Histamine is a biogenic amine present in many animal and plant tissues that function as neurotransmitters and are also found in non-neural tissues, have complex physiologic and pathologic effects through multiple receptor subtypes, and are often released locally.
It is also present in venoms and stinging secretions. It is synthesized by decarboxylation of the amino acid, histidine. Histamine is mainly present in storage granules of mast cells in tissues like skin, lungs, liver, gastric mucosa, placenta, etc. It is one of the mediators involved in inflammatory and hypersensitivity reactions.
Histamine is a biogenic amine present in many animal and plant tissues that function as neurotransmitters and are also found in non-neural tissues, have complex physiologic and pathologic effects through multiple receptor subtypes, and are often released locally.
It is also present in venoms and stinging secretions. It is synthesized by decarboxylation of the amino acid, histidine. Histamine is mainly present in storage granules of mast cells in tissues like skin, lungs, liver, gastric mucosa, placenta, etc. It is one of the mediators involved in inflammatory and hypersensitivity reactions.
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones
respiratory drugs is a very important topic for pg entrance.....topics dicussed in this ppt are :
1) drugs for bronchial asthma
2) antitussives
3) mucolytics
4) expectorants
5) drugs for PAH
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones
respiratory drugs is a very important topic for pg entrance.....topics dicussed in this ppt are :
1) drugs for bronchial asthma
2) antitussives
3) mucolytics
4) expectorants
5) drugs for PAH
Drug & substance abuse Marijuana, Cocaine, Heroine, alcohol and prescription...OrnellaRN
Risk Factors, Effects on the brain,Symptoms, Warning signs and treatment.
Drugs and substances such as marijuana, cocaine and heroine are not the only substances that can be abused. Alcohol, prescription drugs and over-the-counter medications, inhalant and solvents, sedatives, coffee and cigarettes.
3 Proven Sales Email Templates Used by Successful CompaniesHubSpot
76% of emails never get opened. That makes life for salespeople very difficult. So we've partnered up with Breakthrough Email to bring you email templates that are proven to engage prospects and close more deals. Start using them today and grow your revenue.
The lack of visible female role models is pervasive in the tech industry, particularly on Wikipedia, where just under 17% of Wikipedia biographies were on women. That's why HubSpot wrote fourteen Wikipedia entries for remarkable women in tech to help inspire young women to reach positions at the highest levels of STEM.
Workplace bullying demonstrates a lack of which one of the three types of organizational justice?
What aspects of motivation might workplace bullying reduce? For example, are there likely to be effects on an employee’s self-efficacy? If so, what might those effects be?
If you were a victim of workplace bullying, what steps would you take to reduce its occurrence? What strategies would be most effective? Least effective? What would you do if one of your colleagues was a victim?
What factors do you believe contribute to workplace bullying? Are bullies a product of the situations, or do they have flawed personalities? What situations and what personality factors might contribute to the presence of bullies?
Why You Should Consider Linux on IBM POWER8 - How IBM Partners are Driving Bu...Paula Koziol
Discover new solutions for your industry and IT challenges. ISV solutions built on IBM Power Systems are designed to provide an open innovation platform for organizations of all sizes to transform big data and analytics, cloud and mobile into a competitive advantage. Linux on Power Systems is the only infrastructure that offers both scale-out and scale-up choices that optimize your workloads for emerging business challenges.
This presentation highlights several high value solutions we have developed with Independent Software Vendors (ISVs). Hear directly from our ISV partners on the partnership and value we deliver to our joint customers.
Visit http://www.ibm.com/power for more information.
Also visit the IBM Systems ISVs YouTube video channel for additional ISV Solutions on IBM Power Systems: https://www.youtube.com/channel/UCIF83SHiUhzwttJuT_Rww5w.
This is the overview report of the 6th Global Symposium on Gender in Aquaculture and Fisheries (GAF6), Bangkok, Thailand 3-7 August 2016. [website: http://genderaquafish.org/]
GAF6 – Engendering Security in Fisheries and Aquaculture – focused on multiple facets in fish value chains and society that matter in realising the security of women, in particular, but also men and communities. These facets include food security and nutrition, legal rights, access to resources and industry opportunities, fair livelihoods, dignified work, safety within the household, and resilience in the face of natural and climate change related disasters.
Key conclusions of GAF6 were:
- Participants were urged to focus on gender relationships, not simply roles, and on intersectionality, as women’s and men’s lives were interconnected and gender interacted with other systems in society, e.g., cultural, political and economic structures.
- The 2014 Small-Scale Fisheries Voluntary Guidelines are opening up new policy space on gender equality. Yet, in implementing the Guidelines, women have been deterred from taking part in decision-making, are invisible in most fisheries statistics and their interests excluded from national policies – unless NGOs and women’s groups have advocated for inclusion. Even when women’s needs are recognized, money and expertise may not have been allocated. In a hopeful sign, some recent projects are committed to gender equality.
- Aquaculture is gendered. Gender roles and relationships in aquaculture follow typical social patterns of ownership, rights and power. Unless they break out as entrepreneurs, women are positioned in small-scale, near-home, and low technology aquaculture, or as low-paid labour in medium and industrial scale operations. Nevertheless, small-scale household aquaculture can fulfill important subsistence roles and be improved to better satisfy food security and nutrition.
- A persistent thread on fair livelihoods in fish value chains was that gender equality and equity must be fought for, and protected by active measures, rather than expecting it to happen through a sense of natural justice.
- Using a gender lens brings deeper understanding of climate and disaster adaptation. Flexibility, versatility and agency are keys to people’s resilience. Gender-blind efforts to help people adapt should always be challenged.
