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N102: Unit Eight- Routes and Formulations Learning Objectives Provider of care: Theoretical knowledge and critical thinking 1. List the various routes by which a drug may be given. 2. Describe different preparations used for giving enteral medication. 3. List the different dosage formulations of oral medications. 4. Use common terms to describe oral medications. 5. Identify the equipment used to administer oral medications. 6. Describe different preparations used for giving parenteral medications. 7. List administration devices used for giving parenteral medications. 8. Recognize various injection sites 9. Recite the procedure for injection of medications 10. Match equipment needed for each method of administration of medications Member of the discipline of nursing: Professional behaviors 11. Discuss the legal implications of drug therapy. Content I. Types of Routes 1. Enteral 2. Parenteral Formulations 1. Local effects 2. Systemic effects Oral Formulations 1. Solid 2. Liquid Sublingual Formulations Rectal Formulations Parenteral A. Injection non-injection B. Advantages C. Disadvantages D. Injection routes E. Injection Characteristics Teaching Learning Activities Chapter 10 Reread pages 86-87 Book's CD video clips #7 Oral med to #13 IM injections Class participation: Go to a Pharmacy, find the formulations this is the form it comes in ; ie suppository, tablets, liquids ; and prices of Genadryl and Tylenol or their generics. Bring the medication vials, and ampules to class from your nurse pack.
Another roughly 40% of the households in each group are in are in the range of , 000 per year or higher, and slightly less than half of these are in the 5, 000 or more range, with the exception of Indians which have slightly more than half over 5, 000. Likewise, examination of the average and median incomes for each sample group reveal that the average Indian household income bracket is slightly higher i.e. up to K ; than its median, and both the average and median for the Chinese and Korean groups, respectively. This illustrates that the Indian incomes are slightly skewed toward the higher end, relative to the incomes of the Chinese and Koreans. The Indian case of more households falling into!

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Ust about every one who travels needs to take medireactions, decongestants, a cream for skin rashes, and cine at some time or another: at some point, we reach something for an upset stomach or diarrhea. Examples of out for the little amber bottle, which may or may not these include Tylenol, aspirin, ibuprofen; Benadryl; Sudafed; be there. The chances for needing some sort of medicine, calamine, or Benadrryl cream; Tums, Rolaids, or Peptowhether prescription or over-the-counter PTC ; is not small: bismol and Imodium. for 100, 000 travelers to Routine Travel Medicines the developing world for 1 Travelers with illnesses month, 50, 000 will develop should take their regular some sort of health problem medications on every trip, during the course of their and these should be fresh, trip; 8, 000 travelers will with plenty of time left before see a physician about their the expiration date. If the problem; 5, 000 travelers will medicine is vitally important, have to stay in bed during or the trip is a long one or to their trip; 1, 100 travelers the developing world, take will be incapacitated in their extras and keep these spares work either abroad or returnin separate luggage in case ing home; 300 travelers will of loss or theft. If the drug have to be hospitalized either contains narcotics, such as during their trip or upon their Vicodin, it may catch the return; 50 travelers will have attention of border officials in to be air evacuated out of other countries, and a letter the country they are visiting. from your doctor explaining For simplicity let's divide their legitimate need should travel medications into two It is best to buy your medications before you leave the USA help avoid problems. categories: Special and Routine. On the same note, keep your Special Travel Medicines If your trip is taking you to areas that may contain malaria you ought to take medication to avoid this serious and potentially deadly disease. There are several choices available, and the best decision for you is best made in consultation with a travel or tropical medicine specialist. You may also need medication to prevent or treat altitude illness if you are traveling to over 8, 500 feet. Another consideration is taking a prescription antibiotic for infections which you may acquire while on the road. It is not enough to just have the drugs with you - you must clearly know how to take them properly and under which conditions to use them. Here is a suggestion for a personal OTC mini-travel pharmacy: medicine for inflammation, fever pain, allergic pills in their original pharmacy-labelled bottles. It can eliminate many hassles, especially when crossing borders. Buying medicine overseas can be a risky proposition. While many more drugs are available over-the-counter outside the USA, you can't always be sure that the medication is not fake, or the correct dose, or even expired but re-labeled - all of which are quite common in the developing world. It is best to buy your medications before you leave the USA, and know that what you have is reliable and safe. n Healthy Travels! Dr. Spira.

