General Information about Tenormin

In some cases, Tenormin is probably not suitable for individuals with sure medical circumstances, similar to bronchial asthma, diabetes, and heart problems. It is important to inform the physician of any pre-existing conditions or medicines being taken before beginning Tenormin.

Another situation that Tenormin is used to treat is angina, which is chest pain caused by reduced blood move to the center muscle. Angina might occur when the guts muscle doesn't receive enough oxygen-rich blood because of narrowed or blocked arteries. Tenormin helps to relax and widen the blood vessels, permitting extra oxygen-rich blood to achieve the center, thereby decreasing the frequency and severity of angina episodes.

High blood pressure, or hypertension, is a common situation that affects approximately one-third of adults worldwide. It is also recognized as the 'silent killer' as a result of it could have no symptoms and go undetected for years, but can result in critical well being problems such as heart assault, stroke, and coronary heart failure. Tenormin is used to treat hypertension by enjoyable the blood vessels, allowing blood to move extra easily and lowering the strain on the center.

Tenormin comes in tablet kind and is usually taken once or twice a day, relying on the power prescribed by the physician. It is essential to take the treatment as directed and never skip or miss doses, as this could have an result on its effectiveness. It can be advisable to examine blood stress and heart rate frequently whereas taking Tenormin to watch its effects.

Tenormin, also recognized by its generic name atenolol, is a generally prescribed medicine for the remedy of hypertension, discount of coronary heart price, and angina. It belongs to a category of drugs known as beta blockers, which work by blocking the effects of adrenaline on the body's beta receptors. This results in a lower in the workload of the center, leading to a discount in blood stress and coronary heart price.

Like any medication, Tenormin could cause side effects in some people. Common unwanted side effects might embrace dizziness, lightheadedness, fatigue, and nausea. These usually subside because the body adjusts to the treatment. However, if the side effects persist or become extreme, it may be very important inform the doctor.

Aside from managing high blood pressure, Tenormin can additionally be prescribed to reduce the heart fee in cases of tachycardia (rapid heart rate) and atrial fibrillation (irregular heartbeat). By blocking the beta receptors in the heart, the treatment helps decelerate the heart price and enhance its regularity. This can be helpful for people with coronary heart situations or those that expertise episodes of speedy or irregular heartbeats.

In conclusion, Tenormin is a widely prescribed beta blocker for the therapy of hypertension, discount of heart price, and administration of angina. It works by blocking the consequences of adrenaline on the body's beta receptors, leading to a lower in blood pressure and coronary heart rate. While typically considered a secure and effective medicine, it is essential to observe the physician's instructions and regularly monitor blood stress and heart rate while taking Tenormin.

