Azmarda is usesful for the heart patient. Heart failure is a progressive chronic syndrome characterized by decrease in functional status and quality of life.
Azmarda has sacubitril and valsartan which is the first approved agent in a new class of drug called angiotensin receptor neprilysin inhibitor (ARNI)3. Azmarda containing Sacubitril/ Valsartan is indicated in adults with long-term heart failure who have symptoms of the disease to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.Azmarda containing Sacubitril/ Valsartan exhibits the novel mechanism of action of an angiotensin receptor neprilysin inhibitor (ARNI) by simultaneously inhibiting neprilysin (neutral endopeptidase; NEP) via sacubitril, the active metabolite of the prodrug sacubitril, and by blocking the angiotensin II type-1 (AT1) receptor via valsartan. The complementary cardiovascular benefits and renal effects of Azmarda in heart failure patients are attributed to the enhancement of peptides that are degraded by neprilysin, such as natriuretic peptides (NP), by sacubitril and the simultaneous inhibition of the deleterious effects of angiotensin II by valsartan.
Sustained activation of the renin-angiotensin-aldosterone system results in vasoconstriction, renal sodium and fluid retention, activation of cellular growth and proliferation, and subsequent maladaptive cardiovascular remodeling. Valsartan inhibits detrimental cardiovascular and renal effects of angiotensin II by selectively blocking the AT1 receptor and also inhibits angiotensin II-dependent aldosterone release Read more about Azmarda https://medicaldialogues.in/partner/jbcpl/azmarda-sacubitril-valsartan
Medikay Cardiac Centre is a state-of-the-art 60-bedded cardiovascular heart centre in Islamabad, located on Park Road, Chak Shahzad. At Medikay, our qualified and experienced team of experts aims to provide the best quality of cardiac treatment and care available in Islamabad and Rawalpindi. Our Centre provides a holistic set of diagnostic, therapeutic and rehabilitative cardiac services using the latest, most innovative techniques.
Azmarda has sacubitril and valsartan which is the first approved agent in a new class of drug called angiotensin receptor neprilysin inhibitor (ARNI)3. Azmarda containing Sacubitril/ Valsartan is indicated in adults with long-term heart failure who have symptoms of the disease to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.Azmarda containing Sacubitril/ Valsartan exhibits the novel mechanism of action of an angiotensin receptor neprilysin inhibitor (ARNI) by simultaneously inhibiting neprilysin (neutral endopeptidase; NEP) via sacubitril, the active metabolite of the prodrug sacubitril, and by blocking the angiotensin II type-1 (AT1) receptor via valsartan. The complementary cardiovascular benefits and renal effects of Azmarda in heart failure patients are attributed to the enhancement of peptides that are degraded by neprilysin, such as natriuretic peptides (NP), by sacubitril and the simultaneous inhibition of the deleterious effects of angiotensin II by valsartan.
Sustained activation of the renin-angiotensin-aldosterone system results in vasoconstriction, renal sodium and fluid retention, activation of cellular growth and proliferation, and subsequent maladaptive cardiovascular remodeling. Valsartan inhibits detrimental cardiovascular and renal effects of angiotensin II by selectively blocking the AT1 receptor and also inhibits angiotensin II-dependent aldosterone release Read more about Azmarda https://medicaldialogues.in/partner/jbcpl/azmarda-sacubitril-valsartan
Medikay Cardiac Centre is a state-of-the-art 60-bedded cardiovascular heart centre in Islamabad, located on Park Road, Chak Shahzad. At Medikay, our qualified and experienced team of experts aims to provide the best quality of cardiac treatment and care available in Islamabad and Rawalpindi. Our Centre provides a holistic set of diagnostic, therapeutic and rehabilitative cardiac services using the latest, most innovative techniques.
