Ebook Basic and clinical pharmacology (13th edition): Part
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Basic and clinical pharmacology (13th edition): Part
Ebook Basic and clinical pharmacology (13th edition): Part
SECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): Part STUDYA 65-year-old woman Will a long-standing lifitory of poorly controlled type 2 diabetes mellitus presents with increasing numbness and paresthesias in her extremities, generalized weakness, a sore tongue. and gastrointestinal discomfort Physical examination reveals a fraiHookiig. pale woman wit Ebook Basic and clinical pharmacology (13th edition): Parth diminished vibration sensation, diminished spinal reflexes, and a positive Babmski sign. Examination of her oral cavity reveals atropilic glossitis,Ebook Basic and clinical pharmacology (13th edition): Part
in wliich the tongue appears deep red in color and abnormally smooth and shiny due to atrophy of tire lingual papillae. Laboratory testing reveak a mSECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): PartdL). an erythrocyte mean cell volume (MCV) of 123 IL (normal 84-99 ÍL). an erythrocyte mean cell Iremogbbin concentration (NICHC) of 34% (normal 31-36%), and a tow reticulocyte count. Further laboratory testing reveals a normal serum folate concentration and a serum vitamin B1: (cobalanùn) concentra Ebook Basic and clinical pharmacology (13th edition): Parttion of 98 pginL (normal 250-1100 pginL). Results of a Scliilling test indicate a diagnosis of pernicious anemia. Once megaloblastic anemia was identiEbook Basic and clinical pharmacology (13th edition): Part
fied, why was it important to measure serum concentrations of both folic acid and cobalamin? Should tins patient be treated with oral or parenteral viSECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): Partss that produces over 200 billion new blood cells pel day in the normal person and even greater numbers of celb m people with conditions that cause loss 01 destruction of blood celk. The hematopoietic machinery resides primarily in tire bone mairow in adults and requires a constant supply of three e Ebook Basic and clinical pharmacology (13th edition): Partssential nutrients—iron. vitamin Bi2. and folic acid—as well as the presence of hematopoietic growth factors, proteins that regulate tire proliferatioEbook Basic and clinical pharmacology (13th edition): Part
n and differentiation of hematopoietic cells Inadequate supplies of eitlrer the essential nutrients or the growth factors result m deficiency of functSECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): Part condition resulting from a genetic alteration m the hemoglobin molecule, is common but is not easily treated It is discussed ni the Box: Sickle Cell Disease and Hydroxyurea. Thrombocytopenia and neutro|>enia are not rare, and some forms are amenable to drug therapy. In this chapter, we fust conside Ebook Basic and clinical pharmacology (13th edition): Partr treatment of anemia due to deficiency of non. vitamin Bi;. or folk acid and then hull to the medical use of hematopoietic growth factors to combat aEbook Basic and clinical pharmacology (13th edition): Part
nemia, thrombocytopenia, and neutropenia, and to support stem cell transplantation.g AGENTS USED IN ANEMIASIRONB a sic p ha nil a c o logyIron deficieSECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): Partnal dyspnea, and other generalized symptoms of tissue hypoxia. The cardiovascular adaptations to chronic anemia—tachycardia, increased cardiac output, vasodilation—can worsen the condition of patients with underlying cardiovascular disease.Iron forms tbe nucleus of the non-porphyiui Ireme ring, winc Ebook Basic and clinical pharmacology (13th edition): Parth together with global chains forms Iremoglobni. Hemoglobin reversibly binds oxygen and provides tire critical mechanism for oxygen delivery from theEbook Basic and clinical pharmacology (13th edition): Part
hmgs to other tissues. In the absence of adequate iron, small erythrocytes with insufficient hemoglobin are foimed. giving use to microcytic hypochromSECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): Part inorganic non b extremely toxic, blit non is required for essential proteiis such as hemoglobni. therefore, evolution lias provided an elaborate system for regulating non absorption. transport. and storage (Figure 33-1). The system uses specialized transport, storage, fenireductase, and fenoxidase Ebook Basic and clinical pharmacology (13th edition): Partproteins whose concenhatKHis are controlled by the body’s demand fur hemoglobin synthesis and adequate non stores (Table 33-1). A peptide called hcpciEbook Basic and clinical pharmacology (13th edition): Part
