Introduction
Classification of Helminthiasis
Classification of Anthelmintics Drugs
Mebendazole
Albendazole
Pyrentel pamoate
Peperazine
Levamisole
Praziquantel
Niclosamide
Ivermectin
Diethylcarbamazine
Helminthiasis, also known as worm infection, is any macroparasitic disease of humans and other animals in which a part of the body is infected with parasitic worms, known as helminths. There are numerous species of these parasites, which are broadly classified into tapeworms, flukes, and roundworms.
The helminths worms are macroscopic, multicellular organisms having their own digestive, excretory, reproductive and nervous system. The helminths could be nemathelminths (round bodied worms) or platyhelminths (flat bodied worms).
Nematodes (round worms) are long, round bodied segmented worms that are tapered at both ends . In festation occurs if the embryonated eggs or tissues of infested host contain larva of the nematode.
Introduction
Classification of Helminthiasis
Classification of Anthelmintics Drugs
Mebendazole
Albendazole
Pyrentel pamoate
Peperazine
Levamisole
Praziquantel
Niclosamide
Ivermectin
Diethylcarbamazine
Helminthiasis, also known as worm infection, is any macroparasitic disease of humans and other animals in which a part of the body is infected with parasitic worms, known as helminths. There are numerous species of these parasites, which are broadly classified into tapeworms, flukes, and roundworms.
The helminths worms are macroscopic, multicellular organisms having their own digestive, excretory, reproductive and nervous system. The helminths could be nemathelminths (round bodied worms) or platyhelminths (flat bodied worms).
Nematodes (round worms) are long, round bodied segmented worms that are tapered at both ends . In festation occurs if the embryonated eggs or tissues of infested host contain larva of the nematode.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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
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
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
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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!
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
2. • Antihelmintics are drugs that either kill
(vermicide) or expel (vermifuge) infesting
helminths.
• Nematodes, trematodes, and cestodes are three
major groups of helminthes (worms) that infect
humans.
• Nematodes are elongated roundworms that
possess a complete digestive system. They
cause infections of the intestine as well as the
blood and tissues.
• We use: mebendazole, albendazole, pyrantel,
levamisol, piperazine.
3.
4. Mebendazole
• Uses: whipworms (Trichuris trichiura), pinworms
(Enterobius vermicularis), hookworms (Necator
americanus and Ancylostoma duodenale), and
roundworms (Ascaris lumbricoides);
in high doses: extraintestinal helminthiasis
(trichinellosis and echinococcosis)
• It inhibits the assembly of the microtubules and
glucose utilization in helminthes and paralyses them.
It kills ova and larvae of Ascaris.
• Absorption from intestines – 10-15%
• Adverse effects: abdominal pain, diarrhea,
headache, allergic reactions
5. Albendazole
Uses: ascariasis, hookworms and enterobiasis
(a single dose) , toxocariasis, filariasis,
cysticercosis, echinococcosis (long-term
therapy).
It is absorbed from GIT, metabolized in the
liver.
Adverse effects: headache, diarrhea, dizziness,
leucopenia, skin rashes, abdominal pain,
vomiting.
6. Levamisole
Uses: a single dose – ascariasis, less effective
– ankylostomiasis, strongyloidiasis, filariasis.
Mechanism: stimulation of ganglia, drug-
induced paralysis of helminthes due to
depolarization of their muscles, inhibition of
fumarate reductase and metabolism.
Adverse effects: abdominal pain, diarrhea,
nausea
7.
8. • Pyrantel is active against Ascaris, Enterobius,
Ancylostoma, Necator, Strongyloides
• Mechanism: activation of nicotinic cholinergic
receptors in the worms → persistent
depolarization → slowly developing
contracture and spastic paralysis.
• Absorption from GIT – 10-15%.
• Adverse effects: nausea, vomiting, abdominal
pain, headache and dizziness
9. Diethylcarbamazine citrate is
microfilaricidal. It has a highly selective effect
on microfilariae and against adult worms.
It is rapidly absorbed following oral
administration with meals and is excreted
mainly in the urine.
Adverse effects may include fever, nausea,
vomiting, arthralgia, and headache.
10. Niclosamide
• Uses: Taenia saginata, Diphyllobothrium latum
and Hymenolepis nana.
• It inhibits the mitochondrial phosphorylation of
adenosine diphosphate (ADP). Anaerobic
metabolism may also be inhibited.
• In cases of T. solium, digestion of the dead
segments can be hazardous, because the ova
released from them may develop into larvae in the
intestine, penetrate its wall and cause visceral
cysticercosis.
