Loperamide - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

LOPERAMIDE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Loperamide: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00672-3 1. Loperamide-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on loperamide. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON LOPERAMIDE ............................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Loperamide .................................................................................. 10 E-Journals: PubMed Central ....................................................................................................... 11 The National Library of Medicine: PubMed ................................................................................ 11 CHAPTER 2. NUTRITION AND LOPERAMIDE ................................................................................... 41 Overview...................................................................................................................................... 41 Finding Nutrition Studies on Loperamide................................................................................... 41 Federal Resources on Nutrition ................................................................................................... 43 Additional Web Resources ........................................................................................................... 44 CHAPTER 3. ALTERNATIVE MEDICINE AND LOPERAMIDE............................................................. 45 Overview...................................................................................................................................... 45 National Center for Complementary and Alternative Medicine.................................................. 45 Additional Web Resources ........................................................................................................... 51 General References ....................................................................................................................... 53 CHAPTER 4. PATENTS ON LOPERAMIDE ......................................................................................... 55 Overview...................................................................................................................................... 55 Patents on Loperamide................................................................................................................. 55 Patent Applications on Loperamide ............................................................................................. 59 Keeping Current .......................................................................................................................... 60 CHAPTER 5. BOOKS ON LOPERAMIDE ............................................................................................. 61 Overview...................................................................................................................................... 61 Book Summaries: Federal Agencies.............................................................................................. 61 Chapters on Loperamide............................................................................................................... 62 CHAPTER 6. PERIODICALS AND NEWS ON LOPERAMIDE ............................................................... 63 Overview...................................................................................................................................... 63 News Services and Press Releases................................................................................................ 63 Newsletters on Loperamide .......................................................................................................... 64 Academic Periodicals covering Loperamide ................................................................................. 65 CHAPTER 7. RESEARCHING MEDICATIONS .................................................................................... 67 Overview...................................................................................................................................... 67 U.S. Pharmacopeia....................................................................................................................... 67 Commercial Databases ................................................................................................................. 68 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 71 Overview...................................................................................................................................... 71 NIH Guidelines............................................................................................................................ 71 NIH Databases............................................................................................................................. 73 Other Commercial Databases....................................................................................................... 75 APPENDIX B. PATIENT RESOURCES ................................................................................................. 77 Overview...................................................................................................................................... 77 Patient Guideline Sources............................................................................................................ 77 Finding Associations.................................................................................................................... 80 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 83 Overview...................................................................................................................................... 83 Preparation................................................................................................................................... 83 Finding a Local Medical Library.................................................................................................. 83 Medical Libraries in the U.S. and Canada ................................................................................... 83

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ONLINE GLOSSARIES.................................................................................................................. 89 Online Dictionary Directories ..................................................................................................... 89 LOPERAMIDE DICTIONARY...................................................................................................... 91 INDEX .............................................................................................................................................. 133

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with loperamide is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about loperamide, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to loperamide, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on loperamide. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to loperamide, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on loperamide. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON LOPERAMIDE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on loperamide.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and loperamide, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “loperamide” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Guidelines for Adults on Self-Medication for the Treatment of Acute Diarrhoea Source: Alimentary Pharmacology and Therapeutics. 15(6): 773-782. June 2001. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. Email: [email protected]. Website: www.blackwell-science.com. Summary: Acute uncomplicated diarrhea is commonly treated by self medication. Guidelines for treatment exist, but are inconsistent, sometimes contradictory, and often owe more to dogma than to evidence. This article reports on a review of the literature to determine best practice and guidelines for adults on self medication for the treatment of acute diarrhea. In general, it is recognized that treatment of acute episodes relieves discomfort and social dysfunction. There is no evidence that it prolongs the illness. Self

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medication in otherwise healthy adults is safe. Oral loperamide is the treatment of choice. Older antidiarrheal drugs are also effective in the relief of symptoms, but carry the risk of unwanted adverse effects. Oral rehydration solutions do not relieve diarrhea and confer no added benefit for adults who can maintain their fluid intake. Probiotic agents are, at present, limited in efficacy and availability. Antimicrobial drugs, available without prescription in some countries, are not generally appropriate for self medication, except for travelers on the basis of medical advice prior to departure. Medical intervention is recommended for the management of acute diarrhea in the frail, the elderly (older than 75 years), persons with concurrent chronic disease, and children. Medical intervention is also required when there is no abatement of the symptoms after 48 hours, or when there is evidence of deterioration, such as dehydration, abdominal distention, or the onset of dysentery (fever and or bloody stools). 1 table. 79 references. •

Guide to the Treatment of GI Motility Disorders Source: Drug Therapy. 21(12): 15-16, 21, 25-26, 28. December 1991. Summary: Disorders of gastrointestinal (GI) motility result from disturbances of extrinsic neural control, enteric nervous system, or smooth muscle; rarely, changes in the hormonal system results in alterations in GI transit. This article presents a guide to the treatment of GI motility disorders, focusing on the restoration of propulsion in the affected segments to normal. The author covers 5 groups of prokinetic agents: cholinergic agonists and anticholinesterases, substituted benzamides, dopamine antagonists, 5-HT3 antagonists, and motilinomemetic agents. The author briefly considers pharmacotherapy that retards GI transit. Drugs discussed in the article include bethanechol, cisapride, codeine, domperidone, erythromycin, loperamide, metoclopramide, neostigmine, octreotide, ondansetron, and pyridostigmine. 1 figure. 2 tables. 35 references.

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Infectious Diarrhea in HIV: Coping With the Many Causes Source: IM. Internal Medicine. 18(2): 54-58, 60, 63. February 1997. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Summary: Increased susceptibility to a number of bacterial, parasitic, viral, and fungal agents makes recurrent diarrhea a common complication of HIV. In many instances, diarrhea becomes a chronic condition, and patients experience multiple relapses. This article outlines suggestions for coping with the many causes of infectious diarrhea in patients with HIV. The authors stress that a high index of suspicion for opportunistic infections, coupled with a thorough history, attention to degree of immunodeficiency, and appropriate laboratory studies can help pinpoint the etiology. They note that, since many of the treatments of recurrent diarrhea in patients with HIV are not curative, supportive therapies may be necessary. Antimotility agents such as diphenoxylate hydrocholorid and loperamide can play a role in decreasing the number of stools and total volume losses once invasive organisms are ruled out. These patients have large volume stool outputs and should be encouraged to maintain adequate oral hydration with electrolyte-and dextrose-containing fluids. Close monitoring of serum electrolytes is often necessary. 33 references. (AA-M).

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Management of the Irritable Bowel Syndrome Source: Gastroenterology. 120(3): 652-668. February 2001.

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Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Website: www.gastrojournal.org. Summary: Irritable bowel syndrome (IBS) is the most common disorder diagnosed by gastroenterologists and one of the more common ones encountered in general practice. This article reviews the management of IBS, focusing on the definitions, epidemiology, and pathophysiology as a means of understanding strategies for optimal management; the natural history and 'safety' of the disorder that justifies a conservation and reassuring approach to patients; and consideration of conventional and newer treatments of IBS. The overall prevalence rate is similar (approximately 10 percent) in most industrialized countries; the illness has a large economic impact on health care use and indirect costs, chiefly through absenteeism. IBS is a biopsychosocial disorder in which 3 major mechanisms interact: psychosocial factors, altered motility, and heightened sensory function of the intestine. Subtle inflammatory changes suggest a role for inflammation, especially after infectious enteritis, but this has not yet resulted in changes in the approach to patient treatment. Treatment of patients is based on positive diagnosis of the symptom complex, limited exclusion of underlying organic disease, and institution of a therapeutic trial. If patient symptoms are intractable, further investigations are needed to exclude specific motility (movement) or other disorders. Symptoms tend to fluctuate over time; treatment is often restricted to times when patients experience symptoms. Symptomatic treatment includes supplementing fiber to achieve a total intake of up to 30 grams in those with constipation, those taking loperamide or other opioids for diarrhea, and those taking low dose antidepressants or infrequently using antispasmodics for pain. Older conventional therapies do not address pain in IBS. Behavioral psychotherapy and hynotherapy are also being evaluated. Novel approaches include alosetron; a 5 HT3 antagonist, tegaserod, a partial 5 HT4 agonist, K opioid agonists, and neurokinin antagonists to address the remaining challenging symptoms of pain, constipation, and bloating. The author concludes that understanding the brain gut connection is the key to the eventual development of effective therapies for IBS. 7 figures. 7 tables. 176 references. •

Irritable Bowel Syndrome: Streamlining the Diagnosis Source: Postgraduate Medicine. 102(3): 197-198, 201-204, 207-208. September 1997. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Summary: Irritable bowel syndrome (IBS), a common gastrointestinal disorder, is the condition for which patients are most often referred to gastroenterologists. Symptoms may be distressing enough to cause avoidance of work and social activities. Stress often exacerbates symptoms, and sensory abnormalities are common in patients with the disease. In this article, the authors describe how careful history taking and physical examination can avoid the overuse of diagnostic testing and point to the most effective treatment. Differential diagnosis for IBS includes consideration of many common gastrointestinal illnesses, including parasitic infections, salmonellosis, celiac sprue (gluten intolerance), chronic pancreatitis, Crohn's disease, ulcerative colitis, peptic ulcer disease, colon cancer, Campylobacter jejuni infection, and endometriosis. A strong physician-patient relationship at the time of IBS diagnosis improves the patient's ability to cope with the disease and reduces the number of subsequent office visits. The physician needs to involve the patient as a collaborative partner in the decision-making process and to avoid extensive invasive procedures if there is no firm indication for them. The patient's concerns and fears need to be addressed. Dietary changes, specifically elimination of troublesome foods, such as sorbitol, alcohol, caffeine, fats,

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legumes, sugar and, in lactose-intolerant patients, milk products, may benefit IBS patients. Relief of colonic spasm may be obtained with short-acting anticholinergics and other antispasmodic medications. Loperamide may also prove to be beneficial, especially in reducing post-meal diarrhea. Antidepressants are now being evaluated as potential therapeutic agents for IBS. One sidebar lists sources of information on IBS for physicians and patients, including organizations and Internet sites. 1 figure. 1 table. 21 references. (AA-M). •

Quick Relief from Traveler's Diarrhea Source: Emergency Medicine. 22(10): 89-90. May 30, 1990. Summary: This article describes a new method of combination therapy to provide quick relief from traveler's diarrhea. By eliminating both the pathogen and the symptoms the combination of a short course of antibiotic with an antimotility agent appears to offer speedy results. The article reviews a clinical study that used loperamide as the antimotility drug. The author concludes that the hope with this combination treatment is to avoid medication side effects and streamline the whole approach to therapy. (AAM).

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Travelers' Diarrhea Source: Practical Gastroenterology. 16(8): 38, 40-42, 45-46. September 1992. Summary: This article explains that travelers' diarrhea (TD) is a common illness that is primarily caused by bacteria, but also by viruses and parasites. The article emphasizes the prevention and treatment of TD. Topics include the epidemiology of TD; etiologic agents, particularly enterotoxigenic E. coli; geographic and seasonal differences; the pathogenesis of TD; the heat-labile toxin and cholera; invasive pathogens, including C. jejuni, salmonella, shigella, yersinia enterocolitica, and invasive E. coli; treatment; oral fluid replacement; trimethoprim-sulfamethoxazole; ciprofloxacin; loperamide; antibiotics; and the use of prophylactics for TD. 2 tables. 11 references.

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Man with Acute Abdominal Pain and Diarrhea Source: Consultant. 39(5): 1521-1522. May 1999. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: This article offers a brief case report, with a discussion of appropriate treatment. The case was a 57 year old man who began experiencing acute abdominal pain with mild diarrhea 2 weeks after his return from New Mexico. The pain originated in the hypogastrium and involved the lower quadrant and the perineum. The diarrhea was characterized as two loose stools on the first day and two watery stools on the second day. The patient did not note blood or pus in the stools. The patient's history was unremarkable except for mild exercise induced asthma. His physical condition was normal except for very mild end expiratory wheezing and some diffuse abdominal tenderness with guarding but no rebound in the left lower quadrant. No masses were felt on abdominal palpation, and there was no hepatosplenomegaly. Blood studies revealed a mild leukocytosis; stool was trace heme positive. The author asks readers to choose from a set of five management options for the first 12 hours of handling this patient. The author stresses that the differential diagnosis for a patient who presents with abdominal pain and mild diarrhea is broad. The acute nature of the pain and the lack of a toxic appearance in this case suggest either an infectious diarrheal disease or

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diverticulitis. A broad spectrum antibiotic (for instance, a fluoroquinolone such as trovafloxacin) with activity against the major gastrointestinal pathogens and the enteric flora found in diverticulitis is a good initial treatment for febrile patients with diarrhea of undetermined cause. The use of loperamide or narcotics as antimotility agents in patients with undiagnosed diarrhea and fever is a practice that should be discouraged. The authors stresses that physicians should consider surgery only if there is evidence of peritonitis or progression of disease with medical management. 4 references. •

Guidelines on Acute Infectious Diarrhea in Adults Source: American Journal of Gastroenterology. 92(11): 1962-1975. November 1997. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-6423 or (410) 528-8555. Summary: This article presents guidelines for the evaluation and management of the patient with acute diarrhea. The guidelines are divided into eight subheadings: importance of diarrhea, patient evaluation, noninfectious and extraintestinal causes, empiric therapy in selected patients, laboratory evaluation, management, the international traveler, and the immunocompromised patient. Most cases of diarrhea are managed by the affected patient or by a family member without need for medical attention. Medical evaluation should occur for a subset of patients with more severe illness. The clinical and epidemiologic history is central to patient medical evaluation and management. Noninfectious and extraintestinal processes may present as acute diarrhea. There are two types of patients who might be considered for empiric antimicrobial therapy without additional evaluation: patients in whom bacterial diarrhea is suggested by clinical features or patients in whom diarrhea has persisted for 2 weeks or longer and Giardia is suspected. The fecal leukocyte, lactoferrin, or hemoccult blood test is a useful screening test in patients with moderate to severe acute infectious diarrhea because they support the use of empiric therapy in the febrile patient and when negative may eliminate the need for stool culture in some cases of diarrhea. In all patients with diarrhea requiring medical evaluation, fluid and electrolyte therapy and alteration of the diet should be part of the management. When nonspecific therapy is desired, loperamide is the drug of choice for most cases of diarrhea. Bismuth subsalicylate is the preferred agent when vomiting is the important clinical manifestation of enteric infection. Specific antimicrobial therapy is given when a treatable pathogen is identified in stool samples. Immunocompromised patients with diarrhea should receive a limited evaluation followed by full evaluation if they fail to respond to specific or symptomatic treatment. 2 figures. 7 tables. 104 references.

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Pharmacologic Treatment of the Irritable Bowel Syndrome: A Systematic Review of Randomized, Controlled Trials Source: Annals of Internal Medicine. 133(2): 136-147. July 18, 2000. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: This article reports on a study undertaken to evaluate the efficacy of pharmacologic agents (drugs) for irritable bowel syndrome (IBS). The study featured an electronic literature search (1966 to 1999) and a manual search of references from bibliographies of identified articles. Studies chosen for inclusion were randomized, double blind, placebo controlled, parallel or crossover trials of a pharmacologic intervention for adult patients; the studies had to report outcomes of improvement in

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global or IBS specific symptoms. Seventy studies met the inclusion criteria. The most common medication classes were smooth muscle relaxants (16 trials), bulking agents (13 trials), prokinetic agents (6 trials), psychotropic agents (7 trials), and loperamide (4 trials). The strongest evidence for efficacy was shown for smooth muscle relaxants in patients with abdominal pain as the predominant symptom. Loperamide seems to reduce diarrhea but does not relieve abdominal pain. Although psychotropic agents were shown to produce global improvement, the evidence is based on a small number of studies of suboptimal quality. Other treatment options, including psychotropic drugs, 5 hydroxytryptamine (5 HT) receptor antagonists, peppermint oil, and Chinese herbal medicine, require further study. 3 tables. 109 references. •

Review Article: Irritable Bowel Syndrome Source: Alimentary Pharmacology and Therapeutics. 11(1): 3-15. February 1997. Contact: Available from Mercury Airfreight International, Ltd. 2323 EF, Randolph Avenue, Avenel, NJ 07001. E-mail: [email protected]. Summary: This article reviews current knowledge on irritable bowel syndrome (IBS), the most common disease diagnosed by gastroenterologists and one that affects about 20 percent of all people at any one time. IBS can be diagnosed positively on the basis of an established series of criteria and limited exclusion of organic disease. Symptoms fluctuate, and the overall prevalence rate is relatively constant in Western communities. Ten percent of patients present to their physicians. The illness has a large economic impact on health care utilization and absenteeism. IBS is a biopsychosocial disorder in which three major mechanisms interact: psychosocial factors, altered motility, and or sensory function of the intestine. Management of patients is based on positive diagnosis of the symptom complex, limited exclusion of underlying organic disease, and institution of a therapeutic trial. If patient symptoms are intractable, further investigations are needed to exclude significant motility or other disorders. Symptomatic treatment includes fiber for constipation, loperamide for diarrhea, and low-dose antidepressants or infrequent use of antispasmodics for pain. The authors note that new pharmacological agents, psychotherapy, and hypnotherapy are being evaluated for their use in treating IBS. 5 figures. 6 tables. 109 references. (AA-M).

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Acute Infectious Diarrhea in Adults Source: Patient Care. 33(15): 58-60, 63, 67, 70, 73-74, 76-77. September 30, 1999. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This article reviews the diagnosis and treatment of acute infectious diarrhea in adults, focusing on determining when to provide supportive therapy versus a more detailed workup and targeted antibiotic therapy. Diarrhea can be defined as the passage of three or more unformed stools during a 24 hour period; the condition is acute if it persists for less than 14 days. The infectious agents that cause acute diarrhea are usually acquired by fecal oral transmission. Food may be contaminated by an infectious agent as a result of poor personal hygiene, a deficient sewage system, or by the use of inadequately purified water. The organisms most commonly isolated from patients with infectious diarrhea are Campylobacter jejuni, Salmonella species, diarrheagenic Escherichia coli, and Shigella species. Less frequent causes of diarrhea include Staphylococci, Bacillus cereus, Clostridium perfringens, Clostridium difficile, Vibrio species, and Yersinia species. The author discusses the special situation of diarrhea in patients with AIDS and briefly reviews the pathophysiology of diarrhea. For most

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patients with mild to moderate diarrhea, a diagnostic workup may not be necessary, and empiric, supportive treatment is usually sufficient. The author reviews the tests that may be used for more severe diarrhea, including fecal leukocyte testing, flexible sigmoidoscopy, stool culture, blood culture, ova and parasite examinations, and the C difficile toxin test. Fluid and electrolyte replacement usually are sufficient for mild diarrhea. Moderate diarrhea in adults or older children may be treated with bismuth subsalicylate, loperamide, or attapulgite. Antibiotic therapy may be appropriate for patients with febrile dysentery (fever is present), severe diarrhea with many fecal leukocytes (white blood cells in the feces), or with moderate to severe travelers' diarrhea. Specific antibiotic therapy is given when a treatable enteric pathogen is identified by stool or blood cultures. The article concludes with a section describing prophylaxis for travelers' diarrhea. 1 figure. 4 tables. 5 references. •

Travel Risks: Update on Traveler's Diarrhea and Other Common Problems Source: Consultant. 42(14): 1778-1784. December 2002. Contact: Available from Cliggott Publishing Company. 330 Boston Post Road, Darien, CT 06820-4027. (203) 661-0600. Summary: This article updates physicians on traveler's diarrhea and other common travel-related problems. The author notes that patients can greatly reduce the risk of traveler's diarrhea by drinking only bottled water and eating only hot foods prepared in sanitary conditions or peelable fruits and vegetables. Antibiotic prophylaxis for traveler's diarrhea is no longer routinely recommended; this approach should be reserved for patients who may have to consume food and beverages of questionable safety, those with reduced immunity, and those likely to experience serious consequences of illness. Adequate hydration is the first step in treating traveler's diarrhea. Drug therapy (loperamide or fluoroquinolones in adults and bismuth subsalicylate or azithromycin in children) can ameliorate symptoms and speed recovery. The article also discusses motion sickness, altitude sickness, travel medicine kits, and contraindications to air travel. 5 tables. 18 references.

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Monitoring IBD Medications: Part II Source: Foundation Focus. p. 8. July 1993. Contact: Available from Crohns and Colitis Foundation of America. 386 Park Avenue South, 17th Floor, New York, NY 10016-8804. (800) 343-3637 or (212) 685-3440. Summary: This brief article is the second of a two-part summary of the tests that monitor side effects of inflammatory bowel disease (IBD) medications. The author describes immunomodulators (six-mercaptopurine and azathioprine); cyclosporine; methotrexate; metronidazole (Flagyl); and antidiarrheal medications (loperamide and diphenoxylate/atropine).

