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He completed his internship and residency in neurology at the Hospital of the University of Pennsylvania generic zyprexa 7.5 mg overnight delivery, followed by fellowship training in movement disorders at Pennsylvania Hospital in Philadelphia purchase zyprexa 5mg on-line. Houghton began his clinical and academic pursuits at the University of Louisville as an assistant professor and clinical director of the Movement Disorder Surgical Program order 20mg zyprexa visa. He joined the Ochsner Health System in New Orleans buy discount zyprexa 5mg online, Louisiana zyprexa 2.5mg on-line, in 2012 as Chief of the Division of Movement and Memory Disorders. Hurtig has conducted clinical research in experimental therapeutics, clinical-pathological correlations of Parkinson’s disease and other parkinsonian syndromes and neuroimaging. Lauren Hawthorne is project specialist at Keck School of Medicine of the University of Southern California. Michael Jakowec, PhD, is associate professor of research neurology at Keck School of Medicine of the University of Southern California. National Parkinson Foundation Educational Books This book is part of the National Parkinson Foundation’s Educational Book Series, which addresses important topics for people with Parkinson’s disease. The National Parkinson Foundation is proud to provide these educational materials at no cost to individuals around the globe. If you find these materials helpful, please consider a gift so that we may continue to fight Parkinson’s on all fronts: funding innovative research, providing support services and offering educational materials such as this publication. Three principles outline the expectations related to Nurses: medication practices that promote public protection. In judgment, and get help as needed, and addition, Nurse Practitioners are accountable for the do not perform medication practices that they are medication practices outlined in the Nurse Practitioner not competent to perform. Safety A glossary of bolded terms is provided at the end of Nurses promote safe care, and contribute to a culture this document. Authority Nurses must have the necessary authority to perform Nurses: medication practices. When a nurse receives a medication order that is unclear, incomplete or inappropriate, the nurse must not perform the medication practice. Reactions may be evident within minutes or years after exposure to the product and may range from minor reactions like a skin rash, to serious and life-threatening events such as a heart attack or liver damage. Controlled Acts: Acts that could cause harm if performed by those who do not have the knowledge, skill and judgment to perform them. Dispensing: To select, prepare and transfer stock medication for one or more prescribed medication doses to a client or the client’s representative for administration at a later time. Drug Diversion: When controlled substances are intentionally transferred from legitimate distribution and dispensing channels. Evidence-Informed: Practice that is based on successful strategies that improve client outcomes and are derived from a combination of various sources of evidence, including client perspective, research, national guidelines, policies, consensus statements, expert opinion and quality improvement data. Medication Error: Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Canadian guideline for safe and effective use of opioids for chronic non-cancer pain©. Our purpose is to inform clinical decision-making concerning the prescribing of medications for older adults in order to improve safety and quality of care. Prescribing and Cardiovascular managing disease conditions should be individualized and involve shared decision-making. The criteria are not applicable in all circumstances (eg, patient’s receiving palliative and hospice care). In n Triprolidine general, rate control is preferred over rhythm control for atrial Antiparkinson agents Avoid. Nonbenzodiazepine Avoid chronic use (>90 days) hypnotics Benzodiazepine-receptor agonists that have adverse events similar Potential for hypotension; risk of precipitating myocardial ischemia. Topical vaginal cream: Ac- n Trimipramine ceptable to use low-dose intravaginal estrogen for the management of dyspareunia, lower urinary tract infec- Antipsychotics, frst- (conventional) and sec- Avoid use for behavioral problems of dementia unless tions, and other vaginal symptoms. Evidence that vaginal estrogens for treatment of vaginal dryness is Increased risk of cerebrovascular accident (stroke) and mortality in safe and effective in women with breast cancer, especially at dos- persons with dementia. Benzodiazepines Avoid benzodiazepines (any type) for treatment of insom- Minimal effect on weight; increases risk of thrombotic events and Short- and intermediate-acting: nia, agitation, or delirium. Glyburide: higher risk of severe prolonged hypoglycemia in older n Triazolam adults.

