By L. Ningal. Oregon Institute of Technology.
Examples of problem focused coping include devising a revision plan and sticking to it buy discount imitrex 50mg on line spasms constipation, setting an agenda for a busy day buy imitrex 25mg online muscle relaxant anxiety, studying for extra qualiﬁcations to enable a career change and organizing counselling for a failing relationship order imitrex 25mg online muscle relaxant without drowsiness. Emotion focused coping: This involves attempts to manage the emotions evoked by the stressful event generic imitrex 50mg with amex muscle relaxant metaxalone side effects. Examples of behavioural strategies include talking to friends about a problem, turning to drink or smoking more or getting distracted by shopping or watching a ﬁlm. Examples of cognitive strategies include denying the importance of the problem and trying to think about the problem in a positive way. Several factors have been shown to inﬂuence which coping strategy is used: Type of problem: Work problems seem to evoke more problem focused coping whereas health and relationship problems tend to evoke emotion focused coping (Vitaliano et al. Age: Children tend to use more problem focused coping strategies whereas emotion focused strategies seems to develop in adolescence (Compas et al. Gender: It is generally believed that women use more emotion focused coping and that men are more problem focused. For example, Stone and Neale (1984) considered coping with daily events and reported that men were more likely to direct action than women. However, Folkman and Lazarus (1980) and Hamilton and Fagot (1988) found no gender diﬀerences. In contrast they use more emotion focused coping if the problem is perceived as being out of their control (Lazarus and Folkman 1987). Available resources: Coping is inﬂuenced by external resources such as time, money, education, children, family and education (Terry 1994). Poor resources may make people feel that the stressor is less controllable by them resulting in a tendency not to use problem focused coping. Measuring coping The diﬀerent styles of coping have been operationalized in several measures which have described a range of speciﬁc coping strategies. The most commonly used measures are the Ways of Coping checklist (Folkman and Lazarus 1988) and Cope (Carver et al. The coping strategies described by these measures include the following: s Active coping (e. Some of these strategies are clearly problem focused coping such as active coping and planning. For example, positive reframing involves thinking about the problem in a diﬀerent way as a means to alter the emotional response to it. Some strategies can also be considered approach coping such as using emotional support and planning whereas others reﬂect a more avoidance coping style such as denial and substance use. Therefore eﬀective coping can be classiﬁed as that which reduces the stressor and minimizes the negative outcomes. In addition, recent research has shifted the emphasis away from just the absence of illness towards positive outcomes. Much research has addressed the impact of coping on the physiological and self-report dimensions of the stress response. Coping and the stress illness link: Some research indicates that coping styles may moderate the association between stress and illness. For some studies the outcome vari- able has been more psychological in its emphasis and has taken the form of well-being, psychological distress or adjustment. For example, Kneebone and Martin (2003) critic- ally reviewed the research exploring coping in carers of persons with dementia. They examined both cross-sectional and longitudinal studies and concluded that problem- solving and acceptance styles of coping seemed to be more eﬀective at reducing stress and distress. In a similar vein, research exploring coping with rheumatoid arthritis sug- gests that active and problem-solving coping are associated with better outcomes whereas passive avoidant coping is associated with poorer outcomes (Manne and Zautra 1992; Young 1992; Newman et al. Similarly, research exploring stress and psoriasis shows that avoidant coping is least useful (e. For example, Holahan and Moos (1986) examined the relationship between the use of avoidance coping, stress and symptoms such as stomach-ache and headaches. The results after one year showed that of those who had experienced stress, those who used avoidance coping had more symptoms than those who use more approach coping strategies. Coping and positive outcomes: Over recent years there has been an increasing recognition that stressful events such as life events and illness may not only result in negative outcomes but may also lead to some positive changes in people lives. This phenomenon has been given a range of names including stress related growth (Park et al. This ﬁnds reﬂection in Taylor’s cognitive adaptation theory (Taylor 1983) and is in line with a new movement called ‘positive psychology’ (Seligman and Csikszentmihalyi 2000). Although a new ﬁeld of study, research indicates that coping processes which involve ﬁnding meaning in the stressful event, positive reappraisal and problem focused coping are more associated with positive outcomes (Folkman and Moskowitz 2000). Coping