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Professor, Neurology UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA

https://profiles.ucsf.edu/william.weiss

Brainstem ﬁndings include oculomotor disturbances trusted 20 mg nexium gastritis diet ��, dysarthria cheap 20mg nexium otc gastritis diet ��, ataxia cheap 40mg nexium free shipping gastritis diet ��, and impaired arousal buy 20mg nexium mastercard chronic gastritis bile reflux. Cross Reference Hallucination Peek Sign One of the eye signs of myasthenia gravis: on attempted forced eye closure, orbicularis oculi may fatigue such that the patient ‘peeks’ through the partially open palpebral ﬁssure. Peliopsia, Pelopsia Peliopsia or pelopsia is a form of metamorphopsia characterized by the misperception of objects as closer to the observer than they really are (cf. Cross References Metamorphopsia; Porropsia Pelvic Thrusting Pelvic thrusting may be a feature of epileptic seizures of frontal lobe origin; occasionally it may occur in temporal lobe seizures. Pelvic thrusting also occurs in pseudoseizures, particularly those of the ‘thrashing’ variety. Choreiform disorders may involve the pelvic region causing thrusting or rocking movements. Cross References Automatism; Chorea, Choreoathetosis; Seizure Pendular Nystagmus Pendular or undulatory nystagmus is characterized by eye movements which are more or less equal in amplitude and velocity (sinusoidal oscillations) about a central (null) point. In acquired causes such as multiple sclerosis, this may produce oscillopsia and blurred vision. Acquired pendular nystagmus in multiple sclerosis: an examiner–blind cross-over treatment study of memantine and gabapentin. Cross References Nystagmus; Oscillopsia Percussion Myotonia Percussion myotonia is the myotonic response of a muscle to a mechanical stimulus. For example, a blow to the thenar eminence may produce involuntary and sustained ﬂexion of the thumb. This -273 P Periodic Alternating Nystagmus response, which may be seen in myotonic dystrophy, reﬂects the impaired muscle relaxation which characterizes myotonia. Cross Reference Myotonia Periodic Alternating Nystagmus Periodic alternating nystagmus is a horizontal jerk nystagmus, which damps or stops for a few seconds and then reverses direction. Periodic alternating nystagmus may be congenital or acquired, if the latter then its localizing value is similar to that of downbeat nystagmus (with which it may coexist), especially for lesions at the cervico-medullary junction. Treatment of the associated lesion may be undertaken, otherwise periodic alternating nystagmus usually responds to baclofen, hence the importance of correctly identifying this particular form of nystagmus. Cross Reference Nystagmus Periodic Respiration Periodic respiration is a cyclical waxing and waning of the depth and rate of breathing (Cheyne–Stokes breathing or respiration), over about 2 min, the crescendo–decrescendo sequence being separated by central apnoeas. Periodic respiration may be observed in unconscious patients with lesions of the deep cerebral hemispheres, diencephalon, or upper pons, or with central or tonsillar brain herniation; it has also been reported in multiple system atrophy. Cross References Coma Perseveration Perseveration refers to any continuation or recurrence of activity without appropriate stimulus (cf. A number of varieties of perseveration have been described, associated with lesions in different areas of the brain:. Cross References Aphasia; Dysexecutive syndrome; Frontal lobe syndromes; Intrusion; Logoclonia; Palinopsia Personiﬁcation of Paralyzed Limbs Critchley drew attention to the tendency observed in some hemiplegic patients to give their paralyzed limbs a name or nickname and to invest them with a personality or identity of their own. This sometimes follows a period of anosognosia and may coexist with a degree of anosodiaphoria; it is much more commonly seen with left hemiplegia. A similar phenomenon may occur with amputated limbs, and it has been reported in a functional limb weakness. Cross References Anosodiaphoria; Anosognosia Pes Cavus Pes cavus is a high-arched foot due to equinus (plantar ﬂexion) deformity of the ﬁrst ray, with secondary changes in the other rays. Surgical treatment of pes cavus may be necessary, especially if there are secondary deformities causing pain, skin breakdown, or gait problems. Patients may volunteer that they experience such symptoms when carrying heavy items such as shopping bags which puts the hand in a similar posture. Hyperextension of the wrist (‘reverse Phalen’s manoeuvre’) may also reproduce symptoms. These are signs of compression of the median nerve at the wrist (carpal tunnel syndrome). Tinel’s sign), the sensitivity and speciﬁcity of Phalen’s sign for this diagnosis are variable (10–91% and 33–86%). The pathophysiology of Phalen’s sign is probably the lower threshold of injured nerves to mechanical stimuli, as for Tinel’s sign and Lhermitte’s sign. Cross References Erythropsia; ‘Monochromatopsia’; Phantom vision Phantom Limb Phantom limbs, or ghost limbs, are the subjective report of the awareness of a non-existing or deafferented body part in a mentally otherwise competent 276 Phonemic Disintegration P individual. The term was coined by Weir Mitchell in the nineteenth century, but parts other than limbs (either congenitally absent or following amputation) may be affected by