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Ramona R. Johnson, 41, of the 1600 block of Allegheny Lane, faces 26 charges of obtaining drugs by fraud.

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Managing acute renal colic in primary care

A diagnosis of acute renal colic usually leaves GPs with little option but to admit immediately. Here urology GPSI Dr Jonathan Rees explains how patients can be managed at home with good analgesia.

Renal colic is a common – often recurrent – condition, with an estimated annual incidence of one or two cases per 1,000, and a lifetime risk of 10-20% for men and 3-5% for women. The diagnosis has often left GPs with little choice but to admit acutely for analgesia and to confirm the diagnosis and plan management. But it is often possible for patients to be managed at home, as long as appropriate analgesia is provided and urgent investigation and outpatient follow-up can be arranged.

Making the diagnosis

Typical history is of pain originating in the loin or flank, radiating to the labia majora in women or to the groin or testicle in men .

Pain is usually a strong ache with episodic severe exacerbations of a colicky nature, with the patient unable to find a comfortable position – unlike in peritonitis, where patients typically lie still and resist moving. Men often say it is the worst pain they have ever experienced. Women liken it to labour pain in terms of severity.

A past history of renal colic would increase the likelihood of the same diagnosis on this occasion.

Consider other causes of the pain, particularly appendicitis (if right-sided), diverticulitis (if left-sided), pyelonephritis or salpingitis in females. Beware left-sided ruptured aortic aneurysm, as this can sometimes mimic left-sided ureteric colic. This carries a lower threshold for admission and investigation in high-risk groups, such as men over 60 with left-sided pain.

In males with pain referred into the external genitalia, the testes must be examined to exclude torsion, especially in high-risk age groups.

Examination and investigations

Examine the patient to exclude other causes and in particular to exclude urinary sepsis. All patients with renal colic and fever should be admitted as they may have infection proximal to the stone that can rapidly cause irreversible kidney damage. An obstructed, infected kidney is a very serious emergency.

Signs that should raise concern include marked tenderness in the loin. Renal colic does not usually present with tenderness unless there is associated obstruction or infection. Be concerned also about a high temperature or a patient who looks unwell.

Urine dipstick testing should be performed where possible on all patients with suspected renal colic. Haematuria will be found in about 80% of renal colic patients. Remember, though, that a negative result does not exclude the diagnosis. The prevalence of dipstick haematuria decreases with time, dropping to 65% on third or fourth day.

Dipstick testing is more sensitive than microscopy as red blood cells lyse and disappear if urine is not examined within a few hours. So the old advice of checking all cases of dipstick haematuria with urine microscopy is incorrect, as a positive dipstick is the most reliable test.

Immediate management

With such severe pain it is crucial to see the patient urgently. A target of assessment – by home visit or in surgery – in 30 minutes is recommended for those in severe pain. If urgent assessment is not possible, patients may be advised to call an ambulance.

Recommended first-line analgesia is intramuscular diclofenac 75mg or rectal diclofenac 100mg, unless NSAIDs are contraindicated – in which case an intra-muscular opiate plus anti-emetic should be used. Oral tramadol ( click here to buy Tramadol ) is an alternative.

Many urologists believe rectal diclofenac is the most effective and there is evidence that patients receiving NSAIDs achieve greater reductions in pain scores and are less likely to require further analgesia in the short term than those receiving opioids.

Remember to provide a supply of oral or rectal analgesia for ongoing pain relief.

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Some studies have shown local warming of the abdomen and lower back can provide significant analgesia and anxiolysis.

Acupuncture is used effectively in China and Taiwan and has a rapid analgesic effect in studies – more rapid than conventional analgesia – so this may be an option for patients who are not admitted to hospital.

Alternative drugs could be considered for those whose pain is not fully controlled. Isosorbide dinitrate has been shown to augment the effect of NSAIDs, and glyceryl trinitrate patches have also been used with some effect on pain. Calcium channel blockers or a-blockers, when used regularly, may decrease analgesic requirements and promote spontaneous stone passage.

Continuing management

Following immediate pain relief, the GP should reassess the patient – by telephone if necessary – after about an hour to check the response to analgesia.

Inadequate response requires either further analgesia or admission to hospital.

Advise patients to maintain a normal fluid intake. Excess intake can increase the degree of hydronephrosis, making ureteric peristalsis less efficient and decreasing the chance of spontaneous stone passage.

If possible, patients should void into a container or through a tea strainer to try to catch any identifiable calculus, as this will help in future management.

If you are not acutely admitting the patient, consider arranging an MSU (to look for leucocytes, crystals and to exclude infection), serum urea, electrolytes and creatinine to assess renal function and calcium, phosphate and urate as part of a metabolic screen to assess the cause.

Investigation and referral
All those with suspected renal colic require an urgent CT scan (CT KUB) or intravenous urogram within a week. This may require a discussion with radiology to ensure priority.

Urgent referral for outpatient assessment is required – ideally within 14 days – if a calculus is identified.

Management will depend on the size of the stone – 90% of ureteric stones of less than 4mm will pass spontaneously over one to three weeks, and conservative management is preferred where possible.

This rate of stone passage is reduced to about 50% with stones measuring 4-6mm, whereas stones larger than 6mm are likely to need surgical intervention, as fewer than 10% will pass spontaneously. Open surgery is uncommon as most stones will respond to extracorporeal shockwave lithotripsy or extraction with the ureteroscope.

Dr Jonathan Rees is a GPSI in urology at the Backwell and Nailsea Medical Group

Competing interests: None declared
Article source: http://www.pulsetoday.co.uk/story.asp?sectioncode=18&storycode=4118723&c=1

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Tramadol (INN) (pronounced /ˈtræmədɒl/) is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain. It is a synthetic agent, as a 4-phenyl-piperidine analogue of codeine,[1][2] and appears to have actions on the GABAergic, noradrenergic and serotonergic systems. Tramadol was developed by the German pharmaceutical company Grünenthal GmbH in the last years of 1970s and marketed under the trade name Tramal. Grünenthal has also cross licensed the drug to many other pharmaceutical companies that market it under various names.

Tramadol is usually marketed as the hydrochloride salt (tramadol hydrochloride) and is available in both injectable (intravenous and/or intramuscular) and oral preparations. It is also available in conjunction with paracetamol (acetaminophen).

