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By M. Wilson. Louisburg College. 2018.
Both the dispersion of initial judgments and degree of convergence after the announced group norm and during the last week of the course were significantly greater for group-centered classes cheap nicotinell 52.5mg without prescription quit smoking nhs. Maier and Solem (94) arranged for half the groups to have leaders instructed to encourage member participation nicotinell 17.5 mg fast delivery quit smoking vietnam, and the other half, observers free -241- to participate only in member roles. After an eight-minute discussion of the Maier Horse Trading Problem, groups with leaders significantly increased their per cent of correct answers. Preston and Heintz (108) had students first give individual rankings of the names of twelve prominent men for their desirability as President of the United States; next, a group ranking of the twelve names in four- to five-person groups having either participatory or supervisory leaders; and a final individual ranking. Final individual rankings of participatory leaders and followers correlated significantly higher with the group rankings. There also was more shifting from initial to final rankings for those working under participatory leaders. Hare (56) replicated the experiment by Preston and Heintz (108), and reports similar findings. Berkowitz (12) had partners send and decode messages transmitted by telegraph keys to each other. Subjects who believed they would gain a prize worked fastest on improvement trials; those who believed only their partners would gain a prize worked faster than subjects who knew nothing of the prize. Facilitation from perceived dependency on another for attaining a goal constitutes a significant influence factor. Kidd and Campbell (77) varied reported success of the group on a preliminary anagram task. Members who had had prior experience of success with one another conformed to a significantly greater degree to the attributed group norm for a later task. This may be because individual differences become more evident and greater possibilities exist for the exertion of pressure. Findings also indicate that greater pressure exists when one member recognizes that another member is dependent on his performance for success, and that greater susceptibility occurs among members who have shared success. Cohesion and Valuation of Group Membership Cohesion is a variable in the group situation. Both subjects wrote a story about three sets of pictures, differing primarily in details, and then discussed them with each other. Festinger, Gerard, Hymovitch, Kelley, and Raven (40) report similar findings, as does Berkowitz (13). Schchater, Ellertson, McBride, and Gregory (116) created high and low cohesion among undergraduate women subjects in three person groups. During interaction each subject worked alone, but communicated with fictitious other persons through a series of notes controlled by an experimenter. Positive influence induction consisted of notes encouraging increased production for half of the subjects under each condition, and negative influence for the other half. Under negative influence, high cohesion subjects significantly decreased their productivity; the low cohesion group showed no changes. In a study of children by Grossner, Polansky, and Lippitt (53), the collaborator was friendly with half the subjects and encouraged their working together; with the other half, he acted withdrawn and worked separately. The critical subject more frequently chose the same toy as the friendly collaborator. High cohesion subjects shifted their opinions toward the group recommendation significantly more than those under the low cohesion condition. In the study by Dittes and Kelley (37), group members were given false ratings of the degree to which others present liked them and wished them to remain in the discussion. Those in the very low acceptance group, who had the lowest index of private conformity, showed the highest degree of public conformity. Those participating under average attraction conditions exhibited the greatest degree of shifting toward the group view, indicating a consistency in private conviction and public expression.
Time consuming Unlike most antibiotics 35mg nicotinell visa quit smoking you fool, antitubercular drugs may need to be ad- ministered over many months order nicotinell 17.5mg without prescription quit smoking cold turkey side effects. This creates problems, such as pa- tient noncompliance, the development of bacterial resistance, and drug toxicity. One regimen may succeed another The antitubercular regimen should be modified if local testing shows resistance to one or more of these drugs. Be- Streptomycin was the first drug recognized as cause these drugs have a greater incidence of effective in treating tuberculosis. Of these two drugs, ofloxacin mycin is excreted primarily by the kidneys as is more potent and may be an initial choice in unchanged drug. These drugs are administered tomycin well, but those receiving large doses orally and are generally well tolerated. However, resistance to fluoroquinolones devel- ops rapidly when these drugs are used alone or in insufficient doses. At usual dos- es, ethambutol and isoniazid are tuberculostatic, meaning that they inhibit the growth of M. In contrast, rifampin is tuberculocidal, meaning that it destroys the