Going International
Title Going International
Prefered Language style English (U.S.)
Type of document Essay
Number of pages/words 1 Page Double Spaced (approx 275 words per page)
Subject area Business
Academic Level Undergraduate
Style APA
Number of sources/references 3
Order description:
What are the advantages of a small business going international through incremental stages rather than as a global start-up?
Advanced Pathophysiology week 11 response 1
Title Advanced Pathophysiology week 11 response 1
Prefered Language style English (U.S.)
Type of document Essay
Number of pages/words 1 Page Double Spaced (approx 275 words per page)
Subject area Nursing
Academic Level Master
Style APA
Number of sources/references 3
Order description:
Please respond to Traceys post by Share insights on how the factor you selected my factor was behavior impacts the pathophysiology of the disorder your colleague selected.
Offer alternative diagnoses and prescription of treatment options for the disorder your colleague selected.
Validate an idea with your own experience and additional research and use the required readings for at least 2 references
Required Readings
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Chapter 32, “Structure and Function of the Reproductive Systems”
This chapter establishes a foundation for examining alterations of reproductive systems by examining the female and male reproductive systems. It covers the development of both reproductive systems and effects of aging on the systems.
Chapter 33, “Alterations of the Female Reproductive System
This chapter covers alterations of the female reproductive systems. It also explores the epidemiology, clinical manifestations, evaluation, and treatment of sexually transmitted infections.
Chapter 34, “Alterations of the Male Reproductive System”
This chapter covers alterations of the male reproductive systems. It also explores the epidemiology, clinical manifestations, evaluation, and treatment of sexually transmitted infections.
Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.
Chapter 22, “Disorders of the Female Reproductive Tract”
This chapter reviews the normal structure and function of the female reproductive tract. It then examines disorders specific to the female reproductive tract such as menstrual disorders and infertility.
Chapter 23, “Disorders of the Male Reproductive Tract”
This chapter reviews the normal structure and function of the male reproductive tract. It then explores disorders specific to the male reproductive tract such as male infertility and benign prostatic hyperplasia.
Required Media
Laureate Education, Inc. (Executive Producer). (2012b). Final course review. Baltimore, MD: Author.
Traceys post
1 day ago Tracey Rusnak
WK 11 Infertility
COLLAPSE
NURS-6501N-15: Advanced Pathophysiology
Disorders of the Reproductive System
Infertility is defined as not being able to conceive after one year or longer of unprotected sex. For a pregnancy to happen, four steps must occur. First, a woman’s body must release an egg from one of her ovaries. Next, sperm must join with the egg and fertilize. This fertilized egg must then go through a fallopian tube towards the uterus. Finally, the fertilized egg must attach to the inside of the uterus. A problem with any of these steps can lead to infertility (CDC, 2018).
Male Infertility
The most common cause of male infertility is due to varicoceles. This refers to an abnormally dilated scrotal vein that causes impaired spermatogenesis by increasing scrotal temperatures, altering testicular blood flow, reducing testicular size, decreasing serum testosterone levels, and damaging DNA (Hammer & McPhee, 2014). Sperm production may also be affected by trauma to the testes, anabolic steroid use, heavy alcohol or illicit drug use, cancer treatment, or medical conditions such as diabetes, certain infections, or autoimmune disorders that cause testicular failure. Testing the semen for sperm concentration, motility, and morphology helps determine if the male factor contributes to the infertility (CDC, 2018).
Female Infertility
The ovaries are the female’s primary reproductive organs with its two main functions of secreting sex hormones and releasing ova (eggs). A woman is born with all the eggs she will ever have, approximately one to two million at birth. The number of eggs at puberty is decreased to 300,000 to 500,000. The number of eggs continue to diminish until the ovaries atrophy and cease, signaling menopause. Each month, as one of the ovarian follicles reaches maturation and discharges its ovum it develops into the corpus luteum. If fertilization occurs, the corpus luteum begins to secrete hormones that maintain and support pregnancy. If fertilization does not occur, then the corpus luteum degenerates, signaling the menstrual flow and triggers maturation of another follicle (Huether & McCance, 2017).