- Real progress in securing gender equality will not be achieved unless social norms are transformed.
Prokinetics are the type of drugs which enhances gastrointestinal motility/transit by
increasing the frequency or strength of contractions.
They speed up gastric emptying by enhancing coordinated propulsive motility.
Treat Gastrointestinal symptoms : Abdominal discomfort, Bloating, constipation,
Heart burn, nausea and vomiting. And few gastrointestinal disorders : irritable bowel
Syndrome, gastritis, gastroparesis and functional dyspepsia.
Increases gastric emptying
Relief of gastric stasis
Decreases reflux esophagitis/heart burn
Decreases regurgitation of gastric contents& emesis
Presentation on Antacids and antiulcer drugs. Introduction to ulcers, classification of antiulcer drugs, their pharmacological actions, uses and adverse effects.
Lafutidine, Second generation histamine H2 receptor antagonistKamal Chandra Upreti
Second generation histamine H2 receptor antagonist having multimodal mechanism of action and used to treat gastrointestinal disorders. gastric ulcers, duodenal ulcers, stomal ulcers, wounds in the lining of the stomach associated with acute gastritis and with acute exacerbation of chronic gastritis.
VILDAGLIPTIN: DPP-IV INHIBITOR
Generic name: Vildagliptin
Brand name: Galvus
Treatment for: type 2 diabetes
selective inhibitor of dipeptidyl-
peptidase IV (DPP-IV)
- the first in a new class of oral antidiabetic agents
- known as dipeptidyl peptidase IV inhibitors
(DPP-IV) inhibitors
Dr Jeenal Mistry_Recent Advances in DM_8th Sept 2022.pptxDr Jeenal Mistry
The pharmacotherapy of DM has evolved tremendously in the last
100 years since the successful extraction of insulin in 1921. The efficacy of multiple drugs has been established for microvascular and
macrovascular outcomes. Despite manufacturing successful insulinanalogues, newer analogues such as icodec and newer automated
insulin delivery pumps are in the pipeline to further improve glycaemic
control. CVOTs were initiated to establish the safety of antidiabetics;
however, apart from establishing efficacy as well, some drugs have
grown to the extent of establishing efficacy and safety in nondiabetic
patients as well. Current research must be directed towards new therapeutic options for TIDM and evaluating efficacy of antidiabetics for
diseases concomitantly associated with DM, such as cerebrovascular
diseases, neuropathies, retinopathies and cancers. Diabetes with
COVID-19 provides a therapeutic dilemma for establishing adequate
glycaemic control as well as managing complications. Numerous
hypotheses exist for the management of COVID-19 with diabetics,
which need to be evaluated. Various new drug delivery systems and
drugs with novel mechanisms of action, are in the pipeline for the
management of TIDM and TIIDM, with some of them demonstrating
adequate promise in clinical trials or other diseases.
Exercise Testing in Cardiology : Dr. Akif Baigakifab93
The testing modality and protocol should be selected in accordance with the patient’s estimated functional capacity based on age, estimated physical fitness from the patient’s history, and underlying disease
Several exercise test protocols are available for both treadmill and stationary cycle ergometers
Patients who have low estimated fitness levels or are deemed to be at higher risk because of underlying disease (e.g., recent MI, heart failure) should be tested with a less aggressive exercise protocol
Treadmill and cycle ergometers may use stepped or continuous ramp protocols
Work rate increments (stages) during stepped protocols can vary from 1 to 2.5 METs
Ramp protocols are designed with stages that are no longer than 1 minute and for the patient to attain peak effort within 8 to 12 minutes
The natriuretic peptide system works antagonistically to the RAAS and has favorable effects on the pathogenesis of heart failure
Natriuretic peptides are broken down by an enzyme called neprilysin
Neprilysin is also responsible for the breakdown of other substances, including bradykinin and angiotensin II
Sacubitril/valsartan is a combination product
Sacubitril is a pro-drug that, upon activation, acts as a neprilysin inhibitor
It works by blocking the action of neprilysin, thus preventing the breakdown of natriuretic peptides
This leads to a prolonged duration of the favorable effects of these peptides
Coronary heart disease (CHD) remains a leading cause of death worldwide, accounting for 16% of total deaths globally .
Atherosclerosis plays a central role, with early fatty streaks progressing to late complex atheromas
Vascular calcification, the pathogenic and process of ectopic bone production, specifically was shown to strongly correlate with degree of atherosclerosis (both calcified and noncalcified)
Vascular calcification was shown independently to predict cardiovascular morbidity and mortality
These associations, combined with the radio-opaque appearance of calcium hydroxyappatite on CT images, have led to extensive investigation of the quantification, or scoring, of coronary artery calcium (CAC).
CAC scoring has emerged as a widely available and powerful tool for stratifying cardiovascular risk, predicting patient outcomes, and guiding preventive therapy
A coronary bifurcation consists of a flow divider (carina) and three vessel segments:
The proximal main vessel (PMV)
The distal main vessel (DMV) and
The side branch (SB).
A bifurcation lesion is a major epicardial coronary artery stenosis next to and/or including the ostium of a significant side branch
A significant SB is a branch whose severe narrowing or acute occlusion before or during intervention can cause considerable ischemia or a new infarction area that will worsen the clinical course of a particular patient.
