This document discusses drugs used to treat congestive heart failure. It describes several classes of drugs and their mechanisms of action. The main drug classes discussed are: ACE inhibitors, ARBs, beta-blockers, diuretics, direct vasodilators, inotropic agents like cardiac glycosides and beta-agonists, and aldosterone antagonists. The goal of treatment is to increase cardiac output, relieve symptoms, slow disease progression, and improve survival by reducing preload and afterload on the heart.
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
Diuretics
Pharmacology
Katzung
Abnormalities in fluid volume and electrolyte composition are common and important clinical disorders. Drugs that block specific transport functions of the renal tubules are valuable clinical tools in the treatment of these disorders. Although various agents that increase urine volume (diuretics) have been described since antiquity, it was not until 1937 that carbonic anhydrase inhibitors were first described and not until 1957 that a much more useful and powerful diuretic agent (chlorothiazide) became available. Technically, a “diuretic” is an agent that increases urine volume, whereas a “natriuretic” causes an increase in renal sodium excretion and an “aquaretic” increases excretion of solute-free water. Because natriuretics almost always also increase water excretion, they are usually called diuretics. Osmotic diuretics and antidiuretic hormone antagonists (see Agents That Alter Water Excretion) are aquaretics that are not directly natriuretic.
Diuretics
Pharmacology
Katzung
Abnormalities in fluid volume and electrolyte composition are common and important clinical disorders. Drugs that block specific transport functions of the renal tubules are valuable clinical tools in the treatment of these disorders. Although various agents that increase urine volume (diuretics) have been described since antiquity, it was not until 1937 that carbonic anhydrase inhibitors were first described and not until 1957 that a much more useful and powerful diuretic agent (chlorothiazide) became available. Technically, a “diuretic” is an agent that increases urine volume, whereas a “natriuretic” causes an increase in renal sodium excretion and an “aquaretic” increases excretion of solute-free water. Because natriuretics almost always also increase water excretion, they are usually called diuretics. Osmotic diuretics and antidiuretic hormone antagonists (see Agents That Alter Water Excretion) are aquaretics that are not directly natriuretic.
Antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction.
This presentation deals with the most common antihypertensive drugs used in our day-to-day practice. The common 4 ABCDs (Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, diuretics)
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
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- 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
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
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.
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!
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
1. Drugs Used In the Treatment of
Congestive heart failure
Dr. Hiwa K. SaaedDr. Hiwa K. Saaed,,
PhD PharmacologyPhD Pharmacology
School of Pharmacy, University of SulaimaniSchool of Pharmacy, University of Sulaimani
2. Congestive Heart Failure (CHF)
• Heart failure (HF) is a complex, progressive disorder in which
the heart is unable to pump sufficient blood to meet the
needs of the body.
• Chronic CHF: the clinical condition in which an individual
expels less than 40% of the blood from the left ventricle per
heartbeat (ejection fraction [EF] 40%).
• A normal individual expels about 55 to 65% of the blood from
the left ventricle per heart- beat (EF 55–65%).
• HF is due to an impaired ability of the heart to adequately fill
(diastolic failure) with and/or eject blood (Systolic failure).
• It is often accompanied by abnormal increases in blood
volume and interstitial fluid, hence the term congestive HF.
3. • Can involve the heart: left side (usually), right side, or both
side
• Its cardinal symptoms are: Dyspnea, Fatigue, and Fluid
retention.
• symptoms include dyspnea from pulmonary congestion in left
HF, and peripheral edema in right HF.
• Underlying causes of HF include:
– arteriosclerotic heart disease,
– Myocardial Infarction,
– hypertensive heart disease,
– valvular heart disease,
– dilated cardiomyopathy,
– and congenital heart disease.
Congestive Heart Failure (CHF)
4.
5.
6. The pathophysiology
Reduce Cardiac output:
low renal perfusion renin production
angiotensin
1- stimulation of aldosterne Na+
and fluid retention in venous return
in preload
2- peripheral vasoconstriction ( in after load and preload)
low carotid sinus flow in the sympathetic activity to
maintain ventricular contractility tachycardia and in
TPR.
7.
8. In CHF, the impaired contractile function of the heart is exacerbated
by compensatory increase in preload and afterload
9. Physiology of cardiac muscle contraction
The myocardium,
•like smooth and skeletal muscle, responds to stimulation
by depolarization of the membrane.
•However, the cardiac muscle cells are interconnected in
groups that respond to stimuli as a unit, contracting
together whenever a single cell is stimulated.
•unlike skeletal muscle, which shows graded contractions
depending on the number of muscle cells that are
stimulated,
12. Therapeutic strategies in HF
Chronic HF is typically managed by:
• a reduction in physical activity,
• fluid limitations (less than 1.5 to 2 L daily);
• low dietary intake of sodium (<1500 mg/day),
• treatment of comorbid conditions, and judicious use of:
– diuretics,
– inhibitors of the renin-angiotensin system,
– and inotropic agents.
Avoid Drugs that may precipitate or exacerbate
HF, such as:
• NSAIDs (nonsteroidal anti-inflammatory drugs),
• alcohol,
• Nondihydropyridine calcium-channel blockers,
• some antiarrhythmic drugs, should be avoided if possible.
13. The therapeutic goal for CHF
Increase cardiac output, relieve the symptoms of cardiac
insufficiency, Slow disease progression, and improve
survival do not reverse the underlying pathologic condition.
1.inhibitors of the renin-angiotensin system (RAS).
2.β-adrenoreceptor blockers.
