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    Type II cells produce surfactant order citalopram 40mg without a prescription, a lipoprotein sels and develop collateral circulation when normal vessels substance that decreases the surface tension in the alveoli and are blocked (eg order citalopram 20mg line, in pulmonary embolism) discount citalopram 20 mg. The alveoli also contain macrophages that helps to keep lung tissue alive until circulation can be help to protect and defend the lungs. The lungs are encased in a membrane called the pleura, Capillaries in the lungs are lined by a single layer of ep- which is composed of two layers. Once thought to be a pas- adheres to the surface of the lung, is called the visceral sive conduit for blood, it is now known that the endothelium pleura. The outer layer, which lines the thoracic cavity, is performs several important functions. The potential space between the rier that prevents leakage of water and other substances into layers is called the pleural cavity. Second, it participates in the transport of respi- allows the layers to glide over each other and minimizes ratory gases, water, and solutes. The lungs expand and relax in response to changes in pres- Nitric oxide also regulates smooth muscle tone in the sure relationships (intrapulmonic and intrapleural pressures). Elastic tissue in the bronchioles and alveoli allows the lungs When pulmonary endothelium is injured (eg, by endotoxins to stretch or expand to accommodate incoming air. This abil- or drugs such as bleomycin, an anticancer drug), these func- ity is called compliance. The respiratory center is stimulated orders may be caused by agents that reach the system through primarily by increased CO2 in the fluids of the center. A lesser tract secretions, asthma, and other chronic obstructive pul- stimulus to the respiratory center is decreased oxygen in monary diseases). The cough reflex is especially important edema, acute respiratory distress syndrome) is associated because it helps protect the lungs from foreign particles, air with the release of histamine and other biologically active pollutants, bacteria, and other potentially harmful substances. These mediators often A cough occurs when nerve endings in the respiratory tract cause inflammation and constriction of the airways. Once injured, cellular functions are impaired (eg, decreased mu- Musculoskeletal System cociliary clearance). Common signs and symptoms of respira- tory disorders include cough, increased secretions, mucosal The musculoskeletal system participates in chest expansion congestion, and bronchospasm. Normally, the diaphragm and external inter- treatment may lead to cell necrosis or respiratory failure. The abdominal and internal intercostal muscles are the muscles of expiration. DRUG THERAPY In general, drug therapy is more effective in relieving respira- SUMMARY tory symptoms than in curing the underlying disorders that cause the symptoms. Major drug groups used to treat respi- Overall, normal respiration requires: ratory symptoms are bronchodilating and anti-inflammatory 1. Ventilation, in turn, requires decongestants, antitussives, and cold remedies (see Chap. Adequate diffusion of O2 and CO2 through the alveolar– capillary membrane. Where does the exchange of oxygen and carbon dioxide and pressure differences between gases on each side of occur? What are common signs and symptoms of respiratory dis- orders for which drug therapy is often used? Approximately 500 mL of air is inspired and expired with a normal breath (tidal volume); deep breaths or sighs occur 6 to 10 times SELECTED REFERENCES per hour to ventilate more alveoli. Pathophysiology: Concepts of altered health tives, and opioid analgesics, slow respiration. Discuss reasons for using inhaled drugs when istics of asthma and other bronchoconstrictive possible.

    All of these drugs may be more effective if taken ✔ A low-fat diet is needed buy citalopram 20mg on-line. This is often the first step in treat- in the evening or at bedtime cheap 20mg citalopram with mastercard, probably because more cho- ing high cholesterol or triglyceride levels discount 40 mg citalopram with amex, and may be pre- lesterol is produced at nighttime and the drugs block cho- scribed for 6 months or longer before drug therapy is lesterol production. When drug therapy is prescribed, the diet should ✔ Take fenofibrate with food; food increases drug ab- be continued. In addition, eat- ✔ Take gemfibrozil on an empty stomach, 30 minutes be- ing a bowl of oat cereal daily can help lower cholesterol by fore morning and evening meals. Diet counseling by a dietitian or nutritionist can ✔ Take immediate-release niacin with meals to decrease be helpful in developing guidelines that fit your needs and stomach upset; take timed-release niacin without regard lifestyle. These drug forms ing weight (raises HDL, lowers LDL, lowers triglycerides); should not be taken dry. People If taking other drugs, take them 1 hour before or 4 to with a personal or family history of dyslipidemia or other 6 hours after cholestyramine or colestipol. As with adults, initial management con- John Dwyer, 55 years of age, visits his primary health care sists of diet therapy (for 6 to 12 months) and management of provider. His cholesterol level (306 mg/dL) has been elevated for any secondary causes, especially with younger children. His health care provider prescribes niacin (nico- additional risk factors or primary familial hypercholes- tinic acid) to reduce his cholesterol level. Describe the data you terolemia (type IIa), however, these measures are not likely will collect and how you will use it to individualize a teaching plan. CHAPTER 58 DRUGS FOR DYSLIPIDEMIA 859 Dyslipidemic drugs are not recommended for children • With pravastatin, initiate therapy with 10 mg/day. Lovastatin recently received • With simvastatin, initiate therapy with 5 mg/day and Food and Drug Administration approval for use in children monitor closely. Oral dosing recommendations are 10 to Fibrates are excreted mainly by the kidneys and therefore 20 mg daily with a meal, initially, and increasing up to accumulate in the serum of clients with renal impairment. Other statin drugs are not recommended in impairment in clients whose baseline serum creatinine levels children younger than 18 years of age, and the safety and ef- were higher than 2 mg/dL. A different type of dyslipidemic fectiveness of the fibrates have not been established. Fenofibrate is con- acid sequestrants are considered the drugs of choice, and traindicated in clients with severe renal impairment, and the niacin also may be used. Recommendations for oral dos- effects on renal function and triglyceride levels should be ing of cholestyramine are 240 mg/kg/day to be given in evaluated before dosage is increased. Niacin dosage is 55 to 87 mg/kg/d to be given orally 3 to 4 times a day with or just after meals. The long-term consequences of dyslipidemic drug therapy in Use in Hepatic Impairment children are unknown. Statins are metabolized in the liver and may accumulate in clients with impaired hepatic function. They are contraindi- Use in Older Adults cated in clients with active liver disease or unexplained el- evations of serum aspartate or alanine aminotransferase. As with younger adults, diet, exercise, and weight control They should be used cautiously, in reduced dosages, for should be tried first. When drug therapy is required, statins clients who ingest substantial amounts of alcohol or have a are effective for lowering LDL cholesterol and usually are history of liver disease. Liver function tests are recommended before starting a Niacin and bile acid sequestrants are effective, but older statin, at 6 and 12 weeks after starting the drug or increasing adults do not tolerate their adverse effects very well. Monitor clients who have in- menopausal women, estrogen replacement therapy increases creased serum aminotransferases until the abnormal values HDL cholesterol.

    Citalopram
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