This presentation is made for students of Pharmacology and Medicine to apprise them of the basic features of Parkinson's Disease and evolution of its drug treatment strategies. Important drugs used in Parkinso's Disease are described. Marketing and Sales teams of pharmaceutical companies may also find it useful.
Anti-depressant drugs. Dr. Ashok Kumar Batham,M.D.,DrAshok Batham
This presentation gives a broad and comprehensive overview of anti-depressants. Mono-aminergic theory of depression which forms the basis of development of anti-depressant drugs is given along with the history of development of these drugs. Subsequently, mechanism-based classification, uses, efficacy and general adverse effects of anti-depressants are systematically described. Hopefully, this slide-share would be useful to medical students and also to those studying clinical pharmacy, and undergoing basic training in pharmaceutical marketing.
This comprehensive presentation is aimed at opening the window to the knowledge of Anti-epileptic Drugs (AEDs). It provides a very useful mechanism-based classification explaining the mechanisms of action and therapeutic applications of AEDs. Common problems associated with AEDs and important pharmacokinetic features of these drugs are described. Salient features of the available AEDs are described.
Antidepressants: Mechanisms based classification & challenges in therapeutic ...DrAshok Batham
Mechanisms based classification & challenges in therapeutic applications. Hopefully it would be useful to medical students and also students of pharmacy, Ayurveda, homeopathy studying pharmacology.
Anti-depressant drugs. Dr. Ashok Kumar Batham,M.D.,DrAshok Batham
This presentation gives a broad and comprehensive overview of anti-depressants. Mono-aminergic theory of depression which forms the basis of development of anti-depressant drugs is given along with the history of development of these drugs. Subsequently, mechanism-based classification, uses, efficacy and general adverse effects of anti-depressants are systematically described. Hopefully, this slide-share would be useful to medical students and also to those studying clinical pharmacy, and undergoing basic training in pharmaceutical marketing.
This comprehensive presentation is aimed at opening the window to the knowledge of Anti-epileptic Drugs (AEDs). It provides a very useful mechanism-based classification explaining the mechanisms of action and therapeutic applications of AEDs. Common problems associated with AEDs and important pharmacokinetic features of these drugs are described. Salient features of the available AEDs are described.
Antidepressants: Mechanisms based classification & challenges in therapeutic ...DrAshok Batham
Mechanisms based classification & challenges in therapeutic applications. Hopefully it would be useful to medical students and also students of pharmacy, Ayurveda, homeopathy studying pharmacology.
Introduction to Neuro Degenerative Diseases, Neurodegenerative diseases, Parkinson Disease, Alzhimer’s Disease, Newer Drugs
Presented by
K. THANMAYA DIVYA
Department of Pharmacology
It contains classification, SAR, MOA, metabolism and usd of hypnotics and sedatives. Barbiturates and benzodiazepines were discussed as per PCI syllabus. This helps B.Pharm students to learn with focus
TCAs increase neurotransmitter levels by preventing nerve endings — called synapses — from drawing these chemicals back into their tissues, which is normally how the body reduces their concentrations. They increase levels of norepinephrine and serotonin, two neurotransmitters, and block the action of acetylcholine, another neurotransmitter, this helps nerve signalling in the brain, which can help relieve depression. Tricyclic antidepressants are most effective for people with severe depression compared with those with mild to moderate depression, but they are also given as alternatives to SSRIs (selective serotonin re-uptake inhibitors) and are sometimes used in panic disorder, obsessive compulsive disorder and the treatment of chronic pain.
Parkinson’s disease is a progressive disorder of the nervous system that, in the early stages, is characterized by mild signs that are often missed. These signs can be remembered by the mnemonic “SMART”
S = Shuffling-Gait
M = Mask-like Face
A = Akinesia
R = Rigidity
T = Tremor
Anti-anxiety Drugs:Benzodiazepine Receptor Agonists. Dr. Ashok Kumar Batham, ...DrAshok Batham
This presentation titled “Anti-anxiety Drugs: Benzodiazepine Receptor Agonists” includes the pharmacological actions, mechanism of actions, pharmacokinetics, and clinically relevant classifications of Benzodiazepines. Non-Benzodiazepine drugs acting through Gaba-ergic benzodiazepine receptors are also described comprehensively.
Benzodiazepine receptor antagonist, flumazenil, used as an anti-dote in poisoning is also described.
