By C. Gunock. Southwest Baptist University.

In high intracellular concentrations order uroxatral 10 mg with mastercard, iodide inhibits several steps in thyroid hormone bio- synthesis buy generic uroxatral 10 mg, including iodide transport and organification (Wolff-Chaikoff effect) order uroxatral 10mg amex. This agent is used before thyroid surgery buy uroxatral 10mg with visa, causing firming of thyroid tissues and decreased thyroid vascularity, and in the treatment of spirotrichosis. Iodide may cause angioedema, rash, a metallic taste on administration, and hypersensitivity reactions. Radioactive iodine I emits beta particles and x-rays and has a radioactive t1/2 of approxi- 131 mately 8 days. Radioactive iodine 131I treats hyperthyroidism via nonsurgical ablation of the thyroid gland or reduction of hyperactive thyroid gland without damage to surrounding tissue. This agent is helpful (in low doses) in the diagnosis of hyperthyroidism, hypothyroidism, and goiter; it may be used to assess thyroid responsiveness. Bovine insulin differs from human insulin at three amino acid sites; porcine insulin differs in only one amino acid. Insulin is stored as a complex with Zn2+; two molecules of zinc complex six molecules of insulin. Insulin synthesis and release are modulated by the following: (1) The most important stimulus is glucose. Insulin alters the phosphorylation state of key metabolic enzymes, leading to enzymatic activation or inactivation. Insulin induces the transcription of several genes involved in increasing glucose catabolism and specifically inhibits transcription of other genes involved in gluconeogenesis. Liver (1) Inhibits glucose production and increases glycolysis (2) Inhibits glycogenolysis and stimulates glycogen synthesis (3) Increases the synthesis of triglycerides (4) Increases protein synthesis b. Muscle (1) Increases glucose transport and glycolysis (2) Increases glycogen deposition (3) Increases protein synthesis c. Adipose tissue (1) Increases glucose transport (2) Increases lipogenesis and lipoprotein lipase (3) Decreases intracellular lipolysis 4. Insulin is degraded by hepatic glutathione–insulin transhydrogenase, which reduces the di- sulfide linkages between the A and B chains, producing two biologically inactive peptides. Insulin preparations are often mixed to control blood sugar levels: A single morning injec- tion of a lente or ultralente form is typically supplemented with preprandial injections of a rapid-acting product. Insulin glulisine, insulin aspart, and insulin lispro are human insulins that have been modified at 1–2 amino acids in the B chain to increase their solubility. They provide bet- ter postprandial control of glucose levels than regular insulin. Hypoglycemia may occur from insulin overdose, insufficient caloric intake, strenuous exer- cise, or when combined with ethanol. Sequelae include tachycardia, sweating, and sympa- thetic and parasympathetic actions that can progress to coma. Structure (1) First-generation compounds include tolbutamide, acetohexamide, tolazamide, and chlorpropamide. Mechanism of action (1) Sulfonylureas cause an increase in the amount of insulin secreted by the b cells in response to a glucose challenge. Sulfonylureas block K+ channels in b cells, leading to depolarization, increased Ca2+ entry via voltage-dependent calcium channels, and increased secretion. However, sulfonylureas do not decrease the insulin requirements of patients with type I diabetes. Pharmacologic failure with oral antidiabetic agents is common, initially affecting 15%–30% of patients and as many as 90% after 6–7 years of therapy. Chapter 10 Drugs Acting on the Endocrine System 241 (c) As with all sulfonylureas, hypoglycemia is a potentially dangerous adverse effect of these short-acting agents. Water retention is common, and alcohol consumption produces a disul- firam-like reaction in some patients. Metformin reduces hepatic glucose production and intestinal absorption of glucose; it does not alter insulin secretion. Metformin may be used alone or in combination with sulfonylureas and thiazolidinediones. Nateglinide has a more rapid onset of action and is more specific for pancreatic K channels than repaglinide. These drugs are metabolized by the liver and should not be used in patients with hepatic insufficiency. They act as competitive, reversible inhibitors of pancreatic a-amylase and intestinal a- glucosidase enzymes; they act in the lumen of the intestine. Inhibition of a-glucosidase prolongs digestion of carbohydrates and reduces peak plasma glucose levels. Unlike acarbose, miglitol does not inhibit pancreatic a-amylase but does inhibit isomaltose. These drugs are usually combined with a sulfonylurea or another oral hypoglycemic agent. Thiazolidinediones are a new class of oral hypoglycemic agents that act by increasing tissue sensitivity to insulin. Thiazolidinediones predominantly affect liver, skeletal muscle, and adipose tissue. Exenatide decreases glucagon secretion, slows gastric emptying, reduces food intake, and promotes b-cell proliferation. Sitagliptin is the first in a new class of antidiabetic agents that act by inhibiting dipeptidyl peptidase 4, a serine protease. In monotherapy or in combination with metformin, sitagliptin decreased fasting and post- prandial plasma glucose concentrations and plasma HbA1c concentration. Amylin is a polypeptide stored and secreted by b-cells of the pancreas, and it acts in concert with insulin to reduce blood sugar. Pramlintide