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Following oral administration of 20 mg birth control 3 months order drospirenone in united states online, rabeprazole is absorbed and can be detected in plasma by one hour birth control for women with diabetes order drospirenone mastercard. It is indicated in erosive and ulcerative gastroesophageal reflux disease birth control headaches order 3.03mg drospirenone with amex, healing of duodenal ulcers and Zollinger Ellison syndrome birth control pill 72 hours after intercourse india order drospirenone 3.03mg otc. Pantoprazole is the new H+K+ATPase inhibitor with similar properties and action to omeprazole. They decrease acid secretion and improve mucosal defense mechanism by: Stimulation of synthesis and release of mucus. It acts by increasing mucus production, slowing turnover of gastric cells and increasing regeneration of cells around ulcer. Its mineralocorticoid side effects lead to Na + and water retention and K + loss preclude its use on large scale. It also binds to basic fibroblast growth factor preventing its degradation and thereby promotes healing. It also helps in formation of new blood vessels (angiogenesis) and helps in cell division (mitogenic). It precipitates surface proteins at ulcer base and act as a physical barrier, preventing acid, pepsin and bile from coming in contact with ulcer base. It also augments gastric mucosal PG synthesis thereby enhancing protective action. It promotes healing of both gastric and duodenal ulcers and also prevents ulcer recurrence. Topical sucralfate (4-10%) is also useful in management of decubitus ulcer, diabetic ulcers, chemical and thermal burns, radiation induced skin damage, vaginal ulceration, oral and genital ulceration. Side effects include dry mouth, constipation, nausea, vomiting, rash, pruritus, dizziness. It adsorbs and interferes with absorption of tetracycline, cimetidine, digoxin and phenytoin. It polymerizes at pH < 4 to form a sticky, viscid yellow white gel which adheres to ulcer base. The gel acts as a strong mechanical barrier because of a strong Section 8 Drugs Acting on Endocrine System this page intentionally left blank (Drugs used in A 8. The anterior lobe secretes various trophic hormones, the posterior lobe is responsible for the secretion of oxytocin and antidiuretic hormone (vasopressin) and middle lobe secretes melanocyte-stimulating hormone (MSH) which may affect the synthesis of melanin. Human growth hormone has a single straight chain polypeptide structure containing two intramolecular disulphide bridges and is composed of 188 amino acids. It stimulates the multiplication of the cells of epiphyseal cartilage and thus increases the length of the cartilage bone. After administration, there is an increased body growth due to its direct effect on the tissues. The anterior lobe secretes the following hormones: 270 Section 8/ Drugs Acting on Endocrine System Growth hormone promotes protein metabolism. It increases nucleic acid and protein synthesis, decreases nitrogen excretion in the urine. It diminishes the amino acid content of the plasma by transferring it into the tissues and helps in the growth of tissue. In mineral metabolism, it increases intestinal absorption of calcium as well as its secretion. The secretion of growth hormone by acidophil cells is regulated by the hypothalamic hormone, the growth hormone-releasing factor (GHRF). GHRF levels in the hypothalamus are reduced by corticosteroids and increased by thyroxine. Certain stimuli which can increase growth hormone secretion are insulin-induced hypoglycemia, fasting, physical exercise, amino acid administration. Clinical Preparations Human growth hormone is produced by recombinant DNA technique. Side effects include allergic reaction, pain at the site of injection, hypothyroidism and glucose intolerance. Because of its shorter duration of action and lack of specificity in inhibiting only GH secretion, its use in the treatment of acromegaly is limited. Another newer synthetic compound, octerotride is a longer acting analogue of somatostatin and is used in acromegaly. It influences Anterior Pituitary Hormones 271 the uptake of iodine, synthesis of thyroxine (T4) and triiodothyronine (T3) by the thyroid gland and their release into the blood stream. It is secreted by basophil cells under the control of CRF (corticotropin releasing factor) from the hypothalamus. ACTH controls the growth of adrenal cortex and the synthesis of corticosteroids and is essential to life. The amount of ACTH secreted depends upon the concentration in the blood of the hormones from the adrenal cortex and on stimulation by hypothalamus. Angiotensin (vasopressor agent) produced by the renin (from kidneys) stimulates the secretion of aldosterone. Sex Hormones the secretion of estrogens in females and androgens in males by the adrenal cortex is controlled by ACTH. They are responsible for the development and maintenance of secondary sexual characters in both males and females. They also increase the deposition of protein in muscles and reduce the excretion of nitrogen in males.

