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•• determine if antibiotic therapy is indicated or if observation can be used. •• determine whether the patient has prescription coverage and if the desired antibiotic is covered by their insurance. Care plan development. •• select analgesic therapy that will provide optimal pain relief and appropriate adjunctive therapies to relieve symptoms. •• if appropriate, select antibiotic therapy that is likely to be effective and safe (see figure 72–3). •• select an optimal antibiotic dose (see table 72–4) and an appropriate duration of treatment based on patient age and severity of illness. •• discuss potential adverse effects and how to manage them. •• discuss importance of medication adherence to treat infection and clinical symptoms. Follow-up evaluation. •• reevaluate patient if symptoms persist beyond 5 days or worsen at any time. •• if recurrent infections or chronic sinusitis develop, refer to a specialist. Outcome evaluation antibiotics relieve symptoms of streptococcal pharyngitis within 3 to 5 days, and patients can return to work or school if improved after the first 24 hours of therapy.

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Ann palliat med. 2012;1:115–120. 34. Affronti ml, bubalo j. Palonosetron in the management of chemotherapy-induced nausea and vomiting in patients receiving multiple-day chemotherapy. Cancer manag res. 2014:6;329–337. 35. Navari rm. Management of chemotherapy-induced nausea and vomiting. Focus on newer agents and new uses for older agents. Drugs. 2013;73:249–262. 36. Dos santos lv, souza fh, brunetto at, et al. Neurokinin-1 receptor antagonists for chemotherapy-induced nausea and vomiting. A systematic review. J natl cancer inst. 2012;104:1280–1292.

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1986;256:1449–1455. 37. Center for substance abuse treatment. Incorporating alcohol pharmacotherapies into medical practice. Treatment improvement protocol (tip) series 49. Hhs publication no. (sma) 09-4380. Rockville, md. Substance abuse and mental health services administration. 2009. 38. Petrakis il, poling j, levinson c, et al. Naltrexone and disulfiram in patients with alcohol dependence and comorbid psychiatric disorders. Biol psychiatry. 2005;57:1128–1137. 39. Mattick rp, kimber j, breen c, davoli m. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane database syst rev. 2008;(3). Cd002207. 40. Gray km, carpenter mj, baker nl, et al. A double-blind randomized controlled trial of n-acetylcysteine in cannabisdependent adolescents. Am j psychiatry. 2012;169(8):805–812. 41. Mcrae al, brady kt, carter re. Buspirone for treatment of marijuana dependence.

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Identify treatment goals for the patient. Describe nonpharmacologic and pharmacologic treatments that are available for the patient. Pharmacotherapy or starting medications early on an individual patient basis. 25 nonpharmacologic therapy »» lifestyle modifications nonpharmacologic therapy, including education and lifestyle modifications such as exercise, should be started early and continued throughout treatment for pd. These treatments may improve adls, gait, balance, and mental health. The most common interventions include maintaining good nutrition, physical condition, and social interactions. 1,10. Coordinated care with an optometrist/ophthalmologist, dentist, dietician, physical therapists, speech therapist, and social worker is needed to maximize patient outcomes. Each of these specialists plays a specific role in the treatment team (table 33–1). 30 surgery as patients develop inadequate control of motor symptoms despite medical treatment, surgery with deep brain stimulation (dbs) may be considered. This procedure electrically stimulates the subthalamic nucleus or globus pallidus interna. Dbs may significantly reduce motor symptoms and complications and improve qol compared to medication management. Trials indicate that targeting the subthalamic nucleus is preferred when a decrease in pd medication use is desired while targeting the globus pallidus may be better suited when dyskinesias are present. 31,32 these surgeries are not without risk and are generally table 33–1  specialist care for patients with pd provider reason for referral dentist pd medications may decrease saliva flow and increase the risk of dental caries dietician recommend appropriate caloric intake, meal selection, and protein consumption which may. •• improve constipation and nausea •• decrease weight loss and aspiration •• minimize erratic drug absorption speech therapist improved swallowing, articulation, and force of speech physical therapy improve strength, activity, sleep quality and reduce fall risk may provide neuroprotection occupational educate on adaptive environment of home, therapist specialized clothing, and personal training to evaluate and maximize. •• independence •• safety •• adls •• handwriting •• driving ability •• use of communication software social worker arrange for community assistance programs increase engagement in family activities, and minimize conflict through family counseling nutt jg, wooten gf. Diagnosis and initial management of parkinson’s disease. N engl j med. 2005;353:1021–1027. 1 anonymous. Drugs for parkinson’s disease. Treat guidel med lett.