The vaccine should be given to pregnant or lactating women only if clearly needed to protect the health of the mother or child. Standardization: the active ingredients of goldenseal include hydrastine and berberine. Enterobiasis: Infection by the pinworm Enterobius vermicularis is the most common helminth infection in the United States, afflicting as many as 40 million people, mostly children. Additional social and financial resources may be needed, including alternative care environments. The effectiveness of the vaccine in producing immunity in adults declines with age. Adverse Effects: Azathioprine causes bone marrow suppression that can result in pancytopenia, agranulocytosis, leukopenia, and thrombocytopenia. Many of the drugs used for inflammation also reduce fever and relieve mild to moderate pain. The growing amino acid chain is prematurely terminated and protein synthesis is inhibited. The entry of Ca2 into the cells signals the release of additional calcium ions that had been held in storage inside the sarcoplasmic reticula. The primary concern with spironolactone is potassium retention, which can result in serious hyperkalemia. Myopathy has been recorded in a small percentage of patients taking daptomycin; therefore, the nurse should carefully monitor for muscle pain or weakness. Mechanism of Action: Fexofenadine acts by competing with histamine for binding to histamine (H1) receptor sites. For some viruses, the entire virion enters the cell, whereas others simply "inject" their genes and enzymes into the host cell. Patients with normal diets consume plenty of potassium for bodily functions because the mineral is abundant in fruits, vegetables, and meats. What laboratory tests were probably obtained during this visit to the urgent care center What information should the nurse provide to the patient concerning the antibiotic She was recently seen by her health care provider for removal of a noncancerous skin lesion. In patients with asthma, orally administered caffeine will produce bronchodilation and smooth muscle relaxation. Treatment of Overdose: Overdose with ipratropium is unlikely because very little of the drug is absorbed. When he retired, his outgoing nature was an asset for the many community agencies at which he volunteered to help. Blood products include whole blood, packed red cells, fresh frozen plasma, cryoprecipitate, immune globulins, and platelet infusions. Potassium supplements are sometimes prescribed during thiazide therapy to prevent hypokalemia. Lifespan and Diversity Considerations: Due to age-related changes in peristalsis and bowel function, monitor the older adult for constipation. Drug Interactions: When given concurrently, naloxone reverses all the effects of opioids. In addition to affecting their target cells, cytokines interact with each other by turning the synthesis of other cytokines on or off. A fifth drug in this class, bretylium, was discontinued in the United States due to the availability of safer and more effective antidysrhythmic drugs. Continuous pharmacotherapy over many years promotes viral resistance so that when the acute stage eventually develops, the medications may no longer be effective. Other large collections of lymphoid tissue include the tonsils, spleen, and thymus. Levetiracetam is well tolerated, with the most common adverse effects being drowsiness, dizziness, infections, headache, and asthenia. Treatment of Overdose: Overdose of milrinone causes hypotension, which may be treated with the administration of normal saline or a vasopressor. The drug of choice for both intestinal and hepatic amebiasis is metronidazole, due to its safety and efficacy.
If a patient does not respond to these agents with relaxation or sleep, it indicates a serious underlying psychiatric or medical condition that requires further assessment by behavioral specialists. Multidrug therapy is common in these patients and the nurse serves a key role in teaching patients how to space drug administration times to minimize hypotensive adverse effects. The nasal spray formulation of ipratropium was approved in 1995 for the symptomatic relief of rhinorrhea associated with the common cold and perennial rhinitis. As directed, she made an appointment and saw her health care provider for a checkup. Chol830 era toxin from Vibrio cholerae aerobic, 829 causes large amounts of fluid to anaerobic, 829 be secreted into the intestinal antibiotic, 829 lumen. Isosorbide dinitrate (Isordil) is a long-acting organic nitrate that reduces preload by directly dilating veins. At the onset of therapy, as many as 50% of patients experience acute, infusion-related fever and chills, vomiting, anorexia, and headache. The two major drug classes used to terminate migraines, the triptans and the ergot alkaloids, are both serotonin receptor agonists. In other words, individuals of Asian descent will develop signs of toxicity more quickly than non-Asians. The development of clinical practice guidelines for thrombolytic therapy remains an area of active research. Dibucaine (Nupercainal): Approved in 1947, dibucaine is administered to relieve pain and itching related to hemorrhoids and other anorectal disorders. This drug should be used with caution in patients with preexisting pulmonary disease, and pulmonary function should be closely monitored throughout therapy. It is important to distinguish bipolar disorder from drug abuse, severe anxiety disorders, schizophrenia, dementia, or electrolyte disturbances, which can all produce symptoms similar to those of bipolar disorder. Recognition of the antigen is dependent on the immune cells interacting with specific foreign proteins. Evidence: Despite its popularity, few controlled research studies have been conducted on goldenseal (National Center for Complementary and Alternative Medicine, National Institutes of Health, 