Loading

Penosil

Viagra Professional

By S. Ramirez. Saint Petersburg College.

Medical examiners’ ofces vary in their organization order viagra professional 50 mg with visa, but it is possible to describe the organization and function of a “generic” ofce purchase viagra professional 50 mg otc. It is typically an investigator who takes initial reports of a death buy discount viagra professional 100mg on line, and makes a determination as to whether or not the case falls under medical examiner jurisdiction buy viagra professional mastercard. Te investigator will also take a leading role in helping to establish positive identifcation of the decedent. Identifcation techniques are discussed at length in a subsequent chapter, and are one of the most critical functions of any medicolegal examination. Just as a physician must take a medical history before examining or treating a patient, so must the forensic pathologist obtain background information on a death before examining a decedent. As the subject of the examination obviously cannot be interviewed, it is up to the investigator to gather this information from whatever source is available. Tis may involve visitation of the scene of death to photograph and describe fndings (Figure 4. Ofen the position of the decedent may give critical information about the factors that lead to death. Conditions at the scene may implicate environmental factors in the death, or the fnding of medications or intoxicants may result in suspicion of a drug-related demise. Indeed, interpretation of drug levels found in the body on toxicologic testing ofen relies heavily on scene or historical infor- mation about the decedent’s prior drug use. Scene fndings, correlated with autopsy fndings, ofen provide information about how a death occurred (manner of death), in addition to what caused the death. Apart from the scene investigation, investigators obtain other information regarding the medical 52 Forensic dentistry a b Figure 4. Alternatively, some or all of these duties may be shared with other sections of the ofce. In large ofces, the investigation section is usually composed of a number of full-time employees. In smaller ofces, much of the investigative functions may be performed by the forensic pathologist or other staf. Te medical or autopsy section includes forensic pathologists and the technicians who assist them in performing examinations of decedents (Figure 4. Tese examinations may take the form of full or limited autopsy examinations, or be limited to external examination of the body. Te extent of the examination will be determined by the medical examiner afer reviewing the decedent’s medical history and circumstances of death. In elderly individuals or those with extensive and potentially fatal medi- cal histories, found dead under circumstances that indicate a death due to natural causes, examination may be limited to external inspection of the body to exclude any evidence of trauma. On the other hand, in cases of acute traumatic death, particularly in the case of apparent homicide, a full autopsy will generally be indicated. In most cases, blood and other body fuids or tissues will be drawn at the time of examination for submission to the toxi- cology laboratory at the discretion of the forensic pathologist. Photographs of injuries and of the decedent for identif- cation and documentation purposes will also be obtained. Te degree to which autopsy technicians assist forensic pathologists will vary from ofce to ofce, depending on stafng, tradition, and local philosophy. In some ofces, assistants may perform eviscerations of bodies under supervision of forensic pathologists (Figure 4. Either system is acceptable as long as all of these activities are under the direct supervision of a forensic pathologist. Assistants may also perform clerical duties, take radiographs, draw blood or other toxicol- ogy specimens, suture bodies closed, clean the body and examination area, assist in removal of clothing, and assist with inventory and preservation of clothing and evidence. As a part of the medical or autopsy section, a modern medical examiner’s ofce will maintain relationships with expert consultants to assist the medical examiner in specialized areas. One of the most important and commonly utilized consultants is the forensic odontologist. A trained and certifed dental practitioner provides invaluable aid in helping to establish identifcation of decedents by dental comparison and in the evaluation of bitemark evidence, which may be invaluable in linking an assailant to a homicide victim. Anthropologists assist the pathologist in evaluation of skeletal remains, again, in an efort to establish identifcation by narrowing the age, race, and sex of death investigation systems 55 Figure 4. Tey may also assist in evaluating traumatic or other changes in the skeleton that may show acute or remote injury. Neuropathologists, pediatric pathologists, radiologists, and other medical specialists may provide valuable input into the investigation of specialized medical aspects of a case, and nonmedical specialists, such as engineers, electricians, entomologists, meteorologists, and geologists, may assist in the evaluation