#Uses of Doxycycline
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#Doxycycline & Lactic Acid Bacillus Capsules#PCD pharma franchises#Uses of Doxycycline#Antibacterial Powerhouse#Gut Health Guardian#Medconic Dermaceutics
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#lmfao my friend has a max fun membership n a bunch of us bought the sawbones pin through her not bc we listen to sawbones#but bc it just says doxycycline amd we all thought that was fucking hilarious bc we use so much doxy at work#god if they had a gaba pin
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#ziverdo kit tablets#ziverdo kit#ziverdo kit tablet uses#ziverdo kit tab#ziverdo tablet uses#doxycycline capsules#doxycycline capsule 100mg#doxycycline capsule uses#doxycycline hydrochloride capsules#zinc acetate tablets 50mg uses#zinc acetate tablets#zinc acetate tablets uses#ivermectin dispersible tablet
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Ziverdo Kit is Best Solution For Viral care & Covid-19 Treatment
Typically, ziverdo kit tablets contain a mixture of Zinc acetate 50mg, Doxycycline 100, and Ivermectin 12mg as its chief ingredients. It is a medicine that you use in the treatment of bacterial and parasitic infections.
As well as a medical condition like Wilson disease. Also, you need to understand that one of the major ziverdo kit tablet uses is that it is used as prescription medication. Specifically, in the treatment of COVID-19 viral infection.
Besides, these days doctors have started prescribing a doxycycline capsule 100mg and zinc acetate tablets for the management of coronavirus symptoms.
Hence here is presenting to you this article explaining why Ziverdo Kit is possibly the best solution for managing Covid-19 Treatment and overall viral care.
Ziverdo Kit Tablets Contains Zinc Acetate:
This medication contains three chief ingredients. These include Zinc acetate 50mg, Doxycycline 100, and Ivermectin 12mg. Of which Zinc acetate exhibits effects which help in the treating COVID-19 symptoms. It does so by clearing up the respiratory system by impairing viral multiplication.
Besides, when you take zinc acetate tablets it helps in significantly strengthening your immune system. Which helps in reducing the damage done to the lungs by the COVID-19 virus.
As a result these days healthcare professionals have begun prescribing doxycycline hydrochloride capsules for managing coronavirus.
Long Lasting Effects of This Infection Medication:
Usually, on consuming doxycycline hydrochloride capsules. All the three ingredients of this medication lasts in the body. For a minimum of 48 hours and a maximum of a few days.
Unique Working Mechanism of Ziverdo Kit Tablets:
When you take an ivermectin dispersible tablet this medicine works like an ‘Antibiotic’ to kill a bacterial infection. The ivermectin in it acts to kill ‘Parasites’ and eliminate an infection.
Finally, zinc acetate exerts effects that help in neutralising symptoms caused by the COVID-19 virus. It does so by binding eventually to the nerve and muscle cells of a virus. Thereby making ziverdo kit tablets the ideal solution for managing coronavirus symptoms.
Specific Dosage Schedule of This Infection Medicine:
Typically, most of the healthcare professionals will prescribe ziverdo kit tablets dosage that will include a Ivermectin 12 mg pill one time a day, a doxycycline capsule 100mg once a day, and 50 mg Zinc Acetate.
Which means that when you take an ivermectin dispersible tablet apart from bacteria it will also help you manage your coronavirus symptoms effectively.
So if you are looking to buy ziverdo kit tablets at an affordable price then you need to click the link.
To purchase more generic medications at a flat $25 discount and along with it get ‘FREE SHIPPING’ then you need to visit our ‘E-Store’.
#ziverdo kit tablets#ziverdo kit#ziverdo kit tablet uses#ziverdo kit tab#ziverdo tablet uses#doxycycline capsules#doxycycline capsule 100mg#doxycycline capsule uses#doxycycline hydrochloride capsules#zinc acetate tablets 50mg uses#zinc acetate tablets#zinc acetate tablets uses#ivermectin dispersible tablet
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Excerpt from this story from Mother Jones:
When a man with painful cystic acne came to dermatologist Eva Rawlings Parker for help in a Nashville clinic, she couldn’t prescribe him doxycycline or minocycline, two medications she’d typically use to treat this condition. This is because the man was a roofer, says Parker, and these medications would have impacted his ability to tolerate heat.
Parker’s patient was far from alone. Other common medications for physical health, like beta blockers, can impact people’s ability to handle heat. Many medications for mental health do, too.
Conventional wisdom tells people with conditions that make them unusually vulnerable to the sun, like the autoimmune disorder lupus, or are on medications that lead to heat sensitivity, to avoid staying outside when the sun is at its strongest.
But for the one-third of US workers who must spend regular time outdoors, that advice bursts into flames. For some, such as farmworkers, hours and hours of heat exposure, with minimal or no reprieve, are just part of the job. Increasing heat waves and more frequent wildfires point to the need to find real solutions for outdoor workers—and highlight how labor and climate change are intertwined.
