This document provides information on antitubercular drugs used to treat tuberculosis. It discusses first-line drugs like isoniazid, rifampin, pyrazinamide, ethambutol and streptomycin that are routinely used. It also discusses second-line drugs used when first-line drugs are ineffective or cannot be tolerated. The document describes the mechanisms of action, pharmacokinetics, resistance mechanisms and adverse effects of various antitubercular drugs. It also discusses treatment considerations for special populations like pregnant women, HIV patients and for chemoprophylaxis.
This ppt deals with the sulfonamide group of drugs with classification, mechanism, spectrum, resistance, uses and adverse effects discussed in detail. It also discusses in detail about Cotrimoxazole
this presentation gives the knowledge about the decongestants are a type of medication that can provide short relief for a blocked nose ................
synthetic antimicrobials having a quinolone structure that are active primarily against gram-negative bacteria, though newer fluorinated compounds also inhibit gram-positive ones.
Definition
History
Chemistry
Properties
Classification & its Generation
Pharmacokinetics
Mechanism of action
Indication
Contraindication
Therapeutic use
Adverse effect
Resistance
Comparison with penicillin
Market preparation
This ppt deals with the sulfonamide group of drugs with classification, mechanism, spectrum, resistance, uses and adverse effects discussed in detail. It also discusses in detail about Cotrimoxazole
this presentation gives the knowledge about the decongestants are a type of medication that can provide short relief for a blocked nose ................
synthetic antimicrobials having a quinolone structure that are active primarily against gram-negative bacteria, though newer fluorinated compounds also inhibit gram-positive ones.
Definition
History
Chemistry
Properties
Classification & its Generation
Pharmacokinetics
Mechanism of action
Indication
Contraindication
Therapeutic use
Adverse effect
Resistance
Comparison with penicillin
Market preparation
Anti Tubercular Drugs - Mechanism of Action and Adverse effects Thomas Kurian
A brief outline of the mechanism of action and adverse effects of anti tubercular drugs
Only First line and second line drugs are dealt with.First line drugs may be useful for MBBS students and the rest is directed for postgraduate students.
Hope you find it useful.
complete information of tuberculosis including OLD RNTCP and new RNTCP with the novel drug that is marketed; classification of tuberculosis (MDR XDR TDR). special population and tuberculosis treatment clinical presentation and diagnosis
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.
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
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!
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
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
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
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.
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
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. Introduction
• Tuberculosis is a chronic granulomatous
disease and a major health problem in
developing countries.
• About 1/3rd of the world’s population is
infected with Mycobact. tuberculosis.
• In India, control and treatment of TB is
covered under a National programme which
provides free treatment to all TB cases.
3. • India has a large load of HIV infected subjects,
and these patients are especially vulnerable to
severe forms of tubercular/MAC infection.
• Mycobacteria have caused epic diseases:
Tuberculosis (TB) and leprosy have terrorized
humankind since antiquity.
• Although the burden of leprosy has decreased,
TB is still the most important infectious killer of
humans.
4. Introduction
• Mycobacterium, from the Greek "mycos,"
refers to Mycobacteria's waxy appearance,
which is due to the composition of their cell
walls. More than 60% of the cell wall is lipid,
mainly mycolic acids.
• This extraordinary shield prevents many
pharmacological compounds from getting to
the bacterial cell membrane or inside the
cytosol.
5. • Another barrier is the propensity of some of
the bacilli to hide inside the patient's cells,
thereby surrounding themselves with an extra
physicochemical barrier that antimicrobial
agents must cross to be effective.
6. Classification
• According to their clinical utility the anti-TB
drugs can be divided into:
• First line: These drugs have high
antitubercular efficacy as well as low toxicity;
are used routinely.
• Second line: These drugs have either low
antitubercular efficacy or higher toxicity or
both; and are used as reserve drugs.
