C. Jerek. National Defense University. 2019.
Quassia in infusion will destroy small insects quality citalopram 20mg anxiety guru, ants generic 20 mg citalopram otc depression definition webster, flies and lice of all kinds citalopram 40 mg line depression youth symptoms. The pediculus capitis and pediculus pubis are readily destroyed by frequent washing with a strong infusion of the drug. Therapy—The agent is of value in epidemic dysentery acute and chronic diarrhea, obstinate intermittents, pulmonary and laryngeal phthisis tabes mesenterica, great exhaustion of the vital powers from disease, profuse, exhausting night sweats, colliquative sweats in the advanced stages of adynamic fevers, and debility, and severe diarrhea in sickly children, scrofula, gangrene, ulcerated sore throat, fetid, ill-conditioned and gangrenous ulcers, relaxed mucous membranes with profuse discharges, bronchorrhea, passive hemorrhages, relaxed uvula and sore throat, spongy granulations, diabetes, prolapsus ani, bleeding hemorrhoids, leucorrhea, menorrhagia, hemoptysis. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 368 Generally white oak bark is used locally, in decoction, for the general purpose of an astringent, but it is also tonic and antiseptic, and possesses specific powers. In severe epidemic dysentery, a strong decoction of white oak bark, given internally, in doses of a wineglassful every hour or two, the bowels being first evacuated by a cathartic of castor oil and turpentine, has effected cures where other treatment had proved of little or no avail. In marasmus, cholera infantum, scrofula, and diseases attended with great exhaustion, baths medicated with white oak bark, accompanied by brisk friction, have restored the waning powers of life. When employed as a local application to ill-conditioned ulcers and gangrene, either a poultice of the ground bark, or cloths wet with the decoction may be applied. In pulmonary and laryngeal phthisis a very fine powder of the bark may be inhaled. I have depended upon a decoction of white oak bark one ounce to the pint of boiling water, to which I have added after straining, a dram of boric acid for all ulcerations of the mouth or throat, both in the early stages and in many chronic cases. It is surprising how many simple early throat troubles this will abort, and bow frequently it will prevent suppuration in tonsillitis. Combined with Yellow Dock, it has cured for me the severest cases of nursing sore mouth that I have had, after other lauded remedies had signally failed. When the remedy is given internally in diarrhoea and dysentery, it should be combined with cinnamon or other astringent aromatic. Dose, as a stomachic tonic and function restorer, three to ten minims; laxative, five to twenty minims four times a day; as a cathartic, twenty to sixty minims morning and evening. Dose, as a laxative, one-half to two grains; as a cathartic, three to eight grains. Powdered Extract Cascara Sagrada, produced by evaporating the solid extract at a low temperature and triturated with sugar of milk, same strength as the solid extract. Bundy, the discoverer of cascara, writing in 1878, says: “I employ a fluid extract of cascara, using one ounce in a four ounce mixture in combination with other remedies or alone, as the case may require. It acts upon the sympathetic nervous system, especially upon the solar plexus, stimulating the nutritive and assimilative forces, increasing the digestive processes generally. It acts upon the secretory system in a marvelous manner, especially where the secretions are deficient and perverted, and this seems be one of its special indications. Constipation depends upon the nature of the diet, deficiency or a faulty composition of the intestinal secretions, disordered glands that pour their secretions into the intestines, impairment of muscular power, which leads to a deficiency in their propelling power which may result from nervous or mechanical influences, congestion of the portal circulation, normal secretion of intestinal juices interfered with, deficiency in biliary secretions of a healthy character, congestion of mucous membranes of intestines, and last and the most frequent, constipation which has been caused by resisting the calls of nature from carelessness or circumstances that prevent obedience at the proper time. Record) made the following observations: “In doses from four to ten cubic centimetres (with double quantity of water), cascara sagrada excites the secretion of gastric juice and increases it during digestion. It acts upon the vasomotor Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 370 system, stimulating the glandular apparatus of the intestinal tract to more perfect secretion, and increasing peristaltic action. It is especially indicated in torpidity or atonicity, quickly restoring functional activity. It is not a cathartic in the common acceptation of the term, but by restoring normal function, by its tonic influence, bowel movement of a natural character follows. It does not mechanically liquefy and empty the intestinal canal, but it restores normal elasticity and tone to the relaxed structures, and natural vermicular motion and peristaltic action, exercising a direct influence upon muscular structure of the intestinal walls. It materially influences the venous and capillary circulation of the entire intestinal tract, thus proving of much value in hemorrhoids. Administration—In prescribing cascara for the cure of chronic constipation, large doses at the first are undesirable. If a single dose, so large as to produce a cathartic effect be administered, subsequent small doses will prove insufficient to restore tone, and the constipation will remain unless the large dose is constantly repeated. If a dose of from two to ten drops in a proper vehicle be given, three, four or five times