is considered to moderate the stress/illness link and to impact upon the extent of the stressor. Much research has involved the description of the kinds of coping styles and strategies used by people and some studies suggest that some styles might be more eﬀective than others. Initially, it was deﬁned according to the number of friends that were available to the individual. However, this has been developed to include not only the number of friends supplying social support, but the satisfaction with this support (Sarason et al. Wills (1985) has deﬁned several types of social support: s esteem support, whereby other people increase one’s own self-esteem; s informational support, whereby other people are available to oﬀer advice; s social companionship, which involves support through activities; s instrumental support, which involves physical help. The term ‘social support’ is generally used to refer to the perceived comfort, caring, esteem or help one individual receives from others (e. A number of studies have examined whether social support inﬂuences the health status of the individual. Lynch (1977) reported that widowed, divorced or single individuals have higher mortality rates from heart disease than married people and suggested that heart disease and mortality are related to lower levels of social support. However, prob- lems with this study include the absence of a direct measure of social support and the implicit assumption that marriage is an eﬀective source of social support. Berkman and Syme (1979) reported the results of a prospective study whereby they measured social support in 4700 men and women aged 30–69, whom they followed up for nine years. Research has also indicated that birth complications are lower in women who have high levels of social support, again suggesting a link between social support and health status (Oakley 1992). Research has also examined the eﬀects of social support on immune functioning and consequently health. The unemployed group received either standard economic beneﬁts only or received beneﬁts as well as a psychosocial support programme. The results showed that those unemployed subjects who received the psychosocial support showed better immune functioning than the subjects who received beneﬁts only. It would seem that social support reduced immuno- suppression, thus promoting health. If social support does inﬂuence or mediate the stress–illness link, then what are the possible mechanisms? This suggests that social support mediates the stress–illness link, with its very presence reducing the eﬀect of the stressor and its absence itself acting as a stressor. This process, which has been described using social comparison theory, suggests that the existence of other people enables individuals exposed to a stressor to select an appropri- ate coping strategy by comparing themselves with others. For example, if an individual was going through a stressful life event, such as divorce, and existed in a social group where other people had dealt with divorces, the experiences of others would help them to choose a suitable coping strategy. This suggests that social support enables individuals to change their role or identity according to the demands of the stressor.
Amino acids that give rise to ketone bodies (acetylCoA or acetoacetyl- CoA quality imitrex 25 mg muscle relaxant depression, neither of which can bring about net glucose production) are called ketogenic amino acids proven imitrex 25mg spasms early pregnancy. However discount imitrex 25mg on line muscle relaxant that starts with the letter z, the liver is the major site of metabolism of nitrogenous compounds in the body cheap imitrex 50mg visa muscle relaxant comparison. Digestion of dietary proteins produces amino acids, which are absorbed through epithelial cells and enter the blood. In our bodies, amino acids are used for the synthesis of proteins and other nitrogen-containing compounds, or they are oxidized to produce energy. Cellular proteins, hormones (thyroxine, epinephrine and insulin), neuro- transmitters, creatine phosphate, the haem of haemoglobin, cytochrome, melanin (skin pigment) and nucleic acid bases (purine and pyrimidine) are examples of amino-acid-derived nitrogen-containing biologically important group of compounds found in humans. The high melting points and greater water solubility than in ether are saltlike characteristics, not the characteristics of uncharged organic molecules. Water is the best solvent for most amino acids because it solvates ionic groups much as it solvates the ions of a salt. A large dipole moment is characteristic of zwitterionic compounds that contain great deal of separated charge. The pKa values for amino acids are also typical of zwitterionic forms of neutral molecules. The process that separates proteins according to their isoelectric point is called isoelectric focusing. At a pH below the pI proteins carry a net positive charge, whereas above the pI they carry a net negative charge. Appling this principle, gel electrophoretic methods have been developed to separate proteins. If the pH of the buffer is above the pI of the protein being run, the protein will migrate to the positive pole (negative charge is attracted to a positive pole). Similarly, if the pH