Public Interest Law Initiative


By U. Hurit. Dean College. 2018.

Acetaminophen does not produce tiinflammatory effects of aspirin cabergoline 0.5 mg lowest price women's health center kirkland wa, whereas reserpine de- the gastric ulceration that can occur with aspirin and is creases its analgesic effects generic cabergoline 0.25 mg otc breast cancer 14s. Adverse Effects, Contraindications, and Drug p-Aminophenol Derivatives Interactions Acetaminophen (Tylenol) is the active metabolite of Toxicity from overdose with acetaminophen differs in both phenacetin and acetanilide but has fewer toxic ef- time course and mechanism from that observed with the fects than either precursor. The onset of toxicity may not occur for several are no longer used therapeutically because they have days, and the predominant damage is to the liver. Peak acetylcysteine is used to treat acetaminophen toxicity, al- plasma concentrations are observed within 30 minutes though many patients are hypersensitive to such treat- to 2 hours. In addition, gastric lavage with activated charcoal administration but varies with suppository forms of the can be used immediately after ingestion of the drug to drug. Following the use of normal therapeutic holism, since chronic alcohol consumption can induce doses of acetaminophen, metabolism and conjugation the P450 system, leading to increased production of the to sulfate or glucuronides occurs, and clearance of these toxic metabolite of acetaminophen, hence to liver necro- metabolites occurs in the kidney. In addition, barbiturates and phenytoin induce the lite is generated by the metabolism of acetaminophen liver P450 system and may decrease the effectiveness of via the P450 mixed-function oxidase system. Acetaminophen crosses the placenta metabolite is normally conjugated to glutathione in the but is nonetheless used in pregnant women with few side liver and excreted via the kidney as conjugated cysteine effects for the mother or the fetus. However, with the depletion of has been shown to be present in breast milk, no conclu- glutathione in certain disease states, such as liver cir- sive evidence links the drug to abnormalities associated rhosis and necrosis, and following chronic use of high with consumption of breast milk by the newborn. Indoles (indomethacin) and Related Compounds Mechanism of Action Chemistry and Mechanism of Action Acetaminophen is a weak inhibitor of peripheral COX. Indomethacin (Indocin) is an acetic acid derivative re- Its analgesic effects may arise from inhibition of lated functionally to sulindac (Clinoril), a prodrug with prostanoid synthesis in the CNS or other centrally me- a long half-life, and etodolac (Lodine). The antipyretic ef- olized in the liver and excreted as metabolites in the 26 Opioid and Nonopioid Analgesics 315 bile and via the kidney. They are potent inhibitors of they produce analgesia, antipyresis, and antiinflamma- COX and thus extremely effective antiinflammatory tory effects. Ketoprofen inhibits lipoxygenase and COX, Clinical Uses, Adverse Effects, thus decreasing the production of both leukotrienes and and Contraindications prostaglandins. The principal differ- All of these drugs produce analgesic effects, antipyresis, ences among these drugs lie in the time to onset and du- and antiinflammatory effects. Naproxen has a long half-life, whereas of gastric irritation, headache, nausea, and other side ef- fenoprofen and ketoprofen have short half-lives. All of fects, including hematological effects and coronary the drugs are extensively metabolized in the liver and re- vasoconstriction, they are not useful as an initial treat- quire adequate kidney function for clearance of the ment for pain. Indomethacin is useful in but clearly all are bound to a relatively high degree and the treatment of acute gout, osteoarthritis, ankylosing can interfere with the binding of other drugs that com- spondylitis, and acceleration of the closure of the ductus pete for plasma protein binding (as described for as- arteriosus in premature infants. The one exception is ketoprofen, which although indomethacin to prevent preterm labor are the result of highly bound to plasma proteins, does not appear to al- its effects on prostaglandin synthesis. Indomethacin is contraindicated in pregnancy, in asthmatics, and in those with gastric ul- Clinical Uses, Adverse Effects, cers or other ulceration of the GI tract. The drug should duction of mild to moderate pain and fever, and for pain be used with caution in such patients. Side effects of the drugs are similar to but less severe than those described for Fenamates the salicylates. Those who are sensitive to salicylates also may be sensitive to and have adverse reactions Meclofenamate (Meclomen) and mefenamic acid when taking ibuprofen and related drugs. Acute hyper- (Ponstel) exhibit potency and side effects similar to sensitivity to ibuprofen has been reported in patients those of other nonsalicylate NSAIDs. The hypersensitivity reaction to sulindac can drugs produce serious side effects, have a short duration be fatal. The con- agents indicated for mild to moderate pain, treatment current use of ibuprofen with aspirin reduces the anti- of dysmenorrhea, rheumatoid arthritis, and osteoarthri- inflammatory effects of both drugs. These drugs are metabolized via glucuronidation in traindicated in patients with aspirin sensitivity leading the liver and excreted via the kidney. Thus, fenamates to bronchiolar constriction and in patients with an- require normal liver and kidney function for excretion gioedema. As with all NSAIDs, renal and liver function and are contraindicated in patients with either liver or should be normal for adequate clearance of the drugs. Overdose with fenamates leads to seizures that are sometimes insensitive to traditional treatment with benzodiazepines. In cases of overdose with Pyrazolone Derivatives meclofenamate dialysis may be required to restore fluid and electrolyte balance. Phenylbutazone (Butazolidin) is metabolized to oxy- phenbutazone (Phlogistol), and both compounds have all of the activities associated with the NSAIDs.