Clinical Effectiveness of Dabigatran Versus Apixaban in Non-Valvular Atrial F...Premier Publishers
Many real-world studies conducted across the world revealed that the use of dabigatran and apixaban is similar or superior to warfarin in reducing the risk of stroke and bleeding. But its safety and efficacy in Indian scenario is not that much well established. The aim of this study was to evaluate the clinical outcomes such as ischemic stroke (efficacy end-point) and major bleeding (safety end-point) of dabigatran in clinical practice when compared to apixaban in non-valvular atrial fibrillation real world south Indian patients. Among non-valvular atrial fibrillation patients who initiated dabigatran or apixaban therapy during the period between 2016 and 2018, 82 patients were included in the study. The follow up period was 1 year. Compared to dabigatran group, the hazard ratios of ischemic stroke, major bleeding and minor bleeding in the apixaban group were 0.0031 [95% Confidence Interval (CI): 0.0000-3.2586, P = 0.3363], 1.1108 [CI: 0.0903-13.6604, P=0.9406] and 0.2465 [0.0839-0.7238, P=0.0046] respectively. The ability of dabigatran to prevent ischemic stroke was comparable to that of apixaban; efficacy rate was higher for apixaban and safety outcome was higher for dabigatran. Dabigatran was associated with lower risk of minor bleeding as compared to apixaban. Dabigatran 110 mg bid propound best benefit-risk balance for stroke prevention in non-valvular atrial fibrillation. Dabigatran 150 mg may be favoured for high risk embolism patients.
The author reported an update of main deep vein thrombosis prophylaxis and pulmonary embolism risk factors after total knee arthroplasty, divided into mechanical and pharmacological were reported. The principal currently used drugs, their dosage, comparative risks and benefits are discussed.
MD Microbiology also known as Doctor of Medicine in Microbiology, its a course of postgraduate level done after MBBS. Basically, it is a study of diagnosis, prevention, and treatment of all infectious diseases and understanding of the pathogenesis and laboratory diagnosis of infectious and non-infectious diseases. Read more about MD Microbiology In India https://medicaldialogues.in/medical-courses/md-microbiology-in-india-check-out-admission-process-fees-medical-colleges-to-apply-eligibility-criteria-99008
एम्लोडीपिन कैल्शियम चैनल ब्लॉकर वर्ग से संबंधित एक उच्चरक्तचापरोधी एजेंट है। एम्लोडीपिन एक कैल्शियम चैनल अवरोधक है जिसका उपयोग उच्च रक्तचाप और एनजाइना के इलाज के लिए किया जाता है। अधिक पढ़ें Amlodipine in hindi- एम्लोडीपिन के बारे में https://medicaldialogues.in/hi/generics/amlodipine-2721953
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Clinical Effectiveness of Dabigatran Versus Apixaban in Non-Valvular Atrial F...Premier Publishers
Many real-world studies conducted across the world revealed that the use of dabigatran and apixaban is similar or superior to warfarin in reducing the risk of stroke and bleeding. But its safety and efficacy in Indian scenario is not that much well established. The aim of this study was to evaluate the clinical outcomes such as ischemic stroke (efficacy end-point) and major bleeding (safety end-point) of dabigatran in clinical practice when compared to apixaban in non-valvular atrial fibrillation real world south Indian patients. Among non-valvular atrial fibrillation patients who initiated dabigatran or apixaban therapy during the period between 2016 and 2018, 82 patients were included in the study. The follow up period was 1 year. Compared to dabigatran group, the hazard ratios of ischemic stroke, major bleeding and minor bleeding in the apixaban group were 0.0031 [95% Confidence Interval (CI): 0.0000-3.2586, P = 0.3363], 1.1108 [CI: 0.0903-13.6604, P=0.9406] and 0.2465 [0.0839-0.7238, P=0.0046] respectively. The ability of dabigatran to prevent ischemic stroke was comparable to that of apixaban; efficacy rate was higher for apixaban and safety outcome was higher for dabigatran. Dabigatran was associated with lower risk of minor bleeding as compared to apixaban. Dabigatran 110 mg bid propound best benefit-risk balance for stroke prevention in non-valvular atrial fibrillation. Dabigatran 150 mg may be favoured for high risk embolism patients.
The author reported an update of main deep vein thrombosis prophylaxis and pulmonary embolism risk factors after total knee arthroplasty, divided into mechanical and pharmacological were reported. The principal currently used drugs, their dosage, comparative risks and benefits are discussed.
