This document provides information on various anticoagulant drugs including heparin, low molecular weight heparins, synthetic heparin derivatives like fondaparinux, direct thrombin inhibitors, and oral vitamin K antagonists like warfarin. It discusses their mechanisms of action, indications, dosing, advantages and disadvantages, interactions, and adverse effects. Key anticoagulants covered are heparin, enoxaparin, fondaparinux, dabigatran, rivaroxaban, and warfarin.
Anticoagulants, commonly referred to as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time.
Anticoagulants, commonly referred to as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time.
heparin in detail : mechanism of action, pharmacokinetics, clinical uses, adverse effect and contraindication of heparin and low molecular heparin.
for undergraduates.
Warfarin. Most used oral anticoagulant in the world. In some cases it has no alternative. Has many side effects. Careful monitoring and judicious titration of dose can make it best. Live long Warfarin.
heparin in detail : mechanism of action, pharmacokinetics, clinical uses, adverse effect and contraindication of heparin and low molecular heparin.
for undergraduates.
Warfarin. Most used oral anticoagulant in the world. In some cases it has no alternative. Has many side effects. Careful monitoring and judicious titration of dose can make it best. Live long Warfarin.
- Describe the basic characteristics of new oral anticoagulants (OACs)
- Recognize potential candidates for new anticoagulants for atrial fibrillation and treatment of venous thrombosis
a clinically oriented discussion of blood coagulation and related diseases and treatment. also discussing DIC, plasma fractions and anti-platelet drugs.
Oral Surgery in Patients on Anticoagulant TherapyVarun Mittal
Management of patients on Anticoagulant Therapy in Surgical Practice with special emphasis on Oral Surgical Procedures; along with Guidelines drawn from various Text Books and Journals
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
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
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.
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
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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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
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.
3. Coumarin derivatives: warfarin,
acenocumarol, ethyl biscoumacetate and
dicumarol
Indanedione group: phenindione and
Anisindione
4. Factor Name
I Fibrinogen
II Prothrombin
III Tissue Factor or thromboplastin
IV Ca++
V Proaccelerin
VII Proconvertin
VIII Antihemophilic A factor
IX Christmas factor or
X Stuart factor
XI Plasma thomboplastin antecedent
XII Hageman factor
XIII Fibrin stabilizing factor
5.
6. INTRINSIC PATHWAY
All clotting factors are
within the blood vessels
Clotting slower
Activated partial
thromboplastin test (aPTT)
EXTRINSIC PATHWAY
Initiating factor is outside
the blood vessels - tissue
factor
Clotting - faster - in
Seconds
Prothrombin test (PT)
7.
8. Heparin is a non-uniform mixture of straight chain
mucopolysaccharide molecules
The mean molecular weight of heparin is 15,000 D
Strongest organic acid present in body
Source- mast cells lung, liver, Int.mucosa
Actions –acts both in-vivo and invitro
Antithrombin III (ATIII) binding is necessary for its
anticoagulant activity
9. Antithrombin III (ATIII) is a slow endogenous progressive
inhibitor of thrombin and other clotting enzymes.
Higher doses inhibits
platelet aggregation and
Prolongs bleeding time.
Lipaemia clearing
10. Large, highly ionised molecule,
Bioavailability- sc -variable, IV
Does not cross –BBB or placenta
Excreted in urine
T1/2-1-4 hrs
1000, 5000 u/ml 5ml vials
Should not be mixed with penicillin,
tetracyclines.
11. Bleeding: they both lead to bleeding but the
bleeding is less in LMWH
To treat bleeding: inject antidote protamine sulphate
(1mg IV for each 100 units of UFH) (reversal effect)
Thrombosis: heparin ↓ ATIII ↑risk of
thrombosis
12. Thrombocytopenia: Heparin-induced thrombocytopenia
(HIT) is a life threatening immune reaction
HIT ↑ platelet activation platelet aggregation
thrombosis.
HIT endothelial damage
HIT may occur in the early stages of treatment (within 5
days) but it’s non-immune reaction (not life threatening)
LMWHs, though of lower risk, are contraindicated with
HIT.
Osteoporosis, hyperkalemia, hypersensitivity
13. Bleeding or hemophilia
Severe hypertension
Thrombocytopenia or purpura-HIT
Intracranial hemorrhage
Recent surgery-ocular, neuro, lumbar
Hypersensitivity to heparin
TB
GIT ulcer
Hepatic or renal disease, chronic alcoholics
Use of digoxin
14. M.Wt 2000-8000 Da ( avg 4500 Da )- prepared from SH by
fractionation & enzymatic degradation .
Commercial preprn : Enoxaparin, Dalteparin, Ardeparin,
Tinzaparin, Reviparin, Nadroparin
Routes : SC (OD)
High anti-Xa and low anti-IIa activity↔ greater
antithrombotic and lower anticoag activity
Low anti-IIa activity, hence, aPTT, TT are not ideal for
monitoring. Anti-Xa assay ideal
Less complicated, dose independent clearance and more
predictable anticoagulant response than UFH.
