The main focus of this presentation is to discuss all the drugs used nowadays in clinical practice to treat/ manage bronchial asthma. Along with the mechanism of action, use and adverse effects of anti-asthma drugs, we have given a highlight of the pathophysiology of asthma and how the drugs individually act at individual set point(s) to bring the clinical outcome.
It is a anti- hypertensive drug. It is non-selective beta blocker drug. Hence it is beta blocker drug so it has many side effect.Not only Propranolol but also Timolol,Atenolol are beta blocker drugs.
This PPT covers drug therapy for tuberculosis. It includes classification of antitubercular drugs, chemotherapy for tuberculosis, strategies for addressing resistance and pharmacotherapy of antitubercular drugs
Every pregnancy is special and every pregnant woman must receive special care.The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is being introduced to ensure quality Antenatal to over 3 crore pregnant women in the country.
Under the campaign, a minimum package of antenatal care services would be provided to the beneficiaries on the 9th day of every month at the Pradhan Mantri Surakshit Matritva Clinics to ensure that every pregnant woman receives at least one checkup in the 2nd and 3rd trimester of pregnancy.
This short presentation demonstrates important adverse effects of common anti-psychotic medications in clinical practice and how to effectively manage the adverse events.
It is a anti- hypertensive drug. It is non-selective beta blocker drug. Hence it is beta blocker drug so it has many side effect.Not only Propranolol but also Timolol,Atenolol are beta blocker drugs.
This PPT covers drug therapy for tuberculosis. It includes classification of antitubercular drugs, chemotherapy for tuberculosis, strategies for addressing resistance and pharmacotherapy of antitubercular drugs
Every pregnancy is special and every pregnant woman must receive special care.The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is being introduced to ensure quality Antenatal to over 3 crore pregnant women in the country.
Under the campaign, a minimum package of antenatal care services would be provided to the beneficiaries on the 9th day of every month at the Pradhan Mantri Surakshit Matritva Clinics to ensure that every pregnant woman receives at least one checkup in the 2nd and 3rd trimester of pregnancy.
This short presentation demonstrates important adverse effects of common anti-psychotic medications in clinical practice and how to effectively manage the adverse events.
This is a slideshow made essentially for undergraduate MBBS students to have a working knowledge about CT scan of brain in diagnosing common medical and surgical conditions. It includes detection of major anatomical structures in CT and prompt diagnosis of emergency conditions like head trauma and cerebrovascular accident. Last but not the least, I have also touched the areas where CT scan is not the first mode of diagnosis (like diagnosis of brain tumor and evaluation of headache).
Preterm labor is labor that happens too early, before 37 weeks of pregnancy. Preterm labor can lead to premature birth. This means your baby is born before 37 weeks of pregnancy. Babies born this early can face serious health problems. India has the largest number of premature births compared to any other country.
Presentation made by Drs. Charles Driscoll and Ms. Angela Taylor at the live webinar hosted by AlzPossible on the 29th of May, 2014. See recording at http://www.alzpossible.org/wordpress-3.1.4/wordpress/webinars-2/dementia-with-lewy-bodies/
Hypertensive retinopathy is a very important topic for PG examinations of all types. Especially, the fundal changes are important; Keith and Wegner Grading is also a repeated topic in PG. This slide represents all information in a compressed fashion. Have fun!
Brain CT Anatomy and Basic Interpretation Part IISakher Alkhaderi
Detailed anatomy of the brain ventricles , CSF production and pathway and arterial supply and venous drainage of the brain and corresponding CT cross sectional anatomy and definition of sulcus and gyrus and fissure and the names of the important gyri .
INTRAOPERATIVE BRONCHOSPASM by Dr M.Karthik EmmanuelMKARTHIKEMMANUEL
Funny way to learn
Easy way to understand
Pictorial representation to learn quick
Smart way of creating complicated things into normal and simple and crazy way to learn
This presentation comprises of congenital anomalies of kidney and urinary tract made concise and in depth for PG preparation. It contains all important topics of the regarding subject covered in detail.
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. GDM affects 2-10% of women during pregnancy.It is important to recognize and treat gestational diabetes as soon as possible to minimize the risk of complications to mother and baby.
This is a presentation which contains basics of polytrauma management,ATLS, triage, critical decision making skills, application of Glasgow coma scale and complications of different management strategies, if not applied properly.
