Six September 1965 in Pakistan a Great War in Asia

First of all the question is that what is this 6 September 1965? These words have a great importance in the history of the Pakistan because it is the defense day of the Pakistan. On that day a great took place between Pakistan and India. These two countries fight with each other on the issue of Kashmir. Pakistanis thought that Kashmir is the part of the Pakistan and Indians thought that Kashmir is the part of the India. So they fight with each other because of the Kashmir.

India invades in Pakistan and wants to rule the Pakistan. They came near the river known as the Ravi. But they do not know that Pakistani forces are waiting for them. Pakistani army opened their fire on the Indian soldiers. Indians fight back and this war continue for many days without any result. Many of the soldiers of both countries died in this war. But at the end Pakistani soldiers take control of the situation and won the war. Although Pakistan won this war but his loss is huge. Many of the soldiers of the Pakistan gave their life for their country but the others were happy because they won the war. On the other hand loss of India was much more than Pakistan because they lose the war, they spend a lot of money on this war, and they lose their men and many more things. Pakistan’s air force was the best at that time. On 6 September there is a holiday in the whole Pakistan. Different programs are held on this issue. Pakistani army gave their salute to the soldiers who gave their lives for the Pakistan. In the morning first of all they give honor with the guns and then president of Pakistan raise the national flag of the Pakistan. Then national song of the Pakistan is sung by the army. Then army shows the people their achievements in the army. They show their guns, tanks, different kind of missiles and many more things. At the end I will only say that this day has very importance in the lives of the Muslims of the Pakistan because it is the defense day of the Pakistan. At that day they won the war against the Indians and protect the Kashmir from the army of the India. This is the all about the 6 September 1965 or you can also say it the defense day of Pakistan. 

How We Can Make VCC for Payapal

It is matter of fact that not all the internet users have their own credit card so they can not enjoy the convenience of transaction. People always hesitate in while showing their credit card information with the fear that their credit card information might not compromised. To solve these problems, business developers came up with brand new solution for these problems and that is VCC.

VCC stands of virtual credit card, it is new term it is similar to the debit card as most of the VCC are pre loaded and some time reload option is also present. VCC is just like the debit card but only major difference is you don’t have any physical card. You can do shopping and transaction online with out any tension that your information might not compromised and you can reveal your information without any tension and fear. You can give your personal information without any tension and fear as you can use it with any kind of name or address. The VCC is accepted on all those sites which accept world top credit cards.

Any one belong to any part of the world are eligible for making his own virtual credit card. The application process of VCC varies with the different VCC provider. You have go the website of the VCC card provider and fill up the form and after that they will provide you a software to downloading and installation for security purpose of your VCC. After making the first payment (payment can be made through any online payment process such as liberty reserve, money booker, PayPal etc). they will send you information regarding your VCC card such as type of virtual credit card either it is Visa, Master Card or American express, your card number, verification code, and also expiry date of your virtual credit card. They also take monthly maintenance charges as well. The most of the user are using the Visa virtual VCC which is powered by the “Visa”. If some illegally use the VCC then all the responsibility in this case is of client not company.

Make your own virtual credit card now and enjoy the convenience of transaction you can use it online only you can not use it physically. The number of user of these virtual credit cards is increasing day by day as people getting the awareness of the benefits of virtual credit card in online payment process. 

Early Problems of Pakistan and India 1947

On the eve of its creation Pakistan faced a number of stupendous problems which hardly had any parallel in the history of the world especially of any newly born state. She had too many burdens to carry and too many problems to solve. She came into being almost with practically no central administration of office routine. She was a state without any practicable economic or geographic basis, political organization or political tradition with any pertinence to modern conditions. Militarily she was weak and defenseless, with enemies, not reconciled to her establishment, busy in conspiring to strangulate her on its very birth. But fortunately she had a great leader and organizer in person of Quaid-I-Azam to steer the ship of her destiny to safety and security. Almost single handedly he grappled with all these problems which would have broken a man of lesser mettle. But he was not a man to be over-powered by any danger, challenge or obstacle that confronted him. Under his inspired leadership the nation also showed its inherent strength to grapple with these problems with remarkable determination and success.

