The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Guide to creation of game concept documentEmma Westecott
The document summarizes guidelines for creating effective design documents in multi-part game development projects. It discusses the purpose and benefits of documentation, and provides guidelines for key parts of design documents including the game concept document and game proposal. These guidelines are intended to help communicate the vision, ensure consistency and clarity, and facilitate implementation planning and scheduling.
The document discusses the benefits of meditation for reducing stress and anxiety. Regular meditation practice can help calm the mind and body by lowering heart rate and blood pressure. Studies have shown that meditating for just 10-20 minutes per day can have significant positive impacts on both mental and physical health over time.
Heart failure occurs when the heart cannot pump enough blood to meet the body's needs. It can be chronic or acute and symptoms include shortness of breath, fatigue, swelling, and reduced ability to exercise. It is often caused by conditions like coronary artery disease, high blood pressure, or heart attack that damage the heart muscle over time. Treatment involves lifestyle changes like reducing salt, exercising, and weight control as well as medications to remove fluid, lower blood pressure on the heart, strengthen contractions, or improve pumping ability.
This document discusses two case studies about prescribing analgesics for pain management.
In the first case study, a 35-year old man had hemorrhoid surgery and was initially prescribed paracetamol and celecoxib, but still reported a pain score of 7/10 after 4 hours.
The second case study describes an 81-year old woman with hip fracture reporting an 8/10 pain score. She has various medical conditions including hypertension, coronary artery disease, and diabetes.
The document prompts the reader to consider what additional analgesics they would prescribe for each case, taking into account factors like the patients' medical histories and reported pain levels.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Guide to creation of game concept documentEmma Westecott
The document summarizes guidelines for creating effective design documents in multi-part game development projects. It discusses the purpose and benefits of documentation, and provides guidelines for key parts of design documents including the game concept document and game proposal. These guidelines are intended to help communicate the vision, ensure consistency and clarity, and facilitate implementation planning and scheduling.
The document discusses the benefits of meditation for reducing stress and anxiety. Regular meditation practice can help calm the mind and body by lowering heart rate and blood pressure. Studies have shown that meditating for just 10-20 minutes per day can have significant positive impacts on both mental and physical health over time.
Heart failure occurs when the heart cannot pump enough blood to meet the body's needs. It can be chronic or acute and symptoms include shortness of breath, fatigue, swelling, and reduced ability to exercise. It is often caused by conditions like coronary artery disease, high blood pressure, or heart attack that damage the heart muscle over time. Treatment involves lifestyle changes like reducing salt, exercising, and weight control as well as medications to remove fluid, lower blood pressure on the heart, strengthen contractions, or improve pumping ability.
This document discusses two case studies about prescribing analgesics for pain management.
In the first case study, a 35-year old man had hemorrhoid surgery and was initially prescribed paracetamol and celecoxib, but still reported a pain score of 7/10 after 4 hours.
The second case study describes an 81-year old woman with hip fracture reporting an 8/10 pain score. She has various medical conditions including hypertension, coronary artery disease, and diabetes.
The document prompts the reader to consider what additional analgesics they would prescribe for each case, taking into account factors like the patients' medical histories and reported pain levels.
This document provides an overview of various drugs that act on the kidney. It discusses osmotic diuretics, carbonic anhydrase inhibitors, vasopressin receptors agonists and antagonists, prostaglandins, SGLT2 inhibitors for diabetes, and uricosuric agents. The key learning objectives are to understand the mechanisms and clinical uses of these drug classes for conditions like edema, glaucoma, diabetes insipidus, heart failure, and gout.
The document summarizes clinical trials evaluating SGLT2 inhibitors:
1) The EMPA-REG trial found that empagliflozin reduced the risk of cardiovascular death, hospitalization for heart failure, and all-cause mortality compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
2) The CANVAS trial found that canagliflozin reduced the risk of major adverse cardiovascular events and hospitalization for heart failure compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
3) The DECLARE-TIMI 58 trial found that dapagliflozin did not increase the risk of major adverse cardiovascular events compared to placebo in patients with type 2 diabetes
1. SGLT2 inhibitors are a class of newer oral hypoglycemic agents that work by inhibiting sodium-glucose transporter 2 (SGLT2) in the kidneys, increasing glucose excretion in the urine and reducing blood glucose levels.
2. Their mechanism of action is independent of insulin. They promote weight loss and reduce blood pressure in addition to lowering blood glucose.
