The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
In this presentation I tried to explain the classification of muscle relaxants. along with differences between these classes. there is also a brief discussion about NMT and how they work. furthermore it has dose, maintenance dose, adverse effects and how to manage toxicity about these drugs.
This presentation was given by me during my M.pharm.
It contains description, classification, mechanism of actions and therapeutic uses of Neuromuscular blockers.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
In this presentation I tried to explain the classification of muscle relaxants. along with differences between these classes. there is also a brief discussion about NMT and how they work. furthermore it has dose, maintenance dose, adverse effects and how to manage toxicity about these drugs.
This presentation was given by me during my M.pharm.
It contains description, classification, mechanism of actions and therapeutic uses of Neuromuscular blockers.
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
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
2. Where to use
As adjuvant in surgical anaesthesia to
obtained relaxation of skeletal muscle
Relaxation of skeletal muscle to make
operative manipulations easy.
Endotracheal intubation.
Counteract laryngospasm during
barbiturate anaesthesia.
Require lighter level of anaesthesia.
Shorten post-anaesthesia recovery period.
2
5. 5
Classification on basis of site of action and
mechanism of action
A) Peripherally Acting
Acts at N-M junction fall into two catagories :
i- Non depolarizing (Competitive blockers)- prevent access of
Ach at Nm rec of motor end plate- prevent depolarization
a). Long acting
Pancuronuium, Doxacurium, Pipecuronium
b). Intermediate acting
Vecuronium, Atracurium, Rocuronium
c). Short acting
Mivacurium, Rapacuronium
ii-Depolarizing:
Act as agonists at acetylcholine receptors.
6. 6
B) Centrally acting (spasmolytic drugs)
Selective action in the cerebrospinal axis.
Carisoprodol, Chlorzoxazone, Chlormezanone,
Methocarbamol
Diazepam, Clonazepam ( act through GABA A
receptors)
Baclofen (GABA B receptors)
Tizanidine (central α2 agonist)
7. C) Directing acting (spasmolytic drugs)
Dantroline ( act directly by interfering release
of calcium from sarcoplasmic reticulum)
7
8. 8
Mechanism of Sk. muscle
contraction
Initiation of impulse
Release of acetylcholine
Activation of nicotinic receptor at motor end
plate
Opening of ion channel, passage of Na+ ,
depolarization of end plate
Muscle contraction.
10. 10
Mechanism of action
(non depolarizing agents)
a) At low doses:
These drugs combine with nicotinic receptors
and prevent acetylcholine binding. As they
compete with acetylcholine for receptor
binding they are called competitive blockers.
Thus prevent depolarization at end-plate.
Hence inhibit muscle contraction, relaxation of
skeletal muscle occurs.
11. Their action can be overcome by increasing
conc. of acetylcholine in the synaptic gap (by
ihibition of acetyle choline estrase enzyme,
e.g.: Neostigmine ,physostigmine )
Anaesthetist can apply this strategy to shorten
the duration of blockage or overcome the over
dosage.
11
12. 12
At high doses
These drugs block ion channels of the end
plate.
Leads to further weakening of the
transmission and reduces the ability of Ach-
esterase inhibitors to reverse the action.
13. 13
ACTIONS
All the muscles are not equally sensitive to
blockade.
Small and rapidly contracting muscles are
paralyzed first.
Respiratory muscles are last to be affected and
first to recover.
14. 14
Pharmacokinetics:
Administered intravenously (not absorbed
orally as they remain ionized at physiological
pH).
Cross blood brain barrier poorly (they are
poorly lipid soluble)
They have limited volume of distribution as
they are highly ionized.
15. Drugs excreted by kidney
-Longer duration of action (35-100min)
Drugs eliminated by liver
-Intermediate duration of action (25-50min)
Drugs inactivated spontaneously in plasma
(Hoffmann elimination)
-Intermediate duration of action (25-50min)
Drugs inactivated by plasma cholinesterase
-Shorter duration of action (15-20min)
15
16. Atracurium is degraded spontaneously in
plasma by ester hydrolysis
it releases histamine and can produce a fall in
blood pressure ,flushing and
bronchoconstriction.
Its metabolite can provoke seizures.
Cisatracurium with similar pharmacokinetics is
more safer.
16
17. 17
Drug interactions
Choline esterase inhibitors such as neostigmine,
pyridostimine and edrophonium reduces or overcome
their activity but with high doses they can cause
depolarizing block due to elevated acetylcholine
concentration at the end plate.
Halothane, aminoglycosides , calcium channel
blockers synergize their effect.
18. 18
Unwanted effects
Fall in arterial pressure- chiefly a result to ganglion
block , may also be due to histamine release .
Bronchospasm due to histamine release from mast
cells (especially with tubocurarine ,mivacurium ,and
atracurium).
