This document discusses drugs that affect the central nervous system, specifically those used for pain management. It defines different types of pain and discusses cultural considerations around pain. Opioid and nonopioid analgesics are explained, including mechanisms of action, dosing, effects, and nursing responsibilities. Specific drugs covered include morphine, fentanyl, meperidine, codeine, acetaminophen, aspirin, and naproxen. Risks of addiction, dependence, and toxicity are also addressed.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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!
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
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
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.
2. Pain
Defined as an unpleasant sensory and
emotional experience associated with either
actual or potential tissue damage.
Pain is what a client says it is.
Pain exists whenever the patient says it does.
3. Acute Pain
Pain that is sudden in onset, usually subsides
when treated, and typically occurs over less
than 6-week period of time.
4. Chronic Pain
Persistent or recurring pain that is often
difficult to treat. Typically lasts longer than 3
months.
6. Pain Tolerance
The amount of pain a client can endure
without it interfering with normal function.
7. Pain Source
Somatic pain: originates from skeletal
muscles, ligaments and joints.
Visceral pain: originates from organs and
smooth muscle.
Superficial pain: originates from skin and
mucous membranes.
8. Cultural Implications
Each culture has its own beliefs, thoughts,
and ways of approaching, defining, and
managing pain.
Prayer
Laying on of hands
Healers
9. Implications for Transcultural Nursing
Practice
Assessment of the type of intervention the
person desires.
Does the person wish traditional
interventions, expressions of nurturance and
compassion, psychological support, physical
interventions (soothing, having a brow wiped,
relaxation)? cultural support? medication? Or
a combination of these?
10. Cultural Groups and Pain
Stereotypes:
Mexican Americans have a low pain tolerance.
Italian Americans are very dramatic about their
pain
Jewish Americans complain a lot about pain.
African Americans report higher levels of chronic
pain and have a greater sensitivity to acute pain.
Asian Americans do not express their pain.
13. Nerve Pain Tincture
Recipe
1 tsp Saint Johns Wort (flowering top), skull cap
leaves, fresh oats & licorice root.
½ gtt each tincture
Ginger rhizome
Vervain leaves
14. Nursing Responsibilities
Do a thorough assessment that includes
questions about the patients cultural
background and practices is important in the
effective and individualized delivery of
nursing care.
15. JCAHO Pain Standards
The Joint Commission's 2001 pain
management standards state that every
patient has a right to have his or her pain
assessed and treated.
JCAHO standards dictate that a nurse will
evaluate the patients response to the pain
medication within 30 minutes to one hour
after administration of the pain medication.
19. Opioid Drugs
Originate from the opium poppy.
20 different alkaloids are obtained from the
unripe seed of the plant.
20. Opioid Analgesics
Powerful pain relievers.
Classified according to their chemical
structure and action.
Simple chemical modifications of the opium
alkaloids produce three different drugs.
morphine-like drugs
meperidine-like drugs
methadone-like drugs
21. Anesthetic Drugs
Strong opioid analgesics used in combination
with anesthetics during surgery.
fentanyl
sufentanil
alfentanil
Goal: not only to relieve pain but also to maintain
a balanced state of anesthesia.
22. General Anesthesia
Loss of sensation and usually of
consciousness without loss of vital functions
artificially produced by the administration of
one or more agents that block the passage of
pain impulses along nerve pathways to the
brain
23. Local Anesthesia
Loss of sensation in a limited and usually
superficial area especially from the effect of a
local anesthetic.
24. Fentanyl
Fentanyl injection has a rapid onset and short
duration.
Transdermal fentanyl patch is used for long-
term pain management.
26. Schedule II Drugs
Classification – Opioid analgesics
Morphine
Codeine – often used in combination with
acetaminophen – Tylenol with codeine
Hydrocodone – Vicodin - used in combination with
acetaminophen / aspirin / ibuprofen
Hydromorphine – Dilaudid - More potent than
morphine
Meperidine – Demerol
Oxycodone – Percocet (with acetaminophen) or
Percodan (with aspirin)
28. Contraindications
Known drug allergy
Severe asthma
Used with caution in:
Patients with severe head injuries (mask level of
consciousness or LOC)
Morbid obesity with sleep apnea (depress
respirations while asleep)
Paralytic ileus (bowel paralysis) – opioids tend to
slow bowel
29. Psychologic Dependence
Addiction: characterized by behaviors that
include one or more of the following:
Impaired control over drug use
Compulsive use
Continued use despite harm
Craving
30. Physical Dependency
Physiological adaption
Results in withdrawal symptoms when the
drug is discontinued.
