This document provides guidelines for prescribing medications to geriatric and pediatric patients. For geriatric patients, polypharmacy increases risk of interactions and side effects. Organ functions like absorption, distribution, metabolism, and excretion decline with age. Close monitoring is needed and non-drug therapies should be considered. In pediatrics, drug effects are not well-researched and formulations must be tailored to the patient's developmental stage. Dosages are based on weight and potential adverse drug reactions vary significantly compared to adults. Special care is required in administration and education of caregivers.
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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. Geriatric Patients
Aim of therapy: To prolong life and improve the QoL of
the patient.
Elderly people often receive multiple drugs for their
multiple diseases.
Polypharmacy increases the risk of drug interactions and
ADRs.
CV agents, Diuretics, Analgesics, GI agents, Antidiabetics,
Potassium supplements are among the drug classes that
are very problematic in the geriatric populations.
For certain conditions, it is better to advise non-drug
therapies of proven efficiency.
3. Common hepato-renal issues in geriatric pts.:
• Reduced renal clearance;
• Limited reserves of renal function;
• Highly susceptible to nephrotoxic drugs;
• Excrete drugs slowly;
• Reduced hepatic metabolism of drugs;
Unnecessary use of hypnotics should be avoided
(measures could include emptying the bladder before
going to bed to avoid having to get up in the middle of
the night, or avoiding stimulant drugs in the evening or
night).
4. Decline in integrity of various organs and systems
involved in the ADME of drugs.
On average, there is a 7x increase in drug toxicity as
age increases from 20 – 79 yrs.
5. Absorption:
• gastric acid secretion, gastric pH;
• GI motility
• active absorption of Vitamins, Fe, Ca.
Distribution:
• body fat from 15-30% (on average);
• lean body wt. proportionally to body weight;
• Vd of lipophilic drugs (diazepam, chlordiazepoxide, etc.);
• albumin conc. (Inc. unbound fraction of drugs like
phenytoin in the circulation);
• On average, total PP conc. is relatively constant
6. Metabolism:
liver mass and liver blood flow;
For drugs which undergo Phase-I metabolism
(oxidation and reduction), metabolism with increase in
age (e.g.,Lidocaine, propranolol, phenytoin,
theophylline, etc.).
For drugs which undergo Phase-II metabolism, the
metabolism is relatively unaffected (Isoniazid by
acetylation; Temazepam by glucuronidation).
7. Excretion:
• nephron nos.;
• functioning glomeruli;
• renal blood flow;
• GFR,
• muscle mass leading to SCr
• Dose adjustments must definitely be made for
aminoglycosides, digoxin, methotrexate, quinidine,
tetracyclines.
8. The margin between therapeutic effect and toxicity is
so small.
E.g., Age-related toxicity of BZs with long half-lives has
made the use of these drugs undesirable in elderly
patients.
(Amitryptylline, Barbiturates, Reserpine, indomethacin,
Chlorpropamide).
Always ensure that the optimal number of drugs are
prescribed for the patient.
9. Complex drug regimen mostly results in non-
compliance due to age-related slowness of
comprehension, memory lapses, and loss of vision.
For complex therapeutic regimen, it is better to use
different coloured medications (as much as
possible).
It is better to avoid large tablets and capsules due
to difficulty in swallowing.
As far as possible, aim for OD dosing than more
frequent dosing regimen.
10. Elderly patients should be taught to ‘understand’ the drugs
they must take.
Spend extra time to advise (in a more simplified manner)
the patients regarding the administration technique, dosing
schedule.
Sometimes it may be necessary to provide clear
instructions in writing.
Use of drug diary or calendar should be encouraged.
For geriatric patients, it is also better to involve family
members / close friends / care home staff.
Regular review of the medications administered to the
geriatric patients must be done.
12. • Compared to the adult population, drug use has not been as
extensively researched.
• In many cases, drug treatment is not really required.
• The increased affinity (in general) towards naturopathy has
resulted in exacerbation of many disease conditions.
