In painful or longstanding spasmodic affections of the pulmonary region purchase kamagra 100mg online erectile dysfunction medication online pharmacy, as in whooping cough or bronchitis buy generic kamagra 50mg online erectile dysfunction caused by hemorrhoids, it will be advantageous and discount kamagra 50mg without prescription what food causes erectile dysfunction, at the same time, it influences the digestive apparatus, correcting nausea, cholera and diarrhea, which may be present. Newton considered its most important influence to be exercised upon the generative apparatus. It is a stimulant to the muscular structure of the womb and to the ovaries, and is abortive and an active parturient, and may be given to good advantage in recent cases of amenorrhea from cold. During labor, when the pains are excessive, and when there is extreme erythism, a few drops of the tincture may be put in half a glass of water and a teaspoonful administered every five or ten minutes. In metrorrhagia and in menorrhagia, where the flow is steady but not free, where there are cutting pains in the abdomen and groin, extending down the thighs, with aching in the back, the patient nervous and irritable, this remedy will restore the flow to its normal proportions, will relieve the nerve tension and subdue pain. Violent pain in the small of the back on the approach of the menstrual epoch, which seems to interfere with the breathing, is said to be a diagnostic indication for this Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 56 remedy. Where there is melancholy and nervous disturbance in the early part of pregnancy, so that miscarriage seems to be threatened, a teaspoonful of asarum every two or three hours will sometimes restore the patient to normal condition. Swamp milkweed affects the heart and arteries like digitalis, and is a speedy and certain diuretic. Specific Symptomatology—Asclepias Incarnata strengthens the heart and is given in small doses, instead of digitalis, as a diuretic in dropsy. It often promptly relieves the general distress from extreme infiltration of the tissues especially the dyspnea. Therapy—It may be given in coughs and colds, rheumatism from cold, painful stitches in the chest with threatened inflammation of the lungs and pleura, asthma, chronic gastric catarrh, diarrhea, dysentery, dropsy, worms, erysipelatous diseases. It improves digestion, and is a good remedy in chronic catarrh of the stomach, and in catarrhal inflammation of the respiratory organs. It is both emetic and cathartic and may be used with advantage in the early stages of dysentery and diarrhea. In rheumatic and catarrhal inflammations it should be given to produce slight nausea. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 57 It is also beneficial as a local and internal remedy in erysipelas and erysipelatous diseases. He says: “No other remedy with which we are acquainted is so universally admissible in the treatment of disease, either alone or in combination. In fact we think of no pathological condition that would be aggravated by its employment. It expels wind, relieves pain, relaxes spasm, induces and promotes perspiration, equalizes the circulation, harmonizes the action of the nervous system, and accomplishes its work without excitement; neither increasing the force or frequency of the pulse, nor raising the temperature of the body. It is of special service in the treatment of affections involving the serous membranes, as pleuritis, peritonitis, etc. The most active apparent influence of this agent is upon the sudori- parous glands. It is mild in its influence, but if given with confidence it will produce good results. Specific Symptomatology—Its first direct effect is upon the serous membranes within the thorax. It is specific in pleuritic pains, both of the acute and subacute variety, in doses of fifteen drops every two or three hours. For these I have long prescribed this agent with positiveness, and have yet to be disappointed. If effusion be present, its rapid removal is Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 58 facilitated. The pain and distress abate, the cough disappears, the respiration becomes free and natural, the inspiration being especially pleasant; the heart takes on increased tone, and the entire contents of the thoracic cavity seemed benefited. I have treated with this remedy the “stitch in the side,” which had been present for many months after pleurisy, and have removed it satisfactorily. This agent will cure pains in the chest unaccompanied by prominent symptoms, acute, sharp and cutting, recurrent or persistent in their character, if given in doses of half a dram every two or three hours and persisted in for a few days. Therapy—It is beneficial in acute pleuritis specifically, also in bronchitis, pneumonitis and peritonitis. In tight and painful coughs with difficult respiration, especially where there is a general suspension of