By J. Innostian. West Virginia Wesleyan College. 2018.

They history of stroke within 30 days or any history of hemor- stimulate conversion of plasminogen to plasmin (also called rhagic stroke; major surgery or severe physical trauma fibrinolysin) discount feldene 20mg amex, a proteolytic enzyme that breaks down fibrin buy feldene 20 mg on line, within the previous month; severe hypertension (systolic the framework of a thrombus. The main use of thrombolytic blood pressure >180 mm Hg with tirofiban or >200 mm Hg agents is for management of acute, severe thromboembolic with eptifibatide, or diastolic blood pressure >110 mm Hg disease, such as myocardial infarction, pulmonary embolism, with either drug); a history of intracranial hemorrhage, neo- and iliofemoral thrombosis. Heparin and warfarin above (for the 180 mcg/kg bolus and the 2 mcg/kg/min in- are given after completion of thrombolytic therapy. Throm- fusion) or 4 mg/dL or above (for the 135 mcg/kg bolus and bolytic drugs are also used to dissolve clots in arterial or the 0. Alteplase, reteplase, and tenecteplase are tissue plas- Bleeding is the most common adverse effect, with most minogen activators used mainly in acute myocardial infarction major bleeding occurring at the arterial access site for car- to dissolve clots obstructing coronary arteries and re-establish diac catheterization. If bleeding occurs and cannot be con- perfusion of tissues beyond the thrombotic area. The drugs trolled with pressure, the drug infusion and heparin should bind to fibrin in a clot and act locally to dissolve the clot. Phosphodiesterase Inhibitor Streptokinase and urokinase are enzymes that break down Cilostazol inhibits phosphodiesterase, an enzyme that me- fibrin. They are used mainly to lyse coronary artery clots in tabolizes cyclic adenosine monophosphate (cAMP). Streptokinase may also be used to hibition increases intracellular cAMP, which then inhibits dissolve clots in vascular catheters and to treat acute, severe, platelet aggregation and produces vasodilation. Urokinase versibly inhibits platelet aggregation induced by various is recommended for use in clients allergic to streptokinase. As stimuli (eg, thrombin, ADP, collagen, arachidonic acid, epi- with other anticoagulants and thrombolytic agents, bleeding is nephrine, and shear stress). Symptoms usually improve within Drotrecogin alfa (Xigris) is a recombinant version of 2 to 4 weeks, but may take as long as 12 weeks. The drug is human activated protein C that is approved for use in severe contraindicated in clients with heart failure. Severe sepsis is characterized by an Cilostazol is highly protein bound (95% to 98%), mainly excessive inflammatory reaction to infection, inappropriate to albumin, extensively metabolized by hepatic cytochrome blood clot formation, and impaired breakdown of clots. The Drotrecogin alfa is given for its thrombolytic effects, along drug and two active metabolites accumulate with chronic ad- with other therapies for inflammation and infection.

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Drugs that decrease effects of pancreatic enzymes (1) Antacids with calcium carbonate or magnesium May prevent action of enzymes; do not give at the same time cheap 20mg feldene with amex. The infusion rate is for 2000 mL breakfast) decreases drug effectiveness discount feldene 20 mg overnight delivery. Review your abbreviations per 24 hours, which calculates to an hourly rate of 83 mL/hour. Weight con- Review and Application Exercises trol and risk factor reduction in obese subjects treated for 2 years with orli- stat: A randomized controlled trial. Differentiate clients who are at high risk for development DerMarderosian, A. What are pharmacologic and nonpharmacologic inter- and overfatness in a multiethnic pediatric population. American Journal ventions to restore fluid balance when an imbalance of Clinical Nutrition, 67, 602–610. For clients who are unable to ingest food, which nutrients American Journal of Clinical Nutrition, 68, 899–917. Severe hepatotox- icity associated with the dietary supplement LipoKinetix. What is the role of lipid emulsions in parenteral nutri- ternal Medicine, 136(8), 590–595. In an infant receiving parenteral nutrition, what is the best tary & alternative medicines. In an outpatient or home care client with a protein-calorie Journal of Clinical Nutrition, 67, 1130–1135. Patient Care, weight, what are some nursing interventions to assist and 32(16), 29–50. With critically ill clients, what special needs must be con- Pathophysiology: Concepts of altered health states, 6th ed. Delineate circumstances in which therapeutic vitamins are likely to be needed. Critical Thinking Scenario You have been asked to speak with a group of senior citizens, living independently in a retirement community, about vitamins and health.