Chloramphenicol

By Q. Zapotek. University of Dubuque.

Although Beringer () in his drug studies discount chloramphenicol 500 mg on-line, using mescaline generic 250mg chloramphenicol free shipping, did not find any correlation between personality and drug reaction, Stockings (122) found that cyclothymic and schizothymic individuals re- -107- sponded differently. Bensheim (15) thought that the cyclothymic group responded with euphoria and depression to mescaline and the schizothymic group with ecstasy. Guttman and MacClay (59) and Sarwer-Foner (118) also found correlations between personality and drug reactions. It is perhaps of interest here that Russian scientists have also emphasized the differential response of different types of individuals to drugs, specifically chlorpromazine (86). It has been obvious to those who listen to and study people with personality disorders that the verbal behavior of an individual suffering from an emotional disorder is relatively peculiar, both in form and in content. The hysteric and schizophrenic are quite variable in the duration and length of their remarks. There are typical thematic and structural characteristics of the speech habits of patients with these types of psychiatric disorders. Years of intensive research are needed to supply some of this unavailable knowledge. However, it is already acknowledged that individuals with features of hysterical, conversion, or dissociative reactions are likely to be suggestible and to react strongly to all psychopharmacologic agents, including placebos (83, 85). Drugs may tend to reinforce the need to give for individuals burdened with feelings of neurotic shame and guilt, especially if such feelings are enhanced by the interrogator. Drugs may also furnish the needed excuse and relief from personal responsibility for sources who violate internalized values and loyalties in revealing information. The pharmacologic effect of the drug is probably of less decisive influence in facilitating information- getting (although acting as a catalyst) than is the potential readiness of individuals with such per- -108- sonality features to behave in a typical way under certain circumstances. The consideration of drugs as an aid to interrogation presupposes a thorough understanding of the personality characteristics of the informant and of drugs, to predict what might be expected by their use. If so, this propensity is pertinent to our specific interest regarding the use of drugs in affecting the verbal behavior of informants. It is difficult to ascertain to what extent the behavioral alterations that have been noted under various physiologic conditions are mediated by biochemical changes per se, and to what extent they are secondary psychophysiologic reactions to subtle changes in body chemistry. The answer need not occupy us here, except to note that a chemical alteration within the body is probably one important feature of the varying responsivity of the individual. Under such circumstances, the addition of other chemicals complicates the problem of predicting the behavioral outcome. This is particularly true if the new chemical introduced into the body is mild in its effects, or if it is given in a small dosage. Citation of every technical article bearing on this point would be unnecessarily burdensome here. Benedek and Rubenstein (12, 13) have studied the relationship of associative material presented by women during psychoanalysis at various phases of their menstrual cycle, as measured by vaginal smears. These two types of data, verbal material and physiologic changes in the vaginal mucosa, were collected and analyzed independently by the two investigators, one a psychoanalyst and the other an endocrinologist. After a long period of collecting such data, the investigators related verbal productions to the phases of the menstrual cycle. However, because of the importance of the psychophysiologic implications of this classical study, independent validation by other investigators would be desirable. In brief, the investigators found that during the estrogen phase of the menstrual cycle, the women were more extroverted, had more fantasies, dreams, and subjective experiences indicating strivings to be loved and impregnated and had con- -109- flicts about such strivings. During the progesterone phase, the women were more introverted, were more preoccupied with interests in their own body and self. During the premenstrual phase of the cycle, there were increased references to cleaning out, washing out, evacuating, losing something, and the women were more depressed. Studies of the effects of the state of nutrition, especially vitamin deficiency, on human behavior are replete in the medical literature and indicate that neurological and psychiatric disorders may ensue with various vitamin deficiencies, particularly of the B complex. The effects of starvation, voluntary and enforced, in provoking increasing lassitude, apathy, depression, preoccupation with food, flattening of affect, and mood are sufficiently well known and are discussed in another chapter of this study. The more subtle effects of satiation with food and the brief deprivation of food typical of everyday rhythmical eating habits on response patterns to psychologic tests and interviewing procedures have received little careful study, even apart from problems of drug effects. Clinical psychiatric experience indicates that some individuals become querulous, demanding, restless, even paranoid, and experience hunger contractions if they have not eaten for one to two hours, although they show no demonstrable pathologic, metabolic processes. Other individuals may miss several meals, yet experience no subjective reactions and show no signs of distinctly different behavior. Gottschalk and Gleser (55) did a controlled study of the effect of fasting for twelve hours on the speech patterns of six paid physically healthy and occupationally adjusted volunteers, three males and three females. No homogeneous effect of fasting states on thematic speech variables or on the proportion of various categories of word-types was found under these experimental conditions. In one subject, however, characteristic and repetitive reactions occurred to the stress of the mild fasting, reactions which were principally in the form of significantly increased references to food, home, mainland, mother, and involving attempts to bridge the distances between such objects. Hypoglycemic states were induced by the injection of intravenous insulin in this same subject and the effects of these states were noted. A repetitive, but different, thematic reaction occurred to this experimentally induced hypoglycemia as -110- compared to voluntary fasting for twelve hours. The investigators concluded that fasting for twelve hours was not enough of a stress to produce consistent effects in the speech patterns of five, out of six, paid volunteers.