Eurax Ovide COLD, COUGH, ALLERGY, DECONGESTANTS Actifed Guaifenesin Sinex Neo-Synephrine Vicks Formula 44 Afrin nasal spray Halls lozenges nasal spray Zinc lozenges Benadry Nasal Crom Sucrets Zyrtec Claritin Claritin-D Rhinocort Aqua Sudafed Chlor-Trimetron Robitussin plain ; Sudafed-PE Dextromethorphan Saline nasal spray Tylenol Plus INDIGESTION, HEARTBURN Axid Maalox Riopan Note: Rolaids Tums Carafate Mylanta Tagamet can cause rebound Gas-X Mylicon Pepcid Zantac heartburn; try Maalox Gaviscon Reglan Avoid Pepto-Bismol Mylanta first NAUSEA, VOMITING Antivert Bonine Dramamine Reglan Zofran Anzemet Emetrol if not diabetic ; Tigan Compazine Phenergan Unisom DIARRHEA Immodium A-D Kaopectate CONSTIPATION First: increase fluids, fiber bran, grape prune juice, regular exercise Benefiber Colace Fiberall Fibercon Milk of magnesia Citrucel Dialose Metamucil Surfak HEMORRHOIDS Anusol Preparation H Tucks VAGINAL YEAST INFECTIONS Gynelotrimin Monistat Terazol Avoid Diflucan PAIN Tylenol Regular or Darvocet Lortab Vicodin Tylenol with codeine Extra Strength ; Fioricet Midrin RASHES Benaddryl cream Calamine Caladryl Hydrocortisone cream Oatmeal bath Aveeno ; DENTAL Anbesol Novacaine If dental x-ray is done, a lead apron must be used to shield the abdomen PPD skin test is acceptable. Flu vaccine is strongly encouraged if pregnant during flu season and claritin.

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No sign of degradation 11 ; . They have exceptionally low levels of circulating viral antigens and of viral RNA and DNA in peripheral blood mononuclear cells. However, virus has been recovered consistently from lymph-node cells 11 ; and their vigorous immune responses are indicative of sustained viral replication. The possibility that these patients are infected with HIV variants of low virulence remains open. Such variants have been widely sought, but they have been reported only on one occasion when a variant with deletions in the critical nef gene was isolated 12 ; . Thus far, no special characteristics of the immune response have been identified in these patients, but they remain a focus of intense interest 13 ; . Evidence has been accumulating for several years that HIV infection is sometimes abortive in both adults 14, 15 ; and neonates 16-18 ; . More recently, early cellular immune responses -- particularly the proliferation of interleukin-2 following exposure to HIV-specific peptide antigens -- have been demonstrated both in adults and neonates who remained seronegative following potential exposure to HIV 19-23 ; . With time, it seems that persistence of proviral DNA may provide the only evidence of earlier infection in such individuals 24 ; . There are still tantalizing inconsistencies to be resolved in current knowledge regarding vertical transmission of HIV from mother to infant 25 ; . Whereas evidence of HIV infection has been found in a large majority of fetuses electively aborted in the first and second trimesters from HIV-positive women 26 ; , only some 25% of infants born at term to infected mothers are estimated to have evidence of infection 27 ; . Moreover, two-thirds of these infections can be prevented by zidovudine which, in other circumstances, is a relatively weak antiretroviral agent ; see p. 199 ; . Particularly intriguing, is the finding that some exposed but apparently uninfected neonates harbour HIV-specific cytotoxic T lymphocytes -- which are associated in adults with rapidly replicating virus 28 ; . Given its allegedly immature immune system, this apparent capacity of the fetus to eliminate the virus could provide vital clues to the development of new therapeutic approaches. Existing HIV-2 infection has been found to protect against subsequent HIV-1 infection by some 70% 29 ; . These results were obtained by following a group of some 750 female prostitutes in Dakar, Senegal for a period of nine years. Of 618 women. A chimeric monoclonal antibody 34% mouse protein Binds to external domain of EGFR, then internalized Inhibits tyrosine kinase activity causing cell arrest & apoptosis Demonstrates synergism with radiation & chemo Pharmacokinetics Mean T1 2 is hrs. + - 70-95 hr. ; Non-linear `saturable' clearance Loading dose - 400mg m2 over 2 hr. on day 1, then 250mg m2 weekly over 1 hr. inline 0.22 micron filter ; Premedication with benadryl is recommended and pulmicort.

