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These include: fi Overweight/obesity fi Disorders associated with various vitamin deficiencies fi Disorders associated with deficiency of some trace minerals 1. With regard to manifestation, clinical and anthropometric features are distinguished: 1. Casually the child may appear normal, but on close examination, the child looks thinner and smaller than other children of the same age. He has very severe muscle wasting with flaccid, wrinkled skin and bony prominence. There is failure of growth but the child is not as severely wasted as in marasmus. The child shows hair changes (having turned brown, straight and soft) and rashes on the skin (flaky paint dermatitis). It reflects failure to receive adequate nutrition over a long period of time and is also affected by recurrent and chronic illness. This is a composite indicator which takes into account both chronic and acute malnutrition. Causes include inadequate maternal food intake during pregnancy, short maternal stature and infection such as malaria. Cigarette smoking on the part of the mother also is associated with low birth weight. Most common medical complications in severely malnourished children include generalized oedema, hypothermia, hypoglycaemia, dehydration, anaemia, septicemia/infections and cardiac failure. Treat complications eg dehydration, shock, anemia, infections, hypothermia, hypoglycemia and electrolyte imbalance. In this regard men with over 24 percent body fat and women with over 35 percent body fat are considered obese. Desirable amounts are 8 to 24 percent body fat for men and 21 to 35 percent for women. Four major groups are distinguished: fi Haemorrhagic anaemia develops due to various forms of bleeding (trauma, excessive menses, bleeding associated with pregnancy and birth giving, and parasitic infestations such as hookworms and scistosomiasis). Bone marrow depression can be caused by diseases (autoimmune, viral infection), radiation and chemotherapy and intake of some drugs (anti-inflammatory, antibiotics). Nutritional anaemias are o Iron deficiency anaemia o Folic acid deficiency anaemia o Vitamin B12 deficiency anaemia Anaemia affects all population groups but children aged below five years and pregnant women are the most vulnerable. Detection of anaemia is by determining the concentration Hb and the cut-off points at sea level are as follows: Table 4: Population group Hb levels indicating anaemia (g/dl) Children 6 to 59 months Below 11. Iron in foods of animal origin (haem iron) is more easily absorbed compared with iron in foods of plant origin (which is mostly nonhaem iron). Vitamin C enhances absorption of iron while tea and coffee inhibits iron absorption. Iron Deficiency the main function of iron is transport of oxygen at various sites in the body. Thus iron is a component of haemoglobin and myglobin (protein molecule in the muscle which carries oxygen for muscle metabolism). Iron is a component of cytochromes (involved in cell respiration); component of xanthine oxidase (involved in catabolism of purines which make nucleic acids). Iron deficiency erythropoiesis: storage levels substantially reduced, inadequate iron is available in the bone marrow for the synthesis of Hb.


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Alternatively, diagnosis is made by touching the perianal skin with transparent (not translucent) adhesive tape to collect any eggs that may be present; the tape is then applied to a glass slide and examined under a low-power microscopic lens. Specimens should be obtained on 3 consecutive mornings when the patient frst awakens, before washing. For children younger than 2 years of age, in whom experience with these drugs is limited, risks and benefts should be considered before drug administration. Reinfection with pinworms occurs easily; prevention should be discussed when treatment is given. Infected people should bathe in the morning; bathing removes a large proportion of eggs. Specifc personal hygiene measures (eg, exercising hand hygiene before eating or preparing food, keeping fngernails short, avoiding scratching of the perianal region, and avoiding nail biting) may decrease risk of autoinfection and continued transmission. All household members should be treated as a group in situations in which multiple or repeated symptomatic infections occur. In institutions, mass and simultaneous treatment, repeated in 2 weeks, can be effective. Bed linen and underclothing of infected children should be handled carefully, should not be shaken (to avoid spreading ova into the air), and should be laundered promptly. Lesions can be hypopigmented or hyperpigmented (fawn colored or brown), and both types of lesions can coexist in the same person. Lesions fail to tan during the summer and during the winter are relatively darker, hence the term versicolor. Common conditions confused with this disorder include pityriasis alba, postinfammatory hypopigmentation, vitiligo, melasma, seborrheic dermatitis, pityriasis rosea, pityriasis lichenoides, and dermatologic manifestations of secondary syphilis. Although primarily a disorder of adolescents and young adults, pityriasis versicolor also may occur in prepubertal children and infants. Malassezia