Panmycin

By K. Harek. Keiser University.

Once the drug enters the bloodstream it is distributed around the body and purchase panmycin 250mg amex, so discount 250 mg panmycin amex, a proportion of the drug is either lost by excretion metabolism to other products or is bound to biological sites other than its target site. As a result, the dose administered is inevitably higher than that which would be needed if all the drug reached the appropriate site of biological action. The dose of a drug administered to a patient is the amount that is required to reach and maintain the concentration necessary to produce a favourable response at the site of biological action. Too high a dose usually causes unacceptable side effects whilst too low a dose results in a failure of the therapy. The limits between which the drug is an effective therapeutic agent is known as its therapeutic window (Figure 2. The amount of a drug the plasma can contain coupled with processes that irreversibly eliminate (see Section 2. Too high a dose will give a plateau above the therapeutic window and toxic side effects. Too low a dose will result in the plateau below the therapeutic window and ineffective treatment. Dosage regimens may vary from a single dose taken to relieve a headache through regular daily doses taken to counteract the effects of epilepsy and diabetes to continuous intravenous infusions for seriously ill patients. Regimens are designed to maintain the concentration of the drug within the thera- peutic window at the site of action for the period of time that is required for therapeutic success. The design of the regimen depends on the nature of the medical condition and the medicant. The latter requires not just a knowledge of a drug’s biological effects but also its pharmacokinetic properties, that is, the rate of its absorption, distribution, metabolism and eliminination from the body. Too toxic, too many side effects The plateau Therapeutic window Drug concentration in the plasma Too little to be effective x x x Time Figure 2. When one or more active drug molecules bind to the target en- dogenous and exogenous molecules, they cause a change or inhibit the bio- logical activity of these molecules. The effectiveness of a drug in bringing about these changes normally depends on the stability of the drug–substrate complex, whereas the medical success of the drug intervention usually depends on whether enough drug molecules bind to sufficient substrate molecules to have a marked effect on the course of the disease state. The degree of drug activity is directly related to the concentration of the drug in the aqueous medium in contact with the substrate molecules. The factors affecting this concentration in a biological system can be classified into the phar- macokinetic phase and the pharmacodynamic phase of drug action. The pharma- cokinetic phase concerns the study of the parameters that control the journey of the drug from its point of administration to its point of action. The pharmaco- dynamic phase concerns the chemical nature of the relationship between the drug and its target: in other words, the effect of the drug on the body. Many of the factors that influence drug action apply to all aspects of the pharmacokinetic phase. Furthermore, the rate of drug dissolution, that is, the rate at which a solid drug dissolves in the aqueous medium, controls its activity when a solid drug is administered by enteral routes (see Section 2. Drugs that are too polar will tend to remain in the bloodstream, whilst those that are too nonpolar will tend to be absorbed into and remain within the lipid interior of the membranes (see Appendix 3). The degree of absorption can be related to such parameters as partition coefficient, solubility, pKa, excipients and particle size. For example, the ioniza- tion of the analgesic aspirin is suppressed in the stomach by the acids produced from the parietal cells in the stomach lining. As a result, it is absorbed into the bloodstream in significant quantities in its unionized and hence uncharged form through the stomach membrane. The main route is the circulatory system; however, some distribution does occur via the lymphatic system. In the former case, once the drug is absorbed, it is rapidly distributed throughout all the areas of the body reached by the blood. Drugs are transported dissolved in the aqueous medium of the blood either in a ‘free form’ or reversibly bound to the plasma proteins. Drug Ð Drug À Protein complex Drug molecules bound to plasma proteins have no pharmacological effect until they are released from those proteins. However, it is possible for one drug to displace another from a protein if it forms a more stable complex with that protein. This may result in unwanted side effects, which could cause compli- cations when designing drug regimens involving more than one drug. Moreover, low plasma protein concentrations can affect the distribution of a drug in some diseases, such as rheumatoid arthritis. Sparingly water soluble compounds may be deposited in the blood vessels, leading to restriction in blood flow. Decompositions such as these can result in a higher dose of the drug being needed in order to achieve the desired pharmacological effect, which increases the risk oftoxic side effects in the patient. However, the active form of some drugs is produced by the decom- position of the administered drug. For example, the bacteriacide prontosil, discovered in 1935, is not active but is metabolized in situ to the antibacterial sulphanilamide. These biotransformations occur mainly in the liver but they can also occur in blood and other organs such as the brain, lungs and kidneys (see Section 9.