secretion, with dry skin and mucous membranes, and in soreness of the chest from coughing, it is a most excellent remedy. In all these conditions if there is the least elevation of temperature its influence will be greatly enhanced if given in conjunction with aconite. It was in great repute among the older Eclectic physicians in the treatment of acute pleuritis, as suggested above. They also used it in acute inflammations of serous membranes, especially if there were acute, quick pains, and a tendency to serous effusion. Its eliminative action upon the skin greatly enhances its influence in these cases. It may be combined with such agents as cimicifuga and colchicum, and will markedly intensify their action, especially if aconite be indicated. Therapy—A most active gastro-intestinal irritant, it is given to remove tapeworm, The oleoresin is given in doses of half a dram in capsules. One-half to one dram of the fluid extract may be given, or half an ounce of the leaves are steeped in half a pint of water and this is taken before breakfast. Oils should not be given after this agent, as they facilitate the absorption of its toxic principle which exercises a profound influence upon the nervous system. The usual preparation of the patient is essential and it is necessary to follow the removal of the worm with mild tonics and restoratives. Unlike those often used, this agent does not produce unpleasant results, being in every way a safe remedy if taken in proper doses. Extractum Belladonnae Foliorum Alcoholicum, Alcoholic Extract of Belladonna Leaves. Admistration—The official fluid preparations in most part of Belladonna Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 60 vary so much in strength that they cannot be relied upon for activity as compared with each other. Using the product of a single reliable manufacturer one ultimately learns the strength of that product and is thus able to adjust it accurately. The normal tincture of The Merrell Company, the Homeopathic mother tincture, and the specific medicine are all reliable preparations, but vary greatly in comparative strength. The specific medicine is very active, and I would advise that each prescriber dilute a given quantity with four parts of alcohol and prescribe this as a strong tincture. Ten drops of this in a four-ounce mixture given in dram doses will be found uniformly active for children. Physiologic Influence—In its full primary influence, belladonna is an excitant to the cerebrum, promoting active hyperemia—a profoundly full, active condition of the cerebral capillary circulation. I will show later on that this influence of dilating the capillaries, combined with the stimulating influence of the agent upon the heart, with a characteristic influence in contracting the capillaries of the splanchnic area, makes this the most powerful agent known, in its direct influence upon pathologic hyperemia or a tendency to stagnation in any of the capillaries, whatever organ they may be distributed to. I will also show that this influence can serve as a guide in the prescribing of this remedy in a rational manner, more profoundly than any other influence the remedy exercises. When given in full doses the fulness of the capillary circulation induced produces a flushing of the face, a bright redness of the skin, which in sufficient dose is general over the entire body.
The Swan-Ganz catheter can also be used to determine cardiac output by injection of saline into the right atrium buy kamagra 50mg with visa erectile dysfunction inventory of treatment satisfaction questionnaire. A thermistor on the Swan-Ganz catheter tip allows thermodilution analysis and calculation of blood flow through the heart buy 100 mg kamagra with mastercard erectile dysfunction 37 years old. Because all blood that passes through the pulmonary artery is soon ejected from the heart by the left ventricle generic kamagra 100mg visa erectile dysfunction uptodate, this technique is used to approximate left ventricular output. Techniques for measuring cardiac chamber volume are also available, including transthoracic and transesophageal echocardiography (see Figures 4-6). A certain degree of expertise is required to perform these procedures, and the studies can be technically difficult in certain patients. Echocardiography is advantageous in that it allows the simultaneous evaluation of cardiac chamber volume, wall motion, and valvular function. Transthoracic and transesophageal echocardiography can be used to evaluate cardiac function and structure. The transthoracic approach is more expedient and can be performed on awake, non-sedated patients. However, the quality of the images may be inferior to those obtained using the transesophageal approach. In addition, transthoracic echocardiography requires that appropriate acoustic windows be identified. In certain patients (patients with chest wall deformities, trauma patients Congestive Heart Failure – Andrew Patterson, M. However, the transesophageal approach requires placement of the echo probe into the esophagus and/or the stomach. Transesophageal echocardiography, therefore, requires that the patient be sedated or undergo general anesthesia. Four views are used in transthoracic echocardiography: parasternal, apical, subcostal, and suprasternal. To obtain an appropriate image, an acoustic window must be identified that avoids the sternum, the ribs, or other organs. The apical approach affords a four-chamber view that can be used to estimate ventricular volume. Transthoracic Echocardiography can be used to determine Preload and Stroke Volume/Cardiac Output. Preload can be evaluated in two ways: By estimating the left ventricle end diastolic volume and by evaluating the inferior vena cava diameter. Stroke volume/cardiac output can also be evaluated in two ways: By using the Simpson Method and by measure how much blood flows through the left ventricle outflow tract during each heart beat. The Simpson Method involves tracing the endocardial border of the left ventricle at end systole (top left) and at end diastole (top right). The calculated end systolic volume is then subtracted from the end diastolic volume to determine the stroke volume. The cardiac output can then be estimated by multiplying the stroke volume by the heart rate. Note that echocardiography provides two- dimensional images of a three dimensional structure. On the right side, an M- mode beam is shown being directed across the inferior vena cava as it enters the right atrium. To evaluate left ventricle preload, the diameter of the inferior vena cava is measured at inspiration and at expiration. The objective is to assess whether respiratory variation in the inferior vena cava diameter is present. If the inferior vena cava is less than 2 cm or if respiratory variation exists, the patient’s intravascular volume may be depleted and cardiac output might be improved by increasing the intravascular volume (i. On the right, its diameter is measured after zooming in on the structure during mid-systole. Using the diameter measurement, a Cross Sectional Area of the left ventricle outflow tract can be calculated. This is part of the calculation to determine how much blood is flowing through the left ventricle outflow tract with each heart beat. The other part of the calculation involves determination of the Velocity Time Integral using the apical five chamber view. In the fourth row of images, an apical five chamber view is Congestive Heart Failure – Andrew Patterson, M. The apical five chamber view can be used to calculate the Velocity Time Integral using pulse doppler imaging. On the left, the pulse doppler beam is directed in the line of the left ventricular outflow tract. On the right, a pulse doppler measurement is taken just proximal to the aortic valve and the Velocity Time Integral is calculated by determining the area under the curve. The left ventricle stroke volume can be calculated by multiplying the Cross Sectional Area of the left ventricle outflow tract and the Velocity Time Integral. The details of the measurements described in this figure legend are beyond the scope of this course. However, the idea that left ventricle preload and stroke volume/cardiac output can be easily determined using echocardiography should be appreciated (i. Increasing “preload” (1) will improve ventricular output in normal, hyperdynamic, and failing hearts within certain limits. Venodilators (4) and diuretics (5) can decrease ventricular volume by causing “pooling” of blood outside the central venous system and by reducing intravascular volume, respectively. Clinically, it is useful to plot “preload” versus ventricular output (the Starling relationship). By doing so, one can easily identify normal, hypodynamic, and hyperdynamic ventricular function. The inotropic state of the cardiac muscle as well as the “afterload” determines the Starling Curve on which the heart “moves. Thompson) presents to your clinic with shortness of breath that has become progressively more severe during the past month. Thompson reports that during the past month she developed an intolerance to lying flat and now requires four pillows to prop her head up when sleeping. She also describes fatigue that has worsened over the course of the past six weeks. She had been breastfeeding, but her fatigue and shortness of breath have forced her to transition the baby to formula feeds. Auscultation of the chest reveals bilateral crackles, a third heart sound, and a pansystolic murmur best heart at the apex consistent with mitral regurgitation. If you were to repeat the transthoracic echocardiogram, would you expect to see a difference in the wall motion or dimensions of the left ventricle compared to the prior examination? You decide to begin an infusion of dobutamine (an inotropic and afterload reducing agent). If you were to repeat the transthoracic echocardiogram once again, would you expect the wall motion of the left ventricle to change after institution of the dobutamine infusion? The pressure volume-loop (see Figure 8) diagrams the relationship between intraventricular pressure and volume throughout the cardiac cycle.
