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Reasons for using iron dextran injec- may cause diarrhea; their uses as antacids and cathartics are tion include peptic ulcer or inflammatory bowel disease discussed in Chapters 60 and 61 generic 100mcg cytotec free shipping, respectively. Iron Preparations Ferrous gluconate (Fergon) Iron deficiency anemia PO 320–640 mg (40–80 mg elemen- PO 100–300 mg (12. A small test dose is re- required before therapeutic doses quired before therapeutic doses are given. Magnesium Preparations Magnesium oxide Prevent or treat hypo- Hypomagnesemia, PO magnesium Convulsions: IM, 20–40 mg/kg in a Magnesium hydroxide magnesemia oxide 250–500 mg 3–4 times 20% solution; repeat as necessary Magnesium sulfate Treat hypertension or convul- daily, milk of magnesia 5 mL sions associated with tox- 4 times daily, or a magnesium- emia of pregnancy or acute containing antacid 15 mL 3 times nephritis in children daily; IM (magnesium sulfate) 1–2 g (2–4 mL of 50% solution) 1–2 times daily based on serum magnesium levels Eclampsia, IM 1–2 g (2–4 mL of 50% solution) initially, then 1 g every 30 min until seizures stop Convulsive seizures, IM 1 g (2 mL of 50% solution) repeated PRN IV, do not exceed 150 mg/min (1. With Zinc Preparations magnesium sulfate, oral preparations act in 1 to 2 hours and last 3 to 4 hours; IM injections act in 1 hour and last 3 to 4 hours; Zinc sulfate is available in tablets containing 110 or 220 mg and IV administration produces immediate action that lasts of zinc sulfate (equivalent to 25 and 50 mg of elemental zinc, about 30 minutes. It is also an ingredient in several vitamin–mineral combination prod- ucts. Zinc sulfate is given orally as a dietary supplement to Potassium Preparations prevent or treat zinc deficiency. It is metabolized in the liver and excreted Potassium chloride (KCl) is the drug of choice for prevent- in feces; its half-life is unknown. It may be prescribed for clients who are receiving potassium-losing diuretics (eg, hy- Multiple Mineral–Electrolyte Preparations drochlorothiazide, furosemide), those who are receiving digoxin (hypokalemia increases risks of digoxin toxicity), There are numerous commercially prepared electrolyte solu- and those who are receiving only IV fluids because of surgi- tions for IV use. One group provides maintenance amounts cal procedures, GI disease, or other conditions. KCl also may of fluids and electrolytes when oral intake of food and fluids be used to replace chloride in hypochloremic metabolic al- is restricted or contraindicated. It is contraindicated in clients with renal failure and in the number and amount of particular electrolytes.

Allergic and irritant reactions to preservatives generic 200mcg cytotec visa, fragrances, and other ingredients may prevent healing or worsen dermatitis. In ad- dition, children are at higher risk because they may absorb pro- portionally larger amounts and be more sensitive to systemic toxicity. Little adrenal suppression is likely to occur with doses less than 50 g weekly for an adult and 15 g weekly for a small child, unless occlusive dressings are used. With topical antibiotics, superinfection and sensitization Superinfection with drug-resistant organisms may occur with any may occur. Sensitization may cause serious al- lergic reactions if the same drug is given systemically at a later time. With oral retinoids, observe for hypervitaminosis A (nausea, Adverse effects commonly occur with usual doses but are more vomiting, headache, blurred vision, eye irritation, conjunctivi- severe with higher doses. Observe for drug interactions Clinically significant drug interactions rarely occur with topical agents. Nursing Notes: Apply Your Knowledge Answer: Never use a drug that is not labeled clearly. When pouring liquids, Answer: Ask the mother to describe when the rash appeared and always pour away from the label, so that accidental spillage will not impair the written drug label. Another concern in this situation is if its occurrence corresponded with diarrhea or new foods being sterility. Using previously opened bottles, where sterility cannot be introduced in the diet. Question the mother regarding the types guaranteed, is not acceptable practice.

