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Other substances can be made radioactive for medical purposes by making their nuclei unstable birth control pills januvia generic levlen 0.15mg line, so forming radioactive isotopes birth control 43701 discount levlen 0.15 mg fast delivery. Radioactive isotopes of various chemicals are used to check the functioning of birth control doctor buy levlen 0.15mg visa, or disease in birth control that stops periods best buy for levlen, internal organs. Radioactive isotopes of various chemicals are used to check the way organs function or if they are diseased: for example, radioisotopes of iodine are used to investigate thyroid activity. Rashes can be very irritating, but the itching can be relieved by applying calamine lotion. She recovered her eyesight even though the doctors had thought she would be permanently blind. Also called proctocele rectopexy / rektpeksi/ noun a surgical operation to attach a rectum which has prolapsed rectoscope / rektskp/ noun an instrument for looking into the rectum rectosigmoid / rekt sI mId/ noun the part of the large intestine where the sigmoid colon joins the rectum rectosigmoidectomy / rekt sI mI dektmi/ noun the surgical removal of the sigmoid colon and the rectum rectovaginal / rektv d aInl/ adjective relating to both the rectum and the vagina rectovaginal examination / rektv d aInl I z mI neIn/ noun an examination of the rectum and vagina rectovesical / rekt vesIkl/ adjective referring to the rectum and the bladder rectum / rektm/ noun the end part of the large intestine leading from the sigmoid colon to the anus. Also called optometer refractory /rI fr ktri/ adjective difficult or impossible to treat, or not responding to treatment refractory period /rI fr ktri pIrid/ noun a short space of time after the ventricles of the heart have contracted, when they cannot contract again refrigerate /rI frId reIt/ verb to make something cold the serum should be kept refrigerated. They went to register the birth with the Registrar of Births, Marriages and Deaths. For liquids and solids the standard substance is usually water, and for gases, it is air. For example, the relative risk of myocardial infarction for oral contraceptive users is 1. Also called hypothalamic horrelaxin release releasing factor releasing hormone mone relief /rI li f/ noun the process of making something better or easier the drug provides rapid relief for patients with bronchial spasms. Also called renal sinus renal transplant renal tubule removal /rI mu vl/ noun the action of removing something An appendicectomy is the surgical removal of an appendix. Also called Malpighian body renal cortex / ri nl k teks/ noun the outer covering of the kidney, immediately beneath the capsule. Also called dialysis renal hypertension / ri nl haIp tenn/ noun high blood pressure linked to kidney disease renal medulla / ri nl me d l/ noun the inner part of a kidney containing no glomeruli. Full form repetatur repair /rI pe/ verb to make something that is damaged good again Surgeons operated to repair a hernia. Occupational diseases or serious accidents at work must be reported to the local officials. In the female, an ovum, produced by one of the two ovaries, passes through the Fallopian tube where it is fertilised by a spermatozoon from the male. Air is taken into the respiratory system through the nose or mouth, and goes down into the lungs through the pharynx, larynx and windpipe. In the lungs, the bronchi take the air to the alveoli (air sacs) where oxygen in the air is passed to the bloodstream in exchange for waste carbon dioxide which is then breathed out. Also called Vitamin retinae retinal retinal artery retinal detachment retinitis retinitis pigmentosa retinoretinoblastoma retinol A fore vowels) retinopathy / retI npi/ noun any disease of the retina retinoscope / retInskp/ noun an instrument with various lenses, used to measure the refraction of the eye retinoscopy / retI nskpi/ noun a method of measuring refractive errors in the eye using a retinoscope retire /rI taI/ verb to stop work at a particular age Most men retire at 65, but women only go on working until they are 60. Also called