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New Vaccine Holds Off Montezuma Source: American Health. 9(6): 12. July-August 1990. Summary: This brief article reports that a new vaccine against cholera seems to protect against traveler's diarrhea also. To see if the vaccine really works, Johns Hopkins investigators are asking for help from people travelling to Latin America and other developing countries. Those volunteers who are accepted into the program will be randomly assigned to receive either the traveler's diarrhea-cholera vaccine (with a protective B subunit) or its cholera-only twin (no subunit). The article notes that chances

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of getting hit by traveler's diarrhea, which is spread by food and water contaminated with Escherichia coli, are about 50 percent for a three-week trip to Mexico, Latin America or East Africa. The author concludes with another tip for dealing with traveler's diarrhea: a multi-drug counterattack with Bactrim or Septra (sulfamethoxazole/trimethoprim) and Imodium (loperamide) can wipe out diarrhea symptoms in an hour. •

Review Article: Clinical Evidence to Support Current Therapies of Irritable Bowel Syndrome Source: Alimentary Pharmacology and Therapeutics. 13(Supplement 2): 48-53. May 1999. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. Email: [email protected]. Website: www.blackwell-science.com. Summary: This review article summarizes the clinical evidence to support current therapies in irritable bowel syndrome (IBS). In patients with constipation predominant IBS, fiber is indicated at a dose of at least 12 grams per day. Loperamide (and probably other opioid agonists) are of proven benefit in diarrhea predominant IBS; loperamide may also aid continence by enhancing resting anal tone. In general, smooth muscle relaxants are best used sparingly, on an as needed basis, since their overall efficacy is unclear. Psychotropic agents are important in relieving depression and are of proven benefit for pain and diarrhea in patients with depression associated with IBS. Further trials with selective serotonic reuptake inhibitors (SRRIs) are underway. Psychological treatments, including hypnotherapy are less widely available but may play an important role in pain relief. The author concludes that current therapies targeted on the predominant symptoms in IBS are moderately successful. However, therapies are needed to more effectively relieve this syndrome, not just symptoms. 1 figure. 3 tables. 60 references.

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Traveler's Diarrhea Source: Current Opinion in Gastroenterology. 8(1): 110-114. February 1992. Summary: Traveler's diarrhea is an acute, self-limited illness, mostly of infectious causes, which occurs in approximately 20 to 50 percent of international travelers with a variable worldwide incidence. The authors first focus on its etiology, including infection with escherichia coli, salmonella, shigella, entamoeba histolytica, cyanobacteria-like bodies, or Norwalk virus. They then turn to considerations of therapy, primarily fluid replacement, the use of loperamide, and antimicrobial agents. A final section briefly considers the role of prophylaxis in preventing traveler's diarrhea. 18 references.

Federally Funded Research on Loperamide The U.S. Government supports a variety of research studies relating to loperamide. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to loperamide. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore loperamide.

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “loperamide” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for loperamide in the PubMed Central database: •

Optimal dosing of trimethoprim-sulfamethoxazole when used with loperamide to treat traveler's diarrhea. by Ericsson CD, Nicholls-Vasquez I, DuPont HL, Mathewson JJ.; 1992 Dec; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245552

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals.

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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To generate your own bibliography of studies dealing with loperamide, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “loperamide” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for loperamide (hyperlinks lead to article summaries): •

A comparative double-blind study of two antidiarrhoeals, difenoxine and loperamide. Author(s): de Coster M, Kerremans R, Beckers J. Source: Tijdschr Gastroenterol. 1972; 15(5): 337-42. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4569431

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A comparative study of loperamide and diphenoxylate in the treatment of chronic diarrhoea caused by intestinal resection. Author(s): Bergman L, Djarv L. Source: Ann Clin Res. 1981 December; 13(6): 402-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6753707

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A comparative trial of cholestyramine and loperamide for acute diarrhoea in infants treated as outpatients. Author(s): Vesikari T, Isolauri E. Source: Acta Paediatr Scand. 1985 September; 74(5): 650-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3901661

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A double blind crossover comparison of loperamide with diphenoxylate in the symptomatic treatment of chronic diarrhea. Author(s): Pelemans W, Vantrappen F. Source: Gastroenterology. 1976 June; 70(6): 1030-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=773736

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A double-blind crossover comparison of lidamidine, loperamide and placebo for the control of chronic diarrhoea. Author(s): Allison MC, Sercombe J, Pounder RE. Source: Alimentary Pharmacology & Therapeutics. 1988 August; 2(4): 347-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2979258

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A double-blind crossover study of the effect of loperamide hydrochloride and codeine phosphate on ileostomy output. Author(s): King RF, Norton T, Hill GL. Source: The Australian and New Zealand Journal of Surgery. 1982 April; 52(2): 121-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7044361

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A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Author(s): Efskind PS, Bernklev T, Vatn MH. Source: Scandinavian Journal of Gastroenterology. 1996 May; 31(5): 463-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8734343

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A double-blind trial of loperamide in the treatment of chronic diarrhoea. Author(s): Barbezat GO, Clain JE, Halter F. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1979 March 24; 55(13): 502-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=377521

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A multicenter double-blind controlled trial comparing lidamidine HCl and loperamide in the symptomatic treatment of acute diarrhoea. Author(s): Gasbarrini G, Corazza GR, Feliciani M, Albano O, Stufano N, Altomare E, Fontana G, Valpiani D, Chiodo F, Banterle C, et al. Source: Arzneimittel-Forschung. 1986 December; 36(12): 1843-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3551969

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A multicenter randomized controlled trial of a liquid loperamide product versus placebo in the treatment of acute diarrhea in children. Author(s): Kaplan MA, Prior MJ, McKonly KI, DuPont HL, Temple AR, Nelson EB. Source: Clinical Pediatrics. 1999 October; 38(10): 579-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10544864

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A multicentre double-blind study in acute diarrhoea comparing loperamide (R 18553) with two common antidiarrhoeal agents and a placebo. Author(s): Amery W, Duyck F, Polak J, van den Bouwhuysen G. Source: Curr Ther Res Clin Exp. 1975 March; 17(3): 263-70. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=123844

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A multinational comparison of racecadotril and loperamide in the treatment of acute watery diarrhoea in adults. Author(s): Prado D; Global Adult Racecadotril Study Group. Source: Scandinavian Journal of Gastroenterology. 2002 June; 37(6): 656-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12126242

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A randomized, open-label comparison of nonprescription loperamide and attapulgite in the symptomatic treatment of acute diarrhea. Author(s): DuPont HL, Ericsson CD, DuPont MW, Cruz Luna A, Mathewson JJ. Source: The American Journal of Medicine. 1990 June 20; 88(6A): 20S-23S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2192554

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A scintigraphic study to investigate the potential for altered gut distribution of loperamide from a loperamide-simethicone formulation in man. Author(s): Connor AL, Wray H, Cottrell J, Wilding IR. Source: European Journal of Pharmaceutical Sciences : Official Journal of the European Federation for Pharmaceutical Sciences. 2001 July; 13(4): 369-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11408151

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A suspected case of loperamide toxicity. Author(s): Ramirez MS, Bastidas O, Bermudez EL. Source: Vet Hum Toxicol. 1983 October; 25(5): 341. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6636507

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Abuse potential of loperamide. Author(s): Jaffe JH, Kanzler M, Green J. Source: Clinical Pharmacology and Therapeutics. 1980 December; 28(6): 812-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7438696

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Abuse potential of loperamide: adaptation of established evaluative methods to volunteer subjects. Author(s): Jaffe JH, Kanzler M, Green J. Source: Nida Res Monogr. 1981 February; 34: 232-40. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6783938

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Antipruritic and antihyperalgesic actions of loperamide and analogs. Author(s): DeHaven-Hudkins DL, Cowan A, Cortes Burgos L, Daubert JD, Cassel JA, DeHaven RN, Kehner GB, Kumar V. Source: Life Sciences. 2002 October 25; 71(23): 2787-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12383884

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Antisecretory effect of loperamide in colon epithelial cells by inhibition of basolateral K+ conductance. Author(s): Epple HJ, Fromm M, Riecken EO, Schulzke JD. Source: Scandinavian Journal of Gastroenterology. 2001 July; 36(7): 731-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11444472

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Appendicitis associated with loperamide hydrochloride abuse. Author(s): Katz JP, Sturmann KM. Source: The Annals of Pharmacotherapy. 1993 March; 27(3): 369-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8453179

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Benefit/risk considerations with respect to OTC-descheduling of loperamide. Author(s): Fletcher P, Steffen R, DuPont H. Source: Arzneimittel-Forschung. 1995 May; 45(5): 608-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7612062

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Bioequivalence evaluation of two different oral formulations of loperamide (Diarex Lactab vs Imodium capsules). Author(s): Doser K, Meyer B, Nitsche V, Binkert-Graber P. Source: Int J Clin Pharmacol Ther. 1995 August; 33(8): 431-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8556221

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Calmodulin-mediated effects of loperamide on chloride transport by brush border membrane vesicles from human ileum. Author(s): Stoll R, Ruppin H, Domschke W. Source: Gastroenterology. 1988 July; 95(1): 69-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2836258

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Characterization of the antidiarrhoeal loperamide by gas chromatography-mass spectrometry and application of the Hofmann degradation and Cope elimination reaction. Author(s): Leis HJ, Gleispach H. Source: Journal of Chromatography. 1989 September 29; 494: 324-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2584329

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Ciprofloxacin and loperamide in the treatment of bacillary dysentery. Author(s): Murphy GS, Bodhidatta L, Echeverria P, Tansuphaswadikul S, Hoge CW, Imlarp S, Tamura K. Source: Annals of Internal Medicine. 1993 April 15; 118(8): 582-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8452323

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Comparative efficacy of loperamide hydrochloride and bismuth subsalicylate in the management of acute diarrhea. Author(s): DuPont HL, Flores Sanchez J, Ericsson CD, Mendiola Gomez J, DuPont MW, Cruz Luna A, Mathewson JJ. Source: The American Journal of Medicine. 1990 June 20; 88(6A): 15S-19S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2192553

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Comparison between the suppressive effects of dexamethasone and loperamide on cortisol and ACTH secretion in some pathological conditions. Author(s): Bernini GP, Argenio GF, Cerri F, Franchi F. Source: J Endocrinol Invest. 1994 November; 17(10): 799-804. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7699214

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Comparison of loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea. Author(s): Johnson PC, Ericsson CD, DuPont HL, Morgan DR, Bitsura JA, Wood LV. Source: Jama : the Journal of the American Medical Association. 1986 February 14; 255(6): 757-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3944976

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Comparison of racecadotril and loperamide in adults with acute diarrhoea. Author(s): Vetel JM, Berard H, Fretault N, Lecomte JM. Source: Alimentary Pharmacology & Therapeutics. 1999 December; 13 Suppl 6: 21-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10646048

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Comparison of racecadotril and loperamide in children with acute diarrhoea. Author(s): Turck D, Berard H, Fretault N, Lecomte JM. Source: Alimentary Pharmacology & Therapeutics. 1999 December; 13 Suppl 6: 27-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10646049

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Confusion over loperamide. Author(s): Sandhu B, Tripp JH, Candy DC, Harries JT. Source: Lancet. 1980 March 1; 1(8166): 483. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6102205

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Dependence liability of two antidiarrheals, nufenoxole and loperamide. Author(s): Korey A, Zilm DH, Sellers EM. Source: Clinical Pharmacology and Therapeutics. 1980 May; 27(5): 659-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7371363

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Dependence potential of loperamide studied in rhesus monkeys. Author(s): Yanagita T, Miyasato K, Sato J. Source: Nida Res Monogr. 1979; 27: 106-13. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=121326

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Diarrhoea following jejuno-ileostomy for morbid obesity. A randomised trial of loperamide and diphenoxylate. Author(s): Wille-Jorgensen P, Gudmand-Hoyer E, Skovbjerg H, Andersen B. Source: Acta Chir Scand. 1982; 148(2): 157-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6755999

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Dose proportionality study of loperamide following oral administration of loperamide oxide. Author(s): Kamali F, Adriaens L, Huang ML, Woestenborghs R, Emanuel M, Rawlins MD. Source: European Journal of Clinical Pharmacology. 1992; 42(6): 693-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1623916

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Double blind trial of loperamide for treating acute watery diarrhoea in expatriates in Bangladesh. Author(s): van Loon FP, Bennish ML, Speelman P, Butler C. Source: Gut. 1989 April; 30(4): 492-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2653972

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Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea. Author(s): Palmer KR, Corbett CL, Holdsworth CD. Source: Gastroenterology. 1980 December; 79(6): 1272-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7002706

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Double-blind placebo-controlled study of loperamide (Imodium) in chronic diarrhoea caused by ileocolic disease or resection. Author(s): Mainguet P, Fiasse R. Source: Gut. 1977 July; 18(7): 575-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=326642

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Early pregnancy termination with vaginal misoprostol combined with loperamide and acetaminophen prophylaxis. Author(s): Jain JK, Harwood B, Meckstroth KR, Mishell DR. Source: Contraception. 2001 April; 63(4): 217-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11376649

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Effect of codeine and loperamide on upper intestinal transit and absorption in normal subjects and patients with postvagotomy diarrhoea. Author(s): O'Brien JD, Thompson DG, McIntyre A, Burnham WR, Walker E. Source: Gut. 1988 March; 29(3): 312-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3356363

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Effect of finite doses of propylene glycol on enhancement of in vitro percutaneous permeation of loperamide hydrochloride. Author(s): Trottet L, Merly C, Mirza M, Hadgraft J, Davis AF. Source: International Journal of Pharmaceutics. 2004 April 15; 274(1-2): 213-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15072797

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Effect of increasing oral doses of loperamide on gallbladder motility in man. Author(s): Hopman WP, Rosenbusch G, Jansen JB, Lamers CB. Source: British Journal of Clinical Pharmacology. 1990 January; 29(1): 55-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2297461

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Effect of lidamidine hydrochloride and loperamide on gastric emptying and transit of the small intestine. A double-blind study. Author(s): Sninsky CA, Davis RH, Clench MH, Thomas KD, Mathias JR. Source: Gastroenterology. 1986 January; 90(1): 68-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3940258

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Effect of loperamide and delay of bowel motility on bile acid malabsorption caused by late radiation damage and ileal resection. Author(s): Valdes Olmos R, den Hartog Jager F, Hoefnagel C, Taal B. Source: European Journal of Nuclear Medicine. 1991; 18(5): 346-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1936043

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Effect of loperamide and naloxone on gastric acid secretion in healthy man. Author(s): Caldara R, Cambielli M, Masci E, Guslandi M, Barbieri C, Ferrari C. Source: Gut. 1981 September; 22(9): 720-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7297919

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Effect of loperamide and naloxone on mouth-to-caecum transit time evaluated by lactulose hydrogen breath test. Author(s): Basilisco G, Bozzani A, Camboni G, Recchia M, Quatrini M, Conte D, Penagini R, Bianchi PA. Source: Gut. 1985 July; 26(7): 700-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4018633

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Effect of loperamide on faecal control after rectoplasty for high imperforate anus. Author(s): Arnbjornsson E, Breland U, Kullendorff CM, Okmian L. Source: Acta Chir Scand. 1986 March; 152: 215-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3716742

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Effect of loperamide on fecal output and composition in well-established ileostomy and ileorectal anastomosis. Author(s): Tytgat GN, Huibregtse K, Dagevos J, van den Ende A. Source: Am J Dig Dis. 1977 August; 22(8): 669-76. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=327797

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Effect of loperamide on gastro-oesophageal reflux. Author(s): Allocca M, Mangano M, Colombo P, Penagini R. Source: Scandinavian Journal of Gastroenterology. 2003 April; 38(4): 343-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12739704

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Effect of loperamide on jejunal electrolyte and water transport, prostaglandin E2induced secretion and intestinal transit time in man. Author(s): Press AG, Ewe K, Schmidt J, Junge H. Source: European Journal of Clinical Pharmacology. 1991; 41(3): 239-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1748140

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Effect of loperamide on lower oesophageal sphincter pressure in idiopathic achalasia. Author(s): Penagini, Bartesaghi B, Negri G, Bianchi PA. Source: Scandinavian Journal of Gastroenterology. 1994 December; 29(12): 1057-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7886391

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Effect of loperamide on stool output and duration of acute infectious diarrhea in infants. Author(s): Motala C, Hill ID, Mann MD, Bowie MD. Source: The Journal of Pediatrics. 1990 September; 117(3): 467-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2391607

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Effect of loperamide, a peripheral opiate agonist, on circulating glucose, free fatty acids, insulin, C-peptide and pituitary hormones in healthy man. Author(s): Caldara R, Testori GP, Ferrari C, Romussi M, Rampini P, Borzio M, Barbieri C. Source: European Journal of Clinical Pharmacology. 1981; 21(3): 185-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6797827

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Effect of metoclopramide and loperamide on the pharmacokinetics of didanosine in HIV seropositive asymptomatic male and female patients. Author(s): Knupp CA, Milbrath RL, Barbhaiya RH. Source: European Journal of Clinical Pharmacology. 1993; 45(5): 409-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8112368

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Effect of metoclopramide, bethanechol, and loperamide on gastric residence time, gastric emptying, and mouth-to-cecum transit time. Author(s): Kirby MG, Dukes GE, Heizer WD, Bryson JC, Powell JR. Source: Pharmacotherapy. 1989; 9(4): 226-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2771808

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Effects of ABCB1 (multidrug resistance transporter) gene mutations on disposition and central nervous effects of loperamide in healthy volunteers. Author(s): Skarke C, Jarrar M, Schmidt H, Kauert G, Langer M, Geisslinger G, Lotsch J. Source: Pharmacogenetics. 2003 November; 13(11): 651-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14583678

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Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Author(s): Read M, Read NW, Barber DC, Duthie HL. Source: Digestive Diseases and Sciences. 1982 September; 27(9): 807-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7105952

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Effects of loperamide on ileoanal pouch function. Author(s): Herbst F, Kamm MA, Nicholls RJ. Source: The British Journal of Surgery. 1998 October; 85(10): 1428-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9782031

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Effects of loperamide on the human hypothalamo-pituitary-adrenal axis in vivo and in vitro. Author(s): Auernhammer CJ, Stalla GK, Lange M, Pfeiffer A, Muller OA. Source: The Journal of Clinical Endocrinology and Metabolism. 1992 August; 75(2): 5527. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1322429

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Effects of loperamide oxide on gastrointestinal transit time and anorectal function in patients with chronic diarrhoea and faecal incontinence. Author(s): Sun WM, Read NW, Verlinden M. Source: Scandinavian Journal of Gastroenterology. 1997 January; 32(1): 34-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9018764

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Effects of the opiate agonist loperamide on pituitary-adrenal function in patients with suspected hypercortisolism. Author(s): Ambrosi B, Bochicchio D, Ferrario R, Colombo P, Faglia G. Source: J Endocrinol Invest. 1989 January; 12(1): 31-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2545766

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Effects of the prodrug loperamide oxide, loperamide, and placebo on jejunal motor activity. Author(s): Stacher G, Steinringer H, Schneider C, Vacariu-Granser GV, Castiglione F, Gaupmann G, Weber U, Stacher-Janotta G. Source: Digestive Diseases and Sciences. 1992 February; 37(2): 198-204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1735336

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First-line treatment in acute non-dysenteric diarrhoea: clinical comparison of loperamide oxide, loperamide and placebo. UK Janssen Research Group of General Practitioners. Author(s): Hughes IW. Source: Br J Clin Pract. 1995 July-August; 49(4): 181-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7547157

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High dose loperamide suppositories: a novel approach for improving clinical function after restorative proctocolectomy. Author(s): Levitt MD, Jenner DC, Maher MJ. Source: The Australian and New Zealand Journal of Surgery. 1995 December; 65(12): 881-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8611112

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High-dose loperamide in the treatment of 5-fluorouracil-induced diarrhea in colorectal cancer patients. Author(s): Cascinu S, Bichisao E, Amadori D, Silingardi V, Giordani P, Sansoni E, Luppi G, Catalano V, Agostinelli R, Catalano G. Source: Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer. 2000 January; 8(1): 65-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10650901

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Human pharmacokinetics and comparative bioavailability of loperamide hydrochloride. Author(s): Killinger JM, Weintraub HS, Fuller BL. Source: Journal of Clinical Pharmacology. 1979 April; 19(4): 211-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=438356

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In man the mu-opiate agonist loperamide specifically inhibits ACTH secretion induced by the cholecystokinin-like peptide ceruletide. Author(s): Auernhammer CJ, Riepl RL, Schopohl J, Lehnert P, Muller OA, Stalla GK. Source: Neuroendocrinology. 1994 July; 60(1): 16-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8090278

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Increased systemic availability of loperamide after oral administration of loperamide and loperamide oxide with cotrimoxazole. Author(s): Kamali F, Huang ML. Source: British Journal of Clinical Pharmacology. 1996 February; 41(2): 125-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8838438

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Influence of cisapride, metoclopramide and loperamide on gastric emptying of normal volunteers as measured by means of the area under the curve of the cumulative fraction absorbed-time profiles of paracetamol. Author(s): van Wyk M, Sommers DK, Moncrieff J. Source: Methods Find Exp Clin Pharmacol. 1992 June; 14(5): 379-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1513194

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Influence of loperamide and loperamide oxide on the anal sphincter. A manometric study. Author(s): Goke M, Ewe K, Donner K, Meyer zum Buschenfelde KH. Source: Diseases of the Colon and Rectum. 1992 September; 35(9): 857-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1511646

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Influence of loperamide on lactose handling and oral-caecal transit time. Author(s): Szilagyi A, Salomon R, Seidman E. Source: Alimentary Pharmacology & Therapeutics. 1996 October; 10(5): 765-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8899085

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Influence of the preparation methods on the drug release behaviour of loperamideloaded nanoparticles. Author(s): Ueda M, Iwara A, Kreuter J. Source: Journal of Microencapsulation. 1998 May-June; 15(3): 361-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9608398

