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write my essay i want an a 5–2 hypokalemia and other furosemide (lasix) 20–80 electrolyte imbalances torsemide (demadex) 2. 5–10 ethacrynic acid (edecrin) 25–100 potassium-sparing aldosterone antagonists amiloride (midamor) 5–10 hyperkalemia triamterene (dyrenium) 50–100 gynecomastia spironolactone (aldactone) (spironolactone) 25–100 potassium-sparing eplerenone (inspra) 50–100 diuretics may enhance hyperkalemic effects of drug therapies (eg, ace inhibitor, aldosterone antagonist) β-blocker cardioselective nonselective mixed α- and β-blocker ccb nondihydropyridines dihydropyridines atenolol (tenormin) 25–100 bisoprolol (zebeta) 2. 5–10 metoprolol tartrate (lopressor) 50–100 metoprolol succinate (toprol xl) 25–100 bradycardia heart block heart failure dyspnea, bronchospasm fatigue, dizziness, lethargy, depression nadolol (corgard) 20–120 hyper/hypoglycemia, nebivolol (bystolic) 5–40 hyperkalemia, propranolol (inderal) 40–160 hyperlipidemia propranolol long-acting (inderal la, innopran xl) 60–180 timolol (blocadren) 20–60 carvedilol (coreg) 12. 5–50 carvedilol cr (coreg cr) 20–80 labetalol (trandate) 200–800 diltiazem long-acting (cardizem sr, cardizem cd, others) 180–420 verapamil sustained-release (calan sr, isoptin sr, verelan) 120–360 amlodipine (norvasc) 2. 5–10 felodipine (plendil) 2. 5–10 isradipine sr (dynacirc sr) 1. 25–10 nicardipine sr (cardene sr) 60–120 nifedipine long-acting (adalat cc, procardia xl) 30–60 nisoldipine (sular) 10–40 bradycardia, heart block (nondihydropyridines) constipation (nondihydropyridines) peripheral edema, headache, flushing gingival hyperplasia (dihydropyridines) reflex tachycardia (dihydropyridines) caution with heart rate less than 60 and respiratory disease selectivity of β1 agents is diminished at higher doses abrupt discontinuation may cause rebound hypertension may mask signs/symptoms of hypoglycaemia in diabetic patients contraindicated in hypersensitivity, sinus node dysfunction or severe sinus bradycardia (in the absence of a pacemaker), heart block (greater than first-degree), cardiogenic shock, acute decompensated heart failure caution with heart rate < 60 (verapamil, diltiazem) use caution in concomitant use with β-blocker. May potentiate heart block extended-release formulations are preferred for onceor twice-daily medication administration contraindicated in hypersensitivity, sinus node dysfunction, or severe sinus bradycardia (in the absence of a pacemaker) (nondihydropyridines), heart block (greater than first degree) in the absence of a pacemaker [nondihydropyridines], atrial fibrillation/flutter associated with accessory bypass tract (nondihydropyridines), reduced ejection fraction (most ccbs except amlodipine) (continued ) chapter 5  |  hypertension  55 table 5–6  commonly used oral antihypertensive drugs by pharmacologic class19,26 (continued ) class ace inhibitors arbs direct renin inhibitors drug name and usual oral dosage range (mg/day) benazepril (lotensin) 10–40 captopril (capoten) 25–100 enalapril (vasotec) 2. 5–40 fosinopril (monopril) 10–40 lisinopril (prinivil, zestril) 5–40 moexipril (univasc) 7. 5–30 perindopril (aceon) 4–8 quinapril (accupril) 10–80 ramipril (altace) 2. 5–20 trandolapril (mavik) 1–4 azilsartan (edarbi) 40–80 candesartan (atacand) 8–32 eprosartan (teveten) 400–800 irbesartan (avapro) 150–300 losartan (cozaar) 25–100 olmesartan (benicar) 20–40 telmisartan (micardis) 20–80 valsartan (diovan) 80–320 aliskiren (tekturna) 150–300 central α-2 agonists methyldopa 250–1000 clonidine (catapres) 0. 1–0. 8 clonidine patch (catapres tts) 0. 1–0. 3 guanabenz 4–32 guanfacine 1–2 α-1 blockers doxazosin (cardura) 1–16 prazosin (minipress) 2–20 terazosin (hytrin) 1–20 isosorbide dinitrate 20 mg and hydralazine 37. 5 (bidil) 1–2 tablets three times a day hydralazine (apresoline) 25–100 minoxidil (loniten) 2. 5–80 reserpine 0. 05–0. 