of the external or environmental factors in a death. Te toxicology section is integral to the function of any modern medical examiner’s ofce. Proper analysis of the blood and other body fuids is not only required to confrm cause of death in cases of apparent drug overdose, but is routinely performed in cases of deaths due to unknown causes, deaths due to trauma, and some deaths due to apparent natural disease. Information on intoxication is critical to adjudication of many traumatic deaths, and ofen drug intoxication is found in deaths initially thought to be solely due to natural disease. Tough many large medical examiners’ ofces will have an on-site dedicated toxicology laboratory (Figure 4. In either case, it is imperative that the laboratory be appropriately accredited and supervised, and that protocols for specimen collection, retention, and analysis be well established and meet the require- ments of the chief medical examiner or supervising forensic pathologist. It is also necessary that the forensic toxicologist be available for ready consulta- tion in difcult or problematic cases. Tis section will also respond to subpoenas, public information queries, and the myriad other requests for information that are submitted to the medical examiner’s ofce each day. In a medical examiner system, ofce administration must be under the auspices of the chief medical examiner. It is imperative that this individual have full authority over operational, budgetary, and personnel matters, though he or she may employ administrative, fscal, and other assistants, and delegate duties to them as needed. It is the chief medical examiner who will determine the procedures and policies of the ofce, and fnal author- ity over the ofce must reside with him or her, as well as responsibility for the performance of all aspects of the ofce. Tis includes responsibility for all investigations and examinations, and for maintaining the quality of the ofce’s work products. Adequate civil service protection is optimal for all medical examiners, to help ensure that these physicians are not intimidated or punished for their honest professional opinions, which form the true work product of the organization. Coroner systems will have many organizational facets in common with medical examiners’ ofces, with the exception that fnal authority of the medical investigative agency does not reside with a trained physician (with the exception of rare cases in which the coroner is also a board-certifed forensic pathologist). It is imperative, then, that the coroner’s chief forensic pathologist has adequate authority over all operational matters to ensure that good forensic pathology procedures are followed in all areas. Tis will require adequate input into budgetary and personnel matters, as well as medical matters. In modern medical practice, board certifcation of physicians is expected and usually required for the full exercise of the practice privileges in a medical specialty. If these requirements are met, the physi- cian will receive certifcation in anatomic pathology, and special qualifca- tion in the feld of forensic pathology, also referred to as board certifcation. In addition to board certifcation, practitioners may now be held to pro- fessional standards of practice in the feld of forensic pathology. Te National Association of Medical Examiners has published such standards to provide guidance and objective criteria for the assessment of the practice of forensic pathology. Tese set forth stan- dards for practice of forensic autopsy pathology, provide some defnitions related to the feld, and discuss standards for associated techniques, such as toxicological analysis, radiography, histology, and written reports. While broad and relatively basic, such standards do require a certain level of prac- tice by physicians and can serve as an objective guide in assessing an indi- vidual’s level of practice. While certifcation and standards refer to the practitioner and his or her practice, accreditation refers to the assessment of a death investigation system or ofce as an organization, without assessing the performance of any individual practitioner. If the inspection is not successful, the ofce management will be counseled regarding defciencies and methods of correcting them. Provisional accreditation for a brief period and reinspec- tion are available to assist ofces in meeting this goal. Each state sets its own legal and governmental framework for the type and extent of medicolegal investigation, resulting in a patchwork of systems throughout the country that tends to confound any classifcation scheme. However, there are basic consistencies in the goals and practice of good quality death investigation, and thanks to organizations such as the National Association of Medical Examiners, uniform medical practice standards and accredita- tion criteria are now published, serving as a benchmark for the nationwide evaluation of forensic pathology and death investigation practice. Adherence to these criteria will help to ensure that medicolegal investigation in this country meets minimal approved standards and best serves the needs of the citizens of the various jurisdictions.