Multiple myeloma is the most common primary malignant bone tumor in the world. It is usually seen in elderly individuals of >40 years. In this presentation, all the important aspects of Multiple myeloma have been discussed extensively and in brief..
Ewing's sarcoma is the 3rd most common primary malignant bone tumor in the world. It affects people at first 2 decades. In this presentation, every important aspect of this bone tumor has been described extensively but in brief.
This is a powerpoint slideshow discussing some of the commonest disorders of colon; namely Hirschsprung's disease, Diverticular diseases of colon, ulcerative colitis, pseudomembranous colitis and ischemic colitis.
This is a presentation regarding the most salient features of PCPNDT act, India (formerly known as PNDT act). It is made for undergraduate medical students (MBBS). Hope it will help you in your examinations.
It is one of the most viewed document from Pgblaster India website: Disorders of ocular motility with an emphasis on squint. In this document I have tried to give some important concepts of the different types of squints in simple words.At a glance, it is a much harder and complex topic of ophthalmology but I had made it as simpler as I could. Hope it will help you..
This is a beginner's guide to retinoblastoma. I have briefly covered all the aspects of this most common intraocular tumor of childhood. Hope it will help the undergraduate medical students. Please check out our blog, http://pgblaster.wordpress.com for more presentations and useful stuffs like this one.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
1. DRUGS FOR BRONCHIAL ASTHMA
EDITED BY:
PRITHWIRAJ MAITI, MBBS
HOUSE PHYSICIAN
DEPARTMENT OF INTERNAL MEDICINE, R.G.KAR MEDICAL COLLEGE
AUTHOR: “AN ULTIMATE GUIDE TO COMMUNITY MEDICINE”
AUTHOR: “A PRACTICAL HANDBOOK OF PATHOLOGY SPECIMENS AND SLIDES”
[BOTH PUBLISHED BY JAYPEE BROTHERS MEDICAL PUBLISHERS, INDIA]
2. DRUGS FOR BRONCHIAL ASTHMA
• DEFINITION
• SYMPTOMS
• PREDISPOSING FACTORS
• TYPES
• MECHANISM OF BRONCHIAL ASTHMA
• APPROACHES TO TREATMENT
• CLASSIFICATION OF DRUGS APPLIED
• DRUGS
• CHOICE OF TREATMENT
3. DEFINITION
• Bronchial asthma is characterized by hyper-responsiveness of
tracheobronchial smooth muscle to a variety of stimuli.
• This results in narrowing of air tubes.
• This is often accompanied by increased secretion, mucosal
edema and mucus plugging.
6. TYPES
• There are mainly two types of bronchial asthma:
1. Extrinsic asthma: Episodic, less prone to status asthmaticus.
2. Intrinsic asthma: Perennial, more prone to status asthmaticus.
7. MECHANISM OF ASTHMA
• Due to the predisposing factors, in the site of asthma, there are
recruitment of two types of cells. They are:
1. Mast cells
2. Other inflammatory cells
• These cells secrete a variety of mediators:
1. Stored in granules: Histamines, Proteases, TNF-α
2. From cell membrane: PGs, LTs, PAF
3. Specific proteins: Interleukins, TNF-α
8. • The mediators together causes the following:
1. Constrict bronchial smooth muscle
2. Cause mucosal edema
3. Hyperemia
4. Produce viscid secretion
• All these results in reversible airway obstruction.
9. APPROACHES TO TREATMENT
• Prevention of antigen-antibody reaction
• Neutralization of IgE
• Suppression of inflammation and bronchial hyperactivity
• Prevention of release of mediators
• Antagonism of released mediators
• Blockade of constrictor neurotransmitter
• Sympathomimetics
• Directly acting bronchodilators
12. SYMPATHOMIMETICS
• Mechanism of action:
• Adrenergic drugs
• Work through β2 receptor stimulation
• Increased level of c-AMP in bronchial smooth muscle cells
• Bronchial smooth muscle relaxation
• Conditions where these drugs should not be used:
1. Hypertensives
2. Ischaemic heart diseases
3. Patients being treated with Digitalis
13. SALBUTAMOL
• It is a highly selective β2 agonist.
• It can be administered in two routes:
1. Inhalation route
2. Oral route
• Inhaled salbutamol produces bronchodilation within 5 minutes
and action lasts for 2-4 hours. So it is used to prevent terminate
attacks of asthma.
• Orally taken salbutamol’s bioavailability is 50% due to its
digestion in the gut wall. Its action lasts for 4-6 hours.