25 direct vasodilator peripheral sympathetic inhibitors select adverse events cough hyperkalemia renal insufficiency angioedema hyperkalemia renal function deterioration angioedema hypotension/syncope hyperkalemia hypotension transient sedation initially hepatotoxicity, hemolytic anemia, peripheral edema (methyldopa) orthostatic hypotension (methyldopa, clonidine) dry mouth, muscle weakness (clonidine) syncope, dizziness, palpitations, orthostatic hypotension edema, hypertrichosis (minoxidil) tachycardia lupus-like syndrome (hydralazine) mental depression orthostatic hypotension nasal congestion, fluid retention, peripheral edema diarrhea, increased gastric secretion commentsa monitor electrolytes (ie, serum potassium) monitor renal function initial dose may be reduced in renal impairment, the elderly, patients who are volume depleted or maintained on diuretic therapy use with caution in patients with baseline hyperkalemia contraindicated in pregnancy and hypersensitivity, bilateral renal artery stenosis or unilateral renal artery stenosis in a solitary functional kidney above comments to ace inhibitors also apply to arbs use caution in patients with severe renal impairment and in patients with deteriorating renal function or renal artery stenosis, both bi- and unilateral contraindicated in combination with ace-is or arbs in patients with diabetes first-line agent in pregnancy (methyldopa) tolerance may occur 2–3 months after initiation of methyldopa. Increase dose or add diuretic contraindications include hypersensitivity, concurrent use of mao inhibitor (methyldopa), hepatic disease [methyldopa], pheochromocytoma (methyldopa) contraindicated in hypersensitivity give minoxidil with diuretic and β-blocker to mitigate side effects contraindicated in hypersensitivity, pheochromocytoma (minoxidil), increased intracranial pressure [isosorbide dinitrate + hydralazine] contraindications include hypersensitivity, peptic ulcer disease or ulcerative colitis, history of mental depression or electroconvulsive therapy ace, angiotensin-converting enzyme.

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http://manila.lpu.edu.ph/about.php?test=advanced-accounting-homework-help advanced accounting homework help Pathology used a new molecular test with modest sensitivity (ie, 80%) but very high specificity (ie, 99%) on the tissue sample to further analyze the radiographic abnormality. Although the test was negative, the tissue findings were consistent with atypical hyperplasia. Summarize what would be appropriate to tell this 62-year-old woman regarding the needle aspirate findings. Formulate a follow-up plan for this patient. Finally, the issue regarding the role of pharmacogenomics in tailoring tamoxifen therapy is both persuasive and controversial. 26,27 as such, routine screening for germline variants of cyp2d6 has not been endorsed. Nonetheless, drugs that do inhibit the enzyme should be avoided if possible. In postmenopausal women, the use of adjuvant ais has been studied in three different ways. (a) direct comparison with tamoxifen, (b) after 5 years of tamoxifen therapy, and (c) sequentially after 2 to 3 years of tamoxifen. 28 based on the positive results of several studies, expert panels strongly recommend ais for postmenopausal women with hormone-dependent breast cancer. 29 although 5 years of adjuvant ai therapy is considered standard, there is also strong support for continuing hormonal therapy (beyond 5 years) if tamoxifen was used initially, especially in patients with high-risk features such as node-positive disease. Further support of extended endocrine therapy that includes an ai has been noted previously. 25 while these recommendations can be applied to most postmenopausal patients, tamoxifen can still be used first line or as an alternative in those who do not tolerate ai therapy. Ai therapy is associated with several adverse effects, including hypercholesterolemia, atherosclerotic cardiovascular disease, and skeletal-related events. The three available ais are anastrozole, letrozole, and exemestane (table 89–7). Locally advanced breast cancer (stage iii) treatment desired outcome locally advanced breast cancer is defined by tumors greater than or equal to 5 cm and a high likelihood of nodal involvement in the absence of demonstrable distant metastasis. A wide variety of clinical scenarios can be seen within this group of patients, including tumors that have been neglected for a period of time and inflammatory breast cancer, which is a unique clinical entity. Inflammatory breast cancer has, at times, been misdiagnosed as cellulitis. Treatment of stage iii breast cancer consists of all modalities used in the management of early breast cancer. The goal of therapy is to achieve optimal systemic control of the disease. However, despite treatment, systemic relapse and death are common even when local-regional control is accomplished. One major difference related to the systemic therapies is the use of chemotherapy plus ant-her2 therapy (if indicated) or hormonal therapy before surgery. This approach, referred to as neoadjuvant therapy, can render initially inoperable tumors resectable, even with the possibility of bcs.

