Respiratory diseases (acute bronchitis, chronic bronchitis, bronchial asthma, pneumonia, lung abscess, tuberculosis, compression of the trachea and bronchi by enlarged lymph nodes);
Diseases of the cardiovascular system (chronic heart failure, pulmonary embolism, pericarditis, heart defects);
Diseases of the ENT-organs (rhinosinusitis, pharyngitis, laryngeal tumors, reflex cough in diseases of the external and middle ear);
Diseases of the gastrointestinal tract (gastroesophageal reflex disease, hernia of the esophageal orifice of the diaphragm);
Side effects of medications (angiotensin-converting enzyme inhibitors (blood pressure lowering drugs), aerosols, oxygen);
Cough associated with smoking (smoker’s bronchitis);
Allergic diseases (rhinitis, bronchial asthma);
Cough associated with toxic substances in people working at harmful industries.
The nature of the cough is classified as follows
Non-productive, or dry;
Productive (that is, with release of sputum).
Productive cough is observed in diseases associated with inflammatory/infectious lesions of the respiratory tract.
It is important to distinguish false productive cough, which can be observed with “postnasal congestion” in patients with ENT-organ diseases (sinusitis, rhinitis).
By duration of coughing act
Episodic short-term or seizure-like;
Types of cough by duration:
Acute cough (short-term, lasting less than 3 weeks) – usually caused by acute viral infections of the upper and lower respiratory tract;
Subacute (“post-infection”, most often caused by bronchial hyperresponsiveness due to a viral infection);
Chronic ( long, more than 8 weeks) can be observed in chronic obstructive pulmonary disease, bronchiectatic disease, neoplasms in the airways and lungs, lung abscess;
Dry, prolonged cough is often seen in patients with chronic diseases of the ENT organs (sinusitis, rhinitis), gastroesophageal reflux disease.
Seeking advice from your doctor, try to tell about your problem as much as possible, it will give the opportunity to more correctly prescribe examination and treatment.
1. Grievance collection
The first important point in this question is to gather your complaints.
Help your doctor and talk about them as much as possible:
Characterization of the cough by its duration;
dry or productive;
triggering factors (allergens, taking medications, physical exertion);
What time of day does it occur?
Whether there is any improvement from taking medications.
2. Blood count + C-reactive protein
Important indicators of inflammation.
Sputum analysis – quantity, color:
Increased volume of normally discharged sputum by a patient suffering from chronic bronchitis/chronic obstructive pulmonary disease is a criterion for exacerbation, and increasing its purulence (sputum acquires greenish tint/color) is one of the indications for prescription of antibacterial therapy (but not the main one);
Patients with pulmonary edema due to acute left ventricular failure are characterized by the separation of large amounts of frothy pink sputum;
Viscous, difficult to separate, so-called vitreous sputum is observed in bronchial asthma;
In lumpy pneumonia there is “rusty” sputum;
Sputum in the form of “currant” or “raspberry” jelly is characteristic of pneumonia caused by Klebsiella pneumoniae;
Sputum is stained yellow by eosinophils (bronchial asthma, eosinophilic processes in the lungs);
Bleeding – among the main causes of hemoptysis are pulmonary embolism, neoplasms, autoimmune diseases (Goodpasture syndrome, Wegener’s granulomatosis).
4. Collection of anamnesis (life history, diseases)
Fact of smoking with determination of duration;
Family history of bronchial asthma, tuberculosis;
Relation to taking medications;
Occupational, harmful factors.
5. Lung auscultation (listening)
Presence of dry coherent ralescence indicates lesions of the lower airways – acute bronchitis, exacerbation of chronic, bronchial asthma;
Identification of an area of moist small bubbling rales is a typical sign of pneumonia;
Multiple moist rales are observed in pulmonary edema;
Inspiratory crepitation (“cellophane crackle” when listening) characteristic of interstitial lung diseases.
Familiar to almost everyone disease of the gastrointestinal tract can be both an independent disease and a symptom of another, more serious pathology, but you help Ametik
What is gastroenteritis, its causes
Gastroenteritis is a very common inflammatory disease of the stomach and intestines. Vomiting, diarrhea, colic, weakness, and sometimes fever are its basic and familiar symptoms.
