By P. Bram. College of New Rochelle.

Participants were given a taste of the hot sauce (it Attributed to Charles Stangor Saylor keppra 500 mg amex. Furthermore purchase discount keppra on-line, they were told that the other person would have to eat all the sauce order discount keppra. On the other hand, the participants who were both provoked by the other person and who had also been reminded of their own death administered significantly more hot sauce than did the participants in the other three conditions. When we are concerned about dying we become more motivated to defend these important beliefs from the challenges made by others, in this case by aggressing through the hot sauce. Terror management and aggression: Evidence that mortality salience motivates aggression against worldview-threatening others. Strengths and Limitations of Freudian and Neo-Freudian Approaches Attributed to Charles Stangor Saylor. Although Freudian psychologists no longer talk about oral, anal, or genital “fixations,‖ they do continue to believe that our childhood experiences and unconscious motivations shape our personalities and our attachments with others, and they still make use of psychodynamic concepts when they conduct psychological therapy. Nevertheless, Freud‘s theories, as well as those of the neo-Freudians, have in many cases failed to pass the test of empiricism, and as a result they are less influential now than they have been in [5] the past (Crews, 1998). The problems are first, that it has proved to be difficult to rigorously test Freudian theory because the predictions that it makes (particularly those regarding defense mechanisms) are often vague and unfalsifiable, and second, that the aspects of the theory that can be tested often have not received much empirical support. As examples, although Freud claimed that children exposed to overly harsh toilet training would become fixated in the anal stage and thus be prone to excessive neatness, stinginess, and stubbornness in adulthood, research has found few reliable associations between toilet training [6] practices and adult personality (Fisher & Greenberg, 1996). And since the time of Freud, the need to repress sexual desires would seem to have become much less necessary as societies have tolerated a wider variety of sexual practices. And yet the psychological disorders that Freud thought we caused by this repression have not decreased. There is also little scientific support for most of the Freudian defense mechanisms. For example, studies have failed to yield evidence for the existence of repression. People who are exposed to traumatic experiences in war have been found to remember their traumas only too well [7] (Kihlstrom, 1997). Although we may attempt to push information that is anxiety-arousing into our unconscious, this often has the ironic effect of making us think about the information even [8] more strongly than if we hadn‘t tried to repress it (Newman, Duff, & Baumeister, 1997). It is true that children remember little of their childhood experiences, but this seems to be true of both negative as well as positive experiences, is true for animals as well, and probably is better Attributed to Charles Stangor Saylor. On the other hand, Freud‘s important idea that expressing or talking through one‘s difficulties can be psychologically helpful has been supported in current research (Baddeley & [9] Pennebaker, 2009) and has become a mainstay of psychological therapy. A particular problem for testing Freudian theories is that almost anything that conflicts with a prediction based in Freudian theory can be explained away in terms of the use of a defense mechanism. A man who expresses a lot of anger toward his father may be seen via Freudian theory to be experiencing the Oedipus complex, which includes conflict with the father. But a man who expresses no anger at all toward the father also may be seen as experiencing the Oedipus complex by repressing the anger. Because Freud hypothesized that either was possible, but did not specify when repression would or would not occur, the theory is difficult to falsify. In terms of the important role of the unconscious, Freud seems to have been at least in part correct. More and more research demonstrates that a large part of everyday behavior is driven by [10] processes that are outside our conscious awareness (Kihlstrom, 1987). And yet, although our unconscious motivations influence every aspect of our learning and behavior Freud probably overestimated the extent to which these unconscious motivations are primarily sexual and aggressive. Taken together, it is fair to say that Freudian theory, like most psychological theories, was not entirely correct and that it has had to be modified over time as the results of new studies have become available. But the fundamental ideas about personality that Freud proposed, as well as the use of talk therapy as an essential component of therapy, are nevertheless still a major part of psychology and are used by clinical psychologists every day. Focusing on the Self: Humanism and Self-Actualization Psychoanalytic models of personality were complemented during the 1950s and 1960s by the theories of humanistic psychologists. In contrast to the proponents of psychoanalysis, humanists Attributed to Charles Stangor Saylor. Arguing that people are free to choose their own lives and make their own decisions, humanistic psychologists focused on the underlying motivations that they believed drove personality, focusing on the nature of the self-concept,the set of beliefs about who we are, and self-esteem, our positive feelings about the self. One of the most important humanists, Abraham Maslow (1908–1970), conceptualized personality in terms of a pyramid-shaped hierarchy of motives(Figure 11. At the base of the pyramid are the lowest-level motivations, including hunger and thirst, and safety and belongingness. Maslow argued that only when people are able to meet the lower-level needs are they able to move on to achieve the higher-level needs of self- esteem, and eventually self-actualization, which is the motivation to develop our innate potential to the fullest possible extent. Maslow studied how successful people, including Albert Einstein, Abraham Lincoln, Martin Luther King Jr. Maslow (1970) believed that self-actualized people are creative, spontaneous, and loving of themselves and others. They tend to have a few deep friendships rather than many superficial ones, and are generally private.

