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By: Brian A. Hemstreet, PharmD, FCCP, BCPS Assistant Dean for Student Affairs; Associate Professor of Pharmacy Practice, Regis University School of Pharmacy, Denver, Colorado

For example: 15 drops/min = 15 ml/hour a Daily needs are calculated according the following formula: Children 0-10 kg: 100 ml/kg per day Children 11-20 kg: 1000 ml + (50 ml/kg for every kg over 10 kg) per day Children > 20 kg: 1500 ml + (20-25 ml/kg for every kg over 20 kg) per day Adults: 2 litres per day 343 Appendix 1b Appendix 1b order fluticasone asthma definition karma. Fluid to be administered The fluid of choice in children is Ringer lactate-Glucose 5% order fluticasone paypal asthma types. Look at: a Condition Well cheap 500 mcg fluticasone mastercard asthma attack, alert Restless buy generic antabuse on line, irritable Lethargic or unconscious b Eyes Normal Sunken Sunken Thirst Drinks normally discount 80 mg top avana with amex, not Thirsty buy nizagara 50mg with visa, drinks eagerly Drinks poorly or not able to thirsty drink 2. Decide: The patient has If the patient has two or If the patient has two or no signs of more signs in B, there is more signs in C, there is dehydration some dehydration severe dehydration 4. Treat: Use Treatment Plan A Weigh the patient, if Weigh the patient and use possible, and use Treatment Plan C Treatment Plan B Urgently a Being lethargic and sleepy are not the same. It is helpful to ask the mother if the child’s eyes are normal or more sunken than usual. The treatment of diarrhoea - a manual for physicians and other senior health workers. Give 100 ml/kg Ringer’s Lactate Solution (or if not available normal saline), divided as follows: Age First give Then give ȱ ȱ 30 ml/kg in: 70 ml/kg in: Infants ȱ ȱ (under 12 months) 1 hour* 5 hours Older 30 minutes* 2 ½ hours ȱ ȱ * Repeat once if radial pulse is still very weak or non- ȱ No ȱ ȱ detectable. If the patient is over two years old and there is cholera in your area, give an appropriate oral antibiotic after the patient is alert. Practical advice for writing medical certificates in the event of sexual violence Physicians are often the first to be confronted with the consequences of violence. Victims are sometimes afraid to report to the authorities concerned, particularly when the population affected is vulnerable (refugees, prisoners, civilian victims of war etc. In such a situation, the physician should try to determine if the event was isolated or part of larger scale violence (e. Faced with sexual violence, the physician is obliged to complete a medical certificate for the benefit of the victim, irrespective of the country in which (s)he is practising. The certificate is individual (for the benefit of the individual or their beneficiaries) and confidential (it falls within professional confidentiality). The examples of certificates presented in the following pages are written for sexual violence, but the approach is the same for all forms of intentional violence. Keep a copy of the medical certificate (or, if the case should arise, of the mandatory reporta) in the patient record, archived to allow future authentication of the certificate given to the victim. What the practitioner should not do: – Rephrase the words of the victim as the practitioner ’s own. The only exception is if there is a risk that reporting may further harm the situation of the child.

