Many medical centers have pastoral care departments staffed by chaplains who represent many religious faiths and Religious involvement pain medication for dogs over the counter buy 400mg motrin otc, spirituality and medicine 239 denominations pain treatment hepatitis c motrin 600mg discount. Chaplains are important sources for presence pain treatment center seattle buy discount motrin 600mg on line, support, counseling, sacramental needs and guidance regarding spiritual issues. Pastoral care departments also have access to community resources such as local congregations, spiritual care providers representing minority faiths, support groups and parish nurses. Religious involvement, spirituality, and medicine: implications for clinical practice. Complementary therapies in neurology 240 CONCLUSIONS Most patients have a spiritual life and regard their spiritual health and physical health as equally important. A large and growing number of studies have shown a direct relationship between religious involvement and spirituality and positive health outcomes, including mortality, physical illnesses, mental illness, HRQOL, and coping with illness (including terminal illness). Studies also suggest that addressing the spiritual needs of patients may facilitate recovery from illness. Although the relationship between religious involvement and spirituality and health outcomes seems valid, it is difficult to establish causality. While religiously involved persons embrace health-promoting behaviors, eschew risky behaviors and have strong support networks, these factors do not account for all of the salutary benefits of religious involvement and spirituality. Rather, these benefits are likely to be conveyed through complex psychosocial-behavioral and biological processes that are incompletely understood. Discerning, acknowledging and supporting the spiritual needs of patients can be done in a straightforward, ethical and non-controversial manner and may relieve suffering and facilitate recovery from illness. The spiritual history and the open-ended questions reviewed above help the clinician discern the spiritual needs of patients. Furthermore, such inquiry is a form of spiritual care, in that it allows patients to voice their spiritual and existential doubts. In addition, many other sources of spiritual care, especially chaplains, are available to address the spiritual concerns and needs of patients. Addressing the spiritual concerns and needs of patients may be a valuable adjunct to standard medical care. A brief spiritual beliefs inventory for use in quality of life research in life-threatening illness. Cultural considerations in the assessment and treatment of religious and spiritual problems. Religious commitment and health status: a review of the research and implications for family medicine. J Fam Pract 1991; 32:210–13 Religious involvement, spirituality and medicine 241 10. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Patient attitudes regarding physician inquiry into spiritual and religious issues. Experiments on distant intercessory prayer: God, science, and the lesson of Massah. Should academic medical centers conduct clinical trials of the efficacy of intercessory prayer? Systematic analysis of research on religious variables in four major psychiatric journals, 1978–1982.
Thyrotoxic crisis may be related to cytokine re- Tapazole) are the most commonly used preparations in lease and an acute immunological disturbance caused by the United States joint pain treatment in urdu buy motrin 400 mg mastercard. In the thyroid gland treatment pain when urinating buy motrin 600mg low price, they inhibit Although the serum thyroid hormone levels may not be the activity of the enzyme TPO pain neck treatment buy motrin australia, which is required for appreciably greater than those in uncomplicated thyro- the intrathyroidal oxidation of I, the incorporation of toxicosis, the clinical picture is severe hypermetabolism I into Tg, and the coupling of iodotyrosyl residues to with fever, profuse sweating, tachycardia, arrhythmias, form thyroid hormones. With progression of the disorder, apa- Propylthiouracil, but not methimazole, also inhibits D1, thy, stupor, and coma may supervene, and hypotension which deiodinates T4 to T3. There are no foolproof criteria by which se- action, propylthiouracil is often used to provide a rapid vere thyrotoxicosis complicated by some other serious alleviation of severe thyrotoxicosis. In any