Dose Oral or intramuscular injecton or Slow intravenous injecton Adult- Nausea and vomitng chloramphenicol 250mg mastercard, gastro- esophageal refux generic 250 mg chloramphenicol visa, gastroparesis: (over 1 to 2 min for slow intravenous injecton), 10 mg 3 tmes daily. Aid to gastrointestnal intubaton: 20 mg as a single dose 5 to 10 min before examinaton; Adolescent (15 to 19 years), 10 mg. Child- Up to 1 year (up to 10 kg) 1 mg twice daily; 1 to 3years (10 to 14 kg) 1 mg 2 to 3 tmes daily; 3 to 5 years (15 to 19 kg) 2 mg 2 to3 tmes daily; 5 to 9 years (20 to 29 kg) 2. Contraindicatons Gastrointestnal obstructon, haemorrhage or perforaton, 3-4 days afer gastrointestnal surgery; convulsive disorders; pheochromo- cytoma; hypersensitvity. Precautons Elderly, children and young adults; hepatc impairment (Appendix 7a); renal impairment (Appendix 7d); pregnancy (Appendix 7c); may mask underlying disorders such as cerebral irritaton; avoid for 3-4 days afer gastrointestnal surgery; lactaton (Appendix 7b); interactons (Appendix 6a); Parkinson’s disease; epilepsy; depression; porphyria; driving or operatng machines; hypertension; cirrhosis; congestve heart failure. Dose Oral Preventon of post-operatve nausea and vomitng: Adult 16 mg, 1 h before inducton of anaesthesia. Nausea and vomitng associated withcancer chemotherapy: Adult- 24 mg as a single dose taken 30 min before start of single day chemotherapy. Child (4-11 yrs)- 4 mg tablets 3 tmes a day; contnue for 1-2 days afer completon of chemotherapy. Adverse Efects Headache, constpaton or diarrhoea, dizziness; fushing, hypersensitvity reacton, anaphylaxis/anaphylactoid reactons, angioedema; bronchospasm, hypotension, laryngeal edema, urtcaria, hiccups, oculagyric crisis. Dose Oral and intravenous injecton Adult- Nausea, vomitng acute atack: initally 20 mg then 20 mg every 2 h. Adult- Labyrinthine disorder: 5 mg 3 tmes daily increased to 30 mg daily in divided doses that decrease afer meal to 5 to 10 mg daily. Most antpsychotcs are best avoided during pregnancy; hypersensitvity; prolactn dependant tumors. Cauton is also required in severe respiratory disease and in patents with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infecton or fever develops). Cauton should be taken in elderly, who are partcularly susceptble to postural hypotension and to hyper- or hypothermia in very hot or cold weather. Serious consideraton should be given before prescribing these drugs for elderly patents. As photosensitsaton may occur with higher dosages, patents should avoid direct sunlight; extrapyramidal syndrome; pregnancy (Appendix 7c); interactons (Appendix 6a). Adverse Efects Less sedatng; extrapyramidal symptoms, partcularly dystonias, more frequent; respiratory depression may occur in suscep- tble patents; amenorrhoea; blurred vision; cholestatc jaundice; neuroleptc malignant syndrome; leucopenia; agranulocytosis. Moton sickness, preventon: 20 to 25 mg at bedtme on night before travel, repeated on day of travel if necessary. Child- Moton sickness, preventon; 2 to 5 years: 5 mg at night and on day of travel, if necessary. Precautons Prostatc hypertrophy; urinary retenton; glaucoma; hepatc disease (Appendix 7a); epilepsy; elderly and children (more susceptble to adverse efects); lactaton (Appendix 7b); pregnancy (Appendix 7c); interactons (Appendix 6a). May impair ability to perform skilled tasks, for example operatng machinery, driving. Adverse Efects Drowsiness, dizziness, sedaton (but para- doxical stmulaton may occur, especially with high doses or in children and eld- erly); headache, psychomotor impairment; urinary retenton, dry mouth, blurred vision, gastrointestnal disturbances; hypersensitv- ity reactons, rashes, photosensitvity reac- tons; jaundice; blood disorders; cardiovas- cular adverse efects-afer injecton; venous thrombosis at site of intravenous injecton; pain on intramuscular injecton; somnolence; tortcollis; tnnitus; leucopenia; thrombocy- topenia, agranulcytosis; apnoea; angioneu- rotc edema. It is transmited by the faeco-oral route and infecton is usually caused by ingeston of cysts from contaminated food and drink. In non-endemic areas, sympto mless carriers should be treated with a luminal amoebicide which will reduce the risk of transmission and protect the patent from invasive amoe- biasis. Diloxanide furoate is most widely used, but other compounds, including clefamide, etofamide and teclozan, are also efectve. Treatment with diloxanide furoate is regarded as successful if stools are free of E. Symptomatc (invasive) amoebiasis may be classifed as intestnal or extra-intestnal. Intestnal amoebiasis is either amoebic dysentery or non-dysenteric amoebic colits. Extra- intestnal amoebiasis most commonly involves the liver, but may involve the skin, genito-urinary tract, lung and brain. Invasive amoebiasis is more likely in malnutriton, immu- nosuppression and pregnancy. Amoebic dysentery may take a fulminatng course in late pregnancy and the puer- perium; treatment with metronidazole may be life saving. In less severe infecton, metronidazole should, if possible, be avoided in the frst trimester. All patents with invasive amoebiasis require treatment with a systemically actve compound such as metronidazole, ornidazole and tnidazole followed by a luminal amoebicide in order to eliminate any surviving organisms in the colon. In severe cases of amoebic dysentery, tetracycline given in combinaton with a systemic amoebicide lessens the risk of superinfecton, intestnal perforaton and peritonits.