Management of respiratory allergy By Nonallergists

Allergic rhinitis and bronchial asthma are the most common respiratory allergies. An attempt to determine the allergenic factor is essential, but should not delay symptomatic treatment. When antihistamines and decongestants fail to control symptoms of allergie rhinitis and adequate avoidance of allergens is impractical, immunotherapy should be given. If rhinitis persists or takes on a perennial pattern in spite of continuous medication, corticosteroids may be indicated.     

Public Health Implications of Counterfeit Medications

Counterfeit medications are broadly defined as drugs that can contain inadequate amounts of active ingredients, contain the wrong active ingredients, be contaminated with harmful substances, and/or be falsely labeled. These medications are a public health issue globally, and their presence in the United States is growing. Counterfeit medications are produced without regulatory oversight and are distributed illegally, often via online sources. Use of these medications can result in adverse effects or a lack of improvement in a person's health condition. Nurses can assess where individuals are obtaining their medications and provide education about the potentially serious risks posed by counterfeit medications and how to avoid them.     

Selecting an Appropriate Medication for Treating Neuropathic Pain in Patients with Diabetes: A Study Using the U.K. and Germany Mediplus Databases

Objective:   To evaluate the appropriateness of prescribing select neuropathic pain medications to diabetes patients based on the potential for drug–drug interactions with medications diabetes patients were prescribed continuously for ≥ 3 months (chronic use).
Methods:   Medical records of patients with a diagnosis of diabetes or use of antidiabetic medications between January 1, 2002 and September 30, 2005 in the U.K. and Germany Mediplus databases were obtained.
Patients:   Medication use profiles were evaluated between April 2004 and September 2005. The metabolic pathways associated with medications that were prescribed chronically to at least 10% of study patients were compared with the metabolic pathways of neuropathic pain medications to identify potential drug–drug interactions.
Results:   A total of 40,448 patients in the U.K. (63.6 ± 16.6 years, 51% male) and 31,930 patients in Germany (68.9 ± 12.7 years, 46% male) were identified. Frequently prescribed medications in the U.K. included aspirin (33.7%), metformin (32.7%), simvastatin (25.5%), atorvastatin (19.4%), atenolol (18.1%), and in Germany hydrochlorothiazide (35.8%), aspirin (25.2%), metformin (21.6%), metoprolol (20.3%), and simvastatin (18.3%). Several neuropathic pain medications have potential for drug–drug interactions with medications prescribed to diabetes patients. Examples include (neuropathic pain medications vs. diabetes medications): duloxetine, paroxetine, and methadone (CYP2D6 inhibitors) and oxycodone HCL, hydrocodone (CYP2D6 substrates) vs. metoprolol and bisoprolol (CYP2D6 substrates); and carbamazepine (CYP3A4 inducer) vs. simvastatin, and atorvastatin (CYP3A4 substrates).
Conclusions/Interpretation:   Our findings underscore the need for medical vigilance when selecting medications for treating neuropathic pain in diabetes patients. ▪     

住院老年患者服药过程安全管理的探讨

目的探讨住院老年患者服药过程中存在的安全隐患,防止发生服药意外。方法通过发放问卷调查老年患者服药过程中存在的不安全因素,有针对性地对护士进行安全管理教育,对患者家属等进行安全服药的宣传,并制定相应管理措施,采取预防性护理。结果护士树立了较强的服药安全管理意识,自觉执行各种安全措施,坚持为患者服药到口,并得到患者家属的理解和支持,将服药过程中安全隐患消灭在萌芽状态。结论护士长对服药到口落实过程加大管理力度,护士加强安全服药意识,是老年患者安全服药的保障。     

Polypharmacy in the elderly: a literature review

PURPOSE: To review the body of literature addressing polypharmacy in individuals aged 60 years and older to (a) determine primary care providers' definition of polypharmacy, (b) explore how polypharmacy was assessed in primary care, and (c) seek tested interventions that address polypharmacy. DATA SOURCES: A systematic review of electronic bibliographic databases (e.g. EBSCOHost, InfoTrac, OVID, FirstSearch, and FirstSearch Deluxe) utilizing the search terms "polypharmacy," "polypharmacy and elderly," "polypharmacy and research," and "multiple medications" for the period January 1991 to October 2003 was completed. The search was supplemented with online site searches of relevant journals and review of reference lists of each article. CONCLUSIONS: Results of the literature review revealed that polypharmacy continues to be a significant issue and little research has been conducted regarding the methods primary care providers utilize to assess polypharmacy. Also, there is a gap in the literature regarding the interventions implemented by primary care providers to address polypharmacy. IMPLICATIONS FOR PRACTICE: The following definition of polypharmacy in clinical practice might be more practical: the use of medications that are not clinically indicated. Selecting appropriate limits for numbers of medications may be counterproductive in populations with multiple comorbidities.     

