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Smaller nonmyelinated dorsal root type C nerve fibers and lightly myelinated delta type A nerve fibers diclofenac 50 mg amex, which carry pain and temperature sen- sations (and also sympathetic type C unmyelinated postganglionic nerve fibers) discount 100mg diclofenac with mastercard, are blocked before larger, heavily myelinated type A fibers, which transmit sensory proprioception and motor functions. Local anesthetics are generally classified as either esters or amides and are usually linked to a lipophilic aromatic group and to a hydrophilic, ionizable tertiary (sometimes secondary) amine. Most are weak bases with pKa values between 8 and 9, and at physiologic pH they are primarily in the charged, cationic form. The potency of local anesthetics is positively correlated with their lipid solubility, which may vary 16-fold, and negatively correlated with their molecular size. These anesthetics are selected for use on the basis of the duration of drug action (short, 20 min; intermediate, 1–1. Local anesthetics act by blocking sodium channels and the conduction of action potentials along sensory nerves. At rest, the voltage-dependent sodium (Na ) channels of sensory nerves are in the resting + (closed) state. Following the action potential the Na channel becomes active (open) and then converts to an inactive (closed) state that is insensitive to depolarization. Following repolariza- tion of the plasma membrane there is a slow reversion of channels from the inactive to the rest- ing state, which can again be activated by depolarization. During excitation the cationic charged form of local anesthetics interacts preferentially with the inactivated state of the Na+ channels on the inner aspect of the sodium channel to block sodium current and increase the threshold for excitation. This results in a dose-dependent decrease in impulse conduction and in the rate of rise and ampli- tude of the action potential. This is more pronounced in rapidly firing axons, suggesting that local anesthetics gain access to the inner axonal membrane by traversing sodium channels while they are more often in an open configuration. Access to the inner axonal membrane may also occur by passage of the more lipophilic anesthetic molecules directly through the plasma membrane. They are adminis- tered topically, by infiltration into tissues to bathe local nerves, by injection directly around nerves and their branches, and by injection into epidural or subarachnoid spaces. The rate and extent of absorption to and from nerves are important in determining the rate of onset of action and termination of action and also the potential for systemic adverse effects. Their absorption rate is correlated with the relative lipid solubility of the uncharged form and is influenced by the dose and the drug’s physicochemical properties, as well as by tissue blood flow and drug binding. This reduces systemic absorption of the local anesthetic from the site of application, prolongs its action, and reduces its potential for toxicity. Epinephrine should not be coadministered for nerve block in areas such as fingers and toes that are supplied with end-arteries because it may cause ischemia or necrosis, and it should be used cautiously in patients in labor and in patients with thyro- toxicosis or cardiovascular disease. Ester-type local anesthetics are metabolized by plasma butyrylcholinesterase and thus have very short plasma half-lives. The metabolic rate of these anesthetics is decreased in patients with decreased or genetically atypical cholinesterase. Amide-type local anesthetics are metabolized at varying rates and to varying extents by he- patic microsomal enzymes (dealkylation and conjugation). The rate of metabolism of these anesthetics is decreased in patients with liver disease or decreased hepatic blood flow, or by drugs that interfere with cytochrome P-450 enzymes (e. Lidocaine (1) Lidocaine is the prototype amide; it has an intermediate duration of action. Mepivacaine (1) Mepivacaine has an intermediate duration of action that is longer than that of lidocaine. Chapter 5 Drugs Acting on the Central Nervous System 135 (2) Mepivacaine has actions similar to those of lidocaine, but it causes less drowsiness and sedation. Prilocaine (1) Prilocaine has an intermediate duration of action that is longer than that of lidocaine. Bupivacaine, Ropivacaine, Etidocaine (1) These drugs have a long duration of action. Cocaine (also see X D) (1) Cocaine is a short-acting, naturally occurring alkaloid that is used medically only for the topical anesthesia of mucous membranes. Tetracaine (1) Tetracaine is long acting but has a slow onset of action (>10 min). These anesthetics are used topically only to treat sun- burn, minor burns, and pruritus. Proparacaine is used topically for ophthalmology when rapid onset and short duration are desirable. Adverse effects are generally an extension of therapeutic action to block the membrane sodium channel. They are usually the result of overdose or inadver- tent injection into the vascular system. Systemic effects are most likely to occur with admin- istration of the amide class.

