1) The document provides an overview of paracetamol (acetaminophen), including its history, pharmacokinetics, mechanism of action, toxicity, diagnosis, treatment, and prognosis.
2) It describes paracetamol's absorption in the small intestine, metabolism primarily in the liver, and excretion mainly through the kidneys. Toxicity can occur when a toxic metabolite, NAPQI, is formed and not detoxified.
3) Treatment for paracetamol overdose involves gastric decontamination, administration of the antidote N-acetylcysteine to replenish glutathione levels and prevent liver damage, and potentially hemodialysis or liver transplant for
Sean Kelly is an Emergency Physician and Intensivist who's the director at Gosford ICU in New South Wales. He's also the medical director at ICCMU. He gave this great talk at Bedside Critical Care 2012 on Daydream Island. He'll be at SMACC. Check out the ICCMU website.
Sean Kelly is an Emergency Physician and Intensivist who's the director at Gosford ICU in New South Wales. He's also the medical director at ICCMU. He gave this great talk at Bedside Critical Care 2012 on Daydream Island. He'll be at SMACC. Check out the ICCMU website.
this ppt deals with different types of drug interactions with examples and highlights important principles in monitoring drug therapy....for better understanding of complexity of multiple drug usage (polypharmacy)
this ppt deals with different types of drug interactions with examples and highlights important principles in monitoring drug therapy....for better understanding of complexity of multiple drug usage (polypharmacy)
Please find the power point on Paracetamol poisoning. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Anticonvulsants are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Charles Locock commented in the Lancet on his use of potassium bromide in 15 cases of "hysterical" epilepsy in young women. The next development was the serendipitous discovery of the anticonvulsant properties of phenobarbital by Alfred Hauptmann in 1912. This predated by more than 20 years the screening of potential therapeutic agents against "electrical seizures" in cats by Houston Merritt and Tracy Putnam. The result was the launching of phenytoin in 1938. Next came primidone, ethosuximide, carbamazepine and valproic acid, all of which can be regarded as first generation antiepileptic drugs (AEDs). Shortly after their synthesis, the benzodiazepines were rapidly recognised as having anticonvulsant activity. The modern era focused on the systematic screening of many thousands of compounds against rodent seizure models under the Anticonvulsant Drug Development Program in the US. This resulted in the global licensing, in chronological order, of vigabatrin, zonisamide, oxcarbazepine, lamotrigine, felbamate, gabapentin, topiramate, tiagabine, levetiracetam, pregabalin and lacosamide.
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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.
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
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
3. 1948
Discovery of
Paracetamol
1878 Two France Doctors.
Wrong medication for anti-parasite.
From Naphthalene-> Acetanilide.
Decrease body temperature
Side effect: Methemoglobinemia.
Germany doctor: Phenacetin.
Analgesic nephropathy
1948 Found N-acetyl-P-aminophenol
Co-Metabolite of Acetanilide
and Phenacetin
.
5. Pharmacokinetics
ABOSORPTION
• Good GI absorption: Oral Bioavailability 60-98%
• Main absorption at Small intestine
• Depend on gastric emptying time
• ↑Gastric emptying time ↓Absorption rate
• Example: Opioid
• 3 Main types
• Immediate-release : 30-45 mins in adult and
30 mins in ped syrups
• Extended-release : in 1-2 h and within 4 h
• Rectal route in pediatric : 107 mins to 5 hours
24. Tintinali’s Goldfrank’s Australia CPG
Single Dose
Adult>6 yrs >10 g, > 200 mg/kg >7.5 gm >10g, >200mg/kg
Child<6 yrs >200 mg/kg >150 mg/kg >200 mg/kg
RSTI
Adult>6 yrs >10g,>200mg/kg
in 24 h
>10g,>200mg/kg
in 24h
>10g,>200mg/kg
in 24 h
>6g,
>150mg/kg
in 24 h x 2days
>6g,
>150mg/kg
in 24 h x 2days
>12g,
>300 mg/kg
in 48 h
>60mg/kg[>4g] in48 h
+ clinical
Child<6 yrs
>200 mg/kg in 8h
>150 mg/kg
in 24 x2 days
>100 mg/kg/d in 72h Massive >= 30 g
25. Sign and symptom
Early recognition and treatment of patient with
Paracetamol poisoning are essential.
26. Risk stratification
Pediatrics
Normal child Risk ⇣
• Sulfation > adult
• Elixer Prep Add
propyleneglycol
⇣ NAPQI
Prolong use in
chronic illness
GSH↓Risk↑
Geriatrics
Paracetamol
metabolism is
Age-dependent
↑Age ,Risk↑
Pregnancy
Cross placenta
Fetal undeveloped
CYP enzyme
1st trimester :
Abortion
2nd trimester:
fetal Demise
Alcoholism
CYP2E1↑,
GSH↓
Risk↑ in RSTI
Normal Risk in
acute over dose
Or normal dose
Acute alcohol
ingestion
29. • Unknown, Uncertain time of ingestion
• Duration > 24 h
• Prior treat with NAC
• Modified-release paracetamol
• Intravenous paracetamol
• RSTI
Limitation of nomogram
Rumack-matthew nomogram
30.
31. Acetaminophen-Aminotransferase
multiplication product [APxAT]
< 1500 mg.IU/L
1500-10000 mg.IU/L
No need treatment.
Low risk
- Use AST or ALT which is higher
- If no paracetamol level use 5 instead
Possible
> 10,000 mg.IU/L Probable
Paracetamol level x AST/ALT
35. 02 Decontamination
No role of NG lavage
: rapid absorption
Activated charcoal
more benefit
Activated charcoal: 50 g in an adult
Awake and cooperative patients!
• Within 2 hours of ingesting a toxic dose.
