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Unproven Uses: Internally for gynecological disorders and Production: White Mustard seed consists of the ripe buy discount atorlip-10 10 mg line, dried externally for ulcers generic 10mg atorlip-10, inflammation, furuncles, finger ulcers, seed of Sinapis alba. The drug is also used externally as a Glucosinolates: chiefly sinalbin (p-hydroxybenzylglucosino- wet compress (paste). Treat- poultices for congestion of the respiratory tract, for topical ment should not exceed 2 weeks. Mustard baths are used in the treatment of paralytic 30 to 60 minutes (acute) or 1 to 3 times daily (chronic); symptoms. Storage: The drug must be protected from light and Mustard is used in footbaths, and for the treatment of moisture. Homeopathic Uses: Sinapis alba is used to treat inflamma- tion of the gastrointestinal tract and the respiratory tract. Long-term external application carries the Teuscher E, Lindequist U, Biogene Gifte - Biologie, Chemie, danger of skin injury. Flower and Fruit: The white, fairly large bilabiate flowers Preparation: To prepare an external foot bath, 20 to 30 gm are in axillary false whorls of 6 to 16 flowers. The tube of the Mustard bath, 150 gm of the Mustard flour in a pouch is used corolla is bent like a knee and the upper lip is curved like a in the bathwater. The Daily Dosage: The average daily dose of the drug is 60 to tube has 1 large and 1 small tip at the edge. To brighten and clear the voice, Mustard flour is and 2 short stamens under the upper lip. When the nut is Chinese Medicine: In Chinese medicine, White Nettle is ripe, slight pressure is sufficient to fling out the seeds. These are erect, quadrangular, grooved, hollow and No health hazards or side effects are known in conjunction noded. The leaves are crossed opposite, petiolate, ovate to with the proper administration of designated therapeutic cordate, acuminate and serrate. Mode of Administration: Comminuted drug for infusions and Characteristics: The flowers have a weak honey-like fra- other galenic preparations for internal applications, rinses, grance and a slimy-sweet taste. Preparation: Production: White Nettle flower consists of the dried petal Infusion — Pour one cup of water over 1 gm drug, leave to with attached stamens of Lamium album as well as its draw for 5 minutes and strain. Extract for poultices — Scald 50 gm of flowers with 500 ml Other Names: Blind Nettle. Stingless Nettle, White Archangel Daily Dosage: For internal use, the average daily dose is 3 gm drug. Chemical comparative studies of the herb and Triterpene saponins flowers of Lamium album L. In: Acta Pol Pharm 40(3):389- Caffeic acid derivatives: including among others rosmaric 393. They are dioecious and appear at the same Willow Bark is contraindicated in patients that have a time as the leaves on leafy stems in erect catkins. Salicylates should not be used catkins are densely blossomed and cylindrical, up to 6. The leaves are short- the proper administration of designated therapeutic dosages. Drug Interactions: Due to the salicin component, caution Characteristics: The annual twigs are not easy to break off at should be exercised when used in combination with salicy- the base. There are reports that salicylate decreased serum naproxen concen- Habitat: The plant is indigenous to central and southern trations markedly and increased serum naproxen clearance Europe. Production: White Willow bark consists of the bark of the Though there are no reports of interactions with drugs that young, 2 to 3 year old branches harvested during early spring affect blood clotting times, and some studies suggest that of Salix alba, Salix purpurea, Salix fragilis and other thrombocyte inhibition is unlikely. Hemophiliacs or anyone with a bleeding disorder should not The efficacy of the drug is due mainly to the proportion of use Willow Bark. White Willow bark is the phytotherapeutic precursor to acetylsalicylic acid (aspirin). Nursing Mothers: Salicylates have been associated with rashes in breast-fed infants; use is not recommended. The salicin component is responsible for the anti-inflamma- tory and antipyretic effects. Drug extracts are contained in some standardized Approved by Commission E: preparations of analgesics/antirheumatics, hypnotics/seda- • Rheumatism tives, and gastrointestinal remedies. Baird I, Leak A, Metabolic acidosis induced by carbonic anhydrase inhibitors and Wild Carrot salicylates in patients with normal renal function. Flower and Fruit: The flowers are in compact, terminal umbels or flattened, compound capitula. Schmid B, Heide L, Wirksamkeit und Vertraglichkeit von Weidenrinde bei Arthrose: Design und Durchfuhrung einer Production: Wild Carrots are the roots of Daucus carota. Volatile oil (very little): including among others p-cymene, Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, limonene, dipenten, geraniol, alpha- and beta- caryophyllene Nachdruck, Georg Olms Verlag Hildesheim 1979. Polyynes: including falcarinol (carotatoxin) Schulz R, Hansel R, Rationale Phytotherapie, Springer Verlag Heidelberg 1996.

