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Devorah R. Wieder, MD, MPH

• Associate Staff, Center for Specialized Women? Health, Obstetrics, Gynecology,
• and Women? Health Institute, Cleveland Clinic, Cleveland, Ohio

Morphine analgesic tolerance: Its situation specificity supports a Pavlovian conditioning model erectile dysfunction at age 26 buy kamagra polo 100mg visa. Requirements for extinction of relapse-facilitating variables and for rehabilitation in a narcotic-antagonist treatment program erectile dysfunction doctors fort lauderdale discount kamagra polo 100mg with visa. Reported to the Committee on Prob lems of Drug Dependence erectile dysfunction at age 27 buy kamagra polo 100 mg on line, National Research Council erectile dysfunction drugs in pakistan buy genuine kamagra polo on line, National Academy of Sciences, 1967. For many years psychotropic drugs have been characterized and classified using methods designed to measure their subjective effects in humans (Beecher 1959). This research approach has two principal purposes: 1) to investigate the efficacy of a drug in attenuating unwanted subjective states in patients. In regard to the latter, such methods have been used to determine whether there are any common subjective states produced by all drugs of abuse. The subjective effects of morphine and related compounds were an important aspect of this evaluation. The research demonstrated that morphine and related narcotic analgesics produced a unique spectrum of subjective effects that can be reliably discriminated from subjective effects produced by other psychotropic drugs in experienced narcotic addicts (Hill et al. Other studies have also shown that the methods for measuring the subjective effects of drugs are useful for characterizing and differentiating other classes of abused drugs. Thus, it is possible to determine whether an unknown drug belongs to the opiate, psychomotor stimulant, sedative-hypnotic, or hallucinogenic drug class on the basis of its subjective effects. Until recently, measurement of drug-induced changes in subjective effects was possible only with humans, since only this species has the necessary verbal skills to describe how a drug makes them feel. However, behavioral methods have been developed over the past decade which 116 allow animals to report on discriminations between psychotropic drugs (Schuster and Balster 1977). This has led many researchers in behavioral pharmacology to make the working assumption that the components of drug action responsible for the discrimination among various classes of psychotropic drugs by animals are the same as those responsible for the differences in the subjective effects of these drugs in humans. In part, the purpose of the present paper is to show that this concordance across species is not surprising, since the same learning processes are involved in both species. The fact that humans learn to apply a topographically unique response (verbal) to drug-induced discriminative stimuli should not mask the fact that the same fundamental processes are involved. A second major purpose of this paper is to examine the hypothesis that although each class produces certain distinctive subjective effects, all drugs of abuse produce certain common subjective effects. The most common instruments used to measure subjective states are paper and pencil inventories. Some of these instruments are composed of a list of adjectives commonly used to describe mood. Other instruments consist of statements related to sensations and perceptions about which subjects are asked to indicate their agreement or disagreement. In some procedures, greater quantification is obtained by having subjects indicate the strength of then mood or agreement with each adjective or statement on an ordinal scale. Instructions to the subjects indicate that they should respond in a manner which best reflects how they feel at that moment. The responses before and after drug or under drug and placebo conditions are compared to determine whether the drug has produced a significant change. For most purposes, such as drug classification, this problem can be ignored as long as the data produced are lawful. The self-reporting response is operant behavior controlled by its consequences and thus susceptible to change by a variety of influences 117 besides the drug administered. It is well established for example, that verbal behavior can be markedly altered by social contingencies. The Greenspoon phenomenon (1955) has amply demonstrated that powerful control can be exerted over the verbal behavior of subjects who were unaware that their behavior was being manipulated by subtle responses of the experimenter. In the Greenspoon study, human subjects were instructed to "say words" during a 50-minute experimental session. When the experimenter made a specific verbal response ("mmm-hmm") following every plural noun uttered by the subject, there was a significant increase in that class of verbal responses (plural nouns). The existence of such influences make one less comfortable in assuming the accuracy of the reporting of private events. Therefore, one approach in dealing with self-report data is to treat the verbal response as devoid of a referent. Thus, if after being given a sedative drug, Subjects say I feel sleepy, one can record this as a change in verbal behavior induced by the drug, without any inference about changed in subjective state. However this black box approach iS inadequate to account for the subjective drug effects data. If drug-induced changes in verbal responses are treated as devoid of a referent the meaning of the verbal response should be irrelevant. Subjects could be asked to check off boxes labeled with color names or numbers rather than mood descriptors. Since we usually have no discriminative training for applying such color names or numbers