Estrace

By Y. Thorek. Olin College of Engineering. 2018.

Another effect buy 1mg estrace overnight delivery women's health best body meal plan reviews, associated water and plasma volume estrace 1 mg on-line women's health big book of exercises barnes and noble, decreased receptor sensitivity to with long-term use or higher doses, leads to sodium and fluid vasopressor substances such as angiotensin, direct arteriolar retention and a need for concurrent diuretic therapy. Cen- vasodilation, and arteriolar vasodilation secondary to elec- trally acting sympatholytics (eg, clonidine) stimulate pre- trolyte depletion in the vessel wall. When these drugs are taken, less to a diuretic alone, the diuretic may be continued and another norepinephrine is released and sympathetic outflow from the antihypertensive drug added, or monotherapy with a differ- vasomotor center is reduced. Stimulation of presynaptic ent type of antihypertensive drug may be tried. Reduced sympathetic activity commonly used in the management of hypertension. Loop CHAPTER 55 ANTIHYPERTENSIVE DRUGS 803 diuretics (eg, furosemide) or potassium-sparing diuretics • Oral contraceptives, corticosteroids, appetite sup- (eg, spironolactone) may be useful in some circumstances; pressants, nasal decongestants, non-steroidal anti- see Chapter 56 for discussion of diuretic drugs. Vasodilators (Direct Acting) • Check blood pressure accurately and repeatedly. As a rule, multiple measurements in which systolic pressure Vasodilator antihypertensive drugs directly relax smooth is above 140 mm Hg and/or diastolic pressure is above muscle in blood vessels, resulting in dilation and decreased peripheral vascular resistance. They also reduce afterload and 90 mm Hg, are necessary to establish a diagnosis of may be used in management of heart failure. These drugs have a limited effect surements cannot be overemphasized because there on hypertension when used alone because the vasodilating are many possibilities for errors. Some ways to im- action that lowers blood pressure also stimulates the SNS and prove accuracy and validity include using correct triggers reflexive compensatory mechanisms (vasoconstric- equipment (eg, proper cuff size), having the client tion, tachycardia, and increased cardiac output), which raise rested and in the same position each time blood pres- blood pressure. This effect can be prevented during long-term sure is measured (eg, sitting or supine with arm at therapy by also giving a drug that prevents excessive sym- heart level), and using the same arm for repeated mea- pathetic stimulation (eg, propranolol, an adrenergic blocker). These drugs also cause sodium and water retention, which • In most cases of early hypertension, elevated blood may be minimized by concomitant diuretic therapy. If symptoms do occur, they are usually nonspecific (eg, headache, weakness, fatigue, tachycardia, dizziness, palpitations, INDIVIDUAL DRUGS epistaxis). Antiadrenergic drugs are discussed in Chapter 19 and pectoris, myocardial infarction, or heart failure. Antihypertensive agents are pain, tachycardia, dyspnea, fatigue, and edema may shown in the Drugs at a Glance: Antihypertensive Drugs; occur. Brain damage may be indicated by transient antihypertensive-diuretic combination products are listed ischemic attacks or strokes of varying severity with in Drugs at a Glance: Oral Antihypertensive Combination symptoms ranging from syncope to hemiparesis. Ophthalmoscopic examination may reveal hem- orrhages, sclerosis of arterioles, and inflammation of Nursing Process the optic nerve (papilledema). Because arterioles can be visualized in the retina of the eye, damage to retinal Assessment vessels may indicate damage to arterioles in the heart, brain, and kidneys. These include: • Decreased Cardiac Output related to disease process or • Obesity drug therapy • Elevated serum cholesterol (total and low-density • Ineffective Coping related to long-term lifestyle changes lipoprotein) and triglycerides and drug therapy • Cigarette smoking • Noncompliance related to lack of knowledge about hyper- • Sedentary lifestyle tension and its management, costs and adverse effects of • Family history of hypertension or other cardiovascular disease drug therapy, and psychosocial factors • African-American race • Disturbed Body Image related to the need for long-term • Renal disease (eg, renal artery stenosis) management and medical supervision • Adrenal disease (eg, hypersecretion of aldosterone, • Fatigue related to antihypertensive drug therapy pheochromocytoma) • Deficient Knowledge related to hypertension, anti- • Other cardiovascular disorders (eg, atherosclerosis, left hypertensive drug therapy, and nondrug lifestyle ventricular hypertrophy) changes • Diabetes mellitus • Sexual Dysfunction related to adverse drug effects 804 SECTION 9 DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM Planning/Goals clothing, too loosely, deflated too rapidly, or reinflated be- The client will: fore completely deflated; a regular-sized cuff used on large arms that need a large cuff; using the stethoscope di- • Receive or take antihypertensive drugs correctly aphragm rather than the bell). It is disturbing to think that • Be monitored closely for therapeutic and adverse drug antihypertensive drugs may be prescribed and dosages effects, especially when drug therapy is started, when changed on the basis of inaccurate blood pressures. PRINCIPLES OF THERAPY Preventive measures are mainly lifestyle changes to reduce risk factors. These measures should be started in childhood Therapeutic Regimens and continued throughout life. Once hypertension is diag- nosed, lifetime adherence to a therapeutic regimen may be Once the diagnosis of hypertension is established, a thera- necessary to control the disease and prevent complications. If this intervention at community, family, and personal levels in- goal cannot be achieved, lowering blood pressure to any ex- clude the following: tent is still considered beneficial in decreasing the incidence • Participate in programs to promote healthful lifestyles of coronary artery disease and stroke. If hypertension develops in women taking oral intake, regular physical activity, moderate alcohol intake, contraceptives, the drug should be discontinued for 3 to and no smoking). If these modifications do not produce 6 months to see whether blood pressure decreases without goal blood pressure or substantial progress toward goal antihypertensive drugs. Studies also indicate decreased cardio- portance of effective management, especially as related to vascular morbidity and mortality with ACE inhibitors. In addition, several studies blood pressure, options for further management include in- have shown that compliance decreases as the number of creasing the drug dose, substituting another drug, or adding drugs and number of doses increase. If the response is still The nurse can help increase compliance by teaching inadequate, a second or third drug may be added, including the client about hypertension, helping the client make a diuretic if not previously prescribed.

