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  • Clinical Instructor, Department of Pharmacotherapy and Outcomes Sciences, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia

Using such predictions symptoms narcolepsy buy probenecid 500mg on line, the next step is to adhd medications 6 year old buy cheap probenecid 500 mg online simulate conditions within mite habitats 2d6 medications buy 500 mg probenecid with visa, such as beds and carpets. The advent of small cheap sensors and loggers has catalysed interest in this area (Cunningham, 1996, 1998; Lowe, 2000; Pretlove et al. The final step is then to simulate how habitat conditions affect mite populations (Crowther et al. Preliminary results of this modelling effort are promising and tend to confirm that the considerable variation in mite numbers found both seasonally and between similarly located households can indeed be explained and simulated using computer modelling techniques. Sensitivity analyses also show that factors that relate to a building and its occupants have more effect than other factors, such as the physical properties of the bedding, and that relatively small changes can make a substantial difference in hygrothermal conditions in mite habitats. This confirms the potential for controlling mite populations by environmental means. Modelling techniques thus make it possible to investigate which modifications to home environments have most impact on mite populations, for any given climatic region, housing type and pattern of occupant behaviour. Constructional changes to improve conditions In advance of such modelling studies, it is still worth discussing, in general terms, changes in building construction that improve conditions. Improved maintenance and the avoidance of excess moisture According to Eldridge (1976): Defects in buildings and building materials are often said to be caused by the weather, especially when severe or unusual conditions have been experienced. However, careful diagnosis will demonstrate that faulty design, the wrong choice of materials or faults on site are usually the root cause, the weather only providing the appropriate conditions for the failure to occur. Higher ventilation rates can thus be achieved for less energy loss, thus encouraging householders to raise their ventilation standards. For this method to work, however, both outgoing and incoming air need to be ducted, with an electric fan in each direction, and the dwelling needs to be relatively airtight, to maximize the proportion of ventilated air that passes through the system. This last requirement makes the method more relevant to new housing than to older housing, where airtightness is more difficult to achieve. The amount of ductwork required is another obstacle for use in refurbished houses. Other possible problems relate to the correct positioning of inlet and outlet air grilles and to the need for regular cleaning of input air ductwork, as well as filters. Although electric fans are becoming quieter, the energy consumption and noise of two fans is also likely to attract the attention of householders. Even if properly installed, it puts a considerable onus on householders to use it correctly and to keep it well maintained. Moreover, the energy apparently saved is offset by the energy used (and carbon dioxide emissions produced) by the two electric fans. The system thus makes most sense in regions with very cold winters and hydroelectric power, such as northern Scandinavia. In these systems, the two fans, filters and grilles are all combined in one compact unit that can be installed in an external wall. With virtually no ductwork, cleaning and maintaining, these systems are less problematic. However, Htut and colleagues (1996) found that the unit could only be operated 24 hours a day at the lowest setting without producing unacceptable noise at night. At this setting, the unit did reduce humidity and mite numbers in an occupied bedroom (compared with a control), but not sufficiently to effect a permanent reduction. Even though regularly updated guides for diagnosing and avoiding building defects are published in most high- and middle-income countries, and the importance of avoiding excess moisture is generally well recognized, many obstacles to making progress persist. Elaborating on this point, the Committee on Damp Indoor Spaces and Health (2004) called attention to the lack of sufficient information on which to base quantitative recommendations, as well as to institutional, social and economic factors that tend to hinder the widespread adoption of technical measures and practices that could improve the situation. Improved insulation and ventilation standards As suggested earlier, providing affordable heating and improved insulation standards is likely to have the beneficial effect of lowering bedroom relative humidity levels and thus reducing mite populations, provided that ventilation standards are maintained. This proviso needs to be stressed, and it is vital that insulation standards are improved in conjunction with measures that enable and encourage householders to achieve good ventilation. Householders can do a great deal to modify hygrothermal conditions, to reduce mite population growth, both by controlling moisture production and by being aware of the need to ventilate adequately in winter.