Any disruption in the ovarian cycle can cause infertility. Polycystic ovarian syndrome is the most common cause of female infertility in which the woman does not ovulate or ovulates irregularly. Diminished ovarian reserve, hypothalamic amenorrhea, and a dysfunction of the hypothalamus and pituitary glands to produce hormones to maintain normal ovarian function are other causes of infertility (CDC, 2018).
The fallopian tubes direct the ova from the spaces around the ovaries to the uterus. The distal third of the fallopian tube is the usual site of fertilization. If an ovum is present in either fallopian tube, and sperm enters, then fertilization can occur. Any obstruction in the fallopian tube that causes difficulty for the sperm or egg to transport can cause infertility. In addition, conditions that cause failure of implantation due to adhesions or edema or the implantation in an inappropriate location can cause infertility (Huether & McCance, 2017. Occlusion can be caused from pelvic infection, history of ruptured appendicitis, gonorrhea or chlamydia, endometriosis, or abdominal surgery (CDC, 2018).
Similarities and Differences
Women are born with all the eggs they will ever have. The production of sperm can be influenced by life style behaviors. Age is a very influential factor for women conceiving due to diminishing quality and quantity of eggs with advanced aging. Smoking, excessive alcohol use, obesity, radiation, environmental exposures and certain medications can affect infertility in both men and women (CDC, 2018).
References
Centers for Disease Control and Prevention (CDC). (2018). Infertility FAQs. Retrieved from
https://www.cdc.gov/reproductivehealth/infertility/index.htm
Hammer, G. G., & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical
medicine. (7th ed.) New York, NY: McGraw-Hill Education.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis,
Advanced pathophysiology response 2 week 11
Title Advanced pathophysiology response 2 week 11
Prefered Language style English (U.S.)
Type of document Essay
Number of pages/words 1 Page Double Spaced (approx 275 words per page)
Subject area Nursing
Academic Level Master
Style APA
Number of sources/references 3
Order description:
Please respond to Gayla post by Share insights on how the factor you selected my factor was behavior impacts the pathophysiology of the disorder your colleague selected.
Offer alternative diagnoses and prescription of treatment options for the disorder your colleague selected.
Validate an idea with your own experience and additional research and use the required readings for at least 2 references
Required Readings
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Chapter 32, “Structure and Function of the Reproductive Systems”
This chapter establishes a foundation for examining alterations of reproductive systems by examining the female and male reproductive systems. It covers the development of both reproductive systems and effects of aging on the systems.
Chapter 33, “Alterations of the Female Reproductive System
This chapter covers alterations of the female reproductive systems. It also explores the epidemiology, clinical manifestations, evaluation, and treatment of sexually transmitted infections.
Chapter 34, “Alterations of the Male Reproductive System”
This chapter covers alterations of the male reproductive systems. It also explores the epidemiology, clinical manifestations, evaluation, and treatment of sexually transmitted infections.
Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.
Chapter 22, “Disorders of the Female Reproductive Tract”
This chapter reviews the normal structure and function of the female reproductive tract. It then examines disorders specific to the female reproductive tract such as menstrual disorders and infertility.
Chapter 23, “Disorders of the Male Reproductive Tract”
This chapter reviews the normal structure and function of the male reproductive tract. It then explores disorders specific to the male reproductive tract such as male infertility and benign prostatic hyperplasia.
Required Media
Laureate Education, Inc. (Executive Producer). (2012b). Final course review. Baltimore, MD: Author.
