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By D. Eusebio. Dallas Theological Seminary. 2018.

You choose the fol- stenosis lowing drug to treat the patient because it slows heart rate by blocking L-type calcium channels in ANSWERS the SA node: 1 forzest 20mg fast delivery. Nitroglycerin can reduce preload discount forzest 20mg with mastercard, which in turn cial results observed in patients with secondary reduces wall tension and increases subendocardial angina? Nitroglycerin also reduces afterload, but (A) Reduction in the force of myocardial contrac- this is a small effect compared to the reduction in tion preload. Its effects on heart rate and contractility (B) Reduction in systemic vascular resistance (af- are minimal, and if anything reflex tachycardia and terload) increase in contractility would be detrimental ef- (C) Increased heart rate fects of too much nitroglycerin. Nitroglycerin can increase heart rate via an in- (E) Increased blood flow to the subepicardium crease in sympathetic tone to the heart due to an 3. A woman is prescribed a combination of drugs con- excessive decrease in blood pressure; propranolol sisting of a nitroglycerin patch and a -blocker, such would block the -receptors responsible for the as propranolol, to treat her attacks of secondary tachycardia. Which effect of propranolol would counter- and its effect to decrease afterload would exacer- act an adverse effect of nitroglycerin? Propranolol does not increase myocardial (B) A decrease in afterload contractile force and could actually increase the in- (C) A decrease in heart rate cidence of vasospasm by unmasking -adrenocep- (D) An increase in myocardial contractile force tors in the coronary blood vessels. Propranolol would fice complaining of increased frequency of chest tend to produce vasoconstriction, not vasodilation. An increase in time spent in diastole would in- nolol and give him diltiazem because you suspect crease subendocardial blood flow. Metoprolol would produce which beneficial effect nists, nitrates and beta blockers on platelet function: in a patient with secondary angina? Evidence for a causal role of the renin- (C) An increase in afterload angiotensin system in nitrate tolerance. Drug therapy: Nitrate ther- erance, vasoconstrictor sensitivity and vascular su- apy for stable angina pectoris. Case Study Treatment of Coronary Vasospasm 60-year-old man comes into the office com- ANSWER: Treat the patient with sublingual nitroglyc- Aplaining of chest pains that primarily occur in erin for the acute attacks because of its rapid onset the early morning and do not appear to be associ- of action and its powerful vasodilating effect on the ated with stress or exercise. Following coronary an- large epicardial conductance coronary arteries, giography and a positive ergonovine test you deter- which are normally the primary site of the spasm. How would you (1) treat ties, an oral calcium channel blocker, such as am- the patient to alleviate the acute attacks when they lodipine or verapamil, or a long-acting nitrate occur and (2) treat chronically to prevent their re- preparation, such as the transdermal form of nitro- occurrence? Cassis DRUG LIST GENERIC NAME PAGE GENERIC NAME PAGE Benzapril 212 Losartan 213 Candesartan 213 Moexipril 212 Captopril 210 Quinapril 212 Enalapril 212 Perindopril 212 Eprosartan 213 Ramipril 212 Fosinopril 212 Spironolactone 214 Irbesartan 213 Telmisartan 213 Lisinopril 212 Valsartan 213 THE RENIN–ANGIOTENSIN SYSTEM duction of a family of structurally related peptides (e. Sites for pharmacological inter- regulation of vascular smooth muscle tone, fluid and vention in this system include the enzymatic steps cat- electrolyte balance, and the growth of cardiac and vas- alyzed by renin, angiotensin-converting enzyme (ACE), cular smooth muscle. A normally functioning renin– and angiotensin receptors that mediate a particular angiotensin system contributes to the routine control of physiological response. A variety of basic and clinical investigations have resulted in a broader understanding Renin of the role of the renin–angiotensin system in the car- diovascular pathophysiology of hypertension, conges- Renin is an enzyme that is synthesized and stored in the tive heart failure, and more recently, atherosclerosis. Renin has a narrow substrate of these diseases, pharmacological inhibition of the specificity that is limited to a single peptide bond in an- renin–angiotensin system has proved to be a valuable giotensinogen, a precursor of angiotensin I. Renin is therapeutic strategy in the treatment of hypertension and considered to control the rate-limiting step in the ulti- congestive heart failure.

