Lowest effect

R = / -C H ), in low doses, exhibits the former behavior and is used primarily as an extradural agent in obstetrics. The lowest effective extradural concentration of etidocaine (21, X = CH, R = R = 2H, R = / -C H ), however, shows both adequate sensory and profound motor blockade so that it is useful in surgical situations where maximum neuromuscular blockade is necessary. In an isolated nerve preparation, bupivacaine blocks unmyelinated C fibers which are mainly responsible for pain perception at a much greater extent than the myelinated A fibers which carry motor impulses. It is postulated that absorption of bupivacaine by the vasculature at the site of injection, combined with the slow diffusion of this agent, results in an insufficient amount of the drug penetrating the large A fibers to cause motor conduction blockade. Clinically, motor block can be observed in some procedures. 

The patient should be kept calm as much as possible, but this may be difficult if they are delirious, and sometimes the use of sedating medications is necessary. This carries with it the risk of confounding the neurological exam, which is vital to follow during this acute period when the patient is at risk for deterioration. Thus, short-acting medications in the lowest effective doses should be administered. 

The effectiveness of alkaline additives tends to increase with increasing pH. However, for most reservoirs, the reaction of the alkaline additives with minerals is a serious problem for strong alkalis, and a flood needs to be operated at the lowest effective pH, approximately 10. The ideal process by which alkaline agents reduce losses of surfactants and polymers in oil recovery by chemical injection has been detailed in the literature [1126]. 

Ranitidine 1 50 mg If symptoms recur frequently, consider maintenance therapy with the lowest effective dose. 

If the prolactin level is well controlled with dopamine agonist therapy for 2 to 3 years, gradually taper therapy to the lowest effective dose. Check prolactin levels after each dose reduction.46... 

If the prolactin level remains normal for 2 years, reassess the need to continue treatment. Make sure that the patient is taking the lowest effective dose for management of hyperprolactinemia. 

Oral or transdermal estrogen products should be prescribed at the lowest effective dose for the relief of vasomotor symptoms. Topical products in the form of creams, tablets, or rings should be prescribed for women exclusively experiencing vulvovaginal atrophy. 

SSRIs are theorized to reduce the frequency of hot flashes by increasing serotonin in the central nervous system and by decreasing LH. Of the SSRIs, citalopram, paroxetine, and sertraline all have been studied and have demonstrated a reduction in hot flashes while treating other symptomatic complaints such as depression and anxiety.33 Venlafaxine, which blocks the reuptake of serotonin and norepinephrine, has demonstrated a reduction in hot flashes primarily in the oncology population.34 Overall, these antidepressant medications offer a reasonable option for women who are unwilling or cannot take hormonal therapies, particularly those who suffer from depression or anxiety. These agents should be prescribed at the lowest effective dose to treat symptoms and may be titrated based on individual response. 

Recommend the appropriate dose of HRT, and use the lowest effective dose for the shortest duration possible. 

Use the lowest effective dose to limit adverse effects. 6Not FDA approved for this indication, initial dose must be titrated in physician s office. MUSE, medicated urethral system for erection. 

Consider tracheal intubation in cases of respiratory compromise. Treat patients who have bronchospasm with aerosolized bronchodilators. Use these and all catecholamines with caution because of the enhanced risk of cardiac dysrhythmias after exposure to some chemicals. When bronchodilators are needed, the lowest effective dose should be given and cardiac rhythm should be monitored. After decontamination, patients who are comatose,... 

The lowest effective dose of ET and HT should still be used for preventing and controlling menopausal symptoms with use discontinued with symptom abatement. Many contraindications to ET and HT exist and must be identified before starting therapy. 

High-dose oral or intravenous bursts may be used for several days to suppress disease flares. After symptoms are controlled, the drug should be tapered to the lowest effective dose. 

A flare of acne may appear suddenly after initiation of treatment, followed by clinical clearing in 8 to 12 weeks. Once control is established, therapy should be continued at the lowest effective concentration and the longest effective interval that minimizes acne exacerbations. 