phantom phenomena, such as lips, tongue, nose, eye, penis, breast and nipple, teeth, and viscera. Phantom phenomena are perceived as real by the patient, may be subject to a wide range of sensations (pressure, temperature, tickle, pain), and are perceived as an integral part of the self. Such ‘limbless perception’ is thought to reﬂect the mental representation of body parts generated within the brain (body schema), such that perception is carried out without somatic peripheral input. Reorganization of cortical connections following amputation may explain phantom phenomena such as representation of a hand on the chest or face, for which there is also evidence from functional brain imaging. Phantom Vision this name has been given to visual hallucinations following eye enucleation, by analogy with somaesthetic sensation experienced in a phantom limb after amputation. Similar phenomena may occur after acute visual loss and may overlap with phantom chromatopsia. Unformed or simple hallucinations are more common than formed or complex hallucinations. Phonagnosia is the equivalent in the auditory domain of prosopagnosia in the visual domain. Cross References Agnosia; Auditory agnosia; Prosopagnosia; Pure word deafness Phonemic Disintegration Phonemic disintegration refers to an impaired ability to organize phonemes, the smallest units in which spoken language may be sequentially described, resulting -277 P Phonetic Disintegration in substitutions, deletions, and misorderings of phonemes. Phonemic disintegration is relatively common in aphasic disorders, including Broca’s aphasia, conduction aphasia, and transcortical motor aphasia. The neural substrate may be primary motor cortex of the left inferior precentral gyrus and subjacent white matter, with sparing of Broca’s area. Clinical–anatomical correlation in a selective phonemic speech production impairment.

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A noncatecholamine that has a methyl biochemical reactions that ultimately result in the gengroup attached to generic 40 mg nexium otc gastritis diet zx its -carbon will not be metabolized eration of a speciﬁc physiological response by that cell by either enzyme and will have a greatly prolonged du(Figs buy generic nexium 20 mg online gastritis diet ��. The speciﬁc second-messenger pathways constitute a the Role of Second Messengers in highly versatile signaling system that can modify (stimuReceptor-mediated Responses late or inhibit) numerous cellular processes including the adrenomimetic drugs generic 20mg nexium fast delivery gastritis severe pain, including the naturally ocsecretion buy nexium 40mg on-line gastritis que hacer, contraction and relaxation, metabolism, neucurring catecholamines, initiate their responses by comronal excitability, cell growth, and apoptosis. For example, inositol triphosphate afﬁnities possessed by the catecholamines for and functions by mobilizing calcium from intracellular stores -adrenoceptors and to differences in the relative disor opening channels; the calcium can be used to inititribution of the receptors in a particular vascular bed. Diacylglycerol is known to stimulate an enzyme, protein the blood vessels of the skin and mucous memkinase C, that phosphorylates speciﬁc intracellular probranes predominantly contain -adrenoceptors. Both teins, some of which regulate ionic mechanisms such as epinephrine and norepinephrine produce a powerful the Na /H exchanger and potassium channels. It appears that a pure -adrenoceptor agonist, has little effect on the protein phosphorylation is a ﬁnal common pathway in vasculature of the skin and mucous membranes. The the molecular mechanisms through which neurotransblood vessels in visceral organs, including the kidneys, mitters, hormones, and the nerve impulse produce many contain predominantly -adrenoceptors, although some of their biological effects in target cells. Norepinephrine constricts these Vascular Effects blood vessels and reduces blood ﬂow through an interthe cardiovascular effects of norepinephrine, epinephaction with -adrenoceptors. Whether epinephrine heart rate and ventricular contractile force therefore produces vasodilation or vasoconstriction in skeletal varies with the dose of norepinephrine, the physical acmuscle depends on the dose administered. Low doses of tivity of the subject, any prior cardiovascular and baroepinephrine will dilate the blood vessels; larger doses receptor pathology, and the presence of other drugs that will constrict them. Although several factors can inﬂuence the ﬂow of In a normal resting subject who is receiving no blood through the coronary vessels, the most important drugs, there is a moderate parasympathetic tone to the of these is the local production of vasodilator metabolites heart, and sympathetic activity is relatively low. The that results from stimulation-induced increased work by ventricular muscle receives little, if any, parasympathetic the heart. As the blood pressure rises in response to the coronary vascular beds do not play a major role in norepinephrine, the baroreceptor reﬂex is activated, determining the vasodilator effects of the administraparasympathetic impulses (which are inhibitory) to the tion of epinephrine or norepinephrine. Heart rate is slowed so much that the direct effect of norepinephrine to inEffects on the Intact Cardiovascular System crease the rate is masked and there is a net