Considering that cheap generic viagra professional uk, in this respect order viagra professional 50mg, police play a vital role in all the member states safe viagra professional 100 mg, that they are frequently called on to intervene in conditions which are dangerous for their members order 50 mg viagra professional mastercard, and that their duties are made yet more difficult if the rules of conduct of their members are not sufficiently precisely defined; 3. Being of the opinion that it is inappropriate for those who have committed vio- lations of human rights while members of police forces, or those who have belonged to any police force that has been disbanded on account of inhumane practices, to be employed as policemen; 4. Being of the opinion that the European system for the protection of human rights would be improved if there were generally accepted rules concerning the profes- sional ethics of the police that take account of the principles of human rights and fundamental freedoms; 5. Considering that it is desirable that police officers have the active moral and physical support of the community they are serving; 6. Considering that police officers should enjoy status and rights comparable to those of members of the civil service; 7. Believing that it may be desirable to lay down guidelines for the behavior of police officers in case of war and other emergency situations and in the event of occupation by a foreign power; 8. Adopts the following Declaration on the Police, which forms an integral part of this resolution; 9. Instructs its Committee on Parliamentary and Public Relations and its Legal Affairs Committee and the Secretary General of the Council of Europe to give maximum publicity to the declaration. A police officer shall fulfill the duties the law imposes upon him by protecting his fellow citizens and the community against violent, predatory, and other harm- ful acts, as defined by law. In particular, he shall refrain from and vigorously oppose all acts of corruption. Summary executions, torture, and other forms of inhuman or degrading treat- ment or punishment remain prohibited in all circumstances. A police officer is under an obligation to disobey or disregard any order or instruction involving such measures. A police officer shall carry out orders properly issued by his hierarchical supe- rior, but he shall refrain from carrying out any order he knows, or ought to know, is unlawful. If immediate or irreparable and serious harm should result from permitting the violation to take place he shall take immediate action, to the best of his ability. If no immediate or irreparable and serious harm is threatened, he must endeavor to avert the consequences of this violation, or its repetition, by reporting the mat- ter to his superiors. No criminal or disciplinary action shall be taken against a police officer who has refused to carry out an unlawful order. A police officer shall not cooperate in the tracing, arresting, guarding, or convey- ing of persons who, while not being suspected of having committed an illegal act, are searched for, detained, or prosecuted because of their race, religion or politi- cal belief. A police officer shall be personally liable for his own acts and for acts of com- mission or omission he has ordered and that are unlawful. It should always be possible to deter- mine which superior may be ultimately responsible for acts or omissions of a police officer. Legislation must provide for a system of legal guarantees and remedies against any damage resulting from police activities. In performing his duties, a police officer shall use all necessary determination to achieve an aim that is legally required or allowed, but he may never use more force than is reasonable. Police officers shall receive clear and precise instructions as to the manner and circumstances in which they should make use of arms. A police officer having the custody of a person needing medical attention shall secure such attention by medical personnel and, if necessary, take measures for the preservation of the life and health of this person. He shall follow the instruc- tions of doctors and other competent medical workers when they place a detainee under medical care. A police officer shall keep secret all matters of a confidential nature coming to his attention, unless the performance of duty or legal provisions require otherwise. A police officer who complies with the provisions of this declaration is entitled to the active moral and physical support of the community he is serving. Document 3 Declaration of Tokyo Guidelines for Medical Doctors concerning Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment in relation to Detention and Imprisonment. The utmost respect for human life is to be maintained even under threat, and no use made of any medical knowledge contrary to the laws of humanity. For the purpose of this Declaration, torture is defined as the deliberate, systematic, or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority to force another person to yield information, to make a confession, or for any other reason. Declaration The doctor shall not countenance, condone, or participate in the practice of torture or other forms of cruel, inhuman, or degrading procedures, what- ever the offence of which the victim of such procedure is suspected, accused, or guilty, and whatever the victim’s belief or motives, and in all situations, including armed conflict and civil strife. The doctor shall not provide any premises, instruments, substances, or knowledge to facilitate the practice of torture or other forms of cruel, inhu- man, or degrading treatment or to diminish the ability of the victim to resist such treatment. The doctor shall not be present during any procedure during which tor- ture or