Proventil

By S. Ernesto. Centre College, Danville Kentucky.

The first sign of impetigo is a patch of red quality proventil 100 mcg, method that does not use the living organism as the host of the test buy proventil 100 mcg mastercard. Examples of his or her family because of having a medical con- inborn error of metabolism include albinism and dition. There are hundreds of person has glaucoma, and subsequently other cases known inborn errors of metabolism. See also of glaucoma are found in the person’s family, that albinism; cystinuria; phenylketonuria. The induction therapy, for example, in acute incidence The frequency with which something, leukemia is the initial chemotherapy designed to such as a disease or trait, appears in a particular bring about a remission. Symptoms include discolored skin that appears within two weeks of infarction, acute myocardial See heart attack. Neurological abnormalities can include slow motor development, seizures, mental retardation, infection The invasion and multiplication of visual problems, and muscle weakness. An infection may remain localized, or it be experiencing infertility if conception has not may spread through the blood or lymphatic vessels occurred after 12 months of sexual activity without to become systemic (bodywide). Infertility can have many that live naturally in the body are not considered causes and may be related to factors in the male, infections. Most people who get influenza recover completely in 1 to 2 weeks, but infection, rotavirus See rotavirus. The nasal-spray flu vaccine is a vac- infectious hepatitis immunization See hepa- cine made with live, weakened flu viruses (some- titis A immunization. The viruses in the vaccine change each infectious mononucleosis See mononucleosis. See also the flu virus develop about 2 weeks after vaccina- Appendix B, “Anatomic Orientation Terms. Many types of infertility are patient learns about and understands the purpose, treatable. Using medications or assisted reproduc- benefits, and potential risks of a medical or surgical tive tecnologies. Informed consent generally requires the have Y chromosomes, Y-linked genes can be trans- patient or responsible party to sign a statement con- mitted only from father to son. Also known as firming that they understand the risks and benefits holandric inheritance. The inhibins are also involved in the control of the production of gametes and embryonic and inguinal Having to do with the groin. Because inhibin-A is elevated in the blood serum of women carrying a fetus with inguinal canal A passage in the lower anterior Down syndrome, inhibin-A is included in the mater- abdominal wall that in the male allows passage of nal serum screening tests for Down syndrome in the the spermatic cord and in the female contains the second trimester of pregnancy. Because of the weakness the inguinal canal creates in the abdominal wall, it is inhibitor, protease See protease inhibitor. For exam- insect sting A sting from a stinging insect, such ple, the pattern of inheritance may be as an autoso- as a bee, hornet, yellow jacket, or wasp, that can mal dominant trait that is transmitted from father or trigger allergic reactions. In selected cases, allergy injection inheritance, holandric See inheritance, Y- therapy is highly effective. Mitochondrial inheritance does not obey the classic By artificial means, such as intrauterine insemina- rules of genetics. The mitochondria are structures in the cell’s cytoplasm, located outside the nucleus, and insemination, heterologous See artificial are responsible for energy production (metabo- insemination by donor. Many common traits and many common diseases insertion A chromosome abnormality that is due are multifactorial. Skin color, for example, is multi- to insertion of a segment from one chromosome factorially determined, as is intelligence. There ber of hours of sleep a person gets or how long it are many types of intelligence tests, and they may takes to fall asleep; it is a measure of satisfaction with measure learning and/or ability in a wide variety of sleep. Insomnia may cause (intelligence quotient), as a mental age, or on a problems during the day, such as tiredness, a lack of scale. National Academy of Sciences that works outside the framework of government to provide evidence- intention tremor An abnormal, repetitive shak- based research and recommendations for public ing movement of the body that appears during vol- health and science policy. An intention tremor suggests a problem with the cerebellum of the brain, the region important insufficiency, pancreatic See pancreatic for coordination and balance. A person with this type of diabetes must Interferon also boosts the immune system. There inject insulin from other sources, such as synthetic are a number of different interferons, and they fall insulin. All insulin pump A mechanical device used in the interferons are proteins (lymphokines) normally treatment of diabetes mellitus that delivers insulin produced by the body in response to infection. Some of these side effects, particularly depression, can be successfully insulin-dependent diabetes mellitus See dia- treated with additional medications. They ity to understand and answer questions given in may be used in biological therapy to stimulate the writing or verbally. Interphase was internal cardiac defibrillator See cardiac once thought to be a resting phase, but it is actually defibrillator, implantable. The condi- jugular veins in the neck that drain blood from the tion was formerly termed hermaphroditism or head, brain, face, and neck, and then convey it pseudohermaphroditism.

