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Price lists may be available from the hospital pharmacy or from a national formulary (see Table 4 generic cialis super active 20mg on-line erectile dysfunction frequency age, Chapter 3 for an example) cheap generic cialis super active uk erectile dysfunction causes ppt. Keep in mind that drugs sold under generic (nonproprietary) name are usually cheaper than patented brand-name products purchase cialis super active 20mg overnight delivery injections for erectile dysfunction forum. If two drugs from the same group appear equal you could consider which drug has been longest on the market (indicating wide experience and probably safety) cialis super active 20mg lowest price erectile dysfunction fpnotebook, or which drug is manufactured in your country. This will give you an alternative if one is not suitable for a particular patient. Choose a standard dosage schedule A recommended dosage schedule is based on clinical investigations in a group of patients. However, this statistical average is not necessarily the optimal schedule for your individual patient. If age, metabolism, absorption and excretion in your patient are all average, and if no other diseases or other drugs are involved, the average dosage is probably adequate. The more your patient varies from this average, the more likely the need for an individualized dosage schedule. Recommended dosage schedules for all P-drugs can be found in formularies, desk references or pharmacology textbooks. In most of these references you will find rather vague statements such as ‘2-4 times 30-90 mg per day’. The best solution is to copy the different dosage schedules into your own formulary. Some drugs need an initial loading dose to quickly reach steady state plasma concentration. Others require a slowly rising dosage schedule, usually to let the patient adapt to the side effects. By knowing the pathophysiology and the prognosis of the disease you will usually have a good idea of how long the treatment should be 35 Guide to Good Prescribing continued. The total amount of a drug to be prescribed depends on the dosage schedule and the duration of the treatment. For example, in a patient with bronchitis you may prescribe penicillin for seven days. You will only need to see the patient again if there is no improvement and so you can prescribe the total amount at once. If the duration of treatment is not known, the monitoring interval becomes important. For example, you may request a patient with newly diagnosed hypertension to come back in two weeks so that you can monitor blood pressure and any side effects of the treatment. As you get to know the patient better you could extend the monitoring interval, say, to one month. Three months should be about the maximum monitoring interval for drug treatment of a chronic disease. Summary How to select a P-drug i Define the diagnosis (pathophysiology) ii Specify the therapeutic objective iii Make an inventory of effective groups iv Choose a group according to criteria efficacy safety suitability cost Group 1 Group 2 Group 3 v Choose a P-drug efficacy safety suitability cost Drug 1 Drug 2 Drug 3 Conclusion: Active substance, dosage form: Standard dosage schedule: Standard duration: 36 Chapter 5 P-drug versus P-treatment C hapter 5 P-drug and P-treatment Not all health problems need treatment with drugs. As explained in Chapter l, the treatment can consist of advice and information, non-drug therapy, drug treatments, referral for treatment, or combinations of these. Making an inventory of effective treatment alternatives is especially important in order not to forget that non-drug treatment is often possible and desirable. As with selecting your P-drugs, the criteria of efficacy, safety, suitability and cost should be used when comparing treatment alternatives. Exercise Make a list of possible effective and safe treatments for the following common patient problems: constipation, acute diarrhoea with mild dehydration in a child, and a superficial open wound. Constipation Constipation is usually defined as a failure to pass stools for at least a week. Because of tolerance, laxatives are only effective for a short period and may then lead to abuse and eventually even to electrolyte disturbances. The first treatment plan, your P-treatment, should therefore be advice; not drugs! Acute watery diarrhoea with mild dehydration in a child 37 Guide to Good Prescribing In acute diarrhoea with mild dehydration in a child, the main objective of the treatment is to prevent further dehydration and to rehydrate; the goal is not to cure the infection! The inventory of possible effective treatments is therefore: Advice and information: Continue breast feeding and other regular feeding; careful observation. Non-drug treatment: Additional fluids (rice water, fruit juice, homemade sugar/salt solution). Metronidazole and antibiotics, such as cotrimoxazole or ampicillin, are not listed in the inventory because these are not effective in treating watery diarrhoea. Antibiotics are only indicated for persistent bloody and/or slimy diarrhoea, which