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By D. Norris. Newport University.

Long-term- adrenal insufficiency discount cefixime 200 mg on-line get smart antibiotic resistance questions and answers, growth suppression in children 200mg cefixime otc vyrus 985 c3 4v, osteoporosis order cefixime 100mg with mastercard virus map, cataract formation purchase 200 mg cefixime overnight delivery medicine for uti boots, glaucoma, dermal thinning Medication (brand name) Availability Adult Dose Child Dose Notes Prednisone 1, 2. Step 3 Step 4 or 5 Recommended Step for Initiating Step 1 Step 2 Consider short course of oral systemic corticosteroids for Therapy all ages In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly. The Treatment-related adverse level of intensity does not correlate to specific levels of control but should be considered in the effects overall risk assessment. Purpose This Guideline provides recommendations regarding best practice for avoidance of issues related to animal products, whether for patient safety or cultural reasons. Guideline for the use of medicines/pharmaceuticals of animal origin Guidance Statement People who are allergic to certain substances, or who want to avoid certain animal products for religious or cultural reasons may need to know about the origin/source of drugs and excipients contained within their medicines. This document provides information to assist clinicians in dealing with these types of situations. Background A number of medicines (including tablets, injections, capsules, creams, mixtures and vaccines) contain animal products or are animal derived. For example, gelatin is a partially hydrolysed collagen which is usually bovine (beef) or porcine (pig) in origin. Gelatin is used in making capsule shells and is one of many types of stabilisers added to pharmaceutical 1 products such as vaccines. Further examples of pharmaceutical products known to be of animal origin are listed Patients are much more likely to comply with treatment if they have been active partners in the decision making process and their views and preferences have been recognised. For this reason, healthcare professionals should take into consideration patients’ religious 3 beliefs and lifestyles when prescribing and administering medicines. Particular faiths have dietary restrictions that may forbid certain animal products (eg. A United Kingdom publication titled “Drugs of porcine origin and their 3 clinical alternatives - An introductory guide” gives further information on drugs of porcine origin and is available at: http://www. However, informing patients about the origins (if animal derived and no suitable synthetic alterative exists) of their proposed medication will assist them in making informed 3 decisions regarding their treatment. There may be provisions within various religious groups to provide some form of dispensation, depending on the nature of the need for treatment. A Canadian question and answer document produced by the Calgary Health Region provides healthcare professionals with an introduction to the religious and cultural issues associated with drugs of animal origin and the need for informed choice in a multicultural 4 society. This document, titled “Medications derived from animals and culturally diverse patients” is available at: http://www. However, these leaflets are produced in English only, so further assistance may be needed. There appears to be no practical way of identifying whether the gelatin in products has come from beef or pork. For further clarification, the patient could seek guidance from their religious organisation. Review This Guideline is due for review on: 01/11/2018 Date of Last Review: 01/11/2013 Supersedes: Medicines of Animal Origin: Version 1 2007 5. Business Area Contact Medication Services Queensland Effective From: 01/11/2013 Page 2 of 3 Department of Health: Guideline for the use of medicines/pharmaceuticals of animal origin 6. Approval and Implementation Policy Custodian: Senior Pharmacist Manager, Medication Services Queensland Responsible Executive Team Member: Chief Executive, Health Services Support Agency Approving Officer: Director, Medication Services Queensland Approval date: 01 November 2013 Effective from: 01 November 2013 Version Control Version Date Prepared by Comments 2. Religious restrictions Religion Countries where widely practised Restrictions (relevant to Queensland) Buddhism Tibet, Bhutan, India, Nepal, Sri Lanka, - values non-violence and encourages a Burma, Thailand, Laos, Cambodia, vegetarian diet Malaysia, Vietnam, China, Bangladesh, - however, no fixed diet. Vivaxim Hepatitis A vaccine; Vaccines Bovine serum albumin Salmonella typhi vaccine <10 ng (Inactive component) Zyderm Collagen Collagen Other dermatological implants preparations Zyplast Collagen Collagen Other dermatological implants preparations Bovine – Manufacture includes exposure to bovine materials “Bovine-Indirect” Product name Generic name Therapeutic