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You might wonder how a chapter on nutrition slipped into a book on phar- macology cheap 100mg allopurinol free shipping gastritis diet . Nutrients are given to patients who are at risk for malnutrition caused by disease and caused by treatments given to cure diseases generic allopurinol 100 mg with amex gastritis treatment guidelines. Nutrients are also given to strengthen the patient following a trauma such as surgery generic allopurinol 100mg on-line gastritis tylenol. In this chapter order 100mg allopurinol mastercard gastritis eating habits, you’ll learn about nutritional support therapies, how to pre- pare them, how to administer them, and how to avoid any complications that might arise. Nutrition Nutrition is a three-step process that gives the body materials needed to make the body grow and function. Other nutrients become involved in enzyme activities and carbohydrate-fat-protein synthesis. And just like your car, your body can continue to operate without a full complement of nutrients—that is, without a full tank of gas. A healthy, well- nourished person has a nutritional level to last 14 days before they begin to show signs of malnutrition. However, there comes a point when your performance sputters—the level of nutrients fall below the level needed to sustain your daily activity. You simply run out of fuel and become fatigued, irritable, and exhibit an abnormal appearance. These are surgery, trauma, malignancy, and other illnesses that break down (catabolize) the body. A nutritional deficit prolongs healing and severe cases can prevent total recovery. Critically ill patients have sufficient nutrients to sustain them for a few days to a week before they begin to show signs of nutritional deficit. Healthcare professionals provide nutritional support therapy for patients who are at risk for nutritional deficit. Nutritional support therapy replaces nutrients that the patient has lost and thereby provide the patient with the fuel needed for a full recovery. A nutritional deficit is called a negative nitrogen balance, which means that the patient lacks sufficient nitrogen to fight infectious disease. Healthcare pro- fessionals treat patients who are at risk for negative nitrogen balance by provid- ing the patient with nutrients before the imbalance occurs. A common misnomer is that dextrose 5% in water (D5W), normal saline, and lactated Ringer’s solution provide nutrients to the patient. The parenteral route is the least preferred because the process is three times more expensive than enteral with- out a significantly improved benefit. Enteral nutrition Enteral feeding is the preferred method of providing nutritional support to a patient. Otherwise, the patient may experience uncontrolled vomiting and become at high risk for aspiration should the intestine be obstructed. It consists of a tube passed through the nose and down the esophagus ending shortly below the xiphoid process. A tube is passed through the nose and down the esophagus ending in the small intestine. This consists of liquids that are individually prepared based on the nutritional needs of the patient and can include baby food with added liquid. Powder mixed with milk or water is given in large amounts to provide complete nutritional requirements and can be used as a nutri- tional supplement in smaller amounts. Liquid is used for replacement feedings and consists of 50% carbohydrates, 15% protein, 15% fat, and 20% other nutrients in an isotonic solution (300 to 340 mOsm/kg H2O). Regardless of the group, these solutions consists of • Carbohydrates in the form of dextrose, sucrose, and lactose. The patient may experience nausea, vomiting, aspi- ration, abdominal cramping, and diarrhea if he or she cannot tolerate the large amount of solution given in a short timeframe. This method is used for treating critically ill patients and for patients who have a feeding tube in their small intestine or in the stomach. An insufficient amount of water is given to the patient or a hyperosmolar solution is given, which draws water from the cells to main- tain serum iso-omolality. Prevent this by raising the head of the bed 30° and check for gastric resid- uals by gently aspirating the stomach contents before the next feeding. Decreasing the infusion rate, diluting the solution, changing the solution, discontinuing the medication, or increasing daily water intake helps to manage diarrhea. Calculate the drug order to determine the volume of the drug: D × V or H:V::D:x H D: Desired dose: dose ordered H: Have (on-hand dose; dose on label of container [bottle, vial or ampule]) V: Vehicle: form and amount in which the drug is available (tablet, capsule, liquid) 2. Determine the osmolality of the drug (drug literature or pharmacist) and liquid dilution. D × V = 650 mg × 1 mL = 10 mL H 65 mg H V x 65 mg : 1mL :: 650 mg: :xmL 65x = 650 x = 10 mL of acetaminophen 2. In addition, the patient might be given fat emulsion supplemental therapy to increase the number