Gayla post
Gayla Cragg
Cragg DB 11 Testicular Torsion & Gynecomastia
COLLAPSE
Torsion of the Testes
Torsion of the testes occurs when the blood supply to the testicle is interrupted by a rotation of the vascular pedicle (Rodway & McCance, 2017). Often one testicle may appear larger than the other. More often the left side is affected, than the right side (Urology Care Foundation, n.d.). The testicle often will turn red due to the changes in blood flow (Urology Care Foundation, n.d.). This swelling results in testicular pain and swelling, which does not go away with rest or elevation (Rodway & McCance, 2017). Other symptoms include nausea, vomiting, fever, and frequent urination (Mayo Clinic, 2018). Death of tissue can occur due to the vascular swelling (Rodway & McCance, 2017).
Testicular Torsion is common in adolescence. Possible causes include trauma, as well as the rapid growth of the testicle during puberty (Mayo Clinic, 2018). The Urology Care Foundation (n.d.) notes that physical activity does not cause testicular torsion, as it can occur in any position and during sleep. However, Fehér and Bajory (2016) noted that cycling could be a contributing factor due to the physical activity mechanism, as well as cold airflow.
There has been found to be a genetic cause, which is an inherited trait that allows the testicle to rotate within in the scrotum (Mayo Clinic, 2018). The exact genetic mechanism of testicular torsion is unclear. Fehér and Bajory (2016) noted that there are “suspected elements of a genetic origin, such as the insulin-like 3 hormone and its receptor, Rxlf2” (p. 2). Alireza Bolourian and Mojtahedi (2018) discussed that blocking natural killer cells in testicular torsion has shown some promise for preventing progression of the disease, which could prevent the loss of fertility if used in addition to surgery. Further research is needed in this area.
Testicular torsion can also occur in newborns (Rodway & McCance, 2017). The infant’s testicle is often hard, swollen, and discolored (Mayo Clinic, 2018). Surgery may be considered to repair, remove, as well as stitch the testicle to the scrotum to prevent recurrence (Mayo Clinic, 2018).
Treatment is through manual reduction, as well as surgery within 6 hours if a reduction is not possible (Rodway & McCance, 2017). This condition is considered a medical emergency (Rodway & McCance, 2017). Diagnosis is usually made by checking a urinalysis for infection, as well as a Doppler ultrasound (Rodway & McCance, 2017). The sooner a repair of the spermatic cord can be completed, the less likely there will be permanent damage which may include loss of fertility.
Gynecomastia
Gynecomastia is the “overdevelopment of breast tissue in a male” (Rodway & McCance, 2017, p. 876). This condition occurs commonly in “adolescents and men older than 50 years” (Rodway & McCance, 2017, p. 876). Often the left breast is involved when the condition affects one side (Rodway & McCance, 2017). Gynecomastia occurs due to an imbalance in the estrogen/testosterone ratio, which can “be idiopathic, or caused by systemic disorders, drugs, or neoplasms” (Rodway & McCance, 2017, p. 876). Heredity and obesity are causes of breast enlargement (Whiteman, n.d.).
Medications which can cause gynecomastia include spironolactone, digitalis, thiazide, tricyclic antidepressants, calcium channel blockers, diazepam, cimetidine, and anabolic steroids (Rodway & McCance, 2017; “Enlarged breasts in men”, 2018). Breast enlargement has been found in males who are transitioning to females utilizing estrogen therapy (Rodway & McCance, 2017).
Gynecomastia can occur in newborns, due to their mother’s estrogen levels; however, this condition resolves in two to three weeks (“Enlarged breasts in men”, 2018). Hormone changes can also cause breast enlargement during puberty, which will also resolve on its own (“Enlarged breasts in men”, 2018). If pain or nipple discharge accompany breast enlargement, pathologic causes should be ruled out (“Enlarged breasts in men”, 2018). Diagnosis is completed by physical examination (Rodway & McCance, 2017). Identification of cause will determine treatment. If medication is felt to be contributing to breast enlargement, an alternative medication should be considered. If breast enlargement persists, surgery can be considered (Whiteman, n.d.). If treatment does not resolve the concern, the patient should be educated on self-breast exams due to the risk of breast cancer (Rodway & McCance, 2017). Mammograms should be completed to monitor for breast cancer (Rodway & McCance, 2017).
