By C. Folleck. California State University, Monterey.
Its elimination half-life averages 25 hours in not be used in conjunction with ophthalmic cortico- young adults and 32 hours in the elderly 5 ml fml forte otc. Less than 25% steroids, since these drugs increase the spread of HSV of the dose is excreted in the urine as unchanged drug; infection and may produce side effects such as in- the remainder is eliminated as hydroxylated or conju- creased intraocular pressure, glaucoma, and cataracts. Clinical Uses ANTIINFLUENZA AGENTS Amantadine and rimantadine are used for the treat- Inﬂuenza is responsible for several thousand deaths ment of diseases caused by inﬂuenza A strains. Individuals over the age of 65, residents of these agents are administered within 48 hours of the on- long-term care facilities, and patients with long-term set of symptoms, they reduce the duration of fever and health problems (i. Yearly vac- to suggest that treatment with these drugs will prevent 576 VI CHEMOTHERAPY the development of inﬂuenza A virus pneumonitis or Oseltamivir other complications in high-risk patients. However, when vaccination aminidase, like hemagglutinin, is a viral surface glyco- is contraindicated or early vaccination is not possible, protein that interacts with host cell receptors containing amantadine and rimantadine are effective prophylactic terminal neuraminic acid residues. The binding of agents that have been shown to protect approximately hemagglutinin to its cellular receptors initiates viral 70 to 90% of patients from inﬂuenza A infection. Since penetration and promotes the fusion of the viral enve- these drugs do not prevent the host immune response to lope to the plasma membrane. Neuraminidase then de- inﬂuenza A, they may be used to prevent infection during stroys these hemagglutinin receptors by breaking the the 2- to 4-week period required to develop immunity bond between the terminal neuraminic acid residue and following vaccination. It also facilitates the spread of infection by allowing viral particles to penetrate the Adverse Effects, Contraindications, neuraminic acid–rich respiratory mucus and by pre- and Drug Interactions venting the clumping of virus that results from the bind- ing of hemagglutinins to neuraminic acid residues on The most frequently reported side effects of amanta- neighboring viral particles. Inhibition of neuraminidase dine and rimantadine are nausea, anorexia, dizziness, activity prevents the release of progeny virus and inhibits and insomnia. High doses of Inﬂuenza virus resistant to oseltamivir has not been amantadine may produce cardiac arrhythmias, delirium, found in naturally acquired isolates but has been iso- hallucinations, and suicidal ideation; long-term treat- lated from inﬂuenza patients who have undergone ment may cause peripheral edema, orthostatic hypoten- treatment with this drug. Abrupt with- mutations in the active site of neuraminidase and are drawal of amantadine may produce a neuroleptic generally less virulent and infective than nonresistant malignant syndrome. Animal studies of oseltamivir carboxylate can produce mutations in have shown that amantadine is teratogenic and riman- hemagglutinin that decrease the overall dependence of tadine may be embryotoxic. Individuals with congestive heart failure, edema, orthostatic hypotension, seizure disorders, or uncontrolled psychosis should be closely monitored Absorption, Metabolism, and Excretion during therapy with amantadine.
Any study of a disease usually includes some indication of incidence buy fml forte 5 ml without prescription, which means its a given disease is found to a lesser extent but continu- range of occurrence and its tendency to affect certain groups ously in a particular region, the disease is endemic to that of individuals more than other groups. A disease that is prevalent throughout an entire appear in one gender, age group, or race more or less fre- country or continent, or the whole world, is said to be quently than another is usually included in any study on dis- pandemic. Box 5-1 A Closer Look The CDC: Making People Safer and HealthierThe CDC: Making People Safer and Healthier he Centers for Disease Control and Prevention (CDC) in polio, which has virtually been eliminated in the United States. TAtlanta, Georgia, are responsible for protecting and im- In the 1960s the CDC joined the World Health Organization in proving the health of the American public—at home and efforts to eradicate smallpox worldwide, and in the 1970s, it abroad. During the 1990s, CDC researchers rapidly identified works to protect the public from environmental hazards such the strain of hantavirus that caused a serious and often fatal as waterborne illnesses, weather emergencies, biologic and pulmonary disease in people in the Southwestern U. National Institutes of Health (NIH) has es- To treat a patient, a physician must first make a diagnosis tablished the National Center for Complementary and Al- (di-ag-NO-sis), that is, reach a conclusion as to the nature ternative Medicine (NCCAM) to study the value of these of the illness. A characteristic typically they are measured, purified, and often modified group of symptoms and signs that accompanies a disease is instead of being used in their natural state. Some complex disorders purity, safety, dosage, and effectiveness have arisen in the even have “syndrome” in their names, such as Down syn- use of herbal remedies as, to date, they have not been drome, premenstrual syndrome, acquired immunodefi- tested as rigorously as conventional drugs. Common methods used for diagnosis however, restrictions on the health claims that can be include imaging studies, blood tests, and study of tissues re- made by the manufacturers, and the Federal Drug Admin- moved in biopsy. Nurses and other healthcare professionals play an ex- tremely valuable role in the diagnostic process by observ- Prevention of Disease ing closely for signs, collecting and organizing informa- In recent years, physicians, nurses, and other healthcare tion from the patient about his or her symptoms, and then workers have taken on increasing responsibilities in pre- reporting this information to the physician. The modern concept of prevention, however, include drugs, surgery, radiation, counseling, physical or seeks to stop disease before it actually happens—to keep occupational therapy, and many others, alone or in com- people well through the promotion of health. Specific measures in a course of treatment in- provement include cessation of smoking, improved diet, clude those carried out by the nurse and other healthcare weight control, and adequate exercise. An insect or other animal that transmits a mans, and many are beneficial, a few types cause illness; disease-causing organism from one host to another is that is, they are pathogenic (path-o-JEN-ic). For example, people with depressed ample, discharges from the respiratory and intestinal tracts immune systems, such as those with AIDS become infected may spread infection through air, by contamination of hands, with organisms that are ordinarily harmless. In close quarters, germ-laden droplets discharged by Box 5-2 • Health Maintenance The Cold Facts about the Common ColdThe Cold Facts about the Common Cold very year, an estimated one billion Americans suffer from temperature and humidity, these particles may live as long as Ethe symptoms of the common cold—runny nose, sneez- 3 to 6 hours, and others who touch the contaminated surface ing, coughing, and headache.