This student "cheat sheet" is designed to provide medical students with basic information regarding the diagnosis and treatment of type 2 DM. It includes Questions to Ask, what to look for on a Physical Exam, Labs to Order, and basic Treatment Plans.
These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
General introduction to diabetes mellitusSnigdha Maity
Its very important topic in periodontology as Diabetes Mellitus has high impact on periodontium. So before going into details how it act on periodontium, we have to know what it is and how it is detected in blood. Here is the vast knowledge on diabetes mellitus
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
This student "cheat sheet" is designed to provide medical students with basic information regarding the diagnosis and treatment of type 2 DM. It includes Questions to Ask, what to look for on a Physical Exam, Labs to Order, and basic Treatment Plans.
These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
General introduction to diabetes mellitusSnigdha Maity
Its very important topic in periodontology as Diabetes Mellitus has high impact on periodontium. So before going into details how it act on periodontium, we have to know what it is and how it is detected in blood. Here is the vast knowledge on diabetes mellitus
Definition of diabetes - introduction - classification of diabetes - etiology of diabetes type 1 and type 2- risk factors for diabetes - diagnosis of diabetes - clinical manifestations of diabetes type 1 and type 2- investigations for diabetes - treatment of diabetes - non-pharmacological treatment and pharmacological treatment - pharmacotherapy of type 1 and type 2 - acute complications of diabetes and treatment
COMPLICATIONS, MANAGEMENT AND TREATMENT APPROACH OF DIABETES MELLITUSAnas Indabawa
Diabetes describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Mellitus is Latin for “sweet as honey”.
Pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.
The Pancreas secretes insulin and Glucagon directly into the blood stream.
It also secretes digestive enzymes into the pancreatic duct, which joins the common bile duct from the liver and drains into the small intestine.
Insulin and Glucagon have opposite effects on liver and other tissues for controlling blood-glucose levels.
This student "cheat sheet" is designed to provide medical students with basic information regarding the diagnosis and treatment of type 2 DM. It includes Questions to Ask, what to look for on a Physical Exam, Labs to Order, and basic Treatment Plans.
These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
COMPLICATIONS, MANAGEMENT AND TREATMENT APPROACH OF DIABETES MELLITUSAnas Indabawa
Diabetes describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Mellitus is Latin for “sweet as honey”.
Pancreas is an elongated, tapered gland that is located behind the stomach and secretes digestive enzymes and the hormones insulin and glucagon.
The Pancreas secretes insulin and Glucagon directly into the blood stream.
It also secretes digestive enzymes into the pancreatic duct, which joins the common bile duct from the liver and drains into the small intestine.
Insulin and Glucagon have opposite effects on liver and other tissues for controlling blood-glucose levels.
This student "cheat sheet" is designed to provide medical students with basic information regarding the diagnosis and treatment of type 2 DM. It includes Questions to Ask, what to look for on a Physical Exam, Labs to Order, and basic Treatment Plans.
These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
Presentation about Knowledge and medical and nursing Management , Dm types , clinical features, complications of diabetes mellitus
. King Saud university
Includes Information about Pharmacotherapeutic of Diabetes Mellitus, all details about etiology, Pathophysiology, pharmacology, treatment, current clinical trials on DM etc.