other forms of cruel, inhuman, or degrading treatment are used or threat- ened. A doctor must have complete clinical independence in deciding on the care of a person for whom he or she is medically responsible. The doctor’s fundamental role is to alleviate the distress of his or her fellow men, and no motive, whether personal, collective, or political, shall prevail against this higher purpose. Where a prisoner refuses nourishment and is considered by the doctor as capable of forming an unimpaired and rational judgment concerning the con- sequences of such voluntary refusal of nourishment, he or she shall not be fed artificially. The decision regarding the capacity of the prisoner to form such a judgment should be confirmed by at least one other independent doctor. The consequences of the refusal of nourishment shall be explained by the doctor to the prisoner. The World Medical Association will support and should encourage the international community the national medical associations and fellow doctors to support the doctor and his or her family in the face of threats or reprisals resulting from a refusal to condone the use of torture or other forms of cruel, inhuman, or degrading treatment. Principle 1 Health personnel, particularly physicians, charged with the medical care of prisoners and detainees have a duty to provide them with protection of their physical and mental health and treatment of disease of the same quality and standard as is afforded to those who are not imprisoned or detained. Principle 2 It is a gross contravention of medical ethics, as well as an offense under applicable international instruments, for health personnel, particularly physi- cians, to engage, actively, or passively, in acts that constitute participation in, complicity in, incitement to or attempts to commit torture or other cruel, inhu- man or degrading treatment or punishment. Principle 3 It is a contravention of medical ethics for health personnel, particularly physicians, to be involved in any professional relationship with prisoners or detainees the purpose of which is not solely to evaluate, protect or improve their physical and mental health. Principle 4 It is a contravention of medical ethics for health personnel, particularly physicians: a. To apply their knowledge and skills in order to assist in the interrogation of pris- oners and detainees in a manner that may adversely affect the physical or mental health or condition of such prisoners or detainees and which is not in accordance with the relevant international instruments; b. To certify or to participate in the certification of the fitness of prisoners or detainees for any form of treatment or punishment that may adversely affect their physical or mental health and which is not in accordance with the relevant international instruments or to participate in any way in the infliction of any such treatment or punishment that is not in accordance with the relevant inter- national instruments. Principle 6 There may be no derogation from the foregoing principles on any ground whatsoever, including public emergency. At the meeting of the Council of National Representatives of the Interna- tional Council of Nurses in Singapore in August 1975, a statement on the role of the nurse in the care of detainees and prisoners was adopted. The fundamental responsibility of the nurse is fourfold: to promote health, to prevent illness, to restore health, and to alleviate suffering. The nurse, when acting in a professional capacity, should at all times maintain standards of personal conduct that reflect credit on the profession. The nurse takes appropriate action to safeguard the individual when his or her care is endangered by a coworker or any other person. Members of the armed forces, prisoners and persons taking no active part in the hostilities a. The following acts are and shall remain prohibited at any time and in any place whatsoever with respect to the above-mentioned persons: a. Everyone is entitled to all the rights and freedoms, set forth in this Declara- tion, without distinction of any kind, such as race, color, sex, language, reli- gion, political or other opinion, national or social origin, property, birth or other status (Article 2), b. No one shall be subjected to torture or to cruel, inhuman, or degrading treat- ment or punishment (Article 5). In relation to detainees and prisoners of conscience, interrogation proce- dures are increasingly being employed resulting in ill effects, often perma- nent, on the person’s mental and physical health. Nurses having knowledge of physical or mental ill-treatment of detain- ees and prisoners must take appropriate action, including reporting the matter to appropriate national and/or international bodies. Nurses participate in clinical research carried out on prisoners only if the freely given consent of the patient has been secured after a complete explana- tion and understanding by the patient of the nature and risk of the research. The nurse’s first responsibility is to the patients, notwithstanding con- siderations of national security and interest. It will come into effect at some future date (unknown at the time of writing), and the Act will give effect to rights and freedoms guaranteed under the European Convention on Human Rights. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which this penalty is provided by law. Deprivation of life shall not be regarded as inflicted in contravention of this article when it results from the use of force that is no more than absolutely necessary: a. Ethical Documents 401 Article 3 No one shall be subjected to torture or to inhuman or degrading treat- ment or punishment. No one shall be deprived of his liberty save in the following cases and in accordance with a procedure prescribed by law: a.

