"Order baycip 500 mg, medications 3605".

W. Rasul, M.B. B.A.O., M.B.B.Ch., Ph.D.

Co-Director, Chicago Medical School of Rosalind Franklin University of Medicine and Science

In each question with five alternatives, of which one is correct, there are four alternatives that are incorrect. If deductive reasoning is used, the choices can be viewed as having possibilities of being correct. The elimination of wrong choices increases the odds that a student will be able to recognize the correct choice. Even if the correct choice does not become evident, the probability of guessing correctly increases. Eliminating incorrect choices on a test can result in choosing the correct answer. Answering questions based on what is incorrect is difficult for many students because they have had nearly 20 years of experience taking tests with the implied assertion that knowledge can be displayed only by knowing what is correct. It must be remembered, however, that students can display knowledge by knowing something is wrong, just as they can display it by knowing something is right. They are defeated before they begin because either they cannot get through all the material, leaving areas unstudied, or they race through the material so quickly that they cannot benefit from the activity. It is generally more efficient for the student to use materials already at hand-that is, class notes, one good outline to cover and strengthen all areas and to quickly review the whole topic, and one good text as a reference for complex material that requires further explanation. Although some of the material may seem irrelevant, the more you learn now, the less you will have to learn later. Also, do not let the fear of the test rob you of an important part of your education. If you study to learn, the task is less distasteful than studying solely to pass a test. You should not be selective by studying perceived weak areas and ignoring perceived strong areas. Understanding the connections among these points allows for longer retention and aids in those situations when guessing strategies may be needed. Studying up to the last moment will increase your anxiety and cause potential confusion. Adjectives and adverbs can completely change the meaning of questions-pay close attention to them. Remember in multiple choice questions, there is one correct answer and there are four distractors, or incorrect answers. Many students think that they must always start at option A and make a decision before they move to option B, thus forcing decisions they are not ready to make. Your first decisions should be made on those choices you feel the most confident about. If you believe a choice is partially incorrect, tentatively eliminate that choice. One method is to place a minus sign next to the choices you are certain are incorrect and a plus sign next to those that potentially are correct. Finally, place a zero next to any choice you do not understand or need to come back to for further inspection. Do not feel that you must make final decisions until you have examined all choices carefully. When you have eliminated as many choices as you can, decide which of those that remain has the highest probability of being correct. If you do not know the answer, eliminate as many choices as possible and choose reasonably. There are two general types of multiple choice questions, including (1) the more traditional single answer type question in which the candidate must decide one of five choices (a, b, c, d, or e) and (2) the combined response ("K" type) multiple choice question, which is shown next. You should use all of your allotted time; if you finish too early, you probably did so by moving too quickly through the test. Read each question and all the alternatives carefully before you begin to make decisions. You would be amazed at how many students make mistakes in tests simply because they have not paid close attention to the directions. It is not advisable to leave blanks with the intention of coming back to answer questions later. If you feel that you must come back to a question, mark the best choice and place a note in the margin. Generally speaking, it is best not to change answers once you have made a decision.

