By Q. Musan. Great Lakes Maritime Academy.
When these restrain- ing on various surfaces (eg 16 mg duetact sale, the mold that forms on spoiled ing forces are altered (eg duetact 17 mg for sale, by suppression of the immune sys- food and the mildew that forms on clothing in damp environ- tem or antibacterial drug therapy), fungal overgrowth and ments). In addition, some fungi dermatophytes, can grow only at the cooler temperatures of have characteristics that enhance their ability to cause disease. Other fungi, called dimorphic, can grow as Cryptococcus neoformans organisms, for example, can be- molds outside the body and as yeasts in the warm tempera- come encapsulated, which allows them to evade the normal tures of the body. As molds, these fungi produce spores that immune defense mechanism of phagocytosis. Aspergillus can persist indeﬁnitely in the environment and be carried by organisms produce protease, an enzyme that allows them to the wind to distant locations. When these mold spores enter the destroy structural proteins and penetrate body tissues. They have a thick, rigid cell wall, of which one of the com- human pathogens such as those that cause blastomycosis, ponents is a polysaccharide called glucan. Fungi also 595 596 SECTION 6 DRUGS USED TO TREAT INFECTIONS have a cell membrane composed of lipids, glycoproteins, and tochrome P450 enzyme (14-alpha demethylase) that is re- sterols. One of the sterols is ergosterol, a lipid that is similar to quired for synthesis of ergosterol from lanosterol, a precursor. Within This action causes production of a defective cell membrane, the cell membrane, structures are essentially the same as those which also allows leakage of intracellular contents and de- in human cells (eg, a nucleus, mitochondria, Golgi apparatus, struction of the cell. Both types of drugs also affect cholesterol ribosomes attached to endoplasmic reticulum, and a cyto- in human cell membranes, and this characteristic is considered skeleton with microtubules and ﬁlaments). Echinocandins or glucan synthesis inhibitors (eg, caspo- fungin) are a new class of antifungal drugs that disrupt fun- FUNGAL INFECTIONS gal cell walls rather than fungal cell membranes. They act by inhibiting beta-(1,3)-D-glucan synthetase, an enzyme re- Fungal infections (mycoses) may be mild and superﬁcial or quired for synthesis of glucan. Dermatophytes cause superﬁ- saccharide in the fungal cell wall; its depletion leads to cial infections of the skin, hair, and nails. Drugs for superﬁcial fungal infections of skin and mucous Most fungal infections occur in healthy people but are more membranes are usually applied topically. Patients with HIV infections (eg, oral, intestinal, or vaginal candidiasis) with anti- infection need aggressive treatment of primary fungal infec- bacterial drug therapy.
Use in Renal Impairment Home Care Amantadine is excreted primarily by the kidneys and should be used with caution in clients with renal failure discount 16 mg duetact mastercard. With pramipex- The home care nurse can help clients and caregivers under- ole discount 17 mg duetact otc, clearance is reduced in clients with moderate or severe stand that the purpose of drug therapy is to control symp- renal impairment and lower initial and maintenance doses toms and that noticeable improvement may not occur for are recommended. Also, the nurse can encourage clients to con- adjustments are needed for renal impairment. In addition, teaching may be needed about preventing Use in Hepatic Impairment or managing adverse drug effects. Caregivers may need to be informed that most activities (eg, eating, dressing) take Ropinirole should be used cautiously in hepatic impairment longer and require considerable effort by clients with and dosage may need to be reduced. NURSING Antiparkinson Drugs ACTIONS NURSING ACTIONS RATIONALE/EXPLANATION 1. Give most antiparkinson drugs with or just after food; To prevent or reduce nausea and vomiting entacapone can be given without regard to meals. Do not crush Sinemet CR and instruct clients not to chew Crushing and chewing destroys the controlled-release feature of the tablet. Do not give levodopa with iron preparations or multivitamin- Iron decreases absorption of levodopa. To decrease central nervous system (CNS) stimulating effects that may interfere with sleep if the drug is taken in the evening 2. With anticholinergic agents, observe for decreased tremor, Decreased salivation and sweating are therapeutic effects when salivation, drooling, and sweating. With levodopa and dopaminergic agents, observe for im- Therapeutic effects are usually evident within 2–3 weeks, as levo- provement in mobility, balance, posture, gait, speech, hand- dopa dosage approaches 2–3 g/d, but may not reach optimum writing, and self-care ability. With anticholinergic drugs, observe for atropine-like effects, such as: (1) Tachycardia and palpitations These effects may occur with usual therapeutic doses but are not likely to be serious except in people with underlying heart disease. The drug has anti- histaminic and anticholinergic properties, and sedation is attributed to the antihistamine effect.
Less knee flexion and ankle dorsiflexion during swing discount duetact 16mg with mastercard, compensated by circum- The observational gait of patients with spastic duction of the affected leg paraparesis reveals a variety of compensatory 258 Common Practices Across Disorders mechanisms to achieve locomotion proven duetact 17 mg. The devi- Gait with Poliomyelitis ations noted for hemiplegic gait apply to both lower extremities. Hip and knee flexion can be Anterior trunk flexion with knee hyperexten- prominent in swing and stance, especially in sion is a common compensation for severe patients with a cervical central cord syndrome. This paresis The gait may look like the stepping pattern of can cause degenerative disease of the knee a child with spastic diplegia from cerebral joints. Heel contact may be absent, replaced by as the paraspinals and hip and ankle movers, a plantarflexed or flat-footed initial floor con- yield a variety of gait deviations and compen- tact. Severely affected patients re- vents the ankle from dorsiflexing into a posi- quire bracing the ankles and knees. Electromyographic (EMG) analysis often Biomechanics, kinesiology, electrophysiology, shows a prolonged duration of EMG activation and computer modeling have contributed to with premature recruitment and delayed re- research into the mechanisms and evaluation laxation compared with healthy persons. Quantitative EMG bursts tend to be flat with decreased or methods of gait analysis draw from these dis- absent peaks. Studies reveal information about nor- nemius muscles show reduced activity over the mal16 and abnormal17 motor control and can whole step cycle, whereas the tibialis anterior lead to therapeutic interventions and to as- may show increased activity during early swing. Some Prolonged bursts can accompany passive mus- of the practical techniques for gait analysis are cle lengthening. Techniques for Injury to even a single nerve may cause con- Gait Analysis siderable deviations and secondary compen- TIME-DISTANCE VARIABLES sations in gait. For example, paralysis of the tibialis anterior muscle decreases walking ve- Footswitch stride analyzer locity by several mechanisms. Step length de- Footprint analysis creases, mostly on the nonparalyzed side. On Conductive or pressure-sensitive walkway the paralyzed side, one may find a decrease in ankle dorsiflexion moment at the end of KINEMATICS stance, a decrease in vertical ground reaction Electrogoniometers force, a decrease in weight transfer to the for- ward part of the foot, a decrease in knee ex- Computerized video analysis with joint markers tensor range and torque in the stance phase, Electromagnetic field motion analysis an increase in ankle dorsiflexion range in 14 DYNAMIC ELECTROMYOGRAPHY stance, and increased energy cost. Step Surface and fine wire electrodes length decreases on the nonparalyzed side.