Alzheimer's is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer's, individuals lose the ability to carry on a conversation and respond to their environment.
Alzheimer's is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer's, individuals lose the ability to carry on a conversation and respond to their environment.
Neurocognitive disorders includes : Delirium and Dementia.
This presentation focuses on causes, risk factors, management and how to prevent its complication
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Neurocognitive disorders includes : Delirium and Dementia.
This presentation focuses on causes, risk factors, management and how to prevent its complication
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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.
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.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
1. Dr. Nora D. Volkow, MD,
Director, National Institute on
Drug Abuse (NIDA) National
Institute of Health
2. Prescription Drug Abuse:
It s Not What the Doctor Ordered
April 10-12, 2012
Walt Disney World Swan Resort
Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse
3. Learning Objectives
Attendance at this presentation will give participants
a better understanding of:
• Recent increasing trends in the misuse and abuse of
prescription drugs as well as the growing number of opioid
and stimulant prescriptions being dispensed by retail
pharmacies in the U.S.
• The ways in which the most commonly abused prescription
drug classes affect the brain and body and the possible
deleterious consequences that can result from such use
and abuse.
• Strategies being developed and implemented that will increase
awareness of the growing problem, and research aimed at
identifying tools and interventions to most effectively
prevent and treat prescription drug abuse.
5. Pharmaceutical Drug Abuse is a
Major Problem in the US
Past Month Use
(Among Persons Aged 12 or Older) in Millions
Source: 2010 National Survey on Drug Use and Health, SAMHSA, 2011.
6. 2011 Monitoring the Future Study
Prevalence of Past Year Drug Use Among 12th graders
Drug Prev. Drug Prev.
Alcohol 63.5 OxyContin* 4.9
Marijuana/Hashish 36.4 Sedatives* 4.3
Synthetic Marijuana 11.4 Hall other than LSD 4.3
Amphetamines* 8.2 Inhalants 3.2
Vicodin* 8.1 Cocaine (any form) 2.9
Adderall* 6.5 LSD 2.7
Salvia 5.9 Ritalin* 2.6
Tranquilizers* 5.6 Ketamine 1.7
Cough Medicine* 5.3 Provigil 1.5
MDMA (Ecstasy) 5.3 GHB 1.4
Hallucinogens 5.2 Methamphetamine 1.4
* Nonmedical use Categories not mutually exclusive
7. Past Year Initiates of Specific Illicit Drugs
Among Persons Aged 12 or Older: 2010
Numbers in Thousands
Source: 2010 National Survey on Drug Use and Health, SAMHSA, 2011.
9. Dentists and Emergency Medicine Physicians were the
main prescribers for patients 5-29 years of age
5.5
million
prescrip8ons
were
prescribed
to
children
and
teens
(19
years
and
under)
in
2009
900
800
700
600
Rate
per
10,000
persons
GP/FM/DO
500
IM
400
DENT
ORTH
SURG
300
EM
200
100
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐39
40-‐59
60+
Age
Group
10. Eight-Fold Deaths
from Drug Overdoses 1971-2007
Source: CDC, Unintentional Drug Poisoning in
the US, National Vital Statistics System, 2010
11. Trends in ED Visits Involving the Nonmedical
Use of Narcotic Pain Relievers
Number of ED Visits
Source: 2008 (8/2009 update) SAMHSA DAWN
12. Number of Stimulant Prescriptions Dispensed by
U.S. Retail Pharmacies, Years 1991-2011
13. The use of stimulant
medications among
healthy individuals
for cognitive
enhancement is
increasing,
raising questions
not only about safety
but also its efficacy
across cognitive tasks
and individuals
14. Source of Prescription Drugs
(how they obtained the drugs they most recently used nonmedically)
Rates averaged across 2009 and 2010
Percent
Source: 2010 National Survey on Drug Use and Health, SAMHSA 2011.
15. Why Do People Abuse Prescription Drugs?
These prescription drugs, like other 1100
% of Basal Release
1000 AMPHETAMINE
drugs of abuse (cocaine, heroin, 900
800
marijuana) raise brain dopamine levels 700
600
500
400
Dopamine
300
200
frontal Neurotransmission
100
0
0 1 2 3 4 5 hr
cortex Time After Amphetamine
200 FOOD
% of Basal Release
nucleus VTA/SN 150
accumbens
100
Empty
50 Box Feeding
0
0 60 120 180
Time (min)
Di Chiara et al.