3. Incretin therapies work by mimicking the effects of the gut hormones GLP-1 and GIP. GLP-1 receptor agonists are resistant to degradation by DPP-4, allowing them to increase insulin secretion, suppress glucagon, reduce appetite and weight. DPP-4 inhibitors prevent degradation
00. ppt on renal benefit of empagliflozin.pptxFatemaBegum22
SGLT2 inhibitors like empagliflozin are unique oral anti-diabetic drugs that work independently of insulin by inhibiting glucose reabsorption in the kidneys and increasing glucose excretion in the urine. Empagliflozin has shown improved cardiovascular and renal outcomes compared to other anti-diabetic medications by reducing clinically relevant renal events like doubling of serum creatinine or initiation of renal replacement therapy by 38% based on the EMPA-REG OUTCOME trial. More recently, the EMPEROR-Reduced trial found that empagliflozin reduced the composite outcome of cardiovascular death or hospitalization for heart failure by 25% compared to placebo in patients with chronic heart failure and reduced ejection fraction
Diuretics work by inhibiting reabsorption of sodium and water in the kidneys, increasing urine output. There are several types of diuretics that act in different parts of the kidney: loop diuretics act in the ascending limb of Henle's loop, thiazide diuretics act in the distal convoluted tubule, and potassium-sparing diuretics act in the cortical collecting tubule. Diuretics are used to treat conditions like heart failure, liver failure, renal failure, and hypertension by mobilizing edema fluid and maintaining urine volume. Common side effects include hypokalemia, hyperglycemia, and increased uric acid levels.
ACE Inhibitors and receptor blockers.pptxHaider Ali
This document discusses ACE inhibitors and angiotensin receptor blockers (ARBs). It begins by explaining that ACE stands for angiotensin-converting enzyme, which plays a key role in regulating blood pressure. ACE inhibitors work by blocking this enzyme, reducing angiotensin II and vasoconstriction. The document then covers the classification, mechanisms of action, pharmacokinetics and uses of several common ACE inhibitors and ARBs, including captopril, enalapril, losartan and candesartan. It concludes by describing the renin-angiotensin-aldosterone system and angiotensin receptor types.
This document discusses noradrenergic transmission and classification of adrenoceptor agonists and antagonists. It describes the effects of agonists on alpha and beta receptors, including their pharmacological actions on the cardiovascular, respiratory, and other body systems. It also summarizes the clinical uses of adrenoceptor agonists and antagonists for conditions like hypertension, heart disease, glaucoma, and others. Drugs that affect neurotransmitter release and uptake like reserpine, guanethidine, and cocaine are also briefly discussed.
This document discusses gout, a type of inflammatory arthritis caused by precipitation of urate crystals in the joints and tissues. It presents information on the pathogenesis of acute and chronic gout, the aims of treatment including decreasing symptoms and lowering urate levels, and the classes of drugs used to treat acute flares and prevent future attacks. These include nonsteroidal anti-inflammatories, colchicine, corticosteroids, allopurinol, febuxostat, and uricosuric agents like probenecid. Adverse effects and considerations for each drug class are also outlined.
The document discusses drugs and their effects on the kidney. It covers normal kidney function, estimation of renal function, loop and thiazide diuretics, nephrotoxic drugs such as NSAIDs and aminoglycosides, and prescribing considerations in kidney disease. The ALLHAT trial found thiazide-type diuretics were superior to other antihypertensives in preventing cardiovascular disease due to their lower cost and greater efficacy.
Gagal ginjal kronis dari sudut pandang keperawatan paliatif octo zulkarnain
1. Chronic kidney disease (CKD) is the gradual loss of kidney function over time. It is classified into 5 stages based on glomerular filtration rate.
2. Common causes of CKD include hypertension, diabetes, glomerulonephritis, and urinary tract obstructions.
3. Manifestations include generalized edema, pulmonary crackles, anemia, weight loss, hyperkalemia, and others resulting from hormonal imbalances and fluid retention as kidney function declines.
Hyponatremia is very common in patients with cirrhosis. Treatment is indicated for neurological symptoms or sodium levels below 120 mEq/L. Management involves fluid restriction and correcting hypokalemia. Hypertonic saline may be used for severe hyponatremia below 110 mEq/L or before liver transplant to prevent rapid correction. While vasopressin receptor antagonists show promise, none are currently approved for use in liver disease patients.
This document provides an overview of angiotensin-converting enzyme (ACE) inhibitors, including their indications, mechanisms of action, and evidence of effectiveness. ACE inhibitors are used to treat hypertension, congestive heart failure, myocardial infarction, diabetes, proteinuria, and other conditions. They work by inhibiting the conversion of angiotensin I to angiotensin II in the renin-angiotensin-aldosterone system. Clinical trials have shown that ACE inhibitors reduce blood pressure, prevent complications of heart failure and diabetes, and slow the progression of kidney disease. Common ACE inhibitors discussed include captopril, enalapril, lisinopril, and fosinopril.