Hopefully, students of pharmacology and medicine in medical and pharmacy colleges will find it useful. Marketing and sales teams of pharmaceutical companies may also find this presentation useful from the point-of-view of understanding their products in proper perspective.
Introduction to Neuro Degenerative Diseases, Neurodegenerative diseases, Parkinson Disease, Alzhimer’s Disease, Newer Drugs
Presented by
K. THANMAYA DIVYA
Department of Pharmacology
It contains classification, SAR, MOA, metabolism and usd of hypnotics and sedatives. Barbiturates and benzodiazepines were discussed as per PCI syllabus. This helps B.Pharm students to learn with focus
TCAs increase neurotransmitter levels by preventing nerve endings — called synapses — from drawing these chemicals back into their tissues, which is normally how the body reduces their concentrations. They increase levels of norepinephrine and serotonin, two neurotransmitters, and block the action of acetylcholine, another neurotransmitter, this helps nerve signalling in the brain, which can help relieve depression. Tricyclic antidepressants are most effective for people with severe depression compared with those with mild to moderate depression, but they are also given as alternatives to SSRIs (selective serotonin re-uptake inhibitors) and are sometimes used in panic disorder, obsessive compulsive disorder and the treatment of chronic pain.
Parkinson’s disease is a progressive disorder of the nervous system that, in the early stages, is characterized by mild signs that are often missed. These signs can be remembered by the mnemonic “SMART”
S = Shuffling-Gait
M = Mask-like Face
A = Akinesia
R = Rigidity
T = Tremor
Anti-anxiety Drugs:Benzodiazepine Receptor Agonists. Dr. Ashok Kumar Batham, ...DrAshok Batham
This presentation titled “Anti-anxiety Drugs: Benzodiazepine Receptor Agonists” includes the pharmacological actions, mechanism of actions, pharmacokinetics, and clinically relevant classifications of Benzodiazepines. Non-Benzodiazepine drugs acting through Gaba-ergic benzodiazepine receptors are also described comprehensively.
Benzodiazepine receptor antagonist, flumazenil, used as an anti-dote in poisoning is also described.
Hopefully, students of pharmacology and medicine in medical and pharmacy colleges will find it useful. Marketing and sales teams of pharmaceutical companies may also find this presentation useful from the point-of-view of understanding their products in proper perspective.
It may contain a brief intoduction of disease, etiology, types of parkinson disease, clinical findings, dignosis, pathophysiology, treatment, drug classification and their mechanisms of actions.
A disorder of the central nervous system that affects movement, often including tremors.
Nerve cell damage in the brain causes dopamine levels to drop, leading to the symptoms of Parkinson's.
Parkinson's often starts with a tremor in one hand. Other symptoms are slow movement, stiffness and loss of balance.
Treatment consists of medications to increase dopamine.
Anti epileptic drugs used for non-epileptic disorders : Dr. Ashok Kumar BathamDrAshok Batham
This presentation highlights the uses of anti-epileptic drugs in non-epileptic disorders, such as painful neuropathies like diabetic polyneuropathy, post-herpetic neuralgia, sciatic pain with spinal cord disease, trigeminal neuralgia; bipolar disorder; generalised anxiety disorder; cardiac arrhythmias, migraine prophylaxis; obesity etc. It would be useful to students of pharmacology studying in medical, pharmacy, Ayurvedic and homeopathic colleges, and those working in pharmaceutical industry.
Anti-epileptic Drugs : Applications Outside Epilepsy
(Reverse Engineering)
Anti-epileptic Drugs are Approved and Used Outside Epilepsy. Phenytoin, Carbamazepine, and Oxcarbazepine have proven efficacies in Trigeminal Neuralgia.
Gabapentin and Pregabalin are established in the treatment of postherpetic neuralgia (PHN) and painful diabetic neuropathy (PDN).Divalproex sodium is approved for use in the treatment of bipolar disorder and prevention of migraine.
Overlapping pathophysiology of some disorders and mechanisms of action of many Anti-epileptic Drugs : Applications Outside Epilepsy
(Reverse Engineering)antiepileptic drugs are evidently responsible for the applications of anti-epileptic drugs (AEDs) in clinical conditions outside epilepsy.
New drug candidates will, therefore, be developed for both the sets of therapeutic applications (epilepsy and outside epilepsy).
