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By N. Kerth. Trevecca Nazarene University.

Unfortunately generic bentyl 10 mg amex, they are also moderately effective in causing both major varieties of side effects—end-organ toxicity and proarrhythmias 10 mg bentyl mastercard. Quinidine Quinidine is the D-isomer of the antimalarial quinine bentyl 10mg line, a drug that was noted to be effective in the treatmentofpalpitationsaslong 55 56 Chapter 3 Figure 3. Quinidine itself was recognized as an effective antiarrhythmic agent in the early twentieth century. Clinical pharmacology Quinidine isadministered orally as one of three salts (quinidinesul- fate, quinidine gluconate, or quinidine polygalacturonate). All three forms of the drug have beenmade available because some patients tolerate one salt better than another. Approximately 80–90% of the sulfate preparationis absorbed after oral administration,and peak plasma concentrations are reachedwithin 2 hours. The gluconate and polygalacturonate preparations are absorbedmore slowly and less completely than the sulfate formulation. Quinidine is 80–90% protein bound in the circulation and has a large volumeofdistribu- tion. The concentration of the drug is 4–10 times higher in the heart, liver, and kidneys thanit is in the circulation. Its elimination half-life is 5–8 hours but may be prolongedinpatients with congestive heart failure or in the elderly. Electrophysiologic effects Quinidine blocks the sodium channel and slows the rate of depo- larization of the actionpotential. Its effects on the potassium channels result in prolongation of the actionpotential and, therefore, of the refractory period. Like all drugs that prolong refractoriness, quinidine cancause early afterdepolar- izations(and thus torsades de pointes) in susceptible individuals. Hemodynamic effects Quinidine blocks the α-adrenergic receptors, which can lead to pe- ripheral vasodilation and reflex sinustachycardia. The effects tend to be minimal when the drug is given orally but can be profound with intravenousadministration. Therapeutic uses Quinidine is moderately effective in treating both atrial and ven- tricular tachyarrhythmias. Approximately 50% of patients treated with quinidine for atrial fibrillation remain in sinus rhythm af- ter 1 year. Thus, quinidine has Class I antiarrhythmic drugs 59 beenused to treat virtually all varieties of reentrantsupraventricular tachyarrhythmias. Quinidine is effective in suppressing premature ventricular com- plexes and nonsustained ventricular tachycardias, butbecause of the proarrhythmic potential of quinidine(and most other antiarrhyth- mic agents), these arrhythmias shouldnot be treated excepttosup- press significantsymptoms. For the same reason,quinidine should not be used to treat sustained ventricular tachycardia without the protection of an implantable defibrillator. Adverse effects and interactions Symptomatic side effects occur in 30–50% of patients taking quini- dine, and the drug must be discontinuedin20–30% of patients be- cause of toxicity. Ingeneral, if diarrhea occurs, the drug should be discontinued,because the diarrhea is usually not adequately con- trolledwith medication and the resultant electrolyte imbalances may exacerbate the very arrhythmias that are being treated. Quinidine can also cause dizziness, headache, or cinchonism (tinnitus, visual blurring,and hearing disturbances). Rashes are fairly common,and significanthypersensitivity reactionssuchashemolytic anemiaand thrombocytopenia can also occur. Any drug that prolongs the duration of the actionpotential canproduce torsades de pointes in susceptible individuals, and any drug that alters conduction veloc- ity or refractoriness can exacerbate reentrant arrhythmias. Quini- dinethus can (and does) cause ventricular arrhythmias by either of these mechanisms. Quinidine-induced syncope was recognized decades ago, but it was only relatively recently that this clinical syn- drome was shown to be caused by ventricular tachyarrhythmias. Quinidine-induced ventricular arrhythmias often occur early, usu- ally within 3–5 days after the drug isbegun,but can be seen at anytime. Although the incidenceofquinidine-inducedproarrhyth- mia is difficult to quantify, a meta-analysisofrandomized trials using quinidine to treat atrial fibrillation indicated a total mortality of 2. Because of the risk of proarrhythmia, doctors should 60 Chapter 3 strongly consider placing patients on a cardiacmonitor for several days when treatment with quinidine is elected. Increased digoxin levels routinely occur when quinidine is given to patients taking digoxin. Quinidine levels are decreased by phenobarbital, rifampin,and phenytoin; they are in- creased by amiodarone. Its availability in both oral and intravenous forms made itan attractive drug for many years in the treatment of both acute and chronic tachyarrhythmias. Clinical pharmacology Whengivenintravenously, procainamide’s onset of actionisalmost immediate; after oral intake, the onset of actionisapproximately 1 hour. Dosage Intravenous loading of procainamide should be givenno more rapidly than 50 mg/min to minimizehemodynamic side effects, to a total dose of 15 mg/kg. With currently available long-acting preparations, procainamide can be given every 6–12 hours. Because of its short half-life, administra- tion every 3–4 hours is requiredwith short-acting preparations. Class I antiarrhythmic drugs 61 Electrophysiologic effects The electrophysiologic effects of procainamide are similar to those of quinidine. Hemodynamic effects Like quinidine, procainamide causes arteriolar vasodilation,an ef- fect that is seen almost exclusively when the drug is givenintra- venously. Thisside effect is easier to control with procainamide than with quinidinebytitrating the infusion rate. Procainamide has an anticholinergic effectbut it is of less magnitude than that of quini- dine. Therapeutic uses The therapeutic uses of procainamide are similar to those of quini- dine.

