By T. Merdarion. Florida Christian College. 2017.

Ephedra (ma huang) trusted 2mg coumadin, an adrenergic-type product best coumadin 5mg, in a metered-dose aerosol and a solution for use with a power- may also have bronchodilating effects. A nasal solution is also available for pre- excessive cardiac and CNS stimulation, and deaths have been vention and treatment of allergic rhinitis. In general, herbal and dietary therapies in asthma, as in Mast cell stabilizers are contraindicated in clients who are other disorders, have not been studied in controlled clinical hypersensitive to the drugs. Because asthma can result in in clients with impaired renal or hepatic function. Also, the death in a matter of minutes, patients should be counseled propellants in the aerosols may aggravate coronary artery dis- not to use dietary or herbal supplements in place of pre- ease or dysrhythmias. Delays in appropriate treatment can have serious, even fatal, consequences. Herbal and Dietary Supplements Numerous preparations are promoted to relieve symptoms of Nursing Process asthma and patients with asthma are increasingly using alter- native and complementary therapies. For example, • General assessment factors include rate and character of caffeine is a xanthine and therefore has bronchodilating respiration, skin color, arterial blood gas analysis, and effects similar to, but weaker than, those of theophylline. Abnormal breathing patterns • Use mechanical measures for removing excessive respi- (eg, rate below 12 or above 24 per minute, dyspnea, ratory tract secretions and preventing their retention. For example, oxia include mental confusion, restlessness, anxiety, allergens may be removed from the home, school, or and increased blood pressure and pulse rate. Late signs work environment; cigarette smoke should be avoided include cyanosis and decreased blood pressure and pulse. When bronchospasm is precipitated by Hypoxemia is confirmed if arterial blood gas analysis exercise, prophylaxis by prior inhalation of bronchodi- shows decreased partial pressure of oxygen (PO2). A charac- • Assist clients with asthma to identify early signs of diffi- teristic feature of bronchospasm is forceful expiration or culty, including increased need for beta-adrenergic ago- wheezing. This is an objec- between acute attacks, such as restrictions in activities of tive measure of airflow/airway obstruction and helps to daily living due to asthma. Clients with a and character of sputum, exercise tolerance (eg, dyspnea decreased PEFR may need treatment to prevent acute, se- on exertion, dyspnea at rest), medications, and nondrug vere respiratory distress. Nursing Diagnoses • Try to prevent or reduce anxiety, which may aggravate • Impaired Gas Exchange related to bronchoconstriction bronchospasm.

Drugs that increase effects of lithium: (1) Angiotensin-converting enzyme inhibitors (eg generic 2 mg coumadin with amex, captopril) Decrease renal clearance of lithium and thus increase serum lithium levels and risks of toxicity generic coumadin 5 mg amex. These drugs also may precipitate a manic episode and increase risks of hypothyroidism. Drugs that decrease effects of lithium: (1) Acetazolamide, sodium chloride (in excessive amounts), Increase excretion of lithium drugs with a high sodium content (eg, ticarcillin), theo- phylline 3. When a client begins antidepressant drug therapy, why they can be forgotten or taken away with the food tray. In this sit- is it important to explain that relief of depression may uation, special care should be taken to supervise all medications. The risk for this increases as the antidepressant drugs may they be minimized? What is the advantage of giving a TCA at bedtime rather tions as you watch. For a client taking an MAOI, what information would you provide for preventing a hypertensive crisis? How do the newer drugs, mirtazapine, nefazodone, and venlafaxine, compare with the SSRIs in terms of adverse effects and adverse drug–drug interactions? List the main elements of treatment for antidepressant longer than a week to reach steady state. It is important to teach all clients beginning therapy with antidepressants that they may not see sig- 12. What are common adverse effects of lithium, and how nificant improvement in their depression for a number of weeks. During the initial assessment of any client, what kinds of Adverse Drug Reaction Bulletin, No. Update on the neurobiology of depres- in primary care, 2: Treatment of major depression.