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If you would like medications being taken and dosage discount fluticasone master card asthma symptoms worsening, including more information on Parkinson’s disease talk with over-the-counter preparations purchase fluticasone 250 mcg overnight delivery asthma symptoms fatigue, vitamins discount fluticasone 100mcg amex asthma symptoms pain in back, your doctor or pharmacist purchase tadapox toronto. The physician will specify the exact amount of been checked with their physician and a change medication and when it should be taken discount apcalis sx 20mg with amex. A doctor must be consulted in order to safely change the dose in response to The risk of birth defects associated with benztro- side effects of the antipsychotic medications order viagra plus master card. For all women of childbearing age • Dizziness who may be or think they may be pregnant, the • Dry mouth physician should discuss the safety of this medica- • Heart failure tion before starting, continuing, or discontinuing • Irritability medication treatment. Substance abuse counselors • Light-headedness may have a role in encouraging this discussion by suggesting their clients talk with the prescribing • Stomach upset physician. By valproic acid Depakene leveling mood swings with antimanic medications, some of the suicidal and other self-harming Atypical antipsychotics behaviors can be decreased. Certain medications will require a mood swings of bipolar (manic–depressive) illness. The “highs” and “lows” vary in Lithium products: Most common side effects are intensity, frequency, and severity. However, too much • Under or overactive thyroid* 11 fuid in a person’s diet can “wash” the lithium out • Weakness of his or her system, and too little fuid can allow • Weight gain the lithium to concentrate in the system. Additionally, anything that can decrease sodium in *These side effects are associated with lithium, the body (i. People taking any antimanic medications should have blood levels tested regularly to check Lithium overdose is a life-threatening emergency. Specifcally, people taking lithium products, vomiting, diarrhea, drowsiness, mental dullness, carbamazepine and valproic acid and divalproex slurred speech, confusion, dizziness, muscle sodium, need their blood levels monitored for twitching, irregular heartbeat and blurred vision. An overdose of any of the other antimanic medica- 12 tions is always considered an emergency and Anticonvulsant products: Most common side treatment should be sought immediately. There are case reports in the literature For the most common side effects of atypical that do however show the potential for abuse of antipsychotics, refer to Antipsychotics/ lithium. It is likely that all of the newer that lithium can produce a “buzz” at high doses. Their abuse potential alone is • Blurred vision low; however, combining anticonvulsants with • Coma* alcohol on the other hand can lead to increased • Diarrhea* drowsiness. Physical dependence has not been • Drowsiness associated with lithium or anticonvulsants to date. Patients on anticonvulsants should not stop • Increased thirst and urination* their medications without medical supervision. Slow tapering off periods (two to • Kidney damage* four weeks depending on the drug) are recom- • Liver infammation, hepatitis mended to slow or prevent the withdrawal effects • Nausea or vomiting described. For patients with active seizures after • Problems with the blood, both red and white cells sudden withdrawal of anticonvulsants, benzodiaz- epines like diazepam and lorazepam may be used • Rash and skin changes to treat the immediate seizure. John’s stops convulsions; an abnormal violent, involuntary wort, echinacea, ginkgo, ginseng). Some antimanic medications, such as valproic acid, • Persons taking antimanic medications are are associated with several birth defects if taken particularly vulnerable to adverse medical during pregnancy.

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The level of asexual parasitaemia determined by microscopy can be expressed in several ways: the percentage of infected red blood cells discount fluticasone 250 mcg with visa asthma diagnosis code, the number of infected red cells per unit volume of blood quality fluticasone 250 mcg asthma definition repoire, the number of parasites seen in one feld on high power microscopy examination of a thick blood flm generic fluticasone 100 mcg otc asthma treatment before inhalers, or the number of parasites seen per 200–1000 white blood cells on high-power examination of a thick blood flm order 20 mg levitra soft mastercard. A combination of two or more classes of antimalarial drug with unrelated mechanisms of action generic viagra extra dosage 200 mg otc. The ability of a parasite strain to survive and/or to multiply despite the administration and absorption of a drug given in doses equal to or higher than those usually recommended purchase zoloft no prescription, provided the exposure is adequate. Resistance to antimalarial agents arises because of the selection of parasites with genetic changes (mutations or gene amplifcations) that confer reduced susceptibility. The sexual stages of malaria parasites that infect anopheline mosquitoes when taken up during a blood meal. A combination in which two antimalarial drugs are formulated together in the same tablet, capsule, powder, suspension or granule. A high density of parasites in the blood, which increases the risk of deterioration to severe malaria (although the risk varies in different endemic areas according to the level of transmission) and of subsequent treatment failure. In this document, the term is used to refer to a parasite density > 4% (~ 200 000/ µL). A dark-brown granular material formed by malaria parasites as a by-product of haemoglobin digestion. It may also be phagocytosed by monocytes, macrophages and polymorphonuclear neutrophils. Parasite released into the host bloodstream when a hepatic or erythrocytic schizont bursts. Antimalarial treatment with a single medicine: either a single active compound or a synergistic combination of two compounds with related mechanisms of action. A genus of protozoan vertebrate blood parasites that includes the causal agents of malaria. After inoculation into a human by a female anopheline mosquito, sporozoites invade hepatocytes in the host liver and multiply there for 5–12 days, forming hepatic schizonts. These then burst, liberating merozoites into the bloodstream, where they subsequently invade red blood cells. This term refers to both cure of blood-stage infection and prevention of relapses by killing hypnozoites (in P. An antigen-based stick, cassette or card test for malaria in which a coloured line indicates the presence of plasmodial antigens. Recurrence of asexual parasitaemia following antimalarial treatment comprising the same genotype(s) that caused the original illness. This results from incomplete clearance of asexual parasitaemia because of inadequate or ineffective treatment.

