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The mechanism of stimulant purgatives is: a) Increasing the volume of non-absorbable solid residue b) Increasing motility and secretion c) Altering the consistency of the feces d) Increasing the water content 031 medications used to treat fibromyalgia cheap eldepryl on line. Choose the drug irritating the gut and causing increased peristalsis: a) Phenolphthalein b) Methyl cellulose c) Proserine d) Mineral oil 032 treatment tinnitus order eldepryl discount. Tick the stimulant of bile production of vegetable origin: a) Oxaphenamide b) Papaverine c) Cholenzyme d) Cholosas 034 symptoms 5 days after iui discount eldepryl online mastercard. Select the drug which inhibits peristalsis: a) Castor oil b) Bisacodyl c) Loperamide d) Sorbitol 035 medicine natural discount 5mg eldepryl otc. Choose the drug depressing erythrogenesis: a) Radioactive phosphorus 32 b) Ferrous sulfate c) Molgramostim d) Folic acid 003. Iron deficiency anemia leads to pallor, fatigue, dizziness, exertional dyspnea and other symptoms of tissue ischemia. Tick the drug for parenteral iron therapy: a) Ferrous sulfate b) Fercoven c) Ferrous lactate d) Ferrous fumarate 007. Indicate the drug which increases absorption of iron from intestine: a) Cyanocobalamin b) Folic acid c) Ascorbic acid d) Erythropoetin 008. Pernicious anemia is developed due to deficiency of: a) Erythropoetin b) Vitamin B12 c) Iron d) Vitamin B6 010. Select the drug used for pernicious anemia: a) Ferrous lactate b) Cyanocobalamin c) Iron dextran d) Ferrous gluconate 011. An adverse effect of oral iron therapy is: a) Anemia b) Thrombocytopenia c) Headache d) Constipation 012. Choose the drug which contains cobalt atom: 74 a) Folic acid b) Iron dextran c) Cyanocobalamine d) Ferrous gluconate 013. Tick the drug used in aplastic anemia: a) Fercoven b) Cyanocobalamine c) Epoetin alpha d) Folic acid 014. Which of the following substances is synthesized within vessel walls and inhibits thrombogenesis Pick out the drug belonging to anticoagulants of direct action: a) Aspirin b) Heparin c) Dicumarol d) Phenprocoumon 005. Indicate the drug belonging to antagonists of heparin: a) Aspirin b) Dicumarol c) Dalteparin d) Protamine sulfate 007. Tick the drug used as an oral anticoagulant: a) Heparin b) Daltreparin c) Dicumarol d) Enoxaparin 008. Indicate the drug belonging to fibrinoliytic inhibitors: a) Aminocapronic acid b) Ticlopidine c) Streptokinase d) Vitamin K 021. Aminocapronic acid is a drug of choice for treatment of: a) Acute myocardial infarction b) Bleeding from fibrinolytic therapy c) Heart failure d) Multiple pulmonary emboli 022. The non-glycoside positive inotropic drug is: a) Digoxin b) Strophantin K c) Dobutamine d) Digitoxin 006. Sugar molecules in the structure of glycosides influence: a) Cardiotonic action b) Pharmacokinetic properties c) Toxic properties d) All of the above 007. Aglycone is essential for: a) Plasma protein binding b) Half-life c) Cardiotonic action d) Metabolism 008. Choose the derivative of the plant Foxglove (Digitalis): a) Digoxin b) Strophantin K c) Dobutamine d) Amrinone 009. Digoxin is thought to increase intracellular concentrations of calcium in myocardial cells by indirectly slowing the action of the sodium-calcium exchanger. Compare the half-life of digoxin and the half-life of digitoxin: a) Digoxin is greater than digitoxin b) Digitoxin is greater than digoxin 013. The most cardiac manifestation of glycosides intoxication is: a) Atrioventricular junctional rhythm b) Second-degree atrioventricular blockade c) Ventricular tachycardia d) All the above 016. The manifestations of glycosides intoxication are: a) Visual changes b) Ventricular tachyarrhythmias c) Gastrointestinal disturbances d) All the above 017. For digitalis-induced arrhythmias the following drug is favored: a) Verapamil b) Amiodarone c) Lidocaine d) Propanolol 018. In very severe digitalis intoxication the best choice is to use: a) Lidocaine b) Digibind (Digoxin immune fab) c) Oral potassium supplementation d) Reducing the dose of the drug 019. This drug is a selective beta-1 agonist: a) Digoxin b) Dobutamine c) Amrinone d) Dopamine 021. Tolerance to this inotropic drug develops after a few days: a) Amrinone b) Amiodarone c) Dobutamine d) Adenosine 022. This drug is useful for treating heart failure because it increases the inotropic state and reduces afterload: a) Amiodarone b) Amrinone c) Propanolol d) Enalapril 024.

