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Normal saline at 150 mL/h is initiated books on women's health issues clomiphene 100 mg amex, and she is admitted to the inpatient oncology service for further management menopause age range purchase clomiphene 25 mg online. What information (signs breast cancer 2nd time around generic clomiphene 25 mg on line, symptoms breast cancer diet nutrition cheap 50 mg clomiphene fast delivery, laboratory values) indicates the presence or severity of hypercalcemia? He requests that you stop all pain medications because his wife has no pain at this time. She is discharged from the hospital on the same pain regimen she was taking prior to admission. The last two episodes were separated by 2 weeks, and both were treated by her outpatient oncologist with normal saline rehydration and zoledronic acid. What are the therapeutic options for the acute and chronic treatment of hypercalcemia? Bentley and her family about the treatment regimen you recommended for her hypercalcemia? How would you monitor the therapy you recommended for efficacy and adverse effects? Bentley completed the initial treatment for hypercalcemia you recommended without difficulty. The sustained-release morphine sulfate was subsequently increased to 90 mg Q 12 h over the next 11/2 months to adequately control her pain. Her use of immediate-release morphine dropped from four times a day to zero over a period of 3 days. What are the roles of oral bisphosphonates and intranasal calcitonin in the treatment of hypercalcemia? What treatment(s) can decrease the risk of developing hypercalcemia in patients receiving calcitriol for anticancer therapy? Practical guidelines for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in patients with cancer. Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials. Wentz was unusually sleepy during the day, and yesterday he complained of feeling weak and fatigued. This morning, he was insisting that he had to attend a lodge meeting because it was elections. He attempts to respond to questions and follow commands during the examination, but he cannot remain awake. Select the appropriate route of administration and dose of electrolyte replacement therapy specific for a patient. Monitor patients receiving electrolyte replacement therapy for efficacy and toxicity. He is unable to raise his legs from the bed and cannot raise his arms for any extended period of time. What information (signs, symptoms, laboratory values) indicates the presence and severity of the electrolyte abnormalities? What feasible pharmacotherapeutic alternatives are available for treatment of dehydration, hypokalemia, and hypomagnesemia? Given the therapeutic alternatives outlined above, what is the most appropriate therapy? What clinical and laboratory parameters are necessary to evaluate the therapy for the desired therapeutic outcome and prevention of adverse effects? Outline a therapeutic plan for the treatment of portal hypertension in this patient. In patients refractory to potassium replacement, magnesium concentrations 147 should be evaluated, and any magnesium deficit must be corrected before potassium can be appropriately replaced. Rapid correction of hypokalemia using concentrated intravenous potassium chloride infusions. Efficacy and safety of potassium infusion therapy in hypokalemic critically ill patients. Develop a patient-specific pharmacotherapeutic plan for treating chronic metabolic acidosis. She further reports that over the last few months she has experienced a decrease in appetite and occasionally feels nauseated without vomiting. She reports frequent nonadherence to her antihypertensive regimen "when I feel good. Minimal sternal and quadriceps tenderness Neuro No focal cranial nerve deficits; strength 5/5 in all extremities. Differentiate between the bone disease of metabolic acidosis versus that associated with chronic renal failure and osteoporosis. Identify the type of acidosis (metabolic versus respiratory) this patient exhibits, calculate the anion gap, and identify the potential causes. What medical conditions present in this patient are either untreated or inadequately treated? What are the proposed mechanisms of metabolic acidosis in patients with chronic kidney disease? What are the complications associated with prolonged acidosis in patients with chronic kidney disease? What treatment alternatives are available to achieve the desired therapeutic outcomes? Design a pharmacotherapeutic plan for the management of metabolic acidosis and its complications in this patient. How should the patient be counseled about the drug therapy to treat chronic metabolic acidosis? During the patient interview, she states that her adherence to her medications has improved. Describe patient-specific factors that contribute to the development of metabolic disorders. Recommend appropriate therapeutic alternatives for the treatment of metabolic alkalosis. Formulate a patient-specific pharmacotherapeutic plan for the treatment and monitoring of metabolic alkalosis. He is a computer