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Since ethyl alcohol in large Post Date: Sat, 11 Oct 2008 16:35:26 +0000 There is no universal agreement as to the relative importance of exogenous purines and xanthines, as opposed to those synthesized in the body, as sources of uric acid in gout. However, it is generally agreed that, after a patient has become stabilized on uri-cosuric therapy, a more liberal diet can be allowed, and only foods of high purine content need be avoided. Since ethyl alcohol in large amounts ele-vates plasma uric acid concentration, alcoholic bev-erages must be used in moderation. Autor of the post: Undefined Uricosuric agents, as well Post Date: Sat, 11 Oct 2008 16:19:52 +0000 (For detailed evaluations of uricosuric agents, see Gutman, 1966; Yu and Gutman, 1967; Yii, 1974.)Other Hyperuricemic States. Uricosuric agents, as well as allopurinol, can be useful in those patients who show elevated plasma uric acid concentrations during the administration of chlorothiazide or other diuretics (Beyer and Baer, 1961; Smilo et al, 1962). Autor of the post: Undefined The hyperuricemia may remain asymptomatic Post Date: Sat, 11 Oct 2008 16:08:29 +0000 They are also useful for the control of the hyper-uricemia resulting from the use of the cytotoxic antineoplastic agents or from diseases that involve accelerated formation and destruction of blood cells. The use of other drugs, such as levodopa and eth-ambutol, as well as certain disease states, including toxemia of pregnancy, diabetic ketosis, and uremia, may be accompanied by moderate-to-marked eleva-tion of plasma uric acid. The hyperuricemia may remain asymptomatic, but attacks of gout or renal precipitation of urate may occur. Autor of the post: Undefined These are oxy-tocin, certain Post Date: Sat, 11 Oct 2008 15:52:09 +0000 Many drugs possess oxytocic activity, namely, the ability to stimulate the smooth muscle of the uterus. However, only a few have uterine effects sufficiently selective and predictable to justify their use as oxytocic agents in obstetrical practice. These are oxy-tocin, certain of the prostaglandins, and the ergot alkaloids ergonovine and methylergono-vine. Autor of the post: Undefined The prostaglandins are the latest group Post Date: Sat, 11 Oct 2008 15:33:09 +0000 Each, in appropriate doses during preg-nancy, is capable of eliciting graded increases in uterine motility from a moderate increase in the rate and force of spontaneous motor activity to sustained "tetanic" contraction, while causing minimal side effects in healthy subjects. Although these agents have other physiological and pharmacological effects that will be described in some detail, the dangers as well as the value of their use in obstetrics reside largely in this single common action.The prostaglandins are the latest group of oxytocic agents to be studied. Autor of the post: Undefined Physiological and Post Date: Sat, 11 Oct 2008 15:13:16 +0000 Discussion in this chapter will be limited to the effects of prostaglandins of the E and F types on the uterus and their potential for use as aborti-facients and as oxytocic agents at term. The general discussion of the prostaglandins ap-pears in Chapter 30.Physiological and Anatomical Considerations. Autor of the post: Undefined Cell-to-cell spread of excitation occurs Post Date: Sat, 11 Oct 2008 14:55:42 +0000 Uterine smooth muscle is characterized by a high degree of spontaneous electrical and contractile ac-tivity. Waves of decreased membrane potential with superimposed spike activity are associated with con-traction. Cell-to-cell spread of excitation occurs. Autor of the post: Undefined As in most excitable tissues Post Date: Sat, 11 Oct 2008 14:42:18 +0000 In-creased frequency and duration of spike activity in "pacemaker" areas and more extensive spread of excitation are associated with increases in force of contraction. Widespread depolarization of the myo-metrium, for example, by high concentrations of potassium ion in vitro, results in sustained contrac-ture. As in most excitable tissues, movement of so-dium ions appears to play the primary role in de-polarization, whereas calcium ions are required for excitation-contraction coupling. Autor of the post: Undefined Both can elicit increased activity Post Date: Sat, 11 Oct 2008 14:26:38 +0000 The availability of calcium ion strongly influences the response of uter-ine smooth muscle to physiological and pharmaco-logical stimulation and inhibition.The uterus has parasympathetic and sympathetic innervation, the former by way of the pelvic nerve and the latter by way of postganglionic fibers from the inferior mesenteric and hypogastric ganglia. Both can elicit increased activity in the mature human uterus, but denervation causes little change in uter-ine motor activity. Autor of the post: Undefined Al-though quite capable of affecting Post Date: Sat, 11 Oct 2008 14:07:06 +0000 Both alpha-(excitatory) andbeta-(inhibitory, hyperpolarizing)-adrenergic recep-tors are clearly demonstrable in the myometrium of mammals. Stimulation of sympathetic nerves sup-plying the uterus also causes vasoconstriction. Al-though quite capable of affecting the motility of the uterus, autonomic agonist drugs are not useful for this purpose in clinical practice, largely because they lack the desired selectivity. 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