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By Z. Ramon. Pepperdine University. 2018.

CAUSE WHAT IS IT YPICAL SYMPTOMS Anxiety or Chronic feelings of a low Numbness in both hands order 500mg hydrea overnight delivery symptoms vitamin b deficiency, depression (See mood or anxiety faintness buy 500mg hydrea amex treatment kidney infection, pins and needles chapter on around lips, trouble breath- Depression, ing, occurs in people con- Suicidal cerned about their heart Thoughts, or health, can be a “panic Anxiety. If you are experiencing chest pain other than heartburn, refer to the chapter on Chest Pain for more information. If your pain is centered more in your abdomen, see the chapter on Abdominal Pain for more information. Your Doctor Visit What your doctor will ask you about: anxiety, depression, weight loss, weakness, abdominal pain, nausea, vomiting blood, tarry stools, results of any recent tests of the insides of your stomach, any suc- cesses with previous treatments or diets. Your doctor will want to know if you or anyone in your family has had any of these conditions: abdominal surgery, liver disease, arthritis, chronic lung disease, alcoholism, ulcer disease. Your doctor will want to know when and how you first noticed your heartburn, and how many times it has recurred. Some important factors to consider with ulcers caused by heartburn: • Ulcers are caused by the movement of stomach acid up into and through the esophagus, which connects the throat to the stom- ach. Over time, this movement of acid can lead to ulcer, or irri- tation of the stomach or intestinal lining. To keep this from happening, your doc- tor may ask you to: • Limit your intake of caffeine, cigarettes, alcohol, and cer- tain medications. Heatstroke What it feels like: collapse during extreme heat, sometimes leading to delirium or coma. Someone with a mild form of heatstroke, known as heat prostration, will appear faint, have cold and clammy skin, and have a slight fever. If a person with heatstroke falls into a coma, becomes delirious, or has hot and dry skin and a temperature of more than 103 degrees F, seek medical help immediately. Your Doctor Visit What your doctor will ask you about: headache, changes in think- ing, loss of consciousness, nausea, vomiting, diarrhea, decreased urine output, sweating, cold skin, muscle cramps, bleeding. Your doctor will want to know if you or anyone in your family has had any of these conditions: alcoholism, heart disease, high blood pressure, diabetes. Your doctor will want to know how long you were in a hot environ- ment, the temperature of the environment, your temperature at the time of collapse, and what you were doing when you collapsed. Your doctor will do a physical examination including the fol- lowing: temperature, breathing rate, blood pressure, pulse, thorough exam of your reflexes and movement, checking skin for sweating, color, and warmth. RISK FACTOR WHAT IS IT YPICAL SYMPTOMS Dehydration Not drinking enough Dry mouth, producing little water or no urine, sunken eyes, more common in people taking blood pressure med- ication or drinking alcohol Inadequate An inability to cool Lack of sweating when hot, sweating down by sweating more common in the eld- erly, diabetics, those with high cholesterol, people wearing too much clothing or engaging in excessive exercise, or people taking anticholinergic medica- tions such as Benadryl and Cogentin, or phenoth- iazines such as the antipsy- chotic Haldol Heavy Drinking (Alcohol) What it is: your drinking patterns become a problem when you expe- rience withdrawal if you stop drinking alcohol (see below), you devel- op an illness related to drinking, or it interferes with your social or work life; drinking to excess – a six-pack of beer in one sitting, or a fifth of a gallon of whiskey, for example, without becoming drunk – is also probably a sign of problem drinking. For example, if you answer “yes” to any of the following ques- tions, you may have a drinking problem: 1. Have you ever had a drink when you wake up, to “steady your nerves” or cure a hangover? Your doctor will also want to know if you or anyone in your fam- ily has had any of these conditions: seizures, delirium after cutting 119 Copyright © 2004 by The McGraw-Hill Companies, Inc. Your doctor will do a physical examination including the fol- lowing: temperature, pulse, blood