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Resources • Provide access to current medicines information resources for the staff order 80 mg super levitra with visa erectile dysfunction drugs market, residents and health professionals buy discount super levitra 80mg erectile dysfunction pump hcpc. Sharing medicines • Never give medicine to anyone other than the person for whom it is labelled discount 80mg super levitra free shipping erectile dysfunction drugs don't work. Bulk supply • Bulk supply is only suitable for facilities with hospital certifcation. Medicines Care Guides for Residential Aged Care 15 Cytotoxic Medicines • Cytotoxic medicines have the ability to kill or slow the growth of living cells and are used to treat conditions such as cancer, rheumatoid arthritis and myeloproliferative disorders. The following cytotoxic medicines are sometimes prescribed for residents in residential aged care: • methotrexate Cytotoxic • hydroxyurea medicines • chlorambucil • cyclophosphamide • azathioprine • fuorouacil. Cytotoxic medicines should be stored in a locked cabinet, in a locked Storage medicine room, separate from other medicines. Medicines Care Guides for Residential Aged Care 17 Residents Self-Medicating There are many reasons why it might be preferable for residents to self-medicate (eg, to maintain autonomy or as part of a rehabilitation programme). As part of the assessment, it may be benefcial to ask the resident what they know about their medicines and conditions, which medicines are actually being taken and how they take them, and any benefcial and/or unwanted effects experiences they have had. Alternative medicines • Include over-the-counter, complementary, homeopathic, naturopathic, traditional and supplementary medicines on the medicines chart as these can sometimes cause side effects, adverse drug reactions and interactions. Monitoring and documentation • Identify on the medicines chart that the resident is self-medicating. Storage • Provide locked storage that is only accessible to the resident and authorised staff. Medicines management for facility leave • Document in the clinical fle who is taking responsibility for medicines management while resident is on leave. Medicines Care Guides for Residential Aged Care 19 Residents Self-Medicating – Factors to considerTher Use the following guide to assess a resident’s ability to self-medicate safely. If their ability is on the blue end of each indicator, they are likely to be able to self-medicate. However, if their ability for any indication is on the red section, the ability to self-medicate is questionable. Self-medication risk Low Medium High Medicine Minimal side effects/adverse effects Some adverse effects – Narrow therapeutic index, potentially not serious serious adverse effects Administration diffculty Topical/oral Subcutaneous/intramuscular/rectal/vaginal Intravenous infusion/pump Functional ability Independent/previous self-medication Some functional dependency Dependent Environment Own home/supported living Rest home/private hospital Hospital ward/intensive care unit Monitoring required Responses easily judged Simple questions/physical, cognitive assessment Complex monitoring and assessment Packaging/regimen complexity Unit dose packaging Simple regimen Moderately complex Complex regimen Medicines not (eg, blister-packed) Few changes regimen Frequent changes pre-packaged 20 Medicines Care Guides for Residential Aged Care Medicines Review Multidisciplinary team medicines review Assessment for Medicines reviews Resident and/or family Resident input Education for staff medicines review to be undertaken education/information Include: • On admission • Direct contact • Disease process Evidence-based practice • Goals of care • Every 3 months between reviewers • Medicines desired regarding medicines • Resident medicines • When health and resident/ effects/benefts used within the facility history status changes representative offers • Potential side including: • Allergies/sensitivities essential advantages. When stopping medicines, consider reducing them gradually as stopping medicines abruptly can cause unwanted effects. Consider stopping medicines that are Consider the appropriateness of medicines potentially inappropriate for the resident in light of: because of: • organ function (eg, renal /hepatic, tissue • development of an adverse effect/drug perfusion, nutritional status) interaction • electrolyte levels/hydration • inconsistency with current goals of therapy (eg, end of life care) • pharmacogenetic factors • the resident’s life expectancy • recent baseline observations, including body mass index and blood pressure • other co-morbidities. Consider