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Interestingly discount 200mg zagam free shipping, herbs are the raw material of old and new pharmaceutical med- ication buy 200 mg zagam with visa. For example cheap zagam 200 mg overnight delivery, the herb foxglove is the source for digitalis and the herb salicin is the source for aspirin. Although the therapeutic effect of herbs have been well known for thou- sands of years, there seems to be a lack of uniform information about them that describes their use, dosage, side effects, and contraindications. In addition, there aren’t any qualitative monographs that provide guidelines for compounding and standards of purity for herbal medication. One in five people in the United States who have taken prescription medication also have taken herbal medications. One such herb is fresh aloe, which can be used topically to treat burns and minor cuts. Herbs are living organisms that have a very short life after they are removed from their source of nutrition (that is, picked from the ground). Enzyme activity begins to cause the herb to decay immediately after the herb is harvested. Therefore, steps must be taken to preserve the herb by drying it in sunlight or by using another heat source. The most commonly used extraction technique is to first isolate the part of the herb that contains the therapeutic material and then soak that part in alcohol or water. Herbal oil is prepared by soaking the dried herb in olive oil or vegetable oil and heating the herb for an extended period of time. Oils promote the concentration of the therapeutic material and, if properly stored, extend the therapeutic life of the material for months. They are prepared in a way similar to herbal oils except once the dried herb is soaked in oil, melted wax is mixed with the oil. Once the herb blends with the water, the resulting tea can be stored in the refrigerator for later use as a drink, bath water additive, or applied topically in a compress to the skin. Chaparral tincture, for example, contains important ingredients that cannot be dissolved in water. Tinctures are also a con- venient way to take herbs that does not require kitchen preparation. Disagreeable- tasting herbs can be swallowed more quickly and can be masked with juice. Tinctures are made by soaking fresh or dried herbs in water or alcohol causing the water-soluble and fat-soluble components of the herb to concentrate. Herbal tablets are similar to herbal capsules except the dried, pulverized herb is combined with stabilizers and binders and then compressed into a tablet. A stabilizer is an ingredient that assures that the herb maintains its therapeutic effect. A binder is an ingredient that acts like glue to hold together the powdery mixture of herb and stabilizer. Syrups are made by drying the herb and soaking it in water or oil and then adding a sweetener to the mix. Hazards of Herbal Therapeutics Herbal therapies have a therapeutic effect and are acceptable interventions for diseases and symptoms. However, the lack of standards in manufacturing and lack of oversight by regulatory agencies exposes patients to potential hazards. Pharmaceuticals approved for distribution in the Untied States have under- gone rigorous testing that identifies the purity and concentration of the active ingredient that delivers the therapeutic effect. This also identifies the toxic lev- els that can cause serious and potentially lethal toxic effects. Anyone can sell herbal therapy without having to receive approval from a governmental agency or from the medical community. A major concern is the effect herbal therapy has on the patient who is also tak- ing prescribed medications. A prescriber should always ask what medication the patient is taking and review the patient’s chart before prescribing another medication. For example, a patient who takes cascara—a laxative for constipation—and senna—also a laxative—along with Digoxin—which is used to treat an irregu- lar heart rhythm—can develop a toxicity. For example, comfrey is used as an ointment to relieve swelling that is associated with abrasions and sprains. The herbal dietary supplement ephedra, commonly known as ma huang, is used as an energy boost and for losing weight. Ephedrine and pseudoephedrine are components of ephedra that have a stimulant and bronchodilation effect. How- ever, ephedra has an adverse effect of palpitations—which can result in stroke. Herbal Therapy and the Nursing Process Nurses need to include a discussion about the patient’s use of nonconventional therapeutic agents by name, dosage, frequency, side effects and why the patient is taking this remedy in the nursing assessment. This assessment should include information about all prescription and over-the-counter medications taken by the patient and why the patient is taking these drugs. Herbal medications, over the counter medications, and prescribed medications can combine to create undesir- able results and in some cases can have a toxic and dangerous effect on the patient. After assessing the patient, the nurse considers a nursing diagnosis that is related to herbal therapies. The patient may be unaware of the impact herbal ther- apies have on the patient’s health. The patient may be unaware of how herbal therapies alter the patient’s nutritional balance. The patient might be experiencing nausea, diarrhea, headache, fatigue, and other symptoms that are side effects of herbal therapies.

