This document summarizes a medication therapy management (MTM) session for a 93-year-old male patient with urinary incontinence. The patient was taking oxybutynin but experiencing anticholinergic side effects. The MTM team recommends switching the patient to the extended release formulation of oxybutynin or an alternative like mirabegron to address his symptoms and concerns about accidents when leaving home. Close monitoring is advised to ensure the new treatment improves the patient's quality of life.
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Angina pectoris is a syndrome characterized by sudden severe pressing substernal chest pain or heaviness radiating to the neck, jaw, back and arms.
Those drugs used to prevent, abort or terminate angina are anti angina drugs.
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Angina pectoris is a syndrome characterized by sudden severe pressing substernal chest pain or heaviness radiating to the neck, jaw, back and arms.
Those drugs used to prevent, abort or terminate angina are anti angina drugs.
The Interstitial Cystitis Association (ICA), a non-profit health association, hosted a Patient Forum in Atlanta on Sunday, August 23, 2009. This CDC-funded event offered healthcare providers, patients and caregivers a chance to meet with leaders in the field to learn more about interstitial cystitis - a severely painful and chronic bladder condition affecting an estimated 3 million women and 1 million men in the United States. Speakers included Dr. Jeffrey Proctor, Dr. Anna Kelly and Susan Bilheimer.
Pancreatitis is the Inflammation of the pancreatic parenchyma. Acute condition of diffuse pancreatic inflammation & auto digestion, presents with abdominal pain, and is usually associated with raised pancreatic enzyme levels in the blood &urine. this is a case study on acute pancreatitis describing factors such as patient demographic data , pharmacist intervention , pathophysiology , treatment , prevention , imaging techniques , diagnosis , lab investigation etc
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A seizure is a sudden, uncontrolled burst of electrical activity in the brain. It can cause changes in behavior, movements, feelings and levels of consciousness. Having two or more seizures at least 24 hours apart that don't have a known cause is considered to be epilepsy.
There are many types of seizures, and they have a range of symptoms and severity. Seizure types vary by where they begin in the brain and how far they spread. Most seizures last from 30 seconds to two minutes. A seizure that lasts longer than five minutes is a medical emergency.
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The Interstitial Cystitis Association (ICA), a non-profit health association, hosted a Patient Forum in Atlanta on Sunday, August 23, 2009. This CDC-funded event offered healthcare providers, patients and caregivers a chance to meet with leaders in the field to learn more about interstitial cystitis - a severely painful and chronic bladder condition affecting an estimated 3 million women and 1 million men in the United States. Speakers included Dr. Jeffrey Proctor, Dr. Anna Kelly and Susan Bilheimer.
Pancreatitis is the Inflammation of the pancreatic parenchyma. Acute condition of diffuse pancreatic inflammation & auto digestion, presents with abdominal pain, and is usually associated with raised pancreatic enzyme levels in the blood &urine. this is a case study on acute pancreatitis describing factors such as patient demographic data , pharmacist intervention , pathophysiology , treatment , prevention , imaging techniques , diagnosis , lab investigation etc
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A case study on migraine with folliculitis martinshaji
this case study on migraine with folliculitis , describes about the management, diagnosis ,patient counselling, pharmacist interventions , treatment of both migraine and folliculitis
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A case presentation on Seizure disorder and Drug.pptxSamiraBt3
A seizure is a sudden, uncontrolled burst of electrical activity in the brain. It can cause changes in behavior, movements, feelings and levels of consciousness. Having two or more seizures at least 24 hours apart that don't have a known cause is considered to be epilepsy.
There are many types of seizures, and they have a range of symptoms and severity. Seizure types vary by where they begin in the brain and how far they spread. Most seizures last from 30 seconds to two minutes. A seizure that lasts longer than five minutes is a medical emergency.
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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.
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
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
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The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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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
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
2. “I don’t want to worry about car trips longer
than 10 minutes!”
3. FS is a 93 year old man presenting at an MTM
session. FS was started on immediate release
oxybutynin 5 mg PO daily and 1 tablet 30
minutes prior to leaving the house 4 years ago to
treat urinary incontinence secondary to BPH.
Recently he has been taking ½ tablet PO at
bedtime. He is currently being treated with
tamsulosin 0.8 mg PO daily and finasteride 5 mg
PO daily for BPH symptoms with some
improvement. FS has an extensive medication list
and multiple disease states. The patient has been
struggling the last few years with apprehension
and worry leaving the house not knowing if a
bathroom will be close by.
