Lee A. Fleisher, MD, FACC, fa ha
Disorders of perception diabetes test glucose tolerance order discount acarbose on line, thought content blood sugar s x magik generic acarbose 25mg fast delivery, thought processes diabetes mellitus katze symptome purchase acarbose overnight, and form of thought (Table 11-1) occur during an acute psychotic episode diabetes mellitus signs and symptoms type 1 buy acarbose 25 mg low price. In the residual phase (time period between psychotic episodes), the patient is in touch with reality but does not behave normally. Schizophrenia usually involves repeated psychotic episodes and a chronic, downhill course over years. More than 50% attempt suicide (often during post-psychotic depression or when having hallucinations "commanding" them to harm themselves), and 10% of those die in the attempt. The prognosis is better and the suicide risk is lower if the patient is older at onset of illness, is married, has social relationships, is female, has a good employment history, has mood symptoms, has few negative symptoms, and has few relapses. While the etiology of schizophrenia is not known, certain factors have been implicated in its development. Persons with a close genetic relationship to a patient with schizophrenia are more likely than those with a more distant relationship to develop the disorder (Table 11-2). Markers on many chromosomes including 1, 2, 5, 6, 7, 8, 11, 13, 15, 17, 18, 19, 22, and the X chromosome have been associated with schizophrenia. One possible explanation for this finding is viral infection of the mother during pregnancy, since such infections occur seasonally. However, because patients with schizophrenia tend to drift down the socioeconomic scale as a result of their social deficits (the "downward drift" hypothesis), they are often found in lower socioeconomic groups. Lateral and third ventricle enlargement, abnormal cerebral symmetry, and changes in brain density also may be present. The dopamine hypothesis of schizophrenia states that schizophrenia results from excessive dopaminergic activity. As evidence for this hypothesis, stimulant drugs that increase dopamine availability. Medical illnesses that can cause psychotic symptoms, and thus mimic schizophrenia. Medications that can cause psychotic symptoms include analgesics, antibiotics, anticholinergics, antihistamines, antineoplastics, cardiac glycosides. Psychiatric illnesses other than schizophrenia that may be associated with psychotic symptoms include: a. Schizotypal, paranoid, and borderline personality disorders (see Chapter 14) are not characterized by frank psychotic symptoms but have other characteristics of schizophrenia. Pharmacologic treatments for schizophrenia include traditional antipsychotics (dopamine-2 [D]-receptor antagonists) and atypical2 antipsychotic agents (see Chapter 16). Because of their better side-effect profiles, the atypical agents are now first-line treatments. Psychological treatments, including individual, family, and group psychotherapy (see Chapter 17), are useful to provide long-term support and to foster compliance with the drug regimen. Psychotic disorders are all characterized at some point during their course by a loss of touch with reality. However, the other psychotic disorders do not include all of the criteria required for the diagnosis of schizophrenia. The husband tells the doctor that his wife has shown odd behavior ever since failing an exam 2 weeks ago. The woman has no prior psychiatric history, and physical examination and laboratory results are unremarkable. Believing that people are trying to poison her is an example of (A) an illusion (B) a neologism (C) a hallucination (D) a delusion (E) an idea of reference View Answer 3. Analysis of neurotransmitter availability in the brain of this patient is most likely to reveal (A) increased dopamine (B) decreased dopamine (C) increased acetylcholine (D) decreased histamine (E) decreased serotonin View Answer 4. A 27-year-old patient with schizophrenia shows extreme psychomotor agitation to the point of physical exhaustion. This patient is most likely to have which of the following subtypes of schizophrenia This symptom indicates that the patient is most likely to have which of the following types of schizophrenia Which of the following symptoms of schizophrenia is likely to respond best to antipsychotic medication When compared to traditional antipsychotic medication, atypical antipsychotic medication is more likely to be helpful for which of the following symptoms A 20-year-old woman tells the physician that sometimes she becomes frightened when her room is dark because her computer looks like a lion lurking in the corner. This is an example of (A) an illusion (B) a neologism (C) a hallucination (D) a delusion (E) an idea of reference View