Drugs . See

High yields of the enantiomerically pure alcohol and enantiomerically pure ester are reg ularly achieved The growing interest m chiral drugs (see the boxed essay on this topic p 296) has stimulated the development of large scale enzymatic resolution as a com mercial process... 

In spite of the fact that few cycloalkynes occur naturally, they gained recent attention when it was discovered that some of them hold promise as anticancer drugs. (See the boxed essay Natural and Designed Enediyne Antibiotics following this section.)... 

Operational model, devised and published by James Black and Paul Leff (Proc. R. Soc. Lond. Biol. 220,141-162, 1983), this model uses experimental observation to describe the production of a physiological response by an agonist in general terms. It defines affinity and the ability of a drug to induce a response as a value of x, which is a term describing the system (receptor density and efficiency of the cell to convert an activated receptor stimulus into a response) and the agonist (efficacy). It has provided a major advance in the description of functional effects of drugs see Chapter 3.6 for further discussion. 

Chloramphenicol (Chloromycetin) interferes witii or inhibits protein synthesis, a process necessary for the growth and multiplication of microorganisms. This is a potentially dangerous drug (see below), and therefore its use is limited to serious infections when less potentially dangerous drugp are ineffective or contraindicated. 

The exact mode of action of diazepam (Valium), an antianxiety drug (see Chap. 30), in die relief of painful musculoskeletal conditions is unknown. The drug does have a sedative action, which may account for some of its ability to relieve muscle spasm and pain. 

Although the use of barbiturates and miscellaneous sedatives and hypnotics for sedation has largely been replaced by the antianxiety drugs (see Chap. 30), they occasionally may be used to provide sedation before certain types of procedures such as cardiac catheterization or the administration of a local or general anesthesia Sedative doses usually given during daytime hours, may be used to treat anxiety and apprehension. Fhtients with chronic disease may require sedation, not only to reduce anxiety, but also as an adjunct in the treatment of their disease... 

Amantadine is less effective than levodopa in the treatment of Fhrkinson s disease but more effective than die anticholinergics. Amantadine may be given alone or in combination witii an antiparkinsonism drug witii anticholinergic activity. Amantadine is also used as an antiviral drug (see Chap. 14). 

Follow die directions for application of transdennal scopolamine that are supplied with the drug (see Fhtient and Family Teaching Checklist Applying Transdennal Scopolamine). 

The preanesthetic drug is usually selected by the anesthesiologist and may consist of one or more drug (Table 35-2). A narcotic (see Chap. 19), antianxiety drug (see Chap. 30), or barbiturate (see Chap. 26) may be given to... 

Additional adverse reactions that may be seen when an antihypertensive drug is administered are listed in the Summary Drug Table Antihypertensive Drugs. For the adverse reactions that may be seen when a diuretic is used as an antihypertensive drug, see the Summary Drug Table Diuretics in Chapter 46. 

Dry mouth, blurred vision, urinary hesitancy, urinary retention, nausea, vomiting, palpitations, and headache are some of die adverse reactions that may be seen witii die use of anticholinergic drug (see Chap. 25). 

Oral administration of mesalamine may cause abdominal pain, nausea, headache dizziness, fever, and weakness. The adverse reactions associated witii rectal administration are less than those seen witii oral administration, but headache abdominal discomfort, flu-like syndrome, and weakness may still occur. Olsalazine administration may result in diarrhea, abdominal discomfort, and nausea Sulfasalazine is a sulfonamide witii adverse reactions the same as for the sulfonamide drugs (see Chap. 6). 

Insulin is necessary for controlling type 1 diabetes mellitus that is caused by a marked decrease in the amount of insulin produced by die pancreas. Insulin is also used to control the more severe and complicated forms of type 2 diabetes mellitus. However, many patients can control type 2 diabetes with diet and exercise alone or with diet, exercise, and an oral antidiabetic drug (see section Oral Antidiabetic Dmgp ). Insulin may also be used in the treatment of severe diabetic ketoacidosis (DKA) or diabetic coma. Insulin is also used in combination with glucose to treat hypokalemia by producing a shift of potassium from die blood and into die cells. 

The patient with hyperthyroidism is likely to have cardiac symptoms such as tachycardia or palpitations. Propranolol, a adrenergic blocking drug (see Chap. 21), may be prescribed by tlie primary health care provider as adjunctive treatment for several weeks until tlie therapeutic effects of tlie antithyroid drug are obtained. 

Cycloplegic mydriatics cause mydriasis and cyclople-gia (paralysis of the ciliary muscle, resulting in an inability to focus the eye). These drugs (see Chap. 25) are used in the treatment of inflammatory conditions of the iris and uveal tract of the eye and for examination of the eye... 

Certain patient populations require special considerations due to their altered metabolism, unique volume of distribution, or increased risk for side effects.43 Although many of these patients are excluded from clinical trials in SE, the standard algorithm for SE still applies for these patients in terms of immediate care, assessment, and drugs (see Table 28-2). 

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