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Springer Verlag Berlin generic 10mg atorlip-10 with amex, Heidelberg buy atorlip-10 10 mg, New York, 1992- Knitbone, Salsify, Slippery Root, Wallwort, Consolida, 1994. Mucilages (Fructans) Triterpene saponins: including symphytoxide A Combretum micranthum Tannins See Opium Antidote Silicic acid: to some extent water-soluble Pyrrolizidine alkaloids (0. Hepatocelluar adenomas have been Hypotensive Effect—Symphytoxide A, a triterpene saponin, reported in animal models receiving diets containing Com- exhibited hypotensive activity in anesthetized rats (Ahmad, frey roots and leaves (Hirono, 1978). Tissue/Nerve Stimulation—Allantoin, a component in Com- frey, stimulates tissue repair and wound healing through cell Gastrointestinal/Kidney/Pancreas Effects: Comfrey, through proliferation (Rieth, 1968). Allantoin has also had significant the pyrrolizidine alkaloids, has been shown to produce effect on cellular multiplication in degenerating and regener- lesions in the gastrointestinal tract, pancreas, and renal ating peripheral nerves (Loots, 1979). The patient Use in Pregnancy: The drug is contraindicated during illnesses consisted of epicondylitis, tendovaginitis, and peri- pregnancy. Efficacy was determined by evaluation of different Use in Nursing Mothers: Use of the drug while nursing is pain parameters (tenderness on pressure, pain at rest, pain on contraindicated. There was significant improvement with the ointment compared to placebo at weeks 1, 2. There was improvement with Mode of Administration: The crushed root, extracts, and M. The drug is a in the peri-arthritis patients in either of the two treatment component of standardized preparations of analgesics, anti- groups (Petersen, 1993). For external application, a decoction of 1:10 is used, or the fresh Unproven Uses: The root has been used externally as a roots are mashed. Internally, the root has been used for gastritis Daily Dosage: and gastrointestinal ulcers. In Folk medicine, the root of the External Use—The daily dosage should not exceed 1 meg of plant has been used for rheumatism, pleuritis, and as an anti- pyrrolizidine alkaloids for external preparations calculated diarrheal agent. Symphytoxide hepatocyte membrane injury with hemorrhagic necrosis and A, a triterpenoid saponin from the roots of Symphytum loss of microvilli (Yeong, 1993). Studies on the effect of with Comfrey ingestion, and in one case report, death an alkaloid extract of Symphytum officinale on human resulted by liver failure (Ridker, 1989; Yeong, 1990). Hepatic poisonous plants (Senecio jacobaea, Symphytum officinale, veno-occlusive disease associated with comfrey ingestion. J Pteridium aquilinum, Hypericum perforatum) by rats: chronic Gastroenterol Hepatol 1990 Mar-Apr;5(2):211-4. The effect of allantoin on Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, cellular multiplication in degenerating and regenerating nerves. Phytopharmaka und pflanzliche Homoopathika, Fischer-Verlag, Stuttgart, Jena, New Noorwala M et al. Stimulation of tissue reparation with allantoin as adjuvant of the antifungal treatment. The papilonaceous flowers are almost Unproven Uses: Kidney Vetch tea is used in the treatment of sessile and have an upright corolla up to 20 mm long. It is tubular- also used in a tea for coughs that also contains ribwort, as an bottle-shaped and shaggy to felt-haired. It is used internally for diseases of the mouth and petals are whitish-yellow to yellow or occasionally crimson. No health hazards or side effects are known in conjunction The ovaries are stemmed with a thickened style and rounded with the proper administration of designated therapeutic stigma. Mode of Administration: Preparations are available for internal uses, often as teas, and external uses including Leaves, Stem and Root: Anthyllis vulneraria is a 15 to 30 cm poultices, washes and rinses. The stem is upright, Preparation: To prepare tea, use 1 dessertspoonful of the flowers per 250 ml of water. The stipules are B, Glinkowska G, Malinowski J, Strzelecka H, Isolation and small and generally connected to a clasping sheath. Habitat: The plant is found all across Europe to the Vetter J, Seregelyes-Csomos A, Magy Allatory Lapja 43(8):479- 482. Woundwort is collected in the (Drogen), Springer Verlag Berlin, Heidelberg, New York, 1992- wild and then dried quickly in the shade. Flower and Fruit: The flowers are leafy, twining cymes on 4f Isoflavonoids short pedicles. There are 5 ovate sepals and 5 golden yellow petals that are 7 to 9 mm long, lanceolate and twice as long Lectins as the calyx. The flavonols quercetin and rhamnetin have a Leaves, Stem and Root: The perennial plant grows 2 to 15 mutagenic effect. It has many heavily branched shoots, which often and wounds may be due to the tannins (probably of the creep underground and form grass.