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The Pharmaceutical Schedule shows the level of subsidy payable in respect of each Community Pharmaceutical so that the amount payable by the Government to Contractors discount 100mcg fluticasone visa chronic asthma definition, for each Community Pharmaceutical cheap fluticasone 500mcg without a prescription asthma definition unity, can be calculated purchase fluticasone 500 mcg amex asthma disease. This Schedule is dated 1 February 2018 and is to be referred to as the Pharmaceutical Schedule Volume 25 Number 0 buy super p-force 160mg on-line, 2018 buy nizagara 50mg with visa. The specifics of these criteria are conveyed in the Ministry of Health guidelines generic 140mg malegra fxt free shipping, which are issued from time to time. The criteria the patient must meet are that they: a) have limited physical mobility; b) live and work more than 30 minutes from the nearest pharmacy by their normal form of transport; c) are relocating to another area; d) are travelling extensively and will be out of town when the repeat prescriptions are due. The Annotation must include the details specified in the Schedule, including the date the prescriber was contacted (if applicable) and be initialled by the dispensing pharmacist. An authority to substitute letter, which may be used by Practitioners, is available on the final page of the Schedule. Alternatively a copy of the invoice for the purchase of the Pharmaceutical may be attached to the prescription, in the place of an annotation, in order to be eligible for Subsidy. The endorsement can be written as “certified condition”, or state the condition of the patient, where that condition is specified for the Community Pharmaceutical in Section B of the Pharmaceutical Schedule. Where the Prescriber writes “certified condition” as the endorsement, he/she is making a declaration that the patient meets the criteria as set out in Section B of the Pharmaceutical Schedule. For the purposes of the definition it makes no difference whether or not the Specialist is employed by a hospital. For the purposes of this definition, a “specialist” means a doctor who holds a current annual practicing certificate and who satisfies the criteria set out in paragraphs (a) or (b) or (c) of the definitions of Specialist below. Where the Contractor has an electronic record of such an Endorsement or Annotation from a previous prescription for the same Community Pharmaceutical written by a prescriber for the same patient, they may annotate the prescription accordingly. Only that part of any Prescription that is dispensed within the time frames specified above is eligible for Subsidy. At the time of dispensing the Contractor must keep a record of the quantity discarded. To ensure wastage is reduced, the Contractor should reduce the amount dispensed to make it equal to the quantity contained in a whole pack where: a) the difference between the amount dispensed and the amount prescribed or ordered by the Prescriber is less than 10% (eg; if a prescription is for 105 mls then a 100 ml pack would be dispensed); and b) in the reasonable opinion of the Contractor the difference would not affect the efficacy of the course of treatment prescribed or ordered by the Prescriber. Note: For the purposes of audit and compliance it is an act of fraud to claim wastage and then use the wastage amount for any subsequent prescription. Registered Nurse Prescribers are not eligible to apply for Special Authority approvals (initial or renewal). This Dispensing Frequency Rule defines patient groups or medicines eligible for more frequent dispensing periods for Community Pharmaceuticals; and the conditions that must be met to enable any pharmacy to claim for payment of handling fees for the additional dispensings made. This Dispensing Frequency Rule relates to the circumstances in which a subsidy is payable for the Community Pharmaceutical; it does not override alternative dispensing frequencies as expressly stated in the Medicines Act, Medicines Regulations, Pharmacy Services Agreement or Pharmaceutical Schedule. For the purposes of this Dispensing Frequency Rule: “Frequent Dispensing” means: i) for a Community Pharmaceutical referred to in Section F Part I, (the Stat exemption) dispensing in quantities less than one 90 Day Lot (or for oral contraceptives, less than one 180 Day Lot); or ii) for any other Community Pharmaceutical dispensing in quantities less than a Monthly Lot “Safety Medicine” i) an antidepressant listed under the “Cyclic and Related Agents”subheading; ii) an antipsychotic; iii) a benzodiazepine; iv) a Class B Controlled Drug; v) codeine (includes combination products); vi) buprenorphine with naloxone; or vii) zopiclone.