This document summarizes analgesics including opioids and NSAIDs. It discusses how opioids like morphine act on opioid receptors in the CNS to relieve pain and cause side effects like sedation and respiratory depression. NSAIDs like ibuprofen and aspirin inhibit prostaglandin synthesis to reduce inflammation and pain but can cause gastrointestinal side effects. Acetaminophen is also summarized as having weaker anti-inflammatory effects than NSAIDs due to peripheral inactivation, making it safer for patients at risk of NSAID side effects.
Overview of Discussion
Introduction
Which are the features of inflammation…?
Functional importance of eicosanoids and other chemical mediators
Pharmacological/physiological effects of inflammatory mediators
How PGs produce PAIN?
How PGs produces FEVER?
How PGs produces INFLAMMATION?
About NSAIDs...
Classification of NSAIDs
Mechanism of Action: NSAIDs
Pharmacology of Individual Class of NSAIDs
Choice of NSAIDs
Analgesic combinations
9. NSAIDS.pptxNSAIDS inhibit the enzyme cyclooxygenase (COX) types 1 and 2, w...samiyamohammed284
Renal
Renally produced prostaglandins (PGE2 and PGI2) are essential
in maintaining adequate renal perfusion when the level of circulating vasoconstrictors Platelets
Impaired platelet function (reduced aggregation).
as a result of decreased thromboxane A2 (TXA2) production.
TXA2 is present in large amounts in activated platelets and acts locally as a chemo-attractant for other platelets, leads to the formation of a platelet plug and induces localized vasoconstric
Overview of Discussion
Introduction
Which are the features of inflammation…?
Functional importance of eicosanoids and other chemical mediators
Pharmacological/physiological effects of inflammatory mediators
How PGs produce PAIN?
How PGs produces FEVER?
How PGs produces INFLAMMATION?
About NSAIDs...
Classification of NSAIDs
Mechanism of Action: NSAIDs
Pharmacology of Individual Class of NSAIDs
Choice of NSAIDs
Analgesic combinations
9. NSAIDS.pptxNSAIDS inhibit the enzyme cyclooxygenase (COX) types 1 and 2, w...samiyamohammed284
Renal
Renally produced prostaglandins (PGE2 and PGI2) are essential
in maintaining adequate renal perfusion when the level of circulating vasoconstrictors Platelets
Impaired platelet function (reduced aggregation).
as a result of decreased thromboxane A2 (TXA2) production.
TXA2 is present in large amounts in activated platelets and acts locally as a chemo-attractant for other platelets, leads to the formation of a platelet plug and induces localized vasoconstric
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
2. Pain:
Pain is a protective reflex for self-preservation
due to presence of tissue damage.
Analgesics: Medications that relieve pain
without causing loss of consciousness.
Alleviation of pain depends on the specific type of
pain (nociceptive or neuropathic pain).
For example, with mild to moderate arthritic pain
(nociceptive pain), non-opioid analgesics as non
steroidal anti-inflammatory drugs (NSAIDs) are often
effective.
However, for severe acute pain or chronic malignant
or nonmalignant pain, opioids can be considered as
part of the treatment plan in select patients.
3. Opioids analgesics
Opium: is the dried juice of the seed-head of opium
poppy.
Opioids are natural, semisynthetic, or synthetic
compounds that produce morphine-like effects.
Classification
• Strong (e.g. Morphine)
• Moderate (e.g. Codeine)
• Weak (e.g. Propoxyphene)
4. Mechanism of action: Opioids act by binding to specific
opioid receptors in the CNS to produce effects that mimic the
action of endogenous peptide neurotransmitters (as endorphins,
enkephalins, and dynorphins).
The major effects of the opioids are mediated by three main
receptor families, commonly designated as μ (mu), κ (kappa),
and δ (delta).
5. Systemic effects of opioid analgesics
1. Central nervous system: It cause Sedation, Respiratory
depression, Cough inhibition, Miosis, and powerful sense of
contentment and well-being (Euphoria) which may be caused
by disinhibition of the dopamine-containing neurons in the
brain.
2. Cardiovascular system: Peripheral vasodilatation leading to
hypotension, which benefit in acute myocardial infarction and
left ventricular failure by reducing pain, anxiety, and preload.
3. Gastrointestinal tract:
Reduced peristalsis and delayed gastric emptying (cause
constipation),
Directly stimulates the chemoreceptor trigger zone in the area
postrema that causes vomiting,
Constrict the sphincter of Oddi and thereby increase pressure
within the biliary tree (biliary spasm).
6. Clinical Uses
1. Analgesia (Codeine, morphine)
2. Cough Suppression (Codeine, Dextromethorphan)
3. Antidiarrheal (Diphenoxylate, Loperamide)
4. Acute Pulmonary edema (Morphine)
5. Anesthesia (Fentanyl)
Opioids relieve pain by raising the pain threshold at the
spinal cord level and by altering the brain’s perception of
pain.
