Pharmacotherapies for neurodegenerative disordersBrian Piper
This seminar was presented to 2nd year pharmacy students enrolled in a pharmacology & toxicology course and accompanies Goodman & Gilman's (12e) chapter 22.
Introduction to Neuro Degenerative Diseases, Neurodegenerative diseases, Parkinson Disease, Alzhimer’s Disease, Newer Drugs
Presented by
K. THANMAYA DIVYA
Department of Pharmacology
Presentation on recent advances in Parkinsons disease. Tried to cover up new drugs as well as new devices like Duodopa set up. . i have tried to put a light on the established treatment of Parkinson's disease along with its mechanism of actions in circuit loops which will help to understand the topic in depth!
Pharmacotherapies for neurodegenerative disordersBrian Piper
This seminar was presented to 2nd year pharmacy students enrolled in a pharmacology & toxicology course and accompanies Goodman & Gilman's (12e) chapter 22.
Introduction to Neuro Degenerative Diseases, Neurodegenerative diseases, Parkinson Disease, Alzhimer’s Disease, Newer Drugs
Presented by
K. THANMAYA DIVYA
Department of Pharmacology
Presentation on recent advances in Parkinsons disease. Tried to cover up new drugs as well as new devices like Duodopa set up. . i have tried to put a light on the established treatment of Parkinson's disease along with its mechanism of actions in circuit loops which will help to understand the topic in depth!
5-Hydroxytryptamine & it’s Antagonist is a Topic in Pharmacology which will defiantly Help You in pharmacy field All information is related to pharmacology drug acting and it's effect on body. it is collage project given by our department i would like to share with you.
In this slide contains definition, types, causes, inducers and inhibitors, complex drug interactions.
Presented by: SUMASHREE AGGIM (Department of pharmacology).
RIPER, anantapur
This slideshare is about what is autocoid,and differences between harmone and autocoid and had expalined about an example which is an autocoid and also an chemical messenger.and it is also known as happy harmone.
5HT widely distributed in:
GIT enterochromaffin cells (90%)
myenteric plexus where it serves as a prokinetic agent
As a neurotransmitter in CNS
platelets where it diffuses inside from plasma by active transport, and is released at the site of damage after platelet aggregation,
In lungs, bone marrow, pineal gland (as a precursor of melatonin)
5- HT is then stored in 5-HT containing cells such as enterochromaffin cells and neurons as co-transmitter together with various peptide hormones such as somatostatin, vasoactive intestinal peptide and substance P
5-HT is stored within storage vesicles, and its uptake at the vesicular membrane by vesicular monoamine transporter (VMAT-2) is inhibited by reserpine.
Degradation occurs through oxidative deamination by MAO, to 5-hydroxyindole acetaldehyde followed by its oxidation to 5-hydroxyindole acetic acid (5-HIAA)
5- HIAA is excreted in urine
Gaddum and Picarelli (1957) classified 5-HT receptors into musculotropic (D type) and neurotropic (M type) on the basis of their blockade by Dibenzyline (phenoxybenzamine) and Morphine.
5- HT Receptors: there are seven main types (5-HT1, to 5- HT7) of serotonin receptors. Of these, 5-HT1, and 5- HT2, are subdivided further. With a total of 14 (types plus subtypes) receptors.
5-HT Receptors Location: 5-HT, receptors are located mainly in CNS. They function as inhibitory presynaptic receptors (auto receptor) and belong to the family of G-protein coupled receptors linked to adenylate cyclase
5-HT1 : Auto receptors; inhibit serotonergic neural activity in brain.
5-HT1A—present in raphe nuclei and hippocampus; buspirone (antianxiety) may act through these receptors.
5-HT1D/1B—Constricts cranial blood vessels and inhibits release of inflammatory neuropeptides in them; sumatriptan (antimigraine) acts through these receptors.
5-HT2A : Previously D type receptor; most important post junctional receptor mediating direct actions of 5-HT like vascular and visceral smooth muscle contraction, platelet aggregation, neuronal activation in brain; ketanserin blocks these receptors.
5-HT3 : Previously M type receptor; depolarizes neurones by gating cation channels; elicits reflex effects of 5-HT—emesis, gut peristalsis, bradycardia, transient hypotension, apnoea, pain, itch; ondansetron (antiemetic) acts by blocking these receptors.
