Usmle review 11
Danil
HAMMOUDI.MD
The only test that would reveal proviral DNA is the polymerase chain reaction [pcr] .
phenoxybenzamine and phentolamine are alpha blockers used in the management of pheochromocytoma and associated with the devlpt of incontinence.
SIDE EFFECTS
Anticholinergics produce certain effects, most of which are extensions of their pharmacologic actions. Adverse reactions to anticholinergics in general may include dry mouth: urinary hesitancy and retention; blurred vision due to mydriasis; increased oculartension; tachycardia; palpitation; decreased sweating; lossof taste; headache; nervousness; drowsiness; weakness; dizziness; insomnia; nausea; vomiting; impotence; suppressionof lactation; constipation; bloatedfeeling; severe allergicreactionor drugidiosyncrasies including anaphylaxis; urticariaand other dermal manifestations; some degree of mentalconfusionand/or excitement, especially in elderly persons.
Glycopyrrolate is chemically a quaternary ammoniumcompound; hence, its passageacross lipid membranes, such as the blood- brainbarrieris limited in contrastto atropine sulfateand scopolamine hydrobromide. For this reason the occurrence of CNSrelated sideeffects is lower, in comparison to their incidencefollowing administrationof anticholinergics which are chemically tertiary amines that can crossthis barrierreadily.
DRUG INTERACTIONS
The intravenousadministrationof any anticholinergicin the presence of cyclopropaneanesthesiacan result in ventriculararrhythmias; therefore, caution should be observed if glycopyrrolateinjectionis used during cyclopropane anethesia. If the drugis given in small incremental doses of 0.1 mg or less, the likelihood of producing ventriculararrhythmias is reduced.
An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction. Because this is a synthetic drug and falls into a class called quaternary ammonium compounds, it differs in some ways from the other anticholinergics such as hyoscyamine (Levsin) and dicyclomine (Bentyl). The manufacturer notes that there are no known drug interactions but it may be wise to note the interactions with other drugs in this class.
Interactions with
this drug may occur with the following:
Is there a problem if I have another disorder or disease?
At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease.
With this drug, the following disorders may be a problem:
glaucoma
prostate enlargement - BPH
hypertension (high blood pressure)
congestive heart failure
severe ulcerative colitis where bowel movements have stopped
lipoprotein lipase is the enzyme complex in blood to binds to and utilizes circulating chylomicrons.
lipoprotein lipase (LPL) is a key enzyme in the regulation of lipid- and lipoprotein metabolism, changes in LPL activity may contribute to these effects of GH.
It is characterised by the presence of chylomicrons in fasting plasma. Characteristically there is a fasting hypertriglyceridaemia and chylomicronaemia. Possible clinical features include: hepatosplenomegaly eruptive xanthomas lipaemia retinalis (turbid blood in the retinal vessels). pancreatitis Note that there is an overlap between lipoprotein lipase deficiency and apolipoprotein C-II Deficiency (familial inhibitor to lipoprotein lipase is a rare autosomal recessive hereditary disorder) apolipoprotein C-II (apoC-II) is a necessary cofactor for the activation of lipoprotein lipase. this condition is characterized by a deficiency of apolipoprotein C-II, causing an accumulation of chylomicrons and very low density lipoproteins (VLDL) xanthomas and hepatosplenomegaly are less common in C-II anapolipoproteinemia than in lipoprotein lipase deficiency (1) |
apo B-48 deficiency decresed production of chylomicron
the secretion of testosterone by interstitial
[leydig] cells in the testes is stimulated by the
secretions of cell pituitary basophils
leydig cells are stimulated by the secretion of
LH , which is secreted by pituitary basophils.
Pituitary acidophils secrete growth hormone and prolactin.
Control of
Testicular Function
1. GnRH
- secreted by hypothalmus
- stimulates
secretion of LH and FSH
2. Luteinizing hormone (LH)
- acts on leydig
cells
- stimulate synthesis
of testosterone
3. Follicle
stimulating hormone (FSH)- initiation of
spermatogenesis
- seminiferous tubule
development
- acts on sertoli cell to stimulate
inhibin secretion
4. Testosterone-
required for spermatogenesis
- secreted by Leydig cells
- synthesis stimulated by LH
- feedback to AP and HP to decrease LH
5.
