Bisphosphonates are a class of drugs that prevent bone loss and are used to treat bone metastases, osteoporosis, and Paget's disease. They have a high affinity for hydroxyapatite crystals in bone and work by inhibiting bone resorption. There are two types - non-nitrogenous bisphosphonates which induce osteoclast apoptosis, and nitrogenous bisphosphonates which inhibit protein prenylation in osteoclasts. Common indications include postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, and bone metastases. While generally well-tolerated, side effects can include upset stomach, esophagus problems, and osteonecrosis of the
In pharmacology,bisphosphonates (also called:diphosphonates) are a class of drugs that inhibit osteoclast action and the resorption of bone.
Its uses include the prevention and treatment of osteoporosis, osteitis deformans ("Paget's disease of bone"), bone metastasis (with or without hypercalcaemia), multiple myeloma and other conditions that feature bone fragility.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
In pharmacology,bisphosphonates (also called:diphosphonates) are a class of drugs that inhibit osteoclast action and the resorption of bone.
Its uses include the prevention and treatment of osteoporosis, osteitis deformans ("Paget's disease of bone"), bone metastasis (with or without hypercalcaemia), multiple myeloma and other conditions that feature bone fragility.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Host modulatory therapy does not shut off the normal defence mechanism of inflammation instead, they ameliorate excessive or pathologically elevated inflammatory process to enhance the opportunities for wound healing and periodontal stability.
Pharmacological agents are used to stop the progression of periodontitis by intervention of the pathogenic mechanism.
It is used as an adjunct with conventional periodontal disease treatment.
It offers the opportunity for modulating or reducing destruction by treating chronic inflammatory response.
The concept was introduced by William and Golub in 1990.
Initially adjunctive therapies were solely anti-microbial such as use of antibiotics and antiseptics.
New approaches include modulation of host response.
Host modulatory therapy is considered as a BENCH-MARK in the treatment of patients with periodontal diseases.
Also, Useful in the following patients :
Diabetes & immunocompromised situations
peri-implant dis-ease (local and systemic efficiency of host modulatory therapy are used as an adjunct to conventional local disinfection treatment)
Although the efficacy and usefulness of host modulating agents have improved the treatment in several folds still, more research is required to make treatment response faster and to increase periodontal stability.
The lectures in points : -
1- Osteoporosis.
2- Paget's disease.
3- Drugs used in osteoporosis and paget's disease treatment.
4- Practical notes.
5- Rapid review.
6- Test yourself.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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.
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
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!
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
2. • Introduction
• History
• Chemical Structure
• Types Of Bisphosphonates
• Pharmacokinetics
• Mechanism Of Action
• Drug Administration And Dosage
• Common Uses Of Bisphosphonates
• Contraindications Of Bisphosphonates
3. • Bisphosphonates (also called diphosphonates) are
a class of drugs that prevent the loss of bone
mass.
• Used in the treatment of many skeletal disorders-
Bone metastases,
osteoporosis,
Paget’s disease etc.
4. • The “bis” prefix is a term indicating two -
phosphonate groups, attached to a common
carbon atom.
• These are structurally similar to natural
pyrophosphate (PP), which is a normal product of
human metabolism that has a calcium chelating
property.
5. • These drugs have a high attraction for
hydroxyapatite crystals and thus rapidly
included into all parts of the skeleton.
• They are used as inhibitors of osteoclastic
activity to alleviate bone pain that results from
the release of biochemical mediators in
metastatic bone disease.
6. • In 1897, Von Baeyer and Hoffman reported the
synthesis of the first bisphosphonates.
• Initially used in chemical industry as
anticorrosive & anti-scaling agent by virtue of
their ability to inhibit formation of calcium on
surfaces.
7. • In 1960, Fleisch et al. first reported their
ability to inhibit hydroxyapetite dissolution in
bone.
• First human use of a bisphosphonate,
etidronate, was reported by Bassett et al. in
1969 for the treatment of Myositis Ossificans
Progressiva (MPO).
• Smith et al.(1971) were the first to report the
evidence of effectiveness of the
bisphosphonates for the treatment of Paget’s
disease of bone.
9. • Minimally modified side
chains (R1 R2) contain a
chlorophenyl group.
• Metabolized into a non-
hydrolyzable ATP analog
that accumulates within
osteoclasts and induces
apoptosis. which account
for its antiresorptive effect.
• Least potent.
Etidronate
Medronate
Clodronate
Tiludronate
10. • Contains nitrogen group (amino
terminal) in the side chain.
• Primarily inhibits bone resorption.