Similarities and Differences
Similarities in these conditions include the prevalence in adolescence and newborns. Another similarity is the potential need for surgical correction in both conditions. Differences include that testicular torsion involves structural pathophysiology, whereas gynecomastia involves a hormonal imbalance. Another difference is that medication can contribute to gynecomastia.
Effect of Age and Impact on Diagnosis and Treatment
Both Testicular torsion and gynecomastia can occur in newborns and adolescents. Testicular torsion bears more significance as a newborn, as the testes may not be saved, which can impact reproductive development and fertility in the future. Whereas, testicular torsion in adolescence is a medical emergency. Swift diagnosis and treatment have the potential to allow for repair and the return of testicular function.
Gynecomastia has been noted in newborns, which is related to maternal estrogen levels. This condition resolves on its own. Gynecomastia can also occur due to hormonal changes in puberty. If pain or nipple discharge is noticed, pathology will need to be determined. Potential medication causes should be ruled out.
Physical examination and history should be completed to assess for symptoms, as well as obtaining family history (Rodway & McCance, 2017). Genetic testing will allow for the discussion of treatment options to prevent life-altering or life-ending complications in testicular torsion.
References
Alireza Bolourian, A., & Mojtahedi, Z. (2018). Blocking natural killer cells in testicular torsion may prevent autoimmunity against low expressing major histocompatibility complex class I germ cells. Indian Journal of Medical Research, 147(2), 128-131. doi:10.4103/ijmr.IJMR_1705_16
Enlarged breasts in men (gynecomastia). (2018, March 10). Retrieved from https://www.mayoclinic.org/diseases-conditions/gynecomastia/symptoms-causes/syc-20351793
Fehér, Á. M., & Bajory, Z. (2016). Review article: A review of main controversial aspects of acute testicular torsion. Journal of Acute Disease, 51-8. doi:10.1016/j.joad.2015.06.017
Mayo Clinic. (2018, May 5). Testicular Torsion. Retrieved August 6, 2018, from https://www.mayoclinic.org/diseases-conditions/testicular-torsion/symptoms-causes/syc-20378270
Rodway, G.W., & McCance, K.L. (2017). Alterations of the male reproductive system. In Huether, S. E., & McCance, K. L. Understanding pathophysiology (6th ed., pp. 854-883). St. Louis, MO: Mosby.
Urology Care Foundation. (n.d.). What are the Signs of Testicular Torsion? Retrieved August 7, 2018, from http://www.urologyhealth.org/urologic-conditions/testicular-torsion/symptoms
Whiteman, D. (n.d.). Gynecomastia Surgery. Retrieved August 7, 2018, from https://www.plasticsurgery.org/cosmetic-procedures/gynecomastia-surgery
Advanced pharmacology week 11 response 1
Title Advanced pharmacology week 11 response 1
Prefered Language style English (U.S.)
Type of document Essay
Number of pages/words 1 Page Double Spaced (approx 275 words per page)
Subject area Pharmacology
Academic Level Master
Style APA
Number of sources/references 3
Order description:
Please respond to Barnabys post by who provided a different rationale than you did, in one or more of the following ways:
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research. and use the readings for at least 2 of the references
Learning Resources
This page contains the Learning Resources for this week.
Required Readings
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Review Chapter 4, “Principles of Pharmacotherapy in Pediatrics” (pp. 53-63)
This chapter explores concepts relating to drug selection, administration, and interaction for pediatric patients. It also compares age-related pharmacokinetic differences in children and adults.
Chapter 17, “Ophthalmic Disorders” (pp. 221-243)
This chapter examines the causes, pathophysiology, diagnostic criteria, and drug treatment for four ophthalmic disorders: blepharitis, conjunctivitis, keratoconjunctivitis sicca, and glaucoma. It also explores methods of monitoring patient response to treatment.
Chapter 43, “Attention-Deficit/Hyperactivity Disorder” (pp. 743-756)
This chapter explains the process of diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD). It also identifies drugs for treating patients with ADHD, including proper dosages, selected adverse events, and special considerations for each drug.
