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Children weighing 20-30 kg injected a dose of 600 units 20 mg crestor with mastercard, and for all other age patient groups injected dose of 1200000 units discount crestor 20 mg free shipping. If the patient has allergy to penicillin discount crestor 5mg on-line, macrolides secondary prevention is carried out in cycles of 10 days each month Children who have had rheumatic fever without carditis, secondary prevention is carried out for 5 years or until the age of 21 years old. This inflammation leads to a violation of the secretory, motor, and often the endocrine functions of the stomach and duodenum. Prescribe colloidal bismuth subcitrate in a dose of 4-8 mg/kg per day in combination with amoxicillin at 25 mg/kg and nifuratel 15 mg/kg for 7 days. In the presence of an allergy to penicillin is used in the scheme clarithromycin therapy at a dose of 7. Blockers H2-histamine receptors are used in the schema therapy for children up to 12 years. Ranitidine is prescribed for 75-150 mg at twice a day for 20 minutes before eating or for famotidine 10-20 mg twice a day regardless of the meal. The drug is administered for 7-10 days and then the dose is reduced by 2 times and the treatment continues for 2-3 weeks. In children over 12 years prescribe triple therapy with the aim of eradication of Н. Four- component therapy includes nifuratel, colloidal bismuth subcitrate in combination with amoxycillin or clarithromycin. Omeprazole appoint 10-20 mg (pantoprazole 20-40 mg per day) once a day in the morning before eating for 7-10 days. Four- component therapy is indicated for the ineffectiveness three- component therapy of first-line therapy. The main cause of death, even working age is coronary heart disease due to the development cardiosclerosis. Atherosclerosis is a disease characterized by lesions of artery walls due to the formation of atherosclerotic plaques that have varying degrees of narrowing the lumen, leading to acute or chronic reduction of blood flow to vital authorities. For pharmacotherapy of atherosclerosis use following groups of drugs: statins, fibrates, bile acid sequestrants and other lipid- lowering agents. Of the group of statins are recommend following medication: lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin. In addition, cholesterol- lowering statins are used in combination with other lipid-lowering agents: inedzhi (a combination of 20 mg of simvastatin and 10 mg of ezetimibe), and asia-ator (a combination of 10 mg of atorvastatin and 10 mgezetimibu). Quite often, the choice is between atorvastatin and rosuvastatin – modern synthetic statins, has a marked effect lipid-lowering effect. A number of studies have been conduct directly comparing the original atorvastatin and rosuvastatin. The aim of our study was to examine the results of a multicenter study compared the effectiveness of atorvastatin and rosuvastatin. Rosuvastatin has some advantage over atorvastatin in lowering total cholesterol and low-density lipoprotein cholesterol. It has been proved that long-term use rosuvastatin 40mg reduces the diameter of the atherosclerotic plaque in the vessel. Rosuvastatin had significant advantages over atorvastatin in influencing the level of inflammatory markers, as well as the progression of atherosclerosis. Atorvastatin has the largest list of indications for use for both primary and secondary prevention of cardiovascular disease. Rosuvastatin has registered indications for use - secondary prevention of cardiovascular disease. Having conducted a comparative analysis of the effectiveness of atorvastatin and rosuvastatin in the pharmacotherapy of atherosclerosis, we can conclude that both drugs are approve for use and do not have clear benefits to each other. The study of the current standards of care for patients with acute respiratory viral infections. We analyzed the articles, adapted clinical guidelines based on evidence, unified clinical protocols of emergency medical care for acute respiratory infections, including influenza. For each type of virus is the most difficult lesions characteristic of a particular department of the upper respiratory tract with the development of characteristic symptoms. Etiotropic antiviral pharmacotherapy was conduct with influenza (A and B) drugs from the group neuraminidase (oseltamivir, zanamivir). Apply the following drugs: antipyretic agents (ibuprofen, acetominiphen), antihistamines for systemic use (chloropyramine, clemastine, loratadine, dezloratadine, cetirizine), decongestants and other drugs for topical application in