By S. Owen. Empire State College.
Maternal metabolic abnormalities (gluconeogenesis cheap singulair 10mg with amex asthmatic bronchitis in toddlers, hypokalemia buy generic singulair 10mg on-line asthma treatment vs copd, and hyper- glycemia), as well as cardiopulmonary complications (tachycardia, hypotension, arrhyth- mias, myocardial ischemia, pulmonary edema) are associated with beta-agonist tocolyt- ics (Box 15. Every beta-agonist is associated with pulmonary edema and occurs among as many as 5 percent of gravidas who took any of these drugs (Boyle, 1995; McCombs, 1995). Maternal tocolytic therapy has been associated with neonatal hypoglycemia and tachycardia. Several fetal and neonatal cardiovascular adverse effects are associated with beta-sympathomimetic therapy (Katz and Seeds, 1989) (Box 15. Decreases in the systolic/diastolic ratios of the umbilical artery have been reported in patients using either terbutaline or ritodrine (Brar et al. By 1979, ritodrine was available as a tocolytic agent in 23 foreign countries (Barden, et al. Ritodrine hydrochloride is a beta-adrenergic agonist with beta2-receptor effects that relax smooth muscle in the arterioles, bronchi, and uterus. Although ritodrine use is in widespread use for the inhibition of preterm labor (Leveno et al. No long-term benefi- cial effect of tocolytic therapy (decreased perinatal mortality or severe neonatal respira- tory disorders) was found in meta-analysis of 890 pregnancies in which ritodrine or another beta-mimetic tocolytic agent was used to prevent premature delivery (King et al. Downregulation of beta2-adrenergic receptors following the use of these drugs may explain their poor efficacy because uterine-relaxant effects are short lived (Berg et al. For this indication, a dose of 1–3 mg is usually given over a 2-min period (Smith, 1991). It is possible that a weak effect was pres- ent and the signal could not be separated from background noise. Maternal effects Acute maternal pulmonary edema, in addition to hypokalemia and hyperglycemia, has been reported among women given ritodrine. Steroids administered concomitantly to accelerate fetal lung maturity seem to increase the risk for this maternal complication Tocolytics 283 (see Box 15. Severe maternal cardiovascular complications occurred among nearly 5 percent of women treated with terbutaline (Katz et al. Beta-mimetics also alter glucose tolerance and have been associated with ketoacidosis among women with poorly controlled insulin-dependent diabetes. Fetal effects Fetal tachycardia and arrhythmias are associated with beta-mimetic therapy, including ritodrine (Barden et al. Protracted ritodrine therapy has been associated with increased septal thickness in exposed neonates (Nuchpuckdee et al. However, these do not appear to be frequent complications of ritodrine, or beta-mimetic, therapy in general. Beta-sympathomimetic tocolytic therapy, including ritodrine, was associated with a 2. In another investiga- tion, no association of ritodrine with intraventricular–periventricular hemorrhage was found (Box 15. Beta-mimetics are generally not used during the period of organogenesis, with the exception of terbutaline for asthma. An increased frequency of cardiovascular anomalies in chick embryos exposed to ritodrine and terbutaline was found in one study, and it was concluded that teratogenic effects were secondary to stimulation of beta-2-adrenergic receptors (Lenselink et al. Interestingly, according to its manufacturer, it should not be used for tocolysis. Terbutaline has also been utilized in the management of symptomatic placenta previa in pregnancies remote from term (Besinger et al. Neonatal myocardial dysfunction and necrosis have been associated with terbutaline tocolytic therapy (Fletcher et al. Neonatal hypoglycemia and fetal tachycardia were associated with terbutaline tocolytic therapy late in pregnancy (Peterson et al. Neonatal behavior was transiently altered among the infants of pregnant women who received terbutaline tocolysis (Thayer and Hupp, 1997). One review of car- diopulmonary effects of low-dose continuous terbutaline infusion in 8709 women found 47 women (0. In another review of 1000 women given a combination of intravenous terbutaline and mag- nesium sulfate, the side effects of protracted therapy were negligible (Kosasa et al.