Other important elements to consider that are not inherent in the bifurcation classifications include:
Extent of disease on the SB (limited to the ostium or involving the vessel beyond the ostium)
Its size (over 2.5mm in reference diameter)
Bifurcation angle, and
Disease distribution
Left ventricular (LV) dysfunction remains one of the
best prognostic determinants of survival in patients
with coronary artery disease (CAD)
⚫ It was originally thought that dysfunctional
myocardium after an infarction was irreversibly
damaged
⚫ However, it was later recognized that some of the
involved tissue remained viable and contractility may
be restored with revascularization
HCM is a common genetic heart disease reported in populations globally
Inherited in an autosomal dominant pattern
The distribution of HCM is equal by sex, although women are diagnosed less commonly than men
The prevalence of unexplained asymptomatic hypertrophy in young adults has been reported to range from 1:200 to 1:500
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Ventricular septal defects occur either as an isolated defect or as a component of a more complex lesion
It occurs in 50 percent of all children with CHD and in 20 to 30 percent as an isolated lesion
Most common congenital cardiac anomaly in children
Second most common congenital abnormality in adults, second only to bicuspid aortic valves
They are more common in premature infants and those born with low weight
VSDs are slightly more common in females (56%)
Patients with peripheral artery disease who have undergone lower-extremity revascularization are at high risk for major adverse limb and cardiovascular events
The efficacy and safety of rivaroxaban in this context are uncertain
Most common cyanotic heart defect seen in children beyond infancy, accounting for a third of all congenital heart disease (CHD) in this age group
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Bentracimab (also known as PB2452) is a neutralizing recombinant human immunoglobulin G1 monoclonal antibody antigen-binding fragment that binds ticagrelor and its major active circulating metabolite with high affinity and specificity
Chlorthalidone for hypertension in advanced ckdakifab93
Chlorthalidone, a thiazide-like diuretic, reduces cardiovascular morbidity, such as the incidence of stroke and heart failure, and cardiovascular mortality
However, its efficacy and safety among patients with advanced chronic kidney disease remain poorly understood
An acute illness caused by an autoimmune response to infection with group A Streptococcus, leading to a range of possible symptoms and signs affecting any or all of heart, joints, brain, skin and subcutaneous tissues
Amyloidosis is a group of protein-folding disorders in which >1 organ is infiltrated by proteinaceous deposits known as amyloid. Amyloid involvement of the heart (cardiac amyloidosis) carries the worst prognosis of any involved organ, and light-chain (AL) amyloidosis is the most serious form of the disease
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
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
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.
- 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
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/
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
4. PROTON PUMP
INHIBITORS
1) Most effective Antisecretory drug
2) Half life =30-120min
3) Duration of action = >24hrs
4) Even though PPIs have a short half life but their duration of action is more
since they binds with receptors irreversibly and takes around 24hrs for
new receptors to form. Thus these are known as Hit and Run Drugs
5) Should be given 30 minutes prior to taking food so that when food is
ingested they should be available at the site of action.
STEP TO PG-MD/MS DR.AKIF A.B
6. PROTON PUMP
INHIBITORS
DRUG FEATURES
Lansoprazole -PPI of choice in pregnancy
- Enzyme Inhibitor
Omeprazole - Both Enzyme inducer(CYP1A2)
and Enzyme Inhibitor(CYP2C19)
Pantoprazole
Rabeprazole -most potent and fastest acting.
STEP TO PG-MD/MS DR.AKIF A.B
9. S/E of PROTON PUMP
INHIBITORS
1) Acid is required for proper digestion of food. So when acid is decreased
food is not digested properly and leads to:
1) Nausea
2) Flatulence
3) Constipation/ Diarrhoea
2) Pseudomembranous colitis :Decrease in acid leads to survival of bacterias
and leads to infection.
3) Hypergastrinemia
STEP TO PG-MD/MS DR.AKIF A.B
10. Chronic S/E of PROTON
PUMP INHIBITORS
-Decrease acid impairs absorption of calcium , Iron, Magnesium and Vitamin B12.
1) Osteoporosis
2)Anemia
3)Hypomagnesemia
STEP TO PG-MD/MS DR.AKIF A.B
11. DRUG INTERACTIONS
OF PPIs
CYP2C9 enzyme activates clopidogrel
PPIs inhibits CYP2C9
Thus PPIs shouldn’t be combined with Clopidogrel
Since it will decrease the activation of clopidogrel
And its Antiaggregant effect.
STEP TO PG-MD/MS DR.AKIF A.B
12. ENZYME INDUCERS
G =Griseofulvin
P = Phenytoin
R = Rifampicin
S = Smoking
Cell = Carbamazepine
Phone = Phenobarbitone
STEP TO PG-MD/MS DR.AKIF A.B
13. ENZYME INHIBITORS
Vitamin = Valproate
K =ketoconazole
Can = Cimetidine
Cause = Ciprofloxacin
Enzyme =Erythromycin
Inhibition =Isoniazid
STEP TO PG-MD/MS DR.AKIF A.B
14. 1. Which of the following drugs is not used for H. pylori treatment? (LQ)
A Oxytetracycline
B Bismuth compounds
C Amoxicillin
D Mosapride
STEP TO PG-MD/MS DR.AKIF A.B
15. Ans. D Mosapride
Mosapride is a 5-HT4 agonist used in GERD. Rest of all drugs are used in H.Pylori
Drugs used against H. Pylori are:
1. Amoxicillin
2. Clarithromycin
3. Tetracycline
4. Metronidazole /Tinidazole
5. Bismuth subsalicylate
6. Omeprazole/ Lansoprazole
Monotherapy has failed in treatment of H. Pylori infections. Hence, multidrug regimens
given for 7-14 days are generally used.
