dextroamphetamine sustained-action capsule - oral, Dexedrine Glossary of Terms

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Abnormal: Outside the expected norm, or uncharacteristic of a particular patient.

ADHD: Attention deficit hyperactivity disorder.

Allergic reaction: The hypersensitive response of the immune system of an allergic individual to a substance.
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Amitriptyline: An antidepressant medication. In some patients with depression, abnormal levels of brain chemicals called neurotransmitters may relate to the depression. Amitriptyline elevates mood by raising the level of neurotransmitters in brain tissue. Amitriptyline is also a sedative that is useful for depressed patients with insomnia, restlessness, and nervousness. It is sometimes used to treat fibromyalgia and symptoms related to chronic pain. Brand names are Elavil and Endep. A generic version is available.

Amphetamine: A drug that has a stimulant effect on the central nervous system that can be both physically and psychologically addictive when overused. Amphetamine has been much abused recreationally. The street term 'speed' refers to stimulant drugs such as amphetamine.

Angina: Chest pain due to an inadequate supply of oxygen to the heart muscle. The pain is typically severe and crushing, and it is characterized by a feeling of pressure and suffocation just behind the breastbone. Angina can accompany or be a precursor of a heart attack.

Antidepressants: Anything, and especially a drug, used to prevent or treat depression.
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Antihistamines: Drugs that combat the histamine released during an allergic reaction by blocking the action of the histamine on the tissue. Antihistamines do not stop the formation of histamine nor do they stop the conflict between the IgE and antigen. Therefore, antihistamines do not stop the allergic reaction but protect tissues from some of its effects. Antihistamines frequently cause mouth dryness and sleepiness. Newer "non sedating" antihistamines are generally thought to be somewhat less effective. Antihistamine side effects that very occasionally occur include urine retention in males and fast heart rate.

Artery: A vessel that carries blood high in oxygen content away from the heart to the farthest reaches of the body. Since blood in arteries is usually full of oxygen, the hemoglobin in the red blood cells is oxygenated. The resultant form of hemoglobin (oxyhemoglobin) is what makes arterial blood look bright red.
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Ascorbic acid: Vitamin C, an essential nutrient found mainly in fruits and vegetables. The body requires ascorbic acid in order to form and maintain bones, blood vessels, and skin. Ascorbic acid also promotes the healing of cuts, abrasions and wounds; helps fight infections; inhibits conversion of irritants in smog, tobacco smoke, and certain foods into cancer-causing substances; appears to lessen the risk of developing high blood pressure and heart disease; helps regulate cholesterol levels; prevents the development of scurvy; appears to lower the risk of developing cataracts; and aids in iron absorption. Ascorbic acid can cause adverse reactions when taken with some drugs.

Attention deficit hyperactivity disorder: A disorder in which a person is unable to control behavior due to difficulty in processing neural stimuli, accompanied by an extremely high level of motor activity. Abbreviated ADHD. ADHD can affect children and adults, but it is easiest to perceive during schooling. A child with ADHD may be extremely distractible, unable to remain still, and very talkative. ADHD is diagnosed by using a combination of parent and/or patient interview, observation of the patient, and sometimes use of standardized screening instruments. Treatments include making adjustments to the environment to accommodate the disorder, behavior modification, and the use of medications. Stimulants are the most common drugs used, although certain other medications can be effective.

Bicarbonate: In medicine, bicarbonate usually refers to bicarbonate of soda (sodium bicarbonate, baking soda), a white powder that is a common ingredient in antacids. Also, the bicarbonate level is an indirect measure of the acidity of the blood that is determined when electrolytes are tested. The normal serum range for bicarbonate is 22'30 mmol/liter.

Bipolar disorder: A mood disorder sometimes called manic-depressive illness or manic-depression that characteristically involves cycles of depression and elation or mania. Sometimes the mood switches from high to low and back again are dramatic and rapid, but more often they are gradual and slow, and intervals of normal mood may occur between the high (manic) and low (depressive) phases of the condition. The symptoms of both the depressive and manic cycles may be severe and often lead to impaired functioning.
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Blood pressure: The blood pressure is the pressure of the blood within the arteries. It is produced primarily by the contraction of the heart muscle. It's measurement is recorded by two numbers. The first (systolic pressure) is measured after the heart contracts and is highest. The second (diastolic pressure) is measured before the heart contracts and lowest. A blood pressure cuff is used to measure the pressure. Elevation of blood pressure is called "hypertension".

