Ischemic heart disease causes a lack of oxygen to heart muscle. Angina pectoris is a symptom of this condition and feels like chest pain or discomfort that may spread to other areas. There are different types of angina depending on when the pain occurs. Treatment involves drugs that increase oxygen supply like nitrates or reduce oxygen demand like beta blockers. Nitrates work by dilating blood vessels to decrease blood pressure and the workload on the heart. Beta blockers lower heart rate and contraction strength. Calcium channel blockers also dilate vessels and relax heart muscle. These drugs are used alone or in combinations to prevent and treat angina attacks.
1) Asthma is a chronic inflammatory airway disease characterized by recurrent episodes of breathlessness, wheezing, coughing and chest tightness. 2) Pharmacotherapy includes relievers like beta-2 agonists for acute symptoms and controllers like inhaled corticosteroids to control underlying inflammation. 3) Other controller options include leukotriene modifiers, theophylline, mast cell stabilizers and monoclonal antibody omalizumab for severe asthma.
This document contains a suspected adverse drug reaction reporting form used by healthcare professionals in India to voluntarily report adverse drug reactions to the Indian Pharmacopoeia Commission. The multi-page form collects information about the patient, suspected reaction, suspected medications, actions taken, outcomes and reporter details. It advises what types of reactions should be reported, who can report, where to submit reports, how submitted information is handled confidentially, and mandatory fields for reporting.
Esomeprazole is a proton pump inhibitor used to treat gastroesophageal reflux disease and other acid-related conditions. It works by blocking the final step of acid production in the stomach. It is indicated for GERD, erosive esophagitis, risk reduction of NSAID-associated ulcers, H. pylori eradication, and duodenal/gastric ulcers. Esomeprazole is contraindicated in those with known hypersensitivity. It is unlikely to pose teratogenic risk during pregnancy but should only be used if benefits outweigh risks. It is excreted in breastmilk so discontinuation should be considered based on importance to mother. Common side effects include
This document discusses anti-asthma drugs and their mechanisms of action. It covers short-acting beta-2 agonists like salbutamol that work within hours to dilate airways. Long acting beta-2 agonists and methylxanthines like theophylline are also discussed, working for longer periods by inhibiting phosphodiesterase. The document details how these drugs increase cAMP levels to relax smooth muscle. Adverse effects like tachycardia are also summarized.
This document defines key terms related to adverse drug reactions such as adverse events, adverse drug reactions, and medication errors. It describes the etiology and various classification systems for adverse drug reactions. The document outlines methods for detecting, reporting, and assessing the severity and seriousness of adverse drug reactions. It also covers predicting and preventing adverse drug reactions, and how to manage adverse drug reactions when they occur. The document emphasizes the importance of reporting all suspected adverse drug reactions to assist in ensuring drug safety.
This document summarizes information about proton pump inhibitors (PPIs). It defines a proton pump and PPIs, explaining that PPIs reduce stomach acid production by blocking the proton pump enzyme. The document outlines the main uses of PPIs as relieving acid reflux and treating ulcers. It describes the mechanism of action of PPIs in blocking gastric acid secretion. Examples of common PPI drugs are provided. Risks of overuse are mentioned, as well as the need to step down therapy when stopping PPIs to avoid rebound acid effects.
This document provides an overview of metoprolol, a beta1-selective adrenergic receptor blocker used to treat hypertension, angina, arrhythmias, and migraine headaches. It discusses metoprolol's mechanism of action, pharmacokinetics, indications and uses, adverse effects, drug interactions, formulations, and dosage information. The document also references current research on metoprolol and beta blockers in general.
This document discusses antiplatelet drugs used to treat arterial and venous thrombosis. It describes the role of platelets in arterial thrombosis, triggered by disruption of atherosclerotic plaque. Common antiplatelet drugs discussed include aspirin, clopidogrel, prasugrel, ticlopidine, dipyridamole, and glycoprotein IIb/IIIa inhibitors like abciximab and tirofiban. Their mechanisms of action, indications, and side effects are summarized. Clopidogrel resistance due to genetic factors is also mentioned.
This document provides information on the management of peptic ulcer disease. It discusses the physiology of gastric acid secretion, introduces peptic ulcer disease, and outlines various drugs used to treat PUD. Key drugs mentioned include proton pump inhibitors like omeprazole, H2 receptor antagonists like ranitidine, prostaglandin analogues like misoprostol, antacids, and combinations used to eradicate Helicobacter pylori.