class Comment Adacel Pertussis vaccine, Vaccine Diphtheria toxoid, Tetanus toxoid, Poliomyelitis vaccine. Used for many capsules Glycerol May be derived from animal fats Lactose From cows milk. Usually made synthetically (Common filler in tablets) Lanolin Fat extracted from sheep’s wool Oleic oil and oleostearin From pressed tallow Propolis Bee glue Shellac Insect secretion Stearic acid Fat from cows, sheep, dogs or cats. Can be obtained from vegetable sources Trypsin Enzyme from pork pancreas 7 *some Muslims accept a ruling by the World Health Organisation that gelatin has been transformed to such an extent from its original source, that it is permissible. Others do not accept this and will object to the presence of gelatin in medicines. Religious Organisations consulted: • Buddhist Council of Queensland (President) • Hindu Council of Australia Ltd (Chairman) • Sikh Temple of Queensland (President) • South Queensland Conference of the Seventh-Day Adventist Church (Pastor & General Secretary) • Kosher Australia Pty Ltd (General Manager) • Islamic Council of Queensland (past President) and Holland Park Mosque (Imam) References: 1. Queensland Drug Information Centre – Response to query “Identification of pharmaceutical products/medicines of animal origin” (prepared 18/01/2007) 3. For facts about your medicine – Get your free consumer medicines information leaflet. World Health Organisation Regional Office for the Eastern Mediterranean - The use of unlawful or juridically unclean substances in food and medicine (correspondence dated 17 July 2001). E Sleep is a complex and pervasive cognitive state affected by medications in many different ways. The field Sleep disorders can be divided into those pro- of sleep disorders medicine has become increasingly ducing insomnia, those causing daytime sleepi- complex with more than 90 disorders of sleep described, ness, and those disrupting sleep. Transient insom- nia is extremely common, afflicting up to 80% of each with clear diagnostic criteria. Chronic insomnia affects 15% of of diseases produces mental or physical discomfort affect- the population. Two newer benzodiazepine-like agents, zolpidem and zaleplon, have fewer side sleep), (2) those with a primary complaint of daytime effects, yet good efficacy. Other agents for insom- sleepiness, and (3) those associated with disruptive be- nia include sedating antidepressants and over-the- haviors during sleep—the disorders of arousal. Medications, including Sedatives and Hypnotics amphetamines, may be used to induce daytime alertness. Chronic medical ill- insomnia (< 2 weeks in duration) affects up to 80% of the nesses can become symptomatic during specific population on a yearly basis. In the 1990s in the United States, stages and can thus cause sleep disorders or 2. The comparative restless legs syndrome and periodic limb move- frequency of the more common diagnoses resulting in ment disorder may be treated with dopamine ago- 5 chronic insomnia is presented graphically in Figure 1. An understanding of the disorders of sleep Historically, sedative/hypnotics have been some of the and the effects of medications is required for the appropriate use of medications affecting sleep. Chloral hydrate was (Primary Care Companion J Clin Psychiatry 2001;3:118–125) the original “Mickey Finn” slipped into the drinks of un- suspecting marks for the purposes of criminal activity. In the years of Family Practice, University of Colorado School of Medicine, the Sleep Disorders Center of Southern Colorado and Penrose/St. Francis Sleep leading up to the 1960s, barbiturates were commonly uti- Laboratory, and Parkview Neurological Institute (Dr. Unfortunately, these medi- Department of Family Medicine and Division of Geriatrics, Department of Medicine, University of Colorado Health Sciences Center (Dr. Pagel has received grant/research support Morrison, among others, were celebrities who died during from Sepacor and has served on the speakers/advisory board for Cephalon, Wyeth-Ayerst, and Searle. Diagnoses Resulting in Chronic Insom nia result in a dependence on that agent to induce sleep. Idio- Inadequate Sleep Hygiene syncratic reactions of persistent daytime somnolence and/ Other Substance or memory loss have been reported in some patients. Abuse Tachyphylaxis is unusual, and thus they can be used on a Anxiety Psychopathologic Insomnia long-term basis. Clinical comparison of these Respiratory agents suggests that zolpidem may have greater sleep- Mood Disorder Sleep Disorders inducing efficacy and zaleplon, fewer side effects. Disorder This decrease most likely reflects the public’s and the aMeta-analysis data from Sateia et al. Nonpharmacologic behavioral methods, such as sleep hy- In the 1970s benzodiazepines became available for the giene, hypnosis, relaxation training, sleep restriction, and treatment of insomnia. Insomnia is com- viewed therapeutically based on their pharmacodynamics monly a symptom of nocturnal discomfort, whether psy- (Table 1).