retinopathy retinoscope retinoscopy retire retirement retraction retraction ring retina / retIn/ noun the inside layer of the eye which is sensitive to light. Light-sensitive cells in the retina (cones and rods) convert the light to nervous impulses. The optic nerve sends these impulses to the brain which interprets them as images. Also called optic neuritis retroflexion / retr flekn/ noun the fact of being bent backwards retroflexion of the uterus a condition in which the uterus bends backwards away from its usual position retrograde / retr reId/ adjective going backwards or deteriorating, getting worse retrograde pyelography / retr reId paI l rfi/ noun an X-ray examination of the kidney where a catheter is passed into the kidney and an opaque liquid is injected directly into it retrogression / retr ren/ noun returning to an earlier state retrolental fibroplasia / retr lentl faIbr pleIzi/ noun a condition in which fibrous tissue develops behind the lens of the eye, resulting in blindness retroflexion retrograde retrograde pyelography retrogression retrolental fibroplasia rhesus factor the back of the eye retroperitoneal / retr perIt ni l/ adjective at the back of the peritoneum retroperitoneal space / retr peritni l speIs/ noun the area between the posterior parietal peritoneum and the posterior abdominal wall, containing the kidneys, adrenal glands, duodenum, ureters and pancreas retropharyngeal / retr f rIn d i l/ adjective at the back of the pharynx retropubic / retr pju bIk/ adjective at the back of the pubis retropubic prostatectomy / retrpju bIk prst tektmi/ noun removal of the prostate gland which is carried out through a suprapubic incision and by cutting the membrane which surrounds the gland retrospection / retr spekn/ noun the act of recalling what happened in the past retrospective / retr spektIv/ adjective applying to the past, tracing what has happened already to selected people retroversion / retr v n/ noun the fact of sloping backwards retroversion of the uterus Same as retroverted uterus retroverted uterus / retrv tId ju trs/ noun a condition in which the uterus slopes backwards away from its usual position. This can be prevented by an injection of anti D immunoglobulin immediately after the birth of the first Rh-positive child and any subsequent Rhpositive children. If an Rh-negative mother has formed antibodies to Rh-positive blood in the past, these antibodies will affect the blood rhesus factor disease rhesus factor disease 354 rhino- /raIn/ prefix referring to the nose rhinology /raI nld i/ noun a branch of medicine dealing with diseases of the nose and the nasal passages rhinomycosis / raInmaI ksIs/ noun an infection of the nasal passages by a fungus rhinopharyngitis / raInf rIn d aItIs/ noun inflammation of the mucous membranes in the nose and pharynx rhinophyma / raIn faIm/ noun a condition caused by rosacea, in which the nose becomes permanently red and swollen rhinoplasty / raInpl sti/ noun plastic surgery to correct the appearance of the nose rhinorrhoea / raIn rI/ noun a watery discharge from the nose rhinoscope / raInskp/ noun an instrument for examining the inside of the nose rhinoscopy /raI nskpi/ noun an examination of the inside of the nose rhinosinusitis / raIn saIn saItIs/ noun swelling of the lining of the nose and paranasal sinuses, as a result of either a viral infection or allergic rhinitis. Also called visual purple rhombencephalon / rmben kefln/ noun the hindbrain, the part of the brain which contains the cerebellum, the medulla oblongata and the pons rhomboid / rmbId/ noun one of two muscles in the top part of the back which move the shoulder blades rhonchus / rks/ noun an unusual sound in the chest, heard through a stethoscope, caused by a partial blockage in the bronchi rhinorhinology rhinomycosis rhinopharyngitis rhinophyma rhinoplasty rhinorrhoea rhinoscope rhinoscopy rhinosinusitis rhinosporidiosis rhinovirus rhizrhizotomy Rh-negative rhodopsin rhombencephalon rhomboid rhonchus blood of a fetus has a different rhesus factor from that of the mother. Also called acute rheumatic rheumatic fever and stiffness in the joints and muscles (informal) She has rheumatism in her hips.