starting preventative medicines that are consistent with the resident’s goals. Consider the possibility of: • medicine-disease interactions Prescription considerations • medicine-medicine interactions Consider the possibility that: • the resident is taking more of the medicine • medicine-food interactions than prescribed • compounded adverse effects • the resident is taking less than or none of • risks related to polypharmacy. The criteria are organised by organ system (eg, cardiovascular system, central nervous system, etc). Benzodiazepines, antipsychotic High risk of falls (> 1 fall in past These medicines adversely affect medicines (neuroleptics), frst- 3 months) those residents who are prone to generation antihistamines, falls. Loop diuretic for dependent ankle No clinical signs of heart failure Compression therapy may be more oedema appropriate. Loop diuretic Not appropriate as frst-line Safer, more effective alternatives treatment for hypertension are available. Aspirin and warfarin Without the use of histamine H2 Creates high risk of receptor antagonist or proton gastrointestinal bleeding. Alpha blockers In male clients with frequent Increased risk of increasing urinary incontinence (one or more frequency and worsening of incontinence episodes per day) incontinence. With clients that have long-term This medicine is not appropriate/ in-dwelling catheters (longer than indicated. Nebulised Ipratropium With history of glaucoma May cause exacerbation of glaucoma. Endocrine system Condition(s) Potential risk Glibenclamide or chlorpropamide With type 2 diabetes mellitus Increased risk of prolonged hypoglycaemia. Beta blockers With diabetes mellitus and Has the risk of masking frequent hypoglycaemia (one or hypoglycaemic symptoms. Regular opiates for more than With chronic constipation without Increased risk of severe 2 weeks use of concurrent laxatives constipation. Long-term opiates in those with Unless indicated for palliative care Increased risk of exacerbation of dementia of management of moderate to cognitive impairment. With moderate to severe Increased risk of exacerbation of hypertension hypertension. Long-term corticosteroid use As monotherapy for rheumatoid Risk of major systemic > 3 months arthritis or osteoarthritis corticosteroid side effects. Aspirin, clopidogrel, dipyridamole With a concurrent bleeding Creates a high risk of bleeding. Prescribed with opiate or calcium Increased risk of severe channel blocker constipation. Long-term (> 1 month) For long-term hypnotics Increased risk of confusion, antipsychotic medicines hypotension, falls, extrapyramidal (neuroleptics) side effects. To treat extrapyramidal side effects Increased risk of anticholinergic of neuroleptic medicines toxicity. Prolonged use (> 1 week) of frst- Increased risk of sedation and generation antihistamines anticholinergic side effects. In the treatment of severe infective Increased risk of exacerbation or gastroenteritis protraction or infection. Prochlorperazine or With Parkinsonism Increased risk of exacerbation of metoclopramide Parkinsonism. Anticholinergic antispasmodic Chronic constipation Increased risk of exacerbation of medicines constipation. However, the use of these medicines should be limited, closely monitored by the multidisciplinary team, and decreased or discontinued whenever possible. They will be able to give guidance on managing the behaviour, based on their experience. Antipsychotics are unlikely to be useful when: • the behaviour is intermittent • the behaviour is situation-specifc (eg, resisting showers vs resisting all care) • the behaviour is goal directed • there is apathy, wandering (we all need to walk about), calling out, mood disorder • loss of toileting skills or sexual behaviour in the wrong context. When the behaviour has settled and been maintained for three months, then slowly reduce medicine/dose by 25 percent every two weeks. If the behaviour is stable, there should still be a regular review with the goal of reducing the dose and stopping it eventually. Effect of new medicine on existing Commonly used high-risk medicines medicines All medicines have side effects, but some • New medicines can interact with medicines are particularly high risk for existing medicines and cause adverse adverse effects. Crushing these medicines may result in altered absorption or an unintended large bolus dose. Medicines labelled with the terms below are slow-release formulations or have Things to look for when new medicines special coatings and should not be crushed are prescribed without pharmacist advice.