diagnosis & complication of Diabetes mellitus including Diabetic ketoacidosis & HHS
anaesthesia managment for patient with DM posted for surgery both emergency and elective surgery
gestational diabetes mellitus
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
1. Dave Jay S. Manriquez(INP – CHECKOUT)
1. WilliamHonda: Type 2 DiabetesMellitis,Glaucoma,Prostatitis
Allergies:Noknownallergies
Lab Values:FastingGlucose:5 mmol/L(4-7 mmol/L)
Urine C & S: Klebsiellapneumoniaover100 M CFU/L. Patienthaving infection
Type 2 DM
- Adult onset>30 yrs old,non-insulindependent,mostprevalenttype ofDM
- Chronicconditionthataffectsbody’swayof metabolizingglucose
- Body eitherresiststhe effectsofinsulinor doesn’tproduce enoughinsulin to maintain a
normal blood glucose level
- Insulin=a hormone thatregulatesthe movementof sugarintocells
- Symptoms = 3Ps - polyphagia,polydipsia,polyuria,
Fatigue,frequentinfections,areasof darkenedskin,(armpits/neck) =acanthosis
nigricans
- Risk factors = overweight,age (older),Race (Hispanics,Asian-Americans),Aboriginal people
- Complications= heart and bloodvessel disease (angina,atherosclerosis)
Nerve damage (neuropathy) – tingling,numbness,pain
Kidneydamage (nephropathy)
Eye damage (diabeticretinopathy),glaucoma and cataract – leadstoblindness
Footdamage - nerve damage inthe feetbecof poorblood flow tothe feet
- Tests= Fastingblood glucose = >=7mmol/L
Randombloodglucose = >=11.1 mmol/L
Two-hourOGTT = >=11.1 mmol/L
HgbA1c = >=6.5%
- Treatment = Insulinalone or in combinationwith oral hypoglycemicagents
Lifestyle changes
Glaucoma
- A groupof relatedeye disorderscharacterized by elevatedintraocularpressure (IOP),if
untreated, resultsto optic nerve atrophy and peripheral visionloss (blindness)
- Primary open-angle glaucoma(POAG)
= mostcommon type;outflowof aqueoushumor is decreaseddue to cloggeddrainage
channels
= developsslowlyandw/osymptoms
- Primary angle-closure glaucoma(PACG)
= causedby reduction on the outflow ofaqueous humor due to angle closure
= symptoms = sudden,intense painin or around the eye,n/v
- TONOMETER = usedto measure IOP
- Increase IOP = problemwith aqueoushumor eithertoo much fluidis produced or its not
draining properly
- Normal IOP = 10-21mmHg
- Treatment = focus is to keepthe IOP low to preventoptic nerve damage
2. Prostatitis
- Inflammationof the prostate gland usuallydue to infection
- 5-10% caused by bacterial infection
- Affect10-14% of men of all ages
- 4 Catergories
a. Acute bacterial prostatitis
b. Chronicbacterial prostatitis
c. Chronicprostatitis-chronicpelvicpainsyndrome
d. Asymptomaticinflammatoryprostatitis
- Commoncausative agents= E. coli,Klebsiella,Pseudomonas,Enterobacter
- Clinical Manifestations = fever,chills,backpain,perinealpain,dysuria,urinaryfrequency,
urgencyand cloudyurine
- Chronicprostatitis=lasts more than3 months; can predispose the patienttorecurrentUTIs
- Treatment = antibiotics
Meds:
1. Metformin1000 mg PO BID. Available stock is 500 mg tablets. Gluchopage
To be given:2 tablets
Indication:ManagementofType 2 DM (Biguanides)
Action:Lowersblood glucose by helpinginsulintowork better.Increase sensitivityto insulin.
Maintenance of bloodglucose.
Metabolism:eliminatedalmostunchangedinkidneys
Half-life:17.6 hrs
N. Dose: 500mg twice daily,may increase by 500mg at weeklyintervalsup to 2000mg/day
Contraindicated:hypersensitivity,metabolicacidosis,dehydration
S/E: diarrhea,nauseaandvomiting
NursingCons:Whencombinedwithsulfonylureas(stimulate the bodytomake more insulin),
observe forsignandsymptomsof hypoglycemia,(abdpain,sweating,weakness)
2. Glyburide 5mg PO daily.
Diabeta,Glynase (Sulfonylurea)
Used:to treat type 2 diabetesnot for type 1, stimulatesthe body to make more insulin
N. Dose: 2.5mg to 5mg PO/daily
S/E: hypoglycemia,diarrhea,allergicskinreaction
NursingCons:Monitorbloodglucose level. Before andaftergiving.
3. CiprofloxacinOral Suspension750mg PO BID x 14 days. Available concentrationis 500mg/5ml.
To be given:7.5 ml.Cipro
Indication:treatmentof the ff. bacterial infection.(Fluoroquinolones)
Action:Deathof susceptible bacteria. Anti-infectives
Metabolism:Liver, excretethrukidney
Contraindicated:hypersensitivity
N. Dose:500mg-700mg q12 hrs
S/E: dizziness,headache,insomnia,diarrhea,nausea
3. NursingCons:Assessforinfection(v/s,appearance of wound,sputum, urineandstool,WBC,
Urinalysis,frequencyandurgencyof urination.)