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Further comments on the estimation of error associated with the Gustafson dental age estimation method buy keppra 250mg with amex. Model of age estimation based on dental factors of unknown cadavers among Iranians keppra 500 mg amex. Age-related transparent root dentin: Mineral concen- tration generic keppra 250mg fast delivery, crystallite size, and mechanical properties. Etude de la translucidite et descanalicules dentinaires pour l’apprdciatio de l’age. Root dentine transparency: Age determination of human teeth using computerized densitometric analysis. Te biological basis for seasonal increments in dental cementum and thier applications to archaeological research. Incremental lines in root cementum of human teeth: An approach to their ultrastructural nature by microscopy. Evaluation of preparation, staining and microscopic techniques for counting incremental lines in cemen- tum of human teeth. On the validity of individual age-at-death diag- nosis by incremental line counts in human dental cementum. Tooth cementum annu- lation for age estimation: Results from a large known-age validation study. Age-at-death diagnosis and determination of life-history parameters by incremental lines in human dental cementum as an identifcation aid. Dental pathology of American Indian tribes of varied environ- mental and food conditions. Tooth wear and culture: A survey of tooth functions among some prehistoric popula- tions. Severity, distribution, and correlates of occlusal tooth wear in a sample of Mexican-American and European-American adults. Te accuracy and precision of third molar development as an indicator of chronological age in Hispanics. Tird molar root development in relation to chronological age: A large sample sized retrospective study. Radiographic survey of third molar development in relation to chronological age among Japanese juveniles. Forensic age estimation in living subjects: Te ethnic factor in wisdom tooth mineralization. Reliability of third molar development for age estimation in a Texas Hispanic population: A comparison study. Te accuracy and precision of the third man- dibular molar as an indicator of chronological age. Dental maturity in South France: A com- parison between Demirjian’s method and polynomial functions. Some considerations regarding the use of amino acid racemization in human dentine as an indicator of age at death. Paleoanthropological applications of amino acid racemization dating of fossil bones and teeth. Aspartic acid racemisation in the human lens during ageing and in cataract formation. Postmortem estimation of age at death based on aspartic acid racemization in dentin: Its applicability for root dentin. A review of the methodological aspects of aspartic acid racemization analysis for use in forensic science. Dead victim identifcation: Age determination by analysis of bomb-pulse radiocarbon in tooth enamel. Te marks made by human teeth in inanimate objects and in human skin have been reported and recorded in both ancient and modern history. Although scientifc information is limited in early recorded history, the anecdotal information is vivid and sometimes astonishing. Although he was in prison at the time of the alleged attacks, the bitemarks were judged to have been made by Burroughs’s specter. B’s would then appear upon them, which could be distinguished from those of some other mens” (Cotton Mather in Burr3). Burroughs’s mouth was reportedly pried open in court and his teeth were said to match the bitemarks. Te above examples notwithstanding, there were other early cases that indicate that bitemark evidence was recognized and utilized in Europe, Asia, and North America, with cases cited in France, Belgium, England, Scotland, Japan, Canada, and the United States. Tese cases included bitemarks in foodstufs, other inanimate items, and human skin. Many of the same argu- ments that are ofered in modern cases were argued by both prosecution and defense teams in those cases.