• Within 4 hours of ingesting
1. ≥ 30 g of immediate- release paracetamol
2. toxic dose of modified-release paracetamol.
(Large dose: may be indicated up to 24 hours)
• Not indicated in children < 6 years!
37. 03 Enhance
Elimination
Hemodialysis Plasma
exchange Liver dialysis
Hemodialysis Plasma exchange Liver dialysis
Low Vd: Both Intermittent,
continuous CVVHD able to
Eliminate drug
Indication:
• Paracetamol level > 500
• Slow clearance in normal
treatment
Must increase dose NAC
during HD
• improve coagulopathy,
• minimal eliminate plasma
paracetamol level
• Not enough study
• MARS,SPAD
• Use in prior to Transplant
• Maintain hemodynamic
• Improve encephalopathy
38. 04 Specific
Antidote
Mechanism of action
• Improve hepatic sulfation
-> decrease serum paracetamol
• Precursor of glutathione synthesis
• Act as glutathione
• antioxidant ,decrease free radical
• increase oxygen delivery to mitochondria,
increase ATP
N-acetylcysteine(NAC)
39. 04 Specific
Antidote
2 Routes
• Oral route: 72 hours regimen
• 140 mg/kg(loading dose)
• then 70 mg/kg q 4 hours x 17 dose
• Total 1330 mg /kg
• Dilute in to 5% and mixed with soft drink
• Repeat dose if vomit within 1 hour
• IV Route
N-acetylcysteine(NAC)
40. 04 Specific
Antidote N-acetylcysteine(NAC)
Three-Bag regimen Two-Bag regimen
NAC
(mg/kg)
5%DW (mL)
Duration
IV drip in
NAC
(mg/kg)
5% glucose or
NSS
(mL)
Duration
IV drip in
Initial
150
mg/kg
200 mL 15-60 mins
200 mg/kg
(Max 22g)
500 mL
(เด็ก 7 mL/kg)
4 h
Second
50
mg/kg
500 mL
4 h 100 mg/kg
(Max 11g)
1000 mL
(เด็ก 14 mL/kg)
16 h
Third
100
mg/kg
1000 mL 16 h
Dosing should be based on actual body
weight rounded up to the nearest 10 kg,
with a ceiling weight of 110 kg.
Same efficacy: Decrease in side effect such as non-IgE mediated anaphylactic reaction or anaphylactoid
42. Updated guidelines for the
management of paracetamol poisoning
in Australia and New Zealand
- March 2020
43. New guideline
Acute ingestion
Immediate-Release
Modified-
Release
RSTI
Massive ingestion
Unknown time
Multiple ingestion
Massive ingestion.
Major changes in management in the guidelines:
• Two-bag acetylcysteine infusion regimen
• Massive overdose with double the nomogram line
should increased dose of acetylcysteine.
• All potentially toxic modified release should
receive a full course of acetylcysteine.
47. 04 Specific
Antidote
Multiple or staggered immediate release
paracetamol ingestions
• multiple or staggered paracetamol ingestions over more
than 2 hours for the purpose of deliberate self-harm
• be treated as per acute immediate release
• If the first paracetamol concentration was measured within
2 hours of the last ingested paracetamol dose, repeated
after 2 hours to ensure there is no ongoing absorption
Specific situation
48. 04 Specific
Antidote
Unknow time of ingestion
If the time of ingestion is unknown,
or clinician is not confident of the history of ingestion
it is safest to treat the patient as a delayed presentation.
recommendation is to follow the > 8 hours scenario in
Massive ingestion >= 30 g
If the concentration is double nomogram line
Increase second bag regimen
If triple nomogram: Consult toxicologist
Specific situation
49. 04 Specific
Antidote
Cessation of Acetylcysteine
if all the following criteria have been met:
• ALT or AST are decreasing
• INR < 2.0
• Patient clinically well
N-acetylcysteine(NAC)
52. 04 Specific
Antidote
Cessation of Acetylcysteine
if all the following criteria have been met:
• ALT or AST are decreasing
• INR < 2.0
• Patient clinically well
AND
For modified-release ingestions and those with an initial paracetamol
concentration greater than double the nomogram line:
paracetamol concentration < 10 mg/L (66 μmol/L)
N-acetylcysteine(NAC)
55. 04 Specific
Antidote
Pediatric (< 6 years) liquid paracetamol
ingestion
• Activated charcoal is not indicated in this group as liquid
preparations have rapid absorption.
• measured at least 2 hours post-ingestion
• If the 2 (to 4) hour concentration is below 150 mg/L (1000 μmol/L),
acetylcysteine is not required.
• If the 2-hour paracetamol concentration is greater than 150 mg/L
repeated 4 hours post-ingestion
and acetylcysteine commenced if this is ≥ 150 mg/L (1000 μmol/L).
Specific situation
56. 04 Specific
Antidote
Intravenous paracetamol medication errors
A clinical toxicologist or Poisons Information Centre should be
contacted regarding these cases.
Specific situation
57. The King’s college criteria
For paracetamol toxicity
The patient who met this criteria has
survival rate <20%
Immediate transplant must be perform.
• Arterial pH <7.3 or Lactate> 3.0
After adequate fluid resuscitate
Or all of the following
• Creatinine >= 3.3 mg/dL
• INR>6.5 or PTT > 100 sec
• Hepatic encephalopathy grade III, IV
Liver transplant
King’s college criteria
O r g a n d o n a t i o n
58. STOP TREATMENT WHEN MET THE CRITERIA
Consult psychiatrist in Suicidal case
AS SHOWN IN PREVIOUS SLIDE
GOLDFRANK’S CRITERIA
• Serum paracetamol cannot detected
• AST with in normal limit.
.
D I S P O S I T I O N
AFTER TREATMENT
D I S C H R A G E H O M E