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Chronic phase – Follows a long latent period after the acute phase: cardiac lesions (arrhythmia and conduction disorders purchase rizatriptan 10mg on-line pain medication for dog hip dysplasia, cardiomyopathy trusted 10 mg rizatriptan pain management in dogs, heart failure cheap rizatriptan 10mg on line pain management senior dogs, chest pain buy generic rizatriptan 10mg on-line pain treatment center baton rouge, thromboembolism) and gastrointestinal lesions (megaoesophagus and megacolon). Laboratory Acute phase – Thin or thick film: detection of the parasite in blood or lymph nodes. In the event of purpura with fever, paraesthesia or peripheral polyneuritis, stop treament. Prevention – Improvement of housing and vector control: plastered walls and cement floors, corrugated- iron roofs, insecticide spraying. Clinical features Cutaneous and mucocutaneous leishmaniasis – Single or multiple lesions on the uncovered parts of the body: an erythematous papule 6 begins at the sandfly bite, enlarges to a nodule and extends in surface and depth to form a scabbed ulcer. Usually, lesions heal spontaneously, leaving a scar, and result in lifelong protection from disease. Visceral leishmaniasis Visceral leishmaniasis (kala azar) is a systemic disease, resulting in pancytopenia, immuno- suppression, and death if left untreated. Post-kala azar dermal leishmaniasis Macular, nodular or papular skin rash of unknown aetiology, particularly on the face, and typically occurring after apparent cure of visceral leishmaniasis. Laboratory Cutaneous and mucocutaneous leishmaniasis – Parasitological diagnosis: identification of Giemsa-stained parasites in smears of tissue biopsy from the edge of the ulcer. Splenic aspiration is the most sensitive technique but carries a theoretical risk of potentially fatal haemorrhage. For information: Cutaneous and mucocutaneous leishmaniasis – Cutaneous lesions generally heal spontaneously in 3 to 6 months. Treatment is only indicated if lesions are persistent (> 6 months), disfiguring, ulcerating, or disseminated. Intestinal protozoa are transmitted by the faecal-oral route (soiled hands, ingestion of food or water contaminated with faeces) and may cause both individual cases of diarrhoea and epidemic diarrhoea outbreaks. Clinical features – Amoebiasis gives rise to bloody diarrhoea (see Amoebiasis, Chapter 3). These patients are likely to develop severe, intermittent or chronic diarrhoea that may be complicated by malabsorption with significant wasting (or failure to gain weight in children) or severe dehydration. Laboratory Definitive diagnosis relies on parasite identification in stool specimens (trophozoites and cysts for giardia; oocysts for cryptosporidium, cyclospora, isospora). Two to three samples, collected 2 to 3 days apart are necessary, as pathogens are shed intermittently. Treatment – Correct dehydration if present (for clinical features and management, see Appendix 2). An empirical treatment (using tinidazole or metronidazole and cotrimoxazole as 6 above, together or in succession) may be tried in the case of prolonged diarrhoea or steatorrhoea. In endemic areas, paragonimosis Children > 2 years and adults: Distribution: South-East Asia, China, should be considered whenever pulmonary tuberculosis is suspected as the clinical 75 mg/kg/day in 3 divided parts of Cameroon, Nigeria, Gabon, and radiological features overlap. Paragonimosis is confirmed when eggs are doses for 2 to 3 days Congo, Colombia, Peru detected in sputum (or possibly in stools). At this stage, the Children and adults: Distribution: worldwide, in areas where diagnosis is rarely considered and can only be confirmed through serology; 10 mg/kg as a single dose sheep and cattle are raised parasitological examination of stools is always negative. May repeat in 24 hours in the Transmission: eating uncooked aquatic Once adult flukes are present in the biliary tract: presentation resembles event of severe infection plants cholelithiasis: right upper quadrant pain, recurrent episodes of obstructive jaundice/ febrile cholangitis. The diagnosis is confirmed when parasite eggs are detected in stools (or flukes are seen in the biliary tract with sonography). Children > 2 years and adults: Opisthorchis viverrini The diagnosis