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By Y. Gambal. Mount Ida College. 2019.

One way that we perceive the emotions of others is through theirnonverbal communication purchase 100mg viagra soft tabs visa, that is generic viagra soft tabs 100mg mastercard, communication that does not involve words (Ambady & [16] Weisbuch discount viagra soft tabs 100 mg line, 2010; Anderson purchase viagra soft tabs 100 mg overnight delivery, 2007). Nonverbal communication includes our tone of voice, gait, posture, touch, and facial expressions, and we can often accurately detect the emotions that other people are experiencing through these channels. Body building, breast augmentation, weight loss, piercings, Expressions based on alterations to and tattoos are often used to appear more attractive to Body appearance our body others. Body positioning Expressions based on how our body A more “peno ‖ body position can denote liking; a faster and movement appears walking speed can communicate dominance. Behaviors and signs made with our The peace sign communicates liking; the “finger‖ Gestures hands or faces communicates disrespect. The variety of emotions that we Smiling or frowning and staring or avoiding looking at the express, or attempt to hide, through other can express liking or disliking, as well as dominance Facial expressions our face or submission. Clues to identity or emotions Pronunciation, accents, and dialect can be used to Paralanguage contained in our voices communicate identity and liking. Just as there is no “universal‖ spoken language, there is no universal nonverbal language. For instance, in the United States and many Western cultures we express disrespect by showing the middle finger (the “finger‖ or the “bird‖). But in Britain, Ireland, Australia and New Zealand, the “V‖ sign (made with back of the hand facing the recipient) serves a similar purpose. In countries where Spanish, Portuguese, or French are spoken, a gesture in which a fist is raised and the arm is slapped on the bicep is equivalent to the finger, and in Russia, Indonesia, Turkey, and China a sign in which the hand and fingers are curled and the thumb is thrust between the middle and index fingers is used for the same purpose. The face contains 43 different muscles that allow it to make more than 10,000 unique configurations and to express a wide variety of emotions. For example, happiness is expressed by smiles, which are created by two of the major muscles surrounding the mouth and the eyes, and anger is created by lowered brows and firmly pressed lips. The facial feedback hypothesis proposes that the movement of our facial muscles can trigger [17] corresponding emotions. Fritz Strack and his colleagues (1988) asked their research participants to hold a pen in their teeth (mimicking the facial action of a smile) or between their lips (similar to a frown), and then had them rate the funniness of a cartoon. They found that the cartoons were rated as more amusing when the pen was held in the “smiling‖ position—the subjective experience of emotion was intensified by the action of the facial muscles. These results, and others like them, show that our behaviors, including our facial expressions, are influenced by, but also influence our affect. And we may stand up straight because we are proud, but we are [18] proud because we are standing up straight (Stepper & Strack, 1993). They can be biological, such as hunger and thirst; personal, such as the motivation for achievement; or social, such as the motivation for acceptance and belonging. Consider the three theories of emotion that we have discussed and provide an example of a situation in which a person might experience each of the three proposed patterns of arousal and emotion. Describe a time when you used nonverbal behaviors to express your emotions or to detect the emotions of others. On the universality and cultural specificity of emotion recognition: A meta-analysis. The devil is in the deliberation: Thinking too much reduces preference consistency. Inhibiting and facilitating conditions of the human smile: A nonobtrusive test of the facial feedback hypothesis. And there is no emotional experience that has a more powerful influence on us than stress. Stress refers to the physiological responses that occur when an organism fails to respond appropriately to emotional or physical threats (Selye, [1] 1956). Survivors of hurricane Katrina had three times the rate of heart attacks than the national average in the years following the disaster, and this is probably due to the stress that the hurricane created (American [2] Medical Association, 2009). And people in New York City who lived nearer to the site of the 9/11 terrorist attacks reported experiencing more stress in the year following it than those who [3] lived farther away (Pulcino et al. It can also occur, and have a variety of negative outcomes, in our everyday lives. The Negative Effects of Stress The physiologist Hans Seyle (1907–1982) studied stress by examining how rats responded to being exposed to stressors such as extreme cold, infection, shock, or excessive exercise (Seyle, Attributed to Charles Stangor Saylor. Seyle found that regardless of the source of the stress, the rats experienced the same series of physiological changes as they suffered the prolonged stress. Seyle created the termgeneral adaptation syndrome to refer to the three distinct phases of physiological change that occur in response to long-term stress: alarm, resistance, and exhaustion (Figure 10. The initial arousal that accompanies stress is normally quite adaptive because it helps us respond to potentially dangerous events. This increased cortisol production exhausts the stress mechanism, leading to fatigue and depression. As a result, wounds heal more slowly when we are under stress, and we