Edward Flores, faculty director of the Community and Labor Center at the University of California, Merced, specializes in the conditions of low-wage and immigrant workers in California. He says the need for heat safety policy reform is acute. “We know that workers have been dying,” Flores says, “because of chronic conditions that accumulate through heat stress over many years and decades that lead to shorter life spans.”
Parker, the dermatologist, is acutely aware of how heat can trigger or worsen skin problems. She is co-chair of the American Academy of Dermatology’s group on climate change and environmental issues, and was an author of a 2023 review on the ways climate change can contribute to dermatological issues, including triggering flares of conditions like hidradenitis suppurativa—which causes painful lumps deep in a person’s skin—and skin cancer.
Workers do have some legal rights to breaks and water, depending on the locale. California, Oregon, and Washington are the only states that mandate those breaks. And roughly half of crop farmworkers have no legal work authorization. That lack of legal status, and the threat of deportation, gives many workers reason to fear complaining about working conditions.
In July, the Occupational Safety and Health Administration proposed a new set of rules which would help protect more than 36 million workers from heat-related illness or death. The proposed OSHA rules would require employers to monitor their workers for heat exhaustion symptoms, provide adequate water and shade, designate break areas, and provide mandatory rest breaks, among other things.
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141 and what their patient file looks like
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summary: This is what I imagine everyone's favorite pharmacist as well as medics see when they look at 141's medical file.
Based on this pharmacist and 141 interactions
pairing: Task Force 141 x pharmacist!Reader
warnings: medical/pharmacy terminology, medical inaccuracies, swearing, depiction of wounds, mention of substance use disorder and abuse
Terms
PMH - Past medical history - the total sum of a patient's health status prior to the presenting problem
FH - Family history - contributing family history, generally parents and siblings
SH - Social history - contributing social behavior and routine
a/n: not canon at all! this is just a reference for me
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Price
PMH
Height: 1.88 m (6' 2'')
Weight: 93 kg (205 lbs)
Blood type: O+
Extensive physical injuries
21+ stab wounds - 2 required antibiotics for recurrent infection
9x bullet wound - 5x in the extremities, 4x in the chest (no perforation of vital organs), healed without complication
5x abrasion collar - 1 near right eyebrow became infected following medical eval and stitches
3x diagnosed concussion
Aspirin-sensitivity
Previously evaluated for tinnitus and hearing loss
FH
Father - deceased at 76 from liver disease - 50 pack years, mycardial infarction (x2)
Mother - deceased at 84 due to chronic heart failure (CHF) -Glaucoma, asthma, CHF
Sister - Sports induced asthma, hypothyroidism
Negative family history of diabetes, hypertension, and cancer
SH
Smokes - 30 pack years
Drinks regularly - 4-5 hard liquor each weekend; 1 glass of whiskey occasionally
Physically active - Enjoys recreational activities such as hiking, swimming, and biking
Has 1 dog, currently under the care of pt's younger sister
History of monogynous long term relationships, currently single
Medication list + indications
Amoxicillin/Clavulanic acid 625mg - Infection
Morphine 15mg + Ketamine 3mg - IV - Pain
Paracetamol 750mg - Pain
Buproprion SR 150mg - Smoking cessation - not-taking est 2004
Allergies
Aspirin allergy - Reaction: hives and asthma - ONLY PRESCRIBE PARACETAMOL
No environmental, food, or animal allergies
Notes
Patient has denied smoking cessation options
Soap
PMH
Height: 1.88 m (6' 2'')
Weight: 91 kg (200 lbs)
Blood type: O+
7x stab wound - 6 required antibiotics for recurrent infection, 2 MRSA resistant
2x bullet wound - 2x in lower extremities, healed with no complication
6x abrasion collar
2x broken collar bone - healed, with no complication
Lactose sensitivity - Recurrent IBS if ingested
Chipped first left molar following opening a beer with teeth
FH
Father deceased at 68 due to heart failure - Type 2 Diabetes Mellitus, high cholesterol
Mother - Stage I HTN (hypertension)
Sister #1 - Postpartum depression, generalized anxiety disorder
Sister #2 - Elevated cholesterol/triglycerides
Brother - No known chronic health issues
Positive family history of diabetes and hypertension, but no cancer
SH
Drinks regularly and heavily - 8-12 beers and 2-3 glasses of hard liquor each weekend; 1 glass of scotch occasionally
Smokes socially - 5 pack years
Physically active
Close relationship with family, has 4 dogs at home under the care of pt's mothers
Avid fan of The Glasgow Football Club
Medication list + indications
