Catherine Koshland PhD, MS, BA
https://publichealth.berkeley.edu/people/catherine-koshland/
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It is orally active menstrual flooding discount dostinex 0.5 mg with visa, undergoes fir t pass metabolism in liver into acti ve as well as inactive metabolites, wh ich are eliminated mai nly in faeces. A small amount is hydrolysed into estradiol and normu stin e producing myelosupprcssion and esrrogenic adverse effects, viz. Docetaxe l has been fou nd effective in breast a nd ova rian cancer re frac tory to fi rst li ne drugs. Maj or toxic ity is neutropenia (more than paclitaxel), but neuropathy is less frequent. Their binding to this nuclear enzyme allows single strand breaks in D A, but not its resealing after the strand has untwisted. Topotecan It is used in metastatic carcinoma of ovary and small cell lung cancer after primary chemotherapy has failed. Prominent adverse effects are vomiting, stomatitis, diarrhoea, erythema and desquamation of skin, alopecia and bone marrow depression. Neutropenia, th rombocytopenia, haemorrhage, bodyache and weakness are the other adverse effects. Dactinomyc in has been combined with Mtx for cure of choriocarcinoma, or may be used in Mtx resistant cases. Whereas, utility of daunorubicin is limited to acute myeloid and lymphoblastic leukaemia (in which it is highly acti ve), doxorubicin, in addition, is effective in many solid tumours, such as breast, thyroid, ovary, bladder and lung cancers, sarcomas and neuroblastoma. Maximum action is exerted at S phase, but toxicity is usually exhi bited in G, phase. Both, daunorubicin a- doxorubiein, produce nd cardiotoxicity as a unique adverse effect. Marrow depression, alopecia, stomatitis, vomiting and local tissue damage (on extravasation) are the other adverse e! Epirubicin has been primarily used as a component of regimen for adjuvant therapy of breast carcinoma. Other indications are gastroesophageaL pancreatic, ovarian, hepatic and bladder carc inoma. Alopecia, hypc rpigmcntation of skin a nd o ral mucosa, painful ora l ulcers, fever and g. Mitoxantrone It is an anthracycl inc deri,ati,e related to doxorubicin "ith lower cardiolo1-icity. However, 11 does bind to D A, inhibits topoisonerase-2 causing trand breaks and inhibiting D. Clinical utility is restricted mo,tly to acute myeloid leukaemia, ad, a need hormone-refractory prostate cancer and occasionally in breast and hepatic carcinoma, non-Hodgkin lymphoma.
Hypercalcaemia s hould be watched for and therapy promptly interrupted for few days when it develops women's health center jacksonville nc buy cheap dostinex 0.25 mg line. Adm in istration of phosphate with high dose of calcitriol or alfacalc idol is beneficial. Senile or postmenopausal osteoporosis Age-re lated decrease in calciu m absorpt io n from g ut has been noted. Vit D 3 + calcium have been shown to improve calcium balance in osteoporotic fema les a nd e lde rly ma les. However, benefit in terms of improved bo ne mass or reduced fracture ris k is controversial or margina l (see p. Vit D defic ie ncy resu lts in secondary hyperparathyroid ism which contributes to osteoporos is. Calc itriol therapy carries the risk of hypercalcaemia, calcium stones and metastatic calcificatio n which should be watched for. Hypoparathyroidism D ihydrotachysterol or calcitri ol or alfaca lcidol are more effective tha n vit D2 or D3, because they act quickly and direc tly with ou t requiring h yd roxyl ation Use 1. Prophy laxis (oral or parenteral as appropriate) may be g iven in obstructi ve jaundice, steatorrhoea and other co nditions whi ch pred ispose to v it D deficiency. Metabolic rickets T hese are a group of conditions in whic h tissues do not respond to no rmal doses of vit D. Fanconi syndrome Vit D can raise the lowered phosphate leve ls that occur in this condition. Phenytoi n and pheno barbitone reduce the respons iveness of target tissues to calcitrio l; the ir pro longed use (for e pilepsy) can cause ric kets/osteomalacia. However, now it has been shown that plasma leve l of calcitri ol is normal, but its effect on intestine and bone is diminished. The fi rst gene ration compounds have simpler side c hains, are the least potent a nd seldom used now. The second and third generation compoun ds have an amin o or nitrogenous ring substitut ion in the side c hain, are more pote nt, ha ve hi ghe r effi cacy and additio na l mode of action. The two main components of bone are pro the in ma trix a nd the solid mineral phase (hydroxyapatite). On the surface of resorptive pi ts, the mine ral phase is solubilized in the clear acidic zone created at the ruffled border of osteoclasts, followed by resorption of protein matrix in this area by ac id hydro lases secreted from osteoclasts. Interference with mevalonate pathway may a lso impa rt a ntitumour activity on bony metastas is.