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Inhibition of brush-border membrane Na+-H+ exchanger by loperamide. Author(s): Balkovetz DF, Miyamoto Y, Tiruppathi C, Mahesh VB, Leibach FH, Ganapathy V. Source: The Journal of Pharmacology and Experimental Therapeutics. 1987 October; 243(1): 150-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2822894

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Inhibition of pancreaticobiliary secretion by loperamide in humans. Author(s): Thimister PW, Hopman WP, van Roermund RF, Willems HL, Rosenbusch G, Woestenborghs R, Jansen JB. Source: Hepatology (Baltimore, Md.). 1997 August; 26(2): 256-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9252131

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Inhibition of postprandial pancreatic and biliary secretion by loperamide in patients with short bowel syndrome. Author(s): Remington M, Fleming CR, Malagelada JR. Source: Gut. 1982 February; 23(2): 98-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7068042

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Interaction of morphine, fentanyl, sufentanil, alfentanil, and loperamide with the efflux drug transporter P-glycoprotein. Author(s): Wandel C, Kim R, Wood M, Wood A. Source: Anesthesiology. 2002 April; 96(4): 913-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11964599

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Investigations on drug produced and subjectively experienced discriminative stimuli. 2. Loperamide, an antidiarrheal devoid of narcotic cue producing actions. Author(s): Colpaert FC, Niemegeers CJ, Lal H, Janssen PA. Source: Life Sciences. 1975 March 1; 16(5): 717-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1168299

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Is loperamide contraindicated in the treatment of bacillary dysentery? Author(s): Oldfield EC 3rd. Source: The American Journal of Gastroenterology. 1995 February; 90(2): 327-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7847317

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Lethal gastroenteritis associated with clozapine and loperamide. Author(s): Eronen M, Putkonen H, Hallikainen T, Vartiainen H. Source: The American Journal of Psychiatry. 2003 December; 160(12): 2242-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14638602

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Letter: Loperamide and ileostomy output. Author(s): Tytgat GN. Source: British Medical Journal. 1975 August 23; 3(5981): 489. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1156841

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Letter: Loperamide in treatment of persistent diarrhoea in children. Author(s): Buts JP, Petit BF, de Meyer R. Source: British Medical Journal. 1975 September 27; 3(5986): 766-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1174894

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Local inhibition of myoelectrical activity of human colon by loperamide. Author(s): Altaparmakov I, Wienbeck M. Source: Digestive Diseases and Sciences. 1984 March; 29(3): 232-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6697863

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Long-term survey of the treatment of diarrhoea with loperamide. Author(s): Mainguet P, Fiasse R, Turine JB. Source: Digestion. 1977; 16(1-2): 69-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=355023

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Loperamide (ADL 2-1294), an opioid antihyperalgesic agent with peripheral selectivity. Author(s): DeHaven-Hudkins DL, Burgos LC, Cassel JA, Daubert JD, DeHaven RN, Mansson E, Nagasaka H, Yu G, Yaksh T. Source: The Journal of Pharmacology and Experimental Therapeutics. 1999 April; 289(1): 494-502. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10087042

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Loperamide (imodium)--clinical trial. Author(s): Dzieniszewski J, Ciok J, Jarosz M. Source: Ther Hung. 1990; 38(2): 60-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2198677

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Loperamide (R 18 553), a novel type of antidiarrheal agent. Part 5: the pharmacokinetics of loperamide in rats and man. Author(s): Heykants J, Michiels M, Knaeps A, Brugmans J. Source: Arzneimittel-Forschung. 1974 October; 24(10): 1649-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4479779

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Loperamide (R 18 553), a novel type of antidiarrheal agent. Part 6: Clinical pharmacology. Placebo-controlled comparison of the constipating activity and safety of loperamide, diphenoxylate and codeine in normal volunteers. Author(s): Schuermans V, Van Lommel R, Dom J, Brugmans J. Source: Arzneimittel-Forschung. 1974 October; 24(10): 1653-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4611432

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Loperamide (R 18 553), a novel type of antidiarrheal agent. Part 7: Clinical investigation. Efficacy and safety of loperamide in patients with severe chronic diarrhea. Author(s): Verhaegen H, De Cree J, Schuermans V. Source: Arzneimittel-Forschung. 1974 October; 24(10): 1657-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4611433

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Loperamide (R 18 553), a novel type of antidiarrheal agent. Part 8: Clinical investigation. Use of a flexible dosage schedule in a double-blind comparison of loperamide with diphenoxylate in 614 patients suffering from acute diarrhea. Author(s): Dom J, Leyman R, Schuermans V, Brugmans J. Source: Arzneimittel-Forschung. 1974 October; 24(10): 1660-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4611434

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Loperamide abolishes exercise-induced orocecal liquid transit acceleration. Author(s): Keeling WF, Harris A, Martin BJ. Source: Digestive Diseases and Sciences. 1993 October; 38(10): 1783-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8404397

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Loperamide and acute infective diarrhoea in children. Author(s): Heap J. Source: Lancet. 1979 December 15; 2(8155): 1299. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=93209

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Loperamide and acute infective diarrhoea in children. Author(s): Cutting WA, Marshall WC. Source: Lancet. 1979 November 10; 2(8150): 1022. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=91757

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Loperamide and calmodulin. Author(s): Merritt JE, Brown BL, Tomlinson S. Source: Lancet. 1982 January 30; 1(8266): 283. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6120299

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Loperamide and ileostomy output--placebo-controled double-blind crossover study. Author(s): Tytgat GN, Huibregtse K. Source: British Medical Journal. 1975 June 21; 2(5972): 667. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1095117

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Loperamide and oro-caecal transit delay. Author(s): Basilisco G, Camboni G, Bozzani A, Bianchi PA. Source: British Journal of Clinical Pharmacology. 1986 September; 22(3): 371-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3768253

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Loperamide as a symptomatic treatment in pediatric surgery: a double-blind crossover study. Author(s): Kekomaki M, Vilkki P, Gordin A, Salo H. Source: Z Kinderchir. 1981 March; 32(3): 237-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7282057

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Loperamide associated necrotising enterocolitis. Author(s): Chow CB, Li SH, Leung NK. Source: Acta Paediatr Scand. 1986 November; 75(6): 1034-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3564964

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Loperamide but not morphine has anti-secretory effects in human colon, in vitro. Author(s): Burleigh DE. Source: European Journal of Pharmacology. 1991 September 17; 202(2): 277-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1802746

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Loperamide dependence. Author(s): Hill MA, Greason FC. Source: The Journal of Clinical Psychiatry. 1992 December; 53(12): 450. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1487475

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Loperamide for acute diarrhoea in infancy (a clinical experience). Author(s): Soeparto P, Djupri L, Soeparto H, Noerasid H. Source: Paediatr Indones. 1981 May-June; 21(5-6): 115-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7290716

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Loperamide for treatment of acute diarrhoea in infants and young children. A doubleblind placebo-controlled trial. Author(s): Bowie MD, Hill ID, Mann MD. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1995 September; 85(9): 885-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8545750

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Loperamide has antisecretory activity in the human jejunum in vivo. Author(s): Hughes S, Higgs NB, Turnberg LA. Source: Gut. 1984 September; 25(9): 931-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6590431

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Loperamide hydrochloride. Author(s): Daugherty LM. Source: Am Pharm. 1990 December; Ns30(12): 45-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2275455

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Loperamide improves anal sphincter function and continence after restorative proctocolectomy. Author(s): Hallgren T, Fasth S, Delbro DS, Nordgren S, Oresland T, Hulten L. Source: Digestive Diseases and Sciences. 1994 December; 39(12): 2612-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7995187

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Loperamide in "toddler diarrhoea". Author(s): Marcovitch H. Source: Lancet. 1980 June 28; 1(8183): 1413. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6104192

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Loperamide in acute childhood diarrhoea: a double blind controlled trial. Author(s): Kassem AS, Madkour AA, Massoud BZ, Mehanna ZM. Source: J Diarrhoeal Dis Res. 1983 March; 1(1): 10-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6384353

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Loperamide in acute diarrhoea in childhood: results of a double blind, placebo controlled clinical trial. Author(s): Karrar ZA, Abdulla MA, Moody JB, Macfarlane SB, Al Bwardy M, Hendrickse RG. Source: Annals of Tropical Paediatrics. 1987 June; 7(2): 122-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2441648

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Loperamide in childhood diarrhoea. Author(s): Heap J, Macnair A. Source: Lancet. 1980 May 17; 1(8177): 1085-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6103418

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Loperamide in chronic diarrhea and after ileostomy: a placebo-controlled doubleblind cross-over study. Author(s): Tytgat GN, Huibregtse K, Meuwissen SG. Source: Arch Chir Neerl. 1976; 28(1): 13-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=779663

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Loperamide in patients with radiotherapy-induced diarrhoea. Author(s): Chapaux J, Chapaux P, Royer E. Source: Arzneimittel-Forschung. 1978; 28(5): 864-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=581966

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Loperamide in severe protracted diarrhoea. Author(s): Sandhu BK, Tripp JH, Milla PJ, Harries JT. Source: Archives of Disease in Childhood. 1983 January; 58(1): 39-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6830273

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Loperamide in the symptomatic control of chronic diarrhoea. Double-blind placebocontrolled study. Author(s): Tijtgat GN, Meuwissen SG, Huibregtse K. Source: Ann Clin Res. 1975 October; 7(5): 325-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1108754

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Loperamide in the treatment of acute gastroenteritis in early childhood. Report of a two centre, double-blind, controlled clinical trial. Author(s): Owens JR, Broadhead R, Hendrickse RG, Jaswal OP, Gangal RN. Source: Annals of Tropical Paediatrics. 1981 September; 1(3): 135-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6185060

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Loperamide in treatment of irritable bowel syndrome--a double-blind placebo controlled study. Author(s): Lavo B, Stenstam M, Nielsen AL. Source: Scandinavian Journal of Gastroenterology. Supplement. 1987; 130: 77-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3306903

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Loperamide inhibits the enhanced intestinal glucose absorption of cystic fibrosis in vitro. Author(s): Hardcastle J, Hardcastle PT, Taylor CJ. Source: Pediatric Research. 1994 March; 35(3): 354-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8190526

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Loperamide intoxication in a baby. Author(s): Tan SH. Source: Singapore Med J. 1983 August; 24(4): 227-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6648555

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Loperamide modifies but does not block the corticotropin-releasing hormoneinduced ACTH response in patients with Addison's disease. Author(s): Ambrosi B, Bochicchio D, Colombo P, Ferrario R, Faglia G. Source: Horm Metab Res Suppl. 1987; 16: 74-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2832297

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Loperamide not for children. Author(s): Tulloch J. Source: Am Pharm. 1991 September; Ns31(9): 6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1951042

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Loperamide overdose managed by naloxone. Author(s): Friedli G, Haenggeli CA. Source: Lancet. 1980 June 28; 1(8183): 1413. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6104193

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Loperamide oxide for the treatment of chronic diarrhoea in Crohn's disease. Author(s): van Outryve M, Toussaint J. Source: J Int Med Res. 1995 September-October; 23(5): 335-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8529776

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Loperamide oxide in acute diarrhoea: a double-blind, placebo-controlled trial. The Dutch Diarrhoea Trialists Group. Author(s): Dreverman JW, Van der Poel AJ. Source: Alimentary Pharmacology & Therapeutics. 1995 August; 9(4): 441-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8527621

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Loperamide oxide in the treatment of acute diarrhea in adults. Author(s): Dettmer A. Source: Clinical Therapeutics. 1994 November-December; 16(6): 972-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7697694

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Loperamide poisoning in children. Author(s): Minton NA, Henry JA. Source: Lancet. 1990 March 31; 335(8692): 788. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1969527

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Loperamide poisoning in children. Author(s): Bhutta TI, Tahir KI. Source: Lancet. 1990 February 10; 335(8685): 363. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1967807

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Loperamide related toxic megacolon in Clostridium difficile colitis. Author(s): Walley T, Milson D. Source: Postgraduate Medical Journal. 1990 July; 66(777): 582. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2217023

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Loperamide suppositories in an adolescent with childhood-onset functional nonretentive fecal soiling. Author(s): Voskuijl WP, van Ginkel R, Taminiau JA, Boeckxstaens GE, Benninga MA. Source: Journal of Pediatric Gastroenterology and Nutrition. 2003 August; 37(2): 198-200. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12883310

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Loperamide test: a simple and highly specific screening test for hypercortisolism in children and adolescents. Author(s): Buzi F, Corna A, Pilotta A, Negrini F, Lombardi A, Re T, Ambrosi B. Source: Acta Paediatrica (Oslo, Norway : 1992). 1997 November; 86(11): 1177-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9401509

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Loperamide therapy in a child with vipoma-associated diarrhoea. Author(s): Yamashiro Y, Yamamoto K, Sato M. Source: Lancet. 1982 June 19; 1(8286): 1413. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6123702

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Loperamide therapy in a patient with diarrhea and resistant hypertension. Author(s): Morimoto S, Sasaki S, Itoh H, Nakata T, Takeda K, Nakagawa M. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 2000 April; 13(4 Pt 1): 431-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10821347

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Loperamide to diagnose Cushing's syndrome. Author(s): Ambrosi B, Bochicchio D, Colombo P, Fadin C, Faglia G. Source: Jama : the Journal of the American Medical Association. 1993 November 17; 270(19): 2301-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8230590

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Loperamide toxicity in a child after a single dose. Author(s): Minton NA, Smith PG. Source: British Medical Journal (Clinical Research Ed.). 1987 May 30; 294(6584): 1383. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3109665

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Loperamide toxicity in an infant. Author(s): Tan SH. Source: Aust Paediatr J. 1983 March; 19(1): 55. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6870704

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Loperamide toxicity in severe protracted diarrhoea. Author(s): Weaver LT, Richmond SW, Nelson R. Source: Archives of Disease in Childhood. 1983 July; 58(7): 568-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6870341

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Loperamide treatment of the irritable bowel syndrome. Author(s): Hovdenak N. Source: Scandinavian Journal of Gastroenterology. Supplement. 1987; 130: 81-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3306904

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Loperamide versus copamide. Author(s): Singh DS, Singh NK, Srivastava PK. Source: J Assoc Physicians India. 1984 May; 32(5): 460. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6501189

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Loperamide versus diphenoxylate in diarrhea of infants and children. Author(s): Prakash P, Saxena S, Sareen DK. Source: Indian J Pediatr. 1980 July-August; 47(387): 303-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7228230

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Loperamide, a new antidiarrheal agent in the treatment of chronic diarrhea. Author(s): Galambos JT. Source: Schweiz Med Wochenschr. 1978 July 15; 108(28): 1080-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=97779

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Loperamide, an opiate analog, differently modifies the adrenocorticotropin responses to corticotropin-releasing hormone and lysine vasopressin in patients with Addison's disease. Author(s): Bochicchio D, Ambrosi B, Faglia G. Source: Neuroendocrinology. 1988 December; 48(6): 611-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2855105

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Loperamide, an opiate analogue, inhibits plasma ACTH levels in patients with Addison's disease. Author(s): Ambrosi B, Bochicchio D, Faglia G. Source: Clinical Endocrinology. 1986 May; 24(5): 483-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3024866

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Loperamide, diphenoxylate, and codeine phosphate in chronic diarrhoea. Author(s): Shee CD, Pounder RE. Source: British Medical Journal. 1980 February 23; 280(6213): 524. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6989434

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Loperamide. Survey of studies on mechanism of its antidiarrheal activity. Author(s): Awouters F, Megens A, Verlinden M, Schuurkes J, Niemegeers C, Janssen PA. Source: Digestive Diseases and Sciences. 1993 June; 38(6): 977-95. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8508715

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Loperamide: a new antidiarrheal agent in the treatment of chronic diarrhea. Author(s): Galambos JT, Hersh T, Schroder S, Wenger J. Source: Gastroenterology. 1976 June; 70(6): 1026-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=773735

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Loperamide

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Loperamide: a positive modulator for store-operated calcium channels? Author(s): Harper JL, Shin Y, Daly JW. Source: Proceedings of the National Academy of Sciences of the United States of America. 1997 December 23; 94(26): 14912-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9405713

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Loperamide: a review of its pharmacological properties and therapeutic efficacy in diarrhoea. Author(s): Heel RC, Brogden RN, Speight TM, Avery GS. Source: Drugs. 1978 January; 15(1): 33-52. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=342229

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Loperamide: an open multicentre trial and double-blind cross-over comparison with placebo in patients with chronic diarrhoea. Author(s): Demeulenaere L, Verbeke S, Muls M, Reyntjens A. Source: Curr Ther Res Clin Exp. 1974 January; 16(1): 32-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4203846

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Loperamide: novel effects on capacitative calcium influx. Author(s): Daly JW, Harper J. Source: Cellular and Molecular Life Sciences : Cmls. 2000 January 20; 57(1): 149-57. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10949586

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Loperamide--an opiate receptor agonist with gastrointestinal motility effects. Author(s): Mellstrand T. Source: Scandinavian Journal of Gastroenterology. Supplement. 1987; 130: 65-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2820051

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Loperamide-induced ileus. Author(s): von Muhlendahl KE, Bunjes R, Krienke EG. Source: Lancet. 1980 January 26; 1(8161): 209. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6101664

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Loperamide-simethicone vs loperamide alone, simethicone alone, and placebo in the treatment of acute diarrhea with gas-related abdominal discomfort. A randomized controlled trial. Author(s): Kaplan MA, Prior MJ, Ash RR, McKonly KI, Helzner EC, Nelson EB. Source: Archives of Family Medicine. 1999 May-June; 8(3): 243-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10333820

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Mechanism of the antidiarrheal effect of loperamide. Author(s): Schiller LR, Santa Ana CA, Morawski SG, Fordtran JS. Source: Gastroenterology. 1984 June; 86(6): 1475-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6714575

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Mechanisms of action of loperamide. Author(s): Ooms LA, Degryse AD, Janssen PA. Source: Scandinavian Journal of Gastroenterology. Supplement. 1984; 96: 145-55. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6382576

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Misuse of loperamide in anxiety disorder patients. Author(s): Lavin MR. Source: Depression and Anxiety. 1996-97; 4(5): 254-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9167796

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Moderation of urinary and faecal incontinence with loperamide. Author(s): Szule E. Source: Ther Hung. 1989; 37(4): 234-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2631292

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Necrotising colitis with perforation in diarrhoic patients treated with loperamide. Author(s): Olm M, Gonzalez FJ, Garcia-Valdecasas JC, Fuster J, Bertran A, Milla J. Source: European Journal of Clinical Pharmacology. 1991; 40(4): 415-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2050178

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No effect of MDR1 C3435T variant on loperamide disposition and central nervous system effects. Author(s): Pauli-Magnus C, Feiner J, Brett C, Lin E, Kroetz DL. Source: Clinical Pharmacology and Therapeutics. 2003 November; 74(5): 487-98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14586389

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Observations with Imodium in diarrhoeal women. Author(s): Sasdi A. Source: Ther Hung. 1990; 38(3): 129-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2284622

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Octreotide versus loperamide in the treatment of fluorouracil-induced diarrhea: a randomized trial. Author(s): Cascinu S, Fedeli A, Fedeli SL, Catalano G. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1993 January; 11(1): 148-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8418225

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Opioid and non-opioid actions of loperamide on cholinergic nerve function in human isolated colon. Author(s): Burleigh DE. Source: European Journal of Pharmacology. 1988 July 26; 152(1-2): 39-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2850201

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Optimal dosing of ofloxacin with loperamide in the treatment of non-dysenteric travelers' diarrhea. Author(s): Ericsson CD, DuPont HL, Mathewson JJ. Source: Journal of Travel Medicine : Official Publication of the International Society of Travel Medicine and the Asia Pacific Travel Health Association. 2001 July-August; 8(4): 207-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11703897

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Optimal dosing of trimethoprim-sulfamethoxazole when used with loperamide to treat traveler's diarrhea. Author(s): Ericsson CD, Nicholls-Vasquez I, DuPont HL, Mathewson JJ. Source: Antimicrobial Agents and Chemotherapy. 1992 December; 36(12): 2821-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1482152

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Oral naloxone antagonizes loperamide-induced delay of orocecal transit. Author(s): Basilisco G, Camboni G, Bozzani A, Paravicini M, Bianchi PA. Source: Digestive Diseases and Sciences. 1987 August; 32(8): 829-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3608730

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Oral rehydration therapy plus loperamide versus loperamide alone in the treatment of traveler's diarrhea. Author(s): Caeiro JP, DuPont HL, Albrecht H, Ericsson CD. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1999 June; 28(6): 1286-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10451167

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Pancreatitis caused by loperamide overdose. Author(s): Epelde F, Boada L, Tost J. Source: The Annals of Pharmacotherapy. 1996 November; 30(11): 1339. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8913421

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Possible therapeutic use of loperamide for symptoms of lactose intolerance. Author(s): Szilagyi A, Torchinsky A, Calacone A. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2000 July-August; 14(7): 581-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10978944

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Potential roles of P-gp and calcium channels in loperamide and diphenoxylate transport. Author(s): Crowe A, Wong P. Source: Toxicology and Applied Pharmacology. 2003 November 15; 193(1): 127-37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14613723

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Potentiation of the antiproliferative activity of MKT-077 by loperamide, diltiazem and tamoxifen. Author(s): Abdul M, Hoosein N. Source: Oncol Rep. 2003 November-December; 10(6): 2023-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14534737