Gastric ulcers (which may be mucosa of most clients with chronic gastritis discount 5mg coumadin free shipping, about 75% of preceded by less severe mucosal defects such as erosions or clients with gastric ulcers order coumadin 2mg, and more than 90% of clients with gastritis) are often associated with stress (eg, major trauma or duodenal ulcers. They are often manifested by painless biopsy forceps, and nasogastric tubes has also occurred. Gas- in the body, the organism colonizes the mucus-secreting ep- tric ulcers associated with stress may occur in any age group ithelial cells of the stomach mucosa and is thought to produce and are usually acute in nature; those associated with H. Erad- lori infection or NSAID ingestion are more likely to occur in ication of the organism accelerates ulcer healing and signifi- older adults, especially in the sixth and seventh decades, and cantly decreases the rate of ulcer recurrence. Duodenal ulcers are strongly associ- CHAPTER 60 DRUGS USED FOR PEPTIC ULCER AND ACID REFLUX DISORDERS 869 ated with H. GERD occurs in men, women, and children, but is espe- Gastroesophageal Reflux Disease (GERD) cially common during pregnancy and after 40 years of age. GERD, the most common disorder of the esophagus, is char- acterized by regurgitation of gastric contents into the esoph- TYPES OF DRUGS agus and exposure of esophageal mucosa to gastric acid and pepsin. The same amount of acid–pepsin exposure may lead Drugs used in the treatment of acid-peptic disorders promote to different amounts of mucosal damage, possibly related to healing of lesions and prevent recurrence of lesions by individual variations in esophageal mucosal resistance. Several types of drugs are used, alone and in various creases during sleep. Antacids neutralize gastric acid and decrease sis), which increases with a recumbent position or bending pepsin production; antimicrobials and bismuth can eliminate over. Drugs at a Glance: Representative Antacid Products Antacids Components Magnesium Oxide or Aluminum Calcium Trade Name Hydroxide Hydroxide Carbonate Other Route and Dosge Ranges (Adults) Aludrox 103 mg/5 mL 307 mg/5 mL PO 10 mL q4h, or as needed Amphojel 300 or 600 mg/tab, PO 10 mL or 600 mg 5 or 6 times daily 320 mg/5 mL Di-Gel 200 mg/5 mL Simethicone PO 2 tsp liquid q2h, after meals or between 20 mg/5 mL meals, and at bedtime. Gelusil 200 mg/tab 200 mg/tab Simethicone PO 10 or more mL or 2 or more tablets after 25 mg/tab meals and at bedtime or as directed by physician to a maximum of 12 tablets or tsp/24 h Maalox 200 mg/5 mL 225 mg/5 mL PO 30 mL 4 times daily, after meals and at suspension bedtime or as directed by physician; maxi- mal dose, 16 tsp/24 h Mylanta 200 mg/tab, 200 mg/tab, Simethicone PO 5–10 mL or 1–2 tablets q2–4h, between 200 mg/5 mL 200 mg/5 mL 25 mg/tab, meals and at bedtime or as directed by 20 mg/5 mL physician Mylanta 400 mg/tab, 400 mg/tab, Simethicone Same as Mylanta Double 400 mg/5 mL 400 mg/5 mL 30 mg/tab, strength 30 mg/5 mL Titralac 420 mg/tab, Glycine PO 1 tsp or 2 tablets, after meals or as 1 g/5 mL 180 mg/tab, directed by physician, to maximal dose of 300 mg/ 19 tablets or 8 tsp/24 h 5 mL 870 SECTION 10 DRUGS AFFECTING THE DIGESTIVE SYSTEM Drugs at a Glance: Drugs for Acid-Peptic Disorders Generic/Trade Name Indications for Use Routes and Dosage Ranges (Adults) Histamine-2 Receptor Treatment of peptic ulcers and GERD, to Antagonists promote healing, then maintenance to prevent recurrence Prevention of stress ulcers, GI bleeding, and aspiration pneumonitis Treatment of Zollinger-Ellison syndrome Treatment of heartburn Cimetidine (Tagamet) Duodenal or gastric ulcer, PO 800 mg once daily at bedtime or 300 mg 4 times daily or 400 mg twice daily. Maintenance, PO 400 mg at bedtime IV injection, 300 mg, diluted in 20 mL of 0. COMBINATION REGIMENS Bismuth subsalicylate, PO bismuth 525 mg (2 tabs), metronidazole 250 mg (1 tab), metronidazole, and tetracycline 500 mg (1 capsule) 4 times daily for 14 d tetracycline (Helidac) Amoxicillin, clarithromycin, PO amoxicillin 1 g, clarithromycin 500 mg, lansoprazole 30 mg and lansoprazole (Prevpac) twice daily, morning and evening, for 14 d Ranitidine and bismuth PO 400 mg twice daily for 4 wk, with clarithromycin 500 mg citrate (Tritec) 3 times daily for the first 2 wk GERD, gastroesophageal reflux disease, including erosive esophagitis; GI, gastrointestinal; NSAID, nonsteroidal anti-inflammatory drug. Antacids people who ingest large amounts of aluminum-based antacids over a long period, hypophosphatemia and osteomalacia may Antacids are alkaline substances that neutralize acids.