are more likely [8] to get cancer (Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002; Wells, 2006). Although heart disease is caused in part by genetic factors, as well as high blood pressure, high cholesterol, and cigarette smoking, it [9] is also caused by stress (Krantz & McCeney, 2002). The combination of increased blood flow and arterial constriction leads to increased blood pressure (hypertension), which can damage the heart muscle, leading to heart attack and death. Although these are probably not on your top-10 list of most common stressors, the stress that you experience in your [11] everyday life can also be taxing. Thomas Holmes and Richard Rahe (1967) developed a measure of some everyday life events that might lead to stress, and you can assess your own likely stress level by completing the measure in Table 10. You might want to pay particular attention to this score, because it can predict the likelihood that [12] you will get sick. Rahe and colleagues (1970) asked 2,500 members of the military to complete the rating scale and then assessed the health records of the soldiers over the following 6 months. The results were clear: The higher the scale score, the more likely the soldier was to end up in the hospital. Our everyday interactions with the environment that are essentially negative, known asdaily hassles, can also create stress as well as poorer health [13] outcomes (Hutchinson & Williams, 2007). Events that may seem rather trivial altogether, such as misplacing our keys, having to reboot our computer because it has frozen, being late for an assignment, or getting cut off by another car in rush-hour traffic, can produce stress [14] [15] (Fiksenbaum, Greenglass, & Eaton, 2006). Glaser (1985) found that medical students who were tested during, rather than several weeks before, their school examination periods showed lower immune system functioning. Other research has found that even more minor stressors, Attributed to Charles Stangor Saylor. Responses to Stress Not all people experience and respond to stress in the same way, and these differences can be [17] important. Rosenman (1974) were among the first to study the link between stress and heart disease. In their research they noticed that even though the partners in married couples often had similar lifestyles, diet, and exercise patterns, the husbands nevertheless generally had more heart disease than did the wives. As they tried to explain the difference, they focused on the personality characteristics of the partners, finding that the husbands were more likely than the wives to respond to stressors with negative emotions and hostility. Recent research has shown that the strongest predictor of a physiological stress response from daily hassles is the amount of negative emotion that they evoke. People who experience strong negative emotions as a result of everyday hassles, and who respond to stress with hostility experience more negative health outcomes than do those who react in a less negative way [18] (McIntyre, Korn, & Matsuo, 2008; Suls & Bunde, 2005). Williams and his colleagues [19] (2001) found that people who scored high on measures of anger were three times more likely to suffer from heart attacks in comparison to those who scored lower on anger. On average, men are more likely than are women to respond to stress by activating the fight-or- flight response, which is an emotional and behavioral reaction to stress that increases the readiness for action. The arousal that men experience when they are stressed leads them to either go on the attack, in an aggressive or revenging way, or else retreat as quickly as they can to safety from the stressor. The fight-or-flight response allows men to control the source of the stress if they think they can do so, or if that is not possible, it allows them to save face by leaving the situation. Rather, they [20] are more likely to take a tend-and-befriend response (Taylor et al. The tend-and- befriend response is a behavioral reaction to stress that involves activities designed to create social networks that provide protection from threats. This approach is also self-protective because it allows the individual to talk to others about her concerns, as well as to exchange resources, such as child care. The tend-and-befriend response is triggered in women by the release of the hormone ocytocin, which promotes affiliation. This may help explain why women, on average, have less heart disease and live longer than men. Managing Stress No matter how healthy and happy we are in our everyday lives, there are going to be times when we experience stress. But we do not need to throw up our hands in despair when things go wrong; rather, we can use our personal and social resources to help us. Perhaps the most common approach to dealing with negative affect is to attempt to suppress, avoid, or deny it. You probably know people who seem to be stressed, depressed, or anxious, but they cannot or will not see it in themselves. Perhaps you tried to talk to them about it, to get them to open up to you, but were rebuffed. They seem to act as if there is no problem at all, simply moving on with life without admitting or even trying to deal with the negative feelings. Have you ever had an important test to study for or an important job interview coming up, and rather than planning and preparing for it, you simply tried put it out of your mind entirely? Research has found that ignoring stress is not a good approach for coping with it. If we experience so much stress that we get sick, these events will be detrimental to our life even if we do not or cannot admit that they are Attributed to Charles Stangor Saylor. Suppressing our negative emotions is also not a very good option, at least in the long [21] run, because it tends to fail (Gross & Levenson, 1997).