Inhibin
- secreted by
sertoli cells
- inhibits FSH
secretion
1. Regulation of
spermatogenesis by testosterone
Testosterone,
a major androgen produced in Leydig cells, is
essential for normal spermatogenesis. While there have been numerous studies of
endocrine effects of testosterone in spermatogenesis, just beginning are the
molecular studies of how the hormone supports male germ cell development.
A number of studies
reported so far imply that testosterone indirectly controls spermatogenesis by
regulating gene expression and function of supporting cells, Sertoli and Myoid cells in the
testis. Our
2. Cloning and
functional analysis of genes that regulate spermatogenesis
Spermatogenesis
is an extremely complex process of cellular differentiation that includes the
dramatic morphological transformation of haploid spermatids. This elaborately controlled process is
regulated by many hormones and factors involved in cell-cell communications.
Many genes are speculated to be involved in this process and their
expressions tightly regulated developmentally by external signals and internal
programs in testicular cells. Our lab has been looking for genes that have
a role in the regulation of spermatogenesis and investigating their functions in
male germ cell development.
spermatocyte
1
2
3
1 This field shows three Sertoli cells(only one is labeled)
at low magnification, to demonstrate their relationship to the wall of the
tubule and to other cells in the seminiferous
epithelium. Sertoli cells are really the only true
resident cell of the seminiferous
tubules.
·
The
various stages of spermatozoan development (except
perhaps the ancestral spermatogonia) all are destined
to mature and be used up.
·
The Sertoli cell is present before puberty and remains in place
until death.
·
The Sertoli cells are a permanent population; they don't
normally divide and proliferate, unlike the various stages of the developing
sperm around them.
·
They can
occasionally become neoplastic, producing a Sertoli cell tumor.
2In this image the
peculiar appearance of the Sertoli cell's nucleus,
with its rhomboid inclusion and vesicular nucleoplasm,
is clearly evident. So is its relationship to the various stages of developing
sperm cells around it.
3In this image you
see two Sertoli cells with some early (ES) and late
(LS) spermatids in their upper
reaches.
Each spermatogonium lining the tubules divides so rapidly that
each testicle can produce between 300 and 600 sperm per gram of testis per
second.
• On average, sperm
are produced at a rate of 1,500 per second per testicle.
• Sperm take 74 days
to form and a further 26 days to mature and pass through the epididymis and vas deferens.
• Sperm swim at a
rate of 3 mm (1/10 in) per hour.
• A sperm lashes its
tail 800 times to swim one cm (1/3 in).
• Sperm must travel
through 3040 cm (1013 in) of male and female 'plumbing' to reach the Fallopian
tube this is equivalent to swimming more than 100,000 times their own length.
• Sperm reach the
Fallopian tubes within 3060 minutes after ejaculation into the female tract,
helped along by eddy currents.
• Sperm normally only
survive in the vagina for up to six hours as the acid vaginal secretions are
hostile once in the alkaline mucus of the cervix, however, they can survive for
several days.
• The average
survival time for a sperm in the female reproductive tract is 34 days live sperm
have been found in the female tract 7 days after ejaculation, but whether or not
they are capable of fertilization remains unknown.
ceftazidime + gentamycin
=è
pneumonia aquire institution
treatment
ceftazidine = cephalosporin third generation against
enteric gram negative rods and antipsudomonal
activity
Ceftazidime (Fortaz, Ceptaz, Tazicef, Tazidime)
Category:
Antibiotic
Description:
Cephalosporin, Third
Generation
Indications:
Contraindications:
Cross sensitivity
with penicillin allergies
Precautions:
Pregnancy category
B
Use with caution in
patients with penicillin allergy (5-10% chance of
cross-reactivity)
Dosage modifications
are generally only required in patients with severe renal
impairment
Adverse Reactions
(Side Effects):
Hypersensitivity
reactions
Gastrointestinal:
nausea, vomiting, diarrhea
Vaginitis
Dosage:
Administered by
injection (IM and IV)
Adults:
1 gram IV or IM every
8-12 hours
uncomplicated urinary tract infections:
250mg IV or IM every
12 hours
complicated urinary tract infections:
500mg IV or IM every
8-12 hours
meningitis:
2 grams IV every 8
hours
uncomplicated pneumonia, mild skin infections:
500mg – 1 gram IV or
IM every 8 hours
bone and joint infections:
2 grams IV every 12
hours
meningitis:
2 grams IV every 8
hours
severe, life-threatening infections:
2 grams IV every 8
hours
pseudomonal lung infections:
30-50mg/kg IV every 8
hours (maximum 6 grams per day)
Infants and Children
(1 month – 1 year)
30-50mg/kg IV every 8
hours (maximum 6 grams per day)
Neonates (0-4 weeks):
30mg/kg IV every 12
hours
Side
Effects (Reactions) of Smallpox Vaccine
Smallpox
Overview
Smallpox is a
serious, contagious, and sometimes fatal infectious disease. There is no
specific treatment for smallpox disease, and the only prevention is vaccination.