Experimental evidence (a) Digoxin In a study birth control pills knee pain discount levlen online mastercard, mice fed two ashwagandha extracts (in quantities that equated to human doses) developed apparent serum digoxin levels of 0 birth control pills near me order levlen 0.15mg mastercard. Effect of Indian Ayurvedic medicine ashwagandha on measurement of serum digoxin and 11 commonly monitored drugs using immunoassays: study of protein binding and interaction with Digibind birth control meme best levlen 0.15mg. Interference of Asian birth control for women 60 cost of levlen, American, and Indian (Ashwagandha) ginsengs in serum digoxin measurements by a fluorescence polarization immunoassay can be minimized by using a new enzyme-linked chemiluminescent immunosorbent or turbidimetric assay. Effect of Brazilian, Indian, Siberian, Asian, and North American ginseng on serum digoxin measurement by immunoassays and binding of digoxin-like immunoreactive components of ginseng with Fab fragment of antidigoxin antibody (Digibind). A Ashwagandha + Antidiabetics Limited evidence suggests that ashwagandha has blood-glucoselowering effects, which may be additive with conventional antidiabetics. Clinical evidence In 6 subjects with mild type 2 diabetes, giving powdered root of ashwagandha 1 g three times daily after meals for 30 days reduced blood-glucose levels by 12% (from 11. Importance and management the limited evidence suggests that ashwagandha might have bloodglucose-lowering effects. Until further information is available, if a patient taking antidiabetic drugs wants to take ashwagandha it may be prudent to discuss these potential additive effects, and advise an increase in blood-glucose monitoring should an interaction be suspected. However, bear in mind that, although ashwagandha has been used for a wide number of complaints, it does not appear to be used for diabetes, suggesting that any effects are mild, and probably not clinically relevant. Hypoglycemic, diuretic and hypocholesterolemic effect of winter cherry (Withania somnifera, Dunal) root. Ashwagandha + Digoxin Ashwagandha has been shown to interfere with some methods of measuring serum digoxin levels; see Ashwagandha + Laboratory tests below. Ashwagandha + Thyroid and Antithyroid drugs Limited evidence suggests that ashwagandha increases thyroid hormone levels and therefore interferes with the control of hypoand hyperthyroidism. Clinical evidence A 32-year-old healthy woman developed clinical symptoms of thyrotoxicosis, and was found to have elevated levels of thyroid hormones when she increased the dose of capsules containing ashwagandha herbal extract that she had been taking for chronic fatigue. Ashwagandha does not interfere with in vitro assays for carbamazepine, gentamicin, paracetamol, phenytoin, Ashwagandha Experimental evidence In a study in mice, ashwagandha root extract 1. Importance and management Although the evidence is limited, until more is known, it might be 43 prudent to advise caution if patients taking levothyroxine (or other thyroid hormones) want to take ashwagandha because of the possibility of an increase in effects. Furthermore, on the basis of this evidence, ashwagandha may be expected to antagonise the effects of antithyroid drugs, such as propylthiouracil. In both cases it may be prudent to consider monitoring thyroid function tests if symptoms of hypo- or hyperthyroidism begin to emerge. Changes in thyroid hormone concentrations after administration of ashwagandha root extract to adult male mice. For information on the pharmacokinetics of individual flavonoids present in asparagus, see flavonoids, page 186. Constituents Asparagus contains saponins called asparagosides, steroidal glycosides, asparagusic acid and its derivatives, flavonoids (including rutin, kaempferol and quercetin) and various amino acids and polysaccharides. Interactions overview No interactions with asparagus found; however, note that asparagus contains a moderate amount of vitamin K and may therefore reduce the effectiveness of warfarin and other similar anticoagulants if eaten in large quantities. For information on the interactions of individual flavonoids present in asparagus, see under flavonoids, page 186. Use and indications the root and green parts of asparagus have been used as a diuretic, laxative, cardiac tonic and sedative. The young 44 Asparagus 45 Asparagus + Food No interactions found, but note that asparagus is extensively used as a foodstuff. Asparagus + Warfarin and related drugs Patients taking coumarins and indanediones should avoid taking excessive amounts of asparagus because of its vitamin K1 content. Evidence, mechanism, importance and management Asparagus1 contains a moderate amount of vitamin K1, which reduces the effect of coumarin and indanedione anticoagulants, which are vitamin K antagonists. Patients taking these anticoagulants are advised to maintain a regular amount of vitamin K from the diet. A Astragalus Astragalus membranaceus Bunge (Fabaceae) Synonym(s) and related species Huang qi. Not to be confused with the pharmaceutical excipient, tragacanth (Astragalus gummifer). Pharmacokinetics Few data are available, but in a study in one healthy subject, who was given astragalus root decoction orally twice daily before meals of bread and honey for 5 days, urine samples were found to contain calycosin and formononetin and various isoflavonoid glucuronide metabolites.