5-HT4 : Mediate intestinal secretion, augmentation of peristalsis. Renzapride (prokinetic) is a selective 5-HT4 agonist.Central Nervous System : 5-HT is an important neurotransmitter in CNS
5-HT is involved in the regulation of mood, behaviour, sleep, depression, pain perception, sexual activity, thermoregulation
in the hypothalamic control of the release of pituitary hormones.
My presentation on neurotransmitter glutamate. References from Comprehensive textbook of psychiatry 9th edition and Stahl's essential psychopharmacology 4th edition.
Introduction to Physiological and pathological role of serotonin
Autocoids, Classification, synthesis ,Serotonergic receptors, Physiological actions, Pathophysiological role
Presented by
K.Firdous banu
Department of Pharmacology
This presentation done by omkar kapil a student at NIPER-A basically this presentation is regarding to the discussion of novel target and therapies in the case of pancreatitis from understanding this we can easily attack on the site and from inhibition of of that site we will be beneficial in human welfare
5-Hydroxytryptamine & it’s Antagonist is a Topic in Pharmacology which will defiantly Help You in pharmacy field All information is related to pharmacology drug acting and it's effect on body. it is collage project given by our department i would like to share with you.
In this slide contains definition, types, causes, inducers and inhibitors, complex drug interactions.
Presented by: SUMASHREE AGGIM (Department of pharmacology).
RIPER, anantapur
This slideshare is about what is autocoid,and differences between harmone and autocoid and had expalined about an example which is an autocoid and also an chemical messenger.and it is also known as happy harmone.
5HT widely distributed in:
GIT enterochromaffin cells (90%)
myenteric plexus where it serves as a prokinetic agent
As a neurotransmitter in CNS
platelets where it diffuses inside from plasma by active transport, and is released at the site of damage after platelet aggregation,
In lungs, bone marrow, pineal gland (as a precursor of melatonin)
5- HT is then stored in 5-HT containing cells such as enterochromaffin cells and neurons as co-transmitter together with various peptide hormones such as somatostatin, vasoactive intestinal peptide and substance P
5-HT is stored within storage vesicles, and its uptake at the vesicular membrane by vesicular monoamine transporter (VMAT-2) is inhibited by reserpine.
Degradation occurs through oxidative deamination by MAO, to 5-hydroxyindole acetaldehyde followed by its oxidation to 5-hydroxyindole acetic acid (5-HIAA)
5- HIAA is excreted in urine
Gaddum and Picarelli (1957) classified 5-HT receptors into musculotropic (D type) and neurotropic (M type) on the basis of their blockade by Dibenzyline (phenoxybenzamine) and Morphine.
5- HT Receptors: there are seven main types (5-HT1, to 5- HT7) of serotonin receptors. Of these, 5-HT1, and 5- HT2, are subdivided further. With a total of 14 (types plus subtypes) receptors.
5-HT Receptors Location: 5-HT, receptors are located mainly in CNS. They function as inhibitory presynaptic receptors (auto receptor) and belong to the family of G-protein coupled receptors linked to adenylate cyclase
5-HT1 : Auto receptors; inhibit serotonergic neural activity in brain.
5-HT1A—present in raphe nuclei and hippocampus; buspirone (antianxiety) may act through these receptors.
5-HT1D/1B—Constricts cranial blood vessels and inhibits release of inflammatory neuropeptides in them; sumatriptan (antimigraine) acts through these receptors.
5-HT2A : Previously D type receptor; most important post junctional receptor mediating direct actions of 5-HT like vascular and visceral smooth muscle contraction, platelet aggregation, neuronal activation in brain; ketanserin blocks these receptors.
5-HT3 : Previously M type receptor; depolarizes neurones by gating cation channels; elicits reflex effects of 5-HT—emesis, gut peristalsis, bradycardia, transient hypotension, apnoea, pain, itch; ondansetron (antiemetic) acts by blocking these receptors.
5-HT4 : Mediate intestinal secretion, augmentation of peristalsis. Renzapride (prokinetic) is a selective 5-HT4 agonist.Central Nervous System : 5-HT is an important neurotransmitter in CNS
5-HT is involved in the regulation of mood, behaviour, sleep, depression, pain perception, sexual activity, thermoregulation
in the hypothalamic control of the release of pituitary hormones.
My presentation on neurotransmitter glutamate. References from Comprehensive textbook of psychiatry 9th edition and Stahl's essential psychopharmacology 4th edition.
