Pleural effusions are defined as an accumulation of fluid in the pleural space. Treatment is generally palliative. Intrapleural administration of talc, bleomycin, and doxycycline are effective sclerosing agents for treatment of recurrent, symptomatic pleural effusions. Although the most cost-effective agent has not been determined, doxycycline is an inexpensive alternative to bleomycin, and may have fewer adverse effects than talc.
A total of 129 products (98 chemical entities) were reviewed. Fifty-four (42 percent) of the products examined contained sorbitol. The frequency of sorbitol presence by liquid type was: solutions (33 percent), suspensions (43 percent), syrups (59 percent), elixirs (43 percent), concentrates (67 percent), drops (33 percent), tinctures (0 percent), and emulsions (0 percent). The percentage of listings indicating the presence of sorbitol was: manufacturer's product information (79 percent), Facts and Comparisons (52 percent), and AHFS Drug Information 91 (13 percent). Only three of the 54 products had the exact sorbitol content stated in any source.
Some basic principles to consider in giving medications to patients receiving enteral nutrition include: 1. If the patient is able to take medication by mouth, this is the preferred route. 2. Liquid medications are the preferred dosage form. 3. The use of oral medications that are not meant to be crushed for enteral tube administration should be avoided. 4. For individual doses of most medications, the tube should be flushed with at least 30 ml of water before and after administration of medications. 5. Highly concentrated solutions should be diluted with 60 ml of water. 6. When several medications are to be administered to the same patient, all medications should be delivered separately and the tube flushed with at least 5 ml of water after each dose. 7. Medications should not be added directly to the feeding formulation. 8. Drug-nutrient interactions should be considered. 9. GI side effects are the most common adverse effects that occur with enteral feedings, and treatment depends on the cause.
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