By X. Yugul. Auburn University, Montgomery.

Malnutrition occurs when there is a deficiency in intake of some or all of the above nutrients cheap 600 mg neurontin mastercard symptoms 5dp5dt. It is most commonly seen in children less than five years proven neurontin 600 mg treatment zona, particularly after weaning. In many cases, the malnourished child is brought to the health unit because of other complaints such as diarrhoea, vomiting, fever, worms or cough. An infection in a malnourished individual may thus become very severe and result in death. A child suffering from malnutrition may have features of marasmus, kwashiorkor or both (marasmic-kwashiokor). The bleeding may be due to defective blood vessels, platelet disorders or clotting factor deficiency. The pattern of bleeding is a helpful guide to its cause: in platelet and vessel wall defects, bleeding is usually into skin and mucosal surfaces like the gums, nose, gastrointestinal tract; in coagulation factor deficiency (e. In newborns with Vitamin K deficiency (which leads to multiple coagulation factor deficiency) spontaneous bleeding occurs from various sites such as the umbilical cord, gastrointestinal tract, scalp, brain. Patients may be severely anaemic and in haemorrhagic shock if there is a large bleed. Note For information on appropriate blood products for various bleeding disorders see “National Guidelines for the Clinical Use of Blood and Blood Products in Ghana” for more details. The possession of one normal haemoglobin (haemoglobin A) together with one abnormal haemoglobin (e. Sickle cell disease patients may present either in the steady state, in crises or with complications. The crises are commonly vaso-occlusive (precipitated by cold weather, dehydration, infection, ischaemia or physical exertion), which often cause pain in the bones. In sequestration crises, the spleen and liver enlarge rapidly due to trapping of red blood cells. Patients with sickle cell disease should be encouraged to have periodic check-ups at a Sickle Cell Clinic. Transfusion will be necessary if haemoglobin level < 5 g/dl In the Steady State • Folic acid, oral, Adults 5 mg daily Children > 1 year; 5 mg daily < 1 year; 2. The abnormal plasma cells in the bone marrow result in a reduction in normal blood cell production and erosion of bone with release of calcium. The abnormal immunoglobulin in blood results in hyperviscosity, renal failure and impaired ability to fight infections. Follow-up can be done by a physician specialist with guidance from the haematologist. There are two main types of leukaemia depending on the type of white cell affected. Each can further be divided into acute (where the patient falls suddenly ill) and chronic (where the patient may have been harbouring the disease for months and occasionally years without knowing). Follow-up can continue at a regional centre by a physician under the distant guidance of a haematologist in the case of chronic leukaemias. From the tertiary centre, patients with a good chance of cure by bone marrow transplant and who have a stem cell donor should be referred to the appropriate centre. There are three clinical variants - the endemic, sporadic and immunodeficiency associated forms. The endemic form is found in tropical and malaria endemic regions like Ghana and commonly presents as a jaw swelling with loosening of the associated teeth. Follow-up can continue at a regional centre by a physician under the distant guidance of a haematologist. The vaccine protects all children against Diptheria, Pertussis, Tetanus, Hepatitis B and Haemophilus influenzae Type B. The pentavalent vaccine should not be given to children above 2 years because of the increase in side effects due to the Pertussis component. Measles -No child should be denied measles vaccine because of a past episode of presumed measles 2. It is very infectious from up to 7 days before to 5 days after appearance of the rash. Measles is often complicated by croup, vitamin A deficiency leading to xerophthalmia and blindness, otitis media and deafness from otitis media. Other complications include bronchopneumonia, diarrhoea, malnutrition and activation of latent tuberculosis.

