Development of adult diabetes

Marcus Gunn Jaw Winking Syndrome

Compared with a normal subject, the obese subject requires a continually elevated output of insulin (orange curves) to avoid an excessive rise of blood glucose levels (green curves) during a glucose load. When the secretory capacity of the pancreas decreases, this is first noted as a rise in blood glucose during glucose loading (latent diabetes). Subsequently, not even the fasting blood level can be maintained (manifest, overt diabetes). A diabetic condition has developed, although insulin...

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Anticholinergic Effects

Glycogenolysis, lipolysis, silent stress The dried and cured leaves of the nightshade plant Nicotiana tabacum are known as tobacco. Tobacco is mostly smoked, less frequently chewed or taken as dry snuff. Combustion of tobacco generates approx. 4000 chemical compounds in detectable quantities. The xenobiotic burden on the smoker depends on a range of parameters, including tobacco quality, presence of a filter, rate and temperature of combustion, depth of inhalation, and duration of breath...

Thyroid Hormone Therapy

Effect Thyroid Hormornes Cells

Thyroid hormones accelerate metabolism. Their release A is regulated by the hypophyseal glycoprotein TSH, whose release, in turn, is controlled by the hypothalamic tripeptide TRH. Secretion of TSH declines as the blood level of thyroid hormones rises by means of this negative feedback mechanism, hormone production is automatically adjusted to demand. The thyroid releases predominantly thyroxine T4 . However, the active form appears to be triiodothyronine T3 T4 is converted in part to T3,...

Diuretics of the Sulfonamide Type

These drugs contain the sulfonamide group -SO2NH2. They are suitable for oral administration. In addition to being filtered at the glomerulus, they are subject to tubular secretion. Their concentration in urine is higher than in blood. They act on the luminal membrane of the tubule cells. Loop diuretics have the highest efficacy. Thiazides are most frequently used. Their forerunners, the carbonic anhydrase inhibitors, are now restricted to special indications. Carbonic anhydrase CAH inhibitors,...

Drugs Used to Influence Smooth Muscle Organs

Smooth Muscle Spasm

Narrowing of bronchioles raises airway resistance, e.g., in bronchial or bronchitic asthma. Several substances that are employed as bronchodilators are described elsewhere in more detail 2-sympathomimetics p. 84, given by pulmonary, parenteral, or oral route , the methylxanthine theo-phylline p. 326, given parenterally or orally , as well as the parasympatholytic ipratropium pp. 104, 107, given by inhalation . Spasmolytics. N-Butylscopolamine p. 104 is used for the relief of...

Calcium Antagonists

Calcium Blockers And Cyp Enzymes

During electrical excitation of the cell membrane of heart or smooth muscle, different ionic currents are activated, including an inward Ca2 current. The term Ca2 antagonist is applied to drugs that inhibit the influx of Ca2 ions without affecting inward Na or outward K currents to a significant degree. Other labels are Ca-entry blocker or Ca-channel blocker. Therapeutically used Ca2 antagonists can be divided into three groups according to their effects on heart and vasculature. I....

Treatment of Insulin Dependent Diabetes Mellitus

Diabetic Lunch Meal

Juvenile onset type I diabetes mellitus is caused by the destruction of insulin-producing B cells in the pancreas, necessitating replacement of insulin daily dose approx. 40 U, equivalent to approx. 1.6 mg . Therapeutic objectives are 1 prevention of life-threatening hypergly-cemic diabetic coma 2 prevention of diabetic sequelae angiopathy with blindness, myocardial infarction, renal failure , with precise titration of the patient being essential to avoid even short-term spells of pathological...

Drugs for Treating Endo and Ectoparasitic Infestations

Diuretic Adverse Reactions

Adverse hygienic conditions favor human infestation with multicellular organisms referred to here as parasites . Skin and hair are colonization sites for arthropod ectoparasites, such as insects lice, fleas and arachnids mites . Against these, insecticidal or arachnici-dal agents, respectively, can be used. Endoparasites invade the intestines or even internal organs, and are mostly members of the phyla of flatworms and roundworms. They are combated with anthelmintics. Anthelmintics. As shown in...

Antimalarials

The causative agents of malaria are Plasmodia, unicellular organisms belonging to the order hemosporidia class protozoa . The infective form, the sporozoite, is inoculated into skin capillaries when infected female Anopheles mosquitoes A suck blood from humans. The sporo-zoites invade liver parenchymal cells where they develop into primary tissue schizonts. After multiple fission, these schizonts produce numerous mero-zoites that enter the blood. The pre-erythrocytic stage is symptom free. In...