decrease in An increase in sympathetic neuronal activity causes an rate. Under the conditions described, however, the imincrease in heart rate (positive chronotropic effect, or pact of the reﬂex on the ventricles is very slight because tachycardia) and an increase in cardiac contractile force there is no parasympathetic innervation and the preex(positive inotropic effect) such that the stroke output is isting level of sympathetic activity is already low. Cardiac output, which is a function of rate ther decrease in sympathetic activity therefore would and stroke output, is thus increased. The reﬂex nature of the bradycardia induced by An increase in sympathetic tone constricts blood parenterally administered norepinephrine can readily vessels in most vascular beds and therefore causes a net be demonstrated by administration of atropine, a choliincrease in total peripheral resistance. Atropine abolishes the comthetic tone increases neural release of norepinephrine pensatory vagal reﬂexes. Under conditions of vagal and its interaction both with -adrenoceptors on carblockade, the direct cardiac stimulatory effects of nordiac cells and with -adrenoceptors on vascular smooth epinephrine are unmasked. As a consequence, the systolic and diastolic dia, an increase in stroke volume, and as a consequence, blood pressures are elevated. Epinephrine Norepinephrine A small dose of epinephrine causes a fall in mean Norepinephrine, administered to a normotensive and diastolic pressure with little or no effect on systolic adult either subcutaneously or by slow intravenous inpressure. This is due to the net decrease in total periphjection, constricts most blood vessels. Venules as well as eral resistance that results from the predominance of arterioles are constricted. The baroreceptor may decrease, remain unchanged, or increase slightly, reﬂexes are discussed in detail in Chapter 9. The cardiac effects of epinephrine are due to its ac(2) the reﬂex initiated is inhibitory, that is, opposite to tion on -adrenoceptors in the heart. Heart rate is given in beats per minute, blood pressure in millimeters of mercury, and peripheral resistance in arterial blood pressure. Peripheral vascular effects of noradrenaline, isopropyl-noradrenaline, and dopamine. Vascular endothelium also plays an important role in Isoproterenol maintaining vascular tone. The endothelium can modulate Slow intravenous infusion of therapeutic doses of both vasodilation and vasoconstriction through its ability isoproterenol in humans produces a marked decrease in to locally synthesize and release vasodilators such as nitric total peripheral resistance, owing to the predominance oxide, endothelium-derived hyperpolarizing factor, and of vasodilation in skeletal muscle vascular beds. The depressor action of isoproterenol is more Stimulation of 2-adrenoceptors located on the endothepronounced than that of epinephrine because isoprolial cells in certain vascular beds (such as the coronary arterenol causes no vasoconstriction, whereas epinephrine tery) results in the release of nitric oxide and vasodilation. Systolic blood pressure may In any blood vessel, the ﬁnal integrated response to remain unchanged or may increase. When an increase in either neuronally released norepinephrine or to circusystolic blood pressure is seen, it is due to the marked inlating epinephrine probably depends on the relative crease in cardiac output produced by isoproterenol. This is ate constriction of vascular smooth muscle, while prepartly due to its ability to decrease mean blood presjunctional and endothelial 2-adrenoceptors mediate sure, which then reﬂexively diminishes vagal activity, vasodilation. Effects on Vascular Smooth Muscle Postjunctional 1-adrenoceptors are always found in Effects on Nonvascular Smooth Muscle veins, arteries, and arterioles. Activation of these receptors results in the entry of extracellular calcium through In general, the responses to administered catecholreceptor-operated channels and in the release of intraamines are similar to those seen after sympathetic nerve cellularly stored calcium; this is brought about through stimulation and depend on the type of adrenoceptor in the participation of the inositol triphosphate secondthe muscle. Most of these are mediated through an and isoproterenol through their interaction with 2interaction with -adrenoceptors. Epinephrine and tent bronchodilators, while norepinephrine has a relaisoproterenol in therapeutic doses increase oxygen contively weak action in this regard (see Chapter 39). Endogenous epinephrine seSmooth muscle of the gastrointestinal tract is genercreted by the adrenal medulla in response to stress such ally relaxed by catecholamines, but this may depend on as exercise increases blood levels of glucose, lactic acid, the existing state of muscle tone. Catecholamines apglycogenolysis, gives rise to glucose, which readily enpear to produce relaxation of the gut through an action ters the circulation; isoproterenol produces relatively on 2-adrenoceptors on ganglionic cells. Administration of both and these receptors reduces acetylcholine release from -adrenoceptor blocking agents is necessary for comcholinergic neurons. Catecholamines also may produce plete antagonism of glycogenolysis in this tissue. Contraction of tal muscle glycogenolysis, followed by epinephrine the sphincters occurs through an action on 1-adrenoand norepinephrine.

