Claritin

Saumil Mahendra Chudgar, MD

• Associate Professor of Medicine

https://medicine.duke.edu/faculty/saumil-mahendra-chudgar-md

The following additional information is relevant to specific antimalarial drugs: Chloroquine: Take this drug with food or milk allergy symptoms to kerosene claritin 10 mg order mastercard. Avoid foods that acidify the urine (cranberries allergy medicine for toddlers under 2 generic claritin 10 mg on-line, plums allergy forecast knoxville claritin 10 mg purchase fast delivery, prunes allergy treatment for 6 month old trusted claritin 10 mg, meats, cheeses, eggs, fish, and grains). This drug may cause diarrhea, loss of appetite, nausea, stomach pain, or vomiting. Chloroquine may cause a yellow or brownish discoloration to the urine; this is normal and will go away when the drug therapy is discontinued. Notify the primary health care provider if any of the following occur: Nursing Alert the nurse reports any visual disturbance in patients taking chloroquine to the primary health care provider. Irreversible retinal damage has occurred in patients on long-term therapy with these drugs. When vision is affected, the patient is assessed for the extent of visual impairment. If treated outside the hospital, it is important to instruct the patient not to drive until assessed by an ophthalmologist. Environmental safety is accomplished by measures such as positioning doors and furniture so they are out of walkways, removing scatter rugs, placing items frequently used in convenient places, and strategically placing grab bars to aid in maintaining balance. Avoid exposure to the sun by wearing protective clothing (eg, long-sleeved shirts and wide-brimmed hats) and by using a sunscreen. Do not drive or perform other hazardous tasks requiring alertness if blurred vision or dizziness occurs. If the tablet or capsule is difficult to swallow, do not chew the tablet or open the capsule because the drug is irritating to the stomach. If itching, rash, fever, difficult breathing, or vision problems occur, stop taking the drug and notify the primary health care provider. The patient verbalizes the importance of complying with the prescribed therapeutic or prophylactic regimen. In the extraintestinal form, the ameba is found outside of the intestine, such as in the liver. Iodoquinol (Yodoxin) and metronidazole (Flagyl) are used to treat intestinal amebiasis. Metronidazole is also used to treat infections caused by susceptible microorganisms and is discussed in Chapter 11. Paromomycin is an aminoglycoside with amebicidal activity and is used to treat intestinal amebiasis. High doses and prolonged therapy are avoided because the drug may be absorbed in large amounts by patients with bowel disease, causing ototoxicity and renal impairment. The more serious adverse reactions, although rare, are nephrotoxicity and ototoxicity. Once the patient has received a diagnosis of amebiasis, local health department regulations often require investigation into the source of infection. In addition, it is common practice to test immediate family members for amebiasis. The nurse evaluates the general physical status of the patient and looks for evidence of dehydration, especially if severe vomiting and diarrhea have occurred. Ongoing Assessment If the patient is acutely ill or has vomiting and diarrhea, the nurse measures the fluid intake and output and observes the patient closely for signs of dehydration. Precautions and interactions for chloroquine are provided in the discussion of the drug in the Antimalarial Drugs section. Iodoquinol is used with caution in patients with thyroid disease and during pregnancy and lactation. This interference not only occurs during therapy, but may last as long as 6 months after iodoquinol therapy is discontinued. Metronidazole Metronidazole is contraindicated in patients with known hypersensitivity. Metronidazole is contraindicated during the first trimester of pregnancy (Category B).

