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Latanoprost was the frst prostaglandin drug indicated Alprostadil is given by continuous intravenous infusion to for the treatment of glaucoma order lumigan us treatment hypothyroidism. It is administered topically maintain the patency of the ductus arteriosus in neonates as eyedrops and is used to treat open-angle glaucoma that is who are awaiting surgery for some types of congenital heart resistant to other pharmacologic treatments purchase 3ml lumigan amex medicine you can overdose on. It can alter the color of the iris and cause a permanent (coarctation of the aorta and hypoplastic left ventricle) purchase cheap lisinopril line. For this oped for the reduction of intraocular pressure in patients purpose, the drug is injected into the cavernosa of the with open-angle glaucoma or ocular hypertension are bima­ penis, or slow-release pellets or drops of cream are inserted toprost and travoprost. Given the rise in the use of oral drugs to (prostacyclin) that is used to treat pulmonary arterial treat erectile dysfunction, for example, sildenafl (Viagra), hypertension. Misoprostol acts locally on the gastrointestinal mucosa a continuous subcutaneous infusion via a self-inserted sub- to exert a cytoprotective effect by inhibiting gastric acid cutaneous catheter using a microinfusion pump designed secretion and by increasing bicarbonate secretion from specifcally for subcutaneous drug delivery. The two main and in women of childbearing age who are not using hor- groups of eicosanoids are prostaglandins and leukot- monal contraceptives. Alprostadil is used to maintain patency of the although the clinical impact of such high selectivity is not ductus arteriosus in neonates awaiting surgery for known. It is also used to treat erectile dysfunc- hepatic function and enzyme level monitoring. As sildenafl inhibits phosphodiester- ripening before induction of labor and for evacuation ase type 5, an increase of cyclic guanosine monophosphate of the uterine contents. Latanoprost and other prosta- glandin antiglaucoma drugs that increase the aqueous humor outfow are used to treat glaucoma. These substances usually act tan, endothelin-1 receptor antagonists, and a new on the same tissue in which they are produced. Cetirizine, desloratadine, and loratadine also (A) selectivity at H1 receptors lack cardiac effects. Answer E, indications for use, is not correct tacyclin) and is used for the treatment of pulmonary because both types of agents are used for allergies. This type of receptor for sero- (A) misoprostol tonin is famous as the only biogenic amine receptor that (B) alprostadil is ionotropic. The other answers, A through C and E, are (C) epoprostenol all types of metabotropic receptors, also known as G (D) treprostinil protein–coupled receptors. Answer D, treprostinil, is also used for pulmonary hypertension but is a stable analogue of prostacyclin, not the same as prostacyclin itself. The answer is B: ocular hypertension and open-angle antihistamine with higher antiemetic activity than other glaucoma. Answer C, ocular albinism, might make Answer D, diphenhydramine, has antiemetic effects but sense considering the bizarre adverse effect of latanoprost is more sedating than meclizine and thus is not the ideal in darkening the color of the iris but is not approved by treatment agent. Food and Drug Administration as an indication diphenhydramine and 8-chlorotheophylline, is used for for latanoprost.

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A: It is an inherited disorder in which there is impairment of haemoglobin production due to partial or complete failure to synthesize the specifc type of globin chain (structure of globin chain is normal) order lumigan in india medicine abuse. Thalassaemia intermedia order lumigan with a visa symptoms women heart attack, characterized by the combination of homozygous mild b-thalassaemia plus a-thalassaemia order quibron-t with a mastercard. It is usually less severe and does not require blood transfusion as anaemia is mild to moderate. Iron containing drugs and diet are avoided (iron can only be given if there is defciency). Oral iron chelating agents such as deferiprone (75 mg/kg in 2 to 4 divided doses) or deferasirox may be used. A: As follows: • Hypersplenism: As suggested by repeated transfusion in a short interval. A: As follows: • Repeated transfusion may cause haemosiderosis (usually when more than 30 to 50 L of blood is transfused). If b thalassaemia is found in the foetus, then termination of pregnancy is indicated. Main differences are: • Anaemia is more marked in iron defciency and relatively less in thalassaemia minor. A: As follows: • Bleeding from any site (haemorrhoid, haematemesis, melaena, gum bleeding, any bleeding disorder, injury). It means eating of unusual items such as earth, coal, ice or some foods in excess like tomato, sour foods. A: As follows: • Bleeding due to any cause: Commonest from gastrointestinal tract (haemorrhoid, colorectal carcinoma, carcinoma stomach, diverticulitis, angiodysplasia), menorrhagia in female. Test to fnd out the causes (according to the history and suspicion of cause): • Stool for ova or cyst of hookworm, occult blood test. Bone marrow to see stainable iron (by Prussian blue shows empty stain): not a routine, may be done in some cases. A: Common symptoms of anaemia with brittle nails, spoon shaped nails (koilonychia), atrophy of the papillae of the tongue, angular stomatitis, brittle hair, a syndrome of dysphagia and glossitis (Plummer Vinson or Paterson Brown Kelly syndrome). A: As follows: • If severe anaemia or haemoglobin is low: blood transfusion (packed cell). To be given for 3 to 6 months after haemoglobin is normal to replenish the iron store. A: Anaemia may be defned as a clinical condition, characterized by reduced level of haemoglobin according to the age and sex of the individual. Causes are: • Acute: Trauma, postpartum bleeding, haematemesis, melaena, epistaxis. A: When both microcytes and macrocytes are found, this is called dimorphic anaemia. Malaria, chronic haemolytic anaemia, acute infection, leukaemia, lymphoma, portal hypertension 5.

