W. Abe. Texas A&M University, Texarkana.

It became obvious to me that psychotherapy is more effective once the brain is functioning properly 1 mg coumadin sale blood pressure medication safe for pregnancy. These can range from low blood sugar purchase coumadin without a prescription blood pressure low pulse high, viral and fungal infections discount coumadin 1mg blood pressure chart age 40, hormonal imbalances, allergies, and toxic overload to deficiencies of specific nutrients. Then I can often help correct the imbalances with natural approaches, including the use of well-researched nutritional supplements. In contrast, conventional physicians are most likely to prescribe first and test second, if at all, with problematic results. This approach is often like unplugging the noisy smoke alarm instead of looking for the fire. In my move toward “integral” or holistic psychiatry, I found myself treating a variety of medical conditions, from chronic fatigue to irritable bowel syndrome. Our bodies do not separate into specialized compartments for the convenience of cardiologists, allergists, endocrinologists, or gastroenterologists. You can’t get to the right diagnosis and treatment without looking at all systems! Conventional medicine has segmented the body into the various specialties and often fails to address the reality of interactive systems. Holistic or integrative medicine, on the other hand, addresses the interactive systems of the whole person. The patient is evaluated in a variety of ways and supplied with specific health prescriptions—for supplements, foods, exercise, natural hormones, mind-body techniques, and even prescription drugs when indicated. Moreover, the individual has to partner with the doctor in this process, both to carry out the regimen and to give feedback in order to fine-tune the program. Compared to drug therapy, natural treatments offer safer, more user-friendly solutions with far fewer and less harmful side effects. They work with the body’s chemistry rather than adding what can be toxic substances to an already impaired body. A Case in Point I remember one early patient in particular, a 55-year-old college teacher named Jean whose story is pretty typical. She was being treated by her internist for high blood pressure, osteoporosis, 80 | Complementary and Alternative Medicine Treatments in Psychiatry and heart palpitations. She was referred to me, a psychiatrist, because of her anxiety, depression, and insomnia. I could find no obvious psychological explanation for these symptoms, except maybe for the stress of her physical illness. Based on some simple lab tests and my own clinical experience, I determined that a likely common cause was a magnesium deficiency. After a brief trial on this inexpensive and common mineral, together with a multivitamin-mineral formula and essential fatty acids, Jean was able to decrease her medications. Encouraged by this result, she trusted me enough to eliminate some foods to which she was allergic, which helped her even more. In a short time, not only were her anxiety, depression, and insomnia gone, but she soon was medication-free, depending instead on a list of supplements (I added a few to those mentioned here) to restore her normal body chemistry. Physical Inventory I typically take a client’s vital signs and ensure they have a primary-care doctor for major medical issues. It measures specific plasma or blood cell levels of vitamins, minerals, amino acids, fatty acids and toxic minerals such as mercury, lead and cadmium. These tests require some skill in interpreting since there isn’t a linear relationship between urine and blood levels. Good resources for information on nutritional and functional approaches are the books New Optimum Nutrition for the Mind by Patrick Holford (go. A few pieces of significant data gleaned from the patient—that he or she may even consider unimportant—can make or break a patient’s recovery. If you answer “yes” to any of the following, please provide details below:  Do you have a history of allergies, asthma, eczema? Stress inventory: Please check any current areas of stress in your life:  Parents  Children  Spouse  Work  School  Social life  Finances  Sex  Do you find it hard to relax? While the client could be primarily suffering from stress, where lifestyle changes or counseling would be in order, more often I find physical issues—commonly a number of them—impacting behavior, emotions, and cognitive function. Frequent issues that appear include: − Nutrient deficiency such as B vitamins, minerals, amino acids − Neurotransmitter depletion: can be due to genetics, poor diet or malabsorption due to gut disturbance (e. As symptoms | 91 improve, a slow titration down from current meds may be in order. As brain chemistry begins to normalize through proper nutrient and endocrine balance, patients usually begin to feel better. By re-evaluating the patient’s progress at regular intervals, we adjust the plan as needed to keep him or her on a path to recovery and greater wellness. Summary Though learning the arts of integrative psychiatry takes some time and effort, the rewards are worth it. Instead of maintaining patients on a steady dose of medication, monitoring them for inevitable side effects and adjusting meds when things go awry, you start thinking in terms of recovery. Lots of my clients simply recover from their underlying bodily issues and get well. In fact, in many cultures worldwide, psychotic and other psychiatric conditions are regularly treated by family and community support, without the recurrence that we in the West assume is inevitable. Even those who remain symptomatic can often be helped with treatments such as herbs, supplements, or lifestyle changes that bring relief—regardless of the cause—without the downsides of meds. That means greater wellness for my patients and happier lives for them and their families. Resources American College for Advancement in Medicine, organization of integrative physicians: www. Integrative Psychiatry listserv: A listserv for health professionals for the interchange of information on integrative treatments in psychiatry: www. Safe Harbor, nonprofit for education about non-drug treatments in mental health: http://www. Walsh Research Institute, nonprofit for physician education in nutritional psychiatry: www. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo- controlled trial. Systematic review of the efficacy of meditation techniques as treatments for medical illness. An effective exercise-based intervention for improving mental health and quality of life measures: a randomized controlled trial. Mindfulness training as a clinical intervention: a conceptual and empirical review.