Smallpox outbreaks have occurred from time to time for thousands of years, but
the disease is now eradicated after a successful worldwide vaccination program.
The last case of smallpox in the
Viscera/Fascia | ||
Organ |
Location/Description |
Notes |
heart |
located within middle mediastinum within pericardial sac, nearly surrounded
by pericardial cavity |
|
coronary sulcus |
groove separating atria from
ventricles |
coronary sinus, circumflex a., & right coronary a.
lie in coronary sulcus, (coronary = something that is "crown-like", i.e.,
goes around in a loop) |
a thin internal layer or lining membrane of the heart
that also covers its valves |
| |
a thick middle layer composed of cardiac
muscle |
| |
a thin external layer (mesothelium) formed by the visceral layer of serous
pericardium |
| |
loose connective tissue in the epicardial (outer) space |
| |
thick collagenous rings
surrounding the four orifices of the valves of the heart |
(Latin, annulus =
ring) | |
superoanterior part of the
left ventricle |
leads to the aortic orifice | |
apex |
tip of left ventricle |
located 3" left of midline at level of 5th intercostal space (Latin,
apex = tip) |
forms the right margin of the heart |
receives blood from the superior vena cava, inferior
vena cava & coronary sinus | |
located on the posterior aspect of the
heart |
receives blood from the pulmonary
vv. | |
projects anteriorly from the
atrium |
one on each atrium, they lie beside aorta &
pulmonary trunk (Latin, auricula = little ear; the auricle of the atrium is
shaped like a little ear) | |
base |
superior aspect of heart |
where aorta, pulmonary trunk & superior vena cava
enter the heart |
strong, obliquely placed partition between the left and
right ventricles |
has membranous and muscular parts | |
interventricular sulcus,
anterior |
groove between ventricles on anterior surface of
heart |
anterior interventricular a.
& great cardiac v. lie within sulcus (Latin/Greek, holkos
(sulcus) = furrow) |
interventricular sulcus,
posterior |
groove between ventricles on diaphragmatic surface of
heart |
posterior interventricular a.
& middle cardiac v. lie within sulcus (Latin/Greek, holkos
(sulcus) = furrow) |
remnant of ductus arteriosus; connects
left pulmonary a. near origin with undersurface of aortic
arch |
left recurrent laryngeal n. passes beneath it
| |
pericardial
sinus, oblique |
recess of pericardial cavity located behind left atrium
of heart |
serous pericardium reflects on inferior vena cava &
pulmonary vv. (Latin, sinus = fold,
hollow) |
pericardial
sinus, transverse |
recess of pericardial cavity located behind aorta &
pulmonary trunk and anterior to superior vena cava |
(Latin, sinus = fold,
hollow) |
pericardium,
fibrous |
forms pericardial sac attached to central tendon of
diaphragm; fuses superiorly to adventitia of great vessels; contains
pericardial cavity & heart; lined by parietal layer of serous
pericardium |
defines outermost boundary of middle mediastinum |
pericardium,
parietal serous |
serous lining of pericardial cavity on inner surface of
fibrous pericardium (pericardial sac) |
reflects onto heart at great
vessels |
pericardium,
visceral serous |
serous lining of pericardial cavity on surface of
heart; reflects at inferior vena cava & pulmonary vv. to form oblique
pericardial sinus |
also known as: epicardium |
groove on right atrium marking crista terminalis, which is
seen within the atrium |
(Latin/Greek, holkos (sulcus) =
furrow) | |
|
features moderator band and 3 papillary mm.; pumps
blood into pulmonary trunk | |
|
features only 2 papillary mm., pumps
blood into ascending aorta | |
thin connective tissue cords that attach atrioventricular valve cusps to papillary
mm. |
(Latin,
chordae = cord + tendere = to
stretch) | |
ridge of cardiac muscle separating smooth sinus venarum posteriorly from
rough wall of primitive atrium anterioly |
sinuatrial node lies within
superior end of crista terminalis (Latin, crista = crest) | |
atrioventricular
bundle |