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Since in practice the fixed consulting hours of doctors set limits to the dispersion or flexibility of the work amount cabergoline 0.5mg otc women's health vancouver, we can argue that the more validate and relevant information the practitioners get within constant time to access it the better discount 0.25 mg cabergoline visa breast cancer foundation. A cautious approach to introduce knowledge management issues in clinical applications can be seen as a virtue. For example the fact that an article is published in an academic journal does not guarantee that the information is true. One such article presented findings from a research that demonstrated how sodium fluoride effectively prevents contracting osteoporosis. Later another more validate research findings proved that there truly was causality between these two—only the effect sodium fluoride had on the illness was just the opposite (Slawson & Shaughnessy, 1997). One barrier to the widespread use of knowledge management tools is the psychological need of clinicians. Weinberg, Ullian, Richards, and Cooper (1981) found that 81 American doctors in a distant geographical area consulted 23 experts, logging 11 calls to experts each month. Six of these experts received over 90 percent of the calls, about 90 each a month. The other doctors can also provide the psychological benefits that are not available from books, journals, and computers. On the other hand, the doctors “answering” the questions may sometimes not be much more knowledgeable than the doctors seeking answers. Also a review article by Smith in 1996 which looked at the information needs of general practitioners made several similar conclusions, one of which was that doctors are looking for guidance, psychological support, affirmation, commiseration, sympathy, judgement, and feedback. Usefulness of medical information USEFULNESS OF MEDICAL R ELEVANCE x VALIDITY INFORM ATION = W ORK Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Towards Knowledge Intensive Inter-Organizational Systems in Healthcare 281 particularly poorly explored, and yet it may well be the most important need and the biggest stumbling block to a technical solution. The electronic consultation and knowledge management tools, such as decision-support systems, could support each other in various ways. Doctors could use the knowledge system for retrieving required information before referring to the specialist. They could for example check what are the necessary laboratory tests that should be done before referring. Conclusions Within the healthcare sector, different types of process can be identified with different demands on the quality of information and knowledge required. The amount of reference information needed to make a diagnosis differs from one specialization to the next in a hospital. In some fields, the information required by a doctor consists mainly of basic data, observations recorded in numbers and text, whereas in other fields an image or video clip is considered crucial for drawing conclusions. While the significance of what is known as tacit information is important in some fields, in the majority of cases it is explicit information that is required; and it is in care chains relying heavily on explicit information that the potential of information technology can be put to the best use. We examined the impacts on adoption of a new inter-organizational system in healthcare. The consequences from using the Intranet-type referral system in the example case were, first, that the number of patients who were asked to actually visit a specialist was reduced to half thus reducing the burden on specialist resources. According to the doctors involved, this happened in 75 percent of the cases without any observable problems to fulfill the appropriate treatment. However, there were differences between the benefits in different medical areas according to nature of information related to education of different specialists. This should be considered more carefully in the future, when new information systems will be planned and developed. Evidently in internal medicine, specialists make conclusions from pieces of information of symptoms, medical histories and laboratory tests. The information used is explicit, reasonably well structured and treatment is often medication. Intranet referral system both increased the utilization of specialist consultation and decreased the need for secondary care services by transferring information and knowledge to primary care. Because all patients were thoroughly examined beforehand, the numbers of repeat visits as well as direct costs remained lower. In orthopedic surgery the situation appeared to be different, as the diagnostic process is based more on tacit knowledge and the specialist frequently rely on direct observa- tions.

