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Treatment is generally initiated with the lowest dose that effectively provides contraceptive protection blood pressure jumps from low to high purchase 5 mg lisinopril with amex. This reduction has resulted in a significant decrease in estrogen-related adverse effects pulse pressure heart failure buy cheap lisinopril. Although the placebo serves no pharmacologic purpose blood pressure log sheet printable buy lisinopril no prescription, it does encourage the patient to take the pills on a daily basis arrhythmia upon exertion order lisinopril with american express. Some of these placebos contain iron, which replaces iron lost due to menstrual bleeding. If one dose is missed, taking two pills the following day usually provides for continuous contraception. If two consecutive doses are missed, two tablets should be taken on both the day the missed doses are remembered and the following day. The regular schedule should then be continued, but a second method of contraception should be used for at least 7 days after restarting the pills. The estrogen-progestin agents also make the uterine endometrium less favorable to receiving an embryo, thus reducing the likelihood of implantation. In addition, the hormones promote the formation of a thick cervical mucus that slows sperm transport and inhibits the process that allows sperm to penetrate the ovum. From what you learned in Chapter 72, name this class of drugs and explain how they are used to increase fertility. In biphasic agents, the amount of estrogen in each pill remains constant, but the amount of progestin is increased toward the end of the treatment cycle to better nourish the uterine lining. In triphasic formulations, the amounts of both estrogen and progestin vary in three distinct phases during the treatment cycle. Natazia contains a synthetic estrogen called estradiol valerate and a progestin called dienogest; this is the first time this specific combination has been used. The manufacturer claims that this four-phase combination more closely resembles the natural monthly hormonal variation. Some women can conceive in the first month, whereas others experience a delay for up to a year before fertility is restored. Several approaches are feasible, including suppressing or halting sperm production, or blocking or inhibiting sperm function. Large-scale clinical trials and comparative studies among different ethnic groups are still needed for these drugs. Other approaches include the use of nonhormonal natural compounds such as gossypol, a substance found in cotton seeds, and drugs that affect sperm motility based on calcium ion channel disruption. Therapeutic Effects and Uses: the primary use of OrthoNovum is to prevent conception, for which it is nearly 100% effective. Off-label indications for the drug include acne vulgaris (in females who have achieved menarche), endometriosis, hypermenorrhea, dysfunctional uterine bleeding, and hirsutism related to hyposecretion of estrogen or oversecretion of androgens. Noncontraceptive benefits of Ortho-Novum include improvement in menstrual cycle regularity and decreased incidence of dysmenorrhea. Seasonale consists of tablets containing levonorgestrel and ethinyl estradiol that are taken for 84 consecutive days, followed by seven placebo tablets (without hormones). This allows for continuous contraceptive protection while extending the time between menses; only four periods are experienced per year. Seasonique is similar, but instead of inert tablets for 7 days, the patient takes low-dose estrogen tablets. Seasonique, which was approved in 2006, is claimed by the manufacturer to have a lower incidence of bloating and breakthrough bleeding. In 2008, a lower dose formulation of Seasonique, called LoSeasonique, was marketed. Less common serious adverse effects include edema, unexplained loss of vision, diplopia, intolerance to contact lenses, gallbladder disease, nausea, abdominal cramps, changes in urinary function, dysmenorrhea, breast fullness, fatigue, skin rash, acne, headache, vaginal candidiasis, photosensitivity, and changes in urinary patterns. The estrogen component of the pill can lead to venous and arterial thrombosis, which results in pulmonary, myocardial, and thrombotic strokes. This risk increases markedly with age (over age 35) and with heavy smoking (more than 15 cigarettes per day). Lifespan and Diversity Considerations: Monitor women with preexisting liver conditions more frequently to ensure optimal therapeutic effects and minimize adverse effects. Patient and Family Education: Limit caffeine intake because estrogen depresses caffeine metabolism. It is likely that the relationship between the long-term use of these drugs and cancer will continue to be a controversial and frequently researched topic. Obesity is a risk factor for treatment failure and for increased possibilities of thromboembolic events. They prevent pregnancy primarily by causing a thick, viscous cervical mucus at the entrance to the uterus that discourages sperm penetration. Minipills are somewhat less effective than estrogen-progestin combinations, having a failure rate of 1% to 4%. Their use also results in a higher incidence of irregular menstrual cycles, including amenorrhea, prolonged bleeding, or breakthrough spotting. Unlike estrogens, progestins are not associated with a higher risk of thromboembolic events, and they do not have any effect on breast cancer. In addition to contraception, norethindrone therapy is approved to treat amenorrhea, dysfunctional uterine bleeding, and endometriosis. Detailed information on the contraindications, drug interactions, and adverse effects of progestins are included in Chapter 72, along with a prototype feature for medroxyprogesterone (Provera). Assessment throughout administration: Potential Nursing Diagnoses Decisional Conflict Disturbed Body Image Deficient Knowledge (Drug Therapy) Risk of Excess Fluid Volume, related to adverse drug effects Risk for Ineffective Peripheral Tissue Perfusion, related to adverse drug effects Risk for Ineffective Cerebral Tissue Perfusion, related to adverse drug effects Risk for Decreased Cardiac Tissue Perfusion, related to adverse drug effects Assess for desired therapeutic effects dependent on the reason the drug is given. Do not omit, increase, or decrease doses without consulting the health care provider.