Darkfeld microscopic examination mation concerning the treatment of sex partners should be of suspicious lesions or body fuids (e buy generic coumadin 5 mg on line blood pressure medication orthostatic hypotension. Routine screening of newborn sera or umbilical cord blood Te following scenarios describe the evaluation and treat- is not recommended discount coumadin 2 mg with visa sinus arrhythmia icd 10. Other causes of elevated values should be considered when an infant is being evaluated for congenital syphilis discount coumadin 2mg with amex heart attack grill dallas. When possible, If the mother has untreated early syphilis at delivery, 10 a full 10-day course of penicillin is preferred, even if ampicil- days of parenteral therapy can be considered. Te use of agents Scenario 3 other than penicillin requires close serologic follow-up to assess adequacy of therapy. In all other situations, the maternal history Infants who have a normal physical examination and a of infection with T. Passively transferred maternal Older infants and children aged ≥1 month who are identi- treponemal antibodies can be present in an infant until age fed as having reactive serologic tests for syphilis should have 15 months; therefore, a reactive treponemal test after age 18 maternal serology and records reviewed to assess whether months is diagnostic of congenital syphilis. If the nontrepone- they have congenital or acquired syphilis (see Primary and mal test is nonreactive at this time, no further evaluation or Secondary Syphilis and Latent Syphilis, Sexual Assault or Abuse treatment is necessary. Tis treatment also would Penicillin Shortage be adequate for children who might have other treponemal infections. During periods when the availability of penicillin is com- promised, the following is recommended (see http://www. For infants with clinical evidence of congenital syphilis seroreactive at delivery) should receive careful follow-up (Scenario 1), check local sources for aqueous crystalline examinations and serologic testing (i. Ceftriaxone must response after therapy might be slower for infants treated after be used with caution in infants with jaundice. Terefore, ceftriaxone should be used in consultation who have had a severe reaction to penicillin stop expressing pen- with a specialist in the treatment of infants with congenital icillin-specifc IgE (238,239). For infants without any clinical evidence of infection at high risk for penicillin reactions (238,239). Although these (Scenario 2 and Scenario 3), use reagents are easily generated and have been available for more a. Skin-test–positive patients should be desensitized Evidence is insufcient to determine whether infants who before initiating treatment. One approach suggests that persons Management of Persons Who with a history of allergy who have negative test results should be regarded as possibly allergic and desensitized. Another Have a History of Penicillin Allergy approach in those with negative skin-test results involves test- No proven alternatives to penicillin are available for treating dosing gradually with oral penicillin in a monitored setting in neurosyphilis, congenital syphilis, or syphilis in pregnant women. Because anaphylactic reactions to penicillin can be fatal, every efort should be made Penicillin Allergy Skin Testing to avoid administering penicillin to penicillin-allergic patients, unless they undergo acute desensitization to eliminate anaphy- Patients at high risk for anaphylaxis, including those who lactic sensitivity. Skin-test reagents for identifying persons at risk for adverse reactions to penicillin* skin-test reagents before being tested with full-strength reagents. In these situations, patients should be tested in a Major Determinant monitored setting in which treatment for an anaphylactic • Benzylpenicilloyl poly-L-lysine (PrePen) (AllerQuest, reaction is available. Beall and test is positive if the average wheal diameter after 15 minutes Annals of Internal Medicine. Te margins of the Urethritis, as characterized by urethral infammation, can wheals induced by the injections should be marked with a ball result from infectious and noninfectious conditions. An intradermal test is positive if the average wheal if present, include discharge of mucopurulent or purulent diameter 15 minutes after injection is >2 mm larger than the material, dysuria, or urethral pruritis. Although the two approaches have not been compared, with drug regimens efective against both gonorrhea and oral desensitization is regarded as safer and easier to perform. Further testing to determine the specifc etiology Patients should be desensitized in a hospital setting because seri- is recommended because both chlamydia and