is much less common than watery diarrhoea; metronidazole is mainly used for proven amoebiasis. Antidiarrhoeal drugs, such as loperamide and diphenoxylate, are not indicated, especially for children, as they mask the continuing loss of body fluids into the intestines and may give the false impression that ‘something is being done’. Superficial open wound The therapeutic objective in the treatment of an open wound is to promote healing and to prevent infection. The inventory of possible treatments is: Advice and information: Regularly inspect the wound; return in case of wound infection or fever. The wound should be cleaned and dressed, and tetanus prophylaxis should probably be given. All patients with an open wound should be warned about possible signs of infection, and to return immediately if these occur. Local antibiotics are never indicated in wound infections because of their low penetration and the risk of sensibilization. Systemic antibiotics are rarely indicated for prophylactic purposes, except in some defined cases such as intestinal surgery. They will not prevent infection, as permeability into the 38 Chapter 5 P-drug versus P-treatment wound tissue is low, but they can have serious side effects (allergy, diarrhoea) and may cause resistance. Your P-treatment for a superficial open wound is therefore to clean and dress the wound, give antitetanus prophylaxis, and advice on regular wound inspection. Advice, fluids and rehydration are essential in the treatment of acute watery diarrhoea, rather than antidiarrhoeals or antibiotics. Practical examples illustrate how to select, prescribe and monitor the treatment, and how to communicate effectively with your patients. When you have gone through this material you are ready to put into practice what you have learned. It is obvious that making the right diagnosis is a crucial step in starting the correct treatment. Making the right diagnosis is based on integrating many pieces of information: the complaint as described by the patient; a detailed history; physical examination; laboratory tests; X-rays and other investigations. In the next sections on (drug) treatment we shall therefore assume that the diagnosis has been made correctly. Complains of a sore throat but is also very tired and has enlarged lymph nodes in her neck. She is a little shy and has never consulted you before for such a minor complaint. Very sore throat, caused by a severe bacterial infection, despite penicillin prescribed last week.
It is not possible to negate the effect of such mixing discount cialis super active 20mg visa erectile dysfunction causes uk, and tastes and odours may occur purchase cialis super active with amex erectile dysfunction doctor in columbus ohio. It is important that all customers buy 20 mg cialis super active with visa erectile dysfunction at 18, and the customer service department order 20 mg cialis super active otc erectile dysfunction treatment tablets, are informed of the change so that customer complaints/queries can be minimised and dealt with efficiently. One example, is where fish keepers may remove free chlorine by allowing water to stand and fish deaths result after a changeover to the longer lasting chloramine. Health authorities would need to be informed because of the possible implications for kidney dialysis water treatment systems. It should be borne in mind that a greater contact time with the carbon is required for chloramine. Good practice would be to introduce additional monitoring in the weeks before, during and after chloramination is implemented. Such monitoring will assist detection of possible problems as well as highlighting benefits. As chloramine displaces chlorinated water, during initial implementation, any booster chlorination stations will need to be turned off. This needs to coincide with the arrival of water that contains sufficient chloramine to ensure that the system is not without disinfectant for an unacceptable period. In the most basic system the ratio between chlorine dose (or residual) and ammonia is automatically controlled to a set-point. For greater security, particularly in systems that use a solution of ammonia salt, additional downstream monitoring of ammonia is used to trim the dose. Systems should therefore be designed to provide a ratio of 5:1 but it is recommended that the system is started up at a ratio of 4. There are good reasons for operating below the 5:1 ratio, as the presence of a small amount of free ammonia is found to increase the stability of the monochloramine. The free ammonia and free chlorine should be measured and the ammonia dose adjusted to provide a trace (approximately 0. The chemistry of chloramination is not straightforward, as it is for chlorination. The process for generating chloramine requires accurate control at the treatment works to ensure that the desired product (monochloramine) is formed and not dichloramine or trichloramine. Overall experience is that this risk is very small for control systems that are well designed and operated. Water Treatment Manual Disinfection There is also a risk in networks which are