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In oth- may be used to reduce the use of illicit opi- er instances buy discount oxytrol 2.5 mg on line, these medications are ates and the high-risk behaviors associat- obtained illegally generic oxytrol 5 mg without a prescription. O’Connor order 2.5 mg oxytrol with visa, 2000) purchase oxytrol 5mg free shipping, as well as to provide In addition to producing pain relief discount oxytrol 5mg otc, medical assistance with withdrawal of opi- narcotics produce euphoria, sedation, and ates. At first, individu- drug dosage is gradually tapered during als may take illegal narcotics primarily for the withdrawal period. Repeated admin- may be enrolled in a maintenance program istration rapidly produces tolerance and in which they do not undergo detoxifica- intense physical dependence. Eventually, tion but rather receive maintenance dos- as the dosage and/or frequency of drug es of an opiate substitute along with administration increases, individuals need counseling. The goal of such programs is to continue to take the drug regularly to first to help individuals return to a social- avoid symptoms of physical withdrawal. Drugs that are injected increase individuals’ risk of Stimulants contracting HIV infection or hepatitis C if needles are shared. Adding adulterants to Acting directly on the central nervous substances or using nonsterile techniques system, stimulants create an increased state of injection may also produce medical of arousal and concentration and speed up complications. Individuals may (inflammation of tissues), thrombophle- take stimulants for such effects as in- bitis (inflammation of a vein with associ- creased alertness and increased sense of ated clot formation), septicemia (presence well-being, increased confidence, reduc- of toxins in the blood), and bacterial tion of fatigue, or decrease in appetite. They can be taken Withdrawal symptoms vary in severity orally, topically, intravenously, or by inhala- and duration, depending on the particu- tion. In addition to central nervous system 216 CHAPTER 7 CONDITIONS RELATED TO SUBSTANCE USE effects, stimulants have generalized sys- lasts only a matter of minutes, however, temic effects, including an increase in heart and is often followed by irritability, rest- rate, an increase in blood pressure, a rise in lessness, and depression. The aftereffects body temperature, and the constriction of of crack can be so intense that individuals peripheral blood vessels (Sarnyai, Shaham, continue to smoke it, despite obvious & Heinrichs, 2001). It Aside from its psychological, social, and may be taken orally, used intranasally vocational consequences, cocaine use can (snorted), smoked, or injected intraven- have serious medical consequences. The technique of free-basing basing or smoking crack can lead to pul- cocaine, which gained popularity in the monary complications. Chronic use of 1980s, involves heating a flammable sol- intranasal cocaine may cause ulceration or vent such as petroleum or ether, and then perforation of the nasal septum. The process intoxication can produce neurologic effects, “frees” cocaine hydrochloride from its such as confusion, anxiety, hyperexcitabil- salts and adulterants, converting it to a ity, agitation, and violence. The effects are the result of acute cocaine toxi- free-base cocaine can be inhaled or city, which is dose related, in which indi- smoked, usually with a water pipe, for viduals can experience stroke or seizures, direct absorption through the alveoli in severe hyperthermia (increased body the lungs. The technique rapidly delivers temperature), arrhythmia (irregular heart- high concentrations of cocaine to the beat), myocardial infarction (heart brain and results in blood levels as high attack), and, in some instances, sudden as those for self-injection. Cocaine psychosis, another side The free-basing technique can cause effect of cocaine use, is manifested by additional disability caused by the burns paranoia, panic, hallucinations, insomnia, from fires started during the free-basing and picking at the skin. The level of tolerance for cocaine episode can last from 24 to 36 hours. Dependence is produced profit on its sale, may cause additional very rapidly. Its concentrated form and its route result from the nature of the substance of administration make its potency many used to cut the cocaine or from the dosage times greater than that of cocaine alone. Adulterants such as talc or corn- The euphoric effect produced by crack starch can cause complications ranging Use Disorders Involving Other Substances 217 from inflammation to embolus (undis- psychoactive responses to the drug depend solved matter in the blood). Often, users report a sense of time tain of cocaine’s potency, the effects are slowing and an impairment in their abil- not always predictable. The withdrawal ity to learn new facts while they are under syndrome from cocaine consists of a crav- the influence of the drug. Because it is not unusu- an increase in heart rate, dilation of the al for individuals who are cocaine depend- bronchioles, and dilation of the peripher- ent to also be dependent on other drugs, al blood vessels. Because of the stimulato- a withdrawal reaction from other sub- ry effect on the heart, cannabis use may stances may be experienced as well. Chronic smoking amphetamine is crystalline methampheta- of cannabis produces inflammatory mine (“ice”), which is highly addictive changes in the lungs that contribute to the physically and psychologically (Lukas, development of chronic conditions such 1997). The technique is similar to that more, the use of other drugs, including of smoking free-base cocaine. Ice has alcohol and tobacco, may compound greater strength and more enduring the adverse effects of cannabis. Greater ple, the combination of tobacco and stimulation to the brain makes it more cannabis use is thought to increase the risk dangerous mentally because it creates a of lung cancer. Toxic lev- orally, oral consumption can delay its els can produce severe paranoid thinking effects for up to an hour, and the effects with hallucinations. Chronic use of form of THC, is also smoked and has con- methamphetamine in any form can result siderably more potency than does cannabis.