Opioids relieves diarrhea by decreasing the motility and
increasing the tone of the intestinal smooth muscle. It also
increases the tone of the anal sphincter.
7. Adverse effects
1. CNS: Sedation, euphoria, dysphasia, respiratory
depression, pruritis, nausea and vomiting (Many of these
effects diminish as tolerance develops).
2. GIT: Constipation and dry mouth ( lead to dental caries)
are more resistant to tolerance and remain problems.
3. Tolerance: Repeated use produces tolerance to the
respiratory depressant, analgesic, euphoric, emetic, and
sedative effects of opioids.
4. Physical dependence: Physical and psychological
dependence can occur with all opioids.
Withdrawal produces a series of autonomic, motor, and
psychological responses that can be severe, although it is
rare that withdrawal effects cause death.
10. NSAIDs and Prostaglandin (PG) synthesis inhibition
NSAIDs are a group of chemically dissimilar agents that differ in their
antipyretic, analgesic, and anti-inflammatory activities.
NSAIDs act through inhibition of the synthesis of prostaglandins.
They act primarily by inhibiting the cyclooxygenase enzymes that
leads to decreased prostaglandin synthesis with both beneficial and
unwanted effects.
Functions of PGs vary depending on the tissue and the specific
enzymes at that particular site.
For example, release of thromboxane A2 (TXA2) from platelets
triggers aggregation and local vasoconstriction.
However, prostacyclin (PGI2), from endothelial cells, has opposite
effects, inhibiting platelet aggregation and producing vasodilation.
Prostaglandins, prostacyclin (PGI2), and thromboxane A2(TXA2) are
produced from arachidonic acid by the enzyme cyclooxygenase.
11. Inhibition of COX-2 is thought to cause the anti-
inflammatory and analgesic actions of NSAIDs, whereas
inhibition of COX-1 is responsible for preventing
cardiovascular events & other events.
12. Classification of NSAIDs
A. Non-selective COX inhibitors (traditional NSAIDs)
1. Salicylates: Aspirin
2. Propionic acid derivatives: Ibuprofen, Naproxen,
3. Anthranilic acid derivative: Mefenamic acid
4. Aryl-acetic acid derivatives: Diclofenac.
5. Oxicam derivatives: Piroxicam.
6. Indole derivative: Indomethacin.
B. Preferential COX-2 inhibitors: Meloxicam.
C. Selective COX-2 inhibitors: Celecoxib.
D. Analgesic-antipyretic with poor anti-inflammatory action:
Paracetamol
13. Action of NSAIDs:
1. Anti-inflammatory effect: due to the inhibition of the
enzymes that produce cyclooxygenase, or COX.
2. Analgesic effect: The analgesic effect of NSAIDs is thought to
be related to:
The peripheral inhibition of prostaglandin production
May also be due to the inhibition of pain stimuli at a
subcortical site.
3. Antipyretic effect: The antipyretic effect of NSAIDs is
believed to be related to:
Inhibiting production of PGs in the hypothalamus,
“Resetting” of the thermoregulatory system, leading to
vasodilatation and increased heat loss.
14.
15. Adverse effects:
Because of the adverse effects profile, it is preferable to use NSAIDs
at the lowest effective dose for the shortest duration possible.
1. Gastrointestinal: ranging from dyspepsia to bleeding & peptic ulcer.
NSAIDs should be taken with food or fluids to diminish GI upset.
2. Renal effects: NSAIDs may result in retention of sodium and water
and may cause edema.
3. An increased risk for cardiovascular events, MI and stroke may be
associated with the use of any NSAIDs except aspirin.
4. CNS effects, such as headache, tinnitus & dizziness, may occur.
5. Allergy including urticaria, bronchoconstriction, and angioedema.
NSAIDs should be used with caution in patients with asthma.
6. Teratogenicity: NSAIDs should be used in pregnancy only if benefits
outweigh risks to the developing fetus. In the third trimester, NSAIDs
should generally be avoided due to the risk of premature closure of the
ductus arteriosus.
16. Acetaminophen
Acetaminophen inhibits prostaglandin synthesis in the CNS,
leading to antipyretic and analgesic effects.
Acetaminophen has less effect on cyclooxygenase in peripheral
tissues (due to peripheral inactivation), which accounts for its
weak anti-inflammatory activity.
Acetaminophen does not affect platelet function or increase
bleeding time. It is not considered an NSAID.
Therapeutic uses
Acetaminophen is used for the treatment of fever and the relief
of pain.
It is useful in patients with gastric risks with NSAIDs and those
who do not require the anti-inflammatory effect of NSAIDs.
Acetaminophen is the analgesic/antipyretic of choice for
children with viral infections or chickenpox (due to the risk of
Reye syndrome with aspirin).