Medication intake

Practical Problems Related to the Patients Medication Intake... 

Keywords Practical problems Generic drug Analogue drug Medication intake Food interactions... 

Pharmacists need to know patients prescription and nonprescription medication intake use of nutritional supplements that may be pharmacologically active, physical, and psychiatric diagnoses and relevant laboratory test data when they are available. Usually, that information is available from the primary physician s referral and the documentation from the intake interview. Frequently, laboratory test data are not available because of the hospice philosophy of only doing tests that will directly affect patient outcomes. Renal function often can be estimated from the quantity and quality of the patient s urinary output balanced against intake. Carelhl dose titration is often needed in the absence of laboratory test data as patients metabolic and elimination capabilities decline. Sometimes, pharmacists make home vi.sils to get more complete medication histories, and to ascertain the family s understanding of medications and ability to administer them correctly. 

DILI is a term that describes a condition in which medical intake of a drag(s) causes an individual to have abnormalities in liver tests, often manifested by an increase in serum ALT levels. DILI can cause severe liver injury, with the most catastrophic consequence being acute liver failure leading to death or requiring a liver transplant (Ulrich 2007). It has been estimated that around 60% of all cases of acute liver failure are caused by drugs (Kaplowitz 2005 Ostapowicz et al. 2002). The clinical cases of acute liver failure due to DILI are primarily due to overdose of APAP ( 50% of acute liver failure due to drugs) and drugs that cause idiosyncratic liver injury (-10%). 

Under psycho-physical, dietary, and environmental stress conditions, or after medication intake, there is an imbalance of microflora that makes the body susceptible to attack by pathogens. A proper diet is one of the main factors that influence the qualitative and quantitative composition of intestinal microflora. The most common approach involves the consumption of traditional foods, such as yogurt and fermented milk, which essentially contain probiotics, defined as live microorganisms, which can positively affect the host by improving its intestinal microbial balance. 

Part 2 Prior to anesthesia induction, the patient is identified again by name and birth date, which are compared with ID bracelet and records. The scheduled surgical procedure is confirmed by the patient, and the surgical site marking by the OR staff. A brief review of patient s written informed consent, allergies, fasting interval, airway anatomy, ordered antibiotic prophylaxis, availability of blood products and readiness of anesthesia equipment is completed. Specifically in these patients, preoperative information is verified on correct medication intake, on fluid restriction orders, the interval since last hemodialysis and residual urinary output. 

Elaborate precautions must be taken to prevent the entrance of Pu iato the worker s body by ingestion, inhalation, or entry through the skin, because all common Pu isotopes except for Pu ate a-emitters. Pu is a P-emitter, but it decays to Am, which emits both (X- and y-rays. Acute intake of Pu, from ingestion or a wound, thus mandates prompt and aggressive medical intervention to remove as much Pu as possible before it deposits in the body. Subcutaneous deposition of plutonium from a puncture wound has been effectively controlled by prompt surgical excision followed by prolonged intravenous chelation therapy with diethylenetriaminepentaacetate (Ca " —DTPA) (171). 

Iodized Salt. Iodized table salt has been used to provide supplemental iodine to the U.S. population since 1924, when producers, in cooperation with the Michigan State Medical Society (24), began a voluntary program of salt iodization in Michigan that ultimately led to the elimination of iodine deficiency in the United States. More than 50% of the table salt sold in the United States is iodized. Potassium iodide in table salt at levels of 0.006% to 0.01% KI is one of two sources of iodine for food-grade salt approved by the U.S. Food and Dmg Administration. The other, cuprous iodide, is not used by U.S. salt producers. Iodine may be added to a food so that the daily intake does not exceed 225 p.g for adults and children over four years of age. Potassium iodide is unstable under conditions of extreme moisture and temperature, particularly in an acid environment. Sodium carbonate or sodium bicarbonate is added to increase alkalinity, and sodium thiosulfate or dextrose is added to stabilize potassium iodide. Without a stabilizer, potassium iodide is oxidized to iodine and lost by volatilization from the product. Potassium iodate, far more stable than potassium iodide, is widely used in other parts of the world, but is not approved for use in the United States. 

Maintenance doses widely vary among patients (e.g., from 1 to 20 mg/day for warfarin), and are influenced by diet (variable vitamin K intake) and medications that affect coumarin metabolism (decreased drug clearance e.g., cotrimoxazole, amiodarone, erythromycin increased clearance e.g., barbiturates, carbamaze-pine, rifampin). Thus, regular monitoring is needed... 

Due to bleeding risk, individuals on anticoagulant therapy or individuals who are vitamin K-deficient should not take vitamin E supplementation without close medical supervision. Absent of that, vitamin E is a well-tolerated relatively non-toxic nutrient. A tolerable upper intake level of 1,000 mg daily of a-tocopherol of any form (equivalent to 1,500 IU of RRR a-tocopherol or 1,100 IU of all-rac-a-tocopherol) would be, according to the Food and Nutrition Board of the Institute of Medicine, the highest dose unlikely to result in haemorrhage in almost all adults. 

Attention to iron metabolism is particularly important in women for the reason mentioned above. Additionally, in pregnancy, allowances must be made for the growing fetus. Older people with poor dietary habits ( tea and toasters ) may develop iron deficiency. Iron deficiency anemia due to inadequate intake, inadequate utilization, or excessive loss of iron is one of the most prevalent conditions seen in medical practice. 

KNEKT p, JARIVNEN R, REUNANEN A, MAATELA J (1996) Flavonoid intake and coronary mortality in Finland a cohort study, British Medical Journal, 312, 478-81. 

HF medications deserves special attention, as it is the most common cause of acute decompensation and can be prevented. As such, an accurate history regarding diet, food choices, and the patient s knowledge regarding sodium and fluid intake (including alcohol) is valuable in assessing dietary indiscretion. Nonadherence with medical recommendations such as laboratory and other appointment follow-up can also be indicative of non-adherence with diet or medications. 

Most healthy adults with diarrhea do not develop dehydration or other complications and can be treated symptomatically by self medication. When diarrhea is severe and oral intake is limited, dehydration can occur, particularly in the elderly and infants. Other complications of diarrhea resulting from fluid loss include electrolyte disturbances, metabolic acidosis, and cardiovascular collapse. 

Interview the patient and/or caregivers to obtain a complete medical history, which should include family medical history, current and past prescription and nonprescription medications, and dietary intake. Determine whether the patient is taking medication/supplements that could interfere with the therapy. 

Electrolytes are involved in many metabolic and homeostatic functions, including enzymatic and biochemical reactions, maintenance of cell membrane structure and function, neurotransmission, hormone function, muscle contraction, cardiovascular function, bone composition, and fluid homeostasis. The causes of electrolyte abnormalities in patients receiving PN may be multifactorial, including altered absorption and distribution excessive or inadequate intake altered hormonal, neurologic, and homeostatic mechanisms altered excretion via gastrointestinal and renal losses changes in fluid status and fluid shifts and medications. 

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