Ways to Reduce Allergies

How To Win Your War Against Allergies

How To Win Your War Against Allergies

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TABLE 302 Anaphylaxis and Allergic Reactions Drug Dosing

For minor allergic reactions that do not involve hypotension or respiratory symptoms, epinephrine is not needed. The causative agent should be identified and discontinued. The patient may be given oral (PO), intramuscular (IM), or IV diphenhydramine 25 to 50 mg and observed for a response for at least 1 h. 10 If the patient is stable, he or she can be discharged on an antihistamine and prednisone 20 mg bid or 40 mg qd for 4 days. 2

Systemic Allergic Reaction Or Toxicity

Although touted by the manufacturer as the natural sclerosing agent, sodium morrhuate causes a variety of allergic reactions, ranging from mild erythema with pruritus to generalized urticaria to GI disturbances with abdominal pain and diarrhea to anaphylaxis. It has been estimated that unfavorable reactions from the treatment of varicose leg veins occur in 3 of patients.40 The reason for the high number of allergic reactions with this product may be related to the inability to remove all the fish proteins present in sodium morrhuate. In fact, 20.8 of the fatty acid composition of the solution is unknown. Ethanolamine oleate (Ethamolin) is a synthetic mixture of ethanolamine and oleic acid with an empirical formula of C20H41NO3. The minimal lethal IV dose in rabbits is 130 mg kg. The oleic acid component is responsible for the inflammatory action. Oleic acid also may activate coagulation in vitro by release of tissue factor and Hageman factor. Etha-nolamine oleate is thought to have a...

General aspects of allergy and intolerance 1421 Definitions

Allergy is defined as an abnormal reaction of the immune system to foreign (not infectious) material, leading to injury to the body that may be either reversible or irreversible. In I Food allergy general, four different types of immunological hypersensitivity reactions are recognized. In a food-allergic reaction, this abnormal immunological response is directed against a specific protein or part of a protein in food. Food-intolerance reactions are defined as reactions caused by an abnormal physiological reaction of the body to a specific food (component). 14.2.2 Allergy 14.2.2.1 Types of hypersensitivity There are four types of immunological hypersensitivity reactions. Of the four types of hypersensitivity reactions, type I reactions are probably the most important, as will become evident in this chapter. This does not mean though, that other types of reactions or combinations do not occur. A food-allergic reaction takes place only if the immune system of the body reacts to food in a...

Allergies

An allergy is a reaction of the immune system to a substance that is typically harmless to most people. In a person with an allergy, the body treats the substance, called an allergen, as an invader. Some of the most common allergens are pollen, dust mites (tiny bugs that live in household dust particles), molds, cockroaches, animal dander (especially cats and dogs), and foods such as peanuts, egg whites, wheat, fish (including shellfish), soy, citrus, and dairy products (milk products). Insect bites or stings can also cause allergic reactions. Allergy symptoms can be seasonal, occurring only when the allergen (such as pollen) is in the air, or chronic, such as an allergy to dust mites. With most common allergies, the person's immune system produces antibodies against the particular allergen involved. When the person is exposed to the allergen, the attack mounted by the immune system against this substance triggers the release of certain body chemicals that cause the symptoms...

Clinical Features

Anaphylaxis is the most severe life-threatening form of a systemic allergic reaction involving respiratory or cardiovascular compromise. The clinician must keep in mind that even mild, localized urticaria can progress to full anaphylaxis and death. The clinical signs of systemic allergic reactions include urticaria, angioedema, abdominal pain or cramping, nausea, vomiting, diarrhea, bronchospasm, rhinorrhea, conjunctivitis, dysrhythmias, and or hypotension. 3 Anaphylaxis can include any combination of these signs along with hypotension or airway compromise. Dermatologic manifestations of pruritus and urticaria are the most common initial symptoms. The classic presentation of anaphylaxis begins with pruritus, cutaneous flushing, and urticaria. These symptoms are followed by a sense of fullness in the throat, anxiety, a sensation of chest tightness, shortness of breath, lightheadedness, and finally loss of consciousness. 5 A complaint of a lump in the throat and hoarseness heralds...

Betaadrenergic Blocking Agents

Special Concerns Use with caution in diabetes, thyrotoxicosis, ce-rebrovascular insufficiency, and impaired hepatic and renal function. Withdrawing beta blockers before major surgery is controversial. Safe use during pregnancy and lactation and in children has not been established. May be absorbed systemically when used for glaucoma thus, there is the potential for an additive effect with beta blockers used systemically. Certain of the products for use in glaucoma contain sulfites, which may result in an allergic reaction. Also, see individual agents. Side Effects Oral dry mouth. CV bradycardia, CHF, cold extremities, postural hypotension, profound hypotension, 2nd or 3rd degree heart block. CNS catatonia, depression, dizziness, drowsiness, fatigue, hallucinations, insomnia, lethargy, mental changes, memory loss, strange dreams. GI Diarrhea, ischemic colitis, nausea, mesenteric arterial thrombosis, vomiting. Hematologic agranulo-cytosis, thrombocytopenia. Allergic fever, sore throat,...

Cholinergic Blocking Agents

Contraindications Glaucoma, adhesions between iris and lens of the eye, tachycardia, myocardial ischemia, unstable CV state in acute hemorrhage, partial obstruction of the GI and biliary tracts, prostatic hypertrophy, renal disease, myasthenia gravis, hepatic disease, paralytic ileus, pylo-roduodenal stenosis, pyloric obstruction, intestinal atony, ulcerative colitis, obstructive uropathy. Cardiac clients, especially when there is danger of tachycardia older persons suffering from atherosclerosis or mental impairment. Lactation. Special Concerns Use with caution in pregnancy. Infants and young children are more susceptible to the toxic side effects of anticholi-nergic drugs. Use in children when the ambient temperature is high may cause a rapid increase in body temperature due to suppression of sweat glands. Geriatric clients are particularly likely to manifest anti-cholinergic side effects and CNS effects, including agitation, confusion, drowsiness,...

Selective Serotonin Reuptake Inhibitors

Constipation, cramps, vomiting, flatulence, decreased appetite. CNS Headache, nervousness, insomnia, drowsiness, anxiety, dizziness, fa-tique, sedation, agitation. CV Hot flashes, palpitations. Pulmonary Infection, pharyngitis, nasal congestion, sinus headache, sinusitis, cough, dyspnea, bronchitis. GU Decreased libido, delayed ejaculation. Eyes Visual changes, eye pain, photophobia. Miscellaneous Sweating, rash, pruritus, urticaria, pain, asthenia, viral infection, fever, allergy, chills. Drug Interactions See individual agents.

[ahTOVahkwohn Pregnancy Category C Mepron [Rx

The tablet formulation has been replaced by a suspension, as the latter achieves plasma levels of atova-quone that are 58 higher than those reached using tablets. Plasma levels in AIDS clients are about one-third to one-half the levels achieved in asymptomatic HIV-infected volunteers. tV2 2.2 days in AIDS clients due to enterohepatic cycling and eventually fecal elimination. Not metabolized in the liver over 94 is excreted unchanged in the feces. Uses Acute oral treatment of mild to moderate P. carinii in clients who are intolerant to trimethoprim-sul-famethoxazole. The drug has not been evaluated as an agent for prophylaxis of P. carinii. Not effective for concurrent pulmonary diseases such as bacterial, viral, or fungal pneumonia or in mycobacterial diseases. Contraindications Hypersensitiv-ity to atovaquone or any components of the formulation potentially life-threatening allergic reactions are possible.

Ergonovine and Methylergonovine

The adverse reactions associated with ergonovine and methylergonovine include nausea, vomiting, elevated blood pressure, temporary chest pain, dizziness, water intoxication, and headache. Allergic reactions may also be seen. In some instances hypertension associated with seizure or headache may occur. Ergotism (overdosage of ergonovine) is manifested by nausea, vomiting, abdominal pain, numbness, tingling of the extremities, and an increase in blood pressure. In severe cases, these symptoms are followed by hypotension, respiratory depression, hypothermia, gangrene of the fingers and toes, convulsions, hallucinations, and coma.