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In ble treatment plan for anxiety purchase eldepryl without a prescription, data from the studies described earlier in this section addition medications 4 less canada order eldepryl 5mg online, a recent review of 14 short-term treatment 5th metatarsal stress fracture eldepryl 5mg fast delivery, double-blind were combined treatment jalapeno skin burn cheap 5 mg eldepryl amex, and the persistence of the antidepressive trials conducted in outpatients with mild to moderate response was determined (478). Side effects were observed in a that response at 2 years, suggesting persistent benefits of lower proportion of individuals taking St. An additional uncontrolled multisite European trial showed somewhat lower rates of sustained response (44%) b. Side effects were mild and tran during the initial 3 months of treatment (282), with about sient. Data from two multicenter studies also Copyright 2010, American Psychiatric Association. In one of the larger trol condition for bright light therapy may have contributed controlled trials, which included 293 participants, Pancheri to the limited evidence base to date. Despite mouth at a dose of 150 mg/day) to be similarly efficacious in heterogeneity of designs and results, evidence supports the a 4-week trial. Two large meta-analyses found benefits of omega-3 fatty acids overall in mood disorder trials (384, 385) but also f. Acupuncture highlighted the heterogeneity of study designs and re Assessment of the evidence base for acupuncture is compli sults. Folate chosen from more than 200 studies on the basis of having In a study by Coppen and Bailey (389) that included a randomized design, specific diagnostic criteria for de 127 subjects, 94% of women who received fluoxetine and pression, and specific acupuncture interventions (manual, 500 mcg/day of folate responded to treatment, compared electro-acupuncture, or laser). Patients who received folate were also less Chinese Classification of Mental Disorders criteria. Light therapy over control conditions on either response rates or remis In a meta-analysis, Golden et al. Consequently, additional system pressive disorder (eight studies), with a large effect size atic study is required to assess the role of acupuncture for (0. The active acupuncture group experi major depressive disorder was not found to be significantly enced a significantly greater remission rate. After 8 weeks, there for an active treatment condition for bright light treat was no evidence of benefit for the acupuncture intervention ment). Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 93 In another randomized study, Luo et al. Cognitive and behavioral therapies sponse and remission in individuals with moderate to severe major depressive disorder. Cognitive-behavioral therapy was given in 16 ses tients with more severe depression, behavioral activation sions over 20 weeks, with two booster sessions at 72 weeks. This study shows that behavioral interventions associated with higher remission rates. Cognitive-behavioral therapy had tween 1980 and October 2004, conducted by Hollon et al. After 8 months, the proportions of pa assignment and adequate control conditions. Psychodynamic psychotherapy havioral activation treatment in which patients learn how Psychodynamic psychotherapy has been used widely in to increase the number of pleasant activities and interac clinical practice for the treatment of patients with depres tions with their environment, was found in a meta-analy sive symptoms and syndromes and is sometimes preferred sis to be an effective treatment for depression (706). However, its efficacy in major depres sive disorder has not been adequately studied in con 2. Subsequently, some clinical severe major depressive disorder, whereas cognitive ther trials of psychodynamic psychotherapy have reported apy was not superior to placebo. Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 95 difficult to draw conclusions from meta-analyses that in during a psychiatric hospitalization for major depressive corporate a variety of study populations and designs (286, disorder were randomly assigned to pharmacotherapy 1130, 1131). A recent meta-analysis (1132) acknowledged alone; combined pharmacotherapy and cognitive therapy; that the quality of available studies on psychodynamic combined pharmacotherapy and family therapy; and com psychotherapy for treatment of depression was not opti bined pharmacotherapy, cognitive therapy, and family ther mal. Patients who received treatment that included a family yses of psychotherapy may lead to overestimations of therapy component were more likely to improve and had effect sizes (1133). With these caveats, some findings from significant reductions in interviewer-rated depression and meta-analyses of short-term (1132) and long-term (1130) suicidal ideation, compared with those whose treatment did psychodynamic psychotherapy suggest possible benefits not include family therapy (343). Problem-solving therapy have beneficial effects in individuals with depressive and Some studies have reported modest improvement in sub anxiety symptoms (1130).

