Lecture slides for undergraduate MBBS class in Pharmacology on " Drugs for Diarrhoea" . It includes various treatment modalities which are used in the management of Diarrhoea. Basic source of information for preparing this slides is" Essentials of Pharmacology by KD tripathi, 7th Edition". Images are searched with the help of google images.
The main focus of this presentation is to discuss all the drugs used nowadays in clinical practice to treat/ manage bronchial asthma. Along with the mechanism of action, use and adverse effects of anti-asthma drugs, we have given a highlight of the pathophysiology of asthma and how the drugs individually act at individual set point(s) to bring the clinical outcome.
Lecture slides for undergraduate MBBS class in Pharmacology on " Drugs for Diarrhoea" . It includes various treatment modalities which are used in the management of Diarrhoea. Basic source of information for preparing this slides is" Essentials of Pharmacology by KD tripathi, 7th Edition". Images are searched with the help of google images.
The main focus of this presentation is to discuss all the drugs used nowadays in clinical practice to treat/ manage bronchial asthma. Along with the mechanism of action, use and adverse effects of anti-asthma drugs, we have given a highlight of the pathophysiology of asthma and how the drugs individually act at individual set point(s) to bring the clinical outcome.
DRUGS USED IN THE TREATMENT OF BRONCHIAL ASTHMA AND COPD
Characterized by hyper responsiveness of bronchial smooth muscle to a variety of stimuli”
Resulting in:
Narrowing of air ways
Increased secretion
Mucosal edema
Mucus plugging
pharmacothrapy of asthma.pptxBronchial asthma is a chronic respiratory diseas...AbhishekKumarGupta86
pharmacotherpy of asthma M pharm 2nd sem.
Bronchial asthma is a chronic respiratory disease characterized by inflammation and narrowing of airways in the lungs, which cause difficulty in breathing.
Symptoms can include coughing, wheezing, shortness of breath and chest tightness. These symptoms can be mild or severe and can come and go over time.
Although asthma can be a serious condition, it can be managed with the right treatment.
Asthma affected an estimated 262 million people in 2019 (1) and caused 455 000 deaths.
Chronic Obstructive Pulmonary Disease basis of drugs used in treatment and Describe the factors which affect the quality of life of individuals suffering from COPD
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
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
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.
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.
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
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
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.
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Bronchial asthma
1. Bronchial Asthma:
Pharmacotherapy
Dr. Pravin Prasad
MBBS, MD Clinical Pharmacology
Assistant Professor, Department of Clinical Pharmacology
Maharajgunj Medical Campus
Maharajgunj, Kathmandu
2 June 2020 (20 Jestha 2077), Monday
2. By The Of This Discussion B. Pharm 3rd Year
Students Will Be Able To:
Understand the term Bronchial Asthma (BA)
List the risk factors and explain the pathophysiology for BA
Enumerate the therapeutic objectives in BA and classify the response of
patients based on the objectives
List the modalities for management of BA
Explain the pharmacological management of BA
Outline the stepwise approach for the management of chronic asthma
List the drugs used in management of acute severe asthma
2
3. Introduction
Asthma is a chronic inflammatory disorder of the airways, in which many
cells and cellular elements play a role.
Associated with airway hyper-responsiveness with recurrent symptoms
Accompanied by variable airflow obstruction that is often reversible either
spontaneously or with treatment.
3
5. Triggers of Bronchial Asthma
Allergens
Upper respiratory tract viral infections
Exercise and hyperventilation
Cold air
Sulfur dioxide and irritant gases
Drugs (beta blockers, aspirin)
Stress
Irritants (Household sprays, paint, fumes)
5
6. Pathophysiology: Bronchial Asthma
Allergenic Exposure
Activation of allergen specific IgE in
the surface of the cell
Release of inflammatory mediations
Contraction of airway smooth muscle,
mucus secretion and mucus plugging
Microvascular Leakage
Exudation of plasma proteins
Plasma protein leakage induce a
thickened, engorged, edematous airway
wall
Narrowing of airway and reduced
mucus clearance
Airway inflammation
Bronchial responsiveness
Airway remodelling (structural changes)
6
8. Clinical Presentation
Symptoms:
Characteristic symptoms of asthma are wheezing, dyspnea, and coughing,
which are variable, both spontaneously and with therapy.
increased ventilation and use of accessory muscles of ventilation
May show variations thorough the day (diurnal variation)
Increased thick tenacious mucus production that is difficult to expectorate.
