The Most Equations use for Therapeutic Drugs Monitoring :
- TDM of Aminoglycoside
- TDM of Vancomycine
- TDM of Valproic Acid
- TDM of Carbamazepine
- TDM of Digoxin
This document provides an outline and overview of diabetes mellitus. It defines diabetes as a metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion or insulin action. The document classifies diabetes according to the American Diabetes Association and discusses the main types: type 1 diabetes, type 2 diabetes, gestational diabetes, and other specific rare types. It also covers the epidemiology, pathophysiology, clinical manifestations, diagnostic criteria, and management of diabetes.
The document discusses various aspects of metformin, including:
- Metformin's mechanisms of action involve both direct and indirect activation of AMPK, leading to effects like decreased glucose, lipid, and protein synthesis.
- Studies have shown metformin may be associated with better cardiac outcomes compared to other glucose-lowering drugs and should not be withheld in patients with stable heart disease or heart failure.
- Infants exposed to metformin in utero had increased subscapular skinfolds but similar body fat compared to unexposed infants, potentially signaling healthier fat distribution.
- Metformin may lower B12 levels but does not necessarily cause deficiency if metabolic markers remain normal, as cellular B12 uptake may increase with metformin therapy
The document discusses the anatomy and physiology of the islets of Langerhans within the pancreas. It provides details on:
- The islets comprising 2-3% of the pancreatic volume and containing different endocrine cell types including beta cells that produce insulin.
- Each islet being served by its own blood supply and varying in size from 100-200 micrometers in diameter.
- The islets containing thousands of cells each and accounting for a disproportionate 15% of pancreatic blood flow relative to their size.
Glibenclamide or glyburide is an oral antihyperglycemic agent used for the treatment of non-insulin-dependent diabetes mellitus (NIDDM)
It was discovered in 1969 and approved for medical use in the united states in 1984.
Sulfonylureas increase both basal insulin secretion and meal-stimulated insulin release.
Drug Class : Hypoglycemics ;Sulfonylureas
Indications : Diabetes mellitus, type 2
SIDE EFFECTS : Hypoglycemia, Angioedema, Weight gain etc.
IBD Therapy discusses treatments for Crohn's disease and ulcerative colitis. 5-aminosalicylates are first-line treatments for mild to moderate disease. Corticosteroids are effective for inducing remission but not maintaining it. Immunosuppressants like azathioprine and methotrexate are used when steroids cannot be tapered. Anti-TNF antibodies like infliximab are effective for severe disease refractory to other therapies. Nutritional supplementation is important for patients with Crohn's disease due to potential deficiencies from the condition.
This document provides guidelines for classifying and diagnosing different types of diabetes. It discusses five general categories: type 1 diabetes, type 2 diabetes, specific types due to other causes like monogenic diabetes, gestational diabetes mellitus, and diabetes related to other conditions like cystic fibrosis or organ transplantation. For each type, it provides recommendations for screening and diagnosis, including which tests to use and at what age or time periods patients should be tested. The guidelines are meant to help ensure accurate diagnosis and avoid missed or misdiagnoses.
This document provides an outline and overview of diabetes mellitus. It defines diabetes as a metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion or insulin action. The document classifies diabetes according to the American Diabetes Association and discusses the main types: type 1 diabetes, type 2 diabetes, gestational diabetes, and other specific rare types. It also covers the epidemiology, pathophysiology, clinical manifestations, diagnostic criteria, and management of diabetes.
The document discusses various aspects of metformin, including:
- Metformin's mechanisms of action involve both direct and indirect activation of AMPK, leading to effects like decreased glucose, lipid, and protein synthesis.
- Studies have shown metformin may be associated with better cardiac outcomes compared to other glucose-lowering drugs and should not be withheld in patients with stable heart disease or heart failure.
- Infants exposed to metformin in utero had increased subscapular skinfolds but similar body fat compared to unexposed infants, potentially signaling healthier fat distribution.
- Metformin may lower B12 levels but does not necessarily cause deficiency if metabolic markers remain normal, as cellular B12 uptake may increase with metformin therapy
The document discusses the anatomy and physiology of the islets of Langerhans within the pancreas. It provides details on:
- The islets comprising 2-3% of the pancreatic volume and containing different endocrine cell types including beta cells that produce insulin.
- Each islet being served by its own blood supply and varying in size from 100-200 micrometers in diameter.
- The islets containing thousands of cells each and accounting for a disproportionate 15% of pancreatic blood flow relative to their size.
Glibenclamide or glyburide is an oral antihyperglycemic agent used for the treatment of non-insulin-dependent diabetes mellitus (NIDDM)
It was discovered in 1969 and approved for medical use in the united states in 1984.
