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| What sorts of things influence enzyme induction |
| 2008-05-04 09:34:47 |
What sorts of things influence enzyme induction? Well, the dose of the inducer. I’ve already talk about age. Genetics can … we can have slow acetylators and fast acetylators. For example, when we think about monitoring procainamide levels. We monitor procainamide in NAPA. NAPA stands for N-acetyl-procainamide and the reason we do that is because [...]...
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| Carafate, or sucralfate will bind up ciprofloxacin |
| 2008-04-24 10:29:25 |
Carafate, or sucralfate will bind up ciprofloxacin, norfloxacin, and phenytoin. The Carafate or sucralfate and ciprofloxacin doesn’t work to separate them by two to three hours. They’ve done some studies looking at it and they still found about 95% to 98% absorption of ciprofloxacin even with dosage separation of three hours. So what I would [...]...
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| The first type |
| 2008-04-23 12:49:16 |
The first type, or the first sub-category if you will, within the pharmacokinetic is altered absorption through gastric pH. We know that the H2 receptor antagonists increase gastric pH. Cimetidine, ranitidine and also famotidine and nizatidine all will do that and with those drugs they will cause an increase in aspirin absorption. Now you may [...]...
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| Specific examples with the drug/drug interactions |
| 2008-04-22 15:30:24 |
Lets move on to some more specific examples with the drug/drug interactions. The first ones we are going to talk about are the pharmacodynamic drug/drug interactions. We talked about that and kind of told you what that was. That’s when you have two or more drugs when given together that have action at the same [...]...
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| The pharmacokinetic drug interactions |
| 2008-04-21 16:42:27 |
The pharmacokinetic drug/drug interactions actually start over on this side, on the left side, and move all the way through to the right side. And that is when you have drugs administered simultaneously and because of something that happens - either through absorption or distribution or metabolism - you have a change in the plasma [...]...
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| Drug Interactions |
| 2008-04-21 16:40:00 |
Clinically important drug/drug interactions. A drug/drug interaction is a pharmacologic response which cannot be explained by the action of a single drug alone, but rather it is due to two or more drugs acting simultaneously. I made absolutely no comments as to whether or not it was beneficial or harmful. The reason for that is [...]...
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| Management of iron deficiency |
| 2008-04-15 11:05:17 |
1. Identify the cause. Iron deficiency as the cause of anemia is suspected on epidemiologic grounds. As discussed above, the condition is a common cause of low hemoglobin in infants, adolescents, women of childbearing age, individuals with hookworm infestation and patients with chronic blood loss from the gastrointestinal tract or other sites. Before treatment, consideration [...]...
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| The serum ferritin |
| 2008-04-10 11:18:33 |
The serum ferritin is a very helpful measure of total body iron stores and a low level (<12 mg/L) is diagnostic of iron deficiency. The serum ferritin is a positive acute phase reactant and may not reflect iron deficiency in a patient with both lack of iron and an inflammatory process. Typically the transferrin saturation [...]...
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| Symptoms. Iron Deficiency |
| 2008-04-10 11:13:21 |
Symptoms. Even in the absence of anemia, iron deficiency may have adverse effects. Non-anemic children with prolonged iron deficiency in the second year of life were later found to have impaired mental and motor development at five years of age. In pregnancy, maternal iron deficiency may be associated with low fetal birth weight and increased [...]...
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| Causes of iron deficiency |
| 2008-04-08 11:55:37 |
Inadequate dietary iron for high physiologic requirements. Iron deficiency is the most common nutritional deficiency in the world. Infants, adolescents and women of child bearing age are at the highest risk of iron deficiency and may become iron deficient because of inadequate dietary iron to meet physiologic needs. Infants one to two years of age [...]...
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| Iron Deficiency |
| 2008-04-08 11:52:47 |
Iron deficiency is the most common cause of anemia in many parts of the world and is usually the result of blood loss, often combined with inadequate dietary iron. Iron deficiency occurs most commonly in menstruating women. When iron deficiency occurs in men or non menstruating women, the most likely site of blood loss is [...]...
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| Leukotriene modifiers |
| 2008-04-03 15:09:43 |
Leukotriene modifiers; this was real exciting when these first came out, and unfortunately they are not ending up quite as powerful as we had hoped. Leukotrienes are chemical mediators that are released by leukocyte’s mast cells. They break down products of arachidonic acid. And different leukotrienes will do different things. Certain ones will cause mucus [...]...
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| Inhaled steroids |
| 2008-04-03 15:06:26 |
Inhaled steroids; still far and away the best long-term preventive agent for asthma, period. The problem is potential side effects. If basically decreases the late response. It doesn’t stop the initial bronchoconstriction but also deals with the hyper-responsiveness and you can see improvement within a few days in lung function, on inhaled steroids. Maxing out [...]...
