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Let it sit for a minute or two buy levlen 0.15mg otc, and tap the side to try and separate the clear upper layer cheap 0.15 mg levlen with visa. Then buy levlen 0.15mg free shipping, draw off the top (ether) layer with the eyedropper, and throw away the lower (water) and cloudy layer. Do this carefully, as the mixture will become hot, and give off hydrogen gas and/or steam. It is very important to expose every molecule of the free-base to the ether for as long as possible. This will cause the free base to dissolve into the ether (it -is- soluble in ether). Remove the top (ether) layer with the eyedropper, being careful not to get any of the middle layer in it. Add to the third bottle enough water to fill it half-way and about 5 drops of muriatic acid. The determined experimenter could obtain a pile of red phosphorus by scraping off the striking pads of matchbooks with a sharp knife. A typical composition of the striking pad is about 50% red phosphorus, along with about 30% antimony sulfide, and lesser amounts of glue, iron oxide, MnO2, and glass powder. Naturally, it is a tedious process to get large amounts of red phosphorus by scraping the striking pads off matchbooks, but who cares? When making hydroiodic acid from iodine and red phosphorus, the acid is prepared first, and allowed to come to complete reaction for 20 minutes before adding the ephedrine to it. The way around the roadblock here is to just boil off some more of the water from the ephedrine extract, and make the acid mixture in fresh pure water. Now, Making Methamphetamine: To do the reaction, a 1000 ml round bottom flask is filled with 150 grams of ephedrine. Also added to the flask are 40 grams of red phosphorus and 340 ml of 47% hydroiodic acid. This same acid and red phosphorus mixture can be prepared from adding 150 grams of iodine crystals to 150 grams of red phosphorus in 300 ml of water. With the ingredients mixed together in the flask, a condenser is attached to the flask, and the mixture is boiled for one day. This length of time is needed for best yields and highest octane numbers on the product. While it is cooking, the mixture is quite red and messy looking from the red phosphorus floating around in it. When one day of boiling under reflux is up, the flask is allowed to cool, then it is diluted with an equal volume of water. A series of doubled up coffee filters will work to get out all the red phosphorus, but real filter paper is better. If filtering does not remove the red color, there may be iodine floating around the solution. It can be removed by adding a few dashes of sodium bisulfate or sodium thiosulfate. A strong lye solution is mixed up and added to the batch while shaking until the batch is strongly basic. The strongly basic solution is shaken vigorously to ensure that all the meth has been converted to the free base. You now can sell or use the free base for injection use or with free base meth now obtained, the next step you can do is to form the crystalline hydrochloride salt of meth. To do this, a few hundred mls of toluene is added to the batch, and the meth free base extracted out as usual. If the chemist’s cooking has been careful, the color of the toluene extract will be clear to pale yellow. If the toluene extract is darker colored, a distillation is called for to get pure meth free base. Is popular at raves and parties because many users compare it’s effects of that of ecstasy. Place the content of the gamma butyrolactone bottle in a stainless steel or pyrex glass saucepan. Between step 4 and 6 you might see a white compound on the side of the saucepan (it doesn’t happen everytime). When you are finished, put it in a measuring cup (Pyrex) and fill it with water (when I’m in a hurry to taste it I use ice) to 1000ml (a little more than 4 cups). Once the solution begins boiling, you can turn the heat off - the reaction will make its own heat. This mixture will still have unreacted lactone in it - so now it is time to do some steam distillation. Steam Distillation (The purification step) 10) Put a thermometer in the solution capable of measuring 200C and crank the heat up on the solution. You may want to add a boiling stone made from a clean piece of pea gravel to the solution (don’t use a boiling stick because you will burn it up, and don’t use a chemical boiling stone because they contain metals that are not supposed to go into humans). Let the strips cool - they will begin to curl up if the strips are about ½” to 1” in width. Scrape them up with a metal spatula and put them into a sealed tupperware container. Pour out more strips and repeat the procedure until you have used up all of the melt. You may have to shake the blender around a bit to make sure everything is ground into powder. If any of the reagents or intermediates contacts the skin, wash well with cold water. Denatured ethanol can also be used, but be sure to let it completely evaporate before ingesting it. Methanol can also be used, but this is toxic, and excess must be removed before ingestion. If methanol is used, only 500ml is required, but be sure all the methanol is evaporated before ingesting it (check there is no methanol odor left). Those chemicals are so common that you won’t be asked what you are going to do with it. After allowing it to stand, filter the product through the 2 coffee filters (placed inside each other), collecting the precipitate.

