The document discusses the nervous system, specifically focusing on the peripheral nervous system (PNS) and its divisions - the autonomic nervous system (ANS) and somatic nervous system. The ANS can be further divided into the sympathetic and parasympathetic nervous systems, which have opposing effects. The parasympathetic system uses acetylcholine as its main neurotransmitter and targets organs via muscarinic receptors to induce relaxation responses. Cholinergic drugs that act on muscarinic receptors are used to treat various conditions like glaucoma and myasthenia gravis.
introduction to Autonomic Nervous System consisting of Cholinergic, adrenergic and enteric Nervous system with focus on location of neurotransmitters and broad functions of parasympathetic and sympathetic nervous system.
introduction to Autonomic Nervous System consisting of Cholinergic, adrenergic and enteric Nervous system with focus on location of neurotransmitters and broad functions of parasympathetic and sympathetic nervous system.
Individualized Webcam facilitated and e-Classroom USMLE Step 1 Tutorials with Dr. Cray. For questions or more information.. drcray@imhotepvirtualmedsch.com
Learn the nor adrenergic transmission in ANS. Synthesis, storage ,release, uptake,metabolism of nor-adrenaline. Types of adrenoceptors. Agonist and antagonist of adrenoceptors.
Individualized Webcam facilitated and e-Classroom USMLE Step 1 Tutorials with Dr. Cray. For questions or more information.. drcray@imhotepvirtualmedsch.com
Learn the nor adrenergic transmission in ANS. Synthesis, storage ,release, uptake,metabolism of nor-adrenaline. Types of adrenoceptors. Agonist and antagonist of adrenoceptors.
COMPLETE EXAMINATION OF RESPIRATORY SYSTEM IN PEDIATRICS. IT HAS BEEN SUMMARIZED FROM ALL WELL KNOWN 32 BOOKS UNDER GUIDANCE OF ONE OF THE BEST PEDIATRIC DOCTORS AND PROFESSORS .
BY DR. SURAJ R. DHANKIKAR.
This presentation covers an introduction to Autonomic Nervous System.. only enough to understand the actions of cholinergic and anticholinergic drugs. This presentation does not include anticholinergic drugs.
- 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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
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!
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
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
4. ANS
• Auto: Self; Nomos:Governing
involuntary and maintain
homeostasis
• Each autonomic fibres made
up of two neurons
• It innervates the heart,
smooth muscles and
endocrine glands
• ANS controls visceral
functions such as circulation,
digestion, excretion etc.,
Somatic nervous system
• Voluntary control
• Somatic fibres made up of
single motor neuron, connect
CNS to skeletal muscle
• It innervates skeletal muscle
• Controls skeletal muscle
tone
E
7. Branching of axons
NT released by preganglionic axons
NT released by post ganglionic axons
8. Anger, Alert,
Aggressive
Flushing of Face
Bronchodilatation
Mydriasis
In. Cardiac output
Inc. Muscle tone
Lipolysis-Energy
Liver
Glucogenolysis
More energy prod
Large B vessels
dilate to speed
up blood flow
9. Anger, Alert,
Aggressive
Flushing of Face
Bronchodilatation
Mydriasis
In. Cardiac output
Inc. Muscle tone
Lipolysis-Energy
Liver
Glucogenolysis
More energy prod
Large B vessels
dilate to speed
up blood flow
10. Parasympathetic system
• ACh is a first neurotransmitter discovered
• It is synthesized from two common chemicals
Acetyl Co enzyme A and Choline.
• Cholinomimetics, mimic the action of Ach
c/s parasympathomimetics”
• External Ach is no therapeutic value due to its ultra
short acting.
• Hypothalamus is major controlling centre
• It is metabolized by Acetylcholine esterase.
14. • Hemicholinium: It acts by blocking choline
uptake.
