Medical directives

It is generally not recommended to mix medications directly into the EN formula because of concerns that physical incompatibilities between the medications and the formula might lead to tube occlusion. There is some evidence that polymeric formulas are more likely to demonstrate physical incompatibility with medications compared with monomeric formulas, although most of the work in this area has used casein or caseinate-based formulas, and other proteins may act differently.38 The limited data currently available would indicate that acidic syrups and elixirs may be the worst for causing physical incompatibility when admixed with EN formulas. It has been postulated that this incompatibility is due to changes in the protein structure after exposure to acid or alcohol.38... 

Parenteral Dosage Forms and Invasive Devices. Parenteral and invasive devices provide the distinct advantage of the delivery of medication directly into the bloodstream or at the site of action. Additionally, these methods result in assures patient compliance because, in most cases, an individual other than the patient is responsible for the administration of medication by these means. Unfortunately, this attribute is counteracted by numerous problems that are illustrated in Table 11. 

The pharmaceutical physician provides a medical direction to marketing strategy and ensures that product literature and promotional material are legal and factually accurate. This is an important contribution to the medical department s role as medical conscience, as discussed in Section 10.2. Medical input remains necessary to the servicing and support of marketed products throughout their life cycle. 

Mixing with other medications - Direct mixing of iloprost with other medications in the Prodose AAD system has not been evaluated. 

It is very important to choose medications with the least possibility of making an ill pediatric patient suffer additional morbidity from side effects to medication directed at mood or behavior. For these reasons, mood stabilizers such as lamotrigine (which carries with it the risk of a severely toxic rash) should be seen only as third- or fourth-line agents. 

Monoamine oxidase inhibitors [MAOls] have been historically the most extensively studied class of medications directed against social anxiety. Early... 

Pharmacological treatments were used by nearly half of the 149 services which offered any treatment, with a wide range of medications directed at various features of cocaine usage. Fluoxetine and desipramine were the most frequently prescribed antidepressants, with benzodiazepines used to aid sleep and reduce distress in withdrawal states. Sedative antipsychotics were used, apparently in states of severe agitation as well as more directly for psychotic complications. 

Subcutaneous. Injecting medications directly beneath the skin is used when a local response is desired, such as in certain situations requiring local anesthesia. Also, a slower, more prolonged release of the medication into the systemic circulation can be achieved in situations where this is the desired effect. A primary example is insulin injection in a patient with diabetes mellitus. Subcutaneous administration provides a relatively easy route of parenteral injection that can be performed by patients themselves, providing they are properly trained. 

Halfway around our circuit of the walls, he presented me to the equerry in charge—who looked all of eighteen—and explained that the doge s doctor required me to deliver all medications directly to the patient but I wouldn t need more than a minute. It does help to have influential friends. Three more black robes tottered in and were seated with the rest. Then another equerry entered by the inner door. 

Costs are often separated into direct and indirect costs. Direct costs typically consist of hospitalization costs, physician fees, laboratory fees, and costs of medical treatments/medications. Direct nonmedical costs can include costs of using transportation to and from the medical facility. Thus far, only direct costs have been estimated. Indirect/opportunity costs incurred with the death of a patient or while the individual is undergoing treatment are often expressed as days lost from work and reduced productivity. The so-called intangible costs are the monetary values of the results of pain and suffering. 

According to the Healthcare Distribution Management Association (HDMA—formerly the National Wholesale Druggists Association), there are thousands of wholesalers. Fewer than a half dozen are responsible for a majority of sales. These full-line or full-service wholesalers obtain medications directly from the manufacturers and distribute the medications to pharmacies (both independent and chains), institutions, and other wholesalers. Some chain pharmacies have regional or local distribution centers that receive medications from the wholesaler in large quantities and repackage the medications into package sizes that are more feasible at the store level. 

Have you counseled a patient whom you know did not understand his or her doctors instructions What steps did you take to ensure that the patient thoroughly knew his or her medication, directions, and indication for use ... 

Topical antibiotics may be considered to be advantageous over their systemic counterparts because they deliver a higher concentration of medication directly to the desired area and are less frequently implicated in causing bacterial resistance. An ideal topical antimicrobial has a broad spectrum of activity, persistent antibacterial effects, and minimal toxicity or incidence of allergy. 

The oral route is typically the preferred route for medication administration to pediatric patients. Other routes may be used, if the patient cannot take a medication orally because of vomiting, being unable to swallow, or the medication is imavailable for oral use. In addition, for specific problems it may be better to deliver the medication directly to the area being treated, for example, inhalation, ophthalmic administration, or otic administration. 

The first pass effect occurs when medication is administered orally, is absorbed into the GI tract, and enters the bloodstream. Medication particles are transported through the portal vein into the liver, where the medication is metabolized. Medication can bypass the first pass effect by being administered sublingual (under the tongue) or buccal (between the gums and the cheek). These sites absorb medication directly into the bloodstream and avoid the stomach, where medication particles might be destroyed by hydrochloric acid. 

Do not pour medications directly into your hand. 

Vaginal pessaries and creams are medications directly inserted into the vagina, either with or without the aid of an applicator. Vaginal pessaries and creams are used for a number of purposes ... 

Many of the promotional activities of the pharmaceutical industry are directed at professionals in the healthcare market (doctors, pharmacists, hospitals, etc.), as advertising POM medications directly to the patient is prohibited. However, companies are receiving an increasing number of enquiries directly from patients about their products. This has necessitated the provision of a regulatory Guidance for companies on how to answer such direct requests for information from the general public. 

Medical direction may be provided by a single medical director or by more than one individual. If more than one individual provides medical direction, one individual must be designated as medical director and that person is responsible for approving other individuals involved and for coordinating their activities. 

The medical director and all other individuals designated as providers of medical direction must have medical staff appointments at an inpatient treatment facility, must be involved in the management of poisoned patients, and must regularly consult with Specialists in Poison Information about the management of poisoned patients. 

The individual or individuals providing medical direction must individually or collectively devote at least 20 hours per week of professional activity time to toxicology. An additional 10 hours per week of medical direction time must be provided for each 25,000 human poison exposure cases per year received by the certified poison center, above... 

The time requirements for medical direction are summarized in Table 1. 

Medical backup must be available, in a timely manner, at all times. If not provided by the medical director, medical backup may be provided by those providing medical direction or other individuals designated by the medical director. All medical backup must be provided by board-certified or board-prepared medical toxicologists. Other individuals identified and qualified by the medical director (e.g., fellows, managing director) may serve as immediate certified poison center backup if timely secondary backup is provided at all times by a board-certified or board-prepared medical toxicologist. Direct clinical effort as backup can be applied to item 4.A. above. 

Health care costs can be categorized as direct medical, direct nonmedical, indirect nonmedical, intangible, opportunity, and incremental costs. 

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