of calories and to receive fat-soluble vitamins. The infusion is given through a central venous line such as the subclavian or internal jugular vein to prevent irritation to the peripheral veins. The nurse must monitor the patient for signs of complications as a result of inserting the catheter and the infusion of the feeding. The pharmacy uses a laminar airflow hood when preparing parenteral nutritional solutions to reduce this risk. Monitor the patient carefully for hyperglycemia when you initiate parenteral nutrition support because the pancreas needs time to adjust to the hypertonic dextrose solution, which is high in glucose. Sometimes hyperglycemia is tem- porary and dissipates once the pancreas makes the necessary adjustments. To pre- vent this from occurring, begin with 1 liter of solution for the first 24 hours. Increase this by 500 to 1000 mL each day until you reach a daily volume of 2500 mL to 3000 mL. Caution: Don’t suddenly interrupt parenteral nutrition support because the patient can experience hypoglycemia. Nutrients enter the body as food and are absorbed as chemical reactions break down food into molecules that enter the bloodstream where they are distributed throughout the body. Surgery, trauma, malignancy, and other catabolic illnesses cause a nutritional imbalance that, if prolonged, can have a dramatic impact on the patient that could ultimately lead to death. Enteral nutritional support therapy introduces nutrition into the patient by mouth or a feeding tube that is directly inserted in the stomach or small intestine. Parenteral nutritional support therapy administers high caloric nutrients through large veins such as the subclavian vein. Nausea and vomiting may occur during enteral therapy if which of the following occurs? A healthy, well-nourished person has a nutritional level to last 14 days before they begin to show signs of malnutrition. Fortunately, most times the pain goes away and the inflammation subsides relatively quickly and doesn’t interfere with daily activities.

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They provide structure for devel- innovative approaches that grow out of members’ oping discount 300 mg allopurinol visa gastritis wiki, evaluating discount allopurinol 100 mg otc gastritis diet 21, and using nursing scholarship reflections and insights buy cheap allopurinol 300mg online gastritis diet under 1000. Nursing theories either implicitly Domain or explicitly direct all avenues of nursing cheap allopurinol 300mg without a prescription gastritis cancer, including A discipline of knowledge and professional practice nursing education and administration. Nursing must be clearly defined by statements of the do- theories provide concepts and designs that define main—the theoretical and practical boundaries the place of nursing in health and illness care. The domain of nurs- Through theories, nurses are offered perspectives ing includes the phenomena of interest, problems for relating with professionals from other disci- to be addressed, main content and methods used, plines who join with nurses to provide human serv- and roles required of the discipline’s members ices. The processes and prac- At the same time, theories must provide structure tices claimed by members of the discipline commu- and substance to ground the practice and scholar- nity grow out of these domain statements. Nursing ship of nursing and also be flexible and dynamic to theories containing descriptions of nursing’s do- keep pace with the growth and changes in the dis- main may incorporate a statement of the disci- cipline and practice of nursing. The focus may be set in statements about human, social, and ecological concerns addressed by nursing. Later, Donaldson and Crowley (1978) stated that a disci- The discipline of nursing is a community pline has a special way of viewing phenomena and of scholars, including nurses in all venues, a distinct perspective that defines the work of the where nursing occurs. The call for clarity of focus continues in the current environment of nursing practice (Parse, 1997). This enhances auton- developed over centuries to communicate the na- omy, and accountability and responsibility are de- ture and development of nursing. The domain of nursing is also other forums on every aspect of nursing and for called the “metaparadigm of nursing,” as described nurses of all interests occur frequently throughout in the previous section of this chapter. Nursing the- Syntactical and Conceptual Structures ories form the bases for many of the major contri- Syntactical and conceptual structures are essential butions to the literature, conferences, societies, and to the discipline and are inherent in each of the other communication networks of the nursing dis- nursing theories. This struc- The tradition and history of the nursing discipline ture is grounded in the metaparadigm and is evident in study of nursing theories that have philosophies of nursing. There is recognition that relates concepts within nursing