However generic 200 mg zagam otc, an alternative explanation of the relation- ship focuses on the subjective experience of craving for a substance order zagam 200 mg mastercard. The subjective experience of craving The desire to eat and the response to food deprivation is characterized by the experience of ‘emptiness’ buy generic zagam 200 mg on line, ‘tension’, ‘agitation’, ‘light-headedness’ as well as more specific feelings such as a ‘rumbling stomach’. Smoking abstainers also describe their desire for a cigarette in similar ways, again using language such as ‘emptiness’, ‘agitation’ and ‘light-headedness’. A possible explanation of the interaction between smoking and eating is that sensations of deprivation may be interchangeable. Alcohol research suggests that craving for alcohol may be a form of misattribution of internal states, with the alcoholic labelling internal states as a desire for alcohol (Ludwig and Stark 1974; Marlatt 1978). With reference to eating and smoking, the desire to smoke may be labelled as hunger and therefore satiated by food intake. In a recent experimental study, smokers were asked either to abstain for 24 hours or to continue smoking as usual, and their craving for food and cigarettes and food intake was compared with each other and with a group of non-smokers (Ogden 1994). The results showed that smoking abstinence resulted in an increased craving for food and increased food intake. In addition, the results showed that an increased craving for cigarettes resulted in increased food intake. Furthermore, the results showed that this association between craving for cigarettes and food was greater in women than men, and particularly apparent in dieting women. These studies support a cross-behavioural perspective of addictions and suggest an interrelationship between different behaviours. It is possible that because women dieters may use smoking as a means to reduce their eating they develop an association between these behaviours. It is also possible that the substitution between addictive behaviours may also exist between other behaviours such as alcohol and smoking (stopping smoking increases drinking), or gambling and eating (stopping gambling increases eating). There are many different theories to explain why people smoke or drink and how they can be encouraged to adopt healthy behaviours. This chapter examined the different models of addiction, including the moral model, the disease models and the social learning perspective. Finally, this chapter examined the interrelationship between different behaviours, in particular smoking and eating, to examine the validity of a cross- behavioural perspective. Theories of addictions and addictive behaviour emphasize either the psychological or physiological processes. This separation is reflected in the differences between the disease models and the social learning perspectives. It is often assumed that the most recent theoretical perspective is an improvement of previous theories. In terms of addictive behaviours, the moral model is seen as more naïve than the disease model, which is more naïve than a social learning theory perspective. However, perhaps these different models also illustrate different (and not necessarily better) ways of explaining behaviour and of describing the individual. This book examines the different theories of addictive behaviours and in particular outlines the contribution of social learning theory. This book provides a detailed analysis and background to relapse prevention and applies this approach to a variety of addictive behaviours. This book illustrates the extent to which different addictive behaviours share common variables in both their initiation and maintenance and discusses the interrelationship between physiological and psychological factors. This is a very clearly written accessible book which describes physiological and psychosocial reasons for smoking and provides an excellent account of smoking cessation strategies. Three main psychological perspectives which have been used to study food intake are then described. First, the chapter describes developmental models of eating behaviour with their focus on exposure, social learning and associative learning. Second, it examines cognitive theories with their emphasis on motivation and social cognition models. Third, it explores the emphasis on weight concern and the role of body dissatisfaction and restrained eating. Dinner is later described as similar to breakfast with ‘no vegetables, boiled meat, no made dishes being permitted much less fruit, sweet things or pastry. Similarly in the 1840s Dr Kitchener recommended in his diet book a lunch of ‘a bit of roasted poultry, a basin of good beef tea, eggs poached. Nowadays, there is, however, a consensus among nutritionists as to what constitutes a healthy diet (DoH 1991). Food can be considered in terms of its basic constituents: carbohydrate, protein, alcohol and fat. Descriptions of healthy eating tend to describe food in terms of broader food groups and make recommendations as to the relative consumption of each of these groups as follows. Other recommendations for a healthy diet include a moderate intake of alcohol (a maximum of 3–4 units per day for men and 2–3 units per day for women), the consump- tion of fluoridated water where possible, a limited salt intake of 6g per day, eating unsaturated fats from olive oil and oily fish rather than saturated fats from butter and margarine and consuming complex carbohydrates (e. It is also recommended that men aged between 19 and 59 require 2550 calories per day and that similarly aged women require 1920 calories per day although this depends upon body size and degree of physical activity (DoH 1995). Diet is linked to health in two ways: by influencing the onset of illness and as part of treatment and management once illness has been diagnosed. Eating disorders are linked to physical problems such as heart irregularities, heart attacks, stunted growth, osteoporosis and reproduction. Obesity is linked to diabetes, heart disease and some forms of cancer (see Chapter 15). In addition, some research suggests a direct link between diet and illnesses such as heart disease, cancer and diabetes (see Chapters 14 and 15). Much research has addressed the role of diet in health and although at times controversial, studies suggest that foods such as fruits and vegetables, oily fish and oat fibre can be protective whilst salt and saturated fats can facilitate poor health. Diet and treating illness Diet also has a role to play in treating illness once diagnosed.