Ciprofloxacin and raloxifene have also been shown to interact with levothyroxine when administered together. Separate administration times by 6 hrs for ciprofloxacin and by 12 hrs for raloxifene. Euthyroid patients receiving oral replacement therapy have become hypothyroid after concomitant administration of bile acid sequestrant therapy. It appears that bioavailability is reduced as a result of administering these agents at close dosing intervals. It is recommended that at least 6 hrs pass before administration of a bile acid sequestrant. It would be preferable to select another nonbile acid sequestrant when clinically possible. Cost versus benefit is critical to the decision of choosing to screen entire populations, and screening for thyroid disease has been shown to not be cost effective in the general healthy population. Screening recommendations from major medical groups has been conflicting; however, none of them recommend the routine screening of young, healthy adults. The average adult maintenance dose is 75 to 150 mcg/ day, which has been shown to be 1. Elderly or chronically ill patients require an average dose of 50 to 100 mcg/day, which is 25 to 50 mcg/day less than otherwise healthy adults of the same height and weight. Patients receiving amiodarone therapy are at risk of developing hypothyroidism especially if there is underlying thyroid disease. Amiodarone delivers high levels of iodine to the system contributing to subclinical or clinical hypothyroidism more often. Some patients without underlying thyroid disease may experience changes in thyroid function, while patients with underlying disease are more likely to present with hypothyroidism. Patients should be monitored closely for thyroid function when beginning amiodarone therapy. Over replacement can result in symptoms of hyperthyroidism and lead to bone mineral density loss, osteoporosis, and palpitations. Serum T4 concentrations can be useful when nonadherence is suspected, but these concentrations are not routinely needed to monitor levothyroxine therapy. Levothyroxine and desiccated thyroid are both oral thyroid hormone preparations that are indicated for primary hypothyroidism. Hashimoto thyroiditis is an autoimmune hypothyroid disorder and is unlikely as the patient already has a history of Graves hyperthyroidism. Factitious hyperthyroidism is the result of an overdose of thyroid hormone, while the clinical symptoms may suggest this; her medical history rules it out. The addition of a synthetic thyroid hormone like levothyroxine has no place in thyroid storm; it will not induce negative feedback; on the contrary, it would contribute to the hyperthyroid state. They are ineffective for weight reduction in euthyroid patients and may produce serious or even life-threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects. Extrinsic obstruction, as from hematoma, inflammatory bowel disease, or accidental surgical ligation C. The serum sodium concentration falls below normal from intracellular fluid shifting and dilution. Hyperkalemia occurs due to the accumulation of organic acids (metabolic acidosis). If potassium intake is not restricted or body potassium is not removed, hyperkalemia results. Without treatment, hyperkalemia may lead to neuromuscular depression and paralysis, impaired cardiac conduction, arrhythmias, respiratory muscle paralysis, cardiac arrest, and ultimately death. This phase begins when urine output rises above 500 mL/day-typically after several days of oliguria. A rise in urine output or a "diuretic response" may not be seen in non-oliguric patients.

Documentation of the results of a therapeutic intervention is required if the prescription or medication order is changed. The name of the prescriber, date of communication, issues discussed, and resolution should be included in the documentation. This information should be kept for the same period as the prescription or medication order. If the pharmacist feels that, in his or her professional judgment, an order is inappropriate and could harm the patient, the pharmacist should not process the order. If, after a therapeutic intervention, the pharmacist believes the order is still inappropriate, the guidelines of the institution and professional judgment should be followed. An environment that limits distractions and disruptions will assist in increasing the accuracy of this process. Automation and the use of pharmacy technicians allow the pharmacist to oversee these functions. The time saved allows the pharmacist greater time for patient-focused activities, such as counseling and patient education. Generic substitution statutes, as well as formulary and therapeutic substitution policies, might provide direction in product selection. Selection of the proper package or container is required to ensure product stability, to promote patient compliance, and to comply with legal requirements. Auxiliary and cautionary labels ensure proper medication use, storage, and compliance and reinforce information provided during counseling. The pharmacist is required to maintain prescription files and records in accordance with standards of sound practice and statutory requirements. State prescription monitoring programs may require pharmacists to collect and provide information regarding the use of controlled substances. A patient profile contains patient demographic information and a complete chronological record of all medication use and services provided in the delivery of pharmaceutical care. Any known allergies, sensitivities, or history of idiosyncratic reactions to previous medications d. Clinical condition(s) (to help assess the appropriateness of the medication and to prevent drug­disease interactions) f. Occupation (to detect conditions associated with a particular occupation and to help determine if the patient will be able to comply with the regimen) h. Nonprescription medication use (to prevent drug interactions, to assess medication effectiveness, and to detect possible adverse effects) 2. In addition, the patient profile should contain the following information from each prescription or medication order: a. The dispensing of medication requires that the pharmacist verify that patients have the necessary knowledge and ability to adhere to the prescribed treatment. The pharmacist may need to advise patients regarding the proper dosage, appearance, and name of the medication. Information about the route of administration, instructions for use, duration of use, and the reason the product was prescribed may also be needed. As appropriate, the pharmacist should advise patients how to take the medication. The pharmacist should ensure that patients are aware of the possible adverse effects associated with a medication. This will help patients recognize common adverse effects and not be overly concerned with those that are rare. This will help patients focus on those adverse effects that are severe and not those that are inconsequential. This will help patients deal with possible adverse effects in the appropriate manner. The pharmacist should counsel patients on how to store medications properly to ensure stability and potency.