Blurred vision: Lack of sharpness of vision with, as a result, the inability to see fine detail. Blurred vision can occur when a person who wears corrective lens is without them. Blurred vision can also be an important clue to eye disease.

Brain: The portion of the central nervous system that is located within the skull. It functions as a primary receiver, organizer, and distributor of information for the body. It has a right half and a left half, each of which is called a hemisphere.

Breast milk: Milk from the breast. Human milk contains a balance of nutrients that closely matches infant requirements for brain development, growth and a healthy immune system. Human milk also contains immunologic agents and other compounds that act against viruses, bacteria, and parasites. Since an infant's immune system is not fully developed until age 2, human milk provides a distinct advantage over formula.
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Breathing: The process of respiration, during which air is inhaled into the lungs through the mouth or nose due to muscle contraction and then exhaled due to muscle relaxation.

Caffeine: A stimulant compound found naturally in coffee, tea, cocoa (chocolate), and kola nuts (cola) and added to soft drinks, foods, and medicines. Caffeine can cause anxiety, insomnia, nervousness, and hypertension. Caffeine is a diuretic and increases urination. It can decrease a person's ability to lose weight because it stimulates insulin secretion, which reduces blood sugar, which increases hunger. Caffeine can help to relieve headaches, so a number of over-the-counter and prescription pain relievers include it as an ingredient, usually with aspirin or another analgesic.

Capsule: Capsule has many meanings in medicine including the following:

1. In medicine, a membranous structure that envelops an organ, a joint, tumor, or any other part of the body. It is usually made up of dense collagen-containing connective tissue.
2. In pharmacy, a solid dosage form in which the drug is enclosed in a hard or soft soluble container, usually of a form of gelatin.
3. In microbiology, a coat around a microbe, such as a bacterium or fungus.

Cardiomyopathy: Disease of the heart muscle (myocardium).

Chest: The area of the body located between the neck and the abdomen. The chest contains the lungs, the heart, and part of the aorta. The walls of the chest are supported by the dorsal vertebrae, the ribs, and the sternum. Also known as thorax.

Chest pain: Pain in the chest that can be a result of many things, including angina, heart attack (coronary occlusion), and other important diseases. Chest pain is a warning to seek medical attention, so one should try not to ignore chest pain and 'work through it.'

Chloride: The major anion (negatively charged substance) in the blood and extracellular fluid (the body fluid that lies outside cells). Blood and other body fluids have almost the same concentration of chloride ion as sea water. The balance of chloride ion (Cl^-) is closely regulated by the body.
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Coronary artery disease: Impedance or blockage of one or more arteries that supply blood to the heart, usually due to atherosclerosis (hardening of the arteries). Abbreviated CAD. A major cause of illness and death, CAD begins when hard cholesterol substances (plaques) are deposited within a coronary artery. The plaques in the coronary arteries can lead to the formation of tiny clots that can obstruct the flow of blood to the heart muscle, producing symptoms and signs of CAD, including chest pain (angina pectoris), heart attack (myocardial infarction), and sudden death. Treatment for CAD includes bypass surgery, balloon angioplasty, and the use of stents.

Depression: An illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about himself or herself, and thinks about things. Depression is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be wished away. People with depression cannot merely 'pull themselves together' and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. The signs and symptoms of depression include loss of interest in activities that were once interesting or enjoyable, including sex; loss of appetite, with weight loss, or overeating, with weight gain; loss of emotional expression (flat affect); a persistently sad, anxious, or empty mood; feelings of hopelessness, pessimism, guilt, worthlessness, or helplessness; social withdrawal; unusual fatigue, low energy level, a feeling of being slowed down; sleep disturbance and insomnia, early-morning awakening or oversleeping; trouble concentrating, remembering, or making decisions; unusual restlessness or irritability; persistent physical problems such as headaches, digestive disorders, or chronic pain that do not respond to treatment, and thoughts of death or suicide or suicide attempts. The principal types of depression are called major depression, dysthymia, and bipolar disease (manic-depressive disease).