is confirmed when parasite eggs are detected in stools. The three main species infecting humans are Schistosoma haematobium, Schistosoma mansoni and Schistosoma japonicum. Schistosoma mekongi and Schistosoma intercalatum have a more limited distribution (see table next page). Humans are infected while wading/bathing in fresh water infested with schistosome larvae. Symptoms occurring during the phases of parasite invasion (transient localized itching as larvae penetrate the skin) and migration (allergic manifestations and gastrointestinal symptoms during migration of schistosomules) are frequently overlooked. In general, schistosomiasis is suspected when symptoms of established infection become evident (see table next page). Each species gives rise to a specific clinical form: genito-urinary schistosomiasis due to S. Heavily infected patients are prone to 6 visceral lesions with potentially irreversible sequelae. Children aged 5 to 15 years are particularly at risk: prevalence and parasite load are highest in this age group. An antiparasitic treatment should be administered to reduce the risk of severe lesions, even if there is a likelihood of re-infection. Haematuria is frequently associated with polyuria/ dysuria (frequent and painful micturition). The same antiparasitic • If left untreated: risk of recurrent urinary tract infections, fibrosis/calcification of treatment is used for all the bladder and ureters, bladder cancer; increased susceptibility to sexually species: transmitted infections and risk of infertility. Cambodia (along the Mekong River) • In the absence of reliable parasitological diagnosis: in areas where intestinal S. For the other indications, treatment can usually be deferred until after delivery. Cestodes (larvae) Parasites Clinical features/Laboratory Treatment Transmission/Prevention Cysticercosis • Muscular: asymptomatic or Neurological and ocular cysticercosis should be managed Transmission by eating food Taenia solium myalgia in specialized facilities. The 15 mg/kg/day in 2 divided doses Prevention: cyst becomes symptomatic when Adults over 60 kg: • individual: avoid contact with dogs complications develop (biliary 800 mg/day in 2 divided doses • collective: eliminate stray dogs, obstruction; anaphylactic shock in monitor slaughterhouses Treatment duration: the event of rupture into peritoneal In addition to surgery (pre-operatively or post- cavity, vessels or an organ; febrile operatively): continuous course of minimum 2 months painful jaundice in the event of or at least two 28-day courses with a drug-free interval rupture into the biliary tree, etc. Inoperable cases: 28-day courses with drug-free intervals of 14 days, for 3 to 6 months (on average), possibly up to 1 year. In general, the diagnosis is made when adult worms are but < 10 kg) expelled from the anus (or occasionally from the mouth). Ascaris are large (15-30 cm), or Transmission: ingestion of cylindrical worms, pinkish-white, with slightly tapered ends. Worms may (100 mg/day in 2 divided doses in accidentally migrate to gall bladder, liver or peritoneum, causing jaundice, liver abscess, or children > 6 months but < 10 kg) peritonitis. Ankylostomiasea • During larval penetration/migration albendazole as a single dose (as for Ancylostoma duodenale Cutaneous signs (pruritic papulo-vesicular rash at the site of penetration, usually the feet) ascariasis) is much more effective Necator americanus and pulmonary symptoms (similar to ascariasis). Distribution: tropical and • Once adult worms are present in the intestine When using mebendazole, a 3-day subtropical regions Mild abdominal pain. Attachment of the parasite to the mucosa leads to chronic blood treatment (as for ascariasis) is loss and anaemia (in endemic areas, antihelminthic treatment is recommended for recommended. Chronic infections for trichuriasis) may be an result in prolonged or recurrent pulmonary and gastrointestinal symptoms. Transcutaneous migration of intestinal larvae gives rise to a typical rash (larva currens), mainly in the anal region and on the trunk: sinuous, raised, linear, migrating lesion, intensely pruritic, moving rapidly (5 to 10 cm/hour) and lasting several hours or days. This form occurs mainly in patients receiving immunosuppressive intermittent multiple-dose regimens therapy (e.

