Amlodipine is a 4th generation dihydropyridine calcium channel blocker which is permitted for the treatment ofessential hypertension and angina pectoris. The main mechanism of calcium channel blockers are blocks the voltage sensitive L-type calcium channels by binding to alpha-1 subunit, so prevent the entry of calcium in to the cells finally no excitation-contraction coupling in the heart and vascular smooth muscles. It is absorbed slowly after oral administration. But its bioavailability is high. It has a longer duration of action than ahenefidipine. It dilates both peripheral as well as coronary vessels. It is an alternative anti-hypertensive drug for patients with Nefidipine induced pedaledema. This drug is expected to produce a more incidence of pedal oedema, as compared to Nefidipine and other calcium channel blockers, based on the limited data available from clinical trials. The common adverse effects of Amlodipine are nausea, abdominal pain, vomiting, dry mouth, constipation, gingival hypertrophy, dizziness, heartburn, photosensitivity, headache, light headedness and insomnia. We report a case of Amlodipine induced pedal edema.
Related with cardio vascular system. Angina is Retrosternal chest pain which if left untreated can cause the higher complications with respect to cardiac health of human body. May be this is simple chest pain but if exceeds can cause major damage # prevention is better than cure :-)
A blockage of blood flow to the heart muscle. A heart attack is a medical emergency.A heart attack usually occurs when a blood clot blocks blood flow to the heart.Without blood,tissues loses oxygen and dies
Related with cardio vascular system. Angina is Retrosternal chest pain which if left untreated can cause the higher complications with respect to cardiac health of human body. May be this is simple chest pain but if exceeds can cause major damage # prevention is better than cure :-)
A blockage of blood flow to the heart muscle. A heart attack is a medical emergency.A heart attack usually occurs when a blood clot blocks blood flow to the heart.Without blood,tissues loses oxygen and dies
Blood products topic is very important for Medical students as they have to know which blood product will be much beneficial to patients when they go into clinical practice. This PPT provides all of them.
Amlodipine is a calcium channel blocker used to treat high blood pressure (hypertension). If you have high blood pressure, taking amlodipine can help to prevent future heart disease, heart attacks, and strokes.
Rare case report on amikacin induced nephrotic syndromeSriramNagarajan16
Nephrotic syndrome is a collection of symptoms due to the many nephrotic drugs and some diseases effecting to the kidney characterized by hypo proteinaemia, hyper cholesterolaemia, generalized edema and heavy proteinuria. Amikacin is the antibiotic which is used in treating many infectious diseases in children. It is having many side effects like nephrotoxicity, hypersensitivity reactions and Ototoxicity etc. The therapeutic dose of amikacin also leads to the nephrotoxicity in the childrens due to the pharmacokinetic and pharmacodynamic changes. Here in this case report a 10 years old female child was presented with facial puffiness, generalized edema, increased total cholesterol, decreased serum albumin and urine output due the usage of amikacin.
Blood products topic is very important for Medical students as they have to know which blood product will be much beneficial to patients when they go into clinical practice. This PPT provides all of them.
Amlodipine is a calcium channel blocker used to treat high blood pressure (hypertension). If you have high blood pressure, taking amlodipine can help to prevent future heart disease, heart attacks, and strokes.
Rare case report on amikacin induced nephrotic syndromeSriramNagarajan16
Nephrotic syndrome is a collection of symptoms due to the many nephrotic drugs and some diseases effecting to the kidney characterized by hypo proteinaemia, hyper cholesterolaemia, generalized edema and heavy proteinuria. Amikacin is the antibiotic which is used in treating many infectious diseases in children. It is having many side effects like nephrotoxicity, hypersensitivity reactions and Ototoxicity etc. The therapeutic dose of amikacin also leads to the nephrotoxicity in the childrens due to the pharmacokinetic and pharmacodynamic changes. Here in this case report a 10 years old female child was presented with facial puffiness, generalized edema, increased total cholesterol, decreased serum albumin and urine output due the usage of amikacin.
