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The client also may require sodium chloride alents apply only to drugs given orally or IV generic lumigan 3 ml symptoms zyrtec overdose. Dosage for children is calculated according to severity is present, and supportive measures if shock occurs. For people receiving chronic corticosteroid therapy, traumatic injury or invasive diagnostic tests (eg, an- dosage must be increased during periods of stress. ADT is used only for maintenance therapy (ie, clin- costeroid therapy are characterized by exacerba- ical signs and symptoms are controlled initially with tions and remissions. ADT can be usually must be increased during acute flare-ups of started once symptoms have subsided and stabilized. ADT does not retard growth in children, as do other ally to maintenance levels. One way is to reduce the dose gradually prednisolone, and methylprednisolone), are the drugs until symptoms worsen, indicating the minimally ef- of choice for ADT. ADT is not usually indicated in clients who have re- ceived long-term corticosteroid therapy. First, these Corticosteroid drugs can be given by several different routes clients already have maximal HPA suppression, so to achieve local or systemic effects. Second, if they should be given locally rather than systemically to prevent or are transferred to ADT, recurrence of symptoms decrease systemic toxicity. When corticosteroids must be and considerable discomfort may occur on days given systemically, the oral route is preferred. Clients with severe disease ministration is indicated only for clients who are seriously ill and very painful or disabling symptoms also may or unable to take oral medications. Scheduling Guidelines Use in Specific Conditions Scheduling of drug administration is more important with Allergic Rhinitis corticosteroids than with most other drug classes. Most adverse Allergic rhinitis (also called seasonal rhinitis or hay fever and effects occur with long-term administration of high doses. A perennial rhinitis) is a common problem for which cortico- major adverse reaction is suppression of the HPA axis and steroids are given by nasal spray, once or twice daily. Although opinions peutic effects usually occur within a few days with regular differ, the following schedules are often recommended to use. Systemic adverse effects are minimal with recommended prevent or minimize HPA suppression: doses but may occur with higher doses, including adrenocor- 1. Short-term use (approximately 1 week) in acute sit- tical insufficiency from HPA suppression.

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Low serum sodium and due to endocrine purchase 3ml lumigan visa symptoms of flu, renal, hematocrit Pancreatin and pancrelipase are commercial preparations cardiovascular, or central 6. Disorientation of pancreatic enzymes (eg, lipase, protease, and amylase). Circulatory overload and pul- The preparations are used to aid digestion and absorption of monary edema if water excess is severe or develops rapidly dietary carbohydrate, protein, and fat in conditions charac- terized by pancreatic enzyme deficiency. These conditions 436 SECTION 5 NUTRIENTS, FLUIDS, AND ELECTROLYTES TABLE 30–3 Intravenous Fluids Type/Characteristics Uses Comments Dextrose Injection Available in preparations containing To provide water and calories The dextrose in D5W is rapidly 2. They are hypertonic and must be given through a central or subclavian catheter. Dextrose and Sodium Chloride Injection Available in several concentrations Maintenance fluids, usually with Frequently used are 5% dextrose in added potassium chloride, in 0. Crystalline Amino Acid Solutions (Aminosyn, Freamine) Contain essential and nonessential As a component of peripheral or Special formulations are amino acids central IV parenteral nutrition, available for use in patients with concentrated dextrose with renal or hepatic failure. Obesity may occur in any group but is more likely to occur in women, minority groups, and poor people. It results from consistent ingestion of more calories than are used, and it sub- OBESITY stantially increases risks for development of cardiovascular disease (eg, hypertension, angina pectoris, myocardial infarc- Overweight and obesity are widespread and increasing in the tion, stroke), diabetes mellitus, dyslipidemias (eg, increased United States, in both children and adults. They are considered major public health problems because of their association with * Weight (pounds) high rates of morbidity and mortality. Nursoy, ProSobee, Soyalac As milk substitutes for infants who are allergic Provide all other essential nutrients for normal Hypoallergenic, milk-free formulas to milk growth and development Contain soy protein Provide 20 calories/oz when mixed as directed Nutramigen Infants and children who are allergic to Nutritionally complete, hypoallergenic formula ordinary food proteins or have diarrhea or containing predigested protein other GI problems PediaSure Children 1–6 years of age Amounts should be individualized Nutritionally complete, for oral use Precision diets These formulas can be given to children if These preparations are ingested or given by Nutritionally complete, high-nitrogen, low- the amount is calculated to provide rec- tube slowly over 4 hours. Requires little digestion and leaves little fecal residue Adults Amin-Aid As a source of protein for clients with acute Provides amino acids, carbohydrates, and a or chronic renal failure few electrolytes Ensure, Isocal, Osmolite As the sole source of nutrients or a supple- 2000 mL daily meets basic nutritional Nutritionally complete ment when food intake is decreased or needs for adults. May be given orally or by tube feeding does not meet nutritional needs MCT Oil Clients with fat malabsorption syndromes Limit use in clients with severe hepatic cirrho- A preparation of medium-chain triglycerides, sis because it may precipitate encephalopa- which are easier to digest than the long- thy and coma. Polycose Increase caloric intake in clients on protein-, Individualize amounts by calories needed and An oral supplement derived from carbohydrate electrolyte-, or fat-restricted diets tolerance. Available in liquid and powder May be mixed with water or other beverages and with foods Portagen For clients with fat malabsorption problems, May induce coma in clients with severe he- Nutritionally complete formula that contains as the complete diet, as a beverage with patic cirrhosis medium-chain triglycerides, an easily meals, or as an addition to various recipes digested form of fat Precision diets These preparations are ingested or given by Nutritionally complete, high nitrogen, low- tube slowly over 4 hours. The carbohydrate residue formulas for oral or tube feedings content may produce hyperglycemia; there- fore, they should not be used in clients with diabetes mellitus. When produces less carbon dioxide than carbo- carbon dioxide accumulates in the body, hydrate metabolism. Sustacal As the complete diet or to supplement other Nutritionally complete sources of nutrients May be given orally or by tube feeding TraumaCal, Vivonex Clients with hypermetabolic states (eg, severe The amount, concentration, and rate of Nutritionally complete, high-protein formulas burns, trauma, or sepsis), to help meet administration can be adjusted to meet with easily assimilated amino acids and nutritional needs and promote healing nutritional needs and tolerance. In addition, more children are developing type 2 decreased high-density lipoprotein (HDL) cholesterol, some diabetes, which was formerly believed to occur only in types of cancer (eg, breast, prostate, endometrium, and colon), adults. The increase in obesity and type 2 diabetes is mainly gallbladder disease, sleep apnea, and osteoarthritis of the attributed to poor eating habits and too little exercise. These disorders are mainly attributed to the multiple metabolic abnormalities associated with obesity. Abdominal fat out of proportion to total body fat (also called central obe- Drugs for Obesity sity), which often occurs in men, is considered a greater risk factor for disease and death than lower body obesity.

