INDEX side-effects

Practically all lubricating oils contain at least one additive some oils contain several. The amount of additive that is used varies from < 0.01 to 30% or more. Additives can have detrimental side effects, especially if the dosage is excessive or if interactions with other additives occur. Some additives are multifimctional, eg, certain VI improvers also function as pour-point depressants or dispersants. The additives most commonly used in hydrautic fluids include pour-point depressants, viscosity index improvers, defoamers, oxidation inhibitors, mst and corrosion inhibitors, and antiwear compounds. 

Improvements in asthma treatment include the development of more effective, safer formulations of known dmgs. The aerosol adrninistration of P2-agonists or corticosteroids results in a decrease in side effects. Also, the use of reUable sustained release formulations has revolutionized the use of oral xanthines which have a very narrow therapeutic index (see Controlled release technology). For many individuals, asthma symptoms tend to worsen at night and the inhaled bronchodilatots do not usually last through an entire night s sleep (26,27). 

The single dose of a drug is mo.stly derived from experience it is only possible in a very few cases to calculate it from the activity of the constituents. However, as many herbal drugs arc only weakly active and contain non-toxic substances, i.e, the therapeutic index is large, exceeding the dose is usually only of minor significance nevertheless, the pharmacist must know what the exceptions are in this book, the sections on Side effects and Making the tea draw particular attention to such cases, c.g. arnica flowers, liquorice root, etc. 

The configuration most often used in SPR instruments relies on the phenomenon of total internal reflectance and was developed by Kretchmann (Fig. 8).71,73 Total internal reflectance occurs when light traveling from a medium of higher refractive index toward a medium of lower refractive index reaches the interface and is reflected back completely into the higher refractive index medium. An important side effect of total internal reflection is the propagation of an evanescent wave across the interface into the medium of lower refractive index. 

Here functions Qnt X), Qj(X), and QP(X) can be determined experimentally using calibration samples. If these functions are linear independent then the parameters Ank, A, and Ap can be uniquely determined from the variation of P /1, , n2,. .. /( . /. / considered as a function of X. In particular, the side effects, i.e., the temperature and pressure dependences, can be eliminated from the transmission spectrum. The sensing method based on this simple idea was applied in Ref. 69 for determination of microfluidic refractive index changes in two microcapillaries coupled to a single MNF illustrated in Fig. 13.26c. The developed approach allowed to compensate the side temperature and pressure variation effects. 

The current method of drug discovery commences with the study of how the body functions, in both normal and abnormal cases afflicted with diseases. The aim is to break down the disease process into cellular and molecular levels. An understanding of the status of genes and their associated proteins would help to pinpoint the cause of the disease. Drugs can be tailor-made to attack the epicenter of diseases. In this way, more specific (fewer side effects) and effective (high therapeutic index, see Section 5.2) drugs can be discovered and manufactured to intervene or restore the cellular or molecular dysfunction. 

As lithium is an alkaline earth metal which readily exchanges with sodium and potassium, it is actively transported across cell membranes. The penetration of kidney cells is particularly rapid, while that of bone, liver and brain tissue is much slower. The plasma CSE ratio in man has been calculated to be between 2 1 and 3 1, which is similar to that found for the plasma red blood cell (RBC) ratio. This suggests that the plasma RBC ratio might be a useful index of the brain concentration and may be predictive of the onset of side effects, as these appear to correlate well with the intracellular concentration of the drug. 

In CONCLUSION, lithium is universally accepted as a mood-stabilizing drug and an effective antimanic agent whose value is limited by its poor therapeutic index (i.e. its therapeutic to toxicity ratio). Neuroleptics are effective in attenuating the symptoms of acute mania but they too have serious adverse side effects. High potency typical neuroleptics appear to increase the likelihood of tardive dyskinesia. Of the less well-established treatments, carbamazepine would appear to have a role, particularly in the more advanced stages of the illness when lithium is less effective. 

Phenytoin is an anti-epileptic drug. Patients taking anti-epileptic drugs are advised to take the medicine routinely, as directed, to stabilise and to avoid epileptic attacks as much as possible. Phenytoin has a narrow therapeutic index so it is important to identify side-effects. It may cause blood disorders. Patients are therefore advised to report immediately any symptoms of bruising or unexplained bleeding. Visual symptoms as a result of phenytoin do not commonly occur. Their occurrence may indicate overdosage. 

A good look at the index of this book indicates the items commonly encountered in examinations. The index is an exhaustive one and is divided into proprietary names, generic names, subject areas and conditions. A self-assessment exercise is to check that you have adequate knowledge of examples of the topics listed above and then attempt the tests. A review of the drugs in the index provides examples of medicines that certainly need attention. You should be familiar with the action, classification, side-effects, clinically significant drug interactions, contraindications and cautions of a number of classes of drugs, such as ... 

The clinical value of monitoring drug therapy by measuring plasma levels is probably best exemplified by reference to lithium (F6). It is a useful drug, which has a narrow therapeutic index, and treatment without reference to plasma levels is probably not ethically justified. Toxic side effects are predictable and severe. It has an acceptably long plasma half-life, and its measurement both in blood and urine is comparatively simple. Moreover, there is no problem of interference from either active or inactive metabolites. 

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