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This document was developed through a collaborative effort between some of the best minds in addiction care today and will help you make wise decisions discount 5mg procyclidine with mastercard, ensuring that medications you may be prescribed and incidental exposure to alcohol do not threaten your hard won recovery buy generic procyclidine 5 mg on-line. This guide is divided into three sections and is based on the drug classifcation system developed nearly 20 years ago by Dr procyclidine 5 mg line. Avoiding these products will decrease the likelihood you will absorb or ingest small quantities of alcohol that could sensitize your system and threaten recovery buy cheap procyclidine 5 mg on-line. Please remember that this guide is only intended as a quick reference and never as a substitute for the advice of your own personal physician. It is essential that you inform all of your personal physicians, dentists and other health care providers of your chemical dependency history so that medications can be prescribed safely and appro- priately when they are deemed necessary. Never discontinue or make any changes in the doses of medication that you may have been prescribed. Doing so may result in unexpected problems such as withdrawal reactions, which in some cases can be life-threatening. The bottom line is that a recovering addict or alcoholic needs to become a good consumer. The danger is not always that a recovering addict may develop a new addiction (though this certainly can happen), but that one can be led back into dependence on their drug of choice. The latest scientifc research has proven that all the dependence- producing drugs act on the brain in the same way to produce addiction, despite having different effects or a differ- ent kind of “high” when taken. In addition, if urine drug screening is part of the recovering person’s continuing treatment program, use of many types of medications can result in falsely positive tests for the more highly addictive classes of drugs, resulting in negative consequences. Therefore, it is very important for a recovering person to learn about the different types of medications and drugs, as well as which ones present a special risk to continuing recovery and sobriety. The com- monly available medications and drugs are divided into three classes – A, B and C – to indicate three levels of risk. Class A drugs must be avoided completely, as they are well known to produce addiction and are the most dan- gerous of all. Only under very unusual conditions can Class A drugs be taken by a recovering addict or alcoholic, and only when given by a physician or dentist and with the consent of the addiction medicine physician that follows your care. These exceptional circumstances can include severe illness and injuries, including major surgery, car ac- cidents and other trauma, and tests or procedures that can only be done under sedation or anesthesia. Medication treatments for certain psychiatric conditions are in this category as are medications used for drug detoxifcation. The medications in Class B are also potentially dangerous, especially when taken by recovering persons without the guidance of a physician or another health care professional. However, under certain circumstances, the Class B group can be taken safely under a physician’s care. We strongly urge you to have an addiction medicine specialist follow your treatment when you are prescribed these medications. Class C medications are generally safe from the point of view of addiction recovery. However, overuse of any medication, even the common over-the-counter remedies, can result in unwanted side effects. People who have struggled with drug addiction or alcoholism must remain aware of the tendency to look for external solutions for internal problems and should avoid taking any of these medications on their own in order to medicate emotions and feelings. The tools of recovery, including participation at 12-Step fellowship meetings, working the Steps, or talking with a sponsor, counselor or doctor, provide safe and healthy ways to deal with the strong feelings that can come up at any time in early sobriety. The three classes of medications that appear on the following pages include both the brand name (i. On the following pages, look for the brand