By V. Goran. East-West University. 2018.
This condition is largely a glucocorticoid deﬁ- tion buy 800 mg viagra vigour amex impotence underwear, which then leads to excessive adrenal secretion of ciency; mineralocorticoid secretion is not signiﬁcantly androgens and hyperplasia viagra vigour 800 mg line erectile dysfunction what doctor to see. Low plasma result from excessive corticotropin or a primary adrenal levels of cortisol lead to excessive corticotropin secre- tumor. CHAPTER 24 CORTICOSTEROIDS 337 BOX 24–2 EFFECTS OF MINERALOCORTICOIDS ON BODY PROCESSES AND SYSTEMS • The overall physiologic effects are to conserve sodium and high, the sodium level of extracellular ﬂuid is low, the renin– water and eliminate potassium. Aldosterone increases sodium re- angiotensin system of the kidneys is activated, or the anterior absorption from kidney tubules, and water is reabsorbed along pituitary gland secretes corticotropin. When sodium is conserved, another cation must • Inadequate secretion of aldosterone causes hyperkalemia, hypo- be excreted to maintain electrical neutrality of body ﬂuids; thus, natremia, and extracellular ﬂuid volume deﬁcit (dehydration). This is the only potent mechanism for con- Hypotension and shock may result from decreased cardiac out- trolling the concentration of potassium ions in extracellular ﬂuids. In general, secretion is hypernatremia, and extracellular fluid volume excess (water increased when the potassium level of extracellular fluid is intoxication). Benign tumors often produce one corticosteroid normally for most clients, especially for those with diabetes mel- secreted by the adrenal cortex, but malignant tumors litus. In addition, some clients respond more favorably often secrete several corticosteroids. This is partly caused by indi- noma or hyperplasia of the adrenal cortex cells that pro- vidual differences in the rate at which corticosteroids are duce aldosterone. This decreases secretion of corticotropin, which, in turn, causes atrophy of the adrenal cortex and EXOGENOUS CORTICOSTEROIDS decreased production of endogenous adrenal cortico- steroids. Daily administration of physiologic doses (15 to (GLUCOCORTICOID DRUGS) 20 mg of hydrocortisone or its equivalent) or adminis- When corticosteroids are administered from sources outside tration of pharmacologic doses (more than 15 to 20 mg the body, they are given mainly for replacement or therapeu- of hydrocortisone or its equivalent) for approximately tic purposes. Replacement involves small doses to correct a 2 weeks suppresses the HPA axis. Therapeutic occurs within a few weeks or months after corticosteroids purposes involve relatively large doses to exert pharmaco- are discontinued, but may take 9 to 12 months. Drug effects involve extension of the physio- time, supplemental corticosteroids are usually needed dur- logic effects of endogenous corticosteroids and new effects ing stressful situations (eg, fever, illness, surgical proce- that do not occur with small, physiologic doses. These are glucocorticoid • Hydrocortisone, the exogenous equivalent of endoge- effects. Mineralocorticoid and androgenic effects are usually nous cortisol, is the prototype of corticosteroid drugs. Additional characteristics of When a new corticosteroid is developed, it is compared therapeutic corticosteroids include the following: with hydrocortisone to determine its potency in produc- • All adrenal corticosteroids are available as drug prepa- ing anti-inﬂammatory and antiallergic responses, in- rations, as are many synthetic derivatives developed by creasing deposition of liver glycogen, and suppressing altering the basic steroid molecule in efforts to increase secretion of corticotropin. Mineralocorticoid activity is high in activities of daily living and