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654-5988 Voice users ; . If you require another alternative, please contact Thomas Vracarich at 717 ; 783-2209. FEATHER O. HOUSTOUN, Secretary Purpose The purpose of this notice is to: 1. add a new definition of "emergency medical condition" and "emergency medical care"; 2. revise the Medical Assistance definition of "emergency admission"; 3. delete the definitions of "emergency situation" and "emergency accident care"; and 4. delete Appendix A of 55 Pa. Code, Chapter 1221, relating to Clinic and Emergency Room Services. Scope This notice applies to all providers enrolled in the Medical Assistance Program, as well as both voluntary and mandatory managed care organizations under contract with the Department. Background On August 5, 1997, President Clinton signed the Balanced Budget Act of 1997 BBA ; , which included a revised definition of "emergency medical condition." To be consistent with BBA, the Department, in consultation with the Pennsylvania Chapter of the American College of Emergency Physicians and the Hospital and Healthservices Association of Pennsylvania, is deleting the current 1101.21 definition of an "emergency situation" and replacing it with the definition of "emergency medical condition." Effective July 1, 1998, 1101.21, relating to definitions, will include the following definition of "emergency medical condition": Emergency Medical Condition--A medical condition manifesting itself by acute symptoms of sufficient severity including severe pain ; such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in-- i ; placing the health of the individual or, with respect to a pregnant woman, the health of the woman or her unborn child ; in serious jeopardy, ii ; serious impairment to bodily functions, or iii ; serious dysfunction of any bodily organ or part. The Department is replacing the definition of "emergency situation" in 1141.2 with a definition of "emergency medical care"; deleting the definition of "emergency accident care" and modifying the definition of "emergency medical care" in 1221.2; and revising the definition of "emergency admission" in 1150.2. In addition, the Department is revising the section on "Non-emergency use of the emergency room" under "Noncompensable services" in 1141.59 and 1221.59. Because of the unlimited numbers of medical conditions that could constitute an emergency situation, the list of symptoms and diagnoses in Appendix A to Chapter 1221 has become unintentionally restrictive. As a result, the Department is deleting Appendix A and all references to Appendix A throughout the regulations. Policy Effective July 1, 1998, Chapter 1101--General Provisions, Chapter 1141--Physicians' Services, Chapter and psilocybin, for instance, drug interactions. 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Reference Books: 1. 2. 3. Physical Pharmacy Martin, Swarbrick and Commarata Elements of Physical Chemistry Glasstone and Lewis Physical Chemistry Maron S. and Pruton Remington's Pharmaceutical Sciences. Theory & Practice of Industrial Pharmacy Lachman Liebermann and Kanig Physical Chemistry Bahl and Tuli Pharmaceutical Technology Eugene Parrott Essentials of Physical Chemistry and Pharmacy S. S. Kadam, H. J. Arnikar and K. N. Gujar.
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Continued from page 1 ; TABLE 2. HERBS WITH POTENTIAL TO LOWER BLOOD GLUCOSE Hypoglycemic effect of insulin and oral hypoglycemic agents may be enhanced. Patients with diabetes should be closely monitored to prevent hypoglycemia and or loss of blood glucose control. There is the potential for some herbs to decrease insulin resistance, which may be helpful to patients with increased blood glucose induced by protease inhibitor. The expertise of a qualified medical provider should be sought to monitor patients. Aloe gel Aloe spp. ; 67, 105, 117, -glibencamide and gel, 164 Atractylodes Atractylodes ovata, Atractylodes macrocephala ; 34, 35, 105, Bitter Melon Momordica charantia ; 53, 67, 76, Box Thorn Leaf Lycium barbarum ; 34, 35, 106, Burdock Root Arctium lappa ; 34, 35, 67, Compound Q Chinese Cucumber Trichosanthes kirilowii ; 35, 105, 106 Dan Shen Salvia miltiorrhizia ; 35 Dandelion Plant Taraxacum officinale ; 46, 67, 90, Ganoderma Ganoderma lucidum ; 67, 120, 128, Garlic Allium sativum ; 40, 41, 44, hyperglycemic peaks only, 105, 110, 117, Ginger Zingiber officinale ; 50-excessive intake, 53, 67, 105, Ginseng, Panax Panax Ginseng ; 50, 67, 105, of significance, 147, 155, 156 Ginseng, Siberian or Eleuthero Root Eleutherococcus senticosus ; 67, 105, 117, Goldenseal Hydrastis canadensis ; 44, 67, 105, Olive Leaf Olea europaea ; 70, 105, 156 Psyllium Plantago spp. ; 26, 66, 116, Wormwood Artemisia absinthium ; 105, because side effect.
