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An elastomer seal This is critical to the valve performance as it controls propellant leakage and metering reproducibility buy discount propranolol 80 mg on-line. Chemical constituent extraction from the seals by the propellants should be tightly controlled cheap 40mg propranolol amex. The actuator This permits easy actuation of the valve, provides an orifice through which the spray is discharged and directs the spray into the patient’s mouth. Orifice size can vary: large orifices in combination with large- volume metering valves permit the administration of concentrated, i. However, smaller orifices are generally preferred since for low volume, dilute suspensions, a small drop size is produced, with the potential for greater penetration of the airways. Depression of the actuator opens the valve and the metered volume is discharged through the orifice as a result of the internal pressure within the aerosol canister. The rapid reduction in pressure to atmospheric induces extremely rapid evaporation, or flashing, of the propellant. It is the latent heat of evaporation of the volatile propellant that provides the energy for atomization. The energy disrupts the liquid into large drops moving at a velocity of approximately 30 m s−1. Evaporation therefore proceeds much more slowly and requires energy from the surrounding atmosphere. The higher the vapor pressure, the greater the velocity and generally higher oropharyngeal deposition will occur. Lowering the vapor pressure will reduce the oropharyngeal deposition but will almost certainly produce larger, more slowly evaporating propellant drops which will subsequently deposit high in the bronchial tree. Solvency Since most drugs are insoluble in the propellants, they are usually presented as suspensions. Micronized drug is dispersed with the aid of a surfactant such as oleic acid, sorbitan trioleate or lecithin. At concentrations up to 2% w/w the surfactant stabilizes the suspended particles by adsorption at the drug propellant interface and in addition serves as a valve lubricant. Low surfactant concentrations will also avoid substantial reductions in the propellant evaporation rates from aerosolized drops. Density Differences in density between drug particles and the propellant will determine sedimentation rates (either sinking or floating). Deflocculation of the suspension by judicious surfactant selection may minimize the effect which can give rise to variable dosing during the life of the pressurized pack. In order to be effective, metered-dose aerosols should be triggered during the course of a deep, slow (>5 seconds) inhalation, followed by 5–10 seconds of breath holding. The breath-holding period is intended to maximize particle deposition by sedimentation and diffusion mechanisms (see Section 10. Patients can experience problems in developing an adequate inhaler technique and coordinating actuation with inspiration. Studies have shown that 50% or more adult patients have difficulty using conventional metered- dose inhalers efficiently, even after careful training. These are essentially extension tubes which effectively increase the distance between the orifice and the patient’s oropharynx. This allows for 268 deceleration of the particles and hence reduces oropharyngeal deposition. In-built flow restrictors have been introduced in attempts to control patients inhalation rate. For patient convenience, spacers and reservoirs have been’ designed as collapsible or concertina-like structures. An alternative approach to achieving patient coordination between actuation and inhalation is a breath actuated device such as the Autohaler. Conventionally, this has been achieved by micronization, although more recently spray-drying and supercritical fluid technologies have been employed. However, particles of such small sizes exhibit exceptionally high surface energies, so that: • particle aggregation readily occurs, making redispersion a difficult process; • the formulation has poor flow and entrainment properties. The most frequently employed approach to overcoming the problems associated with particle size is to use a carrier particle such as lactose. When the micronized drug is blended with a carrier of much larger size range (usually 20–100 μm), many of the drug particles become loosely associated with the lactose surface. The turbulent airflow within the device detaches the drug particles from the carrier particles within the device itself; the drug particles are then carried on the airstream into the lungs. Those carrier particles that escape from the device are largely deposited in the oropharynx of the patient. Although high levels of turbulence will facilitate stripping of the drug particles from the carrier particles within the device, this course of action will also lead to an increase in resistance of the inhaler to airflow and thus to difficulties in inhaling through the device at a flow rate which produces optimum drug delivery.