of the buffer is below the pI of the protein being run, the protein will migrate to the negative pole of the gel (positive charge is attracted to the negative pole). If the protein is run with a buffer pH that is equal to the pI, it will not migrate at all. A drug’s pharmacological activity is inherently related to its chemical struc- ture. Various functional groups present in the drug molecules are involved in the drug–receptor binding or interaction. For example, drugs containing hydroxyl or amino groups tend to be involved in hydrogen bonding with the receptor. The activity can be a pharmacological response, binding, toxicity or any other quantiﬁable event. These essential functional groups for the pharmacological activities are called pharmacophores. A number of approved drugs have also been forced to be withdrawn from the market beacuse of toxicities. For example, in 2004, Merck’s arthritis drug Vioxx was withdrawn owing to severe cardiovascular side-effects, and the Parke-Davis and Warner-Lambert antidiabetic drug troglitazone (Rezulin) was withdrawn from the market in 2000 after it was found to cause severe liver toxicity. The drug industries expend considerable time and effort trying to avoid or minimize toxic effects by identifying and altering the functional groups responsible for toxic effects. A change in functional groups leading to toxicty can be demonstrated by paracetamol toxicity. The sulpha drugs and the penicillin group of antibacterial agents can be the ideal examples for demonstrating the importance of functional groups in drug actions and effectiveness. In Chapter 6, you will also see how a small change in the functional group(s) of steroidal molecules can render remarkable changes in their pharmacological and hormonal functions. In addition, the following structural features have to be present in sulpha drugs for the optimum antibacterial activity. As result, it does not have any in vitro antibacterial activity, but in vivo Prontosil is converted via reduction of the ÀÀNÀÀÀÀNÀÀ linkage to its active metabolite sulphanilamide. They are generally more water soluble, and thus better absorbed and retained better, i. Penicillin G, the parent of all these antibiotics, was ﬁrst isolated from a fungal species, Penicillium notatum. Since the discovery of this antibiotic, several modiﬁcations have been introduced to the parent structure in order to enhance the activity, increase the acid resistance, facilitate bioavailability 4. Penicillin G is rather a complex molecule, and possesses various types of functional group, e. All penicillins are susceptible to attack in acidic solution via intramole- cular attack of the amide carbonyl oxygen on the b-lactam carbonyl, leading to the complete destruction of the b-lactam ring, and thus the antibacterial activity. Similarly, penicillins are unstable in basic solution because of b- lactam ring opening by free basic nucleophiles. Thus, for the antibacterial activity, the stability of the b-lactam functional group in penicillins is of paramount importance. For example, the amino group of amoxicillin and ampicillin makes these molecules acid stable. For example, the amino group in amoxicillin gives the molecule polarity, and makes it effective against both Gram-positive and Gram-negative bacteria. A bulky group directly adjacent to the amide carbonyl will prevent the penicillin from entering the active site of penicillin-destroying enzymes, e. For example, methicillin has a bulky group directly adjacent to the amide carbonyl, and is b-lactamase resistance. For example, the enzymatic breakdown of the analgesic acet- aminophen (paracetamol), where the aromatic nature and the hydroxyl functionality in paracetamol are lost, yields N-acetyl-p-benzoquinone imine, a hepatotoxic agent. Paracetamol can cause liver damage and even liver failure, especially when combined with alcohol. Similarly, many drug molecules are susceptible to oxidation because of certain oxidizable func- tional groups, e. Like any other proteins in the gastrointestinal tract, insulin is reduced to its amino acid components, and the activity is totally lost. Many drugs having oleﬁnic double bonds exhibit trans–cis isomerism in the presence of light. Similarly, because of the presence of certain functional groups or the chemical structure, a drug can be sensitive to heat. Addition reactions Addition means two systems Alkenes, alkynes, aldehydes combine to a single entity. Elimination reactions Elimination refers to the loss Alcohols, alkyl halides and of water, hydrogen halide or alkyl dihalides. Substitution reactions Substitution implies that one Alkyl halides, alcohols, group replaces the other. Alkene, alkyne, aldehydes, ketones, alkyl halides, nitriles, carboxylic acid and its derivatives, and benzene and its derivatives. Pericyclic reactions Concerted reaction that takes Conjugated dienes and place as a result of a cyclic a,b-unsaturated carbonyl rearrangement of electrons. So their chemistry is very different from the chemistry of even-electron and electron-deﬁcient species, e. A radical behaves like an electrophile, as it requires only a single electron to complete its octet. All chain reactions have three steps: chain initiation, chain propagation and chain termination.