Introduction to Physiological and pathological role of serotonin
Autocoids, Classification, synthesis ,Serotonergic receptors, Physiological actions, Pathophysiological role
Presented by
K.Firdous banu
Department of Pharmacology
This presentation done by omkar kapil a student at NIPER-A basically this presentation is regarding to the discussion of novel target and therapies in the case of pancreatitis from understanding this we can easily attack on the site and from inhibition of of that site we will be beneficial in human welfare
Pharmacogenetics is the study of influences of a gene on therapeutic and adverse effects of drugs.
Pharmacogenetics plays an important role in drug development and drug safety.
Glucagon like peptide-1 (GLP-1) is an incretin secretory molecule. GLP-1 receptor agonists (GLP-1RAs) are widely used in the treatment of type 2 diabetes (T2DM) due to their attributes such as body weight loss, protection of islet β cells, promotion of islet β cell proliferation and minimal side effects. Studies have found that GLP-1R is widely distributed on pancreatic and other tissues and has multiple biological effects, such as reducing neuroinflammation, promoting nerve growth, improving heart function, suppressing appetite, delaying gastric emptying, regulating blood lipid metabolism and reducing fat deposition. Moreover, GLP-1RAs have neuroprotective, anti-infectious, cardiovascular protective, and metabolic regulatory effects, exhibiting good application prospects. Growing attention has been paid to the relationship between GLP-1RAs and tumorigenesis, development and prognosis in patient with T2DM. Here, we reviewed the therapeutic effects and possible mechanisms of action of GLP-1RAs in the nervous, cardiovascular, and endocrine systems and their correlation with metabolism, tumours and other diseases.
Brian Covello: Diabetes Research ProposalBrian Covello
Brian Covello's diabetes research proposal. Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion.
Essential update: FDA approves subcutaneous albiglutide for management of DM2
The FDA has approved once-weekly injectable albiglutide (Tanzeum), a glucagonlike peptide 1 (GLP-1) receptor agonist, along with diet and exercise for the treatment of type 2 diabetes.[1, 2] This agent may be used either as monotherapy or in combination with metformin, glimepiride, pioglitazone, or insulin.
Albiglutide should not be used for the following[1, 2] :
Patients with type 1 diabetes
Patients with diabetic ketoacidosis
First-line therapy in patients who can’t be managed with diet and exercise
Patients who have a personal or family history of medullary thyroid carcinoma (MTC)
Patients who have multiple endocrine neoplasia syndrome type 2
The most common adverse reactions associated with albiglutide were nausea/diarrhea and injection-site reactions.
There will be a boxed warning on albiglutide’s labeling about thyroid C-cell tumors being observed in rodent studies with this class of drugs; it is currently unknown whether albiglutide causes these tumors in humans, including MTC.[1, 2] Moreover, the FDA is also requiring a number of postmarketing studies, including a pediatric trial; an MTC case registry (≥15 y); and a cardiovascular (CV)-outcomes trial in patients with a baseline high risk of CV disease.
Signs and symptoms
Many patients with type 2 diabetes are asymptomatic. Clinical manifestations include the following:
Classic symptoms: Polyuria, polydipsia, polyphagia, and weight loss
Blurred vision
Lower-extremity paresthesias
Yeast infections (eg, balanitis in men)
See Presentation for more detail.
Diagnosis
Diagnostic criteria by the American Diabetes Association (ADA) include the following[3] :
A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher, or
A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during a 75-g oral glucose tolerance test (OGTT), or
A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis
Whether a hemoglobin A1c (HbA1c) level of 6.5% or higher should be a primary diagnostic criterion or an optional criterion remains a point of controversy.
Indications for diabetes screening in asymptomatic adults includes the following[4, 5] :
Sustained blood pressure >135/80 mm Hg
Overweight and 1 or more other risk factors for diabetes (eg, first-degree relative with diabetes, BP >140/90 mm Hg, and HDL < 35 mg/dL and/or triglyceride level >250 mg/dL)
ADA recommends screening at age 45 years in the absence of the above criteria
See Workup for more detail.
George L. Bakris, MD, FASN, FAHA, prepared useful practice aids pertaining to hyperkalemia for this CME activity titled Recent Advances in the Management of Hyperkalemia: The Role of Newer Treatment Strategies to Improve Patient Outcomes. For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2RpQZTi. CME credit will be available until December 12, 2020.
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
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
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
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!
