By O. Orknarok. Southern Connecticut State University. 2019.
The clinical infection usually starts from an innoculation site and spreads peripherally hence the annular lesions with an active border cheap gasex online mastercard. Treatment Drug of choice A: Compound benzoic acid (Whitfield’s ointment) applied two times a day for up to 4 weeks gasex 100caps mastercard. Treat with: B: Griseofulvin (O) 500mg daily for 6 week purchase gasex with american express, together with fatty meals Children 15-20mg/kg once daily Note: Do not crush the tablet (micronised tablet) 2 gasex 100 caps low cost. Hypopigmented/hyperpigmented confluent patches of varying size with fine scale on the chest, back, arms and occasionally neck and face. Treat any bacterial superinfection first: First choice: A: Whitefield’s lotion twice daily for 2 weeks Second choice: If fails to respond, try A: Clotrimazole cream 1% twice daily for 2 weeks. The skin lesions are characterized by an erythematous, moist exudate in the skin folds. Involvement of the nails lead to painful swelling of the nail bed and folds which may discharge pus and is made worse by contact with water. Oral lesions are characterized by white, adherent mucosal plaques in buccal cavity including tongue which may be forcibly removed. Vulval-vaginal candidiasis is characterized by itchy, curd-like whitish vaginal discharge, dysuria and dyspareunia. Treatment For Actinomycetomas A: Co-trimoxazole 960mg every 12 hours Plus S: Rifampicin 300mg every 12 hours for 2-4 months Alternative drugs for Adults: A: Phenoxymethylpenicillin(O) 500 mg every 6 hours 2-4 months; for Children: Phenoxymethylpenicillin (O)25 mg/kg body weight 6 hourly for 2-4 months. Alternative drug for Nocardiosis Adult: S: Dapsone 100 mg every 24 hours for 2-4 months Children: Dapsone 25 – 50 mg every 24 hours for 2-4 months 142 | P a g e 3. The main clinical features are, a short elevated serpiginous (S-shaped) track in the superficial epidermis, known as a burrow, this is pathognomonic of a scabies infestation. A small vesicle or papule may appear at the end of the burrow or occur independently. Norwegian scabies presents with extensive crusting (psoriasiformlike lesions) of the skin with thick, hyperkeratotic scales overlying the elbows, knees, palms, and soles. Note Treat all close contacts, especially children in the same household with Wash clothes and beddings, leave in the sun to dry followed by ironing. The main clinical features are: prodromal symptoms of tingling discomfort or itching, followed by vesicular formation. Treatment B: Acyclovir (O) 400mg 8 hourly for 7 – 10 days Note: Use of systemic Acyclovir is optimum when given within the first 48 4. Severe burning pain precedes the appearance of grouped vesicles overlying erythematous skin and following a dermatome; does not cross the midline. Lesions are preceded by fever and characteristically vesicular in different stages of development. Treatment complications Adult A: Paracetamol 1 g every 8 hours Plus A: Calamine lotion with 1% phenol, apply over the whole body every 24 hours Children A: Paracetamol 10 mg/kg body weight every 8 hourly Plus A: Calamine lotion with 1% phenolas in adults 5. These persons are also more susceptible to herpes simplex and vaccinia (but not varicella-zoster). Infantile eczema (“milk crust”): usually appears at 3 months of age with oozing and crusting affecting the cheeks, forehead and scalp. Flexural eczema: starts at 3-4 years, affecting the flexure surface of elbows, knees and nape of neck (thickening and lichenificaiton). In adults any part of the body may be affected with intense itching, particularly at night. Note: Eczema may evolve through acute (weepy), subacute (crusted lesions), and chronic (lichenified, scaly) forms. Choice of skin preparations depends on whether lesions are wet (exudative) or dry/lichenified (thickened skin with increased skin markings). Where large areas are involved give a course of antibiotics for 5-10 days (as for impetigo) After the lesions have dried, apply an aqueous cream for a soothing effect. Use the mildest topical corticosteroid which is effective, start with: C: Hydrocortisone 1% cream for wet, ointment for dry skin. Striae, acne, hyperpigmentation and hypopigmentation, hirsutism and atrophy may result. Treatment If acute (existing for less than 3 months), exclude drug reactions (e. If no improvement after 1 month or chronic problem, refer to specialist for combination therapy (H1, H2 inhibitors). Treatment Sun exposure to the lesions for half an hour or one hour daily may be of benefit C:Crude Coal tar 5% in Vaseline in the morning Plus C:Salicylic acid 5% in Vaseline to descale Plus C: Betamethasone ointment 0. If not responding well, refer to specialist for appropriate systemic treatment with methotrexate, cyclosporine, azathioprine etc. Cardinal signs: diarrhea, dermatitis (sites exposed to sun and pressure) and dementia. Important skin findings include: Casal’s necklace; hyperpigmented scaling involving the neck region Hyperpigmented scaly lesions on sun exposed areas Treatment Treat both adults and children