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Pyruvate kinase deficiency c) Haemoglobin -Abnormal haemoglobin such as HbS discount 1mg cardura, C generic cardura 4mg, Unstable Hb Clinical features  The disease may occur at any age and sex  Patient may present with symptom and features of Anaemia  Symptoms are usually slow in onset however rapidly developing anaemia can occur  Splenomegaly is common but no always observed  Jaundice Treatment i buy discount cardura 1 mg on-line. Immunosuppressive drugs for the patients who fail to respond to corticosteroids and splenectomy. Symptoms may include anaemia, dactylitis, recurrent infections, impaired growth and development. Crises Three distinct types of crises develop in patients with sickle cell disease  Vaso-occlusive or painful crises are more common occurring with a frequency from almost daily to yearly. It is important to distinguish between painful crises and pain caused by another process  Aplastic crises occurs when erythropoiesis is suppressed  Sequestration crises occurs in children or occasional in adult with an enlarged spleen due to massive pooling of red cells in the spleen Treatment Guidelines Nonspecific measures A: Folic acid 5mg once daily Specific measures S: Hydroxyurea 15mg/kg/day. Maximum dose: 35mg/kg Management of Complication  Patients undergoing vascular crises should be kept warm and given adequate hydration and pain control (Inj pethedine 100mg 6hrly, Oral morphine 5mg/kg) and oxygen  Acute chest syndrome is a life threatening complication and empiric antibiotics should be given. Usually asymptomatic but liable to haemolysis if incriminated drugs or foods are taken (e. Treatment Guidelines  Avoid incriminated agents/foods or drugs  Transfusion of packed red blood cells in severe anaemia. Most frequent haemorrhage involves joints or muscles and bleeding parttens differ with age: Infants usually bleed into soft tissues ar from the mouth but as the boy grows, characterist joint bleeding becomes more common. Frequent spontaneous haemarthrosis factor is needed several times Moderate 2-5%of normal 1Haemorrhage secondary 0. Patients present with a history of easy bruising, menorrhagea, gum bleeding and spontaneous joint bleeding in severe form. In the acute form massive activation of coagulation does not allow time for compensatory increase in production of coagulant and anticoagulant factors. Patients present with bleeding manifestation, extensive organ dysfunction, shock, renal corticle ischemia, coma, delirium and focal neurological symptoms. Clinical feature for adult thrombocytopenia appears to be more common in young women than in young men but amoung older patients, the sex incidence may be equal. Most adult patient presents with a long history of purpura, menorrhagia, epistaxis and gingival haemorrhage. Treatment of Venous Thromboembolism Long term anticoagulation is required to prevent a frequency of symptomatic extension of thrombosis and/or recurrent venous thromboembolic events. Warfarin is started with initial heparin or clexane therapy and then overlapped for 4-5days. The aim in handling major trauma is to look for life threatening complications which if missed may endanger the patient’s life. We will exclude maxillo-facial injuries and eye injuries from this discussion (Ref this to eye section).

