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Even one or two lectures on hypnosis might be highly effective in conveying the information that an individual cannot be hypnotized against his will anastrozole 1mg amex, but that a situation can be devised where he could be tricked into believing that he has been hypnotized purchase generic anastrozole from india. Furthermore order anastrozole from india, demon- -209- strating that the individual is able to lie under hypnosis and cannot be compelled to speak the truth, or to follow suggestions really contrary to his beliefs, would probably be extremely effective. A method of "trance induction," similar to what we have called the "magic room," could be employed to produce a hypnotic situation. The use of the hypnotic situation, as opposed to hypnosis, would make this interrogation technique applicable to a greater percentage of potential informants. Defensive measures to protect personnel from those techniques depend upon the knowledge and confidence of the subject. Summary and Conclusions This report has attempted to evaluate the utility of hypnosis in interrogation procedures. Because of the dearth of evidence bearing directly on the question of the use of hypnosis in interrogation, the problem was broken down into a series of component questions, with each considered separately. A review of the available literature bearing on the question of whether trance can be induced in resistant subjects led us to conclude that such a possibility is extremely doubtful. Assuming that a trance may be induced in a potential informant, what degree of behavioral control does hypnosis allow? This question generally focuses on the possibility of inducing a subject to violate social prohibitions. Although many laboratory experiments have -210- been directed at this question, they suffer from the criticism that they are only, after all, "contrived" situations and the subject, in all probability, perceives them as such at some level. There are three documented cases of "real, nonlaboratory" situations involving the use of hypnosis for compelling criminal behavior. However, close scrutiny of these instances reveals that in each case an intense emotional relationship existed between hypnotist and subject. One need not invoke hypnosis to explain behavior on the part of one individual to please another, be it criminal or not, when an intense emotional relationship exists between the individuals involved. The question of the accuracy of information obtained during a hypnotic trance has been considered. It seems clear from the evidence that such information need not be veridical; the subject remains fully capable of distortions, despite hypnotic suggestions to the contrary. These various proposals lo utilize hypnosis as a defense against interrogation have been discussed: (a) to give hypnotic suggestions designed to prevent further trance induction, (b) to increase resistance to pain and psychic stress by appropriate posthypnotic suggestion, and (c) to induce amnesia posthypnotically for sensitive information in the event of capture. They function as artificially induced repressive mechanisms and suffer from the same drawbacks commonly seen in repression: a loss of ego control and a consequent lessened degree of flexibility in dealing with reality. Captured personnel are already threatened by loss of ego control, and we feel that proposals which would further impoverish the ego are extremely hazardous and would make the individual more vulnerable than he already is. We have suggested alternative defensive measures which would not sacrifice ego control, namely, appropriate instructions and the technique of autogenous training. The distinction has been drawn between the use of hypnosis per se and the hypnotic situation. The hypnotic situation could be used quite effectively for interrogation purposes. The common belief that -211- an individual in hypnosis is not responsible for his actions, although probably incorrect, could be exploited. The hypnotic situation, by relieving the subject of responsibility for his actions, alleviates guilt and thus allows the captive to divulge information which he might not otherwise yield. Ways in which an interrogator might seek to maximize the effectiveness of such a situation include the use of drugs, the use of a technique we have called the "magic room," various social measures, etc. Defensive measures necessary against such a technique would involve the dissemination of appropriate information. Lackland Air Force Base, Texas: Air Force Personnel and Training Research Center, Dec. Social-psychological needs and "involuntary" behavior as illustrated by compliance in interrogition. A number of disciplines have long been concerned with the discrepancies between the actions, opinions, and judgments an individual displays when he is alone and those he displays when he is interacting with others who behave differently. This chapter will review experimental investigations of the conditions under which individuals change or resist changing their behavior to accord with that of others with whom they are interacting. Consideration will be given here to shifts of behavior in the direction of the frame of reference of others ("conformity"), absence of movement or shifts in a different direction ("resistance"), and to the observance of some explicit request or prohibition ("compliance"). Although experimental work has largely been confined to observations of