Reflexive multiple/multiplicity

Holzer, P., 1989. Ascending enteric reflex multiple neurotransmitter systems and interactions Am. J. Physiol. 256, G540-G545. 

A site is a reflexive multiplicity that belongs to itself and hence transgresses the laws of being. 

Nasogastric or orogastric Short-term Intact gag reflex Normal gastric emptying Manually at bedside Ease of placement Allows for all methods of administration Inexpensive Multiple commercially available tubes and sizes Potential tube displacement Potential increased aspiration risk... 

Pharmacology Meprobamate has selective effects at multiple sites in the CNS, including the thalamus and limbic system. It also appears to inhibit multineuronal spinal reflexes. Meprobamate is mildly tranquilizing, and has some anticonvulsant and muscle relaxant properties. 

Benzodiazepines also possess muscle relaxant activity. Their pharmacology is discussed in Chapter 30. Diazepam Valium) has been used for control of flexor and extensor spasms, spinal spasticity, and multiple sclerosis. The muscle relaxant effect of the benzodiazepines may be mediated by an action on the primary afferents in the spinal cord, resulting in an increased level of presynaptic inhibition of muscle tone. Polysynaptic reflexes are inhibited. The most troublesome side effect is drowsiness, which is dose dependent. Tolerance to both the therapeutic effects and the side effects develops. 

Anxiety and insomnia are prevalent symptoms with multiple etiologies. Effective treatments are available, but they vary by diagnosis. In most instances, the best course of action is to treat the underlying disorder rather than reflexively to institute treatment with a nonspecific anxiolytic. 

Tizanidine o -Adrenoceptor agonist in the spinal cord Presynaptic and postsynaptic inhibition of reflex motor output Spasm due to multiple sclerosis, stroke, amyotrophic lateral sclerosis Renal and hepatic elimination t duration, 3-6 h Toxicities Weakness, sedation hypotension... 

The epithelium, the most superficial cellular layer of the cornea of the eye, is chemically less resistant than the keratinized epidermis of the skin. However, during ocular accidents, we know that it takes a few seconds for the first lesions to appear. This delay is bound to multiple factors, winking reflex, protective and diluting effect of the lachrymal liquid, effect of sweeping of the palpebral movements. After a short period, a kinetic of diffusion will set up in a variable way according to the nature of the corrosive. 

A 28 year-old woman with Kearns-Sayre Syndrome, previously exposed multiple times to lidocaine, underwent planned tooth extraction after injection of articaine 1.5 ml (60 mg) with adrenaline (0.009 mg) (168). Within 5 minutes she complained of a feeling of heat, fatigue, weakness, and a desire to sleep. She was unable to walk or stand and had frequent urination. At 20 hours after the injection she had diffuse weakness, reduced tendon and absent patellar reflexes, and sub-clonic Achilles tendon reflexes. She recovered fully 48 hours after the injection. 

DPI Dry powder insufflation. Avoids coordination problems lower drug loss by impaction and no propellant problems associated with pMDIs. High inspiratory effort may be required coughing reflex may be less convenient then pMDI. More sophisticated multiple dose devices. 

Nifedipine [nye FED i peen] functions mainly as an arteriolar vasodilator. This drug has minimal effect on cardiac conduction or heart rate. Nifedipine is administered orally and has a short half-life (about 4 hours) requiring multiple dosing. The vasodilation effect of nifedipine is useful in the treatment of variant angina caused by spontaneous coronary spasm. Nifedipine can cause flushing, headache, hypotension, and peripheral edema as side effects of its vasodilation activity. The drug may cause reflex tachycardia if peripheral vasodilation is marked resulting in a substantial decrease in blood pressure. 

MALDI mass spectra were acquired on a Broker Reflex mass spectrometer equipped with a 337 nm nitrogen laser and a multiple sample stage source. The spectra were acquired in linear mode, represent the sum of 20 laser shots, and are un-smoothed. All ions were desorbed at a laser power just above threshold, at an ion extraction voltage of 30 kV. The matrix used was a saturated solution of 3,5-dimethoxy-4-hydroxycinnamic acid (sinapinic acid, Aldrich Chemicals) in a 1 1 water/acetonitrile solution. Low-mass matrix ions were deflected by the application of a voltage pulse. 

Fig. 31.19 Chronic hepatic porphyria Sonographically, multiple, ring-shaped foci with marginal hyperechoic ring and central hypo-echoic reflexes. (Completely reversible after alcohol abstinence)...

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