with: C: Nicotinamide (O) 500mg once daily for four weeks or until healing is complete; Children give 5mg/kg per day for children. Advice on Diet: The diet should be rich in protein (meat, groundnuts, and beans) 6. Clinical features include depigmentation of patches of skin that occurs on the face, neck, trunk and extremities Treatment There is no cure for vitiligo, but there are a number of treatments that improve the condition. Treatment options generally fall into four groups: Sub block Skin camouflage Corticosteroids Depigmentation Note: Counsell the patient about the condition 6. It is characterized by sweating, weakness, headache, anorexia, fever, malaise, arthralgia, weight loss, and pain in the limbs, back and rigorous. Treatment Adults: A: Doxycycline (O)100mg once daily for 4 weeks Plus A: Co-trimoxazole (O) 960 mg every 12 hours for 4 weeks. Primary lesions are characterized by violaceous, shiny flat topped papules which may coalesce and evolve into into scaly plaques distributed over inner wrists, arms and thighs as well as sacral area. Scarring alopecia may result from lichen planopilaris (severe) Treatment A: Chlorpheniramine (O) 4mg 6 hourly Plus A:Betamethasone valerate ointment 0. One useful approach is to separate predictable reactions occurring in normal patients from unpredictablereactions occurring in susceptible patients. Predictable adverse reactions Overdosage (wrong dosage or defect in drug metabolism) Side effects (sleepiness from antihistamines) Indirect effects (antibiotics change normal flora) Drug interactions (alter metabolism of drugs; most commonly the cytochromeP-450 system) Unpredictable adverse reactions Allergic reaction (drug allergy or hypersensitivity; immunologic reaction to drug; requires previous exposure or cross-reaction). Clinically, one must learn which reactions are most likely to produce certain findings. Main differential diagnostic consideration is viral exanthem or on occasion acute exanthem such as guttae psoriasis or pityriasis rosea. It is a cutaneous drug reaction that recurs at exactly the same site with repeated exposure to the agent. Clinical features include typically red-brown patch or plaque; occasionally may be bullous. Erythema multiforme Most erythema multiforme is caused by herpes simplex virus, especially if recurrent. The classical clinical findings are iris or target lesions, most often on the distal limbs. Lesions caused by mycoplasma or especially drugs are moreoften on the trunk and less like to have a target pattern. We prefer the term erythema multiforme–like for such lesions, which carry the risk of developing into severe skin reactions. Management Short burst of systemic corticosteroids helpful in many cases but two problems: Exclude or treat underlying infection, which could beworsened by immunosuppression. Toxic epidermal necrolysis It is a severe life-threatening disorder with generalized loss of epidermis and mucosa Clinical features: Prodrome depends on underlying disease and triggering drug Sudden onset of either diffuse maculae (erythema multiforme–like drug reaction) or diffuse erythema without maculae Then prompt progression towards widespread erythema and peeling of skin; skin lies in sheets and folds on the bedding. Treatment Systemic corticosteroids, if employed, should be used early to attempt to abort the immunologic reaction. Note: Ophthalmologic monitoring is essential, as risk of scarring and blindness is significant d. Many types of albinism exist, all of which involve lack of pigment in varying degrees. The condition, which is found in all races, may be accompanied by eye problems and may lead to skin cancer later in life if not well prevented at elarly childhood. Recently, a blood test has been developed that can identify carriers of the gene for some types of albinism; a similar test during amniocentesis can diagnose some types of albinism in an unborn child. A chorionic villus sampling test during the fifth week of pregnancy may also reveal some types of albinism. The specific type of albinism a person has can be determined by taking a good family history and examining the patient and several close relatives.
Avery’s Drug Treatment is a more 86 Chapter 12 How to keep up-to-date about drugs specialized book safe gasex 100caps, appropriate for prescribers with a special interest in clinical pharmacology gasex 100caps visa. Other specialized books address such areas as psychotropic drugs discount gasex 100caps line, or specific risk groups such as drugs in lactation buy 100caps gasex with amex, drugs for children, or drugs for the elderly. Drug compendia In many countries there are publications that list the drugs available on the market. These compendia vary in type and scope but usually include generic and brand names; chemical composition; clinical indications and contraindications; warnings, precautions and interactions; side effects; administration and dosage recommendations. Some are based on the official labelling information for the product as approved by the national regulatory authority. For example, the drug listing may be incomplete, and