duL produced primarily by liver cells, serves as a key central regulator of lire system. Nearly all of the iron used to support hematopoiesis is rechiSECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): Partietary requirements are small and easily fulfilled by tire iron available in a wide variety of foods. However, in special populations with either increased non requirements (eg. growing children, pregnant women) or increased losses of iron (eg. menstruating women), iron requirements can exceed norma Ebook Basic and clinical pharmacology (13th edition): Partl dietary supplies, and iron deficiency can develop.FIGURE 33-1 Absorption. transport, and storage of non. Intestinal epithelial cells actively absorlEbook Basic and clinical pharmacology (13th edition): Part
https 7/khothUVĨê r1 com transporter 1 (DMT1) and heme non via the heme carrier protein 1 (HCP1). lion tliat is absorbedm the intestine (1) is activeSECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): Parterrin (Tf) to erythroid precursors in the bone marrow for synthesis of hemoglobin (Hgb) (2) or to hepatocytes for storage as ferritin (3). Tl»e transferrin-iron complex binds to transfenin receptors (TfR) in erythroid precursors and hepatocytes and is internalized. After release of iron, the TfR-Tf Ebook Basic and clinical pharmacology (13th edition): Partcomplex is recycled to the plasma membrane and Tf is released. Maciopliages that pliagocytize senescent erythrocytes (RBC) reclaim the non from the RBEbook Basic and clinical pharmacology (13th edition): Part
C hemoglobin and either export It or store It as ferritin (4). Hepatocytes use several mechanisms to take up non and store tile non as ferritin. FO. fSECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): PartGraw-Hill Companies, Inc.)1 ABLE 33 1 Iron distribution in normal adults.1Iron Content (mg)MenWomenHemoglobin30501700Myoglobin430Ị300Enzymes108Transport (transferrin)86Ek AStorage (ferritin and other forms)750300Total42482314’values are based on data from various sources and assume that normal men w Ebook Basic and clinical pharmacology (13th edition): Parteigh 80 kg and have a hemoglobin level of 16 g/dL and that normal women weigh 55 kg and have a hemoglobin level of 14 g/dl.Adapted, with permission, fEbook Basic and clinical pharmacology (13th edition): Part
rom Kushner JP: Hypochromic anemias. In: Wyngaarden JB, Smith LH (editors). Cedi Textbook of Medicine. 18th ed. Saunders, 1988. Copyright ElsevierSickSECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): Partstruction, instead of the reduced mature erythrocyte production seen with iron. folk acid, and vitamin B|2 deficiency. Patients with sickle cell disease are homozygous for the aben ant 0-hemoglobin s (HbS) allele (substitution of valine for glutamic acid at amino acid 6 of p-globm) or heterozygous f Ebook Basic and clinical pharmacology (13th edition): Partor HbS and a second mutated p-hemoglobm gene such as hemoglobin c (HbC) or p-thalassemia Sickle cell disease lias an increased pievalence m individualEbook Basic and clinical pharmacology (13th edition): Part
s of African descent because rhe heterozygous trait confers resistance to malariaIn the majority of patients with sickle cell disease, anemia is not tSECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): Partglobin level (7-10 g dL). and an elevated reticulocyte coiuit. Instead, the primary problem K tliat deoxygenated HbS chains fonn polymeric structures that dramatically change erythrocyte sliape. reduce deformability, and elicit membrane permeability changes tliat further promote hemoglobin polymeriz Ebook Basic and clinical pharmacology (13th edition): Partation. Abnormal erytluocytes aggregate hl tire microvasculature—where oxygen tension is tow and hemoglobin is deoxygenated—and cause veno-occlusive daEbook Basic and clinical pharmacology (13th edition): Part
mage. In tire musculoskeletal system, tlris results in characteristic.extremely severe iKHie and .ionit pain. In the cerebral vascular system, it causSECTION VI DRUGS USED TO TREAT DISEASES OF THE INFLAMMATION, & GOUTJJAgents Used in Cytopenias; Hematopoietic Growth FactorsJames L. Zehnder, MD*CASE Ebook Basic and clinical pharmacology (13th edition): Part infection and. m adults, an increase in emboBsm and pulmonary hypeileiLSKni. ouppmuvc Iieauiicni iicRioes analgesics, antibiotics, pneumococcal vaccination. and blood transfusions In addition, the cancer chemotherapeutic ding hydroxyurea (hydroxycarbamide) reduces veno-occlusive events. It is appro Ebook Basic and clinical pharmacology (13th edition): Partved in the United States for treatment of adults with recurrent sickle cell crises and approved in Europe in aduhs and children with recurrent vaso-ocEbook Basic and clinical pharmacology (13th edition): Part
clusive events. As an anticancer dntg used DI tire treatment of chronic and acute myelogenous leukemia, hydroxyurea inhibits ribonucleotide reductaseGọi ngay
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