4. Timolol 0.5% eye drops, 1 drop ineach eye BID.
Used: Treatingpressure in the eye (ocular hypertension) andopen-angle glaucoma.Timolol drops
are a beta blocker.It works too decrease fluidproductionand pressure inside the eye.
N. Dose: 0.25% OR 0.5%
Do not use timolol if :allergic,COPD,heartfailure,shockdue toHF
Interactwithinsulinororal antidiabetics,mayhide certainsignsof low bloodsugar.
NursingCons:Monitorpatientbloodglucose levelandBP.
4. 2. PeterDodge: Angina Pectoris,Congestive HeartFailure
Allergies–Morphine
Lab Values– DigoxinLeve:1.9 mmol/L(1.0 – 2.6 mmol/L)
Electrolytes:Potassium4.2(3.5 – 5.0 mmol/L),Sodium142 (134-145 mmol/L)
Congestive Heart Failure
- Alsoknownas Heart Failure (HF)
- Heart muscle weaknessdue to narrowing and constrictionof blood vessel whichresultedto
poor functioningvalvescausing dilationof heart chambers and resultedto decreased
contractility and increase workload of the heart. Congestionusuallydevelopsbecause the
heart is unable to move bloodas quicklyas possible asit shouldto meetthe tissue
requirementsforoxygen.
Etiology:
AtherosclerosisandHypertension(HPN) isa majorcontributingfactor,riskof HF increases
progressivelywiththe severityof HPN
DM predisposesanindividual toHFregardlessof the presence of concomitantCADorHPN
Otherriskfactors – cigarette smoking,obesityandhighserumcholesterol
- May be causedby anyinterferencewiththe normal mechanismsregulatingcardiacoutput(CO)
- CO dependson1. Preload,2.Afterload,3.Myocardial contractility,
4. Heart rate, 5. metabolicstate of the individual
Anyalterationinthese factorscanresultto manifestationsof HF
- Types:
Left SidedHeart Failure – mostcommonform of initial heartfailure;
Resultsfromleftventriculardysfunction,whichcausesbloodtobackup
throughthe L atriumand intothe pulmonaryveins,manifestedas
pulmonary congestionand edema
Right SidedHeart Failure – causesbackwardbloodflow tothe R atriumand venous circulation.
Venouscongestioninthe systemiccirculationresultsin peripheral edema,hepatomegaly,
splenomegaly, ascitesandjugular venousdistention.
- Clinical Manifestations=dependonage,underlyingtype andextentof heartdisease andwhich
ventricle isfailingtopumpeffectively
Fatigue,Dyspnea,Tachycardia,Edema,Nocturia,Skinchanges,Behavioral Changes,ChestPain,
WeightChanges
- Treatment:
1. Diuretics
2. Angiotensin-ConvertingEnzyme Inhibitors
3. B-AdrenergicBlockers
4. InotropicDrugs
a. SympathomimeticDrugs – dopamine,dobutamine,epinephrineandnorepinephrine
b. Phosphodiesterase Inhibitors –Milrinone
c. DigitalisPreparations –digoxin(Lanoxin)
5. d. Vasodilatordrugs
d.1 Nitrates
d.2 SodiumNitroprusside
Angina Pectoris
- Commonlyknownas angina
- Sensationof chest pain,pressure or squeezing, due topartial occlusion or narrowing of the
coronary artery impedingthe blood flowand causing ischemia of tissuesand myocardium.
Main cause is coronaryartery disease whichisanatheroscleroticprocessaffectingthe arteries
feedingthe heart.
