Tetanus and diphtheria booster vaccine Meningococcal vaccine Monthly self-examination; by provider every 3 years starting at age 20 Once to twice a year Talk to your provider or nurse Annually if risk factors exist Every 6-8 years if risk factors warrant Every 10 years Talk to your provider , if you attend the faculty Monthly self-exam; by provider every year Once to twice a year Talk to your provider or nurse Annually if risk factors exist Every 6-8 years if risk factors warrant Every 10 years Monthly mole self-exam; provider every year One to two times every year Talk to your provider or nurse. Every year if there are risk factors. Every 6-8 years if risk factors warrant. Every 10 years. Monthly spot self-examination; by provider every year Once to twice a year Talk to your provider or nurse.
Adult W omen’ s Health Screening Guidelines
Adult W omen’ s Health Screening Guidelines—cont’d
6SCREENING
Every 5-10 years (if you have not had a colonoscopy or sigmoidoscopy) Every 10 years Every 5-10 years with each examination (sigmoidoscopy, colonoscopy or DCBE) Every year Every 5 years (if you have not had a colonoscopy) Every 5-10 years (if you have not had colonoscopies or sigmoidoscopies) Every 10 years Every 5-10 years with each examination (sigmoidoscopy, colonoscopy or DCBE).
8SCREENING
Recommended Before entering college If risk factors are presentIf risk factors are presentEvery 10 years AnnualIf risk factors are presentEvery 10 years.
10SCREENING
Adult Treatment Panel (ATP) III Guidelines for Cholesterol Management
Determine Lipoprotein Levels Obtain complete lipoprotein profile after 9- to 12-hour fast
Classification of LDL Cholesterol (mg/dL)
Classification of Total Cholesterol (mg/dL)
Classification of HDL Cholesterol (mg/dL)
Determine Risk Category
LDL Cholesterol Goals and Cutpoints for TLC and Drug Therapy in Different Risk Categories
12SCREENING
LDL Cholesterol Goals and Cutpoints for TLC and Drug Therapy in Different Risk Categories—cont’d
Initiate TLC If LDL Is Above Goal
Consider Adding Drug Therapy
Drugs Affecting Lipoprotein Metabolism
Drugs Affecting Lipoprotein Metabolism—cont’d
14SCREENING
Question Yes No Relaxation: Do you ever use drugs or drink alcohol in 1 0 to relax or improve your self-esteem. Annoyed: Have you ever felt annoyed at being criticized 1 0 for your drinking or drug use.
CAGE Questionnaire
Cut Down: Have you ever felt like you should cut down on your drinking or drug use by 10? Eye opener: Have you ever needed an eye opener (alcohol 1 0 or drugs) after waking up to get rid of a hangover.
RAFT Questionnaire
16SCREENING
Zung Self-Rating Depression Scale
A Little Some A Good Most of the of the Part of of the
Edinburgh Postnatal Depression Scale
Edinburgh Postnatal Depression Scale Physician Instructions
Edinburgh Postnatal Depression Scale—cont’d
18SCREENING
Source: Cox, J.L., Holden, J.M., and Sagovsky, R.: Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale.
Nutritional Deficiency
20SCREENING
Geriatric Depression Scale
Simplified Nutrition Assessment Questionnaire (SNAQ)
22SCREENING
Visual Body Map
Body Mass Index
Domestic Violence Assessment
Have you ever been hit, kicked, slapped, pushed or pushed by your partner during this pregnancy. Have you ever been forced or pressured to have sex when you didn't want to?
SCREENING
Have you ever been raped or forced to engage in sexual activity against your will? Are you currently in a relationship, or have you ever been in a relationship in which you were physically hurt, threatened, or frightened?
Developing a Genetic Pedigree Chart
An accurate pedigree can be just as helpful in determining that a disease is not genetic as it is in determining that a disease is inherited in a family. It is also extremely useful in assessing the hereditary component of common cancers such as breast and colon cancer.
Common Symbols Used to Develop Genetic Pedigrees
Multiple previous partners need not be shown if they do not affect genetic assessment. If the degree of relationship is not clear from the family tree, it must be stated (e.g. third cousins) above the line of relationship.
Factual and Health Information to Include in a Pedigree
PQRSTOA Symptom Assessment27
28SCREENING
Preventive Services Recommended by the USPSTF
30SCREENING
Vision Testing
The lack of a red reflex means that the lens of the eye is opaque, which can be caused by cataracts. The clinical identification of metabolic syndrome involves three of the risk factors listed in the following table.
