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Treatment is supportive and symptomatic and replacement of fluid and electrolyte losses may be necessary buy cheap cardizem online hypertension warning signs. There are also increased potassium losses with steroids and amphotericin B; and increased hypersensitivity reactions to allopurinol purchase 60mg cardizem fast delivery blood pressure 90 over 60. There is increased inci- dence of digoxin toxicity caused by hypokalemia and hypomagnesemia buy cardizem 180 mg on line hypertensive crisis. It increases the excretion of sodium best 60 mg cardizem pulse pressure 70-80, chloride, and water and inhibits the excretion of potassium and hydro- gen. Neonates: Diuretic: 1 to 3 mg/kg/day divided every 12 to 24 hours Children: Diuretic, hypertension: 1. The protein binding of the drug ranges from 91 to 98%, with hepatic metabolism to multiple metabolites, including the active agent, canrenone. The half-life of spironolactone is 78 to 84 minutes and the half-life of canrenone is 13 to 24 hours. Diuretic Medications 133 Use with caution in patients with decreased renal function, hyponatremia, dehydration, or reduced hepatic function. Adverse reactions associated with spironolactone include hyperkalemia, dehydration, hyponatremia, hyperchloremic metabolic alkalosis, headaches, fever, diarrhea, vomiting, nausea, lethargy, rash, anorexia, gynecomastia (in males), amenorrhea, agranulocytosis, and decreased renal function. Poisoning Information Symptoms of spironolactone overdose include lethargy, fatigue, drowsi- ness, dizziness, confusion, nausea, and vomiting. Dehydration, electrolyte imbalance, and severe hyperkalemia may occur with large doses. Spironolactone use may decrease clearance of digoxin; may cause a decreased response to norepinephrine; and may decrease the effects of oral anticoagulants. Mechanism of Action Amiloride inhibits sodium-potassium ion exchange in the distal convoluted tubule by inhibiting cellular sodium transport mechanisms and inhibits hydro- gen ion secretion; its diuretic activity is not dependent on aldosterone. Kazmerski Pharmacokinetics Amiloride has an onset of action of 2 hours and a duration of 24 hours. The half-life in normal renal function is 6 to 9 hours and up to 144 hours in severe renal disease. Carbonic Anhydrase Inhibitors Acetazolamide Indication Acetazolamide is used to reduce intraocular pressure in glaucoma and as a diuretic. Diuretic Medications 135 Mechanism of Action As a diuretic, acetazolamide initiates competitive, reversible inhibition of car- bonic anhydrase, which results in increased renal excretion of sodium, potas- sium, bicarbonate, and water. Absorption of acetazolamide is dose dependent, and acetazolamide distributes into erythro- cytes and the kidneys. Use with caution in patients with chronic obstructive pulmonary disease, respiratory acidosis, gout, and diabetes mellitus; reduce dosage in patients with renal dysfunction. Common side effects of acetazolamide include cyanosis, drowsiness, fever, seizures, dizziness, depression, rash, photosensitivity, vertigo, hypokalemia, hyperchloremic metabolic acidosis, hyperglycemia, nausea, vomiting, black 136 D. Kazmerski stools, polyuria, muscle weakness, anorexia, cholestatic jaundice, hepatic insufficiency, and hyperpnea. Poisoning Information Symptoms of acetazolamide overdose include drowsiness, nausea, vomiting, confusion, tachycardia, sweating, dizziness, convulsions, tingling of lips and tongue, and low blood sugar. Drug-Drug Interactions Acetazolamide may decrease the rate of excretion of other drugs, such as pro- cainamide, flecainide, quinidine, and tricyclic antidepressants; and it may increase the excretion of salicylates and phenobarbital. Acetazolamide use may increase toxicity with propofol (cardiorespiratory instability); may increase cyclosporine levels; and may increase the risk of developing osteomalacia in patients receiving phenytoin or phenobarbital. Compatible Diluents/Administration Reconstituted injectable formulation at 100 mg/mL concentration is stable for 1 week refrigerated. Osmotic Diuretics Mannitol Indication Mannitol is used to promote diuresis in the treatment of oliguria or anuria caused by acute renal failure. Mannitol is also used to reduce increased intrac- ranial pressure associated with cerebral edema. Mechanism of Action Mannitol is an osmotic diuretic that increases the osmotic pressure of the glomerular filtrate, inhibits the tubular reabsorption of water and electrolytes, and increases urinary output. Diuretic Medications 137 Dosing Children: Test dose (to assess adequate renal function): 200mg/kg (maximum, 12. The drug remains confined to the extracellular space except in high concentrations or acidosis. Monitoring parameters: serum electrolytes, renal function, daily inputs and outputs, serum and urine osmolality (maintain serum osmolality 310–320 mOsm/kg for treatment of elevated intracranial pressure) Contraindications: severe pulmonary edema or congestion, severe renal