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It produces the side effects common Amprenavir (Agenerase) is administered twice daily 250 mg terramycin visa virus bulletin pc matic, to all protease inhibitors and also may produce providing the patient with an advantage over other pro- nephrolithiasis buy generic terramycin 250mg on-line antibiotic cephalexin, urolithiasis, and possibly renal insuffi- tease inhibitors that must be taken more frequently ciency or renal failure. Common side effects of am- 51 Therapy of Human Immunodeficiency Virus 593 prenavir include nausea, vomiting, diarrhea, and perio- THE USE OF ANTIRETROVIRAL DRUGS ral paraesthesias. Rash occurs in approximately 20 to IN PREGNANCY 30% of patients and can be mild or severe (Stevens- Zidovudine was the first agent to be used to prevent the Johnson syndrome). Pregnant women should not take amprenavir oral The teratogenic risk associated with administration of solution, as fetal toxicity may result. Amprenavir is a sul- antiretroviral drugs during the first trimester of pregnancy fonamide and should be used with caution in patients is not clear. Lopinavir–Ritonavir In the United States, the Centers for Disease Lopinavir is available in the United States only as a Control recommend that HIV-infected mothers avoid fixed-dose combination with ritonavir (Kaletra). In this breast-feeding to prevent the transmission of the virus regimen, a low dose of ritonavir is used to inhibit the to their infants. Side effects, mission ranges from 5 to 20%; longer durations of which are generally mild, include diarrhea, nausea, as- breast-feeding, mastitis, and abscesses are associated thenia, and headache. In developing countries in which Ritonavir is a potent inhibitor of CYP3A4 and also in- safe infant formula is not readily available, the avoid- hibits CYP2D6. The fenone, pimozide, and rifampin should not be given with World Health Organization recommends that under lopinavir–ritonavir combination therapy. The mechanism of action of lamivudine differs from been taking zidovudine and abacavir for the past 3 that of efavirenz in that years to treat HIV infection. These factors put her (A) Lamivudine inhibits HIV protease; efavirenz at high risk for drug-induced inhibits reverse transcriptase. She has a history of alcohol abuse and has of diazepam overdose, including grogginess and 594 VI CHEMOTHERAPY difficulty waking and maintaining consciousness. Diazepam is metabolized in the liver by diazepam CYP3A4 and CYP2C19; efavirenz inhibits both of (B) Efavirenz competes with diazepam for renal these isozymes and is likely to increase plasma lev- elimination els of diazepam. Diazepam is almost completely (C) Lamivudine potentiates the depressant activity converted to inactive metabolites; therefore, renal of diazepam elimination is not much of a concern. Lamivudine (D) Zidovudine induces the metabolism of di- may produce fatigue as a side effect but does not azepam potentiate the depressant activity of diazepam. Myelotoxicity is associated with certain NRTIs (A) Central fat accumulation and peripheral fat such as zidovudine. Fat redistribution, drug interac- wasting tions involving CYP3A4, dyslipidemia, and diabetic (B) Drug interactions involving cytochrome P450 symptoms are all side effects common to the pro- enzymes tease inhibitors. Ritonavir is a potent inhibitor of CYP3A4, the (D) Hypercholesterolemia and hypertriglyc- enzyme that rapidly inactivates lopinavir. This com- eridemia bination includes a low dose of ritonavir that is not (E) Hyperglycemia and insulin resistance likely to cause serious side effects but instead in- 5. Lopinavir is almost completely (A) Ritonavir and lopinavir inhibit HIV reverse eliminated by metabolism to inactive metabolites; transcriptase in different ways little is eliminated unchanged by the kidney. Lopinavir inhibits the enzyme HIV pro- (C) Ritonavir decreases the renal elimination of tease, not a structural protein. Non-nucleoside HIV-1 reverse tran- scriptase (RT) inhibitors: Past, present, and future ANSWERS perspectives. Risk factors associated with utilization of viruses in the latent reservoir for hu- the development of this syndrome include female man immunodeficiency virus type 1. Hyperuricemia is not associated with verse transcriptase gene can influence the clinical these risk factors. During this time, his CD4 sulting in the loss of virological response and possi- count raised from 200 cells/mm3 to 725 cells/mm3. R returned to his physician it appears that saquinavir was no longer present at with a severe herpes outbreak on one side of his an effective concentration and the HIV virus be- face. Many antidepressants are metabo- wort is a potent inducer of intestinal and hepatic lized by cytochrome P450 systems; thus, a reduction CYP3A4. Saquinavir undergoes extensive first-pass in antidepressant dosage may be necessary because metabolism by intestinal CYP3A4 and is metabo- NNRTIs and protease inhibitors inhibit cytochrome lized in the liver by CYP3A4. Slagle DRUG LIST GENERIC NAME PAGE GENERIC NAME PAGE Amphotericin B 596 Miconazole 600 Butoconazole 