This presentation deals with the beta blockers commonly used in day-to-day practice alongwith some interesting mnemonics to remember their names & site of action
ABSTRACT
Carvedilol is a cardiovascular drug of multifaceted therapeutic potential, with beta-blocker and vasodilatative activity. These actions confer to the above mentioned beta blocker some beneficial properties on several processes involving cardiovascular system. Carvedilol provides hemodynamic, ant ischemic, anti-proliferative and antiarrhytmic benefits, for its antioxidant neuro humoral and electrophysiological effects. All these actions provide the basis for usefulness of the drug in the treatment of hypertension, coronary heart disease, and congestive heart failure. In this review we report the beneficial properties of Carvedilol and we analyze the rational clinical use of this beta blocker taking special attention on recent clinical trial in heart failure where it appears evidence supporting an important, favorable effect of the drug.
KEYWORDS: Carvedilol, Hypertension, Coronary disease, Hearth failure.
This presentation deals with the beta blockers commonly used in day-to-day practice alongwith some interesting mnemonics to remember their names & site of action
ABSTRACT
Carvedilol is a cardiovascular drug of multifaceted therapeutic potential, with beta-blocker and vasodilatative activity. These actions confer to the above mentioned beta blocker some beneficial properties on several processes involving cardiovascular system. Carvedilol provides hemodynamic, ant ischemic, anti-proliferative and antiarrhytmic benefits, for its antioxidant neuro humoral and electrophysiological effects. All these actions provide the basis for usefulness of the drug in the treatment of hypertension, coronary heart disease, and congestive heart failure. In this review we report the beneficial properties of Carvedilol and we analyze the rational clinical use of this beta blocker taking special attention on recent clinical trial in heart failure where it appears evidence supporting an important, favorable effect of the drug.
KEYWORDS: Carvedilol, Hypertension, Coronary disease, Hearth failure.
Richard's aventures in two entangled wonderlandsRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
The ability to recreate computational results with minimal effort and actionable metrics provides a solid foundation for scientific research and software development. When people can replicate an analysis at the touch of a button using open-source software, open data, and methods to assess and compare proposals, it significantly eases verification of results, engagement with a diverse range of contributors, and progress. However, we have yet to fully achieve this; there are still many sociotechnical frictions.
Inspired by David Donoho's vision, this talk aims to revisit the three crucial pillars of frictionless reproducibility (data sharing, code sharing, and competitive challenges) with the perspective of deep software variability.
Our observation is that multiple layers — hardware, operating systems, third-party libraries, software versions, input data, compile-time options, and parameters — are subject to variability that exacerbates frictions but is also essential for achieving robust, generalizable results and fostering innovation. I will first review the literature, providing evidence of how the complex variability interactions across these layers affect qualitative and quantitative software properties, thereby complicating the reproduction and replication of scientific studies in various fields.
I will then present some software engineering and AI techniques that can support the strategic exploration of variability spaces. These include the use of abstractions and models (e.g., feature models), sampling strategies (e.g., uniform, random), cost-effective measurements (e.g., incremental build of software configurations), and dimensionality reduction methods (e.g., transfer learning, feature selection, software debloating).
I will finally argue that deep variability is both the problem and solution of frictionless reproducibility, calling the software science community to develop new methods and tools to manage variability and foster reproducibility in software systems.
Exposé invité Journées Nationales du GDR GPL 2024
THE IMPORTANCE OF MARTIAN ATMOSPHERE SAMPLE RETURN.Sérgio Sacani
The return of a sample of near-surface atmosphere from Mars would facilitate answers to several first-order science questions surrounding the formation and evolution of the planet. One of the important aspects of terrestrial planet formation in general is the role that primary atmospheres played in influencing the chemistry and structure of the planets and their antecedents. Studies of the martian atmosphere can be used to investigate the role of a primary atmosphere in its history. Atmosphere samples would also inform our understanding of the near-surface chemistry of the planet, and ultimately the prospects for life. High-precision isotopic analyses of constituent gases are needed to address these questions, requiring that the analyses are made on returned samples rather than in situ.
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Earliest Galaxies in the JADES Origins Field: Luminosity Function and Cosmic ...Sérgio Sacani
We characterize the earliest galaxy population in the JADES Origins Field (JOF), the deepest
imaging field observed with JWST. We make use of the ancillary Hubble optical images (5 filters
spanning 0.4−0.9µm) and novel JWST images with 14 filters spanning 0.8−5µm, including 7 mediumband filters, and reaching total exposure times of up to 46 hours per filter. We combine all our data
at > 2.3µm to construct an ultradeep image, reaching as deep as ≈ 31.4 AB mag in the stack and
30.3-31.0 AB mag (5σ, r = 0.1” circular aperture) in individual filters. We measure photometric
redshifts and use robust selection criteria to identify a sample of eight galaxy candidates at redshifts
z = 11.5 − 15. These objects show compact half-light radii of R1/2 ∼ 50 − 200pc, stellar masses of
M⋆ ∼ 107−108M⊙, and star-formation rates of SFR ∼ 0.1−1 M⊙ yr−1
. Our search finds no candidates
at 15 < z < 20, placing upper limits at these redshifts. We develop a forward modeling approach to
infer the properties of the evolving luminosity function without binning in redshift or luminosity that
marginalizes over the photometric redshift uncertainty of our candidate galaxies and incorporates the
impact of non-detections. We find a z = 12 luminosity function in good agreement with prior results,
and that the luminosity function normalization and UV luminosity density decline by a factor of ∼ 2.5
from z = 12 to z = 14. We discuss the possible implications of our results in the context of theoretical
models for evolution of the dark matter halo mass function.
