Escitalopram
By V. Hernando. Rice University.
These are nasal decongestants that provide quick relief to the patient; systemic decongestants that provide a longer lasting relief from congestion; and intranasal glucocorticoids that are used to treat seasonal and perennial rhinitis 10 mg escitalopram mastercard anxiety symptoms diarrhea. Cough Preparations A cough is a common symptom of a cold brought about by the body’s effort to remove nasal mucous that might drain into the respiratory tract cheap 5 mg escitalopram with visa anxiety zen youtube. Antitussives are the ingredients used in cough medicine to suppress the cough center in the medulla. Although the cough reflex is useful to clear the air passages, suppres- sion of the cough reflex can provide some rest for the patient. Expectorants When an individual has a cold or other respiratory infection, it is common to have rather thick mucous that is difficult to expectorate. Expectorants are med- ications that loosen the secretions making it easier for the patient to cough up and expel the mucous. They work by increasing the fluid output of the respira- tory tract and decrease the adhesiveness and surface tension to promote removal of viscous mucus. A list of drugs utilized in the treatment of upper respiratory tract disorders is provided in the Appendix. Patients may take systemic or nasal decongestants to reduce the congestion that frequently accompanies sinusitis. Patients are told to drink plenty of fluids, to rest, and to take acetaminophen (Tylenol) or ibupro- fen for discomfort. In some cases, antibiotics are prescribed if the condition is severe or long lasting and an infection is suspected. Pharyngitis is caused by a virus (viral pharyngitis) or by bacteria (bacteria pharyngitis) such as the beta-hemolytic streptococci. Sometimes patients experience acute pharyngitis along with other upper respiratory tract disease such as a cold, rhinitis, or acute sinusitis. Patients who have a viral pharyngitis are given medications that treat the symptoms rather than attacking the underlying virus. Acetaminophen or ibupro- fen is given to reduce the patient’s temperature and discomfort. Saline gargles, lozenges, and increased fluid are usually helpful to soothe the sore throat. Patients who have bacterial pharyngitis are given antibiotics to destroy the beta-hemolytic streptococci bacteria. However, antibiotics are only prescribed if the result of the throat culture is positive for bacteria. Patients are also given the same treatments for viral pharyngitis to address the symptoms of pharyngitis. Patients who come down with acute tonsillitis experi- ence a sore throat, chills, fever, aching muscles, and pain when they swallow. A throat culture is taken to determine the cause of the infection before an appropriate antibiotic is prescribed to the patient. The patient is also given acet- aminophen or ibuprofen to reduce the fever and the aches and pains associated with acute tonsillitis. The patient is also encouraged to use saline gargles, lozenges, and increased fluid to soothe the soreness brought on by infected ton- sils. Other times it is caused by stress or overuse of the vocal cords—a common occurrence for fans whose team wins the Super Bowl. Refraining from speaking and avoiding exposure to substances that can irritate the vocal cords, such as smoking, is the preferred treatment for acute laryngitis. The result is an impairment of oxygen reach- ing lung tissues that can in some cases irreversibly damage lung tissues. The airway obstruction occurs when the bronchioles constrict (bronchospasm) and mucous secretions increase causing the patient to experience difficulty breathing (dyspnea). Symptoms include fever, chills, cough, rapid breathing, wheezing and/or grunting respirations, labored breathing, vomiting, chest pain, abdominal pain, loss of appetite, decreased activity, and, in extreme cases, signs of hypoxia (low oxygen levels) or cyanosis such as a bluish tint around the mouth or fingernails. That is, bronchodilators, antipyretics (fever reducing), analgesics such as ibuprofen, cough medications that include expectorants, mucolytics, as well as suppressants to help the patient sleep. Bacterial and fungal pneumonia are treated with antimicrobials as well as the above treatment for viral pneumonia. The antimicrobial is chosen based on the specific microorganism causing the pneumonia.
