The document discusses calcium regulation and drugs that affect calcium balance such as parathyroid hormone, calcitonin, vitamin D, and bisphosphonates. It describes the actions and uses of these drugs to treat conditions like hypocalcemia, hypercalcemia, osteoporosis, and rickets. The management of hypercalcemia, osteoporosis, and side effects of drugs affecting calcium balance is also reviewed.
This presentation provides knowledge about Calcium, its role in human body, homeostasis, factors affecting calcium absorption, drugs affecting calcium regulation, various endogeneous & exogeneous substances, recent research. This ia an assignment in the subject Advanced Pharmacology -II, 1st year M.Pharm, 2nd semester.
This ppt discusses pharmacological actions, toxic effects and clinical applications of corticosteroids. It also mentions precations to be taken while using steroids
This presentation provides knowledge about Calcium, its role in human body, homeostasis, factors affecting calcium absorption, drugs affecting calcium regulation, various endogeneous & exogeneous substances, recent research. This ia an assignment in the subject Advanced Pharmacology -II, 1st year M.Pharm, 2nd semester.
This ppt discusses pharmacological actions, toxic effects and clinical applications of corticosteroids. It also mentions precations to be taken while using steroids
Prokinetics are the type of drugs which enhances gastrointestinal motility/transit by
increasing the frequency or strength of contractions.
They speed up gastric emptying by enhancing coordinated propulsive motility.
Treat Gastrointestinal symptoms : Abdominal discomfort, Bloating, constipation,
Heart burn, nausea and vomiting. And few gastrointestinal disorders : irritable bowel
Syndrome, gastritis, gastroparesis and functional dyspepsia.
Increases gastric emptying
Relief of gastric stasis
Decreases reflux esophagitis/heart burn
Decreases regurgitation of gastric contents& emesis
ANTIDIARREHAL AGENTS, therapy,ORS, DRUGS used ,
IBD DRUGS, loperamide, probiotics,antisecreatory drugs, antimotility
mechanism of each drugs used in diarrhea
Detailed information of all terms like Thyroid gland, Thyroxine, Triidothyronine, Calcitonine, growth and development , propylthiouracil, Calorigenesis, tadpole to frog, Oligomenorrhoea, snehal chakorkar, pharmacology, Cretinism, Myxoedema coma, Graves disease, Thiocynates, Perchlorate, Nitrates.
Radioactive iodine, I131
Presentation for Medical undergraduates for teaching pharmacology. It deals with Physiology of steroid hormones and their action along with agents which are used therapeutically with their action, adverse effects and therapeutic uses.
Prokinetics are the type of drugs which enhances gastrointestinal motility/transit by
increasing the frequency or strength of contractions.
They speed up gastric emptying by enhancing coordinated propulsive motility.
Treat Gastrointestinal symptoms : Abdominal discomfort, Bloating, constipation,
Heart burn, nausea and vomiting. And few gastrointestinal disorders : irritable bowel
Syndrome, gastritis, gastroparesis and functional dyspepsia.
Increases gastric emptying
Relief of gastric stasis
Decreases reflux esophagitis/heart burn
Decreases regurgitation of gastric contents& emesis
ANTIDIARREHAL AGENTS, therapy,ORS, DRUGS used ,
IBD DRUGS, loperamide, probiotics,antisecreatory drugs, antimotility
mechanism of each drugs used in diarrhea
Detailed information of all terms like Thyroid gland, Thyroxine, Triidothyronine, Calcitonine, growth and development , propylthiouracil, Calorigenesis, tadpole to frog, Oligomenorrhoea, snehal chakorkar, pharmacology, Cretinism, Myxoedema coma, Graves disease, Thiocynates, Perchlorate, Nitrates.
Radioactive iodine, I131
Presentation for Medical undergraduates for teaching pharmacology. It deals with Physiology of steroid hormones and their action along with agents which are used therapeutically with their action, adverse effects and therapeutic uses.
CALCIUM METABOLISM:
VITAMIN D-PARATHYROID-CALCITONIN ROLE
(Rickets,Osteoporosis,Renal Osteodystrophy)
Prevention Dr.Sandeep C Agrawal Agrasen Hospital Gondia India
Metabolic Bone Diseases:phosphorus,magnesium and other minerals ,Calcium and vitamin D rich diets,Sunlight exposure,vitamin D synthesis,Osteoporosis prevention and diet
Immunosupressants and Immunostimulants their pharmacology, uses etc. Basics of immunology, innate immune response, acquired immune response, role of complement in innate immune response. Major histocompatibility complex, antibody structure. classification of immunosupressants, their mechanism of action, uses and adverse effects.