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Contraction along the humerus discount forzest 20mg, is the muscle you usually display of the intercostal muscles serves to elevate the ribs buy forzest 20mg lowest price, thus when you want to “flex your muscles” to show your enlarging the thoracic cavity from side to side and from strength (Fig. Another flexor of the forearm at the elbow is the bra- chioradialis (bra-ke-o-ra-de-A-lis), a prominent muscle Checkpoint 8-13 What muscle is most important in breathing? Muscles of the Abdomen and Pelvis The wall of The triceps brachii, located on the posterior of the the abdomen has three layers of muscle that extend from arm, inserts on the olecranon of the ulna (Fig. They are the ex- 166 ✦ CHAPTER EIGHT ternal oblique on the outside, the in- ternal oblique in the middle, and the Biceps Triceps brachii transversus abdominis, the inner- brachii most. The connective tissue from Brachioradialis these muscles extends forward and en- closes the vertical rectus abdominis of Extensor carpi the anterior abdominal wall. The fibers radialis longus of these muscles, as well as their con- nective tissue extensions (aponeu- Brachioradialis Extensor carpi radialis brevis roses), run in different directions, re- sembling the layers in plywood and Flexor carpi Flexor carpi resulting in a strong abdominal wall. Deep Muscles of the Back The deep muscles of the back, which act on Intercostal Left lung the vertebral column itself, are thick muscles vertical masses that lie under the trapezius and latissimus dorsi. Muscles of the Lower Extremities The muscles in the lower extremities, among the longest and strongest mus- cles in the body, are specialized for lo- comotion and balance. Rectus External Muscles that Move the Thigh abdominis oblique and Leg The gluteus maximus (Linea alba) Internal (GLU-te-us MAK-sim-us), which oblique forms much of the fleshy part of the (Umbilicus) Transversus buttock, is relatively large in humans abdominis because of its support function when a (Abdominal aponeurosis) person is standing in the erect position (Fig. It is a powerful Table 8•5 Muscles of the Trunk* flexor of the thigh and helps keep the trunk from falling backward when one NAME LOCATION FUNCTION is standing erect. These strong thoracic cavity Muscles of abdomi- muscles press the thighs together, as Anterolateral abdominal Compress abdominal nal wall: wall cavity and expel in grasping a saddle between the External oblique substances from body; knees when riding a horse. Gluteus medius Iliopsoas Gluteus maximus Sartorius (Iliotibial tract) Adductor Adductor Vastus lateralis longus magnus Gracilis Gracilis Quadriceps femoris: Adductor Sartorius magnus Rectus femoris Hamstring group: Vastus lateralis Biceps femoris Vastus medialis Semitendinosus Vastus intermedius (not shown) Semimembranosus (Patella) A Anterior view B Posterior view Figure 8-16 Muscles of the thigh. Their tendons can Gluteus medius Deep buttock, to femur Abducts thigh Iliopsoas Crosses front of hip Flexes thigh be felt behind the knee as they de- joint, to femur scend to insert on the tibia and fibula. Individually, adductor magnus) Sartorius Winds down thigh, Flexes thigh and leg moving from lateral to medial posi- ilium to tibia (to sit cross-legged) tion, they are the biceps femoris, the Gracilis Pubic bone to medial Adducts thigh at hip; semimembranosus, and the semi- surface of tibia flexes leg at knee tendinosus. The name of this muscle Quadriceps femoris: Anterior thigh, to tibia Extends leg group refers to the tendons at the back Rectus femoris Vastus medialis of the knee by which these muscles Vastus lateralis insert on the leg. Vastus intermedius (deep; not shown) Muscles That Move the Foot Hamstring group: Posterior thigh, to tibia Flexes leg Biceps femoris and fibula The gastrocnemius (gas-trok-NE-me- Semimembranosus us) is the chief muscle of the calf of the Semitendinosus leg (its name means “belly of the leg”) Gastrocnemius Calf of leg, to calca- Plantar flexes foot at (Fig. According to Greek outward) mythology, the region above the heel Flexor digitorum Posterior leg and foot Flex toes was the only place that Achilles was groups to inferior surface of vulnerable, and if the