pressure, thorough skin examina- tion, tests of memory, pushing on your abdomen, checking your limbs for tremors or shakiness, tests of brain function involving bal- ance, eye movements, and reflexes. PROBLEM WHAT IS IT YPICAL SYMPTOMS Tremulousness Trembling or shaking Irritability, flushed skin, stomach upset, sleepiness, occurs after several days of drinking Delirium Delirium that occurs Fever, confusion, tremor, tremens when you stop drinking hallucinations, sweating, dilated pupils Seizures Convulsions Occur within 2 days of when you stop drinking Cerebellar A type of brain disorder Unsteadiness, abnormal degeneration eyeball movements, unco- ordinated gait Wernicke- A brain disorder caused Confusion, memory loss, Korsakoff by a lack of thiamine disorientation, abnormal psychosis (vitamin B1) eyeball movements Neuropathy Nerve damage in the Unsteadiness, numbness or extremities burning in feet or hands Hiccough What it feels like: an involuntary and rapid intake of breath accom- panied by tightness in the abdomen, often persistent. Most cases of hiccoughs occur in people who are in otherwise perfect health, often the result of eating too quickly. Your Doctor Visit What your doctor will ask you about: abdominal pain, weakness, chest pain, new cough or change in cough pattern, trouble swallow- ing, anxiety. Your doctor will want to know if you or anyone in your family has had any of these conditions: alcoholism, kidney disease, liver disease, nervous system disease. CAUSE WHAT IS IT YPICAL SYMPTOMS Rapid eating Eating too quickly Otherwise healthy Gastroenteritis Infection of the stomach Nausea, vomiting, diar- rhea, cramping, muscle aches, slight fever Gastric An expansion of the “Gas,” discomfort distention (see stomach, either by food chapter on or gas Bloating) Lung tumor Unchecked, abnormal Change in cough patterns, growth of cells in the coughing up blood, chest lungs ache, more common in cigarette smokers Advanced renal Inability of the kidneys Pallor, gradual lapse into failure to function properly coma, history of kidney disease Encephalitis Inflammation or infection Fever, nausea, vomiting, of the brain stiff neck, headache, grad- ual lapse into coma Hoarseness What it feels like: a dry, scratchy voice. The most common cause of hoarseness that has lasted less than 2 weeks is inflammation in the voice box, often accompanied by a cold and sore throat. Your Doctor Visit What your doctor will ask you about: cough, fever, sore throat, trouble breathing, wheezing, weight loss, coughing up blood, neck or chest pain, trouble swallowing, thickening of hair, cold intolerance. Your doctor will want to know if you or anyone in your family has had any of these conditions: any chronic disease, alcoholism.

These are the recommendations of the ACS and may not be supported by other organizations hydrea 500 mg lowest price medications listed alphabetically. EPIDEMIOLOGY BASICS Number of persons who have a disease at one point in time Prevalence = Number of persons at risk at that point (continued on page 645) 639 Copyright 2002 The McGraw-Hill Companies buy cheap hydrea 500 mg medications j-tube, Inc. Source: United States Department of Agriculture and United States Department of Health and Human Resources, 1990. The point of intersection on the body surface line gives the body surface area (in m2). The point of intersection on the body surface line gives the body surface area (in m2). Appendix 645 (continued from page 639) Number of new cases of a disease over a period of time Incidence = Number of persons at risk during that period Sensitivity = Proportion of subjects with the disease who have a positive test = (a/a + c) Specificity = Proportion of subjects without the disease who have a negative test = (d/b + d) Predictive value = Positive: likelihood of a positive test indicates disease = (a/a + b) = Negative: likelihood of a negative test indicates lack of disease = (d/c + d) Disease + (Present) (Absent) (+) a b Test ( ) GLASCOW COMA SCALE The Glasgow Coma Scale (EMV Scale) gives a fairly reliable, objective way to monitor changes in levels of consciousness. Household 1 teaspoon (tsp) = 5 mL 1 tablespoon (tbsp) = 15 mL 1 ounce (oz) = 30 mL 8 ounces (oz) = 1 cup = 240 mL 1 quart (qt) = 946 mL Apothecary 1 grain (gr) = 60 mg 30 gram (g) = 1 oz 1 g = 15 gr SI PREFIXES AND SYMBOLS Factor Prefix Symbol 109 giga G 