By X. Sugut. University of Wisconsin-Platteville.

The process removes impurities and is also excreted in breast milk of nursing mothers discount ofloxacin 200 mg infection preventionist salary. When the drug is heated and the effects include nausea in new smokers at low blood levels vapors inhaled trusted 200 mg ofloxacin medication for uti relief, crack acts within a few seconds. It reportedly and in experienced smokers at blood levels higher than their can cause psychological dependence with one use. Nicotine poisoning can occur in infants and children from ingestion of tobacco products, skin contact with used nicotine transdermal patches, or chewing nicotine Treatment of Cocaine Abuse gum. Poisoning may also occur with accidental ingestion of in- Drug therapy is largely symptomatic. Oral ingestion usually hyperactivity may be treated with a benzodiazepine antianxiety causes vomiting, which limits the amount of nicotine absorbed. With chronic tobacco use, nico- treated by standard methods; and so forth. Initial detoxifica- tine is implicated in the vascular disease and sudden cardiac tion and long-term treatment are best accomplished in centers death associated with smoking. However, the role of nicotine or units that specialize in substance abuse disorders. With inhalation of crack cocaine vapors, Cerebral infarct, subarachnoid and other hemorrhages; excessive respiratory symptoms occur in up to 25% of users and may include central nervous system stimulation, manifested by anxiety, agita- bronchitis, bronchospasm, cough, dyspnea, pneumonia, pulmo- tion, delirium, hyperactivity, irritability, insomnia, anorexia and nary edema, and fatal lung hemorrhage. Cardiovascular Effects Genitourinary Effects Dysrhythmias, including tachycardia, premature ventricular con- Delayed orgasm for men and women; difficulty in maintaining tractions, ventricular tachycardia and fibrillation, and asystole; erection. Hepatitis; human immunodeficiency virus infection; endocarditis; cellulitis; abscesses. Respiratory Effects With snorting of cocaine, rhinitis, rhinorrhea, and damage (ulcer- ation, perforation, necrosis) of the nasal septum from vasocon- CHAPTER 15 SUBSTANCE ABUSE DISORDERS 245 disease) associated with chronic use of tobacco is unknown. Nicotine products are intended to be used for limited pe- Nicotine Dependence riods of 3 to 6 months, with tapering of dosage and discon- Like alcohol and opiate dependence, nicotine dependence is tinuation. Although they are effective in helping smokers characterized by compulsive use and the development of tol- achieve abstinence, many resume smoking. Mental depression is also Overall, treatment regimens that combine counseling and associated with nicotine dependence. It is unknown whether behavioral therapy with drug therapy are more successful depression leads to smoking or develops concomitantly with than those using drug therapy alone. Evidence indicates a compulsion to smoke when blood levels of nicotine become low. Abstinence from smoking leads to signs and symptoms Marijuana of withdrawal (eg, anxiety, irritability, difficulty concentrat- ing, restlessness, headache, increased appetite, weight gain, Marijuana and other cannabis preparations are obtained from sleep disturbances), which usually begin within 24 hours of Cannabis sativa, the hemp plant, which grows in most parts the last exposure to nicotine. Marijuana and hashish are the two cannabis preparations used in the United States. Marijuana is obtained from leaves and stems; Treatment of Nicotine Dependence hashish, prepared from plant resin, is 5 to 10 times as potent Most tobacco users who quit do so on their own. These cannabis prepara- who are strongly dependent and unable or unwilling to tions contain several related compounds called cannabinoids. Delta-9-tetrahydrocannabinol (∆-9-THC) is the main psycho- One method is the use of bupropion, an antidepressant (see active ingredient, but metabolites and other constituents also Chap. The antidepressant formulation is marketed may exert pharmacologic activity. The mechanism of action as Wellbutrin; the smoking-cessation formulation is Zyban, is unknown, although specific cannabinoid receptors have a sustained-release tablet. The other method is nicotine been identified in several regions of the brain. It is also dif- and spray are used intermittently during the day; the trans- ficult to predict the effects of these drugs. One factor is the amount produce a steady blood level of nicotine and patients seem of active ingredients, which varies with the climate and soil to use them more consistently than they use the other prod- where the plants are grown and with the method of preparation. The patches and gum are available over the counter; Other factors include dose, route of administration, personal- the inhaler and nasal spray require a prescription. The prod- ity variables, and the environment in which the drug is taken.