differences between behavior in an interpersonal influence situation and that in a prior private situation, those few studies which have measured the persistence and stability of the change will also be considered. Continued display of conformity behavior when the person is no longer interacting with the source of influence may be termed "conversion. Muzafer Sherif who offered valuable suggestions regarding certain aspects of this report. The relevance of this review for the problem of the volume rests on the validity of the assumption that the dynamics of influence operate beyond the range of intensity of conflic. At the conclusion of this review we will consider the problem of extrapolation by briefly assessing the implications of the current knowledge of the dynamics of interpersonal influence. Several types of investigations have been excluded from this review: (a) anthropological reports in which conformity behavior has been noted but has not been subjected to experimental analysis; (b) investigations of audiences or meetings of larger assemblages where acceptance of or resistance to influence does not result from direct interaction among those composing the situation; (c) investigations dealing with shifts in reaction from knowledge or awareness of norms attributed by the experimenter to groups whose members are not psychologically present; (d) influence aspects of reference group behavior which contain variables that differ in kind and complexity from those inherent in influence exerted under face-to-face conditions; and (e) programmatic research reports and theoretical discussions of various aspects of the problem that are available in a number of other sources (2, 17, 29, 39, 46, 65, 90, 91, 99, 121, 126). Characteristics of the Experimental Situations Material and Instructions Experimental situations used to study conformity, compliance, and conversion are described here according to the following characteristics: (a) types of stimulus materials employed; (b) contexts or background conditions in which pressures are exerted; (c) personal dimensions used to assess the contribution of individual differences to conformity and conversion behavior; and (d) methods of measuring the impact of conformity pressures on a critical subject. A variety of tasks and performances figured in the studies which -217- have been reviewed. Instructions and stimulus materials have been used to produce the following types of responses: (a) expressions of opinions, attitudes, preferences, and interpretations, (b) perceptual and factual judgments, (c) attempts at logical analyses, and (d) behavior in relation to a direct request or an explicit prohibition. Others have reported findings for a number of attitude statements without giving complete descriptions of their composition (8, 34, 64). The expression of opinions or attitudes regarding typical cases or problem issues has also been used (27, 81, 92, 114, 120, 134). Typical discussion topics include federal aid to education (47), labor-management relations (40, 48), nationalism vs. Ratings of personality and social characteristics of both self and others also have been used as stimulus tasks (24, 57). The expression of personal preferences has included such items as line drawings (8, 34), food preferences (38, 73, 95), ranking of camping equipment for a hypothetical trip (55, 56), and ranking men in order of desirability as President of the United States (108). Pictures that are subject to personal interpretation as the basis for composing a story (4), or unclear drawings that are named by the subject (88, 90, 131, 132, 133) comprise another type of problem. Making such judgments as the truthfulness of a person defending himself against charges of revealing a fictitious crime (25), the intelligence of people from photographs (49), the better one of two paintings (97), the driver at fault from a picture of an auto accident (129), or revealing of discrepancies in examination grades (93) constitute other tasks that have been used. Examples are requests for volunteers (9, 112, 113, 117) and for the endorsement of a petition (19); prohibitions, such as a poster forbidding entry to a building (45); a stoplight regulating pedestrian traffic (83); a sign prohibiting drinking from a fountain (78); a traffic light where turning signals are legal (5), or a command to stop a designated activity (53). The task involving the cutting of squares or other geometric forms under pressure from others to change the rate of production contains some elements of the direct request or prohibition stimulus (109, 110, 120). The first group includes the autokinetic problem (16, 21, 23, 30, 36, 42, 58, 69, 75, 79, 84, 85, 91, 101, 111, 121, 122, 124, 125, 130), estimation of the number of dots on a card or slide (37, 43, 74, 100), the number of beans in a jar (70), the length of rectangles (22, 65), the distance between rectangles (65), the length of lines (98, 102, 18), the length of a slot of light (11, 97), the distance traversed by a moving light (118), the number of flashes of light in a standard time interval (76, 77), the number of clicks of a metronome (18, 103, 105, 123), the weight of a series of standard objects (60), size estimation of unspecified objects (72), and recognition of simple visual objects (115). Discrimination tasks include judging which is the shorter of two lines (87, 89), whether there is an odor in a bottle of odorless water (28), and which square has the largest number of dots (74).