species commonly colonize the skin in the frst year of life and usually are harmless commensals. Malassezia infection can be associated with bloodstream infections, especially in neonates receiving total parenteral nutrition with lipids. Growth of this yeast in culture requires a source of long-chain fatty acids, which may be provided by overlaying Sabouraud dextrose agar medium with sterile olive oil. Other topical preparations with off-label therapeutic effcacy include sodium hyposulfte or thiosulfate in 15% to 25% concentrations (eg, Tinver lotion) applied twice a day for 2 to 4 weeks. Oral antifungal therapy has advantages over topical therapy, including ease of administration and shorter duration of treatment, but oral therapy is more expensive and associated with a greater risk of adverse reactions. A single dose of ketoconazole (400 mg, orally) or fuconazole (400 mg, orally) or a 5-day course of itraconazole (200 mg, orally, once a day) has been effective in adults. Some experts recommend that children receive 3 days of ketoconazole therapy rather than the single dose given to adults. For pediatric dosage recommendations for ketoconazole, fuconazole, and itraconazole, see Recommended Doses of Parenteral and Oral Antifungal Drugs, p 831. Exercise to increase sweating and skin concentrations of medication may enhance the effectiveness of systemic therapy. Patients should be advised that repigmentation may not occur for several months after successful treatment. Buboes develop most commonly in the inguinal region but also occur in axillary or cervical areas. Less commonly, plague manifests in the septicemic form (hypotension, acute respiratory distress, purpuric skin lesions, intravascular coagulopathy, organ failure) or as pneumonic plague (cough, fever, dyspnea, and hemoptysis) and rarely as meningeal, pharyngeal, ocular, or gastrointestinal plague. Abrupt onset of fever, chills, headache, and malaise are characteristic in all cases.

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Mode of Transmission the common cold is transmitted by direct contact, by respiratory droplets from sneezing or coughing, or by sharing items contaminated with saliva or droplets. Instruct students not to share items that may be contaminated with saliva, such as beverage containers 5. If the student develops ear pain, severe sore throat, difficulty breathing, or exhibits symptoms beyond 10 days, advise the parent/guardian to call their licensed health care provider. Infants, children, and teenagers should not use aspirin unless prescribed by a health care provider because of its association with Reye Syndrome. Vision is usually normal; however, the eye may water profusely and feel irritated. Rare severe causes of conjunctivitis are herpes and gonococcui, which need treatment. Conjunctivitis may also be caused from allergens, such as cosmetics or pollen; reaction to air pollutants, such as dust or smoke; and foreign bodies in the eye, such as contact lenses. Exclude student from school and refer to licensed health care provider if there is white or yellow drainage from the eye, altered vision, and/or redness of the eyelid or skip surrounding the eye. If the student wears contact lenses, advise the student and parents to consult with a licensed eye care professional. Students with conjunctivitis should not share school or classroom equipment that touches the eyes, such as microscopes. Report to your local health jurisdiction clusters of cases, regardless of the suspected cause of conjunctivitis. During outbreaks in schools, students and staff with certain high-risk conditions (anemia, immunodeficiencies, and pregnancy) should be informed of the possible risks of acquiring the infection. Instruct staff who care for infants in proper methods of diaper changing and disposal of soiled materials. On the basis of the test and in consultation with her licensed health care provider, a decision can be made on acceptable risk in unusual school settings involving frequent, sustained contact with secretions or urine. Wash hands after contact with respiratory secretions, urine, or feces, and properly discard any material contaminated with secretions or excretions, such as tissues or diapers. Most cases are due to viruses, but other causes include bacteria and parasites like Giardia. Type and severity of symptoms vary by the causative organism and the resistance of the person infected. Food handlers with diarrhea should be cleared by a licensed health care provider or their local health jurisdiction before returning to work. The importance of proper handwashing techniques, refrigeration, cooking, and serving of food must be stressed to employees. Future Prevention and Education the main methods of prevention are reinforcement of principles of personal hygiene such as proper hand washing techniques after using the bathroom or touching animals. Students will be kept at home during the times that symptoms make them uncomfortable or when their health care provider or local health jurisdiction so advises. Students may be excluded for certain transmissible infections until testing negative. Persons ill with diarrhea should not swim in pools or lakes and should not handle food to be eaten by others until symptoms are gone.

