By Q. Sanford. Bowling Green State University. 2018.

It commonly causes weight gain and hair loss buy prilosec 10mg mastercard gastric bypass diet, but it can also damage the liver and so if this medicine is being taken purchase prilosec 20 mg otc chronic gastritis support group, regular blood test called S. If the symptoms point out to this the drug may have to be stopped after conducting the blood test again and confirming the clinical findings. If a pregnant woman takes this drug there are reports of damage to the spinal cord of the baby, though the proportion is in 10 babies out of every 1000. The presence of this defect can be ascertained by sonography, blood test called alpha-fetoprotein, or amniocentesis and if a problem is detected the pregnancy should be terminated. Instead of this drug, another slightly different drug called eterobarb is used in Europe, which has fewer side - effects. Therefore, this medicine is usually given to patients before age of 60 years, who do not have problems of prostrate. While on this medicine, it happens quite often that the patient may try to get up suddenly and fall adown due to sudden drop of blood pressure; this is known as postural hypotension. If this happens the medicine has to be given in a different form, changed or eventually surgery has to be resorted to. But it can also cause side - effects like skin diseases in the feet (Livedo reticularis), heart problems, swelling in legs, mental confusion, depression etc. Latest medicines like Pramipexole, Ropinirole, Tolcapone,Entacapone, etc have lesser side effects and are comparatively more effective. Long term side effects are yet to be ascertained, as these drugs have not been around for a long period. Nausea, vomiting, acidity, are common side- effects and peptic ulcer can also lead to vomiting of blood. Usually in 2% to 3 % of cases decrease in blood white cells occurs apart from allergy, stomach upset, diarrhoea etc. In addition to this in some specific cases oral anticoagulant (Warfarin, Acitrom) drugs are also given to prevent coagulation of the blood. It can also lower the blood pressure and the heart beats If this drug in taken in a large dose for a long time it can cause impotence in men and the circulation of blood in the legs is compromised. But now-a-days it has been observed that these medicines are being used inappropriately and in improper doses in very simple diseases and in most cases unnecessarily. Sometimes the blood becomes too thin and bleeding may start (Cephalosporin), occasionally, penicillin group of antibiotics may cause a severe reaction a few minutes after being injected and the patient may die right in presence of the doctor. These antibiotics should be used only where they are required and before administering a full dose, a test dose is given on the skin and if there is no reaction within half an hour then the full dose is given. Finally, once again I would like to draw your attention to the fact that the above mentioned drugs should never be taken without medical advice and supervision The above mentioned particulars are only for the sake of information, which I personally feel can save life. Especially if the patient is unconscious, the condition is very serious or is extremely weak at that time; special care is very essential. If the relatives of a hospitalized patient are aware of the following information regarding the various treatments, it can be very helpful during patient mangement. The bubbles in the bottle kept besides the oxygen cylinder indicate that the patient is getting oxygen. Now-a-days, in many city hospitals oxygen is supplied through a central line, where such supervision is not required. If the fluid stops or leaks or the speed of the fluid falls or increases or there is a swelling or redness in the place where the needle is injected or the patient feels cold or shivering occurs or gets fever the attending nurse/staff should be immediately informed. If the relative of a patient has to perform this function, he should understand the procedure very clearly. As instructed, one should give these liquids in the quantity decided by the doctor every 2 to 3 hours and a note of the same should be maintained for the doctor’s information. This is done through a small cut in the skin over the abdomen, a special long - lasting tube is inserted into the stomach. If the patient is likely to remain unconscious for more than 1-2 weeks the hazards of nasal tube feeding can be averted with such gastrostomy tube insertion, which can save life of the patient. One should make a note of the total amount of urine passed by the patient during 24 hours and this should be reported to the doctor.