Clindamycin 300mg with ciprofloxacin 400mg - Infection
Amoxicillin/Clauvanic acid 625mg - Infection
Vancomycin 18mg/kg - MRSA resistant infection
Paracetamol 500mg - Pain
Morphine 15mg IV - Pain
Doxycycline 100mg - Acne discontinued in 2004
Allergies
Insect stings - Observed anaphylaxis to childhood bee sting
Notes
Patient demonstrates medication non-adherence, counsel ESPECIALLY with antibiotics
Scored 6 on Alcohol use disorders identification test for consumption (AUDIT C)
Gaz
PMH
Height: 1.86 m (6' 1'')
Weight: 93 kg (205 lbs)
Blood type: B-
3x stab wound - healed, no complications
1x broken collar bone
2x broken femur
Diagnosed concussion - evaluated in Oct. '19
FH
Father - Type 1 Diabetes, high cholesterol
Mother - Vitiligo, Stage 3 breast cancer
Positive family history of maternal cancer and diabetes, but no hypertension
SH
Social drinker - 3-4 beers each weekend
Does not smoke
Physically active - Enjoys morning and evening runs
Enjoys spicy food and tries to introduce into diet
When on leave, enjoys attending concerts and music festivals
Medication list + indications
Piriteze 10mg - Allergic rhinitis
Fluticasone Propionate - 93 mcg/actuation - Allergic rhinitis
Paracetamol 500mg - Pain
Allergies
Seasonal - Pollen and pet dander
β-Lactam allergy - Reaction: anaphylaxis evaluated in '19
Notes
Organ donor
Ghost
PMH
Height: Weight: 1.93 m (6' 4'')
WeighT: 100 kg (220 lbs)
Blood type: AB-
Extensive cuts and scarring to entire body
4+ stab wounds - healed, no complications
Gun shot to lower abdomen - healed, no complications, evaluated in Nov. '22
13+ collar abrasion
2x broken nose
Childhood injury of broken tibia and large toe
Psych eval - History of depression and post traumatic stress disorder, childhood history indicates emotional and physical abuse
FH
Father - status unknown Diagnosed alcohol use disorder
Brother - deceased, cause of death non-contributory - Substance use disorder
Mother - deceased, cause of death non-contributory - Hypertension, thrombophilia (blood clotting disorder)
Positive family history of hypertension, but no diabetes or cancer
SH
Social drinker - 3-4 glasses of hard liquor each weekend
Smokes socially - 10 pack years
Physically active - Enjoys nightly walks
Psych eval - Other squad members act as his emotional support
Expressed interest in cats and tattoo art (FLAGGED: Further input and comments from other medical professionals would be appreciated)
Medication list + indications
Paracetamol 1000mg - Pain
Amoxicillin/Clavulanic acid 625mg - Infection
Morphine 20mg + Ketamine 4.5mg IV - Pain
Mafenide acetate 5% topical - Antimicrobial, burn wounds
Fluoxetine 20mg twice daily - Depression - not taking est 2001
Allergies
NKDA - No known drug allergies
No environmental, food, or animal allergies
Psych recommends evaluation of a pet, such as cat, for pt while on leave
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#task force 141 x reader#task force 141#cod x reader#call of duty modern warfare#cod mwii#modern warfare 2#simon riley x reader#simon ghost riley#call of duty#john soap mactavish#kyle gaz garrick#gaz x reader#soap x reader#price x reader#kyle garrick x reader#john price x reader#Johnny mactavish x reader#mw2 imagine#madebyizzie#mw2#izzie is writing#pharmacist! series
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The only heartworm allowed in this house is a plush one - after nine months of treatment, Jackie is heartworm-free!
Her journey's been a bit different from the traditional path. For one, she's been on heartworm preventatives for a long time. The problem is that heartworm takes six months to show up on a test. She was taken in by a shelter at two months; we adopted her at seven months. Somewhere in her early puppyhood, an infected mosquito must've gotten her and the worms grew until they could finally be detected after she'd settled into her forever home with us. So takeaway #1 - always test for heartworms, even if they've been on preventatives, especially if there's a gap in their history!
For another thing, we opted to try the Moxi-Doxy protocol, a method less tested than the traditional treatment, but super promising in cases like hers, where the dog is healthy and the disease is young. The problem with Moxi-Doxy is that it takes longer than arsenical injections, so it's not a great pick if the worms are already doing damage or causing symptoms. The advantage, however, is that the restrictions and side effects are WAY fewer!
You start off with a month of Doxycycline, same as with traditional treatments. It kills a symbiotic bacteria in the worms and weakens them. This was actually the hardest part of the treatment for Jackie, as the dosage is high and is given all month, but she only had issues in the last week of it, so we were able to push through. The big difference in treatments comes after that - with Moxi-Doxy, the next (and potentially final) step is application of drops containing Moxidectin as directed for as long as it takes. For us, we put Advantage Multi on Jackie once a month.
