By Q. Folleck. Missouri Western State College.
In negative feedback generic lopid 300mg without prescription symptoms endometriosis, the hormone it- and the endocrine system enable endocrine function to self (or the result of its action) controls further hormone adjust to the demands of a changing environment cheap 300mg lopid overnight delivery medicine lake mn. As described in more detail later in from the endocrine glands are released directly into the the chapter, a pituitary hormone, called thyroid-stimulat- bloodstream, which carries them to all parts of the body. When hormone levels fall on the thyroid gland; another, adreno- corticotropic hormone (ACTH), stim- ulates only the outer portion of the ad- Hypothalamus renal gland. The Low level of thyroid cells that make up these tissues have hormones stimulates receptors in the plasma membrane or release of TSH within the cytoplasm to which the hormone attaches. Once a hormone binds to a receptor on or in a target Anterior cell, it affects cell activities, regulating pituitary the manufacture of proteins, changing the permeability of the membrane, or affecting metabolic reactions. Hormone Chemistry Thyroid Stimulates gland Chemically, hormones fall into two main categories: High level of thyroid Inhibits hormones inhibits ◗ Amino acid compounds. The anterior pitu- All hormones except those of the ad- itary releases thyroid stimulating hormone (TSH) when the blood level of thyroid hor- renal cortex and the sex glands fall mones is low. This is a typical example of the kind of self- also includes information on the effects of hypersecretion regulating system that keeps hormone levels within a set (oversecretion) or hyposecretion (undersecretion) of a normal range. That is, they produce substances that act on other Chapter 1, and the release of some hormones in the men- tissues, usually at some distance from where they are strual cycle, as described in Chapter 23. Hormones The pituitary is often called the master gland because The remainder of this chapter deals with hormones and it releases hormones that affect the working of other the tissues that produce them. By this circulatory “detour,” Ovaries some of the blood that leaves the hy- Testes pothalamus travels to capillaries in the anterior pituitary before returning to the heart. For example, the 248 ✦ CHAPTER TWELVE Table 12•1 The Endocrine Glands and Their Hormones GLAND HORMONE PRINCIPAL FUNCTIONS Anterior pituitary GH (growth hormone) Promotes growth of all body tissues TSH (thyroid-stimulating hormone) Stimulates thyroid gland to produce thyroid hormones ACTH (adrenocorticotropic hormone) Stimulates adrenal cortex to produce cortical hor- mones; aids in protecting body in stress situations (injury, pain) PRL (prolactin) Stimulates secretion of milk by mammary glands FSH (follicle-stimulating hormone) Stimulates growth and hormone activity of ovarian follicles; stimulates growth of testes; promotes development of sperm cells LH (luteinizing hormone); ICSH (interstitial Causes development of corpus luteum at site of cell-stimulating hormone) in males ruptured ovarian follicle in female; stimulates secretion of testosterone in male Posterior pituitary ADH (antidiuretic hormone) Promotes reabsorption of water in kidney tubules; at high concentration stimulates constriction of blood vessels Oxytocin Causes contraction of uterine muscle; causes ejection of milk from mammary glands Thyroid Thyroxine (T4) and triiodothyronine(T3) Increases metabolic rate, influencing both physical and mental activities; required for normal growth Calcitonin Decreases calcium level in blood Parathyroids Parathyroid hormone (PTH) Regulates exchange of calcium between blood and bones; increases calcium level in blood Adrenal medulla Epinephrine and norephinephrine Increases blood pressure and heart rate; activates cells influenced by sympathetic nervous system plus many not affected by sympathetic nerves Adrenal cortex Cortisol (95% of glucocorticoids) Aids in metabolism of carbohydrates, proteins, and fats; active during stress Aldosterone (95% of mineralocorticoids) Aids in regulating electrolytes and water balance Sex hormones May influence secondary sexual characteristics Pancreatic islets Insulin Needed for transport of glucose into cells; required for cellular metabolism of foods, especially glucose; decreases blood sugar levels Glucagon Stimulates liver to release glucose, thereby increasing blood sugar levels Testes Testosterone Stimulates growth and development of sexual organs (testes, penis) plus development of secondary sexual characteristics, such as hair growth on body and face and deepening of voice; stimulates maturation of sperm cells Ovaries Estrogens (e. In- uretic hormone, or ADH, and oxytocin) are actually pro- hibiting hormones suppress both