Unfortunately discount viagra soft tabs 100 mg without prescription, the majority of sources of information on herbs do not provide evidence that a specific botanical specimen was gathered by or known to an informant discount viagra soft tabs 50mg on-line. Reference to purgative action seems out of keeping with other uses that can be rationalised on the basis of astringency (see below) and confusion with another ‘alder’ (in fact 100 mg viagra soft tabs visa, alder buckthorn) has to be considered generic viagra soft tabs 50 mg free shipping. To offer just one point: a number of illnesses are listed because of a reputation to relieve a common symptom, although the latter is not specifically mentioned, e. Halifax: Nimbus Publishing, 1994: 22, on the use of alder in Conne River relates a case of ‘lameness’ – the patient recovered despite a doctor saying that there was ‘no cure’: ‘The individual collected a large bag of alder leaves and spent the following night treating the problem. The leaves were placed over the affected areas of the body, and were replaced with a fresh covering whenever they became “too hot. This account by Chief Joe has been told to many visitors to the Conne River reserve, especially on a walk through the community’s Medicine Trail. For example, from the writings of well-known herb author, Steven Foster: Black cohosh Cimicifuga racemosa (Actaea racemosa). The impact of the materia medica of the North American Indians on professional practice. The comment is based on a clinical paper in the same issue of the journal: Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and on various blood parameters in post- menopausal women: a double-blind placebo-controlled and conjugated estrogens-controlled 64 | Traditional medicine study. Intentional ignorance: a history of blind assessment and placebo controls in medicine. Hagar seemingly did not consider whether or not the ‘directions’ for preparing the seven sorts incorpo- rated, knowingly or unknowingly, empirical advice long recognised among Euro-North Americans for collecting herbs, e. Specifically for Conne River, a well-known healer Kitty Burke was said to be successful in making the plaster. Traditional Medicine, unpublished manuscript (copy kindly provided by Dr Margaret Mackey). Brief report – ethnomedicine: the sweat lodge healing experience: an integrative medical perspective. Aung generally follows the language commonly used, namely in terms of benefits from physical, mental and spiritual purification that discharges emotional and other forms of pollution. To reinforce that ‘ritual events’ span all areas of healthcare, the following references are useful: Montagne M. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. They have brought with them their own conceptions of the environ- ment and world, and amalgamated their diverse religious beliefs with those of the native groups. Traditionally, the elders are responsible for transmitting ancestral knowledge to their younger generations, but the Colombian State education system, contrary to that of the indigenous groups, separates the children from their elders. This has resulted in the present generation of indigenous children following a school curriculum with no allowance for a smooth transition between one system and the other. Similarly, there is an enormous gap between the traditional medicine practised widely in Colombia, and that of western medicine. These researchers looked at the process of adaptation to urban medicine while retaining native traditional medicine. The Colombian Amazon forest is inhabited by numerous native ethnic groups, migrants and colonists. They speak diverse languages and dialects, many of them from totally unrelated linguistic families and they all have their own particular traditions including medical practice. The sabedores live mainly in resguardos of the departments of Amazonas and Caquetá medio. Resguardos are areas protected by the Colombian government for the benefit of the indigenous people and environment. In the department of Amazonas alone there are 26 different ethnic groups recorded who live in 19 indigenous resguardos. As these groups live in the tropical forest, they have unsurpassed knowledge of survival and living in this environment. However, also due to living in this highly diverse habitat, the indigenous groups have been exposed to the effects of colonists and outsiders who have come to search for plants, animal skins and minerals. In particular, the Uitoto groups were victims of the rubber trade of the nineteenth and twentieth centuries where their numbers were reduced to a minimum as a result of slave labour and torture. Notwithstanding these influences, many of the ethnic groups have maintained their language and traditions. We refer to selected examples of traditional medicine used by a few of these Amazon ethnic groups, including indigenous elders who live on the border of Peru/Brazil/Colombia or in the Ecuadorian Amazon forest. Traditional Amazonian medical practice The Historia In spite of the problems involved, the elders of the Amazon ethnic groups continue to practise the traditions of their oral Historia, a mythical work that contains all the historical actions of the gods of creation of the universe, the world, humanity, origin of the pueblos and punishments (illnesses and healing, evilness and how to combat it). In this way, the ethnic groups follow their