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censorship argumentative essay 1994;330:1253. Ffrom martin m, et al. N engl j med 2005;325:2302. Gfrom green mc, et al. J clin oncol 2005;23:5983. Hfrom bonadonna g, et al. N engl j med. 1976;294:405. Ifrom fisher b, et al. N engl j med. 1989;32:473. Jfrom levine mn, et al. J clin oncol. 1998;16:2651. Kfrom citron, et al. J clin oncol. 2003;21;1431. Lfrom taxol (paclitaxel) product information. Bristol-myers squibb, april 2003.

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csassignmenthelp com •• obtain a history of prescription and over-the-counter medications and dietary supplements. Verify patient allergies and intolerances. •• review available diagnostic tests (eg, serologic testing, urea breath test, stool antigen assay, endoscopy) to determine etiology of peptic ulcer. For 72 hours (because most rebleeding occurs during this time) followed by oral ppi therapy. Three-day ppi infusion therapy has been shown to be as effective as twice-daily iv ppi therapy. 36 »» treatment of refractory ulcers refractory ulcers are defined as ulcers that fail to heal despite 8 to 12 weeks of acid suppressive therapy. 1 the presence of refractory ulcers requires a thorough assessment, including evaluation of medication adherence, extensive counseling and questioning regarding recent over-the-counter and prescription medication use, and testing for h. Pylori using a different method than previously done if testing was negative. Changing from h2ra therapy to a ppi should be considered. 15 other considerations include esophagogastroduodenoscopy (egd) with biopsy of the ulcer to exclude malignancy, h. Pylori testing (if not done initially), serum gastrin measurement to exclude zes, and gastric acid studies. Increasing the starting dose of ppi therapy may heal up to 90% of refractory ulcers after 8 weeks of therapy. 16 outcome evaluation •• obtain a baseline complete blood count (cbc). Recheck the cbc if the patient exhibits alarm signs or symptoms. •• obtain a baseline serum creatinine measurement. Calculate the estimated creatinine clearance and adjust the dose of h2ras and sucralfate if needed. •• obtain a history of symptoms from the patient. Monitor for improvements in pain symptoms (eg, epigastric or abdominal pain) daily. Therapy evaluation. •• if patient is already receiving pharmacotherapy, assess its efficacy, safety, and patient adherence. Are there any significant drug interactions?. •• if patient has been diagnosed with a peptic ulcer, determine which course of therapy is indicated. •• evaluate patient accessibility to medication (eg, formulary status, insurance coverage). Care plan development. •• recommend an appropriate regimen (tables 18–2 and 18–3) that will eradicate h. Pylori and/or heal the peptic ulcer. •• avoid drug classes to which the patient is allergic.

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