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Using the formula: 212 Answers rate (mL/hour) amount of drug 1 buy cardura 1mg without a prescription,000 mcg/kg/min = weight (kkg) volume (mL) 60 where in this case: rate = 28mL/hour amount of drug (mg) = 50mg weight (kg) = 78kg volume (mL) = 50mL 60 converts minutes to hours 1 purchase 1mg cardura with visa,000 converts mg to mcg Substituting the numbers into the formula: 28 50 1 000 cheap cardura 1 mg with visa, = 5. Question 17 First, convert the volume to drops by multiplying the volume of the infusion by the number of drops/mL for the giving set: 500 × 20 = 10,000 drops Next, calculate how many minutes it will take for 1 drop: 42 drops per minute 1 1 drop will take min 42 Calculate how many minutes it will take to infuse the total number of drops: 1 10,000 drops will take × 10,000 = 238min 42 Convert minutes to hours by dividing by 60: 238 238min = = 3. Using the formula: Chapter 8 Infusion rate calculations 213 number of hours the infusion is to run = volume of the infusion × drip rate of giving set rate (drops/min)×60 where, in this case: volume of the infusion = 500mL rate (drops/min) = 42 drops/min drip rate of giving set = 20 drops/mL Substituting the numbers into the formula: 500×20 = 3. Question 18 Divide the volume by the rate to give you the time over which the infusion is to run: calculated rate = 83mL/hour volume = 1,000mL 1 000, = 12. Using the formula: Number of hours the infusion is to run = where in this case: volume of the infusion = 1,000mL rate (mL/hour) = 83mL/hour Substituting the numbers into the formula: 1 000, = 12. Convert to milligrams as the vial strength is in milligrams (500mg): 4g = 4,000mg Calculate the number of vials used per day by dividing the total daily dose by the vial strength, i. Chapter 9 Action and administration of drugs 215 Chapter 9 Action and administration of drugs Question 1 0. Cancer drugs have a lower therapeutic index (the difference between an effective and a toxic dose) than most other drugs, i. Several different formulae and nomograms have been derived for predicting surface area from measurements of height and weight. Slide rules and nomograms are incapable of calculating with this degree of accuracy. In addition, they suffer from error associated with their analogue nature and the formulae on which they are based. It is: 2 height (cm)× weight (kg) m = 36, 00 For example, you want to know the body surface area of a child whose weight is 16. However, many investigators have since questioned the accuracy of the Du Bois formula. Before you can use the nomogram, you have to know the patient’s height and weight. Geometric method for measuring body surface area: a height–weight formula validated in infants, children and adults. Patients’ weights are usually given in stones and have to be converted to kilograms, especially when working out dosages. Patients’ heights are usually given in feet and inches and have to be converted to centimetres. Formulae to calculate surface area require weight in kilograms and height in centimetres. Diabetes, cancer, high blood pressure and osteoarthritis are also common consequences of overweight and obesity in adults.

These men benefit from treatment of women will have recurrent disease after maintenance therapy with topical antifungal agents to relieve symptoms discount cardura 1 mg line. Symptomatic women who remain culture- positive despite maintenance therapy should be managed in Special Considerations consultation with a specialist discount cardura 2mg with amex. Oral azoles occasionally excoriation cheap cardura 1mg amex, and fissure formation) is associated with lower cause nausea, abdominal pain, and headache. Therapy with clinical response rates in patients treated with short courses the oral azoles has been associated rarely with abnormal of topical or oral therapy. Clinically important interactions 150 mg of fluconazole in two sequential oral doses (second can occur when oral azoles agents are administered with other dose 72 hours after initial dose) is recommended. Options include longer duration of therapy becoming more common in vaginal isolates (723,724), (7–14 days) with a nonfluconazole azole regimen (oral or susceptibility testing is usually not warranted for individual topical) as first-line therapy. This regimen has clinical and Recurrent Vulvovaginal Candidiasis mycologic eradication rates of approximately 70% (726). Delay in diagnosis and treatment probably not differ from that for seronegative women. Although contributes to inflammatory sequelae in the upper reproductive long-term prophylactic therapy with fluconazole at a dose tract. Laparoscopy can be used to obtain a more accurate of 200 mg weekly has been effective in reducing C. Although some cases • elevated C-reactive protein; and are asymptomatic, others are not diagnosed because the patient • laboratory documentation of cervical infection with or the health-care provider fails to recognize the implications N. Diagnosis • endometrial biopsy with histopathologic evidence of and management of other common causes of lower abdominal endometritis; pain (e. After deciding clinical and microbiologic cure in randomized clinical trials whether to initiate empiric treatment, clinicians should also with short-term follow-up (741,742). Treatment should be initiated as soon as the doxycycline should be administered orally when possible. The decision of whether hospitalization used 24–48 hours after clinical improvement to complete the is necessary should be based on provider judgment and whether 14 days of therapy for the clindamycin/gentamicin regimen, the woman meets any of the following suggested criteria: and oral therapy with clindamycin (450 mg orally four times • surgical emergencies (e. However, when tubo-ovarian • pregnancy; abscess is present, clindamycin (450 mg orally four times daily) • severe illness, nausea and vomiting, or high fever; or metronidazole (500 mg twice daily) should be used to • unable to follow or tolerate an outpatient oral regimen; complete at least 14 days of therapy with doxycycline to provide or more effective anaerobic coverage than doxycycline alone. Limited data are available to support use of other parenteral No evidence is available to suggest that adolescents have second- or third-generation cephalosporins (e. In addition, these cephalosporins are and the clinical response to outpatient treatment is similar less active than cefotetan or cefoxitin against anaerobic bacteria.

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