Pancuronium block muscarinic receptors also,
particularly in heart which may results tachycardia.
Hypoxia and respiratory paralysis.
19. 19
DEPOLARIZING AGENTS
DRUG- Succinylcholine
Mechanism of action:
act like acetylcholine but persist at the synapse at high
concentration and for longer duration and constantly stimulate
the receptor.
First, opening of the Na+ channel occurs resulting in
depolarization, this leads to transient twitching of the muscle,
continued binding of drugs make the receptor incapable to
transmit the impulses, paralysis occurs.
The continued depolarization makes the receptor incapable of
transmitting further impulses.
20. 20
Therapeutic uses:
When rapid endotracheal intubations is required.
Bronchoscopy
laryngoscopy
Electroconvulsive shock therapy.
Pharmacokinetics:
Administered intravenously.
Due to rapid inactivation by plasma cholinestrase,
given by continued infusion.
21. 21
Succinylcholine (cont)
• It causes paralysis of skeletal muscle.
Sequence of paralysis may be different from that of
non depolarizing drugs but respiratory muscles are
paralyzed last.
Produces a transient twitching of skeletal muscle
before causing block.
It causes maintained depolarization at the end plate,
which leads to a loss of electrical excitability.
It has shorter duration of action (5-10 min).
22. 22
It stimulate ganglion (sympathetic and para
sympathetic both).
In low dose it produces negative ionotropic
and chronotropic effect
In high dose it produces positive ionotropic
and chronotropic effect.
23. 23
It act like acetylcholine but diffuse slowly to
the end plate and remain there for long enough
that the depolarization causes loss of electrical
excitability
If cholinestrase is inhibited ,it is possible for
circulating acetylcholine to reach a level
sufficient to cause depolarization block.
24. 24
Unwanted effects:
Bradycardia (preventable by atropine).
Hyperkalemia in patients with trauma or burns.
this may cause arrhythmia or even cardiac arrest.
Increase intraocular pressure due to contracture of
extra ocular muscles .
increase intragastric pressure which may lead to
emesis and aspiration of gastric content.
25. 25
Malignant hyperthermia: rare inherited condition
probably caused by a mutation of Ca++ release
channel of sarcoplasmic reticulum, which results
muscle spasm and dramatic rise in body temperature.
(This is treated by cooling the body and administration of Dantrolene)
Prolonged paralysis: due to factors which reduce the
activity of plasma cholinesterase
genetic variants as abnormal cholinesterase, its severe
deficiency.
anti -cholinesterase drugs
neonates
liver disease
29. Centrally acting muscle relaxants
(Spasmolytic Drugs)
Mephenesin group-
Carisoprodol, Chlorzoxazone, Chlormezanone,
Methocarbamol
Diazepam, Clonazepam ( act through GABA A
receptors)
Baclofen (GABA B receptors)
Tizanidine (central α2 agonist)
29
30. Mechanisms underlying spasticity involve
- stretch reflex arc itself
-also higher centers in the CNS (ie, upper
motor neuron lesion), with damage to
descending pathways in the spinal cord
resulting in hyperexcitability of the alpha
motoneurons in the cord.
30
31. Pharmacologic therapy
- ameliorate some of the symptoms of
spasticity by modifying the stretch reflex
arc
-or by interfering directly with skeletal
muscle (ie, excitation-contraction
coupling).
31
32. 32
Baclofen
It acts through GABA- B receptors
It causes hyper polarization by increased K+ conductance,
reducing calcium influx and reduces excitatory transmitter in brain
as well as spinal cord
It also reduces pain by inhibitory substance P. in spinal cord
It is less sedative
It is rapidly and completely absorbed orally
It has a half life of 3- 4 hours
It may increases seizures in epileptics
It is also useful to prevent migraine.
33. Tizanidine
Tizanidine has significant (α2), -
adrenoceptor agonist effects
tizanidine reinforces both presynaptic and
postsynaptic inhibition in the cord.
It also inhibits nociceptive transmission in
the spinal dorsal horn.
33
34. 34
Dantrolene
It acts directly
It reduces skeletal muscle strength by interfering with
excitation-contraction coupling into the muscle fiber,
by inhibiting the release of activator calcium from the
sarcoplasmic stores.
It is very useful in the treatment of malignant
hyperthermia caused by depolarizing relaxants.
This drug can be administered orally as well as
intravenously. Oral absorption is only one third.
Half life of the drug is 8-9 hours.
35. Sites of spasmolytic action of tizanidine (α2), benzodiazepines (GABAA), and
baclofen (GABAB) in the spinal cord. Tizanidine may also have a postsynaptic
inhibitory effect. Dantrolene acts on the sarcoplasmic reticulum in skeletal
muscle. Glu, glutamatergic neuron.