Any substance that promotes the production of urine
All diuretics increase the excretion of water from bodies
Alternatively, an antidiuretic such as vasopressin, or antidiuretic hormone.
Diuretics are used to treat heart failure, liver cirrhosis, hypertension, water poisoning, and certain kidney diseases
Non-opioid analgesics provide analgesic, anti-inflammatory, and antipyretic effects through inhibiting prostaglandin production via binding to the cyclooxygenase (COX) enzyme. They have weaker analgesic effects than opioids, do not cause central nervous system depression, and have no abuse or dependence potential. Common non-opioid analgesics include aspirin, ibuprofen, and naproxen which are non-selective COX inhibitors, and celecoxib which selectively inhibits COX-2 with fewer gastrointestinal side effects but increased cardiovascular risk. Non-opioid analgesics are used for mild to moderate pain and inflammatory conditions like arthritis but have potential adverse effects including gastrointestinal bleeding, hypersensitivity reactions, and salicylate
This document discusses hypertension and antihypertensive drugs. It defines hypertension as a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher. It describes the various classes of antihypertensive drugs including ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and diuretics. The mechanisms of action and side effects of these drug classes are explained in detail.
the detail study of diuretics which include their drugs, use,classification of diuretics, side effect, mechanism of action, metabolism, synthesis etc. this all things are cover in this presentation.
the topic contain nonsteroidal antiinflammatory drugs which include, mediatorsof inflammation, cox-1 and cox-2, classification of drugs, its pharmacological effect and adverse reaction of drug.
The document discusses renal impairment in anesthesia, including acute kidney injury (AKI) and chronic kidney disease (CKD). It covers the definition, causes, and staging of AKI and CKD. Pre-operative management of patients with renal impairment focuses on optimizing fluid, electrolyte and acid-base status. Intra-operatively, reduced doses of medications may be needed due to impaired drug clearance. Regional anesthesia offers advantages over general anesthesia when possible. Careful post-operative monitoring of fluid balance and renal function is also emphasized.
This a is a slide set (42 slides) covering clinically used drugs for lipid lowering. This is an updated version of the lecture series for the 2021-2022 academic year. Suitable for intermediate level learners
The document announces a virtual conference on June 30th, 2021 hosted by the IUPHAR Education Section to discuss future-proofing pharmacology education. The conference consists of two sessions:
Session 1 from 9:00-10:30 am UTC will feature a keynote by Professor Ray Land on transformational approaches to pharmacology education, followed by Q&A on prerecorded presentations on student-led pharmacology research and transforming pharmacology practicals for blended learning.
Session 2 from 21:00-22:30 pm UTC will include a workshop on core concepts and concept inventories led by Professor Paul White, followed by Q&A on prerecorded presentations about coming together as a society to future
This document provides an overview of various drugs that act on the kidney. It discusses osmotic diuretics, carbonic anhydrase inhibitors, vasopressin receptors agonists and antagonists, prostaglandins, SGLT2 inhibitors for diabetes, and uricosuric agents. The key learning objectives are to understand the mechanisms and clinical uses of these drug classes for conditions like edema, glaucoma, diabetes insipidus, heart failure, and gout.
The document summarizes clinical trials evaluating SGLT2 inhibitors:
1) The EMPA-REG trial found that empagliflozin reduced the risk of cardiovascular death, hospitalization for heart failure, and all-cause mortality compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
2) The CANVAS trial found that canagliflozin reduced the risk of major adverse cardiovascular events and hospitalization for heart failure compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
3) The DECLARE-TIMI 58 trial found that dapagliflozin did not increase the risk of major adverse cardiovascular events compared to placebo in patients with type 2 diabetes
1. SGLT2 inhibitors are a class of newer oral hypoglycemic agents that work by inhibiting sodium-glucose transporter 2 (SGLT2) in the kidneys, increasing glucose excretion in the urine and reducing blood glucose levels.
2. Their mechanism of action is independent of insulin. They promote weight loss and reduce blood pressure in addition to lowering blood glucose.