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Probable interaction of loperamide and cholestyramine. Author(s): Ti TY, Giles HG, Sellers EM. Source: Can Med Assoc J. 1978 September 23; 119(6): 607-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=709452

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Prospective, controlled, multicentre study of loperamide in pregnancy. Author(s): Einarson A, Mastroiacovo P, Arnon J, Ornoy A, Addis A, Malm H, Koren G. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2000 March; 14(3): 185-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10758415

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Prostaglandin-induced diarrhoea treated with loperamide or diphenoxylate. A double-blind study. Author(s): Lange AP, Secher NJ, Amery W. Source: Acta Med Scand. 1977; 202(6): 449-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=339672

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Quantitation of loperamide and N-demethyl-loperamide in human plasma using electrospray ionization with selected reaction ion monitoring liquid chromatographymass spectrometry. Author(s): He H, Sadeque A, Erve JC, Wood AJ, Hachey DL. Source: J Chromatogr B Biomed Sci Appl. 2000 July 21; 744(2): 323-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10993521

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Racecadotril versus loperamide: antidiarrheal research revisited. Author(s): Huighebaert S, Awouters F, Tytgat GN. Source: Digestive Diseases and Sciences. 2003 February; 48(2): 239-50. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12643598

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Radioimmunoassay of the antidiarrhoeal loperamide. Author(s): Michiels M, Hendriks R, Heykants J. Source: Life Sciences. 1977 August 1; 21(3): 451-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=895377

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Randomized trial of loperamide versus dose escalation of octreotide acetate for chemotherapy-induced diarrhea in bone marrow transplant and leukemia patients. Author(s): Geller RB, Gilmore CE, Dix SP, Lin LS, Topping DL, Davidson TG, Holland HK, Wingard JR. Source: American Journal of Hematology. 1995 November; 50(3): 167-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7485077

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Reduction of the prodrug loperamide oxide to its active drug loperamide in the gut of rats, dogs, and humans. Author(s): Lavrijsen K, van Dyck D, van Houdt J, Hendrickx J, Monbaliu J, Woestenborghs R, Meuldermans W, Heykants J. Source: Drug Metabolism and Disposition: the Biological Fate of Chemicals. 1995 March; 23(3): 354-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7628301

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Report of a case of intractable paraneoplastic diarrhea remarkably improved by an association of diphenoxylate and loperamide. Author(s): Bleiberg H, Jortay A. Source: Acta Gastroenterol Belg. 1975 January-February; 38(1-2): 77-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1224912

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Review: loperamide--a potent antidiarrhoeal drug with actions along the alimentary tract. Author(s): Ruppin H. Source: Alimentary Pharmacology & Therapeutics. 1987 June; 1(3): 179-90. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2979222

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Ritonavir increases loperamide plasma concentrations without evidence for Pglycoprotein involvement. Author(s): Tayrouz Y, Ganssmann B, Ding R, Klingmann A, Aderjan R, Burhenne J, Haefeli WE, Mikus G. Source: Clinical Pharmacology and Therapeutics. 2001 November; 70(5): 405-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11719726

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Role of loperamide and placebo in management of irritable bowel syndrome (IBS). Author(s): Cann PA, Read NW, Holdsworth CD, Barends D. Source: Digestive Diseases and Sciences. 1984 March; 29(3): 239-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6365490

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Safety and efficacy of loperamide. Author(s): Ericsson CD, Johnson PC. Source: The American Journal of Medicine. 1990 June 20; 88(6A): 10S-14S. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2192552

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Safety of loperamide in infants with diarrhea. Author(s): Bhutta Z, Molla AM. Source: The Journal of Pediatrics. 1991 November; 119(5): 842-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1941400

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Secretion of the antidiarrhoeal agent loperamide oxide in breast milk. Author(s): Nikodem VC, Hofmeyr GJ. Source: European Journal of Clinical Pharmacology. 1992; 42(6): 695-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1623917

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Store-operated calcium channels in HL-60 cells effects of temperature, differentiation and loperamide. Author(s): Harper JL, Daly JW. Source: Life Sciences. 2000 June 30; 67(6): 651-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12659171

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Subcutaneous octreotide versus oral loperamide in the treatment of diarrhea following chemotherapy. Author(s): Gebbia V, Carreca I, Testa A, Valenza R, Curto G, Cannata G, Borsellino N, Latteri MA, Cipolla C, Florena M, et al. Source: Anti-Cancer Drugs. 1993 August; 4(4): 443-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8400346

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Suppression of vagus-mediated pancreatic polypeptide release by the mu-opiate receptor agonist loperamide in man. Author(s): Riepl RL, Reichardt B, Auernhammer CJ, Beier G, Schopohl J, Stalla GK, Lehnert P. Source: British Journal of Clinical Pharmacology. 1996 September; 42(3): 371-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8877029

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Symptomatic treatment of acute infectious diarrhoea: loperamide versus placebo in a double-blind trial. Author(s): Bergstrom T, Alestig K, Thoren K, Trollfors B. Source: The Journal of Infection. 1986 January; 12(1): 35-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3514770

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The effect of loperamide on anorectal function in normal healthy men. Author(s): Musial F, Enck P, Kalveram KT, Erckenbrecht JF. Source: Journal of Clinical Gastroenterology. 1992 December; 15(4): 321-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1294638

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The effect of loperamide on bowel habits and anal sphincter function in patients with ileoanal anastomosis. Author(s): Emblem R, Stien R, Morkrid L. Source: Scandinavian Journal of Gastroenterology. 1989 October; 24(8): 1019-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2688066

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The effect of loperamide on prostaglandin induced diarrhoea in rat and man. Author(s): Karim SM, Adaikan PG. Source: Prostaglandins. 1977 February; 13(2): 321-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=847235

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The enkephalinase inhibitor, acetorphan, in acute diarrhoea. A double-blind, controlled clinical trial versus loperamide. Author(s): Roge J, Baumer P, Berard H, Schwartz JC, Lecomte JM. Source: Scandinavian Journal of Gastroenterology. 1993 April; 28(4): 352-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8488368

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The use of loperamide for treatment of "difficult to manage" chronic diarrhoea in adults. Author(s): Paterson ID. Source: J Int Med Res. 1977; 5(6): 459-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=590602

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The use of loperamide to regulate peristalsis and improve bowel control: a preliminary report. Author(s): Nixon HH. Source: Journal of Pediatric Surgery. 1978 February; 13(1): 87-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=633059

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Toddler diarrhoea: observations on the effects of aspirin and loperamide. Author(s): Hamdi I, Dodge JA. Source: Journal of Pediatric Gastroenterology and Nutrition. 1985 June; 4(3): 362-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3926980

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Toxic delirium possibly caused by loperamide. Author(s): Schwartz RH, Rodriquez WJ. Source: The Journal of Pediatrics. 1991 April; 118(4 ( Pt 1)): 656-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2007949

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Toxic megacolon associated with loperamide therapy. Author(s): Brown JW. Source: Jama : the Journal of the American Medical Association. 1979 February 2; 241(5): 501-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=759668

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Treatment of irritable bowel syndrome with loperamide oxide. An open study to determine optimal dosage. Author(s): Ragnarsson G, Bodemar G. Source: Journal of Internal Medicine. 2000 August; 248(2): 165-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10947896

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Treatment of traveler's diarrhea with ciprofloxacin and loperamide. Author(s): Petruccelli BP, Murphy GS, Sanchez JL, Walz S, DeFraites R, Gelnett J, Haberberger RL, Echeverria P, Taylor DN. Source: The Journal of Infectious Diseases. 1992 March; 165(3): 557-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1538160

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Treatment of traveler's diarrhea with sulfamethoxazole and trimethoprim and loperamide. Author(s): Ericsson CD, DuPont HL, Mathewson JJ, West MS, Johnson PC, Bitsura JA. Source: Jama : the Journal of the American Medical Association. 1990 January 12; 263(2): 257-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2403603

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Treatment of travelers' diarrhea: ciprofloxacin plus loperamide compared with ciprofloxacin alone. A placebo-controlled, randomized trial. Author(s): Taylor DN, Sanchez JL, Candler W, Thornton S, McQueen C, Echeverria P. Source: Annals of Internal Medicine. 1991 May 1; 114(9): 731-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2012354

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Treatment of travellers' diarrhoea: zaldaride compared with loperamide and placebo. Author(s): Silberschmidt G, Schick MT, Steffen R, Kilpatrick ME, Murphy JR, Oyofo BA, el-Etr S, Gyurech D, Mourad AS, Mathewson JT, et al. Source: European Journal of Gastroenterology & Hepatology. 1995 September; 7(9): 8715. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8574720

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Use of loperamide hydrochloride in children. Author(s): Moy RJ. Source: Cent Afr J Med. 1992 March; 38(3): 133. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1516123

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Use of loperamide hydrochloride in children. Author(s): Ward JM. Source: Cent Afr J Med. 1991 July; 37(7): 226. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1811911

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Use of loperamide in children. Author(s): Ward JM. Source: Cent Afr J Med. 1994 October; 40(10): 292-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7828184

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Withdrawal of loperamide drops. Author(s): Gussin RZ. Source: Lancet. 1990 June 30; 335(8705): 1603-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1972530

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Zaldaride maleate (a new calmodulin antagonist) versus loperamide in the treatment of traveler's diarrhea: randomized, placebo-controlled trial. Author(s): Okhuysen PC, DuPont HL, Ericsson CD, Marani S, Martinez-Sandoval FG, Olesen MA, Ravelli GP. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1995 August; 21(2): 341-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8562742

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CHAPTER 2. NUTRITION AND LOPERAMIDE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and loperamide.

Finding Nutrition Studies on Loperamide The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “loperamide” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “loperamide” (or a synonym): •

Activation of opioid mu-receptor by loperamide to lower plasma glucose in streptozotocin-induced diabetic rats. Author(s): Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan. Source: Liu, I M Chi, T C Chen, Y C Lu, F H Cheng, J T Neurosci-Lett. 1999 April 23; 265(3): 183-6 0304-3940

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Antisecretory activities of orally administered loperamide and loperamide oxide on intestinal secretion in rats. Author(s): Department of Experimental and Clinical Pharmacology, University of Graz, Austria. Source: Beubler, E Badhri, P Schirgi Degen, A J-Pharm-Pharmacol. 1993 September; 45(9): 803-6 0022-3573

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Comparison of the antisecretory effects of loperamide and loperamide oxide in the jejunum and the colon of rats in-vivo. Author(s): Department of Experimental and Clinical Pharmacology, University of Graz, Austria. Source: Beubler, E Badhri, P J-Pharm-Pharmacol. 1990 October; 42(10): 689-92 0022-3573

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Comparison of the effects of loperamide and loperamide oxide on absorptive processes in rat small intestine. Author(s): Department of Biomedical Science, The University, Sheffield, UK. Source: Hardcastle, J Hardcastle, P T Goldhill, J J-Pharm-Pharmacol. 1993 October; 45(10): 919-21 0022-3573

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Comparison of the peripheral and central effects of the opioid agonists loperamide and morphine in the formalin test in rats. Author(s): Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA. [email protected] Source: Shannon, Harlan E Lutz, Elizabeth A Neuropharmacology. 2002 February; 42(2): 253-61 0028-3908

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Effect of loperamide and bisacodyl on intestinal transit time, fecal weight and short chain fatty acid excretion in the rat. Author(s): Instituto de Gastroenterologia Dr. Jorge Perez Companc, Buenos Aires, Rep. Argentina. Source: Bustos, D Ogawa, K Pons, S Soriano, E Bandi, J C Bustos Fernandez, L ActaGastroenterol-Latinoam. 1991; 21(1): 3-9 0300-9033

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Effects of atropine and loperamide on the agitating force and GI transit time in dogs in drug absorption studies. Author(s): National Institute of Health Sciences, Tokyo, Japan. Source: Katori, N Aoyagi, N Kojima, S Biol-Pharm-Bull. 1996 October; 19(10): 1338-40 0918-6158

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Effects of loperamide and other opioid-related substances on the transcriptional regulation of the rat pro-opiomelanocortin gene in AtT20 cells. Author(s): First Department of Internal Medicine, Nagoya University School of Medicine and Hospital, Nagoya, Japan. Source: Nomura, A Iwasaki, Y Aoki, Y Yamamori, E Mutsuga, N Yoshida, M Asai, M Oiso, Y Saito, H Neuroendocrinology. 2001 August; 74(2): 87-94 0028-3835

Nutrition

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Germinated barley foodstuff improves constipation induced by loperamide in rats. Author(s): Applied Bioresearch Center, Corporate Research and Development Division Kirin Brewery Co. Ltd., Gunma, Japan. Source: Kanauchi, O Hitomi, Y Agata, K Nakamura, T Fushiki, T Biosci-BiotechnolBiochem. 1998 September; 62(9): 1788-90 0916-8451

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Inhibition by loperamide of mucus secretion in the rat colon in vivo. Author(s): Medizinische Klinik Innenstadt, University of Munich, F.R.G. Source: Loeschke, K Schmid, T Farack, U M Eur-J-Pharmacol. 1989 October 24; 170(1-2): 41-6 0014-2999

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Inhibition of thromboxane A(2)-induced Cl(-) secretion by antidiarrhea drug loperamide in isolated rat colon. Author(s): Department of Pharmaceutical Physiology, Faculty of Pharmaceutical Sciences, Toyama Medical and Pharmaceutical University, Sugitani, Toyama, Japan. Source: Suzuki, T Sakai, H Ikari, A Takeguchi, N J-Pharmacol-Exp-Ther. 2000 October; 295(1): 233-8 0022-3565

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Local and systemic actions of loperamide on fluid transport and transmural potential difference across rat small intestine. Author(s): Department of Biomedical Science, The University, Sheffield, UK. Source: Goldhill, J Hardcastle, J Hardcastle, P T J-Pharm-Pharmacol. 1993 March; 45(3): 210-4 0022-3573

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Ricinoleic acid and loperamide have opposite motor effects in the small and large intestine of the cat. Author(s): Medizinische Klinik und Poliklinik der Universitat Dusseldorf. Source: Wienbeck, M Wallenfels, M Kortenhaus, E Z-Gastroenterol. 1987 July; 25(7): 35563 0044-2771

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Substantial activity of budesonide in patients with irinotecan (CPT-11) and 5fluorouracil induced diarrhea and failure of loperamide treatment. Author(s): Department of Medicine (Gastroenterology/Medical Oncology/Endocrinology), Staedtische Kliniken Dortmund, Germany. [email protected] Source: Lenfers, B H Loeffler, T M Droege, C M Hausamen, T U Ann-Oncol. 1999 October; 10(10): 1251-3 0923-7534

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Treatment of chronic diarrhoea: loperamide versus ispaghula husk and calcium. Author(s): Surgical and Medical Dept. of Gastroenterology, Hvidovre Hospital, University of Copenhagen. Source: Qvitzau, S Matzen, P Madsen, P Scand-J-Gastroenterol. 1988 December; 23(10): 1237-40 0036-5521

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND LOPERAMIDE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to loperamide. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to loperamide and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “loperamide” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to loperamide: •

A multicenter, phase II trial of weekly irinotecan (CPT-11) in patients with previously treated colorectal carcinoma. Author(s): Rothenberg ML, Cox JV, DeVore RF, Hainsworth JD, Pazdur R, Rivkin SE, Macdonald JS, Geyer CE Jr, Sandbach J, Wolf DL, Mohrland JS, Elfring GL, Miller LL, Von Hoff DD. Source: Cancer. 1999 February 15; 85(4): 786-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10091755

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A new enkephalinase inhibitor as an alternative to loperamide in the prevention of diarrhea induced by CPT-11. Author(s): Goncalves E, de Costa L, Abigerges D, Armand JP. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1995 August; 13(8): 2144-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7636561

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A strategy for management of the irritable bowel. Author(s): Thompson WG. Source: The American Journal of Gastroenterology. 1986 February; 81(2): 95-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3004197

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Antidiarrhoeal activity of hot water extract of black tea (Camellia sinensis). Author(s): Besra SE, Gomes A, Ganguly DK, Vedasiromoni JR. Source: Phytotherapy Research : Ptr. 2003 April; 17(4): 380-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12722145

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Antidiarrhoeal activity of seed extract of Albizzia lebbeck Benth. Author(s): Besra SE, Gomes A, Chaudhury L, Vedasiromoni JR, Ganguly DK. Source: Phytotherapy Research : Ptr. 2002 September; 16(6): 529-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12237809

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Anti-diarrhoeal drugs. Author(s): Soeparto P. Source: Southeast Asian J Trop Med Public Health. 1982 September; 13(3): 412-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7163848

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Bioactivation of the anticancer agent CPT-11 to SN-38 by human hepatic microsomal carboxylesterases and the in vitro assessment of potential drug interactions. Author(s): Slatter JG, Su P, Sams JP, Schaaf LJ, Wienkers LC. Source: Drug Metabolism and Disposition: the Biological Fate of Chemicals. 1997 October; 25(10): 1157-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9321519

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Biosynthesis of an aminopiperidino metabolite of irinotecan [7-ethyl-10-[4-(1piperidino)-1-piperidino]carbonyloxycamptothecine] by human hepatic microsomes. Author(s): Haaz MC, Riche C, Rivory LP, Robert J. Source: Drug Metabolism and Disposition: the Biological Fate of Chemicals. 1998 August; 26(8): 769-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9698291

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Broad spectrum antiemetic effects of CP-122,721, a tachykinin NK1 receptor antagonist, in ferrets. Author(s): Gonsalves S, Watson J, Ashton C. Source: European Journal of Pharmacology. 1996 June 3; 305(1-3): 181-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8813551

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Characterisation and clinical management of CPT-11 (irinotecan)-induced adverse events: the European perspective. Author(s): Bleiberg H, Cvitkovic E.

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Source: European Journal of Cancer (Oxford, England : 1990). 1996; 32A Suppl 3: S18-23. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8943661 •

Control of irinotecan-induced diarrhea by octreotide after loperamide failure. Author(s): Barbounis V, Koumakis G, Vassilomanolakis M, Demiri M, Efremidis AP. Source: Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer. 2001 June; 9(4): 258-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11430421

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Conversion of irinotecan (CPT-11) to its active metabolite, 7-ethyl-10hydroxycamptothecin (SN-38), by human liver carboxylesterase. Author(s): Rivory LP, Bowles MR, Robert J, Pond SM. Source: Biochemical Pharmacology. 1996 October 11; 52(7): 1103-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8831730

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CPT-11 in the treatment of colorectal cancer: clinical efficacy and safety profile. Author(s): Rougier P, Bugat R. Source: Seminars in Oncology. 1996 February; 23(1 Suppl 3): 34-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8633252

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CPT-11. The European experience. Author(s): Armand JP, Terret C, Couteau C, Rixe O. Source: Annals of the New York Academy of Sciences. 1996 December 13; 803: 282-91. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8993522

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CPT-11: clinical experience in phase I studies. Author(s): Armand JP. Source: Seminars in Oncology. 1996 February; 23(1 Suppl 3): 27-33. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8633250

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CPT-11: the European clinical development. Author(s): Terret C, Couteau C, Armand JP. Source: J Infus Chemother. 1996 Summer; 6(3): 152-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9229329

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Direct translation of a protracted irinotecan schedule from a xenograft model to a phase I trial in children. Author(s): Furman WL, Stewart CF, Poquette CA, Pratt CB, Santana VM, Zamboni WC, Bowman LC, Ma MK, Hoffer FA, Meyer WH, Pappo AS, Walter AW, Houghton PJ.

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Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1999 June; 17(6): 1815-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10561220 •

Disorders of colonic motility in patients with diabetes mellitus. Author(s): Battle WM, Cohen JD, Snape WJ Jr. Source: Yale J Biol Med. 1983 July-August; 56(4): 277-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6670291

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Dose-response relationship and mechanism of action of Saccharomyces boulardii in castor oil-induced diarrhea in rats. Author(s): Girard P, Pansart Y, Lorette I, Gillardin JM. Source: Digestive Diseases and Sciences. 2003 April; 48(4): 770-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12741470

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Drug treatment for faecal incontinence in adults. Author(s): Cheetham M, Brazzelli M, Norton C, Glazener CM. Source: Cochrane Database Syst Rev. 2003; (3): Cd002116. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12917921

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Effect of changing transit time on colonic microbial metabolism in man. Author(s): Stephen AM, Wiggins HS, Cummings JH. Source: Gut. 1987 May; 28(5): 601-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3596341

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Effects of yogurt supplemented with brewer's yeast cell wall on constipation and intestinal microflora in rats. Author(s): Nakamura T, Nishida S, Mizutani M, Iino H. Source: J Nutr Sci Vitaminol (Tokyo). 2001 December; 47(6): 367-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11922109

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Efficacy and toxicity of irinotecan in patients with colorectal cancer. Author(s): Rothenberg ML. Source: Seminars in Oncology. 1998 October; 25(5 Suppl 11): 39-46. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9786315

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Efficacy of prophylactic anti-diarrhoeal treatment in patients receiving Campto for advanced colorectal cancer. Author(s): Duffour J, Gourgou S, Seitz JF, Senesse P, Boutet O, Castera D, Kramar A, Ychou M.