National Cholesterol Education Program GuidelinesAssessment and Treatment of Metabolic
Deviation of the eyes inwards or outwards is abnormal, as is abnormal elongation of the eyes (Graves disease).
Syndrome
32SCREENING
Cranial Nerve Assessment
Legal and ethical parameters should be maintained, such as informed consent, privacy and confidentiality rights. Authentic listening to the patient means that attention, skill and focus is on the patient; only necessary interruptions should be allowed.
Patient Assessment Assumptions and Guidelines
Interactions, including verbal and physical examination, should be conducted using language and actions matched to respect the patient's dignity and characteristics, such as age, mental status, education, ethnicity, culture, and religion. A qualified interpreter should be available if needed; a family member or caregiver may be needed in certain situations, such as with an elderly patient with some dementia or in certain cultures.
Documentation GuidelinesASSESS
The history interview is done with the patient clothed or draped and sitting comfortably or in bed (if in hospital).
SOAP Method
Health History
Source of Referral and Reliability of Person Giving History
Chief Complaint or Reason for Visit (RFV)
History of Present Illness or Current Health Status
Significant negatives related to symptoms and signs, such as no history of heart disease, HTN, respiratory disease. If the patient is having a routine check-up, record information about health status since the last visit, any significant findings from recent examinations and test results, relevant medications, and negatives relevant to the visit.
Past Medical History (PMH) or Past Health Status (PHS)
Medications and Therapies
38 Allergies
Family History
Personal/Social History*
Sexual History
ASSESS
Violence History
Reproductive/Gynecologic History
Guidelines
Review of Systems
40 General
Integumentary
Head, Eyes, Ears, Nose, and Throat
Neck
Chest
Breasts/Axillae
Cardiovascular
42 Peripheral Vascular
Gastrointestinal
Urinary
Male Genitalia
Female Genitalia*
Musculoskeletal
Neurologic/Psychiatric
Hematologic/Immune
Endocrine
Comprehensive Physical Examination
Overview and Systematic Approach
Equipment
General Survey
Vital Signs
Body temperature in infants and young children is higher until age 3 years; children's temperature varies up to 3°F in a day, even up to 100.8/9°F. Obtain initial radial or apical pulse for 1 minute; recheck the character of heart and pulse, including rate, rhythm, and volume/intensity, when performing cardiovascular or peripheral vascular examination.
48ASSESS
Integumentary System
Head, Eyes, Ears, Nose and Sinuses, and Throat
Inspect and palpate the lymph nodes of the face and neck for enlargement, pain or tenderness, irregular shape, or hardness.
Posterior Thorax and Lungs
Hyperresonance: Very loud, longer than resonance, lower-pitched sound not normally heard; heard over lungs with abnormalities such as emphysema or pneumothorax. Tympania: High-pitched, variable-duration, often high-pitched sound heard over gastric bubble (normal) or pneumothorax (abnormal).
Anterior Thorax and Lungs
Breasts, Axillae, and Epitrochlear Nodes
Heart
To focus on internal jugular venous pulsations, it may be necessary to lower or raise the head; the height change does not affect the findings. Find the peak of pulsations of the internal carotid artery; place a long, straight card or object in a horizontal position from the highest point of the pulsation so that it crosses a vertical ruler placed from the sternal angle to form a right angle.
Abdomen
Percussion for splenic enlargement by finding and percussing the lowest left interspace in the left anterior axillary line; when the patient is asked to inhale deeply, the percussion tone changes from tympany before breathing to dullness during breathing, indicating that the spleen may be enlarged. Slap the ball of one hand over each CVA with the ulnar fist of the other hand to assess for kidney tenderness.
Musculoskeletal System *
Spinal ROM test, including flexion, extension, rotation, and lateral bending; and hips, including flexion, extension, abduction, adduction, and internal and external rotation. Examine and palpate the muscles, bursae, ligaments, tendons, capsules, menisci, surrounding tissues of the lower extremities for crepitation, atrophy, nodules, swelling, tenderness, thickening, swelling, or bruising.
Nervous System Mental Status/Behavior
Thought processes, content, perceptions, insights, judgement: Patient's thought processes are logical, organized, relevant, understandable, coherent and purposeful. Thought content does not show compulsivity, obsessions, phobias, anxiety, feelings of unreality or depersonalization, or delusions.
Cognitive Function Rudimentary Cognitive Functions
Learning and immediate memorization: At the end of the examination, the patient can repeat a series of 3 to 4 words given at the beginning of the examination. Computational ability: The patient is able to correctly complete addition and multiplication at a simple and slightly more complex level or correctly answer situational math problems.
