Warts are communicable from one part of the body to another part of the body and from one person to another as well. So, if any of the family member suffer from this health issue, the others should be careful. The warts can broadly be classified into four major categories; they are common warts, foot warts, flat warts and genital warts.

Some of the warts symptoms are as follows:

• One of the most common warts symptom found in all types of warts is the urge to scratch the affected area.
• The affected area will become rough.
• The bumps will be fleshy, small and grainy.
• The affected area might have a color change like tan, white or pink.

Types of warts:

• Common warts are called common hand warts, which grows around the nails on the back of the hands and on the fingers. This appears very often when the skin is broken due to biting of finger nails or peeling of skin from the finger.
• Flat Warts are known to grow in higher numbers and are smoother and smaller as compared to other warts. This can appear anywhere in the body like faces of children (commonly known as facial warts), legs of women, in the face of young adult males, who does shaving.
• Foot warts are also called as planter warts in medical terms. Foot warts normally appear as single or even as in clusters. Some of the areas in foot, which are prone to warts are the heel, the ball of the foot and the plantar part of the toes since these areas are often subject to pressure due to the body weight. People with diabetes are most prone to foot warts. So, they should be careful about this health issue.

Genital Warts:
Genital warts are also known as venereal warts or condylomata acuminate. These are growths in the genital area caused by a virus called Human papilloma virus or HPV. HPVs are about 80 different types and Genital warts are caused by HPV types 18, 16, 11, 6, 2 and 1. The genital warts symptoms include pain, bleeding and odor.

Different methods are being followed by people suffering from warts for treatment. The warts treatments can broadly be classified into Professional treatment and home/self treatment. Self treatment includes the common medications for warts being sold in medical stores like lotions, ointments or plasters. But, if you are not able to cure warts with the help of these lotions and ointments even after using them for months together, it is better to go for professional treatments, which will be of great use in treating the warts.

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1. Critical illnesses are often associated with circulatory, respiratory, hepatic and/or renal dys­function that may alter the pharmacokinetics and/or pharmacodynamics of drugs.
2. Decisions about routes of administration and doses of drugs used during medical emergen­cies must consider the physiological status of the patient, the pharmacokinetic and pharmacodynamic characteristics of the particular drug, and how the two interact.
3. Adverse drug reactions and interactions are more likely in critically ill patients due to the effect of the disease on drug kinetics, the decreased toxic-therapeutic ratio due to severe under­lying illness, and the large number of medications that such patients receive. Adverse reactions to drugs should be considered when unexplained deterioration or failure to respond to therapy are encountered.
4. Preservation of function of vital organs is a fundamental concept of critical care therapeutics. Preservation of cardiovascular functions requires attention to fluid and electrolyte status, prompt correction of arrhythmias and shock, and measures to preserve the myocardium against ischaemic injury.
5. Preservation of respiratory function requires protection of the airway, cautious use of fluids and oxygen, and prompt recognition and management of infection.
6. Preservation of cerebral function requires maintaining cerebral blood flow with adequate oxygen and glucose sufficient to meet the metabolic demands of the brain. This entails main­taining adequate systemic circulation, control of intracranial hypertension, and prompt control of seizures and hyperthermia.



7. Critically ill patients are particularly susceptible to infections, gastric stress erosions and ulcers, adult respiratory distress syndrome, pulmonary emboli, and haemostatic disorders. The risks of such complications may be reduced by meticulous care of catheters, pulmonary toilet, cautious use of fluids, prompt treatment of infection when it occurs, and selective prophylactic drug therapies.
8. Shock can be produced by many different processes including myocardial infarction, hypovolaemia, sepsis, drug overdose, burns, hypothermia, spinal cord transsection and anaphylaxis. Optimum treatment of shock depends on knowledge of the pathophysiology of the shock state and the pharmacology of the drugs.
9. Features of acute drug intoxication include coma, agitated delirium, seizures, hypo- and hyperthermia, shock, arrhythmias, aspiration and pulmonary oedema. Successful therapy of acute drug intoxication depends on the integration and application of knowledge of the pharmacology of both the intoxicating drug and the drugs used in therapy, as well as the principles of supportive critical care.

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Circulatory failure, or the inability of the heart to provide sufficient cardiac output to sat­isfy tissue metabolic requirements, is the most important and most common cause of altered pharmacokinetics during cardiac emergencies. Circulatory failure may result from decreased myocardial contractility, arrhythmias that allow insufficient time for diastolic filling or impair atrioventricular synchrony, circulatory stresses such as increased afterload or hypovolaemia, valvular dysfunction, tamponade, or a variety of less common insults.

Regardless of the aetiology, circulatory fail­ure elicits characteristic compensatory haemodynamic adjustments, mediated in large part by activation of the sympathetic nervous system [Peniel & Benowitz 1984; Benowitz & Meister 1978]. Enhanced sympathetic tone in­creases cardiac contractility and peripheral vas­cular resistance, both of which serve to main­tain arterial blood pressure. The increase in peripheral vascular resistance, however, is not uniform among different vascular beds.