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Oval fat body Renal tubular epithe- Renal tubules Same as renal tubular Maltese crosses with lial cell containing fat epithelial cells polarized light droplets buy diclofenac 50 mg mastercard. Calcium oxalate Octahedral (8-sided) envelope form is most Occasionally found in slightly alk urine buy generic diclofenac 50 mg. Triple phosphate “Coffin-lid” crystal Ammonium biurate Yellow-brown “thorn apples” & spheres Seen in old specimens. Tyrosine Fine yellow needles in sheaves Severe liver disease Often seen with leucine. Ovoid, colorless, Usually due to vaginal or Add 2% acetic acid to differentiate from smooth, refractile. Protein/blood/microscopic Large amounts of blood or myoglobin can cause pos protein. Glucose/protein/microscopic Renal disease is common complication of diabetes mellitus. Type of process Noninflammatory Inflammatory Color Colorless Yellow, brown, red, green Clarity Clear Cloudy Specific gravity <1. Yellow when long axis of crystal is parallel to slow wave of red compensator; blue when perpendicular. Blue when long axis of crystal is parallel to slow wave of red compensator; yellow when perpendicular. Deliver to lab within Test monthly beginning 2 months after vasec- 1 hr of collection. Abnormalities: double heads, giant heads, amorphous heads, pinheads, tapering heads, constricted heads, double tails, coiled tails, large numbers of spermatids (immature forms). Foam stability index Fetal lung maturity Shake with increasing Index is highest concentration of ethanol (shake test) amounts of 95% ethanol that supports ring of foam after shaking. Lamellar body count Fetal lung maturity Count in platelet channel Number correlates with amount of phos- of hematology analyzers pholipid present in fetal lungs. Amniotic fluid bilirubin Hemolytic disease of the Direct spectrophotometric Bilirubin has peak absorbance at 450 nm. Gene Specific sequence of nucleotides (1,000–4,000) at particular location on chromosome. Starts at 5’end with promoter region that initiates transcription & ends at 3’end with terminator sequence that ends transcription. Present in nucleus & in cytoplasm where it’s associated with ribosomes (free or attached to endoplasmic reticulum). A pentose sugar with nitrogen base attached to 1’C & 1–3 phosphate groups attached to 5’C. Superscript (prime) differentiates Cs in sugar from Cs in bases, which are numbered 1–9. Base pairs Purine from 1 strand of nucleic acid & pyrimidine from another strand joined by hydrogen (H) bonds. Composition Repeating nucleotides linked by phosphodiester bonds between 5’ Repeating nucleotides linked by phosphate group of 1 sugar & 3’hydroxyl group of next. Synthesis on 5’–3’template is discontinuous, forming lagging strand of disconnected Okazaki fragments. Hybridization Pairing of complementary strands of nucleic acid, 1 from sample & 1 a reagent. Labeled with fluorescent or chemiluminescent dyes, enzymes, or radioisotopes to produce visible sign of hybridization. Lysis of cells, isolation by phenol-chloroform extraction or binding to silica, precipitation in alcohol. Can be stored suspended in ethanol for several months at –20°C or long term at –70°C. Target amplification Technique to↑amount of target nucleic acid in sample through in vitro replication, e. Probe amplification Technique to↑amount of probe bound to target so very small amounts of nucleic acid can be detected, e. Signal amplification Technique to↑signal generated so that very small amounts of nucleic acid can be detected, e. Polymerase Enzyme that assembles nucleotides to produce new strand of nucleic acid. Originally isolated from bacteriumThermus aquaticusin hot springs of Yellowstone National Park. Annealing (hybridization) 50°–70°C/ Primers attach to both template strands by binding with complementary 20–90 sec.