Doses range from 50–400 mg daily, with up to 600 mg daily when given IV/IM. The formulation containing APAP contains 37.5 mg of tramadol (click here to buy tramadol) and 325 mg of paracetamol, intended for oral administration with a common dosing recommendation of one or two tabs every four to six hours.

Unlike most other opioids, Tramadol (click here to buy tramadol) is not considered a controlled substance in many countries (the U.S. and Australia, among others), and is available with a normal prescription. Tramadol is also available over-the-counter without prescription in a few countries.[3] Tramadol is sometimes mistakenly classified as a non-opioid analgesic, because its abuse liability is lower than that of other opioids and because it has multiple mechanisms of action (including, but not limited to mu-opioid activity).
Contents

* 1 Uses
o 1.1 Off-label and investigational uses
o 1.2 Veterinary
* 2 Mechanism of action
* 3 Metabolism
* 4 Adverse effects
* 5 Dependency
* 6 Recreational use
* 7 Animal treatment
* 8 Proprietary preparations
* 9 References
* 10 External links

Uses

Tramadol (click here to buy tramadol) is used to treat moderate and severe pain and most types of neuralgia, including trigeminal neuralgia. It has been suggested that Tramadol could be effective for alleviating symptoms of depression and anxiety because of its action on GABAergic, noradrenergic and specifically serotonergic systems, the involvement of which appear to play a part in its ability to alleviate the perception of pain. However, health professionals have not yet endorsed its use on a large scale for disorders such as this.[4][5]

Off-label and investigational uses

* diabetic neuropathy[6][7]
* postherpetic neuralgia[8][9]
* fibromyalgia[10]
* restless legs syndrome[11]
* opiate withdrawal management[12][13]
* migraine headache[14]
* obsessive-compulsive disorder[15]
* premature ejaculation[16]

Veterinary

Tramadol (click here to buy tramadol) is used to treat post-operative and/or chronic (e.g. cancer-related) pain in dogs and cats.[1]

Mechanism of action

The mode of action of Tramadol has yet to be fully understood, but it is believed to work through modulation of the GABAergic, noradrenergic and serotonergic systems, in addition to its mild agonism of the μ-opioid receptor. The contribution of non-opioid activity is demonstrated by the analgesic effects of Tramadol not being fully antagonised by the μ-opioid receptor antagonist naloxone.

Tramadol (click here to buy tramadol) is marketed as a racemic mixture with a weak affinity for the μ-opioid receptor (approximately 1/6th that of morphine). The (+)-enantiomer is approximately four times more potent than the (-)-enantiomer in terms of μ-opioid receptor affinity and 5-HT reuptake, whereas the (-)-enantiomer is responsible for noradrenaline reuptake effects (Shipton, 2000). These actions appear to produce a synergistic analgesic effect, with (+)-Tramadol exhibiting 10-fold higher analgesic activity than (-)-Tramadol (Goeringer et al., 1997).

The serotonergic modulating properties of Tramadol (click here to buy tramadol) mean that it has the potential to interact with other serotonergic agents. There is an increased risk of serotonin syndrome when Tramadol is taken in combination with serotonin reuptake inhibitors (e.g. SSRIs) or with use of a light box, since these agents not only potentiate the effect of 5-HT but also inhibit Tramadol metabolism. Tramadol is also thought to have some NMDA-type antagonist effects which has given it a potential application in neuropathic pain states.

Metabolism

Tramadol (click here to buy tramadol) undergoes hepatic metabolism via the cytochrome P450 isozyme CYP2D6, being O- and N-demethylated to five different metabolites. Of these, M1 (O-DesmethylTramadol ) is the most significant since it has 200 times the μ-affinity of (+)-Tramadol , and furthermore has an elimination half-life of nine hours, compared with six hours for Tramadol itself. In the 6% of the population who have slow CYP2D6 activity, there is therefore a slightly reduced analgesic effect. Phase II hepatic metabolism renders the metabolites water-soluble and they are excreted by the kidneys. Thus reduced doses may be used in renal and hepatic impairment.

Adverse effects

The most commonly reported adverse drug reactions are nausea, vomiting, sweating and constipation. Drowsiness is reported, although it is less of an issue than for other opioids. Respiratory depression, a common side effect of most opioids, is not clinically significant in normal doses. By itself, it can decrease the seizure threshold. When combined with SSRIs, tricyclic antidepressants, or in patients with epilepsy, the seizure threshold is further decreased. Seizures have been reported in humans receiving excessive single oral doses (700 mg) or large intravenous doses (300 mg). An Australian study found that of 97 confirmed new-onset seizures, eight were associated with Tramadol (click here to buy tramadol), and that in the authors' First Seizure Clinic, "Tramadol is the most frequently suspected cause of provoked seizures" (Labate 2005). Dosages of coumadin/warfarin may need to be reduced for anticoagulated patients to avoid bleeding complications. Constipation can be severe especially in the elderly requiring manual evacuation of the bowel.

Dependency

Some controversy exists regarding the dependence liability of Tramadol (click here to buy tramadol). Grünenthal has promoted it as an opioid with a lower risk of opioid dependence than that of traditional opioids, claiming little evidence of such dependence in clinical trials. They offer the theory that since the M1 metabolite is the principal agonist at μ-opioid receptors, the delayed agonist activity reduces dependence liability. The noradrenaline reuptake effects may also play a role in reducing dependence.

