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It is useful in strangury generic aurogra 100 mg with mastercard, and in some dropsies where there is absence of acute inflammation buy 100 mg aurogra. It may be applied directly order 100mg aurogra with amex, but is quite severe upon an irritable or sensitive surface. It is a useful agent in psoriasis, and as a parasiticide it will destroy psora and cure favus. It was at one time in common use as an application to skin diseases and parasites in domestic animals. Physiological Action—In Kalmia we have a remedy acting in a manner somewhat like veratrum viride, both in controlling fevers and in inflammations, as well as in its influence as an alterative, it having been successfully used both in primary and secondary syphilis. Like veratrum it has also been employed hypodermically in the treatment of neuralgia of the face, and sciatica. The patient at the time I saw him had several chancres; the surface of the body and head was covered with small red pimples, elevated above a jaundiced skin, and be was in a very debilitated condition. I administered a saturated tincture of the leaves of Kalmia, and touched the chancre with tincture of muriate of iron, and effected a cure in four weeks, removing the jaundice at the same time. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 271 If Kalmia would relieve other cases of syphilis as it did this one, we may safely say that we have no other alterative in our materia medica equal to it. It has not been extensively used, but it is without doubt beneficial in glandular disorders, scrofula, and in mild cases of secondary syphilis. Kalmia exercises a sedative influence over the heart, controls the pulse beat without depression. It is markedly alterative but must not be pushed because of this slowing influence. Homeopathists give it in cardiac hypertrophy, and for painful rheumatic affections, for facial neuralgia, for tobacco heart, and it will probably act well in rheumatic endocarditis. It will be found of service in inflammatory diseases, also in hypertrophy of the heart with palpitation, diarrhea and dysentery, rheumatism, chronic inflammations, with atonicity, neuralgia, active hemorrhages, threatened abortion from syphilitic taint, active menorrhagia, pain in the limbs and back during menstruation, jaundice, and also in scleritis, with pain in turning the eyes, and in ophthalmia. Specific Symptomatology—This agent is positive in suppressed lochia from any cause, amenorrhea from cold; dysmenorrhea, with morbid nervous excitability, and hysteria. John King regarded motherwort as superior to all other remedies in suppression of the lochia, giving it internally and applying a fomentation of the herb over the lower abdominal region. Therapy—It is prescribed in the above conditions, also in delirium tre- mens, typhoid state in fevers, chronic diseases with wakefulness, restlessness, disturbed sleep, spinal irritation, neuralgia of the stomach Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 272 and head, feeble digestion, general debility, chorea, convulsions, nervousness fr om irregular menstruation, palpitation of the heart, associated with uterine disease, amenorrhea, with chlorosis, cachexia and an irritable, excitable, enfeebled state of the nervous system, spasms and harrassing bearing down pains, and morbid sensibility from uterine disease, pain in the pelvic and lumbar regions in females. It is a simple heart tonic, promoting normal action, probably very mild in its influence. It would work well combined with cactus or crataegus or both, especially in the presence of nux vomica or collinsonia. Motherwort is tonic and laxative, a diaphoretic somewhat like asclepias, an emmenagogue like cimicifuga and a nervine like scutellaria. Tiger Lily seems to act upon the sympathetic nerves of the pelvis, increasing their strength and tone. It operates through the spinal cord, decreasing sexual irritability and materially improving the pelvic circulation. This influence is exercised best when the uterus and ovaries are greatly engorged and if there be displacement or subinvolution. Those conditions which occur from getting up too soon after confinement are improved by it, and those where the parts are slow in recovering tone, from any cause, or where there is danger of permanent prolapse from engorgement, are benefited by it. Specific Symptomatology—Neuralgic pain in the uterus, ovaries, and mammae, acid leucorrhea excoriating to the labia, causing an eruption about the vulva and inflammation of the vagina; nausea from uterine disease or pregnancy; headache from uterine disease; nervous sick- headache; chronic inflammation of the uterus, with displacement; tedious recovery after child-birth; amenorrhea, with burning pain in the ovaries; distress about the heart, with prolapse of the uterus; pain under the left breast; dysmenorrhea; neuralgic pain in the uterus and ovaries Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 273 extending down the inside of the thighs; a sense of weight and downward pressure in the lower abdomen; uterine displacements in general from debility. Therapy—These symptoms of uterine disease, cured or relieved by tiger lily, show the action of the remedy within a limited sphere; but it is probable that it has a much wider range of action, as we find that the common white meadow lily was employed by the early settlers in this country as a general and local tonic in prolapsus uteri; and as a tonic in debilitated states of the female organs of generation, and in dropsy, while the root of the white pond lily was used as a local application to ulcers and inflammations. John King says: “I recollect a lady who, several years since, was pronounced by several physicians to