Answer 10. A 53-year-old hospitalized patient with schizophrenia tells the physician that a newscaster was talking about her when he said on television, "A woman was found shoplifting today. A 35-year-old man who lives in a group home says that his roommates are spying on him by listening to him through the electrical outlets. For this reason, he has changed roommates a number of times over the last 5 years. A 20-year-old man reports that he just found out that his mother (whom he believed had died when he was a child) has been in an institution for the past 15 years with schizophrenia. He asks what the chances are that he will develop schizophrenia over the course of his life. The most correct answer is approximately (A) 1% (B) 5% (C) 10% (D) 50% (E) 80% View Answer 13. A patient reports that his 19-year-old identical twin brother has just been diagnosed with schizophrenia and wants to know what the likelihood is that he will develop this disorder. The most correct answer is approximately (A) 1% (B) 5% (C) 12% (D) 50% (E) 80% View Answer 14. The percentage of patients with schizophrenia who attempt suicide is approximately (A) 1% (B) 5% (C) 12% (D) 50% (E) 80% View Answer 15. Which of the following is most closely associated with a good prognosis in schizophrenia The most common type of hallucination seen in schizophrenia is (A) visual (B) gustatory (C) auditory (D) olfactory (E) hypnagogic View Answer 17. A 45-year-old man with a 20-year history of severe depression and psychotic symptoms has held different jobs, but none of them for more than 6 months. He is successfully treated for his severe depressive symptoms, but he remains withdrawn and odd. A 68-year-old patient tells the physician that for the last 7 years his neighbor has been trying to get him evicted from his apartment by telling lies about him to the landlord. The patient is married and is retired from his job, which he held for over 30 years. A 60-year-old woman whose husband believes (in the absence of any evidence) that their house is filled with radioactive dust worries about her ability to clear the house of the dust when he is hospitalized. When he locks himself in the basement and refuses to come out, the police are called and he is taken to the emergency room of the local hospital. The wife notes that the patient has been showing increasingly strange behavior over the past 9 months. In patients with schizophrenia, the size of cerebral ventricles, glucose utilization in the frontal lobes, and size of limbic structures are most likely to be increased, decreased, and decreased, respectively. This disorder is characterized by psychotic symptoms lasting >1 day, but <1 month; she has had symptoms for the past 2 weeks. Also, the stress of failing the exam is likely to be a precipitating psychosocial factor in this patient. Schizoaffective disorder is characterized by symptoms of a mood disorder, as well as psychotic symptoms, and lifelong social and occupational impairment. In schizophrenia, psychotic and residual symptoms last >6 months, and there is lifelong social and occupational impairment. In delusional disorder, which often lasts for years, there is a fixed, non-bizarre delusional system; few, if any, other thought disorders; and relatively normal social and occupational functioning. In shared psychotic disorder, a person develops the same delusion as a person with delusional disorder with whom they are in a close relationship. Psychosis due to a general medical condition involves psychotic symptoms occurring as a result of physical illness. Tumours and tumour-like lesions may arise from different components of the skin such as surface epidermis diabetes medications brand names acarbose 25mg with amex, epidermal appendages and dermal tissues diabetes symptoms in young children order acarbose with amex. Another 527 group of tumours have their origin from elsewhere in the body but are cellular migrants to the skin diabetes insipidus drug induced order acarbose without a prescription. M/E the pathognomonic feature is a sharply-demarcated exophytic tumour overlying a straight line from the normal epidermis at one end of the tumour to the normal epidermis at the other end blood sugar numbers for diabetics buy 50mg acarbose. The other features are papillomatosis, hyperkeratosis and acanthosis as seen in squamous cell papillomas. M/E Epidermal cysts have a cyst wall composed of true epidermis with laminated layers of keratin. Rupture of the cyst may incite foreign body giant cell infammatory reaction in the wall. M/E the cyst walls are composed of several layers of epithelial cells and contain lobules of sebaceous glands in the cyst wall. Similar lesions may be induced by exposure to ionising radiation, hydrocarbons and arsenicals. The condition is considered to be a forerunner