Syndromes

Bone age may be adequately determined by comparing a dorsal radiograph of the hands with the standards of Pyle birth control gildess cheap 3.03mg drospirenone amex, Waterhouse birth control jasmine buy generic drospirenone on line, and Greulich birth control 997 effective buy 3.03mg drospirenone otc. In proportionate short stature birth control velivet quality 3.03mg drospirenone, the cranium, trunk, and limb proportions appear normal, whereas in disproportionate short stature, the trunk or limbs are shortened to a greater degree than other portions of the body. Short stature of the short limb type can be due to shortening of all segments of the lower limb or to rhizomelic (thigh) or mesomelic (leg) shortening. In that it is a characteristic defined by deviation from the mean, short stature occurs in 2. Pathologic causes of short stature may be identified in an equivalent number of individuals (Table 1. The potential for finding a reversible cause for short stature is sufficient to require certain diagnostic tests on all persons with short stature in whom the cause is not immediately obvious. Emotional deprivation may be suspected from the history, but confirmation of this possibility requires documentation of a growth spurt on removal from the home environment. These include chromosome aberrations, prenatal trophogenic insults, skeletal dysplasias, and recognizable syndromes of known and unknown etiology (Table 1. Virtually all of the skeletal dysplasias identifiable at birth include short stature as a feature. In the pathologic situation, an individual genetic or environmental influence may be sufficient to cause short stature. Individuals with achondroplasia, for example, have short stature irrespective of parental height, nutrition, hormone production, or other factors. The same applies to individuals with certain chromosome aberrations, prenatal environmental insults, and syndromal entities. Insulin, growth hormone, androgens, and thyroxin are the most important hormonal growth factors. Middle: Short limbs and short stature in a 5-year-old male with achondrodysplasia. Right: Short trunk and short stature in an adult with spondyloepiphyseal dysplasia. Many of the genes associated with skeletal dysplasias and other recognizable syndromes that present with short stature have been identified. Sonographic examination permits prenatal diagnosis in cases when the long bones are short and in those with certain associated anomalies. In addition to careful examination of the morphology and length of the lower limbs, evaluations of head size, facial structure, thorax configuration, heart, kidneys, and movement help in the sonographic diagnosis of many skeletal dysplasias and other syndromes that include short stature. Treatment: Hypothyroidism and growth hormone deficiencies, the two most frequent endocrinopathies, require replacement therapy with thyroxine or human growth hormone. With the availability of a safe and abundant supply of growth hormone, this growth promoter has also been utilized in an attempt to increase stature in individuals without GH deficiency. The experience has been most extensive in Turner syndrome, with less experience in skeletal dysplasias and other syndromes with short stature. Some treatment regimens include combination therapy with estrogen and oxandrolone. Rather, they must be produced elsewhere and released into the circulation to reach the bones. Cartilage has specific receptors that recognize the growth factors and permit their biological activity. Genetic (familial) short stature and constitutional delay of growth and development account for the overwhelming majority of patients so affected. The response to GH therapy in children with chondrodysplasias has been mixed, depending on the type of dysplasia. A significant but smaller increase in growth velocity has been noted in achondroplasia and metaphyseal dysplasia. No growth gain has been achieved by GH treatment in pseudoachondroplasia and spondyloepiphyseal dysplasia. Trials of GH in infants and children with Prader-Willi syndrome have been shown to normalize statural growth, decrease body mass index, and increase lean body mass and strength. Deaths have occurred after starting GH therapy in patients with pretreatment respiratory impairment and morbid obesity. Short stature related to chromosome aberrations, certain prenatal environmental insults to growth, and most recognizable syndromes that include short stature are likewise resistant to therapy. No treatment is available nor is it usually indicated in cases of neurotrophic short stature such as spina bifida. In recent years, long bone lengthening has offered hope of increasing stature to an acceptable range for patients with skeletal dysplasias. Surgical bone lengthening was devised in the 1920s as a means of equalizing lower limb length in patients with polio and osteomyelitis. Modification of the procedures for bone lengthening has decreased the complication rate sufficiently that they can now be recommended for patients with short stature.