The shortage of trained human power especially senior officers was a serious problem in the setting up of federal government in Karachi. Most of them had migrated to India. There was a shortage of office space, equipment and furniture. This disturbed the direct connections between the federal government and provincial governments. On the other hand, the provincial governments were overburdened that needed very accurate connection between the center and the provinces to solve the problems of the Muslim refugees who had nothing to eat, drink, wear, rest, etc. To counter the critical situation, the official system should have been efficient but due to the lack of all these facilities the administrative authorities were painfully facing difficulties.

2: Division of Assets

The Indian government was not cooperative for transfer of record and equipment to Pakistan. The civil administration was not handing over the promised financial, military, and other shares that created mountainous hurdles to eradicate the pains and miseries of the refugees.

Financial Assets

The full financial share of Pakistan was not transferred. Initially rupees 200 million were transferred that were not sufficient to meet the expenditures of the newly born state. The Indian government was so reactionary that it tried its level best to block these funds to suffocate the newly born Muslim state as they expected foolishly that Pakistan would collapse and rejoin India soon after its existence. They did not release the remaining funds until Gandhi’s threat of man Bert (fast until death). Under this pressure, more funds were sent in early 1948 but no installment was later paid.

Cricket World Cup 2013 Results

Cricket is a game that has a huge fan following in the third world countries, with India and Pakistan being synonymous of an east against west clash.  Cricket is not just a game for these two countries.  It is war.  Both countries fight tooth and nail against each other to rise victorious by any means.  The teams of these countries labor day and night to develop that winning edge for each new match.  They also go to great lengths to make every game a sure win for their side.  Most often, they even go to the extend of accepting bribes and giving in to match fixing tactics, for the scourge of the victory-thirsty masses who follow the happenings in each match as if their lives depended on them.  The fans of the game are quite often disoriented by the cheap ways with which even some of the top players become a burden to their team through match fixing.  The Cricket World Cup 2013 Results were proclaimed in such tumultuous times, and to the well-earned satisfaction of fans all over the world, India was declared victorious.

World cup cricket, being the king of all cricket matches, is the favorite of cricket fans.  The support that the people of each participating nation give to their respective teams is just simply awe inspiring.  It is as if the fans see their cricket stars as gods.  When the games are being played, there is seldom a home in the countries that take part in the game that does not have their TV sets on, telecasting the match live.  World cup cricket is like an international festival for the young and the old alike.  Some people even give their lives for the game, especially, in Pakistan and India.  When the Cricket World Cup 2013 Results were announced, fans of the game, irrespective of country, rose in salute to the winning team, which was India.  India became the first country that rose victorious in a world cup series that was hosted on its own soil.  This victory gave a solid boost both to the winning as well as die hard fans of the game.

The world cup cricket 2011 was hosted in three countries, namely, India, Sri Lanka, and Bangladesh.  Though Pakistan was also supposed to be one of the hosts of the tournament, the attacks on the Sri Lankan cricket team in Lahore made them lose that opportunity.  In fact, Sri Lanka was hosting a world cup series for the first time.

The final match of the 2011 world cup cricket tournament was held between India and Sri Lanka.  The match in itself was a hair-raising affair.  Sri Lanka lost the match by six wickets.  The man of the match of the game was none other than the ever-powerful Mahendra Singh Dhoni.  The man of the tournament was the very talented Indian cricketer Yuvraj Singh.  To know the further details of this spellbinding match and also all the other matches in the tournament, just check out the Cricket World Cup 2013 Results online.

Triond is Best Site

Triond is not only a website, its platform where writers from across the world can interact with each other and can also publish their articles on the web site through which they can earn money as well. In the past earning money through Triond didn’t a good option but recently they have made some changes in there earning method, so that now you can earn more amount of money as compare to the past. For this reason Triond is become a best source for earning money through the articles. Here are few pros and cons about Triond.

You can earn money on Triond in two different ways, first when you publish your article on Triond, they pay your page views, the more number of people view your page more amount of money you earn, they pay you one penny for ten page views and secondly on the space above of your page views, you can also earn money throughGoogle Ad Sense from the moment you have published your first five articles on the Triond.