14. SALBUTAMOL
• The side effects are:
1. Palpitation
2. Restlessness
3. Throat irritation
4. Ankle edema
DOSAGE:
2-4 mg oral, .25-.50 mg i,m/s.c, 100-200 microgram by inhalation.
15. TERBULATINE
• It is similar to salbutamol in properties and use.
• Dosage: 5 mg oral, .25 mg s.c, 250 microgram inhalation.
Effect of regular use of salbutamol and terbutaline:
1. Regular use of these two drugs may increase bronchial hyper
responsiveness.
2. Regular use also downregulates bronchial β2 receptors.
3. So it is advised to patients that patients requiring regular
medication should be treated with inhaled steroids.
16. OTHER SYMPATHOMIMETIC DRUGS
DRUGS SOURCE/
NATURE
MECHANISM OF
ACTION
SIDE EFFECTS DOSAGE
Bambuterol Bis-carbamate
ester
The drug is slowly
hydrolyzed in
plasma and lungs
by pseudo-
cholinesterase.
Single evening
dose: 10-20 mg.
Salmeterol It is a long acting
selective β2
agonist with slow
onset of action.
Long use may
worse the condition
of asthma.
It is advised that
long acting β2
agonists should be
used with an
inhaled steroid.
Formoterol Another long acting
β2 agonist with
faster onset of
action
It can act for 12
hours after
inhalation.
12-24 microgram
inhalation twice
daily
Ephedrine It has α + β1+ β2
actions.
Causes mild slowly
development of
bronchodilation for
3-5 hours.
Low efficacy
Frequent side
effects
It is not used now.
18. METHYL XANTHINES: DRUGS
• The main compounds in methyl xanthine family are theophylline
and it’s compounds.
• But they are not used as the first line drug in treatment of asthma.
• They are primarily used in the treatment of COPD.
• All these compounds are derived from plant sources as:
1. Caffeine
2. Theophylline
3. Theobromine
19. MECHANISM OF ACTION
• There are three distinct mechanisms of action of methyl xanthine compounds:
• Release of Ca++ from sarcoplasmic reticulum.
• Inhibition of PDE (Phosphodiesterase):So produces intracellular degradation
of ATP and increased production of c-AMP. So following functions occur:
1. Bronchodilation
2. Cardiac stimulation
3. Vasodilation
• Blockade of adenosine receptors: Increased intracellular level of adenosine in
CVS and CNS and smooth muscle cells causing:
1. Bronchodilation
2. Cerebral artery dilation
3. Cardiac pacemaker inhibition
4. Gastric secretion inhibition
21. EFFECT ON CNS:
• Methyl xanthines are primarily
CNS stimulants.
• Caffeine works better than
theophylline.
• The main functions are:
1. Sense of well being
2. Alertness
3. Improve performance
4. Increase motor activity
5. Stimulation of respiratory, vagal
and vasomotor centres.
EFFECTS ON CVS:
1. Dilation of systemic blood vessels. (Theophylline)
2. Constriction of cerebral blood vessels. (Caffeine)
3. Its effect on BP is variable and unpredictable.
4. Directly stimulate the heart.
5. Increases the force of contraction.
6. It increases cardiac output and cardiac work.
7. It has dual role on heart rate:
• It increases heart rate by direct action. Example:
Theophylline.
• At the same time decreases it by vagal stimulation.
Example: Caffeine.
PHARMACOLOGICAL ACTIONS (PART 1)
22. SMOOTH MUSCLES:
1. All smooth muscles are
relaxed. Most prominent
effect is on bronchi.
2. Bronchodilation produced is
slow and sustained.
3. Vital capacity is increased.
4. Biliary spasm is relieved.
* Theophylline is more potent
than caffeine in this action.
KIDNEY:
1. Methyl xanthines are mild
diuretics.
2. They act by inhibiting
reabsorption of Na+ and
water.
3. Additional effects are
increased blood flow and
GFR.
*Theophylline is more potent than
caffeine in this action.
PHARMACOLOGICAL ACTIONS (PART 2)
23. SKELETAL MUSCLE:
1. It is primarily the action of
caffeine.
2. High conc. of caffeine
increases release of Ca++
from sarcoplasmic reticulum,
which increases the
contractile power of skeletal
muscle.
3. It increases neuromuscular
transmission by increasing
Ach release, which increases
muscular work.
STOMACH:
1. Methyl xanthines increase
secretion od HCl and pepsin
in stomach.