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Drugs acting on ppar
1. Dr Karuna Sree P
Asst. Professor
Dept. Of Pharmacology
Kamineni Institute of Medical Sciences
2. Introduction
PPAR receptors – types
Mechanism of action
Role of PPARS
Clinical significance
Conclusion
3/23/2015 2Dr Karuna Sree P, Dept. of Pharmacology, KIMS
3. Issemann and Green discovered Peroxisome
proliferator activated receptors (PPAR).
The different types of PPAR initially identified in
xenopus frog.
Belongs to nuclear receptor family.
3/23/2015 3Dr Karuna Sree P, Dept. of Pharmacology, KIMS
4. Nuclear Receptor Superfamily
Type 1
Receptors
Eg. GR, MR,
AR,ER,PR
Steroids
Type 2 Receptors
Eg. TR, VDR, RAR,
PPAR
Thyroid hormone
Vitamin D
Retinoic acid
Lipid derivatives
Orphan
receptors
Ligands not
known
Eg. SF-1, HNF4
3/23/2015 4Dr Karuna Sree P, Dept. of Pharmacology, KIMS
5. Binds to response
elements on DNA
Ligands
bind
Co-activators
Co-regulator
proteins
3/23/2015 5Dr Karuna Sree P, Dept. of Pharmacology, KIMS
*Daryl K Granner. Hormone Action & SignalTransduction. In: Robert K. Murray, Daryl K. Granner, PeterA. Mayes,VictorW. Rodwell
editors. Harper’s Illustrated Biochemistry. 26th ed. NewYork McGraw-Hill
6. Plays a central role in the regulation of
Storage and catabolism of dietary fats and
carbohydrates
Adipocyte differentiation
Inflammatory responses
Cancer
Types :
PPAR α
PPAR β / δ
PPAR γ
3/23/2015 6Dr Karuna Sree P, Dept. of Pharmacology, KIMS
7. Ubiquitous but predominant in
α - Liver, kidney, heart, muscle, adipose tissue.
β / δ - Brain, adipose tissue, and skin.
γ - three forms:
γ1 - Heart, muscle, colon, kidney, pancreas &
spleen.
γ 2 - Adipose tissue.
γ 3 - Macrophages, large intestine, white adipose
tissue.
3/23/2015 7Dr Karuna Sree P, Dept. of Pharmacology, KIMS
8. PPAR Partner Ligand
Process
affected
Related
disease process
PPAR α
Active state -
fasting
Retinoic
acid X
receptor
Fatty
acids(FA)
Fibrates Peroxisome
proliferation
Dyslipidaemia
PPAR - β/δ
FA
Proteins
Dyslipidaemia
Obesity
PPAR - γ
Active state -
fed
FA,TZD
Lipid & CHO
metabolism
Insulin
resistance
Obesity,
Metabolic
syndrome
PCOS, NAFLD
Cardiac
steatosis
3/23/2015 8Dr Karuna Sree P, Dept. of Pharmacology, KIMS
11. Cellular organelle
More than 50 enzymes are present in it, among
which catalase and oxidase are important
Role : In the metabolism of
fatty acids and other lipids (cholesterol, bile
acids)
Purines
Aminoacids
Hydrogen peroxide
3/23/2015 11Dr Karuna Sree P, Dept. of Pharmacology, KIMS
*Robert K. Murray, Daryl K. Granner, PeterA. Mayes,VictorW. Rodwell. Harper’s Illustrated Biochemistry. 26th ed. NewYork
McGraw-Hill.
17. Pk Dose uses
Gemfibrozil
T1/2 : 1-2hrs, High efficacy
in Type III & ↓CH, Factor
VII-PL complex & promotes
fibrinolysis
Absorption :
Oral -
Complete
Metabolism:
Glucuronida
tion
Excretion:
urine
600mg
BD before
meals
Type III
Type
IV,V
And as
adjuvant
in Type II
200mg
TDS
Bezafibrate
Dose reduction needed in
elderly / renal insufficiency
↑action of warfarin
200mg
OD with
mealsFenofibrate
T1/2 : 20 hrs
Greater ↓ in CH & ↑ HDL
Most suitable combination
with statins
3/23/2015
Dr Karuna Sree P, Dept. of Pharmacology, KIMS
17
18. Uses : Hypertriglyceridaemias.
Fenofibrate is uricosuric - given in coexisting
hyperuricaemia
ADR : GI, skin rashes, body ache, myalgia, reversible
myopathy.