2010). Patients with a compelling condition, however, may benefit from a second drug, either in combination with the thiazide or in place of the thiazide. Mechanism of Action: Potassium chloride is a replacement solution for lost potassium. As it progresses, the walls of the arteries gradually thicken, in an attempt to protect the vessels against injury from the increased pressure. Aspirin should not be taken during pregnancy, especially in the third trimester; it may prolong bleeding and inhibit natural contractions caused by prostaglandins in the uterus. Like epoetin alfa, darbepoetin should only be administered to patients with anemia secondary to the chemotherapy, and not caused by the malignancy itself. Patients on high doses for prolonged periods, however, may exhibit a mild withdrawal syndrome on discontinuation and experience symptoms such as irritability, nausea, sleep impairment, muscle aches, and fatigue. The acellular form of pertussis vaccine became available in 1996 and has replaced the original form. What symptoms would you expect to observe in Jonas if he is experiencing early signs of toxicity Create a list of things to avoid for an individual who is receiving theophylline therapy. Agents administered to achieve balanced anesthesia include neuromuscular blockers, short-acting benzodiazepines, opioids, and general anesthetics. The nurse must judiciously monitor all prescribed drugs because suicidal patients often take overdoses of their medications. The drug is used off-label for many other indications, depending on the sensitivity of the microbe. These agents have not been found to produce any significant reduction in the progression of dementia. The types of adverse events associated with local anesthesia are relatively minor relative to the potential risks of general anesthesia. In nearly all cases, medications are unable to cure or reverse the progressive nature of these disorders, and the symptomatic relief provided by the drugs is only temporary. Similarly, fish tapeworms may be acquired through ingestion of raw or poorly cooked fish containing the parasites.
Drugs Similar to Ciprofloxacin (Cipro) Other fluoroquinolones include besifloxacin, gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin. As many as 25% of patients who are taking aminoglycoside antibiotics may experience some ototoxicity. Red blood cells are so numerous that they comprise approximately one third of all cells in the body (Martini, Nath, & Bartholomew, 2012). The three nonstimulants do not appear to have any abuse potential and are not classified as controlled substances. The osmotic pressure is so high within a bacterial cell that the cell would rupture without the containment of this rigid structure. Targeting the sarcolemmal calcium pump: A potential novel strategy for the treatment of cardiovascular disease. They are safe drugs, with excessive urinary potassium loss being the primary adverse effect. Leaves of the plant are rich in vitamin A, potassium, minerals, and fiber and have been eaten raw in salads or cooked like spinach as a major nutritional source. Adolescents involved in competitive sports activities may have heard about epoetin and may question its advantages. Mechanism of Action: Furosemide prevents the reabsorption of sodium and chloride by blocking the Na -K -2Cl symporter in the loop of Henle. Signs of allergy include fever, chills, urticaria, rash, dyspnea, and possibly hypotension. Berberine, a compound found in goldenseal, has been used in traditional Chinese medicine for diarrhea (University of Maryland Medical Center, 2009). The first general anesthetic was the gas diethyl ether, which was discovered in the 1840s. Patient and Family Education: Do not discontinue taking this drug without approval of the health care provider. Generalized dystonias are treated with high doses of anticholinergic drugs such as benztropine, benzodiazepines, and baclofen. If the antigen is present, the individual is said to be Rh positive (Rh) and if it is missing, Rh negative (Rh); 85% of individuals living in North America are Rh positive. If the patient or family so chooses, notify the provider so that appropriate alternatives may be considered. Flumazenil must be used cautiously because the patient may awaken abruptly with dysphoria, agitation, and even seizures. Once engulfed, the phagocytes destroy the microbe in vesicles called lysosomes, which contain powerful destructive enzymes. Treatment of Overdose: Effects of the drug usually diminish quickly after the gas is discontinued. Ticlopidine is approved to prevent thrombotic stroke, and has been used to prevent thromboembolic events in those receiving coronary artery stents. Infusion with the opioid antagonist naloxone (Narcan) may be used to reverse respiratory depression and other acute symptoms. In the late 1970s substances were isolated from various species of fungi that were found to inhibit cholesterol production in human cells in the laboratory. The first dose is administered at age 12 to 15 months and the second dose at age 4 to 6 years. Because of potential serious adverse effects, vigabratin is available in a restricted distribution program and is only prescribed when patients have not responded adequately to other medications. Patient and Family Education: Do not crush or chew enteric-coated or sustained release tablets. Each involves a progressive and irreversible loss of neuron function in the brain or spinal cord, or both. Oldways, an international nonprofit group, perhaps best known for its development of the Mediterranean food pyramid, offers dietary guidance and Latino, Asian, Mediterranean, and Vegetarian Food Pyramids. When used in high doses, however, these drugs can cause sedation and induce unconsciousness. Viruses, bacteria, cellular debris, and even cancer cells can enter these vessels.