disease, dehydration, and active intracranial bleeding Precautions/Adverse Effects Mannitol should not be administered until adequate renal function and urine flow is established with test doses and cardiovascular status is evalu- ated. High doses may cause renal dysfunction—use caution in patients tak- ing other nephrotoxic agents, with sepsis, or underlying renal disease. Poisoning Information Symptoms of mannitol overdose include acute renal failure, hypotension, pulmonary edema, cardiovascular collapse, polyuria, oliguria, seizures, hyponatremia, and hypokalemia. They have been shown to decrease morbidity and mortality in several randomized controlled studies. Nonetheless, one has to take into consideration some of the differences that exist between pediatric and adult heart failure when considering β-blockers. Pediatric heart failure can be secondary to primary systolic dysfunction that is either acquired or congenital but most commonly is caused by congenital structural defects. Patients born with single ventricle defects, and especially those with a single right ventricle, seem to be particularly prone to ventricular dysfunction over time. Despite these differences in the etiology of heart failure, there is substantial evidence that infants and children have alterations in their neurohormonal axes that are similar to adults. In advanced heart failure, there is downregulation of β1-adrenergic receptors, with resulting decreased contractility, ventricular dilation, and apoptosis. The high level of circulating catecholamines found in severe heart failure is toxic to the myocardium. Bradycardia may improve coronary blood flow and decrease myo- cardial oxygen demand. Start with a lower dose and titrate up slowly, watching for side effects, and, if nec- essary, decrease the dose or advance more gradually. Some of the original β-blockers, including propranolol and atenolol, have not been extensively studied in heart failure. Kazmerski β-blockade is a slow process that requires careful supervision and may temporar- ily worsen the heart failure. An interesting strategy to appraise tolerance and benefits of β-blockers in a par- ticular patient consists in using intravenous (I. Esmolol offers the advantage of being easy to titrate and of having a very short half-life, which may be useful in cases of poor tolerance. Blocking of reflex sympathetic stimulation in the heart with a fall in cardiac output and a late decrease in peripheral vascular resistance are possible mechanisms. Dosing Neonates/infants: no data available Children/adolescents: there is limited pediatric dosing information available.
No fin- product that you receive for packaging ished batch of dietary supplements or labeling as a dietary supplement may be released for distribution unless (and for distribution rather than for re- it complies with §111 buy cardizem 60mg free shipping arterial disease. I (4–1–10 Edition) (5) Documentation for why any com- identity safe 60 mg cardizem arteria axilar, purity order cardizem paypal blood pressure medication starting with v, strength order cardizem australia ulterior motive, or composi- ponent and in-process testing, exam- tion of a dietary supplement; ination, or monitoring, and any other (b) Reviewing and approving the doc- information, will ensure that a product umentation setting forth the basis for specification that is exempted under qualification of any supplier; §111. To do so, quality control per- must include: sonnel must perform operations that (a) Reviewing and approving all lab- include: oratory control processes associated (a) Approving or rejecting all proc- with the production and process con- esses, specifications, written proce- trol system; dures, controls, tests, and examina- (b) Ensuring that all tests and exami- tions, and deviations from or modifica- nations required under §111. I (4–1–10 Edition) modifications to the master manufac- ensure that specifications established turing records; under §111. I (4–1–10 Edition) (c) You must quarantine components (c) You must quarantine packaging before you use them in the manufac- and labels before you use them in the ture of a dietary supplement until: manufacture of a dietary supplement (1) You collect representative sam- until: ples of each unique lot of components (1) You collect representative sam- (and, for components that you receive, ples of each unique shipment, and of of each unique shipment, and of each each unique lot within each unique unique lot within each unique ship- shipment, of packaging and labels and, ment); at a minimum, conduct a visual identi- (2) Quality control personnel review fication of the immediate containers and approve the results of any tests or and closures; examinations conducted on compo- (2) Quality control personnel review nents; and and approve the results of any tests or (3) Quality control personnel approve examinations conducted on the pack- the components for use in the manufac- aging and labels; and ture of a dietary supplement, including (3) Quality