the case of diseases of the nose (oxymetazoline, xilometazoline, nafazoline, tramazoline, tetryzoline), antiseptics used for treatment of throat (ambazone, chlorhexidine), expectorants (guaifenesin, marshmallow root, leaf ivy), mucolytic drugs (acetylcysteine, bromhexinum, ambroxol, carbocisteine), antitussive agents (glaucine hydrobromide, okseladyn). A specific vaccine prophylaxis was carry out under the threat of epidemic (pandemic) Influenza. In 2015-2016 years in Ukraine registered the following vaccines: Vaxigrip, Influvak. Opioids – a substance derived from the opium poppy, and their synthetic analogs having similar effects. Opioids have the ability to cause drug dependence and are characterized by a strong desire to use them, they also cause tachyphylaxis, which sooner or later leads to poisoning and overdose. The aim of our study was to investigate modern rational pharmacotherapy for opiate poisoning. We was study the adapted clinical guidelines based on evidence, articles, unified clinical protocols of emergency medical care and pharmacotherapy for poisoning opiates. The main symptoms of acute intoxication by opiates are dizziness, tinnitus, dry mouth, nausea, sometimes vomiting. The skin of the face and torso hyperemic or pale, sometimes puffiness of the face, itching and rash. The body temperature is reduce, skin feels wet and cold, cold extremities is observe. Pharmacotherapy of opioid addicts consists of three main phases: detoxification (mild withdrawal syndrome); somatoneurological correction of mental disorders and primary preventive treatment; supporting preventive treatment. For the relief of withdrawal symptoms using integrated circuit with psychopharmacological agents, wegetotropic drugs, muscle relaxants, painkillers, treat with prolonged medicated sleep (with the use of anesthesia: thiopental sodium, sodium hydroxybutyrate); replacement therapy with the use of narcotic analgesics and their gradual cancellation (methadone, buprenorphine programs, the legalization of soft drugs and delivery of treated persons drugs addiction), rapid opioid detoxification. The main objectives of the second phase of pharmacotherapy are correction somatovegetativnyh postabstinent violations in the form of asthenic syndrome, vegetative and psychopathological disorders (neuroleptics: haloperidol, periciazine, amitriptyline, thioridazine hydrochloride; antiepileptic: karbmazepin, levomepromazine, analgesics: flupirtine maleate; antispasmodics: drotaverinum; alpha-blockers: pirroxan). The basis of third stage constitute non-pharmacological methods, especially psychotherapy. Thus, the main directions of modern pharmacotherapy of opiate poisoning are detoxification, somatoneurological correction of mental disorders and primary preventive treatment; supporting preventive treatment. Today the problem of onychomycosis is urgent, due to the prevalence of onychomycosis in the population and their high contagiousness. According to epidemiological data onychomycosis incidence is 20% of the population and 50-70% in the structure of fungal diseases. Onychomycosis – is a generic term that refers to fungal infection of nails feet and hands, caused dermatophyte, mold fungi. The most common causative agents of disease are fungi of the genus Trichophyton, Candida and Epidermophyton. To study the basic aspects of epidemiology, etiology, pathogenesis, clinical manifestations and modern pharmacotherapy for onychomycosis. The analysis of foreign literature, modern domestic and foreign standards of care for patients with onychomycosis. The main clinical symptoms of onychomycosis are changes in color, shape of the nail due to subungual hyperkeratosis and destruction of the nail plate. For the diagnosis of onychomycosis used bacterioscopic and bacteriological methods. Modern pharmacotherapy for onychomycosis includes systemic and topical antifungal therapy. Topical therapy may only be apply in case of damage of less than 30% of the nail plate in the absence or low hyperkeratosis, contraindications to systemic therapy. Local antifungal therapy include using of keratolytics for lysis of the affected nail plate from the nail bed, followed by treatment antifungals for topical use. There form of drugs for the topical application are lacquer, cream, ointment, containing ketoconazole, terbinafine, oxiconazole, miconazole, and undecylenic acid. Systemic antifungal therapy is required to shown at the defeat of more than 50% of the nail plate, a 2-3 defeat of the nail plate, nail plate pronounced changes (hyperkeratosis, onycholysis), the defeat of the nail matrix.