software engineer and lives at home with his wife and two children. Urine output has decreased over the past 24 hours since he reports last taking his medication or anything else by mouth. What information should be provided to the patient regarding the use of lisinopril and any other antihypertensive medications the patient may require? Prepare a paper on the use of hydrochloric acid for treatment of metabolic alkalosis. Include indications, dosing, infusion preparation, and safe administration technique in your discussion. Describe how urine electrolytes play a role in the diagnosis and treatment of metabolic alkalosis. However, correcting the underlying cause does not always reverse the alkalosis, and additional therapy may be required. What pharmacologic and nonpharmacologic alternatives should be considered for the treatment of metabolic alkalosis in this patient? Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Single versus multiple doses of acetazolamide for metabolic alkalosis in critically ill medical patients: a randomized, double-blind trial. What clinical and laboratory parameters are necessary to evaluate the therapy for achievement of the desired outcome and prevention of adverse effects? Urine output improved from 15 mL/h during the first 2 hours after admission to 50 mL/h. Laboratory values 24 hours after the initiation of therapy are as follows: Na 142 mEq/L K 3.
Family income had no statistically significant effect on gestational age but had significant effect on birth weight (P=0 pregnancy fruit comparison order 25mg clomiphene with amex. And the model correctly fits which confirmed by Hosmer and Leme show goodness of fit test (Chi-square= 1 teva women's health birth control clomiphene 100 mg generic. Table 4: Multiple logistic regression analysis of risk factors for preterm birth Parameter Age (Years) 24 > 24 Body mass index (kg/m2) Underweight Overweight Normal Preconception Weight 40 kg > 40 kg 2 unusual women's health issues buy clomiphene 100mg low price. And the model correctly fits which confirmed by Hosmer and Leme show goodness of fit test (Chi-square=0 the women's health big book of exercises pdf free discount 100 mg clomiphene with mastercard. The rate of premature birth in our research was in lines of Kader and Tripathi who found 10. Only three clinic considered for data collection, so this result was not generalizable. Also, some adulthood diseases are consequences of preterm birth and child malnutrition. Proper pre pregnancy diets and economic security may reduce the vulnerable situations in the study area. Global, regional, and national causes of child mortality in 2000- 13, with projections to inform post-2015 priorities: an updated systematicanalysis. Risk factors associated with pretermbirth in the Gaza strip: hospital-based case-control study. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Analysis of low birth weight and its co-variants in Bangladesh based on a sub-sample from nationally representative survey. Assessment of Under Nutrition of Bangladeshi Adults Using Anthropometry: Can Body Mass Index Be Replaced by Mid-Upper-Arm-Circumference? Influence of Maternal Height and Weight on Low Birth Weight: A Cross-Sectional Study in Poor Communities of Northeastern Brazil. National, regional, and worldwide estimates of low birth weight in 2015, with trends from 2000: a systematic analysis". Small for Gestational Age Babies: Morbidity and Immediate Outcome in a Tertiary Care Hospital - A Prospective Study. Mid-arm circumference at birth as predictor of low birth weight and neonatal mortality. Methodology: this experimental study was conducted among elderly who suffering from diabetes and/ or hypertension. Data were collected at baseline and 3 months after the implementation of a participatory health promotion program. Results: the results indicated an effectiveness of the participatory health promotion program. After adjusting the baseline and controlling other covariates, the experimental group demonstrated improving of outcomes including reduced triglyceride(adjusted mean different = -32. Keywords: Elderly health care, Municipality, Non-communicable disease, Participatory health promotion program, Self-management. Introduction the most common diseases among elderly in Thailand were hypertension, diabetes, arthritis/ degeneration, emphysema, cardiovascular diseases, myocardial infarction, and paralysis1. More than 60% and 10% of the elderly aged 80 years old and over suffering with high blood pressure and diabetes, respectively. About 56% of the elderly reported that they had chronic diseases such as diabetes, high blood Corresponding Author: Nittaya Pensirinapa Associate Professor, Dr, School of Health Science, Sukhothai Thammathirat Open University, Thailand pressure. Regarding social problems, it was found that the rate of dependency of the elderly population towards 100 working people was 25. The policy recommendations were to increase the effectiveness of health promotion and disease prevention in the elderly, especially the on