It was the Crimean War that provided the woman into these hitherto uncharted waters was stage for her to actualize these foundational beliefs panmycin 250 mg without prescription, risky at best purchase panmycin 250mg on-line. But, as is well known, Nightingale was rooting forever in her mind certain “truths. It was in the Barracks Hospital of Scutari questing her to accept this post, Herbert wrote: that Nightingale acted justly and responded to a call for nursing from the prolonged cries of the Your own personal qualities, your knowledge and your power of administration, and among greater British soldiers (Boykin and Dunphy, 2002, p. Accompanied by 38 handpicked “nurses” —Nightingale, cited in Woodham-Smith (1983) who had no formal training, she arrived on November 4, 1854, to “take charge” and did not re- Nightingale had powerful friends and had turn to England until August 1856. When Great own correspondence, as cited in a number of Britain became involved in the Crimean War in sources (Cook, 1913; Huxley, 1975; Goldie, 1987; 1854, Nightingale was ensconced in her first official Summers, 1988; Vicinus & Nergaard, 1990), paint nursing post at 1 Harley Street. Designed by Manuel Lopez Parras in Elspeth Huxley, Florence Nightingale (1975), p. Nightingale sustained there, experiences that ce- There were no pillows, no blankets; the men lay, with mented her views on disease and contagion, as well their heads on their boots, wrapped in the blanket or as her commitment to an environmental approach greatcoat stiff with blood and filth which had been their sole covering for more than a week. The men in the corri- than 1000 men suffering from acute diarrhea and dors lay on unwashed floors crawling with vermin. In this filth lay the men’s food—Miss Nightingale saw the skinned carcass of a sheep lie in a wardallnight... Nightingale’s reply: “The strongest will be wanted at the wash tub” (Cook, 1913; Dolan, 1971). Although the bulk of this work continued to be cleansed sewers, limewashed walls, tore out shelves done by orderlies after Nightingale’s arrival (with that harbored rats, and got rid of vermin. The com- the laundry farmed out to the soldiers’ wives), it mission, Nightingale said,“saved the British Army. Because no antidote to infection existed at this Her spirituality involved the sense of a presence time, the provision—by Nightingale and her higher than human presence, the divine intelli- nurses—of cleanliness, order, encouragement to gence that creates, sustains, and organizes the uni- eat, feeding, clean bed linen, clean bodies, and clean verse, and an awareness of our inner connection to wards, was essential to recovery (Summers, 1988). Through this inner connection Mortality rates at the Barrack Hospital in flows creative endeavors and insight, a sense of pur- Scutari fell. For Miss Nightingale, spiritual- the prime minister had sent to the Crimea a sani- ity was intrinsic to human nature and was the tary commission to investigate the high mortality deepest, most potent resource for healing. Beginning their work in March, they de- Nightingale was to write in Suggestions for Thought scribed the conditions at the Barrack Hospital as (Calabria & Macrae, 1994, p. The commission cleared “556 handcarts and ness to unity with the divine was an evolutionary large baskets full of rubbish... There were four miles of beds in the Barrack Hospital at Scutari, a suburb of Constantinople. A letter to the London Times dated February 24, 1855, reported the following: When all the medical officers have retired for the night and silence and darkness have settled upon those miles of prostrate sick, she may be observed, alone with a little lamp in her hand, making her Image rights unavailable. In April 1855, after having been in Scutari for six months, Florence wrote to her mother, “[A]m in sympathy with God, fulfilling the purpose I came into the world for” (Woodham-Smith, 1983, p. Henry Wadsworth Longfellow authored “Santa Filomena” to commemorate Miss Nightingale. Miss Nightingale slipped home quietly, arriving but she had left her heart on the battlefields of the at Lea Hurst in Derbyshire on August 7, 1856, after Crimea and in the graveyards of Scutari” (Huxley, 22 months in the Crimea and after sustained illness 1975, p. The In watching disease, both in private homes and next morning, a peal of the village church bells public hospitals, the thing which strikes the expe- and a prayer of Thanksgiving were, her sister wrote, rienced observer most forcefully is this, that the “‘all the innocent greeting’ except for those pro- symptoms or the sufferings generally considered to be vided by the spoils of war that had proceeded her— inevitable and incident to the disease are very often a one-legged sailor boy, a small Russian orphan, not symptoms of the disease at all, but of some- and a large puppy found in some rocks near thing quite different—of the want of fresh air, or Balaclava. At this point in time, in the mid-nineteenth cen- To gain a better understanding of Nightingale’s tury, there were two competing theories regarding ideas on nursing, one must enter the peculiar world the nature and origin of disease. One view was of nineteenth-century medicine and its views on known as “contagionism,” postulating that some health and disease. Considerable new medical diseases were communicable, spread via commerce knowledge had been gained by 1800. The strategic conse- anatomy was well known; chemistry promised to quences of this explanatory model was quarantine, throw light on various body processes. Vaccination and its attendant bureaucracy aimed at shutting against smallpox existed. There were some estab- down commerce and trade to keep disease away lished drugs in the pharmacopoeia: cinchona bark, from noninfected areas. Certain major diseases, such emerging merchant classes, quarantine represented as leprosy and the bubonic plague had almost dis- government interference and control (Ackernecht, appeared. It postulated that disease resulted from local envi- Yet physicians at the turn of the century, in 1800, ronmental sources and arose out of “miasmas”— still had only the vaguest notion of diagnosis. It was this shift in thought—a paradigm William Farr, another Nightingale associate and shift of the first order—that gave us the triumph of avid anticontagionist, was Britain’s statistical super- twentieth-century medicine, with all its attendant intendent of the General Register Office. The debate as to whether based on “empirics” or “experience,” trial and error, fermentation was a chemical process or a “vitalis- with an emphasis on curative remedies; the other tic” one had been raging for some time (Swazey & based on Hippocratic notions and learning. The familiarity of the process of fer- Evidence of both these trends persisted into mentation helps to explain its appeal.