not single source and where chloraminated and chlorinated water can blend in unsuitable proportions. There is a risk that the disinfection residual will be reduced and/or dichloramine may be formed which has a strong chlorine taste. Nitrification due to excess ammonia in the distribution network Chloramination is achieved through a controlled reaction between chlorine and ammonia. Under ideal conditions all of the ammonia can react but it is more usual that small concentrations of ammonia are present after chloramination. Whilst free ammonia is subject to regulation, the main concern relates to nitrite, which is subject to tighter regulation. Ammonia can be converted to nitrite by naturally occurring bacteria that are harmless to human health. This process is known as nitrification, and in extreme cases can lead to marked depletion of oxygen, but generally the issue is the concentration of nitrite. Originally exceedance of the regulatory limit for nitrite was one of the major barriers to wider application of chloramination. A past revision of the Water Quality Regulations increased the allowable concentration of nitrite at the tap from 0. It is a more effective bactericide and virucide than chlorine; effective against Giardia; and the most effective of all the chemical disinfectants used in water treatment against Cryptosporidium. It decays more rapidly than other disinfectants, so does not maintain a persistent residual. Ozone can only be used as a primary disinfectant and should be coupled with a secondary disinfectant for a complete disinfection system for generation of a verifiable residual in distribution networks. Ozone is a toxic, bluish, unstable, potentially explosive gas and is a hazard to plants and animals (Braker and Mossman, 1980). Ozone leak detectors should be installed to give audible/visible warnings and shut down the generators in the event of a leak. The gas is highly corrosive in the presence of moisture; hence piping and other equipment must be constructed of resistant materials. At low pH levels, precursor destruction is quite effective; above some critical pH, ozone is less effective, and sometimes increases the amount of chlorination by-product precursors. This is because alkalinity scavenges any hydroxyl free radicals formed during ozonation, leaving molecular ozone as the sole oxidant, which has a lower oxidation potential than the hydroxyl free radical. It is important when considering ozonation that the objectives for doing so are clear, because the optimum dose and contact time, and the most appropriate location in the treatment train and contactor configuration, all depend on the treatment objective. Parallel reactions will occur, so a single ozonation stage may achieve more than one treatment objective, but problems may arise if inappropriate combinations of objectives are attempted. This occurs due to a decrease in the efficiency of transfer of ozone into water as temperature increases. Dissolved ozone can react directly or indirectly with the water into which it is dosed. Indirect reactions occur with hydroxyl radicals that are formed when molecular ozone decomposes in water. In practice, reactions by both mechanisms are likely to occur in parallel, with the prevailing water quality influencing the extent to which hydroxyl radicals are formed. For primary disinfection there will be a requirement to achieve some target Ct value, for which purpose promoting ozone decay is disadvantageous because of the need to maintain the ozone residual. Complete mineralisation of organic material by ozone does not usually occur to any great extent under drinking water disinfection conditions. Hence, if ozone is used for disinfection, a process should be included downstream which is able to ameliorate the increase in biodegradability. As ozone introduces large amounts of oxygen to the water, its addition to water also promotes biological growth on the filter media. A number of factors contribute to the extent of bromate formation, with the following trends being apparent (Amy et al, 1995). Bromate formation: increases with increasing bromide ion concentration increases with increasing pH, up to a pH of 8. These trends provide possible approaches for restricting bromate formation if there is a risk of exceeding the regulatory limit. Lowering the pH, quenching ozone residual with bisulphite or adding ammonia may be feasible in some cases. The use of oxygen enables ozone to be generated at higher concentrations, which is more energy efficient and beneficial for mass transfer, but carries the additional cost of the oxygen. There are some air-fed installations which have the facility to enrich the feed gas with oxygen, which may be justifiable where there are infrequent short-term peak ozone demands (Langlais et al, 1991). The required o dryness depends on the generator, but the maximum operating dew point is unlikely to be above -60 C and o may be lower than -80 C (Langlais et al, 1991).