Protection of acid- (C) 300 mEq pH (mm Hg) (mm Hg) (mEq/L) base balance by pH regulation of acid (D) 500 mEq (A) 7 buy oxytrol 2.5mg. Acid and basics: A guide to un- (B) Adrenal cortical insufficiency emergency department shortly before derstanding acid-base disorders generic oxytrol 2.5mg fast delivery. Clinical Physiology of Acid-Base (D) An increase in intracellular pH attempted to kill herself by swallowing and Electrolyte Disorders buy 5 mg oxytrol free shipping. New (E) An increase in tubular sodium the contents of a bottle of aspirin York: McGraw-Hill generic 5mg oxytrol with visa, 1994 purchase oxytrol 5mg overnight delivery. A homeless woman was found on a hot the following set of arterial blood Basic Concepts and Clinical Manage- summer night lying on a park bench in values is expected? CASE STUDIES FOR PART IV • • • microscopy, but effacement of podocyte foot processes CASE STUDY FOR CHAPTER 23 and loss of filtration slits is seen with the electron micro- Nephrotic Syndrome scope. No immune deposits or complement are seen af- A 6-year-old boy is brought to the pediatrician by his ter immunostaining. The biopsy indicates minimal mother because of a puffy face and lethargy. The podocyte cell surface and weeks before, he had an upper respiratory tract infec- glomerular basement membrane show reduced staining tion, probably caused by a virus. What features in this case would cause suspicion of swelling, and pitting edema in the legs are observed. Why does the abnormally high rate of urinary protein excre- reveals no cellular elements or casts. Answers to Case Study Questions for Chapter 23 The child is treated with the corticosteroid prednisone, 1. The child has the classical feature of nephrotic syndrome: and the edema and proteinuria disappear in 2 weeks. She is transferred to a general hospital and, dur- ability of the glomerular filtration barrier to the normal ing transfer, has three grand mal seizures and arrives in plasma proteins. This condition might be a result of an in- a semiconscious, uncooperative state. A blood sample creased size of “holes” or pores in the basement membrane reveals a plasma [Na ] of 103 mEq/L. The decreased staining with a 362 mOsm/kg H O and urine [Na ] is 57 mEq/L. She is 2 cationic dye, however, suggests that there was a loss of given an intravenous infusion of hypertonic saline (1. Several days after serum albumin bears a net negative charge at physiological she had improved, bronchoscopy is performed. Proteins that have leaked across the glomerular filtration sion of 1 L of 1. Assume barrier are not only excreted in the urine but are reabsorbed that her total body water is 25 L (50% of her body weight). The endocytosed proteins are digested Why is the total body water used as the volume of distribu- in lysosomes to amino acids, which are returned to the cir- tion of Na , even though the administered Na is limited to culation. The liver, which synthe- Why should the hypertonic saline be administered slowly? The endogenous creatinine (CR) clearance (an estimate of Answers to Case Study Questions for Chapter 24 GFR) equals (UCR V)/PCR (60 1. Note that the permeability of with an impaired ability to dilute the urine (note the inap- the glomerular filtration barrier to macromolecules (plasma propriately high urine osmolality), led to severe hypona- proteins) was abnormally high, but permeability to fluid tremia and water intoxication. Addition of 1 L of 308 mEq Na /L to 25 L produces an in- may be significant and may lead to a reduced fluid perme- ability and GFR. The edema is a result of altered capillary Starling forces and used in this calculation because when hypertonic NaCl is added to the ECF, it causes the movement of water out of renal retention of salt and water. The decline in plasma the cell compartment, diluting the extracellular Na. Because the brain is enclosed in a nondistensible cranium, ing fluid movement out of the capillaries into the interstitial compartment. The edema is particularly noticeable in the when water moves into brain cells and causes them to swell, intracranial pressure can rise to very high values. The abdomi- nal distension (in the absence of organ enlargement) sug- This can damage nervous tissue directly or indirectly by im- gests ascites (an abnormal accumulation of fluid in the ab- pairing cerebral blood flow. The neurological symptoms seen in this patient (headache, semiconsciousness, grand dominal cavity).