601 Naftifine hydrochloride 602 Capsofungin 601 Nystatin 598 Ciclopirox 602 Oxiconazole nitrate 601 Clotrimazole 600 Sulconazole nitrate 601 Econazole 601 Terbinifine hydrochloride 602 Fluconazole 598 Terconazole 601 Flucytosine 601 Tioconazole 601 Griseofulvin 602 Tolnaftate 602 Itraconazole 599 Undecylenic acid 602 Ketoconazole 599 Voriconazole 600 Fungal infections are usually more difficult to treat seated or disseminated fungal infections caused by di- than bacterial infections, because fungal organisms grow morphic fungi, the yeasts Cryptococcus neoformans, and slowly and because fungal infections often occur in tis- various Candida spp. Therapy of fungal ene), amphotericin B liposomal preparations, flucyto- infections usually requires prolonged treatment. Poten- sine (a pyrimidine antimetabolite), the newer azoles, in- tially life-threatening infections caused by dimorphic cluding ketoconazole, fluconazole, itraconazole and fungi are becoming more common because increasing voriconazole, and capsofungin (an echinocandin).

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It emphasizes meat cheap terramycin 250 mg without a prescription antibiotic resistance usa today, cheese generic 250 mg terramycin free shipping virus 007, and eggs, while discouraging foods such as bread, pasta, fruit, and sugar. The book quickly became a bestseller but unlike most other fad diet books, this one has remained popular. At last count, it had been reprinted 28 times and sold more than 10 million copies worldwide. Since then, Atkins has au- thored a number of other books on his diet theme, includ- ing Dr. During his life, Atkins saw about 60,000 patients in his more than 30 years of practice. He also appeared on numerous radio and television talk shows, had his own syndicated radio program, Your Health Choices, and au- thored the monthly newsletter Dr. He was the director of the Atkins Center for Com- plementary Medicine which he founded in the early Dr. The center is located at Michigan in 1951 and received his medical degree from 152 E. The diet is a keto- experience low energy levels and muscle fatigue from ing their cholesterol. Research & general acceptance Training & certification Opinion from the general medical community re- mains mixed on the Atkins diet, but is generally unfavor- There is no formal training or certification required. A number of leading medical and Resources health organizations, including the American Medical As- BOOKS sociation, American Dietetic Association (ADA), and the Atkins, Dr. Department of Agriculture and the National Insti- Calorie Way to Stay Thin Forever. Carbohydrates—Neutral compounds of carbon, Atractylodes hydrogen, and oxygen found in sugar, starches, Description and cellulose. Atractylodes is the dried or steam-dried rhizome Hypertension—Abnormally high arterial blood (rootstalk) of Atractylodes macrocephala or A. In autumn, it ly high amount of fat, and small amounts of car- presents magenta corolla blooms. In Mandarin, atractylodes is called Bai Zhu, Bai Shu, Ketosis—An abnormal increase in ketones in the Yu Zhu, and Dong Zhu. The Cantonese term is Paak Sat, body, usually found in people with uncontrolled and the Japanese call it Byakujutsu. Its pharmaceutical name, used to distinguish it in humans, and a constituent of coenzyme A. Practitioners of Chinese medicine believe that “Atkins Diet Vindicated But Long-term Success Questionable. White atractylodes has the additional benefit of being a “Spleen Qi tonic,” meaning that it rebuilds metabolic func- OTHER tion by increasing nutrition, increasing energy, and regulat- Atkins Center for Complementary Medicine. In-vitro and animal studies show it GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 155 • Gray or black atractylodes (Atractylodes japonica, KEY TERMS Cang Zhu) for damp-cold painful obstruction or vagi-. Cold—In Chinese pathology, the term defines a • Sclerotium Poriae Cocos (Poria cocos; Fu Ling; tucka- condition that has insufficient warmth, either ob- hoe, poria, or Indian bread) and Ramulus Cinnamomi jective (hypothermia) or subjective (feeling cold). Cassiae (Cinnamomum cassia, Gui Zhi, cinnamon Decoction—A strong tea brewed for twenty to twig) for congested fluids with distention of the chest thirty minutes. Heat—In Chinese pathology, the term defines a • Astragalus (Astragalus membranaceus, Huang Qi) and condition that has excessive heat, either objective Fructus Tritici (Triticum aestivum, Fu Xiao Mai, name (fever, infection) or subjective (feeling hot). Meridians—Energetic pathways inside the body • Ramulus Perillae (Perilla frutescens, Su Geng) and through which qi flows; also called channels. Pericarpium Citri Reticulatae (Citrus reticulata, Chen Tincture—A solution of medicinal substance in alco- Pi, aged tangerine rind) for restless fetus disorder with hol, usually more or less diluted. Herb tinctures are qi stagnation giving rise to distention and fullness in made by infusing the alcohol with plant material. Precautions According to tradition, atractylodes is contraindicat- ed in the presence of deficient heat conditions.