The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1 purchase 20 mg cialis super active erectile dysfunction joke. Risk factors for primary Pneumocystis carinii pneumonia in human immunodeficiency virus-infected adolescents and adults in the United States: reassessment of indications for chemoprophylaxis buy cialis super active 20mg cheap erectile dysfunction pills at walgreens. Epidemiology of Pneumocystis carinii pneumonia in an era of effective prophylaxis: the relative contribution of non-adherence and drug failure purchase genuine cialis super active erectile dysfunction injection medication. Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies purchase cialis super active 20 mg without a prescription erectile dysfunction nerve. Severe exercise hypoxaemia with normal or near normal X-rays: a feature of Pneumocystis carinii infection. Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Diagnosis of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients with polymerase chain reaction: a blinded comparison to standard methods. Diagnosis of pneumocystis pneumonia using serum (1-3)-beta-D-Glucan: a bivariate meta-analysis and systematic review. Quantification and spread of Pneumocystis jirovecii in the surrounding air of patients with Pneumocystis pneumonia. A Pneumocystis jirovecii pneumonia outbreak in a single kidney- transplant center: role of cytomegalovirus co-infection. A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. Efficacy and toxicity of two doses of trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus. A randomized trial of daily and thrice-weekly trimethoprim- sulfamethoxazole for the prevention of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected persons. Atovaquone suspension compared with aerosolized pentamidine for prevention of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected subjects intolerant of trimethoprim or sulfonamides. Discontinuation of primary prophylaxis for Pneumocystis carinii pneumonia and toxoplasmic encephalitis in human immunodeficiency virus type I-infected patients: the changes in opportunistic prophylaxis study. A prospective multicentre study of discontinuing prophylaxis for opportunistic infections after effective antiretroviral therapy. A double-blind, randomized, trial of oral trimethoprim-sulfamethoxazole, dapsone-trimethoprim, and clindamycin-primaquine. Sulfa use, dihydropteroate synthase mutations, and Pneumocystis jiroveccii pneumonia. A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. The National Institutes of Health-University of California Expert Panel for Corticosteroids as Adjunctive Therapy for Pneumocystis Pneumonia. Consensus statement on the use of corticosteroids as adjunctive therapy for pneumocystis pneumonia in the acquired immunodeficiency syndrome. The effect of adjunctive corticosteroids for the treatment of Pneumocystis carinii pneumonia on mortality and subsequent complications. Oral therapy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Trimethoprim-sulfamethoxazole or pentamidine for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Clindamycin-primaquine versus pentamidine for the second-line treatment of pneumocystis pneumonia. Pentamidine aerosol versus trimethoprim-sulfamethoxazole for Pneumocystis carinii in acquired immune deficiency syndrome. Risk factor analyses for immune reconstitution inflammatory syndrome in a randomized study of early vs. Life-threatening immune reconstitution inflammatory syndrome after Pneumocystis pneumonia: a cautionary case series. Adverse reactions to trimethoprim-sulfamethoxazole in patients with the acquired immunodeficiency syndrome. Long-term safety of discontinuation of secondary prophylaxis against Pneumocystis pneumonia: prospective multicentre study. The teratogenic risk of trimethoprim-sulfonamides: a population based case-control study. Neural tube defects in relation to use of folic acid antagonistis during pregnancy. Is first trimester exposure to the combination of antiretoviral therapy and folate antagonists a risk factor for congenital abnormalities? Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. Failure of trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis carinii pneumonia with concurrent leucovorin use. Respiratory failure in pregnancy due to Pneumocystis carinii: report a successful outcome. Pneumonia during pregnancy: has modern technology improved maternal and fetal outcome? Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Maternal drug use and infant cleft lip/palate with special reference to corticoids. Safety, efficacy and determinants of effectiveness of antimalarial drugs during pregnancy: implications for prevention programmes in Plasmodium falciparum-endemic sub-Saharan Africa. Embryofetal effects of pentamidine isethionate administered to pregnant Sprague-Dawley rats. Disease appears to occur almost exclusively because of reactivation of latent tissue cysts. Epidemiology Seroprevalence of anti-Toxoplasma antibody varies substantially among different geographic locales, with a prevalence of approximately 11% in the United States, versus 50% to 80% in certain European, Latin American, and African countries. If patients are truly seronegative, their toxoplasmosis presumably represents one of