Tolerance to some physical actions (such as higher pulse rate) has been measured safe singulair 5mg asthma 2014 rotten tomatoes, but tolerance to increase of blood pressure has not been seen purchase singulair 5 mg on line asthma rescue inhalers. Larger doses created muscle tremors and increased insight into psychological issues. In a controlled experimental setting with volunteers interested in using the drug to gain better awareness of themselves, the drug stimulated thoughts, feelings, and physical senses. People became more articulate, saw new meaning in or- dinary experiences, and became more inclined to self-examination. The drug may be safe from a tech- nical pharmaceutical standpoint because there is a huge difference between the size of a therapeutic dose and a lethal one, but the drug is so potent that small doses are known to kill. Characteristics of overdose can resemble those of am- phetamine, including fear and physical aggression. One person who did ingest the real thing described hallu- cinations, brightened mood, more awareness of colors, more enjoyment of music and sex, and various insights into personal issues facilitated by the drug. Results from another experiment showed increased awareness of emotion and thoughts, leading researchers to conclude that the substance might be useful in psychotherapy. An experiment documented physical sensations that included warmth, tingling, dizziness, nausea, tremors, rapid heartbeat, impaired move- ment, coughing, sweating, and lack of hunger. Supposedly effects from a single dose can last for three days, but in a group of 25 volunteers who took substantial doses, only 2 persons experienced effects lasting past the day of the experiment, and none had any effects on the second day afterward. Compared to infrequent marijuana users, fre- quent marijuana users are better at identifying whether they have received dronabinol or a placebo. Alzheimer’s patients who received experimental drona- binol showed improved appetites and reduction of behavior associated with the disease. Research indicates that the drug may widen airways, a help to persons suffering from breathing difﬁculty. Experimental success has also been achieved in treating spasticity, reducing not only that afﬂiction but its associated rigidity and pain. Many of marijuana’s actions are experienced with dronabinol: euphoria, hallucinations, more acute- ness in physical senses, altered time perception, memory trouble, confusion, and drowsiness. Not everyone ﬁnds marijuana actions to be pleasant, and some nausea patients ﬁnd those effects so unpleasant that they would rather forgo the dronabinol and endure the nausea. Some other effects associated with marijuana have not been observed with medical use of dronabinol, such as trouble with thinking skills and lack of ambition. Dependence is reported, with withdrawal symptoms in- 140 Dronabinol cluding sleeping difﬁculty, peevishness, ﬁdgeting, perspiration, runny nose, appetite loss, and loose bowel movements. In one study withdrawal symp- toms lasted three days and gradually cleared up over that time. No one in a ﬁve-month study, including persons who had pre- viously abused other drugs, began abusing dronabinol; nor did any of these persons exhibit changes of personality or changes of ability to function in society. Apparently persons interested in recreational effects of dronabinol pre- fer marijuana. Animal experimentation has found that dronabinol substantially increases the pain relieving qualities of codeine, heroin, hydro- morphone, meperidine, methadone, morphine, and oxymorphone. The an- tinausea drug prochlorperazine appears to reduce the unwanted marijuana actions of dronabinol. The Ames test, a standard laboratory procedure for detecting cancer-causing potential, revealed none. No birth defects have been attributed to dronabinol in mice and rat experiments, although more pregnancy failures occurred. It passes into milk of nursing mothers, and levels in milk are higher than in the mothers’ bloodstream. Although natural products containing the drug have a long history, ephedrine was not isolated from ma huang until the 1880s. Despite ma huang’s familiar use as a medicinal herb, Western med- icine did not accept ephedrine until the 1920s.
You may also have heard reports that cases of type 2 generic 10mg singulair visa asthma emedicine, or adult-onset buy cheap singulair 5 mg line allergic asthma medical definition, diabetes have been steadily rising in this country. Chronically high insulin increases estrogen; estrone, specifically, increases the cells’ resistance to insulin. Ultimately, you get into a vicious cycle: higher insulin creates higher estrogen, which can lead to higher insulin and insulin resistance, which tends to make you gain weight, which leads to making more estrogen. Enough to get you out there walking, and to just say no when the waitress offers the dessert menu? There is a difference in estrogen levels, however, depending on menopausal status. Before menopause, women make estrogen mostly in the ovaries, though remember that fat cells still do produce estrogen. Overweight or obese women have more fat cells than lean women, so they produce more estrogen. Before menopause, overweight women have lower estrogen than women of normal weight. Because premenopausal women with a high body mass index are more inclined to ovulate irregularly, which results in lower levels of circulating estrogens. After menopause, the opposite is true—overweight women consistently have higher estrogen levels. In one study from the National Cancer Institute of more than one hundred thousand women, those who gained more than 44 pounds since age eighteen had a fivefold increased risk of endometrial cancer. In summary, higher estrogen in postmenopause is a risk factor for breast cancer, and you can modify your estrogen level. Reduce your excess estrogen by getting your weight down to normal and changing your food plan. Diet Many women have found that a diet high in conventionally raised red meat and refined carbohydrates is likely to cause estrogen overload. That could be because of hormones in the meat, or perhaps from the type of bacteria cultivated in the gut by people who eat a lot of meat. If you don’t have a certain type of bacteria in your gut to process it, the estrogen will stay in your system. When this happens, you don’t follow the Golden Rule of Estrogen—“use it and lose it. The “wrong” bacteria are predominant in people who consume large amounts of meats and refined carbs. I call this approach the Paleolista Food Plan, which also emphasizes nuts and fresh, low-glycemic fruits and vegetables. I abhor white bread, white sugar, and white rice for many reasons, but one important reason is that they reduce progesterone and worsen estrogen dominance. My recommendation: reduce your intake of refined carbohydrates as a key step to rebalancing your neuroendocrine system. Wine lowers your risk of heart disease and stroke, but excess estrogen can increase your risk of breast cancer. Here’s what: calculate your risk of breast cancer, heart disease, and stroke, and then decide. If you are at high risk for breast cancer, I suggest drinking minimally, if at all. And remember that alcohol interferes with your fat- burning mechanism, if you’re concerned about those extra pounds. Nutritional deficiencies Specific nutritional deficiencies can also lead to excess estrogen. Low magnesium, for example, is associated with high estrogen levels in both premenopausal and postmenopausal women. If you have five or more of the symptoms in the questionnaire corresponding to this chapter, ask your doctor for a blood test to measure your magnesium, zinc, copper, vitamin B12, and folate levels. She has built a thriving practice around mercury toxicity, although that was never her intended path. Her interest began when she saw a series of patients with vague symptoms, such as fatigue, nausea, and brain fog, and found that a common link was a robust appetite for fish consumption.