Another example is alternate hot and cold applications in conquering infec- tions in the extremities allergy symptoms muscle weakness cheap claritin 10 mg line. A powerful new surge of blood is brought to the infected hand allergy symptoms toddler claritin 10 mg buy cheap, arm allergy and asthma cheap 10 mg claritin free shipping, foot allergy shots depression claritin 10 mg with mastercard, or leg, as it is alternately plunged into the hot pail of water and then into the cold. Frequently, this will be an area that is closer to the surface and outside of the trunk. This deeper, congested area is often in the trunk, and the hot application (or a cold-toheating application) was placed on the skin just above that organ. This is called "derivation" and is frequently done at the same time that an application is made just above the internal organ (or to a reflex area connected to it by nerves) is given to also pull blood away from that congested organ. Here is how this works: Place an ice bag on your upper forearm, and you will lessen the amount of blood supplied to everything below it (the lower arm and the hand). Place an ice compress around the neck, and you will greatly reduce the amount of blood flowing into the head. In most instances, the area they are connected with is the skin surface directly above that organ. These exceptions are primarily the brain, the mucous membrane of the upper respiratory tract, and the organs within the pelvis. But before describing them, here is an example of reflex nerve action: Place the left hand in hot water, and the right hand (as well as the left) will quicken in its blood flow; place either hand in cold water, and the circulation of blood will lessen in both hands. The skin areas of the face, scalp, and back of the neck are reflexly related to the brain. The skin of the chest (front, back, and sides), dorsal region, and shoulders has reflex relations with the lungs. The precordia [see chart] is in very perfect reflex relation with the heart through its accelerator nerves (sympathetic). The skin of the central abdomen from the naval to the pubes is in reflex relation with kidneys and ureters. The lower lumbar and sacral spine [both on lower back], to the pelvic organs (uterus, ovaries, bladder, and rectum). The skin of the entire abdomen, especially that of the umbilical [naval] region, is reflexly related to the intestines. The lower abdomen, including the groin, and the upper inner surfaces of the thighs, are reflexly related to the pelvic organs. The saddle-shaped area covered by a sitz bath [page 118-121] is in reflex relation with the prostate and seminal vesicles. The skin of the feet and legs is reflexly related to the brain, the lungs, and the pelvic organs. As the above three medical authorities tell us: "When an application to the skin affects a part through nerve connection, it is said to produce a reflex effect. The next several paragraphs (paragraphs 25-35) will provide you with far more general cautions than you will find in many modern textbooks on hydrotherapy. Too lengthy a water treatment may cause "hydrotherapy headache" for a while afterward. Here are three things that could cause this headache: (1) Applications that are too long, an incomplete or an excessive reaction, or insufficient time in bed afterward to obtain the needed reaction. Do this for all kinds of elevated temperatures: fevers as well as water treatment induced. Neutral and warm applications can be continued for quite some time, Very hot applications should rarely be more than a minute in length. When used to reduce fevers, cool applications, without percussion or friction, can be prolonged to 1520 minutes. But in such instances, the temperature was carefully watched so that there would be no reaction or chilling. The best and most durable effects come from short cold applications, frequently repeated. This would also include those with neuralgia, myalgia, painful congestions, or chronic rheumatism with painful joints. Those that can only take a very brief cold should first receive a hot application. This would also apply to those who are very sensitive, timid, or hypochondriac in temperament. Avoid cold baths during menstruation, pregnancy, and old age (especially if the aged have arteriosclerosis and similar degeneration, cardiac weakness, emphysema, or bronchits).

The fingers flex and extend as tension is generated in the tendons via muscular activity in the upper forearm allergy forecast san ramon generic 10 mg claritin fast delivery. The thumb has eight muscles that control and generate an expansive array of movements allergy symptoms child claritin 10 mg low price. Opposition is the most important movement of the thumb because it provides the opportunity to pinch allergy under eye swelling buy claritin 10 mg without a prescription, grasp allergy jalapeno peppers buy 10 mg claritin fast delivery, or grip an object by bringing the thumb across to meet any of the fingers. Although all of the hypothenar muscles contribute to opposition, the main muscle responsible for initiating the movement is the opponens pollicis. Whereas a firm grip requiring maximum output uses the extrinsic muscles, fine movements, such as a pinch, use more of the intrinsic muscles to fine-tune the movements. The thumb determines whether a fine preci- sion position or power position is generated. If the thumb remains in the plane of the hand in an adducted position and the fingers flex around an object, a power position is created. This power position still allows for some precision, which is important in directing the golf club or the javelin. Power in the grip can be enhanced by producing a fist with the thumb wrapped over the fully flexed fingers. In activities that require precise actions, the thumb is held more perpendicular to the hand and moved into opposition, with limited flexion at the fingers. In a pinch or prehensile grip, greater force can be generated if the pulp of the thumb is placed against the pulps of the index and long fingers. This pinch is 40% stronger than the pinch grip with the tips of the thumb and fingers (39). Placing the wrist in slight extension and ulnar flexion increases the finger flexion strength. The least finger strength can be generated in a flexed and radial flexed wrist position. Grip strength at approximately 40° of wrist hyperextension is more than three times that of grip strength measured in 40° of wrist flexion (89). The strength of the grip may increase with specific wrist positioning, but the incidence of strain or impingement on structures around the wrist also increases. The neutral position of the wrist is the safest position because it reduces strain on the wrist structures. The strongest muscles in the hand region, capable of the greatest work capacity, in order from high to low are the flexor digitorum profundus, flexor carpi ulnaris, extensor digitorum, flexor pollicis longus, extensor carpi ulnaris, and extensor carpi radialis longus. Two muscles that are weak and capable of little work capacity are the palmaris longus and the extensor pollicis longus. First, the fingers can be strengthened to enhance the grip strength in athletes who participate in racket sports, individuals who work with implements, and individuals who lack the ability to grasp or grip objects. Second, the muscles acting at the wrist joint are usually strengthened and stretched to facilitate a wrist position for racket sports or to enhance wrist action in a throwing or striking event, such as volleyball. Wrist extension draws the hand back, and wrist flexion snaps the hand forward in activities such as serving and spiking in volleyball, dribbling in basketball, and throwing a baseball. Even though the speed of the flexion and extension movement may be determined by contributions from adjacent joints, strengthening the wrist flexor and extensor muscles enhances the force production. A precision grip usually involves slight flexion at a small number of finger joints with the thumb perpendicular to the hand. In tennis and racket sports, for example, the wrist is held either in the neutral position or in a slightly radially flexed position. If the wrist is held stationary, the force applied to the ball by the racket will not be lost through movements occurring at the wrist. Another example of maintaining wrist position is in the volleyball underhand pass, in which the wrist is maintained in an ulnar flexed position. This opens up a broader area for contact and locks the elbows so they maintain an extended position upon contact. The wrist must be maintained in a stable, static position to achieve maximal performance from the fingers. Thus, while playing a piano or typing, the wrist must be maintained in the optimal position for finger usage. The tension developed in the hand and finger flexor and extensor muscles places considerable strain on the medial and lateral aspect of the elbow joint.