comparative assessments are usually lacking. However, comprehensive and objective compendia are available which do include comparative assessments and/or provide criteria for choice within well- defined therapeutic drug categories. The latter includes information on cost, which is not often included in other compendia. In fact, they are issued so frequently that old copies, which may be available at very low cost or free of charge, remain useful for quite some time. National lists of essential drugs and treatment guidelines In many developing countries a national list of essential drugs exists. It usually indicates the essential drugs chosen for each level of care (dispensary, health centre, district hospital, referral hospital). It is based on a consensus on the treatment of choice for the most common diseases and complaints, and defines the range of drugs that is available to prescribers. Very often national treatment guidelines, which include the most important clinical information for the prescriber (treatment of choice, recommended dosage schedule, side effects, contraindications, alternative drugs, etc. Drug formularies Formularies contain a list of pharmaceutical products, together with information on each drug. They are usually developed by therapeutic committees and they list the drugs that are approved for use in that country, region, district or hospital. In many countries drug formularies are also developed for health insurance programmes, listing the products that are reimbursed. Their value is enhanced if they contain comparisons between drugs, evaluations and cost information, but that is often not the case. Drug bulletins These periodicals promote rational drug therapy and appear at frequent intervals, ranging from weekly to quarterly. Drug bulletins can be a critical source of information in helping prescribers to determine the relative merits of new drugs and in keeping up-to-date. Drug bulletins can have a variety of sponsors, such as government agencies, professional bodies, university departments, philanthropic foundations and consumer organizations. They are published in many countries, are often free of charge, and are highly respected because of their unbiased information. A good independent drug bulletin in French is Prescrire; it is not free of charge. National drug bulletins are appearing in an increasing number of developing countries, which include Bolivia, Cameroon, Malawi, the Philippines and Zimbabwe. The main advantages of national drug bulletins are that they can select topics of national relevance and use the national language. Medical journals Some medical journals are general, such as The Lancet, the New England Journal of Medicine or the British Medical Journal; others are more specialized. The specialized journals include more detailed information on drug therapy for specific diseases. You can usually check whether journals meet this important criterion by reading the published instructions for submission of articles. They are usually glossy and often present information in an easily digestible format. They can be characterized as: free of charge, carrying more advertisements than text, not published by professional bodies, not publishing original work, variably subject to peer review, and deficient in critical editorials and correspondence. They sometimes report on commercially sponsored conferences; in fact, the whole supplement may be sponsored. Only a relatively small proportion publish scientifically validated, peer reviewed articles. If in doubt about the scientific value of a journal, verify its sponsors, consult senior colleagues, and check whether it is included in the Index Medicus, which covers all major reputable journals. Verbal information Another way to keep up-to-date is by drawing on the knowledge of specialists, colleagues, pharmacists or pharmacologists, informally or in a more structured way through postgraduate training courses or participation in therapeutic committees. Community based committees typically consist of general practitioners and one or more pharmacists. In a hospital setting they may include several specialists, a clinical pharmacologist and/or a clinical pharmacist. Using a clinical specialist as the first source of information may not be ideal when you are a primary health care physician. In many instances the knowledge of specialists may not really be applicable to your patients. Some of the diagnostic tools or more sophisticated drugs may not be available, or needed, at that level of care. Drug information centres Some countries have drug information centres, often linked to poison information centres. Health workers, and sometimes the general public, can call and get help with questions concerning drug use, intoxications, etc. Many major reference data bases, such as Martindale and Meylers Side Effects of Drugs, are now directly accessible 89 Guide to Good Prescribing through international electronic networks. Cartoon 5 When drug information centres are run by the pharmaceutical department of the ministry of health, the information is usually drug