S

Sulfadoxine Pyrimethamine Sulfamethoxazole Sulfapyridine Sulfisoxazole Azaline, Azulfidine, S.A.S.-500, Salazopyrin Proventil, Novosalmol, Ventolin Acnex, Sebcur, Soluver, Trans-Ver-Sal Serevent Black Draught, Fletcher's Castoria, Genna, Gentle Kabikinase, Streptase Strepolin, Streptosol Zanosar AK-Sulf Forte, Cetamide, Sulamyd, Sulair, Sulfex, Sulten Gamazole, Gantanol, Methanoxanol Dagenan

Follicular Growth and Ovulation Estrogen and Progestin Production

Estrogen Follicular Growth

Follicular maturation and ovulation, as well as the associated production of female gonadal hormones, are controlled by the hypophyseal gonadotropins FSH follicle-stimulating hormone and LH luteinizing hormone . In the first half of the menstrual cycle, FSH promotes growth and maturation of ovarian follicles that respond with accelerating synthesis of estradiol. Estradiol stimulates endometrial growth and increases the permeability of cervical mucus for sperm cells. When the estradiol blood...

Opioid Analgesics Morphine Type

Opioid Efficacy

Morphine is an opium alkaloid p. 4 . Besides morphine, opium contains alkaloids devoid of analgesic activity, e.g., the spasmolytic pa-paverine, that are also classified as opium alkaloids. All semisynthetic derivatives hydromorphone and fully synthetic derivatives pentazocine, pethidine meperidine, l-methadone, and fentanyl are collectively referred to as opioids. The high analgesic effectiveness of xenobiotic opioids derives from their affinity for receptors normally acted...

Inhibitors of the RAA System

Raa System

Angiotensin-converting enzyme ACE is a component of the antihypotensive renin-angiotensin-aldosterone RAA system. Renin is produced by specialized cells in the wall of the afferent arteriole of the renal glomerulus. These cells belong to the juxtaglomerular apparatus of the nephron, the site of contact between afferent arteriole and distal tubule, and play an important part in controlling nephron function. Stimuli eliciting release of renin are a drop in renal perfusion pressure, decreased rate...

Insulin Therapy

Insulin Effects

Insulin is synthesized in the B- or p- cells of the pancreatic islets of Langerhans. It is a protein MW 5800 consisting of two peptide chains linked by two disulfide bridges the A chain has 21 and the B chain 30 amino acids. Insulin is the blood-sugar lowering hormone. Upon ingestion of dietary carbohydrates, it is released into the blood and acts to prevent a significant rise in blood glucose concentration by promoting uptake of glucose in specific organs, viz., the heart, adipose tissue, and...

Events Underlying Contraction and Relaxation B

Phosphodiesterase Inhibitors Heart

The signal triggering contraction is a propagated action potential AP generated in the sinoatrial node. Depolarization of the plasmalemma leads to a rapid rise in cytosolic Ca2 levels, which causes the contractile filaments to shorten electromechanical coupling . The level of Ca2 concentration attained determines the degree of shortening, i.e., the force of contraction. Sources of Ca2 are a extracellular Ca2 entering the cell through voltage-gated Ca2 channels b Ca2 stored in membranous sacs of...

Intestinal Permeability Is Increased In Bronchial Asthma

Pathophysiology Tonic Clonic Seizures

Accumulation in airways of mucus, inadequate expulsion by cough IgE-mediated allergic reactions p. 72 involve mast cell release of histamine p. 114 and production of other mediators such as leukotrienes, p. 196 . Resultant responses include relaxation of vascular smooth muscle, as evidenced locally by vasodilation e.g., conjunctival congestion or systemically by hypotension as in anaphylactic shock enhanced capillary permeability with transudation of fluid into tissues swelling of conjunctiva...

Inhibitors of Cell Wall Synthesis

Blocks Cell Wall Synthesis Penicillin

In most bacteria, a cell wall surrounds the cell like a rigid shell that protects against noxious outside influences and prevents rupture of the plasma membrane from a high internal osmotic pressure. The structural stability of the cell wall is due mainly to the murein peptidoglycan lattice. This consists of basic building blocks linked together to form a large macromolecule. Each basic unit contains the two linked aminosug-ars N-acetylglucosamine and N-acetyl-muramyl acid the latter bears a...

Flucortisone Against Blackouts Bradycardia

Bradycardia With Hypercalcemia

Coronary atherosclerosis angina pectoris, myocardial infarction, arrhythmia Atherosclerosis of cerebral vessels cerebral infarction stroke Cerebral hemorrhage Atherosclerosis of renal vessels renal failure A. Arterial hypertension and pharmacotherapeutic approaches The venous side of the circulation, excluding the pulmonary circulation, accommodates 60 of the total blood volume because of the low venous pressure mean -15 mmHg it is part of the low-pressure system. The arterial vascular beds,...

Organic Nitrates

Edrf Nitrates

Various esters of nitric acid HNO3 and polyvalent alcohols relax vascular smooth muscle, e.g., nitroglycerin gly-ceryltrinitrate and isosorbide dinitrate. The effect is more pronounced in venous than in arterial beds. These vasodilator effects produce hemodynamic consequences that can be put to therapeutic use. Due to a decrease in both venous return preload and arterial afterload, cardiac work is decreased p. 308 . As a result, the cardiac oxygen balance improves. Spasmodic constriction of...