Diarrhea: A common condition that involves unusually frequent and liquid bowel movements. The opposite of constipation. There are many infectious and noninfectious causes of diarrhea. Persistent diarrhea is both uncomfortable and dangerous to the health because it can indicate an underlying infection and may mean that the body is not able to absorb some nutrients due to a problem in the bowels. Treatment includes drinking plenty of fluids to prevent dehydration and taking over-the-counter remedies. People with diarrhea that persists for more than a couple days, particularly small children or elderly people, should seek medical attention.

Dizziness: Painless head discomfort with many possible causes including disturbances of vision, the brain, balance (vestibular) system of the inner ear, and gastrointestinal system. Dizziness is a medically indistinct term which laypersons use to describe a variety of conditions ranging from lightheadedness, unsteadiness to vertigo.
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Drain: A device for removing fluid from a cavity or wound. A drain is typically a tube or wick. As a verb, to allow fluid to be released from a confined area.

Dry mouth: The condition of not having enough saliva to keep the mouth wet. This is due to inadequate function of the salivary glands. Everyone has dry mouth once in a while when they are nervous, upset or under stress. But if someone has a dry mouth most all of the time, it can be uncomfortable and lead to serious health problems.
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Duloxetine: See: Cymbalta.

Epinephrine: A substance produced by the medulla (inside) of the adrenal gland. The name epinephrine was coined in 1898 by the American pharmacologist and physiologic chemist (biochemist) John Jacob Abel who isolated it from the adrenal gland which is located above (epi-) the kidney ("nephros" in Greek). (Abel also crystallized insulin). Technically speaking, epinephrine is a sympathomimetic catecholamine. It causes quickening of the heart beat, strengthens the force of the heart's contraction, opens up the airways (bronchioles) in the lungs and has numerous other effects. The secretion of epinephrine by the adrenal is part of the fight-or-flight reaction. Adrenaline is a synonym of epinephrine and is the official name in the British Pharmacopoeia.

Family history: The family structure and relationships within the family, including information about diseases in family members.
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FDA: Food and Drug Administration.

Flush: (1) A redness of the skin, typically over the cheeks or neck. A flush is usually temporary and brought on by excitement, exercise, fever, or embarrassment. Flushing is an involuntary (uncontrollable) response of the nervous system leading to widening of the capillaries of the involved skin. Also referred to as a blush (or, as a verb, to blush). Flushing may also be caused by medications or other substances that cause widening of the capillaries, such as niacin. (2) Flush also means to wash out a wound or body area.

Generic: 1. The chemical name of a drug. 2. A term referring to the chemical makeup of a drug rather than to the advertised brand name under which the drug may be sold. 3.A term referring to any drug marketed under its chemical name without advertising.

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Glaucoma: A common eye condition in which the fluid pressure inside the eyes rises because of slowed fluid drainage from the eye. If untreated, it may damage the optic nerve and other parts of the eye, causing the loss of vision or even blindness.
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Glutamic acid: An amino acid, one of the 20 building blocks of protein. A nonessential amino acid, glutamic acid is present in many animal and plant proteins. It is involved in ammonia metabolism and serves as a neurotransmitter. Glutamic acid was isolated from wheat gluten in 1866 and first synthesized in 1890. Symbol: Glu.

Headache: A pain in the head with the pain being above the eyes or the ears, behind the head (occipital), or in the back of the upper neck. Headache, like chest pain or back ache, has many causes.
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Heart: The muscle that pumps blood received from veins into arteries throughout the body. The heart is positioned in the chest behind the sternum (breastbone); in front of the trachea, esophagus, and aorta; and above the diaphragm. A normal heart is about the size of a closed fist and weighs about 298 grams or 10.5 ounces. It is cone-shaped, with the point of the cone pointing down to the left. Two-thirds of the heart lies in the left side of the chest, with the balance in the right side of the chest. The heart is composed of specialized cardiac muscle, and it is four-chambered, with a right atrium and ventricle, and an anatomically separate left atrium and ventricle. The blood flows from the systemic veins into the right atrium, thence to the right ventricle, from which it is pumped to the lungs and then returned into the left atrium, thence to the left ventricle, from which it is driven into the systemic arteries. The heart is thus functionally composed of two hearts: the right heart and the left heart. The right heart consists of the right atrium, which receives deoxygenated blood from the body, and the right ventricle, which pumps the deoxygenated blood to the lungs under low pressure; and the left heart, which consists of the left atrium, which receives oxygenated blood from the lung, and the left ventricle, which pumps the oxygenated blood out to the body under high pressure.