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| Chronic asthma |
| 2008-04-02 14:55:02 |
Okay, let’s talk real quickly about chronic asthma. The National Heart/Lung Institute has had two documents out over the last about five or six years. The Expert Panel’s Report on Asthma. If you guys are actually general pediatricians and take care of asthmatics, get on their web site and download the Expert Panel II. A [...]...
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| Oral steroids: these are the indications |
| 2008-04-02 14:48:41 |
Oral steroids; these are the indications. These are pretty straightforward. If it’s a severe exacerbation, moderate to severe, you just go ahead and use them. If they are not responding well to the albuterol, if they are using steroids recently, the fourth one there. You always go home with one more medication than you came [...]...
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| Risk factors for fatal asthma |
| 2008-04-01 15:01:52 |
Okay, risk factors for fatal asthma. These things are pretty self-evident most of the time. Previous life-threatening exacerbation. In adults, if you had almost died from asthma, 10% of those adults die within the following year from their asthma. It’s a big time, important problem if somebody gets intubated with asthma. Hospitalized more than once; [...]...
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| Lab studies |
| 2008-04-01 14:58:54 |
Lab studies; one thing I try to tell our residents, don’t get a chest x-ray in kids with asthma, because then you will be forced to throw them on antibiotics because they are going to have mucus plugging and they are going to have infiltrates. The only reason to get an x-ray on a kid [...]...
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| Alternative diagnosis. Asthma |
| 2008-04-01 14:57:57 |
Alternative diagnosis; if these things are present, you have to think of something other than asthma. There’s an old adage that “all that wheezes is not asthma.” Well, the corollary to that is, “Almost all that wheezes is asthma” and it’s only in rare cases that you have to worry about other things. But obviously [...]...
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| Common triggers |
| 2008-03-24 11:10:27 |
Human growth hormone
Common triggers; most common trigger, under about 3-5 years of age, RSV. Most common trigger after five-years-of-age that’s viral, is actually rhinovirus. Interestingly, a virus that primarily affects the nose - for reasons that are not clear - leads to exacerbations of asthma. Most bacterial infections do not exacerbate asthma with one big [...]...
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| A couple of terms from the allergy literature |
| 2008-03-24 11:07:50 |
A couple of terms from the allergy literature that you have to know about, the early response to asthma. If you are allergic to cats and I throw you into a room with cats, you are going to start wheezing pretty quickly, within about five or ten minutes. If I then take the cats out [...]...
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| Asthma |
| 2008-03-24 11:05:34 |
Asthma is an inflammatory disorder. Even in mild asthma there is inflammation. Recurrent episodes of wheezing, shortness of breath, chest tightness, coughing. The key symptom in kids is coughing. Not wheezing. Prolonged cough in children, especially at night or in the morning, is asthma until proven otherwise. Asthma obviously has three main components, and [...]...
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| If one found growth hormone. Growth Disorders |
| 2007-12-26 09:39:36 |
If one found growth hormone deficiency and still needed to look further, the MRI is a very beautiful tool. What you see here is the hypothalamic-pituitary stalk, the nose is out here and there is a transection. You see where it is black in the middle and this is where the MRI has helped to [...]...
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| Now growth hormone deficiency |
| 2007-12-21 12:53:42 |
Now growth hormone deficiency, if present, can be an isolated phenomenon or a current combination with other pituitary hormone deficiencies. Its etiology is usually a hypothalamic deficiency, which really means that the patients aren’t truly growth hormone deficient; they are deficient in the hypothalamic factor growth hormone releasing hormone which regulates growth hormone. But from [...]...
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| Growth Disorders. Now here is a young lady |
| 2007-12-21 12:50:37 |
Now here is a young lady who doesn’t look very happy, and you would probably have trouble telling - and I’m going to give you a better demonstration in the second talk about this - but she happens to have myxedema of her face, which you might not be able to tell, but I show [...]...
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| Growth Disorders. Now only half of the patients |
| 2007-12-20 10:18:51 |
Now only half of the patients with Turner’s syndrome have the classic 45 X karyotype. It used to be called 45 XO but technically there is no O chromosome, so we just call it 45 X. The remainder are mosaics, and contrary to popular opinion they are not necessarily less stigmatized. There is certainly no [...]...
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| Growth Disorders. This is a child with Russell-Silver |
| 2007-12-20 10:13:25 |
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This is a child with Russell-Silver syndrome who is about nine-months-old, who had intrauterine and postnatal growth retardation with a relative sparing of the head. That’s why the face has sort of a triangular appearance to it. The brain is growing behind the forehead normally and causes this relative dysmorphism but that’s actually [...]...
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| Growth Disorders. When you do the physical exam |
| 2007-12-11 12:43:41 |
When you do the physical exam on these children it’s normal. If the child is typically around the age that puberty would be expected to start, it usually hasn’t. If you do the bone age - typically I would - you would find it to be delayed. Also remember, very importantly, the timing of puberty [...]...