BUT dopamine is also elevated by
natural reinforcers
16. Drugs of Abuse Act on the Reward & Ancillary Circuits
Through Different Mechanisms…But All Lead to
Similar Dopaminergic Effects in the VTA & NAc
Nicotine
+
Opiates
Alcohol
Opioid
Glutamate inputs
- Peptides
(e.g., from cortex)
Opiates
Alcohol
VTA
GABA
?
Interneuron
- PCP
Alcohol
` -
? Stimulants
+
Nicotine
+ DA
DA
Glutamate
+ Cannabinoids
-
inputs
(e.g., from
amygdala
PPT/LDT)
Adapted from Nestler 2005.
18. Opioids
Examples: OxyContin, Vicodin
Activate Opiate Receptors,
How They Work… which Modulate Pain & Reward
Attach to opioid receptors in the
brain and spinal cord, blocking the
transmission of pain messages and Thalamus
(pain)
causing an increase in the activity NAc
(reward)
of dopamine Opiate Receptors
Activate Amydala
Dopamine Cells (reward)
Opioids are Generally Prescribed for:
• Postsurgical pain relief
• Management of acute or chronic pain
• Relief of coughs and diarrhea
20. Stimulants
Example: Ritalin
How They Work…
Enhance brain activity by increasing the activity of brain
excitatory chemical messengers, such as norepinephrine
and dopamine, leading to mental stimulation
Stimulants Are Generally Prescribed For:
• ADHD
• Narcolepsy
• Depression that does not
respond to other treatments
• Asthma that does not
respond to other treatment
21. CNS Depressants
Examples: Valium, Xanax
How They Work…
Cause an increase in gamma-aminobutyric acid
(GABA), an inhibitory chemical messenger leading
to a decrease in brain activity
CNS Depressants are Generally Prescribed for:
• Anxiety
• Tension
• Panic attacks
• Acute stress reactions
• Sleep disorders
• Anesthesia (at high doses)
22. Sedatives
Examples: Valium, Xanax, Librium
Activate the Same Receptor as Alcohol
Brain areas where activity is increased by
sedative drugs and by alcohol
Sedative Drug Alcohol
23. What is the Difference Between
Therapeutic Use and Abuse?
• Dose and Frequency of Dosing
Lower, fixed regimes vs higher, escalating use
• Route of Administration
Oral vs injection, smoking, snorting
• Expectation of Drug Effects
Expectation of clinical benefits vs euphoria high
• Context of Administration
School, clinic, home vs bar,
discotheque
26. Effects Depend on the Drug Pharmacokinetics—
How fast it gets into the Brain
[11C]Cocaine [11C]Methylphenidate
100 100
80 80
% Peak
60 60
40 40
20 20
"High"
"High"
0 0
0 10 20 30 40 50 60 70 80 0 10 20 30 40 50 60 70 80
Time (min)
27. When Used Therapeutically Drugs are Given Orally which
Results in Slow Brain Uptake When Abused Drugs are
Snorted or Injected which Results n Fast Brain Uptake
oral Ritalin
0.0035
0.003
0.0025
0.002
0.0015
Slow!!!
0.001
0.0005
00 20 40 60 80 100 120
Time (minutes)
0.06
iv Ritalin
Uptake in Striatum (nCi/cc)
Uptake in Striatum (%/cc)
0.05
0.04
0.03
0.02 Fast!!!
0.01
0
0 20 40 60 80 100 120
Time (minutes)
28. What is the Difference Between
Therapeutic Use and Abuse?
• Dose and Frequency of Dosing
Lower, fixed regimes vs higher, escalating use
• Route of Administration
Oral vs injection, smoking, snorting
• Expectation of Drug Effects
Expectation of clinical benefits vs euphoria high
• Context of Administration
School, clinic, home vs bar,
discotheque
29. Glucose Metabolism Was Greatly Increased
By the Expectation of the Drug
30
25
% Change
20
Unexpected MP 15
70
10
5
0
Expected MP
Unexpected
Expected MP
Got Placebo
Expected
MP
MP
Increases in Metabolism Were About
0
50% Larger When MP Was
µmol/100g/min Expected Than Unexpected
Source: Volkow, ND et al., Journal of Neuroscience,
23, pp. 11461-11468, December 2003.