daily for many days, even if the constipation does not at first yield, the effects after a few days are usually salutary. There is a normal movement in the morning and the habit of regular evacuation can be soon fixed, and as the agent is continued the dose may be slowly decreased until a single drop at each dose is given. Finally, a single small dose morning and night may be continued for a time and then stopped, the bowels continuing their normal action. If constipation pre-exists, it is well to give a simple laxative or to flush the bowels thoroughly with some other agent before beginning the use of this, to overcome the chronic condition. In the temporary constipation of pregnancy or in the convalescence of acute disease, doses of from one-fourth to one-half dram in a tonic mixture, preferably of malt extract, taken at the bed hour will be most satisfactory. Often a single dose followed by a glass of cold water on rising will have a salutary effect. This is true of constipation extending over a short period, not necessarily chronic. To produce an immediate effect as a physic, a dram of the fluid extract should be given, and it will probably Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 371 induce some pain. The agent should not be used in this active form for its immediate effects during the pregnant term, as its irritating influence may be sufficient to produce miscarriage. It quickly restores the normal tone of the mucous membranes, suspending undue secretion and acting in perfect harmony with other measures adopted. It is a useful remedy in many cases of chronic indigestion and in chronic disease of the liver. It is useful in jaundice with deficient excretion of bile, and corrects catarrh of the bile duct. It is useful in diarrhea, subacute or chronic, depending on deficient liver action, and upon catarrhal and atonic conditions of the intestinal tract. In 1886 quite an interest was excited by the assertion of Goodwin, of New York, that cascara was an excellent remedy for rheumatism. Many experimented with it and some reported excellent results, but its use for this purpose has not been continued. It is, however, of value in the treatment of those cases where gastric and intestinal disorders are present, given in conjunction with more specific agents. Syrupus Rhei et Potassae Compositus, Compound Syrup of Rhubarb and Potassa, Neutralizing Cordial. It is a laxative first, cathartic if in extreme doses, and subsequently astringent. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 372 It tones the gastro-intestinal tract to a marked degree, if debilitated, and if over-activity is prevent, the agent restrains that condition. It mildly and satisfactorily evacuates the bowels without irritation or stimulation. Some individuals eat a few grains of the crude root, which they carry in the pocket, every day for chronic constipation, others are not benefited with large doses. Therapy—In atonic conditions of the bowels, with debility or general relaxation, whether diarrhoea, dysentery, cholera morbus or cholera infantum is present, it is a most useful remedy. Its tonic powers are promptly exercised, and properly combined with indicated remedies, it produces markedly restorative effects.
Orthostatic hypotension may occur as the result of volume depletion or disorders of autonomic regulation of vascular tone resulting in excessive peripheral vasodilatation cheap citalopram master card depression definition and meaning. The most important issue in determining the approach to the patient with syncope is the presence of structural heart disease cheap 20 mg citalopram mastercard mood disorder youth. The etiologies of syncope range from the relatively benign disorders such as neutrally mediated syncope to life-threatening ventricular arrhythmias discount 20mg citalopram with amex mood disorder journal pdf. When a patient has evidence of structural heart disease, it is important to consider ventricular tachyarrhythmias as possible causes of syncope since they may be life-threatening. Treatment of Bradyarrhythmias The common indication for the treatment of bradyarrhythmias are symptoms such as syncope or near syncope, fatigue, or congestive heart failure which may result from excessively slow rates. Neurological and cardiovascular characteristics of the patient make the rate and duration of bradycardia which results in syncope variable. No pharmacologic therapy is commonly used to treat bradyarrhythmias which otherwise would be treated with pacemakers. Treatment of Supraventricular Tachyarrhythmias Supraventricular tachycardias which utilize the A-V node as an obligate part of the reentrant circuit (A-V nodal reentrant tachycardia or A-V reciprocating tachycardia utilizing an accessory pathway or bypass tract) may be acutely treated with vagal maneuvers such as carotid sinus massage or Valsalva maneuver or with intravenous medications which block A-V nodal conduction. The drug of first choice is adenosine while other agents such as beta-adrenergic receptor antagonists and calcium channel antagonists verapamil or diltiazem may also be effective. Arrhythmias that result in hypotension should be immediately treated with cardioversion. Radiofrequency catheter ablation, a technique in which a small amount of energy is delivered via a thin tube advanced from an artery or vein to the exact region of the heart responsible for the arrhythmia. The energy creates a very small (several millimeters) “burn”-like lesion in the myocardial tissue responsible for the arrhythmia. Radiofrequency ablation is highly effective for the treatment of Wolff-Parkinson-White syndrome and may result in the cure o the patient in over 90% of cases. Digoxin is avoided in patients with Wolff-Parkinson-White syndrome since it may shorten the refractory period of the bypass tract, resulting in more