- From Latinword angere “tostrangle”and pectus“chest”
- Classification:
a. Stable angina
– effortangina,classictype,anginarelatedtomyocardial ischemia,precipitatedbysome
activity and usually relievedbyrestor after administrationof nitroglycerinSL
b. Unstable angina
– “crescendoangina”,aform of acute coronarysyndrome, anginapectoristhat worsens
Occurs at rest or evenwithminimal exertion. It issevere andof new onset.Occurs with a
crescendopattern (more severe,prolonged,frequent).Maybe a seriousindicator of
impendingheart attack
- Signs and Symptoms = chestdiscomfortdescribedaspressure,heaviness,tightness,squeezing,
burning,orchokingsensation
- Risk factors = smoking,diabetes,highcholesterol,highBP,sedentarylifestyle,familyhistoryof
heartdisease
- Treatment(patient):ASA,Antihypertensive,Anticoagulants,CardiacBypass
Nitroglycerintransdermal patch
Meds:
1. Digoxin0.125mg PO daily. Lanoxin
Indication:Heartfailure.Antiarrythmics
Action:Increasesthe force of myocardial contraction.Increasedcardiacoutput(positiveinotropic
effect) andslowingof the heartrate (negative chronotropiceffect).
Metabolism:Kidney
Half-life:36-48 hrs
N. Dose: 0.125-0.5 mg
Adverse/S/E:fatigue,bradycardia,andnauseaandvomiting
NursingCons:Monitorapical pulse for1 full minbefore administration.Withholddose andnotify
healthcare professional if pulse rate is<60 bpminan adult.
2. Furosemide 20mg PO daily.
Lasix (Loop Diuretic)
Indication:Edemadue to heart failure,hepaticimpairementorrenal dse.Hypertension
Action:Inhibitsreabsorptionof sodiumandchloridefromloopof Henle.Increaserenal excretionof
H2O, Na, Cl,Mg, K and Ca. Diuresis(excessfluidedema,pleural effusions).Decrease BP
6. Metabolism:Liver
Half-life:30-60 mins
N. Dose: 20-80 mg
Contraindicated:Hypersensitivity
S/E: headache,hypotension,dehydration
NursingCons:MonitorBP and pulse,watchforfalls,assessfluidstatus.
3. KCL Elixir 20mEq PO daily.Available concentration is20mEq/15 mls.
To be given:15 ml
Indication:PO/IV: Treatmentofpotassiumdepletion.Arrythmiasdue to digoxintoxicity.
Action:Preventionof deficiency.
Metabolism:excretiononkidney
N. Dose: 20-40 mEq/day
Contraindicated:Hyperkalemia,severe renal impairment
S/E: adb pain,diarrhea,flatulence,nauseaandvomiting
NursingCons:Monitorpulse andBP. Assessforsignandsymptomsof hypokalemiasuchas
weaknessandfatigue
4. Nitroglycerin0.4mg/hr transdermal patch. Apply one patch in am and remove at HS
Indication:Anti-anginals,mgtofangina pectoris.
Action:Increasescoronarybloodflow bydilatingcoronaryarteriesandimprovingimproving
collateral flowtoischemicregions.Relief fromanginaattack.Increasedcardiacoutput,reductionof
BP.
Metabolism:Liver
Half-life:1-4min
N. Dose: 0.2-0.4 mh/hr
Contraindicated:hypersensitivity
S/E: dizziness,headache,hypotension
NursingCons:Assesspain,monitorBPandpulse
7. 3. Sarah Buick: Emphysema,Parkinson’s Disease
Allergies:Penicillin
Lab Values:CXR(one monthago) hyper-inflatedlungssuggestingemphysema
Emphysema
- Chronicobstructive pulmonarydisease(COPD)
- “pinkpuffers”
- Permanentinflammationor destruction inalveoli and as a result impede gasexchange that
will leadto increase CO2 retention.