name listed frst, followed by the (generic name) in parentheses. For street drugs, the common name is listed frst, and the chemical name or street name is in parentheses. For each drug group in Class A and B, there is also a brief explanation of the dangers associated with taking the medication or street drug. Please note that there is a variety of cough and cold preparations that contain alcohol and that medications which can be taken in tablet form will not contain ethyl alcohol. Certain topical products, soft-gels and capsules contain ethyl alcohol and should be avoided. Please refer to the table at the end of the document for a list of alcohol-containing products to avoid. These medications bind to opiate receptors in the central nervous system, altering the perception of and response to pain and produce generalized central nervous system depression and may alter mood or cause sedation. Barbiturates: Amytal (amobarbital) Esgic (acetaminophen/butalbital/caffeine) Barbita (phenobarbital) Fioricet (butalbital/acetaminophen/caffeine) Butisol (butabarbital) Fiorinal (butalbital/aspirin/ caffeine) Donnatal (phenobarbital/atropine/hyoscyamine/ Nembutal (pentobarbital) scopolamine) Seconal (secobarbital) These medications can produce central nervous system depression ranging from mild (sedation) to hypnotic (sleep induction). Abrupt discontinuation or a large decrease in dose can lead to seizures, coma or death. Using these substances can possibly lead to memory disturbances, psychosis and vivid hallucinations. Marinol is the psychoactive substance in marijuana and may cause withdrawal symptoms if stopped suddenly. Inhalants: Aerosols (hair sprays, deodorants) Nail Polish Remover (acetone) Airplane Glue Paint (butane, propane, toluene) Amyl Nitrate (poppers) Solvents (paint thinner, gasoline, glue, correction Butyl Nitrate (room deodorizer) fuid, felt tip marker) Gases (ether, chloroform, nitrous oxide, butane Varnish (xylene, toluene) lighters, propane tanks, whipped cream dispensers) Inhalants are central nervous system depressants. Use of inhalants can cause sedation and loss of inhibitions possibly leading to liver, kidney, nerve, heart, brain, throat, nasal and lung damage up to and including coma and death. Buprenorphine binds to mu receptors in the brain leading to a suppression of withdrawal and cravings but also feeling of euphoria. Most of the drugs in this class have the potential for drug dependency and abrupt cessation may precipitate withdrawal. Gastrointestinal (Anti-Diarrheals): Lomotil (atropine/diphenoxylate) Motofen (atropine/difenoxin) Diphenoxylate is a member of the opioid class of drugs. At recommended doses, the atropine causes no effects but in larger doses, unpleasant symptoms are ex- perienced. These medications should not be used because high doses may cause physical and psychological depen- dence with prolonged use. Stimulants: Adderall (amphetamine/dextroamphetamine) Meridia (sibutramine) Adipex-P (phentermine) Metadate (methylphenidate) Cocaine (blow, coke, crack, rock, snow, white) Methamphetamine (crank, crystal meth, glass, ice, Concerta (methylphenidate) speed) Cylert (pemoline) Methylin (methylphenidate) Dexedrine (dextroamphetamine) Preludin (phenmetrazine) Fastin (phentermine) Ritalin (methylphenidate) Focalin (dexmethylphenidate) Tenuate (diethylpropion) Stimulants cause physical and psychological addiction, impair memory and learning, hearing and seeing, speed of information processing, and problem-solving ability. However, their proper use in the context of a recovery program requires monitoring by a health care professional, and it is for this reason that we place them in Class B. Clonidine acts via autoreceptors in the locus coeruleus to suppress adrenergic hyperactivity there that is involved in the expression of the opioid withdrawal syndrome. Chantix and Zyban are medications to help with nicotine (cigarettes, cigars, chewing tobacco, snuff) addiction. Respiratory depression and perceptual distortions can also be seen in those people taking large doses. Neuropathic Pain: Lyrica (pregabalin) Lyrica acts in the central nervous system as a depressant and can lead to withdrawal symptoms upon discontinuation. Steroids Decadron (dexamethasone) Medrol (methylprednisolone) Deltasone (prednisone) It is important to take steroids exactly as directed.