STEP TO PG-MD/MS DR.AKIF A.B
16. Anti-H.pylori Agents
Triple Therapy Quadruple therapy
PPI OD PPI BD
Clarithromycin Metronidazole
Metronidazole or
Amoxicillin or
Tetracycline
Tetracycline
Bismuth Subsalicylate
- Given for 14days
STEP TO PG-MD/MS DR.AKIF A.B
17. 2. All are antiemetic except (DNB Dec 2009)
A Domperidone
B Metoclopramide
C Cinnarizine
D Ondansetron
STEP TO PG-MD/MS DR.AKIF A.B
19. Class of emetics Example
Anticholinergics Hyoscine, Dicyclomine
H1 antihistaminics
Promethazine, Diphenhydramine, Meclizine,
Dimenhydrinate, Cyclizine,
Neuroleptics
Chlorpromazine, Prochlorperazine,
Haloperidol,
etc.
Prokinetic drugs
Metoclopramide, Domperidone, Ciaspride,
Mosapride
5-HT 3 antagonists Ondansetron, Granisetron
Substance-P/Neurokinin Receptor Antagonist
(used inchemotherapy induced vomitting)
Aprepitant
Adjuvant antiemetics
Dexamethasone, Benzodiazepines,
Cannabinoids
STEP TO PG-MD/MS DR.AKIF A.B
20. 3. Most potent anti-emetic is: (DNB June 2010)
A Ondansetron
B Granisetron
C Dolasetron
D Palonosetron
STEP TO PG-MD/MS DR.AKIF A.B
21. Ans. D Palonosetron
5HT3 antagonist potency sequence {Mnemonics: PGOD}:
Palonosetron>Granisetron>Odansetron>Dolasetron
-5HT3 Receptor is present at CTZ area and its inhibition
prevents vomiting
STEP TO PG-MD/MS DR.AKIF A.B
22. Type of vomiting DOC
Early onset chemotherapy
Induced vomiting
Ondansetron
Late onset chemotherapy
Induced vomiting
Aprepitant
Motion sickness Scopalamine
>Hyoscine/Dicyclomine
Morning Sickness Pyridoxine + Doxylamine
STEP TO PG-MD/MS DR.AKIF A.B
23. 4. We have two patients. One requires suppression of emesis caused by an
anticancer drug that causes a high incidence and severity of vomiting (highly
emetogenic drug). Another patient has severe diabetic gastroparesis and
gastroesophageal reflux, which requires relief. Which one drug would be suitable
for both indications (assuming no specific contraindications)? (LQ)
A Diphenoxylate
B Dronabinol
C Loperamide
D Metoclopramide
STEP TO PG-MD/MS DR.AKIF A.B
24. Ans. D Metoclopramide
a. Metoclopramide has clinically useful antiemetic and prokinetic actions and
would be suitable for either of the patients described in the question.
b. The antiemetic effect arises from blockade of dopamine (and, probably,
serotonin) receptors in the brain’s chemoreceptor trigger zone (CTZ).
c. The enhanced gastric and upper intestinal motility probably reflects an
enhancement of the expected effects of ACh on muscarinic receptors found on
longitudinal smooth muscle in the GI tract.
d. Metoclopramide raises the lower esophageal sphincter tone and relaxes
the pyloric sphincter, which hastens gastric emptying.
e. This helps explain its beneficial effects in both gastroparesis and GERD.
Importantly, the drug should not be given along with atropine because of its
cholinergic properties.
STEP TO PG-MD/MS DR.AKIF A.B
25. -Acts by stimulating A-ch which increases motility and peristalsis of GIT
-A-ch stimulates GI Motility
-Dopaminergic(D2) and serotonergic (5HT4) neurons acts by forming synapse with
cholinergic neurons
-D2 is an Inhibitory neuron
-5HT4 is an stimulatory neuron.
-CCK and motilin are other receptors which increases GI motility
-Prokinetics acts by inhibiting D2 receptor and stimulating 5HT4, Motilin
and CCK.
STEP TO PG-MD/MS DR.AKIF A.B
27. D2 Antagonists
-Prokinetic effect
-Extra effects :
1) Antiemetic : Due to D2 antagonist effect at CTZ area
2) Increases Lower Esophageal Sphincter
3) Increases Gastric motility and emptying
4) Increases small intestinal motility
5) No effect on Large Intestine
STEP TO PG-MD/MS DR.AKIF A.B
28. - Prokinetic agent
-D2 Antagonist
-Also 5HT3 antagonist and 5HT4 agonist
-Uses : 1) Gastroparesis : Since it increases Gastric motility
2) GERD : Since it increases LES pressure
3) Post op Ileus : Since it increases motility of small intestine
4) Hiccups
-It is lipid soluble drug. Hence easily crosses BBB and due to D2 Antagonism
it causes Hyperprolactinemia, Extrapyramidal S/E.
STEP TO PG-MD/MS DR.AKIF A.B
29. -Exclusively D2 receptor Antagonism
-Lipid insoluble drug. Hence doesn’t crosses BBB
-Doesn’t cause Hyperprolactinemia, Extrapyramidal S/E.
-Uses similar to Metoclopromide
STEP TO PG-MD/MS DR.AKIF A.B
30. 5. A patient presents with severe abdominal pain. Endoscopy reveals several
benign ulcers in the antral mucosa of the stomach. When therapy is started,
which will provide the fastest relief of the discomfort with just a single dose?