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Warnings/precautions • Use with caution in patients with head injury with increased intracranial pressure buy 1mg anastrozole with visa, serious alcoholism order anastrozole on line, prostatic hypertro- phy buy anastrozole with american express, chronic preliminary disease, severe liver or kidney disease, disorders of biliary tract, and in postoperative patients with pulmonary disease. Have the following available when treating patient with this drug: naloxone (Narcan) or other antagonist, means of administering oxygen, and support of respiration. If nausea and vomiting persist, it may be necessary to administer an antiemetic, eg, droperidol or prochlorperazine. Editorial comments • Administration of nalbuphine in narcotic-dependent individu- als may result in withdrawal reaction. If no response is observed after 10 mg, the diag- nosis of opioid overdose is questionable. Warnings/precautions • Use with caution in patients with opioid addiction, cardiac irregularities. May precipitate full-blown opioid withdrawal at high doses in patients receiving an opioid longer than 1 week. Accordingly, vigilance is required and repeated doses are usually necessary to manage acute narcotic overdose. Naloxone must be used with great caution in such patients to avoid precipitating withdrawal symptoms in the neonate. Parameters to monitor • Monitor all vital signs and level of consciousness frequently for 3–4 hours after peak blood concentrations of naloxone. Editorial comments • When treating drug overdose, adjuvant therapy using the fol- lowing may be necessary: mechanical ventilation, oxygen, vasopressors, nasogastric lavage. Mechanism of action: Competitive binding at opioid receptor sites reduces euphoria and drug craving without supporting the addiction. Warnings/precautions • Use with caution in patients with history of liver disease. Advice to patient • Carry an identification card indicating you are undergoing nal- trexone therapy. Clinically important drug interactions • Drugs that increase effects/toxicity of naltrexone: Thiorida- zine. Parameters to monitor • Evidence of suicidal tendency (higher risk in opiate abusers). Editorial comments: It is necessary to determine when the patient last received an opioid. Such patients should be free of opioids for a minimum of 7–10 days before starting naloxone. Editorial comments • Some rheumatologists consider aspirin to be the first-line drug for treatment of rheumatoid arthritis. Mechanism of action: Inhibits acetylcholinesterase, thereby increasing acetylcholine at cholinergic receptor sites. Contraindications: Hypersensitivity to neostigmine or bromides, peritonitis, mechanical obstruction of intestinal or urinary tract. Warnings/precautions • Use with caution in patients with the following conditions: epilepsy, bronchial asthma, bradycardia, recent coronary occlu- sion, hyperthyroidism, cardiac arrhythmias, peptic ulcer. This will enable the physician to evaluate the dosage and, if neces- sary, make adjustments. Adverse reactions • Common: bowel cramps, salivation, diarrhea, fasciculations, muscle cramps. Clinically important drug interactions • Drugs that increase effects/toxicity of cholinesterase inhibitors: aminoglycosides (neomycin, streptomycin, kanamycin), local anesthetics, general anesthetics, magnesium salts. Parameters to monitor • Status