Chapter 51, “Immunizations” (pp. 906-926)
This chapter explores vaccines that are licensed for use in the United States and provides a recommended vaccination schedule for pediatric patients and adults.
Chapter 52, “Smoking Cessation” (pp. 927-943)
This chapter examines clinical implications of smoking. It also covers various approaches for aiding patients who are dependent on nicotine but want to stop smoking.
Chapter 54, “Weight Loss” (pp. 945-956)
This chapter begins by reviewing patient factors that contribute to obesity. It also examines drug therapy for initiating weight loss in patients, as well as alternative non-drug treatments.
Bazzano, A. T, Mangione-Smith, R., Schonlau, M., Suttorp, M. J., & Brook, R. H. (2009). Off-label prescribing to children in the United States outpatient setting. Academic Pediatrics, 9(2), 81–88.
Note: Retrieved from the Walden Library databases.
This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing.
Mayhew, M. (2009). Off-label prescribing. The Journal for Nurse Practitioners, 5(2), 122–123.
Note: Retrieved from the Walden Library databases.
This article reviews the prevalence of off-label prescribing, including its benefits and risks. It also explores issues regarding the safety of off-label prescribing and when it is unavoidable.
Drugs.com. (2012). Retrieved from http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
Required Media
Laureate Education, Inc. (Executive Producer). (2012). Advanced pharmacology – Final course review. Baltimore, MD: Author
Barnabys post
18 hours ago Barnaby Urias
DQ 11- Off-Label Drug Use in Pediatrics
COLLAPSE
Professor and Class,
When treating pediatric patients, many health care practitioners use the terms, infant, child, or even kid, interchangeably. Several barriers exist for pharmaceutical manufacturers in conducting pediatric clinical trials, such as fears of unforeseen adverse events affecting growth and development or difficulties in obtaining informed consent or blood samples. In turn, the lack of clinical trials in pediatric patients prevents the U.S. Food and Drug Administration (FDA) from approving drugs for use in the pediatric population. Without FDA approval or adequate documentation information, many practitioners are uncertain how to use drugs in pediatrics. This leaves practitioners little choice but to use drugs in pediatric patients in an off-label capacity, based on adult data, uncontrolled pediatric studies, or personal experience (Arcangelo, 2017).
Off Label Usage
Some variables that may explain off-label prescribing, such as physician and family attitudes, previously used medications, and the context of the visit, are not included in National Ambulatory Medical Care Surveys (NAMCS) (Bazzano, 2009).
The prescription of off-label medication is commonplace since more beneficial treatments for children are often not available, while trials for many medicines intended for children have in fact not been carried out. The most common reasons given by respondents for a dispensed prescription being off label were younger age than recommended. The majority of respondents were not familiar with the concept of off label medicines. While reporting to have gained their knowledge from their professional experience, only a minority of respondents reported knowingly dispensing off-label medicines for pediatric patients. Respondents indicated that manufacturing more appropriate formulations for pediatric patients would reduce such practices in this population. Having concerns regarding the efficacy and safety of off-label medicines used for pediatric patients, respondents felt that the use of off-label medicines would increase the likelihood of adverse drug reactions (ADRs). Finally, respondents felt that such practice of prescribing and dispensing should receive parental consent (Tareq, 2018).
Infancy to Adolescence
Pediatric patients differ from adults, anatomically and physiologically. For safe use of drugs in pediatrics, prescribers and other caregivers need to recognize the potential for very different pharmacokinetics in pediatric patients as opposed to adults. The differences are based on developing body tissues and organs, which affect a drug’s absorption, distribution, metabolism, and excretion. Changes in a pediatric patient’s body proportions and composition and the relative size of the liver and kidneys can alter the pharmacokinetics of a drug. During the first of the several years of life, a child undergoes rapid changes in growth and development, most rapid during infancy. Growth is qualitative change in skills or functions. Maturation, genetically controlled development independent of the environment, is a slower process, lasting until late childhood (Arcangelo, 2017).