Organs with high metabolic requirements such as the heart and brain exhibit autoregulation; despite sympathetic stimulation, the vessels in these or­gans remain relatively vasodilated as a result of the local effects of hypoxia, lactic acid or other products of anaerobic metabolism that accu­mulate when organ perfusion is reduced. Blood flow to the heart and brain tends to be pre­served, while vasoconstriction decreases blood flow in other organs such as the skin, muscles, and splanchnic organs.

Pathophysiology of Cardiopulmonary Resuscitation (CPR)

Cardiac output during cardiopulmonary resuscitation (CPR) is severely compromised; in humans the mean arterial pressure is less than 50% of normal (Chandra et al. 1981; McDonald 1981), and cardiac output in dogs is less than 30% of normal (Vorhees et al. 1980). Haemodynamic measurements are difficult to obtain in patients during CPR, but animal data suggest that changes in blood flow distribution are qualitatively similar to those observed with circulatory failure and spontaneous circulation.

Blood flow during CPR in anaesthetised, electrically fibrillated dogs is reduced to all organs, but is least reduced to the brain and next least to the heart (Vorhees et al. 1980). For the purpose of pharmacokinetic considerations, CPR and circulatory failure with spontaneous circulation can be considered to be similar, in that total cardiac output is reduced and the pattern of blood redistribution during promptly initiated CPR resembles that seen in circulatory failure.

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• Drug Overdosage and Poisoning – Synopsis of Important Principles

The mechanism by which anaesthetic drugs produce unconsciousness is still unknown. Meyer in 1899 and Overton in 1901 noted that within any group of drugs, anaesthetic potency correlates well with lipid solubility, and most modern theories agree that the site of action is probably the lipid bilayer of nerve cell mem­branes, or possibly a protein receptor in this sit­uation, but further knowledge is limited.

Inhalational Agents

Anaesthetic practice is unique in that a high proportion of the drugs are administered by the inhalational route. Such agents must either be gaseous, or the vapour of volatile liquids (Vari­ous Authors 1984).
Of the original three inhalational agents – ni­trous oxide, ether and chloroform – the first two are still used widely.

The greatest disadvantage of many of the volatile liquids and gases has been their flammable nature; the main reason for the decline of cyclopropane, which enjoyed wide popularity until the advent of halothane in 1956. Halothane, which has been firmly es­tablished as the basis of many general anaes­thetic techniques over the past 25 years, is not without its drawbacks, and investigation of new compounds continues. None of these is better overall than halothane, but in recent years ha­lothane has been slowly yielding popularity to enflurane and more recently to isoflurane.

Disposition and Pharmacological Properties

The uptake and distribution of inhalational anaesthetics is complex (Eger 1974). One must distinguish between an effective gas tension (partial pressure) and the total amount of drug dissolved in blood; it is the tension which de­termines the depth of anaesthesia. When a con­stant concentration of the anaesthetic is in­haled, the concentration in the alveoli rises gradually toward the inhaled level.

How quickly it rises will depend on the ventilation of the al­veoli (which may be reduced if the drug is ir­ritant or depresses respiration) and on the rate at which the drug is taken up into the blood from the alveoli. If the solubility (blood/gas sol­ubility coefficient) of the drug is high, then it will take longer for equilibrium to be attained, because (a) more of the drug needs to be dissolved in the blood for a given tension to be reached, and (b) the more rapid removal of the drug from the alveoli reduces the concentration here, and therefore reduces the gradient driving it from alveolus to capillary blood. A less sol­uble drug will likewise reach equilibrium more rapidly.

The rate of removal of drug into the blood will also depend on the cardiac output, which may be influenced by the drug itself; and finally the rate at which the tension of the drug in the blood rises toward that in alveoli will also depend on the rate at which it is distributed to other tissues, not only the target organ (brain), but also muscle, fat depots, etc. Such differences between infants and adults helps to explain the more rapid alveolar uptake of inhalational anaesthetics in the neonate. (Cook 1976; Eger et al. 1971).

The ability of the drug in the blood to pro­duce anaesthesia will depend on its anaesthetic potency. The minimal alveolar concentration (MAC) of the drug which will cause anaesthesia in 50% of patients is a measure often used to compare the potencies of different inhalational agents.

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1. The main aim of anaesthesia is the prevention of pain during surgery and at other times.
2. Anaesthesia involves a balanced approach, in which the individual patient’s psyche and pathophysiology are taken into account and drugs are used to modify and control any aspect as required.
3. The decision to use a particular drug or technique must be made after careful consideration of the pathophysiological features of the individual case and how these may affect the phar­macokinetic handling and tissue response to the drugs available.
4. Any associated disease or pathophysiological abnormality should wherever possible be treated or corrected before operation, and potentially dangerous physiological disturbances avoided during and after anaesthesia.
5. Anaesthetic drugs are relatively non-toxic but there are some important effects. Halothane is occasionally associated with hepatitis and methoxyflurane with kidney damage. Malignant hyperpyrexia, the aetiology of which is uncertain, is a rare but often fatal condition which can be triggered off by several anaesthetic drugs in genetically susceptible individuals.
6. Drugs used in anaesthesia can be involved in significant unwanted interactions with other drugs.
7. The treatment of respiratory failure is usually the responsibility of the anaesthetist. Although ventilatory assistance, physiotherapy, etc. are often the mainstay of treatment, drugs of different pharmacological classes are used.
8. Pain perception is an individual sensation. Symptomatic treatment of acute pain should not therefore be based on a concept of the painfulness of certain conditions, although some anal­gesics may be more appropriate for pain of certain conditions.
9. Strong analgesics for severe chronic pain should preferably be given orally, in adequate dosage, and on a regular individualised dosage schedule.