theories, and it is theories most useful today often have threads of from this structure that we learn what is and what connection with theoretical developments of past is not nursing. For example, many theorists have acknowl- nurses and other professionals understand the tal- edged the influence of Florence Nightingale and ents, skills, and abilities that must be developed have acclaimed her leadership in influencing nurs- within the community. In addition, nursing has a rich scriptions of data needed from research as well as heritage of practice. Nursing’s practical experience evidence required to demonstrate the impact of and knowledge have been shared, transformed into nursing practice. It is only by being Values and Beliefs thoroughly grounded in the discipline’s concepts, substance, and modes of inquiry that the bound- Nursing has distinctive views of persons and strong aries of the discipline, however tentative, can be un- commitments to compassionate and knowledge- derstood and possibilities for creativity across able care of persons through nursing. Nurses often interdisciplinary borders can be created and ex- express their love and passion for nursing. The state- concepts, language, and forms of data that reflect ments of values and beliefs are expressed in the new ways of thinking and knowing in nursing. The philosophies of nursing that are essential under- complex concepts used in nursing scholarship and pinnings of theoretical developments in the disci- practice require language that can be used and un- pline. The language of nursing theory facilitates Systems of Education communication among members of the discipline. Expert knowledge of the discipline is often required Nursing holds the stature and place of a discipline for full understanding of the meaning of special of knowledge and professional practice within in- terms. A distinguishing mark of any disci- This attribute calls attention to the array of books, pline is the education of future and current mem- periodicals, artifacts, and aesthetic expressions, as bers of the community. These indicators in- Closely aligned with attributes of nursing as a dis- clude procedures, tools, and instruments to cipline previously described is consideration of determine the impact of nursing practice and are nursing as a professional practice. Professional essential to research and management of outcomes practice includes clinical scholarship and processes of practice (Jennings & Staggers, 1998). Resulting of nursing persons, groups, and populations who data form the basis for improving quality of nurs- need the special human service that is nursing. Theory-based research is needed in ery and interdisciplinary work demands practice order to explain and predict nursing outcomes es- from a theoretical perspective. Nursing’s discipli- sential to the delivery of nursing care that is both nary focus is essential within an interdisciplinary humane and cost-effective (Gioiella, 1996). Because environment (Allison & McLaughlin-Renpenning, nursing theory exists to improve practice, the test of 1999). Nursing actions reflect nursing concepts and nursing theory is a test of its usefulness in profes- thought. Careful, reflective, and critical thinking is sional practice (Fitzpatrick, 1997; Colley, 2003). Chapters in and use of nursing theory offer opportunity for the remaining sections of this book highlight use of successful collaboration with related disciplines nursing theories in nursing practice. From the viewpoint of practice, know what they are doing, why they are doing what Gray and Forsstrom (1991) suggest that through they are doing, what may be the range of outcomes use of theory, nurses find different ways of looking of nursing, and indicators for measuring nursing’s at and assessing phenomena, have rationale for impact. These nursing theoretical frameworks serve their practice, and have criteria for evaluating out- in powerful ways as guides for articulating, report- comes. Recent studies reported in the literature af- ing, and recording nursing thought and action. Further, these tion and refinement through research, must be re- studies illustrate that nursing theory can stimulate turned to practice (Dickoff, James, & Wiedenbach, creative thinking, facilitate communication, and 1968). Within nursing as a practice discipline, nurs- clarify purposes and relationships of practice. The ing theory is stimulated by questions and curiosi- practicing nurse has an ethical responsibility to use ties arising from nursing practice. Development of the discipline’s theoretical knowledge base, just as it nursing knowledge is a result of theory-based nurs- is the nurse scholar’s ethical responsibility to de- ing inquiry. The circle continues as data, conclu- velop the knowledge base specific to nursing prac- sions, and recommendations of nursing research tice (Cody, 1997, 2003). Can nursing theories in- form us how to stand with and learn from peoples Nursing Theory and the Future of the world? Can we learn from