...Fluticasone Propionate (FP), a component of Advair Diskus, is a corticosteroid primarily used in the treatment of asthma, allergic rhinitis (AR), or chronic obstructive pulmonary disease (COPD).1,2,3,4 In patients with allergic rhinits, is it most often used intranasally, falling under the class of “intranasal corticosteroids”, or INS.3 However, in the case of asthma, the drug is classified as an “inhaled corticosteroid” or ICS.5 Typically short-acting β2 adrenoreceptor agonists are used to rapidly treat the symptoms of asthma, but corticosteroids like FP are utilized when long-term contol is required.6 FP has been obsered to have synergistic effects when used in co-therapy with these short-acting β2 adrenoreceptor agonists, yielding a greater improvement in lung treatment and symptom control than when either of the two drugs is adminstered alone.6 The corticosteroid drug class has been around...
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...that it is likely he now has moderate to severe asthma instead of mild asthma. Due to worsening asthmatic symptoms, it is best to add on another medication. We do not want to stop the Albuterol nebulizer, because all asthmatic patients must have a quick relief medication on hand. As discussed earlier, Jack has moderate to severe asthma that it is recommended to start an inhaled corticosteroid with a leukotriene modifier. An inhaled corticosteroid works to suppress inflammatory cell activation and function to decrease airway inflammation, prevent microvascular leakage to decrease airway edema, decrease mucus production,...
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...Eur Respir J 1999; 14: 452±467 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 1999 European Respiratory Journal ISSN 0903-1936 SERIES "CHEST PHYSIOTHERAPY" Edited by S.L. Hill and B. Webber Number 3 in this Series Effects of drugs on mucus clearance E. Houtmeyers, R. Gosselink, G. Gayan-Ramirez, M. Decramer Effects of drugs on mucus clearance. E. Houtmeyers, R. Gosselink, G. Gayan-Ramirez, M. Decramer. #ERS Journals Ltd 1999. ABSTRACT: Mucociliary clearance (MCC), the process in which airway mucus together with substances trapped within are moved out of the lungs, is an important defence mechanism of the human body. Drugs may alter this process, such that it is necessary to know the effect of the drugs on MCC. Indeed, agents stimulating MCC may be used therapeutically in respiratory medicine, especially in patients suspected of having an impairment of their mucociliary transport system. In contrast, caution should be taken with drugs depressing MCC as an undesired side-effect, independently of their therapeutic indication. Since cough clearance (CC) serves as a back-up system when MCC fails, the influence of drugs must be examined not only on MCC but also on CC. Ultimately, the clinical repercussions of alterations in mucus transport induced by drug administration must be studied. Tertiary ammonium compounds (anticholinergics), aspirin, anaesthetic agents and benzodiazepines have been shown to be capable of depressing the mucociliary transport system...
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...Lupus Erythematous: The Butterfly Effect Lupus erythematosus (LE) first originated in 1833 by many physicians throughout the historical periods of; the classical period, the neoclassical period, and the modern period. During the classical period of the 1800s, lupus was first coined. It comes from the Latin word ‘wolf’ that attributed to the thirteenth century by physician Rogerius who used the word to describe erosive facial lesions that manifested from a wolf’s bite (Lupus Foundation of America, n.d.). In the neoclassical period of the 1900s, scientists discovered that there are many sub forms of lupus, the most common type known as systemic lupus erythematosus (SLE). SLE has many other forms of names such as discoid and disseminated lupus....
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...The patient’s weight is needed because many medication doses are based per Kilogram (Kg). This also gives a baseline to indicate weight gain/loss during therapy. The age of the client is of importance because of the effects age has on metabolism of drugs. If the older client can’t metabolize drugs effectively, the chance of drug toxicity is increased. The patient needs to be monitored and the medications titrated to therapeutic blood levels to ensure safety. Taking vital signs (V/S) before drug administration will give the nurse a baseline to guide therapy. It can also be an indicator of when medications should be held, or of possible adverse reactions to a drug. Knowing any cognitive barriers will help the nurse in making safe choices for the patient. The education of the patient may need to extend to family members or care takers. If the patient cannot identify adverse reactions, the teaching will have to be shared with whoever is around to identify these signs and symptoms. The life-long and numerous medications that accompany RA can be difficult to...
