Lamotrigine is an antiepileptic drug approved for the treatment of bipolar disorder and epilepsy. It is effective as monotherapy and adjunctive therapy for bipolar depression. Lamotrigine has a lower risk of serious rash than other antiepileptics like carbamazepine, but rash remains a risk, especially in children and at higher doses. Guidelines recommend lamotrigine as a first-line treatment for bipolar depression.
Mirtazapine 30mg tablets smpc taj pharmaceuticalsTaj Pharma
Mirtazapine 30mg Tablets Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Mirtazapine Dosage & Rx Info | Mirtazapine Uses, Side Effects - Mirtazapine: Indications, Side Effects, Warnings, Mirtazapine - Drug Information - Taj Pharma, Mirtazapine dose Taj pharmaceuticals Mirtazapine interactions, Taj Pharmaceutical Mirtazapine contraindications, Mirtazapine price, Mirtazapine Taj Pharma Mirtazapine 30mg Tablets SMPC- Taj Pharma . Stay connected to all updated on Mirtazapine Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Imipramine tablets bp 25mg smpc taj pharmaceuticalsTaj Pharma
IMIPRAMINE Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, IMIPRAMINE Dosage & Rx Info | IMIPRAMINE Uses, Side Effects -: Indications, Side Effects, Warnings, IMIPRAMINE - Drug Information - Taj Pharma, IMIPRAMINE dose Taj pharmaceuticals IMIPRAMINE interactions, Taj Pharmaceutical IMIPRAMINE contraindications, IMIPRAMINE price, IMIPRAMINE Taj Pharma IMIPRAMINE TABLETS BP 25mg SMPC- Taj Pharma . Stay connected to all updated on IMIPRAMINE Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Maball 100mg and Maball 500mg injection - Rituximab sharonpaula
Maball 100mg injection (Rituximab) is an anticancer medicine which is used in the treatment of non-hodgkin lymphoma (nhl), blood cancer (chronic lymphocytic leukemia), rheumatoid arthritis etc @ myapplepharma
Lametec (Lamotrigine Tablets) is an antiepileptic drug (AED) used for adjunctive therapy for Epilepsy in patients 2 years of age and above, Epilepsy monotherapy in patients 16 years of age and above and Bipolar Disorder in patients 18 years of age and above.
Thalidomide Capsule USP Taj Pharma SmPCTajPharmaQC
Thalidomide Capsule USP 50mg/100mg/200mg/250mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Thalidomide Dosage & Rx Info | Thalidomide Uses, Side Effects Thalidomide: Indications, Side Effects, Warnings, Thalidomide -Drug Information –Taj Pharma, Thalidomide dose Taj pharmaceuticals Thalidomide interactions, Taj Pharmaceutical Thalidomide contraindications, Thalidomide price, Thalidomide Taj Pharma Thalidomide SmPC-Taj Pharma Stay connected to all updated on Thalidomide Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
Lamictal is a brand name drug containing the active ingredient lamotrigine, which is used as an adjunctive therapy to treat partial seizures, primary generalized tonic-clonic seizures, and generalized seizures of Lennox-Gastaut syndrome in patients aged 2 or older. It is available in several forms including tablets, chewable dispersible tablets, orally disintegrating tablets, and patient titration kits. The document provides dosage forms and strengths, illustrations, information on protected drug classes and Medicare criteria, state-specific requirements for commercial Lamictal brand, and quiz questions about Lamictal and its generic equivalent lamotrigine.
This document provides an overview of newer antiepileptic drugs (AEDs) including their mechanisms of action, dosages, treatment uses, and common side effects. Some of the newer AEDs discussed include gabapentin, lamotrigine, topiramate, tiagabine, levetiracetam, oxcarbazepine, zonisamide, pregabalin, and lacosamide. These drugs were developed starting in the early 1990s and generally have fewer drug interactions and side effect profiles than older AEDs like phenobarbital, phenytoin, and carbamazepine. The document reviews each drug's pharmacological properties and position as an adjunctive therapy
Ranolazine Tablets 500mg, 750mg, 1000mg Taj Pharma SmPCTajPharmaQC
Ranolazine Tablets 500mg, 750mg, 1000mg Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Ranolazine Dosage & Rx Info | Ranolazine Uses, Side Effects, Anti-anginal, Ranolazine : Indications, Side Effects, Warnings, Ranolazine - Drug Information - Taj Pharma, Ranolazine dose Taj pharmaceuticals Ranolazine interactions, Taj Pharmaceutical Ranolazine contraindications, Ranolazine price, Ranolazine Taj Pharma Anti-anginal Ranolazine Powder for Tablets SmPC.
Mirtazapine 30mg tablets smpc taj pharmaceuticalsTaj Pharma
Mirtazapine 30mg Tablets Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Mirtazapine Dosage & Rx Info | Mirtazapine Uses, Side Effects - Mirtazapine: Indications, Side Effects, Warnings, Mirtazapine - Drug Information - Taj Pharma, Mirtazapine dose Taj pharmaceuticals Mirtazapine interactions, Taj Pharmaceutical Mirtazapine contraindications, Mirtazapine price, Mirtazapine Taj Pharma Mirtazapine 30mg Tablets SMPC- Taj Pharma . Stay connected to all updated on Mirtazapine Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Imipramine tablets bp 25mg smpc taj pharmaceuticalsTaj Pharma
IMIPRAMINE Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, IMIPRAMINE Dosage & Rx Info | IMIPRAMINE Uses, Side Effects -: Indications, Side Effects, Warnings, IMIPRAMINE - Drug Information - Taj Pharma, IMIPRAMINE dose Taj pharmaceuticals IMIPRAMINE interactions, Taj Pharmaceutical IMIPRAMINE contraindications, IMIPRAMINE price, IMIPRAMINE Taj Pharma IMIPRAMINE TABLETS BP 25mg SMPC- Taj Pharma . Stay connected to all updated on IMIPRAMINE Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Maball 100mg and Maball 500mg injection - Rituximab sharonpaula
Maball 100mg injection (Rituximab) is an anticancer medicine which is used in the treatment of non-hodgkin lymphoma (nhl), blood cancer (chronic lymphocytic leukemia), rheumatoid arthritis etc @ myapplepharma
Lametec (Lamotrigine Tablets) is an antiepileptic drug (AED) used for adjunctive therapy for Epilepsy in patients 2 years of age and above, Epilepsy monotherapy in patients 16 years of age and above and Bipolar Disorder in patients 18 years of age and above.
Thalidomide Capsule USP Taj Pharma SmPCTajPharmaQC
Thalidomide Capsule USP 50mg/100mg/200mg/250mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Thalidomide Dosage & Rx Info | Thalidomide Uses, Side Effects Thalidomide: Indications, Side Effects, Warnings, Thalidomide -Drug Information –Taj Pharma, Thalidomide dose Taj pharmaceuticals Thalidomide interactions, Taj Pharmaceutical Thalidomide contraindications, Thalidomide price, Thalidomide Taj Pharma Thalidomide SmPC-Taj Pharma Stay connected to all updated on Thalidomide Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
Lamictal is a brand name drug containing the active ingredient lamotrigine, which is used as an adjunctive therapy to treat partial seizures, primary generalized tonic-clonic seizures, and generalized seizures of Lennox-Gastaut syndrome in patients aged 2 or older. It is available in several forms including tablets, chewable dispersible tablets, orally disintegrating tablets, and patient titration kits. The document provides dosage forms and strengths, illustrations, information on protected drug classes and Medicare criteria, state-specific requirements for commercial Lamictal brand, and quiz questions about Lamictal and its generic equivalent lamotrigine.