Amlodipine 10mg tablets smpc taj pharmaceuticalsTaj Pharma
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Enoxaparin is extensively used in the treatment of venousthrombo-embolic disease (VTED) which inhibits blood clotting inside the blood vessels by the inhibition of factor Xa activity through antithrombin. Local hypersensitivity reactions are one of the rare adverse drug reactions (ADR) of enoxaparin which may lead to hospitalization and excessive burden to the patient. A 72 years male patient was admitted in general medicine department with retrosternal pain even at rest and was diagnosed with unstable angina pectoris. He was administered with anti-coagulantEnoxaparin 0.4ml (40 I.U)subcutaneouslyalong with other supportive medications. Patient have developed severe local hyper sensitivity reactions like erythema,pain,swelling,irritation at the site of injection, and suspected as an ADR of Enoxaparin and immediately drug was withdrawn, then it was confirmed through causality assessment and this ADR have shown +ve for rechallenge;patient was fallowed for improvement and the symptoms especially swelling and irritations were not subsidedeven on 9th day. By this case study we strongly recommend the testingof drug sensitivity before initiating Enoxaparin therapy,and need to collect past history comprehensively for safe and effective outcome of therapy.
Corticosteroids are the steroid hormones, which are mainly used in the treatment of rheumatoid arthritis, osteoarthritis, rheumatic fever, gout, allergic reactions, renal disease, haematological disorders and shock. The use of glucocorticoids in supra physiological doses for more than 2-3 weeks causes a number of undesirable effects. Most of the adverse effects are extension of pharmacological actions such as hyperglycaemia, Cushing syndrome, oedema, hypertension, CCF, steroid myopathy, glaucoma, various fungal infections etc. Diclofenac is a Non-Steroidal Anti Inflammatory Drug; it is high potent anti-inflammatory and analgesic drug. The mechanism of acute bronchitis due to the diclofenac still not known but increased production of leukotrienes may cause bronchitis. Here we report a 45 years old female patient was experienced moon face, pedal oedema, increased RBS, LDL, total cholesterol, abdominal striae, acute bronchitis and increased blood presser due to the prolonged using of corticosteroids and NSAIDs since 2 years regularly.
Digoxin is extensively used in the treatment of congestive heart failure
(CHF). It improves blood circulation to peripheral tissues by increasing
contractility of myocardial cells by binding to Na+-K+ ATPase pump.
Arrhythmias are the major Adverse Drug Reaction (ADR) of Digoxin which
may lead to hospitalization, morbidity and even mortality. A 60 years male
patient was admitted with breathlessness, pedal edema and was diagnosed as
CHF. He was prescribed with Digoxin 5 day therapy along with other
medications, on 5th day we observed Electro Cardio Gram (ECG) changes
indicating ventricular tachycardia as a suspected ADR of Digoxin and was
confirmed by causality assessment, immediately suspected drug was stopped,
patient was monitored for progression and on 9 th day ECG showed no
tachycardia changes. We strongly recommends to monitor the patients receiving
digoxin (especially those aged > 60years of age) for safe and effective outcome
of therapy.
EVALUATION OF PRESCRIPTIONS GENERATED IN HOSPITAL FOR DRUG INTERACTIONS AND F...knight116
These were some of the prescriptions i've found in the hospital with interactions, these may be mild/moderate/severe. The interactions were minimised after they have been identified.
There are numerous studies that report anemia and hematological
abnormalities in patients with human immunodeficiency virus (HIV) infection
and acquired immunodeficiency syndrome (AIDS). Highly Active Antiretroviral
therapy (HAART) is the best suited regimen that is potent enough to reduce the
viral load in patients with HIV/AIDS. On the other hand, this regimen has the
tendency to cause anemia and bone marrow suppression. We report a case of 26
years female patient confirmed with HIV infection since 6 months and is on
Zidovudine, Lamivudine and Nevirapine therapy for the past 4 months. While the
patient was in this regimen it leads to severe anemia and acute gastritis. The
relationship between the suspected drug and reaction was established by
performing casualty assessment. There is a need of close monitoring at regular
intervals to find the development of bone marrow toxicity and other
complications which help in prevention and better management of disease and
therapy problems
The intention with the suicidal thoughts, hair dye (super vasmol-33) poisoning cases are increasing in many parts of world to free their souls. Hence we felt it as a social need to conduct this type of study. Objective to understand the prevalence of ―Vasmol‖ poisoning cases and to analyze the presenting features, clinical course and their outcome in general medicine and emergency units of a tertiary care teaching hospital. This is a Prospective observational Study conducted for a period of six months. Any adult individual who consumed the vasmol poison intentionally were included as the study subjects. A total number of 380 vasmol poisoning cases have been collected. Out of them, 168(44.21%) cases were in the age group of 11-20 years, 120 (31.57%) were in between 21-30 years. 347 (91.31%) patients were illiterates. Out of 380 cases, 258 (67.89%) were recovered with the supportive therapy, 14 (3.68%) were died and 83 (21.84%) were referred to higher institution for better treatment. The death rate was found to be 1:27 i.e. out of every 27 cases 1 death was observed. Out of 14 deaths, 8 were due to cardio-respiratory failure, 3 were due to Myocarditis, 1 due to cardiac arrest, and 2 were due to acute renal failure. Vasmol hair dye ingestion is a life threatening condition and is a serious social issue to be addressed immediately. Early recognition, prompt referral, and supportive therapy are the factors on which clinical outcomes depend.
