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By S. Mirzo. Nyack College. 2018.

Insulin syringes should sulin and heparin; IM is used for only a few drugs; always be used for insulin and tuberculin syringes intradermal is used mainly to inject skin test ma- are recommended for measuring small amounts of terial rather than therapeutic drugs order 2 mg risperdal free shipping. Suspensions PO purchase 3mg risperdal with mastercard, SC (NPH and • These are particles of active drug suspended in Drug particles settle to the bottom on standing order risperdal 2 mg on-line. If Lente insulins) a liquid; the liquid must be rotated or shaken not remixed discount risperdal 3mg, the liquid vehicle is given rather than before measuring a dose. Dermatologic Creams, Lotions, Ointments Topically to skin • Most are formulated for minimal absorption Formulations vary with intended uses and are not through skin and local effects at the site of appli- interchangeable. Solutions and Powders for • Oral inhalations are used mainly for asthma; nasal Several research studies indicate that patients often Oral or Nasal Inhalation, sprays for nasal allergies (allergic rhinitis) do not use MDIs correctly and sometimes are in- Including Metered Dose • Effective with less systemic effect than oral drugs correctly taught by health care providers. Correct Inhalers (MDIs) • Deliver a specified dose per inhalation use is essential to obtaining therapeutic effects and avoiding adverse effects. Eye Solutions and Ointments • Should be sterile Can be systemically absorbed and cause systemic • Most are packaged in small amounts, to be used adverse effects by a single patient Throat Lozenges • Used for cough and sore throat Ear Solutions • Used mainly for ear infections (continued) 34 SECTION 1 INTRODUCTION TO DRUG THERAPY TABLE 3–2 Drug Dosage Forms (continued) Dosage Forms and Their Routes of Administration Characteristics Considerations/Precautions Vaginal Creams and • Formulated for insertion into the vagina Suppositories • Commonly used to treat vaginal infections Rectal Suppositories • Formulated for insertion into the rectum Effects somewhat unpredictable because absorption and Enemas • Suppositories may be used to administer seda- is erratic tives, analgesics, laxatives • Medicated enemas are used to treat inflammatory bowel diseases (eg, ulcerative colitis) PO, oral; GI, gastrointestinal; IV, intravenous; IM, intramuscular; SC, subcutaneous. CALCULATING DRUG DOSAGES animal tests (ie, the amount of drug required to produce a particular response). For ex- When calculating drug doses, the importance of accuracy ample, concentrations of insulin and heparin are both ex- cannot be overemphasized. Accuracy requires basic skills in pressed in units, but there is no relation between a unit of mathematics, knowledge of common units of measurement, insulin and a unit of heparin. These drugs are usually ordered and methods of using data in performing calculations. Milliequivalents express the ionic ac- The most commonly used system of measurement is the met- tivity of a drug. Drugs such as potassium chloride are ordered ric system, in which the meter is used for linear measure, the and labeled in the number of milliequivalents per dose, tablet, gram for weight, and the liter for volume. The apothecary system, now obsolete and rarely used, has units called grains, minims, drams, ounces, pounds, pints, Mathematical Calculations and quarts. The household system, with units of drops, tea- spoons, tablespoons, and cups, is infrequently used in health Most drug orders and labels are expressed in metric units of care agencies but may be used at home. If the amount specified in the order is the same alent measurements within and among these systems. Equiv- as that on the drug label, no calculations are required, and alents are approximate. For example, if A few drugs are ordered and measured in terms of units the order reads ibuprofen 400 mg PO and the drug label or milliequivalents (mEq). Units express biologic activity in reads ibuprofen 400 mg per tablet, it is clear that one tablet is to be given. What happens if the order calls for a 400-mg dose and 200-mg tablets are available? The question is, How many TABLE 3–3 Equivalents 200-mg tablets are needed to give a dose of 400 mg? This is a simple example that also can be 1 mL = 1 cc = 15 or 16 minims = 15 or 16 drops used to illustrate mathematical calculations. This problem 4 or 5 mL = 1 fluid dram = 1 tsp can be solved by several acceptable methods; the following 60 or 65 mg = 1 gr 30 or 32 mg = 1/2 gr formula is presented because of its relative simplicity for stu- 30 g = 30 mL = 1 oz = 2 tbsp dents lacking a more familiar method. V = unit (one tablet, here) CHAPTER 3 ADMINISTERING MEDICATIONS 35 400 mg X ablett 3. Order: 4 mg IV = Label: 10 mg/mL 200 mg 1 tablet Cross multiply: 4 mg X mL = 200X = 400 10 mg 1 mL 10X = 4 400 X = = 2 tablets 200 4 X = = 04. The desired or ordered dose and the available or label dose 10,000X = 5000 must be in the same units of measurement. Using the equiva- 5000 lents (ie, 1 g = 1000 mg) listed in Table 3–2, an equation can X = = 05. Each has advantages, disadvan- tages, indications for use, and specific techniques of admin- The same procedure and formula can be used to calculate istration (Table 3–4).