Postexposure Prophylaxis

In the United States, postexposure prophylaxis consists of a regimen of 1 dose of human rabies immune globulin (HRIG) and 5 doses of rabies vaccine over a 28-day period (Table ,1.4,1,-3). Rabies immune globulin and the first dose of rabies vaccine should be given as soon as possible after exposure, preferably within 24 hours. Rabies vaccines available in the United States include human diploid cell vaccine (HDCV) (produced in human diploid cells Imovax, Pasteur Merieux Connaught), rabies vaccine absorbed (RVA) (produced in fetal rhesus diploid lung cells Rabies Vaccine Absorbed, SmithKline Beecham), and purified chick embryo cell culture vaccine (PCEC) (produced in chick embryo cells RabAvert, Chiron).24 All currently used vaccines are produced in cell culture and are significantly less toxic than older vaccines that were produced in neural tissue. Side effects, including mild erythema, swelling, and pain at the injection site, have been reported among 30 to 74 percent of vaccine...

Treatment With Oral Medications

Side effects from BoNT injections may be divided into 4 categories generalized, local, undesirable muscle weakness, and immune reactions. Patients may report generalized discomfort such as fatigue, malaise, headaches, dizziness, nausea, and flu-like symptoms. All these are transient and resolve spontaneously within a few days. In a published doubleblind study, more patients complained of these generalized side effects when they received placebo injections. Local pain and ecchymoses around the injection site may occur. Local trauma may be minimized by using small-gauged needles, such as 30 G, and by avoiding injecting a large volume into a single site. Neck weakness may occur in some patients who are unusually sensitive to the injections. Dysphagia has been reported to occur in 1.7 to 90 of patients, and is believed to be related to local diffusion of BoNT into the pharyngeal muscles. It has been suggested that bilateral sternocleidomastoid injections are more prone to producing...

Treatment of anaphylaxis

Foods are the commonest cause of anaphylaxis and there appears to be a rise in its prevalence.14 There is no universally agreed definition of anaphylaxis, as symptoms of acute allergic reaction may vary widely. Allergic reactions with one or more life-threatening features may be regarded as anaphylaxis. There have been several reports of deaths due to anaphylactic reactions to foods, especially peanuts and tree nuts. A history of previous anaphylactic reaction to a food is the most important risk factor for the prediction of future anaphylaxis. A wide range of symptoms has been observed in allergic reactions to foods (Table 5.7). The type and severity of symptoms depend on the patient's sensitivity to the food, the amount ingested and the route of entry of the allergenic food.14 Those who are highly sensitive may react to even smell and or touch of the food. Local reactions such as urticarial rash and itching may occur even on touching the food. Children who are highly allergic to...

[flewOXehteen Pregnancy Category B

Upper respiratory tract infections, pharyngitis, cough, dyspnea, rhinitis, bronchitis, nasal congestion, sinusitis, sinus headache, yawn. Skin Rash, pruritus, excessive sweating. Muscu-loskeletal Muscle, joint, or back pain. Miscellaneous Flu-like symptoms, asthenia, fever, chest pain, allergy, visual disturbances, blurred vision, weight loss, bacterial or viral infection, limb pain, chills.

Chlorinated Hydrocarbons

CLINICAL FEATURES These compounds are responsible for dermal, pulmonary, gastrointestinal, and neurologic findings. Allergy, however, is their most common effect. Allergic reactions manifest as dermatitis, asthma, allergic rhinitis, hypersensitivity pneumonitis, and anaphylaxis. Dermal absorption is minimal, but these compounds are well absorbed from the gastrointestinal tract. Skin contact may lead to tingling and burning within 30 min of exposure and persisting up to 8 h. Contact dermatitis syndromes and allergic rhinitis result from both compounds. Allergic reactions including fatal asthma attacks have been reported. Upper and lower airway irritation occurs with local inhalation exposure. When absorbed, these compounds are metabolized rapidly in the liver, thus resulting in minimal systemic toxicity. These compounds are responsible for occasional systemic occupational poisonings. Systemic symptoms of paresthesias, hyperexcitability, tremors, incoordination, seizures, muscle...

Cromolyn sodium Sodium cromoglycate

Action Kinetics Acts locally to inhibit the degranulation of sensitized mast cells that occurs after exposure to certain antigens. Prevents the release of histamine, slow-reacting substance of anaphylaxis, and other endogenous substances causing hy-persensitivity reactions. When effective, reduces the number and intensity of asthmatic attacks as well as decreasing allergic reactions in the eye. The drug has no antihistaminic, anti-inflammatory, or bronchodilator effects and has no role in terminating an acute attack of asthma. After inhalation, some of the drug is absorbed systemically. tV2 81 min from lungs 60 min. About 50 excreted unchanged through the urine and 50 through the bile. When used in the eye, approximately 0.03 is absorbed. Onset, ophthalmic Several days. Onset, nasal Less than 1 week. Time to peak effect, nasal Up to 4 weeks. Uses Inhalation Prophylactic and adjunct in the management of severe bronchial asthma in selected clients. Prophylaxis of exercise-induced...

Primary Nursing Diagnosis

Primary intervention focuses on locating and correcting the contributing causes. Medical therapy centers around vitamin B12 replacement. Oral vitamin B12 is indicated for rare dietary deficiencies when intrinsic factor is intact. More often, vitamin B12 is given parenterally, but because of the risk of allergic reactions, it should be started slowly. A generally well-balanced diet with emphasis on vitamin B12-rich foods, such as animal protein, eggs, and dairy products, is important. Soybean milk may be offered as a source of vitamin B12 for strict vegetarians. A low-sodium diet may be imposed.

Classification Smoking deterrent

Action Kinetics Nicotine transdermal system is a multilayered film that provides systemic delivery of varying amounts of nicotine over a 24hr period after applying to the skin. The nicotine transdermal system produces an initial (first day of use) increase in BP, an increase in HR (3 -7 ), and a decrease in SV after 10 days. Metabolized in the liver to a large number of metabolites, all of which are less active than nicotine. tv2, following removal of the system from the skin 3-4 hr. Uses As an aid to stopping smoking for the relief of nicotine withdrawal symptoms. Should be used in conjunction with a comprehensive behavioral smoking cessation program. Contraindications Hypersensitiv-ity or allergy to nicotine or any components of the therapeutic system. Use in children and during pregnancy, labor, and delivery. Lactation. Use in those with heart disease, hypertension, a recent MI, severe or worsening angina pectoris, and those taking certain antidepressants or antiasthmatic drugs....

Factors to Be Considered on an Individual Basis Favoring Treatment of Otitis Media with Effusion

Demonstrate their efficacy in eliminating middle ear effusion.15 Despite the apparent efficacy of systemic corticosteroid therapy in clinical trials, a recent official government guideline found the risks of this option in children to outweigh its possible benefits.16 Clinical trials have not been reported that have tested the efficacy of topical nasal corticosteroid treatment, immunotherapy, and control of allergy in children who have nasal allergy and middle ear disease. Nevertheless, this method of management seems reasonable in children who have frequently recurrent or chronic otitis media with effusion and evidence of upper respiratory allergy.

Drug administration route

Hypersensitivity has been reported in 0-8 of patients in trials of intravesical epirubicin the symptoms included generalized skin rash, vulval irritation, or urinary frequency and dysuria, or were not stated (100,103,104). One of 34 patients developed symptoms characterized as allergic (dizziness, nausea, hypotension) 1 hour after instillation of epirubicin (105). Two patients who received epirubicin developed severe allergic reactions and one died (106,107).

Organs and Systems Cardiovascular

In pulmonary hypertension, both verapamil and nifedi-pine increase mean right atrial pressure in association with hypotension, chest pain, dyspnea, and hypoxemia the severe hemodynamic upset resulted in cardiac arrest in two patients after verapamil and death in another after nifedipine (54). A patient with pulmonary hypertension also developed pulmonary edema whilst taking nifedipine (55) and another seems to have developed this as an allergic reaction (56). Verapamil, nifedipine, and diltiazem have all been associated with allergic reactions, including skin eruptions and effects on liver and kidney function. Nifedipine has also been reported to cause a febrile reaction (116), and diltiazem was associated with fever, lymphadenopathy, hepatosplenomegaly, an erythema-tous maculopapular rash, and eosinophilia in a 50-year-old man (117).

General adverse effects

Visual disturbances are the most common adverse effects and also the most important. These include diminished visual acuity, retrobulbar neuritis, retinal pigment displacement, and (rarely) hemorrhages. Gastrointestinal symptoms (abdominal pain or vomiting), and headache, dizziness, mental confusion, and hallucinations are all rarely seen. Adverse effects are more frequent in elderly patients and patients with alcoholism, diabetes, or renal insufficiency. Stevens-Johnson syndrome, toxic epidermal necrolysis (3), purpura-like vasculitis, acute thrombo-genic purpura, joint pain, drug fever, tachycardia, and leukopenia have been attributed to allergy. As these reactions often arise during combined treatment with other tuberculostatic drugs, it is difficult or impossible to determine which drug is responsible. Tumor-inducing and teratogenic effects have not been described.