three possible scenarios: 1) Primary infection, 2) Re-activation of latent disease in individuals who cannot produce detectable antibodies, or 3) Testing with insensitive assays. In the United States, eating raw shellfish including oysters, clams, and mussels recently was identified as a novel risk factor for acute infection. Focal neurological abnormalities may be present on physical examination, and in the absence of treatment, disease progression results in seizures, stupor, coma, and death. On imaging studies, lesions are usually ring-enhancing and have a predilection for the basal ganglia. Most clinicians initially rely on an empiric diagnosis, which can be established as an objective response, documented by clinical and radiographic improvement, to specific anti-T. They also should be counseled regarding sources of Toxoplasma infection, especially if they lack IgG antibody to Toxoplasma. Lamb, beef, venison, and pork should be cooked to an internal temperature of 165°F to 170°F;24 meat cooked until it is no longer pink inside usually has an internal temperature of 165°F to 170°F, and therefore, from a more practical perspective, satisfies this requirement.
Because these on a coin fip in determining who will adhere to treatment and who won’t (even among patients they know well) purchase cialis super active 20mg impotence and high blood pressure. Controlling For likely to develop coronary disease generic cialis super active 20 mg with amex erectile dysfunction pills for high blood pressure, cerebrovascular disease order cialis super active 20mg with mastercard erectile dysfunction medicine online, Other Relevant Factors generic 20mg cialis super active visa erectile dysfunction niacin, Poor Adherence Is and chronic heart failure, respectively, over a 3-year period Associated With Increased Hospitalizations, when compared to those who took their antihypertensive medicines as directed. Nonadherent patients were also 17 Nursing Home Admissions, Physician Visits, percent more likely to be hospitalized and had an average And Avoidable Health Care Costs. Researchers estimated that total A meta-analysis combining the results of numerous studies hospitalization costs could have been reduced by more than found that relative to patients with high levels of adherence, $25 million if nonadherent patients had been compliant with the risk of poor clinical outcomes—including hospitalization, xix their treatment regimens. Nau, “Oral Antihyperglycemic Medication Nonadherence and Subsequent Hospitalization Among Individuals with Type 2 Diabetes. Overall, improving adherence to prescribed 9 For example, 32 million Americans use three or more medicines for diabetes, cholesterol, and blood pressure medicines daily, while the average 75-year old has 3 control resulted in $4 to $7 reductions in total health costs chronic conditions and takes 5 medicines. Researchers also found an unambiguous association between higher medication copays or cost-sharing and increased use of hospitalizations and emergency medical services for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia. Use of medicines to treat hypertension, high copayments for insulin and all oral diabetes medicines all saw cholesterol, and diabetes was 15 percent, 27 percent, signifcant increases in adherence for their employees with and 21 percent lower, respectively, for patients subject to diabetes. Relative to employees whose copayments for diabetes the cap relative to those with full coverage. The cap was medicines did not change, those whose copayments were also associated with poorer control of blood pressure, lipid waived or reduced were more likely to fll new prescriptions levels, and glucose levels, and savings from reduced use xxxvii and more likely to continue their diabetes treatment over time. Generating Positive Returns On Their Additional research by these authors indicates that this Investments Through Productivity Gains And increase in employee adherence led to reduced use of other Lower Overall Health Care Spending. Researchers estimated that lowering patient to 4 percent increase in the average adherence rate relative copays would improve medication adherence, reducing lost to a control group whose copays did not change. Pill bottles are topped with special caps Experimenting With A Range Of Efforts To that signal patients with light and sound. An embedded Encourage Patients To Use Their Medicines wireless connection enables the cap to send automated As Directed: calls to patients to inform them of missed doses and can also provide weekly progress reports and refll reminders. They not only feel better, they can potentially avoid costly medical problems xli Improving adherence holds great potential to contribute that could result from delaying appropriate therapy. In the private sector, forward-looking provide diabetes medicines at no charge to patients who employers are taking steps to improve adherence, take steps to manage their condition and participate in xlvi particularly among workers with chronic illnesses. Many of these initiatives include quality better quality care, healthier