The person who intends to perform or induce the abortion believes cheap cefixime 100 mg mastercard antibiotics for acne bad, to the best of his or her medical judgment based on the facts of the case before him or her order cefixime 100mg on line antibiotic x-206, that a medical emergency exists that complicates the pregnancy so as to require an immediate abortion buy cefixime 200 mg fast delivery zinc antimicrobial properties. The minor provides the person who intends to perform or induce the abortion with a written statement buy cefixime 200mg on line antibiotic resistance lab high school, signed and dated by the minor, in which the minor swears that the pregnancy is the result of a sexual assault in violation of s. Any minor who makes a false statement under this subdivision, which the minor does not believe is true, is subject to a proceeding under s. A physician who specializes in psychiatry or a licensed psychologist, as defined in s. The minor provides the person who intends to perform or induce the abortion with a written statement, signed and dated by the minor, that the pregnancy is the result of sexual intercourse with a caregiver specified in s. The person who intends to perform or induce the abortion shall report the sexual intercourse as required under s. The person who intends to perform or induce the abortion shall report the abuse as required under s. Any minor who is pregnant and who is seeking an abortion and any minor who has had an abortion may receive counseling from a counselor of her choice. Set a time for a hearing on the petition that will enable the court to act within the time period specified in par. The court shall hold a confidential hearing on a petition that is filed by a minor. The hearing shall be held in chambers, unless a public fact-finding hearing is demanded by the minor through her counsel. At the hearing, the court shall consider the report of the guardian ad litem, if any, and hear evidence relating to all of the following: 1. The understanding of the minor about the nature of, possible consequences of and alternatives to the intended abortion procedure. Any other evidence that the court may find useful in making the determination under par. Any information supplied by a minor to a member of the clergy in preparation of the petition under s. The court shall grant the petition if the court finds that any of the following standards applies: 158 1. That the minor is mature and well-informed enough to make the abortion decision on her own. The court shall prepare and file with the clerk of court findings of fact, conclusions of law and a final order granting or denying the petition within 24 hours after making the determination and order. A temporary reserve judge assigned under this subdivision to make a determination under par. Counsel for the minor, or the member of the clergy who filed the petition on behalf of the minor, if any, shall immediately, upon notification under subd. If the court has granted the petition, counsel for the minor, or the member of the clergy who filed the petition on behalf of the minor, if any, shall hand deliver a certified copy of the court order to the person who intends to perform or induce the abortion. If a clinic or medical facility is specified in the petition as the corporation, limited liability company, partnership or other unincorporated association that employs the person who intends to perform or induce the abortion, then counsel for the minor, or the member of the clergy who filed the petition on behalf of the minor, if any, shall hand deliver a certified copy of the order to an agent of the corporation, limited liability company, partnership or other unincorporated association at its principal place of business. An appeal by a minor from an order of the trial court denying a petition under sub. If a minor who is contemplating an abortion requests assistance from a county department under s. For the purpose of this Chapter, the following terms shall be defined as follows: (1) Minor shall be any person under the age of eighteen (18). Public and private hospitals, or public and private clinics or physicians licensed to practice medicine or osteopathy, shall not inform the spouse or parent of any minor patient of the provision of medical care and services to the minor or disclose any information pertaining to such care and services without the specific consent of the minor patient to whom such medical care and services have been provided under this Chapter. A minor who consents to the provision of medical care and services shall thereby assume financial responsibility for the costs of such medical care and services. Such counseling shall seek to open the lines of communication between parent and child. The clinics and hospitals which render said services are, likewise, hereby relieved of liability. Such notification or disclosure shall not constitute libel or slander, a violation of the