gonorrhea are ous IgE-mediated allergic reactions can occur. Desensitization reportable to health departments and a specifc diagnosis might usually can be completed in approximately 4–12 hours, after improve partner notifcation and treatment. Penicillin V Amount§ Cumulative Etiology suspension dose† (units/mL) mL Units dose (units) Several organisms can cause infectious urethritis. Documentation of chlamydial infection Note: Observation period was 30 minutes before parenteral administration is essential because of the need for partner referral for evalua- of penicillin. Enteric bacteria have been identifed as an uncom- and sex partners referred for evaluation and treatment. Such patients should be treated with drug regimens efective against Clinicians should attempt to obtain objective evidence of gonorrhea and chlamydia. Te Gram stain is the preferred chlamydia is strongly recommended because of the increased rapid diagnostic test for evaluating urethritis and is highly utility and availability of highly sensitive and specifc testing sensitive and specifc for documenting both urethritis methods (e. However, because men Treatment should be initiated as soon as possible after diag- with documented chlamydial or gonococcal infections have nosis. Azithromycin and doxycycline are highly efective for a high rate of reinfection within 6 months after treatment chlamydial urethritis; however, infections with M. Single-dose regi- or gonorrhea is recommended 3–6 months after treatment, mens have the advantage of improved compliance and directly regardless of whether patients believe that their sex partners observed treatment. Expedited partner treatment and patient Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days referral are alternative approaches to treating partners (71). Persons who have persistent or be instructed to abstain from sexual intercourse for 7 days after recurrent urethritis can be retreated with the initial regimen single-dose therapy or until completion of a 7-day regimen, if they did not comply with the treatment regimen or if they provided their symptoms have resolved. Persistent urethritis for reinfection, men should be instructed to abstain from sexual after doxycycline treatment might be caused by doxycycline- intercourse until all of their sex partners are treated. If compliant with the initial regimen and re-exposure can be excluded, the fol- Follow-Up lowing regimen is recommended while awaiting the results of Patients should be instructed to return for evaluation if symp- the diagnostic tests. Symptoms Recommended Regimens alone, without documentation of signs or laboratory evidence of urethral infammation, are not a sufcient basis for retreatment. A four-glass Meares-Stamey lower-urinary- diagnosis of gonococcal cervical infection, it is not a sensitive tract localization procedure (or four-glass test) might be helpful indicator, because it is observed in only 50% of women with in localizing pathogens to the prostate (255). Estimates vary When an etiologic organism is isolated in the presence considerably depending on the source and sensitivity of the of cervicitis, it is typically C. For reasons that are unclear, cervicitis the suspected cause, all partners in the past 60 days before the can persist despite repeated courses of antimicrobial therapy. Because the sensitivity of microscopy (commonly referred to as mucopurulent cervicitis or cervicitis) to detect T. Several factors should affect the decision to provide presumptive therapy for cervicitis or to await the results of Management of Sex Partners diagnostic tests. Expedited partner treatment and patient referral (see For women in whom any component of (or all) presumptive Partner Management) are alternative approaches to treating therapy is deferred, the results of sensitive tests for C. Women who receive such therapy should return infectious disease in the United States, and prevalence is high- after treatment so that a determination can be made regard- est in persons aged ≤25 years (93). Some women who have uncomplicated cervical infection are clearly attributable to cervicitis, referral to a gynecologic already have subclinical upper-reproductive–tract infection specialist can be considered. To detect chlamydial infections, health-care provid- Follow-up should be conducted as recommended for the ers frequently rely on screening tests. If symptoms persist, sexually active women aged ≤25 years is recommended, as is women should be instructed to return for re-evaluation because screening of older women with risk factors (e. Recent evidence to recommend annual chlamydia screening of sexually active suggests that the liquid-based cytology specimens collected for women aged ≤25 years.