part of conduction system of heart; passes through
right fibrous trigone, below membranous part of
interventricular septum |
divides into right & left branches to supply
ventricles |
part of conduction system of heart; located in wall of
right atrium above ostium of coronary sinus
& septal cusp of tricuspid
valve |
| |
atrioventricular valve,
left |
between the left atrium and left
ventricle |
also known as: mitral or
bicuspid valve |
between the right atrium and right
ventricle |
also known as: tricuspid valve | |
depression in left wall of right
atrium |
remnant of foramen ovale
connecting right & left atria in the fetus (Latin, fossa = ditch +
ovale = oval) | |
ridge around the fossa ovalis in right atrium |
its limbus is located on the
interatrial septal
wall (Latin, limbus
= border + fossa = ditch + ovale = oval) | |
between left atrium and left
ventricle |
also known as: bicuspid or left atrioventricular valve; possesses anterior &
posterior cusps (Latin, mitra = a a coif or turban,
shaped like a bishope's miter, as are the two
leaflets of the bicuspid or mitral valve of the
heart) | |
moderator band |
|
also known as: septomarginal
trabecula |
attach to cusps of atrioventricular valves via chordae tendineae; right:
anterior, posterior & septal; left: anterior
& posterior |
(Latin, papilla =
nipple) | |
located near auricles in walls of both atria; more
pronounced in right atrium |
(Latin, pecten = comb) | |
smooth area of right ventricle below pulmonary
trunk |
pulmonary part of the conus
arteriosus | |
located in base of pulmonary trunk & ascending
aorta; free margin of cusps called lunula, dense
nodule located at midpoint of free margin |
pulmonary valve has
anterior, left & right cusps; aortic valve has right, left &
posterior cusps (Latin, semis = half + luna = moon, the cusps of semilunar valves are shaped like a half
moon) | |
ridge of cardiac muscle stretching from interventricular septum to anterior papillary m. in
right ventricle; contains part of right branch of atrioventricular bundle |
also known as: moderator band | |
located within crista terminalis near superior vena cava |
"pacemaker" of heart | |
ridges of cardiac muscle within both
ventricles |
(Latin, trabeculae = little beam, carnae = meaty) | |
|
also known as: right atrioventricular valve; possesses anterior, posterior
& septal cusps | |
right atrium |
|
Infarction of cardiac
muscle located near the posterior interventricular
sulcus would most indicate a blockade of the left
anterior descending artery branch of the right coronary
artery.
Circumflex artery
supplies most of the left atrium and a prtion of the
ventricle
The left descending
artery branch of the left coronary artery supplies the anterior part of the
interventricular septum
Left coronary artery
=è
left ventricle and part of the left atrium.
Marginal artery
=è
right ventricle
Bipolar disorder involves cycles of mania and
depression.
Signs and symptoms of mania include discrete periods
of:
Signs and symptoms of depression include discrete periods
of:
Depression: I doubt completely my ability to do
anything well. It seems as though my mind has slowed down and burned out to the
point of being virtually useless...[I am]
haunt[ed]..with the total, the desperate hopelessness
of it all... Others say, “It’s only temporary, it will pass, you will get over
it,” but of course they haven’t any idea of how I feel, although they are
certain they do. If I can’t feel, move, think or care, then what on earth is the
point?
Hypomania: At first when I’m high, it’s
tremendous...ideas are fast...like shooting stars you follow until brighter ones
appear... All shyness disappears, the right words and gestures are suddenly
there...uninteresting people, things become intensely interesting Sensuality is
pervasive, the desire to seduce and be seduced is irresistible. Your marrow is
infused with unbelievable feelings of ease, power, well-being, omnipotence,
euphoria... you can do anything...but, somewhere this
changes.