(AIPG 2010)
A Antacids
B Ranitidine
C Misoprostol
D Omeprazole
STEP TO PG-MD/MS DR.AKIF A.B
31. Ans. A Antacids
a. The typical symptoms of acid-peptic disease are caused by acid.
b. Although antacids seem to have no ability to accelerate ulcer healing, they act
almost instantaneously to neutralize acid (provided adequate dosages are given),
thereby relieving pain and other discomforts that are due to the acid in a matter
of a minute or so.
c. All the other drugs can, to varying degrees, suppress gastric acid secretion and
ultimately get the patient near or to a “no acid, no pain” state. However, it takes
some time (variable, but clearly longer than it takes for an antacid to work) for
other medications to be absorbed and reach blood levels sufficient to suppress
acid production and then reduce symptoms.
STEP TO PG-MD/MS DR.AKIF A.B
32. Traditional and obsolete Now being used
Calcium carbonate Combination of Aluminium
and Magnesium salt
Sodium bicarbonate
- Calcium carbonate and Sodium bicarbonate is not being used due to risk of
MILK-ALKALI Syndrome.
-Aluminium salts causes Constipation and Magnesium salts causes
Diarrhoea. Hence both are combined to counteract their extra effects.
-Aluminium hydroxide is absolutely C.I in Renal failure
-Magnesium hydroxide can decrease absorption of fat soluble vitamins.
Hence should be avoided in elderly patients.
STEP TO PG-MD/MS DR.AKIF A.B
34. 6. Which of the following drug is not a gastrokinetic
drug:
A Erythromycin
B Domperidone
C Cisapride
D Ampicillin
STEP TO PG-MD/MS DR.AKIF A.B
35. Ans. D Ampicillin
GASTROKINETIC DRUGS:
Metoclopramide
Domperidone
Cisapride
Erythromycin (via motilin receptors)
*Prokinetic drugs act by promoting gastric motility, increase gastric
emptying, prevent the retention and reflux of gastric contents and thus
provide symptomatic relief.
STEP TO PG-MD/MS DR.AKIF A.B
36. 7. Misoprostol is a: (DNB June 2012)
A Prostaglandin E1 analogue
B Prostaglandin E2 analogue
C Prostaglandin antagonist
D Antiprogestin
STEP TO PG-MD/MS DR.AKIF A.B
37. Ans. A Prostaglandin E1 analogue
Prostaglandin Analogues:
MOA
It is a synthetic analogue of PGE1. It produces significant reduction of basal and
food stimulated acid secretion. It is rapidly absorbed undergoes extensive first
pass metabolism. Peak effect seen in 60 min and lasts for 3 hours.
INDICATION
The primary use of PG analogue is in the prevention of NSAID associated
gastrointestinal injury and blood loss. Especially in patients in which NSAIDS
can not be stopped.
CONTRAINDICATION
Inflammatory bowel disease
ADVERSE EFFECTS
N/V, diarrhea, abdominal cramps. It can cause bleeding and abortion in
pregnancy
STEP TO PG-MD/MS DR.AKIF A.B
39. 8. Which one of the following drugs increases gastrointestinal motility? (LQ)
A Glycopyrrolate
B Atropine
C Neostigmine
D Fentanyl
STEP TO PG-MD/MS DR.AKIF A.B
40. Ans. C Neostigmine
Anticholinesterase drugs increase the level of ACh by protecting it from hydrolysis.
Neostigmine is an anticholinesterase drug.
Fentanyl:
a. It is an opioid analgesic which leads to constipation by:
b. Direct action on GIT/CNS increases tone and segmentation but decreases
propulsive movement.
c. Spasm of pyloric / ileo-caecal and anal sphincters.
d. Decrease in all GIT secretions.
f. Central action causing inattention to defecation reflex.
Glycopyrrolate :
a. Anticholinergic drug. Hence decreases Gastric motility
b. Potent anti secretory
c. Potent antibradycardia drug
d. Lack of central action
e. Used in preanesthetic medication
STEP TO PG-MD/MS DR.AKIF A.B
41. ANTICHOLINERGICS IN PEPTIC
ULCER DISEASE
1) Pirenzepine
2) Telenzepine
-Decreases Acid secretion by Inhibiting M1 Receptors
-Not being used much because of other better drugs.
STEP TO PG-MD/MS DR.AKIF A.B
42. 9. Drug implicated for prolonging QT interval in a premature baby is:
(AIIMS Nov 2010)
A Domperidone
B Metoclopramide
C Cisapride
D Omeprazole
STEP TO PG-MD/MS DR.AKIF A.B
43. Ans. C Cisapride
Drugs causing prolonged QT interval / Torsades de pointes
Antiarrhythmic Antihistaminics CYP 3A4
inhibitors
Others
Quinidine
Amiodarone
Procainamide
Disopyramide
Terfenadine
Astemizole
Ketoconazole
Fluconazole
Imipramine
Amitriptyline
Erythromycin
Haloperidol
Cisapride
STEP TO PG-MD/MS DR.AKIF A.B
44. 10. Which of the following is false regarding metoclopramide: (AIIMS May 2009)
A Extrapyramidal side effects
B Promotes gastric motility
C Milk secretion
D Stimulates chemo trigger zone
STEP TO PG-MD/MS DR.AKIF A.B
45. Ans. D Stimulates chemo trigger zone
b. It speeds gastric emptying by increasing gastric peristalsis and relaxing
pylorus and first part of duodenum. It directly acts on CTZ and blocks it.
c. It is a dopamine (D2) receptor blocker and produces extrapyramidal side
effects and hyperprolactinemia.
