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Read carefully purchase 500mg sumycin with mastercard antibiotics for acne work, and save all materials from your employer or union to know your options discount 250 mg sumycin with amex antibiotics uses. You may have to make choices about your employer/union drug coverage and Medicare drug coverage: During your 7-month Initial Enrollment Period purchase sumycin in india infection preventionist salary, when you frst become eligible for Medicare (see page 18 for details) During Open Enrollment buy 250mg sumycin with visa antibiotic cement spacer, between October 15–December 7 each year When your employer/union coverage changes or ends 53 Your Coverage Choices 4 I have Medicare and get drug coverage from a current or former employer or union (continued) Some important questions to answer before making a decision: Is your employer or union drug coverage creditable (on average, does it expect to pay at least as much as standard Medicare drug coverage)? If not, in most cases, you’ll have to pay a late enrollment penalty if you don’t join a Medicare drug plan when you’re frst eligible. Note: Keep materials your employer or union sends you that tell you your drug coverage is creditable. You may need to show it to your Medicare drug plan as proof of creditable prescription drug coverage if you decide to join a Medicare drug plan later. If you don’t enroll when you’re frst eligible, you may have to wait to join a Medicare drug plan until Open Enrollment, which is October 15–December 7. You may be able to do one of these: Keep your current employer or union drug coverage, and join a Medicare drug plan to get more complete drug coverage. If you join a Medicare drug plan later, you may have to pay a late enrollment penalty if your current drug coverage isn’t creditable. Words in Drop your current coverage and join a Medicare drug plan, or red are join a Medicare health plan that covers prescription drugs. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health coverage. If you drop coverage for yourself, you may also have to drop coverage for your spouse and dependents. Medicare doesn’t have information about how your current employer or union drug coverage will be afected by your enrollment in a Medicare drug plan, so talk to your employer or union’s benefts administrator before you make any decisions about your drug coverage. It’ll almost always be to your advantage to keep your current coverage without any changes. It’s almost always on pages to your advantage to keep your current coverage without any changes. Words in Because you have Medicaid, Medicare automatically gives you Extra Help red are with your Medicare drug plan costs. If you live in an institution (like a nursing home), in most on pages cases, you pay nothing for your covered drugs. If you haven’t joined a Medicare drug plan, Medicare will enroll you in a drug plan to make sure you have drug coverage (unless you already have certain retiree drug coverage). Medicare sends you a yellow notice telling you what drug plan you’re in and when your coverage starts. Check to see if the plan covers the drugs you take and includes the pharmacies you use. If you flled any covered prescriptions before your Medicare drug plan coverage started, you may be able to get back some of the money you spent. In limited cases, some state Medicaid programs may pay for drugs Medicare doesn’t cover. If you continue to qualify for Medicaid, Medicaid will still cover the other health care costs that Medicare doesn’t cover. If you aren’t sure whether you still qualify for Medicaid, call your State Medical Assistance (Medicaid) ofce. If you don’t join a Medicare drug plan on your own, Medicare will enroll you in a Medicare Prescription Drug Plan, to make sure you have coverage, unless you already have certain retiree drug coverage. Medicare sends you a yellow or a green notice letting you know when your coverage begins. You can switch to a diferent Medicare drug plan at any time as long as you continue to qualify for Extra Help. You can change your mind and join a Medicare drug plan at any time without paying a late enrollment penalty as long as you continue to qualify for Extra Help. Tis long-term care pharmacy usually contracts with (or is owned and operated by) your institution. Medicaid coverage, you pay nothing for your covered drugs afer Medicaid has paid for your stay for at least one full calendar month. Note: Institutions don’t include assisted living, adult living facilities, residential homes, or any kind of nursing home not certifed by Medicare or Medicaid. If you don’t have Medicaid coverage, you may still qualify for Extra Help paying for Medicare drug coverage. If they don’t cover other drugs, they aren’t creditable prescription drug coverage. If you don’t have creditable prescription drug coverage and delay joining a Medicare drug plan, you may have to pay a late enrollment penalty to join later. Ask your health provider or benefts coordinator if joining a plan is right for you. See your Indian Words in health provider or check with the benefts coordinator at your local red are Indian health pharmacy to get more information on how to join a defned plan. Ask your Indian health care provider for a letter stating you