Eosnophilia, Impotence, Blurred Vision, cholelithiasis with
Gemfibrozil
↑ Aminotransferases & Alk. Phosphatase – Fenofibrate
DI : with statins increase myositis, potentiates affect of
warfarin
3/23/2015 Dr Karuna Sree P, Dept. of Pharmacology, KIMS 18
20. These are insulin-sensitizing drugs
Rosiglitazone
Pioglitazone
TZDs have also effects on TG, FFA, and ketone
body level in several animal models of T2DM*
3/23/2015 20Dr Karuna Sree P, Dept. of Pharmacology, KIMS
*Caring for diabetes.Treatment and prevention : Emerging therapies.
Available at www.caring for diabetes.com.
21. Because of Antiproliferative, Anti-inflammatory,
Immunomodulatory effects
Have potential role
In the treatment of diabetic complications
inflammatory-proliferative diseases in non-
insulin-resistant euglycaemic individuals
Autoimmune
Atopic and inflammatory diseases
sepsis and reperfusion injury.
3/23/2015 21Dr Karuna Sree P, Dept. of Pharmacology, KIMS
22. Rosiglitazone
Pioglitazone
3/23/2015 22Dr Karuna Sree P, Dept. of Pharmacology, KIMS
Activate insulin responsive genes -
regulate carbohydrate & lipid metabolism
Sensitize the peripheral tissues to insulin
↑ Glucose transport
into muscle & adipose
tissue
Inhibit hepatic
gluconeogenesis
Promote
lipogenesis
↓Blood Glucose
Selective agonists of PPAR -
bind to the receptor
23. Pioglitazone has no effect on LDL levels, ↓
triglyceride & ↑ HDL
Rosiglitazone has inconsistent effect on lipid
profile it ↑ HDL & LDL levels
The TZDs lead to a favorable redistribution of
fat from visceral to subcutaneous tissues.
3/23/2015 23Dr Karuna Sree P, Dept. of Pharmacology, KIMS
24. Absorption : Completely absorbed from GIT
Distribution : >95% bound to plasma proteins
Metabolism : Rosiglitazone - CYP2C8
Pioglitazone - CYP2C8 & CYP3A4
Excretion : Rosiglitazone in urine
Pioglitazone in bile
Drug interactions less with rosiglitazone
3/23/2015 24Dr Karuna Sree P, Dept. of Pharmacology, KIMS
25. Pt who benefit most are type II DM with
substantial amount of insulin resistance
Also used in PCOD
Monotherapy – Hypoglycemia rare
Slow acting – takes 1 month for its action
Dose
Pioglitazone: 15 to 45 mg once daily orally
Rosiglitazone: 4 to 8 mg once daily orally
3/23/2015 Dr Karuna Sree P, Dept. of Pharmacology, KIMS 25
26. Weight gain: due to fluid retention & edema
↑ Extracellular fluid volume
Worsening of CHF
↑ Deposition of subcutaneous fat
Mild anemia: due to hemodilution
Hepatotoxicity : rare
Rosiglitazone: ↑risk of fractures especially in
elderly women
3/23/2015 26Dr Karuna Sree P, Dept. of Pharmacology, KIMS
29. Rosiglitazone banned in India* - GSR NO. 910(E) on
12.11.2010, as well in European medicines agency
US FDA# – in Nov 2013 removed the warnings/ restrictions
on Rosiglitazone initially put in 2010 for causing heart
failure.
Pioglitazone : Banned in India & reintroduced- 2011.
^US FDA drug safety communication recommend –
Not to use / use with caution in patients with active / prior
h/o bladder cancer
3/23/2015 29Dr Karuna Sree P, Dept. of Pharmacology, KIMS
*www.cdsco.nic.in/writereaddata/prohibition_rosiglitazone.pdf
#http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsand
Providers/ucm376365.htm
^http://www.fda.gov/Drugs/DrugSafety/ucm266555.htm
30. Selective PPAR Modulators gained importance
to combat the side effect profile of glitazones.
SPPARM have partially activated PPARγ target
genes involved in adipogenesis and more
agonistic activity on target genes influencing
insulin sensitivity.
INT131, MBX-102, antihypertensive drug -
Telmisartan
3/23/2015 Dr Karuna Sree P, Dept. of Pharmacology, KIMS 30
31. These are termed as glitazars, several
dual PPAR-α/γ agonists have been
developed.