STEP TO PG-MD/MS DR.AKIF A.B
46. 11) Dimethyl polysiloxane acts as: (LQ)
A Defoaming agent
B Local antacids
C Systemic antacids
D Ulcer healing agents
STEP TO PG-MD/MS DR.AKIF A.B
47. Ans. A Defoaming agent
Dimethyl Polysiloxane (Simethicone) is a silicon polymer, which reduces
surface tension and collapses the froth (antifoaming agent).
It is not absorbed from intestine and is pharmacologically inert.
It reduces flatulence.
STEP TO PG-MD/MS DR.AKIF A.B
48. 12) Proton pump inhibitors are most effective when: (LQ)
A Given after prolonged fasting
B Along with an H2 blocker
C Given with meals
D Given before meals
STEP TO PG-MD/MS DR.AKIF A.B
49. Ans. D Given before meals ‘
Proton pump inhibitors are most effective when taken
immediately before a meal, preferably with the morning
meal.
STEP TO PG-MD/MS DR.AKIF A.B
50. PROTON PUMP
INHIBITORS
1) Most effective Antisecretory drug
2) Half life =30-120min
3) Duration of action = >24hrs
4) Even though PPIs have a short half life but their duration of action is more
since they binds with receptors irreversibly and takes around 24hrs for
new receptors to form. Thus these are known as Hit and Run Drugs
5) Should be given 30 minutes prior to taking food so that when food is
ingested they should be available at the site of action.
STEP TO PG-MD/MS DR.AKIF A.B
51. 13. Ondansetron is a potent: (DNB Dec 2012)
A
Antiemetic
B
Anxiolytic
C
Analgesic
D
Antidepressant
STEP TO PG-MD/MS DR.AKIF A.B
52. Ans. A Antiemetic
a. Ondansetron is a competitive, highly selective antagonist of 5-hydroxy
tryptamine (serotonin) subtype-3 (5HT3) receptors.
b. Ondansetron is indicated for the prevention of nausea and vomiting
associated with initial and repeat courses of moderately of highly emetogenic
cancer chemotherapy, including high-dose cisplatin.
STEP TO PG-MD/MS DR.AKIF A.B
53. 14. Which one of the following drugs has been shown to offer protection from
gastric aspiration syndrome in a patient with symptoms of reflux? (LQ)
A Ondansetron
B Metoclopramide
C Sodium citrate
D Atropine
STEP TO PG-MD/MS DR.AKIF A.B
54. Ans. B Metoclopramide
a. Metoclopramide has been used in patients with gastroesophageal reflux
disease (GERD); it can produce symptomatic relief without necessarily
promoting healing of associated esophagitis.
b. Metoclopramide is indicated more often in symptomatic patients with
gastroparesis, in whom it may cause mild to moderate improvement in gastric
emptying.
STEP TO PG-MD/MS DR.AKIF A.B
55. 15. The two most common ingredients in over-the-counter antacid combination
products are a magnesium salt and an aluminum salt. The rationale for this
particular combination is that: (LQ)
A. Al salts counteract the gastric mucosal-irritating effects of Mg salts
B. Al salts require activation by an Mg-dependent enzyme
C. Mg salts cause a diuresis that helps reduce systemic accumulation of the Al salt
by increasing renal Al excretion
D. Mg salts tend to cause a laxative effect that counteracts the tendency of an Al
salt to cause constipation
STEP TO PG-MD/MS DR.AKIF A.B
56. Ans. D Mg salts tend to cause a laxative effect that counteracts the tendency of
an Al salt to cause constipation.
a. Magnesium salts used alone tend to cause a laxative effect. (Indeed, at dosages
higher than those used for acid neutralization, magnesium salts are used for
their laxative or cathartic effects.) Aluminum (and calcium) antacids, given
alone, tend to cause constipation. Combining a magnesium salt with an
aluminum (and/or calcium antacid) is an often successful approach to
minimizing antacid-induced changes of net gut motility
STEP TO PG-MD/MS DR.AKIF A.B
57. 16. A 55-year-old woman with insulin-dependent diabetes of 40 years' duration
complains of severe bloating and abdominal distress, especially after meals.
Evaluation is consistent with diabetic gastroparesis. The drug you would be most
likely to recommend is (AIPG 2011)
A.Docusate
B.Dopamine
C.Loperamide
D.Metoclopramide
E.Sucralfate
STEP TO PG-MD/MS DR.AKIF A.B
58. Ans. D Metoclopramide
Of the drugs listed, only metoclopramide is considered a
prokinetic agent, i.e. one that increases propulsive motility in
the gut.
STEP TO PG-MD/MS DR.AKIF A.B
59. - Prokinetic agent
-D2 Antagonist
-Also 5HT3 antagonist and 5HT4 agonist
-Uses : 1) Gastroparesis : Since it increases Gastric motility
2) GERD : Since it increases LES pressure
3) Post op Ileus : Since it increases motility of small intestine
4) Hiccups
-It is lipid soluble drug. Hence easily crosses BBB and due to D2 Antagonism
it causes Hyperprolactinemia, Extrapyramidal S/E.
STEP TO PG-MD/MS DR.AKIF A.B
60. 17.A patient who must take verapamil for hypertension and angina has become
severely constipated. Which of the following drugs would be most suitable as a
cathartic? (LQ)
A
Aluminum hydroxide
B
Diphenoxylate
C
Magnesium hydroxide
D
Metoclopramide
E
Mineral oil
STEP TO PG-MD/MS DR.AKIF A.B
61. Ans. C) Magnesium hydroxide
A cathartic that mildly stimulates the gut would be most suitable in a patient
taking a smooth muscle relaxant drug such as verapamil.