Sulfonylureas increase both basal insulin secretion and meal-stimulated insulin release.
Drug Class : Hypoglycemics ;Sulfonylureas
Indications : Diabetes mellitus, type 2
SIDE EFFECTS : Hypoglycemia, Angioedema, Weight gain etc.
IBD Therapy discusses treatments for Crohn's disease and ulcerative colitis. 5-aminosalicylates are first-line treatments for mild to moderate disease. Corticosteroids are effective for inducing remission but not maintaining it. Immunosuppressants like azathioprine and methotrexate are used when steroids cannot be tapered. Anti-TNF antibodies like infliximab are effective for severe disease refractory to other therapies. Nutritional supplementation is important for patients with Crohn's disease due to potential deficiencies from the condition.
This document provides guidelines for classifying and diagnosing different types of diabetes. It discusses five general categories: type 1 diabetes, type 2 diabetes, specific types due to other causes like monogenic diabetes, gestational diabetes mellitus, and diabetes related to other conditions like cystic fibrosis or organ transplantation. For each type, it provides recommendations for screening and diagnosis, including which tests to use and at what age or time periods patients should be tested. The guidelines are meant to help ensure accurate diagnosis and avoid missed or misdiagnoses.
Calcium channel blockers (CCBs) work by blocking the movement of calcium ions into cardiac and vascular smooth muscle cells. There are three main classes of CCBs: phenylalkylamines like verapamil, benzothiazepines like diltiazem, and dihydropyridines like nifedipine. CCBs cause vasodilation of arteries and relax vascular smooth muscle by inhibiting L-type calcium channels, reducing blood pressure and cardiac workload. Different CCBs have varying effects on heart rate, contractility and conduction. CCBs are used to treat hypertension, angina, arrhythmias and other cardiovascular conditions.
This document discusses the drug management of diabetes mellitus. It begins by classifying the different types of diabetes and criteria for diagnosis. It then discusses the therapeutic aims of glycemic control and treatment of associated conditions. The main therapeutic strategies discussed are medical nutrition therapy, exercise, and pharmacologic therapy including insulin for type 1 diabetes and oral glucose lowering agents or insulin for type 2 diabetes. Finally, it summarizes the mechanisms and examples of common classes of oral glucose lowering drugs including sulfonylureas, meglitinides, biguanides, and alpha-glucosidase inhibitors.
This document outlines the key components of non-pharmacological diabetes management, including diabetes self-management education, medical nutrition therapy, physical activity, smoking cessation, immunization, psychological issues, exercise, stress management, foot care, education, self-monitoring of blood glucose, diet, and lifestyle management. It provides details on recommendations and guidelines for each component from organizations like the International Diabetes Federation, emphasizing that non-pharmacological approaches are effective, safe and can be affordable forms of diabetes care when implemented properly through education and lifestyle changes.
Fenofibrate is a fibric acid derivative used to treat high triglyceride levels and increase HDL cholesterol. It works differently than statins in that it is more effective at raising HDL and lowering triglycerides compared to LDL lowering. The document discusses fenofibrate's market trends, size, and competition with gemfibrozil. It provides data on fenofibrate 160mg market share and sales goals, with the objective to capture 5-15% of the total fibrate market by 2011 by targeting hospitals and offering a competitive unit dose product between 4-6 Baht per tablet. The marketing plan budget is outlined as 313,190 Baht.
This document summarizes the clinical pharmacokinetics of the cardiac glycoside drug digoxin. It outlines digoxin's absorption, distribution, metabolism and elimination. Absorption is around 80% orally but is affected by foods and other drugs. Distribution is extensive with a large volume of distribution that is correlated to lean body mass. Metabolism involves hepatic and renal pathways. The document then demonstrates how to determine an appropriate digoxin dose regimen for a case study patient based on pharmacokinetic parameters like volume of distribution and drug clearance. The case study calculates a loading dose and maintenance dose for the patient.
It includes information about Hybrid closed loop insulin delivery system-Artificial Pancreas.Its details and how insulin pump develops with the time.It also includes the information about companies which manufacturing pumps.Also includes info about diabetes mellitus.
Learning objectives:
Understand the definition, causes, symptoms, risk factors of type 1 Diabetes.
Understand the definition, causes, symptoms, risk factors of type 2 Diabetes.
Understand the definition, causes, symptoms of Gestational Diabetes.