• It is minimally absorbed from GIT.
• Adverse effects: dyspepsia, allergic reactions.
11.
12. Praziquantel
Uses: all forms of schistosomiasis, other
trematode infections, cestode infections such as
taeniasis, cysticercosis (caused by Taenia solium
larvae)
Mechanism: leakage of intracellular calcium from
the membranes → contracture and paralysis.
It is rapidly absorbed after oral administration and
distributes into the cerebrospinal fluid (CSF). It is
extensively metabolized, and the inactive
metabolites are excreted primarily in the urine.
Adverse effects: dizziness, malaise, headache
13. Antiprotozoal drugs are used for the treatment
and prophylaxis of:
Malaria
Amebiasis
Giardiasis (Metronidazole, furazolidone)
Trixomoniasis (Metronidazole, furazolidone,
Diiodohydroxyquin rect.)
16. Antiamoebic drugs - drugs useful in infection
caused by the anaerobic protozoa Entamoeba
histolytica.
17. CLASSIFICATION
1. Tissue amoebicides
For both intestinal and extraintestinal amoebiasis:
Nitroimidazoles: Metronidazole, Tinidazole,
Ornidazole
For extraintestinal amoebiasis only: Chloroquine
2. Luminal amoebicides: Tetracyclines
18. • Nitroimidazoles (Metronidazole) is used for the
treatment of infections caused by:
• Entamoeba histolytica,
• Giardia lamblia,
• Trichomonas vaginalis,
• anaerobic cocci, and anaerobic gram-negative
bacilli (Bacteroides species),
• for the treatment of pseudomembranous colitis
caused by the anaerobic, gram-positive bacillus
Clostridium difficile.
19.
20. • The nitro group of Nitroimidazoles is able to
serve as an electron acceptor, forming reduced
cytotoxic compounds that bind to proteins and
DNA. The drugs disrupt metabolism and cause
death of microorganisms.
• They are absorbed well from GIT, distribute well
throughout body tissues and fluids. Therapeutic
levels can be found in vaginal and seminal fluids,
saliva, breast milk, and cerebrospinal fluid (CSF).
• Tinidazole and ornidazole are well absorbed from
GIT, accumulated in the plasma in higher
concentrations than Metronidazole and provide
longer effect than it.
21. Adverse effects:
nausea, vomiting, epigastric distress, and
abdominal cramps, an unpleasant,
metallic taste,
oral moniliasis (yeast infection of the
mouth),
neurotoxicity (dizziness, vertigo, and
numbness or paresthesia),
a disulfiram-like reaction (if taken with
alcohol).
22. • Malaria is one of the most common diseases
worldwide and a leading cause of death. Plasmodium
species that infect humans (P falciparum, P malariae,
P ovale, P vivax) undergo a primary developmental
stage in the liver and then parasitize erythrocytes. P
falciparum and P malariae have only 1 cycle of liver
cell invasion. The other species have a dormant
hepatic stage responsible for recurrent infections and
relapses. Primary tissue schizonticides (eg,
primaquine) kill schizonts in the liver, whereas
blood schizonticides (eg, chloroquine, quinine) kill
these parasitic forms only in the erythrocyte.
Sporonticides (proguanil, pyrimethamine) prevent
sporogony and multiplication in the mosquito.
24. Principals of antimalarial drugs use
1. Individual chemoprophylaxis: prevention of the
development of malaria in men during the time
of residency in a area which has a high risk of
malaria. We can use drugs influencing on
preerythrocytic forms or hematoshizotropic
drugs (pyrimethamine, chloroquin)
2. The treatment: oral administration of
hematoshizotropic drugs, which influence
erythrocytic forms of plasmodia. These drugs are
used to cure the acute attacks of M.
25. 3. Prevention of delayed relapses: administration
of drugs which have tropism towards
paraerythrocytic forms (primaquine).
4. Social chemoprophylaxis: prevention of the
transmission of the infection by a sick person.
We use gametotropic drugs (primaquine,
pyrimethamine).
26.
27. • Chinine (Quinine) complexes with
doublestranded DNA and prevents strand
separation, blocks DNA replication and
transcription to RNA. It is solely a blood
schizonticide.
• It is rapidly absorbed orally and is metabolized
before renal excretion. Intravenous administration
of quinine is possible in severe infections.
• It is used in the treatment of severe or
complicated falciparum malaria.
• Adverse effects: cinchonism (gastrointestinal
distress, headache, vertigo, blurred vision and
tinnitus).
28. • Chloroquine is rapidly absorbed when given
orally, is widely distributed to tissues.