acts to slow gastric emptying, decrease glucagon secretion, and decreases appetite. Structure and synthesis (1) Glucagon is a single-chain polypeptide of 29 amino acids produced by the a cells of the pancreas. Chapter 10 Drugs Acting on the Endocrine System 243 (3) Secretion of glucagon is inhibited by elevated plasma glucose, insulin, and somatostatin. Glucagon rapidly increases blood glucose in insulin-induced hypoglycemia if hepatic glycogen stores are adequate. The adverse effects of glucagon are minimal; there is a low incidence of nausea and vomiting. Diazoxide is a nondiuretic thiazide that promptly increases blood glucose levels by direct inhibition of insulin secretion. Calcium is the major extracellular divalent cation, primarily (40%–50%) existing as free ion- 2+ 2+ ized Ca (the biologically active fraction). Approximately 40% of serum Ca is bound to plasma proteins, especially albumin, with the remaining 10% complexed to such anions as citrate. This is mediated by cytokines produced by osteoblasts that regulate the number and activity of osteoclasts. Infrequent adverse effects include dizziness, depression, pain, headache, and leg cramps. Calcitonin is a 32-amino acid peptide secreted by perifollicular cells of the thyroid gland in response to elevated plasma Ca2+.

Aldosterone stimulates reabsorption of salt and water from the distal convoluted tubules safe 10 mg uroxatral. Then uroxatral 10mg without prescription, gradually progresses to edema of lower limbs; especially on prolonged standing and at the end of the day discount 10mg uroxatral otc. In severe cases edema may progress to be generalized anasarca with ascites- even pleural and pericardial effusion discount 10 mg uroxatral free shipping. Hypertension: may be detected in nearly 50% of the cases, according to the etiologic and pathologic type of nephrotic syndrome. For example idiopathic minimal change nephrotic syndrome cases are always normotensive while cases with mesangiocapillary glomerulonephritis whether idiopathic or secondary are always hypertensive. Hypertension is either due to salt and water retention or it may be due to the excess secretion of renin. Other manifestations of nephrotic syndrome include lassitude, anorexia, loss of appetite and pallor. Manifestations of the etiologic cause in secondary cases as manifestations of diabetes in cases with diabetic nephropathy. Subnutritional State: Due to poor dieting, and urinary losses of protein and other substances. Recurrent infection is due to nutritional deficiencies, urinary loss of immunoglobulins and complements. Increased concentration of coagulation factors resulting from an increased hepatic synthesis e. This complication occurs mainly in cases with frequent relapses or cases resistant to treatment. Other Immunosuppressive drugs as cyclophosphamide which may cause haemorrhagic cystitis, alopecia, infection and malignancy. Acute renal failure, this may be due to severe hypovolaemia (due to the severe hypoalbuminaemia and use of big doses of diuretics), or due to acute interstitial nephritis (drug induced as large dose of furosemide). Bone disease: Due to hypocalcemia (resulting from deficient intake and urinary loss of vitamin D binding globulin). Urine analysis for proteinuria, microscopic haematuria, pus cells, casts, also collect 24 hours urine for quantitation of urinary protein excretion. Blood for hypoalbuminaemia, hyperlipidaemia, hypocalcaemia and for serum creatinine level. Kidney biopsy: in children, kidney biopsy is indicated only in steroid resistant or steroid dependent cases as well as in frequent relapsers and those with impaired kidney functions. But in adults, it is wise to routinely obtain kidney biopsy to determine the underlying pathology so that specific treatment can be initiated if indicated. Treatment of the cause in secondary cases- for example- by proper control of blood sugar in D. Treatment of complications as infection by antibiotics and under nutrition by giving proper dieting, minerals and vitamins. Protein content should equal the daily physiologic needs (1g/kg) plus the amount of daily urinary protein loss e. Frusemide) initially can be given orally in variable doses (according to severity and response e. Addition of metolazone (a thiazide diuretic) may have a potentiating effect for frusemide in diuretic resistant cases. So it is indicated only when there is severe oedema resistant to large doses of diuretics and if the nephrotic patient is to be subjected to surgery or invasive procedure (e. This improves circulating blood volume and prevents hypotension or shock during the procedure. Corticosteroids are given when there is no response to previous lines of treatment. Minimal change glomerulonephritis gives the best response while mesangiocapillary glomerulonephritis is always steroid resistant. The dose and duration of steroid treatment depends on the type of disease and response. In primary (idiopathic) minimal change nephritis 40-60 mg daily prednisone are given orally (for children 1- 2 mg/kg/d), for 4-6 weeks followed by gradual withdrawal. Other immunosuppressive drugs as cyclophosphamide, azathioprine and ciclosporin are indicated in selected cases. The period between infection and the appearance of glomerulonephritis (latent period) is 1-3 weeks for pharyngeal infection and 2-4 weeks for skin infection. Clinical picture: Usually the patients present with manifestations of acute nephritic syndrome with oliguria, smoky urine, puffiness