Unlike the other writing platforms, Triond has not put any kind of rules on the article length. It all depends upon the writer how long or short article he wants to writes and Triond will accept all the articles without putting any objection on the length. Triond is giving a forum to its writer, where they can interact with the other writers and if there is any question in your mind then this is a platform where you can ask it and there will be lot of person who will happily give answer of your question in this way you canmake friends on this platform. Triond is providing you a platform where you can create your personal online presence. There are lots of writer on Triond who are writing for some sort of income but still Triond always encourage them to keep going.

You can not create promotional links for other site on Triond as they have put “Not follow tag” in their anchor tag so Triond can not be use as site of creating back links. It is reported that when you incorporated your AdSenceaccount into Triond system the page views decreases significantly. So if you are earning well through your page views then there is no need of putting Google AdSence. Despites these cons Triond is consider as he best platform for creating online presence and becoming a part of search engine result. 

Developing a Pharmaceutical Care Plan

Patient care planning involves systematically assessing a patient’s health problems and needs, setting objectives, performing interventions, and evaluating results. Not all patients require a written PCP. Pharmacists must assess their own patients and identify specific areas on which to focus. For example, the pharmacist may want to identify patients with specific diseases (e.g., asthma, hypertension, diabetes mellitus, or hyper-cholesterolemia).

The development of a PCP can be summarized as a five step process involving the SOAP format (Subjective data, Objective data. Assessment, and Plan of care). Using the example in Figure 1 for an asthma patient, the process can be described as follows.

Step 1. Gathering Information

The pharmacist should gather an accurate medication history, including both prescription and non-prescription medications and the reasons the medications were prescribed or taken. The pharmacist will likely have to obtain some information from the physician, such as laboratory test results and hospitalizations. If so, the pharmacist should get written permission from the patient before soliciting this information. Once this information is compiled, the preparation of a PCP can begin.

Step 2. Identifying Problems

From the patient’s medication profile in Figure I, only one problem is evident: diagnosis of asthma. If applicable, the other problem should also be listed.

In Figure I, subjective and objective findings correlated to the problem are listed. Subjective findings are those that the patient describes (e.g., ’I feel tired all the time, “I feel bloated,” or “I woke up coughing”). References 12, 13, and 14 describe methods to ascertain this information. Objective findings are those that can be observed or measured by the pharmacist (e.g., patient appears tired, blood pressure is 180/105, pitting edema in ankles).

In the patient with asthma, the pharmacist would have the patient use a peak expiratory flow meter and record the results.

Stop 3. Assessing Problems.

The pharmacist analyzes and integrates tile information gathered in steps 1 and 2 and draws conclusions in preparation for developing a patient-specific PCP, For example, in the asthma case (Figure 1), the pharmacist may first investigate the etiology of the factors that exacerbated the asthma. The pharmacist does not have to be involved in skin testing, nor does the pharmacist have to conduct a detailed, extensive history of all of the factors that may have precipitated the asthma. However, the pharmacist should attempt to determine if drugs (e.g., aspirin, non-steroidal anti-inflammatory agents, or beta-blockers) caused or exacerbated the asthma in the patient. Thus, the importance of an accurate and complete drug history becomes evident 12, 14

Next, the pharmacist assesses the severity of the asthma. This could be accomplished (as shown in the plan) by determining the PEFR, examining the patient’s daily symptom and peak flow diary, or determining if the patient had been hospitalized and placed on steroidsor a mechanical ventilator.

Step 4. Developing the Plan

In step 4, the pharmacist establishes goals linked to each of the patient’s problems and specifies a course of action aimed at meeting each goal.

Each goal (i.e., desired improvement) should be stated in terms of measurable outcomes that indicate the extent to which the particular problem has been resolved. Often, the patient has several problems, and the plan must be comprehensive enough to have a positive effect on the overall health of the patient. 

Three Things Yоu Dіdn’t Κnоw аbоut Yоur Pharmacist Тhаt Соuld Save Yоur Life

One оf thе outcomes оf mоst life-altering diagnoses іs а treatment regimen thаt includes sоmе type оf medication. Тhе doctor hands уоu а prescription аnd оff tо thе pharmacy уоu gо. Моst people bеlіеvе thаt аll pharmacists dо іs count pills аnd slap а label оn thе bottle. Тhеу aren’t aware оf thе training involved іn bесоmіng а pharmacist аnd thаt training соuld save уоur life.