ancestral knowledge to achieve a valid manner for survival and maintenance of their daily lives. The Historia is related by means of ‘words of power’ in a sacred space in the maloca – the plurifamilial house for the extended family by the sabedores (see below). This includes how to make a diagnosis, look for possible cures, combat and allay spiritual illness, and extract ‘bad energies’ implanted by ‘spells’ and revenge, as well those of physical illnesses. To be recognised as a healer capable of managing and applying numerous techniques in the treat- ment of illnesses, the sabedor must demonstrate his powers of healing to his community and beyond. He or she must become familiar with the ritual plants, their effects and their results in order to ‘extract’ illnesses. This can include undertaking highly sacred journeys in which he or she is expected to be able to recover the spirit of the patient completely by investigating how the illness ‘arrived’. If thought necessary, the illness or ‘bad energy’ may be returned to the enemy who sent it in the first place. The sabedores realise that there are illnesses that are outside their social context. By recurring to the entheogens (see below) they are able to find the cause of the illness. When the sabedores suspect that the cause of the illness is of viral or bacterial origin they say that these illnesses come from blancos or white people. In the same way serious injuries such as fractures are referred to western medical doctors. The payé The payé is a person who has achieved the ability to ‘see’ further than his or her own environment, e. The shaman The word shaman is derived from the Manchu–Tungus word sˇaman, Sha or Sa (knowledgeable person) and man (a being who is dedicated to knowl- edge). With respect to the indigenous tribes of the Amazon forest, the term is the one that westerners or incomers use – the tribes themselves use their own terminology depending on their respec- tive language and culture. They are the people who maintain the traditional knowledge and who have taken responsibility for the spiritual and material health of their pueblos. The knowledge held by these healers is based on ancestral wisdom as well as constant experimentation with plants and other healing materials, and is transmitted by the sabedores. The true shaman is created from birth or, as is the case for the Uitoto ethnic group, the parents and grandparents communicate with the future shaman before birth, caressing and relating the Historia to the unborn child. In addition to these ‘true’ shamans there are other types of shaman who are not formed from birth. These include, for example, individuals who have managed to survive a serious illness, an animal attack or a lightning bolt, and from that point Traditional medicine used in the Colombian Amazon forest | 69 have dedicated their lives to shamanic rituals. These rituals include learning with the aid of drums, maracas, chanting and body paint. Another variety of shaman is one known as the ‘chaman de agua’ (water shaman) whose illness has been converted into a piranha tooth, an animal bone or other object such as a plant seed. For all types of shaman, certain costumes and private or secret ‘energy protectors’ are used that are relevant to their formation. These may be made of a variety of natural materials such as feathers, seeds, bones or minerals. Approach to healing The relationship between the traditional healer and his or her patient is not limited to the treatment of an illness, x or y, but is immersed in a socio- cultural context within the environment. This includes the spiritual and phys- ical state of the patient’s health and how it relates to a specific environment. The latter is almost always associated with sacred spaces or locations such as the Maloca, where the transmission of knowledge of the environment and the surrounding forest is narrated. The traditional practitioner is expected to treat both physical and spiritual ailments. The diagnosis and treatment take the form of seeking possible causes of the pain or discomfort that the patient is experiencing – this may be a result of physical causes, illness or disease, or can be suspected because someone has ‘sent’ it. Diagnosis As already indicated, there is a vast difference between the medicine prac- tised by traditional medicine practitioners in the Amazon tropical forest and western medicine. In modern or western medicine the initial diagnosis is made by the practitioner listening to the patient’s description of symptoms, as well as a physical examination. The causes of the illness or discomfort felt by the patient are related directly to the function of the human body. In contrast, indigenous traditional medicine has other forms of diagnosis because the causes of the illness are variable: sometimes these coincide with modern medicine but in other cases they do not, e. The cure is based on conjuration, or methods such as ‘sucking’ the 70 | Traditional medicine bad energy or illness out of the body. The positive energy is restored to the body using water, massage, plants and other natural materials, or a mixture of these techniques. These can be the ordinary curative plants or those of ‘extreme’ knowledge, such as a diverse selection of entheogenic plants. Entheogen, derived from part of the Greek root en- theos or god, literally translated means ‘which generates the experience of god within us’.