MOORE, J. Keith Harper, an inmate at David Wade Correctional Center "DWCC" ; , appeals a summary judgment dismissing his claims for injunctive relief and damages against prison officials. He alleged that after sustaining an anaphylactic reaction to a yellow jacket sting, he was the victim of "medical negligence, deliberate indifference, denial of medical care, and improper work classification." We affirm. Factual Background Harper entered DWCC in June 2001. His initial intake screening showed he was healthy with no known allergies; he was issued a regular work duty status. On October 23, he was working in a field outside the compound when a yellow jacket stung him on the right arm. He alleged that he fell to the ground unconscious and was taken to the DWCC infirmary. He was found to be sweaty and clammy with a BP of 38, elevated pulse and temperature of 97.6E; he was given 50 mg of Benadrhl and a saline IV, and taken to LSU Medical Center E.A. Conway ; in Monroe. Later that day he was returned to DWCC, alert and oriented; the next day he had a rash on his arms, chest and back, for which he was given regular doses of Benadryl. His condition gradually improved. Dr. Pam Hearn, the medical director at DWCC, concluded that Harper's medical condition would not prevent him from working in the field; she also felt that he was just as likely to receive a bee sting on the compound as in the field. She wrote a duty status report allowing him to return to regular work but to carry a 50 mg Benadryl on his person "in case.
Medications to stop before initial appointment Some medications, especially antihistamines, affect the results of skin testing and need to be stopped if skin testing is to be performed. Stop these oral antihistamines for 5 days before your appointment: o Allegra Fexofenadine ; o Atarax, Vistaril Hydroxyzine ; o Zyrtec Cetirizine ; o Claritin Alavert Loratidine ; o Clarinex Stop Xyzal 7 days before your appointment Stop these oral antihistmanines for 3-4 days before your appointment: o Actifed, Dimetapp Brompheniramine ; o Benadryl Diphenhydramine ; o Chlortrimeton Chlorpheniramine ; o Phenergan Promethazine ; o Tavist, Antihist Clemastine ; o Actifed, Aller-Chlor, Bromfed, Drixoral, Dura-tab, Novafed-A, Ornade, Poly-Histine-D, Trinalin Combination medicines ; o Astelin nasal spray o Any over the counter medication that has "Allergy" in its name. Stop Singulair the night before your appointment. Stop these reflux medications the morning before your appointment o Tagamet cimetadine ; , Zantac ranitidine ; , Pepcid famotidine ; and Axid nizatidine ; . You can continue your antihistamines if you are not comfortable with stopping them, especially if you have poorly controlled hives or swelling. We will discuss testing options at your initial visit. Some antidepressants, such as Elavil Amitriptyline ; , can also act as an antihistamine. Let Dr. Hwan know if you are on any antidepressants before your skin testing. Continue your steroid nasal sprays Nasonex, Nasacort, Fluticasone Flonase ; , Veramyst or Rhinocort ; . Continue to take all your other medicine including asthma medications ; as you usually do. Skin testing may not be performed at the first visit if you are on a beta-blocker or if you have poorly controlled asthma. If you have any questions regarding which medications to stop before the first visit, please call our office. 215 ; 723-5111 and medrol.

