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Inhalation (aerosol): 100 micrograms per dose super cialis 80mg visa;  budesonide [c] 200 micrograms per dose generic super cialis 80mg with visa. Injection: 1 mg (as hydrochloride or hydrogen epinephrine (adrenaline) tartrate) in 1‐ mL ampoule generic 80 mg super cialis overnight delivery. It implies that there is no difference in clinical efficacy or safety between the available dosage forms generic super cialis 80 mg online, and countries should therefore choose the form(s) to be listed Solid oral dosage form depending on quality and availability buy 80mg super cialis with amex. The term ʹsolid oral dosage formʹ is never intended to allow any type of modified‐release tablet. Refers to:  uncoated or coated (film‐coated or sugar‐coated) tablets that are intended to be swallowed whole;  unscored and scored ;*  tablets that are intended to be chewed before being swallowed; Tablets  tablets that are intended to be dispersed or dissolved in water or another suitable liquid before being swallowed;  tablets that are intended to be crushed before being swallowed. The term ʹtabletʹ without qualification is never intended to allow any type of modified‐release tablet. Refers to a specific type of tablet: chewable ‐ tablets that are intended to be chewed before being swallowed; dispersible ‐ tablets that are intended to be dispersed in water or another suitable liquid before being swallowed; soluble ‐ tablets that are intended to be dissolved in water or another suitable liquid before being swallowed; crushable ‐ tablets that are intended to be crushed before being swallowed; Tablets (qualified) scored ‐ tablets bearing a break mark or marks where sub‐division is intended in order to provide doses of less than one tablet; sublingual ‐ tablets that are intended to be placed beneath the tongue. The term ʹtabletʹ is always qualified with an additional term (in parentheses) in entries where one of the following types of tablet is intended: gastro‐resistant (such tablets may sometimes be described as enteric‐coated or as delayed‐release), prolonged‐release or another modified‐release form. Capsules The term ʹcapsuleʹ without qualification is never intended to allow any type of modified‐release capsule. The term ʹcapsuleʹ with qualification refers to gastro‐resistant (such capsules may sometimes be described as enteric‐coated or as delayed‐ Capsules (qualified) release), prolonged‐release or another modified‐release form. Preparations that are issued to patient as granules to be swallowed without further preparation, to be chewed, or to be taken in or with water or another suitable liquid. Granules The term ʹgranulesʹ without further qualification is never intended to allow any type of modified‐release granules. Preparations that are issued to patient as powder (usually as single‐ Oral powder dose) to be taken in or with water or another suitable liquid. Oral liquids presented as powders or granules may offer benefits in the Oral liquid form of better stability and lower transport costs. It is preferable that oral liquids do not contain sugar and that solutions for children do not contain alcohol. Injection (qualified) Route of administration is indicated in parentheses where relevant. Injection (oily) The term `injection’ is qualified by `(oily)’ in relevant entries. Intravenous infusion Refers to solutions and emulsions including those constituted from powders or concentrated solutions. Other dosage forms Mode of Term to be used administration To the eye Eye drops, eye ointments. Use this guide to alert you to possible “food-drug interactions” and to help you learn what you can do to prevent them. In this guide, a food-drug interaction is a change in how a medicine works caused by food, caffeine, or alcohol. A food-drug interaction can: ▪ prevent a medicine from working the way it should ▪ cause a side effect from a medicine to get worse or better ▪ cause a new side effect A medicine can also change the way your body uses a food. This guide covers interactions between some common prescription and over-the- counter medicines and food, caffeine, and alcohol. Your age, weight, and sex; medical conditions; the dose of the medicine; other medicines; and vitamins, herbals, and other dietary supplements can affect how your medicines work. Every time you use a medicine, carefully follow the information on the label and directions from your doctor or pharmacist. Some medicines can work faster, slower, better, or worse when you take them on a full or empty stomach. On the other hand, some medicines will upset your stomach, and if there is food in your stomach, that can help reduce the upset. If you don’t see directions on your medicine labels, ask your doctor or pharmacist if it is best to take your medicines on an empty stomach (one hour before eating, or two hours after eating),with food, or after a meal (full stomach). Yes, the way your medicine works can change when: ▪ you swallow your medicine with alcohol ▪ you drink alcohol after you’ve taken your medicine ▪ you take your medicine after you’ve had alcohol to drink Alcohol can also add to the side effects caused by medicines. Some foods and drinks with caffeine are coffee, cola drinks, teas, chocolate, some high-energy drinks, and other soft drinks. This guide should never take the place of the advice from your doctor, pharmacist, or other health care professionals. Always ask them if there are any problems you could have when you use your medicines with other medicines; with vitamins, herbals and other dietary supplements; or with food, caffeine, or alcohol. This guide won’t include every medicine and every type of medicine that’s used to treat a medical condition.