Central Europe and the Near and Middle East/South- In recent years discount super levitra online american express erectile dysfunction what age does it start, seizures of cannabis herb in Turkey have West Asia buy generic super levitra on line erectile dysfunction drugs gnc, and the drop was partially offset by seizures followed a notable increasing trend purchase super levitra 80 mg on-line impotence cream, rising six-fold over a in North Africa. According to Turkish authorities,46 tends to be met by production occurring in relative the increase in cannabis trafficking was attributable to proximity to consumption, large quantities of cannabis illicit cultivation taking place in some rural parts of the resin are trafficked significant distances to reach con- country. Cannabis resin Europe and North Africa Global cannabis resin seizures reached a record of 1,648 Spain continued to report the largest annual seizures of mt in 2008, and in 2009 declined to 1,261 mt - a level cannabis resin worldwide. Every resin are trafficked from the source country of Morocco year from 2001 onwards, West and Central Europe, the to Spain, and on to other countries in Europe. Distribution Absolute values 100% 1,800 90% 1,600 80% 1,400 70% 60% 1,200 50% 1,000 40% 800 30% 600 20% 10% 400 0% 200 0 Near and Middle East/ South-West Asia Rest of the world Global total North Africa West & Central Europe West & Central Europe Near and Middle East /South-West Asia North Africa 45 This figure represents an aggregate of 624 kg of cannabis herb Rest of the world together with 11,042 seeds or bags, converted assuming a weight of half a gram per unit. In Algeria and Egypt, 500 200 seizures more than doubled in 2008, reaching a record 400 level of 38 mt in Algeria and a level of 12. Algeria reported that in 2009 cannabis 0 0 resin and cannabis herb in its territory originated entirely in Morocco. Quantity (mt) Seizure data and, to some extent, price data support the Number of seizures flow of cannabis resin from North Africa into western Europe via Spain. Apart from Spain, which reports the seizures of cannabis resin in Spain fell to 445 mt – the largest cannabis seizures in Europe by far, the largest lowest level since 1999 (431 mt) - while seizures in seizures among European countries in 2009 were Morocco rose from 114 mt in 2008 to 188 mt in 2009 reported by France and Portugal, followed by Italy and – the highest level on record. The decrease in seizures in Spain in 2009 was 2009, approximately one half of significant individual reflected in similar decreases in the four European coun- drug seizures reported by Spain involved cannabis resin. Seizures in However, Morocco is likely not the only source country Belgium have fluctuated considerably, amounting to for cannabis resin reaching Europe, and Spain assessed 18. In 2008, almost one half of cannabis resin cannabis resin in Pakistan originating seizures in the Americas were made by Canada (899 kg). Moreover, the traffick- 100 600 ing routes for cannabis resin reaching Canada appeared 90 to undergo significant changes. Canada identified the 500 Caribbean, North Africa and South-East Asia as the 80 70 origin for cannabis resin reaching its territory in 2008, 400 but these were replaced by Southern Africa and South- 60 West Asia in 2009. The United States also assessed that, 30 in 2008, cannabis resin was trafficked both to the United 20 100 States via Canada (from North Africa), and to Canada 10 via the United States (of Caribbean origin). Seizures of 0 0 cannabis resin in Mexico rose from 6 kg in 2007 to 297 kg in 2008 – the highest level since 1995. In Brazil, cannabis resin Quantity (tons) seizures tripled between 2006 and 2008, reaching the Number of seizures record level of 301 kg in 2008, but fell to 204 kg in 2009. Cannabis resin was further distributed from India to other destinations via cargo couriers. Near and Middle East/South-West Asia Seizures of cannabis resin in Pakistan rose for two years running, reaching 205 mt in 2009 – the highest level since 1995. Pakistan continued to assess the share of cannabis resin originating in Afghanistan at 98%. Over the period 1999-2009, 41% of significant individual drug seizures reported by Pakistan involved cannabis resin; the country of origin for these consignments was identified almost exclusively as Afghanistan. In the Islamic Republic of Iran, seizures of cannabis resin fell twice in succession, from the record level of 2007 (90 mt) to 69 mt in 2009. Based on data for the first nine months of the year, it appears that the decreas- ing trend continued into 2010. The Islamic Republic of Iran assessed that, in 2009, one quarter of cannabis resin trafficked on its territory was intended for the country itself, with the remainder intended for Arab countries, Turkey