Chapter 21 Goals Page 881 Students will be able to:

Chapter 21 Goals Page 881 Students will be able to:
Describe the various subspecialty areas of pharmacology. Identify the various routes & schedule of drug administration Differentiate among the various classes of drugs & name their primary actions & side effects Define medical terms using combining forms & prefixes that relate to pharmacology Apply your new knowledge to understanding medical terms in their proper contexts, such as medical reports & records.

Pharmacology Chapter 21 Pages 881 – 920

Introduction Medicines are substances used to prevent or treat a disease or condition. Some drugs are obtained from plants such as the roots, leaves, & fruit. Other drugs are derived from molds. Drugs also are obtained from animals. Virtually all drugs are synthesized for commercial purposes in a laboratory. Vitamins are drugs that are isolated from plant or animal sources & are contained in foods. An example of a plant-derived drug is a cardiac medicine, digitalis (from the foxglove plant). Other drugs are derived from molds (antibiotics such as penicillin) For example, some pharmaceutical hormones are secretions from the glands of animals, & anti-venoms are prepared from the venom of snakes, spiders, or other species with poisonous bites or stings.

Introduction: Cont. Page 882
A pharmacist prepares & dispenses drugs through a pharmacy on a written order from a physician. The order is called a prescription. Most colleges of pharmacy offer a PharmD degree after 6 years. As a health care professional, a pharmacist cooperates with, consults with, & sometimes advises licensed practitioners concerning drugs. In addition, the pharmacist answers patients’ questions about their prescription. A pharmacy technician helps licensed pharmacists provide medication & other health care products to patients. PharmD = doctor of pharmacy MD = doctor of medicine PD = doctor of philosophy

Pharmacology = the study of the discovery, properties, & uses of drugs. A pharmacologist is either an MD or a PhD who specializes in the study of medicines. Pharmacology contains many subdivisions of study: medicinal chemistry, pharmacodynamics, pharmacokinetics, molecular pharmacology, chemotherapy, & toxicology.

Medicinal chemistry = the study of new drug synthesis & the relationship between chemical structure & biologic effects. Pharmacodynamics = the study of a drug’s effects in the body. Pharmacokinetics = the study of a drug’s absorption, distribution in to body compartments, metabolism, & excretion over a period of time. Molecular pharmacology = the study of the interaction of drugs & subcellular entities, such as DNA, RNA, & enzymes. It provides important information about the mechanism of action of drugs. Absorption = how drugs pass into the bloodstream Metabolism = changes that drugs undergo within the body Excretion = removal of the drug from the body

Chemotherapy = the study of drugs that destroy microorganisms, parasites, or malignant cells within the body. Chemotherapy includes treatment of infectious diseases & cancer. Toxicology = the study of the harmful effects of drugs & chemicals on the body. Toxicology studies are conducted in animals, as required by law, before new drugs can be tested in humans. A toxicologist also is interested in finding proper antidotes to any harmful effects of drugs. Antidotes are substances given to neutralize unwanted effects of drugs. Absorption = how drugs pass into the bloodstream Metabolism = changes that drugs undergo within the body Excretion = removal of the drug from the body

Drug Names, Standards, & References
Page 883 Drug Names, Standards, & References Names A drug can have three different names. The chemical name specifies the exact chemical makeup of the drug. The generic name identifies the drug legally & scientifically. It becomes public property after 17 years of use by the original manufacturer, & any drug manufacturer may use it thereafter. The brand name is the private property of the individual drug manufacturer, & no competitor may use it. chemical name – This name often is long & complicated The generic name – typically shorter & less complicated. There is only one generic name for each drug. The brand name – Drugs can have several brand names, because each manufacturer producing the drug gives it a different name. When a specific brand name is ordered on a prescription by a physician, it must be dispensed by the pharmacist; no other brand name may be substituted. It is usual practice to capitalize the first letter of a brand name. A brand name (or trade name) often has the ® after or before the name, indicating that it is a registered brand name.

