INDEX contraindications

Lithium is a drug with a narrow therapeutic index and therefore plasma concentrations are regularly monitored. Lithium is used in the prophylaxis and treatment of mania. Concurrent administration of lithium and diuretics, particularly the thiazides, is contraindicated as lithium excretion is reduced, resulting in increased plasma-lithium concentration and hence toxicity. 

A good look at the index of this book indicates the items commonly encountered in examinations. The index is an exhaustive one and is divided into proprietary names, generic names, subject areas and conditions. A self-assessment exercise is to check that you have adequate knowledge of examples of the topics listed above and then attempt the tests. A review of the drugs in the index provides examples of medicines that certainly need attention. You should be familiar with the action, classification, side-effects, clinically significant drug interactions, contraindications and cautions of a number of classes of drugs, such as ... 

Using the index it is possible to gain an insight into the selection of drugs covered in such examinations. Check that you know the meaning of the conditions listed in Appendix B and make lists of medicines that are indicated and contraindicated or that may precipitate the condition. 

This patient s obesity would also contraindicate CHCs, which should generally be avoided in women with a body mass index >35 kg/m. ... 

Longer-term use is more problematic, given the probable increase (though < 2-fold) in fhe risk of breast cancer associated with extended use. Reasonable candidates are the small proportion of postmenopausal women with documented osteoporosis or osteopenia (decreased bone density) or those at increased risk for osteoporosis (personal or family history of nontraumatic fracture, ciurent smokers, or those with a body-mass index < 22) who do not have a personal or family history of breast cancer or other contraindications and who are willing to try this therapy. With more long-term... 

Be sure that the list of medications a client is taking is updated. If it cannot be easily tracked in the client s record, other ways of providing this information should be instituted. For example, the social worker can help the client to create an index card that lists current and past medications. The client should have the card available for review at every appointment with a health care provider. Be sure that all medications are listed including the name, dose, number, and date of last refill. By ensuring that all providers are aware of what a client is taking, problems with duplicate prescriptions, drug interactions and side effects, contraindicated medications, and errors in dosages can be avoided. 

A critical issue for the successful development of such systems is the creation of a solid indexing system, since the success of a diagnosis depends heavily on the selection of the best stored case. Any misdirection can lead a query down a path of secondary symptoms and factors. It is therefore very important to establish an indexing system that will effectively indicate or contraindicate the applicability... 

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