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Thus treatment interventions purchase eldepryl 5 mg without a prescription, determination of nutritional status clin ically compares favorably with determination of nutritional status by a battery of anthropomorphical and biochemical indices treatment 4 water buy discount eldepryl online. However symptoms gluten intolerance order eldepryl australia, 25 to treatment table purchase eldepryl without prescription 30% of subjects fall into an intermediate zone between well nourished and undernourished. These subjects are classi ed as borderline or at risk of undernutrition and require further assessment by biochemical markers or additional clinical evaluation. Defects in appetite often precede the onset of weight loss and complicate treatment with hypercaloric sup plements or feeding. When I eat I feel full I feel full I feel full I feel full I hardly after after after after ever feel eating eating eating eating full only a few about a over half most of mouthfuls third of of a meal the meal my meal 3. Normally I eat Less than One meal a Two meals Three More than one meal day a day meals a three a day day meals a day Total Source: Wilson, M. The sensitivity and speci city were 81 and 76% for predicting a 5% weight loss and 88 and 84% for a 10% weight loss. Early identi cation of older persons with abnormalities in appetite who are at high risk for ensuing weight loss with a four-question instrument may allow prompt intervention to ameliorate nutritional problems. In a study of hospitalized subjects older than 70 years, 38% of patients with albumin levels of 4. No single albumin level was associated with acceptable sensitivity and speci city as a predictor of Subjective Global Assessment classi cation. The ability of either measure to predict the other measure was only marginally better than chance (0. Thus, both measures are limited as markers of nutritional status and may re ect fundamentally different clinical processes. Using mortality Nutritional Assessment in Older Persons 207 rates completed in 1993, subjects with a normal baseline score had a lower mortality risk (0. Neither instrument correlated well with the Quick Nutritional Index or with bio chemical changes. It is critical to understand that these nutritional risk assessment instruments are predictive of only hospital complications or future mortality. When used in this way, the instruments are highly predictive of persons at risk for these outcomes. However, it is not clear that these instruments are measuring true nutritional status or simply sicker individuals. While these instruments indicate that they measure undernutrition or nutritional risk, it is not clear that they do so. These instruments do not indicate which persons will respond to nutritional interventions. The results of most clinical trials of refeeding or energy-dense nutritional supplements have not shown that the measured adverse outcomes can be corrected. However, a large number of patients who appear to be undernourished (that is, who exhibit the phenotype of kwashiokor or marasmus) fail to respond to refeeding in published nutritional intervention trials. A meta-analysis of 55 randomized controlled trials with 9187 older participants evaluated the effect of nutritional supplements across a variety of healthcare set tings. Mortality in the supple mented group was reduced, although the reduction was only borderline statistically signi cant (odds ratio, 0. However, a reduction in mortality was seen in trials that only included undernourished subjects (odds ratio, 0. A reduction in mortality was not seen in supplemented residents in long-term-care settings (odds ratio, 0. Hospitalized patients who were given supplements had a statistically signi cant decrease in complications (odds ratio, 0. Despite a signi cant improvement in dietary intakes and body weight in the inter vention group, no signi cant changes were found for biological markers of nutrition, functional status, or cognitive function. However, the use of nutritional support is not associated with a reduction in the length of the hospital stay. However, the incidence of protein energy undernutrition, as evidenced by decreased arm muscle circumference (<80% of normal) and hypoalbuminemia (<35 g/l), was signi cantly higher in the patients with tube feeding than in the orally fed older persons. This suggests that a proportion of persons who are labeled as undernourished may in fact have another clinical syndrome.

