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If streptokinase (SK) or anistreplase (APSAC) is used, heparin should be given only in those patients who are at high risk for systemic emboli (. large anterior MI, atrial fibrillation, previous embolus, or known LV thrombus) (See standard dosage). Heparin should not be given <= 4 hours after fibrinolytic therapy and should be given when the aPTT is < 70 (goal aPTT 50—70 seconds). After 48 hours, consideration may be given to subcutaneous heparin administration (initial dose about 17,500 Units every 12 hours to maintain aPTT —2 times control), LMWH, or oral anticoagulants. If the patient has no risk factors and SK or APSAC is the thrombolytic that was used, therapeutic heparin is not recommended.

Norgestimate, also known as 17α-ethynyl-18-methyl-19-nortestosterone 3-oxime 17β-acetate or as 17α-ethynyl-18-methylestr-4-en-17β-ol-3-one 3-oxime 17β-acetate , is a synthetic estrane steroid and a derivative of testosterone . [7] [8] It is more specifically a derivative of norethisterone (17α-ethynyl-19-nortestosterone) and is a member of the gonane (18-methylestrane) subgroup of the 19-nortestosterone family of progestins. [9] Norgestimate is the C3 oxime and C17β acetate ester of levonorgestrel and is also known as levonorgestrel acetate oxime . [10] A related compound is norethisterone acetate oxime (norethisterone-3-oxime 17β-acetate).

Treatment of children and infants on insulin therapy (including regular insulin; isophane insulin, NPH) requires special care. In general, special attention must be given to caloric intake, insulin dosage adjustments, and avoidance of low blood glucose concentrations. Because children < 5 years of age may not be able to identify symptoms of hypoglycemia, several pediatric textbooks recommend less stringent goals for fasting or preprandial blood glucose concentrations (100—200 mg/dL) and HbA1C (—9). The majority of insulin preparations have been studied in pediatric patients; however, it may be difficult to achieve glycemic control in children with fixed ratios of quick-acting and intermediate-acting insulin mixtures. When using fixed ratio mixtures of insulin, both insulin types (., the quick-acting and the intermediate-acting components) are adjusted upward or downward which may affect glycemic control undesirably.

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