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By N. Marius. University of Southern Maine.

The ROS pro- Thalidomide is a highly teratogenic drug generic 300mg zantac mastercard, characteris- duce cytotoxic effects that may explain therapeutic effi- tically causing phocomelia (aplasia of the midportions of cacy order zantac 150mg fast delivery. Thalidomide should be prescribed to women of childbearing potential only when no acceptable alterna- tive exists purchase zantac 300mg free shipping. Because it is not known whether thalidomide DAPSONE is present in the ejaculate of males receiving the drug buy zantac 300 mg fast delivery, Although dapsone (Avlosulfon) is most often used as an male patients must use a latex condom when engaging in antimicrobial agent, it has important antiinflammatory sexual activity with women of childbearing potential. Mupirocin binds to bacterial isoleucyl- transfer RNA synthetase and prevents the incorpora- Like dapsone, the antimalarial drugs chloroquine, hy- tion of isoleucine into protein sequences. Mupirocin is droxychloroquine, and quinacrine are useful in some most effective against gram-positive bacteria. Metronidazole is Antimalarial drugs have many effects, including im- a synthetic nitroimidazole derivative that reduces in- pairment of lysosomal phagosomal activity, inhibition flammation by an unknown mechanism. Other selected of neutrophilic iodination and locomotion, and diminu- topical antibiotics are listed in Table 41. Chloroquine (Aralen) and hydroxychloroquine (Plaquenil) also form complexes with hepatic por- DRUGS FOR CUTANEOUS FUNGAL phyrins and can chelate iron, thereby enhancing their INFECTIONS urinary excretion. Both drugs have an affinity for melanin, which may at least partially explain their oph- Like bacterial infections of skin, cutaneous fungal in- thalmological toxicities (retinopathy). Low-dose chloroquine is Systemic Agents used for the therapy of porphyria cutanea tarda in pa- Griseofulvin tients in whom phlebotomy has failed or is contraindi- Griseofulvin (Fulvicin, Grifulvin V) has been used cated. Other skin diseases in which the drugs are useful safely and effectively for decades for dermatophyte in- (after sunscreens and avoidance of sun exposure) in- fections of scalp and nails and for more widespread skin clude polymorphous light eruption and solar urticaria. The drug is generally well toler- longer than it is for malaria, and therefore, dose-related ated, even in the long-term courses necessary for nail toxicities are important. Reversible alterations include ciliary body dysfunction and corneal changes with edema and Ketoconazole deposits. Irreversible retinopathy also occurs; however, it is less common with quinacrine than with the other two Ketoconazole (Nizoral) is approved for treating der- drugs. Toxicity may be asymptomatic, but the earliest matophyte infections unresponsive to griseofulvin and symptoms are night blindness, scotoma, or tunnel vision. Noninfectious skin eruptions, such as acne vulgaris and acne rosacea, are Clindamycin Acne vulgaris Erythromycin Acne vulgaris often treated with systemic antibiotics. The mechanism Metronidazole Acne rosacea of action is not clear, although tetracycline inhibits li- Bacitracin Superficial infection (gram-positive pases derived from resident flora in the sebaceous folli- bacteria) cle (Staphylococcus epidermidis, Propionibacterium ac- Polymixin B Superficial infection (gram-negative nes). These lipases cleave irritating fatty acids from bacteria) Neomycin Superficial infection (mainly gram- triglycerides in sebum, presumably contributing to cuta- negative bacteria) neous inflammation. Topical Agents Fluconazole Many effective topical agents are available both with Fluconazole (Diflucan) may be better absorbed and is and without a prescription for treating cutaneous der- possibly less hepatotoxic than ketoconazole, but it is matophyte infections and seborrheic dermatitis (Table considerably more expensive, an important considera- 41. Itraconazole DRUGS FOR CUTANEOUS VIRAL Itraconazole (Sporanox), a triazole, is highly lipophilic INFECTIONS and concentrates in skin. It is approved for both cuta- The specific antiviral agents used to treat cutaneous in- neous deep fungal infections and dermatophyte nail dis- fections caused by herpes simplex and varicella zoster ease, for which shorter courses of therapy are probably viruses are discussed in Chapter 50. Pulse therapy, whereby the drug is adminis- tered for 1 week and then the patient is off treatment for 3 weeks between pulses, may reduce toxicity without Interferons compromising antifungal efficacy. Interferons -2b (Intron-A), -nl, and -n3 (Alferon N) have both intrinsic antiviral effects and antiproliferative Terbinafine and immunomodulatory actions. These interferons are Terbinafine (Lamisil), an antifungal drug, is highly approved for intralesional therapy of refractory or re- lipophilic and concentrates in stratum corneum and nail current condylomata (genital warts). It is very effective for many dermatophyte infec- flulike symptoms, nausea, depression of the white blood tions, especially those of the nails, with which it may cell count, and mild diminution in hematocrit. Meta-analysis suggests that long-term efficacy of Podophyllotoxin terbinafine is superior to that of the other antifungal Podophyllotoxin (Podofilox) is available alone and as drugs used in treating onychomycosis. The drugs are used to treat condylo- phatic form of sporotrichosis, although newer agents mata acuminata.