106 mega M 103 kilo k 102 hecto h 101 deka da 10–1 deci d 10–2 centi c 10–3 milli m 10–6 micro µ 10–9 nano n 10–12 pico p 10–15 femto f PERFORMANCE STATUS SCALES Table A–5 lists the most common performance scales used clinically. RADIATION TERMINOLOGY Measure Old Term SI Unit Activity curie becquerel (Bq) Absorbed dose rad gray (Gy) TEMPERATURE CONVERSION Table A–6 gives information for converting temperature from the Fahrenheit (F) scale to the centigrade, or Celsius (C), scale and vice versa. Professor Emeritus Professor Department of Pharmacology Department of Pharmacology University of Kiel University of Kiel Germany Germany Klaus Mohr, M. Professor Professor Department of Pharmacology Division of Basic Medical Sciences and Toxicology Faculty of Medicine Institute of Pharmacy Memorial University of University of Bonn Newfoundland Germany St. IV Library of Congress Cataloging-in-Publication Data Taschenatlas der Pharmakologie. Research and clinical experience are This book is an authorized revised and ex- continually expanding our knowledge, in par- panded translation of the 3rd German edition ticular our knowledge of proper treatment and published and copyrighted 1996 by Georg drug therapy. Title of the any dosage or application, readers may rest as- German edition: sured that the authors, editors and publishers Taschenatlas der Pharmakologie have made every effort to ensure that such ref- Some of the product names, patents and regis- erences are in accordance with the state of tered designs referred to in this book are in knowledge at the time of production of the fact registered trademarks or proprietary book. Therefore, express any guarantee or responsibility on the the appearance of a name without designation part of the publishers in respect of any dosage as proprietary is not to be construed as a instructions and forms of application stated in representation by the publisher that it is in the the book. Such examination is tostat reproduction, copying, mimeographing particularly important with drugs that are or duplication of any kind, translating, prepa- either rarely used or have been newly released ration of microfilms, and electronic data pro- on the market. The au- ©2000 Georg Thieme Verlag, Rüdigerstrasse14, thors and publishers request every user to re- D-70469 Stuttgart, Germany port to the publishers any discrepancies or in- Thieme New York, 333 Seventh Avenue, New accuracies noticed. York, NY 10001, USA Typesetting by Gulde Druck, Tübingen Printed in Germany by Staudigl, Donauwörth ISBN 3-13-781702-1 (GTV) ISBN 0-86577-843-4 (TNY) 1 2 3 4 5 6 Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. V Preface The present second edition of the Color Atlas of Pharmacology goes to print six years after the first edition. Numerous revisions were needed, highlighting the dramatic continuing progress in the drug sciences. In particular, it appeared necessary to in- clude novel therapeutic principles, such as the inhibitors of platelet aggregation from the group of integrin GPIIB/IIIA antagonists, the inhibitors of viral protease, or the non-nucleoside inhibitors of reverse transcriptase. In each instance, the primary emphasis was placed on essential sites of action and basic pharmacological princi- ples. Details and individual drug properties were deliberately omitted in the interest of making drug action more transparent and affording an overview of the pharmaco- logical basis of drug therapy. The authors wish to reiterate that the Color Atlas of Pharmacology cannot replace a textbook of pharmacology, nor does it aim to do so. Rather, this little book is desi- gned to arouse the curiosity of the pharmacological novice; to help students of me- dicine and pharmacy gain an overview of the discipline and to review certain bits of information in a concise format; and, finally, to enable the experienced therapist to recall certain factual data, with perhaps some occasional amusement. Our cordial thanks go to the many readers of the multilingual editions of the Color Atlas for their suggestions. Heinz Lüllmann Klaus Mohr Albrecht Ziegler Detlef Bieger Jürgen Wirth Fall 1999 Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. General Pharmacology Lüllmann, Color Atlas of Pharmacology © 2000 Thieme All rights reserved. The herbals of an- tiquity describe the therapeutic powers of certain plants and minerals.

