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By T. Dudley. University of California, Irvine. 2018.
Dannon P order buspirone 10mg with visa anxiety icd 10, Sasson Y, Hirschmann S, Iancu I, Grunhaus L, Zohar J: Pindolol comparison of aripiprazole and risperidone augmentation in selective augmentation in treatment-resistant obsessive compulsive disorder: a serotonin reuptake inhibitor-refractory obsessive-compulsive disorder: a double-blind placebo controlled trial. Mundo E, Guglielmo E, Bellodi L: Effect of adjuvant pindolol on the placebo-controlled study of risperidone addition in serotonin reuptake antiobsessional response to fluvoxamine: a double-blind, placebo- inhibitor-refractory obsessive-compulsive disorder. Hollander E, Baldini Rossi N, Sood E, Pallanti S: Risperidone augmentation strategies in treatment-resistant obsessive-compulsive disorder: in treatment-resistant obsessive-compulsive disorder: a double-blind, preliminary findings. Erzegovesi S, Guglielmo E, Siliprandi F, Bellodi L: Low-dose risperidone Salimi S, Tabrizi M, Ashrafi M, et al: Granisetron adjunct to fluvoxamine for augmentation of fluvoxamine treatment in obsessive-compulsive moderate to severe obsessive-compulsive disorder: a randomized, disorder: a double-blind, placebo-controlled study. Biol behavioral therapy vs risperidone for augmenting serotonin reuptake Psychiatry 2012, 72:964-970. Oulis P, Mourikis I, Konstantakopoulos G: Pregabalin augmentation in Ashrafi M, Hajiaghaee R, Akhondzadeh S: Memantine add-on in moderate treatment-resistant obsessive-compulsive disorder. Int Clin to severe obsessive-compulsive disorder: randomized double-blind Psychopharmacol 2011, 26:221-224. Pallanti S, Bernardi S, Antonini S, Singh N, Hollander E: Ondansetron improvement in obsessive-compulsive disorder? Eur Arch Psychiatry Clin augmentation in treatment-resistant obsessive-compulsive disorder: a Neurosci 2008, 258:319-323. Soltani F, Sayyah M, Feizy F, Malayeri A, Siahpoosh A, Motlagh I: A double- disorder [Letter]. Van Ameringen M, Patterson B, Simpson W, Turna J: N-acetylcysteine a double-blind placebo-controlled cross-over study. Eur augmentation in treatment resistant obsessive compulsive disorder: A Neuropsychopharmacol 2008, 18:455-461. J Clin Psychopharmacol obsessive-compulsive disorder to treatment with citalopram or 2008, 28:363-367. J Clin Pharmacotherapy augmentation strategies in treatment-resistant Psychopharmacol 1992, 12:11-18. Eur Neuropsychopharmacol Hollander E: Double-blind, placebo-controlled trial of topiramate 2007, 17:430-439. Van Ameringen M, Mancini C, Patterson B, Bennett M: Topiramate of fluoxetine versus placebo. Ruffini C, Locatelli M, Lucca A, Benedetti F, Insacco C, Smeraldi E: officinalis L. J Complement Integr Med 2011, 8, over the orbitofrontal cortex in drug-resistant obsessive-compulsive 10. Liu K, Zhang H, Liu C, Guan Y, Lang L, Cheng Y, Sun B, Wang H, Zuo C, Neugebauer R, Lantigua R, Shea S, Neria Y: Functional impairment in Pan L, et al: Stereotactic treatment of refractory obsessive compulsive adults with past posttraumatic stress disorder: findings from primary disorder by bilateral capsulotomy with 3 years follow-up. Poundja J, Fikretoglu D, Guay S, Brunet A: Validation of the French capsular/ventral striatal gamma capsulotomy: a pilot prospective study. Babson K, Feldner M, Badour C, Trainor C, Blumenthal H, Sachs-Ericsson N, anterior cingulotomy for refractory obsessive-compulsive disorder: Schmidt N: Posttraumatic stress and sleep: differential relations across Long-term follow-up results. Lagarde G, Doyon J, Brunet A: Memory and executive dysfunctions cingulotomy for refractory obsessive-compulsive disorder. Sharp S, Thomas C, Rosenberg L, Rosenberg M, Meyer W 3rd: Propranolol alexithymia in posttraumatic stress disorder. J Trauma Stress 2008, does not reduce risk for acute stress disorder in pediatric burn trauma. Pitman R, Sanders K, Zusman R, Healy A, Cheema F, Lasko N, Cahill L, seeking by military members with posttraumatic stress disorder: Orr S: Pilot study of secondary prevention of posttraumatic stress findings on rates, characteristics, and predictors from a nationally disorder with propranolol. Nacasch N, Fostick L, Zohar J: High prevalence of obsessive-compulsive the protective function of acute morphine administration on disorder among posttraumatic stress disorder patients. Saxe G, Geary M, Bedard K, Bosquet M, Miller A, Koenen K, Stoddard F, disorder, anxiety and depression: a 20-year longitudinal study of war Moulton S: Separation anxiety as a mediator between acute morphine veterans. Findings from a and psychotherapy in treatment of combat-related post-traumatic nationally representative sample. Kornor H, Winje D, Ekeberg O, Weisaeth L, Kirkehei I, Johansen K, Steiro A: Xu Y: A randomized clinical trial to dismantle components of cognitive Early trauma-focused cognitive-behavioural therapy to prevent chronic processing therapy for posttraumatic stress disorder in female victims post-traumatic stress disorder and related symptoms: a systematic of interpersonal violence.
