By Y. Anog. The Art Institute of Washington.

A new formulation of a saline laxative purchase benadryl 25 mg mastercard, Visicol purchase 25 mg benadryl overnight delivery, that Osmotic Laxatives is useful to prepare patients for procedures, was ap- proved for use in 2001. Visicol tablets, taken in two creases, and fluid movement occurs secondary to os- doses of 30 g approximately 12 hours apart, induce di- motic pressure. Lactulose is a synthetic disaccharide arrhea that rapidly and effectively cleanses the entire that is poorly absorbed from the GI tract, since no colon. Each administration has a purgative effect for mammalian enzyme is capable of hydrolyzing it to its approximately 1 to 3 hours. It therefore reaches the colon unchanged and is metabolized by colonic bacteria to lactic acid and to small quantities of formic and acetic Stimulant Cathartics acids. Since lactulose does contain galactose, it is con- The stimulant cathartics contain a variety of drugs traindicated in patients who require a galactose-free whose exact mode of action is not known, although it is diet. Metabolism of lactulose by intestinal bacteria may thought that they act on the mucosa of the intestine to result in increased formation of intraluminal gas and stimulate peristalsis either by irritation or by exciting abdominal distention. Polyethylene glycol (Miralax) is another osmotic They produce irritation of the mucosa if given in large laxative that is colorless and tasteless once it is mixed. It has been suggested that these drugs may Saline laxatives are soluble inorganic salts that contain act by stimulating afferent nerves to initiate a reflex in- multivalent cations or anions (milk of magnesia, mag- crease in gut motility. These charged particles do not readily cross the senna, and rhubarb) are among the oldest laxatives intestinal mucosa and therefore tend to remain in the known. They act on the colon rather than on the ileum lumen of the GI tract, where they help retain fluid and produce evacuation 8 to 10 hours after administra- through the osmotic effect exerted by the unabsorbed tion. Cascara sagrada is one of the mildest of the the colon and producing a physiological stimulus for anthraquinone-containing laxatives.

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Hyperprolactinemia has been tradition- growth hormone buy 25 mg benadryl otc, usually as a result of pituitary ade- ally treated by the dopaminergic agonist bromocriptine noma generic 25 mg benadryl mastercard. The skin and side effects, nausea and postural hypotension, are less soft tissues thicken, and the viscera enlarge. More recently, however, the growth hormone secretion is demonstrated by elevated more potent, long-lasting dopaminergic agonist cabergo- serum levels of growth hormone after glucose adminis- line (Dostinex) has been found to be at least as effective tration, since glucose is less effective in inhibiting and has a lower incidence of side effects. TSH stimulates the thyroid gland to signed to simulate the normal menstrual cycle as far as produce thyroid hormones. A common protocol is daily injections of giving thyroxine itself rather than TSH, but TSH is menotropins for 9 to 12 days, until estradiol levels are available for diagnostic purposes to differentiate be- equal to that in a normal woman, followed by a single tween pituitary and thyroid gland failure as causes of dose of hCG to induce ovulation. Ovarian hyperstimulation is characterized by sudden ovarian enlargement associ- Gonadotropins ated with an increase in vascular permeability and Follicle-stimulating hormone (FSH), luteinizing hor- rapid accumulation of fluid in peritoneal, pleural, and mone (LH), and human chorionic gonadotropin (hCG) pericardial cavities. A sulfated N-acetylgalactosamine Purified FSH is used to prepare follicles for in vitro attached to LH but not FSH causes LH to be more rap- fertilization because LH activity in menotropins may idly metabolized; the half-life of LH is 30 minutes and cause premature ovulation. For several ing the follicular phase of the menstrual cycle and is re- weeks hCG is injected to increase testosterone levels, quired for proper development of ovarian follicles and followed by injections of menotropins for several for estrogen synthesis from granulosa cells of the ovary. Prepubertal cryptorchidism can be treated by Most LH secretion occurs in an abrupt burst just before injections of hCG for up to several months. LH is required for progesterone synthesis in luteal cells and androgen synthesis in thecal cells of the Adrenocorticotropic Hormone ovary. FSH stimulates spermatogenesis and synthesis of androgen-binding protein in Sertoli cells of the testes. Adrenocorticotropic hormone (ACTH), or corti- LH stimulates testosterone production from Leydig cotropin, a peptide of 39 amino acids, is first synthe- cells. Production of LH and FSH is controlled by sized as a larger precursor from which ACTH is de- gonadotropin-releasing hormone (GnRH) from the hy- rived by proteolytic cleavage. ACTH stimulates pothalamus and by feedback control from target organs production of glucocorticoids from the adrenal cortex through steroids and multiple forms of a protein, in- (see Chapter 60). Traditional sources of is easier and less expensive to treat patients having gonadotropins are from human urine. Human adrenocortical insufficiency with glucocorticoid re- menopausal gonadotropins (menotropins, Humegon, placement therapy than it is to use ACTH.

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Which of the following classes of agents is useful tention deficit disorder are among only a few ap- in the treatment of attention deficit hyperkinetic proved uses of the psychomotor stimulants of the disorder? Analeptic stimulants order benadryl 25 mg otc, such as pentylenetetrazol (B) Benzodiazepines and picrotoxin discount benadryl 25mg without prescription, act by inhibiting chloride influx at (C) Xanthines the GABAA receptor–chloride channel complex. However, the concen- GABA receptor–chloride channel complex tration of cAMP that is required for such action is (B) Increased release of catecholamines from CNS above the threshold of CNS stimulation. Since the neurons methylxanthines are relatively potent antagonists of (C) Inhibition of cholinesterase leading to in- adenosine and since adenosine has been shown to creased acetylcholine levels be a reasonably potent inhibitor of both central and (D) Antagonism of CNS adrenoceptors to reduce peripheral neurons, the most likely mechanism by inhibition produced by catecholamines which CNS stimulation occurs is through antago- (E) Antagonism of nicotinic receptors that inhibit nism of adenosine receptors. The CNS stimulation produced by methylxanthines, are also indirectly acting sympathomimetics that in- such as caffeine, is most likely due to the antago- crease the release of catecholamines from sympa- nism of which of the following receptors? While amphetamine and (A) Glycine receptors other congeners possess additional actions on pe- (B) Adenosine receptors ripheral sympathetic nerves, this is the most likely (C) Glutamate receptors explanation for the cardiac stimulation observed (D) GABA receptors following the administration of these agents. Cardiac stimulation is an adverse effect associated with the use of the psychomotor stimulants, such as SUPPLEMENTAL READING amphetamine. From GABAA receptor diversity emerges a (C) Inhibition of a GABA-mediated negative unified vision of GABAergic inhibition. What types Wnessman who often spends long hours at the of pathological conditions can lead to excessive office or in his automobile traveling to meet new somnolence? Sleep apnea is characterized by pauses in the past several years, the number of daytime respiration during sleep and usually excessive snor- episodes has begun to increase, and he recently be- ing. Patients with sleep apnea have EDS but often gan to lose mobility in his arms and legs during the awake without feeling rested. Your examination re- clearly defined by determining whether he has a veals an individual who is in otherwise excellent specific human leukocyte antigen associated with health and mentation with no apparent significant the disorder (HLA-DR2). He indicates that he has several periods colepsy is accomplished with psychomotor stimu- of EDS during the day and that the frequency of lants of the amphetamine type. While he feels modafinil, pemoline, and dextroamphetamine all are well rested upon waking, he is especially concerned effective in managing the EDS periods, while about the recent loss of skeletal muscle function imipramine and clomipramine can be used to man- and fears that he may be developing some degener- age any cataplexy.