and Europe. Seizures in Afghanistan fell from the record level of 2008 (271 mt) to the relatively low level of 10. Neverthe- less, Canada has a significant consumer market for can- 200 The cannabis market Fig. Figures in brackets represent the upper and lowest and highest provincial price observed. Myanmar, reported eradication of opium poppy by region (ha), 2006-2010 Region 2006 2007 2008 2009 2010 East Shan 32 1,101 1,249 702 868 North Shan 76 916 932 546 1,309 South Shan 3,175 1,316 1,748 1,466 3,138 Shan State total 3,283 3,333 3,929 2,714 5,316 Kachin 678 189 790 1,350 2,936 Kayah 0 12 12 14 13 Total within the surveyed area 3,961 3,534 4,731 4,078 8,265 Magwe 0 45 0 1 1 Chin 0 10 86 5 2 Mandalay Sagaing Other states 9 64 0 0 0 Total (national) 3,970 3,598 4,820 4,087 8,268 25 The estimates in Kayah for 2008 and 2009 are not directly compara- ble due to a change in methodology. For the calculation of coca 29 Takes into account all coca leaf produced, irrespective of its use. The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by United Nations. Aggregation of subregional estimates rolled-up into government reports and scientific literature were also regional results to arrive at global estimates. Assessing the extent of drug use (the number of drug In cases of estimates referring to previous years, the users) is a particularly difficult undertaking because it prevalence rates were left unchanged and applied to new involves measuring the size of a ‘hidden’ population. Currently, only Margins of error are considerable, and tend to increase two countries measure drug prevalence among the gen- as the scale of estimation is raised, from local to national, eral population on an annual basis. Regional and global estimates countries that regularly measure it - typically the more are reported as ranges to reflect the information gaps. Identiﬁcation of key benchmark ﬁgures for the level of countries in Oceania and a limited number of countries drug use in all countries where data are available (an- in Asia and Africa. One key problem in national data is nual prevalence of drug use among the general popu- the level of accuracy, which varies strongly from country lation aged 15-64) which then serve as ‘anchor points’ to country. Not all estimates are based on sound epide- for subsequent calculations; miological surveys. In some cases, the estimates simply reflect the aggregate number of drug users found in drug 3. Even in cases where the World Drug Report (for example, from age group detailed information is available, there is often consider- 12 and above to a standard age group of 15-64) ; able divergence in definitions used, such as chronic or 4. Adjustments of national indicators to estimate an an- regular users; registry data (people in contact with the nual prevalence rate if such a rate is not available (for treatment system or the judicial system) versus survey example, by using the lifetime prevalence or current data (usually extrapolation of results obtained through use rates; or lifetime or annual prevalence rates among interviews of a selected sample); general population the student population). Tis includes the identiﬁca- versus specific surveys of groups in terms of age (such as tion of adjustment factors based on information from school surveys), special settings (such as hospitals or neighbouring countries with similar cultural, social prisons), et cetera. Imputation for countries where data is not available, aggregating such diverse estimates, an attempt has been based on data from countries in the same subregion. All available estimates were transformed 90th percentile of the subregional distribution; into one single indicator – annual prevalence among the general population aged 15 to 64 - using transformation 6. Extrapolation of available results for a subregion were ratios derived from analysis of the situation in neigh- calculated only for subregions where prevalence esti- bouring countries, and if such data were not available, mates for at least two countries covering at least 20% using global average estimates. If, due to a lack of that though the level of drug use differs between coun- data, subregional estimates were not extrapolated, a tries, there are general patterns (for example, lifetime regional calculation was extrapolated based on the prevalence is higher than annual prevalence; young 10th and 90th percentile of the distribution of the people consume more drugs than older people; males data available from countries in the region. For example, it is generally accepted that nation- rates than the general population, et cetera) which apply ally representative household surveys are reasonably