This is so because they act indirectl y by interfering with the synthesis of vit K dependent clotting factors in li ver menopause diagnosis buy dostinex 0.5 mg line. They apparently behave as competiti ve antagonists of vit K and lower the plas ma leve ls of fun ctional c lotting factors in a dose-dependent ma nne r. I lowever, effect or decline in levels or protein C and protein S is overshadowed by the decline in the le vels or cloning factors. Whi le osteocalcin defi cit may depress new bone formation, dcnsily of adult bone is little affected. K antagonists are primari ly pharmacokinetic and in the adverse side effects produced by them. Though the synthesis of clolling factors diminishes within 2- 4 hours of warfa rin admin istration, anticoagulant effect develops grad ually over the next 1-3 days as the levels of the clotting factors already present in pla ma decline according to their half li ves. Thus, there is always a delay betv,een administration of coumarin drugs and the anticoagulant effect. The commercial preparation of warfa rin is a mixture of R (dextrorotatory) and S (levorotatory) enantiomers. Both are partial ly conj ugated with glucuronic acid and undergo some enterohepatic circulation; finally excreted in urine. Warfarin is rapidly and completel y absorbed fro m intestines and is 99% plasma protein bound. It crosses placenta and is secreted in milk: however, quantity of acti ve form is generally insufficient to affect the suckling infant. Acenocoumarol (Nicoumalone) Ethylbiscoumacetate 36-48 18-24 3-6 2-1or 2-8 Alopecia, dermatitis, diarrhoea Oral ulceration, g. But this va lue di fThe rs depending on the source of the thromboplastin (T p) that has been used for the tes t. Bleeding is more li ke ly if therapy is not properly monitored, or whe n the Inte rnationa l normalized ratio (I R) exceeds 4, or interacting drugs/contraindications are present. Cutaneous necrosis is a rare complication that can occur with any coumarin an ticoagula nt. Wa rfarin and acenoco umarol are considered to be the most sui table and better tolerated drugs. Factors whi ch enhance the effect of coumari n anticoagulants (see above) should a lso be taken into consideration. Warfari n given in early pregna ncy inc reases birth defects, especia lly ske letal abnorma liti es. It c an produce foetal warfarin syndro111e- hy po plasia of nose, eye socke t, ha nd bones, and growth retardation.
Its d-isomer quinidi nc is used as an antiarrhythm ic (and for malaria as well in some countries) breast cancer mammogram buy 0.25 mg dostinex free shipping. However, resistance even to quinine has been described in certain parts of Southeast Asia and in Brazil where quinine + tetracycline has been the standard treatment of complicated malaria. Quinine-resistance has been encountered sporadically in India, particularly along Myanmar border. Though effective in terminating an acute attack of falciparum malaria, quinine may not prevent recrudescence-indicating incomplete clearance of the parasites. It is 70% bound to plasma proteins, especiall y a 1 acid glycoprotein, which increases during acute malarial in fection. Adverse effects Toxicity of quinine is high and dose related; 8- 10 g taken in a single dose may be fatal. Poisoning "ith still higher doses results in lhe above symptoms in an exaggerated form. Few individuals arc idiosyncra tic/ hypersensitive to quinine: cinchonism may appear after a single therapeutic dose. Q uinine occasionally causes hacmolysis, especially in pregnant women and m patients of falciparum malaria, resulting 111 haemoglobinuria (blac k \ ater fever) and kidney damage. During pregnancy it should be used only for serious falciparum ma laria, with special care to prevent hypoglycaemia. Proguanil (Chloroguanlde) It is a relatively slow-acting erythrocytic schizontocide for both Pf and P,i In addition. In the late 1940s and early 1950s proguanil was extensively used as a clinical curative for vivax malaria, especially in endemic areas with panially immune population. I lowcvcr, such use is now obsolete, because proguanil alone cannot be relied upon in nonimmunc patients, panicularly those with falciparnm malaria, due to slow response and chances of rapid resistance. Currently in India, proguan il has little role either in prophylaxis or in clinical cure of malaria. However, c linical trials have established that parenteral artemisinins are faster acting. Though, both components a re slow acting, the combination acts faster, so that it can be e mployed as a clinical curati ve for P falciparum. By the add ition of sulfo namide, development of resistance to pyrimetham ine is retarded.