In this book buy rizatriptan 10 mg low price chronic pelvic pain treatment guidelines, compliance was defined as �the exnto which a person�s behavior (in rms of taking medications order 10 mg rizatriptan with visa neuropathic pain treatment, following diets 10mg rizatriptan visa cordova pain treatment center memphis, or executing lifestyle changes) coincides with medical or health advice� purchase rizatriptan 10mg on line pain treatment in cats. According to Haynes (1979), the rms �compliance� and �adherence� can be used inrchangeably, while Lutfey and Wishner (1999), for instance, thoughthathe rm �adherence� includes more of the patient�s righto self- dermination concerning his/her treatmenthan the rm �compliance�. In his introduction to �Compliance in Health Care� Brian Haynes (1979) comments that, although some sps forward have been taken, however, the solution of non- compliance is still noin sight. Since then, the associations of compliance with over 200 background variables have been studied (Morisky eal 1986). The las30 years of research on compliance have noproduced much more reliable information than thapatients do noalways take their medications as prescribed (Morris and Schulz 1992). Furthermore, the studied variables have been mainly contradictory in differenstudies and are thus nouseful in explaining compliance (Morris and Schulz 1992). A quarr of a century afr the publication of firsbook, Brian Haynes and his colleagues (2002) commenthathere is a need for studies thaare able to improve compliance. Furthermore, the studies 16 thahave successfully used long-rm medications have been complex, and abest, have had only modesffects on non-compliance. In the lirature, when defining compliance there seems to be a common thoughthathe patient�s behaviour is the exclusive reason for non-compliance, withoutaking into accounthe roles of the physician, the health care organization and the patient-doctor relationship, which mighshow non-compliance to be due to concordance problems between the patienand health care professionals (Lutfey and Wishner 1999, Nilsson 2002). The problem with the rm �compliance� has been the perception thathe patienreceives commands from healthcare professionals. Therefore, the rm �concordance� was recently introduced, which looks acompliance from a differenperspective. Iis an agreemenreached afr negotiation between a patienand a healthcare professional tharespects the beliefs and wishes of the patienin dermining whether, when, and how medicines are to be taken� (Dickinson eal. The patient�s views should be taken into accounven if s/he does noactively participa in the decision-making process (Elwyn eal 2003). The making of maximally well- informed treatmendecisions is one of the keys to concordance (Dickinson eal. Thus, one importanrole of the physician is to ensure thathe patienhas adequa access to information and, when necessary provide an inrpretation of this information to the patien(Kennedy 2003). Furthermore, if the patienlets you know thas/he does nowanto take a certain medicine, the reasons for thashould be discussed (Elwyn eal 2003). Iis nomeaningful to discuss compliance when a patienhas been offered treatmenthas/he finds unacceptable because of ethical/moral or religious reasons, while concordance does nopresena problem in a corresponding situation. The patienhence has the righto choose whether or nos/he accepts the medication, and the health care professional should accepthis as a parof the process of moving from compliance to concordance (Heath 2003). However, there mighbe some situations where the use of �concordance� and the patienas a decision-maker are problematic. These are clinical trials where almosfull compliance is needed to ensure reliable results (Milburn and Cochrane 1997). The research on human medication-taking behaviour is also relad to compliance and thus 17 nosuitable for the �concordance� concep(Milburn and Cochrane 1997). Furthermore, �concordance� is nouseful in the case of pontially fatal infectious diseases because persons with this kind of disease will risk the health of other people by infecting them and contributing to bacrial resistance againsantibiotics (Milburn and Cochrane 1997). Ihas also been suggesd thathe decision to involve the patieninto decision-making should be made individually in each case by taking into accountheir comprehension and decision-making abilities (Lakshmi 1999, Lamon1999). Patients come to seek help from a physician, and if the decision-making is repeadly lefto the patiens/he may