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Induction of labor in women of high parity (five or more pregnancies) carries a high risk of uterine rupture pain treatment center pasadena drive lexington ky maxalt 10 mg cheap visa, and hence oxytocin must be used with great caution in these women breast pain treatment vitamin e 10 mg maxalt mastercard. If large volumes of fluid have been administered along with oxytocin groin pain treatment video order maxalt 10 mg mastercard, retention of water may produce water intoxication. Solutions should be dilute (10 milliunits/mL), and administered with an infusion pump that allows precise flow-rate control. However, the high-dose regimen works faster and is associated with less chorioamnionitis, and less need for cesarean delivery. With both regimens, the dose is gradually increased until uterine contractions resembling those of spontaneous labor have been produced (ie, contractions every 2 to 3 minutes and lasting 45 to 60 seconds). The mother should be monitored for blood pressure, pulse rate, and uterine contractility (frequency, duration, and intensity). In the event of significant maternal or fetal distress, the infusion should be stopped; contractions will diminish rapidly. Complications that usually require interruption of the infusion are (1) elevation of resting uterine pressure above 15 to 20 mm Hg, (2) contractions that persist for more than 1 minute, (3) contractions that occur more often than every 2 to 3 minutes, and (4) pronounced alteration in fetal heart rate or rhythm. However, patients must be judiciously selected, and dosage must be regulated with special care. As a rule, oxytocic agents should not be used to promote labor that is already in progress, even if labor is proceeding slowly: By intensifying the force of contractions, oxytocin may cause uterine damage (laceration or rupture) or trauma to the infant. Oxytocin has been employed during the second trimester to manage incomplete abortion. Intravenous infusion at a rate of 10 to 20 milliunits/min is often effective However, oxytocin is not a method of choice. Traditionally, postpartum hemorrhage has been defined as blood loss exceeding 500 mL during vaginal delivery or 1000 mL during cesarean delivery. However, a more workable definition is bleeding of any amount sufficient to cause hemodynamic instability. Normally, the uterus contracts following delivery, allowing the placenta to separate from the uterine surface. After expulsion of the placenta, the uterus continues to contract, causing blood vessels that supplied the placenta to squeeze shut. In about 80% of cases, postpartum hemorrhage results from uterine atony (failure of the uterus to contract). Most of the remaining cases result from lacerations, maternal coagulopathies, or retention of placental tissue. Drugs that promote uterine contraction (uterotonic drugs) can reduce bleeding caused by uterine atony. Two of these drugs-oxytocin and misoprostol-were discussed previously under Drugs for Cervical Ripening and Induction of Labor. Two additional drugs-methylergonovine, and carboprost tromethamine-are introduced below. Of all these drugs, oxytocin is considered the agent of first choice for control of postpartum hemorrhage. Oxytocin and Misoprostol Oxytocin [Pitocin] and misoprostol [Cytotec] are powerful uterotonic agents, and hence can stop postpartum hemorrhage resulting from uterine atony. The drug suppresses bleeding primarily by causing intense uterine contractions, and partly by causing direct vasoconstriction. In addition to its postpartum use, carboprost is used to induce abortion (see Chapter 62). Gastrointestinal reactions can be reduced by pretreatment with antiemetic and antidiarrheal medications. If body temperature rises, it is important to differentiate between drug-induced fever and pyrexia resulting from endometritis. Like other prostaglandins, carboprost causes vasoconstriction and constriction of the bronchi. Precautions and Contraindications Carboprost is contraindicated for women with acute pelvic inflammatory disease and active disease of the heart, lungs, kidneys, or liver. The drug should be used with caution in women with a history of asthma, hypertension, diabetes, or uterine scarring.
