This session was presented at the 2012 American Association of Museum’s annual meeting by Nina Simon (Santa Cruz Museum of Art & History), Ellen Rosenthal (Conner Prairie), and Eric Siegel (New York Hall of Science). These short presentations were followed by an extensive dialogue about museums, financial models, and budgeting.
This session was presented at the 2012 American Association of Museum’s annual meeting by Nina Simon (Santa Cruz Museum of Art & History), Ellen Rosenthal (Conner Prairie), and Eric Siegel (New York Hall of Science). These short presentations were followed by an extensive dialogue about museums, financial models, and budgeting.
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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.
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
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
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
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References: 1.8akns Gl. Fonseca V. Kalholi RE, GL ,lor loo Gfl'I'I~II~veslll;l ors. Mel<UJooliC errc<:ls 01
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randDmli:ed to receive 20, 40, or 80 mg 00 of COREG OR or placebo for 6 weeks. Mean sitting SBP and DBP al baseline were 150 mmHg and
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References: 1, Data on fite (#81), (#82), and (#77), GlaxoSl1lllhKI·ne. 2, Prescribing rquot;lormalion for
COREG CR. GlaxoS rtIIKIJOO. j, Weber MA, Sica DA. Tarka EA, Iyergar M, Fleck R. Bakris til Controlled·
re:p.asp. f.arvedilol ill he tr tmenl of esse'llial h 'petleflSilln Am J CardIa!. 2006,98(snppl):32 -38l 4. Wp.bec
MA. Bakris Gl. Taf1<a EA, 'Iyengar M, FI'eck R, Sica lJ Efficacy Of a once· dally [armulatloll of carverlilol lor the
treatment of hypel1ension J Clln Hypertens. 2006;8840.849
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Endocr Pracl. 2004;10:353-361.)
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hypenension Endocr Pract. 2006:12:193-222. 2. Egan BM, Basiie J. Gillilan RJ. Cohen jD Cardioprotecllofl'l e I I beta blocker th fO,DY J elm Hyper!lHIs 2005;7 09-416
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by 23% (95°/0 C ,2 % '040 0
pa quot;e /or,2
Post-MI LV
All-cause mortality was 15% in
Fatal or Nonfatal Reinfarction U the placebo group and 12% in the
COREG group1
% Added cardioprotection on top
II>
of current standard therapies
in Post-MI LVDt
PATIENT TYPE STARTING DOSE
POST-MI LVD
Please see Indications Statements and Important Safety Information on pages 10 and 11.
'Carvedtlol Post-Infarct Survival Control in LV Dysfunction (CAPRICORN) was a double-blind study comparing COREG and placebo in 1959 plUl nls with a recent
MI (within 21 days) and left ventricular ejection fraction (LVEF) .-;40%, with (47%) or without (53%) symptoms of HF. Patients given COREG rec.1 d 6.25 mg BID,
titrated as tolerated to 25 I11g BID. Entry cnteria inclUded a systolic BP >90 mmHg. a sitting heart rate >60 beats/minute. and no contraindlcations 0 Il-blocker use.
, Support for the use of COREG CR for the treatment of mild-to-severe HF and Post-MI LVD is based on the equivalence of pharmacok,netlc and pharmacodynamic
UJ,-blockadej parameters between COREG CR and COREG.
'ACE inhibitors or angiotensin II receptor blockers (97%). aspirin (85%). dluret1cs (34%), lipid-lowering agents (23%). and anticoagulants (20%); 47% were
revascularized.
'Starling dose: 20 m9 00. Uptitrate to 40 m9 00 after 3-10 days as tolerated The maximum/target dose is 80 mg 00. If clinically indicated. start at 10 m9 00
and/or uptitrate more slowly. Patients should be malntalOed on lower doses If higher doses are not tolerated. No dosing alteration needed when slarted after IV
or oral iI-blocker MI treatment.
8
9. ...Across the
cardiovascular continuum
ortality in sy p oma'c HF
quot;: COR G reduc,ed
------
•
17% 19% 67%
RISK REDUCTION RISK REDUCTION RISK REDUCTION
o qql
in e COREG group 0
~G n ttl.
