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What are the 2 types of hearing loss?
- conductive hearing loss
- sensorineural hearing loss
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Conductive Hearing Loss (causes?)
- occurs when sound is not conducted efficiently through the outer ear canal to the middle ear
- usually involves a reduction in sound level, or the ability to hear faint sounds
- often corrected medically or surgically
- causes: otitis media, perforated eardrum, benign tumors, impacted earwax (cerumen), foreign body, malformation of the outer ear, ear canal, or middle ear
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Sensorineural Hearing Loss (causes?)
- occurs when there is damage to the inner ear (cochlea)
- involves a reduction in sounds level, ability to hear faint sounds, affects speech and understanding
- not corrected medically or surgically
- causes: birth injury, ototoxic drugs, noise exposure, viruses, head trauma, aging, tumors
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Meniere's Disease
- an inner ear disorder associated with excess fluid in the labyrinth
- typically, the attack is characterized by a combination of vertigo, tinnitus, and hearing loss lasting several hours
- causes is unknown
- treatment: low sodium diet, no caffeine, alcohol or tabacco, decrease stress, diruretics, antiemetics, antivert
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Ototoxicity ("ear poisoning")
- due to drugs or chemicals that damage the inner ear or the vestibulo-cochlear nerve, which sends balance and hearing information from the inner ear to the brain
- can result in temporary or permanent disturbances of hearing, balance, or both
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Otitis externa "swimmer's ear"
- an infection of the ear canal from bacteria or fungi
- symptoms: primary symptoms is ear pain, swelling of canal, full feeling in ear, redness and swelling in outer ear, swollen lymph nodes, discharge from ear
- treatment: wick, antibiotics, steroids
- pain with application of pressure on the tragus is a hallmark sign
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Acute otitis media "middle-ear"
- the presence of fluid, typically pus, in the middle ear, typically viral
- symptoms: pain, redness of the eardrum, and possible fever
- treatment: motrin, tylenol for pain and fever, antibiotics only for bacteria infections (rare)
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What are some viral infections of the integumentary system?
- verrucae/warts
- herpes simplex (HSV)
- herpes zoster (shingles)
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Verrucae or Warts
- benign papilloma caused by papillomarviruses
- thickening of stratum corneum
- treatment: liquid nitrogen, acid chemicals, cryotherapy, salicylic acid paint
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Herpes Simplex (HSV)
- HSV-1: occurs above the waist
- HSV-2: genital region
- begin with burning or tingling sensation
- develop vesicles and erythema, and progress to putules, ulcers, and crusts
- heals within 10-14 days
- recurrent lesions percipitated by stress, sunlight, menses, or injury
- treatment: antivirals-shorten duration only
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Herpes Zoster (shingles)
- vesicles with erythematous bases that are restricted to areas of sensory neurons
- may last 2-3 weeks
- severe pain and paresthesia are common
- pain in elderly may persist for 1 year
- treatment: antivirals
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What are some fungal infections that affect the integrumentary system?