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The initial workup is therefore focused on differentiating benign functional illness from organic pathology generic atorlip-10 10 mg free shipping. Helpful historical clues include the overall time course of the problem purchase 10 mg atorlip-10 with mastercard, whether pain is constant or intermittent, abnormalities in bowel habits, and aggravating/alleviating factors. Since many multisystem illnesses could contribute to a nonspecific abdominal complaint, a full physical exam should be performed. Specifically, the physical examination should clarify any focus of abdominal tenderness that may merit and focus further investigation. University of South Alabama, Department of Family Medicine June 30, 2008 12 Initial diagnostic testing The following tests should be considered in most patients with chronic abdominal pain: Complete blood count with differential. C-reactive protein and erythrocyte sedimentation rate are sensitive but nonspecific markers that may suggest the presence of occult organic disease; in selected cases, they may have some utility in ruling out organic causes of chronic abdominal pain. Subsequent Diagnostic Testing At the conclusion of the initial workup, young patients with no evidence of organic disease can be treated symptomatically. The use of further invasive testing should be directed at ruling in or out specific diseases and not as a general screen. A diagnosis of new-onset functional illness should only be made with great caution in patients over 50 years of age. Simon, Emily Melton; Update On Helicobacter Pylori Treatment; American Family Physician; Volume 75, Number 3; February 1, 2007 ---------------------- Ramakrishnan, Kalyanakrishnan, Robert Salinas; Peptic Ulcer Disease; American Family Physician, Volume 76; Number 7, October 1, 2007 University of South Alabama, Department of Family Medicine June 30, 2008 16 Asthma 493. General Approach to the patient: There are four main components in the management of asthma patients: 1. Despite an increased understanding of pathophysiology and treatment options, the disease remains undertreated. Asthma guidelines have been established to address the disparity between scientific knowledge and actual management. The Encounter Chief Complaint: Patients often seek medical attention complaining of episodes of wheezing, shortness of breath, or coughing. In the case of exercise induced asthma patients present with similar symptoms brought about mainly by physical exercise. History of Present Illness: Symptoms of asthma are often worsened by allergens or irritants and in a lot of cases by upper respiratory tract infections. Some patients will give a history of multiple doctor visits or emergency room visits for similar symptoms prior to being diagnosed with asthma. University of South Alabama, Department of Family Medicine June 30, 2008 17 Physical: It is important to keep in mind that asthma patients may have no pertinent findings on examination due to the episodic nature of the illness. However, symptomatic patients may have one or more of the following findings: Wheezing during normal respiration or induced by forced expiration. In acute exacerbations, evidence of respiratory distress in the form of tachypnea, hypoxia and use of accessory muscles may be seen. In this population, the diagnostic criteria discussed above apply as well, however, spirometry is not possible. Hence, a diagnosis is not needed to begin to treat recurrent episodes of wheezing. Classification of Asthma severity: The following classification is used to describe asthma severity in individual patients and aids the physician in choosing the appropriate medication for every patient. Patients at any level of severity of persistent asthma can have mild, moderate, or severe exacerbations of asthma. Some patients with intermittent asthma experience severe and life-threatening exacerbations separated by long periods of normal lung function and no symptoms. Minimizing side effects of therapy Patient Education: The following key points should be addressed following the diagnosis of asthma: Patients can live a normal life if the asthma is managed correctly. Lack of symptoms does not equal absence of inflammation of the airways, hence, long- term anti-inflammatory medications, if indicated, are important in asthma control. Many exacerbating factors exist in the home, school, or work environment which may lead to asthma attacks. Pharmacotherapy: Medications used to control asthma consist of: Long-term control medications: These medications are used daily in the treatment of persistent asthma and include anti-inflammatory agents, long-acting bronchodilators, and leukotriene modifiers. Corticosteroids: Most potent and effective anti-inflammatory medication currently available. The Inhaled form is used as the first line of therapy in the treatment of persistent asthma. Systemic corticosteroids are often used during asthma exacerbations for prompt alleviation of symptoms. Long-acting beta2-agonists: Long-acting bronchodilator used concomitantly with anti- inflammatory medications for long-term control of symptoms. Methylxanthines: Theophylline is a mild-to-moderate bronchodilator used principally as an adjuvant to inhaled corticosteroids in severe cases. Leukotriene modifiers: Leukotriene modifiers may be considered an alternative or used as an adjunct therapy to low doses of inhaled corticosteroids. Budesonide although studies are not conclusive, and clinical - Reduce need for oral Flunisolide significance of these effects has not been corticosteroid. Triamcinolone acetonide -Short-term use: reversible, abnormalities in glucose metabolism, increased appetite, fluid retention, weight gain, mood alteration, hypertension, peptic -For short-term (3–10 days) ulcer, and rarely aseptic necrosis of femur.

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