/uspi_procardia.pdf
    nimodipine (nimotop) http://www.univgraph.com/bayer/inserts/nimotop.pdf

    hemorrheologic

    pentoxifylline (trental) http://www.aventis-us.com/PIs/trental_TXT.html#
    increases tissue perfusion and microcirculation


    description

    decrease peripheral resistance by exerting a direct action on the arteries or on both the arteries and veins
    increase blood flow to the extremities.
    used in peripheral vascular disorders of venous and arterial vessels
    most effective for disorders resulting from raynaud's disease.
    these medications may decrease some of the symptoms of cerebral vascular insuffiency.

    side effects

    light headedness, dizziness
    postural hypotension
    tachycardia
    palpitations
    flushing
    GI distress


    implementation

    monitor vital signs, especially the BP and heart rate
    monitor for orthostatic hypotension and tachycardia
    monitor for signs of inadequate blood flow to the extremities such as pallor, coldness of the extremities and pain.
    instruct the client that it may take longer up to 3 months for a desired therapuetic response.
    advise the client not to smoke because smoking increases vasospasm.
    instruct teh client to avoid aspirin or aspirin like compounds unless approved by the physician.
    instruct the client to take the medication with meals if GI disturbances occur.
    instruct teh client to avoid alcohol because alcohol may cause a hypotensive reaction.
    encourage teh client to change positions slowly to avoid orthostatic hypotension.

    :: Sindhu's Medical News @ 8:28 PM [+]

    ...
    antilipemic medications

    description

    reduce serum levels of cholesterol , triglycerides, or low density lipoproteins (LDL)
    when cholesterol, triglycerides and LDL are elevated, the client is at increased risk for coronary artery disease.
    in many cases, diet alone will not lower blood lipid levels; therefore antilipemic medications will be prescribed.

    bile sequestrants

    bile acid sequestrants

    cholestyramine (questran) http://www.rxlist.com/cgi/generic3/cholestyramine.htm
    colestipol (colestid) http://www.rxlist.com/cgi/generic/colestipol.htm

    description

    binds with acids in the intestines
    bile acid sequestrants should not be used as the only therapy in clients with elevated triglycerides, because they raise triglyceride levels.

    side effects

    constipation and peptic ulcer

    implementation

    cholestyramine (questran) comes in a gritty powder that must be mixed thoroughly in juice or water before administration
    monitor the client for early signs of peptic ulcer such as nausea and abdominal pain and distention
    instruct the client that medication must be taken with and followed by sufficient fluids.

    HMG-CoA reductase inhibitors

    atorvastatin (lipitor) http://www.lipitor.com

    cerivastin (baycol) http://www.fda.gov/cder/drug/infopage/baycol/default.htm
    fluvastatin (lescol) http://www.pharma.us.novartis.com/product/pi/pdf/Lescol.pdf">
    lovastatin (mevacor)http://www.merck.com/product/usa/pi_circulars/m/mevacor/mevacor_pi.pdf
    rosuvastatin (crestor) http://www.crestor.com/strong>
    simvastatin (zocor) http://www.zocor.com
    pravastatin (pravachol) http://www.rxlist.com/cgi/generic/pravast.htm

    description

    lovastatin (mevacor) is highly protein bound and should not be administered with anticoagulants
    lovastatin should not be administered with lopid
    lovastatin should be used in caution to clients who take immunosuppresant medications

    side effects

    nausea
    vomiting
    abdominal pian or cramps
    flatulence
    dizziness
    headaches
    blurred vision
    rash
    pruritis
    elevated liver enzymes
    causes GI disturbances, headaches, muscle cramps, and fatigue


    implementation

    monitor serum liver enzymes
    instruct the client to receive an annual examination because the medication causes cataract formation
    if lovastatin is not effective in lowering the lipid level after 3 months, it should be discontinued

    other antilipemic medications

    clofibrate (atromid-s) fenofibrate (tricor) http://www.rxlist.com/cgi/generic3/fenofibrate.htm
    gemfibrozil (lopid) http://www.pharmacynetworkgroup.com/d/lopid-description.htm
    nicotinic acid (niacor, niacin) [+]

    ...
    bronchodilators

    bronchodilators:sympathomimetics


    beta-receptor agonists

    albuterol (proventil, ventolin)
    bitoletrol mesylate (tornalate)
    ephedrine sulfate
    epinephrine (base) suspension (sus-phrine)
    epinephrine (asthmahaler mist)
    epinephrine bitratrate (bronkaid suspension mist)
    epinephrine (racemic) (vaponefrin)
    epinephrine hydrochloride (adrenalin chloride)
    ethylnorepinephrine (bronkopherin)
    isoetharine hydrochloride (bronkosol)
    isoetharine mesylate (bronkometer)
    isoproterenol hydrochloride (isuprel glossets, isuprel mistometer)
    isoproterenol sulfate (medihaler-iso)
    metaproterenol sulfate (alupent, metaprel)
    pirbuterol acetate (maxair, autoinahler)
    salmeterol (serevent)
    terbutaline sulfate (brethine, bricanyl, brethaire)