To help you navigate through this book best viagra professional 50 mg, we use the following typographical conventions: Italics are used for emphasis and to highlight new words or terms that are defined in the text purchase cheapest viagra professional and viagra professional. Boldface is used to indicate keywords in bulleted lists or the action parts of numbered steps order viagra professional 100mg otc. Anatomy & Physiology Workbook For Dummies 2 Foolish Assumptions In writing Anatomy & Physiology Workbook For Dummies 50mg viagra professional for sale, we had to make some assumptions about you, the reader. If any of the following apply, this book’s for you: You’re an advanced high school student or college student trying to puzzle out anatomy and physiology for the first time. You’re a student at any level who’s returning to the topic after some time away, and you need some refreshing. You’re facing an anatomy and physiology exam and want a good study tool to ensure that you have a firm grasp of the topic. Because this is a workbook, we had to limit our exposition of each and every topic so that we could include lots of practice questions to keep you guessing. How This Book Is Organized Anatomy and physiology are very far-reaching topics, so it only makes sense that this workbook is divided into parts, each of which is divided into a number of chapters. The following sections preview the part topics to give you an idea of what you can find where. Part I: Building Blocks of the Body We begin at the very beginning — chemistry — because it’s a very good place to start. Stop moaning and groaning — chemistry really isn’t as difficult as it’s been made out to be. It’s an integral part of understanding what the body’s cells are doing and how they’re doing it. We cover the basics from the atom on up and introduce the processes that keep the whole package operating smoothly. Cells are living things, just like the bodies of which they are a part, and they have the same cycles as all living things do: They grow, mature, reproduce, and die. By layering thousands upon thousands of similar cells on top of one another, tissues with unique structures and functions are formed. This part covers the primary types of tissues and where you’ll find them in the body. In this part, we breathe life into the respiratory system with a close look at the lungs and everything attached to them, we feed your hunger for knowledge about how nutrients fuel the anatomical package, and we get to the heart of the well-oiled human machine to show how the central pump is the hardest-working muscle in the entire body. None of that matters without a strong defense system, so we touch on the lymphatic system. And don’t forget: All that metabolizing is bound to lead to some waste and by-products; we package up the trash and show you how the body takes it to the dumpster. But we do take a close look at perpetuating humanity through reproductive successes. This part takes the male and female halves of the equation one at a time, delving into the parts of the male and female reproductive systems as well as the functions of those parts. We already have gotten things moving before this part, but now it’s time to study how nerves and hormones keep things hopping. In this part, we lay out the basic building blocks of the nervous system, help you wire it all together, and then show you how the body sends messages flying along a solid spine of brainy material. After that, we come to our senses with an overview of the eyes and ears (we cover taste in the digestive system chapter, touch in the skin chapter, and smell in the respi- ratory chapter). Then we turn hormonal to absorb what the endocrine system does, including observing the functions of the ringmaster of this multi-ring circus, the pitu- itary gland. We also delve into the various hormones coursing through your body, why they’re there, and how they do what they do. First we identify ten Web sites that can help you advance your knowledge of anatomy and physiology. Then we give you a list of ten key things to keep in mind as you study this illustrious and fascinating topic. Icons Used in This Book Throughout this book, you’ll find symbols in the margins that highlight critical ideas and information. Here’s what they mean: The tip icon gives you juicy tidbits about how best to remember tricky terms or con- cepts in anatomy and physiology. Anatomy & Physiology Workbook For Dummies 4 The example icon marks questions for you to try your hand at. We give you the answer straightaway to get your juices flowing and your brain warmed up for more practice questions. The remember icon highlights key material that you should pay extra attention to in order to keep everything straight. The sizzling bomb icon — otherwise known as the warning icon — points out areas and topics where common pitfalls can lead you astray. Where to Go from Here If you purchased this book and you’re already partway through an anatomy and physi- ology class, check the table of contents and zoom ahead to whichever segment your instructor is covering currently. When you have a few spare minutes, review the chap- ters that address topics your class already has covered. If you haven’t yet started an anatomy and physiology class, you have the freedom to start wherever you like (although we suggest that you begin