This occurs when an antihypertensive (high blood pressure) drug interferes with the process that constricts blood vessels and may cause blood pressure to rise generic zagam 200mg online. A drug action begins when the drug enters the body and is absorbed into the bloodstream where the drug is transported to receptor sites throughout the body (see Pharmacokinetics generic zagam 200mg on line, in this chapter) cheap zagam 200 mg free shipping. Once the drug hooks onto a receptor site, the drug’s pharmacological response initiates. The pharmacological response is the therapeutic effect that makes the patient well. The desirable effect is what makes the patient well or prevents the disease or disorder. Some side effects are desirable and others are undesirable (see Side Effects, in this chapter). The strength of a drug action is determined by how much of the drug is given, (the dose) and how often the drug is given (the frequency). For example, a patient who has a sore throat can be given a large dose of an antibiotic—a loading dose— on the first day of treatment and a normal or maintenance dose for the next five days. These are: • Pharmaceutic Phase: This phase occurs after the drug is given and involves disintegration and dissolution of the dosage form. The inactive ingredient, called excipient, is the substance that has no pharmaceutical response but helps in the delivery of the drug. The coating around tiny particles of a capsule that causes a timed-release action of the drug is an inactive ingredient. The time necessary for the drug to disintegrate and dissolve so it can be absorbed is called the rate limiting time. A drug has a higher rate limiting time (Table 2-1) if it is absorbed in acidic fluids rather than alkaline fluids. Some drugs are more effective if absorbed in the small intestine rather than the stomach. Therefore, pharmaceutical manufacturers place an enteric coating around the drug that resists disintegration in the stomach. Enteric coating is also used to delay the onset of the pharmaceutical response and to prevent food in the stomach from interfering with the dissolution and absorption of the drug. Tip: Never crush a capsule that contains enteric release beads or is coated for timed-release. Drug molecules move to the intended site of action in the plasma but sometimes this journey can be limited because they have to get into the interior of a cell or body compartment through cell membranes. These membranes could be in the skin, the intestinal tract, or the intended site of action. Drug particles then attach themselves to receptor sites resulting in its therapeutic effect. These are: Passive Diffusion Passive diffusion is the flow of drug particles from a high concentration to a low concentration—similar to how water flows downstream. There is no energy expended in passive diffusion because drug particles are moving along the natural flow. Active Diffusion Active diffusion is how drug particles swim upstream against the natural flow when there is a higher concentration of plasma than there is of drug particles. Drug particles don’t have enough energy to go against the natural flow without help. Help comes from an enzyme or protein carrier that transports drug parti- cles upstream across the membrane and into the plasma. Pinocytosis Pinocytosis is the process of engulfing the drug particle and pulling it across the membrane. This is similar to how you eat an ice pop by engulfing a piece of it in with your mouth and swallowing it. How long the drug will be effective and how much drug is needed depends on the route of administration, the dose of the drug, and the dosage form (tablet, capsule, or liquid). The absorption rate of a drug is influenced by a number of factors that might increase or decrease the rate, This is similar to how more gasoline is used to drive at faster speeds. Absorption is affected by many factors that include pain, stress, hunger, fasting, food, and pH. Hot, solid, fatty foods can slow absorption such as eating a Big Mac before taking medication. During exercise, circulation to the stomach is diverted to other areas of the body and drug absorption is decreased. Circulation Blood flow to the site of administration of the drug will help increase the rate of absorption. An area that has a lot of blood vessels and good circulation will help absorb the drug quickly and circulate it to the intended site. When a patient is in shock and has a low blood pressure due to decreased circulation (blood flow) drugs may not be absorbed very quickly. Route of Administration The rate at which drug particles are absorbed is determined by the amount of blood vessels there are in the area where the drug is administered. For example, a drug is absorbed faster in the deltoid (arm) muscle than in the gluteal (butt) muscle because there are more blood vessels in the del- toid muscle. This additional step causes water- soluble drugs to be absorbed more slowly than fat-soluble drugs.