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Source: Anticancer Res. 2002 November-December; 22(6B): 3727-31. Erratum In: Anticancer Res. 2003 March-April; 23(2B): Following 1648. Anticancer Res. 2003; 23: 5369. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12552984 •

Evaluation of a vincristine resistant Caco-2 cell line for use in a calcein AM extrusion screening assay for P-glycoprotein interaction. Author(s): Eneroth A, Astrom E, Hoogstraate J, Schrenk D, Conrad S, Kauffmann HM, Gjellan K. Source: European Journal of Pharmaceutical Sciences : Official Journal of the European Federation for Pharmaceutical Sciences. 2001 January; 12(3): 205-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11113639

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Evaluation of anti-diarrhoeal activity in seed extracts of Mangifera indica. Author(s): Sairam K, Hemalatha S, Kumar A, Srinivasan T, Ganesh J, Shankar M, Venkataraman S. Source: Journal of Ethnopharmacology. 2003 January; 84(1): 11-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12499070

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Evaluation of the calcium-antagonist, antidiarrhoeic and central nervous system activities of Baccharis serraefolia. Author(s): Tortoriello J, Aguilar-Santamaria L. Source: Journal of Ethnopharmacology. 1996 September; 53(3): 157-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8887023

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Faecal incontinence. Author(s): Schiller LR. Source: Clin Gastroenterol. 1986 July; 15(3): 687-704. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3527498

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Fecal incontinence. Author(s): Fogel R. Source: Current Treatment Options in Gastroenterology. 2001 June; 4(3): 261-266. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11469983

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Gastrointestinal function in chronic radiation enteritis--effects of loperamide-Noxide. Author(s): Yeoh EK, Horowitz M, Russo A, Muecke T, Robb T, Chatterton BE. Source: Gut. 1993 April; 34(4): 476-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8491393

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Influence of 1,8-dihydroxyanthraquinone and loperamide on the paracellular permeability across colonic mucosa. Author(s): Verhaeren EH, Dreessen MJ, Lemli JA. Source: The Journal of Pharmacy and Pharmacology. 1981 August; 33(8): 526-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6115928

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Influence of senna, fibre, and fibre + senna on colonic transit in loperamide-induced constipation. Author(s): Ewe K, Ueberschaer B, Press AG. Source: Pharmacology. 1993 October; 47 Suppl 1: 242-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8234436

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Inhibition of thromboxane A(2)-induced Cl(-) secretion by antidiarrhea drug loperamide in isolated rat colon. Author(s): Suzuki T, Sakai H, Ikari A, Takeguchi N. Source: The Journal of Pharmacology and Experimental Therapeutics. 2000 October; 295(1): 233-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10991984

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Interaction of loperamide and diphenoxylate with ethanol and methohexital. Author(s): Mcguire JL, Awouters F, Niemegeers CJ. Source: Arch Int Pharmacodyn Ther. 1978 November; 236(1): 51-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=747464

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Irinotecan (CPT-11) high-dose escalation using intensive high-dose loperamide to control diarrhea. Author(s): Abigerges D, Armand JP, Chabot GG, Da Costa L, Fadel E, Cote C, Herait P, Gandia D. Source: Journal of the National Cancer Institute. 1994 March 16; 86(6): 446-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8120919

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Substantial activity of budesonide in patients with irinotecan (CPT-11) and 5fluorouracil induced diarrhea and failure of loperamide treatment. Author(s): Lenfers BH, Loeffler TM, Droege CM, Hausamen TU. Source: Annals of Oncology : Official Journal of the European Society for Medical Oncology / Esmo. 1999 October; 10(10): 1251-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10586346

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Surveillance of loperamide ingestions: an analysis of 216 poison center reports. Author(s): Litovitz T, Clancy C, Korberly B, Temple AR, Mann KV. Source: Journal of Toxicology. Clinical Toxicology. 1997; 35(1): 11-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9022646

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The effects of octreotide, soy polysaccharide, codeine and loperamide on nutrient, fluid and electrolyte absorption in the short-bowel syndrome. Author(s): Rodrigues CA, Lennard-Jones JE, Thompson DG, Farthing MJ. Source: Alimentary Pharmacology & Therapeutics. 1989 April; 3(2): 159-69. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2491467

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Treatment of chronic diarrhoea: loperamide versus ispaghula husk and calcium. Author(s): Qvitzau S, Matzen P, Madsen P. Source: Scandinavian Journal of Gastroenterology. 1988 December; 23(10): 1237-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3074458

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to loperamide; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Crohn's Disease Source: Healthnotes, Inc.; www.healthnotes.com

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Depression Source: Integrative Medicine Communications; www.drkoop.com Diarrhea Source: Healthnotes, Inc.; www.healthnotes.com Diarrhea Source: Integrative Medicine Communications; www.drkoop.com Inflammatory Bowel Disease Source: Integrative Medicine Communications; www.drkoop.com Irritable Bowel Syndrome Source: Integrative Medicine Communications; www.drkoop.com Parasites Source: Healthnotes, Inc.; www.healthnotes.com Spastic Colon Source: Integrative Medicine Communications; www.drkoop.com Ulcerative Colitis Source: Healthnotes, Inc.; www.healthnotes.com Ulcerative Colitis Source: Integrative Medicine Communications; www.drkoop.com •

Homeopathy Antimonium Crudum Source: Healthnotes, Inc.; www.healthnotes.com

•

Herbs and Supplements Hypericum Perforatum Alternative names: St. John's Wort Source: Integrative Medicine Communications; www.drkoop.com Klamathweed Alternative names: St. John's Wort Source: Integrative Medicine Communications; www.drkoop.com Loperamide Source: Healthnotes, Inc.; www.healthnotes.com Plantago Psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

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Senna Alternative names: Cassia senna, Cassia angustifolia Source: Healthnotes, Inc.; www.healthnotes.com St. John's Wort Alternative names: Hypericum perforatum Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. PATENTS ON LOPERAMIDE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “loperamide” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on loperamide, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Loperamide By performing a patent search focusing on loperamide, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on loperamide: •

Antidiarrheal compositions containing loperamide hydrochloride and a saccharide Inventor(s): Imamori; Katsumi (Yotsukaido, JP), Iwasa; Akira (Yotsukaido, JP), Kurazumi; Toshiaki (Narita, JP), Mizuno; Hiroyuki (Chiba, JP) Assignee(s): SS Pharmaceutical Co., Ltd. (Tokyo, JP) Patent Number: 5,348,744 Date filed: September 14, 1992 Abstract: Described herein are antidiarrheal compositions containing loperamide hydrochloride as an effective ingredient and a saccharide, for example, a monosaccharide, oligosaccharide or sugar alcohol in an amount as much as at least 3,000 times the weight of loperamide hydrochloride. Excerpt(s): This invention relates to antidiarrheal compositions with loperamide hydrochloride contained therein, and more specifically to antidiarrheal compositions which enhance the antidiarrheal efficacy of loperamide hydrochloride yet contain less loperamide hydrochloride to reduce development of its side effects. Of gastrointestinal symptoms, the most frequent is diarrhea. Diarrhea is known to be induced by an increase of peristalsis due to inflammation of the enteromucosa by a cause such as infection by a virus or bacterium, emotion or psychogenesis, overeating or the eating of spoiled food or the like. If taken into consideration that diarrhea is a biodefense reaction for earlier excretion of a substance toxic to the living body, early recourse to the use of an antidiarrheal should be avoided. Web site: http://www.delphion.com/details?pn=US05348744__

•

Method of treating or preventing microbial infections with loperamide Inventor(s): Keene; Carol (Shepperton, GB), Malcolm; Angus (Cobham, GB) Assignee(s): SmithKline Beecham p.l.c. (Brentford, GB) Patent Number: 6,566,374 Date filed: September 13, 2000 Abstract: A composition comprising loperamide or a pharmaceutically acceptable salt thereof for use in the prevention and/or treatment of microbial infections. Excerpt(s): The present invention relates to the prevention and/or treatment of microbial infections and to the use of the compound, loperamide, in the preparation of a medicament for preventing and/or treating such infections. Loperamide (4-(pchlorophenyl)-4-hydroxy-N,N-dimethyl-.alpha.,.alpha.-diphenyl-1-pipe ridinebutyramide) is a synthetic opioid analogue. It is a selective opiate agonist drug which does not stimulate central nervous system opiate receptors. Loperamide has been used for many years as an orally administered treatment for acute and chronic diarrohoea (Merck Index, 12th Edition). U.S. Pat. No. 5,116,847 discloses the use of loperamide and related compounds for the treatment of symptoms associated with respiratory diseases such as colds, flu, allergic and asomotor rhinitis, asthma, and bronchitis. Compositions for topical administration of these compounds to the eyes, nasal passages, sinuses, bronchial passages and the lungs are disclosed.

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Web site: http://www.delphion.com/details?pn=US06566374__ •

Pharmaceutical formulation in the form of an effervescent and/or disintegrating tablet or of instant granulate, and process for their preparation Inventor(s): Gergely; Gerhard (Vienna, AT), Gergely; Irmgard (Vienna, AT), Gergely; Thomas (Vienna, AT) Assignee(s): Gerhard Gergeky (AT) Patent Number: 5,587,179 Date filed: July 13, 1994 Abstract: The pharmaceutical formulation in the form of an effervescent and/or disintegrating tablet or of instant granules contains at least one active ingredient having an irritating taste and at least one matrix which delays the release of the active ingredient and is present as an intimate mixture with the active ingredient particles or covers said particles and is applied to a carrier. The formulation releases at most 65%, preferably at most 50%, of the active ingredient in aqueous solution at room temperature within about 2 min but more than 70%, preferably at least 80%, of the active ingredient within max. 20 min, preferably max. 15 min, in 0.1N HCl at 38.degree. C. The matrix preferably contains at least one fatty ester and/or one wax, preferably having a melting point between 30.degree. and 45.degree. C., in particular between 32.degree. and 35.degree. C., and/or at least one cellulose derivative and/or at least one polymethacrylate. In particular, the active ingredient is present in an amount of less than 60 mg, preferably less than 10 mg, and the matrix is present in an amount of 1 to 10, preferably 3 to 5, times the amount of active ingredient per tablet or granule dose. For the treatment of diarrhoea by means of loperamide, the matrix additionally contains a mixture which serves to compensate for the electrolyte loss in the body and an amount of alkali metal and/or alkaline earth metal salts, preferably of organic salts, and of chlorides. Excerpt(s): The invention relates to a pharmaceutical formulation in the form of an effervescent and/or disintegrating tablet or of instant granules, containing at least one active ingredient having an irritating taste and at least one matrix which delays the release of the active ingredient. The invention also relates to a process for the preparation of such a pharmaceutical formulation. The preparation of instant systems, such as, for example, effervescent tablets and granules, and soluble systems has so far been restricted to active ingredients having a neutral taste. However, it is increasingly being required also to incorporate into soluble instant systems active ingredients which irritate the taste nerves, particularly when they have a very bitter taste. Examples of these are dimenhydrinate, codeine, loperamide, diclophenac, acelastin, loperamide oxide, domperidone, cisaprid, paracetamol and many others. Another difficulty in the incorporation of such active ingredients is the fact that in the case of effervescent tablets, which generally weight 2-4 g, the ratio of active ingredient to effervescent granules may be up to 1:1000. Apart from the problem of the bitterness, this also gives rise to the problem of the uniform distribution of the active ingredient, which is difficult to solve. Web site: http://www.delphion.com/details?pn=US05587179__

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System for percutaneous delivery of opioid analgesics Inventor(s): Osborne; David W. (Fort Collins, CO) Assignee(s): Atrix Laboratories, Inc. (Fort Collins, CO) Patent Number: 6,355,657 Date filed: December 30, 1999 Abstract: Compositions and methods for the topical delivery of loperamide hydrochloride are disclosed. Novel solvent mixtures have been found to be beneficial in enhancing the penetration of loperamide hydrochloride through the skin. Excerpt(s): The invention relates to methods and compositions for the percutaneous delivery of opioid analgesics through the epidermis and, more specifically, to methods and compositions for the percutaneous delivery of loperamide hydrochloride through the epidermis. Opioid analgesics such as morphine are known for the ability to relieve pain. This pharmacological effect occurs in at least three ways: (1) reduction of the central perception of pain probably at the thalamic level, (2) alteration of the reaction to pain probably at the level of the cerebral cortex, and (3) elevation of the pain threshold by inducing sedation or sleep. Certain opioids are also known to be antihyperalgesic. As an antihyperalgesic opioid, loperamide hydrochloride is effective in treating pain and hypersensitivity to painful stimuli associated with inflammatory skin conditions. Due to its high affinity for peripheral opioid receptors and poor ability to penetrate the central nervous system, loperamide hydrochloride is an excellent candidate for topical administration of an antihyperalgesic. Web site: http://www.delphion.com/details?pn=US06355657__

•

Use of loperamide and related compounds for treatment of respiratory disease symptoms Inventor(s): Charest; Robert P. (Forest Park, OH), Gilbert; Sheri A. (Cincinnati, OH), Mizoguchi; Haruko (Fairfield, OH), O'Neill; Timothy P. (Wyoming, OH), Smith; Ronald L. (West Chester, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,116,847 Date filed: January 25, 1991 Abstract: The subject invention involves compositions and methods of using loperamide and related compounds for treatment of symptoms associated with respiratory diseases. Excerpt(s): The subject invention relates to the use of loperamide and related compounds for the treatment of symptoms such as nasal congestion, runny nose, sneezing, itchy nose, itchy eyes, watery eyes, cough, bronchoconstriction and post-nasal drip. Such symptoms are associated with respiratory diseases such as colds, flu, allergic and vasomotor rhinitis, asthma and bronchitis. Loperamide is an opiate agonist used for the treatment of diarrhea; see "5396. Loperamide", The Merck Index, Tenth Edition, M. Windholz, ed., p. 797; and Physicians' Desk Reference for Nonprescription Drugs, 11th Ed. (1990), E. R. Barnhart, pub., pp. 593-594. Loperamide is one of a class of compounds disclosed in U.S. Pat. No. 3,714,159 issued to Janssen, Niemegeers, Stokbroekx & Vandenberk on Jan. 30, 1973. Lomeramide N-oxide is disclosed in "Drug Compendium", Comprehensive Medicinal Chemistry, Vol. 6 (1990), C. Hansch, P. G. Sammes, J. B.

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Taylor & C. J. Drayton, eds., Pergamon Press, N.Y., p. 629, and in Niemegeers, C. J. E., F. Awouters, F. M. Lenaerts, K. S. K. Artois & J. Vermeire, "Antidiarrheal Specificity and Safety of the N-Oxide of Loperamide (R 58 425) in Rats", Drug Development Research, Vol. 8 (1986), pp. 279-286. The above references are hereby incorporated herein by reference. Loperamide is similar to other opiate agonists in having binding affinities at mu and delta opiate receptors. See, e.g., Mackerer, C. R., G. A. Clay & E. Z. Dajani, "Loperamide Binding to Opiate Receptor Sites of the Brain and Myenteric Plexus", Journal of Pharmacology and Experimental Therapeutics, Vol. 199, No. 1 (1976), pp. 131140; Stahl, K. D., W. Van Bever, P. Janssen & E. J. Simon, "Receptor Affinity and Pharmacological Potency of a Series of Narcotic Analgesic, Anti-Diarrheal and Neuroleptic Drugs", Eurpoean Journal of Pharmacology, Vol. 46 (1977), pp. 199-205; Wuster, M. & A. Herz, "Opiate Agonist Action of Antidiarrheal Agents In Vitro and In Vivo--Findings in Support for Selective Action", Naunyn-Schmiedeberg's Archives of Pharmacology, Vol. 301 (1978), pp. 187-194; and Giagnoni, G., L. Casiraghi, R. Senini, L. Revel, D. Parolaro, M. Sala & E. Gori, "Loperamide: Evidence of Interaction with.mu. and.delta. Opioid Receptors", Life Sciences, Vol. 33, Suppl. 1 (1983), pp. 315-318. It is generally accepted that mu and/or delta opioid agonists bind to opioid receptors on the presynaptic terminals of peripheral parasympathetic nerves or sensory nerves and inhibit the release of neurotransmitters from these nerve terminals in a number of model systems. See, e.g., Mudge, A. W., S. E. Leeman & G. D. Fischbach, "Enkephaline Inhibits Release of Substance P from Sensory Neurons in Culture and Decreases Action Potential Duration" , Proceedings of the National Academy of Science, USA, Vol. 76, No. 1 (Jan. 1979), pp. 526-530; Frossard, N. & P. J. Barnes, ".mu.-Opioid Receptors Modulate Noncholinergic Constrictor Nerves in Guinea-Pig Airways", European Journal of Pharmacology, Vol. 141 (1987), pp. 519-522; Burleigh, D. E., "Opioid and Non-opioid Actions of Loperamide on Cholinergic Nerve Function in Human Isolated Colon", European Journal of Pharmacology, Vol. 152 (1988), pp. 39-46; Belvisi, M. G., D. F. Rogers & P. J. Barnes, "Neurogenic Plasma Extravasation: Inhibition by Morphine in Guinea Pig Airways In Vivo", Journal of Applied PhysiologyVol. 66 (1989), pp. 268-272; and Matran, R., C.-R. Martling & J. Lundberg, "Inhibition of Cholinergic and Nonadrenergic, Non-cholinergic Bronchoconstriction in the Guinea Pig Mediated by Neuropeptide Y and.alpha.sub.2 -adrenoceptors and Opiate Receptors", European Journal of Pharmacology, Vol. 163 (1989), pp. 15-23. This inhibition is prevented or reversed by the mu and delta selective opioid antagonist naloxone. Web site: http://www.delphion.com/details?pn=US05116847__

Patent Applications on Loperamide As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to loperamide:

9

This has been a common practice outside the United States prior to December 2000.

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Oral rehydration methods and compositions Inventor(s): Bobrowski, Paul J.; (Scottsdale, AZ) Correspondence: Ellis & Venable, PC; 101 North First AVE.; Suite 1875; Phoenix; AZ; 85003; US Patent Application Number: 20040071793 Date filed: October 3, 2003 Abstract: An improved oral rehydration solution comprising standard formulae of sugars, mineral salts and bicarbonates in combination with Croton species materials with or without the inclusion of material from the Uncaria species. The botanical components are concentrated biologically active materials and thus enhance therapeutic benefit. The Croton component functions as an effective non-paralytic agent in managing diarrhea that is superior to loperamide resulting in a lower stool output. The functionality of the Uncaria species is as an effective anti-inflammatory agent via NF.quadrature.B activation inhibition and protecting gastrointestinal epithelial cells from oxidant-induced death. Excerpt(s): This application claims benefit of U.S. Provisional Application serial No. 60/416,714 filed on Oct. 5, 2002. In mammals, there are a variety of factors which may cause gastrointestinal distress accompanied by a loss of fluid (e.g. vomiting, diarrhea). If transient, the condition may go untreated. However, often the event can cause a fluid loss accompanied by dehydration, such as in some cases of pediatric or amoebic diarrhea, necessitating intervention. Diarrhea is primarily addressed by either the administration of an agent which absorbs pathogenic bacteria, digestive enzymes, toxins, and nutrients from the gastrointestinal tract, or the administration of an oral electrolyte/sugar replacement fluid, more commonly as an oral rehydration solution (ORS). In the latter approach the goal is to simply replace fluid and electrolytes that have been lost, in order to avoid dehydration and electrolyte imbalance. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with loperamide, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “loperamide” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on loperamide. You can also use this procedure to view pending patent applications concerning loperamide. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON LOPERAMIDE Overview This chapter provides bibliographic book references relating to loperamide. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on loperamide include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “loperamide” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on loperamide: •

Rational Use of Drugs in the Management of Acute Diarrhoea in Children Source: Geneva, Switzerland: World Health Organization. 1990. 75 p. Contact: Available from WHO Publications Center USA. 49 Sheridan Avenue, Albany, NY 12210. (518) 436-9686. Fax (518) 436-7433. PRICE: $12.60. ISBN: 9241561424. Order number 1150355. Summary: This book provides information about the rational use of drugs in the management of acute diarrhea in infants and young children, and tackles the problems posed by the prescribing of clinically useless and potentially dangerous drugs. The authors argue against the widespread use of medicines that have no established clinical benefits, are frequently harmful, and may delay or replace effective treatment measures. A table of drugs judged effective lists four first-choice antimicrobials, and six alternatives, useful in the management of cholera, shigella dysentery, amoebiasis, and giardiasis. Apart from these cases of specific etiology, readers are informed that

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antidiarrheal drugs and antiemetic should never be used for children, as none has any proven practical value and some are frankly dangerous. This statement is substantiated through a thorough review of data on eleven antidiarrheal drugs widely used in paediatric practice. The book concludes that none of these preparations has any documented benefits, some actually prolong diarrhoea, and others have been shown to produce severe and sometimes fatal side-effects. Specific compounds covered include diphenoxylate hydrochloride, loperamide, streptomycin and dihydrostreptomycin, neomycin, hydroxyquinolines, nonabsorbable sulfonamides, kaolin and pectin, activated charcoal, and attapulgite and smectite. Each chapter includes numerous references. (AA-M).

