A good read for undergraduate students in Pharmacy studying at the University of Mumbai. I will highly recommend Essentials of Medical Pharmacology by KD Tripathi. All copyright to the original authors and publishers.
The parasympathetic division typically acts in opposition to the sympathetic autonomic nervous system through negative feedback control.
This action is a complementary response, causing a balance of sympathetic and parasympathetic responses.
Overall, the parasympathetic outflow results in the conservation and restoration of energy, reduction in heart rate and blood pressure, facilitation of digestion and absorption of nutrients, and excretion of waste products.
These are drugs that produce actions similar to that of Acetylcholine hence known as parasympathomimetics.
They act either by directly interacting with cholinergic receptors or by increasing the availability of Acetylcholine at these sites.
Autonomic nervous system ( by Dr. Takele Beyene,DVM,MSc,@AAU)AAU
I have no contribution in any part of all my lecture notes on slideshare, but I've just saved them as to make them ma favorites, then 2get them anywhere I go!!! Here, one 've 2know that I never let him/her save the lectures & Every body is blocked of downloading the notes! When you read the notes online GIVE PRIOR THANKS FOR MY INSTRUCTORS & I NEED NO THANKS !!! Omega Kifle
A good read for undergraduate students in Pharmacy studying at the University of Mumbai. I will highly recommend Essentials of Medical Pharmacology by KD Tripathi. All copyright to the original authors and publishers.
The parasympathetic division typically acts in opposition to the sympathetic autonomic nervous system through negative feedback control.
This action is a complementary response, causing a balance of sympathetic and parasympathetic responses.
Overall, the parasympathetic outflow results in the conservation and restoration of energy, reduction in heart rate and blood pressure, facilitation of digestion and absorption of nutrients, and excretion of waste products.
These are drugs that produce actions similar to that of Acetylcholine hence known as parasympathomimetics.
They act either by directly interacting with cholinergic receptors or by increasing the availability of Acetylcholine at these sites.
Autonomic nervous system ( by Dr. Takele Beyene,DVM,MSc,@AAU)AAU
I have no contribution in any part of all my lecture notes on slideshare, but I've just saved them as to make them ma favorites, then 2get them anywhere I go!!! Here, one 've 2know that I never let him/her save the lectures & Every body is blocked of downloading the notes! When you read the notes online GIVE PRIOR THANKS FOR MY INSTRUCTORS & I NEED NO THANKS !!! Omega Kifle
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
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
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
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
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
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
3. Introduction-Synapse
In the nervous system, a synapse is a
structure that permits a neuron to pass
an electrical or chemical signal to
another cell (neural or otherwise).
Synapses are essential to neuronal
function: neurons are cells that are
specialized to pass signals to individual
target cells.
5. Introduction-Synapse
There are two fundamentally different types of
synapses:
In a chemical synapse, the presynaptic neuron
releases a chemical called a neurotransmitter
that binds to receptors located in the
postsynaptic cell.
In an electrical synapse, the presynaptic and
postsynaptic cell membranes are connected
by channels that are capable of passing
electrical current, causing voltage changes in
the presynaptic cell to induce voltage changes
in the postsynaptic cell.
6. The Peripheral Nervous System
The peripheral nervous system consists of the
following principal elements:
autonomic nervous system, which includes the
enteric nervous system
somatic efferent nerves, innervating skeletal
muscle
somatic and visceral afferent nerves.
7. Autonomic Nervous System
Autonomic pathways -consists of two neurons
arranged in series
somatic efferent pathways - a single motor neuron
connects the central nervous system to the skeletal
muscle fibre.
The two neurons in the autonomic pathway are
known, respectively, as preganglionic and
postganglionic.
9. Autonomic Nervous System
The autonomic nervous system conveys
all the outputs from the central nervous
system to the rest of the body, except for
the motor innervations of skeletal
muscle.