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Genoptic ointment: Apply a small amount (about 1/2 inch) to the affected eye two to three times a day zyprexa 2.5mg mastercard. Neosporin Ophthalmic Ointment Description: Neosporin Ophthalmic Ointment (neomycin and polymyxin B sulfates and bacitracin zinc ophthalmic ointment) is a sterile antimicrobial ointment for ophthalmic use generic zyprexa 5 mg on-line. Neomycin sulfate is the sulfate salt of neomycin B and C proven zyprexa 7.5mg, which are produced by the growth of Streptomyces Fradiae Waksman (Fam discount zyprexa 20 mg online. It has a potency equivalent of not less than 600 mcgm of neomycin standard per mg buy cheap zyprexa 2.5 mg, calculated on an anhydrous basis. Polymyxin B sulfate is the sulfate salt of polymyxin B1 and B2 which are produced by the growth of Bacillus Polymyxa (Prazmowski) Migula (Fam. It has a potency of not less than 6,000 polymyxin B units per mg, calculated on an anhydrous basis. Bacitracin zinc is the zinc salt of bacitracin, a mixture of related cyclic polypeptides (mainly bacitracin A) produced by the growth of an organism of the Licheniformis group of Bacillus Subtilis var Tracy. Usage: A wide range of antibacterial action is provided by the overlapping spectra of neomycin, polymyxin B sulfate, and bacitracin. Bacitracin is bactericidal for a variety of gram‐ positive and gram‐negative organisms. It interferes with bacterial cell wall synthesis by inhibition of the regeneration of phospholipid receptors involved in peptidoglycan synthesis. Neomycin sulfate, polymyxin B sulfate, and bacitracin zinc together are considered active against the following microorganisms: Staphylococcus Aureus, streptococci including Streptococcus Pneumoniae, Escherichia Coli, Haemophilus Influenzae, Klebsiella/Enterobacter species, Neisseria species, and Pseudomonas Aeruginosa. Neosporin Ophthalmic Ointment is indicated for the topical treatment of superficial infections of the external eye and its adnexa caused by susceptible bacteria. Panalog Dosage: Panalog cream combines nystatin, neomycin sulfate, thiostrepton, and triamcinolone acetonide (potent corticosteroid). Usage: It provides four basic therapeutic effects: anti‐ inflammatory, antipruritic, antifungal and antibacterial. Dosage and Administration: For mild inflammations, application may range from once daily to once a week. For severe conditions Panalog Cream may be applied as often as 2 to 3 times daily, if necessary. Polytrim (trimethoprim & polymyxin) Description: Polytrim Ophthalmic Solution (trimethoprim sulfate and polymyxin B sulfate) is a sterile antimicrobial solution for topical ophthalmic use. Each mL contains trimethoprim sulfate equivalent to 1 mg trimethoprim and polymyxin B sulfate 10,000 units. Trimethoprim is a synthetic antibacterial drug active against a wide variety of aerobic gram‐ positive and gram‐negative ophthalmic pathogens. Trimethoprim blocks the production of tetrahydrofolic acid from dihydrofolic acid by binding to and reversibly inhibiting the enzyme dihydrofolate reductase. This binding is very much stronger for the bacterial enzyme than for the corresponding mammalian enzyme. For that reason, trimethoprim selectively interferes with bacterial biosynthesis of nucleic acids and proteins. When used topically, trimethoprim and polymyxin B absorption through intact skin and mucous membranes is insignificant. Vitro studies have demonstrated that the anti‐infective components of Polytrim are active against the following bacterial pathogens that are capable of causing external infections of the eye: Staphylococcus Aureus and Staphylococcus Epidermidis, Streptococcus Pyogenes, Streptococcus Faecalis, Streptococcus Pneumoniae, Haemophilus Influenzae, Haemophilus Aegyptius, Escherichia Coli, Klebsiella Pneumoniae, Proteus Mirabilis (indole‐negative), Proteus Vulgaris (indole‐ positive), Enterobacter Aerogenes, and Serratia Marcescens. Usage: Polytrim Ophthalmic Solution is indicated in the treatment of surface ocular bacterial infections, including acute bacterial conjunctivitis, and blepharoconjunctivitis, caused by susceptible strains of the following microorganisms: Staphylococcus Aureus, Staphylococcus Epidermidis, Streptococcus Pneumoniae, Streptococcus Viridans, Haemophilus Influenzae and Pseudomonas Aeruginosa. Dosage and Administration: Clinical studies have shown Polytrim to be safe and effective for use in children over two months of age. Tribrissen Description: Tribrissen is a combination of 40 mg trimethoprim and 200 mg sulfadiazine in 30 ml of 24% aqueous suspension for subcutaneous administration. It is active against a wide spectrum of bacterial pathogens, both gram‐ negative and gram‐positive. Tribrissen therapy is indicated in animals where potent systemic antibacterial action against sensitive organisms is required.