Echothiophate and isoflurophate are examples of organic derivatives of phosphoric acid discount proventil 100mcg with amex. Hydrolysis of the carbamylserine residue is much slower than that of acetylserine (30 min–6 h) generic proventil 100mcg online. It binds the anionic site and undergoes a nucleophilic reaction with P¼O group of alkylphosphorylated serine to cause hydrolysis of the phosphoserine bond that is at 6 least 10 times faster than that occurring in water. With the major exception of arteriole tone and blood pressure, where their effects are less pronounced, the pharmacologic effects of indirect-acting parasympathomimetic agents are similar to those of direct-acting muscarinic cholinoceptor agonists. The effect is more pronounced if muscle contraction is already weak, as occurs in myasthenia gravis. Glaucoma (1) Physostigmine is often used concurrently with pilocarpine for maximum effect in the treatment of acute angle-closure glaucoma, a medical emergency. Myasthenia gravis (1) Myasthenia gravis is an autoimmune disease in which antibodies complex with nico- tinic receptors at the neuromuscular junction to cause skeletal muscle weakness and fa- tigue. Neostigmine or edrophonium can be used following surgery to reverse neuromuscular blockade and paralysis resulting from adjunct use of nondepolarizing agents. Atropine and scopolamine poisoning can be treated with physostigmine, which reverses the central and (to some extent) the peripheral effects of competitive muscarinic antagonists. The adverse effects associated with indirect-acting sympathomimetic agents are an exten- sion of pharmacologic activity and arise from excessive cholinergic stimulation. Adverse effects include muscarinic effects similar to those of direct-acting cholinergic drugs and nicotinic effects such as muscle weakness, cramps and fasciculations, exces- sive bronchial secretions, convulsions, coma, cardiovascular collapse, and respiratory failure. Treatment includes the following steps: (1) Maintain respiration and decontaminate to prevent further absorption. Muscarinic-receptor antagonists produce cycloplegia by blocking parasympathetic tone, leading to paralysis of the ciliary muscle and loss of accommodation. These drugs produce mydriasis by blocking parasympathetic tone to the iris circular (con- strictor) muscle. Unopposed sympathetic stimulation of the radial muscle results in dilation of the pupil. These drugs dilate blood vessels in facial blush area (atropine flush), which is not related to the antagonist action. These drugs reduce peristalsis, resulting in prolonged gastric emptying and intestinal transit. Muscarinic-receptor antagonists produce some bronchodilation and decrease mucus secretion. These drugs relax the ureters and bladder in the urinary tract and constrict the urinary sphincter. Tertiary amines can produce restlessness, headache, excitement, hallucinations, and delirium. These drugs produce anhidrosis and dry skin because of the inhibition of sympathetic cho- linergic innervation of the sweat glands. Longer-acting muscarinic-receptor antagonists (such as homatropine) are generally pre- ferred as adjuncts to phenylephrine to prevent synechia formation in anterior uveitis and iritis. Cardiovascular system uses are limited and include the administration of these drugs as a treatment for acute myocardial infarction with accompanying bradycardia and hypotension or arrhythmias (e. Urinary tract uses of atropine and other muscarinic-receptor antagonists include the adminis- tration of these drugs for symptomatic treatment of urinary urgency in inflammatory bladder disorder. Oxybutynin (Ditropan), a selective muscarinc M2-receptor antagonist, tolterodine (Detrol), a selective muscarinic M3-receptor antagonist, and trospium (Spas Max), are addi- tional agents in this class used to treat certain urinary disorders. Antimuscarinic drugs, benztropine, biperiden, trihexyphenidyl, and others, are used as adjunct to levodopa therapy for some patients with Parkinson disease (see Chapter 5). The adverse effects of muscarinic-receptor antagonists are extensions of pharmacologic activ- ity and include mydriasis, cycloplegia, dry