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They decrease the number of acid producing pathogen birth control symptoms discount 3.03mg drospirenone otc, decrease the acidity of the oral cavity and dissolve the dental plaques birth control over the counter generic drospirenone 3.03mg without prescription. The incidence of dental caries can be significantly decreased by adding fluorides into the drinking water supply birth control insert 3.03mg drospirenone with mastercard. Fluorides prevent decalcification of the structure of tooth by inhibiting bacterial enzymes which produce lactic acid birth control pills delay period generic 3.03 mg drospirenone amex. Prophylactically, fluoride (in the form of sodium fluoride) can be used in drinking water and one part of fluoride to one million part of drinking water is sufficient for reducing the incidence of dental caries by 50%. Therapeutically, 2% sodium fluoride solution is applied locally to the teeth after cleaning. The local application of fluoride leads to the absorption of fluorine on the enamel surface as calcium fluoride. But, sodium fluoride must be used with caution as it may cause nausea, vomiting and abdominal pain and on chronic ingestion it may lead to chronic fluoride poisoning and also affects enamel and dentine of developing teeth. Certain other agents such as hexachlorophene, silver nitrate, chlorophyll are also used to clean debris and decaying material and incidence of dental caries. The contents of the pulp chamber and root canals are removed, followed by thorough cleaning, antisepsis and filling. Apical peridontitis- A severely inflammed pulp will eventually necrose, causing apical peridontitis, which is the inflammation around the apex of the tooth. It is characterised by severe spontaneous and persistent pain and regional lymphadenopathy can be present. Antibiotics are generally not necessary but patients should be advised to report back to dentist/physician, if swelling or other evidence of infection occurs. Periapical abscess- It is pulpal inflammation characterized by localized pain and swelling. If the pulpitis is not treated successfully, infection may spread beyond the tooth apex into the peridontal ligament. This infection causes acute inflammation with pain on chewing or on percussion is present. The treatment of the most common oral condition and dental emergency is dental caries, which is a destructive disease of the hard tissues of the teeth due to bacterial infection with Streptococcus mutans and other bacteria. Dental decay presents as opaque white areas of enamel with grey undertones and in more advanced cases, brownish discoloured cavitations. Dental caries is initially asymptomatic and pain does not occur until the decay impinges on the pulp, and an inflammation develops. Treatment of caries involves removal of the softened and infected hard tissues, sealing of exposed dentines and restoration of the lost tooth structure with porcelain, silver, amalgam, composite plastic, gold etc. The common dental emergencies are: Pulpitis- If the caries lesion progresses, infection of the dental pulp may occur, causing acute pulpitis (Pulpal inflammation). The tooth become sensitive to hot or cold, and then severe continuous throbbing pain ensues. Cellulitis- Proliferation of epithelial cell cysts may convert the granuloma into a periapical cyst. The pus in the periapical abscess may track through the alveolar bone into soft tissues, causing cellulitis and bacteremia, or may discharge into the oral cavity, into the maxillary sinus, or through the skin of the face or submandibular area. Maxillary infection also may spread to the periorbital area, increasing the risk of other serious complications including loss of vision, carvernous sinus thrombosis and CNS involvement. Outpatient with localized cellulitis should be treated by the physician with antistreptococcal oral antibiotics. In severe infection, patients be hospitalized under the direct supervision of physician and treatment should be started immediately with intravenous broad- spectrum antibiotics and surgical drainage if abscess formation is detected. Peridontal disease- It is an inflammatory destruction of the periodontal ligament and supporting alveolar bone and the main etiologic agent is bacterial plaque. Multiple bacteria are implicated but after progressing the disease, gram negative anaerobes predominate. It is characterized by throbbing pain with erythema and swelling over the affected tissue. At this stage, if left untreated, the abscess may rupture or less commonly, progress to cellulitis. The treatment is drainage and debridement of the infected perdontal area supported with antibiotics. Pericoronitis- It is the inflammation of soft tissues surrounding the crown of a partially erupted tooth and most commonly, a wisdom tooth. It generally occurs when bacterial plaque and food debris accumulate beneath the flap of gum covering the partially erupted tooth. It is characterized by inflammation, often complicated by trauma from the opposing tooth, leads to swelling of the flap, tenderness, pain and a bad taste due to pus oozing from beneath the flap. In localized pericoronitis, hot saline mouthwashes and irrigation under the flap can resolve symptoms in most of the cases. Severe disseminated cases with spreading cellulitis should be treated with penicillin and appropriate medication for pain. Dental trauma- Dental trauma is extremely common in children with injuries to their primary or permanent teeth. Examination of any injury should focus on related soft tissue injuries and the need for suturing, signs of tooth loosening, displacement or fracture or any other disturbance in the bite or other signs of alveolar fracture. The complete diagnosis require dental radiograph (x-rays) and need follow up with the dentist for complete diagnosis, treatment and longterm care. Tooth fracture may involve the crown, root or both and with or without the exposure of the pulp. Fracture exposing the Pharmacotherapy of Common Oral Conditions and Dental Emergencies 427 pulp are often painful and immediately require referral to a dentist and definitive treatment may involve root canal treatment or extraction depending on the exact nature of the root fracture.

