This document discusses drugs used to treat ischemic heart disease. It begins by classifying anti-anginal drugs into nitrates, beta blockers, calcium channel blockers, and potassium channel openers. It then provides details on the pharmacology of nitrates, including their mechanism of action, effects, pharmacokinetics, uses, and adverse effects like tolerance and dependence. Beta blockers are described as improving blood supply and being more effective for exercise or emotion-related angina. The document concludes by noting nitrates donate nitric oxide to cause vasodilation, beta blockers have a better prognosis for classical angina, and nicorandil benefits ischemic heart disease through its dual mechanism of action.
Cardiovascular pharmacology
Cardiovascular (=Circulatory) system – heart and blood vessels
Arteries – transport blood to tissues
Capillaries – sites of exchange, fluid O2, CO2, nutrients etc.
Venules – collect blood from capillaries
Veins – transport blood back to heart
Blood moves within vessels – higher pressure to lower pressure
Resistance to flow depends on vessel diameter, length and viscosity of blood
Cardiovascular pharmacology
Cardiovascular (=Circulatory) system – heart and blood vessels
Arteries – transport blood to tissues
Capillaries – sites of exchange, fluid O2, CO2, nutrients etc.
Venules – collect blood from capillaries
Veins – transport blood back to heart
Blood moves within vessels – higher pressure to lower pressure
Resistance to flow depends on vessel diameter, length and viscosity of blood
This presentation deals with the use of various drugs in the treatment of heart failure such as Digoxin, ace inhibitors, beta bloockers, calcium channel blockers
This presentation deals with the use of various drugs in the treatment of heart failure such as Digoxin, ace inhibitors, beta bloockers, calcium channel blockers
This presentation was used as lecture for BNS 1st year students. For further details on the topic please refer to other presentations of the same topic uploaded by me (intended for MBBS students)
PH1.28 Describe the mechanisms of action, types, doses, side effects, indicat...Dr Pankaj Kumar Gupta
PH1.28 Describe the mechanisms of action, types, doses, side effects, indications and contraindications of the drugs used in ischemic heart disease (stable, unstable angina and myocardial infarction), peripheral vascular disease
Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesn't get as much blood as it needs. This usually happens because one or more of the heart's arteries is narrowed or blocked, also called ischemia.
An interesting ppt on antianginal drugs and drug therapy of myocardial infarction with illustrations for better understanding of concepts and grasping facts...
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
- 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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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.
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!
1. Drugs Used In Ischaemic
Heart Disease
Dr. Pravin Prasad
M.B.B.S, MD Clinical Pharmacology
Asst Prof, Maharajgunj Medical Campus
7 April, 2020 (25 Chatira 2076), Tuesday
2. By the end of the class, MBBS II
year students will be able to:
Classify anti-anginal drugs
Describe the pharmacology of nitrates and their
role in treatment of Ischaemic Heart Disease (IHD)
Explain the pharmacological basis of beta blockers
in IHD
Explain the role of potassium channel blockers in
IHD
3. Lets revise some concepts
What is your understanding about:
? Types of blood vessels of heart
? Preload
? Afterload
? Factors affecting Cardiac O2 consumption
? Smooth muscle contraction
? Ischaemic Heart Disease
• What are included in it?
9. Nitrates: Mechanism of Action
Rapidly denitrated to reactive free radical nitric
oxide (NO)
Activates guanylyl cyclase
Increased cGMP levels
Inhibits phosphorylation (activation) of MLCK
interaction between myosin and actin
prevented relaxation (vasodilatation)
Reduced Ca2+ entry inside cells
10. Nitrates: Effects
Preload reduction (venodilatation):
End diastolic size and pressure reduced
Decreased cardiac work
Sub endocardial crunch abolished
Laplace law:
T = P x R
Relief in classical angina
T= Wall tension
P= Intraventricular Pressure
R= Intraventricular Radius
12. Nitrates: Effects
Afterload reduction (arteriolar dilatation):
Large doses/ significant fall in mean BP
Reflex sympathetic stimulation
Tachycardia, increased cardiac work, angina
precipitated
• Fainting and cold sweat (cerebral ischemia)
• Rx: lying down and raising the foot end
13. Nitrates: Effects
Redistribution of coronary flow:
Dilates conducting vessels (larger coronary
arteries)
Ischaemic area resistance vessels (smaller
arterioles) already dilated
Increased blood flow to ischaemic area
Relief in variant angina
14. Nitrates: Effects
Heart and peripheral blood flow:
No direct effect on heart
Dilate cutaneous vessels: Flushing
Dilate meningeal vessels: Headache
Splanchnic and renal blood flow:
Shifting of blood from lungs to systemic
circulation: decongestion of lungs
16. Nitrates: Pharmacokinetics
Absorption:
Lipid soluble: well absorbed from buccal
mucosa, intestines and skin
Oral administration: extensive and variable
first pass metabolism in liver
• Not seen with Isosorbide mononitrate
(IMN))
17. Nitrates: Pharmacokinetics
Metabolism:
Rapidly denitrated (glutathione reductase,