Since the worms are being killed so much more slowly than with arsenical injections, the risk of embolism from multiple worms detaching/breaking down at once is considerably lower. We couldn't take her on any super long walks or to dog parks or other places that would raise her heart rate and keep it up for a prolonged period, but she was still allowed normal walks. She still got to play fetch. She could still wander around the house freely and thrash her toys and even have brief stints of zoomies. And there was no pain from injections or deleterious side effects - just some painless drops on her skin once a month.
There's still much to be said for the traditional method. It has a higher success rate (we were always aware that Jackie's treatment could fail and we'd end up having to start the traditional protocol after a year and a half of failed efforts) and it works much faster. I think there's a lot to be said for Moxi-Doxy as well, though, since it's a much more comfortable process. And it's always nice to have options. It's a much newer protocol and I had never heard of it until a vet suggested it could be an option for Jackie, so I figured I'd put this information out there for dog owners who might be similarly unaware. For us, at the very least, Moxi-Doxy worked without side effects and cured our Jackie in less than a year. I think that's worth telling people.
#dog#dogs#mutts#mixed breed#giant microbes#giantmicrobes#heartworm#heartworms#jackie the dog#my petses
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I've had rats for years at this point now and finally want to put down the best tips I've learned. This won't work for everyone, some are very conditional to me, but maybe some of these will help someone. Fleece hammocks: Boo. Microplastics and too warming. Canvas hammocks: Yes, please. Highly washable. Far more tough. I wish they were easier to find. Coiled rope baskets are also a godsend. I hang them by the handles in the cage, they love them way more than anything marketed to rats. Bottles are nice but some rats wanna splash and have a place to wash their little hands. Fresh in pod peas are by the pound at my supermarket. I usually spend 70 cents on the amount for several treat sessions. All my frozen peas end up getting freezer burnt by the time I get halfway through the bag. Antibiotics will be needed if you keep rats. Do not give antibiotics with dairy, many classes of antibiotics bond to calcium thereby making them far less effective. Speaking of, antibiotics seem to have the hardest taste to cover up. Ground meat baby food, Hershey simply five syrup (Just a little), peanut powder (No added sugar, oils), fruit compote/jam/jelly, small absorbent bread snacks/cereal, smushed pasta, cream of wheat, are all options to get meds into rats. You can call exotic vets and ask for an estimate on a basic rat exam. Do it, the prices vary WILDLY. We had a vet who charged us 35$ to see three rats at once and one who quoted us 200$ to look at one. You're gonna notice a trend if you call vets in higher class/rich areas. Fuck em'. Also ask your vet if you can keep a supply of meds on hand just in case. If they last at room temp you can buy some preemptively. Things like doxycycline you can get from human pharmacies.
Zip ties are god. All hail zip ties. Same with swivel clasps. Between them both you can cage mount anything your heart desires.
Leave bedding in a hot car or freezing conditions for a night. Warehouses get mites. Mites are a dick to deal with. Kill em' all.
Give them a variety of fresh things while they're young. Not always but sometimes I'd get an older gent rescue who had no idea what to do with berries or tomatoes and would refuse them. They learn better what is safe when young. At some point you will have an emergency. Make sure you know where an emergency vet is and that they keep night/weekend hours. Keep funds on hand for that day.
Rats hide pain well. When they age you may need to start pain management if you notice them moving differently even if they don't show their pain blatantly. Just start with low doses and see if they act like their old selves again. Research your breeders. Get recommendations from other rat people. Check and see if there are rat rescues in your area. Also the Humane Society sometimes takes in rodents.
Controversial take: You will encounter people in ratkeeping who say buying feeders is a sin. It's not. Feeder supply will exist whether or not every rat fancier boycotts them. We are far far fewer in number than snake/lizard people. Wherever you got your rats it's valid so long as you give them healthcare, good nutritious food, love, and mental stimulation. A lot of the 'foods to avoid, foods to include' lists are not researched. I've seen lists that ban chocolate. Rats freaking love chocolate they just need to take it easy on fats and sugars but cocoa powder can be a good mix in and can help ratty blood flow. I've seen people ban mango. if you read the study that led to this they gave rats an obscene amount of D-limonene to trigger cancer and small amounts had no side effects at all. Read the studies, look for sources.
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spent the night in the ER. As we all may or may not know, I got an IUD placed in Oct when I was 4 months postpartum.
I've been bleeding ever since. Not "spotting," but bleeding. Heavily. I've had ultrasounds to check on the position - it's in place. at 6 months of bleeding, I was put on Junel Fe to see if it would calm down. Nope. I started getting cramping so bad, I thought I had another cyst burst. I was getting really big clots/tissue.
Back to the doctors, I'm taken off Junel and put on doxycycline bc I guess it can slow the bleeding? and an ultrasound is scheduled for the first week in June, where, after imaging, I'd most likely have it taken out.
well, 3 days later and I'm bleeding so heavily and passing tissue like I've given birth. I bled through a heavy overnight pad in 3 hours, and left a blood pool on my cough 6 inches wide. the tissue I passed was like the size of my palm. I called the on-call midwife and she told me to go to the ER.
