By P. Asam. Loyola University, New Orleans. 2018.

Analysis of literature and teaching experience allow to identify the main pedagogical conditions of introduction of person-oriented education in teaching discipline "Psychiatry and Narcology" generic 500 mg metformin visa blood sugar 83. The pedagogical conditions includes the creation of personality-oriented environment in the educational space of the university discount 500 mg metformin free shipping diabetes news, the use of student-centered teaching methods, ensuring internal professionally significant motivation of the students during the study of the discipline. The questions of improvement of the health system in Ukraine according to market requirements have gained great importance at the present stage of development of Ukraine. It is possible to prepare such a specialist providing an appropriate learning environment which would include a system of independent study. Give haracteristics to different types, forms and methods of independent study in the discipline "Fundamentals of Economic Theory" at a Medical College. To solve the given problems we applied theoretical and empirical methods such as observation and discussion. Theoretical analysis of the term "independent students study" allows to consider it master educational material. Independent learning as a didactic form of teaching includes the following organization stages: planning, organization process and supervision; effective control and assessment. Our experience shows that the teacher should provide a variety of types, forms and methods of independent work of students for effective learning in the sphere of economics at a Medical College. Implementation of innovative teaching methods allows to carry out part-investigative, creative and research work in the classroom and extracurriculum independent students work. Planning of independent students work in the discipline "Fundamentals of Economic Theory" also includs group and individual students work. Organizing extracurricular work of students we tried to establish interaction between the participants of educational process. Consultations and different support that teachers give to their students create the atmosphere of cooperation between them. Analysis of pedagogical sources of literature allows to mention different methods and techniques which help to develop critical thinking among them 373 there is case method, methods of clusters, mental maps, digests and method of project. Innovative teaching approach in the discipline of "Fundamentals of Economic Theory" at Medical College consisted of making clusters to memorize the teaching material at the end of the lectures. The use of cluster has allowed to make clear the process of thinking and reflect nonstandard forms of thinking. That is why the method of critical thinking is sometimes called "visual brainstorming". The algorithm for organization of independent learning in making up a cluster is the following: 1. A key word or a sentence which reflects the core idea or a theme is written on a worksheet. The words must be connected with the subject notions that reflects logical relationship. During seminar classes in the given discipline we applied the case method where each student made his/her decision of situational task and offered his/her decision for discussion in the group. While making up the mental card during the seminars, students selected opinions, facts, arguments and their symbolic images. Project activities and intellectual games on separate topics helped us to give the learning process research character. In the teaching process of the discipline "Fundamentals of Economic Theory" it is important to organize individual and group forms of work in the classroom and extracurricular time. The use of critical thinking methodgives us possibility to use different methods of problem-searching. The method of projects gives us a good chance to apply creativity and scientific research in the independent learning of students. Formation of professional competence of specialists in higher education is not possible without immersing students in active learning activities. A number of modern researchers in their publications lighthts the essence of innovative teaching methods and especially their implementation in terms of higher education. Aim – to summarize the peculiarities of interactive teaching methods when preparing future professionals at the universities. To solve the tasks used theoretical (study and analysis of pedagogical literature) and empirical methods (observation, interviews). The concept of interactive (from «inter» - mutual and «act» - act) means suitable of interaction, dialogue.

This purchase metformin 500 mg mastercard type 2 diabetes medications side effects, in turn 500mg metformin for sale american diabetes association definition hypoglycemia, reduces the oxygen re- The more …And the harder I quirements of the heart. By dilating Don’t fight it the harder I veins, nitrates reduce have to work… the blood in my The arterioles provide the ventricles—so I can most resistance to the blood get some rest. Nitrates decrease af- terload by dilating the arteri- oles, reducing resistance, eas- ing the heart’s workload, and easing the demand for oxygen. For speedy relief… The rapidly absorbed nitrates, such as nitroglycerin, are the drugs of choice for relief of acute angina because: • they have a rapid onset of action • they’re easy to take Warning! Most adverse reactions to nitrates result from changes in the cardio- Drug interactions vascular system. These • Severe hypotension can result when nitrates interact with alco- reactions usually disap- hol. The three H’s • Absorption of sublingual nitrates may be delayed when taken Headache is the most with an anticholinergic drug. Hypotension may a person stands up) with light-headedness, fainting, or blurred vi- also occur, accompa- sion may occur when calcium channel blockers, antihyperten- nied by dizziness and in- sives, beta-adrenergic blockers, or phenothiazines and nitrates are creased heart rate. Beta-adrenergic blockers in- clude: • atenolol • metoprolol • nadolol • propranolol. Making an escape Propranolol and metoprolol are metabolized in the liver, and their metabolites are excreted in urine. Atenolol and nadolol aren’t me- tabolized and are excreted unchanged in urine and stool. Pharmacodynamics Beta-adrenergic blockers decrease blood pressure and block beta- adrenergic receptor sites in the heart muscle and the conduction system. This decreases the heart rate and reduces the force of the heart’s contractions, resulting in a lower demand for oxygen. Pharmacotherapeutics Beta-adrenergic blockers are indicated for long-term prevention of angina. Because of their ability to reduce blood pressure, beta-adren- ergic blockers are also first-line therapy for treating hypertension. Adverse reactions to beta- adrenergic blockers Beta-adrenergic blockers may • nausea and vomiting cause: • diarrhea • bradycardia • significant constriction of the • angina bronchioles. As mentioned earlier, several of the calcium channel blockers are also used as antiarrhythmics and to treat hypertension. Calcium channel blockers used to treat angina include: • amlodipine • diltiazem • nicardipine • nifedipine • verapamil. How calcium channel blockers work Calcium channel blockers in- crease the myocardial oxygen Calcium ion supply and slow the heart rate. Apparently, the drugs produce these effects by blocking the slow calcium Some calcium channel. This action inhibits channel blockers Calcium channel the influx of extracellular cal- blocker slow the heart rate but don’t cium ions across both myo- change the level cardial and vascular smooth of calcium in the muscle cell membranes. Cell membrane Cell membrane No calcium = dilation This calcium blockade causes the coronary arteries (and, to a lesser extent, the peripheral arteries and arterioles) to di- late, decreasing afterload and Slow calcium increasing myocardial oxygen channel supply. Pharmacokinetics When administered orally, calcium channel blockers are absorbed quickly and almost completely. Because of the first-pass effect, however, the bioavailability of these drugs is much lower. Gone without a trace All calcium channel blockers are metabolized rapidly and almost completely in the liver. This causes dilation of the coronary and peripheral arteries, which decreases the force of the heart’s contractions and reduces Warning! The relaxation response Adverse Also, by preventing arterioles from constricting, calcium channel blockers reduce afterload. Decreasing afterload further decreases reactions to the oxygen demands of the heart. A slower heart rate reduces the heart’s need for additional lar reactions are the oxygen.

Certain carriers prolong the time during which therapeutic plasma concentrations of drug are maintained generic 500 mg metformin otc xylitol blood sugar levels, effectively providing sustained release cheap metformin 500 mg online diabetes mellitus type 1. This is believed to occur due to the rate and extent of water uptake being modified by the formulation, as well as to the type of gel formed by the excipients. As the polymers hydrate by withdrawing water from the secretions of the nasal epithelium, localized changes in mucociliary clearance occur, due to the presence of a hydrating polymer and potentially due to induced alterations in the viscoelasticity of the mucus gel. Colloidal bioadhesives Bioadhesive microspheres composed from a variety of materials such as starch, carbomer, hyaluronan esters, dextrans have been used to prolong the retention time of the drug within the nasal cavity. The clearance half-life of microspheres can be in the order of 3–4 hours, in comparison with 15 minutes for a simple solution. Improved bioavailabilities have been seen for gentamicin, insulin and desmopressin. A temporary widening of the tight junctions of cultured cells, which coincided with an increase in the rate of absorption of the applied drug, insulin, has been observed in the presence of starch microspheres. It is likely that the dry starch microspheres took up water from the cells causing them to dehydrate and “shrink” resulting in a separation of the intercellular junctions. Should this be the case, it provides evidence for the paracellular absorption of insulin. This can be achieved by including an excipient in the formulation with a reversible ciliostatic effect; such agents include certain preservatives. However, it is important that the chosen strategy does not permanently compromise mucociliary clearance, which would adversely affect airway homeostasis and defense. However the long-term effects of even a temporary impediment to the mechanism of nasal clearance is unknown and such an approach should be used with caution. For instance, cytochrome P450-dependent monooxygenase metabolizes nasal decongestants, nicotine, cocaine and progesterone. With respect to the degradation of peptides and proteins, a variety of protease inhibitors have been studied including bestatin, diprotinin A and aprotinin, which inhibit leucine aminopeptidase, dipeptidyl peptidase and trypsin respectively (Table 9. Some inhibitors are active against more than one peptidase, for example leupeptin inhibits both cathepsin and trypsin. The choice of inhibitor depends upon the peptide, for instance inhibitors having a trypsin- inhibitory effect have been shown to enhance the nasal absorption of salmon calcitonin in rats. Interestingly, compounds which have been investigated for their penetration-enhancing effect at the absorbing membrane have also been shown to decrease the metabolism of certain peptides. By denaturing leucine aminopeptidase and preventing enzyme-substrate complex formation, the bile salt sodium glycocholate has been shown to protect insulin from proteolysis in the rat nasal mucosa. In addition to formulation additives, peptides can be chemically modified to improve their stability to proteases, as described in Chapter 1 (Section 1. However, altering the tonicity of the formulation had no effect on the absorption of human granulocyte colony-stimulating factor (molecular weight 19 kDa). In another study, decreasing the pH of the formulation was shown to enhance absorption. Alterations of osmotic pressure and pH beyond a certain range might be expected to result in damage to the epithelium and hence increase its permeability to xenobiotics. Delivering the drug as a dry powder 243 A further approach has been to deliver drugs in the form of a powder (but without a bioadhesive carrier). For example, freeze-dried insulin has been shown to be better absorbed as a powder than in solution, although the absorption of glucagon and dihydroergotamine, when delivered from liquid or powder formulations, was equivalent. However, problems which require resolving include developing absorption promoters with minimal toxicity and overcoming adverse nasal pathology to ensure accurate and reproducible dosing. List the mechanisms by which the permeability of the nasal epithelium may be increased to improve the efficacy of nasal drug delivery. Delivery of anti-asthmatic and other locally acting drugs directly 245 to their site of action reduces the dose needed to produce a pharmacological effect, while the low concentrations in the systemic circulation may also reduce side-effects. The lung may additionally be employed as a route for delivery of drugs into the systemic circulation, and onward to an effect site located elsewhere in the body. A product containing ergotamine tartrate is available as an aerosolized dosage inhaler for the treatment of migraine. Volatile anesthetics, including, for example, halothane, are also given via the pulmonary route. In recent years, the possibility of utilizing the pulmonary route for the systemic delivery of peptides and other molecules which are not absorbed through the gastrointestinal tract has also been explored.

