Dr. D. K. Brahma discusses antiplatelet drugs, which interfere with platelet function and are useful for preventing thromboembolic disorders. The document defines antiplatelet drugs and describes the role of platelets in thrombosis formation. It then discusses the mechanisms of various antiplatelet drugs including aspirin, dipyridamole, ticlodipine, clopidogrel, prasugrel, and GPIIb/IIIa receptor antagonists like abciximab. The uses of these antiplatelet drugs for conditions like heart attacks, strokes, angioplasty and stents are summarized.
An antiplatelet drug (antiaggregant), also known as a platelet agglutination inhibitor or platelet aggregation inhibitor, is a member of a class of pharmaceuticals that decrease platelet aggregation and inhibit thrombus formation. They are effective in the arterial circulation, where anticoagulants have little effect.
A Power point presentation on Betalactam antibiotics suitable for undergraduate medical students. This Ppt is already presented in theory class lectures to the students of NEIGRIHMS, Shillong, Meghalaya
A Powerpoint presentation on drugs excretion and elimination suitable for UG medical students. This ppt is already presented to my students in one of the theory classes.
A PowerPoint presentation on "NSAIDS" suitable for reading by UG and PG Medical/Paramedical students of Pharmacology and Pharmacy sciences. This Ppt. is prepared for academic purpose only and already presented to my students in one of the theory classes of mine.
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.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Antiplatelet drugs (antithrombotics)
1. Dr. D. K. Brahma
Associate Professor
Department of Pharmacology
NEIGRIHMS, Shillong
Antiplatelet Drugs
(Antithrombotic Drugs)
2. Definition
• Drugs which interfere with platelet function
and are useful in prophylaxis of
thromboembolic disorders
– The principal function of platelets is to prevent
bleeding – by THROMBUS formation
3. Background –
Platelet Aggregation
• Glycoprotein (GP) integrin Receptors
• Platelet Activation: Collagen reacts with GPIa and GPIb
receptors via vWF
• Release of TXA2, ADP and 5-HT etc.
• Conformational changes at GPIIb/IIIa – binding of fibrinogen
– cross linkage – Platelet PLUG formation
• Thrombus in arteries – only mass in Arteries; In veins - Red
tail – antiplatelet drugs are useful
• Balance between PGI2 and TXA2 – controls intavascular
Thrombus
9. Aspirin
• MOA: Acetylates COX 1 and TX-synthase – irreversible inactivation -
in portal circulation (Deacetylation of Aspirin)occurs in liver
– TXA2 formation suppressed – fresh enzyme synthesis takes time – at
low doses
– Prolongation of bleeding time for 5 – 7 days
– Cumulative effect – 40 mg/day – max. at 160 mg
– Low doses – only TXA2 but higher doses both TXA2 and PGI2 (Clinically
irrelevant)
– In vessel wall – PGI2 suppression - can synthesize new enzymes
– At low doses (75 – 150 mg/day) – selective suppression of TXA2 –
higher doses – both TXA2 and PGI2
– Also inhibition of ADP – sticking interfered
10. Acetylsalicylic acid – major use
• Secondary prevention of transient ischaemic attack
(TIA), ischaemic stroke and myocardial infarction
• Prevention of ischaemic events in patients with
angina pectoris
• Prevention of coronary artery bypass graft (CABG)
occlusion
11. Dipyridamole -Vasodilator – used in angina
• MOA:
– Phosphodiesterase enzyme inhibitor
– increases cAMP conc.
– Inhibits uptake of Adenosine in
Platelets – increase c AMP
– cAMP - Overall, Potentiates PGI2
– Levels of TXA2 and PGI2 are not
altered – life span increased
• Uses: Used to enhance the action of
Warfarin and Aspirin in TE events –
Risk of stroke in TIA
– To decrease the incidence of
thromboemboism in prosthetic heart
valve
– TIA – risk of stroke reduced
– As vasodilator: myocardial perfusion
imaging (Thallium scanning)
Resistance
vessels
12. Dipyridamole - Kinetics
• Incompletely absorbed from the gastrointestinal tract with
peak plasma concentration occurring about 75 minutes after
oral administration
• More than 90% bound to plasma proteins
• A terminal half-life of 10 to 12 hours
• Metabolised in the liver
• Mainly excreted as glucuronides in the bile; a small amount is
excreted in the urine
• Available as 75 mg and 100 mg preparations
13. Ticlodipine
• Thienopyridine derivative: Alters surface receptors on
Platelets and inhibits ADP and fibrinogen induced platelet
aggregation
• MOA:
1. Gi coupled P2Y12 (P2YAC ) receptor mediates ADP induced adenylyl cyclase
inhibition – blocked – platelet activation interfered
2. Also prevents binding of fibrinogens to platelets – but does not interfere
GPIIb/IIIa receptors
3. TXA2 is not affected – but bleeding time prolonged - platelet survival in
extra-crporeal circulation increased
4. Synergistic action with aspirin
• Kinetics: Well absorbed orally – converts to active metabolite in body –
single dose Half life 8 hrs - cumulates – peak effect 8 – 10 days - lasts for
5-6 days
15. Ticlodipine - Uses