In order to obtain clinically relevant results order cheap kamagra on-line erectile dysfunction injections videos, the metabolism of the drug candidate by human liver microsomes must be examined at pharmacologically relevant concentrations of the drug candidate order genuine kamagra on-line erectile dysfunction solutions, as illustrated for lansoprazole 5-hydroxylation in Figure 20 generic kamagra 50mg with mastercard purchase erectile dysfunction drugs. In our laboratory, reaction phenotyping is carried out with a bank of human liver microsomal samples (e. Banks of human liver microsomes intended for correlation analysis are commercially available as kits (e. The latter determination also provides a measure of the statistical significance of any correlations. Correlation analysis provides valuable information on the extent to which the metabolism of a drug candidate will potentially vary from one subject to the next (i. However, when two or more enzymes contribute to metabolite formation, corre- lation analysis may lack the statistical power to establish the identity of each enzyme. Statistically significant correlations should always be confirmed with a visual inspection of the graph because there are two situations that can produce a misleadingly high correlation coefficient: (1) the regression line does not pass through or near the origin and (2) there is an outlying data point that skews the correlation analysis, as illustrated in Figure 25. Correlation analysis works particularly well when a single enzyme dominates the formation of a particular metabolite. This approach success- fully identifies the enzymes involved when each enzyme contributes 25% or more to metabolite formation, but it will likely not identify an enzyme that contributes only approximately 10%. A graphical representation of the application of multivariate analysis to the results of a reaction phenotyping experiment is shown in Figure 26, on the basis of an examination of the sample-to-sample variation in the 1-hydroxylation of bufuralol (12 mM) by a panel of human liver microsomes. The sample-to-sample variation in bufuralol 1-hydroxylation correlates reasonably well with In Vitro Study of Drug-Metabolizing Enzymes 327 Figure 25 Common pitfalls in correlation analysis. Correlation analysis is suspected when the regression line is unduly affected by a single outlying data point, or when the regression line does not pass near the origin. When two enzymes contribute significantly to metabolite formation, their identity and relative con- tribution can be established by performing correlation analysis in the presence and absence of an inhibitor of one of the participating enzymes (preferably the major contributor). This approach works even when one of the enzymes contributes substantially less than 25% to metabolite formation, as was demonstrated by 328 Ogilvie et al. Chemical and Antibody Inhibition Chemical and antibody inhibition represent the second and third approaches to reaction phenotyping. As in the case of correlation analysis, chemical and antibody inhibition experiments must be conducted with pharmacologically relevant concentrations of the drug candidate in order to obtain clinically relevant results. Therefore, appropriate solvent and preincubation controls should be included in all chemical inhibition experiments. The lack of specificity can complicate the interpretation of chemical inhibition experiments. If a drug candidate is metabolized by a high-affinity enzyme, the con- centration of a competitive chemical inhibitor must be increased with increasing concentration of the drug candidate in order to achieve a high degree of inhi- bition. A good rule of thumb is to use multiples (generally up to 10-fold) of the lowest inhibitor concentration, which is calculated from the following equation: ½DrugÁKiðinhibitorÞ Lowest½Inhibitor¼ ð10Þ KmðDrugÞ where [Drug] is the intended final concentration of the drug candidate added to the microsomal incubation, Ki is the inhibition constant of the inhibitor for a given enzyme, and Km is the Michaelis constant of the drug candidate (as determined in Step 3). This method of calculating of the lowest concentration of inhibitor is applicable to competitive inhibitors but not to noncompetitive or metabolism-dependent inhibitors. A range of inhibitor concentrations is rec- ommended to demonstrate concentration dependence. For example, if the lowest concentration of the chemical inhibitor were calculated to be 1 mM (from the above equation), then the range of inhibitor concentration should span at least 10-fold (e. If both enzymes contribute to metabolite formation, the inhibitory