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Bloody diarrhoea is usually a sign of invasive enteric infec- ton and should be treated with an appropriate ant-infectve agent 20 mg crestor with visa. Contraindicatons Conditons where inhibiton of peristalsis should be avoided; abdominal distension; acute diarrhoeal conditons such as ulceratve colits or antbiotc-associated colits; acute respiratory depression buy crestor 5mg without a prescription. Precautons Tolerance or dependence may occur with prolonged use; elderly and debilitated patents; hepatc impairment (Appendix 7a); renal impairment; lactaton; overdosage: see chapter 7 purchase crestor 5mg. Adverse Efects Nausea, vomitng, constpaton, drowsiness; respiratory depression and hypotension (large doses); dependence; difculty with micturiton; ureteric or biliary spasm; dry mouth, sweatng, headache, facial fushing, vertgo, bradycardia, tachycardia, palpitatons, hypothermia, hallucinatons, dysphoria, mood changes, miosis, decreased libido or potency, rash, urtcaria, pruritus; convulsions (large doses). Furazolidone Pregnancy Category-C Schedule H Indicatons Giardiasis; cholera; gastrointestnal infectons; protozoal or bacterial diarrhoea and enterits; food poisoning. Precautons Urine colour changes to yellow afer administraton; orthostatc hypotension; hypoglycaemia; pregnancy (Appendix 7c); interactons (Appendix 6a, 6c). Adverse Efects Nausea, vomitng, headache; hypotension; urtcaria; dyspnea; dizziness. Loperamide Pregnancy Category-C Schedule H Indicatons For the control and symptomatc relief of acute nonspecifc diarrhoea and chronic diarrhoea associated with infammatory bowel disease or gastroenterits; for reducing the volume of discharge from ileostomies. Contraindicatons Conditons where inhibiton of peristalsis should be avoided, where abdominal distension develops, or in conditons such as actve ulceratve colits or antbiotc- associated colits. Precautons Liver disease; pregnancy: (Appendix 7c); interactons (Appendix 6c); glaucoma; Crohn’s disease; urinary bladder obstructon. Adverse Efects Abdominal cramps, dizziness, drowsiness and skin reactons including urtcaria; paralytc ileus and abdominal bloatng also reported; constpaton; headache; meteorism; nausea; dry mouth; urinary retenton. Before prescribing laxatves, it is important to be sure that the patent is constpated and that the constpaton is not secondary to an underlying undiagnosed complaint. It is also important that the patent understands that bowel habit can vary considerably in frequency without doing harm. For example, some people consider themselves constpated if they do not have a bowel movement each day. A useful defniton of constpaton is the passage of hard stools less frequently than the patent’s own normal patern and this should be explained to the patent since misconceptons about bowel habits have led to excessive laxatve use which in turn has led to hypokalaemia and an atonic non-functoning colon. Laxatves should generally be avoided except where straining will exacerbate a conditon such as angina or increase the risk of rectal bleeding as in haemorrhoids. Laxatves are of value in drug-induced constpaton, for the expulsion of parasites afer anthelminthic treatment and to clear the alimentary tract before surgery and radiological procedures. Prolonged treat- ment of constpaton is rarely, necessary except occasionally in the elderly. These include bulk-forming laxatves which relieve constpaton by increasing faecal mass and stmulatng peristalsis, stmulant laxatves which increase intestnal motlity and ofen cause abdominal cramp, faecal sofeners which lubricate and sofen impacted faeces and osmotc laxatves which act by retaining fuid in the bowel by osmosis. Bowel cleansing solutons are used before colonic surgery, colonoscopy or radiological examinaton to ensure that the bowel is free of solid contents; they are not a treat- ment for constpaton. Contraindicatons Intestnal obstructon (causes abdominal cramps), acute surgical abdominal conditons, acute infammatory bowel disease, severe dehydraton; faecal impacton, chronic use. Precautons Excessive use of stmulant laxatves can cause diarrhoea and related efects such as hypokalaemia; however, prolonged use may be justfable in some circumstances; don’t give antacid within 1 hour, pregnancy (Appendix 7c), infammatory bowel disease, pre-existng heart disease or bowel disease, allergies, interactons (Appendix 6d). Adverse Efects Tablets- griping; suppositories-local irritaton; faintng, dizziness, soreness in anal region due to suppository leakage; abdominal discomfort, electrolyte