Off-label prescribing is more frequent for younger children and those receiving care from specialist pediatricians. Increased dissemination of pediatric studies and label information may be helpful to guide clinical practice. Further research should be prioritized for the medications most commonly prescribed off label and to determine outcomes, causes, and appropriateness of off-label prescribing to children (Bazzano, 2009).
There are some positive aspects to off-label prescribing. Prescribing a drug off-label may be necessary when no FDA-approved drug is available due to lack of research. Pediatrics is an area where there is a dearth of adequate studies, necessitating off-label prescribing (Mayhew, 2009).
Medications
Rofecoxib (Vioxx) is cited as an example of a drug whose adverse effects became apparent only after considerable use and testing. Off-label prescribing may allow drug manufacturers to circumvent the research they might conduct on a drug. The off-label use of new, expensive drugs instead of older generic medications can increase health care costs (Mayhew, 2009).
Vioxx was withdrawn from the U.S. market in 2004. The manufacturer of Vioxx has announced a voluntary withdrawal of the drug from the U.S. and worldwide market. This withdrawal is due to safety concerns of an increased risk of cardiovascular events (including heart attack and stroke) in patients taking Vioxx. General side effects have included asthenia, fatigue, dizziness, influenza-like disease, lower extremity edema, sinusitis and upper respiratory infection. Other general side effects have included abscess, chest pain, chills, contusion, cyst, diaphragmatic hernia, fever, fluid retention, flushing, fungal infection, infection, laceration, pain, pelvic pain, peripheral edema, postoperative pain, syncope, trauma, upper extremity edema, viral syndrome, cerumen impaction, epistaxis, dry throat, otic pain, otitis, otitis media, pharyngitis, tinnitus, and tonsillitis (Drugs, 2012).
Reference
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins
Bazzano, A. T, Mangione-Smith, R., Schonlau, M., Suttorp, M. J., & Brook, R. H. (2009). Off-label prescribing to children in the United States outpatient setting. Academic Pediatrics, 9(2), 81–88
Mayhew, M. (2009). Off-label prescribing. The Journal for Nurse Practitioners, 5(2), 122–123
Drugs.com. (2012). Retrieved from http://www.drugs.com/
Tareq L., M., Karem H., A., Amani M., A., Anan S., J., Rana K. Abu, F., Mohammad B., N., & James C., M. (2018). Perceptions and attitudes towards off-label dispensing for pediatric patients, a study of hospital based pharmacists in Jordan. Saudi
Advanced Pharmacology week 11 response 2
Title Advanced Pharmacology week 11 response 2
Prefered Language style English (U.S.)
Type of document Essay
Number of pages/words 1 Page Double Spaced (approx 275 words per page)
Subject area Pharmacology
Academic Level Master
Style APA
Number of sources/references 3
Order description:
Please respond to Gayla post by who provided a different rationale than you did, in one or more of the following ways:
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research. and use the readings for at least 2 of the references
Learning Resources
This page contains the Learning Resources for this week.
Required Readings
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Review Chapter 4, “Principles of Pharmacotherapy in Pediatrics†(pp. 53-63)
This chapter explores concepts relating to drug selection, administration, and interaction for pediatric patients. It also compares age-related pharmacokinetic differences in children and adults.
Chapter 17, “Ophthalmic Disorders†(pp. 221-243)
This chapter examines the causes, pathophysiology, diagnostic criteria, and drug treatment for four ophthalmic disorders: blepharitis, conjunctivitis, keratoconjunctivitis sicca, and glaucoma. It also explores methods of monitoring patient response to treatment.
Chapter 43, “Attention-Deficit/Hyperactivity Disorder†(pp. 743-756)
This chapter explains the process of diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD). It also identifies drugs for treating patients with ADHD, including proper dosages, selected adverse events, and special considerations for each drug.
Chapter 51, “Immunizations†(pp. 906-926)
This chapter explores vaccines that are licensed for use in the United States and provides a recommended vaccination schedule for pediatric patients and adults.