to internal states, we would probably get little consistency in drug effects. On the other hand, as we will illustrate, when we allow subjects to respond using common adjective or simple descriptive statements of mood words, we see a fair degree of agreement in responses across individuals who are given certain psychotropic drugs. This agreement is based on a common conditioning history in which certain adjectives or mood descriptions have been associated with certain internal states. Whether or not one chooses to ignore the internal cues, we are taking advantage of a conditioning history based on these internal cues when self-report methods are used for investigating drug effects. It is clear how children can be differentially reinforced for correctly labeling colors, sounds, and other publicly observable stimulus events. Internal stimuli represent a special problem for such differential conditioning since the mediator of reinforcement cannot observe the private event to determine the accuracy of the labeling. Under these conditions, the trainer uses a combination of observing the external environment for significant cues and collateral responses as an indication of the veracity of the verbal label. Conversely, if she comes bounding in the door, whistling and swinging her lunch pail with a smile on her face to show us her good report card, we would reinforce 118 her for saying she is happy. As a child matures, some of the more observable parts of these behavior patterns. It is this type of conditioning history which we utilize when subjects are asked to match their internal state with a list of adjectives or statements. It is most remarkable that such conditioning histories are consistent enough across individuals so that drugs induce a fairly close agreement in self-reports of internal states. Although some radical behaviorists may still choose to deal with such self-reports as simply verbal behavior and ignore the internal cues setting the occasion for the responses, it is obvious that the subjects do not ignore them. For example, we could arrange conditions so that following 24 hrs of food deprivation an animal would be reinforced with the termination of electric shock for turning right in a T-maze. Turning left would not be reinforced under these stimulus conditions but would be reinforced when the animal was not food deprived. The animal is correctly identifying an internal state in the same way that a human subject might check the adjective hungry under similar food deprivation conditions. In the case of the animal, we have controlled the conditioning history, whereas in the human we usually assume that such discriminative training has already occurred. In the same manner, animals can be taught to discriminate between various drugs (Schuster and Balster 1977). Holtzman and his colleagues have developed a method using a discrete-trial avoidance-escape paradigm in which animals (rats and monkeys) can prevent the onset of or terminate an electric shock by pressing one of two choice levers (Schaefer and Holtzman 1977, Shannon and Holtzman 1976, 1977). The animals were trained to press one lever after drug injection (morphine or cyclazocine) and the other lever after placebo administration. During the session, a light was illuminated for 5 seconds prior to the onset of electric shock. Depression of the correct choice lever terminated the light (an avoidance response) or both the light and shock (escape response).

Erratum to: the laparoscopic modified Sugarbaker technique is safe and has a low 406 erectile dysfunction protocol by jason 100 mg kamagra polo with mastercard. Surgical treatment: Myomectomy and Laparoscopic Chromopertubation erectile dysfunction drugs and alcohol cheap 100 mg kamagra polo free shipping, hysterectomy; Endoscopy: A major Myomectomy with Opening of the Uterine advancement erectile dysfunction enlarged prostate cheap 100 mg kamagra polo overnight delivery. Iatrogenic parasitic Hysterectomy for benign disease: clinical leiomyoma and leiomyomatosis peritonealis practice guidelines from the French College disseminata following uterine morcellation medication that causes erectile dysfunction buy discount kamagra polo online. Feasibility of Thermal Imaging as a Future Prevalence of Occult Malignancy Within Portal Imaging Device for Therapeutic Morcellated Specimens Removed During Ultrasound. A Safety and economical innovations multicenter study comparing surgical regarding surgical treatment of fibroids. Women with 2 or More Recurrent [Management of uterine myomas during Pregnancy Losses: A Systematic Review. Tragedy, Trade resonance-guided laser interstitial thermal offs, and the Demise of Morcellation. Interim myomectomy in an experimental uterine analysis of a randomized controlled trial model. Magnetic resonance Erratum to: Is self-weighing an effective enema versus rectal water contrast tool for weight loss: a systematic literature transvaginal ultrasonography in the review and meta-analysis. Letter to the Food and Drug Administration Ileo-uterine fistula in a degenerated Regarding the Use of Morcellation posterior wall fibroid after Caesarean Procedures in Women Having Surgery for section. Removal by Transvaginal and Uterine Universal Cystoscopy After Benign Morcellation Approaches. X-2 Acetate for the Management of Fibroid Related Acute Abnormal Uterine Bleeding. Laparoscopic Approach for Fibroid Focused Ultrasound Ablation of Uterine Removal at 18 Weeks of Pregnancy. Predicting postoperative day 1 hematocrit method to determine the suitability for levels after uncomplicated hysterectomy. High gynaecological diseases: A review of safety intensity focused ultrasound ablation for and efficacy. Reasons for exclusion: Key Question 4 (n = 979*) Exclusion Code Exclusion Reason Count* L1: X-1; L2: X-1 Not original research 272 L1: X-2 Not women with fibroids 345 L1: X-3; L2: X-4 Does not include at least patients treated for uterine fibroids 491 L1: X-4; L2: X-2 Does not report method for tissue removal 200 Does not report outcome(s) related to leiomyosarcoma subsequent to treatment for L1: X-5; L2: X-5 584 uterine fibroids L2: X-3 Ineligible study design or article type 9 L2: X-10 Unavailable 1 L2: X-11 Non-English 1 *Total count exceeds number of records as records can be excluded for more than one reason 1. Surgical Methods for the Treatment single-site myomectomy: initial report and of Uterine Fibroids Risk of Uterine technique. Intracorporeal electromechanical tissue Options on fibroid morcellation: a literature morcellation: a critical review and review. Is open advance access platforms and 3M Steri surgery the solution to avoid morcellation of Drape endobag. L1: X-1 during gynaecologic surgery: its uses, complications, and risks of unsuspected 17. A critical assessment of morcellation in Laparoscopic Supracervical and its impact on gynecologic surgery and Hysterectomy and Laparoscopic the limitations of the existing literature. Twelve-month morcellation on survival outcomes of outcomes for patients undergoing patients with unexpected uterine hysteroscopic morcellation of uterine polyps leiomyosarcoma: A systematic review and and myomas in an office or ambulatory meta-analysis. Contained power morcellation within an Incidental gynecologic neoplasms in insufflated isolation bag. In-bag Arthroscopic delivery of cancellous tibial morcellation for presumed myoma retrieval autograft for unstable osteochondral lesions at laparoscopy. New hysteroscopic techniques laser (RevoLix) vaporesection versus for submucosal uterine fibroids. Loop the effects of dexamethasone and electrosurgical excision procedure and risk metoclopramide on early and late of preterm birth: a systematic review and postoperative nausea and vomiting in meta-analysis. L1: X-1 Perspectives of obstetricians on labour and delivery after abdominal or laparoscopic 119. Electromechanical morcellators in Transvaginal specimen extraction after minimally invasive gynecologic surgery: an combined laparoscopic splenectomy and update. Difficulty in the Laparoscopic nephrectomy in dogs: an intravesical morcellation procedure for initial experience of 16 experimental leiomyoma of the prostate enucleated by procedures. Iatrogenic intestinal and mesenteric injuries Postoperative infectious complications in with small bowel volvulus following use of our early experience with holmium laser barbed suture during laparoscopic enucleation of the prostate for benign myomectomy. Bogusiewicz M, Rosinska-Bogusiewicz K, Outpatient procedure for the treatment and Walczyna B, et al. L1: X-4, X-5 dinoprostone intravaginal suppository: a randomized placebo-controlled pilot study. L1: Comparison of the efficacy and X-1, X-3, X-4, X-5 complications of different surgical methods 228. Thulium laser versus holmium laser [Relationship between morcellation transurethral enucleation of the prostate: 18 efficiency and enucleated tissue weight in month follow-up data of a single center. L1: X-5 simultaneous morcellation in situ in laparoscopic myomectomy of larger uterine 264. L1: X-1 the uterus: an original technique that permits the safe and quick removal of a large uterus. Is an emerging complication in the use of laparoscopic extirpation of the cervical morcellator Progression of pelvic implants to Simultaneous enucleation and in situ complex atypical endometrial hyperplasia morcellation of myomas in laparoscopic after uterine morcellation. Hybrid transureteral natural orifice translumenal endoscopic nephrectomy: a feasibility study in the porcine model. Early postoperative small bowel factors for uterine rupture after laparoscopic obstruction after laparoscopic myomectomy. Pregnancy outcome after treatment for Retained uterine fundus after vaginal cervical intraepithelial neoplasia. Laparoscopic laparoscopic radical nephrectomy for myomectomy: an intent-to-treat study. L1: X-1, X-2 Approach and specimen handling do not influence oncological perioperative and 350. L1: X-1, X-2, X-3 cervical intraepithelial neoplasia by the loop electrosurgical excision procedure and cold 361. L1: X removal of large laparoscopic nephrectomy 3, X-4, X-5 specimens without morcellation. Cervical stenosis following What determines the need to morcellate the electrosurgical conization. L1: X-1, X-2, X-3 Outpatient operative polypectomy using a 5 mm-hysteroscope without anaesthesia 394. Potential underdetection of pT(3a) Electromechanical morcellation in renal-cell carcinoma with laparoscopic laparoscopic subtotal hysterectomy. L1: X-2, X-3, X-4, X-5 laser enucleation of the prostate: experience in the first 280 patients, and a review of 420. L1: X-3 Prospective evaluation of the learning curve for holmium laser enucleation of the 421. Transvaginal hysterectomy for Posthysterectomy pelvic adenomyotic enlarged leiomyomata uteri in a Medical masses observed in 8 cases out of a series of Department Activity environment. Iatrogenic peritoneal adenomyoma after Laparoscopy-assisted right hepatic laparoscopic subtotal hysterectomy and lobectomy using a wall-lifting procedure. Post-loop electrosurgical excision comparison of efficiency measures at two procedure sepsis in a human institutions. Novel direct old-fashioned surgical techniques for vision renal morcellation with orthopedic improved cost-effectiveness in laparoscopic rotary shaver-blade instrumentation. Modified hysteroscopic Holmium laser enucleation of the prostate myomectomy of large submucous fibroids. L1: X-2, X-3 between bisection/morcellation and myometrial coring for reducing large uteri 486. Novel technique of 16 cases of uterine perforation during renal entrapment for morcellation. L1: X-1, X-3, X-4 Laparoscopic nephrectomy: assessment of morcellation versus intact specimen 500.