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http://projects.csail.mit.edu/courseware/?term=reflective-essay-about-yourself reflective essay about yourself The p wave on the ecg represents atrial depolarization (atrial depolarization is not depicted in the action potential shown in figure 9–2, which shows only viagra side effects in marathi the ventricular action potential). Phase 0 of the action potential corresponds to the qrs complex. Therefore, the qrs complex on the ecg is a noninvasive representation of ventricular depolarization. The t wave on the ecg corresponds to phase 3 ventricular repolarization. The interval from the beginning of the q wave to the end of the t wave, known as the qt interval, is used as a noninvasive marker of ventricular repolarization time. Atrial repolarization is not visible on the ecg because it occurs during ventricular depolarization and is obscured by the qrs complex. Several ecg intervals and durations are routinely measured. The pr interval represents the time of conduction of impulses from the atria to the ventricles through the av node. The normal pr interval in adults is 0. 12 to 0. 2 seconds. The qrs duration represents the time required for ventricular depolarization, which is normally 0. 08 to 0. 12 seconds in adults. The qt interval, measuring 0. 32 to 0.

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http://ccsa.edu.sv/study.php?online=thesis-format-wikipedia thesis format wikipedia ) therapy. Both 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitors (hmg-coa reductase inhibitors or statins) and angiotensin-converting enzyme (ace) inhibitors are believed to provide vasculoprotective effects (eg, anti-inflammatory effects, antiplatelet effects, improvement in endothelial function, and/ or improvement in arterial compliance and tone). Together with aspirin, these drugs have been shown to reduce the risk of acute coronary events and death in patients with ihd. In select patients with ihd (following hospitalization for acs ± pci and/ or following intracoronary stent placement), dual antiplatelet therapy with aspirin and a p2y12 antagonist has also been shown to reduce ischemic events. Angiotensin receptor blockers (arbs) may be used in patients who cannot tolerate ace inhibitors because of side effects (eg, chronic cough). Β-blockers have been shown to decrease morbidity and improve survival in patients who have suffered an mi. Therapies to alleviate and prevent angina are aimed at improving the balance between myocardial oxygen demand and supply. Drug treatment is primarily aimed at reducing oxygen demand whereas revascularization by pci and coronary artery bypass graft (cabg) surgery effectively restore coronary blood flow, improving myocardial oxygen supply. Coronary revascularization is generally reserved for patients with symptoms despite optimal medical therapy and those hospitalized for acs. Adverse treatment effects can be averted by avoiding drug interactions and the use of drugs that may have unfavorable effects on comorbid diseases. Appropriate drug dosing and monitoring reduces the risk for adverse treatment effects. Drugs should be initiated in low doses, with careful up-titration as necessary to control symptoms of angina and cardiovascular risk factors. Lifestyle modifications lifestyle modifications (smoking cessation, avoidance of secondhand smoke, dietary modifications, increased physical activity, and weight loss) reduce cardiovascular risk factors, slow the progression of ihd, and decrease the risk for ihd-related complications. Cigarette smoking is the single most preventable 98  section 1  |  cardiovascular disorders ischemic heart disease/chronic stable angina lipid-lowering therapy ldl elevated. Statin add p2y12 antagonist for ≥ 1–12 monthsa depending on stent type lifestyle modifications diet, exercise, weight loss, smoking cessation + recent acs?. Bms?. Des?. Aspirin 81–162 mg daily ir nitrate ntg sl or spray + contraindication?. Intolerance?. Clopidogrel 75 mg daily diabetes mellitus, hypertension, and/or chronic kidney disease?. Yes no consider ace-i or arb + β-blocker prior myocardial infarction and/or lv dysfunction?. Yes consider ace-i or arb no β-blocker (unless contraindicated) alternatives. ⇑bp. Ccb ⇓ bp or ⇓ hr. La nitrate ineffective?. No prinzmetal or variant angina?. Yes ⇑ bp. Ccb ⇓ bp. La nitrate intolerant?. ⇑ bp. Add ccb or β-blocker (if not 1st drug) ⇓ bp or ⇓ hr. Add la nitrate or ranolazine refractory symptoms?. Consider triple therapy β-blocker + ccb + la nitrate or ranolazine consider revascularization (eg, pci or cabg surgery) figure 7–5. The treatment algorithm for ischemic heart disease.

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