Diabetes Mellitus Type 2 is a heterogeneous group of disorders characterized by elevated blood glucose levels. It occurs when the body becomes resistant to insulin or cannot produce enough insulin. Symptoms include frequent urination, excessive thirst, and unexplained weight loss. Risk factors include family history, obesity, hypertension, and sedentary lifestyle. Treatment involves diet, oral medications, insulin injections, blood glucose monitoring, and preventative foot and eye care to reduce complications which can include cardiovascular, kidney, nerve and foot problems. Non-pharmacological interventions like diet, exercise, weight control, and smoking cessation can also help manage the condition.
Acute coronary syndrome (ACS) results from an imbalance between myocardial oxygen supply and demand due to diminished blood flow from an occlusive coronary artery thrombus. ACS is classified as ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS), which includes non-STEMI and unstable angina. Treatment involves antiplatelet and anticoagulant medications, revascularization procedures like percutaneous coronary intervention (PCI), and lifestyle modifications to prevent recurrent events.
Sodium glucose co transporter( SGLT2) Inhibitors Philip Vaidyan
This document discusses sodium-glucose co-transporter 2 (SGLT2) inhibitors, a new class of drugs for treating type 2 diabetes. SGLT2 inhibitors work by blocking glucose reabsorption in the kidney, increasing urinary glucose excretion in a glucose-dependent manner. Three SGLT2 inhibitors have been approved by the FDA - canagliflozin, dapagliflozin, and empagliflozin. SGLT2 inhibitors offer advantages over other anti-diabetic drugs in that they are non-insulin dependent and can be used throughout the course of diabetes. However, long-term safety studies are still needed to fully assess their risk-benefit profile.
Insulin pumps are small, computerized devices that help manage blood sugar levels in people with diabetes by continuously delivering rapid-acting insulin. They consist of a pump unit that holds insulin, a disposable infusion set that delivers insulin under the skin, and a control unit to program insulin delivery. Insulin pumps can deliver basal insulin throughout the day and bolus doses around meals. They provide flexibility but must be constantly worn. New hybrid closed-loop systems like the Medtronic 670G combine continuous glucose monitoring with automatic insulin delivery based on glucose levels.
1. Insulin therapy is needed for all patients with type 1 diabetes and many with type 2 diabetes as their beta cell function declines.
2. Insulin can be initiated if diet and exercise fail to control blood sugar, and oral medications are not achieving target goals.
3. There are different types of insulin preparations that provide either basal insulin levels or rapid-acting insulin to cover meals. Intensive regimens separate these types of insulin to better mimic natural patterns.
Clinical Practice Guidelines for Traumatic Brain Injury 2556Utai Sukviwatsirikul
Clinical Practice Guidelines for Traumatic Brain Injury 2556
แนวทางเวชปฏิบัติกรณีสมองบาดเจ็บ (Clinical Practice Guidelines for Traumatic Brain Injury) พิมพ์ครั้งที่ 1 2556
http://pni.go.th/pnigoth/wp-content/uploads//2013/10/Clinical-Practice-Guidelines-for-Traumatic-Brain-Injury.pdf
Individualized Diabetes treatment in Indian scenarioPrithvi Puwar
This document discusses approaches to individualizing treatment for diabetes in India. It presents three case studies and their clinical details. It then compares a guideline-based "treat to failure" approach versus a pathophysiological approach using initial combination therapy. Key factors to consider when choosing therapies are also outlined, such as minimizing hypoglycemia risk, weight gain, costs, and addressing comorbidities. Treatment options like metformin, sulfonylureas, gliptins, glitazones, and others are also discussed in terms of their advantages and disadvantages. The document emphasizes the need for individualized, combination therapy approaches given challenges with India's diabetes population like late diagnoses and high baseline A1C levels.
This document discusses diabetic nephropathy, including its causes, risk factors, stages, diagnosis, progression, and treatment strategies. It notes that diabetic nephropathy is a major complication of diabetes and a leading cause of end-stage renal disease. Key points include that strict control of blood pressure, blood glucose, diet, and lifestyle factors can help prevent or slow the progression of kidney damage caused by diabetes.
- Bronchiolitis is a common viral infection that affects the lower respiratory tract of infants, caused primarily by respiratory syncytial virus. It presents with cough, wheezing, difficulty breathing and is usually self-limiting.
- Treatment focuses on supportive care like fluids, oxygen therapy, and monitoring for dehydration or respiratory distress. Medications like bronchodilators or antibiotics are not routinely recommended.
- Hospitalization is considered if the infant has toxic appearance, poor feeding, respiratory distress, apnea or hypoxemia. The clinical status, fluid balance and oxygen levels should be closely monitored.