Pharmacology of antimalarial drugs with treatment of malaria. mechanism of action, uses, adverse effects of antimalarial drugs like chloroquine, quinine, artemisinin compounds.
Antileprosy drugs have been described with their pharmacology also this topic covers Multidrug treatment for leprosy including paucibacillary and multibacillary leprosy and lepra reactions
Pharmacology of cephalosporins, monobactums and carbapenums including their mechanism of action, indications, adverse effects.
The various generations of cephalosporins and their spectrum of action
Pharmacology of Penicllins (Beta lactam antibiotics), description of their mechanism of action, mechanism of resistance, classification, indications and adverse effects
Drugs for treatment of Diabetes MellitusNaser Tadvi
These slides contain the brief description of Insulin and the other oral drugs indicated in the treatment of Diabetes Mellitus. Their mechanism of action, effects, uses, Adverse effects etc.
Introduction to Autonomic Nervous systemNaser Tadvi
Lecture intends to give a brief overview of autonomic nervous system.
it includes the anatomical distribution of ANS, Neurohumoral transmission, co-transmission, receptors for ANS and synthesis of the neurotransmitters, Acetylcholine and Catecholamines
Lecture covers the pharmacology of anticholinergic drugs. Includes classification, therapeutic uses, adverse effects of anticholinergics. Atropine has been described as prototype drug.
Lecture includes definition of bioassay, Types of Assay and Bioassay , Indications, principles, advantages of bioassay. Example of a Bioassay with calculations. This lecture will be of help for postgraduate pharmacology students as well as undergraduates
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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.
2. Objectives
• Recall the physiological functions of calcium
• Describe the regulation of plasma calcium
• Describe Pharmacokinetics of calcium
• Enlist the oral and parenteral preparations of
calcium
• Describe therapeutic uses of Calcium salts
• Explain the treatment of Hypercalcemia
• Discuss the Pharmacology of Parathyroid
hormone (MOA, actions, uses)
3. Case study
• A 28-year-old female presented to Medicine
OPD with complains of numbness and tingling
sensation in perioral area since past few days
• She also had muscle cramps in back and lower
extremities
• The casualty doctor elicited Trosseu`s and
Chvostek`s sign and found them to be positive
5. Calcium
• More than 90 % stored in bones & teeth rest
distributed to plasma & all tissues of cells
• Normal levels = 9 to 11mg/dL
Ionized Protein Bound Complexed to
anions
50 % exerts
the biological
action
40 % to
albumin
10 % phosphates,
citrates
6. Physiological
Functions of
calcium
Controls
Excitability of
Nerves and Muscle
Essential for
Muscular
Contraction
Formation of
Bone and teeth
Hormonal and
neurotransmitter
release
Second
messenger in
some hormonal
actions
Blood clotting
Maintains
integrity of cell
membrane and
regulates cell
adhesion
9. Absorption of Calcium
• Facilitated diffusion from entire small intestine
• Carrier mediated active transport under
influence of Vit-D in duodenum
• Low calcium intake,
• Vitamin D and PTH
• Oxalates, phosphates &
phytates
• Glucocorticoids
• Phenytoin
Agents ↑ absorption: Agents ↓ absorption:
Normally only 1/3 of ingested calcium is absorbed
10. Excretion of calcium
• 300 mg of endogenous calcium excreted daily
• 150 mg in urine and 150 mg in feces
• Recommended daily allowance
– 800 mg to 1500 mg
12. Preparations of calcium
S.N Preparation Characteristic
1 Calcium Carbonate (40%
Ca)
Tasteless, non irritating, also
used as antacid
2 Calcium lactate (13 % ) orally well tolerated, non
irritating
3 Calcium Citrate (21%) Tasteless and non irritating
4 Calcium dibasic
phosphate ( 23%)
used as antacid and calcium
supplement
5 Calcium gluconate (9%) non irritating, Sense of warmth
produced on injection
6 Calcium chloride (27%) highly irritant , not for IM use.
13.
14. Uses of Calcium Preparations
1. To prevent or correct calcium deficiency
• Children 1-10 yr :0.8 – 1.2 g /day
• Young adult, pregnant, lactating female: 1.2 -1.5 g
• Men : 1 g
• Women> 50 yr not taking HRT: 1.5 g
15. Uses of Calcium Preparations
2. Tetany (Hypocalcemia) :
• 10 -20 ml of calcium gluconate 90 – 180 mg
injected IV over 10 min.
• Followed by slow IV infusion. Total of 50-
100 ml of 10 % calcium gluconate required
to reverse the muscle spasms over 6 hrs.