mycobacteria. Be- cause bacterial resistance to isoniazid and rifampin can develop rapidly, they should always be used with other antitubercular drugs. Antireplication station The exact mechanism of action of ethambutol remains unclear, but it may be related to inhibition of cell metabolism, arrest of multiplication, and cell death. It can Although isoniazid’s exact mechanism of action isn’t known, the take as many as five drug is believed to inhibit the synthesis of mycolic acids, impor- or six drugs to wipe tant components of the mycobacterium cell wall. The drug is effective primarily in replicating bacteria, but may have some effect on resting bacteria as well. Acid based The exact mechanism of action of pyrazinamide isn’t known, but the antimycobacterial activity appears to be linked to the drug’s conversion to the active metabolite pyrazinoic acid. Pyrazinoic acid, in turn, creates an acidic environment where mycobacteria can’t replicate. Pharmacotherapeutics Isoniazid usually is used with ethambutol, rifampin, or pyrazi- namide. Isoniazid is typically given orally, but may be given intravenously, if necessary. It combats many gram-positive and some gram-negative bacteria, but is seldom used for nonmycobacterial infections because bacterial resistance develops rapidly. It’s used to treat asymptomatic carriers of Neisseria meningitidis when the risk of meningitis is high, but it isn’t used to treat N. Adverse reactions to antitubercular drugs Here are common adverse reactions to antitubercular drugs. Pyrazinamide Liver toxicity is the major limiting adverse reac- Isoniazid Rifampin is tion. Antimycotic drugs Antimycotic, or antifungal, drugs are used to treat fungal infec- tions. The major antifungal drug groups include: • polyenes • fluorinated pyrimidine • imidazole • synthetic triazoles • glucan synthesis inhibitors • synthetic allylamine derivatives. Ampho- tericin B’s potency has made it the most widely used antimycotic drug for severe systemic fungal infections. It’s available in several forms, including lipid-based preparations that may decrease renal or systemic toxicity. Nystatin is used only topically or orally to treat local fungal infections because it’s extremely toxic when ad- ministered parenterally. Available as miconazole or miconazole nitrate, this imidazole derivative is used to treat local fungal infections, such as vagi- Clotrimazole nal and vulvar candidiasis, and topical fungal infections such as An imidazole derivative, clotrimazole is used: chronic candidiasis of the skin and mucous membranes.
The combinaton ofen produces a synergistc efect on solute and water excreton buy generic nicotinell 35mg on line quit smoking key chain, which relieves symptoms in the diuretc-resistant heart failure patent discount nicotinell 52.5 mg on-line quit smoking florida free patches. However, the combinaton may produce excessive intravascular volume depleton and electrolyte disturbances including potentally life-threatening hypokalaemia. Digoxin, a cardiac glycoside, increases the strength of cardiac muscle contractons and increases cardiac output. In mild heart failure, digoxin inhibits the sympathetc nervous system and produces arterial vasodilaton. It produces symptomatc improvement, increases exercise tolerance and reduces hospi- talizaton, but it does not reduce mortality. Isosorbide dinitrate produces mainly venous dilataton, which reduces lef ventricular preload, leading to a reducton in pulmonary congeston and dysp- noea. Hydralazine produces mainly arterial vasodilaton, which reduces lef ventricular aferload and increases stroke volume and cardiac output. Dopamine, an inotropic sympathomimetc, may be given for short periods in the treatment of severe heart failure. Dosage is critcal; at low doses it stmulates myocardial contractlity and increases cardiac output, however, higher doses (more than 5 µg/kg per min) cause vasoconstricton, with a wors- ening of heart failure. Adverse Efects Tachycardia and marked increase in systolic blood pressure indicate overdosage; phlebits; rarely, thrombocytopenia. Dopamine* Pregnancy Category-C Schedule H Indicatons Cardiogenic shock in myocardial infarcton or cardiac surgery; acute heart failure. Dose Intravenous infusion Adult- Cardiogenic shock: into large vein, initally 2 to 5 µg/kg/min; gradually increased by 5 to 10 µg/kg/min according to blood pressure, cardiac output and urine output; seriously ill patents up to 20 to 50 µg/kg/ min. By intravenous route initally 1 to 5 µg/ kg/min can be increased gradually to 5 to 10 µg/kg/min. Contraindicatons Hypersensitvity; tachyarrhythmias, ven- tricular fbrillaton, ischaemic heart disease; pheochromocytoma; hyperthyroidism. Precautons Correct hypovolaemia before and maintain blood volume during treatment; correct hypoxia; hypercapnia and metabolic acidosis before or at same tme as startng treatment; low dose in shock due to myocardial infarcton; history of peripheral vascular disease (increased risk of ischaemia of extremites); elderly; interactons (Appendix 6c); history of atherosclerosis; Raynaud’s disease; diabetc endocardits; dispropotonate increase in diastolic pressure; pregnancy (Appendix 7c); lactaton; paediatrics. Adverse Efects Nausea and vomitng; peripheral vasoconstricton; hypotension with dizziness; faintng; fushing; tachycardia; ectopic beats; palpitatons; anginal pain; headache; dyspnoea; hypertension partcularly