Pharmacists Κnоw Моrе Тhаn Doctors

Whether оr nоt уоur doctor wаnts tо admit іt, thе pharmacist knоws mоrе аbоut interactions оf medications thаn thе doctor. А huge component оf pharmacy training includes chemistry аnd learning thе interactions bеtwееn classes оf medication. Doctors аrе mоrе lіkеlу tо knоw аbоut thе drugs thеу mоst usе іn thеіr specialty, but dоn’t hаvе thе іn depth knowledge асrоss specialties.

Pharmacist аs Air Traffic Controller

When facing а life-altering health challenge уоu оftеn sее mоrе thаn оnе doctor, еsресіаllу іf surgery іs раrt оf thе treatment protocol. Yоu mау hаvе prescription frоm еасh doctor. Аs а patient, уоu mау bе overwhelmed wіth thе amount оf medication уоur tаkіng аnd іt mау nоt cross уоur mind tо tеll оnе doctor аbоut thе оthеr medications уоu’vе bееn prescribed. Yоur pharmacist аnd thаnks tо modern technology will knоw аbоut аll уоur prescribed medications. Тhе pharmacist will bесоmе alarmed іf sоmе оf уоur medications аrе knоwn tо interact іn а bad wау. Computer programs іn pharmacies аlsо аrе аblе tо cross reference interactions аnd display аn alert іf twо оf уоur medications mау interact рооrlу. Тhе pharmacist саn literally save уоur life.

How to take Patients History

Patients History.

Name: ABC        

Address: ABC

Age: x

Sex: x

Marital Status: x

Occupation: x

Religion: x

 Chief Complaint

The patient came in the emergency with complaint of high grade fever 102*F to 104*F and general body ache from last 4 days. He also vomited 4 to 6 times in last two days but he didn’t see any blood. Due to the body ache he is not stand in any position; swear body painand neck pain.

History of the patient’s illness

  The symptoms started to appear gradually about 5 days back when he returned from work, at first the patient experienced body fatigue with mild fever, next came general body ache with vomiting.                                                                       The patient told he had never had such high fever before. The patient had no idea what caused this condition. As the patient was experiencing this situation for the first time he was not sure of the aggravating or alleviating factors of the problem.

Past History

 On asking the patient and his mother told that he had no major childhood illness. As the patient’s family is illiterate he had never been vaccinated and never experienced any allergies or reaction to any medicine. He had never been hospitalized before and is not using any type of prescribed drugs.

Family history & illness

The patient has 9 siblings (7 sisters and 2 brothers) and 2 patents alive. No record of past illness is present but patients elder brother had the same signs & symptoms before him and was diagnosed with dengue fever. Other than that the patient’s family has no history of a major disease or illness.

Lifestyle

Patient does not smoke, , illicit drugs or recreational drugs. He informed that he takes three meals balanced diet daily and drinks plenty of water. Patient’s mother told that they are not getting clean water so they bring clean water form a different source.                                                                                                               Patients sleep and rest pattern is not altered, he sleeps around 8pm and wakes up at 6 am in the morning. Daily activities include going to work and coming back home.

What is Enzymes Kits

Enzymatic Kits:

Reagent kits (for the quantitative determination of serum 25-OH vitamin D, Alkaline Phosphatase and calcium) will be purchased from market.

Subjects:

These will be divided into three groups with fifty subjects in each group. First group will contain 50 healthy volunteer subjects (as control) with no current disease symptoms and medical history of arthritis or joints pain. Second group will contain 50 patients with clinically diagnosed and established Rheumatoid arthritis while third group will contain 50 patients with confirmed Gout.

Experimental design:

150 subjects will be divided into three groups.

  Sr.#          Groups         No. of subjects              Disease condition

1                   A                       50              Healthy (Controls)

2                   B                       50              Rheumatoid arthritis

3                   C                       50              Gout

Estimation of 25-OH vitamin D:

Principle:

The IDS 25-hydroxy vitamin D kit is an enzyme immunoassay for the quantitation of 25-OH D andotherhydroxylated metabolites in serum or plasma. Calibrators, controls and samples are diluted with Biotin labeled 25-OH D. the diluted samples are incubated in microtitre wells which are coated with a highly specipic sheep 25-OH D antibodies for 2 hours at room temperature before aspiration and washing. Enzyme (horseradish peroxidase) labeled avidin, is added and binds selectively to complexed biotin and, following a further wash step, colour is developed using a chromogenic substrate (TMB).The absorbance of stopped reaction mixtures are read in a microtitre plate reader, colour intensity developed being inversely proportional to the concentration of 25-OH D. (Hyponen et al 2007)