Achilles tendon is toe bones Extensor digitorum Anterior surface of leg Extend toes cut, it is impossible to walk. The anterior and lateral femur are covered by the The muscle for eversion of the foot is the peroneus (per- quadriceps femoris (KWOD-re-seps FEM-or-is), a large o-NE-us) longus, located on the lateral part of the leg. The individual parts The long tendon of this muscle crosses under the foot, are as follows: in the center, covering the anterior thigh, forming a sling that supports the transverse (metatarsal) the rectus femoris; on either side, the vastus medialis arch. The tendons of the extensor muscles nates from the ilium, and the other three are from the are located in superior part of the foot and insert on the femur, but all four have a common tendon of insertion on superior surface of the phalanges (toe bones). The term Charley horse comes from the cise throughout life delay and decrease these undesirable practice of using Charley as a name for old lame horses effects of aging. Even among the elderly, resistance exer- that were kept around for family use when they were no cise, such as weight lifting, increases muscle strength and longer able to do hard work.

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The growth of obesity as a widespread problem is illuustrated in the comparison of its spread in 1991 and 2001 buy forzest 20mg overnight delivery. Oils high in linoleic acid include soybean purchase forzest 20 mg with visa, based meats and the under-consumption of cold-water peanut, corn, sunflower seed, cottonseed, soy, sesame, fish and unprocessed oils can lead to an over-production and safflower. There is no official recommended daily of inflammation-producing PGE2 and an under-produc- dose for omega-6 fatty acids. The mately 1–2% of the daily calorie intake, or 1 tsp (3–6 g goal is to consume omega-6 fatty acids in a balance with per day), should prevent signs of deficiency in most omega-3 fatty acids. An optimal dose is around 3–6% of daily calorie omega-6 fatty acids to omega-3 fatty acids that should be intake, or 1 tbsp (9–18 g daily). For GLA supplementation, primrose oil, borage oil, Daily consumption of omega-6 fatty acids by many and are available in capsule form. To achieve a, alcohol consumption, and prescription medi- more desirable ratio, an approach is to eliminate sources cines can interfere with the conversion of linoleic acid to of omega-6 fatty acids, especially those hidden in its derivatives. Therefore, those with such conditions processed foods and to increase the amount of omega-3 may benefit from the use of GLA supplementation to im- fatty acids consumed through or supple- prove the production of prostaglandins. In addition, to convert the omega-6 fatty acids improve prostaglandin production, the use of un- present in oils (such as corn, safflower, or soybean) to processed, unheated omega-6 oils in the cis form is rec- GLA requires that the oils be unprocessed and unheated ommended. In oils that have un- dergone processing (heating and/or hydrogenation) to prolong shelf life (e. Deficiencies are considered to be (ARMD), a disease of the eye that leads to a pro- rare and limited to people with severe malabsorption, gressive loss of vision and eventual blindness. For those who are unable to convert LA to GLA, dietary supplements containing GLA can be taken to increase the production of prostaglandins. Evening Nutrients essential for the use of omega-6 fatty acids primrose, black currant, and all contain GLA. Long term exclusive or excessive use of flaxseed oil, which contains large amounts of omega-3 fatty acids, can result in omega-6 fatty acid deficiency and require the addition of oils containing omega-6 fatty Gittleman, Ann Louise. Omega-6 fatty acids may be consumed either as linoleic acid in oils that contain high levels of linoleic “Harvard Study Outlines Role of Fats in Blinding Eye Dis- acid, or in the converted form, GLA, in dietary supple- ease. Oregano essential oil Description General use GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1491 diets pain yoga meditation cholesterol atherosclerosis pain martial arts reiki stressre- laxation massage therapy —A condition caused by a dietary defi- ciency of