• Vesamicol: It acts by inhibiting active transport
of ACh into synaptic vesicle by interfering with
VAT
• Botulinum toxin : It acts by inhibiting release of
ACh from synaptic vesicle.
• Black widow spider: It acts by inducing
massive release and causes depletion of ACh.
15. Metabolism:- In synaptic cleft, Ach is rapidly hydrolyzed by
acetyl cholinesterase (AChE) enzyme
Two type of cholinesterases.
True And Pseudo cholinesterase
True cholinesterase:
• Found in cholinergic neurons, ganglia, RBCs and NMJ.
• Highly specific for Ach, other acetylesters (methacholine
and bethanechol)
16. Pseudo cholinesterase/ butyrylcholinesterase /
Plasma choline esterase :
• Synthesized in liver
• found in plasma and intestine .
• Actions are non specific
• It hydrolyzed Ach, benzoylcholine and butyrylcholine esters
• Genetically variation
• atypicalcholine esterase slowly hydrolyzesis
• Typical choline (Fast acetylates)
17.
18. N receptors
• The cholinergic receptors are divided into
Nicotinic and Muscarinic.
• Nicotinic receptors located
– NMJ and Autonomic ganglia
– brain (located presynaptically) facilitator role in
release of other NT like DA and Glutamate.
• N receptor subtypes are muscle type (NM),
neuronal type (NN) and central nicotinic
receptors.
19. Nicotinic receptors
NM NN Central N
Location Skeletal NMJ
post synaptic
All autonamic
ganglia and
adrenal medulla
Sensory nerve
terminals
presynaptically
Function Contraction
of Sk. muscle
NE & E from
adrenal medulla
Facilitate
release of
Dopamine,
glutamate
Mechanism Ligand gated
channel
Ligand gated
channel
20. • N receptors are inotropic receptors
• Quaternary structure indicate five sub
units (two alpha, beta, delta and gamma)
• Ach binding sites between α and γ subunit,
and α and δ subunit
21. Mechanism of action
• Ach interacts with nicotinic Ach receptor, it
opens Na+ channel and Na+ ions flow into
the membrane
• Causes a depolarization, and result in
EPP.
• It cause excitatory on skeletal muscle.
Response is fast and short lived.
22. Muscarinic
• Parasympathetic neuro effector junction of all smooth muscle
and glands.
• M receptors are linked to G-protein (metabotrophic)
• Responses are slower and longer lived
• Serpantain receptor(7phosphtidil )
23. Types of M receptors
• 5 types of “M” receptors
• M1,M3,M5 (Odd) are excitatory effect through
IP3,DAG.
• M2,M4 are inhibitory effect cAMP and opening of
K+ channels.
• M1,M2,M3 are well characterized. M
1 3
2
26. M1 (Neuronal
and gastric)
M2 (Cardiac) M3(Glandular) M4 M5
Distrib
ution
Ganglia,
Gastric (parietal) ,
CNS (cortex,
hippocampus)
Myocardium,
presynaptic CNS
Glands
GIT smooth muscle
Bladder
Bronchus
CNS
Neostriatum Substanti
a nigra
Functi
on
Gastric acid
secretion, GI
motility, CNS
excitation
SA node rate of
impulse generation
AV node velocity
and decrease atrial
and ventricular
contraction
Exocrine
secretions.
Smooth muscle
contraction
(expect urinary,
Blood vessels
- -
Mech G protein (Gq),
IP3,DAG,depolari
zation
Gi cAmp, opening
of K+ channels
G protein (Gq),
IP3,DAG,depolari
zation
Gi cAmp,
opening of
K+ channels
G (Gq),
IP3,DAG,
depolariz
27. • Ach is more effective with “M” receptors.
• “N” receptor activation require larger
doses.
• At high dose it acts on “N” receptors cause
release of NE & Epinephrine from adrenal
medulla.