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Pharmacodynamics Fluconazole inhibits fungal cytochrome P-450 generic levlen 0.15 mg otc, an enzyme respon- sible for fungal sterol synthesis best 0.15 mg levlen, causing fungal cell walls to weak- en generic 0.15mg levlen with amex. Itraconazole and voriconazole interfere with fungal cell-wall synthesis by inhibiting the formation of ergosterol and increasing cell-wall permeability, making the fungus susceptible to osmotic instability. Osis, smosis Itraconazole is used to treat blastomycosis, nonmeningeal histo- plasmosis, candidiasis, aspergillosis, and fungal nail disease. Voriconazole is used to treat invasive aspergillosis and serious fungal infections caused by Scedosporium apiospermum and Fusarium species. Drug interactions Fluconazole may have interactions with other drugs: • Using fluconazole with warfarin may increase the risk of bleed- ing. Adverse reactions to synthetic triazoles Adverse reactions to flucona- Adverse reactions to itracon- Adverse reactions to voricon- zole include: azole include: azole include: • abdominal pain • dizziness • vision disturbances • diarrhea • headache • fever • dizziness • hypertension • chills • headache • impaired liver function • headache • elevated liver enzyme levels • nausea. Caspofungin is used to treat invasive Glucan synthesis inhibitors aspergillosis in the patient who hasn’t Caspofungin is a drug in a new class of agents known as glucan responded to, or synthesis inhibitors (also called echinocandins). Its major use is can’t tolerate, other in the patient who hasn’t responded to other antifungal therapies, antifungals. Pharmacodynamics Caspofungin inhibits the synthesis of beta (1,3) D-glucan, an inte- gral component of the fungal cell wall. Adverse reactions to Drug interactions caspofungin • Patients taking caspofungin and tacrolimus may need higher Adverse reactions to doses of tacrolimus because caspofungin decreases the blood caspofungin include: tacrolimus level. Terbinafine, the most commonly used synthetic allylamine deriva- tive, is an allylamine antifungal, which inhibits fungal cell growth by inhibiting an enzyme responsible for the manufacture of ergos- terol. Pharmacokinetics Terbinafine is well absorbed and distributed throughout the body, especially if taken with food. It’s extensively metabolized; more than two-thirds of the drug is excreted in urine. Risk to liver Rare cases of liver failure have occurred with terbinafine use, even in the patient with no known history of liver disease. Avoid using this drug if liver disease is suspected, and obtain baseline liver enzyme test results before use. Pharmacodynamics Terbinafine is thought to inhibit squalene epoxidase, which blocks the biosynthesis of ergosterol, an essential component of fungal cell membranes. Adverse Drug interactions reactions to • Terbinafine clearance is decreased when it’s taken with cimeti- dine and increased when it’s taken with rifampin. Pharmacodynamics Although drotrecogin alfa’s anti-infective action isn’t known, it may work by producing dose-dependent reductions in D-dimer and interleukin-6. Safe and sound Contraindications for drotrecogin alfa Adverse reactions to This drug is contraindicated in patients who are hypersensitive to the drug or any of its compo- nents. It’s also contraindicated in patients with active internal bleeding and those who have had drotrecogin alfa hemorrhagic stroke in the past 3 months or intracranial or intraspinal surgery in the past 2 The most common ad- months. In addition, the drug is contraindicated in patients with severe head trauma, trauma with verse reaction to increased risk of life-threatening bleeding, an epidural catheter, an intracranial neoplasm or mass drotrecogin alfa is lesion, or cerebral herniation. Drotrecogin alfa is used to treat adults who have severe sepsis as- sociated with acute organ dysfunction and who have a high risk of death. Drug interactions Drotrecogin alfa may interact with another drug that affects he- mostasis, such as an anticoagulant, antiplatelet drug, or throm- bolytic, possibly increasing the risk of bleeding. Which rationale best justifies administering different antitu- bercular drugs concurrently in treating active tuberculosis? Combination therapy can prevent or delay bacterial resistance to antitubercular drugs. Today’s lesson includes information Immune and inflammatory responses protect the body from invad- about drug classes ing foreign substances. These responses can be modified by cer- that can modify tain classes of drugs: responses. Histamine-1 receptor antagonists The term antihistamine refers to drugs that act as histamine-1 (H1) receptor antagonists; that is, they compete with histamine for binding to H1-receptor sites throughout the body. It’s all about chemistry Based on chemical structure, antihistamines are categorized into five major classes: • Ethanolamines include clemastine fumarate, dimenhydrinate, and diphenhydramine hydrochloride. Pharmacokinetics (how drugs circulate) H1-receptor antagonists are well absorbed after oral or parenteral administration. Pharmacodynamics (how drugs act) H1-receptor antagonists compete with histamine for H1 receptors on effector cells (the cells that cause allergic symptoms), blocking histamine from producing its effects. These drugs include diphenhydramine, dimenhydrinate, promethazine, and various piperidine derivatives. No stomach for this H1-receptor antagonists don’t affect parietal cell secretion in the stomach because their receptors are H2 receptors, not H1. The first one there wins Release the mediators Chlorpheniramine competes with histamine for H1-receptor When sensitized to an antigen, a mast cell reacts to repeated sites on the effector cells. By attaching to these sites first, the antigen exposure by releasing chemical mediators. Not just for allergies Antihistamines can have other therapeutic uses: Adverse • Many are used primarily as antiemetics (to control nausea and vomiting). The most common ad- • Diphenhydramine can help treat Parkinson’s disease and drug- verse reaction to anti- induced extrapyramidal reactions (abnormal involuntary move- ments). They can get the heart racing Corticosteroids Cardiovascular reac- tions may include: Corticosteroids suppress immune responses and reduce inflam- • hypotension mation. Natural and synthetic corticosteroids are classified ac- Sensitivity reactions can cording to their biological activities: also occur. Glucocorticoids Most glucocorticoids are synthetic analogues of hormones secret- ed by the adrenal cortex. Drugs in this class include: • beclomethasone • betamethasone • cortisone • dexamethasone • hydrocortisone • methylprednisolone • prednisolone • prednisone • triamcinolone. Distribution Glucocorticoids are bound to plasma proteins and distributed through the blood. Unfortunately, Metabolism and excretion when glucocorticoids inhibit the immune Glucocorticoids are metabolized in the liver and excreted by the response they may kidneys. Glucocorticoids suppress hypersensitivity and immune responses through a process that isn’t entirely understood. Researchers be- lieve that glucocorticoids inhibit immune responses by: • suppressing or preventing cell-mediated immune reactions • reducing levels of leukocytes, monocytes, and eosinophils • decreasing the binding of immunoglobulins to cell surface re- ceptors • inhibiting interleukin synthesis. Taking the red (and more) out Glucocorticoids suppress the redness, edema, heat, and tender- ness associated with the inflammatory response. How methylprednisolone works Tissue trauma normally leads to tissue irritation, edema, inflammation, and production of scar tissue.