    anticholinergic

    ipratropium bromide (atrovent)

    bronchodilator:xanthines

    aminophylline (generic, truphylline, phyllocontin)
    theophylline

    theophylline (aerolate, slo-phyllin, theolair)
    theophylline (theo-dur, slo-bid, theo-24, uni-dur, uniphyl)
    oxitriphylline (choledyl, choledyl SA)


    description

    sympathomimetic bronchodilators dilate teh airways of the respiratory tree, making air exchange and respiration easier for the client, and relax the smooth muscle of the bronchi.
    xanthine bronchodilators stimulate the central nervous system and respiration, dilate coronary and pulmonary vessels, cause diuresis and relax smooth muscles.
    used to treat allergic rhinitis and sinusitis, acute bronchospasm, acute and chronic asthma, bronchitis, chronic obstructive pulmonary disease, and emphysema.
    contraindicated in individuals with hypersensitivity, peptic ulcer disease, severe cardiac disease and cardiac dysrhthmias, hyperthyroidism, and uncontrolled seizure disorders
    used in caution in clients with hypertension, diabetes mellitus, and narrow angle glaucoma
    theophylline increases the risk of digitalis toxicity and decreases the effects of lithium and phenytoin (dilantin)
    if theophylline and a beta adrenergic agonist are administered together, cardiac dysrhythmias may result
    beta blockers cimetidine (tagamet) and erythromycin increase the effects of theophylline
    barbituates and carbamazepine (tegretol) decrease teh effects of theophylline

    side effects

    palpitations
    tachycardia
    dysrhythmias
    restlessness, nervousness, tremors
    anorexia, nausea and vomiting
    headaches, and dizziness
    hyperglycemia
    decreased clotting time
    mouth dryness and throat irritation with inhalers
    tolerance and paradoxical bronchoconstriction with inhalers


    implementation

    assess vital signs
    monitor for cardiac dysrhythmias
    assess for cough, wheezing, decreased breath sounds, and sputum production
    monitor for restless and confusion
    provide adequate hydration
    administer the medication at regular intervals around the clock to maintain a sustained therapeutic level
    administer oral medications with or after meals to decrease GI irritation
    instruct the client not to crush enteric coated or sustained release tablets or capsules
    instruct the client to avoid caffeine products such as coffee, tea, cola and chocolate
    instruct the client in the side effects of bronchodilators
    instruct the client to monitor the pulse and to report any abnormalities to the physician
    instruct the client how to use an inhaler or nebulizer and how to monitor the amount of medication remaining in an inhaler canister
    instruct the client to avoid over the counter medications
    instruct the client to stop smoking and provide information regarding support services
    instruct the client with diabetes mellitus to monitor blood glucose levels
    instruct the client with asthma to wear a medic-alert bracelet
    monitor for a therapeutic serum theophylline level of 10 to 20 mg/ml
    note that toxicity is likely to occur when the serum level is greater than 20 mg/ml
    Iv aminophylline or theophylline preparations should be administered slowly and always via an infusion pump.

    :: Sindhu's Medical News @ 12:30 AM [+]

    ...
    :: Monday, September 08, 2003 ::
    glucocorticoids medication continued

    bethamethasone (celestone)
    cortisone (cortone)
    fludrocortisone (florinef)
    hydrocortisone (cortef)
    triamcinolone (aristocort, kenacort)
    dexamethasone (decadron)
    methylprednisolone (depo-medrol, solu-medrol)
    prednisolone (delta-cortef, prelone)
    prednisone (deltasone, orasone, and meticorten)


    description

    produce metabolic effects
    alter the immune response and suppress inflammation
    promote sodium and water retention and potassium excretion
    produce antiinflammatory, antiallergic and antistress effects
    may be used as replacement for adrenocortical insuffiency

    side effects

    hyperglycemia
    hypokalemia
    sodium and water retention
    edema
    cause muscle wasting, osteoporosis, growth retardation in children, peptic ulcer, increased serum glucose levels, hypertension, convulsions, mood swings, cataracts, glaucoma, fragile skin, hirsutism, altered fat distribution.
    masks the signs and symptoms of infection.


    contraindications and cautions

    contraindicated in hypersensitivity, psychosis, and fungal infections.
    use with caution in diabetes mellitus
    dexamethasone (decadron) decreases the effects of oral anticoagulants and oral antidiabetic agents
    increase the potency of medications taken concurrently, such as aspirin, and nonsteroidal antiinflammatory drugs (NSAIDS), thus increasing the risk of GI bleeding and ulceration
    use of potassium wasting diuretics increases potassium loss, resulting in hypokalemia.
    barbituates, phenytoin (dilantin) and rifampin (rifadin) decrease the effect of prednisone
    the action of dexamethasone (decadron ) is decreased by the use of phenytoin (dilantin), theophylline, rifampin (rifadin), barbituates and antacids
    NSAIds, aspirin, and estrogen increase the effect of dexamethasone (decadron)
    should be used with extreme caution in clients with infections because they mask the signs and symptoms of an infection
    advise the client to wear a medic-alert bracelet.