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However, disturbed sleep and nightmares have been reported and these can sometimes be avoided by giving the drug in the morning. Mechanical Nebulizer: A small, portable machine used to deliver certain asthma medications. The nebulizer is plugged into an electrical outlet or may be battery powered. A nebulizer treatment usually takes 10-15 minutes to administer. Students requiring regular nebulizer treatments may need to keep the nebulizer at school. Metered Dose Inhaler MDI ; : MDIs are the most common delivery devices for inhaled medications. Appropriate technique is important to ensure adequate delivery of medication to the airways. Use with a spacer holding chamber is recommended. Open mouth and closed mouth techniques may be used if a spacer is not available. Other types of delivery devices that do not require a spacer include Dry Powder Inhalers DPI ; and Breath Actuated MDIs. Oral Corticosteroids prednisone, methylprednisolone ; : Used for moderate to severe asthma exacerbations to speed recovery and prevent relapse of exacerbations. These are generally prescribed for once daily "burst" therapy lasting three to ten days. Frequent courses of oral corticosteroids are an indication of poorly controlled asthma. Some individuals with severe persistent asthma may require the long-term use of oral corticosteroids. Peak Flow Meter: A peak flow meter is a device that measures how well air moves out of the lungs peak expiratory flow [PEF] ; . When airflow is obstructed by asthma, the peak flow meter provides an objective measure of the severity of the airway obstruction. The peak flow meter may detect airway narrowing from asthma before noticeable symptoms occur. Children over five years old are generally able to use these devices. Pulse Oximeter: A portable electric pulse oximeter can measure the oxygen saturation in an individual's bloodstream through an electronic sensor applied to the fingertip. The normal oxygen saturation measurement in a healthy individual is 100 percent. An oxygen saturation measurement below 92 percent is a medical alert value. While many individuals experiencing asthma symptoms may have reduced oxygen saturation levels, a normal oxygen saturation measurement does not exclude the possibility that an individual is experiencing asthma symptoms. Quick-Relief Medications: See Asthma Relievers for names and photos of different medications in Appendix, page 54. ; Medications that give prompt relief of bronchoconstriction and accompanying acute symptoms: coughing, wheezing, shortness of breath, rapid breathing, and chest tightness. Short acting bronchodilators are the most effective medication for relieving acute bronchospasm. Frequent use of quick relief medications greater than twice weekly in intermittent asthma; daily or increasing use in persistent asthma ; may indicate inadequate asthma control. If frequent use is noted, the student's parent or guardian and health care provider should be advised to consider initiating or increasing ; long-term asthma control medication. All students with asthma should have their quick relief medication available at school in case of unexpected exposure to asthma triggers or an asthma episode. Examples of quick relief medications include: Albuterol Ventolin, Proventil ; Levalbuterol Xopenex ; Metaproterenol Alupent ; Ipratroprium bromide Atrovent ; 11 and serevent and proventil. Given the advantages of this route of administration from an anatomical and histological viewpoint, it is likely that many other drugs will be available for vaginal administration in the future! Christine Koczmara, RN, BScPsy, is an analyst with ISMP Canada. 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