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As the number is divided by 10 six times generic super cialis 80mg visa, this would mean 5 zeros before the 4 (don’t forget that the decimal point is originally after the [4 generic super cialis 80mg. Question 9 Answer: 500 micrograms digoxin in 2mL First convert milligrams to micrograms cheap 80mg super cialis with visa. You are going from a larger unit to a smaller unit discount super cialis 80mg without a prescription; so you multiply by 1 80 mg super cialis fast delivery,000 to remove the decimal point: 0. Chapter 5 Drug strengths or concentrations 187 To find out how much is in a 2mL ampoule, multiply by 2: 50 micrograms × 2 = 100 micrograms Chapter 5 Drug strengths or concentrations Question 1 0. First, ensure units are the same – convert the amount needed to nanograms: 1 micrograms = 1,000 nanograms Each capsule contains 250 nanograms, so how many capsules contain 1,000 nanograms? Divide the dose needed (1,000 nanograms) by the strength of the capsule (250 nanograms). Answer: 110mg Chapter 6 Dosage calculations 189 Question 4 Answer: 720mg Question 5 Answer: 97mg Question 6 Answer: 186mg Question 7 Answer: (i) 21,600mcg; (ii) 21. Volume to be given: you have 100 mg in 1 mL, which is equivalent to: 1 1mgin mL 100 Therefore for 88. Answer: 3mL of ranitidine liquid 150mg in 10mL Question 18 Total amount required = 18. Therefore, for each dose, you will need: 8160, = 2,040mg 4 Chapter 6 Dosage calculations 193 You have co-trimoxazole ampoules containing 96 mg/mL. To work out how many ampoules are needed, divide the total volume required by the volume of each ampoule, i. Answer: 5 ampoules per dose iii) Since it is to be given in four divided doses; to calculate how many ampoules are needed for 1 day, multiply the amount for each dose by 4, i. Now you have a final concentration of 100 mg/mL (1 g or 1,000mg per 10mL): 194 Answers 100mg in 1mL 1 350 mg = ( × 350) mL = 3. Total daily dose = weight × dose = 18 × 150 = 2,700mg 2,700 Each dose = = 675 mg 4 You have 250mg in 1mL: 1 675 mg =( × 675) mL = 2. Chapter 7 Moles and millimoles 195 Chapter 7 Moles and millimoles Question 1 One millimole of sodium chloride will give one millimole of sodium. So the amount (in milligrams) for one millimole of sodium chloride will give one millimole of sodium. You have 27mg/mL sodium chloride, thus in 500mL: 27 × 500 = 13,500mg Next work out the number of millimoles for the infusion: 8160, 1mg will give millimoles. If using the formula: mg/mL total millimoles = × volume (mL) mg of substance containing 1mmol In this case: mg/mL = 27 mg of substance containing 1mmol = 58. One millimole of sodium chloride gives one millimole of sodium and one millimole of chloride. Thus to find the total amount of chloride, add the amount for the sodium and potassium together. Chapter 7 Moles and millimoles 197 If using the formula: percentage strength (% w/v) mmol = × 10 × volume (mL) mg of substance cconntaining 1mmol In this case: percentage strength (% w/v) = 0. Question 6 In this case one millimole of calcium chloride will give one millimole of calcium and two millimoles of chloride. So the amount (in milligrams) for one millimole of calcium chloride will give one millimole of calcium and two millimoles of chloride. So 147mg (one millimole) of calcium chloride will give one millimole of calcium and two millimoles of chloride. Now calculate how much calcium chloride in the 10mL ampoule containing calcium chloride 10%. If using the formula: percentage strength (% w/v) mmol = × 10 × volume (mL) mg of substance cconntaining 1mmol For calcium: percentage strength (% w/v) = 10 mg of substance containing 1mmol = 147 volume (mL) = 10 Substituting the numbers into the formula: 10 × 10 × 10 = 6. Answer: There are approximaetly 7 millimoles of calcium and 14 millimoles of chloride in a 10 mL ampoule of calcium chloride 10%. To convert this to a molar concentration, you need to calculate the equivalent number of moles per litre (1,000mL). Alternatively, a formula can be used: weight (g) × 1,000 concentration (mol/L or M)= molecular weight × final volumev (mL) In this case: weight (g) = 8. Alternatively, a formula can be used: concentration (mol/L or M)× molecular weight×× final volume (mL) weight (g) = 1,000 In this case: desired concentration (mol/L or M) = 0. Chapter 8 Infusion rate calculations 201 Chapter 8 Infusion rate calculations Question 1 First convert the volume to a number of drops.