Babies may not sequence found in association with numerous syndromes require any therapy if they have no symptoms of breath- may have a mode of inheritance that is related to the ing difficulties and no feeding difficulties syndrome itself purchase 150mg zantac otc. The mode of inheritance includes single If breathing difficulties are mild buy zantac 300mg line, the easiest manage- gene as well as chromosomal abnormalities order 300 mg zantac visa. This posi- The cause of the abnormal lower jaw in Pierre-Robin tion causes the tongue to fall forward order zantac 150mg with mastercard, relieving the syndrome may be mechanical, genetic, teratogenic, or obstruction. A thorough evaluation of these patients must 924 GALE ENCYCLOPEDIA OF GENETIC DISORDERS be conducted, which includes endoscopy of the airways sequence. Close monitoring must be type will achieve near normal jaw size within a few maintained because the prone position may obscure years of birth. If positioning the patient prone fails, a nasopharyn- geal airway may be used but only for a short time. The Resources airway is a tube passed through the nose into the upper airway, which the baby can breath through. Surgical procedures include glossopexy, in which the tongue is sutured to the lower Cohen, N. Glossopexy and tracheotomy are tempo- Otolaryngology–Head and Neck Surgery 118, no. If the child has a cleft palate, it is usually surgically repaired between the ages of nine and 18 months. Gulli, MD Prognosis The prognosis for individuals with Pierre-Robin Pierre-Robin syndrome see Pierre-Robin sequence varies with the severity of symptoms and if it is sequence associated with other congenital abnormalities. The more severe the symptoms and associated congenital abnor- malities, the greater the risk of complications. Pierre-Robin syndrome with fetal The rate at which the lower jaw starts to catch up chrondrodysplasia see Weissenbacher- in growth depends on the cause of Pierre-Robin Zweymuller syndrome GALE ENCYCLOPEDIA OF GENETIC DISORDERS 925 IPituitary dwarfism KEY TERMS Definition Adrenocorticotropin (corticotrophin)—A hor- Dwarfism is a condition in which the growth of the mone that acts on cells of the adrenal cortex, caus- individual is very slow or delayed. The word pituitary is in reference to the hormones that control water and mineral balance pituitary gland in the body. Therefore, pituitary Antidiuretic hormone (vasopressin)—A hormone dwarfism is decreased bodily growth due to hormonal that acts on the kidneys to regulate water balance. The end result is a proportionate little person, because the height as well as the growth of all other Craniopharyngioma—A tumor near the pituitary structures of the individual are decreased. Description Deprivational dwarfism—A condition where emotional disturbances are associated with growth Pituitary dwarfism is caused by problems arising failure and abnormalities of pituitary function. The pituitary gland is also called Follicle-stimulating hormone (FSH)—A hormone the hypophysis. The pituitary gland is divided into two that in females stimulates estrogen and in males halves: the anterior (front) and posterior (back) halves. The anterior half produces six hormones: growth hor- mone, adrenocorticotropin (corticotropin), thyroid Growth hormone—A hormone that eventually stimulating homone (thyrotropin), prolactin, follicle stimulates growth. The Hormone—A chemical messenger produced by posterior pituitary gland only produces two hormones. Most forms of dwarfism are a result of decreased Lutenizing hormone—A hormone secreted by the production of hormones from the anterior half of the pitu- pituitary gland that regulates the menstrual cycle itary gland. When all of the hormones of the anterior pituitary Panhypopituitarism—Generalized decrease of all gland are not produced, this is called panhypopituitarism. Dwarfism can also result from a Prolactin—A hormone that helps the breast pre- lack of somatomedin C (also called insulin like growth pare for milk production during pregnancy. Somatomedin C is a hormone Puberty—Point in development when the gonads produced in the liver that increases bone growth when begin to function and secondary sexual character- growth hormone is present. Levi-Lorain dwarfs lack the ability to produce Thyroid stimulating hormone (thyrotropin)—A somatomedin C in response to growth hormone. All hormone that stimulates the thyroid gland to pro- causes of dwarfism lead to a proportionate little person. Thus, growth can be slowed down or pituitary gland when growth hormone-releasing hormone stopped if there is a problem making any of these hor- (GHRH), is released by the hypothalamus. Growth hor- mones or if there is a problem with the cells receiving mone is then released and stimulates the liver to produce these hormones.