Studies into the dependence liability of Tramadol show that patients are no more likely to abuse the drug than normal NSAIDs. Despite these claims, it is apparent in community practice that dependence to this agent may occur, but in higher does and long-term usage.[17] However, this dependence liability is considered relatively low by health authorities, such that Tramadol (click here to buy tramadol) is classified as a Schedule 4 Prescription Only Medicine in Australia, rather than as a Schedule 8 Controlled Drug like other opioids (Rossi, 2004). Similarly, Tramadolis not currently scheduled by the U.S. DEA, unlike other opioid analgesics. Nevertheless, the prescribing information for Ultram warns that Tramadol "may induce psychological and physical dependence of the morphine-type". In addition, there are widespread reports by consumers of extremely difficult withdrawal experiences[18] including acute depression and suicidal urges.[19]

A controlled study that compared different medications found "the percent of subjects who scored positive for abuse at least once during the 12-month follow-up were 2.5% for NSAIDs, 2.7% for Tramadol (click here to buy tramadol), and 4.9% for hydrocodone. When more than one hit on the dependency algorithm was used as a measure of persistence, abuse rates were 0.5% for NSAIDs, 0.7% for Tramadol, and 1.2% for hydrocodone. Thus, the results of this study suggest that the prevalence of abuse/dependence over a 12-month period in a CNP population that was primarily female was equivalent for Tramadol and NSAIDs, with both significantly less than the rate for hydrocodone". This means that the abuse liability of Tramadol was almost the same as that of normal NSAIDs, such as ibuprofen.[18]

Recreational use

As an opioid analgesic, Tramadol (click here to buy tramadol) has been proposed as a possible recreational drug. However, due to the possibility of convulsions at high doses, recreational use is very dangerous. It can, however, via agonism of μ opioid receptors, produce effects similar to those of other opioids (e.g., morphine or hydrocodone), although not nearly as intense due to Tramadol's much lower affinity for the receptor. However, the metabolite M1 is produced after demethylation of the drug in the liver. The M1 metabolite has an estimated 200x greater affinity for the mu1, and mu2 opioid receptors. In addition to acting as an opioid, Tramadol is also a very weak but rapidly acting serotonin-norepinephrine reuptake inhibitor.[20] When taken in amounts larger than normal therapeutic doses, Tramado can cause seizures (typically tonic-clonic) and severe nausea, which could deter abuse to some extent. Tramadol has been known to produce severe withdrawal symptoms with abrupt cessation after prolonged use. In addition, Tramadol can help alleviate withdrawal symptoms from more addictive opiates, and is much easier to lower quantity of usage compared to opiates such as hydrocodone and oxycodone.[18]

Animal treatment

Tramadol (click here to buy tramadol) for animals is one of the most reliable and useful active principles available to veterinarians for treating animals in pain. It has a dual mode of action: mu agonism and monoamine reuptake inhibition, which produces mild anti-anxiety results. Tramadol may be utilized for relieving pain in cats and dogs. This is an advantage because the use of some non-steroidal anti-inflammatory substances in these animals may be dangerous.

When animals are administered Tramadol (click here to buy tramadol), adverse reactions can occur. The most common are: constipation, upset stomach, decreased heart rate. In case of overdose, mental alteration, pinpoint pupils and seizures may appear. In such case, veterinarians should evaluate the correct treatment for these events. Some contraindications have been noted in treated animals taking certain other drugs. Tramadol should not be co-administered with Deprenyl or any other psychoactive ingredient such as: serotonin reuptake inhibitors, tricyclic antidepressants, or monoamine oxidase inhibitors. In animals, Tramadol is removed from the body via liver and kidney excretion. Animals suffering from diseases in these systems should be monitored by a veterinarian, as it may be necessary to adjust the dose.

Dosage and administration of Tramadol (click here to buy tramadol) for animals: in dogs a starting dosage of 1-2 mg/kg twice a day will be useful for pain management. Cats are administered 2-4 mg/kg twice a day.

Proprietary preparations

Grünenthal, which still owns the patent to Tramadol (click here to buy tramadol), has cross-licensed the agent to pharmaceutical companies internationally. Thus, Tramadol is marketed under many trade names around the world, including:

* Adolan
* Adolonta
* Anadol
* Boldol (in Bosnia and Herzegovina)
* Calmador (in Argentina)
* Contramal
* Crispin
* Campex (in Pakistan)
* Dolol (in Denmark)
* Dromadol (in UK)
* Exopen (in South Korea)
* Ixprim (in France)
* Lumidol
* Mandolgin (in Denmark)
* Mandolgine
* Mosepan



* Nobligan
* Poltram
* Ralivia (In Canada)
* Sintradon
* Siverol (in the Philippines)
* Tandol (in South Korea)
* Tiparol
* Toplagic
* Tradol
* Tradolan
* Tradolan (in Sweden)
* Tradonal (in the Philippines)
* Tralgit
* Tralodie (in Italy)
* Tramacet (in Costa Rica)



* Tramacip
* Tramadex (in Israel)
* Tramake Insts (in United Kingdom)
* Tramadin
* Tramadol (click here to buy tramadol) STADA (in Sweden)
* Tramadol or
* Tramal (in the Netherlands, Finland, Slovenia, Chile, Romania, Australia, New Zealand and Switzerland)
* Tramalgic (in Hungary)
* Tramahexal
* Tramacet (combined with paracetamol)
* Tramazac (in India)
* Trama-Klosidol



* Tramedo
* Tridol (in South Korea)
* Trodon (in Serbia)
* Ultracet (combined with paracetamol)
* Ultram and Ultram ER (in the US)
* Veldrol (in Mexico)
* Zaldiar (combined with paracetamol, in Russia)
* Zaledor (in Chile)
* Zamadol (in UK)
* Zamudol
* Zydol (in the UK and Australia)
* Zytram
* Zytrim (in Spain)