This document provides an overview of newer antiepileptic drugs (AEDs) including their mechanisms of action, dosages, treatment uses, and common side effects. Some of the newer AEDs discussed include gabapentin, lamotrigine, topiramate, tiagabine, levetiracetam, oxcarbazepine, zonisamide, pregabalin, and lacosamide. These drugs were developed starting in the early 1990s and generally have fewer drug interactions and side effect profiles than older AEDs like phenobarbital, phenytoin, and carbamazepine. The document reviews each drug's pharmacological properties and position as an adjunctive therapy
Ranolazine Tablets 500mg, 750mg, 1000mg Taj Pharma SmPCTajPharmaQC
Ranolazine Tablets 500mg, 750mg, 1000mg Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Ranolazine Dosage & Rx Info | Ranolazine Uses, Side Effects, Anti-anginal, Ranolazine : Indications, Side Effects, Warnings, Ranolazine - Drug Information - Taj Pharma, Ranolazine dose Taj pharmaceuticals Ranolazine interactions, Taj Pharmaceutical Ranolazine contraindications, Ranolazine price, Ranolazine Taj Pharma Anti-anginal Ranolazine Powder for Tablets SmPC.
Phenytoin sodium 100 mg film coated tablets smpc- taj pharmaceuticalsTaj Pharma
Phenytoin Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Phenytoin Dosage & Rx Info | Phenytoin Uses, Side Effects -: Indications, Side Effects, Warnings, Phenytoin - Drug Information - Taj Pharma, Phenytoin dose Taj pharmaceuticals Phenytoin interactions, Taj Pharmaceutical Phenytoin contraindications, Phenytoin price, Phenytoin Taj Pharma Phenytoin 100mg Film Coated Tablets SMPC- Taj Pharma . Stay connected to all updated on Phenytoin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Phenytoin is an anticonvulsant drug effective against partial and tonic-clonic seizures. It was first synthesized in 1908 but its anticonvulsant properties were not discovered until 1938. Phenytoin works by slowing the recovery of voltage-gated sodium channels from inactivation, limiting repetitive neuronal firing. Its effects are concentration-dependent and it has a narrow therapeutic index. Phenytoin is extensively bound to serum proteins and has nonlinear pharmacokinetics, making dosage adjustments complex. It can interact with many other drugs through effects on hepatic cytochrome P450 enzymes.
This document provides product information for Imuran (azathioprine) 50mg tablets. It warns that chronic immunosuppression with Imuran increases the risk of malignancy in humans. It describes Imuran as an immunosuppressive antimetabolite that is well absorbed orally and metabolized in the liver and erythrocytes. The main metabolites are 6-mercaptopurine and 6-thioguanine nucleotides, which can incorporate into DNA.
Temozolomide Capsules 5mg/20mg/100mg/140mg/180mg/250mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Temozolomide Dosage & Rx Info | Temozolomide Uses, Side Effects Temozolomide: Indications, Side Effects, Warnings, Temozolomide -Drug Information –Taj Pharma, Temozolomide dose Taj pharmaceuticals Temozolomide interactions, Taj Pharmaceutical Temozolomide contraindications, Temozolomide price, Temozolomide Taj Pharma Temozolomide SmPC-Taj Pharma Stay connected to all updated on Temozolomide Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
Everolimus Tablets 5mg, 10mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Everolimus Dosage & Rx Info | Everolimus Uses, Side Effects Everolimus: Indications, Side Effects, Warnings, Everolimus -Drug Information –Taj Pharma, Everolimus dose Taj pharmaceuticals Everolimus interactions, Taj Pharmaceutical Everolimus contraindications, Everolimus price, Everolimus Taj Pharma Everolimus SmPC-Taj Pharma Stay connected to all updated on Everolimus Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
Cytarabine Injection BP Taj Pharma SmPCTajPharmaQC
Cytarabine Injection BP 100mg/1ml Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Cytarabine Dosage & Rx Info | Cytarabine Uses, Side Effects Cytarabine: Indications, Side Effects, Warnings, Cytarabine -Drug Information –Taj Pharma, Cytarabine dose Taj pharmaceuticals Cytarabine interactions, Taj Pharmaceutical Cytarabine contraindications, Cytarabine price, Cytarabine Taj Pharma Cytarabine SmPC-Taj Pharma Stay connected to all updated on Cytarabine Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
Amlodipine 10mg tablets smpc taj pharmaceuticalsTaj Pharma
Amlodipine 5mg, 10mg Tablets Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Amlodipine Dosage & Rx Info | Amlodipine Uses, Side Effects - Amlodipine : Indications, Side Effects, Warnings, Amlodipine - Drug Information - Taj Pharma, Amlodipine dose Taj pharmaceuticals Amlodipine interactions, Taj Pharmaceutical Amlodipine contraindications, Amlodipine price, Amlodipine Taj Pharma Amlodipine 5mg, 10mg Tablets SMPC- Taj Pharma . Stay connected to all updated on Amlodipine Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
ADRs- Their mechanisms, various ADRs, & role of drugs - by RxVichuZ!! :)RxVichuZ
This is my 38th powerpoint..
It deals with the pathophysiological mechanisms involved in ADRs, the roles of drugs involved in specific ADRs(in alphabetical order "A")
In future slides, i will present the remaining ADRs, and causative drugs, in alphabetical order...!
Happy reading!!!
@RxVichu-alwz4uh! :)
-Management of various of forms of epilepsies including treatment of status epilepticus
-Status of newer anti-epileptic drugs in treatment of epilepsies
Flagyl is used to treat bacterial infections of the vagina, stomach, skin, joints, and respiratory tract. This medication will not treat a vaginal yeast infection.
Lenalidomide Capsules 5mg/10mg/15mg/25mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Lenalidomide Dosage & Rx Info | Lenalidomide Uses, Side Effects Lenalidomide: Indications, Side Effects, Warnings, Lenalidomide -Drug Information –Taj Pharma, Lenalidomide dose Taj pharmaceuticals Lenalidomide interactions, Taj Pharmaceutical Lenalidomide contraindications, Lenalidomide price, Lenalidomide Taj Pharma Lenalidomide SmPC-Taj Pharma Stay connected to all updated on Lenalidomide Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
This document discusses the management of chemotherapy complications. It begins by explaining how chemotherapy affects both cancer cells and normal cells, particularly blood cells. It then covers chemotherapy side effects including immediate effects during infusion, delayed effects within days, and late effects within weeks or years. The document focuses on managing chemotherapy-induced nausea and vomiting through the appropriate use of antiemetic drugs based on the emetogenic risk of the chemotherapy regimen and individual patient risk factors. It also addresses treating breakthrough or refractory nausea and vomiting as well as anticipatory nausea. Non-medical measures are briefly discussed.
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in blood to individualize drug dosing and maximize efficacy while minimizing toxicity. TDM is useful for drugs with a narrow therapeutic index, significant pharmacokinetic variability, or where the desired therapeutic effect is difficult to monitor. Commonly monitored drugs include theophylline, aminoglycosides, immunosuppressants like cyclosporine, and anticancer drugs like methotrexate. TDM can optimize dosing, avoid toxicity from overdose or interactions, identify noncompliance or malabsorption, and facilitate adjustment of drug regimens.
This document discusses iatrogenic disorders, which are adverse effects caused by medical diagnostic and therapeutic procedures. Some key points:
- Diagnostic procedures like imaging with contrast dye and biopsies can cause side effects ranging from mild reactions to death.
- Therapeutic regimens, especially multiple drug prescriptions, increase the risk of adverse drug reactions in patients. When 15 or more drugs are prescribed, the risk of adverse reactions increases to over 20%.
- Adverse drug reactions can affect many body systems and organs. They include cutaneous issues, blood disorders, gastrointestinal problems, respiratory conditions, cardiovascular disease, and renal failure.