3. Incretin therapies work by mimicking the effects of the gut hormones GLP-1 and GIP. GLP-1 receptor agonists are resistant to degradation by DPP-4, allowing them to increase insulin secretion, suppress glucagon, reduce appetite and weight. DPP-4 inhibitors prevent degradation
00. ppt on renal benefit of empagliflozin.pptxFatemaBegum22
SGLT2 inhibitors like empagliflozin are unique oral anti-diabetic drugs that work independently of insulin by inhibiting glucose reabsorption in the kidneys and increasing glucose excretion in the urine. Empagliflozin has shown improved cardiovascular and renal outcomes compared to other anti-diabetic medications by reducing clinically relevant renal events like doubling of serum creatinine or initiation of renal replacement therapy by 38% based on the EMPA-REG OUTCOME trial. More recently, the EMPEROR-Reduced trial found that empagliflozin reduced the composite outcome of cardiovascular death or hospitalization for heart failure by 25% compared to placebo in patients with chronic heart failure and reduced ejection fraction
Diuretics work by inhibiting reabsorption of sodium and water in the kidneys, increasing urine output. There are several types of diuretics that act in different parts of the kidney: loop diuretics act in the ascending limb of Henle's loop, thiazide diuretics act in the distal convoluted tubule, and potassium-sparing diuretics act in the cortical collecting tubule. Diuretics are used to treat conditions like heart failure, liver failure, renal failure, and hypertension by mobilizing edema fluid and maintaining urine volume. Common side effects include hypokalemia, hyperglycemia, and increased uric acid levels.
ACE Inhibitors and receptor blockers.pptxHaider Ali
This document discusses ACE inhibitors and angiotensin receptor blockers (ARBs). It begins by explaining that ACE stands for angiotensin-converting enzyme, which plays a key role in regulating blood pressure. ACE inhibitors work by blocking this enzyme, reducing angiotensin II and vasoconstriction. The document then covers the classification, mechanisms of action, pharmacokinetics and uses of several common ACE inhibitors and ARBs, including captopril, enalapril, losartan and candesartan. It concludes by describing the renin-angiotensin-aldosterone system and angiotensin receptor types.
This document discusses noradrenergic transmission and classification of adrenoceptor agonists and antagonists. It describes the effects of agonists on alpha and beta receptors, including their pharmacological actions on the cardiovascular, respiratory, and other body systems. It also summarizes the clinical uses of adrenoceptor agonists and antagonists for conditions like hypertension, heart disease, glaucoma, and others. Drugs that affect neurotransmitter release and uptake like reserpine, guanethidine, and cocaine are also briefly discussed.
This document discusses gout, a type of inflammatory arthritis caused by precipitation of urate crystals in the joints and tissues. It presents information on the pathogenesis of acute and chronic gout, the aims of treatment including decreasing symptoms and lowering urate levels, and the classes of drugs used to treat acute flares and prevent future attacks. These include nonsteroidal anti-inflammatories, colchicine, corticosteroids, allopurinol, febuxostat, and uricosuric agents like probenecid. Adverse effects and considerations for each drug class are also outlined.
The document discusses drugs and their effects on the kidney. It covers normal kidney function, estimation of renal function, loop and thiazide diuretics, nephrotoxic drugs such as NSAIDs and aminoglycosides, and prescribing considerations in kidney disease. The ALLHAT trial found thiazide-type diuretics were superior to other antihypertensives in preventing cardiovascular disease due to their lower cost and greater efficacy.
Gagal ginjal kronis dari sudut pandang keperawatan paliatif octo zulkarnain
1. Chronic kidney disease (CKD) is the gradual loss of kidney function over time. It is classified into 5 stages based on glomerular filtration rate.
2. Common causes of CKD include hypertension, diabetes, glomerulonephritis, and urinary tract obstructions.
3. Manifestations include generalized edema, pulmonary crackles, anemia, weight loss, hyperkalemia, and others resulting from hormonal imbalances and fluid retention as kidney function declines.
Hyponatremia is very common in patients with cirrhosis. Treatment is indicated for neurological symptoms or sodium levels below 120 mEq/L. Management involves fluid restriction and correcting hypokalemia. Hypertonic saline may be used for severe hyponatremia below 110 mEq/L or before liver transplant to prevent rapid correction. While vasopressin receptor antagonists show promise, none are currently approved for use in liver disease patients.
This document provides an overview of angiotensin-converting enzyme (ACE) inhibitors, including their indications, mechanisms of action, and evidence of effectiveness. ACE inhibitors are used to treat hypertension, congestive heart failure, myocardial infarction, diabetes, proteinuria, and other conditions. They work by inhibiting the conversion of angiotensin I to angiotensin II in the renin-angiotensin-aldosterone system. Clinical trials have shown that ACE inhibitors reduce blood pressure, prevent complications of heart failure and diabetes, and slow the progression of kidney disease. Common ACE inhibitors discussed include captopril, enalapril, lisinopril, and fosinopril.