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For contraindicated drugs discount risperdal 4 mg on-line, it is usually recommended that the mother stop the drug or stop breast-feeding purchase risperdal 3 mg visa. Counsel pregnant women about the use of immuniza- lowest effective dose for the shortest effective time risperdal 4mg cheap. The American Academy of Pediatrics (AAP) supports mumps risperdal 2mg low price, polio, rubella, yellow fever) should be avoided breast-feeding as optimal nutrition for infants and does because of possible harmful effects to the fetus. In some instances, mothers may hepatitis B (if the mother is high risk and negative for pump and discard breast milk while receiving thera- hepatitis B antigen) and toxoids (eg, diphtheria, tetanus) peutic drugs, to maintain lactation. Women with human immunodeficiency virus (HIV) in- globulins can be given to pregnant women who are ex- fection should not breast-feed. The virus can be trans- posed to hepatitis B, rabies, tetanus, or varicella. Most systemic drugs taken by the mother reach the in- Oxytocin is usually the drug of choice for induction or aug- fant in breast milk. For some, the amount of drug is too mentation of labor because physiologic doses produce a rhyth- BOX 67-3 DRUG EFFECTS IN LACTATION Overview antihistamines, antihypertensives (angiotensin-converting enzyme The American Academy of Pediatrics (AAP) recommends breast- [ACE] inhibitors, calcium channel blockers), butorphanol, caffeine feeding for optimal nutrition during the first year of life and is con- (in moderate amounts), corticosteroids (prednisolone or inhaled sidered the most authoritative source of information about drug products), cromolyn, decongestants (oxymetolazine nose drops effects in lactation. Most drugs have not been tested in nursing or spray), digoxin, famotidine, ibuprofen, insulin, levothyroxine, women and no one knows exactly how a given drug will affect a progestin-only birth control pills (the mini-pill), sucralfate nursing infant. Even the clinical practice guidelines from the AAP Drugs To Be Used With Caution During Lactation emphasize that the reported effects of drug safety or nonsafety are Alcohol (within 2 hours of breast-feeding), aluminum-containing often anecdotal and based on observations in a single infant or a antacids, amantadine, antianxiety agents (benzodiazepines), anti- few infants rather than well-designed studies. There is some degree of risk with any systemic medication psychotics (older or typical agents), aspirin, beta blockers (acebu- ingested by the mother. However, in many instances, the infant cause other adverse effects in nursing infants), diuretics, dys- may not receive sufficient drug to produce adverse effects. The lowest dose and the shortest effective duration are rec- infant], statins), methadone, metoclopramide, theophylline ommended. Most over-the-counter and prescription drugs, taken in mod- in the infant]), antineoplastics (cyclophosphamide, doxorubicin, eration and only when needed, are thought to be safe. It is also the drug of choice for pre- use of any nonprescription and nontherapeutic drugs. A sys- vention or control of postpartum uterine bleeding because it is tematic assessment of maternal and fetal responses should be less likely to cause hypertension than the ergot alkaloids. Home care visits also allow for assessment of compli- ance with the proposed management plan. Understanding of Home Care previous teaching should be evaluated on each visit. It is es- pecially important for the client to know the danger signs Many obstetric clients with conditions such as preterm labor, and symptoms that may necessitate notifying a health care hyperemesis, and elevated blood pressure are now being provider. The home care nurse who assists in The overall goal of home care is to maintain the pregnancy managing these clients should be an obstetric specialist who to the most advanced gestational age possible. Home care fol- is knowledgeable about normal pregnancy and potential com- low-up by a nurse has been demonstrated to positively affect plications. The nurse should be aware of the drugs being used the outcome of a high-risk pregnancy. Give abortifacients orally (PO), intramuscularly (IM), or intravaginally. Give tocolytics intravenously (IV) initially, via an infusion The side-lying position decreases risks of hypotension. For IV oxytocin, dilute the drug in an IV sodium chloride Oxytocin may cause water intoxication, which is less likely to solution, and piggyback the solution into a primary IV line. Infusion pumps deliver more accurate doses and minimize the risk of overdosage. Give IM oxytocin immediately after delivery of the To prevent excessive postpartum bleeding placenta. When an abortifacient is given, observe for the onset of Abortion usually occurs within 24 h after a prostaglandin is given uterine bleeding and the expulsion of the fetus and placenta. When a tocolytic drug is given in threatened abortion or The goal of drug therapy is to stop the labor process. When oxytocin is given to induce or augment labor, ob- Oxytocin is given to stimulate the normal labor process. Con- serve for firm uterine contractions at a rate of three to four per tractions should become regular and increase in duration and 10 min.