have uterine cancer, and which resisted all their treatment; she was permanently cured by a squaw, who gave her to drink freely of the decoction of a root, as well as to inject it in the vagina, which proved to be that of the white pond lily—Nuphar Alba. Baldwin, of Michigan, uses the fluid extract of Nuphar Lutea in the local treatment of chronic uterine disease of whatever character or however severe, with the most gratifying results. Specific Symptomatology—Persistent, dry, hard, ringing or resonant Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 274 bronchial cough, hoarse, barking or metallic cough. It is peculiarly sedative to the entire mucous surfaces of the post-nasal region and bronchial tubes. The experience of the writer has proven it specific in the peculiar, deep, resonant, barking, winter cough, without secretion, common to many ladies in the northern States, usually absent in the summer, very persistent, stubborn and difficult to cure. In every case the cough failed to recur in the following winter, as it had recurred before in several preceding winters. Note—In the early editions of my work on Materia Medica, this agent was classed from our knowledge of its action per os, as a nauseating expectorant and respiratory sedative. Since that time, the very wide observations made of its action hypodermically have changed the most of our ideas concerning it, and have placed it in an entirely different class. Given hypodermically but very few patients are nauseated by it, and almost the whole number, notwithstanding its sedative and anti-spasmodic influence, experience a physical uplift from its action. I have thought best, however, to leave this agent in its original class, until laboratory experiments have proven its exact influence upon the nervous and circulatory systems. Tinctura Lobeliae, Tincture of Lobelia; dose, from five to thirty Specific Medicine Lobelia; dose, from one to twenty minims. Subculoid (hypodermic) Lobelia; dose, from two to sixty minims; usually from ten or thirty minims repeated as occasion demands. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 275 The preparation of lobelia which is to be used hypodermically, must be selected with great care. If the agent be given internally, any good fluid preparation is effective, but in its hypodermic use, local irritation, nausea, severe vomiting, even general prostration occur more frequently from the ordinary fluid preparations. If depression with the above complications can be properly antagonized, and is not objectional in a sthenic patient. Extended and persistent experimentation has been made nearly as possible a perfect fluid preparation for hypodermic use. This is devoid to a very large extent of the objectionable features of the other preparations, and so nearly devoid of emetic properties that this is now considered a negligible quality. It is always best however to use any preparation hypodermically warmed, the parts aseptic, and to apply a hot compress over the seat of the application immediately for a few minutes. Except for its local effects, there is but little difference between the Subculoid lobelia and the specific medicine lobelia. Administration—Given by mouth for the various purposes for which it has long been used, the dosage of the specific medicine should be small, and frequently repeated. If no untoward results occur after the first dose, and the condition demands it, a more or less frequent dose and an increase in the size of the dose is justified by the severity of the symptoms, and by the demand for its influence. But in its antispasmodic and relaxing influence it is not narcotic in the same sense as opium.

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Differences in substance use between weekdays and weekends are important to ascertain order aurogra with a mastercard, because it is common for the user’s pattern of use to differ greatly between these two time periods discount aurogra 100mg with amex. The patient should describe her daily activities buy 100mg aurogra with amex, including any substances used, from awaken- ing to going to sleep at night on a normal weekday. The patient should be asked when she begins drinking or using drugs during the course of a day and the duration of such use. For example, does the patient use the sub- stance as an ‘eye-opener’ in the morning (Sokol et al. The patient should be asked to disclose how much of the substance is used in an average day and approximately how much would be consumed in an hour. Combined with information about the weekly pattern (weekend versus weekday), a semiquantita- tive estimate of the amount and frequency of substance use can be made. Alcohol use during pregnancy is well studied and crude risks of fetal alcohol syn- drome can actually be made by estimating the average daily dose. With other less well- researched substances used during pregnancy, daily dose information can be used only to assess the severity of maternal addiction. Very serious dependencies are, of course, associated with more severe adverse effects. At the outset, the physician should explain to the patient that the purpose of obtaining this personal and private informa- tion is to better manage the pregnancy, i. The author’s spouse is an attorney, and states that no release should ever be signed and that each person must protect their individual rights to privacy assertively. Another important aspect of patient consultation is to provide information regarding specific risks from substance use (Tables 16. The most ethical and legally sound approach is to provide information that may be verified directly with the medical litera- ture. Ultimately, the clinical conclusion/treatment is that social and illicit substance use during pregnancy