• Over-prescription of antibiotics is a huge concern.
• When dispensing a medication for an acute illness, the
pharmacist must explain the reason(s) for the medication
being given; dose and dosing frequency; precautions to be
taken to the parents.
• Drug selection should be based on relative risk and clinical
considerations.
• Focus should also be on the AEs of the medications in the
paediatric patients.
E.g., Sulphonamides (cotrimoxazole, among others) cause
kernicterus.
13. Medications
Sulphonamides (including
cotrimoxazole)
Kernicterus (bilirubin-induced brain dysfunction)
Tetracyclines Tooth staining and damage
Aspirin Reye’s syndrome (causes swelling in liver and
brain)
Ibuprofen Can cause serious toxicity in children with renal
diseases.
Potent topical corticosteroids Unsuitable for routine use in neonates and young
children due to significant systemic absorption,
adrenal suppression and growth retardation.
Lidocaine High potential for seizures
MMR Vaccine (gelatin or egg
proteins)
Anaphylaxis
14. The choice of formulation is extremely important for this
population.
Review various info.: ease of administration, routes
available, size of medication, taste, safety and the
excipients.
Generally, the dosage is calculated based on the body
weight, BSA, developmental stage, and physiological
function.
The rapidly changing body size, body weight, and
physiological function observed in children undergoing
treatment make it necessary to constantly review and adjust
drug dosages (if required).
Rectal suppositories cannot be reliably absorbed unless they
are retained in the body. This is very difficult to assure in
case of paediatric cases.
15. Paediatric issues with routes of administration:
Slow infusion rates of medication
Low muscle mass; Skin absorption capacity;
Rapid GI transit; Lack of anal sphincter control
Poor compliance w/ administration
E.g., If a life-saving drug is administered into a slowly
running I.V. line running at 3ml/hr, it can take 6-8 hrs.
before a detectable conc. begins to appear in the plasma.
This can potentially lethal in many paediatric patients.
Rapid GI transit time unreliable absorption of slowly
absorbed orally administered drugs
• E.g., SR preparations are formulated to release the drug
over 12 – 24 hrs. The dose cannot be delivered reliably if
the preparations are excreted from the body 2-4 hrs.
post-administration.
16. Whenever possible, the oral route of admn. should be
preferred.
Liquid preparations (oral route) are most suitable for
children < 5 yrs.
Though liquid preparations are suitable, they contain sugar,
which can increase the risk of dental decay. For long-term
therapy, it is better to switch to sugar-free versions.
Capsules can be emptied and ‘disguised’ in jam or honey.
Parenteral routes are more appropriate in cases where the
patient presents with vomiting or significant diarrhoea.
Rectal admn. has been proven to be useful in certain cases:
• Diazepam for convulsions;
• Glycerin for constipation;
• Paracetamol for fever w/ vomiting;
Inhalers: Paediatric patients in most cases won’t be able to
properly use inhalers. It is better to use ‘nebulizers’ and/or
‘spacers’.
17. Factors to consider when opting for the type of oral dosage
form:
BA; Palatability; Convenience; Availability of various drug
forms; Cost; Stability; Toxicity;
Dosage is based on body weight, body surface area.
Medication errors can occur due to difficulty in accurately
measuring paediatric doses / use of incorrect / inaccurate
measuring devices.
Household teaspoons can contain anywhere between 2.5-7.5
ml. They can be confused with tablespoon, especially when
abbreviations are used on the prescription.
Use of oral syringes and/or cups can eliminate certain
administration errors. However, this is also problematic in
case of parents who cannot read properly or understand cup
markings.
Pharmacists should countercheck if the medication should be
diluted for paediatric cases.
18. Pharmacists must advise parents not to add any medicines
to the content of the infant’s feeding bottle, since the drug
may interact with milk or other liquid in it. The ingested
dosage may be reduced, if the child does not drink all the
contents.
Parents should be warned to keep all medicines out of the
reach of children.