have creditable prescription drug coverage. Use the personal worksheets on pages 68–69 to help decide which plan meets your needs: Step 1: Prepare—Gather information about your current drug coverage and needs. Step 2: Compare—Compare Medicare drug plans based on cost, coverage, and customer service. Tip: Before considering which Medicare drug plan to join, check out how any current health coverage you have could afect your drug coverage choices. Step 1: Gather information about your current drug coverage and needs Before choosing a Medicare drug plan, you may want to gather some information. You need information about any drug coverage you may currently have, as well as a list of the drugs and doses you currently take. Also, gather any notices you get from Medicare, Social Security, or your current Medicare drug plan about changes to your plan. If you have drug coverage, you need to fnd out whether it’s creditable prescription drug coverage. Your current insurer or plan provider is required to notify you each year whether your coverage is creditable prescription drug coverage. If you haven’t heard from your insurer or plan, call the insurer, your plan, or your benefts administrator to fnd out. Request a notice about whether your coverage is creditable prescription drug coverage if you didn’t get one. Also, you may want to consider keeping your creditable prescription drug coverage rather than choosing a Medicare drug plan. Plan name: Monthly Yearly My drugs My drugs Amount Could I Is mail premium deductible that are that aren’t I’d pay for use my order $ $ covered covered each drug pharmacy? Compare the Medicare drug plans based on what’s most important to your situation and your drug needs. Step 3: Decide which plan is best for you, and join Afer you pick a plan that meets your needs, call the company ofering it and ask how to join. Te frst time you use your new Medicare drug plan, you should come to the pharmacy with as much information as possible.

Here are some of the different routes: Oral: when medications are taken by Nasal (into the nose) generic sumycin 250 mg on line antibiotics for dogs eye infection, buccal (placed in the cheek) and mouth purchase generic sumycin online antibiotic lyme disease, in pill order sumycin 250mg free shipping treatment for early uti, capsule or liquid form purchase sumycin 250 mg with visa antibiotics kill acne, sublingual (placed under the tongue) medications are absorbed they are swallowed and pass into the through the thin mucous membrane that lines the inside of the digestive system. The medications are then broken down in either the stomach or the intestines and are absorbed in the same way as food. They then pass through the liver Eye drops and ear drops are applied before entering the bloodstream. However, some eye drops, such as those used to treat glaucoma, can be absorbed into the bloodstream. Transdermal (through the skin) medications are applied to the skin either by patch or in creams or lotions and pass through the skin into the blood vessels. Subcutaneous medications are injected into the fatty tissue just below the skin and travel from the fatty tissue into the bloodstream. Enteral medications, those given through a G tube or a J tube go directly into the stomach or intestine and pass into the digestive system and then through the liver and into the bloodstream. Rectal and vaginal medications, such as suppositories, enemas and creams are inserted into the Inhaled medications have a rectum or the vagina and direct effect on the lungs. These applications tend to have a very localized effect and do not usually enter the bloodstream in significant quantities. The ointment stays on the surface of the skin, where the medication effect is needed. Systemic Effect: Some medications, such as pills or liquids given orally, rectal suppositories, Transdermal patches and subcutaneous injections end up in the bloodstream and act on a specific organ or system within the body. For example: anti-depressant medications taken orally are circulated through the bloodstream and work by increasing the amount of certain chemicals in the brain. Almost all medications that have a systemic effect on the body will cause side effects. Some medications that have a localized effect on the body can also cause side effects. Most side effects are not serious and some may decrease as the body becomes used to a medication. For example, some blood pressure medications, because of the way that they act on the heart, can cause the person to feel tired. Other medications can cause side effects such as dry mouth, stomach upset or headache. Side effects to anti-psychotic medications can include severe extrapyramidal reactions and tardive dyskinesia. An adverse effect may be related to an increased dosage of a medication or when a medication accumulates in the body, causing toxicity. Toxicity can damage tissues and organs and can also, in some cases, lead to death. For example, some seizure medications and some psychiatric medications require monitoring for adverse physical symptoms and monitoring through blood tests to make sure that the level of medication in the body is not toxic. Additionally, lithium interferes with the regulation of sodium and water levels in the body, and can cause dehydration