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Pharmaceutical factors are therefore important should be by generic name or by proprietary (brand) name 100 mg viagra soft tabs visa. This is determined by the lipid solubility of Time→ the drug and the area of membrane available for Figure 4 50 mg viagra soft tabs. Sometimes polar drugs can be absorbed via specific transport processes (carriers) buy viagra soft tabs 50mg line. It is usually available only from the company liver order 50 mg viagra soft tabs with visa, which can extract drug from the portal blood that introduced it until the patent expires. After this, other com- before it reaches the systemic circulation via the hepatic vein. This is called presystemic (or ‘first-pass’) panies can manufacture and market the product, sometimes metabolism. At this time, pharmacists usually shop • ‘Bioavailability’ describes the completeness of around for the best buy. If a hospital doctor prescribes by propri- absorption into the systemic circulation. The amount of etary name, the same drug produced by another company may drug absorbed is determined by measuring the plasma be substituted. The for- bioavailability implies that no drug enters the systemic mulation of a drug (i. This is a particular concern with slow-release or drugs and different pharmaceutical formulations of the sustained-release preparations, or preparations to be adminis- same drug, but also from one individual to another, tered by different routes. Drug regulatory bodies have strict cri- depending on factors such as dose, whether the dose teria to assess whether such products can be licensed without is taken on an empty stomach, and the presence of gastro-intestinal disease, or other drugs. The rate at which a drug enters the body determines for another may give rise to clinical problems unless the the onset of its pharmacological action, and also influences the preparations are ‘bioequivalent’. Regulatory authorities intensity and sometimes the duration of its action, and is therefore require evidence of bioequivalence before important in addition to the completeness of absorption. They provide an approach to improving (brand named or generic) are sufficiently similar for their sub- absorption and distribution. If evidence is presented that a new One approach to improving absorption or distribution to a rel- generic product can be treated as therapeutically equivalent to atively inaccessible tissue (e. This does not imply that all possible pharmacokinetic absorbed and from which active drug is liberated after absorp- parameters are identical between the two products, but that tion. There are two main mechanisms of Oral drug administration may be used to produce local effects drug absorption by the gut (Figure 4. Non-polar lipid-soluble dependent acrylic coat that degrades at alkaline pH as in the agents are well absorbed from the gut, mainly from the small intestine, because of the enormous absorptive surface area provided by villi and microvilli. Naturally occurring polar substances, including sugars, amino acids and vitamins, are Relatively well- Relatively poorly absorbed and/or absorbed and/or absorbed by active or facilitated transport mechanisms. Drugs good tissue poor tissue that are analogues of such molecules compete with them for penetration penetration transport via the carrier. The following advantages have been claimed for the rec- tal route of administration of systemically active drugs: Prolonged action and sustained-release preparations 1. Exposure to the acidity of the gastric juice and to digestive Some drugs with short elimination half-lives need to be adminis- enzymes is avoided. The portal circulation is partly bypassed, reducing ence to the prescribed regimen difficult for the patient. The aim of such Rectal diazepam is useful for controlling status epilepticus in sustained-release preparations is to release a steady ‘infusion’ of children. Metronidazole is well absorbed when administered drug into the gut lumen for absorption during transit through rectally, and is less expensive than intravenous preparations. Reduced dosing frequency may improve However, there are usually more reliable alternatives, and compliance and, in the case of some drugs (e. Other limitations of slow-release preparations are: Drugs are applied topically to treat skin disease (Chapter 51). Transit time through the small intestine is about six hours, Systemic absorption via the skin can cause undesirable effects, so once daily dosing may lead to unacceptably low trough for example in the case of potent glucocorticoids, but the concentrations. If the gut lumen is narrowed or intestinal transit is slow, temic therapeutic effect (e. Osmosin™, an osmotically released formulation of Factors affecting percutaneous drug absorption include: indometacin, had to be withdrawn because it caused 1. Plastic-film occlusion (sometimes employed by dermatologists) increases hydration. The Sublingual administration has distinct advantages over oral physical chemistry of these mixtures may be very complex administration (i. Glyceryl trinitrate, buprenorphine and fentanyl are enhances absorption, and solutions penetrate best of all; given sublingually for this reason. Sublingual adminis- important when treating infants who have a relatively tration provides short-term effects which can be terminated by large surface area to volume ratio. The rate of absorption is increased when the solution is Drugs, notably steroids, β2-adrenoceptor agonists and mus- distributed throughout a large volume of muscle. Dispersion is carinic receptor antagonists, are inhaled as