Headache, pharyngitis, and xerostomia are the most frequently reported adverse effects. Changes to nasal structure and mucous membranes in older patients may increase symptoms of rhinitis. Unless exercise is extreme or prolonged, athletes, especially children, should be encouraged to drink when thirsty and maintain urine at a color of clear yellow, not dark yellow or colorless. Vaccination outside the guidelines of the vaccination schedule is permitted, but its effectiveness may be reduced. Therapeutic Effects and Uses: Procaine is used for spinal, epidural, and peripheral nerve blocks through injection or infiltration. The implantation of a vagal nerve stimulator in the brain is a type of therapy that delivers electrical signals to the vagus nerve to reduce the frequency of seizures. Herbal/Food: Increased action of haloperidol may occur if chamomile, hops, kava, nutmeg, skullcap, or valerian is used concurrently. Nurses must be aware that many patients taking antidepressants stop taking their medication without notifying their health care provider. To diagnose coagulation and thromboembolic disorders, a thorough medical history and physical examination are necessary. Symbyax is a fixed-dose combination of fluoxetine and olanzapine that is indicated for bipolar disorder. In contrast, H2 receptors are present primarily in the stomach, and their stimulation results in the secretion of large amounts of hydrochloric acid. A urine culture is also collected during this visit, and the results will be reported within 48 h. Other symptoms are muscle twitching, fatigue, paresthesias, dyspnea, cramping, and diarrhea. Dystonia is a chronic neurologic disorder that is characterized by involuntary muscle contraction that forces body parts into abnormal, painful movements or postures. Hypermagnesemia: Advanced renal failure is the only major cause of hypermagnesemia, although overtreatment with magnesium supplements may also lead to excessive serum magnesium levels. That theme is the ability to prevent major causes of morbidity and mortality through control of healthy lifestyle choices. Depending on anticipated patient adherence, the dose may be daily (300 mg) or twice weekly (15 mg/kg). Caspofungin (Cancidas) is becoming an important alternative to amphotericin B in the treatment of aspergillosis. An intraocular implant containing ganciclovir (Vitrasert) is available that releases the drug slowly over 5 to 8 months. Severe hypotension, seizures, dysrhythmias, or palpitations may signal drug toxicity and are immediately reported. Second generation: Second-generation cephalosporins include cefaclor (Ceclor), cefotetan (Cefotan), cefoxitin (Mefoxin), cefprozil (Cefzil), and cefuroxime (Ceftin, Zinacef). The final formed elements of the blood are thrombocytes or platelets, which are actually fragments of larger cells called megakaryocytes. Galantamine (Razadyne): Galantamine is an oral cholinesterase inhibitor that has the same uses and actions as donepezil. Seizures, hallucinations, high intracranial pressure, confusion, and toxic psychoses have been reported in patients taking fluoroquinolones. They are not recommended in patients with a history of heart attack, heart block, or dysrhythmia. Treatment of Overdose: Overdose will cause hypotension, which may be treated with an infusion of normal saline or a vasopressor. The rapid release of the chemical mediators of inflammation on a large scale throughout the body is responsible for anaphylaxis, a life-threatening allergic response that may result in shock and death. Following the discussion of the two prototypes, other miscellaneous drugs and their indications are described. Each type varies in lipid and apoprotein makeup and serves a different function in transporting lipids from the sites of synthesis and absorption to the sites of utilization. Immediately notify the provider if symptoms continue to increase, especially if respiratory involvement worsens or fever is present. The vasomotor center reacts to information from baroreceptors and chemoreceptors by raising or lowering blood pressure accordingly.