- The elderly are more susceptible to adverse drug reactions due to age
Nilotinib Capsules 50mg/150mg/200mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Nilotinib Dosage & Rx Info | Nilotinib Uses, Side Effects Nilotinib: Indications, Side Effects, Warnings, Nilotinib -Drug Information –Taj Pharma, Nilotinib dose Taj pharmaceuticals Nilotinib interactions, Taj Pharmaceutical Nilotinib contraindications, Nilotinib price, Nilotinib Taj Pharma Nilotinib SmPC-Taj Pharma Stay connected to all updated on Nilotinib Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
Imatinib Capsules 100mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Imatinib Dosage & Rx Info | Imatinib Uses, Side Effects Imatinib: Indications, Side Effects, Warnings, Imatinib -Drug Information –Taj Pharma, Imatinib dose Taj pharmaceuticals Imatinib interactions, Taj Pharmaceutical Imatinib contraindications, Imatinib price, Imatinib Taj Pharma Imatinib SmPC-Taj Pharma Stay connected to all updated on Imatinib Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
Lenalidomide Capsules 5mg/10mg/15mg/25mg Taj Pharma PILTajPharmaQC
Lenalidomide Capsules 5mg/10mg/15mg/25mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Lenalidomide Dosage & Rx Info | Lenalidomide Uses, Side Effects Lenalidomide: Indications, Side Effects, Warnings, Lenalidomide -Drug Information –Taj Pharma, Lenalidomide dose Taj pharmaceuticals Lenalidomide interactions, Taj Pharmaceutical Lenalidomide contraindications, Lenalidomide price, Lenalidomide Taj Pharma Lenalidomide SmPC-Taj Pharma Stay connected to all updated on Lenalidomide Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
According to Syllabus of Gujarat Technological University
Pharmacy Practice
Topic :
Classifications of Adverse Drug Reaction
1. Excessive Pharmacological effects
2. Secondary Pharmacological effects
3. Idiosyncrasy
4. Allergic reactions
5. Genetic make up of the patients
6. Sudden drug withdrawal
7. Drug interactions
https://youtu.be/OHwPDeD-xyc
The development of psychiatry in the arab worldWALID SARHAN
The document provides an overview of the development of psychiatry in the Arab world, highlighting several key points:
- Islamic Bimaristans (hospitals) in the Middle Ages included sections for mentally ill patients, showing early recognition of their needs. Prominent Muslim physicians like Rhazes and Avicenna made important contributions.
- Modern psychiatric services have shifted from large mental hospitals to psychiatric units within general hospitals. However, most Arab countries still have relatively few psychiatric resources like beds, professionals and legislation.
- Lifetime prevalence of mental disorders is significant, around 14-17% for anxiety and 7.5-12.6% for mood disorders. However, services and spending on mental health remain limited
This document discusses cultural factors that are relevant to understanding depression among Arab populations. It notes that depression may present with more somatic symptoms and use different idioms of distress compared to Western cultures. Family and religious/spiritual beliefs also influence the experience and treatment of depression. The document recommends that clinicians be aware of these cultural differences to avoid misdiagnosis and provide culturally-sensitive care when treating Arab patients for depression.
This document summarizes a presentation on suicide given at the First International Scientific Convention in Amman, Jordan in 2004. It defines suicide and provides global statistics on suicide rates. It discusses cultural differences in attitudes toward suicide between Western cultures, Islamic cultures, Hinduism, Confucianism, and Japanese traditions. Risk factors for suicide are identified including demographic, clinical, and precipitating factors. Specific factors related to youth suicide are also outlined.
The development of psychiatry in the arab worldWALID SARHAN
The document discusses the history and current state of psychiatry in the Arab world. It describes how Islamic hospitals (bimaristans) in the Middle Ages included sections for treating mentally ill patients. Notable early Muslim physicians and scholars like Rhazes and Avicenna made important contributions to the field. Today, most Arab countries have national mental health policies and legislation but resources and services remain limited. Rates of psychiatric disorders are high while numbers of psychiatrists, beds, and facilities are low in many areas. Efforts are being made to shift care from large institutions to community services.
Phenytoin sodium 100 mg film coated tablets smpc- taj pharmaceuticalsTaj Pharma
Phenytoin Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Phenytoin Dosage & Rx Info | Phenytoin Uses, Side Effects -: Indications, Side Effects, Warnings, Phenytoin - Drug Information - Taj Pharma, Phenytoin dose Taj pharmaceuticals Phenytoin interactions, Taj Pharmaceutical Phenytoin contraindications, Phenytoin price, Phenytoin Taj Pharma Phenytoin 100mg Film Coated Tablets SMPC- Taj Pharma . Stay connected to all updated on Phenytoin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Phenytoin is an anticonvulsant drug effective against partial and tonic-clonic seizures. It was first synthesized in 1908 but its anticonvulsant properties were not discovered until 1938. Phenytoin works by slowing the recovery of voltage-gated sodium channels from inactivation, limiting repetitive neuronal firing. Its effects are concentration-dependent and it has a narrow therapeutic index. Phenytoin is extensively bound to serum proteins and has nonlinear pharmacokinetics, making dosage adjustments complex. It can interact with many other drugs through effects on hepatic cytochrome P450 enzymes.
This document provides product information for Imuran (azathioprine) 50mg tablets. It warns that chronic immunosuppression with Imuran increases the risk of malignancy in humans. It describes Imuran as an immunosuppressive antimetabolite that is well absorbed orally and metabolized in the liver and erythrocytes. The main metabolites are 6-mercaptopurine and 6-thioguanine nucleotides, which can incorporate into DNA.
Temozolomide Capsules 5mg/20mg/100mg/140mg/180mg/250mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Temozolomide Dosage & Rx Info | Temozolomide Uses, Side Effects Temozolomide: Indications, Side Effects, Warnings, Temozolomide -Drug Information –Taj Pharma, Temozolomide dose Taj pharmaceuticals Temozolomide interactions, Taj Pharmaceutical Temozolomide contraindications, Temozolomide price, Temozolomide Taj Pharma Temozolomide SmPC-Taj Pharma Stay connected to all updated on Temozolomide Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
Everolimus Tablets 5mg, 10mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Everolimus Dosage & Rx Info | Everolimus Uses, Side Effects Everolimus: Indications, Side Effects, Warnings, Everolimus -Drug Information –Taj Pharma, Everolimus dose Taj pharmaceuticals Everolimus interactions, Taj Pharmaceutical Everolimus contraindications, Everolimus price, Everolimus Taj Pharma Everolimus SmPC-Taj Pharma Stay connected to all updated on Everolimus Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
Cytarabine Injection BP Taj Pharma SmPCTajPharmaQC
Cytarabine Injection BP 100mg/1ml Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Cytarabine Dosage & Rx Info | Cytarabine Uses, Side Effects Cytarabine: Indications, Side Effects, Warnings, Cytarabine -Drug Information –Taj Pharma, Cytarabine dose Taj pharmaceuticals Cytarabine interactions, Taj Pharmaceutical Cytarabine contraindications, Cytarabine price, Cytarabine Taj Pharma Cytarabine SmPC-Taj Pharma Stay connected to all updated on Cytarabine Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
Amlodipine 10mg tablets smpc taj pharmaceuticalsTaj Pharma
Amlodipine 5mg, 10mg Tablets Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Amlodipine Dosage & Rx Info | Amlodipine Uses, Side Effects - Amlodipine : Indications, Side Effects, Warnings, Amlodipine - Drug Information - Taj Pharma, Amlodipine dose Taj pharmaceuticals Amlodipine interactions, Taj Pharmaceutical Amlodipine contraindications, Amlodipine price, Amlodipine Taj Pharma Amlodipine 5mg, 10mg Tablets SMPC- Taj Pharma . Stay connected to all updated on Amlodipine Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
ADRs- Their mechanisms, various ADRs, & role of drugs - by RxVichuZ!! :)RxVichuZ
This is my 38th powerpoint..
It deals with the pathophysiological mechanisms involved in ADRs, the roles of drugs involved in specific ADRs(in alphabetical order "A")
In future slides, i will present the remaining ADRs, and causative drugs, in alphabetical order...!
Happy reading!!!
@RxVichu-alwz4uh! :)
-Management of various of forms of epilepsies including treatment of status epilepticus
-Status of newer anti-epileptic drugs in treatment of epilepsies
Flagyl is used to treat bacterial infections of the vagina, stomach, skin, joints, and respiratory tract. This medication will not treat a vaginal yeast infection.