Balloon tamponade is effective in controlling bleeding temporarily with immediate control of haemorrhage in over 80% of patients (Avgerinos and Armonis blood pressure ratio tenormin 100 mg buy with visa, 1994). However, its use is associated with potentially lethal complications such as aspiration and necrosis and perforation of the oesophagus. Specific clinical scenarios in palliative care Management of terminal haemorrhaging the options for managing terminal haemorrhage can be divided into three categories (Harris and Noble, 2009): (1) general supportive measures such as the use of dark towels and staying with and comforting the patient; (2) general resuscitative measures such as fluid replacement; and (3) specific measures to stop the bleeding such as wound packing, haemostatic agents, haemostatic radiotherapy, and interventional radiology. Sedative medications to alleviate patient distress and provide comfort are often recommended (MacMillan and Struthers, 1987; Regnard and Makin, 1992; Fortunato and Ridge, 1995; Gagnon et al. It is important to note that the intent is to relieve distress and not to hasten death. Midazolam is the most frequently recommended drug because of its rapid onset and short duration of action (Oneschuk, 1998). The commonly recommended routes are intravenous or subcutaneously, at doses of between 2. The intramuscular route has been suggested but bioavailability of this route may be compromised by peripheral circulation shutdown during hypovolemic shock Harris and colleagues recently explored the utility of crisis medication in the management of terminal haemorrhage by interviewing 11 nurses who had managed such events (Harris et al. Participants reported crisis medication (such as midazolam) to have little role in many cases. Terminal haemorrhage often occurred rapidly, with the majority of patients dying before medications could be administered. Many events had not been predicted and so anticipatory prescribing of crisis medications did not always occur. A focus on accessing crisis medicines was done to the detriment of staying with and supporting the patient and using dark-coloured towels, which were reported to be the most useful measures. The researchers stressed that crisis medications, although generally not useful, may be of benefit in some situations, specifically those in which bleeding occurs over several hours. Harris and Noble (2009) and Regnard and Makin (1992) have published guidelines in this area. Haemorrhagic bladder Three reviews of the topic provide a comprehensive review of the management of intractable bladder haemorrhaging in cancer care (Choong et al. Ghahestani and Shakhssalim propose alum instillations or radiotherapy, after irrigation and evacuation of blood clots, as first-line options. In the case of a sloughing tumour as aetiology, internal iliac artery embolization is a second-line option, while hyperbaric oxygenation and embolization or transurethral fulguration are second-line options in the case of radiation cystitis. Formalin, because of significant adverse effects, is relegated to a last-resort option. Bladder outlet obstruction from clots can lead to urosepsis, bladder rupture, and renal failure. Clot evacuation can be performed at the bedside by carefully placing a large, stiff-walled haematuria catheter. After clot evacuation, if haematuria persists, a three-way catheter can be inserted and continuous bladder irrigation with saline can be started. All clots must be removed before continuous irrigation is started to avoid over distention and bladder rupture. The patient should be vigorously hydrated using oral and/or intravenous fluids to keep clots from reforming. If clot evacuation is unsuccessful with this approach, the patient should undergo cystoscopy with clot evacuation and consideration of treatments previously described, including fulguration and instillation/injection of agents. Last-resort options include urinary diversion (prevents urine urokinase from coming into contact with the fragile haemorrhagic mucosa) and radical cystectomy (Zebic et al. Bleeding oesophageal varices Current therapies and recommendations for the management of oesophageal and gastric variceal haemorrhage from advanced liver disease are published elsewhere (Garcia-Tsao et al. When endoscopy is used, variceal ligation appears to be generally preferred over sclerotherapy (Garcia-Pagan and Bosch, 2005; Garcia-Tsao et al. A meta-analysis showed superiority of endoscopic (sclerotherapy or variceal ligation) plus pharmacological (octreotide, somatostatin, vapreotide) therapy over endoscopic therapy alone (Banares et al. Despite urgent endoscopic and/or pharmacological therapy, variceal bleeding cannot be controlled or recurs early in about 10­20% of patients (Banares et al. For heavier bleeding, haemostatic surgical dressings will provide rapid haemostasis and can be left on the wound and covered with an appropriate dressing. A number of other options are available and these are described above and elsewhere (Grocott, 2000; McDonald and Lesage, 2006). Conclusion Bleeding in the palliative care setting may have a variety of causes and clinical presentations. A large number of treatment modalities, local and systemic, are available to address bleeding and massive haemorrhages. The large majority of evidence in support of these modalities, however, is based on case reports, case series, and expert opinion, with only a small number of large randomized studies. Selecting between the different modalities is therefore seldom guided by comparative studies between the modalities. A number of factors need to be considered when selecting between modalities and the overall care approach. These include patient prognosis and expected survival, access to modalities, quality of life, functional status, and ultimately goals of care and patient wishes. A comprehensive review of topical hemostatic agents: efficacy and recommendations for use. Aerosolized vasopressin is a safe and effective treatment for mild to moderate recurrent hemoptysis in palliative care patients. The use of crisis medication in the management of terminal haemorrhage due to incurable cancer: a qualitative study. Management of terminal hemorrhage in patients with advanced cancer: a systematic literature review. Oxidized cellulose dressings for persistent bleeding from a superficial malignant tumor.

