(8 points) There is an endocrine disorder we did not get a c…

(8 points) There is an endocrine disorder we did not get a chance to discuss called central diabetes insipidus, in which the pituitary gland does not make sufficient ADH (anti-diuretic hormone), leading to abnormally high amounts of urination.  The condition is treated using desmopressin (Minirin), a synthetic version of human ADH hormone.    Desmopressin is available as a nasal spray taken once daily.  It is not significantly metabolized.   Please answer both question A and B in the space provided (there is more than enough room)   A. (3 points) If a patient were to take this as an IV dose once daily, would the IV dose be much larger, much smaller, or about the same amount as the nasal spray dose?   B. (5 points) A potential side effect of desmopressin is hyponatremia (very low blood sodium levels).  Patients with very low plasma sodium levels are at high risk of brain seizures.  Explain the pathophysiologic mechanism by which hyponatremia lowers the threshold for a seizure in the brain.

(6 points) 43-year-old Charlize T. suffers from chronic GERD…

(6 points) 43-year-old Charlize T. suffers from chronic GERD.  She’s been taking over-the-counter pantoprazole (Protonix) for the last four years under the supervision of a GI surgeon, even though the “Drug Facts” panel on the back of the package specifically states “do not take for more than 14 days unless directed by a doctor”.        Give ANY two (2) medical reasons why Charlize should not be taking specifically a drug like pantoprazole for four years except under the supervision of a healthcare professional (other than generalized things like “because the directions say not to” or “you need a doctor when you take medicine”).

19-year-old Joffrey L. is brought to the emergency room unco…

19-year-old Joffrey L. is brought to the emergency room unconscious with a respiratory rate of only 6 (this is very low).  His new roommate reports that Joffrey is otherwise totally healthy but says he saw Joffrey taking some medicine earlier.  He hands over the bottle of medicine he saw Joffrey use and you see it is a alprazolam (Xanax), a benzodiazepine used commonly for certain anxiety disorders.   Dr. Snow arrives, glances at the bottle and then elbows you aside.  He administers an IV dose of the benzodiazepine antagonist flumazenil.  Joffrey begins to have convulsions.    A. Explain in detail the mechanism by which the benzodiazepine antagonist flumazenil can potentially cause a seizure in a patient with no prior history of epilepsy.