patients, and reduced overall targets likely to require improved medication adherence. Interventions will be tailored to the needs of the specifc patient and may include reminders, pharmacist consultations, lower copays, and automatic home delivery of reflled prescriptions. DeMatteo, “Variation in Patients’ Adherence to on Adherence to Prescription Medications,” Journal of General Internal Medicine, 2008 Medical Recommendations: A Quantitative Review of 50 Years of Research,” Medical and P. Subsequent Hospitalization among Individuals with Type 2 Diabetes,” Diabetes Care, unitedhealthgroup. They are selected with regard to disease prevalence, safety, efficacy, and comparative cost- effectiveness. Each country is encouraged to prepare their own lists taking into consideration local priorities. Africa Medicines Region Country Agency/Authorit Medicines Agency/Authority Web site Essential Medicine List Essential Medicine List Year y Acronym http://www. Vincent & the Grenadines Pharmacy Council ocs/documents/s18854en/s188 2010 Caribbean Grenadines 54en. Schizoprenia is caused by Levodopa works to Prevents the bone from balance of some of the agent’ which has both an over-activity of replace some of the being broken down and chemicals in the brain reduced inflammation Exact mechanism chemicals in transmission dopamine your brain is by helping to rebuild (neurotransmitters). An Early use improves and interfere with blocking the receptors in your symptoms, in factors can also help altered balance of outcome and neurotransmitter release the brain that are involved particularly your rigidity with this, such as serotonin and other symptoms. How to take Tablet Tablet usually Tablet, capsule or syrup Tablet or depot injection Tablet Swallow tablet with full Injection also available glass of water Start at a small dose and build up over week or 2. Anxiety for 2w fever/other infection drowsiness) domperidone signs) Lithium toxicity symptoms Anti-adrenergic (peripheral dopamine 2. A synthetic version of the normal Statins stops the liver making Increases the sensitivity of Replace your body’s store of hormone produced by the cholesterol. It is important to also address other risk factors… Treatment Timeline Once daily (usually in the Once daily before breakfast Once daily in the evening Once daily with breakfast 1-3 times daily (depending on course evening) (may be increased to twice brand) daily) How to take Tablet(s) Tablet Tablet Take tablet with or Work best if taken on empty immediately after a meal at stomach but most take with the same time each day food because iron can irritate the stomach. Taste bad May be hyperthyroid symptoms Also diarrhoea, rash, hair loss, if level is too high (vomiting, Also nausea, sickness, diarrhoea, nausea. Drug abuse refers to (1) the use of prescribed or “over-the-counter” drugs in excess of the directions, and (2) any non-medical use of drugs. Can you get through the week without using drugs (other than those required for medical reasons)? Have you ever been arrested because of unusual behavior while under the influence of drugs? Have you ever been involved in a treatment program specifically related to drug use? Using a cutoff score of 6 has been found to provide excellent sensitivity for identifying patients with substance use disorders as well as satisfactory specificity (i. Using a cutoff score of <11 somewhat reduces the sensitivity for identifying patients with substance use disorders, but more accurately identifies the patients who do not have a substance use disorders. In a heterogeneous psychiatric patient population, most items have been shown to correlate at least moderately well with the total scale scores. The items that correlate poorly with the total scale scores appear to be items 4,7,16,20, and 22. In this context it is important to distinguish an occurs between the drug and the solution, incompatibility reaction from an interaction. The two types of incompatibilities associated with intravenous An interaction occurs inside the body and therefore cannot be administration are physical and chemical seen. In contrast to the interaction, an incompatibility reaction occurs inside a fuid container or infusion line and is usually visible. Physical reactions Physical reactions of drugs usually refer to either phase separation Defnition of interactions or precipitation (e. The situation in an infusion regimen is specifc to the combination of drugs and solution used. Usually, the drug has the greatest infuence and therefore defnes the pH-value of the solution in- fused. Many drugs are weak bases, present as the water soluble salts of the corresponding acids. Because of the low aqueous solubility of such bases, particles may precipitate (Fig. The process of precipitation is infuenced by the relative quantity of the drugs added, as well as their bufering capacity. These pH- dependent precipitation reactions are usually very rapid and can be identifed within a few centimeters in the infusion tubing system. Further invisible physical incompatibilities are reactions between drugs and plastic materials (adsorption efects).