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The reader will notice that classification grows more difficult as we progress feldene 20mg line, and calls for closer study purchase feldene 20mg fast delivery, and more thought generic feldene 20mg without a prescription. But it has this in its favor, that it brings out all we know of medicine, and enables us to classify our own knowledge and that of the books, so as to make them useful. When we study local remedies we find that they may be classified in a similar manner, some of them readily, others with difficulty. We have remedies that influence the respiratory organs, the digestive apparatus, the urinary apparatus, the excretory apparatus - skin, kidneys, bowels - the brain, etc. We find also that some remedies may be classified as they influence special tissues - mucous membranes, serous membranes, connective tissue, bones, etc. Let us call this the first study of remedies, a study that recalls and fixes that which we know, and that gathers from books the essential facts, or what seems to us essential facts of drug action. It is work, but I will guarantee that the physician comes out of it stronger in mind, and very much better able to prescribe for disease. There are some things which can only be learned by experiment, and I would urge every one to some effort in this direction. You have your own bodies, and though you may value them highly, it will do little harm to test some medicines upon your own person. There is nothing in medicine that I would not test on my own person, if I was engaged in studying its action. Very certainly if the physician has occasion to take medicine for any disease, he should carefully note its effects from hour to hour. Let us call this the second method of studying remedies, it is the Homœopathic method, though employed to some extent by all classes of physicians. It gives most excellent and reliable results, and we can not afford to dispense with it. The third method is by carefully studying the effects of remedies administered for disease. This study can only be made to advantage where notes are kept, when care is used in the diagnosis, and when single remedies, or remedies that act in the same way, are employed, It is true that we can carry something in our memories, and by repeated observations facts will become familiar, but it is not a good plan to trust the memory too far. There are two things we want to know - the expression of disease, and the action of remedies - and in so far as we can, we want to associate them together. We may keep a record of cases with but little writing, if we have a plan to commence with. One word will sometimes express the condition of disease, it will rarely require more than a line. Now when giving remedies we may note nearly as briefly the reason why we have selected the remedy. Pulse small, frequent - Aconite; pulse frequent, sharp - Rhus; veins full - Podophyllum; tissues full, œdematous - Apocynum; muscular pain - Macrotys; nervous, free from fever - Pulsatilla; periodicity - Quinine; dull, stupid, sleepy - Belladonna; pain of serous membranes - Bryonia; dusky coloration of surface or mucous membranes - Baptisia; mucous membranes deep red - Acids; mucous membranes pale - Alkalies; feeble heart - beef-tea; strong circulation, high temperature - boiled milk. I give examples as my memory recalls them, but I think that the majority can have a record in about as many words. We do not want to write a book for other persons, but to make such notes as will enable us to recall the entire history of the disease, with its expressions that have suggested the use of the remedies employed. The reader will see that the record of the effect of the medicine can be easily kept. A 0 will tell the story of no effect, and a group of half a dozen adjectives will note the more important influences that we wish to record. In making a study of our working materia medica, it is well to note the advantages of carrying remedies, and of extemporaneous prescription at the bedside. The advantages are threefold - to the physician, to the patient, and to the friends. To the physician in that he learns his remedies better, and prescribes with greater certainty. To the patient, that the remedies are given in less doses, are promptly administered, and are not admixed with unpleasant vehicles, and are of more certain value and action. I have no special love for retail druggists, and many unpleasant experiences have shown me that it is quite possible to procure the poorest drugs in the market from them, and that it is quite uncertain what you will get in any given case. Of course there are many exceptions, but this is applicable to the druggist in ordinary, who makes it a rule to buy cheap, and sell dear. I need not say that a contract between physician and druggist, by which the former receives a percentage on prescriptions, is a very small species of swindling, and unworthy the profession. Patients will soon recognize the advantage that comes from a well filled medicine case, and will pay their bills more promptly if they are not bled by the druggist. Talking about bleeding, I have seen, time and again, a poor family saddled with an expense of from thirty cents to a dollar and a half a day for weeks, and for drugs that were useless, or in quantities much larger than were necessary. Recently I counted on the mantel of a patient, seven four-ounce, two six-ounce, and three two-ounce bottles, with three boxes of powders, all of which had been procured in seven days for a child four months old.