Therapeutic drug monitoring (TDM) involves measuring specific drug levels in patients to maintain concentrations in the therapeutic range. The goals are to individualize drug dosing for optimal benefit and assess drug efficacy and safety. TDM is indicated when drugs have a narrow therapeutic index, clinical response is difficult to assess, or metabolism varies between patients. The TDM process includes deciding when to measure levels, collecting samples, analyzing samples using validated methods, communicating results, and clinicians interpreting results in the context of the patient's treatment. TDM aims to promote optimal drug therapy by maintaining therapeutic drug concentrations.
detection methods of Adverse drug reactions, postal survey method, Reporting of Adverse drug reactions, Preventability assessment, predictability assessments
Heparin is a glycosaminoglycan found in mast cells that acts as an anticoagulant by catalyzing the inhibition of coagulation factors like thrombin and factor Xa by antithrombin. It is commonly extracted from pig intestines or cow lungs. Low molecular weight heparins produced by fractionation have a higher affinity for inhibiting factor Xa over thrombin. Heparin is used to prevent and treat deep vein thrombosis and pulmonary embolism and in other conditions like myocardial infarction and unstable angina. Adverse effects include heparin-induced thrombocytopenia and osteoporosis with prolonged use.
This presentation consists of various approaches to treat hypertension depending on severity. It also include treatment according to international guidelines. Classification and brief description of each antihypertensive agent has been mentioned.
LCZ696 was more effective than enalapril in reducing the risks of CV death and HF hospitalization, CV death, HF hospitalization, and all-cause mortality in patients with heart failure with reduced ejection fraction. LCZ696 also provided incremental improvements in symptoms and physical limitations. LCZ696 was better tolerated than enalapril with lower rates of symptomatic hypotension, hyperkalemia, renal impairment, and cough.
Pharmacovigilance involves monitoring the safety of drugs on the market. It is important for improving patient care and safety, as shown by the thalidomide tragedy. Key aspects of pharmacovigilance include timely reporting and assessment of adverse drug reactions and signals to identify relationships between drugs and side effects. Causality assessment tools are used to evaluate reported adverse events and determine if the drug likely caused the reaction. Pharmacovigilance systems help manage this process from case intake to reporting.
Anticoagulants, commonly referred to as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time.
Drug use evaluation (DUE) is a quality improvement process that reviews prescribing patterns to promote appropriate drug use. It involves identifying a drug or therapeutic area, developing criteria and standards, collecting data, evaluating results, providing feedback, and implementing interventions. The process then reevaluates drug use and revises the DUE program as needed. The presented document outlines the 11 steps of a DUE process focusing on monitoring renal function during aminoglycoside therapy.
This document discusses various antiplatelet and fibrinolytic drugs used to inhibit platelet activation and aggregation in acute coronary syndrome (ACS). It describes the classes and mechanisms of action of antiplatelet drugs including cyclooxygenase inhibitors like aspirin, phosphodiesterase inhibitors like dipyridamole, ADP receptor antagonists like clopidogrel and ticagrelor, and GPIIb/IIIa receptor inhibitors like abciximab. It provides details on dosing, indications, adverse effects and drug interactions for individual drugs.
This document discusses medication errors, adverse drug events, and potential solutions. It defines key terms like adverse drug event and adverse drug reaction. Medication errors can be caused by factors related to healthcare professionals, patients, tasks, environments, and computer systems. Reporting errors is important to identify issues and implement corrective actions. Potential solutions mentioned include medication reviews, reconciliation, education, and automated/computerized systems with decision support.
This document discusses various types of anemia and treatments. It covers iron deficiency anemia in detail, including causes and signs. It describes how iron is absorbed and transported in the body. Oral and intravenous iron preparations are listed to treat iron deficiency. The document also discusses vitamin B12, folic acid, ascorbic acid and erythropoietin, and their roles in anemia treatment.
This document discusses various types of anemia and treatments. It covers iron deficiency anemia in detail, including causes and signs. It describes how iron is absorbed and transported in the body. Common oral iron supplements are listed. The document also discusses vitamin B12 and folic acid deficiency anemia, their roles, and supplement options. Erythropoietin and other hematopoietic growth factors used to treat anemia are explained.
This document discusses various types of anemia and treatments. It covers iron deficiency anemia in detail, including causes and signs. It describes how iron is absorbed and transported in the body. Common oral and intravenous iron preparations are listed to treat iron deficiency. The document also discusses vitamin B12 and folic acid deficiency anemia and treatments. Erythropoietin and other hematopoietic growth factors used to treat anemia are covered.
