Condet

Mark James Levis, M.D., Ph.D.

• Program Leader, Hematologic Malignancies and Bone Marrow Transplant Program, Sidney Kimmel Comprehensive Cancer Center
• Professor of Oncology

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0007613/mark-levis

The major ingredient in these products is (A) ammonium chloride (B) calcium chloride (C) potassium chloride (D) potassium iodide (E) none of these 31 medicine 95a pill 75mg clopidogrel otc. Benzalkonium chloride is a germicidal sur- factant that is rendered inactive in the presence of (A) organic acids (B) gram-negative organisms (C) cationic surfactants (D) soaps (E) inorganic salts 27 symptoms 4 days post ovulation cheap clopidogrel 75 mg on-line. Which of the following statements concern- purified water are mixed is primarily due to (A) attractive van der Waals forces (B) covalent bonding (C) hydrogen bonding (D) ionic bonding (E) temperature changes 28 medicine 02 clopidogrel 75 mg online. Which one of the following sequences lists the three types of cautions in the order of least serious to most serious According to the Poiseuille equation medications you can take when pregnant cheap clopidogrel 75 mg amex, the factor that has the relatively greatest influence on the rate of flow of liquid through a capillary tube is the (A) length of the tube (B) viscosity of the liquid (C) pressure differential on the tube 64 3: Pharmacy 34. A comparison of individual amino acids present in commercial amino acids injection solutions may be found in I. Which one of the following needles is most suited for the administration of insulin solutions The containers used to package drugs may consist of several components andlor be composed of several materials. The release of an ingredient from packaging components into the actual product is best described by the term (A) adsorption (B) absorption (C) leaching (D) permeation (E) porosity 36. The gauge number refers to the (A) bevel size (B) external diameter of the cannula (C) internal diameter of the cannula (D) length of the needle (E) size of the lumen opening 37. Insulin preparations are usually administered by (A) intradermal injection (B) intramuscular injection (B) 21G 1/2" (C) 21G 5/8" (D) 25G 5/8" (E) 25G I" 40. The term "venoclysis" is most closely associated with (A) intravenous injections (B) intrathecal injections (C) intravenous infusions (D) intrapleural withdrawals (E) peritoneal dialysis 41. The designation "minibottles" refers to (A) partially filled parenteral bottles with 50- to 150-mL volumes (B) any parenteral bottle with a capacity of less than 1 L (C) 10 to 30 mL glass vials (D) prescription bottles with capacities of 4 oz or less (E) vials with a capacity of less than 10 mL 42. The term "piggyback" is most commonly associated with (A) intermittent therapy (B) intrathecal injections (C) intravenous bolus (D) slow intravenous infusions (E) total parenteral nutrition 43. What is the approximate maximum volume of fluid that should be administered daily by intravenous infusion to a stabilized patient Although isotonicity is desirable for almost all parenterals, it is particularly critical for (A) intra-articular injections (B) intradermal injections (C) intramuscular injections (D) intravenous injections (E) subcutaneous injections 46. Which one of the following designations is most appropriate for a medical order requiring an intravenous bolus injection Which one of the following commonly available large-volume dextrose solutions for intravenous use is isotonic The usual expiration date that should be placed on a parenteral admixture prepared in a hospital pharmacy is (A) 1 hour (B) 24 hours (C) 48 hours (D) 72 hours (E) 1 week 66 3: Pharmacy 53. Which of the following types of injection routes should be limited to volumes of 1 mL or less Which one of the following parenteral solutions is considered to most closely approximate the extracellular fluid of the human body Parenteral solutions that are isotonic with human red blood cells have an osmolality of approximately how many mOsm/L A health worker will inject the smallest volume of drug solution when using which one of the following routes of administration What is the usual maximum volume allowed as a parenteral package for Bacteriostatic Water for Injection All of the following are used for the prophy- for active immunization against measles (rubeola) All of the following are bacterial infections usually administered by what type of injection Which of the following preparations will in- duce passive rather than active immunity There is the equivalent of 20 mL of absolute alcohol present in every 100 mL of syrup. Which of the following is considered effec- cluded in topical formulas as sunscreens