Chapter 52, “Smoking Cessation†(pp. 927-943)
This chapter examines clinical implications of smoking. It also covers various approaches for aiding patients who are dependent on nicotine but want to stop smoking.
Chapter 54, “Weight Loss†(pp. 945-956)
This chapter begins by reviewing patient factors that contribute to obesity. It also examines drug therapy for initiating weight loss in patients, as well as alternative non-drug treatments.
Bazzano, A. T, Mangione-Smith, R., Schonlau, M., Suttorp, M. J., & Brook, R. H. (2009). Off-label prescribing to children in the United States outpatient setting. Academic Pediatrics, 9(2), 81–88.
Note: Retrieved from the Walden Library databases.
This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing.
Mayhew, M. (2009). Off-label prescribing. The Journal for Nurse Practitioners, 5(2), 122–123.
Note: Retrieved from the Walden Library databases.
This article reviews the prevalence of off-label prescribing, including its benefits and risks. It also explores issues regarding the safety of off-label prescribing and when it is unavoidable.
Drugs.com. (2012). Retrieved from http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
Required Media
Laureate Education, Inc. (Executive Producer). (2012). Advanced pharmacology – Final course review. Baltimore, MD: Author
Gayla post
10 hours ago Gayla Cragg
Cragg DB 11
COLLAPSE
Off-Label Prescribing for Children
The ability to obtain the Food and Drug Administration approval for a drug to be used in children requires evidence-based proof that the medication is beneficial for this population and without significant risk. Unfortunately, the aspect of completing a research trial on young children would be challenging due to the potential risk. Medications often do not have appropriate dosage ranges listed in drug reference information due to the lack of FDA approval (Balan, Hassali, & Mak, 2017). Also, insurance companies’ pharmaceutical formularies may require providers to choose alternative medications (Mayhew, 2009). These factors have led to the need for and use of medications off-label. This practice can be a risky proposition as children’s bodies process medications differently than adults.
Drugs Commonly Used Off-Label
Examples of medications which have been used off-label include Loratadine, Amoxicillin, Amoxicillin/Clavulanate potassium, Azithromycin, Cetirizine, Albuterol, and Montelukast (Bazzano, Mangione-Smith, Schonlau, Suttorp, & Brook, 2009).
Amoxicillin is an Aminopenicillin (Amoxicillin, 2018). Amoxicillin/Clavulanate potassium is a beta-lactamase inhibitor (Augmentin, 2018). Azithromycin is a macrolide antibiotic (Azithromycin, 2017). These are common antibiotics which would be used for common infections such as upper respiratory and sinus infections.
Cetirizine and loratadine are antihistamines (Cetirizine, 2017; Loratadine, 2018). Both medications are used to treat allergies, which is another common need in children.
Albuterol is an adrenergic bronchodilator, which is used to relax the muscles and improve airflow in the lungs (Albuterol, 2017). Montelukast is a leukotriene modifier, which is helpful in preventing allergen response, especially with asthma symptoms (Montelukast, 2017). Again, upper respiratory infections and asthma are common conditions which children require treatment for acute and chronic illness.
Advanced practice nurses and other healthcare professionals should continue to advocate for research on commonly used off-label medications to fully understand their safety and efficacy (Bazzano et al., 2009).
The Rationale for the use of Drugs Off-Label
Off-label prescribing should be considered when the failure to provide treatment would cause more risk than the potential for risk from using the off-label medication. Also, the advance-practice nurse and parent should discuss the off-label use of the drug, as well as the risks versus benefits of the drug (Balan, Hassali, & Mak, 2017). This decision rationale and discussion should be documented in the patient record.
