This document discusses antihypertensive drugs, classification of blood pressure, and treatment of hypertension. It describes the different classes of antihypertensive drugs including ACE inhibitors, ARBs, calcium channel blockers, diuretics, sympatholytics, and vasodilators. It provides details on their mechanisms of action, therapeutic uses, advantages, adverse effects, and drug interactions. The document also covers non-pharmacological approaches for hypertension and guidelines for selection and combination of antihypertensive drugs based on individual patient factors.
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Individualized Webcam facilitated and e-Classroom USMLE Step 1 Tutorials with Dr. Cray. 1 BMS Unit is 4 hr. General Principles and some Organ System require multiple units to complete in preparation for the USMLE Step 1 A HIGH YIELD FOCUS IN Biochemistry / Cell Biology, Microbiology / Immunology and the 4 P’s-Phiso, Pathophys, Path and Pharm. Webcam Facilitated USMLE Step 2 Clinical Knowledge and Clinical Skills diadactic tutorials /1 Unit is 4 hours, individualized one-on-one and group sessions, Including all Internal Medicine sub-sub-specitialities. For questions or more information.. drcray@imhotepvirtualmedsch.com
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A powerpoint program describing the energy system of the human body and how energy therapy can help "tune-up" this system and assist you in feeling better. By Kathy Arneson.
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This presentation deals with the most common antihypertensive drugs used in our day-to-day practice. The common 4 ABCDs (Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, diuretics)
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this presentation describes the rational treatment of hypertension and its management. there are some pharmacological and non - pharmacological approaches.
hypertensive drugs in various conditions.pptxSunandaMohan
Electrolyte imbalance
Metabolic: hyperglycemia, hyperlipidemia, hyperuricemia.
Erectile dysfunction
Not effective in chronic renal disease.
More effective in elderly: also in patients with isolated systolic hypertension.
Long acting, used once a day
No tolerance and no fluid retention
Reduce calcium excretion, preferred in osteoporosis (especially older women).
Hydrochlorothiazide is one commonly used thiazide and consider as 1st choice.
the main problem with thiazide is hypokalemia and this can be avoided by K+ supplementation or using K+ sparing diuretics.
However, ACEI/ARBs should not combined with K+ sparing diuretics which cause dangerous hyperkaliemia in some pt.
Indications: HT, especially co-existing with:-
DM,
Nephropathy,
Left Ventricular Hypertrophy (LVF),
Chronic Heart Failure (CHF),
Angina,
Post Myocardial Infarction (MI) cases.
ADRs: Dry persistent cough, Fetal malformations, granulocytopenia, proteinuria (Rare).
Efficacy as monotherapy ~30-40%. Always combined with other drugs
Slow onset (1-3 weeks), well sustained action
Gradual in BP in hypertensives only.
Mech : Initially, TPR increases due to -blockade
Later TPR decreases – resistance vessels adapt to chronically decreased CO
Both systolic & diastolic BP reduced.
Also, ↓ release of NA from sympathetic nerve endings, ↓ Renin release from kidney (1).
Contraindicated in CHF, Pulmonary diseases (Bronchial asthma/COPD), Peripheral vascular disease and Variant angina.
Cardioprotective – especially helpful to prevent sudden cardiac death if given Post MI, along with ACEIs.
Hypoglycemic episodes – (1 selective less risky)
Absence of SEs like Postural Hypotension, GIT effects etc
Efficacy as monotherapy ~30-40%. Always combined with other drugs
Slow onset (1-3 weeks), well sustained action
Gradual in BP in hypertensives only.
Mech : Initially, TPR increases due to -blockade
Later TPR decreases – resistance vessels adapt to chronically decreased CO
Both systolic & diastolic BP reduced.
Also, ↓ release of NA from sympathetic nerve endings, ↓ Renin release from kidney (1).
Almost obsolete drugs
Reserpine – R.serpentina roots. Indigenous. Inhibits tpt of NA into storage granules depletion. Slow onset (2-3 wks). Also CA & 5HT depletion in brain depression, antipsychotic effect & Parkinsonism like symptoms. Not preferred as anti-HT drug now.
Guanethidine – Displaces NA from storage granules, release of NA from nerve terminals & NA reuptake inhibited depletion. Obsolete drug.
Latest guidelines (JNC8, NICE 2011): Consider:-
Age / Race: Younger patients (↑ renin) respond better to ACEIs/ARBs. Blacks & aged respond better to CCBs. Diuretics alternatives to CCBs.
If monotherapy ineffective – ACEIs/ARBs + CCBs/Diuretics.
ACEIs/ARBs + CCBs + Diuretics – 3rd step
If all fails – resistant HT – add a aldosterone antagonist or beta-blocker with vasodilator action.