aerosols or particles enhanced by massage of the injection site. Nebulized antibiotics are the injection site is governed by muscle blood flow, and this also sometimes used in children with cystic fibrosis and recur- varies from site to site (deltoid vastus lateralis gluteus max- rent Pseudomonas infections. Blood flow to muscle is increased by exercise and absorp- temic absorption are desirable. For example, ipratropium is a tion rates are increased in all sites after exercise. Conversely, quaternary ammonium ion analogue of atropine which is shock, heart failure or other conditions that decrease muscle highly polar, and is consequently poorly absorbed and has blood flow reduce absorption. A large fraction of an The drug must be sufficiently water soluble to remain in ‘inhaled’ dose of salbutamol is in fact swallowed. This is a the bioavailability of swallowed salbutamol is low due to inac- problem for some drugs, including phenytoin, diazepam and tivation in the gut wall, so systemic effects such as tremor are digoxin, as crystallization and/or poor absorption occur when minimized in comparison to effects on the bronchioles. Slow absorption is useful in some circum- phase, since the total respiratory surface area is about 60m2, stances where appreciable concentrations of drug are required through which only 60mL blood are percolating in the capil- for prolonged periods. This is exploited in the case of volatile anaesthetics, as used to improve compliance in psychiatric patients (e. Anasal/inhaled preparation of insulin decanoate ester of fluphenazine which is slowly hydrolysed to was introduced for type 2 diabetes (Chapter 37), but was not release active free drug). This has opened up an area of therapeutics than the oral route; that was previously limited by the inconvenience of repeated 7. Absorption is retarded by immobiliza- tion, reduction of blood flow by a tourniquet and local cooling. Drugs are administered topically to these sites for their local Adrenaline incorporated into an injection (e. Occasionally, important clinically, most notably in the treatment of insulin- they are absorbed in sufficient quantity to have undesirable sys- dependent diabetics, different rates of absorption being temic effects, such as worsening of bronchospasm in asthmatics achieved by different insulin preparations (see Chapter 37). Penicillin used to be administered intrathecally to patients with pneumococcal meningitis, because of the belief that it penetrated the blood–brain barrier inadequately. Intravenous penicillin should now This has the following advantages: always be used for meningitis, since penicillin is a predictable 1. It is also used for drugs that are too painful Key points or toxic to be given intramuscularly. Cytotoxic drugs must not be allowed to leak from the vein or considerable local • Oral – generally safe and convenient • Buccal/sublingual – circumvents presystemic metabolism damage and pain will result as many of them are severe • Rectal – useful in patients who are vomiting vesicants (e. This is • Lungs – volatile anaesthetics essential for drugs such as sodium nitroprusside and • Nasal – useful absorption of some peptides (e. High concentrations result if the drug is given too rapidly – potentially very dangerous, as a high concentration the right heart receives the highest concentration. Embolism of foreign particles or air, sepsis or • Intrathecal – specialized use by anaesthetists thrombosis. Inadvertent intra-arterial injection can cause arterial Case history spasm and peripheral gangrene. The health visitor is concerned about an eight-month-old girl who is failing to grow. On further enquiry, the mother tells you that she has been This route provides access to the central nervous system for applying clobetasone, which she had been prescribed her- self for eczema, to the baby’s napkin area. The mother stops using the clobetasone this route should never be used without adequate training. It is prescribed for its top-ical effect, but can penetrate disability is such that extra care must be taken in checking that skin, especially of an infant. Examples of drugs used appropriate for an adult would readily cover a large frac- in this way include methotrexate and local anaesthetics (e. Microspheres for controlled release drug deliv- Therapeutic Drug Carrier Systems 2003; 20: 153–2. The pharmacological activity of many drugs is reduced or Hepatocyte endoplasmic reticulum is particularly important, abolished by enzymatic processes, and drug metabolism is one but the cytosol and mitochondria are also involved. These metabolic delayed effects of the long-lasting metabolite as it accumulates reactions include oxidation, reduction and hydrolysis. Monoamine oxidase is found in liver, kidney, intestine and nervous tissue, and its substrates include catecholamines Glycine and glutamine are the amino acids chiefly involved in conjugation reactions in humans. Hepatocellular damage depletes the intracellular pool of these amino acids, thus restricting this pathway. Acetylating – Hydrolysis – Glucuronidation – Sulphation activity resides in the cytosol and occurs in leucocytes, gastro- – Mercaptopuric intestinal epithelium and the liver (in reticulo-endothelial rather acid formation than parenchymal cells). Some patients inherit a deficiency of glu- with thiol donors such as N-acetyl cysteine or methionine to curonide formation that presents clinically as a non- increase the endogenous supply of reduced glutathione. Drugs that are normally conju- gated via this pathway aggravate jaundice in such patients.

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