M N
28. Ach- contraction circular
muscle of iris- Miosis . (M3)
Contraction of ciliary muscle (M3)
- suspensory ligaments loose-
eye accommodated for near
vision
Miosis
Accommodated for near vision
Inc. drainage
Lacrimal gland (M3) inc. secretion
LENS
Ciliary
muscle
Circular
muscle
Radial
muscle
29. • Parasympathetic supply only up to
SA node, atria and AV node.
• Ventricular myocardium has M receptors
but no innervation.
• SA node M2 receptors activation:
– heart rate (-ve chronotrophic)
– contractile strength(-ve inotrophic)
• AV node M2 activation:
conduction velocity and
refractory period
33. Detrusor muscle (M3)- Contraction
Relaxation of sphincter .
Emptying of urinary bladder.
Vascular bed of erectile tissue is
dilated,
venous sphincters closed.
Erection of penis.
34. • Arteries have no parasympathetic, but M
receptors.
• Release EDRF, cause vasodilatation.
• Exogenous Ach cause fall in BP, it evoke
baroreceptor reflex, result sympathetic
discharge at heart.
• Bardycardia initial, after followed by
tachycardia.
37. Methacholine:- Seldom used therapeutically
Use to supra ventricular tachycardia but now not
using better drugs available.
Muscarinic Mycocardium (3Ms)
Bethanechol:- (Urocholine) resistant to
True/Pseudocholinestrase , t½ long (M action)
• Uses:-
i) To reverse post operative atony of baldder
ii) To treat GIT atony, inc motility, tone
iii) to treat salivary gland malfunction
iv) intra cerebroventricular inj beneficial effect in
Alzheimer's disease
38. Carbachol:
– Totally resistances to true/Pseudo chE
– N and M action
– Avoided therapeutic use bcoz of Large nicotinic action
Precautions : for all cholinesters
– Never give IV
• Sudden rise cardiac collapse
CI:
– Bronchial asthma
– Peptic ulcers
– MI
– Hyperthyrodism
39. Pilocarpine (natural)
• Obtained from the leaves of Pilocrapus
microphyllus.
• Tertiary amine cross BBB
• Prominent Muscarinic action.
• Increases all the secretions .
• Have complex effect on CVS, small doses
decreases BP but larger doses have opposite
action. (Ganglionic stimulation NN stimulation)
40. • Penetrates cornea
• Promptly causes miosis
• Ciliary muscle contracts and IOP reduces.
• Uses:
0.5 - 4% eye drops for open angle glaucoma.
To counteract mydriatics after refraction testing.
To prevent or break adhesions of iris with lens
• A/E: stinging sensations, painful spasms of
accomodation.
41. • Muscarine :source Amantia muscaria
Not used therapeutically
• Arecoiline: Found in Beetel nuts Areca
catechu
Muscrinic as well as nicotinic action
Not used therapeutically
42. Side effects:- result of over stimulation
of the parasympathetic system .
• Cardiovascular:
– Bradycardia, hypotension, conduction
abnormalities (AV block and cardiac arrest)
• CNS:
– Headache, dizziness, convulsions
• Gastrointestinal:
– Abdominal cramps, increased secretions,
nausea, vomiting
43. • Respiratory:
– Increased bronchial secretions,
bronchospasms
Other:
– Lacrimation, sweating, salivation, loss of
binocular accommodation, miosis
45. Physostigmine and Neostigmine
Physostigmine Neostigmine
Source Natural alkaloid Synthetic
Chemistry Tertiary amine Quaternary amine
CNS action Present Absent
Oral absorption Good Poor
Applied to eye Cross cornea No
Action on cholino receptors Absent Present
Prominent effect on Autonomic effectors Skeletal muscles (Post
operative decurization)
Post operative paralytic ileus /
urinary retention (1mg SC)
Use Glaucoma Myasthenia gravis
46. Belladona (Atropine) poison
• Physostigimine specific antidote for
atropine
• It cross BBB dec central action and
peripheral action
• Poison :- 0.5- 1mg IM dose.