The doctor again advises the patient to stop smoking super cialis 80 mg visa, and writes a prescription for codeine tablets 15 mg buy super cialis 80 mg low price, 1 tablet 3 times daily for 3 days order 80mg super cialis fast delivery. When you observe experienced physicians order super cialis 80 mg with visa, the process of choosing a treatment and writing a prescription seems easy generic 80 mg super cialis otc. Choosing a treatment is more difficult than it seems, and to gain experience you need to work very systematically. You start by considering your ‘first-choice’ treatment, which is the result of a selection process done earlier. The second stage is to verify that your first-choice treatment is suitable for this particular patient. So, in order to continue, we should define our first-choice treatment for dry cough. Rather than reviewing all possible drugs for the treatment of dry cough every time you need one, you should decide, in advance, your first-choice treatment. The general approach in doing that is to specify your therapeutic objective, to make an inventory of possible treatments, and to choose your ‘P(ersonal) treatment’, on the basis of a comparison of their efficacy, safety, suitability and cost. This process of choosing your P-treatment is summarized in this chapter and discussed in more detail in Part 2 of this manual. Specify your therapeutic objective In this example we are choosing our P-treatment for the suppression of dry cough. Make an inventory of possible treatments In general, there are four possible approaches to treatment: information or advice; treatment without drugs; treatment with a drug; and referral. For dry cough, information and advice can Cartoon 1 be given, explaining that the mucous membrane will not heal because of the cough and advising a patient to avoid further irritation, such as smoking or traffic exhaust fumes. Specific non-drug treatment for this condition doesn’t exist, but there are a few drugs to treat a dry cough. You should make your personal selection while still in medical school, and then get to know these ‘P(ersonal) drugs’ thoroughly. In the case of dry cough an opioid cough suppressant or a sedative antihistamine could be considered as potential P-drugs. The last therapeutic possibility is to refer the patient for further analysis and treatment. In summary, treatment of dry cough may consist of advice to avoid irritation of the 8 Chapter 1 The process of rational treatment lungs, and/or suppression of the cough by a drug. Choose your P-treatment on the basis of efficacy, safety, suitability and cost The next stage is to compare the various treatment alternatives. To do this in a scientific and objective manner you need to consider four criteria: efficacy, safety, suitability and cost. If the patient is willing and able to follow advice to avoid lung irritation from smoking or other causes, this will be therapeutically effective, since the inflammation of the mucous membrane will subside within a few days. However, the discomfort of nicotine withdrawal may cause habituated smokers to ignore such advice. Opioid cough depressants, such as codeine, noscapine, pholcodine, dextromethorfan and the stronger opiates such as morphine, diamorphine and methadone, effectively suppress the cough reflex. This allows the mucous membrane to regenerate, although the effect will be less if the lungs continue to be irritated. Sedative antihistamines, such as diphenhydramine, are used as the cough depressant component of many compound cough preparations; all tend to cause drowsiness and their efficacy is disputed. Weighing these facts is the most difficult step, and one where you must make your own decisions. Although the implications of most data are fairly clear, prescribers work in varying sociocultural contexts and with different treatment alternatives available. So the aim of this manual is to teach you how, and not what, to choose, within the possibilities of your health care systems. In looking at these two drug groups one has to conclude that there are not many alternatives available for treating dry cough. In fact, many prescribers would argue that there is hardly any need for such drugs. This is especially true for the many cough and cold preparations that are on the market. However, for the sake of this example, we may conclude that an unproductive, dry cough can be very inconvenient, and that suppressing such a cough for a few days may have a beneficial effect. On the grounds of better efficacy we would then prefer a drug from the group of opioids. Noscapine may have teratogenic side effects; it is not included in the British National Formulary but is available in other countries.