right of privacy, or a violation of the rule of privileged communication. In the event that the minor is found not to be pregnant or not afflicted with venereal disease or not suffering from drug or controlled substance abuse, then no information with respect to any appointment, examination, test or other medical procedure shall be given to the parent, parents, legal guardian or any other person. The standard mileage rate al- lowed for operating expenses for a car when you use it for medical reasons is 17 cents a mile. Useful Items Introduction You may want to see: This publication explains the itemized deduction for medi- cal and dental expenses that you claim on Schedule A Publication (Form 1040). It also tells you how to report the de- Forms (and Instructions) duction on your tax return and what to do if you sell medi- 1040 U. Individual Income Tax Return cal property or receive damages for a personal injury. Medical expenses include dental expenses, and in this Schedule A (Form 1040) Itemized Deductions publication the term “medical expenses” is often used to 8885 Health Coverage Tax Credit refer to medical and dental expenses. They include the costs of This publication also explains how to treat impair- equipment, supplies, and diagnostic devices needed for ment-related work expenses, health insurance premiums these purposes. Medical expenses include the premiums you pay for in- See How To Get Tax Help near the end of this publica- surance that covers the expenses of medical care, and tion for information about getting publications and forms. We welcome your com- qualified long-term care services and limited amounts ments about this publication and your suggestions for fu- paid for any qualified long-term care insurance contract. Or you can write to: What Expenses Can You Internal Revenue Service Include This Year? If you use a “pay-by-phone” or “online” account to pay your medical Whose Medical Expenses expenses, the date reported on the statement of the finan- cial institution showing when payment was made is the Can You Include? If you use a credit card, include medical expenses you charge to your credit card in the year the You can generally include medical expenses you pay for charge is made, not when you actually pay the amount yourself, as well as those you pay for someone who was charged. There are differ- would have been deductible in an earlier year, you can file ent rules for decedents and for individuals who are the Form 1040X, Amended U. To include these expenses, you must have been insurance companies or other sources. This is true married either at the time your spouse received the medi- whether the payments were made directly to you, to the cal services or at the time you paid the medical expenses. Bill paid for the treatment after they mar- community property state and file separate returns, each ried. Bill can include these expenses in figuring his medi- of you can include only the medical expenses each ac- cal expense deduction even if Bill and Mary file separate tually paid. If they filed a joint return, the medical expen- live in a community property state and file separate re- ses both paid during the year would be used to figure their turns or are registered domestic partners in Nevada, medical expense deduction. Washington, or California, any medical expenses paid out of community funds are divided equally. This year, John paid medical expenses for of you should include half the expenses. John married Belle ses are paid out of the separate funds of one individual, this year and they file a joint return. Because John was only the individual who paid the medical expenses can in- married to Louise when she received the medical serv- clude them. Dependent How Much of the Expenses You can include medical expenses you paid for your de- Can You Deduct? For you to include these expenses, the person must have been your dependent either at the time the Generally, you can deduct on Schedule A (Form 1040) medical services were provided or at the time you paid the only the amount of your medical and dental expenses that expenses.

The traffickers were believed to 68 World Customs Organization order cefixime 200 mg overnight delivery necro hack infection, Customs and Drugs Report 2009 discount 200mg cefixime with mastercard antibiotic jaundice. Turkish Report on Drugs and 159 World Drug Report 2011 discovered in Istanbul in September 2009 discount cefixime 200mg without prescription virus - ruchki zippy. In by air to countries in East and South-East Asia such as 2010 seizures of Captagon tablets fell to 1 cheap cefixime 100mg without a prescription antibiotics oral contraceptives. Indonesia also mentioned the Islamic Republic of Iran Increased seizures of methamphetamine in the as a source country for methamphetamine in 2009, and Islamic Republic of Iran Turkey as a transit country. Trafficking of metham- phetamine from the Islamic Republic of Iran via Turkey