References

1. ^ Dayer P, Desmeules J, Collart L (1997). "[Pharmacology of Tramadol]". Drugs 53 Suppl 2: 18–24. PMID 9190321.
2. ^ Opioids.com
3. ^ Erowid
4. ^ Opioids.com
5. ^ Opioids.com
6. ^ Harati Y, Gooch C, Swenson M, et al (1998). "Double-blind randomized trial of Tramadol (click here to buy tramadol) for the treatment of the pain of diabetic neuropathy". Neurology 50 (6): 1842–46. PMID 9633738.
7. ^ Harati Y, Gooch C, Swenson M, et al (2000). "Maintenance of the long-term effectiveness of Tramadol in treatment of the pain of diabetic neuropathy". J. Diabetes Complicat. 14 (2): 65–70. PMID 10959067.
8. ^ Göbel H, Stadler T (1997). "[Treatment of post-herpes zoster pain with Tramadol. Results of an open pilot study versus clomipramine with or without levomepromazine]" (in French). Drugs 53 Suppl 2: 34–39. PMID 9190323.
9. ^ Boureau F, Legallicier P, Kabir-Ahmadi M (2003). "Tramadol in post-herpetic neuralgia: a randomized, double-blind, placebo-controlled trial". Pain 104 (1–2): 323–31. PMID 12855342.
10. ^ Bennett RM, Kamin M, Karim R, Rosenthal N (2003). "Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized, placebo-controlled study". Am. J. Med. 114 (7): 537–45. PMID 12753877.
11. ^ Lauerma H, Markkula J (1999). "Treatment of restless legs syndrome with Tramadol : an open study". The Journal of clinical psychiatry 60 (4): 241–44. PMID 10221285.
12. ^ Sobey PW, Parran TV, Grey SF, Adelman CL, Yu J (2003). "The use of Tramadol for acute heroin withdrawal: a comparison to clonidine". J Addict Dis 22 (4): 13–25. PMID 14723475.
13. ^ Threlkeld M, Parran TV, Adelman CA, Grey SF, Yu J (2006). "Tramadol versus buprenorphine for the management of acute heroin withdrawal: a retrospective matched cohort controlled study". Am J Addict 15 (2): 186–91. doi:10.1080/10550490500528712. PMID 16595358.
14. ^ Engindeniz Z, Demircan C, Karli N, et al (Jun 2005). "Intramuscular Tramadol vs. diclofenac sodium for the treatment of acute migraine attacks in emergency department: a prospective, randomised, double-blind study". J Headache Pain 6 (3): 143–48. doi:10.1007/s10194-005-0169-y. PMID 16355295.
15. ^ Goldsmith TB, Shapira NA, Keck PE (1999). "Rapid remission of OCD with Tramadol hydrochloride". The American journal of psychiatry 156 (4): 660–61. PMID 10200754.
16. ^ Salem EA, Wilson SK, Bissada NK, Delk JR, Hellstrom WJ, Cleves MA (2007). "Tramadol HCL has Promise in On-Demand Use to Treat Premature Ejaculation". The Journal of Sexual Medicine (OnlineEarly Articles). PMID 17362279.
17. ^ McDiarmid, Todd; Mackler, Leslie (2005-01-01). "What is the addiction risk associated with Tramadol (click here to buy tramadol)". Journal of Family Practice 54 (1). Retrieved on 2007-09-17.
18. ^ a b c Adams, Edgar; Breiner, Scott; Cicero, Theodore; Geller, Anne; Inciardi, James; Schnoll, Sidney; Senay, Edward; Woody, George (May 2006). "A Comparison of the Abuse Liability of Tramadol, NSAIDs, and Hydrocodone in Patients with Chronic Pain". Journal of Pain and Symptom Management 31 (5): 465–76. Retrieved on 2007-01-13.
19. ^ Tramadol
20. ^ King, Steven A. (2007-06-01). "NSAIDs and Cardiovascular Disease". Psychiatric Times 24 (7). Retrieved on 2007-08-01.

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Nonsteroidal anti-inflammatory drugs such as Advil, Aleve, Motrin, and Naprosyn
Rifampin (Rifadin, Rifamate, Rifater)
Tolbutamide (Orinase)

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Arava geriatric use

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way as they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of Arava in the elderly with use in other age groups. However, elderly people may be more sensitive to the effects of Arava. This may increase the chance of side effects during treatment.

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Arava pediatric use

Although there is no specific information comparing use of Arava in children with use in any other age group, use is not recommended in children up to 18 years of age.

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Arava dosing instructions

ADULTS

The recommended starting dose is one 100-milligram tablet daily for the first 3 days. If you have an increased risk for blood disorders or liver problems, your doctor may choose to eliminate the 100-milligram starting dose to reduce the risk of serious side effects.

After the first 3 days, the doctor will reduce the dose to 20 milligrams a day. If side effects appear, the dose may be further decreased to 10 milligrams a day.

CHILDREN

Arava is not recommended for children less than 18 years old.

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Arava and breastfeeding

Do not take Arava while pregnant or breastfeeding. And although it is not known whether Arava appears in breast milk, there is good reason to suspect that it will cause serious side effects in nursing infants.

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Arava and pregnancy

You MUST NOT take Arava if you are pregnant; it can harm the developing baby. If you are still in your childbearing years, your doctor will want to see negative results from a pregnancy test before starting you on Arava. You'll also need to use reliable contraceptive measures as long as you take the drug.

If you become pregnant while taking Arava, your doctor will stop the drug immediately and prescribe a regimen of cholestyramine (Questran) in 8-gram doses 3 times a day for 11 days. Questran helps to clear Arava from the bloodstream, possibly preventing harm to the unborn child.

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Arava uses

Arava is used in the treatment of rheumatoid arthritis. It reduces the pain, stiffness, inflammation, and swelling associated with this disease, improves physical function, and staves off the joint damage that ultimately results.

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Medicines

Natural Alternative Medicines For Healing

Naturopathic medicine is a natural alternative form of medicine that is also known as naturopathy. It is used as a form of alternative medicine, or in tandem with more traditional and modern forms of medicine. Naturopathic medicine emphasizes and works with the body's ability to heal itself, which practitioners of natural medicines believe is an innate power in all living things. Naturopathic practice may include different modalities such as acupuncture, acupressure, cleansing the colon regularly, hypnosis, herbal teas, and a variety of other natural remedies.

Practitioners emphasize a more natural or holistic approach to a patient's care, and a good holistic doctor may also recommend that his or her patient's use modern forms of medical treatment along with the natural treatments. Practitioners of Naturopathic medicine usually prefer not to use invasive methods, such as surgery, or any of synthetic pills and other such drugs preferring to use natural remedies such as herbs and foods in their whole and non-chemically processed forms. Practitioners from accredited schools of Naturopathy are trained to use many of the diagnostic tests, such as blood tests, before deciding upon a course of treatment.

If the patient does not improve with the naturopathic treatments, they are referred to doctors in the standard field of medical care to help treat the illness or other condition. The origins of Naturopathy arises from a number of medicine practices from around the world, including Ayurveda, which began in India, and Nature Cure which originates in Europe. Naturopathy is practiced in many countries but is subject to different standards and levels of acceptance.

The Greek known as Hippocrates, also called the "Father of Medicine", is considered to be one of the first advocates of naturopathic medicine. In Scotland during the 1880s, a Doctor Allinson started promoting a natural form of medicine along with diet, exercise, plenty of rest, and the avoidance of tobacco and overworking.