nursing theory how to come to know those we nurse, how to be Nursing theory in the future will be more fully in- with them, to truly listen and hear? Can these ques- tegrated with all domains of the discipline and tions be recognized as appropriate for scholarly practice of nursing. New, more open and inclusive ways to theo- ways to inform nurses for humane leadership in na- rize about nursing will be developed. Abdellah notes that nurses in with other disciplines such as politics, economics, other countries have often developed their systems and aesthetics. These authors expect a continuing of education, practice, and research based on learn- emphasis on unifying theory and practice that will ing from our mistakes. She further proposes an in- contribute to the validation of the nursing disci- ternational electronic “think tank” for nurses pline. Reed (1995) notes the “ground shifting” with around the globe to dialogue about nursing reforming of philosophies of nursing science and (McAuliffe, 1998). Such opportunities could lead calls for a more open philosophy, grounded in nurses to truly listen, learn, and adapt theoretical nursing’s values, which connects science, philoso- perspectives to accommodate cultural variations. Theorists will work in groups to We must somehow come to appreciate the essence develop knowledge in an area of concern to nurs- and beauty of nursing, just as Nightingale knew it ing, and these phenomena of interest, rather than to be.

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Alligood (1995) applied the theory to within the Framework orthopedic nursing with adults trusted allopurinol 300 mg chronic superficial gastritis diet. In contrast buy cheap allopurinol 100mg line gastritis natural treatment, Advocacy Bramlett buy 100 mg allopurinol fast delivery gastritis garlic, Gueldner allopurinol 300mg gastritis diet plan, 1990 Benedict and Frey (1995) examined the use of the and Sowell theory within the delivery of emergency care. Autonomy Glenn* 1989 The midrange Theory of Goal Attainment Coping King 1983 (King, 1981) is also used when nurses wish to ex- Empathy Alligood, Evans, and 1995 plore a particular concept within a theoretical con- Wilt text. Temple and Fawdry (1992) examined caregiver Health King 1990 role strain while perceptual congruency between Health (social system) Sieloff 1995 nurses and clients was explored by Froman (1995). Health (systems) Winker 1995 Nurses also use the Theory of Goal Attainment Power Hawkes 1991 (King, 1981) to examine concepts related to the Quality of life King 1993 theory. This application was demonstrated by Social support Frey 1989 Kameoka (1995) as she analyzed nurse-patient in- Space Rooke 1995 teractions in Japan. Transaction Binder* 1992 Finally, the theory has been applied in nonclini- cal nursing situations. Messmer (1995) used the *Indicates thesis or dissertation theory in implementing theory-based nursing practice. In summary, Table 16–3 system (Sieloff, 1995b), health of systems (Winker, chronicles applications of King’s midrange Theory 1995), and space (Rooke, 1995b). Within the nursing profession, the nursing pro- cess has consistently been used as the basis for Theory of Goal Attainment nursing practice. Although many published the Interacting Systems Framework, she developed applications have broad reference to the nursing the midrange Theory of Goal Attainment (1981) process, several deserve special recognition. Other explicit examples of integration with This midrange theory has found great application the nursing process are those by Woods (1994), and to nursing practice, since the theory focuses on Frey and Norris (1997). Additionally, Frey and concepts relevant to all nursing situations—the at- Norris also drew parallels between the processes of tainment of client goals. These Attainment, (3) exploring a particular concept re- languages include the Nursing Diagnoses, Nursing lated to the Theory of Goal Attainment, and (4) Interventions, and Nursing Outcomes. Although application of the theory in nonclinical nursing these languages were developed after many of the situations. The focus was to develop the concepts (revised to group 1996* of judgment and action as core concepts in the power) 1995 personal system. Other concepts in the theory in- Families, children, Frey 1995 cluded communication, perception, and decision and chronic illness 1993 making. Family health Wicks 1995 In relation to the interpersonal system, several Family health Doornbos 1995 middle-range theories have been developed regard- (families with young chronic ing families. Doornbos (2000) addressed family mentally ill health in terms of families with young chronically individuals) mentally ill individuals. Frey (1995) developed a Perceptual awareness Brooks and 1997 middle-range theory regarding families, children, Thomas and chronic illness; and Wicks (1995) delineated a Satisfaction, client Killeen* 1996 middle-range theory regarding the broader concept of family health. In relation to social