This document provides guidelines for the management and treatment of migraines. It discusses various drug options for acute/abortive treatment, preventative treatment, and treatment of refractory cases. It also addresses special considerations for medication overuse headache, menstrual migraine, and pregnancy-related migraine management. Non-pharmacological options including behavioral therapies and physical treatments are also summarized. Recent developments involving CGRP antagonists as a new drug class for migraine prevention are mentioned.
learning objective includes : pathogenesis,clinical features, classification of migraine, pharmacology about specific antimigraine drugs, coverage to newer triptan- Lasmiditan and newer prophylactic drug Erenumab a CGRP receptor antagonist.
learning objective includes : pathogenesis,clinical features, classification of migraine, pharmacology about specific antimigraine drugs, coverage to newer triptan- Lasmiditan and newer prophylactic drug Erenumab a CGRP receptor antagonist.
I am professionally pharmacist. These slides for clinical subject. Especially for pharmacy department students. I hope these students get more benefits about it.
Peripheral neuropathy is a side effect of some cancer treatments and can result in pain, tingling or numbness in the area affected. Consultant Medical Oncologist Shirley Wong presented on why it happens, risk factors and what can be done to help. A BreaCan presentation held at Sunshine Hospital on 25 August 2016.
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CONCEPT OF NODOPATHIES AND PARANODOPATHIES.pptxNeurologyKota
emergence of autoimmune neuropathies and role of nodal and paranodal regions in their pathophysiology.
Peripheral neuropathies are traditionally categorized into demyelinating or axonal.
dysfunction at nodal/paranodal region key for better understanding of patients with immune mediated neuropathies.
antibodies targeting node and paranode of myelinated nerves have been increasingly detected in patients with immune mediated neuropathies.
have clinical phenotype similar common inflammatory neuropathies like Guillain Barre syndrome and chronic inflammatory demyelinating polyradiculoneuropathy
they respond poorly to conventional first line immunotherapies like IVIG
This presentation briefs out the approach of dementia assessment in line with consideration of recent advances. Now the pattern of assessment has evolved towards examining each individual domain rather than lobar assessment.
This presentation contains information about Dementia in Young onset. Also it describes the etiologies, clinical feature of common YOD & their management.
Entrapment Syndromes of Lower Limb.pptxNeurologyKota
This presentation contains information about the various Entrapment syndromes of Lower limb in descending order of topography. It also contains information about etiology, clinical features and management of each of these entrapment syndromes with special emphasis on electrodiagnostic confirmation.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
migraine management guidelines )
1. Migraine
Management Guidelines
Dr. Rahi kiran. B
SR Neurology
GMC Kota
British Association for the Study of Headache September 2010
AAFP Guidelines 2011
Indian Medicine APICON update 2008- migraine therapy
The American Headache Society 2016
4. Drugs approved
First line drugs
• propranolol,
• timolol,
• amitriptyline,
• divalproex,
• sodium valproate,
• topiramate
Second line drugs
• gabapentin,
• dihydroergotamine,
• candesartan,
• lisinopril,
• atenolol, nadolol,
metoprolol,
• fluoxetine,
• verapamil, Flunarizine
• magnesium,
• riboflavin, coenzyme Q10,
• botulinum toxin type A,
5. Severity of attacks
• mild -can continue his or her usual activities with only
minimal disruption
• moderate -activities are significantly impaired
• severe -unable to continue his or her normal activities and
can function only with severe discomfort and impaired
efficiency
6. Question 1-Acute/Abortive
• first-line :
• mild to moderate
• moderate to severe
• Ergotamine- lower relapse rates, very poor bioavailability,side
effects
• C/I - opioids
Triptans
NSAIDs
7. Question 2-When to start treatment?
1. Recurring migraines, significantly interfere with ADL, despite
acute treatment (e.g., two or more attacks a month or
infrequent but produce profound disability)
2. Frequent headaches (more than 2 a week) or a pattern of
increasing attacks over time.
3. Contraindication or failure or Adverse events or overuse of
acute therapies
4. Patient preference
5. Presence of uncommon migraine conditions, including
hemiplegic migraine, basilar migraine, migraine with
prolonged aura, or migrainous infarctions
8. Question 3-What treatment to start?
• Initiate therapy with medications that have the highest level
of evidence-based efficacy with the lowest effective dose.
• Increase it slowly and give each drug an adequate trial of 2 to
3 months to achieve clinical benefit.