imbalance, hypokalaemia. Contraindicatons Galactosemia, intestnal obstructon, patents on low galactose diet. Adverse efects Diarrhoea (dose related), nausea, vomitng, hypokalaemia; dehydraton; hypernatremia; bloatng and abdominal cramps. Dose Oral Adult- 2 to 4 tablets, usually at night; inital dose should be low, then gradually increased. Precautons Avoid prolonged use unless indicated for preventon of faecal impacton; pregnancy (Appendix 7c), lactaton (Appendix 7b); hypersensitvity, undiagnosed abdominal pain, intestnal blockage. Adverse Efects Abdominal discomfort; atonic non- functoning colon and hypokalaemia (with prolonged use or overdosage); red or yellow brown urine, diarrhoea, nausea, vomitng, bloatng. Severely dehydrated patents must be treated initally with intravenous fuids untl they are able to take fuids by mouth. For oral rehydraton it is important to administer the soluton in small amounts at regular intervals as indicated below. Plan A: No dehydraton: Nutritonal advice and increased fuid intake are sufcient (soup, rice, water and yoghurt, or even water). For infants aged under 6 months who have not yet started taking solids, oral rehydraton soluton must be presented before ofering milk. In the case of mixed breast-milk/formula feeding, the contributon of lactaton must be increased. Plan B: Moderate dehydraton: Whatever the child’s age, a 4-h treatment plan is applied to avoid short-term problems. It is recom- mended that parents are shown how to give approximately 75 ml/kg of oral rehydraton soluton with a spoon over a 4-h period and it is suggested that parents should be watched to see how they cope at the beginning of the treatment. A larger amount of soluton can be given if the child contnues to have frequent stools. In case of vomitng, rehydraton must be discontnued for 10 min and then resumed at a slower rate (about one teaspoonful every 2 min). The child’s status must be re-assessed afer 4 h to decide on the most appropriate subsequent treatment. Oral rehydraton soluton should contnue to be ofered once dehydraton has been controlled, for as long as the child contnues to have diarrhoea. Plan C: Severe dehydraton: Hospitalizaton is necessary, but the most urgent priority is to start rehydraton. In hospital (or elsewhere), if the child can drink, oral rehydraton soluton must be given pending, and even during intravenous infusion (20 ml/kg every h by mouth before infusion, then 5 ml/kg every h by mouth during intravenous rehydraton). For intra- venous supplementaton, it is recommended that compound soluton of sodium lactate (see chapter 28. If the intravenous route is unavailable, a nasogastric tube is also suitable for administering oral rehydraton soluton, at a rate of 20 ml/kg every h. If the child vomits, the rate of administra- ton of the oral soluton should be reduced. Note: The soluton may be prepared either from prepackaged sugar/salt mixtures or from bulk substances and water. Solutons must be freshly prepared, preferably with recently boiled and cooled water. Accurate weighing and thorough mixing and dissoluton of ingredients in the correct volume of clean water is important. Adult- Fluid and electrolyte loss in acute diarrhoea; 200 to 400 ml soluton afer every loose moton. Adverse Efects Vomitng- may indicate too rapid administraton; hypernatraemia and hyperkalaemia may result from overdose in renal impairment or administraton of too concentrated a soluton. Antdotes and Substances Used in Poisoning These notes are only guidelines and it is strongly recom- mended that poisons informaton centres (Appendix 5) be consulted in cases where there is doubt about the degree of risk or about appropriate management. Patents who have taken poisons with delayed actons should also be admited, even if they appear well; delayed-acton poisons include acetylsalicylic acid, iron, lithium, paracetamol, paraquat, tricyclic antdepressants and warfarin. However, it is ofen impossible to establish with certainty the identty of the poison and the size of the dose but informaton on the type and tming of poisoning may be useful for symptomatc management. Cardiac conducton defects and arrhythmias ofen respond to correcton of underlying hypoxia, acidosis, or other biochemical abnormalites. Hypothermia which may develop in patents who have been unconscious for some hour is best treated by wrapping the patent in blankets to conserve body heat. Convulsions which are prolonged or recurrent may be controlled by intravenous diazepam. In some situatons removal of the poison from the stomach by gastric lavage may be appropriate (see below). Actvated