and result in increased lithium levels. There are several drugs that when taken require regular monitoring of blood levels. For example, those who use lithium should receive regular blood tests and should monitor thyroid function annually and kidney function for abnormalities. Severe allergic reactions to medications can occur, sometimes called “anaphylactic reactions” or “anaphylaxis,” and can be life-threatening. For example: Certain medications that are taken for a long time can cause the body to adapt to them. Tolerance is good when it means that the body has adapted to the minor side effects of the medications. Tolerance can be a problem if it makes the medication less effective so that a higher dose of the medication is needed. Medication dependence is when an individual develops a physical or psychological need for a medication. For example: People who take laxatives for a long time can become physically dependent on the laxatives in order to have a bowel movement because the body loses the ability to work without it. A person can also develop a psychological dependence on anti-anxiety medications and think that they cannot function without taking the medication on a regular basis. For example: Two or more medications given together can produce a stronger response. Two or more medications given together can reduce or cancel out the effect of one or more medications. It is important to ask the pharmacist if certain liquids should be given with the medication. An example of a paradoxical effect to Benadryl might be that the individual becomes hyperactive or agitated. It is your responsibility to observe the individual carefully and to document and report all medication effects. It is very important that you understand what medications require blood level monitoring! Things to remember about medication blood levels and other blood tests: • Drugs such as lithium, Depakote, and Tegretol can reach toxic levels in a person’s blood stream and even cause death. Some medication blood levels require that you “hold” the medication until after the blood sample has been taken. Sometimes it is necessary for the individual to "fast" (have nothing to eat or drink) until after the blood test has been done. You must observe individuals and determine if the medication appears to be working. Your determinations are based on knowledge of why the medication is being given, what the desired effect is and what to do if that effect is not achieved. The medication cycle shows the basic steps for monitoring, reporting and following up on symptoms and medications. It is continuous which means that you are constantly observing, monitoring and reporting to the appropriate persons the effects of medications on individuals. The only way to make sure that all changes are noted is to carefully observe the individual and document and report any changes that you see. Can you think of a situation where you have used the medication cycle in your own health care or in the care of someone else? Perhaps a situation where the whole cycle was completed, but the medication did not work and you had to start through the cycle again? Can you think of some physical and/or behavioral changes that you might see in the individuals that you work with? These are medications that you There are special procedures that you have to can typically get at the pharmacy follow when controlled medications are without a prescription or prescribed.

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A placebo-controlled purchase online sumycin zithromax antibiotic resistance, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder cheap sumycin 500 mg overnight delivery infection rash. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis discount sumycin 250mg without a prescription infection risk factors. Antipsychotic-induced weight gain and metabolic abnormalities: implications for increased mortality in patients with schizophrenia purchase sumycin us antibiotics for acne scars. Hormonal correlates of clozapine-induced weight gain in psychotic children: an exploratory study. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. Differential effects of various typical and atypical antipsychotics on plasma glucose and insulin levels in the mouse: evidence for the involvement of sympathetic regulation. Insulin resistance and secretion in vivo: effects of different antipsychotics in an animal model. The atypical antipsychotic clozapine impairs insulin secretion by inhibiting glucose metabolism and distal steps in rat pancreatic islets. The antipsychotics clozapine and olanzapine increase plasma glucose and corticosterone levels in rats: comparison with aripiprazole, ziprasidone, bifeprunox and F15063. Second-generation antipsychotic-associated diabetes mellitus and diabetic ketoacidosis: mechanisms, predictors, and screening need [American Society of Clinical Psychopharmacology Corner]. Electrocardiographic changes in children and adolescents treated with ziprasidone: a prospective study. Risperidone in children and adolescents with pervasive developmental disorder: pilot trial and follow-up. Prolactin levels during long-term risperidone treatment in children and adolescents. Prolactin levels in young children with pervasive developmental disorders during