This document provides guidelines on the prevention and management of iron deficiency anaemia during pregnancy. It defines anaemia levels and discusses the high prevalence of anaemia among pregnant women in India. The causes of iron deficiency anaemia include inadequate iron intake, poor absorption, and increased requirements during pregnancy. Left untreated, it can lead to maternal and infant complications. The guidelines recommend dietary changes, iron supplementation, investigation and treatment based on anaemia severity. It also covers vitamin B12 and folate deficiency anaemias, including symptoms, investigations and management.
The document discusses various types of anemia, their causes, and treatment with iron supplements. It notes that anemia is characterized by a decreased oxygen-carrying capacity of blood due to low hemoglobin or red blood cell counts. Common causes include dietary iron deficiency, blood loss, and bone marrow disorders. Oral iron is usually the first line treatment, while parenteral iron may be used for more severe cases or those with intestinal malabsorption. The roles of iron in hemoglobin formation and the mechanisms of iron absorption and transport in the body are also summarized.
This document discusses haematinics and erythropoietin. It defines haematinics as substances required for blood formation that are used to treat anaemia. Iron is an essential nutrient distributed mainly in haemoglobin, iron stores, myoglobin and enzymes. Dietary iron absorption requires reduction to the ferrous form and is facilitated by acids and meat. Oral iron preparations include ferrous salts while injectable forms include iron dextran and ferric carboxymaltose. Erythropoietin is a hormone that stimulates red blood cell production. Iron poisoning in children can cause vomiting, haematemesis and potentially death. Supportive care includes fluid replacement and preventing further iron absorption.
Physiological changes during pregnancy cause a dilution of blood which results in mild anemia. Iron deficiency is the most common type of anemia seen in pregnancy. It is important to supplement with iron and folic acid during pregnancy to meet increased demands and prevent deficiencies. Mild to moderate anemia is treated with oral iron supplements while more severe cases may require intravenous iron. Untreated anemia can have negative effects on both mother and fetus.
Hematinics are substances used to treat and prevent anemia. Megaloblastic anemias are caused by vitamin B12 or folate deficiencies and are characterized by large, abnormal red blood cells. Vitamin B12 is essential for two metabolic reactions and acts as a coenzyme. It is absorbed in the ileum with intrinsic factor and stored in the liver. Deficiencies can be detected using the Schilling test which evaluates vitamin B12 absorption. Treatment involves cyanocobalamin injections or oral methylcobalamin supplements.
This document discusses hematopoietic drugs used to treat blood disorders. It describes how hematopoiesis is regulated by growth factors and nutrients, and how deficiencies can cause anemia, thrombocytopenia or neutropenia. It then classifies and describes drugs for treating different types of anemia, such as iron deficiency anemia treated with oral or injectable iron preparations, and megaloblastic anemia treated with vitamin B12 and folic acid supplements. Hematopoietic growth factors like erythropoietin and colony stimulating factors are also outlined for treating related blood conditions.
1. Anemia is common in pregnancy, with iron deficiency being the most frequent cause affecting up to 90% of cases.
2. Iron deficiency anemia develops over stages from depletion of iron stores to a reduction in hemoglobin and impairment of oxygen carrying capacity in the blood.
3. Screening and treatment of iron deficiency anemia in pregnancy aims to prevent maternal complications during pregnancy, childbirth, and the postpartum period as well as fetal growth restriction and low birth weight.
4. Treatment involves oral or intravenous iron supplementation depending on severity, with the goals of replenishing iron stores and raising hemoglobin levels.
This document discusses hematinic drugs used to treat anemia. It describes three main categories of hematinics: iron supplements, which come in various oral and injectable forms; vitamin B12 and folic acid, which are important for red blood cell maturation; and erythropoietin, a hormone produced in the kidney that is essential for red blood cell production. Side effects of oral iron supplements include gastrointestinal issues. Parenteral iron is recommended when oral iron is not absorbed or tolerated. Vitamin B12 and folic acid deficiencies can cause megaloblastic anemia.
Anemia__BY_MADHURI.pptx treatment of iron deficiency anemiaDrMADHURI6
This document discusses the evaluation and treatment of anemia in pregnancy. It begins by outlining the clinical and laboratory assessment of anemia severity and type. This includes a history, physical exam, hemoglobin levels, iron studies, peripheral smear, and other tests. The stages of iron deficiency anemia are defined. Treatment involves oral or intravenous iron supplementation, with oral ferrous sulfate being first-line. Parenteral iron is indicated if oral is ineffective, not tolerated, or rapid response is needed. Close monitoring of treatment response via hemoglobin levels is important.
