Multiple sclerosis is an autoimmune disease of the central nervous system in which the cells that produce the myelin sheath of neurons are progressively destroyed. Particular areas of the central nervous system affected are the optic nerves, brain stem and cerebellum, corticospinal tracts of the spinal cord and areas around the ventricles. Demyelination leads to variable symptoms depending on where the lesions are. Double vision and vertigo are common presenting signs of brain stem involvement. Difficulty in walking with sensory disturbances is a sign of spinal cord lesions.

Older antihistamines are the most likely to cause drowsiness. Newer ones, for example acrivastine, are preferred because they penetrate the blood-brain barrier less easily and cause less sedation. Nevertheless, all antihistamines should be labelled with a warning that they may cause drowsiness and patients should not drive or operate machinery when taking them. Antihistamines should be used with caution in people with epilepsy, enlargement of the prostate, urinary retention, glaucoma and hepatic disease. Children and older people are more susceptible to the adverse effects.

These adverse drug reactions are generally dose-related and most can be predicted. They can be caused by an exaggeration of a drugs intended pharmacological effect or by an unwanted action or side effect. Type A adverse reactions are most likely to occur with drugs that have a steep doseresponse curve andor small therapeutic ratio. The TR of a buy online levitra is the ratio of the maximum non-toxic dose to the minimum dose that has a therapeutic effect and is essentially a measure of a drugs safety margin. TR maximum non-toxic doseminimum effective dose The most dangerous drugs are those with a small TR where the maximum non-toxic dose is very close to the effective dose.

Because of HIV resistance, several similar drugs have been developed, including abacavir and lamivudine. All drugs in this group are toxic, common side effects being gastrointestinal disturbances, anorexia, pancreatitis and liver damage. Non-nucleoside reverse transcriptase inhibitors such as efavirenz and nevirapine are similar and have a similar profile of adverse effects. Viral protease is essential in retroviruses for the production of mature viral particles. Inhibition of the enzyme slows spread of virus from cell to cell because immature particles cannot infect host cells.

Examples of atypical anti-psychotic drugs are clozapine, risperidone, olanzapine and quetiapine. Clozapine can cause agranulocytosis and should only be used if other drugs are not effective. Other adverse effects of most anti-psychotic drugs are anti-cholinergic effects such as dry mouth, constipation and urinary retention and α-adrenergic blocking effects, primarily vasodilation leading to a fall in blood pressure especially in the elderly. Neuroleptic malignant syndrome is a rare but potentially fatal adverse reaction to some anti-psychotic drugs and requires immediate withdrawal of the drug. Symptoms are hyperthermia, fluctuating level of consciousness, muscular rigidity and autonomic dysfunction and can last five to seven days after withdrawal of the drug.

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Treatment is by vitamin D replacement. Myasthenia gravis is an autoimmune disease where acetylcholine receptors at the neuromuscular junction are progressively destroyed. This interferes with muscle contraction causing muscle weakness and fatigue. In many patients, removal of the thymus gland can induce remission of the disease.

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Anxiety and insomnia are discussed together because the drugs used to treat them are often the same. Anxiety may be described as an unpleasant experience or fear of the unknown. Symptoms are those of increased sympathetic activity including increased heart rate and blood pressure, sweating and tremor and a dry mouth. Anxiety can be associated with pain and breathing difficulties.

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Oestrogen normally plays a role in the inhibition of bone digestion and this protection is lost after the menopause. Osteoporosis may also occur due to hormone imbalances or chronic hormone therapy. Bone mass begins to decline naturally after the age of vertebral collapse. Specialized radiographic imaging techniques or bone biopsy are used to diagnose and monitor the condition.

Hyposecretion of aldosterone and cortisol is life threatening and must be treated with replacement therapy of both hormones. Diabetes mellitus is due to either absolute deficiency of insulin or insulin resistance and reduced insulin secretion. In both types metabolic disturbances of carbohydrates, proteins and lipids occur with serious long-term consequences including atheroma, micro-angiopathy and neuropathy.

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A derivative of this chemical, etoposide, is used in small cell lung cancer, lymphoma and testicular cancer. The mode of action of etoposide is not completely known, but it may be due to an inhibitory effect on topoisomerase similar to that of doxorubicin. Adverse effects of etoposide are nausea and vomiting, hair loss and bone marrow suppression. Hormones are used specifically in cancers that are hormone dependent. Growth of such tumours can be suppressed by hormones with the opposite action, by hormone antagonists or by inhibition of hormone secretion.

When taken at the bought online levitra dosage, there are few side effects with paracetamol and no major interactions with other drugs. In substantial overdose, severe, life-threatening liver damage is likely to occur due to excessive production of a toxic metabolite. There is an antidote to paracetamol overdose (acetylcysteine) and provided it is given within eight hours a complete recovery can be made. In the liver, acetylcysteine is converted to glutathione, which forms a harmless conjugate with paracetamol. Centrally acting analgesics are also known as narcotics or opioids.

Adverse effects of metformin are few, mainly gastrointestinal upsets and a rare but potentially fatal lactic acidosis, which is why other drugs in this class are unavailable. Metformin should never be prescribed for patients with renal disease or severe pulmonary or cardiac disease. Metformin is contraindicated with concurrent use of iodine containing contrast agents. Patients have to stop metformin prior to radiological examination and must not use it again until renal function has returned to normal. Drug interactions with sulfonylureas and biguanides are common: non-steroidal antiinflammatory drugs, warfarin, alcohol, monoamine oxidase inhibitors, some uricosurics, some antibacterials and some antifungals can interact with them.

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