The causative agents of infectious and parasitic diseases are excreted into the external environment with the feces, often in huge quantities. That’s why earlier epidemics of intestinal infections (cholera, diphtheria, typhoid) spread so quickly and took a huge number of lives. In the human body they enter with contaminated food and water. Therefore, failure to follow basic rules of personal hygiene (careful hand washing after toileting, before eating) and visiting catering establishments that violate sanitary norms greatly increases the chances of encountering gastroenteritis.
Classification of gastroenteritis
Gastroenteritis is divided into two large groups: infectious and non-infectious. Infectious (contagious) gastroenteritis is caused by pathogens – viruses (50-70%), bacteria (15-20%), parasites (10-15%). You can catch such a disease: not washing your hands, using common with the sick person utensils and food, eating unwashed fruits and vegetables. Viral gastroenteritis develops when infected with many types of viruses. Among them, the most common are rota-, noro-, adeno-, and coronavirus infections. They are all treated the same way, so the doctor does not need to distinguish between them. Among the many causative agents of bacterial gastroenteritis, the most common are Salmonella, Campylobacter, Shigella, Escherichia coli, and Clostridium difficile. Lamblia and Cryptosporidium are single-celled parasites that cause, as you can easily guess, parasitic gastroenteritis.
Non-infectious gastroenteritis is less common than infectious gastroenteritis. Inflammation of the stomach and intestines can provoke an improper diet, some medications, chemo- and radiotherapy, microbiological toxins, allergies to food components. Some diseases (AIDS, certain types of cancer, peptic ulcer disease, Crohn’s disease) are also accompanied by gastroenteritis as a symptom, sometimes the main one.
Gastroenteritis can be acute or chronic. Infectious processes are acute; they begin abruptly; symptoms are pronounced; the duration of the disease is relatively short. Non-infectious gastroenteritis can be acute or chronic. Chronic ones last a long time; periods of exacerbation alternate with asymptomatic ones.
The ICD-10 code for gastroenteritis of infectious origin is A00 to A09 depending on the causative agent, non-infectious K50 to K52 depending on the cause.
Gastroenteritis in children
Infectious gastroenteritis is one of the most typical diseases in children. Infected gastroenteritis is most common in babies under five years of age, in children under one year old, and in children under six months of age it is very serious. The immune system being formed, frequent visits to large groups of the same age (kindergartens, schools) and even imperfect hygiene habits (putting everything into their mouth, not always washing their hands) contribute greatly to the rapid spread of intestinal infections among children.
While for an average adult infectious gastroenteritis is usually an unpleasant thing, but not dangerous, for the health of children they are a real threat. In children, diarrhea and vomiting very quickly disrupt the water-electrolyte balance, which can lead to shock, coma, and even death. Today, it is these diseases that take the greatest number of children’s lives. Therefore, parents need to be very careful. If the child against the background of infection is drowsiness, very little urination, hands or feet are cold, the fontanel is sunken, breathing is frequent – it is necessary to seek help as soon as possible.
Symptoms and signs of gastroenteritis
Symptoms of gastroenteritis vary depending on the cause of the disease. Infectious gastroenteritis usually begins suddenly. Vomiting, diarrhea (diarrhea) with or without blood and mucus, intestinal cramps, weakness, fever (moderate or high) are classic signs of an intestinal infection. The disease may also be accompanied by muscle pain and prostration.
Parasitic gastroenteritis is usually manifested by chronic diarrhea, in most cases without blood, with the exception of amebic dysentery. Weakness and weight loss are seen when diarrhea is severe.
Non-infectious gastroenteritis is mainly accompanied by digestive disorders. Their manifestations may be very slight (soft stool, flatulence) or pronounced (severe diarrhea, colic, weakness, weight loss, deterioration of the general condition).
Children, the elderly, and patients with immune disorders may be especially ill. Severe vomiting can cause severe dehydration, leading to severe complications including death. In moderate dehydration, symptoms such as dry mouth, inconsistent urination, and weakness are observed. This degree can be corrected without hospitalization by drinking enough fluids. Alarming signs of severe dehydration (cold extremities, drowsiness, very little or no urination, frequent shallow breathing) require urgent medical attention.
Diagnosis of gastroenteritis
The clinical picture of many types of gastroenteritis is very clear. In order to make a diagnosis, it is sufficient for the doctor to ask the patient about his complaints and conduct a general examination. A palpation of the abdomen reveals bloated bowel loops. The doctor may also listen to the bowel movements. It is usually very active, accompanied by many sounds.