In America, the term naturopathy was coined by John Scheel, sometime before the turn of the century, and used by a man called Benedict Lust. Lust was well-schooled in a form of natural medicine called hydrotherapy as well as a few other forms of natural health in by a German priest called Father Kneipp who in turn sent Lust to America to bring them Kneipp's methods of natural healing. In the very early 1900s Lust founded the American School of Naturopathy. Situated in New York, it was the first naturopathic college in the United States. Lust took pains to promote the profession and help make the passage of licensing laws in many states just before 1935 and help to found several more naturopathic colleges.

Unfortunately, interest in naturopathic medicine began to decline, along with many of the other natural health professions, after the 1930s due to the discovery of penicillin and the discovery of synthetic drugs.

After Lust's death the conflicts developed amongst the various schools of natural medicine, and with the rise of new medical technology, these were all contributing factors for the seeming death nell for the future of homeopathic and other forms of natural medicine.

Fortunately, Naturopathic medicine never completely ceased to exist, and has began to see a revival in the late 20th and early 21st centuries. There are now many accredited schools offering 4 year degrees in Natural medicine.

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Medication

Before Regulation There Was Patent Medication

Long before medicines were controlled and regulated by a federal agency, the vast majority of people relied on patent medicines to try and sooth their ills. While many compounds and elixirs were used prior to the 1600's, it was then that royalty began issuing "patents" to the makers of potions they liked as a form of advertising.

The term "patent medicine" became a popular term to use when describing these mysterious potions whether they had real royal support or not. The primary focus of the makers and distributors of these potions was in the "brand name" used. While often priced expensively, the ingredients were seldom costly and were usually commonly available substances.

In America after the revolution, the name stuck and patent medicines were the first product to be heavily advertised. It was not until 1925 that a patent requirement was even developed. While the term "patent" was still used, very few were actually patented as that would have required listing the actual ingredients.

Sometimes these patent medicines actually contained an herbal remedy for some illnesses. The primary active ingredients were usually alcohol and various opiates including cocaine. Due to the nature of these drugs, patent medicines at least made the user feel better whether they were ever cured or not. The often-addictive nature of these patent medicines finally led to their legal banishment in 1936.

Besides addiction, some of the patent medicines were actually toxic. A common patent medicine to take care of "women's problems" was in fact an extract of pennyroyal and tansy, which was used to abort early pregnancy. One of the more high profile deaths contributed to patent medicine was the steel manufacturer Eben Byers. A supporter of a form of irradiated water, the tonic contained the radioactive element radium. In unsuccessfully attempting to heal himself from bone cancer with this "healthy" water he ultimately died from radium poisoning.

Many patent medicines grew in popularity and usage during the American Prohibition movement. Patent medicines were exempt from the ban on alcohol so tonics such as "Peruna", which had an eighteen percent/thirty two proof dose, was a prohibition era favorite as it at least cured sobriety.

It came as something of a shock to the government when, in 1917, they seized and tested Clark Stanley's extremely popular "Snake Oil Liniment" and found that it contained mineral oil, one percent fatty oils, camphor, turpentine and red pepper. Not only was it safe, it was actually a formula that performed as advertised, although not made from crushed snakes. It was very similar to the camphor and capsaicin liniments still found on the market today.

Patent medicines were very good at advertising themselves as a cure for just about any ailment known to man. They were, however, usually ineffective medicinally. A few did prove to be either surprisingly useful or at least not harmful and some of these old brands still carry on in certain over the counter treatments. Just a few of the survivors include Luden's Cough Drops, Vicks VapoRub and Phillips' Milk of Magnesia.

Other herbal "medicines" have found new life as hair shampoos. The old advertising lessons are still in effect, telling of the benefits of fruit and herbal essences on your hair while usually only being an effective perfume. Some old patent medicines have become even more popular in another form. Once Coca-Cola took the cocaine out of their tonic, rather than go out of business, they became one of the biggest soft drink companies on the planet.

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Discount Online Pharmacies

The world of online pharmacy business has been increasingly thriving since the invention of the internet.

Conventional cheap pharmacy locations were only existent in the physical world and therefore further costs would have to be endured to obtain discount drugs. But since the internet has indeed spawned a slew of cheap pharmacy options, customers have a wider range of choices in discount drugs.

What to Expect from an Online Discount Pharmacy
The great thing about the Internet is that many customers can purchase drugs at an online pharmacy with no prescription. This new pharmacy no prescription idea has been a hit among those who wish to keep confidentiality, yet also benefits those who can't necessarily afford a doctor.

These online pharmacy resources are legal, since they are often established in foreign countries- so there are no legal liability concerns. The best benefit of online pharmacy businesses is that they offer many popular types of drugs for discounted rates.

Discount Tramadol, for instance, is completely necessary to patients who need medication for severe pain, but don't have a lot of money to spend. This cheap Tramadol enables even middle class or low class families to get the medication they need.

Other less serious discount drugs such as discount Fioricet or cheap Soma have also been a hit among patients. It seems that through an online pharmacy, more people have access to what they need at a cheaper rate.

The Premise behind the Common Discount Pharmacy
So how does a discount pharmacy work? Most would tell you that the Internet allows for added efficiency in processing orders, so the savings on drugs such as cheap Soma are passed onto the customer. While this is true, discount drugs are also made possible through foreign countries.

Another reason many online pharmacy resources are so cheap is that they sell generic discount drugs- meaning they aren't brand name. While this may not be the same Tramadol you see in commercials, the discount Tramadol you buy online is virtually the same- without the brand name.

Since many discount drugs such as discount Fioricet do indeed come from foreign sources, some doubt the reliability of these discount drugs. But rest assured- good research to find the best discount online pharmacy resources will provide reliable sources.

It's important to note that if you reside in the United States, the FDA won't be able to safeguard online discount pharmacy patients from danger, if there is indeed any.

This, however, is considered to be a small price to pay for discount drugs. With enough research, there is no need to worry whether or not the discount Tramadol you ordered is indeed what it claims to be.

Closing Comments on Discount Online Pharmacies
It's highly recommended to only buy from U.S.A based, FDA approved pharmacies for your protection.