of muscle strength to differentiate between myasthenic and cholinergic crises. Onset of weakness 1 hour after taking the drug indicates drug overdose (cholinergic crisis). Onset of weakness 3 hours or more after taking drug indicates drug underdosage (myasthenic crisis). Editorial comments: Unapproved use of neostigmine includes treatment of intestinal pseudo-obstruction (Ogilve’s syndrome). Susceptible organisms in vivo: Staphylococci (penicillinase and nonpenicillinase), Acinetobacter sp, Citrobacter sp, Enterobac- ter sp, Escherichia coli, Klebsiella sp, Neisseria sp, Proteus sp, Pseudomonas sp, Salmonella sp, Serratia sp, Shigella sp. Adjustment of dosage • Kidney disease: Creatinine clearance 40–50 mL/min: adminis- ter 50% of usual dose q8h; creatinine clearance 30–40 mL/min: administer 35% of usual dose q8h; creatinine clearance 20–30 mL/min: administer 25% of usual dose q8h. Contraindications: Hypersensitivity to calcium blockers, advanced aortic stenosis. Advice to patient • Use two forms of birth control including hormonal and barrier methods. Sit at the edge of the bed for several minutes before standing, and lie down if feeling faint or dizzy. Clinically important drug interactions • Drugs that increase effects/toxicity of calcium blockers: cime- tidine, β blockers, cyclosporine. Impaired renal function prolongs duration of action and increases tendency for toxicity. Editorial comments • Use with caution in cerebral edema or if intracranial pressure is severely raised. Mechanisms of action: Inhibits acetyl coenzyme A and bacter- ial cell wall synthesis. Contraindications: Pregnancy at term, imminent labor, during labor and delivery, anuria, anemia. Advice to patient: Report following to treating physican: flu- like symptoms, numbness in extremities, difficulty breathing, jaundice. Clinically important drug interactions • Drugs that increase effects/toxicity of nitrofurantoin: sulfin- pyrazone, anticholinergic drugs, probenecid. Editorial comments • It is recommended that therapy be continued for at least 3 days after urine specimens are shown to be sterile. Parameters to monitor: Possible overgrowth of fungi or other organisms that are not susceptible to nitrofurazone action. Editorial Comments • This drug is not listed in the Physician’s Desk Reference, 54th edition, 2000. Mechanism of action: Reduces peripheral resistance (arterial and venous) by vasodilation; decreases left ventricular pressure. Contraindications: Hypersensitivity to nitrates or nitrites, hypoten- sion or uncorrected hypovolemia, increased intracranial pressure, inadequate cerebral circulation, constrictive pericarditis and peri- cardial tamponade. Editorial comments • This drug is not listed in Physician’s Desk Reference, 54th edi- tion, 2000. Mechanism of action: Reduces peripheral resistance (arterial and venous) by vasodilation; decreases left ventricular pressure. Onset of Action Duration 20–45 min 3–8 h Food: Take 1 hour before or 2 hours after meals with full glass of water. These symptoms generally occur within 2–3 minutes of alcohol ingestion and may last 1–4 hours. Sit at the edge of the bed for several minutes before standing, and lie down if feeling faint or dizzy. Clinically important drug interactions • Drugs that increase effects/toxicity of nitrates: alcohol, antihy- pertensive drugs, aspirin, β blockers, calcium channel blockers, vasodilators.