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V /Q can A Despopoulos buy generic hydrea 500mg medicine under tongue, Color Atlas of Physiology © 2003 Thieme All rights reserved purchase hydrea 500 mg fast delivery medications causing dry mouth. Regional blood flow in the lung (upright chest position) Alveolus Zone 1 PA> Pprecap> Ppostcap Pulmonary Pulmonary artery vein Zone 2 Pprecap> PA> Ppostcap Lung Zone 3 Pprecap> Ppostcap> PA Pprecap PA Ppostcap Perfusion Q · · B. Effect of ventilation-perfusion ratio (VA/Q) ventilation of lung on partial pressures in lung Pressures in kPa Ambient air: PO2= 20, PCO2= 0 VA/Q 0 3 Apex VA= 0 VA VA 2 VA Q PO2 = 5. Deoxygenated hemoglobin (Hb) can bycellsofthebodyundergoesphysicaldissolu- take up more H+ ions than oxygenated tion and diffuses into adjacent blood capillar- hemoglobin (Oxy-Hb) because Hb is a weaker ies. This promotes CO2 uptake in the dissolved,whiletherestischemicallyboundin peripheral circulation (Haldane effect) because form of HCO3– and carbamate residues of of the simultaneous liberation of O2 from ery- hemoglobin (! Since the PCO2 CO2 entering the pulmonary capillaries is re- in alveoli is lower than in venous blood, CO2 leased from the compounds (! HCO3– and Hb carbamate whereby H+ ions (re- The enzyme carbonic anhydrase (carbonate leased from Hb) are bound in both reactions dehydratase) catalyzes the reaction (! A7, A8), and the direction of HCO3–/Cl– ex- HCO3– + H+ CO2 + H O2 change reverses (! Because it acceler- toOxy-Hbinthelungpromotesthisprocessby ates the establishment of equilibrium, the increasing the supply of H+ ions (Haldane ef- short contact time (! CO2 distribution in blood (mmol/L blood, CO2 diffusing from the peripheral cells (! The HCO3– Mixed venous blood: concentration in erythrocytes therefore be- Plasma* 0. Percentage of total arteriovenous difference H+ ions are liberated when CO2 in red cells 9% 78% 13% 100% circulating in the periphery is converted to * Approx 0. Since the removal of H+ ions Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. CO2 transport in blood Expelled from lung 8 Oxy- Hb CO Hb 2 NH COO– NH2 CO2 Alveolus H+ O2 Hb Oxy- H Hb H In lung H O + 2 H 7 – 9 – CO HCO3 HCO3 2 Carbonic anhydrase Cl– Erythrocyte In plasma In periphery 5 Carbonic anhydrase HCO– HCO– CO2 3 3 Bicarbonate formation 2 – 4 Cl H2O H+ 6 Hb Hemoglobin Oxy- H as buffer Hb H O2 H+ Hemoglobin carbamate Oxy- Hb formation Hb 3 NH2 NH COO– Hemoglobin CO2 CO2 carbamate 1 Tissue 125 Metabolism Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. TheCO2dis- CO2 in Cerebrospinal Fluid sociation curve illustrates how the total CO2 concentration depends on PCO (! Unlike HCO3– and H, CO+ 2 can cross the blood- 2 TheconcentrationofdissolvedCO2,[CO2],in cerebrospinal fluid (CSF) barrier with relative plasma is directly proportional to the PCO2 in ease (! The PCO2 in CSF there- plasma and can be calculated as follows: fore adapts quickly to acute changes in the PCO2 [CO ] =2 αCO2! The dissociation curve for total CO2 is The concentration of non-bicarbonate calculated from the sum of dissolved and buffers in blood (hemoglobin, plasma pro- bound CO2 (! When the CO2 concentration in- CO2 binding with hemoglobin depends on creases, the liberated H+ ions are therefore ef- the degree of oxygen saturation (SO2) of fectively buffered in the blood. Blood completely saturated with HCO3– concentration in blood then rises rela- O2 is not able to bind as much CO2 as O -free2 tively slowly, to ultimately become higher blood at equal PCO levels (! B2), result- loaded with O,2 the buffer capacity of ing in a renewed increase in the pH of the hemoglobin and, consequently, the levels of CSF because the HCO3–/CO2 ratio increases chemical CO2 binding decrease due to the Hal- (! Venous blood is never respiratory activity (via central chemosen- completely void of O, but is always O -satu-2 2 sors), a process enhanced by renal compensa- rated to a certain degree, depending on the tion, i. The SO2 of mixed venous blood is ultimately adapts to chronic elevation in PCO2— about 0. The normal range of CO2 Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. Effect of CO2 on pH of CSF Example: 1 Acute Respiratory acidosis 2 Chronic Renal compensation CO2 HCO3– CO2 HCO3– H2O H+ Blood H2O H+ Blood-CSF NBB barrier pH NBB pH CO2 HCO3– CO2 HCO3– H O H+ 2 CSF H2O H+ pH NBB pH ( ) Central chemoreceptors Central chemoreceptors Strong signal for 127 respiratory regulation Weak signal (adaptation) Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. Shifts to Hb is also involved in CO2 transport and is an the left are caused by increases in pH (with or important blood pH buffer (! Hb is a tetramer with 4 subunits PCO2, temperature and 2,3-bisphosphoglyc- (adults: 98%: 2α + 2" = HbA; 2% 2α +2δ = erate (BPG; normally 1mol/mol Hb tetramer). Each of the and/or increases in PCO2, temperature and 2,3- four Fe(II) atoms (each linked with one his- BPG(!