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| This is one of about ten growth charts |
| 2007-12-11 12:41:31 |
This is one of about ten growth charts that are in your packet sort of as an appendix. What is shown here is a growth chart showing heights of a female child between the ages of about 3 all the way up to about 18, and I’ll sort of say it in words. You can [...]...
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| Growth Disorders |
| 2007-12-10 14:51:00 |
The highest growth rate that occurs during life occurs in utero. You’ll all recall that an average birth length is 20 inches, or 51 centimeters, which is achieved in a nine-month period of fetal life, which translates out to 68 centimeters per year were it maintained. After birth the growth rate decreases rapidly over the [...]...
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| Complementary Therapies for Depression. Conclusions 2 |
| 2007-12-05 09:44:14 |
A number of mechanisms by which exercise may improve mood have been proposed. (41, 46) These include physiological effects, such as changes in endorphin and monoamine levels; psychological effects, such as subject expectation, diversion from stressful stimuli, the effects of receiving attention, improved self-image, and feelings of control; and sociological factors, such as the benefits [...]...
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| Complementary Therapies for Depression. Conclusions |
| 2007-12-05 09:41:51 |
Because of the nature of the evidence relating to CAM and depression, a qualitative overview seemed preferable to a systematic review. Collectively, the above data suggest that exercise and H perforatum are effective symptomatic treatments for mild to moderate depression. The evidence for acupuncture, massage, and relaxation is promising, but not compelling.
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Acupuncture and [...]...
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| Massage therapy. Relaxation therapy |
| 2007-12-05 09:38:36 |
MASSAGE THERAPY
There are several different forms and traditions of massage therapy. (72) In the context of this article, massage uses typically a gentle manual stroking technique over the body (usually the back). This has a number of complex physiological and psychological effects, not least of which is relaxation of both the musculature and the mind. [...]...
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| Homeopathy. Hypnotherapy. Therapies for Depression |
| 2007-12-04 12:57:21 |
HOMEOPATHY
Homeopathy is based on the “like cures like” principle that suggests that a remedy (often, but not always, plant based), which causes certain symptoms in a healthy individual, can be used as a treatment for patients presenting with such symptoms. Furthermore, homeopaths believe that, by “potentizing” (stepwise dilutions combined with vigorous shaking) a remedy, it [...]...
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| Exercise. Aromatherapy. Therapies for Depression |
| 2007-12-04 12:44:26 |
EXERCISE
Many categories of physical exercise exist, eg, leisure-time and work-related physical activity or single bout and regular exercise. Their physiological responses may differ considerably. For the purpose of the following discussion, it is helpful to distinguish between regular endurance (mostly aerobic) exercise and power (mostly anaerobic) exercise. For the treatment of depression, exercise can be [...]...
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| ACUPUNCTURE. Depression |
| 2007-12-04 12:37:36 |
Acupuncture is an ancient Chinese treatment. Based on the belief that 2 types of “energies” flow in “meridians” throughout the body and that an imbalance of these energies constitutes illness, acupuncturists insert needles into points located on meridians with the aim of correcting the imbalance and restoring health. Western acupuncturists are critical of these Taoist [...]...
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| Complementary Therapies for Depression |
| 2007-12-04 12:29:27 |
Depression has a prevalence of 5% in the general population. It is estimated that at least one third of all individuals are likely to experience an episode of depression during their lifetime. Complementary and alternative medicine (CAM) is often negatively defined, for example, as “a system of health care which lies for the most part [...]...
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| Physical therapy modalities |
| 2007-11-26 09:31:02 |
Rest. Two to three days of bed rest in a supine position may be recommended for patients with acute radiculopathy. Sitting raises intradiscal pressures and can theoretically worsen disc herniation and pain. Activity modification is recommended for patients with nonneurogenic pain. With activity restriction, the patient avoids painful arcs of motion and tasks that exacerbate [...]...
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| Pharmacologic Therapy |
| 2007-11-26 09:29:01 |
The mainstay of pharmacologic therapy for acute low back pain is acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). If no medical contraindications are present, a two- to four-week course of medication at anti-inflammatory levels is suggested.
Naproxen ( Naprosyn) 500 mg followed by 250 mg PO tid-qid prn [250, 375,500 mg].
Naproxen sodium ( Aleve) 200 mg [...]...
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| Laboratory tests |
| 2007-11-26 09:25:14 |
Laboratory tests
Evaluation may include a complete blood count, determination of erythrocyte sedimentation rate.
Radiographic evaluation. Plain-film radiography is rarely useful in the initial evaluation of patients with acute-onset low back pain. Plain-film radiographs are normal or demonstrate changes of equivocal clinical significance in more than 75 percent of patients with low back pain. Views of the [...]...
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