10. Basic Anatomy and Physiology of the
Autonomic Nervous System
The autonomic nervous system consists of three
main anatomical divisions:
1. Sympathetic
2. Parasympathetic and
3. The Enteric Nervous System
(consisting of the intrinsic nerve plexuses of the
gastrointestinal tract, which are closely interconnected
with the sympathetic and parasympathetic systems)
11. Physiology of the Autonomic Nervous
System
Sympathetic activity increases in stress ('fight
or flight' response), whereas parasympathetic
activity predominates at rest.
Both systems exert a continuous physiological
control of specific organs under normal
conditions, when the body is at neither
extreme.
12. Physiology of the Autonomic Nervous
System
The main processes that it regulates are:
contraction and relaxation of vascular and
visceral smooth muscle
all exocrine and certain endocrine secretions
the heartbeat(rate and force of the heart)
energy metabolism, particularly in liver and
skeletal muscle.
13. The main effects of the Autonomic Nervous
System
Organ Sympathetic effect Adrenergic receptor type Parasympathetic effect Cholinergic receptor type
Eye
Pupil Dilatation α Constriction M3
Ciliary muscle Relaxation (slight) β Contraction M3
Heart
Sinoatrial node Rate ↑ β1 Rate ↓ M2
Atrial muscle Force ↑ β1 Force ↓ M2
Atrioventricular node Automaticity ↑ β1 Conduction velocity ↓
Atrioventricular block
M2
M2
Ventricular muscle Automaticity ↑
Force ↑
β1 No effect M2
Blood vessels
Constriction α Dilatation M3
14. The main effects of the Autonomic Nervous
System
Organ Sympathetic effect Adrenergic
receptor type
Parasympathetic
effect
Cholinergic receptor
type
Viscera
Bronchi
Smooth muscle No sympathetic
innervation,
but dilated by
circulating
adrenaline
(epinephrine)
β2 Constriction M3
Glands No effect - Secretion M3
Gastrointestinal tract
Smooth muscle Motility ↓ α1, α2, β2 Motility ↑ M3
Sphincters Constriction α2, β2 Dilatation M3
Glands No effect - Secretion
Gastric acid
secretion
M3
M3
Bladder Relaxation β2
Sphincter
contraction
α1 Sphincter
relaxation
Sphincter relaxation
15. The main effects of the
Autonomic Nervous System
Organ Sympathetic effect Adrenergic receptor type Parasympathetic effect Cholinergic receptor type
Salivary glands Secretion α, β Secretion M3
Kidney Renin secretion β1 No effect -
Liver Glycogenolysis
Gluconeogenesis
α, β2 No effect
16. Neuro transmitters of the Autonomic
Nervous System
The principal transmitters are
Parasympathetic activity - acetylcholine
Sympathetic activity- nor adrenalin.
Other transmitters are also used extensively
in the autonomic nervous system. The main
ones are nitric oxide and vasoactive intestinal
peptide (parasympathetic), ATP and
neuropeptideY (sympathetic)
18. Parasympathetic/Cholinergic Receptors
Main subdivision - muscarnic and nicotinic subtypes.
Three main types of muscarnic receptors occur(mainly
heart, smooth muscle, glands)
M1 receptors ('neural') producing slow excitation of
ganglia.
M2 receptors ('cardiac') causing decrease in cardiac
rate and force of contraction (mainly of atria).
M3 receptors ('glandular') causing secretion,
contraction of visceral smooth muscle, vascular
relaxation.
Two further molecular muscarnic receptors subtypes,
M4 and M5, occur mainly in the CNS.
20. Effects of Drugs on Cholinergic Transmission
Drugs can influence cholinergic transmission either by acting
on postsynaptic ACh receptors as agonists or antagonists or by
affecting the release or destruction of endogenous ACh.
According to their physiological site of action:
1. muscarnic agonists
2. muscarnic antagonists
3. ganglion-stimulating drugs
4. ganglion-blocking drugs
5. neuromuscular-blocking drugs
6. Anticholinesterases and other drugs that enhance cholinergic
transmission.
22. Drugs Affecting Muscarnic Receptors
Muscarnic agonists
Important compounds include acetylcholine, carbachol,
methacholine, muscarine and pilocarpine.