5. Appendectomy
Cholecystectomy
Edentulous, full dentures
Angioplasty lower left leg
Bilateral cataract surgery
Partial colectomy - diverticulitis
6. Only child
Mother deceased age 34 Hodgkin’s
Lymphoma 1937, treated for a heart
condition for 2 years prior to death
Father deceased age 49 stroke or MI, can’t
recall which but he had atherosclerosis
7. Former smoker, cigarettes, pipes and cigars,
reports quitting 40-50 years ago
Drinks 1-2 1.5% abv beers at supper
Former US Marine
Metallurgist, still working 1 day a week
Widower 2008
2 children (1 daughter, deceased and one son
who currently lives with him)
9. warfarin 2 mg PO daily (2000)
amlodipine 5 mg PO daily with food (2000)
potassium chloride ER 10 mEq 2 tabs PO daily (1130)
paroxetine 40 mg tablet PO daily (0630)
finasteride 5 mg PO daily (1130)
simvastatin 10 mg PO daily (2000)
oxybutynin 5 mg ½ tab PO daily (2000)
captopril 25 mg PO TID 1 hr before meals avoid antacids (0600,
1030, 1900)
lorazepam 0.5 mg PO 1-4 x daily PRN
latanoprost 0.005% sol 1 gtt OU HS (2200)
furosemide 20 mg PO QAM (0630)
acetaminophen 325 mg 2 tabs PO q4h PRN pain
Tylenol PM® 500 mg (50mg diphenhydramine) 2 caplets PO HS
10. tamsulosin 0.4 mg 2 caps PO daily (2000)
erythromycin 5mg/gm ophthalmic ointment Apply a small
amount to lids BID PRN
vitamin B1 100 mg tab PO daily (0630)
vitamin B12 1,000 mg tab PO daily (1130)
vitamin C 500mg/D3 1,000 IU 1 tab PO daily (0630)
Prostate Health Essentials® 300 mg saw palmetto 1 tab PO daily
(2000)
Preservision® 1 cap PO daily (0630)
vitamin C with Rose Hips 500 mg 1 tab PO daily (1130)
omega 3 Fish Oil 1,250 mg (EPA 500 mg /DHA 650 mg) 1 cap PO
BID (0630, 1130)
acidophilus 1 cap PO daily (1130)
vitamin D3 2,000 IU 1 cap PO daily (0630)
Metamucil powder 1 tsp. PO mixed in 8 oz of water or juice BID
(0630, 2000)
11. ROS: not available
VS: WNL per viewing encounter notes from
primary care physician from 5/14/14 office
visit. Was unable to obtain this information
again since interviewing the patient.
We would like to know all of his vital signs.
13. “I don’t want to worry about car trips longer than
10 minutes!”
Initially prescribed 5 mg oxybutynin daily and ½
tab 30 minutes prior to leaving the house on
longer trips
Patient currently takes 2.5 mg PO daily HS
Treated for BPH with tamsulosin 0.8 mg PO daily
and finasteride 5 mg PO daily
FS feel “lousy” in the morning and complains of
dry mouth and other anticholinergic side-effects
FS “feels lethargic in the morning and takes all
morning to get going for the last 3-4 years”
14. No significant objective information
regarding specific patient complaint (patient
is apprehensive about going out in public and
having an accident)
15. FS is a 93 year old man generally well-controlled on his
current medication regimen. His chief complaint is a
significant annoyance affecting his quality-of-life. First line
therapy for urinary incontinence is lifestyle modification
such as fluid-diet management and second-line therapies
include anti-muscarinic medications and β3 adrenergic
antagonists.1 It is recommended that ER formulations are
used over IR formulations, if the drug is anticholinergic in
nature. Due to FS’s increasing age, and anticholinergic
symptoms especially when he wakes up, the following
should be addressed with the patient and his provider: the
time of day he takes his medication, the medication
formulation and MOA itself and life-style modifications he
can make to improve his symptoms. To ease the patient’s
concerns about having an accident when outside of his
pharmacy would like to recommend the patient begin
mirabegron 25 PO daily and D/C his oxybutynin.
16. Goals of therapy
◦ Teach the patient life-style changes like bladder
training, bladder control strategies, and fluid
management
◦ Improve symptoms of urinary incontinence
◦ Improve the patient’s quality-of-life
Treatment Plan
◦ Switch from and IR to an ER formulation of
oxybutynin if mirabegron not an option due to cost
◦ Recommend Myrbetriq® (mirabegron) 25 mg PO
daily a β3 adrenergic antagonist with no known
anticholinergic side effects, as an alternative to
oxybutynin
17. Monitoring parameters
◦ Efficacy and safety
Recommend FS use a diary to record how many times a day he uses the
rest room
See if drying symptoms improve with an ER formulation or with
mirabegron
◦ Plan for follow-up
Follow up in 2 weeks with PCP to see if symptoms have improved
Patient education
◦ Take your medication as prescribed and do not miss doses
◦ Stay hydrated but be conscious if your water pill (furosemide) is
not working well or if you have increasing edema in your legs
◦ Use the rest room often at scheduled intervals even if you do not
feel as though you need to urinate
◦ Do not take other anticholinergic drug like Tylenol PM® as they
will exacerbate your dry mouth and feelings of fogginess because
they contain the ingredient diphenhydramine, also known as
Benadryl®
18. • Chronic urinary incontinence related to enlarged
prostate as evident by urgency and frequency.
• Anxiety related to embarrassment as evidence by
increased apprehension
• Acute pain related to skin irritation as evidence by
restlessness
19. • Effect on lifestyle and self esteem
• Effect on skin integrity
• Increased risk for infection
• Increase risk for skin breakdown
• Increased anxiety
• Decreased socialization/increased isolation
20. • Schedule voiding times to reduce incontinence
• Restrict fluids 2 to 3 hours before bedtime
• Limit caffeine and alcohol intake (diuretics)
• Bring extra clothes on trips
• Use of adult absorbing pads
21. We all had a diverse discussion from varied
perspectives placing the needs of the patient first in
all instances
All group members interviewed our patient by phone,
patient and FS was grateful for the opportunity and
initial feedback
Our group worked well together – everyone was
professional, courteous and respectful
Optimal medication management therapy and non-
pharmacological strategies were discussed and
reviewed effectively between the two health
professions
With teamwork, communication and collaboration
between the two health professions we were able to
recommend a safe and effective patient-oriented plan
22. Gormley EA, Lightner DJ, Burgio KL, et al.
American Urological Association. Diagnosis
and treatment of overactive bladder (non-
neurogenic) in adults: AUA/SUFU guideline.
Updated June 11, 2013. Accessed May 29,
2014.