Drug Names, Standards, & References: Cont.
Page 883 Drug Names, Standards, & References: Cont. Standards The U.S. Food & Drug Administration (FDA) has the legal responsibility for deciding whether a drug may be distributed & sold. It sets strict standards for efficacy, safety, & purity. The FDA requires extensive experimental testing in animals & people before it approves a new drug for sale for a specific medical use. An independent committee of physicians, pharmacologists, pharmacists, & manufactures, called the Untied States Pharmacopeia (USP), reviews the available commercial drugs & continually reappraises their effectiveness in specific medical conditions. efficacy = effectivenees

Drug Names, Standards, & References: Cont.
Page 883 Drug Names, Standards, & References: Cont. References Two reference listings of drugs are available: Hospital formulary = The most complete & up-to-date listing, it gives information about the characteristics of drugs & their clinical usage as approved by a particular hospital. Physician’s Desk Reference (PDF) = published by a private firm, & drug manufacturers pay to have their products listed. clinical usage = application to patient care The PDR is a useful reference with several different indices to identify drugs, along with a complete description of the drug’s properties & approved indications. It also gives precautions, warnings about side effects, & information about the recommended dosage & administration of each drug.

Administration of Drugs
Page 884 Administration of Drugs The route of administration of a drug determines how well it is absorbed into the blood, & its speed & duration of action. Various methods of administering drugs are: Oral administration. Drugs given by mouth are slowly absorbed into the bloodstream through the stomach or intestinal wall. Sublingual administration. Drugs placed under the tongue dissolve in the saliva. Rectal administration. Suppositories (cone-shaped objects contain drugs) & aqueous solutions are inserted into the rectum. Route of administration of a drug (how it is taken into the body) angina (chest pain) Oral administration - This method, although convenient for the patient, has several disadvantages. If the drug is destroyed in the digestive tract by digestive juices, or if the drug is unable to pass through the intestinal wall, it will be ineffective. Oral administration is also a disadvantage if a rapid onset of action is desired. It takes several hours for oral medication to be fully absorbed into the bloodstream. Sublingual administration - For some agents, absorption may be rapid. Nitroglycerin tablets are administered in this way to treat attacks of angina. Rectal administration - Drugs are given by rectum when oral administration presents difficulties, as when the patient is nauseated & vomiting.

Administration of Drugs: Cont.
Page 884 Administration of Drugs: Cont. Parenteral administration. Injection of drug from a syringe through a hollow needle placed under the skin, into a muscle, vein, or body cavity. There are several types of parenteral injections & instillations: Intracavitary instillation. This injection is made into a body cavity, such as the peritoneal or pleural cavity. Intradermal injection. This shallow injection is made into the upper layers of the skin & is used chiefly in skin testing for allergic reactions. Intracavitary instillation – For example, drugs may be introduced into the pleural cavity in people who have pleural effusions due to malignant disease. The drug causes the pleural surfaces to adhere, thereby obliterating the pleural space & preventing the accumulation of fluid. This procedures is known as pleurodesis.

Page 884 Administration of Drugs: Cont. Subcutaneous (hypodermic) injection (subQ). A small hypodermic needle is introduced into the subcutaneous tissue under the skin, usually on the upper arm, thigh, or abdomen. Intramuscular injection (IM). The buttock or upper arm is the usual site for this injection into muscle. Intrathecal instillation. This installation is into the space under the membranes surrounding the spinal cord & brain. Intravenous injection (IV). This injection is given directly into a vein. membranes (meninges) Subcutaneous (hypodermic) injection (subQ) – Insulin is injected daily via this route Intramuscular injection (IM) – When drugs are irritating to the skin or when a large volume or solution must be administered, IM injections are used. Intrathecal instillation – Methotrexate (a cancer chemotherapeutic drug) is introduced intrathecally for treatment of leukemia involving the spinal canal. Intravenous injection (IV). – It is used when an immediate effect from the drug is desired or when the drug is poorly absorbed into the bloodstream after oral administration. Good technical skill is needed with intravenous injections because leakage of a drug into surrounding tissue may result in irritation & inflammation. Some medicines, such as anticancer drugs, are dissolved in a large volume of fluid & given by a several-hour-long intravenous infusion.

Pages 884 – 885 Administration of Drugs: Cont. Inhalation. Vapors, or gases, taken into the nose or mouth are absorbed into the bloodstream through the thin walls of air sacs in the lungs. Topical application. Drugs are applied locally on the skin or mucous membranes of the body. Inhalation – Aerosols (particles of drugs suspended in air) are administered by inhalation, as are many anesthetics. Aerosolized medicines are used to treat asthma (spasm of the lung airways). Topical application – Antiseptics (against infection) & antipruritics (against itching) commonly are used as ointment, creams, & lotions. Transdermal patches are used to deliver drugs (such as estrogen for hormone replacement therapy, slow-release pain medications, & nicotine for smoking cessation programs) continuously through the skin.