7. First line drugs
• 1. Isoniazid (H)
• 2. Rifampin (R)
• 3. Pyrazinamide (Z)
• 4. Ethambutol (E)
• 5. Streptomycin (S)
11. Drugs acting on rapidly
dividing bacilli
Isoniazid(H) + Rifampin(R)
+ Pyrazinamide(Z)+
Ethambutol (E)+
Streptomycin(S)
Drugs acting on slowly
dividing bacilli
Rifampin(R) +
Pyrazinamide(Z)
Drugs acting on dormant
bacilli
-
12. Isoniazid (Isonicotinic acid hydrazide,
H)
• It is primarily tuberculocidal.
• Isoniazid inhibits synthesis of mycolic acids,
which are essential components of
mycobacterial cell walls.
• Isoniazid is a prodrug that is activated by KatG,
the mycobacterial catalase-peroxidase.
13. • Pharmacokinetics
• INH is completely absorbed orally and
penetrates all body tissues, tubercular
cavities, placenta and meninges.
• It is extensively metabolized in liver; most
important pathway being N-acetylation.
14. Isoniazid: Metabolism
• The rate of INH acetylation shows genetic
variation. There are either:
• Fast acetylators: (30–40% of Indians) t½ of
INH 1 hr.
• Slow acetylators:(60–70% of Indians) t½ of
INH 3 hr.
• Isoniazid induced peripheral neuropathy is
more common in slow acetylators.
15. Isoniazid: Adverse Effects
• Hepatitis
• a major adverse effect of INH, is rare in
children, but more common in older people and
in alcoholics (chronic alcoholism induces
CYP2E1 which generates the hepato- toxic
metabolite).
• INH hepatotoxicity is due to dose-related
damage to liver cells, but is reversible on
stopping the drug.
16. Isoniazid: Adverse Effects
• Peripheral neuritis
• Due to interference with production of the active
coenzyme pyridoxal phosphate from pyridoxine, and its
increased excretion in urine .
• Pyridoxine given prophylactically (10 mg/day)
prevents the neurotoxicity even with higher doses.
• Prophylactic pyridoxine must be given to diabetics,
chronic alcoholics, malnourished, pregnant, lactating
and HIV infected patients, but routine use is not
mandatory.
• INH neurotoxicity is treated by pyridoxine 100 mg/day.
17. Isoniazid
• 1 in 106 bacteria are resistant to INH.
• Resistance: inh A gene
18. Rifampin (Rifampicin, R)
• Bactericidal to M. tuberculosis.
• Acts best on slowly or intermittently dividing ones
(spurters).
• Both extra- and intracellular organisms are affected.
• It can kill organisms that are poorly accessible to many
other drugs, such as intracellular organisms and those
sequestered in abscesses and lung cavities.
• Rifampin binds to bacterial DNA-dependent RNA
polymerase and thereby inhibits RNA synthesis.
19. Rifampin
• Pharmacokinetics
• It is well absorbed orally,(bioavailability is ~
70%), but food decreases absorption; rifampin
is to be taken in empty stomach.
• It is widely distributed in the body:penetrates
intracellularly, enters tubercular cavities,
caseous masses and placenta.
20. Rifampin
• Interactions
• Rifampin is a microsomal enzyme inducer.
• Dose titration is necessary when Rifampin is
taken alongwith OCP, antiretroviral drugs.
21. Rifampin
• Adverse effects
• Cholestatic jaundice and occasionally hepatitis.
• Cutaneous syndrome: flushing, pruritus + rash
(especially on face and scalp), redness and
watering of eyes.
• Flu syndrome: with chills, fever, headache, malaise
and bone pain.
• Abdominal syndrome: nausea, vomiting,
abdominal cramps with or without diarrhoea.
• Urine and secretions may become orange-red—
but this is harmless.
22. Rifampin
• 1 in 107 bacilli are resistant to rifampin.
• Mechanism of resistance : rpo B gene.
23. Pyrazinamide (Z)
• Chemically similar to INH
• It is weakly tuberculocidal.
• More active in acidic medium.
• It is more lethal to intracellularly locate bacilli
and to those at sites showing an inflammatory
response (pH is acidic at both these locations).