Any substance that promotes the production of urine
All diuretics increase the excretion of water from bodies
Alternatively, an antidiuretic such as vasopressin, or antidiuretic hormone.
Diuretics are used to treat heart failure, liver cirrhosis, hypertension, water poisoning, and certain kidney diseases
Non-opioid analgesics provide analgesic, anti-inflammatory, and antipyretic effects through inhibiting prostaglandin production via binding to the cyclooxygenase (COX) enzyme. They have weaker analgesic effects than opioids, do not cause central nervous system depression, and have no abuse or dependence potential. Common non-opioid analgesics include aspirin, ibuprofen, and naproxen which are non-selective COX inhibitors, and celecoxib which selectively inhibits COX-2 with fewer gastrointestinal side effects but increased cardiovascular risk. Non-opioid analgesics are used for mild to moderate pain and inflammatory conditions like arthritis but have potential adverse effects including gastrointestinal bleeding, hypersensitivity reactions, and salicylate
This document discusses hypertension and antihypertensive drugs. It defines hypertension as a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher. It describes the various classes of antihypertensive drugs including ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and diuretics. The mechanisms of action and side effects of these drug classes are explained in detail.
the detail study of diuretics which include their drugs, use,classification of diuretics, side effect, mechanism of action, metabolism, synthesis etc. this all things are cover in this presentation.
the topic contain nonsteroidal antiinflammatory drugs which include, mediatorsof inflammation, cox-1 and cox-2, classification of drugs, its pharmacological effect and adverse reaction of drug.
The document discusses renal impairment in anesthesia, including acute kidney injury (AKI) and chronic kidney disease (CKD). It covers the definition, causes, and staging of AKI and CKD. Pre-operative management of patients with renal impairment focuses on optimizing fluid, electrolyte and acid-base status. Intra-operatively, reduced doses of medications may be needed due to impaired drug clearance. Regional anesthesia offers advantages over general anesthesia when possible. Careful post-operative monitoring of fluid balance and renal function is also emphasized.
This a is a slide set (42 slides) covering clinically used drugs for lipid lowering. This is an updated version of the lecture series for the 2021-2022 academic year. Suitable for intermediate level learners
The document announces a virtual conference on June 30th, 2021 hosted by the IUPHAR Education Section to discuss future-proofing pharmacology education. The conference consists of two sessions:
Session 1 from 9:00-10:30 am UTC will feature a keynote by Professor Ray Land on transformational approaches to pharmacology education, followed by Q&A on prerecorded presentations on student-led pharmacology research and transforming pharmacology practicals for blended learning.
Session 2 from 21:00-22:30 pm UTC will include a workshop on core concepts and concept inventories led by Professor Paul White, followed by Q&A on prerecorded presentations about coming together as a society to future
The document announces an IUPHAR virtual conference on June 30th, 2021 about future-proofing pharmacology education. The conference consists of two sessions.
Session 1 runs from 9-10:30 am UTC and features a keynote by Professor Ray Land on threshold concepts and troublesome knowledge in pharmacology education. It also includes prerecorded presentations on student-led pharmacology research, transforming pharmacology practicals for blended learning, incorporating gamification to engage learners, and the IUPHAR Pharmacology Education Project.
Session 2 runs from 9-10:30 pm UTC and includes a workshop on core concepts and concept inventories led by Professor Paul White. It also features prerecorded presentations on
40 slides that focus on the drugs used to treat epilepsy (anti-epileptic drugs) and their their primary molecular mechanisms of action. Produced by Stephen Kelley (University of Dundee, UK).
This document provides an overview of epilepsy pharmacotherapy, including classification of seizures and epilepsy. It discusses the pathophysiology and causes of epilepsy, classification of seizure types, management strategies, first aid for seizures, and considerations for pregnancy. Key points covered include the definition of seizures and epilepsy, that up to 1/3 of cases are idiopathic while others are symptomatic, classification of focal and generalized seizures, and first-line treatment involving antiepileptic drugs.
A teaching slide set describing the mechanisms of action and clinical use of local anaesthetics. This session is a basic introduction to the pharmacodynamics and pharmacokinetics of local anaesthetics. It is aimed at preclinical medical or dental students, or students in the early years of a pharmacology degree.
This 11-slide slide set created with PowerPoint describes the organic nitrates and their use in the treatment of angina pectoris. Contributed by Christopher Fowler, Umeå University, Sweden.