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Either a person tries to get away from the family or is banished from the family, or an ancestor was banished from the family and the client reenacts that banishment. People in North America or Australia may express Lyme as a result of this conflict. One client was a woman from New Zealand; she was out of her pack and had a Lyme reaction. In their consultation the woman talked about this type of separation, and then her symptoms were exacerbated and then resolved. The immune system tries valiantly but it can no longer cope without the proper building blocks. However, when it is given the structural support with the proper nutrients, things begin to turn around. They each describe how they got involved in treating Lyme; the increasing epidemic of Lyme; and a dozen co-infections with up to 1,000 strains of some; the testing to try to verify infections; and the extensive treatment protocols involving dozens of remedies. I think this protocol gives you something quite simple to follow that can help eliminate a large part of the problem and give you a strong foundation on which to build your health. These steps, beyond diet, probiotics, and antifungals, will help you fine-tune your Yeast ReSet and reach your balance point. You may, of course, incorporate all these steps from the beginning of your Yeast ReSet Protocol. I spoke about leaky gut in Chapter 3, but leaky sinus and leaky nasal mucosa membranes are also created by yeast. Leaky sinuses allow the same to happen when you inhale toxic fumes and microscopic particulate matter from cigarette smoke, car exhaust, gasoline, mold, perfume, and even laundry products. Being sensitive to one chemical often triggers a whole list of offenders as the immune system is forced to deal with increasing levels of foreign chemicals. Even if you are in a sealed up room, the outgassing of rugs, furniture, appliances, paint, and office equipment can build up to measureable levels. But, you can try and limit your exposure and be sure to air out stuffy rooms to help take the pressure off your immune system. You can review the following list of chemical contacts and take steps to minimize your exposure. Remarkably, outside air is often less contaminated than indoor air, even taking into consideration the dangers of air pollution.

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Because sexual contact is the only known route of transmission, the diagnosis of chancroid in infants and young children is strong evidence of sexual abuse. Confrmation is made by isolation of Haemophilus ducreyi from a genital ulcer or lymph node aspirate, although sensitivity is less than 80%. Because special culture media and conditions are required for isolation, laboratory personnel should be informed of the suspicion of chancroid. Fluorescent monoclonal antibody stains and polymerase chain reaction assays can provide a specifc diagnosis but are not available in most clinical laboratories. H ducreyi strains with intermediate resistance to ciprofoxacin or erythromycin have been reported worldwide. Clinical improvement occurs 3 to 7 days after initiation of therapy, and healing is complete in approximately 2 weeks. Adenitis often is slow to resolve and can require needle aspiration or surgical incision. Patients should be reexamined 3 to 7 days after initiating therapy to verify healing. If healing has not occurred, the diagnosis can be incorrect or the patient may have an additional sexually transmitted infection, so further testing is required. Close clinical follow-up is recommended; retreatment with the original regimen usually is effective in patients who experience a relapse. Regular condom use may decrease transmission, and male circumcision is thought to be partially protective. Immunization status for hepatitis B and human papillomavirus should be reviewed and updated if necessary. C pneumoniae can present as severe community-acquired pneumonia in immunocompromised hosts and has been associated with acute respiratory tract exacerbation in patients with cystic fbrosis and in acute chest syndrome in children with sickle cell disease. Physical examination may reveal nonexudative pharyngitis, pulmonary rales, and bronchospasm. Chest radiography may reveal an infltrate(s) of a variety of patterns ranging from pleural effusion and bilateral infltrates to a single patchy subsegmental infltrate. C pneumoniae is distinct antigenically, genetically, and morphologically from Chlamydia species and is grouped in the genus Chlamydophila. The disease occurs worldwide, but in tropical and less developed areas, disease occurs earlier in life than in industrialized countries in temperate climates. In the United States, approximately 50% of adults have C pneumoniae-specifc serum antibody by 20 years of age, indicating prior infection by the organism. Serologic testing has been the primary laboratory means of diagnosis of C pneumoniae infection. Of the serologic tests, the microimmunofuorescent antibody test is the most sensitive and specifc serologic test for acute infection and currently is the only endorsed approach. A fourfold increase in immunoglobulin (Ig) G titer between acute and convalescent sera or an IgM titer of 16 or greater is evidence of acute infection; use of acute and convalescent titers is preferable over an IgM titer. Use of a single IgG titer in diagnosis of acute infection is not recommended, because during primary infection, IgG antibody may not appear until 6 to 8 weeks after onset of illness and increases within 1 to 2 weeks with reinfection. In primary infection, IgM antibody appears approximately 2 to 3 weeks after onset of illness, but caution is advised when interpreting a single IgM antibody titer for diagnosis, because a single result can be either falsely positive because of cross-reactivity with other Chlamydia species or falsely negative in cases of reinfection, when IgM may not appear. C pneumoniae can be isolated from swab specimens obtained from the nasopharynx or oropharynx or from sputum, bronchoalveolar lavage, or tissue biopsy specimens. Culturing C pneumoniae is diffcult and often fails to detect presence of the organism. A positive culture is confrmed by propagation of the isolate or a positive polymerase chain reaction assay result. Nasopharyngeal shedding can occur for months after acute disease, even with treatment.