30. What is the Difference Between
Therapeutic Use and Abuse?
• Dose and Frequency of Dosing
Lower, fixed regimes vs higher, escalating use
• Route of Administration
Oral vs injection, smoking, snorting
• Expectation of Drug Effects
Expectation of clinical benefits vs euphoria high
• Context of Administration
School, clinic, home vs bar,
discotheque
31. MP ability to increase DA is affected by the
rate of DA release; which makes its effects
Context Dependent
20
P < 0.05
MP-induced change in DA
15
10
low DA cell firing! high DA cell firing!
5
DA"
0
MP MP
Neutral Salient
DAT"
MP" Context Context
DA D2-R"
signal! signal!
32. Four-Fold Substance Use Disorder TX Admissions
Pain Relievers: 1998-2008
Source: SAMHSA Treatment Episode Data Set
(TEDS), 1998 and 2008.
34. Full and Partial Agonists vs Antagonists
Treatment Strategies for Opioid Addiction
antagonist
agonist
Full Agonist
(Methadone)
Opioid Effect
no effect
Partial Agonist
(Buprenorphine)
an antagonist drug is close
effect
enough in shape to bind to
the receptor but not close
an agonist drug has an
enough to produce an
active site of similar shape
effect. It also takes up Antagonist
to the endogenous ligand
receptor space and so (Naloxone)
so binds to the receptor
prevents the endogenous
and produces the same ligand from binding
Log Dose
effect
35. Buprenorphine for the Treatment of
Addiction to Opioid Medication
Subutex® -- Monotherapy product
Suboxone® -- Buprenorphine/Naloxone
Currently 19,000 physicians
are certified to prescribe buprenorphine
Related toCSAT Buprenorphine Information Center)
(Source: morphine (partial agonist)
Uses same receptors as morphine but does not
produce the same high
Can be abused, but combining with naloxone decreases
abuse potential
Long-lasting, less likely to cause respiratory depression
36. Medications to Treat Those Addicted
Specific Binding
Specific Binding
[18F]cyclofoxy (µ ligand)
[11C]carfentail (µ ligand)
Normal Control
Methadone Maintained Patient
27-47 % occupancy for 2mg Bup
30-35 % receptor occupancy for 85-92% occupancy for 16 mg Bup
methadone doses > 80 mg a day 94-98% occupancy for 32 mg Bup
Source: Kling et al., JPET, 2000.
Greenwald, MK et al., Neuropsychoph, 2003.
37. Need for New Medications
• Develop medications with lower abuse
Uptake in Striatum (nCi/cc)
0.0035
0.003
potential including drugs that don’t 0.0025
0.002
0.0015
Slow!
cross BBB (i.e., CbR2 agonist) 0.001
0.0005 !!
00 20 40 60 80 100 120
Time (minutes)
• Develop slow release formulations
(low dose and long duration)
• Develop novel formulations to reduce
abuse liability including mixture
formulations (e.g., naloxone
and buprenorphine)
38. How to Minimize the Diversion and
Abuse of Prescription Medications
39. Prevention Strategies - Training & Education
• Enhance clinical training for
physicians, nurses, dentists and
pharmacists in the areas of pain
management, opioid pharmacology
and abuse and addiction
40. Prevention Strategies – Public Education
• Increase patient, lay public, and
policy makers’ awareness of the
potential risks for abuse inherent
in all opioid analgesics
41. Take Back Programs
Maine model
– Postage paid medicine return
envelopes distributed across the state
– Disposal in compliance with state and
federal laws and sound environmental
practices
– 3850 envelopes returned (85%
prescription drugs)
– Psychotherapeutics made up 31%
of returns for individuals ages 50
and under
42. Prescription Monitoring Programs
• Statewide electronic database collects data on
substances dispensed in the state.
• Through the database, physicians and
pharmacies can identify patients who are
seeking multiple prescriptions.
• As of the summer of 2010, 34 states
had operational programs.
43. www.drugabuse.gov
Revised Jan 2012
Revised Dec 2011
Published Dec 2011 Revised Oct 2011