3/23/2015 32Dr Karuna Sree P, Dept. of Pharmacology, KIMS
33. Drug Reasons for stopping the
trials
Ragaglitazar, MK-0767,
Naveglitazar
bladder cancer and
hyperplasia in rodent studies
Tesaglitazar renal dysfunction
Muraglitazar – completed
phase III studies
increased risk of death,
myocardial infarction, or
stroke when compared with
patients who received either
pioglitazone or placebo.
Aliglitazar Side effect proflie on kidneys
and heart
3/23/2015 Dr Karuna Sree P, Dept. of Pharmacology, KIMS 34
34. The first Glitazar to be approved in India-2013
Indication : diabetic dyslipidemia or
hypertriglyceridemia in type-2 diabetes not
controlled by statins alone.
Development of saroglitazar
3/23/2015 Dr Karuna Sree P, Dept. of Pharmacology, KIMS 35
35. Chemical structure : aryl alkoxy propionic acid
Strong PPAR-α effect with moderate PPAR-γ
effect
Pk : well absorbed, nearly 96% plasma protein
bound, metabolism by oxidation & excreted in
bile
Dose : 4mg oral tablet OD
Adverse effects : gastritis, asthenia and pyrexia
3/23/2015 Dr Karuna Sree P, Dept. of Pharmacology, KIMS 36
36. PPAR δ regulates fatty acid metabolism in the brain,
skeletal muscle and adipose tissue.
Actions : improves insulin sensitivity and ↑HDL in T2DM,
dyslipidemia & obesity.
Cancer
Atherosclerosis
Enhance oligodendrocyte maturation and
differentiation & regulates myelination of neurons
Drugs under development for treating obesity, cancer,
Infertility
GW501516
GW0742
3/23/2015 37Dr Karuna Sree P, Dept. of Pharmacology, KIMS
38. Agonist actions on PPAR α, β/δ, γ receptors
Being developed for type 2 diabetes and
dyslipidemia
*Bezafibrate found to have pan agonist action
3/23/2015 39Dr Karuna Sree P, Dept. of Pharmacology, KIMS
*Tenenbaum A, Motro M, Fisman EZ. Dual and pan-peroxisome proliferator-activated
receptors (PPAR) co-agonism: the bezafibrate lessons. Cardiovasc Diabetol 2005 ;16:4-14.
41. PPARs are interesting pharmaceutical targets.
They have multiple beneficial effects.
New PPAR drugs showing co agonism or pan-
agonism are expected to show synergistic
effects on various metabolic and inflammatory
diseases.
Long-term trials are needed to evaluate the
efficacy and safety of these wonder agents.
3/23/2015 Dr Karuna Sree P, Dept. of Pharmacology, KIMS 42
42. Guyton AC, Hall JE. Text book of Medical physiology. 11th ed.
Philadelphia (Pa): Saunders; 2006.
Laurence L. Brunton, Keith L. Parker, editors. Textbook of Goodman
and Gillman’s Manual of Pharmacology and therapeutics, 12th ed.
New York:Mac Graw Hill’s Companies;2010.
Kumar A, Hasamnis A. A clinical update on peroxisome proliferator-
activated receptors. Syst Rev Pharm 2010;1:175-81.
V. A. Javiya, J. A. Patel. The role of peroxisome proliferator –
activated receptors in human disease. Indian J Pharmacol
2006;38:243-53
Taygerly JP, McGee LR, Rubenstein SM, Houze JB, Cushing TD, Li
Y. Discovery of INT131: a selective PPARγ modulator that enhances
insulin sensitivity. Bioorg Med Chem 2013;21:979-92.
3/23/2015 Dr Karuna Sree P, Dept. of Pharmacology, KIMS 43
Members of this family are
divided into six structural domains (A–F). Domain A/B is also called AF-1, or the
modulator region, because it is involved in activating transcription. The C domain
consists of the DNA-binding domain (DBD). The D region contains the
hinge, which provides flexibility between the DBD and the ligand-binding domain
(LBD, region E). The amino (N) terminal part of region E contains AF-2, another
domain important for transactivation. The F region is poorly defined.
Peroxisomes are found in many tissues, including liver.