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These metabolic delayed effects of the long-lasting metabolite as it accumulates reactions include oxidation cheap 250mg keppra with visa, reduction and hydrolysis buy generic keppra 500mg line. Monoamine oxidase is found in liver best purchase keppra, kidney, intestine and nervous tissue, and its substrates include catecholamines Glycine and glutamine are the amino acids chiefly involved in conjugation reactions in humans. Hepatocellular damage depletes the intracellular pool of these amino acids, thus restricting this pathway. Acetylating – Hydrolysis – Glucuronidation – Sulphation activity resides in the cytosol and occurs in leucocytes, gastro- – Mercaptopuric intestinal epithelium and the liver (in reticulo-endothelial rather acid formation than parenchymal cells). Some patients inherit a deficiency of glu- with thiol donors such as N-acetyl cysteine or methionine to curonide formation that presents clinically as a non- increase the endogenous supply of reduced glutathione. Drugs that are normally conju- gated via this pathway aggravate jaundice in such patients. This occurs with drugs such as Naphthalene and some sulphonamides also form conjugates paracetamol and morphine. It is present in bronchoconstrictor mediators in anaphylaxis and in asthma the cytosol, and catalyses the transfer of a methyl group to (see Chapters 12 and 33). Phenylethanolamine N-methyltransferase is also important in catecholamine metabolism. It is induced by which enzyme activity is enhanced, usually because of increased corticosteroids, and its high activity in the adrenal medulla enzyme synthesis (or, less often, reduced enzyme degrada- reflects the anatomical arrangement of the blood supply to the tion). The increase in enzyme synthesis is often caused by medulla which comes from the adrenal cortex and conse- xenobiotics binding to nuclear receptors (e. Under physiological conditions, sulphotrans- hexachloride), herbicides, polycyclic aromatic hydrocarbons, ferases generate heparin and chondroitin sulphate. In addition, dyes, food preservatives, nicotine, ethanol and hyperforin in they produce ethereal sulphates from several oestrogens, St John’s wort. Apractical consequence of enzyme induction is androgens, from 3-hydroxycoumarin (a phase I metabolite of that, when two or more drugs are given simultaneously, then warfarin) and paracetamol. There are a number of sulphotrans- if one drug is an inducing agent it can accelerate the metabo- ferases in the hepatocyte, with different specificities. The availability of glutathione is critical ↓ Effect of target in determining the clinical outcome. Patients who have drug ingested large amounts of paracetamol are therefore treated Figure 5. Aconsiderably smaller fraction of the absorbed dose goes of some enzymes may be increased and that of others reduced. It is important in drug elim- If a drug is subject to a high hepatic clearance (i. Neonates fail to form glu- extracted from the portal blood and metabolized before it curonide conjugates because of immaturity of hepatic uridyl reaches the systemic circulation. This, in combination with glucuronyl transferases with clinically important conse- intestinal mucosal metabolism, is known as presystemic or quences, e. The route of administration and presystemic metabolism markedly influence the pattern of drug metabolism. Propranolol Allopurinol, methotrexate, angiotensin converting enzyme undergoes substantial hepatic presystemic metabolism, and inhibitors, non-steroidal anti-inflammatory drugs and many small doses given orally are completely metabolized before others, exert their therapeutic effects by enzyme inhibition they reach the systematic circulation. Quite apart from such direct actions, inhibition of istration, the area under the plasma concentration–time curve drug-metabolizing enzymes by a concurrently administered is proportional to the dose administered and passes through drug (Table 5. For example, warfarin and phenytoin compete with the liver, hepatic presystemic metabolism is bypassed, so one another for metabolism, and co-administration results in very small drug doses are needed compared to the usual elevation of plasma steady-state concentrations of both drugs. Metronidazole is a non-competitive inhibitor of microsomal Presystemic metabolism is not limited to the liver, since the gastro-intestinal mucosa contains many drug-metabolizing enzymes (e. Pronounced first-pass metabolism by isoenzyme(s) of target drug either the