Lenalidomide Capsules 5mg/10mg/15mg/25mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Lenalidomide Dosage & Rx Info | Lenalidomide Uses, Side Effects Lenalidomide: Indications, Side Effects, Warnings, Lenalidomide -Drug Information –Taj Pharma, Lenalidomide dose Taj pharmaceuticals Lenalidomide interactions, Taj Pharmaceutical Lenalidomide contraindications, Lenalidomide price, Lenalidomide Taj Pharma Lenalidomide SmPC-Taj Pharma Stay connected to all updated on Lenalidomide Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
This document discusses the management of chemotherapy complications. It begins by explaining how chemotherapy affects both cancer cells and normal cells, particularly blood cells. It then covers chemotherapy side effects including immediate effects during infusion, delayed effects within days, and late effects within weeks or years. The document focuses on managing chemotherapy-induced nausea and vomiting through the appropriate use of antiemetic drugs based on the emetogenic risk of the chemotherapy regimen and individual patient risk factors. It also addresses treating breakthrough or refractory nausea and vomiting as well as anticipatory nausea. Non-medical measures are briefly discussed.
Therapeutic drug monitoring (TDM) involves measuring drug concentrations in blood to individualize drug dosing and maximize efficacy while minimizing toxicity. TDM is useful for drugs with a narrow therapeutic index, significant pharmacokinetic variability, or where the desired therapeutic effect is difficult to monitor. Commonly monitored drugs include theophylline, aminoglycosides, immunosuppressants like cyclosporine, and anticancer drugs like methotrexate. TDM can optimize dosing, avoid toxicity from overdose or interactions, identify noncompliance or malabsorption, and facilitate adjustment of drug regimens.
This document discusses iatrogenic disorders, which are adverse effects caused by medical diagnostic and therapeutic procedures. Some key points:
- Diagnostic procedures like imaging with contrast dye and biopsies can cause side effects ranging from mild reactions to death.
- Therapeutic regimens, especially multiple drug prescriptions, increase the risk of adverse drug reactions in patients. When 15 or more drugs are prescribed, the risk of adverse reactions increases to over 20%.
- Adverse drug reactions can affect many body systems and organs. They include cutaneous issues, blood disorders, gastrointestinal problems, respiratory conditions, cardiovascular disease, and renal failure.
- The elderly are more susceptible to adverse drug reactions due to age
Nilotinib Capsules 50mg/150mg/200mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Nilotinib Dosage & Rx Info | Nilotinib Uses, Side Effects Nilotinib: Indications, Side Effects, Warnings, Nilotinib -Drug Information –Taj Pharma, Nilotinib dose Taj pharmaceuticals Nilotinib interactions, Taj Pharmaceutical Nilotinib contraindications, Nilotinib price, Nilotinib Taj Pharma Nilotinib SmPC-Taj Pharma Stay connected to all updated on Nilotinib Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
Imatinib Capsules 100mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Imatinib Dosage & Rx Info | Imatinib Uses, Side Effects Imatinib: Indications, Side Effects, Warnings, Imatinib -Drug Information –Taj Pharma, Imatinib dose Taj pharmaceuticals Imatinib interactions, Taj Pharmaceutical Imatinib contraindications, Imatinib price, Imatinib Taj Pharma Imatinib SmPC-Taj Pharma Stay connected to all updated on Imatinib Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
Lenalidomide Capsules 5mg/10mg/15mg/25mg Taj Pharma PILTajPharmaQC
Lenalidomide Capsules 5mg/10mg/15mg/25mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Lenalidomide Dosage & Rx Info | Lenalidomide Uses, Side Effects Lenalidomide: Indications, Side Effects, Warnings, Lenalidomide -Drug Information –Taj Pharma, Lenalidomide dose Taj pharmaceuticals Lenalidomide interactions, Taj Pharmaceutical Lenalidomide contraindications, Lenalidomide price, Lenalidomide Taj Pharma Lenalidomide SmPC-Taj Pharma Stay connected to all updated on Lenalidomide Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
According to Syllabus of Gujarat Technological University
Pharmacy Practice
Topic :
Classifications of Adverse Drug Reaction
1. Excessive Pharmacological effects
2. Secondary Pharmacological effects
3. Idiosyncrasy
4. Allergic reactions
5. Genetic make up of the patients
6. Sudden drug withdrawal
7. Drug interactions
https://youtu.be/OHwPDeD-xyc
The development of psychiatry in the arab worldWALID SARHAN
The document provides an overview of the development of psychiatry in the Arab world, highlighting several key points:
- Islamic Bimaristans (hospitals) in the Middle Ages included sections for mentally ill patients, showing early recognition of their needs. Prominent Muslim physicians like Rhazes and Avicenna made important contributions.
- Modern psychiatric services have shifted from large mental hospitals to psychiatric units within general hospitals. However, most Arab countries still have relatively few psychiatric resources like beds, professionals and legislation.
- Lifetime prevalence of mental disorders is significant, around 14-17% for anxiety and 7.5-12.6% for mood disorders. However, services and spending on mental health remain limited
This document discusses cultural factors that are relevant to understanding depression among Arab populations. It notes that depression may present with more somatic symptoms and use different idioms of distress compared to Western cultures. Family and religious/spiritual beliefs also influence the experience and treatment of depression. The document recommends that clinicians be aware of these cultural differences to avoid misdiagnosis and provide culturally-sensitive care when treating Arab patients for depression.
This document summarizes a presentation on suicide given at the First International Scientific Convention in Amman, Jordan in 2004. It defines suicide and provides global statistics on suicide rates. It discusses cultural differences in attitudes toward suicide between Western cultures, Islamic cultures, Hinduism, Confucianism, and Japanese traditions. Risk factors for suicide are identified including demographic, clinical, and precipitating factors. Specific factors related to youth suicide are also outlined.
The development of psychiatry in the arab worldWALID SARHAN
The document discusses the history and current state of psychiatry in the Arab world. It describes how Islamic hospitals (bimaristans) in the Middle Ages included sections for treating mentally ill patients. Notable early Muslim physicians and scholars like Rhazes and Avicenna made important contributions to the field. Today, most Arab countries have national mental health policies and legislation but resources and services remain limited. Rates of psychiatric disorders are high while numbers of psychiatrists, beds, and facilities are low in many areas. Efforts are being made to shift care from large institutions to community services.
Cultural aspects of depression in the arab worldWALID SARHAN
This document discusses cultural factors that influence depression in Arab populations. It notes that depression presentations may differ across cultures, with Arab/Muslim patients more likely to present with somatic symptoms rather than psychological ones. Religious and family influences are also discussed, as they can impact expression of distress, help-seeking behaviors, and views of illness causation. Specific symptom presentations found in some studies of Arab/Muslim depressed patients are also outlined.
This document appears to be a questionnaire about sexual knowledge, attitudes, and behaviors among single Jordanian men and married Jordanian women. It contains over 50 questions on topics like sources of sexual knowledge, views on sex education, masturbation, homosexuality, sexual practices, and perceptions of male and female sexuality. The questions were asked to gather information about the sexual mindsets and experiences of men and women in Jordan.
1) A study of mortality rates in patients with schizophrenia in Sweden found rates were 2-3 times higher than the general population, with suicide rates being particularly elevated.
2) Recovery from schizophrenia is possible for many patients with appropriate treatment, though a meta-analysis found only 13.5% of patients met strict recovery criteria.
3) Guidelines provide no clear consensus on the optimal duration of antipsychotic treatment for multi-episode schizophrenia. Long-term treatment aims to reduce relapse rates but risks include brain tissue reduction.
The document discusses several topics:
1. Baxdrostat, a new drug to treat resistant hypertension by inhibiting aldosterone synthase. It was well tolerated in trials and significantly lowered blood pressure.
2. Finerenone, a mineralocorticoid receptor antagonist approved to reduce kidney disease progression in type 2 diabetes. It has fewer side effects like hyperkalemia than existing drugs.
3. Zavegepant, the first intranasal CGRP receptor antagonist approved for acute migraine treatment. It provided pain relief within 2 hours and was generally well tolerated in trials.
