By Z. Grimboll. Rose-Hulman Institute of Technology. 2017.

Individuals with mouth that allows the nasal passages and the BOR syndrome typically have physical differences that mouth to be improperly connected prometrium 100mg amex. These birth defects are Congenital—Refers to a disorder which is present caused by a change (mutation) in a gene discount prometrium 100 mg line. Cyst—An abnormal sac or closed cavity filled with Genetic profile liquid or semisolid matter. Scientists recently discovered that mutations in the Deoxyribonucleic acid (DNA)—The genetic EYA1 gene cause BOR syndrome. The EYA1 gene is material in cells that holds the inherited instruc- located on chromosome 8. The exact function of the tions for growth, development, and cellular func- EYA1 gene is unknown, but mutations in this gene dis- tioning. The branchial arches are Fistula—An abnormal passage or communication tissues that develop very early in pregnancy and are between two different organs or surfaces. Gene—A building block of inheritance, which BOR syndrome is inherited in a dominant manner. Each gene is son has a mutation in one of their EYA1 genes, the dis- found on a precise location on a chromosome. The characteristics of the Gustatory lacrimation—Abnormal development syndrome can be extremely variable in severity. A mutation can also occur by chance, in an individual without a family history of Microtia—Small or underdeveloped ears. If a child inherits an abnormal gene Mutation—A permanent change in the genetic from a parent, the signs of the disorder can be very dif- material that may alter a trait or characteristic of ferent between the parent and the child. This is called an individual, or manifest as disease, and can be variable expressivity. Once an individual has a mutation in the EYA1 gene, there is a 50/50 chance with each pregnancy that the gene Renal agenesis—Absence or failure of one or both will be passed on.

Throughout most of the world proven 100 mg prometrium, epinephrine adrenomimetic drugs are an important group of thera- and norepinephrine are known as adrenaline and nora- peutic agents that can be used to maintain blood pres- drenaline generic prometrium 200mg mastercard, respectively. They are also present in many over- the basic catecholamine structure primarily by having the-counter cold preparations because they constrict substitutions on their benzene ring. MECHANISM OF ACTION CHEMISTRY Many adrenomimetic drugs produce responses by inter- The adrenomimetic drugs can be divided into two ma- acting with the adrenoceptors on sympathetic effector jor groups on the basis of their chemical structure: the cells. The cate- thetic effectors have activity at 1-, 2-, 1-, or 2- cholamines include norepinephrine, epinephrine, and adrenoreceptors or in some cases, combinations of these dopamine, all of which are naturally occurring, and sev- adrenoceptors. Adrenomimetic drugs vary in their affini- eral synthetic substances, the most important of which ties for each subgroup of adrenoceptors. The skele- nephrine, have a high affinity for all of the adrenocep- 96 10 Adrenomimetic Drugs 97 An important characteristic of indirectly acting OH (para) adrenomimetic drugs is that repeated injections or pro- longed infusion can lead to tachyphylaxis (gradually di- OH (meta) Catechol minished responses to repeated administration). This is a result of a gradually diminishing availability of re- leasable norepinephrine stores on repeated drug ad- C ministration. Ethylamine The actions of many indirectly acting adreno- N mimetic drugs are reduced or abolished by the prior ad- ministration of either cocaine or tricyclic antidepressant FIGURE 10. Nor- Destruction or surgical interruption of the adrener- epinephrine has a high affinity for - and 1-adrenocep- gic nerves leading to an effector tissue renders indirectly tors but a relatively low affinity for 2-receptors. Also, patients being ity of the drug, the response characteristics of the effector treated for hypertension with reserpine or guanethidine, cells, and the predominant type of adrenoceptor found on which deplete the norepinephrine stores in adrenergic the cells. For example, the smooth muscle cells of many neurons (see Chapter 20), respond poorly to administra- blood vessels have only or predominantly -adrenocep- tion of indirectly acting adrenomimetic drugs. The interaction of compounds with these adreno- Some adrenomimetic drugs act both directly and in- ceptors initiates a chain of events in the vascular smooth directly; that is, they release some norepinephrine from muscle cells that leads to activation of the contractile storage sites and also directly activate tissue receptors. Since bronchial smooth muscle contains 2- adrenoceptors, the response in this tissue elicited by the Structure–Activity Relationships Among action of 2-adrenoceptor agonists is relaxation of Adrenomimetic Drugs smooth muscle cells. Epinephrine and isoproterenol, which have high affinities for 2-adrenoceptors, cause re- The nature of the substitutions made on the basic laxation of bronchial smooth muscle. Norepinephrine phenylethylamine skeleton at the para and meta positions has a lower affinity for 2-adrenoceptors and has rela- of the benzene ring or on the -carbon of the side chain tively weak bronchiolar relaxing properties.