Common side effects of mexiletine include dizziness erectile dysfunction drug warnings order discount kamagra polo, anxiety erectile dysfunction diabetes symptoms cheap kamagra polo 100 mg mastercard, unsteadiness when walking erectile dysfunction doctor calgary kamagra polo 100mg on line, heartburn erectile dysfunction treatment in dubai buy kamagra polo 100 mg mastercard, nausea, and vomiting. Consult a health care professional if pregnant or planning to get pregnant, have a history of heart attack, are a smoker, or take any of the following medications: amiodarone, fluvoxamine, dofetilide (Tikosyn), bupropion, or sodium bicarbonate. Mexiletine should be taken three times daily with food to lessen stomach irritation. Infrequent adverse reactions include sore throat, fever, mouth sores, blurred vision, confusion, constipation, diarrhea, headache, and numbness or tingling in the hands and feet. Serious symptoms occur with overdose including seizures, convulsions, chest pain, shortness of breath, irregular or fast heartbeat, and cardiac arrest. It has also been effective for treating certain painful conditions related to neuropathic pain. Although cardiac side effects with flecainide may be infrequent, they can be catastrophic. This drug should probably not be used for pain management in patients with a history of cardiovascular or heart disease. The health care professional should be made aware of any kidney or liver problems because this may require American Chronic Pain Association Copyright 2018 119 monitoring of drug levels or a dosage reduction. Flecainide interacts with amiodarone, several antipsychotic and anti-arrhythmic medications, and ranolazine (Ranexa). Common side effects, which usually occur within the first two to four weeks of therapy, are nausea or vomiting, constipation, headache, dizziness, visual disturbances, edema, and tremor. Topical agents should be distinguished from transdermal medications, which are also applied directly to the skin. Whereas topical agents work locally and must be applied directly over the painful area, transdermal drugs have effects throughout the body and work when applied away from the area of pain (currently available transdermal drugs include fentanyl, buprenorphine, and clonidine; topical drugs include diclofenac and lidocaine with or without tetracaine and prilocaine). Transdermal medication in a patch is absorbed through the skin by the bloodstream over a period of time. They come from the bark of the willow tree and are the pain-relieving substances found in aspirin. Large amounts can be absorbed and lead to similar adverse effects as when given orally. The use of topical medications, which include salicylates or aspirin, should not be used for more than 7 days. This is important because many topicals contain salicylates and should not be used on a chronic basis and for not more than 3 or 4 days, perhaps 7 at the most. Counterirritants Counterirritants (including salicylates), another group of topical agents, are specifically approved for the topical treatment of minor aches and pains of muscles and joints (simple backache, arthritis pain, strains, bruises, and sprains). They stimulate nerve endings in the skin to cause feelings of cold, warmth, or itching. This produces a paradoxical pain-relieving effect by producing less American Chronic Pain Association Copyright 2018 120 severe pain to counter a more intense one. Some topical pain relievers (counterirritants) are methyl salicylate, menthol, camphor, eucalyptus oil, turpentine oil, histamine dihydrochloride, and methyl nicotinate. Menthol Counterirritants come in various forms such as balms, creams, gels, and patches under several brands such as BenGay, Icy Hot, Salonpas, and Thera-Gesic for ease of application. The balms, creams, and gels can be applied to the painful area(s) three to four times a day (usually for up to one week). When using the BenGay patch product, one patch can be applied for up to 8 to 12 hours; if pain is still present, a second patch may be applied for up to 8 to 12 hours (maximum: two patches in 24 hours for no longer than three days of consecutive use). It is approved for temporary relief of mild-to-moderate aches and pains of muscles and joints associated with strains, sprains, simple backache, arthritis, and bruises. Lastly, after application, hands should be washed thoroughly to avoid getting these products in sensitive areas such as the eyes. When removing and discarding used patches, fold the used patches so that the adhesive side sticks to itself. Several studies have suggested that capsaicin can be an effective analgesic in at least some types of neuropathic pain and arthritic conditions (osteoarthritis and rheumatoid arthritis). An adequate trial of capsaicin usually requires four applications daily, around the clock, for at least three to four weeks. Some individuals may experience a burning sensation, which usually lessens within 72 hours with repeated use. Gloves should be worn during application and hands should be washed with soap and water after application to avoid contact with the eyes or mucous membranes. This combination results in a relatively constant release