By I. Rathgar. Virginia University of Lynchburg.

    Total nasal symptom score at 2 weeks: meta-analysis of 4 trials–combination intranasal corticosteroid plus nasal antihistamine versus nasal antihistamine atarax 10 mg free shipping. Total ocular symptom score at 2 weeks: meta-analysis of 4 trials–combination intranasal corticosteroid plus nasal antihistamine versus nasal antihistamine buy atarax 25mg with mastercard. Although pollen seasons vary across the United States cheap atarax 25 mg amex, generally, tree pollens emerge in the spring, grass pollens in the summer, and weed pollens in the fall. The four defining symptoms of allergic rhinitis are nasal congestion, nasal discharge (rhinorrhea), sneezing, and/or nasal itch. Many patients also experience eye symptoms, such as itching, 3 tearing, and redness. Additional signs of rhinitis include the “allergic salute” (rubbing the hand against the nose in response to itching and rhinorrhea), “allergic shiner” (bruised appearance of the skin under one or both eyes), and “allergic crease” (a wrinkle across the bridge of the nose 4-7 8-10 11,12 caused by repeated allergic salute). Antihistamines used to treat allergic rhinitis bind peripheral H1 histamine receptors selectively or nonselectively. Nonselective binding to other receptor types can cause dry mouth, dry eyes, urinary retention, constipation, and tachycardia. In contrast, selective antihistamines may 18 have reduced incidence of adverse effects. Both selective and nonselective 4 antihistamines interact with drugs that inhibit cytochrome P450 isoenzymes, which may impact patient selection. Intranasal corticosteroids are 5,19 recommended as first-line treatment for moderate/severe or persistent allergic rhinitis. However, their efficacy for the symptom of nasal congestion compared with nasal 20,21 antihistamine is uncertain, particularly in patients with mild allergic rhinitis. For patients with unresponsive symptoms, it is unclear whether adding oral or nasal antihistamine provides any additional benefit. Little is known about cumulative corticosteroid effects in patients who take concomitant oral or inhaled formulations for other diseases. Adverse local effects may include increased intraocular pressure and nasal stinging, burning, bleeding, and dryness. Decongestants stimulate the sympathetic nervous system to produce vasoconstriction, which results in decreased nasal swelling and decreased congestion. After several days of nasal decongestant use, rebound congestion (rhinitis medicamentosa) may occur. Other local adverse effects may include nosebleeds, stinging, burning, and dryness. Systemic adverse effects of decongestants may include hypertension, tachycardia, insomnia, 4,22 headaches, and irritability. Decongestants are used with caution, if at all, in patients with diabetes mellitus, ischemic heart disease, unstable hypertension, prostatic hypertrophy, hyperthyroidism, and narrow-angle glaucoma. Oral decongestants are contraindicated with coadministered monoamine oxidase inhibitors and in patients with 23 uncontrolled hypertension or severe coronary artery disease. Cautious use is advised for patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder neck obstruction, particularly if another anticholinergic is coadministered. Nasal mast cell stabilizers are commonly administered prophylactically, before an allergic reaction is triggered, although as-needed use has been described and may be of benefit. For prophylaxis, it requires a loading period during which it is applied four times daily for several weeks. Local adverse effects may 4,23 include nasal irritation, sneezing, and an unpleasant taste.

