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The menstrual cycle ends about 14 they are difficult to explain by transcriptional activa- days later with the regression of the corpus luteum and 706 VII DRUGS AFFECTING THE ENDOCRINE SYSTEM a concomitant fall in estrogen and progesterone pro- bleeding ensues buy 40 mg cialis extra dosage free shipping impotence hypertension medication. In the event that pregnancy occurs cheap 100mg cialis extra dosage overnight delivery impotence newsletter, human chorionic go- Growth and Development nadotropin secretion by the embryo maintains the cor- pus luteum through stimulation of progesterone and es- Estrogens cause the growth of the uterus, fallopian trogen synthesis. Stimulation of proliferation of the vaginal epithelium is checked by the cyclical exposure to progesterone during the luteal phase in the mature Control of Pregnancy female. Estrogens also are responsible for the expres- Ovulation sion of female secondary sex characteristics during pu- During the follicular phase of the menstrual cycle, one berty. FSH and tion of body hair, body contours as determined by estrogens are the most important hormones for this de- subcutaneous fat deposition, and skin texture. Complete follicular maturation development, estrogens stimulate proliferation of the cannot occur in the absence of LH. Progesterone me- follicle follows the midcycle peak of LH and FSH by diates lobuloalveolar development at the ends of these about 24 hours. During the luteal phase of the men- breast cell proliferation occur during the menstrual cy- strual cycle and under the influence of LH, the ovarian cle, with the highest levels of proliferation occurring granulosa cells of the corpus luteum become vacuolated during the luteal phase, when circulating levels of both and accumulate a yellow pigment called lutein. This has led to the idea that progesterone, as well as estrogens, exerts mi- totic effects in adult human breast tissue. The effects of Implantation estrogens and progesterone on breast development are The lining of the uterus, that is, the endometrium, is crit- most noticeable during puberty and pregnancy. The en- Estrogens can stimulate the release of growth hor- dometrium consists of a layer of epithelial cells overly- mone and exert a positive effect on nitrogen balance. Under the These effects contribute to the growth spurt during pu- influence of estrogen and progesterone, the endome- berty. Closure of the bone epiphyses signaling the end trium undergoes cyclical changes that prepare it for the of long bone growth is also estrogen mediated. Estrogens to high concentrations of progesterone and moderate maintain bone mass by inhibiting bone resorption by estradiol levels, the mitotic activity in the endometrial the osteoclasts. The action of progesterone on the tokines by peripheral blood cells and the osteoblasts endometrium converts it from a proliferative state to a that stimulate osteoclast activity. The epithelial cell structure assumes a women, declining estrogen levels give rise to a net in- more glandular appearance. Vascularization of the crease in osteoclast activity and loss of bone mass re- stroma increases, and some stromal cells begin to look sulting in the serious condition osteoporosis. Estriol is produced in high concentrations by Other Actions of Estrogens the placenta in pregnant women. The high levels of estrogens and progesterone associ- Under the influence of high levels of estrogen or pro- ated with pregnancy may alter liver function and glu- gesterone, the physicochemical composition of cervical cose metabolism. High circulating levels of estrogen can mucus may reduce sperm motility and provide a barrier cause mild glucose intolerance. Modifications at positions the formation of high-density lipoproteins and reducing C6 and C7 increase their progestational activity. Reductions in serum albumin Examples of these synthetic progestins include me- and antithrombin III synthesis can occur in the pres- droxyprogesterone and megestrol acetate (Megace). These compounds are metabolized in the same manner In males, estrogens stimulate the growth of the stro- as progesterone and are excreted in the urine. SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMs) SYNTHETIC AGENTS ACTING VIA ESTROGEN AND PROGESTERONE Selective ER modulators (SERMs) are nonhormonal RECEPTORS pharmacological agents that bind to ERs. A characteris- tic feature of the SERMs is that a given agent will act as Long-acting semisynthetic estrogens and progestins an estrogen agonist in one or more tissues and as an es- contain esterified lipophilic substituents. Esterification trogen antagonist in one or more other estrogen target of steroids prolongs their release from depot injection organs. Medroxyprogesterone acetate (Amen, Cyctin, rate (Clomid, Serophene) and raloxifene (Evista) are Provera, Depo-Provera) is a widely used long-acting examples of nonsteroidal SERMs. SERM is tamoxifen citrate, a drug formerly character- Synthetic steroid hormones retain the common ized as an antiestrogen. The two most thus is used as a treatment and chemopreventative for widely used synthetic steroid estrogens are ethinyl estra- breast cancer. Tamoxifen is a full agonist in bone and diol (Estinyl) and mestranol, found in oral contracep- endometrium, and prolonged use of tamoxifen leads to tives. Synthetic steroids containing an ethinyl substitution a fourfold to fivefold increase in the incidence of en- are metabolized more slowly.