General Considerations

Although achieving insensibility to pain and to unpleasant surroundings has been the goal of much human activity since prehistoric times, it is only since 1846 with the introduction of ether by Morton that this could be done with any re­liable chance of success. Anaesthesia has devel­oped and been refined considerably since that time, and several important milestones are re­cognized and worthy of recall. These include the discovery of the local anaesthetic action of co­caine by Koller in 1884 and its use to produce spinal anaesthesia by Bier in 1898, the perfec­tion of endotracheal anaesthesia by Magill and Rowbotham about 1920, the introduction of the first barbiturate for induction of anaesthesia in 1932, and the introduction of curare in 1942.
In recent years, the specialty of anaesthesia has been broadened, and its scope is well de­scribed in a definition for the US Department of Labor (Dripps 1966):

Anesthesiology is a practice of medicine dealing with:

• The management of procedures for ren­dering a patient insensible to pain during surgical procedures.
• The support of life functions under the stress of anesthetic and surgical manipu­lations.
• The clinical management of the patient unconscious from whatever cause.
• The management of problems in pain re­lief.
• The management of problems in cardiac and respiratory resuscitation.
• The application of specific methods of inhalational therapy.
• The clinical management of various fluid electrolyte and metabolic disturbances.

The modern concept is one of ‘balanced an­aesthesia’, in which the whole of the patient’s psyche and pathophysiology are taken into ac­count and drugs are used to modify and control any aspect as required. Thus, as well as general anaesthetic agents, drugs of many classes – tran­quillisers, analgesics, muscle relaxants, drugs af­fecting the autonomic system etc. – all fall within the sphere of interest of the anaesthetist. ( Some of the more important of these will be discussed further at later part – Drugs Used in Anaesthesia .)

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Although the use of cathartics and enemas is traditional, these measures are most unlikely to reduce absorption since this usually occurs rap­idly in the upper small intestine. They can only add to the misery and discomfort of the patient Efficacy in removal of drug has never been es­tablished. In one recent study, saline catharsis had no beneficial effect whatsoever on the ab­sorption of aspirin taken with charcoal (Sketris et al. 1982).

Whole Gut Lavage

One situation where attempts to empty the bowel may be helpful is in poisoning with ’slow’ or ‘timed release’ formulations. The number of such preparations on the market is increasing and since they usually contain a much larger dose of drug than ordinary tablets, intoxication may be severe and prolonged.

In such circumstances, rapid emptying of the bowel might limit in absorption. The preferred technique is ‘whole gut lavage’ in which normal saline is given by nasogastric tube at a rate of 2 litres an hour (Woo et al. 1976). Although this technique is readily controlled and rapidly effective in emptying the bowel in conscious patients being prepared for abdominal surgery, its efficacy in removing un-absorbed drug has yet to be established. It may not be effective and could possibly be dangerous in poisoned patients with grossly depressed gas­trointestinal motility.

Activated Charcoal

Activated charcoal has great adsorptive ca­pacity and can reduce the absorption of many compounds if taken orally at the same time (Neuvonen 1982; Pond 1986). The charcoal must be given in great excess (at least 10 times the weight of the drug) and efficacy falls off rap­idly as the time interval between ingestion of the poison and administration of the charcoal increases. After 1 hour, there is little inhibitory effect on the absorption of most drugs, although a significant reduction has been reported with phenytoin.

The time interval during which ac­tivated charcoal can significantly reduce ab­sorption following overdosage may be increased by the presence of food in the stomach (Olkkola & Neuvonen 1984). Oral activated charcoal ap­pears to be as effective as emesis induced by syrup of ipecac in limiting absorption (Neuvo­nen et al. 1983), but its administration after gas­tric lavage is of little or no benefit (Comstock et al. 1982).

Although the delay between inges­tion of the drug and arrival in hospital is usually such that significant reduction in absorption by oral activated charcoal is unlikely, there is no contraindication to its use and repeated admin­istration greatly increases the elimination of some drugs.

• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Methods for Enhancement of Drug Elimination
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Drug Overdosage and Poisoning – Synopsis of Important Principles
• Gastric Aspiration and Lavage
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• Symptoms, Types and Treatment Options for Warts
• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
• Pathophysiology of Circulatory Failure and Cardiopulmonary Resuscitation
• Anaesthetic Agents – Drugs Used in Anaesthesia

General Information of the drug

• Miglitol works differently from other oral antidiabetes drugs, which control blood sugar levels by increasing the production of insulin or helping the body to use the hormone more efficiently.
• Miglitol delays the digestion of carbohydrates (sugars) by acting in the cells that line the small intestine, where sugar is absorbed. This results in less sugar being absorbed into the blood and therefore, a lower blood-sugar level.
• Miglitol also has some effect against the enzyme lactase, but usually does not cause lactose intolerance. Hypoglycemia (very low blood sugar) is unlikely with miglitol because of the way the drug works in diabetes.
• Miglitol may be prescribed with another antidiabetic drug if single-drug therapy is not enough to adequately control blood sugar levels.



• People taking miglitol should have their blood sugar checked periodically to see how well the drug is working. Your blood glucose should be carefully monitored if you add or withdraw any of these drugs while taking miglitol or acarbose. It is common for patients to equip themselves with Home Glucose Monitors, which is widely available.
• Thiazides and other diuretics, corticosteroid anti-inflammatory drugs, phenothiazines, thyroid drugs, estrogens, contraceptive drugs, phenytoin, nicotinic acid, stimulants, calcium channel blockers, and isoniazid may increase blood sugar levels.
• Miglitol and acarbose add to the blood-sugar-lowering effect of sulfonylureas, insulin, and other antidiabetes drugs and may increase the risk of hypoglycemia (low blood sugar) associated with these drugs.
• Miglitol may interfere with the absorption of several drugs into the blood, including propranolol, ranitidine, digoxin, glyburide, and metformin. Seek advise with your doctor as he/she may need to adjust your dose of these drugs.
• Digestive enzyme preparations, charcoal, kaolin (an ingredient in Kaopectate), and antacids—as well as other drugs intended to absorb stomach contents—reduce the effects of miglitol and acarbose. Separate dosing of these drugs by at least 2 hours.
• Combining acarbose and digoxin may increase the effects of digoxin.
• As Miglitol prevents the breakdown of table sugar, if you take Miglitol in combination with insulin or a sulfonylurea prescription drugs, make sure to have a quick source of glucose (dextrose) with you to treat hypoglycemia ( symptoms include increased hunger, tiredness, sweating, increased heart rate, and numbness in the arms and legs ).
• Take your dose with the first bite of each meal. The drug has to be present in your intestine to prevent the absorption of sugar into your blood.
• As Miglitol cannot work unless there is food in your stomach, if you do forget to take a dose of miglitol with your meal, skip the dose you forgot. At the beginning of your next meal, continue with your regular dose .
• Before buying any nonprescription drug, seek advice with your pharmacist to be sure if it is safe for diabetics to take together with acarbose.

Cautions

• Do not take miglitol if you are sensitive or allergic to any of its ingredients
• If you have diabetic ketoacidosis, cirrhosis of the liver, inflammatory bowel disease, ulcers in the colon, intestinal obstruction, absorption or digestion diseases, or if intestinal gas, it will be a severe problem. Consult your doctor before taking this prescription.
• Acarbose may lead to liver inflammation.
• People with kidney disease retain higher levels of miglitol in the blood, but this does not affect the drug’s action because it acts locally in cells lining the small intestine. For patients with severe kidney disease should not take this drug due to drug retention in the blood.

Dosage and Possible Overdose ( This Prescription is not for Child )

• Acarbose :- Adult: 25-100 mg with breakfast, lunch, and dinner.
• Miglitol :- Adult: 25-100 mg with breakfast, lunch, and dinner.
• Miglitol must be taken with the first bite of each main meal.
• Unlike other antidiabetic medicines, a miglitol overdose does not cause hypoglycemia. Overdose symptoms are likely to include gas, diarrhea, and pain.
• Follow your doctor’s instructions especially for dietary plan, exercise, and blood- sugar testing. ( See Possible Side Effects below )

Possible Side Effects
a. Acarbose
Intestinal side effects of acarbose tend to improve or go away after a few weeks.
Most common:

• stomach gas (in 75% of people who take it),
• abdominal pain,
• and diarrhea.

( These side effects may be worse if you don’t restrict the amount of carbohydrate in your diet. Consult your doctor on proper dietary plan )

Less common or Rarely Occurs :

• skin rashes.
• swelling and itching,
• hepatitis or yellowing of the skin or whites of the eyes,
• abdominal distress,
• abdominal obstruction,
• liver irritation,
• abnormalities in blood tests.

b. Miglitol ( Most side effects of miglitol go away with continued use of the drug )
Most common:  gas, diarrhea, and abdominal pain.
Less common or Rare Effects : rash and low blood iron.

** For Unusual Side Effects that you may notice, seek your doctor advise immediately !

Pregnancy/Breast-feeding period :
Nursing Mothers who must take this drug should use infant formula, as the safety of using miglitol during pregnancy is not known, but small amounts of miglitol pass into breast milk. ( Diabetes during pregnancy is usually treated with insulin. )

Seniors Adult Consumption
Seniors with severe kidney disease should avoid this medication.