Mania: The fast ideas become too fast and there
are far too many...overwhelming confusion replaces clarity... you stop keeping
up with it--memory goes. Infectious humor ceases to amuse. Your friends become
frightened...everything is now against the grain..you are irritable, angry, frightened,
uncontrollable, and trapped.
Recognition of the
various mood states is essential so that the person who has manic-depressive
illness can obtain effective treatment and avoid the harmful consequences of the
disease, which include destruction of personal relationships, loss of
employment, and suicide.
Manic-depressive
illness is often not recognized by the patient, relatives, friends, or even
physicians.
An early sign of
manic-depressive illness may be hypomania--a state in which the person shows a
high level of energy, excessive moodiness or irritability and impulsive or
reckless behavior .
Hypomania may feel
good to the person who experiences it. Thus even when family and friends learn
to recognize the mood swings the individual often will deny that anything is
wrong.
In its early stages
bipolar disorder may masquerade as a problem other than mental illness. For
example, it may first appear as alcohol or drug abuse, or poor school or work
performance.
If left untreated,
bipolar disorder tends to worsen and the person experiences episodes of
full-fledged mania and clinical depression.
Treatment
Obsessive-compulsive
disorder (OCD), one of the anxiety disorders, is a potentially disabling
condition that can persist throughout a person’s life. The individual who
suffers from OCD becomes trapped in a pattern of repetitive thoughts and
behaviors that are senseless and distressing but extremely difficult to
overcome. OCD occurs in a spectrum from mild to severe, but if severe and left
untreated, can destroy a person’s capacity to function at work, at school, or
even in the home.
The following three
case histories are typical for those who suffer from obsessive-compulsive
disorder--a disorder that can be effectively treated.
KEY FEATURES OF
OCD
These are unwanted
ideas or impulses that repeatedly well up in the mind of the person with OCD.
Persistent fears that harm may come to self or a loved one, an unreasonable
belief that one has a terrible illness, or an excessive need to do things
correctly or perfectly, are common. Again and again, the individual experiences
a disturbing thought, such as, “My hands may be contaminated--I must wash them”;
“I may have left the gas on”; or “I am going to injure my child.” These thoughts
are intrusive, unpleasant, and produce a high degree of anxiety. Often the
obsessions are of a violent or a sexual nature, or concern
illness.
·
Compulsions
In response to their
obsessions, most people with OCD resort to repetitive behaviors called
compulsions. The most common of these are washing and checking. Other compulsive
behaviors include counting (often while performing another compulsive action
such as hand washing), repeating, hoarding, and endlessly rearranging objects in
an effort to keep them in precise alignment with each other. These behaviors
generally are intended to ward off harm to the person with OCD or others. Some
people with OCD have regimented rituals while others have rituals that are
complex and changing. Performing rituals may give the person with OCD some
relief from anxiety, but it is only temporary.
·
Insight
People with OCD
usually have considerable insight into their own problems. Most of the time,
they know that their obsessive thoughts are senseless or exaggerated, and that
their compulsive behaviors are not really necessary. However, this knowledge is
not sufficient to enable them to stop obsessing or the carrying out of rituals.
Most people with OCD
struggle to banish their unwanted, obsessive thoughts and to prevent themselves
from engaging in compulsive behaviors. Many are able to keep their
obsessive-compulsive symptoms under control during the hours when they are at
work or attending school. But over the months or years, resistance may weaken,
and when this happens, OCD may become so severe that time-consuming rituals take
over the sufferers’ lives, making it impossible for them to continue activities
outside the home.
·
Shame and
Secrecy
OCD sufferers often
attempt to hide their disorder rather than seek help. Often they are successful
in concealing their obsessive-compulsive symptoms from friends and coworkers. An
unfortunate consequence of this secrecy is that people with OCD usually do not
receive professional help until years after the onset of their disease. By that
time, they may have learned to work their lives--and family members’
lives--around the rituals.
·
Long-lasting
Symptoms
OCD tends to last for
years, even decades. The symptoms may become less severe from time to time, and
there may be long intervals when the symptoms are mild, but for most individuals
with OCD, the symptoms are chronic.