- Smoking isthe leadingcause
- The innerwallsof the air sacs weaken andeventuallyrupture,reducesthe surface areaof the
lungsand the amountof oxygenthatreachesthe bloodstream
- Impedesgasexchange leadingtoimpairedrespiratoryfunction
- Symptoms = dyspneaonexertionorat rest,cough,orthopnea,wheezes,use of accessory
muscles (barrel chestand diminishedlungexpansion),fatigue,CO2retention(confusion,
anxiety,feelingsof suffocation,thinonappearance)
Parkinson’sDisease
- A progressive disease ofthe nervoussystemmarked by tremor,muscular rigidity,and
bradykinesia
- Associatedwithdegenerationof the basal gangliaof the brainand the deficiencyofdopamine
- Extrapyramidal Symptoms = tremor, bradykinesia,rigidmuscles,impairedposture and
balance,loss of automatic movements,speechchanges
- Causes= unknown
- Risk factors = age (60 & older),M>F,Heredity,Exposuretotoxins(pesticides)
- Complications= thinking difficulties,depressionandemotional changes,swallowingproblem,
sleepproblems,bladderproblems, constipation,BPchanges,smell dysfunction,fatigue,pain,
sexual dysfunction
- Treatment = Carbidopa/Levodopa, Dopamine agonists, MAO inhibitors,Anticholinergics
Meds:
1. Carbidopa/Levodopa CR 50mg/200mg PO QID. Sinemet
Indication:ParkinsonDisease.Antiparkinson
Action:Levodopais convertedto dopamine in the CNS,where it servesas a neurotransmitter.
Carbidopa, a decarboxylase inhibitor,preventsperipheral destructionoflevodopa.Reliefof
tremor and rigidity inParkinson’s syndrome.
Metabolize:liverandGItract
Half-life:Levodopa1hrand Carbidopa1-2hr
N. Dose: 25mg carbidopa/100mg levodopa3x daily,max = 8 tabletsof 25mg carbidopa/100mg
levodopa/day
Contraindicated:Hypersensitivity
S/E: involuntarymovements,nauseaandvomiting
NursingCons:AssessforParkinsonsymptoms(rigidity,tremors,akinesia).MonitorBPandpulse.
8. 2. Entacapone 200mg PO QID. Comtan
Indication:withlevodopa/carbidopatotreatidiopathicParkinsondse.Antiparkinson
Action:Preventsthe breakdown of levodopa,increasingavailabilityinCNS. Prolongduration
response to levodopawith end-to-dose motorfluctuations.
Half-life:initial phase 0.4-0.7hr; secondphase 2.4 hr
N. Dose: 200mg max to 8x daily
Adverse Effects:Psychosis,dizziness,hallucinations
Contraindicated:Hypersensitivity
NursingCons:Assessparkinsonianandextrapyramidalsymptoms.Monitorfordiarrhea.
3. Docusate Sodium100mg PO daily. Available concentrationis 50mg/5ml. Colace
To be given:10ml
Indication:Laxative (Stool Softeners).Preventionofconstipation.
Action:Promotesincorporation of water into stool,resultingin softerfecal mass. Softeningand
passage of stool.
N. Dose: 50mg-400mg
Adverse Effects:diarrhea
NursingCons:Assessforabddistension,presence of bowel sound.Assesscolor,consistency,and
amountof stool.
4. Fluticasone Aerosol Inhaler44 mcg, 2 puffsBID. FloventDiskus
Indication:Corticosteroids(Inhalation)
Action:Decreasedfrequencyandseverityof asthmaattacks.Act as anti-inflammatory.
Half-life:7.8hr
N. Dose: 88 mcg twice daily
Contraindicated:Hypersensitivity
Adverse Efffect:headache,dysphonia,hoarseness
NursingCons:Monitorrespiratorystatusandlung sounds.
Give a cup ofwater to the patientto gargle. It can cause oral trush.
9. 4. LillyLotus: Pneumonia,Vaginitis
Allergies:Noknownallergies
Lab Values:CXR(3 daysago) patchy airspace disease ispresentinbothbasessuggesting
pneumonia
Pneumonia
- Inflammationof the lungcaused by a microbial agent. Virus,bacteria, aspiration.