• MOA: inhibits mycolic acid synthesis (cell wall
synthesis inhibition).
24. Pyrazinamide (Z)
• Pharmacokinetics
• Pyrazinamide is absorbed orally, widely
distributed, has good penetration in CSF,
because of which it is highly useful in
meningeal TB; extensively metabolized in liver
and excreted in urine; plasma t½ is 6–10
hours.
25. Pyrazinamide (Z)
• Adverse effects
• Hepatotoxicity
• Hyperuricaemia
• Other adverse effects are abdominal distress,
arthralgia, flushing, rashes, fever and loss of
diabetes control: repeated blood glucose
monitoring is warranted in diabetics.
26. Ethambutol (E)
• Tuberculostatic
• Fast multiplying bacilli are more susceptible.
• MOA: to inhibit arabinosyl transferases
involved in arabinogalactan synthesis thereby
interfering with mycolic acid incorporation in
mycobacterial cell wall.
• Renal excretion
28. Streptomycin (S)
• Tuberculocidal
• Acts only on extracellular bacilli (because of
poor penetration into cells).
• It penetrates tubercular cavities, but does not
cross to the CSF, and has poor action in acidic
medium.
29. Disadvantages of Streptomycin(S)
• Need for i.m. injections.
• lower margin of safety
• (ototoxicity and nephrotoxicity)
• S is used only as an alternative to or in
addition to other 1st line anti- TB drugs.
• Use is restricted to a maximum of 2 months. It
is thus also labelled as a ‘supplemental’ 1st
line drug.
36. Tuberculosis in pregnant women
• 2 HRE + 7HR (total 9 months).
• S is contraindicated because it is ototoxic to
the foetus.
• Z is not recommended (due to lack of
adequate teratogenicity data).
37. Treatment of breastfeeding women
• All anti-TB drugs are compatible with
breastfeeding;
• full course should be given to the mother, but
the baby should be watched.
• The infant should receive BCG vaccination
and 6 month isoniazid preventive treatment
after ruling out active TB.
38. Chemoprophylaxis
• This is indicated only in :
• (a) Contacts of open cases who show recent Mantoux
conversion.
• (b) Children with positive Mantoux and a TB patient in
the family.
• (c) Neonate of tubercular mother.
• (d) Patients of leukaemia, diabetes, silicosis, or those
who are HIV positive, or are on corticosteroid therapy
who show a positive Mantoux.
• (e) Patients with old inactive disease who are assessed
to have received inadequate therapy.
39. • The standard drug for chemoprophylaxis of TB
is H 300 mg (10 mg/kg in children) daily for 6
months.
• Because of spread of INH resistance, a
combination of H (5 mg/kg) and R (10 mg/kg,
maximum 600 mg) daily given for 3 months is
preferred in some areas.
40. Tuberculosis in AIDS patients
• Initial intensive phase therapy with daily HRZE
for 2 months is started immediately on the
diagnosis of TB, and is followed by a
continuation phase of HR for 4–7 months
(total 6–9 months).
• Pyridoxine 25–50 mg/day is routinely given
along with H to counteract its neurological
side effects, which are more likely in AIDS
patients.
41. Tuberculosis in AIDS patients
• All HIV positive TB patients should also receive
cotrimoxazole preventive therapy at least
throughout the anti-TB regimen.
• Rifabutin (a less potent enzyme inducer)
given for 9–12 months may be substituted for
rifampin.
42. Take home message
• All first line drugs are bacteriocidal except
ethambutol.
• Most potent first line drug-Rifampin
• Drug acting well in acidic and intracellular
environment- pyrazinamide(Z)
• Drug acting in intracellular+ extracellular
environment- Rifampin
• Drugs acting on Rapid dividing and intermittant
dividing bacilli- Rifampin + Pyrazinamide
43. Take home message
• Drug causing blindness-Ethambutol
• Drug acting extracellularly and in alkaline
medium- streptomycin