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...Inflammatory Musculoskeletal Diseases Name Instructor Institution Musculoskeletal disorders are common and they can affect different age groups, frequently causing disability and immobility. They cause discomfort or pain in the joints, bones and muscles. The disorders can range from being acute to chronic, diffuse or focal. The chances of a person developing musculoskeletal disorders increase with age, but they are more common among the elderly. The disorders can range from back pain and gout, as well as rheumatoid arthritis, musculoskeletal pain and tendinitis. Treatments vary depending on the age of the patient, and there is a need for physicians to intervene early before the disease progresses to ensure better chances of recovery. The physiology of aging is an important aspect of treatment for musculoskeletal problems. “Immunosenescence” is a term that refers to changes in the immune system which is characterized by declined cellular immunity resulting to increase in auto antibodies. T-cell and cytokine production also decrease. Aging results in musculoskeletal changes. The tendons, ligaments and where they attach to bonesfray and weaken; muscle mass, quality, and strength also lessen. The gait of a person with musculoskeletal problems changes with age; gait speed, stride length and step length are reduced ((Phyllis & Samuel, 2009). Treatment in older patients is risky because of polypharmacy where patients attend different...
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...This is the second case study that is required for the class. Please submit a paper (doesn’t have to be long; you could even give me bullet-point answers to the questions listed below) that answers all of the questions posed after Case Study 1. I have included an easy second case study which, if you complete it, will be worth extra credit. Answers to the first Case Study are worth 25 points and responding to Case Study 1 is required work for the course. The extra credit, which is not required, will be worth a total of 10 points. Both are due at the beginning of class on Tuesday, March 10, 2015. Case 1 R.S. has smoked for many years and has developed chronic bronchitis, a chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral arterial vascular disease. His arterial blood gas (ABG) values are pH = 7.32, PaCO2 = 60 mm Hg, PaO2 = 50 mm Hg, HCO3- = 30 mEq/L. His hematocrit is 52% with normal red cell indices. He is using an inhaled ß2 agonist and theophylline to manage his respiratory disease. At this clinic visit, it is noted on a chest x-ray that R.S. has an area of consolidation in his right lower lobe that is thought to be consistent with pneumonia. Discussion Questions 1. What clinical findings are likely in R.S. as a consequence of his COPD? How would these differ from those of emphysematous COPD? Chronic Obstructive Pulmonary Disease (COPD) is comprised primarily of two related diseases: Chronic Bronchitis...
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...can exacerbate the degree of permanent neurological damage following cardiac arrest. Each degree Celsius higher than 37C can cause cerebral destruction through increased metabolic expenditure, excitatory neurotransmitters resulting in calcium cellular reflux and accumulation of oxygen free radicals (Busto et al., 1987). To improve the outcome of patients who survive cardiac arrest requires not only reducing the ischemic process as quickly as possible, caused by cardiac arrest, but also preventing post resuscitation syndrome caused from reperfusion (Safar, 1993). Cerebral reperfusion after successful resuscitation can trigger harmful chemical cascades such as oxygen free radical production which can result in multifocal brain damage. Therapeutic hypothermia (TH) is considered as an effective method for reducing the deleterious neurological outcomes in patients who have out-of-hospital cardiac arrest. Clinical and animal studies have shown that TH following cardiac arrest reduces both the cerebral metabolic rate and oxygen demand and it is thought to attenuate reperfusion injury, global inflammation and endothelial dysfunction, all consequences of cerebral...