eyes, tachycardia, dry mouth, elevated temperature, dry skin, urine retention, agitation, hallucinations, and delirium (‘‘hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter’’). Physostigmine administration for treatment of tertiary amine overdose is not recommended. Neostigmine is used to treat poisoning with quaternary muscarinic-receptor antagonists. Drug interactions of muscarinic-receptor antagonists include the production of additive effects when administered with other drugs with muscarinic-receptor antagonist activity (certain anti- depressants, antipsychotics, and antihistamines). Because of a lack of selectivity and numerous adverse effects, they are used rarely in the clinical setting (hypertensive emergencies). Classified as either nondepolarizing or depolarizing types, neuromuscular junction-blocking drugs cause neuromuscular paralysis. Nondepolarizing neuromuscular junction-blocking drugs, the prototype is tubocurarine, are arranged in a bulky, rigid conformation. These agents prevent depolarization of the muscle and propagation of the action potential. Nondepolarizing agents are administered parenterally and are generally used for long-term motor paralysis. Nondepolarizing agents have durations of action that range from 20–90 minutes, which can be extended by supplemental fractional dosing and is increased by larger initial doses (although this also increases the likelihood of adverse effects).

Tetany is generally considered to result from very low calcium levels in the blood proventil 100 mcg with mastercard. However order proventil 100mcg visa, testis The male sex gland, located behind the penis tetany can also result from reduction in the ionized in a pouch of skin called the scrotum. The testes pro- fraction of plasma calcium without marked duce and store sperm and are also the body’s main hypocalcemia, as is the case in severe alkalosis source of male hormones, such as testosterone. These hormones control the development of the reproductive organs and other male characteristics, tetralogy of Fallot A combination of four heart such as body and facial hair, low voice, and wide defects that are present at birth and account for shoulders. Testosterone is made by the hole between the two bottom chambers, testes in response to luteinizing hormone from the the ventricles, of the heart that permits pituitary gland. Androgens promote the develop- oxygen-poor blood from the right ventri- ment of adult male sex characteristics, such as deep cle to mix with oxygen-rich blood from voice; they strengthen muscle and bone mass; and the left ventricle. High levels of testosterone appear to pro- outlet to the pulmonary artery area with mote good health in men, lowering the risk of high an abnormal pulmonary valve impeding blood pressure and heart attack, for example. High blood flow from the right ventricle to the testosterone levels may also correlate with risky lungs. As with estrogen Open-heart surgery is done on patients with tetral- replacement therapy for women, dosing must be ogy of Fallot in infancy or early childhood. In humans, tetraploid is equal to 92 hemoglobin during fetal development, there are two chromosomes. T-4 cells are Depending on which globin chain is affected, the active in the body’s immune response, helping to mutation leads to underproduction or absence of that turn on this system when it is challenged by an globin chain, a deficiency of hemoglobin, and anemia. These two classes of inherits two genes for alpha thalassemia, one from response are generally incompatible with one each parent, the disorder is lethal before birth: No another and require coordination by substances alpha chains can be made, and without alpha called cytokines to promote one response while chains, there can be no fetal hemoglobin. Children with thalassemia major seem stereotactic surgery and is designed to destroy part of entirely normal at birth because at birth they still the thalamus in order to relieve intractable pain, have predominantly fetal hemoglobin, which does seizures, or involuntary movements, as in Parkinson’s not contain beta chains. The gene for thalassemia major is relatively sphere) that