Heart attack: The death of heart muscle due to the loss of blood supply. The loss of blood supply is usually caused by a complete blockage of a coronary artery, one of the arteries that supplies blood to the heart muscle. Death of the heart muscle, in turn, causes chest pain and electrical instability of the heart muscle tissue.
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Heart failure: Inability of the heart to keep up with the demands on it and, specifically, failure of the heart to pump blood with normal efficiency. When this occurs, the heart is unable to provide adequate blood flow to other organs such as the brain, liver and kidneys. Heart failure may be due to failure of the right or left or both ventricles. The signs and symptoms depend upon which side of the heart is failing. They can include shortness of breath (dyspnea), asthma due to the heart (cardiac asthma), pooling of blood (stasis) in the general body (systemic) circulation or in the liver's (portal) circulation, swelling (edema), blueness or duskiness (cyanosis), and enlargement (hypertrophy) of the heart.
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Heart rate: The number of heartbeats per unit of time, usually per minute. The heart rate is based on the number of contractions of the ventricles (the lower chambers of the heart). The heart rate may be too fast (tachycardia) or too slow (bradycardia). The pulse is a bulge of an artery from waves of blood that course through the blood vessels each time the heart beats. The pulse is often taken at the wrist to estimate the heart rate.

High blood pressure: A repeatedly elevated blood pressure exceeding 140 over 90 mmHg. Chronic high blood pressure can stealthily cause blood vessel changes in the back of the eye (retina), abnormal thickening of the heart muscle, kidney failure, and brain damage. No specific cause for high blood pressure is found in 95 percent of patients. Treatment for high blood pressure involves dietary changes, regular aerobic exercise, and medication. There are many types of medications used to treat high blood pressure including diuretics, beta-blockers, blood vessel dilators, and others. Also known as hypertension.

Hyperactivity: A higher than normal level of activity. An organ can be described as hyperactive if it is more active than usual. Behavior can also be hyperactive.
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Hypertension: High blood pressure, defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above 140 with a diastolic pressure above 90.
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Infant: A young baby, from birth to 12 months of age.

Insomnia: The perception or complaint of inadequate or poor-quality sleep due to a number of factors, such as difficulty falling asleep, waking up frequently during the night with difficulty returning to sleep, waking up too early in the morning, or unrefreshing sleep. Insomnia is not defined by the number of hours of sleep a person gets or how long it takes to fall asleep; it is a measure of satisfaction with sleep. Individuals vary normally in their need for and their satisfaction with sleep. Insomnia may cause problems during the day, such as tiredness, a lack of energy, difficulty concentrating, and irritability.

Laboratory: A place for doing tests and research procedures, and for preparing chemicals and some medications. Also known as lab.

Lithium: A naturally occurring salt that, in purified form, is used to treat certain psychiatric disorders, especially bipolar disease The therapeutic level of lithium'the amount needed to treat bipolar disorders'is perilously close to the level that can cause toxicity, so monitoring of blood levels is required. Symptoms of lithium toxicity include diarrhea, vomiting, blurred vision, loss of coordination, and loss of motor control. Treatment of lithium toxicity involves immediately reducing or discontinuing lithium use under medical supervision.

Medical history: 1. In clinical medicine, the patient's past and present which may contain relevant information bearing on their health past, present, and future. The medical history, being an account of all medical events and problems a person has experienced is an important tool in the management of the patient.
2. The history of medicine.

Mouth: 1. The upper opening of the digestive tract, beginning with the lips and containing the teeth, gums, and tongue. Foodstuffs are broken down mechanically in the mouth by chewing and saliva is added as a lubricant. Saliva contains amylase, an enzyme that digests starch. 2. Any opening or aperture in the body. The mouth in both senses of the word is also called the os, the Latin word for an opening, or mouth. The o in os is pronounced as in hope. The genitive form of os is oris from which comes the word oral.