As with several of the MPS disorders generic 250mg terramycin mastercard antibiotics for acne how long to work, Morquio syn- drome was diagnosed by the presence of particular signs MPS IX (Hyaluronidase deficiency) and symptoms order 250 mg terramycin amex antibiotics for acne and birth control pills. However, it is now known that the defi- MPS IX is a condition that was first described in ciency of two different enzymes can cause the character- 1996 and has been grouped with the other MPS condi- istics of MPS IV. The intelligence of individuals with MPS IV is individuals described with this condition, the symptoms often completely normal. In individuals with a severe are variable, but some develop soft-tissue masses form, skeletal abnormalities can be extreme and include (growths under the skin). Also, these individuals are dwarfism, kyphosis (outward-curved spine), prominent shorter than expected for their age. One of the earli- MPS IX is believed to be located on the short arm of est symptoms seen in this condition usually is a differ- chromosome 3 (possibly 3p21. In individuals with a Many individuals with an MPS condition have prob- mild form of MPS IV, limb stiffness and joint pain are the lems with airway constriction. MPS IV is one of the rarest MPS dis- so serious as to create significant difficulties in adminis- orders, with approximately one baby in 300,000 born tering general anesthesia. The gene involved with MPS IV A is located on the long arm of chromosome 16 (location 16q24. While a diagnosis for each type of MPS can be made on the basis of the physical signs described above, sev- MPS IV B (MORQUIO SYNDROME TYPE B) MPS IV B eral of the conditions have similar features. The enzyme analysis is used to determine the specific MPS enzyme, beta-galactosidase, is deficient in MPS IV B. Enzyme analysis usually cannot accurately The location of the gene that produces beta-galactosidase determine if an individual is a carrier for a MPS condi- is located on the short arm of chromosome 3 (location tion. With many MPS VI (Maroteaux-Lamy syndrome) of the MPS conditions, several mutations have been MPS VI, which is another rare form of MPS, is found in each gene involved that can cause symptoms of caused by a deficiency of the enzyme N-acetylglu- each condition. Typically, the nervous system or intelligence of an tion, prenatal diagnosis is available to them to help deter- individual with MPS VI is not affected. Individuals with mine if a fetus is affected with the same MPS as their a more severe form of MPS VI can have airway obstruc- other child. This can be accomplished through testing tion, develop hydrocephalus (extra fluid accumulating samples using procedures such as an amniocentesis or in the brain) and have bone changes. Each of these proce- viduals with a severe form of MPS VI are more likely to dures has its own risks, benefits, and limitations. With a milder form of the condi- tion, individuals tend to be shorter than expected for their Treatment age, develop corneal clouding, and live longer. The gene involved in MPS VI is believed to be located on the long There is no cure for mucopolysaccharidosis, how- arm of chromosome 5 (approximate location 5q11-13). In those conditions, bone marrow transplantation Quadrangle, Crewe Hall, Weston Rd. PO Box Furthermore, bone marrow transplantation is not felt to 8923, New Fairfield, CT 06812-8923. National healthy individuals who are carriers of the defective Center for Biotechnology Information. There is also the availability of prenatal diagnosis for all MPS disease to detect affected fetuses. Aufox, MS, CGC Resources Mucoxiscidosis see Cystic fibrosis PERIODICALS Bax, Martin C. Originally thought Canadian Society for Mucopolysaccharide and Related to be separate conditions, it is now known that Muir- Diseases. Torre syndrome and Hereditary non-polyposis colon can- GALE ENCYCLOPEDIA OF GENETIC DISORDERS 757 KEY TERMS Allelic—Related to the same gene. Lymph node—A bean-sized mass of tissue that is Benign—A non-cancerous tumor that does not part of the immune system and is found in different spread and is not life-threatening. Biopsy—The surgical removal and microscopic Lynch syndrome—A genetic syndrome causing examination of living tissue for diagnostic purposes. Colonoscopy—Procedure for viewing the large intestine (colon) by inserting an illuminated tube Malignant—A tumor growth that spreads to another into the rectum and guiding it up the large intestine. Mismatch repair—Repair of gene alterations due to Gene—A building block of inheritance, which con- mismatching.