in overdosage. Slow intravenous injecton Adult- Acute pulmonary oedema: 20 to 50 mg, if necessary increase by 20 mg step-by- step every 2 h; if efectve single dose is more than 50 mg, at a rate not exceeding 4 mg/ min. Slow intravenous infusion Adult- Oliguria (glomerular fltraton rate less than 20 ml/min): at a rate not exceeding 4 mg/min, initally 250 mg over 1 h. If urine output not satsfactory during the h afer frst dose, infuse 500 mg over 2 h then; if no satsfactory response is there in an h afer second dose, infuse 1g over 4 h. Contraindicatons Renal failure with anuria; precomatose states associated with liver cirrhosis; severe sodium and water depleton; hypersensitvity to sulphonamides and furosemide; hypokalaemia; addison’s disease; lactaton. Adverse Efects Hypokalaemia; hypomagnesaemia; hyponat- raemia; hypochloraemic alkalosis (for symp- toms of fuid and electrolyte imbalance; see introductory notes); increased calcium excreton; hypovolaemia; hyperglycaemia (but less ofen than with thiazide diuret- ics); temporary increase in plasma cho- lesterol and triglyceride concentraton; less commonly hyperuricaemia and gout; rarely, rash; photosensitvity; bone marrow depression (withdraw treatment); pancreat- ts (with large parenteral doses); tnnitus and deafness (with rapid administraton of large parenteral doses and in renal impairment; deafness may be permanent if other ototoxic drugs taken); gastrointestnal upset; malaise; blood dyscrasias; vertgo; orthostatc hypo- tension; jaundice; tnnitus; renal calcifcaton in premature infants. Various classes of drugs used as lipid lowering drugs are- H mg-CoA reductase inhibitors They are the most efcacious and tolerable drugs like simv- astatn, pravastatn, atorvastatn etc. They are primarily indi- cated in secondary preventon of myocardial infarcton and stroke in patents who have symptomatc atherosclerotc disease following acute myocardial infarcton or stroke and in primary preventon of arterial disease in patents who are at high risk because of elevated serum cholesterol concentra- ton. Common adverse efects include mild gastrointestnal disturbances, rhabdomyolysis etc.
This chapter discusses the two main classes of skeletal muscle relaxants—centrally acting and direct-acting—as well as other muscle relaxants purchase nicotinell 17.5mg with mastercard quit smoking 003. These sensory impulses can cause a reflex (involuntary) muscle contraction or spasm from trauma nicotinell 17.5mg discount quit smoking games, epilepsy, hypocalcemia (low calcium levels), or muscle disorders. For intermittent or chronic spasms A patient with intermittent or chronic spasms may receive tizani- dine. For acute spasms …and A patient with acute muscle spasms may receive one of these skeletal muscle drugs: relaxants help • carisoprodol to break the pattern. Pharmacokinetics (how drugs circulate) There’s still a lot we don’t know about how centrally acting skele- tal muscle relaxants circulate within the body. Cyclobenzaprine sticks around When these drugs are administered orally, it can take from 30 min- utes to 1 hour for effects to be achieved. The duration of action of most of these drugs varies from 4 to 6 hours; cyclobenzaprine has the longest duration of action, at 12 to 25 hours. Their treat painful muscle relaxant effects may be related to their sedative effects. Pharmacotherapeutics (how drugs are used) Patients receive centrally acting skeletal muscle relaxants to treat acute, painful musculoskeletal conditions. Hormonal contraceptives may re- duce the clearance of tizanidine, necessitating a dosage reduction. Adverse reactions to centrally acting skeletal muscle relaxants A patient can develop physical and psychological dependence • Ataxia after long-term use of these drugs. Abruptly stopping any of • Constipation these drugs can cause severe withdrawal symptoms. Although dantrolene has a similar therapeutic effect to the centrally acting drugs, it works through a different mechanism of action. Common adverse effects of dantrolene include drowsiness, dizziness, malaise, fatigue, and weakness. Safe and Because it produces muscle weakness, dantrolene is of question- sound able benefit in patients with borderline strength. Dantrolene Pharmacokinetics Because of the risk of Although the peak drug concentration of dantrolene usually oc- liver damage with long- curs within about 5 hours after it’s ingested, the patient may not term use of dantrolene, notice the therapeutic benefit for a week or more. How dantrolene reduces muscle Pharmacodynamics rigidity Dantrolene is chemically and pharmacologically unrelated to the other skeletal muscle relaxants. It interferes decrease the number of with calcium ion release from the sarcoplasmic reticulum and calcium ions released weakens the force of contractions. At therapeutic concentrations, from the sarcoplasmic dantrolene has little effect on cardiac or intestinal smooth muscle. This rare but potentially fatal complication of anesthesia is characterized by skeletal muscle rigidity and high fever. Reducing rigidity, • Estrogens, when given with dantrolene, can increase the risk of halting hyperthermia liver toxicity. Other skeletal muscle relaxants Two other drugs used as skeletal muscle relaxants are baclofen and diazepam. Other uses of diazepam include treating anxiety, alcohol withdraw- al, and seizures.
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