Alex Han Cho, MD
https://medicine.duke.edu/faculty/alex-han-cho-md
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Explain the etiology administering medications 7th edition evecare 30 caps otc, pathogenesis, and pharmacotherapy for acne vulgaris, rosacea, dermatitis, and psoriasis. For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. Apply the nursing process to the care of patients who are receiving pharmacotherapy for skin disorders. At times, however, environmental conditions damage the skin, or conditions within the body change, resulting in unhealthy skin. Some of these changes can even lead to systemic changes that affect tissues outside the integumentary system. The purpose of this chapter is to examine the broad scope of skin disorders and the drugs used for skin pharmacotherapy. To understand the actions of dermatologic drugs, it is necessary to have a thorough knowledge of the structure of the skin. The epidermis is the visible, outermost layer that constitutes only about 5% of the skin depth. The middle layer is the dermis, which accounts for about 95% of the entire skin thickness. Some textbooks consider the subcutaneous layer as being separate from the skin and not one of its layers. Each layer of skin is distinct in form and function and provides the basis for how drugs are injected or topically applied. Epidermis: the epidermis consists of epithelial cells with either four or five sublayers depending on its location. The stratum corneum is referred to as the "horny layer" because of the abundance of the protein keratin, a water-insoluble material secreted by keratinocytes, which is also found in the hair, hooves, and horns of many mammals. Keratin gives the skin its tough, protective seal, forming a barrier that repels bacteria and foreign matter. The largest amount of keratin is found in those areas subject to mechanical stress, for example, the soles of the feet and the palms of the hands. The deepest epidermal sublayer, the stratum basale, supplies the epidermis with new cells after older superficial cells have been damaged or lost through normal wear. Over time, these newly created cells migrate from the stratum basale to the outermost layers of the skin. As these cells are pushed to the surface they are flattened and covered with keratin. The outermost skin layer, called the stratum corneum, is composed of these dead cells. On average, it takes a cell about 2-3 weeks to move from the stratum basale to the body surface. Specialized cells within the deeper layers of the epidermis, called melanocytes, secrete the dark pigment melanin. The number and type of melanocytes determine the overall pigment of the skin and determine racial differences in skin tone.
Diseases
Cognitive Level: Applying; Client Need: Safe and Effective Care Environment; Nursing Process: Implementation 3 Answer: 3 Rationale: Peristalsis is the wavelike muscular contraction that pushes food into the stomach and helps to mix stomach contents medications borderline personality disorder order evecare 30 caps with mastercard. A delay in peristalsis would prolong absorption time, and peristalsis is not involved in the distribution of drugs to their target sites. Cognitive Level: Applying; Patient Need: Physiological Integrity; Nursing Process: Evaluation 4 Answer: 3 Rationale: Inhaled drugs produce an immediate therapeutic response. Inhaled medication can be used at any time during the day and is not restricted to the morning. Doses for inhaled drugs are small compared to orally ingested medications, and because these drugs go directly to the lung surface area and are readily absorbed, very little of the substance is lost due to metabolism. Cognitive Level: Applying; Client Need: Health Promotion and Maintenance; Nursing Process: Evaluation 5 Answer: 4 Rationale: the length of time a drug concentration remains in the therapeutic range is its duration of action. Clients with hepatic impairment do not effectively metabolize drugs, which increases the duration of action. In clients with hepatic disease, the duration of action most likely will increase since drug metabolism is impaired. Although the duration of action is extended, the effects of the drug are not improved. Cognitive Level: Applying; Client Need: Safe and Effective Care Environment; Nursing Process: Evaluation 6 Answer: 2, 4 Rationale: A therapeutic drug level that is in the accepted range indicates that the drug is at a minimally effective concentration but not at a toxic level. Because individual client responses to drugs can be highly variable, adverse effects, toxicities, or even no effect may occur at levels within the therapeutic range. Therapeutic effectiveness of a drug depends on many factors and the therapeutic range of a drug is the level between minimally effective and toxic levels. It is not an indicator of how effective a drug will be in treating an individual condition. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Evaluation Chapter 5 1 Answer: 1, 2, 3, 5 Rationale: One of the critical determinants of the effectiveness of drug therapy is a physical examination. Nurses will utilize assessment skills to ascertain whether the drug is being effective. The effects of many drugs are monitored by diagnostic laboratory values such as white blood cell counts, cultures, and electrolyte levels. Efficacy is the term that describes the ability of a drug to produce the desired therapeutic effect. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Evaluation 2 Answer: 1 Rationale: Therapeutic index is the ratio between the therapeutic dose and the toxic dose of a drug, and is used as a measure of the relative safety of the drug. A drug may be labeled "dangerous" for many reasons other than the therapeutic index, including the potential for abuse. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation 3 Answer: 1 Rationale: A dose response curve is a graphic representation that shows the relationship between the amount of a drug administered and the extent of the response it produces. If a toxic level is reached from too large a dose, the drug will have adverse effects instead of a better therapeutic response.