This set of 17 slides introduces students to the some of the basic physiological processes that are the targets of many analgesic drug classes. It is suitable for beginner/intermediate level learners.
This slide set provides an introduction at new learner to intermediate level to some of the most common drugs that are used clinically to modulate the rate and force of contraction of the heart. Created by Prof. JA Peters, University of Dundee School of Medicine.
This 20-slide slide set created with PowerPoint describes prostanoid synthesis and their effects on the body; mechanisms of action, beneficial and adverse effects of NSAIDS; the difference between the effects of low and high dose aspirin; and the effects and toxicity of paracetamol (acetaminophen). This is an introduction to the topic of NSAIDS which would be appropriate for beginners. Contributed by Christopher Fowler, Umeå University, Sweden.
This 9-slide slide set created with PowerPoint is a short introduction to corticosteroids, in particular, the glucocorticoids, describing their receptor-mediated effects as well as why they exert both wanted and unwanted effects when used as anti-inflammatory and immunosuppressant drugs. This introduction to the topic of corticosteroids would be appropriate for beginners. Contributed by Christopher Fowler, Umeå University, Sweden.
This 12-slide slide set created with PowerPoint presents an introduction into the pharmacology of opioid analgesics in order to provide a basic background to facilitate later understanding of more detailed pharmacology of opioid analgesics. Topics covered include: opioid receptors, their signaling mechanisms and responses; and pharmacological effects of opioid receptor ligands. This introduction to the topic of opioid analgesics would be appropriate for intermediate level learners. Contributed by Christopher Fowler, Umeå University, Sweden.
This 13-slide slide set created with PowerPoint provides an introduction to antidepressants describing their discovery and development; their modes of action and relationship to the monoamine hypothesis of depression; and their efficacy, latency and unwanted actions. The beginner level introduction is tailored to aid the understanding of individual antidepressants. Contributed by Christopher Fowler, Umeå University, Sweden.
This document provides information about drugs used in hematology, including anticoagulants, antiplatelet agents, and thrombolytic agents. It begins with learning outcomes and an outline of topics to be covered, including disorders of inappropriate blood clotting that these drugs treat. The document then discusses the normal coagulation process and thrombosis. It describes the two main types of thrombus and how anticoagulants, antiplatelet agents, and thrombolytic agents work to prevent and treat them. Specific drug classes are covered in more depth, including heparin and low molecular weight heparins, warfarin, and fibrinolytic agents. Clinical uses and guidelines for these drugs are also summarized.
This document provides an overview of receptor pharmacology and key concepts. It defines drugs and how they act through receptors and other targets. It explains the terms agonist, antagonist, affinity, efficacy and potency. It describes competitive and non-competitive antagonism and their effects on concentration-response curves. The learning objectives are to understand these pharmacological concepts and be able to interpret graphs of drug-receptor interactions.
This is a 16 slide presentation covering the the classes of drugs used in T2DM and their molecular mechanisms of action. Provided by Professor John A Peters, University of Dundee.
Slide set for medical students discussing the physiology and pharmacology of nausea and vomiting. Provided by Professor John A Peters, University of Dundee.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
Renal lecture 3 2017 18_jap
1. Drugs Acting on the Kidney (3)
Professor John Peters
E-mail j.a.peters@dundee.ac.uk
2. Learning Objectives
Following this lecture, students should be able to:
Comment upon the mechanism of action and clinical use of osmotic diuretics
and inhibitors of carbonic anhydrase
Describe the utility of agonists and antagonists of vasopressin receptors in
neurogenic diabetes insipidus and hypervolaemic hyponatraemia, respectively
Describe the role of renal prostaglandins (PGE2 and PGI2) in kidney function
and their importance when renal blood flow is compromised
Note the recent introduction of inhibitors of sodium-glucose co-transporter 2
(SGLT2) inhibitors in type 2 diabetes mellitus (T2DM) and the characteristics of
this transporter vs. sodium glucose co-transporter 1 (SGLT1)
Recognise the now limited role of uricosuric agents in the treatment of gout
Recommended reading
• Bailey (2011). Renal glucose reabsorption inhibitors to treat diabetes.