diabetes, hypertension, falls and mental health. We should enhance the role of local administrative organizations in developing a seamless health service system in the context of the area1, 5. A municipality is a local administrative 2456Indian Journal of Public Health Research & Development, March 2020, Vol. One of its authority and duties is to promote the development of women, children, youth, the elderly and the disabled. Both ddiseases common risk factor: overweight, hypelipidemic, inappropriate health behaviors especially dietary, exercise, stress management, and taking medications as prescribed by the doctor. It was recommended that self-care for the elderly with chronic health problems should focus on maximizing independence, vigor, and life satisfaction. Health promotion in this population is vital to prevent complications and decrease risks that reduce life quality8, 9. In addition, an effective health promotion model should be relevant with the environmental and economic context with create a balance between the need to use resources for health development and other developments8. Nonthaburi Municipality has 6 public health centers providing health promotion services, disease prevention, medical treatment, and rehabilitation. There are unclear system and network between the community and public health centers for promoting self-care of these patients7. There were limited roles of patients to plan and set goals for their self-care with medical personnel. There were recommended thatincreasing supports for patients to take care of themselves together with the participation of the community would result in the reduction and prevention of risks thatlead to better health outcomes of the patients. In order to prevent the loss of samples, therefore, it was added to each group of 45 people, including a sample group of 90 people. Inclusion criteria were people aged 60-80 years old who were diagnosed with hypertension and/or diabetes by physician, able to communicate with researcher, voluntarily participate in the study and could be followed for 12 weeks. After baseline data collection the experimental group received an intervention which was a health promotion program developed from the contribution of stakeholders and the suggestion of experts as an empowerment learning process, focused on how to help patients become more knowledgeable and take control over their bodies, disease, and treatment. The program initiated with building relationships with the elderly, learning about diabetes and hypertension, risk level, sharing self-care experience and determining alternatives for behaviour modification, dietary for diabetes and hypertension patients, forming a team for peer-assisted, setting self-care goals, making the next appointment. It aimed to inspire, inform, support and facilitate their efforts to identify and attain their own goals. The health record book was used for an individual to record their health data, learning, goals setting and planning for self-care, appointment, and having essential health knowledge. Instruments were a structured questionnaire, physical checkup and laboratory tests. The total samples who were completed data at the 12 weeks were 84 participants, 40 in the experimental group and 44 in the control group. An intention-to-treat protocol was used to determine the effectiveness of the participatory health promotion program. Method this experimental study was conducted among elderly who suffering from diabetes and/or hypertension. The median monthly income of the control group was 12,000 Baht (min: 600, max: 40,000), which not much different with that of the experimentalgroup of 11,000 Baht (min: 600, max: 100,000). This could be due to the effectiveness of this health promotion program which included activities focused on how to help patients become more knowledgeable and take control over their bodies, disease, and treatment. This participatory health promotion program was in line with the suggested guideline from Foundation for Gerontology Research and Development Institute which stated that patients should be considered as patience center care by increasing the support them to be able to perform self-care management in the community as well as focusing on skill care development practices, sharing experience and lifelong learning1,13. Moreover, the support from local administration organization for budget on laboratory test and engaging in mobilization processes also influence the success of the program14, 15. This health promotion program was designed to improve participating and context of the areas16-18. This reason could due to difference of self-care behaviors as well as the different in evaluation criteria. Acknowledgments: We would like to express our sincere appreciation for the Sukhothai Thammathirat Open University for funding the study, as well as Nonthaburi Municipality for allowing to organize the program and support budget of laboratory test. Moreover, sincerely thank to all experts and colleagues who contributed to this study. Ethical Clearance: Taken from Human Research Ethics Committee of Nonthaburi Provincial Health Office Endorsement on 16 May 2017. Source of Funding: Research and Training Center for Enhancing Quality of Life for Working Age People, KhonKaen University, Thailand. Nakhon Pathom: Foundation for Gerontology Research and Development Institute; 2017. Older Population and Health System:A profile of Thailand 2016 [Available from.