delay disability. However, cortisone (which is rarely used), intermediate in hydro- the disease may continue to progress and long-term use cortisone, prednisolone, and prednisone, and low in of systemic corticosteroids inevitably produces serious newer agents. For ex- Several of these drugs can be given by more than one ample, an increased blood sugar level is therapeutic for route; others can be given only orally or topically. For the client with adrenocortical insufﬁciency or an islet example, in recent years there have been several for- cell adenoma of the pancreas, but an adverse reaction mulations developed for oral inhalation in the treatment 338 SECTION 4 DRUGS AFFECTING THE ENDOCRINE SYSTEM of asthma and for nasal inhalation in the treatment of stances from lysosomes. For intra-articular or and thus prevents leakage of ﬂuid into the injured area intralesional injections, acetate salts are used because and development of edema. It also reduces the chemicals they have low solubility in water and provide prolonged that normally cause vasodilation and tissue irritation. Betamethasone and dexamethasone last 48 hours, contributes to the anti-inﬂammatory and immunosup- methylprednisolone, prednisolone, prednisone and tri- pressant effects of glucocorticoids. The drugs inhibit the ability Mechanisms of Action of these immune cells to increase in number and per- form their functions. Like endogenous glucocorticoids, exogenous drug mole- • Inhibiting tissue repair. The drugs inhibit the growth cules act at the cellular level by binding to glucocorticoid of new capillaries, ﬁbroblasts, and collagen needed for receptors in target tissues. Once inside the cell, they bind with receptors in intracellu- lar cytoplasm. The drug–receptor complex then moves to the Indications for Use cell nucleus, where it interacts with DNA to stimulate or sup- press gene transcription. Corticosteroids are extensively used to treat many different Glucocorticoid drugs increase or decrease transcription of disorders. Except for replacement therapy in deﬁciency many genes to alter the synthesis of proteins that regulate states, the use of corticosteroids is largely empiric. Because their many physiologic effects (eg, enzymes, transport pro- the drugs affect virtually every aspect of inﬂammatory and teins, structural proteins). Metabolic effects do not occur for immune responses, they are used in the treatment of a broad at least 45 to 60 minutes because of the time required for pro- spectrum of diseases with an inﬂammatory or immunologic tein synthesis.
These cases were between the ages of 6-13 years old buy viagra vigour 800 mg amex erectile dysfunction doctors naples fl, with a median age of 7 order 800 mg viagra vigour amex erectile dysfunction age 27. The course of disease was seven weeks to seven years long, with a median duration of 1. In this group, the patients had enuresis 1-4 times per night, with a median occurrence of 1. Therefore, there was no significant difference between the two groups prior to treatment. Treatment method: The treatment group was administered Yi Niao Ling Fang (Effective Enuresis Formula) which was composed of: 88 Treating Pediatric Bed-wetting with Acupuncture & Chinese Medicine fresh Bai Guo (Semen Ginkgonis), 10g Mu Li (Concha Ostreae), 10g Sang Ji Sheng (Herba Taxilli), 10g Sang Piao Xiao (Ootheca Mantidis), 10g Wu Bei Zi (Galla Rhois), 10g Wu Wei Zi (Fructus Schisandrae), 10g Yi Zhi Ren (Fructus Alpiniae Oxyphyllae), 10g Shan Zhu Yu (Fructus Corni), 10g Shu Di (cooked Radix Rehmanniae), 10g Suan Zao Ren (Semen Zizyphi Spinosae), 10g Shan Yao (Radix Dioscoreae), 8g Jiu Cai Zi (Semen Alli Tuberosi), 8g If there was encumbered sleep and inability to wake, Ban Xia (Rhizoma Pinelliae Ternatae) and Shi Chang Pu (Rhizoma Acori