gastro-intestinal mucosa (e. Liver disease increases the bioavailability of some drugs with extensive first-pass extraction (e. For example, in the case of estradiol, which is excreted in bile as a glucuronide conjugate, bacteria-derived enzymes cleave the glucuronide so that free drug is available for reabsorption in the terminal ileum. A small proportion of the dose (approximately 7%) is excreted in the faeces under normal circumstances; this increases if gastro-intestinal dis- ease or concurrent antibiotic therapy alter the intestinal flora. They have distinct isoenzyme forms Variability in first-pass metabolism results from: and are critical for phase I reactions. Genetic variations – for example, the bioavailability of pharmacologically active, as well as being chemically hydralazine is about double in slow compared to fast reactive, and can be hepatotoxic. Presystemic hydroxylation of metoprolol and glucuronidation, sulphation, methylation). Drugs that increase liver blood flow have similar effects to protease inhibitors, quinolones, metronidazole) and food – for example, hydralazine increases propranolol dietary constituents (e. Dissecting the func- and Emergency Department by her sister, having swal- tion of P450. Cytochrome P450: nature’s most versatile biological cata- down with vodka six hours previously, following an argu- lyst.

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Instead generic keppra 500 mg without a prescription, gently separate the skin edges to see if the base of the wound can be visualized buy keppra discount. Posterior packing is mandated using either a commercially available balloon or a standard Foley catheter inserted into the posterior nares and inflated with water buy keppra on line. In addition to cardiac dysrhythmias, myocardial infarc- tions, cerebrovascular accidents, and aspiration have been reported in these patients. Antibiotics are often started to prevent sinusitis and toxic shock syndrome from obstruction of the nasal packing. Airway assessment and management have prior- ity over all other aspects of resuscitation in the critically ill or injured patient. Moreover, airway management is not simply the passage of a tube through the trachea. It involves a series of actions ranging from reposition- ing a patient’s head and neck, suctioning secretions in the posterior pharynx to supplying supplemental oxygen or performing an emergent cricothyro- tomy. Whatever the intervention, it is important to know when and how to manage an airway. There are many reasons for definitive airway management with an orotracheal tube, the obvious being in patients who are not breath- ing. However, there are instances that require definitive management even when a patient is spontaneously breathing. Any patient who is at risk of los- ing the ability to protect their airway should be considered for intubation. This includes intoxicated patients, the poisoned patient, worsening hypoxia, those with evolving laryngeal edema or hematoma near the trachea, and patients with significant head injuries. The diaphragm is innervated by the phrenic nerve, which originates from the spinal cord at the C3-C4 level, whereas the intercostal muscles of the rib cage are supplied by nerves that originate in the thoracic spine. Therefore, abdominal breathing in the absence of thoracic breathing indicates an injury below C4. His bradycardia in the presence of hypotension is suspicious for neurogenic hypotension, which is caused by loss of vasomotor tone and lack of reflex tachycardia from the disruption of autonomic ganglia. However, this is a diagnosis of exclusion and should only be made once all other forms of shock are ruled out. It is important to maintain c-spine immobilization to prevent further progression of an injury. Pulmonary contusion is reported to be present in 30% to 75% of patients with significant blunt chest trauma, most often from automobile collisions with rapid deceleration. It can also be caused by high-velocity missile wounds and the high-energy shock waves of an explosion in air or water. Clini- cal manifestations include dyspnea that is usually worsening, tachypnea, cyanosis, tachycardia, hypotension, chest wall bruising, decreasing oxygen Trauma Answers 171 saturation, and increasing A-a gradient. Typical radiographic findings begin to appear within min- utes of injury and range from patchy, irregular, alveolar infiltrate to frank consolidation. Almost 90% occur on the left side since the liver protects and prevents herniation of