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Rash appears on the upper trunk around the fifth day of illness and spreads to involve all body-surface areas except the face womens health lynchburg buy 100mg clomiphene overnight delivery, palms pregnancy yoga dvd cheap 100mg clomiphene free shipping, and soles women's health clinic dunedin clomiphene 25 mg visa. Diagnosis the diagnosis can be based on serology or immunohistochemistry or on detection of the organism in a louse found on a pt menstruation 2 purchase 25 mg clomiphene free shipping. After a median incubation period of 8 days, pts develop fever, headache, myalgia, and malaise. Bone marrow examination reveals hypercellular marrow, and noncaseating granulomas may be evident. The primary sources of human infection are infected cattle, sheep, and goats, but cats, rabbits, pigeons, and dogs can transmit the disease as well. At parturition, the organism is dispersed as an aerosol, and infection usually follows inhalation. Ingestion of contaminated milk is believed to be an important route of transmission in some areas, although the evidence on this point is contradictory. Hepatomegaly and/or splenomegaly in combination with a positive rheumatoid factor, high erythrocyte sedimentation rate, high C-reactive protein level, and/or increased -globulin concentration suggests the diagnosis. Pts should be advised about photosensitivity and retinal toxicity risks with treatment. Pts who cannot receive this regimen should be treated with at least two agents active against C. The combination of rifampin (300 mg once daily) plus doxycycline (100 mg bid) or ciprofloxacin (750 mg bid) has been used with success. Children <5 years old usually have only upper respiratory tract disease; children >5 years old and adults usually have bronchitis and pneumonia. Pts often have antecedent upper respiratory tract symptoms and then develop fever, sore throat, and prominent headache and cough. Diagnosis Chest x-ray may show reticulonodular or interstitial infiltrates, primarily in the lower lobes. Pneumonia is usually self-limited, but effective antibiotics shorten the duration of illness and reduce coughing and therefore may also reduce transmission. After replication, reticulate bodies condense into elementary bodies that are released to infect other cells or people. Destruction of goblet cells, lacrimal ducts, and glands causes dry-eye syndrome, with resultant corneal opacity and secondary bacterial corneal ulcers. Physical findings are less prominent than symptoms and x-ray findings would suggest. Diagnosis this diagnosis should be considered in a pt with pneumonia and splenomegaly and is confirmed by serologic studies. Erythromycin is an alternative agent; azithromycin and some fluoroquinolones are active in vitro and are likely to be effective. Pts commonly have gingivostomatitis, pharyngitis, and up to 2 weeks of fever, malaise, myalgia, inability to eat, and cervical adenopathy with lesions on the palate, gingiva, tongue, lip, face, posterior pharynx, and/or tonsillar pillars. Even without a history of rectal intercourse, perianal lesions can occur as a result of latency established in the sacral dermatome from prior genital tract infection. Hematogenous dissemination from other sites can cause bilateral interstitial pneumonitis. Symptomatic recurrent genital herpes: Short-course (1- to 3-day) regimens are preferred because of low cost and convenience. First episode: Oral acyclovir (200 mg) is given 4 or 5 times per day; an oral acyclovir suspension can be used (600 mg/m2 qid). Regimens include oral famciclovir (a 1500-mg single dose or 750 mg bid for 1 day) or valacyclovir (a 2-g single dose or 2 g bid for 1 day). Acute cerebellar ataxia and meningeal irritation usually appear ~21 days after the onset of rash and run a benign course. Good hygiene, meticulous skin care, and antipruritic drugs are important to relieve symptoms and prevent bacterial superinfection of skin lesions. Low-risk immunocompromised pts can be treated with oral valacyclovir or famciclovir. This virus has been implicated in graft dysfunction and increased all-cause mortality in transplant recipients and may contribute to the pathogenesis of multiple sclerosis. Most pts are asymptomatic, but interstitial pneumonitis and other opportunistic infections can occur, particularly in premature infants. Increased serum levels of aminotransferases and alkaline phosphatase as well as immunologic abnormalities. The risk of severe disease may be reduced by antiviral prophylaxis or preemptive therapy. Lesions begin as small white areas of granular retinal necrosis, with later development of hemorrhages, vessel