systems, *Indicates thesis or dissertation or research in progress Sieloff (1995a) developed the Theory of Depart- mental Power to assist in explaining the power of groups within organizations. Table 16–5 further works, nursing frameworks such as King’s Inter- lists middle-range theories developed within King’s acting Systems Framework (1981) can still find ap- framework (1981). And, it is this type of application that further demonstrates the frame- Instrument Development work’s utility across time. Instrument development in nursing is needed in (1995) implemented nursing diagnoses within the order to measure relevant nursing concepts. Table 16–4 provides a However, instruments developed for a research listing of applications of King’s work in relation to study rarely undergo the rigor of research the nursing process and to nursing languages. King (1988a) developed the Health Development of middle-range theories is a natural Goal Attainment instrument, designed to detail the extension of a conceptual framework. Middle- level of attainment of health goals by individual range theories, clearly developed from within a clients. The Family Needs Assessment Tool was de- conceptual framework, accomplish two goals: (1) veloped by Rawlins, Rawlins, and Horner (1990). Such theories can be directly applied to nursing sit- Table 16–6 provides a listing of instruments devel- uations, whereas a conceptual framework is usually oped in relation to King’s work. Additional evidence of the scope and usefulness of In addition to the midrange Theory of Goal King’s framework and theory is its use with clients Attainment (King, 1981), several other midrange across the life span. Several applications have tar- theories have been developed from within King’s geted high-risk infants (Frey & Norris, 1997; Norris Interacting Systems framework. Hanna (1993) investigated the effect of systems (the nursing staff and hospital environ- nurse-client interactions on oral-contraceptive ad- ment). Interestingly, these theory is their utility in encompassing complex set- studies considered personal systems (infants), in- tings and situations. Kenny (1990) also studied the 1988), and renal procedures (Hanucharurnkui role of the elderly in their care. Gender-specific work in- ied the “impact of information on the health be- cluded Sharts-Hopko’s (1995) use of concepts haviors of older adults” (p. Clearly, focus of care (client system) and/or focus of health these applications, and others, show how the problem (phenomenon of concern). The focus of complexity of King’s framework and midrange the- care, or interest, can be an individual (personal sys- ory increases its usefulness for nursing (refer to tem) or group (interpersonal or social system). Thus, application of King’s work, across client sys- tems, would be divided into the three systems iden- Client Systems tified within King’s Interacting Systems Framework A major strength of King’s work is that it can (1981): personal (the individual), interpersonal be used with virtually all client populations. Frey addition, applications proposed the Theory of and Norris (1997) used both the Interacting Sys- Goal Attainment as the practice model for case tems Framework and Theory of Goal Attain- management (Hampton, 1994; Tritsch, 1996). The earliest 1995a) and revised into a Theory of Group Power applications involved the use of the framework and within Organizations (2003). Educational settings, theory to guide continuing education (Brown & also considered as social systems, have also been Lee, 1980) and nursing curricula (Daubenmire, the focus of application of King’s work (Bello, 1989; Gulitz & King, 1988). Table 16–9 sum- marizes applications related to clients’ phenomena Phenomena of Concern to Clients of concern; the table also groups these applications, Within King’s work, it is critically important for the primarily identified by disease or medical diagno- nurse to focus on, and address, the phenomenon of sis, as illness management. Without this emphasis on the Health is one area that certainly binds clients client’s perspective, mutual goal-setting cannot and nurses. Hence, a client’s phenomena of concern was end point, or outcome, of nursing care and selected as neutral terminology that clearly demon- something to which clients aspire. In addition, Frey applications, tends to support the goal of improved (1996) expanded her research to include risky health directly and/or indirectly, as the result of the behaviors. Health status is explic- As stated previously, diseases or diagnoses are itly the outcome of concern in practice applica- often identified as the focus for the application of tions by Smith (1988). For example, Kohler (1988) conducted research with patients with broncho- focused on increased morale and satisfaction, and pneumonia, while patients with end-stage renal DeHowitt (1992) studied well-being. In Health promotion has also been an emphasis for addition, clients with chronic inflammatory bowel the application of King’s ideas.