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Further, it is reasonable to presume that diagnosis of some of the components of the metabolic syndrome may be anxiolytic. For example, irrespective of actual blood pressure levels, perceived hypertensive status was positively associated with anxiety (Spruill et al. A recent review concluded that evidence relating depression to the metabolic syndrome was stronger for women than men (Goldbacher & Matthews, 2007). Finally, although we adjusted for many possible confounders, residual confounding as a consequence of poorly measured or unmeasured variables cannot be wholly discounted. However, there is at least some cross-sectional and prospective evidence of a positive association (Patten et al. At the medical examination in 1986, with the participant in a sitting position, a registered nurse, using a standard mercury sphygmomanometer to blood pressure measured, twice consecutively, from both arms. Hypertension was defined by having one of the following: a reported physician-diagnosis at interview; reported taking antihypertensive medication; an average systolic blood pressure fi 140 mmHg; an average diastolic blood pressure fi 90 mmHg at the medical examination. There were 441 participants who indicated during the telephone interview that they had a physician diagnosis of hypertension and a further 98 who, although not reporting a diagnosis of hypertension, indicated that they were taking antihypertensive medication. Others have encountered individuals without an acknowledged diagnosis of hypertension who report taking antihypertensive medication and have designated them as hypertensive (Patten et al. The remainder and majority (N = 842) of those classified as hypertensive was as a result of the blood pressure assessment at the medical examination. This suggests that there was substantial undiagnosed and/or untreated hypertension. As our outcome measure is hypertension, it is essential to include participants with a physician diagnosis of hypertension in that outcome. Of the participants with a diagnosis of hypertension, 292 (66%) were taking anti-hypertensive medication. The effect of this would be to lower blood pressure, such that some of these participants (N = 108) no longer met a criterion solely based on measured blood pressure. Given that antihypertensive medication can be prescribed for conditions other than hypertension, hypertension was redefined based on only physician diagnosis and measured blood pressure. This reduced the sample to 4180 and the numbers classified as hypertensive as 1329 (32%). Generalised Anxiety Disorder, Mortality and Disease: A Stronger Predictor than Major Depressive Disorder 131 However, in the fully adjusted comorbidity competitive analysis, no statistically significant relationships emerged. The only association to approach significance was between co-morbidity and hypertension. This proportion is somewhat higher than that reported from studies with participants of a similar mean age. However, in part this could reflect different definitions of hypertension; relying solely on reported diagnostic and medication status, and not including measured blood pressure, will almost certainly lead to an underestimate of prevalence. In addition, the present sample was clustered at the low end of the socio-economic spectrum. Other analyses indicate an inverse gradient between socio-economic status and measured blood pressure, although a less consistent association between socio-economic position and hypertension treatment rates (Colhoun, Hemingway, & Poulter, 1998). In the present sample, however, household income in midlife was associated with hypertension. The latter result is consistent with the cross-sectional and prospective outcomes from the Canadian National Population Health Survey (Patten et al. It is possible that co-morbidity signals more severe psychiatric dysfunction and that it is the severity of dysfunction that is associated with physical health outcomes, similar to the findings for mortality above. However, it is also possible that comorbidity reflects a greater negative disposition, and it is this which is associated with hypertension (Suls & Bunde, 2005). In addition, in the majority of instances in the present study, hypertension was apparently undiagnosed. In the present analyses, the associations were still evident following adjustment for two of the most prominent unhealthy behaviours, smoking and high levels of alcohol consumption. That smokers have lower blood pressure and that alcohol consumption is positively related to hypertension are common observations (Beilin, 1987; Green, Jucha, & Luz, 1986). Although we have no data directly pertaining to the second route, others have observed altered activity of the hypothalamic132 Anxiety and Related Disorders pituitary-adrenal axis in approximately 50% of depressed patients (Brown, Varghese, & McEwen, 2004), which, in turn, may increase the risk of hypertension (Torpy, Mullen, Ilias, & Nieman, 2002).

