The document discusses lithium, its uses, monitoring, and side effects. It is used to treat bipolar disorder, especially the manic phase. The success rate for remission from mania is as high as 80% but lower in hospitalized patients. Maintenance treatment is about 60% effective overall. Therapeutic levels are monitored through serum tests. Common side effects include tremors, thyroid issues, and kidney problems. Lithium levels must be closely monitored due to drug and diet interactions and changes during pregnancy.
To explain pathogenesis of Schizophrenia
To classify antipsychotic drugs
To describe mechanism of action of antipsychotics
To enlist side effects of antipsychotic drugs.
Atypical antipsychotics have mixtures of pharmacological properties.
Beyond antagonism of 5HT2A and D2 receptors, they interact with multiple other receptor subtypes for both dopamine and serotonin, and have effects on other neurotransmitter systems as well.
Some of these multiple pharmacological properties can contribute to the therapeutic effects of atypical antipsychotics (e.g., antidepressant, antimanic, and anxiolytic effects), whereas others can contribute to their side effects (e.g,. sedative-hypnotic and cardiometabolic effects).
No two atypical antipsychotics have identical binding properties, which probably helps to explain why they all have distinctive clinical properties.
They are specific 5-HT and various degrees NE reuptake inhibition.
Venlafaxine, at lower doses (75–100 mg/day) acts as SSRI. As the dose increases it inhibit NE reuptake (& 2ry ↓ DA reuptake in prefrontal cortex, which lacks DAT→ ↑ DA).
To explain pathogenesis of Schizophrenia
To classify antipsychotic drugs
To describe mechanism of action of antipsychotics
To enlist side effects of antipsychotic drugs.
Atypical antipsychotics have mixtures of pharmacological properties.
Beyond antagonism of 5HT2A and D2 receptors, they interact with multiple other receptor subtypes for both dopamine and serotonin, and have effects on other neurotransmitter systems as well.
Some of these multiple pharmacological properties can contribute to the therapeutic effects of atypical antipsychotics (e.g., antidepressant, antimanic, and anxiolytic effects), whereas others can contribute to their side effects (e.g,. sedative-hypnotic and cardiometabolic effects).
No two atypical antipsychotics have identical binding properties, which probably helps to explain why they all have distinctive clinical properties.
They are specific 5-HT and various degrees NE reuptake inhibition.
Venlafaxine, at lower doses (75–100 mg/day) acts as SSRI. As the dose increases it inhibit NE reuptake (& 2ry ↓ DA reuptake in prefrontal cortex, which lacks DAT→ ↑ DA).
Choosing the right drug for your patient is the most satisfactory feeling a physician get.
This presentation gives you the pharmacological profile, pharmacokinetics, mechanism of action, indication, indication in special groups, side effect profile, drug interactions, and cost of use.
The medications include lithium, valproate, lamotrigine, Carbamazepine, oxcarbazepine, licarbazepine, and others
Psycotropics, anti psycotics 1st and second generation,anti parkinsons, anti depressants mood stabilizers, sedative hypnotics side effects, management of side effects
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
3. Bipolar affective disorder (BAD)
• Smaller percentage of bipolar patients
now recieve lithium because lithium has a
slow onset of action.
• The overall success rate for achieving
remission from the manic phase of BAD
can be as high as 80%, but lower among
patients who require hospitalization.
Katzung, Masters, Trevor.
Basic and clinical
4. Bipolar affective disorder (BAD)
• Maintenance treatment is about 60% effective
overall, but less in severely ill patients.
• Increased use of combined treatment in
severe cases!
• After mania is controlled, the antipsychotic
drug may be stopped and benzodiazepines
and lithium continued as maintenance
therapy.
Katzung, Masters, Trevor.
Basic and clinical
5. Bipolar affective disorder (BAD)
• The depressive phase of BAD often requires
concurrent use of an antidepressant drug.
• Tricyclic antidepressant agents have been linked
to precipitation of mania, with more rapid
cycling of mood swings.
• Selective serotonin reuptake inhibitors (SSRIs)
are less likely to induce mania, but may have
limited efficacy.
Katzung, Masters, Trevor.
Basic and clinical
6. Bipolar affective disorder (BAD)
• Bupropion may be efficacious, but it may
induce mania at higher doses.
• The anticonvulsant lamotrigine is
effective for many patients with bipolar
depression.
• Quetiapine and the combination of
olanzapine and fluoxetine has been
approved for use in bipolar depression.
Katzung, Masters, Trevor.