with Chapter 1) and proceed onward and upward through the glorious machine that is the human body! That means getting down to the true basics: chemistry, cells, cell division, and how tissues are formed. This part helps you discover that chemistry isn’t all that tough, particularly when you focus on the organic elements involved in the chemistry of life. You look at how that chem- istry takes place inside the bricks-and-mortar of the body (its cells) and take things a step further with the wonders of self-perpetuation through mitotic cell division. Chapter 1 The Chemistry of Life In This Chapter Getting to the heart of all matter: Atoms Checking into chemical reactions and compounds Making sense of metabolism e can hear your cries of alarm. You thought you were getting ready to learn about Wthe knee bone connecting to the thigh bone. As much as you may not want to admit it, chemistry — particularly organic chemistry, or that branch of the field that focuses on carbon-based molecules — is a crucial starting point for understanding how the human body works. When all is said and done, the universe boils down to two fundamental components: matter, which occupies space and has mass; and energy, or the ability to do work or create change. This is the chap- ter where we review the interactions between matter and energy to give you some insight into what you need to know to ace those early-term tests. Building from Scratch: Atoms and Elements All matter — be it solid, liquid, or gas — is composed of atoms. An atom is the smallest unit of matter capable of retaining the identity of an element during a chemical reaction. An element is a substance that can’t be broken down into simpler substances by normal chemical reactions. There are 92 naturally occurring atoms in nature and 17 (at last count) artificially created atoms for a total of 109 known atoms. However, additional spaces have yet to be filled in on the periodic chart of elements, which organizes all the elements by name, symbol, atomic weight, and atomic number. Atoms are made up of the subatomic particles protons and neutrons, which are in the atom’s nucleus, and clouds of electrons orbiting the nucleus. The atomic weight, or mass, of an atom is the total number of protons and neutrons in its nucleus. The atomic number of an atom is its number of protons or electrons; conveniently, atoms always have the same number of protons as electrons, which means that an atom is always electrically neutral because it Part I: Building Blocks of the Body 8 always has the same number of positive charges as negative charges. Opposite charges attract, so negatively charged electrons are attracted to positively charged protons. The more protons there are in the nucleus, the stronger the atom’s positive charge is and the more electrons it can attract. Electrons circle an atom’s nucleus at different energy levels, also known as orbits or shells (see Figure 1-1). Each orbit can accommodate only a limited number of electrons and lies at a fixed distance from the nucleus. Each level must be filled to capacity with electrons before a new level can get started. The orbit closest to the nucleus, which may be referred to as the first level or first shell, can accommodate up to two electrons. The second level can have eight electrons and the third also can have eight electrons.

Drug packaging standards determine what infor- mation needs to be displayed on packages of drugs order generic viagra professional. In addition to these standards buy viagra professional in india, there are a number of important laws that have been enacted to control the sale and distribution of drugs viagra professional 100 mg fast delivery. This changed when a drug company distributed a sulfa drug to treat pediatric patients buy discount viagra professional 50 mg on line. With the passage of the Durham- Humphrey amendment to the Food, Drug and Cosmetic Act of 1938, a group of drugs was defined that could only be purchased if the patient had a prescription from a licensed practitioner. This amendment tightened con- trols on drug safety by requiring drug manufacturers to use standard labeling of drug containers. The label lists adverse reactions and contraindications or reasons why the drug should not be used. In an effort to con- tain this problem, Congress passed the Comprehensive Drug Abuse Prevent and Control Act. This act categorized controlled substances according to a schedule based on potential for abuse. The same might be true if you ask an adult where drugs come from and he answers from the drug store. Drugs can be purchased from a drug store, but the origins are from one of four sources. Pharmaceutical firms harvest these plants and transform them into drugs that have a specific purity and strength sufficient to treat diseases. Digitalis is made from leaves of the foxglove plant and is used to treat congestive heart failure and cardiac arrhythmias. For example, Premarin is a drug that contains estrogen that is recovered from mare urine. Insulin is another hormonal drug that is used to regulate blood sugar levels in patients with diabetes mellitus. Patients lacking an adequate level of these materials may take specific mineral- based drugs to raise the level of minerals. Iron is a natural metal that is an integral part of body proteins such as hemoglobin that carries