Graphites may be employed when the monthly discharge is pale and watery order feldene 20 mg with amex, with prominent hysteric symptoms generic feldene 20 mg with visa. Polygonum discount 20 mg feldene visa, when there is a sensation of weight and fullness in the pelvis, with aching in the hips. The Mitchella, Senecio and Helonias find a use here, but I am not able to point out the special indications for either. Tincture of Phosphorus may be thought of as a remedy when there is want of innervation, and the reproductive function (venereal desire) is markedly impaired. Iodine has a similar use, and is usually associated with Nux (compound iodine pill), to give energy to the reproductive organs. When we think of the remedies for the conditions of too free, too frequent in recurrence, and prolonged, we wish to make a classification into those for plus vascular and nervous excitement - active condition; and minus vascular and nervous excitement - passive condition. The remedies for the first will be found in the class sedative - Aconite, Veratrum, Lobelia, Bryonia, Rhus, Lycopus, Gelseminum, Asclepias, and we need not give them an individual study here. It not only regulates the menstrual discharge as to quantity, frequency of recurrence, and duration, but it exerts a marked influence upon the nutrition of these tissues. I use a trituration one to ten, and possibly it would be better in some cases to use a second trituration. The Hamamelis is another very valuable remedy, and is indicated by fullness of pelvic tissues, laxity of perineum, and impairment of the venous circulation. These are the indications for the remedy, whether there is a wrong of the menstrual function or not. Ergot may be employed when the tissues are full and relaxed, and when there is oppression of the nervous system, the patient being dull, stupid and careless. Ipecac is a very valuable remedy when there is local irritability with lax tissues, though it may be employed in any case in which irritability of the mucous membranes is a marked feature. There may be nothing characteristic about it or it may point out the remedy for us. Do not mistake the language - there is a uterine pain that simulates colic, even to its wandering character in the lower abdomen and pelvis. The remedy not only relieves the pain, but greatly aids in establishing normal nutrition and functional activity. I saw a marked case in the early part of the year 1874, in which the woman had been a constant sufferer from uterine disease since 1867. The character of the pain was so decided that I gave her nothing but Nux at first, and as the results were so satisfactory, no other remedy was employed, and she made a good recovery in three months. We do not want to forget that the Macrotys, Caulophyllum, Actæa and Pulsatilla, are remedies for pain, and may be indicated by pain. As remarked at first, nearly all of these remedies look toward a normal function, whatever may be the indication for their use. The Viburnum (Opulus) high cranberry, cramp bark, is a most valuable uterine remedy, and not only looks to normal innervation, but to normal circulation and nutrition as well. It is indicated by pain - its common name, cramp bark, is very suggestive of the kind of pain - uterine spasm. The Viburnum (Prunifolium), black haw, exerts a very similar action, and is also indicated by pain - expulsive and intermittent. Both are remedies for abortion, and especially to remove the predisposition to it The reader will recall cases in which there is a continued tendency to abortion, and will probably recollect that the ordinary treatment of uterine disease in such cases is very unsatisfactory. I think the experienced physician will be able to think of a condition of the reproductive organs, which, without any history of the case, would impress his mind as one favoring abortion. Rhus is indicated by the usual symptoms, burning pain and heat, structures pinched. Collinsonia is sometimes a remedy, the indication being a sense of heat, rawness and contraction, usually about the anus or in the rectum (associated with hemorrhoids), or sometimes at the entrance of the vagina. Cannabis Indica is a remedy for erythism of the reproductive organs, and venereal excitement. Staphysagria is a remedy where there is fullness of tissue, abundant mucoid discharge, and dull brooding of the mind with involuntary outbursts of passion. This is a very brief sketch of some of the remedies employed for their direct action upon the uterus. I have pointed out some of the more prominent indications for their use, especially with reference to impairment of the function of the reproductive apparatus. One can not, in a brief article, give full descriptions; it is at best suggestive for further study. In this case, as in some others, I would advise a study of our materia medica with reference to the action of remedies upon the reproductive organs and function. The evidences of health are - the ability to do the work required of the whole or a part, and the ability to do it with pleasure. The use of the eye, the ear, the nose, the mastication of food, the act of digestion, defecation and urination, the use of the muscular system, and the action of the mind.