• Long term oral treatment to provide. 1- 1.5
g of calcium daily is instituted along with
Vit D
16. Other uses of calcium
3. Osteoporosis:
4. As antacid
5. Placebo
6. Sometimes in treating dermatoses and
urticaria
7. As Phosphate binder in CKD
Uses of Calcium Preparations
18. Treatment of hypercalcemia
• Hydration & dietary calcium restriction < 400 mg
• Sodium chloride:causes renal elimination of
calcium
• Furosemide 20 -40 mg every 6 to 12 hourly
• Bisphosphonates
• Glucocorticoids:
• Calcitonin: 4 IU/kg SC OR IM twice or once daily
• Mithramycin : 25 μg/kg IV over period of 4- 6 Hr
• Inorganic phosphate: phosphosoda 5 ml TDS
20. Parathyroid Hormone (PTH)
• Polypeptide – 84 AA
• Mol. Wt = 9500
• released by chief cells in the parathyroid gland.
• Chief cells contain receptors for Ca2+
• Calcium-sensing receptor (CaSR)
• ↓ in plasma Ca2+ levels mediates the release of
PTH by ↑ cAMP
• PTH rapidly degraded in kidney & liver
21. Actions of PTH
Increases resorption of
calcium from bone
Increases
number of
bone
remodelling
units
Activates the
osteoclastsIncreases
calcium
resorption in
distal tubule
No direct effect
increases calcium
absorption by
enhancing formation of
calcitriol
22. precursor
Mechanism of Action of PTH
PTH receptor : Gprotein
coupled , activation
↑cAMP and ↑ calcium
in target cells
Target cell in bone
↑bone remodelling units
with osteoclast recruitment
. Proliferation &
differentiation of pro-
osteoblast & deposition of
osteoid as well
Secrete acid and
proteolytic enzymes
Resorb bone matrix
23. Cinacalcet
• Activates CaSR in parathyroids and blocks PTH secretion
• Indicated in secondary hyperparathyroidism (due to renal
disease) & in parathyroid tumor
Uses of PTH
• Not used in hypoparathyroidism because Vitamin D can be
used more conveniently
Teriparatide
• Recombinant preparation 1-34 residues of AA, duplicates all
actions of PTH. Approved for severe osteoporosis
26. Objectives
• Describe the pharmacological actions and
therapeutic uses of calcitonin
• Recall the steps in activation of Vitamin D, its
mechanism of action and Physiological actions
• Enlist Vit D preparations and describe their salient
pharmacokinetic features, ADR and Therapeutic uses
• Describe the mechanism of action, salient
pharmacokinetic features, ADR and therapeutic uses
of bisphosphonates
• Explain the management of osteoporosis
27. • A hypocalcemic hormone discovered by
Copp
• 32 AA, 3600 Mol.Wt
• Produced by C-cells
• Physiological effects are opposite to those
of PTH
• Plasma t ½ of calcitonin is 10 minutes but
its action last for several hours
Calcitonin
28. Calcitonin
Bone Kidney
Directly inhibits the
osteoclasts of bone
Decreased bone
resorption
↓↓ plasma calcium
↓↓ Plasma phosphate
Inhibits the reabsorption
of Ca & Po4 in proximal
renal tubule
Actions of calcitonin
29. Preparations of calcitonin
• Porcine (Natural) calcitonin: Antigenic
• Synthetic salmon calcitonin: More potent due
to slower metabolism
• Synthetic human calcitonin:
• 1 IU = 4 μg of std preparation
• Calcitonin is given by SC/IM routes.
• Salmon calcitonin also available as nasal spray
30. Uses of calcitonin
• Hypercalcemic states
• Pagets disease of bone
• Adjuvant second line drug
• Postmenopausal osteoporosis
– Salmon calcitonin is used as nasal spray along
with Vit D supplements 200 IU /day
31. Vitamin D
• Vitamin D1:
– Mixture of antirachitic substances found in
the food- only of historic interest
• Vitamin D2:
– calciferol- present in irradiated food- yeasts,
fungi, bread, milk
• Vitamin D3:
– cholecalciferol- synthesized in skin under
influence of UV rays
32. Activation of Vit D
7 dehydrocholesterol Ergosterol
Cholecalciferol (Vit D3) Calciferol (Vit D2)
(25 OH Vit D3)
Calcitriol (1,25 (OH)2 Vit D3)
25 OH Vit D2
1,25 (OH)2 Vit D2
UV Light
Liver microsomes
Kidney mitochondria
Active forms
33.
34. Actions of Vit D
• ↑absorption of calcium & phosphate from
intestine
• ↑ resorption of calcium & phosphate from bone
• ↑ tubular resorption of calcium and phosphate
in kidneys
• Cell differentiation: particularly of collagen &
skin epithelium
• Important for Cell Mediated Immunity &
coordination of the immune response.