4. New guidelines for gastroparesis diagnosis and management, recommending pharmacologic treatment like metoclopramide
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This document provides information on rheumatoid arthritis (RA) including its pathophysiology, epidemiology, clinical features, and treatment with disease-modifying antirheumatic drugs (DMARDs). RA is a chronic inflammatory disease that causes peripheral polyarthritis. Treatment involves non-biological DMARDs like methotrexate and sulfasalazine as well as biological DMARDs that target cytokines like TNF-α. Biological agents have improved treatment outcomes for RA by reducing joint damage and disability.
this article include useful information about antibiotic working in DNA inhibitor may direct action as sulfonamide or indirect action as fluroquinolone groups.
the presentation show mechanism of actions,uses , adverse effect ,also resistance and pharma-cokinetic properties of each drug.
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1. The document discusses various medications used to treat central vertigo such as antihistamines, benzodiazepines, corticosteroids, and diuretics.
2. It provides dosing guidelines for adults and pediatrics for many of these medications.
3. Most patients with central vertigo should be admitted to the hospital for further evaluation and treatment under a neurologist or neurosurgeon due to the serious nature of the underlying causes.
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Dapsone is an antibacterial drug used to treat leprosy, dermatitis herpetiformis, and other conditions. It works by inhibiting bacterial synthesis of dihydrofolic acid. Common side effects include nausea, headache, and rash. Severe side effects include methemoglobinemia and blood disorders. Dapsone is generally taken once daily but the dosage varies depending on the condition being treated and patient age. It can interact with other medications in ways that affect absorption or increase the risk of side effects.
To explain pathogenesis of Bipolar Disorders
To classify drugs used for treatment of Bipolar Disorders
To describe mechanism of action of drugs used for treatment of Bipolar Disorders
To enlist side effects of drugs used for treatment of Bipolar Disorders.
Indications: Bipolar, cyclothymia, schizoaffective, impulse control and intermittent explosive disorders.
Classes: Lithium, anticonvulsants, antipsychotics
Which you select depends on what you are treating and again the side effect profile.
1. The document outlines India's national policy for malaria control, which focuses on early detection and treatment of cases in communities through trained health workers. It also describes vector control strategies like indoor residual spraying and larviciding.
2. The treatment guidelines recommend chloroquine as first-line treatment, switching to ACT for resistant cases. Guidelines for treating uncomplicated and severe malaria are provided, along with dosages for different antimalarial drugs.
3. The policy emphasizes active community participation in control efforts and an integrated approach combining vector control with case management.
The document summarizes several newer antiepileptic drugs including levetiracetam, lacosamide, zonisamide, vigabatrin, rufinamide, and topiramate. It discusses their mechanisms of action, indications, dosages, advantages, side effects, drug interactions, and considerations for use in women. The newer AEDs have fewer drug interactions than older AEDs, unique mechanisms of action, and broader spectrum of activity against different seizure types.
As reproductive clinicians, it is important that the pathological relevance of hyperprolactinemia is established before commencing treatment for this endocrinological disorder.
Most cases of true hyperprolactinemia are associated with amenorrhea or hormone deprivation in premenopausal women and can be managed by dopamine agonist or hormone replacement therapy respectively
This document outlines prolactinomas, which are the most common functional pituitary adenomas. It discusses the epidemiology, clinical manifestations, diagnosis, and treatment of prolactinomas. Prolactinomas are most frequently diagnosed in women between ages 20-50 and are caused by a prolactin-secreting tumor in the pituitary gland. Diagnosis involves assessing clinical symptoms, serum prolactin levels, and MRI imaging of the pituitary. Medical treatment with dopamine agonists is the primary treatment, with cabergoline being the first-line therapy due to its effectiveness and safety. Surgery and radiation are reserved for cases where medical treatment is ineffective or for large macroadenomas.
This document discusses anti-tuberculosis drugs used to treat bone tuberculosis. It describes the standard Category I treatment regimen of 2 months of isoniazid, rifampin, pyrazinamide, and ethambutol, followed by 4 months of isoniazid and rifampin. While treatment duration was historically long, modern drugs achieve high bone concentrations and shorter regimens are effective. The document also details first-line drugs like isoniazid and rifampin and second-line drugs used to treat multidrug-resistant tuberculosis. Adverse effects and mechanisms of action are provided for each major anti-tuberculosis medication.
Pomalidomide (POMALYST) is indicated for the treatment of multiple myeloma in patients who have received at least two prior therapies including lenalidomide and bortezomib and have disease progression. It is dosed at 4 mg orally daily for 21 days of a 28-day cycle along with dexamethasone. Clinical trials demonstrated higher response rates when combined with low-dose dexamethasone compared to pomalidomide alone. Common adverse events included fatigue, neutropenia, anemia, and thrombocytopenia. Special precautions are required due to its teratogenic risks.
This document provides an overview of pharmacotherapy for Parkinsonism. It discusses the clinical features and etiology of Parkinson's disease and outlines the mechanisms and uses of various drug classes for treatment, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, and other drugs. Side effects and considerations for each class are also reviewed. Non-motor symptoms can be treated with additional drugs like antidepressants, anxiolytics, and atypical antipsychotics as adjunctive therapy.
This document provides information on the psychiatric aspects of cannabis use. It begins with definitions of cannabis, THC, and other cannabis derivatives. It then discusses the endocannabinoid system and its role in various physiological and neurological processes. The document compares THC and cannabidiol, describing their different binding properties, psychiatric effects, and approved medical uses. It discusses the effects of chronic heavy cannabis use on the endocannabinoid system and considers evidence regarding whether cannabis use can affect the developing brain, cognitive capacity, and motivation.
Obesity obesity and mental health 11-may-2015WALID SARHAN
Obesity is often associated with stigma and considered undesirable, while leanness is viewed as beautiful. There is a complex relationship between physical health and mental health in relation to obesity. Several studies have found that obese individuals have a higher risk of developing mental illnesses like depression and anxiety compared to normal weight individuals, and the relationship between obesity and mental illness appears to go both ways. Certain antidepressants and antipsychotic medications are also known to cause weight gain, which can further exacerbate the issue.
This Cochrane review summarizes evidence on interventions for smoking cessation and reduction in individuals with schizophrenia. The review finds that bupropion is effective for smoking cessation in patients with schizophrenia based on available evidence. No significant deterioration of mental state or increased seizure risk was found from bupropion use. Evidence for bupropion's effect on smoking reduction is inconclusive. The review also found some evidence supporting varenicline for smoking cessation in this population, though the evidence is limited compared to studies of bupropion.
This document provides information on FDA pregnancy drug labeling categories and discusses various antidepressant and other psychotropic medications. It describes the FDA categories A through X for evaluating risks of medications during pregnancy and lists common antidepressants along with their FDA categories. For each medication class, it summarizes potential risks to the fetus or newborn based on available studies. The document emphasizes making individualized treatment decisions and monitoring for potential neonatal side effects.
This document discusses cognitive behavioral therapy for treating Islamic religious obsessive compulsive disorder. It provides information on the prevalence of OCD, common religious rituals and symptoms in Islam that relate to OCD, and components of treatment including education, psychotherapy using CBT and exposure response prevention, and medication. Tailoring CBT to religious patients, such as using "guided prayer" is discussed, as well as avoiding compulsions and gaining relief through resistance rather than giving in to rituals.
This document discusses internet sex addiction and its impacts. Some key points include:
- Pornography consumption on the internet is widespread, with over 70% of porn traffic occurring during work hours and children as young as 11 being exposed.
- Sex addiction can negatively impact relationships, productivity, and mental health, with up to 15% of online porn users developing disruptive behaviors.
- The pornography industry generates over $97 billion in annual revenue worldwide, dwarfing other entertainment industries, yet prevalence estimates of sex addiction remain inconsistent due to lack of research funding.
Cognitive behavioral therapy is an effective treatment for Islamic religious obsessive compulsive disorder. It involves exposing patients to feared religious obsessions while preventing compulsions, to help reduce anxiety and compulsions over time. Religious rituals in Islam can relate to OCD symptoms, like repetitive washing and praying, so CBT techniques must be adapted sensitively while respecting patients' faith. The document discusses prevalence, symptoms, and treatments for religious OCD in Islamic cultures.