ultimaly lose respecfor the physician (Carvel 1999). However, the patienas a co- worker is essential for effective discussion between the patienand the physician, where mutual understanding will lead to a rapid diagnosis, and discussion of treatmenchoices may lead to a higher probability of good compliance (Slowie 1999). Patients need clear, unambiguous information abouthings thamatr to them, and physicians need practical tools for sharing thainformation (Jones 2003). Furthermore, the biggesfuture challenge for the concepof concordance will be the need of health care professionals to adopnew values (Jones 2003). Furthermore, iwas found among treatment-resistanhypernsive patients with a three-drug combination thaone-third of the patients� blood pressure values were normalized by using compliance monitoring alone (Burnier eal 2001). However, a recenreview of compliance with antihypernsive medication, which included studies where electronic devices had been used to measure compliance, concluded thathere is no convincing evidence to suppor18 the association between non-compliance and blood pressure control (Wetzels eal 2004). Either our antihypernsive drugs are ineffective or our methods of measuring compliance are inadequa. Non-compliance is a universal problem, and ialso concerns possible life-threaning conditions (Wrigh1993). A recenstudy of renal transplanpatients indicad thala acu rejections were more prevalenamong non-complianpatients with immunosuppressive therapy (Vlaminck eal 2004). Non-compliance in organ transplanrecipients usually also ranged between 20% and 50% and was associad with grafloss and death (Laederach-Hofmann and Bunzel 2000). Noven patienducation is enough to ensure good compliance of patients with organ transplants. In these cases the importanissue is thathe grafthahas been losbecause of non-compliance could have been transpland into somebody else, who mighhave lived with a trasnsplanbudied while waiting for the graf(Laederach- Hofmann and Bunzel 2000). Studies have also shown thagood compliance with placebo has been associad with betr treatmenoutcomes than non-compliance with the use of placebo tablets (Horwitz and Horwitz 1993). Unwillingness to take medicines is a profound and widespread problem (Vermeire eal 2001). Ihas been suggesd, possibly with humour, tharesearch on patients� medication-taking could be called reality-based medicine to distinguish ifrom evidence-based medicine (Chapman 2000). The crucial questions in the efforts to control chronic diseases are: Do patients follow the instructions and take their drugs, and how well are the physicians aware of this (Chapman 2000)? For the physician, iis naturally much easier to wri oua prescription than spend annoying moments discussing the patient�s attitudes towards medication-taking (Chapman 2000). However, iis the health care personnel�s responsibility to understand the help-seeking patient�s view (Delgado 2000). Maybe we should nopay atntion to compliance, burather to our ability to understand and participa in patients� decision-making processes aboutheir medication-taking (Donovan and Blake 1992). Patients today make their decisions aboumedication- 19 taking on their own, busimple information sharing would allow them to make decisions thabetr fitheir life situation and beliefs and would also offer the view of modern medicine abouthe benefits and harmful effects of drugs (Donovan and Blake 1992). The advice given by the physician needs to compe with many other opinions before the patiendecides abouwhether or nos/he will follow the physician�s advice aboutreatmen(Donovan and Blake 1992). Iis up to the physician to make sure thathe patienlls abouall of his/her medication problems and to offer enough information to make the patienconvinced of the suitability of his/her medication (DiMato 1994). Even when the patienaccepts the treatmenprescribed to him/her, success dependenon how difficuliis to follow the treatmeninstructions and whether s/he receives supporin the treatmenprocess (DiMato 1994). Compliance with long-rm medications in differendiseases seems to be abou50% (Sacketand Snow 1979). Compliance of 50% may mean thahalf of the patients stopped taking their medication, or thapatients consume an average of 50% of the medications prescribed to them (Farmer 1999). A patienwho takes an average 50% of the medications prescribed to him/her may take half of the medications every day or all the medications every second day or engage in various combinations of taking and notaking medications.

