Skelaxin

By F. Vandorn. Northwestern Oklahoma State University.

Its active ingredi- at a Glance: Topical Corticosteroids cheap skelaxin 400mg with mastercard, and Drugs at a Glance: ents are unknown. Wound healing is attributed to moisturizing Miscellaneous Dermatologic Agents. Benzoyl peroxide Acne To affected areas, after cleansing, 1–3 times daily Clindamycin (Cleocin T) Acne vulgaris To affected areas, twice daily Erythromycin (Aknemycin) Acne vulgaris To affected areas, after cleansing, twice daily, morning and evening Gentamicin (Garamycin) Skin infections caused by susceptible strains of To infected areas, 3–4 times daily. Cover with streptococci, staphylococci, and gram-negative dressing if desired. Eradication of nasal colonization with methicillin- Other skin lesions: Cream, 3 times daily for resistant S. Eradication of nasal colonization: Ointment from single-use tube, one half in each nostril, morning and evening for 5 d Neomycin (Myciguent) Bacterial skin infections To affected area, after cleansing, 1–3 times daily, small, fingertip-size amount. Silver sulfadiazine (Silvadene) Prevent or treat infection in burn wounds caused by To affected area, after cleansing, once or twice Pseudomonas and many other organisms daily, using sterile technique Sulfacetamide sodium Bacterial skin infections Skin infections: 2–4 times daily until infection clears (Sebizon) Seborrheic dermatitis Seborrhea: to scalp and adjacent skin areas, at bedtime Tetracycline (Topicycline) Acne vulgaris To affected areas, twice daily, morning and evening Combination Products Bacitracin and polymyxin B Bacterial skin infections To lesions, 2–3 times daily (Polysporin) Erythromycin/benzoyl Acne To affected areas, after cleansing, twice daily, peroxide (Benzamycin) morning and evening Neomycin, polymyxin B and Bacterial skin infections To lesions, 2–3 times daily bacitracin (Neosporin) (continued) 954 SECTION 11 DRUGS USED IN SPECIAL CONDITIONS Drugs at a Glance: Topical Antimicrobial Agents (continued) Generic/Trade Name Indications for Use Application Antifungal Agents Amphotericin B (Fungizone) Cutaneous candidiasis To affected areas, 2–4 times daily Butenafine (Mentax) Tinea pedis To affected area, once daily for 4 wk Ciclopirox (Loprox) Tinea infections To affected area, twice daily for 2–4 wk Cutaneous candidiasis Clioquinol (Vioform) Fungal skin infection and inflammation To affected areas, 2–3 times daily. Clotrimazole (Lotrimin, Tinea infections To affected areas, twice daily, morning and evening Mycelex) Cutaneous candidiasis Econazole (Spectazole) Tinea infections Tinea infections: To affected areas, once daily Cutaneous candidiasis Cutaneous candidiasis: To affected areas, twice daily Haloprogin (Halotex) Tinea infections To affected area, twice daily for 2–4 wk Ketoconazole (Nizoral) Tinea infections Tinea infections and cutaneous candidiasis: To Cutaneous candidiasis affected areas, once daily for 2–4 wk Seborrheic dermatitis Seborrheic dermatitis: To affected areas twice daily for 4 wk or until clinical clearing Miconazole (Micatin) Tinea infections To affected areas, twice daily for 2–4 wk Cutaneous candidiasis Naftifine (Naftin) Tinea infections To affected areas, once daily with cream, twice daily with gel Nystatin (Mycostatin) Candidiasis of skin and mucous membranes To affected areas, after cleansing, 2–3 times daily until healing is complete Oxiconazole (Oxistat) Tinea infections To affected areas, once or twice daily for 2–4 wk Sulconazole (Exelderm) Tinea infections To affected areas, once or twice daily Terbinafine (Lamisil) Tinea infections To affected areas, twice daily for 1–4 wk Antiviral Agents Acyclovir (Zovirax) Herpes genitalis To lesions, q3h six times daily for 7 d