control personnel approve approval of any treatment (including the packaging and labels for use in the in-process adjustments) of components manufacture of a dietary supplement to make them suitable for use in the and release them from quarantine. I (4–1–10 Edition) (1) Identify specifications for the erence to the physical location of the points, steps, or stages in the manufac- actual or representative label; turing process where control is nec- (h) Written instructions, including essary to ensure the quality of the die- the following: tary supplement and that the dietary (1) Specifications for each point, supplement is packaged and labeled as step, or stage in the manufacturing specified in the master manufacturing process where control is necessary to record; and ensure the quality of the dietary sup- (2) Establish controls and procedures plement and that the dietary supple- to ensure that each batch of dietary ment is packaged and labeled as speci- supplement that you manufacture fied in the master manufacturing meets the specifications identified in record; accordance with paragraph (b)(1) of (2) Procedures for sampling and a this section. I (4–1–10 Edition) (4) Approved and released, or re- ment (and for distribution rather than jected, the packaged and labeled die- for return to the supplier); and tary supplement, including any repack- (5) Packaged and labeled dietary sup- aged or relabeled dietary supplement. These precautions in- or dietary supplements, by, for exam- clude: ple: (a) Performing manufacturing oper- (1) Filters or strainers, ations under conditions and controls (2) Traps, that protect against the potential for (3) Magnets, or growth of microorganisms and the po- (4) Electronic metal detectors. You must do (a) You must make and keep records this using any effective means, includ- required under this subpart K in ac- ing the following: cordance with subpart P of this part. You must clearly identify, hold, and control under a quarantine system for (a) You must hold reserve samples of appropriate disposition any packaged dietary supplements in a manner that and labeled dietary supplement that is protects against contamination and de- rejected for distribution. You must identify and quarantine re- (a) You must make and keep records turned dietary supplements until qual- required under this subpart N in ac- cordance with subpart P of this part. Subpart O—Product Complaints You may salvage a returned dietary supplement only if quality control per- §111. For the purposes of this part, the fol- (f) Critical factor means any property, lowing definitions apply: characteristic, condition, aspect, or (a) Aseptic processing and packaging other parameter, variation of which means the filling of a commercially may affect the scheduled process and sterilized cooled product into pre- sterilized containers, followed by asep- the attainment of commercial ste- tic hermetical sealing, with a rility. A Bleeders may serve as a means of re- holding period in a heated section may moving condensate. Persons en- vertical distance between the level of gaged in the production of foods that the product (generally the liquid sur- are to be used in market or consumer face) in the upright rigid container and tests are also included. Tomatoes and tomato prod- shall apply in determining whether the ucts having a finished equilibrium pH facilities, methods, practices, and con- less than 4. Commissioner for giving instruction (r) Scheduled process means the proc- appropriate to the preservation tech- ess selected by the processor as ade- nology involved and who has been iden- quate under the conditions of manufac- tified by that school as having satisfac- ture for a given product to achieve torily completed the prescribed course commercial sterility. This person shall super- be in excess of that necessary to ensure vise only in those areas for which a destruction of microorganisms of pub- school approved by the Commissioner lic health significance, and shall be at identifies the person as having satisfac- least equivalent to the process estab- torily completed training. Subpart C—Equipment (t) Should is used to state rec- ommended or advisory procedures or to §113. Each retort shall be equipped with the scheduled process, the maintenance at least one mercury-in-glass ther- of which vacuum is critical to the ade- mometer whose divisions are easily quacy of the scheduled process. Thermometers shall cock, or other adequate valves used for be tested for accuracy against a known the elimination of air during the vent- accurate standard thermometer upon ing period. I (4–1–10 Edition) thereafter, or more frequently if nec- the retort shell or in a well attached to essary, to ensure their accuracy. Each temperature-recorder Records of thermometer accuracy bulb well shall have a 1⁄16-inch or larger checks that specify date, standard bleeder which emits steam continu- used, method used, and person per- ously during the processing period. A thermometer be equipped with a pressure gage that