Alternatively (or drugs with neuromuscular blocking activity buy discount escitalopram 20 mg online anxiety in children symptoms, including subsequently if adenosine is not effective order escitalopram 10mg without prescription anxiety zoning out, which would aminoglycoside antibiotics. Pharmacokinetics Magnesium salts are not well absorbed from the gastrointest- Case history inal tract, accounting for their efficacy as osmotic laxatives when given by mouth. Mg2 is eliminated in the urine and A 66-year-old man made a good recovery from a transmural therapy with magnesium salts should be avoided or the dose (Q-wave) anterior myocardial infarction complicated by mild 2 transient left ventricular dysfunction, and was sent home tak- reduced (and frequency of determination of plasma Mg ing aspirin, atenolol, enalapril and simvastatin. Three months concentration increased) in patients with glomerular filtration later, when he is seen in outpatients, he is feeling reasonably rates 20mL/min. Question Magnesium salts form precipitates if they are mixed with Decide whether management might appropriately include sodium bicarbonate and, as with calcium chloride, magnesium each of the following: salts should not be administered at the same time as sodium (a) consideration of cardiac catheterization; bicarbonate, or through the same line without an intervening (b) invasive electrophysiological studies, including provo- saline flush. Hypermagnesaemia increases neuromuscular cation of dysrhythmia; (c) adding flecainide; blockade caused by drugs with nicotinic-receptor-antagonist (d) stopping atenolol; properties (e. Answer (a) True (b) False Case history (c) False A 16-year-old girl is brought to the Accident and Emergency (d) False Department by her mother having collapsed at home. As a (e) False baby she had cardiac surgery and was followed up by a paedi- (f) False atric cardiologist until the age of 12 years, when she Comment rebelled. She was always small for her age and did not play It is important to continue a beta-blocker, which will games, but went to a normal school and was studying for improve this patient’s survival. On examination, she is ill and unable to give a cardiac catheterization to define his coronary anatomy and history, and has a heart rate of 160 beats per minute (regu- to identify whether he would benefit from some revascular- lar) and blood pressure of 80/60mmHg. Other classes of anti-dysrhythmic drugs murmurs which are difficult to characterize. New Emergency Department complaining of rapid regular pal- England Journal of Medicine 2006; 354: 1039–51. Implantable cardioverter-defibrillators: library for his final examinations which start next week. Decide whether initial management might reasonably include each of the following: (a) i. Answer (a) False (b) True (c) False (d) True (e) False (f) True (g) False Comment Students who are studying for examinations often consume excessive amounts of coffee and a history of caffeine intake should be sought. Vagal manoeuvres may terminate the dysrhythmia but, if not, overnight observation may see the rhythm revert spontaneously to sinus. This mani- Society guidelines and involves the following: fests as the triad of wheeze, cough and breathlessness. These symptoms are due to a combination of constriction of bronchial • assessment of asthma severity (e. Asthma is broadly categorized expiratory flow rate, pulse oximetry and blood gases if into non-allergic and allergic, but there is considerable overlap. Increased parasympa- injection); thetic tone due to local and centrally mediated stimuli also pro- • in refractory cases, consider magnesium sulphate (slow motes bronchoconstriction. Aerosols are particularly useful for ventilation will probably be needed; treating an acute episode of breathlessness. Oral • general care: monitor fluid/electrolyte status (especially preparations have a role in young children who cannot hypokalaemia) and correct if necessary. There are several alternative approaches, including breath-activated devices and The primary objectives of the pharmacological management of devices that administer the dose in the form of a dry chronic asthma are to obtain full symptom control, prevent exac- powder that is sucked into the airways. Patients should contact their physician promptly if their with minimal side effects. The British Thoracic Society/Scottish clinical state deteriorates or their β2-agonist use is increasing. Step 1 is for mild asthmatics with intermittent symp- of short-acting β2-agonist bronchodilator are toms occurring only once or twice a week; step 2 is for patients required; with more symptoms (more than three episodes of asthma symp- • repeated attacks interfere with work or school. Step 3 is for patients who have continuing symptoms despite step 2 treatment and Adverse effects are minimized by using the inhaled route. In moderate to severe steroid-dependent chronic asthma, Acute bronchitis is common. There is little convincing evi- the anti-IgE monoclonal antibody omalizumab can dence that antibiotics confer benefit in otherwise fit patients improve asthmatic control and reduce the need for presenting with cough and purulent sputum, and usually the glucocorticosteroids. Hypnotics and sedatives should be avoided, as for acute or evidence of pneumonia, it seems appropriate to avoid asthma. Patients can perform home peak flow monitoring first thing in the morning and last thing at night, as soon as asthmatic symptoms develop or worsen.