Purple patches discount bentyl 10mg, like bruises discount 10mg bentyl fast delivery, on the hands or arms of an eld- erly person are called purpura order 10 mg bentyl mastercard, and is also caused by sorghum molds. Test in a saliva sample for all the sweetenings used recently (at least an hour ago). The kidney herbs (page 549), at half dose level (½ cup a day instead of a whole cup) can be given daily for three weeks and then on alternate days indefinitely. Try other kidney herbs from time to time: shave grass, cedar berries, juniper berries, butcher’s broom, cornsilk. Be prepared to use ex- tra paper padding in underwear to help catch the extra urine output. After the blood pressure comes up to 115 (systolic) mental performance will be greatly improved. Use an electronic device to measure blood pressure, one with a finger cuff, not an arm cuff which can itself induce broken blood vessels. Purchase a device that needs no adjustments of any kind and has automatic cuff tension control (see mail order catalogs if your pharmacy does not have one). Clean up the air according to the general principles of environmental cleanup (see Four Clean-ups, page 409). Shower water puts a lot of chlorine into the bathroom air which then distributes itself through the rest of the house. Notice whether your elderly person goes into the bathroom in fair shape mentally but comes out confused, unreasonable. Figure out how long it should last and write the date for replacement on the outside of it for your own convenience. Washing hands and face in chlorinated water can give off enough chlorine to trigger a manic episode in a manic-depressive person. It should not be used while the elderly person is in the house and never for his or her laundry. The body makes tumors out of them in order to stop them from cutting through your tissue. Air filters may remove some of the toxic elements but by blowing the air (and dust) around vigorously the remaining toxins are made much more vicious in their effect. The noise of a filter motor and fumes it may put out itself adds misery to the simple job of breathing. Make sure all fragrances are removed from the air, even though family members “like” them. The lungs treat them like toxins to be coughed up or removed by the kidneys and immune system. People who must use fragrance should apply it outdoors to keep the indoor air less polluted. They were meant to be an exact shape and size to fit the most oxygen molecules onto them. What a relief for the bone marrow whose job it is to make red blood cells to have enough vitamin B12 again! Killing Ascaris twice a week by zapping and taking B12 lozenges (see Sources) is a better solution. Provide vodka yourself in a small pocket flask or 70% grain alcohol for this purpose. Unfortunately, the shot itself may contain traces of this harmful solvent—take a sample home for testing. Most regular anemias, including low iron levels, are associ- ated with hookworm infestations. It is not wise to take iron pills, even if they do raise hemoglobin lev- els, except in life-threatening situations. Iron in the form of pills is too easily snatched up by bacteria who also need it, making them more virulent to the body. Use grain alcohol rinse in the bathroom to kill Ascaris and hookworm eggs under fin- gernails. It takes nutritious food to build the blood back up to its normal hemoglobin level. Eggs and meats (all very well cooked) are the richest sources of iron and other minerals used in blood building. B and other vitamins are also involved and can be6 given as a B-complex (see Sources). Do not use black strap molasses as an iron source, or any molasses, since it contains toxic molds. However, I have not tested enough molasses for solvents and you cannot risk these. Now it has molds which cause platelet destruction, (purpuric spots) internal bleeding, and immune failure. Acid levels operate the latching system that decides whether oxygen will be attached to hemoglobin or let go! Acid was meant to be removed from the blood and loaded into the stomach at mealtime for digestion. If the body acid level is too high, help the kidneys excrete it by adding more water to the diet and more minerals to neutralize the acid. In this case, filter it with a small all-carbon unit that is changed right on sched- ule.

