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CHAPTER 24 CORTICOSTEROIDS 337 BOX 24–2 EFFECTS OF MINERALOCORTICOIDS ON BODY PROCESSES AND SYSTEMS • The overall physiologic effects are to conserve sodium and high buy 625 mg augmentin with amex antibiotics for acne in uk, the sodium level of extracellular fluid is low discount 625mg augmentin visa antibiotics libido, the renin– water and eliminate potassium. Aldosterone increases sodium re- angiotensin system of the kidneys is activated, or the anterior absorption from kidney tubules, and water is reabsorbed along pituitary gland secretes corticotropin. When sodium is conserved, another cation must • Inadequate secretion of aldosterone causes hyperkalemia, hypo- be excreted to maintain electrical neutrality of body fluids; thus, natremia, and extracellular fluid volume deficit (dehydration). This is the only potent mechanism for con- Hypotension and shock may result from decreased cardiac out- trolling the concentration of potassium ions in extracellular fluids. In general, secretion is hypernatremia, and extracellular fluid volume excess (water increased when the potassium level of extracellular fluid is intoxication). Benign tumors often produce one corticosteroid normally for most clients, especially for those with diabetes mel- secreted by the adrenal cortex, but malignant tumors litus. In addition, some clients respond more favorably often secrete several corticosteroids. This is partly caused by indi- noma or hyperplasia of the adrenal cortex cells that pro- vidual differences in the rate at which corticosteroids are duce aldosterone. This decreases secretion of corticotropin, which, in turn, causes atrophy of the adrenal cortex and EXOGENOUS CORTICOSTEROIDS decreased production of endogenous adrenal cortico- steroids. Daily administration of physiologic doses (15 to (GLUCOCORTICOID DRUGS) 20 mg of hydrocortisone or its equivalent) or adminis- When corticosteroids are administered from sources outside tration of pharmacologic doses (more than 15 to 20 mg the body, they are given mainly for replacement or therapeu- of hydrocortisone or its equivalent) for approximately tic purposes. Replacement involves small doses to correct a 2 weeks suppresses the HPA axis. Therapeutic occurs within a few weeks or months after corticosteroids purposes involve relatively large doses to exert pharmaco- are discontinued, but may take 9 to 12 months. Drug effects involve extension of the physio- time, supplemental corticosteroids are usually needed dur- logic effects of endogenous corticosteroids and new effects ing stressful situations (eg, fever, illness, surgical proce- that do not occur with small, physiologic doses. These are glucocorticoid • Hydrocortisone, the exogenous equivalent of endoge- effects. Mineralocorticoid and androgenic effects are usually nous cortisol, is the prototype of corticosteroid drugs. Additional characteristics of When a new corticosteroid is developed, it is compared therapeutic corticosteroids include the following: with hydrocortisone to determine its potency in produc- • All adrenal corticosteroids are available as drug prepa- ing anti-inflammatory and antiallergic responses, in- rations, as are many synthetic derivatives developed by creasing deposition of liver glycogen, and suppressing altering the basic steroid molecule in efforts to increase secretion of corticotropin. Mineralocorticoid activity is high in activities of daily living and delay disability. However, cortisone (which is rarely used), intermediate in hydro- the disease may continue to progress and long-term use cortisone, prednisolone, and prednisone, and low in of systemic corticosteroids inevitably produces serious newer agents. For ex- Several of these drugs can be given by more than one ample, an increased blood sugar level is therapeutic for route; others can be given only orally or topically. For the client with adrenocortical insufficiency or an islet example, in recent years there have been several for- cell adenoma of the pancreas, but an adverse reaction mulations developed for oral inhalation in the treatment 338 SECTION 4 DRUGS AFFECTING THE ENDOCRINE SYSTEM of asthma and for nasal inhalation in the treatment of stances from lysosomes. For intra-articular or and thus prevents leakage of fluid into the injured area intralesional injections, acetate salts are used because and development of edema. It also reduces the chemicals they have low solubility in water and provide prolonged that normally cause vasodilation and tissue irritation. Betamethasone and dexamethasone last 48 hours, contributes to the anti-inflammatory and immunosup- methylprednisolone, prednisolone, prednisone and tri- pressant effects of glucocorticoids. The drugs inhibit the ability Mechanisms of Action of these immune cells to increase in number and per- form their functions. Like endogenous glucocorticoids, exogenous drug mole- • Inhibiting tissue repair. The drugs inhibit the growth cules act at the cellular level by binding to glucocorticoid of new capillaries, fibroblasts, and collagen needed for receptors in target tissues. Once inside the cell, they bind with receptors in intracellu- lar cytoplasm. The drug–receptor complex then moves to the Indications for Use cell nucleus, where it interacts with DNA to stimulate or sup- press gene transcription.

