For example, a local anaesthetic injected into a blood vessel rather than into the tissues produces a rapid rise in blood level and this increases the risk of unwanted effects of the drug. Age can affect the response to drugs, because in the old and the very young metabolism and excretion are not as efficient in comparison to the young healthy adult. Distribution can also be affected due to differences in body composition and the availability of plasma proteins for binding. At these extremes of life, drugs tend to produce greater and more prolonged effects. Many disease states can cause individual variation in response to drugs. Any disease that results in alteration in the pharmacokinetics of a drug will create these variations. Diseases of the liver and kidney, any disease that affects intestinal motility, mal-absorption syndromes and any condition that reduces plasma protein concentration are all implicated.

It is not, however, useful for other types of inflammation. Colchicine can cause diarrhoea, nausea, and abdominal cramps and bone marrow depression, which limits its long-term use. NSAIDs are used to relieve the pain and swelling of an acute attack. Aspirin should not be used because it competes with uric acid for tubular secretion in the kidney. Long-term treatment with drugs that control uric acid levels prevents future episodes of gout and helps resolve tophi.

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These are unlicensed medicines that have not been given a Marketing Authorization by the Medicines and Healthcare Products Regulatory Agency and can only be obtained from the pharmaceutical company or manufacturer. This is a major group of anthelmintics. Mebendazole is a broad-spectrum anthelmintic effective against threadworms, hookworms and round worms. Its mode of action is to bind to β tubulin in the worm, which interferes with microtubular transport of glucose by the worm. Mebendazole has few side effects; it may cause mild gastrointestinal disturbances. Piperazine is effective against round worms and threadworms. Its mode of action is to inhibit neuromuscular transmission in the worm. It does this by acting on GABA receptors, which causes the opening of chloride channels and hyperpolarization of muscle cells in the worm. This causes paralysis of the worm.

Xanthines are of principle use in the immediate phase reaction of asthma but also buy adipex p 37.5 mg some effect on the late phase reaction. They are used to treat severe acute asthma attacks and chronic asthma, in particular control of nocturnal asthma and early morning wheezing. Xanthines also have some use in chronic bronchitis. Formulations of xanthines include intravenous injection, tablets and capsules. Examples of xanthine bronchodilators are theophylline and aminophylline.

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There is a major risk of malformation up to eight weeks post conception; therefore, drugs are best avoided for the first trimester of pregnancy. However, pregnancy may not be confirmed until towards the end of this period. Before drugs are given or other potentially harmful procedures undertaken, it should always be determined whether a woman might be pregnant. Particular groups of drugs known to be potentially harmful to the foetus in the first trimester include male and female hormones, iron preparations, aspirin-like drugs, alcohol and barbiturates. These are only examples many others exist. Drugs may also affect the foetus at later stages of pregnancy so the best advice is to avoid drug use during pregnancy unless absolutely necessary.

Because of side effects, use of these drugs is now limited to treatment of familial hyperlipidaemia in combination with bile acid sequestrants. There are many disorders of the cardiovascular system and blood. Common cardiovascular disorders are cardiac failure, ischaemic heart disease, arrhythmias and hypertension. Although these conditions cannot be cured by drug therapy, there are many drugs available to help control them. Cardiac glycosides are useful in cardiac failure and arrhythmias because they improve myocardial contractility and slow conduction through the heart. Diuretics encourage water loss from the body and this helps reduce circulating blood volume.

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Parkinsons disease was the first neurological disorder to be associated with deficiency of a specific neurotransmitter. In Parkinsons disease, there is a deficiency of dopamine in the basal nuclei, which leads to overactivity of cholinergic pathways and the characteristic hypokinesia, rigidity and tremor. Drugs used to treat Parkinsons disease aim to replace dopamine; stimulate dopamine receptors or the release of remaining dopamine; reduce breakdown of dopamine or reduce excessive parasympathetic activity. More recently, attempts have been made to replace dopamine-secreting cells by transplantation of fetal brain tssue. Epilepsy is caused by abnormal high-frequency firing of neurons, either in the whole of the cerebral cortex or in discrete areas of the cerebral cortex (partial epilepsy). The abnormal activity may be due to increased excitatory neuronal transmission, possibly involving abnormal sodium ion channels or decreased inhibitory transmission, possibly due to abnormality at GABA receptors.

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Inhibition of MAO-B slows the breakdown of dopamine thereby increasing its availability at synapses and prolonging its effects. An example of a MAO-B inhibitor is selegiline, which is used in combination with levodopa. The dose of levodopa can be reduced and there is evidence that this combination has a neuroprotective effect and slows the progression of the disease. This may be because in Parkinsons disease, MAO-B is involved in the production of an endogenous neurotoxin. Combination therapy with levodopa also reduces end of dose deterioration.

She asks you to explain. Discuss how you would address Annies concerns. Mrs Howe, aged at home for two days after being in hospital with a broken hip sustained after a fall. For the time being Mrs Howe is mostly bedridden while she recovers further. Before leaving the hospital, Mrs Howes consultant prescribed several drugs, including analgesics and laxatives.

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