35. Actions of Vit D
Groff & Gropper, 2000
• 1,25-(OH)2 D binds
to vitamin D
receptor (VDR) in
cytoplasm
• ↑ in calbindin
(Ca-binding protein)
• Net effect is ↑
absorption of
calcium &
phosphorus from
intestine
36. Pharmacokinetics
• Well absorbed from intestines in presence of bile salts
• Absorption of D3 little better than D2
• in circulation bound to alpha globulin and stored mainly in
adipose tissues for months
• Hyroxylated in liver to active & inactive compounds
• Half life varies 1- 18 days , 25-OH D3 has longest half life
Unitage
• 1 μg of cholecalciferol = 40 IU of Vit D
• RDA = 400 IU /day
37. Preparations
• Calciferol (Vit D2): Gelatin filled capsules 25000 to 50000 IU
• Cholecalciferol (Vit D3): Oral/IM injection
• 60000 IU capsules & 3-6 lac IU / ml inj
• Calcitriol: oral capsules & solution
• 0.25-1 μg daily or IV on alternate days
• Alfacalcidiol & dihydrotachysterol:
• Effective in renal bone disease & hypoparathyroidism
• Calcipotriol : Vitamin D analog used topically in psoriasis
38.
39. Uses of Vitamin D
1. Prophylaxis and treatment of nutritional Vitamin D
deficiency
– For prevention or treatment of rickets in children and osteomalacia
in adults
– Prophylactic dose is 400 IU/ day, therapeutic dose is 3000 to 4000
IU/day
– Alternatively 3 lac to 6 lac IU can be given orally / IM once in 2 to 6
months
40. Uses of Vit D
2. Metabolic rickets :
3. Senile or post menopausal osteoporosis
4. Hypoparathyroidism : calcitriol or
alphacalcidiol are better
5. Fanconis syndrome:
– ↑es phosphate levels
6. Calcipotriol : Vitamin D analog used topically
in psoriasis
43. Treatment of rickets
1. Food and nursing care
2. Prevention of complications
3. Special therapy
1) Vitamin D therapy
A. General method
Vitamin D 2000-4000IU/day for 2-4 weeks, then change to
preventive dosage (400IU).
B. A single large dose:
For severe case, or Rickets with complication, or those who
can’t bear oral therapy. Vitamin D3 300000-600000IU, im,
preventive dosage can be used after 2-6 months.
44. Prevention
1. pregnant and lactating women should take
adequate amount of vitamin D.
2. Advocate sunbathing
3.Advocate breast feeding, give supplementary food
on time
4. Vitamin D supplementation:
• In prematures, twins & weak babies: 800 IU/day
• For term babies and infants : 400 IU per day,
• For those babies who can’t maintain a daily
supplementation: Vitamin D3 1L-2L IU IM.
5. Calcium supplementation:
46. Biphosphonates
• Analogs of pyrophosphate
• First generation:
• Etidronate
• Second generation:
• Pamidronate
• Alendronate
• Third generation :
• Risedronate
• Zoledronate
47. • Mechanism of action
Protect dissolution
of hydroxyapatite
from bone
Accelerates apoptosis
of osteoclasts
Inhibits release of IL-6
48. • Highly polar so less poorly absorbed through GIT
• Alendronate, ibandronate and risedronate administered
orally
• Pamidronate and Zoledronate administered IV
• Part of absorbed drug is incorporated into bone &
remains for long periods years to months
• The free drug is excreted unchanged in urine
• Pharmacokinetics
49. Biphosphonates uses and adverse effects
• Uses
• Pagets disease of bone: treatment of choice
• prevention & treatment of post-menopausal osteoporosis
• prevent corticosteroid induced osteoporosis
• Hypercalcemia of malignancy: Zolendronate
• Control hypercalcemia of hyperparathyroidism
• To relieve pain of lytic bone lesions
• Nausea, vomiting diarrhoea, esophagitis, peptic ulcer,
fever, myalgia, hypocalcemia, headache & skin rashes
• OSTEONECROSIS , renal impairment
• Adverse effects
50.
51. Pro’s and Con’s of Available Osteoporosis Therapies
Agent Pro’s Con’s
Calcium/Vit D Cheap, accessible Partial efficacy
HRT Effective breast ca, DVT, MI, CVA
Raloxifene vert Fx, breast ca Less effect on BMD
Bisphosphonates vert and nonvert Fx GI intolerance
Strontium Bulky, daily dosing ? Mechanism
Teriparatide Effective Expensive, daily injections