is contraindicated because of the associated maternal and embryo fetal risks. The need for services to assist pregnant substance users is being recognized, and pro- grams exist in most areas. For assistance in locating such a treatment program, the physi- cian can contact their local substance abuse service, or their state’s commission on sub- stance abuse that accredits treatment facilities. Ideally, the pregnant substance user should be managed by the obstetrician in conjunction with a program designed to promote absti- nence or at least to reduce the substance use during pregnancy. The medical positions of abstinence and treatment are the only appropriate ones clinically and legally. One’s medical mal- practice insurance provider is often the most economical and efficient source of legal infor- mation as this service is often included as a provision of a medical malpractice policy. Drug injec- tion sites on the upper forearm (‘track marks’) are strong evidence of a serious substance use problem, but this is not frequently observed. Substances of abuse usually have an anorectic effect and often result in poor weight gain during pregnancy. Other possible signs of substance use during pregnancy include new-onset ‘spontaneously arising’ heart murmur and hypertension not associated with preeclampsia. Heart murmurs occur with increased frequency among women who are Clinical evaluation 301 chronic substance users. Heart murmurs also occur in association with bacterial endocarditis or a history of this disease. Chronic substance use can induce hypertension in the nonpregnant adult, although not all have been studied for hypertensive effects dur- ing pregnancy. Cocaine, heroin, and tobacco use is known to be associated with hyper- tension during pregnancy (Abel, 1980a,b; Little et al. In addition, abruptio placentae or a history of this serious complication is also an indication that substance use may be a factor. Risk of abruptio placentae may be as high as 1–2 percent among substance abusers compared to 0. A history of stillbirths may, along with other risk fac- tors, be a clue to the obstetrician that substance abuse is a complicating factor. Hidden risks of substance abuse: impurities All substances of abuse, even alcohol, may be contaminated by certain impurities. Amphetamine and methampheta- mines may contain impurities, such as lead oxides (Allcott et al. Leaded gasoline is sometimes used as the solvent, resulting in lead contamination in the extraction of cocaine paste from cocoa leaves. If not fully reacted, cyanide may be contained in the final product because illicit laboratories are usually crudely equipped for purification, with no quality control. Lead and cyanide poisoning have resulted from the use of illic- itly manufactured substances and are associated with significant maternal–fetal morbid- ity and mortality. Drugs avail- able as tablets or capsules (for example, codeine, methadone, morphine, benzodi- azepines, pentazocine) contain a significant amount of the tablet/capsule vehicle agent (usually more than 97 percent), typically microcrystalline cellulose. Inhalants are aromatic (benzene ring-containing) substances, such as toluene or gaso- line, that may also contain lead or nitriles that can cause toxicity. Even marijuana may contain dangerous vegetable contaminants such as nightshade, poison sumac, poison ivy, and poison oak, all of which may cause serious pulmonary-cardiac morbidity or even death when smoked. Other drugs and chemicals as dilutants Other substances are used by dealers to ‘cut’ or dilute illicit drugs to increase their prof- its. Amphetamines are diluted, 302 Substance abuse during pregnancy sometimes heavily, with certain antihistamines or ephedrine. Heroin is known to have been cut with diverse compounds: talcum, confectioner’s sugar, and even finely ground sawdust. Perhaps the most notorious case of the dilutant being more dangerous than the substance of abuse is cutting heroin with warfarin, leading to a cluster of warfarin embryopathy cases that were never published. Some of these dilutants were teratogenic and these and others may cause serious maternal and/or placental complications, espe- cially when used parenterally. Opiates are the exception because methadone replacement/maintenance therapy is available for such drugs as heroin. Regimens used as an adjunct to assist in withdrawal include a benzodiazepine plus an antidepressant (e. A differ- ent pharmacological strategy is suppression of alpha-adrenergic action with drugs, such as clonidine, and to alleviate withdrawal symptoms, frequently with a benzodiazepine or barbiturate (nembutal) adjunct. Such regimens are given in doses adjusted to the indi- vidual case to facilitate asymptomatic withdrawal, and the dose is gradually decreased over periods ranging from 10 days to 3–6 months. Substance addiction is a psychological phenomenon as well as a physical one, and both aspects must be addressed adequately in treatment protocols. Specialists in addic- tion psychology/psychiatry should be involved in the treatment plan early. We reported that in patient substance abuse treatment during pregnancy was associ- ated with increased birth weight and head circumference, and fewer perinatal complica- tions compared to untreated matched substance-abusing pregnant controls (Little et al. Obstetrical goals of substance abuse treatment Minimization of maternal and fetal/infant morbidity and mortality is the obstetrical goal of substance abuse treatment during pregnancy. In one study, prenatal care was the main determinant of pregnancy outcome among substance abusers, not attaining abstinence (MacGregor et al.

N. Grompel. Colorado State - Pueblo.

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