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AM trained medical doctors purchase 300 mg zantac with visa, insurance policies often cover doctors believe that true healing must first bring an illness their fees discount 150 mg zantac mastercard, although consumers should be aware of their out in order to heal it cheap zantac 150mg with mastercard, and that healing requires change policy restrictions purchase zantac 150mg on line. AM also asserts, as did the early healer Paracelsus, Preparations that every illness has a cure that can be found in nature. Paracelsus is the pseudonym for a Swiss-born alchemist AM doctors may give new patients packages of ma- and physician who lived from 1493–1541. Nature and terials before treatment, which include thorough ques- the human body are made up of the plant, animal, and tionnaires and explanations of AM. Anthroposophical mineral kingdoms, and thus AM doctors use medicines physicians encourage patients to prepare for treatment that are made from plants, animals (usually in the form by becoming willing to take responsibility for their con- of organ extracts), and minerals. AM remedies are usual- dition and health, and to change their behaviors and ly given in homeopathic doses, which are very diluted, lifestyles in the interest of healing. Side effects Treatment by an anthroposophical physician AM medications are safe and non-toxic. During All anthroposophical physicians are conventionally treatment, some patients may experience what doctors trained M. Ayurvedic medicine—System of healing originat- ORGANIZATIONS Anthroposophic Press. Chi—Universal life energy as defined by tradition- Artemesia, The Association for Anthroposophical Renewal of al Chinese medicine. Yin and yang—Two opposite and complimentary characteristics used to describe the universe and Douglas Dupler phenomena, defined by traditional Chinese medi- cine. Antioxidants Description Research & general acceptance Antioxidants are a broad group of compounds that Active research in AM is being regularly conducted destroy single oxygen molecules, also called free radi- in Europe, mainly in Germany, Holland, Switzerland, and cals, in the body, thereby protecting against oxidative France. They are essential to good health and centered research have shown promising results with the are found naturally in a wide variety of foods and plants, AM cure for cancer, which utilizes the herbal remedy including many fruits and vegetables. Other research dants, either singly or in combination, are also available has shown that AM is less expensive than conventional as over-the-counter nutritional supplements in tablet or medical treatment, with 50% fewer illness days than when capsule form. Others in- studies appear in the quarterly Journal of Anthroposophi- clude grape seed extract, vitamin A, selenium, and cal Medicine, as well as in European publications. It is unknown whether or not supplemen- tal antioxidants provide the same benefits as those occur- ring naturally in foods, however. Training & certification Currently, there is no course for the certification of AM practitioners, although every AM doctor is required General use to obtain training as a certified M. Afterwards, physi- In brief, antioxidants destroy free radicals in the cians may specialize in AM by taking a series of courses body. The Physicians Associa- lism that can damage cells and are among the causes of tion for Anthroposophic Medicine (PAAM) is the largest many degenerative diseases, especially diseases associat- association in North America. As a person ages, cell damage accumu- medicine is Artemesia, The Association for Anthropo- lates, and supplementing the diet with extra antioxidant- sophical Renewal of Healing. Scientific studies validate the role of antioxidants Resources in preventing many diseases. Although studies have BOOKS shown lower rates of cancer and heart disease in people Bott, Victor. Hudson, New York: who eat a recommended amount of fruits and vegetables, Anthroposophic Press, 1985. Past studies have demon- risk of cardiovascular disease or certain other diseases. Many herbs and medicinal plants are good natural In fact, the combination of Vitamin C and E can slow pro- sources of antioxidants. These include carrots, tomatoes, gression of cardiovascular disease following heart trans- yams, leafy greens, blueberries, billberries, ginkgo bilo- plant. In 2002, researchers stated that the vitamin combina- ba, garlic, and green tea, to name a few. In ad- vitamin C, vitamin E, and beta carotene may help reduce dition, Harvard Medical School reported in the same year the risk of some cancers, heart disease, cataracts, and that Vitamin E might play a role in helping people live strokes. Vitamin A Carotenoids A study by the University of Arizona found that vita- This class of antioxidants includes beta carotene, min A has a protective affect against many types of cancer, lutein, and lycopene.