Lamotrigine is an antiepileptic drug approved for use in epilepsy, bipolar disorder, and other conditions. It is chemically unrelated to other AEDs and works by inhibiting sodium channels. Lamotrigine has a low risk of serious rash (under 1%) and is metabolized primarily through glucuronidation. It is effective for bipolar depression and as maintenance therapy to delay mood episodes. Slow titration reduces the risk of rash.
Sexual knowledge, attitude and behavior among marriedWALID SARHAN
1) A questionnaire on sexual knowledge, attitudes, and behavior was distributed to married Jordanian men, but many refused to participate or complete it. Of the 200 fully completed questionnaires obtained, most had low sexual knowledge.
2) While many supported sex education and discussing sexuality, attitudes towards topics like masturbation, premarital sex, and homosexuality were mixed or confused. A majority were uncertain in their responses.
3) The study results were limited due to non-random sampling and bias from excluding illiterate men. But they indicated many married Jordanian men have poor sexual knowledge and could benefit from more sex education and discussions on these sensitive topics.
Attitude knowledge & behaviour among physicians towardWALID SARHAN
A questionnaire was distributed to 115 physicians from various specialties in Jordan to assess their attitudes, knowledge, and behaviors regarding psychiatry. 100 questionnaires were completed and returned. The questionnaire included 30 questions on attitudes toward psychiatry, knowledge of psychiatric disorders and treatment, and how physicians would handle personal or family psychiatric issues. Results found that while most physicians believe in psychiatry, many have limited knowledge and concerns about confidentiality, social stigma, and compatibility with religion influence willingness to consult psychiatrists. Recommendations include increasing psychiatry education and continuing medical education, improving awareness efforts, and further research.
This document provides information about cannabis (also known as marijuana). It discusses the botanical classification of cannabis, the different varieties and methods of preparation (such as marijuana and hashish). It describes the main psychoactive component, THC, and how it works in the body. The document also covers the history of cannabis use, routes of administration, effects, risks, treatment for dependence, and potential medical uses.
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
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• Equipping health professionals to address questions, concerns and health misinformation
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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2. Newer Antiepileptic Drugs( Second- Generation ) Vigabatrin 1989 Gabapentin 1993 Lamotrigine 1994 Topiramate 1996 Tiagabine 1997 levetiracetam 1999 Oxcarbazepine 2000 (safety profile similar to CBZ). Hyponatremia is also problem, however it is less likely to cause rash than CBZ. Zonisamide 2000
3. Description Lamotrigine an AED of the phenyltriazine class, is chemically unrelated to existing AEDs. Its chemical name is 3,5-diamino-6-(2,3-dichlorophenyl)-as-triazine. Lamotrigine is a white to pale cream-colored powder . Lamotrigine is soluble in water .
4. Mechanism of action Lamotrigine inhibits voltage-sensitive sodium channels, thereby stabilizing neuronal membranes and consequently modulating presynaptic transmitter release of excitatory amino acids (e.g., glutamate and aspartate).
5. Metabolism Lamotrigine is metabolized predominantly by glucuronic acid conjugation; the major metabolite is an inactive 2-N-glucuronide conjugate. After oral administration ,94% was recovered in the urine and 2% was recovered in the feces.
6. INDICATIONS Epilepsy—adjunctive therapy in patients ≥2 years of age: partial seizures. primary generalized tonic-clonic seizures. generalized seizures of Lennox-Gastaut syndrome. Epilepsy—monotherapy in patients ≥16 years of age: conversion to monotherapy in patients with partial seizures who are receiving treatment with Carbamazepine, Phenobarbital, phenytoin, primidone, or Valproate as the single AED.
7. INDICATIONS Bipolar Disorder in patients ≥18 years of age: maintenance treatment of Bipolar I Disorder to delay the time to occurrence of mood episodes .
8. INDICATIONS Acute treatment of bipolar depression I, Maintenance treatment for rapid-cycling BP II (no antimanic properties) BP I recently manic or depressed
9. INDICATIONS Less effective for mixed episode, rapid cycling Borderline PD & schizoaffective disorder, also for migraine, impulsivity & compulsivity Bipolar II disorders, post traumatic stress disorder, Adjunctive therapy for "treatment-resistant" unipolar depression .
10. Indications The treatment of peripheral neuropathy, trigeminal neuralgia, cluster headaches, migraines, and reducing neuropathic pain.
11. NOTE Traditional anticonvulsant drugs are primarily antimanics, Lamitrogine is most effective in the treatment and prophylaxis of bipolar depression.
12. Bipolar I Depression:Lamotrigine Monotherapy Week 0 0.5 1 2 3 4 5 6 7 0 -2 *P < .05 vs placebo -4 -6 -8 MADRS Change From Baseline * -10 * -12 * * * -14 * * * Placebo -16 * Lamotrigine 50 mg/d -18 Lamotrigine 200 mg/d -20 Dose > 50 mg/d in lamotrigine 200 mg/d group only after week 3 Calabrese JR, et al. J Clin Psychiatry. 2002;63(suppl 3):5-9.
13. The Evidence for Lamotrigine in Rapid-Cycling Bipolar Disorder Lamotrigine monotherapy is useful treatment for some patients with rapid-cycling bipolar disorder Among patients with rapid-cycling bipolar disorder, 41% of lamotrigine patients vs 26% of placebo patients were stable without relapse for 6 months of monotherapy Overall survival time in study favored lamotrigine (6 weeks longer than placebo) Calabrese JR, et al. J Clin Psychiatry. 2000;61:841-850.
14. 2002 American Psychiatric Association guidelines Lamitrogine as a first-line treatment for acute depression in bipolar disorder as well as a maintenance therapy
15. Approach to the Patient WithBipolar Depression Is the patient already in treatment with amood stabilizer? Yes Then optimize the dose of the mood stabilizer Then add antidepressant No Then … APA Practice Guidelines Am J Psychiatry. 2002;159(4)supplement.
16. Approach to the Patient with Bipolar DepressionThen... For less severely ill patients initiate lithium or lamotrigine For more severely ill patients initiate lithium and an antidepressant For those with psychosis or at high suicide risk add antipsychotic ECT APA Practice Guidelines Am J Psychiatry. 2002;159(4)supplement.
17. Adverse Reaction Most common adverse reactions (incidence ≥10%) in adult epilepsy clinical studies were dizziness, headache, diplopia, ataxia, nausea, blurred vision, somnolence, rhinitis, and rash.
18. Adverse Reaction Additional adverse reactions (incidence ≥10%) reported in children in epilepsy clinical studies included vomiting, infection, fever, accidental injury, pharyngitis, abdominal pain, and tremor.
19. Adverse Reaction Most common adverse reactions (incidence >5%) in adult bipolar clinical studies were nausea, insomnia, somnolence, back pain, fatigue, rash, rhinitis, abdominal pain, and xerostomia.
20. Black box: WARNING: SERIOUS SKIN RASHES Cases of life-threatening serious rashes, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and/or rash-related death, have been caused by LAITROGINE. The rate of serious rash is greater in pediatric patients than in adults. Additional factors that may increase the risk of rash include : - coadministration with Valproate -exceeding recommended initial dose . -exceeding recommended dose escalation . Benign rashes are also caused by LAMITROGINE; however, it is not possible to predict which rashes will prove to be serious or life threatening. LAMITROGINE should be discontinued at the first sign of rash, unless the rash is clearly not drug related.
21. Risk factors Existing medical conditions. Viral infections, , human immunodeficiency virus (HIV) and systemic lupus erythematosus . Genetics. Carrying a gene called HLA-B12 is more susceptible to Stevens-Johnson syndrome
22. Causes of Stevens-Johnson syndrome Medication causes Anti-gout medications, such as allopurinol Nonsteroidal anti-inflammatory drugs . Anticonvulsants.