oxygen throughout the body. A synthetic drug is produced using chemical synthesis, which rearranges chemical derivatives to form a new compound. Sulfonamides are a common group of synthesized drugs that are used to treat many infections including bronchitis, pneumonia, and meningitis. Unlike drugs that are governed by the Food and Drug Administration, dietary supplements are not tested or regulated and can be sold over-the-counter without a prescription. This lack of monitoring means there are no standards for purity and strength for herbals. Two packages of the same herbal distributed by the same company might have different purity and strength that makes the effect of the herb unreliable. There is no control over the manufacturing process and that can lead to contamination. The law prohibits dis- tributors of herbals from claiming that an herbal can cure a disease. For example, the manufacturer can say that an herbal increases blood flow to the heart, but cannot say that the herb prevents heart disease. Herbals can lead to unwanted side effects and undesirable interactions with prescription drugs. For example, ginkgo inhibits platelet aggregation (grouping to form clots) if taken with coumadin, an anticoagulant. The interaction of herbals with other drugs can be unpredictable and even dangerous. Healthcare pro- viders should encourage patients to reveal any herbal preparations they are taking. The chemical name is important to chemists, pharmacists, and researchers who work with drugs at the chemical level. A chemical name looks strange to anyone who isn’t a chemist and is difficult for most of us to pronounce. The pharmaceutical company that patents a drug has exclusive rights to sell it until the patent expires. When the patent expires, other drug manufacturers may distribute the drug under the drug’s generic name or create a brand name. The generic version of a drug may be cheaper than the original drug and the cost is usually reimbursed by insurance companies. The generic name is easier to read and pronounce than the drug’s chemical name, N-acetyl-p-aminophenol. Brand name drugs may be more costly than generic drugs and are partially reimbursed or not covered at all by insurance companies. A brand name for acetaminophen is Tylenol (patented by Johnson & Johnson Pharmaceuticals). This drug is a diuretic used for many patients with hypertension (high blood pressure) or cardiac (heart) disease. Prescription versus Over-the-Counter Drugs The 1952 Durham-Humphrey Amendment to the Food, Drug and Cosmetic Act requires that certain classifications of drugs be accessible only by prescription from a licensed practitioner. These are commonly referred to as prescription drugs or legend drugs because the drug label must display the legend “Caution: Federal law prohibits dispensing without prescription” on the label of the drug. Some over-the-counter drugs were at one time available by prescription, but later were considered safe for use by the public or reformulated for over-the-counter use. The therapeutic effect is the intended physiological effect or the reason the drug is being given. Another physiological effect can be the side effects that occur in the body such as nausea and vomiting or a skin rash. A side effect is a physiologic effect that is not the intended action such as the drowsiness that occurs when a patient takes an antihistamine. Some side effects are beneficial while others are adverse effects that can be harmful to a patient. Healthcare providers must identify all known side effects of a drug and weigh any adverse effects with the therapeutic effect before administering a drug. Patients must also be informed about expected side effects and provided instruc- tions about how to manage adverse side effects if at all possible. For example, female patients are instructed to drink buttermilk and eat yogurt when taking a broad-spectrum antibiotic. This counters a possible vaginal yeast infection, which is a common adverse effect of broad-spectrum antibiotics. Additionally, a female patient should be instructed to use other forms of birth control when taking this medication because antibiotics lower the effectiveness of birth control pills. Many times patients will discontinue the use of a medication because the side effects are so unpleasant. Antihypertensive medications (blood pressure medicine) can cause side effects such as drowsiness or the inability to achieve an erection in a male. Patients may decide that this effect is undesirable and discontinue the use of the prescribed drug. Patients should be encouraged to discuss any and all side effects with the provider. Abruptly discontinuing the use of a drug may not be in the best interest of a patient. Sometimes patients discontinue taking a drug because they feel better, however, the condition being treated is still present. Drug Safety Drugs must undergo rigorous testing before being approved by the Food and Drug Administration for use in humans. Acute toxicity is the dose that is lethal or kills 50% of the laboratory animals tested. The testing is also done to determine what symptoms are experienced by the animals and the time the symptoms appear. Physical examina- tions and laboratory tests are performed throughout the study and at the end of the study to see what organs may have been adversely affected by the drug.