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Those with asthma should avoid exposure to tobacco smoke and should not “Identification of New Asthma Genes Demonstrates Model for exercise outside when air pollution levels are high cheap hydrea 500mg online symptoms diarrhea. Children Diagnosed With Asthma buy hydrea 500mg fast delivery 897 treatment plant rd, New sufferers who live in heavily polluted areas, moving to less Report Finds. Cornea Center for Complementary and Alternative Medicine Research in Asthma, Allergy, and Immunology. Odle Horizontal line out of focus Astigmatism Definition Astigmatism is a problem of visual distortion caused by a misshapen cornea. If the cornea does not have the proper shape, the eye is unable to properly focus an image. Description Light rays entering a normal eye come to a point of Astigmatism corrected by lens focus on the retina through a transparent, dome-shaped layer called the cornea. In astigmatism there is unequal Astigmatism can be treated by the use of cylindrical lenses. Usually the degree of astigmatism re- used to determine the presence of astigmatism. Factors such as stress, continual reading in dim lighting, or excessive close-up work may also contribute The Bates method or other type of visual training to the development of astigmatism. It is sometimes may be helpful in improving vision and reducing symp- caused by pressure from chalazion, a condition that toms. The homeopathic remedies Ruta graveolens (from causes the eyelid to swell; from scars on the cornea; or common rue) and Apis mellifica (from the honey bee) from keratoconus, a condition that involves swelling of can be used to relieve eyestrain, one of the main symp- the cornea. The main symptom of astigmatism is blurred toms and possible contributors to astigmatism. There may also be a history of Acupuncture treatment or Traditional Chinese headaches, eye strain, fatigue, and double vision. Certain treatments can strengthen and Diagnosis correct the skewing of the Liver qi. It is sometimes associated with cer- test, given by an optometrist or opthalmologist, is tain organs. Chalazion—A condition in which clogging of the Expected results Meibomiam gland causes a cyst inside the eyelid. Effects of astigmatism can generally be greatly im- Keratoconus—A progressive condition in which proved with eyeglasses or contact lenses. The major risks of surgery include Refraction—The turning or bending of light waves chronic visual problems, injury to the eye tissue, infec- as the light passes from one medium or layer to tion, and over- or under-correction, which would still another. Complications may require the to bend light so that an image is focused onto the use of medication or further surgery. The lenses are made so as Minimizes Tissue Removal, not Ideal for High-Correction to counteract the shape of the sections of cornea that are Cases. Contact lenses that are used to correct OTHER astigmatism are called toric lenses. In radial keratotomy (RK) for astigmatism, cuts are made into the cornea with a dia- mond blade instrument. In photorefractive keratectomy (PRK), a laser is used to improve the shape of the cornea by removing micro-thin slices. Laser assisted in situ ker- atomileusis (LASIK) is the most recently developed type Aston-Patterning of refractive surgery. A flap of the cornea is cut with a Definition laser and then the corneal tissue underneath is shaved to improve the shape. Aston-Patterning is an integrated system of move- ment education, bodywork, ergonomic adjustments, and Doctors continue to improve LASIK techniques. In fitness training that recognizes the relationship between 2002, a cross-cylinder method was developed in refrac- the body and mind for well being. It helps people who tive surgery to help treat mixed astigmatism, one of the seek a remedy from acute or chronic pain by teaching most difficult types to treat. Anyone considering it should make sure that the surgeon has a lot of experience in Origins the procedure. There should also be an in-depth discus- sion of the possible side effects and risks of the proce- Aston-Patterning is a process originated by Judith dure. After graduating from college with an come out of surgery with more light distortion than advanced degree in dance, Aston began working with 144 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 athletes, dancers, and actors in movement education pro- grams in California. Aston recovered from her injuries, Rolf asked her to de- She graduated from University of California at Los An- velop a movement education program that would com- geles with a B.

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