23. Causes of Stevens-Johnson syndrome Infectious causes Herpes (herpes simplex or herpes zoster) Influenza HIV Diphtheria Typhoid Hepatitis Other causes physical stimuli, such as radiation therapy or ultraviolet light.
24. Signs and symptoms of Stevens-Johnson syndrome include Facial swelling Tongue swelling Skin pain A red or purple skin rash that spreads within hours to days over the skin and mucous membranes, mouth, nose and eyes
30. Concomitant use of Lamitrogine and aripiperzole increases risk of Stevens-Johnson syndrome? Shen, Yu-Chiha b c; Chen, Shaw-Jia b; Lin, Chaucer C.H.a b c; Chen, Chia-Hsianga b c International Clinical Psychopharmacology: July 2007 - Volume 22 - Issue 4 - pp 247-248 doi: 10.1097/01.yic.0000224789.21406.81
31. RECENT MAJOR CHANGES Warnings and Precautions, Aseptic Meningitis 35 cases in children October 2010
32.
33. Carbamazepine, phenytoin, Phenobarbital, and primidone decrease Lamotrigine concentrations by approximately 40%.
34.
35. Dosing of Lamitrogine in adults & adolescents (once daily nocte) Week Daily dose (mg) 1 25 2 25 3 50 4 50 5 100 6 200 NB 50% dose with Valproate & 200% with Carbamazepine; caution if on birth control pills (increased during the active hormone days, but reduced during the off hormone days) Ref: Calabrese et al, J ClinPsychiat 2002, 63, 1012-1019
41. Plasma Levels A therapeutic plasma concentration range has not been established for Lamotrigine. Dosing should be based on therapeutic response
42. Tips for Using Lamotrigine Very slow titration reduces risk of rash (25 mg/day as starting dose; can increase to 50 mg/day at week three, 100 mg/day at week five, and 200 mg/day at week six) Risk of serious rash with Lamotrigine is under 1% and is comparable to risk with carbamazepine, phenytoin, and phenobarbital
43. Tips for Using Lamotrigine To avoid unrelated rash Patients should not try new medications, bath products, or foods during the first three months of Lamotrigine treatment Patients should not start Lamotrigine within two weeks of viral infection, rash, or vaccination
44. Summary of DSM-IV-TR Classification of Bipolar Disorders Bipolar DisorderNot OtherwiseSpecified Cyclothymic Bipolar II Bipolar I One or more major depressive episodes accompanied by at least one hypomanic episode FEMALE>MALE Bipolar features that do not meet criteria for any specific bipolar disorders At least 2 years of numerous periods of hypomanic and depressive symptoms* One or more manic or mixed episodes, usually accompanied by major depressive episodes MALE=FEMALE * Symptoms do not meet criteria for manic and depressive episodes. First, ed. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Rev. Washington, DC: American Psychiatric Association; 2000:345-428.
45. Bipolar Depression 50% of first bipolar episodes are depressive episodes Depressive episodes in bipolar disorder are associated with considerable morbidity and mortality Bipolar depressive episodes have a chronic course Goodwin FK and Jamison KR. Manic Depressive Illnessn
46. Bipolar Depression 80% of patients exhibit significant suicidality 60% of patients with dysphoric mania exhibit suicidality Depressive episodes dominate course of bipolar disorder (twice the amount of time as in mania) 25-30% of patients initially diagnosed with unipolar depression subsequently have a manic or hypomanic episode Goodwin FK and Jamison KR. Manic Depressive Illnessn
47. Bipolar Disorder > 50% alcohol and/or other substance abuse About 50% attempt suicide About 15% succeed 1Cookson J. Br J Psychiatry. 2001;178(suppl. 41): s148–s156. 2Strakowski SM, et al. Expert Opin. Pharmacother. 2003;4:751-760.
48. Predictors of Suicide in Bipolar Disorder High Impulsivity Alcohol and Substance Abuse DEPRESSION and MIXED Episodes History of Abuse in Childhood Exacerbated by incorrect treatment Akiskal. J Clin Psychopharmacol. 1996;16(suppl 1):4S-14S.
49. Treatment Challenges in Bipolar Disorder Often unrecognized Often untreated Often misdiagnosed Often inadequately treated Exacerbated by incorrect treatment Akiskal. J Clin Psychopharmacol. 1996;16(suppl 1):4S-14S.
50. Texas Implementation of Medication Algorithms initiative that made specific recommendations for patients presenting with hypomanic, manic, mixed episodes, or depressive episodes. TIMA
51. Stage 1: Monotherapy* 1ALithium, valproate, atypicals excluding olanzapine and clozapine Nonresponse:Try alternate monotherapy Stage 2: Two-drug combination*Lithium, valproate, atypical antipsychoticChoose 2 (not 2 atypicals, not aripiprazole or clozapine) Partial response or nonresponse:Further medical consult or referralfor other treatment options Partial response TIMA Algorithm for Treatment of Acute Manic Episodes 1B: Olanzapine†or carbamazepine† Response:Continue with therapy Response:Continue with therapy *Use targeted adjunctive treatment as necessary before moving to next stage. Agitation/Aggression─clonidine, sedatives; Insomnia─hypnotics; Anxiety─benzodiazepines, gabapentin. †All agents in Stage 1A and 1B are indicated for acute mania associated with bipolar I disorder. Safety and other concerns led to placement of olanzapine and carbamazepine as alternate first-stage choices. Suppes T, et al. J Clin Psychiatry. 2005;66:870-886.
52. TIMA Bipolar: Treatment of Acute Depressive Episodes (Stages 1–3) Response: Continue with therapy Response: Continue with therapy Partial response or nonresponse Partial response or nonresponsive Taking no antimanic, with history of severe and/or recent mania Taking no antimanic, without history of severe and/or recent mania Taking otherantimanic Taking Li Increase to ≥ 0.8 mEq/L (continue) Stage 1 Antimanic + LTG LTG Stage 2 OFCaor QTPa Stage 3 Combination from Li, LTG, QTP, or OFC aNote safety issue described in reference listed below (ie, olanzapine is associated with weight gain, quetiapine is associated with sedation and somnolence). Li = lithium; LTG = lamotrigine; OFC = olanzapine-fluoxetine combination; QTP = quetiapine. Suppes T, et al. J Clin Psychiatry. 2005;66:870-886.
53. Response: Continue with therapy Response: Continue with therapy Partial response or nonresponse Partial response or nonresponse TIMA Bipolar: Treatment of Acute Depressive Episodes (Stages 4–5) Stage 4 Li,LTGb, OFC, VPA, or CBZ + SSRIc, BUP, or VEN or ECT or QTP* Stage 5 MAOIs, tricyclics, pramipexole, other AAPsa, OXC, other combinations of drugs at stages, inositol, stimulants, thyroid aNote safety issue described in reference listed below (ie, olanzapine is associated with weight gain, quetiapine is associated with sedation and somnolence). bLamotrigine has limited antimanic efficacy and, in combination with an antidepressant, may require the addition of an antimanic. cSSRIs include citalopram, escitalopram, fluoxetine, paroxetine, sertraline, and fluvoxamine. *Evidence supported by randomized controlled clinical trials with large effect sizes. AAP = atypical antipsychotic; BUP = bupropion; CBZ = carbamazepine; CONT = continuation; ECT = electroconvulsive therapy; Li = lithium; LTG = lamotrigine; MAOI = monoamine oxidase inhibitor; OFC = olanzapine-fluoxetine combination; OXC = oxcarbazepine; QTP = quetiapine; SSRI = selective serotonin reuptake inhibitor; VEN = venlafaxine; VPA = valproate. Suppes T, et al. J Clin Psychiatry. 2005;66:870-886.
54. Evidence-based guidelines for treating bipolar disorder: revised second edition recommendations from the British Association for Psychopharmacology J Psychopharmacology 2009 23: 346 originally published online 27 March 2009
55.
56. Treatment with an antidepressant (e.g. selective serotoninreuptake inhibitor (SSRI) and an anti-manic agent (e.g. lithium, Valproate or an antipsychotic) together may be considered for patients with a history of mania
57.