rapid conduction in atrial fibrillation. Sole therapy using agents which block the A-V node should usually be avoided in Wolff-Parkinson-White syndrome, since the rates in atrial fibrillation should be avoided. Intravenous verapamil should be avoided for this reason and because of its acute hypotensive effects. The absence of coordinated contraction of the atria may lead to stasis of blood, promoting thrombus formation, which may be the source of embolism including stroke. In most patients the extremely rapid rate of atrial depolarization will result in high ventricular rate. Thus, agents such as digoxin, beta-receptor antagonists, or calcium channel antagonists such as diltiazem or verapamil may be used to modulate the ventricular rate. Electrical cardioversion may be needed in some patients to re-establish sinus rhythm. Catheter ablation for atrial fibrillation is having increasing success in treating patients with atrial fibrillation. In selected patients with difficult to control ventricular rates, a catheter based technique for the ablation of the A-V node to destroy conduction completely may be employed with implantation of a permanent pacemaker. Treatment of Ventricular Arrhythmias Patients with ventricular arrhythmias within 48 hours of an acute myocardial infarction are not felt to be at substantial risk of long term recurrence of these arrhythmias. However, patients with sustained ventricular tachycardia or fibrillation which does not occur Arrhythmias - Paul J. This type of device is implanted subcutaneously and connected via a special lead which is inserted via the cephalic or subclavian vein and advanced to the right ventricle. The device automatically monitors the heart rate using this lead and when a programmed is achieved, the device will deliver a synchronized electrical shock to the lead in the right ventricle (and possibly right atrium or superior vena cava) which will reuslt in conversion of the ventricular tachycardia or ventricular fibrillation. For some reentrant ventricular tachycardias, the implantable defibrillator may pace in the heart at rates faster than the ventricular tachycardia, resulting in termination of the arrhythmia without the need for an electrical shock. For the acute treatment of ventricular arrhythmias, intravenous lidocaine and amiodarone and less commonly procainamide may be administered. Catheter ablation techniques for ventricular tachycardia may be used but are more complex than for supraventricular tachycardias. Such a device may be used to quantitate frequency symptomatic or asymptomatic arrhythmias. Patients with less frequent but prolonged (> 1 minute) episodes of arrhythmias without syncope may use an event monitor which is carried with the patient and connected only in the event of an arrhythmia. Patients with episodes of syncope or very brief episodes of arrhythmias may use a “loop” monitor which is connected to the patient for several weeks to several months. The recorder saves the preceding several minutes and may be transmitted via a telephone hookup Autonomic Drugs (Sympathomimetics 1) - James Whitlock, M. Understand the differences between direct-acting and indirect acting sympathomimetic drugs. Become familiar with the major structure-activity relationships among sympathomimetic drugs. Continue to learn the tissue distribution of adrenergic receptor subtypes and their responses following agonist administration. The primary role of each atrium is to act as a reservoir and "booster pump" for venous blood entering the ventricles. Recently, with the discovery of atrial naturetic hormone, other homeostatic roles of the atrium have been proposed. The primary physiologic function of each ventricle is to maintain circulation of blood to the organs of the body. The left heart receives oxygenated blood from the pulmonary circulation, and contraction of the muscles of the left ventricle provide energy to propel that blood through the systemic arterial network. The right ventricle receives blood from the systemic venous system and propels it through the lungs and onward to the left ventricle. The reason that blood flows through the system is because of the pressure gradients set up by the ventricles between the various parts of the circulatory system. In order to understand how the heart performs its task, one must have an appreciation of the force-generating properties of cardiac muscle, the factors which regulate the transformation of muscle force into intraventricular pressure, the functioning of the cardiac valves, and something about the load against which the ventricles contract, i. You have learned about the properties of cardiac muscle and vascular systems in previous lectures. This session will focus on a description of the pump function of the ventricles with particular attention to a description of those properties as represented on the pressure-volume diagram. The ventricles are chambers whose walls are composed predominantly of cardiac muscle. Therefore, when considering the properties of the ventricle as a mechanical pump, one should keep in mind the underlying force-generating properties of cardiac muscle and the structural features of the ventricle which determine how muscle force translates into pressure inside the ventricle. The force generated by a muscle is directly influenced by the initial (or "diastolic") length of the muscle -- increased diastolic length results in greater force production. When the volume of the heart is changed, so too is the length of the muscles in the wall of the heart. There are at least four factors that contribute to determining the relationship between muscle properties (length and force) and ventricular properties (volume and pressure): 1. Muscle Mass It is intuitively obvious that the more muscle that comprises the chamber wall the stronger the ventricle will be.