So, new pants, fresh pad (heavy flow overnight ~guaranteed 10 hours!~, I go to the ER and I'm ofc crying bc I didn't know wtf is going on and I hate leaving Aidan. I think I sat in the waiting room for less than 2 hours, getting up twice to get vitals and bloodwork done. When i got up to be wheeled to ultrasound, I realized I had bled through my pad and my pants again. Badly. I told the attendant while holding up my blood covered hand and he just went "oh. I'm sorry" LOL K
The tech tells me to get undressed and get on the table etc and I'm like "um, I'm bleeding like really really bad.." she was just like "it's fine" and left. I'm crying a little, and I pull down my underwear and I shit you not, felt clots and blood just gush out and splatter on the floor.
Now I'm sobbing bc there's nothing for me to clean it up, I can't find a trash can, and I just keep bleeding anyways, so I put some paper towels over the murder scene on the floor and lay on the bed, covering my face with my arm unable to stop crying. the tech is a cold bitch as usual and then I'm told to get dressed (in my bloody clothes thanks!) and sit in the wheelchair to be picked up.
the attendant. brings me back. to the waiting room. WHICH HAS BEEN PACKED WITH PEOPLE BY THE WAY! I'm crying still, and I get out if the chair and go to the desk to be like "hi I'm bleeding through my clothes??" but the male nurse grabbed and was like "THERE YOU ARE! I've got a room ready for you! I tried to call ultrasound but they didn't answer. what were you looking for?" and I just mumbled that I didn't want to get blood on the furniture as I followed him.
he had the nurse get me mesh underwear and pads and it was the first time I felt like someone empathize with me. he said "it's gonna be ok" with a reassuring look, and left.
I waited a while in there. listening to the ridiculous chaos that they were dealing with, all definitely more acute than me - esp bc my bloodwork showed I wasn't bleeding out or anything. a man with dementia was being aggressive with the staff even though he had broken ribs and a pneumothorax and had been dosed with fentanyl. he kept trying to dismantle his bed, almost broke his foot, and I was just waiting for one of the nurses to get hurt.
I got a pelvic exam, and the doctor used about 12 gigantic swabs trying to get all the clots he saw. he said "yeah i see what you mean, it's a slow constant ooze" wow, I feel sexy.
ultrasound was apparently clear, and he asked if I preferred to go home for the night or stay -bc he wanted me to be seen by obgyn within 2 days. I chose to go home. it was after midnight. I asked for scrubs to go home in and thankfully got some.
my ultrasound showed my right ovary was fine, no torsion,cyst etc. then "suboptimal view of left ovary due to secondary location"
sorry What. also my uterus is LARGE and my endometrium is thickened to 11mm AND THATS AFTER 7 MONTHS OF BLEEDING THAT i KEPT GETTING TOLD WAS My UTERINE LINING THINNING OUT BC THATS THE IUD'S JOB
all I can think is endo/adenomyosis/cancer.
so I'm getting this thing (the iud) taken out. I want my hormones checked. and the dr im seeing already said i can get a hysterectomy or my tubes tied or whatever. and I can't stop thinking of my aunt who died of ovarian cancer bc they failed to catch it in time despite her going to doctors constantly with symptoms.
I'm really scared,actually. my history of medical trauma is on hyperdrive. I feel like I'm failing my kid. I'm not capable of being the mom I want to be. I feel betrayed and sabotaged by my body again. I also can't think straight whatsoever so I could be misunderstanding the meanings of things.
just don't kill me you piece of shit meatsack. not now that I've been trying to actually stay alive.
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Drugs!
Masterlist
Everyone loves drugs, right? And boy are there some juicy ones in surgery. There are more, especially of emergency drugs, but these are some common ones
Anaesthetic drugs
Propofol - the main sleepy juice. It looks like milk, hence the name 'milk of amnesia' (also called jackson juice because it's what killed MJ)
Ketamine - horse tranquiliser. But also used for humans! Very fast acting, and gives good pain relief too (you only need a small amount)
Isoflurane, sevoflurane - anaesthetic gases (bye desflurane, you've polluted the atmosphere for too long)
Atracurium, rocuronium - reversible muscle relaxants, they take a few minutes to fully kick in
Neostigmine, sugammadex - muscle relaxant reversal, sugammadex (nicknamed sugar) is more powerful
Suxamethonium - nonreversible muscle relaxant. It wears off after 2-6 minutes unless you have a rare genetic condition. Also works really quickly (30 seconds)
Lidocaine, bupivacaine - local anaesthetic, injected into the area you want to numb, or used in a spinal anaesthetic
Benzodiazepines (midazolam, diazepam etc.) - sedatives, not enough to fully conk you out, but will make you a bit sleepy and more relaxed
Pain relief
Paracetamol (tylenol) - mild pain relief, can be given through IV for better results
Morphine - the simplest opioid, usually IV or given orally (apparently tastes a bit like liquorice?)