Those injections with a value of approximately 300 mOsm/L will be isoosmotic and presumably isotonic with the blood treatment 2011 discount 75 mg clopidogrel free shipping. One calculates the osmolarity of a solution by first determining the millimoles of chemical present medications prescribed for depression cheap clopidogrel 75mg with amex, then multiplying by the number of ions formed from one molecule medicine daughter purchase 75 mg clopidogrel mastercard. The health professional simply has to engage the vial into the bag treatment notes generic 75mg clopidogrel mastercard, thus allowing reconstitution of the powder and subsequent mixing with the main body of diluent. The 1M route is not used since it may be painful and also may cause a localized hematoma. The Abbott system uses a filtered airway that is an integral part of the administration set. Insulin is filtered through the glomeruli and reabsorbed by the tubules, where some degradation occurs. Approximately 50% of the insulin that reaches the liver through the portal vein is destroyed. The fat-soluble vitamin E also possesses antioxidant properties, especially within the body. Answers: 55-72 97 Vitamin D 2 prevents or treats rickets and is used in the management of hypoparathyroidism and hypocalcemia. Of the five antibiotics listed, it is the only one marketed as an aqueous solution, ready for injection. Toxicity, preservative effect, and lipid solubility all increase as the molecular weight increases. Of the four esters-methyl, ethyl, propyl, and butyl-the latter two are more suitable for oils and fats. They are often used in combination with each other, but these chemicals are slow-acting and are now unacceptable as ophthalmic antimicrobial preservatives. Passive immunity does not last long; usually not more than 2 or 3 weeks of protection are achieved. Active immunity implies that the recipient of the biological will develop specific immunity due to an active response to the introduction of antigenic substances. Usually the vaccine is administered as part of the measles, mumps, and rubella virus mixture. However, all individuals born after 1956 are considered susceptible to natural measles and should be revaccinated if they are unable to show immunity to measles. Tuberculin can be administered intracutaneously (Mantoux test) or by the multiple-puncture method (tine test). The first strength (1 U) is generally used for individuals suspected of being highly sensitive, and the second strength (250 U) is exclusively for those who did not react to previous injections of either 1 or 5 units. These units are ideal when reconstituting an antibiotic powder for transfer into several minibottles or bags. There are also special forms for individuals exposed to mumps, pertussis, tetanus, vaccinia, and rabies. Two additional injections are given at 6-week intervals, with a final dose given 1 year later. Active immunizations are usually accomplished by the administration of one of the following: (1) toxoids, (2) inactivated (killed) vaccines, (3) live attenuated vaccines. It is effective against both gram-positive and gram-negative bacteria as a skin cleanser, hand wash and surgical scrub. However, they must not be used concurrently because the charcoal will adsorb the active alkaloids present in ipecac syrup. If both agents are to be administered, it is best to induce vomiting first with the ipecac, then administer the charcoal to absorb remnants of the poison. Often a mild cathartic such as magnesium sulfate is administered after the charcoal. Some charcoal products already contain either sorbitol or methylcellulose as a laxative. The "universal antidote" is a mixture of activated charcoal, magnesium oxide, and tannic acid. Only the charcoal in this combination is effective, and its activity is probably reduced by the other two ingredients. Methyl salicylate (oil of wintergreen) is included in topical products mainly for its pleasant odor.

The gamma energy is weak enough to achieve good collimation medications 5 songs 75 mg clopidogrel with mastercard, yet strong enough to penetrate tissue sufficiently to permit deep-organ scanning 909 treatment 75mg clopidogrel sale. Radioisotope generators treatment yeast uti purchase clopidogrel 75mg on-line, or "cows treatment xanax overdose generic clopidogrel 75 mg free shipping," have been developed to deal with this problem. A radioisotope generator is an ion-exchange column containing a resin of alumina on which a long-lived parent nuclide is absorbed. Radioactive decay of the long-lived parent results in the production of a short-lived daughter nuclide that is eluted or "milked" from the column by means of an appropriate solvent such as sterile, pyrogenfree saline. Original concentration After one half-life (1 day) After two half-lives (2 days) After three half-lives (3 days) = = = = salt pH = pKa + log -:-d aCl 10,000 units/mL 5,000 units 2,500 units 1,250 units pH = 9. Strong acids ionize almost completely into hydronium ions and the corresponding anions. Of the acids listed, boric acid has the highest pKa; thus, it is the weakest of these acids. In preparing a buffer system, one should choose an acid or a base with a pKa close to the desired pH. For example, lactic acid and sodium lactate can be combined to obtain a pH of exactly 4. The needed molar concentration of each may be calculated by using the Henderson-Hasselbalch equation. The duration of activity of drugs with half-lives between 2 and 8 hours can be extended to obtain convenient once- or twicedaily dosing. Although it would be desirable to increase the therapeutic duration of those drugs with half-lives of less than 2 hours, the required high drug-release rates and high drug concentration in the dosage form reservoir usually preclude sustained-release dosage formulation. Also, individual biologic variation could result in either sub- or hypertherapeutic blood levels. Drugs with halflives greater than 8 hours usually have long intervals between dosing, making sustainedrelease formulations unnecessary. Some pellets are uncoated to give almost immediate drug release, whereas other pellets have lipid coatings of various thicknesses. Thus, the initial dose is reinforced with additional drug release over periods of time. Another group of products based on the same principle are the sequels such as Artane, Diamox, and Ferro-Sequels. Almost all sustained-release products are designed for the treatment of chronic conditions in which acute dosing adjustments are not necessary. Hopefully, sustainedrelease products will improve patient compliance by requiring less frequent dosing. Since phospholipids have both hydrophilic and hydrophobic portions, either lipophilic or hydrophilic drugs may be incorporated into the structure. Liposomal forms of amphotericin B have activity targeted at fungi localized in tissue, thus allowing lower doses and fewer side effects. The chemotherapeutic agent, doxorubicin, has been formulated into parenteral liposomes with reduced cardiotoxicity when compared to the conventional product. Tilade Inhaler (Nedocromil) is used in maintenance therapy in patients with mild to moderate bronchial asthma. Intal inhaler (cromolyn sodium) is a mast-cell stabilizer, which prevents acute bronchospasms. A somewhat similar product is E-Mycin Delayed Release Tablets, which are enteric-coated tablets. It is available as a regular 10-mg tablet and as Claritin Reditabs, which contain 10 mg of micronized drug for faster dissolution by placement on the tongue. When it reacts with hydrochloric acid in the stomach, hydrated silicon dioxide, which may coat ulcers, is formed. Gaviscon and Gaviscon-2 contains alginic acid, which forms a viscous solution, thereby prolonging contact time. All of the other Gaviscon products (Extra Strength and Liquid) contain aluminum hydroxide and magnesium carbonate but no magnesium silicate. Side effects include constipation, which may be prevented by combining calcium carbonate with either magnesium carbonate or magnesium oxide. Prolonged use of calcium carbonate may result in the formation of urinary calculi. It is fitted onto the syringe body either by a locking system such as the Luer-Lok or by a simple friction fit.