of invasive squamous cell and/or basal cell carcinoma. The condition may occur anywhere on the skin but is found more often on the trunk, buttocks and extremities. The disorder may lead to multiple malignancies of the skin such as basal cell carcinoma, squamous cell carcinoma and malignant melanoma. Squamous cell carcinoma may arise on any part of the skin and mucous membranes lined by squamous epithelium. Most common locations are the face, pinna of the ears, back of hands and mucocutaneous junctions such as on the lips, anal canal and glans penis. It occurs exclusively on hairy skin, the most common location (90%) being the face, usually above a line from the lobe of the ear to the corner of the mouth. G/A the most common pattern is a nodulo-ulcerative basal cell carcinoma in which a slow-growing small nodule undergoes central ulceration with pearly, rolled margins. The tumour enlarges in size by burrowing and by destroying the tissues locally like a rodent and hence the name with rodent ulcer. M/E the most characteristic feature is the proliferation of basaloid cells (resembling basal layer of epidermis). The most characteristic histologic feature is the presence of multiple horn cysts having keratinised centre and surrounded by basophilic cells resembling basal cells. The tumour is composed of irregular lobules of incompletely differentiated sebaceous glands. The tumour cells show marked cytologic atypia such as pleomorphism and hyperchromasia. Papillary hidradenoma represents an adenoma with apocrine differentiation and containing papillary, tubular and cystic structures. M/E the tumour is composed of irregular islands of tumour cells creating 531 a pattern resembling jigsaw puzzle. The tumour cells comprising the islands consist of 2 types of epithelial cells: peripheral small cells with dark nuclei, and inner large cells with light staining nuclei. They are often fat or slightly elevated lesions; rarely they may be papillomatous or pedunculated. The important histological variants of naevi are as under: i) Lentigo is the replacement of the basal layer of the epidermis by melanocytes. These lesions, in addition to the junctional activity as in junctional naevi, show nests of naevus cells in the dermis to a variable depth. The lesion is mainly located in the upper dermis as nests and cords of naevus cells. These lesions are larger than the usual acquired naevi, are often multiple, and appear as fat macules to slightly elevated plaques with irregular borders and variable pigmentation. Besides the skin, melanomas may occur at various other sites such as oral and anogenital mucosa, oesophagus, conjunctiva, orbit and leptomeninges. Some high risk factors associated with increased incidence of malignant melanoma are as under: i) Persistent change in appearance of a mole. G/A Depending upon the clinical course and prognosis, cutaneous malignant melanomas are of the following 5 types: i) Lentigo maligna melanoma this often develops from a pre-existing lentigo. The tumour cells have amphophilic cytoplasm and large, pleomorphic nuclei with conspicuous nucleoli. The prognosis for patients with malignant melanoma depends upon the stage at presentation. Just as in breast cancer, sentinel lymph node biopsy is quite helpful in evaluation of regional nodal 533 status. The commonest sites are the lower and upper extremities, followed in decreasing frequency, by abdominal cavity and retroperitoneum. The benign variety contains uniform spindle-shaped cells with admixture of numerous foamy histiocytes. The malignant fbrous histiocytoma shows pleomorphic tumour cells and some multinucleate giant cells in a stroma that may show myxoid change and infammatory infltrate. M/E the tumour is very cellular and is composed of uniform fbroblasts arranged in a cartwheel or storiform pattern. M/E Xanthomas are composed of dermal collections of benign-appearing foamy histiocytes. Multinucleate tumour giant cells surrounded by lipid-laden cytoplasm are often present. Which of the following is true about the behaviour of dermato fbrosarcoma protuberans Neuroendocrine cells which are present in the gastric and intestinal mucosa and elaborate peptide hormones. Isolated cells in the left atrium of the heart secrete atrial natriuretic (salt losing) peptide hormone. Major functions of hormones are as under: i) Growth and differentiation of cells: by pituitary hormones, thyroid, parathyroid, steroid hormones. Hypofunction Defciency of hormones occurs from destruction of hormone-forming tissues from infammation (often autoimmune), infections, iatrogenic. These epithelial cells, depending upon their staining characteristics and functions, are divided into 3 types, each of which performs separate functions: 1. Chromophil cells with basophilic granules these cells constitute