Magnesium hydroxide, by holding water in the intestine, provides additional
bulk and stimulates increased contractions.
STEP TO PG-MD/MS DR.AKIF A.B
62. 18. Your cousin is planning a three-week trip overseas and asks your advice
regarding medications for traveler's diarrhea. A drug suitable for noninfectious
diarrhea is
A
Aluminum hydroxide
B
Diphenoxylate
C
Magnesium hydroxide
D
Metoclopramide
E
Mineral oil
STEP TO PG-MD/MS DR.AKIF A.B
63. Ans. B Diphenoxylate
Diphenoxylate and Ioperamide are the traditional traveler's antidiarrheal
drugs.
Diphenoxylate requires a prescription in the USA but is less expensive than
loperamide.
STEP TO PG-MD/MS DR.AKIF A.B
65. LOPERAMIDE
-Opioid
-Mu receptor antagonist
-Decreases intestinal motility
-Increases anal sphincter pressure
-DOC in :
1) Irritable Bowel Sx
2) Ironitecan induced Diarrhea
-Also used in Traveller’s Diarrhea
-C.I : 1) Children <2yrs
2) Inflammatory Bowel Sx
STEP TO PG-MD/MS DR.AKIF A.B
66. OCTREOTIDE
-Somatostatin analog
-Inhibits secretion of various hormones in GIT like Serotonin, Gastrin ,VIP etc.
which leads to decrease GI Secretion and Motility.
-DOC in: HIV associated Diarrhea
-Other uses : 1) Secretory diarrhea
2) chemotherapy induced diarrhea
STEP TO PG-MD/MS DR.AKIF A.B
67. 19. Which of the following drugs or drug groups is not useful in the prevention
of nausea and vomiting induced by cancer chemotherapy (LQ)
A
Dexamethasone
B
Dronabinol
C
Ketanserin
D
Ondansetron
E
Phenothiazines
STEP TO PG-MD/MS DR.AKIF A.B
68. Ans. C Ketanserin
Ketanserin is an inhibitor of 5-HT 2 receptors and has no antiemetic action. All
of the other drugs listed are useful in preventing chemotherapy-induced nausea
and vomiting.
STEP TO PG-MD/MS DR.AKIF A.B
70. 20. On your way to an examination you experience that vulnerable feeling that
an attack of diarrhea is imminent. If you stopped at a drugstore, you could buy
this antidiarrheal drug without a prescription even though it is related
chemically to the strong opioid-analgesic meperidine (AIPG 2009)
A
Aluminum hydroxide
B
Diphenoxylate
C
Loperamide
D
Magnesium hydroxide
E
Metoclopramide
STEP TO PG-MD/MS DR.AKIF A.B
71. Ans. C Loperamide
a. Aluminum hydroxide is constipating but is not related chemically to
meperidine; magnesium hydroxide is a strong laxative.
b. The two antidiarrheal drugs that are structurally related to opioids are
diphenoxylate and loperamide.
c. Loperamide is available over-the-counter; diphenoxylate is mixed with atropine
alkaloids, and the product (Lomotil, others) requires a prescription.
STEP TO PG-MD/MS DR.AKIF A.B
72. 21. PPI with CYPP450 enzyme inhibiting activity (LQ)
A
Omeprazole
B
Rabeprazole
C
Esomeprazole
D
Pantoprazole
STEP TO PG-MD/MS DR.AKIF A.B
73. Ans. A Omeprazole
a. Omeprazole has maximum enzyme inhibiting action on CYPP450 among PPI.
The drug can inhibit metabolism of warfarin and therefore can lead to
bleeding. Pantoprazole is claimed to have lesser possibility of drug
interactions and stable pharmacokinetics.
b. Rabeprazole has best 24 hours pain relief and the drug has marginally better
efficacy than other proton pump inhibitors. Esomeprazole is an optical isomer of
omeprazole
STEP TO PG-MD/MS DR.AKIF A.B
74. 22) Which of the following drug is wrong about proton pump inhibitors (AIIMS
Nov 2010)
A
Pro-drugs
B
Short acting
C
Long acting
D
High first pass metabolism
STEP TO PG-MD/MS DR.AKIF A.B
75. Ans. B Short acting
a. These act by blocking the enzyme Na+K+ ATPase.
b. The drugs are well absorbed orally and in the apex of parietal canaliculi; these
drugs get converted into their active moiety.
b. The drugs have high first pass metabolism. They form a covalent bond with
their target. Perhaps, that is the reason of their long duration of action.
STEP TO PG-MD/MS DR.AKIF A.B
76. PROTON PUMP
INHIBITORS
1) Most effective Antisecretory drug
2) Half life =30-120min
3) Duration of action = >24hrs
4) Even though PPIs have a short half life but their duration of action is more
since they binds with receptors irreversibly and takes around 24hrs for
new receptors to form. Thus these are known as Hit and Run Drugs
5) Should be given 30 minutes prior to taking food so that when food is
ingested they should be available at the site of action.
STEP TO PG-MD/MS DR.AKIF A.B
77. S/E of PROTON PUMP
INHIBITORS
1) Acid is required for proper digestion of food. So when acid is decreased
food is not digested properly and leads to:
1) Nausea
2) Flatulence
3) Constipation/ Diarrhoea
2) Pseudomembranous colitis :Decrease in acid leads to survival of bacterias
and leads to infection.