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The presence of pedal oedema or excessive weight gain may also be a feature of pre-eclampsia treatment group discount 500 mg probenecid otc. Blood pressure monitoring every 4 hours together with daily weighing of the patient are essential in the management of pre-eclampsia alongside the recommended investigations kerafill keratin treatment discount 500mg probenecid visa. While blood pressure reduction is essential medications xerostomia purchase probenecid 500mg with mastercard, lowering the blood pressure below 140/90mmHg may cause foetal distress and should be avoided. These cases are best managed in hospital under the supervision of an obstetrician. When the "obstetrician" considers that the foetus is immature, the patient should be transferred to a hospital capable of looking after the immature baby. Caesarean section is done when there is foetal distress or the cervix is unfavourable for induction and when there are other problems precluding safe vaginal delivery. The diastolic pressure should not go below 90 mmHg as placental perfusion may be impaired with resultant foetal distress. Double the infusion rate at 30-minute intervals until satisfactory response or a dose of 160mg per hour is attained. Toxicity to Magnesium sulphate presents as slowing or arrest of the heart beat and the respiration and loss of the deep tendon reflexes. Before giving a dose ensure that the following parameters are normal: Respiratory rate >12-16 per minute. Do not give furosemide (frusemide) as part of the treatment for the hypertension unless there is pulmonary oedema present. It is associated with increased rate of miscarriage, preterm delivery, fetal growth restriction, fetal demise and increased perinatal loss. Pharmacological treatment (Evidence rating: C) Ferrous sulphate, oral, 200 mg 8 hourly (This may be increased to 400 mg 8 hourly in severe cases if no gastric symptoms occur) Folic acid, oral, 5 mg daily Multivitamin, oral, One tablet 8 hourly Parenteral Iron: For those with iron deficiency anaemia who are unable to tolerate oral iron, parenteral iron may be given. This should be given under careful observation and a small test dose should first be given (check product leaflet for test dose). Treatment for severe anaemia (Hb < 7g/dL) is best given in health facilities with blood transfusion capability 101. A fasting blood glucose test and 2-hour post-prandial blood glucose test must be done on all pregnant women at booking and also at 28-32 weeks (see section on Antenatal Care). The management of diabetes mellitus in pregnancy involves a multidisciplinary approach comprising a team of obstetricians, midwives, nurses, dieticians, physicians, anaesthetists and paediatricians. For those who can afford a glucose meter, it would be prudent to do a glucose profile every 2-4 weeks. This involves the recording of fasting blood glucose, prebreakfast, pre-lunch, post-lunch, pre-dinner and post-dinner levels. Exercise is contraindicated in Pregnancy induced hypertension Preterm rupture of membranes Preterm labour Incompetent cervix Persistent second/ third trimester bleeding Intra uterine growth retardation. Adjust the insulin doses before breakfast and/or dinner by plus or minus 2 units according to results of blood glucose tests. Keep fasting glucose levels between 4-6 mmol/L and 2-hour postprandial glucose between 4-7 mmol/L. However, some patients would need to be admitted to hospital for short periods to ensure good glycaemic control. If complications exist then earlier delivery may be indicated Indications for Caesarean section include severe pre-eclampsia, previous caesarean section, advanced maternal age, malpresentation or foetal macrosomia If elective preterm delivery is necessary, confirm pulmonary maturity with amniocentesis (if facilities are available). There may be the need to mature the foetal lungs with corticosteroids under specialist care. The baby needs special care and is best managed by a paediatrician/ neonatologist. For the convenience of patients shared care between specialist and medical officer may be appropriate. Cardiac disease may be present before the pregnancy or develop during the pregnancy or puerperium (peripartum cardiomyopathy). Examples are the increasing pulse rate, collapsing pulse and the presence of cardiac murmurs and a slight rise in the jugular venous pressure. Management involves a multi-disciplinary team including the obstetrician, neonatologist and physician.