Starting in 2005, the Islamic Republic of Iran has seized was also confirmed by Philippine authorities. In the first nine months of 2010, the country seized 883 kg of Asia-Pacific: Increased seizures of methamphetamine, up from 571 kg in 2009. The Islamic Republic Cambodia, the Lao People’s Democratic Republic, of Iran reported that, in 2009, methamphetamine traf- Myanmar, Thailand, Viet Nam and bordering provinces ficked on its territory originated in North-West Asia, of south China - continued to be affected by manufac- South-East Asia and northern and western Europe, with ture, trafficking and consumption of methamphetamine 1% manufactured domestically. In 2009, seizures in East and South-East detection of six ‘kitchen’ laboratories manufacturing Asia rose by more than one third, from 11. In relative terms, Thailand recently also registered Iran registered legitimate requirements of 55 mt of the significant increases. The largest seizures in the Asia- precursor pseudoepehedrine, the fourth largest level Pacific region continued to be made by China, while worldwide for that year. East and South-East Asia as a whole continued to According to Thai authorities,76 there was an emergent account for approximately one half of global seizures of trend of Iranian nationals trafficking methamphetamine methamphetamine. This pattern was also observed in Japan, sification in trafficking routes, with methamphetamine where Iranian nationals accounted for one fifth of arrests reaching the region from Africa and the Islamic Repub- of non-resident foreigners related to methampheta- lic of Iran. According methamphetamine on flights from the United Arab 81 to Chinese authorities, there was an increase in traf- Emirates. There was also an increase in the domestic manu- 72 Ministry of Interior, Turkish National Police, Department of Anti- facture of illicit drugs, with the number of dismantled Smuggling and Organized Crime. Drug control substances involved were mainly amphetamine-type in 2008, Annual Report and Rapid Situation Assessment, stimulants and ketamine. In a single seizure in May 2009, Malaysian police seized 20 978 kg of high purity crystalline methamphetamine in the city of Johor Bahru. Indonesia also reported 5 the seizure of five ‘kitchen’ methamphetamine laborato- 0 ries in 2008 and 17 in 2009. The general declining trend in ecstasy seizures prevalent worldwide since 2007 (with the exception of North Rest of the world America) was also to be seen in several countries in the North America Asia-Pacific region. By 2009, ecstasy seizures in China, East and South-East Asia Indonesia, Japan, Malaysia and Thailand had fallen sig- China nificantly by comparison with the level in 2007. How- ever, Indonesia reported that nine ‘kitchen’ laboratories In 2009, a notable increase in methamphetamine sei- manufacturing ecstasy were seized in 2008 and 18 in zures was registered in Myanmar, where annual seizures 2009. This increase amphetamine, methamphetamine and ecstasy, with no was concurrent with a similar increase in heroin seizures single type dominating the market. In 2009, Australia in the same country and may reflect a strengthened pres- seized 56 kg of amphetamine, 150 kg of methampheta- ence of law enforcement agencies in parts of Myanmar. According to data were manufacturing amphetamine or methampheta- collated by the Drug Abuse Information Network for mine. New Zealand also seized smaller quantities of Asia and the Pacific, seizures of methamphetamine tab- amphetamine, methamphetamine and ecstasy; however, lets rose from 14 million in 2007 to 22 million in 2008 all 135 seized laboratories reported by New Zealand and 27 million in 2009, while seizures of crystalline were manufacturing methamphetamine. Several African countries appear to be affected by trafficking in, and consumption of, diverted 82 In its reply to the Annual Reports Questionnaire for 2009, Thailand or counterfeit prescription drugs containing controlled reported seizures of 2. Morocco reported 40 36 seizures of 48,293 units of psychotropic substances in 35 2008, rising to 61,254 in 2009 and 105,940 in 2010. Algeria reported aggregate sei- 20 20 1718 zures of 90,630 tablets of sedatives and tranquillisers in 15 13 12 2009. Côte d’Ivoire seized 43 kg of amphetamine in 11 10 10 2008, as well as 17,155 amphetamine tablets (in addi- 10 87 6 tion to seizures of clonazepam and diazepam tablets). The World Customs Organization also 0 reported that Sudanese officials foiled an attempt to smuggle 18. Cathinone/methcathinone Every year from 2000 to 2009, Egyptian authorities *Covers the period 1 April 2008 to 31 March 2009 seized small quantities of ‘ecstasy tablets’. Seizures exceeded 10,000 tablets in 2006, but had fallen to 203 tablets by 2008 to 76 tablets in 2009. In April 2010,88 Methamphetamine trafficking from Africa to Japan one methamphetamine laboratory was seized in Egypt. The proportion of methamphetamine