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Histamine injection is used to diagnose skin allergy positive control ; , while betazole histamine analog ; is used to stimulate gastric acid secretion for diagnosis of hypochlorhydria. Anti-histamines are widely used as competitive antagonists2 of histamine receptors. They do not prevent histamine release. However, Disodium cromoglycate cromolyn sodium ; does. It is used prophylactically by asthmatics human medicine ; because it inhibits the degranulation and release by mast cells of histamine and slow-reacting substance of anaphylaxis SRS-A ; , two potent bronchoconstrictors that mediate asthmatic attacks caused by allergens. At the present time cromolyn sodium is available only as a fine powder for inhalation. Its utility in veterinary medicine remains exploratory; however, doses of 80 to 200 mg given by inhalation seem useful in the management of airway inflammation in horses ; . Nedocromil is another stabilizer of mast cells used in horses. H1 receptor antagonists: Antihistamines that act against H1 receptors are lipid soluble and cross the blood-brain barrier. They are used to antagonize histamine action on bronchial, intestinal contractility ; , uterine, and vascular smooth muscles. They only partially antagonize histamine-induced hypotension. They are partially effective to block allergic reactions edema, urticaria, itch they are ineffective in case of anaphylaxis. Because they can cross the blood-brain barrier they are also used to treat motion sickness they block H1 receptors in the vestibular apparatus and the emetic center ; . H1 antihistamines are absorbed per os, except in ruminants. Following per os absorption, their onset of action takes 20-45 minutes and their duration of action lasts 3-12 hours. IM injection is also commonly used; however, H1 antihistamines are not usually given IV because of the risk associated with CNS stimulation. Clinical use: H1 antihistamines are mainly used to treat dermal and respiratory allergies. Dyphenhydramine Benadryl ; , Caladryl, can be used for dermal application. They are also used to prevent motion sickness e.g., Benadryl, dimenhydrinate, Dramamine, promethazine, Phenergan ; . These drugs have fewer side effects than scopolamine cholinergic antagonist ; . They have also some effect against vertigo. Side effects: Antihistamines induce sedation at lower doses while at higher doses they induce irritability, convulsions, hyperpyrexia and possibly death. Their anticholinergic effect is associated with papillary dilatation, dry mouth, blurred vision and tachycardia. They are terratogenic and periactin.

Scribed in detail in Anderson et al. 1972a ; . Following saturation analysis by [3H] -estradiol exchange, nuclear pellets were washed with TE buffer to remove free hormone, extracted with ethanol, and the extracts counted by liquid scintillation spectrometry to determine the quantity of [3 H ; -estradiol bound. Specific. Induction, which occurred during initial programming and resolved immediately on discontinuing stimulation 1 patient ; or by the induction of bothersome parasthesiae 4 patients ; . The stimulators were then programmed, choosing the widest electrode contact separation to facilitate the largest possible area for current spread. The settings are presented in Table 1. The stimulators were left at these settings and remained on 24 hours per day. All patients had a decline in their motor scores at 3- to 6-month follow-up evaluations Table 2 ; . The UPDRS motor subscore worsened by 25.6% 95% confidence interval, 58.7 to 7.5; P .06 ; , and the activities of daily living subscore worsened by 9.7% 95% confidence interval, 32.3 to 13.0; P .37 ; . Two patients underwent evaluation after 12-hour medication withdrawal and then again following their usual morning dose of antiparkinsonian medications. There were no significant differences in their motor scores with or without medications. Despite objective worsening over time and no deterioration when stimulation was immediately turned off, 3 patients still claimed subjective benefit Table 2 ; and requested continued stimulation. No patients experienced adverse effects from the surgery or long-term stimulation. Three patients died 6, 9, and 24 months after the completion of the study from disease-related respiratory complications 2 ; and after a urinary tract infection 1 ; . These patients had continuous stimulation until the time of death. No autopsies were performed and entocort.

What lessons can we learn? The rise and fall of the coxibs provides a salutary reminder that drug safety cannot be taken for granted. Premarketing clinical trials involve too few patients to provide a reliable estimate of the possible risk of uncommon but serious adverse events particularly when those events are relatively frequent, as is the case with myocardial infarction26. Only long-term use can provide the necessary clinical experience in large numbers of patients, including groups with comorbidities who are more vulnerable27. 6.

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For symptomatic patient with: Organophosphate poisoning: Atropine 1 mg IV per dose every 3 5 minutes, until secretions dry Dystonic reaction: Diphenhydramine Benadryl ; 1.0 mg kg IV or IM. Beta blocker OD: Glucagon 1 mg IV Sympathomimetic ingestion cocaine or amphetamines ; : Midazolam Versed ; 0.1 mg kg IV or IM Calcium channel blocker OD: Calcium Chloride 1 gram IV, or Glucagon 1 mg IV.