• Secondary prevention of Stroke, TIA
• Intermittent claudication
• Unstable angina
• PCI
• Coronary artery bypass surgery
• Prophylaxis of MI
• With aspirin prevents restenosis after PCI and stent
• ADRs: Diarrhoea, vomiting, abdominal pain, headache,
tinnitus, skin rash
– Bleeding, neutropenia, thrombocytopemia and jaundice
– Limited Use
16. Clopidogrel
• Newer and more potent congener of Ticlodipine
• MOA – same with Ticlodipine but safer and better tolerated
• Studies: CAPRIE study - Slightly lower risk of ischaemic events
than aspirin recipients for primary ischemic events –
combination in checking restenosis in stent coronary
• Kinetics: Prodrug – 50% absorption
– Only a fraction is activated in liver by CYP2C19
– CYP2C19 – genetic polymorphism – interindividual variation of action
– Some are non responsive
– Omeprazole - DI
• ADRs: Bleeding – double with aspirin
– neutropenia, thrombocytopenia are rarer than Ticlodipine
17. Prasugrel
• Newer, most potent and faster P2Y12 purinergic receptor blocker
• Preferred in Acute Coronary Syndromes (ACS) and when strong
antiplatelet action required
• Prodrug – but faster and complete absorption – completely activated
• CYP2C19 substrate – but Genetic polymorphism related decrease and DI
with Omeprazole is rare
• Uses: STEMI, ACS to cover angioplasty
– Comparison with clopidogrel in STEMI and NSTEMI – Prasugrel – better in reduction in
death due to CVS causes
– Superior results in reduction of STENT thrombosis
• ADRs: Bleeding complications – severe, Intracranial haemorrhage – in TIA
and stroke patients
• CI: Ischaemic stroke and TIA
• Dose: 10 mg OD (available as 5 and 10 mg tablets)
18. GPIIb/IIIa receptor antagonists
• Newer potent platelet aggregation inhibitor -
Abciximab, eptifibatide and tirofiban
• GPIIb/IIIa is an adhesive receptor aggregation –
antagonists block aggregation -
24. Abciximab
• Chimeric monoclonal antibody against - GPIIb/IIIa receptor
• But nonspecific – binds to some other proteins also
• Available only in IV form – intravenous bolus dose followed by continuous
IV – with aspirin + heparin during PCI (reduced restenosis – MI and Death)
• After a bolus dose: action remains for 12-24 Hrs, t1/2 – 10 - 30 min
• After continuous infusion: after stoppage – clears rapidly in 6 Hrs – then
slowly – remains in blood for 15 days
• ADRs: Haemorrhage, Thrombocytopenia – should not be repeated 2nd
time, paralytic ileus, constipation, arrhythmia - nonantigenic
• Drawback: Expensive
• Uses: Unstable angina and as an adjuvant to coronary thrombolysis/PCI
with Stent application
25. Eftibatide
• Synthetic – selective to platelet GPIIb/IIIa
receptor
• Longer plasma half life – but inhibition of
platelet reverses sooner (6 hours)
• Uses: Unstable angina, coronary angioplasty
– Given with aspirin and heparin
• ADR: Bleeding, thrombocytopenia,
anaphylaxis
26. Uses of Antiplatelets
1. Coronary Artery Disease:
• MI: Immediately after MI low dose aspirin
• Aspirin: routinely used after thrombolytic therapy to prevent
reocclusion; to cover PCI with heparin
• Unstable angina: Aspirin reduces risk of MI
• Primary and secondary prevention of MI: Evidence of coronary artery
disease - aspirin
2. Cerebrovascular Disease: Do not have much effect but prevents TIAs
3. Coronary angioplasty, stents etc.: patency of re-canalized artery or implant
bypass vessels improved – re-occlusion reduced
4. Prosthetic Heart Valve and Arteriovenous shunts: reduce formation of
microthrombi in heart valves
5. Venous Thromboembolism
6. Peripheral Vascular Disease
27. Must Know
• Aspirin as antiplatelet agent
• Clopidogrelel
An Aspirin a Day: The Wonder Drug That Could
Save YOUR Life
Following vascular injury, von Willebrand factor binds to collagen in the exposed subendothelium at the site of injury. The other site of the “rod-formed” von Willebrand factor binds to the platelet receptor GPIb and platelets are thereby anchored to the site of the injured entothelium. This is called adhesion.
Following adhesion, agonists such as collagen, thrombin, adenosine diphosphate (ADP), and thromboxane A2 activate platelets by binding to their respective platelet receptors.
As a result of agonist binding, platelets undergo a shape change and new structures such as phospholipids and GPIIb/IIIa receptors are exposed on the cell membrane. This is called activation.
The third step of platelet response is aggregation. After activation, fibrinogen binds to GPIIb/IIIa to connect platelets together into a loose platelet plug.
The glycoprotein IIb/IIIa receptor is exposed on the platelet membrane after activation and is responsible for mediating platelet aggregation.
Once activated, the receptor becomes functional and binds fibrinogen, leading to the formation of platelet aggregates.
Glycoprotein IIb/IIIa receptors therefore mediate the final common pathway of platelet aggregation.
GPIIb/IIIa antagonists hava a high affinity for the fibrinogen receptor…
…and when binding is completed…
…they will prevent fibrinogen from binding to the receptors.