Wells Belinda Rowland order cialis extra dosage 200mg without prescription impotence yohimbe, PhD Science Writer Medical Writer Laguna Hills buy 200mg cialis extra dosage otc can you get erectile dysfunction young age, CA Voorheesville, NY Joan M. Schonbeck, RN Angela Woodward Medical Writer Science Writer Marlborough, MA Madison, WI Gabriele Schubert, MS Kathleen Wright, RN Medical Writer Medical Writer San Diego, CA Delmar, DE Kim Sharp, M Ln Jennifer L. Wurges Medical Writer Medical Writer Houston, TX Rochester Hills, MI XXII GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 A Abdominal pain see Stomachaches • Dental abscess. People who have a birth defect in- volving a tiny opening in the skin just above the anus Abscess may have fecal bacteria enter this opening, causing an infection and a subsequent abscess. An abscess is a place of accumulation of the creamy As a result of throat infections like strep throat and white, yellow, or greenish fluid, known as pus, surround- tonsillitis, bacteria invade the deeper tissues of the ed by reddened tissue. A retropharyngeal abscess is a result of some- viral, parasitic, or fungal infection. An abscess usually thing usually blood-borne, and not from a direct spread dries out and resolves when it is drained of pus. These abscesses can compromise swal- most common parts of the body affected by abscesses lowing and even breathing. During or after pneumonia, an abscess glands (oil glands), and the breast during lactation. Bacteria, parasites, or amoeba from the Description intestines can spread through the blood to the liver and Most abscesses are septic, which means they are the cause abscesses. An abscess can develop in the psoas cells (WBCs) gather in response to an infection. They pro- muscles, when an infection spreads from the appendix, duce oxidants (for example, superoxide radical) and en- the large intestine, or the fallopian tubes. The infective agents are then broken down by the that stimulate pus production (pyogenic organisms). WBCs into small pieces that can be transported through Can cause abscesses in possibly many sites. The resulting liquid of this digestion is pus, which contains the remains of the Causes & symptoms infective agents, tissue, white blood cells, and enzymes. The most A sterile abscess is one that is not produced by an common are the pyogenic, or pus-forming bacteria, such infection. It is caused by irritants, such as foreign bodies as Staphylococcus aureus, which is nearly always the or injected drugs, and medications that have not been to- cause of abscesses directly under the skin. Sterile abscesses quite often heal into usually caused by organisms that normally inhabit near- hardened scar tissue. For example, abscesses around the anus may be caused by any of the numerous Common types of abscesses: bacteria found within the large intestine. Sebaceous glands and superficial and liver abscesses are caused by the bacteria, amoeba, skin are the places usually infected. In addition, vitamins A and C, beta-carotene, zinc, liquid chlorophyll, and garlic are useful as supportive daily nutrients to help clear up abscesses. The doctor may often put a piece of cloth or rubber, called a drain, in the cavity of the abscess to prevent it from clos- ing until all the pus has drained. Any underlying diseases will determine es include heat, redness, swelling, and pain over the af- the overall outcome of the condition. Abscesses in other places may produce only especially those on the skin, return due to either defec- generalized symptoms, such as fever and discomfort. A tive/altered immunity, or staph overgrowth, where there is sterile abscess may present as painful lump deep under high bacterial colonization on the skin. A severe infection may bring on consult a physician for treatment with which to wash the fever, fatigue, weight loss, and chills. If the abscess ruptures into neighboring areas or if the infectious agent spills into the bloodstream, serious consequences are likely. Abscesses in and around the Diagnosis nasal sinuses, face, ears, and scalp may spread the infec- A general physical examination and a detailed pa- tion into the brain.