Panic Disorder occurs
in one out of every 75 people and usually appears during the teens or early
adulthood. Many times Panic Attacks can be triggered by a stressful event
along with a physiological
response.
There is a connection with major life transitions which are potentially
stressful: such as graduating from college, getting married, having a first
child, and so on.
There is more risk of it occurring if
there is a genetic predisposition; or if a family member has suffered from panic
disorder; or when a person is experiencing a time
in his/her life that is particularly stressful.
A panic attack is a
sudden surge of overwhelming fear that comes without warning and without any
obvious reason. It is far more intense than the feeling of being 'stressed out'
that most people experience. Symptoms of a panic attack
include:
Several classes of
medication can reduce or prevent panic attacks and therefore substantially
decrease patients' anticipatory anxiety about having attacks. The medications
most often used are:
Antidepressants,
including tricyclics, monoamine oxidase inhibitors, and serotonin reuptake inhibitors;
Certain high-potency
benzodiazepines
Each of these classes
of medications works differently and has different side effects. The latest
information about the pharmacotherapy of panic and related disorders is
available in clinical handbooks of psychotherapeutic medications. For most of
these medications, treatment lasts 6 months to a year. With all of them, proper
dosing and monitoring is essential.
The practitioner who
administers medication for panic disorder should be well versed in the clinical
use of the relevant psychotherapeutic medications. It is important to start with
a low dose and increase it gradually. Build up to the recommended dosage for the
particular medication you are prescribing, watching for troublesome side effects
as well as for a decrease in panic attacks. The goal should be to stop the panic
attacks. Make sure the patient is maintained on a dose that is in the
therapeutic range. When withdrawing medication, reduce
the dosage gradually, and watch for possible relapse. To improve compliance, it
is important to educate the patient about the medication and its side
effects.
trt: alprazolam =
xanax = benzodiazepine
What are the different
kinds of antidepressants?
There are many different kinds of antidepressants, including:
·
Selective serotonin reuptake inhibitors (SSRIs)
·
Tricyclic
antidepressants (tricyclics)
·
Others
SSRIs
SSRIs are a group of
antidepressants that includes drugs such as citalopram (brand name: Celexa),
fluoxetine (brand name: Prozac), paroxetine (brand name: Paxil) and
sertraline (brand name: Zoloft). These medicines tend
to have fewer side effects than the tricyclics. Some
of the side effects that can be caused by SSRIs
include dry mouth, nausea, nervousness, insomnia, headache and sexual problems.
People taking fluoxetine might also have a feeling of
being unable to sit still. People taking paroxetine
might feel tired. People taking sertraline might have
runny stools and diarrhea.
Tricyclics
The tricyclics have been used to treat depression
for a long time. They include amitriptyline (brand
name: Elavil), desipramine
(brand name: Norpramin), imipramine (brand name: Tofranil),
nortriptyline (brand names: Aventyl, Pamelor) and trimipramine
(brand name: Surmentil). Common side effects caused by
these medicines include dry mouth, blurred vision, constipation, difficulty
urinating, worsening of glaucoma, impaired thinking and tiredness. These
antidepressants can also affect a person's blood pressure and heart
rate.
Other antidepressants
Other antidepressants exist that have different ways of working than the
SSRIs and tricyclics.
Commonly used ones are venlafaxine, nefazadone, bupropion, mirtazapine and trazodone. Less
commonly used are the monoamine oxidase inhibitors
(MAOIs).
Some of the most common side effects in people taking venlafaxine (brand name: Effexor)
include nausea and loss of appetite, anxiety and nervousness, headache, insomnia
and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased
blood pressure, increased heart rate and increased cholesterol levels can also
occur.
Nefazodone (brand name: Serzone) can cause headaches, blurred vision,
dizziness, nausea, constipation, dry mouth and tiredness. This drug may cause
serious liver problems in some patients, although this is not common. Bupropion (brand name: Wellbutrin)
can cause agitation, insomnia, headache and nausea. Mirtazapine (brand name: Remeron)
can cause sedation, increased appetite, weight gain, dizziness, dry mouth and
constipation. Some of the most common side effects of trazodone (brand name: Desyrel)
are sedation, dry mouth and nausea.
MAOI antidepressants like phenelzine (brand name:
Nardil) and tranylcypromine
(brand name: Parnate) commonly cause weakness,
dizziness, headaches and tremor.