Downloaded by [Chulalongkorn University (Faculty of Engineering)] at 222 Pediatric Nail Disorders 81 medicine klimt generic clopidogrel 75 mg line. Imaging of osteochondroma: Variants and complications with radiologic-pathologic correlation treatment high blood pressure discount clopidogrel 75 mg online. Diagnostic features 911 treatment for hair clopidogrel 75 mg, differential diagnosis medications kidney disease order 75mg clopidogrel fast delivery, and treatment of subungual osteochondroma. Insights into enchondroma, enchondromatosis and the risk of secondary chondrosarcoma. Review of the literature with an emphasis on the clinical behaviour, radiology, malignant transformation and the follow up. Chondrosarcoma of the phalanx: A locally aggressive lesion with minimal metastatic potential: A report of 35 cases and a review of the literature. Nail dystrophy as a presenting sign of a chondrosarcoma of the distal phalanx-Case report and review of the literature. Downloaded by [Chulalongkorn University (Faculty of Engineering)] at Nail Tumors in Children 223 110. Giant cell tumor of the distal phalanx of the biphalangeal fifth toe: A case report and review of the literature. An isolated granular cell tumour of the thumb pulp clinically mimicking a glomus tumour. Clinical profile of Langerhans cell histiocytosis at a tertiary centre: A prospective study. Downloaded by [Chulalongkorn University (Faculty of Engineering)] at 224 Pediatric Nail Disorders 138. Multiple exostoses syndrome presenting as nail malalignment and longitudinal dystrophy of fingers. Hereditary multiple exostoses: Report of a case presenting with proximal nail fold and nail swelling. Glomus tumors in neurofibromatosis type 1: Genetic, functional, and clinical evidence of a novel association. Painful glomus tumour of the thumb in an 11-year-old child with neurofibromatosis 1. Skin lesions in children with tuberous sclerosis complex: Their prevalence, natural course, and diagnostic significance. Multiple ungual fibromas as an only cutaneous manifestation of tuberous sclerosis complex. Successful treatment of subungual fibromas of tuberous sclerosis with topical rapamycin. Juvenile hyaline fibromatosis: A case report follow-up after 3 years and a review of the literature. Congenital hypertrophy of the lateral nail folds of the hallux: Clinical features and follow-up of seven cases. Downloaded by [Chulalongkorn University (Faculty of Engineering)] at 16 the Painful Nail Marie Caucanas and Bertrand Richert Onychalgia comes from the rich innervation of the terminal phalanx, with 60% of digital nerve axons. Ungual pain develops in the context of a unique anatomic configuration: the absence of subcutaneous tissue between the plate and the underlying bony phalanx, added to the presence of fibrous collagenic fibers firmly attaching the plate to the terminal phalanx, thus making the subungual space virtual, without possible dilation. With the help of the parents, the anamnesis aims to qualify the pain: its way of development (quick, progressive, insidious); its type (continuous, repetitive, throbbing); its intensity (acute, moderate, mild); its rhythm (diurnal, nocturnal); and the existence of precipitating, aggravating, or relieving factors (pressure, temperature, elevation of the limb, drug). Traumas Nail bed injuries are the commonest pediatric hand injuries presented to the emergency department. These injuries are often underestimated and, consequently, delegated to the most junior and inexperienced staff. This is mainly their sequelae that are a frequent cause of pediatric nail consultation. Too often, patients ask for help for late dystrophies resulting from inadequate management of a nail trauma in early childhood. Radiographs should always be performed and hand surgeons involved if necessary (Figure 16. Great care should be taken in their management, as initial care and treatment are vital for the best patient outcome.

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References

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