Therapeutic level of Phenobarbital (anticonvulsant) is 15 to 40 mcg/ml (both anticonvulsants) order feldene 20 mg line. Available forms are: capsules in 100 mg cheap feldene 20mg free shipping, 300 mg purchase 20mg feldene fast delivery, and 400 mg; oral solution 250 mg/5 ml; tablets in 100 mg, 300 mg, 400 mg, 600 mg and 800 mg. Nursing Considerations: Antacids may decrease absorption of Neurontin (anticonvulsant). Seizures and delirium may occur within 16 hours and last up to 5 days after abruptly stopping drug. Children ages 6 to 12, initially 100 mg orally twice a day (conventional or extended release tablets) or 50 mg of suspension orally four times a day with meals, increased at 88 weekly intervals by up to 100 mg oral divided in three or four doses daily (divided twice a day for extended release form). Usual maintenance dosage is 400 mg to 800 mg daily or 20 mg/kg to 30 mg/kg in divided doses three or four times daily. Children older than 12 and adults, initially 200 mg orally twice a day (conventional or extended release tablets), or 100 mg orally four times a day of suspension with meals. May be increased weekly by 200 mg orally daily in divided doses at 12 hour intervals for extended release tablets or 6 to 8 hour intervals for conventional tablets or suspension, adjusted to minimum effective level. Maximum, 1000 mg daily in children ages 12 to 15 and 1200 mg daily in patients older than age 15. Available forms are: capsules (extended-release 100 mg, 200 mg and 300 mg; oral suspension 100 mg/5 mg; tablets 200 mg; tablets (chewable) 100 mg and 200 mg; tablets (extended - release) 100mg, 200 mg, 300 mg and 400 mg. The peak time for tablets is 1½ hours to 12 hours and the peak time for tablets (extended release) is 4 to 8 hours. Nursing Consideration: Atracurium, Cisatracurium, Pancuronium, Rocuronium, Vecuronium (all blocking agents), may decrease the effects of nondepolarizing muscle relaxant, causing it to be less effective. Capsules and tablets should not be crushed or chewed, unless labeled as chewable form. Do not confuse Carbatrol (anticonvulsant) with Carvedilol (Coreg – antihypertensive). Tell patient taking suspension form to shake container well before measuring dose. Advise him to avoid hazardous activities until effects disappear, usually within 3 or 4 days. Nursing Considerations: Contraindications are those with a hypersensitivity to Benzodiazepines, Acute Angle Closure Glaucoma, Psychosis, concurrent Ketoconazole (Nizoral - antifungal) or Itraconazole (Sporonox - antifungal) therapy, and children younger than age 9. Instruct patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. Increase at 1 or 2 week intervals by 1 mg/kg to 3 mg/kg daily in two divided doses to achieve optimal response. Children over age 10 and adults, initially 25 mg to 50 mg orally daily, increase gradually by 25 mg to 50 mg weekly until an effective daily dose is reached. Adjust to recommended daily dose of 200 mg to 400 mg orally in two divided doses for those with partial seizures or 400 mg orally in two divided doses for those with primary generalized tonic clonic seizures. Available forms are: capsules, sprinkles in 15 mg and 25 mg; tablets 25 mg, 50 mg, 100 mg, and 200 mg. Nursing Considerations: Tegretol (anticonvulsant) may decrease Topamax (anticonvulsant) level. May decrease Bicarbonate (buffer system in acid-base system) and hemoglobin levels and 97 hemacrit. Factors that may predispose patients to acidosis, such as renal disease, severe respiratory disorders, status epilepticus, diarrhea, surgery, ketogenic diet, or drugs, may add to Topamax’s (anticonvulsant) bicarbonate lowering effects. If metabolic acidosis develops and persists, consider reducing the dose, gradually stopping the drug, or alkali treatment. The target maintenance dose depends on patient’s weight and should be divided twice a day. If patient weights between 20 kg and 29 kg (44 and 64 pounds), target maintenance dose is 900 mg daily. If patient weighs between 29 and 39 kg (64 and 86 100 pounds), target maintenance dose is 1200 mg daily. If patient weighs more than 39 kg (86 pounds), target maintenance dose is 1800 mg daily. Increase by a maximum of 600 mg daily (300 mg orally twice a day) at weekly intervals. Available forms are: oral suspension 300 mg/5ml (60 mg/ml); tablets (film coated) 150 mg, 300 mg, and 600 mg Nursing Considerations: Carbamazepine (Tegretol - anticonvulsant), Valproic Acid (Depakote - anticonvulsant), Verapamil (Calan – heart) may decrease level of active metabolite of Trileptal (anticonvulsant). Monitor Dilantin (anticonvulsant) level closely when starting therapy in these patients. Ask patient about Tegretol (anticonvulsant) hypersensitivities and stop drug immediately if signs or symptoms of hypersensitivity 101 occur. Available forms: injection 5mg/ml; oral solution 5 mg/ml, 5 mg/5 mg; rectal gel twin packs 2. If not, inject slowly through infusion tubing as near to the insertion site as possible.