Usage: Enrofloxacin is one of the most important antibiotics for our lab discount 10 mg rizatriptan with amex postoperative pain treatment guidelines, not only because it has a broad range of activity cheap rizatriptan 10mg without a prescription shoulder pain treatment yahoo, but also because it penetrates all tissues and body fluids generic rizatriptan 10mg with mastercard pain management for dogs with bone cancer, including the brain buy rizatriptan 10 mg free shipping back pain treatment kerala. Moreover, it is very effective for treating dermal infections caused by susceptible strains of Escherichia coli and Staphylococcus aureus, the 2 most common bacteria around the implants. Dosage and Administration: Enrofloxacin is one of the very few drugs we have that can be administered once a day, thereby eliminating the need of injecting the animal multiple times daily. It should be used whenever mild to moderate infections are noticed, and definitely before and after every surgical operation. If possible (if the animal is anesthetized) the dosage can be divided in two injections daily. Cephalothin Description: Cephalothin is a broad‐spectrum antibiotic acting against streptococci, staphylococci, Klebsiella, salmonella. Do not confuse Cephalothin with the regular triple antibiotics (that cannot be applied on the eye). Dosage and Administration: The ointment can be applied to the eye 3‐4 times daily. It enters the cerebrospinal fluid even in the absence of meningeal inflammation, appearing in concentrations about half of those found in the blood. Serious and fatal blood dyscrasias are known to occur after the administration of chloramphenicol. Cleocin Description: Cleocin phosphate Sterile Solution in vials contains Clindamycin phosphate, a water soluble ester of Clindamycin and phosphoric acid. Usage: Clindamycin is an antibiotic used in the treatment of infections caused by susceptible anaerobic bacteria as well as for infections caused by streptococci, staphylococci and pneumococci. Anaerobic bacteria are responsible for certain serious respiratory tract infections, serious skin and soft tissue infections, septicemia. Since Clindamycin does not diffuse adequately into the cerebrospinal fluid, the drug should not be used in the treatment of meningitis. It should be noted that Clindamycin therapy has been associated with severe colitis which may end up being fatal. As an alternative to dosing on a body weight basis, monkeys may be dosed on the basis of square meters body surface: 350 mg/M(squared)/day for serious infections and 450 mg/M(squared)/day for more severe infections. It does not penetrate the blood‐brain barrier, but it diffuses readily into intracellular fluids, and antibacterial activity can be achieved at essentially all the other sites. It can be used for minor streptococcal and staphylococcal infections Usage: Used in the chambers or systemically, according to the veterinarian’s instructions. Erythromycin ethylsuccinate suspensions may be administered without regard to meals in a dosage 10‐20 mg/kg/day in equally divided doses. Genoptic Ointment and Solution (Gentamycin Ophthalmic) Description: Genoptic is a sterile, topical anti‐infective agent for ophthalmic use. Gentamicin sulfate occurs as a white to buff powder and is soluble in water and insoluble in alcohol. Usage: In Vitro gentamicin sulfate is active against many strains of the following microorganisms: Staphylococcus Aureus, Staphylococcus Epidermidis, Streptococcus Pyogenes, Streptococcus Pneumoniae, Enterobacter Aerogenes, Escherichia Coli, Haemophilus Influenzae, Klebsiella Pneumoniae, Neisseria Gonorrhoeae, Pseudomonas Aeruginosa, and Serratia Marcescens. Genoptic ointment and solution are indicated in the topical treatment of ocular bacterial infections including conjunctivitis, keratitis, keratoconjunctivitis, corneal ulcers, blepharitis, blepharoconjunctivitis, acute meibomianitis, and dacryocystitis, caused by susceptible strains of the following microorganisms: Staphylococcus Aureus, Staphylococcus Epidermidis, Streptococcus