Drug Actions & Interactions
Page 886 Drug Actions & Interactions When a drug enters the body, it produces its effect by interacting with a specific target, or receptor. A drug may cross the cell membrane to reach its intracellular receptor or may react with a receptor on the cell’s surface. The dose of a drug is the amount of drug administered, usually measured in milligrams or grams. Schedule is the exact timing & frequency of drug administration.

Drug Actions & Interactions: Cont.
Page 886 Drug Actions & Interactions: Cont. Various actions & interactions of drugs in the body can occur after they have been absorbed into the blood stream. Additive action = the combination of two similar drugs is equal to the sum of the effects of each. Antagonistic = two drugs give less than an additive effect. Synergistic = two drugs cause an effect that is greater than the sum of the individual effects of each drug given alone. Additive action = For example, if drug A gives 10% tumor kill as a chemotherapeutic agent & drug B gives 20% tumor kill, using A & B together would give 30% tumor kill. Synergistic = For example, INH (isoniazid) & rifampin, two antibiotic drugs, are given together in the treatment of tuberculosis because of their synergistic action to cure the disease. Individually, the drugs are not as effective.

Drug Actions & Interactions: Cont.
Page 886 Drug Actions & Interactions: Cont. Response = a desired & beneficial effect of a drug. Lowering blood pressure by antihypertensive drugs is an example. Tolerance = For some drugs, the effects of a given dose diminish as treatment continues, & increasing amounts are needed to produce the same effect. Tolerance is a feature of addiction to drugs such as morphine & meperidine hydrochloride (Demerol). Addiction is the physical & psychological dependence on & craving for a drug & the presence of clearly unpleasant effects when that drug or other agent such as a narcotic is stopped. Controlled substances are drugs such as opioids or narcotics that produce dependence & have potential for abuse or addition.

Drug Toxicity Drug toxicity = an unpleasant & potentially dangerous effect of a drug. Idiosyncrasy = any unexpected & uncommon side effect that develops after administration of a drug. Other types of drug toxicity are more predictable & expected, such as stomach upset after aspirin use. Physicians are trained to be aware of the potential toxic effects of all drugs that they prescribe. Iatrogenic disorders can occur as a result of mistakes in drug use or because of individual sensitivity to a given agent. anaphylaxis (acute hypersensitivity with asthma & shock) foreign substance (antigen) Iatrogenic disorders (produced by treatment) Idiosyncrasy – For example, in some people, penicillin causes an idiosyncratic reaction, such as anaphylaxis. Anaphylaxis occurs as a result of exposure to a previously encountered drug or foreign substance.

Pages 886 – 887 Drug Toxicity Side effects = unpleasant effects that routinely result from the use of a drug. They often occur with the usual therapeutic dosage of a drug & generally are tolerable & reversible when the drug is discontinued. Other, rare side effects may be life-threatening. Contraindications = factors in a patient’s condition that make the use of a particular drug dangerous & ill- advised. Drug resistance = the reduction in effectiveness of a drug. It is seen when drugs are unable to control the disease process in a particular patient. Resistance results from an important mutation in disease. mutation (genetic change) disease (bacterial, viral, or cancer) Side effects = For example, nausea, vomiting, & alopecia are common side effects of the chemotherapeutic drugs used to treat cancer. rare side effects that are life-threatening = severe allergic reactions. Contraindications = For example, in the presence of kidney failure, it is unwise to administer a drug, such as methotrexate, that is normally eliminated by the kidneys because excess drug will accumulate in the body & cause adverse effects.

Classes of Drugs The following are major classes of drugs with indications for their uses. Notice that many drug types end with the adjectival suffix –ic, meaning pertaining to, although they are used as nouns.