niacin, one of the B vitamins. The cysts that appear during the regular activity of and Paclitaxel (EPI-TAX Regimen) for Advanced Ovarian the ovaries are called functional cysts. The following herbs the duodenum (the upper part of the small intestine), are helpful in treating parasitic infestations: which are then analyzed for the presence of parasites. First discovered by • and vaginal swab to detect, Australian aborigines, has many uses, in- a parasite that causes vaginitis. Computed axial tomography (CT) scans bial alkaloid that can prevent parasites from attaching and magnetic resonance imaging (MRI) are used to di- to the intestinal walls of human hosts. Oregon grape and goldthread Alternative therapies for parasitic infections reduce () is a very safe parasitic infections by improving and strength- remedy for pinworm infection. The melon is a vegetable ening the immune system through herbal therapy and shaped like a cucumber with a bitter taste.

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Anytime a child with Neu-Laxova syndrome is a rare disorder character- NLS is born trusted 20 mg forzest, the parents must be obligate order 20 mg forzest with amex, or mandatory, ized by onset of severe growth delay during pregnancy, carriers of one NLS gene. As such, they face an increased multiple birth defects, and abnormal physical develop- risk in future pregnancies together of having another ment of the brain. Thus, it is not possible to perform direct genetic testing to Description determine carrier status, confirm a clinical diagnosis, or In 1971, Dr. Each child had an unusually small Demographics head (microcephaly) and abnormalities of their arms, Adequate data are not available to provide a specific legs, skin, and external genitalia. The condition is daughters were each stillborn, while the affected son only very rare. Laxova described a of Neu-Laxova syndrome had been reported up to that different family whose children had birth defects similar point in medical literature. Taken Signs and symptoms together, these two families were considered evidence of a previously unrecognized genetic syndrome. The disor- Stillborn or newborn infants with NLS have a char- der was named Neu-Laxova syndrome in honor of these acteristic pattern of internal and external abnormalities. Not all affected infants will have all of the features listed Neu-Laxova syndrome (NLS) has since become below, and some anomalies are slightly more common known as a rare, lethal inherited condition characterized than others. Their heads are very small, and scaly skin, generalized swelling of body tissues (edema), their foreheads appear to slant backwards. The external features of the head and face are a Agenesis of the corpus callosum—Failure of the reflection of severe physical abnormalities of the brain. The corpus is not unusual for an infant with NLS to have an under- callosum is the band of nerve fibers located developed cerebellum or even lissencephaly, a more seri- between the two sides, or hemispheres, of the ous malformation characterized by a smooth brain brain. Normal development of the brain includes an Cataract—A clouding of the eye lens or its sur- intricate pattern of grooves, or gyri, on its outer surface. Surgery may be per- dation among survivors and an increased frequency of formed to remove the cataract. Other reported brain malformations include agenesis of the corpus cal- Cerebellum—A portion of the brain consisting of losum and Dandy-Walker malformation. The cerebellum is involved in control A variety of limb abnormalities have also been of skeletal muscles and plays an important role in described in NLS. Affected individuals often have short- the coordination of voluntary muscle movement. It ened arms and legs that are held out from the body in an interrelates with other areas of the brain to facili- unusual, fixed position. This positioning is often referred tate a variety of movements, including maintaining to as flexion contractures. The fingers and toes may proper posture and balance, walking, running, and appear underdeveloped (hypoplastic) and/or fused fine motor skills, such as writing, dressing, and together (syndactyly).

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