that has a divided mercury column or should be graduated in divisions of 2 that cannot be adjusted to the stand- pounds or less. Thermom- be equipped with an automatic steam eters shall be installed where they can controller to maintain the retort tem- be accurately and easily read. This may be a recording-con- indicating thermometers shall be in- trolling instrument when combined stalled either within the retort shell or with a recording thermometer. The in external wells attached to the re- steam controller may be air-operated tort. External wells or pipes shall be and actuated by a temperature sensor connected to the retort through at positioned near the mercury-in-glass least a 3⁄4-inch diameter opening and thermometer in the retort; a steam equipped with a 1⁄16-inch or larger controller activated by the steam pres- bleeder opening so located as to pro- sure of the retort is acceptable if it is vide a full flow of steam past the carefully maintained mechanically so length of the thermometer bulb. The steam inlet to steam continuously during the entire each still retort shall be large enough processing period. The mercury ther- to provide sufficient steam for proper mometer—not the recorder chart— operation of the retort. Steam may shall be the reference instrument for enter either the top portion or the bot- indicating the processing temperature. Each case, shall enter the portion of the re- still retort shall have an accurate tem- tort opposite the vent; for example, perature-recording device. Graduations steam inlet in bottom portion and vent on the temperature-recording devices in top portion. Baffle plates shall not be used of not more than 55 °F per inch within in the bottom of still retorts. The temperature chart shall are continuations of the steam inlet be adjusted to agree as nearly as pos- line inside the retort. Horizontal still sible with, but to be in no event higher retorts shall be equipped with steam than, the known accurate mercury-in- spreaders that extend the length of the glass thermometer during the process retort. A means of preventing unauthor- bottom of the retort, the perforations ized changes in adjustment shall be should be along the top 90° of this pipe, provided. A lock, or a notice from man- that is, within 45° on either side of the agement posted at or near the record- top center. Horizontal still retorts over ing device which provides a warning 30 feet long should have two steam in- that only authorized persons are per- lets connected to the spreader. In mitted to make adjustments, is a satis- vertical still retorts, the steam spread- factory means for preventing unau- ers, if used, should be perforated along thorized changes. The recorder may be the center line of the pipe facing the combined with the steam controller interior of the retort or along the sides and may be a recording-controlling in- of the pipe. Bleeders, except those for shall not be connected directly to a thermometer wells, shall be one-eighth closed drain system. If the overflow is inch or larger and shall be wide open used as a vent, there shall be an atmos- during the entire process, including the pheric break in the line before it con- come-up-time. The vent shall torts, bleeders shall be located within be located in that portion of the retort approximately 1 foot of the outermost opposite the steam inlet; for example, locations of containers at each end steam inlet in bottom portion and vent along the top of the retort; additional in top portion. Where a retort manifold bleeders shall be located not more than connects several vent pipes from a sin- 8 feet apart along the top. Bleeders gle still retort, it shall be controlled by may be installed at positions other a gate, plug cock, or other adequate than those specified above, as long as type valve. The retort manifold shall there is evidence in the form of heat be of a size that the cross-sectional distribution data that they accomplish area of the pipe is larger than the total adequate removal of air and circula- cross-sectional area of all connecting tion of steam within the retort. The discharge shall not be di- Vertical retorts shall have at least one rectly connected to a closed drain bleeder opening located in that portion without an atmospheric break in the of the retort opposite the steam inlet. A manifold header connecting In retorts having top steam inlet and vents or manifolds from several still bottom venting, a bleeder shall be in- retorts shall lead to the atmosphere.