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Lewis body dementia is an accumulation of α-synuclein protein within the cell and it represents 5 to 40 mg nexium with amex gastritis diet gastritis symptoms 15% of neurodegenerative diseases safe 40 mg nexium gastritis diet zucchini. Frontotemporal dementia as the name suggests nexium 20mg discount gastritis food to eat, is a degeneration of the region of the frontal and temporal anterior cortex order 40 mg nexium visa gastritis diet 7 up calories. The high profile failures of antiamyloid interventions and lack of agreement on which form the β-amyloid is toxic and the mechanism by which this occurs force the scientific community to consider amyloid only as one part of a multi-factorial disease process including a variety of aggravating factors. A recent paper entitled Changing perspectives on Alzheimer’s Disease: Thinking outside the amyloid Box resume this thinking (D’Alton & George, 2011). Within this category there are "typical" Alzheimer and those who are called "atypical" which means that their profile may include some features of vascular dementia or components of Lewis Body dementia. However, it is only at death that the diagnosis can be confirmed by neuropathological brain examination of the abundance of β-amyloid plaques and neurofibrillary tangle, even if the amyloid theory is increasingly questioned. Not surprisingly, neuropathological diagnosis of post-mortem brain does not always correlate with the clinical diagnosis. Alzheimer’s Disease: diagnosis of exclusion (Adapted from Whitehouse, 2008) the mismatch between clinical diagnosis and aβ and tau neuropathology at death shakes the causation link and suggests the importance of other aspects in the etiology of the cognitive decline associated with aging. Despite representing about 2% of adult body weight, the brain uses about 23 % of the body’s total energy needs. The brain gets its energy from glucose to 97% making it the main energy substrate. Every day, an average human brain consumes approximately 16% of the total oxygen consumption and metabolizes approximately 110 to 145 g of glucose. It is still unclear as to whether or not healthy aging (no cognitive impairment) is associated with reduction in brain glucose metabolism. Cunnane and collegues reviewed the literature on this specific question and they found out that eight studies showed that cerebral glucose metabolism does not decline with healthy aging and nine studies have demonstrated that it does in a proportion of about 18% (Cunnane et al. It could be a problem in the glucose transport, glucose availability, or a dysfunction in the production of energy derived from glucose. The brain uses glucose as main energy source but can also use ketones as an alternative energy source in situations of glucose deprivation (fasting, intense physical activity). In starvation conditions, up to 60% of the human brain energy requirements can be met by ketones (Owen, 1967). Based on the fact that ketones are energetic molecules and used by the brain as an alternative to glucose, some studies have demonstrated the ability of ketones to improve some cognitive dysfunction in diabetic hypoglycemia (Page et al. Although brain ketone metabolism is less known in the elderly population, fundamental and clinical studies suggests that they could represents an interesting therapeutic potential for cognitive decline (reviewed in Veech et al. It is true that the passage of time cannot be slowing down, but individuals can play a role in modifying their "biological" age or their metabolic condition. Effectively, aging naturally tends to reduce the cognitive functioning but also worsen the metabolic condition. At advanced age, the prevalence of hypertension, dyslipidemia, inflammation, atherosclerosis and diabetes increase. To prevent these metabolic problems, it is highly documented that the adoption of a healthy lifestyle (physical activities and equilibrate diet) through the lifespan is an efficient way (Colcombe et al. The rising insulin level that occurs with aging is also a strong predicator of cognitive impairments, in non-diabetics. The Italian Longitudinal study on aging shows that patients with mild cognitive impairment who were also afflict by metabolic syndrome had a higher risk of progression to dementia compared with those without metabolic syndrome. Hypertriglyceridemia was the major component of metabolic syndrome related to dementia (Solfrizzi et al. Longitudinal studies have reported that obesity and chronic hypertension are also associated with higher risk of cognitive decline (reviewed in Frisardi et al. Then, improvement in those metabolic parameters could modify the individual risk for dementia. Preventive activities during the lifespan are primordial but