By Z. Angir. Central Christian College of the Bible. 2019.
The therapeutic ratio of anti-epileptics is often small from an anaesthetist are essential 200 mg topamax sale. Intravenous thiopental is and changes in plasma concentrations can seriously affect both sometimes used in this situation order topamax 200 mg with mastercard. In addition, anti-epileptics are prescribed over long periods, so there is a considerable likelihood that sooner or later they will be combined with another drug. Several mechanisms are involved: Key points • enzyme induction, so the hepatic metabolism of the anti- Status epilepticus epileptic is enhanced, plasma concentration lowered and efficacy reduced; If fits are 5 minutes in duration or there is incomplete recovery from fits of shorter duration, suppress seizure • enzyme inhibition, so the metabolism of the anti-epileptic activity as soon as possible. Assess the patient, verify the diagnosis and place them in the lateral semi-prone In addition to this, several anti-epileptics (e. Phenytoin, phenobarbital, topiramate and carbamazepine • If fits continue, transfer to intensive care unit, consult induce the metabolism of oestrogen and can lead to unwanted anaesthetist, paralyse if necessary, ventilate, give pregnancy: alternative forms of contraception or a relatively thiopental, monitor cerebral function, check pentobarbitone levels. Up to 70% of epileptics eventually enter a prolonged remission and do not require medication. Indivi- Status epilepticus is a medical emergency with a mortality of duals with a history of adult-onset epilepsy of long duration about 10%, and neurological and psychiatric sequelae possible which has been difficult to control, partial seizures and/ in survivors. Drug withdrawal itself may precipitate seizures, and the usually be achieved with intravenous benzodiazepines possible medical and social consequences of recurrent seizures (e. Despite the usually insignificant medical consequences, a Patients affected by drowsiness should not drive or operate febrile convulsion is a terrifying experience to parents. It is usual to reduce fever by giving paracetamol, removal of clothing, tepid sponging and fanning. Fever is usually due to viral infection, but if a bacter- dose should be reduced gradually (e. Uncomplicated febrile seizures have an excellent progno- Patients should not drive during withdrawal or for six months sis, so the parents can be confidently reassured. Rectal diazepam may be administered by par- Febrile seizures are the most common seizures of childhood. A ents as prophylaxis during a febrile illness, or to stop a pro- febrile convulsion is defined as a convulsion that occurs in a longed convulsion. Drugs and tonic–clonic seizures have been well controlled with carba- Therapeutics Bulletin 2003; 41: 41–43. Answer 1 Erythromycin inhibits the metabolism of carbamazepine, and the symptoms described are attributable to a raised plasma concentration of carbamazepine. Answer 2 This patient is not adequately protected against conception with the low-dose oestrogen pill, since carbamazepine induces the metabolism of oestrogen. The aura is associated with intracra- In the majority of patients with migraine, the combination of a nial vasoconstriction and localized cerebral ischaemia. Shortly mild analgesic with an anti-emetic and, if possible, a period of after this, the extracranial vessels dilate and pulsate in associ- rest aborts the acute attack. During a migraine attack, gastric stasis occurs and this oppose the effects of kinins, prostaglandins and histamine to impairs drug absorption. Several other idiosyncratic precipitating factors are rec- ognized anecdotally, although in some cases (e. Sedative anti- spondylosis, sleep (too much or too little), ingestion of tyramine- emetics (e. A scheme for the cranial circulation, thereby causing vasoconstriction predom- acute treatment and for the prophylaxis of migraine, as well as inantly of the carotids; they are very effective in the treatment of the types of medication used for each, is shown in Figure 23. Sumatriptan is also of value in cluster • are significantly symptomatic despite suitable treatment headache. Importantly, they can cause vasoconstriction in other for migraine attacks; vascular beds, notably the coronary and pulmonary vascula- • cannot take suitable treatment for migraine attacks. They should not be com- then withdrawn with monitoring of the frequency of attacks. Its bioavailability is only 14% when given orally due action of the β-blockers in this regard is uncertain, but they may to substantial presystemic hepatic metabolism. It is related be taken at any time during a migraine attack, but are most effec- to the tricyclic antidepressants. It affords good prophylaxis, but can cause drowsiness, appetite stimula- tion and weight gain. The anti-epileptic drugs topiramate and sodium valproate Migraine prophylaxis should be considered in patients who: (see Chapter 22) also have good effectiveness in the prophy- • suffer at least two attacks a month; laxis of migraine. Topiramate should only be initiated under • are experiencing an increasing frequency of headaches; specialist supervision. One evening she develops a particularly antagonist and calcium channel-antagonist activity.