These reactions are usually eczema- confluent in areas on her abdomen and chest imitrex 50 mg without prescription muscle relaxant sciatica, and there is tous buy 25mg imitrex spasms cerebral palsy, and may persist for months or years after withdrawal of evidence of skin blistering and desquamation on her chest order imitrex 25 mg without prescription spasms icd 9 code. Answer Key points The most likely diagnosis of a rapidly progressive general- ized body rash involving the eyes order imitrex 25 mg amex spasms on right side of stomach, mouth and genitalia • Treatment of skin disorders depends on accurate with systemic fever and early desquamation is erythema diagnosis; steroids are not useful for all rashes and multiforme-major (Stevens Johnson syndrome, see indeed may cause harm if used inappropriately. The most common • Acne is treated first line with keratolytics; if systemic causes of this syndrome are viral infections, especially her- antibiotics are indicated, use oral oxytetracycline or pes virus, drugs and (less frequently) systemic bacterial erythromycin (but do not use tetracyclines in children infections, such as meningitis, nephritis and streptococcal under 12 years). In this patient for wet eczema use drying lotions or zinc-medicated the most likely aetiology is that she is taking co-trimoxa- bandages. Use the lowest potency steroid for the shortest time Her further management should include admission to hospi- possible required to produce clinical benefit. Although her condition is very severe, the patient may need to be glucocorticosteroids are effective, tachyphylaxis occurs, transferred to a burns unit. Short courses of high-dose gluco- and on withdrawal pustular psoriasis may appear. The disease may progress for up to four or five days and recovery may Case history take from one to several weeks. In the early morning of the last day of therapy, she develops a general- Series of articles relating to current treatment of dermatological condi- ized rash on her body, which is itchy and worsens, despite the tions. The structures of the eye itself are divided into the anterior and Contraction of this muscle also widens the spaces in the trabecu- posterior segments. The anterior segment includes the cornea, lar meshwork and this also explains, in part, the effect of limbus, anterior and posterior chambers, trabecular meshwork, parasympathomimetics in lowering intra-ocular pressure. The lacrimal gland has both sympa- The bioavailability of intra-ocularly administered drugs thetic and parasympathetic innervation. Parasympathetic inner- depends on pH and other pharmaceutical properties of the vation is relevant in that many drugs with anticholinergic side vehicle. Most ophthalmic drugs in general use are delivered as effects cause the symptom of dry eyes (see Table 52. Formulations which prolong drainage starts through small puncta located in the medial aspects the time for which a drug remains in contact with the eye surface of the eyelids. Blinking causes tears to enter the puncta and drain include gels, ointments, solid inserts, soft contact lenses and col- through the canaliculi, lacrimal sac and nasolacrimal duct into the lagen shields. The nose is lined with highly vascular epithelium which per- mately linearly related to the concentration of drug applied. Nasolachrymal drainage plays a key role in the systemic Consequently, even though the dose administered as eye drops is absorption of drugs administered to the eye, and drugs much smaller than the usual dose of the same drug (e. Thus ocular drugs such as β-adrenergic antagonists can nonetheless lead to unwanted systemic effects. Agents that dilate the and flows from the posterior chamber through the pupil into the pupil may abruptly increase the intra-ocular pressure in anterior chamber. Around 80–95% of it exits via the trabecular closed-angle glaucoma by causing obstruction to the outflow meshwork and into the canal of Schlemm and subsequently into tract, and are contraindicated in this condition. Patients the episcleral venous plexus and eventually into the systemic should be asked whether they are driving before having their circulation. Fluid can also flow via the ciliary muscles into the pupils dilated and should be warned not to drive afterwards suprachoroidal space. The geometry of the anterior chamber dif- until their vision has returned to normal. Open-angle glaucoma is usually treated medically in the first instance, by reducing aqueous Tears humour flow and/or production. Closed-angle glaucoma is treated by iridectomy following urgent medical treatment to Conjunctiva reduce the intra-ocular pressure in preparation for surgery. Mannitol can reduce Iris Ciliary body the intra-ocular pressure acutely by its osmotic effect. In add- ition, therapy with a carbonic anhydrase inhibitor (intra- venous acetazolamide or topical dorzolamide) may be Systemic circulation required. The free acid dif- fuses out of the cornea into the aqueous humour and lowers Mannitol (Chapter 36) is an osmotic diuretic. It shifts water from intracellular and transcellular com- The main side effects are local irritation with stinging, burning partments (including the eye) into the plasma, and promotes and blurred vision. Punctate keratopathy has occurred, and it loss of fluid by its diuretic action on the kidney. Its major increases the amount of brown pigment in the iris in patients adverse effect is dehydration. It was previously used as Brimonidine is a selective α2-agonist, used for chronic open- a