This document discusses antiarrhythmic drug therapy. It describes the normal cardiac conduction pathway and how arrhythmias disrupt normal rhythm. There are several classes of antiarrhythmic drugs that work by different mechanisms, such as blocking sodium, potassium, calcium channels or beta receptors. The drugs have various uses for treating supraventricular and ventricular arrhythmias. Adverse effects and drug interactions are also reviewed for specific antiarrhythmic medications.
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
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.
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!
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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ASA GUIDELINE
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
2. Normal conduction pathway
SA node
Generates action
potential
AV node
Delivers the
impulse to purkinje
fibers
Purkinje fibers
Conduct the
impulse to the
ventricles
8. Pharmacologic rationale & Goal
The ultimate goal of antiarrhythmic drug
therapy:
Restore normal sinus rhythm and conduction
Prevent more serious and possibly lethal
arrhythmias from occurring.
Antiarrhythmic drugs are used to:
Decrease conduction velocity
Change the duration of the effective refractory
period (ERP)
Suppress abnormal automaticityShrivatsa U, Wadhani M, Singh AB; Mechanisms of antiarrhythmic drug action & their clinical relevance for
controlling disorders of cardiac rhythm; Curr Cardiol Rep 2002;4;401
9. Classification of Antiarrhythmic
Drugs
Classified a/c to Vaughan William into four
classesClass Mechanism Action Notes
I
Na+ channel
blocker
Change the slope of phase 0
Can abolish
tachyarrhythmia
caused by reentry
circuit
II β blocker
↓heart rate and conduction
velocity
Can indirectly alter
K and Ca
conductance
III
K+ channel
blocker
1. ↑action potential duration
(APD) or effective refractory
period (ERP).
2. Delay repolarization.
Inhibit reentry
tachycardia
Ca++ channel Slowing the rate of rise in phase
↓conduction
11. Treatment of tachyarrhythmias:
Class I drugs (Membrane stabilizing drugs) :
Mechanism:
Class I drugs block fast Na+ channels, thereby
Reducing the rate of phase 0
depolarization
Prolonging the effective refractory period
Increasing the threshold of excitability
Reducing phase 4 depolarization
These drugs also have local anestheticWoosely RL. Antiarrhythmic drugs. Hurst’s The Heart (Ed. Fuster V, Alexander RW, O’Rourke RA,
et al.) 10th edition.2001;1:899–924
12. Class IA
1. Quinidine
Alkaloid – cinchona , dextro isomer of quinine.
Blocks sodium channel & potassium channel
also
Anti-muscarinic and Alpha blocking action
Administered orally & is rapidly absorbed from
gastrointestinal tract
Hydroxylated in the liver
t1/2 of approximately 5—12 hours, longer in
hepatic or renal disease & in heart failure
Bitter and irritant
Inhibitor of CYP P450 system.
13. 1. Quinidine
↑↑ plasma conc of digoxin by displacing it from
tissue binding sites & decreasing its renal &
biliary clearance.