Bronchiolitis is commonly caused by viral infections in young children under 2 years old, most commonly respiratory syncytial virus (RSV). It involves inflammation of the small airways (bronchioles) causing wheezing, coughing, and difficulty breathing. Symptoms typically last 2-5 days but wheezing may persist over a week. Treatment is supportive with oxygen, fluids, and monitoring for deterioration. Antibiotics are not effective as it is primarily a viral illness. Hospitalization may be required for severe cases or young infants. While symptoms are usually self-limited, bronchiolitis can increase the risk of subsequent wheezing and asthma.
Calcium channel blockers (CCBs) work by blocking the movement of calcium ions into cardiac and vascular smooth muscle cells. There are three main classes of CCBs: phenylalkylamines like verapamil, benzothiazepines like diltiazem, and dihydropyridines like nifedipine. CCBs cause vasodilation of arteries and relax vascular smooth muscle by inhibiting L-type calcium channels, reducing blood pressure and cardiac workload. Different CCBs have varying effects on heart rate, contractility and conduction. CCBs are used to treat hypertension, angina, arrhythmias and other cardiovascular conditions.
This document discusses the drug management of diabetes mellitus. It begins by classifying the different types of diabetes and criteria for diagnosis. It then discusses the therapeutic aims of glycemic control and treatment of associated conditions. The main therapeutic strategies discussed are medical nutrition therapy, exercise, and pharmacologic therapy including insulin for type 1 diabetes and oral glucose lowering agents or insulin for type 2 diabetes. Finally, it summarizes the mechanisms and examples of common classes of oral glucose lowering drugs including sulfonylureas, meglitinides, biguanides, and alpha-glucosidase inhibitors.
This document outlines the key components of non-pharmacological diabetes management, including diabetes self-management education, medical nutrition therapy, physical activity, smoking cessation, immunization, psychological issues, exercise, stress management, foot care, education, self-monitoring of blood glucose, diet, and lifestyle management. It provides details on recommendations and guidelines for each component from organizations like the International Diabetes Federation, emphasizing that non-pharmacological approaches are effective, safe and can be affordable forms of diabetes care when implemented properly through education and lifestyle changes.
Fenofibrate is a fibric acid derivative used to treat high triglyceride levels and increase HDL cholesterol. It works differently than statins in that it is more effective at raising HDL and lowering triglycerides compared to LDL lowering. The document discusses fenofibrate's market trends, size, and competition with gemfibrozil. It provides data on fenofibrate 160mg market share and sales goals, with the objective to capture 5-15% of the total fibrate market by 2011 by targeting hospitals and offering a competitive unit dose product between 4-6 Baht per tablet. The marketing plan budget is outlined as 313,190 Baht.
This document summarizes the clinical pharmacokinetics of the cardiac glycoside drug digoxin. It outlines digoxin's absorption, distribution, metabolism and elimination. Absorption is around 80% orally but is affected by foods and other drugs. Distribution is extensive with a large volume of distribution that is correlated to lean body mass. Metabolism involves hepatic and renal pathways. The document then demonstrates how to determine an appropriate digoxin dose regimen for a case study patient based on pharmacokinetic parameters like volume of distribution and drug clearance. The case study calculates a loading dose and maintenance dose for the patient.
It includes information about Hybrid closed loop insulin delivery system-Artificial Pancreas.Its details and how insulin pump develops with the time.It also includes the information about companies which manufacturing pumps.Also includes info about diabetes mellitus.
Learning objectives:
Understand the definition, causes, symptoms, risk factors of type 1 Diabetes.
Understand the definition, causes, symptoms, risk factors of type 2 Diabetes.
Understand the definition, causes, symptoms of Gestational Diabetes.
Diabetes Mellitus Type 2 is a heterogeneous group of disorders characterized by elevated blood glucose levels. It occurs when the body becomes resistant to insulin or cannot produce enough insulin. Symptoms include frequent urination, excessive thirst, and unexplained weight loss. Risk factors include family history, obesity, hypertension, and sedentary lifestyle. Treatment involves diet, oral medications, insulin injections, blood glucose monitoring, and preventative foot and eye care to reduce complications which can include cardiovascular, kidney, nerve and foot problems. Non-pharmacological interventions like diet, exercise, weight control, and smoking cessation can also help manage the condition.
Acute coronary syndrome (ACS) results from an imbalance between myocardial oxygen supply and demand due to diminished blood flow from an occlusive coronary artery thrombus. ACS is classified as ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS), which includes non-STEMI and unstable angina. Treatment involves antiplatelet and anticoagulant medications, revascularization procedures like percutaneous coronary intervention (PCI), and lifestyle modifications to prevent recurrent events.