As technology grows ever further, we can only continue to appreciate the cost-cutting measures that come with it. The online pharmacy is perhaps one of the most helpful benefits the internet has wrought. With it, discount drugs are made available to even the most under privileged social classes.

With a guarantee like that, it's hard to discount the importance of such cheap online pharmacies. After all, why pay more for Soma when cheap Soma can be found on the internet for less? In the end, it's all a matter of supply and demand- both in the physical and virtual world.

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A Guide To No Prescription Drugs

In some countries, there is a need to obtain what is called a prescription before medicine can be obtained. These prescription drugs can't always be accessible to some, so there is a need for such people to get alternative treatments. But how does one go about getting a dependable drug without the prescription given by a doctor?

Drugs That Don't Need Prescriptions: Several types of drugs are not regulated this included herbs, minerals, vitamins, and food supplements. Since these items are not regulated, there is no prescription required for them.

It should be noted that since these drugs are not, in fact, regulated they may not live up to their claims. It is commonplace to see an herbal remedy make falsified claims, simply because they can get away with it and make extra sales.

The majority of these drugs do work, however. But there is still a need for more powerful and dependable drugs- such as the kind that would have a prescription attached to them. But how do we obtain a prescription drug without a doctor's approval?

How to Get Prescription Drugs without a Prescription: There are several legit reasons why one would need a prescription drug without the prescription. Cost is a large factor- not every family has the money that is needed to see a doctor and then pay for the medicine too. Others can't make it to the doctor's office because of disabilities. Whatever the case, there are truly logical reason why one would need such drug without a prescription.

The beautiful thing about the Internet is that it has become a large marketplace of goods and services. Literally anyone around the world can obtain items and services from locations throughout every country on Earth.

The best part of the scheme is that not every country has prescription laws- meaning that prescription drugs could be shipped to one's household from another country. In many cases, it is even less expensive than what the medicine would cost otherwise. This is due to the fact that there is no regulation- and because drugs can often be produced cheaper outside country borders.

It's very important that one take care when buying drugs without a prescription online. First, there are many scams or tricks that fake Internet companies play on needy consumers. There is also concern in the fact that prescriptions are usually required for a reason. A doctor may be needed to check for family history or problems that one might encounter from the drug.

In most cases, buying online drugs without a prescription is perfectly safe. With a little research and optimism, reliable sources of prescription drugs can be found. And thanks to the global shipping system that only takes days to get an item around the world (given enough money is paid), emergencies can be tended to whereas they might not have been previously.

Final Thoughts on Obtaining Drugs without a Prescription: As with everything, make sure you engage in a sense of caution. Do your research, and make sure that the drug is completely safe to use. If there is any high risk or doubt, be sure to see a doctor. In every other case, you may enjoy the benefits of cheap drugs- both from saving you doctor visits and bloated medicine fees at the pharmacy.

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How to Get FDA Approved Medications Online

There is a current struggle against the United States Food and Drug Administration, or FDA, and the online pharmacy business that has bloomed in recent years. The FDA has found it increasingly difficult to get online pharmacies to abide by standards and laws that are present in the Unites States. There are, however, safe ways to get FDA approved medication online.

What Online FDA Approved Medication Requires

In order for an online website to legally sell prescription drugs, they must abide by certain rules. First, the website must have a physician on hand who can prescribe the requested medication. In some cases physicians are needed to check a patient's history, ask critical questions, and inform them of side effects. Without this extra input by a real physician, the FDA claims that websites will not be able to sell prescription drugs.

Over 200 websites have been legally permitted to do this, but don't be fooled. There are some websites that claim a simple online survey can replace a physician. Not only this illegal, but this is far from the truth. While a survey may be able to help diagnose a patient, surveys are limited in gathering knowledge about a patient. For this reason, the FDA claims that these survey websites can't legally replace a real physician.

These precautions, the FDA states, save hundreds of lives per year. As an example with Viagra, there are critical side effects that may lead to death if certain conditions are present. Viagra is a prescription drug for a reason- only a doctor will be able to run necessary tests and ask the right questions.

Legalities of Imported Prescriptions

The FDA is also fighting an uphill battle over foreign imports on prescription drugs. In the majority of cases, Internet users resort to foreign sources to get prescription drugs. This has led to a wide array of complications- as the FDA will not be able to screen the imports to ensure safety.

The FDA has declared these imports as illegal. It is officially illegal to buy or import prescription drugs from a foreign source. In some special situations, the FDA allows loopholes; but don't expect to legally import prescription drugs from foreign sources.

Interestingly enough, it is also illegal for the foreign pharmacies to sell such drugs to American patients. Although it's quite hard for the FDA to enforce this law in another country, it is still considered to be wrong. As statistics show, illegal online pharmacies in the United States itself get prosecuted much more often- as well as United States companies that help import the foreign prescription drugs.

Final Thoughts on the FDA and Prescription Drugs

Prescription drugs require doctor approval for special reasons. Bypassing this safety measure means that a certain amount of risk is going to be run when taking the drug. The appeal of online privacy can still be had, although conferencing with an online physician will be required.

The quality of imported drugs has also be sub par leading many patients to be cheated out of their money. Many people claim that foreign imports are cheaper- but if they quality of the drug isn't up to par, then the customer is getting cheated more so than usual. To avoid such turmoil and frustration, and to stay out of the watchful eye of the United States Food and Drug Administration, be sure to stick to physician-based websites.

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Risks Associated with Online Pharmacies

The benefits of online pharmacies are great, which has led many traditional patients to switch over to the Internet for prescriptions. There are cost reductions, confidential transactions, and even overnight FedEx shipping. But what consumers seem to forget is that there are indeed several risks to look out for when using an online pharmacy.

Risk with Foreign Pharmacies

Foreign pharmacies tend to have some of the cheapest drugs around. There are several reasons for this- from economic conditions to different production environments. But this low cost is often associated with generic forms of brand name prescription medication. While this in itself isn't a bad thing if the generic version is legit, many times scams are created that sell fake medication to unknowing patients.

Foreign pharmacies also commonly sell prescribed medications without the proper prescription that some countries demand. The United States, for instance, has a food and drug administration that oversees prescriptions, among other things. It is currently against the law for anyone to purchase such prescription drugs from foreign sources- something that could potentially get an unknowing patient in legal trouble.