9. Question 4-Treatment of relapse
• Treatment of relapse within the same attack after initial effi
cacy-
• repeat same drug-if still- naproxen 500mg or tolfenamic acid
200mg
• Patients who consistently experience relapse-
• use drugs with less relapse rate - Naratriptan, eletriptan,
frovatriptan , Ergotamine, Naproxen, tolfenamic acid
10. Question 5 - Non responders
• Drug should be
tried in three attacks
Given for 6-8 weeks without side-effects
dose titrated before it is rejected for lack of efficacy
• Step one: simple oral analgesic ± anti-emetic
• Step two: rectal analgesic ± anti-emetic
• Step three: specific anti-migraine drugs
• Step four: combinations- 1 + 3 f/b 2 + 3
11. Other drugs used in prophylaxis
• limited or uncertain efficacy
• OnabotulinumtoxinA - licensed for prophylaxis of patients
with more than 15 headache days per month, of which at
least eight days are with migraine.
• Clonidine
• Verapamil MR 120-240mg bd
• Fluoxetine 20 - 40mg od
• co-enzyme Q10
• Transcranial magnetic stimulation
12. Question 6 - When to stop treatment?
• If after 3 to 6 months headaches are well controlled, consider
tapering or discontinuing treatment.
• Withdrawal is best achieved by tapering the dose over 2-3
weeks.
13. Question 7 - If complications occur?
• Patients with nausea and vomiting -sumatriptan
subcutaneously or as a nasal spray. (1/2 cc = 6 mg)
14. Question 7 - Dosages
• sumatriptan - 25 mg orally, increase the dose in increments of
50 mg to a maximum of 300 mg per day
• NSAIDs - aspirin 600-900mg, • ibuprofen 400-600mg
naproxen 750-825mg, • diclofenac-potassium 50-100mg
16. Question 8 - medication-induced
(rebound) headache
• use of triptans on 10 or more days a month or analgesics on
15 or more days a month is inappropriate for migraine and is
associated with a clear risk
• Taper the drug over weeks and use alternative
17. Question 9 - Status migranosus
• Fluids
• NSAIDs - Acetaminophen 1 gm IV, Naproxen , diclofenac 50 im,
ketorolac 30mgiv,
• Triptans- sumatriptan 6mg sc-best studied
• DHE - 1mg iv/im-
• Antidopaminergic Agents- iv metoclopramide, Prochlorperazine
and chlorpromazine (Level B)
• Corticosteroids-dexamethasone- should be offered to these
patients to prevent recurrence of headache (Should offer—Level B)
• Opioids- only to pregnant patients who are refractory to all
• Magnesium, propofol – unknown
• Lignocaine, opioid, octreotide - avoid
18. Question 10 - Contraindications
• Triptans - during the aura phase, within 24 hours of the
administration of DHE, cardiac risk factors, cardiac disease or
uncontrolled hypertension, pregnant
• Beta-blockers - asthma, chronic obstructive pulmonary
disease, insulin-dependent diabetes mellitus, heart block or
failure, or peripheral vascular disease.
• Calcium-channel -pregnant patients, hypotension, congestive
heart failure or arrhythmia
• Amitryptiline -severe cardiac, glaucoma, hypotension, seizure
disorder and use of a monoamine oxidase inhibitor.
20. Question 12 - Special situations
• Co-morbidity Drugs to be avoided
• Epilepsy Tricyclic antidepressants
• Depression β blockers
• Obesity Tricyclic antidepressants,
valproate
21. Question 13 - Pregnancy
• Avoid ergot, valproate, lisinopril and candesartan
• beta blockers, propranolol, topiramate, amitriptyline and
gabapentin (relative)
• Triptans- limited knowledge, so better to avoid
Children
• Trigger avoidance and simple analgesics
• No response-then-Propranolol-effective and approved
• Others-unknown
22. Question 14 - Menstrual migraine
• Acute - Same as for nonmenstrual attacks
• there is no concern regarding medication overuse unless used >
15days/ month
• Prophylaxis - tried for a minimum of three cycles at maximum
dose before it is deemed ineffective.
• Mefenamic acid 500mg tds - from the onset of menstruation
until the last day of bleeding.
• frovatriptan for 6 days (5mg bd on day 1; 2.5mg bd on days 2-6)
• Transdermal estrogen 7-day patch(50μg)
23. Question 15 - Migraine and hormones
• Combined hormonal contraceptives- contraindication
• Progestogen-only contraception is acceptable- no thrombotic risk
• HRT in menopause not contraindicated- no evidence that risk of
stroke is elevated or reduced by the use of HRT
29. • who have one or more of the following characteristics:
– Patient preference for nonpharmacologic interventions
– Poor tolerance to specific pharmacologic treatments
– Medical contraindications for specific pharmacologic
treatments
– Insufficient or no response to pharmacologic treatment
– Pregnancy, planned pregnancy, or nursing
– History of long-term, frequent, or excessive use of
analgesic or acute medications that can aggravate
headache problems (or lead to decreased responsiveness
to other pharmacotherapies)
– Significant stress or deficient stress-coping skills
Question 9- Non-pharmacologic therapy