Drug Administration Drug formulations

Of Dy-EOB-DTPA, 0.05, 0.1, 0.25, 0.375, or 0.5 mmol kg over 10 minutes (n 6 in each group), or placebo (n 2 in each group). There were adverse effects in four of the 10 patients who were given placebo and 22 of the 30 who were given Dy-EOB-DTPA. The most common adverse events were nausea (25 ), headache (18 ), paresthesia (15 ), loss of appetite, allergic reactions, back pain, and injection site hemorrhage (7.5 ). The adverse effects were generally mild or moderate, but there was a slight increase in intensity at the higher doses. There were gastrointestinal adverse events in all six of the volunteers who received 0.5 mmol kg. Nausea was the longest lasting and in one case it was severe. The results of laboratory tests did not exceed the reference ranges. Vital signs, hemodynamic parameters, and electrocardiography were not affected by the contrast agent. Over 50 of the adverse events were considered to be unrelated to the drug. The authors concluded that this liver-specific contrast...

See also Antiepileptic drugs General Information

The safety profile of levetiracetam has been reviewed (7). The authors assessed the integrated summary of safety reports submitted for regulatory review in order to obtain information about abnormal laboratory test values and adverse events collected during the overall levetiracetam development program. The analysis included 3347 patients exposed to levetiracetam in clinical trials for epilepsy, cognition, and anxiety disorders. Safety data from all the studies showed a similar pattern of adverse effects, predominantly somnolence, weakness, and dizziness, which occurred most often during the first month of treatment. Laboratory tests that changed significantly in placebo-controlled trials nevertheless stayed in the reference ranges. The incidences of any types of allergic reactions were similar between levetiracetam and placebo (0.3 and 0.2 ). Cases of common cold and upper respiratory infection were significantly more frequent with levetiracetam than placebo (13 versus 7.5 ), but...

General Information

In a review of safety data from nearly 3100 patients included in 53 clinical trials, tiagabine had no significant effect on hepatic metabolic processes, serum concentrations of concomitant anticonvulsants, and blood chemistry and hematology tests (2). Allergic reactions, such as skin rashes, were less common with tiagabine than with most other anticonvulsants. Adverse effects were generally mild and affected mainly the central nervous system, the most common being dizziness, weakness, nervousness, tremor, difficulty with concentration and attention, speech disorders, depression, and abdominal pain. About 1 of patients given tiagabine experienced weakness severe enough to cause falls or inability to walk, and some form of weakness occurred in about 9 of patients, especially at high dosages or after stopping a single concomitant enzyme-inducing antiepileptic drug.

Energy Substrates

Low- or high-molecular-weight dextran administration may result in allergic reactions, which are evidenced by urticaria, hypotension, nausea, vomiting, headache, dyspnea, fever, tightness of the chest, and wheezing. Hyperglycemia and phlebitis may be seen with administration of glucose.

Appendix List of miscellaneous compounds General Information

Allergic reactions (asthma etc.) Allergies Contact allergies Allergic contact eczema Death Calcified right atrial thrombus Electrolyte disturbances Embolia cutis medicamentosa Allergic contact dermatitis Allergic reactions, thrombosis Follicular contact dermatitis Contact dermatitis Contact allergy (facial eczema) Allergic contact dermatitis Contact allergy Complex ventricular dysrhythmias Drug-induced esophagitis Skin rash, respiratory reaction, hemolysis Allergic reactions, death Contact dermatitis Contact allergy Cystitis

Amoebic hepatitis See amebic hepatitis

Amoxicillin is generally well tolerated. The most common side effects are minor and include rashes, heartburn, nausea, vomiting, or diarrhea. These side effects are likely to occur in people who are allergic to penicillin or have a history of allergy, asthma, or hay fever. Rarely, some people taking amoxicillin experience agitation, anxiety, insomnia, dizziness, confusion, or behavioral changes.

[Case history by Marianne Leuzinger Bohleber

We presumed that the enormity of the attack and the silence indicated a traumatization suffered in a very early stage of Mr. X's development, probably during his first year of life, in a phase of development in which physical and affective states of mind can not yet be either enclosed or symbolized. Had he suffered from an early traumatization, perhaps caused by separation from the primary object which I felt in my depressive countertransference feelings The discussion with my colleague had, for me, mediated a certain distance and enabled me to increasingly reflect critically on my fierce reactions and countertransference fantasies. Not long after, Mr. X, following a session that had included heavy outbursts of rage, arrived a bit calmer to the next appointment. I carefully communicated my supposition that the long summer break could have led to an intense reactivation of unbearable feelings of dependence and desolation, which he could have tried to cope with by means of extreme...

Clinical practice guidelines

At hospitals across the country, the National Institute of Allergy and Infectious Diseases (NIAID), the research arm of the United States public health service, has set up a group of research centers called aids clinical trials units (ACTUs), where these tests take place. The ACTUs together make up the aids clinical trials group (ACTG). In addition, doctors who are part of NIAID's community programs FOR CLINICAL RESEARCH ON AIDS conduct studies of AIDS drugs at hospitals and clinics in the communities where the impact of the AIDS epidemic is severe. Clinical trials are also sponsored by drug companies, other government agencies, and private research organizations.

Evaluation Guidelines Tables125 and 126

Blood tests are triggered by specific symptom complexes, and there is no routine set of values obtained in every patient. In particular, chemistry panels, complete blood counts, glucose tolerance tests, and allergy tests need not be routinely ordered. Similarly, urine testing is rarely productive in disorders of cranial nerve VIII.

Syndromes Primarily Involving Hearing

Hearing loss is highly prevalent, especially in the older population, and three types are commonly encountered conductive, sensorineural, and central hearing loss. In conductive hearing loss, sound is not transmitted into the inner ear. Diagnosis is ordinarily made via observation of an air-bone gap on audiometry, meaning that hearing is superior when sound is transmitted in such a way that it bypasses the middle ear ossicular chain. Causes include a buildup of ear wax, foreign body in the ear canal, otosclerosis, external or middle ear infections, allergy with serous otitis, and perforation of the tympanic membrane. Characteristically, hearing aids work well for this population.

Overthecounter OTC drugs

Over-the-counter (OTC) drugs Drug products that can be purchased without prescription, for example aspirin. Like the more potent drug products sold only on prescription, they are chemicals that are capable of a wide variety of actions on biological systems. Within the last 30 years, many OTC drugs have assumed greater importance because of their ability to interact favorably with widely used prescription drugs. Serious problems in drug management can arise when the patient fails to tell the physician of the OTC drug(s) he or she is taking and when the physician fails to note the inclusion of OTC drugs when asking the patient about what medicines the patient currently uses. During any course of treatment, whether medical or surgical, the patient should consult with the physician regarding any OTC drug that the patient wishes to take. The major classes of OTC drugs for internal use include allergy medicines, antacids, antiworm medicines, aspirin and aspirin combinations, aspirin...

Safety And Tolerability

Cardiac, renal, or hepatic dysfunction, or in pregnant women (Chang and But, 1986). Interestingly, the pharmacokinetics of artemisinin are not affected in patients with cirrhosis of the liver (De Vries et al., 1997), but artemisinin does induce certain liver enzymes, and thus interacts with some other drugs such as omeprazole (Svensson et al., 1998). Observational studies in Africa found that 25 of malaria patients being treated with A. annua infusion had nausea, although none vomited. Other mild adverse events during treatment included dizziness, tinnitus, pruritus, and abdominal pain (Hirt, 2001). Nausea and tinnitus were much less common in patients taking oral Artemisia annua infusion than in those taking quinine (Mueller et al., 2004). In a group of 14 healthy volunteers given a high-dose oral infusion of A. annua, only one patient experienced an adverse event, which was diagnosed as an allergic reaction. The patient's cough and skin rash resolved quickly and did not require...

Acetaminophen with propoxyphene Trade

Side effects In therapeutic doses acetaminophen seldom causes side serious effects. Nausea occurs but is not related to damage to the gut. Allergy and rash are rare. Liver damage has occurred, usually when doses of acetaminophen larger than the prescribed dose have been taken. In overdose fatal liver failure can occur. The narcotic component of combination analgesics frequently causes minor side effects, including nausea, vomiting, constipation, dizziness, and lightheadedness. Allergic reactions resulting in rash or bron-chospasm are uncommon. Addiction is rare. common. Difficulty swallowing, vomiting, erosive esophagitis (ulcers in the esophagus), and allergic reactions are rare. Side effects Common Mild allergic rash. Uncommon Can precipitate an acute attack of gout when treatment is started. To prevent this, many physicians also prescribe an NSAID or colchicine for a few months. An allergic reaction called the allopurinol hypersensitivity syndrome causes severe rash, often with...