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Asking whether you are taking the right beta-blocker dose for heart failure will help your health care provider consider your particular case cheap procyclidine 5 mg on-line. Taking your diuretic as directed can decrease the chance that you will have to go to the hospital discount procyclidine 5 mg fast delivery. Diuretics: Management Tips and Common Side Effects Sometimes a diuretic causes people to lose potassium 5 mg procyclidine with visa. Potassium is needed for the body to work properly and to ensure that your heart rhythm is okay order procyclidine 5mg without prescription. Other medicines you are probably taking cause the body to hold onto potassium, so potassium should never be taken unless your health care provider tells you to take it. If you are taking a diuretic, your blood should be checked periodically to make sure that your potassium level is normal. Diuretics can also cause people to lose too much fuid, so that they become dehydrated. While taking a diuretic, it is a good idea to weigh yourself daily and go over your weight log with your health care provider to make sure you are not losing too much fuid. Questions and Answers About Diuretics Taking a diuretic can make it hard to leave home. For several days, pay attention to when you urinate the most after taking your diuretic. When you go to a new place, find out where the bathroom is when you first get there. For example, you could take it several hours before you plan to go out or wait until after you return from your outing to take it. My diuretic causes trouble with my sleep, because I have to get up at night to urinate. That means you will have to go to the bathroom more frequently during the first two to three hours after taking your diuretic. If you take a diuretic two times a day, take the second dose about 5 hours after your first dose. What if I take my diuretic as directed, but my breathing gets worse, or I have more swelling? If you notice that you are breathing harder or that you have more swelling in your feet, legs, or hands, call your health care provider right away to let them know. They can decide if your medicine is working or if you need a different amount or kind of medicine. See Module 4: Self-Care: Following Your Treatment Plan and Dealing with Your Symptoms for more information on monitoring and managing weight gain. They will explain exactly when you should take the extra dose of diuretic and if you will need to take an extra dose of potassium. Do not take an extra dose of your diuretic or your potassium without con- sulting your health care provider first. Multiple studies have shown that drugs that block aldosterone help people with heart failure live longer and do better overall, with less need for hospitalizations. One added advantage of taking aldosterone blockers is that they prevent the kidneys from getting rid of too much potassium while you are taking other stronger diuretics. Make sure you let your health care provider know if you are taking potassium pills if they start you on an aldosterone antagonist medication. Aldosterone Antagonists: Management Tips and Common Side Effects Aldosterone antagonists can: Cause breast enlargement or tenderness, especially in men. If this happens, the specifc aldosterone antagonist can be changed to one that does not have this effect. Your health care provider will need to check your potassium levels to make sure your potassium level is normal. Your health care provider will closely monitor your blood by checking your potassium levels and kidney function. Ask your health care provider how often you should have your blood checked for these problems. Talk to your health care provider if these or other side effects are a problem for you. This medication is helpful in some people with heart failure, especially African Americans. It has helped African Americans live longer, be in the hospital less, and feel better. If your health care provider prescribes isosorbide dinitrate and hydralazine for you, it is very important that you continue to take all of your other heart failure medicines so that you help your heart as much as possible. These medications come as a combination tablet or they may be prescribed as two separate medications. Isosorbide dinitrate is usually taken three times daily whereas isosorbide mononitrate is once daily. Management Tips and Common Side Effects The combination of isosorbide dinitrate and hydralazine can cause headaches, especially right after you start taking the medicine. Other commonly reported side effects (reactions) are: Dizziness Nausea at high doses Feeling lightheaded or even fainting, if you consume too much alcohol or do not drink enough fuids All nitrates, including nitroglycerin (taken under the tongue) and the combination of isosorbide dinitrate and hydralazine can cause low blood pressure. When nitrates are combined with drugs designed to treat erectile dysfunction, low blood pressure can also occur. Nitrates should never be taken if you are taking medications for erectile dysfunction. Talk to your health care provider if the side effects listed or others are a concern. Reason for asking this question: Research shows that a combination of isosorbide dinitrate and hydralazine can help African Americans feel better, stay out of the hospital, and live longer. This type of medicine should be considered in addition to other heart failure medicines. So it is important for you to ask your health care provider if you are taking a combination of isosorbide dinitrate and hydralazine. Reason for asking this question: Medicines with a combination of isosorbide dinitrate and hydralazine were tested in a special study that included only people who considered themselves African American. Although the combination of medications was studied in African Americans, the individual medications were studied in non- African Americans. If you still have heart failure symptoms despite taking all of your medicines as prescribed, your health care provider may consider prescribing the combination of isosorbide dinitrate and hydralazine for you. It may improve heart function by making the heart beat stronger and also may possibly help to correct hormonal imbalance. Studies show that among patients with heart failure, those who take digoxin may go to the hospital less often than patients who are not taking this type of medicine. Digoxin: Management Tips and Common Side Effects Excessive amounts of digoxin may cause: Nausea or vomiting. If you are taking both digoxin and a diuretic (commonly called a water pill), you should: Have your blood tested at regular times to check your potassium level and kidney function. Anticoagulant Medicines Some people with heart failure need anticoagulant medicines (commonly called blood thinners).