Negative symptoms and cognitive symptoms are not consistently improved by antipsychotic medication treatment 5 mg buspirone with amex anxiety symptoms returning. Doses below the dopamine binding threshold (approximately 60% dopamine receptor occupancy) are clinically ineffective for treating schizophrenia. The atypical medications, in general, have a wider therapeutic window, meaning that the difference between therapeutic and toxic levels is larger (Jones & Buckley, 2006). Another hypothesis is that the new medications are more selective in the parts of the brain they affect (Weiden et al. For example, there is more than one type of dopamine receptor, and different antipsychotics may have different effects on each type (Mueser & Gingerich, 2006). It was originally termed a ‘major tranquiliser’ due to its calmative effects in addition to dramatically reducing psychotic symptoms amongst agitated patients (Jones & Buckley, 2006; Schulz & McGorry, 2000; Weiden et al. The introduction of Chlorpromazine represented the first effective medical management strategy for schizophrenia and was, thus, deemed one of the great medical advances of the twentieth century (Sharif et al. Typical antipsychotics were breakthrough medications, as they provided therapy for psychosis, which had previously been almost impossible to treat (Conley, 2000). The effectiveness of antipsychotics in reducing the intensity of consumers’ positive symptoms- has permitted the outpatient treatment of schizophrenia and was associated with a dramatic reduction in mental hospital populations (Freedman, 2005; Schulz & McGorry, 2000). The typical antipsychotic medications currently in use include: Haloperidol, Thieridaxine, Thiothixene, Fluphenazine, Trifluoperazine, Chlorpromazine and Perphenazine. Over one hundred clinical trials have demonstrated the effectiveness of typical antipsychotic medications, including a series of double-blind placebo studies (Sharif et al. Research that has not supported the effectiveness of typical medications is generally restricted to poorly designed studies that involved ineffective dosages (Sharif et al. Although typical antipsychotic medications substantially reduce the positive symptoms of schizophrenia in some people, they have been documented as having no appreciable effect on cognitive dysfunction, and as having only a limited effect on, and even worsening, negative and depressive symptoms (Conley, 2000; Jones & Buckley, 2006; 19 Mueser & Gingerich, 2006; Weiden et al. Contradictory evidence exists, however, which points to clinical trials that indicate that all symptoms associated with schizophrenia improve with typical antipsychotic medication although, in general, positive symptoms respond to a greater degree and more consistently than negative symptoms (Sharif et al. Extensive evidence indicates that typical antipsychotic medications are essentially similar in efficacy profiles, however, individual consumers may respond better to one drug than another due to their different side effect profiles (Sharif et al. For example, while Chlorpromazine is quite sedating, Haloperidol is not (Mueser & Gingerich, 2006). The side effects of typical antipsychotic medications are frequently distressing and prominent and in addition to sedation, include: slowed thinking, dizziness, sexual dysfunction and sensitivity to sunlight. Anticholinergic side effects are also associated with typical antipsychotics, which include dry mouth, blurry vision, constipation, difficulty urinating and memory problems (Mueser & Gingerich, 2006). Tardive dyskinesia typically 20 emerges several months after the commencement of treatment and is potentially a lifelong condition (Weiden et al. It usually consists of involuntary movements of the head, tongue, lips, hands and feet and can affect speech, posture and sometimes breathing (Birchwood & Jackson, 2001; Jones & Buckley, 2006; Mueser & Gingerich, 2006). Typical presentations of the conditions involve protruding tongue, facial grimaces, and slow rhythmical movements of the hands and feet, sometimes even without the person knowing it (McEvoy et al. The chances of developing tardive dyskinesia can reportedly be reduced by using the lowest possible effective dose of medication (McEvoy et al. Since the development of the new, atypical antipsychotic medications, indications for typical antipsychotic medications are shrinking. McGorry (1992) posits that typical