Gently pull the pinna down and back for children under age 3 symptoms 5 weeks 3 days evecare 30caps buy, up and back for children over age 3, adolescents, and adults. A small piece of cotton may be placed at the entrance to the ear canal if any solution returns upon arising. Therese Duclos, a 65-year-old African American woman, visits her ophthalmologist with reports of blurry vision and not being able to see well at night while driving. Her health history includes adult-onset diabetes for the past 10 years and osteoporosis since age 55. Gently put pressure on the inner canthus (tear duct) for 1 minute after instilling the timolol drop. The nurse is providing health teaching to a client who has been prescribed latanoprost (Xalatan) for open-angle glaucoma. While harmless, the nurse would caution the patient about which potential nonocular effects of the drug A permanent bluish tint to the conjunctiva Pilocarpine (Isopto Carpine) has been ordered for a client with closed-angle glaucoma who has not responded well to other drugs. Pilocarpine causes, which stretches the trabecular meshwork, allowing a greater outflow of aqueous humor and lowering intraocular pressure. The nurse is teaching a 25-year-old client about the administration of ciprofloxacin with hydrocortisone (Cipro) for otitis. The nurse is teaching a client with otitis about a prescription for polymyxin B, neomycin, with hydrocortisone (Cortisporin). Phenylephrine is used prior to cataract surgery because it causes, allowing visualization of the operative area. His mother takes him to the health care provider and he is diagnosed with otitis media. Zachary is prescribed ciprofloxacin with dexamethasone (Ciprodex) otic drops to be instilled in his right ear two times a day for a week. To ensure that the mother is knowledgeable in this form of administration, the nurse will teach her about the proper technique. Enhancing the growth of natural eyelashes: the mechanism of bimatoprost-induced eyelash growth. Reported effects of non-traditional treatments and complementary and alternative medicine by retinitis pigmentosa patients. Cerumen removal: Comparison of cerumenolytic agents and effect on cognition among the elderly. Discuss the role of professional nursing in emergency preparedness and the management of poisoning. Discuss the purpose, function, and components of the Strategic National Stockpile.
This chapter focuses on the role of pharmacology in emergency preparedness as related to bioterrorism and management of poisoning symptoms thyroid cancer buy evecare 30 caps low price. The last decade has brought the acts and effects of terrorism to the forefront of discussion in this and other countries. Terrorism is generally defined as the systematic use of terror, violence, or intimidation to achieve a desired purpose or end. Federal Criminal Code describes terrorism as activities that involve life-threatening acts intended to coerce or intimidate a given population. Terrorists use chemical, nuclear, radiological, explosive, or biological hazards to commit violent and intimidating crimes against general and special targeted populations. Bioterrorism is the intentional release of an infectious agent for the purpose of causing harm to a large number of people. In the wrong hands, simple and easily obtained toxic agents could be disseminated for public harm. However, of greatest concern is the use of highly infectious diseases such as anthrax, smallpox, hemorrhagic viruses, and plague, or toxic agents such as nerve gas, cyanide, and chlorinated agents as well as nuclear and radiation threats. Emergency preparedness has been an emerging role of professional nursing for many years. In the past, however, most training focused on emergency management for natural disasters, catastrophic accidents, or infectious epidemics. Today, nurses must learn how to respond to mass casualty incidents and potential disasters that can result from agents that are biologic, chemical, radiologic, nuclear, or explosive in nature. Standard emergency triage may be reversed, focusing on patients with the best chance to live. Nurses may be among the first responders to victims who arrive at emergency departments, clinics, health care provider offices, or school health settings. They must be prepared to assess and recognize when someone has been exposed to potential hazards and to take appropriate actions. Since the terrorist attacks of September 11, 2001, Americans are more concerned with threats of terrorism and are more aware of emergency preparedness than ever before. Health care providers must continually update their knowledge of emergency management and think more globally in dealing with patients whose illness presents in a less typical way. Knowledge of treatment modalities related to bioterrorism has become a basic competency required of all health care providers. Florence Nightingale began defining the role of nursing in emergency preparedness as early as the Crimean War. Throughout many wars and disasters, nurses have honed their assessment and critical care skills to support people in need and improve health care outcomes. The Civil War was a time when nurses worked together with leaders like Clara Barton to establish the American Red Cross, with nursing becoming a special service in 1909. These wartime nurses learned triage, provided trauma care, and administered penicillin to save many lives. Nurses have played a major role in providing emergency assistance in natural disasters such as earthquakes, tornados, hurricanes, floods, and tsunamis.
