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Sulfonamides depression nos definition quality 150 mg wellbutrin sr, for example, can reach levels in milk that are sufficient to cause kernicterus in nursing newborns. As a general guideline, antibiotics and all other drugs should be avoided by women who are breast-feeding. In the older adult, heightened drug sensitivity is due in large part to reduced rates of drug metabolism and drug excretion, which can result in accumulation of antibiotics to toxic levels. Children/ adolescents Other Host Factors Previous Allergic Reaction Severe allergic reactions are more common with the penicillins than with any other family of drugs. As a rule, patients with a history of severe allergy to the penicillins should not receive them again. The exception is treatment of a life-threatening infection for which no suitable alternative is available. In addition to the penicillins, other antibiotics (sulfonamides, trimethoprim, erythromycin) are associated with a high incidence of allergic responses. Clearly, people with this deficiency should not be given antibiotics that are likely to induce red cell lysis. For example, hepatic inactivation of isoniazid is rapid in some people and slow in others. If the dosage is not adjusted accordingly, isoniazid may accumulate to toxic levels in the slow metabolizers and may fail to achieve therapeutic levels in the rapid metabolizers. Pregnant women Breast-feeding women Older adults responsible for relapse are likely to be more drug resistant than those present when treatment began. However, it should be stressed that although antibiotic combinations do have a valuable therapeutic role, routine use of two or more antibiotics should be discouraged. When an infection is caused by a single identified microbe, treatment with just one drug is usually most appropriate. Duration of therapy depends on a number of variables, including the status of host defenses, the site of the infection, and the identity of the infecting organism. Accordingly, patients should be instructed to take their medication for the entire prescribed course, even though symptoms may subside before the full course has been completed. Early discontinuation is a common cause of recurrent infection, and the organisms Antimicrobial Effects of Antibiotic Combinations When two antibiotics are used together, the result may be additive, potentiative, or, in certain cases, antagonistic. A potentiative interaction (also called a synergistic interaction) is one in which the effect of the combination is greater than the sum of the effects of the individual agents. A classic example of potentiation is produced by trimethoprim plus sulfamethoxazole, drugs that inhibit sequential steps in the synthesis of tetrahydrofolic acid (see Chapter 88). In certain cases, a combination of two antibiotics may be less effective than one of the agents by itself, inducing antagonism between the drugs. Antagonism occurs because bactericidal drugs are usually effective only against organisms that are actively growing.
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Because sodium excess can exacerbate hypertension and heart failure depression line generic wellbutrin sr 150 mg amex, patients with these disorders should avoid preparations that have high sodium content. These interactions can be minimized by allowing 1 hour between taking antacids and these other drugs. Elevation of urinary pH can accelerate excretion of acidic drugs and delay excretion of basic drugs. Antacid Families There are four major groups of antacids: (1) aluminum compounds, (2) magnesium compounds, (3) calcium compounds, and (4) sodium compounds. In this section, we discuss the two most commonly used antacids, magnesium hydroxide and aluminum hydroxide, and two less commonly used drugs-calcium carbonate and sodium bicarbonate. The liquid formulation of magnesium hydroxide is often referred to as milk of magnesia. The most prominent adverse effect is diarrhea, which results from retention of water in the intestinal lumen. To compensate for this effect, magnesium hydroxide is usually administered in combination with aluminum hydroxide, an antacid that promotes constipation. However, if the dose of magnesium hydroxide is sufficiently high, no amount of aluminum hydroxide will prevent diarrhea. Since stimulation of the bowel can be hazardous for patients with intestinal obstruction or appendicitis, magnesium hydroxide should be avoided in those with undiagnosed abdominal pain. Because of its effect on the bowel, magnesium hydroxide is frequently employed as a laxative (see Chapter 79). In patients with renal impairment, magnesium may accumulate to high levels, causing signs of toxicity. Although rarely used alone, this compound is widely used in combination with magnesium hydroxide (see Table 78. Aluminum hydroxide preparations contain significant amounts of sodium; appropriate caution should be exercised. By binding with phosphate, the drug can reduce phosphate absorption and can thereby cause hypophosphatemia. Because of these properties, calcium carbonate was once considered the ideal antacid. However, because of concerns about acid rebound (stimulation of acid secretion), the use of calcium carbonate has declined. The principal adverse effect is constipation, which can be overcome by combining calcium carbonate with a magnesium-containing antacid. Calcium carbonate releases carbon dioxide in the stomach and can thereby cause eructation (belching) and flatulence. Rarely, systemic absorption is sufficient to produce the milk-alkali syndrome, a condition characterized by hypercalcemia, metabolic alkalosis, soft tissue calcification, and impaired renal function. Although capable of neutralizing gastric acid, sodium bicarbonate is unfit for treating ulcers.
However depression definition hse buy wellbutrin sr 150 mg with mastercard, because of their ability to conserve potassium, these drugs can play an important role in an antihypertensive regimen. Specifically, they can balance potassium loss caused by thiazides or loop diuretics. The most significant adverse effect of the potassium-sparing agents is hyperkalemia. Because of the risk of hyperkalemia, potassiumsparing diuretics must not be used in combination with one another or with potassium supplements. Sympatholytics (Antiadrenergic Drugs) Sympatholytic drugs suppress the influence of the sympathetic nervous system on the heart, blood vessels, and other structures. First, blockade of cardiac beta1 receptors decreases heart rate and contractility, thereby causing cardiac output to decline. Fourth, long-term use of beta blockers reduces peripheral vascular resistance by a mechanism that is unknown. That is, they can produce mild activation of beta receptors while blocking receptor activation by strong agonists. Accordingly, if a patient develops symptomatic bradycardia with another beta blocker, switching to one of these may help. Beta blockers can mask signs of hypoglycemia; therefore, they must be used with caution in patients with diabetes. Potential side effects of beta blockers include depression, insomnia, bizarre dreams, and sexual dysfunction; however, a review of older clinical trials has shown that the risk is small or nonexistent. The resultant vasodilation reduces both peripheral resistance and venous return to the heart. The American College of Cardiology recommends that alpha blockers not be used as first-line therapy for hypertension. It is not clear whether doxazosin increased cardiovascular risk or chlorthalidone decreased risk. Carvedilol and labetalol are unusual in that they can block alpha1 receptors as well as beta receptors. Blood pressure reduction results from a combination of actions: (1) alpha1 blockade promotes dilation of arterioles and veins, (2) blockade of cardiac beta1 receptors reduces heart rate and contractility, and (3) blockade of beta1 receptors on juxtaglomerular cells suppresses release of renin. Presumably, these drugs also share the ability of other beta blockers to reduce peripheral vascular resistance. In addition, clonidine can cause severe rebound hypertension if treatment is abruptly discontinued. Reserpine-the only adrenergic neuron blocker still available-depletes norepinephrine from postganglionic sympathetic nerve terminals, reducing sympathetic stimulation of the heart and blood vessels. In addition to its peripheral effects, reserpine depletes serotonin and catecholamines from neurons in the central nervous system, causing deep emotional depression. Accordingly, reserpine is absolutely contraindicated for patients with a history of depressive illness.
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Sebastian, 51 years: These reactions develop rapidly and are characterized by the widespread appearance of red and intensely itchy welts.
Vasco, 62 years: These drugs can reduce inflammation and pain, but do not alter the course of the disease.
Cobryn, 29 years: Heart rate is increased by sympathetic nerve impulses and decreased by parasympathetic impulses.
Mazin, 53 years: In addition, erythromycin cannot cross the mitochondrial membrane, and therefore it does not inhibit protein synthesis in host mitochondria.