The most important thing is to establish the cause of the disease, as this determines the treatment plan. Therefore, in some cases, the doctor prescribes additional tests. For many infectious diseases, tests have been developed that can detect the causative agent; parasites and bacteria are detected by microscopy or stool cultures.
General and biochemical blood tests are prescribed for patients with severe disease, since in these cases the functioning of internal organs is impaired (for example, the kidneys are affected in gastroenteritis caused by E. coli).
Treatment of gastroenteritis
Gastroenteritis therapy works in two ways:
Eliminates the underlying cause, if possible; corrects the symptoms and consequences. There is no specific treatment for viral gastroenteritis. With moderate symptoms, rest and plenty of fluids are all that is needed for a successful recovery. Severe dehydration, lack of fluids and certain electrolytes are corrected by the introduction of intravenous solutions.
Bacterial gastroenteritis requires treatment with antibiotics, parasitic – with antihelminthics. When food intolerance is suspected, it is most important to exclude from the diet foods that may cause the painful condition. If gastroenteritis develops as a side effect of medications, the doctor may try to replace drugs from the current regimen with analogues. In cases where the inflammation is only a symptom, the way to get rid of it is to treat the underlying disease.
They are prescribed only to children over two years of age with watery diarrhea, and only after a fecal occult blood test.
Rehydration drinks are recommended for children and other people at risk for diarrhea and vomiting.
Diet for gastroenteritis
The most important thing in gastroenteritis is to drink. It should be done correctly: often, but a little at a time, small sips. Older children and adults in the acute course of the disease can try to suck ice. Vomiting and diarrhea releases a lot of minerals, especially calcium, sodium, potassium, magnesium. To compensate for the loss is shown to drink mineral water of alkaline composition.
Food intake should be resumed carefully. First try to eat something light: vegetable or chicken broth, oatmeal, banana, rice – all low-salted and without spices. If the vomiting comes back – again take a break without food (at least a few hours), then you can eat again. You will have to give up alcohol, fatty and spicy foods, dairy products, coffee, carbonated drinks. New products are added to the diet little by little, watching how you feel.
When gastroenteritis, provoked by intolerance of food components, the main treatment – diet. It can be very strict, to exclude even trace amounts of a particular food component or recommend reducing the consumption of certain products. It all depends on the diagnosis and the individual course of the disease.
Prevention of gastroenteritis
The best prevention of infectious gastroenteritis is to follow the elementary rules of personal hygiene that everyone is familiar with:
Wash your hands thoroughly after toileting and before eating; Do not drink raw water, especially from unfamiliar sources and standing water; avoid suspicious catering establishments; if there is a sick person at home – give him/her individual dishes, do not share towels with him/her; disinfect the places of swaddling and diaper changing, if a child is sick; Travelers are advised to find out in advance about the peculiarities of the local cuisine and avoid potentially dangerous dishes. In the first place, this applies to visiting countries where native cuisine is very different from what you are used to, or where ingredients are used that are not heat-treated. It is better to buy bottled water. A healthy diet and lifestyle can help prevent chronic gastroenteritis.
Children can be vaccinated against the most common intestinal virus – rotavirus. Ask your pediatrician if a vaccination is needed and for details.
Plenty of drinking is always necessary, and antipyretics are prescribed for fever. Antidiarrheals, such as Imodium, are not always welcome.
Sometimes, to get away from the stress of treatment, you need to please yourself. You can help with that here:
Used as an anti-allergic, antihistamine, sedative, antiemetic, antipruritic, hypnotic, and local anesthetic. Competitively blocks H1-histamine receptors, has anti-exudative, anti-allergic, anti-inflammatory effects. Reduces capillary permeability, swelling of mucous membranes, itching. Blocks alpha-adrenoreceptors, M-cholinoreceptors. Inhibits histamine-N-methyltransferase, blocks central histamine H3-receptors. Depresses CNS, has sedative, anxiolytic, antipsychotic and hypnotic effects, lowers body temperature. It reduces excitability of vestibular receptors, inhibits labyrinth function, eliminates dizziness. The antiemetic effect promethazine is due to blockade of M-receptors in the chemoreceptor zone of the vomiting center of the medulla oblongata. It penetrates through the HEB. When administered 2 weeks before delivery, it may inhibit platelet aggregation in newborns. No mutagenic effects or adverse effects on fetal development have been found in experimental studies.
