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How many cases of tylenol overdoses are there each year
200,000
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What is the maximum dose for tyelnolper day
4 grams with a healthy liver
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extra strength tylenol is how many mg per tablet?
500
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Regular tylenol is how many mg per tablet
325
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Its easy for the elderly to overdose on tylenol which causes
liver failure
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Tylenol is the number one over the counter drug used for
arthritis, fever, chills, and body aches
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_____ of Americans use and OTC every 2 days
40%
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____ of all medications administered are OTC
60%
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most common OTC drug is
ASA (Aspirin) keep platelets from clotting, relief of inflammation and pain.
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2nd most common drug is
tylenol for fever, aches, but can cause hepatotoxicity with large doses; over 4g a day
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common errors with OTC drugs include:
- self dosing or overdosing. Client may not be aware of their own metabolism, body chemistry, kidney function or liver function.
- mixing herbals with OTC drugs can cause an increase or decrease in absorption
- taking meds with or without food such as grapefruit juice can increase absorption in the stomach causing higher or toxic levels of drugs released into the blood stream.
- interactions with other meds the client is on
- using OTC drugs in the wrong route. ex glycerin suppositories
- trade name confusion- using the wrong drug for the wrong complaint.
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education for clients taking OTC drugs include
- time and correct dosage
- correct route and usage
- Don't take oral OTC drugs with grapefruit juice and other Rx meds.
- Take all NSAIDs with food (ibuprofen (motrin), naprosyn (Aleve)) to prevent GI bleeds
- Stop any herbals and ASA (aspirin) one week prior to surgery
- supplements such as creatinine and protein can be hard on the kidneys, if you have trouble urinating see a doctor and stop all herbals immediatly
- tylenol should not be taken if they have liver disease.
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doasge forms include
- OTC are usually oral, nasally, or topical
- forms include: creams, liquids, syrups, pills and capsules
- The strength of an OTC is half the strength of a perscription to prevent overdosing.
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FDA classifies herbs as
"dietary supplements"
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Other then Phytomedicines herbs include:
botanicals, neutraceuticals, vitamins, and dietary supplements.
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Problems with herbs are
- herbs are not standardized except in Germany. The strength, method of delivery, and half lives vary depending on the dosage, delivery, and amount of binders
- most herbs except ginger are contraindicated in pregnancy
- there are not very many randomized trials so they may not be safe
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common myth about herbs is
herbs are not medicines
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more then ______ americans use herbal supplements
28 million
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Billberry (huckleberry)
route, dosage, frequency
indications:
side effects:
education:
contraindication:
- route, dosage, frequency: oral, 60mg-240mg of extract, bid or tid
- indications: relaxes smooth muscle, used for simple diarrhea.
- side effects: inhibits platelet congregation, increases coagulation time, interferes with iron absorption.
- education: should not be used with aspirin, anticoagulants, fish oil, garlic, ginger, ginko biloba.
- contraindication: pregnancy
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Black Cohosh (black snake root, squaw root)
route, dosage, frequency
indications:
side effects:
education:
contraindication:
- route, dosage, frequency: oral form, 40mg per day
- indications: used for PMS, post and perimenopausal symptoms
- side effects: causes hypotension, bradycardia, and can promote abortion
- education: should not be used in pregnancy
- contraindication: antihypertensives
- native americans use a topical treatment for snake-bites
- stimulates estrogen production
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Echinacea (American purple coneflower)
route, dosage, frequency
action:
indications:
side effects:
contraindication:
- route, dosage, frequency: capsule, tablet, lollipops, lozenges, tea, tinctures, extracts. 3.5% echinoside, 380 mg capsules tid
- action: stimulates tumor necrosis factor, interferon, and activates T lymphocytes and macrophages to fight disease and infection, anti-oxidant
- indications: boost immune system. fight influenza
- side effects: heptatoxicity, jaundice
- contraindication: pregnancy, HIV or immunosuppressed clients, MS, TB, allergies to sunflowers
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Garlic (stinking root, most widely researched herb)
route, dosage, frequency
indications:
side effects:
education:
contraindication:
- route, dosage, frequency: dried powder, capsules, fresh bulbs, antiseptic oil, fresh extract, 5000mcg of total allicin, or 10mg aliin daily
- indications: reduces triglycerides and cholesterol, treatment of mile hypertension, anti-bacterial salve, reduces risk of stroke.
- side effects: gastric distress, bad breath, inhibits platelet aggregation
- education: should not be used in high doses with aspirin, coumadin, ginko biloba, billberry, or ginger as it prolongs bleeding
- contraindication: pregnancy, GI bleeds, peptic ulcers, and other bleeding disorders
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Ginger (the root of the ginger plant)
route, dosage, frequency
indications:
side effects:
contraindication:
- route, dosage, frequency: tea, powdered, 500mg capsules, fresh ginger root, canddied root, 500mg - 1000mg a day
- indications: anti-emetic, digestion aid, anti-inflammatory for osteoarthritis, muscle pain. Used for motion sickness and vertigo. 500mg-1g every 4 hours during travel.
- side effects:headache, anxiety, insomnia, tachycardia, hypertension, asthma attack, thinning of the blood, GI ulcers
- contraindication: pregnancy, GI bleeds, patients on anticoagulants
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Ginkgo Biloba (EGB 761, GBE)
route, dosage, frequency
indications:
actions:
side effects:
contraindication:
- route, dosage, frequency: capsules, tablets, nutrition bars, sublingual sprays, 120-160mg per day
- indications: relief of organic short term memory loss, peripheral vascular disease, depression, tinnitus, vertigo, early dimentia
- actions: mild anticoagulant, antioxidant, protects the brain from effects of hypoxia, increases cerebral circulation used alot by students for studying/concentration.
- side effects: allergy to urushiol (related to poison ivy) = itching, restlessness, headahe, GI upset, diarrhea
- contraindication:Patients on anticoagulants, ASA, in pregnancy, children, prior to surgery, clients with bleeding disorders.
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assessment includes:
- a history of what OTC drugs the client is using and a list of their current medications. Do they see multiple doctors.
- Do they understand the side effects of their drugs and the different drug interactions.
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nursing diagnoses include
- knowledge deficit
- potential for drug interactions
- potential life threatening side effects
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elderly risks are
- the baby boomers with 5,000 people per day turning 65
- rate of absorption may be slower for PO drugs due to slow GI motility and lower concentration of gastric acids
- distribution: a deacrease in muscle mass and an increase in body fat causes a depot for lipid soluble drugs
- meabolism: liver function is diminished causing slower metabolism which can increase the half life of drugs
- excretion: renal function starts to decline in early adulthood. toxicity due to renal function the number one cause of adverse events in the elderly.
- 40% of all elderly paitients fail to take their meds as perscribed.
- multi-dosing encourage your patient to get a pill box with times and days on it and set up their meds on sunday for the whole week.
- vision problems? Can they read the labels on their meds? make a sheet with large enough writing to put on the cabinet or refrigerator so they have instructions and schedules for their drugs.
- 75% of all noncompliance in elderly is intentional. many elderly take 20 pills a day.
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