changing individual behaviour is a long term challenge for the public health. The use of metabolic regulator as a secondary prevention may become essential in individuals at middle age who presents a poor metabolic condition (high blood glucose, deteriorated lipids profile, hypertension, etc. It is well known that if you want to avoid a pulmonary cancer you should not smoke cigarettes, but the population feels armed less in front of neurodegenerative disorders and should not: progression to dementia can be prevented or modified (Haan et Wallace 2004). This receptor is activated by fatty acids and their derivates and among the synthetic ligands; by compounds of the fibrate family. Primordial and secondary preventions, by regulating metabolic condition, may maintain cognitive capacity above the clinical threshold of cognitive decline. Tertiary prevention can modestly help to delays progression of dementia once it is installed. Progression of cognitive capacity in Alzheimer’s disease ( ) and in cognitively healthy elderly ( ). In another observational study Rodriguez et al, showed that in a population of 845 individuals, 20. Next sections will focused on how fibrates intake can be protective for the aging brain. Insulin resistance occur when the cells (insulin receptors) are progressively unable to have a proper insulin response resulting in an inadequate entry of glucose in the cells. If the higher amount of insulin is still inefficient to control blood glucose, the person with high insulin and high glucose level will present a situation of prediabetes and insulin resistance. If not treated well, diabetic patient will present high circulating glucose level that can causes deleterious effects including cardiovascular disease, kidney disease, nerve damage, retinopathy, etc. This condition will also lead to deficits in cellular energy production, increased oxidative stress and reduced neuronal survival. Given that brain cells are dependent on a high glucose supply, brain and peripheral insulin may then play an essential role in brain glucose homeostasis.

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It is obtained from cultures of Streptomyces anmay not be covered by a particular year’s vaccine buy nexium 40 mg with visa gastritis kas tai per liga. Amantadine (Symmetrel) is a synthetic tricyclic amine discount nexium 20 mg gastritis diet ��, Vidarabine triphosphate competes with deoxyadenoand rimantadine (Flumadine) is its -methyl derivative buy 20 mg nexium with mastercard gastritis shortness of breath. Vidarabine also inhibits riviral M2 protein nexium 40mg lowest price gastritis diet 9 month, an integral membrane protein that acts bonucleoside reductase and other enzymes. In certain Absorption, Metabolism, and Excretion strains, the pH changes that result from M2 inhibition alter the conformation of hemagglutinin, hence inhibit Vidarabine is administered only as a topical ophthalmic viral assembly. It has relatively limited solubility and is not Viral resistance develops rapidly in approximately signiﬁcantly absorbed after application to the eye. Resistant viruses are associated with the failure of pal metabolite, arabinosyl hypoxanthine, which retains drug prophylaxis in close contacts of infected individusome degree of antiviral activity. Mutation in the transmembrane domain of the M2 proClinical Uses tein is the most frequent cause of resistance to amantathe principal use of vidarabine is in the treatment of dine and rimantadine. It is also used to treat superﬁcial keratitis in patients unresponsive or hypersensiAbsorption, Metabolism, and Excretion tive to topical idoxuridine. Amantadine is rapidly and completely absorbed from the gastrointestinal tract, and peak blood levels are Adverse Effects, Contraindications, achieved in 2 to 5 hours. The serum half-life of amantaand Drug Interactions dine averages 17 hours in young adults and 29 hours in the most commonly observed side effects associated the elderly. Most of the drug (90%) is eliminated unwith vidarabine are lacrimation, burning, irritation, changed by glomerular ﬁltration and tubular secretion. Vidarabine has oncogenic and Rimantadine is well absorbed following oral adminmutagenic potential; however, the risk of systemic efistration, with peak blood levels achieved in 5 to 7 fects is low because of its limited absorption. Its elimination half-life averages 25 hours in not be used in conjunction with ophthalmic corticoyoung adults and 32 hours in the elderly. Individuals over the age of 65, residents of these agents are administered within 48 hours of the onlong-term care facilities, and patients with long-term set of symptoms, they reduce the duration of fever and health problems. However, when vaccination aminidase, like hemagglutinin, is a viral