Chapters on Loperamide In order to find chapters that specifically relate to loperamide, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and loperamide using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “loperamide” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on loperamide: •

Loperamide Source: in Rational Use of Drugs in the Management of Acute Diarrhoea in Children. Geneva, Switzerland: World Health Organization. 1990. p. 17-22. Contact: Available from WHO Publications Center USA. 49 Sheridan Avenue, Albany, NY 12210. (518) 436-9686. Fax (518) 436-7433. PRICE: $12.60. ISBN: 9241561424. Order number 1150355. Summary: This chapter, from a guidebook detailing the use of drugs in the management of acute diarrhea in children, discusses loperamide. The authors contend that there is no clear evidence that conventional doses of loperamide can reduce the losses of fluids and electrolytes in children with diarrhea. The authors discuss the formulations, pharmacology, mechanism of action, efficacy, and adverse effects of the drug. Following reports of with fatal episodes of paralytic ileus in infants and young children associated with loperamide, the major manufacturer has withdrawn the drop formulation from the market throughout the world. The authors maintain that loperamide cannot be recommended for the management of diarrhea in children, and there is thus no rationale for the production and sale of liquid and syrup formulations of the drug for pediatric use. 36 references. (AA-M).

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CHAPTER 6. PERIODICALS AND NEWS ON LOPERAMIDE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover loperamide.

News Services and Press Releases One of the simplest ways of tracking press releases on loperamide is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “loperamide” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to loperamide. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “loperamide” (or synonyms). The following was recently listed in this archive for loperamide: •

Oral rehydration does not enhance loperamide treatment of traveler's diarrhea Source: Reuters Medical News Date: June 23, 1999

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “loperamide” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “loperamide” (or synonyms). If you know the name of a company that is relevant to loperamide, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “loperamide” (or synonyms).

Newsletters on Loperamide Find newsletters on loperamide using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following

Periodicals and News

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hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “loperamide.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “loperamide” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Bowel Management Medication Source: Pull-Thru Network News. 2(3): 4-5. Spring 1993. Contact: Available from Greater New York Pull-Thru Network. c/o Scott and Karen Brownlow, 4 Woody Lane, West Port, CT 06880. (201) 221-7530. Summary: This newsletter article provides information for parents about using various bowel management medications in their children. The introduction discusses the problems with differentiating between medications; the variety of medications on the market; how the FDA approves drugs; long-term usage and possible side effects; and using generic products. The remainder of the article is divided into two sections: laxatives and antidiarrheals. The laxative section covers bulk-forming laxatives, hyperosmotic laxatives (saline), lubricants, stimulant (contact) laxatives, and stool softeners. The antidiarrheal sections discusses opiates, polycarbophil, loperamide hydrochloride, aluminum powder (hydrated), bismuth subsalicylate, attapulgite, kaolin, activated charcoal, lactobacillus, and pectin. For each agent discussed, the author provides the brand name of product(s) that include that agent. The article concludes with a list of books and the address and telephone number for the National Digestive Diseases Information Clearinghouse for obtaining additional information.

Academic Periodicals covering Loperamide Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to loperamide. In addition to these sources, you can search for articles covering loperamide that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 7. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for loperamide. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with loperamide. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to loperamide: Loperamide •

Oral - U.S. Brands: Imodium; Imodium A-D; Imodium A-D Caplets; Kaopectate II; Maalox Anti-Diarrheal; Pepto Diarrhea Control http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202332.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

71

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “loperamide” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 1010 6 12 14 9 1051

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “loperamide” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on loperamide can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to loperamide. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to loperamide. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “loperamide”:

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Bacterial Infections http://www.nlm.nih.gov/medlineplus/bacterialinfections.html Crohn's Disease http://www.nlm.nih.gov/medlineplus/crohnsdisease.html Drinking Water http://www.nlm.nih.gov/medlineplus/drinkingwater.html E. Coli Infections http://www.nlm.nih.gov/medlineplus/ecoliinfections.html Gallbladder Diseases http://www.nlm.nih.gov/medlineplus/gallbladderdiseases.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on loperamide. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Medications for Inflammatory Bowel Disease Source: New York, NY: Crohn's and Colitis Foundation of America, Inc. (CCFA). 199x. 20 p. Contact: Available from Crohn's and Colitis Foundation of America, Inc. (CCFA). 386 Park Avenue South, 17th Floor, New York, NY 10016-8804. (800) 343-3637 or (800) 9322423 or (212) 685-3440. Fax (212) 779-4098. Website: www.ccfa.org. E-mail: [email protected] PRICE: Single copy free. Summary: This brochure reviews for health professionals the available information on both the standard drug therapy for inflammatory bowel disease (IBD) and the agents under investigation. Topics include 5-ASA agents, including sulfasalazine, topical and oral forms of aminosalicylates, slow-release agents (mesalamine), chemically linked agents (olsalazine), and the side effects of these drugs; corticosteroids in topical, oral, parenteral, and rapidly-metabolized forms; immunomodulators, including 6mercaptopurine and azathioprine, cyclosporin, and methotrexate; antibiotics, including metronidazole, ciproflaxin, and antituberculous agents; lipoxygenase inhibitors; nicotine; antidiarrheal agents, including loperamide, diphenoxylate with atropine, codeine, and deodorized tincture of opium; anticholinergic agents; psychotropic agents; miscellaneous agents that show potential benefit; and drugs that may exacerbate colitis.

Patient Resources

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The brochure includes a section on the management of the pediatric patient, including the use of sulfasalazine, aminosalicylates, corticosteroids, immunomodulators, antibiotics, and antidiarrheal agents. It also addresses specific issues of adolescents. •

Antidiarrheal Therapy Source: Canadian Journal of Gastroenterology. 13(3): 207-208. April 1999. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Summary: This fact sheet, from a professional journal of gastroenterology, guides patients who have been advised to use an antidiarrheal medication. The fact sheet describes various medications used to control diarrhea and the potential risks involved in taking these drugs. Diarrhea is defined as more water in the stool than normal. Antidiarrheal medications are helpful for occasional or short term treatment of diarrhea that the physician does not feel is specifically caused by an inflammatory or serious infectious disease of the intestines. Patients with irritable bowel syndrome (IBS) occasionally take these medications to control diarrhea. The most commonly used antidiarrheal medications are loperamide hydrochloride (Apo Loperamide or Imodium), diphenoxylate with atropine (Lomotil), codeine, bismuth subsalicylate (Pepto Bismol), and cholestyramine (Questran). Most of these medications (all except cholestyramine) work by slowing the movement of food through the intestines. This gives the intestine more time to absorb the water and makes the stool less watery. Cholestyramine binds to the bile in the intestines, helping certain patients (particularly those who have had surgery to remove a section of their small intestine) have fewer problems with diarrhea. These medications are generally very safe for patients with mild diarrhea but can be potentially dangerous for patients with severe diarrhea. Patients are encouraged to work closely with their physicians to manage any problems.

•

Irritable Bowel Syndrome: Tips on Controlling Your Symptoms Source: Kansas City, MO: American Academy of Family Physicians. 2001. 4 p. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. PRICE: $12.50 for 50 copies for members, $18.75 for 50 copies for nonmembers. Order number: 1521. Summary: This patient education brochure helps readers understand irritable bowel syndrome (IBS) and how they can control the symptoms it may cause. In IBS, the intestines squeeze too hard or not hard enough and cause food to move too fast or too slowly through the gastrointestinal (GI) tract. IBS can cause diarrhea, constipation, or both. The symptoms may get worse when the patient experiences stress, including that associated with travel, social events, menstrual cycles, or a change in daily routine. The brochure outlines diagnostic and treatment options, the role of dietary fiber, the impact of diet on IBS symptoms, the role of milk and milk products and the issue of lactose intolerance, managing stress, and drug therapy. The brochure notes that because IBS is a chronic disease, health care providers are hesitant to prescribe long term drug therapy. However, for acute attacks, antispasmodic drugs, loperamide, sedatives, or antidepressants may be prescribed. The brochure encourages readers to find new freedom from IBS by following a management plan that includes a healthy diet, learning new ways to deal with stress, and avoiding foods that make symptoms worse. 2 tables. (AA-M).

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The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to loperamide. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to loperamide. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with loperamide. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about loperamide. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at

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http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “loperamide” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “loperamide”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “loperamide” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “loperamide” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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LOPERAMIDE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Absenteeism: Chronic absence from work or other duty. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of

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antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Alfentanil: A short-acting opioid anesthetic and analgesic derivative of fentanyl. It produces an early peak analgesic effect and fast recovery of consciousness. Alfentanil is effective as an anesthetic during surgery, for supplementation of analgesia during surgical procedures, and as an analgesic for critically ill patients. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergic Rhinitis: Inflammation of the nasal mucous membrane associated with hay fever; fits may be provoked by substances in the working environment. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Altitude Sickness: A morbid condition of anoxia caused by the reduced available oxygen at high altitudes. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility. [NIH]

Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Amebic dysentery: A form of dysentery, usually mild, found especially in childhood epidemics in many temperate countries. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration.

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Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]

Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anoxia: Clinical manifestation of respiratory distress consisting of a relatively complete absence of oxygen. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anti-Anxiety Agents: Agents that alleviate anxiety, tension, and neurotic symptoms, promote sedation, and have a calming effect without affecting clarity of consciousness or neurologic conditions. Some are also effective as anticonvulsants, muscle relaxants, or anesthesia adjuvants. Adrenergic beta-antagonists are commonly used in the symptomatic treatment of anxiety but are not included here. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Antidepressive Agents: Mood-stimulating drugs used primarily in the treatment of

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affective disorders and related conditions. Several monoamine oxidase inhibitors are useful as antidepressants apparently as a long-term consequence of their modulation of catecholamine levels. The tricyclic compounds useful as antidepressive agents also appear to act through brain catecholamine systems. A third group (antidepressive agents, secondgeneration) is a diverse group of drugs including some that act specifically on serotonergic systems. [NIH] Antidiarrheals: Miscellaneous agents found useful in the symptomatic treatment of diarrhea. They have no effect on the agent(s) that cause diarrhea, but merely alleviate the condition. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-infective: An agent that so acts. [EU] Anti-Infective Agents: Substances that prevent infectious agents or organisms from spreading or kill infectious agents in order to prevent the spread of infection. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antiproliferative: Counteracting a process of proliferation. [EU] Antipruritic: Relieving or preventing itching. [EU] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antipsychotic Agents: Agents that control agitated psychotic behavior, alleviate acute

Dictionary 95

psychotic states, reduce psychotic symptoms, and exert a quieting effect. They are used in schizophrenia, senile dementia, transient psychosis following surgery or myocardial infarction, etc. These drugs are often referred to as neuroleptics alluding to the tendency to produce neurological side effects, but not all antipsychotics are likely to produce such effects. Many of these drugs may also be effective against nausea, emesis, and pruritus. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antispasmodic: An agent that relieves spasm. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aqueous: Having to do with water. [NIH] Arachidonate 12-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 12-hydroperoxyarachidonate (12-HPETE) which is itself rapidly converted by a peroxidase to 12-hydroxy-5,8,10,14-eicosatetraenoate (12-HETE). The 12-hydroperoxides are preferentially formed in platelets. EC 1.13.11.31. [NIH] Arachidonate 15-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 15-hydroperoxyarachidonate (15-HPETE) which is rapidly converted to 15-hydroxy5,8,11,13-eicosatetraenoate (15-HETE). The 15-hydroperoxides are preferentially formed in neutrophils and lymphocytes. EC 1.13.11.33. [NIH] Arachidonate Lipoxygenases: Enzymes catalyzing the oxidation of arachidonic acid to hydroperoxyarachidonates (HPETES). These products are then rapidly converted by a peroxidase to hydroxyeicosatetraenoic acids (HETES). The positional specificity of the enzyme reaction varies from tissue to tissue. The final lipoxygenase pathway leads to the leukotrienes. EC 1.13.11.- . [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrial: Pertaining to an atrium. [EU] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH]

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Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Base Sequence: The sequence of purines and pyrimidines in nucleic acids and polynucleotides. It is also called nucleotide or nucleoside sequence. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Belladonna: A species of very poisonous Solanaceous plants yielding atropine (hyoscyamine), scopolamine, and other belladonna alkaloids, used to block the muscarinic autonomic nervous system. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzamides: Benzoic acid amides. [NIH] Bethanechol: A slowly hydrolyzed muscarinic agonist with no nicotinic effects. Bethanechol is generally used to increase smooth muscle tone, as in the GI tract following abdominal surgery or in urinary retention in the absence of obstruction. It may cause hypotension, cardiac rate changes, and bronchial spasms. [NIH] Bicarbonates: Inorganic salts that contain the -HCO3 radical. They are an important factor in determining the pH of the blood and the concentration of bicarbonate ions is regulated by the kidney. Levels in the blood are an index of the alkali reserve or buffering capacity. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of

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fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Bismuth Subsalicylate: A nonprescription medicine such as Pepto-Bismol. Used to treat diarrhea, heartburn, indigestion, and nausea. It is also part of the treatment for ulcers caused by the bacterium Helicobacter pylori (HELL-uh-koh-BAK-tur py-LOH-ree). [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists

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mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchial Spasm: Spasmodic contraction of the smooth muscle of the bronchi. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchoconstriction: Diminution of the caliber of a bronchus physiologically or as a result of pharmacological intervention. [NIH] Bronchus: A large air passage that leads from the trachea (windpipe) to the lung. [NIH] Budesonide: A glucocorticoid used in the management of asthma, the treatment of various skin disorders, and allergic rhinitis. [NIH] Bulking Agents: Laxatives that make bowel movements soft and easy to pass. [NIH] Caecum: The blind pouch in which the large intestine begins and into which the ileum opens from one side. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Channels: Voltage-dependent cell membrane glycoproteins selectively permeable to calcium ions. They are categorized as L-, T-, N-, P-, Q-, and R-types based on the activation and inactivation kinetics, ion specificity, and sensitivity to drugs and toxins. The L- and T-types are present throughout the cardiovascular and central nervous systems and the N-, P-, Q-, & R-types are located in neuronal tissue. [NIH] Calmodulin: A heat-stable, low-molecular-weight activator protein found mainly in the brain and heart. The binding of calcium ions to this protein allows this protein to bind to cyclic nucleotide phosphodiesterases and to adenyl cyclase with subsequent activation. Thereby this protein modulates cyclic AMP and cyclic GMP levels. [NIH] Camptothecin: An alkaloid isolated from the stem wood of the Chinese tree, Camptotheca acuminata. This compound selectively inhibits the nuclear enzyme DNA topoisomerase.

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Several semisynthetic analogs of camptothecin have demonstrated antitumor activity. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Castor Oil: Oil obtained from seeds of Ricinus communis that is used as a cathartic and as a plasticizer. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH]

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Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chlorides: Inorganic compounds derived from hydrochloric acid that contain the Cl- ion. [NIH]

Chlorophyll: Porphyrin derivatives containing magnesium that act to convert light energy in photosynthetic organisms. [NIH] Chloroplasts: Plant cell inclusion bodies that contain the photosynthetic pigment chlorophyll, which is associated with the membrane of thylakoids. Chloroplasts occur in cells of leaves and young stems of higher plants. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholestyramine: Strongly basic anion exchange resin whose main constituent is polystyrene trimethylbenzylammonium as Cl(-) anion. It exchanges chloride ions with bile salts, thus decreasing their concentration and that of cholesterol. It is used as a hypocholesteremic in diarrhea and biliary obstruction and as an antipruritic. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Cholinergic Agonists: Drugs that bind to and activate cholinergic receptors. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH]

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Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clozapine: A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with administration of this agent. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Colitis: Inflammation of the colon. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Communis: Common tendon of the rectus group of muscles that surrounds the optic foramen and a portion of the superior orbital fissure, to the anterior margin of which it is attached at the spina recti lateralis. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy,

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spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Continence: The ability to hold in a bowel movement or urine. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Corneum: The superficial layer of the epidermis containing keratinized cells. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU]

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Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corticotropin-Releasing Hormone: A neuropeptide released by the hypothalamus that stimulates the release of corticotropin by the anterior pituitary gland. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyanobacteria: A subgroup of the oxygenic photosynthetic bacteria comprised of unicellular to multicellular photosynthetic bacteria possessing chlorophyll a and carrying out oxygenic photosynthesis. Cyanobacteria are the only known organisms capable of fixing both carbon dioxide (in the presence of light) and nitrogen. Formerly called blue-green algae, cyanobacteria were traditionally treated as algae. By the late 19th century, however, it was realized that the blue-green algae were unique and lacked the traditional nucleus and chloroplasts of the green and other algae. The comparison of nucleotide base sequence data from 16S and 5S rRNA indicates that cyanobacteria represent a moderately deep phylogenetic unit within the gram-negative bacteria. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxic chemotherapy: Anticancer drugs that kill cells, especially cancer cells. [NIH] Dehydration: The condition that results from excessive loss of body water. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which

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results in a change in the social, political, and economic structures. [NIH] Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastolic: Of or pertaining to the diastole. [EU] Didanosine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. Didanosine is a potent inhibitor of HIV replication, acting as a chain-terminator of viral DNA by binding to reverse transcriptase; ddI is then metabolized to dideoxyadenosine triphosphate, its putative active metabolite. [NIH] Dideoxyadenosine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. The compound is an inhibitor of HIV replication, acting as a chain-terminator of viral DNA by binding to reverse transcriptase. Its principal side effect is nephrotoxicity. In vivo, dideoxyadenosine is rapidly metabolized to didanosine (ddI) by enzymatic deamination; ddI is then converted to dideoxyinosine monophosphate and ultimately to dideoxyadenosine triphosphate, the putative active metabolite. [NIH] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Dimenhydrinate: A drug combination that contains diphenhydramine and theophylline. It is used for treating vertigo, motion sickness, and nausea associated with pregnancy. It is not effective in the treatment of nausea associated with cancer chemotherapy. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Diphenhydramine: A histamine H1 antagonist used as an antiemetic, antitussive, for dermatoses and pruritus, for hypersensitivity reactions, as a hypnotic, an antiparkinson, and as an ingredient in common cold preparations. It has some undesired antimuscarinic and sedative effects. [NIH] Diphenoxylate: A meperidine congener used as an antidiarrheal, usually in combination with atropine. At high doses, it acts like morphine. Its unesterified metabolite difenoxin has similar properties and is used similarly. It has little or no analgesic activity. [NIH]

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Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU] Diuresis: Increased excretion of urine. [EU] Diuretic: A drug that increases the production of urine. [NIH] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Domperidone: A specific blocker of dopamine receptors. It speeds gastrointestinal peristalsis, causes prolactin release, and is used as antiemetic and tool in the study of dopaminergic mechanisms. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dopamine Antagonists: Drugs that bind to but do not activate dopamine receptors, thereby blocking the actions of dopamine or exogenous agonists. Many drugs used in the treatment of psychotic disorders (antipsychotic agents) are dopamine antagonists, although their therapeutic effects may be due to long-term adjustments of the brain rather than to the acute effects of blocking dopamine receptors. Dopamine antagonists have been used for several other clinical purposes including as antiemetics, in the treatment of Tourette syndrome, and for hiccup. [NIH] Dosage schedule: A scheme set up to determine and regulate size, frequency and number of doses. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is

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receiving. [EU] Drip: The continuous slow introduction of a fluid containing nutrients or drugs. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU]

Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the pro-opiomelanocortin precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; opioid peptides is used for the broader group. [NIH] Enkephalin: A natural opiate painkiller, in the hypothalamus. [NIH] Entamoeba: A genus of ameboid protozoa characterized by the presence of beaded chromatin on the inner surface of the nuclear membrane. Its organisms are parasitic in invertebrates and vertebrates, including humans. [NIH] Entamoeba histolytica: A species of parasitic protozoa causing entamoebiasis and amebic dysentery. Characteristics include a single nucleus containing a small central karyosome and peripheral chromatin that is finely and regularly beaded. [NIH] Entamoebiasis: Infection with amoebae of the genus Entamoeba. Infection with E. histolytica causes dysentery, amebic and liver abscess, amebic. [NIH] Enteric Nervous System: The entire nerve apparatus composed of the brain, spinal cord,

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nerves and ganglia. [NIH] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterocolitis: Inflammation of the intestinal mucosa of the small and large bowel. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warm-blooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Escherichia coli: A species of gram-negative, facultatively anaerobic, rod-shaped bacteria commonly found in the lower part of the intestine of warm-blooded animals. It is usually nonpathogenic, but some strains are known to produce diarrhea and pyogenic infections. [NIH]

Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Evacuation: An emptying, as of the bowels. [EU]

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Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Extrapyramidal: Outside of the pyramidal tracts. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Ferrets: Semidomesticated variety of European polecat much used for hunting rodents and/or rabbits and as a laboratory animal. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Food and Beverages: Edible or potable substances. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH]

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Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastrointestinal Transit: Passage of food (sometimes in the form of a test meal) through the gastrointestinal tract as measured in minutes or hours. The rate of passage through the intestine is an indicator of small bowel function. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genital: Pertaining to the genitalia. [EU] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of

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peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-Negative Bacteria: Bacteria which lose crystal violet stain but are stained pink when treated by Gram's method. [NIH] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granule: A small pill made from sucrose. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Harlan: A test for malingering in which a 6D-convex lens is placed before the admittedly good eye and a plano lens before the allegedly bind eye, in addition to the correction for ametropia. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hepatic: Refers to the liver. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH]

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Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydration: Combining with water. [NIH] Hydrochloric Acid: A strong corrosive acid that is commonly used as a laboratory reagent. It is formed by dissolving hydrogen chloride in water. Gastric acid is the hydrochloric acid component of gastric juice. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Breath Test: A test for lactose intolerance. It measures breath samples for too much hydrogen. The body makes too much hydrogen when lactose is not broken down properly in the small intestine. [NIH] Hydroxyquinolines: The 8-hydroxy derivatives inhibit various enzymes and their halogenated derivatives, though neurotoxic, are used as topical anti-infective agents, among other uses. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotherapy: Sleeping-cure. [NIH] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hypoxic: Having too little oxygen. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Ileum: The lower end of the small intestine. [NIH] Ileus: Obstruction of the intestines. [EU]