They are effective against some species that are resistant to penicillins and other cell wall inhibitors blood pressure medication lipitor purchase on line lisinopril. Because of widespread bacterial resistance arteria jugularis interna buy 10mg lisinopril with amex, however blood pressure medication used to stop contractions lisinopril 10mg for sale, they are the drugs of choice for only a few diseases: Rocky Mountain spotted fever heart attack like symptoms cheap 10 mg lisinopril otc, typhus, cholera, Lyme disease, peptic ulcers caused by Helicobacter pylori, and chlamydial infections. In addition, Treponema pallidum (syphilis) responds well to tetracycline therapy for patients who are allergic to penicillin. Although traditionally used for gonorrhea, most strains of Neisseria gonorrhoeae are now resistant to tetracyclines. Once resistance develops to one tetracycline, it usually extends to all drugs in this class. Tetracyclines exert a bacteriostatic effect by selectively inhibiting bacterial protein synthesis. Resistance to tetracyclines develops when bacteria prevent tetracyclines from concentrating inside their cells, or when their ribosome shape is altered so the antibiotic can no longer bind. In addition to having ribosomes with different structures, human cells lack the active transport system required for tetracyclines to enter their cells. All tetracyclines have the same spectrum of antimicrobial activity and similar adverse effects. Photosensitivity is a relatively common adverse reaction to some medications, especially antibiotics. Nurses should counsel patients on the risk of medication-induced photosensitivity and ways to avoid this problem. However, this medication-induced adverse effect can present in two categories: phototoxicity and photoallergic reactions. The more common of the two conditions is phototoxicity, which encompasses both sunburn and reactions caused by chemical photosensitizers such as medications. Both reactions are typically manifested by delayed redness and edema followed by hyperpigmentation. These reactions present as variations of contact dermatitis and are the result of hypersensitivity. In photoallergic reactions, the drug forms an immunogenic complex with cutaneous proteins due to the presence of light energy. Nurses should educate patients about various methods to protect the skin from damage and severe reactions to the sun. The proper use of protective clothing and sunscreens and restrictions on the amount of time spent in direct sunlight are needed to avoid these problems. They are sometimes classified by their duration of action as short acting, intermediate acting, or long acting. Because gastric distress is relatively common with drugs in this class, patients will often take tetracyclines with food. However, these drugs bind metal ions such as calcium and iron, and tetracyclines should not be taken with milk or iron supplements. Food does not interfere with absorption of the longer acting drugs doxycycline and minocycline. Tetracycline-induced diarrhea is common and could indicate toxic effects on normal flora or a bowel superinfection. Caused by Clostridium difficile, this is a rare though potentially severe disorder resulting from therapy with tetracyclines and other classes of antibiotics. When administered parenterally or in high doses, certain tetracyclines can cause hepatotoxicity, especially in patients with preexisting liver disease. Some patients experience photosensitivity during therapy, making their skin especially susceptible to sunburn. Photosensitivity may appear as exaggerated sunburn within minutes to hours of exposure and is often accompanied by a tingling, burning sensation. Because of their broad spectrum, superinfections due to Candida albicans are relatively common. Women who are on oral contraceptives may be more susceptible to vaginal candidiasis. Tetracyclines are usually contraindicated in pregnant or lactating women and in children under the age of 8 because these drugs cause yellow-brown teeth discoloration and may slow the overall growth rate in fetuses or children. Oral and topical preparations are available for treating inflammatory acne vulgaris. The growing amino acid chain is prematurely terminated and protein synthesis is inhibited. Tetracycline is usually considered bacteriostatic, although it can be bacteriocidal at high concentrations. Other frequent adverse effects include nausea, vomiting, epigastric burning, diarrhea, discoloration of the teeth, and photosensitivity. Serious adverse reactions include anaphylaxis; fatty degeneration of the liver, producing jaundice; and exfoliative dermatitis. Although not nephrotoxic, tetracycline can worsen kidney impairment in patients with preexisting disease. As a pregnancy category D agent, tetracycline should not be used during pregnancy. Drug therapy must be monitored carefully in patients with impaired hepatic or renal function, because this drug is excreted by these routes. Drug Interactions: Calcium or iron supplements, magnesiumcontaining laxatives, and antacids reduce the absorption and serum levels of oral tetracycline.