abdominal organs through right-sided defects. Typically, patients are tachypneic and have absent breath sounds and dullness to percussion of the chest sec- ondary to the accumulation of blood. The contusion usually manifests itself within min- utes of the initial injury, is usually localized to a segment or a lobe, is usually apparent on the initial chest radiograph, and tends to last 48 to 72 hours. Soft signs include diminished ankle-brachial indices, asymmetri- cally absent or weak distal pulse, history of moderate hemorrhage or wound close to a major artery, and a peripheral nerve deficit. Emergent surgery is generally necessary when there are hard signs of vascular injury. When severe ischemia is present, the repair must be completed within 6 to 8 hours to prevent irreversible muscle ischemia and loss of limb function. In the presence of hard signs without evidence of ischemia, some surgeons may prefer to first perform angiography to better define the injury. However, when there is evidence of limb ischemia, the patient should undergo exploration and repair immediately. Although compartment syndrome can occur with blunt and penetrating extremity trauma, it is more common in crush injuries or fractures with marked swelling. It may be required, but should be performed in conjunction with and after the establishment of arterial blood flow. Herniation can occur within minutes or up to days after a trau- matic brain injury. Once the signs of herniation are present, mortality approaches 100% without rapid reversal or temporizing measures.

However purchase keppra 500 mg amex, there are many side effects with these drugs buy keppra with a visa, and it is best to try natural methods first quality 250 mg keppra. Bone-building drugs such as bisphosphonates (Didrocal, Fosamax, and Actonel) or selective estrogen receptor modulators (Evista) are often given to women with osteoporosis or those at great risk. It is still important that women taking these drugs get adequate calcium intake and weight-bearing exercise for optimal bone health. Most blood tests measure hor- mones that are bound to protein, not that which is available to the tissues. Saliva tests M measure the amount of hormone that has made it into tissue because hormones pass through the salivary gland tissue before getting into saliva. Dietary Recommendations Foods to include: • Vegetables, fruit, whole grains, and legumes provide essential vitamins, minerals, anti- oxidants, fibre, and compounds that can reduce the risk of cancer and heart disease and improve overall health. In particular, load up on broccoli, Brussels sprouts, cauliflower, and cabbage, as these vegetables contain compounds that help the liver process hormones while reducing the risk of breast cancer. It also contains lignans (another form of phytoestrogen), which may help balance estrogens and reduce menopausal symptoms. Stress can make menopausal symptoms more pronounced and af- fect your adrenal gland function, reducing hormone production. Massage and acupuncture promote relax- ation and studies have shown that acupuncture can reduce hot flashes. Studies have shown that regular exercise reduces the frequency and severity of hot flashes. It also improves mood and sleep, protects against heart disease, and weight-bearing activities strengthen the bones. Smoking can worsen hot flashes and symptoms of anxiety, irritability, and depression. Watch funny movies, go to comedy shows, and spend time M with people who make you happy and laugh. Top Recommended Supplements Black cohosh: An herb that has been found in many studies to reduce hot flashes, night sweats, insomnia, nervousness, and irritability. Calcium and magnesium: Important minerals for bone health; women over 50 years should have 1,200 mg of calcium and 320 mg of magnesium daily, or more if they have osteopo- rosis. It is difficult to get this amount from diet alone, so supplements are often necessary. Chasteberry: An herb that helps balance hormones and is particularly helpful during peri- menopause. Fish oils: Help to protect against heart disease by lowering blood pressure and cholesterol, reducing atherosclerosis, and protecting against heart attack. Complementary Supplements Ginkgo biloba: An herb that helps improve memory and cognitive function by increasing blood flow to the brain. Supplements help improve sleep quality by reducing the time needed to fall asleep and nighttime wakening. While there may be certain symptoms, they are usually short-lived and can often be managed