growth hormone, duced in the hypothalamus and stored in the posterior pi- which stimulates growth and metabolism, and prolactin, tuitary. THE ENDOCRINE SYSTEM: GLANDS AND HORMONES ✦ 249 Table 12•2 Disorders Associated with Endocrine Dysfunction HORMONE EFFECTS OF HYPERSECRETION EFFECTS OF HYPOSECRETION Growth hormone Gigantism (children), acromegaly (adults) Dwarfism (children) Antidiuretic hormone Syndrome of inappropriate antidiuretic Diabetes insipidus hormone (SIADH) Aldosterone Aldosteronism Addison disease Cortisol Cushing syndrome Addison disease Thyroid hormone Graves disease, thyrotoxicosis Infantile hypothyroidism (cretinism) in chil- dren; myxedema in adults Insulin Hypoglycemia Diabetes mellitus Parathyroid hormone Bone degeneration Tetany (muscle spasms) Internal-external stimuli Neurotransmitters Hypothalamus 12 Releasing hormones secreted ADH Oxytocin Infundibulum Portal system Posterior pituitary Hormones feed back to anterior pituitary Anterior pituitary and hypothalamus Breast Oxytocin Thyroid TSH ADH Uterus Thyroid hormones ACTH Adrenal Kidney PRL FSH Ovary FSH GH Adrenocorticosteroids LH LH (ICSH) Estrogen Corpus Breast luteum Testes Bone and Progesterone soft tissues Testosterone Figure 12-3 The hypothalamus, pituitary gland, and target tissues. This ◗ Growth hormone (GH), or somatotropin (so-mah-to- type of diabetes should not be confused with diabetes TRO-pin), acts directly on most body tissues, promot- mellitus, which is due to inadequate amounts of in- ing protein manufacture that is essential for growth. Tumors of the Pituitary The effects of pituitary tu- ◗ Follicle-stimulating hormone (FSH) stimulates the devel- mors depend on the cell types in the excess tissue. A person who develops ovulation in females and sex hormone secretion in both such a tumor in childhood will grow to an abnormally tall males and females; in males, the hormone is sometimes stature, a condition called gigantism (ji-GAN-tizm) (see called interstitial cell–stimulating hormone (ICSH). FSH and LH are classified as gonadotropins (gon-ah- If the GH-producing cells become overactive in the do-TRO-pinz), hormones that act on the gonads to regu- adult, a disorder known as acromegaly (ak-ro-MEG-ah- late growth, development, and function of the reproduc- le) develops. The fingers resemble a spatula, and the face takes on a coarse appearance: the nose widens, the Hormones of the Posterior Lobe lower jaw protrudes, and the forehead bones may bulge. In hu- itary tries to compensate for decreased glucocorticoid levels mans, though, MSH levels are usually so low that its role as a by increasing POMC production. This is so because pituitary regulating pigmentation, women do produce more MSH dur- cells do not produce ACTH directly but produce a large pre- ing pregnancy and often have darker skin. Calcitonin works with parathyroid hor- exhibit signs of underactivity of other endocrine glands mone and with vitamin D to regulate calcium metabo- that are controlled by the pituitary, such as the ovaries, lism, as described below. Disorders of the Thyroid Gland A goiter (GOY- Evidence of tumor formation in the pituitary gland ter) is an enlargement of the thyroid gland, which may may be obtained by radiographic examinations of the or may not be associated with overproduction of hor- skull. Computed tomography (CT) and magnetic res- adenomatous (ad-eh-NO-mah-tus), or nodular, goiter onance imaging (MRI) scans are also used to diagnose pi- is an irregular-appearing goiter accompanied by tumor tuitary abnormalities. Underactivity of the thy- roid, known as hypothyroidism (hi-po-THI-royd-izm), The thyroid, located in the neck, is the largest of the en- shows up as two characteristic states related to age: docrine glands (Fig. The thyroid has two roughly oval lateral lobes on either side of the larynx (voice box) ◗ Infantile hypothyroidism, also known as cretinism connected by a narrow band called an isthmus (IS-mus). Iodine deficiency is rare now myxedema regains health easily, although treatment due to widespread availability of this mineral in iodized must be maintained throughout life. Hyperthyroidism is the opposite of hypothyroidism, Another hormone produced by the thyroid gland is that is, overactivity of the thyroid gland with excessive se- calcitonin (kal-sih-TO-nin), which is active in calcium cretion of hormone. A common form of hyperthyroidism is Graves disease, which is characterized by a goiter, a strained appearance of the face, intense nervousness, Epiglottis weight loss, a rapid pulse, sweating, tremors, and an ab- normally quick metabolism. Another characteristic symp- Thyroid gland Hyoid bone (right lobe) tom is protrusion (bulging) of the eyes, known as exoph- thalmos (ek-sof-THAL-mos), which is caused by swelling of the tissue behind the eyes (Fig.