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To avoid adverse take some weeks tobe deficit/hyperactivity and cardiac effect cheap coumadin 2mg overnight delivery hypertension kidney and dialysis specialists, pt over 40 established discount 2 mg coumadin mastercard heart attack ne demek, treatment panic disorder and those with heart may go up to 6-12 mths discount coumadin 5mg with mastercard blood pressure chart british heart foundation. Intramuscular injections Given in the vasuts Spread skin taught to Aspirate to determine if lateralis in children up bring muscle near surface needle enter a vessel. If to 3 of skin, with dartlike there is blood return motion insert needle at discard the needle and 90 degrees meds and start procedure over. Blood administration Start blood transfusion Observe for acute Observe for delayed slow 2 ml/min. Mannitol) there is It acts by increasing the (Mannitol and glucose) amount of substance reabsorption in proximal increase excretion of osmolality of plasma, Use in oliguria and acute which cannot be tubule, descending limb water and sodium glomerular filtrate, and renal failure. Can be blood can come up Treat cauterization Ice pack to forehead or rupture of blood vessels anterior or posterior. May be use to treat hardening of the arteries, heart attack, stroke, arthritis and gangrene because of its ability to remove excess calcium from the body. Trnsmit through Transmitted through replicate only with Hep inconsistently shed in fecal-oral through blood percutanous, B. Spread to acativity semen, blood Hep B infection, may be Occur in india, Africa, person by person and saliva, vaginal secretion. Symptom rash vasculitis, jaundice condition and rapid milder in children than in Icteric phase progression of cirrhosis adult. Eat at the same snack before and after hard candy, sugar cubes Place child on the side Hypoglycemic reaction time each day. Teaching their own insulin with spread with peanut butter through the tubing to give injection. Make sure you institute insulin injection before you stop the infusion if not, there might be prolonged hyperglycemia Crack abuse It crosses the placenta Some infant showed late effect on newborns and enter the fetus. Infant may appear There may be growth normal or develop retardation, small head neurological problem. High dose Ibuprofhen Treat mild to moderate Other reaction affects the Increase toxicity of dig, therapy. Metabolize in liver Nephrotoxicity,; dysuria, Nurse report blurred hematuria, oleguria, vision ringing and Therapeutic effect takes azotemia, blurred vision. Use to anoxia, asphyxia, pattern is achieved life 3-5 min stimulate the letdown bradycardia (contraction frequency of reflex. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. All copies must retain all author credits and copyright notices included in the original document. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. Rao, Amare Mengistu, Solomomon Worku, Eshetu Legesse, Musie Aberra, Dawit All rights reserved. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. Finally, we thank the department heads and the faculty heads of the health institutions for their cooperation to participate in the preparation of the lecture note. Therefore, it is of utmost importance to describe the pharmacological basis of therapeutics in order to maximize the benefits and minimize the risks of drugs to recipients. This lecture note on pharmacology is primarily a note for undergraduate health science students such as health officer, nursing, midwifery and laboratory technology students. However, other health professionals whose career involves drug therapy or related aspects should also find much of the material relevant. The goal is to empower the practitioner through an understanding of the fundamental scientific principles of pharmacology. The effects of prototypical drugs on physiological and pathophysiological processes are clearly explained to promote understanding. The selection of the drugs is based on the national drugs list for Ethiopia and on the accumulated experience of teaching pharmacology to many health profession students. The chapters open with a list of objectives to guide the reader, and most end with questions which challenge the reader’s understanding of the concepts covered with in the chapter. Most sections have an introduction that provides an overview of the material to be covered. Readers are encouraged to refer the references mentioned for further information and we hope that this material will be a valuable companion in our pursuit of a fundamental understanding in a most fascinating area of clinical knowledge, pharmacology. Understand theoritical pharmacokinetics like half-life, order of kinetics, steady state plasma concentration. Understand drug safety and effectiveness like factors affecting drug action and adverse drug reactions. Pharmacology: Pharmacology is the study of interaction of drugs with living organisms. It also includes history, source, physicochemical properties, dosage forms, methods of administration, absorption, distribution mechanism of action, biotransformation, excretion, clinical uses and adverse effects of drugs. Clinical Pharmacology: It evaluate the pharmacological action of drug preferred route of administration and safe dosage range in human by clinical trails. Drugs are generally given for the diagnosis, prevention, control or cure of disease. Pharmacy: It is the science of identification, selection, preservation, standardisation, compounding and dispensing of medical substances. Pharmacodynamics: The study of the biological and therapeutic effects of drugs (i. Pharmacotherapeutics: It deals with the proper selection and use of drugs for the prevention and treatment of disease. Poisons are substances that cause harmful, dangerous or fatal symptoms in living substances. Chemotherapy: It’s the effect of drugs upon microorganisms, parasites and neoplastic cells living and multiplying in living organisms. Pharmacopoeia: An official code containing a selected list of the established drugs and medical preparations with descriptions of their physical properties and tests for their identity, purity and potency e. Out of all the above sources, majority of the drugs currently used in therapeutics are from synthetic source. Pharmacodynamics Involves how the drugs act on target cells to alter cellular function. Receptor and non-receptor mechanisms: Most of the drugs act by interacting with a cellular component called receptor.

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