Fentanyl and alfentanyl - much stronger pain relief, used rarely except during induction of anaesthesia
Antibiotics
Not always given, used more in orthopaedics or where there's a risk of infection. The type given is usually up to the anaesthetist's preference unless there's an existing infection that's been cultured
Common ones: amoxicillin, vancomycin, gentamicin, clindamycin, flucloxacillin, doxycycline
Emergency drugs
Tranexamic acid - sometimes given at the start if there's a risk of bleeding. Helps to prevent blood loss
Atropine - increases heart rate
Glycopyrronium - increases heart rate, also reduces saliva production
Ephedrine - increases blood pressure
Metaraminol - increases blood pressure
Adrenaline - increases heart rate and blood pressure, used for cardiac arrests and anaphylaxis
Intralipid - treats local anaesthetic toxicity
Dantrolene - treats malignant hyperthermia (a life threatening condition where the body temperature raises really high)
Adenosine, amiodarone - treats arrhythmias
Digoxin - slows heart rate
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Medicine may be about to achieve a long-sought goal: a “morning-after pill” to prevent sexually transmitted infections. It could sharply reduce soaring rates of illness and huge health care costs.
The effectiveness of this pill—and it literally is a pill, a 200-milligram tablet of the antibiotic doxycycline—has been studied for a decade, and people have taken it covertly for years. But study results published in The New England Journal of Medicine look likely to tip the pill into clinical practice. In the study, conducted in San Francisco and Seattle, participants who took a single dose within 72 hours of having sex without a condom were only a third as likely to contract chlamydia, gonorrhea, or syphilis as those who didn’t take the pills.
As with everything in medicine, there are footnotes to the findings, and risks to balance the benefits. The study was conducted only among gay and bisexual men, along with transgender women and nonbinary people assigned male at birth. Within those groups, it was limited to people who had been diagnosed with a sexually transmitted infection (STI) in the past year. The study didn’t include cisgender women; in past studies, the preventive antibiotic has not worked as well for them. And the study noted, but didn’t explore in depth, the possibility that routinely administering an antibiotic could provoke resistance either among the bacteria that cause STIs or others carried in participants’ bodies.
All that said, the results have created real excitement among physicians and people who would be eligible to take what’s being called doxyPEP (for doxycycline post-exposure prophylaxis)—even though health authorities, such as the US Centers for Disease Control and Prevention, haven’t yet made formal recommendations for its use.
“I think this is a real game-changer,” says Paul Adamson, an infectious disease physician and assistant clinical professor of medicine at the University of California, Los Angeles. “We have a huge amount of bacterial STIs in the US. Gay and bisexual men who have sex with men are disproportionately burdened by them. And we have not had a lot of tools that we can use to help.”
To understand why doxyPEP could be so significant, it’s important to consider what’s been happening with STIs. Briefly: They’re skyrocketing. Since 2017, according to the CDC, the most important of these diseases have reached historic highs: Gonorrhea has increased by 28 percent, and syphilis by 74 percent. And while chlamydia diagnoses haven’t quite returned to their pre-Covid levels, the agency worries that might be due to pandemic disruptions to care, rather than to an actual decrease in transmission. All of those infections have profound long-term consequences if they are not diagnosed and treated, including making people more vulnerable to HIV infection. Collectively, they cost the US health care system more than $1 billion per year.
Meanwhile, congenital syphilis—passed from mother to infant at birth, a sign that the pregnant person never received adequate prenatal care—caused 220 stillbirths and infant deaths in 2021, the last year for which there are national figures. Gonorrhea is gaining resistance to the last antibiotics currently available to treat it.
In medicine, prevention is almost always preferable to treatment: Vaccines and other prophylactic measures are less expensive, and can be planned in advance. So it has been a research goal to find uncomplicated prevention for STIs—something that, like the morning-after pill for pregnancy, can be taken a short time after sex and doesn’t rely on the user making decisions in the moment.
The first test of doxyPEP, a small US trial that took place in 2011 and 2012, was published in 2015, and showed that HIV-positive men who took the post-exposure dose cut their rate of STIs by three-fourths. Fairly soon after that, social networks of men who have sex with men picked up on the findings, and began sharing knowledge about using preventive doxycycline off-label. A large 2017 French study of men using pre-exposure prophylaxis for HIV, known as PrEP, included within it a study of STI rates among men taking post-exposure doxycycline; it showed that doxyPEP could cut rates of syphilis and chlamydia infection by almost 70 percent. And last summer and this spring, the two largest international HIV conferences included presentations that confirmed the doses were successful in most circumstances.