Classes of Drugs: Cont. Page 887
Analgesics = a drug that lessens pain. Mild analgesics relieve mild to moderate pain, such as myalgias, headaches, & toothaches. More potent analgesics are narcotics or opioids, which are derived form opium. These drugs may induce stupor. They are used only to relieve severe pain because they may produce dependence. stupor (a condition of near-unconsciousness & reduce mental & physical activity)

Some non-narcotic analgesics reduce fever, pain, & inflammation & are used for joint disorders, painful menstruation, & acute pain due to minor injuries or infection. These agents are known as nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs act on tissue to inhibit prostaglandins. A newer class of stronger NSAIDs is the COX-2 inhibitors. These agents block prostaglandin production. They relieve pain & inflammation as do traditional NSAIDs with fewer gastrointestinal side effects than NSAIDs. However, they may increase the risk of clot formation & myocardial infarctions. joint disorders (osteoarthritis & rheumatoid arthritis) prostaglandins (hormone-like substances that sensitize peripheral pain receptors) COX-2 (cyclooxygenase-2) heart attacks (myocardial infarctions)

Anesthetics = reduces or eliminates sensation This effect may occur in all tissues of the body (general anesthetic) & puts a patient asleep, or may be limited to a particular region (local anesthetic). General anesthetics are used for surgical procedures. They depress the activity of the central nervous system, producing loss of consciousness, & block the perception of pain. Local anesthetics inhibit the conduction of pain impulses in sensory nerves in the region in which they are injected or applied. An example is dental anesthesia with a local Novocain injection.

Classes of Drugs: Cont. Page 888 Antibiotics & Antivirals
Antibiotic = a chemical substance produced by a microorganism that inhibits or kills bacteria, fungi, or parasites. The use of antibiotics has made it possible to cure many conditions such as pneumonia, urinary tract infection, & streptococcal pharyngitis. Caution about the use of antibiotics is warranted because they are powerful agents. Like all drugs, they have side effects. Also, with indiscriminate use of antibiotics, bacteria & fungi can develop resistance to a particular agent. Infections caused by these resistant bacteria can spread & may be difficult or impossible to cure. microorganism (bacterium, yeast, or mold) inhibits (bacteriostatic) kills (bactericidal) streptococcal pharyngitis (“strep throat”) penicillin was first in general use in the 1940s

Antifungal drugs = treat fungal infections. These infections commonly occur in the skin, vagina, mouth, bloodstream, or lungs. Antitubercular drugs treat tuberculosis, a chronic & often drug-resistant infection. Antiviral drugs = used against infections due to viruses, such as herpes viruses, Epstein-Barr virus, cytomegalovirus (CMV), human immunodeficiency virus (HIV), & hepatitis C virus. skin (ringworm) vagina (moniliasis or candidiasis)

Classes of Drugs: Cont. Page 888 Anticoagulants & Antiplatelet Drugs
Anticoagulants = prevent coagulation of blood. They prevent formation of/break up clots in blood vessels & blood used for transfusions. Heparin = natural anticoagulant purified from pig intestine, bovine lung & granules of certain WBCs. Warfarin (Coumadin) = chemically synthesized anticoagulant; blocks the formation of a number of clot-formatting factors in the blood. Tissue-type plasminogen activator (tPA) dissolves clots & is used to open vessels after heart attacks. clotting (coagulation) white blood cells (WBC) in conditions such as thrombosis & embolism. A more easily administered form of heparin called low-molecular-weight heparin is self-injected on a daily basis & requires no monitoring of blood clotting ability, as is done with regular heparin. Coumadin - Its action is reversed by vitamin K. New anticoagulant drugs that greatly reduce the risk of stroke are called NOACs (new oral anticoagulants) Examples are apixaban (Eliquis), dabigatran (Pradaxa), & rivaroxaban (Xarelto).

Antiplatelet drugs = reduce the tendency of platelets to stick together. Aspirin is an example of an antiplatelet drug; daily aspirin prophylaxis is recommended for patients with coronary artery disease & for those who have had heart attacks. Plavix inhibits clumping of platelets & is used to prevent clotting after heart attacks & blood vessel procedures, such as angioplasty. Clpidogrel (Plavix)

Anticonvulsants = prevent or reduce the frequency of convulsions in various types of seizure disorders or epilepsy. Ideally, anticonvulsants depress abnormal spontaneous activity of the brain arising from areas of scar or tumor, without affecting normal brain function.