Many synthetic steroids have been found to be much more potent than natural steroids order panmycin 500 mg fast delivery. For example cheap panmycin 250 mg free shipping, the contraceptive drug, norethindrone is better than progesterone in arresting (terminating) ovulation. They are synthetic derivatives of testosterone, thus have the same muscle-building effect as testosterone. There are more than 100 different anabolic steroids which, vary in structure, duration of action, relative effects and toxicities. They are used to treat people suffering from traumas accompanied by muscle dete- rioration. The use of anabolic steroid can lead to a number of dangerous side- effects, including lowered levels of high density lipoprotein cholesterol, which benefits the heart, and elevated levels of harmful low density lipopro- tein, stimulation of prostate tumours, clotting disorders and liver problems. Steroid hormones produce their physiological effects by binding to steroid hormone receptor proteins. The binding of steroids to their receptors causes changes in gene transcription and cell function. From biological and physiological viewpoints, probably the most important ster- oids are cholesterol, the steroid hormones, and their precursors and metabo- lites. Cholesterol, a common component of animal cell membranes, is an important steroid alcohol. This condition results in various heart diseases, strokes and high blood pressure, and a high level of cholesterol can be life-threatening. A number of vertebrate hormones, which govern a number of physiological functions, from growth to reproduction, are biosynthesized from cholesterol. Much research is currently underway to determine whether a correlation exists between cholesterol levels in the blood and diet. Cholesterol not only comes from the diet, but is also synthesized in the body from carbohydrates and proteins as well as fat. Therefore, the elimination of cholesterol rich foods from the diet does not necessarily lower blood cholesterol levels. Some studies have found that if certain unsaturated fats and oils are substituted for saturated fats the blood cholesterol level decreases. Male sex hormones are testosterone and 5a-dihydrotestosterone, also known as androgens, which are secreted by the testes. The primary male hormone, testosterone, is respon- sible for the development of secondary sex characteristics during puberty. The two most important female sex hormones are oestradiol and oestrone, also known as oestrogens(estrogens). Oestrogen, along with progester- one, regulates changes occurring in the uterus and ovaries known as the menstrual cycle. Many of the steroid hormones are ketones, including testosterone and progesterone. The male and female hormones have only slight differences in structure, but yet have very different physiological effects. For example, the only difference between testosterone and progesterone is the substituent at C-17. The most important mineralo- corticoid is aldosterone, an aldehyde as well as a ketone, which regulates the reabsorption of sodium and chloride ions in the kidney, and increases the loss of potassium ions. Aldosterone is secreted when blood sodium ion levels are too low to cause the kidney to retain sodium ions. If sodium levels are elevated, aldosterone is not secreted, so some sodium will be lost in the urine and water. These reactions are completed in the liver by taking fatty acids from lipid storage cells and amino acids from body proteins to make glucose and glycogen. Cortisol and its ketone derivative, cortisone, are potent anti- inflammatory agents. Cortisone or similar synthetic derivatives such as prednisolone, the active metabolite of prednisone, are used to treat inflam- matory diseases, rheumatoid arthritis and bronchial asthma. There are many side-effects with the use of cortisone drugs, so their use must be monitored carefully. Prednisolone is designed to be a substitute for cortisone, which has much greater side-effects than prednisolone. Phytosterols found in plants have many applications as food additives and in medicine and cosmetics. Ergosterol is a component of fungal cell membranes, serving the same function that cholesterol serves in animal cells. The presence of ergosterol in fungal cell membranes coupled with its absence from animal cell membranes makes it a useful target for antifungal drugs.