Estimation of Alkaline Phosphatase:

Principle:

Alkaline Phosphatase (ALP) hydrolyzes p-nitrophenyl phosphate into p-nitrophenol and phosphate. The rate at which p-nitrophenol is formed is directly proportional to alkaline phosphatase activity. (tietz et al 1983 )

        p-nitophenyl phosphate + H2O                     ALP            phosphate + p-nitrophenol

Estimation of serum calcium

Principle:

Breuer & Breuer diagnostic kit (Germany) to measure serum calcium will be used. Cresolphthalein complex one reacts with calcium ion in alkaline medium forming a red violet colour. Interference by magnesium is eliminated by addition of 8-hydroxyquinoline. Absorbance is directly proportional to the concentration of calcium in serum. (Baginski et al 1973)

Respiratory Syncytial Virus

Respiratory syncytial virus causes mild respiratory infections such as colds and coughs in adults and severe pulmonary diseases in children e.g. Pneumonia and bronchitis.

Family:

            Belongs to paramyxovirus family

            Prototype of pneumovirus genus of Pneumoviridae family

 Introduction:

Respiratory syncytial virus causes mild respiratory infections such as colds and coughs in adults and severe pulmonary diseases in children e.g. Pneumonia and bronchitis.

Family:

            Belongs to paramyxovirus family

            Prototype of pneumovirus genus of Pneumoviridae family

Shape of RSV

Genome:

Single RNA and helical nucleocapsid

Negative polarity

15 kb genome

Comprises of total 10 genes

Gene structure:

3̒-        NS1-NS2-N-P-M-SH-G-F-M2-L-5̒

            11 viral protein are encoded by:

N: nucleoprotein

P: phosphoprotein

L: RNA polymerase

M2: regulatory proteins:

NS1 and NS2 mediate resistance to interferon induced cellular antiviral responses.

Virus envelop contains:

M: internal matrix protein

SH: small hydrophobic protein

G: presumed attachment protein

F: fusion protein

F and G represent mahor targets for neutralizing antibodies/

Fusion proteins form surface spikes and cause the cells to fuse forming multinucleated giant cell called syncytia.

 Pathogenesis:

Incubation period: 3-6 days

Virus enters via oral and nasal pathways

Spread along epithelium of the respiratory tract, moving to lower tract may cause pneumonia or bronchitis.

In bronchitis, peribronchiolar inflammation with lymphocytes occurs.

In pneumonia, infiltration of intestinal cells with mononuclear cells is seen.

Inflammation of Bronchiole

Immunity:

Severe RSV disease develops in infants with high level of passive maternal antibodies. Maternal antibodies-RSV complex is formed.

Particular concern with premature babies who lack maturity and protective antibodies.

RSV immunity is assoctoiated to little or non-detectable interferon in nasopharyngeal secretions.

Continuous solid level of antibodies is required.

Vaccine produced was more lethal.

IgG appears in 2nd week of infection.

IgA is not found in infants.

IgM is transitory.

Respiratory Syncytial Virus

Clinical Findings:

In infants, RSV is an important cause of lower respiratory tract diseases such as bronchiolitis and Pneumonia.

RSV is also an important cause of otitis media in young children.

In older children and adults, RSV causes upper respiratory tract infections that resemble the common cold.

  Laboratory Diagnosis:

The presence of virus can be detected rapidly by:

Immunofluorescence on smears of respiratory epithelium.

Isolation in cell culture.

Rise in antibody titer of at least 4-fold is also diagnostic.

Treatment:

Aerosolized ribavirin (Virazole) is recommended for severely ill hospitalized infants, but there is uncertainty regarding its effectiveness.

A combination of ribavirin and hyper immune globulins against RSV may be more effective.

Treatment:

Aerosolized ribavirin (Virazole) is recommended for severely ill hospitalized infants, but there is uncertainty regarding its effectiveness.

A combination of ribavirin and hyperimmune globulins against RSV may be more effective.

Prevention:

There is no Vaccine.