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Those cer- jects with traumatically induced spinal pain led to signif- tified can use the title Nationally Certified in Therapeutic icant improvements in acute and chronic pain and in- Massage and Bodywork (NCTMB) order 0.25mg cabergoline visa pregnancy workouts. Department of Education discount 0.25 mg cabergoline amex pregnancy due date predictor, currently rally control pain by stimulating the brain to produce en- recognizes about 70 training programs. Fibromyalgia is an example of a condition Commission of Career Schools and Colleges of Technolo- that may be favorably affected by this effect. A pilot study of five subjects with symptoms of ten- sion and anxiety found a significant response to massage Resources therapy in one or more psycho-physiological parameters of heart rate, frontalis and forearm extensor electromyo- BOOKS grams (EMGs) and skin resistance, which demonstrate Beck, Mark F. Massage Therapy Career Guide for Hands- Lymph drainage massage has been shown to be On Success. New York: Random drugs to control lymphedema secondary to radical mas- House, 1998. A study found that massage therapy can have a powerful PERIODICALS effect upon psycho-emotional distress in persons suffer- Field, T. Massage “Chronic fatigue syndrome: massage therapy effects on GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1301 depression and somatic symptoms in chronic fatigue syn- with such disease conditions as diabetes, heart disease, drome. He noticed many improvements in his own health, exposed preterm neonates show behavioral and hormonal such as lower weight, lower blood cholesterol levels, and differences. Many patients who have undertaken the McDougall diet have found an improvement in such conditions as: Elliot Greene • high blood pressure • diabetes Mastitis see Breastfeeding problems • headaches • constipation • mild arthritis McDougall diet • fatigue Definition • body odor The McDougall diet provides the structure of a low-fat, • oily skin starch-based diet to promote a broad range of such health • allergies benefits as weight loss and the reversal of such serious health conditions as heart disease, without the use of drugs. Another possible benefit of the McDougall program is that patients may find themselves spending less for food. In addition, McDougall points to the possibility of Origins saving considerable amounts of money by avoiding seri- The McDougall diet began as a challenge to Dr. The patient simply asked him if he believed that diet is connected to the health Description problems he saw in his patients. McDougall proper foods, moderate exercise, adequate sunshine, agreed, and the McDougall diet was born. In his practice, he handled a Specifically, the McDougall diet is a very low-fat, variety of medical problems from delivering babies to starch-based program. Grains, fruits and such starchy plant performing brain surgery on accident victims. There are some fruits and Dougall was bothered by his inability to help patients vegetables used in this program that may be quite unfamil- 1302 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 iar to the average person. Some of these include carambo- Side effects la, guava, persimmon, passion fruit, daikon, endive, fava The primary negative side effect of the McDougall beans, bok choy, kale, kohlrabi, taro root and watercress, to diet usually comes from caffeine withdrawal. In addition, some of these foods are more easi- ple find they suffer from headaches while abstaining ly obtained and less expensive in Hawaii than they might from caffeine. There is extensive research about the effect of lifestyle and diet on various health conditions, although Preparations research on the McDougall diet specifically has not yet Patients should check with their physician before been released. Anecdotal evidence suggests, however, they begin this or any other diet and exercise program if that significant improvement in some health problems they have any health problems such as heart disease, can be achieved in a relatively short period of time. Resources McDougall recommends that patients spend some BOOKS time evaluating their reasons for undertaking this program. The McDougall Program: 12 Days Patients should determine how well they think they will be to Dynamic Health. Exam- Women: What Every Woman Needs to Know to Be Healthy ining any aspects of their lifestyle that are harmful to their for Life. Helena Hospital and Health Center), they may find it stressful to work on these lifestyle problems at the same time they are making radical changes in their diet. MCTs see Medium-chain triglycerides Those undertaking this program should also prepare family and friends for the changes this program will cause in their diet. They may find their families unwill- ing to change, and this fact will require a different ap- proach to the program. On the other hand, McDougall Measles points out that family members often decide to undertake Definition the program themselves when they see the positive changes that result from the diet. Measles is a viral infection that causes an illness displaying a characteristic skin rash known as an exan- Before undertaking the program, patients will need them. Measles is also sometimes called rubeola, five-day to stock their pantry with new foods. Inci- Patients should not undertake this diet program dence of the disease in the United States is down to a without the advice of a physician if they have any health record low and only 86 confirmed cases were reported in condition or are currently on medication. Of these, 62% were definitely linked to GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1303 eventually develops some bumps.