Pyogenes, Streptococcus Pneumoniae, Enterobacter Aerogenes, Escherichia Coli, Haemophilus Influenzae, Klebsiella Pneumoniae, Neisseria Gonorrhoeae, Pseudomonas Aeruginosa, And Serratia Marcescens. Dosage and Administration: Genoptic solution: Instill one or two drops into the affected eye(s) every four hours. Genoptic ointment: Apply a small amount (about 1/2 inch) to the affected eye two to three times a day. Neosporin Ophthalmic Ointment Description: Neosporin Ophthalmic Ointment (neomycin and polymyxin B sulfates and bacitracin zinc ophthalmic ointment) is a sterile antimicrobial ointment for ophthalmic use. Neomycin sulfate is the sulfate salt of neomycin B and C, which are produced by the growth of Streptomyces Fradiae Waksman (Fam. It has a potency equivalent of not less than 600 mcgm of neomycin standard per mg, calculated on an anhydrous basis. Polymyxin B sulfate is the sulfate salt of polymyxin B1 and B2 which are produced by the growth of Bacillus Polymyxa (Prazmowski) Migula (Fam. It has a potency of not less than 6,000 polymyxin B units per mg, calculated on an anhydrous basis. Bacitracin zinc is the zinc salt of bacitracin, a mixture of related cyclic polypeptides (mainly bacitracin A) produced by the growth of an organism of the Licheniformis group of Bacillus Subtilis var Tracy. Usage: A wide range of antibacterial action is provided by the overlapping spectra of neomycin, polymyxin B sulfate, and bacitracin. Bacitracin is bactericidal for a variety of gram‐ positive and gram‐negative organisms. It interferes with bacterial cell wall synthesis by inhibition of the regeneration of phospholipid receptors involved in peptidoglycan synthesis. Neomycin sulfate, polymyxin B sulfate, and bacitracin zinc together are considered active against the following microorganisms: Staphylococcus Aureus, streptococci including Streptococcus Pneumoniae, Escherichia Coli, Haemophilus Influenzae, Klebsiella/Enterobacter species, Neisseria species, and Pseudomonas Aeruginosa. Neosporin Ophthalmic Ointment is indicated for the topical treatment of superficial infections of the external eye and its adnexa caused by susceptible bacteria. Panalog Dosage: Panalog cream combines nystatin, neomycin sulfate, thiostrepton, and triamcinolone acetonide (potent corticosteroid). Usage: It provides four basic therapeutic effects: anti‐ inflammatory, antipruritic, antifungal and antibacterial. Dosage and Administration: For mild inflammations, application may range from once daily to once a week. For severe conditions Panalog Cream may be applied as often as 2 to 3 times daily, if necessary. Polytrim (trimethoprim & polymyxin) Description: Polytrim Ophthalmic Solution (trimethoprim sulfate and polymyxin B sulfate) is a sterile antimicrobial solution for topical ophthalmic use. Each mL contains trimethoprim sulfate equivalent to 1 mg trimethoprim and polymyxin B sulfate 10,000 units. Trimethoprim is a synthetic antibacterial drug active against a wide variety of aerobic gram‐ positive and gram‐negative ophthalmic pathogens. Trimethoprim blocks the production of tetrahydrofolic acid from dihydrofolic acid by binding to and reversibly inhibiting the enzyme dihydrofolate reductase. This binding is very much stronger for the bacterial enzyme than for the corresponding mammalian enzyme. For that reason, trimethoprim selectively interferes with bacterial biosynthesis of nucleic acids and proteins. When used topically, trimethoprim and polymyxin B absorption through intact skin and mucous membranes is insignificant. Vitro studies have demonstrated that the anti‐infective components of Polytrim are active against the following bacterial pathogens that are capable of causing external infections of the eye: Staphylococcus Aureus and Staphylococcus Epidermidis, Streptococcus Pyogenes, Streptococcus Faecalis, Streptococcus Pneumoniae, Haemophilus Influenzae, Haemophilus Aegyptius, Escherichia Coli, Klebsiella Pneumoniae, Proteus Mirabilis (indole‐negative), Proteus Vulgaris (indole‐ positive), Enterobacter Aerogenes, and Serratia Marcescens.