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There are many aspects of a paper trusted 200mg ofloxacin infection quizlet, such as the way in which the title is written discount ofloxacin 200 mg antibiotic herbs, or the favoured style, that can be discovered only by careful analysis of the papers published in your target journal (see evidence-based writing). Interviewing The ability to carry out a good interview gives writers a valuable tool. It enables them to gather information quickly from those who have expertise in a given area, and in a language that, because it is informal and spoken, is more likely to pass the pub test and be accessible to the target readers. The quality of an interview, however, depends on how well you have chosen the person to be interviewed. Watch for biases and hidden agendas – and if possible balance one expert with another. Once you have found your interviewee, the following step-by-step plan should be helpful: • Be absolutely clear before you start what you want to achieve. There are, broadly speaking, three reasons for an interview: (1) to get facts and information; (2) to add opinion or description to facts that you already have, and (3) to provide information for a profile of the interviewee. Use a technique such as branching to work out the information you need, and use this to construct a checklist of questions. Group these questions into three or four broad areas and either memorize this summary or write it down on a piece of paper. Check your equipment: most writers have etched on their memories the disas- trous times when they discovered that their tape recorder had broken, or had to borrow a pen or some pieces of paper from the interviewee. Interviews are not the time to make a fashion statement: the more acceptable you appear to the interviewee, the more likely you will be to get good quality informa- tion. This is the time to set any ground rules (see off the record; non-attributable information). These should be negotiated before you start rather than when the questions start getting difficult. Keep the interviewee on track, 65 THE A–Z OF MEDICAL WRITING though sometimes desperate measures may be needed, such as knocking over a glass of water. Using a tape recorder will free you to concentrate on the business in hand – though keep some written notes as well, just in case there is a systems failure. Interviewees will often ask to see a copy of what you have written before it is published. The danger with this is that they will try to get rid of their bright, clear quotes and try to put back their posh overcoat (see putting on the posh overcoat). On the other hand, passing your copy to them will probably pick up one or two errors of fact. Use your discretion: a sensible compromise is to read what you have written over the phone. In that way they can pick up errors but will have no time to fiddle with the style. Wherever possible go through the information as soon as the interview is over. When you come to write, you should be in a position to take out of it, from memory, what you need. Avoid where possible writing up transcripts: this takes up huge amounts of time. The test of a good interviewer is not what the interviewee thinks, but the quality of the information elicited, or the liveliness of the quotes. Introductions Many people believe that the role of the first part of a piece of writing is to introduce the reader to what you are going to say so that the reader can decide whether or not to become involved. This probably stems from school essays and has a slightly old-fashioned feel to it. Intro This is the term used by journalists to describe the first sentence of a news story. It is based on the assumption that your best chance of being read is to put your finest information into the first sentence. Once you have done that, you can put in all the qualifying information, in order of importance. The occasional (or perhaps more than occasional, depending on the papers you buy) lapses into extremity should not distract from the fact that this is a sensible approach, and we should adopt it for many types of writing up to about 400 words – particularly letters, e- mails and executive summaries (see marketing).