3) Hypergastrinemia
STEP TO PG-MD/MS DR.AKIF A.B
78. Chronic S/E of PROTON
PUMP INHIBITORS
-Decrease acid impairs absorption of calcium , Iron, Magnesium and Vitamin B12.
1) Osteoporosis
2)Anemia
3)Hypomagnesemia
STEP TO PG-MD/MS DR.AKIF A.B
79. 23. Drug used in irritable bowel syndrome with consti- pation is (AI 2012)
A Lubiprostone
B Loperamide
C Alosetron
D Clonidine
STEP TO PG-MD/MS DR.AKIF A.B
80. Ans. A Lubiprostone
Lubiprostone acts by stimulating Cl channel opening in the intestine, increasing
liquid secretion in gut and decreasing transit time, therefore used for chronic
constipation.
It has also been approved for constipation dominant irritable bowel syndrome in
women.
STEP TO PG-MD/MS DR.AKIF A.B
82. Probiotics Bifidobacterium
Saccharomyces
Lactobacillus
Prebiotics Psyllium husk, bran, methyl cellulose
Symbiotics Combination of Pro and Prebiotics
Stimulants Bisacodyl, cascara , senna
Osmotic agents Lactulose, sorbitol, mannitol
Stool softeners Docusate sodium and calcium
Mineral oils
Chloride secretory drugs Lubiprostone, Linaclotide
STEP TO PG-MD/MS DR.AKIF A.B
83. PROBIOTICS
-Live organisms that provides benefit to health when taken in adequate amounts.
Bifidobacterium
Saccharomyces
Lactobacillus
STEP TO PG-MD/MS DR.AKIF A.B
84. PREBIOTICS
-Food ingredients that is composed of oligosaccharides, not digestable by humans,
but has a beneficial effect on growth of organisms.
Psyllium husk
Bran
methyl cellulose
STEP TO PG-MD/MS DR.AKIF A.B
86. STIMULANTS
Bisacodyl
cascara
senna
-These irritates colon by inducing inflammation and thus leads to water and solute
accumulation.
-Takes 5-6hrs to act
-Absolutely C.I in Intestinal Obstruction
-Cascara and senna can cause Melanosis coli
STEP TO PG-MD/MS DR.AKIF A.B
87. OSMOTIC AGENTS
Lactulose
Sorbitol
mannitol
-These are non digestible sugars metabolised into short chain fatty acids
which are Osmotic and draws water into intestinal lumen.
-Lactulose when metabolised into Short chain fatty acids makes intestinal pH
acidic which turns ammonia into polar ammonium and facilitates its excretion.
Hence used in Hepatic Encephalopathy.
STEP TO PG-MD/MS DR.AKIF A.B
88. STOOL SOFTENERS
1) Docusate sodium and calcium ; These are surfactants and softens stools by
decreasing Surface tension
2)Mineral oils : They directly enters stools and softens them.
STEP TO PG-MD/MS DR.AKIF A.B
89. 26) Which of the following agents are useful in medical treatment of variceal
bleeding? (AI 2011)
A
Octreotide
B
Pantoprazole
C
Somatotropin
D
Dexamethasone
Flip
STEP TO PG-MD/MS DR.AKIF A.B
90. Ans. A Octreotide
Management of Variceal Bleeding
A. Prevention of re-bleeding
· Non-selective beta blockers (e.g. propanolol)
· Variceal band ligation
B. Management of acute bleed
· Stabilize with fluids and blood
· Octreotide
· Vasopressin (Not preferred now)
· Balioon tamponade:
1. Sengstaken-Blackmore
2. Minnesota Tube
· Variceal ligation
· Variceal sclerotherapy
STEP TO PG-MD/MS DR.AKIF A.B
91. -Made of Sucrose + Aluminium Hydroxide
-acid stimulates its cross linking which produces a polymer which covers
the ulcer site
-Given on empty stomach before meals
-Antacids shouldn’t be given along with it since acid is required
for its function. Thus a minimum of 30 minutes gap should be
maintained between antacids and sucralfate.
-S/E : MC: Constipation
STEP TO PG-MD/MS DR.AKIF A.B
92. These physically binds with ulcer and promotes mucin and bicarbonate production.
-Uses : 1) Anti H.pylori agent
2) Anti secretory hence used in Traveller’s diarrhea
-S/E : constipation and black discolration of tongue and stools
STEP TO PG-MD/MS DR.AKIF A.B
93. -Ranitidine
-Cimetidine = Shortest acting
-Famotidine = Longest acting
-DOC for Prophylaxis of Aspiration Pneumonia in patients undergoing
Surgery.
- Maximum ulcer healing effect is seen after 8 weeks.
STEP TO PG-MD/MS DR.AKIF A.B
94. 1) Enzyme Inhibitor
2) Anti androgenic actions
3) Gynecomastia and impotence in males
4) Hyperprolactnemia
5) Galactorrhea in females
6) Tolerance
7) hepatotoxicity
STEP TO PG-MD/MS DR.AKIF A.B
96. Anti integrin
drugs
Anti –TNF
drugs +/-
Azathioprine
Mesalamine
CyclosporineAzathioprine
ResistanceDependence
Steroids
Mesalamine
Severe
Mild/
Moderate
MaintenanceInduction
Ulcerative
colitis
NR
NR
NR
STEP TO PG-MD/MS DR.AKIF A.B
97. Anti integrin
drugs
Anti –TNF
drugs +/-
Azathioprine
Steroids
Severe
Mild/
Moderate
MaintenanceInduction
Crohn’s
disease
Anti
TNF@
NR
NR –No Response
STEP TO PG-MD/MS DR.AKIF A.B