Withdrawal symptoms include:
Mental agitation
Tachycardia
Elevated blood pressure
Seizures
31. Opioid Tolerance
State of adaption which results in reduced
effects of drug resulting on use of higher
dosing to get desired effect.
32. Toxicity
Opioid antagonist bind to occupy all the
receptor sites blocking the action of the opiod
drug.
nalaxone
naltrexone
33. Naloxone
Brand name: Narcan
Classification Pharmacologic: opioid antagonist
Classification Therapeutic: antidote for opioid
Action: Competitively blocks the effects of opioids,
including CNS and respiratory depression, without
producing any agonist (opioid-like) effects.
Therapeutic Effects: reversal of signs of opioid
excess.
35. Drug Calculation
The IV dose for naloxone (Narcan) is 0.02 to
0.2 mg q 2-3 minutes until response is
obtained.
Physician orders 0.1 mg
The drug is provided as 0.4 mg / mL
How much would you draw up to give the
appropriate dose? ____________
36. Morphine Sulfate
Classification Pharmacologic: Opioid agonist
Classification Therapeutic: opioid analgesic
Indications: severe pain (postoperative,
fractures, burns), pulmonary edema, and pain
associated with myocardial infarct (MI).
37. Morphine
Action: Binds to opiate receptors in the CNS.
Alters the perception of and response to
painful stimuli while producing generalized
CNS depression Therapeutic Effects:
decrease in severity of pain
Adverse Reactions: severe respiratory
depression, constipation
38. Morphine Effects
IV maximal analgesia and respiratory
depression would occur within 10 to 20
minutes
IM: within 30 minutes
Sub Q: 60 to 90 minutes
PO: peak activity occurs in about 60 minutes
* higher dosage needed due to metabolism of
drug in the liver
39. Morphine Dosing
Tablets come in 15 mg or 30 mg
Solution for IM, IV or sub Q: 10 mg/ml most
common
40. Medication Calculation
Physician order 6 mg of morphine sulfate q 3-
4 hours prn for severe pain.
The drug is provided as 10 mg / 1 mL.
How much of the drug would you need to
draw up the give the appropriate dose?
41. Nursing Responsibilities
Pain assessment
Base-line vitals
Re-assess vitals after pain med administered
Assess bowel function
Overdose: Narcan used to reverse
respiratory depression
Constipation: ambulate! dietary fiber, fluids,
stool softener
42. Meperidine
Therapeutic classification: opioid analgesic
Pharmacologic classification: opioid agonist
Schedule II drug
Action: Binds to opiate receptors in the CNS.
Alters the perception of and response to
painful stimuli, while producing generalized
CNS depression
Therapeutic effects: Decrease in severity of
pain.
43. Meperidine
Demerol is a synthetic drug with the same
uses and adverse effects as morphine.
Less nausea and vomiting.
Use with caution due to neurotoxic
metabolism with chronic use
CNS agitation (often exhibited as confusion)
Hallucinations
Tremors
seizures
44. Meperidine Dosing
IV or IM
Provided as 10 mg/mL, 50 mg /mL, 75
mg/mL or 100 mg/mL
Dosage for adults: 50 to 150 mg every 3-4
hours
Dosage for pediatrics: 1 to 1.8 mg / kg q 3-4
hours (not to exceed 100 mg dose)
45. Medication calculation
The physician order meperidine 75 mg prn q
3-4 hours for pain.
The vial provided is 50 mg / 1 mL.
How much of the mediation would you need
to draw up to give the appropriate dose?
46. Codeine
Classification Pharmacologic: opioid agonist
Classification Therapeutic: allergy, cold and
cough remedies, antitussives, opioid
analgesics
Schedule II drug
47. Codeine
Action: Binds to opiate receptors in the CNS.