2. They are also gastric
irritants.
PHARMACOLOGICAL ACTIONS (PART 3)
24. MAST CELLS AND INFLAMMATORY
CELLS:
1. The main effect is by Theophylline.
2. The main effect is inhibition of
inflammatory responses.
3. Theophylline decreases release of
Histamine and other inflammatory
mediators from the above mentioned
cells.
METABOLISM:
1. The main effect is by caffeine.
2. The effects are:
• Increased BMR.
• Increased plasma FFA level.
PHARMACOLOGICAL ACTIONS (PART 4)
26. PHERMACOKINETICS OF THEOPHYLLINE
• This drug is well absorbed orally.
• It is distributed in all tissues. It also crosses the placenta and secreted
as milk.
• The volume of distribution= .5 litre/ kg
• The plasma protein bound form= 50% and free form= 50%.
• There is extensive demethylation and oxidation of the drug in the liver.
• Only 10% of drug is excreted unchanged in urine.
• Plasma half life= 7-12 hours. In children= 24-36 hours.
• Plasma half life is prolonged with higher dose as the kinetics changes
from 1st order to zero order reaction.
27. USES OF THEOPHYLLINE
1. Bronchial asthma: Because of limited efficacy and safety, its use has
declined. Oral theophylline is used in severe asthma, as 3rd line drug.
2. COPD (Chronic obstructive pulmonary disease): It is highly useful in
preventing COPD.
3. Apnoea in premature infant: Theophylline reduces the frequency and
duration of Apnoea.
28. ADVERSE EFFECTS OF THEOPHYLLINE
1. Theophylline has a narrow margin of safety.
2. Toxicity starts from upper part of therapeutic concentration.
3. Primary effect is on CVS, CNS and GIT.
4. There is highly irritant effect of theophylline such as:
• Gastric pain (with oral administration)
• Rectal inflammation (with suppositories)
• Pain at the site of i.m injection
• Rapid i.v may cause precordial pain, syncope and even sudden death.
29. INTERACTIONS OF THEOPHYLLINE
1. Agents which induce its metabolism decreases its plasma level:
a) Smoking
b) Phenytoin
c) Rifampicin
d) Phenobarbitone.
2. Agents which inhibit its metabolism increases its plasma level:
a) Erythromycin
b) Ciprofloxacin
c) Cimetidine
d) Oral contraceptive
e) Allopurinol
30. INTERACTIONS OF THEOPHYLLINE
3. Theophylline increases the effect of some drugs:
a) Sympathomimetics
b) Oral anticoagulants
c) Digitalis
d) Hypoglycaemics
4. Theophylline decreases the effect of some drugs:
a) Phenytoin
b) Lithium
31. DOSAGE
• Theophylline is less soluble in water. So some soluble complexes and
salts have been prepared for parenteral use.
33. DRUGS
• The main anticholinergic drugs used in bronchial asthma are:
Ipratropium and Tiotropium.
34. MECHANISM OF ACTION
• The drugs produce bronchodilation by blocking cholinergic constrictor tone.
• The drugs act primarily on the large airways.
• Combination of ipratropium with a β2 agonist causes more marked and long
lasting bronchodilation.
35. USES
• Anticholinergic drugs are mainly used in treatment of:
1. Asthmatic bronchitis
2. COPD Patients
3. Psychogenic asthma
36. DOSAGE
• Duolin = Salbutamol + Ipratropium
• Duolin inhaler- (100 + 20) microgram per metered dose.
• Duolin rotacap- (200 + 40) microgram per rotacap.
• Duolin respules- (2.5 mg + 500 microgram) in 2.5 ml solution.
38. LEUKOTRIENE ANTAGONISTS: DRUGS
• There are mainly two leukotriene antagonist drugs. They are:
1. Montelukast
2. Zafirlukast
• Both these two drugs are within the chemical family of Cysteinyl
Leukotrienes antagonists.
39. LEUKOTRIENE ANTAGONISTS: PHARMACOKINETICS
• Both the drugs are well absorbed orally.
• They bound with plasma very highly, so the volume of distribution is
very low.
• They are extensively metabolized by CYP2C9 and CYP3A4
isoenzymes in liver.
• Plasma half life: Montelukast: 3-6 hours.
Zafirlukast: 8-12 hours.
40. LEUKOTRIENE ANTAGONISTS: MECHANISM OF ACTION
• Both the drugs Montelukast and Zafirlukast act similarly.