MD Microbiology also known as Doctor of Medicine in Microbiology, its a course of postgraduate level done after MBBS. Basically, it is a study of diagnosis, prevention, and treatment of all infectious diseases and understanding of the pathogenesis and laboratory diagnosis of infectious and non-infectious diseases. Read more about MD Microbiology In India https://medicaldialogues.in/medical-courses/md-microbiology-in-india-check-out-admission-process-fees-medical-colleges-to-apply-eligibility-criteria-99008
एम्लोडीपिन कैल्शियम चैनल ब्लॉकर वर्ग से संबंधित एक उच्चरक्तचापरोधी एजेंट है। एम्लोडीपिन एक कैल्शियम चैनल अवरोधक है जिसका उपयोग उच्च रक्तचाप और एनजाइना के इलाज के लिए किया जाता है। अधिक पढ़ें Amlodipine in hindi- एम्लोडीपिन के बारे में https://medicaldialogues.in/hi/generics/amlodipine-2721953
Ranitidine is a gastro-intestinal agent that inhibits histamine H2 receptors.
The histamine H2 receptor antagonist ranitidine is used to treat erosive esophagitis, Zollinger-Ellison syndrome, gastric ulcers, GERD, and duodenal ulcers.
Prednisone is a member of the corticosteroid drug class. The effects of prednisone are thought to be anti-inflammatory, anti-neoplastic, and vasoconstrictive.
Prednisone has been approved for treating and managing episodes of blood issues, arthritis, cancer, immune system issues, eye diseases, respiratory issues, allergies, etc. as well as reducing their symptoms.
Azilsartan is an angiotensin II receptor blocker and hypertension medication. Azilsartan has been given the go-ahead to treat hypertension. Moreover, it prevents heart attacks and strokes and is used for heart failure.
Digoxin is an inotropic and antiarrhythmic drug that belongs to the class of cardiac glycosides.
Atrial fibrillation, atrial flutter, and heart failure can all be treated with digoxin. Moreover, it is utilised to treat foetal supraventricular tachyarrhythmia and supraventricular tachycardia.
Metronidazole is a member of the Nitroimidazole class of antibiotic, antimicrobial, and antiprotozoal medicines. The nitroimidazole drug metronidazole is used to treat bacterial infections, rosacea inflammation, amebiasis, trichomoniasis, and to prevent postoperative infections.
Lobun forte is a probiotic used for the reduction of uremic toxins in CKD patients. It is a combination of four probiotics, including Lactobacillus acidophilus, Bifidobacterium longum, Bacillus coagulans, and Streptococcus thermophilous. Read more about Lobun Forte https://medicaldialogues.in/partner/jbcpl/lobun-forte
Mannitol is an antihypertensive agent belonging to Osmosis Diuretics. Osmosis diuretics include antihypertensive mannitol. Osmotic diuretics like mannitol can help people with renal illness get rid of extra water and poisons from their bodies. Read more about Mannitol.
Metoprolol succinate, a medicine used to treat hypertension, belongs to the beta-blocker pharmacological class.
Metoprolol, an antihypertensive medication, competes with other medications to block beta-1 receptors at oral doses of less than 100 mg in adults, while having little to no effect on beta-2 receptors. Metoprolol reduces the quantity of oxygen needed by the heart at any given level of exertion, which aids in the treatment of heart failure. The long-term management of angina pectoris is aided as a result.
Vitamin D status is categorized based on serum 25 (OH) D levels, and the half-life of the vitamin is approximately 2 - 4 weeks. However, this half-life may be decreased even less than a week in the event of hemodilution, infection, or other catabolic diseases.D Rise is indicated for the treatment of Vitamin D3 (Cholecalciferol) deficiency. Read more about D rise.
Vitamin D status is categorized based on serum 25 (OH) D levels, and the half-life of the vitamin is approximately 2 - 4 weeks. However, this half-life may be decreased even less than a week in the event of hemodilution, infection, or other catabolic diseases.D Rise is indicated for the treatment of Vitamin D3 (Cholecalciferol) deficiency. Read more about D rise.
Mannitol is an Osmotic diuretic used to remove excess water and toxins from the body in patients with kidney disease. It is also used in the treatment of cerebral edema and intraocular pressure. It common side effects Headache, nausea, diarrhea, vomiting, dry mouth, thirst, dehydration, blurred vision, runny nose, arm pain, chills, dizziness, low blood pressure (hypotension), hives, irregular heartbeat, and electrolyte imbalance, etc. Read more about mannitol
D Rise contains Cholecalciferol, a fat-soluble vitamin that helps regulate serum calcium and phosphorous concentrations by enhancing the efficiency of the small intestine in absorbing these minerals from the diet. Read more about D-rise (https://d-rise.in/)
Amlodipine is a calcium channel blocker used to treat high blood pressure (hypertension). If you have high blood pressure, taking amlodipine can help to prevent future heart disease, heart attacks, and strokes.