Identify A Casualty With Anaphylactic Shock

When you examine (survey) a casualty who has been bitten or stung by an arthropod, watch for signs and symptoms of anaphylactic shock (anaphylaxis). Anaphylactic shock is an unusually severe allergic reaction to a foreign substance, such as the venom of an arthropod. Anaphylactic shock can occur within minutes or seconds after the sting or bite. It affects the respiratory and circulatory systems of the human body and can result in death if adequate measures are not taken. Signs and symptoms of anaphylactic shock include the following

Clinical Management

Studies followed up to 56 days (Table 24.3). There was no control group for comparative cure rates in untreated individuals. Alternative treatment options are limited. Tetrachloroethylene is a suboptimal alternative, with lower efficacy and significant side effects. In one study, tetrachloro-ethylene was effective in eradicating worms in 9 of 11 subjects, with follow-up at 2 and 6 weeks (Plaut et al., 1969). In a separate study, severe allergic reactions with tetrachloroethylene were observed in four of six children who were not pre-treated with antihistamines (Rabbani et al., 1985). Niclosamide has also been tested and has minimal efficacy, with a 10-12 cure in one study compared to 77 for tetrachloroethylene (n 40 patients) (Suntharasamai et al., 1974). Tetrachloroethylene also had severe side effects in this study, with nausea (85 ), vomiting (70 ) and vertigo (31 ). Thiabendazole, mebendazole, levamisole and pyrantel palmoate were ineffective in one study (Rabbani et al., 1985)....

Radiography Studies with Contrast Media

Although great care is taken to ensure the safety of contrast media, the potential for adverse or allergic reactions always exists. Allergic reactions range from a mild rash to anaphylactic shock. Side effects of contrast media can include nausea and vomiting. Iodine contrast media carry the greatest risk for adverse reactions. Table 10-1 summarizes several adverse reactions associated with iodinated contrast media. In most instances, the patient should be NPO (nothing by mouth) the night before the contrasted study is completed. In the past, contrast media were problematic for individuals who were pregnant or who had allergies related to shellfish. With the contrast media currently available the contraindication for individuals who have shellfish allergies no longer applies. In the event that a pregnant patient must have a specific exam, the physician, patient, and appropriate radiology practitioners use all precautions at their disposal.

Ethacrynic Acid Edecrin

Dose (CPB) load with 300 units kg IV maintenance 100 units kg hr IV, titrate to coagulation tests (ACT). Clearance primarily by reticuloendothelial uptake, hepatic biotransformation. Reversal reverse with protamine sulfate. Adverse effects hemorrhage, allergic reactions, thrombocytopenia, allergic reaction, diurese, altered protein binding, decreased MAP, decreased antithrombin III concentration, altered cell morphology,

Adverse Effects and Drug Interactions

Allergic reactions (e.g., rashes, urticaria, and eosino-philia) have been observed. These drugs have occasionally been associated with cholestatic jaundice, blood dyscrasias, hemolytic anemia, hypoglycemia, and nephrotoxicity. Recently the use of ciprofloxacin for prophylaxis protection against anthrax infection has been associated with damage to muscle ligaments.

H Echinacea E pallida and E purpurea

Additionally, Lactobacillus and Bifidobacterium have been evaluated as immune stimulators or biological response modifiers. Probiotic bacteria have been shown to improve mucosal barrier function the hypothesis that they may play a role in moderating allergic response has been tested. Allergy symptoms are reduced in individuals consuming yogurt containing live, active bacteria compared to individuals consuming pasteurized yogurt. These bacteria may influence colonization and activity of H. pylori, which is associated with chronic gastritis, peptic ulcers, and risk for gastric cancer. Animals treated with probiotics excrete higher levels of cholesterol in feces than germ-free animals suggesting that colonizing microbes may influence cholesterol excretion, with potential implications for serum cholesterol levels. In another interesting role, probiotic bacteria could possibly contribute to blood pressure control. Two tripeptides, Val-Pro-Pro and Ile-Pro-Pro, have been isolated from the...

Systemic Effects of Topically Administered Ocular Medications

Any topically administered medication can enter the body system as a whole. First, topical eye medication can be absorbed into the body directly through the mucosal membranes of the eye. A much larger dose, however, can drain through the lacrimal system into the nasal mucosa and can be swallowed, delivering a systemic dose of ocular medication. To avoid this oral dose, patients should be instructed to instill eye drops by using the pouch technique grasping the outer third of the eyelid with the thumb and index finger and forming a pocket. The eye drop is placed into the pocket, the eyelid is gently closed, and the excess is wiped away. This technique prevents activation of the blink mechanism and lacrimal pump, which avoids sucking the medication through the lacrimal system into the nose. If the patient reports that he or she tastes the eye medicine, apply gentle pressure to the lacrimal sac with the finger after putting in the drop. Virtually all topically applied medications are...

Adverse Reactions Contraindications and Interactions

John's wort is usually well tolerated, but insomnia, dizziness, fatigue, restlessness, GI upset, constipation, dry mouth, and allergy are reported as possible side effects. Hypomania has also been reported in several cases, and rarely, photosensitivity can be a problem following high doses hypericin seems to be the component responsible for the photosensitivity. Sun-induced neu ropathy has also been described, and it is possible that hypericin may also increase the risk of cataracts with prolonged use. While a prior allergy to the herb is the main contraindication, St. John's wort should also be avoided in pregnant and breast-feeding women (it may increase uterine tone) and in children until its safety is further established.

Classification Of Cerebral Edema

Other diuretics have been used in the treatment of cerebral edema. Carbonic anhydrase inhibitors have long been used to treat the cerebral edema associated with hydrocephalus 8 . This class of diuretics lower cerebrospinal fluid production 11 , The mechanism of action of these drugs is local inhibition of the carbonic anhydrase activity of the choroid plexus. However, at least 99 of enzyme activity needs to be inhibited before a significant slowing of cerebrospinal fluid flow is seen. Usual doses of acetazolamide, the most commonly used drug in this class, are 500-1000 mg day in divided doses. The effect of carbonic anhydrous inhibitors is blunted by the obligatory metabolic acidosis resulting from drug-induced sodium bicarbonate diuresis, which leads to reflex cerebral vasodilatation. Side-effects of carbonic anhydrase inhibitors include (i) hypokalemia, (ii) metabolic acidosis, and (iii) significant drug allergy.

4131 Alternative remedies and phytotherapeutics

Blessed thistle (Cnicus benedictus) is different from milk thistle (,Sitybum marianum). It has an unjustified reputation as a galactogogue, but is not known to be toxic except for some reported gastrointestinal symptoms and allergic reactions. It contains many chemicals and volatile oils. It has many uses, including bacteriostatic and antiseptic, and for dyspepsia. Experiments show antibacterial effects against a number of bacteria.

Marinol and Cannabis Whats the difference

The lipid soluble nature of Cannabis and Marinol allow it to pass through the blood-brain barrier. (The blood-brain barrier is a cellular membrane that protects the brain and central nervous system from infection by filtering out certain chemical compounds.) This accounts for some of the cognitive effects of Cannabis and THC. Marinol also contains extra chemicals like gelatin, glycerin, methylparaben, propylpara-ben, yellow, red and blue dye, and titanium dioxide. (Vegetarians should be aware that gelatin is an animal product.) Any patient who has an allergy towards any of these substances should avoid taking Marinol.

Amphetamines And Derivatives

Side Effects CNS Nervousness, dizziness, depression, headache, insomnia, euphoria, symptoms of excitation. Rarely, psychoses. In children, manifestation of vocal and motor tics and Tourette's syndrome. Oral Dry mouth, metallic taste. GI N& V, cramps, diarrhea, constipation, anorexia. CV Arrhythmias, palpitations, dyspnea, pulmonary hypertension, peripheral hyper- or hypotension, precordial pain, fainting. Dermatologie Symptoms of allergy including rash, urticaria, erythema, burning. Pallor. GU Urinary frequency, dysuria. Ophthalmologic Blurred vision, mydriasis. Hematologic Agranulocytosis, leukopenia. Endocrine Menstrual irregularities, gynecomastia, impotence, and changes in libido. Miscellaneous Alopecia, increased motor activity, fever, sweating, chills, muscle pain, chest pain.