Antidepressants & Anti-Alzheimer Drugs Antidepressants = elevate mood, increase physical activity & mental alertness, & improve appetite & sleep patterns. Many antidepressants also are mild sedatives & treat mild forms of depression associated with anxiety. Lithium is a drug that is used to stabilize the mood swings & unpredictable behavior of people with bipolar disorder. removal (reuptake) synapses (spaces between nerve cells) The largest class of antidepressants increases the action of neurotransmitters by blocking their removal from the synapses. These drugs include tricyclic antidepressants (TCAs) & selective serotonin reuptake inhibitors (SSRIs). Other antidepressants are monoamine oxidase inhibitors (MAOIs), which increase the length of time neurotransmitters work by blocking monoamine oxidase, an enzyme that normally inactivates neurotransmitters. bipolar disorder (manic-depressive illness)

Anti-Alzheimer drugs, used to treat symptoms of Alzheimer disease, act by aiding brain neurotransmitters (acetylcholine) or shielding brain cells from glutamate, a neurotransmitter that at high levels contributes to death of brain cells.

Antidiabetics = used to treat diabetes mellitus. Patients with type 1 diabetes have lost the ability to produce insulin as children or young adults & must receive daily injections of insulin. Patients with type 2 diabetes have insensitivity in insulin. Their diabetes may be well controlled by limiting sugars in their diet & by taking oral antidiabetic drugs. An insulin pump is a device strapped to the patient’s waist that periodically delivers the desired amount of insulin. diabetes mellitus (condition in which either the hormone insulin is not produced, or the body’s tissue have developed insensitivity to insulin) Human insulin & synthetic derivations produced by recombinant DNA research have largely replaced animal-derived insulin in the management of diabetes. Rapid-acting insulins start working in 15 to 30 minutes & last 3 to 5 hours. Short-acting insulin begins working within 30 minutes to an hour & lasts 5 to 8 hours. Long-acting insulins have a time to onset of 1 to 3 hours & last between 24 & 36 hours. These include sulfonylureas (lower the levels of glucose in the blood by stimulating the production of insulin), biguanides (increase the body’s sensitvitiy to insulin & reduce the productio of glucose by the liver), alpha-glucosidase inhibitors (temporarily block enzymes that digest sugars), thiazolidinediones (enhance glucose uptake into tissues), & meglitinides (stimulate the beta cells in the pancreas to produce insulin).

Antihistamines = block the action of histamine. Histamine causes allergic symptoms such as hives, bronchial asthma, hay fever, & in severe cases, anaphylactic shock. Antihistamines cannot cure the allergic reaction, but they relieve its symptoms. Many antihistamines have strong antiemetic activity & are used to prevent motion sickness. The most common side effects of antihistamines are drowsiness, blurred vision, tremors, digestive upset, & lack of motor coordination. anaphylactic shock (dyspnea, hypotension, & loss of consciousness) antiemetic (prevention of nausea)

Classes of Drugs: Cont. Page 892 Antiosteoporosis Drugs
Osteoporosis is a disorder marked by loss of bone density. Calcium, vitamin D, & estrogen may increase calcium deposition in bone. Several different drugs are used to treat osteoporosis. Bisphosphonates prevent bone loss, & hormone- like drugs called selective estrogen receptor modulators (SERMs) increase bone formation.

Cardiovascular Drugs = act on the heart or the blood vessels to treat hypertension, angina, myocardial infraction, congestive heart failure, & arrhythmias. Often before other drugs are used, daily aspirin therapy & sublingual nitroglycerin are prescribed. Digoxin (Lanoxin) helps the heart pump more forcefully in heart failure. angina (pain due to decreased oxygen delivery to heart muscle) myocardial infraction (heart attack) daily aspirin therapy (to prevent clots in blood vessels) sublingual nitroglycerin (to dilate coronary blood vessels)

Endocrine Drugs = act in much the same manner as naturally occurring hormones discussed in Ch. 18 Androgens are used for male hormone replacement & to treat endometriosis & anemia. Antiandrogens interfere with the production of androgens or with their binding receptors. They are proscribed for prostate cancer. Estrogens are used for symptoms associated estrogen replacement therapy & to prevent postmenopausal osteoporosis. Aromatase inhibitors also reduce the amount of estrogen in the blood & are effective against breast cancer. Androgens normally made by the testes & adrenal glands Estrogens are female hormones, normally produced by the ovaries, Selective estrogen receptor modular (SERMs) have estrogen-like effects on bone (increase in bone density) & on lipid metabolism (decrease in cholesterol levels). However, they lack estrogenic effects on uterus & breast tissue. SERMs are used to treat postmenopausal osteoporosis & breast cancer. Tamoxifen & raloxifene are SERMs. Progestins are prescribed for abnormal uterine bleeding caused by hormonal imbalance &, together with estrogen, in hormone replacement therapy & oral contraceptives.