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These hypothetical situations underscore integral aspect of learning about how the body functions purchase oxytrol 2.5mg without prescription. The solu- integumentary system provides the body with external support tion to the case study is presented at the end of the chapter buy 5 mg oxytrol with mastercard, fol- and protection best oxytrol 5mg, and the skeletal system provides internal support lowing the last major section buy 5mg oxytrol with mastercard. Movement is pos- sible at the joints of the skeleton as the associated skeletal mus- cles are contracted oxytrol 5 mg line. Surface anatomy and regional anatomy are Understanding Anatomical Terminology given detailed coverage in chapter 10 of this unit. Atlas-quality Each technical term is set off in boldface or italic type, and is photographs of dissections of human cadavers are included in often followed by a phonetic pronunciation in parentheses, at this chapter. The roots of each term can be identified by referring to the glos- Unit 5: Integration and Coordination This unit includes sary of prefixes and suffixes found on the inside of the front chapters on the nervous system, endocrine system, and sensory cover. The concepts identified and discussed in these chapters footnotes at the bottom of the page on which the term is intro- are concerned with the integration and coordination of body duced. If students know how a term was derived, and if they can functions and the perception of environmental stimuli. All of these systems work together in maintaining a Each chapter is divided into several major sections, each of stable internal environment in which the cells of the body can which is prefaced by a concept statement and a list of learning thrive on a day-to-day basis. A concept statement is a succinct expression of the main idea, or organizing principle, of the information contained Unit 7: Reproduction and Development The male and fe- in a chapter section. The learning objectives indicate the level of male reproductive systems are described in this unit, and the competency needed to understand the concept thoroughly and continuance of the human species through sexual reproduction is be able to apply it in practical situations. Unit 7 provides an overview of the entire sequence of lows discusses the concept in detail, with reference to the objec- human life, including prenatal development and postnatal tives. Knowledge Check questions at the end of each chapter growth, development, and aging. Basic concepts of genetics and section test student understanding of the concept and mastery of inheritance are also explained. Set off from the text narrative are short paragraphs highlighted Each body system chapter contains one or two Clinical by accompanying topic icons. This interesting information is rel- Practicums, placed before the chapter summary. Detailed answers evant to the discussion that precedes it, but more important, it to the Clinical Practicum questions are provided in Appendix B. The five icons represent the following topic categories: Chapter Summaries Clinical information is indicated by a stethoscope. The information contained in these commentaries provides examples of the applied A summary, in outline form, at the end of each chapter reinforces medical nature of the information featured in the topic discussion. These comprehensive summaries serve as a valuable tool in helping students prepare for examinations. The information contained in these commentaries is relevant to normal aging and indicates how senescence (aging) of body organs impacts body function. Review Activities Following each chapter summary, sets of objective, essay, and Developmental information of practical importance is indicated by a critical thinking questions give students the opportunity to mea- human embryo. Knowledge of pertinent developmental anatomy sure the depth of their understanding and learning. The critical contributes to understanding how congenital problems develop and impact body structure and function. Each answer is explained, so students can effec- that a disruption of homeostasis frequently accompanies most diseases. Academic interest commentaries discuss topics that are relevant to human anatomy that are quite simply of factual interest. Illustrations and Tables In addition to the in-text commentaries, selected develop- Because anatomy is a descriptive science, great care has been mental disorders, aging, clinical procedures, and diseases or dys- taken to continuously enhance the photographs and illustrations functions of specific organ systems are described in Clinical in Human Anatomy. A hallmark feature of the previous editions Considerations sections that appear at the end of most chapters. In keeping with the Photographs of pathological conditions accompany many of objective of forever improving and refining the art program, over these discussions. Each illustration has been checked and rechecked for conceptual clarity and precision of the Developmental Expositions artwork, labels, and captions. Color-coding is used in certain art In each body system chapter, a discussion of prenatal develop- sequences as a technique to aid learning. Each of these of the skull in chapter 6 are color-coded so that each bone can be discussions includes exhibits and explanations of the mor- readily identified in the many renderings included in the chapter. These illustrations represent a collaborative effort between author Placement near the related text discussion ensures that the and illustrator, often involving dissection of cadavers to ensure anatomical terminology needed to understand the embryonic accuracy.