forms part of the walls of the third ven- frequent in people of Mediterranean origin. The thalamus contains a number Children with thalassemia major inherit one tha- of distinct groups of cells, or nuclei, that function as lassemia gene from each parent. Treatment based relay centers for sensory and other impulses on blood transfusions is helpful but not curative. People who thalassemia A group of genetic disorders that are carriers have just one beta thalassemia gene and involve underproduction of hemoglobin, the indis- are essentially normal, although they can transmit pensable molecule in red blood cells that transports the gene to their offspring. The thalidomide A drug (brand name: Thalomid) globin part of hemoglobin is made up of four polypep- that was used in the 1950s and early 1960s to treat tide chains. The use of thalido- predominant type of hemoglobin after the first year of mide had tragic results: When taken during preg- life, two of the globin chains are identical to each nancy, it can cause a syndrome of congenital other and are called the alpha chains. Thalidomide appears to mod- therapeutic abortion An abortion that is ify the reaction of the immune system to the leprosy brought about intentionally. In therapeutic cloning, the Thalidomide is a potent teratogen and should never nucleus of a cell, typically a skin cell, is inserted into be taken by women who are or could become preg- a fertilized egg whose nucleus has been removed. See also thalidomide baby; thalidomide syn- The nucleated egg begins to divide repeatedly to drome, teratogen. Scientists then extract stem cells from the blastocyst and use them to grow cells that thalidomide baby An infant who is affected by are a perfect genetic match for the patient. In 1998, created via therapeutic cloning can then be trans- thalidomide again became available to treat certain planted into the patient to treat a disease from conditions, and there is concern that babies may be which the patient suffers. In contrast to the goal of born with the thalidomide syndrome as they were in therapeutic cloning, the goal of reproductive the 1950s and early 1960s. Therapy is syn- epitomized by the flipper-like limbs (phocomelia), onymous with treatment. There are hypoplasia (underdevelopment) of the arms, espe- many types of medical thermometers, including oral cially affecting the radius and the thumb; thumbs thermometers (placed under the tongue), rectal with three joints; defects of the femur and of the thermometers (placed within the rectum), multipur- tibia; and malformations of the heart, bowel, uterus, pose thermometers (placed under the tongue, in the and gallbladder. The pattern of malformations rectum, or under the armpit), eardrum thermome- depends on the time of intake of the drug. During the sensitive period, ture changes indicating that ovulation has taken place taking thalidomide causes the following sequence of in a woman). In its active form, thi- • 39th–41st day: absent arms amine participates in a range of biochemical reac- tions, including certain reactions that are important • 43rd–44th day: phocomelia with three to carbohydrate metabolism. The thigh has only arms, legs, and internal organs, and the baby may one bone, the femur, which is the largest bone in the die. The thoracic vertebrae third ventricle One cavity in a system of four are represented by the symbols T1 through T12. The third ventricle is a median (mid- thoracotomy An operation to open the chest, line) cavity in the brain and is bounded by the thal- usually in order to gain access to the lungs or heart. It communicates anteriorly (in front) with the lateral thorax The area of the body that is located ventricles, and posteriorly (in back) with the aque- between the abdomen and the neck. Within the tho- duct of the midbrain, also known as the aqueduct of rax are the lungs, the heart, and the first section of Sylvius. For example, the version of a substance called fibrinogen to fibrin, thoracic aorta is the part of the aorta that lies within which promotes blood clotting. The clot lates lymph from the lymphatic circulation into the may plug a vessel in the lungs (pulmonary bloodstream.