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The ma nufa cturer recommends ca uti on when gi vi ng cefoteta n to medicine zoloft discount probenecid 500mg otc a brea s t-feedi ng mother medicine 50 years ago purchase 500 mg probenecid otc. Risk C: Monitor therapy Etha nol /Nutri ti on/Herb Intera cti ons Etha nol: Avoi d etha nol (ma y ca us e a di s ul fi ra m-l i ke rea cti on) severe withdrawal symptoms safe 500mg probenecid. As s es s res ul ts of l a bora tory tes ts (prothrombi n ti me), thera peuti c res pons e, a nd a dvers e effects (eg, hemol yti c a nemi a, hypoprothrombi nemi a, a nd bl eedi ng) regul a rl y duri ng thera py. Tea ch pa ti ent pos s i bl e s i de effects /a ppropri a the i nterventi ons a nd a dvers e s ymptoms to report (eg, nephrotoxi ci ty, opportuni s ti c i nfecti on, hypers ens i ti vi ty rea cti on). Moni tori ng: La b Tes ts Prothrombi n ti me; perform cul ture a nd s ens i ti vi ty s tudi es pri or to i ni ti a ti ng drug thera py; rena l functi on Pa ti ent Educa ti onDo not ta ke a ny new medi ca ti on duri ng thera py unl es s a pproved by pres cri ber. Report i mmedi a tel y a ny rednes s, s wel l i ng, burni ng, or pa i n a t i njecti on/i nfus i on s i te, or i mmedi a tel y report a ny i tchi ng, hi ves, di ffi cul ty s wa l l owi ng, or res pi ra tory di ffi cul ty. Avoi d a l cohol duri ng thera py a nd for 72 hours a fter l a s t dos e (ma y ca us e s evere di s ul fi ra m-l i ke rea cti ons). Injecti on, powder for recons ti tuti on: 1 g, 2 g [conta i ns s odi um 80 mg/g (3. Premi xed frozen s ol uti on, when tha wed, i s s ta bl e for 24 hours a t room tempera ture or 21 da ys when refri gera ted. Y-site administration: Compatible: Acycl ovi r, a mi fos ti ne, a mphoteri ci n B chol es teryl s ul fa the compl ex, a ztreona m, cycl ophos pha mi de, di l ti a zem, doceta xel, doxorubi ci n l i pos ome, etopos i de, fa moti di ne, fl ucona zol e, fos ca rnet, gemci ta bi ne, gra ni s etron, hydromorphone, l i nezol i d, ma gnes i um s ul fa te, meperi di ne, morphi ne, onda ns etron, perphena zi ne, propofol, ra ni ti di ne, remi fenta ni l, teni pos i de, thi otepa. Compatibility when admixed: Compatible: Ami ka ci n, ci meti di ne, cl i nda myci n, genta mi ci n, ka na myci n, metroni da zol e, metroni da zol e wi th s odi um bi ca rbona te, mul ti vi ta mi ns, s odi um bi ca rbona te, tobra myci n, vera pa mi l, vi ta mi n B compl ex wi th C. Contra i ndi ca ti ons Hypers ens i ti vi ty to cefoxi ti n, a ny component of the formul a ti on, or other cepha l os pori ns Al l ergy Cons i dera ti ons Cepha l os pori n Al l ergy Wa rni ngs /Preca uti ons Concerns related to adverse effects: Peni ci l l i n a l l ergy: Us e wi th ca uti on i n pa ti ents wi th a hi s tory of peni ci l l i n a l l ergy, es peci a l l y IgE-medi a ted rea cti ons (eg, a na phyl a xi s, a ngi oedema, urti ca ri a). Pregna ncy Ri s k Fa ctorB Pregna ncy Cons i dera ti ons Advers e events ha ve not been obs erved i n a ni ma l reproducti on s tudi es; therefore, cefoxi ti n i s cl a s s i fi ed a s pregna ncy ca tegory B. Cefoxi ti n cros s es the pl a centa a nd rea ches the cord s erum a nd a mni oti c fl ui d. Adequa the wel l -control l ed s tudi es a re not a va i l a bl e i n pregna nt women. Pea k s erum concentra ti ons of cefoxi ti n duri ng pregna ncy ma y be s i mi l a r to or decrea s ed compa red to nonpregna nt va l ues. Pregna ncy-i nduced hypertens i on i ncrea s es trough concentra ti ons i