Common adverse Cyclosporine increases the effects of caspofungin generic estrace 1 mg otc menstruation lasting 3 weeks, including effects include GI upset (eg discount estrace 1 mg with amex pregnancy week by week, nausea, vomiting, diarrhea), fa- potential liver damage. Concomitant use is not recommended tigue, headache, insomnia, and skin rash. Griseofulvin may decrease the effects of cy- decrease effects include anti-HIV drugs (eg, efavirenz, nelfi- closporine, oral contraceptives, salicylates, and warfarin. War- navir, nevirapine), anticonvulsants (eg, carbamazepine, pheny- farin doses may need to be increased and an alternative method toin), dexamethasone, and rifampin. Concurrent administration of contraception may be needed during griseofulvin therapy. The 5-fluorouracil is has fungicidal activity against dermatophytes and has been then metabolized to products that interfere with the synthesis used primarily for topical treatment of ringworm infections of fungal RNA and DNA. Flucytosine has little activity and oral treatment of onychomycosis (fungal infection of against molds or dimorphic fungi and is mainly used for yeast nails). It has significant activity against Candida and after drug therapy is stopped, because of the time required Cryptococcus neoformans organisms. It is most often used Candida, Aspergillus, and possibly other fungal organisms, in combination with amphotericin B to treat systemic can- terbinafine is being evaluated for possible use in invasive didiasis and cryptococcal meningitis. If high doses of amphotericin B are tabolism reduces bioavailability to approximately 40%. Levels in CSF reach 60% to Common effects with oral use are headache, diarrhea, and 80% of serum levels. Oral drug may also cause skin reactions CHAPTER 40 ANTIFUNGAL DRUGS 605 and liver failure with long-term therapy of onychomycosis. Planning/Goals Hepatotoxicity is uncommon, but has occurred in people with and without preexisting liver disease and has led to The client will: liver transplant or death. Terbinafine is not recommended • Take or receive systemic antifungal drugs as prescribed for patients with chronic or active liver disease and serum • Apply topical drugs accurately aminotransferases (ALT and AST) should be checked before • Act to prevent recurrence of fungal infection starting the drug. Superficial in- Assessment fections (eg, ringworm) are highly contagious and can be spread by sharing towels and hairbrushes. Specific signs and symptoms mycoses are not usually considered contagious. Some lesions are room and request regular cleaning and inspection of air- moist; others are dry and scaling. For outpatients, assist lesions are likely to occur in perineal and intertriginous to identify and avoid areas of potential exposure (eg, soil areas. They are usually moist, inflamed, pruritic areas with contaminated by chicken, bird, or bat droppings; areas papules, vesicles, and pustules. Oral lesions are white where buildings are being razed, constructed, or reno- patches that adhere to the buccal mucosa. If exposure is unavoidable, instruct to spray areas causes a cheesy vaginal discharge, burning, and itching. For clients at risk of ex- causes chills and fever, myalgia, arthralgia, and prostration. Severe histoplasmosis may to intertriginous areas to help prevent irritation and can- also cause fever, anemia, enlarged spleen and liver, didal growth. In clients with AIDS or other immunosup- • For clients with systemic fungal infections, monitor res- pressant disorders, it often involves the central nervous piratory, cardiovascular, and neurologic status at least system (CNS) and produces mental status changes, every 8 hours. Provide comfort measures and medications headache, dizziness, and neck stiffness. Nodules and ulcers • Observe for relief of symptoms for which an antifungal also may develop in local lymphatic channels and nodes. The infection can spread to other parts of the body in • Interview outpatients regarding their compliance with immunocompromised clients. Nursing Diagnoses • Risk for Injury related to fungal infection Nursing Notes: Apply Your Knowledge • Deficient Knowledge: Prevention of fungal infection; accurate drug usage • Noncompliance related to the need for long-term therapy Harold Johnson has oral candidiasis and is being treated with • Risk for Injury: Adverse drug effects with systemic anti- nystatin 5 cc, S & S, after meals and at bedtime. What nursing fungal drugs considerations are important to ensure therapeutic effect?