Cranial Nerves, Motor and Sensory Systems, and Reflexes
Distant and recent memory: The patient is able to provide generally accurate information that can be verified, such as jobs, anniversary, historical events, and people; provides accurate information that is recent, such as appointment time, medications, weather of the day. Compare proximal to distal parts of the body; use non-repetitive patterns to assess so that the patient cannot anticipate the test area.
Muscle Strength TestingASSESS
Ask the patient to bring their feet together with the practitioner's palm resting firmly on the surface between the patient's knees. Ask the patient to spread their legs against the practitioner's palms, which are firmly on the surface on the outside of the patient's knees.
64ASSESS
Sensory System and Reflex Testing
Dermatones
66ASSESS
General Guidelines
Sociocultural–Spiritual Assessment
See the table below for examples of diseases/genetic conditions common to certain ethnic groups. If this is not possible, refer the patient to someone who can care for the patient in an unbiased manner.
Questions for Sociocultural–Spiritual Assessment Communication, Time, Space, Etiquette,
What is most important to your family for a healthcare professional to do to help your family. Would you like to share with me some of the traditions of your culture that you value most.
General Considerations
Nutritional Assessment
Assess the willingness of the patient and family or caregiver to consider indicated dietary modifications. Assess how the patient learns best, for example through written materials, verbal instructions, or visual cues; decide with the patient, family, or caregiver the most effective ways to help him or her make dietary changes; reflect on the success or failure of previous efforts.
Taking a Diet History
Assessment of Anemia
74ASSESS
Assessment of Anemia—cont’d
76ASSESS
Is increasingly called 'anemia due to inflammation'. A form of anemia seen in chronic diseases (e.g. due to chronic infection, chronic immune activation, malignancy). Probably mainly due to the body's production of hepcidin, an important regulator of human iron metabolism. Anemia due to hemolysis, the abnormal breakdown of red blood cells, either in the blood vessels (intravascular hemolysis) or elsewhere in the body (extravascular) • Normocytic • Normochromic • Decreased MCV • Normocytic • Normochromic • Hemolysis of red blood cells • Successful treatment of the chronic disease • Transfusion • Erythropoietin • Definitive therapy depends on the cause • Symptomatic treatment can be given by blood transfusion, if there is overt anemia • In severe immune-related hemolytic anemia, steroid therapy is sometimes necessary • Sometimes splenectomy may be useful as extravascular hemolysis predominates.
78ASSESS
Pediatric Developmental Milestones
Pediatric Assessment
Pediatric Developmental Milestones—cont’d
80ASSESS
Responsibilities of Examiner
Basic Gynecologic Examination*
Do not leave the patient in the lithotomy position with the speculum in place if you must leave the room to obtain additional equipment. Remove the speculum, place the patient's feet flat on the table, then reposition and reinsert the speculum upon return.
Preparation of Equipment and Room
Preparation of Patient
Assist patient into lithotomy position; adjust the table so that the head of the table is raised about 30 degrees. Position the patient's buttocks slightly away from the end of the table so that the speculum can be introduced without interfering with the table.
External Genitalia Assessment
Specimens can be obtained with cervical spatula from ectocervix and with endocervical brush, cervical broom, or other preferred method from endocervix. For women using birth control pills, the transformation zone may be on the ectocervix.
Bimanual Pelvic Examination
Palpate the uterus between both sets of fingers for size, shape, consistency and mobility, and tenderness or masses. Palpate each ovary and adnexa between both sets of fingers for size, shape, consistency, mobility, and tenderness.
Rectovaginal Examination
If the uterus cannot be palpated with the abdominal hand, it is retroverted, retroflexed, or in the mid-plane, or the patient may be obese or have excessive abdominal/pelvic fluid. Assess pelvic floor muscle strength as withdrawal by extending two fingers before exiting the vagina and asking the patient to squeeze the vaginal muscles around your fingers.
Anorectal Examination
Palpate all vaginal walls; fornication around the cervix; and the area of the urethra and bladder for lumps, masses, or tenderness.
Neurologic Assessment
86ASSESS
Using the sides of two pins or the open end of two paper clips, touch the finger pad. Astereognosis (inability to identify objects) suggests a lesion in the sensory cortex Agraphesthesia (inability to identify number on the palm) and lack of two-point discrimination suggest a lesion in the sensory cortex.