Bowers appears to feel that bitemark analysis should only be used to exclude or to associate an individual as a “possible biter cheap 200mg zagam. Only “reasonable medical/dental certainty zagam 200mg on-line,” “probable buy 200 mg zagam otc,” “exclusion,” and “inconclusive” remain as recommended conclusions. Bowers coauthored a textbook, now in its second edition, teaching methods for extensive bitemark detail analysis, metric analysis,exemplar crea- tion, and feature comparison. In spite of past or recent claims to the contrary, it may not be possible to mathematically or statistically prove the uniqueness of the anterior human dentition related to the information found in bitemarks. Consequently, a path similar to that recommended by Saks and Koehler seems the most sensible: Continue research into uniqueness, but collect data and build databases on the frequency with which those features and patterns of the anterior dentition appear, especially those features that may also be discernable in bitemark pat- terns. Tomas Johnson and a Marquette University team reported development of a computerized method of collect- ing data on dental characteristics (oral presentations in Johnson et al. Te method may be the frst step toward the creation of a database of the frequency at which dental characteristics and combinations of characteristics occur in a population. Roger Metcalf reported on an alternate method at the same 2008 meeting (oral presentation in Metcalf et al. Tat method is currently being investigated at the University of Texas Health Science Center in San Antonio. Tere is almost universal agreement among forensic dentists that human skin is a very poor material for faithfully and accurately recording those features. Most early bitemark-related papers that discuss skin con- centrate on the distribution of bitemarks, the classifcation of bitemarks, and the analysis of distortion in bitemarks or in preserved skin with bite- marks. Tose features must then be scientifcally analyzable, the distortion accounted for, and a statistical or mathematical basis for comparisons established. Also known as Leibniz’s law and the probability rule for indepen- dent variables, the rule is most commonly applied to problems in diferential calculus. For forensic research applications the following defnition may be most useful: “Te probability rule for independent variables, or product rule, states that the probability of the simultaneous occurrences of two indepen- dent events equals the product of the probabilities of each event. In the most ofen cited work on the subject of the uniqueness of teeth, the use of the product rule is essen- tial to the conclusion. Until signifcant research shows that the dental features are indeed independent, mathematical or statistical certainty cannot be assigned to either the features of the biting surfaces of the anterior dentition or to the marks that those teeth make in skin. As an alternative to those mathematical or statistical methods, research currently under way on collecting and recording data on the frequency of dental variation features is encouraging. To date there is insufcient scientifcally con- frmed information to support the association of bitemark patterns on human skin and sets of teeth with statistical or mathematical degrees of certainty. Te same seven sets of dental models served as the potential biters in all four cases. In only one of the cases, a bitemark in cheese, was the identity of the true biter known. Tis knowledge was based, at least in part, on the victim’s identifcation of the biter and the biter’s subsequent confession. Results were tabulated and two nondiplomates were authorized to perform a statistical analysis of the results and produce a paper for submission to a refereed journal. Te frst journal to which the paper was submitted, the Journal of Forensic Sciences, rejected the paper, citing the inappropriate design of the workshop for statistical analysis. Perhaps unfortunately, considering the later misinterpretations, the article was submitted to other journals and was ultimately published in 2001 in the journal Forensic Science International. In the paper the authors stated that the primary objective of the study was “to determine the accuracy of examiners in distinguishing the correct dentition that make a bitemark,” and the secondary 356 Forensic dentistry objective was “to determine whether examiner experience, bitemark certainty, or forensic value had an efect on accuracy. Consequently, mathematical or statistical analysis of the opinions of workshop participants was not possible without assuming that a true cause-efect relationship existed in each of the cases. Bitemark Workshop #4 was neither designed as, nor can it be used as, a profciency test for forensic odontology. Tests of consistency and validity (necessary in a profciency examination) were neither accomplished nor attempted; and, as subsequent reviewers of the data correctly pointed out, the construction of the examination and the workshop was not designed to produce an examination that had statistical validity and statistical con- sistency. In 2002 the Supreme Court of Mississippi was consider- ing a petition for postconviction relief in a death penalty case involving alleged bitemarks. Included in the petition was this material described by the court: In support of this claim, Brewer presents the afdavit of Charles Michael Bowers, D. He urges that this Court should not tolerate a science that, as Brewer claims, is more likely than not to identify the wrong suspect. Tese results counter balance the years of assured self-confdence shown by the dentists testifying on bite mark Bitemarks 357 evidence. Tus, they were wrong nearly half the time they tried to identify the source of a bitemark. More specifcally, it is their false positive error rate—the tendency to conclude that an innocent person’s dentition matches the bitemark—that accounts for the bulk of that overall error rate. If this refects their perfor- mance in actual cases, then inculpatory opinions by forensic dentists are more likely to be wrong than right. Bowers claimed, a “study regarding the reliability of bite mark identi- fcation evidence,” nor did it “produce data on the accuracy of results in bite mark identifcation forensic casework. Te authors of the Forensic Science International paper correctly stated in closing, “Tis study, despite its limitations, has opened the debate into evidence-based forensic dentistry. Forensic odontologists must ensure that the techniques they employ are backed by sound scientifc evidence and that the decisions they present in Court serve to promote justice and to strengthen the discipline.