MD Hospital Administration or Doctor of Hospital Administration is a Postgraduate level course for doctors in India that is done by them after completion of their MBBS. The duration of this postgraduate course is 3 years, and it focuses on the study of various concepts related to the field of overseeing the organizational side of health services.
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.
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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
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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.
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
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
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
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
How to Give Better Lectures: Some Tips for Doctors
Azmarda: Indication, Composition, Dosage.
1. 1/17
Overview, Indications, Clinical Evidence & Dosage
medicaldialogues.in/partner/jbcpl/azmarda-sacubitril-valsartan
Heart Failure - Overview
Heart failure is a progressive chronic syndrome characterized by decrease in functional
status and quality of life .
The burden of heart failure has increased to an estimated 23 million people, worldwide.
In India, the prevalence was estimated to be around 1.2/1000 people in the INDUS study.
As prevalence rates of heart failure are high and expected to rise in the near future
because of improved survival from acute cardiac events and the aging of the general
population, thus HF management has come to the front-stage of non-communicable
disease management programmes.
Once developed, heart failure has a 1-year mortality rate of 7.2% and a 1-year
hospitalization rate of 31.9% in patients with chronic heart failure, and in patients
hospitalized for acute heart failure, these rates increase to 17.4% and 43.9% .
The pathophysiology of heart failure involves a maladaptive response during which the
renin-angiotensin-aldosterone system (RAAS) is activated .
RAAS activation leads to vasoconstriction, hypertension, increased aldosterone levels,
increased sympathetic tone, and eventually, cardiac remodeling, all of which are
detrimental to the progression of the disease .
Indication
1
2
3
3
2. 2/17
Heart Failure
To reduce the risk of cardiovascular death and hospitalization for heart failure in
patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
Important update
Understanding ARNI in Hypertension
Understanding Heart Failure in India
Guidlines defined for the treatment of Heart Failure
Quick Review- Role of ARNI in Heart Failure final
Decoding the clinical Evidence for Sacubitril Valsartan in Heart Failure
The Drug Review Sacubitril Valsartan
John McMurray
BHF Cardiovascular Research Centre, University of Glasgow & Queen Elizabeth
University Hospital, Glasgow, Scotland, UK
3. 3/17
Dr. Partho P Chowdhury
MD (DELHI UNIVERSITY), DM (IPGMER,KOL) Consultant Interventional Cardiologist
Specialist in Radial Angioplasty, Complex Angioplasty, Pacemaker, ICD, CRT
Implantation, Device Closure
Meditrina Hospital, Jharkhand
Professor Dr. J.C Mohan
MBBS, MD (General Medicine) DM (Cardiology) M.NAMS FACC (Fellow American
College of Cardiology) FASE (Honorary Fellow of American Society of Echocardiography)
FESC (Fellow of European Society of Cardiology) Jaipur Golden Hospital, Delhi
Dr. Armendra Kumar Pandey
MBBS, DNB (Medicine) FNIC, DNB (Cardilogy)
Consultant-Cardiology Dharamshila Narayana Superspeciality Hospital
Watch Video At: https://youtu.be/sceEr6m2QnQ
Dr. Dilip Kumar
4. 4/17
MBBS, MD, DM (Card) FRCP (GLASG), FHRS, FSCAI, FESC, IBHRE, CCDS Chief
Academic Co-ordinator Medica Institute of Cardiac Sciences Kolkata
Watch Video At: https://youtu.be/5rOxlgEIXaY
Dr. Animesh Agarwal
MD, DM (Cardiology), AFESC International Associate American College of Cardiology
Senior Consultant & HOD Department of Cardiology Jindal Institute of Medical Sciences,
Haryana
5. 5/17
Watch Video At: https://youtu.be/7x2WKKUV1rA
Dr. Harpreet Singh Gilhotra