Thyroid hormone is administered when there is a low output of hormone from the thyroid gland. Calcitonin is used to treat osteoporosis. It increases calcium in the blood & promotes bone deposition. Parathyroid hormone (PTH) given for osteoporosis treatment. This agent stimulates new bone formation. Growth hormone release-inhibiting factor can be manufactured & given to treat gastrointestinal symptoms associated with acromegaly & other tumors. Glucocorticoids are prescribed for reduction of inflammation & a wide range of other disorders Calcitonin a thyroid hormone Growth hormone release-inhibiting factor (somatostatin) Glucocorticoids (adrenal corticosteroids) , including arthritis, sever skin & allergic conditions, respiratory & blood disorders, gastrointestinal ailments, & malignant conditions.

Gastrointestinal Drugs = used to relieve uncomfortable & potentially dangerous symptoms, rather than as cures for specific diseases. Antacids neutralize the hydrochloric acid in the stomach to relieve symptoms of peptic ulcer, esophagitis, & reflux. Antiulcer drugs block secretion of acid by cells in the lining of the stomach & are prescribed for patients with gastric & duodenal ulcers & gastroesophageal reflux disease (GERD). Histamine H2 receptor antagonists such as ranitidine (Zantac) & cimetidine (Tagamet) turn of histamine, which promotes secretion of stomach acid. Another drug, omeprazole (Prilosec), works by stopping acid production by a different method (proton pump inhibition).

Antidiarrheal drugs relieve diarrhea & decrease the rapid movement (peristalsis) in the muscular walls of the colon. Cathartics relieve constipation & promote defection for diagnostic & operative procedures & are used to treat disorders of the gastrointestinal tract. Laxatives are mild cathartics, & purgatives are strong cathartics. Some cathartics increase the intestinal salt content to cause fluid to fill the intestines; others increase the bulk of the feces to promote peristalsis. Another type of cathartic lubricates the intestinal tract to produce soft stools.

Antinauseantes relieve nausea & vomiting & overcome vertigo, dizziness, motion sickness, & similar symptoms due to labyrinthitis. Anti-TNF (tumor necrosis factor) drugs are used to treat autoimmune diseases such as Crohn’s. These drugs also are used against rheumatoid arthritis. Antinauseantes (antiemetics) labyrinthitis (inflammation of the inner ear)

Respiratory Drugs = prescribed for the treatment of asthma & COPD Bronchodilators open bronchial tubes & are administered by injection or aerosol inhalers. Steroid drugs are inhaled or given intravenously & orally to reduce chronic inflammation in respiratory passageways. Leukotriene modifiers are recent additions to the anti-inflammatory therapy of asthma. They prevent asthma attacks & bronchospasms by blocking leukotriene from binding to receptors in respiratory tissues. COPD (chronic obstructive pulmonary diseases such as emphysema & chronic bronchitis) leukotriene (brochoconstrictor)

Sedative-Hypnotics = medications that depress the central nervous system & promote drowsiness & sleep. They are prescribed for insomnia & sleep disorders. These products have a very high abuse potential & should be used only for short periods of time & under close supervision. Barbiturates & benzodiazepines are the two major categories of sedative-hypnotics. Low doses of benzodiazepines may act as sedatives. In higher doses, benzodiazepines may act as hypnotics. drowsiness = sedatives Sleep = hypnotics Benzodiazepines = influences the part of the brain responsible for emotions Hypnotics = to promote sleep

Stimulants = drugs that act on the brain to speed up vital processes in cases of shock & collapse. They also increase alertness & inhibit hyperactive behavior in children. High doses can produce restlessness, insomnia, & hypertension. Examples of stimulants are amphetamines – used to prevent narcolepsy, to suppress appetite, & to calm hyperkinetic children. Caffeine also is a cerebral stimulant. It is used in drugs to relieve certain types of headache by constricting cerebral blood vessels. vital processes (heart & respiration) narcolepsy (seizures of sleep)

Tranquilizers = useful for controlling anxiety. Minor tranquillizers control minor symptoms of anxiety. Major tranquillizers control more severe disturbances of behavior.

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