*Blood levels of acarbose are higher in older adults, but this is usually not considered important. Always consult your doctor if in doubt.

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• Anxiety,
• tension,
• symptoms of acute alcohol withdrawal,
• partial seizures,
• fatigue,
• agitation,
• irritable bowel syndrome,
• and panic attacks.

General Information of the drug

• Clorazepate dipotassium is a benzodiazepine, which directly affect the brain. This drug is a central-nervous-system depressant, and can relax you and make you more tranquil or sleepier, or they can slow nervous system transmissions in such a way as to act as an anticonvulsant.
• Many doctors prefer benzodiazepines to other drugs that can be used to similar effect because they tend to be safer, have fewer side effects.
• Clorazepate may increase blood levels of digoxin and the chances of digoxin toxicity.
• Don’t mix it with alcohol, other sedatives, narcotics, barbiturates, monoamine oxidase inhibitor and other antidepressants, and antihistamines.
• Taking clorazepate with other similar effects drugs may result in excessive depression, tiredness, sleepiness, breathing difficulties, or related symptoms.
• Combining clorazepate with phenytoin may increase phenytoin blood concentrations and the chances of phenytoin toxicity.
• Smoking may reduce clorazepate’s effectiveness by increasing the rate at which it is broken down by the body.
• Clorazepate’s effects may be prolonged when it is mixed with cimetidine, contraceptive drugs, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, probenecid, propoxyphene, propranolol, rifampin, or valproic acid.
• If you have to take Tranxene for a prolong period of time, your doctor will need to monitor your blood counts and liver function to be sure of your health state.
• Theophylline may reduce clorazepate’s sedative effects.
• If you take antacids, separate them from your clorazepate dose by at least 1 hour to prevent them from interfering with the absorption of clorazepate into the bloodstream.
• The effect of levodopa + carbidopa may be decreased if it is taken together with clorazepate.

Cautions ( This drug may be addictive ! )

• Clorazepate may be addictive. It should be used with caution in people with a history of drug dependence.
• Do not take clorazepate if you are allergic or sensitive to any of its ingredients or to another benzodiazepine drug, including clonazepam.
• Clorazepate can aggravate narrow-angle glaucoma, but you may take it if you have open-angle glaucoma and are receiving therapy for it.
• Clorazepate should not be taken by psychotic patients because it is not effective for them and can trigger unusual excitement, stimulation, and rage.
• Clorazepate is not intended to be used for more than 3-4 months at a time. Your doctor should reassess your condition before continuing your prescription beyond that time.
• Your dosage should always be reduced gradually to prevent drug withdrawal symptoms, which may develop if you stop taking it after as few as 4 weeks of regular use but is more likely after longer use.
• Drug withdrawal symptoms may start with anxiety and progress to tingling in the hands or feet, sensitivity to bright light, sleep disturbances, cramps, tremors, muscle tension or twitching, poor concentration, flu-like symptoms, fatigue, appetite loss, sweating. and changes in mental state.
• Other conditions in which clorazepate should be avoided are: severe depression, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, drunkenness, and kidney disease. In each of these conditions, the depressive effects of clorazepate may be enhanced or could be detrimental to your overall condition.

Note

• This drug is for Adult Only ! It is not recommended for child.
• Clorazepate is best taken on an empty stomach, but if it upsets your stomach then it may be taken with food. Consult your doctor on this.
• Clorazepate can cause tiredness, drowsiness, inability to concentrate, or similar symptoms. Be careful if you are driving, operating machinery, or performing other activities that require concentration.
• People taking clorazepate for more than 3 or 4 months at a time may develop drug withdrawal reactions if the medication is stopped suddenly (see “Cautions” section above). Do not stop taking clorazepate or increase or decrease your dosage without first consulting your doctor.
• Do not take a double dose. If you forget a dose of clorazepate, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule.

Pregnancy/Breast-feeding period :

• Clorazepate may cause birth defects if taken during the first 3 months of pregnancy.
• Avoid this drug if you are or might be pregnant, as Clorazepate may pass into breast milk. Nursing mothers who must take clorazepate should switch to use infant formula.

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• Drug Overdosage and Poisoning – Synopsis of Important Principles
• Angiotensin-Converting Enzyme Inhibitor – Vasotec Enalapril
• Gastric Aspiration and Lavage

1. Specific antidotal therapy is available for very few poisons. The mainstay of treatment of severe poisoning is intensive supportive therapy and good nursing care.

2. The great majority of poisoned patients recover with intensive supportive therapy alone, and enthusiastic claims for the success of other treatment often cannot be justified.

3. With some important exceptions, the management of poisoning is not altered by knowledge of plasma drug concentrations. There are many pitfalls in the interpretation of drug concen­trations in poisoned patients, especially when nonspecific analytical methods are used.

4. Gastric lavage and induction of nemesis soon after ingestion may be effective in removing unabsorbed drug, but are unreliable. Adsorbents such as activated charcoal are usually ineffec­tive in limiting absorption when given more than 1 hour after ingestion.