Cimetidine is the least expensive generic allopurinol 300 mg line gastritis diet , but in young men who require prolonged treatment Pregnancy (or desired pregnancy) is an absolute contraindica- ranitidine may be preferable purchase allopurinol 300 mg on line chronic gastritis with focal intestinal metaplasia, due to a lower reported incidence tion to the use of misoprostol cheap allopurinol 300mg amex gastritis diet 1200, as the latter causes abortion purchase 300mg allopurinol amex gastritis medicine cvs. It also include famotidine and nizatidine, but they offer no signifi- stimulates mucus production and may chelate with pepsin, cant advantage over ranitidine. Several studies have shown it to be as active as cimetidine in the healing of duodenal and gas- tric ulcers after four to eight weeks of treatment. H /K -adenosine triphosphatase enzyme system (the proton Bismuth chelate elixir is given diluted with water 30 min- pump) of the gastric parietal cell. Examples are omeprazole, utes before meals and two hours after the last meal of the day. This liquid has an ammoniacal, metallic taste and odour The main differences, if any, appear to be in relation to drug which is unacceptable to some patients, and chewable tablets interactions. Antacids or milk should not be taken con- nificant drug interactions with pantoprazole, whereas omepra- currently. Its action is entirely local, sphincter pressure, and coffee; with minimal if any systemic absorption. In addition it binds to pepsin and bile salts and prevents their contact with the ulcer base. The dose is 1g (one tablet) four times daily for Drugs that may be useful include the following: four to six weeks. It may also improve gastro- Sucralfate is well tolerated but, because it contains aluminium, oesophageal sphincter function and accelerate gastric constipation can occur and in severe renal failure accumulation emptying; is a potential hazard. A 25-year-old male estate agent complains of intermittent heartburn, belching and sub-xiphisternal pain which has been present on most nights for two weeks. It was particu- larly severe the previous Saturday night after he had con- sumed a large curry and several pints of beer. Non-drug measures which may be useful include the following: Prescribe alginate/antacids. If the oesophagus occurs at night when swallowing is much symptoms have still not completely resolved, refer the reduced and acid can remain in contact with the mucosa patient for endoscopy. Nausea and sickness during the first trimester of pregnancy will respond to most anti-emetics, but are rarely treated with drugs because of the possible dangers (currently Act of vomiting unquantifiable) of teratogenesis. Vomiting is preceded by intestinal obstruction, intracerebral space-occupying lesion) usually cures the vomiting. This vomiting centre These act partly by their antimuscarinic action on the gut, as (Figure 34. The major efferent in preventing motion sickness and is useful in single doses for pathways from the vomiting centre are the phrenic nerve, the short journeys, as the anticholinergic side effects make it visceral efferent of the vagus to the stomach and oesophagus, unsuitable for chronic use. Hyoscine is an alternative to anti- and the spinal nerves to the abdominal musculature. Drowsiness, blurred vision, dry mouth and urinary the area postrema of the fourth ventricle which is sensitive to retention are more common at therapeutic doses than is the emetic stimuli such as radiation, bacterial toxins and uraemia. They have additional anticholinergic actions, and these con- Anti-emetic drugs can be classified pharmacologically as tribute to their anti-emetic effect. They should only be used when the cause promethazine, betahistine and cinnarizine. The main limita- of nausea or vomiting is known, otherwise the symptomatic tions of these drugs are their modest efficacy and common dose- relief produced could delay diagnosis of a remediable and related adverse effects, in addition to antimuscarinic