However birth control for women 8 pack discount drospirenone 3.03mg mastercard, if a tentative diagnosis is made due to the limited local resources birth control pills comparison order 3.03mg drospirenone with amex, then it should be reviewed in the light of response to the therapy birth control pills in the 80s buy 3.03mg drospirenone overnight delivery. Compare the effective groups of drugs and then select a drug on the basis of following criteria: Efficacy: Efficacy of a drug is not only based on pharmacodynamic but also on pharmacokinetic parameters birth control reminder app buy generic drospirenone, which have special importance in certain situations where onset and duration of drug effect is to be considered. Monitoring of treatment: the treatment can be monitored by the following methods: i. Passive monitoring: Information is given to the patient regarding the possible side effects with the necessary cautions. Active monitoring: Make an another appointment for active determination of relief or side effects due to drug therapy. New drugs are introduced in the market and more information about existing drugs appear constantly. These should always to available in adequate quantities and in appropriate dosage forms. The selection of the essential drugs should be based on the established health need for the drugs. Changes in the essential drugs list are made according to changes in the health needs, epidemiology of the diseases for which the drugs are prescribed and on therapeutic advances. The WHO list of Essential Drugs published at regular intervals is a model list which could be used at the national, regional, hospital and primary health centre levels (given in appendix III). Drugs and Cosmetics Rules have been divided into 18 parts each dealing with a particular subject. Prior to independence, a Health Survey and Development Committee was appointed in the Year 1943. The committee underscored the future role to be played by the indigenous systems of medicine of India. In 1946, the conference of Health Ministers resolved that adequate provisions should be made at the Centre and provinces for research in indigenous systems of medicine, Ayurveda and Unani. The conference also recommended for starting educational and training institutions of these systems. These committees recommended detailed outline for the development of Indian systems of medicine. The Act and rules have been amended from time to time and the latest and major amendment was made in 1982. Schedules G & H have been revised and new schedule X have been added and schedules E, I & L have been deleted. Part III: Provisions applicable to the manufacture and standardization of diagnostic agents (bacterial origin). In 1995, the Government also set up a full-fledged Department of India Systems of Medicine & Homeopathy (ISM & H) in the Union Ministry of Health & Family Welfare to further boost the development of Unani Medicine and other Indian systems of medicine. Data required to be submitted with application for permission to market a new drug. The primary aim of the Opium Act was the protection of the public welfare by preserving health & eliminating undesirable social and moral effects which are associated with indiscriminate use of opium. Further to "consolidate and amend the law relating to narcotic drugs, to make stringent provisions for the control and regulation of operations relating to narcotic drugs & psychotropic substances, and concerned matters", the "Narcotic Drugs & Psychotropic Substances Act & Rules was passed in September 1985. To provide the new thrust and direction in the policy frame, some new modifications were announced vide Drug policy, 1986. In 1994, new Drug policy guided the better & effective implementation of policy through newer provisions, rationalization, liberalization, minimizing control on drug & pharmaceutical industry sector and encouraging the indigenous research & development. The Drugs (Price Control) Order, 1955 has been promulgated to ensure equitable distribution of essential bulk drugs and to fix the maximum retail prices of drug formulations. The main objective of the Prevention of Food Adulteration Act is to make provision for the prevention of adulteration of food. According to the provisions of the Act, the Central Government has been empowered to regulate the importation of poisons into India whereas the various state governments have been empowered to make rules regarding the possession and sale of poison within their respective territories. Drug administration Absorption Distribution Metabolism Excretion Concentration in blood (systemic circulation) Pharmacokinetic part It is the movement of drug with the circulation from its site and route of administration. Biopharmaceutics is the study of factors influencing the extent and rate of absorption and release of a drug from its various physicochemical properties and dosage forms and the therapeutic response obtained after its administration. During their way to site of action, drug molecules have to cross one or more membranous barrier, which are lipoidal in nature, and having different sizes of pores. The substance with higher water partition coefficient values can penetrate Target organ Pharmacodynamic effect. The natural substances like amino acids, bile salts, glucose readily pass through body membranes even if their molecules are too large. Site of Absorption the site of absorption is mainly localised in mouth (for buccal administration), stomach, intestines or colon. Certain vasodilators (like nitroglycerine) and hormones which can penetrate the buccal mucosal wall will only be kept in buccal cavity or under the tongue. It provides rapid onset of action and prevention of gastrointestinal interactions. The absorption in stomach depends upon the gastric emptying, gastrointestinal motility and its pH. The other important factors controlling the rate of gastric emptying by influencing the gastric motility are the volume of the meal, its temperature, its viscosity and physical position.

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