5. Poisoned patients are often subjected to unnecessary and potentially harmful haemodialysis, haemoperfusion and diuresis. The efficacy of these measures has been established for relatively few substances in terms of reduction in morbidity and mortality or removal of toxicologically significant amounts of active drug or poison.

6. The efficacy of methods for extracorporeal removal can be predicted from pharmacokinetic principles. It depends primarily on the volume of drug distribution, plasma protein binding, rate of transfer from peripheral to central compartments, and dialysis clearance relative to the endogenous total body clearance.

7. Haemoperfusion with activated charcoal or exchange resins is more effective than haemo­dialysis in removing drugs from the blood. Peritoneal dialysis is less effective than haemodi­alysis. Drugs with large volumes of distribution cannot be removed rapidly by any of these techniques, and indications for their use are limited.

8. Forced diuresis can only increase the renal clearance of reabsorbed compounds, and clearance may be dramatically increased by appropriate manipulation of urine pH. However, the renal excretion of most drugs is insignificant in relation to the metabolic clearance. Forced alkaline diuresis is largely restricted to salicylate and phenobarbitone poisoning.

9. Repeated oral activated charcoal effectively increases the body clearance of a number of drugs. It probably acts by irreversibly binding drug diffusing from the circulation to the gut lumen and may also interrupt the enterohepatic circulation.

10. The toxicity of a few drugs and poisons can be reversed by specific antidotal therapy. Mechanisms include pharmacological antagonism, inhibition of conversion to toxic metabolites, inactivation of highly reactive alkylating intermediates, chelation and binding with drug-specific antibodies.

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• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Gastric Aspiration and Lavage
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Collaboration Between Healthcare Provider and Clinical Labora­tory on Therapeutic Drug Monitoring
• Cathartics, Enemas and Activated Charcoal
• Treatments Usage and Effects of Dronabinol Drug (Or Marinol )

• Nausea and vomiting associated with cancer chemotherapy,
• appetite stimulation and weight-loss prevention in people with acquired immunodeficiency syndrome (AIDS).

General Information

• Dronabinol is a legal form of marijuana. The psychoactive chemical in marijuana is delta-9-THC. Dronabinol has all of the psychological effects of marijuana and is therefore considered to be a highly abusable drug.
• Dronabinol increases the effects of alcohol, sleeping pills, sedatives, and other depressants.
• Dronabinol also enhances the effects of psychoactive drugs including tricyclic antidepressants, amphetamines, cocaine, and other stimulants.
• This drug is known to be potential cause of personality changes, feelings of detachment, hallucinations, and euphoria (feeling “high”).
• Younger adults have reported a greater success rate with dronabinol, probably because they are better able to tolerate these effects.
• Most people start taking dronabinol while in the hospital so their response to the drug and its possible adverse effects can be monitored.
• Dronabinol has also been studied as a glaucoma treatment. ( More information to be researched in this field )
• Dronabinol may increase the effects of fluoxetine and disulfiram.
• The effects of theophylline drugs are reduced by dronabinol.
• Combining dronabinol and antihistamines or anticholinergic drugs may cause either rapid heartbeat or excessive drowsiness.

Cautions ( This drug has serious effects ! )

• Do not take dronabinol if you are allergic or sensitive to any of its ingredients, to marijuana. or to sesame oil.
• Dronabinol should be used with caution in those with a history of seizure disorders or substance abuse.
• Dronabinol should be used with caution by people with heart disease or high blood pressure.
• Dronabinol has a profound effect on mental states, as it will impair your ability to operate complex equipment or engage in any activity that requires intense concentration, sound judgment, or coordination—such as driving a car.
• Dronabinol should not be used to treat nausea and vomiting caused by anything other than cancer chemotherapy.
• Dronabinol produces withdrawal symptoms when the drug is stopped. These may develop within 12 hours of the drug’s discontinuation and include restlessness, sleeplessness, and irritability.
• Within a day after the drug has been stopped, symptoms like stuffy nose, hot flashes, sweating, loose stools, hiccups, or appetite loss may occur. These symptoms usually subside within a few days.
• Dronabinol should be used with caution by people with a manic-depressive or schizophrenic history because it may aggravate the underlying disease.

Note :-

• Avoid alcohol and other central nervous system (CNS) depressants.
• The capsules must be stored in the refrigerator.
• Be careful when driving or performing any task that requires concentration.
  Dronabinol may cause acute psychiatric or psychological side effects. Call your doctor for advise.

Common Side Effects of the drug :-

• drowsiness,
• depression,
• loss of muscle coordination,
• unsteadiness,
• paranoia,
• depersonalization,
• disorientation,
• euphoria,
• dizziness,
• weakness,
• sluggishness,
• nausea and vomiting,
• headache,
• a separation in time and space,
• confusion,
• rapid heartbeat.
• hallucinations,
• memory lapses,
• anxiety,
• muddled thinking,
• perceptual difficulties,
• poor coordination,
• irritability,
• dizziness when rising from a sitting or lying position.

