By L. Garik. Oklahoma State University Tulsa.
Therapy must be perience shortness of breath buy keftab 750mg otc, sweating cheap 375 mg keftab fast delivery, nausea buy keftab 125mg on line, vomiting cheap 750 mg keftab free shipping, given promptly to prevent permanent heart muscle dam- or pain in the epigastric region, which can be mistaken age. Healthcare workers monitor people die within the first hour after onset of symptoms, heart rhythm and give medications to maintain a func- but prompt, aggressive treatment can improve outcomes. Some patients require surgery, such as angio- chest pain, stabilize the heart rhythm, and reopen the plasty to reopen vessels or a vascular graft to bypass dam- blocked vessel. Complete and prolonged lack of blood to aged vessels; others may need an artificial pacemaker to any part of the myocardium results in tissue necrosis and maintain a normal heart rhythm. Recovery from a heart attack and resumption of a nor- Angina Pectoris Inadequate blood flow to the heart mal lifestyle is often possible if the patient follows his or muscle causes a characteristic discomfort, called angina her prescribed drug therapy plan and takes steps to re- pectoris (an-JI-nah PEK-to-ris), felt in the region of the duce cardiac risk factors. Angina pectoris may be accompanied by a feeling of suffocation and a Checkpoint 14-13 Narrowing or blockage of the vessels that general sensation of forthcoming doom. People can live with compensated heart failure by attention to diet, drug ther- Risk factors that can be changed include the following: apy, and a balance of activity and rest. These arterial changes result in decreased ◗ The Heart in the Elderly blood flow and poor supply of oxygen and nutrients to There is much individual variation in the way the heart heart muscle. Because of the decrease in the reserve strength of the heart, elderly people are often Efforts to prevent heart disease should include having limited in their ability to respond to physical or emotional regular physical examinations and minimizing the con- stress. HDLs remove found in bile salts needed for digestion of fats, in hormones, cholesterol from the tissues, such as the walls of the arteries, and and in the plasma membrane of the cell. Thus, high levels of cholesterol in the blood have been associated with athero- of HDLs indicate efficient removal of arterial plaques, whereas sclerosis and heart disease. Cholesterol is Saturated fatty acids (found primarily in animal fats) raise transported in the blood in combination with other lipids and LDL levels, while unsaturated fatty acids (found in most veg- with protein, forming compounds called lipoproteins. Thus, a diet lower in saturated fat and higher in unsatu- density lipoprotein (HDL) is about one-half protein, whereas rated fat may reduce the risk of atherosclerosis and heart low-density lipoprotein (LDL) has a higher proportion of cho- disease. The ultrasound waves bounce off the The electrocardiograph (ECG or EKG) is used to heart and are recorded as they return, showing the heart record electrical changes produced as the heart muscle in action. In right heart catheteri- Heart specialists employ medical and surgical approaches zation, an extremely thin tube (catheter) is passed to the treatment of heart disease, often in combination. A fluoroscope (flu-OR- Medications o-scope), an instrument for examining deep structures One of the oldest drugs for heart treatment, and still the with x-rays, is used to show the route taken by the most important drug for many patients, is digitalis (dij-ih- catheter. Blood samples muscle contractions, is obtained from the leaf of the fox- 14 are obtained along the way for testing, and pressure glove, a plant originally found growing wild in many parts readings are taken. Slow calcium-channel blockers aid in the treatment Ventricular Atrial of coronary heart disease and hypertension by several repolarization depolarization mechanisms. They may be used to prevent clot formation in patients with damage to heart valves or S blood vessels or in patients who have had a myocardial in- mm time (sec) 0. Aspirin (AS-pir-in), chemically known as acetyl- Ventricular depolarization salicylic (a-SE-til-sal-ih-sil-ik) acid (ASA), is an inexpen- sive and time-tested drug for pain and inflammation that Figure 14-16 Normal ECG tracing. ZOOMING IN ✦ What is the length of A small daily dose of aspirin is recommended for patients the cardiac cycle shown in this diagram with angina pectoris, those who have suffered a myocardial 300 ✦ CHAPTER FOURTEEN infarction, and those who have undergone surgery to open anormal rhythm. The for people with bleeding disorders or gastric ulcers, be- restoration of a normal heartbeat either by electric shock cause aspirin irritates the lining of the stomach. In cases of severe tachy- If the SA node fails to generate a normal heartbeat or there cardia, tissue that is causing the disturbance can be de- is some failure in the cardiac conduction system, an elec- stroyed by surgery or catheterization. A dual chamber pacemaker has a lead in each machine siphons off the blood from the large vessels chamber to coordinate beats between the atrium and ven- entering the heart on the right side, so that no blood tricle. The effectiveness of Tip of lead this procedure diminishes over a pe- lodged in apex riod of years, however, owing to of right ventricle blockage of the replacement vessels. Less invasive surgical procedures Pacemaker placed include the technique of angioplasty beneath skin (AN-je-o-plas-te), which is used to in pectoral region open restricted arteries in the heart and other areas of the body. There, the THE HEART AND HEART DISEASE ✦ 301 Left subclavian artery Internal mammary Vein graft artery Anterior descending branch of the left coronary artery A B Figure 14-18 Coronary artery bypass graft (CABG) (A) This graft uses a segment of the saphenous vein to carry blood from the aorta to a part of the right coronary artery that is distal to the occlusion. Today, researchers are experi- ternal battery connected to it by a thin wire, the VAD pulls blood menting with a new completely self-contained artificial heart from the ventricle and pumps it to the aorta (in the case of a left that uses a wireless rechargeable external battery.