    implementation

    monitor vital signs
    monitor serum electrolytes and blood glucose level
    monitor for hypokalemia and hyperglycemia
    monitor I and O, weight and edema'
    monitor for hypertension
    check the client's medical history for glaucoma, cataracts, peptic ulcer, mental health disorders or diabetes mellitus
    monitor the older client for signs and symptoms of increased osteoporosis
    monitor for changes in muscle strength
    prepare a schedule for the client on short term, tapered doses.
    instruct the cleint to take it at mealtime or with food
    advise the client to eat foods high in potassium
    instruct the client to avoid individuals with respiratory infections
    advise the client to inform all health care providers of taking the medication
    instruct the client to report signs and symptoms of a medication overdose or cushing's syndrome, including a moon face, puffy eyelids, edema in the feet, increased bruising, dizziness, bleeding, and menstrual irregularities
    note that the client may need additional doses during periods of stress such as surgery
    instruct the client not to stop the medication abruptly, as abrupt withdrawal can result in severe adrenal insufficiency
    advise the client to consult with the physician before receiving vaccinations
    advise the client to wear a medic-alert bracelet

    :: Sindhu's Medical News @ 10:13 PM [+]

    ...
    :: Sunday, September 07, 2003 ::


    :: Sindhu's Medical News @ 11:10 PM [+]

    ...
    glucocorticoids medication continued

    mineralocorticoids

    fludrocortisone (florinef)

    description

    steroid hormones that enhance the reabsorption of sodium and chloride and promote teh excretion of potassium and hydrogen from the renal tubules, thereby, helping to maintain fluid and electrolyte balance.
    used for replacement therapy in primary and secondary adrenal insufficiency in Addison's disease.

    side effects

    sodium and water retention
    hypokalemia
    hypocalcemia
    increased susceptibility to infection
    delayed wound healing
    GI distress
    diarrhea or constipation
    increased appetite
    weight gain
    insomnia
    mood swings
    abdominal distention


    implementation

    monitor vital signs
    monitor weight
    monitor electrolytes and calcium levles
    instruct the client to take the medication with milk
    instruct the client to consume a high potassium diet
    instruct the client not to stop taking the medication abruptly
    instruct the physician to notify the physician if signs of infection, muscle aches, sudden weight gain or headaches occur
    instruct the client to avoid exposure to disease or trauma.

    :: Sindhu's Medical News @ 10:44 PM [+]

    ...
    inhaled non steroidal antiallergy agents

    cromolyn sodium ( intal)
    nedocromil (tilade)


    description

    an antiasthmatic, antiallergic, and mast cell stablizer that inhibits mast cell release after exposure to antigens
    used for the treatment of allergic rhinitis, bronchial asthma, and exercised-induced bronchospasm.
    contraindicated in cilents with known hypersensitivity
    oral cromolyn sodium is used with caution in clients with impaired hepatic or renal function

    side effects

    cough or bronchospasm after inhalation
    nasal sting or sneezing after inhalation
    unpleasant taste in teh mouth

    implementation

    monitor vital signs
    monitor respirations and assess lung sounds for rhonchi, wheezing and rhales.
    instruct the client to drink a few sips of water before and after inhalation to prevent cough and unpleasant taste in the mouth.
    administer oral capsules (cromolyn sodium) atleast 30 minutes before meals.
    instruct the client not to discontinue the medicatin abruptly because a rebound asthmatic attack can occur.

    luekotrine modifiers

    montelukast (singulair)
    zafirlukast (accolate)
    zileuton (zyflo)


    description

    used in the prophylaxis and treatment of chronic bronchial asthma
    not used for acute asthma episodes
    inhibits bronchoconstriction caused by specific antigens
    reduces airway edema and smooth muscle constriction
    contraindicated in hypersensitivity and in breastfeeding mothers
    used with caution in clients with impaired hepatic function
    coadministration of inhaled glucocorticoids increases the risk of upper respiratory infection

    side effects

    headache
    nausea and vomiting
    dyspepsia
    diarrhea
    generalized pain, myalgia
    fever
    dizziness


    implementation

    monitor vital signs
    assess lung sounds for rhonchi, wheezing, and rales
    assess liver funciton tests
    monitor for cyanosis
    instruct the client to take the medication 1 hour before or 2 hours after meals.
    instruct the client to increase fluid intake
    instruct the client not to discontinue medication and to take it as prescribed even during symptom free periods,

    :: Sindhu's Medical News @ 10:34 PM [+]

    ...

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