Anterior median fissure Axon of motor neuron Illustration by Imagineering Media Services Inc buy topamax 100 mg line. The white matter consists of thousands of myelinated nerve fibers arranged in three funiculi (columns) on each side of the spinal cord that convey information up and down the cord’s tracts discount 100 mg topamax with visa. Ascending afferent (sensory) nerve tracts carry impulses to the brain; descending efferent (motor) nerve tracts carry impulses from the brain. Each tract is named according to its origin and the joint of synapse, such as the corti- cospinal and spinothalmic tracts. Thirty-one pairs of spinal nerves arise from the sides of the spinal cord and leave the cord through the intervertebral foramina (spaces) to form the peripheral nervous Chapter 15: Feeling Jumpy: The Nervous System 245 system, which we discuss in the later section “Taking Side Streets: The Peripheral Nervous System. In this section, we review six major divisions of the brain from the bottom up (see Figure 15-3): medulla oblongata, pons, midbrain, cerebellum, diencephalon, and cerebrum. Medulla oblongata The spinal cord meets the brain at the medulla oblongata, or brainstem, just below the right and left cerebellar hemispheres of the brain. In fact, the medulla oblongata is con- tinuous with the spinal cord at its base (inferiorly) and back (dorsally) and located anteriorly and superiorly to the pons. All the afferent and efferent tracts of the cord can be found in the brainstem as part of two bulges of white matter forming an area referred to as the pyramids. Many of the tracts cross from one side to the other at the pyramids, which explains why the right side of the brain controls the left side of the body and vice versa. Along with the pons, the medulla oblongata also forms a network of gray and white matter called the reticular formation, the upper part of the so-called extrapyramidal pathway. With its capacity to arouse the brain to wakefulness, it keeps the brain alert, directs messages in the form of impulses, monitors stimuli entering the sense recep- tors (accepting some and rejecting others it deems to be irrelevant), refines body movements, and effects higher mental processes such as attention, introspection, and reasoning. Although the cortex of the cerebrum is the actual powerhouse of thought, it must be stimulated into action by signals from the reticular formation. Nerve cells in the brainstem are grouped together to form nerve centers (nuclei) that control bodily functions, including cardiac activities, and respiration as well as reflex activities such as sneezing, coughing, vomiting, and alimentary tract movements. The medulla oblongata affects these reactions through the vagus, also referred to as cra- nial nerve X or the 10th cranial nerve. Pons The pons (literally “bridge”) does exactly as its name implies: It connects the cerebel- lum through a structure called the middle peduncle, the cerebrum by the superior peduncle, and the medulla oblongata by the inferior peduncle. It also unites the cere- bellar hemispheres, coordinates muscles on both sides of the body, controls facial muscles (including those used to chew), and regulates the first stage of respiration. Midbrain Between the pons and the diencephalon lies the mesencephalon, or midbrain. It con- tains the corpora quadrigemina, which correlates optical and tactile impulses as well as regulates muscle tone, body posture, and equilibrium through reflex centers in the superior colliculus. The inferior colliculus contains auditory reflex centers and is believed to be responsible for the detection of musical pitch. The midbrain contains Part V: Mission Control: All Systems Go 246 the cerebral aqueduct, which connects the third ventricle of the thalamus with the fourth ventricle of the medulla oblongata (see the section “Ventricles” later in this chapter for more). The red nucleus that contains fibers of the rubrospinal tract, a motor tract that acts as a relay station for impulses from the cerebellum and higher brain centers, also lies within the midbrain, constitut- ing the superior cerebellar peduncle. The second-largest divi- sion of the brain, it’s just above and overhangs the medulla oblongata and lies just beneath the rear portion of the cerebrum. The cerebellar cortex or gray matter contains Purkinje neurons with pear-shaped cell bodies, a multitude of dendrites, and a single axon. It sends impulses to the white matter of the cerebellum and to other deeper nuclei in the cerebellum, and then to the brainstem. The cerebellar cortex has parallel ridges called the folia cerebelli, which are separated by deep sulci. Diencephalon The diencephalon, a region between the mesencephalon and the cerebrum, contains separate brain structures called the thalamus, epithalamus, subthalamus, and hypothal- amus. The region where the two sides of the thalami come in contact and join forces is called the intermediate mass. The thalamus is a primitive receptive center through which the sensory impulses travel on their way to the cerebral cortex. Here, nerve fibers from the spinal cord and lower parts of the brain synapse with neurons leading to the sensory areas of the cortex of the cerebrum. The thalamus is the great integrat- ing center of the brain with the ability to correlate the impulses from tactile, pain, olfactory, and gustatory (taste) senses with motor reactions. The epithalamus contains the choroid plexus, a vascular structure that produces spinal fluid. The pineal body and olfactory centers also lie within the epithalamus, which forms the roof of the third ventricle. The subthalamus is located below the thalamus and regulates the muscles of emotional expression.