The total administered dose of chemotherapy may be rounded up or down within a range of 5% of the actual calculated dose. Compatibility Incompatible with dextrose solutions (or any solution) containing less than 0. Storage and Stability Reconstituted vials are stable for 20 hours at room temperature. Intact vials of cisplatin for injection and powder for injection should be stored at room temperature and protected from light. Storage and Stability Unopened vials of carboplatin are stable for the life indicated on the package when stored at controlled room temperature and protected from light. The protocol permits use of the Cockcroft-Gault formula to estimate creatinine clearance. However, in markedly obese patients, the Cockcroft-Gault formula will tend to overestimate the creatinine clearance. The actual body weight (in kilograms) will be utilized in the Cockcroft-Gault formula. However, if the calculated creatinine clearance exceeds an upper limit for creatinine clearance, as specified below, then this ceiling value for creatinine clearance, rather than the calculated creatinine clearance, will be used in the Calvert formula to calculate the dose of carboplatin. In this case, the measured creatinine clearance can be used to calculate the carboplatin dose in the Calvert formula. Toxicities Myelosuppression, nausea and vomiting, peripheral neuropathy, nephrotoxicity, hepatotoxicity, electrolyte imbalance, hypomagnesemia, hypocalcemia, and allergic reactions. Availability Intravenous etoposide is commercially available (VePesid Injection from Bristol-Myers Oncology) in ampules containing 1000 mg/50 ml, 500 mg/25 ml, 150 mg/7. It is now available from generic sources and is available in a 20 mg/ml, 1 gm vial. Storage and Stability Unopened vials are stable at room temperature for 24 months. Administration Administer the diluted infusion solution at a maximum rate of 500 mg/hr; an administration that is too rapid may be associated with hypotension. Toxicities Myelosuppression, anorexia, nausea and vomiting, headaches, alopecia, phlebitis, fever, and peripheral neuropathy may occur. Anaphylaxis, somnolence and fatigue, rash, pigmentation, urticaria and pruritis may also occur. Treatment with hormones or other chemotherapeutic agents may not be administered except for steroids given for adrenal failure; hormones administered for non-disease-related conditions. Alliance Policy Concerning the Use of Growth Factors the following guidelines are applicable unless otherwise specified in the protocol: 12. If filgrastim/pegfilgrastim or sargramostim are used, they must be obtained from commercial sources. In addition to a baseline scan, confirmatory scans should also be obtained 4 weeks following initial documentation of objective response. Target lesions should be selected on the basis of their size (lesions with the longest diameter) and their suitability for accurate repetitive measurements (either by imaging techniques or clinically). Where response is the primary endpoint, changes in tumor measurements must be confirmed by repeat studies performed no less than 4 weeks after the criteria for response are first met. Patients having a documented response with no reconfirmation of the response will be listed with stable disease. Measurements are not required and these lesions should be followed as "present" or "absent. If tumor markers are initially above the upper normal limit, they must normalize for a patient to be considered in complete clinical response. Although a clear progression of non-target lesions is exceptional, in such circumstances, the opinion of the treating physician should prevail and the progression status should be confirmed later on by the study chair. The cytological confirmation of the neoplastic origin of any effusion that appears or worsens during treatment when the measurable tumor has met criteria for response or stable disease is mandatory to differentiate between response or stable disease (an effusion may be a side effect of the treatment) and progressive disease. For example: Conditions that may define early death include patients that have died without documentation of disease progression and before it was time to conduct the first tumor reassessment.