By K. Vak. Saratoga University School of Law.
However generic 5mg lipitor with mastercard, if given cohol or sedative-type drugs (downers) lipitor 20mg without prescription, are alternated with on a Monday/Wednesday/Friday schedule, the Friday dose CNS stimulants, such as amphetamines (uppers). Also, initial dosage needs care- Treatment of Amphetamine-Type Abuse ful titration to prevent withdrawal symptoms but avoid over- dosage when peak effects occur. Patients must be informed Treatment of amphetamine-type abuse is mainly concerned about the delayed effects of the drug and the risks of over- with overdosage because these drugs do not produce physical dosage if they take other opiates. LAAM has proarrhythmic dependence and withdrawal as alcohol, opiates, and sedative- effects and an electrocardiogram should be done prior to start- hypnotic drugs do. Because amphetamines delay gastric emp- ing the drug and periodically during therapy. The client is likely to be hyper- antagonist that prevents opiates from occupying receptor sites active, agitated, and hallucinating (toxic psychosis) and may and thereby prevents their physiologic effects. Symptomatic tain opiate-free states in the opiate addict, it is recommended treatment includes sedation, lowering of body temperature, for use in conjunction with psychological counseling to pro- and administration of an antipsychotic drug. If the patient taking drugs must be used with great caution, however, because de- naltrexone has mild or moderate pain, nonopioid analgesics pression and sleep usually follow amphetamine use, and these (eg, acetaminophen or a nonsteroidal anti-inflammatory drug) after-effects can be aggravated by sedative administration. If the patient has severe pain and requires an opioid, it should be given in a setting staffed and equipped for cardiopulmonary resuscitation because respiratory depression Cocaine may be deeper and more prolonged than usual. In addition, pa- tients needing elective surgery and opioid analgesics should Cocaine is a popular drug of abuse. It produces powerful be instructed to stop taking naltrexone at least 72 hours before CNS stimulation by preventing reuptake of neurotransmitters the scheduled procedure. Cocaine is commonly Long-term treatment of cocaine abuse usually involves inhaled (snorted) through the nose; crack is heated and psychotherapy, behavioral therapy, and 12-step programs. Acute use of cocaine or crack produces addition, many patients need treatment for coexisting psy- intense euphoria, increased energy and alertness, sexual chiatric disorders. Overdosage can cause cardiac dysrhyth- Nicotine mias, convulsions, myocardial infarction, respiratory failure, stroke, and death, even in young, healthy adults and even Nicotine, one of many active ingredients in tobacco products, with initial exposure. Both acute and chronic use produce is the ingredient that promotes compulsive use, abuse, and numerous physiologic effects (Box 15–2). Inhaling smoke from a cigarette produces CNS stimulation in a few seconds.
Alcohol should be used in moderation and nursing imal to avoid potential damage to the fetus generic 40 mg lipitor mastercard. If women who are sexually active and not through breast milk cheap lipitor 20mg free shipping, with the highest concentration using contraception take any drugs, there is a high risk about 30 to 60 minutes after drinking (60–90 minutes that potentially harmful agents may be ingested before if taken with food). Moderate to heavy drinking during pregnancy include alcohol, caffeine, and cigarette (2 or more drinks per day) can interfere with the abil- smoking. Caffeine intake should be limited to to drink (eg, wine with dinner), you can avoid breast- about three caffeinated beverages per day; excessive in- feeding for a few hours (until the alcohol has time to take should be avoided. Women who smoke should quit leave your system) or you can pump your milk before if possible during pregnancy, to avoid the effects of nico- drinking and give it to the baby after you have had the tine, carbon monoxide, and other chemicals on the fetus. You can also pump and discard the milk that ✔ Herbal supplements are not recommended; their effects is most affected by the ingested alcohol. Nicotine and an avoiding infection (personal hygiene, avoiding contact with active metabolite are concentrated in milk and the people known to have infections, maintaining indicated amounts reaching the infant are proportional to the immunizations). Ideally, ✔ Nondrug measures to relieve common health problems the mother who smokes would stop. If unable or un- include positioning, adequate food and fluid intake, and willing to stop, she should decrease the number of cig- deep breathing. The risk for ✔ Inform any health care provider from whom treatment is sudden infant death syndrome (SIDS) is greater when sought if there is a possibility of pregnancy. CHAPTER 67 DRUG USE DURING PREGNANCY AND LACTATION 977 small to cause significant effects; for others, effects on Nursing Notes: Apply Your Knowledge the nursing infant are unknown or potentially adverse. Drugs that are considered safe, those to be used with caution, and those that are contraindicated are listed in Rosa Sanchez is breast-feeding her 6-month-old son when she Box 67–3. After she has started taking over-the-counter cold remedies, she calls the consulting nurse to see if these med- 2. Give medications only when clearly indicated, weigh- ications will affect her ability to breast-feed her son. If you were ing potential benefit to the mother against possible the consulting nurse, how would you respond?