    Controlled clinical study of the efficacy of loratadine in Nigerian patients with allergic rhinitis cheap atarax 25mg otc. Comparison of nasal cytology and symptom scores in patients with seasonal allergic rhinitis cheap atarax 25 mg on-line, before and after treatment cheap atarax 25mg overnight delivery. Efficacy comparison of levocetirizine vs montelukast in ragweed sensitized patients. Onset of action of azelastine nasal spray compared with mometasone nasal spray and placebo in subjects with seasonal allergic rhinitis evaluated in an environmental exposure chamber. Onset and duration of action of nasal sprays in seasonal allergic rhinitis patients: olopatadine hydrochloride versus mometasone furoate monohydrate. Effects of some drugs applied topically to the nasal mucosa before nasal provocation tests with allergen. Analysis of behavior- related adverse experiences in clinical trials of montelukast. Efficacy of nasal corticosteroids alone or combined with antihistamines or montelukast in treatment of allergic rhinitis. Efficacy and safety of fixed-dose loratadine/montelukast in seasonal allergic rhinitis: effects on nasal congestion. Observational study comparing intranasal mometasone furoate with oral antihistamines for rhinitis and asthma. Efficacy of diphenhydramine vs desloratadine and placebo in patients with moderate-to-severe seasonal allergic rhinitis. Effect of nasal topical corticosteroid and allergen avoidance in children with allergic rhinitis and bronchial asthma. The role of antileukotriene therapy in seasonal allergic rhinitis: a systematic review of randomized trials. Effects on symptoms and quality of life of hypertonic saline nasal spray added to antihistamine in persistent allergic rhinitis--a randomized controlled study. Fluticasone nasal spray and the combination of loratadine and montelukast in seasonal allergic rhinitis. Effect of oral pseudoephedrine on blood pressure and heart rate: a meta- analysis. The treatment of allergic rhinitis improves the recovery from asthma and upper respiratory infections. Efficacy of buffered hypertonic saline nasal irrigation in children with symptomatic allergic rhinitis: A randomized double-blind study. Evaluation of mometasone furoate Nasonex™ nasal spray with the addition of loratadine vs. Health-related quality of life outcomes of desloratadine in patients with moderate- to-severe sar. Triamcinolone Acetonide nasal inhaler vs Loratadine tablets in patients with seasonal ragweed allergic rhinitis. Quality of life in patients with seasonal allergic rhinitis: triamcinolone acetonide aqueous nasal spray versus loratadine. Association between leukotriene- modifying agents and suicide: what is the evidence?. Effect of beclomethasone dipropionate aerosol nasal spray on bone turnover indices in children with seasonal allergic rhinitis. Levocetirizine for the treatment of allergic rhinitis and chronic idiopathic urticaria in adults and children. Sedation in allergic rhinitis is caused by the condition and not by antihistamine treatment.

    It depends only with learner’s will power Age & learning ­ The capacity of learning improves up to 23 years & declines after 40 years Nature of learning:­ Meaningful learning easier than learning with out knowing the meaning of the learning method 74 1) Definite goal: ­ With a clear goal in mind the student works towards a definite purpose generic 10 mg atarax with visa. Regular and frequent review of the amount of progress being made towards the goal promotes effective leaning 3) Distribution of practice board: ­ Shorter practice period are more effective than longer periods this will reduces the mental fatigue 4) Whole versus part method: ­ Whole method should be adopted with easy unit and difficult material can be learned in small units 5) Logical learning: ­ Logical learning calls for an arrangement and also assimilation with ideas in minds buy atarax 25 mg with amex. Students should try to grasp the meaning of text 6) Rest:­ Take rest in between studies prevents mental fatigue 7) Levels of anxiety: ­ Avoids undue worry purchase atarax 25 mg on-line, anxiety & nervousness to promote better learning. Otherwise it will have an inhibiting and interfering effect 8) Over learning/repetitions at regular intervals helps to retain the material over a longer period of time Theories of learning 1) Trail and error 2) Theory of conditioned reflexes A) Classical conditioning B) Operant conditioning 3) Cognitive learning A) Insight learning B) Sign learning Trial and error: ­ Edward Lee Thorndike American Psychologist considered as the father of educa­ tional, psychology conducted series of experiments on trial and error method of learning by animals and found out that all learning is trial & error and he has developed certain laws of learning. They are · Law of effect:­ The response followed by a reward will be strengthened · Law of Exercise:­ There is a direct relationship between repetition and the strength of the stimulus response. Any task that is repeated shows a tendency for the strengthening of the bond Eg: Reading, writing, typing, singing, dancing, drawing learned by constant practice · Law of readiness: Learning takes place best when a person is ready to learn Theory of conditioned reflexes Classical conditioning:­ Ivan Pavlov a Russian physiologist, a researcher experimented on a dog. Later Pavlov observed that the dog salivated at the mere sound of the bell without giving meat powder. Principles of classical conditioning used in the following areas for learning 75 1) Developing good habits 2) Breaking of bad habits and elimination of fear 3) Training of animals 4) Use in psychotherapy 5) Useful in developing favorable attitude Operant