Hyperimmune globulins are also available for prophylaxis in these infants.

Nosocomial outbreaks can be limited by hand washing and use of gloves.

How to Increase Breast Milk Production in Cows

How to increase milk production? This is one of the most common questions that many mothers have during their breastfeeding period. There are several options you have to increase your breast milk production.

One option is equalizing demand to the supply. If you can empty your breast every 2-3 hours a day, your breast milk production will dramatically increase. As a solution, you can use a hospital grade pump to increase your milk production.

Drinking more water also helps to increase the milk production. It is more important to refill fluids lost during breast feeding. Some says that drinking beer increases the milk production. How to increase milk production by drinking a beer?  It is not good for the baby. Drinking beer can reduce the milk production because breast milk flavored with alcohol can be refused by the baby. When the baby does not go to breast feed often, less breast stimulation will occur and it will cause to decrease the milk production.

Soda and coffee are also not good for breast feeding mothers. Caffeine is the main ingredients of those drinks. This ingredient is not good for mothers as well as for babies. Caffeine can remain in the system of the baby much longer time. Therefore do not take drinks with caffeine frequently. 

Milk production can be increased by adapting to certain food habits. Breast milk production is not often associated with a particular food item. But your food habit is a key component to increase your breast milk production. Some breast feeding mothers do not care much about their meals. Some mothers reduce the foods they take to lose their weights and some reduce taking foods with the aim of taking their previous body shape. This is too bad for breast milk production because foods you take provide a great contribution on milk production. Foods such as Brown rice, Beet, Avocados, Carrots, Barley, Dulse, Kombu are much suitable for breast feeding mothers. These foods contain vitamins and other nutrition that provide great support for milk production.

If you are a mother who search for how to increase milk production, these tips will really help you to increase your breast milk production. Therefore drink more water, take good meals every time and avoid taking alcoholic beverages and drinks that contain caffeine. Also do breast pumping if necessary. If you follow these simple steps, it is quite sure that you can increase your breast milk production. 

Here аrе places tо gеt help fоr patient’s wіth а narcotic problem

SAMHSA: Substance Abuse аnd Mental Health Services Association: Тhіs іs а wonderful site thаt соntаіns mаnу topics fоr thе public аnd professionals. Тhе government brochures thеу provide cover аll areas оf substance abuse. Prevention, treatment, аnd relapse topics аrе fоund hеrе. Іt іs аn invaluable resource fоr patients аnd professionals lооkіng fоr training аnd help wіth substance dependence. Іt іs аlsо good fоr families аnd friends lооkіng tо find drug fact іnfоrmаtіоn. Тhеіr web site саn bе fоund аt http://www.samhsa.gov/.

Al-Anon Family Groups: Тhіs organization sауs thеу provide "strength аnd hope fоr friends аnd families оf problem drinkers." Маnу wіth narcotic problems аlsо hаvе drinking problems. Аlthоugh thіs organization helps people enmeshed wіth problem drinkers, thеіr support groups аrе sо helpful, thаt thеу shоuld bе usеd bу families оf thоsе whо hаvе dual addictions. Іf уоur loved оnе оnlу hаs problems wіth pain pills, thеу саn direct уоu tо а good local support group. Тhеіr format іs sіmіlаr tо 12 step programs whеrе thеу sit іn groups. Тhеіr official site саn bе fоund: http://www.al-anon.alateen.org/.

NIDA:National Institute оn Drug Abuse covers аll thе "Science оf Drug Abuse аnd Addiction." Тhеу аrе а complete source fоr drug аnd alcohol usе іnfоrmаtіоn. Тhеіr agency соntаіns scientific іnfоrmаtіоn оn аll drugs оf abuse; аnd mass distribution pamphlets оn numerous drugs оf abuse; аlоng wіth thе latest rеsеаrсh аnd meetings.

Your local mental health authority. Еасh community hаs thеіr оwn programs fоr drug addiction. Yоu саn lооk іn thе Yellow Раgеs оr online аnd dо а search fоr уоu local bу lооkіng uр "community mental health" аnd уоur city аnd stаtе. Тhеsе local organizations hаvе thеіr оwn programs fоr drug abuse treatment. Іn addition, thеу аrе familiar wіth thе resources аnd health care professionals іn thе community thаt provide drug abuse treatment.