n the i mmedi a the pos tpa rtum peri od. The ma nufa cturer recommends tha t ca uti on be exerci s ed when a dmi ni s teri ng cefoxi ti n to nurs i ng women. The Ameri ca n Aca demy of Pedi a tri cs cons i ders cefoxi ti n to be "us ua l l y compa ti bl e wi th brea s t-feedi ng. Moni tori ng: La b Tes ts Prothrombi n ti mes; perform cul ture a nd s ens i ti vi ty s tudi es pri or to i ni ti a ti ng drug thera py; rena l functi on Pa ti ent Educa ti onDo not ta ke a ny new medi ca ti on duri ng thera py unl es s a pproved by pres cri ber. Report i mmedi a tel y a ny rednes s, s wel l i ng, burni ng, or pa i n a t i njecti on/i nfus i on s i te; ches t pa i n, pa l pi ta ti ons, res pi ra tory di ffi cul ty or s wa l l owi ng; i tchi ng or hi ves. A Cl i ni ca l a nd Pha rma coki neti c Study," Eur J Clin Pharmacol, 1983, 25(4):507-9. Bra nd Na mes Va nti n Ca na di a n Bra nd Na mes Va nti n Pha rma col ogi c Ca tegoryAnti bi oti c, Cepha l os pori n (Thi rd Genera ti on) Us e: La bel ed Indi ca ti ons Trea tment of s us cepti bl e a cute, communi ty-a cqui red pneumoni a ca us ed by S. Dos i ng: Pedi a tri c Acute maxillary sinusitis: Ora l: Chi l dren: 2 months to 12 yea rs: 10 mg/kg/da y di vi ded every 12 hours for 10 da ys (ma xi mum: 200 mg/dos e) Acute otitis media: Ora l: Chi l dren: 12 yea rs: 2 months to 12 yea rs: 10 mg/kg/da y di vi ded every 12 hours (400 mg/da y) for 5 da ys (ma xi mum: 200 mg/dos e) 12 yea rs: Refer to a dul t dos i ng. Pharyngitis/tonsillitis: Ora l: Chi l dren: 2 months to 12 yea rs: 10 mg/kg/da y i n 2 di vi ded dos es for 5-10 da ys (ma xi mum: 100 mg/dos e) 12 yea rs: Refer to a dul t dos i ng. Dos i ng: Hepa ti c Impa i rmentDos e a djus tment i s not neces s a ry i n pa ti ents wi th ci rrhos i s. Contra i ndi ca ti ons Hypers ens i ti vi ty to cefpodoxi me, a ny component of the formul a ti on, or other cepha l os pori ns Al l ergy Cons i dera ti ons Cepha l os pori n Al l ergy Wa rni ngs /Preca uti ons Concerns related to adverse effects: Peni ci l l i n a l l ergy: Us e wi th ca uti on i n pa ti ents wi th a hi s tory of peni ci l l i n a l l ergy, es peci a l l y IgE-medi a ted rea cti ons (eg, a na phyl a xi s, a ngi oedema, urti ca ri a). Geri a tri c Cons i dera ti ons Cons i dered one of the drugs of choi ce for outpa ti ent trea tment of communi ty-a cqui red pneumoni a i n the el derl y. Pregna ncy Ri s k Fa ctorB Pregna ncy Cons i dera ti ons Tera togeni c events were not obs erved i n a ni ma l s tudi es; therefore, cefpodoxi me i s cl a s s i fi ed a s pregna ncy ca tegory B. Other cepha l os pori ns cros s the pl a centa a nd a re cons i dered s a fe i n pregna ncy.

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Moni tori ng: La b Tes ts Uri na l ys i s Pa ti ent Educa ti onThi s drug i s gi ven to symptoms gallbladder problems buy probenecid 500mg with amex hel p prevent s i de effects of other chemothera peuti c a gents you a re ta ki ng symptoms uti generic probenecid 500 mg without a prescription. Injecti on medicine man movie purchase probenecid 500mg line, s ol uti on: 100 mg/mL (10 mL) [conta i ns benzyl a l cohol] Mes nex: 100 mg/mL (10 mL) [conta i ns benzyl a l cohol] Ta bl et: Mes nex: 400 mg Generi c Ava i l a bl eYes: Sol uti on for i njecti on Mecha ni s m of Acti onIn bl ood, mes na i s oxi di zed to di mes na whi ch i n turn i s reduced i n the ki dney ba ck to mes na, s uppl yi ng a free thi ol group whi ch bi nds to a nd i na cti va tes a crol ei n, the