Contraindications adverse effects precautions

- Do not administer to patients with allergy to tinidazole or another nitroimidazole (metro-nidazole, secnidazole, etc.). - May cause gastrointestinal disturbances rarely allergic reactions, brownish urine, headache, dizziness. Risk of antabuse reaction when combined with alcohol.

Nicardipine hydrochloride

Side Effects CV Pedal edema, flushing, increased angina, palpitations, tachycardia, other edema, abnormal ECG, hypotension, postural hypotension, syncope, MI, AV block, ventricular extrasystoles, peripheral vascular disease. CNS Dizziness, headache, somnolence, malaise, nervousness, insomnia, abnormal dreams, vertigo, depression, confusion, amnesia, anxiety, weakness, psychoses, hallucinations, paranoia. Oral Dry mouth, sore throat, gingival hyperplasia. GI N& V, dyspepsia, constipation. Neuromuscular Asthenia, myalgia, paresthesia, hyperkine-sia, arthralgia. Miscellaneous Rash, dyspnea, SOB, nocturia, polyuria, allergic reactions, abnormal liver chemistries, hot flashes, impotence, rhinitis, sinusitis, nasal congestion, chest congestion, tinnitus, equilibrium

Nightshades Jimsonweed Datura Belladonna Henbane

Cold and allergy tablets still include it to dry up runny noses. Low doses can be applied to the skin in special patches to prevent motion sickness. Higher doses used to be given by injection to women in labor (Twilight Sleep'7) to make them amnesic for the experience of childbirth, a practice that does not seem beneficial to either mother or baby because it produces a predictable violent delirium. Jimsonweed leaves have been rolled into cigarettes for the treatment of asthma, and tincture of belladonna is still used to treat gastrointestinal spasms.

Treatment Options for Anxiety

Antihistamines This group of medications reduces the excessive mucus secretions in respiratory infections and allergies. They also make people tired, however, and are sometimes used to decrease anxiety because of this sedative quality. They start working within thirty minutes. They can be taken intermittently and are not habit-forming. Their effects are mild.

Clinical Use Of Antihistamines

A position paper from the American Academy of Allergy, Asthma and Immunology addressing the use of antihistamines in patients with asthma has served to clarify the controversy surrounding their use in patients with this disease ( 89). Previously, it had been believed that the anticholinergic properties (i.e., dryness of the airways) of these antagonists could contribute to asthma exacerbations (90). It is now known that antihistamines, including some of the dual-action compounds, may actually serve a beneficial role in the treatment of asthma because of their bronchodilator effect ( 90,91,,92,93 and 94). Although these agents are not considered first-line therapy for asthma, they are certainly not contraindicated in asthma patients who require them for concomitant allergic problems ( 89). The Physician's Desk Reference has subsequently modified warnings stating they should be used cautiously in patients with concomitant asthma ( 24). Studies evaluating these agents in the treatment of...

Withdrawal syndrome and overdose A

Generally, benzodiazepines are well tolerated and have a wide margin of safety. But some people may experience drowsiness, lethargy dizziness or difficulty with co-ordination. High doses lead to heavier sedation and can impair both mental sharpness and physical coordination. Lower doses are recommended for older people and for those with some chronic diseases, since they may be more sensitive to medications and may metabolize them more slowly. It has also been suggested that benzo-diazepines can impair the ability to learn and remember new information. Studies show that anti-anxiety agents, even when correctly prescribed, may interfere with the ability of some users to perform certain physical, intellectual and perceptual functions. Most side-effects usually occur early in treatment and wane over time. For these reasons, individuals should assess their response to benzodiazepines before they operate a motor vehicle or engage in tasks requiring concentration and co-ordination. Such...

Monosodium glutamate and the Chinese restaurant syndrome

Many foodstuffs, especially seaweed and parmesan cheese which have some of the highest levels, and also tomatoes, mushrooms, and soy sauce. E621 is the sodium salt of glutamic acid, a naturally occurring amino acid which has important functions in the body, especially in the brain. Glu-tamic acid is found both free and as part of protein, and when the latter is broken down and digested in the gut glutamic acid is released (see box). The glutamic acid is released relatively slowly, however, and while excess glutamate can be removed by metabolism it is possible that large amounts may accumulate. Too much free glutamic acid in the diet, which can occur if food that contains naturally high levels is consumed with food to which large amounts have been added, can be toxic, leading to unpleasant symptoms. A variety of studies into the effects of MSG have been carried out, but they have shown conflicting results. In one of the most recent properly conducted, double-blind trials, where the...

Short Term Physical Effects

In communities living in the vicinity of the oil spills, even after controlling for preexisting allergies and medical conditions, there was consistent evidence of acute toxic effects (mainly neurological, ocular, and respiratory but not dermal) among exposed residents. However, these effects appear to be transient, said Sathiakumar. Biochemical tests for lung, kidney, and liver function were within normal levels both immediately and 6 months after the spill, and children's respiratory function was within the normal range. In the context of genetic and endocrine toxicity, Sathiakumar referenced an earlier presentation by Blanca Laffon (see Chapter 1), which indicated some genotoxic damage in workers involved with oil spill clean-up activities.

Vertigo And Perforated Tympanic Membrane

Persistent or recurrent drainage from the ear after canal-wall-up (CWU) surgery may be related to surgical technique or patient disease. Drainage indicates the presence of chronic otitis media, but the exact cause of the chronic otitis media must be determined. Factors that may help determine the cause of recurrent aural drainage include the timing of the appearance of the drainage in relation to the original surgery the frequency of the drainage the pathology in the original surgery the status of the tympanic membrane the development of symptoms such as hearing loss, vertigo, or facial palsy and other associated patient disease. The development of aural drainage immediately after surgery suggests failure to exenterate all active disease at the time of the original mastoidectomy. This is usually related to poor surgical technique. Recurrent drainage weeks to months after the initial procedure may also be due to poor technique, but may also be secondary to residual cholesteatoma, or...

Toradol See ketorolac

Side effects Common Nausea, vomiting, constipation, poor appetite, dizziness, feeling lightheaded, and sleepiness. Uncommon Feeling nervous or agitated, sleeping badly, seizures, an allergic reaction with urticarial rash (hives) or bronchospasm, confusion, feeling high, and addiction. Side effects Common Dizziness, drowsiness, dry mouth, and GI side effects such as nausea and diarrhea. Uncommon Tremor, confusion, rash, sexual dysfunction, sedation, allergy, anticholiner-gic side effects such as blurred vision, constipation, and slowness or difficulty passing urine.

Acute Coronary Syndromes

EMS providers can support the airway, administer oxygen (Class lib), and administer aspirin and nitroglycerin. If the patient has not taken aspirin and has no history of aspirin allergy, EMS providers should give the patient 160 to 325 mg of aspirin to chew (Class I) and notify the receiving hospital before arrival.72-75 Paramedics should be trained and equipped to obtain a 12-lead electrocardiogram (ECG) and transmit the ECG or their interpretation of it to the receiving hospital (Class IIa). More specifics on these topics are covered in Part 8 Stabilization of the Patient With Acute Coronary Syndromes.

Hyperimmunoglobulinemia 239

Hypericin A highly concentrated extract of the flowering tops of the St. John's wort plant. It has been used throughout history in many locales for any number of reasons, most applications without any proven efficacy. The same warnings that apply to taking St. John's wort apply to hypericin. It should not be mixed with protease inhibitors, nor taken with other antidepressants. Hypericin causes significant phototoxicity (allergic reactions to light) and has shown no antiretroviral activity in studies conducted with HIV positive patients.

Diphenhydramine hydrochloride

Allerdryl M, AllerMax, AllerMax Allergy & Cough Formula, Banophen Ca-plets, Benadryl, Benadryl Allergy, Benadryl Allergy Ultratabs, Benadryl Dye-Free Allergy, Benadryl Dye-Free Allergy Liqui Gels, Diphen AF, Diphen Cough, Diphenhist, Genahist, Hyrex-in-50, Nytol M, Nytol Extra Strength M, PMS-Diphenhydramine M, Schein-pharm Diphenhydramine M, Scot-Tussin DM, Siladryl, Tusstat (OTC and Rx). Sleep-Aids Dormin, Miles Nervine, Nighttime Sleep Aid, Nytol, Sleep-eze 3, Sleep-Eze D M, Sleepwell 2-nite, Sominex (OTC) Classification Antihistamine, ethanolamine-type antiemetic

Shortterm side effects of psychotropic drugs

As with all types of medication, the side effects of psychotropic drugs should be weighed against their benefits. Symptoms such as dizziness, appetite suppression and sleep disturbance occur quite commonly but often diminish following continual use. Other more serious side effects may involve changes in endocrine and cardiac function, effects which can sometimes be controlled by reducing the drug dose. Finally there are idiosyncratic and allergic reactions such as agranulocytosis which are difficult to predict and which can be fatal in some cases.