Sodium glucose co transporter( SGLT2) Inhibitors Philip Vaidyan
This document discusses sodium-glucose co-transporter 2 (SGLT2) inhibitors, a new class of drugs for treating type 2 diabetes. SGLT2 inhibitors work by blocking glucose reabsorption in the kidney, increasing urinary glucose excretion in a glucose-dependent manner. Three SGLT2 inhibitors have been approved by the FDA - canagliflozin, dapagliflozin, and empagliflozin. SGLT2 inhibitors offer advantages over other anti-diabetic drugs in that they are non-insulin dependent and can be used throughout the course of diabetes. However, long-term safety studies are still needed to fully assess their risk-benefit profile.
Insulin pumps are small, computerized devices that help manage blood sugar levels in people with diabetes by continuously delivering rapid-acting insulin. They consist of a pump unit that holds insulin, a disposable infusion set that delivers insulin under the skin, and a control unit to program insulin delivery. Insulin pumps can deliver basal insulin throughout the day and bolus doses around meals. They provide flexibility but must be constantly worn. New hybrid closed-loop systems like the Medtronic 670G combine continuous glucose monitoring with automatic insulin delivery based on glucose levels.
1. Insulin therapy is needed for all patients with type 1 diabetes and many with type 2 diabetes as their beta cell function declines.
2. Insulin can be initiated if diet and exercise fail to control blood sugar, and oral medications are not achieving target goals.
3. There are different types of insulin preparations that provide either basal insulin levels or rapid-acting insulin to cover meals. Intensive regimens separate these types of insulin to better mimic natural patterns.
Clinical Practice Guidelines for Traumatic Brain Injury 2556Utai Sukviwatsirikul
Clinical Practice Guidelines for Traumatic Brain Injury 2556
แนวทางเวชปฏิบัติกรณีสมองบาดเจ็บ (Clinical Practice Guidelines for Traumatic Brain Injury) พิมพ์ครั้งที่ 1 2556
http://pni.go.th/pnigoth/wp-content/uploads//2013/10/Clinical-Practice-Guidelines-for-Traumatic-Brain-Injury.pdf
Individualized Diabetes treatment in Indian scenarioPrithvi Puwar
This document discusses approaches to individualizing treatment for diabetes in India. It presents three case studies and their clinical details. It then compares a guideline-based "treat to failure" approach versus a pathophysiological approach using initial combination therapy. Key factors to consider when choosing therapies are also outlined, such as minimizing hypoglycemia risk, weight gain, costs, and addressing comorbidities. Treatment options like metformin, sulfonylureas, gliptins, glitazones, and others are also discussed in terms of their advantages and disadvantages. The document emphasizes the need for individualized, combination therapy approaches given challenges with India's diabetes population like late diagnoses and high baseline A1C levels.
This document discusses diabetic nephropathy, including its causes, risk factors, stages, diagnosis, progression, and treatment strategies. It notes that diabetic nephropathy is a major complication of diabetes and a leading cause of end-stage renal disease. Key points include that strict control of blood pressure, blood glucose, diet, and lifestyle factors can help prevent or slow the progression of kidney damage caused by diabetes.
- Bronchiolitis is a common viral infection that affects the lower respiratory tract of infants, caused primarily by respiratory syncytial virus. It presents with cough, wheezing, difficulty breathing and is usually self-limiting.
- Treatment focuses on supportive care like fluids, oxygen therapy, and monitoring for dehydration or respiratory distress. Medications like bronchodilators or antibiotics are not routinely recommended.
- Hospitalization is considered if the infant has toxic appearance, poor feeding, respiratory distress, apnea or hypoxemia. The clinical status, fluid balance and oxygen levels should be closely monitored.
Bronchiolitis is commonly caused by viral infections in young children under 2 years old, most commonly respiratory syncytial virus (RSV). It involves inflammation of the small airways (bronchioles) causing wheezing, coughing, and difficulty breathing. Symptoms typically last 2-5 days but wheezing may persist over a week. Treatment is supportive with oxygen, fluids, and monitoring for deterioration. Antibiotics are not effective as it is primarily a viral illness. Hospitalization may be required for severe cases or young infants. While symptoms are usually self-limited, bronchiolitis can increase the risk of subsequent wheezing and asthma.
Asthma is an inflammatory disorder of the small airways characterized by periodic attacks of wheezing, shortness of breath, chest tightness, coughing and improvement with bronchodilators. It is triggered by environmental stimuli like allergens and respiratory infections. Diagnosis involves lung function tests showing reversible airway obstruction and improvement after bronchodilator use. Treatment includes inhaled corticosteroids, long-acting bronchodilators, immunotherapy, and oral corticosteroids for severe cases. Refractory asthma affects 5-8% of asthmatics and is diagnosed based on medication requirements and symptom control.