Therefore, the initial selection of pharmacotherapy is based on the experience of the prescriber and later adjusted when laboratory results become available. The granulomas serve as a means of protection, walling off the agent from the rest of the body. Vital signs, cardiac and urinary output, and daily weights should remain within the limits set by the health care provider. The induction of a brief convulsion by passing an electric current through the brain as therapy for affective disorders, especially in patients who have not responded to pharmacotherapy. Choline magnesium trisalicylate should not be administered to patients with known hypersensitivity to other salicylates. The heart is the hardest working organ in the body, pumping blood from before birth to the last minute of life. The nurse is caring for a client who is receiving intravenous vancomycin (Vancocin). If the patient is unresponsive and the respiratory rate is less than 12 breaths/min, administer naloxone per protocol. This product should be used with caution in patients taking cardiac glycosides and other prescription medications for cardiovascular disease. Critical Thinking Question A patient is evaluated by a cardiologist for mild chest pain. Clozapine is approved for the management of schizophrenia in patients resistant to standard therapies and to reduce the risk of recurrent suicidal behavior in patients with schizophrenia. First, calcium channels in the sarcolemma open, allowing calcium to rush into the cell. Decreased dopamine in the chemoreceptor trigger zone in the medulla results in an antiemetic effect. Pregnancy is a contraindication for vaccination with live viruses, and women who become pregnant within 3 months of immunization with a live vaccine should consult their health care provider. Treatment of Overdose: Overdoses of phenytoin are treated with activated charcoal with gastric lavage. Abdullah is taken to the emergency department with palpitations, nausea, vomiting, vertigo, and progressive confusion. During the dark winter months, some patients experience a type of depression known as seasonal affective disorder. Nisoldipine (Nisocor, Sular): Approved in 1995, nisoldipine is selective for vascular smooth muscle and has no significant effect on the myocardium. Contraindications/Precautions: the only contraindication is hypersensitivity to nifedipine or other dihydropyridines. Lifespan and Diversity Considerations: Monitor daily weights in children and in the older adult to assess for weight loss and proper nutrition. Although the terms are sometimes used interchangeably, it should be noted that penicillinase is only one type of beta lactamase-that which splits the ring in penicillin antibiotics. In the late 1980s, the development of quinolones with a fluorine side chain resulted in drugs with wider spectrums of activity and longer durations of action. Essentially, the initial composition of filtrate may be thought of as plasma minus proteins. Two drugs in this class, dorzolamide (Trusopt) and brinzolamide (Azopt), are administered topically to the eye for open-angle glaucoma. Cardiac Structure and Function Cardiac Muscle Coronary Arteries Cardiac Conduction System Cardiac Output Hemodynamics and Blood Pressure Hemodynamic Factors Affecting Blood Pressure Neural Regulation of Blood Pressure Hormonal Influences on Blood Pressure It is likely that the nurse will administer more cardiovascular drugs than any other class of medications. The enzyme has no "proofreading" ability, which allows errors in the viral genetic code to accumulate. The drug produces significant anticholinergic effects and orthostatic hypotension; thus it is not a first-line drug for depression. Concurrent treatment with a betaadrenergic agonist may be necessary to counteract these adverse cardiac effects.