- Candida Albicans (thrush, candidiasis)
- tinea (fungal)
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Candida Albicans (thrush)
- overgrowth of yeast. mucous membranes, large skin folds, GI tract, vagina, uncircumcised penis
- treatment: antifungals
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Tinea
- capitis-head or scalp, corporis-ringworm, pedis-athletes foot
- treatment: topical antifungals
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Impetigo
- staphylococci or streptococci infection
- formation of vesicles, pustules, and yellowish crusts
- primarily over mouth and nostrils
- treatment: topical antibacterial cream
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Discoid Lupus Erythematosus (DLE)
- red, scaly, thickened, well-circumscribed patches with enlarged follicles and elevated borders
- may atrophy, scar, and cause pigment changes
- butterfly rash over checks and bridge of nose, scalp, ears, arms, and chest
- treatment: avoid sun exposure (bc of photosensitivity), topical corticosteroids, antimalaria drugs, Thalidomide
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Seborrheic Dermatitis (Cradle cap)
- chronic inflammation of the scalp, eyelids, ear canals, nasolabial folds, axillae, chest, and back
- scaly, white or yellowish plaques or oozing and crusted
- treatment: shampoos with sulfur, salicyclic acid, tar, topical corticosteriods
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Psoriasis
- genetic predisposition
- increased cell turnover rate result in classic features: erythematous plaques covered by silvery white, loosely adherent scales
- remissions are common
- treatment: emollients, keratolytic agents, topical corticosteriods, UV light, tar
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Pityriasis Rosea
- possibly viral origin
- primary eruption: single, salmon pink lesion on the trunk, 2-10 days
- secondary eruptions: trunk and upper extremeties, scaly, red-ring shaped, clear center, symmetrical, 2-10 weeks
- treatment: UV light, topical corticosteriods depending on severity
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Acne Vulgaris
- sebaceous oils and loose epithelial cells obstruct follicular canals
- causes rupture of the wall and tissue inflammation
- treatment: soaps, lotions, and gels containing sulfur, rsorcinol, salicyclic acid, or benzoyl peroxide, astringents, topical antibiotics, retinoic acid, accutane
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Atopic Dermatitis (Eczema)
- predisposition: family history of asthma, allergic rhinitis, dry skin, and exzema
- release of inflammatory mediators, ch. by intense itching, scratching leads to erythema, weeping, scaling, and lichenification
- treatment: avoid irritants, lubricate, preserve skin moisture, topical corticosteroids, treat infection, control itching
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Allergic Contact Dermatitis
- delayed hypersensitivity to a specific allergen
- poison ivy, poison oak, poison sumac
- pruritus, followed by erythema and vesicle formation
- may be spread as long as allergen remains on surface of skin
- treatment: topical corticosteriods, lotions, cooling baths, wet dressings
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Irritant Contact Dermatitis
- non-immunologically mediated inflammation of the skin
- lesions begin in the area of contant
- soaps, detergents, acids (urine) contribute to inflammatory lesions
- treatment: remove source of irritation, topical corticosteoids
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Urticaria or drug erruptions
- adverse reaction to drugs
- erythema or whitish swellings (wheals) of the skin or mucous membranes
- treatment: discontinue drug, oral antihistamines, antipruritic lotions, make sure person knows never to take the drug again
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Scabies
- mites, burrow under skin, finger webs, wrists, umbilicus, groin area
- intense pruritic erruption and spreads
- parasitic infection
- treatment: ectoparasitical drugs
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Lice
- parasitic infection
- visible mites, surface dwellers
- treatment: ectoparasitical drugs
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Ticks
- burrow in the epidermis
- carry bacteria and viruses
- need to remove head of tick
- treatment: ectoparasitical drugs
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What is the problem associated with using ectoparasitical drugs for parasitic infections?
resistance
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Basal Cell Carcinoma
- most common malignant tumor of the skin
- arise from epidermal cells along the basal layer of the epidermis which can erode into surrounding organs
- rarely metastasizes
- presents as a single firm, skin colored nodule with a raised parameter
- have telangiectatic vessels on the surface, bleeds frequently
- treatment: cryotherapy, topical chemotherapy, curettage
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Squamous Cell Carcinoma
- second most common malignancy
- occasionally metastasize
- malignant neoplasm of keratincytes
- affects skin and mucous membranes
- presents with an ulcerated, scaly, thickened nodule or tumor
- CA that arises in sun-damaged skin usually do not metastasize and rarely cause death
- CA arising on areas not exposed to the sun have the greatest risk of metasizing
- treatment: surical excision
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Malignant Melanoma
- rare but highly malignant
- arises from the melanin-producing cells
- at risk: fair complexion and persons with a family history
- slightly elevated black/brown lesion, irregular border, uneven surface that tends to ulcerate and bleed
- prognosis: <1mm thick 90-100%/5 yrs, 3mm or < 50%/5 yrs
- treatment: surigcal exicison including lymph nodes
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Hints to melanomas: ABCDE
- A = asymmetry
- B = border irregularity
- C = color variation
- D = diameter
- E = elevation above the skin level
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Kaposi's Sarcoma