These effects are readily reversed upon drug receptors order lopid 300 mg otc medicine and health, retaining high potency with lesser potential withdrawal order 300mg lopid medicine vs surgery. Current drug development is directed toward a search for atypical antipsychotics like clozap- ine that have a broad spectrum of effects on other neu- CLINICAL USES rotransmitter receptors. The principal goals for the Other Pharmacological Actions management of a chronic schizophrenic disorder are the Antipsychotic drugs produce shifts in the pattern of minimizing of symptoms and the prevention of exacer- electrographic (EEG) frequencies, usually slowing them bations. This slowing is sometimes their ability to reduce the rate of relapse in the chronic focal or unilateral, which may pose diagnostic problems, condition by about two-thirds to three-quarters com- but the frequency and amplitude changes are readily ap- pared to no treatment. The clinical trend is in epileptic patients and for the low incidence of seizures to prescribe the higher-potency atypical agents. All antipsychotics except clozapine have a similar po- Antipsychotics produce striking effects on the re- tential for producing tardive dyskinesia, the most serious productive system. Clozapine is reserved for patients who have been reported in women, whereas decreased li- have failed to respond to therapy with at least two other bido and gynecomastia have been observed in men. Once the disorder is controlled, sin- ten limit the tolerated dose, and may interfere with the gle daily doses are preferred. Use of large doses, or rapidly increasing doses to treat severe conditions, has not proved beneﬁcial be- Sedation is common after use of all antipsychotic drugs cause of the incidence of acute dystonic reactions. A and is especially notable with the low-potency phenoth- parenteral form of haloperidol offers the advantage of iazines; this is a result of their activity at 1-adrenergic greater bioavailability and so can be used for rapid ini- and H1-histaminergic receptors. However, sedation de- tiation or for long-term maintenance in noncompliant creases during long-term treatment, and many patients individuals. Single daily doses given ing with the smallest possible antipsychotic dose is pre- at bedtime minimize this problem. Therapy is typically continued for at least Extrapyramidal Reactions a year after remissions are apparent. Two extrapyramidal conditions, acute dystonia and Schizoaffective disorders have depression or mania akathisia, occur early during treatment, while parkinson- as a major component in addition to psychosis. All lithium or an antidepressant may have to be added to three reactions occur most commonly with the high- the regimen. As the condition sub- in about 5% of patients on antipsychotic therapy, consists sides, the antipsychotic can be withdrawn. It can be treated with centrally acting an- disorder associated with motor and vocal tics of vari- timuscarinic agents, such as benztropine, while antipsy- able form and severity, can be effectively treated with chotic therapy is temporarily discontinued. It hibit a strong antiemetic effect and can sometimes be is frequently unresponsive to anticholinergics and is used clinically for this purpose. Signs of parkinsonism—akinesia, tremor, rigidity— ADVERSE EFFECTS can develop gradually, but this reaction usually re- Antipsychotic drugs are characterized by high thera- sponds favorably to central antimuscarinic agents. As peutic indices with respect to mortality, but side effects with dystonia, parkinsonism may subside, permitting occur routinely at therapeutic doses, mostly as exten- withdrawal of the antimuscarinic drug. It is the most serious adverse the inhibitory actions of dopamine on prolactin secre- effect of the antipsychotic drugs. This results in amenorrhea, galactorrhea, and in- occur in 20 to 40% of chronically treated patients; there fertility in women and in loss of libido and impotence in is no established treatment, and reversibility may be men. An appropri- Other Adverse Effects ate clinical response to these symptoms would be to re- Cholestatic jaundice is observed infrequently, usually duce the dose or discontinue the antipsychotic agent during the ﬁrst few weeks of treatment. This is thought and then eliminate all drugs with central anticholinergic to be a hypersensitivity reaction and is usually mild and action, such as antidepressants. Cutaneous allergic reactions are occasion- ance the risks of continuing treatment in a patient with ally reported. Both types of problems normally disap- tardive dyskinesia with the beneﬁts of antipsychotic ad- pear upon changing to an antipsychotic from a different ministration. Photosensitivity usually manifests as an therapy can be considered, or diazepam can be em- acute hypersensitivity reaction to sun with sunburn or ployed to enhance GABAergic activity. The most serious ocular complication is pigmen- ical emergency involving extrapyramidal symptoms that tary retinopathy associated with high-dose thioridazine occurs in about 1% of patients receiving antipsychotics. The condition is marked by hyper- Agranulocytosis is a potentially catastrophic idio- thermia or fever, diffuse muscular rigidity with severe syncratic reaction that usually appears within the ﬁrst 3 extrapyramidal effects, autonomic dysfunction such as months of therapy. Although the incidence is extremely increased blood pressure and heart rate, and ﬂuctuating low (except for clozapine), mortality is high.