Deep massage can cause bruising or soreness that can persist for several days buy discount keftab 250 mg on line, but icing after a session will reduce 52 the likelihood of these effects generic keftab 125mg free shipping. Cherkin and colleagues found that 13% of 78 patients receiving therapeutic back massage in a randomized trial reported increased pain cheap keftab 125 mg mastercard, but no other adverse effects were elicited buy cheap keftab 250mg line. The most serious adverse effects reported after massage occurred after shiatsu 108 massage was performed on the anterior neck. Two cases of carotid dissection, a well-described complication of head 109 and neck trauma, were reported after using shiatsu-type massage tools (pressure bars). For these reasons, shiatsu massage and other types of pressure point massage on the anterior neck will be excluded from the massage protocol developed for this study. A Report to the National Institutes of Health on Alternative Medical Systems and Practices in the United States. Trends in alternative medicine use in the United States, 1990–1997, J Am Med Assoc 1998; 280:1569–75 Massage therapy 129 5. Characteristics of visits to licensed acupuncturists, chiropractors, massage therapists and naturopathic physicians. Characteristics of licensed acupuncturists, chiropractors, massage therapists and naturopathic physicians. Presentation at the International Symposium on the Science of Touch, Montreal, Quebec, Canada, 2002 16. Issues in planning a placebo-controlled trial of manual methods: results of a pilot study. Lessons from a trial of acupuncture and massage for low-back pain: patient expectations and treatment effects. The influence of manual massage on muscle relaxation: effect on trunk flexion J Am Phys Ther Assoc 1962; 42: 653–7 22. Failure of manual massage to alter limb blood flow: measures by Doppler ultrasound. Effects of sequential connective tissue massage on autonomic nervous system of middle-aged and elderly adults. Prevention of early postoperative deep vein thrombosis by intermittent compression of the leg during surgery. The measurement of skin lymph flow by isotope clearance—reliability, reproducibility, injection dynamics, and the effect of massage. Measures of salivary secretory immunoglobulin A and state anxiety after a nursing back rub. Glucose levels decreased after giving massage therapy to children with diabetes mellitus. Chronic fatigue syndrome: massage therapy effects on depression and somatic symptoms in chronic fatigue syndrome. Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. A study of the effect of manipulative treatment on 158 cases of cervical syndrome. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Motor disorders and their correction in children from a high-risk group for the development of schizophrenia at an early age. Therapeutic effects of massage therapy and handling touch on caregivers of patients undergoing autologous hematopoietic stem cell transplant. Behavioral response to headache: a comparison between migraine and tension-type headache. Does psychological testing help to predict the response to acupuncture or massage/relaxation therapy in patients presenting to a general neurology clinic with headache?