Hydrocortisone, cortisone, and prednisone are the glucocorticoids of choice, administered twice daily at the lowest effective dose while mimicking the normal diurnal rhythm of cortisol production. 

The goals of therapy are to minimize pain and provide reasonable comfort at the lowest effective analgesic dose. With chronic pain, goals may include rehabilitation and resolution of psychosocial issues. 

When lithium is to be used during pregnancy, it should be used at the lowest effective dose in order to avoid floppy infant syndrome, hypothyroidism, and nontoxic goiter in the infant. 

Lithium-induced nephrotoxicity is rare if patients are maintained on the lowest effective dose, if once-daily dosing is used, if good hydration is maintained, and if toxicity is avoided. 

Medication should be continued for at least 12 months after remission of the first psychotic episode. Continuous treatment is necessary in most patients at the lowest effective dose. 

Rechallenge with the lowest effective dose of SGA may be considered only for patients in need of reinstitution of antipsychotics following observation for at least 2 weeks without antipsychotics. There must be careful monitoring and slow-dose titration. 

Rebound insomnia can be minimized by utilizing the lowest effective dose and tapering the dose upon discontinuation. 

To minimize the risk of complications, patients should use the lowest effective dose. 

The ratio between the estimated systemic exposure at the lowest effect level (or highest no-observed-effect-level NOEL) and the estimated systemic exposure at the anticipated therapeutic dosage level (the safety factor ). 

A series of publications dedicated to soil-associated LAS has been authored or initiated by the surfactant-manufacturing industry. It was already in 1990 when Mieure et al. [12] presented a safety assessment for LAS for terrestrial plants and animals comparing measured LAS concentrations in soil environments with the lowest effect concentrations for typical organisms.1 In 1998, de Wolf and Feijtel [13]... 

There is no specific treatment for ingestion of ibotenic acid or muscimol rather, treatment is symptomatic and supportive. Anxiety, hysteria, or convulsions can be treated with sedatives, such as diazepam. This should be done cautiously, however, and with the lowest effective dose because animal studies revealed that respiratory arrest may occur. In severe cases, with prolonged nausea, vomiting, or diarrhea, monitoring of fluid and electrolyte status may be required. Recent cases of muscarine poisonings were reported by Benjamin (1992), and Tupalska-Wilczynska et al. (1997). 

The selection of the preservative system for multiuse new products is the responsibility of the R D formulation group. Typical shelf specifications are 80 to 120% of label specifications. The appropriate preservative system for the particular formulation should be demonstrated to be effective by microbial challenge to at least 75% and preferably 50% of the target concentration. It is recommended that during development the product be formulated with preservative concentrations of 100, 75, and 50% of the labeled amount and be subjected to antimicrobial effectiveness testing to determine the lowest effective preservative concentration. 

Atypical antipsychotics may be helpful in managing the delusions and agitated behavior that can accompany dementia. These medications, include risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and olanzapine (Zyprexa). All antipsychotics, typical and atypical, appear to increase the risk of death in patients with dementia and psychosis. This appears as a warning in the package inserts of the newer drugs. A prudent approach is to discuss this risk with the caregiver, use the lowest effective dose, and monitor for effectiveness. 

Typical Antipsychotics. Low doses of high potency typical antipsychotics such as haloperidol or fluphenazine (0.5-2mg given once or twice daily) are generally quite effective for psychotic symptoms after TBI. Unfortunately, as noted earlier, many post-TBl patients are susceptible to the extrapyramidal side effects of these medicines, especially if there was any injury to brain regions such as the basal ganglia. Low potency antipsychotics are not a viable alternative, because their anticholinergic and sedative effects are equally, if not more, problematic for patients who have suffered TBI. We recommend using typical antipsychotics, even for psychotic symptoms, as briefly as possible and in the lowest effective dose, if at all. Fortunately, there are now alternatives. 

---