Trends Pharmacol. Sci, 32, 63-71. (Excellent review – very easily read and
understood)
• Neal (2016). ‘Medical Pharmacology at a Glance (8th.ed.) Chapter 14
• Rang, Ritter, Flower and Henderson (2016). 'Rang and Dale's Pharmacology’
(8th. ed.). Chapter 29
3. Osmotic Diuretics (1)
Osmotic diuretics (e.g. mannitol IV)
Are membrane impermeant polyhydric alcohols
(hence IV administration). Pharmacologically inert
Enter nephron by glomerular filtration, but are not reabsorbed
Increase the osmolality of the filtrate, opposing the absorption of water
in parts of the nephron that are freely permeable to water
Secondarily decrease
sodium reabsorption in
the proximal tubule (larger
fluid volume decreases
sodium concentration and
electrochemical gradient
for reabsorption) From Lüllmann et al. (2000), Color Atlas of Pharmacology
Major site of action in the
kidney is the proximal
tubule where most iso-
osmotic reabsorption of
water occurs
4. o in urgent treatment of acutely raised intracranial and intraocular
pressure. The solute does not enter the eye, or brain, but increased
plasma osmolality extracts water from these compartments
o in the prevention of acute hypovolaemic renal failure to maintain
urine flow
Osmotic diuresis may also occur:
o in hyperglycaemia – reabsorptive capacity of the proximal tubule for
glucose (by SGLT1 and SGLT2) is exceeded. Glucose remaining in
the filtrate retains fluid (note: SLGT2 is now a target in treatment of T2DM – see
later)
o as a consequence of the use of iodine-based radiocontrast dyes in
imaging. Dye is filtered at the glomerulus, but it not reabsorbed
constituting an osmotic load. Patients with borderline
cardiovascular status may experience hypotension due to reduction
in intravascular volume
Osmotic Diuretics (2)
Osmotic diuretics are used:
Adverse effects include: transient expansion of blood volume and
hyponatraemia
5. Carbonic Anhydrase Inhibitors (and Urinary pH)
Carbonic anhydrase inhibitors (e.g. acetazolamide)
No longer have a role as diuretic agents, but are useful in:
o glaucoma and following eye surgery (to reduce intraocular pressure
by suppressing formation of aqueous humour)
o prophylaxis of altitude sickness
o some forms of infantile epilepsy
Increase excretion of HCO3
- with Na+, K+ and H2O – alkaline* diuresis
and metabolic acidosis result
*Alkalinising the urine with other agents (e.g. citrate salts given
orally which generate HCO3
- via the Krebs cycle) can be useful in:
o relief of dysuria
o prevention of the crystallization of weak acids with limited aqueous
solubility (remember Henderson-Hasselbalch equation!) – favours
ionised form. Can decrease formation of uric acid stones
o enhancing the excretion of weak acids (e.g. salicylates, some
barbiturates) – favours ionised form that is not reabsorbed
6. Aldosterone and Vasopressin at the Collecting Tubule
Enhanced tubular Na+
reabsorption and salt
retention
Aldosterone
secretion from
adrenal cortex
Vasopressin (anti-
diuretic hormone)
secretion from
posterior pituitary
Enhanced H2O
reabsorption
K+
Na+Na+
K+
Na+
H2O
H2O
Aldosterone binds to
cytoplasmic
mineralocorticoid receptor
to alter gene expression
Vasopressin binds to V2
GPCR to cAMP
Na+ channel (ENaC)
K+ channel (ROMK)
Aquaporin
Collecting Tubule
Vasopressin
increases
number
Aldosterone
increases
activity
Aldosterone
increases
synthesis
Na+/K+ ATPase
7. Diabetes Insipidus
Symptoms similar to diabetes mellitus (thirst, polydipsia, polyuria) but
a completely different etiology. Urine is copious and dilute.