effect of the chemical on one enzyme may be offset by its activating effect on the other enzyme. When chemical inhibition experiments are conducted with a relatively metabolically stable drug candidate (one that must be incubated with relatively high concentrations of human liver microsomes for a relatively long time in order to generate quantifiable levels of metabolite), it is important to take into account the metabolic stability of the inhibitors themselves. Lack of metabolic stability makes some compounds poor choices as chemical inhibitors despite their selectivity. Finally, appropriate controls should be included in each chemical inhibi- tion experiment to evaluate whether any of the chemical inhibitors interfere with the chromatographic analysis of the metabolites of interest and whether metabolite formation is inhibited by any of the organic solvents used to dissolve the chemical inhibitors. Unfortu- nately, the utility of this method is limited by the availability of specific inhibitory antibodies and by nonspecific effects associated with the addition of antiserum and ascites fluid to the microsomal incubation. The use of antiserum (for polyclonal antibodies) and ascites fluid (for monoclonal antibodies) rather than purified antibodies often necessitates adding a large amount of albumin and other proteins to the micro- somal incubation. For this reason, control (preimmune) serum and ascites fluid should be included as negative controls in antibody inhibition experiments. These issues are lessened when purified antibodies are used instead of antisera and ascites fluid. As in the case of chemical inhibition, a lack of specificity can complicate the interpretation of antibody inhibition experiments. A lack of specificity and the nonspecific effects outlined above likely account for the majority of cases where the sum of the inhibitory effects of a panel of inhibitory antibodies adds up to greater than 100%. If an antibody inhibits the metabolism of a marker substrate by 80%, and if the same antibody inhibits the metabolism of drug candidate by 80%, there is uncertainty as to whether the inhibited enzyme contributes 80% or 100% to the metabolism of the drug candidate. Genetic or drug- mediated loss of an enzyme that accounts for 80% of a drug’s clearance will cause a fivefold increase in systemic exposure, whereas loss of an enzyme that accounts for 99% of a drug’s clearance will cause a 100-fold increase in exposure. In both cases, cytochrome b5 increases Vmax/Km, which is a measure of in vitro intrinsic clearance. The kinetic constants are only determined for those enzymes that were shown in preliminary experiments to be capable of metabolizing the drug candidate. Unfortunately, this method is complicated by the empirical observation that Km, 334 Ogilvie et al. The Relative Merits of the Four Approaches to Reaction Phenotyping Many of the potential pitfalls and advantages or disadvantages of the four approaches to reaction phenotyping have been mentioned in the preceding sec- tions, and they are summarized in Table 10. Establishes the degree of inter- microsomes (n ¼ 10 or more) individual variation in metabolic formation or substrate disappearance. An outlying data point or a regression line that does not intersect near the origin can produce misleading results. Metabolite formation by high activity samples may violate initial rate conditions (<10% substrate loss). Lack of antibody specificity may reflect cross- fluid or purified antibody) reactivity or an artifact of adding albumin (present at high concentrations in serum and ascites fluid). Solvent controls for all chemical inhibitors and preincubation controls for metabolism-dependent inhibitors must be included. Preimmune serum and ascites (or irrelevant antibodies) should be included as negative controls for antibody inhibition studies. The potency of chemical inhibitors often varies with the concentration of microsomal protein and substrate (drug candidate). Table 10 Continued Procedure Attributes (advantages and disadvantages) Incomplete antibody inhibition complicates interpretation. An inappropriate test system is used to study the metabolism of the drug candidate. In addition, although in vitro drug metabolism studies generally focus on hepatic metabolism, some drugs are extensively metabolized by enzymes in the intestine and other extrahepatic tissues (195–197). The metabolism of the drug candidate is not measured under initial rate conditions. Prior to initiating reaction phenotyping studies, a pool of human liver microsomes should always be used to establish initial rate conditions (i. The metabolism of the drug candidate is not measured at pharmacolog- ically relevant concentrations.