Lastly, foreign pharmacies might not always have the same sanitary standards that other countries have. This is due to a difference in laws and regulations that countries have. In some cases, the lack of sanitation or poor production environments can cause more harm than good.

Personal and Financial Information Risks

There are also risks to one's financial and personal information. It is important to only trust both of these types of information with trusted websites. Be sure to read the Privacy Policy of each pharmacy you visit, just to make sure your details are safe.

While the financial information such as credit card numbers is self-explanatory, personal information can be exploited just as easy. Selling a customer's address or email address to advertisers is just one way that companies can make money of their customers. Again, check the privacy policy to ensure online pharmacies will not engage in this practice.

Dangers of Some Medicines

Some types of medicine are rather dangerous if not taken with care. This is the reason why the FDA regulates prescription drugs- since a physician will need to do background checks and ask certain questions.

Online pharmacies can be legit, however, since a pharmacist may email or call a patient to ensure they are good candidates for a particular drug. But since you are not interacting with the physician face to face, be sure to give them all the information you can. Some drugs, such as Viagra, can be particularly harmful to a select group of individuals- this is just one example of why the FDA places such importance on online pharmacies.

Final Thoughts on Risks Associated with Online Pharmacies

If the FDA wasn't completely satisfied with the legal online pharmacies, they wouldn't exist. This means that getting a prescription over the internet isn't bad at all- just make sure that you know the company well enough before purchasing from them.

Checking user testimonials or reviews on websites that are not associated with the company is always a good idea before proceeding with a purchase. Talking to friends or family members about their experiences can also help prevent hardships from arising. But there isn't usually anything to be worried about the FDA tends to keep online pharmacies in line with regulations and procedures.

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How Legit Online Pharmacies Work

Most of us know the benefits that come from legit online pharmacies. But how do these complicated services work? Without the physical presence of a physician, how are prescriptions written? Thanks to advances in technology, the online pharmacy was made possible- but should consumers be worried that they don't stack up to an office visit?

The Ordering Process for Customers

To order prescription drugs online all that is required is internet access, an email address or telephone, and of course a method of payment (usually credit card). When the initial order is placed, a physician will come into contact with the customer one of several ways. The most popular way to conference with a physician is through telephone- although email can also be used.

After the conference with the physician is complete, the decision as to whether or not the customer needs the prescription will arise. The customer will be notified and if the prescription is approved, the customer can proceed to checkout.

One of the neat things about ordering online is the shipping process. Customers can choose how fast they need the prescription. Faster methods, such as overnight FedEx deliver, will cost more money. But the money saved from an office visit usually enables customers to allow for faster shipping through saved money.

The Job of the Physician in the Process

The primary job for the physician in this process is to ensure that the customer is able to take the drug in question without harmful side effects. A physician should also check to make sure that the customer actually needs the drug, so as to fend off drug junkies.

More importantly, the physician needs to do a thorough family history check- and ask as many questions as possible. Don't be fooled by simple surveys- make sure that physician is present and is keenly interested in providing the best service possible.

After an order is approved by the licensed pharmacist, the pharmacist can send the proof of the prescription to the partnered pharmacy. This process is generally fairly quick, as compared to the office visits that tend to take much longer.

Notes on Online Pharmacy Orders

For United States residents, there are no refunds on prescription medicines. To make sure that investments are kept safe, be sure that the drug is coming from a reputable pharmacy that knows what they are doing. There is nothing worse than getting stuck with a few hundred dollars worth of medicine that is faulty.

Also keep in mind that since these services are internet-based, prices can change at any time and without warning. This can be bad for consumers, but in most cases, drastic changes are not seen very often. It can, however, be very misleading to a customer when they see an advertised price- only to see a different one at checkout.

Final Thoughts on Online Pharmacies

In conclusion, online pharmacies are very advanced examples of technology. Most of the service is digitalized- so fees are generally lower, and time and effort are saved. There are many reasons to choose an online pharmacy over a physical office visit, and judging from the technology that goes into each online pharmacy, customers are in good hands.

It can't be stressed enough that a reputable pharmacy be found. Once a good pharmacy is found, customers can enjoy the great benefits of online pharmacies year round- and in the comfort of their own home.

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Ways to Protect Yourself from Misleading Online Pharmacies

Buying from an online pharmacy has a plethora of benefits. These benefits have led many patients to make use of the Internet technology, and get their medication online. But as they are not dealing with the physical world, there is a lot of room for scams and dirty trickery. So how does one go about finding a legit pharmacy, while steering clear of all the vice?

Common Indicators of Possible Risk

Generally, online pharmacies that don't have an in-house physician are sketchy. Be sure that if you live in a country that regulates drug prescriptions (such as the United States) that you make sure the online pharmacy is indeed prescribing the drugs. If they aren't, you could be in deep legal trouble. In some cases, arrests have been made over such trafficking.

Another common risk to look out for is a simple survey questionnaire. These surveys can never replace a physician. When a customer needs a prescription drug, they should be contacted by a real physician over telephone, email, or some other means of communication. If this contact is not initiated, a red flag should be apparent in the customer's mind.

If an online pharmacy does not list their physical address or telephone number, it's time to get really skeptical. If they do, be sure to check out the address to see if it is legit. A simple search through the phone book or Internet search can help verify a legit business. If the address turns out to be nonexistent or questionable, be sure to bring the matter up to the pharmacy and demand an answer. In many cases, it's best to simply find a new source of prescription drugs (be sure to warn family and friends of any online pharmacies you find to be sketchy.)

Psychological Risks

One of the trickier risks that consumers fall for is based on psychology. Some online pharmacies will promise a miracle drug, or a better deal than their competitors. This should automatically cause consumers to be skeptical in such situations.

Other online pharmacies tend to put limited time offers on their website. This makes consumers think that they should buy on impulse which is never a good decision. Since these pharmacies are trying to get a consumer to buy without much thought, there is generally a good reason for it.

Licensing Information for Pharmacists

If an online pharmacy can't provide proper information to show they do have a licensed pharmacist on hand, be sure to report them to the FDA. This will help other consumers make good choices, and help put the shady online pharmacy out of business.

The National Association of Boards Pharmacy, or NABP, is one source to go to when trying to figure out if an online pharmacy is legit or not. Check their website for more information before any purchase is made with an online pharmacy.