Myasthenia gravis (1) Myasthenia gravis is an autoimmune disease in which antibodies complex with nico- tinic receptors at the neuromuscular junction to cause skeletal muscle weakness and fa- tigue proven proventil 100 mcg. Neostigmine or edrophonium can be used following surgery to reverse neuromuscular blockade and paralysis resulting from adjunct use of nondepolarizing agents proventil 100 mcg mastercard. Atropine and scopolamine poisoning can be treated with physostigmine, which reverses the central and (to some extent) the peripheral effects of competitive muscarinic antagonists. The adverse effects associated with indirect-acting sympathomimetic agents are an exten- sion of pharmacologic activity and arise from excessive cholinergic stimulation. Adverse effects include muscarinic effects similar to those of direct-acting cholinergic drugs and nicotinic effects such as muscle weakness, cramps and fasciculations, exces- sive bronchial secretions, convulsions, coma, cardiovascular collapse, and respiratory failure. Treatment includes the following steps: (1) Maintain respiration and decontaminate to prevent further absorption. Muscarinic-receptor antagonists produce cycloplegia by blocking parasympathetic tone, leading to paralysis of the ciliary muscle and loss of accommodation. These drugs produce mydriasis by blocking parasympathetic tone to the iris circular (con- strictor) muscle. Unopposed sympathetic stimulation of the radial muscle results in dilation of the pupil. These drugs dilate blood vessels in facial blush area (atropine flush), which is not related to the antagonist action. These drugs reduce peristalsis, resulting in prolonged gastric emptying and intestinal transit. Muscarinic-receptor antagonists produce some bronchodilation and decrease mucus secretion. These drugs relax the ureters and bladder in the urinary tract and constrict the urinary sphincter. Tertiary amines can produce restlessness, headache, excitement, hallucinations, and delirium. These drugs produce anhidrosis and dry skin because of the inhibition of sympathetic cho- linergic innervation of the sweat glands. Longer-acting muscarinic-receptor antagonists (such as homatropine) are generally pre- ferred as adjuncts to phenylephrine to prevent synechia formation in anterior uveitis and iritis. Cardiovascular system uses are limited and include the administration of these drugs as a treatment for acute myocardial infarction with accompanying bradycardia and hypotension or arrhythmias (e. Urinary tract uses of atropine and other muscarinic-receptor antagonists include the adminis- tration of these drugs for symptomatic treatment of urinary urgency in inflammatory bladder disorder. Oxybutynin (Ditropan), a selective muscarinc M2-receptor antagonist, tolterodine (Detrol), a selective muscarinic M3-receptor antagonist, and trospium (Spas Max), are addi- tional agents in this class used to treat certain urinary disorders. Antimuscarinic drugs, benztropine, biperiden, trihexyphenidyl, and others, are used as adjunct to levodopa therapy for some patients with Parkinson disease (see Chapter 5). The adverse effects of muscarinic-receptor antagonists are extensions of pharmacologic activ- ity and include mydriasis, cycloplegia, dry eyes, tachycardia, dry mouth, elevated temperature, dry skin, urine retention, agitation, hallucinations, and delirium (‘‘hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter’’). Physostigmine administration for treatment of tertiary amine overdose is not recommended. Neostigmine is used to treat poisoning with quaternary muscarinic-receptor antagonists. Drug interactions of muscarinic-receptor antagonists include the production of additive effects when administered with other drugs with muscarinic-receptor antagonist activity (certain anti- depressants, antipsychotics, and antihistamines). Because of a lack of selectivity and numerous adverse effects, they are used rarely in the clinical setting (hypertensive emergencies). Classified as either nondepolarizing or depolarizing types, neuromuscular junction-blocking drugs cause neuromuscular paralysis. Nondepolarizing neuromuscular junction-blocking drugs, the prototype is tubocurarine, are arranged in a bulky, rigid conformation. These agents prevent depolarization of the muscle and propagation of the action potential. Nondepolarizing agents are administered parenterally and are generally used for long-term motor paralysis. Nondepolarizing agents have durations of action that range from 20–90 minutes, which can be extended by supplemental fractional dosing and is increased by larger initial doses (although this also increases the likelihood of adverse effects). Most nondepolarizing agents are metabolized by the liver or are excreted unchanged. Tubocurarine (prototype), an isoquinoline derivative, is seldom used clinically at this time. It has the same properties, but with less histamine release and thus less hypotension and bronchoconstriction. Chapter 2 Drugs Acting on the Autonomic Nervous System 39 table 2-7 Properties of Some Skeletal Muscle Relaxants Nondepolarizing Duration of Ganglion Histamine Cardiac Muscarinic Agent Action Blockade Release Receptors Comments Tubocurarinea Long + ++ — Prototype Metocurinea Long + + — Less hypotension and broncho- constriction than tubocurarine Atracuriuma Intermediate — + — Inactivated spontaneously in plasma; laudanosine, a break- down product, may cause seizures.