58. It is not recommended for such patients because of the increased risk of switch to mania , and should be used with caution in patients with a history of hypomania .
59. If not already on an antipsychotic, consider adding an antipsychotic when patients have psychotic symptoms .
60.
61.
62. Psychotherapy Consider interpersonal therapy, cognitive behavior therapy or family-focused therapy (FFT) when available since these may shorten the acute episode
63.
64.
65. Choice of antidepressant The limited evidence supports the modest efficacy of antidepressants such as the SSRIs (specifically fluoxetine) in bipolar disorder . However, antidepressants should not be uncritically employed as first-line medicines given continuing doubts about relative efficacy and their potential to destabilize mood
66.
67. An ideal mood stabilizer would prevent relapse to either pole of the illness.
75. When the burden is depressive, Lamitrogine or quetiapine may be more appropriate
76.
77. Lamitrogine:Efficacy in Bipolar Disorder Placebo controlled 18-month trials of Lamotrigine and lithium – pooled analysis 8-16 week open label treatment with Lamotrigine or lithium before randomization: N = 191 for placebo N = 280 for Lamotrigine (100-400 mgs/d) N = 167 for lithium (0.8-1.1 mEq/L) 18-month maintenance treatment phase Both Lamotrigine and lithium superior toplacebo in preventing any mood episode Goodwin GM, et al;J Clin Psych 2004 Mar;65(3):432-441 Bowden CL, et al;Arch Gen Psych 2003 Apr;60(4):392-400 Calabrese JR, et al;J Clin Psych 2003 Sep;64(9):1013-1024
79. Background There is uncertainty about the efficacy of Lamotrigine in bipolardepressive episodes Aims To synthesize the evidence for the efficacy of Lamotrigine inbipolar depressive episodes Method Systematic review and meta-analysis of individual patient datafrom randomized controlled trials comparing Lamotrigine withplacebo.
80. Results Individual data from 1072 participants from five randomisedcontrolled trials were obtained. More individuals treated withlamotrigine than placebo responded to treatment on both theHamilton Rating Scale for Depression (HRSD) (relative risk(RR)=1.27, 95% CI 1.09–1.47, P=0.002) and Montgomery–ÅsbergDepression Rating Scale (MADRS) (RR=1.22, 95% CI 1.06–1.41,P=0.005). There was an interaction (P=0.04) by baseline severityof depression: lamotrigine was superior to placebo in peoplewith HRSD score >24 (RR=1.47, 95% CI 1.16–1.87, P=0.001)but not in people with HRSD score 24 (RR=1.07, 95% CI 0.90–1.27,P=0.445). Results Individual data from 1072 participants from five randomizedcontrolled trials were obtained. More individuals treated withLamotrigine than placebo responded to treatment on both theHamilton Rating Scale for Depression (HRSD) (relative risk(RR)=1.27, 95% CI 1.09–1.47, P=0.002) and Montgomery–ÅsbergDepression Rating Scale (MADRS) (RR=1.22, 95% CI 1.06–1.41,P=0.005).
81. There was an interaction (P=0.04) by baseline severityof depression:lamotriginewas superior to placebo in peoplewith HRSD score >24 (RR=1.47, 95% CI 1.16–1.87, P=0.001)but not in people with HRSD score 24 (RR=1.07, 95% CI 0.90–1.27,P=0.445).
82. Conclusions There is consistent evidence that Lamitrogine has a beneficialeffect on depressive symptoms in the depressed phase of bipolardisorder. The overall pool effect was modest, although theadvantage over placebo was larger in more severely depressedparticipants
83.
84. Switch to mania “Definite” switch involves fulfilling DSM-IV syndromic criteria for a manic, hypomanic, or mixed episode for at least 2 days, within 8 weeks of antidepressant introduction. 75
85. Switch to mania Recent literature suggests that the emergence of mania or hypomania can be reasonably attributed to antidepressant use in no more than 10% to 25% of patients with bipolar disorder
86. Switch to mania “Likely” switches call for at least 2 DSM-IV mania or hypomania symptoms plus a Young Mania Rating Scale (YMRS) score >12, occurring for at least 2 days, within 12 weeks of antidepressant introduction. 77
87. Switch to mania True antidepressant-induced polarity switches persist even after the medication is discontinued 78
88. Switch to mania The largest dataset on this topic—the randomized controlled data from Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)— found that the risk for treatment-emergent manic switch with paroxetine or bupropion was almost identical (about 10%) with or without an FDA-approved antimanic agent. 79
89. Switch to mania The largest dataset on this topic—the randomized controlled data from Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)— found that the risk for treatment-emergent manic switch with paroxetine or bupropion was almost identical (about 10%) with or without an FDA-approved antimanic agent. 80
90. Schneck CD, Miklowitz DJ, Miyahara S, et al. The prospective course of rapid-cycling bipolar disorder: findings from the STEP-BD. Am J Psychiatry. 2008;165:370-377 The use of antidepressants may increase a patient’s risk of rapid-cycling bipolar disorder. The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) included 1742 patients treated with a variety of approved medications for bipolar I and bipolar II disorder, and 32% reported having rapid-cycling at baseline. After 2 years of treatment, 5% still had rapid-cycling bipolar disorder. Those who were treated with an antidepressant were 3.8 times more likely to have rapid-cycling bipolar disorder.
91.
92. Lamotrigine has demonstrated efficacy and safety in a multicenter double-blinded, placebo-controlled study of 195 outpatients with bipolar I disorder, depressed3 1. Muzina DJ, et al. Acta Psychiatr Scand. 2005;111(suppl 426):21-28. 2. Kusumaker V, Yatham L. Psychiatry Res. 1997;72:145-148. 3. Calabrese JR, et al. J Clin Psychiatry. 1999;60:79-88.
93. Antidepressants for acute treatment of bipolar depression: A systematic review and meta-analysis JOURNAL OFCLINICAL PSYCHIATRY M.Sidor &G.MacQueen --October 2010 Conclusion: although antidepressants were found to be safe for the acute treatment of bipolar depression ,their lack of efficacy may limit their clinical utility. further high quality studies are required to address the existing limitations in the literature.
94. Altshuler L, Suppes T, Black D, et al. Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up. Am J Psychiatry. 2003;160:1252-1262 Guidelines state that patients with bipolar depression who are treated with an antidepressant should discontinue therapy within 3 to 6 months after achieving remission. However, discontinuation of antidepressants has been shown to cause depressive relapse in these patients.
95. Bipolar Disorder: Summary of Efficacy Evidence from RCTs Acute Mania MonoCombo AcuteDepression Maintenance Drug
97. Time to Intervention for a Mood Episode Lamotrigine vs Lithium vs Placebo LTG v. PBO, p < 0.001 Li v. PBO, p < 0.001 LTG v. Li, p = 0.629 18 Mon. 12 Mon. Index Manic or Depressed Goodwin et al., 2003 submitted
98. Median = 13 weeks Lamotrigine vs Lithium vs Placebo: Relapse Prevention, Maintenance Therapy 1 Li vs PBO, P = 0.029 LTG vs PBO, P = 0.029 LTG vs Li, P = 0.915 0.9 0.8 0.7 Median = 24 weeks 0.6 Median = 29 weeks Survival Estimate 0.5 Li (n = 46) 0.4 LTG (n = 59) 0.3 PBO (n = 70) 0.2 0.1 0 60 70 0 10 20 30 40 50 LTG = lamotrigine 100 to 400 mg daily Li = lithium 0.8–1.1 mEq/L PBO = placebo Week Time to Intervention for a Mood Episode Bowden CL, et al. Arch Gen Psychiatry. 2003;60:392-400.
99. Summary Lamotrigine is well established antiepileptic Lamotrigine is the second approved drug by FDA for the treatment of B.A.D Type 1. It is useful in the management of bipolar disorder specially the prevention of depressive episodes. It has the potential of helping unipolar depression.
100. Summary Skin rash does not mean always Stevens-Johnson syndrome . Drug interaction is very important .