88ASSESS
Guidelines for Assessment and Intervention89
Suicide Assessment
High-Risk Populations Groups at risk for suicide include
90ASSESS
Erikson’s Developmental Stages*
Try to develop a sense of self-worth by refining skills Identity vs. Role Confusion: Try to integrate many roles (child, sibling, student, athlete, worker) into a self-image under role modeling and peer pressure.
Symptoms of Depression
92ASSESS
Viral URIs:• Usually last less than 10 days • Have clear to yellow nasal discharge and cough • May or may not have fever • Associated with pain, watery eyes and swollen nasal mucosa • May cause chronic cough due to postnasal drip • Response to supportive care, antihistamines, fluids, vitamin C and zinc. Bacterial URI:• High white blood cell count with increased neutrophils on CBC • Increased bands or “left shift” in white blood cell count in acute URI• Elevated monocytes in chronic URI.
94ASSESS
Symptoms of bacterial pneumonia: • Fever, chills, chest pain, green-to-brown sputum, decreased breath sounds and consolidation of breath sounds in one area of the lung. Symptoms of viral pneumonia: • Fever, dry cough, headache, muscle pain, weakness increasing breathlessness and circumoral cyanosis.
96ASSESS
This reaction is sudden, severe and involves the whole body: • Hives • Difficulty breathing • Wheezing • Confusion • Slurred speech • Cyanosis • Dizziness / fainting • Anxiety • Nausea, vomiting, diarrhea • Angioedema swelling may close airway • Armedema • armedema. •Ensure allergens are recorded.•Patient wears MedicAlert bracelet.•Patient wears epinephrine injection.
98ASSESS
Cat and human bites are more likely to become infected than dog bites. Bites on the hand are of special concern because of the possibility of infection in an enclosed space. Antibiotic prophylaxis is indicated for uninfected hand bites and hospitalization is required for infected hand bites. Follow-up to determine the effect of antibiotics • Vigorous cleaning and irrigation of the wound • Debridement of necrotic material • Suturing, but NEVER of an infected wound or a wound to the hand • Prophylactic antibiotics indicated for high-risk bites Cat bites in any location: • Dicloxacillin 0.5 g orally 4 times per day for 3–5 days Hand bites from any animal: • Penicillin V 0.5 g orally 4 times per day for 3–5 days Other options with a broader spectrum of action include: • Cefuroxime • Amoxicillin-clavulanic acid • Clindamycin • Ciprofloxacin or levofloxacin Tetanus and rabies evaluation should be performed in allbite patients.
100ASSESS
Treatments include:• Elevating the uvula with a spoon• Eating 1 teaspoon of dry granulated sugar• Breath holding• Valsalva maneuver• Sneezing• Repeated breathing into a bag•. Keeping knees to chest Drug treatments include:• Chlorpromazine 25–30 mg orally or intramuscularly• Phenytoin• Carbamazepine• Benzodiazepines• Metoclopramide• Gabapentin.
102 Bone Densitometry
Mammogram
LABS
Rays
A diagnostic mammogram is an x-ray examination of the breast in a woman who either has a breast complaint, such as a breast mass or nipple discharge, or had an abnormality found during a screening mammogram. Breast self-examination (BSE) is an important part of cancer prevention, and women should be educated to perform monthly BSE and promptly report any changes in breast architecture.
Diagnostic Use by Anatomic Region
Computed Tomography
Diagnostic Use by Anatomic Region—cont’d
Magnetic Resonance Imaging
Ultrasound
Diagnostic Ultrasound Use by Anatomic Region
Complete Blood Count
Blood and Body Fluid Evaluations
Complete Blood Count—cont’d
Comprehensive Metabolic Panel
Comprehensive Metabolic Panel—cont’d
Thyroid Panel
Thyroid Panel—cont’d
118 Anemia Workup
Prostate-Specific Antigen (PSA)
119 Hepatitis
Prothrombin Time/Partial Thromboplastin Time/International Normalized Ratio
Prothrombin Time/Partial Thromboplastin Time/International Normalized Ratio—cont’d
High-density lipid profile Red top tube—Red top tube Low risk: <240Moderate risk: 241–260High risk: >260 Elevated • Familial hypercholesterolemia • Familial hyperlipidemia • Hypothyroidism • Uncontrolled diabetes • Pregnancy • Nephrotic syndrome • Familial lipotic syndrome • Familial hypercholesterolemia • Familial hyperlipidemia • Hypothyroidism • Uncontrolled diabetes•Pregnancy•Nephrotic syndrome•Family leurotic syndrome. thyroidism •Alcohol consumption•Chronic liver disease•Hepatoma•Cushing's syndrome. TriglyceridesRed top tube Elevated•Glycogen storage disease•Familial hypertriglyceridemia•Hyperlipidemia•Hypothyroidism•High carbohydrate disc•Poorly controlled diabetes•Nephrotic syndrome•Chronic renal failure Decreased•Malabsorption syndrome•Malnutrition syndrome: 1-30 mg/60 5-135 mg/ dL.