Bend your right knee and shift your body weight toward the right buy augmentin 375 mg with amex treating uti homeopathy, placing your palms on your right thigh order augmentin 625 mg on line antibiotic during pregnancy. With your torso upright, abs tight, and palms on your thighs, hold this position as you lift your left heel and come onto the ball of your left foot. Grasp a medi- cine ball with both hands, extending your arms from your chest. Twist your torso to the right, keeping the ball extended from your chest. Place a medicine ball just in front of and to the outside of your right foot. Bend forward from the hips, and grasp the ball with both hands near your foot. Lift the ball in a half circle up the right side of your body, over your head, and down the left side of your body, until it rests on the floor near the outside of your left foot. Make it your goal to progress directly from one exercise into the next without stopping. In the beginning you may find that you need to catch your breath from time to time. As you progress in the program, however, try to minimize your rest breaks. Some movements in this routine require a great deal of balance, coordina- tion, endurance, and strength. Do not attempt this routine until after you have taken the fitness test in Chapter 1 and completed the fitness preprogram, 62 THE ULTIMATE NEW YORK BODY PLAN TLFeBOOK if required. The fitness preprogram will build the balance, coordination, strength, and cardiovascular fitness you need to complete this routine safely. Stand with your feet under your hips and with your stability ball just behind you. Let your butt touch the ball, then press through your heels and rise to the starting position. Stand with your feet under your hips and with your stability ball just behind you. Grasp a medicine ball in both hands with your arms bent, holding the ball near your chest. Let your butt touch the ball, then press through your heels and rise to standing. Grasp a medicine ball with both hands, holding the ball just above your right shoulder as if it were an axe that you were get- ting ready to swing. Bend your left knee and lower yourself into a half squat, keeping the right leg extended. As you bend your knee, swing your axe (the medicine ball) in a diagonal wood-chopping motion, bringing the ball toward and just past your left knee. Jog in place for 30 seconds with the medi- cine ball extended at chest level. Do not put all your weight on your toes, as this will stress your knee joints. As always, I advise you to distribute your body weight in such a way as to minimize stress to the knees. In this case, I would advise you shift your body weight onto the balls of your feet. Continue to jog in place as you rotate your torso to the left with your arms extended. THE ULTIMATE NEW YORK BODY PLAN EXERCISE PROGRAM 65 TLFeBOOK JUMPING JACKS WITH SHOULDER PRESS A. Grasp a dumbbell in each hand with your elbows bent and hands at ear height.

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And just as the Tao functions in this manner to promote harmony and balance buy augmentin 625mg mastercard virus chikungunya, our own actions best augmentin 375 mg antibiotic names starting with z, performed in the spirit of wu-wei, produce the same result. Wu-wei also implies action that is spontaneous, natural, and effortless. As with the Tao, this behavior simply flows through us because it is the right action, appro- priate to its time and place, and serving the purpose of greater harmony and bal- ance. Chuang Tzu refers to this type of being in the world as flowing, or more poetically as purposeless wandering! To have no purpose is unthinkable and even frightening, certainly anti-social, and perhaps pathological in the context of modern- day living. And yet it would be difficult to maintain that our current values have promoted harmony and balance, either environmentally or on an individual or so- cial level. To allow yourself to wander without purpose can be frightening because it challenges some of our most basic assumptions about life, about who we are as humans, and about our roles in the world. From a Taoist point of view, it is our cherished beliefs—that we exist as separate beings, that we can exercise willful control over all situations, and that our role is to conquer our environment—that lead to a state of disharmony and imbalance. If we can learn to follow the Tao, practicing nonaction, then nothing remains undone. In cultivating wu-wei, timing becomes an important aspect of our behavior. We learn to perceive processes in their earliest stage and thus are able to take timely action. And finally, in the words of Chuang Tzu, we learn detachment, forgetfulness of results, and abandonment of all hope of profit. We know intu- itively that actions that are not ego-motivated, but are in response to the needs of the environment, lead harmonious balance and give ultimate meaning and pur- pose to our lives. To allow wu-wei to manifest in our lives may seem like a difficult task. And yet, if we reflect on our past experiences, we will recall possibly many instances when our actions were spontaneous and natural, when they arose out of the needs of the moment without thought of profit or tangible result. By listening carefully within, as well as to our surroundings, by remembering that we are part of an interconnected whole, by remaining still until action is called forth, we can perform valuable, necessary, and long-lasting service in the world while cultivating our ability to be at one with the Tao. Such is the power of wu-wei, allowing ourselves to be guided by the Tao. From a Taoist viewpoint, this term refers to one whose actions are in complete harmony with his surroundings—both the immedi- ate environment and the universe as a whole. Through the example of the sage, Taoism offers us a model of a way of being that is in accordance with the natural laws that govern life. In the English language, the word sage describes a wise person, one of sound judgment. The sage expresses his wisdom by directly manifesting these principles in daily living. Because he truly experiences the unity of all life, the sage perceives and understands all opposites as part of the same system. As the sage does not oppose these opposites, they can bring harmony and balance to all situations. These actions are natural, effortless, and spontaneous and are imbued with the power of the Tao. Taoist thought maintains that cultivating sage-like attributes is part of the pro- cess of human transformation. While we may think that to become sage-like hap- pens only at the final stage of this transformation, we also can recognize and foster those attributes already within us. The early Taoist writers, Lao Tzu and Chuang Tzu, themselves legendary sages, offer us numerous examples of behavior based on sage-like virtues. Whoever dares not to be first in the world can become leader of the world. It is through our caring that we connect with others and with all of life. By practicing frugality, we maintain a balanced existence with our environment and develop simplicity in action and thought. And by learning to follow, we determine the needs of the environment and provide the necessary service.

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