Some authorities recommend an automatic reduction in statin dosage if these inhibitors are used heel pain treatment urdu discount maxalt 10 mg. Furthermore pain medication for glaucoma in dogs maxalt 10 mg buy with amex, the inhibition may persist for 3 days or more after eating the fruit or drinking its juice treatment for pain due to shingles purchase maxalt 10 mg on line. Some statins have caused fetal malformation in animal models-but only at doses far higher than those used in humans. Nonetheless, because statins inhibit synthesis of cholesterol, and since cholesterol is required for synthesis of cell membranes as well as several fetal hormones, concern regarding human fetal injury remains. Women of child-bearing age should be informed about the potential for fetal harm and warned against becoming pregnant. If pregnancy occurs, and the patient plans to continue the pregnancy, statins should be discontinued. Preparations, Dosage, and Administration Statins are available alone and in fixed-dose combinations. The combination products are discussed later in the chapter under the heading Drug Combinations. Seven statins are available for use alone: atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin. Dosing is done once daily, preferably in the evening either with the evening meal or at bedtime. Because endogenous cholesterol synthesis increases during the night, statins have the greatest impact when given in the evening. Furthermore, not only are these two drugs highly effective, clinical experience with them is extensive. However, for patients with significant renal impairment, atorvastatin and fluvastatin are preferred (because no dosage adjustment is needed). The same dose of rosuvastatin, when given to Asian and Caucasian subjects, may produce twofold higher blood levels in the Asians. Accordingly, when rosuvastatin is used in Asians, start with the lowest available dosage and monitor diligently. Five statins-lovastatin, pravastatin, atorvastatin, fluvastatin, and simvastatin-are now available as generic products, and hence are cheaper than all other statins. Niacin is available in three formulations, which differ with respect to onset, duration, and the incidence and severity of side effects. Half received simvastatin plus a placebo, and half received simvastatin plus Niaspan (extendedrelease niacin tablets). While this may seem like a therapeutic advantage (longer lasting high levels of drug), there is an increased risk of hepatotoxicity, and hence this product should be avoided. In addition to being available alone, niacin is available in two fixed-dose combinations: niacin/lovastatin [Advicor] and niacin/simvastatin [Simcor]. The doses employed to correct niacin deficiency are much lower than those employed to reduce lipoprotein levels (about 25 mg/day rather than 1 to 3 gm/day). Intense flushing of the face, neck, and ears occurs in practically all patients receiving niacin in pharmacologic doses. This reaction diminishes in several weeks, and can be attenuated by taking 325 mg of aspirin 30 minutes before each dose. Liver injury is least likely with Niaspan, the extended-release formulation noted above. Other long-acting products- sustained-release, controlled-release, or timed-release (eg, Slo-Niacin)-should be avoided, owing to increased risk of hepatotoxicity. Because of possible hepatotoxicity, liver function should be assessed before treatment and periodically thereafter. The drug is available in tablets (immediate-release, timed-release, controlled-release, sustainedrelease, extended-release) or capsules (timed-release, extended-release, sustained-release). With immediate-release formulations (prescription Niacor and over-thecounter products), blood levels of niacin climb rapidly. As a result, these products are associated with the highest incidence and severity of facial and upper body flushing, at least for the first few weeks. To manage flushing, patients using immediate-release niacin often take prophylactic aspirin. Therefore, to maintain steady blood levels, the total daily dose should be given as two or three divided doses (1 to 3 gm each), rather than as one large dose.
Ascorbic Acid (Vitamin C (Ascorbic Acid)). Maxalt.
- What is Vitamin C (ascorbic Acid)?
- Reducing skin problems in people being treated for cancer with radiation.
- Helping medicines used for chest pain, such as nitroglycerin, to work longer.
- Reducing the risk of certain cancers of the mouth and breast. This only works when fresh fruits and vegetables high in vitamin C are eaten, not with vitamin C supplements.
- Preventing eye disease associated with a medicine called interferon.
- What other names is Vitamin C (ascorbic Acid) known by?
- Flushed looking skin (erythema).
- Improving physical performance and strength in the elderly.
- Treating ulcers in the stomach caused by bacteria called H. pylori.
- Decreasing protein in the urine of people with type 2 diabetes (albuminuria).
Source: http://www.rxlist.com/script/main/art.asp?articlekey=96962
By lowering blood pressure pain hypersensitivity treatment maxalt 10 mg order with mastercard, thiazides can augment the effects of other antihypertensive drugs pain treatment center of america 10 mg maxalt buy visa. In the United States nerve pain treatment options order maxalt 10 mg without a prescription, only one aldosterone antagonist- spironolactone-is used for diuresis. The potassium-sparing effects of spironolactone can result in hyperkalemia, a condition that can produce fatal dysrhythmias. Although hyperkalemia is most likely when spironolactone is used alone, it can also develop when spironolactone is used in conjunction with potassiumwasting agents (thiazides and loop diuretics). If serum potassium rises above 5 mEq/L, or if signs of hyperkalemia develop (eg, abnormal heart rhythm), spironolactone should be discontinued and potassium intake restricted. Injection of insulin can help lower potassium levels by promoting potassium uptake into cells. Spironolactone is a steroid derivative with a structure similar to that of steroid hormones (eg, progesterone, estradiol, testosterone). As a result, spironolactone can cause a variety of endocrine effects, including gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. When