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By U. Darmok. Baldwin-Wallace College. 2017.

Drugs that decrease effects of cholinergic and anticho- linesterase ophthalmic drugs: (1) Anticholinergics and drugs with anticholinergic effects Antagonize antiglaucoma (miotic) effects of cholinergic and anti- (eg 5ml betoptic amex, atropine, antipsychotic agents, tricyclic antidepres- cholinesterase drugs sants, some antihistamines) (2) Corticosteroids Long-term use of corticosteroids, topically or systemically, raises IOP and may cause glaucoma. Therefore, corticosteroids decrease effects of all drugs used for glaucoma. What are important principles and techniques related to Answer: Start by assessing what Mrs. For a client with newly prescribed eye drops, how would Review and write down the order for eye drops. If so, watch her demonstrate this procedure, reinforcing proper technique (tilt head SELECTED REFERENCES back, pull down lower lid, drop medication into sac, close eyes, Alexander, C. Good aseptic technique should be stressed treatment of glaucoma and ocular hypertension. The Annals of Pharma- (wash hands, keep container clean, do not let dropper touch eye). Chloromycetin is used to treat infection that may have been pres- Gourley (Eds. Teach clients, family members, or care- influence drug therapy of dermatologic givers correct administration of dermatologic disorders. For clients with open lesion skin disorders, selected miscellaneous drugs in relation to teach about the importance and techniques of their use in dermatologic disorders. Critical Thinking Scenario Fifteen-year-old Shawn Kelly stops by to talk when you are working in the teen clinic. For the last 6 months, he has had a severe problem with acne and his face is currently spotted with pimples and pustules. OVERVIEW yellow, brown, or black skin coloring in response to genetic influences, melanocyte-stimulating hormone released from The skin, the largest body organ, is the interface between the anterior pituitary gland, and exposure to ultraviolet (UV) the internal and external environments. Epidermal or epithelial The dermis is composed of elastic and fibrous connective tis- cells begin in the basal layer of the epidermis and migrate sue. Dermal structures include blood vessels, lymphatic chan- outward, undergoing degenerative changes in each layer. The dead cells are constantly being subcutaneous tissue, which is composed primarily of fat cells.

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These include drugs that block drugs buy discount betoptic 5 ml line, there is increased risk of bleeding with ticlopidine. It is indicated for reduction of myocardial in- farction, stroke, and vascular death in clients with atheroscle- rosis and reportedly causes fewer or less severe adverse Thromboxane A2 Inhibitors effects than ticlopidine. Aspirin is a commonly used analgesic–antipyretic–anti- inflammatory drug (see Chap. Aspirin exerts pharmacologic actions by inhibiting synthesis of prostaglandins. In this instance, aspirin acetylates Abciximab is a monoclonal antibody that prevents the bind- cyclooxygenase, the enzyme in platelets that normally synthe- ing of fibrinogen, von Willebrand factor, and other molecules sizes thromboxane A2, a prostaglandin product that causes to GP IIb/IIIa receptors on activated platelets. A single dose of 300 to 600 mg nary angioplasty or removal of atherosclerotic plaque to pre- or multiple doses of 30 mg (eg, daily for several days) inhibit vent rethrombosis of treated arteries. It is used with aspirin the cyclooxygenase in circulating platelets almost completely. Aspirin may be used long term for prevention contraindications include active bleeding, thrombocytopenia, of myocardial infarction or stroke, and in clients with pros- history of a serious stroke, surgery or major trauma within the thetic heart valves. It is also used for the immediate treatment previous 6 weeks, uncontrolled hypertension, or hypersensi- of suspected or actual acute myocardial infarction, for transient tivity to drug components. Ad- Eptifibatide and tirofiban inhibit platelet aggregation by verse effects are uncommon with the small doses used for preventing activation of GP IIb/IIIa receptors on the platelet antiplatelet effects. However, there is an increased risk of surface and the subsequent binding of fibrinogen and von bleeding, including hemorrhagic stroke. Antiplatelet effects occur dur- mately 85% of strokes are thrombotic, the benefits of aspirin ing drug infusion and stop when the drug is stopped. The or other antiplatelet agents are thought to outweigh the risks of drugs are indicated for acute coronary syndrome (eg, unsta- hemorrhagic strokes (approximately 15%). Their antiplatelet effects subside and 2 hours for tirofiban; the drugs are cleared mainly by when the drugs are eliminated from the circulation and the renal excretion. With tirofiban, plasma clearance is approxi- 840 SECTION 9 DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM mately 25% lower in older adults and approximately 50% boembolism after cardiac valve replacement and is given lower in clients with severe renal impairment (creatinine with warfarin.