Herpes labialis in immunosuppressed clients Penciclovir (Denavir) Herpes labialis To lesions, q2h while awake for 4 d Drugs at a Glance: Topical Corticosteroids Generic/Trade Names Dosage Forms Potency Alclometasone (Aclovate) Cream, ointment Low Amcinonide (Cyclocort) Cream, lotion, ointment High Augmented betamethasone Cream, gel, lotion, ointment Ointment very high; cream high dipropionate (Diprolene) Betamethasone dipropionate Aerosol, cream, lotion, ointment Cream and ointment high; lotion medium (Alphatrex, others) Betamethasone valerate Cream, foam, lotion, ointment Ointment high; cream medium (Valisone, others) Clobetasol (Temovate) Cream, gel, ointment, scalp application Very high Clocortolone (Cloderm) Cream Medium Desonide (Tridesilon) Cream, lotion, ointment Low Desoximetasone (Topicort) Cream, gel, ointment Medium Dexamethasone (Decaderm, Aerosol, cream Low Decadron) Diflorasone (Florone, Maxiflor) Cream, ointment Ointment, very high; cream, high Fluocinolone (Synalar, others) Cream, oil, ointment, shampoo, solution High Fluocinonide (Lidex) Cream, gel, ointment, solution High Flurandrenolide (Cordran) Cream, lotion, ointment, tape Medium Fluticasone (Cutivate) Cream, ointment Medium Halcinonide (Halog) Cream, ointment, solution High Halobetasol (Ultravate) Cream, ointment Very high Hydrocortisone (Cortril, Cream, lotion, ointment, solution, spray, Medium or low Hydrocortone, others) roll-on stick Mometasone (Elocon) Cream, lotion, ointment Medium Triamcinolone acetonide Aerosol, cream, lotion, ointment 0. Also available in combination with hydrocortisone and other substances Colloidal oatmeal (Aveeno) Antipruritic Pruritus Topically as a bath solution (1 cup in bathtub of water) Dextranomer (Debrisan) Absorbs exudates from wound Cleansing of ulcers (eg, venous Apply to a clean, moist wound sur- surfaces stasis, decubitus) and wounds face q12h initially, then less (eg, burn, surgical, traumatic) often as exudate decreases Fluorouracil (Efudex) Antineoplastic Actinic keratoses Topically to skin lesions twice daily Superficial basal cell carcinomas for 2–6 wk Masoprocol (Actinex) Inhibits proliferation of keratin- Actinic keratoses Topically to skin lesions morning containing cells and evening for 28 d Salicylic acid Keratolytic, antifungal Removal of warts, corns, calluses Topically to lesions Superficial fungal infections Seborrheic dermatitis Acne Psoriasis Selenium sulfide (Selsun) Antifungal, antidandruff Dandruff Topically to scalp as shampoo once Tinea versicolor or twice weekly 956 SECTION 11 DRUGS USED IN SPECIAL CONDITIONS effects and increased blood flow to the area. Many commonly used drugs may mation and pain may result from inhibition of arachadonic acid cause skin lesions, including antibiotics (eg, peni- metabolism and formation of inflammatory prostaglandins. Commercial products are available for topical use, but • Irritants or allergens may cause contact dermatitis. When used for this For example, dermatitis involving the hands may be purpose, a clear, thin, gel-like liquid can be squeezed directly caused by soaps, detergents, or various other cleans- from a plant leaf onto the burned or injured area several times ing agents. Topical use has not been associated with se- from allergic reactions to clothing. Oats contain gluten, which forms a sticky mass that drainage, and whether the lesion appears infected or con- holds moisture in the skin when it is mixed with a liquid and tains necrotic material. For topical use, oats are contained in described as petechiae (pinpoint hemorrhages) or ecchy- bath products, cleansing bars, and lotions (eg, Aveeno prod- moses (bruises). Burn wounds are usually described in ucts) that can be used once or twice daily.