about 10% of the anterior lobe. Gigantism, therefore, occurs in prepubertal boys and girls and is much less frequent than acromegaly. There is enlargement of hands and feet, coarseness of facial features with increase in soft tissues, prominent supraorbital ridges and a more prominent lower jaw which when clenched results in protrusion of the lower teeth in front of upper teeth. This may result from anterior pituitary lesions or pressure and destruction from adjacent lesions. Empty-sella syndrome Empty-sella syndrome is characterised by the appearance of an empty sella and features of panhypopituitarism. G/A Pituitary adenomas range in size from small foci of less than 10 mm in size (termed microadenoma) to large adenomas several centimeters in diameter (> 1 cm called macroadenomas). M/E By light microscopy of H & E stained sections, an adenoma is composed predominantly of one of the normal cell types of the anterior pituitary i. G/A the tumour is encapsulated, adherent to surrounding structures and is typically cystic, reddish-grey mass. The fuid in the cystic cavity typically has colour and consistency of machinery oil. Stratifed squamous epithelium frequently lining a cyst and containing loose stellate cells in the centre. Buy cheap acarbose 50mg line. Diabetes has been annoying lately..
The aggregates are continuously controlled and maintained against re-agglomeration throughout the process resulting in enhanced effcacy of this material diabetes mellitus type 2 definition who buy generic acarbose 50mg line. This is a multiple functionality innovation since the spherical outer matrix of the composite allows for a micron size powder to be generated while providing mechanical resistance during use and enhanced tactile properties in application diabetes type 1 diet plan cheap acarbose american express. The manufacturing technique used to generate this composite allows for dispersed nano-particles to be encapsulated into an acrylate copolymer matrix with the resultant material being of the order of the micron size level diabetes lifestyle changes buy acarbose online now. The guidelines for these non-nano composite powders are to provide acceptable and also optimum levels of effcacy diabetic quinoa salad recipes generic acarbose 50 mg on line, color intensity, and minimal whitening in cosmetic formulation. The matrix is engineered to limit re-agglomeration of the aggregates to achieve the desirable cos metic effect. From a sensory perspective, the micron sized composite materials offer superior tactile properties. This composite technology is of exceptional value to the advancement of cosmetic material science and technology. Furthermore, there is the potential to incorporate other ingredients based from the same conceptual idea, which shows the boundless opportunity to form derivative products. As industry looks towards solutions for the dilemma of nano-sized raw materials, it is clear that forward thinking has paved the way for new materials such as those presented in this section. Decorative Cosmetics 197 Iron Oxides Iron oxides are used in an array of cosmetic products. The inherent colors (black, red, and yellow) have the ability to be blended in varying ratios to create a broader range of colors including brown, tans, umbers, and sienna. It is prepared by controlled oxida tion of ferrous sulfate under alkaline conditions. Ultramarines Chemically, ultramarines are polysulfde sodium/aluminum sulfo-silicates. The colors of these materials are in a range from blue to violet, pink, and even green. Phosphorous acid is added and the mixture is heated until the violet color is developed. This material is generated through the reaction of sodium ferrocyanide and ferrous sulfate in the presence of ammonium sulfate. Chromium Oxide Chromium oxide (Cr2O3) is a dull yellowish-green pigment that may be prepared by blending an alkali dichromate with sulfur or with a carbonaceous material. Pearlescent Pigments and Other Specialty Pigments Pearlescent Pigments Pearlescent pigments are unique additives to provide formulations with exceptional intensity, brilliance, and luster. Ideal application for such pigments is in color cosmetics including foundations, face powder, lipsticks, eye shadows, and nail care. Other applicable areas are in plastics, industrial coatings, printing inks, and automotive paints. Synthetic pearlescent pig ments are transparent or light absorbing crystal structures. This structure can be monocrystalline or 198 Cosmeceuticals and Active Cosmetics multi-layered where the material consists of alternating materials with differing refractive indices and light absorption properties. As a general guideline, these types of pigments work best in transparent formulations and can be employed as a combination of color components to generate