15. 1. Heparin –IV -5000-10000 units
2. Low dose regimen-sc-DVT
LMWH-
1. Prophylaxis and trmt of DVT, pulm. Embolism-
enoxaparin -30mg sc
2. Unstable angina and MI-
3. To maintain patency of canula and shunts
4. RHD
5. Cerebrovascular diseases
6. DIC
7. Anticoagulation in pregnancy
8. Treatment of peripheral embolism
16. Dabigatran etexilate is a new oral direct thrombin
inhibitor and the prodrug of Dabigatran
Rivaroxaban is an orally available, small-molecule,
active site-directed factor Xa inhibitor
Knee replacement surgeries
Equivalent to LMWH
17. first selective factor Xa inhibitor,
55% better than enoxaparin (LMWH) at reducing risk
of VTE
synthetic pentasaccharide: “represents the
oligosaccharide consensus sequence of heparin”
Indirect inhibition: binds to antithrombin and
increases antithrombin’s affinity for factor Xa by
300-fold
18. Fondaparinux is given –sc- once daily
Long elimination t 1/2 (20 hrs). Renal clearance
Uses
1. Initial treatment of deep vein thrombosis (DVT)
2. pulmonary embolism (PE) and for
3. Venous thromboembolism prevention in patients
undergoing surgery for hip fracture or hip/knee
replacement
19. Lepirudin (DTI) derived from hirudin from leech
salivary glands.
-ischemic conditions associated with unstable angina
Better in hepatic insufficiency patients
Bivalirudin (DTI) approved for use during heparin-
induced thrombocytopenia (HIT) & percutaneous
coronary interventions
Argatroban (DTI) can be used in patients with risk of
(HIT)
Desirudin -DVT
20. Danaparoid-84% heparan sulphate+12% dermatan
sulphate+ 4% chondroitin sulphate
Drotrecogin Alfa
Human recombinant activated protein C
used in patients with sepsis; recombinant form of
activated protein C that inhibits f Va and f VIIIa
21. Vitamin K Antagonists (The Coumarins)
Vitamin K is co-factor for the hepatic
synthesis of clotting factors II, VII, IX & X
Warfarin inhibits Vit. K reductase
no active form of Vit. K
no synthesis of clotting factors
Clinical anticoagulant activity needs
several days to develop (due to the
already circulating clotting factors)
So the action of warfarin will appear
after the elimination of prior
clotting factors.
22. Onset: starts after 12-16 hours
lasts for 4-5 days
Elimination time (factor II needs: 60 hours factor
X: 40 hours)
Overlap heparin & warfarin therapy taken
together until the effect of warfarin appears
(after 5 days) then stop taking heparin.
23. Warfarin has 100% oral bioavailability,
plasma protein binding-99% &
long plasma t1/2 of 36 hours
A high loading dose followed by an adjusted
maintenance dose
Contraindicated with pregnancy -is teratogenic in
the first trimester & and induce intracranial
hemorrhage in the baby during delivery
Warfarin is metabolized by hepatic Cytochrome
P450 enzymes with half-life of 40 hrs
25. Prophylaxis and/or treatment of:
Venous thrombosis and its extension-2-2.5
Pulmonary embolism
Thromboembolic complications associated with AF
and cardiac valve replacement-
Post MI, to reduce the risk of death, recurrent MI,
and thromboembolic events such as stroke or
systemic embolization-3-3.5
Prevention and treatment of cardiac embolism.
26. INR= patients PT in seconds
mean normal PT in seconds
ISI
INR = International Normalized Ratio
ISI = International Sensitivity Index
27. Food and drug interactions
Genetic variation in metabolism
narrow therapeutic window
slow onset of action
overlap with parenteral drugs
dosage adjustments &
freq. monitor with INR
28. 1. Induce microsomal enzymes (barbiturates,
meprobamate and other sedative-hypnotic drugs;
griseofulvin).
2. Inhibition of metabolism (e.g., allopurinol disulfiram.
3. Displaced from binding sites by phenylbutazone,
phenytoin, sulfinpyrazone, clofibrate, Salicylates,
Indomethacin, Oral Contraceptives
4. Acetaminophen inhibits warfarin degradation
5. Effect of anticoagulants on other drugs -Coumarin
agents prolong and intensify action of chlorpropamide,
tolbutamide, phenytoin and phenobarbital.
Editor's Notes
The blood coagulation process can be activated by one of two pathways, the tissue Factor pathway (formerly known as the extrinsic pathway) and the contact activation pathway (known as the intrinsic pathway).
Tissue Factor binds to and activates Factor VII and the Tissue Factor/VIIa complex then activates Factor X and Factor IX to Xa and Ixa respectively. Factor X can also be converted to Xa by Ixa (in the presence of Factor VIII).
The intrinsic pathway is activated when Factor XII comes in contact with a foreign surface. The resulting Factor XIIa then activates Factor XI, which in turn activates Factor IX. Factor Ixa then activates Factor X.
Thus Factor Xa can be generated by activation of the tissue factor or contact activation pathways. Factor Xa then cleves prothrombin and the resulting thrombin converts fibrinogen to fibrin.
Four of these clotting factors (Factors IX, VII, X and prothrombin) are Vitamin K dependent and therefore their activity is decreased by the Vitamin K antagonist, warfarin. The half-lives of these four Vitamin K dependent clotting factors are shown on this slide.
Factor VII has the shortest half life of the Vitamin K dependent coagulation factors. However, for adequate anticoagulation one needs to reduce the other coagulation factors appropriately, including Factor II (prothrombin) which has a 60 hour half life. It takes several days after initiation of warfarin therapy to reduce Factor II and thus warfarin and heparin need to overlap for approximately 4–5 days when starting therapy.