focused. Centres located in teaching hospitals or universities may be more drug problem or clinically oriented. Computerized information Computerized drug information systems that maintain medication profiles for every patient have been developed. Some of these systems are quite sophisticated and include modules to identify drug interactions or contraindications. Some systems include a formulary for every diagnosis, presenting the prescriber with a number of indicated drugs from which to choose, including dosage schedule and quantity. If this is done, regular updating is needed using the sources of information described here. In many parts of the world access to the hardware and software needed for this technology will remain beyond the reach of individual prescribers. In countries where such technology is easily accessible it can make a useful contribution to prescribing practice. However, such systems cannot replace informed prescriber choice, tailored to meet the needs of individual patients. Pharmaceutical industry sources of information Information from the pharmaceutical industry is usually readily available through all channels of communication: verbal, written and computerized. Industry promotion budgets are large and the information produced is invariably attractive and easy to digest. However, commercial sources of information often emphasize only the positive aspects of products and overlook or give little coverage to the negative aspects. This should be no surprise, as the primary goal of the information is to promote a particular product. This means that the information is provided through a number of media: medical representatives (detail men/women), stands at professional meetings, advertising in journals and direct mailing. Often over 50% of the promotional budget of pharmaceutical companies in industrialized countries is spent on representatives. Studies from a number of countries have shown that over 90% of physicians see representatives, and a substantial percentage rely heavily on them as sources of information about therapeutics. However, the literature also shows that the more reliant doctors are on commercial sources of information only, the less adequate they are as prescribers. In deciding whether or not to use the services of drug representatives to update your knowledge on drugs, you should compare the potential benefits with those of spending the same time reading objective comparative information. If you do decide to see representatives, there are ways to optimize the time you spend with them.
It provides information about the planned medication to other actors such as the Community Pharmacy Manager generic gasex 100caps amex. It provides information about the prescribed medication to other actors such as the Community Pharmacy Manager buy gasex mastercard. It provides this information to other actors such as the Community Pharmacy Manager order gasex 100caps visa. It provides the dispensed medication of the patient to other actors such as the Community Pharmacy Manager purchase discount gasex online. The 355 Administered Medication Repository provides the administered medication of the patient to other actors such as the Community Pharmacy Manager. Implementation scenarios in real-world projects will most likely differ from the topology of 360 having exactly three repositories. Querying actors may be: 375 • Medication Treatment Planner • Prescription Placer • Pharmaceutical Adviser • Medication Dispenser • Medication Administration Performer 380 This transaction provides a set of specialized queries: 17 Rev. These are: • FindMedicationTreatmentPlans (if “Medication Treatment Planning” Option is 385 supported) Find planned medication documents and their related documents • FindPrescriptions Find prescription documents and their related documents • FindDispenses 390 Find dispense documents and their related documents • FindMedicationAdministrations Find administered medication documents and their related documents • FindPrescriptionsForValidation Find prescriptions and their related documents containing Prescription Items ready to 395 be validated • FindPrescriptionsForDispense Find prescriptions and their related documents containing Prescription Items ready to be dispensed The last two queries can be parameterized to … 400 1. In this case the query returns all prescriptions which are in the requested status (e. In this model, generally speaking, information is generated by a placer type actor (Medication Treatment Planner, Prescription Placer, Pharmaceutical Adviser, Medication Dispenser or Medication Administration Performer) 485 and stored by means of a repository type actor. This approach may apply to health systems where information is accessed on a centralized basis and, therefore, is made available to a collective of potential users (such as prescriptions available for dispense in any community pharmacy). The alternative approach is the direct push model where information is sent directly to the actor 490 intended to use it (e. This model focuses on direct communication instead of availability to (more) potential