Both cardiac and smooth muscles are under the control of the autonomic nervous system allergy treatment emedicine purchase claritin 10 mg otc. All aspects of muscle structure and function related to human movement and efficiency of muscular contribution are explored in this chapter allergy testing cats buy claritin 10 mg free shipping. Because muscles are responsible for locomotion allergy medicine makes me dizzy buy claritin 10 mg cheap, limb movements allergy treatment muscle testing discount claritin 10 mg buy on line, and posture and joint stability, a good understanding of the features and limitations of muscle action is necessary. Although it is not the function of this chapter to describe all of the muscles and their actions, it is necessary for the reader to have a good understanding of the location and action of the primary skeletal muscles. Muscle Tissue Properties Muscle tissue is very resilient and can be stretched or shortened at fairly high speeds without major damage to the tissue. The performance of the muscle tissue under varying loads and velocities is determined by the four properties of the muscle tissue: irritability, contractility, extensibility, and elasticity. A closer examination of these properties as they relate specifically to skeletal muscle tissue will enhance the understanding of skeletal muscle actions described later in the chapter. In a muscle, the stimulation is provided by a motor neuron releasing a chemical neurotransmitter. Skeletal muscle tissue is one of the most sensitive and responsive tissues in the body. As an excitable tissue, skeletal muscle can be recruited quickly, with significant control over how many muscle fibers and which ones will be stimulated for a movement. The distance through which a muscle shortens is usually limited by the physical confinement of the body. For example, the sartorius muscle can shorten more than half of its length if it is removed and stimulated in a laboratory, but in the body, the shortening distance is restrained by the hip joint and positioning of the trunk and thigh. The skeletal muscle itself cannot produce the elongation; another muscle or an external force 62 Section i Foundations of Human Movement is required. The amount of extensibility in the muscle is determined by the connective tissue surrounding and within the muscle. Elasticity in the muscle is determined by the connective tissue in the muscle rather than the fibrils themselves. The properties of elasticity and extensibility are protective mechanisms that maintain the integrity and basic length of the muscle. Elasticity is also a critical component in facilitating output in a shortening muscle action that is preceded by a stretch. Using a ligament as a comparison makes it easy to see how elasticity benefits muscle tissue. Ligaments, which are largely collagenous, have little elasticity, and if they are stretched beyond their resting length, they will not return to the original length but rather will remain extended. This can create laxity around the joint when the ligament is too long to exert much control over the joint motion. First, muscles support and protect the visceral organs and protect the internal tissues from injury. Second, tension in the muscle tissue can alter and control pressures within the cavities. Third, skeletal muscle contributes to the maintenance of body temperature by producing heat. Fourth, the muscles control the entrances and exits to the body through voluntary control over swallowing, defecation, and urination. Muscles rarely act individually but rather interact with other muscles in a multitude of roles. To understand muscle function, the structural organization of muscle from the macroscopic external anatomy all the way down to the microscopic level of muscular action must be examined. A good starting point is the gross anatomy and external arrangement of muscles and the microscopic view of the muscle fiber. The three functions relating specifically to human movement are contributing to the production of skeletal movement, assisting in joint stability, and maintaining posture and body positioning.

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