If referral is not possible immediately cheap procyclidine 5mg with amex, continue treatment until referral is possible buy procyclidine 5mg on line. Have the patient lie down on his/her side during the journey to avoid aspiration in case of vomiting cheap procyclidine 5 mg with mastercard. Send a clear letter or referral form about the clinical picture proven procyclidine 5 mg, the type of treatment given, dosages, times and route of administration for any medications given. Due to the risk of adverse drug effects in the first trimester of pregnancy, it is especially preferable to confirm the presence of malaria parasites before treatment is initiated. However, unavailability of laboratory testing should not be a reason for withholding anti-malaria treatment in pregnant women. Other conditions including urinary tract infection; pneumonia; enteric fever; intra- uterine infections (chorioamnionitis) may present with fever during pregnancy. To rule out other non-malarious causes of fever, it is therefore essential to take a comprehensive history and conduct a thorough examination, followed by a request for other relevant laboratory investigations (such as urine analysis). Two options are available: Ÿ Oral Quinine at 10mg/kg body weight (max 600 mg) three times per day for seven days. However, their use shall not be withheld in cases where they are considered to be life saving, or where other anti-malarials are considered to be unsuitable, including the possibility of non-compliance with a 7 day treatment with quinine. The following should be established before a diagnosis of treatment failure is made: a. That she completed the full treatment course and did not vomit after taking medications. That the symptoms are not due to other common infections such as ear, nose, throat, urinary tract infection, chorioamnionitis, enteric fever (typhoid), etc. In the event of treatment failure, the alternative drug to be used depends on which medicine was given first. It mostly occurs in children under five (5) years of age, pregnant women and non- immune individuals. The most common complications of severe/complicated malaria responsible for most deaths particularly in children under 5 years of age are: Ÿ Cerebral malaria – Prolonged coma not attributed to any other cause in a patient with falciparum malaria. The patient is likely to have experienced some of the typical symptoms of malaria. These may have included: chills, rigors, headache, body aches, sweating, nausea/vomiting, loss of appetite, and/or abdominal pain. In all patients, clinical diagnosis of severe/complicated malaria should be made in a patient with: Ÿ fever (history of fever or axillary temperature³ 38. In young children, a clinical diagnosis of severe/complicated malaria can also be made if there is; Ÿ fever (history of fever or axillary temperature ³ 38. While laboratory tests should not delay the initiation of treatment, it is mandatory to test for Plasmodium falciparum. Note: High parasitaemia is not always present in severe disease, and the initial blood slide examination may be negative. Where there is high clinical suspicion of malaria, the test should be repeated at 6 hourly intervals. Laboratory Findings: Ÿ Severe normocytic anaemia (severe anaemia; haematocrit <15% or Hb <5g/dl). These are non-specific clinical findings that suggest the presence of serious underlying illness. A child with fever and any general danger sign should be diagnosed and treated for severe/complicated malaria. The goals of management of severe/complicated malaria are to provide: Ÿ Urgent treatment of life threatening problems. This section provides guidance on