Mild deficiency or prophylaxis of folate deficiency is accomplished by increasing the dietary intake of folic acid through fresh green vegetables, dried beans, and wheat products. Although corticosteroids are very effective at reducing allergy symptoms, their oral and parenteral uses are limited by potentially serious adverse effects. One day at the shopping mall she saw an automatic blood pressure machine and thought she would try it. These drugs are primarily used to speed clot formation to limit bleeding from a surgical site, and are Anticoagulants 41. This provides pain relief during minor skin surgeries or dental procedures, or prior to deep needlesticks. The repair of the injured area can proceed at a faster pace by neutralizing the foreign agent and removing cellular debris and dead cells. Selected Therapies epoetin alfa (Procrit, Epogen) Dietary restriction of potassium; polystyrene sulfate (Kayexalate) with sorbitol Dietary restriction of phosphate; phosphate binders such as calcium carbonate (Os-Cal 500, others), calcium acetate (Calphron, PhosLo), lanthanum carbonate (Fosrenol), or sevelamer (Renagel) Dietary restriction of sodium; loop diuretics in acute conditions, thiazide diuretics in mild conditions Usually corrected by reversing the hyperphosphatemia, but additional calcium supplements may be necessary Sodium bicarbonate or sodium citrate Hypervolemia Hypocalcemia Metabolic acidosis Kidneys are unable to excrete sufficient sodium and water, leading to water retention. Suicide risk is high and many patients stop taking their medication during the course of pharmacotherapy. Hydrochlorothiazide, furosemide, and spironolactone are featured as drug prototypes in Chapter 35. The patient should be observed closely after the first dose, and any subsequent swelling of the facial, oral, or pharynx areas should be immediately reported to the provider. Rimantadine (Flumadine): Approved in 1993, rimantadine is chemically similar to amantadine, and acts by a similar mechanism. Drug Interaction: the administration of adrenergic agonists (such as epinephrine) or caffeine with nitrous oxide may exacerbate dysrhythmias. Adults with chickenpox have more intense symptoms than children and have a seven times greater risk of encephalitis. For most of the viral pathogens, pharmacologic cures are not possible; thus, antivirals remain the least effective of all the anti-infective classes. It can affect someone at any stage of the life span (American Dystonia Society, 2011). Rapid infusions can cause fluid overload, pulmonary edema, and cardiovascular stress. Current use of erectile dysfunction drugs, as noted on medication history, is contraindicated with nitrates. Assessment throughout administration: Continue frequent assessments for therapeutic effects. Initial three-drug regimen that includes dapsone, clofazimine (Lamprene), and rifampin (Rifadin) given for 2 to 5 years. Depending on the stage of the disease, dietary management may include restriction of protein and reduction of dietary sodium, potassium, phosphorous, and magnesium intake. Adverse Effects: Carbamazepine is well tolerated; adverse effects are usually transient and diminish as therapy progresses. This enzyme is injected multiple times into the affected cord, over a 4-week interval. Thus if the patient was using the opioid for analgesia, naloxone will reverse this effect and pain will quickly return. In children less than 5 years old, 50% to 90% of infections are asymptomatic, whereas 70% to 95% of adults will exhibit symptoms. For pinworm infections, a single dose is taken, followed by a second dose in 2 weeks. Gradual improvement should be noted, and the patient should be encouraged to continue taking the medication. Persons reporting an allergy to neomycin or gelatin because the vaccine contains these substances. Trazodone (Desyrel, Oleptro): Approved in 1981, trazodone works by producing a moderate, selective blockade of serotonin reuptake. Blood pressure should be monitored during therapy because the drug can cause hypotension, syncope, and bradycardia. Treatment of Overdose: the treatment of overdosage of amphetamine and amphetamine-related medications includes gastric lavage and the administration of chlorpromazine. Anidulafungin, the newest drug in this class, was approved in 2006 for candidemia and other systemic Candida infections.
They do this through two basic mechanisms: blocking flow through ion channels (conduction) or altering autonomic activity (automaticity). Other adverse effects include cramping, constipation, poor concentration, diarrhea, hot flashes, palpitations, and nervousness. Because of the rapid emergence of resistant strains, it is reserved for multidrug-resistant strains of Plasmodium. The iminostilbenes, carbamazepine (Tegretol) and oxcarbazepine (Trileptal), have a similar pharmacologic activity. Patients always take at least two of these drugs (and usually more), which often interact with other medications to cause additional adverse effects. These are called polyclonal antibodies because they contain a wide mixture of different antibodies. Grape seed extract has antioxidant properties (University of Maryland Medical Center, 2010). Because of this potentially serious adverse effect in patients with bipolar disorder, antidepressants are administered concurrently with a mood stabilizer. The neonate may exhibit symptoms of Mechanism of Action: As with other serotonin reuptake inhibitors, fluoxetine blocks the uptake of the neurotransmitter serotonin (but not norepinephrine) at the neuronal presynaptic membrane. Phototherapy uses artificial lighting approximately 5 to 20 times brighter than normal indoor lighting while