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He has been self-treating with over-the-counter (OTC) medications a friend in the dorms gave him buy skelaxin 400 mg with amex. Antihistamines are drugs that antagonize the action of his- Histamine is discharged from mast cells and basophils in tamine. Thus, to understand the use of these drugs, it is nec- response to certain stimuli (eg, allergic reactions, cellular in- essary to understand histamine and its effects on body tissues, jury, extreme cold). Once released, it diffuses rapidly into characteristics of allergic reactions, and selected conditions other tissues, where it interacts with histamine receptors on for which antihistamines are used. H1 receptors are located mainly on smooth muscle cells in blood vessels and the res- piratory and GI tracts. When histamine binds with these re- HISTAMINE AND ITS RECEPTORS ceptors and stimulates them, effects include: • Contraction of smooth muscle in the bronchi and bron- Histamine is the first chemical mediator to be released in im- chioles (producing bronchoconstriction and respiratory mune and inflammatory responses. It is synthesized and stored distress) in most body tissues, with high concentrations in tissues ex- • Stimulation of vagus nerve endings to produce reflex posed to environmental substances (eg, the skin and mucosal bronchoconstriction and cough surfaces of the eye, nose, lungs, and gastrointestinal [GI] • Increased permeability of veins and capillaries, which tract). In allows fluid to flow into subcutaneous tissues and form these tissues, histamine is located mainly in secretory granules edema 715 716 SECTION 8 DRUGS AFFECTING THE RESPIRATORY SYSTEM • Increased secretion of mucous glands. They and increased nasal mucus produce the nasal congestion produce direct damage to the cell surface. Serum creased secretion of gastric acid and pepsin, increased rate sickness, the prototype of these reactions, occurs when and force of myocardial contraction, and decreased immuno- excess antigen combines with antibodies to form immune logic and proinflammatory reactions (eg, decreased release of complexes. The complexes then diffuse into affected tis- histamine from basophils, decreased movement of neu- sues, where they cause tissue damage by activating the trophils and basophils into areas of injury, inhibited T- and complement system and initiating the inflammatory re- B-lymphocyte function). If small amounts of immune complexes are de- ceptors causes peripheral vasodilation (with hypotension, posited locally, the antigenic material can be phagocytized headache, and skin flushing) and increases bronchial, intesti- and digested by white blood cells and macrophages nal, and salivary secretion of mucus. If large amounts are de- posited locally or reach the bloodstream and become deposited in blood vessel walls, the lysosomal enzymes HYPERSENSITIVITY released during phagocytosis may cause permanent tis- (ALLERGIC) REACTIONS sue destruction. That is, the person is hypersensitive antigen to cause inflammation mediated by release of or allergic to the substance (called an antigen or allergen). Allergic reactions may result from specific antibodies, sen- sitized T lymphocytes, or both, formed during exposure to an antigen.

Cutaneous ing the swing phase of gait and are involved in lift- reflexes are also evoked in contralateral muscles buy skelaxin 400 mg on-line. Changes in patients and clinical implications Why a transcortical component to the response? Similar reflex responses have been described in the Changes in cutaneous reflexes, in particular in with- spinalised cat during walking, and could play a sim- drawal reflexes, are of clinical importance in the ilar role (see p. The exaggeration of flexor reflexes and the Studies in patients 433 release of flexor spasms may, in addition, contribute tibial nerve can be graded with respect to motor to the discomfort of these patients. Complete spinal transection Afferents contributing to the flexion reflex Early responses are replaced by long-latency In these patients, they include cutaneous affer- withdrawal reflexes ents, since the responses are evoked by sural nerve stimulation (Roby-Brami & Bussel, 1987), but also These long-latency responses are mediated through probably high-threshold muscle afferents (Schmit, pathways analogous to those transmitting long- McKenna-Cole & Rymer, 2000), much as in FRA- latency FRA responses in the DOPA-treated cat. Threephasescanbedistinguishedintheevolutionof reflexesinthesepatients(Hiersmenzel,Curt&Dietz, 2000): (i) During the initial phase of spinal shock, with- Upper motoneurone lesions other than drawal reflexes are abolished. There are no long- acompletespinaltransectionproducecharacteristic latency responses. The disappearance of cuta- liest plantar response after stimulation of the sole neous reflexes on the affected side of patients with of the foot is then recorded in the extensor hallucis hemiplegia was recognised by Jastrowitz in 1875 for longus where it appears with a latency similar to that the cremasteric reflexes and by Rosenbach in 1876 of long-latency withdrawal responses (Roby-Brami, for the abdominal reflexes (cited by van Gijn, 1996). When the Babinski response is manifest (see below), this is in part because the normal downward move- ment of the hallux, which is a segmental cutaneo- Receptive field muscular reflex involving the flexor hallucis brevis, Incontrasttothemodularorganisationofearlywith- disappears after upper motoneurone lesions (cf. The disappearance of these cutaneous responses in patients with a chronic spinal cord responses after upper motoneurone lesions implies injury have an invariant pattern of flexion, regard- that the relevant pathways normally receive tonic lessofthestimuluslocationonthefootorleg(Schmit descending excitation from the corticospinal tract. The finding that similar responses occur with stimulation of the sural and posterior tibial The Babinski response nerves (Roby-Brami & Bussel, 1987) is of methodo- logical interest: it is not possible to grade the stimu- The replacement of the normal plantar flexion of toe lus intensity with respect to the perception (or pain) 1bydorsiflexion constitutes the Babinski response, threshold in these patients, but stimulation of the a major sign of an upper motor neurone lesion. The documented in EMG recordings absence of an expected Babinski sign or an equiv- ocal response is often due to the technique used to Using natural mechanical stimuli, Landau & Clare elicit the response. The differences in these stud- Withdrawal (flexor) reflexes in the lower limb ies may be due to the different method of stimula- Alterations of lower-limb withdrawal tion – electrical stimulation is artificial, quite unlike reflexes in spasticity the situation when neurologists test the reflex.