Main effects are bradycardia and vasodilatation
(endothelium-dependent), leading to fall in blood pressure;
contraction of visceral smooth muscle (gut, bladder, bronchi,
etc.); exocrine secretions, pupillary constriction and ciliary
muscle contraction, leading to decrease of intraocular
pressure.
Main use is in treatment of glaucoma (especially
pilocarpine).
23. Drugs Affecting Muscarnic Receptors
Muscarnic antagonists
Most important compounds are atropine, scopolamine,
ipratropium and pirenzepine.
Main effects are inhibition of secretions; tachycardia,
pupillary dilatation and paralysis of accommodation;
relaxation of smooth muscle (gut, bronchi, biliary tract,
bladder); inhibition of gastric acid secretion (especially
pirenzepine); central nervous system effects (mainly
excitatory with atropine; depressant, including
amnesia, with scopolamine), including antiemetic
effect and antiparkinsonian effect.
24. Clinical uses of Muscarnic Antagonists
Cardiovascular
Treatment of sinus bradycardia (e.g. after myocardial infarction):
atropine.
Ophthalmic
To dilate the pupil: for example tropicamide or cyclopentolate eye
drops.
Neurological
Prevention of motion sickness: for example scopolamine (orally or
transdermally).
Parkinsonism especially to counteract movement disorders caused
by antipsychotic drugs : for example benzhexol, benztropine.
25. Clinical uses of Muscarnic Antagonists
Respiratory
Asthma and chronic obstructive pulmonary disease -ipratropium or tiotropium by
inhalation.
Anaesthetic premedication
To dry secretions: for example atropine, scopolamine. (Current anaesthetics are
relatively non-irritant,, so this use is now less important.)
Gastrointestinal
To facilitate endoscopy and gastrointestinal radiology by relaxing gastrointestinal
smooth muscle (antispasmodic action): for example scopolamine.
As an antispasmodic in irritable bowel syndrome or colonic diverticular disease: for
example dicycloverine (dicyclomine).
To treat peptic ulcer disease by suppressing gastric acid secretion for example
pirenzepine (M1-selective antagonist). This is used less since the introduction of
histamine H2 antagonists and proton pump inhibitors.
26. Nicotine receptor agonists and
antagonists/Drugs acting on autonomic
ganglia
Nicotine receptor agonists /Ganglion-stimulating drugs
Compounds include nicotine, dimethylphenylpiperazinium
(DMPP).
Both sympathetic and parasympathetic ganglia are stimulated,
so effects are complex, including tachycardia and increase of
blood pressure; variable effects on gastrointestinal motility and
secretions; increased bronchial, salivary and sweat secretions.
Additional effects result from stimulation of other neuronal
structures, including sensory and noradrenergic nerve
terminals.
Nicotine also has important central nervous system effects.
No therapeutic uses, except for nicotine to assist giving up
smoking.
27. Nicotine receptor agonists and
antagonists/Drugs acting on autonomic
ganglia
Nicotine receptor antagonists/Ganglion-blocking drugs
Compounds include hexamethonium, trimetaphan,
tubocurarine.
Block all autonomic ganglia and enteric ganglia.
Main effects: hypotension and loss of cardiovascular
reflexes, inhibition of secretions, gastrointestinal
paralysis, impaired micturition.
Clinically obsolete, except for occasional use of
trimetaphan to produce controlled hypotension in
anaesthesia
28. Noradrenergic transmission
CATECHOLAMINES
Catecholamines are compounds containing a catechol moiety
(a benzene ring with two adjacent hydroxyl groups) and an amine
side-chain Pharmacologically, the most important ones are:
Noradrenaline (norepinephrine), a transmitter released by
sympathetic nerve terminals
Adrenaline (epinephrine), a hormone secreted by the adrenal
medulla
Dopamine, the metabolic precursor of noradrenaline and
adrenaline, also a transmitter/neuromodulator in the central
nervous system
29. Classification of adrenoceptors
Main pharmacological classification into α and
β subtypes
two main α-receptor subtypes, α1 and α2,
each divided into three further subtypes
three β-adrenoceptor subtypes (β1, β2, β3)
all belong to the super family of G-protein-
coupled receptors.