of dissolvable local anesthetics that can diffuse through the skin and soft tissue. The minimal application time to obtain reliable superficial pain relief is one hour. However, the cream may be left on the skin for up to two hours, depending on the degreeof the procedure performed. Pain relief can be expected to increase for up to three hours under occlusive dressing and persist for one to two hours after removal of the cream. In younger individuals or in cases in which too much has been applied, negative effects can occur to hemoglobin (red blood cells). It has not been shown to be effective for chronic pain most likely because of its short duration. It measures 10 cm x 14 cm and has a clear plastic backing that must be removed before application of the patch to the skin. The manufacturer states that up to three patches canbe applied simultaneously to intact skin for up to 12 hours in any 24-hour period. Side effects of topical local anesthetics are usually minimal and include localized skin irritation and swelling that generally disappear within two to three hours after the local anesthetic is removed from the skin. As a rule, blood concentrations of topical local anesthetics are well below toxic levels. American Chronic Pain Association Copyright 2018 122 Potential hazards still exist, however. At risk are consumers, especially those without the supervision of a health care professional. Issues may arise particularly if the consumer applies large amounts of anesthetics or cover large areas of the skin, leaves these products on for long periods of time, or uses materials, wraps, or dressings to cover the skin after anesthetic application. Application to areas of skin irritation, rash, or broken skin may also increase the risk of systemic absorption. These compounded mixtures are prepared uniquely for each individual but have not passed rigorous scientific study. Use of these compounded mixtures is controversial and most insurance companies will not pay for these medications. This topic is included here for educational purposes as some physicians prescribe compounded topical agents. They typically contain ingredients such as lidocaine, amitriptyline, ibuprofen, gabapentin, and/or ketoprofen. The benefit to this type of delivery system is that medication is localized to the area of pain. There is one study of topical baclofen, amitriptyline, and ketamine that was shown to be effective in relieving chemotherapy induced peripheral neuropathy. The study has been repeated with mixed results but suggesting more effective treatment for the hands than the feet. To justify continued use of these agents beyond the initial prescription, there should be documentation of effectiveness, including functional improvement, and/or decreased use of other pain medications. Other compounded agents include those injected into the epidural and spinal canal. Many intraspinal or intrathecal (injection into the sheath surrounding the spinal cord) analgesics need to be compounded for improved pain relief and delivered via intraspinal drug delivery systems or pumps. The best recommendation is to work with a compounding pharmacy that has a history of quality care and can answer questions about stability and sterility of their compounding techniques. Many states now regulate and oversee compounding pharmacies under the Board of American Chronic Pain Association Copyright 2018 124 Pharmacy, thus, compounding pharmacies with active licenses in good standing should be sought out. Prior to using a compounded medication, it is important to know the clear risk vs. People who have chronic sleep problems may be getting substantially less sleep than is needed for good health.

The treatment of the antimuscarinic effects can be carried out with: a) Neostigmine b) Hexametonium c) Homatropine d) Acetylcholine 034 erectile dysfunction caused by spinal stenosis kamagra polo 100 mg visa. Contraindications to the use of antimuscarinic drugs are all of the following except: a) Glaucoma b) Myasthenia c) Bronchial asthma d) Paralytic ileus and atony of the urinary bladder 035 impotence yoga buy generic kamagra polo 100mg on line. Hexamethonium blocks the action of acethylcholine and similar agonists at: 22 a) Muscarinic receptor site b) Neuromuscular junction c) Autonomic ganglia d) Axonal transmission 036 statistics of erectile dysfunction in india cheap 100mg kamagra polo mastercard. Indicate the ganglion-blocking drug impotence define purchase kamagra polo overnight delivery, which can be taken orally for the treatment of hypertension Agents that produce neuromuscular blockade act by inhibiting: a) Interaction of acetylcholine with cholinergic receptors b) Release of acetylcholine from prejunctional membrane c) Packaging of acetylcholine into synaptic vesicles d) Reuptake of acetylcholine into the nerve ending 042. Nondepolarisation neuromuscular blocking agents: a) Block acetylcholine reuptake b) Prevent access of the transmitter to its receptor and depolarization c) Block transmission by an excess of a depolarizing agonist d) All of the above 044. Indicate the long-acting neuromuscular blocking agent: a) Rapacuronium b) Mivacurium c) Tubocurarine