It is quickly and completely absorbed from the gastrointestinal tract. It takes 15-60 min to produce effects when administered orally, 20 min after intramuscular injection, 3-5 min after intravenous injection. Duration of action is 4-6 hours (after intravenous administration – up to 12 hours). It is 65-90% bound to blood plasma proteins. It is metabolized in the liver and partially in the kidneys to form promethazine sulfoxides, N-desmethylpromethazine and other derivatives. The elimination half-life is 7-14 hours. It is eliminated mainly in the urine, including in the form of metabolites.
Allergic dermatoses, prurigo, eczema, exudative diathesis, urticaria, rash and other skin allergic reactions to drugs and chemicals, itching, allergic conjunctivitis, allergic rhinitis, pollinosis, stings of wasps, bees, scorpions, bumblebees, serum sickness, angioneurotic edema, false croup, asthmatic bronchitis, atopic bronchial asthma, anaphylactic and anaphylactoid reactions (as part of complex therapy), rheumatism with a pronounced allergic component; Meniere’s syndrome, dizziness, nausea and vomiting, motion sickness; anxiety, neurosis and neurosis-like conditions, psychosis, insomnia, extrapyramidal disorders (against the background of taking neuroleptics), trigeminal neuralgia, migraine, chorea, hyperthermia; premedication and postoperative period (as a sedative, for artificial hibernation, potentiation of anesthesia and local anesthesia), study of gastric secretion (when used as a stimulant of histamine secretion).
Hypersensitivity (including to other phenothiazines), coma, concomitant use of MAO inhibitors and the period within 14 days after completion of their administration, alcohol intoxication, hepatic and/or renal failure, pregnancy, lactation, occasional vomiting in children of unspecified genesis, early childhood under 2 months (for parenteral administration), childhood under 6 years (for oral administration). Contraindicated in pregnancy.
Medical tourism in Latin America is formed in a very competitive environment, because many countries in the region, such as Brazil and Costa Rica, in recent years have invested heavily to take its place in this area.
There are several reasons why many foreign patients still prefer Colombia:
Acceptable cost of treatment
In large hospitals with worldwide recognition you can get quality treatment, which sometimes will cost only 30-50% of the cost of the same procedures in the U.S. or Canada. At the same time, you should consider inexpensive accommodation, food, and entertainment in Colombia.
2. Strategic Location
Colombia is located in the northwestern part of South America, just a couple of hours flight from the USA. The major cities of the country, which may be of interest to medical tourists, have international airports that accept regular flights from Europe and North America.
High quality specialized treatment
Colombia has established itself as a country providing quality medical services in the fields of dentistry, cosmetic and plastic surgery, cardiology, ophthalmology, transplantology, gynecology, otorhinolaryngology and infertility treatment.
Colombia does not yet have a very strong medical education system. Most health care professionals who are medical tourists have completed their studies in Western countries such as the United States and the United Kingdom. That is why local doctors have no problems with English, they are well acquainted with modern medicine and international treatment standards, and are able to work with new equipment.
Hospitals with international accreditation
The Colombian government is working hard to create an optimal climate for medical tourism in the country. In particular, it assists local hospitals in obtaining international accreditation. Today 12 Colombian hospitals are accredited by JCI, including such well-known names as Fundacion Santa Fe de Bogota, Fundacion Cardiovascular de Colombia and Fundacion Cardioinfantil.
Medical tourists visiting Colombia can note the minimum waiting time for planned treatment.
If in some overcrowded clinics in Asia or the Middle East you will have to make an appointment a few weeks before the procedure, you can usually agree on treatment for the next few days, and in the remaining time of vacation to rest and recover on the beautiful ocean beaches.
Colombia is an equatorial country, where warm, sunny weather prevails throughout the year, with an average monthly temperature in the lowlands of about 30 degrees (in the mountains it is much cooler). Variety of climatic conditions in the four natural zones of Colombia is suitable for recreation and recovery after illness or surgery.
Perfect infrastructure for tourists
Although, as we have already said, in the Colombian province, medicine can not boast of anything outstanding, in large cities for medical tourists created everything necessary.
The medical facilities here are equipped with the latest technology, which allows performing complex laparoscopic surgeries, organ transplantations, catheterization of the heart, plastic surgeries, etc. The medical facilities are also equipped with the latest technology. Some hospitals provide apartments corresponding to the level of a 5-star hotel.
