Cardiovascular pharmacology
Cardiovascular (=Circulatory) system – heart and blood vessels
Arteries – transport blood to tissues
Capillaries – sites of exchange, fluid O2, CO2, nutrients etc.
Venules – collect blood from capillaries
Veins – transport blood back to heart
Blood moves within vessels – higher pressure to lower pressure
Resistance to flow depends on vessel diameter, length and viscosity of blood
Myocardial Infarction Treatment
Classes of drugs used in the treatment of myocardial infarction
Vasodilators
General Pharmacology
Cardiac depressant drugs
Antiarrhythmics
Anti-thrombotics
Thrombolytics
Analgesics
General Mechanisms of Action
This presentation provides a knowledge about Ischemic heart Disease, Ischemia, Mechanism of Action, signs and symptoms, Causes of Ischemia, Ischemia in different body parts, Angina, Myocardial Infarction, Artherosclerosis, Drugs used to treat ischemia and recent discovery related to Cardiac ischemia. An assignment for the subject, Advanced Pharmacology-I, 1st year M.Pharm, 1st semester.
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Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
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
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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!
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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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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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.
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.
3. BIMM118
Cardiovascular Pharmacology
• Cardiovascular (=Circulatory) system – heart and blood vessels
• Arteries – transport blood to tissues
• Capillaries – sites of exchange, fluid O2, CO2, nutrients etc.
• Venules – collect blood from capillaries
• Veins – transport blood back to heart
• Blood moves within vessels – higher pressure to lower pressure
Resistance to flow depends on vessel diameter, length and
viscosity of blood
5. BIMM118
Antihypertensive Drugs
Four major drug categories
• Sympathetic nervous system suppressors:
– α1 and β1 antagonists
– α2 agonists
• Direct vasodilators:
– Calcium channel antagonists
– Potassium channel agonists
• Renin-angiotensin system targeting drugs:
– ACE inhibitors
– Angiotensin II receptor antagonists
• Diuretics:
– Thiazides
– Loop diuretics
– K+
- sparing diuretics
6. BIMM118
Antihypertensive Drugs:Vasodilators
Calcium channel blockers (= Calcium antagonists):
– Inhibit calcium entry into cells of the arteries
=> decreased afterload
Dihydropyridines:
– Target specifically L-type channels on vascular smooth muscle cells
– No cardiac effects (“Vasoselective Ca++
antagonists”)
– Can cause peripheral edema
• Nifedipine
– Prototype
• Nicardipine
• Nimodipine
• Nisoldipine
• Amlodipine
7. BIMM118
Antihypertensive Drugs: Vasodilators
Potassium channel agonists:
• Minoxidil
– Increases outward K+
current => membrane hyperpolarization, which
inhibits Ca++
channel activity
– Used only for severe, treatment-resistant hypertension
– Major side effect: Hirsutism => used topically to treat baldness
(Rogaine® )
8. BIMM118
Antihypertensive Drugs: Vasodilators
• Nitroprusside
– Very unstable (only iv)
– Metabolized by blood vessels into NO
=> activates cGMP production => vasodilation
– Rapid action (30 sec !), short duration (effect ends after 3 min) => blood
pressure “titration”
– Used only to treat hypertensive emergencies
9. BIMM118
Antihypertensive Drugs: RAAS-targeting drugs
Renin-angiotensin system
• Important role in regulating blood volume, arterial
pressure, and cardiac and vascular function.
• Most important site for renin release is the kidney:
sympathetic stimulation (acting via β1-adrenoceptors),
renal artery hypotension (e.g. stenosis), and decreased
sodium delivery to the distal tubules stimulate the
release of renin by the kidney.
• Renin acts upon a circulating substrate,
angiotensinogen (produced mainly by the liver) which
undergoes proteolytic cleavage to form the decapeptide
angiotensin I (AT I).
• Vascular endothelium, particularly in the lungs,
contains angiotensin converting enzyme (ACE), which
cleaves off two amino acids to form the octapeptide,
angiotensin II (AT II).
10. BIMM118
Antihypertensive Drugs: RAAS-targeting drugs
Renin-angiotensin system
Angiotensin II
• Constricts vessels thereby increasing vascular
resistance and arterial pressure
• Stimulates the adrenal cortex to release aldosterone,
which acts upon the kidneys to increase sodium and
fluid retention
• Stimulates the release of vasopressin (antidiuretic
hormone, ADH) from the pituitary which acts upon the
kidneys to increase fluid retention
• Facilitates norepinephrine release and inhibits re-
uptake from nerve endings, thereby enhancing
sympathetic adrenergic function
• Stimulates cardiac and vascular hypertrophy
11. BIMM118
Antihypertensive Drugs: RAAS-targeting drugs
ACE - Inhibitors
• Captopril
– First ACE inhibitor
– Given po
– Frequent side effect: cough (reduced inactivation of kinins)
• Enalapril
• Benazepril
• Ramipril
• Lisinopril
• Etc…
12. BIMM118
Antihypertensive Drugs: RAAS-targeting drugs
AT II Receptor Antagonists
Do not interfer with kinin processing => no cough
• Losartan
• Candesartan
• Eprosartan
• Valsartan
• Irbesartan
• Etc…
13. BIMM118
Angina pectoris
• Medical term for chest pain or discomfort due to coronary heart
disease. Typical angina pectoris (=“tight heart” is uncomfortable
pressure, fullness, squeezing or pain in the center of the chest
• Angina is a symptom of myocardial ischemia, which occurs when the
myocardium does not receive sufficient oxygen.