Several of those presentations were drawn from the San Francisco and Seattle study just published in NEJM. Its results were so dramatic that the authors stopped the trial earlier than planned, in May 2022: They revealed that, among 501 men who were either living with HIV or taking HIV PrEP, consuming that single dose of doxycycline within 72 hours of sex without a condom reduced the combined incidence of the three major STIs by roughly two-thirds.
“Our goal was to understand this in a real-world setting, in a heterogeneous population of people taking HIV PrEP but also living with HIV—which biologically aren’t different populations, but may be different in terms of sexual behaviors, sexual networks,” says Anne Luetkemeyer, one of the study’s principal investigators and a professor of medicine at the University of California, San Francisco. Combined with the French research, she adds, “we now have two studies that really showed very remarkably similar efficacy in this population.”
Those two sets of results may be enough to let doxyPEP enter mainstream medicine. In some places, it already has. Last October, San Francisco’s public health department became the first local department to support doxyPEP use in its jurisdiction. And after the NEJM paper, individual physicians tweeted they would begin prescribing doxyPEP because the results looked so solid—something they can do off-label because the Food and Drug Administration already approved the drug decades ago to treat a range of infections.
When a new way of controlling a disease seems likely to enter the US mainstream, the CDC is expected to weigh in. So far, the agency hasn’t published official guidelines regarding the use of doxyPEP. Following the release of preliminary data at conferences, the CDC published “considerations for individuals and healthcare providers,” a strategy for sharing what’s known so far, as well as an acknowledgment that doxyPEP already is being used off-label. A CDC spokesperson told WIRED by email that formal draft guidance for physicians could come “by the end of the summer.”
When that guidance does arrive, it isn’t expected to recommend doxyPEP for everyone. “We should consider offering this to people who have an elevated risk” of STIs, Luetkemeyer says. “And that group is men who have sex with men, on PrEP, or living with HIV, who've had a history of STIs. I think that's a reasonable group.”
And eligible people may not want to take it. Like almost all antibiotics, doxycycline has side effects: sun sensitivity, diarrhea, serious nausea. And it hasn’t worked equally well for everyone. In the trial done in French men, the antibiotic did not suppress gonorrhea infections, even though it had a dramatic effect on reducing syphilis and chlamydia. In the one trial done so far among cis women, launched in Kenya in 2021, doxycycline prophylaxis (known in this case as dPEP) had no effect on suppressing STIs.
That was disappointing; women who are at high risk of STIs need prevention as much as men do. Equally, it was mystifying for the researchers, who now are poring through their data to see what might have made a difference: whether the 449 participants had difficulty taking the drug at the right time, for instance, or whether doxycycline behaves differently in female organs than in men’s. “We had more than 200 women show up to hear the results, and they were so shocked and disappointed,” says Jenell Stewart, the study director and a physician-scientist and assistant professor at Hennepin Healthcare in Minneapolis. “We are very focused on understanding these results before we say this doesn’t work for women.”
One thing that might have played a role in Kenya and France—and is raising red flags for doxyPEP use in the US—is antibiotic resistance. Stewart says 100 percent of the gonorrhea isolates tested so far from women who became infected while on dPEP showed high levels of resistance to tetracycline, the drug family that doxycycline belongs to; at the time of the French study, the background rate of resistance in gonorrhea there was 56 percent. In the US, where doxycycline isn’t the first-line treatment for gonorrhea, the rate of resistance is only 20 percent. That may provide a clue to why doxyPEP worked better in the US trial than in any other. But it also immediately raises the concern that if doxyPEP goes into wide use, it might make resistance worse.
The US study could not provide an answer: Though some men in the trial did contract gonorrhea while taking doxyPEP, not enough testing was done to confirm whether their strains were resistant to the medication and thus not knocked out by the single dose. Tests did suggest the drug might be affecting other bacteria in participants’ bodies, but the results were contradictory. Those taking doxyPEP ended up harboring 40 percent less staph bacteria—something that all of us carry—than those not taking the drug; but the staph they were still carrying showed “modestly higher” resistance. Whether killing some bacteria was more beneficial than making others potentially hazardous, the trial didn’t last long enough to say.
So the calculation inherent in doxyPEP may not be risk versus benefit, as much as it is risk versus risk: preventing an infection while provoking resistance through small doses, or contracting an infection that requires larger doses over a longer period of time. “We’re not comparing doxyPEP to no antibiotics,” says Adamson, who researches drug-resistant gonorrhea and has prescribed doxyPEP for some patients. “We’re comparing doxyPEP to potentially significant amounts of ceftriaxone, or penicillin, or doxycycline perhaps, if somebody’s getting infections a lot.”
It’s a question that research will have to answer—because, no matter how the CDC weighs in, doxyPEP use is moving ahead. Joseph Osmundson, a microbiologist and author in New York City—where STI rates are rising just as they are nationally—recently sought a prescription from his regular physician. As a queer sexual-health activist, he says, it only made sense, not only to prevent infections and antibiotic side effects for himself, but also to keep from increasing infection rates in an already overburdened city.
