Dapsone

Adrianne K. Thompson, MD

• Chief, Body Imaging
• Wilford Hall Medical Center
• Lackland AFB, Texas

First aid providers should call for help and administer a single oral dose of 150­300 mg chewable or soluble aspirin whilst waiting for healthcare professional assistance to arrive acne hat . Aspirin should not be administered to patients who have a known allergy or contraindications to aspirin acne rash . It is recognised that a first aid provider might have difficulty in identifying chest pain of cardiac origin and the pre-hospital administration of aspirin by first aid providers to adults with chest pain of unclear aetiology is not recommended skin care 40s . If there is any doubt call for the advice and assistance of a healthcare professional acne getting worse . It is a rapid multi-organ system reaction, affecting the cutaneous, respiratory, cardiovascular, and gastrointestinal systems, usually characterised by swelling, breathing difficulty, shock and even death. If symptoms are not relieved within 5­15 min of the initial dose or reoccur, a second dose of intramuscular adrenaline is recommended. Use of auto-injectors by first aid providers should minimize the opportunity for mis-dosing or administration of adrenaline by the intravenous route. Hypoglycaemia treatment Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin, a hormone that regulates blood sugar, or when the body cannot effectively use the insulin it produces. Diabetes is frequently complicated by serious events such as heart attack and stroke but significant or extreme alterations of blood sugar level (hyper- and hypoglycaemia) can present as a medical emergency. Hypoglycaemia is usually a sudden and life-threatening event with the typical symptoms of hunger, headache, agitation, tremor, sweating, psychotic behaviour (frequently resembling drunkenness) and loss of consciousness. Glucose tablets equating to glucose 15­20 g should be used by first aid providers, before dietary forms of sugar for treating symptomatic hypoglycaemia, in conscious patients who are able to follow commands and swallow. If the patient is unconscious or unable to swallow then oral treatment should be withheld due to the risk of aspiration, and the emergency medical services should be called. Exertion-related dehydration and rehydration therapy First aid providers are often called upon to assist at "hydration stations" for sporting events such as bicycle races or foot races. Failure to hydrate adequately before, during and following exercise contributes to exercise-associated dehydration. When vigorous exercise takes place during periods of high ambient temperatures, dehydration may be associated with heat cramps, heat exhaustion or heat stroke. Water is commonly used for rehydration following exercise, but newer commercial "sports drinks" are often promoted for this purpose. Furthermore, alternative beverages (tea or coconut water) have recently been promoted as acceptable for oral rehydration and some athletes may have a cultural preference for these beverages. Solutions made from oral rehydration salt packets and homemade solutions are more commonly used for rehydration following gastrointestinal losses and are not as practical for use following exercise-associated dehydration. The exact amount of liquid required for adequate rehydration may not be determinable in the first aid setting. Oral hydration may not be appropriate for individuals with severe dehydration associated with hypotension, hyperpyrexia or mental status changes. Eye injury from chemical exposure Accidental exposure of the eye to chemical substances is a common problem in both the household and industrial setting and it is often difficult to identify precisely what chemical has entered the eye. Alkali injury to the cornea has been shown to cause severe corneal injury and risk of blindness. Irrigation with large volumes of water was more effective at improving corneal pH as compared to using low volumes or saline irrigation. Where there is a known high risk of eye contamination by particular chemicals, specific antidotes should be readily available. Take care that the rinsing water does not come into contact with the other eye (Good Practice Point). Refer the individual for emergency healthcare professional review (Good Practice Point). First aid for trauma emergencies Control of bleeding There is a paucity of literature comparing different bleeding control strategies commonly employed by first aiders. The best control of bleeding is to apply direct pressure to the wound where possible. Localised cold therapy, with or without pressure, may be beneficial in haemostasis for minor or closed bleeding in extremities although this is based on in-hospital evidence.