unique color effects. It is important to avoid grinding or milling of these pearlescent pigments to retain the integ rity of its structure and subsequent color. Furthermore, the formulator must pay close attention to make sure the pigments are non-toxic and meet all heavy metal safety requirements. Organic Pearls Since ancient times, pearls and nacreous shells have been used for beautifying purposes. Guanine yields a pearly iridescent effect and can fnd cosmetic applicability in shampoo, eye shadow, and nail enamel. Organic pearls appear as a bright silver effect typically obtainable from sources like the scales of some fsh in the form of platelets or needles. These forms are highly refective and essential to producing this unique effect pigment. Inorganic pearlescent pigments are available in an array of colors, substrates, and matrix structures. Mica based pearlescent pigments are predominant on the market, accounting for >90%. For instance, a particular substrate coated with TiO2 will produce a material different from a substrate coated with iron oxides. This effect is attributed to a dual inter ference refection matrix achieved by a unique composite comprised of a substrate coated by layers of varying materials with varying thicknesses. This technology provides vivid effect pigments possessing intense saturation of color. In addition to the options available from different substrates, coatings, and matrix, hydrophobic surface treatments can be applied to these pearlescent pigments to enhance fow, dispersion, wear, and appearance. Bismuth Oxychloride (BioCl) this material is synthesized as tetragonal crystals and produces a silvery grey pearlescent effect. The lower end of the size range results in a soft, opaque, smooth luster while the upper end of the size range will give a more brilliant sparkle effect. A drawback of using this ingredient in formulation is its poor light stability, which has the possibility of causing darkening over prolonged exposure. Modifcation of BioCl can be made by depositing the material on mica, TiO2, or talc. TiO2 Coated Mica As mentioned previously, TiO2 coated mica is widely used in color cosmetic applications. Rutile crystals supersede the effect of anastase grade in that they give a brilliant pearl effect due to a high refractive index. Another form is interference pearlescent products, which are made by altering the thickness of the coating flm. The concept behind this type of product is that at certain thicknesses, some wavelengths of incident light are refected while others are transmitted. The refection colors progress from silvery white, to yellow-gold, to red, to blue and then green. Decorative Cosmetics 199 Specialties Other pigment systems include polyester foil cut into regular shapes that are epoxy coated with light fast pigments for use in nail enamels and body makeup. In order for the latter to be used in cosmetic applications, 100% alumi num powder is expected to pass through a 200 mesh screen and 95% of the same powder particles are expected to pass through a 325 mesh screen. Pigment particles commonly agglomerate and exhibit poor skin feel as well as a multitude of other problems including poor wettability and dispersibility in cosmetic grade media, poor dispersion and formulation stability, poor chemical stability of metal oxides, and pressability in pressed powders. With this said, surface modifcation is an essential tool in enhancing the performance of pigments while also tailoring the pigment properties to individual needs (Table 17. Colors and substrates altered with organic and inorganic surface treatments are a valuable tool to chem ists. Surface treatments provide the ability to tailor the properties of a substrate, namely esthetics and functional qualities in order to optimally incorporate the ingredient into formulation. The treatments are designed to enhance the surface of the material through the alteration of the chemical and physical properties. Overall performance is dependent on the physical and chemical properties of the treatment, integrity of the bonding between the treatment and substrate, the degree of coverage the coating pro vides, and the potential of the substrate for surface treatment due to available reaction sites. The potential for individual surfaces to react with a surface treatment will vary based on the substrate material. The bond strength with the particle substrate can achieve enhanced mechanical properties, reduced shrinkage, increased stability, and lessening of surface defects. Treated substrates result in enhanced dispersion, powder fow characteristics and fow during mixing. In addition, treatments allow for higher fller loading with the loading level on the fller surface dependent on the surface area of the fller. The properties obtained by implementing surface treatments provide variations like hydrophobicity, hydrophilicity, and lipophilicity with the selection of a treatment dependent on the desired properties to be exhibited by the treated substrate. The chemistry of the surface treatments differ over a broad range including those that are Ecocert approved.