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Caerulein and cholecystokinin suppress beta-endorphin-induced analgesia in the rat medications side effects cheap 30caps evecare overnight delivery. Peak B endorphin concentration in cerebrospinal fluid: reduced in chronic pain patients and increased during the placebo response. Today, it is well established that different endogenous neuronal networks are responsible for the modulation of pain by placebos and nocebos. By using new experimental designs and techniques, such as in vivo receptor binding, recording from neurons in awake humans, and a combination of imaging and electrophysiologic techniques, a future challenge will be to understand the interaction between a complex mental activity, like expectation of a future event, and all these neurochemical systems, and this approach will allow us to better describe the intricate connections between mind, brain and body. Opioid-mediated placebo responses boost pain endurance and physical performance: is it doping in sport competitions Disruption of opioid-induced placebo responses by activation of cholecystokinin type-2 receptors. Lipid mediators in health and disease: enzymes and receptors as therapeutic targets for the regulation of immunity and inflammation. Individual differences in reward responding explain placebo-induced expectations and effects. Involvement of cholecystokininergic systems in anxiety-induced hyperalgesia in male rats: behavioral and biochemical studies. Cholecystokinin type-A and type-B receptors and their modulation of opioid analgesia. Cholecystokinin and endogenous opioid peptides: interactive influence on pain, cognition, and emotion. Pro-nociceptive action of cholecystokinin in the periaqueductal grey: a role in neuropathic and anxiety-induced hyperalgesic states. The contribution of the rostral ventromedial medulla to the antinociceptive effects of systemic morphine in restrained and unrestrained rats. Circuitry underlying antiopioid actions of cholecystokinin within the rostral ventromedial medulla. Expectation of pain enhances responses to nonpainful somatosensory stimulation in the anterior cingulated cortex and parietal operculum/posterior insula: an event-related functional magnetic resonance imaging study. Isolating the modulatory effect of expectation on pain transmission: a functional magnetic imaging study. Opioid and non-opioid stress analgesia from cold water swim: importance of stress severity. It represents a situation where the administration of an ineffective substance produces an analgesic effect when the subject is convinced that the substance is a potent painkiller. It is not surprising then that a considerable effort has been committed over the last three decades to the study of mechanisms that may account for placebo-induced analgesic effects. The neural basis of placebo analgesia was first established by Levine et al,3 who discovered that the placebo response could be blocked by the opioid receptor antagonist naloxone. Following this finding, complex experimental designs have elucidated several components underlying the placebo analgesic response, and other studies have subsequently confirmed this exciting and provocative hypothesis. In particular, they suggested that different physical, physiologic, and environmental situations could affect the endogenous opioid system differently.
Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Assessment 5 Answer: Tetracycline antibiotics should not be taken concurrently with dairy products medications 123 cheap evecare 30caps mastercard, iron-containing preparations such as multivitamins, or with antacids. If these products are to be consumed, they should be taken 1 h before or 2 h after the tetracycline. Cognitive Level: Applying; Client Need: Health Promotion and Maintenance; Nursing Process: Implementation 6 Answer: 1, 2, 4, 5 Aminoglycosides are renal, oto-, and neurotoxic. Muscle weakness may indicate neuromuscular blockade and may last for several days. Gentamicin is not metabolized, and changes in liver function tests would not be drug related. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Assessment 5 Answer: 4 Rationale: Fluoroquinolones such as ciprofloxacin may cause profound muscle weakness in clients with myasthenia gravis. Anxiety and nervousness do not require cautious use and are not contraindications to ciprofloxacin. While the incidence of tendonitis and tendon rupture is higher in the adult over age 65, the drug is not contraindicated in this population. Cross-allergy to penicillins is not known for the fluoroquinolones and a history of penicillin is not a contraindication to ciprofloxacin. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Assessment 6 Answer: 1 Rationale: Polymyxin B is a topical antibiotic used to promote wound healing. Polymyxin B will cause cell death of the invading pathogenic bacteria but will not completely sterilize the skin. Polymyxin B does not prevent allergic reaction, nor does it provide pain relief to wounds. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Planning Chapter 53 1 Answer: 3 Rationale: Crystalluria is the excretion of crystals in the urine. To prevent this adverse effect, clients are instructed to consume approximately 2 to 3 L of fluid per day. However, the effects attributed to alcohol consumption do not include crystalluria. The excretion of urine is not affected by this drug, and the drug is not used for pyelonephritis. The drug is pregnancy category C (D in the third trimester), and the use of the drug may result in kernicterus in the newborn. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Assessment 4 Answer: 3 Rationale: Nausea and vomiting are the most common adverse effects of oral sulfonamide therapy but should not occur with topical use. If they occur, the client should be evaluated for possible systemic effects and for the proper self-administration of the topical drug. Excess potassium consumption should be avoided with the oral forms of sulfonamides, but is not necessary with the topical drug.