seized in club drugs such as ecstasy and cathinone, continued to Japan that was sourced from Africa increased from 7. The West and tion of ecstasy, were manufactured locally in clandestine Central African countries of Benin, Nigeria, Cameroon laboratories, while ecstasy was mainly smuggled in from and Senegal were prominent among the source countries Europe by air freight and parcel post. South Africa also reported that an increase of this trend, together with reports from other countries in methamphetamine trafficking allowed for a decrease in the region, suggests that African trafficking syndicates prices. Countries in West Africa, which have assumed an important role in the trafficking of cocaine, are also vulnerable to a potentially increased role in the traffick- 86 Official communication from the Government of Morocco. The replies to the Annual Reports Questionnaire for the year 2009 and ing or manufacture of other drugs, including ampheta- 2010 from the Kingdom of Morocco were not available at the time mine-type stimulants. In a separate single seizure, also in July 2009, the high level of 2008, was partly offset by increased Nigerian officials seized 10 kg of crystalline metham- seizures in France, while seizures in Germany continued phetamine and 10 kg of amphetamine along with 57 kg the gradually increasing trend that can be traced back to of the precursor chemical ephedrine. Among all countries worldwide, the Netherlands made at the departure concourse of a flight en route to continued to be the most frequently mentioned country South Africa. In 2010, Nigeria seized 75 kg of meth- eight amphetamine laboratories in 2009, and identified amphetamine: over the nine-month period May 2010 Germany, Scandinavia and the United Kingdom as the – January 2011, 11 out of 150 seizures made by author- main destinations for amphetamine manufactured in ities at Murtala Muhammed International Airport Poland. Seizures of ecstasy in Europe have declined sharply, Europe: Amphetamine seizures appear to recede standing at 1. Amphetamine The decreases were prevalent throughout Europe but seizures in West and Central Europe reached a record were more pronounced in some countries than others; level (8. In 2007 and 2008, the Nether- accounted for a dominant portion of European ‘ecstasy’ lands, the United Kingdom and Germany collectively seizures (notably the United Kingdom and, up till 2008, accounted for more than 70% of annual amphetamine the Netherlands), in 2009 the largest ‘ecstasy’ seizures seizures in West and Central Europe, and in 2009 the reported by European countries were made in Turkey United Kingdom and Germany accounted for the larg- (432,513 tablets) and Spain (404,334 tablets), while est and second largest seizure levels in Europe, respec- Poland registered seizures comparable with the quanti- tively. Seizure data from the Netherlands for 2009 were ties seized in the United Kingdom (6% of the European not available; however, a comparison of seizure totals for total). Poland assessed that some of the `ecstasy’ on 2008 and 2009 excluding the Netherlands indicates a its territory originated in Poland itself, as well as the decline of 20%. Over the period 2002-2009, Lithuania syndicates were accepting payment for cocaine in the and the Netherlands were the European countries most form of ‘ecstasy’ tablets manufactured in Europe. Similar frequently mentioned as a country of origin for meth- arrangements were also reported from other European amphetamine, followed by Poland, the Czech Republic countries in the past. The Czech Republic reported seizures have seen the emergence of methamphetamine manu- of a large number of methamphetamine laboratories facture, trafficking and consumption in parts of Europe. Methamphetamine in pill form has been reported as the primary drug of use in the Lao People’s Demo- 600 cratic Republic and Thailand, while methamphetamine in crystalline form has been reported as the primary 400 drug of use in Brunei Darussalam, Cambodia, Japan, the Republic of Korea and the Philippines. Metham- 200 phetamine in pill and crystalline form ranked as the 0 second most commonly used drug type in China, with 2005 2006 2007 2008 2009 ‘ecstasy’ ranking third. In Indonesia, crystalline meth- amphetamine and ‘ecstasy’ ranked as the second and third most commonly used drugs, respectively. Almost 90% of this was seized in China, which, along with India, is one Over the past few years, several expanding markets have of the major source countries for ketamine in the region. For example, the market for Ketamine seizure figures are almost certainly under- methamphetamine in Viet Nam has grown as the coun- reported, particularly in Asia. Ketamine is not under try becomes an attractive target for traffickers due to its international control and only some countries in the large, increasingly affluent and urban population.

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