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‘My book is a b-hearted celebration of codes, compiled by artists, writers, ers and composers, that have stubbornly refused to reveal their secrets over the years. Caution should be used in the elderly because paroxetine is the most sedating and anticholinergic of the selective serotonin reuptake inhibitors The elderly are prone to SSRI/SNRI-induced hyponatremia; monitor closely 65 years In children and young adults, risks must be wehed against the benefits of taking antidepressants Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during the initial 1-2 months of therapy and dosage adjustments The patient’s family should communicate any abrupt changes in behavior to the healthcare provider Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy This drug is not approved for use in pediatric patients Clinical worsening and suicidal ideation may occur despite medication in adolescents and young adults (18-24 years) Use caution in patients with bipolar disorder, seizure disorder, history of suicidal thought/behavior Risk of mydriasis; may trger angle closure attack in patients with angle closure glaucoma with anatomiy narrow angles without a patent iridectomy Conflicting evidence regarding use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn (see Pregnancy) Risk of complications such as feeding difficulties, irritability, and respiratory problems reported in neonates exposed to SNRIs/SSRIs late in third trimester Risk of cardiovascular defects in infants whose mothers took drug during early pregnancy Withdraw gradually Use lower starting dose in renal impairment (Cr Cl Pregnancy category: D Teratogenic effects: Epidemiologic studies have shown that infants exposed to paroxetine in the first trimester of pregnancy have an increased risk of congenital malformations, particularly cardiovascular malformations Use late in the third trimester associated with complications in newborns and may require prolonged hospitalization, respiratory support, and tube feeding A study of nearly 28,000 women taking SSRIs confirmed 5 previously reported birth defercts associated with paroxetine, including heart defects, anencephaly, and abdominal wall defects (BMJ 2015; 351:h3190) Several SSRIs (eg, fluoxetine, fluvoxamine, paroxetine, sertraline) are metabolized by CYP2D6 CYP2D6 is involved in the metabolism of approximately 20% of drugs in clinical use, and it displays large individual-to-individual variability in activity due to genetic polymorphisms More than 80 CYP2D6 variant alleles have been identified; however, 4 of the most prevalent alleles, CYP2D6*3, *4, *5, and *6, account for 93-97% of CYP2D6 poor metabolizers (PMs) CYP2D6*4, the most common variant (~25% frequency in whites), causes a splicing defect; CYP2D6*3 (2.7% frequency) causes a frameshift mutation; and CYP3D6*5 (2.6%) is an entire deletion of the CYP2D6 gene; individuals homozygous for these alleles have no CYP2D6 activity The impact of CYP2D6 activity is further complicated in some SSRIs (eg, fluoxetine, fluvoxamine, paroxetine, sertraline) that in addition to being substrates for CYP2D6, are also known to moderately inhibit CYP2D6 activity The above information is provided for general informational and educational purposes only.
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Ali) They reject (the warning) and follow their (own) lusts but every matter has its appointed time. Ali) There have already come to them Recitals wherein there is (enough) to check (them), 54:4 (Picktall) And surely there hath come unto them news whereof the purport should deter, Translations 54:6 (Y. The Day that the er will (them) to a terrible affair, 54:6 (Picktall) So withdraw from them (O Muhammad) on the day when the Summoner summoneth unto a painful thing. Ali) They will come forth,- their eyes humbled - from (their) graves, (torpid) like locusts scattered abroad, 54:7 (Picktall) With downcast eyes, they come forth from the graves as they were locusts spread abroad, Translations 54:8 (Y. 54:8 (Picktall) Hastening toward the Summoner; the disbelievers say: This is a hard day. Ali) Before them the People of Noah rejected (their apostle): they rejected Our servant, and said, "Here is one possessed! 54:9 (Picktall) The folk of Noah denied before them, yea, they denied Our slave and said: A madman; and he was repulsed. Ali) And We caused the earth to gush forth with springs, so the waters met (and rose) to the extent decreed. (Picktall) For they said: Is it a mortal man, alone among us, that we are to follow? Ali) And tell them that the water is to be divided between them: Each one's rht to drink being brought forward (by suitable turns). Ali) For We sent against them a single Mhty Blast, and they became like the dry stubble used by one who pens cattle. We sent upon them one Shout, and they became as the dry tws (rejected by) the builder of a cattle fold. Ali) And We have indeed made the Qur'an easy to understand and remember: then is there any that will receive admonition? Julie currently offers private study and production coaching.
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