Part I: Analyzing Angst and Preparing a Plan This part is all about helping you identify your problem and take the ﬁrst small steps toward recovery buy propranolol 80mg on-line. Chapter 1 helps you discover whether you have a problem with anxiety or depression order propranolol 80mg line. The quizzes in this chapter help you see where these problems show up in your world and what they do to your thoughts, behaviors, feelings, and relationships. In Chapter 2, you go on a journey to the origins of your problems with anxiety and depression because knowing where it all began helps you realize that you’re not to blame. Because change some- times feels overwhelming, Chapter 3 addresses self-sabotage and helps you keep moving forward. Chapter 4 provides you with ways for keeping track of your moods and becoming more aware of your thoughts. In Chapter 5, you ﬁnd out how to examine your thoughts for distortions; then, in Chapter 6, you prosecute those dis- torted thoughts and rehabilitate them. Chapter 7 shows you how certain core beliefs darken and distort your view of yourself, your world, and your future as surely as eyeglasses with the wrong prescription muddle normal sight. Finally, in Chapter 8, you have the opportunity to practice mindfulness and acceptance — more techniques for handling troubling thoughts. In Chapter 10, we get you up and moving by providing workbook-type exercises that encourage physical exercise. When you’re depressed or anx- ious, few activities sound like fun, so Chapter 11 has worksheets for reintroducing pleasure into your life. Finally, Chapter 12 helps you tackle life problems that grow out of your emo- tional distress. Excessive stress associated with anxiety and depression produces hormones that ravage the body by increasing blood pressure and contributing to stomach problems, weight gain, and heart disease. Therefore, relaxation techniques play an important role in alleviating anxiety and depression. Because medication is an additional option for many people who are depressed or anxious, Chapter 14 guides you through the decision of whether or not med- ications are the right choice for you. Anxiety & Depression Workbook For Dummies 4 Part V: Relationship Therapy Depression and anxiety can spill over and contaminate your relationships like sewage dumped into a river. Good relationships offer support in dealing with emotional distress, whereas spoiled relationships just make things worse. Chapter 15 helps you ﬁgure out if your relationships are suffering, and the worksheets and exercises in Chapter 16 guide you in improving the quality of your relationships. Chapter 17 tells you how to prepare for and deal with any setbacks in your condition, and Chapter 18 helps you develop positive habits that lead to a more joyful, meaningful, and connected life. Chapter 19 recommends ten resources for getting help in dealing with your depression and anxiety. If you’re looking for a quick way out of a bad mood, Chapter 20 is for you — it lists ten remedies that don’t take a whole lot of effort. Characters in This Book Throughout this workbook, we use ﬁctional characters to illustrate how you can complete the various worksheets and exercises. Although these characters aren’t real people, they represent composites of various clients and others we’ve known and worked with over the years. Any resemblance to an actual individual, whether alive or deceased, is unintended and coincidental. Nonetheless, we believe you’ll ﬁnd yourself relating to these characters and ﬁnd their experiences useful. Icons Used in This Book Throughout the book, icons in the margins alert you to important types of information: This icon marks particularly noteworthy information that we hope you’ll remember long after you read this workbook. This icon points to speciﬁc examples that show you the way through worksheets or exercises. Introduction 5 This icon appears when you need to take care; you may need professional help or should be on the lookout for possible trouble. Where to Go from Here The Anxiety & Depression Workbook For Dummies can help you deal with your depression and anxiety. As such, this workbook doesn’t devote a lot of text to lengthy explanations or embellishments of basic concepts, so you may wish to ﬁnd out more about speciﬁc types of depression and anxiety, available medications, and alternative treatments. For that purpose, we strongly recommend that you consider reading one or both of the companion books, Depression For Dummies (Wiley) and Overcoming Anxiety For Dummies (Wiley). Anxiety & Depression Workbook For Dummies 6 Par t I Analyzing Angst and Preparing a Plan In this part. You discover how your problems began and work toward accepting that you’re not to blame for having them.