• They competitively inhibit cysteinyl leukotriene receptors and causes:
1. Bronchodilation
2. Suppression of bronchial inflammation
3. Reduced sputum eosinophil count
• They are used for prophylactic therapy of mild to moderate asthma as
alternatives of inhaled glucocorticoids.
• In severe asthma they may be used to reduce dosage of steroids.
• They are not to be used for terminating episodes of asthmatic attack.
• They are effective in treatment of aspirin induced asthma.
41. LEUKOTRIENE ANTAGONISTS: SIDE EFFECTS
• Montelukast and zafirlukast are very safe drugs.
• They produce very few side effects like headache and rashes.
• Very few cases of Churg-Strauss syndrome (vasculitis with
eosinophilia) has been reported.
45. MAST CELL STABILIZERS: PHARMACOKINETICS
1. Sodium cromoglycate:
• Sodium cromoglycate is not absorbed orally.
• It is absorbed as an aerosol through metered dose inhaler.
• Only a small fraction is absorbed systemically.
• Rest of the portion is rapidly excreted unchanged in urine and bile.
2. Kitotifen:
• It is absorbed orally.
• Bioavailability is 50% due to first pass metabolism.
• It is largely metabolized.
• Plasma half life is 20-22 hours.
46. MAST CELL STABILIZERS: MECHANISM OF ACTION
• These drugs inhibit degranulation of mast cells.
• Release of mediators like Histamine, LT, PAF, IL is inhibited.
• This action may include delayed Cl channel.
• Chemotaxis of inflammatory cells is inhibited.
• Bronchial hyperactivity is reduced.
• Bronchospasm due to various stimuli (allergens, irritants, cold air and
exercise) is prevented.
• It can’t be used to prevent attack of asthma because it does not affect
the constrictor action of histamine.
47. MAST CELL STABILIZERS: USES
• Sodium cromoglycate:
1. Bronchial asthma: It is used as a long term prophylactic in mild to
moderate asthma. Decrease in frequency and severity of attacks and
improvement in lung function is more likely in extrinsic asthma.
Improvement in lung function occurs within 2-4 weeks slowly and
lasts 1-2 weeks after discontinuing.
2. Allergic rhinitis: Sodium cromoglycate is not a nasal decongestant.
But 4 times daily use as a nasal spray can produce symptomatic
improvement in 4-6 weeks.
3. Allergic conjunctivitis: Regular use as eye drops is beneficial in some
chronic uses.
48. MAST CELL STABILIZERS: USES
• Ketotifen:
1. After 6-12 weeks of use, it reduces symptoms in about 50% patients of
bronchial asthma.
2. But lung function improvement is marginal.
3. It also produces symptomatic relief in patients with Atopic dermatitis,
Perennial rhinitis, Conjunctivitis, Urticaria and Food allergy. Thus, it is
essentially indicated in patients with multiple disorders.
49. MAST CELL STABILIZERS: ADVERSE EFFECTS
• Sodium cromoglycate: It is poorly water soluble, so poorly absorbed
and systemic toxicity is minimal. Rare side effects are:
1. Bronchospasm
2. Throat irritation
3. Cough
4. Headache
5. Dizziness
6. Arthralgia
7. Rashes
8. Dysuria
50. MAST CELL STABILIZERS: ADVERSE EFFECTS
• Ketotifen: Generally this drug is well tolerated. Rare side effects are:
1. Sedation
2. Dry mouth
3. Dizziness
4. Nausea
5. Weight gain
52. CORTICOSTEROIDS
• MECHANISM OF ACTION
• SYSTEMIC STEROID THERAPY
• INHALED STEROIDS
• PRECAUTION OF USING CORCICOSTEROIDS
• INDIVIDUAL DISCUSSION ON INHALED STEROIDS
53. CORTICOSTEROIDS: MECHANISM OF ACTION
• Glucocorticoids are not bronchodilators.
• They act by reducing-
1. Bronchial hypersensitivity.
2. Mucosal edema.
3. Inflammatory response to AG-AB reaction.
• Corticosteroids produce more complete and sustained symptomatic
relief than bronchodilators and cromoglycates.
54. CORTICOSTEROIDS: SYSTEMIC STEROID THERAPY
• Systemic steroid therapy is applied in two following cases:
1. Severe chronic asthma: When it is not controlled by bronchodilator and
inhaled steroids or when recurrences or severities occur.
*In these cases start with prednisolone 20-60 mg daily.