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With alcohol abuse medications while breastfeeding discount eldepryl master card, increased urinary loss (due to moroccanoil treatment eldepryl 5 mg online high uid intake and urine production) exacerbates poor nutritional intake medications zolpidem eldepryl 5mg without prescription. Prolonged diuretic use in renal insufficiency may prevent renal tubular reabsorption of thiamin (Suter et al medicine cabinet shelves buy 5mg eldepryl with mastercard. Increased utilization of thiamin may be seen with vigorous activity, prolonged fever, and physiologic stress, such as major operation, and may precipitate a de ciency state in those with marginal levels. Refeeding after starvation and administering glucose to thiamin-depleted persons require thiamin supplementation due to the metabolic demand of glucose utilization. Early symptoms of thiamin de ciency may be vague or insidious and include constipation, anorexia, nausea, fatigue, and peripheral neuropathy. The severe de ciency state, known as beriberi, is not commonly seen in developed countries. In Southeast Asia, it is the result of a diet rich in carbohydrates that has been stripped of nutrients, such as polished rice. The purported etymology of beriberi is from the Sinhalese word for weakness, depicting the peripheral neuropathy that accompa nies the disease. If untreated, the clinical course may rapidly deteriorate to vomiting, hypothermia, hypotension, stupor, coma, and death. At this late stage, the symptoms are not likely to fully reverse with thiamin replace ment. No randomized controlled trials have satisfactorily addressed this question to date, but early studies provide some insight. Finally, a controlled trial in 80 older females with marginal baseline thiamin levels suggested that thiamin supplementation improved overall quality of life as measured by improved appetite, sleep pattern, activity level, and decreased fatigue (Smidt et al. Flavins also participate in the hepatic metabolism of drugs and toxins, in conjunction with cytochrome P-450. Sources of ribo avin include dairy products, forti ed cereals, meat, liver, eggs, cheese, sh, and green leafy vegetables. It rarely occurs in isolation and is more likely to be seen in conjunction with other water-soluble vitamin de ciencies. Ribo avin de ciency may present with in ammation of the oral mucosa, cheilosis, angular stomatitis, magenta tongue (in ammation and redness of the tongue), seb orrheic dermatitis, revascularization of the cornea, and normochromic normocytic anemia. These symptoms are not pathognomonic of aribo avinosis, as some may occur with other other vitamin B-complex de ciencies. The role of ribo avin in the pathogenesis of age-related cataracts has recently been studied. Opaci cation due to oxidative damage of lens proteins can theoretically be reduced with nutritional antioxidants. In controlled studies, cataract formation was inversely related to ribo avin intake (Cumming et al. In both studies, however, cataract prevention also correlated with other antioxidant vitamins and protein nutritional status. A third prospective study of over 50,000 women failed to show any correlation between ribo avin and cataracts (Hankinson et al. Niacin can also be synthesized in the liver from dietary tryptophan, or by the intestinal ora. In natural cereal grains such as corn, millet, and wheat, niacin may be bound to sugars in the form of glycosides, which severely limits bioavailability (Gregory 1998).