34% In t . CO group 14S'~
17. t 8 melopr I tar rme roup 2.5 In m Jopr I
...0% It the. .e1oprc I Irtml quot; Ollp u 18
95 95 u Ct, gc,;, to 32.' CI, 38 ~ lJ H~,fl
9quot;'
p= 11006
:::.0
Extrapolation from the survival curves suggested that COREG
extended median survival by 1.4 years 4
20% cardiovascular death risk reduction (29% in the COREG group,
35% in the metoprolol tartrate group; 95% CI, 10% to 30%; P=0.0004)5
In a separate, crossover study of patients with HF or Post-MI LVD receiving
COREG CR, the most common adverse events were dizziness (3%) and
headache (2%)~3
Carvedilol Metoprolol European Trial (COMET) was a dou 'ind,
~ bllllZed, roup loal comparing COREG with metoprolol tartr;;lte
In 3029 pallents with chronic HF (NYHA Class II-IV) followed for
'PATIENT TYPE STARTING DOSE
approxim 5 years.
COMET compared carvedilol (target dose: 25 m9 BID) to metoprolol tartrate
H ART FAILURE'
(targel dose: 50 Ing BID). It is not known whether this formulation of
metoprolol at any dose or this low dose of metoprololln any formulalton has
any effect on survival or hospitalization In patients wllll HF. Metoprolol tartrate
is not Indicated in the Uniled Stales for HF. COMET did not compare
carvedilol to metoprolol succlnale (Toprol-XL-). The efficacy of carvedildl
versus metoprolol succinate in HF has not been established In a head-to
ilead outcomes study. The target dose of metoprolol succinate in HF IS 200 ~ 00.quot; Thus. thiS tnill extends the time over which carvediloJ manilests benafi g SI)
'n HF, but It IS not evidenoe that carvedilollmproves outcrnne CtL'et' the formlJlatj~ of metoprolol ( oprol-XL ) with benefits in HF.
·Nonrandomlz.ed, crossover study of 174 patients with mild-to-!ilevere HF or aSYlllptolquot;latlc Post-MI LV lilat compared tho pllarrT1flLquot;Oknnic profil~ 01 COREG and
CORt::G CR. Patients received COREG (3.125, 6.25,12.5, or 25 mg twice dally) for 2 weeks and then the eqUivalent dose of COREG CR (10. 20, 40. or 00 mg CIlcedaily)
for 2 weeks.
'Start ng dose: 10 mg 00 for 2 weeks. Uptltration to 20, 40, and 80 mg 00 should occur over successive intervals of at least 2 weeks, based on olera ,I.
The maximum/target dose is 80 mg 00. Patients should be 'I11all'llarned on lower doses If higher doses are not tolerated.
References: 1,1re CAPRICORN I ve 'galors E eel of carwllllol on olJleome aIle.
,quot;'{O(;iIroi Ir1 a'ction II) PJtle!1ts wi h 3ft-ven rleli f dysflll'C!lon: UN! CAPRICORN
I. L'J'quot;,el 200Ul57J385-1390. 2. F'reseriiJlnli Inlonn~li n lor
r~n~omised
COREG Cll GI~xoS ~ lin 3. [lara 011 file (g66) and (#78), GIsxOSl1llIRKlil18 4. Pnoll7
'/1I50n PA. Swenberg K_ Icli!nd JG~, et al. lor tile COMET IIIvb'!;[llfalors. Comparison of
cllrtk~J oulcolnes 'II p~1iefll~ v!itluh~nir. rt a I Te I~ tile
c.lIF'o'edliol af)U m loprol
r..edllal r Metoprolal European Trial (COMET!' randCnUsed conlnllled triol Lancet.
2003;362:7-13 5_ Tor·)·Pl!der en C. Poo - san PA, Swedberg K, at ai, forlhe COMET
In~llSlJjJalllt'$. ~fi1ecl~ or metoprolol an aquot;Mllllol on cami,e-speci!lc morJa'lty and
Lower p ess ra wi hoo 10 ing
Il'lDrbi~ll,!, In palienls vquot;llh I;l']rome hem f Illre-OOMET Am Hem J. 2005:149:370-376. COil r
6. Toprol-XL· Pr ~rRiI11l111In·mallon. Wlm ngm ,Oe Asl neca LP: 2007
10. ONCE-A-DAY
CR e
Indications
Hypertension
COREG CR is indicated for the management of essential hypertension.
COREG CR can be used alone or in combination with other
antihypertensive agents, especially thiazide-type diuretics.
Post-M I Left entric lar Dysfunction (l:.VD)
COREG CR is indicated to reduce cardiovascular mortality in
clinically stable patients who have survived the acute phase of an
MI and have a left ventricular ejection fraction (LVEF) -:;40%
(with or without symptomatic heart failure [HF]).