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Afer pushing for 90 minutes buy lumigan with visa treatment using drugs, ventouse delivery was performed for maternal exhaustion and the baby was born in good condition effective lumigan 3ml symptoms 13dpo. The parents were extremely anxious afer looking at the large sof tissue swelling of the fetal scalp at the ventouse cup application area 60caps serpina with amex. Open airway and give 3 infation breaths Instructions For each of the scenarios below, choose the single most immediate plan of action from the above list of options. A 30-year-old nulliparous woman with no known medical problems had an uncomplicated low-risk pregnancy and went in to spontaneous labour at 39 weeks’ gestation. She had good progress in labour and has just delivered a male neonate, who cried at birth, pink, breathing and has good tone. A 33-year-old para 2 woman just delivered a male infant who is blue, foppy at birth with poor respiratory efort and a slow heart rate. The umbilical cord is clamped and cut immediately and placed on the warm resuscitaire afer drying and wrapping with warm towels. A 33-year-old para 2 woman just delivered a male infant who is blue, foppy at birth with poor respiratory efort and a slow heart rate. The umbilical cord is clamped and cut immediately and placed on the warm resuscitaire afer drying and wrapping with warm towels. Antibiotics to the newborn Instructions Each clinical scenario described below tests knowledge about management of a woman in labour and/or postnatally. For each case, choose the single most appropriate course of action from the above list. A 36-year-old woman in her second pregnancy is admitted in early labour with ruptured membranes. A 34-year-old woman is seen in the antenatal clinic with a history of lower abdominal pain for the past 4 days. Gram-negative bacteria Instructions Each clinical scenario described below tests knowledge about the most probable cause of sepsis in a woman postnatally. A 36-year-old woman who had an emergency caesarean section 5 days ago has presented feeling unwell with lower abdominal pain. She is seen by the community midwife, who notices that she looks unwell and checks her temperature, which records 39. The woman is sufering from abdominal pain and loin pain, and was treated for urinary tract infection while pregnant. A 38-year-old woman is brought by ambulance in a state of shock, with sudden-onset lower abdominal pain.

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A: Delayed resolution means when the physical signs persist for more than 2 weeks and radiological features persist for more than 4 weeks after antibiotic therapy order lumigan american express medicine effexor. A: As follows: • Bronchial obstruction (bronchial carcinoma purchase lumigan without a prescription treatment 7th feb cardiff, adenoma purchase triamterene with mastercard, foreign body). Score 1 point for each of the following features: • Confusion (mini mental score 8 or less or new disorientation in person, place or time). Other markers of severity of pneumonia: • Chest X-ray: More than one lobe involved. A: To discharge, the patient should be clinically stable with no more than one of the following clinical signs: • Temperature. A: New episode of pneumonia occurring at least 2 days after admission in the hospital is called nosocomial pneumonia. If it occurs later (late onset), common organisms are: • Gram-negative Enterobacteriaceae (Escherichia coli, Klebsiella and Pseudomonas aeruginosa) are common. A: After admission in hospital, associated with the predisposing factors, if the patient develops cough with purulent sputum, fever associated with radiological infltrate, leucocytosis or leucopenia, un- explained increase in oxygen requirement. A: It is defned as ‘wide spread diffuse patchy alveolar opacity associated with bronchial and bron- chiolar infammation, often affecting both lower lobes’. In children, it occurs as a complication of measles or whooping cough and in elderly, as a complication following bronchitis or infuenza. A: Typical pneumonia is characterized by high temperature with cough, pleuritic chest pain, features of consolidation, caused by S. B: Remember the following points: • The term atypical pneumonia is abandoned as the clinical and radiological picture does not differ suffciently from one organism to another. A: It is common in children and young adults, usually associated with headache, malaise, myalgia and severe cough. A: 3 patterns of Legionnaires’ disease may occur: • Outbreak of infection is usually associated with contaminated water supply or cooling system, or from stagnant water in cistern or shower head. Features are: • Initially viral-like illness with high fever, chill and rigor, malaise, myalgia and headache, dry cough, later productive and purulent. Treatment: • Clarithromycin 500 mg twice daily orally or I/V or Erythromycin 500 mg 6 hourly orally or I/V for 7 to 10 days. Systemic features High-grade fever with chill and Low-grade fever, headache and rigor. Less common (respiratory complains are less common) and constitutional symptoms are more.