Candidiasis: 600–1800 mg/day ÷ Q8h Intravaginally: Insert 1 applicatorful or supp hs for 7 d SUPPLIED: Topical cream 2%; lotion 2%; powder 2%; spray 2%; vaginal supp 100 effective prometrium 200mg, 200 mg; vaginal cream 2% generic 200 mg prometrium, IU forms NOTES: Antagonistic to amphotericin B in vivo; rapid IV infusion may cause tachycardia or ar- rhythmias; may potentiate warfarin drug activity Midazolam (Versed) [C-IV] COMMON USES: Preoperative sedation, conscious sedation for short procedures, and induction of general anesthesia ACTIONS: Short-acting benzodiazepine DOSAGE: Adults. DOSAGE: 15 mg PO hs, up to 45 mg/d hs SUPPLIED: Tabs 15, 30, 45 mg NOTES: Do NOT ↑ dose at intervals of less than 1–2 wk; may cause agranulocytosis Misoprostol (Cytotec) COMMON USES: Prevention of NSAID-induced gastric ulcers ACTIONS: Synthetic prostaglandin with both antisecretory and mucosal protective properties DOSAGE: 200 µg PO qid with meals SUPPLIED: Tabs 100, 200 µg NOTES: Do NOT take during PRG; can cause miscarriage with potentially dangerous bleeding; GI side effects common Mitomycin C (Mutamycin) COMMON USES: Adenocarcinomas of the stomach, pancreas, colon, and breast; non-small-cell lung cancer; head and neck cancer; cervical cancer; squamous cell carcinoma of the anus; and blad- der cancer (intravesically) ACTIONS: Alkylating agent; may also generate oxygen free radicals, which induce DNA strand breaks DOSAGE: 20 mg/m2 q 6–8 wk or 10 mg/m2 in combination with other myelosuppressive drugs; bladder cancer 20–40 mg in 40 mL of NS via a urethral catheter once/wk for 8 wk, followed by monthly treatments for 1 y SUPPLIED: Inj NOTES: Toxicity symptoms: Myelosuppression, which may persist up to 3–8 wk after a dose and may be cumulative (minimized by a lifetime dose <50–60 mg/m2), nausea and vomiting, anorexia, stomatitis, and renal toxicity. Microangiopathic hemolytic anemia (similar to hemolytic-uremic syndrome) with progressive renal failure. Venoocclusive disease of the liver, interstitial pneumonia, and alopecia (rare); extravasation reactions can be severe. Adjust dose in renal impairment Mitotane (Lysodren) COMMON USES: Palliative treatment of inoperable adrenal cortex carcinoma ACTIONS: Exact action unclear; induces mitochondrial injury in adrenocortical cells DOSAGE: 8–10 g/d in 3–4 ÷ doses (begin at 2 g/d with full glucocorticoid replacement therapy) SUPPLIED: Tabs 500 mg NOTES: Toxicity symptoms: Anorexia, nausea and vomiting, and diarrhea. Acute adrenal insuffi- ciency may be precipitated by physical stresses (shock, trauma, infection), in which case cortico- steroid replacement necessary. Nasal:Apply bid in the nostrils SUPPLIED: Oint 2%; cream 2% NOTES: Do NOT use concurrently with other nasal products Muromonab-CD3 [OKT3] (Orthoclone OKT3) COMMON USES: Acute rejection following organ transplantation ACTIONS: Blocks T-cell function DOSAGE: Adults. Sup- pressive: 33 mg/kg/d in 4 ÷ doses SUPPLIED: Tabs 250 mg, 500 mg, 1 g; oral susp 250 mg/5 mL NOTES: Resistance emerges within 48 h in a significant percentage of trials; may enhance the effect of oral anticoagulants; may cause CNS adverse effects that reverse on discontinuation; decreased effect with concurrent use of antacids Naloxone (Narcan) Used for emergency care (see also Chapter 21) COMMON USES: Reversal of narcotic effect ACTIONS: Competitive narcotic antagonist DOSAGE: Adults. Ophth:Apply a thin layer to the eye(s) or 1 gt 1–4×/d SUPPLIED: Otic susp; ophth soln; ophth oint Neomycin, Polymyxin-B and Prednisolone (Poly-Pred Opthalmic) COMMON USES: Steroid-responsive ocular conditions with bacterial infection ACTIONS: Antibiotic and antiinflammatory DOSAGE: 1–2 gtt in eye(s) q4–6h; apply oint in eye(s) 3–4×/d SUPPLIED: Susp, neomycin 0. Max 30 pieces/d SUPPLIED: 2 mg (96 pieces/box); Nicorette DS has 4 mg/piece NOTES: Patients must stop smoking and perform behavior modification for max effect Nicotine Nasal Spray (Nicotrol NS) COMMON USES: Aid to smoking cessation for the relief of nicotine withdrawal ACTIONS: Provides systemic delivery of nicotine DOSAGE: 0. Chil- dren: See Adult dosage SUPPLIED: Oral susp 100,000 U/mL; oral tabs 500,000 U; troches 200,000 U; vaginal tabs 100,000 U; topical cream and oint 100,000 U/g NOTES: Not absorbed orally; therefore, NOT effective for systemic infections Octreotide (Sandostatin) COMMON USES: Suppresses or inhibits severe diarrhea associated with carcinoid and neuroen- docrine tumors of the intestinal tract; bleeding esophageal varices ACTIONS: Long-acting peptide that mimics the natural hormone somatostatin 22 22 Commonly Used Medications 581 DOSAGE: Adults. Adults & Peds >12 y: Otic 10 gtt in ear(s) bid for 10 d SUPPLIED: Tabs 200, 300, 400 mg; inj 20, 40 mg/mL; ophth 0. Over long periods can ↓ risk of ectopic preg- nancy, benign breast disease, and future development of ovarian, and uterine cancer. Absolute con- tra: Undiagnosed abnormal vaginal bleeding, pregnancy, estrogen-dependent malignancy, hypercoagulation disorders, liver disease, and smokers >35 y. Relative contra: Migraine headaches, HTN, diabetes, sickle cell disease, and gallbladder disease.