Yohimbe And Yohimbine

Precautions It should not be used by those with an allergy to yohimbine or any of the Rauwolfia alkaloids, angina pectoris, hepatitis, hypoglycemia, blood pressure disorders, ulcers, diabetes, kidney disease, liver disease, heart disease, panic attacks, bipolar disorder, or schizophrenia. Those suffering from or being treated for depression, any psychiatric disorder, any other allergy, or those taking any drugs that interfere with norepinephrine's neuronal uptake or metabolism (including Selegiline) should use yohimbe only under a physician's guidance in fact, many herbalists caution that the potent herb should never be used without the advice of a physician or herbalist.

Dr Harold Buttram

A combination of subtle brain damage from environmental chemicals, nutritional deficiencies, a crippling of the detoxification systems of the body, food allergies, and an overgrowth of candida in the system produces a very sick child. The manifestation of this will be a crippled immune system. This means the child will have more allergies. He will be sick a lot of the time and on antibiotics. The brain function cannot possibly be normal it would be a miracle if it were. The hyperactivity, attention deficit, and behavioral problems, in my opinion, are all actually a continued spectrum of the same thing. Food Allergy Testing

Side Effects

Limited safety information is available for stevia, the herbal sweetener. Stevia may cause nausea and abdominal fullness. It also may decrease blood sugar levels and may decrease blood pressure. Other possible side effects include headache, dizziness, myalgia, and numbness. Stevia may cause allergic reactions in people who are allergic to plants in the Asteraceae Compositae family, which includes daisies, marigold, ragweed, and chrysanthemums. The safety of long-term stevia use is not known. In the United States, although the Food and Drug Administration (FDA) allows stevia to be imported as a dietary supplement, it is classified as an unsafe food additive due to the limited safety information.

Local Anesthesia

Patients who report previous allergies to anesthetics may present a challenge to surgeons performing liposuction. Although local anesthetics of the aminoester class such as procaine are associated with allergic reactions, true allergic phenomena to local anesthetics of the aminoamide class, such as lidocaine, are extremely rare 158,159 . Allergic reactions may occur to the preservative in the multidose vials. Tachycardia and generalized flushing may occur with rapid absorption of the epinephrine contained in some standard local anesthetic preparations. The development of vasovagal reactions after injections of any kind may cause hypotension, bradycardia, diaphoresis, pallor, nausea, and loss of consciousness. These adverse reactions maybe misinterpreted by the patient and even the physician as allergic reactions 159 . A careful history from the patient describing the apparent reaction usually clarifies the cause. If there is still concern about the possibility of true allergy to local...

Vascular Disorders

In general, when vascular compromise is suspected, medications that impair platelet function may improve things. Short of full anticoagulation, daily aspirin may help, if not contraindicated. Some patients balk at this recommendation due to gastric symptoms, but it is unlikely that one grain a day would bother anyone, barring true aspirin allergy.

Chapter Summary

In closing this presentation of the types of sensorineural hearing loss, let us emphasize that there is obvious overlap between some of the disorders we have discussed, especially with respect to symptoms. This applies to Meniere's disease, sudden sensorineural hearing loss, infectious sensorineural loss, autoimmune loss, spontaneous perilymph fistula (Chapter 5), and acoustic neuroma. Of interest, any of the categories of medical disease may be involved in causing a sensorineural hearing loss, including trauma, neoplasm, allergy, infection, heredity, autoimmunity, metabolic disease, and nutrition.

Celecoxib Celebrex

Lower initial doses are recommended in the elderly and in the setting of hepatic insufficiency. Potential drug interactions have been identified with lithium and fluconazole. Celecoxib may be taken with low-dose aspirin, warfarin, and MTX and appears to have no effect on platelet function at therapeutic levels. The drug is contraindicated in patients with known allergies to other NSAIDs or to sulfonamides and should also be avoided in pregnancy.

Clofibrate

Special Concerns Use with caution in clients with gout and peptic ulcer. Reduced dosage may be required in geriatric clients due to age-related decreases in renal function. Side Effects Oral Stomatitis. GI Nausea, dyspepsia, weight gain, gastritis, vomiting, bloating, flatulence, abdominal distress, loose stools, diarrhea, hepatomegaly, cholelithiasis, gallstones. CNS Headaches, dizziness, fatigue, weakness, drowsiness. CV Changes in blood-clotting time, arrhythmias, increased or decreased angina, intermittent claudication, thromboembolic events, thrombophlebitis, swelling and phlebitis at xanthoma site, pulmonary embolism. Skeletal muscle Asthenia, ar-thralgia, myalgia, weakness, muscle cramps, aches. GU Impotence, dys-uria, hematuria, decreased urine output, decreased libido, proteinu-ria. Hematologic Anemia, leukopenia, eosinophilia. Dermatologic Allergic reactions, including urticaria, skin rash, dry skin, pruritus, dry brittle hair, alopecia. Other Dyspnea, polyphagia, flu-like...

Indinavir sulfate

Hematologic Anemia, lym-phadenopathy, spleen disorder. Respiratory Cough, dyspnea, halitosis, pharyngeal hyperemia, pharyngitis, pneumonia, rales, rhonchi, respiratory failure, sinus disorder, sinusitis, URI. Dermatologie. Body odor, contact dermatitis, dermatitis, dry skin, flushing, folliculitis, herpes simplex, herpes zoster, night sweats, pruritus, seborrhea, skin disorder, skin infection, sweating, urticaria. GU Nephrolithiasis, dysuria, hematuria, hydronephrosis, nocturia, PMS, proteinuria, renal colic, urinary frequency, UTI, uterine abnormality, urine sediment abnormality, urolithiasis. Ophthalmic Accommodation disorder, blurred vision, eye pain, eye swelling, orbital edema. Miscellaneous Asymptomatic hyperbilirubinemia, food allergy, taste disorder. Drug Interactions Astemizole i Metabolism of astem-izole possibility of cardiac arrhythmias and prolonged sedation Clarithromycin T Plasma levels of both indinavir and clarithromycin Fluconazole i Plasma levels of in-dinavir

Cephalosporins

Side Effects Oral Sore mouth or tongue, dysgeusia, candidiasis, glossitis. GI N& V, diarrhea, abdominal cramps or pain, dyspepsia, glossitis, heartburn, anorexia, flatulence, cho-lestasis. Pseudomembranous colitis. Allergic Urticaria, rashes (maculo-papular, morbilliform, or erythema-tous), pruritus (including anal and genital areas), fever, chills, erythema, angioedema, serum sickness, joint pain, exfoliative dermatitis, chest tightness, myalgia, erythema multiforme, edema, itching, numbness, chills, Stevens-Johnson syndrome, anaphylaxis. NOTE Cross-allergy may be manifested between cephalosporins and penicillins. Hematologic Leukopenia, leukocy-tosis, lymphocytosis, neutropenia (transient), eosinophilia, thrombocy-topenia, thrombocythemia, agranu-locytosis, granulocytopenia, bone marrow depression, hemolytic anemia, pancytopenia, decreased platelet function, aplastic anemia, hypo-prothrombinemia (may lead to bleeding), thrombocytosis (transient). CNS Headache, malaise, fatigue,...

Premedications

The goals of premedications include anxiety relief, sedation, analgesia, amnesia, antisialagogue effect, increase in gastric fluid pH, decrease in gastric fluid volume, attenuation of sympathetic nervous system reflex responses, decrease in anesthetic requirements, prevent bronchospasm, prophylaxis against allergic reactions, and decrease post-op nausea vomiting.

Ephedra And Mahuang

It is said to be useful in the treatment of asthma (by dilating the bronchioles), narcolepsy, nasal congestion, and allergies. Some claim it helps to burn off fat and contribute to weight loss. Ephedra sinica may contain a substance that prevents the growth of the Influenza B virus. Dymetadrine 25 is an over-the-counter drug that is pure ephedrine. The effects wear off rapidly, so that larger and larger doses are needed to achieve the same effect. Large doses can cause headache, nervousness, nausea, palpitations, dizziness, difficult urination, insomnia, and chest pain. Overuse may also lead to a condition called the serotonin syndrome, where serotonin levels in the body are too high, and which is characterized by restlessness, confusion, sweating, diarrhea, excessive salivation, high blood pressure, increased body temperature, rapid heart rate, tremors, and seizures. There are twenty reported cases of ephedrine psychosis attributed to overuse, and attempts by individuals to obtain a...