Hypnotics : Based on New Concepts (orexin/hypocretin antagonism, melatonin ag...DrAshok Batham
This slide share is all about the sleeping-pills available to the practitioners of modern medicine. Hypnotics, the drugs used to treat insomnia (difficulty in falling asleep, staying asleep, frequent awakenings in the night, morning awakening without feeling fresh) are described with special reference to drugs based on New Concepts (orexin/hypocretin antagonism, melatonin agonism, GABA-agonism) in the back-drop of old drugs. This way all the hypnotic drugs, including the new as well old, and drugs having sedating effects, such as, some anti-histaminics, used in insomnia, are included in this presentation, with the hope that medical students and those studying pharmacology in pharmacy and ayurvedic colleges will find it useful.
Depressive Disorders: An Overview of Full Spectrum. Dr. Ashok Kumar Batham.DrAshok Batham
Medical specialists outside the area of psychiatry and those who practice family medicine generally get fragmented information about mental depression. Therefore, an endeavour has been made to provide a complete overview of various depressive disorders, such as, Major Depressive Disorder (MDD), Persistent Depressive Disorder (PDD) or Dysthymia, Disruptive Mood Dysregulation Disorder (DMDD), Premenstrual Dysphoric Disorder (PMDD), Substance/Medication Induced Depressive Disorder, Depressive Disorder Due to Another Medical Condition, and other depressive disorders. DSM-5 diagnostic criteria of each of these disorders are given along with vignettes of diagnosis and treatment of the same are presented. Hopefully, this slide share will help non-psychiatrists to understand the complete spectrum of depressive disorders.
Anti-migraine drugs. Dr. Ashok Kumar Batham,MB,BS,MD,DCR, DrAshok Batham
This presentation on Migraine and Anti-Migraine Drugs provides a comprehensive description of migraine including its symptomatology and pathophysiology. On the basis of these aspects drugs used in the treatment of migraine are described with special emphasis on ergotamines and tryptans.
Hopefully, students of pharmacology and medicine in medical and pharmacy colleges will find it useful. Marketing and sales teams of pharmaceutical companies may also find this presentation useful from the point-of-view of understanding their products in proper perspective.
Bioequivalence study Exemptions- and Waivers:Ashok Kumar Batham.ashokpharmaco...DrAshok Batham
BIOEQUIVALENCE STUDY: EXEMPTIONS AND WAIVERS
This presentation is based on:
1. Waiver of In Vivo Bioavailability and Bioequivalence Studies for Immediate-Release Solid Oral Dosage Forms Based on a Biopharmaceutics Classification System Guidance for Industry
U.S. Department of Health and Human Services Food and Drug Administration
Center for Drug Evaluation and Research (CDER).December 2017. Biopharmaceutics.
2. ICH guideline Q3D M9 on biopharmaceutics classification system based biowaivers
EMA/CHMP/ICH/493213/2018
3. Guidelines For Bioavailability & Bioequivalence Studies
Central Drugs Standard Control Organization, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, New Delhi.
(March 2005)
Objectives of this presentation:
Understand the drug regulatory requirements for:
Conducting Bioequivalence Study or
Not Conducting Bioequivalence Study for obtaining regulatory marketing authorization for pharmaceutical formulations,
Bioequivalence studies are required or mandatory for certain formulations,
Exemptions are available for Bioequivalence Studies on certain formulations,
Waivers are granted by drugs regulatory authorities in certain cases, like Biopharmaceutical Classification System (BCS) Class-I and Class-III, Pharmaceutical Drugs, and some drug products with high safety margin,
Propose a clinical classification system-Biotherapeutics Classification System (BTCS) based upon:
Bioavailability of pharmaceutical drug, and
Clinical Safety Margin of pharmaceutical drug
Based on this Biotherapeutics Classification System (BTCS) Waivers may be requested for some pharmaceutical drug formulations, such as those with High Bioavailability and High safety Margin.
New Drugs For Multiple Sclerosis approved by The US FDA in 10 Years.DrAshok Batham
There is no specific curative drug available for the treatment of multiple sclerosis.
Fortunately, a large number of disease modifying drugs have been developed.
New drug development for the treatment of multiple sclerosis is a hot-area, a large number of disease modifying drugs have been developed in the last 2 decades.
Nearly 70 different drugs are now available to deal with this debilitating and disabling disease.