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...caution. Non-prescription medications include “Nonsteroidal anti-inflammatory drugs (NSAIDs), including Tylenol, Excedrin, Ibuprofen, Motrin, Aleve, Advil, etc. Then you have prescription medications which are Corticosteroids, Opioids, Antidepressants, Anticonvulsants (anti-seizure medications) and many others”. These can be used to get rid of the common headache, arthritis, or muscle and joint pain. In some cases it may take weeks before a specific medication starts to work, therefore making a person turn to another option (WebMD, 2008). Morphine is a narcotic pain drug indicated for the relief of pain in patients who require opioid analgesics for more than a few days. Morphine interacts predominantly with the opioid mu-receptor. “These mu-binding sites are discretely distributed in the human brain, with high densities in the posterior amygdala, hypothalamus, thalamus, nucleus caudatus, putamen, and certain cortical areas. They are also found on the terminal axons of primary afferents within laminae I and II (substantia gelatinosa) of the spinal cord and in the spinal nucleus of the trigeminal nerve.” In clinical settings, morphine exerts its principal pharmacological effect on the central nervous system and gastrointestinal tract. Its primary actions of therapeutic value are analgesia and sedation. (Chahl, 1996)...
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...gru NURSES RESPOSIBILITY | Instruct patient to take acamprosate exactlyas prescribed, even if a relapse occurs,and to seek help for a relapse.•Warn patient that acamprosate won’treduce symptoms of alcohol withdrawal ifrelapse occurs followed by cessation.• Urge caregivers to monitor patient for evidenceof depression (lack of appetite orinterest in life, fatigue, excessive sleeping,difficulty concentrating) or suicidal tendenciesbecause a small number ofpatients taking acamprosate have attemptedsuicide.• Advise patient to use caution when performinghazardous activities until adverseCNS effects of drug are known. | SIDE EFFECTS | Adverse ReactionsCNS: Abnormal thinking, amnesia, anxiety,asthenia, chills, depression, dizziness,headache, insomnia, paresthesia, somnolence,suicidal ideation, syncope, tremorCV: Chest pain, hypertension, palpitations,peripheral edema, vasodilationEENT: Abnormal vision, dry mouth,pharyngitis, rhinitis, taste perversionGI: Abdominal pain, anorexia, constipation,diarrhea, flatulence, increased appetite,indigestion, nausea, vomitingGU: Acute renal failure, decreased libido,impotenceHEME: Leukopenia, lymphocytosis, thrombocytopeniaMS: Arthralgia, back pain, myalgiaRESP: Bronchitis, cough, dyspneaSKIN: Diaphoresis, pruritus, rash | INDICATION | To maintain abstinence from alcohol foralcohol-dependent patients who areabstinent at the start of treatment CONTRAINDICATIONHypersensitivity to acamprosate or its com- ponents, severe hepatic (Child-Pugh...
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...most common illness reported. (Braun et al., 2000). Vitamin C was introduced in the 1930’s In relation to treating respiratory infections. Once isolated It became world wide treatment when Nobel Prize winner Linus Pauling explained from his placebo-controlled trials that Vitamin C would prevent and cure the common cold in the 1970’s (Carr AB, 2010) Since then Vitamin C has been widely used as a therapeutic and preventative agent to combat the common cold. Over the past few decades’ studies have shown that when taken daily it may assist in reducing the symptoms, duration and severity of the common cold. (Gwaltney, 2002) This review will give insight into the truth of Vitamin C and the common cold outlining the validity and truth behind the treatment with investigations of over 20 studies examined. The common cold Viruses are the main cause for Nasopharyngitis, commonly known as the common cold or Upper respiratory infection. Treatment usually is in the form of antibiotics or cough and cold medications over the counter. Other medications usually used are inhaled corticosteroids, Echinacea and oral prednisolone. (Audera C, 2009) Vitamin C Vitamin C also known as L-ascorbic acid or ascorbate is a water soluble vitamin. Unlike other animals humans can’t produce Vitamin C naturally hence need to obtain it through their diet. The recommended daily amount is 75-90mg/day as per Australian national health research council. (Cowan,D, 2009) Studies hypothesised that consuming over...