Safety Mechanisms when Using Drugs Off-Label
When prescribing an off-label drug, the advanced practice nurse should be aware of the potential effects of the drug, as well as check for drug interactions if the patient is on multiple medications. Baseline data should be taken, such as height, weight, and vital signs. Appropriate blood tests should be ordered, especially if similar testing would be done on other age groups. Lambert (2010) discussed the care provided by Dr. Kifuji for her patient. Dr. Kifuji acknowledged not checking her patient’s blood pressure or pulse during a visit (Lambert, 2010). Often many decisions can be placed under a microscope in a court of law. However, would have to take the child’s vital led the doctor to recognize a dangerously low blood pressure or pulse? This example provides good practice for an advanced practice nurse to learn from when assessing, diagnosing, and prescribing medications off-label. The importance of completing a comprehensive physical exam, medical history, and documenting the results in the patient’s record cannot be understated. The final thought would be to carefully document decisions made. Another area of concern with Dr. Kifuji’s example was the number of times the mother called in for medication adjustments. Often prescribers may desire to please the parent’s expectation for changing a prescription (Balan, Hassali, & Mak, 2017). This decision to change medications would be best done in an office visit setting, where careful discussion, assessment, and documentation can be completed.
References
Albuterol – FDA prescribing information, side effects and uses. (2017). Retrieved August 7, 2018, from https://www.drugs.com/albuterol.html
Amoxicillin – FDA prescribing information, side effects and uses. (2018). Retrieved August 7, 2018, from https://www.drugs.com/amoxicillin.html
Augmentin – FDA prescribing information, side effects and uses. (2018). Retrieved August 7, 2018, from https://www.drugs.com/augmentin.html
Azithromycin – FDA prescribing information, side effects and uses. (2017). Retrieved August 7, 2018, from https://www.drugs.com/azithromycin.html
Balan, S., Hassali, M. A., & Mak, V. L. (2017, November/December). Non-regulatory related factors leading to off-label prescribing in children: A concept map. Research in Social & Administrative Pharmacy, 13(6), 1219-1221.
Bazzano, A. F., Mangione-Smith, R., Schonlau, M., Suttorp, M. J., & Brook, R. H. (2009). Off-label prescribing to children in the United States outpatient setting. Academic Pediatrics, 9(2), 81-88. doi:10.1016/j.acap.2008.11.010
Cetirizine – FDA prescribing information, side effects and uses. (2017). Retrieved August 7, 2018, from https://www.drugs.com/zyrtec.html
Lambert, L. (2010, April 10). Rebecca Riley’s doctor on the defense. Patriot Ledger. Retrieved from http://www.patriotledger.com/news/x905416295/Rebecca-Riley-sdoctor-on-the-defense?zc_p=0
Loratadine – FDA prescribing information, side effects and uses. (2018). Retrieved August 7, 2018, from https://www.drugs.com/loratadine.html
Mayhew, M. (2009). Off-label prescribing. The Journal for Nurse Practitioners, 5(2), 122–123.
Montelukast – FDA prescribing information, side effects and uses. (2017). Retrieved August 7, 2018, from https://www.drugs.com/mtm/montelukast.html
Emotion in Negotiation
Title Emotion in Negotiation
Prefered Language style English (U.S.)
Type of document Essay
Number of pages/words 3 Pages Double Spaced (approx 275 words per page)
Subject area Management
Academic Level Undergraduate
Style APA
Number of sources/references 4
Order description:
Emotion in Negotiation
Conduct a light research on the role of emotion in negotiation process, and the effect it has on the outcome of the negotiation. In your essay, try to answer the following the questions:
Does emotion delay the negotiation process, or prevents parties from reaching an agreement? Why or why not?
As a negotiator, what are the benefits of emotion in negotiation?
Evaluate some of the strategies for dealing with emotion in negotiation.
High- and Low-Context Language
Title High- and Low-Context Language
Prefered Language style English (U.S.)
Type of document Essay
Number of pages/words 1 Page Double Spaced (approx 275 words per page)
Subject area Business
Academic Level Undergraduate
Style APA
Number of sources/references 2
Order description:
What is the difference between a high- and a low-context language? Discuss some of the potential problems a person with a low-context language may face when negotiating with people from a high-context language.