Muscle: Muscle is the tissue of the body which primarily functions as a source of power. There are three types of muscle in the body. Muscle which is responsible for moving extremities and external areas of the body is called "skeletal muscle." Heart muscle is called "cardiac muscle." Muscle that is in the walls of arteries and bowel is called "smooth muscle."

Narcolepsy: A neurological disorder that is marked by the recurrent, sudden, uncontrollable compulsion to sleep. Narcolepsy is often associated with cataplexy (a sudden loss of muscle tone and paralysis of voluntary muscles associated with a strong emotion), sleep paralysis (immobility of the body that occurs in the transition from sleep to wakefulness), hypnagogic hallucinations (presleep dreams), and automatic behaviors (such as doing something 'automatically' and not remembering afterward how one did it). The causes of narcolepsy are unknown. Narcolepsy is not a fatal disorder in itself, but it can lead to fatalities. For example, affected persons may fall asleep while driving. Also known as excessive daytime sleepiness, hypnolepsy, sleeping disease, paroxysmal sleep, and Gelineau syndrome.

Nausea: Stomach queasiness, the urge to vomit. Nausea can be brought on by many causes, including systemic illnesses (such as influenza), medications, pain, and inner ear disease.

Nursing: 1) Profession concerned with the provision of services essential to the maintenance and restoration of health by attending the needs of sick persons. 2) Feeding a infant at the breast.

Pain: An unpleasant sensation that can range from mild, localized discomfort to agony. Pain has both physical and emotional components. The physical part of pain results from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it can be more diffuse, as in disorders like fibromyalgia. Pain is mediated by specific nerve fibers that carry the pain impulses to the brain where their conscious appreciation may be modified by many factors.
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Pharmacist: A professional who fills prescriptions and, in the case of a compounding pharmacist, makes them. Pharmacists are very familiar with medication ingredients, interactions, and cautions.

Phosphate: A form of phosphoric acid. Calcium phosphate makes bones and teeth hard.

Poison: Any substance that can cause severe organ damage or death if ingested, breathed in, or absorbed through the skin. Many substances that normally cause no problems, including water and most vitamins, can be poisonous if taken in excessive quantity. Poison treatment depends on the 'substance.

Poison control center: A special information center set up to inform people about how to respond to potential poisoning. These centers maintain databases of poisons and appropriate emergency treatment. Local poison control centers should be listed with other community-service numbers in the front of the telephone book, and they can also be reached immediately through any telephone operator.

Pregnancy: The state of carrying a developing embryo or fetus within the female body. This condition can be indicated by positive results on an over-the-counter urine test, and confirmed through a blood test, ultrasound, detection of fetal heartbeat, or an X-ray. Pregnancy lasts for about nine months, measured from the date of the woman's last menstrual period (LMP). It is conventionally divided into three trimesters, each roughly three months long.
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Prescription: A physician's order for the preparation and administration of a drug or device for a patient. A prescription has several parts. They include the superscription or heading with the symbol "R" or "Rx", which stands for the word recipe (meaning, in Latin, to take); the inscription, which contains the names and quantities of the ingredients; the subscription or directions for compounding the drug; and the signature which is often preceded by the sign "s" standing for signa (Latin for mark), giving the directions to be marked on the container.

Psychosis: In the general sense, a mental illness that markedly interferes with a person's capacity to meet life's everyday demands. In a specific sense, it refers to a thought disorder in which reality testing is grossly impaired.
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Rash: Breaking out (eruption) of the skin. A rash can be caused by an underlying medical condition, hormonal cycles, allergies, or contact with irritating substances. Treatment depends on the underlying cause of the rash. Medically, a rash is referred to as an exanthem.

Seizure: Uncontrolled electrical activity in the brain, which may produce a physical convulsion, minor physical signs, thought disturbances, or a combination of symptoms.
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Shortness of breath: Difficulty in breathing. Medically referred to as dyspnea. Shortness of breath can be caused by respiratory (breathing passages and lungs) or circulatory (heart and blood vessels) conditions and other conditions such as severe anemia or high fever. See also dyspnea.