Signs:
Hyperinflated lungs
Noisy breathing (inspiratory as well as expiratory ronchi)
https://youtu.be/T4qNgi4Vrvo
8
9. Bronchial Asthma: Diagnosis
Usually clinical
Objective diagnosis necessary for monitoring response to treatment
Lung function Tests
Reduced Forced Expiratory Volume at 1 second (FEV1), FEV1/FVC ratio
Reduced Peak Expiratory Flowrate (PEF)
Reversible with drugs
Chest X-ray
Hyperinflated Lungs
Skin Tests
To identify culprit allergen
9
10. Therapeutic Objectives and responses
Characteristics Controlled (all of the
following)
Partly controlled Uncontrolled
Daytime symptoms None (=< 2/week) > 2/week Three or more
features of the
partly controlledLimitation of activities None Any
Nocturnal symptoms/
awakenings
None Any
Need for reliever/ rescue
treatment
None (=< 2/week) > 2/week
Lung Function (PEF or FEV1) Normal < 80% predicted or personal
best if known
For acute asthma: Termination of attack of asthma
10
11. 11
Treatment options
General information and advice
Non-pharmacological therapy
Pharmacological Therapy
Referral
11
• Identify and avoid allergens
• Reduce adverse environment, house
mites/cockroaches
• Smoking cessation
16. Beta agonists
Most effective bronchodilator
Relaxes airway smooth-muscle cells of all airways
Reversing and preventing contraction of airway smooth-muscle cells by all
known bronchoconstrictors
Additional non-bronchodilator effects also seen
Usually given by inhalation
SABA: rapid onset of action (3-6 hrs)
In high doses by nebulizer or via a metered-dose inhaler (MDI) with a spacer.
LABA: slow sustained action (12 hrs or more)
Improve asthma control and reduce exacerbations when added to ICS, which
allows asthma to be managed with lower doses of corticosteroids.
16
17. Anticholinergics
Muscarinic receptor antagonists prevent cholinergic nerve-induced
bronchoconstriction and mucus secretion.
They are less effective than β2-agonists in asthma therapy
LAMA: additional bronchodilator in patients with asthma that is not
controlled by maximal doses of ICS-LABA combinations, and improve lung
function and further reduce exacerbations
High doses of short-acting anticholinergics for termination of attack
As an add on to β2 agonist
17
18. Methyl Xanthines (Phosphodiesterase inhibitors)
Inexpensive bronchodilator
Effect seen due to inhibition of phosphodiesterases in airway smooth-
muscle cells, which increases cyclic AMP
Accompanied with significant side effects at therapeutic doses (narrow
therapeutic index)
Possibility of anti-inflammatory effects at lower doses
By switching off activated inflammatory genes
May reduce corticosteroid insensitivity in severe asthma
Given orally as slow release tablets as an add-on therapy
Slow i.v. infusion in acute exacerbations refractory to SABA
18
19. Inhaled Corticosteroids
Most effective controller, instituted at early stages of diseases
Acts by switching off the transcription of multiple activated genes that
encode inflammatory proteins such as cytokines, chemokines, adhesion
molecules, and inflammatory enzymes
Additional activation of anti-inflammatory genes
Usually given twice daily as first line therapy for persistent asthma
Rapidly improve the symptoms of asthma, and lung function improves over
several days.
Early treatment with ICS appears to prevent irreversible changes in airway
function that occur with chronic asthma.