“When people want an intervention to have a healthier sex life, you cannot not give it to them,” he says. “Withholding the intervention will not prevent people from having the kind of sex that they enjoy. The question is: Are they going to be provided with as many interventions as possible to have that type of sex with less risk of infectious disease?”
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These photos are taken yesterday, here at Malabon while I’m at my work. I’m currently working at the Hospital here.
Naka pasok pa ako kahapon ng hanggang paa palang ang baha, around 8AM. By around 9AM, tumataas na yung baha since malapit rin kami sa lawa dito, high tide since Tuesday pa. Dagdag mo na rin yung walang tigil ng pag hampas ng ulan na umabot sa puntong hanggang bewang na yung baha around 10AM. By 11PM umaapaw na yung tubig sa DAM at nag pakawala na sila, umabot sa punto na ng hanggang dibdib na ang baha ng 12PM.
Nung una,desidido pa kong umuwi at lumusong sa baha hanggang maka uwi samin (since malapit lang rin naman ako dito), pero habang tumatagal pataas pa ito ng pataas hanggang sa napag desisyonan ko na na dito na rin sa Hospital mag stay at matulog. May mga kwarto naman na available pa o bakante, kahit wala akong gamit pamalit, dumito na rin muna ako. 6PM ang out ko sa regular day ko mula Monday hanggang Friday, and by that time, lagpas ulo ko na ang baha. Hindi na rin talaga kakayanin pang lumusong pauwi. Kahit sabihin mo pa na marunong akong lumangoy, nakakatakot parin. Malakas rin ang agos at ang hampas ng hanggin. Yung mga lumusong sa baha, binibigyan rin namin ng 2 Doxycycline capsule. May sugat man o wala basta lumusong sa baha kahit saglit or matagal pa, binibigyan namin ng gamot.
Hopefully, all of us are safe, and yung mga nasalanta ng Bagyong Carina sana nasa maayos sila na mga Evacuating Center o maayos na matutuluyan, na nabibigyan ng mga pagkain at tubig. Yung ibang nag work dito samin, pati family naka stay in na dahil lubog na lubog na talaga sila. Kung kayang mag donate, please do. If kayang tumulong, tumulong po tayo.
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Ziverdo Kit is Best Solution For Viral care & Covid-19 Treatment
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I know it’s very early in residency both for me to have this opinion and to be judgmental about it, but my god progress notes should contain a real assessment. It sucks on crosscover to not have a good idea of why a team is doing the things they’re doing and then to have to make decisions about a patient I barely know with little information. Here’s an example: Mr. A is being treated for cellulitis. He is also getting a very thorough workup for osteomyelitis for reasons I can’t discern—is it his clinical picture? Is it some risk factor I’m unaware of? The imaging so far has been negative, so I’m not sure why it’s still being pursued. Then I’m paged that he’s having excruciating pain. I’m not sure how suspicious to be for underlying osteo—was the team very concerned and just waiting for a change in his picture, or was the additional workup CYA medicine? Should I give Tylenol or would it be better not to mask a fever so we can see if the antibiotics are working while we wait for the remaining imaging to be read? I’m sure an even slightly more experienced resident would not be fazed by this, but I honestly find it very frustrating. Like at least tip me off at signout as to what you’re thinking. But since you can’t anticipate every question I’ll be asked or everything that will come up, it’s probably best to write a good assessment. I’m only asking for a sentence or two on what you’re thinking. It really really really does help me understand where the patient is at. In conclusion, this shit is of the devil:
Mr. A is a 50 y/o M with PMHx of HTN, BPH admitted for cellulitis.
#cellulitis
- doxycycline 100 mg PO BID
- negative XR
- negative US
- MRI pending
#I’m not asking for a novel#just give me some indication of what you think is going on#why are you clearly working this person up for osteo but you haven’t mentioned it in your note??#it’s internal medicine ffs#write a good note#a good assessment is so valuable for anyone helping with your patient’s care#nurses consultants crosscover etc#ok I’m done#medicine#residency#medblr#my content#my text posts
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Poor pasha had a health scare yesterday. She suddenly collapsed, seemed to lock up and faint. I saw her gums had gone pale bluegray so we headed to the urgent vet, an awful 40 min drive. She was already getting better by the time we arrived but they did a full work up, blood and X-rays. Then, In the exam room her face started swelling up, not sure if it was an allergen in the clinic or if it’s related to her earlier fainting episode, maybe anaphylaxis from a scorpion sting? A shot of antihistamine helped the swelling.
They sent us home with steroids and said to monitor closely for more collapses, spoil her, and recheck with her local vet.
She is 3 weeks into heartworm treatment with doxycycline, so I originally thought she might have had a stroke, really glad that doesn’t seem to be the case.
Cute little doggo is doing good so far, back to normal.
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