Basic and clinical
7. Bipolar affective disorder (BAD)
• Lithium ion at therapeutic
concentrations is devoid of autonomic
blocking effects and of activating or
sedating effects.
• Lithium can produce nausea and tremor.
• Prophylactic use of lithium can prevent
both mania nad depression.
Katzung, Masters, Trevor.
Basic and clinical
8. Bipolar affective disorder (BAD)
Antipsychotics
Used in the manic phase:
aripiprazole, olanzapine,
quetiapine, risperidone…
Lithium
Treatment of BAD, especially
in the manic phase.
Bipolar depression
Lamotrigine,
bupropion, SSRIs
Prophylactic use of Li
Prevention of both mania
and depression
Combination
Combined treatment in severe
cases: lithium and antipsychotics
Antipsychotics
Li + Lamotrigine
Li
Katzung, Masters, Trevor.
Basic and clinical
10. Other applications
Recurrent endogenous depression
Recurrent endogenous
depression with a cyclic
pattern is controlled by
either lithium or imipramine.
Katzung, Masters, Trevor.
Basic and clinical
11. Other applications
Schizoaffective disorder
• Schizoaffective disorder is characterized by a
mixture of schizophrenic symptoms and
depression or excitement.
• It is treated with antipsychotic drugs alone or
combined with lithium.
• Various antidepressants are added if
depression is present.
Katzung, Masters, Trevor.
Basic and clinical
12. Other applications
Schizophrenia
• Lithium alone is rarely successful in treating
schizophrenia.
• Adding the lithium to an antipsychotic may
salvage an otherwise treatment-resistant
patient.
• Carbamazepine may work equally well when
added to an antipsychotic drug.
Katzung, Masters, Trevor.
Basic and clinical
13. Other applications
Unipolar depression
• Lithium may be added to tricyclic
antidepressants or SSRIs in patients with
unipolar depression who do not respond fully
to monotherapy with the antidepressant.
• For this indication, concentrations of lithium
at the lower end of the recommended range
for BAD are adequate.
Katzung, Masters, Trevor.
Basic and clinical
15. Monitoring treatment
• An initial determination of serum lithium
concentration should be obtained about 5 days
after the start of treatment.
If the clinical response suggests a change in
dosage, simple arithmetic should produce the
desired level:
• New dose=
𝑷𝒓𝒆𝒔𝒆𝒏𝒕 𝒅𝒐𝒔𝒆 𝑿 𝑫𝒆𝒔𝒊𝒓𝒆𝒅 𝒃𝒍𝒐𝒐𝒅 𝒍𝒆𝒗𝒆𝒍
𝑷𝒓𝒆𝒔𝒆𝒏𝒕 𝒃𝒍𝒐𝒐𝒅 𝒍𝒆𝒗𝒆𝒍
Katzung, Masters, Trevor.
Basic and clinical
16. Monitoring treatment
• The serum concentration attained with
the adjusted dosage can be checked after
another 5 days.
• Once the desired concentration has been
achieved, levels can be measured at
increasing intervals unless the schedule is
influenced by intercurrent illness or the
introduction of a new drug.
Katzung, Masters, Trevor.
Basic and clinical
18. Maintenance treatment
The decision to use lithium as prophylactic
treatment depends on:
• FREQUENCY and SEVERITY of previous
episodes
• CRESCENDO pattern of appearance
• DEGREE to which the patient is willing to
follow a program of indefinite
maintenance therapy
Katzung, Masters, Trevor.
Basic and clinical
19. Maintenance treatment
• If the present attack was the patient´s
first or if the patient is unreliable, one
might prefer to terminate treatment after
the episode has subsided.
• Patients who have one or more episodes
of illness per year are candidates for
maintenance treatment.
Katzung, Masters, Trevor.
Basic and clinical
20. Maintenance treatment
Some patients can be maintained with
serum levels as low as 0,6 mEq/L.
The best results have been obtained
with higher levels, such as 0,9 mEq/L.
Katzung, Masters, Trevor.
Basic and clinical
22. Drug interactions
• Renal clearance of lithium is reduced about
25% by diuretics (eg, thiazides): doses may
need to be reduced by a smiliar amount.
• A similar reduction in lithium clearance has
been noted with several of the newer
NSAIDs that block synthesis of prostaglandis,
but not with aspirin and acetaminophen.
Katzung, Masters, Trevor.
Basic and clinical
23. Drug interactions
Many neuroleptics, except of
clozapine and the newer atypical
antipsychotics, may produce more
severe extrapyramidal syndromes
when combined with lithium.
