By M. Orknarok. Patrick Henry College.

It is Aminoglutethimide (Cytadren) is a competitive in- advised to measure serum mitotane levels and urinary hibitor of desmolase generic prograf 1 mg with amex, the enzyme that catalyzes the con- free cortisol excretion to ensure adequate therapeutic version of cholesterol to pregnenolone; it also inhibits concentrations generic prograf 0,5 mg online. This drug also reduces estrogen terol by inhibiting cytochrome P450–mediated reac- production by inhibiting the aromatase enzyme com- tions and therefore contributes to the cardiovascular plex in peripheral (skin, muscle, fat) and steroid target events that are a significant cause of mortality in un- tissues. Such a medical adrenalectomy is an efficacious Mitotane, being closely related to the organochlo- treatment for metastatic breast and prostate cancer, rine insecticides, shares its inductive effects on the liver since it diminishes the levels of circulating sex hor- microsomal drug-metabolizing enzyme system, and its mones. Glucocorticoids are administered concomitantly use may therefore alter the requirement for concomi- to suppress enhanced corticotrophin release. Cortisol is tantly administered drugs that are also metabolized by preferable to dexamethasone in this situation because this pathway. Hepatic en- zyme induction may be responsible for the develop- Ketoconazole ment of tolerance to the side effects of aminoglu- tethimide, such as ataxia, lethargy, dizziness, and rashes. Since aminoglutethimide ther- the C17-20 lyase reaction involved in the formation of apy is frequently associated with mineralocorticoid de- sex steroids. Cholesterol Aminoglutethimide and metyrapone are frequently side-chain cleavage and 11 /18-hydroxylase are second- used in combination at lower doses of both drugs as an ary sites of inhibition. Because Mitotane (Lysodren) produces selective atrophy of the surgical treatment is not always well tolerated by eld- zona fasciculata and zona reticularis, which results in a erly patients, ketoconazole 200 to 1,000 mg/day can be a decrease in the secretion of 17-hydroxycorticosteroids. Direct inhibition of cholesterol side-chain cleavage and Common side effects include pruritus, liver dysfunction, 11 /18-hydroxylase activities has also been demon- and gastrointestinal symptoms. On the other hand, Moreover, more than half of patients relapse following the antiandrogenic effects of ketoconazole may prove cessation of therapy. Hypoadrenalism, nausea, and drowsiness have been reported during prolonged ad- Mifepristone is a progesterone receptor antagonist that ministration of mifepristone. This drug has recently been approved for Dexamethasone use in the United States for the treatment of hypercor- tisolism. The addition of a fluoride group on ring C of corti- glucocorticoid therapy sol to give 9- -fluorocortisol (A) Prompt recovery of the hypothalamic– (A) Will shorten its half-life pituitary–adrenal axis results in restoration of en- (B) Will increase both glucocorticoid and miner- dogenous corticotrophin release. Dexamethasone uted to steroid withdrawal may be difficult to distin- (A) Is adequate replacement therapy in an adrena- guish from reactivation of rheumatic disease. Which one of the following enzymes is required for (B) Has a half-life equivalent to that of cortisol cortisol biosynthesis?

The difference between the classes of drugs is primarily Ethanol is the most widely abused drug in the world cheap prograf 5mg with mastercard. Intoxication progresses from mild There are more than 10 million alcoholics in the United to severe over a relatively narrow dose range in the case States alone cheap 5mg prograf overnight delivery. The benzodiazepine dose–response ages has been linked to as many as half of all traffic ac- curve is such that great increases in dose are necessary cidents, two-thirds of homicides, and three-fourths of to make such a transition. Thus, the benzodiazepines are suicides, and it is a significant factor in other crimes, in a safer class of depressant drugs. The annual cost to the American economy has ria, anxiety reduction, anticonvulsant activity, sedation, been estimated to exceed $100 billion in lost productiv- ataxia, motor incoordination, impaired judgment, anes- ity, medical care, and property damage. A person is generally considered an al- ity, but all CNS depressants enhance the effects of other coholic, however, when his or her lifestyle is dominated depressant drugs. The physiological effects of high-dose by the procurement and consumption of alcoholic bev- depressants include miosis, shallow respiration, and re- erages and when this behavior interferes with personal, duction in reflex responses. A light drinker generally is defined as one who con- sumes an average of one drink or less per day, usually Tolerance and Dependence with the evening meal; a moderate drinker is one who has approximately three drinks per day; and a heavy Tolerance to many of the effects of the depressants de- drinker is one who has five or more drinks per day (or velops. Unlike opioids, barbiturate and benzodiazepine in the case of binge drinkers, at least once per week with tolerance develops slowly. The lethal dose in a tol- Chemistry erant individual is not much different from that of the Ethanol (ethyl alcohol, alcohol) is a simple organic mol- general population. Cross-tolerance develops to some ecule composed of a single hydroxyl group and a short degree between the depressant classes of drugs. The hydroxyl 3 2 Dependence on benzodiazepines, as evidenced by a and ethyl moieties confer both hydrophilic and withdrawal syndrome, can develop to large doses of lipophilic properties on the molecule.

