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Severe cases of tetanus and status epilep Reversal has also been obtained in neuroleptic ticus, who are not controlled by diazepam or malignant syndrome, though this reaction has a other drugs, may be paralysed by a neuromus different pathogenesis. Troublesome diarrhoea is Dantrolene this muscle relaxant is chemically another problem. Long term use causes dose and pharmacologically entirely different from dependent serious liver toxicity in 0. This has restricted its use in chronic resembles that of centrally acting muscle disorders. Thus, responses to repetitive nerve Receptor) calcium channels in the sarcoplasmic stimulation are reduced. It decreases muscle reticulum of skeletal muscles and prevents Ca2+ tone in myotonia congenita. Since Ca2+ channels in the sarcoplasmic reticulum of cardiac and smooth muscles are these are drugs which reduce skeletal muscle of a different subtype (RyR2), these muscles tone by a selective action in the cerebrospinal are affected little by dantrolene. They selec Dantrolene is slowly but adequately absorbed tively depress spinal and supraspinal polysynap from the g. It penetrates brain and produces tic reflexes involved in the regulation of muscle some sedation, but has no selective effect on tone without significantly affecting monosynap polysynaptic reflexes responsible for spasticity. All centrally acting muscle relaxants do disorders, hemiplegia, paraplegia, cerebral palsy have some sedative property. Decrease muscle tone without reducing Cause muscle paralysis, voluntary movements voluntary power lost 2. Used in chronic spastic conditions, Used for short-term purposes acute muscle spasms, tetanus (surgical operations) on neuromuscular transmission and on muscle 3. Chlorzoxazone It is pharmacologically fibres, but reduce decerebrate rigidity, upper similar to mephenesin, but has a longer duration motor neurone spasticity and hyperreflexia. Chlormezanone It has antianxiety and (i) Mephenesin Mephenesin, hypnotic actions as well, and has been used for congeners Carisoprodol, tension states associated with increased muscle Chlorzoxazone, tone. Mephenesin It was the first drug found to cause muscle used for orthopedic procedures and tetanus. It is not used clinically because orally it causes marked gastric irritation, Clinical efficacy of none of the above drugs and injected i.

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Prophylaxis against bacterial, viral or fungal infections is advised after bone marrow or haematopoietic stem cell transplantation or in high-risk patient after chemotherapy. Infections following haematopoietic stem cell transplant are generally similar to that in the solid organ transplant setting. It is recommended that these measures be continued in patients with active graft-vs-host disease and in those remaining on high dose immunosuppressive agents. Modification of antibiotic regimen if deterioration of clinical status or if there is no clinical improvement in 72-96h in a stable patient d. The antibiotics are generally kept for a minimal duration of 5 to 7 days or stopped if afebrile for 3 days in patients with improving neutrophil counts. Venous cannula must be inspected daily for signs of phlebitis and changed every 72h or when necessary. Central devices are to be removed if there is clinical deterioration in spite of appropriate antibiotics for 48-72h References: 1. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropaenia. Surviving sepsis campaign : international guidelines for management of severe sepsis and septic shock. Granulopoiesis-stimulating factors to prevent adverse effects in the treatment of malignant lymphoma. Empirical antibiotics against Gram-positive infections for febrile neutropenia : Systemic review and meta-analysis of randomized controlled trials. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European conference on the infections in Leukaemia. Empirical antibiotic monotherapy for febrile neutropenia: Systematic review and meta-analysis of randomized controlled trials. Primary prophylaxis of invasive fungal infections in patients with hematologic malignancies. Recommendations of the Infectious Diseases Working Party of the German Society for Haematology and oncology. Gastroenteritis: 7-10 days Bacteraemia: 14 days Recurrent: 2-6 weeks Campylobacteriosis Mild to Moderate Disease Duration: Campylobacter sp. Few may deteriorate due to immune reconstitution Cryptosporidiosis Cryptosporidium sp. Refer Copious irrigation with topical saline (including neonates) to Sexually Transmitted drops or artificial tears every 30-60 Neisseria Gonorrhoea Infections & Neonatal Infection minutes Sections Ciprofloxacin 0.

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Eyelash changes are usually reversible upon the recommended dosage is 1 drop in the affected eye(s) once daily in the discontinuation of treatment. If more than 1 topical ophthalmic drug is being used, Adverse Reactions the drugs should be administered at least 5 minutes apart. In postmarketing use with prostaglandin analogs, periorbital increase the pigmentation of the iris, periorbital tissue (eyelid), and eyelashes. After Use in Specic Populations discontinuation of travoprost, pigmentation of the iris is likely to be permanent, Use in pediatric patients below the age of 16 years is not recommended because while pigmentation of the periorbital tissue and eyelash changes have been of potential safety concerns related to increased pigmentation following long-term reported to be reversible in some patients. Inthe offspring of female rats that received travoprost subcutaneously fromDay 7of pregnancy to lactationDay 21at doses of 0. Neonataldevelopment wasalso affected,evidencedby delayedeye opening,pinna detachment andpreputialseparation, andby decreased motor activitytt. Reduction of the intraocular pressure starts approximately 2 hours after the rst administration with Pediatric Use maximum effect reached after 12 hours. If more than one topical ophthalmic drug is being used,the drugs should be Geriatric Use administered at least ve (5) minutes apart. After discontinuation of travoprost,pigmentation of the iris is likely to be permanent, while didnot showany evidence of carcinogenic potential. Patients who receive treatment should be informed of the possibility of increased pigmentation. Patients should be instructed to avoid allowing the tip of the dispensing container to contact the eye, surrounding structures,ngers, or any other surface in order to avoid contamination of the solution by Bacterial Keratitis common bacteria known to cause ocular infections. Serious damage to the eye and subsequent loss of There have been reports of bacterial keratitis associated with the use of multiple-dose containers of vision may result from using contaminated solutions. These containers had been inadvertently contaminated by patients who, in most cases, had a concurrent corneal disease or a disruption of the ocular epithelial surface. When to Seek Physician Advice Patients should also be advised that if they develop an intercurrent ocular condition. Ocular adverse Rx Only reactions reportedat anincidence of 5 to 10%in theseclinicalstudiesincludeddecreased visual acuity, eye U. Understanding this is strument, I go through one of the frag neal disease can potentially limit the important to avoid having a false sense mentation lines into the mid-periphery energy penetration.

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