Adrenaline (C9H13NO3)

Definition:

Adrenaline is a natural stimulant made in the adrenal gland of the kidney. Its biological name is epinephrine, from the Greek “nephros” for kidney. Adrenaline is carried in the bloodstream and affects the autonomous nervous system, which controls functions such as the heart rate, dilation of the pupils, and secretion of sweat and saliva.

Adrenaline is a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives, and other symptoms of an allergic reaction.

Purpose:

Frequently used to aid in weaning off bypass due to its potent b1 stimulation

•          Bradycardia [heart blocks] & cardiac arrest

•          Ventricular dysfunction, vasodilatation, bronchoconstriction, anaphylaxis

•          Drug of 1st choice in anaphylactic shock as:

i) Vasopressor; elevates systolic BP due to:

a) Positive inotropic & chronotropic cardiac effect [b1-receptors]

b) Vasoconstriction [a-receptors]

ii) Antihistamine action

iii) Bronchodilator [b2-receptors]

Side Effects:

Common side effects include agitation , increased heart rate, sweating, sleeplessness, fatigue, dizziness, hallucinations, impaired memory, weakness, disorientation, breathlessness, reddening of the skin and face, cold fingers and toes, increase blood sugar levels and raised blood pressure.

Doses:

•     Adrenaline is only for subcutaneous or intramuscular use. It is not an intravenous drug.

•     It’s essential that patients understand how, when and where to give themselves an adrenaline injection.

•     Do not use if the injection is brown or contains a precipitate.

•     The adrenaline is supplied as a single use prefilled syringe. After using the drug, discard the syringe with any remaining solution.

•     It’s pertinent that patients seek medical advice soon after administering an adrenaline injection so that patient is monitored.

•     Adrenaline should be stored in the dark and below 25 degrees; however, it should not be refrigerated.

Intravenous:

USE 1 IN 10,000 AMPOULES ONLY

0.1 – 0.3mL/kg/dose

Intravenous infusion:

USE 1 in 1000 AMPOULE ONLY

To be further diluted (see Preparation section)

Initially 0.1microgram/kg/minute, increasing to a maximum of

1microgram/kg/min

Endotracheal tube:

USE 1 IN 10,000 AMPOULES ONLY

0.1 – 0.3mL/kg/dose

For ease of calculation in an acute resuscitation a dose of 1mL may be given

In a term infant and 0.5mL in a preterm infant. Repeated doses may be required.

Nebulization:

Using Respirator Solution

0.05mL/kg/dose

Using 1 in 1000 ampoule only

0.5mL/kg/dose

Dilute to 2-4mL with saline.

Routes of Administration:

•     Intravenous injection

•     Intravenous infusion

•     Umbilical arterial/venous injection

•     Nebulization

Method of administration

•     1:1000 (1mg/ml) or 1:10,000 (1mg/10ml)

•     May be made up: 10mg/500 ml

•     Continuous infusion e.g. 0.05 1g/Kg/min

Brands:

•     Barrett

•     Dosaco

•     Elite

•     HSC

•     MBL

•     Opth-Pharma

•     Orient

•     PDH

•     Shifa

Toxicity of Adrenaline:

•     Arrhythmias

•     Elevated BP with secondary: cerebral hemorrhage; pulmonary edema

•     Increased myocardial work load

•     Extravasations into subcutaneous tissues may cause local ischemia

•     Vasoconstriction

•     Tachycardia, hypertension, tremor, cold extremities, agitation

•     Severe hypertension, cardiac arrhythmias, pulmonary edema and cerebral hemorrhage.

Clobevate cream

Clobevate

Contains:

Clobevate cream / Ointment contain Clobevate Propionate USP 0.05% w/w.

Properties:

Topical use for relief of the inflammatory and pruritic which is of particular value when used in short courses for the treatment of more resistant dermatosis such as: Psoriasis.

Dosage

Apply to the affected area 1-2 times daily or as prescribed by the physician. The treatment should not be continuing for more than 2 weeks.

Contraindications:

Patients with known hypersensitivity to Clobevate propionate or to any other ingredient in the product should not use.

Precautions:

Avoid contact with eyes, mouth and other mucous membranes. Limit use in children or on face to maximum 5 days.