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Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunocompromised: Having a weakened immune system caused by certain diseases or treatments. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppression: Deliberate prevention or diminution of the host's immune response. It may be nonspecific as in the administration of immunosuppressive agents (drugs or radiation) or by lymphocyte depletion or may be specific as in desensitization or the simultaneous administration of antigen and immunosuppressive drugs. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Imperforate Anus: A birth defect in which the anal canal fails to develop. The condition is treated with an operation. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infectious Diarrhea: Diarrhea caused by infection from bacteria, viruses, or parasites. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues

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caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Invertebrates: Animals that have no spinal column. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH]

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Irinotecan: An anticancer drug that belongs to a family of anticancer drugs called topoisomerase inhibitors. It is a camptothecin analogue. Also called CPT 11. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Jejuno-ileostomy: A surgical procedure that limits the amount of food the stomach can hold by closing off part of the stomach. Food intake is restricted by creating a small pouch at the top of the stomach where the food enters from the esophagus. The pouch initially holds about 1 ounce of food and expands to 2-3 ounces with time. The pouch's lower outlet usually has a diameter of about 1/4 inch. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness. [NIH] Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Lactose Intolerance: The disease state resulting from the absence of lactase enzyme in the musocal cells of the gastrointestinal tract, and therefore an inability to break down the disaccharide lactose in milk for absorption from the gastrointestinal tract. It is manifested by indigestion of a mild nature to severe diarrhea. It may be due to inborn defect genetically conditioned or may be acquired. [NIH] Lactulose: A mild laxative. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukocytosis: A transient increase in the number of leukocytes in a body fluid. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together

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from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5lipoxygenase, arachidonate 12-lipoxygenase, and arachidonate 15-lipoxygenase. EC 1.13.11.12. [NIH] Lipoxygenase Inhibitors: Compounds or agents that combine with lipoxygenase and thereby prevent its substrate-enzyme combination with arachidonic acid and the formation of the eicosanoid products hydroxyeicosatetraenoic acid and various leukotrienes. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Loperamide hydrochloride: An antidiarrheal drug. [NIH] Lubricants: Oily or slippery substances. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malingering: Simulation of symptoms of illness or injury with intent to deceive in order to obtain a goal, e.g., a claim of physical illness to avoid jury duty. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megacolon: Pathological enlargement of the colon. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Meperidine: 1-Methyl-4-phenyl-4-piperidinecarboxylic acid ethyl ester. A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including

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postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration. [NIH] Mercaptopurine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methohexital: An intravenous anesthetic with a short duration of action that may be used for induction of anesthesia. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU] Micturition: The passage of urine; urination. [EU] Misoprostol: A synthetic analog of natural prostaglandin E1. It produces a dose-related inhibition of gastric acid and pepsin secretion, and enhances mucosal resistance to injury. It is an effective anti-ulcer agent and also has oxytocic properties. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH]

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Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multidrug resistance: Adaptation of tumor cells to anticancer drugs in ways that make the drugs less effective. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Neomycin: Antibiotic complex produced by Streptomyces fradiae. It is composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neostigmine: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike physostigmine, does not cross the blood-brain barrier. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH]

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Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurokinin A: A mammalian decapeptide tachykinin found in the central nervous system. It is similar in structure and action to substance P and neurokinin K. The compound has bronchoconstrictor, smooth muscle constrictor, and hypotensive effects and also activates the micturition reflex. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used

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pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Octreotide: A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. It inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH] Ofloxacin: An orally administered broad-spectrum quinolone antibacterial drug active against most gram-negative and gram-positive bacteria. [NIH] Ondansetron: A competitive serotonin type 3 receptor antagonist. It is effective in the treatment of nausea and vomiting caused by cytotoxic chemotherapy drugs, including cisplatin, and it has reported anxiolytic and neuroleptic properties. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Oxytocic: 1. Pertaining to, characterized by, or promoting oxytocia (= rapid labor). 2. An agent that hastens evacuation of the uterus by stimulating contractions of the myometrium. [EU]

Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH]

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Pancreatic Polypeptide: A 36-amino acid polypeptide with physiological regulatory functions. It is secreted by pancreatic tissue. Plasma pancreatic polypeptide increases after ingestion of food, with age, and in disease states. A lack of pancreatic polypeptide in the islets of Langerhans has been associated with the obese syndrome in rats and mice. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Papaverine: An alkaloid found in opium but not closely related to the other opium alkaloids in its structure or pharmacological actions. It is a direct-acting smooth muscle relaxant used in the treatment of impotence and as a vasodilator, especially for cerebral vasodilation. The mechanism of its pharmacological actions is not clear, but it apparently can inhibit phosphodiesterases and it may have direct actions on calcium channels. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous

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system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peristalsis: The rippling motion of muscles in the intestine or other tubular organs characterized by the alternate contraction and relaxation of the muscles that propel the contents onward. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physician-Patient Relations: The interactions between physician and patient. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Physostigmine: A cholinesterase inhibitor that is rapidly absorbed through membranes. It can be applied topically to the conjunctiva. It also can cross the blood-brain barrier and is used when central nervous system effects are desired, as in the treatment of severe anticholinergic toxicity. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Pituitary Hormones: Hormones secreted by the anterior and posterior lobes of the pituitary gland and the pars intermedia, an ill-defined region between the two. Their secretion is regulated by the hypothalamus. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid

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and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Proctocolectomy: An operation to remove the colon and rectum. Also called coloproctectomy. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Pro-Opiomelanocortin: A precursor protein, MW 30,000, synthesized mainly in the anterior pituitary gland but also found in the hypothalamus, brain, and several peripheral tissues. It incorporates the amino acid sequences of ACTH and beta-lipotropin. These two hormones, in turn, contain the biologically active peptides MSH, corticotropin-like intermediate lobe

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peptide, alpha-lipotropin, endorphins, and methionine enkephalin. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propylene Glycol: A clear, colorless, viscous organic solvent and diluent used in pharmaceutical preparations. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoan: 1. Any individual of the protozoa; protozoon. 2. Of or pertaining to the protozoa; protozoal. [EU] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Psychotropic Drugs: A loosely defined grouping of drugs that have effects on psychological function. Here the psychotropic agents include the antidepressive agents, hallucinogens, and tranquilizing agents (including the antipsychotics and anti-anxiety agents). [NIH] Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purgative: 1. Cathartic (def. 1); causing evacuation of the bowels. 2. A cathartic, particularly one that stimulates peristaltic action. [EU] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH]

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Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Rehydration: The restoration of water or of fluid content to a body or to substance which has become dehydrated. [EU] Rehydration Solutions: Fluids restored to the body in order to maintain normal waterelectrolyte balance. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH]

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Rod: A reception for vision, located in the retina. [NIH] Saline: A solution of salt and water. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Salmonellosis: Infection by salmonellae. [NIH] Sanitary: Relating or belonging to health and hygiene; conductive to the restoration or maintenance of health. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Self Administration: Administration of a drug or chemical by the individual under the direction of a physician. It includes administration clinically or experimentally, by human or animal. [NIH] Self Medication: The self administration of medication not prescribed by a physician or in a manner not directed by a physician. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shigella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that

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ferments sugar without gas production. Its organisms are intestinal pathogens of man and other primates and cause bacillary dysentery. [NIH] Short Bowel Syndrome: A malabsorption syndrome resulting from extensive operative resection of small bowel. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Simethicone: A mixture of dimethyl polysiloxanes and silica gel used as an antiflatulent. Without the addition of silica gel (dimethicone), it is used as an ointment base ingredient and skin protectant. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter in the central and peripheral nervous systems. [NIH] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and

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the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Sprue: A non febrile tropical disease of uncertain origin. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Streptomycin: O-2-Deoxy-2-(methylamino)-alpha-L-glucopyranosyl-(1-2)-O-5- deoxy-3-Cformyl-alpha-L-lyxofuranosyl-(1-4)-N,N'-bis(aminoiminomethyl)-D-streptamine. Antibiotic substance produced by the soil actinomycete Streptomyces griseus. It acts by inhibiting the initiation and elongation processes during protein synthesis. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

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Substrate: A substance upon which an enzyme acts. [EU] Sufentanil: An opioid analgesic that is used as an adjunct in anesthesia, in balanced anesthesia, and as a primary anesthetic agent. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Telencephalon: Paired anteriolateral evaginations of the prosencephalon plus the lamina terminalis. The cerebral hemispheres are derived from it. Many authors consider cerebrum a synonymous term to telencephalon, though a minority include diencephalon as part of the cerebrum (Anthoney, 1994). [NIH] Tenesmus: Straining, especially ineffectual and painful straining at stool or in urination. [EU] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart

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and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Topoisomerase inhibitors: A family of anticancer drugs. The topoisomerase enzymes are responsible for the arrangement and rearrangement of DNA in the cell and for cell growth and replication. Inhibiting these enzymes may kill cancer cells or stop their growth. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Tranquilizing Agents: A traditional grouping of drugs said to have a soothing or calming effect on mood, thought, or behavior. Included here are the anti-anxiety agents (minor tranquilizers), antimanic agents, and the antipsychotic agents (major tranquilizers). These drugs act by different mechanisms and are used for different therapeutic purposes. [NIH] Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of

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ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Tricuspid Atresia: Absence of the orifice between the right atrium and ventricle, with the presence of an atrial defect through which all the systemic venous return reaches the left heart. As a result, there is left ventricular hypertrophy because the right ventricle is absent or not functional. [NIH] Trimethoprim-sulfamethoxazole: An antibiotic drug used to treat infection and prevent pneumocystis carinii pneumonia. [NIH] Tubocurarine: A neuromuscular blocker and active ingredient in curare; plant based alkaloid of Menispermaceae. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]

Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU]

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Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vibrio: A genus of Vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Wheezing: Breathing with a rasp or whistling sound; a sign of airway constriction or obstruction. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]

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Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yersinia enterocolitica: A species of the genus Yersinia, isolated from both man and animal. It is a frequent cause of bacterial gastroenteritis in children. [NIH]

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INDEX A Abdominal, 4, 6, 8, 32, 91, 96, 109, 114, 119, 120, 121, 130 Abdominal Pain, 6, 8, 91, 109, 114, 121, 130 Absenteeism, 5, 8, 91 Acetaminophen, 17, 91 Acetylcholine, 91, 100, 118 Adaptation, 14, 91, 117 Adenosine, 91, 98, 121, 129 Adjustment, 91 Adrenal Cortex, 91, 103 Adrenergic, 59, 91, 93, 94, 105, 107, 128 Adverse Effect, 4, 62, 91, 101, 126 Affinity, 58, 59, 91, 92, 101 Agonist, 5, 19, 20, 21, 32, 38, 56, 58, 92, 96, 105, 118, 128 Airway, 92, 131 Alertness, 92, 98 Alfentanil, 23, 92 Algorithms, 92, 97 Alimentary, 3, 8, 10, 12, 16, 22, 29, 36, 51, 92, 104, 120 Alkaline, 57, 92, 98 Alkaloid, 92, 95, 98, 117, 118, 120, 128, 130 Allergic Rhinitis, 92, 98 Alpha Particles, 92, 123 Alternative medicine, 64, 92 Altitude Sickness, 9, 92 Aluminum, 65, 92 Ambulatory Care, 92 Amebiasis, 92, 116 Amebic dysentery, 92, 106 Amino acid, 92, 93, 104, 107, 115, 116, 118, 120, 122, 123, 124, 125, 127, 130 Amino Acid Sequence, 93, 122 Amygdala, 93, 128 Anaerobic, 93, 107, 125 Anal, 10, 20, 22, 26, 38, 93, 108, 112 Analgesic, 59, 91, 92, 93, 101, 104, 115, 117, 119, 128 Analog, 31, 93, 108, 116, 119 Anastomosis, 18, 38, 93 Anesthesia, 92, 93, 103, 116, 128 Anorectal, 20, 38, 93 Anorexia, 93, 109, 130 Anoxia, 92, 93 Antagonism, 93, 98, 101, 104, 129

Anti-Anxiety Agents, 93, 123, 129 Antibacterial, 93, 119, 127 Antibiotic, 6, 7, 8, 9, 93, 96, 98, 107, 117, 127, 130 Antibody, 92, 93, 94, 101, 110, 112, 124, 126 Anticholinergic, 78, 93, 121 Antidepressive Agents, 93, 123 Antidiarrheals, 16, 65, 94 Antiemetic, 46, 62, 94, 104, 105, 116 Antigen, 91, 93, 94, 101, 111, 112 Anti-infective, 94, 111 Anti-Infective Agents, 94, 111 Anti-inflammatory, 60, 91, 94, 95, 104, 109 Anti-Inflammatory Agents, 94, 95 Antimetabolite, 94, 108, 116 Antimicrobial, 4, 7, 10, 34, 94, 100 Antineoplastic, 94, 108, 116, 131 Antiproliferative, 35, 94 Antipruritic, 14, 94, 100 Antipsychotic, 94, 101, 105, 118, 129 Antipsychotic Agents, 94, 105, 129 Antipyretic, 91, 95 Antispasmodic, 6, 79, 95, 119 Antitussive, 95, 104, 119 Anus, 93, 95, 98, 101, 120 Anxiety, 33, 93, 95 Anxiolytic, 95, 119 Aqueous, 57, 95, 114 Arachidonate 12-Lipoxygenase, 95, 115 Arachidonate 15-Lipoxygenase, 95, 115 Arachidonate Lipoxygenases, 95, 115 Arachidonic Acid, 95, 115 Arterial, 95, 102, 111, 123, 128 Arteries, 95, 97, 102, 116, 123 Aspirin, 39, 95 Assay, 49, 95 Asymptomatic, 19, 92, 95, 120 Atrial, 95, 102, 130 Atrioventricular, 95, 102 Atrium, 95, 102, 130, 131 Atropine, 9, 42, 78, 79, 95, 96, 104 Atypical, 96, 101 Autodigestion, 96, 120 Axons, 96, 122 Azithromycin, 9, 96 B Bacteremia, 96, 125

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Bacterial Physiology, 91, 96 Bactericidal, 96, 107 Bacteriophage, 96, 125 Bacteriostatic, 96, 107 Bacterium, 56, 96, 97 Base Sequence, 96, 103 Basophils, 96, 110, 114 Belladonna, 95, 96 Benign, 96, 110, 117, 124 Benzamides, 4, 96 Bethanechol, 4, 19, 96 Bicarbonates, 60, 96 Bile, 18, 79, 96, 97, 100, 108, 115, 127 Bile Acids, 96, 97, 127 Bile Acids and Salts, 96, 97 Bile duct, 97 Biliary, 22, 97, 100, 120 Biliary Tract, 97, 120 Bioavailability, 21, 97 Biopsy, 97, 120 Biotechnology, 11, 64, 73, 97 Biotransformation, 97 Bismuth, 7, 9, 15, 16, 65, 79, 97 Bismuth Subsalicylate, 9, 15, 16, 65, 79, 97 Bladder, 97, 112, 130 Bloating, 5, 97, 112, 114 Blood Coagulation, 97, 98 Blood pressure, 97, 111, 116, 123 Blood vessel, 97, 99, 102, 108, 126, 129, 130, 131 Blood-Brain Barrier, 97, 117, 121 Bone Marrow, 36, 97, 103, 115, 117 Bowel Movement, 98, 102, 104, 127 Broad-spectrum, 98, 119 Bronchi, 98, 107, 129 Bronchial, 56, 96, 98, 110, 129 Bronchial Spasm, 96, 98 Bronchitis, 56, 58, 98 Bronchoconstriction, 58, 98 Bronchus, 98 Budesonide, 43, 50, 98 Bulking Agents, 8, 98 C Caecum, 18, 98 Caffeine, 5, 98 Calcium, 32, 35, 37, 43, 49, 51, 98, 101, 104, 120 Calcium Channels, 32, 35, 37, 98, 120 Calmodulin, 15, 25, 40, 98 Camptothecin, 98, 114 Capsules, 15, 99, 109 Carbohydrate, 99, 122

Carbon Dioxide, 99, 103, 124 Carcinogen, 99, 116 Carcinoma, 45, 99 Cardiac, 96, 98, 99, 102, 107, 117, 127 Cardiovascular, 98, 99, 125 Case report, 6, 99, 100 Case series, 99, 100 Castor Oil, 48, 99 Catecholamine, 94, 99, 105, 121 Cecum, 19, 99, 114 Cell Division, 96, 99, 121 Cell membrane, 98, 99 Cellobiose, 99 Cellulose, 57, 99, 121 Central Nervous System, 33, 49, 56, 58, 91, 98, 99, 101, 108, 110, 117, 118, 121, 125, 129 Centrifugation, 99, 116 Cerebral, 58, 97, 100, 103, 107, 120, 123, 126, 128 Cerebral Cortex, 58, 100 Cerebrum, 100, 128 Character, 100, 109 Chemotherapy, 34, 36, 37, 100, 104 Chlorides, 57, 100 Chlorophyll, 100, 103 Chloroplasts, 100, 103 Cholera, 6, 9, 61, 100, 131 Cholesterol, 96, 97, 100, 127, 128 Cholestyramine, 12, 35, 79, 100 Cholinergic, 4, 34, 59, 94, 100, 118 Cholinergic Agonists, 4, 100 Chromatin, 100, 106, 107, 115, 118 Chronic Disease, 4, 79, 100 Ciprofloxacin, 6, 15, 39, 40, 100 Cisplatin, 100, 119 Clinical study, 6, 100, 102 Clinical trial, 11, 24, 73, 100, 102, 103, 105, 124 Cloning, 97, 101 Clozapine, 23, 101 Codeine, 4, 12, 17, 24, 31, 51, 57, 78, 79, 101, 119 Colitis, 9, 29, 33, 52, 78, 101, 114 Colon, 5, 14, 22, 23, 26, 34, 42, 43, 50, 52, 59, 101, 106, 113, 114, 115, 122, 126, 130 Colorectal, 21, 45, 47, 48, 101 Colorectal Cancer, 21, 47, 48, 101 Communis, 99, 101 Complement, 101, 102 Complementary and alternative medicine, 45, 53, 101

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Complementary medicine, 45, 102 Computational Biology, 73, 102 Cone, 102, 128 Congestion, 58, 94, 102 Connective Tissue, 98, 102, 108, 109 Consciousness, 92, 93, 102, 103, 105 Constipation, 5, 8, 10, 43, 48, 50, 79, 94, 102, 114, 121 Constriction, 102, 131 Continence, 10, 26, 102 Contraindications, ii, 9, 102 Controlled clinical trial, 27, 28, 38, 102 Controlled study, 17, 27, 28, 102 Cor, 28, 31, 102, 103, 122 Corneum, 102, 107 Coronary, 102, 103, 116 Coronary Thrombosis, 103, 116 Corticotropin-Releasing Hormone, 28, 31, 103 Cortisol, 15, 103 Cortisone, 103, 104 Cryptosporidiosis, 96, 103 Curare, 103, 117, 130 Curative, 4, 103, 129 Cyanobacteria, 10, 103 Cyclic, 98, 103, 125, 129 Cyclosporine, 9, 103 Cytotoxic, 103, 119, 124 Cytotoxic chemotherapy, 103, 119 D Dehydration, 4, 60, 100, 103 Delirium, 39, 94, 103 Deuterium, 103, 111 Developing Countries, 9, 103 Dexamethasone, 15, 104 Diabetes Mellitus, 48, 104, 109, 110, 119 Diagnostic procedure, 55, 64, 104 Diastolic, 104, 111 Didanosine, 19, 104 Dideoxyadenosine, 104 Dietary Fiber, 79, 104 Digestion, 23, 92, 96, 97, 98, 104, 112, 113, 115, 120, 127 Digestive system, 104, 109 Digestive tract, 104, 126 Diltiazem, 35, 104 Dimenhydrinate, 57, 104 Dimethyl, 56, 104, 126 Diphenhydramine, 104 Diphenoxylate, 4, 9, 12, 16, 17, 24, 31, 35, 36, 50, 62, 78, 79, 104 Direct, iii, 47, 67, 105, 109, 120, 124, 128

Disinfectant, 105, 107 Disorientation, 103, 105 Disposition, 20, 33, 36, 46, 105 Dissociation, 91, 105, 113 Distal, 105, 122 Distention, 4, 105 Diuresis, 98, 105, 129 Diuretic, 105, 126 Diverticula, 105 Diverticulitis, 7, 105 Diverticulum, 105 Domperidone, 4, 57, 105 Dopamine, 4, 94, 101, 105, 116, 118 Dopamine Antagonists, 4, 105 Dosage schedule, 24, 105 Double-blind, 12, 13, 17, 18, 24, 25, 26, 27, 28, 29, 32, 35, 38, 105 Drip, 58, 106 Drug Interactions, 46, 68, 106 Duodenum, 96, 106, 108, 114, 120, 127 Dysentery, 4, 9, 15, 23, 61, 92, 106, 126 E Effector, 91, 101, 106 Effector cell, 106 Efficacy, 4, 7, 10, 15, 24, 32, 37, 47, 48, 56, 62, 106 Elastic, 106, 109 Electrolyte, 4, 7, 9, 19, 51, 57, 60, 103, 106, 124, 130 Electrons, 106, 113, 123, 124 Empiric, 7, 9, 106 Endemic, 100, 106 Endogenous, 105, 106 Endorphins, 106, 118, 123 Enkephalin, 106, 123 Entamoeba, 10, 106 Entamoeba histolytica, 10, 106 Entamoebiasis, 106 Enteric Nervous System, 4, 106 Enteritis, 5, 49, 107 Enterocolitis, 25, 107 Environmental Health, 72, 74, 107 Enzymatic, 93, 98, 101, 104, 107, 110 Enzyme, 95, 98, 106, 107, 108, 114, 115, 120, 124, 128, 129, 131 Eosinophils, 107, 110, 114 Epidermis, 58, 102, 107 Epinephrine, 91, 105, 107, 118, 130 Epithelial, 14, 60, 107 Epithelial Cells, 14, 60, 107 Erythrocytes, 98, 107 Erythromycin, 4, 96, 107