to most countries. Thus, household survey results were usu- among the general population, except for emerging drug ally given priority over other sources of prevalence esti- trends, do not vary greatly among countries with similar mates. It is also part of the Lisbon number of ‘indirect’ methods have been developed to Consensus on core epidemiological demand indicators provide estimates for this group of drug users, including which has been endorsed by the Commission on Nar- benchmark and multiplier methods (benchmark data cotic Drugs. Drug consumption among the youth population countries where there was evidence that the primary (prevalence and incidence); ‘problem drug’ was opiates, and an indirect estimate existed for ‘problem drug use’ or injecting drug use, this 3. High-risk drug use (number of injecting drug users was preferred over household survey estimates of heroin and the proportion engaged in high-risk behaviour, use.
The “nr = not reported due to measurement issues” notation indicates that the estimate could be calculated based on available data but is not calculated due to potential measurement issues cheap super levitra 80mg free shipping erectile dysfunction 30s. Illicit drug use includes the misuse of prescription psychotherapeutics or the use of marijuana discount super levitra 80mg visa erectile dysfunction which doctor to consult, cocaine (including crack) purchase super levitra with visa erectile dysfunction jacksonville florida, heroin, hallucinogens, inhalants, or methamphetamine. As of June 2016, 25 states and the District of Columbia have legalized medical marijuana use. Four states have legalized retail marijuana sales; the District of Columbia has legalized personal use and home cultivation (both medical and recreational). Misuse of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs. Estimates of misuse of psychotherapeutics and stimulants do not include data from new methamphetamine items added in 2005 and 2006. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription psychotherapeutics used non-medically. Nonmedical use of prescription psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives. Individuals with substance use disorders have elevated rates of substance misuse– related health and social problems and costs, but as shown in the last columns of Table 1. For example, binge drinking at least once during the past month was self-reported by over 66 million individuals. By defnition, those episodes have the potential for producing harm to the user and/ or to those around them, through increases in motor vehicle crashes, violence, and alcohol-poisonings. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or misuse of prescription- type psychotherapeutics, including data from original methamphetamine questions but not including new methamphetamine items added in 2005 and 2006. In fact, greater impact is likely to be achieved by reducing substance misuse in the general population—that is, among people who are not addicted—than among those with severe substance use problems. Of course, efforts to reduce general population rates of substance use and misuse are also likely to reduce rates of substance use disorders, because substance use disorders typically develop over time following repeated episodes of misuse (often at escalating rates) that result in the progressive changes to brain circuitry that underlie addiction. Costs and Impact of Substance Use and Misuse Alcohol misuse, illicit drug use, misuse of medications, and substance use disorders are estimated to cost the United States more than $400 billion in lost workplace productivity (in part, due to premature mortality), health care expenses, law enforcement and other criminal justice costs (e. A 2010 study examined the global burden of disability attributable to substance misuse problems and disorders, focusing particularly on lost ability to work and years of life lost to premature mortality. In addition to the costs to society, substance misuse can have many direct and indirect health and personal consequences for individuals. The direct effects on the user depend on the specifc substances used, how much and how often they are used, how they are taken (e. Acute effects can range from changes in mood and basic body functions, such as heart rate or blood pressure, to overdose and death. Alcohol misuse and drug use can also have long-term effects on physical and mental health and can lead to substance use disorders. For example, drug use is associated with chronic pain conditions and cardiovascular and cardiopulmonary diseases. Use of some drugs, such as cocaine, during pregnancy may also lead to premature birth or miscarriage. In