After surgery for breast cancer purchase kamagra 100mg overnight delivery impotence type 1 diabetes, a patient is to undergo chemotherapy with a regimen that consists of cyclophosphamide buy kamagra 50mg without a prescription erectile dysfunction louisville ky, methotrexate order kamagra online from canada erectile dysfunction more causes risk factors, 5-fluorouracil, and doxorubicin. Which one of the following agents is most likely to be protective against the toxicity of methotrexate? Which anticancer drug, acting mainly in the G2 phase of the cell cycle, can cause blisters on the palms of the hands and soles of the feet and can make it difficult for the patient to breathe? Resistance to which anticancer drug, used mainly in childhood leukemia, is high in neo- plastic cells that have low activities of hypoxanthine guanine phosphoribosyltransferase? Bladder irritation with hematuria is a fairly common complaint of patients treated with cyclo- phosphamide. It appears to be due to acrolein, a product formed when cyclophosphamide is bioactivated by liver P450 to form cytotoxic metabolites. Urinary tract problems may also occur with methotrexate from crystalluria due to its low water solubility. All of the drugs listed are antimetabolites used in cancer chemotherapy or as immunosuppressants. Mercaptoethanesulfonate (rnesna), which inactivates acrolein, is available for protection against hemorrhagic cystitis in patients treated with cyclophosphamide and related drugs. It helps to know which anticancer drugs are cell-cycle specific and which have characteristic toxicities. Bleomycin fits both categories; acting mainly in Gz, it is cell-cycle specific and is distinctive for causing mucocutaneous reactions and pulmonary dysfunc- tion. Busulfan and procarbazine may also cause pulmonary toxicity, but neither drug is cell-cycle specific. Anti-D immunoglobin is given to Rh-negative mothers shortly after parturition to prevent hemolytic disease in future births. Which one of the following agents is paired correctly with its suggested clinical use and/or mechanism of action? Esmolol Theophylline, beta agonists I Ethanol, fomepizole Methanol or ethylene glycol Flumazenil Benzodiazepines, zolpidem, zaleplon Naloxone Opioid analgesics Oxygen Carbon monoxide Penicillamine Copper (e. Evidence supporting the clinical effectiveness of herbal products is commonly incomplete. Symptoms of iron poisoning in a 3-year-old child may include severe gastrointestinal distress with hematemesis, a shock-like state with marked dehydration and progressive hemorrhagic gastritis. Regarding the management of iron toxicity, which one of the fol- lowing statements is accurate? Which one of the following symptoms is most likely to be associated with lead poisoning? Gastric lavage should be attempted with care regarding aspiration, but changes in urine pH have no effect on the elimination of iron. The systemic absorption of many drugs taken orally can be reduced by activated charcoal; unfortunately, iron is not one of them. The profile of lead toxicity includes decreased heme synthesis, anemia, nephropathy, and peripheral neuropathy, the last leading to foot or wrist drop. Bzzt Anastrazole, 288 summary list, 323t Androgens, 290 for toxic syndromes, 32lt side effects, 290 Antiemetics, 232 summary list, 299t drug actions, 232f uses, 290 summary list, 255 Anesthetics Antifolates,213t compartmentalization in body, 145f Antifungal agents, 197-199 general, 145-146 azoles,197-198 local. See Autonomic nervous system Antihyperlipidemics, 117-119 Antacids, 231 summary list, 12lt and drug absorption, 231 use summary, 119t side effects, 23lt Antihypertensives, 44 Antagonists altering sympathetic activity, 97 competitive vs. See Parasympathetic autonomic nervous overview, 209t system Antipsychotic drugs receptors, 26, 26f characteristic properties, 159t summary drug list, 73 parenteral formulations, 159 sympathetic. See Sympathetic autonomic nervous system for schizophrenia, 158 Azathioprine, 315 summary list, 169t Azidothymidine. See Zidovudine Antiretroviral agents, 20lt, 205, 213t Azole antifungals, 197-198 Antirheumatic drugs, disease-modifying. See Zidovudine antirheumatic drugs Aztreonam,185 Antithyroid agents, 293 effects, 293t B summary list, 299t Bacillus anthracis, 191 synthesis and actions, 293t Bacteria. See Aspirin uses,135t Asparaginase toxicity, 309t Benztropine, 157 Aspergillus spp. See also Beta blockers Buspirone, 136,235 ~-receptors, 57f, 58t Busulfan toxicity, 309t effect on heart rate and blood pressure, 60, 60f mixed-acting agonists and. See Calcium channel blockers anticoagulants, 269-271 Ceiling effect, 23, 23f antiplatelet, 273 Celecoxib, 243 summary list, 277 Cell death thrombolytics, 273 inhibitors, 183 Blood pressure thymineless, 308 ~-receptor activation and, 60, 60f Cell-cycle specificity, cytotoxic drugs, 307, 307f, 308t effect of epinephrine on, 61, 61f Cell-wall synthesis inhibitors, 182-186 effect of norepinephrine on, 60, 60f summary list, 213t feedback loops, 42-44, 43f, 44f Central nervous system a-receptor activation and, 59, 59f antiparkinsonian drugs and, 156f tracings, 44f