They are rich in oxidases and in catalase
Similar to other nuclear hormone receptores, PPAR acts as a ligand activated transcription factor. Upon binding fatty acids or hypolipidemic drugs, PPARa interacts with RXR and regulates the expression of target genes. These genes are involved in the catabolism of fatty acids. Conversely, PPARg is activated by prostaglandins, leukotrienes and anti-diabetic thiazolidinediones and affects the expression of genes involved in the storage of the fatty acids. PPARb is only weakly activated by fatty acids, prostaglandins and leukotrienes and has no known physiologically relevant ligand. However, data from PPARb null mice suggest PPARb does serve a role in fatty acid metabolism and perhaps in skin proliferation and cancer.
Differs from lysosomes in self replication and no hydrolase
In 1962, Thorp and Waring reported that ethyl chlorophenoxyisobutyrate lowered lipid levels in rats. In 1967, the ester form (clofibrate) was approved for use in the U.S. and became the most widely prescribed hypolipidemic drug.
Ref.3 Caring for diabetes>treatment and prevention> emerging therapies. Emerging therapies.www.caring for diabetes.com.
PEROXISOME PROLIFERATOR ACTIVATED RECEPTOR GAMMA RECEPTORS
Reverse insulin resistance by stimulating GLUT 4 EXPRESSion and translocation and entry of glucose
The first thiazolidinedione, ciglitazone, was synthesized in 1982(1). It was soon thereafter discovered that ciglitazone reduced insulin resistance in obese and diabetic animals. Because of their effects on insulin resistance, thiozolidinediones have been developed as pharmacological agents for the management of type 2 diabetes, although they were initially synthesized as potential lipid-reducing agents. Since their discovery, three thiozolidinediones have been introduced to the market in the U.S. : troglitazone (Rezulin), rosiglitazone (Avandia), and pioglitazone (Actos). In March 2000, troglitazone was withdrawn from the market because of liver toxicity.
Reset glucose fatty acid cycle by reduction in circulating free fatty acids and by transcription of several genes that are imp for otimal insulin sensitivity as well as glucose and fat metabolism
[Note: Whether the adipogenic effects can be separated from those of increased insulin sensitivity is the subject of much research, particularly because of the role of obesity in this disease.] Pioglitazone and rosiglitazone can be used as monotherapy or in combination with other hypoglycemics or with insulin. The dose of insulin required for adequate glucose control in these circumstances may have to be lowered. The glitazones are recommended as a second-line alternative for patients who fail or have contraindications to metformin therapy.
FAILURE OF ORAL CONTRACEPTION CAN OCCUR WITH PIOGLITAZONE THERAPY, KETOCONAZOLE INHIBITS METABOLISM OF PIOGLITAZONE
Duration of effect lasts more than 24 hours
Suppresses & Prevents TNF alfa
Risk Evaluation and Mitigation Strategy (REMS), called the Rosiglitazone REMS program. The Rosiglitazone REMS program restricted the use of rosiglitazone medicines to help ensure that their benefits outweighed the risks.
Therapeutic targets of PPARδ in the metabolic syndrome. Receptor activation improves multiple aspects of the metabolic syndrome through tissue- and cell-specific effects. In skeletal muscle, PPARδ regulates fatty acid transport and oxidation, thermogenesis, and the formation of slow-twitch muscle fibers, resulting in enhanced endurance performance. It likewise activates fatty acid transport and oxidation as well as thermogenesis in adipose tissue, retarding weight gain. PPARδ regulates the availability of BCL-6, an inflammatory suppressor protein released upon ligation of PPARδ, thereby functioning as an “antiinflammatory switch” to control macrophage-elicited inflammation and atherogenesis. In the liver, PPARδ activation suppresses glucose production by upregulating the pentose phosphate shunt. PPARδ activation also improves atherogenic dyslipidemia by raising serum HDL cholesterol levels via unclear mechanisms. Additionally, PPARδ activation in the heart enhances contractile function and may improve cardiomyopathy.
PPAR alpha activation inhibits amyloid peptide stimulated expression of tumor necrosis factor alpha and interleukin-6. PPAR gamma activation inhibits the β-amyloid stimulated expression of inflammatory cytokines. It also induces the clearance of β-amyloid peptide.
Multiple sclerosis Neuroinflammation is the key to the pathophysiology of multiple sclerosis. PPAR gamma activation inhibits the production of nitric oxide, proinflammatory cytokines (tumor necrosis factor α, interleukin-1β, interleukin-6), and chemokine MCP-1 by microglia and astrocytes cells. PPAR γ activators also suppress T-cell proliferation by 40-50%.
Colorectal –delta, other cancers- gamma agonists