Examples of regulated products are over-the-counter drugs buy metformin 500 mg on-line diabetes prevention program 2002, prescription drugs cheap 500mg metformin free shipping diabetic nephropathy symptoms, alcohol and tobacco. Rehabilitation In the field of Substance use, the process by which an individual with a substance use disorder achieves an optimal state of health, psychological functioning, and social wellbeing. Rehabilitation follows the initial phase of treatment (which may involve Detoxification and medical and psychiatric treatment). It encompasses a variety of approaches, including group therapy, specific behaviour therapies to prevent relapse, involvement with a mutual-help group, residence in a therapeutic community or half- way house, vocational training, and work experience. Relapse A return to drug use after a period, of abstinence or controlled use, often accompanied by reinstatement of Dependence symptoms. Some distinguish between relapse and lapse (‘slip’), with the latter denoting an isolated occasion of alcohol or drug use. This can be pharmacological (eg naltrexone-maintained abstinence from opioid use), or a psychosocial intervention such as cognitive-behavioural therapy, which focuses on helping users to identify situations where they are most vulnerable to drug use and to develop coping skills to deal with these situations. In the context of Illicit drug use, it can refer to a period of abstinence or controlled use, or to a period of freedom from the Craving associated with Dependence. Residential rehabilitation Prolonged residential treatment in a home, hostel or hospital unit, for Dependence, usually on a Psychoactive drug. There is a positive and highly structured drug-free environment with strict rules, where residents are expected to participate in a programme of Rehabilitation, based on self-help and mutual support. Substitution treatment Treatment of Dependence on a Psychoactive drug with a substitute drug with cross-dependence and cross-Tolerance. The goal is to reduce or eliminate use of the original drug and/or to reduce harm from a particular method of administration. Therapeutic community A structured environment where individuals with Substance use disorders live, to achieve Rehabilitation. Such communities are often specifically designed for individuals with Dependence on Psychoactive drugs, are run according to strict rules, based on self-help and mutual support, and are often geographically isolated. They use a hierarchical model with treatment stages that reflect increased levels of personal and social responsibility. Peer influence, mediated through a variety of group processes, is used to help individuals learn and assimilate social norms and develop more effective social skills. Increased doses of alcohol or other drugs are required to achieve the effects originally produced by lower doses. Physiological and psychosocial factors may contribute to the development of tolerance, which may be physical, behavioural or psychological. With respect to physiological factors, both metabolic and/or functional tolerance may develop. By increasing the rate of metabolism of the substance, the body may be able to eliminate the substance more readily. Functional tolerance is defined as a decrease in sensitivity of the central nervous system to the substance. Behavioural tolerance is a change in the effect of a drug as a result of learning or alteration of environmental constraints. Acute tolerance is rapid, temporary accommodation to the effect of a substance following a single dose. Reverse tolerance, also known as sensitisation, refers to a condition in which the response to a substance increases with repeated use. Withdrawal syndrome A group of symptoms of variable clustering and degree of severity that occur on cessation or reduction of use of a Psychoactive substance that has been taken repeatedly, usually for a prolonged period and/or in high doses. It is also the defining characteristic of the narrower Psychopharmacological meaning of Dependence. The onset and course of the withdrawal syndrome are time limited and are related to the type of substance and dose being taken immediately before cessation or reduction of use. Typically, the features of a withdrawal syndrome are the opposite of those of acute Intoxication. The first step in such a debate is to ensure that the facts are presented, along with the evidence to support them.