Drug
Class |
Primary
Effects/Approved Medicinal Uses |
Examples |
analgesia, cough suppression, antidiarrhea, suppression of opiate withdrawal,
sedation; currently used therapeutically for the first four
effects |
opium, morphine, codeine, heroin (diacetyl morphine), fentanyl, methadone, meperidine, L-alpha-acetylmethadol (LAAM) | |
block the effects of narcotics; used to treat opiate
overdose |
naloxone, naltrexone | |
stimulate psychological and sensory-motor functioning;
used therapeutically to treat ADHD and narcolepsy, sometimes as an
appetite suppressant, occasionally antifatigue,
formerly for asthma and for sinsus
decongestion |
amphetamine, methamphetamine, cocaine,
methylphenidate | |
similar to psychomotor stimulants but with much less
efficacy; various therapeutic effects including caffeine compounded with
aspirin in some OTC pain relievers, ephedrine in OTC asthma medicines,
pseudoephedrine in OTC sinus decongestants and
OTC appetite suppressants |
caffeine, nicotine, ephedrine, pseudoephedrine | |
general decrease in CNS arousal/excitability level;
used therapeutically for anesthetic, anticonvulsant, sedative, and
hypnotic effects |
thiopental, secobarbital,
pentobarbital, phenobarbital | |
general decrease in CNS arousal/excitability level, but
low dose are somewhat selective for anxiety and much less sedative than
barbiturates; used therapeutically as anxiolytics, benzodiazepines also as anesthetics and
anticonvulsants |
includes two subclasses: benzodiazepines (e.g.,.
diazepam, chlordiazepoxide, flunitrazepam [Rohypnol]) and muscle relaxants
(e.g., meprobamate) | |
general sedation at high doses, with selective
antipsychotic activity at lower doses; used therapeutically to treat
schizophrenia and other major psychotic disorders |
haloperidol, pimozide, flupenthixol, chlorpromazine, spiroperidol, clozapine | |
no perceptible CNS effects in normals, but effectively alleviate depression in many
depressives; used therapeutically to treat depression |
includes three subclasses: · monoamine oxidase inhibitors (e.g., pargyline), · tricyclic antidepressants (e.g., amitriptyline, desmethylimipramine), ·
selective serotonin reuptake
inhibitors (SSRIs: e.g., sertaline) | |
Antimanic |
dampens extreme mood swings in some people; used to
treat manic-depressive (bipolar) disorders |
lithium |
Alcohol |
general decrease in CNS arousal/excitability level; no
current therapeutic uses, but formerly used as an anesthetic and a
sedative |
ethyl alcohol (other alcohols have similar actions but
are associated with very toxic effects, e.g.,
methanol) |
general decrease in CNS arousal/excitability level;
used therapeutically for anesthesia |
nitrous oxide, halothane, ether | |
Volatile Solvents |
produce feelings of intoxication, can produce
hallucinations at high doses; no therapeutics uses (all can cause marked
brain damage in moderately low concentrations |
toluene, benzene, naphtha |
produce altered states of consciousness; hallucinogenics produce hallucinations
sometimes reported as "mystic" experiences; cannabinoids usually produce increased feelings
of "well being" and "mellow" intoxication; the "pleasantness" of the
states produced by both classes probably depends partially on
expectancies; no approved therapeutic uses, but cannabinoids are being increasingly used for their
antinausea, anxiolytic, and appetite-stimulating effects in
severely ill patients (e.g., AIDS) |
includes two subclasses: hallucinogenics (e.g., lysergic acid diethylaminde [LSD], mescaline, psilocybin) and cannabinoids (e.g., marijuana,
hashish). | |
Stimulatory Hallucinogenics (cf. former psychotomimetics) |
produce a mixture of psychomotor stimulant and
hallucinogenic effects, depending on dose and other factors; no
therapeutic uses, except phencyclidine as a veterinary
anesthetic |
MDMA (ecstasy), phencyclidine (PCP), ketamine (?) |
Abbreviations: ADHD, attention deficit
hyperactivity disorder; AIDS, acquired immune deficiency syndrome;
CNS, central nervous system; OTC, over-the-counter
(nonprescription) medicines. |