She is Ethosuximide should be discontinued immedi- taking oxcarbazepine keftab 250 mg without a prescription, valproic acid generic keftab 125mg line, and ethosux- ately purchase keftab 375mg fast delivery. Is there the dose of oxcarbazepine should be decreased by any significance to the apparent decreased inci- 50% if there is no increased incidence of seizures dence of seizures during pregnancy? Ethosuximide has seizure incidence and contact you immediately if not cheap 375 mg keftab with mastercard, but there is little evidence that ethosuximide is the incidence appears to be increasing. Azzaro DRUG LIST GENERIC NAME PAGE GENERIC NAME PAGE Amitriptyline 389 Mirtazapine 388 Amoxapine 389 Nefazodone 389 Bupropion 388 Nortriptyline 389 Carbamazepine 395 Olanzapine 395 Citalopram 388 Paroxetine 388 Clomipramine 389 Phenelzine 392 Desipramine 389 Protriptyline 389 Doxepin 389 Sertraline 387 Fluoxetine 387 Tranylcypromine 392 Fluvoxamine 386 Trazodone 389 Imipramine 389 Trimipramine 389 Isocarboxazid 392 Valproic acid 395 Lithium 393 Venlafaxine 388 Maprotiline 389 The most common mood disorders are major de- Both major depression and manic-depressive disor- pression (unipolar depression) and manic-depressive ders are characterized by exaggerated mood associated illness (bipolar disorder). Major depression is a com- with physiological, cognitive, and psychomotor distur- mon disorder that continues to result in considerable bances. Major depression generally presents as de- morbidity and mortality despite major advances in pressed mood, diminished interest in normal activities, treatment. Approximately 1 in 10 Americans will be de- anorexia with significant weight loss, insomnia, fatigue, pressed during their lifetime. By contrast, manic curring in the United States each year, 70% can be ac- episodes associated with manic-depressive illness are counted for by depression. Antidepressants are now the characterized by expansive mood, grandiosity, inflated mainstay of treatment for this potentially lethal disor- self-esteem, pressured speech, flight of ideas, and der, with patients showing some response to treatment poverty of sleep. With the exception of varying the mood disturbance is essential before additional degrees of sedation, the antidepressants have little ef- treatment is initiated. During this period This chapter covers the basic and clinical pharmacol- patients will, however, have side effects specific to the ogy of each class of agents demonstrating efficacy in the class and agent being used. Only after 2 to 3 weeks of treatment of major depression and manic-depressive ill- dosing will a therapeutic benefit on depression emerge. The distinguishing features among agents for the At this point the patient begins to demonstrate eleva- treatment of each illness are their side effect profiles tion in mood and self-esteem. Failure to continue the medication, however, will for the individualization of medication to meet the pa- result in an immediate relapse into the depressive state. A list of drugs and their half-lives are Therefore, maintenance therapy must be continued for shown in Table 33. Fluoxetine belongs to a class of agents referred to as selective sero- Drug (trade name) Half-life (hr) tonin reuptake inhibitors (SSRIs). The SSRIs now in- clude sertraline (Zoloft), fluvoxamine (Luvox), paroxe- Heterocyclics tine (Paxil), and citalopram (Celexa). Fluvoxamine is Amitriptyline (Elavil) 16–26 approved for use only in obsessive-compulsive disorder Nortriptyline (Pamelor) 19–45 and is not discussed in this chapter. Imipramine (Tofranil) 11–25 With the introduction of the SSRIs, the safety and Desipramine (Norpramin) 20–25 tolerability of antidepressants improved remarkably. As Protriptyline (Vivactil) 67–89 Trimipramine (Surmontil) 8 a class, these medications have little or no affinity for Doxepin (Sinequan) 11–23 cholinergic, -adrenergic or histamine receptors and do Maprotiline (Ludiomil) 27–58 not interfere with cardiac conduction. They are well tol- Amoxapine (Asendin) 8 erated by patients with heart disease and by the elderly, SSRIs who are especially sensitive to the anticholinergic and orthostatic effects of the tricyclic antidepressant agents Fluoxetine (Prozac) 168–216a (TCAs) and monoamine oxidase inhibitors (MAOIs). Sertraline (Zoloft) 25 The high degree of selectivity of SSRIs for the nerve Paroxetine (Paxil) 21 Citalopram (Celexa) 35 terminal serotonin reuptake system has supported the hypothesis that these agents produce their therapeutic MAOIs action through an ability to modulate serotonin neuro- Phenelzine (Nardil) 1. Increased 5- HT levels activate 5-HT1A autoreceptors and result in a Trazodone (Desyrel) 5–9 decrease in neuronal firing. Desensitization of this re- Bupropion (Wellbutrin SR) 21a a ceptor results in enhanced serotonin release. The termi- Nefazodone (Serzone) 18 Venlafaxine (Effexor XR) 11a nal 5-HT1B autoreceptors normally inhibiting release of Mirtazapine (Remeron) 30 serotonin also become desensitized. These events, trig- gered by a sustained inhibition of the nerve terminal SSRI, selective serotonin reuptake inhibitor; MAOI, monoamine oxidase inhibitor. As many as one-third of pa- Normal tients taking SSRIs may complain of sexual dysfunc- tion, including decreased libido, delayed ejaculation, and anorgasmia. The SSRIs tend to be weight neutral with the exception of paroxetine (Paxil), which is asso- ciated with weight gain. Fluoxetine Fluoxetine (Prozac) is given in the morning because of Acute treatment with a SSRI its potential for being activating and causing insomnia. Food does not affect its systemic bioavailability and may actually lessen the nausea reported by some pa- tients.