Scientists should pay more attention to the field of the phobias purchase cardizem cheap blood pressure lower number, their influence on the human body and more effective methods of treatment discount 60 mg cardizem amex blood pressure number meanings. In every age it has its own characteristics and susceptibility to certain problems purchase generic cardizem on-line arteria in english. As you know buy cardizem with mastercard arrhythmia specialists, the skin is an important organ of cover, so-called protective barrier for the whole body. Among the internal factors that influence the skin condition is heredity, metabolic disorders and various diseases of internal organs. Different methods are highly effective, but are expensive and require a lot of time. To develop and recommend an easy, effective and popular way to prevent skin aging. To achieve this goal we worked out the literature and found that most meet the requirements rejuvenating facials masks, which are used in home conditions. The principle of action of the rejuvenating masks is that when in contact with skin mask substances moisturize and nourish it, improve microcirculation and, consequently, color, stimulate the regeneration of skin cells. For the experiment, we chose those ingredients that are easily available to all citizens. The recipe was as follows: milled oatmeal mixed with orange juice and a teaspoon of honey. After the study, all the women were satisfied with the result: improved skin color, decreased or disappeared excessive dryness and flaking, wrinkles became less noticeable, improved overall health, mood. Negative effects, side effects and complications any women were noted, which allows us to use the proposed mask for widespread use. Thus, carrying out the study, we have proved that rejuvenating masks at home are really effective, activate skin rejuvenation processes, inhibit the aging process. Another important advantage of their use is the naturalness, safety and financial affordability. Corn oil is attracting the attention of quite a high content of fat-soluble vitamins A and E and a favorable ratio of their different forms. On the other hand, quantitatively predominant component of the fatty acid composition of corn oil is diene linoleic acid which acts as though vitamin F, but is prone to peroxidation series to form intermediate products with extremely undesirable physiological effects. Therefore, among the areas of improvement of maize for special attention to the quality of oil particularly noteworthy increase in the content monoenic oleic acid, which has high thermal stability and significantly increased resistance to peroxidation. And, despite the significant amount of the research, reliable sources of high oleate content in maize has not yet been identified. Genetic analysis of oleic acid glycerides content in corn lines and hybrids oil and genetic identification of corn oil sources with a high content of oleic acid for pharmaceutical practice using. The material for the research were presented as a representative samples of kindred origin of the traditional type of maize lines and lines-carrier of endospermic monogenic mutations reliably registered beneficial effect on the seed biochemical composition - o2 (opaque-2), sh1 (shrunken-1), sh2 (shrunken-2) , su1 (sugary-1), su2 (sugary-2), ae (amylose extender) and wx (waxy). Genetic analysis was performed on a series of hybrids which were obtained by cross of lines with identical allelic status of each of the genes in the endosperm structure schemes diallel crosses by Griffings method. The fatty acid composition of the oil was analyzed by modified Peysker gas chromatographic method after transesterification of glycerol esters into methyl one. Identification of fatty acid component composition was carried out at the time of their retention, set to valid standards. The results showed endospermic mutants high efficiency to improve oil fraction of oleic acid glycerids. However, these results cannot be considered as evidence of the content of the monogenic regulation of recessive oleate mutant genes su1 and sh2 yet. As in the usual corn, as in carriers of mutations of the above oleate content was clearly a quantitative nature and varied rather widely. At the same time the best lines of the traditional type of maize reached levels of oleate 34. The results showed that even if the monogenic regulation of oleate content by third and fourth chromosomes locuses occurs, it is carried out not by su1 and sh2 genes, but by the linked space with them oleate coding locuses. On the other hand, the results indicate that the effects of monogenic locuses are modified by polygenic complexes that can both strengthen and weaken the level of phenotypic feature manifestation. When the genetic trait analysis was conducted it was found that high level of oleate regulated by polygenic type and system of genetic regulation of oleate content approaches to the additive - dominant Hayman model. The predominant type of high oleate content inheritance was incomplete dominance with a significant contribution to the dispersion of the additive effects. Such type of inheritance creates favorable conditions for the improvement of the genetic trait. At the same time inbreed lines of maize, based on a single mutation, were very differed by the effects of combining ability according to the content of oleate. It has been established that high levels of oleate in corn oil is regulated by the combined effect of the third and fourth chromosomes locuses and modified by chromosomes polygenic