The mucosal erosions characteristic of ulcerative colitis begin in the rectum and progress in an uninterrupted manner throughout the rest of the large intestine medications heart disease discount evecare 30 caps buy line. While modern medicine has rediscovered old techniques such as the use of leeches to improve microvascular circulation after some forms of transplants. Assessment throughout administration: Potential Nursing Diagnoses Constipation Diarrhea Deficient Knowledge (Drug Therapy) Risk for Deficient Fluid Volume Assess for desired therapeutic effects. Severe abdominal pain, vomiting, coffee-ground emesis, hematemesis, blood in the stool, or tarry stools should be reported immediately. Have the patient keep a diary noting correlations between symptoms and foods, beverages, stress, or medications. Smoking and alcohol use are known to alter normal peristalsis and should be limited or eliminated. Correlating symptoms with medications or stress may help to identify a triggering factor. Provide for dietitian consultation or information on smoking cessation programs as needed. If bowel sounds are hypoactive or absent, consult the health care provider before administering the drug or until bowel obstruction is ruled out. If infection is a possible cause of diarrhea, consult with the provider before giving antidiarrheal drugs because decreased peristalsis may give the infection an opportunity to increase and spread. Any significant increase or decrease in bowel sounds, new onset, or increased discomfort or pain should be reported promptly. If gastric discomfort or pain continues or worsens, the health care provider should be notified. Diphenoxylate with atropine may cause agitation, confusion, or hallucinations in the older adult, particularly if dementia is a preexisting condition. Continued dizziness may indicate electrolyte imbalance, and electrolyte levels should be assessed. Immediately report any agitation, confusion, or hallucinations to the health care provider. Any drowsiness, dizziness, or disorientation should be reported to the provider promptly. Increase the intake of dietary fiber, especially whole grains, fruits, and vegetables. Exceeding the recommended dose or frequent laxative use increases the risk of adverse effects and decreases normal peristalsis over time, resulting in laxative dependence. Powdered formulations should be mixed with a full glass of liquid and immediately taken, followed by an additional full glass of liquid. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that the patient goals and expected outcomes have been met (see "Planning"). Several genes involved with immune responses have been identified as being associated with the disorder. It is hypothesized that these defective genes cause hyperactivity of T-cell responses to normal flora in the terminal ileum and colon.
Chemotherapeutic drugs are not as effective against cells that are in the G0 phase medicine used for uti generic evecare 30 caps line. When a tumor is debulked, a portion is removed surgically, causing the remaining cells to move into the active phases of mitosis. Once the cells enter into mitosis, the chemotherapeutic drugs can more effectively kill the cancer cells. If the desirable outcome is a total cure, then success is measured by how long the patient remains cancer free following treatment. Because chemotherapy is often prolonged and physically challenging, it is crucial that the patient understand the goals of treatment and how they will be measured. In cases of palliation, the patient must weigh whether the adverse effects associated with treatment are worth the anticipated increase in the quality of life. Patients who are undergoing chemotherapy usually receive several rounds of treatment spaced over a designated time, usually several weeks or months. This is because each round of chemotherapy kills a set percentage of cancer cells, usually those that are rapidly dividing at the time of treatment. Another reason is that the chemotherapy always damages normal cells and can cause serious adverse effects. Intervals between treatments allow the body to make more neutrophils so that body defenses are able to fight infections. The cell kill hypothesis is a theoretical model that predicts the ability of antineoplastic drugs to eliminate cancer cells. This hypothesis predicts that a drug will kill a certain percentage, rather than a constant number, of cancer cells. Theoretically, every single cell in a malignant tumor must be eliminated from the body to cure a patient. As an example, consider that a small, 1-cm breast tumor may already contain 1 billion cancer cells before it can be detected during a manual examination. A drug that is able to kill 99% of these cells would be considered a very effective drug indeed. Yet even with this fantastic achievement, 10 million cancer cells would remain, any one of which could potentially cause the tumor to return and kill the patient. It is likely that no antineoplastic drug (or combination of drugs) has the ability to kill 100% of the tumor cells. Because the immune system is able to eliminate only a relatively small number of cancer cells, it is imperative that as many cancerous cells as possible be eliminated during treatment. This example reinforces the need to diagnose and treat tumors at an early stage when the number of cancer cells is smaller. Because of their rapid cell division, tumor cells express a high mutation rate, which continually changes their genetic structure, resulting in a more heterogenous mass as the tumor grows.