Erythrocyte Sedimentation Rate and C-Reactive Protein Assay
T oxoplasmosis, Other , Rubella, Cytomegalovirus [CMV], and Herpes (TORCH) Panel
T oxoplasmosis, Other , Rubella, Cytomegalovirus [CMV], and Herpes (TORCH) Panel—cont’d
White Cell Differential Analysis
Step-by-Step Approach to Reading a Chest X-ray
White Cell Differential Analysis—cont’d
Step-by-Step Approach to Reading a Chest X-ray—cont’d
DIFF DX
Abnormal Vaginal Bleeding
Continued STD protection – at least for one week when the medications started, but continued STD protection was urged.
Acne
Alzheimer’s Disease
It is important for the health care provider to monitor the caregiver's health.
134 Angina
Anorexia Nervosa/Bulimia
Asthma
Escalate therapy if the patient wakes at night with symptoms, has an urgent care visit, has an increased need for short-acting beta2agonist, or uses more than one container of short-acting beta2agonist per month. If asthma symptoms wake the patient at night and the patient experiences severe shortness of breath, the patient should go to the ED.
Back Pain
Cauda equina syndrome is suspected if the patient has loss of bladder or bowel function.
Bacterial Vaginosis
Bipolar Disorder
Benign Prostatic Hypertrophy
Cataracts
Chlamydia Trachomatis
Chronic Obstructive Pulmonary Disease
Moderate COPD: anticholinergic agent (ipratropium bromide), short-acting beta2-agonist and long-acting beta2-agonist.
Depression
Diabetes, Type II
DPP-4 inhibitors: Prevent the breakdown of compounds in the body that increase glucose levels. Incretin mimetics: Naturally occurring hormones that lower blood sugar levels primarily by increasing insulin secretion.
Gastroesophageal Reflux Disease
Genital Herpes
For angle-closure glaucoma (a relatively rare condition), unilateral headache on the same side as the affected eye, blurred vision, nausea and photophobia. Visual field test - loss of visual field due to damage to the optic nerve.
Glaucoma
Gonorrhea
Headache
Post-trauma: changes in vision, reduced cognition and memory, signs of skull or facial injury. Vision changes, severe dizziness, memory loss or cognitive changes, or a very painful stiff neck may indicate a serious brain disease that should be investigated.
Hepatitis A
Mode of transmission: fecal/oral usually sudden onset; loss of appetite, nausea, vomiting, fatigue, muscle/joint pain, fever, possible chills, flu symptoms, diarrhea or constipation, recurrent or intermittent RUQ or epigastric abdominal pain.
Hepatitis B
Human Papillomavirus (HPV)
Provider administered therapy: Gardisil vaccine: 3-dose series approved for females ages 9-26; men considered by the FDA; start before starting sexual activity; have even if previous infection; learn about side effects; do not use if pregnant For warts: weekly examinations until lesions resolve.
Hyperlipidemia
Once the goal is reached and liver function is stable, annual follow-ups are sufficient.
Hypertension
A thiazide-type diuretic should be considered as initial therapy in most patients with uncomplicated hypertension. Other classes of medications that should be used in combination to meet BP goals include beta-adrenergic blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers.
Hypothyroidism
Interstitial Cystitis
Methicillin-Resistant Staphylococcus aureus
Monilia
Otitis Externa
Otorrhea: white mucus for acute bacterial; granulation tissue for chronic bacteria; and white, gray, bluish-green or yellow for mushrooms.
Peptic Ulcers
166 Pharyngitis
Pneumonia
In patients over 40 years of age and in patients who smoke, another chest x-ray should be taken 4 to 6 weeks after treatment to rule out tumor. Hospitalization should be strongly considered for patients older than 65 years if respiratory rate >30 breaths/min, hypotension, or signs of sepsis are present.