Mila-to-Severe F
COREG CR is indicated for the treatment of mild-to-severe HF of
ischemic or cardiomyopathic origin, usually in addition to diuretics,
angiotensin-converting enzyme (ACE) inhibitor, and digitalis, to
increase survival and, also, to reduce the risk of hospitalization.
Please see Important Safety Information on page 11.
o
11. Important Safety Information
Patients taking COREG CR or Coreg® Worsening HF or fluid retention may occur
during uptitration of COREG CR or COREG.
(carvedilol) should avoid abrupt cessation
of therapy. Following abrupt cessation of
The most common side effects reported
therapy with certain ~-blocking agents,
in the controlled trials in HF (reported
exacerbation of angina pectoris and, in
in ~1 0% of patients [both the mild-to
some cases, MI and ventricular
moderate and the severe populations
arrhythmias have occurred. The dosage
studied] and more frequently on COREG)
should be reduced gradually over a 1- to
were dizziness, fatigue, weight increase,
2-week period and the patient should be
hypotension, and bradycardia. Worsening
carefully monitored.
HF symptoms were also reported, but
with equal or greater frequency in
COREG CR and COREG are
placebo-treated patients.
contraindicated in patients with bronchial
asth ma or related bronchospastic
The most common side effects reported
conditions, second- or third-degree
with COREG in the CAPRICORN trial were
AV block, sick sinus syndrome, or severe
consistent with the profile of the drug in
bradycardia (unless a permanent
the US HF trials and the COPERNICUS
pacemaker is in place), in patients with
trial, as well as the health status of
cardiogenic shock or decompensated
patients. The only additional adverse
heart failure (HF) requiring the use of
events reported in >3% of patients and
intravenous inotropic therapy (such
more frequently on COREG in CAPRICORN
patients should first be weaned from
were dyspnea, lung edema, and anemia.
intravenous therapy before initiating
COREG CR or COREG), in patients with
The most common side effects in
clinically manifest hepatic impairment,
hypenension trials with carvedilol were
and in patients who are hypersensitive
nasopharyngitis (COREG CR) and
to any component of this product.
dizziness and fatigue (COREG) and were
generally mild.
Like other I)-blockers, COREG CR and
COREG should be used with caution in
patients with peripheral vascular disease,
thyrotoxicosis or who are undergoing
major surgery. Caution should also be
used in diabetic patients as I)-blockers
may mask some of the manifestations of
hypoglycemia, particularly tachycardia.
Lower press ure wrthout losing control
11
12. C · A once-a-day
e
beta-blocker wit out aU I
No adverse effect on metabolic profile: HbA 1 c'
total cholesterol, triglycerides, HDL and weight 1
Low incidence of adverse events that most cone
to
physicians: fatigue, erectile dysfunction, and dizziness 2
Significant BP reductions throughout the entire 24 hours3
PATIENTS WITH HIYPERTENSION*
STARTI G DOSE
UPT TRATION DOS
MAX MUM TARGET DOSE
o~ tiered commercial managed care plans t4
COREG CR is covered on 89%
'Starting dose: 20 mg 00. Uptilrale to 40 rng 00 after 1 10 2 weeks. as needed for BP control. The ma~nnum/largel doso 80 rng QO, if required.
IS
hier 2 coverago = 54%, Tier 3 coverage = 35%
Relerences: 1. Data on hie (#~5), (#56), allD (#58), GlaxoSmithKlll1e 2 Oata all file (#81). (#S2.), !l1ld ('77). GlaroSnllU Xlln bilr M; SI 011, T I;a E! 1'fEl1'III r M, 1llCl: R,
3.
Bakns GL. Controlled-release carvedllol in the Ireilquot;lme!1! of essenllalllypenensloll. Am J Cardio/. 2005,98(s'JIIPI).32L-38L. 4. MI!(1IlJ1~dl, US~, orJ'lllI f'j CempllS£, NI:J~ be' 2007,
Employer. HMO, HMO-Medicaid, HMO-Medicare. flSurer. MedJcal GrOl,r, PllM. POS. PPO, S1[t M!lIJic:aid Of anllatioll .IDes. N (1,840)
COREG CR should be taken as a whole capsule in the morning with food. It should. not be crushed, chewed, or taken in divided doses.
Please see complete Prescribing Information provided.
COREG
(carvedilol phosphate)
Extended-release Capsules
COHc~;GILquot;'o
GtaxoSmtthKline Lower pressl.J re wirthoullosing control