urotoxi c meta bol i the of i fos fa mi de a nd cycl ophos pha mi de Pha rma codyna mi cs /Ki neti cs Di s tri buti on: No ti s s ue penetra ti on Protei n bi ndi ng: 69% to 75% Meta bol i s m: Ra pi dl y oxi di zed i ntra va s cul a rl y to mes na di s ul fi de (di mes na); di mes na i s reduced i n rena l tubul es ba ck to mes na fol l owi ng gl omerul a r fi l tra ti on Bi oa va i l a bi l i ty: Ora l: 45% to 79% Ha l f-l i fe el i mi na ti on: I. For preventi on hi gh-dos e cycl ophos pha mi de-i nduced urotoxi ci ty (a s s oci a ted wi th s tem cel l tra ns pl a nta ti on), the gui del i nes recommend mes na i n conjuncti on wi th s a l i ne di ures i s (or forced s a l i ne di ures i s a l one). Denta l Hea l th: Effects on Denta l Trea tmentNo s i gni fi ca nt effects or compl i ca ti ons reported Denta l Hea l th: Va s ocons tri ctor/Loca l Anes theti c Preca uti ons No i nforma ti on a va i l a bl e to requi re s peci a l preca uti ons Menta l Hea l th: Effects on Menta l Sta tus Ma y ca us e ma l a i s e Menta l Hea l th: Effects on Ps ychi a tri c Trea tmentNone reported Index Terms Merca ptoetha ne Sul fona te; Sodi um 2-Merca ptoetha ne Sul fona the References Ben Yehuda A, Heyma n A a nd Stei ner Sa l z D, "Fa l s e Pos i ti ve Rea cti on for Uri na ry Ketones Wi th Mes na," Drug Intell Clin Pharm, 1987, 21(6):547-8. Admi ni s tra ti on: Ora l Admi ni s ter a round-the-cl ock to promote l es s va ri a ti on i n pea k a nd trough s erum l evel s. Admi ni s tra ti on: Inha l a ti onDo not us e s ol uti ons for nebul i za ti on i f they a re brown or conta i n a preci pi ta te. Contra i ndi ca ti ons Hypers ens i ti vi ty to meta proterenol or a ny component of the formul a ti on; pre-exi s ti ng ca rdi a c a rrhythmi a s a s s oci a ted wi th ta chyca rdi a Wa rni ngs /Preca uti ons Concerns related to adverse effects: Bronchos pa s m: Ra rel y, pa ra doxi ca l bronchos pa s m ma y occur wi th us e of i nha l ed bronchodi l a ti ng a gents; thi s s houl d be di s ti ngui s hed from i na dequa the res pons. Disease-related concerns: As thma: Appropri a the us e: Opti mi ze a nti -i nfl a mma tory trea tment before i ni ti a ti ng ma i ntena nce trea tment wi th meta proterenol. Dosage form specific issues: Syrup/ta bl ets: Ora l us e s houl d be a voi ded due to the i ncrea s ed i nci dence of a dvers e effects. Other warnings/precautions: Beta a cti vi ty: Meta proterenol ha s more beta 1 a cti vi ty tha n beta 2 -s el ecti ve a gents s uch a s a l buterol a nd, therefore, ma y no l onger be the beta -a goni s t of fi rs t choi ce. The need to i ncrea s e frequency of us e ma y i ndi ca the deteri ora ti on of a s thma, a nd trea tment mus t not be del a yed. Geri a tri c Cons i dera ti ons El derl y ma y fi nd i t us eful to uti l i ze a s pa cer devi ce when us i ng a metered dos e i nha l er. Ora l us e s houl d be a voi ded due to the i ncrea s ed i nci dence of a dvers e effects. Pregna ncy Ri s k Fa ctorC Pregna ncy Cons i dera ti ons No da ta on cros s i ng the pl a centa. Reported a s s oci a ti on wi th pol yda ctyl y i n 1 s tudy; ma y be s econda ry to s evere ma terna l di s ea s e or cha nce. La cta ti onExcreti on i n brea s t mi l k unknown Brea s t-Feedi ng Cons i dera ti ons No da ta on cros s i ng i nto brea s t mi l k or cl i ni ca l effects on the i nfa nt. Advers e Rea cti ons >10%: Ca rdi ova s cul a r: Ta chyca rdi a (<17%) Centra l nervous s ys tem: Nervous nes s (3% to 14%) Endocri ne & meta bol i c: Serum gl ucos e i ncrea s ed, s erum pota s s i um decrea s ed Neuromus cul a r & s kel eta l: Tremor (1% to 33%) 1% to 10%: Ca rdi ova s cul a r: Pa l pi ta ti on (<4%) Centra l nervous s ys tem: Hea da che (<4%), di zzi nes s (1% to 4%), i ns omni a (2%) Ga s troi ntes ti na l: Na us ea, vomi ti ng, ba d ta s te, hea rtburn (4%), xeros tomi a Neuromus cul a r & s kel eta l: Trembl i ng, mus cl e cra mps, wea knes s (1%) Res pi ra tory: Coughi ng, pha ryngi ti s (4%) Mi s cel l a neous: Di a phores i s i ncrea s ed (4%) <1%: Pa ra doxi ca l bronchos pa s m, hypertens i on, hypoka l emi a, ches t pa i n, a ngi na, drows i nes s, di a rrhea, ta s the cha nge Drug Intera cti ons Al pha -/Beta -Bl ockers: Ma y di mi ni s h the thera peuti c effect of Beta 2-Agoni s ts. Moni tor effecti venes s of thera py (rel i ef of a i rwa y obs tructi on) a nd a dvers e rea cti ons a t begi nni ng of thera py a nd peri odi ca l l y wi th l ong-term us. For i npa ti ent ca re, vi ta l s i gns a nd l ung s ounds s houl d be moni tored pri or to a nd peri odi ca l l y duri ng thera py. You ma y experi ence nervous nes s, di zzi nes s, or fa ti gue (us e ca uti on when dri vi ng or enga gi ng i n ta s ks requi ri ng a l ertnes s unti l res pons e to drug i s known); dry mouth, unpl ea s a nt a fterta s te, s toma ch ups et (s ma l l frequent mea l s, frequent mouth ca re, chewi ng gum, or s ucki ng ha rd ca ndy ma y hel p); or i ncrea s ed pers pi ra ti on. Sel f-a dmi ni s tered i nha l a ti on: Store ca ni s ter ups i de down; do not freeze. Cl os e eyes when a dmi ni s teri ng meta proterenol to a voi d s pra y getti ng i nto eyes. Exha l e s l owl y a nd compl etel y through nos e; i nha l e deepl y through mouth whi l e a dmi ni s teri ng a eros ol. If more tha n one i nha l a ti on medi ca ti on i s us ed, us e bronchodi l a tor fi rs t a nd wa i t 5 mi nutes between medi ca ti ons. Brea the ca l ml y a nd deepl y unti l no more mi s t i s formed i n nebul i zer (a bout 5 mi nutes). Hypertens i on a nd ta chyca rdi a a re i ncrea s ed wi th exogenous s ympa thomi meti cs. Duri ng endotra chea l i ntuba ti on, beta 2 -s peci fi c a gent i s more a ppropri a the for peri opera ti ve us. Denta l Hea l th: Effects on Denta l Trea tmentKey a dvers e event(s) rel a ted to denta l trea tment: Ba d ta s the a nd xeros tomi a (norma l s a l i va ry fl ow res umes upon di s conti nua ti on). Bra nd Na mes Skel a xi n Ca na di a n Bra nd Na mes Skel a xi n Pha rma col ogi c Ca tegorySkel eta l Mus cl e Rel a xa nt Us e: La bel ed Indi ca ti ons Rel i ef of di s comfort a s s oci a ted wi th a cute, pa i nful mus cul os kel eta l condi ti ons Dos i ng: Adul ts Muscle discomfort: Ora l: 800 mg 3-4 ti mes /da y Dos i ng: El derl yRefer to a dul t dos i ng. However, s erum concentra ti ons ma y be i ncrea s ed when a dmi ni s tered wi th food; cl i ni ca l s i gni fi ca nce ha s not been es ta bl i s hed. Di eta ry Cons i dera ti ons Admi ni s tra ti on wi th food ma y i ncrea s e s erum concentra ti ons.

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References:

  • https://www.drpopp.com/wp-content/uploads/2020/11/NP20Sleep20Disorder20Assesment.pdf
  • https://www.forwardhealth.wi.gov/kw/archive/DME010218.pdf
  • https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/obstructive-sleep-apnea-treatment.pdf
  • https://medicaid.utah.gov/pharmacy/ptcommittee/files/Criteria%20Review%20Documents/2016/2016.02%20Skeletal%20Muscle%20Relaxant%20Class%20Review.pdf