You should know that the majority of newly marketed drugs do not represent true therapeutic advances but are what is known as ‘me too’ products buy rizatriptan 10mg without a prescription midsouth pain treatment center reviews. In other words proven rizatriptan 10 mg a better life pain treatment center golden valley az, they are very similar in chemical composition and action to other products on the market rizatriptan 10 mg back pain treatment for dogs. The difference is usually in price order rizatriptan 10 mg otc chronic neck pain treatment guidelines; the most recently marketed drug is usually the most expensive! Seeing medical representatives can be useful to learn what is new, but the information should always be verified and compared with impartial, comparative sources. Drug information from commercial sources is also issued as news reports, and as scientific articles in professional journals. A number of countries and professional associations are tightening regulations controlling drug promotion to tackle this problem. Some journals now require that any sponsorship from the pharmaceutical industry should be mentioned in the article. As mentioned above and as studies show, it is not good practice to use only commercial information to keep up-to-date. Although it may seem an easy way 91 Guide to Good Prescribing to gather information, this source is often biased towards certain products and is likely to result in irrational prescribing. This is particularly true for countries without an effective regulatory agency, because more drugs of sometimes doubtful efficacy may be available and there may be little control on the contents of data-sheets and advertisements. The International Federation of Pharmaceutical Manufacturers’ Associations also has a code of pharmaceutical marketing practices. Most guidelines specify that the promotional information should be accurate, complete and in good taste. It is a very good exercise to compare a number of drug advertisements with the national or global criteria. Most guidelines also cover the use of samples and gifts, participation in promotional conferences and clinical trials, etc. Only references in well established peer reviewed journals should be taken seriously. Then check the quality of the research methodology on which the conclusions are based. Third, check what your colleagues, and preferably a specialist in the field, know about the drug. Finally, always collect data from unbiased sources before actually using the drug. Do not start by using free samples on a few patients or family members, and do not base your conclusions on the treatment of a few patients! Yet commercial information is sometimes helpful in a general sense, especially to know of new developments. However, comparative information from drug bulletins or therapeutic reviews is absolutely essential to help you evaluate the new drug in relation to existing treatments, and to decide whether you wish to include it in your personal formulary. Choose between sources of information The advantages and disadvantages of various drug information sources have been outlined. Possible information sources will vary according to country and your own personal situation. Your job is now to decide how best to keep up-to- date, by making a list of all the possible resources to which you have access. Try to find at least one each of the following: (1) medical journals; (2) drug bulletins; (3) pharmacology or clinical reference books; (4) therapeutic committees or consultants or a postgraduate training course. Although your primary source of prescribing information in your daily clinical work should be your personal formulary, you will sometimes face a difficult problem, which calls for an additional source of information. This could be a 92 Chapter 12 How to keep up-to-date about drugs pharmacology or clinical reference book, a drug bulletin, consultants (pharmacist, specialist, colleagues), a drug compendium or a formulary. If you decide, nevertheless, that it has a role to play, follow the ground rules already outlined. But do not use commercial information in isolation from other more objective sources. Efficient reading Articles Many prescribers have a problem in reading everything they would like. The reasons are lack of time and - in industrialized countries - the sheer volume of materials mailed to them. You can save time when reading clinical journals by identifying at an early stage articles which are worth reading, through the steps listed below. The experienced reader will know of many authors whether they generally provide valuable information or not. Consider the site to see if it is sufficiently similar to your own situation, and decide whether the conclusion may be applicable to your work. For example, a conclusion from research in a hospital may not be relevant for primary care. Only by knowing and accepting the research method can you decide whether the conclusion is valid. If you know the subject you will probably be able to judge whether the authors have included the key references in that field. Clinical trials It is beyond the scope of this book to go into the details of how reports on clinical trials should be assessed, but a few general principles are given here. Generally, only randomized, double-blind clinical trials give valid information about the effectiveness of a treatment. Finally you should look at the clinical relevance of the conclusion, not only its statistical significance. If in doubt, first check on the methodology, because different methods may give different results. Then look at the population studied to see which one is more relevant to your situation. If doubts remain, it is better to wait and to postpone a decision on your P-drug choice until more evidence has emerged. Conclusion Keeping up-to-date should not be too difficult for prescribers in developed countries; it can be far from easy in some parts of the world where access to independent sources of drug information is very limited. But wherever you live and work it is important to develop a strategy to maximize your access to the key information you need for optimal benefit of the drugs you prescribe. Be aware of the limitations of some types of information, and spend your time on information that is worth it. Pharmacodynamics deals with the effects of a drug on the body; how a drug acts and its side effects, in which tissues, at which receptor sites, at which concentration, etc. Antagonism, synergism, addition and other phenomena are also described by pharmacodynamics.