Diseases

• Insulinoma
• Compartment syndrome
• Familial colorectal cancer
• Cerebellar hypoplasia tapetoretinal degeneration
• Myopia, infantile severe
• Omphalomesenteric cyst
• Myoclonic progressive familial epilepsy

They are unable to activate -receptors and behave as competitive antagonists of both 1- and 2-adrenergic receptors skin care products online . Blockade of 1- and 2-adrenergic receptors on the arteriolar beds leads to reduced peripheral vascular tone and systemic blood pressure and can be used to treat hypertension acne hoodie . They are also used to manage the hypertensive crisis resulting from catecholamine released by pheochromocytomas skin care 15 days before marriage . Structural formulas of the nonselective -adrenergic antagonists phentolamine acne extraction dermatologist , tolazoline, and phenoxybenzamine. The 1-selective antagonists are represented by prazosin and doxazosin, whereas tamsulosin and silodosin are 1A-selective antagonists. Blockade of -receptors on veins increases venous pooling of blood and can result in orthostatic or postural hypotension. The -haloalkylamine phenoxybenzamine (Dibenzyline) is unique among -antagonists in that the tertiary amine undergoes cyclization (with the loss of the chlorine atom, Figure 9-2) to form a reactive aziridinium intermediate. Cleavage of this ring results in the formation of a highly reactive carbonium ion that alkylates sulfhydryl, carboxyl, and amino groups on proteins. The covalent interaction of the drug with -receptors results in irreversible inactivation of the receptor, which cannot be overcome even with very high catecholamine levels. Phenoxybenzamine is used to manage metastatic pheochromocytoma, where high catecholamine levels would displace reversible antagonists such as phentolamine. Prazosin (Minipress), doxazosin (Cardura; Figure 9-2), and terazosin (Hytrin) belong to the quinazoline class and show increased selectivity for the 1- versus 2-receptors. Vasodilation of arteriolar beds results from antagonism of -receptors that are tonically driven by innervating sympathetic nerves, with reduction in peripheral vascular resistance. A similar mechanism leads to venodilation, which reduces venous return to the heart and, in a sequential manner, decreases end-diastolic filling, myocardial contractility, and eventually cardiac output. Because both peripheral vascular resistance and cardiac output contribute to systemic blood pressure, a reduction of either parameter will decrease systemic blood pressure. Quinazoline antagonists are important in the management of essential hypertension but are also used to manage benign prostatic hyperplasia, especially terazosin. Adverse effects often seen with the use of prazosin and congeners are postural hypotension especially after the first dose, pupil constriction, nasal congestion, and impaired ejaculation. Newer -antagonists tamsulosin (Flomax) and silodosin (Rapaflo) have increased affinity for the 1A-receptors of the prostate as compared to the 1B-receptors of the vasculature, relaxing the prostate and the neck of the bladder without affecting systemic blood pressure. Yohimbine (Yocon) is the only clinically relevant 2-selective antagonist currently on the market and is used to treat erectile dysfunction. It appears to improve this condition by blockade of 2receptors in the penile cavernosum, resulting in vasodilation and increased blood pooling. Although all the drugs in this class are -receptor antagonists, they are heterogeneous with regard to additional actions such as sodium/potassium channel blockade, having inverse or partial agonist activity and blockade of -receptors. Propranolol (Inderal), the prototypical drug in this class, is an aryloxypropanolamine (Figure 9-3), derived from modifications of earlier antagonists such as dichloroisoproterenol and pronethalol. Generally, an arylethylamino or similar large hydrophobic group, without phenolic hydroxyls, is required for antagonistic activity at both 1- and 2-receptors, for example, timolol (Timoptic), nadolol (Corgard), and carteolol (Ocupress) (Figure 9-3). Propranolol and carteolol are -nonselective antagonists, whereas metoprolol is 1-selective. Pindolol is a -nonselective partial agonist; carvedilol is also -nonselective and blocks 1-receptors as well. Pindolol (Visken) and carteolol possess significant agonistic activity at -receptors and are more appropriately partial agonists than antagonists. The S-isomers of labetalol (Trandate) and carvedilol (Coreg; Figure 9-3) appear to have significant 1-receptor antagonist activity in addition to -blocking actions. Propranolol and carvedilol have the ability to block voltage-dependent sodium channels, whereas sotalol (Betapace) is primarily used for its potassium-channel blocking/antiarrhythmic actions rather than its -blocking activity. For the most part, there appears to be no clinical benefit of using 1-selective agents over nonselective antagonists except in special populations: 1-selective agents. Table 9-2 summarizes several important pharmacological actions of -receptor antagonists.