risperidone treatment. A prospective study of hyperprolactinemia in children and adolesceents treated with atypical antipsychotic agents. The effects of olanzapine, risperidone, and haloperidol on plasma prolactin levels in patients with schizophrenia. Antipsychotic-induced hyperprolactinemia: mechanisms, clinical features and management. Quetiapine: are we overreacting in our concern about cataracts (the beagle effect)? Practice parameter on the use of psychotropic medications in children and adolescents. Aripiprazole in Children and Adolescents with Tourette‟s Disorder: An Open-Label Safety and Tolerability Study. A double-blind placebo-controlled trial of sibutramine for olanzapine associated weight gain. Bipolar Disorder Advocacy 51 Author and Expert Consultant Disclosures and Contributing Organizations 52 References 55 The information contained in this guide is not intended as, and is not a substitute for, professional medical ParentsMedGuide. Two decades ago, it was rare for a child or adolescent to be diagnosed with bipolar disorder. Research now suggests that for some, the symptoms of adult bipolar disorder can begin in childhood. However, it is not yet clear how many children and adolescents diagnosed with bipolar disorder will continue to have the disorder as adults. What is very clear is that obtaining a careful clinical assessment is utmost and critical to diagnosing bipolar disorder. During the past decade, the number of children and adolescents diagnosed with bipolar bipolar disorder has increased signifcantly. Yet we do not understand why bipolar disorder is being diagnosed more frequently in children. We suspect that it is because of an increased awareness of the disorder as well as over diagnosis. However, we all agree that children who have issues with mood and behavior need help. Recent research and clinical experience has provided child and adolescent psychiatrists with a better understanding of bipolar disorder and its symptoms. There are still many unanswered scientifc questions about how to best diagnose and treat bipolar disorder in children and adolescents. However, the body of research evidence and clinical consensus on this disorder is growing. The information con- tained in this medication guide refects what medications child psychiatrists currently use when treating bipolar disorder during childhood and adolescence. The guide is intended to provide parents with the latest expert medical opinion about medications used to treat the symptoms of bipolar disorder. While research is ongoing to better understand the benefts and risks of using these medications, only a limited number of these drugs have been approved by the U. For more information about the Parents Medication Guide series of publica- tions, please visit http://www. President American Academy of Child & Adolescent Psychiatry The information contained in this guide is not intended as, and is not a substitute for, professional medical ParentsMedGuide. No pharmaceutical funding was used in the development or maintenance of this guide. The disorder was frst described by French scientist Jules Baillarger in 1854 as “dual-form mental illness. Bipolar disorder is usually characterized by episodes of mania and depression, as well as a combination of the two at the same time called a mixed state. It is often frst diagnosed during adolescence or in young adulthood; however, some people show symptoms of the illness in early childhood. This diagnosis is usually made by a mental health clinician who has evaluated and treated many, many children. It requires that the clinician take a detailed medical and psychiatric history and perform a thorough evaluation. Many parents are challenged by a child who has extreme changes in mood, energy, thinking, and behavior. Careful evaluation will fnd that some of these children are suffering from a mental disorder. While systematic data on the frequency of bipolar disorder among children are only now being collected, recent studies by the National Institute of Mental Health indicate that, overall, children have a lower rate of bipolar disorder than adults. However, the rate increases with age, reaching approximately 1 percent (1 in 100) by adolescence. In adults, the rate of people who have some form of1 the disorder during their lifetime is approximately 4. While the number of children and adolescents who are diagnosed with bipolar disorder is increasing, research into bipolar disorder in children and adoles- cents is limited.