diuretic (see Chapter 36). It decreases aqueous humour production and increases the eye reduces aqueous humour production by the ciliary uveoscleral flow. The major toxicities include local ocular irritation and occasional corneal staining, and sys- Adverse effects temic adverse effects include dry mouth (25% of cases), headache, fatigue, drowsiness and allergic reactions. Acetazolamide is poorly tolerated orally, although a slow- release preparation exists which can be given twice daily and Key points has reduced incidence of side effects. Dorzolamide is a topic- ally applied carbonic anhydrase inhibitor, whose use may Drugs and the pupil reduce the need for systemic acetazolamide therapy (see • Miosis (pupillary constriction) below). Acetazolamide should not be used in patients with – Parasympathetic stimulation: renal failure, renal stones or known hypersensitivity to muscarinic agonists (e. Acute bac- specialist supervision to treat uveitis and scleritis, and some- terial conjunctivitis is usually due to Staphylococcus aureus or times in the post-operative setting. Chloramphenicol, gentamicin, fusidic acid or to treat the undiagnosed ‘red-eye’ which could be due to a one of the fluoroquinolones (e. Furthermore, topical steroids produce or exacerbate glaucoma in genetically pre- disposed individuals (Chapter 14). Several such ophthalmic Topical antihistamines for ophthalmic use include antazoline preparations are available, including diclofenac, flurbiprofen and azelastine. Oxybuprocaine and tetracaine are widely used in the eye as Sodium cromoglicate in particular is very safe and only topical local anaesthetics. Tetracaine causes more profound anaesthesia and is suitable for minor surgical procedures. Lidocaine is also often injected for surgical proced- Pegaptanib and ranibizumab are two newly licensed ures on the globe of the eye. Ocular involvement occurs in up to two- evidence of efficacy and safety; currently, its licensed indica- thirds of patients, of whom approximately one-third suffer tions are metastatic colorectal or breast carcinoma (see permanent visual sequelae. A summary of such – timolol (β-adrenoceptor antagonist); agents is given in Table 52. His angina and blood pressure are well controlled while taking oral therapy with bendroflumethiazide, 2. Expert Opinion on Drug acuity gradually declines and he is diagnosed as having sim- Delivery 2006; 3: 275–87. Management of glaucoma: focus on pharma- day, and carteolol drops, two drops twice a day. Clinical examination reveals a regular pulse of 35 beats per minute, blood pressure of 158/74mmHg and signs of mild left ven- tricular failure. Answer Carteolol is a non-selective β-adrenergic antagonist that can gain access to the systemic circulation via the nasolachrymal apparatus thus avoiding heptic first-pass metabolism. It can thus act (especially in conjunction with a calcium antagonist – diltiazem in this case) on the cardiac conducting system and on the working myocardium. A distinct feature is cross- ing from the interaction between a living organism and a drug tolerance, where tolerance to one type of drug is associated characterized by behavioural and other responses that always with tolerance to other drugs. Cross-tolerance, which can include a compulsion to take the drug on a continuous or encompass chemically distinct drugs, has been clearly demon- periodic basis in order to experience its psychic effects and strated for alcohol, benzodiazepines and other sedative drugs. In the above definitions, a distinction is made between • Continued drug use despite awareness of its harmful physical and psychological dependence. Factors that increase the likelihood of addiction include: after withdrawal of alcohol or benzodiazepines, or depression and lethargy seen after withdrawal of stimulants).
Here’s what you need to do to administer eardrops: • Check the prescriber’s order discount 50 mg imitrex mastercard muscle relaxers to treat addiction. This is a common route used to administer bronchodilators to patients with breathing problems such as asthma purchase imitrex 25mg with visa muscle relaxer zoloft, pneumonia cheap 50 mg imitrex with mastercard infantile spasms 9 months, and chronic obstructive pulmonary disease safe 50mg imitrex spasms of the bladder. The medication enters the lower respiratory tract where it is rapidly absorbed in the bronchioles providing the patient with relief from bronchospasms, wheez- ing, asthma, or allergic reactions. Inhalation is used to deliver antibiotics, steroids and mucolytic agents (drugs that thin secretions making it easier to clear the bronchi). The patient can expe- rience side effects such as tremors, nausea, tachycardia, palpitations, ner- vousness, and dysrhythmias (see Chapter 14). The hand-held metered dose device is a small, metal container about 5 to 6 inches high, with a push button spray device on the top to release the medication. The efficiency increases by using a spacer, which delivers 21% of the medication to the lungs. The medication is released into the spacer and then the patient inhales slowly and deeply to get the drug into the airway. The nasogastric tube is passed through the nose and into the stomach opening with direct access to the stomach through which med- ication can be administered to the patient. The nasogastric tube is also used as a temporary feeding tube and to remove stomach contents. The gastrostomy tube is inserted through the skin and directly into the stomach and is used primarily as a permanent feeding