This evidence-based guideline provides recommendations for the management of bronchiolitis in infants and children under 18 months of age. Key recommendations include:
1) The diagnosis of bronchiolitis is clinical based on symptoms of a respiratory infection followed by cough, fast breathing, wheezing and crackles without need for testing.
2) Treatment is supportive with oxygen and oral hydration; medications like bronchodilators, steroids and antibiotics are not routinely recommended.
3) Severity is classified as mild, moderate, severe or life-threatening to determine appropriate care setting and need for ambulance transport to hospital.
This document provides an overview of hematology and anemia. It discusses the components of blood, red blood cell development and indices, classifications of anemia, laboratory tests used in diagnosis, and the differential diagnosis of anemia types based on red blood cell morphology and etiology. Key points include that anemia is defined as low hemoglobin or red blood cell count, and anemias are caused by either inadequate red blood cell production or accelerated red blood cell destruction. Anemias can be classified as microcytic, normocytic, or macrocytic based on cell size, and have various potential underlying etiologies.
This document provides an overview of common neonatal disorders classified into four categories: birth injuries, disorders related to physiological factors, disorders related to infectious processes, and disorders related to maternal conditions. Specific conditions discussed in detail include respiratory distress syndrome, necrotizing enterocolitis, hemolytic disease of the newborn, and neonatal sepsis. The nursing management of each condition focuses on supportive care, monitoring, treatment, and ensuring optimal outcomes for the infant.
This document discusses neonatal respiratory distress, including signs, symptoms, and common etiologies. The main pulmonary causes discussed are transient tachypnea of newborn, respiratory distress syndrome, meconium aspiration syndrome, pneumonia, and air leak syndromes. For each cause, risk factors, pathophysiology, clinical manifestations, diagnostic findings, and management approaches are summarized. The document provides an overview of evaluation and treatment of neonatal respiratory distress.
Bronchiolitis is an inflammatory disease of the small airways caused primarily by Respiratory Syncytial Virus (RSV) in infants under 1 year old. It leads to obstruction of the small airways due to inflammation, mucus production, and edema. Clinically, infants present with rhinorrhea, cough, tachypnea, wheezing and respiratory distress. Chest X-ray may show hyperinflated lungs. Management is supportive with oxygen, hydration and sometimes bronchodilators. Most infants recover within 2 weeks but some may develop long-term wheezing.
- Bronchiolitis is a common respiratory condition in infants caused by viral infections like respiratory syncytial virus (RSV). It involves inflammation of the smallest air passages in the lungs called bronchioles.
- Symptoms include cough, wheezing, difficulty breathing and feeding. Risk factors for severe disease include age under 6 months, prematurity, and exposure to tobacco smoke. Diagnosis is clinical based on symptoms and signs. Treatment is supportive with oxygen, fluids, and nasal suctioning. Antibiotics and bronchodilators are not recommended. Parents should monitor for worsening symptoms.
Sampling is the process of selecting a subset of individuals from within a population to estimate characteristics of the whole population. There are several sampling techniques including simple random sampling, stratified sampling, cluster sampling, systematic sampling, and non-probability sampling. Each technique has advantages and disadvantages related to accuracy, cost, and generalizability. Proper sampling helps reduce sampling errors and increase the reliability of making inferences about the population from a sample.
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 boosts blood flow and levels of neurotransmitters and endorphins which elevate and stabilize mood.
Pneumonia is an inflammatory lung condition caused by infection, usually bacterial or viral. It is characterized by consolidation of the lungs due to inflammatory exudate, bacteria, and white blood cells filling the alveoli. Pneumonia can be classified as lobar or bronchopneumonia based on location in the lungs and as community-acquired or hospital-acquired based on where infection was contracted. Treatment involves use of antibiotics to eradicate the infecting organism as well as supportive care like oxygen supplementation. Antibiotic selection is based on suspected pathogen, patient age and health status, and severity of illness.
Neonatal jaundice is the yellow discoloration of skin and mucous membranes due to high bilirubin levels in newborns. It is common, occurring in 30-50% of term and 80% of preterm infants. Jaundice can be physiological or pathological. Physiological jaundice is mild and resolves on its own, while pathological jaundice requires treatment. Treatment may include phototherapy, phenobarbital, exchange transfusion or metalloporphyrins depending on bilirubin levels. The goal of treatment is to prevent kernicterus, a toxic brain condition caused by high bilirubin levels.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
1. Equations of TDM
units converter
1 pound = 0.453 kg
1 inch = 2.54 centimeters
1 foot = 30.48 centimeters
Plasma concentration
Zero Order eq . Frist Order eq .