addition, substance use during pregnancy may interfere with a child’s brain development and result in later consequences for mental functioning and behavior. These consequences can all contribute to the spectrum of public health consequences of substance misuse and need to be considered both independently and collectively when developing and implementing clinical and public health interventions. Substance misuse problems can also result in other serious and sometimes fatal health problems and extraordinary costs; they may also lead to unexpected death from other causes. Three examples of these serious, sometimes lethal, problems related to substance misuse are highlighted below. Driving Under the Infuence In 2014, 9,967 people were killed in motor vehicle crashes while driving under the infuence of alcohol, representing nearly one third (31 percent) of all trafc-related fatalities in the United States. Many individuals should not consume alcohol, including individuals who are taking certain over-the-counter or prescription medications or who have certain medical conditions, those who are recovering from an alcohol use disorder or are unable to control the amount they drink, and anyone younger than age 21 years. In addition, drinking during pregnancy may result in negative behavioral or neurological consequences in the offspring. Drug Overdose (Illicit and Prescription Drugs) 1 Opioid analgesic pain relievers are now the most prescribed class of medications in the United States, with more than 289 million prescriptions written each year. Over-prescription of prescriptions of opioid pain relievers has been accompanied powerful opioid pain relievers beginning in the 1990s led to a rapid escalation by dramatic increases in misuse (Table 1. Heroin overdoses were more7 people dying from opioid overdoses than fve times higher in 2014 (10,574) then ten years before soared—increasing nearly four-fold between 1999 and 2014. Additionally, rates of cocaine overdose were higher in 2014 than in the previous six years (5,415 deaths 1 from cocaine overdose). In 2014, there were 17,465 overdoses from illicit drugs and 25,760 overdoses from prescription drugs. Illicit fentanyl, for example, is often combined with heroin or counterfeit prescription drugs or sold as heroin, and may be contributing to recent increases in drug overdose deaths. A recent national survey found that 22 percent of women and 14 percent of men reported experiencing severe physical violence from an intimate partner in their lifetimes. In addition to evidence from the criminal justice arena, recent systematic reviews have found that substance use is both a risk factor for and a consequence of intimate partner violence. Vulnerability to Substance Misuse Problems and Disorders Risk and Protective Factors: Keys to Vulnerability Substance misuse problems and substance use disorders are not inevitable. An individual’s vulnerability may be partly predicted by assessing the nature and number of their community, caregiver/family, and individual-level risk and protective factors. Caregiver/family-level risk factors See Chapter 3 - Prevention Programs include low parental monitoring, a family history of substance and Policies. At the individual level, major risk factors include current mental disorders, low involvement in school, a history of abuse and neglect, and a history of substance use during adolescence, among others. First, no single individual or community-level factor determines whether an individual will develop a substance misuse problem or disorder. Third, although substance misuse problems and disorders may occur at any age, adolescence and young adulthood are particularly critical at- See Chapter 2 - The Neurobiology of risk periods. Research now indicates that the majority of those Substance Use, Misuse, and Addiction. This area of the brain is one of the most affected regions in a substance use disorder. Therefore, it is important to focus on prevention of substance misuse across the lifespan as well as the prevention of substance use disorders. Diagnosing a Substance Use Disorder Changes in Understanding and Diagnosis of Substance Use Disorders Repeated, regular misuse of any of the substances listed in Figure 1. Severe substance use disorders are characterized by compulsive use of 1 substance(s) and impaired control of substance use. Substance use disorder diagnoses are based on criteria specifed in the American Psychiatric Association’s Diagnostic and Statistical Misuse versus Abuse. Much of the substance use uses the term substance misuse, a term disorder data included in this Report is based on defnitions that is roughly equivalent to substance abuse.