BP > 140/90 in pregnancy can be risky
CKD, Diabetes & Chronic HT are risk factors for Pre-eclampsia
Aspirin
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
6. 4. Diuretics :
a) Thiazides & related agents – Hydrochlorothiazide
chlorthalidone
b) Loop diuretics – Furosemide, bumetanide
c) Potassium sparing diuretics – Amiloride
triamterene
spironolactone
5. Sympatholytic drugs:
a) Centrally acting agents – Clonidine, α-methyldopa
b) Ganglion blockers – Trimethaphan
c) Neuronal blockers – Reserpine
7. d) α-Adrenergic blockers:
(i) Non-selective: Phenoxybenzamine
phentolamine
(ii) Selective: Prazosin, terazosin
e) β-Adrenergic blockers:
(i) Non-selective: Propranolol, timolol
(ii) Selective: Atenolol, metoprolol
6. Vasodilators:
a) Arteriolar – Hydralazine, minoxidil, diazoxide
b) Arterial and venodilator – Sodium nitroprusside
8. I. ACEIs : 1st
line agents
Renin
ACE
(vasoconstriction)
BP
ACEIs
Bradykinin PG
Vasodilation
Blood vessel Aldosterone
release
Cardiac hypertrophy
& remodelling
Angiotensinogen
Angiotensin I
Angiotensin II
PVR Na+
& H2O retention
Inactive
9. Mechanism of action:
• Inhibit the generation of angiotensin II – a potent
vasoconstrictor
• Inhibit the degradation of bradykinin – a potent
vasodilator
• Stimulate the synthesis of PGs
• Reduce sympathetic nervous system activity
• Reduce aldosterone production
• Dilates both arteries & veins – afterload and preload
12. Drug interactions :
• ACEI x Potassium sparing diuretics –
hyperkalaemia
• ACEI x Lithium – Li toxicity
Contraindicated in pregnancy
Preferred drug in younger age group,
diabetics – delay or prevent the
progression of renal complications
13. II. ARBs :
MOA : competitevely inhibits the binding of
angiotensin II to AT1 receptors
- do not affect bradykinin production
Therapeutic uses:
• Hypertension
• Diabetic nephropathy
• CCF
Adverse effects:
• Dry cough & angioedema - less
14. III. Diuretics:
Thiazide diuretics –
MOA:
On chronic therapy
Thiazides
Inhibit Na+
-Cl-
symport in the
early distal tubule
Promote Na+
,
H2O excretion
CO
BP
Na+
concentration in
the vascular smooth vessels
PVR
15. Advantages:
• Long duration of action
• Cheaper
• Well tolerated in elderly patients
• Decreases the incidence of fracture in elderly
patients by reducing urinary calcium excretion
Can not be given in patients with gout and
hyperlipidaemia
16. Loop diuretics:
Furosemide – not preferred in uncomplicated
primary HT because of shorter
duration of action
- used in presence of renal failure,
CCF or hypertensive emergency
17. IV. CCBs:
• Dihydropyridines (DHPs) – preferred among CCBs -
more selective action on blood vessels
• Particularly useful in elderly patients and also in
patients with angina, asthma, pvd, migraine,
hyperlipidaemia, diabetes and renal dysfunction
DHPs
Relaxes vascular
smooth muscle
PVR
BP
18. V. Sympatholytics :
a) β-adrenergic blockers –
often used as 1st
line agents in mild to moderate
hypertension
blocks β1 receptors on heart – HR,
FOC, CO - BP
β-blockers
blocks β1 receptors on kidney –
renin release - BP
sympathetic outflow - BP
19. β-adrenergic blockers are mainly useful in
–
• Young hypertensives with high renin
levels
• Patients with associated conditions such
as angina, post MI, migraine and
psychosomatic disorders
• Patients receiving vasodilators
Avoided in pts with asthma, pvd, diabetes,
hyperlipidaemia
20. b) Centrally acting agents:
Clonidine –
MOA:
to
Heart
Blood
vessel
HR, CO
PVR
BP
Clonidine stimulates α2A
receptors in VMC
sympathetic outflow
from VMC
24. c) α-Adrenergic blockers:
α-blockers
Nonselective blockers Selective blockers
Block both α1 & α2- receptors Block selectively α1-
in the blood vessels vascular receptors
Vasodilation & fall in BP Arterial & venodilation
(due to α1-blockade)
Noradrenaline release Fall in BP
(due to presynaptic α2-blockade)
Reflex tachycardia
25. Non-selective drugs – not preferred for
essential hypertension
Used in special conditions –
• Pheochromocytoma
• Clonidine withdrawal
• Cheese reaction
Prazosin – first dose phenomenon – postural
hypotension after the 1st
dose
31. Selection of antihypertensive drugs in
individual patients depends on:
• Comorbidity
• Associated complications
• Age
• Sex
• Cost of the drug
• Concomitant drugs