antipsychotic medications, in low dosages, may still have a role amongst a small proportion of consumers, who demonstrated a positive response to typical schedules including remission and good tolerability. They have also been indicated in the acute management of aggression or violence in some patients in the past (McEvoy et al. Advantages of typical antispychotic medications over atypical antipsychotic medications include greater medication familiarity for some consumers and clinicians and they are less expensive (Weiden et al. The development of atypical antipsychotic medications has also increased the probability of finding a suitable drug for individuals with schizophrenia, as there are now more options available to consumers and practitioners (Janssen et al. The wider choice offered by the advent of atypical medications, in addition to their increased tolerability, have been associated with more sustained adherence to prescriptions (Liberman & Kopelowicz, 2005). Clozapine, the first atypical antipsychotic medication, manufactured in 1959, was first tested in the 1970s and was discontinued due to serious blood reactions (Weiden et al.
In such cases proven 5mg buspirone anxiety symptoms quiz, the combination of peaks is integrated to obtain reproducible peak areas. Representative reconstructed ion chromatograms of a blank poultry muscle sample spiked at target level with the ß-lactams showing the least abundant product ion of each compound’s hydrolysis reaction product. Taking this into account, the linearity over the calibration range is above the criterion of 0. From the linear calibration lines, it is concluded that the within-sample variation is limited and thus it is most likely that the observed deviations are caused by matrix effects and could be resolve if an isotopically labeled internal standard would be available. Based on these outcomes it is concluded that the presented method is suitable for quantitation of the amount of ß-lactams present in poultry muscle at relevant levels except for biapenem. The method is suitable for qualitative analysis of biapenem and thus for monitoring biapenem use in poultry breeding. The method also proved suitable for the detection of cephalosporins and carbapenems at relevant levels. Therefore the calculated values could easily be verified using the available data. For each ß-lactam reaction product, two product ions were selected and based on those the probability of an interfering signal (P(I)) was -7 calculated [81]. If P(I) was above 2 * 10, being a suitable criterion for selectivity as previously proposed [81], as was the case for penicillin G, penicillin V, oxacillin, cefapirin, ceftiofur, cefquinome, imipenem and faropenem, an additional product ion was selected for confirmatory analysis to assure sufficient selectivity. Only for ceftiofur and cefquinome a neutral loss of piperidine was included as the third transition, not to compromise sensitivity too much. Using these ion transitions, no interferences at the retention times of the ß-lactam reaction products were observed in the chromatograms of the blank samples (n=21). Ruggedness Some slight deviations to the procedure that might occur in practice were tested in triplicate: (1) hydrolysis for an additional 60 min, (2) evaporation of the eluent until dryness and leaving the test tubes in the evaporator for 30 min, and (3 and 4) adjustment of the pH of the extract to pH 6. For faropenem and ertapenem a decrease in peak response is observed of approximately 30 %. An incubation time of 60 min was found to be a good 272 Chapter 5 compromise and because internal standards are used for quantitation, slight deviations of the incubation time are acceptable. No degradation of the compounds was observed during prolonged evaporation, except for cefacetrile which showed a drop in the signal of 15 % when left in the evaporator unit 30 min. It is concluded that for this specific compound, the centrifuges tubes should be removed from the evaporator unit directly after dryness. It was found that penicillin solutions in methanol are stable for at least 3 months at < -18 °C with the exception of ampicillin and penicillin G, which are stable for 2 months under these storage conditions. As the penicillins, the the cephalosporins and carbapenems are unstable in methanolic solutions, stored at 4 °C during 2 months, with exception of ceftiofur. When storing the solutions at - 18 °C the cephalosporins and faropenem remain stable during at least two months. The carbapenems seem to drop in response for 10 – 30 % and remain stable afterwards. To prevent degradation of the stock solutions it was decided to store them at < -70 °C. The stability of poultry muscle extracts showed that even if extracts are stored at -18 °C for 7 days, results similar to those for fresh extracts are obtained. It is concluded that muscle extracts obtained with the described method are stable for at least 7 days when stored at -18 °C. Stability of 10 mg L methanolic solutions of cephalosporins and carbapenems during storage at -18 and +4 °C. Compound Relative response compared with t=0 (%) +4 °C -18 °C t = 1 month t = 2 months t = 1 month t = 2 months Cefalexin 87 65 96 98 Cefapirin 85 66 99 99 Cefquinome 89 68 99 100 Ceftiofur 99 97 100 99 Cefacetrile 81 55 97 93 Cefazolin 83 62 96 94 Cefalonium 44 13 97 95 Cefoperazone 85 63 99 98 Imipenem 31 14 85 82 Biapenem 12 2 72 75 Meropenem 50 25 87 87 Doripenem 43 19 86 89 Ertapenem 59 34 86 91 Faropenem 85 81 99 98 Application to routine samples Ceftiofur incurred tissue samples, obtained from chicken that were slaughtered four, eight and 24 hours after intramuscular injection of ceftiofur, were analysed using the presented method (n=3 per group). The results were compared to the results of a previously presented method which was found to give comparable results to a routinely applied method [76]. For the samples obtained four hours after treatment the average ceftiofur concentration of the presented method -1 -1 was 625 µg kg and 587 µg kg for the other method. For the samples taken eight -1 hours after treatment this was 273 respectively 247 µg kg, and 24 hours after -1 treatment 42 respectively 52 µg kg. In all three cases, no statistically significant differences were observed between the results of both methods. From this it is concluded that the method presented here is suitable for detection of incurred poultry muscle samples.
Additionally 5 mg buspirone mastercard anxiety after eating, offensive language fellow laboratory employee and behavior with sexual connotations are forms of C. These documents must be located in an hazardous chemicals address which of the easily accessible place so that all employees have following conditions? Physical characteristics of the chemical once per year during safety inservice training. Specific health hazards associated with the review should reflect the job description used at the chemical time of hire. All of these options job description that states the responsibilities and Education and management/Laboratory regulation activities of the position. Job performance criteria and safety/1 and the rating system used should be clearly stated and available to the employee. Which regulatory agency mandates the following Answers to Questions 41–45 requirements for protection of employees of clinical laboratories? All clinical laboratories in the United States The law requires health care providers to safeguard B. Environmental Protection Agency laboratories and to provide patients with a compliance statement D. Industrial laboratories that defines who is entitled to receive their health Education and management/Apply knowledge of lab information. The physician ordering the tests as regulations/1 well as health care workers directly involved with the patient are allowed to see laboratory results. Records of a patient’s laboratory test results may Laboratory results may also be released to the be released without the prior consent of the patient patient’s insurance provider, and to medical review to all of the following except: officers, and public health officials. All of these options Education and management/Apply knowledge of quality performance/2 45. Improve overall wages for lab employees Education and management/Quality improvement/2 532 Chapter 9 | Education and Management 46. Which of the following is not an appropriate Answers to Questions 46–51 guideline for phlebotomists to follow in order to prevent a malpractice lawsuit? Use aseptic venipuncture technique at all times prevention measures include treating people equally; D. Label specimens only after the blood has been securing informed consent before testing; and drawn listening to patients’ concerns. High school diploma requirement for job performance and is listed in Education and management/Regulation lab/2 the job description. Arrest record for driving under the influence quality control functions are common parameters of alcohol that must be considered. C Point-of-care testing saves time and is invaluable for Education and management/Labor law/2 patient care. When a device is used at the bedside of a patient to produce a laboratory result, it is 49. Some devices used instruments for point-of-care testing utilize equivalent quality C. Tracking of uncrossmatched blood units in control, usually electronic simulation of the Blood Bank measurement that takes place with disposable D. All testing done to the patient to save time and it is applied in the clinical laboratory to reduce