The list presented here includes 10 disease modifying drugs approved by the US FDA in the last 10 years, from January 2010 to October 2019.
In addition to these, a drug, Ampyra (Dalfampridine) 10 mg tablet has been approved by the US FDA in January 2010 for improvement of walking capacity in multiple sclerosis.
Drugs function by altering the existing bodily functions in disease and health; they do not produce any new thing in the body. Essentially, drugs either stimulate or inhibit existing physiological activities, kill disease causing germs, destroy cancer cells, replenish endogenous hormones and correct their deficiencies, and correct deficiencies of vitamins, minerals, essential amino acids, essential fatty acids and anti-oxidants.
This slide presentation gives an overview of all the basic disease processes or mechanisms through which diseases occur and would help the common man have a good understanding of diseases.
This presentation is aimed at putting to-day's antihistamine drugs in a broad and proper perspective. Anti-histamines are classified based on their chemistry and more importantly on the chronology of their introduction. Their general actions, uses, pharmacokinetic features, and adverse effects are described making it easy for medical and pharmacy students to understand this class of widely used drugs.
Epilepsy and antiepileptics. Dr.Ashok Kumar Batham,M.D.,DrAshok Batham
This presentation provides relevant description and classification of epilepsy with easy-to-remember mechanism-based and chemistry-based classifications of Anti-epileptic Drugs (AEDs). General features and salient details of all the Anti-epileptic Drugs (AEDs) are provided that can be used as short-notes. Hopefully, this presentation would be useful to students of medicine, pharmacology, pharmacy, clinical pharmacy, and representatives of pharmaceutical companies.
This presentation provides all the relevant information about mental depression and anti-depressants. It will be useful to students of medicine, pharmacology, pharmacy, and pharmaceutical industry.
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
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
1. Parkinson’s Disease : Drug Treatment
Strategies
Dr. Ashok Kumar Batham, M.B.,B.S., M.D., D.C.R.,
Chief Consultant, Dr Batham Pharma Consultants
Phone: +91 93280 18777
Email: ashokpharmacol@gmail.Com
Dr. Ashok Kumar Batham 1
2. Parkinson’s Disease - Primary
Neurodegenerative disease
Affects 1% people above 65 years of age
Progresses to rigid akinetic state over 5-10 years,
if left untreated
Dr. Ashok Kumar Batham 2
3. Cerebral stroke
Use of drugs, like certain antipsychotics (Haloperidol, Thorazine)
and anti-emetics (Prochlorperazine, Metoclopramide)
Other rare neurodegenerative disorders
Parkinson’s Disease – Secondary (due to)
Dr. Ashok Kumar Batham 3
4. Parkinson’s Disease: Cardinal Features
Bradykinesia (slowness and poverty of movement)
Muscular rigidity
Resting tremor (abates during voluntary movement)
Impairment of postural balance – gait disturbances and falling
Dr. Ashok Kumar Batham 4
5. Parkinson’s Disease : Other Clinical Features
Sleep disorders
Depression and cognitive impairment - 80% patients
Memory impairment (Dementia) – 40% patients
• % Dr. Ashok Kumar Batham 5
6. Parkinson’s Disease - Pathophysiology
Primarily affects Substantia Niagra Pars Compacta & Basal
Ganglia (Putamen and Caudate nucleus) – Causes Loss of
dopaminergic neurons to the extent of 70-80%
Other brain areas affected – brain stem, hippocampus,
cerebral cortex
Degeneration of neurons and appearance of Lewy bodies
(intracellular inclusions)
Dr. Ashok Kumar Batham 6
7. Abnormalities of neurotransmission in Substantia Niagra Pars Compacta & Basal
Ganglia (Putamen and Caudate nucleus) in Parkinson’s Disease
Deficiency of Dopamine to the extent of 70-80%
Excessive Cholinergic (Acetyl Choline) activity
Deficiency of Gamma Aminobutyric Acid (GABA) and GABAergic neurotransmission
Excessive Glutamate activity and Glutaminergic neurotransmission
Other neurotransmitters may also be involved, such as, Neurotensin, Cholecystokinin, Dynorphin
and Substance P.