19
20. Systemic Corticosteroids
Can be give intravenously ororally in severe asthma
Oral prednisolone 35-40 mg once daily for 5-10 days
Tapering not required at the end of therapy
Systemic side effects seen
Consider steroid-sparing therapies (SST)
None of SSTs have any long-term benefit and each is associated with a
relatively high risk of side effects
20
21. Antileukotrienes
Block cys-LT1-receptors and provide modest clinical benefit in asthma
Less effective than ICS or LABA
Useful as an add-on therapy
They are given orally once or twice daily and are well tolerated
21
22. Mast cell stabilizers
Cromolyn sodium and nedocromil sodium
Appear to inhibit mast cell and sensory nerve activation
Relatively little benefit in the long-term control of asthma
Very safe and were popular in the treatment of childhood asthma
22
23. Anti-allergics
Anti-IgE Omalizumab
Blocking antibody that neutralizes circulating IgE
Reduces the number of exacerbations
Very expensive and is only suitable for highly selected patients
Patient should be given a 3- to 4-month trial of therapy to show objective
benefit
Anti-IL-5 Mepolizumab, Reslizumab, Benralizumab
Markedly reduce blood and tissue eosinophils
Reduce exacerbations in patients who have persistently increased sputum
eosinophils despite maximal ICS therapy
23
24. Vaccines
Recommended to prevent infection, which may precipitate an exacerbation
e.g: influenza vaccine
24
26. Management of Acute Severe Asthma
Oxygen. High concentrations (humidified if possible) should be administered
to maintain the oxygen saturation above 92% in adults.
High doses of inhaled bronchodilators
SABA via nebulizer or multiple dose MDI
Short acting anticholinergics
Systemic corticosteroids
Reduces the inflammatory response and hasten the resolution of an
exacerbation.
Orally or parenterally
Others: Intravenous magnesium, intravenous aminophylline, mechanical
ventilation
26
The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night and in the early morning.
Acts as functional antagonists
additional non-bronchodilator effects that may be clinically useful, including inhibition of mast cell mediator release, reduction in plasma exudation, and inhibition of sensory nerve activation
β2-Agonists are usually given by inhalation to reduce side effects. SABA, such as albuterol and terbutaline, have a duration of action of 3–6 h. They have a rapid onset of bronchodilatation and are, therefore, used as needed for symptom relief (relievers). Increased use of SABA indicates that asthma is not controlled. They are also useful in preventing EIA if taken prior to exercise. SABA are used in high doses by nebulizer or via a metered-dose inhaler (MDI) with a spacer. Long-acting β2-agonists (LABA) include salmeterol and formoterol, both of which have a duration of action over 12 h and are given twice daily by inhalation; and indacaterol, olodaterol, and vilanterol, which are given once daily. LABA have replaced the regular use of SABA, but LABA should not be given in the absence of ICS therapy as they do not control the underlying inflammation. They do, however, improve asthma control and reduce exacerbations when added to ICS, which allows asthma to be managed with lower doses of corticosteroids. This observation has led to the widespread use of fixed combination inhalers that contain a corticosteroid and a LABA, which have proved to be highly effective in the control of asthma and prevention of exacerbations.
They are less effective than β2-agonists in asthma therapy as they inhibit only the cholinergic reflex component of bronchoconstriction, whereas β2-agonists prevent all bronchoconstrictor mechanisms.
Long-acting muscarinic antagonists (LAMA), including tiotropium bromide or glycopyrronium bromide, may be used as an additional bronchodilator in patients with asthma that is not controlled by maximal doses of ICS-LABA combinations, and improve lung function and further reduce exacerbations.
This effect involves several mechanisms, including inhibition of the transcription factors NF-κB, but an important mechanism is recruitment of HDAC2 to the inflammatory gene complex, which reverses the histone acetylation associated with increased gene transcription.
Corticosteroids also activate anti-inflammatory genes such as mitogen-activated protein (MAP) kinase phosphatase-1, and increase the expression of β2-receptors.
They are effective in preventing asthma symptoms, such as EIA and nocturnal exacerbations, but also prevent severe exacerbations.
ICS reduce AHR, but maximal improvement may take several months of therapy
Corticosteroids are used intravenously (hydrocortisone or methylprednisolone) for the treatment of acute severe asthma, although several studies now show that OCS are as effective and easier to administer. A course of OCS (usually prednisone or prednisolone 30–45 mg once daily for 5–10 days) is used to treat acute exacerbations of asthma; no tapering of the dose is needed. Approximately 1% of asthma patients may require maintenance treatment with OCS; the lowest dose necessary to maintain control needs to be determined.
Systemic side effects, including truncal obesity, bruising, osteoporosis, diabetes, hypertension, gastric ulceration, proximal myopathy, depression, and cataracts, may be a major problem, and steroid-sparing therapies may be considered if side effects are a significant problem.