B. Any clinical lab testing done at the patient’s five steps: define, measure, analyze, improve, and bedside control. Satellite lab testing so precise that six times the standard deviation Education and management/Laboratory economics/2 still results in a useful product (laboratory test result that is within acceptable limits for total allowable 51. All of these options Education and management/Apply knowledge of quality assurance/1 Chapter 9 | Education and Management 533 52. Go directly to the emergency department for will be documented in the laboratory’s chemical treatment hygiene plan. Report directly to her immediate supervisor basic functions such as test ordering and worklist Education and management/Laboratory operations/ generation through real-time interfaces with Safety/1 laboratory instruments, quality control and assurance management, inventory control, and production of 54. In addition, they are capable of algorithm based on the delta check process to immediate decision making based on validated identify erroneous results. Electronic crossmatching laboratories on all nonwaived tests at least one time before the test is performed on patient samples.
Red blood cells made from the used for intrauterine transfusion; units intended whole blood were transfused to a recipient of a for immunocompromised patients who are community hospital in June with no apparent seronegative; prospective transplant recipients who complications 10 mg buspirone anxiety symptoms 101. Te blood supplier notified the are seronegative; or transplant recipients who have medical director of the hospital that the donor received a seronegative organ. Repeat the reverse grouping using A1 cells that inconclusive are negative for M antigen D. Repeat the reverse grouping using A1 cells that nonsecretor are positive for M antigen Blood bank/Evaluate laboratory data to make D. A The blood typing result demonstrates A antigen on Mixed field 0 1+ 4+ the red cells and anti-B in the serum. Type patient cells with anti-A1 lectin and type agglutination when A1 cells were added. Retype patient cells; type with anti-H and H antigen; therefore, the H antigen in the saliva anti-A,B; use screen cells or A2 cells on patient would be bound by anti-H reagent. No agglutination serum; run patient autocontrol would occur when the O cells are added. A positive reaction with anti-A,B would help to differentiate an A subgroup from group O. If A2 cells are not agglutinated by patient serum, the result would indicate the presence of anti-A1. If the patient’s serum agglutinates A2 cells, then an alloantibody or autoantibody should be considered. B The scenario showed an antibody in the patient serum directed toward the M antigen, and the M antigen happened to be on the A1 cells in reverse grouping. An Rh phenotyping shows the following results: department of a community hospital complaining Anti-D Anti-C Anti-E Anti-c Anti-e of dizziness and fatigue. History included no 4+ 2+ 0 0 3+ transfusions and a positive rheumatoid factor 1 year ago. Fearing the sample would clog the ProVue, testing was performed Blood bank/Apply knowledge of fundamental using the tube method. An obstetric patient, 34 weeks pregnant, shows Anti-A Anti-B Anti-D Rh Control A1 cells B cells a positive antibody screen at the indirect 0 0 4+ 2+ 4+ 4+ antiglobulin phase of testing. She has with saline, and testing was repeated giving the no prior history of transfusion. What is the most following results: likely explanation for the positive antibody screen? She has developed an antibody to fetal red cells Anti-A Anti-B Anti-D Rh Control A1 cells B cells B. She received an antenatal dose of RhIg Crossmatch testing using two O-positive donor D. Run the crossmatch using the Gel system plasma proteins causing a positive result with the D. Perform a saline replacement technique Blood bank/Correlate clinical and laboratory data/Rh to rectify the incompatible crossmatches at discrepancy/3 immediate spin. Run a saline control in forward grouping pregnant, she probably has not formed any atypical D. Although technical error cannot be ruled out, it is far less likely than RhIg administration. What technique(s) may be helpful to anti-Jka (reaction enhanced) and anti-Fya (destroyed). Lowering the pH and increasing the incubation help to reveal an additional antibody or antibodies. Because the detection of Kidd more clinically significant antibodies may be antibodies is subject to dosage effect, selection of revealed? Adsorption with homozygous cells would also react more strongly in the presence of D. However, because this patient was recently anti-Jka, but the antibody identification panel does transfused, the variation in reaction strength may be not fit this pattern conclusively.