effectively with proper lifestyle measures and supplements. Ensure adequate calcium intake or take a mineral supplement for bone health; consider fish oils for heart health. Having just one of these conditions increases your risk of disease, but having them in combination multiplies the risk significantly. Ac- M cording to research, those who have three features of metabolic syndrome are nearly twice as likely to have a heart attack or stroke and more than three times as likely to develop heart disease as are those with no features. There is a great deal of research focused on this problem as it is affecting a grow- ing number of our population. According to reports, over half of people over age 60 meet the criteria for metabolic syndrome, and overall about 25 percent of the entire population are classified as having metabolic syndrome. Researchers believe that insulin resistance is the key underlying cause of this syn- drome and responsible for the metabolic changes that occur. Insulin is the hormone secreted by the pancreas that takes glucose from your blood and moves it into the cells to be used for energy. In people with insulin resistance, cells don’t respond to insulin and glucose can’t enter the cells. The pancreas reacts by releasing more and more insulin to help glucose get into your cells. High insulin levels also promote fat storage around the belly, lead- ing to abdominal obesity. These combined factors greatly increase one’s risk of heart disease, stroke, diabetes, and other conditions. The key to the management of metabolic syndrome and the prevention of its con- sequences is to address insulin resistance. This can be done effectively with lifestyle strategies (diet, exercise, and supplements).

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Thus high pH favours A buy generic keppra, the charged form of the weak probenecid competitively inhibits the tubular secretion of acid which remains in the tubular fluid and is excreted in the methotrexate cheap 500 mg keppra fast delivery. The extent to which urinary pH affects renal excretion of The renal tubule behaves like a lipid barrier separating the weak acids and bases depends quantitatively upon the pKa of high drug concentration in the tubular lumen and the lower the drug best purchase for keppra. The critical range of pKa values for pH-dependent concentration in the interstitial fluid and plasma. For highly lipid-soluble drugs, reabsorption is so effec- which is excreted unchanged. Diuresis may be induced deliberately in order to nary screening tests more difficult. Uric Accident and Emergency Department with a six-hour his- tory of fevers, chills, loin pain and dysuria. She looks very ill, acid is reabsorbed by an active transport system which is with a temperature of 39. Lithium also undergoes active tubular reab- raised at 15000/μL, and there are numerous white cells and sorption (hitching a ride on the proximal sodium ion transport rod-shaped organisms in the urine. Despite the normal creatinine level, he is concerned that the dose may need to be adjusted and calls the resident medical officer for advice. The patient is hypotensive • The kidney cannot excrete non-polar substances and will be perfusing her kidneys poorly. Serum creatinine efficiently, since these diffuse back into blood as the may be normal in rapid onset acute renal failure. Consequently, the kidney tant to obtain an adequate peak concentration to combat excretes polar drugs and/or the polar metabolites of her presumed Gram-negative septicaemia. This will achieve the usual peak concentra- depend on glomerular filtration, so the dose of drugs, tion (since the volume of distribution will be similar to such as digoxin, must be reduced, or the dose interval that in a healthy person). Competition for these carriers can cause drug interactions, although less commonly than induction or inhibition of cytochrome P450. Oxford: Oxford University Press, 2005: • The urine may be deliberately alkalinized by infusing 2599–618. Polyspecific organic cation transporters: their functions tubule by the same system that normally reabsorbs and interactions with drugs. Trends in Pharmacological Sciences sodium, so salt depletion (which causes increased 2004; 25: 375–81. Gastro-intestinal, cardiac, renal, liver and thyroid infarction, acute abdomen) Coeliac disease disorders all influence drug pharmacokinetics, and individu- Diabetic neuropathy Drugs, e. This can cause therapeutic failure, so alternative routes of administration (Chapter 4) are