3.diuretics; decease extracellular fluid volume,
4.inotropic agents; increase the strength of contraction of
cardiac muscle
5.direct vasodilators; reduce the load on the myocardium.
6.aldosterone antagonists
14. Angiotensin converting enzyme (ACE) inhibitors
ex : captopril, lisinopril, enalapril
ACE inhibitors decrease:
1. vascular resistance,
2. venous tone,
3. blood pressure,
resulting in an increased cardiac output
Adverse effects
postural hypotension
renal insufficiency
persistent dry cough
should not be used in pregnant women
16. Angiotensin receptor blockers (ARBs):
Ex: losartan, valsartan, etc
are nonpeptide, orally active compounds that are
extremely potent competitive antagonists of the AT1
receptor.
ARBs have the advantage of more complete blockade of
angiotensin action, because ACE inhibitors inhibit only
one enzyme responsible for the production of
angiotensin II.
17. β-blockers
Carvedilol, metoprolol and bisprolol
• The benefit of β-blockers is attributed, in part, to their
ability to prevent the changes that occur because of the
chronic activation of the sympathetic nervous system,
including decreasing the heart rate and inhibiting the
release of renin.
• In addition, β -blockers also prevent the direct
deleterious effects of norepinephrine on the cardiac
muscle fibers, decreasing remodeling, hypertrophy and
cell death.
18. Diuretics
bumetanide, furosemide, hydrochlorothiazide
Thiazide diuretics are relatively mild diuretics and lose
efficacy if patient creatinine clearance is less than 50
ml/min. Loop diuretics are used in patients with renal
insufficiency
Diuretics:
•relieve pulmonary congestion and peripheral edema
•useful in reducing the symptoms of volume overload
including orthopnea and nocturnal dyspnea
•↓ plasma volume: ↓preload→↓ cardiac work & O2
demand
• ↓aftereload→ ↓ BP
19. Direct vasodilators
Vasodilators are useful in reducing excessive preload and
afterload as follow
• venodilator→↓preload
• arterial dilators →↓afterload
• Nitrates are commonly employed venodilator in
CHF
• CCBs should be avoided
20. Inotropic agents
• positive inotropic agents
• enhance cardiac muscle contractility
• increase cardiac output
• although these drugs act by different mechanisms ,in
each case the inotropic action is the result of an
increased cytoplasmic calcium concentration that
enhances the contractility of the cardiac muscle
22. Therapeutic uses
• digoxin is indicated in patients with severe left ventricular
systolic dysfunction after initiation of diuretic and
vasodilation therapy
• NOT indicated in patient with diastolic or right sided heart
failure
• patients with mild to moderate heart failure will often
respond to treatment with ACE inhibitors and diuretics
and do not require digoxin
N.B. The digitalis glycosides have low therapeutic index
23. Adverse effects
• Cardiac effects: is arrhythmia (common), characterized by
slowing of AV conduction associated with atrial arrhythmias.
hypokalemia is the primary predisposing factor in these effects.
Caused by thiazide or loop diuretics and prevented by use
of a K sparing diuretics or supplementation with KCl
• GIT effects: Anorexia, nausea, and vomiting.
• CNS effects: headache, fatigue, confusion, blurred vision,
alteration of color perception, and halos on dark objects.
24. Factors predisposing to digitalis toxicity
a) Electrolytic disturbances
– hypokalemia can preciptate serious
arrhythmia
– hypercalcemia and hypomagnesemia
also predispose to digitalis toxicity.
B) drugs:
– Quinidine, verapamil, amiodarone:
displacing digoxin from protein binding
and by competing with digoxin for renal
excretion
– Erythromycin and tetracycline
– Thiazide and loop diuretics
C) Disease: hypothyroidism, hypoxia,
renal failure, myocarditis
25. Another inotropic agent: β1-AGONISTS
• ex : dobutamine →↑cAMP→ activation of protein
kinase → slow Ca+2
channel phosphorylation → Ca+2
entry → enhancing contraction
• improves cardiac performance by both
positive inotropic effects and vasodilation
• must be given by I.V. infusion and is primarily used in
the treatment of acute heart failure in hospital setting
27. Spirolactone (Aldosterone antagonists)
Patients with advanced heart disease have elevated
levels of aldosterone due to:
– angiotensin II stimulation
– reduced hepatic clearance of the hormone.
Adverse effects include
•gastric disturbances, such as gastritis and peptic ulcer
•CNS effects, such as lethargy and confusion
•endocrine abnormalities, such as
– gynecomastia,
– decreased libido,
– menstrual irregularities.
29. Treatment options for various stages of heart failure.
Stage D (refractory symptoms requiring special interventions) is not shown.
Editor's Notes
Experts have classified HF into four stages, from least severe to most severe. Note that as the disease progresses, polytherapy is initiated. In patients with overt HF, loop diuretics are often introduced first for relief of signs or symptoms of volume overload, such as dyspnea and peripheral edema. ACE inhibitors or ARBs (if ACE inhibitors are not tolerated) are added after the optimization of diuretic therapy. The dosage is gradually titrated to that which is maximally tolerated and/or produces optimal cardiac output. Historically, β-blockers were added after optimization of ACE inhibitor or ARB therapy; however, most patients newly diagnosed with HFrEF are initiated on both low doses of an ACE inhibitor and β-blocker after initial stabilization. These agents are slowly titrated to optimal levels to increase tolerability. Digoxin, aldosterone antagonists, and fixed-dose hydralazine and isosorbide dinitrate are initiated in patients who continue to have HF symptoms despite optimal doses of an ACE inhibitor and β-blocker.