The Republic of Colombia is a sovereign state in the northwestern part of South America that has access to both the Caribbean Sea and the Pacific Ocean.
Colombia borders with Panama, Venezuela, Brazil, Ecuador and Peru. This country has a huge diversity of nature – snow-capped Andean peaks, the Amazon forest, the Caribbean and Pacific coast, and the desert area of Guayahira.
Thanks to its stunning nature, Colombia is one of the world leaders in ecotourism, and is also one of the four leading countries in environmental diversity in the UNEP program.
The Colombian government has long been working on measures to promote medical tourism in the country, investing heavily in improving medical infrastructure and helping leading hospitals gain international accreditation.
Among the most popular medical destinations in Colombia:
Treatment of addiction.
Stem cell therapy.
In this case, any treatment in Colombia can be obtained for a sum 1.5-3 times less than in America, Canada and Great Britain.
In terms of quality, treatment in this country is as good as most other popular medical tourism destinations, such as Brazil or Mexico.
The capital of Colombia, Bogota, is the center of the best hospitals in the country. Medicine is on a high level in major cities – Medellin, Cartagena, Cali.
For example, JCI accredited modern Hospital Universitario San Vicente de Paul is located in Medellin, near the international airport, and offers a wide range of medical services – from cosmetic surgery to organ transplantation.
However, it is not recommended to look for a cheaper hospital in the Colombian province, because there may be problems with infrastructure, modern equipment, hospital standards, and good specialists. All the technical and human resources potential of local medicine is, we can say, concentrated in several major Colombian cities.
Colombia is one of the most visited countries in South America, especially after the end of internal conflicts that used to scare tourists away from this stunning country. Tourists from the United States, Canada, Europe, and Latin America come here to enjoy the exotic landscapes and explore the rich history and culture, and take part in famous festivals.
According to the regional economic magazine America Economia, Colombia has one of the most developed medical infrastructures in Latin America. There are more than 50 companies-providers of medical services in the country, and a number of large hospitals are certified by Joint Commission International (JCI).
The benefits of medical tourism in Colombia:
Strategic location – convenient flight from the USA, Canada and European Union countries.
Qualified doctors, including those with degrees from Western universities, are available.
Excellent accommodation conditions and developed infrastructure in major cities.
The tropical climate is good for recovery after some diseases.
Moderate pricing policy, allowing a lot of savings compared to Western clinics.
High blood sugar levels, or hyperglycemia, is a condition in which the blood glucose concentration is too high. This disease is usually found in people with diabetes and is caused when the body does not produce enough hormonal insulin or is resistant to its effects, says Dr. Slinkin. Close women’s hands with a lance on your fingers to check blood sugar levels.If you’ve tried to lower your blood sugar level FBS, but it’s consistently above 240 mg/dL, ask for emergency medical help. When high blood sugar levels remain untreated, it can lead to organ and tissue damage, coma and death, according to the American Diabetes Association. Monitoring your blood sugar level is a good way to solve your high blood sugar problem quickly, and there are several ways to reduce your blood sugar level quickly, says Mr. Denis.
Exercises can help reduce blood sugar levels FBS by using surplus sugar as a fuel, according to the American Diabetes Association. If, however, your blood sugar level is above 240 mg/dL, use a urine test strip to check for ketones. When ketones are produced by the body, exercise may cause your blood sugar level to rise rather than fall. Physical activity can have an immediate benefit in lowering blood sugar, as well as a long-term benefit in helping to stabilise blood sugar levels. Let’s consider your next meal carefully.People with diabetes often follow a nutrition plan developed with the help of a doctor. If you have hyperglycemia for diabetes, stick to your plan. Think about reducing your portion size and avoiding snacks and sweetened drinks, according to the Mayo Clinic.
Read more: The best nuts for people with diabetes.Talk to your Doctor. If you are taking medication to fight diabetes, take it as prescribed at the Mayo Clinic. But talk to your doctor about whether changing your medication dosage may also be appropriate. Your health professional can also help rule out other diseases or infections that may cause your blood sugar levels to rise.
The even numbers are printed as numbers in the dose indicator window, the odd numbers are printed as straight lines between the even numbers.
If the required dose exceeds the number of units remaining in the cartridge, you can enter the remaining humulin-r amount of insulin in this pen and then use a new pen to complete the required dose, or you can enter all the required Dmitry Sazonov dose using a new pen.