Uses:
Atrial fibrillation
Ventricular tachycardia
Adverse effects :
GIT : Diarrhea, nausea, vomiting and
cinchonism
Thrombocytopenia
Precipitate torsade de pointes by prolonging
14. 1. Quinidine
Drug interactions
Increases digoxin plasma levels &risk of
digitalis toxicity
t1/2 reduced by agents that induce drug-
metabolizing enzymes (phenobarbital,
phenytoin)
May enhance the activity of coumarin
anticoagulants & other drugs metabolized by
hepatic microsomal enzymes
Cardiotoxic effects exacerbated by
15. 2. Procainamide
Like quinidine, but
Safer to use intravenously
Produces fewer adverse GI effects
Acetylated in liver to N-acetylprocainamide
(NAPA)
Eliminated by the kidney (t ½ -3 – 5 hrs)
More likely than quinidine to produce severe or
irreversible heart failure
Adverse effects
SLE like syndrome consisting of arthralgia and
arthritis specially in slow acetylators
16. Class IB
1. Lidocaine:
Least cardiotoxic : (t ½ - 1.5 - 2 hrs)
Block inactivated Na channels : preferred for
partially depolarized cells in ischemic area
High first pass metabolism – not given orally
Used in:
Ventricular arrhythmia
Digoxin induced arrhythmia
Main toxicity:
Neurological – drowsiness, nystagmus &
17. 2. Mexiletine and Tocainide
Similar in action to lidocaine
Can be administered orally
T ½ - Mexiletine – 10-12 hrs
- Tocanide – 11-23 hrs
Used for long-term treatment of ventricular
arrhythmias associated with previous
Myocardial Infarction
Adverse events:
Mexiletine : Ataxia, dizziness, tremors
Tocainide : Blood dyscrasias, pulmonary
fibrosis, GI and neurological symptoms
18. Class IC
Class of potent Na channel blocker
Drugs of this class have negative inotropic effect
High pro-arrhythmogenic potential – sudden
death
19. Class IC
1.Flecainide
Orally active antiarrhythmic
Metabolized by microsomal enzymes (t ½ - 20
hrs)
Used for ventricular tachyarrhythmias &
maintenance of sinus rhythm in patients with
paroxysmal atrial fibrillation and/or atrial flutter
& WPW
C/I in pts with structural heart disease
Adverse events :
Heart failure, dizziness, headache , Blurred
20. 2. Propafenone
Spectrum of action similar to that of quinidine
Possesses β-adrenoceptor antagonist activity
Metabolized by hepatic microsomal enzymes
T ½ - 2 – 10 hrs
Approved for treatment of supraventricular
arrhythmias and suppression of life-threatening
ventricular arrhythmias
C/I in structural heart disease
Adverse events:
Nausea, Vomitting, altered taste
21.
22. Class II
They Are β-adrenoceptor antagonists,
including propranolol
Act by reducing sympathetic stimulation
Inhibit phase 4 depolarization
Depress automaticity
Prolong AV conduction
Decrease
Heart rate
Contractility
23. Class II
Major drugs
Propranolol, a nonselective β-adrenoceptor
antagonist
Acebutolol & esmolol, more selective β1-
adrenoceptor antagonists
Used to treat ventricular arrhythmias
Propranolol, metoprolol, nadolol, and
timolol frequently used to prevent recurrent
MI
24. Class II
Absorption and elimination:
Propranolol: oral, iv
Esmolol: iv only (very short acting T½, 9 min)
Cardiac effects
APD and refractory period in AV node to
slow AV conduction velocity
decrease phase 4 depolarization
(catecholamine dependent)
25. Class II
Uses:
Treating sinus and catecholamine dependent
tachyarrhythmias
Converting reentrant arrhythmias in AV
Protecting the ventricles from high atrial rates
Side effects:
Bronchospasm
Hypotension
Don’t use in partial AV block or ventricular
failure
26. Class III
Class III drugs:
Prolong action potential duration
Prolong effective refractory period
Act by:
interfering with outward K+ currents or
slow inward Na+ currents
27. 1. Amiodarone
Structurally related to thyroxine.
Net effect:
Increases refractoriness
Depresses sinus node automaticity
Slows conduction.
Long half-life (14—100 days) ↑ risk of toxicity
Plasma conc not well correlated with its effects
After parenteral administration:
Electrophysiologic effects →within hours
Effects on abnormal rhythms may not be seen
for several days
28. 1. Amiodarone
Antiarrhythmic effects may last for weeks or
months after the drug is discontinued
Uses:
Refractory life-threatening ventricular
arrhythmias in preference to lidocaine
T/t of atrial and/or ventricular arrhythmias
Adverse effects
Pulmonary fibrosis
Skin pigmentation
Corneal deposits
Interferes with the thyroid function
29. Class IV
Mechanism
Class IV drugs selectively block L-type calcium
channels.
