Kamagra
By V. Jensgar. Lesley University.
Clients/Consumers People may take drugs from several prescribers; fail to inform one Circumstances physician about drugs prescribed by another; get prescriptions Prescribers buy kamagra 100mg with amex erectile dysfunction at 25, pharmacists discount 100 mg kamagra visa impotence urinary, and nurses may have a heavy workload, filled at more than one pharmacy; fail to get prescriptions filled or with resultant rushing of prescribing, dispensing, or administering refilled; underuse or overuse an appropriately prescribed drug; medications. They may also experience distractions by interrup- take drugs left over from a previous illness or prescribed for some- tions, noise, and other events in the work environment that make one else; fail to follow instructions for drug administration or stor- it difficult to pay needed attention to the medication-related task. Occasionally, verbal or telephone orders are accept- DRUG PREPARATIONS AND able. Some drugs are available in only one dosage pharmacy staff prepare a computer-generated MAR for each form; others are available in several forms. For clients in ambulatory care settings, the procedure is es- Dosage forms of systemic drugs include liquids, tablets, sentially the same for drugs to be given immediately. For drugs capsules, suppositories, and transdermal and pump delivery to be taken at home, written prescriptions are given. Systemic liquids are given orally (PO) or by injec- tion to the previous information, a prescription should include tion. Prescriptions for drug plus binders, colorants, preservatives, and other sub- Schedule II controlled drugs cannot be refilled. Capsules contain active drug enclosed in a gelatin cap- To interpret medication orders accurately, the nurse must sule. Most tablets and capsules dissolve in the acidic fluids of know commonly used abbreviations for routes, dosages, and the stomach and are absorbed in the alkaline fluids of the upper times of drug administration (Table 3–1). Tablets for sublingual or buccal ad- ministration must be specifically formulated for such use. TABLE 3–1 Common Abbreviations Several controlled-release dosage forms and drug delivery systems are available and more continue to be developed. Routes of Drug Administration These formulations maintain more consistent serum drug lev- IM intramuscular els and allow less frequent administration, which is more con- IV intravenous venient for clients. Oral tablets and capsules are called by a OD right eye* variety of names (eg, timed release, sustained release, extended OS left eye* release) and their names usually include SR, XL, or other OU both eyes* PO by mouth, oral indications that they are long-acting formulations. Most of SC subcutaneous these formulations are given once or twice daily. Because controlled-release cc cubic centimeter g gram tablets and capsules contain high amounts of drug intended to gr grain be absorbed slowly and act over a prolonged period of time, gt drop† they should never be broken, opened, crushed, or chewed. Such mg milligram an action allows the full dose to be absorbed immediately and mL milliliter constitutes an overdose, with potential organ damage or death. These medications are slowly absorbed from the skin patches over varying periods of time (eg, 1 week for cloni- ac before meals dine and estrogen). Pump delivery systems may be external or ad lib as desired implanted under the skin and refillable or long acting without bid twice daily hs bedtime refills. Pumps are used to administer insulin, opioid analgesics, pc after meals antineoplastics, and other drugs. PRN when needed Solutions, ointments, creams, and suppositories are applied qd every day, daily topically to skin or mucous membranes. They are formulated q4h every four hours for the intended route of administration. For example, several qid four times daily qod every other day drugs are available in solutions for nasal or oral inhalation; they stat immediately are usually self-administered as a spray into the nose or mouth. Commonly used combina- *Because of errors made with the abbreviations, some authorities recommend spelling out the site (eg, right eye). CHAPTER 3 ADMINISTERING MEDICATIONS 33 TABLE 3–2 Drug Dosage Forms Dosage Forms and Their Routes of Administration Characteristics Considerations/Precautions Tablets Regular: PO, GI tube (crushed • Contain active drug plus binders, dyes, preservatives 8 oz of water recommended when taken orally, to and mixed with water) • Dissolve in gastric fluids promote dissolution and absorption Chewable: PO Colorful and flavored, mainly for young children who Colors and flavors appeal to children; keep out of are unable to swallow or who refuse regular tablets reach to avoid accidental overdose. Enteric coated: PO Dissolve in small intestine rather than stomach; Do not crush; instruct clients not to chew or crush. Solutions Oral: PO, GI tube • Absorbed rapidly because they do not need to be Use of appropriate measuring devices and accurate dissolved measurement are extremely important. Parenteral: IV, IM SC, • Medications and all administration devices must Use of appropriate equipment (eg, needles, syringes, intradermal be sterile IV administration sets) and accurate measurement • IV produces rapid effects; SC is used mainly for in- are extremely important.