Radioisotope treatment can cause transient bone marrow depression hypertension 4010 discount tenormin 50 mg free shipping, but this is rarely of clinical significance provided patients have a normal blood count at the start of therapy. These compounds are cleared by renal excretion and patients must be continent of urine to prevent contamination, or be prepared to have an indwelling catheter for the duration of radioactive excretion. Renal impairment is a relative contraindication because reduced clearance can prolong radiation exposure and potentially exacerbate bone marrow toxicity. In contrast to patients with multiple metastases, those with only one or two (oligometastases) are potential candidates for local therapy using a high enough dose to achieve both pain relief and local tumour control. This may be accomplished using stereotactic body radiotherapy, which enables localization of very high-dose radiation in a small area. The evidence base for such treatments is evolving; good pain relief with local control rates of 60­70% at 1 year have been reported (Lo et al. The increased understanding of the pathophysiology of metastatic bone pain has led to further developments in treatment. Although there is some evidence that radiotherapy can prevent the later development of pain metastases or pain, there is no routine role for prophylactic treatment. Inadvertent treatment of the thoracic spine when a breast is irradiated has been shown to reduce the instance of subsequent bone metastases. Hemibody irradiation and strontium therapy both modestly reduce subsequent episodes of bone pain (Poulter et al. There is stronger evidence in favour of bisphosphonate treatment, which is now routinely given for myeloma and high-risk patients with breast cancer (Diel et al. The relative roles of radiotherapy and bisphosphonates, and the interaction between them, in the overall management of bone metastases have yet to be adequately defined and are currently an active area of research (Hoskin, 2003). Early results from a recent randomized trial suggest that radiotherapy and ibandronate are equivalent in achieving pain control with some suggestion of a synergistic effect (Hoskin et al. Although there are no data to define the optimal dose, single dose of 8 Gy is adequate when the object of treatment is pain relief alone; about two-thirds of patients achieve pain relief. In practice most patients will receive courses delivering 20­30 Gy in 5­10 fractions over 1­2 weeks. Remineralization is reported in one-third of patients after doses of 40­50 Gy delivered in 4­5 weeks, but anecdotally, also occurs after lower doses of only 20 Gy in 2 weeks. Radiotherapy may also be indicated postoperatively following internal fixation to prevent further progression of the remaining metastatic tumour and enable healing of the bone around the prosthesis. Although there are few data to support this common practice, a non-randomized study suggests better functional recovery when radiotherapy is given (Townsend et al. Conventionally, fields covering the entire length of the prosthesis or intramedullary nail are used because of the perceived risk of tumour dissemination through the marrow cavity by the operative procedure. Patients with widespread metastatic disease, limited survival, and adequate pain control gain little benefit from postoperative radiotherapy. Although a considerable proportion of malignant cells within a tumour mass are undoubtedly killed after small single doses of radiation, rapid tumour shrinkage is not routinely observed. Pain relief may be seen within 24 hours, particularly after hemibody irradiation and there is no relationship between pain relief and histological types of tumour correlating with variations in radiosensitivity. Osteoclast activation may be another important factor, as suggested by the efficacy of bisphosphonate drugs. Following radiotherapy, changes Neurological symptoms and disorders Spinal cord and cauda equina compression Spinal cord or cauda equina compression may cause catastrophic loss of limb function and sphincter control (see Chapters 14. As tumour compresses neurological tissue in the spinal canal, there is early venous engorgement and oedema followed by mechanical compression that ultimately leads to irreversible damage. The commonest causes of spinal cord compression are tumours of the breast, lung, or prostate, each of which accounts for about 20% of patients in most series. Most other primary sites have also been associated with spinal canal involvement, with the next two commonest being kidney and lymphoma. If a patient with metastatic disease presents with spinal cord compression, it is usually reasonable to assume that this will be the same disease process unless there are atypical features to suggest a second primary. Patients with spinal cord or cauda equina compression and no history of metastatic disease require a histological diagnosis before treatment. In one series, 48% of patients with spinal cord compression had no previous history of malignant disease (Shaw et al. The initial management of spinal cord or cauda equina compression includes administration of a corticosteroid and local irradiation to the spinal site. The corticosteroid doses used in practice vary greatly but are generally relatively high, for example, dexamethasone 4 mg every 6 hours or higher. Both radiotherapy and decompressive surgery are effective in the initial management of spinal cord compression. Primary treatment of some tumours, such as lymphoma and small cell lung cancer, includes chemotherapy. One randomized trial that compared radiotherapy with decompressive surgery via an anterior approach followed by radiotherapy showed significant advantage for the group receiving surgery, both for functional status and survival. The population in this trial was selected for those with good performance status, absent metastases elsewhere and a single level of spinal cord compression; patients with these characteristics should be referred for surgery followed by radiotherapy, if possible. Whilst no randomized comparison of the two modalities of treatment with sufficient numbers to provide a true comparison has been undertaken, no advantage of surgery over radiotherapy has been demonstrated in published series where patients have a previously confirmed diagnosis of malignant disease and no evidence of vertebral collapse. The role of postoperative radiotherapy has not been tested but a non-randomized comparison has suggested that better pain relief is seen after radiotherapy or where radiotherapy is given postoperatively (Findlay, 1984). In patients who have extensive vertebral collapse with intrusion to the spinal canal, radiotherapy is of little value in re-establishing neurological function, and surgery using an anterior approach and spinal stabilization also must be considered.