management of severe/complicated malaria in the outpatient setting, prior to referral. If referral is not feasible immediately, continue treatment until the referral becomes possible. It is especially appropriate for the home/community setting, where there are no trained health workers who can administer injections. In the event that an artesunate suppository is expelled from the rectum within 30 minutes of insertion, a second suppository should be used especially in young children. The buttocks should be held together for 10 min to ensure retention of the rectal dose of artesunate. Table 9: Rectal Artesunate (Pre-Referral Treatment in Children) Weight (kg) Age Artesunate Dose Regimen (mg) 5 – 8 0 – 12 months 50 One 50mg suppository 9 – 19 13 – 42 months 100 Two 50mg suppositories 20 – 29 43 – 60 months 200 One 200mg suppository 30 – 39 6 – 13 years 300 Two suppositories of the 50mg and one of the 200mg suppository >40 > 14 years 400 Two of the 200mg suppositories Table 10: Rectal Artesunate (Pre-Referral Treatment in Adults) Weight (kg) Artesunate Dose (mg) Regimen 40 – 50 400 Two of the 200mg suppositories 60 – 80 800 Four of the 200mg suppositories >80 1200 Six of the 200mg suppositories 4. In situations where the patient is still within the facility following referral, parenteral treatment should be continued while waiting until patient leaves. Shake for 2-3 minutes minutes to ensure minutes to ensure to ensure dissolution dissolution into a dissolution into into a clear solution. Step 4 Step 4 Step 4 4 Withdraw the 4 Withdraw the 4 Withdraw the required amount of required amount of required amount of solution and inject at solution and inject solution and inject the chosen site. To prepare this, draw 2mls of Quinine 600mg and add 4mls of sterile water or saline (not dextrose). Supportive Treatment for Severe/Complicated Malaria in the Outpatient Setting Use ofAntipyretics In young children, high temperatures are associated with vomiting, often regurgitating their medication, and seizures. Antipyretics should be used if axillary temperatures are ³ 38°C) and the patient can tolerate oral medication. Paracetamol (acetaminophen) 15 mg/kg every 4 hours is widely used; it is safe and well tolerated, given orally or as a suppository (Refer Tables 6 and 7 for dosing). In case of convulsions the following should be done: Ÿ Clear and maintain airway Ÿ Treat with diazepam: – A slow intravenous injection of diazepam [0. Nursing Care Ÿ Provide good nursing care: For example, keep an unconscious patient on his or her side and monitor vital signs. If Hb<5gm/dl and Hct<15 - 20%, do grouping and cross-matching for possible transfusion. Parenteral treatment provides adequate blood-serum concentrations as quickly as possible initially. Parenteral treatment should continue until patient is well enough to swallow, and for at least 24 hours even if the patient is well enough to swallow before 24hours. Reconstituting ParenteralArtesunate Artesunate is dispensed as a powder of artesunic acid in vials of 30mg, 60mg or 120mg and usually in packs containing sodium bicarbonate solution and normal saline. Check the brand available at your facility and follow the general instructions provided below. Step 2 Step 2 Step 2 Gently Shake for 2–3 Gently Shake for 2–3 Gently Shake for 2–3 minutes to ensure minutes to ensure minutes to ensure dissolution dissolution dissolution into a clear solution. Withdraw the required amount required amount required amount of the solution of the solution and of the solution and and inject slowly inject slowly at a inject slowly at a rate at a rate of 3-4ml rate of 3-4ml per of 3-4ml per minute.