If patients require maintenance treatment with OCS, it is important to monitor bone density so that preventive treatment with bisphosphonates or estrogen inpostmenopausal women may be initiated if bone density is low.
Intramuscular triamcinolone acetonide is a depot preparation that is occasionally used in noncompliant patients, but proximal myopathy is a major problem with this therapy.
Cysteinyl-leukotrienes are potent bronchoconstrictors; they cause microvascular leakage and increase eosinophilic inflammation through the activation of cys-LT1-receptors. These inflammatory mediators are produced predominantly by mast cells and, to a lesser extent, eosinophils in asthma.
Antileukotrienes, such as montelukast and zafirlukast, block cys-LT1-receptors and provide modest clinical benefit in asthma. They are less effective than ICS in controlling asthma and have less effect on airway inflammation, but are useful as an add-on therapy in some patients not controlled with low doses of ICS, although less effective than a LABA.
They are given orally once or twice daily and are well tolerated. Somepatients show a better response than others to antileukotrienes, butthis has not been convincingly linked to any genomic differences inthe leukotriene pathway.
Cromolyn sodium and nedocromil sodium are asthmacontroller drugs that appear to inhibit mast cell and sensory nerveactivation and are, therefore, effective in blocking trigger-inducedasthma such as EIA and allergen- and sulfur dioxide-inducedsymptoms. Cromones have relatively little benefit in the long-termcontrol of asthma due to their short duration of action (at least fourtimes daily by inhalation). They are very safe and were popular inthe treatment of childhood asthma, although now low doses of ICSare preferred as they are far more effective and have a proven safetyprofile.
Anti-IgE Omalizumab is a blocking antibody that neutralizes circulating IgE without binding to cell-bound IgE and, thus, inhibits IgE-mediated reactions. This treatment has been shown to reduce the number of exacerbations in patients with severe asthma and may improve asthma control. However, the treatment is very expensive and is only suitable for highly selected patients who are not controlled on maximal doses of inhaler therapy and have a circulating IgE within a specified range. Patients should be given a 3- to 4-month trial of therapy to show objective benefit. Omalizumab is usually given as a subcutaneous injection every 2–4 weeks and appears not to have significant side effects, although anaphylaxis is very occasionally seen.
Anti-IL-5 Antibodies that block IL-5 (mepolizumab, reslizumab) or its receptor (benralizumab) markedly reduce blood and tissue eosinophils and reduce exacerbations in patients who have persistently increased sputum eosinophils despite maximal ICS therapy.
Step-down therapyOnce asthma control is established, the dose of inhaled (or oral) corticosteroid should be titrated to the lowest dose at which effective control of asthma is maintained. Decreasing the dose of ICS by around 25–50% every 3 months is a reasonable strategy for most patients.
Mild to moderatae exacerbations: short term oral corticosteroids, do not taper before stopping if used for less than 3 weeks
Oxygen. High concentrations (humidified if possible) should be administered to maintain the oxygen saturation above 92% in adults. The presence of a high PaCO2 should not be taken as an indication to reduce oxygen concentration, but as a warning sign of a severe or life-threatening attack. Failure to achieve appropriate oxygenation is an indication for assisted ventilation.
High doses of inhaled bronchodilators. Short-acting β2-agonists are the agent of choice. In hospital, they are most conveniently given via a nebuliser driven by oxygen, but delivery of multiple doses of salbutamol via a metered-dose inhaler through a spacer device provides equivalent bronchodilatation and can be used in primary care. Ipratropium bromide provides further bronchodilator therapy and should be added to salbutamol in acute severe or life-threatening attacks.
Systemic corticosteroids. These reduce the inflammatory response and hasten the resolution of an exacerbation. They should be administered to all patients with an acute severe attack. They can usually be administered orally as prednisolone, but intravenous hydrocortisone may be used in patients who are vomiting or unable to swallow.
If patients fail to improve, a number of further options may be considered. Intravenous magnesium may provide additional bronchodilatation in patients whose presenting PEF is below 30% predicted. Some patients appear to benefit from the use of intravenous aminophylline but cardiac monitoring is recommended.