charcoal can bind many poisons in the stomach and therefore prevent absorp- ton. Actve eliminaton techniques such as repeated adminis- traton of actvated charcoal can enhance the eliminaton of some drugs afer they have been absorbed (see below). Other techniques to enhance eliminaton of poisons afer their absorpton are only practcal in hospital and are only suitable for a small number of patents and only to a limited number of poisons. Gastric Lavage: The dangers of atemptng to empty the stomach have to be balanced against the toxicity of the ingested poison, as assessed by the quantty ingested, the inherent toxicity of the poison and the tme since ingeston. Gastric emptying is clearly unnecessary if the risk of toxicity is small or if the patent presents too late.

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Onset of action 10 mg crestor overnight delivery, peak effect order 5mg crestor mastercard, and duration: Wherever available discount crestor 20mg free shipping, time of onset of action, peak effect, and duration are listed. This information is considered most important for the proper spacing of drug administration. Other aspects of pharmacokinetics— peak serum levels, bioavailability, protein binding, half-life—as included in many sources, are not considered of utmost impor- tance in pharmacotherapy per se and are not included. Food: Wherever possible, mention is made of those foods to be avoided and whether or not the drug should be taken with food. Pregnancy: The pregnancy category as proposed by the Food and Drug Administration is indicated for each drug. Lactation: Available information regarding the presence of the drug in breast milk is given. A general guideline provided in a brief statement (such as “avoid breastfeeding”) is provided. Warnings/precautions: All warnings provided by the manufac- turer have been set forth as succinctly as possible. Other statements are made to alert the health provider to potential problems with the drug and how to avoid them. Advice to patients: This represents our opinions regarding what the treating clinician needs to tell the patient to attempt to avoid or minimize problems with the drug. Adverse reactions: These are defined as common (occurring in ≥ 10% of the patients taking the drug in pre- or postmarketing testing) and serious (potentially life threatening or with the risk of causing organ damage). Side effects that are serious as well as common are listed as serious but in boldface type. Clinically important drug interactions: All too frequently, drug compendia list too many such interactions and/or fail to indicate which of these enhance or diminish the actions of a particular drug. Our list of drug interactions includes only those that, by consensus, are clinically relevant and include a statement regarding the actual effect of the interaction. Parameters to monitor: We consider it to be of great importance that the treating clinician follow up on how a drug is acting on the patient by monitoring various vital functions. If these sug- gestions are followed, we believe many serious adverse reactions may be avoided or minimized. Judgment regarding actual monitoring in individual patients must ultimately be made by the treating clinician. Despite our best efforts to provide accurate information and opinions about each drug considered, the authors, members of the Advisory Board, and publisher do not guarantee that all of the material presented is completely accurate. The authors, reviewers, and publishers are not responsible for any errors, either those of omission or commission, that may arise in applying the enclosed information. Furthermore, not all authorities will agree with all our facts and/or evalua- tions. Accordingly, we can consider the material presented only as guidelines for drug administration, not the final word. The clinician or other health care provider must use his or her personal, independent judgment in applying the information in actual practice. In this regard, it is suggested that if the clinician disagrees with something in our drug monograph, he or she should check with the manufacturer’s label for the particular drug before using it. The authors, reviewers, and publisher disclaim any liabil- ity for any claim for losses or alleged losses that may have resulted from the use of the information contained herein whether directly or indirectly applied. The authors, reviewers, and publisher have no connection with any pharmaceutical company or federal agency. This book was commissioned solely by McGraw–Hill Company and the authors have written it without endorse- ment