Buckup buy 300mg lopid fast delivery medicine to induce labor, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved buy 300 mg lopid visa 85 medications that interact with grapefruit. Costoclavicular Test Assesses a neurovascular compression syndrome in the costoclavicular region. The examiner palpates the wrists to take the pulse in both radial arteries, noting amplitude and pulse rate. With the patient in this position, the examiner again palpates the wrists and evaluates the pulse in both radial arteries. Assessment: Unilateral weakness or absence of the pulse in the radial artery, ischemic skin changes, and paresthesia are clear signs of com- pression of the neurovascular bundle in the costoclavicular region (be- tween the first rib and clavicle). Procedure: The standing patient abducts both arms past 90° while retracting the shoulders. Assessment: Pain in the shoulder and arm, ischemic skin changes, and paresthesia are clear signs of compression of the neurovascular bundle, which is primarily attributable to changes in the scalene muscles (fib- rosis, hypertrophy, or presence of a small scalene muscle). Then the patient is instructed to rapidly flex and extend the fingers of each hand for one minute. Assessment: If one arm begins to droop after a few cycles of finger motion and ischemic skin changes, paresthesia, and pain in the shoulder and arm occur, this suggests a costoclavicular compression syndrome affecting neurovascular structures. Causes include osteophytes, rib changes, and anatomic variations in the scalene muscles. Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. The affected arm is held in a middle position alongside the trunk with the elbow flexed 90°. The patient is asked to rotate his or her head toward the contralateral side (away from the side being examined). Assessment: Weakening or loss of the pulse in the radial artery, pain in the shoulder and arm, ischemic changes, and paresthesia are signs of a costoclavicular syndrome (compression of the subclavian artery be- tween the first rib and the clavicle) or of a scalene muscle syndrome (compression of the neurovascular bundle between the middle and anterior scalene muscles due to fibrosis or hypertrophy). Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Procedure: The patient is asked to supinate both arms and raise them to 90° while keeping his or her eyes closed. Procedure: The patient is supine and is asked to close his or her eyes and flex both hips and both knees. Assessment: The neurologic examination of the lower extremities in a patient capable of standing and walking begins with inspection of gait. With the Buckup, Clinical Tests for the Musculoskeletal System © 2004 Thieme All rights reserved. Strength in the extensor digitorum and hallucis longus is tested by dorsiflexion of the toes (L5) against resistance, and strength in the triceps surae is tested by plantar flexion of the foot (S1) against resist- ance. It does so by highlighting those features of anatomy which are of clinical importance using a vertical blue bar, in radiology, pathology, medicine and midwifery as well as in surgery. It presents the facts which students might reasonably be expected to carry with them during their years on the wards, through their ﬁnal examinations and into their postgraduate years; it is designed for the clini- cal student. Anatomy is a vast subject and, therefore, in order to achieve this goal, I have deliberately carried out a rigorous selection of material so as to cover only those of its thousands of facts which I consider form the necessary anatomical scaffolding for the clinician. Wherever possible practical appli- cations are indicated throughout the text— they cannot, within the limita- tions of a book of this size, be exhaustive, but I hope that they will act as signposts to the student and indicate how many clinical phenomena can be understood and remembered on simple anatomical grounds. Repre- sentative computerized axial tomography and magnetic resonance imaging ﬁlms have been included, since these techniques have given increased impetus to the clinical importance of topographical anatomy. The continued success of this volume, now in its forty-seventh year of publication, owes much to the helpful comments which the author has received from readers all over the world. Harold Ellis 2006 xiii Acknowledgements I wish to thank the many students who have sent suggestions to me, many of which have been incorporated into this new edition. To Mrs Katherine Ellis go my grateful thanks for invaluable secretarial assistance.