complexes. The most promising genetic material for improving the content of oleate are the carriers of endospermic mutations su1 and sh2. Arterial hypertension is accompanied by severe metabolic disorders of water-electrolyte metabolism. Creatinine and urea are early and most informative markers of disorder of renal functional status in patients with arterial hypertension, and their level characterizes nitrogen-releasing state of renal function. Aim of research is to study biochemical mechanisms of water-electrolyte imbalance metabolic disorders in experimental hypertensive rats and prospects for their correction with hynokarb, new quinoline-2-carboxylic acid derivative. Throughout the experiment, animals were kept in a vivarium at 20-25 °С, humidity not more than 50%, natural light mode "day-night", in standard plastic cages on a standard diet. Effect of hynokarb on a renovascular system state was examined during 7-day administration in rats, by determining level of creatinine, urea and total protein in blood. Comparator drugs were Hydrochlorothiazide granules, which contain 25 mg of hydrochlorothiazide and Berlipril granules, which contain 5 mg of enalapril maleate. Hynokarb and hydrochlorothiazide dose of 10 mg/kg (as active substance) is maximally effective diuretic dose, as has been found in earlier experiments. Intragastric administration of hynokarb had no statistically significant effect on creatinine, urea and total protein content. The change direction of total protein and creatinine in blood of experimentally hypertensive rats had positive nature as a result of the tendency to renew these indicators to the level of physiological norm in healthy normotensive rats. As for changes of the level of urea in blood downward, this trend should be considered as positive in terms of activation of nitrogen-releasing renal function. In the same animals, hydrochlorothiazide caused no significant changes in creatinine, urea and total protein content in the blood compared with untreated control. In experimental rats, intragastric administration of enalapril caused a tendency to increase the content of creatinine, urea and a statistically significant increase in total protein content in the blood. Experimentally hypertensive rats developed disorders of fluid and electrolyte homeostasis, which was reflected in increasing of serum creatinine and total protein levels. Mechanisms for implementation of antihypertensive response of hynokarb are based on activation of nitrogen-releasing renal function. Parasitic diseases, caused by helminthes, one-celled and arthropods, are a wide group of illnesses, that largely determine the state of health of the population. The share of parasitic diseases account for 14 million deaths per year, representing 25% of the total Earth mortality – every fourth death. The aim of the study was to investigate the distribution of the most important parasitic disease of people in Ukraine.
When a drug displays an affinity for a receptor and stimulates it order cardizem once a day blood pressure empty chart, the drug acts as an agonist purchase cardizem with paypal arrhythmia kids. This ability to initiate a response after bind- ing with the receptor is referred to as intrinsic activity buy discount cardizem 120 mg online hypertension hereditary. Antagonist drugs If a drug has an affinity for a receptor but displays little or no in- trinsic activity purchase cardizem 60 mg with mastercard hypertension in dogs, it’s called an antagonist. Because this type of antagonist binds reversibly to the re- ceptor site, administering larger doses of an agonist can overcome the antagonist’s effects. Administering larger doses of the ago- Stimulate nist can’t reverse the antagonist’s action. If a drug acts on a variety of receptors, it’s said to be nonselective and can cause multiple and widespread effects. For exam- ple, beta receptors typically produce increased heart rate and bronchial relaxation as well as other systemic effects. Beta receptors, however, can be further divided into beta1 re- ceptors (which act primarily on the heart) and beta2 receptors (which act primarily on smooth muscles and gland cells). Potent power Drug potency refers to the relative amount of a drug required to produce a desired response. If drug X produces the same response as drug Y but at a lower dose, then drug X is more potent than drug Y. As its name implies, a dose-response curve is used to graphi- cally represent the relationship between the dose of a drug and the response it produces. The relationship between a drug’s desired therapeutic effects and its adverse effects is called the drug’s therapeutic index. The therapeutic index usually measures the differ- ence between: • an effective dose for 50% of the patients treated • the minimal dose at which adverse reactions occur. Narrow index = potential danger Drugs with a narrow, or low, therapeutic index have a narrow margin of safety. This means that there’s a nar- row range of safety between an effective dose and a lethal