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It must be remembered that crystalloid infusions should be provided while the blood compound is obtained prilosec 40mg visa gastritis symptoms in dogs. Symptomatic patients exhibiting air hunger generic prilosec 10mg free shipping gastritis with duodenitis, dizziness, significant tachycardia or cardiac failure should, of course, be transfused. Component therapy is indicated when specific factor deficiencies are demonstrated. Compatibility tests If administrated blood is incompatible with the patients own blood, life threatening reactions may result. Group-A contains anti-B antibodies, Group-B contains anti-A antibodies, Group-O contains anti-A and anti B antibodies. In some instances when fully cross- matched compatible blood is depleted or unavailable; type specific or O negative blood should be given. Irregular recipient antibodies cannot be detected and extra vascular hemolysis can also occur. Overall, O negative blood, if randomly transfused, has a serologic safety of about 99. Component therapy Treatment of specific hematologic abnormality often requires only a single component of whole blood. Blood banks reduce the whole blood received from donors to a variety of components. The available products include whole blood, red blood cells, white blood cells, platelet concentrates and plasma in several forms. When it is used within 24 hours it is considered fresh, whole blood and after this time it is referred to as stored. In acute massive hemorrhage transfusion with one unit of whole blood raises the recipient’s hematocrite by 3%. Platelet concentrate Platelets are separated from one unit of blood and suspended in a small volume of the original plasma. Cryoprecipitate 0 This is a protein fraction removed from a unit of fresh frozen plasma that is thawed at 4 c. Plasma protein fraction Similar to albumin but contains additional protein molecules. Complications and risks of blood transfusion Hemolytic transfusion reactions Intravascular hemolytic transfusion reactions; are potentially life threatening reactions that can occur by blood transfusion. Pathophysiology During hemolytic transfusion reaction all donor cells hemolyze, leading to hemoglobinemia, hemoglobinuria and renal failure. These reactions also activate the complement system with subsequent release of vasoacative amines causing hypotension. Treatment ƒ Stop transfusion immediately ƒ Administration of fluids and diuresis with mannitol or frusemide ƒ Transfused blood with patients blood sample should be sent for analysis ƒ Sodium bicarbonate may prevent precipitation of hemoglobin in the renal tubules ƒ Steroids may ameliorate the immunologic consequences. Transfusion reactions from mismatches involving the Rh system or minor antibodies usually induce extravascular hemolysis, since these reactions occur slowly, serious complications do not often develop. Non-hemolytic transfusion reaction Non-hemolytic reaction may occur after transfusions. Allergic reaction: occurs in 2-3% of all transfusion and manifests by urticaria and rashes. Other complications: Complications that can occur with massive transfusion include • Citrate toxicity • Acidosis • Hyperkalemia N. B:- As blood transfusion is accompanied by various complications mentioned above, the decision to transfuse should only be made when it is believed to be life saving. What factors determine the need for blood transfusion in patients with chronic blood loss or chronic anemia? But in addition to this, the patient’s pre-operative situation should be well evaluated so as to make the patient able to withstand the stress of surgery. Factors which make the patient high risk for surgery should be controlled as much as possible. Also, the patients’ postoperative course highly depends on the postoperative care given, and anticipation with early diagnosis and management of postoperative complications. General consideration Preoperative evaluation should include a general medical and surgical history, a complete physical examination and laboratory tests. The most important laboratory tests are: • Complete blood count • Blood typing and Rh-factor determination • Urinalysis • Chest x-ray Further laboratory tests should be performed only when indicated by the patients’ medical condition or by the type of surgery to be performed. Patients with heart disease should be considered high-risk surgical candidates and must be fully evaluated.

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D) Forensic toxicology Forensic toxicology closely related to clinical toxicology buy discount prilosec 20mg line gastritis diet . It deals with the medical and legal aspects of the harmful effects of chemicals on man purchase prilosec 20mg with mastercard gastritis diet fish, often in post mortem material, for instance, where there is a suspicion of murder, attempted murder or suicide by poisoning. Toxicokinetics and Toxicodynamics - Toxicokinetics deals with absorption, distribution, biotransformation (biotransformation) and excretion of chemicals. Toxicokinetics i) Absorption Absorption is the process by which the chemical enters the body. It depends on the route of administration, dissociation (to become ionized), dissolution (ability of solid dosage form to become soluble), concentration, blood flow to the site, and the area of the absorptive site. Bioavailability is the fraction of unchanged drug reaching the systemic circulation following of non-vascular administration. Volume of distribution (Vd) is calculated from the dose taken and the resulting plasma concentration: Vd = dose /plasma concentration The importance of volume of distribution in toxicology is - Predicting peak blood concentration of the chemical taken - Calculating the amount of substance in the body to verify the quantity ingested - Deciding whether to apply systemic toxin elimination techniques Factors determining the rate of distribution of chemicals in the body are - Protein binding – chemicals highly bound to protein have small volume of distribution - Plasma concentration – when the volume of distribution of chemicals is small, most of the chemical remains in the plasma - Physiological barriers – chemicals will not uniformly distributed to the body due to specialized barriers e. It is a process by which the body transforms a chemical and makes it more water soluble so the chemical can be eliminated more rapidly via the kidney into the urine. Biotransformation can produce metabolites that are pharmacologically active and toxic E. Liver is the major site of biotransformation for many chemicals & other organs that are involved are lungs, kidneys, skin &so on. Interactions during biotransformation includes There are two phases of biotransformation Phase I – the drug is converted into more polar compound e. Half life (t ½) –is the time required to reduce the blood concentration of the chemical to half. Excretion through the lungs is the major route for gaseous substances; and in the case of non-volatile water – soluble drugs, the kidneys are the most important routes of excretion. Additional routes include sweat, saliva, tears, nasal secretions, milk, bile and feces. It is a quantitative measure of the volume of blood cleared of drug per unit time, usually expressed in milliliter pe4r minute. B - Certain points regarding the toxicokinetics of toxic agents;  Drug absorption after a toxic ingestion may be delayed and prolonged;  The half-life and total body clearance are often lengthened;  Liver-metabolizing enzymes may become saturated, slowing hepatic elimination; 12 Toxicology  Chemicals with large volumes of distribution are often highly tissue-bound and measures to enhance their elimination are not effective;  Poor perfusion of the liver and kidneys secondary to the toxic effects of the substance may slow clearance. Toxicodynamics Toxicodynamics is the mechanism of action of a toxic chemical to the body (what chemicals do to the body). We have two types of responses so called Quantal dose response (all- or – none response) & graded dose response (when dose increases, the response increases in graded fashion). Comparison of dose –response curves for efficacy (A), toxicity (B), & lethality (C). The effective,toxic, &lethal dosage for 50% of the population in the groupcan be estimated as shown. Common effects of chemicals to cause symptoms Chemicals can cause symptoms through the following mechanisms a. Interfere with the transport or tissue utilization of oxygen (carbon monoxide, cyanide), resulting in hypoxia or a decrease in an essential substrate such as glucose b. Affect the autonomic nervous system, producing cholinergic action (organophosphate insecticide) d. Affect the heart and vasculature producing myocardial dysfunction, dysrrhythmias (antiarrhythmic agents) and hypertension or hypotension f. Potential sources of toxicities The potential causes of toxicities include • Therapeutic agents –drug toxicity can be due to over doses, unusual adverse effects, frequent administrations of therapeutic doses & drug interactions 15 Toxicology • Industrial chemicals- these chemicals may contribute to environmental pollution & they may be a direct hazard in the work place they are used. Environmental pollutants may be released into the air, water, or dumped onto land. Natural toxins may feature in poisoning via containing in food, by accidental ingestions of poisonous plants or animals & by stinging & biting • Food additives – have usually low biological activity. Many different additives are added to food to alter the flavor or colour, prevent spoilage or in some other way change the nature of the food stuff. There are also many potentially toxic substances which are regarded as contaminants. Unfortunately, misconceptions regarding safety &efficacy of the agents are common. Furthermore, the doses for 16 Toxicology active botanical substances may be higher. There are a lot of drugs of abuse with high potential of dependence & tolerance (e.