*may also be of value (along with other measures) in the treatment of nocturnal enuresis
(bed wetting) in older (>10 yrs) children
Disturbance of signalling by vasopressin (ADH): one of two types
o Neurogenic diabetes insipidus – lack of vasopressin secretion from
the posterior pituitary. Treated with desmopressin* (synthetic analogue
of vasopressin with V2 receptor selectivity – avoids increase in blood
pressure associated with V1 receptor activation)
Note: ethanol inhibits secretion of vasopressin; nicotine enhances
o Nephrogenic diabetes insipidus – inability of the nephron to respond
to vasopressin. Rare and usually caused by recessive and X-linked
mutations in the V2 receptor gene (AVPR2) – no current
pharmacological treatment
Note: action of vasopressin on the kidney is inhibited by:
o lithium (used in bipolar disorder)
o demeclocycline – antibiotic but has been used to block effects of excessive
release of vasopressin (e.g. tumours)
o ‘vaptans’ – next slide
8. ‘Aquaretics’ ‘Vaptans’
Act as competitive antagonists
of vasopressin receptors
(which occur as V1A, V1B and V2
GPCR subtypes)
V1A receptors mediate
vasoconstriction; V2 mediate
H2O reabsorption in collecting
tubule by directing aquaporin 2
(AQP2)-containing vesicles to
the apical membrane
Blockade of V2 receptors
causes excretion of water
without accompanying Na+ and
thus raises plasma Na+
concentration
Place of ‘vaptans’ (i.e. conivaptan (V1A and V2 antagonist) and tolvaptan (V2
antagonist) in treatment of heart failure is still being determined – most likely of
value in hypervolaemic hyponatraemia (to reduce preload)
Tolvaptan is used in syndrome of inappropriate anti-diuretic hormone secretion
(SIADH) to correct hyponatraemia (conivaptan not listed in BNF, but FDA approved)
9. Inhibitors of Sodium Glucose Co-transporter 2 (SGLT2) (1)
Reabsorption of glucose occurs in the proximal tubule mediated by
sodium glucose co-transporters (SGLT) 1 and 2 - normally 100%
efficient – glucose only appears in urine if filtrate concentration of
glucose exceeds the renal threshold (about 11 mmol l-1)
Reabsorption is by secondary active transport (apical membrane) and
facilitated diffusion (basolateral membrane)
SGLT1 is expressed in both the
intestine (enterocytes) and the
kidney, SGLT2 is almost
exclusively confined to the
proximal tubule of the latter –
drugs that selectively block
SGLT2 affect only renal
reabsorption of glucose
SGLT2 (S1 segment) and
SGLT1 (S2/3 segment reabsorb
up to 90% and 10%) of filtered
glucose, respectively
10. Inhibitors of Sodium Glucose Co-transporter 2 (SGLT2) (2)
Both SGLT1 and SGLT2 transport glucose
against a concentration gradient by coupling
it to Na+ influx glucose
Transporter stoichiometry is SGLT1 2Na+:1
glucose and SGLT2 1Na+: 1 glucose
o SGLT2: low affinity, high capacity
o SGLT1: high affinity, low capacity
Inhibition of SGLT2 results in glucosuria
[note this mimics the condition familial renal
glucosuria (FRG) which tends to be benign]
Canagliflozin, dapagliflozin and empagliflozin
are competitive inhibitors of SGLT2 available
in the UK to treat T2DM as part of combination
therapy (note independent of insulin)
SGLT2 inhibitors cause:
o excretion of glucose
o decreases in HbA1c
o weight loss (calorific loss and mild osmotic
diuresis contribute)
Clinical experience limited – most common adverse effects reported are increased
incidence of genital bacterial and fungal infections
11. Prostaglandins and Renal Function
Prostaglandins are part of a family of molecules (prostanoids) formed
from the fatty acid arachidonic acid by the cyclo-oxygenase enzymes
(COX1 and 2)
The major prostaglandins synthesised by the kidney are:
o PGE2 – medulla
o PGI2 (prostacyclin) – glomeruli
Both act as vasodilators, are natriuretic, and are synthesised in
response to ischaemia, mechanical trauma, angiotensin II, ADH and
bradykinin
Under normal conditions, prostaglandins have little effect upon on
renal blood flow (RBF), or glomerular filtration rate (GFR)
Prostaglandins gain importance under conditions of vasoconstriction,
or decreased effective arterial blood volume, where they cause
compensatory vasodilation
12. Non-steroidal anti-inflammatory drugs (NSAIDS) inhibit COX and may
precipitate acute renal failure (greatly decreased GFR) in conditions
where renal blood flow is dependent upon vasodilator prostaglandins
(cirrhosis of the liver, heart failure, the nephrotic syndrome)
Prostaglandins affect GFR by:
o a direct vasodilator effect upon the afferent arteriole
o releasing renin leading to increased levels of angiotensin II that
vasoconstricts the efferent arteriole – filtration pressure increases
Combination of ACEI (or ARB), diuretic and NSIAD may be particularly
detrimental the ‘triple whammy’ effect
13. Uricosuric Agents
Uric acid is formed by the catabolism of purines
Elevated plasma urate predisposes to gout - deposition of urate
crystals in joints and soft tissues
Probenecid and sulfinpyrazole can be useful in the treatment of gout
by blocking reabsorption of urate in the proximal tubule (although
largely supplanted by allopurinol which inhibits urate synthesis)
1
2
3
1 Urate filtration
2 Urate secretion - blocked by low –
subtherapeutic – doses of probenecid
and sulfinpyrazole
Urate secretion and reabsorption - blocked by
therapeutic doses of probenecid and sulfinpyrazole
– net effect enhanced excretion
32 +