Candidiasis is a fungal infection caused by yeasts from the genus Candida. It is commonly called oral candidiasis or thrush when it affects the mouth. It is one of the common side effects associated with the long term use of steroid inhalers. Nebulizing therapy with corticosteroids is widely accepted treatment approach for patients with acute exacerbations of Chronic Obstructive Pulmonary Disease. The other side effects of steroid inhalers include hoarseness of voice and dysphonia, which are usually ignorable. We report this case of 74 year old male patient who was on metered dosage inhaler and nebulizer therapy with corticosteroid and presented with oral candidiasis. If oral thrush develops, treatment with oral fluconazole or nystatin mouth wash is beneficial. Proper patient education by the clinical pharmacist to the patient regarding safe and effective usage of inhalers and nebulizers especially corticosteroids can minimize these drug related problems.
The trend of consuming hair dyes intentionally to free their souls is increasing day by day especially among rural indian population. Among them super vasmol 33 is a well known emulsion base type hair dye brand. The main content in vasmol is paraphenylenediamine (PPD).the major toxic effects of this chemical were found to be cervicofacial edema, rhabdomyolysis and renal failure. Quick recognition and immediate supportive therapy helps to recover completely. We report a case which highlights the toxic effects upon vasmol ingestion.
Number of people exposed to traumatic events is on rise
day by day. Despite of this increased rate of exposure, little
is known about the disease, treatments available for
preventing/relieving PTSD symptoms. As research is a
continuous process and huge body of evidence is being
added to the existing literature, it is very important to
update ourselves. All the conclusions made by various
researchers are the result of experiments performed in
their set up which is different from ours. The applicability
of those conclusions in our kind of population has to be
evaluated and build our own body of evidence.
Effect of Patient Counseling in Improving Physical and Mental Health of Type-...Gangula Amareswara Reddy
The present study concluded that chronic diseases like diabetes affect the quality of life of patients.As the main goal of any medical care is the improvement of the patients’ overall quality of life, the clinical pharmacist imparted patient education through counseling has a major role in improving the physical as well as mental health outcomes.
A PILOT STUDY ON DRUG - DRUG INTERACTIONS AMONG THE SCHIZOPHRENIA PATIENTS IN...Gangula Amareswara Reddy
As the improvement in schizophrenia patients is seen with only long term therapy, being adhered to the regimen all the way is very important. Development of drug-drug interactions among prescribed agents is the main reason for drug non adherence.Hence prior assessment of prescriptions is mandatory for the prescriptions with multiple drug therapy.The study opens door for larger studies to emphasize the role of pharmacist in identifying and preventing drug-drug interactions.
ASSESSMENT OF SELF MEDICATION AMONG RURAL VILLAGE POPULATION IN A HEALTH SCRE...Gangula Amareswara Reddy
THE STUDY AIMS AT IDENTIFYING SELF MEDICATION PATTERN AMONG RURAL POPULATION AND VARIOUS FACTORS INFLUENCING IT LIKE OCCUPATION, HABITS, LITERACY RATE, EXTENT OF AWARENESS, SOURCE FOR DRUG INFORMATION ETC.......
