This document discusses commonly used drugs that require dosage adjustment or caution in patients with chronic kidney disease (CKD). It notes that around 50% of patients with an estimated glomerular filtration rate (eGFR) below 60 mL/min experience drug-related adverse events, with risks increased in those who are non-white, older, have diabetes, or more advanced CKD. Common adverse events reported include hypoglycemia, falling, nausea, hyperkalemia, and confusion. Several classes of drugs like NSAIDs, sodium phosphate preparations, iodinated contrast, gadolinium, antibiotics, antihypertensives, and lipid-lowering drugs require caution or dosage adjustment in CKD. The document emphasizes reviewing medications for
this PowerPoint is about most common adverse reaction chemotherapy such as nausea ,vomiting ,diarrhea .I have used applied therapeutic and Uptodate as a reference
Antitubercular drugs for Second Year MBBS Pharmacology students. It contains recent recall questions from NEET PG 2021 and AIIMS 2020 exams, highlighting the importance of the topic. Don't miss the summary at the end.
this PowerPoint is about most common adverse reaction chemotherapy such as nausea ,vomiting ,diarrhea .I have used applied therapeutic and Uptodate as a reference
Antitubercular drugs for Second Year MBBS Pharmacology students. It contains recent recall questions from NEET PG 2021 and AIIMS 2020 exams, highlighting the importance of the topic. Don't miss the summary at the end.
- Application of drugs in body re medicines
- Bridges gap between laboratory science and medical practice
- Safety of prescribed medicine, maximise drug effects, minimise side effects
Emeset (Generic Ondansetron Hydrochloride Tablets) is used for the management of nausea and vomiting induced by cytotoxic chemotherapy and radiotherapy, and for the prevention and treatment of post-operative nausea and vomiting (PONV).
The main focus of this presentation is to discuss all the drugs used nowadays in clinical practice to treat/ manage bronchial asthma. Along with the mechanism of action, use and adverse effects of anti-asthma drugs, we have given a highlight of the pathophysiology of asthma and how the drugs individually act at individual set point(s) to bring the clinical outcome.
All about barbiturate poisoning , causes , clinical symptoms , types of poisoning , barbiturates classification , adverse effects and toxic effects of barbiturate poisoning , Management of barbiturate poisoning , Scandinavian method , support vital function , prevention and further absorption .
- Application of drugs in body re medicines
- Bridges gap between laboratory science and medical practice
- Safety of prescribed medicine, maximise drug effects, minimise side effects
Emeset (Generic Ondansetron Hydrochloride Tablets) is used for the management of nausea and vomiting induced by cytotoxic chemotherapy and radiotherapy, and for the prevention and treatment of post-operative nausea and vomiting (PONV).
The main focus of this presentation is to discuss all the drugs used nowadays in clinical practice to treat/ manage bronchial asthma. Along with the mechanism of action, use and adverse effects of anti-asthma drugs, we have given a highlight of the pathophysiology of asthma and how the drugs individually act at individual set point(s) to bring the clinical outcome.
All about barbiturate poisoning , causes , clinical symptoms , types of poisoning , barbiturates classification , adverse effects and toxic effects of barbiturate poisoning , Management of barbiturate poisoning , Scandinavian method , support vital function , prevention and further absorption .
Newer Oral Anticoagulant in Chronic Kidney DiseaseAbdullah Ansari
Kidney specific mechanisms leading to atrial fibrillation
Possible mechanism of CKD progression in atrial fibrillation
Atherosclerosis Risk in Communities (ARIC) study
Guidelines
Pulmonary embolism & deep vein thrombosis
Nephrotic syndrome
Problems with Vit K antagonists in CKD
Non Vit K oral anticoagulants
Site of action of NOACs and VKAs
Pharmacology of Direct Oral Anticoagulants
Trials for NOACs
Dose NOACs according to renal function
Laboratory monitoring of NOACs
Anticoagulant reversal of NOACs
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- 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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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. How often? And Who’s at risk?