surface glycois contraindicated or early vaccination is not possible, protein that interacts with host cell receptors containing amantadine and rimantadine are effective prophylactic terminal neuraminic acid residues. The binding of agents that have been shown to protect approximately hemagglutinin to its cellular receptors initiates viral 70 to 90% of patients from inﬂuenza A infection. Since penetration and promotes the fusion of the viral envethese drugs do not prevent the host immune response to lope to the plasma membrane. Neuraminidase then deinﬂuenza A, they may be used to prevent infection during stroys these hemagglutinin receptors by breaking the the 2to 4-week period required to develop immunity bond between the terminal neuraminic acid residue and following vaccination. The cleavage of hemaggluunrelated to its antiviral activity, is in the therapy of tinin receptors is required for the release of progeny Parkinson’s disease (see Chapter 31). It also facilitates the spread of infection by allowing viral particles to penetrate the Adverse Effects, Contraindications, neuraminic acid–rich respiratory mucus and by preand Drug Interactions venting the clumping of virus that results from the binding of hemagglutinins to neuraminic acid residues on the most frequently reported side effects of amantaneighboring viral particles. Inhibition of neuraminidase dine and rimantadine are nausea, anorexia, dizziness, activity prevents the release of progeny virus and inhibits and insomnia. The active site of neuraminidase is highly more common with amantadine than rimantadine. High doses of Inﬂuenza virus resistant to oseltamivir has not been amantadine may produce cardiac arrhythmias, delirium, found in naturally acquired isolates but has been isohallucinations, and suicidal ideation; long-term treatlated from inﬂuenza patients who have undergone ment may cause peripheral edema, orthostatic hypotentreatment with this drug. Abrupt withmutations in the active site of neuraminidase and are drawal of amantadine may produce a neuroleptic generally less virulent and infective than nonresistant malignant syndrome. In vitro passage of inﬂuenza virus in the presence or worsen preexisting seizure disorders. Animal studies of oseltamivir carboxylate can produce mutations in have shown that amantadine is teratogenic and rimanhemagglutinin that decrease the overall dependence of tadine may be embryotoxic. Individuals with congestive heart failure, edema, orthostatic hypotension, seizure disorders, or uncontrolled psychosis should be closely monitored Absorption, Metabolism, and Excretion during therapy with amantadine. The dosage of rimanOrally administered oseltamivir phosphate is rapidly abtadine must be decreased in cases of renal or hepatic sorbed and converted by hepatic esterases to oseltamivir impairment, whereas amantadine requires dosage adcarboxylate. Approximately 80% of an oral dose reaches justment only when renal impairment is present. The the systemic circulation as oseltamivir carboxylate, with elderly are more susceptible to the central nervous syspeak plasma concentrations achieved within 2. The plasma elimination half-life of oseltamivir rimantadine is generally better tolerated in this populacarboxylate is 7 to 9 hours. Individuals over age 65 require half the dose of eidrug and its active metabolite occurs primarily by active ther drug given to younger adults. Several drug interactions involving amantadine and rimantadine are clinically signiﬁcant. Thiazide–triamterene, trimethoprim–sulfamethoxazole, Oseltamivir is approved for the treatment of uncompliquinine, and quinidine increase plasma amantadine levels. Cimetidine decreases rimantadine clearance, and aspirin It decreases the duration of illness by 1 to 1. Oseltamivir is also indicated for the prophythat delivers the drug as an aerosol in a lactose carrier. It rethe lactose particles are large, and about 78% deposit in duces infection rates to approximately 10 to 25% of that the oropharynx. Following oral inhalation, zanamivir has found in untreated populations; however, it is not ina bioavailability of 12 to 17%, with peak plasma concentended to substitute for the early vaccination recomtrations being reached within 1. Oseltamivir can be used as postinated by the kidneys without signiﬁcant metabolism and exposure prophylaxis in household contacts of infected has a plasma elimination half-life of 2. Clinical Uses Zanamivir is indicated for treatment of uncomplicated Adverse Effects, Contraindications, acute inﬂuenza A and B virus in patients aged 7 and and Drug Interactions older. Treatment should be initiated no later than 2 days the most frequently reported adverse effects of osafter the onset of symptoms.

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