- skin cancer associated with immunosupression (common with patients with HIV)
- presents as a purple lesion that becomes nodular, may itch or hurt
- treatment: surgically excision, chemotherapy, comfort measures
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antiseptic
used to clean the skin
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Disinfectant
cleans inanimate objects
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astringents
- an agent that has a constricting or binding effect
- used for drying effects on exudative lesions
- priniciple astringents are salts and metals, aluminum salts, zinc oxide
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emollients
- fatty or oily substances that softens or soothes irritated skin
- can be used to prevent friction, lubricate a catheter before insertion, or moisturize dry skin
- priniciple emollients are: KY jelly, petroleum jelly, lanolin
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Cleaners or Baths
- free of soap or modified soap products
- recommended for sensitive, dry, or irritated skin
- principle cleaners: aveeno, pHisoDerm
- principle baths: oatmeal, starch, gelatin
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Rubs/Liniments
- indicated for pain relief when skin is intact
- principle rubs: BenGay, Vicks Vaporub, Aspercreme
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Corticosteriods/Glucocorticoids
- used for relief of inflammatory and pruritic dermatitis
- available as creams, gels, lotions, ointments, or solutions
- principle corticosteriods: Cylocort cream, Hytone Ointment
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Protectives
- soothing, cooling preparations that form a barrier on the skin
- skin must be washed and dried throughly between applications
- principle protectives: Zinc Oxide, Talcum powder
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Keratolytics
- soften scales and loosen outer horny layer of the skin
- used to treat warts, corns, acne, and chronic types of dermatitis
- principle keratolytics: compound W, silver nitrate
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Antiinfectives
- antibacterial
- antifungal
- antiviral
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Ectoparasiticidal
- kills bugs on outer surface of the body blocking or inhibiting the function of thier CNS
- must treat all contacts and clean entire house
- major problem in schools due to noncompliance with treatment
- principle ectoparasiticidals: Kwell, Lindane, Scabene
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Acne Medications
Benzoyl Peroxide, Retin A, Accutane
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Benzoyl Peroxide
- topical antibiotic acne medication
- used to treat mild to moderate acne
- reduces the amount of P. acnes bacteria and promotes keratolysis (peeling of the horny layer of the epidermis)
- adverse effects: drying, peeling, burning, blistering, scaling, swelling
- contraindications: formulas containing sulfites which can cause serious allergic reactions especially in asthma patients
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Retina A
- topical antibiotic acne medication
- used for mild to moderate acne
- normalizes hyperproliferation of epithelial cells within hair follicles thus unclogging pores and preventing new plugs
- causes thinning of the stratum corneum and can facilitate penetration of other drugs
- adverse effects: stinging, redness, dryness, itching, scaling, mild burning, edema
- contraindications: increased susceptibility to the sun
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Accutane
- oral antibiotic
- used to treat severe acne when other methods have failed
- decreases sebum production which decreases the skins population of the microbe P. acnes, sebaceous gland size, inflammation, and keratinization all decreased
- side effects: nosebleeds, inflammation of lips/eyes, dryness or itching, pain or tenderness in the joints, sensitization to the sun, cataracts and other eye ds, elevated trigylceride levels, depression
- contraindications: pregnant woman (highly teratogenic risk category X), avoid the use of alcohol
- requirements for users: register with iPLEDGE, 2 pregnancy tests prior to initial prescription, 1 negative pregnancy test required for montly refills, use of 2 effective forms of birth control, patient education
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neuropharmacology
the study of drugs that alter processes controlled by the nervouse system
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What are the 2 categories of neuropharmacologic agents?
- peripheral nervous system drugs
- central nervous system drugs
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What are the basic mechanisms of neuropharmalogical agents?
- synaptic transmission
- axonal conduction
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Synaptic transmission
- information is carried acorss the neuron gap and the postsynaptic cell
- most neuropharmacologic agents act by altering synaptic transmission and can produce effects that are more selective
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Axonal Conduction
- action potential is carried down the axon
- not very selective
- conduction will take place in all nerves to which it has access
- ex. local anesthetics
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Five steps in synaptic transmission
- 1. transmitter synthesis: drugs can increase or decrease transmitter synthesis, can enhance effect of transmitter by making super transmitter
- 2. transmitter storage: stored until released from the vesicle
- 3. transmitter release: release after triggered by action potential
- 4. receptor binding: neuropharmacologic drugs that act directly on the receptors and bind can cause activation, prevent activation, or enhance activation
- 5. termination of transmission: by reuptake, enzymatic degradation, diffusion
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What are the 2 divisions of the nervous system? How are they linked?