d) Rocuronium 046. Which of the following neuromuscular blocking drugs is an intermediate-duration muscle relaxant Indicate the neuromuscular blocker, whose breakdown product readily crosses the blood-brain barrier and may cause seizures: a) Pancuronium b) Succinylcholine c) Tubocurarine d) Atracurium 049. Which competitive neuromuscular blocking agent could be used in patients with renal failure Indicate the nondepolarizing agent, which has short duration of action: a) Succinylcholine b) Tubocurarine c) Mivacurium d) Pancuronium 051. Neuromuscular blockade by both succinylcholine and mivacurium may be prolonged in patients with: a) Renal failure b) An abnormal variant of plasma cholinesterase c) Hepatic disease d) Both b and c 053. Which of the following neuromuscular blockers causes transient muscle fasciculations Indicate muscles, which are more resistant to block and recover more rapidly: a) Hand b) Leg c) Neck d) Diaphragm 056. Which neuromuscular blocking agent has the potential to cause the greatest release of histamine Indicate the neuromuscular blocker, which causes tachycardia: a) Tubocurarine b) Atracurium c) Pancuronium d) Succinylcholine 059. Indicate the following neuromuscular blocker, which would be contraindicated in patients with renal failure: a) Pipecuronium b) Succinylcholine c) Atracurium d) Rapacuronium 063. Which of the following diseases can augment the neuromuscular blockade produced by nondepolarizing muscle relaxants Sympathetic stimulation is mediated by: a) Release of norepinephrine from nerve terminals b) Activation of adrenoreceptors on postsynaptic sites c) Release of epinephrine from the adrenal medulla d) All of the above 002. Epinephrine decreases intracellular camp levels by acting on: a) 1 receptor b) 2 receptor c) beta1 receptor d) beta2 receptor 007. Direct effects on the heart are determined largely by: a) Alfa1 receptor b) Alfa2 receptor c) Beta1 receptor d) Beta2 receptor 009. Which of the following effects is related to direct beta1-adrenoreceptor stimulation Distribution of alfa adrenoreceptor subtypes is associated with all of the following tissues except those of: a) Heart b) Blood vessels c) Prostate d) Pupillary dilator muscle 011. In which of the following tissues both alfa and beta1 adrenergic stimulation produces the same effect The effects of sympathomimetics on blood pressure are associated with their effects on: a) the heart b) the peripheral resistance c) the venous return d) All of the above 014. A bronchial smooth muscle contains: a) lfa1 receptor b) lfa2 receptor c) Beta 1 receptor 26 d) Beta 2 receptor 018. Which of the following drugs causes bronchodilation without significant cardiac stimulation Hyperglycemia induced by epinephrine is due to: a) Gluconeogenesis (beta2) b) Inhibition of insulin secretion (alfa) c) Stimulation of glycogenolysis (beta2) d) All of the above 024. Indicate the drug, which is a direct-acting both alfa and beta-receptor agonist: a) Norepinephrine b) Methoxamine c) Isoproterenol d) Ephedrine 027. Indicate the direct-acting sympathomimetic, which is an alfa1 alfa2 beta1 receptor agonist: a) Isoproterenol b) Ephedrine c) Dobutamine d) Norepinephrine 029. Indicate the alfa2-selective agonist: a) Xylometazoline b) Epinephrine c) Dobutamine d) Methoxamine 031. Indicate the beta1-selective agonist: a) Isoproterenol b) Dobutamine c) Metaproterenol d) Epinephrine 033. Indicate the indirect-acting sympathomimetic agent: a) Epinephrine b) Phenylephrine c) Ephedrine d) Isoproterenol 035. Norepinephrine produces: a) Vasoconstriction b) Vasodilatation c) Bronchodilation d) Decresed potassium concentration in the plasma 040. Which of the following direct-acting drugs is a relatively pure alfa agonist, an effective mydriatic and decongestant and can be used to raise blood pressure Which of the following agents is an alfa2-selective agonist with ability to promote constriction of the nasal mucosa Indicate the sympathomimetic, which may cause hypotension, presumably because of a clonidine-like effect: a) Methoxamine b) Phenylephrine c) Xylometazoline d) Isoproterenol 044. Isoproterenol is: a) Both an alfa and beta-receptor agonist b) beta1-selective agonist c) beta2-selective agonist d) Nonselective beta receptor agonist 045. Which of the following sympathomimetics is preferable for the treatment of chronic orthostatic hypotension Indicate the sympathomimetic drug, which is used in a hypotensive emergency: a) Xylometazoline b) Ephedrine c) Terbutaline d) Phenylephrine 053. Which of the following sympathomimetics is preferable for the emergency therapy of cardiogenic shock Indicate the sympathomimetic agent, which is combined with a local anesthetic to prolong the duration of infiltration nerve block: a) Epinephrine b) Xylometazoline c) Isoproterenol d) Dobutamine 055. Which of the following sympathomimetics is related to short-acting topical decongestant agents Indicate the long-acting topical decongestant agents: a) Epinephrine b) Norepinephrine c) Phenylephrine d) Xylometazoline 057. Indicate the sympathomimetic, which may be useful in the emergency management of cardiac arrest: a) Methoxamine b) Phenylephrine c) Epinephrine d) Xylometazoline 