Tatarinowii) were added. If there was poor appetite and sloppy stools, Dang Shen (Radix Codonopsitis), Fu Ling (Poria), and Bai Zhu (Rhizoma Atractylodis Macrocephalae) were added. If the disease was enduring and there was low-grade fever, fre- quent urination, a red tongue with scanty fur, the above formula was used in combination with Zhi Bai Di Huang Wan (Anemarrhena & Phellodendron Rehmannia Pills). Study outcomes: GROUP CURED IMPROVED NO TOTAL IMPROVEMENT EFFECTIVENESS Treatment 42(84%) 7(14%) 1(2%) 98% Comparison 22(47. Four cases in the comparison group had side effects of dizziness and dry mouth that disappeared with a decrease in dosage. Discussion: Within the above Chinese medicinal formula, Shan Zhu Yu and Shu Di Huang supplement the kidneys and secure the root. Wu Bei Zi, Wu Wei Zi, and Shan Zhu Yu are sour and constrain, secure, and astringe. Sang Ji Sheng and Sang Piao Xiao supplement the kidneys, secure the essence, and reduce urination. Jiu Cai Zi is acrid and warm, homes to the kidneys and warms the bladder. The flavor of fresh Bai Guo is particularly excellent at treating this disease. This medici- nal is excellent for treatment to constrain the lungs and calm pant- ing and is also taken to constrain, astringe, and reduce urination. The Ben Cao Gang Mu (Detailed Outline of Materia Medica) says this medicinal can reduce urination and stop white turbidity. This formula overall is warm but not drying and uses many ingredients that are sour, astringent, and neutral that effect the three main viscera involved in enuresis—the lungs, spleen, and kidneys. From The Treatment of 30 Cases of Pediatric Enuresis with Yi Qi Suo Niao Yin (Boost the Qi & Reduce Urine Beverage) by Zhao Ling, Si Chuan Zhong Yi (Sichuan Chinese Medicine), 2002, #8, p. The course of the disease was as short as 30 days and as long as 12 years. In 10 cases, the child would have enuresis 2-3 times a night, in 15 cases, they would urinate one time per night, and five cases had intermittent enuresis. Three to 15 grams of each medicinal were prescribed and one packet was administered each day. One packet was soaked in 30 Chinese teacups of cold water, decocted, and boiled three times. After decocting three times, the resulting medicinal liquid was mixed together and divided into three doses for each day. Simultaneously, the par- ents or guardian of the child were told to pay attention to limiting the amount of water the child drank each evening before bed. To support and achieve better results, the parents or guardians were encouraged to remind the child to urinate before sleep each night. Scheduling a time to wake up and urinate each night also increased the curative effect of the medicinals. Counseling was given to anyone whose course of disease was more than one year. This counseling was used in order to overcome the disease by establishing confidence in the treatment and to eliminate any feelings of pessimism. For lassitude of the spirit and lack of strength, reduced food intake and sloppy stools, 10 grams of processed Huang Qi (Radix Astragali Membranacei), three grams of Sha Ren (Fructus Chinese Research on the Treatment of Pediatric Enuresis 91 Amomi), and five grams of Bai Zhu (Rhizoma Atractylodis Macrocephalae) were added. For a vacuous body and/or profuse sweating, 10 grams each of calcined Long Gu (Os Draconis), Mu Li (Conchae Ostreae), and Tai Zi Shen (Radix Pseudostellariae) were added. For a bright white facial complexion, fear of cold, and chilled limbs, 10 grams of Bu Gu Zhi (Fructus Psoraleae) were added. Study outcomes: In 15 cases, symptoms disappeared after one course of treat- ment, and in 10 cases, the symptoms disappeared after two courses of treatment. An obvious decrease in frequency of enure- sis was observed in five cases.