users. The current revision of the Integration Profile covers use cases relying on the publish & pull model only. Note: The optional initial planning and the documentation of the administration of the medication would be eligible to be included in this scenario steps, but are not represented here in order to limit complexity. The practitioner examines John and prescribes the active substance 545 “Fenoterol” in his “Prescription Placer” software. Since prescriptions are available to a wide range of pharmacies, John picks the pharmacy closest to his office. The pharmacist asks for John’s health card in order to retrieve the patient’s active prescriptions. The information on the pharmaceutical advice is electronically sent to the “Pharmaceutical Advice Repository”. He consults his inventory and picks Berotec® which is in the range of prices approved by the health system. He gives out this medicine to the patient and records the transaction in the “Medication Dispenser”. The information on the medication dispensed is electronically sent to 555 the “Dispensed Medication Repository”. The physician examines John and decides to add John to a drug-substitution programme on Methadone. He adds “Methadone” to the planned medications in his “Medication Treatment Plan Planner” software. The new planned medication “Methadone” is electronically sent to the “Medication Treatment Plan Repository”. As a prescription is required for getting this medication from the pharmacy, the physician also 605 prescribes “10mg Methadone” as repeatable prescription in his “Prescription Placer” software. Regulations according to the drug-substitution therapy require the medication to be taken by the patient directly in the dispensing pharmacy so that the pharmacist witnesses the intake and is able to electronically document the administration. The patient drinks the Methadone solution in front of the pharmacist and the pharmacist documents the administration act in his “Medication Administration Performer” software. The documentation of the administration is electronically sent to the “Administered Medication 615 Repository”. This requires the support of the “Provision of Medication List” Option at the Community Pharmacy Manager. The practitioner examines John and wants to prescribe the active substance “Fenoterol” in his “Prescription Placer” software. To ensure that there are no conflicts between the new medication and the patient’s current medication status, the physician requests the Medication List. The Community Pharmacy Manager queries the registry for the on-demand document entry of the Medication List to this patient. Either the found or just created Document Entry will be returned to the calling Prescription Placer. Once the document is assembled it returns the document to the calling Prescription Placer. If the “Persistence of Retrieved Documents” Option is used the returned document is also provided and registered in 650 the registry/repository backend. The physician performs another physical examination to confirm the improved health status and decides to amend the treatment with Fenoterol by either changing it (e. The physician issues a Community Pharmaceutical Advice document to record the command and instructs the patient. After getting a chemotherapy medication administered by a nurse and the administration act was fully documented, the patient goes home, but since he felt very bad, she returns to the outpatient department of the hospital and faints while waiting for her oncologist. After arrival, the oncologist performs a physical examination and recognizes a potential relation 710 of this issue to the just administered chemotherapy medication. The oncologist issues a Community Pharmaceutical Advice document related to the documented administration to document this potential medication-related issue. The planning, prescription and dispense process of real-world projects involves several parties acting in the different abstract roles (Medication Treatment Planner, Prescription Placer, Pharmaceutical Adviser, Medication Dispenser, Medication Administration Performer). The Medication Treatment Planner and Prescription Placer roles are usually taken by physicians; the 730 Pharmaceutical Adviser and Medication Dispenser role is usually taken by pharmacists; the Medication Administration Performer role may be taken by physicians or nurses, which all are usually organized in different organizations. This results in a wide variety of implementation requirements together with the need of not only organizational but also technical separation of systems. Physicians may want to store plans, 735 prescriptions and administrations in another repository other than where pharmacists store dispenses or nurses store administrations. Any political intended separation has to be technically bridged at one point otherwise a common 740 planning, prescription and dispense process cannot be established. To minimize the possible points of contact between the domains the Community Pharmacy Manager was introduced. On the other hand a simple scenario like this may not be applicable to