Pharmaceutical treatments and safety considerations in clinical practice

¶ … acetaminophen (Tylenol) the drug of choice for treating fevers in children?

Both aspirin and acetaminophen are equally effective in reducing temperature. Because of the recent statistical evidence linking aspirin to Reye's Syndrome, this should not be used in treating temperatures when the cause is not firmly established. Acetaminophen is therefore the drug of choice. Reye's Syndrome is a two-phase illness because it is almost always associated with a previous viral infection, such as influenza, cold, or chicken pox. So it is important to get a diagnosis to rule out this infection.

Why shouldn't antipyretics been given for low fevers (less than 101 degrees F)?

There are common misconceptions that fevers are dangerous and if they run higher can cause brain damage. The temperature should be treated if the illness is responsible for a middle ear infection or the "strep" throat. Most experts agree that temperatures in and of themselves are not harmful and therefore do not recommend routine treatment. However, if the temperature makes the child uncomfortable, then treatment may be recommended.

Why do some people become addicted to over-the-counter cough syrups?

An educated guess would be that because these syrups come in fruity flavors and contain a small amount of alcohol and well as sedatives to make one drousy, it is expected that some people may enjoy these feelings over time. Any time, one ingests a drug, there is the chance it will have affective on the person. Also over-the-counter medicine is available for anyone to purcahse and this is why you see more and more teenagers using these medicines as a gateway to other illegal drugs.

What is the reason for checking the respiratory rate before giving morphine to someone who has been receiving it every six hours for pain?

Morphine is absorbed through the blood stream and can cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people. Respiratory depression is the chief hazard of all morphine preparations. Respiratory depression occurs more frequently in elderly and debilitated patients, and those suffering from conditions accompanied by hypoxia, hypercapnia, or upper airway obstruction.

Explain why celecoxib (Celebrex) has less risk of GI irritation or bleeding than ibuprofen (Advil) when they are both prescribed to relieve pain and inflammation?

Celebrex has been shown to have a lower GI toxicity profile based on short-term endoscopic studies showing less ulcers and gastric irritation compared to other NSAIDs. However, long-term studies of the incidence of clinically significant GI bleeding are still forthcoming. These current reports may point out that Celebrex, while significantly safer that other NSAIDs, will continue to have some GI toxicity.

What daily activities must be performed cautiously when given anticoagulants?

Anticoagulants cause the blood not to clot as platets are being produced. Daily activites that should performed cautiously could be cooking, driving, sports or anything that will cause an accidental cut or bruise.

What are low molecular weight heparins? What is their mechanism of anticoagulant action? What are some advantages of low molecular weight heparins over heparin sodium?

Heparin and its derivative, low-molecular-weight heparin (LMWH), are the anticoagulants of choice when a rapid anticoagulant effect is required, because their onset of action is immediate when administered by IV injection. Both types of heparins are administered in lower doses for primary prophylaxis than for treatment of venous thrombosis or acute myocardial ischemia. Heparin has pharmacokinetic limitations1 not shared by LMWHs. Based on these pharmacokinetic limitations, heparin therapy is usually restricted to the hospital setting, where its effect can be monitored and its dosage adjusted frequently. In contrast, LMWH preparations can be administered in either the in-hospital or out-of-hospital setting because they can be administered subcutaneously (sc) without the need for laboratory monitoring.

Why is important to determine if a stroke is the result of a ruptured blood vessel or a thrombus in a blood vessel before giving a thrombolytic agent? What diagnostic test can determine this?

Thrombolytic agents act to burst the clot. It is important to know what has cuased the stroke so that the wrong treatment is not used. If it is a ruptured vessel and thrombolytic therapy is used, this could cause internal bleeding.

The chest pain if angina is a symptom of inadequate blood flow to the heart muscle. Drugs that are used to treat angina work by: (a) increasing blood flow through the coronary arteries, thus bringing more blood to the heart muscle, or (b) decreasing the oxygen consumption of the heart, thus allowing the heart muscle to function. Nitrates help to keep the coronary arteries as wide open as possible, so that as much oxygen as possible gets to the heart to relieve the pain. Nitrates also open up other arteries in the body. This makes it easier for the heart to pump blood around the body, putting the heart under less strain. It then can get by with less oxygen.

Use part a or b above to discuss the use of beta blockers and how they restore the balance between coronary blood flow and heart work.

Some heart conditions, in addition to high blood pressure, that can be treated with a beta-blocker include an irregular heartbeat and chest pain (angina). People with heart failure may also benefit from beta-blockers, although not everyone with severe failure can take them. Receiving beta-blocker therapy following a heart attack significantly reduces a person's risk of having another one. Many doctors, however, don't prescribe beta-blockers in such cases. This is partly because they want to avoid potentially harmful side effects, especially in the elderly and those with diabetes or heart failure.

16. Why is the cholesterol on low-density lipoproteins (LDL) considered "bad" cholesterol; while the cholesterol in high density lipoproteins (HDL) are considered "good"?

A patient has been taking Lipitor 80 mg daily for 8 weeks. The blood lipid levels are still elevated. The physician finds out that the patient is eating a lot of foods high in cholesterol and saturated fats. The patient states, "I thought the 'pill' was going to take care of everything." What would you tell the patient? I would reason with them and advise chaging their diet to suggest this way they would benefit completely. Also no pill will change everything. One must be willing to change their lifestyle as well.

Why do some people still need an antihyperlipidemic agent even though they have reduced their dietary intake of cholesterol and saturated fats?

Why is it better to sue selective beta2 agonists, rather than non-selective beta-adrenergic agonists, for a patient who has both asthma and heart disease?

Why is the combination of a glucocorticoid and a beta2 adrenergic agonist used sometimes in treating asthma? What is the difference in their mechanisms of action?

Use

http://lungusa.org/asthmato answer: (a) what is a peak flow meter and how is it used in asthma clients? (b) Is low or high humidity in the home better for asthma clients? - What aspects of weather are triggers for asthma?

Based upon your knowledge of the mechanism of action of the following drug classes, explain the rationale for using the following to treat peptic ulcer disease: (a) Antibiotics, (b) Proton pump inhibitors, - Antacids, (d) Histamine H2 receptor blockers.

Use

http://nccam.nih.gov/health/supplements.htm. Pick one specific supplement and briefly answer the following questions: (a) what is this supplement most often used for? (b) what is the presumed mechanism of action? - what clinical studies have been done to demonstrate its effectiveness? (d) what clinical studies have been done to demonstrate its safety? (e) What additional information would you like to see before recommending a patient to take the supplement?