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H Pharmacokinetics An isolated in vitro study suggests that horse chestnut may 254 Horse chestnut 255 Horse chestnut + Digoxin the interaction between horse chestnut and digoxin is based on experimental evidence only birth control list buy levlen 0.15 mg low cost. Evidence birth control for women equality best 0.15mg levlen, mechanism birth control for 8 days trusted 0.15mg levlen, importance and management An in vitro study to investigate the effects of a horse chestnut product (Venostat) on P-glycoprotein transport found that the extract inhibited the transport of digoxin by P-glycoprotein to a minor extent birth control pills vs depo shot buy levlen 0.15mg amex. Nevertheless, the authors predicted that inhibitory levels might easily be reached in the small intestine with usual therapeutic doses of horse chestnut. No specific recommendations can be made on the basis of this single in vitro study. Use and indications Horsetail is used mainly as an astringent, haemostatic and anti-inflammatory agent, and for urinary tract complaints such as cystitis, prostatitis, urethritis and enuresis. There is little pharmacological, and no clinical, evidence to support the main uses. Constituents Horsetail contains high concentrations of silicic acid, up to 8%, and is sometimes used as an organic source of silicon. It also contains flavonoids such as apigenin, kaempferol, luteolin and quercetin and their derivatives, and may be standardised to the total flavonoid content expressed as isoquercitroside. Other polyphenolic compounds such as caffeic acid derivatives, and trace amounts of the alkaloid nicotine, and sterols including cholesterol, isofucosterol and campesterol, are also present. Horsetail also contains thiaminase (an enzyme that breaks down thiamine), and this is inactivated in some supplements. Interactions overview An isolated case of lithium toxicity has been reported in a patient who took a herbal diuretic containing horsetail among other ingredients, see under Parsley + Lithium, page 305. For information on the interactions of individual flavonoids present in horsetail, see under flavonoids, page 186. Horsetail + Lithium `For mention of a case of lithium toxicity in a woman who had been taking a non-prescription herbal diuretic containing corn silk, Equisetum hyemale, juniper, buchu, parsley and bearberry, all of which are believed to have diuretic actions, see under Parsley + Lithium, page 305. Note that this case was with Equisetum hyemale, which is not the species more commonly used (Equisetum arvense). H Isoflavones Isoflavonoids this is a large group of related compounds with similar structures and biological properties in common, which are widely available as additives in dietary supplements as well as the herbs or foods that they were originally derived from. Isoflavones are the subject of intensive investigations and new information is constantly being published. The information in this monograph relates to the individual isoflavones, and the reader is referred back to the herb (and vice versa) where appropriate. It is very difficult to confidently predict whether a herb that contains one of the isoflavones mentioned will interact in the same way. The levels of the isoflavone in the particular herb can vary a great deal between specimens, related species, extracts and brands, and it is important to take this into account when viewing the interactions described below. Types, sources and related compounds Isoflavones are plant-derived polyphenolic compounds that are a distinct group of flavonoids, page 186. Most occur as simple isoflavones, but there are other derivatives such as the coumestans, the pterocarpans and the rotenoids, some of which also have oestrogenic properties. The isoflavones are found in small amounts in many legumes, seeds, grains and vegetables, but soya, page 356, is by far the most concentrated dietary source; it contains principally genistein and daidzein. There are various other isoflavone-rich supplements, including those derived from alfalfa, page 21 and red clover, page 332 (both of which are rich in biochanin A and formononetin), and kudzu, page 267, which contains puerarin. In addition, some popular herbal medicines, such as astragalus, page 46 and shatavari, page 353 contain isoflavones as well as other types of active constituents. The most important isoflavones are: genistein and daidzein, which are hydrolysed from their glycosides genistin, daidzin and puerarin (daidzein 8-C-glucoside); glycetein and its glycoside glycitin; formononetin, biochanin A, isoformononetin, prunetin, calycosin, ononin, orobol; and others. I used for these possible benefits, it remains to be seen whether they are effective. Isoflavones have weak oestrogenic effects, but under certain conditions (for example, in premenopausal women) they can also act as oestrogen antagonists by preventing the more potent natural compounds, such as estriol, from binding to receptor sites. Isoflavones also inhibit the synthesis and activity of enzymes involved in oestrogen and testosterone metabolism, such as aromatase. Because of their oestrogenic effects, isoflavone supplements have been investigated for treating menopausal symptoms such as hot flushes (hot flashes)1,2 and for prevention of menopausal osteoporosis,3 with generally modest to no benefits when compared with placebo in randomised controlled studies.