Dr. Ashok Kumar Batham 7
8. Drug Treatment Strategies for Parkinson’s Disease
- Facilitation of Dopaminergic Neurotransmission
Dopamine Precursor
• Levodopa (in combination with Carbidopa & Entacapone or Tolcapone)
MAO-B (Monoamine Oxidase B – Inhibitors
• Selegiline
• Rasagiline
Dopamine Receptor Agonists
• Ropinirole
• Pramipexole
• Bromocriptine
• Apomorphine
Dr. Ashok Kumar Batham 8
14. LEVODOPA METABOLISM IN PRE & POST-SYNAPTIC NEURONS
LEVODOPA
DOPAMINE
3,4-DIHYDROXYPHENYLACETIC
ACID
3-O-METHYLDOPA
3-
METHOXYTYRAMINE
3-METHOXY-4-HYDROXY-
PHENYLACETIC ACID
(HVA)
COMT
COMT
COMT
AADC
MAO &
ALDH
NE
Dr. Ashok Kumar Batham 14
15. Levodopa
Logical therapy to correct dopamine deficiency in substantia niagra and
nigrostriatal neurons
Levodopa is the prodrug – Converted into Dopamine by AADC (aromatic aminoacid
decarboxylase or dopa decarboxylase)
Shortcomings of Levodopa
• Very poor (1%) access (availability) to the brain (desired site of
action)
• Peripheral adverse effects – nausea and hypotension
Dr. Ashok Kumar Batham 15
16. Levodopa: Strategies to enhance its effects in brain and
minimize side-effects (nausea & hypotension)
Co-administration with Carbidopa to prevent wastage of levodopa
outside the brain by inhibiting peripheral AADC (aromatic amino acid
decarboxylase or dopa decarboxylase) – bioavailability in the brain is
increased and side effects (nausea and hypotension) are reduced
Co-administration with Entacapone or Tolcapone, that inhibit
Catechol-0-methyl transferase (COMT) and prevent metabolism of
dopamine thus building up dopamine concentration in substantia
niagra pars compacta
Dr. Ashok Kumar Batham 16
17. Levodopa
Levodopa is always used in combination with Carbidopa (25)
and Entacapone (200 mg)/Tolcapone (100 mg)
Most individuals need 75 mg carbidopa and 300 mg levodopa
per day, therefore, carbidopa and levodopa 25/100 mg is
commonly used.
Entacapone (200 mg)/Tolcapone (100 mg) added to the
above combination
Dr. Ashok Kumar Batham 17
18. Dopamine Agonists
Apomorphine 2 mg sc injection
Bromocriptine 1.25 mg
Ropinirole 0.25 mg tid, Ropinirole SRT 2 mg od
Pramipexole 0.125 mg tid
Dr. Ashok Kumar Batham 18
19. Ropinirole and Pramipexole - orally active and long-acting. They exert
selective agonistic activity at D2 class sites, specifically at D2 and D3
receptor.
Pergolide (withdrawn in the US because of cardiac valve fibrosis) &
Bromocriptine (loosing popularity because of availability of above
drugs).
Apomorphine - used as a rescue medication for ”off” phenomenon
to relieve the symptoms. It mostly acts on D4 receptors.
Dopamine Agonists
Dr. Ashok Kumar Batham 19
21. Anti-cholinergic Drugs
Block the cholinergic interneurons in Striatum
Modest effectiveness
Used in the initial treatment of PD
Adjuncts to levodopa therapy
SEs: sedation, confusion, urinary difficulty, constipation, cycloplegia,
photophobia
Dr. Ashok Kumar Batham 21
22. Selective MAO-B Inhibitors
MAO-B mostly present in striatum and responsible for oxidative metabolism of
dopamine
Selegiline and Rasagiline cause irreversible inhibition of MAO-B
No peripheral effects and “Cheese Effect”
Selegiline is metabolized into amphetamine and methamphetamine – may cause
anxiety, insomnia, anorexia.
Rasagiline is not metabolized to amphetamine and methamphetamine
Both of these drugs are used in early PD as adjunct to levodopa (reduced
wearing-off effect)
Dr. Ashok Kumar Batham 22
24. Amantadine
Antiviral drug used in influenza (prophylaxis and treatment)
Possesses modest antiparkinsonian efficacy
Useful in dealing with levodopa induced on-off phenomenon and dyskinesias
Probable mechanisms of action
alters Dopamine release
blocks NMDA glutamate receptors
blocks cholinergic receptors
Dosage 100 mg 2 times a day
SEs: dizziness, lethargy and atropine like effects
Dr. Ashok Kumar Batham 24