The need fo r 14 daily doses o fprimaquine for effective re lapse prevention is the biggest hurdle in implementing antirelapse therapy pregnancy depression dostinex 0.25 mg on line. It markedly potentiates the antimalarial activity of quinine and artcmisinin, and is always used in combi nation with one of these. C lindamycin is a second choice drug to doxycycline for adding to quinine or 10 artesunate for the treatment of rnultidrug resistant falc iparum malaria. However, clindamycin is not used for prophylaxis of malaria, because of thrice daily dosing and ri,k of adverse cfl"ects. It is a sesquiterpene lactone endoperox ide acti ve against Pfalciparum resistant to a ll other antima la rial drugs as well as sensitive strains and other malaria l species. Howeve r, no c li nic a ll y use ful action is exerted on the preerythrocytic stage. By decreasi ng the population of ga metes, they reduce but do not totally interrupt disease transmission. Recnidescence depends upon the dose and duration of therapy as well as on severity of disease. Resistance among Pf to artemisinins is not a clinical problem yet, but in some areas (Cambodia, Thailand. After 5 days treatment recrudescence rate is ~ I0%, while with a 3 day course it is ~50%. After oral ingesti on, absorption is incomplete but fast, reaching peak in <60 min. The endoperoxide bridge in its molec ul e appea rs to interact wi th hae me in the parasite. Ferrous iron-mediated cleavage Arteether this compound developed in India is available for i. Adverse effects Data from > I 0000 monitored patients shows that artesunate and artemether produce few adverse effects; most are mild: nausea, vomiting, abdominal pain, itching, drug fever, delayed haemolysis and other hypersensitivity reactions. Headache, tinnitus, dizziness, bleeding, dark urine, transient reticulopenia and leucopenia are rare and subside when the patient improves or the drug is stopped. Millions of patients have been treated so far without any serious neurological or other toxicity, but close monitoring of the patient is advocated. Interactions Concurrent administration of artemisinins with drugs prolonging Q-T, like antiarrhythmics, tricyclic antidepressants and phenothiazines may increase the risk of cardiac conduction defects.
Oral iron should not be g iven conc urrentl y and till 5 days after the last injection women's health clinic pueblo co discount 0.25 mg dostinex with amex. Ferric carboxymaltose In this formulat ion the ferric hydrox ide core is stabilized by a carbohydrate shell. In cli nical trials, it has caused a rapid increase in haemoglobin level in anaemia patients a nd replenished stores. Iron deficiency is the commonest cause of anaemia, especially in developing countries where a sizable percentage of population is anaemic. Iron de fic iency also accompanies repeated a11acks of malaria a nd chronic inflammatory diseases. Iron should be norma lly administered orally; parenteral therapy is to be reserved for special c ircumstances (see p. It consists of iron bound tig htly in a matrix of isomaltosie- 1000, whi ch is an oli gosaccharide with mean M. The tig ht binding within the matrix re leases very little labile iron which is respo nsible for toxic ity. The immunogenic potentia l of iron isomaltoside-1000 is low, and it has been well to lerated in c linica l tria ls Iron isomaltoside-1000 Prophylaxis: The amount of iron available fro m average diet and the absorpti ve processes in the in testine place a ceiling on iron absorption of - 3 mg/day. Later half of pregnancy and infancy are periods when iron deficiency wi ll develop unless medicinal iron is supplemented. The iron status of these patients shou ld be evaluated and iron given accordi ngly. Supportive measures Fluid and e lectro lyte bala nce should be maintai ned and ac idosis corrected by appro priate i. Miscellaneous/Adjuvant haematinies Hacme synthesis is interfered in copper deficiency. I lowever, copper is a Lracc metal for ma n und c linica l de fi c iency is very rare. Sideroblastie anaemia associated with isoniaLid and pyrazinamide therapy (which interfere with pyridoxinc metabolism and action) needs to be treated with pyridoxine. Manifestations are vomiting, abdomina l pai n, haemate mes is, dia rrhoea, letha rgy, cya nos is, dehydration, acidosis, con vulsions; finally shock, cardiovascular collapse and death. In few cases death occurs early (within 6 hours), but is typically de layed to 12-36 hours, with a ppa rent improvement in the intervening period. The pathological lesion is haemon-hage and inflammation in the gut which may progress to necrotizing e nteritis, hepatic necrosis and bra in damage. Apa rt from haemopoieti c cells, other rapidl y pro lifera ting ti ssues a lso suffe r. To prevent further absorption of iron from gut (a) Induce vomiting or perfo rm gastric lavage with sodium bicarbonate solutio n- to render iron inso luble.
Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death pregnancy acne cheap 0.5 mg dostinex overnight delivery, myocardial infarction, and stroke in high risk patients. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events 33. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Meta-analysis of trials comparing beta-blockers, calcium antagonists, and nitrates for stable angina. Benefit of -blocker treatment for patients with acute myocardial infarction and preserved systolic function after percutaneous coronary intervention. A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo- 43. Angiotensinconverting enzyme inhibitors in coronary artery disease and preserved left ventricular systolic function: a systematic review and meta-analysis of randomized controlled trials. Blood pressure-dependent and independent effects of agents that inhibit the renin-angiotensin system. Effects of annual influenza vaccination on winter mortality in elderly people with chronic heart disease. Patterns and intensity of medical therapy in patients undergoing percutaneous coronary intervention. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. If achieved with rosiglitazone, risk of cardiovascular complications is reduced 4. Moderate-intensity physical activity is recommended for 20 minutes 3 times per week. Highintensity statin therapy includes atorvastatin 40 to 80 mg daily or rosuvastatin 20 to 40 mg daily.
Arakos, 33 years: Though liothyronine (T3) acts faster, its use is attended by higher risk of cardiac arrhythmias, angina, etc. Primary di sease: Topical treatment has low efficacy; 5% o intment is applied locally 6 times a day for 10 days.
Lester, 57 years: These apps can provide structured educational content or "just-in-time knowledge chunks" that can assist the interventional cardiologist at the bedside. Iron dissociates from the complex at the ac idic pH of the intracellular vesicles; the released iron is utilized fo r haemoglobin synthesis or other purposes, w hile Tf and TfR are returned to the eel I surface to carry fresh loads.
Aschnu, 51 years: It is a lso long-acting, causes marked pituitary-adrenal suppression, but fluid retention and hypertension are not a problem. They often finance the patent application process and explain how to license technology in order to start up a new business.
Cronos, 64 years: Buspirone relieves generalized anxiety of mild-to-moderate intensity, but is ineffective in severe cases and in those showi ng panic reaction. When clinical information is embedded in enduring materials, its relevancy is quickly dated and it requires significant financial resources and effort to keep clinical information up to date, especially when it is in noneditable formats such as video or web-based packages.
Ketil, 27 years: It emulsifies the colonic contents and increases penetration of water into the faeces. The basal ganglia modulatory loop serves to smoothen output to the spinal motor neurone and reduce basal tone.
Kerth, 46 years: Other side effects are increased appetite and weight gain (not with haloperidol); aggravation of seizures in epileptics; even nonepileptics may develop seizures with high doses of some antipsychotics like c lozapine an d occasionally olan z apine. Moreover, trimethopr im is more rapid ly absorbed than sulfamethoxazole-concentration ratios may vary with time.
Tarok, 32 years: Patients have, in the most profound situations, hemodynamic collapse or a severe ischemic syndrome, depending on the size of the affected vessel territory. It is an u ltrashort acting thiobarbiturate, highly solu ble in water yielding a very alkaline solution, which must be prepared freshly before inj ection.
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