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American Academy of Pediatrics buy genuine sumycin xarelto antibiotics, Policy Statement: Breastfeeding and the Use of Human Milk purchase 500 mg sumycin with visa 1d infection tumblr, Pediatrics 2012 cheap 500 mg sumycin visa antibiotics alcohol;129(3):e827-841 4 order generic sumycin virus 65. Fortinguerra F et al, Psychotropic Drug Use During Breastfeeding: A Review of The Evidence, Pediatrics 2009;124:e537 5. National Committee on Breastfeeding, Breastfeeding in Ireland, A five-year strategic action plan, Department of health and children 2005, downloaded from http://www. Begley C et al, The National Infant Feeding Survey 2008, University of Dublin Trinity College Dublin School of Nursing and Midwifery (prepared for the Health Service Executive) http://www. Amir L, Pirotta M, Raval M, Breastfeeding – evidence based guidelines for the use of medicines, Australian Family Physician 2011;40(9):684-690 10. A survey from the Netherlands, European Journal of Clinical Nutrition 2004;58:386-90 11. Rowe H et al, Maternal medication, drug use, and breastfeeding, Pediatr Clin N Am 2013;60:275-294 14. Committee on Drugs, The transfer of drugs and other chemicals into human milk, Pediatrics 2001;108(3): 776-789 15. Nice F, Luo A, Medications and breast-feeding: current concepts, J Am Pharm Soc 2012;52:86-94 16. Ilett K et al, Use of a sparse sampling study design to assess transfer of tramadol and its O-desmethyl metabolite into translational breast milk, British Journal of Clinical Pharmacology, 2008;65(5):661-666 19. Walters Burkey B, Holmes A, Evaluating medication use in pregnancy and lactation: what every pharmacist should know, J Pediatr Pharmacol Ther 2013;18(3):247-258 20. Chung A et al, Antibiotics and Breast-Feeding: A Critical Review of the Literature, Pediatr Drugs 2002; 4 (12): 817-837 23. Chad L et al, Update on antidepressant use during breastfeeding, Canadian Family Physician June 2013;59:633-634 31. Clinical knowledge summaries – Depression – antenatal and postnatal, downloaded from http://cks. Weissman A et al, Pooled analysis of antidepressant levels in lactating mothers, breast milk and nursing infants, Am J Psychiatry 2004;161:1066-78 34. Kendall-Tackett K, Hale T, Review: the use of antidepressants in pregnant and breastfeeding women: a review of recent studies, J Hum Lact 2012;26:187- 195 35. Gentile S, Tricyclic antidepressants in pregnancy and puerperium, Expert Opin Drug Saf 2014;13(2):207-225 37. Genung V, Psychologypharmacology column: a review of psychotropic medication lactation risks for infants during breastfeeding, Journal of Child and Adolescent Psychiatric Nursing 2013;26:214-219 38. Bloor M et al, Tramadol in pregnancy and lactation, International Journal of Obstetric Anesthesia 2012;21:163-167 41. Yet Common Problem research shows that medicines commonly are not used as Nonadherence to needed medicines takes many forms. Nonadherence to medicines is a major health While the most common is simply forgetting to take a care cost and quality problem, with numerous studies prescribed medicine, almost one-third of patients stop showing high rates of nonadherence directly related to taking their medicine earlier than instructed. The cost of nonadherence has been estimated more ways, such as not flling a new prescription or taking at $100 billion to $300 billion annually, including costs less than the dose recommended by the physician. Chronic disease affects nearly one in two Americans showing that many patients stop taking their medicines and treating chronically ill patients accounts for $3 out of soon after having them flled. In a recent commentary,ii information technology and electronic prescribing systems Harvard University researchers remarked that poor adherence allows researchers to study how likely patients are to fll a among patients with chronic conditions persists “despite new prescription in the frst place, a measure referred to conclusive evidence that medication therapy can substantially as “primary nonadherence. Forward-looking employers, health plans, and diabetes, high blood pressure, or cholesterol medicine is other stakeholders have begun implementing programs to encourage better adherence to medicines, but more eight times as great as the share who maintain ongoing use, but who do not routinely refll their prescriptions on time. Secondary Nonadherence Unfortunately, doctors are unable to predict which of their patients will likely be nonadherent to treatment. Because these on a coin fip in determining who will adhere to treatment and who won’t (even among patients they know well). Controlling For likely to develop coronary disease, cerebrovascular disease, Other Relevant Factors, Poor Adherence Is and chronic heart failure, respectively, over a 3-year period Associated With Increased Hospitalizations, when compared to those who took their antihypertensive medicines as directed. Nonadherent patients were also 17 Nursing Home Admissions, Physician Visits, percent more likely to be hospitalized and had an average And Avoidable Health Care Costs. Researchers estimated that total A meta-analysis combining the results of numerous studies hospitalization costs could have been reduced by more than found that relative to patients with high levels of adherence, $25 million if nonadherent patients had been compliant with the risk of poor clinical outcomes—including hospitalization, xix their treatment regimens. Nau, “Oral Antihyperglycemic Medication Nonadherence and Subsequent Hospitalization Among Individuals with Type 2 Diabetes. Overall, improving adherence to prescribed 9 For example, 32 million Americans use three or more medicines for diabetes, cholesterol, and blood pressure medicines daily, while the average 75-year old has 3 control resulted in $4 to $7 reductions in total health costs chronic conditions and takes 5 medicines. Researchers also found an unambiguous association between higher medication copays or cost-sharing and increased use of hospitalizations and emergency medical services