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In the main effective shuddha guggulu 60 caps, they accomplish this by de- effected by the Na /K -ATPase, shown by the filled circle in creasing salt and water reabsorption in the tubules. K Carbonic Anhydrase Inhibitors 3 entry and H secretion are mediated by an H /K ATPase, In the late 1930s, it was reported that sulfanilam ide and which is shown by the filled circle in the apical cell membrane of the intercalated cell. It was soon realized that these com pounds inhibited carbonic anhydrase, an little net K transport occurs under K -replete condi- enzym e highly concentrated in renal tissue, and that this tions. This is relevant to the action of anhydrase inhibitors is an unsubstituted sulfonam ide spironolactone, a diuretic that is a com petitive inhibitor m oiety. It is also pertinent be- com pounds capable of inhibiting carbonic anhydrase, cause adm inistration of diuretics can cause secondary the m ost useful of which was acetazolam ide (D iam ox), hyperaldosteronism, which m ay exaggerate the potas- which is considered the prototype of this class of di- sium wasting that is a consequence of the increased de- uretics. A lthough the clinical use of carbonic anhydrase livery of Na and enhanced flow through distal convo- inhibitors has greatly dim inished since the 1960s, when luted tubules and collecting ducts. In the absence of vitally im portant in helping to delineate the physiologi- A D H, the collecting ducts are essentially im perm eable cal role of carbonic anhydrase in electrolyte conserva- to water. In other words, the clear- dichlorphenam ide (D aranide), and m ethazolam ide ance of solute-free water (CH 2O ) is greater than the os- (Neptazane) are the carbonic anhydrase inhibitors m olar clearance (Cosm ). The driving force for water trans- anhydrase decreases bicarbonate reabsorption, and this port is the osm otic gradient between the m edullary in- accounts for their diuretic effect. NaCl and urea are the anhydrase inhibitors affect both distal tubule and col- two m ajor solutes accounting for the hypertonicity. The lecting duct H secretion by inhibiting intracellular car- NaCl in the interstitium results from the reabsorption of bonic anhydrase. The fractional excretion of Na is The thiazidelike com pounds, including chlorthali- generally lim ited to 5%, as a consequence of down- done (H ygroton), quinethazone (H ydrom ox), and stream com pensatory Na reabsorption. A lthough dis- m etolazone (Zaroxolyn) have sim ilar m echanism s of tal nephron sites recapture m uch of the Na, they pos- action, but they differ substantially from one another in sess only a lim ited ability to absorb H CO. Fractional their duration of action, the degree of carbonic anhy- 3 K excretion, however, can be as m uch as 70%.

Sexual arousal stim- cause some relatively minor side effects discount 60caps shuddha guggulu with visa, including headache, ulates parasympathetic nerves in the penis to release a com- nasal congestion, stomach upset, and blue-tinged vision. Via- pound called nitric oxide (NO), which activates the vascular gra should never be used by men who are taking nitrate drugs smooth muscle enzyme guanylyl cyclase. Because nitrate drugs elevate NO levels, taking alyzes production of cyclic GMP (cGMP), a potent vasodilator them with Viagra, a drug that prolongs the effects of NO, can that increases blood flow into the penis to cause erection. Infections Sexually transmitted infections (STI), formerly known as sexually transmitted diseases (STD) or venereal diseases Epididymis (VD), are spread through sexual contact in both males and females. The infection may travel along the mucous membrane into the prostate gland and the A B epididymis; if both sides are affected and enough scar tis- sue is formed to destroy the tubules, sterility may result. Because syphilis In this region, during development, the testis pushes its spreads quickly in the bloodstream, it is regarded as a sys- way through the muscles and connective tissues of the temic disorder (see Appendix 5, Table 1). The genital ul- abdominal wall, carrying with it the blood vessels and cers caused by syphilis increase the chances of infection other structures that form the spermatic cord. A congenital mal- Phimosis (fi-MO-sis) is a tightness of the foreskin formation in the urinary tract can predispose to epi- (prepuce), so that it cannot be drawn back. While not Sgonorrhea, genital herpes, HIV, and syphilis are some of the 100% effective, condoms greatly reduce the risk of con- most common infectious diseases in the United States, affect- tracting an STI. Women may be diseases are associated with complications such as pelvic in- more infectious as well as more susceptible to certain flammatory disease, epididymitis, infertility, liver failure, neu- STIs during this time. Back pressure may destroy kidney tis- is an option for men about to undergo treatment for tes- sue and may lead to stasis of urine in the bladder with a ticular cancer. If urinary function is The female gonads are the ovaries (O-vah-reze), where threatened, however, surgery is performed to reduce the the female sex cells, or ova, are formed (Fig. Most commonly, surgery is performed remainder of the female reproductive tract consists of an through the urethra, in a transurethral prostatectomy organ (uterus) to hold and nourish a developing infant, (TURP).

Some metabolites order 60caps shuddha guggulu otc, as clozapine and risperidone, have a weaker affinity for such as 7-hydroxychlorpromazine, retain measurable ac- D2-receptors and bind more strongly to 5-HT2 (5- tivity, but this effect is not considered to be clinically im- hydroxytryptamine) serotonergic receptors. Thus, lesser portant; an exception to this observation is the major activity at the D2-receptor relative to other transmitter metabolite of thioridazine, which is more potent than receptors may diminish untoward side effects such as the parent drug. However, the antipsychotics less potent antipsychotics are lower after several weeks also have variable antagonist actions at muscarinic, of treatment at the same dose, it is believed that these -adrenergic, and histaminergic receptors in brain and compounds may weakly induce their own metabolism. The antimuscarinic activities cause Also, the ability to metabolize and eliminate these drugs blurred vision, dry mouth, and urinary retention and has been shown to diminish with age. The antihistaminergic Pharmacological Distinctions actions of these drugs probably contribute to drowsi- ness and sedation also. Despite differences in potency, all commonly used an- tipsychotic drugs have approximately equal efficacy in equivalent doses. PHARMACOLOGY Prototype or representative members of the antipsy- Phenothiazines are classified on the basis of their chem- chotics are arranged in decreasing order of potency in istry, pharmacological actions, and potency. Generally, these trends are reversed as potency are generally more potent and pharmacologically se- decreases. For example, chlorpromazine and 400 IV DRUGS AFFECTING THE CENTRAL NERVOUS SYSTEM TABLE 34. Haloperidol can result from the use of the low-potency phenothi- and pimozide (Orap) act mainly on D2-receptors (ex- azines. Mean arterial pressure, peripheral resistance, trapyramidal toxicity) with negligible activity at D1- and stroke volume are decreased, while pulse rate is in- receptors. Abnormal electrocardiograms (ECGs) have (Zyprex) show marked clinical differences from the been observed, especially following thioridazine admin- other drugs. These findings include prolongation of the QT H1-receptors (autonomic and sedative side effects) than interval and abnormal configurations of the ST segment to either D2 (low extrapyramidal activity) or D1 sites. These effects are readily reversed upon drug receptors, retaining high potency with lesser potential withdrawal. Current drug development is directed toward a search for atypical antipsychotics like clozap- ine that have a broad spectrum of effects on other neu- CLINICAL USES rotransmitter receptors. The principal goals for the Other Pharmacological Actions management of a chronic schizophrenic disorder are the Antipsychotic drugs produce shifts in the pattern of minimizing of symptoms and the prevention of exacer- electrographic (EEG) frequencies, usually slowing them bations.