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Requirements vary based on the treatment protocol and the agents to be administered acne 9 days before period . Chemotherapy agents that commonly cause alopecia include cyclophosphamide acne quiz neutrogena , doxorubicin korean skin care , mechlorethamine acne medication accutane , and paclitaxel. Local tissue necrosis may result from extravasation of vesicant chemotherapeutic agents outside the vein and into the subcutaneous tissue during administration. Significant tissue injury, including ulceration or necrosis, may require plastic surgery intervention. Heat or cold packs and chemicals such as hyaluronidase or dexrazoxane (Totect) may be used. Examples of vesicant agents include dactinomycin, daunorubicin, doxorubicin, idarubicin, mechlorethamine, mitomycin, vinblastine, vincristine, and vinorelbine. The development of this rash may be associated with a greater success in treating specific types of cancers. Cancer chemotherapy can cause other skin changes such as dryness and photosensitivity. However, this side effect can generally be prevented or controlled with the use of currently available antiemetics. Nausea and vomiting may be classified as acute, delayed, anticipatory, or breakthrough in nature. Antiemetics should be used prophylactically to prevent the occurrence of nausea and vomiting, particularly with chemotherapeutic agents that have a high emetogenic risk. Various clinical guidelines have been created to guide the use of antiemetics in patients receiving chemotherapy. Severe vomiting can result in dehydration, electrolyte imbalances, and esophageal tears and may result in interruptions in therapy or therapy discontinuation. Table 50-3 lists commonly used chemotherapeutic agents and their emetogenic potential on a scale of 1 to 5. The occurrence of nausea and vomiting is influenced by the emetogenicity of the chemotherapeutic agent or combination of agents, the chemotherapeutic dose, the method of administration, and individual patient characteristics. Signs and symptoms include erythema, pain, dryness of the mouth, burning or tingling of the lips, ulcerations, and bleeding. Chemotherapy agents commonly associated with stomatitis include capecitabine, fluorouracil, and methotrexate. Stomatitis usually appears within a week after the offending agent is administered and resolves in 10 to 14 days. Consequences of stomatitis include infection of the ulcerated areas, inability to eat, pain requiring opioid analgesics, and subsequent decreases in chemotherapy doses. Topical and local analgesics in the form of mouth rinses are commonly used and can help with mouth and throat pain. Owing to the spontaneous lysis of cells from treatment with chemotherapy, cell lysis causes release of intracellular products, including uric acid, potassium, and phosphate, which can lead to renal failure and cardiac arrhythmias. This may be prevented by giving intravenous hydration, by alkalinizing the urine, and by giving agents such as allopurinol or rasburicase (Elitek) to decrease uric acid. Hypercalcemia may occur in patients with solid or hematologic malignancies and can often be the presenting sign of malignancy. Common presenting symptoms include mental status changes, fatigue and muscle weakness, polyuria, polydipsia, nausea, and vomiting. Treatment includes aggressive hydration with normal saline; calciuric therapy, which consists of calcitonin; and bisphosphonates such as pamidronate (Aredia) or zoledronic acid (Zometa). Chills and fever may occur after the administration of some chemotherapy and biological agents. This fever generally can be differentiated from fever owing to infection because of its temporal relationship to chemotherapy administration. Signs and symptoms are shortness of breath, nonproductive cough, and low-grade fever.

Ivy (American Ivy). Dapsone.

• Are there safety concerns?
• Dosing considerations for American Ivy.
• How does American Ivy work?
• Digestive disorders, stimulating sweating, reducing swelling (astringent), and as a tonic.
• What is American Ivy?

Source: http://www.rxlist.com/script/main/art.asp?articlekey=96300

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