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A recent meta-analysis demonstrated the efficacy of these agents in the management of mood symptoms in palliative care patients but found limited evidence to support the superiority of any one agent when compared to others within the class (Rayner et al blood pressure numbers purchase tenormin 100 mg otc. Music, aroma, and art therapies Music is often used to enhance well-being, reduce stress, and distract patients from unpleasant symptoms. Munro and Mount (1978) have written extensively on the use of music therapy with cancer patients, documenting clinical examples and suggesting mechanisms of action. Although there are wide variations in individual preferences, music appears to exert direct physiologic effects through the autonomic nervous system and can be particularly helpful in managing the discomfort associated with procedures (Chlan et al. Music can often capture the focus of attention like no other stimulus, offers patients a new form of expression, and helps patients distract themselves from their perception of pain, while expressing themselves in meaningful ways (Schroeder-Sheker, 1993; Magill, 2001). As a general relaxation technique, aromatherapy may have an application for pain management, but studies are limited and the technique warrants further investigation. Palliative care clinicians may use art therapy to explore issues relating to loss of control, helplessness, and hopelessness (Trauger-Querry, 2001). Among others, they include venlafaxine and duloxetine, which are widely used as first-line agents in the treatment of depression and anxiety disorders. Venlafaxine may worsen hypertension, however, and is more likely to produce withdrawal symptoms when discontinued than other drugs. Although large studies are lacking in the use of these agents in patients with pain related to cancer, there are some smaller studies that demonstrate efficacy of these agents in the treatment of neuropathic syndromes following chemotherapeutic and surgical interventions for 9. Stimulants Stimulant drugs such as methylphenidate and dextroamphetamine/amphetamine, are typically used in the treatment of conditions such as attention deficit/hyperactivity disorder. However, in the medically ill, they do have a role in the treatment of depression (Kaufmann et al. The various agents in this group differ in their potency at each of these sites, as well by their affinity at the receptor sites for other neurotransmitters. There are two broad categories: the tertiary amine drugs, such as amitriptyline and imipramine, tend to cause more side effects (particularly anticholinergic effects) than the secondary amine drugs, such as nortriptyline and desipramine. Nevertheless, there is substantial evidence that these drugs have primary analgesic effects for diverse painful conditions (Raja et al. Specific evidence in populations with cancer or other serious illnesses is limited, however (Kautio et al. Mood stabilizers Mood stabilizers describe a group of medications typically intended to treat bipolar spectrum disorders. Broadly, this group consists of lithium, antiepileptic drugs, and medications generally utilized in the treatment of psychotic disorders. Lithium is a first-line treatment for mania and bipolar disorder, notwithstanding a narrow therapeutic window and the need for close follow-up to avoid potentially fatal toxicities, particularly in the elderly and those with chronic medical illness. It also has limiting side effects including tremor, gastrointestinal disturbance, and nephrotoxicity, amongst other issues. Some antiepileptics are approved for bipolar disorder and may have utility in the treatment of neuropathic pain. Other antiepileptic medications used for psychiatric indications also are occasionally considered for pain. Valproic acid and its derivatives, such as divalproex sodium, are older drugs with well-established indications for a range of neurological and psychiatric conditions. Although they are generally considered to be a first-line treatment for mania, their broader use is limited by a side effect profile that includes gastrointestinal disturbances and the potential for hepatotoxicity and hyperammonaemia. Carbamazepine also has efficacy in the treatment of mania, but generally is not considered first line because of the potential for bone marrow suppression and hepatotoxicity, and concern about drug­drug interactions. It, too, may have efficacy in neuropathic pain, and is indicated for the treatment of trigeminal neuralgia (Eisenberg, 2007; Howard et al. Oxcarbazepine is similar to carbamazepine, but has less risk of toxicity; evidence in bipolar disorder is limited, as is evidence in pain syndromes such as trigeminal neuralgia (Eisenberg, 2007). Lamotrigine has demonstrated efficacy primarily in the management of depressive symptoms in bipolar disorder, but its use is hindered by the risk of cutaneous hypersensitivity syndromes, which necessitate a slow increase in the dose when starting therapy and avoidance of the drug in children. These agents have largely been relegated to the treatment of refractory depression due to their potential complications, including orthostatic hypotension, interactions with other serotonergic agents leading to serotonin syndrome, and the potential for hypertensive crisis if exposed to certain medications and tyramine-containing foods. Other antidepressants Mirtazapine is an antagonist at presynaptic alpha-2 receptors on noradrenergic neurons and has gained some popularity in medically ill populations due to its propensity to enhance appetite and promote sedation at lower doses (effects that tend to decrease as the dose increases), and its potential for reducing nausea. It has current indications for the treatment of depression, smoking cessation, and attention deficit/hyperactivity disorder. However, there is evidence of dose dependent increases in seizures, especially in patients with eating disorders. There is little evidence of analgesic efficacy, but it is sometimes tried when its profile of effects would be beneficial. It has indications for the treatment of depression and anxiety, but has been relegated to the treatment of primarily insomnia due to its tendency to cause sedation. The knowledge, attitudes, and experience of medical personnel treating pain in the terminally ill. Pilot study of duloxetine for treatment of aromotase inhibitor-associated musculoskeletal symptoms. A comparative evaluation of amitriptyline and duloxetine in painful diabetic neuropathy. Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations. Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients. Evidence of efficacy is very limited, and it is reasonable to consider this agent primary for those circumstances in which anxiety complicates significant neuropathic pain. Antipsychotics Antipsychotic drugs are used to manage psychotic disorders, such as schizophrenia; problems such as agitation and aggression that may be complicating other psychiatric disorders; and manifestations of organic brain disorders, including frank delirium.