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Auriculotherapy should not be performed on pregnant women during the first two trimesters (six months) of buy cheap cialis extra dosage 200 mg impotence bicycle seat, and afterwards only on very par- Fleischman order 40mg cialis extra dosage fast delivery erectile dysfunction pump youtube, Dr. Patients with ner- vous conditions should be thoroughly relaxed and pre- pared before treatment. Some patients may experience uncomfortable side American Academy of Medical Acupuncture. These reactions may be due to National Commission for Certification of Acupuncturists. Side effects can be alleviated by removing the needles and allowing the Douglas Dupler patient to lie down under supervision. Odle that occur during treatment, such as, in- creased pulse, and temporarily increased symptoms, are considered normal and usually disappear quickly. The American Academy of Medical Acupuncture (AAMA) was chartered in 1987 to support the education and correct practice of physician-trained acupuncturists. Autism is a chronic and often severe disorder of Its members must be either MDs or DOs who have com- brain functioning that begins during childhood. The American Association of Acupuncture and Ori- Autism is a lifelong disorder that interferes with the ental Medicine (AAAOM) is the largest organization for ability to understand what is seen, heard, and touched. Antidepressant Asperger syndrome Encephalitis Fragile X syndrome Phenylketonuria (PKU) Allopathic treatment Rubella Tuberous sclerosis Prevention Resources BOOKS Expected results 172 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 doshasvata, pitta, and kapha prakriti prana chi be treated differently. Much more scientific research has been conducted over the past several decades in India. Much research in the United States is being supported by the Maharishi Ayur-Ved organization, which studies the Ayurvedic products it sells and its clinical practices. In 2002, India took steps to make some of its most important ayurvedic knowledge more widely available. The task force developed a digital library with international and Indian languages describ- ing about 35,000 ayurvedic herbal processes and formu- lations to cure all kinds of diseases. Wis- vitamins A, C, and E, and some have also been shown in consin: Lotus Press, 1984. A group of patients with “India to Publish Ayurvedic Tracts on the Internet in Six Lan- chronic illnesses, including asthma, chronic bronchitis, guages. Other studies have shown that Ayurvedic therapies can significantly lower cholesterol and blood pressure in American Institute of Vedic Studiess. In the United States, there is no standardized pro- The College of Maharishi Ayur-Ved, Maharishi International gram for the certification of Ayurvedic practitioners. Antiemetic Bitter Cholagogue Decoction Hepatic Leishmaniasis Laxative Protozoa Ventricular Precautions Resources BOOKS OTHER Side effects Interactions Barley grass Description GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 183 tained that it was the muscles around the eye that caused The exercises themselves are simple, but Bates the eye to focus. Thus, traditional ophthalmologists stressed that it takes discipline and attention to detail in blamed problems like nearsightedness on a failure of the order to achieve improvement. Some of the principal ex- lens to properly focus, while Bates believed it was due to ercises of the Bates method are described below. Bates had come to this conclusion after performing eye surgery on cataract patients and finding that some of Palming is aimed at calming the visual system. In them could still see distance without glasses even though this exercise, patients close their eyes and cover them he had removed the lens from their eyes; therefore, he with the palms of their hands, allowing the fingers to determined that the lens did not play a role in refractive cross on the forehead. Next, the patient At this point, Bates broke from his counterparts and should open his or her eyes and see if any light is getting began focusing his attention on the muscles surrounding in. He also blamed problems on artificial light, which Sitting at a table is a good palming position. A per- kept the eyes working longer hours each day than they son can place a cushion on the table on which to rest were intended to. Bates developed a series of eye exer- their arms, and should check the height to be sure their cises to retrain the optic muscles to solve this evolution- hands are not too high or too low. While palming, patients should imagine a re- riorate, and his treatment was simple: like any other laxing scene, such as a sunrise or ocean. He focused sociation for Vision Education website suggests palming on the functioning of the six small muscles that control in 5–10-minute sessions, at least once a day. When they become tense, they gradually found unpleasant, a person can try mini-sessions, palm- grow weak and result in nearsightedness, farsightedness, ing for a period of 15 breaths, up to 20 times a day. To do this exercise, the patient should focus on a fixed object, then swing the head or the entire body from side to side while keeping the object in view by An advantage of the Bates method is that the treat- moving the head instead of the eyes. Also, if patients stick to the routine and eye improvement is gained, they may benefit by being able to discard their corrective lenses, escaping a lifetime of Based on the idea that practice makes perfect, this costs for glasses, lenses, and contact solutions.