event, the differentiation amide drugs may also exert an immunosuppressive ef- between these alternatives is of no great significance be- fect. As the drug is concentrated in thyroid follicular cause treatment of the two is the same, directed at sys- cells, the expression of thyroid antigen and the release temic support and amelioration of the thyrotoxicosis. Thion- amides also inhibit the generation of oxygen radicals in T cells, B cells, and particularly the antigen-presenting DRUGS USED IN THE TREATMENT cells within the thyroid gland. Thus, thionamides may OF HYPERTHYROIDISM cause a decline in thyroid autoantibody titers, although Treatment of hyperthyroidism is directed at reducing the clinical importance of immunosuppression is un- the excessive synthesis and secretion of thyroid hor- clear. This may be accomplished by inhibiting thy- Thionamide drugs are well absorbed from the gas- roidal synthesis and secretion with antithyroid drugs, by trointestinal tract. Although they have short plasma reducing the amount of functional thyroid tissue, or by half-lives (propylthiouracil 1. Unfortunately, only a small proportion of patients hours), they accumulate in the thyroid gland, and a sin- treated with antithyroid drugs obtain long-term remis- gle daily dose may exert effects for greater than 24 sion of their hyperthyroidism. Since many of the signs and symptoms of hy- form glucuronides and are excreted in the bile and perthyroidism reflect increased cellular sensitivity to urine. Nevertheless, few glucuronide conjugates are adrenergic stimulation, a -adrenergic antagonist is of- found in the feces because they are absorbed from the ten used adjunctively. It of hyperthyroidism and thyrotoxic crisis and in the may reduce thyrotoxicosis-induced tachycardia, palpita- preparation of patients for surgical subtotal thyroidec- tions, tremor, sweating, heat intolerance, and anxiety, tomy. Although the use of thionamides alone may re- which are largely mediated through the adrenergic store euthyroidism, it is difficult to adjust the dosage in nervous system. The use of propranolol is contraindi- and-replace regimens in which a full blocking dose of cated in thyrotoxic patients with asthma or chronic thionamide plus a levothyroxine supplement is pre- obstructive pulmonary disease because it impairs bron- scribed. It is also contraindicated in patients with perthyroidism during pregnancy, they should be given heart block and those with congestive heart failure, un- in minimally effective doses to avoid inducing infantile less severe tachycardia is a contributory factor. If given in excessive amounts over a long period, Thionamides thionamides may cause hypothyroidism and enlargement Thionamides are the primary drugs used to decrease of the thyroid gland. They do not inhibit secre- granulocytopenia and agranulocytosis, which occur in tion of stored thyroid hormone, and therefore, when about 0. The most frequently observed adverse 65 Thyroid and Antithyroid Drugs 751 effect is rash. Arthralgia, myalgia, cholestatic jaundice, iopanoic acid (Telepaque), tyropanoic acid (Bilopaque), lymphadenopathy, drug fever, psychosis, and a lupuslike and iocetamic acid (Cholebrine). These actions make OCAs useful as adjunctive therapy with other antithyroid drugs by promoting a rapid fall in the plasma T3 concentration of the seriously Iodine and Iodine-Containing Agents thyrotoxic patient. Iodides In addition, the metabolism of OCAs results in the The effects of iodide on the thyroid gland are complex. As When administered in pharmacological amounts, potas- described for KI, I released from OCAs may have ef- sium iodide (KI) causes a transient inhibition of the up- fects at the thyroid gland and if used alone to treat hy- take and incorporation of I into Tg (Wolff-Chaikoff ef- perthyroidism, OCAs carry the same potential to in- fect). In addition, high doses of KI also inhibit the duce increased secretion of thyroid hormone and secretion of thyroid hormone and thyroid blood flow. When an OCA is used in These effects make KI an ideal agent for treating severe the treatment of hyperthyroidism, large doses of an- thyrotoxicosis or thyroid crisis when a rapid decrease in tithyroid agents are usually administered concomi- plasma T4 and T3 is desirable. However, the combination of OCAs and antithy- capes from Wolff-Chaikoff effect, I accumulates within roid drugs may cause resistance to the antithyroid drugs the gland and hormone synthesis resumes.