Paclitaxel and colchicine also produce pharmacologic actions by binding to tubulin medicine quotes doctor evecare 30 caps buy online, but they bind at a different location than vincristine. Other adverse reactions include hepatotoxicity, rash, paralytic ileus (especially in children), and alopecia. Black Box Warnings: Myelosuppression may be severe and predispose to opportunistic infections. If extravasation occurs, treatment with warm compresses and hyaluronidase is implemented; cold compresses will significantly increase the toxicity of vinca alkaloids. Patient and Family Education: Immediately report stomach, bone, or joint pain, and swelling of the lower legs and ankles to the health care provider. Contraindications/Precautions: Contraindications to the use of vincristine include obstructive jaundice, men and women of childbearing age, active infection, adynamic ileus, radiation of the liver, infants, pregnancy, and lactation. Cautions must be taken when administering vincristine to patients with leukopenia, preexisting neuromuscular or neurologic disease, hypertension, or hepatic or renal disease; those who are taking drugs with neurotoxic properties; and the elderly. Vincristine is a vesicant and caution must be used to avoid exposure of the skin to this drug. Drugs Similar to Vincristine (Oncovin) the two additional vinca alkaloids include vinblastine and vinorelbine. Other classes of natural products include the taxanes (cabazitaxel, docetaxel, and paclitaxel) and the topoisomerase inhibitors (irinotecan, topotecan, etoposide, and teniposide). Vinblastine (Velban): Vinblastine is obtained from the periwinkle plant and has a chemical structure and mechanism of action very similar to those of vincristine. Off-label uses include treatment of prostate, bladder, and lung cancers and metastatic malignant melanoma. Instead, myelosuppression is the dose-limiting toxicity (especially neutropenia) with a nadir at 4 to 10 days and recovery between days 7 and 21. Vinorelbine (Navelbine): Vinorelbine is a semisynthetic drug derived from vinblastine to which it shares structural and functional similarities. The primary dose-limiting toxicity is myelosuppression (especially neutropenia) with a nadir at 7 to 14 days and recovery between days 14 and 24. Vincristine will increase the action of methotrexate, bleomycin, and anticoagulants. Administration of L-asparaginase just prior to vincristine will cause additive neurotoxicity. Concurrent administration with mitomycin may cause acute dyspnea and severe bronchospasm. Lifespan and Diversity Considerations: Monitor laboratory studies and other diagnostic testing frequently in the older adult because normal physiological changes related to aging may increase the risk of adverse effects. Taxanes: Cabazitaxel (Jevtana): the newest of the taxanes, approved in 2010, cabazitaxel is indicated for hormone-refractory metastatic prostate cancer that has not responded to a docetaxelcontaining regimen. Cabazitaxel carries black box warnings regarding severe hypersensitivity reactions and low neutrophil counts.
Chris, 51 years: Do not take other medications concurrently unless available as a combination product or directed to do so by the health care provider.
Anog, 53 years: The drug has been used off-label as a tocolytic as an option to magnesium sulfate.
Taklar, 38 years: Which early sign of magnesium toxicity would prompt the nurse to stop the infusion and notify the provider They inform the nurse that the husband has a 3-year-old son from an earlier relationship.
Aidan, 36 years: It is correct for the nurse to attempt to comfort the client using a number of nursing interventions for pain.
Agenak, 35 years: Other dose-related adverse effects include skin hyperpigmentation, agranulocytosis, leukopenia, photosensitivity, neuroleptic malignant syndrome, and retinopathy.
Irhabar, 26 years: A peptic ulcer is a lesion or erosion located in either the stomach (gastric) or small intestine (duodenal) mucosa that is usually associated with acute inflammation.
Achmed, 32 years: Flavor packets are available to improve the taste, but they are generally unpalatable and best suited for tube feedings.
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