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The manufacturer of the drug has yet to publish a detailed report equivalent to those available in the literature on aciclovir and zidovudine best order anastrozole. Mutagenicity was seen in vitro and in vivo only with high doses of didanosine (Table 1) discount anastrozole on line. Didanosine did not induce reverse mutation in Salmonella typhimurium with or without exogenous metabolic activation [no information on doses or strains] and did not induce differential toxicity in Escherichia coli or Bacillus subtilis order genuine anastrozole online. Didanosine caused clastogenic effects in Chinese hamster ovary cells and human lymphocytes. Studies of the mutagenicity of didanosine in animals in vivo are limited to assays for micronucleus formation in rodents. As didanosine can be inacti- vated by the low pH of the stomach, it was subsequently administered by intra- peritoneal injection for three consecutive days. A significant clastogenic response was found in peripheral blood at the low and high doses. Over a range of concentrations, the induced mutant frequencies at the two loci were three to four times greater than the values obtained after exposure to didanosine or zidovudine alone. The few available studies on the mutagenicity of didanosine show that it produces primarily clastogenic effects at high doses. It is in widespread use in combination regimens with other antiretroviral agents, and potentiation of the anti- viral effect of didanosine by hydroxyurea is being investigated. About half of the human urinary metabolites are represented by hypoxanthine, and 40% is unchanged drug. Phosphorylation is a minor pathway but is essential for the antiviral activity of the drug. The toxic effects of didanosine in humans include peripheral neuropathy, pancrea- titis, hepatitis and leukopenia. No relevant studies of the reproductive and prenatal effects of didanosine in humans were available. Didanosine crosses the placenta of women and monkeys by bidirectional, passive diffusion. Didanosine but not didanosine triphosphate was observed in placental and fetal tissues. Little information was available on the genetic and related effects of didanosine. Treatment of human cells in culture significantly increased the mutant frequencies after short-term expo- sure to concentrations 10–20-fold greater than the peak plasma concentrations found in some patients. In the same studies, didanosine was more cytotoxic and less muta- genic than zidovudine. There is inadequate evidence in experimental animals for the carcinogenicity of didanosine. Overall evaluation Didanosine is not classifiable as to its carcinogenicity to humans (Group 3). A review of its antiviral activity, pharmaco- kinetic properties and therapeutic potential in human immunodeficiency virus infection. The gelatin capsules may also contain citric acid, gelatin, glycerol, iron oxide, parabens (ethyl and propyl), polyethylene glycol 400, sorbitol and titanium dioxide. Etoposide concentrate for injection is a sterile, non-aqueous solution of the drug in a vehicle, which may be benzyl alcohol, citric acid, ethanol, polyethylene glycol 300 or polysorbate 80. Etoposide phosphate for injection is a sterile, non-pyrogenic, lyophilized powder containing sodium citrate and dextran 40; after reconstitution of the drug with water for injection to a concentration of 1 mg/mL, the solution has a pH of 2. The following impurities are limited by the requirements of The British Pharma- copoeia: 4′-carbenzoxy ethylidene lignan P, picroethylidene lignan P, α-ethylidene lignan P, lignan P and 4′-demethylepipodophyllotoxin (British Pharmacopoeia Commission, 1994). Trade names for etoposide phosphate include Etopofos and Etopophos (Swiss Pharmaceutical Society, 1999). Methods for the analysis of etoposide and its metabolites in plasma, serum and urine have included reversed-phase high-performance liquid chromatography with oxidative electrochemical detection, fluorescence detection and ultraviolet detection. Podophyllotoxin is isolated from the dried roots and rhizomes of species of the genus Podophyllin, such as the may apple or American mandrake (Podophyllin peltatum L. Etoposide can be synthesized from naturally occurring podophyllotoxin by first treating the podophyllotoxin with hydrogen bromide to produce 1-bromo-1-deoxyepi- podophyllotoxin, which is demethylated to 1-bromo-4′-demethylepipodophyllotoxin. The bromine is replaced by a hydroxy group, resulting in 4′-demethylepipodo- phyllotoxin. After protection of the phenolic hydroxyl, the 4-hydroxy group is coupled with 2,3,4,6-tetra-O-acetyl-β-D-glucopyranose. The protecting group at the 4′- hydroxy is removed by hydrogenolysis and the acyl groups by hydrolysis, and the cyclic O-4,6 