059. Which of the following sympathomimetics is used in the therapy of bronchial asthma Indicate the agent of choice in the emergency therapy of anaphylactic shock: a) Methoxamine b) Terbutaline c) Norepinephrine d) Epinephrine 061. Indicate the alfa1-selective antagonist: a) Phentolamine b) Dihydroergotamine c) Prazosin d) Labetalol 003. Indicate the irreversible alfa receptor antagonist: a) Tolazoline b) Labetalol c) Prazosin d) Phenoxybenzamine 005. Indicate the beta1-selective antagonist: a) Propranolol b) Metoprolol c) Carvedilol d) Sotalol 007. Indicate the indirect-acting adrenoreceptor blocking drug: a) Tolazoline b) Reserpine c) Carvedilol d) Prazosin 011. Which of the following drugs is an imidazoline derivative and a potent competitive antagonist at both alfa1 and alfa2 receptors The principal mechanism of phentolamine-induced tachycardia is: a) Antagonism of presynaptic alfa2 receptors enhances norepinephrine release, which causes cardiac stimulation via unblocked beta receptors 31 b) Baroreflex mechanism c) Direct effect on the heart by stimulation of beta1 receptors d) Inhibition of transmitter reuptake at noradrenergic synapses 016. Nonselective alfa-receptor antagonists are most useful in the treatment of: a) Asthma b) Cardiac arrhythmias c) Pheochromocytoma d) Chronic hypertension 017. The main reason for using alfa-receptor antagonists in the management of pheochromocytoma is: a) Inhibition of the release of epinephrine from the adrenal medulla b) Blockade of alfa2 receptors on vascular smooth muscle results in epinephrine stimulation of unblocked alfa2 receptors c) Direct interaction with and inhibition of beta2 adrenoreceptors d) Antagonism to the release of renin 018. Indicate adrenoreceptor antagonist agents, which are used for the management of pheochromocytoma: a) Selective beta2-receptor antagonists b) Nonselective beta-receptor antagonists c) Indirect-acting adrenoreceptor antagonist drugs d) lfa-receptor antagonists 020. Indicate the reversible nonselective alfa-receptor antagonist, which is an ergot derivative: a) Ergotamine b) Prazosin c) Phenoxybenzamine d) Carvedilol 022. Indicate an alfa-receptor antagonist, which binds covalently to alfa receptors, causing irreversible blockade of long duration (14-48 hours or longer): a) Phentolamine b) Phenoxybenzamine c) Ergotamine d) Prazosin 023. Indicate an alfa1 adrenoreceptor antagonist, which has great selectivity for alfa1a subtype: a) Prazosin b) Tamsulosin c) Phenoxybenzamine d) Phentolamine 026. Indicate an alfa receptor antagonist, which is an efficacious drug in the treatment of mild to moderate systemic hypertension: a) Phentolamine b) Tolazoline c) Ergotamine d) Prazosin 028. Which of the following alfa receptor antagonists is useful in reversing the intense local vasoconstriction caused by inadvertent infiltration of norepinephrine into subcutaneous tissue during intravenous administration

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It can be characterized by enthesitis impotence word meaning purchase kamagra polo toronto, which is tenderness where the bone meets a tendon erectile dysfunction treatment bangalore order kamagra polo 100mg on line, ligament or other connective tissue erectile dysfunction treatment herbal purchase generic kamagra polo on-line. In addition impotence essential oils purchase kamagra polo 100 mg on-line, this form of arthritis may be characterized by infammation in the sacroiliac joints and other spine joints. Undifferentiated arthritis describes juvenile arthritis that does not ft into any of the other types, or involves symptoms spanning two or more subtypes. Doctors are progressive joint damage actively researching this to better understand how the disease continued exposure to chronic arthritis treatments impacts daily life and how best to support patients with the decreased health-related quality of life (Weitzman 2018) disease. In autoimmune diseases, the immune system turns against the body for unknown reasons. Lupus can affect different body organs, and the organs affected can differ from patient to patient. Joint Involvement Mood disorder ranges from mild to major depression (depression may be normal and appropriate reaction for an Arthritis occurs in about 60 to 90 percent of patients with adolescent dealing with chronic disease). Localized juvenile scleroderma can damage the skin, muscle, bones and joints, depending on the type. Juvenile-onset scleroderma can occur at any age and in any race, but it is more common in girls. However, it is the third most frequent rheumatic condition in childhood after juvenile idiopathic arthritis and systemic lupus erythematosus (Zulian 2013). Prevalence Health Burdens Juvenile Localized Scleroderma It is estimated that 10 percent of all patients with scleroderma About 50 percent of children with linear scleroderma of the develop the disease before the age of 8. While this disease can occur at any age, it usually appears in children and adolescents between the ages of 5 and 15 and in adults between the ages of 40 and 60. People with this disease may fnd it diffcult to perform everyday tasks like climbing stairs, getting out of a chair, or