Alters the perception of and response to
painful stimuli while producing generalized
CNS depression – decreases cough reflex –
decreases GI motility
48. Codeine
Side Effects: confusion, sedation,
hypotension, constipation
Nursing responsibilities - same as morphine
Evaluation of effectiveness:
Decrease in severity of pain without significant
alteration in level of consciousness
Suppression of cough
Control of diarrhea
49. Codeine Dosing
Usually supplied in combination with other
analgesics
Tylenol with codeine
Tylenol # 2 = 15 mg codeine + 300 mg Tylenol
Tylenol # 3 = 30 mg codeine + 300 mg Tylenol
Tylenol # 4 = 60 mg codeine + 300 mg Tylenol
Most often given po with food
Most common side-effect: constipation
50. Methadone
The drug of choice for detoxification
treatment for opioid addiction.
52. Acetaminophen
Action: blocks peripheral pain impulses by
inhibition of prostaglandin synthesis.
Indication: treatment of mild to moderate
pain.
Contraindications:
Drug allergy
Severe liver disease
G6PD disease
53. Toxicity
Ingestion of large amounts of
acetaminophen, as in acute overdose, or
even chronic unintentional misuse can cause
hepatic necrosis.
Acute ingestion of acetaminophen doses of
150 mg / kg or more may result in hepatic
toxicity.
54. Treatment
Acetylcysteine or Mucomyst
Action: Works by preventing the hepatotoxic
metabolites of acetaminophen from forming.
Initial loading dose of 140 mg / kg orally.
Followed by 70 mg / kg every 4 hours for 17
additional doses.
Note: if patient vomits within 1 hour the dose
should be given immediately.
All 17 doses must be given.
55. Drug Calculation
A teenage girl is admitted for Tylenol
overdose weight is 120 pounds.
Mucomyst is ordered at 140 mg / kg for the
lst dose.
Weight in kg ______
What dose would you give __________ in
mg?
What dose would you give ________ in
grams?
57. Inflammation
Localized protective response stimulated by
injury to tissues that serves to destroy, dilute,
or wall off both the injurious agent and the
injured tissue.
61. How do they work?
Anti-inflammatories worth by inhibiting the
leukotriene (LT) and prostaglandin (PG)
pathways.
Most NSAIDS act on one or both of the
pathways.
Two important enzymes: Cox 1 and Cox 2
(they have a role in maintaining
gastrointestinal mucosa.
62. Side Effects of NSAIDs
One of the more common complaints is
gastrointestinal distress
Heart burn
Gastrointestinal bleeding
64. Rheumatoid Arthritis
Systemic inflammatory disease often
effecting multiple joints. Involves
inflammation of the tissue surrounding the
joints that can lead to destruction of the joint.
Symptoms include pain, stiffness and
reduced range of motion.
Goal of drug therapy is to reduce the
symptoms – no cure
66. Drugs used in arthritis
Drugs:
Aspirin (has been placed by newer drugs due to
gastrointestinal bleeding)
NSAIDs
DMARDs (Disease-modifying antirheumatic
drugs)
67. Acetic Acid Drugs
Most widely knows: Aspirin
Aspirin (acetylsalicylic acid) was the first of
this drug classification (1899).
Other acetic drugs:
indomethacin (Indocin)
diclofenac (Voltaren, Cataflam)
68. Reyes Syndrome
The acetic classification of drugs (Aspirin) is
contraindicated in children.
Reyes syndrome is a neurological disease
process thought to be trigger by the use of
aspirin in children (flu and chickenpox).
Fever in children should always be managed
with acetaminophen (Tylenol).
70. Antirheumatic Drugs
Disease-modifying antirheumatic drugs
Drugs have a slow onset of action often
taking up to several weeks to see results.
A whole new group of IV meds have been
developed to control symptoms in patients
with multiple joint involvement.
71. Gout
When the body has to much uric acid, deposits
of uric acid crystals collect in tissue and joints
72. allopurinol
Trade name: Lopurin, Aloprim
Action: inhibits the production of uric acid.
Client teaching:
Advise patient to take with large glass of water.
Alcohol may decrease effectiveness of the drug