mitochondrial aldehyde dehydrogenase)
Partly denitrated metabolites: less active, longer t½
Duration of action depends on the site of
administration:
• Sub-lingual GTN, IDN- short acting
• Oral GTN, IDN- long acting
18. Nitrates: Adverse effects
Due to Vasodilation:
Fullness in head, throbbing headache
Flushing, weakness, sweating, palpitation,
dizziness, fainting
Methemoglobinemia
Significant in severe anaemia
Tolerance
Dependence
Rashes: pentaerythritol tetranitrate
19. Nitrates: Tolerance
Dose/Duration dependent; weans off rapidly
Significant: continuous intra-venous infusion, oral &
transdermal administration
Cross tolerance seen
Possible mechanism:
Depleted SH radicals
Compensatory mechanism, oxidative stress
Rx: Provide nitrate free interval everyday
20. Nitrates: Dependence
Prolonged exposure sudden withdrawal
spasm of coronary and peripheral blood vessels
Lowering of angina threshold seen
Can lead to MI, sudden deaths
Rx:
Gradual withdrawal
Use another class of drug
21. Nitrates: GTN
Volatile liquid
Should be stored in a tightly closed glass container
Sublingual tablet/spray:
To terminate attack
Crush the tablet under the teeth spread over
buccal mucosa
Acts within 1-2 mins
Anginal pain relieved spit or swallow the
remaining tablet
22. Nitrates: GTN
Sustained release capsules
For chronic prophylaxis
Cutaneous application:
Ointment: effects in 4-6 hrs
Transdermal patch:
• Effects seen in 60 mins
• Tolerance, Dependence seen
Transmucosal dosage (Gum):
• Acts in 5 mins, for 4-6 hrs
23. Nitrates: GTN
Intravenous infusion
Rapid, steady, titratable plasma concentration
Begin with 5mcg/min, titrate as required
Unstable angina, coronary vasospasm, LVF with
MI, hypertension during cardiac surgery
24. Nitrates: Isosorbides
Dinitrate:
Solid form
Available for oral as well as sub lingual
administration
• Variable and high first pass metabolism on
oral administration
• t½ 40 mins; sustained release formulation
effective for 6-10 hrs
Last dose before 6 pm
28. Nitrates: Uses
Acute Coronary Syndrome
GTN, sublingually, 1 tablet, repeat in 5 mins if not
improved up to 3 tablets
• Start i.v. infusion of GTN
Other drugs/modalities:
• Antiplatelet drugs
• Beta blockers
• CCBs
• Revascularization (pharmacological or surgical)
29. Nitrates: Uses
Myocardial Infarction:
GTN, i.v. infusion, titrated according to response
Avoid hypotension and tachycardia
DO NOT ADMINISTER IF:
• Systolic BP < 90 mmHg
• HR <50 or >100 bpm
• RV infarction suspected
• Patient has taken sildenafil in the past 24 hrs
31. Beta Blockers
Improves blood supply by:
Decreased heart rate, inotropic state and mean
BP
• Reduced cardiac work and O2 consumption
• Increased diastolic period
Cardio-selective agents preferred
Atenolol, Acebutolol, Bisoprolol, Metoprolol,
Nebivolol, Carvedilol
32. Beta Blockers
More effective in exercise, emotion related angina
(classical angina)
High dose may precipitate angina
To be taken on a regular schedule
Dose has to be individualised
Do not discontinue abruptly
• May precipitate angina, MI
Long term therapy: reduced cardiac deaths in IHD
Use cautiously in variant angina
33. Beta Blockers
Acute Coronary Syndrome
Routinely used
• If coronary vasospasm- After administering
nitrates +/- CCBs
Benefits by:
• Reducing O2 demand
• Reducing risk of impending MI/ sudden
cardiac death
34. Potassium Channel Openers
Minoxidil, Diazoxide
Marked compensatory reflexes activated
Diazoxide: reduced insulin secretion
Nicorandil, Pinacidil, Cromakalim
Beneficial for both classical and vasospastic
angina
35. Potassium Channel Openers
Mechanism of action:
Opens K+
ATP channels (smooth muscles)
• Hyperpolarization of cells and relaxation of
vessels
Also acts as NO donor
• cGMP mediated activity
Decreased preload, afterload and increased
coronary flow
39. Conclusion
Nitrates acts by donating nitric oxide and
increasing cGMP
Always be alert for tolerance and dependence on
nitrates
Beta blockers are has better prognosis in classical
angina
Not suitable for variant angina
Nicorandil benefits by dual mechanism in IHD
Blood vessels of heart: larger conducting vessels, smaller arterioles (resistance vessels)
Preload: degree to which myocardium is stretched before it contracts (mainly by end diastolic volume)
Afterload: resistance against which the blood is expelled (mainly by tpr)
Factors affecting cardiac o2 consumption: cardiac work (intramyocardial tension, contractile state of myocardium, heart rate)
IHD: stable angina, variant angina, unstable angina, MI
Systolic BP- mainly by tpr… nitrates decreases tpr
Diastolic BP- effect of nitrate blunted by reflex sympathetic activity
Risk of total blockade of beta effects (beta-2 mediated vasodilatation) and unopposed alpha action if non-selective beta blockers are used.
Only antianginal drug that prolongs the life expectancy of CAD patients
Carvedilol and nebivolol: vasoldilator
High dose: disturbs synergy of ventricular muscle fibres contraction dilatation, increased end disatolic volume; increased ejection time (slow conduction) decreased diastolic period (the period in which o2 is supplied to the heart)
Opening of ATP sensitive K channels vasodilatation (arteriolar)
NO donor venodilatation
Hyperpolarization closing of Na/Ca exchanger, decreased intracellular Ca, decreased myosin and actin interaction.
Brief period of ischaemia and reperfusion exert a cardioprotective effect on subsequent total vascular occlusion, involves opening of mito.KATP channels