Butorphanol

Some recreational users combine butorphanol with the common cold and allergy remedy diphenhydramine to produce a typical opiate-type stupor. Users of that combination sometimes report loss of interest in other drugs. Unwanted results can include emotional flip-flops, dizziness, nausea, vomiting, breathing difficulty, and general reduction of mental and physical abilities. Withdrawal symptoms from the combination may involve impaired concentration, mental restlessness and unease, and emotional instability and peevishness.

Scopolamine

An alkaloid found in belladonna, datura, henbane, and mandrake. In the early 1900s, it was used as an analgesic for childbirth until it was found to cause an abnormally high infant mortality rate. It was tested as a truth serum by the Germans and U.S. in World War II, both of whom found it unreliable. Nevertheless, the Soviets, according to William Burroughs, experimented with it and found that, even though the subject may have been willing to give up secrets, he oftentimes could not remember them. It is still used in some sleeping medications, and cold and allergy remedies, and can also be used to treat asthma, gastrointestinal spasms, and motion sickness.

RlSperidone

Precautions Its memory-enhancing effects on non-schizophrenics are still unknown. It should not be taken by those who are allergic to it. It may be dangerous for individuals with liver or kidney disease, allergies to other medications, or a history of seizures. A small percentage of Caucasians and Asians are poor metabolizers of the drug because of a lack of inadequate liver enzyme to break it down, taking five days for a steady dose to reach the blood instead of the usual one. Side effects may be more pronounced in the elderly, and it may lead to photosensitivity in some people. Those taking it should refrain from driving or piloting any craft, or working in high places.

Oxprenolol

Precautions It is not taken by anyone with an allergy to any beta-adrenergic blocker by those with hypotension, as it lowers blood pressure, aggravates any condition of congestive heart failure, produces tingling in the extremities, and light-headedness by those with asthma, pollen allergies, upper respiratory disease, or arterial spasms or by those who have taken MAO inhibitors or other psychiatric or psychotropic drugs within the preceding two weeks. It is used by those who have chronic obstructive pulmonary diseases (e.g., asthma, bronchitis, hay fever, or emphysema), diabetes or hypoglycemia, kidney or liver problems, heart disease or poor circulation in the limbs, an overactive thyroid function, or surgery within the previous two months (including dental surgery) that requires general or spinal anesthesia. There is an increased drop in blood pressure when taken with alcohol, calcium channel blockers, Clonidine, Diazoxide, or Guanabenz. When combined with angiotensin-converting...

Propranolol

It is not taken by anyone with an allergy to any beta-adrenergic blocker by those with hypotension, as it lowers blood pressure, aggravates any condition of congestive heart failure, produces tingling in the extremities, and light-headedness by those with asthma, pollen allergies, upper respiratory disease, or arterial spasms or by those who have taken MAO inhibitors or other psychiatric or psychotropic drugs within the preceding two weeks. It is prescribed for those who have chronic obstructive pulmonary diseases (e.g., asthma, bronchitis or emphysema), diabetes or hypoglycemia, kidney or liver problems, heart disease or poor circulation in the limbs, an overactive thyroid function, or surgery within the last two months (including dental surgery) that requires general or spinal anesthesia. There is an increased drop in blood pressure when taken with alcohol, calcium channel blockers, Clonidine, Diazoxide, or Guanabenz. When combined with angiotensin-converting (ACE) inhibitors or...

Asymptomatic

Astemizole An antihistamine drug used for the treatment of allergies. Astemizole cannot be taken when taking ketoconazole, all protease inhibitors, macrolide antibiotics (clarithromycin), selective serotonin reuptake inhibitors (see antidepressant), and several other drugs. In 1999, the manufacturer of astemizole stopped making the medication for sale in the United States and withdrew all hismanol products from that market as a result of serious side effects the drug caused when taken with numerous medications. It is still available in other countries. (Its trade name is Hismanol.) asthma A condition characterized by recurring sudden attacks of paroxysmal shortness of breath, accompanied by coughing and wheezing. The wheezing is caused by spasmodic contractions of the bronchi (bronchial tubes) or by swelling of the bronchial mucous membrane. Asthma may be an allergic reaction or be caused by other factors, such as physical, mental, or emotional stress fatigue and pollutant irritants....

Lovastatin 289

Loperamide A drug used to treat the symptoms of diarrhea. In people with HIV, it is often used to treat diarrhea caused by intestinal infections or that is a side effect of other drugs. Loperamide is available by prescription and over the counter as a liquid and in tablet form for oral administration. The prescription form of the drug should be used only under the guidance of a physician. At over-the-counter and prescribed doses, loperamide is generally well tolerated. Reported side effects include allergic reactions, abdominal pain or discomfort, nausea, vomiting, constipation, tiredness, drowsiness or dizziness, and dry mouth.

Answers

The answer is C. (Chapter 32) Slow injections limit the chance for local anesthetic toxicity. When history of allergy is uncertain, an antihistamine such as diphenhydramine injected directly into the wound can be used as an alternative and achieves anesthesia in approximately 30 min. True allergic reactions to local anesthetics are rare, especially to aminoamide compounds such as lidocaine and bupivicaine. The ester derivatives of para-aminobenzoic acid, such as procaine, are responsible for most local anesthetic allergic reactions. Toxicity should be suspected in patients who complain of dizziness, tinnitus, and periorbital tingling. Rarely, systemic convulsions follow. These are usually self-limited because of rapid redistribution of the drug, with resultant lower serum levels.

Skin care of 457

Sinusitis An inflammation of one or more of the sinuses, often as a complication of an upper respiratory infection or dental infection. It also may be caused by allergies, air travel, or underwater swimming. sinusitis is extremely common and afflicts some people with every bout of the common cold. In many children, once a tendency toward sinusitis develops, the condition recurs with each viral infection.

Untoward Effects

Hypersensitivity Allergic reactions occur, especially in persons with asthma, urticaria, angioedema, or similar conditions. Hypersensitivity reactions include localized swellings, particularly of the eyelids, cheeks, or lips, and erythematous dermatitis. Rarely, exfoliative dermatitis may be caused by phenobarbital and can prove fatal the skin eruption may be associated with fever, delirium, and marked degenerative changes in the liver and other parenchymatous organs.

Insulin

Dose (glucose intolerance in low birth weight infants < 1000 gm) IV infusion 0.04-0.05 units kg hr, titrate to desired blood glucose concentration. Clearance hepatic and renal metabolism 30 -80 renal elimination unchanged insulin is reabsorbed. Adverse effects hypoglycemia, allergic reactions, synthesis of insulin antibodies. Comments absorbed by plastic in IV tubing.

Aminoglycosides

Assess the patient according to the guidelines for all antibiotics as described previously in this chapter for penicillin. Infants with botulism and patients with myasthenia gravis or Parkinsonism will experience more muscle weakness than other patients who are treated with animoglycosides. You must also assess if the patient has hearing or kidney problems or allergies.

APropranolol Inderal

Propranolol should not be administered to patients who have bronchial asthma, cardiogenic shock, or sinus bradycardia. It should be used in caution with patients who have a history of allergies, diabetes mellitus, congestive heart failure, and emphysema. It is important to note that the abrupt withdrawal of this agent with patients who have heart disease (that is, angina) can cause arrhythmias or myocardial infarction (heart attack). This occurs because the sympathetic tone is adjusted to the blockage (probably by producing extra amounts of norepinephrine) thus, when the blockage is withdrawn, the heart cannot tolerate the extra norepinephrine that is present.

Steroid Management

The process oftapering or weaning steroid medications requires close monitoring. Steroids may be tapered by reducing the pill strength or by reducing the number of daily doses. There is no one tapering schedule that will work for every patient. Patients who have been on steroids for a short period of time can be tapered quickly whereas patients who have been on steroids for a prolonged period of time may require weeks to months to taper and in some cases may not be able to completely taper off the medication. Patients should be cautioned never to decrease or stop their medication abruptly. Patients also must contact their health care provider if they are unable to take their medications orally as a result of nausea or vomiting. Acute adrenal insufficiency can result with fever, muscle and joint pain, nausea, anorexia, orthostatic hypotension, dizziness, fainting, and hypoglycemia often requiring hospitalization. Steroid withdrawal can occur at any point during a steroid taper and...