S u s p e c t l a r g e b o w e l : c l i n d a m y c i n p l u s a m i n o g l y c o s i d e P e r i t o n e a l d i a l y s i s - r e l a t e d S order lopid 300 mg symptoms irritable bowel syndrome. E n t e r o b a c t e r i a c e a e S K I N / S O F T T I S S U E A c n e P r o p i o n i b a c t e r i u m a c n e T e t r a c y c l i n e buy lopid 300 mg online treatment 9mm kidney stones, m i n o c y c l i n e, t o p i c a l c l i n d a m y c i n A c n e r o s a c e a P o s s i b l e s k i n m i t e T o p i c a l : m e t r o n i d a z o l e, d o x y c y c l i n e B u r n s S. T i n e a c o r p o r i s ( b o d y ) F u n g u s : T r i c h o p h y t o n s p p. U L C E R D I S E A S E H e l i c o b a c t e r p y l o r i O m e p r a z o l e p l u s a m o x i c i l l i n p l u s ( d u o d e n a l o r g a s t r i c, c l a r i t h r o m y c i n n o t N S A I D r e l a t e d ) V A G I N A C a n d i d i a s i s C. S e e a ls o T a b le s 7 – 3 ( V i r a l), 7 – 4 ( H I V ), 7 – 5 ( F u n g a l), a n d 7 – 6 ( P a r a s i t i c ) 7 – 7 ( T i c k -B o r n e ). N o t e : T h e s e g u i d e li n e s a r e b a s e d o n a g e n t s c o m m o n ly i n v o lv e d i n a d u lt i n f e c t i o n s. A c t u a l m i c r o b i a l t r e a t m e n t s h o u ld b e g u i d e d b y m i c r o b i o lo g i c s t u d i e s i n t e r - p r e t e d i n t h e c li n i c a l s e t t i n g. A b b r e v i a t i o n s : A I D S = a c q u i r e d i m m u n o d e f i c i e n c y s y n d r o m e ; C O P D = c h r o n i c o b s t r u c t i v e p u lm o n a r y d i s e a s e ; H I V = h u m a n i m m u n o d e f i c i e n c y v i r u s ; I N H = i s o n i a z i d ; I V = i n t r a v e n o u s ; N S A I D = n o n s t e r o i d a l a n t i i n f la m m a t o r y d r u g ; P O = b y m o u t h ; P P D = p u r i f i e d p r o t e i n d e r i v a t i v e ; T B = t u b e r c u lo s i s ; T M P – S M X = t r i m e t h o p r i m – s u lf a m e t h o x a z o le. T A B L E 7 – 3 P a t h o g e n s a n d D r u g s o f C h o i c e f o r T r e a t i n g C o m m o n V i r a l I n f e c t i o n s * V i r a l I n f e c t i o n D r u g o f C h o i c e A d u l t D o s a g e C M V R e t i n i t i s, c o l i t i s, e s o p h a g i t i s G a n c i c l o v i r ( C y t o v e n e ) † 5 m g / k g I V q 1 2 h × 1 4 – 2 1 d, 5 m g / k g / d I V o r 6 m g / k g I V 5 × / w k o r 1 g P O t i d ( V i t r a s e r t ) i m p l a n t s 4. A b b r e v i a t i o n s : C M V = c y t o m e g a lo v i r u s ; E B V = E p s t e i n – B a r r v i r u s ; H A V = h e p a t i t i s A v i r u s ; H B V = h e p a t i t i s B v i r u s ; H C V = h e p a t i t i s C v i r u s ; H I V = h u m a n i m - m u n o d e f i c i e n c y v i r u s ; H P V = h u m a n p a p i llo m a v i r u s ; H S V = h e r p e s s i m p le x v i r u s ; R S V = r e s p i r a t o r y s y n c y t i a l v i r u s ; V Z V = v a r i c e lla z o s t e r v i r u s. One of the following: zidovudine + lamivudine; zidovudine + didanosine; stavudine + lamivudine; stavudine + didanosine; zidovudine + zalcitabine. Nevirapine and delavirdine