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Thirty minutes after the last dose of curcumin birth control for women with high blood pressure buy levlen mastercard, a single 20-mg/kg dose of midazolam was given birth control 72 hour pill purchase levlen 0.15 mg otc. These findings are difficult to reliably extrapolate to humans birth control lo loestrin fe order levlen 0.15 mg, but birth control arm implant buy levlen overnight delivery, as the effect was so large, it would seem reasonable to assume that curcumin could cause a clinically relevant increase in the bioavailability of midazolam, which may lead to an increase in the sedative effects of midazolam. It is not clear whether turmeric, of which curcumin is a major constituent, would have similar effects, but if large doses are given an effect seems possible. It would seem prudent to warn patients taking curcumin, and turmeric, about the possible increase in sedative effects. T No interactions have been included for herbal medicines or dietary supplements beginning with the letter U U 393 Valerian Valeriana officinalis L. In vitro investigations have suggested that valerian may inhibit P-glycoprotein,1,5 although the authors of one study concluded that this is unlikely to be clinically relevant, because the concentration at which this occurred is unlikely to be attained in vivo,5 and the findings of another study suggested that the effects were much weaker than those of verapamil, a known, clinically relevant P-glycoprotein inhibitor. Constituents Valerian root and rhizome contains a large number of constituents which vary considerably according to the source of the plant material and the method of processing and storage. Many are known to contribute to the activity, and even those that are known to be unstable may produce active decomposition products. The valepotriates include the valtrates, which are active constituents, but decompose on storage to form other actives including baldrinal, and volatile constituents. The volatile oil is composed of valerenic acids and their esters, and other derivatives including isovaleric acid (which is responsible for the odour of valerian), and others. Valerian dry hydroalcoholic extract is an extract produced from valerian root and contains a minimum of 0. It has long been used as a hypnotic, sedative, anxiolytic, antispasmodic, carminative and antihypertensive, and for hypochondriasis, migraine, cramp, intestinal colic, rheumatic pains and dysmenorrhoea. A recent study suggested that it is safe, but not necessarily effective; however, many analytical reports also show that extracts and products of valerian vary greatly in both chemical composition and biological activity, and it may be that only certain preparations have any therapeutic benefit. Many commercial products use valerian in combin- Interactions overview Valerian does not appear to affect the metabolism of alprazolam, caffeine, chlorzoxazone, dextromethorphan or midazolam to a clinically relevant extent. Valerian may increase the sleeping time in mice in response to alcohol and barbiturates. For information on the interactions of individual flavonoids present in valerian, see under flavonoids, page 186. In vitro activity of commercial valerian root extracts against human cytochrome P450 3A4. Other barbiturates do not appear to have been studied, but it seems likely that they will interact similarly. It may therefore be prudent to consider the potential additive sedative effects in any patient taking barbiturates with valerian. This seems most likely to be of importance with the use of phenobarbital (or other barbiturates) for epilepsy, when sedative effects are less desirable. It would be prudent to warn patients that they may be more sedated and, if this occurs, to avoid undertaking skilled tasks. Valerian + Alcohol the interaction between valerian and alcohol is based on experimental evidence only. Experimental evidence In a study in mice, a valepotriate extract of valerian, given in high doses, almost doubled the sleeping time in response to alcohol. In contrast, in a separate experiment, the extract appeared to antagonise the effects of alcohol on motor activity. Importance and management the evidence of an interaction between valerian and alcohol appears to be limited to a study in mice. However, valerian is said to have sedative effects, and is used for insomnia, and so additive effects on sedation seem possible. It would be prudent to warn patients that they may be more sedated if they drink alcohol while taking valerian and, if this occurs, to avoid undertaking skilled tasks. Note that, in the study in mice, the sedative effects of valepotriates, even in large doses, were more modest than those of diazepam and chlordiazepoxide. Valerian + Benzodiazepines Valerian does not affect the pharmacokinetics of alprazolam or midazolam to a clinically relevant extent. Clinical evidence In a crossover study, 12 healthy subjects were given valerian root extract 1 g each night for 14 days, with a single 2-mg dose of alprazolam on the morning of day 15. Valerian increased the maximum plasma concentration of alprazolam by 20%, but there were no other statistically significant changes in the pharmacokinetics of alprazolam. In another study, 12 healthy subjects were given valerian root extract 125 mg three times daily for 28 days before receiving a single dose of midazolam.

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