Hold this position cheap 800mg viagra vigour visa can you get erectile dysfunction pills over the counter, while continuing to breathe generic viagra vigour 800 mg erectile dysfunction options, for five seconds, and then return your head to the center position. Now we will let the head tilt forward gently, again letting the weight of the head pull it forward without straining. Finally, let the head tilt backward, as if looking at the ceiling, and hold for five seconds. Hold for five seconds, remembering to breathe as you do so, then release. Fingers Hold your left thumb with your fisted right hand, as if getting ready to pull your thumb outward. Pull gently, being especially careful if you have arthritis or carpal tunnel syndrome. Repeat this exercise for the right hand, using the fisted left hand to pull each finger gently for five seconds. TLFeBOOK W arm-U p E xercises / 63 Now, make a tight fist with your left hand, hold for five seconds, and then re- lease. Wrists Roll both wrists simultaneously, first in a clockwise direction, then in a counter- clockwise direction. Start with the fingers open, and perform 10 slow rolls in each direction. Then make fists of your two hands and repeat the exercise, performing 10 rolls in each direction. Now, hold your left hand parallel to the floor in front of you, with the fingers pointing across your body to the right, at chest level. Place the palm of your right hand across the back of the left-hand fingers, and keeping the left arm horizontal, attempt to bend the left wrist downward by pressing on the left fingers. Now place your right fingers beneath the left fingers, and press the left hand backward, as if trying to touch the back of your left forearm. Press only enough to get a good stretch—there should be no pain encountered when you perform this movement. Now repeat both of these exercises on the right hand, making sure to breathe deeply and keep your body aligned properly. Bring the arm across your body to the right at chest level, lifting the left elbow until it is parallel to the floor. Try to touch that fist to your left shoulder, and lift your left elbow upward toward the ceiling. Finally, with the left hand again held in a loose fist, drive the left elbow back- wards, as if trying to push a wall behind you with your elbow. Keep your left fist close to the left side of the body, near your lower ribs. Hold the stretch for five seconds, and then return to the starting position. With the fingers open and loose, start to make circles on the right side of your body, making them as large as you comfortably can. Make five circles with the right arm, then stop and repeat with the left arm. Shoulder Stretches From either a standing or seated position, reach both arms forward as far as possible, locking the elbows and straightening the fingers. Stretch and hold for five seconds, then relax your arms, allowing the elbows and fingers to bend slightly. For the next movement, repeat the above exercise, but with the arms stretched out to the sides instead of forward. Finally, repeat the above movements with the arms at the sides, fingers point- ing toward the floor. Waist and Hips From either a standing or seated position, be sure that your body alignment is proper—head up, feet flat, level gaze. If standing, let your arms hang at your sides; if sitting, place your hands on your knees. Bend your torso to the right side slowly, letting the weight of your upper body provide the pulling force. Hold the stretch for five seconds and then slowly return to an upright position. From a standing position, and keeping the feet firmly planted, slowly start to rotate your waist from side to side, allowing your relaxed arms to swing gently back and forth from left to right, then back again. Repeat for as long as it is comfortable, combining the movements with deep, relaxed breathing. TLFeBOOK W arm-U p E xercises / 65 Waist Bends Standing upright, lock your knees so that your legs are totally straight. Let your arms dangle down in front of you as if you are trying to touch your toes. Ankle Circles Sit on a chair, or stand while holding the back of a chair. Moving your right foot, make five circles in the air in a clockwise direction, and then make five circles in the opposite direction.