It is characterized by paroxetine [722] cheap 10 mg buspirone visa anxiety symptoms social, sertraline [819], and high-dose fluoxetine the presence of obsessions (persistent, intrusive [820] have demonstrated reductions in relapse rates. Open trials have macotherapy appears to be superior to pharmacotherapy Katzman et al. Third-line agents, ing actual or threatened death, serious injury, or sexual adjunctive therapies, as well as biological and alternative violation [26]. It is characterized by intrusive and distres- therapies may be useful when patients fail to respond to sing memories or dreams, dissociative reactions, and sub- optimal treatment trials of first- and second-line therapies stantial psychological or physiological distress related to used alone and in combination. Onset is generally in the mid to of “traumatic event,” and there are now four symptom late 20s [2], and the prevalence is about twice as high clusters rather than three with the “avoidance” and “numb- among women versus men [849,851]. Psychotherapy individual debriefings only; there is insufficient evidence has demonstrated significant efficacy, although a meta- to comment on the utility of group debriefings. Imaginal gated, in part because they can be administered remotely appears to be as effective as in vivo exposure [69,916]. When used as an adjunct to lished through the internet, which improved the treatment exposure therapy, cognitive restructuring may improve process [936]. In this regard, ment effects of exposure therapy [953,954], and may in Bradley et al. Addition- that benefits are maintained at six- to 18-month assess- ally, numerous studies fail to report whether patients ments after treatment [923,955-958]. Conflicting results may be related to the types of and are summarized in Tables 29 and 30. Debriefing of all trauma victims is not Maintenance pharmacological treatment recommended, rather, screening and treating appropriate Long-term therapy has been evaluated in relapse- individuals is preferred. In general, there is little evidence prevention and naturalistic follow-up studies. Benefits are maintained during placebo over approximately six months (odds ratio for long-term follow-up of up to one to 10 years after treat- relapse was 0. Therefore, augmentation with second- or third-line agents may be Biological and alternative therapies important early in treatment. In general, these therapies may be useful for some Patients who do not respond to multiple courses of ther- patients; however, more data are needed. Third-line agents, ments were maintained at two to three months after treat- adjunctive therapies, as well as biological and alternative ment [1078,1079]. Anxiety disorders small trials; and in a small case series, patients with during the perinatal period are increasingly gaining Katzman et al. Although further investigation is that is gaining increasingly more research attention. The Canadian Hospital for Sick Children Anxiety and related disorders during pregnancy or Motherisk website (http://www. While studies report that Antidepressants: Thereappearstobelittleevidenceofan maternal anxiety disorders are associated with adverse association between maternal antidepressant use and pregnancy outcomes such as a shorter gestational age, increased risks of congenital malformations in general, and premature delivery, or elective cesarean delivery major congenital malformations in infants [1110-1113]. Anxiety symptoms during pregnancy cally, although the clinical significance of this has been have been associated with depressive symptoms, sub- questioned [1108,1113-1117]. There have been reports of stance use, and anemia, as well as decreased use of prena- increased rates of spontaneous abortion following antide- tal vitamins [1093,1097-1099]. Mothers with anxiety disorders have with higher study quality but found by others who included been found to be less promoting of psychological auton- all studies [1118-1120]. Systematic reviews suggest that strong empirical support for the treatment of anxiety and overall prenatal exposure to antidepressants does not related disorders [63,70,71,1104], but evidence of their appear to be associated with changes in long-term neuro- efficacy in perinatal women with anxiety disorders is cognitive or behavioral development in children lacking. Thelackofdataontheuseofstructuredpsychosocial In terms of breastfeeding, potential risks of antidepres- interventions