Cautions: cardiac bradyarrhythmias diabetes medications and heart failure purchase acarbose 25mg overnight delivery, hepatic impairment diabetic log printable order acarbose with a visa, hypothyroidism diabetes prevention diet plan buy acarbose 50mg, renal functions impairment diabetes test chart purchase discount acarbose line, respiratory impairment, elderly. Side effects: drowsiness, nausea or vomiting, brady cardia, hypotension, respiratory depression, cardiac arrythmia, biliary spasm, changes in vision, chills, constipation, ureteral spasm, urinary retention. Assisted respiration: Initially 300-3500mcg (up to 50mcg/kg), then 100-200mcg as required. Child over 2 years: Spontaneous respiration: 1-3mcg/kg in small increments, and supplements of 1mcg/kg as required. Assisted respiration: initially 10 15 mcg/kg, followed by 1 3 mcg/kg as required. Drugs Used in Anesthesia 161 Glycopyrronium Bromide (Glycopyrrolate) Injection, 0. May be used as antidiarrheal and for cholinesterase inhibitor toxicity Cautions: close supervision is recommended for infants, children and geriatric patients. Cardiovascular disease, prostatic enlargement, ulcerative colitis, and pyloric stenosis; pregnancy and breast-feeding. Contraindications: symptomatic reflux, paralytic ileus, glaucoma, cardiac disease, hemorrhage, myasthenia gravis, prostate hypertrophy. Note: Geriatric patients may be more sensitive to the effects of the usual adult dose. Parentral administration of scopolamine in combination with morphine or mepridine is indicated in pre-anaesthesia to reduce excitement and produce amnesia. Contraindications: angle closure glaucoma, pyloric obstruction, urinary bladder neck obstruction, tachycardia, paralytic ileus, hypersensitivity to the drug, ulcerative colitis. Side effects: constipation, decreased sweating, drowsiness, dryness of mouth, skin, throat and nose, loss of memory, redness or other signs of irritation at injection site. Cautions: caution should be taken during near term pregnancy, in elderly and in those patients with epilepsy, bronchial asthma, bradycardia, recent coronary occlusion, vagotonia, hyperthyroidism, cardiac arrhythmias, or peptic ulcer. Drug interactions: anticholinergics especially atropine and related compounds, local and some general anaesthetics such as chloroform, cyclopropane, enflurane, halothane, lidocaine; systemic aminoglycosides, succinylcholine or decamythonium; other cholinesterase inhibitors including demecarium, 5. Drugs Used in Anesthesia 163 echothiopate isophlurophate, edrophonium; ganglionic blocking agents such as guanethidine, mecamylamine, trimethaphan; procainamide. Contraindications: intestinal or urinary tract obstruction (mechanical), hypersensitivity to the drug or bromide, peritonitis, urinary tract infection. Side effects: diarrhoea, increasing sweating, increasing of watering of mouth, nausea, vomiting, stomach cramp, frequent urge to urinate, increased bronchial secretion, miosis, bradycardia, bronchospasm, weakness, muscle cramp, fasciculation, hypotension. Oxygen (white-colored cylinder) Indications: oxygen is given by inhalation to correct hypoxia in conditions causing under ventilation of the lungs, such as exacerbations of chronic bronchitis, pneumonia, or pulmonary oedema, where bronchospasm causes hypoxia, as in asthma, in extensive fibrosing alveolitis after general anaesthesia and in conditions where the oxygen content of the air breathed is inadequate as at high altitudes. Cautions: any fire or spark is highly dangerous in the presence of increased oxygen concentrations especially when oxygen is used under pressure. Metal cylinders containing oxygen should be fitted with a reducing valve by which the rate of flow can be controlled. It is administered by means of nasal catheter, facemask, endotracheal tube, or oxygen tent. Concentration of oxygen in inspired anesthetic gases should never be less than 21 % sideline (carbondioxide absorbent). Drugs Used in Anesthesia Used to absorb carbondioxide, for instance in closed-cicuit anaesthetic apparatus. Local Anesthetics the local anesthetics are compounds which produce reversible loss of sensation by preventing or diminishing the conduction of sensory nerve impulses near to the site of their application or injection. Local anesthetics could also be described as local analgesics as they are most often used to produce loss of pain without loss of nervous control. Also because their mode of action is to decrease permeability of the nerve