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However generic zantac 300 mg online, definitive evidence of the rela- tionship between marijuana smoking and the incidence Extent and Pattern of Abuse of lung cancer is lacking 150mg zantac sale. Because of the rapid tolerance produced does not result in severe withdrawal symptoms generic zantac 300mg line, numer- with these drugs purchase zantac 300 mg mastercard, the typical abuser does not use the ous case reports attest to development of dependence drug on a daily basis. The most prominent symptoms were irritability and Illicit PCP abuse began in the 1960s, primarily by restlessness; others included insomnia, anorexia, in- oral ingestion. Cessation of mild or PCP frequently produced dysphoria, which was unpre- moderate use of marijuana, however, does not produce dictable. The HALLUCINOGENS specific acute effects of a drug like LSD include eupho- The term hallucinogen is often used to describe a drug ria, depersonalization, enhanced awareness of sensory that produces a change in sensory perception, usually ei- input, alterations in the perception of time or space or ther visual or auditory. Drugs commonly assigned to this body image, and to some extent, minor stimulant ef- class include lysergic acid diethylamide (LSD), mesca- fects. Sometimes the dreamlike quality of the experi- line (derived from the peyote cactus), and psilocybin ence produces relaxation, good humor, and a sense of (derived from a mushroom). For this reason the term is sometimes used in- the use of the hallucinogen may have drug-induced anx- terchangeably with psychedelic or psychotomimetic, the iety, panic, or even paranoid ideation. The loss of indi- latter term representing the CNS effects beyond the hal- viduality can be perceived as a disintegration of the per- lucination itself. Even if the drug lucinogen are inadequate, but it should be used to signify experience initially is euphoric, tremendous mood substances that consistently produce changes in sensory swings can occur and suddenly plunge the abuser into perception, thought, and mood. These negative phe- drug that reliably produces alterations in perceptions as nomena are not always precipitated by an unexpected a primary effect. Drugs that should not be included are or sudden frightful event but can be a function of the la- those that produce alterations in sensory perception bile mood induced by the drug. Other types of classified as an hallucinogen if it has other properties as hallucinations are possible. Several drugs that reliably alter mood at low doses volves the belief by the individual that the (altered) sen- and produce altered sensory perceptions at slightly sations and perceptions actually represent reality. These drugs that also reliably lated drugs retains the ability to test reality versus illu- produce differing degrees of CNS stimulation in a dose- sion and knows that the experience is not real. Thus, the 418 IV DRUGS AFFECTING THE CENTRAL NERVOUS SYSTEM typical drug-induced hallucinatory state would be more Tolerance and Dependence appropriately termed a pseudohallucination, though Tolerance to the effects of hallucinogens develops rap- real hallucinations are possible. In fact, a high degree of tolerance can be produced chotomimetic changes are those considered to be after as few as three to four daily doses of drug. These effects are somewhat more Generally, the abuser self-imposes the requirement for variable than the hallucinatory effects or changes in a 2- to 3-day drug-free period before another drug ses- sensory perception. Additionally, there is a tremendous degree of LSD, they seem to be more common with other specific cross-tolerance between the hallucinogens, so other hallucinogens, such as MDMA and MDA. LSD-like hallucinogens cannot be abused during the MDMA (XTC, or ecstasy) possesses hallucinogenic drug-free period either. One danger with the stimulant activity similar to that of mescaline but also produces subclass of hallucinogens is rapid development of toler- stimulant activity similar to that of amphetamine. Despite ity to communicate with others, increases the degree of the apparent overlap of effects with stimulant drugs, intimacy one feels toward others in the surroundings, in- however, there is no cross-tolerance with the CNS stim- creases self-esteem and mood, and generally appears ulants such as amphetamine. One during drug abstinence, nor is there a tremendous crav- residual effect of abuse is the MDMA hangover, which ing for drug during the drug-free period. Therefore, is the occurrence on the second day after abuse of clearly no dependence is attributed to the hallucinogens. Typically, a dose of 75 mg produces the pri- mary psychotomimetic effects, while a dose of 150 mg Treatment Strategies produces LSD-like effects, and a dose of 300 mg pro- The difference between the abused and the lethal dose duces amphetaminelike CNS stimulation. The amphet- of LSD is very large, so little pharmacological interven- aminelike stimulation of the CNS and periphery is tion is necessary. The effects Treatment of PCP intoxication also involves limiting that can be produced by stimulatory doses of hallucino- external stimuli, minimizing lighting, noise, and unneces- gens include tachycardia, hypertension, and arrhyth- sary physical contact. It induces a wide variety of psychotomimetic and hallucinatory effects during emergence from anes- Mechanism of Action thesia. At a low dose, individuals believe they are thinking the hallucinogens is the activation of the 5-HT2-receptor. Other happiness, though (especially at higher doses) the indi- drugs, such as MDMA, induce the release of endogenous vidual can vacillate between euphoria and depression.

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