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Indianapolis order 5 mg oxytrol otc, Indiana Research Pharmacologist discount oxytrol 2.5mg visa, Military Ergonomics Division USARIEM James McGill safe 2.5 mg oxytrol, M buy oxytrol 2.5mg amex. Natick cheap 5 mg oxytrol with visa, Massachusetts Assistant Professor of Medicine Indiana University School of Medicine Jackie D. Indianapolis, Indiana Professor and Chairman, Department of Physiology Ohio State University College of Medicine Columbus, Ohio vii PART I Cellular PhysiologyCellular Physiology CHAPTER Homeostasis and Cellular Signaling Patricia J. Different modes of cell communication differ in terms of and how they are regulated and integrated. Chemical signaling molecules (first messengers) provide function and survival of the organism. Homeostasis is the maintenance of steady states in the clude ions, gases, small peptides, protein hormones, body by coordinated physiological mechanisms. Receptors are the receivers and transmitters of signaling body’s responses to changes in the environment. Second messengers are important for amplification of the while equilibrium represents a balance between opposing signal received by plasma membrane receptors. Cellular communication is essential to integrate and coor- receptors that participate in the regulation of gene ex- dinate the systems of the body so they can participate in pression. It is a broad field that encompasses many dis- modynamic terms, muscle contraction is analyzed in terms of ciplines and has strong roots in physics, chemistry, and math- forces and velocities, and regulation in the body is described ematics. Physiologists assume that the same chemical and in terms of control systems theory. Because the functions of physical laws that apply to the inanimate world govern living systems are carried out by their constituent structures, processes in the body. They attempt to describe functions in knowledge of structure from gross anatomy to the molecular chemical, physical, or engineering terms. In recent years, we have seen many advances in our understanding of phys- Lungs iological processes at the molecular and cellular levels. In higher organisms, changes in cell function always occur in Alimentary the context of a whole organism, and different tissues and tract organs obviously affect one another. The independent ac- Kidneys tivity of an organism requires the coordination of function at all levels, from molecular and cellular to the organism as a whole. An important part of physiology is understanding Internal how different parts of the body are controlled, how they in- environment teract, and how they adapt to changing conditions. For a person to remain healthy, physiological conditions in the body must be kept at optimal levels and closely reg- ulated. Regulation requires effective communication be- Body cells tween cells and tissues. This chapter discusses several top- ics related to regulation and communication: the internal environment, homeostasis of extracellular fluid, intracellu- Skin lar homeostasis, negative and positive feedback, feedfor- ward control, compartments, steady state and equilibrium, intercellular and intracellular communication, nervous and endocrine systems control, cell membrane transduction, and important signal transduction cascades. Exchanges of matter and energy between the body and THE BASIS OF PHYSIOLOGICAL REGULATION the external environment (indicated by arrows) occur via the gas- trointestinal tract, kidneys, lungs, and skin (including the special- Our bodies are made up of incredibly complex and delicate ized sensory organs). It is clear that conditions and processes in the body must be closely maintain a relatively constant internal environment. A Stable Internal Environment Is Essential for Normal Cell Function Homeostasis Is the Maintenance of The nineteenth-century French physiologist Claude Steady States in the Body by Bernard was the first to formulate the concept of the inter- Coordinated Physiological Mechanisms nal environment (milieu intérieur). He pointed out that an ex- ternal environment surrounds multicellular organisms (air The key to maintaining stability of the internal environ- or water), but the cells live in a liquid internal environment ment is the presence of regulatory mechanisms in the body. Most body cells are not directly ex- In the first half of the twentieth century, the American posed to the external world but, rather, interact with it physiologist Walter B. Cannon introduced a concept de- through the internal environment, which is continuously scribing this capacity for self-regulation: homeostasis, the renewed by the circulating blood (Fig. The existence of limited to (1) oxygen and carbon dioxide tensions, (2) con- steady conditions is evidence of regulatory mechanisms in centrations of glucose and other metabolites, (3) osmotic the body that maintain stability. To function optimally un- pressure, (4) concentrations of hydrogen, potassium, cal- der a variety of conditions, the body must sense departures cium, and magnesium ions, and (5) temperature. Depar- from normal and must engage mechanisms for restoring tures from optimal conditions may result in disordered conditions to normal.

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