Because of its ability to slow cardiac conduction discount 50 mg cialis extra dosage otc erectile dysfunction age, disopyramide is not indicated for the treat- A-V Node ment of digitalis-induced ventricular arrhythmias cialis extra dosage 100mg without prescription causes for erectile dysfunction and its symptoms. Moricizine depresses conduction and prolongs re- Patients with congenital prolongation of the QT interval fractoriness in the atrioventricular node and in the in- should not receive quinidine, procainamide, or disopyra- franodal region. These changes are manifest in a pro- mide because further prolongation of the QT interval longation of the PR interval on the electrocardiogram. Because of its anticholinergic properties, disopyra- His-Purkinje System and Ventricular Muscle mide should not be used in patients with glaucoma. The primary electrophysiological effects of mori- Urinary retention and benign prostatic hypertrophy are cizine relate to its inhibition of the fast inward sodium also relative contraindications to disopyramide therapy. Moricizine reduces the maximal upstroke of Patients with myasthenia gravis may have a myasthenic phase 0 and shortens the cardiac transmembrane action crisis after disopyramide administration as a result of potential. An interesting effect of moricizine conjunction with other cardiac depressant drugs, such as is its depressant effect on automaticity in ischemic 176 III DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM Purkinje tissue in contrast to its inability to alter the fects requiring drug withdrawal include conduction de- slope of phase 4 depolarization of spontaneous auto- fects, sinus pauses, junctional rhythm, and A-V block. Contraindications Electrocardiographic Changes Patients with preexisting second- or third-degree A-V The electrocardiographic effects of moricizine include block, cardiogenic shock, or drug hypersensitivity should alterations in conduction velocity without an effect on not be treated with moricizine. Moricizine enhances sinus node automaticity and prolongs sinoatrial and Drug Interactions His-Purkinje intervals and the QRS. Moricizine pro- Clinically significant interactions with moricizine do not longs ventricular conduction, thereby widening the appear to exist. CLASS IB Pharmacokinetics Lidocaine The characteristics of moricizine: Lidocaine (Xylocaine) was introduced as a local anes- thetic and is still used extensively for that purpose (see Oral bioavailability Not known Chapter 27). Lidocaine is an effective sodium channel Onset of action Within 2 hours blocker, binding to channels in the inactivated state. Peak response 6 hours Lidocaine, like other IB agents, acts preferentially in Duration of action 10–24 hours diseased (ischemic) tissue, causing conduction block Plasma half-life 1. Primary route of Hepatic metabolism Electrophysiological Actions Primary route of 56% biliary /fecal; 39% renal Sinoatrial Node excretion When administered in normal therapeutic doses Therapeutic serum Not established (1–5 mg/kg), lidocaine has no effect on the sinus rate. Moricizine is indicated for the treatment of documented Membrane responsiveness, action potential amplitude, ventricular arrhythmias, particularly sustained ventricu- and atrial muscle excitability are all decreased. II clinical trial for the prevention of postinfarction ven- However, the depression of conduction velocity is less tricular premature complexes. Patients in the moricizine Action potential duration of atrial muscle fibers is not arm of the trial exhibited a greater incidence of sudden altered by lidocaine at either normal or subnormal ex- cardiac death than did controls. The ERP of atrial myocardium ei- ther remains the same or increases slightly after lido- Adverse Effects caine administration. Dizziness (11%) is the most frequently Lidocaine minimally affects both the conduction ve- reported CNS-related adverse effect. Lidocaine does not increase in frequency with prolonged drug adminis- possess anticholinergic properties and will not improve tration. A-V transmission when atrial flutter or atrial fibrillation As with other antiarrhythmic drugs, moricizine has is present. These effects are most common in Lidocaine reduces action potential amplitude and patients with depressed left ventricular function and a membrane responsiveness. Cardiovascular ef- action potential duration and ERP occurs at lower con- 16 Antiarrhythmic Drugs 177 centrations of lidocaine in Purkinje fibers than in ven- Lidocaine may produce clinically significant hy- tricular muscle. Lidocaine in very low concentrations potension, but this is exceedingly uncommon if the drug slows phase 4 depolarization in Purkinje fibers and de- is given in moderate dosage. Lidocaine Electrocardiographic Changes is contraindicated in the presence of second- or third- Lidocaine does not usually change the PR, QRS, or QT degree heart block, since it may increase the degree of interval, although the QT may be shortened in some pa- block and can abolish the idioventricular pacemaker re- tients. Drug Interactions The concurrent administration of lidocaine with cimeti- Hemodynamic Effects dine but not ranitidine may cause an increase (15%) in Lidocaine does not depress myocardial function, even the plasma concentration of lidocaine. The myocardial de- Pharmacokinetics pressant effect of lidocaine is enhanced by phenytoin administration. The pharmacokinetic characteristics of lidocaine: Oral bioavailability 30–40% Phenytoin Onset of action 5–15 minutes intramuscularly Phenytoin (Dilantin) was originally introduced for the (IM); immediate intravenously control of convulsive disorders (see Chapter 32) but has (IV) now also been shown to be effective in the treatment of Peak response Unknown cardiac arrhythmias. Phenytoin appears to be particularly Duration of action 60–90 minutes IM; 10–20 effective in treating ventricular arrhythmias in children. However, excretion der as metabolites the hypotension that may follow IV administration of Therapeutic serum 1. Clinical Uses Atrium Phenytoin, like lidocaine, usually does not alter the Lidocaine is useful in the control of ventricular arrhyth- action potential duration or ERP of atrial tissue except mias, particularly in patients with acute myocardial in- at very high concentrations.

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