scenarios in reality, where organizational, strategical or political reasons require more separation between the participating parties (physicians, pharmacists). Note: The “Administration” level (Medication Administration Performer) aligns with the principle as shown and is not included in this scenario in the interest of simplicity. Group of Medication Group of Pharmaceutical Treatment Plan Placers Advisers Community Pharmacy Pharmaceutical Manager Pharmaceuticaladvicer Medication Pharmaceuticaladvicer Pharm. Plan Medication Repository Plan PlacerTreatment Planner Group of Prescription Placers Dispnser Prescription Dispenser Prescriptionplacer Medication Disp. Each group stores its documents in its own dedicated repository, but all use the same document registry of the affinity 22 765 domain. It applies appropriate filtering according to the semantic question “Ready for prescription” (i. Group of Medication Group of Pharmaceutical Treatment Plan Placers Advisers Medication Community TreatmentMedication Pharmacy Pharmaceutical Plan PlacerTreatmentMedication Manager Pharmaceuticaladvicer Plan PlacerTreatment Pharmaceuticaladvicer Pharm. Then the system or the human operator performs the selection of medication treatment plans to prescribe and proceeds with step 4. Plan Repository Group of Prescription Placers Prescription Prescriptionplacer Dispnser Prescriptionplacer Dispenser Placer Medication Disp. Then it retrieves all these documents from the appropriate document 810 repositories. Then the system or the human operator performs validation and proceeds with step 7. Then it retrieves all these documents from the appropriate 840 document repositories. Its main benefit is that a minimum of technical contact is required between the participating parties of such a system (physicians, pharmacists) for 870 achieving technical interoperability. Such utmost separation might be an organizational, strategical or political requirement. Note: The optional “Plan” level (Medication Treatment Planner) and the “Administration” level 875 (Medication Administration Performer) align with the principle as shown and are not included in this scenario in the interest of simplicity.
Chart notes: The protected brand segment includes products that are over two years old and have not yet faced generic competition order gasex 100 caps with visa. Protected brand growth is split by volume and price in Chart 2 order 100 caps gasex visa; only the contribution from volume is shown here cheap gasex 100 caps with mastercard. This analysis does not separate mix change cheap gasex 100 caps with amex, or shifts to more or less expensive brands, from volume and price. They are often initiated by specialists, and include treatments for cancer and other chronic conditions. Chart notes: Oncology market defned as L1 antineoplastics, L2 cytostatic hormone therapies, V3C radio pharmaceuticals, denosumab, lenalidomide, pomalidomide, and aldesleukin. Chart notes: New patients are defned as new to brand prescriptions for Daklinza, Incivek, Victrelis, Sovaldi, Olysio, Harvoni, Technivie and Viekira Pak. Chart notes: Multiple sclerosis market is defned as interferons, dimethyl fumarate, fngolimod, glatiramer, natalizumab, and terifumonide. Other diabetes category includes sulphonylureas, biguanides, glucosidase inhibitors, glinides, insulin devices, glucugon, and combination therapies. Net sales and growth values denote company recognized revenue after discounts, rebates and other price concessions. Existing Mechanism refers to subsequent products with existing mechanisms of action for an indication. All indications are for metastatic disease and second line or lower treatment sequence unless otherwise indicated. Chart notes: Averages are calculated among paid claims where a co-pay card is used as the secondary payer and normalized to 30 days. Chart notes: Cost exposure is calculated using paid and reversed claims where a coupon is the secondary payer and excludes instances in which a coupon is the primary payer, normalized to 30 days. Chart notes: Out-of-pocket costs include co-pay ofsets through coupons; patient categories are defned using longitudinal data to identify deductible spending patterns or mode payer, normalized to 30 days. Chart notes: The cohort of Facility-Other includes facilities for alternative medicine, elder care, labs, correctional programs, and workplace wellness. All facilities from the Healthcare Organization services ofering included except veterinarian facilities. Chart notes: The top states with a healthcare provider gap are defned by the percent of population in healthcare professional s gap areas as compared to the overall state population. Chart notes: Forecast growth reported on an invoice basis excluding of-invoice discounts and rebates. The prices do not refect of-invoice price concessions that reduce the net amount received by manufacturers. The approximately 640,000 facilities includes single ownership relationships and multiple purchasing, distribution, academic and alliance relationships. Formulary measures include tiered co-pay beneft designs, prior