Toxic effects of heavy metals : Lead and Arsenicsanjana502982
Heavy metals are naturally occuring metallic chemical elements that have relatively high density, and are toxic at even low concentrations. All toxic metals are termed as heavy metals irrespective of their atomic mass and density, eg. arsenic, lead, mercury, cadmium, thallium, chromium, etc.
2. Prepared By -
Mustafa Kamal Ahmed Khan.
Subject- Basic Principles of Pharmacology.
Second Presentation.
3rd Semester- 2019.
B.Sc.-M.Sc. Integrated Program
Department of Toxicology.
School of Chemical and Life Sciences.
Jamia Hamdard, New Delhi – 110062.
3. What is Beta Blockers:
Beta-blockers as a class of drugs are primarily used to treat cardiovascular
diseases and other conditions.
Beta Blockers are competitive antagonists that block the receptor sites
for
the endogenous catecholamines epinephrine (adrenaline)and norepinephri
ne (noradrenaline) on adrenergic beta receptors, of the sympathetic
nervous system, which mediates the fight-or-flight response. Some block
activation of all types of β-adrenergic receptors and others are selective
for one of the three known types of beta receptors, designated β1, β2 and
β3 receptors. β1-adrenergic receptors are located mainly in the heart and
in the kidneys. β2-adrenergic receptors are located mainly in the lungs,
gastrointestinal tract, liver, uterus, vascular smooth muscle, and skeletal
muscle. β3-adrenergic receptors are located in fat cells. Blockage of these
receptors by beta-blocking medicines are used to treat a broad range of
illnesses. Beta-blockers as a class of medications are essential drugs and
are first-line treatments in many acute and chronic conditions.
4. Contd.
In 1964, James Black synthesized the first
clinically significant beta blockers—
propranolol and pronethalol; it revolutionized the
medical management of angina pectoris and is
considered by many to be one of the most
important contributions to clinical medicine
and pharmacology of the 20th century.
For the treatment of primary hypertension, meta-
analyses of studies which mostly
used atenolol have shown that although beta
blockers are more effective than placebo in
preventing stroke and total cardiovascular events,
they are not as effective as diuretics, medications
inhibiting the renin–angiotensin system (e.g., ACE
inhibitors), or calcium channel blockers.
5. Skeletal formula of propranolol, the first clinically successful beta blocker.
6. Medical Uses:
Beta blockers are indicated and have FDA approval for the treatment
of tachycardia, hypertension, myocardial infarction, congestive heart
failure, cardiac arrhythmias, coronary artery disease,
hyperthyroidism, essential tremor, aortic dissection, portal
hypertension, glaucoma, migraine prophylaxis, and other conditions.
They are also used to treat less common conditions such as long QT
syndrome and hypertrophic obstructive cardiomyopathy. Beta
blockers are available for administration in three main forms: oral,
intravenous, and ophthalmic and the route of administration is often
determined by the acuity of the illness (parenteral use in
arrhythmias), disease type (topical use in glaucoma) and chronicity
of the disease.
Congestive heart failure patients are treated with beta blockers if
they are in a compensated state. Specifically, the beta blockers
bisoprolol, carvedilol, and metoprolol succinate are the agents
chosen.
7. Contd.
Performance-enhancing use
Athletes and musicians may use beta blockers for their anxiolytic
effect as well as their inhibitory effects on the sympathetic
nervous system. Because they promote lower heart rates and
reduce tremors, beta blockers have been used in professional
sports where high accuracy is required,
including archery, shooting, golf and snooker. Beta blockers are
banned by the International Olympic Committee. In the 2008
Summer Olympics, 50-metre pistol silver medalist and 10-metre
air pistol bronze medalist Kim Jong-su tested positive
for propranolol and was stripped of his medals.
8. Mechanism of Action:
The catecholamines, epinephrine, and norepinephrine
bind to B1 receptors and increase cardiac automaticity as
well as conduction velocity. B1 receptors also induce
renin release, and this leads to an increase in blood
pressure. In contrast, binding to B2 receptors causes
relaxation of the smooth muscles along with increased
metabolic effects such as glycogenolysis.
Beta-blockers vary in their specificity towards different
receptors and accordingly the effects produced are
determined by the type of receptor(s) blocked as well as
the organ system involved. Some beta blockers also bind
to alpha receptors to some degree, allowing them to
induce a different clinical outcome when used in specific
settings.