given long term to rats in doses 25 to 250 times those used in humans, spironolactone has caused benign adenomas of the thyroid and testes, malignant mammary tumors, and proliferative changes in the liver. Spironolactone Mechanism of Action Spironolactone [Aldactone] blocks the actions of aldosterone in the distal nephron. The diuresis caused by spironolactone is scanty because most of the filtered sodium load has already been reabsorbed by the time the filtrate reaches the distal nephron. Recall that aldosterone acts by stimulating cells of the distal nephron to synthesize the proteins required for sodium and potassium transport. Therefore, effects are not visible until the existing proteins complete their normal life cycle-a process that takes 1 or 2 days. Although it can be employed alone, the drug is used most commonly in combination with a thiazide or loop diuretic. The purpose of spironolactone in these combinations is to counteract the potassium-wasting effects of the more powerful diuretics. In patients with severe heart failure, spironolactone reduces mortality and hospital admissions. Benefits derive from protective effects of aldosterone blockade in the heart and blood vessels (see Chapter 48). In addition to the applications discussed above, spironolactone can by used for primary hyperaldosteronism (Chapter 60), premenstrual syndrome (Chapter 61), polycystic ovary syndrome (Chapter 63), and acne in young women (Chapter 105). The basic pharmacology of eplerenone and its main use, heart failure, are discussed in Chapters 44 and 48, respectively. The goal is to counteract the potassium-wasting effects of the more powerful diuretic. Because of the risk of hyperkalemia, caution must be employed when combining spironolactone with potassium supplements, salt substitutes (which contain potassium chloride), or another potassium-sparing diuretic. Preparations, Dosage, and Administration Spironolactone [Aldactone] is dispensed in tablets (25, 50, and 100 mg) for oral dosing. Spironolactone is also marketed in a fixed-dose combination with hydrochlorothiazide under the trade name Aldactazide. Triamterene Mechanism of Action Like spironolactone, triamterene [Dyrenium] disrupts sodiumpotassium exchange in the distal nephron. The net effect of inhibition is a decrease in sodium reabsorption and a reduction in potassium secretion. Because it inhibits ion transport directly, triamterene acts much more quickly than spironolactone. Is pharmacologically inert (ie, it has no direct effects on the biochemistry or physiology of cells). Therapeutic Uses Triamterene can be used alone or in combination with other diuretics to treat hypertension and edema.
When the source of excessive prolactin is a pituitary adenoma pain treatment ibs maxalt 10 mg buy on-line, cabergoline can induce tumor regression pain treatment centers of illinois new lenox cheap maxalt 10 mg with amex. In addition to endometriosis pain treatment center bismarck nd 10 mg maxalt discount mastercard, the drug is indicated for uterine fibroids, central precocious puberty, and advanced prostate cancer (see Chapter 103). Like the normal endometrium, ectopic endometrial implants are dependent on ovarian hormones. Leuprolide suppresses endometriosis by indirectly suppressing ovarian hormone production. By decreasing production of ovarian hormones, the drug reduces the area of endometriosis and improves symptoms. Within 6 months after the drug is withdrawn, symptoms return in up to 50% of women who had previously been rendered symptom free. Common responses include hot flashes, vaginal dryness, decreased libido, mood changes, and headache. To minimize the risk of osteoporosis, the manufacturer recommends that treatment last no more than 6 months. As noted, treatment should stop after 6 months; however, if it is necessary to continue for an additional 6 months, norethindrone should be added to the medication regimen. In addition to reducing the pain and size of endometrial growths associated with endometriosis, it can be used to thin the endometrium in management of dysfunctional uterine bleeding. Goserelin shares the same mechanism of action and adverse effects as leuprolide and nafarelin. Goserelin is available as implants for management of prostate cancer; these are not used for management of endometriosis. Danazol [Cyclomen] can improve symptoms of endometriosis, but does not increase fertility. Treatment leads to complete regression of endometrial implants in the majority of patients. In addition to the therapy of endometriosis, danazol has been used to treat angioneurotic edema and fibrocystic breast disease. First, the drug inhibits several of the enzymes needed to synthesize ovarian hormones, and thereby deprives the implant of the hormonal environment it needs for maintenance. Lastly, danazol may act directly on the implant to block ovarian hormone receptors. Potential manifestations include acne, deepening of the voice, and growth of facial hair. Danazol may also cause edema, and therefore should be used with caution in patients with cardiac and renal disorders. Liver impairment may also occur, and hence liver function should be assessed at baseline and periodically thereafter. Lastly, the drug can masculinize the female fetus, and hence is contraindicated during pregnancy. To ensure that danazol is not taken during pregnancy, therapy should be initiated at the time of menstruation. The most serious adverse effect of menotropins is ovarian hyperstimulation syndrome, characterized by sudden enlargement of the ovaries. Baseline Data Take a complete health and gynecologic history, and assess for tubal patency. Identifying High-Risk Patients Clomiphene is contraindicated during pregnancy and in women with liver disease or abnormal uterine bleeding of undetermined origin. Administration Schedule If cyclic menstrual bleeding has been occurring, begin therapy 5 days after the onset of menses. If ovulation fails to occur, additional courses may be tried, each beginning no sooner than 30 days after the previous course. Implementation: Measures to Enhance Therapeutic Effects Timing of Coitus Advise the couple to have coitus at least every other day during the 5- to 10-day period that follows the last clomiphene dose.