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In this new field generic 200 mcg cytotec free shipping, for example, perspectives on normal functional anatomy, a reporter gene for an enzyme, given to the the effects of a CNS or PNS injury, and on subject by injection of an adenovirus, and a re- spontaneous and rehabilitation-induced plas- porter probe for a radiolabeled substance given ticity. Each varies in its sensitivity for resolving intravenously that stays in the cell if acted on neural events in time and space. One of the by the enzyme, produce a signal in the cell that drawbacks across most techniques is that ex- is imaged. Despite the technical problems posed by these young neuroscientific tools, myriad uses of functional imaging are feasible. NEUROIMAGING TECHNIQUES Table 3–2 lists some of the potential bene- fits of imaging functional anatomy for neuro- Positron Emission Tomography logic rehabilitation. In this chapter, we exam- ine whether resting and activated functional Positron emission tomography and fMRI pro- imaging patterns can serve as surrogate mark- vide a view of the distributed functional and ers for predicting behavioral gains; whether anatomical network engaged by a task. The physical, cognitive, and pharmacologic inter- ability of PET to reveal rCBF and metabolism ventions can be aimed at inducing activations was the first solid advance in functional imag- at key sites to achieve gains by restitution or ing for understanding specific operations substitution; and whether elicited activations within the distributed neural systems for move- can serve as a physiologic marker of the ade- ment, language, attention, memory, percep- quacy of the intensity and duration of a reha- tion, and other aspects of cognition. For neurologic rehabil- technique allows quantification of absolute itationists, the goal will be to harness physiologic variables such as rCBF, oxygen ex- mechanisms of plasticity to drive or restrict traction and utilization, glucose metabolism, changes in functional anatomy that enhance protein synthesis, and the binding of molecules behavioral outcomes. Positron emission to- Future functional imaging techniques and mography is a rather direct measure of synap- multicenter data bases2 may permit map mak- tic activity, although glial activity may account ing at every level of function, from the neural for some tracer uptake. The energy demands networks of behaviors to released neurotrans- of glutaminergic neurons account for approxi- mitters, and to cell responses such as gene ex- mately 85% of total glucose utilization in pression and protein synthesis. Positron emis- studies performed with 18F-fluorodeoxyglucose Functional Neuroimaging of Recovery 149 Table 3–2. Characterize the natural history and relationship of resting metabolic activity (PET, SPECT) to changes in impairment and disability. Relate rCBF and metabolic patterns, at rest or by an activation study for a specific task, to readiness for rehabilitation (PET, fMRI).

Raloxifene is classified as a Estrogens and Antiestrogens selective estrogen receptor modulator and is approved for pre- vention of postmenopausal osteoporosis discount cytotec 200 mcg amex. It has estrogenic ef- Estrogens are discussed here in relation to osteoporosis; see fects in bone tissue, thereby decreasing bone breakdown and Chapter 28 for other uses and dosages. It has antiestrogen effects in therapy (ERT) is beneficial for preventing postmenopausal os- uterine and breast tissue. It is most beneficial immediately after menopause, antiestrogen, is used to prevent and treat breast cancer. Mechanisms has estrogenic effects and can be used to prevent osteoporosis by which ERT protects against bone loss and fractures are and cardiovascular disease, although it is not approved for thought to include decreased bone breakdown, increased cal- these uses. In postmenopausal osteoporosis, these drugs may be used instead of estrogen therapy. Parathyroid Hormone When you perform your morning assessment, she complains of tingling in her fingers. What additional data should be collected Teriparatide (Forteo) is a recombinant DNA version of at this time? Other drugs for osteoporosis slow bone loss; teriparatide increases bone formation by increas- with IV infusion of several liters of 0. It also in- Others recommend its use only if evidence of fluid overload creases serum levels of calcium and calcitriol (a metabolite of or heart failure develops. Thiazide diuretics are contraindi- vitamin D that promotes absorption and use of calcium in cated in clients with hypercalcemia because they decrease bone-building). In clinical trials, it increased vertebral bone urinary excretion of calcium. It is recom- Phosphate salts (Neutra-Phos) inhibit intestinal absorp- mended for use in patients with severe osteoporosis or those tion of calcium and increase deposition of calcium in bone. A potential adverse effect of phosphates is cal- doses for long periods. None developed in humans during cification of soft tissues due to deposition of calcium phos- clinical trials, but the longest of these trials was two years.