• It accumulates in the food vacuole of plasmodia
and prevents polymerization of the hemoglobin
breakdown product heme into hemozoin.
Intracellular accumulation of heme is toxic to the
parasite.
• It is the drug of choice for acute attacks of malaria
and for chemoprophylaxis.
• Side effects: gastrointestinal irritation, skin rash,
and headaches; peripheral neuropathies,
myocardial depression, retinal damage, auditory
impairment, and toxic psychosis
29. • Sulfonamides act as antimetabolites of PABA and
block folic acid synthesis by inhibiting
dihydropteroate synthase.
• Pyrimethamine is a selective inhibitor of
protozoan dihydrofolate reductases. The
combination has synergistic antimalarial effects
(blockade of 2 steps in folic acid synthesis).
• The antifols are blood schizonticides that act
mainly against P falciparum.
• Adverse effects: skin rashes, gastrointestinal
distress, hemolysis, kidney damage.
30. • Primaquine is a synthetic 8-aminoquinoline. It
is used orally.
• It forms quinoline- quinone metabolites, which
are electron-transferring redox compounds that
act as cellular oxidants. The drug is a tissue
schizonticide and also limits malaria
transmission by acting as a gametocide.
• Uses: Eradication of liver stages of P vivax and P
ovale, primary prevention
• Adverse effects: GI distress,
methemoglobinemia, hemolysis in G6PD
deficiency
32. Mechanism:
The restoration of the nitro group to the amino
group under the influence of reductase
microbial cells.
The formation of complexes with nucleic acids,
Disruption of the respiratory chain of
microorganisms.
Increase in the body's resistance to infections.
The decline in the production of toxins.
Type of action: bacteriostatic or bactericidal
33. Side effects
Dyspeptic disorders: nausea, vomiting,
diarrhea;
Cholestasis; disorders of liver function;
Allergic reaction;
Headache, dizziness;
Hemolytic anemia,
Methemoglobinemia in children
up to a year;
Arterial hypertension
34. • Melarsoprol is used for the treatment of
trypanosomal infections. The drug reacts with
sulfhydryl groups of various substances, including
enzymes in both the organism and host.
• It is administered by slow IV injection and has
irritating effect. Adequate trypanocidal
concentrations appear in the CSF. The drug has a
very short half-life and is rapidly excreted in urine.
• Adverse effects: CNS toxicity, peripheral
neuropathy, hypertension, albuminuria; allergy,
febrile reactions; hemolytic anemia in patients
with glucose-6-phosphate dehydrogenase
deficiency.
35.
36. Leishmania, transmitted by flesh-eating flies,
cause various diseases ranging from or
mucocutaneous lesions to splenic and hepatic
enlargement with fever.
37. • Solusurminum and Sodium stibogluconate
(pentavalent antimony) kills the parasite by
inhibition of glycolysis or effects on nucleic
acid metabolism.
• Stibogluconate must be administered
parenterally and is potentially cardiotoxic
(QT prolongation). Alternative agents
include fluconazole or metronidazole (for
cutaneous lesions), and amphotericin (for
mucocutaneous leishmaniasis).
38. Literature
1. Tripathi K.D. Essentials of Medical Pharmacology. Eighth Edition. -2019.- Jaypee
Brothers Medical Publishers. The Health Sciences Publisher. -New Delhi. London. Panama
2. D.A.Kharkevich. Pharmacology. Textbook for medical students. Translation of 12th
edition of Russion textbook “Pharmacology” (2017). – М., ГЭОТАР-Медиа, 2017.
3. Review of pharmacology. Gobind Rai Garg, Sparsh Gupta. 13th edition. - 2019.- Jaypee
Brothers Medical Publishers. The Health Sciences Publisher. -New Delhi. London. Panama
4. Whalen Karen. Lippincott Illustrated Reviews: Pharmacology. Sixth Edition. - Wolters
Kluwer. - 2015.-Philadelphia
5. Color Atlas of Pharmacology. 2nd edition, revised and expanded. Heinz Lüllmann.- 2000
Thieme
6. Pharmacology Examination & Board Review. Tenth Edition. Trevor Anthony J.,
Katzung Bertram G., Kruidering-Hall Marieke, Susan B. Masters. - a LANGE medical
book. - 2013.-New York
7. Medical Pharmacology at a Glance. Eighth Edition. Neal Michael J. – 2016. John Wiley
& Sons, Ltd.
8. USMLE Step 1. Lecture Notes. Pharmacology. Lionel P.Raymon and others.- Kaplan
Medical.Inc. -2009