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Pregnant women during the third trimester of pregnancy should be de- wormed using mebendazole or albendazole (you will learn about the doses for this in Study Session 7 of this Module) 40 mg prilosec mastercard gastritis diet 7 hari. This should include as far as possible food from the different food groups (animal products generic prilosec 40mg without a prescription chronic gastritis group1, fruits, vegetables, cereals and legumes). A pregnant or lactating woman can get extra foods by eating a little more of ordinary meals. She should increase the amount of nourishment at one or two meals, not every meal. They may be anaemic, which in turn means that they may have difficulty in pregnancy and childbirth. A pregnant or breastfeeding mother should have enough iron to keep herself and her baby healthy. She should eat plenty of iron-rich foods every day such as dried beans, legumes, dark green leafy vegetables, liver, kidney and heart. A pregnant mother should go for her first antenatal care visit at the latest by the fourth month of her pregnancy. At the clinic, check her urine for excess sugar and proteins, and her blood for malaria (if she is showing signs of infection). You diagnose anaemia in the following way: Examine the lower eyelids, the inside of the lips and the palms which should be bright pink; if there is anaemia, all of these will be pale whitish. Give the mother iron tablets or tablets with iron and folate to build strong blood 27. If the iron tablets upset the mother or cause side effects, she should not stop taking iron, but eat more leafy vegetables. As a Health Extension Practitioner it is important that you identify the women who may need extra help and support. Encourage them to eat as good mixture of foods as they can afford (fruits, vegetables, animal source foods). Encourage other members of the household to do some of the work and lessen the work burden on the woman. The baby of an anaemic mother will not develop well and will have low birth weight. If there is anaemia, they will be pale whitish; if there is no anaemia they will be pinkish. When a baby sucks at the nipple, this causes the milk to come into the breast and continue to flow. Breastmilk is food produced by the mother’s body especially for the baby, and it contains all the nutrients (nourishment) a healthy baby needs. A lactating woman needs at least two extra meals (550 Kcal) of whatever is available at home. This will enable the baby to get an adequate supply of vitamin A for the first six months. During the first six months the best way of feeding the baby is for the mother to breastfeed exclusively. In addition to extra meals and one high dose of vitamin A, a breastfeeding womanalsoneeds:. Vitamin A rich foods (such as papaya, mango, tomato, carrot and green leafy vegetables) and animal foods (such as fish and liver). You have learnt what pregnant and lactating women require to be healthy and well for themselves and their babies. Now you are going to look at the nutritional requirements of infants, children and adolescents. Small children and infants do not have a well developed body nutrient store, and therefore are more vulnerable to infection. During the pubertal growth spurt, they increase rapidly both in weight and height. Therefore, they need a nutrient intake that is proportional with their rate of growth.

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