sheathing, and retinal edema. Severe disease (red cell aplasia, severe granulocytopenia or pancytopenia, or hemophagocytic syndrome) can occur. Influenza A viruses are subtyped by surface hemagglutinin (H) and neuraminidase (N) antigens. Influenza A and B viruses are major human pathogens and are morphologically similar. The avian influenza strain A/H5N1, first detected in 1997, has not resulted in a pandemic because efficient person-toperson transmission has not been observed; infection is linked to direct contact with infected poultry. Thus far, influenza A/H5N1 has caused 261 cases of infection in 10 countries in Asia and the Middle East. Chronic cardiac and pulmonary disease and old age are prominent risk factors for severe illness. Influenza B viruses have a more restricted host range and do not undergo antigenic shifts, although they do exhibit antigenic drift. Outbreaks are less extensive and less severe than those of influenza A, occurring most commonly in schools and military camps. Extrapulmonary sites of infection are rare, but cytokine induction causes systemic symptoms.
The information and views have been arranged in an orderly sequence of distinct statements women's health quinoa recipes generic clomiphene 100 mg line. I hope this manageable volume book would serve to dispel awe towards pharmacology from the minds of medical students and provide a concise and uptodate information source for prescribers who wish to remain informed of the current concepts and developments concerning drugs women's health clinic doncaster clomiphene 25 mg with mastercard. My sincere thanks are due to my colleagues for their valuable comments and suggestions pregnancy 9 weeks 3 days discount 100mg clomiphene mastercard. Adverse Drug Effects 1 10 22 37 61 82 Section 2 Drugs Acting on Autonomic Nervous System 7a pregnancy stretches generic 100mg clomiphene fast delivery. Antiadrenergic Drugs (Adrenergic Receptor Antagonists) and Drugs for Glaucoma 92 99 113 124 140 Section 11. Histamine and Antihistaminics 3 159 170 181 192 210 Autacoids and Related Drugs 12. Drugs for Cough and Bronchial Asthma 218 Section 5 Hormones and Related Drugs 17a. Drugs Affecting Calcium Balance 234 236 245 258 282 296 306 329 335 Section 6 Drugs Acting on Peripheral (Somatic) Nervous System 25. Antihypertensive Drugs 492 495 512 526 539 558 Section 9 Drugs Acting on Kidney 41a. Antidiuretics 575 579 593 Section 10 Drugs Affecting Blood and Blood Formation 43. Hypolipidaemic Drugs and Plasma Expanders 599 613 634 Section 11 Gastrointestinal Drugs 46. Drugs for Constipation and Diarrhoea 647 661 672 Section 12 Antimicrobial Drugs 49. Macrolide, Lincosamide, Glycopeptide and Other Antibacterial Antibiotics; Urinary Antiseptics 55. Anthelmintic Drugs 733 743 752 765 780 787 798 816 836 849 Section 13 Chemotherapy of Neoplastic Diseases 62. Drug Interactions Appendices Appendix 1: Solution to Problem Directed Study Appendix 2: List of Essential Medicines Appendix 3: Prescribing in Pregnancy Appendix 4: Drugs in Breastfeeding Appendix 5: Drugs and Fixed Dose Combinations Banned in India$ (updated till Dec. It encompasses all aspects of knowledge about drugs, but most importantly those that are relevant to effective and safe use for medicinal purposes. For thousands of years most drugs were crude natural products of unknown composition and limited efficacy. Only the overt effects of these substances on the body were rather imprecisely known, but how the same were produced was entirely unknown. Pharmacology as an experimental science was ushered by Rudolf Buchheim who founded the first institute of pharmacology in 1847 in Germany. Since then drugs have been purified, chemically characterized and a vast variety of highly potent and selective new drugs have been developed. The mechanism of action including molecular target of many drugs has been elucidated. This has been possible due to prolific growth of pharmacology which forms the backbone of rational therapeutics. This includes physiological and biochemical effects of drugs and their mechanism of action at organ system/subcellular/macromolecular levels. This refers to movement of the drug in and alteration of the drug by the body; includes absorption, distribution, binding/localization/storage, biotransformation and excretion of the drug. Drug (French: Drogue-a dry herb) It is the single active chemical entity present in a medicine that is used for diagnosis, prevention, treatment/ cure of a disease. This disease oriented definition of drug does not include contraceptives or use of drugs for improvement of health. Some other important aspects of pharmacology are: Pharmacotherapeutics It is the application of pharmacological information together with knowledge of the disease for its prevention, mitigation or cure. Selection of the most appropriate drug, dosage and duration of treatment taking into account the specific features of a patient are a part of pharmacotherapeutics. Clinical pharmacology It is the scientific study of drugs (both old and new) in man. It includes pharmacodynamic