Anaphylactic response may include cardiovascular collapse; edema of the mouth blood pressure medication memory loss purchase 2.5mg lisinopril fast delivery, tongue hypertension heart disease order 5mg lisinopril mastercard, pharynx blood pressure yahoo health cheapest lisinopril, and larynx; confusion; seizures; and hallucinations hypertension frequent urination buy lisinopril 10 mg low price. Seizures are a rare, though potentially serious, adverse effect of cephalosporin therapy. Immediately report severe or persistent diarrhea accompanied by fever to the health care provider. Drugs Similar to Cefazolin (Ancef, Kefzol) First generation: Other first-generation cephalosporins include cefadroxil (Duricef) and cephalexin (Keflex). These drugs are administered parenterally and have the same spectrum of microbial activity. They have the same basic indications (primarily gram-positive bacteria) and are eliminated by the kidneys. Second generation: Second-generation cephalosporins include cefaclor (Ceclor), cefotetan (Cefotan), cefoxitin (Mefoxin), cefprozil (Cefzil), and cefuroxime (Ceftin, Zinacef). All have the same spectrum of microbial activity and there is little difference among the drugs other than the route of administration (see Table 50. Third generation: Third-generation cephalosporins are the largest group and include cefdinir (Omnicef), cefditoren (Spectracef), cefixime (Suprax), cefotaxime (Claforan), cefpodoxime (Vantin), ceftazidime (Fortaz, Tazicef), ceftibuten (Cedax), ceftizoxime (Cefizox), and ceftriaxone (Rocephin). Ceftazidime is one of the few third-generation drugs with significant activity against P. Cefotaxime is a preferred drug for certain types of meningitis and for infection prophylaxis in patients who are undergoing surgical procedures. It has been used for the treatment of serious infections in hospitalized patients with gram-positive microorganisms such as Enterobacteriaceae, and Pseudomonas. Contraindications/Precautions: Cefazolin is contraindicated in patients who are allergic to any drug in the cephalosporin class and is used cautiously in those with hypersensitivity to penicillins. Because most cefazolin is excreted unchanged by the kidneys, patients with significant renal impairment must be carefully monitored. Drug Interactions: Probenecid decreases the excretion of cefazolin and can lead to antibiotic toxicity. Concurrent use of cefazolin with nephrotoxic drugs, such as aminoglycosides or vancomycin, increases the risk of nephrotoxicity. Cefazolin may have additive or synergistic antimicrobial action with other antibiotics such as aztreonam, carbapenems, and the penicillins. The anticoagulant effect of warfarin may be increased if given concurrently with cefazolin. Patient and Family Education: Consult the health care provider or pharmacist before drinking alcoholic beverages. Assessment throughout administration: Potential Nursing Diagnoses Acute Pain Hyperthermia Deficient Knowledge (Drug Therapy) Risk for Injury, related to adverse drug effects Risk for Deficient Fluid Volume, related to fever and/or diarrhea caused by adverse drug effects Assess for desired therapeutic effects. Severe diarrhea, especially containing mucus, blood, or pus, yellowing of the sclera or skin, decreased urine output, or darkened urine should be reported immediately. The provider should be notified if fever and signs and symptoms of infection remain or increase after 3 days or if the entire course of antibacterial has been taken and signs of infection are still present. Minimizing adverse effects: Continue to monitor vital signs, especially temperature if fever is present. Post-use, residual drug levels, dependent on length of half-life, may cause delayed reactions. Report any significantly large area of reddening such as trunk, head, neck, limbs, or gluteal area, especially if associated with decreased blood pressure or tachycardia. If a significant area is involved, vasodilation from histamine may cause hypotension and reflex tachycardia. Do not share with other family members, and do not stop the medicine when starting to feel better. Symptoms include watery diarrhea with up to 5 to 10 or more occurrences per day, abdominal cramping, fever, blood and mucus in the stool, and dehydration. Although the penicillins and cephalosporins comprise the largest groups of drugs affecting the bacterial cell wall, several other antibacterials also act by this mechanism. These drugs are bacteriocidal and have some of the broadest antimicrobial spectrums of any class of antibiotics. They contain a betalactam ring and kill bacteria by inhibiting construction of the cell wall. Though similar, the ring in carbapenems has a slightly different structure than other beta-lactam antibiotics that makes it very resistant to destruction by beta lactamase. These factors allow the carbapenems to provide better activity against serious gram-negative and multidrug-resistant infections than most cephalosporins or penicillins. Diarrhea, nausea, rashes, and thrombophlebitis at injection sites are the most common adverse effects. Imipenem has a very broad antimicrobial spectrum and is the most widely used carbapenem. Because of its broad spectrum and beta-lactamase resistance, it is effective against most gram-positive and gram-negative microbes, including anaerobic bacteria. It is particularly useful for mixed infections containing both aerobic and anaerobic organisms, including those with S. Although imipenem contains a beta-lactam ring, it is resistant to the actions of beta lactamase. This drug, however, is rapidly destroyed by dipeptidase, an enzyme found in the kidney tubules. Concurrent administration of the drug cilastatin, a renal dipeptidase inhibitor, with imipenem prevents the destruction of imipenem and allows for higher serum levels of the antibiotic.
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