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Alternative strategies for dealing with worry that do not maintain the anxiety and worry are covered in later sections of the manual. This information will help you and your therapist plan the best strategies to help you manage problems with generalized anxiety. The monitoring will also make sure that you are aware of the progress you are making, even if in small steps. If you are often troubled by the following symptoms when anxious or worried, you may be hyperventilating: Dizziness light-headedness Confusion Breathlessness blurred vision feelings of unreality numbness and tingling in the extremities cold, clammy hands stiffness in the muscles tightness or pain in the chest a fear that something bad is about to happen. A number of factors such as emotion, stress, or habit can cause us to increase our breathing. The most important effect of hyperventilation is that it produces a marked drop in carbon dioxide. Through complicated automatic mechanisms designed to restore the balance, a number of physical changes occur, resulting in a slight reduction in the levels of oxygen getting to various parts of the body, including the brain. Many people that over-breathe also tend to breathe with their chest muscles rather than their diaphragm, and these muscles therefore become tight and painful. It is an automatic reaction for the brain to immediately expect danger and for the individual to feel the urge to escape. This leads some people to fear physical harm from the symptoms of anxiety themselves. Their pattern of hyperventilation may be subtle, or they may be only focusing on one or two of the symptoms produced. To 15 assess whether or not you hyperventilate, you can (i) monitor your breathing, or (ii) deliberately hyperventilate to see what physical feelings are produced. For one minute (timed), count one breath in and out as 1, the next breath in and out as 2, and so on. Time yourself for one minute and write the answer here: Now consider the following: Do you breathe too quicklyfi If your rate of breathing is much greater than this (say 15 or more breaths per minute), then you must reduce it. You should breathe from the abdomen and through the nose, consciously attempting to breathe in a smooth and light way. Is your hyperventilation episodic (occurring only during episodes of high anxiety or depression), or habitual (occurring through much of the day)fi Habitual over-breathing involves slight increases in depth or speed of breathing sustained over a long period. Generally, this is not enough to bring on a panic attack, but leaves the person always feeling apprehensive, slightly dizzy, and unable to think clearly. Really work hard to over-breathe, and stop when you experience symptoms in the first stage of hyperventilation. Do this before tackling a difficult situation, or any time when feeling tense or anxious. The more you practice this slow-breathing technique, the better you will become at using it to manage symptoms of hyperventilation. A small number of individuals report that they get symptoms of anxiety when they first start breathing retraining. This is probably due to breathing a little fast or becoming sensitive to breathing patterns when you think about them.

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The possibility of termination of pregnancy or very close follow up Health education and health promotion of foetal development should be discussed with Advice to females planning pregnancy to check parents following infection in early pregnancy. It usually starts behind the ears, can lead to fatal complications including on the forehead, and around the mouth. Many children suffer maculopapular rash quickly spreads over the trunk subsequent deafness, impaired vision or blindness. Prognosis If post-infectious encephalitis occurs the prognosis Manifestations is poor with a 15% mortality. Health education and health promotion Diagnosis As for diphtheria Clinical Methods of treatment Supportive, no specific treatment available. Prevention of spread Prophylaxis is by active immunization with vaccine as part of a combined vaccine with mumps and rubella. Methods of treatment Role of primary health care team Treatment is with antibiotics. Cephalosporins, for example Cefotaxime or Chloramphenicol, are often used empirically until Role of hospital/community setting antibiotic susceptibility is known. See Appendix 1 respiratory infections are treated with ampicillin or cotrimoxazole. Cefotaxime or Chloramphenicol Health education and health promotion are given for epiglottitis. Ninety-nine percent of the deaths occur in pneumonia in young children and the elderly. Streptococcus pneumoniae is the most frequent cause of bacterial pneumonia Prognosis in children. Without Streptococcus pneumoniae may be isolated from treatment pneumonia kills quickly. Due to the emergence of antibiotic resistant strains of Methods of treatment bacteria, treatment is becoming more expensive.