- Resultwhendefence mechanisms become incompetentoroverwhelmedbythe virulence of
infectiousagents
- Types:
Communityacquired pneumonia= onset<48hrs of hospitalization
= S. pneumonia,H. influenza,viral
Hospital acquiredPneumonia= onset>48hrs of hospitalization
= E. coli,Klebsiella,MRSA,Pseudomonas
AspirationPneumonia= due to abnormal entryof secretionsorsubstances intothe lower
airway
- Symptoms = cough productive of purulentsputum,fever,tachypnea,shortnessof breath,
feelingverytiredorveryweak, pleuriticchestpain
- Diagnostics= CXR,sputumcultures
- Treatment = Antibiotics( bacterial pneumonia)
Vaginitis
- Inflammationof the vagina that can resultin discharge,itching and pain
- Occurs whenthe natural defencesof the acidvaginal secretions(maintainedbysufficient
estrogenlevels) isdisrupted
- Types:
1. Bacterial vaginosis= overgrowthof organismsnormallypresentinvagina
2. Yeast infections=usuallydue toCandidaalbicans
3. Trichomoniasis= causedbya parasite,sexuallytransmitted
4. Vaginal atrophy (atrophic vaginitis) = reducedestrogenaftermenopause
- Symptoms = change incolor/odor/amountof vaginal discharge
Vaginal itchingorirritation
Painduringintercourse
Painful urination
Light vaginal bleedingorspotting
- Causes= dependsonthe type of vaginitis
- Risk factors = hormonal changes,sexual activity,STDs,uncontrolledDM,usingIUDsfor birth
control
- Treatment = dependson the type of vaginosis
Meds:
1. Clarithromycin250mg PO dailyx 7 days. Biaxin
Indication:Respiratory tract infectionsincludingstreptococcal pharyngitis, sinusitis,bronchitis,
and pneumonia.Anti-infectives.
10. Action:BacteriostaticAction.
Metabolism:liver
Half-life:3-4hrs
N. Dose: 250mg q 12 hrs for 7-14 days or 1,000mg once daily for 7 days.
Adverse Effect:headache,abdpain,diarrhea
Contraindicated:hypersensitivity
NursingCons:Monitorfor signof infection(redness,vital signs,WBC).Monitorfordiarrhea.
2. Acetaminophen325 mg PO QID. Tylenol
Indication:Treatmentofmild to moderate pain. Fever
Action:Inhibitsynthesisofprostaglandins that may serve as mediator of pain and feverin CNS.
Analgesia.Antipyretic. Non-Opioid
Metabolize:Liver
Half-life:1-3hr
N. Dose: 325mg-650mg q 6 hrs
Contraindicated:productscontainingalcoholandhypersensitivity.
S/E: headache,nauseaandvomiting, constipation
NursingCons:Assessoverall status.Tempforfever.
3. Clotrimazole 200mg vaginal tablets.1 tabletvaginally dailyx 7days. Canesten
Indication:Treatmentofvulvovaginal candidiasis.Antifungal
Action:Inhibitgrowth and death of susceptible Candida,withdecrease inaccompanyingsymptoms
of vulvovaginitis ( vaginal burning,itchingand discharge).
Contraindicated:hypersensitivity
N. Dose: 100mg at bedtime for7 nights or 200mg at bedtime for 3 nights.
Adverse Effect:itching,pelvicpain
NursingCons:Inspectareafor inspectionbefore andaftertherapy.
4. PsylliumPowder10ml PO daily. Metamucil
Indication:Laxatives.Bulkforming. Managementof simple or chronic constipation,particularly if
associatedwith a low-fiberdiet.
Action:Combineswithwater in the intestinal contentsto form emollientgel orvicious solution
that promotesperistalsisand reduce transient time
N. Dose: 1-2 teaspoon or 10ml
Contraindicated:hypersensitivity,abdpain
Adverse Effect:bronchospasm,cramps
NursingCons:Assessforabddistension,presence of bowel sound.Assesscolor,consistency,and
amountof stool.
11. 5. Matilda Lincoln:Transient IschemicAttack, Peripheral Vascular Diseases.Dementia
Allergies:Noknownallergies
Lab Values:INR2.7 (normal 2.0-3.0). Detectbleedingandclottingdisorder.Response to
anticoagulanttherapy.
Electrolytes:Sodium135 (134-143 mmol/L);Potassium3.2 (3.5-5.0 mmol/L)
Transient IschemicAttack
- Oftenlabeled “mini stroke”,“warningstroke”
- Givesa patienttime toact and keepa permanentstroke fromoccuring
- Causedby a clot, blockage is transient (temporary)
- Symptoms occur rapidly and last a relativelyshort time
- Most TIAs lasts lessthan five minutes
- Usuallycauses no permanentinjury to the brain
- Signsand Symptomsof a stroke = FAST
F= face drooping; A= arm weakness;S= speechdifficulty T=time to call 911
Peripheral VascularDisease
- Refersto any disease or disorderof the circulatory systemoutside of the brain and heart.