Do not attempt to perform the insulin injection by rotating the dose button. The patient will not get insulin if he rotates the dose button. Press the dose button in a straight line to get the insulin dose.
Do not try to change the insulin dose during the injection.
Note. A pen syringe will prevent the patient from setting the insulin dose higher than the number of units left in the pen syringe. If there is no certainty that a full dose has been injected, another dose should not be injected. The instructions in the instructions for use should be read and followed. The label on the pen syringe should be checked before each injection to ensure that the drug has not expired and the patient is using the correct type of insulin; the label should not be removed from the pen.
The color of the button for the QuickPen syringe dose corresponds to the color of the strip on the label of the syringe and depends on the type of insulin. In this manual, the dose button is indicated in grey. The beige color of the body of the QuickPen syringe indicates that it is Dmitry Sazonov intended for use with Humulin.
Storage and Disposal
The pen must not be used if it has been outside the refrigerator for longer than the time specified in the instructions for use.
Do not store a pen syringe with a needle attached to it. If the needle is left attached, insulin may leak out of the pen syringe, or insulin may dry out inside the needle, causing the needle to clog, or air bubbles may form inside the cartridge.
Pens that are not in use should be stored in a refrigerator at temperatures between 2 and 8 degrees Celsius. Do not use a pen syringe if it has been frozen.
The pen syringe currently in use should be stored at room temperature in a place protected from heat and light that is inaccessible to children.
Dispose of used needles in puncture-proof, lockable containers (e.g. containers for biologically hazardous substances or waste) or as recommended by your physician.
The needle should be removed after each injection.
In 1 ml of the injection solution contains 50 mg of carprofen as an active substance and a preservative – 1% benzyl alcohol. In appearance it is a transparent solution of light yellow color. It is produced in 20 ml bottles of dark glass, which are packed in cardboard boxes.
Rimadil belongs to the group of non-steroidal anti-inflammatory drugs. It has anti-inflammatory, analgesic and vetprofen desage antipyretic effects. Carprofen, the active substance of rimadil, in a cycle of arachidonic acid mainly inhibits cycloxygenase II, which is produced in the body in response to inflammation. This inhibits the synthesis of inflammatory prostaglandins that cause inflammation, swelling and pain. In therapeutic doses, carprofen has a much weaker effect on cycloxygenase I, and thus has no effect on the synthesis of protective prostaglandins. Carprofen does not prevent normal physiological processes in tissues. Carprofen binds to plasma proteins by more than 99%. The drug is metabolized in the Dmitry Sazonov liver, excreted with faeces (about 80%), as well as urine.
Assigned only to dogs to relieve inflammation and pain in acute and chronic diseases of the musculoskeletal system (osteoarthritis), for analgesia and as an anti-inflammatory agent to reduce postoperative pain and swelling.
DOSES AND METHODS OF USE
The preparation is administered intravenously or subcutaneously at the rate of 4 mg per 1 kg of animal weight, which corresponds to 1 ml of solution per 12.5 kg of animal weight. If necessary, rimadil 5% solution for injection is repeated not earlier than 24 hours in half dose: 2 mg per 1 kg of animal weight, which corresponds to 1 ml solution per 25 kg of animal weight. It is recommended to administer the drug during premedication or during anesthesia. In case of further therapy, the treatment may be continued by prescribing rimadil in the form of tablets. The duration of therapy depends on the condition of the animal, but after 14 days of treatment the animal must be examined again by a veterinarian.
Allergic reactions are possible in hypersensitive animals. Vomiting may occur in rare cases.
Hypersensitivity to the drug. Do not administer rimadil 5% solution for intramuscular injection. Do not use puppy bitches. The drug should be administered with caution to https://pillintrip.com/medicine/vetprofen-dogs animals with heart, kidney and liver diseases. It is not recommended to administer other non-steroidal anti-inflammatory drugs or nephrotoxic drugs earlier than 24 hours after administration of rimadil.
Do not exceed the prescribed dose Dmitry Sazonov or treatment duration. If carprofen and warfarin are used at the same time, the clinical situation must be carefully monitored, as both drugs bind to plasma proteins.