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Contractility: The ability of the heart to alter its contractile force and velocity indepen- dent of fiber length cheap 0.5mg cabergoline otc mistral kitchen. In simple terms buy discount cabergoline 0.5 mg women's health hargreaves street bendigo, it represents the intrinsic strength of the individual muscle fiber cells. Contractility can be increased by stimulation of beta-receptors in the heart (see below). Brief Review of the Adrenergic, or Sympathetic Nervous System Cardiac output and its determinants (preload, afterload, and contractility) are all influenced 20 by the adrenergic nervous system. The adrenergic system releases catecholamines (epineph- rine and norepinephrine), which bind to end-organ receptors. These adrenergic receptors are divided into two classes, designated alpha (α) and beta (β), and their actions are summa- rized in Table 20–1. When stimulated, these receptors cause vasoconstriction and increase BP, SVR, and afterload. When activated, these receptors stimulate the SA node to increase the heart rate and increase contractility. Beta-2 Receptors: Found in the peripheral vascular tree as well as in the bronchial wall smooth muscle. Activation causes vasodilation of the peripheral vasculature and bronchodi- latation. These adrenergic receptors are important because many of the cardiovascular drugs used in the ICU act through their sympathomimetic properties. These drugs usually have specific receptor affinity (ie, β versus α) and consequently differ in their effects. Drugs that act on alpha-1 receptors, for example, are called “vasopressors” because they cause vaso- constriction. Drugs that act on beta-1 receptors are conversely called “inotropes” because they increase contractility and heart rate. CENTRAL VENOUS PRESSURE The CVP catheter is one of two major devices used in cardiovascular instrumentation. The other major device, the pulmonary artery catheter (often called the Swan–Ganz catheter), is considered in the next section. This filling pressure de- fines the ability of the right side of the heart to accept and pump blood. Method 20 A 14-gauge intravenous catheter is inserted into the internal jugular or subclavian vein (see Chapter 13). A chest x-ray is required to confirm the position of the catheter in the superior vena cava. The zero point for the manometer is usually 5 cm below the sternal notch, in the midaxillary line. CVP Limitations • CVP does not reflect total blood volume or left ventricular function. TABLE 20–3 Interpretation of CVP Readings Reading (cm H20) Description Implications <4 Low Fluids may be pushed 4–10 Midrange Not clinically useful >10 High Suspect CHF, cor pulmonale, COPD, ten- 20 sion pneumothorax, cardiac tamponade Abbreviations: CVP = central venous pressure; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease. Technical Tips • If CVP readings do not fluctuate with respiration, the readings are inaccurate. PULMONARY ARTERY CATHETERS The pulmonary artery (PA or Swan–Ganz) catheter is a device that allows the measurement of central circulatory parameters useful in the treatment of the acutely ill patient. The catheter actually passes through the heart; its distal end is in the pulmonary artery (Figure 20–3). It allows the measurement of the pulmonary artery pressure (PAP), the pulmonary artery occlusion pressure (PAOP, also known as the pul- monary capillary wedge pressure, PCWP), the CO, and the CVP. Newer technology also al- lows for the continuous monitoring of mixed venous oxygen saturation (SvO2), measurement of the right ventricular ejection fraction (REF), and the right ventricular end- diastolic volume index (RVEDVI). Indications Common clinical conditions requiring PA catheter monitoring include: • Acute heart failure • Complex circulatory and fluid conditions (massive resuscitation) • Shock states • Diagnosis of pericardial tamponade • Intraoperative management (aneurysm repair, elderly patient undergoing major surgery) • Complicated MI Catheter Description The original PA catheter, still commonly called the Swan–Ganz catheter after its inventors, consists of three lumens and a thermistor at the tip (Figure 20–4).

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