A 48-year-old white man is noted to have osteope- (A) They spend less time outdoors exposed to the nia on a routine LS spine film while being evaluated sun discount prograf 5mg with amex, which is important in the synthesis of vitamin for back pain generic prograf 0,5 mg fast delivery. All of the choices are (B) Their appetite and intake of essential nutrients possible EXCEPT is diminished because of chronic medical conditions (A) He has been taking gabapentin (Neurontin) for associated with aging. An 85-year-old black man is noted to have sclerosis chronically taking these medications should take a of the sacroiliac joint on routine films for back pain. Workup for this condition reveals diuretic will often block the renal loss of calcium minimal involvement of the pelvis and LS spine. Her thyroid functions are nor- is biochemically normal does not need pharmaco- mal and a 123I uptake and scan of the thyroid pro- logical therapy. Her serum calcium levels ment slows progression in individuals with the more were determined to be 14 mg/dL (normal levels 9 to severe form of this disorder. Although all of the conditions can present as an (A) Hyperparathyroidism; serum calcium, PTH asymptomatic nodule in the thyroid, the marked hy- level, and ultrasound of the thyroid should be ob- percalcemia in this patient makes hyperparathy- tained. Carcinomas of the (B) This may be a lymph node, not associated with thyroid are common, and outcomes are improved any thyroid disease. Medullary carcinoma and hy- (C) She may have medullary carcinoma of the thy- perparathyroidism caused by hyperplasia may be roid. Therefore, serum calcitonin, ret-Pro-Oncogene inherited and are associated with the multiple en- determination, and ultrasound of the thyroid should docrine neoplasia syndromes. There is no evidence that affinity for D3 with its on fractures and bone mineral density in post- receptor is altered during aging. Postmenopausal hormone replace- plementation to prevent osteoporosis and the other ment therapy: Scientific review. Dissociation of bone formation from the specific metabolites should be used, such as cal- resorption during two-week treatment with PTHrP citriol. However, he may have longstanding lethargy, increased thirst, and increased urination hyperparathyroidism or milk alkali syndrome from for 3 days. His family states that he has been some- the ingestion of large amounts of calcium carbonate what confused for the past day and is not eating or to treat indigestion. He has a history of each of these causes, but in the interim, this is a chronic bronchitis, a 60–pack year history of smok- medical emergency and you have to treat empiri- ing, and has lost 12 lb over the past month.

Dissertation Abstracts International: Section B: The Sciences & Engineering 2000; 61:125 9 discount 5 mg prograf mastercard. Autonomic and EEG patterns distinguish transcending from other experiences during Transcendental Meditation practice cheap prograf 0,5mg line. The coherence spectral array (COSPAR) and its application to the study of spatial ordering in the EEG. Frontal EEG coherence, H-reflex recov-ery, concept learning, and the TM-Sidhi program. A randomised controlled trial of stress reduction for hypertension in older African Americans. Stress, stress reduction, and hypertension in African Americans: an updated review. A controlled study of the effects of the Transcendental Meditation program on cardiovascular reactivity and ambulatory blood pressure. Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Zamarra JW, Schneider RH, Besseghini I, Robinson DK, Salerno JW, The Department of Medicine SUoNYBUSA. Usefulness of the transcendental meditation program in the treatment of patients with coronary artery disease. Lower lipid peroxide levels in practitioners of the Transcendental Meditation program. The effects of the transcendental meditation and TM-Sidhi program on the aging process. Effectiveness of the Transcendental Meditation program in preventing and treating substance misuse: a review. Disease prevention and health promotion in the aging with a traditional system of natural medicine: Maharishi Vedic Medicine.