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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 generic viagra sublingual 100 mg on line, two-thirds of homicides 100 mg viagra sublingual otc, 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. Once the Absorption, Distribution, Metabolism, and withdrawal syndrome has dissipated, the abusers of Excretion benzodiazepines are not as likely to resume drug con- sumption as are alcoholics. Withdrawal signs appear to After oral administration, ethanol is almost completely be more likely following chronic exposure to short- absorbed throughout the gastrointestinal tract. The rate acting benzodiazepines, such as alprazolam (half-life of of absorption is largely determined by the quantity con- less than 15 hours) or lorazepam than long-acting drugs. Eating food before or during drinking retards ab- ing, clouded sensorium, heightened sensory perception, sorption, especially if the food has a high lipid content. Withdrawal signs brain, liver, lungs, and kidney, equilibrium occurs rap- peak the second day after abrupt withdrawal and last idly.
CELL TYPE (ADULT) FUNCTION Other nicknames are segs buy 100mg viagra sublingual overnight delivery, referring to 54%–62% Phagocytosis the segmented nucleus order viagra sublingual 100 mg otc, and PMNs, an Granulocytes 1%–3% Allergic reactions; defense against abbreviation of polymorphonuclear neu- Neutrophils parasites Eosinophils trophils. Before reaching full maturity 1% Allergic reactions; inflammatory re- and becoming segmented, the nucleus of actions Basophils the neutrophil looks like a thick, curved 25%–38% Immunity (T cells and B cells) band (Fig. An increase in the Agranulocytes 3%–7% Phagocytosis number of these band cells (also called Lymphocytes Monocytes stab or staff cells) is a sign of infection and the active production of neutrophils. They squeeze be- tween the cells of the capillary walls and proceed by ameboid (ah-ME- boyd), or amebalike, motion to the area of infection where they engulf the invaders. When foreign organisms invade, the bone marrow and lymphoid tissue go into emergency production of A Mature neutrophil B Band cell white cells, and their number in- (immature neutrophil) creases enormously as a result. A mixture of dead and living THE BLOOD ✦ 269 Bacterium Leukocyte Lysosome Bacterium Vesicle Lysosome Blood Digestive products Erythrocyte Capillary wall Epithelial cell Residue A B Figure 13-6 Phagocytosis. Hemostasis (he-mo-STA-sis) is the process that prevents blood loss from the circulation when a blood vessel is Checkpoint 13-8 What are the types of granular leukocytes? Activated platelets be- tiny structures are not cells in them- selves but rather fragments constantly Platelets released from giant bone marrow cells called megakaryocytes (meg-ah-KAR- Erythrocytes e-o-sites) (Fig. Serum contains all the com- The many substances necessary for blood clotting, or co- ponents of blood plasma except the clotting factors, as ex- agulation, are normally inactive in the bloodstream. A pressed in the formula: balance is maintained between compounds that promote clotting, known as procoagulants, and those that prevent Plasma serum clotting factors clotting, known as anticoagulants. The final step in these reac- ◗ Blood Types tions is the conversion of a plasma protein called If for some reason the amount of blood in the body is se- fibrinogen (fi-BRIN-o-jen) into solid threads of fibrin, verely reduced, through hemorrhage (HEM-eh-rij) (ex- which form the clot. One possible measure to tion are described below and diagrammed in Figure 13-8: take in such an emergency is to administer blood from ◗ Substances released from damaged tissues result in the another person into the veins of the patient, a procedure formation of prothrombinase (pro-THROM-bih-nase), called transfusion. There are many types of such than the lining of a blood vessel, for example, a glass or proteins, but only two groups are particularly likely to cause a transfusion reaction, the so-called A and B anti- gens and the Rh factor. Injury or removal of blood from vessels The ABO Blood Type Group There are four blood types involving the A and B antigens: Preliminary steps in clotting A, B, AB, and O (Table 13-3). THE BLOOD ✦ 271 Table 13•3 The ABO Blood Group System BLOOD RED BLOOD REACTS WITH PLASMA CAN TAKE CAN TYPE CELL ANTIGEN ANTISERUM ANTIBODIES FROM DONATE TO A Anti-A Anti-B A, O A, AB B Anti-B Anti-A B, O B, AB AB A, B Anti-A, Anti-B None AB, A, B, O AB O None None Anti-A, Anti-B O O, A, B, AB Testing for Blood Type Blood sera containing anti- Anti-A serum Anti-B serum bodies to the A or B antigens are used to test for blood type. Blood serum containing antibodies that can agglutinate and destroy red cells with A antigen is called anti-A serum; blood serum containing antibodies that can destroy red cells with B antigen is called anti-B serum.
