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In LUKE Health, this is implemented with dual-layer PostgreSQL triggers: Layer 1: A database trigger on the orders table checks for an active, non-expired prescription matching the compound being ordered Layer 2: A constraint trigger verifies the prescribing provider's license is valid for the patient's state This isn't application logic that a developer might accidentally bypass during a feature update

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Ligand binding activates adenylyl cyclase, elevating intracellular cAMP and triggering PKA-mediated phosphorylation of downstream steroidogenic targets including CYP11A1, CYP17A1, and 3-HSD

As the antigen continues to interact with antibodies throughout the body, the fourth and final event occurs: The patient demonstrates an outward response to the mediators (i.e