effects. It is more Metoclopramide potentiates the extrapyramidal effects of sedative than cyclizine. Its effects on intestinal • Betahistine is used in vertigo, tinnitus and hearing loss motility result in numerous alterations in drug absorption, associated with Ménière’s disease. Phenothiazines barium to reach the caecum and decreases the number of used as anti-emetics include prochlorperazine, trifluoper- films required; azine, perphenazine and chlorpromazine. They are least effective in the treatment of motion sick- • symptoms of reflux oesophagitis may be improved, as it ness. All of them carry a risk of extrapyramidal disturbances, prevents nausea, regurgitation and reflux. These effects are more common in females and in in the management of acute nausea and vomiting due to cyto- the young. They are treated by stopping metoclopramide and toxic chemotheraphy, although they offer little advantage for giving benztropine or diazepam acutely if necessary (see also delayed emesis, occurring secondary to cytotoxic chemother- Chapter 21). It may be peripheral at abdominal visceral afferent neurones, or central within the Mechanism of action area postrema of the brain, or a combination of both. Metoclopramide increases the amount of acetylcholine Examples include ondansetron, granisetron, dolasetron and released at post-ganglionic terminals. It also decreases the sensitivity of the visceral nerves that carry impulses from the gut to the emetic centre. In an Pharmacokinetics attempt to reduce side effects and increase efficacy, a number Metoclopramide is well absorbed orally and is also given by of analogues, including nabilone, have been synthesized. There is some evidence that opioid pathways Glucocorticosteroids are not suitable for maintenance treatment are involved in these actions. Benzodiazepines given before treatment with cytotox- pository or enema preparations are as effective as systemic ics reduce vomiting, although whether this is a specific anti- steroids. Drugs currently available in this group are sulfasalazine, mesalazine, balsalazide and olsalazine. Although usually well tolerated, and Crohn’s disease include kinins and prostaglandins. The the adverse effects of sulfasalazine are nausea, vomiting, latter stimulate adenylyl cyclase, which induces active ion epigastric discomfort, headache and rashes (including toxic secretion and thus diarrhoea. All of the adverse effects associated with thromboxane A2 and prostacyclin by the gut increases during sulphonamides can occur with sulfasalazine, and they are disease activity, but not during remission. Toxic effects on red cells lates influence the synthesis and metabolism of these are common (70% of cases) and in some cases lead to haemoly- eicosanoids, and influence the course of disease activity. Temporary oligospermia with life-saving) and other non-specific treatment, glucocorticos- decreased sperm motility and infertility occurs in up to 70% of teroids, aminosalicylates and immunosuppressive drugs are males who are treated for over three years. Prednisolone and hydrocorti- ate sulfasalazine and in men who wish to remain fertile. Topical therapy in the form of a rectal drip, foam or enema of Key points hydrocortisone or prednisolone is very effective in milder Aminosalicylates and blood dyscrasias attacks of ulcerative colitis and Crohn’s colitis; some systemic • Any patient who is receiving aminosalicylates must be absorption may occur. Prednisolone is preferred to hydrocortisone as it has less min- • If there is suspicion of blood dyscrasia, stop aminosalicylates. Also, it is important to remember that many drugs is activated in the intestine of patients with inflammatory can cause constipation (Table 34. This forms the rationale for the use of immuno- In general, patients with constipation present in two ways: suppressive agents in the group of patients who do not respond to therapy with aminosalicylates or glucocorticos- 1.

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