Log A =
-kt
+ log A
2.3
Half Life =
0.693
k
A = Ao - Ko t
Half life = 0.5 . Ao
Ko
Extraction
E= Cin-Cout
Cin
CrCl =
Ucr . Vcr
Scr
Cockeroft / Gulft eq .
CrCl (male)(ml/min)=
(140 - age ) (w)
(72)(Scr)
CrCl (famale)(ml/min)= CrCl × 0.85
MDRD :
GFR ( ml / min / 1.73
m2
) = 186 × (Scr)
-1.159
× age
-0.203
K =
clT
ClT = Vd . K
Vd
Cp = Cpoe-kt
Jallffe :
CrCl (male)
(ml/min/1.73
m2
BSA)=
98-[0.8(age-20)]
Scr
BSA =
√ht×wt
3600
Ideal Body Weight (male)(kg)=50+[0.9(H-152)]
Ideal Body Weight (famale)(kg)=45.5+[0.9(H-152)]
bwadj =IBW+0.4(ABW-IBW)
Unstable Renal Function :
CrCl(male) = [(293-2.03(age))]×[1.035-0.01685(Scr+Scr2)]+[49(Scr1-Scr2)]
Salazar Eq :
CrCl(male) (ml/dl) =
(137-age)×[(0.285×w)+(12.1×H
2
)]
51×Scr
Salazar Eq :
CrCl(fmale) (ml/dl) =
(146-age)×[(0.287×w)+(9.74×H
2
)]
60×Scr
CrCl(famale) = CrCl(male) × 0.86
CrCl (ml/min) = CrCl . BSA
1.73
Prepared by : Mohammad Matouq Alghamdi
2. TDM of Aminoglycoside
1. Estimate Creatinine Clearance :
CrClest(ml/min) = [(140 - age ) BW]*0.85 .... ml/min
72×Scr
CrClest(ml/min) = [(140 - age ) BW] .... ml/min
72×Scr
(famale)
(male)
2. Estimate elemination rate constant :
3. Estimate Volume of Distribution :
VD= 0.26 L/kg
VD=0.26[IBM+0.4(TBW-IBW) ..... L/kg in Obese
VD=0.35 ..... L/kg in cystic
VD=(0.26×DBW)+(TBW-DBW) in liver cirrhosis
4.Choose desired stedy state serum concentrations
Css max | Cssmin ug/ml
5. Dosing interval :
interval is rounded to :
6 , 8 , 12 , 18 , 24 , 36 , 48 , 72
mg
mg Computing loding dose if more than 10%
of maintenance dose :
MD
100
LD
T=
[(InCssmax-InCssmin)] + t’ ..... hr
ke
6. Computing maintenance dose :
LD = Ko / ( 1- e
-keT
)
Ko=Cssmax.ke.V[(1-e-kT’
)
]1-e-kt’
Ke = 0.00293(CrCl)+0.014 ..... h-1
t1/2 = 0.693 .... h
ke
In papulation
w
τ
τ
τ
Prepared by : Mohammad Matouq Alghamdi
3. TDM of Aminoglycoside
1. Estimate Creatinine Clearance :
CrClest(ml/min) = [(140 - age ) BW]*0.85 .... ml/min
72×Scr(famale)
(male)
CrClest(ml/min) = [(140 - age ) BW] ..... ml/min
72×Scr
2. Estimate elemination rate constant :
3. Estimate Volume of Distribution :
VD=
D
× 1-e
-kt’
t’ ke [ Cssmax ( Cssmin × e-ket’
)]
4.Choose desired stedy state serum concentrations
Css max | Cssmin ug/ml
5. Dosing interval :
T=
[(InCssmax-InCssmin)] + t’ ..... hr
ke
LD = Ko / ( 1- e
-keT
)
6. Computing loading dose (LD) :
Ko=Cssmax.ke.V[(1-e-kt
)
]1-e-kt
Ke =
(InCssmax-InCssmin)
..... h-1
T-t’
t1/2 = 0.693 .... h
Ke
In individual
τ
τ
τ
τ
Prepared by : Mohammad Matouq Alghamdi
4. TDM of Vancomycine
1. Estimate Creatinine Clearance :
CrClest(ml/min) = [(140 - age ) BW]*0.85 .... ml/min
72×Scr(famale)
(male)
CrClest(ml/min) = [(140 - age ) BW] ..... ml/min
72×Scr
4. Estimate elemination rate constant :
3. Estimate Volume of Distribution :
VD= 0.7 .... L/kg
4.Choose desired stedy state serum concentrations
Css max | Cssmin ug/ml
5. Dosing interval :
interval is rounded to :
6 , 8 , 12 , 18 , 24 , 36 , 48 , 72
if CrCl < 60
T=
[(InCssmax-InCssmin)]
..... hr
ke
7. Computing loading dose (LD) :
6. Required dose (D) :