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...overran by sports more and more over the years. Out of all of the sports, baseball is depicted to be the main event for America. Over the past decade, America's favorite sport has come under review over their players use of steroids and many other performance enhancing drugs. A lot of individuals seemed to be aware of the shocking epidemic that is sweeping all of the sports. A person with a knowledge of the sport world would know of the effects of doping within the sports. Almost weekly there is a headline case on the news referring to another sport doping scandal. A few competitors take a type of steroids, these are called anabolic-Androstenedione gen steroids or simply anabolic steroids. These steroids are used for many different reasons but mainly to expand their bulk and quality of muscle. The fundamental anabolic steroid hormone delivered by your body is testosterone. The promotion in muscle building normal than the average athlete is looked down upon by many different organizations and national sport leagues. The purpose...
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...(National Multiple Sclerosis Society, 2015). Although many ethnicities within the world have members with this disease, most cases of MS are found in Caucasians with ancestry from Northern Europe. Additionally, many countries have zero cases of multiple sclerosis, most of which are the closest to the equator (National Multiple Sclerosis Society, 2015). Treatment The treatment of multiple sclerosis is extremely varied. Ranging from medications, rehabilitative and therapeutic services, as well as alternative methods of management. Current medications for multiple sclerosis include Avonex, Copazone, and Rebif among many others which may be taken via injection. Treatments also may be received orally or by the process of infusion (Mohr et al., 2001). Medication schedules must be followed strictly as an effort to maintain the symptoms associated with the disease. When a person undergoes severe relapses, such as vision loss, weakness or poor balance, they will be prescribed a corticosteroid course of treatment to keep the symptoms at bay. Along with the medications, patients will also take medications for the symptoms associated with the condition, such as bowel dysfunction and muscle weakness (National Multiple Sclerosis Society, 2015). Rehabilitation is an important step for MS patients whom have experienced musculoskeletal dysfunction, such as paralysis or extreme muscle weakness. Physical therapy and occupational therapy may be sought for these individuals...
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...The n e w e ng l a n d j o u r na l of m e dic i n e clinical practice Rotator-Cuff Failure Frederick A. Matsen III, M.D. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. A 63-year-old woman presents with a 2-year history of progressive weakness and discomfort in her right shoulder, especially when she puts dishes on the top shelf in her kitchen. She is otherwise healthy and has had no injuries. Her physician diagnosed “bursitis” and gave her four subacromial corticosteroid injections; the first two seemed to relieve her symptoms temporarily, but the last two were ineffective. Physical examination reveals some atrophy of the muscles of the right shoulder and weakness when her right arm is elevated. Magnetic resonance imaging (MRI) reveals a large defect in the rotator cuff. How should her case be managed? The Cl inic a l Probl e m From the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle. N Engl J Med 2008;358:2138-47. Copyright © 2008 Massachusetts Medical Society. The rotator cuff is a synthesis of the capsule of the glenohumeral joint with the tendons of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles (Fig. 1).1 The rotator-cuff mechanism precisely centers the humeral head by...
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...Spironolactone acts as a diuretic by excreting excess sodium and water, but potassium remains in the body. Spironolactone can be given with other diuretic medications to have an increased effect. Increased amounts of aldosterone, a mineral corticosteroid, and causes primary and secondary hyperaldosteronism. Primary hyperaldosteronism can lead to hypertension and secondary hyperaldosteronism can lead to heart conditions, such as heart failure, and edemas. Spironolactone is effective in treating hypertension from primary hyperaldosteronism. Spironolactone acts primarily at the collecting tubule in the kidneys, but can also act in the heart.3 Aldactone, one of the main components of spironolactone, is quickly absorbed into the body and along with the sulfur components is a main reason for the effectiveness of the drug. Food increases the absorption of the drug and is excreted mainly through urine and partially bile.2 Spironolactone is metabolized into many metabolites...
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