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It is often wounds cheap terramycin 250mg without a prescription bacteria normally carried by about a third of the population, liver problems order terramycin 250 mg with visa treatment for frequent uti, sexual dysfunction, fertility given to people who are in a state of generally poor or problems, and autoimmune diseases. Traditionally, several slices of the root are often togens are usually beneficial in treating chronic condi- added to soups and stews. They have been found to enhance the immune re- boiling three ounces of astragalus root in three cups of sponse, reduce inflammation, stabilize blood sugar, and water and letting the mixture steep for at least five min- support the hormone systems, particularly the adrenal utes. Candied roots Astragalus helps the body function at its best can be purchased ready-made or prepared in the home. It helps the body deal with stress and enhances Preparation involves combining four parts of the dried overall immune function. It has been shown to stimu- root with one part honey in water, then simmering until late production and activation of the white blood cells, the herb is dried and brownish. It is highly recommended for ments are used to heal wounds, particularly those that preventing and alleviating colds and flu. Traditional Chinese Medicine: Heat condition—A disease whose symptoms in- The A-Z Guide to Natural Healing from the Orient. Patience Paradox Spleen—In TCM, the system of organs that in- cludes the pancreas, large muscles, the lips, the eyelids, the lymph system, and the spleen. It also includes the functions that extract nourishment and convert it into qi and Blood. Triple Burner—The pathways and relationships Atherosclerosis between the Spleen, the Lungs and the Kidney. Definition Atherosclerosis is the build up of plaque on the inside Precautions of blood vessels. Atherosclerosis is often called arterioscle- rosis, which is a general term for hardening of the arteries. Since astragalus is a warming herb, its use should be avoided in heat conditions, such as fevers or agitated states. Astragalus membranaceus is the only species of Description its family to have a medicinal use; other species may be Atherosclerosis, a progressive condition responsible toxic. Therefore, local Western varieties should not be for most heart disease, is a type of hardening of the ar- used. Atherosclerosis can begin in the late teens, but it Side effects usually takes decades for the signs and symptoms of the Sometimes individuals experience a slight stomach disease to be apparent. An artery is made up of several layers: an inner lin- ing called the endothelium, an elastic membrane that al- Interactions lows the artery to expand and contract, a layer of smooth muscle, and a layer of connective tissue. Atherosclerosis Astragalus increases the effectiveness of other herbs affects the inner lining of an artery. Users of these medications As plaque builds up in and around the cells of the should consult a healthcare provider before using the herb. It can cause a stroke if it Diagnosis completely blocks the carotid arteries of the brain. Ath- Physicians may be able to make a diagnosis of ath- erosclerosis can also occur in the arteries of the neck, erosclerosis during a physical exam by means of a listen- kidneys, thighs, and arms, and may lead to kidney fail- ing to the activity of the arteries and the heart with a ure, gangrene, and even death. Physical inactivity, damage by ox- Radionuclide angiography and thallium scanning idants, diabetes, and obesity are also risk factors for ath- use radioactive material injected into the bloodstream. High levels of the amino acid homocysteine These tests enable physicians to see the blood flow and abnormal levels of fats called lipoproteins also raise through the coronary arteries and the heart chambers and the risk. Coronary angiography is the most accurate diagnostic method for artheroscerosis, • High triglycerides. Blood triglyceride levels inserts a catheter equipped with a viewing device into a above 400 mg/dL have been linked to atherosclerosis. Lack of exercise increases the risk A contrast dye makes the heart visible to x rays. Excess weight increases the strain on the heart lifestyle changes to reduce cholesterol and other prob- and increases the risk of developing atherosclerosis, lems that contribute to atherosclerosis. People whose parents have coronary artery urated fats, cholesterol, sugar, and animal proteins. Foods disease, atherosclerosis, or stroke at an early age are at high in fiber, such as fresh fruits and vegetables, and increased risk.

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