sometimes needed. Significant reductions in the absorption logical factors alter gastric emptying (Table 7. However, of cefalexin occur in cystic fibrosis, necessitating increased there is little detailed information about the effect of disease doses in such patients. Patients with small bowel resection on drug absorption, in contrast to effects of drugs that slow may absorb lipophilic drugs poorly. Cardiac failure affects pharmacokinetics in several ways and these are discussed below. Absorption of several antibiotics actually increases in cardiac failure as an adaptive response redistributing blood to Crohn’s disease. Usual doses 10 can therefore result in elevated plasma concentrations, pro- Heart ducing toxicity. Drugs such as lidocaine with a high hepatic extraction ratio of 70% show perfusion-limited clearance, and steady- 0 60 120 180 240 state levels are inversely related to cardiac output (Figure 7. Nephrotic syndrome is associated with resistance permission of the American Heart Association Inc. Phenytoin some degree of chronic renal impairment for drugs with a low is an exception, because therapy is guided by plasma concen- therapeutic index that are eliminated mainly by renal excre- tration and routine analytical methods detect total (bound tion. In renal impairment, phenytoin protein bind- there is 50% elimination by renal excretion. The British ing is reduced by competition with accumulated molecules National Formulary tabulates drugs to be avoided or used normally cleared by the kidney and which bind to the same with caution in patients with renal failure. The therapeutic range therefore has to be adjusted to lower values in patients with Clearance renal impairment, as otherwise doses will be selected that (ml/min) Weight cause toxicity. A reduced loading dose of 100 100 Serum digoxin is therefore appropriate in such patients, although the 90 90 creatinine effect of reduced glomerular filtration on digoxin clearance is 80 80 R (mg/100 ml) even more important, necessitating a reduced maintenance 70 70 5. Keep ruler at crossing point on R, then move the right-hand side of the Glomerular filtration and tubular secretion of drugs usually ruler to the appropriate serum creatinine value and read off fall in step with one another in patients with renal impair- clearance from the left-hand scale. Drug excretion is directly related to glomerular filtra- mol/L to mg/100mL, as is used on this scale, simply divide by 88. Low molecular weight heparin Metformin Creatinine would rise gradually over the next few days as it con- tinued to be produced in his body but was not cleared. The high albumin treatment under way but, although precise, such recommenda- concentration in tubular fluid contributes to the resistance to tions are inevitably based only on the effects of reduced renal diuretics that accompanies nephrotic syndrome. Therapy with these drugs is appropriately monitored by measuring ‘peak’ concentrations 1.

Sulphanilamide keppra 250mg mastercard, the first of the sulpha drugs buy generic keppra 250mg line, acts by inhibiting the bacterial enzyme that incorporates para-aminobenzoic acid into folic acid cheap keppra 250mg with visa. The lower layer (aqueous) contains the salt of aniline, and the ether layer has the neutral compound. Ether is evaporated from the ether layer using a rotary evaporator to obtain purified neutral compound. To the aqueous layer, sodium hydroxide and ether are added, and the resulting solution is shaken in a separating funnel. The ether layer (top layer) contains free aniline, and the aqueous layer (bottom layer) has the salt, sodium chloride. Ether is evaporated from the ether layer using a rotary evaporator to obtain purified aniline. In addition to the usual electrophilic substitutions, naphthalene can also undergo oxidation and reduction reactions under specific conditions as outlined below. Oxidation Oxidation of naphthalene by oxygen in the presence of vanadium pentoxide (V2O5) destroys one ring and yields phthalic anhydride (an important industrial process). N, O or S (hetero-atoms), in their rings are called heterocyclic compounds or heterocycles, e. N Pyridine Tetrahydrofuran Thiophene N is the hetero-atom O is the hetero-atom S is the hetero-atom Among the heterocyclic compounds, there are aromatic, e. Serotonin, a neuro- transmitter found in our body, is responsible for various bodily functions. However, there are some general rules to be followed in a heterocycle, especially in the use of suffixes to indicate the ring