9. Contd.
Once beta blockers bind to the B1 and B2 receptors, they inhibit these
effects. Therefore, the chronotropic and inotropic effects on the heart
undergo inhibition, and the heart rate slows down as a result. Beta
blockers also decrease blood pressure via several mechanisms, including
decreased renin and reduced cardiac output. The negative chronotropic
and inotropic effects lead to a decreased oxygen demand; that is how
angina improves after beta-blocker usage. These medications also
prolong the atrial refractory periods and have a potent antiarrhythmic
effect.
Beta-blockers classify as either non-selective and beta-1 selective.
There are also beta-2, and beta-3 selective drugs; neither has a known
clinical purpose to date. Non-selective agents bind to both beta-1 and
beta-2 receptors and induce antagonizing effects via both receptors.
Examples include propranolol, carvedilol, sotalol, and labetalol. Beta-1
receptor selective blockers like atenolol, bisoprolol, metoprolol, and
esmolol only bind to the beta-1 receptors therefor are cardio-selective.
10. Contd.
Beta-blockers lower the secretion of melatonin and hence
may cause insomnia and sleep changes in some patients.
Alpha-1 receptors induce vasoconstriction and increased
cardiac chronotropy; this means agonism at the alpha-1
receptors leads to higher blood pressure and an increased
heart rate. In contrast, antagonism at the alpha-1 receptor
leads to vasodilation and negative chronotropic which leads
to lower blood pressure and decreased heart rate. Some beta
blockers, such as carvedilol, labetalol, and bucindolol, have
additional alpha-1 receptor blockage activity in addition to
their non-selective beta receptor blockage. This property is
clinically useful because beta blockers that also block the
alpha-1 receptor have a more pronounced clinical effect on
treating hypertension.
11. Administration:
Beta blockers are available in oral, intravenous, or
ophthalmic form and can be also injected
intramuscularly.
Dosages are available in various ranges, depending
on the specific medication.
12. Adverse Effects:
Beta receptors are found all over the body and induce a broad
range of physiologic effects. Blockage of these receptors with
beta-blocker medications can lead to many adverse effects.
Bradycardia and hypotension are two adverse effects that
may commonly occur. Fatigue, dizziness, nausea, and
constipation are also widely reported. Some patients report
sexual dysfunction and erectile dysfunction.
Less commonly, bronchospasm presents in patients on beta
blockers. Asthmatic patients are at a higher risk. Patients with
Raynaud syndrome are also at risk of exacerbation. Beta
blockers can induce both hyper glycemia and mask the
hemodynamic signs usually seen in a hypo glycemic patient,
such as tachycardia.
13. Contd.
Some patients report insomnia, sleep changes and
nightmares while using beta blockers. This effect is more
pronounced with beta blockers that cross the blood-brain
barrier.
Carvedilol may increase edema in some patients.
Sotalol blocks the potassium channels in the heart and
thereby induces QT prolongation. It increases the risk of
torsades de pointes.
All beta blockers, especially in patients with cardiac risk
factors, carry a risk of heart block.
14. Contra indications:
Traditionally, beta blockers have been contraindicated
in asthmatic patients. However, recommendations have
aligned for allowing cardio-selective beta blockers, also
known as beta-1 selective, in asthmatics but not non-
selective beta blockers.
Beta blockers should not be used in patients who have
cocaine-induced coronary vasospasm. There is a
significant risk of unopposed alpha receptor activity
which would worsen the vasospasm. Agonist activity at
the alpha receptor leads to increased vasoconstriction
and increased cardiac chronotropy.
15. Contd.
Patients who have either acute or chronic
bradycardia and/or hypotension have relatively
contraindication to beta-blocker usage.
Specific beta blockers are contraindicated depending
on the patient's past medical history. Patients
diagnosed with long QT syndrome or who have had
torsades de pointes in the past should not use the
drug sotalol. Patients with Raynaud phenomenon
should avoid beta blockers due to the risk of
exacerbation.
16. Monitoring:
The patient's heart rate and blood pressure
should be generally monitored while using beta
blockers. When specifically using sotalol, the
QTc interval requires monitoring as sotalol has
QT-prolonging effects.
17. Toxicity:
The antidote for beta-blocker
overdose is glucagon. It is especially
useful in beta-blocker-induced
cardiotoxicity. The second line of
treatment is cardiac pacing if glucagon
fails.
18. Intrinsic sympathomimetic activity:
Also referred to as intrinsic sympathomimetic effect, this term is used
particularly with beta blockers that can show both agonism and
antagonism at a given beta receptor, depending on the concentration of
the agent (beta blocker) and the concentration of the antagonized agent
(usually an endogenous compound, such as norepinephrine). See partial
agonist for a more general description.
Some beta blockers
(e.g. oxprenolol, pindolol, penbutolol, labetalol and acebutolol) exhibit
intrinsic sympathomimetic activity (ISA). These agents are capable of
exerting low-level agonist activity at the β-adrenergic receptor while
simultaneously acting as a receptor site antagonist. These agents,
therefore, may be useful in individuals exhibiting
excessive bradycardia with sustained beta blocker therapy.
Agents with ISA are not used after myocardial infarctions, as they have not
been demonstrated to be beneficial. They may also be less effective than
other beta blockers in the management of angina and tachyarrhythmia.