lifting items above their head. Prevalence Health Burdens Juvenile Myositis In childhood, dematomyositis occurs far more frequently than polymyositis, whereas in adults the ratio is more equal. No matter what age it occurs, fbromyalgia can cause widespread musculoskeletal pain accompanied by fatigue, sleep and mood issues. Scientists are not sure what causes fbromyalgia, but it is seen more often in girls and women, in people with a family history of fbromyalgia, and/or in people with a rheumatic disease (like rheumatoid arthritis or lupus). Sometimes, symptoms gradually accumulate over time with no single triggering event. Sometimes, symptoms begin after a physical trauma, surgery, infection or signifcant psychological stress. This is often described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur above and below the waist on both sides of the body. Despite complaints of severe fatigue, kids with fbromyalgia often take more than an hour to fall asleep. Kids with fbromyalgia may also have other sleep disorders, like restless legs syndrome or sleep apnea. Kids with fbromyalgia may also have pain or cramping in the lower abdomen, may feel like they have brain fog and experience depression and anxiety. Metabolic diseases occur when the body does not break down food (chemicals) in a normal way to produce energy on a cellular level. It is related to the types and amounts of food we eat and how our body processes (metabolizes) them. Rich food and drink can contribute to the development of gout, but the real cause is how the body breaks down purines into uric acid. If excess uric acid builds up, it can form needle-like crystals that cause pain in a joint. The joint pain can appear suddenly, with severe episodes of pain, tenderness, redness, warmth and swelling. The pain may last hours or weeks and make it diffcult to perform daily activities. Despite the pain and challenges gout causes patients, 95 percent of gout patients say there are things a person can to make their arthritis better (source: 2016 Nielsen consumer needs survey conducted for the Arthritis Foundation). Lifestyle factors, such as eating a rich diet high in certain high-purine foods (like red meats or shellfsh), being overweight or obese and excessive alcohol use can, contribute to the development of gout. I was diagnosed with osteoarthritis, having enlarged knuckles and other typical symptoms. My pain intensifed over the next years, causing diffculty in walking and maintaining an active work and home lifestyle. Question: How do the statistics you reviewed apply to what you were going through If I had, I would have posed more specifc questions to my doctor earlier or modifed my diet sooner as a preventive measure. I ramped up my cardio-based fast-walking, and cross trained with weights on alternating days. Research is constantly learning more about these debilitating diseases, so keep the faith and take care. Question: What would you like arthritis researchers and health care experts to focus on To reduce the likelihood of fares, patients should: Obesity is not only a risk factor for incident gout, but is also Limit consumption of certain purine-rich proteins (like red meat, wild associated with an earlier age of gout onset. Fibromyalgia is a condition associated with widespread, amplifed chronic pain, which is experienced in different parts of the body at different times. This, along with other symptoms, such as fatigue, nonrefreshed sleep, memory problems and mood changes, all strongly impact the quality of life for these patients. Although fbromyalgia is not a form of arthritis, because it does not infame or damage joints, it is considered an arthritis-related condition. It is often found as a comorbid condition in people who have different forms of arthritis, like osteoarthritis, rheumatoid arthritis, lupus and infammatory bowel disease. The majority are women between 40 and 75, but it also affects men, young women and children, especially adolescent females. It sometimes occurs in more than one member of the same family, suggesting that a predisposing gene may exist. While the challenges of this disease are diffcult to deal with, 92 percent of fbromyalgia patients say they actively seek out information on their illnesses (source: 2016 Nielsen consumer needs survey conducted for the Arthritis Foundation). About 10 to 30 Fibromyalgia is present in as much as 2 to 8 percent of the percent of patients with those diseases also meet the criteria for population, is characterized by widespread pain, and is often fbromyalgia. But if there is lack of effect, there should be individualized treatment Fibromyalgia symptoms result in signifcant functional impairment based on patient need. Fibromyalgia patients report diffculties in: Experts give a strong recommendation for the use of exercise, Establishing and maintaining physical and emotional particularly given its effect on pain, physical function and well-be relationships with others ing, and its availability, low cost and low-safety concerns. Arthritis Foundation staff, volunteers and partners are working to address many issues preventing people with arthritis from accessing the treatment they need.