Rheumatoid Arthritis
Scabies
Sinusitis
Skin Cancer
172 Syphilis
173 Trichomoniasis
Urinary Incontinence
UI stress: alpha-adrenergic; Estrogen preparations may help women; most useful non-pharmacological therapy for SUI. Refer to physical therapist for perineal muscle control; may be helpful for women without pelvic floor muscle contractions.
Urinary Tract Infection (Lower Tract)
With complicated UTI: trimethoprim-sulfamethoxazole (Bactrim DS 1 tab po q12 h ×10-14 days) or a fluoroquinolone (levofloxacin, gatifloxacin, ofloxacin, norfloxacin). Oral therapy is used only in mild acute cases without sepsis or nausea/vomiting: trimethoprim-sulfamethoxazole or a fluoroquinolone.
Urinary Tract Infection (Upper Tract)
Suppliers receive payment per month. No payment for individual visit. This type of plan pays fees for service at specific rates. Costs are lower for patients if they choose a provider who is in the organization. Fees are set for most services within the association. Fees are set and providers pay a per patient per month fee. Providers in network receive payment per patient per month. Referrals required for visits to specialists. Authorizations required for procedures. Authorizations required for procedures. Authorizations required for procedures. Authorizations required for procedures.
Medicare Part A Covered Services
Medicare is health insurance for people age 65 and older, those younger than 65 with certain disabilities, and any age with permanent kidney failure. Medicare pays NPs at 85% of the physician's hourly rate or 80% of the actual rate, whichever is lower.
Medicare Part B Covered Services
BILLING/
Medicare
Medicaid
members of the National Guard and Reserve; pensioners; and their families, survivors and certain former spouses worldwide. CHAMPUS, the Civilian Health and Medical Program of the Uniformed Services, is a cost-sharing program used to provide inpatient and outpatient care to dependents from civilian sources; it's for military retirees and families.
CODING
Tricare
CPT Codes
Classification takes the patient's condition, illness or injury and translates it into numeric and alphanumeric format for billing and reimbursement purposes. V codes (V01-V83) are used for preventive services that are covered, such as "annual women's health examination".
International Classification of Diseases, 9th edition, Clinical Modifications
Guidelines for Coding and Reporting
Commonly Used Codes
Medicare Documentation
Documenting the patient visit level is important because the higher the visit level, the more reimbursement. Visit levels include: ■ Problem-focused: A limited examination of the affected body area or organ system ■ Extended problem-focused: A limited examination of the affected body area or organ system and systems other symptomatic or organ-related ■ Detailed: An extended examination of affected areas of the body and other symptomatic or organ-related systems ■ Comprehensive: A general multisystem examination or a complete examination of an organ system.
186 CODING
Category B: Animal studies show no risk to the fetus, but human studies have not been performed; or adverse effects in animals but not in well-controlled human studies. Category C: No relevant human or animal studies; or no adverse effects on the fetus in animal studies, but no human data are available.
Aminoglycosides
187 Pregnancy Category
Antibiotics
MEDS
188 Cephalosporin
Fluoroquinolone
Macrolides
Penicillin
Sulfa Antibacterial Drugs
Tetracycline/Doxycycline
Adverse reactions and side effects: Diarrhea, hypersensitivity, nausea, rash, neurotoxicity, urticaria, superinfection (including candidiasis), fever, vomiting, erythema, dermatitis, angioedema, seizures (especially in patients with epilepsy), or pseudomembranous colitis. Do not use in children under 8 years of age and avoid during periods of tooth development.
Angiotensin-Converting Enzyme Inhibitors
Angiotension Receptor Blockers
Antihypertensives
Side effects and side effects: May stain teeth, skin photosensitivity, drug-induced lupus or hepatitis. First dose may cause orthostatic hypotension, rash, diarrhea, dyspepsia, abnormal liver function, muscle cramps, myalgia, back pain, insomnia, decreased hemoglobin level, decreased renal function, pharyngitis and/or nasal congestion.
Beta Adrenergic Blocking Agents
Calcium Channel Blockers
Alpha Blockers
Centrally and Peripherally Acting Antiadrenergic Agents
All patients taking any type of antidepressant should be closely monitored for suicidal ideation. The recommended regimen is to visit the patient 1 week, 2 weeks, and 1 month after starting the medication to determine suicide risk.
Benzodiazepines
The risk may increase when starting antidepressant medication because of the medication itself or because patients have more energy after starting medication and are able to act on suicidal urges. It is imperative to document that suicidal risk (desire, means, and plan) is assessed at each visit and that, if there is any positive risk, then appropriate immediate referral is made.
Antianxiety and Antidepressant Medications