What is the reason for combining clavulanate quality viagra vigour 800mg impotence kit, sulbactam buy 800mg viagra vigour amex erectile dysfunction l-arginine, sound and look alike), these are two different drugs. Cefuroxime is a second-generation cephalosporin and ceftizoxime is a third- or tazobactam with a penicillin? When giving injections of penicillin in an outpatient set- pharmacokinetics are different. When the dispensed medication is ting, it is recommended to keep clients in the area and not identical to the prescribed medication, check with the pharma- observe them for at least 30 minutes. When probenecid is given concurrently with a penicillin, what is its purpose? For clients with renal impairment, which drugs in this chapter require reduced dosages? Which drugs from this chapter may cause pseudomem- she did not state an allergy to cephalosporin antibiotics, 5% to branous (antibiotic-associated) colitis? What are the signs, symptoms, and treatment of pseudo- to cephalosporins because structurally all beta-lactams are similar. Stop the infusing cefotetan but keep the IV line open because you may need to give emergency drugs IV if her condition worsens. Take her vital signs, administer oxygen, and have someone stay SELECTED REFERENCES with her while you contact the physician. What adverse effects are associated with beta-lactam macotherapy, 33, 560–564. Antimicrobial agents: Penicillins, cephalosporins, and other beta-lactam antibiotics. Discuss the importance of serum drug levels in relation to effectiveness, safety, spectrum during aminoglycoside therapy. Describe measures to decrease nephrotoxicity administration, and observation of client and ototoxicity with aminoglycosides. Discuss factors inﬂuencing selection and effects, and nursing process implications of dosage of aminoglycosides. Critical Thinking Scenario George Masury, accompanied by his wife Jennie, visits his primary care provider complaining of upper respira- tory symptoms. George and Jennie have been married for 52 years and Jennie has always cared for George when he was sick and helped make decisions for him. George is hard of hearing, has some forgetfulness, and does not talk very much. Reﬂect on: How you will include George and Jennie in the teaching session. Teaching strategies to individualize for hearing deﬁcits and memory deﬁcits. OVERVIEW ual drugs, with routes of administration and dosage ranges, are listed in the Drugs at a Glance tables. The aminoglycosides have been widely used to treat serious gram-negative infections for many years. The quinolones are AMINOGLYCOSIDES also older drugs originally used only for treatment of urinary tract infections (see Chap. The fluoroquinolones are Aminoglycosides are bactericidal agents with similar pharma- synthesized by adding a ﬂuorine molecule to the quinolone cologic, antimicrobial, and toxicologic characteristics. This addition increases drug activity against gram- used to treat infections caused by gram-negative microorgan- negative microorganisms, broadens the antimicrobial spec- isms such as Pseudomonas and Proteus species, Escherichia trum to include several other microorganisms, and allows use coli, and Klebsiella, Enterobacter, and Serratia species. General character- These drugs are poorly absorbed from the gastrointestinal istics, mechanisms of action, indications for and contraindica- (GI) tract. Thus, when given orally, they exert local effects in tions to use, nursing process implications, and principles of the GI tract. They are well absorbed from intramuscular injec- therapy for these drugs are described in this chapter. Individ- tion sites and reach peak effects in 30 to 90 minutes if circula- 527 528 SECTION 6 DRUGS USED TO TREAT INFECTIONS Drugs at a Glance: Aminoglycosides Routes and Dosage Ranges Generic/Trade Name Characteristics Adults Children Amikacin (Amikin) Retains a broader spectrum of antibac- IM, IV 15 mg/kg q24h, 7. Hepatic coma PO 4–12 g daily in Used topically, often in combination divided doses with other drugs, to treat infections of the eye, ear, and skin (burns, wounds, ulcers, dermatoses) When used for wound or bladder irriga- tions, systemic absorption may occur if the area is large or if drug concen- tration exceeds 0. Netilmicin (Netromycin) Similar to gentamicin in antimicrobial IM, IV 4–6. However, systemic absorption may occur in the presence of inﬂamma- tory or ulcerative bowel disease. CHAPTER 35 AMINOGLYCOSIDES AND FLUOROQUINOLONES 529 Drugs at a Glance: Aminoglycosides (continued) Routes and Dosage Ranges Generic/Trade Name Characteristics Adults Children Streptomycin May be used in a four- to six-drug IM 15 mg/kg/d (maximum 1 g) or IM 20–40 mg/kg/d in two divided regimen for treatment of multidrug- 25–30 mg/kg two or three doses, q12h (maximum dose, resistant tuberculosis times weekly (maximum 1. They accumulate in high concentrations in the kidney effects occur within 30 to 60 minutes. They are poorly distributed to the central nervous 4 hours with normal renal function. After parenteral administration, aminoglycosides are widely Injected drugs are not metabolized; they are excreted un- distributed in extracellular ﬂuid and reach therapeutic levels changed in the urine, primarily by glomerular ﬁltration. Oral in blood, urine, bone, inﬂamed joints, and pleural and ascitic drugs are excreted in feces.
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