cell membrane to sodium ions they are considered to have a membrane stabilizing effect. Local anesthetics are used very widely in dental practice, for brief and superficial interventions for obstetric procedures, and for specialized techniques of regional anesthesia calling for highly developed skills. Where patient cooperation is required the patient must be psychologically prepared to adopt the proposed procedure. Facilities and equipment for resuscitation should be readily available at all times. The drugs used vary widely in their potency, toxicity, duration of action, stability in water, and ability to penetrate mucous membranes. The cold sensation produced by ethyl chloride spray is used to test the onset of regional anaesthesia. Many simple surgical procedures that neither involve the body cavities nor require muscle relaxation can be performed under local infiltration anesthesia. Lower segment caesarean section can also be performed under local infiltration anesthesia. No more than 4 mg/Kg of plain lidocaine or 7 mg/kg of lidocaine with epinephrine should be administered on any one occasion. The addition of epinephrine (adrenaline) diminishes local blood flow, slows the rate of absorption of the local anesthetic, and prolongs its effect. Care is necessary when using epinephrine for this purpose since, in excesses, it may produce ischaemic necrosis. Topical preparations of lidocaine are available and topical eye drop solutions of tetracaine are used for local anaesthesia of the cornea and conjunctiva. A regional nerve block can proceed safe and effective anesthesia but its execution requires considerable training and practice. This is one of the most useful of all anaesthetic techniques and can be used widely for surgery of the abdomen and the lower limbs. Drugs Used in Anesthesia 165 major procedure requiring considerable training and practice. Bupivacaine is particularly useful for producing prolonged analgesia during labour, where the interval between doses is usually 2-3 hours. Cautions: respiratory impairment; hepatic impairment; epilepsy; porphyria; myasthenia gravis; pregnancy and breastfeeding. Contraindications: adjacent skin infection, inflamed skin, concomitant anticoagulant therapy, severe anaemia or heart disease; spinal or epidural anaesthesia in dehydrated or hypovolaemic patient. Side effects: cardiac arrest, hypotension, bradycardia, seizures, restlessness, anxiety, dizziness, nausea, vomiting, blurred vision, tinnitus and apnea. Dose and Administration: Adult: Dosage depends on site of injection, procedure used, and the status of the patient: Not more than 2mg/kg (with or without adrenaline) should be administered in any 4 hour period, and in 24 hours the total amount should not exceed 400mg. Ethyl Chloride Spray, 50ml Indications: as a local anaesthetic in minor operative procedures such as incision of boils and removal of localized growths. Cautions: during application, the skin adjacent to the area being treated should be covered with vaseline to protect against tissue sloughing. Side effects: freezing may injure cells, decrease resistance to infections, and delay healing. Dose and Administration: the container should be held about 12 inches (30 cm) from the area being treated and the spray directed downward until light frosting appears. Because the local anaesthetic effect is very brief, incision should be made as soon as the tissue become white. Drugs Used in Anesthesia Ointment, 5 % in 10 g; Jelly, 2% in 30 ml; Cartridge, 2% in 1. Cautions: caution in patients with inflammation and/or infections at site of injection, and in very young, the elderly, acutely ill, or weak patients. Dose and Administration: Note: Intradermally, subcutaneously, or submucosally (local infiltration). Inject indirectly in to the tissue to be incised or in the immediate area surgery. It should be injected slowly, with frequent aspirations before and during the injection, to reduce the risk of inadvertent intravascular administration. Children should receive smaller amounts of lidocaine, generally in lower concentration than adults. Jelly, Topical, Adult, to the affected area three or four times a day as needed Spray, Topical, Adult, sprayed and/or applied to affected area three or four times a day as needed. Lidocaine Hydrochloride and Adrenaline Injection, 1 % + 1:200,000 in 30 ml Vial Injection, 2 % + 1:200,000 in 20 ml vial See under Lidocaine Hydrochloride Dose and Administrations: Dental Anaesthesia (for infiltration or nerve block) Adult: 20 to 100 mg (1 to 5 ml) of lidocaine hydrochloride as 2 % solution with epinephrine 1:2000,000; Child, 4 to 5 mg of Lidocaine Hydrochloride per kg of body weight or 100 to 150 mg as a single dose. Local infiltration or nerve block 7 mg of lidocaine hydrochloride per kg of body weight as a 0. |