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
A case report on amlodepine induced pedal edema - pitting type
1. Arjun Kumar et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-3(2) 2015 [70-73]
70
IJAMSCR |Volume 3 | Issue 2 | April-June- 2015
www.ijamscr.com
Case report Medical research
A case report on Amlodipine induced pedal edema-pitting type
A Arjun Kumar1
, R Siddarama*2
, M Javeed Baig2
, Gangula Amareswara Reddy2
, R Rohith2
1
MD Associate Professor, General Medicine, Rajiv Gandhi Institute of Medical Sciences, Kadapa, India,
516003
2
Department of Pharmacy Practice, P Rami Reddy Memorial College of Pharmacy, Kadapa, India,
516003
*Corresponding author: A Arjun Kumar
E-mail id: siddaramapharmd22@gmail.com
ABSTRACT
Amlodipine is a 4th
generation dihydropyridine calcium channel blocker which is permitted for the treatment of
essential hypertension and angina pectoris. The main mechanism of calcium channel blockers are blocks the voltage
sensitive L-type calcium channels by binding to alpha-1 subunit, so prevent the entry of calcium in to the cells
finally no excitation-contraction coupling in the heart and vascular smooth muscles. It is absorbed slowly after oral
administration. But its bioavailability is high. It has a longer duration of action than nefidipine. It dilates both
peripheral as well as coronary vessels. It is an alternative anti-hypertensive drug for patients with Nefidipine induced
pedal edema. This drug is expected to produce a more incidence of pedal oedema, as compared to Nefidipine and
other calcium channel blockers, based on the limited data available from clinical trials. The common adverse effects
of Amlodipine are nausea, abdominal pain, vomiting, dry mouth, constipation, gingival hypertrophy, dizziness,
heartburn, photosensitivity, headache, light headedness and insomnia. We report a case of Amlodipine induced
pedal edema.
Keywords: Amlodipine, CCBs, CVA, pedal oedema, ADR analysis.
.
INTRODUCTION
Amlodipine is a 1,4-dihydropyridine derivative
Calcium channel blocker, which is structurally linked
to Felodipine, Nifedipine, and Nimodipine. Distinct
other presently available CCBs in the
dihydropyridine class, amlodipine have a longer
duration of action1
. Among the variety of ADRs,
peripheral oedema (swelling of the hands and Feet)
may inflict a change in drug treatment during
Amlodipine therapy. This ADR is establish to be
dose dependent, with incidence of 1.8 10.8% On a
dose between 2.5 to 10 mg, daily2
. Pedal edema, is a
frequent adverse effect of L-type calcium channel
blocker (CCB) and can sometime progress to
Anasarca3
. CCB usually well-known to cause pedal
edema are amlodipine, felodipine, diltiazem,
nifedipine, manidipine, isradipine, lacidipine,
lercanidipine and nisoldipine3,4
. Amlodipine is a 4 th
generation dihydropyridine CCB permitted for the
treatment of hypertension with efficacy and safety
that is comparable to nifidipine. It is a distinctive L-
type Ca 2+ channel blocker with an inhibitory action
on the sympathetic N-type Ca 2+ channels. It has a
slow onset but the long lasting action5
. It was
introduced in the market, with a claimed lead over
International Journal of Allied Medical Sciences
and Clinical Research (IJAMSCR)
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Amlodipine6
. therapy with amlodipine resulted in
complete resolution of clonidipine induced Oedema
in all the cases without major degeneration of
hypertension or tachycardia and thus it has been
suggested as an alternative anti-hypertensive for
patients with clonidipine induced pedal edema. We
report an inaccessible case of amlodipine induced
pedal edema. Even though, it was a relatively mild
and no serious adverse effect, it can lead to reduced
drug compliance or complete discontinuation of
therapy.
CASE REPORT
A 52 years male patient was admitted in ICU with the
chief complaints of weakness of both right upper and
lower limbs, vomiting and history of tongue bite
present. He was known smoker and alcoholic since
20 years, known case of CVA since 1 year under the
medication and hypertensive patient since 9 years.
General examination of the patient on day-1 he was
semiconscious and incoherent, but on day-4 patient
was conscious and responded to painful stimuli. His
vitals were: B.P-180/100 mm of hg, P.R-84 bpm,
CNS- right hemi paralysis present, P/A-soft, CVS-
S1S2
+
, and his laboratory investigations were found
to be Hb-8 gm %, RBS-72 mgs/dl, CT-Brain-
multiple cell necrosis present. So based on subjective
and objective evaluation patient was diagnosed as a
recurrent CVA. On day-1 the patient was treated with
following medications- Oral anti-platelet drugs
(ecosprin 150mg OD, clopidogrel-75mg OD), Oral
hypo-lipidemic drug (atorvaststin 40 mg od),
parenteral anti-biotic (ceftriaxone 1gm iv bd),
parenteral anti-ulcerative drug (pantoprazole 40 mg
iv bd), parenteral antiemetic (domperidone 10mg tid),
IV Fluids and physiotherapy. No fresh complaints on
day-2, so patient was continued with the same
medications, additionally added T. Amlodipine 5mg,
this treatment was continued for 7 days. From 2nd
day
to 6th
day patient was gradually developed pitting
type of pedal edema, shown in figure:1. This edema
was mainly due to the T. Amlodipine. The common
ADR’s of Amlodipine is headache and edema. On
day-7 we intimated the condition of the patient to the
doctor about the drug and doctor dechallenged the
drug after that patient was recovered from the edema.
