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Awareness of predisposing and precipitating factors can help identify patients in need of screening with tools such as the Geriatric Depression Scale. Selection of an antidepressant medication should be based on the best side effect profile and the lowest risk of drug-drug interaction. If remission is not achieved, then add-on treatments, including other drugs and psychotherapy, may be considered. In cases of severe, psychotic, or refractory depression in the elderly, electroconvulsive therapy is recommended. Depression is the most common mental health problem in the elderly 1 and is associated with a significant burden of illness that affects patients, their families, and communities and takes an economic toll as well. Symptoms include low mood; reduced interest, energy, and concentration; poor sleep and poor appetite; and preoccupation with health problems. Depression in the elderly is associated with functional decline that can require increased care or placement in a facility, family stress, a higher likelihood of comorbid physical illnesses, reduced recovery from illness e.
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Following a Department of Health report in Medicines under Group Protocols, group protocols became known as PGDs. PGDs are written instructions for the supply or administration of medicines to groups of patients, who may not be individually identified before presentation for treatment. The report recommended that the legal position needed clarification, and in August medicines legislation was amended. The majority of clinical care should still be provided on an individual, patient-specific basis. The supply and administration of medicines under PGDs should be reserved for those limited situations where this offers an advantage for patient care without compromising patient safety, and where it is consistent with appropriate professional relationships and accountability.
Iron deficiency and haemorrhagic anaemia are treated with replacement in the form of iron salts, usually ferrous sulfate, and an improved diet. Sometimes a blood transfusion is necessary in the short term. Adverse effects of oral iron preparations are that they cause gastrointestinal irritation including nausea, epigastric pain, diarrhoea andor constipation. Parenteral preparations are available if oral therapy cannot be tolerated. Decreased production of erythrocytes can be a cause of anaemia. This can be due to deficiency of vitamin B for formation of erythrocytes.
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This is treated as an emergency with adrenaline, atropine and oxygen. Antihistamines, aminophylline, salbutamol and corticosteroids may also be necessary. Adjuncts to radiography include peripherally acting analgesics and possibly codeine for pain after injection or other procedures and topical anaesthetics prior to injection. For abdominal examinations using barium contrast agents, laxatives and bowel evacuants are necessary to empty the bowel. The most commonly used preparation for this purpose is Picolax, which is a combination of a stimulant laxative and an osmotic laxative.
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Anti-cholinergic drugs were originally used prior to the development of levodopa because many signs of excessive parasympathetic activity are seen in Parkinsons patients (salivation, sweating and incontinence). The basal nuclei contain many excitatory cholinergic neurons.
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Adverse effects are increase in appetite and weight gain, which is serious in already obese patients. Hypoglycaemia can occur with any of these drugs and is particularly dangerous in the elderly.
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Ethosuximide is effective in absence seizures, but not other types of epilepsy. It may even precipitate tonicclonic seizures in susceptible patients.
They have a short duration of action with little or no hangover effect and a lower dependence potential than benzodiazepines. Clomethiazole is used as a hypnotic for older patients because of its lack of hangover effect but it can still produce dependence. It should be used as a lorazepam 2.5 mg avis only in the short-term. Hypnotics generally should be avoided in older people because of the risk of confusion, ataxia and falls as a consequence. Some antihistamines, for example diphenhydramine and promethazine, are available for occasional insomnia; their prolonged duration of action may often lead to drowsiness the following day. ADHD occurs in childhood and adolescence and may continue into adulthood.
Both toxoplasma and pneumocystis are treated with drugs containing sulphonamides. Infection with parasitic worms in the United Kingdom is usually confined to round worms or ativan without prescription worms. In tropical and subtropical parts of the world, infection with parasitic worms is common and widespread. There are many drugs available (in the United Kingdom on a named-patient basis) to treat parasitic worm infection. Most anthelmintic drugs work by interfering with neuromuscular transmission causing paralysis of the worm.
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This is the case with pethidine (an analgesic). After the age of to decline.
13.08.2016
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