Final Thoughts on Online Pharmacy Protection

As always, check your sources before making a purchase. Online content is available to match an online pharmacy up with the proper credentials. If you do indeed spot an online pharmacy that seems to be dealing in a shady character of business, make sure the website gets reported. Also be sure to tell family and friends, as it would be very unfortunate if they were to fall victim to an online pharmacy scam.

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Protect Your Pharmacy Week

April 14 - April 18 has been declared Protect Your Pharmacy Week. Unfortunately crimes designed to obtain controlled drugs from pharmacies are on the rise. And adding to that pressure most community pharmacies are also part of a general or drug store, so they have the usual shoplifters and cash thieves that these generate.

The aim of the week is to raise awareness with staff and customers about these crimes, and to encourage pharmacists to take steps to prevent them. The National Community Pharmacists Association has joined forces with the FBI Law Enforcement Executive Development Association and Purdue Pharma. Their aim is to improve the security and safety of pharmacies. NCPA members are getting a free toolkit to help them with this aim.

So what can you do to protect your pharmacy?

Firstly sign up and become a member of the NCPA you will then get your toolkit, which includes a training DVD, checklists and discounts on a range of security products.

Become a user of the Rx patrol website rxpatrol. This website is part of a union between law enforcement and the pharmacy industry to use pharmacy theft information to help quickly catch the thieves, and give pharmacists vital information to prevent them becoming victims. Pharmacy crime is often organized with the thieves having a shopping list of items that they already have buyers for. Fast sharing of information can shut down a ring of these thieves whilst they still have the stolen merchandise.

One of the best ways to deter thieves is to have security cameras installed. Many robbers are deterred by seeing themselves on TV, they will simply go elsewhere. And if you should get robbed then the CCTV recordings will help law enforcement catch them!

A visible alarm system is also a good deterrent. If possible get one that has a cell phone backup in case the hard line is cut. Some thieves are getting wise and assume that if they cut the phone lines then the alarm will not summon help. Let them keep this false sense of security until the police turn up to arrest them.

Be aware of the time when most robberies occur at the end of the day when the shop is closing up. Think about what you can do to reduce risk at this time perhaps even call your local police to ask for advice.

If the worst happens and you are the victim of a robbery?

Your robber is probably just as nervous as you are! Don't do anything that might alarm or provoke him. Do not try to tackle him yourself, this is how people get hurt, a scared robber is a dangerous robber. Do just what he says, possessions can be replaced, people cannot.

Try to observe your robber so that you can describe him and make an identification, and silently repeat to yourself important information to help law enforcement personnel.

After the robbery, first call 911 to get an ambulance for anyone who is injured and to summon the police. Only then call your supervisor. Ask any customers who were there to please remain so that they can give their statements to the police, and lock your doors to stop the robbers from returning! Finally don't touch anything, and don't discuss the crime until the police arrive then you can gratefully let them handle it! Finally follow your company policy about who needs to be notified.

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How To Choose A Pharmacist

Choosing a qualified pharmacist is every bit as important as deciding which doctor or other health care worker you are going to have look after your health and well being. While many people worry about the competence of their doctor, the qualifications of the person dispensing their prescription drugs is often overlooked.

Historically, herbalists, chemists and apothecaries filled the role of pharmacist. As the volume of medical lore grew pharmacy became a specialized medical tradition of its own. In some ancient cultures like medieval Japan, the pharmacist was accorded a status even higher than the doctors, acupuncturists and other health related professionals.

The pharmacist is also a trained professional who has passed through extensive medical training and learned how drugs work on the body and the potential interactions of different medicines. They must be familiar with at least basic diagnosis of diseases, their therapeutic effects and the art of prescribed medicines and what forms are best for a doctor's patient.

While your pharmacist is traditionally known to be the dispenser of the drugs your doctor prescribes, his function is much greater. They also work with your doctor in disease state management to monitor treatments and their effects. The pharmacist will provide information to clinics and health care workers about medicine reactions and other information necessary to the betterment of the entire medical field.

Pharmacists may be either independent businessmen or they may ply their trade in a clinic or hospital. The pharmacist is often an important source of information and advice on whether a symptom is a precursor to needing a doctor's care or if the problem is a localized effect that can be taken care of through over the counter methods. They will often work as an intermediary between you and a doctor in checking for more information about treatment of diseases.

The professional pharmacist must be trained in a wide range of medical knowledge, as he is often the first person many people talk to about new ailments. The pharmacist plays a great role in assessing the potential for undiagnosed medical conditions and provides recommendations for the direction of treatment a person should take.

Since the pharmacist is often the first point of contact with the medical profession, the pharmacist must be knowledgeable of the symptoms of many medical conditions and diseases. Various polls have demonstrated that a large number of people will trust their pharmacist more than they do their primary health care provider, especially if they are part of a program where they are treated by a group of doctors rather than a family general practitioner.

Pharmacists in the United States must be board certified to dispense medications. Depending on his specialty the Board of Pharmaceutical Specialties qualify pharmacists in five areas including psychiatric, oncology, cardiology, infectious diseases, nutrition and nuclear pharmacy. A geriatrics certification must come through the Commission for Certification in Geriatric Pharmacy. The certification in the specialized field of toxicology for medical doctors, forensic scientists as well as pharmacist must be obtained through the American Board of Applied Toxicology.

While a pharmacist is not board certified to practice medicine in the same way a licensed doctor is, they still are a very important part of the medical field and can be trained well enough to even catch the occasional mistaken prescription an overworked doctor may make.

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How to get an rx online

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Online Rx is an innovation in health care that utilizes the Internet to improve patient access to the physician. Under this system, the patient no longer needs to receive a traditional physical exam by the physician, rather the patient completes an online questionnaire, and this questionnaire is then submitted to the physician using our secure order system. In must be said that an online Rx can never take the place of traditional medicine, they do provide a valid means for patients to receive treatment for a number of conditions that, in many circumstances, do not actually require a physical exam.


When you submit your order, it id dispatched through our order system to a licensed physician who will review the information you have submitted and approve or decline your request.

When your order is approved, the physician will then write your prescription and our ordering system will ensure that it is sent to the pharmacy where it will be filled and shipped.