acetal is formed by reaction with acetaldehyde dimethyl acetal (Holthuis et al. During early clinical trials for cancer chemotherapeutic use, podophyllotoxin proved to be too toxic and, in the 1960s, two epipodophyllotoxins were described, teniposide (see monograph, this volume) and etoposide (Keller-Juslén et al. The first clinical trial of etoposide was reported in 1971, and etoposide entered routine use after 1981 (Oliver et al. Etoposide is one of the most widely used cytotoxic drugs and has strong anti- tumour activity in cases of small-cell lung cancer, testicular cancer, lymphomas and a variety of childhood malignancies. It is one of the most active single agents in the treatment of small-cell lung cancer (Slevin et al. For testicular germ-cell tumours, etoposide is used in combination with bleomycin and cisplatin. Durable complete responses were achieved in about 80% of patients with disseminated germ-cell tumours; in a randomized trial, the combination resulted in longer overall survival and less toxicity than the standard cisplatin–bleomycin– vinblastine regimen (Williams et al. Three or four cycles of etoposide with cisplatin and bleomycin are now generally regarded as the standard treatment for this disease (Nichols, 1992). Etoposide is active as a single agent in non-Hodgkin lymphoma, with response rates of 17–40% in previously treated patients (O’Reilly et al. It has been investigated for use in combination with the widely used cyclophosphamide–doxo- rubicin–vincristine–prednisone regimen and in a number of new combinations. Etoposide is less commonly used in a number of other tumour types, including non-small-cell lung cancer, breast, ovarian and gastric cancer, leukaemias, Kaposi sarcoma and in histiocytosis (Joel, 1996; Okada et al. The efficacy of etoposide is clearly schedule-dependent, longer exposures of three to five days being more active than a single dose (Slevin et al. A typical intra- venous dose is 375–500 mg/m2 over three to five days days (90–120 mg/m2 per day), repeated every three weeks. Owing to its poor solu- bility, a more water-soluble pro-drug, etoposide phosphate, was developed for clinical use. Once this drug enters the systemic circulation, the phosphate is rapidly and com- pletely cleaved by circulating phosphatases. Studies of Cancer in Humans Several factors make it difficult to evaluate etoposide with respect to the incidence of second malignancies. First, most cancer patients are treated with combined treatment modalities (chemotherapy and radiotherapy), and multiple antineoplastic drugs are usually administered within combination chemotherapy regimens. The administration of possibly carcinogenic drugs other than etoposide was adjusted for in only a few studies. For example, there is now general agreement that the development of leukaemia in patients with mediastinal germ-cell cancer should be regarded as part of the natural history of the disease (Nichols et al. In studies of the risk for treatment-related leukaemia, patients with mediastinal germ-cell cancer should therefore be excluded.

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Ongoing monitoring is suggested and treatment with bisphosphonates or calcitonin is suggested when decreased bone mineral density occurs purchase anastrozole once a day. However order anastrozole canada, if the infection is being treated with appropriate antimicrobials order generic anastrozole from india, antifungals, or antiviral agents, steroid may be prescribed by experienced clinicians. Adjustment of dosage • Kidney disease: Creatinine clearance 50–80 mL/min: adminis- ter q8h; creatinine clearance 10–50 mL/min: administer q8–12h; creatinine clearance <10 mL/min: administer q12–24h. Warnings/precautions: Use with caution in patients with kidney or liver disease, pulmonary insufficiency. Advice to patients • Use two forms of birth control including hormonal and barrier methods. Sit at the edge of the bed for several minutes before standing and lie down if feeling faint or dizzy. Male patients with orthostatic hypotension may be safer urinating while seated on the toilet rather than standing. Adverse reactions • Common: drowsiness, diplopia, nausea, vomiting, ataxia, seda- tion, headache. Clinically important drug interactions • Drugs that increase effects/toxicity of primidone: alcohol, phenytoin, isoniazid, valproic acid. Parameters to monitor • Signs of allergic reaction to phenobarbital (a metabolite of primidone). Editorial comments: Primidone is used alone or in combination with other anticonvulsants. Mechanism of action: Uricosuric action: inhibits active tubular reabsorption of uric acid. Onset of Blockade of Penicillin Excretion Peak Effect Duration 2 h — 8 h Food: Take with food or antacid. Contraindications: Hypersensitivity to probenicid, blood dyscra- sias, acute gout, uric acid kidney stones, children <2 years, con- comitant administration of salicylates. Advice to patient • Do not discontinue drug without consulting treating physician. Clinically important drug interactions • Probenecid increases effects/toxicity of penicillins, cephalos- porins, sulfonamides, fluoroquinolones, sufonylureas, dapsone, methotrexate, nitrofurantoin, zidovudine, acyclovir, indometha- cin, acetaminophen, lorazepam, rifampin. Adjust dose of probenecid to the lowest one that maintains uric acid levels within the normal range (<5 mg/dL). Mechanism of action: Primarily increases the effective refrac- tory period of atrial and ventricular sodium-dependent tissue. Adjustment of dosage • Kidney disease: Creatinine clearance 10–50 mL/min; admin- ister q6–12h; creatinine clearance <10 mL/min: administer q8–24h. Warnings/precautions • Use with caution in patients with heart failure, bundle branch heart block, kidney or liver disease, bone marrow insufficiency, digitalis intoxication, other concurrent antiarrhythmic agents, renal insufficiency, myasthenia gravis. Such preparations should be avoided in patients who have demonstrated previous hypersensitivity reactions to these substances. Advice to patient • Do not double dose if one is missed but take the missed dose as soon as remembered (within 2 hours). Clinically important drug interactions • Drugs that increase effects/toxicity of procainamide: lidocaine, amiodarone, β blockers, antihypertensives, nitrates, antihista- mines, antidepressants, atropine, phenothiazines, cimetidine, ranitidine, quinidine, trimethoprim, pimozide. Procainamide’s usefulness is due to its blocking effect on sodium channels in atrial and ventricular fibers. In atrial fibrillation and flutter of less than 48 hours’ duration, it has a 60% efficacy of pharmacologic conversion. Mechanism of action: Reversibly inhibits initiation and conduc- tion of nerve impulses near site of injection. Contraindications: Hypersensitivity for ester-type local anes- thetic (eg, tetracaine). Use local anesthetics with or without vasoconstrictor with cau- tion in patients with severe liver disease. Use with extreme caution for lumbar and caudal epidural anesthesia, in patients with spinal deformities, pre-existing neurologic disease, severe uncontrolled hypotension, septicemia. Any increase in heart rate and systolic pressure within 45 seconds (the epinephrine response) would indicate that the injection is intravascular. The necessary means must be avail- able to manage this condition (dantrolene, oxygen, supportive measures). Editorial comments • Procaine is not widely used as a local anesthetic today because of its short duration of action and tendency to cause contact dermatitis. Considered com- patible with breastfeeding by American Academy of Pediatrics in 1983. Warnings/precautions • Use with caution in patients with cardiovascular, liver, kidney disease, glaucoma, chronic respiratory disorders, exposure to extreme heat, organophosphate insecticides or atropine-type drugs. Because this syndrome is potentially irreversible, close monitoring for drug-induced movement dis- orders is mandatory for all patients. Management includes drug discontinuation, close monitoring, and symptom-directed therapy including administration of dantrolene. Sui- cide attempts by drug overdose may occur even when patient’s symptoms appear to be improving. This dye can cause a severe allergic reaction, even an asthmatic attack, in susceptible patients, particularly those who are aller- gic to aspirin. Prescribe a drug preparation that does not contain this dye for these individuals. Advice to patient • Avoid driving and other activities requiring mental alertness or that are potentially dangerous until response to drug is known. If this occurs, use extra blankets only, not hot water bottle, heating pad, or electric blanket. Symptoms of this condition include red, dry skin, dyspnea, strong pulse, body temperature above 105°F (40. Other symptoms of withdrawal include abdominal discomfort, dizziness, headache, tachycardia, insomnia. Patient should remain in recumbent position for at least 30 minutes following injection. At first indication of tardive dyskinesia— vermicular movements of tongue—withdraw drug imme- diately. Tardive dyskinesia generally develops several months after treatment with a phenothiazine. Patient should be moni- tored every 6 months for possible development of tardive dyskinesia. If con- trol is lost, it may be necessary to discontinue the drug and substitute another. Adverse ocular reactions include increased intraocular pressure, particle deposition in the cornea and lens, which may lead to venticular opacities, blurred vision, photophobia, ptosis.