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Benzodiazepines have a relatively low • Slowed heart beat (diazepam) potential for abuse in those without substance use disorder histories generic neurontin 400mg with amex medications bipolar, but moderate or higher potential • Stomach upset in those with substance use disorder histories cheap neurontin 300 mg free shipping symptoms 6 months pregnant. Even • Suppressed breathing (restrained or inhibited) when taken as directed, withdrawal symptoms may • Weight gain occur if regular use of benzodiazepines is abruptly stopped. For these reasons benzodiazepines are usually take a form of antianxiety medication—including prescribed for brief periods of time—days or benzodiazepines—at least once each year. If weeks—and sometimes intermittently for stressful antidepressants are included, this fgure is doubled. Except for treating Benzodiazepines may cause at least mild physical alcohol or benzodiazepine withdrawal, or for acute dependence in almost everyone who uses the sedation in manic or psychotic states, benzodiaz- medication for longer than 6 months (i. John’s Abuse and dependence are more likely to occur wort, echinacea, ginkgo, ginseng). Less than 1% of persons who do not have a current • People taking antianxiety medication are particu- substance abuse problem or a history of substance abuse becomes dependent on antianxiety medica- larly vulnerable to adverse medical consequences tions. Certain medications and medical medications or those who are opiate users are at conditions can be impacted by propranolol. Be higher risk of becoming dependent on antianxiety sure to keep the doctor and pharmacists aware of medications. Some studies indicate there is a all medications and medical conditions a client moderately higher risk for alcohol dependent may have. When these much risk of producing a deformed baby as medications are combined with other sedative compared to anticonvulsants (e. It combined with alcohol, the sedation is much appears that short-acting benzodiazepines, like greater. Under these conditions respiratory depres- those used to treat alcohol withdrawal (detoxifca- tion21), can be used in low doses even in the frst sion, which is a life threatening medical emergency, trimester (Robert et al. Overdose on the older tricyclic antide- pressant medications, which are often used for diazepines should be avoided—their use during the combined anxiety depression disorders, can be life third trimester or near delivery can result in a threatening and immediate referral to emergency withdrawal syndrome in the baby (Garbis and care is indicated. Withdrawal from regular use of any of the benzo- diazepines and similar medications must be done 21 detoxifcation: A medical and biopsychosocial procedure that slowly over a month’s time. Abrupt withdrawal assists a person who is dependent on one or more substance from these medications can cause hallucinations, to withdraw from dependence on all substances of abuse. From a clinical stand- role in encouraging this discussion by suggesting point, pregnant women could be at risk for devel- their clients talk with the prescribing physician. Yet at the same time, increased metab- olism of the medication may result, reducing the therapeutic effect (such as with methadone since many women seem to require an increase in their dose of methadone during the last trimester) (Pond et al. In addition, there is a documented withdrawal syndrome in newborns exposed to benzodiazepines in utero (Sutton and Hinderliter 1990). Onset of this syndrome may be delayed more so than that associated with other drugs. The extent to which a drug is bound to plasma can affect the distribution of the drug in the body. The physician will specify the exact amount of atomoxetine Strattera medication and when it should be taken. Other conditions that may be • Dilated pupils treated with stimulants are narcolepsy25, obesity, • Elevated blood pressure and sometimes depression. Psychiatric symptoms including paranoid delu- sions, thought disorders, and hallucinations have been reported when stimulants are used for long periods or taken at high dosages. They are typically The following products use a combination of an used for a short time because they cause physi- opioid or narcotic along with aspirin, Tylenol, or ological tolerance (takes more to get the same other pain reliever to treat mild to moderate pain. Longer- Darvocet N 100 term use is indicated to alleviate the chronic pain associated with cancer and certain other condi- Darvocet N 50 tions, and research has shown that abuse of these E-Lor or Wygesic medications rarely occurs in such patients. Severe Empirin or Phenaphen with Codeine #3 and chronic pain has long been under treated in the Empirin or Phenaphen with Codeine #4 United States due to irrational fears that anyone Endocet prescribed opiates will become addicted. People with Fiorinal with Codeine substance use disorders need pain management just Lorcet Plus like anyone else. Opioids are appropriately Lortab prescribed to manage chronic cancer pain—espe- Maxidone cially fentanyl, oxycodone and methadone.

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The layout of the prescription form and the period of validity may vary between countries 300 mg neurontin amex medications starting with p. As you can check for yourself buy neurontin 300 mg amex medicine 7253 pill, all prescriptions in this chapter include the basic information given above. As she has an appointment with him next week, and he is very busy, he advises you to halve the dose until then. You explain to her that the paracetamol does not work because she vomits the drug before it is absorbed. You prescribe paracetamol plus an anti- emetic suppository, metoclopramide, which she should take first, and wait 20-30 minutes before taking the paracetamol. Today his wife calls and asks you to come earlier because he is in considerable pain. Making sure not to underdose him, you start with 10 mg every six hours, with 20 mg at night. He also has non-insulin dependent diabetes, so you add a refill for his tolbutamide. There is nothing wrong with any of the four prescriptions (Figures 6, 7, 8 and 9). For the opiate for patient 32, the strength and the total amount have been written in words so they cannot easily be altered. In some countries it is mandatory to write an opiate prescription on a separate prescription sheet. She also has a newly diagnosed gastric ulcer, for which she has been prescribed another drug. As the doctor is explaining why she needs the new drug and how she should take it, her thoughts are drifting away. In the pharmacy her thoughts are still wandering off even when the pharmacist is explaining how to take the drug. When she gets home she finds her daughter waiting to hear the results of her visit to the doctor. Without telling her the diagnosis she talks about her worry: how to cope with all these different drugs. Finally her daughter reassures her and says that she will help her to take the drugs correctly. On average, 50% of patients do not take prescribed drugs correctly, take them irregularly, or not at all. The most common reasons are that symptoms have ceased, side effects have occurred, the drug is not perceived as effective, or the dosage schedule is complicated for patients, particularly the elderly. For example, irregular doses of a thiazide still give the same result, as the drug has a long half-life and a flat dose-response curve. Patient adherence to treatment can be improved in three ways: prescribe a well chosen drug treatment; create a good doctor-patient relationship; take time to give the necessary information, instructions and warnings. A number of patient 72 Chapter 10 Step 5: Give information, instructions and warnings aids are discussed in Box 9. A well chosen drug treatment consists of as few drugs as possible (preferably only one), with rapid action, with as few side effects as possible, in an appropriate dosage form, with a simple dosage schedule (one or two times daily), and for the shortest possible duration. Patients need information, instructions and warnings to provide them with the knowledge to accept and follow the treatment and to acquire the necessary skills to take the drugs appropriately. In some studies less than 60% of patients had understood how to take the drugs they had received. Information should be given in clear, common language and it is helpful to ask patients to repeat in their own words some of the core information, to be sure that it has been understood. A functional name, such as a ‘heart pill’ is often easier to remember and clearer in terms of indication. Box 9: Aids to improving patient adherence to treatment Patient leaflets Patient leaflets reinforce the information given by the prescriber and pharmacist. If they are not available, make pictorials or short descriptions for your own P-drugs, and photocopy them. Day calendar A day calendar indicates which drug should be taken at different times of the day. It can use words or pictorials: a low sun on the left for morning, a high sun for midday, a sinking sun for the end of the day and a moon for the night. Drug passport A small book or leaflet with an overview of the different drugs that the patient is using, including recommended dosages.

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