Use in Renal Impairment Effects of Acid Suppressant Drugs on Nutrients A major concern with antacids is the use of magnesium- containing preparations (eg cheap estrace 2mg on-line breast cancer awareness images, Mylanta purchase estrace 1mg with amex women's health birth control article, Maalox). These are Dietary folate, iron, and vitamin B12 are better absorbed from contraindicated in clients with impaired renal function an acidic environment. When gastric fluids are made less (creatinine clearance <30 mL/minute) because 5% to 10% acidic by antacids, H2RAs, or PPIs, deficiencies of these nu- of the magnesium may be absorbed and accumulate to cause trients may occur. In addition, antacids with calcium car- sorption of fat-soluble vitamins, and magnesium-containing bonate can cause alkalosis and raise urine pH; chronic use antacids interfere with absorption of vitamin A. Antacids containing aluminum hydroxide (eg, Amphogel, Rolaids) are the antacids of choice in clients with chronic Use in Children renal failure. Aluminum tends not to accumulate and it binds with phosphate in the GI tract to prevent phosphate absorp- Antacids may be given to ambulatory children in doses of tion and hyperphosphatemia. Safety neys, and dosage needs to be substantially reduced in clients and effectiveness of other antiulcer drugs have not been with renal impairment to avoid adverse effects. Although PPIs are not approved by the Food and Drug It also blocks secretion of creatinine in renal tubules, thereby Administration for use in children and are not available in pe- decreasing creatinine clearance and increasing serum creati- diatric dosage formulations, they are widely used in the treat- nine level. With moderate to severe renal impairment, recom- CHAPTER 60 DRUGS USED FOR PEPTIC ULCER AND ACID REFLUX DISORDERS 879 mended dosages include cimetidine 300 mg every 12 hours, are the strongest gastric acid suppressants and are usually ranitidine 150 mg orally once daily or intravenously every 18 well tolerated. For clients who cannot take drugs orally, pan- to 24 hours, and famotidine 20 mg at bedtime or every 36 to toprazole can be given IV. Dosage may be cautiously increased if stress-induced gastric ulceration in adults and children. For cept for renal impairment, in which dosage must be reduced, clients on hemodialysis, an H2RA should be given at the end information about the pharmacokinetics of these drugs in of dialysis. Compared with healthy people, crit- ically ill clients had a longer half-life and lower clearance rate Use in Hepatic Impairment for H2RAs. Ranitidine or famotidine is preferred because criti- PPIs are metabolized in the liver and may cause transient ele- cally ill clients often require numerous other drugs with vations in liver function tests. With omeprazole, bioavailabil- which cimetidine may interact and alter effects. Nizatidine is ity is increased because of decreased first-pass metabolism, not available in a parenteral formulation. Lansoprazole and rabeprazole should be used cautiously and dosage should be reduced in Home Care clients with severe liver impairment. H2RAs are partly metabolized in the liver and may be All of the antiulcer, anti-heartburn drugs are commonly taken eliminated more slowly in clients with impaired liver func- in the home setting, usually by self-administration. A major concern with cimetidine is that it can inhibit care nurse can assist clients by providing information about hepatic metabolism of many other drugs. If cimet- idine is being taken, the home care nurse needs to assess for potential drug–drug interactions. With OTC H2RAs, clients Use in Critical Illness should be instructed to avoid daily use of maximum doses for longer than 2 weeks. If use of antacids or OTC H2RAs seems Gastric acid suppressant drugs (eg, PPIs and H2RAs) and su- to be excessive or prolonged, the client should be assessed for cralfate, are commonly used in critically ill clients. NURSING Antiulcer Drugs ACTIONS NURSING ACTIONS RATIONALE/EXPLANATION 1. Enteric-coated, delayed-release soprazole capsule can be opened and the granules mixed granules are in oral capsules or separate packets. Chewing or crush- with 60 mL of orange or tomato juice or sprinkled on 1 table- ing destroys the coating; mixing the granules with applesauce or spoon of applesauce, Ensure pudding, cottage cheese, or other acidic substances preserves the coating of the granules, yogurt, and swallowed immediately, without chewing. Use the in-line filter provided; if injecting in a Y-site, the filter should be placed below the Y-site closest to the patient. With histamine (H2) blockers: (1) Give single oral doses at bedtime; give multiple oral The drugs are effective and convenient in a single oral dose at doses of cimetidine with meals and at bedtime and other bedtime. For intermittent infusion, dilute in at least 50 mL of 5% dextrose or 0. With antacids: (1) Do not give doses within approximately 1 h of oral H2 Antacids decrease absorption and therapeutic effectiveness of the antagonists or sucralfate.