for anxiety and related disorders during the sant use during lactation must be weighed against the perinatal period is a significant gap in the literature. Antidepressants are It is important to consider the risks and benefits of excreted into breast milk and although data are limited, pharmacotherapy during pregnancy and while breastfeed- the majority are found in very low amounts with few iso- ing during the postpartum period. If antidepressant newborn should be weighed against that of the potential treatment is indicated, sertraline or paroxetine is preferred harm of untreated anxiety and related disorders, an area [1136]. A recent meta-analysis did not find an decisions should be made with the most up-to-date infor- increased risk of major malformations or cardiac defects mation with the best course of action decided upon with following prenatal benzodiazepine exposure, but con- the patient.
Be sure to tell the Pharmacist at each visit if you are having any problems with your medications cheap buspirone 10 mg with amex anxiety vs panic attack. Food and Drug Administration entitled, “Safe Medical Treatments: Everyone has a role. Regardless of the medication, you took a risk, because giving a drug safely involves many steps, some beyond your control. In this article, the explanation to what questions to ask to help minimize medication errors will be explained. It will test your critical thinking skills and help you get answers to the Who, What, When, Where, Why, and How of drug therapy. Accept an order only from a health care provider who has appropriate licensure and credentials to practice in your state and who’s authorized to prescribe drugs in your health care agency. Typically, this includes a Physician, Nurse Practitioner, Physician Assistant, and Dentist. Some facilities permit Clinical Pharmacists to order drugs and appropriate lab tests based on established physician approved protocols. Make sure the medication order contains all the necessary components: your child’s name plus the drug name, dose, frequency of administration, and route. If an order is illegible or you have questions, do not administer the drug until you call your Physician for clarification. Some orders are based on established protocols, such as bowel protocols in long term care facilities. If you receive such an order, be sure to specify the drug name, its dosage, frequency, time, and route on the medication administration record. Consult your agency’s policy for appropriate medication administration times; keeping in mind that scheduling should be flexible to meet the child’s needs. Some drugs should be taken with food or after meals to maximize their effectiveness or minimize adverse reactions. For example, if your child needs three cardiovascular drugs once a day, you may need to stagger them to prevent an adverse drug-drug interaction. Some cardiovascular drugs cause bradycardia and hypotension, and receiving three at once could increase the risks. The Pharmacist may recommend dosing times based on the physiologic processes that follow predictable patterns. For example, bronchial patency and airflow are typically decreased in the early morning and at their peak in the afternoon. For this reason, one dose of Theophylline in the evening may be more effective than multiple doses throughout the day. Similarly, some antihypertensive agents must be given at a specific time to reach their peak effect at the correct time. In a hospital, the pharmacy generally delivers needed drugs to each nursing unit at scheduled times. Your facility may use one of the approaches to dispense them: A unit dose system of individually wrapped doses kept in the medication cart. Stock medications commonly used for the patients in the unit; these drugs are kept on hand and replenished by the pharmacy as needed. Storing commonly used drugs or prescribed patient doses, it can automatically charge the patient and record that you gave him a drug and when. You need to know the therapeutic effect of any drug you give your child and whether it is appropriate for his condition. Also review pertinent data that affect whether you can safely administer it, such as blood pressure, lab results, and pain level for your child. If the ordered dosage is not within the recommended range, clarify the order with the Physician. When preparing a unit dose oral medication, do not open the package until you enter your child’s room.