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Escalation, 36, 50, 107 Escherichia, 8, 10, 107, 109 Escherichia coli, 8, 10, 107, 109 Esophagus, 104, 107, 109, 110, 114, 120, 124, 127 Estrogen, 107, 122, 125, 128 Ethanol, 50, 107, 108 Evacuation, 102, 107, 108, 114, 119, 123 Exogenous, 97, 105, 106, 108 Expiration, 108, 124 Expiratory, 6, 108 Extrapyramidal, 94, 105, 108 Exudate, 108, 119 F Faecal, 18, 20, 33, 48, 49, 104, 108 Family Planning, 73, 108 Fat, 95, 97, 98, 102, 108, 115, 126 Febrile, 7, 9, 108, 127 Fecal Incontinence, 20, 108, 112 Feces, 9, 102, 108, 127 Fentanyl, 23, 92, 108 Fermentation, 108, 125 Ferrets, 46, 108 Fibrosis, 28, 108 Fistula, 108, 119 Flatus, 108 Fluorouracil, 21, 34, 43, 50, 108 Food and Beverages, 9, 108 G Gallbladder, 18, 78, 91, 97, 104, 108, 109 Gamma Rays, 108, 124 Ganglia, 91, 94, 107, 108, 118, 121 Gas, 15, 32, 99, 108, 111, 112, 114, 118, 126 Gastric, 18, 19, 22, 96, 108, 109, 110, 111, 116, 120 Gastric Acid, 18, 108, 116 Gastric Emptying, 18, 19, 22, 108 Gastric Juices, 109, 120 Gastroenteritis, 23, 28, 109, 125, 132 Gastrointestinal, 4, 5, 7, 20, 32, 49, 56, 60, 79, 100, 105, 107, 109, 114, 125, 126, 127, 131 Gastrointestinal tract, 60, 107, 109, 114, 125, 126 Gastrointestinal Transit, 20, 109 Gelatin, 109, 128 Gene, 20, 42, 97, 109 Genital, 100, 109 Giardiasis, 61, 109, 116 Gland, 91, 103, 109, 119, 121, 125, 127 Glucocorticoid, 98, 104, 109

Glucose, 19, 28, 42, 99, 104, 109, 110, 111, 113, 126 Glucose Intolerance, 104, 109 Gluten, 5, 109 Glycoprotein, 23, 37, 49, 109 Governing Board, 109, 122 Gram-negative, 103, 107, 109, 119, 125, 131 Gram-Negative Bacteria, 103, 110 Gram-positive, 110, 114, 119 Granule, 57, 110, 124 Granulocytes, 110, 131 Gravis, 110, 117 H Haptens, 91, 110 Harlan, 42, 110 Headache, 98, 110, 111 Heartburn, 97, 110, 112 Heme, 6, 110 Hemoglobin, 107, 110 Hepatic, 46, 103, 110 Heredity, 109, 110 Heterogeneity, 91, 110 Hiccup, 105, 110 Histamine, 94, 104, 110 Hormonal, 4, 111 Hormone, 103, 107, 111, 113, 119, 122, 125, 126 Hydration, 4, 9, 111 Hydrochloric Acid, 100, 111 Hydrogen, 18, 99, 103, 104, 111, 116, 118, 123 Hydrogen Breath Test, 18, 111 Hydroxyquinolines, 62, 111 Hypersensitivity, 58, 104, 111 Hypertension, 30, 110, 111, 119, 130 Hypertrophy, 102, 111, 130 Hypnotherapy, 8, 10, 111 Hypoglycaemia, 103, 111 Hypotension, 94, 96, 111 Hypotensive, 111, 118 Hypothalamus, 103, 106, 111, 121, 122, 126 Hypoxia, 103, 111 Hypoxic, 111, 116 I Idiopathic, 19, 111 Ileal, 18, 111 Ileostomy, 12, 18, 23, 25, 27, 111 Ileum, 15, 98, 99, 111, 114 Ileus, 32, 62, 111 Immune response, 94, 103, 110, 112, 127, 131 Immune system, 106, 112, 131

137

Immunocompromised, 7, 112 Immunodeficiency, 4, 112 Immunologic, 112, 124 Immunology, 91, 112 Immunosuppressant, 108, 112, 116 Immunosuppression, 112, 119 Impairment, 103, 112 Imperforate Anus, 18, 112 In vitro, 17, 20, 26, 28, 46, 112 In vivo, 20, 26, 43, 104, 112 Incision, 112, 113 Incontinence, 20, 33, 48, 49, 112 Indigestion, 97, 112, 114 Induction, 94, 112, 116, 122 Infancy, 26, 112 Infarction, 95, 103, 112, 116 Infection, 5, 7, 10, 38, 56, 92, 94, 103, 106, 109, 112, 115, 119, 125, 127, 130, 131 Infectious Diarrhea, 4, 6, 7, 8, 19, 112 Inflammatory bowel disease, 9, 78, 113 Ingestion, 113, 120, 122 Inhalation, 110, 113, 122 Initiation, 113, 127 Inorganic, 96, 100, 113, 117 Inotropic, 105, 113 Insulin, 19, 113 Insulin-dependent diabetes mellitus, 113 Intestinal, 12, 17, 19, 28, 42, 48, 103, 107, 113, 114, 115, 126 Intestinal Mucosa, 107, 113 Intestine, 5, 8, 79, 97, 98, 101, 107, 109, 113, 114, 121 Intoxication, 28, 103, 113, 131 Intracellular, 98, 112, 113, 125 Intramuscular, 113, 120 Intravenous, 113, 116, 120 Intrinsic, 92, 113 Invasive, 4, 5, 6, 113 Invertebrates, 106, 113 Involuntary, 108, 113, 117, 124, 126 Ion Channels, 113, 128 Ionization, 35, 113 Ionizing, 92, 113, 124 Ions, 96, 98, 100, 105, 106, 111, 113 Irinotecan, 43, 45, 46, 47, 48, 50, 114 Irritable Bowel Syndrome, 4, 5, 7, 8, 10, 13, 28, 30, 37, 39, 52, 79, 114 Irritants, 106, 114 J Jejuno-ileostomy, 16, 114 Jejunum, 26, 42, 114

K Kb, 72, 114 Kinetic, 113, 114 L Labile, 6, 101, 114 Lactobacillus, 65, 114 Lactose Intolerance, 35, 79, 111, 114 Lactulose, 18, 114 Large Intestine, 43, 98, 99, 101, 104, 113, 114, 124, 126 Laxative, 65, 114, 126 Lens, 110, 114 Leukemia, 36, 114 Leukocytes, 9, 96, 98, 107, 110, 114, 117, 118 Leukocytosis, 6, 114 Linkages, 104, 110, 114 Lipid, 113, 115 Lipoxygenase, 78, 95, 115 Lipoxygenase Inhibitors, 78, 115 Liver, 47, 91, 95, 96, 97, 104, 106, 108, 109, 110, 115 Lobe, 93, 115, 122 Localized, 112, 115, 121, 130 Lubricants, 65, 115 Lymphatic, 112, 115 Lymphocytes, 94, 95, 114, 115, 131 Lysine, 31, 115 M Malabsorption, 18, 115, 126 Malignant, 94, 115, 117, 124 Malingering, 110, 115 Mammary, 115, 128 Mediate, 105, 115 Medicament, 56, 115, 128 MEDLINE, 73, 115 Megacolon, 29, 39, 115 Membrane, 15, 22, 92, 99, 100, 101, 104, 106, 110, 113, 115, 117, 120, 122, 124 Memory, 93, 103, 115 Meninges, 99, 115 Mental, iv, 10, 72, 74, 100, 103, 105, 115, 123, 130 Meperidine, 104, 115 Mercaptopurine, 9, 78, 116 Metabolite, 46, 47, 97, 104, 116, 122 Methionine, 104, 116, 123 Methohexital, 50, 116 Methotrexate, 9, 78, 116 Metoclopramide, 4, 19, 22, 116 Metronidazole, 9, 78, 116 MI, 89, 116

138

Loperamide

Microbe, 116, 129 Microbiology, 91, 96, 116 Microorganism, 116, 120, 131 Microsomal, 46, 116 Micturition, 116, 118 Misoprostol, 17, 116 Modification, 93, 104, 116 Modulator, 32, 116 Molecular, 32, 73, 75, 93, 97, 98, 102, 116, 122, 129 Molecule, 94, 101, 105, 106, 116, 124, 129 Monitor, 9, 116, 119 Monocytes, 114, 117 Morphine, 23, 26, 42, 58, 59, 101, 104, 116, 117, 119 Motility, 4, 5, 8, 18, 32, 48, 117, 125 Motion Sickness, 9, 104, 117 Motor Activity, 20, 117 Motor nerve, 117 Mucosa, 50, 117, 122 Mucus, 43, 106, 117, 130 Multidrug resistance, 20, 117 Muscle relaxant, 8, 93, 117 Muscle tension, 117 Myasthenia, 117 Myocardium, 116, 117 N Narcosis, 117 Narcotic, 23, 59, 108, 115, 117 Nausea, 94, 95, 97, 104, 109, 112, 117, 119, 130 Necrosis, 112, 116, 117 Neomycin, 62, 117 Neoplasms, 94, 117, 124 Neostigmine, 4, 117 Nerve, 34, 59, 91, 93, 96, 106, 117, 118, 127, 130 Nervous System, 96, 99, 117, 118, 120, 128 Neural, 4, 118 Neurokinin A, 5, 118 Neuroleptic, 59, 94, 101, 118, 119 Neuronal, 98, 117, 118 Neurons, 59, 108, 117, 118, 128 Neuropeptide, 59, 103, 118 Neurotoxic, 111, 118 Neurotransmitter, 91, 93, 105, 110, 113, 118, 125, 126, 127, 128 Neutrons, 92, 118, 123 Neutrophils, 95, 110, 114, 118 Nicotine, 78, 118 Nitrogen, 92, 103, 118 Nonverbal Communication, 118, 123

Norepinephrine, 91, 105, 118 Nuclear, 18, 98, 106, 108, 117, 119 Nucleic acid, 96, 104, 118, 119 Nucleus, 96, 100, 103, 106, 107, 108, 115, 117, 118, 119, 123, 128 O Octreotide, 4, 34, 36, 37, 47, 51, 119 Ofloxacin, 34, 119 Ondansetron, 4, 119 Opiate, 19, 20, 21, 31, 32, 38, 56, 58, 106, 117, 119 Opium, 78, 117, 119, 120 Opportunistic Infections, 4, 119 Orthostatic, 94, 119 Outpatient, 119 Overdose, 28, 34, 119 Oxytocic, 116, 119 P Paediatric, 62, 119 Palliative, 119, 129 Palpation, 6, 119 Pancreas, 91, 104, 109, 113, 119, 120, 126 Pancreatic, 22, 38, 119, 120 Pancreatic Polypeptide, 38, 120 Pancreatitis, 5, 34, 120 Papaverine, 119, 120 Parasite, 9, 120, 130 Parasitic, 4, 5, 103, 106, 120 Parenteral, 78, 120 Pathogen, 6, 7, 9, 120 Pathogenesis, 6, 120 Pathologic, 97, 102, 111, 120 Pathophysiology, 5, 8, 120 Patient Education, 78, 79, 84, 86, 89, 120 Pepsin, 116, 120 Peptic, 5, 120 Peptic Ulcer, 5, 120 Peptide, 19, 21, 92, 120, 122, 123 Perception, 58, 102, 120 Percutaneous, 17, 58, 120 Perforation, 33, 120 Perineum, 6, 120 Peripheral Nervous System, 118, 120, 122, 126, 127 Peristalsis, 39, 56, 105, 121 Peritoneum, 121 Peritonitis, 7, 121 Pharmaceutical Preparations, 99, 107, 109, 121, 123 Pharmacokinetic, 121 Pharmacologic, 7, 93, 121, 129, 130 Pharmacotherapy, 4, 14, 19, 34, 121

139

Phosphorus, 98, 121 Physical Examination, 5, 121 Physician-Patient Relations, 5, 121 Physiologic, 92, 121, 124 Physiology, 43, 109, 121 Physostigmine, 117, 121 Pituitary Gland, 103, 121, 122 Pituitary Hormones, 19, 121 Plants, 92, 95, 96, 99, 100, 109, 118, 121, 129 Plasma, 31, 35, 37, 42, 59, 99, 109, 110, 120, 122 Pneumonia, 102, 122, 130 Poisoning, 29, 103, 109, 113, 117, 122, 125 Polypeptide, 93, 120, 122, 126 Polyposis, 101, 122 Polysaccharide, 51, 94, 99, 122 Posterior, 93, 119, 121, 122 Postprandial, 22, 122 Practice Guidelines, 74, 122 Precursor, 95, 105, 106, 107, 118, 122, 130 Presynaptic, 59, 118, 122, 128 Presynaptic Terminals, 59, 122 Prevalence, 5, 8, 122 Proctocolectomy, 21, 26, 122 Prodrug, 20, 36, 122 Progression, 7, 122 Prolactin, 105, 122 Pro-Opiomelanocortin, 42, 106, 122 Prophylaxis, 9, 10, 17, 123 Propylene Glycol, 17, 123 Protein S, 97, 107, 117, 123, 124, 127 Proteins, 92, 93, 94, 99, 100, 101, 107, 116, 118, 120, 122, 123, 125, 130 Protons, 92, 111, 113, 123 Protozoa, 106, 116, 123, 130 Protozoan, 103, 109, 123, 130 Psychomotor, 103, 118, 123 Psychotherapy, 5, 8, 123 Psychotropic, 8, 10, 78, 123 Psychotropic Drugs, 8, 123 Psyllium, 52, 123 Public Policy, 73, 123 Publishing, 6, 9, 11, 123 Pulmonary, 97, 102, 123, 131 Pulmonary hypertension, 102, 123 Pulse, 116, 123 Purgative, 114, 123 Pyogenic, 107, 123 R Radiation, 18, 49, 108, 112, 113, 116, 123, 124, 132

Radioactive, 111, 113, 119, 124 Radioimmunotherapy, 124 Radiological, 120, 124 Radiotherapy, 27, 124 Randomized, 7, 13, 32, 34, 36, 40, 106, 124 Receptor, 8, 32, 38, 42, 46, 59, 91, 94, 101, 102, 105, 119, 124, 125 Rectum, 22, 93, 95, 98, 101, 104, 108, 112, 113, 114, 122, 124, 128 Reductase, 116, 124 Refer, 1, 101, 106, 118, 124, 129 Reflex, 118, 124 Reflux, 19, 124 Refraction, 124, 127 Regimen, 106, 121, 124 Rehydration, 4, 34, 60, 63, 124 Rehydration Solutions, 4, 124 Relaxant, 120, 124 Renal failure, 103, 124, 130 Resection, 12, 17, 18, 124, 126 Respiration, 99, 103, 116, 124 Rhinitis, 56, 58, 124 Ribosome, 124, 130 Rod, 96, 107, 114, 125 S Saline, 65, 125 Salmonella, 6, 8, 10, 109, 125 Salmonellosis, 5, 125 Sanitary, 9, 125 Screening, 7, 29, 49, 100, 125 Second Messenger Systems, 125 Secretion, 15, 18, 19, 21, 22, 37, 42, 43, 50, 110, 113, 116, 117, 119, 121, 125 Secretory, 26, 125, 128 Sedative, 101, 104, 125 Seizures, 103, 125 Selective estrogen receptor modulator, 125, 128 Self Administration, 125 Self Medication, 3, 125 Senna, 50, 53, 125 Serotonin, 94, 101, 118, 119, 121, 125 Serum, 4, 101, 121, 125 Shigella, 6, 8, 10, 61, 125 Short Bowel Syndrome, 22, 126 Side effect, 6, 9, 56, 65, 67, 78, 91, 94, 95, 104, 126, 129 Sigmoid, 126 Sigmoidoscopy, 9, 126 Simethicone, 14, 32, 126 Skeletal, 103, 126

140

Loperamide

Small intestine, 18, 42, 43, 79, 99, 106, 107, 109, 111, 113, 114, 126 Smooth muscle, 4, 8, 10, 96, 98, 110, 117, 118, 120, 126, 127 Sneezing, 58, 126 Soft tissue, 97, 126 Solvent, 58, 107, 123, 126 Somatostatin, 119, 126 Sorbitol, 5, 126 Spasm, 6, 95, 110, 126 Spastic, 52, 114, 126 Specialist, 80, 126 Species, 8, 60, 96, 103, 106, 107, 109, 114, 120, 126, 127, 131, 132 Specificity, 59, 92, 95, 98, 126 Spectrum, 7, 46, 127 Sphincter, 19, 20, 22, 26, 38, 127 Spinal cord, 99, 100, 106, 115, 118, 120, 124, 127 Spinous, 107, 127 Sprue, 5, 127 Steroid, 97, 103, 127 Stimulant, 65, 98, 110, 127 Stimulus, 106, 113, 124, 127, 129 Stomach, 91, 96, 104, 107, 108, 109, 111, 114, 117, 120, 124, 126, 127 Stool, 4, 6, 7, 9, 19, 60, 65, 79, 101, 112, 114, 127, 128 Streptomycin, 62, 127 Stress, 4, 5, 79, 99, 103, 109, 114, 117, 127 Stupor, 117, 127 Subacute, 112, 127 Subclinical, 112, 125, 127 Subcutaneous, 37, 120, 127 Subspecies, 126, 127 Substance P, 59, 107, 116, 125, 127 Substrate, 115, 128 Sufentanil, 23, 128 Supplementation, 92, 128 Suppositories, 21, 29, 109, 128 Suppression, 38, 128 Suppressive, 15, 128 Sympathomimetic, 105, 107, 119, 128 Symptomatic, 5, 7, 8, 12, 13, 25, 27, 38, 93, 94, 120, 128 Symptomatic treatment, 5, 7, 8, 12, 13, 25, 38, 93, 94, 128 Synapse, 91, 122, 128, 130 Synaptic, 118, 128 Synaptic Transmission, 118, 128 Systemic, 21, 43, 97, 103, 107, 112, 128, 130 Systolic, 111, 128

T Tamoxifen, 35, 125, 128 Telencephalon, 100, 128 Tenesmus, 106, 128 Teratogenic, 104, 128 Thalamic, 58, 128 Theophylline, 104, 128 Therapeutics, 3, 8, 10, 12, 14, 16, 22, 24, 29, 33, 36, 37, 50, 51, 59, 68, 129 Threshold, 58, 111, 129 Tone, 10, 96, 129 Tonus, 129 Tooth Preparation, 91, 129 Topical, 56, 58, 78, 107, 111, 129 Topoisomerase inhibitors, 114, 129 Toxic, iv, 6, 29, 39, 56, 95, 103, 118, 129 Toxicity, 14, 30, 48, 106, 121, 129 Toxicokinetics, 129 Toxicology, 35, 50, 74, 129 Toxin, 6, 9, 129 Tranquilizing Agents, 123, 129 Transcriptase, 104, 129 Transfection, 97, 129 Translation, 47, 92, 107, 117, 129 Translocation, 107, 130 Transmitter, 91, 105, 113, 118, 130 Trauma, 103, 110, 117, 120, 130 Trichomoniasis, 116, 130 Tricuspid Atresia, 102, 130 Trimethoprim-sulfamethoxazole, 6, 11, 34, 130 Tubocurarine, 117, 130 Tunica, 117, 130 Tyrosine, 105, 130 U Ulcer, 116, 130 Ulceration, 120, 130 Ulcerative colitis, 5, 113, 130 Uraemia, 120, 130 Urinary, 33, 96, 100, 112, 130 Urinary Retention, 96, 130 Urine, 97, 102, 105, 112, 116, 130 V Vaccines, 130, 131 Vagina, 114, 130 Vaginal, 17, 130 Vascular, 112, 130 Vasculitis, 120, 131 Vasodilator, 105, 110, 120, 131 Vasomotor, 58, 131 Ventricle, 93, 95, 102, 111, 123, 128, 130, 131

141

Ventricular, 102, 130, 131 Vertigo, 104, 131 Vesicular, 116, 131 Veterinary Medicine, 73, 131 Vibrio, 8, 100, 131 Vinca Alkaloids, 131 Vincristine, 49, 131 Viral, 4, 104, 131 Virulence, 129, 131 Virus, 10, 56, 96, 131 Vitro, 59, 131

Vivo, 42, 59, 131 W Wakefulness, 103, 131 Wheezing, 6, 131 White blood cell, 9, 93, 114, 115, 117, 131 Withdrawal, 40, 103, 116, 131 X Xenograft, 47, 132 X-ray, 108, 119, 124, 132 Y Yersinia enterocolitica, 6, 132

142

Loperamide

143

144

Loperamide