conditioning:­ Skinner experimented on a rat which was placed inside a glass box containing a lever and food tray. Pressing the lever was the response to be learned (the operant response) and the food was the stimulus consequences (reinforcement). Thus the rate of presses increased with rewarding of the rat with food Cognitive learning Learning by insight: ­Gestalt psychologist concluded that the individual learns by his ability known as insight & not by trial & error method. Mean while one end of one stick got incidentally fastened in to the ring fixed on the end of the other stick, with the result that both the sticks were joined together. It takes place by cognition which includes concepts like knowledge, thinking, planning, inference and purpose. Learning consists in the recognition of signs and their meanings in relation to goals in sign learning, a comparison was made between two group of hungry rats in a maze. In one group, each subject received food each time it ran the maze and steady improvement was noticed. In the other, each subject was given access to the maze without finding a food reward and little improvement occurred in time or error scores. However, when food was introduced at the tenth trial, performance soon approximated that of the group which had been rewarded continually. Such sudden improvement suggests that the animals had acquired information about the maze which they did not utilize until, after the tenth day it became advantageous for them to do so. The rats had developed a cognitive map of the maze 76 Bandura’s social cognitive theory: ­Just as Tolman believed that rats gather information and form cognitive maps about their environments through exploring, Bandura believes that humans gather infor­ mation about their environments and behavior of other through observations Social cognitive learning results from watching, imitating and modeling and does not require the observer to perform any observable behavior or receive any observable reward Bandura believes that four process – attention, memory, imitation and motivation – operate during social cognitive learning Theories of transfer of learning: As per Thorndike, the transfer of learning from one situation to another is possible because of identical common elements. For example, in learning cycling and driving a care, the transfer takes place because of the common elements like stearing movements, knowledge of the rules of the road and looking ahead. Ex · Attention to loud sounds · Bright lights · Strong penetrating odours Factors increasing attention by external factors: ­ 1) Nature of the stimulus: ­ More attractive stimulus catches maximum attention (Picture) 2) Locationof the stimulus: ­ Stimulus in front of the eye attracts our attraction 3) Intensity : ­ Loud sound, bright colors 4) Change in the intensity of the stimulus: ­ Ticking of a clock in our room may not attract our attention but when it stops our attention is attracted 5) Movement: ­ A fast moving electric sign attracts our attention 6) Size: ­ Bigger size attracts more attention 7) Contracts:­ A single man among the many woman, a spot on a clean white dress attracts our attention 8) Novelty:­ A new fashion dress attracts our attention 9) Repetition: ­ Repeated cry, repeated ringing of a call bell attracts our attention 77 Factors increasing attention by internal factors: ­ 1) Interest: ­ When we are motivated to a goal 2) Motives: ­ When a child is hungry he looks for a feeding bottle rather than a toy 3) Experience: ­ We attend to object with which we are familiar 4) Mental set: ­ While excepting a friend, we perceive any knocking sound as that of friend’s footstep 5) Emotional stage: ­ Under stressful conditions we fail to perceive our surroundings fully Voluntary or habitual: ­ There is no conscious effort of sensation. Ex: The attention that a teacher gives to her students Span of attention: ­ The maximum amount of material that can be attend to in one period of attention is called span of attention Distraction of attention: ­ Refers to shifting of attention from one stimulus to another. External distraction: Noise pollution Internal distraction: Pain headache Division of attention:­ Refers to the process of dividing our attention equally and simultaneously between two or more objects. Ex: While students reading a book may hear his favorite song Perception : Perception is the process by which we discriminate among stimuli and interpret their meanings and appreciate their significance. Ex When we hear a sound, we are able to identify it as being produced by an aero plane Perceptions are divided in to 1) Visual perception 2) Auditory perception Factors influencing perception: ­ · Functioning of the sense organs · Functioning of the brain · Previous experience · Frequency of exposure · Psychological state of the individual · Interest · Motivation · Behavior of the organism Theories of laws of perceptual organization: ­ 1) Figure – ground relationship: ­ The most fundamental process in form perception is the recognition of a figures standing out from a background. This is because the polar bear is white in color 78 In the above figure you see the light portion as a figure, you will see a water glass or candle holder, if you see the dark portion as a figure, you will see two faces. Either one is a figure against background Grouping of stimuli in perceptual organization: ­ Stimuli are grouped into the smallest possible pattern that has meaning. Important principles of grouping are proximity, similarity, symmetry, closure and continuation Proximity: ­ When objects are close to each other, the tendency is to perceive than together rather than separately.

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