depressants, 165t-166t Blood vessel innervation, 49 drug list summary, 169t Blood-brain barrier, 9, 9f stimulants, 165t Blood-gas ratio, inhaled anesthetics and, 145t, 146 poisoning by, 32lt Bone disorders, drugs used for, 297 Cephalosporins, 184 summary list, 299t chemical structure, 182f Bone marrow suppression, anticancer drug toxicity and, 309, 309t summary list, 213t Borrelia burgdorferi, 183, 188 Cestode infestation, 210 Bosentan,101 Chemoreceptor trigger zone, 155 Botulinum toxin, cholinergic pharmacology and, 47, 47f Chemotherapy Bromocriptine, 157, 295t antimicrobial, principles of, 181, 18lt-182t. See also Bronchiolar smooth muscle, drug actions on, 251f Antibacterial agents Brucella spp. See Oral contraceptives Chlorpheniramine, 228t Contraction, smooth muscle, drugs affecting mechanisms of, 109f Chlorpromazine, 159t Copper poisoning, antidote for, 323t Chlorpropamide, 284 Cortisol, synthetic derivatives, 249t Cholestyramine, 118 Cosyntropin,295t Cholinergic neuroeffector junction, 47-49, 47f Coumarin. See Cyclooxygenases activators, 73 Cromolyn, 252 antagonists, 73 Cryptococcus spp. See Clearance of drugs Cytochrome P450 isozymes, 10-11, 11t Classic angina, drug use strategy in, 107 Cytokines Clearance of drugs, 4f, 5, Sf, 14 clinical uses, 316t calculation, 17 receptors for, 27 Clindamycin,189 Cytomegalovirus, 202 mechanism of action, 187t Cytotoxic drugs. See loop diuretics Emesis osmotic, 112 drugs for, 232 summary list, 121t opioid analgesics and, 232 thiazide. See Disease-modifying antirheumatic drugs Enfuvirtide, mechanism of action, 201t, 205 Dobutamine, 104f, 105 Entacapone, 157 Dopamine Entamoeba spp. See Infusion rate Indomethacin, 240 Ketamine,146 for acute gout episode, 247 as drug of abuse, 166t and aspirin comparison, 242 Ketoconazole,197.... See Skeletal muscle relaxants Metaproterenol,251 Mycobacterium avium-intracellulare infection, 189 Metformin, 285 prophylaxis and treatment regimens for, 192 mode of action, 285f Mycobacterium tuberculosis, 191 Methadone, 152t Mycoplasma spp. See Tricyclic antidepressants Somatostatin, 295t Tegaserod, 236 Somatrem, 295t Temazepam, indications for use, 135t Somatropin, 295t Teratogenicity, 29, 29t Sotalol, 94-95 Terazosin Spironolactone as adrenoceptor antagonist, 63 adrenal steroids and, 289 as antihypertensive, 98 as diuretic, 115 Terbinafine, 198-199 diuretic action and effects, 116t Terbutaline, 251 for heart failure, 105 Teriparatide, 297 Sporothrix spp. See Drugs of abuse Timolol Succimer, as heavy metal poisoning antidote, 322t characteristics, 63t Succinylcholine, 148-149 for glaucoma, mechanism of action, 66t Sucralfate, 230 Tirofiban, 275 Sulfasalazine, 245t Tissue plasminogen activator, 273 Sulfation, 12 Tobramycin, 187 Sulfonamide-containing drugs, cross-allogenicity, 113 Tocainide, 93 Sulfonamides, 190-191, 190f Tolbutamide, 284 Sulfonylureas. See Oral hypoglycemics Tolcapone, 157 Sulindac Tolerance, to sedative-hypnotic-anxiolytics, 135 for acute gout episode, 247 Torsades, treatment of, 95 and aspirin comparison, 242 Torsemide, diuretic action and effects, 116t toxicity, 242 "Tot" toxicity, 243 Sumatriptan, 235 Toxic syndromes Surface area, 4 interventions and antidotes, 32lt Sympathetic autonomic nervous system signs and symptoms, 32lt blood vessel innervation and, 49 Toxicity, 24-25, 24f. See Volume of distribution Valproic acid, 14lt, 142-143 Vancomycin, 185-186 Varicella-zoster virus, 202 Vascularity, 4 Vasopressin, 295t Vasospastic angina, drug use strategy in, 107 Venlafaxine,162 Verapamil as antiarrhythmic, 95 as antihypertensive, 99 for migraine headaches, 236 Vibrio spp. No portion of this book may be reproduced, by any process or technique, without the express written consent of the publisher. This book is useful to a wide variety of persons—from a student doing a term paper to reporters preparing a story, from parents reading that story to a narcotics law enforcement ofﬁcer needing extra information for a public presentation. In writing this book the approach has been multidisciplinary, meaning that perspectives from several ﬁelds of research have been pulled together. The same substance may mean different things to a chemist, a biologist, a physi- cian, or an anthropologist. Thousands of scientiﬁc reports were sifted for in- formation and concepts that will be meaningful to readers seeking basic information about speciﬁc substances and about drugs in general. Some are not ordinarily thought of as drugs, but all have been misused in ways indistin- guishable from drug abuse. While information in the individual listings and elsewhere may refer to various physical effects, such information does not constitute medical advice. Anyone with a medical difﬁculty needs to consult a medical practitioner, not this book. In addition to meaty information about what drugs do, this book includes trivia that might interest, for example, a student preparing a report or a home- work assignment.