require more doses, and have had shorter follow-up in reported studies. Combinations of Efavirenz and nevirapine with protease inhibitors require increasing the dosage of the protease inhibitor. Ritonavir is usually given in dosage of 100–400 mg bid when used with another pro- tease inhibitor. Protease inhibitors that have been combined with ritonavir 100–400 mg bid include indinavir 400–800 mg bid, amprenavir 600–800 mg bid, saquinavir 400–600 mg bid and nelfinavir 500–750 mg bid. Source: Reproduced, with permission, from The Medical Letter Vol 42, Issue 1089, Janu- ary 10, 2000. T A B L E 7 – 5 S y s t e m i c D r u g s f o r T r e a t i n g F u n g a l I n f e c t i o n s I n f e c t i o n D r u g o f C h o i c e A l t e r n a t i v e s A S P E R G I L L O S I S A m p h o t e r i c i n B o r i t r a c o n a z o l e A m p h o t e r i c i n B l i p i d c o m p l e x, a m p h o t e r i c i n c h o l e s t e r y l c o m p l e x l i p o s o m a l a m p h o t e r i c i n B B L A S T O M Y C O S I S I t r a c o n a z o l e o r a m p h o t e r i c i n B F l u c o n a z o l e C A N D I D I A S I S O r a l ( t h r u s h ) F l u c o n a z o l e o r i t r a c o n a z o l e N y s t a t i n l o z e n g e o r s w i s h a n d s w a l l o w S t o m a t i t i s, e o s p h a g i t i s, F l u c o n a z o l e o r i t r a c o n a z o l e P a r e n t e r a l o r o r a l a m p h o t e r i c i n B v a g i n i t i s i n A I D S S y s t e m i c A m p h o t e r i c i n B o r f l u c o n a z o l e C y s t i t i s / v a g i n i t i s S e e T a b l e 7 – 2 C O C C I D I O I D O M Y C O S I S P u l m o n a r y ( n o r m a l i n d i v i d u a l ) N o d r u g u s u a l l y r e c o m m e n d e d P u l m o n a r y ( h i g h r i s k ) I t r a c o n a z o l e o r f l u c o n a z o l e A m p h o t e r i c i n B C R Y P T O C O C C O S I S I n n o n - A I D S p a t i e n t A m p h o t e r i c i n B o r f l u c o n a z o l e A m p h o t e r i c i n B f l u c o n a z o l e M e n i n g i t i s ( H I V / A I D S ) A m p h o t e r i c i n B p l u s 5 - f l u c y t o s i n e ; t h e n A m p h o t e r i c i n B l i p i d c o m p l e x l o n g - t e r m s u p p r e s s i o n w i t h f l u c o n a z o l e H I S T O P L A S M O S I S P u l m o n a r y, d i s s e m i n a t e d N o r m a l i n d i v i d u a l M o d e r a t e d i s e a s e : i t r a c o n a z o l e S e v e r e : a m p h o t e r i c i n B H I V / A I D S A m p h o t e r i c i n B, f o l l o w e d b y I t r a c o n a z o l e i t r a c o n a z o l e s u p p r e s s i o n ( c o n t i n u e d ) T A B L E 7 – 5 ( C o n t i n u e d ) I n f e c t i o n D r u g o f C h o i c e A l t e r n a t i v e s M U C O R M Y C O S I S A m p h o t e r i c i n B N o d e p e n d a b l e a l t e r n a t i v e P A R A C O C C I D I O I D O M Y C O S I S I t r a c o n a z o l e A m p h o t e r i c i n B S P O R O T R I C H O S I S C u t a n e o u s I t r a c o n a z o l e P o t a s s i u m i o d i d e 1 – 5 m L t i d S y s t e m i c I t r a c o n a z o l e A m p h o t e r i c i n B A b b r e v i a t i o n s : A I D S = a c q u i r e d