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Participated in the rally. The messages given `Stop AIDS Keep Promise' `Stops AIDS promise a second chance of life' in decorated IEC Van. The rally was flagged up by Mr. Vishnu Charan Patra, OIC, J. K. pur. He enlightened the participants on the causes of the problem. In this occasion pictorial billboard and stall were displayed and were inaugurated by Dr. B.D. Nayak, ADMO. At the same time a signature campaign was arranged in a 20 meter length cloth and about 500 people gave their views repeating the slogan "KNOW AIDS for NO AIDS". A cricket tournament was also organized by Logan Youth Club with participation of 18 teams entertaining about 2000 audiences. Is assistant professor and assistant residency director in the department of family medicine at the university of maryland school of medicine, baltimore. Rosemary essential oil will clear your airways, just sniff the bottle or put onto hanky and sniff as required and buy phenergan. The day of the reinfusion, better known as the transplant day or day 0, is looked forward to with excitement and sometimes, anxiety. The reinfusion process, however, is very simple and relatively short. Many patients compare the reinfusion of stem cells and or bone marrow to receiving a blood or platelet transfusion. The day of the reinfusion is thought of as a type of birthday. In follow-up visits with the doctor or nurse, this date will be referred to frequently. The stem cells and or bone marrow previously collected from you or your donor have been frozen in special blood bags since the collection. Depending on the number of bags you have to be reinfused, intravenous fluids may or may not be started prior to the procedure. The amount of bags to be reinfused is not directly proportional to the amount of cells which will be reinfused. Your doctor will determine the appropriate amount of cells to be reinfused. The staff nurse will administer premedications e.g., Tylenol, Benadryl ; to you about thirty minutes prior to the actual reinfusion. These pre-medications are given to prevent complications during the reinfusion, such as an allergic reaction, and may make you feel sleepy. At the time of the reinfusion, an advanced practice nurse or a specially trained staff nurse ; will connect you to a small machine that monitors your blood pressure, heart rate, and oxygen level every 15 minutes. In addition, your temperature and respirations will be checked every 15 minutes. A technologist will bring the collected stem cells and or bone marrow to your room where they will be thawed. Once thawed, the stem cells and or bone marrow will be infused through your intravenous catheter. This is a painless procedure. The entire procedure generally lasts 15-30 minutes, although it could take up to 3 hours depending on the number of bags you have for reinfusion. Your vital signs temperature, respirations, pulse, blood pressure ; will be monitored every 15 minutes during the procedure and for one hour after the completion of the reinfusion. Some possible side effects of the reinfusion include: 1. Pink- to red-tinged urine for up to 24 hours this is unlikely if the stem cells and or bone marrow have gone through a special selection process ; . 2. Fever 3. Chills 4. Allergic reactions due to the DMSO used to preserve the stem cells and or bone marrow after collection ; . Allergic reactions may include itching, hives, swelling, facial flushing, and shortness of breath. Emergency medications are kept at your bedside and are used immediately if an allergic. 94 Poisonings until sodium nitrite is administered. Use new amp q3min AND -Sodium nitrite 0.33 ml kg of 3% inj soln max 10 ml ; IV over 5 minutes. Repeat dose 30 min later if inadequate clinical response. Followed By: -Sodium thiosulfate 1.65 ml kg of 25% soln max 50 ml ; IV. Phenothiazine Reaction Extrapyramidal Reaction ; : -Diphenhydramine Benadryl ; 1 mg kg IV IM q6h x 4 doses max 50 mg dose ; followed by 5 mg kg day PO q6h for 2-3 days. Digoxin Overdose: -Digibind Digoxin immune Fab ; . Dose # vials ; digoxin level in ng ml x body wt kg ; 100 OR Dose # of vials ; mg of digoxin ingested divided by 0.6 Benzodiazepine Overdose: -Flumazenil Romazicon ; 0.01 mg kg IV max 0.5 mg ; . Repeat dose if symptoms return. Alcohol Overdose: Cardiorespiratory support -Labs: Blood glucose; CBC, ABG, rapid toxicology screen. -Treatment: Dextrose 0.5-1 gm kg 2-4 ml kg D25W or 5-10 ml kg D10W ; , max 25 gm. -Naloxone Narcan ; 0.1 mg kg max 2 mg ; IV, repeat q2min prn to max dose 8 10 mg if drug overdose suspected. For extreme agitation, give diazepam 0.1 0.5 mg kg IV max 5 mg if 5 yrs, 10 mg if yrs ; . Organophosphate Toxicity -Atropine: 0.01-0.02 mg kg dose minimum dose 0.1mg, maximum dose 0.5 mg in children and 1 mg in adolescents ; IM IV SC. May repeat prn. -Pralidoxime 2-PAM ; : 20-50 mg kg dose IM IV. Repeat in 1-2 hrs if muscle weakness has not been relieved, then at 10-12 hr intervals if cholinergic signs recur. Anticholinergic Toxicity -Physostigmine Antilirium ; : 0.01-0.03 mg kg dose IV; may repeat after 15-20 minutes to a maximum total dose of 2 mg. Heparin Overdose -Protamine sulfate dosage is determined by the most recent dosage of heparin and the time elapsed since the overdose. In such situations, the risk of treatment should be considered in relation to possible benefit, and clinical monitoring is recommended. If a patient has previously experienced a muscle disorder on a fibrate or a statin, treatment with a different member of the class should only be initiated with caution. If CK levels are significantly elevated at baseline 5 x ULN ; , treatment should not be started. Whilst on treatment If muscle pain, weakness or cramps occur whilst a patient is receiving treatment with a statin, their CK levels should be measured. If these levels are found, in the absence of strenuous exercise, to be significantly elevated 5 x ULN ; , treatment should be stopped. If muscular symptoms are severe and cause daily discomfort, even if CK levels are 5 x ULN, treatment discontinuation may be considered. If myopathy is suspected for any other reason, treatment should be discontinued. During your pregnancy, we will ask you to meet each physician since your baby will be delivered by the doctor on call when your labor will occur. 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S pet owners we assume that pets can use human OTC products. However we need to be very cautious about OTC medication use for our pets. For instance Tylenol or acetaminophen can never be given to cats. Cats cannot metabolize acetaminophen because they are deficient an enzyme that metabolizes the Tylenol. This deficiency can lead to liver necrosis and then death. Therefore even small amounts can be lethal to cats. Signs and symptoms of clinical toxicity include vomiting, hyperventilation, weakness, rapid heartbeat, swelling in paws or face, and low body temperature. Aspirin use is also not recommended in cats because they cannot metabolize aspirin and this can lead to over-dosing. Lower doses did not show clinical toxicity. However, regular strength aspirin which is 325mg can be toxic for cats. Signs and symptoms of aspirin toxicity include fever, depression, and seizures. Dogs tolerate Tylenol and aspirin better than cats. However, dogs are more susceptible to gastrointestinal side effects with prolonged use of aspirin. These side effects can lead to a gastric ulcer. Therefore it is important to be cautious when giving dogs aspirin. I strongly recommend consulting with your veterinarian before giving your dog aspirin. Antihistamines like Benadryl diphenhydramine ; and ChlorTrimeton Chlorpheniramine ; can be used to treat allergic reactions for pets. These products can also be used for sedation. It is okay to use these medications by themselves. Pet owners, however, need to be cautious about combination products which often contain Tylenol and aspirin. A lot of over the counter cold and allergy medications containing diphenhydramine and chlorpheniramine also contain Tylenol and aspirin. Always check for active ingredients in these products. Dosing recommendations for cats and dogs with antihistamines are a lot lower than human dosing. Therefore it is imperative to check with your veterinarian about the appropriate dose for your dog or cat.

Undoubtedly, it is the most serious and frequent infection caused by catarrhalis in children, and as such catarrhalis causes tremendous morbidity and requires the widespread use of antibiotics 20 , 58 , 88 , 136 , 137 , 230.

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