DM, FESC Director Cardiology
Sri Guru Harkrishan Sahib (C) Eye Hospital Trust, Sohan (Sohana Hospital)
Watch Video At: https://youtu.be/ovMzlsB4o3M
6. 6/17
Dr. Amit Handa
Consultant- Cardiologist
MD (Med.), DM (Cardiology) Ivy Multi Speciality Hospital Punjab
Watch Video At: https://youtu.be/YzWI1O20RCk
Dr. Niroj Kumar Mishra
M.D. (Medicine) Clinical Director
(AN ISO:9001:2008 CERTIFIED HOSPITAL) KAR CLINIC & HOSPITAL PVT.LTD.,
Bhubaneswar
8. 8/17
Watch Video At: https://youtu.be/YbckiC1zSP8
Dr. Idris Ahmed Khan
MD, DM (Card, PGI Chandigarh)
Consultant Interventional Cardiologist BOMBAY HOSPITAL, INDORE
Watch Video At: https://youtu.be/vc9lm8gWjbg
Dr. Johann Christopher
MD, DNB (Cardiology)
Consultant Cardilogist Division of Cardiac Imaging CARE HOSPITALS, CARE
OUTPATIENT CENTRE Hyderabad
9. 9/17
Watch Video At: https://youtu.be/Kx0B93PygOw
Dr. C.K. Ponde
Consultant Cardiologist M.D. (Gen.Med), D.M (Card),
D.N.B. (Card) FACC (USA), FSCAI (USA) FCSI, FISE, FICC, FIAE
Watch Video At: https://youtu.be/vTx4E4Y3tZs
10. 10/17
Prof Dr Satyanarayan Routray
MBBS, MD (MEDICINE), DM (CARDIOLOGY), FICC,FCSI Professor and HOD
SCB Medical College & Hospital Cuttack
Watch Video At: https://youtu.be/lnBKczf--D0
Dr J.S Hiremath
DM (Cardiology), DNB (Cardiology) Fellow of American College of Cardiology Director:
Cath Lab, Ruby Hall Clinic
Chief Cardiologist, Hearty Transplant Department, Ruby Hall Clinic, Pune
About Azmarda
Azmarda contains Sacubitril/Valsartan, the first agent to be approved in a new class of
drugs called angiotensin receptor neprilysin inhibitor (ARNI) .
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Sacubitril acts as a neprilysin inhibitor by preventing the breakdown of natriuretic
peptides. This leads to a prolonged duration of the favorable effects of these peptides.
Valsartan is an angiotensin receptor blocker, and it works by blocking the renin-
angiotensin-aldosterone system .
Composition
Pharmacokinetics of Azmarda
Absorption
Following oral administration, Azmarda dissociates into sacubitril, which is further
metabolized to sacubitrilat, and valsartan, which reach peak plasma concentrations in
0.5 hours, 2 hours, and 1.5 hours, respectively.
The oral absolute bioavailability of sacubitril and valsartan is estimated to be ≥ 60% and
23%, respectively. Azmarda can be administered with or without food.
Distribution
Azmarda is highly bound to plasma proteins (94% - 97%). Based on the comparison of
plasma and CSF exposures, sacubitrilat does cross the blood brain barrier to a limited
extent (0.28%).
Azmarda has an apparent volume of distribution ranging from 75L to 103L.
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Biotransformation
Sacubitril is readily converted to sacubitrilat by esterases; sacubitrilat is not further
metabolized to a significant extent.
Valsartan is minimally metabolized, as only about 20% of the dose is recovered as
metabolites.
Elimination
Following oral administration, 52 to 68% of sacubitril (primarily as sacubitrilat) and
~13% of valsartan and its metabolites are excreted in urine; 37 to 48% of sacubitril
(primarily as sacubitrilat), and 86% of valsartan and its metabolites are excreted in feces.
Sacubitril, sacubitrilat, and valsartan are eliminated from plasma with a mean
elimination half-life (T1/2) of approximately 1.43 hours, 11.48 hours, and 9.90 hours,
respectively.
Clinical Evidences
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Dosage
The recommended starting dose of AZMARDA is 100 mg twice daily.
A starting dose of 50 mg twice daily is recommended for patients not currently
taking an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II
receptor blocker (ARB), and should be considered for patients previously taking low
doses of these agents.
The dose of AZMARDA should be doubled every 2-4 weeks to the target dose of 200
mg twice daily, as tolerated by the patient.
Questions and Answers
1. What is Azmarda (Sacubitril Valsartan)?
2. What is Azmarda (Sacubitril Valsartan) indicated for?
3. How does Azmarda (Sacubitril Valsartan) work?