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CS was first used as a dietary supplement because stud- ies suggested that it would promote healing of cartilage specifically for the treatment of moderate or severe migraines discount ofloxacin 400 mg amex infection 3 months after miscarriage. Because Proponents of CS cite clinical trials that indicate beneficial of their vasoconstrictive properties cheap 400 mg ofloxacin with visa antibiotic resistance evolves in bacteria when quizlet, the drugs are contra- effects. For example, one study cited by Fetrow and Avila indicated in clients with a history of angina pectoris, myo- compared CS with diclofenac sodium, an NSAID, in 146 clients cardial infarction, or uncontrolled hypertension. The authors concluded that the vary in onset of action, with subcutaneous sumatriptan acting NSAID relieved pain faster but the effects of CS lasted longer, the most rapidly and starting to relieve migraine headache up to 3 months after treatment. Most clients get relief within 1 to 2 hours of CS in comparison with the adverse effects of NSAIDs. The drugs are metabolized in the main adverse effects are reportedly minor stomach upset. In liver by monoamine oxidase or cytochrome P450 enzymes; addition, there is a theoretical risk of bleeding because of the CHAPTER 7 ANALGESIC–ANTIPYRETIC–ANTI-INFLAMMATORY AND RELATED DRUGS 111 CLIENT TEACHING GUIDELINES Acetaminophen, Aspirin, and Other NSAIDs General Considerations ✔ Inform any health care provider if taking aspirin, ibupro- ✔ Aspirin and other nonsteroidal anti-inflammatory drugs fen, or any other NSAID regularly. Aspirin is as effec- lergic reaction (eg, asthma, difficulty in breathing, hives) tive as the more costly NSAIDs, but is more likely to or severe GI symptoms (eg, ulcer, bleeding) after taking cause stomach irritation and bleeding problems. The there is a high risk of overdosing on different products Food and Drug Administration requires an alcohol warn- containing the same drug or products containing similar ing on the labels of OTC pain and fever relievers and drugs. Knowing drug names, reading product labels, and urges people who drink three or more alcoholic drinks using the following precautions can increase safety in every day to ask their doctors before using the products. Rofe- ceptions if you are taking a small dose of aspirin daily coxib (Vioxx) and meloxicam (Mobic) may be taken without (usually 81–325 mg), to prevent heart attack and regard to food. First, you should continue taking the aspirin if ✔ Swallow enteric-coated aspirin (eg, Ecotrin) whole; do not Celebrex, Vioxx, or Bextra is prescribed. The coating is applied to decrease stom- generally safe to take occasional doses of aspirin or ach irritation by making the tablet dissolve in the intes- an NSAID for pain or fever. If you are taking any prescription NSAID regularly, the tablet to dissolve in the stomach. These include diclofenac sodium profen (Actron, Orudis KT), or naproxen (Aleve). Also, (Voltaren or Voltaren XR); diflunisal (Dolobid); etodolac do not combine the OTC products with each other or (Lodine XL); ketoprofen or Oruvail extended release cap- with aspirin. These drugs are available as both pre- sules; naproxen delayed-release (EC-Naprosyn) or scription and OTC products. Recommended doses medicine you are taking is long-acting, ask a health care are smaller for OTC products than for prescription provider. However, any combination of these drugs could ✔ Drink 2–3 quarts of fluid daily when taking an NSAID reg- constitute an overdose. This decreases gastric irritation and helps to main- ✔ With NSAIDs, if one is not effective, another one may work tain good kidney function. Improve- ✔ Report signs of bleeding (eg, nose bleed, vomiting blood, ment of symptoms depends on the reason for use. When bruising, blood in urine or stools), difficulty breathing, taken for pain, the drugs usually act within 30 to 60 min- skin rash or hives, ringing in ears, dizziness, severe stom- utes; when taken for inflammatory disorders, such as ach upset, or swelling and weight gain. If these symptoms persist or worsen, or It may be taken on an empty stomach. If pregnant, do not take aspirin for ap- ✔ Acetaminophen is available in its generic form and with proximately 2 weeks before the estimated delivery date. Most preparations 112 SECTION 2 DRUGS AFFECTING THE CENTRAL NERVOUS SYSTEM CLIENT TEACHING GUIDELINES Acetaminophen, Aspirin, and Other NSAIDs (Continued ) contain 500 mg of drug per tablet or capsule. In addition, pain and fever relievers and urges people who drink three almost all OTC pain relievers (often labeled nonaspirin) or more alcoholic drinks every day to ask their doctors be- and cold, flu, and sinus remedies contain aceta- fore taking products containing acetaminophen. Thus, all consumers should read product la- bels carefully to avoid taking the drug in several products, Antigout Drugs with potential overdoses. For occasional pain relieved in 4–12 hours with IV administration and 24–48 or fever, 650–1000 mg may be taken three or four times hours with oral administration. For daily, long-term use (eg, in osteoarthritis), do may not decrease for several days. Larger doses may taking it as directed (usually one pill every hour for sev- cause life-threatening liver damage.

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