And finally to our parents: Edna Louise Smith cheap 250mg panmycin fast delivery, Joe Bond Elliott panmycin 250 mg without prescription, Tea Elliott, William Thomas Smith (1914-1999), and Suzanne Wieder Elliott (1923–2004). We no longer need to apologize to our family and friends for our neglect; they’re used to it by now! We appreciate the efforts of our agents, Ed and Elizabeth Knappman who have encouraged our pursuits. Thanks also to Elizabeth Deardorf for making our dogs smile in our authors’ picture. Finally, we have been privileged to hear the many stories of suffering, hurt, trauma, hope, recovery, and resilience from our clients over the years. Publisher’s Acknowledgments We’re proud of this book; please send us your comments through our Dummies online registration form located at www. Some of the people who helped bring this book to market include the following: Acquisitions, Editorial, and Media Development Composition Services Senior Project Editor: Tim Gallan Project Coordinator: Adrienne Martinez Acquisitions Editors: Mikal Belicove, Mike Lewis Layout and Graphics: Lauren Goddard, Denny Hager Copy Editor: Elizabeth Rea Proofreaders: Leeann Harney, Sandra Profant Editorial Program Assistant: Courtney Allen Indexer: Naomi Linzer Technical Editor: Linda Ames Editorial Manager: Christine Meloy Beck Editorial Assistants: Nadine Bell, David Lutton, Hanna Scott Cover Photos: © Tim Brown, Stone, Getty Images Cartoons: Rich Tennant (www. Cocks, Product Development Director, Consumer Dummies Michael Spring, Vice President and Publisher, Travel Kelly Regan, Editorial Director, Travel Publishing for Technology Dummies Andy Cummings, Vice President and Publisher, Dummies Technology/General User Composition Services Gerry Fahey, Vice President of Production Services Debbie Stailey, Director of Composition Services Contents at a Glance Foreword.................................................................................... Charles Elliott and Laura Smith have reviewed and distilled the scientific literature on the treatment of depression for the general public. This book is uniquely comprehensive in that it thoroughly covers the scientifically validated treatments for depression, including behav- ior therapy, medications, interpersonal therapy, and cognitive therapy. The authors have also included promising ideas based on mindfulness and posi- tive psychology. However, they have chosen to emphasize the importance of cognitive therapy because no other therapy has received as much support as cognitive therapy for the treatment of depression. Elliott and Smith have woven important cognitive therapy princi- ples into their presentation of the other validated approaches to depression. This decision is appropriate since research has suggested that some of these other therapies may in fact work due in part to the cognitive therapy strate- gies embedded within them. At the time, I was dissatisfied with the lack of evidence supporting the value of the prevailing psychotherapy — Freudian psychoanalysis — in treating depression. Cognitive therapy quickly became established as a highly effective treatment for depression, a finding that has been verified in numerous subsequent clinical trials. Over the ensuing decades, cognitive therapy has also demonstrated excellent outcomes in the treatment of problems with anger, anxiety, panic disorder, stress, relationship problems, substance abuse, eating disorders, and most recently, even schizo- phrenia. To date, no other psychotherapy has demonstrated such consistent effectiveness across a broad swath of problems. Depression For Dummies does a marvelous job of providing readers with the core techniques and prin- ciples of cognitive therapy as applied to depression. I feel it’s important to note that Depression For Dummies is not a book for dummies! Rather, this book lays out the principles of cognitive therapy, as well as other validated psychotherapies, in exceptionally clear terms. Elliott and Smith include fascinating clinical examples and effective exercises within the most reader-friendly, entertaining format I’ve seen in a book of this genre. I have no doubt it will prove to be a powerful self-help resource as well as an adjunct to psychotherapy. Elliott since the early 1980s, when he was a highly skillful cognitive therapist serving in a major psychotherapy outcome study. Elliott and Smith just a few years ago at an interna- tional conference on cognitive therapy in Catania, Italy. Anxiety & Depression Workbook For Dummies xvi If you struggle with depression, I strongly recommend Depression For Dummies. These authors convey considerable compassion, empathy, and insight in addition to unusual clarity. Elliott and Smith have written a compan- ion workbook called Anxiety & Depression Workbook For Dummies. After providing the rudimentary under- standing you need, it quickly shows ways to put that information to work in your own life. You won’t have to spend hours reading about technical jargon and irrelevant material. Almost everything in this book can be immediately applied to improving the way you feel, behave, and think. Elliott and Smith weave humor throughout that man- ages not to demean or condescend. Depression and anxi- ety are serious problems — they darken vision and distort thinking while draining joy and pleasure from life.