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Neurologic changes due to impaired con- beats or atrioventricular block may occur betoptic 5 ml discount, drugs, renal disease, excessive duction of nerve impulses usually in people taking digoxin. Movement of potassium out of serum and cardiac muscle, most likely with 3. Confusion, memory impairment, lethargy, tration of insulin and glucose in treat- impulses are slowed until muscle con- apathy, drowsiness, irritability, delirium ment of diabetic ketoacidosis and in traction cannot occur. Slowed gastric emptying and decreased Weakness of leg muscles usually occurs intestinal motility, probably caused by first. Then weakness ascends to include muscle weakness respiratory muscles and cause respira- 7. Abdominal distention, constipation, para- glomerular filtration rate with prolonged lytic ileus potassium deficiency. Impaired carbohydrate metabolism and deficiency may increase serum creatinine decreased secretion of insulin and blood urea nitrogen 8. Impaired excretion due to renal insuffi- and muscle contraction respiratory insufficiency ciency, oliguria, potassium-saving diuret- 3. Cardiotoxicity, with arrhythmias or ics, aldosterone deficiency, or kalemia anesthetizes nerve and mus- cardiac arrest. Cardiac effects are not adrenocortical deficiency cle cells so electrical current cannot be usually severe until serum levels are 3. ECG changes include food sources of potassium include potas- tion) for an electrical impulse to be initi- a high, peaked T wave, prolonged P-R sium supplements, salt substitutes, ated and conducted. Movement of potassium from cells into serum with burns, crushing injuries, and acidosis ECG, electrocardiogram. Potassium is then eliminated from Alkalinization increases solubility of uric acid and sulfon- the body in the feces. Each gram of resin removes approxi- amide drugs and increases excretion of some acidic drugs mately 1 mEq of potassium. Because the resin requires sev- (eg, salicylates, phenobarbital) when taken in overdose.

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Keller T order 5 ml betoptic with amex, Harrison D, Colloca C, Harri- Ex vivo biomechanical comparison of treatment of vertebral angioma by per- son D, Janik T (2003) Prediction of os- hydroxyapatite and polymethylmeth- cutaneous acrylic vertebroplasty. Spine 28: acrylate cements for use with vertebro- rochirurgie 33:166–168 455–462 plasty. Berlemann U, Ferguson S, Nolte L, of early outcomes of balloon kypho- P, Kaufmann T, Kallmes D (2002) Heini P (2002) Adjacent vertebral fail- plasty. In: Proceedings of the North Unilateral transpedicular percutaneous ure after vertebroplasty. A biome- American Spine Society, Seattle, vertebroplasty: initial experience. Convertino V, Bloomfield S, Greenleaf Kaufmann T, Marx W, Kallmes D teoporosis. Clin Orthop 372:139–150 J (1997) An overview of the issues: (2002) Relevance of antecedent venog- 35. Le Huec J (1998) Evolution of the lo- physiological effects of bed rest and re- raphy in percutaneous vertebroplasty cal calcium content around irradiated stricted physical activity. Med Sci for the treatment of osteoporotic com- beta-tricalcium phosphate ceramic im- Sports Exerc 29:187–190 pression fractures. Lee B, Lee S, Yoo T (2002) Paraplegia Griffith L, Epstein R, Juniper E (1993) Marx W, Kallmes D (2002) The thera- as a complication of percutaneous ver- Quality of life issues in women with peutic benefit of repeat percutaneous tebroplasty with polymethylmethacry- vertebral fractures due to osteoporosis. Am J Epidemiol tebral osteoporotic fractures treated by quality of life component and spinal 137:1001–1005 percutaneous vertebroplasty. Cortet B, Cotten A, Boutry N, Flipo R, tology (Oxford) 39:1410–1414 back pain and women with vertebral Duquesnoy B, Chastanet P, Delcambre 24.

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