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Cabergoline and bromocriptine tablets in higher strengths are classified in N04 - Anti-Parkinson drugs buy generic procyclidine 5 mg. Sex hormones used only in the treatment of cancer (often selected strengths) are classified in L - Antineoplastic and immunomodulating agents discount procyclidine 5mg with amex. Norethandrolone generic 5 mg procyclidine with amex, which has both anabolic and androgenic effects discount procyclidine 5 mg online, is classified in A14A since the anabolic effect is considered to be the most important effect. Combined preparations are included in this group, except combinations with female sex hormones, which are classified in G03E - Androgens and female sex hormones in combination. Estrogens used only in neoplastic diseases, see L - Antineoplastic and immunomodulating agents. Progestogens only used in neoplastic diseases, see L - Antineoplastic and immunomodulating agents. Combination packages with separate tablets containing progestogens and estrogens intended to be taken together are also classified in this group. Combinations of progestogens and estrogens used as contraceptives are classified in G03A. Combination packages with separate tablets containing progestogens and estrogens intended to be taken together and in sequence are also classified in this group. Local anesthetic formulations for treatment of premature ejaculation are classified in N01B. Corticosteroids in combination with antiinfectives/antiseptics for local treatment of gynecological infections, see G01B. The antibacterials are classified according to their mode of action and chemistry. Combinations of antibacterials with other drugs, including local anesthetics or vitamins, are classified at separate 5th levels in the respective antibacterial group by using the 50-series. Common cold preparations containing minimal amounts of antibacterials are classified in R05X. Inhaled antiinfectives are classified here based on the fact that preparations for inhalation can not be separated from preparations for injection. Combinations containing one penicillin and enzyme inhibitor are classified at different 5th levels according to the penicillin. The reference applied when defining generations is “Principles and Practice of Infectious Diseases” by Mandell, Douglas and Benett, sixth edition, 2005. Limited activity against gram-positive cocci, particularly methicillin susceptible S. Preparations containing two or more sulfonamides are classified within the different 4th levels, using the 5th level code 20. In such combinations, the half-life of the most long-acting sulfonamide determines the classification. Preparations, which in addition contain a urine acidifier, such as vitamin C, calcium- or ammonium chloride, are classified at the plain 5th levels. The two components have synergistic antibacterial effect and are always used together. Teicoplanin and intravenous preparations of vancomycin are classified in this group. Oral formulations and suppositories of imidazole derivatives are classified in P01 - Antiprotozoals. Subdivision at the 4th level is made mainly according to indication, while subdivision at the 5th level is mainly related to the manufacturing process. Combinations of vaccines within the same 3rd level are given separate 5th levels using the 50-series. Monovalent vaccines obtained from group A are classified at a separate 5th level, while other monovalent vaccines are classified together. Products containing oligosaccharides instead of polysaccharides may be included at each 5th level. The doses used vary substantially because of various types and severity of neoplastic diseases, and also because of the extensive use of combination therapy. The consumption of the antineoplastic agents is in some countries measured in grams. This is recommended as a method to be used internationally for these particular agents. This means that some strengths may be classified in this group, while remaining strengths are classified in G03 - Sex hormones and modulators of the genital system. The substances in this group have a broad range of indications, however, they should be kept together in M01A. Exception: Salicylates in combination with corticosteroids are classified in M01B. Combined cold preparations with therapeutic levels of antiinflammatory agents are classified in this group at separate 5th levels by using the 50- series. The preparations are classified at 5th levels according to the anti- inflammatory/analgesic component. Penicillamine, which is also used in conditions associated with impaired copper metabolism and as an antidot in copper poisoning, is classified in this group regardless of indication. Exception is a product containing diclofenac formulated as a 3% hyaluronic acid gel which is used in treatment of actinic keratoses. Combinations of non-steroidal antiinflammatory derivatives and other substances for topical use are classified together with plain preparations at the different 5th levels. Combinations of salicylic acid derivatives and other products are classified in this group. Combined preparations are classified at separate 5th levels using the corresponding 50-series (comb. These drugs are used in different conditions associated with pain and rigidity in the muscles, joints etc. Combinations used for cold conditions, containing quinine as an antipyretic, are classified in R05X. All ibuprofen preparations are classified in M01A, even if they are only intended for use as pain relief. Salicylic acid derivatives in combination with corticosteroids are classified in M01B. There are a number of combined preparations, which contain analgesics and psycholeptics. These are classified in N02, as pain relief must be regarded as the main indication. Codeine or dihydrocodeine in combination with other analgesics are classified in this group at separate 5th levels by using the 50-series, if the codeine or dihydrocodeine content is 20 mg or more per unit dose. Combinations with a lower content of codeine or dihydrocodeine are classified at the respective 4th levels in N02B or M01A of the other analgesic components (e. Combinations with opioid analgesics should be classified in N02A at separate 5th levels, using the corresponding 50-series (combinations excl.

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