• Occurs in ~50% of patients with estimated
GFR (eGFR) <60 ml/min
• Risk factors
–Non-white
• Older age
• ACEi/ ARB use
• Diabetes
• More advanced CKD
5. Adverse drug events in ambulatory patients with CKD
PATIENT REPORTED
Hypoglycemia
Falling/ severe dizziness
Nausea, vomiting ± diarrhea
Hyperkalemia
Confusion
Hypoglycemia
Hyperkalemia
Bradycardia
7. CKD progression: biology versus “iatrogenesis”?
time
NSAID for
Gout
Gentamicin for
UTI
Contrast for
coronary cath
CHF with diuresis
leading to AKI
and low BP
GFR
Baseline rate of decline in GFR
ESRD
8. CKD progression: biology versus “iatrogenesis”?
time
NSAID for
Gout
Gentamicin for
UTI
Contrast for
coronary cath
CHF with diuresis
leading to AKI
and low BP
GFR
Baseline rate of decline in GFR
ESRD
9. Modes of Drug
Related Adverse Events in CKD
•Direct kidney injury
•Dosing error
•Drug-drug interaction
10. 10
Drug Elimination in CKD
• Adjustments usually needed when >25-
30% of active drug/metabolite
eliminated renally:
Azithromycin 5-12%
Moxifloxacin 15-21%
Pioglitazone (Actos) 15-30%
Ciprofloxacin 30-57%
Amoxicillin 50-70%
Digoxin 57-80%
13. NSAIDs
• Avoid in patients with:
CKD
Conditions that could lead to “pre-renal
physiology” or dehydration
•CHF
•Cirrhosis
•Renal artery stenosis
•RAAS-blockade
15. Oral Sodium Phosphate
Preparations
• Hyperphosphatemia + volume depletion
• Acute Phosphate Nephropathy
Ca-phosphate deposits in tubules
& interstitium
Leads to AKI/ CKD within days to months
16. Oral Sodium Phosphate
Preparations
Risk factors for phosphate nephropathy
include GFR< 60 mL/min per 1.73 m2, > 60
years of age, women, HTN, diabetes, CHF,
volume depletion, active colitis, and
medications that may predispose to AKI (RAAS
blockers, diuretics, lithium and NSAIDs).
17. Sodium Phosphate Bowel Preparations
• FDA Blackbox warning for OTC oral sodium
phosphate tablets: do not to take more than
one dose/24 hours
• Risk Factors
–Older age,
–Impaired kidney function
–Pre-renal state/ physiology
–Decreased GI motility
–ACEi, ARB or NSAID use
18. Sodium Phosphate Bowel Preparations
Fleets has pulled phospha soda but generic versions
still available OTC
Two OSP tablet preparations are also approved for use:
Visicol, which is similar in content to Fleet's Phospho-
soda, and Osmo-Prep, which contains approximately
20% less phosphate than Visicol .
All OSP preparations lead to both sodium and phosphate
absorption.
If phosphate absorption did not occur, a 100-ml dose
would obligate 4.1 L of stool .
Using more than 1 dose in 24 hours can cause rare but
serious harm to the kidneys and heart, and even death.
20. Iodinated Contrast
• Leads to AKI
• Risk factors
–CKD (esp. eGFR <30 ml/min/1.73m2)
–Diabetes, CHF, gout
–Dehydration
21. Iodinated Contrast
Concurrent use of NSAIDs or RAAS-
antagonists
High osmolality agents, large or repeated
doses
Intra-arterial injection
22. Iodinated Contrast
• Minimize risk of AKI
–Optimize volume status
–Check Scr 48-96 hrs post-procedure
–Avoid repeated contrast load within days
• Prophylactic hemofiltration/hemodialysis of
no benefit
23. Iodinated Contrast
• Minimize risk of AKI
Use low or iso-osmolar agents at
lowest doses possible
Consider d/c NSAIDS, diuretics or
RAAS-antagonists prior and shortly
after procedure
24. Does fluid type matter in preventing contrast
nephropathy?