one. On the other hand, a drug with a high thera- peutic index has a wide margin of safety and poses less risk of toxic effects. Dose-response curve This graph shows the dose- response curve for two different 100 drugs. As you can see, at low C D doses of each drug, a dosage increase results in only a small increase in drug response (for example, from point A to point B for drug X). At higher doses, an Drug X Drug Y increase in dosage produces a 50 much greater response (from point B to point C). As the dosage continues to climb, however, an increase in dosage B produces very little increase in response (from point C to point A E D). When choosing a drug to treat a particular condition, health care providers consider not only the drug’s effectiveness but also other factors such as the type of therapy the patient will receive. Coinciding medical condi- a drug tions and personal lifestyle characteristics must be considered Because no two people when selecting drug therapy. Drug tolerance occurs when a patient develops a decreased • age response to a drug over time. The patient then requires larger dos- • cardiovascular es to produce the same response. Drug interactions Drug interactions can occur between drugs or between drugs and foods. They can interfere with the results of a laboratory test or produce physical or chemical incompatibilities. The more drugs a patient receives, the greater the chances that a drug interaction Memory will occur. The effects are equivalent to the sum of either drug’s effects if it were administered alone in higher doses. Giving two drugs together, such as two analgesics (pain reliev- ers), has several potential advantages: lower doses of each drug, decreased probability of adverse reactions, and greater pain con- trol than from one drug given alone (most likely because of differ- ent mechanisms of action). There’s a decreased risk of adverse ef- fects when giving two drugs for the same condition because the patient is given lower doses of each drug—the higher the dose, the greater the risk of adverse effects. A synergistic situation A synergistic effect, also called potentiation, occurs when two drugs that produce the same effect are given together and one drug potentiates (enhances the effect of) the other drug. Fighting it out An antagonistic effect occurs when the combined response of two drugs is less than the response produced by either drug alone. An absorbing problem Two drugs given together can change the absorption of one or both of the drugs: • Drugs that change the acidity of the stomach can affect the abil- ity of another drug to dissolve in the stomach. Sometimes, an absorption-related drug interaction can be avoided by administering the drugs at least 2 hours apart. Bound and determined After a drug is absorbed, the blood distributes it throughout the body as a free drug or one that’s bound to plasma protein. When two drugs are given together, they can compete for protein-binding sites, leading to an increase in the effects of one drug as that drug is displaced from the protein and becomes a free, unbound drug. Toxic waste Toxic drug levels can occur when a drug’s metabolism and excre- tion are inhibited by another drug. Some drugs stimulate enzyme production, increasing metabol- ic rates and the demand for vitamins that are enzyme cofactors (which must unite with the enzyme in order for the enzyme to function). For instance, when food that contains Vitamin K (such as green, leafy vegeta- bles) is eaten by a person taking warfarin, the drug’s anticoagula- tion properties are decreased and blood clots may form. Grapefruit can inhibit the metabolism of certain medications, resulting in toxic blood levels; examples include fexofenadine, albendazole, and atorvastatin. Because of all the interactions food can have with drug metabolism, being aware of drug interactions is essential. Adverse drug reactions A drug’s desired effect is called the expected therapeutic re- sponse. An adverse drug reaction (also called a side effect or ad- verse effect), on the other hand, is a harmful, undesirable re- sponse. Adverse drug reactions can range from mild ones that dis- appear when the drug is discontinued to debilitating diseases that become chronic. Adverse reactions can appear shortly after start- ing a new medication but may become less severe with time. Dosage dilemma Adverse drug reactions can be classified as dose-related or patient sensitivity–related. Most adverse drug reactions result from the known pharmacologic effects of a drug and are typically dose- related. Dose-related reactions include: • secondary effects • hypersusceptibility • overdose • iatrogenic effects. For example, morphine used for pain control can lead to two extreme sensitivity to undesirable secondary effects: constipation and respiratory de- a drug. Diphenhydramine used as an antihistamine produces se- dation as a secondary effect and is sometimes used as a sleep aid. Enhanced action A patient can be hypersusceptible to the pharmacologic actions of a drug.