*Then reduce the dose after 1-2 weeks of good control.
*Finally try shifting the patient onto an inhaled steroid.
2. Status asthmaticus: When it is not controlled by intensive
bronchodilator therapy.
* Start with a high dose of rapidly acting glucocorticoid therapy.
* Then reduce the dose after 5-7 days of good control.
* Then discontinue suddenly.
55. CORTICOSTEROIDS: INHALED STEROIDS
• The drugs are: 1. Beclomethasone dipropionate
2. Budesonide
3. Fluticasone
4. Ciclesonide
• It has been suggested that inhaled steroids should be the STEP 1
drug for all asthma patients because airway inflammation and
bronchial development starts from the beginning.
• But practically they are introduced only when the disease is not only
episodic and inhaled β2 agonists are required daily.
56. PRECAUTION OF USING CORCICOSTEROIDS
• Inhaled steroids have no role during acute attacks of asthma.
• Their main role is to prevent acute attacks of asthma by suppressing bronchial
inflammation, increase peak expiratory flow rate and reduce need for rescue of inhaled
β2 agonists.
• Peak effect is seen after 4-7 days of starting inhalation and benefit exists for a few
weeks after discontinuation.
• The main danger of using corticosteroids is that: When patients have to be switched
over from oral steroids, they should receive inhaled steroids for additional 1-2
weeks before the oral steroid therapy is discontinued. Otherwise, sudden steroid
discontinuation may manifest:
1. Precipitation of asthma
2. Muscular pain
3. Depression
4. Hypotension
5. Tiredness
57. INDIVIDUAL DISCUSSION ON INHALED STEROIDS
STEROIDS FEATURES USES DOSAGE
BUDESONIDE A nonhalogenated
glucocorticoid with
high topical: systemic
ratio, rapidly
metabolized.
• Asthma
• Allergic rhinitis
• 200-400
microgram BD by
inhalation.
• 200-400
microgram/day by
spray.
FLUTICASONE This newer drug has
high potency and
longer duration.
Asthma 100-250 microgram
BD/day
FLUNISOLIDE Seasonal and
perennial rhinitis.
25 microgram per
nasal spray
CICLESONIDE It is a prodrug that is
cleaved by esterase.
Asthma 80-160 microgram by
inhalation OD.
60. ANTI-IGE –ANTIBODY: USE
• It is used only in severe extrinsic asthma.
• It is very expensive, so use of it is restricted for:
1. Resistant asthma patients.
2. Patients giving positive skin test.
3. Patients with raised IgE level who require frequent hospitalization.
61. ANTI-IGE –ANTIBODY: MECHANISM OF ACTION
• The drug omalizumab is actually a humanized monoclonal antibody.
• It is administered i.m or s.c.
• It neutralizes free IgE in circulation without activating mast cells and
other inflammatory cells.
• So IgE level in plasma is down and so, mast cell-IgE mediated
histamine (inflammatory mediators) release is inhibited.
• So bronchoconstriction occurs.
62. CHOICE OF TREATMENT
1. Mild episodic asthma: Symptoms less than once daily: Inhaled short
acting β2 agonists at onset of each episode.
2. Seasonal asthma: Regular cromoglycate/ low dose inhaled steroid
(200-400 microgram/ day)
3. Mild chronic asthma with occasional exacerbation: Symptoms once
daily: Inhaled low dose inhaled steroid + cromoglycate.
4. Moderate asthma with frequent exacerbation: Occurs>1 daily:
Increased dose of inhaled steroid ( upto 800 microgram/ day) +
Inhaled long-acting β2 agonist.
5. Severe asthma: Continuous symptoms: Regular high dose of inhaled
steroid (2000 microgram/ day) + inhaled long-acting β2 agonist twice
daily.
6. Status asthmaticus:
63. 1. Hydrocortisone hemisuccinate (or any equivalent dose of
glucocorticoid) 100 mg i.v followed by 100-200 mg 4-8 hourly
infusion.
2. Nebulized salbutamol (2.5-5 mg) + Ipratropium bromide (.5mg)
intermittent inhalation driven by O2.
3. High flow humidified oxygen inhalation.
Then if needed,
1. Salbutamol/ Terbutaline .4 mg i.m/ s.c.
2. Inhalation and mechanical ventilation.
3. Treat chest infection with extensive antibiotic therapy.
4. Correct dehydration and acidosis with ( Normal saline + Sodium
bicarbonate) infusion.