the patient sits with eyes open about 3 feet away from and at eye level with the light source. Older adults may have difficulty with numerical rating scales and may respond more appropriately to the Wong-Baker Faces scale. The affected area may become congested with blood, which can lead to significant swelling and pain. They decrease the secretion of inflammatory mediators, reduce tissue edema, and cause a mild vasoconstriction. Iron therapy is initiated to alleviate symptoms of anemia caused by blood loss or dietary deficiency. Patients who are dehydrated with low blood pressure should be given normal saline; the isotonic saline will expand plasma volume and increase blood pressure while hydrating the patient. Piperacillin should not be administered to patients with hypersensitivity to any penicillin. Nonpharmacologic interventions play important roles in the treatment of patients with bipolar disorder. It is only used when other therapies have failed to produce satisfactory outcomes. Describe the general actions, and pharmacotherapeutic applications of central nervous system stimulants. To reduce the toxicity of amphotericin B, the original molecule has been formulated with several different types of lipid molecules: Mechanism of Action: Amphotericin B acts by binding to ergosterol in fungal cell membranes, causing them to become permeable. A baseline program would include increased dietary fiber, adequate fluid intake, and a stool softener such as docusate. Mild hypokalemia is treated by increasing the dietary intake of potassium-rich foods. Although chemical names are sometimes long and difficult to pronounce, placing drugs into chemical classes will assist the student in mentally organizing these drugs into distinct therapeutic groups. On the other hand, the long half-life is more likely to cause sleepiness to carry over into the morning hours and result in daytime sedation. These adverse effects are generally not severe and include fever, diarrhea, hypokalemia, and increases in liver function test values. Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock. Series of at least 20 proteins that combine in a cascade fashion to neutralize or destroy an antigen; stimulates histamine release by mast cells; causes cell lysis.
Lifespan and Diversity Considerations: Monitor hepatic function laboratory values more frequently in the older adult because normal physiological changes related to aging may affect the metabolism of the drug and result in prolonged coagulation. Patients with diabetes should be aware that thiazide diuretics sometimes raise blood glucose levels. Symptoms of acute hepatitis include fever, chills, fatigue, anorexia, nausea, and vomiting. The left ventricle is the largest, because it must hold enough blood to pump to all body tissues. Tissue within the tubercles undergoes necrosis, causing cavities within the lung, which can be identified on chest radiographs. Like human proteins, bacterial proteins are composed of long chains of amino acids. It is also approved for influenza chemoprophylaxis in patients ages 12 months or older. Therapy is usually limited to 4 weeks because of the development of tolerance and the potential for dependence. Plasma protein fraction (Plasmanate) is another albumin product that contains 83% albumin and 17% plasma globulins. As a final step, the viral enzyme protease cleaves some of the larger proteins to smaller, functional forms. It is common practice to combine several childhood vaccines for a single administration. Drugs Similar to Diazepam (Valium) Clonazepam, clorazepate, and lorazepam are benzodiazepine antiepileptic medications. The most common cause of acute renal failure is renal hypoperfusion, the lack of sufficient blood flow through the kidneys. Some individuals may prefer to take cranberry capsules, which are available at most drug stores. With few exceptions, the anti-infective drugs used to treat these disorders are different from those for bacterial or fungal infections. People who lack this enzyme, sometimes called "poor metabolizers," may have up to 50% higher serum levels of haloperidol and other drugs than Caucasians. Some regimens call for the initial use of corticosteroids, with their gradual withdrawal at some point, usually within 3 to 6 months following the transplant. At the spinal cord, glutamate is the neurotransmitter for A fibers, whereas both glutamate and substance P are neurotransmitters for C fibers. Nearly every step of this pathway requires sufficient numbers of properly functioning platelets. The left vagus connects to the brainstem and deep brain structures thought to be involved in epilepsy and some psychiatric disorders. Although rare, reports have cited diffuse interstitial pneumonitis or pulmonary fibrosis as causes of death in patients receiving nitrofurantoin. The most common adverse effects are xerostomia, drowsiness, nausea, vomiting, dizziness, and constipation. Before adding a new drug to the regimen, the nurse should consult a drug guide for potential interactions. They also have a wide safety margin between a therapeutic and a lethal dose; Acute dystonia occurs early in the course of pharmaco- therapy with antipsychotics and involves severe muscle spasms, particularly of the back, neck, tongue, and face. Trifluoperazine was formerly available as Stelazine, but this brand name is no longer marketed. Contraindications/Precautions: Cefazolin is contraindicated in patients who are allergic to any drug in the cephalosporin class and is used cautiously in those with hypersensitivity to penicillins. A black box warning has been issued regarding the possibility of acute liver damage in patients taking mexiletine.