• People with stable angina have episodes of chest discomfort that are
usually predictable, such as on exertion or under stress (Treatment:
Nitrates, β-blockers).
• In people with unstable angina, the chest pain is unexpected and usually
occurs while at rest. The discomfort may be more severe and
prolonged than typical angina (Treatment: Nitrates).
• Variant angina is also called Prinzmetal's angina. Unlike typical angina, it
nearly always occurs when a person is at rest, and does not follow
physical exertion or emotional stress. Variant angina is due to coronary
artery spasm (Treatment: Ca++
channel blockers).
14. BIMM118
Angina pectoris - Nitrates
• Nitroglycerin
– Organic nitrate
– Acts on vascular smooth muscle to promote vasodilation
– Primarily works on veins, only modest dilation of arterioles
– Decreases oxygen demand by decreasing venous return =>
use in stable angina
It was originally believed that nitrates and nitrites dilated coronary blood vessels,
thereby increasing blood flow to the heart. It is now believed that atherosclerosis
limits coronary dilation and that the benefits of nitrates and nitrites are due to
dilation of arterioles and veins in the periphery. The resultant reduction in preload,
and to a lesser extent in afterload, decreases the workload of the heart and lowers
myocardial oxygen demand.
– Oral, sublingual, IV, buccal and transdermal administration
– Adverse effects – headache, tachycardia, hypotension
– Never to be combined with other drugs causing
vasodilation (Viagra® ) or hypotension
15. BIMM118
Angina pectoris - Nitrates
• Isosorbide-dinitrate (ISDN)
– More stable than nitroglycerol
– Longer lasting effect
– Tolerance can occur – give lowest dose possible
• Nitroprusside
17. BIMM118
Cardiac Arrhythmia
Arrhythmias:
Abnormal rhythms of the heart that cause the heart to pump less effectively
Arrhythmia occurs:
– when the heart’s natural pacemaker develops an abnormal rate or rhythm
– when the normal conduction path is interrupted
– when another part of the heart takes over as pacemaker
Types of arrhythmia:
– Tachycardia: unusually fast heartbeat
– Bradycardia: unusually slow heartbeat
– Atrial fibrillation: the atria quiver rather than contract normally because of rapid and irregular
electrical signals in the heart. Beside the abnormal heart beat, there is also a risk that blood
will pool in the atria, possibly causing the formation of blood clots.
– Ventricular fibrillation: life threatening condition in which the heart ceases to beat regularly
and instead “quivers” or fibrillates very rapidly – sometimes at 350 beats per minute or more
(causes 350,000 death/year in the US - “sudden cardiac arrest”)
20. BIMM118
Cardiac Arrhythmia
Arrhythmias:
Class II - β-blockers:
For tachycardia
• Propranolol
Class III - Potassium channel blockers:
• Bretylium
• Amiodarone
Class IV - Calcium channel blockers:
• Verapamil
22. BIMM118
Congestive Heart Failure
Congestive heart failure:
• characterised by inadequate contractility, so that the ventricles have difficulty in
expelling sufficient blood => rise in venous blood pressures
• Raised venous pressures impair fluid drainage from the tissues and produce a
variety of serious clinical effects:
– Right sided heart failure causes lower limb oedema. Blood pooling in the lower
extremities is associated with intravascular clotting and thromboembolism
– Left sided heart failure produces pulmonary oedema and respiratory distress
– Causes: Blocked coronary arteries; viral infections; hypertension; MI; leaky heart valves
27. BIMM118
Congestive Heart Failure
Cardiac Glycosides:
• Cardiac glycosides slow the heart rate and increase the force of
contraction
• Extracts of D. purpurea have been used clinically for over 200 years to
treat heart failure and edema (“dropsy”)
• The cardiac glycosides inhibit the Na+
/K+
-ATPase pump, which causes an
increase in intracellular Na+
=> slowing of the Na+
/Ca++
-exchanger =>
increase in intracellular Ca++
.
• Low therapeutic index => Associated with an appreciable risk of toxicity
• Digoxin is the most widely used preparation of digitalis (half-life = 1-2
days), although digitoxin (half-life = 7 days) is used in situations where
long half-life may be an advantage.
• Digitalis is the drug of choice for heart failure associated with atrial
fibrillation
28. BIMM118
Congestive Heart Failure
Cardiac Glycosides:
• Improve cardiac performance (=positive inotrope)
• Increases cardiac output
• Decreased sympathetic tone
• Increase urine output
• Decreased renin release
• Does not prolong life (only symptom relief)
Toxicity:
• Overdose; drug interaction; accidental ingestion of plants (children!)
• Potassium competes with cardiac glycoside for binding to Na+
/K+
-ATPase
pump => potassium is an “antidot” for cardiac glycoside poisoning
• Injection of anti-cardiac glycoside antibodies