D=Cssmax*V(1-e-keT) .... mg
Ko=Cssmax.V
Ke = Cl / V ( Result*0.06) .... hr
-1
t1/2 = 0.693/ke ... h
2. Estimate clearance of Vancomycine :
Cl = 0.695 ( CrCl / TBW ) + 0.05 ..... ml/min/kg
In papulation
τ
τ
Prepared by : Mohammad Matouq Alghamdi
5. TDM of Vancomycine
1. Estimate Creatinine Clearance :
CrClest(ml/min) = [(140 - age ) BW]*0.85 .... ml/min
72×Scr(famale)
(male)
CrClest(ml/min) = [(140 - age ) BW] ..... ml/min
72×Scr
2. Estimate elemination rate constant :
3. Estimate Volume of Distribution :
VD= D
Cssmax - Cssmin
4.Choose desired stedy state serum concentrations
Css max | Cssmin ug/ml
5. Dosing interval :
T=
[(InCssmax-InCssmin)]
..... hr
ke
7. Computing loading dose (LD) :
6. Required dose (D) :
D=Cssmax*V(1-e-keT
) .... mg
Ko=Cssmax.V
Ke =
(InCssmax-InCssmin)
..... h-1
T-t’
t1/2 = 0.693 .... h
Ke
In indevidual
mg
L
τ
τ
Prepared by : Mohammad Matouq Alghamdi
6. Valproic Acid
Age Condition Rang
Adult 7-12 ml/h/kg
Chlidren without drugs induce enzym 10 - 20 ml/h/kg
Chlidren with drugs induce enzym 20-30 ml/h/kg
Liver Cirrosis & Acute hepatits 3 - 4 ml/h/kg
in adult in children ( under 12 y )
Vd = Weight × 0.15 .... L Vd=Weight × 0.2 ...L
1. Estimate Clerance - Rate of Clearce ......... ml / h
2. Volume of Distrbution
3. t2
/1
& Ke
t2
/1
= ..... H
4. Compute dose regmint :
D= Css × Cl × τ
F
5. Loading dose in I.V :
LD = Css × V ... mg
• Literature - Based recomended dose :
D= Wight × Rang of dose according to age .... mg
• Seudoliner PK method :
Dnew=
Css new
× D old ... mg
Css old
• PK parametar :
Cl=
F( D )
.... L/hr
τ
Css old
0.693×V
Cl
0.693
t2
/1
Ke= .... hr-1
In oral Dose F = 1
In Oral sustaind relase F=0.9
if Dose increase Css change %10 - 20 :
(Css = Css new × 0.9) ( Css=Cssnew×0.8)
if Dose Decrease Css change %10 - 20 :
(Css = Css new × 1.1) ( Css=Cssnew×1.2)
For pediatric 10 mg/kg/day
For pediatric ( Take enzyme inducer ) 20 mg/kg/day
For adult 7.5mg/kg/day
For adult ( Take enzyme inducer ) 15mg/kg/day
Prepared by : Mohammad Matouq Alghamdi
7. Carbamazepine
1. Estimate Carbamazepine dose according to disease state and condotion in patient :
• to compute Css new
Css new=
D new
× Css old ... mg
D old
Conditions Dose
Children under 6 years old 10 - 20 mg/kg/dose
Children 6 - 12 years old 200 mg /day
Adult 400 mg /day
Prepared by : Mohammad Matouq Alghamdi
8. Digoxin
1. Estimate creatinine clearance :
• If not obese use Cockcroft - Gault equation
• If obese use Salazar & Corcoran
2. Estimate clearance
Cl = 1.303 ( CrCl ) ClNR
• ClNR = 40 mL/min since the patient has to mild heart failure
• ClNR = 20 mL/min since the patient has to sever heart failure
3. Use average Css equation to compute digoxin (MD) :
D/τ =
Css × Cl .... ug/d
F
•Note: the result must × by factor 1.44
4. Compute ( LD ) if needed :
• Compute V :
(in patient with renal dysfunction (Cl =< 30 mL/min ) :
V= [ 226 + ( )×( )] ... L
(in patient ( Cl > 30 mL/min ) :
V = 7 × kg .. L
•LD =
( Css × V )
... ug
F
298×CrCl wt
29.1 +CrCl 70
Prepared by : Mohammad Matouq Alghamdi
mmoa92@gmail.com