and pharmacokinetic investigation in healthy volunteers and in patients; evaluation of efficacy and safety of drugs and comparative trials with other forms of treatment; surveillance of patterns of drug use, adverse effects, etc. Chemotherapy It is the treatment of systemic infection/malignancy with specific drugs that have selective toxicity for the infecting organism/ malignant cell with no/minimal effects on the host cells. Drugs in general, can thus be divided into: Pharmacodynamic agents these are designed to have pharmacodynamic effects in the recipient. Chemotherapeutic agents these are designed to inhibit/kill invading parasite/malignant cell and have no/minimal pharmacodynamic effects in the recipient. Pharmacy It is the art and science of compounding and dispensing drugs or preparing suitable dosage forms for administration of drugs to man or animals. It includes collection, identification, purification, isolation, synthesis, standardization and quality control of medicinal substances. Toxicology It is the study of poisonous effect of drugs and other chemicals (household, environmental pollutant, industrial, agricultural, homicidal) with emphasis on detection, prevention and treatment of poisonings. It also includes the study of adverse effects of drugs, since the same substance can be a drug or a poison, depending on the dose. Until the drug is included in a pharmacopoeia, the nonproprietary name may also be called the approved name. In common parlance, the term generic name is used in place of nonproprietary name. Brand names are designed to be catchy, short, easy to remember and often suggestive. Even the same manufacturer may market the same drug under different brand names in different countries. There are many arguments for using the nonproprietary name in prescribing: uniformity, convenience, economy and better comprehension (propranolol, sotalol, timolol, pindolol, metoprolol, acebutolol, atenolol are all blockers, but their brand names have no such similarity). However, when it is important to ensure consistency of the product in terms of quality and bioavailability, etc. Pharmacopoeias and Formularies are broughtout by the Government in a country, hold legal status and are called official compendia. In addition, some non-official compendia are published by professional bodies, which are supplementary and dependable sources of information about drugs. Pharmacopoeias They contain description of chemical structure, molecular weight, physical and chemical characteristics, solubility, identification and assay methods, standards of purity, storage conditions and dosage forms of officially approved drugs in a country. They are useful to drug manufacturers and regulatory authorities, but not to doctors, most of whom never see a pharmacopoeia. Formularies Generally produced in easily carried booklet form, they list indications, dose, dosage forms, contraindications, precautions, adverse effects and storage of selected drugs that are available for medicinal use in a country. A brief commentary on the drug class and clinical conditions in which they are used generally preceeds specifics of individual drugs. It includes new launches and contains pharmaceutical, pharmacological as well as therapeutic information on drugs, which can serve as a reliable reference book. Fixed ratio combination products should be included only when dosage of each ingradient meets the requirements of a defined population group, and when the combination has a proven advantage in therapeutic effect, safety, adherence or in decreasing the emergence of drug resistance. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times and in adequate amounts, in appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford. It has been realized that only a handful of medicines out of the multitude available can meet the health care needs of majority of the people in any country, and that many well tested and cheaper medicines are equally (or more) efficacious and safe as their newer more expensive congeners. For optimum utilization of resources, governments (especially in developing countries) should concentrate on these medicines by identifying them as Essential medicines. India produced its National Essential Drugs List in 1996 and has revised it in 2011 with the title "National List of Essential Medicines". This includes 348 medicines which are considered to be adequate to meet the priority healthcare needs of the general population of the country. Adoption of the essential medicines list for procurement and supply of medicines, especially in the public sector healthcare system, has resulted in improved availability of medicines, cost saving and more rational use of drugs. Prescription and non-prescription drugs As per drug rules, majority of drugs including all antibiotics must be sold in retail only against a prescription issued to a patient by a registered medical practitioner. However, few drugs like simple analgesics (paracetamol aspirin), antacids, laxatives (senna, lactulose), vitamins, ferrous salts, etc.