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This statement understandably caused outrage in Bolivia and Peru where coca leaf chewing is a long established tradition amongst 159 The use of various coca preparations in South America as a traditional medicine in various forms remains widespread discount super cialis 80 mg fast delivery. The traditional use of coca leaf has increasingly become a political fashpoint in the international arena super cialis 80mg without a prescription, as such long established cultural and traditional indigenous practices have collided with the prerogatives of Western governments determined to stamp out the source of illicit cocaine production that exists in parallel with sources for traditional use generic 80mg super cialis with amex. To date discount 80mg super cialis mastercard, this report has never been offcially published although the relevant sections have subsequently 165 been leaked and made available online cheap super cialis 80mg fast delivery. Currently four countries (Bolivia, Peru, Argentina and Colombia) main- tain legislation permitting some form of protection of traditional use, to different extents. Bolivia and Peru allow the growing of the leaves for this use, limiting this to a certain amount of hectares. Argentina allows people to carry leaves for traditional chewing, as does Colombia and Chile for their indigenous peoples. Signifcant problems exist for the legal and quasi-legal markets in coca- based products in that they struggle to compete with the illegal coca production that supplies the illegal cocaine trade. Discussion Legal coca production for use in its raw leaf form, lightly processed products, or pharmaceutical cocaine does not present any signifcant problems in and of itself. Low potency coca products (leaf and tea) do not require any more controls than equivalent products such as coffee, whilst the processing of coca into pharmaceutical cocaine would take place at an industrial level for which any security and product regulation issues would operate within well established models. The key problems in any such system are the ones already seen in coca producing regions: the potentially destabilising economic tensions and pressures created by any remaining parallel illicit market. Regulating legal production of coca leaf in line with the established fair trade guidelines—price guarantees along with a range other social and environmental protections (for growers of coffee, cocoa, sugar, etc. Furthermore, in a similar fashion to opium and cannabis, such problems would progressively diminish with the shrinking demand for illicit supply, as the global market shifted towards legal regulation of production and supply. These include legal regulation of cannabis production for a range of purposes (primarily for various medical uses and preparations, but also, to a lesser extent regulation of industrial hemp production and some sacra- mental/religious uses) in a number of different countries over a number of decades. The challenges and issues raised by these existing models provide a clear indication of how licensed models for cannabis produc- tion for non-medical use can evolve as and when the political and legislative environment allows it. Cannabis holds a unique place within contemporary drug culture and politics, being the most widely used illegal drug globally by an 170 171 enormous margin, as well as being a plant based drug that can be consumed in its raw herbal form without requiring the signifcant levels of processing associated with, for example, heroin or cocaine. Regulatory control issues are also complicated by the fact that the plant itself is uncommonly simple to cultivate in a wide range of environ- mental conditions. The combination of these factors with the enormous and growing demand for the drug (expanding steadily in the West over the past four decades but now showing signs of having fattened off or 172 even falling ) means that regulation of cannabis production, supply, and use has presented an impossible challenge from the perspective of prohibition’s enforcers; illicit production, supply and availability having more than kept pace with demand. Legal cannabis production for medical use The most useful contemporary model for production of cannabis is for its medical uses, in both processed and herbal form. These licences allow the company to research and develop cannabinoid prescription medications such as Sativex. A 2007 case documented street cannabis being bulked up (by weight) with lead particulates leading to a signifcant number of serious lead poisonings, in the New England Journal of Medicine, ‘Lead Poisoning Due to Adulterated Marijuana’, April 10, 2008. It is interesting to note that there are currently two other prescription drugs based on compounds found in the cannabis plant. They notably found that ‘Dronabinol is the main active principle of cannabis and has similar effects on mood, perception and the 178 cardiovascular system’. Gettman—this move was ‘in response to a petition fled by the manufacturer on February 3, 1995’: www. It remains controversial in the medical world because, unlike almost all other licensed drugs, it is consumed in its raw herbal form (seen as a ‘messy’ cocktail of active substances), because it is frequently smoked (although it can be used with a vaporiser or eaten in variety of preparations), and because it has not been through the stan- dardised rigours of other potential prescription drugs. There are also ethical issues around potential side effects, not least plea- surable ones, and concerns about diversion to non-medical use. None the less, provision of medical herbal cannabis does exist in various forms and provides some useful indications for how potential non-med- ical production models may operate in the future. John’s Wort as an anti-depressant, that lacks any parallel non-med- ical/recreational uses), as the issue has become inexorably entwined with the wider political and cultural discourse about non-medical cannabis use and legislation. None the less, the widely reported eff- cacy of herbal cannabis relative to standard prescribed drugs for a large number of individuals with chronic illnesses, who do not ft the bill as stereotyped drug users, has forced the issue. Thirteen states now allow the use of medical cannabis—they are Alaska, California, Colorado, Hawaii, Maine, Maryland, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington. As a result, there have been a series of unpleasant enforcement incidents, with federal police closing down medical production and dispensaries that were offcially sanctioned by state governments. These patients have been provided with medical cannabis for between 11 and 27 years.

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