Unlikely Side Effects :-

• difficulty talking or slurred speech,
• facial flushing
• loss of bowel control,
• excessive perspiration,
• fainting,
• diarrhea,
• nightmares,
• ringing or buzzing in the ears,
• muscle pain

Usual Dose Intake ( Do not take a double dose )

1. Antiemetic :

• 5 mg 1-3 hours before starting chemotherapy treatment and repeated every 2-4 hours after treatment, for a total of 4-6 doses a day.
• Dosage may be increased up to 15 mg per dose if needed; psychiatric side effects increase greatly at higher dosages.

2. Appetite Stimulant:

• 2.5 mg before lunch or dinner, or 2.5 mg at bedtime. Dosage may be increased to 20 mg a day.

Over Dosage Effect(s)

• Overdose symptoms may occur at usual dosages or at higher dosages if the drug is being abused.
• The primary symptoms of overdose are the psychological symptoms listed above (see “Side Effects lists above”).
• In some cases, overdose may lead to panic reactions or seizure.

Pregnancy/Breast-feeding period :

• Dronabinol is known to be passes into breast milk. Nursing mothers who must take this drug should use infant formula. Animal laboratory studies have shown adverse effects on the fetus.

• Generalized Anxiety Disorder Treatment with Clorazepate ( Tranxene )
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• Angiotensin-Converting Enzyme Inhibitor – Vasotec Enalapril
• Pathophysiology of Circulatory Failure and Cardiopulmonary Resuscitation
• Anaesthetic Agents – Drugs Used in Anaesthesia
• Symptoms, Types and Treatment Options for Warts
• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Drug Overdosage and Poisoning – Synopsis of Important Principles

Although unabsorbed drug in the stomach may be removed by gastric aspiration and lav­age its usefulness in practice has been seriously questioned (Proudfoot 1984). Most drugs and poisons seem to be absorbed rapidly and this technique is unlikely to be productive more than 4 hours after ingestion, unless gastric emptying has been delayed by opioid analgesics, anti­cholinergic agents, central nervous system de­pressants, and possibly salicylates. In such circumstances gastric lavage may be worthwhile up to 12 hours after ingestion.

It is said to be contraindicated after ingestion of corrosives and hydrocarbons such as paraffin because of the risks of perforation and lipoid pneumonia, respectively.

The patient must be correctly positioned head down in the left lateral position and a cuffed endotracheal tube inserted beforehand if the protective pharyngeal reflexes are depressed. It is essential to use a large bore tube (e.g. Jacques 30 gauge) and in adults lavage should be carried out with 300ml portions of warm tap water un­til the return is clear. Complications include pulmonary aspiration of stomach contents, and, rarely, oesophageal rupture.

Although gastric lavage is often unrewarding, large amounts of drug are occasionally re­covered. A common cause of failure is the use of too small a tube – an ordinary nasogastric tube is virtually useless. Large amounts of re­sidual drug have been found in the stomach postmortem after attempts at lavage with a nasogastric tube (Jenis et al. 1969), and in i case i large drug mass containing 25g of meproba­mate was removed by gastrotomy 40 hours after ingestion despite gastric lavage (Schwartz 1977).

Emetics

The comparative efficacy of induced emesis and gastric lavage is still debated. Neither guar­antees emptying of the stomach. Lavage is not always practicable in children because of the physical difficulty in passing a tube large enough to allow the passage of tablets, and emesis is probably preferable in young children. In 1 study in children poisoned with salicylates, emesis was claimed to be more effective than lavage (Boxer et al. 1969), but in another, only 10 to 15% of the amount of salicylate taken was recovered, even when emesis occurred within 1 hour of ingestion (Yaffe et al. 1970).

The major disadvantages are failure of eme­sis, particularly if central nervous system de­pressants have been taken, and toxicity, some­times fatal, from the retained emetic. Syrup of ipecac given with water is probably the best emetic, and is often effective within 15 to 30 minutes (Neuvonen et al. 1983).

Other agents which have been used include sodium chloride, copper sulphate, zinc sulphate, tartar emetic (antimony potassium tartrate), apomorphine and mustard. However, the over-enthusiastic use of sodium chloride and heavy metals can be ex­tremely dangerous and fatal poisoning with salt and copper sulphate has been reported (Gresham & Mashru 1982; Stein et al. 1976).

• Generalized Anxiety Disorder Treatment with Clorazepate ( Tranxene )
• Drug Overdosage and Poisoning – Synopsis of Important Principles
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
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• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Cathartics, Enemas and Activated Charcoal
• Methods for Enhancement of Drug Elimination
• Symptoms, Types and Treatment Options for Warts
• Pathophysiology of Circulatory Failure and Cardiopulmonary Resuscitation

General Information of the drug

• Mupirocin nasal is used to prevent resistant Staphylococcus aureus infections from spreading during outbreaks of the infection.
• Mupirocin can also be used to treat diaper rash.
• Mupirocin is a unique, non-penicillin drug that works against the common microorganisms that cause impetigo in children.
• It is used to supplement other treatments for impetigo, although many doctors prefer oral medication.
• Mupirocin works by interfering with bacteria’s ability to make the proteins it needs for survival.
• Large amounts of mupirocin kill bacteria and smaller amounts stop the bacteria from growing. It may be effective against antibiotic- resistant bacteria.