• 2mg IV/IM initially and additional dose if
required
47. Rivastigmine & Tacrine
• Lipophilic
• Cross BBB
• Cerebroselective ChE
• Used for Alzheimer’s Disease
48. Myasthenia gravis
• Autoimmuno disorder
• Occurs 1 in 10,000
• It is associated with production of IgG
antibody that binds to Ach receptors at
post junctional motor end plate
• Fast moving muscles are affected first
52. Glaucoma
• Glaucoma is an increased intraocular
pressure. (>21mm/Hg)
• If persistent it leads to optic nerve damage
result in blindness.
• Glaucoma is caused
• drainage
• aqueous humor production
55. • Narrow angle (Closed angle, Acute congestive)
• Iris physically blocking canal of Schlemm
• It is medical emergency, drugs may control acute
attack but long term surgical (partial iridectomy)
56. • Wide angle (Open angle, Chronic simple):-
• Angle is remain wide but trabecular
meshwork losses patency due to
degeneration.
• So outflow of aqueous humor is impeded.
• surgery is not useful.
57. Cholinomimetics decrease the IOP in both types.
In closed angle:- Pulling the Iris, opening of angle
In open angle : contraction of longitudinal Ciliary
muscle inc. drainage
58.
59. Group Mech Dose
Directly acting
Cholinomimetics
Pilocarpine
Ciliary muscle contraction,
opening of trabecular
meshwork, Inc drainage
0.5 - 4% topical 3times a day
or ocular inserts
Reversible Anti AChE
Physostigmine
Demecuronium
Same 0.25 - 5% topical 2 a day
0.25 - 5% topical 2 a week
Irreversible
Ecothiophate
Only one drug used clinically
Same 0.05 - 0.25% once in 2weeks
0.03% topically
Beta blockers (DOC for Open)
Timolol
Betaxolol
Levobunolol
Carteolol
Dec. aqueous humor by
blocking β2 present in
ciliary epithelium
0.25% - 0.5% topical 2 a day
0.25% - 0.5% topical 2 a day
0.25% - 0.5% topical 1 a day
1% solution topically
Non seletive α agonist
Epinephrine
Dipivefrine
α1 Blood
α 2 Aqueous secretion 0.5 - 2% topically
0.1%opically 2 or 3 a day
Seletive α2 agonist
Apraclonidine
Brimonidine
Dec formation by α2 agonist
Potent ocular hypotensive
≠ BBB no systemic side
effects
0.5 -1% topically
0.5 -1% topically
Restricted use for acute IOP
61. Advantage of β Blockers
• No cahnge in pupil size
• No myopia
• No head ache/brow pain due to persistent
spasmof iris
• No fluctuations in iot (occurs with pilocarpine)
• Convenient twice/once daily
Open
angle B-blockers
Alpha-
Blcokrs
PG
Latanoprost
CAI
Acetazolami
de
63. Mechanism of Action
Phosphorylating the active
Site
Covalent modification
Duration: days
Irreversible action
By the loss of one of the
alkyl group the
phosporylated enzyme may
become resistant to
hydrolysis thus causing
irreversibility.
64. Uses of AChE
Ecothiophate
• Quaternary compound
• Water soluble
• Don’t cross BBB
• Used as miotic and management of
glaucoma (Ophthalmic solution 0.05- 0.25%)
• Potent and longer acting
• No local irritation
Isofluorophosphate :
• oil in character cause local irritation
69. General supportive
Removal of clothes, washing of contaminated skin,
gastric lavage , artificial respiration,
If convulsions Diazeepam
Pradlidoxime 1-2g Slow IV infusion over 15-
30min to reactive and regeneration of AChE
2 mg IV repeated every 10 mins till signs of full
atropinization
i.e. dilatation of pupils, tachycardia
R Organo Phosphorus poison
Diacetylmonoxime cross BBB