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Drugs that decrease effects of zidovudine: (1) Rifampin order lumigan 3 ml free shipping medications elderly should not take, rifabutin Accelerate metabolism of zidovudine p. Drugs that decrease effects of Kaletra: (1) Efavirenz Dosage of Kaletra may need to be increased if it is given concomi- tantly with one of these drugs. New England Journal of Medicine, agnosis and reluctant to ask questions. Stress that genital herpes is the pharmacokinetics, safety, and antiretroviral activity of tenofovir dis- a sexually transmitted disease that can be controlled but not cured oproxil fumarate in human immunodeficiency virus-infected adults. He should complete the entire 10-day pre- Antimicrobial Agents and Chemotherapeutics, 45, 2733–2739. Current illness, emotional stress, or intense sunlight can increase recur- Medical Chemistry, 8, 1529–1558. Valcyte, an oral compound, expands condom to prevent transmission of herpes to a sexual partner. HIV pro- tease inhibitors: Advances in therapy and adverse reactions, including metabolic complications. Which viral infections may be prevented by administration randomized, controlled trial. What are the major adverse effects associated with com- Panel on Clinical Practice for Treatment of HIV Infection convened by the monly used antiviral drugs? How would you assess for Department of Health and Human Services (DHHS) and the Henry J. Teach clients about prevention and treatment terms of indications for use, adverse effects, of fungal infections. Critical Thinking Scenario John Morgan, 79 years of age, is diagnosed with prostate cancer. After his third course of treatment, he becomes neutropenic and an infection develops that is treated with two broad-spectrum antibiotics. OVERVIEW Fungi that are pathogenic in humans exist in soil, decaying plants, and other environmental habitats or as part of the en- Fungi are molds and yeasts that are widely dispersed in the dogenous human flora. For example, Candida albicans organ- environment and are either saprophytic (ie, obtain food from isms are part of the normal microbial flora of the skin, mouth, dead organic matter) or parasitic (ie, obtain nourishment from gastrointestinal (GI) tract, and vagina. Molds are multicellular organisms com- ganisms is normally restrained by intact immune mechanisms prised of colonies of tangled strands. When these restrain- ing on various surfaces (eg, the mold that forms on spoiled ing forces are altered (eg, by suppression of the immune sys- food and the mildew that forms on clothing in damp environ- tem or antibacterial drug therapy), fungal overgrowth and ments).

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