• Antiresorptive activity involves
inhibition of multiple steps in the
pathway from mevalonate to
cholesterol and isoprenoid lipids
that are required for the
prenylation of proteins that are
important for osteoclast function.
• They are 10-100 times more
potent than 1st generation BPs.
Alendronate
Pamidronate
Ibandronate
11. • Contain nitrogen atom
within a heterocyclic ring.
• These are upto 10,000
times more potent than 1st
generation.
Risedronate,
Zoledronate
12. • Inverse relation exists between pharmacologic activity and
oral bioavailability
• Absorption by passive diffusion from gut
• Milk and other dairy products, orange juice, coffee and
calcium and iron products reduce absorption
• Bound to plasma proteins
• 20-80% of the absorbed dose is rapidly taken up by bone.
• Remainder is rapidly excreted in urine
• Long skeletal retention (half life up to 10 years)
13. • Bisphosphonates are used to inhibit bone
resorption & they act through different mode
of actions:
1. Inhibit development of osteoclasts. Induction of
osteoclast apoptosis.
2. Reduction of osteoclast activity.
3. Prevention of development of osteoclasts from
hematopoietic precursors.
4. Stimulation of production of an osteoclast
inhibitory factor.
14.
15. • There are 2 classes of BPs which have different
mechanisms of action:
• Non nitrogen containing BPs are taken up by the osteoclast and
cause cell apoptosis through activation of capsase pathway.
• Nitrogen containing BPs are not metabolised and affect protein
prenylation of osteoclast by inhibiting farnesyl diphosphate
(FPP) synthase, a key enzyme of the mevalonate pathway .
16. • The physicochemical effects are very similar to
pyrophosphate.
• Inhibit the formation and aggregation of calcium
phosphate crystals , even at very low
concentrations.
• Block the transformation of amorphous calcium
phosphate into Hydroxyapetite, and delay the
aggregation of apetite crystals.
• Bisphosphonates also delays the dissolution of
calcium phosphate crystals.
17. • All of these effects are related to the marked
affinity of BPs for the surface of calcium
phosphate where they bind onto the calcium
by chemisorption.
• BPs chiefly act as a crystal poison on both
growth and dissolution.
18. • The inhibition of bone resorption can be explained
largely by cellular mechanisms.
• Can be considered at three levels: tissue, cellular, and
molecular.
• The effect may be directly on the osteoclasts and may
be mediated, via other cells such as osteoblastic
lineage cells and macrophages.
19.
20. Indications for Use
• Indications for bisphosphonates include such conditions
1. Postmenopausal
2. Glucocorticoid-induced osteoporosis,
3. Paget’s disease,
4. Osteolytic and osteoblastic bone metastases,
5. Fibrous dysplasia,
6. Heterotopic ossification,
7. Myositis ossificans.
8. Other bisphosphonates, medronate and oxidronate
are mixed with radioactive technetium and are
injected for imaging bone and detecting bone disease
21. Bisphosphonates in Metastatic disease
1. They control hypercalcemia,
2. Reduce bone pain,
3. Reduce the number of pathologic fractures,
4. Prolong survival.
22. • Intrvenous zolendronate and palmindronate
are the ones most useful and should be
combined with either chemotherapy or
hormonal therapy in women with metastatic
bone disease.
• Zolendronate is the first bisphosphonate
shown to be effective in both lytic and blastic
metastatic disease
23. • Studies suggest the use of bisphosphonates
As oral and local adjuvants in total joint
arthroplasties increase periimplant bone
density or reduce implant migration
24. Drug Interactions
• Bisphosphonates generally should not be taken with
antacids that contain aluminum or magnesium, bottled
water containing minerals, or calcium supplements
because these agents decrease bisphosphonate
absorption.
• A 2-hour interval between meals drug is recommended.
• Aminoglycosides taken with bisphosphonates may cause
severe hypocalcemia.
25. • Upset stomach
• Inflammation/erosions of esophagus
• Fever/flu-like symptoms
• Slight increased risk for electrolyte disturbance
• Uveitis
• Musculoskeletal joint pain
• Bisphosphonate related osteonecrosis of jaw
(BRONJ)
26. • Patients may be considered to have BONJ if
they have exposed bone in the maxillofacial
region for at least 8 weeks, are currently on or
have taken bisphosphonates and have no
history of radiotherapy to the jaws . (AAOMS )
27. Osteonecrosis of the right mandible after
tooth extraction in a patient taking
zoledronic acid for metastatic breast cancer.
Osteonecrosis of the palatal torus in a
patient with osteoporosis taking
alendronate.