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An appropriate amount of this medicinal was ground into powder purchase 4mg risperdal mastercard, mixed with rice vinegar order risperdal 4 mg amex, and applied to the navel order risperdal 2mg fast delivery. Seven days equaled one course of treatment discount risperdal 4 mg without prescription, and the treatment was continued for 1-2 courses. Internal treatment consisted of the oral administration of Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pills). Patients three years old took three pills each time, and the dosage was increased by one pill for every two years of age. The maximum number of pills taken was eight per time, and every patient took their appropriate dosage three times per day. Study outcomes: The above treatment was continued for two weeks, at which Chinese Research on the Treatment of Pediatric Enuresis 119 time, 11 cases were cured and four cases improved. From The Treatment of 25 Cases of Pediatric Enuresis with Suo Quan Wan Jia Wei (Reduce the Stream Pills with Added Flavors) & Powdered Wu Bei Zi (Galla Rhois) Externally Applied to the Umbilicus by Xia Zhen-lian & Li Wei-wei, Si Chuan Zhong Yi (Sichuan Chinese Medicine), 2001, #7, p. The course of disease was between 1-6 years, with an average dura- tion of three years. Treatment method: The internal treatment consisted of the oral administration of Suo Quan Wan Jia Wei (Reduce the Stream Pills with Added Flavors): stir-fried Yi Zhi Ren (Radix Alpiniae Oxyphyllae), 10g stir-fried Wu Yao (Radix Linderae), 10g stir-fried Shan Yao (Radix Dioscoreae), 15g Sang Piao Xiao (Ootheca Mantidis), 25g stir-fried Yan (salt), an appropriate amount Using the stir-fried version of the above medicinals together with an appropriate amount of salt guides this formula to enter the kidneys and strengthens its ability to constrain, secure, and astringe. For kidney qi vacuity, Wu Zi Yan Zong Wan (Five Seeds Increase Progeny Pills) were added. These consist of Gou Qi Zi (Fructus Lycii), Tu Si Zi (Semen Cuscutae), Fu Pen Zi (Fructus Rubi), Wu Wei Zi (Fructus Schisandrae), etc. For spleen vacuity, Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction) was added. This consists of Huang Qi (Radix Astragali), Dang Shen (Radix Codonopsitis), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Sheng Ma (Rhizoma Cimicifugae), Chai Hu (Radix Bupleuri), etc. For spleen-kidney dual vacuity, a combination of the above two formulas was added. One packet of these medicinals was decocted in water and administered in three divided doses per day. External treatment consisted of 10 grams of powdered Wu Bei Zi (Galla Rhois) mixed with an appropriate amount of rice vinegar and applied to the umbilicus. This paste was applied one time per night for five consecutive days (one course of treatment), and then the treatment was stopped for two days. Study outcomes: Fifteen cases (60%) were cured, eight cases (32%) improved, and two cases (8%) had no improvement. From The Treatment of 105 Cases of Pediatric Enuresis with Acupuncture by Gao Jie-yin, Hu Bei Zhong Yi Za Zhi (Hubei Journal of Chinese Medicine), 1992, #5, p. The patients were between 5-10 years old in 56 cases, between 10-14 years old in 43 cases, and more than 14 years old in six cases. These cases of enuresis were often accompanied by poor appetite, a lusterless facial complexion, and decreased essence- spirit. Compared to other children their age, these children had a lower body weight. Treatment method: The main points consisted of: Chinese Research on the Treatment of Pediatric Enuresis 121 Guan Yuan (CV 4) Qi Hai (CV 6) San Yin Jiao (Sp 6) Auxiliary points included: Shen Shu (Bl 23) Zhong Ji (CV 3) Zu San Li (St 36) Two to four points were chosen each time and these points were alternated. Hand stimulation was applied to the points, and the needles were retained for 20 minutes. The patient received two treatments each week, and 2-4 treatments equaled one course. Study outcomes: After 1-2 courses of treatment, 76 cases were cured, 29 cases improved, and two cases did not improve. From The Treatment of 53 Cases of Pediatric Enuresis Using Bai Hui (GV 20) & Pattern Discrimination by Dong Wen- yi & Wu Chao, Liao Ning Zhong Yi Za Zhi (Liaoning Journal of Chinese Medicine), 1995, #9, p.

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