So based on these results the patient had developed
pedal oedema due to the T. Amlodipine.
Figure 1: Amlodipine induced pitting type pedal edema.
ADR analysis
After collecting the past and current medication
history from the patient it was suspected that the
patient had developed drug induced Edema. After
analyzing the ADR profiles of all the drugs, it was
found that the most suspected drug for producing
oedema was Amlodipine. We have further analysed
to establish the relationship between the drug and the
observed ADRs, through causality assessment by
using naranjo’s scale, WHO-UMC ADR assessing
scale as well as Karch and lasagna scale, results were
shown in Table 01. We have also assessed the
severity, predictability, and preventability as a part of
management through Modified Hartwig and Siegel
severity scale, Schumock and Thornton
Preventability Scale.
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ADR Management
Generally, management of ADR includes
withdrawal/suspension, dose reduction of suspected
drug and administration of supportive therapy. Here
in this case report the suspected drug amlodipine was
discontinued.
ADR analysis
Table 1: causality assessment of suspected ADRs
Suspected drug And Reaction(ADR) Naranjos scale WHO-probability scale Karch& Lasagnas scale
Amlodipine induced pedal edema Possible Probable Probable
SEVERITY:-Moderate level 4
PREDICTABILITY: -UN predictable
PREVENTABILITY:- Probably preventable
DISCUSSION
Amlodipine is a 1:1 mixture of S and R enantiomers.
different studies on the racemic mixture of (R) and
(S)isomers, have exposed that the S isomer of
Amlodipine has a better pharmacological effect Than
the R isomers. the S (-) isomer being 1000 times
additional potent than the R (+) isomer6
. Frequent
adverse effects reported with Amlodipine are nausea,
abdominal pain, vomiting, dry mouth, constipation,
gingival hypertrophy, dizziness, heartburn,
photosensitivity, headache, light headedness and
insomnia. hardly ever, hot flushes, palpitations, ECG
abnormalities, chest pain, atrioventricular block,
hypersensitivity reactions, frequent urination and
elevated liver enzyme7
. Amlodipine has been recently
suggested to result in complete declaration of
nefidipine induced oedema and has been suggested as
an alternative antihypertensive for patients with
amlodipine induced pedal oedema. On the other
hand, the opposing our case presented with bilateral
pitting type pedal edema with Amlodipine treatment8
.
The mechanism of amlodipine induced adverse effect
is unknown. But, number of mechanisms has been
postulated for CCBs induced pedal oedema including
inhibition of pre-capillary vasoconstriction through
arteriolar dilatation and consequently, promoting
interstitial edema. CCBs are well-known to origin
pedal edema. This ADR has "probable" causal
relationship with Amlodipine as assessed by
Naranjos scale and WHO-UMC9
. The usual move
toward to patients with CCBs induced pedal oedema
involves cessation of therapy and substitution with an
alternative antihypertensive and thiazide diuretic or
angiotensin receptor blockers (ARBs), angiotensin
converting enzyme inhibitor (ACEI), as was
accepted in our case. A combination therapy of
diuretic, CCB, ARBs are common in clinical practice
in such cases9
. furthermore, the present case report
grass another important message for the practicing
physicians, that not at all be first and last to prescribe
any new drug.
CONCLUSION
The involvement of pedal oedema due to Amlodipine
in this case, so physicians have a responsibility to
closely Monitoring the patients condition during the
administration of drug like Aamlodipine, which do
not have enough safety and efficacy data. Since our
explanation are based on only case reports. In this
case report, the conventional practice to prescribe
ARBs, thiazide diuretic or ACEI should be carried
Until larger clinical trial chains the function of
Amlodipine in such conditions.
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