Cautions

• If you are allergic or sensitive to any of its ingredients – Do not use a mupirocin product.
• Mupirocin ointment is not for use in the eye.
• Taking other antibiotics while using mupirocin can lead to the development of resistant bacteria.
• Mupirocin nasal should be used only to treat Staphylococcus aureus infections, not to prevent them.
• Large quantities of mupirocin ointment should not be applied to an open wound because polyethylene glycol—used as a base in mupirocin ointment—may be absorbed through the wound and damage the kidneys.
• Long-term or chronic use of mupirocin may lead to secondary infection caused by drug-resistant bacteria or fungi.
• Do not use mupirocin nasal at the same time as any other prescription or over-the-counter nasal drug product.

Possible Side Effects ( Contact your doctor if you experience any side effect that’s unusual )

This drug could be in several form, as below :-

Rarely or Less Common Side Effect in using Ointment form :-

• burning,
• pain,
• itching,
• rash,
• stinging or pain where the ointment is applied;
• nausea
• skin redness,
• dry skin,
• tenderness,
• swelling,
• increased oozing from impetigo lesions.

Rarely or Less Common Side Effect in using Cream form :-

• headache,
• rash,
• nausea,
• abdominal pain,
• burning,
• irritation,
• inflammation,
• dizziness,
• itching,
• secondary infection,
• mouth ulcer.

Side Effects in using Nasal Ointment form :-
Most common : headache and runny nose.
Rarely or Less common side effects : respiratory congestion, sore throat, changes in sense of taste, burning or stinging, cough, and itching.

Pregnancy/Breast-feeding period :

The safety of using this drug during pregnancy is not known. Nursing mother who must use this drug is advisable to use infant formula instead, as it is not known if mupirocin passes into breast milk or not.

• Symptoms, Types and Treatment Options for Warts
• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Synopsis of Important Principles – Drugs in Anaesthetic Practice
• Cathartics, Enemas and Activated Charcoal
• Angiotensin-Converting Enzyme Inhibitor – Vasotec Enalapril
• Treating Hypertension with Lexxel Generic Drug
• Pathophysiology of Circulatory Failure and Cardiopulmonary Resuscitation
• Anaesthetic Agents – Drugs Used in Anaesthesia
• Generalized Anxiety Disorder Treatment with Clorazepate ( Tranxene )

Although quinidine is rarely used for this purpose today, because of the advent of DC cardioversion, this study is still almost unique because it defined a target concentration based upon both the probability of therapeutic success and of toxicity.

A concentration of 8 rag/ L was shown to have an 80% chance of converting atrial fibrillation to sinus rhythm and a 20% chance of some serious toxicity. No atten­tion was paid to pharmacokinetics, The target concentration was chosen on the basis of pharmacodynamics, i.e. the effects, both good and bad, observed at particular concentrations.

Rational therapeutics – the aim of rational ther­apeutics is to achieve the desired effect with the cor­rect dose. The foundation of decision making is based on pharmacokinetics and pharmacodynamics which provide the rational principles to link dose and effect through drug concentration.

Rational therapeutics can be defined as the administration of the correct dose to achieve the desired effect. The target concentration concept is at the centre of rational therapeutics where it links dose to effect. Pharmacokinetics is the science that links dose and concentration by defining the processes of drug distribution (volume of distribution) and elimination (clear­ance).

Pharmacodynamics, on the other hand, is the science linking concentration to effect by defining the maximum effect of the drug (Emax) and the sensitivity of the target organ (as de­termined by the EC50; M£ the concentration producing 50% of Emax).

Therapeutic drug monitoring can now be placed at the centre of this therapeutic triangle. This incorporates information about doses, concentrations, and effects in an individ­ual and integrates these data to estimate more precisely the pharmacokinetic (volume of dis­tribution, clearance) and pharmacodynamic (Emax, EC50) parameters in that individual. These new values can then be used to predict the consequences of future dosing decisions and thus enable the selection of a suitable dose to achieve the desired effect, i.e. rational therapeutics.

• Collaboration Between Healthcare Provider and Clinical Labora­tory on Therapeutic Drug Monitoring
• Drugs Usage during Critical Medical Emergencies – Synopsis of Important Principles
• Treating Diabetes Type2 with Miglitol ( Glyset, Acarbose, Precose )
• Generalized Anxiety Disorder Treatment with Clorazepate ( Tranxene )
• Drug Overdosage and Poisoning – Synopsis of Important Principles
• Anaesthetic Agents – Drugs Used in Anaesthesia
• Cathartics, Enemas and Activated Charcoal
• Methods for Enhancement of Drug Elimination
• Treatments Usage and Effects of Dronabinol Drug (Or Marinol )
• Gastric Aspiration and Lavage