Group A: NS 1 ml/kg/h starting @ 8 h pre- and
continued ≥12h post-procedure
Group B: NaHCO3 (166 mEq/L) 3 ml/kg/h 1h pre-
and 1ml/kg/h for 6h post-procedure
Group C: NaHCO3 3ml/kg bolus 20 mins pre +
1,500 mg tab/10kg + 100-200 ml mineral water
orally and 500 ml of mineral water post-procedure
25. Gadolinium
• Linked to nephrogenic systemic fibrosis (NSF)Rare,
but painful debilitating fibrosing disease
Primarily in extremities but may involve lung and
heart
• Increased risk w/ decreased kidney function (AKI,
CKD, post-transplant)
• Avoid gadolinium in patients w/ eGFR <30 ml/min
28. Antihypertensives: RAAS antagonists
• Expect rise in SCr ≤30%
• Can lead to AKI, hyperkalemia
• Risk management
– Avoid in patients with renal artery stenosis
– Assess eGFR and serum K+ 1 wk after initiation
or ↑dose
29. Antihypertensives: RAAS antagonists
• Expect rise in SCr ≤30%
• Can lead to AKI, hyperkalemia
• Risk management
Prior to contrast, major surgery, procedures
/conditions that predispose to dehydration -
consider temporarily d/c
D/C or reduce if SCr increase > 30% or serum K+ >
5.5 mEq/L
30. Patients with kidney dysfunction
exhibited a higher level of serum
gabapentin.
The serum gabapentin elevations seemed
to be proportional to the severity of
kidney dysfunction.
32. Treatment Considerations in CKD Patients with UTI
Ampicillin* • Achieve good urine concentration
Cephalosporins* • Generally low urine concentrations
• Exceptions: cefazolin and ceftriaxone, but not FDA
approved for UTI treatment
Carbepenems • <50% of active drug present in urine
• Unknown efficacy for UTI in CKD patients
Quinolones* • Ciprofloxacin and levofloxacin achieve good urine
concentrations
Nitrofurantoin • Low renal excretion, avoid if eGFR <50 ml/min
Trimethoprim* • Achieve good urine concentration
Aminoglycosides* • Achieve high urine concentrations
• Nephrotoxic
*Requires dose adjustment in CKD
33. Antimicrobials with CKD
• Most require renal dose adjustments
–Common exceptions:
Ceftriaxone, moxifloxacin, macrolides,
doxycycline, clindamycin, linezolid
• Careful monitoring of drug levels needed
for:
Vancomycin. Aminoglycosides
34. Antimicrobials with CKD
• Trimethoprim/ sulfamethoxazole
May ↑SCr slightly due to ↓renal tubular
creatinine excretion– no change in GFR.
Distinguish from AKI due to drug allergic
interstitial nephritis
Hyperkalemia
• Imipenem/ cilastatin
High seizure risk with use of carbepenem in CKD
35. Metformin
• Ideal agent
– Does not raise insulin levels
– No hypoglycemia
– BUT COULD CAUSES
• Lactic acidosis
– 1/20th of phenformin
– ~3 cases per 100,00 pt-yr
35
37. Proposed Metformin Use in CKD
• eGFR 45 to 60 mL/min/1.73m2
–Continue metformin use and ↑ monitoring of
eGFR to every 3 - 6 months
• eGFR 30 to 45 mL/min/1.73m2
Use metformin with caution with lower dose
(50% maximal)
• eGFR < 30 mL/min/1.73m2
Stop metformin
38. Proposed Metformin Use in CKD
• Avoid or hold if Acute Kidney Injury or
high risk AKI
–Iodinated contrast exposure
• Monitor Serum Bicarbonate in addition to
eGFR
–Stop metformin for any new acidosis
39. Hypoglycemics
• Sulfonylureas
Dose adjustment needed for renally
excreted drugs:
chlorpropramide, glyburide {Avoid above two
if eGFR < 50 ml/min}
Insulin
Partially renally excreted and dose adjustment may
be needed for eGFR <30 ml/min
40. Antidiabetic Drugs & CKD
Generic Name ↓A1c
Hypogl
ycemia
↑Wt
Initial
Dose
Max
Dose
CKD
Sulfonylureas
1.0–
1.5
Yes Yes
glyburide
2.5–5
mg/d
10 mg BID avoid
glipizide
5 mg/d or
XL 5 mg/d
20 mg BID or
XL 20 mg/d
use this one
40
42. Lipid-lowering drugs
• Statins
No renal dose adjustment needed
for atorvastatin
Dose adjustments needed when
eGFR <30 ml/min for fluvastatin,
lovastatin, pravastatin, rosuvastatin
and simvistatin { could cause severe muscle
weakness }
44. AWARENESS OF DRUG DRUG
INTERACTIONS IN PATIENTS
Median number pills taken by
dialysis patient is 19/ day
45. Rhabdomyolysis with Statins:
Cytochrome P450 3A4
interactions
Lova >/= Simva > Atorva – not Rosuva or
Prava
•Azoles (ketoconazole the worst)
•Diltazem and Verapamil
•Clarithro and Erythro >>> Azithro
•Ritonavir in HIV patients
•Cyclosporine and FK506 (Tacrolimus)
46. • Bisphosphonates for eGFR > 30 mL/min/
1.73 m2 with normal Ca, phos, intact PTH
with DEXA scans showing osteoporosis .