- central nervous system (brain and spinal cord)
- peripheral nervous system- somatic motor and autonomic (ANS) (parasympathetic and sympathetic)
- linked by cranial nerves and muscle fibers
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What are the priniciple functions of the ANS?
- regulation of the heart
- regulation of the secretory glands (salivary, sweat, gastric, bronchial)
- regulation of smooth muscle (muscles of bronchi, blood vessels, urogenital system and gastrointestinal tract)
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What are the principle transmitters of the PNS?
- acetylcholine
- norepinephrine
- epinephrine
- dopamine
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What are cholinergic and adrenergic receptors of the PNS mediated by?
- cholinergic mediated by Ach
- adrenergic mediated by NE and Epi
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What is the function of the cholinergic receptor nicotinic n?
- promotes ganglia transmission
- promotes release of epi
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What is the function of the cholinergic receptor nicotinic m?
contraction of the skeletal muscles
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What is the function of the muscarinic cholinergic receptor?
activate PNS
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What are the main functions of the SNS?
- regulation of cardiovascular system
- regulation of body temperature
- implementation of "fight or flight" response
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What is the function of alpha 1 adrenergic receptor?
- vasoconstriction
- ejaculation
- contraction of trigon and sphincter in bladder neck and prostate capsule
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What is the function of beta 1 adrenergic receptor?
- in heart: increases heart rate, contraction, and velocity of conduction in AV node
- in kidney: renin release
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What is the function of beta 2 adrenergic receptor?
- bronchodilation
- glycogenolysis
- vasodilation
- relaxes uterus
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What is the function of the dopamine receptor?
dilates renal blood vessels
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Epi activates which receptors?
alpha 1 & 2, beta 1 & 2
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NE activates which receptors?
alpha 1 & 2, beta 1
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dopamine activates which receptors?
- dopamine receptors
- can also activate beta 1 receptor
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What are the 4 phases of pharmacokinetics?
- absorption
- distribution
- metabolism
- excretion
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the study of drugs "movement" throughout the body from the time it enters until its excreted
pharmacokinetics
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the process by which a drug moves from its site of administration, across the cell membranes, and enters into the blood
absorption
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the rapid inactivation of some oral drugs as they pass through the liver after being absorbed
first pass effect
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movement of a drug throughout the body to gain access to its target cell and allow the drug to exit the vascular system for elimination
distribution
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the site of action where the drug response occurs
target cell
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the biological transformation of a drug into an inactive metabolite, a more soluble compound, or a more potent metabolite
metabolism
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What organ is responsible for most of a drugs metabolism?
liver (enzyme P450)
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the removel of drugs from the body
excretion
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What organ is the primary site for excretion?
kidney
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drugs in the bile are secreted into the intestine, some is reabsorbed into the blood, the rest is secreted in the feces
enterohepatic recycling
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time interval between administration of a drug and the first sigh of action
onset of action
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the lowest plasma concentration that will produce a therapeutic effect
minimal effective concentration (MEC)
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the highest plasma concentration attained from a single dose
peak plasma effect
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time interval between onset of action and termination of action
duration of action
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the range of plasma concentration in which the drug effect is produced without producing toxicity
therapeutic range
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The wider the therapeutic range....
more safe the drug is to use
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The narrower the therapeutic range....
the more difficult a drug is to use safely
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the plasma concentration of a drug that results in dangerous adverse effects
toxic level
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period of time in which the drug effect is no longer seen
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the time required for the amount of drug in the body to decrease by 50%
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The half-life of a drug determines...
dosing intervals
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How many half-lives does it take for a drug to reach a steady state?
4-5 half-lives
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the concentration of a drug in the blood which correlates to a drug's response
plasma drug levels
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When should a nurse measure the peak and trough plasma drug levels?
- peak-1.5 hours after initial administration
- trough-30 minutes prior to next dose
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How do you reduce fluctuations in plasma drug levels?
- continuous infusions
- reduce dosage size and interval
- loading dose v. maintenance dose
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When would a nurse administer a loading dose?
when a drug has a long half-life
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