Chlordiasepoxide is a derivative of benzodiazepine. Chlordiasepoxide affects many structures of the central nervous system, primarily the hypothalamus and limbic system, that is, structures that are associated with the regulation of emotional activity. Chlordiasepoxide interacts with specific benzodiazepine receptors, which are located in the post-synaptic GABAA-receptor complex in the amygdala nucleus, cerebral cortex, striate body, hippocampus, cerebellum, podburnum, spinal cord. Chlordiasepoxide, like other benzodiazepines, increases the inhibitory effect of GABAergic cortical neurons, hypothalamus, thalamus. For benzodiazepines, including chlordiazepoxide, there are specific binding sites, which are protein structures of cell membrane and have a connection with the complex, which consists of a chlorine channel and GABAA-A receptor. Chlordiasepoxide modulates the sensitivity of the GABAAergic receptor and increases the affinity of the receptor to gamma-aminobutyric acid, which is a inhibitory endogenous neurotransmitter. As a result of activation of GABAA or benzodiazepine receptor, there is increased transport of chlorine ions into the neuron through the chlorine channel, which leads to hyperpolarization of cell membrane and suppression of neuron activity. Chlorodiazepoxide blocks polysynaptic reflexes. Chlordiasepoxide clinically has a sedative, anxiolytic, moderate sleeping effect, has anticonvulsant effect, reduces the tone of skeletal muscles. Chlordiasepoxide has a pronounced soothing effect on the central nervous system. Chlordiasepoxide suppresses excitement, anxiety, emotional stress. Chlordiazepoxide reduces fears and obsessions, increases susceptibility to hypno-suggetic treatment. Chlordiasepoxide relieves tremor, has antipanic effect, has a weak anticonvulsant effect.
Chlordiasepoxide reduces the severity of fear and anxiety, which are associated with the upcoming surgery. In large doses, chlordiasepoxide can reduce psychomotor agitation. Chlordiasepoxide causes moderate muscle relaxation. Chlordiasepoxide has a moderate sleeping effect, usually expressed in the first 3 – 5 days of treatment, then a positive effect on sleep due to the elimination of various psychogenic irritants. Chlordiazepoxide has a mild analgesic effect, increases appetite. Relieves symptoms of acute alcohol withdrawal, such as nervous tension, anxiety, agitation, anxiety tremor and others.
Chlordiaseepoxide has a high lipophilicity and is almost completely absorbed after ingestion. The starting time and absorption rate of chlordiazepoxide can be varied. At a single oral intake of 15 – 25 mg of chlordiazepoxide suction occurs within 35 – 45 minutes. Absorption slows down the absorption of food. The maximum concentration of chlordiazepoxide in plasma is reached after 0.5 to 4 hours. Chlordiasepoxide binds to plasma proteins by 96 %. The equilibrium chlordiazepoxide concentration is reached after 5 – 12 days from the beginning of therapy. Chlordiazepoxide penetrates the hematoencephalic and placental barrier and is excreted with breast milk. Chlordiasepoxide Contraindications is slowly absorbed from muscle tissue. Chlordiasepoxide is metabolized in the liver by oxidation, N-demethylation, decomposition, hydroxylation with further glucuronation, and pharmacologically active metabolites (desmethylchlordiasepoxide, oxazepam, demoxepam, desmethyldiazepam) are formed. The half-life of chlordiazepoxide is 5 – 30 hours, its metabolites: oxazepam – 5 – 15 hours, desmethylchlordiasepoxide – 8 – 24 hours, demoxepam – 14 – 95 hours, desmethyldiazepam – 30 – 100 hours. Chlordiasepoxide is eliminated by kidneys (1-2% – in its unchanged form, 3-6% is eliminated in a related form). Chlordiasepoxide is cumulated (especially in elderly patients and in liver function disorders). Chlordiasepoxide refers to benzodiazepines with a long period of half-life, excretion after cancellation of chlordiasepoxide therapy is slow, because the metabolites remain in the blood for several days or even weeks. The accumulation of chlordiazepoxide and its active metabolites at repeated use is significant.
In elderly patients, the half-life of chlordiazepoxide is 60% longer than in young patients, while the overall clearance of chlordiazepoxide in elderly patients remains unchanged, as the lengthening of the half-life is balanced by an increase in the volume of distribution observed at this age. In older patients, chlordiazepoxide absorption and metabolism are slower. In cirrhosis of the liver, the clearance of chlordiazepoxide decreases, as the drug has a pronounced liver metabolism, so dose correction is necessary. Metabolic transformations are significantly slowed down in liver damage. Chlordiazepoxide