A virus can damage the tissues in the sinuses and then bacteria can invade buy generic topamax 100mg on-line, creating an infection buy discount topamax 200mg on-line. Acute sinusitis can also result from a fungal infection, especially in those with diabetes or compromised immune function. This is usually S a sign of a suppressed immune system, which leads to recurrent respiratory infections and chronic inﬂammation of the sinuses. There are many things that can be done from a dietary and lifestyle perspective to prevent and manage sinusitis. Nutritional supplements can also play a role in helping to speed healing and reduce inﬂammation. According to a study by the Headache Care Center, 97 percent of people who thought they were sinus headache sufferers actually had symptoms of migraine as deﬁned by the criteria of the International Headache Society. Both migraines and sinus headache, 390 which can cause pain in the area round the sinuses and eyes to tear, can be triggered by weather. When the trigeminal nerve is affected, it sends signals to the sinus region, causing sinus pain. See your doctor for proper diagnosis as the treatment of these headaches is different. If your doctor suspects you have a bacterial infection, then an antibiotic may be neces- sary. If allergies are suspected, you may be referred to an allergist to identify your triggers and develop a treatment strategy. Over-the-counter nasal decongestants, such as pseudoephedrine (Sudafed) and oxymetazoline (Dristan), can help relieve congestion and nasal stufﬁness. Both oral and nasal decongestants can cause racing heart, increased blood pressure, insomnia, and they can interact with certain medications. They should not be used longer than three days because of the risk of rebound congestion. They lubricate the nasal passages and reduce stufﬁness without the side effects of the decongestants. If you suspect food allergies, try an elimination diet (see Appendix D) to determine which foods are triggering your symptoms. S Lifestyle Suggestions • Don’t smoke, and avoid second-hand smoke as tobacco is very irritating to the nasal pas- sages and causes inﬂammation. Top Recommended Supplements Bromelain: An enzyme derived from pineapple, which has anti-inﬂammatory properties and has been shown in studies to reduce symptoms of sinusitis. Echinacea: Helps support immune function, and studies show that it can reduce the sever- ity and frequency of cold symptoms. Dosage: 300–600 mg capsules twice daily or 2–4 mL tincture four to six times daily at the ﬁrst sign of a cold for seven to 10 days. Some products combine echinacea with astragalus, which also has antiviral and antibacterial properties. Vitamin C: Supports immune function and helps prevent oxidative damage to the lungs. Studies have shown that it can reduce the severity and duration of the common cold, which may reduce the likelihood of complications, such as sinusitis. Complementary Supplements Aged garlic extract: Contains antioxidant compounds that help support immune func- tion. One study in children found that daily ﬁsh oil supplements reduced the risk of recurrent respiratory tract infections. This innate mechanism was designed to help us cope with short bursts of stress, such as that caused by the attack of a predator. Our bodies have not adapted to handle the chronic stress so common today, which leads to damage and destruction throughout the body. Hans Selye, one of the founders of the Canadian Institute of Stress, the physical experience of continuous stress has three stages: alarm, resis- tance, and exhaustion. In the alarm stage, our bodies engage in their biologically programmed ﬁght-or-ﬂight mode. The stress hormones catecholamines (adrenaline and noradrenaline) and glucocorticoids (cortisol) are released. When this occurs, the body enters a catabolic state; that is, it begins to break down fuels (fats, stored sugar) to provide energy. Our senses are heightened and heart rate, blood pressure, blood vol- ume, and pulmonary (lung) tone increase to enhance the function of the heart and lungs. At the resistance stage, the body works to heal itself by adapting resistance mechanisms to counter the negative effects of stress. Numerous studies have linked stress to increased risk of heart disease, cancer, diabetes, high cholesterol and blood pressure, anxiety, depression, memory loss, insomnia, muscle tension, obesity, fatigue, low libido, erectile dysfunction, and men- strual cycle disturbances.