- Includesarterial, venous,and lymphatic.Problemwith blood flowthrough peripheral vessel.
Causedby narrowing brought by atherosclerosis.Mayhave partial or complete occlusion.
- Most commoncause isperipheral arterydisease
- Other causes= bloodclot, diabetes,inflammationof the arteries,infection,structural defects,
bloodvessel injury
- Risk factors = positive familyhistoryof prematureheartattacksor strokes,
>50 yo,overweight/obesity,sedentarylifestyle,smoking,DM,
HighBP, highcholesterol
- Symptoms of Peripheral artery disease dependsuponthe location and the extentofthe
blockedarteries
- Intermittentclaudication manifestedby calfpainusually while walkingand dissipatesat restis
the most common symptom ofperipheral artery disease
- Complications= ulcers,gangrene,amputation
- Treatment = angioplasty, medications,surgery,supervisedexercises,lifestyle changes
Dementia
- Progressive decline inmental ability
- Affectsabilityto communicate,carry out purposeful movements,recognize commonobjects
and familiar people,andjudgementand reasoning
- Not a specificdisease,itsanoverall termthat describesa wide range of symptoms associated
with a decline inmemory or other thinkingskillssevere enoughto reduce a person’sabilityto
performeveryday activities
- Alzheimer’sdisease =accounts for 60-80 percentof cases
= amyloidplaquesare presentinthe braininabnormal quantities
= neurofibrillarytangles are presentinsidenerve cells
Vasculardementia=secondmostcommon type of dementia
12. - Symptoms = onsetis usuallygradual with progressive deterioration
= impaired:memory,communicationandlanguage,abilitytofocusandpayattention,
reasoningandjudgement,visual perception
- Causes= damage to brain cellswhich interfereswiththe ability of brain cellsto communicate
with each other,whenbraincellscannotcommunicate normally,thinking,behaviorandfeelings
can be affected
Meds:
1. Warfarin 5mg PO daily. Coumadin
Indication:VenousThrombosis,PulmonaryEmbolism
Action:Interfere withhepatic synthesisofVit K. clotting factors (II,VII, IX, X). Preventionof
thromboembolicevents.
Metabolism:Liver
Half-life:42hr
N. Dose: 2mg-5mg/day for 2-4 days
Contraindicated:uncontrolledbleeding,openwounds
S/E: bleeding
NursingCons:Monitorfor bleedingonstool,gums,nosebleed
2. Risperidone 2mg PO daily.Concentration available is1mg/ml. Risperdal
Indication:Antipsychotics,moodstabilizers.Shortterm treatment of acute manic or mixed
episodesassociatedwithBipolar 1 disorder.
Action:Antagonize dopamine and serotoninin the CNS. Decreasedsymptomsof psychosis,bipolar
mania.
Contraindicated:hypersensitivity
Metabolism:Liver
Half-life:21hr
N. Dose: 1mg twice daily,may increase to 1-2mg/day no more than 24 hrs
Adverse Effect:constipation,diarrhea,headache
NursingCons:Monitorpatientmoodbefore andafter.
3. Hydrochlorothiazide 100mg PO daily. Microzide
Indication:antihypertensive,diuretics.Managementofmildto moderate hypertension.
Treatment of edemaassociatedwith HF.
Action:Increase excretionofNa, water,Cl, K, Mg and bicarbonate. Lower BP and diuresis
Metabolism:excretedinkidney
Half-life:1-2hr
N. Dose: 12.5mg-100mg/day in 1-2 divideddoses
Contraindicated:hypersensitivity
Adverse Effect:hypokalemia
NursingCons:MonitorBP, intake andoutput,dailyweight,assessfeetandlegsforedema.
4. Betamethasone 0.1% cream. Applysparingly to affectedarea BID until clear.
Indication:Corticosteroids(Topical/Local);anti-inflammatory
Action:Suppressionofdermatologicinflammationand immune processes.