size, saturation or unsaturation as shown in the following table. For example, from the name, pyridine, where the suffix is -ine, one can understand that this heterocyclic compound contains nitrogen, has a six- membered ring system and is unsaturated. Ring with nitrogen Ring without nitrogen Ring size Maximum unsaturation Saturation Maximum unsaturation Saturation 3 irine iridine irene irane 4 ete etidine ete etane 5 ole olidine ole olane 6 ine – ine ane 7 epine – epine epane 8 ocine – ocine ocane 9 onine – onine onane 10 ecine – ecine ecane Monocyclic heterocycles containing three to ten members, and one or more hetero-atoms, are named systematically by using a prefix or prefixes to indicate the nature of the hetero-atoms as presented in the following table. Element Prefix Element Prefix Element Prefix O oxa P phospha Ge germa S thia As arsa Sn stanna Se selena Sb stiba Pb plumba Te tellura Bi bisma B bora N aza Si sila Hg mercura Two or more identical hetero-atoms are indicated by use of the multiplying prefixes di-, tri-ortetra-. When more than one distinct hetero-atom is present, the appropriate prefixes are cited in the name in descending order of group number in the periodic table, e. If both lie within the same group of the periodic table, then the order is determined by increasing atomic number, e. In unsaturated heterocycles, if the double bonds can be arranged in more than one way, their positions are defined by indicating the N or C atoms that are not multiply bonded, and consequently carry an ‘extra’ hydrogen atom, by 1H-, 2H- and so on, for example 1H-azepine and 2H-azepine. H 2-Methylpyridine 5-Methylindole 3-Phenylthiophene Heterocyclic aromatic compounds can also have two or more hetero-atoms. If one of the hetero-atoms is a nitrogen atom, and the compound has a five- membered system, their names all end in -azole, and the rest of the name indicates other hetero-atoms. For example, pyrazole and imidazole are two isomeric heterocycles that contain two nitrogen atoms in the ring, thiazole has a sulphur atom and a nitrogen atom in the ring, and oxazole contains an oxygen atom and a nitrogen atom. In imidazole and oxazole, two hetero- atoms are separated by a carbon atom, whereas in their isomers, pyrazole and isoxazole, the hetero-atoms are directly linked to each other. The six- membered aromatic heterocycles with two nitrogens can exist in three isomeric forms, the most important being pyrimidine. For example, pyrrolidine, tetrahydrofuran, isoxazolidine and piperidine are fully saturated derivatives of pyrrole, furan, isoxazole and pyridine, respec- tively. This makes it extremely difficult to generalize the physical properties of these compounds, because they vary significantly depending on the saturation–unsaturation status, aromatic–nonaromatic behaviour, ring sizes and type and number of hetero-atoms present. Saturated hetero- cycles, known as alicyclic heterocycles, containing five or more atoms have physical and chemical properties typical of acyclic compounds that contain the same hetero-atoms. On the other hand, aromatic heterocycles display very characteristic and often complex reactivity. However, aromatic heterocycles show general patterns of reactivity associated with certain ‘molecular fragments’ such that the reactivity of a given heterocycle can be anticipated. Physical and chemical properties of selected important hetero- cyclic compounds are discussed under each compound sub-heading. In pyrrole, there are four p electrons, two short of the 2 Huckel¨ criteria for aromaticity. The nitrogen atom is sp -hybridized, formally containing a lone pair of electrons in the p orbital at right angles to the ring. However, the system delocalizes and pushes the lone pair of electrons into the ring to complete the sextet required for aromaticity. The nonbonding electrons on the nitrogen atom become a part of the aromatic sextet. However, biologically more significant natural pyrroles are rather less simple; they are tetrameric pyrrole derivatives, known as porphyrins, e. Furan, also known as furane and furfuran, is an oxygen-containing five- membered aromatic heterocyclic compound that is usually produced when wood, especially pine wood, is distilled. Although it has a lone pair of electrons, these electrons cannot delocalize easily, and so the system is generally considered to be almost nonaromatic or weakly aromatic. The lone pair electrons of the sulphur are in the 3s orbital, and are less able to interact with the p electrons of the double bonds.