Sleep: The body's rest cycle.
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Sodium: The major positive ion (cation) in the fluid surrounding cells in the body. The chemical notation for sodium is Na+. When sodium is combined with chloride, the resulting substance is a crystal called table salt. Excess dietary sodium is largely excreted in the urine, but too much salt in the diet tends to increase the blood pressure. Too much or too little sodium in the blood (called hypernatremia or hyponatremia respectively) can cause cells to malfunction, and extremes can be fatal. Normal blood sodium level is 135'145 milliEquivalents/liter (mEq/L) or 135'145 millimoles/liter (mmol/L) in international units.

Steroid: One of a large group of chemical substances classified by a specific carbon structure. Steroids include drugs used to relieve swelling and inflammation, such as prednisone and cortisone; vitamin D; and some sex hormones, such as testosterone and estradiol.

Stomach: The digestive organ that is located in the upper abdomen, under the ribs. The upper part of the stomach connects to the esophagus, and the lower part leads into the small intestine. When food enters the stomach, muscles in the stomach wall create a rippling motion (peristalsis) that mixes and mashes the food. At the same time, juices made by glands in the lining of the stomach help digest the food. After about 3 hours, the food becomes a liquid and moves into the small intestine, where digestion continues.

Stroke: The sudden death of brain cells due to lack of oxygen, caused by blockage of blood flow or rupture of an artery to the brain. Sudden loss of speech, weakness, or paralysis of one side of the body can be symptoms. A suspected stroke can be confirmed by scanning the brain with special X-ray tests, such as CAT scans. The death rate and level of disability resulting from strokes can be dramatically reduced by immediate and appropriate medical care. Prevention involves minimizing risk factors, such as controlling high blood pressure and diabetes. Abbreviated CVA. Also known as cerebrovascular accident.

Suicidal: Pertaining to suicide. the taking of ones own life. As in a suicidal gesture, suicidal thought, or suicidal act. An "online lifeline for suicidal undergrads" may help prevent college students from committing suicide.

Surgery: The branch of medicine that employs operations in the treatment of disease or injury. Surgery can involve cutting, abrading, suturing, or otherwise physically changing body tissues and organs.

Sweating: The act of secreting fluid from the skin by the sweat (sudoriferous) glands. These are small tubular glands situated within and under the skin (in the subcutaneous tissue). They discharge by tiny openings in the surface of the skin.
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Syndrome: A combination of symptoms and signs that together represent a disease process.

Therapy: The treatment of disease. Therapy is synonymous with treatment.

Thyroid: 1. The thyroid gland. Also, pertaining to the thyroid gland. 2. A preparation of the thyroid gland used to treat hypothyroidism. 3. Shaped like a shield. (The thyroid gland was so-named by Thomas Wharton in 1656 because it was shaped like an ancient Greek shield.)
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Tiredness: See: Tired.

Tricyclic antidepressants: One of a class of medications used to treat depression. The tricyclic antidepressants (TCAs) are also used for some forms of anxiety, fibromyalgia, and the control of chronic pain.
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Urine: Liquid waste produced by the kidneys. Urine is a clear, transparent fluid that normally has an amber color. The average amount of urine excreted in 24 hours is between 5 to 8 cups or 40 and 60 ounces. Chemically, urine is mainly a watery solution of salt and substances called urea and uric acid. Normally, it contains about 960 parts water to 40 parts solid matter. Abnormally, it may contain sugar (in diabetes), albumin (a protein, as in some forms of kidney disease), bile pigments (as in jaundice), or abnormal quantities of one or another of its normal components.

Vessel: A tube in the body that carries fluids. Examples of vessels are blood vessels and lymph vessels.

Vitamin C: An essential nutrient found mainly in fruits and vegetables. The body requires vitamin C to form and maintain bones, blood vessels, and skin.
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Weight loss: Weight loss is a decrease in body weight resulting from either voluntary (diet, exercise) or involuntary (illness) circumstances. Most instances of weight loss arise due to the loss of body fat, but in cases of extreme or severe weight loss, protein and other substances in the body can also be depleted. Examples of involuntary weight loss include the weight loss associated with cancer, malabsorption (such as from chronic diarrheal illnesses ), and chronic inflammation (such as with rheumatoid arthritis).

Withdrawal symptoms: Abnormal physical or psychological features that follow the abrupt discontinuation of a drug that has the capability of producing physical dependence. In example, common opiates withdrawal symptoms include sweating, goosebumps, vomiting, anxiety, insomnia, and muscle pain.