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For example order bentyl 10mg fast delivery, a person may test positive to aluminum silicate but show no aluminum in the white blood cells generic bentyl 10 mg amex. Sometimes discount bentyl 10 mg fast delivery, toxic elements are present in an organ, but are not present in the white blood cells. Ideally, a test would search all your or- gans, but this would be too time-consuming for my technology. This is because I never could find them present in the white blood cells, and I finally gave up searching for them. The most important thing to do after finding the toxic ele- ment in your body is to track down the source of it in your en- vironment. To test a pill or food, it is put in a plastic bag with filtered water added and tested the same way as the elements. Fine particles and gas mole- cules stick to dust in the air and fall into the water. Alternatively, a dust sample can be obtained by wiping the kitchen table or counter with a dampened piece of paper towel, two inches by two inches square. Most of them were obtained as Atomic Absorption Standard Solutions and are, therefore, very pure. They were stored in ½ ounce brown glass bottles with bakelite caps and permanently sealed with plastic film since testing did not require them to be opened. The exact concentration and the solubility characteristics are not important in this qualitative test. The main sources of these substances in our environment are given beside each item. Tellurium tooth fillings Terbium pollutant in pills Thallium acetate pollutant in mercury tooth fillings Thorium nitrate earth (dust) Thulium pollutant in some brands of vitamin C Tin toothpaste Titanium tooth fillings, body powder Tungsten electric water heater, toaster, hair curler Uranium acetate earth (dust) Urethane plastic teeth and dental resins Vanadium pentoxide gas leak in home, dental metal and dental plastic Ytterbium pollutant in pills Yttrium pollutant in pills Zirconium deodorant, toothpaste Elements like erbium and terbium have only recently come into use. There are 15 of them: lanthanum cerium, praseodymium, neodymium, samarium, europium, gadolinium, terbium, dysprosium, holmium, erbium, thulium, ytterbium, lutetium, and promethium. You can see from the case histories that we have lanthanides in our bodies, widely distributed. They are in our processed foods, in our supplements and medicines, and in our tooth fillings, whether plastic or metal. Is it a good idea for the human species to eat elements that we know nothing about? It should be possible to make a test strip that detects Rare Earth Elements as a group, since they have very similar properties. Government agencies should sup- ply them because it is in the public interest to keep society healthy. The public must not rely on reassurances by industry or government that food or body products are pure and safe. Solvents This is a list of all the solvents in the test together with the main source of them in our environment. These are chemicals, very pure, obtained from chemical supply companies, unless otherwise stated. Most of them are on slides, some are preserved cultures, all are purchased from biological supply companies (see Sources). Stone Comment Cysteine sulfur containing Cystine sulfur containing Dicalcium phosphate also causes common arthritis, hardening of arteries, spurs Monocalcium phosphate also causes common arthritis, hardening of arteries, spurs Tri-calcium phosphate also causes common arthritis, hardening of arteries, spurs Oxalate cause of lower back pain 95% of the time Uric acid also causes gout and arthritis Stones begin as tiny crystals, much too tiny to be seen by X- ray. They get deposited in the tiny tubules that make up the kidney, partly blocking the flow of liquid. As more crystals are formed, they be- gin to deposit in other organs, too, such as joints of feet and hands and the interior of arteries, causing hardening. Bacteria find these nutritious deposits, and ultimately, it is they and their refuse that cause pain. By causing partial blockage, these deposits prevent heavy metals from passing out through the kidneys. Mercury and nickel from tooth fillings are constantly being excreted through the kidney tubules. But as the kidneys get older and the deluge of toxic compounds gets higher, the toxins just attach them- selves to the deposits already there. It is a combination of herbs and nutritional substances, which, together, can dissolve all the 7 kinds of stones. Persons with a history of kidney stones, who know they have large stones, are also told to drink half a dose daily. Persons with sensitive stomachs may not tolerate these herbs; they could try killing their parasites first. It is fair to say that we all develop kidney stones; although they may remain very tiny and cause no pain. Blood Tests There are many blood tests that can be performed by a clinical laboratory. In the case histories I do not list all that were done (I typically ordered about 60), but only the ones that I thought significant. Body waste - controlled by kidneys and liver - too low, due to malonic acid, too high due to bacterial invasion. Cholesterol High amounts are indicative of blocked bile ducts in the liver, preventing excretion. Creatinine Body waste derived from our muscles - controlled by kid- neys and should be 0.