authorization restrictions, and often result in non- preferred prescriptions being rejected or switched at the pharmacy. It uses econometric modeling from the Economist Intelligence Unit to deliver in-depth analysis at a global, regional and country level about therapy class dynamics, distribution channel changes and brand vs. It includes information about product launches in each country, including the indication and price at the time of the initial launch, and covers more than 300, 000 launches. It includes information about the commercial, scientifc and clinical features of the products, analyst predictions of future performance, and reference information on their regulatory stage globally. Page 39 Appendix Top Therapeutic Classes by Prescriptions Dispensed Prescriptions Mn 2011 2012 2013 2014 2015 Total U. Includes prescription-bound products including insulins dispensed through chain and independent pharmacies, food store pharmacies, mail service pharmacies, and long-term care facilities. Prescriptions are not adjusted for length of therapy; 90-day and 30-day prescriptions are both counted as one prescription. Includes prescription and insulin products sold into chain and independent pharmacies, food store pharmacies, mail service pharmacies, long-term care facilities, hospitals, clinics, and other institutional settings. Table shows leading active-ingredients or fxed combinations of ingredients and includes both branded and generic products. Prescriptions for 90 days have been used to estimate 30 day prescriptions in all dispensing locations. Spending fgures also include sales into hospitals, clinics, and other institutional settings. Murray holds a Master of Commerce degree from the University of Auckland in New Zealand, and received an M. Lauren received her bachelor’s degree from James Madison University where she studied health communication. Its mission is to provide key policy setters and decision makers in the global health sector with unique and transformational insights into healthcare dynamics derived from granular analysis of information. Fulflling an essential need within healthcare, the Institute delivers objective, relevant insights and research that accelerate understanding and innovation critical to sound decision making and improved patient care. Timely, high-quality and relevant information is critical to sound healthcare decision making. Optimizing the performance of medical care through better understanding of disease causes, Insights gained from information and analysis treatment consequences and measures to should be made widely available to healthcare improve quality and cost of healthcare delivered stakeholders. Efective use of information is often complex, Understanding the future global role for requiring unique knowledge and expertise. Researching the role of innovation in health system products, processes and delivery Personal health information is confdential systems, and the business and policy systems and patient privacy must be protected. The private sector has a valuable role to play Informing and advancing the healthcare in collaborating with the public sector related agendas in developing nations through to the use of healthcare data. The logging and manufacturing processes are expected to conform to the environmental regulations of the country of origin. Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new adverse effects recognized. For these reasons the reader is strongly urged to consult the drug companies’ printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress. Sometimes, these treatment regimes involve potent and, at times, new and novel drugs. Many of these drugs are toxic or possibly fatal if administered incorrectly or in overdose. It is therefore very important to be able to carry out drug calculations correctly so as not to put the patient at risk. These calculations have to be performed competently and accurately, so as not to put not only the nurse but, more importantly, the patient at risk. This book aims to provide an aid to the basics of mathematics and drug calculations. It is intended to be of use to nurses of all grades and specialities, and to be a handy reference for use on the ward. The concept of this book arose from nurses themselves; a frequently asked question was: ‘Can you help me with drug calculations? This was very well received, and copies were being produced from original copies, indicating the need for such help and a book like this. The content of the book was determined by means of a questionnaire, sent to nurses asking them what they would like to see featured in a drug calculations book. As a result, this book was written and, hopefully, covers the topics that nurses would like to see. Although this book was primarily written with nurses in mind, others who use drug calculations in their work will also find it useful. This book can be used by anyone who wishes to improve their skills in drug calculations or to use it as a refresher course. Before you start, you should attempt the pre-test to assess your current ability in carrying out drug calculations.