Although the in- Atropine Glycopyrrolate (Robinul) crease in heart rate may be therapeutic in bradycardia buy kamagra 100mg low price webmd erectile dysfunction treatment, it Benztropine (Cogentin) Ipratropium (Atrovent) can be an adverse effect in patients with other types of Biperiden (Akineton) Mepenzolate (Cantil) heart disease because atropine increases the myocardial Dicyclomine hydrochloride (Bentyl) Methscopolamine (Pamine) oxygen demand order 100mg kamagra otc erectile dysfunction treatment following radical prostatectomy. Atropine usually has little or no effect Flavoxate (Urispas) Propantheline bromide on blood pressure. Large doses cause facial flushing be- l-Hyoscyamine (Anaspaz) (Pro-Banthine) Oxybutynin (Ditropan) cause of dilation of blood vessels in the neck. Bronchodilation and decreased respiratory tract se- Scopolamine cretions. Bronchodilating effects result from blocking Tolterodine (Detrol and Detrol LA) the bronchoconstrictive effects of acetylcholine. When Trihexyphenidyl (Trihexy) anticholinergic drugs are given systemically, respiratory secretions decrease and may become viscous, resulting in mucous plugging of small respiratory passages. Ad- receptors blocked by anticholinergic drugs and the under- ministering the medications by inhalation decreases this lying degree of parasympathetic activity. Since cholinergic effect while preserving the beneficial bronchodilation muscarinic receptors are widely distributed in the body, anti- effect. Antispasmodic effects in the GI tract due to de- cluding the central nervous system, heart, smooth muscle, creased muscle tone and motility. Central nervous system (CNS) stimulation followed intestinal secretions. Normally, anti- This is most likely to occur with large doses of anti- cholinergics do not change intraocular pressure, but cholinergic drugs that cross the blood–brain barrier with narrow-angle glaucoma, they may increase in- (atropine, scopolamine, and antiparkinson agents). When the pupil is fully dilated, photophobia thetic (vagal) stimulation that slows heart rate. At- may be bothersome, and reflexes to light and accom- ropine is the anticholinergic drug most often used for its modation may disappear. Miscellaneous effects include decreased secretions Life Support (ACLS) protocol (2000), atropine is the from salivary and sweat glands; relaxation of ureters, urinary bladder, and the detrusor muscle; and relaxation of smooth muscle in the gallbladder and bile ducts. The clinical usefulness of anticholinergic drugs is limited by their widespread effects. Consequently, several synthetic drugs have been developed in an effort to increase selectivity Nerve ending Presynaptic vesicles of action on particular body tissues, especially to retain the containing acetylcholine antispasmodic and antisecretory effects of atropine while eliminating its adverse effects. This effort has been less than successful—all the synthetic drugs produce atropine-like ad- verse effects when given in sufficient dosage. One group of synthetic drugs is used for antispasmodic Acetylcholine effects in GI disorders. They balance the rel- drug receptor ative cholinergic dominance that causes the movement dis- orders associated with parkinsonism. Effector target organ Indications for Use Figure 21–1 Mechanism of action of anticholinergic drugs. Anti- Anticholinergic drugs are used for disorders in many body cholinergic (antimuscarinic) blocking agents prevent acetylcholine from interacting with muscarinic receptors on target effector organs, thus systems. Clinical indications for use of anticholinergic drugs blocking or decreasing a parasympathetic response in these organs. They also are Contraindications to Use used before surgery and bronchoscopy. Drugs at a Glance: Selected Anticholinergic Drugs describes the therapeutic use, Contraindications to the use of anticholinergic drugs include dosage and route of administration of selected anticholiner- any condition characterized by symptoms that would be ag- gic medications. Some of these are prostatic hypertrophy, • GI disorders in which anticholinergics have been used myasthenia gravis, hyperthyroidism, glaucoma, tachyarrhyth- include peptic ulcer disease, gastritis, pylorospasm, di- mias, myocardial infarction, and heart failure unless bradycar- verticulitis, ileitis, and ulcerative colitis. They should not be given in hiatal hernia or other tions are often characterized by excessive gastric acid conditions contributing to reflux esophagitis because the drugs and abdominal pain because of increased motility and delay gastric emptying, relax the cardioesophageal sphincter, spasm of GI smooth muscle. The drugs are weak inhibitors of gastric acid secretion even in maximal doses (which INDIVIDUAL usually produce intolerable adverse effects). Although ANTICHOLINERGIC DRUGS they do not heal peptic ulcers, they may relieve abdom- inal pain by relaxing GI smooth muscle. Belladonna Alkaloids and Derivatives Anticholinergics may be helpful in treating irritable colon or colitis, but they may be contraindicated in Atropine, the prototype of anticholinergic drugs, produces chronic inflammatory disorders (eg, diverticulitis, ulcer- the same effects, has the same clinical indications for use, and ative colitis) or acute intestinal infections (eg, bacterial, has the same contraindications as those described earlier. Other drugs are used to decrease diarrhea addition, it is used as an antidote for an overdose of choliner- and intestinal motility in these conditions. It is usually prepared as atropine sulfate, a salt that infections such as cystitis, urethritis, and prostatitis, the is very soluble in water.