Damage to the mitotic spindle B

Effect Cytarabine Mitosis

The contractile proteins of the spindle apparatus must draw apart the replicated chromosomes before the cell can divide. This process is prevented by the so-called spindle poisons see also col-chicine, p. 316 that arrest mitosis at metaphase by disrupting the assembly of microtubules into spindle threads. The vinca alkaloids, vincristine and vin-blastine from the periwinkle plant, Vinca rosea exert such a cell-cycle-specific effect. Damage to the nervous system is a predicted adverse effect...

Drugs Used in the Treatment of Fungal Infections

Infections due to fungi are usually confined to the skin or mucous membranes local or superficial mycosis. However, in immune deficiency states, internal organs may also be affected systemic or deep mycosis. Mycoses are most commonly due to dermatophytes, which affect the skin, hair, and nails following external infection. Candida albicans, a yeast organism normally found on body surfaces, may cause infections of mucous membranes, less frequently of the skin or internal organs when natural...

Antianginal Drugs

Nitrates Decrease Preload Heart

, -Dimethylcysteine chelation with Cu2 and Pb2 Antidotes for cyanide poisoning A . Cyanide ions CN- enter the organism in the form of hydrocyanic acid HCN the latter can be inhaled, released from cyanide salts in the acidic stomach juice, or enzymatically liberated from bitter almonds in the gastrointestinal tract. The lethal dose of HCN can be as low as 50 mg. CN- binds with high affinity to trivalent iron and thereby arrests utilization of oxygen via mitochondrial cytochrome oxidases of the...

Antidiuretic Hormone ADH and Derivatives B

Cimetidine Induced Gynecomastia

ADH, a nonapeptide, released from the posterior pituitary gland promotes reabsorption of water in the kidney. This response is mediated by vasopressin receptors of the V2 subtype. ADH enhances the permeability of collecting duct epithelium for water but not for electrolytes . As a result, water is drawn from urine into the hyperosmolar inter-stitium of the medulla. Nicotine augments p. 110 and ethanol decreases ADH release. At concentrations above those required for antidiuresis, ADH stimulates...

Antipyretic Analgesics

Antipyretic Mechanism Action

Acetaminophen, the amphiphilic acids acetylsalicylic acid ASA , ibuprofen, and others, as well as some pyrazolone derivatives, such as aminopyrine and dipyrone, are grouped under the label antipyretic analgesics to distinguish them from opioid analgesics, because they share the ability to reduce fever. Acetaminophen paracetamol has good analgesic efficacy in toothaches and headaches, but is of little use in inflammatory and visceral pain. Its mechanism of action remains unclear. It can be...

Drugs for Dissolving Gallstones A

Altitude Meteorism

Following its secretion from liver into bile, water-insoluble cholesterol is held in solution in the form of micellar complexes with bile acids and phospholipids. When more cholesterol is secreted than can be emulsified, it precipitates and forms gallstones cholelithiasis . Precipitated cholesterol can be reincorporated into micelles, provided the cholesterol concentration in bile is below saturation. Thus, cholesterol-containing stones can be dissolved slowly. This effect can be achieved by...

Endogenous Depression

In this condition, the patient experiences profound misery beyond the observer's empathy and feelings of severe guilt because of imaginary misconduct. The drive to act or move is inhibited. In addition, there are disturbances mostly of a somatic nature insomnia, loss of appetite, constipation, palpitations, loss of libido, impotence, etc. . Although the patient may have suicidal thoughts, psychomotor retardation prevents suicidal impulses from being carried out. In A, endogenous depression is...

Osmotic Diuretics B

Osmotic Diuretics Mechanism

Site of action mainly the proximal tubules. Mode of action Since NaCl and H2O are reabsorbed together in the proximal tubules, Na concentration in the tubular fluid does not change despite the extensive reabsorption of Na and H2O. Body cells lack transport mechanisms for polyhy-dric alcohols such as mannitol structure on p. 171 and sorbitol, which are thus prevented from penetrating cell membranes. Therefore, they need to be given by intravenous infusion. They also...

Protective Drugs

Propulsive Movement Digestive System

Gravid uterus significantly restrict its therapeutic utility. Carbenoxolone B is a derivative of glycyrrhetinic acid, which occurs in the sap of licorice root succus liquiri-tiae . Carbenoxolone stimulates mucus production. At the same time, it has a mineralocorticoid-like action due to inhibition of 11-p-hydroxysteroid dehy-drogenase that promotes renal reabsorption of NaCl and water. It may, therefore, exacerbate hypertension, congestive heart failure, or edemas. It is obsolete. III....

Heart Pacemaker Cellm2 Receptor Activation

The Effect Nicotine Receptor Sites

Acetylcholine release, effects, and degradation Acetylcholine ACh is too rapidly hy-drolyzed and inactivated by acetylcholinesterase AChE to be of any therapeutic use however, its action can be mimicked by other substances, namely direct or indirect parasympathomimetics. Direct Parasympathomimetics. The choline ester, carbachol, activates M-cholinoceptors, but is not hydrolyzed by AChE. Carbachol can thus be effectively employed for local application to the eye glaucoma and systemic...