Katzung, Masters, Trevor.
Basic and clinical
24. Adverse effects and complications
VI.
Katzung, Masters, Trevor.
Basic and clinical
25. Neurologic and psychiatric adverse
effects
Tremor is one of the most common adverse
effects of lithium treatment.
It occurs with therapeutic doses.
Propranolol and atenolol alleviate lithium-
induced tremor.
Katzung, Masters, Trevor.
Basic and clinical
26. Neurologic and psychiatric adverse
effects
Other neurologic abnormalities are:
• choreoathetosis
• motor hyperactivity
• ataxia
• dysarthria
• aphasia
Katzung, Masters, Trevor.
Basic and clinical
27. Neurologic and psychiatric adverse
effects
• Psychiatric disturbances at toxic
concentrations are generally marked by
mental confusion and withdrawal.
• Appearance of any new neurologic or
psychiatric symptoms or signs is a clear
indication for temporarily stopping
treatment with lithium and for close
monitoring of serum levels.
Katzung, Masters, Trevor.
Basic and clinical
28. Decreased thyroid function
• Lithium probably decreases thyroid function in
most patients exposed to the drug: reversible
and nonprogressive effect.
• Few patients develop frank thyroid
enlargement.
• Fewer show symptoms of hypothyroidism.
• Obtaining a serum TSH concentration
every 6-12 months is recommended.
Katzung, Masters, Trevor.
Basic and clinical
29. Nephrogenic diabetes insipidus
• Polydipsia and polyuria are common, but
reversible concomitants of lithium
treatment, occuring at therapeutic serum
concentrations.
• The principal physiologic lesion involved is
loss of responsiveness to antidiuretic
hormone (nDI).
• Lithium-induced nDI is resistant to
vasopressin, but responds to amiloride.
Katzung, Masters, Trevor.
Basic and clinical
30. Other renal adverse effects
Chronic interstitial nephritis
Minimal-change glomerulopathy with
nephrotic syndrome
Decreased glomerular filtration rate
Katzung, Masters, Trevor.
Basic and clinical
31. Warning!
Patients receiving lithium should avoid
dehydration and the associated increased
concentration of lithium in urine.
Periodic tests of renal concentrating ability
should be performed to detect changes.
Katzung, Masters, Trevor.
Basic and clinical
32. Edema
Edema is common adverse
effect of lithium treatment.
It may be related to some effect
of lithium on sodium retention.
Katzung, Masters, Trevor.
Basic and clinical
33. Cardiac adverse effects
• The bradycardia-tachycardia (sick-
sinus) syndrome is a definite
contraindication to the use of lithium
because this ion further depresses
the sinus node.
• T-wave flattening is often observed
on the ECG.
Katzung, Masters, Trevor.
Basic and clinical
35. Use during pregnancy
• Renal clearance of lithium increases during
pregnancy and reverts to lower levels
immediately after delivery.
• A patient whose serum lithium concentration is
in a good therapeutic range during pregnancy
may develop toxic levels after delivery.
• Lithium is transferred to nursing infants through
breast milk, in which it has a concentration
about one third to one half that of serum.
Katzung, Masters, Trevor.
Basic and clinical
36. Use during pregnancy
Lithium toxicity in newborns:
• LETHARGY
• CYANOSIS
• POOR SUCK REFLEX
• POOR MORO REFLEX
• HEPATOMEGALY
Katzung, Masters, Trevor.
Basic and clinical
37. Miscellaneous
• Transient acneiform eruptions: early in lithium
treatment, some of them subside with
temporary discontinuance of treatment and do
not recur with its resumption.
• Folliculitis: less dramatic, more frequently.
• Leukocytosis: always present during lithium
treatment, therapeutic effect in patients with
low leukocyte counts.
Katzung, Masters, Trevor.
Basic and clinical
39. Overdose
• Therapeutic ovedoses are due to accumulation
of lithium resulting from changes in the
patient´s status: diminished serum sodium, use
of diuretics, fluctuating renal function.
• Any value over 2 mEq/L must be considered as
indicating likely toxicity.
• Lithium is a small ion and it is dialyzed readily:
peritoneal dialysis, hemodialysis.
Katzung, Masters, Trevor.
Basic and clinical
40. Literature
• Katzung, Masters, Trevor.
Basic and clinical
pharmacology.
• Lifeinthefastlane.com
Katzung, Masters, Trevor.
Basic and clinical