Drugs that increase effects of anorexiants: (1) Antidepressants safe kamagra 50 mg erectile dysfunction doctors in coimbatore, tricyclic May increase hypertensive effects (2) Other CNS stimulants Additive stimulant effects (3) Other sympathomimetic drugs (eg discount kamagra 100 mg mastercard erectile dysfunction medication options, epinephrine) Additive hypertensive and other cardiovascular effects b. Drugs that decrease effects of anorexiants: (1) Antihypertensive drugs Decrease blood pressure raising effects of anorexiants (2) CNS depressants (eg, alcohol) Antagonize or decrease effects c. Drugs that increase effects of sibutramine (1) Adrenergics (eg, epinephrine, pseudoephedrine) Additive increases in blood pressure (2) Antidepressants (tricyclics [TCAs; eg, amitripty- TCAs and sibutramine increase levels of norepinephrine and sero- line], selective serotonin reuptake inhibitors [SSRIs; tonin in the brain; SSRIs increase serotonin levels. Concurrent use eg, fluoxetine]) of these drugs may cause excessive CNS stimulation, hyperten- sion, and serotonin syndrome and should be avoided. Drugs that decrease effects of pancreatic enzymes (1) Antacids with calcium carbonate or magnesium May prevent action of enzymes; do not give at the same time. The infusion rate is for 2000 mL breakfast) decreases drug effectiveness. Review your abbreviations per 24 hours, which calculates to an hourly rate of 83 mL/hour. Weight con- Review and Application Exercises trol and risk factor reduction in obese subjects treated for 2 years with orli- stat: A randomized controlled trial. Differentiate clients who are at high risk for development DerMarderosian, A. What are pharmacologic and nonpharmacologic inter- and overfatness in a multiethnic pediatric population. American Journal ventions to restore fluid balance when an imbalance of Clinical Nutrition, 67, 602–610. For clients who are unable to ingest food, which nutrients American Journal of Clinical Nutrition, 68, 899–917. Severe hepatotox- icity associated with the dietary supplement LipoKinetix. What is the role of lipid emulsions in parenteral nutri- ternal Medicine, 136(8), 590–595. In an infant receiving parenteral nutrition, what is the best tary & alternative medicines. In an outpatient or home care client with a protein-calorie Journal of Clinical Nutrition, 67, 1130–1135. Patient Care, weight, what are some nursing interventions to assist and 32(16), 29–50. With critically ill clients, what special needs must be con- Pathophysiology: Concepts of altered health states, 6th ed. Delineate circumstances in which therapeutic vitamins are likely to be needed. Critical Thinking Scenario You have been asked to speak with a group of senior citizens, living independently in a retirement community, about vitamins and health. You have a group of approximately 25 who signed up for this talk as part of a gen- eral education series on Staying Fit and Healthy After 65. Review important vitamins, their benefits, and Recommended Dietary Allowances (RDAs). Problem-solve which nonprescription vitamins are indicated and cost-effective. OVERVIEW Historically, the major concern in relation to vitamins was sufficient intake to promote health and prevent deficiency dis- Vitamins are required for normal body metabolism, growth, eases. Nutritional goals for vitamin intake were established by and development. They are components of enzyme systems that the Food and Nutrition Board of the National Academy of release energy from proteins, fats, and carbohydrates. The are required for formation of red blood cells, nerve cells, RDAs were designed to meet the daily needs of healthy chil- hormones, genetic materials, bones, and other tissues. They are dren and adults; those used in recent years were established in effective in small amounts and are mainly obtained from foods 1989. These RDAs are in the process of being replaced by stan- or supplements. Most nutritionists agree that a varied and well- dards called the Dietary Reference Intakes (DRIs; Box 31–1).