of the face and headache (as a result of hypertension). Some patients may develop encephalopathy as a result of severe hypertension or hyponatraemia or they develop heart failure because of hypertension and fluid retention. Streptococcal antigens stimulate the body to form antibodies against them with the subsequent immune complex formation. Urine may show red cell casts, proteinuria (less than in nephrotic syndrome), haematuria or leucocyturia. Severe cases may show glomerular crescents (cases presenting clinically with rapidly progressive glomerulonephritis). Treatment: Treatment of poststreptococcal glomerulonephritis is mainly symptomatic (rest, salt restriction, diuretics, antihypertensives, treatment of infection and dialysis if renal failure develops). Prognosis: Most of the cases (85%) recover completely, 5% die in early phases from complications (hypertensive encephalopathy or heart failure). The rest of the cases pass to chronic glomerulonephritis and develop chronic renal failure. Signs of bad prognosis are persistently rising serum creatinine, heavy proteinuria, persistent hypertension with gross haematuria and presence of glomerular crescents in renal biopsy. Renal involvement may be the dominant lesion or may be just an incidental finding. Generally, when the kidney is involved, the prognosis and type of treatment are changed drastically. It affects caucasian more than black and occurs more in adolescents than in elderly. Most probably the disease reflects an exaggerated response to common environmental agents in a genetically susceptible host. But, if kidney biopsies are obtained and examined thoroughly, all patients will show glomerular disease. In clinical practice lupus nephritis is responsible for more than 5% of patients presenting with glomerulonephritis. Clinical Manifestations of Lupus Nephritis: It is known that 50-90% of lupus patients will show manifestation(s) of renal disease. Many of such patients may not show any clinically apparent renal disease, but when subjected to kidney biopsy glomerular lesions will be detected.

A person infected with inhalation anthrax cles (for example uroxatral 10mg mastercard, muscles in the bladder) purchase uroxatral 10 mg with visa. Side experiences local bleeding and tissue death (necro- effects of anticholinergic medications include dry sis) in these lymph nodes purchase 10mg uroxatral otc, and the disease spreads to mouth and related dental problems buy uroxatral 10 mg overnight delivery, blurred vision, the adjacent lung tissue. The first symptoms are sub- tendency toward overheating (hyperpyrexia), and in tle, gradual, and somewhat flu-like, including rising some cases, dementia-like symptoms. The phenomenon of Antigen-antibody complexes initiate immune anticipation was once thought to be an artifact, but responses. Antihistamine side effects that may occur include anticoagulant An agent that is used to prevent the urine retention in males and increased heart rate. Some are used for the prevention or treat- antihypertensive A medication or another sub- ment of disorders characterized by abnormal blood stance that reduces high blood pressure (hyperten- clots and emboli. Anticoagulant solutions are also used for the preservation of stored whole antineoplastic 1 Acting to prevent, inhibit, or blood and blood fractions and to keep laboratory halt the development of a neoplasm (a malignant blood specimens from clotting. Some antinuclear antibody An antibody that is antidepressants may also be prescribed for their directed against the structures within the nucleus of other medical effects, including increasing blood a cell and that is characteristic of autoimmunity. Well-known antioxidants include enzymes and other substances, such as vitamin C, vitamin E, and beta antidote A drug that counteracts a poison. Antioxidants are also antifungal A medication that limits or prevents commonly added to food products such as veg- the growth of yeasts and other fungal organisms. Antioxidants clearly slow the progression of combats an antigen with the production of an anti- age-related macular degeneration. Treatments tions used during medical procedures or used to include the comfort offered by understanding the maintain sanitary conditions in nursing homes, bar- condition, avoiding or desensitizing exacerbating sit- bershops, tattoo parlors, and other facilities where uations, and medications. The aorta arises antispasmodic A medication that relieves, pre- from the left ventricle of the heart, ascends a little, vents, or lowers the incidence of muscle spasms, arches, and then descends through the chest and especially those of smooth muscle such as in the the abdomen, ending by dividing into two arteries, bowel wall. Anatomically, the aorta is tradi- antitoxin 1 An antibody that is naturally produced tionally divided into the ascending aorta, the aortic to counteract a toxin, such as a toxin from a bacter- arch, and the descending aorta. The aorta has branches to the head and toxins are of short-term value only and are used for neck, the arms, the major organs in the chest and treatment rather than prevention. See also abdominal aorta; antiviral agent A medication or another agent ascending aorta; descending aorta; thoracic that kills viruses or inhibits their capability to repro- aorta. At the point of coarctation, the sides of the detect and record the contractions of the muscles of aorta appear to be pressed together. Blood pressure the stomach and duodenum in