from any pharmaceutical company or federal agency. Any opinions expressed herein are solely those of the authors and members of their Advisory Board. The authors, Advisory Board, and publisher will not be held liable if the material presented is misused or not applied appropriately by the clinician. Inclusion of one or more brand names should not be construed as an endorsement of the product just as its exclusion does not imply that we have rejected the product or consider it inferior to another. The publisher does not endorse or reject any of the products described and has no opinion regarding any of the products. The publisher has not engaged in or provided any kind of financial support for any of the products described herein. Their knowledge and hands-on experience in specialty patient care has added greatly to the depth of information provided by the book. We also acknowledge Catherine Will and Cheryl Serdar for their excellent assistance with manuscript prepara- tion. Special thanks go to Lynn Kaczmarz for administrative assistance with the book and to the editors of McGraw–Hill for their support and encouragement. Seymour Ehrenpreis: My heartfelt thanks to my wife, Bella, for her forbearance throughout the time devoted to the task of writ- ing this book. Eli Ehrenpreis: I would like to dedicate this book to my wife, Ana, for her encouragement and enthusiasm during the writing of the book and to my children, Benjamin, Jamie, and Joseph, for being so understanding and for sacrificing time that could have been spent with their father. Finally, I dedicate this book to my grandfather, the late Joseph Goodman, a man of great wisdom, energy, and humor who inspired me to achieve these qualities in my personal and professional life. Mechanism of action: Competitive blocker of β adrenergic receptors in heart and blood vessels. Adjustment of dosage • Kidney disease: Creatinine clearance 25–50 mL/min: decrease dose by 50%; creatinine clearance <25 mL/min: decrease dose by 75%. If necessary to dis- continue, taper as follows: reduce dose and reassess after 1–2 weeks; if status is unchanged, reduce by another 50% and reassess after 1–2 weeks. Advice to patient • Avoid driving and other activities requiring mental alertness or that are potentially dangerous until response to drug is known. Clinically important drug interactions • Drugs that increase effects/toxicity of beta blockers: reserpine, bretylium, calcium channel blockers. Stop therapy and administer large doses of β-adrenergic bronchodilator, eg, albuterol, terbutaline, or aminophylline. Some advocate discontinuing the drug 48 hours before surgery; others recommend withdrawal for a considerably longer time. These are drugs of first choice for chronic stable angina, used in conjunction with nitroglycerin. Mechanism of action: Stimulates release of insulin from pancre- atic beta cells; decreases glucose production in liver; increases sensitivity of receptors for insulin, thereby promoting effective- ness of insulin. Dose is best administered before breakfast or, if taken twice a day, before the evening meal. Contraindications: Hypersensitivity to the drug; diabetes com- plicated by ketoacidosis. Editorial comments • This drug is not listed in Physician’s Desk Reference, 54th edi- tion, 2000. Mechanism of action: As mucolytic agent: disrupts disulfide bonds in mucoproteins thereby lowering viscosity of mucus. As antidote for acetaminophen poisoning: complexes with hepato- toxic free radial metabolite of acetaminophen and inactivates it. Onset of Action Duration 5–10 min >1 h Food: Given before meals and just before bedtime for asthma. Warnings/precautions • As antidote for acetaminophen poisoning: Administer as quickly as possible. If this occurs, administer bronchodilator; suction bronchial secretions if they develop after inhalation. Advice to patient: Rinse mouth out and wash face after treatment to remove adhering drug. Parameters to monitor • As antidote for acetaminophen poisoning: Monitor aceta- minophen plasma levels, liver enzymes, bilirubin. Administer acetylcysteine if acetaminophen level is >150 mg/mL12 hours after ingestion. Administer fresh-frozen plasma or vitamin K if prothrombin time >3 seconds compared with control. Signs and symptoms of bronchospasm: if this occurs, administer bronchodilator or discontinue if necessary. Lactation: Appears in breast milk; considered compatible by American Academy of Pediatrics. Warnings/precautions • Use with caution in patients with the following conditions: kidney disease, neurologic disease.

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