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1% 0. 05% 0. 05% 0. 025% four times daily once daily every 4–6 hours four times daily twice daily four times daily twice daily twice daily every 8–12 hours 3 yo or more 2 yo or more 4 yo or more 2 yo or more 3 yo or more 3 yo or more 3 yo or more 2 yo or more 3 yo or more 0. 1%/0. 2% 1. 5% 0. 5% 0. 2% twice daily/once daily twice daily four times daily four times daily 3 yo or more 2 yo or more 3 yo or more adult chapter 63  |  allergic rhinitis  959 table 63–9  routine approach to therapy of ar all patients should practice avoidance of identified allergens mild intermittent   first line.   oral antihistamine (otc, initially. Preferably second generation)   adjunctive/secondary (may use more than one. No specific order intended).    Add nasal saline (eg, as irrigation)   consider intranasal cromolyn, especially preexposure for episodic ar    consider otc incs for refractory symptoms   consider intraocular medications, as needed for ocular symptoms (see table 63–8)    consider otc oral decongestant for nasal congestion   consider otc intranasal decongestant for refractory nasal congestion (not > 3 days)    consider prescription therapy for inadequate response (see below)   possibly consider referral for immunotherapy persistent or moderate–severe   first line.    Intranasal corticosteroid (could try otc product first)    add oral antihistamine for possible additional benefit if necessary   adjunctive/secondary (may use more than one).    Add nasal saline (eg, as irrigation)   consider intraocular medications, as needed for ocular symptoms (see table 63–8)    consider otc oral decongestant for nasal congestion   consider short-term intranasal decongestant for refractory nasal congestion   consider replacement of one first-line agent, if poorly tolerated, with montelukast    consider ipratropium for inadequately controlled rhinorrhea    consider intranasal antihistamine   consider combination intranasal antihistamine with corticosteroid   consider referral for immunotherapy episodic (no order of preference intended)   oral antihistamine (otc, initially. Preferably second generation)  consider addition of or replacement with intranasal cromolyn (otc) or intranasal antihistamine or intranasal corticosteroid special situations (children, pregnant women, elderly, ocular symptoms)   see special populations section of text from refs. 2,5–10,12,14,25,29,33, and 34. Table 63–10  relative efficacy (semiquantitative) by classes of agents for specific symptoms of allergic rhinitis drug class intranasal corticosteroids oral antihistaminesa intranasal antihistamines oral decongestantsa intranasal decongestantsa,b oral leukotriene antagonist intranasal mast cell stabilizera intranasal antimuscarinic nasal congestion 6 2 3 3 6 4 3 0 sneezing rhinorrhea nasal itch 6 4 4 0 0 1 3 0 6 4 4 0 0 4 3 5 5 6 5 0 0 1 3 0 ocular symptoms 4 4 0 0 0 4 2 0 note.

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J clin endocrinol metab. 2006. 91:2592–2599. 19. Hennessey jv. Levothyroxine a new drug?. Since when?. How could that be?. Thyroid. 2003;13:279–282. 694  section 7  |  endocrinologic disorders 20.

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If pulmonary maturity is not certain, amniotic fluid can be obtained before delivery through amniocentesis. Fluid may be evaluated by the lis ratio, fim testing, or spc content (see iy.A. And chap. 33). B. Treatment 1. After the infant is hom, assessment is made on the basis of apgar scores to determine the need for any resuscitative efforts (see chap. 5). The infant should be dried and placed under a warmer. The airway is bulb suctioned for mucus, but the stomach is not aspirated because of the risk of reflex. Bradycardia and apnea from pharyngeal stimulation in the first 5 minutes of life.

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Helbling-leclerc a, bonne g, schwartz k. Emery-drei uss muscular dystrophy. Eur j human genet. 2002;10(3):157-161. 22. Iannaccone s , castro d. Congenital muscular dystrophies and congenital myopathies. Continuum (minneapolis minn). 2013;19(6 muscle disease):1509-1534. 23. Jackson ce, barohn rj. A pattern recognition approach to myopathy. Continuum (minneap minn). 2013;19(6):1674-1697. 24. Koneczny i, cossins j, vincent a. He role o musclespeci ic tyrosine kinase (musk) and mystery o musk myasthenia gravis. J anat. 2014;224(1):29-35. 25. Kress jp, hall jb. Icu-acquired weakness and recovery rom critical illness. N engl j med. 2014;370(17):1626-1635. 708 chapter 42 26. Kusner ll, puwanant a, kaminski hj. Ocular myasthenia.