30. The Effects of adrenoceptors activation
α1-receptors: vasoconstriction, relaxation of
gastrointestinal smooth muscle, salivary
secretion and hepatic glycogenolysis
α2-receptors: inhibition of transmitter release
(including noradrenaline and acetylcholine
release from autonomic nerves), platelet
aggregation, contraction of vascular smooth
muscle, inhibition of insulin release
31. The Effects of adrenoceptors activation
β1-receptors: increased cardiac rate and force
β2-receptors: bronchodilatation,
vasodilatation, relaxation of visceral smooth
muscle, hepatic glycogenolysis and muscle
tremor
β3-receptors: lipolysis.
32. DRUGS ACTING ON NORADRENERGIC
TRANSMISSION
Many clinically important drugs, particularly
those used to treat cardiovascular, respiratory
and psychiatric disorders act by affecting
noradrenergic neuron function.
33. DRUGS ACTING ON NORADRENERGIC
TRANSMISSION
The main drug targets are:
adrenoceptors
monoamine transporters
catecholamine-metabolising enzymes.
34. Adrenoceptor agonists
αagonists
Noradrenaline and adrenaline show
relatively little receptor selectivity.
Selective α1 agonists include phenylephrine
and oxymetazoline.
Selective α2 agonists include clonidine and
α-methylnoradrenaline.
35. Adrenoceptor agonists
Selective β1 agonists include dobutamine.
Selective β2 agonists include salbutamol,
terbutaline and salmeterol
Selective β3 agonists may be developed for the
control of obesity.
36. Clinical uses of adrenoceptor agonists
Cardiovascular system:
cardiac arrest: adrenaline
cardiogenic shock :dobutamine (β1 agonist)
Anaphylaxis: adrenaline.
Respiratory system:
asthma: selective β2-receptor agonists salbutamol, terbutaline,
salmeterol, formoterol
nasal decongestion: drops containing xylometazoline or ephedrine for
short-term use.
Miscellaneous indications:
adrenaline: with local anaesthetics to prolong their action
premature labour
α2 agonists :clonidine to lower blood pressure and intraocular
pressure; and to reduce frequency of migraine attacks.
37. ADRENOCEPTOR ANTAGONISTS
The main groups of α-adrenoceptor antagonists are:
non-selective α-receptor antagonists (e.g.
phenoxybenzamine, phentolamine)
α1-selective antagonists (e.g. prazosin, doxazosin,
terazosin)
α2-selective antagonists (e.g. yohimbine, idazoxan)
Tamsulosin is α1A-selective and acts mainly on the
urogenital tract.
Some drugs (e.g. labetolol, carvedilol) block both
α and β adrenoceptors.
38. Clinical uses of α-adrenoceptor antagonists
Severe hypertension: α1-selective antagonists
(e.g. doxazosin) in combination with other
drugs.
Benign prostatic hypertrophy (e.g. tamsulosin,
a selective α1A-receptor antagonist).
Phaeochromocytoma: phenoxybenzamine
(irreversible antagonist) in preparation for
surgery.
39. β-Adrenoceptor antagonists
Non-selective between β1 and β2
adrenoceptors: propranolol, alprenolol,
oxprenolol.
β1-selective: atenolol, nebivolol.
Alprenolol and oxprenolol have partial agonist
activity.
40. Clinical uses of β-adrenoceptor antagonists
Cardiovascular:
angina pectoris
myocardial infarction
dysrhythmias
heart failure
hypertension (no longer first choice)
Other uses:
glaucoma (e.g. timolol eye drops)
Thyrotoxicosis as adjunct to definitive treatment
Anxiety- to control somatic symptoms (e.g.
palpitations, tremor)
migraine prophylaxis
benign essential tremor (a familial disorder).