Safe Expectations: Current State and Future Directions for Medication Safety in Pregnancy Research

Medication use in pregnancy is common, but information about the safety of most medications in pregnant women or their infants is limited. In the absence of data from randomized clinical trials to guide decisions made by regulators, clinicians, and patients, we often have to rely on well-designed observational studies to generate valid evidence about the benefits and risks of medications in pregnancy. Spontaneous reporting, primary case–control and cohort studies, pregnancy exposure registries, and electronic health data have been used extensively for studying medication safety in pregnancy. This article discusses these data sources, their strengths and limitations, and possible strategies and approaches to mitigating limitations when planning studies or interpreting findings from the literature. Strategies discussed include combining data sources across institutional or national borders, developing and using more sophisticated study designs, and taking advantage of existing analytic methods for more complex data structures, such as time-varying exposure or unmeasured confounding. Finally, we make recommendations for study designs that aid in better risk-related communication.     

Reducing Falls in Residents With Dementia by Reducing Psychotropic Medication Use: Does It Work?

Falls in elderly patients with dementia are common and a leading cause of morbidity and mortality. Psychotropic medications used to treat dementia are discouraged and may contribute to patient falls. Evidence-based clinical guidelines for appropriate antipsychotic use in this population exist. A nurse practitioner–led team used evidence-based tools to reduce psychotropic medication use in residents with dementia on a memory care unit and evaluated the effect on patient falls. Despite evidence linking falls to psychotropic medications, a reduction in resident falls was not found.     

Disciplinary power and its influence on the administration and supply of medications by nurses in rural areas of Australia

Hegney D. International Journal of Nursing Practice 1998; 4 : 144–150
Disciplinary power and its influence on the administration and supply of medications by nurses in rural areas of Australia
This paper reports on aspects of a larger study into rural nursing practice in Australia, 1991–94 (D. Hegney, unpublished data, 1996). Using a Foucauldian framework for analysis of the rural nursing discourses, it presents an interpretation of the statements regarding the administration and supply of medications in rural nursing practice. In particular, it focuses on the supply and administration of medications by rural nurses working in small rural health services. It explains that there are particular issues regarding telephone medication orders and the consequent verification of these orders. It suggests that rural medical practitioners use the power of legislation with regard to the administration and supply of medications to subjugate rural nursing practice. It argues that the nursing profession itself has used, through its silence on the inadequacy of the current Poison Acts and their Regulations, disciplinary power to ensure that rural nursing practice is normalised to metropolitan nursing practice. Further, the lack of educational preparation for this rural nursing role, can be seen as a pedagogical control of rural nursing practice. This paper recommends that the Statute Law regarding the administration and supply of medications be changed to reflect the reality of rural nursing practice, and that rural nurses are prepared adequately for this aspect of rural nursing practice.     

Use, Understanding, and Beliefs about Complementary and Alternative Medicines among Emergency Department Patients

OBJECTIVES: To describe the extent of complementary and alternative medicine (CAM) use among emergency department (ED) patients, to evaluate patients' understanding of CAMs, and to determine gender differences in beliefs about CAMs. METHODS: This study was a convenience sampling of patients seen in an urban ED. Patient demographics were recorded. A questionnaire was administered that assessed patients' knowledge and use of CAMs. Patients were also asked about their beliefs on safety, medication interactions, and conveying information about these substances to their physicians. RESULTS: A total of 350 ED patients were included in the study; 87% had heard of at least one of the CAMs. There was no difference between genders or races concerning knowledge about CAMs. The most commonly known CAMs were ginseng (75%), ginkgo biloba (55%), eucalyptus (58%), and St. John's wort (57%). Forty-three percent of the responders had used CAMs at some time and 24% were presently using CAMs. The most commonly used CAMs were ginseng (13%), St. John's wort (6%), and ginkgo biloba (9%). All CAMs were considered to be safe by 16% of the patients. Only 67% would tell their doctors they were using CAMs. Females were more likely than males to believe that CAMs do not interact with other medications (15% vs 7%, difference 8%, 95% CI = 2% to 15%). CONCLUSIONS: Complementary and alternative medicines are familiar to most patients and used by many of them. Despite this, a large percentage of patients would not tell their physicians about their use of alternative medications. Emergency medicine providers should be aware of the commonly used CAMs, and questions about their use should be routinely included in ED exams.     

Nurses' attitudes towards the use of PRN psychotropic medications in acute and forensic mental health settings

Many countries now have national mental health policies and guidelines to decrease or eliminate the use of seclusion and restraint yet the use of Pro Re Nata (PRN) medications has received less practice evaluation. This research aimed to identify mental health nurses' attitudes towards the use of PRN medications with mental health consumers. Participants were working in forensic mental health and non‐forensic acute mental health settings. The “Attitudes towards PRN medication use survey” was used and data were collected online. Data were analysed using the Statistical Package Social Sciences, Version 22.0. Practice differences between forensic and other acute mental health settings were identified related to the use of PRN medications to manage symptoms from nicotine, alcohol and other drug withdrawal. Differences related to the useage of comfort rooms and conducting comprehensive assessments of consumers' psychiatric symptoms were also detected. Qualitative findings highlighted the need for increased accountability for the prescribing and administration of PRN medications along with more nursing education/training to use alternative first line interventions. Nurses administering PRN medications should be vigilant regarding the indications for this practice to ensure they are facilitating the consumer's recovery by reducing the use of all forms of potentially restrictive practices in the hospital setting. The reasons for using PRN medications and PRN administration rates must be continually monitored to avoid practices such as high dose antipsychotics use and antipsychotic polypharmacy to ensure the efficacy of the consumers' management plans on their health care outcomes.