order to diagnose is increased above the constriction, and the flow of motility disorders of the stomach and small intes- blood is impeded below the level of the constriction. A tube is passed through the nose, throat, Symptoms may not be evident at birth but can esophagus, and stomach, until the tip lies in the develop as soon as the first week after birth, with small intestine. The tube senses when the muscles of congestive heart failure or high blood pressure that the stomach and small intestine contract and call for early surgery. For example, the antrum of the stom- ach (gastric antrum) is a portion before the outlet, aortic arch The second section of the aorta fol- which is lined by mucosa and does not produce lowing the ascending aorta. The paranasal sinuses can be referred to as heart, it gives off the brachiocephalic trunk, and the the frontal antrum, ethmoid antrum, and maxillary left common carotid and subclavian arteries. An Apgar score of 10 means an infant artery and left subclavian artery, the second and is in the best possible condition. The Apgar score is third branches off the aortic arch, perform parallel done routinely 60 seconds after the birth of the functions on the left side. The Apgar score is often aortic insufficiency Backflow of blood from the repeated 5 minutes after birth, and in the event of a aorta into the left ventricle across a weakened aor- difficult resuscitation, the Apgar score may be done tic valve. Aphasia may also be tic valve, the valve between the left ventricle of the used to describe defects in spoken expression or heart and the aorta. The need for surgery apheresis The process of removing a specific depends on the degree of stenosis. Also known as called balloon valvuloplasty has been used in some hemapheresis and pheresis. It normally permits blood from the left ven- harvesting lymphocytes; lymphoplasmapheresis, tricle to flow into the aorta, and prevents blood in harvesting lymphocytes and plasma; and platelet- the aorta from returning to the heart. For example, an apical lung tumor is a tumor aortitis include syphilis and rheumatic fever. Apert syndrome The best-known type of acro- apnea The absence of breathing (respiration). See also acrocephalosyndactyly; apophysitis calcaneus Inflammation of the fibroblast growth factor receptor. The apex of the lung is indeed its be very painful, although it may be dismissed as tip—its rounded most superior portion. This score is determined by scoring the heart rate, respiratory effort, muscle apoptosis A form of cell death in which a pro- tone, skin color, and response to a catheter in the grammed sequence of events leads to the elimination http://www. Apoptosis plays a crucial role motor movement despite being able to demonstrate in developing and maintaining the health of the body normal muscle function. Apraxia is not related to a by eliminating old cells, unnecessary cells, and lack of understanding or to any kind of physical unhealthy cells. The human body replaces perhaps paralysis; rather, it is caused by a problem in the one million cells per second. When apoptosis does not work correctly, cells that should apraxia of speech A severe speech disorder be eliminated may persist and become immortal, characterized by an inability to speak or a severe for example, in cancer and leukemia. Apraxia of speech occurs sis works overly well, it kills too many cells and when the oral-motor muscles do not or cannot obey inflicts grave tissue damage. This is the case in commands from the brain or when the brain cannot strokes and neurodegenerative disorders such as reliably send those commands. Appendicitis may be suspected because of the of four communicating cavities that are continuous medical history and physical examination. The ventri- of appendicitis can be located in various areas of cles are filled with cerebrospinal fluid, which is car- the belly. Sufferers from arachnophobia experi- within the scrotum that is attached to the backside ence undue anxiety, even though they realize that the of the testis), which represents a remnant of the embryologic mesonephros. They may avoid going appendix epiploica A finger-like projection of barefoot and may be especially alert when taking fat attached to the colon. The arguments in their favor are that, for Growth by apposition is characteristic of many tis- patients, the case can be settled faster, and more sues in the body by which nutritive matter from the money can go to the patient (rather than to a blood is transformed on the surface of an organ into lawyer). Many other types of arboviral Arnold Chiari malformation See Chiari mal- encephalitis occur throughout the world. It causes West Nile which essential oils or other scents are inhaled to encephalitis, also known as West Nile fever. When archaea A unique group of microorganisms that stimulated, the arrector pili contracts and causes are called bacteria (Archaeobacteria) but are genet- the hair to become more perpendicular to the skin ically and metabolically different from all other surface, thereby erecting the hair (causing the hair known bacteria. The arrector pili muscle plays a survivors of an ancient group of organisms that key role in forming goose bumps. With an arcus senilis A cloudy opaque arc or circle arrhythmia, the heartbeats may be irregular or too around the edge of the eye, often seen in the eyes of slow (bradycardia), too rapid (tachycardia), or too the elderly.

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