PH1.28 Describe the mechanisms of action, types, doses, side effects, indicat...Dr Pankaj Kumar Gupta
PH1.28 Describe the mechanisms of action, types, doses, side effects, indications and contraindications of the drugs used in ischemic heart disease (stable, unstable angina and myocardial infarction), peripheral vascular disease
PH1.28 Describe the mechanisms of action, types, doses, side effects, indicat...Dr Pankaj Kumar Gupta
PH1.28 Describe the mechanisms of action, types, doses, side effects, indications and contraindications of the drugs used in ischemic heart disease (stable, unstable angina and myocardial infarction), peripheral vascular disease
principle action of drugs,types of angina classification of drugs ,nitrates,calcium channel blockers pharmacological actions ,combination therapy and its sid effects
Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesn't get as much blood as it needs. This usually happens because one or more of the heart's arteries is narrowed or blocked, also called ischemia.
principle action of drugs,types of angina classification of drugs ,nitrates,calcium channel blockers pharmacological actions ,combination therapy and its sid effects
Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesn't get as much blood as it needs. This usually happens because one or more of the heart's arteries is narrowed or blocked, also called ischemia.
General Pharmacology Lecture Slides on Essential Drugs and Rational use of Medicines by Sanjaya Mani Dixit Assistant Professor of Pharmacology at Kathmandu Medical College
Dental Pharmacology Lecture Slides on Sialogogues and Antisialogogues by Sanjaya Mani Dixit Assistant Professor of Pharmacology at Kathmandu Medical College
Pharmacology Lecture Slides on Autonomic Nervous System Introduction by Sanjaya Mani Dixit Assistant Professor of Pharmacology at Kathmandu Medical College
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).
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
3. Angina pectoris
• Angina pectoris, the primary symptom of ischemic
heart disease, is caused by transient episodes of
myocardial ischemia that are due to an imbalance in the
myocardial oxygen supply-demand relationship.
• Sudden, severe, pressing chest pain starting sub-sternal
that often radiates to left arm.
• Strangling or pressure-like pain caused by cardiac
ischemia
• Due to imbalance between myocardium oxygen
requirement and oxygen supply.
Risk factors:
Age, sex, obesity, smoking, diabetes
4. Classification of angina
1. Exertional/Atherosclerotic angina (90%)
Stable, Classic,
Due to obstruction of coronaries by atheroma.
2. Variant, Vasospastic angina, Prinzmetal angina
Occurs at rest, sleep. Due to Spasm of coronary artery.
3- Unstable angina
Due to spasm and partial obstruction of coronaries.
Immediate precursor of myocardial infarction (MI)
5. DETERMINANTS OF CARDIAC O2 NEED
PRELOAD--Diastolic filling pressure
AFTERLOAD --Determined by arterial blood pressure and large artery stiffness
HEART RATE--Contributes to time-integrated fiber tension
MYOCARDIAL FIBER TENSION--A major determinant
(the higher the tension, the higher the O2 requirement)
CARDIAC CONTRACTILITY--Force of cardiac contraction
6. Pharmacological modification of the major determinants of myocardial O2 supply.
• This figure shows the primary hemodynamic sites of action of
pharmacological agents that can reduce O2 demand (left side) or enhance
O2 supply (right side). Some classes of agents have multiple effects.
• Stents, angioplasty, and coronary bypass surgery are mechanical
interventions that increase O2 supply.
• Both pharmacotherapy and mechanotherapy attempt to restore a dynamic
balance between O2 demand and O2 supply.
7. THERAPEUTIC STRATEGIES
Reducing oxygen demands
Reducing heart rate and contractility
Dilating systemic arteries and veins ( wall tension
by lowering heart loads)
Increasing oxygen supply
Dilating coronary arteries ( coronary blood flow)
Promoting regional distribution ( in ischemic
regions)
Others:
Anti- platelet coagulation and thrombus formation
8.
9. Drug treatment of angina
Anti-anginal drugs are those that prevent, abort, or
terminate attacks of angina pectoris.
1- Acute attack
Short acting nitrates or nitrites
2- Prophylactic therapy
Long –acting nitrates
Calcium channel blockers
β- blockers
10. Drug treatment of angina
THERAPEUTIC STRATEGIES
• Nitrates, calcium blockers and beta-blockers
all reduce the O2 requirement in
atherosclerotic angina
• Nitrates and calcium blockers (but not beta-
blockers) can increase O2 delivery by
reducing vasospasm (only in vasospastic
angina)
12. NITROGLYCERINE (NTG)
• Most important of the nitrates
• Acts within 1-2 mins
• Available forms
• Sublingual
• Transdermal
• Sprays
• Injectable
• First-pass effect is 90%
13. Mechanism of Axn
• Nitroglycerine NO
• Guanylyl cyclase and NO
activates increase
cGMP
• cGMP then
dephosphorylates
myosin light chain
(Myosin-LC-po4 ) to
myosin- LC
• End point muscle
relaxation.