for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia. Use of medicines to treat hypertension, high copayments for insulin and all oral diabetes medicines all saw cholesterol, and diabetes was 15 percent, 27 percent, signifcant increases in adherence for their employees with and 21 percent lower, respectively, for patients subject to diabetes. Relative to employees whose copayments for diabetes the cap relative to those with full coverage. The cap was medicines did not change, those whose copayments were also associated with poorer control of blood pressure, lipid waived or reduced were more likely to fll new prescriptions levels, and glucose levels, and savings from reduced use xxxvii and more likely to continue their diabetes treatment over time. Generating Positive Returns On Their Additional research by these authors indicates that this Investments Through Productivity Gains And increase in employee adherence led to reduced use of other Lower Overall Health Care Spending. Researchers estimated that lowering patient to 4 percent increase in the average adherence rate relative copays would improve medication adherence, reducing lost to a control group whose copays did not change. Pill bottles are topped with special caps Experimenting With A Range Of Efforts To that signal patients with light and sound. An embedded Encourage Patients To Use Their Medicines wireless connection enables the cap to send automated As Directed: calls to patients to inform them of missed doses and can also provide weekly progress reports and refll reminders. They not only feel better, they can potentially avoid costly medical problems xli Improving adherence holds great potential to contribute that could result from delaying appropriate therapy. In the private sector, forward-looking provide diabetes medicines at no charge to patients who employers are taking steps to improve adherence, take steps to manage their condition and participate in xlvi particularly among workers with chronic illnesses. Many of these initiatives include quality better quality care, healthier patients, and reduced overall targets likely to require improved medication adherence. Interventions will be tailored to the needs of the specifc patient and may include reminders, pharmacist consultations, lower copays, and automatic home delivery of reflled prescriptions. DeMatteo, “Variation in Patients’ Adherence to on Adherence to Prescription Medications,” Journal of General Internal Medicine, 2008 Medical Recommendations: A Quantitative Review of 50 Years of Research,” Medical and P. Subsequent Hospitalization among Individuals with Type 2 Diabetes,” Diabetes Care, unitedhealthgroup. They are selected with regard to disease prevalence, safety, efficacy, and comparative cost- effectiveness. Each country is encouraged to prepare their own lists taking into consideration local priorities. Africa Medicines Region Country Agency/Authorit Medicines Agency/Authority Web site Essential Medicine List Essential Medicine List Year y Acronym http://www. Vincent & the Grenadines Pharmacy Council ocs/documents/s18854en/s188 2010 Caribbean Grenadines 54en.

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For oral liquids generic sumycin 250mg amex bacteria listeria monocytogenes, it is usually expressed as the number of milligrams in a standard 5mL spoonful cheap 250mg sumycin with mastercard bacterial vaginosis home remedies, e purchase sumycin with amex bacteria helpful to humans. For oral doses that are less than 5mL an oral syringe would be used (see the section ‘Administration of medicines’ in Chapter 9 ‘Action and administration of medicines’ buy generic sumycin 500mg antibiotic cephalexin, page xx). For injections, it is usually expressed as the number of milligrams per volume of the ampoule (1mL, 2mL, 5mL, 10mL and 20mL), e. Only mg/mL will be considered here, but the principles learnt here can be applied to other concentrations or strengths, e. Sometimes it may be useful to convert percentage concentrations to mg/mL concentrations. If you know the percentage concentration, an easy way of finding the strength in mg/mL is by simply multiplying the percentage by 10. Once again, if we use our original lidocaine (lignocaine) as an example: You have lidocaine (lignocaine) 2mg/mL. It usually refers to a solid dissolved in a liquid and, by agreed convention, the weight is expressed in grams and the volume in millilitres. For example: ‘1 in 1,000’ means 1g in 1,000mL ‘1 in 10,000’ means 1g in 10,000mL Therefore it can be seen that 1 in 10,000 is weaker than 1 in 1,000. The drug most commonly expressed this way is adrenaline/epinephrine: Adrenaline/epinephrine 1 in 1,000 which is equal to 1mg in 1mL Adrenaline/epinephrine 1 in 10,000 which is equal to 1mg in 10mL An easy way to remember the above is to cancel out the three zeros that appear after the comma, i. Adrenaline/epinephrine 1 in 1,000 – cancel out the three zeros after the comma: 1,000/ / /, to give: 1 in 1 which can be written as: 1mg in 1mL Similarly, for adrenaline/epinephrine 1 in 10,000 – cancel out the three zeros after the comma: 10,000/// to give: 1 in 10, which can be written as 1mg in 10mL. Just as per cent means parts of a hundred, so parts per million or ppm means parts of a million. It usually