• Efficacy?
BMD weakly related to fracture risk with
stages 4 and 5 CKD
Bisphosphonates
47. • Patients with Chronic Kidney Disease
Mineral Bone Disorder have a
spectrum of bone diseases
Secondary hyperparathyroidism with
↑bone turnover BUT adynamic
bone disease with ↓bone turnover
as well.
Bisphosphonates
48. Bisphosphonates
• Safe?
Long term treatment with bisphosphonates may
cause or exacerbate adynamic
bone disease.
• Refer to a bone specialist with osteoporosis with
eGFR< 30 min per 1.73 m2ml/min
49. Bisphosphonates
• Rare kidney toxicity
IV zolendronic acid associated with
AKI due to ATN.
IV pamidronate, zolendronic acid, oral
alendronate reported with
collapsing FSGS.
51. Minimizing Risk of Adverse Drug Events
• Minimize pill burden as possible
10 – 12 MEDICATIONS PER CKD PATIENT;
17 FOR TRANSPLANTED INDIVIDUALS
• Review medications carefully for
Dosing
Potential interactions
• Educate patient on:
OTC meds to avoid (mainly NSAIDs)
Signs/symptoms of potential drug adverse
effects
52. Dosing Adjustments
• Don’t rely on SCr alone – calculate eGFR or Cr
clearance
–SCr misleading in: extremes of body weight,
poor nutrition
• Cannot rely on eGFR in AKI
If SCr rapidly rising, assume eGFR <10 ml/min
• When in doubt, look up dosing adjustment/
potential interactions or call pharmacy
53. Key Points
• CKD patients at high risk for drug-related
adverse events
• Several classes of drugs renally eliminated
• Consider kidney function and current eGFR
(not just SCr) when prescribing meds
• Minimize pill burden as much as possible
• Remind CKD patients to avoid NSAIDs
54. Common drugs that require dose
adjustment in CKD
• Metoclopramide
Overdose manifests as CNS symptoms/
extrapyramidal movement disorders
50% of normal dose if eGFR <40 ml/min
55. Common drugs that require dose
adjustment in CKD
• Digoxin
–~70% of digoxin is renally eliminated
–30-50% dose reduction for loading
–Maintenance dose reduction based on
kidney function & ideal body wt.
56. Antidiabetic Drugs & CKD
Generic Name
Hypo
glyce
mia
Wt
↑
Initial
Dose
Max
Dose
CKD
Meglitinides Yes Yes
Can be used in
the presence of
renal failure as
the
pharmacokineti
cs are
unaffected
repaglinide
0.5 mg TID 4 mg TID
nateglinide
120 mg TID
180 mg
TID
56
57. Antidiabetic Drugs & CKD
Generic
Name
A1c
↓
Hypogl
ycemia
Wt
↑
Initial
Dose
Max
Dose
$ /
mo
CKD
alpha-
glucosidase
inhibitors
0.5–
1.0
No No Contraindicated in renal failure
acarbose
25 mg TID 100 mg TID $40
miglitol
25 mg TID 100 mg TID $60
57