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Children who are fever, or have passed six or more diarrhoeal stools awake are very thirsty; however, when there is in the past 24 hours. Children with diarrhoea but no signs of dehydration usually have a fluid deficit, but it Severe dehydration requires urgent treatment, usually equals less than 5% of their weight. This category includes both mild and moderate Weight is important for determining the amount dehydration, which are descriptive terms used in of oral or intravenous fluid to be given in treatment many textbooks: plans B and C. There is increased thirst: has been completed and that weight should be older patients ask for water and young children recorded on the chart. If possible, children with drink eagerly when offered fluid from a cup or no signs of dehydration should also be weighed spoon. If Using a patient record form possible, a fresh stool specimen should also be Information on the history, examination, and observed for visible blood. If Giardia cysts, or findings following rehydration therapy at the health trophozoites of either Giardia or E. It also with persistent diarrhoea, therefore such drugs helps remind the healthcare worker of all of the steps should not be given. Additionally, in areas where have normal stools for one or two days after which vitamin A deficiency is a public health problem, diarrhoea resumes. In turn, malnutrition contributes to diarrhoea, which is more severe, Animal milk or infant formula prolonged, and possibly more frequent. When these steps are followed, malnutrition can be either prevented or corrected and the risk of Weaning foods (for children aged 6 months or older): death from a future episode of diarrhoea is much At what age were soft foods startedfi Page 67 problems and to obtain the information needed How much food is given and how to make dietary recommendations. The following examinations may be performed: Weaning foods Have these been continuedfi Weight-for-age is most What does the mother believe about giving valuable when recorded on a growth chart and used breast milk, animal milk, formula, or other to monitor growth over time; a series of points fluids or foods during diarrhoeafi If height ratio is valuable because it detects children rectal thermometers are available and can be with recent weight loss (wasting); however, two disinfected after use, they are preferred. Such children should also be carefully checked for signs Each of the above measurements should be or symptoms of another infection. If the latter are used, national guidelines must be followed for their interpretation in the local setting.

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It can microbial food supplements, eg, be diffcult to prove or otherwise an Lactobacillus and Bifdobacterium species association with the suspect food. Haemorrhoids in children are rare, but may occur in infants with portal hypertension. Gastro-IntestInal system Practical Tips avoid straining due to constipation by Warm baths are soothing for the periensuring that the diet contains lots of anal area. Differential diagnoses as well as other causes of rectal bleeding, rule out other causes of pruritus ani, which may be caused by local dermatitis or irritation or by threadworm. Treatment options treatment depends on the classifcation of haemorrhoid and severity of the symptoms. It is thought that a protective layer is formed so helping to relieve irritation and infammation. Special considerations: Pregnancy Pregnant women are much more likely to suffer from piles than non-pregnant women of the same age. Study the range of topical preparations that you have available to recommend and their ingredients. What frst and second line recommendations will you make to customers looking for a soothing preparationfi Gastro-IntestInal system Case studies Case Study 1 miss scott, a regular customer in her late twenties, asks for something to treat diarrhoea and bloating. Gastro-IntestInal system Make a list of drugs which would alert you to the possibility of drug-induced constipation. Treatment Options Demulcents, expectorants, cough suppressants, and antihistamines are all available either alone or in compound otc preparations for cough. Demulcents such as Simple Linctus contain soothing ingredients such as syrup or glycerol. Expectorants such as ipecacuanha, ammonium chloride and squill in theory produce expulsion of bronchial secretions although there is no evidence that they can specifcally facilitate expectoration. Dextromethorphan (a non-sedating opiate) and menthol have both been shown to suppress the cough refex without the adverse effects of the opiates codeine and pholcodine. Hoarseness, loss of taste and smell, mild burning of the eyes, and a feeling of pressure in the ears or sinuses due to obstruction and/ or mucosal swelling may also occur. Differential diagnoses allergic rhinitis is usually accompanied by a watery rhinorrhoea and sore, streaming eyes. Non-allergic rhinitis would present with chronic nasal discharge, again of watery consistency. Topical nasal decongestants, for example, ephedrine, oxymetazoline, xylometazoline, have an immediate benefcial effect on reducing nasal stuffness. Oral decongestants, for example, pseudoephedrine, phenylpropanolamine, are not as immediately effective as topical preparations but do not cause rebound congestion on withdrawal. Systemic symptoms include tiredness, fever, a pressure sensation in the head, and itchiness. Non-sedating antihistamines, eg loratadine, cetirizine and acrivastine, are more appropriate choices in these instances.


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