14. Mechanism of Action
Nitrates decrease myocardial oxygen demand:
1. The primary effect is a reduction in venous
tone which results in venous pooling
decreasing venous return (decreased
preload).
2. Arteriolar tone is less effectively reduced
resulting in a decrease in PVR (decreased
afterload ) and decreased blood pressure.
3. No. 1 & 2 decrease myocardial wall stress
reducing O2 demand.
4. Dilation of coronary vessels exerts a minor
effect on increasing O2 supply.
16. S/Es
Most common toxic effects are responses evoked by vasodilation
• Tachycardia
• Orthostatic hypotension (direct extension of venodilator
effect)
• Throbbing headache from meningeal artery vasodilatation
• Flushing, weakness, sweating
• Methemoglobinemia at high blood concentration
Withdrawal symptoms may occur (an indication of tolerance)
when nitrate agents are tapered or discontinued, this may
precipitate anginal attacks.
17. Tolerance
Tolerance
Attenuation of haemodynamic & anti-
ischaemic effect of nitrates occurs if nitrates
are continuously present in the body. This
tolerance weans off rapidly (within hours)
when the body is free of the drug.
18. β-Blockers
• The Beta1 receptor antagonism affords heart the
necessary conditions for the treatment of angina.
• β-Blockers decrease O2 demands of the myocardium by
lowering the heart rate and contractility (decrease CO)
particularly the increased demand associated with
exercise.
• They also reduce PVR by direct vasodilation of both
arterial & venous vessels reducing both pre- and after
load. However, preload may increase due to decreased
inotropicity.
19. β-Blockers
• β1 antagonists reduce the frequency and severity of
anginal episodes particularly when used in combination
with nitrates. β-Blockers in combination with nitrtates
can be quite effective.
• β1 antagonists have been shown to improve survival in
post MI patients and decrease the risk of subsequent
cardiac events & complications.
• Contraindications
Asthma & COPD
Diabetes, bradycardia, PVD
20. Reasons for Using Nitrates and Beta Blockers in
Combination in Angina
• Beta Blockers prevent reflex tachycardia and contractility
produced by nitrate-induced hypotension.
• Nitrates prevent any coronary vasospasm produced by Beta
Blockers.
• Nitrates prevent increases in left ventricular filling pressure
or preload resulting from the negative inotropic effects
produced by Beta Blockers.
• Nitrates and Beta Blockers both reduce myocardial oxygen
consumption by different mechanisms.
• Nitrates & Beta Blockers both increase sub-endocardial
blood flow by different mechanisms.
21. Ca+2 Channel Blockers
Ca+2 channel blockers protect tissue by inhibiting the entrance of Ca+2 into
cardiac and smooth muscle cells of the coronary and systemic arterial beds.
All Ca+2 channel blockers produce some vasodilation (↓ PVR) and are negative
inotropes.
Some agents also slow cardiac conduction particularly through the AV node thus
serving to control cardiac rhythm.
Some agents have more effect on cardiac muscle than others but all serve to
lower blood pressure.
CHF patients may suffer exacerbation of their failure as these are negative
inotropes.
They are useful in Prinzmetal angina in conjunction with nitrates.
22.
23.
24. Ca+2 Channel Blockers
Nifedipine:
It works mainly on the arteriolar vasculature
decreasing afterload, it has minimal effect of
conduction or heart rate.
It causes flushing, headache, hypotension and
peripheral edema (vasodilation related effects). It
also has some slowing effect on the GI
musculature resulting in constipation.
A reflex tachycardia associated with the
vasodilation may elicit myocardial ischemia in
weak patients, as such it is generally avoided in
non-hypertensive coronary artery disease.
25. Ca+2 Channel Blockers
Verapamil:
The agents has its main effect on cardiac conduction
decreasing HR and O2 demand.
It also has much more -ve inotropic effect than other
Ca+2 channel blockers. It is a weak vasodilator.
Because of its focused myocardial effects it is not used
as an antianginal unless there is a tachyarrhythmia.
It interferes with digoxin levels causing elevated plasma
levels; caution and monitoring of drug levels are
necessary with concomitant use.
26. Diltiazem:
This agent function similarly to Verapamil
however it is more effective against Prinzmetal
angina.
It has less effect on HR.
Ca+2 Channel Blockers
27. Other treatment methods
Myocardial revascularization corrects coronary
obstruction either by-
• Coronary artery bypass grafting
• Coronary angioplasty and stenting