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A comedo generic diclofenac 100 mg mastercard, the primary sign of acne discount diclofenac 100 mg without a prescription, consists of a widened hair follicle filled with congenital malformation or congenital anomaly. A black- head has a wide opening to the skin and is capped birthmark A discoloration of the skin that may with a blackened mass of skin debris. Occasionally a specific an obstructed opening to the skin and may rupture type of birthmark can be a visible marker for a to cause a low-grade skin inflammatory reaction in more serious health problem. The kidneys filter waste from the the average population, or by the population at blood and produce urine, which enters the bladder midyear. In bisexual 1 An individual who engages in both women, the urethra is a short tube that opens just in heterosexual and homosexual sexual relations. In men, it is longer, passing Bisexual can also refer to the corresponding through the prostate gland and then the penis. Bisphosphonates are used to treat a form of urinary incontinence (the unintentional osteoporosis and the bone pain from diseases such loss of urine) and is relatively common, particularly as metastatic breast cancer, multiple myeloma, and in older adults. Bone is in a constant state of cle strengthening, behavioral therapy, and medica- remodeling, whereby new bone is laid down by cells tions. Bisphosphonates inhibit bladder cancer A common form of cancer that bone removal (resorption) by the osteoclasts. The most com- bisphosphonates include Fosamax (alendronate), mon warning sign is blood in the urine. Symptoms Actonel (risedronate), Boniva (ibandronate), and include pain during urination, frequent urination, Reclast (zoledronate). A diagnosis of bladder cancer is supported by findings bite In dental terms, how well the teeth fit in the medical history, physical examination, exam- together (occlude) in the mouth. Confirmation of the diagnosis requires a bladder pain Pain from the urinary bladder. The bladder is Among the symptoms of bladder infection are feel- lined with cells called transitional cells and squa- ings of pain, pressure, and tenderness around the mous cells. A tumor may grow through the lining bladder, pelvis, and perineum (the area between the into the muscular wall of the bladder and extend anus and vagina or anus and scrotum), which may into nearby organs such as the uterus or vagina (in increase as the bladder fills and decrease as it emp- women) or the prostate gland (in men). When blad- ties; decreased bladder capacity; an urgent need to der cancer spreads beyond the bladder, the malig- urinate; painful sexual intercourse; and, in men, nant cells are frequently found in nearby lymph discomfort or pain in the penis and scrotum. Surgical operations are commonly blastoma A tumor thought to arise in embryonic needed. This term is commonly used as part of the name for a tumor, as in glioblastoma and medul- bladder infection Infection of the urinary blad- loblastoma (types of brain tumors), hepatoblas- der. If bladder inflammation Inflammation of the uri- bleeding is caused by injury to a major blood vessel, nary bladder. Spontaneous bleeding infection from bacteria that ascend the urethra to in the skin can represent a serious underlying illness the bladder or for unknown reasons, such as with and requires medical evaluation. See need to urinate, often accompanied by a burning also hemorrhage; menstruation. As bladder inflammation progresses, blood may be observed in the urine and the patient blepharitis Inflammation of the eyelids. In young chil- Blepharitis occurs in two forms, anterior and poste- dren, attempts to avoid the pain of cystitis can be a rior. Anterior blepharitis affects the outside front of cause for daytime wetting (enuresis). The includes avoiding irritants, such as perfumed soaps, two most common causes of anterior blepharitis are near the urethral opening; increased fluid intake; bacteria (Staphylococcus) and scalp dandruff. Untreated Posterior blepharitis affects the inner eyelid (the bladder inflammation can lead to scarring and the moist part that makes contact with the eye) and is formation of stones when urine is retained for long caused by problems with the oil (meibomian) periods of time to avoid painful urination. Two skin disorders can cause this form of blepharitis: rosacea and seb- orrheic dermatitis. Only one eye may be affected initially, but eventually both eyes are usually blocker, beta See beta blocker. The spasms may leave the eyelids com- pletely closed, causing functional blindness even blood The red fluid in the body that contains though the eyes and vision are normal. Blood flows in two blighted ovum A fertilized ovum (egg) that did directions: away from the heart (arterial blood) and not develop or whose development ceased at an toward the heart (venous blood). On the a high concentration of oxygen and nutrients for ultrasound examination of a blighted ovum, only the body tissues, and venous blood is the means by gestational sac that normally surrounds the embryo which carbon dioxide is transported to the lungs for can be seen. The white blood cells (leukocytes) blinded study A clinical trial of drugs in which are a blood-borne part of the immune system. The the test participants do not know whether they are platelets help blood to clot. Together, these three receiving the product being tested or a placebo types of cells make up about half of the volume of (dummy).