The latter symptom occurs assumed or known modes of action of a number of the after invasion of the intestinal mucosa by the actively agents pain treatment for nerve damage motrin 600mg sale. The treatment of malaria is discussed at the end motile and phagocytic trophozoite form of the proto- of this chapter treatment for long term shingles pain generic motrin 400mg overnight delivery. More recently neuropathic pain treatment guidelines iasp cheap motrin 400 mg with mastercard, it has been The flagellate leishmania is transmitted to humans by recognized that infection can be transmitted by sexual the bite of the female sandfly of the genus Phlebotomus. Three principal diseases result from infection with Balantidium coli is the largest of the protozoans that Leishmania spp. The trophozoite causes superficial necrosis or leishmaniasis, the protozoan parasitizes the reticuloen- deep ulceration in the mucosa and submucosa of the dothelial cells, and this results in an enlargement of the large intestine. Otherwise healthy persons commonly lymph nodes, liver, and spleen; the spleen can become exhibit nausea, vomiting, abdominal pain, and diarrhea, massive. Cutaneous leishmaniasis remains localized to whereas debilitated or nutritionally stressed patients the site of inoculation, where it forms a raised disfiguring may develop severe dysentery. It is characterized by ulceration of the mucous membranes of the nose, mouth, and phar- Trichomoniasis and Giardiasis ynx; some disfiguring skin involvement also is possible. Trichomoniasis is a genital infection produced by the African trypanosomiasis follows the bite of Glos- protozoan Trichomonas vaginalis. Infections frequently sina, a tsetse fly infected with the protozoan Trypano- are asymptomatic in the male, whereas in the female soma brucei. The ensuing illness (sleeping sickness)is vaginitis characterized by a frothy pale yellow discharge initially characterized by the hemolymphatic stage of is common. This latter more 608 VI CHEMOTHERAPY serious stage requires different, more potentially toxic excreted by the kidneys, although small amounts can be drugs than does the hemolymphatic stage. Metronidazole is active against intestinal quite different from African trypanosomiasis in its clin- and extraintestinal cysts and trophozoites. Metronidazole Metronidazole (Flagyl, Metrogel) exerts activity against Adverse Effects most anaerobic bacteria and several protozoa. The drug The most frequently observed adverse reactions to freely penetrates protozoal and bacterial cells but not metronidazole include nausea, vomiting, cramps, diar- mammalian cells. The enzyme, pyruvate-ferredoxin oxidoreduc- paresthesias, peripheral neuropathy, encephalopathy, tase, found only in anaerobic organisms, reduces and neutropenia have been reported. Reduced zole is a weak inhibitor of alcohol dehydrogenase, alco- metronidazole disrupts replication and transcription hol ingestion should be avoided during treatment. Metronidazole interferes with the metabolism of warfarin and may po- Antimicrobial Spectrum tentiate its anticoagulant activity. The drug is not gate anaerobic gram-positive and gram-negative bacte- recommended for use during pregnancy. Drug resistance is Iodoquinol infrequent; the mechanism of resistance is not under- Iodoquinol (diiodohydroxyquin, Yodoxin, Moebiquin) stood. Tinidazole, a 5-nitroimidazole closely related to is a halogenated 8-hydroxyquinoline derivative whose metronidazole, is effective against vaginal trichomonia- precise mechanism of action is not known but is thought sis resistant to metronidazole. The drug is tract and is excreted in the urine as glucuronide and sul- distributed in body fluids and has a half-life of about 8 fate conjugates. Metronidazole is metabolized by oxidation Iodoquinol is the drug of choice in the treatment of and glucuronide formation in the liver and is primarily asymptomatic amebiasis and D. It is 53 Antiprotozoal Drugs 609 also used in combination with other drugs in the treat- may act by inhibiting dihydrofolate reductase and inter- ment of other forms of amebiasis and as an alternative fering with polyamine metabolism. Chronic use of clioquinol, a closely related agent, ticularly the kidney, and is slowly excreted, mostly as the has been linked to a myelitislike illness and to optic at- unmodified drug. Pentamidine is active against Pneumocystis carinii, Diloxanide Furoate trypanosomes, and leishmaniasis unresponsive to pen- Diloxanide furoate (Furamide) is an amebicide that is tavalent antimonials.
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