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Chloroquine and hydroxychloroquine are sometimes used to treat systemic and discoid lupus erythematosus, but should not be used for psoriatic arthritis. Because of the risk of retinopathy, long-term therapy should be reserved for cases in which all other DMARDs have failed. Immunosuppressants, such as azathioprine, ciclosporin and methotrexate, can be used to treat severe inflammatory disease. Their use depends on their ability to inhibit the activity and proliferation of lymphocytes and other leukocytes and because of this they are very toxic to the bone marrow. Other adverse effects are nausea, leukopenia, blurred vision, rashes and hair loss.

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The nervous system in helminths has important differences from that of humans and these differences form the basis of the selective toxicity of most drugs used to treat such infections. For example, nematode muscles have both excitatory and inhibitory neuromuscular junctions. The neurotransmitters are acetylcholine and gamma-aminobutyric acid, respectively. Anthelmintics either act locally to expel worms from the gastrointestinal tract, or systemically to eradicate forms that have invaded tissues and organs. To be effective, the drug must be able to penetrate the worm. Anthelmintics have the following modes of action: cause paralysis of the worm; damage the cuticle of the worm leading to partial digestion or attack by the immune system; interfere with the metabolism of the worm. Many anthelmintics are available in the United Kingdom only on a named-patient basis.

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Folic acid is the starting point for a cofactor necessary for DNA synthesis in both bacterial and human cells. However, in susceptible bacterial cells, folic acid must be synthesized, whereas in humans it is provided preformed in the diet. Sulphonamides interact with warfarin by enhancing the actions of these drugs. The most important adverse effects of sulphonamides are rashes, renal failure and various blood disorders. Trimethoprim inhibits another enzyme, dihydrofolate reductase, in the same folic acid metabolic pathway. Folic acid is converted into folate, which then has to be converted into an activated form by dihydrofolate reductase.

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The passage of food from the stomach to the duodenum becomes less efficient with age, increasing gastric emptying time. This may cause a slight delay in the absorption of drugs in the intestine. With ageing, there is also reduced gastrointestinal blood flow, which can further delay absorption of drugs from the gastrointestinal tract. Alteration in absorption can also make older people more vulnerable to the ulcerogenic effects of some drugs, for example non-steroidal anti-inflammatory drugs. Distribution of drugs around the body is likely to be different in older people because of changes in body composition, plasma protein concentration and blood flow to major organs. With ageing, body composition changes such that there is more body fat with respect to total body weight, and the proportion of body water falls.

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The Committee on the Safety of Medicines (now the Commission on Human Medicines) recommends that repeated use of halothane should be avoided. Isoflurane, desflurane and sevoflurane have superseded halothane. None of them is as potent as halothane, but they are less likely to cause liver toxicity. Isoflurane is widely used. Its main adverse effects are that it can cause myocardial ischaemia in patients with heart disease and it depresses respiration. All of these anaesthetics have the potential to cause malignant hyperthermia.

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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.

Propranolol is a drug commonly used to treat high blood pressure. About phentermine online dr population are poor hydroxylators of propranolol. Because propranolol is extensively metabolized affected individuals show exaggerated and prolonged responses to this drug. Another example is the metabolism of isoniazid, a drug used to treat tuberculosis. This drug is metabolized by acetylation and can lead to toxic effects. Suxamethonium is a neuromuscular blocking drug frequently used as an adjunct to anaesthesia; it causes muscle paralysis.

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Recently, transplantation of foetal brain tissue has been carried out in a number of patients in the hope of reversing the symptoms of Parkinsons disease by providing neurons that produce dopamine. Initially the results looked promising, with some patients with severe disease showing some degree of improvement after surgery. However, it now appears that deterioration with time is likely, although trials are still being evaluated. Alternative approaches have been considered using genetically modified cells, for example fibroblasts from the skin, or retinal cells as sources of dopamine production. These approaches are still very much in the experimental stages. Epilepsy affects approximately The main symptoms are seizures, often together with convulsions, but there are many types of epilepsy.


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If bone pain is severe or if the patient has neurological symptoms, or fractures that will not heal, calcitonin or bisphosphonates may be indicated.

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How can you reassure her that this will not happen again. You should be able to answer these review questions from the material in this chapter.

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In young children, this produces hand-foot syndrome, in which there is swelling and pain in wrists and feet. Sickle cell disease is endemic in parts of Mediterranean Europe, West and East Africa and Asia and is seen in people from those areas in the United Kingdom.

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In response to this, the cardiovascular centre reduces heart rate and force of contraction by decreasing sympathetic stimulation and increasing parasympathetic stimulation of the heart. At the same time sympathetic stimulation of blood vessels decreases.

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Usually the disease is progressive and fatal with most patients dying from respiratory failure and pneumonia within two to three years from onset. (A notable exception to this generalization is Professor Stephen Hawking who was diagnosed with motor neuron disease at the age of later, albeit paralysed for most of that time.

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