refers to a solid dissolved in a liquid but, as with percentage concentrations, it can also be used for two solids or two liquids mixed together. Once again, by agreed convention: 1 ppm means 1g in 1,000,000mL or 1mg in 1 litre (1,000mL) In terms of percentage, 1 ppm equals 0. Other equivalents include: One part per million is one second in 12 days of your life! Haz-Tabs®) are measured in terms of parts per million, such as 1,000 ppm available chlorine. Question 12 It is recommended that children should have fluoride supplements for their teeth if the fluoride content of drinking water is 0. Such large molecules are difficult to purify and so, rather than use a weight, it is more accurate to use the biological activity of the drug, which is expressed in units. The calculation of doses and their translation into suitable dosage forms are similar to the calculations elsewhere in this chapter. Infusions are usually given over 24 hours and the dose is adjusted according to laboratory results. As a result of this cumulative administration error the patient died from a brain haemorrhage which, in the opinion of the pathologist, was due to the overdose of tinzaparin. It was the prescriber’s intention that the patient should receive 9,000 units of tinzaparin each day, but this information was not written on the prescription. The ward sister told a coroner’s court hearing that the prescription was ambiguous. Insulin Injection devices (‘pens’), which hold the insulin in a cartridge and deliver the required dose, are convenient to use. However, the conventional syringe and needle are still the method of insulin administration preferred by many and are also required for insulin not available in cartridge form. Insulin comes in cartridges or vials containing 100 units/mL, and the doses prescribed are written in units. Therefore, all you have to do is to dial or draw up the required dose using a pen device or an insulin syringe. Insulin syringes are calibrated as 100 units in 1mL and are available as 1mL and 0. So if the dose is 30 units, you simply draw up to the 30 unit mark on the syringe. Displacement Values or Volumes • Dry powder injections need to be reconstituted with a diluent before they are used. Sometimes the final volume of the injection will be greater than the volume of liquid that was added to the powder. They include calculating number of tablets or capsules required, divided doses, simple drug dosages and dosages based on patient parameters, e. It is important that you are able to do these calculations confidently, as mistakes may result in the patient receiving the wrong dose which may lead to serious consequences for the patient. After completing this chapter, should you not only be able to do the calculations, but also be able to decide whether your answer is reasonable or not. However, there may be instances when the strength of the tablets or capsules available do not match the dose prescribed. The answer involves finding how many 25s there are in 75 or in other words 75 divided by 25: 75 3 = =3tablets 25 1 Dosages based on patient parameters 83 In most cases, it is a simple sum you can do in your head, but even so, it is a drug calculation – so care must always be taken. A patient is prescribed 2g of flucloxacillin to be given orally but it is available in 500mg capsules. Once again it is a simple calculation but it is slightly more complicated than our earlier example as the dose prescribed and the available medication are in different units. We could either convert the 500 mg into grams, or we could convert the 2 g into milligrams. In this case it is preferable to convert the grams to milligrams as this avoids decimal points. Remember it is best not to work with decimal points – a decimal point in the wrong place can mean a 10-fold or even a 100-fold error. To convert grams to milligrams, multiply by 1,000: 2g = (2 × 1,000)mg = 2,000mg The calculation is now similar to our earlier example. The answer involves finding how many 500s are in 2,000 or in other words 2,000 divided by 500: 2,000 4 = =4capsules 500 1 Once again, it is a simple sum you can do in your head, but it is a drug calculation, so care must always be taken. A formula can be derived: amount prescribed number required = amount inn each tablet or capsule For dosage calculations involving liquids and injections, see the section ‘Calculating drug dosages’ on page 87. This particularly applies to cytotoxics and other drugs that require an accurate individual dose. This means that for every kilogram (kg) of a patient’s weight, you will need 3mg of drug. For example: the dose required is 500mg/m2 and the patient’s body surface area is 1. For every square metre (m2) of a patient’s surface area, you will need 500mg of drug. This can be summarized as: total dose required = dose per m2 × body surface area When using this method of calculation, the actual body weight should be used. However, in the case of obese children, the child may receive an artificially high dose. The reason for this is that fat tissue plays virtually no part in metabolism, and the dose must be estimated on lean or ideal body weight. As a rule of thumb, doses should be reduced by approximately 25% for obese children.

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