These drugs prolong nodal conduction and effective
refractory period and have predominate actions in
nodal tissues
31. Verapamil
Phenylalkylamine that blocks both activated and
inactivated slow calcium channels.
Tissues that depend on L-type calcium channels
are most affected
Has equipotent activity on the AV and SA nodes
and in cardiac and vascular muscle tissues
Useful in:
Supraventricular tachycardia
Atrial flutter and fibrillation
32. Verapamil
Adverse effects:
Negative inotropic action that limits its use
in damaged hearts;
Can lead to AV block when given in large
doses or in patients with partial blockage.
Can precipitate sinus arrest in diseased
patients
Causes peripheral vasodilation.
33. Miscellaneous Antiarrhythmic
Drugs
Adenosine
Acts through specific purinergic (P1)
receptors.
Causes an increase in potassium efflux and
decreases calcium influx.
This hyperpolarizes cardiac cells and
decreases the calcium-dependent portion of
the action potential.
Drug of choice for the treatment of
paroxysmal supraventricular tachycardia,
including those associated with Wolff-
36. Investigational Drugs
Analogs of Amiodarone are being developed
such as:
ATI-2001
Dronedarone
SR-33589
Dronedarone:
Resonable safety profile
Well characterized pharmacokinetic &
pharmacodynamic profile
Effective in doses lower than 2000 mg/dayWolbrette D et al ; Dronedarone for the treatment of atrial fibrillation and atrial flutter: Approval and
efficacy ; Vasc Health Risk Manage 2010;6;517
37. Investigational Drugs
Azimilide :
Potassium-channel blocking properties
Prolongs cardiac AP & refractory periods
Found to be effective in patients with
symptomatic tachyarrhythmias and ICDs
therapies in recent studies
Other drugs, such as Ambasilide, are also in
clinical development
Chromanol 293B is in preclinical testing
Reynolds RM, Josephson ME. Sustained ventricular tachycardiain ischemic cardiomyopathy : current
management. ACC Current Journal Review 2005;14:63-71
38. Treatment of bradyarrhythmias
Atropine
Blocks the effects of acetylcholine.
Elevates sinus rate and AV nodal and sinoatrial
(SA) conduction velocity, & decreases
refractory period
Used to treat bradyarrhythmias that
accompany MI
Adverse effects:
Dry mouth, mydriasis, and cycloplegia;
May induce arrhythmias.
39. T/t of Atrial Flutter/Fibrillation
1. Reduce thrombus formation by using
anticoagulant warfarin
2. Prevent the arrhythmia from converting to
ventricular arrhythmia
First choice: class II drugs:
After MI or surgery
Avoid in case of heart failure
Second choice: class IV drugs
Third choice: digoxin
Only in heart failure of left ventricular
40. T/t of Atrial Flutter/Fibrillation
3. Conversion of the arrhythmia into normal sinus
rhythm
Class III:
IV ibutilide, IV/oral amiodarone, or oral sotalol
Class IA:
Oral quinidine + digoxin (or any drug from the 2nd
step)
Class IC:
Oral propaphenone or IV/oral flecainide
Use direct current in case of unstable
hemodynamic patient
Fuster V et al; ACC/AHA/ESC Guidelines for the management of patients with atrial fibrillation. Circulation
41. T/t of Ventricular Arrhythmia
Premature ventricular beat (PVB)
First choice: class II
IV followed by oral
Early after MI
Second choice: amiodarone
Avoid using class IC after MI ↑ mortality
42. T/t of Ventricular Tachycardia
First choice: Lidocaine IV
Repeat injection if needed
Second choice: procainamide IV
Adjust the dose in case of renal failure
Third choice: class III drugs
Especially amiodarone and sotalol
Grant AO, Recent advances in the treatment of arrhythmia. Circ J 2003;67;651