Don’t know 1% ― Students and people not in employment The frequency of anxious feelings decreased are more likely than those who are working incrementally through the age groups of or retired to feel anxious all of the time respondents buy 80mg propranolol otc, while the proportion of those saying or a lot of the time cheap 80mg propranolol free shipping. People not working for found that 19% of people feel anxious either a lot other reasons than being unemployed (such as of the time or all of the time. For this group, anxiety long-term disability) were three times more likely is something that almost two-thirds (61%) of them (12%) to experience anxious feelings all of the experience on a daily basis and a third (33%) time than the survey sample as a whole (4%). There was a Students (26%), people who are unemployed marked diference between the experiences of (30%), and people not working for other reasons men and women however, in that almost a quarter (33%) were more likely to feel anxious a lot of of the women surveyed (22%) feel anxious a lot the time or all of the time compared to the or all of the time, compared to 15% of the men. A further 41% of people in the survey feel anxious some of the time, meaning that six of every ten respondents said they feel anxious at least some of the time. Women were more likely to experience this frequency of anxiety (68%) compared to men (51%). Additionally, 47% of men said they are either rarely or never anxious in their everyday lives, compared to 31% of women. Almost half of those surveyed (45%) said ― Nearly half of the people who said they that fnancial issues (i. The survey highlighted fnancial issues are a cause of anxiety, but a marked decline in anxiety about fnances this is less likely to be so for older people amongst people aged 55 years and older: nearly (those over 55 years). The survey fndings further suggest that ― Younger people are more likely to feel people in social grades C2D&E (49%) may be anxious about personal relationships. Indeed, signifcantly higher proportions of those in either full- or part-time employment cited work issues (39%) and fear of unemployment (22%) as a cause of anxiety compared to the survey sample as a whole. Personal relationships were said to be a cause of anxious feelings for anxious in your everyday life? Just over one-third of those surveyed Welfare of my loved ones/children 36% (36%) identifed the welfare of a loved one or Other work issues 27% children as a cause of anxiety, but signifcantly (e. Fear of being alone/isolation 16% My own death 16% Age was also a factor in anxiety about growing Fear of crime/personal safety 14% old, with 36% of those aged 55 years and above Other 14% saying they were anxious about this, compared Don’t know/can’t recall 6% to just 15% of 18–24 year olds. Similarly, 29% of the people surveyed from the oldest age group felt anxious about the death of a loved one, compared to 13% from the youngest age group, and twice as many from the oldest age group (19%) were anxious about their own death, compared to the youngest age group (10%). However, the survey also threw up an interesting anomaly around fear of being alone/isolation. We might hypothesise that this would be a particular source of anxiety for older people, yet young people aged 18–24 (28%) were twice as likely to mention it than people in the 55 years and over age group whose response (14%) was lower than the survey sample as a whole (16%). This may be suggestive of the importance placed on belonging to a peer group by young people. Women (19%) were slightly more likely than men (13%) to mention this as a cause of feeling anxious, while students (27%), people working part-time (23%) and people not working for reasons other than unemployment (23%) were also more likely to have anxious feelings about being alone. Talk to a friend or relative 30% ― The most commonly used coping strategies Go for a walk 30% included talking to a friend, going for a walk, Comfort eating 24% and physical exercise. Physical activity/exercise 23% Hide away from the world 18% ― Comfort eating is used by a quarter of people Alcohol 16% (24%) to cope with feelings of anxiety and Relaxation/meditation techniques 13% women and young people are more likely Cigarettes 10% to use this as a way of coping. The most common coping strategy was talking ― People who are unemployed are more likely to a friend or relative, used by 30% of people who to use coping strategies that are potentially feel anxious in their everyday life, although women harmful, such as alcohol and cigarettes, (38%) were more likely to do this than men (21%), than those who are currently employed. Almost one-third of all respondents (30%) said they would go for We asked people who have experienced anxiety a walk to cope with anxiety, a little under a quarter in their lives to identify the diferent ways they said they would undertake a physical activity or do cope with it. Just under one in fve (19%) do not some exercise (23%), while fewer (13%) would do, or use, anything to cope with anxiety in their use relaxation or meditation. Of these, comfort eating, was not using coping strategies was higher (24%) employed by 24% of those surveyed and women than for women (16%), and older people (28%) (29%) were more likely to cope in this way than are less prone to using coping strategies than men (18%). A similar pattern across age and gender emerged in relation to hiding away from the world, which was cited by 18% of respondents. Students were more likely than other groups to hide themselves away; 31% of students in the survey said they use this as a coping strategy. The pattern of usage for alcohol ( just over one in six people) and cigarettes (one in ten people) was not signifcantly diferent across age groups or between men and women. The fndings suggest that unemployment may be a factor in determining the types of strategies that people use to cope with anxious feelings. Unemployed people were more likely than other groups to use potentially harmful strategies: about a quarter (23%) said they would hide away from the world, use alcohol (27%) and use cigarettes (23%). In contrast, people who are retired are much less likely than any of the other groups to use any of these potentially harmful coping strategies to cope with their anxiety. More people agreed People were also asked to indicate the extent (47%) than disagreed (31%) that they get more of their agreement with statements addressing anxious these days than they used to and there aspects of stigma that may be attached to were similar levels of agreement that feelings anxiety. Just over a quarter of respondents of anxiety had stopped them from doing things (26%) felt that feeling anxious is a sign of not in their lives. There was a more clearly defned being able to cope, but almost twice as many tendency for people to agree (57%) than disagree (50%) disagreed with this sentiment. Slightly (14%) when asked if they would like to be less more people (29%) agreed that they would be anxious in their day-to-day lives. In each of these embarrassed to tell someone they have anxieties, domains, the tendency for agreement was larger but again just under half (46%) indicated that for women compared to men and for people in they would not be embarrassed.
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