i m m u n o d e f i c i e n c y s y n d r o m e ; H I V = h u m a n i m m u n o d e f i c i e n c y v i r u s. TABLE 7–6 Drugs for Treating Selected Parasitic Infections Infection Drug Amebiasis (Entamoeba histolytica) Asymptomatic Iodoquinol or paramomycin Mild to moderate intestinal disease Metronidazole or tinidazole Severe intestinal disease, hepatic Metronidazole or tinidazole abscess Ascariasis (Ascaris lumbricoides, Albendazole, mebendazole or roundworm) pyrantel pamoate Cryptosporidiosis (Cryptosporidium) Paromomycin Cutaneous larva migrans (creeping Albendazole, thiabendazole or eruption, dog and cat hookworm ivermectin 7 Cyclospora infection Trimethoprim–sulfamethoxazole Enterobius vermicularis (pinworm) Pyrantel pamoate, mebendazole or albendazole Filariasis (Wuchereria bancrofti, Diethylcarbamazine Brugia malayi, Loa loa) Giardiasis (Giardia lamblia) Metronidazole Hookworm infection (Ancylostoma Albendazole, mebendazole, or duodenale, Necator americanus) pyrantel pamoate Isosporiasis (Isospora belli) Trimethoprim–sulfamethoxazole Lice (Pediculus humanus, P. T A B L E 7 – 7 G u i d e t o C o m m o n T i c k - b o r n e D i s e a s e s C a u s a t i v e D i s e a s e A g e n t S e a s o n V e c t o r H a b i t s R o c k y M o u n t a i n s p o t t e d R i c k e t t s i a r i c k e t t s i i M o s t l y s p r i n g, s u m m e r A m e r i c a n D o g T i c k f e v e r ( b a c t e r i u m ) F o u n d i n h i g h g r a s s a n d l o w s h r u b s, f i e l d s L o n e S t a r T i c k F o u n d i n w o o d l a n d s, f o r e s t e d g e, a n d o l d f i e l d s H u m a n g r a n u l o c y t i c E h r l i c h i a s p p. The guidelines now specify which patients are at high, moderate, or low risk of bacteremia and provide general guidelines for procedures that are more likely to be associated with bacterial endocarditis. SBE prophylaxis is recom- mended only for patients who are at high or moderate risk. Strict Isolation: (Single room, controlled airflow, handwashing, gown, gloves, mask) Varicella, herpes (localized, disseminated, neonatal), wound or burns infected with S. This test gives information on acid–base homeostasis (pH, pCO, [HCO −], and base difference) and on blood oxygenation (pO, O saturation). Normal values for blood gas analysis are given in Table 8–1, page 162, and capillary blood gases are discussed in a following section. Note that the HCO − from the blood gas is a calculated 3 value and should not be used in the interpretation of the blood gas levels, instead the HCO − 3 from a chemistry panel should be used. VENOUS BLOOD GASES There is little difference between arterial and venous pH and bicarbonate (except in cases of CHF and shock); therefore, the venous blood gas level may occasionally be used to assess acid–base status. Venous oxygen levels, however, are significantly less than arterial levels (see Table 8–1). When interpreting a CBG, apply the following rules: • pH: Same as arterial or slightly lower (Normal = 7.
10 of 10 - Review by Q. Folleck
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