tube that can also be used to administer medication. When administering medication through the nasogastric tube and the gas- trostomy tube: • Check the prescriber’s order. It is also used when digestive enzymes change the chemical integrity of the medication. The rectum promotes absorption of the medication because it contains many capillaries and can produce a high blood concentration of the medication. Insulin is injected subcutaneously, although regular insulin can also be administered intravenous. Medications administered intravenously have a faster onset of therapeutic effect than other parenteral routes. Vacci- nations, some antibiotics, and other medications are injected intramuscularly. Medication injected intradermally has a localized effect because it does not enter the bloodstream. Injections are given using a 26–27 gauge needle and a 1 mL syringe calibrated in 0. Here’s how to administer medication intradermally: • Check the prescriber’s medication order. If the patient is allergic to the med- ication, then the diameter of the wheal should increase. Subcutaneous medications are absorbed through capillaries and the onset of the medication is slower than intramuscular and intravenous routes. To prevent lypodystro- phy, sites must be rotated if injections are given frequently. Lypodystrophy is a loss of the fat area under the skin causing ineffective absorption of insulin. These sites are: abdomen, upper hips, upper back, lateral upper arms, and lateral thighs. Subcutaneous injections are given using a 25–27-gauge needle that is 1/2 or 5/8 inches in length and with a 1 to 3 mL syringe calibrated 0. Here’s how to administer medication subcutaneously: • Check the prescriber’s medication order. Choose an injection site based on the size of the muscle with a minimum number of nerves and blood vessels in the area. These sites are: • Ventrogluteal (hip) • Dorsogluteal (buttocks) • Deltoid (upper arm) • Vastus lateralis (front of thigh) See Table 6-1 for more details. Here’s how to administer medication intramuscularly: • Check the prescriber’s medication order. Z-Track Injection Technique The Z-Track inject technique is used to prevent medication from leaking back in the subcutaneous tissue after the medication has been injected into the patient. This technique is used whenever the medication—such as dextran (iron)—might cause a visible and permanent skin discoloration. Here’s how to administer medication using the Z-Track technique: • Check the prescriber’s medication order. Injection Site Description Ventrogluteal • Relatively free of major nerves and vascular branches. Measure 2 to 3 fingers below the acromion process on the lateral midline of the arm to identify the proper site. Tips for Minimizing Pain Receiving medication via injection is a painful process for the patient. However, you can minimize the discomfort by following these tips: • Encourage the patient to relax. Position the patient flat on the abdomen with toes turned inward if you are using the dorsogluteal site. However, cubital veins should be avoided except in emergency situation because cubital veins are used for withdrawing blood specimens for laboratory testing. Medication may be admin- istered directly into the vein with a syringe, into an intermittent catheter inserted into the patient’s vein, or injected into intravenous fluids such as 5% Dextrose in Water (D5W) and delivered as an intravenous drip called a piggy back. Summary Medication is given to a patient using one of several routes depending on the nature of the medication and the patient’s condition. The sublingual and buccal routes are used for rapid absorption of medication because blood vessels are close to the surface of the tongue and gums. Medication is directed to the lungs by using the inhalation route where the patient uses an inhaler. The suppository route is used to absorb medication directly into the rectum or vagina. The parenteral route is used to inject medication directly into the dermal or subcutaneous tissue, muscle, or into the veins. If the dose of a transdermal patch is more than the prescriber’s medica- tion order (a) cut the patch to an appropriate length. The Z-Track injection is used (a) to prevent medication from leaking back onto the tissue. Although the prescriber specifies a dose in the medication order, the dose prescribed may not be the same as the dose that is on hand, requir- ing the nurse to calculate a comparable dose based on available medication. The nurse is responsible for weighing the patient and then applying a formula provided by the prescriber to calculate the actual dose. The Metric System and Medication Medication is prescribed in measurements of the metric system. Unit Purpose Equivalents Gram Weight 1 kilogram (kg) = 1000 grams (g) 1 gram (g) = 1000 milligrams (mg) 1 milligram = 1000 micrograms (mcg) 1 kilometer = 1000 liters Liter Volume 1 liter (L) = 1000 milliliters (mL) = 1000 cubic centimeters (cc) 1 milliliter (mL) = 1 cubic centimeter (cc) Medication calculation requires you to know how to multiply and divide. You’ll also need to know six metric measurements and five household measure- ments (ounces, teaspoon, tablespoon, cup and drop). The metric system uses grams to measure weight and liters to measure volume as shown in Table 7-1. Table 7-2 shows the commonly used prefixes that you’ll see when calculating medication. The prefix is placed before the unit of mea- sure such as 1 kilogram or 1 milliliter.
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