In athletic events discount 10 mg bentyl overnight delivery, long-standing records fell after amphetamines became available; speculation exists about whether diet and training were solely re- sponsible for a sudden burst of feats that no human had ever been able to perform order bentyl 10mg with mastercard. The wartime habit of using amphetamines to increase worker productivity made a peacetime transition in Japan and Sweden order bentyl 10 mg, where amphetamine abuse became a major concern in the 1950s. In the United States concern also grew with publicity about dangerous ingestion of these tablets by exhausted long- haul truckers. Members of New York’s fashionable “beau- tiful people” who used the drug were called the Benzedrine Set, and in Hol- lywood the tablets were called “Dolls. Outside the jails, crimes against property and persons were attributed to in- halers. Although restrictions governed sales of inhalers, they were officially non- prescription and priced under a dollar. The original manufacturer of amphetamine sulfate, along with competitors who produced the drug, tried to mix substances into inhalers that would thwart misuse. Hearing about alleged results of amphetamine abuse may have been exotic entertainment for most Americans, but they became alarmed by stories of pleasure usage by youths. Inhaler parties by teenagers became so notorious around Kansas City, Missouri, that a U. In the 1960s amphetamines received publicity as an element of the hippie pharmacopeia, with that association promoting disdain for a type of drug that had originally been welcomed by ordinary people. Illicit usage of injectable amphetamines became known as “speeding,” a reference to hyperactivity re- 14 The Encyclopedia of Addictive Drugs sulting from such needle work. Varieties available from drugstores de- clined, as did physicians’ ability to prescribe them. The 31 million prescrip- tions made in 1967 comprise a number never equaled since. Amphetamines stimulate the central nervous system (the brain and associ- ated anatomy). At one time evidence of damage to nerve cells was not clear enough to satisfy some credible researchers that such a hazard exists, despite any theoretical reasons for concern, but in the 1990s evidence was becoming persuasive. Nonprescription sales have long been banned in Sweden due to kidney system damage, and amphetamines are suspects in liver dam- age involving hepatitis. To a lesser extent, amphetamines help to open air path- ways in the lungs while stimulating breathing. A less welcome action can be promotion of muscle and vocal tics, causing users to jerk or cry out uncon- trollably. This problem, however, applies more to persons already troubled by tic afflictions than to persons having no such disability. Libido can also change, perhaps involving a stronger sex drive, perhaps involving impotence. Vitamin C and fruit juices lessen amphetamine effects, while common stomach antacid prep- arations increase them. Amphetamines can boost actions of widely prescribed psychological medicines called tricyclic antidepressants, an interaction also affecting heart action. That release can raise blood pressure enough to create headaches while simultaneously raising body temperature enough to kill a person. Lithium carbonate, a medicine used to control manic behavior, can reduce central nervous stimulation caused by amphetamines. In addition to results that many persons would find attractive (noted above), users can also become grouchy, jittery, unable to sleep, and suspicious of other persons. Someone highly intoxicated on am- phetamines can act mixed up and pugnacious, be frightened, and have hal- lucinations. This type of drug promotes impulsive actions—not a good consequence if a user is angry and afraid. Overindulgence can leave a person tired, peevish, confused, and depressed when the drug session ends. Over time some abusers feel a need to increase dosages in order to get the Drug Types 15 same effects that lower doses once provided. That suggests an abuser has developed “tolerance” to the drug, a classic component of addiction. In con- trast to abusers of other drugs, amphetamine abusers commonly fight toler- ance not by gradually increasing their dose but by alternating between periods of little use and binges of massive use, a practice promoting inconsistent be- havior that can bewilder acquaintances. Despite all of this, into the 1980s am- phetamines were described as not addictive. Although amphetamines have a long history and widespread usage, their potential for causing cancer is unknown; necessary animal experiments had not been conducted as the twentieth century closed. Abnormal fetal devel- opment has occurred in mice receiving over 40 times the maximum safe hu- man dose, but normal development of offspring has occurred despite administration of 12. Standard medical advice cautions pregnant women against using the drug without first discussing the issue with a physician. Some stud- ies claim to find that children born of women who abused amphetamines during pregnancy will have long-term problems with personality and intelli- gence—but these same women abused other drugs as well; some were dis- pleased about their pregnancies; and about 80% of children in one study had been taken away from the mothers and put into foster homes. Babies from women who abused amphetamines during pregnancy can exhibit anxiety and physical dis- comfort suggesting dependence and withdrawal. We know that excessive use by a pregnant woman can promote premature birth and reduce a newborn’s weight. Genetic predisposition appears to influence how much this type of drug will affect fetal development. Amphetamines enter human milk and can reach levels three to seven times higher than shown in maternal blood, so nursing mothers can be dosing their infants.