Spider Bites

Another serious, and much more common, aspect of wasp, bee and hornet stings is an allergic reaction. If highly sensitised, symptoms may start within a few seconds, with tingling of the scalp, vasodilatation, hypotension, and death within 1-2 min. In most patients, the reaction begins after 1-2 min with generalised urticaria, followed over the next hour by oedema of the glottis, bronchoconstriction, hypotension, and coma. Subsequent reactions to further stings starts progressively sooner and may be more severe. Delayed allergic reactions may also occur 1-7 days after the sting, with fever, urticaria, enlarged lymph nodes, joint pains, and leuco-cytosis. These episodes usually last between 1 and 2 weeks.

Rauwolfia

Precautions It should not be taken by anyone who suffers from an allergy to rauwolfia alkaloids, depression, peptic ulcers, or ulcerative colitis. Those who suffer from epilepsy or who have had surgery in the past two months requiring general or spinal anesthesia should consult a physician first. Those over age sixty may suffer increased adverse reactions or side effects. Performing isometric exercises while on rauwolfia may cause the blood pressure to rise too high.

Anion

Anaphylaxis A systemic allergic reaction (also called anaphylactic shock) of immediate hypersensi-tivity to a drug or other antigen that results in life-threatening respiratory distress usually accompanied by shock and collapse of blood vessels. Symptoms include acute respiratory distress hypotension edema rash tachycardia pale, cool skin convulsions and cyanosis. If untreated, unconsciousness and death may be the outcome. Edema can be life-threatening if the larynx is involved, since air flow is obstructed with even minimal swelling.

Mnieres Disease

A diagnostic workup regarding contributing factors is good practice. Possible metabolic and allergic problems, mentioned previously, should be investigated. Thyroid function and glucose tolerance tests are recommended by many. Hypothyroidism and diabetes have been associated with the disease. Allergy testing may pick up an abnormality. In addition, an FTA-ABS should be done to rule out syphilis, which can closely mimic the disorder. A serologic test for autoimmune ear disease, namely the 68kD antigen (see the next section), might also be done. A lipid profile may show hyperlipidemia, another possible contributor.

Anticonvulsants

Phenytoin also has well-known sodium-channel-blocking effects and is useful for neuropathic pain (252a). However, it is less effective than carbamazepine for tri-geminal neuralgia (253). We have also noted that neuropathic pain caused by structural lesions causing nerve or root compression can paradoxically increase when phenytoin is administered. Phenytoin has a slow and variable oral absorption, some of which is dependent upon GI motility and transit time. Toxicity includes CNS effects and cardiac conduction abnormalities. Side effects are common and include hirsuitism, gastrointestinal and hematologic effects, and gingival hyperplasia (254). Allergies to phenytoin are common, and may involve skin, liver, and bone marrow. Phenytoin doses in the range of 100 mg twice or three times a day may be helpful for

Poisonous Effects

Animals rarely eat these plants, although, during the food shortage in the Netherlands in the Second World War, some cattle died after being given narcissus bulbs to eat. A tortoise which ate four daffodil leaves lost its appetite and became constipated and listless it died 11 days later. In severe cases it may be necessary to induce vomiting or remove stomach contents (Cooper and Johnson, 1991). In South Africa, similar problems with toxicity are experienced. The bulbs of daffodil and narcissus are known to have caused death when eaten by mistake (Moll and Moll, 1989). A case of poisoning by daffodil bulbs, cooked by mistake in the place of leeks, was reported from Toulouse in 1923. The symptoms were acute abdominal pains and nausea, which yielded to an emetic (Grieve, 1998). The bulbs of Narcissus poeticus, the Poet's narcissus, are reported to be more dangerous than those of the garden daffodil, being powerfully emetic and irritant (Grieve, 1998).

Antihistamines

Some allergic reactions are mediated by an endogenous substance called histamine that strongly affects nerves, blood vessels, and other tissues. In an effort to suppress allergic symptoms, pharmacologists have invented a number of synthetic drugs to block the actions of histamine. Many antihistamines are now available in large-dosage forms they are dispensed by prescription, but lower-dosage forms are sold over the counter. Some of the ones in widespread use are diphenhydramine (Benadryl), chlorpheniramine (Teldrin, Chlor-Trimeton), brompheniramine (Dimetane), dexchlorpheniramine (Polaramine), tripelennamine (PBZ, Pyri-benzamine), tripolidine (Actidil), promethazine (Phenergan), pyril-amine, and doxylamine. Although antihistamines are strong drugs that affect many systems of the body, they are often not very efficient at doing what they are supposed to do counteract histamine and suppress allergies. The central nervous system is especially sensitive to antihistamines. Often these...

Carbamazepine

Carbamazepine causes a variety of rashes and other allergic reactions including fever, hepatosplenomegaly, and lymphadenopathy, but the incidence of serious hy-persensitivity reactions is rare. Systemic lupus erythe-matosus can occur, but discontinuation of the drug leads to eventual disappearance of the symptoms. Idiosyncratic hematological reactions to carbamazepine

Phenytoin

Common side effects include constipation mild dizziness drowsiness gums that are bleeding, swollen, or tender nausea increased susceptibility to sunburn and vomiting. Less common side effects include agitation, breast swelling, confusion, diarrhea, an increase in facial and body hair, hallucinations, headaches, insomnia, muscle twitches, rash, slurred speech, staggering, vision changes. Rare symptoms include abdominal pain, an increased chance of bleeding or bruising, fever, jaundice, and sore throat. Other symptoms cited by some sources include anemia, balding, chest pains, depression, mental confusion and learning disability, conjunctivitis, nervousness, numbness of the hands and feet, nystagmus, retention of water, sensitivity to bright lights, swollen glands, tiredness, irritability, and weight gain, though these also disappear as time goes on and dosage is reduced. A severe allergic reaction could be life-threatening, and could include such symptoms as fever, rash, swollen...

Pefloxacin

The efficacy and safety of pefloxacin, 15-20 mg kg bd for 14-28 days in combination with ceftazidime and amikacin, have been investigated in 21 children (aged 7-16 years) with mucoviscidosis or aplastic anemia (2). Combined therapy had good clinical efficacy. Arthropathy developed frequently and children at risk were over 10 years old and had a history of allergies. The adverse effects of pefloxacin are those of the fluor-oquinolones, which are generally well tolerated. Gastrointestinal complaints occur in some 3-6 , and have included (in declining order of frequency) nausea, abdominal discomfort, vomiting, and diarrhea. Colitis due to Clostridium difficile infection has been reported infrequently. Nervous system effects have been less common, but headache, dizziness, agitation, sleep disturbances, and more rarely seizures, delirium, and hallucinations have been reported. Allergic reactions are infrequent. Photosensitivity reactions have been reported. The qui-nolones cause cartilage...

Dapsone

Gold is contraindicated in patients with previous gold allergy or severe toxic skin, kidney, or bone marrow reaction to gold. Relative contraindications include functional impairment of kidneys or liver. Immunosuppressive agents and penicillamine, agents with a potential to suppress the bone marrow, should not be given with gold. Patients should have frequent complete blood cell counts (including platelets) and a urinalysis before each injection during the first few weeks of therapy and periodically thereafter.

Ginger

Ginkgo biloba contains ginkgolides, molecules that are antagonistic to Platelet Activating Factor (PAF), a major component of asthma, allergies, and inflammatory conditions. It may also be helpful in relieving the symptoms of such conditions as bronchial and cardiac asthma, cold extremities, diabetes, eczema, glaucoma, inner ear dysfunction, macular degeneration, migraine headaches, multiple sclerosis, neuralgia and neuropathy, retinopathy, tinnitus, vascular fragility, and vertigo. There is no evidence it can help sustain male erections. Precautions It has been found to reduce the ability of sperm to penetrate eggs, and individuals should exceed the average daily dose only under a physician's care. Because of the relationship to PAF, it can be a problem for those with clotting disorders. High doses may cause diarrhea, headaches, irritability, nausea, restlessness, skin irritations, and vomiting. The fruit can cause severe allergic reactions much like poison ivy and poison oak. Though...

Infliximab

The monoclonal antibody infliximab is injected intravenously. The usual dose is 3-5 mg kg body weight escalation to 10 mg kg is used in single cases. Infusions are repeated after 2 and 6 weeks and then every 8 weeks. Side effects during infusion include dizziness and headaches. Allergic reactions to infliximab seem to be rare. Similar to etanercept infliximab induces immunosup-pression and thus inhibition of defence from in-fections.Viral and respiratory infections as well as tuberculosis 42 occur frequently. Thus, be