A 23 year-old college student is diagnosed with red-orange discoloration of saliva discount viagra sublingual 100mg without prescription, tears discount viagra sublingual 100 mg with mastercard, and urine Neisseria meningitidis based on his clinical presenta- but not the color vision problems. Isoniazid (E) is tion, gram-negative diplococci on Gram stain, and associated with peripheral neuritis in chronic alco- isolation of bacteria from cerebrospinal fluid. Which holics and malnourished individuals and requires of the following drugs can be used as a prophylactic pyridoxine supplements. Its most disturbing side effect is (C) Dapsone red-brown pigmentation of skin, particularly in (D) Clarithromycin light-skinned persons. A 32-year-old Haitian man has acute-onset confu- Johnson syndrome (dapsone dermatitis), but it is not sion and suicidal ideation. Rifampin combination therapy for multi–drug resistant pul- (B) imparts a harmless red-orange discoloration of monary tuberculosis. He has a history of depression saliva, sweat, urine, feces, tears, and contact lenses that required intermittent treatment in the past. Its use is not (A) Pyrazinamide associated with skin discoloration or pigment prob- (B) Aminosalicylic acid lems. Rifampin, commonly used in the prophylaxis ANSWERS of Neisseriae meningitidis, is given to individuals 1. Pyrazinamide is known to cause hyperuricemia who are in close contact with someone having the and precipitate gouty arthritis. Other drugs that can be used include induced gouty arthritis does not respond to urico- ciprofloxacin and sulfonamides. Amoxicillin (A) is suric therapy with probenecid but may respond to used as prophylaxis of endocarditis in patients acetylsalicylic acid. Cycloserine (A) can cause with a history of endocarditis or a preexisting headaches, confusion, tremors, and seizures, possibly valvular heart disease.
A wide variety of other therapies have been benefi- Care for the caregiver cial in the treatment of the psychologic symptoms of AD buy viagra sublingual 100mg on line. These include: Family members or others caring for a person with • Light therapy in the evening to improve sleep cycle dis- AD have an extremely difficult and stressful job that be- turbances purchase viagra sublingual 100mg without prescription. It is common for caregivers to develop feelings of anger, resentment, guilt, • Supportive therapy through touch, compliments, and and hopelessness, in addition to the sorrow they feel for displays of affection. Outside help, nursing homes, and governmental assistance • Reality-oriented therapy. Most families eventually need outside help to relieve Nursing care and safety some of the burden of around-the-clock care for a person with AD. Personal care assistants, either volunteer or The nursing care required for a person with AD is paid, may be available through local social service agen- easy to learn. Adult daycare facilities are becoming increasingly creasing amounts of time grooming the patient as the dis- common. Many families consider early on to make sure that he or she is taking in enough nursing home care when AD advances to the late-stage. Later on, as movement and swallowing become Several federal government programs may ease the difficult, a feeding tube may be placed into the stomach cost of caring for a person with AD, including Social Se- through the abdominal wall. A feeding tube requires more curity Disability, Medicare, and Supplemental Security attention, but is generally easy to care for if the patient is Income. Incontinence becomes the most dif- sistance for care, medication, or other costs, but none of ficult problem to deal with at home, and is a principal rea- them will pay for nursing home care indefinitely. In the early stages, aid is a state-funded program that may provide for some limiting fluid intake and increasing the frequency of toilet- or all of the cost of nursing home care, although there are ing can help. Details of the benefits and eligi- prevent skin irritation and infection from soiled clothing. In the home, simple Allopathic treatment measures such as grab bars in the bathroom, bed rails on the bed, and easily negotiable passageways can greatly The only two drugs approved for AD, tacrine hy- increase safety.