Exclude fractures by performing appropriate X-rays Note  Referral must not be delayed by waiting for a diagnosis if treatment is logistically impossible  Closed injuries and fractures of long bones may be serious and damage blood vessels  Contamination with dirt and soil complicates the outcome of treatment I 20mg zyprexa with mastercard. Maximum of 4 doses per 24 hours Plus S: Cloxacillin 500mg 6 hourly for 7 days Plus B: Tetanus prophylaxis: 0 buy 2.5 mg zyprexa free shipping. In children less than 6 months calculate dose by weight  Perform X-ray to rule out dislocations or sublaxations 2 Referral  If Severe progressive pain purchase zyprexa 10 mg without prescription. Hemorrhagic shock may ensue in situations involving multiple fractures or pelvic ring fractures generic 20mg zyprexa overnight delivery. Paralysis may be associated buy 7.5 mg zyprexa free shipping, often been brought by improper transfer of the patient to the hospital. Thus lion, tiger, leopard, hyena, bear, elephant, hippopotamus, buffalo, wolf and wild pig are examples of the wild animals that have bitten man. Clinical features of these bites arise from the pathology inflicted by teeth, tusks, claws and horns. Severe facial and eye innuries are common and pneumothorax, hemothorax, bowel perofration and compound fractures have occurred. Treatment  Emergency surgery is often needed  Replace any blood lost  Treat complications of injury e. Symptoms:Most bites and stings result in pain, swelling, redness, and itching to the affected area Treatment and Management Treatment depends on the type of reaction  Cleanse the area with soap and water to remove contaminated particlesleft behind by some insects  Refrain from scratching because this may cause the skin to break down and an infection to form  Treat itching at the site of the bite with antihistamine  Give appropriate analgesics  Where there is an anaphylactic reaction treat according to guideline. If area burnt is larger than 10% of body surface then this is extensive because of fluid loss, catabolism, anaemia and risk of secondary infection. Table 5: Rule of Nine for calculatin % of Body surface burned Body Areas Adult (%) Child % Entire head 9 18 Upper limb 9 18 Anterior or posterior surface of trunk 18 18 Lower limb 18 14 Perineum 1 1 Treatment Ensure that there is an adequate airway, adequate breathing and adequate circulation  Immerse burnt area in cold water for 10 minutes  Clean with Normal saline or Chlorhexidine – cetrimide solution  Apply Gentian Violet solution  Do not cover  Calculate fluid requirement per 24 hours: weight x % of surface burnt x 2 = quantity of fluid  Give 75% of fluid requirement as sodium lactate compound solution and 25% as 6% Dextran 70 as blood/plasma expanders. In such cases refer to secondary or tertiary level health care centre  Children give A: Paracetamol 10 mg/kg every 8 hours Plus C: Procaine Penicillin 0. Foreign bodies introduced through the mouth (or nose) may be arrested in the larynx, bronchial tree, oesophagus or stomach. Foreign bodies in the stomach rarely produce symptoms and active treatment is usaullynot required. Decision of treatment for carcinoma of the cervix is best done in hospital under specialist care. Primary prevention (screening) and early detection:  Vaccination is now available  Avoid early sex. Histology: Usually Adenocarcinoma Others: Clear cell, small cell carcinomas, sarcomas. Decision of treatment for the uterine carcinoma is best done in hospital under specialist care. Chemotherapy regimen for leiomyosarcoma: 2 S: Adriamycin 40mg/m single agent every 3 wks x 6. Decision of treatment for the vulvo-vaginal carcinoma is best done in hospital under specialist care. Regional/zonal or tertiary depending on treatment expertise Treatment: Predominantly surgical. Radiotherapy: Post- operative radiotherapy is indicated for high risk recurrence (positive 265 | P a g e margins and nodal involvement). Patient presents with abnormal vaginal bleeding during or after pregnancy associated with a “large-for-date” uterus. Decision of treatment for malignant trophoblastic tumours is best done in hospital under specialist care. However increasing abdominal distension, palpable mass in the abdomen, pain and presence of ascites are all late signs. Histologies of epithelial tumours: Serous (cyst) adenoma, mucinous (cyst) adenoma, endometrioid adenocarcinoma, clear cell adenocarcinoma, granulosa cell tumour, theca cell tumour, sertoli-Leydig cell tumour, mixed tumours. Referral: All patients must be referred to a gynecologist for evaluation and decision on mode of treatment. If total tumour removal is not possible, then maximum debulking (cyto-reductive) surgery should be done. Chemotherapy Adjuvant chemotherapy: Is indicated for all unfavourable histologies as well as advanced stages.

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