Iron is a mineral that serves three main functions in the human body: carrying oxygen, maintaining immune function, and aiding energy production. Insufficient dietary iron can lead to iron deficiency and related health issues. There are two types of iron - heme iron found mainly in meat which is well absorbed, and non-heme iron found in plants which is less well absorbed and can be improved by consuming vitamin C. Maintaining adequate iron levels through diet and supplements when needed is important for overall health and well-being.
The document discusses various hematinics including iron, vitamin B12, folic acid, and erythropoietin. It describes their roles in blood formation and the treatment of anemias. Iron is needed to form hemoglobin and is often deficient in cases of blood loss or poor diet. Vitamin B12 and folic acid are required for DNA synthesis and the production of red blood cells. Erythropoietin stimulates red blood cell production in the bone marrow. These substances are used to treat different types of anemia resulting from deficiencies or other causes like blood loss.
The document discusses iron in nature, dietary iron sources, iron absorption and transport in the body, iron storage, the iron cycle, roles of iron in the body, iron deficiency, risk groups, causes, signs and symptoms, investigations, consequences, management including oral and parenteral iron therapy and blood transfusions, and prevention of iron deficiency anemia through diet, nutrition education, iron supplementation, and food fortification.
This document discusses anemia during pregnancy. It defines anemia in pregnancy according to the WHO as a hemoglobin level of less than 11 gm%. Iron deficiency anemia is the most common type seen, especially in developing countries, due to low dietary iron intake and other factors. Anemia during pregnancy can cause complications for both mother and baby, including increased risk of preterm delivery and low birth weight. Treatment involves oral or intravenous iron supplementation depending on the severity of the anemia.
This document provides a summary of a presentation on the management of anemia and mineral bone disorders in chronic kidney disease. It defines anemia and its causes in CKD, including relative erythropoietin deficiency and iron deficiency. It outlines the evaluation, treatment, and monitoring of anemia in CKD patients, including the use of iron supplementation, erythropoiesis-stimulating agents, and blood transfusions. It also describes chronic kidney disease-mineral bone disorder, including abnormalities in calcium, phosphorus, PTH, and vitamin D metabolism. It discusses the pathogenesis and types of CKD-MBD, including high turnover bone disease and adynamic bone disease, and their treatment through dietary phosphorus restrictions,
This document discusses haematinics, which are substances that help form red blood cells and treat anemia. It focuses on iron, vitamin B12, and folic acid.
Iron is essential for human life and is found mainly in red blood cells. Dietary iron needs to be converted to a form that can be absorbed in the intestines. It is stored in the liver, spleen, bone marrow and muscles. Oral iron supplements include ferrous sulfate and ferrous gluconate.
Deficiencies in vitamin B12 and folic acid can cause megaloblastic anemia by preventing normal red blood cell maturation. Vitamin B12 is absorbed in the liver and intestines and is important for nerve
Similar to Agents used in anemias hematopoietic growth factors (20)
This document discusses various statistical concepts including outliers, transforming data, normalizing data, weighting data, robustness, and homoscedasticity and heteroscedasticity. Outliers are values far from other data points and should be carefully examined before removing. Data can be transformed using logarithms, square roots, or other functions to better fit a normal distribution or equalize variances between groups. Normalizing data puts variables on comparable scales. Weighting data adjusts for under- or over-representation in samples. Robust tests are resistant to violations of assumptions. Homoscedasticity refers to equal variances between groups while heteroscedasticity refers to unequal variances.
The document provides an overview of correlation, regression, and other statistical methods. It defines correlation as measuring the association between two variables, while regression finds the best fitting line to predict a dependent variable from an independent variable. Simple linear regression uses one predictor variable, while multiple linear regression uses two or more. Logistic regression is used for nominal dependent variables. Nonlinear regression fits curved lines to nonlinear data. The document provides examples and guidelines for choosing the appropriate statistical test based on the type of variables.
This document provides an overview of various statistical tests for comparing variables, including t-tests, ANOVA, MANOVA, ANCOVA, and MANCOVA. It defines each test and provides examples of their proper usage. T-tests are used to compare two groups on a continuous variable, including paired and unpaired, parametric and non-parametric versions. ANOVA and MANOVA are used to compare three or more groups and two or more dependent variables, respectively. ANCOVA and MANCOVA control for covariates/confounding variables in one-way and two-way designs with single or multiple dependent variables. Examples and best practices are given for selecting and conducting each type of test.
This document discusses key concepts in applied statistics including hypothesis testing, p-values, types of errors, sensitivity and specificity. It provides examples and explanations of these topics using scenarios about testing if feeding chickens chocolate changes the gender ratio of offspring. Hypothesis testing involves defining the null and alternative hypotheses and using a statistical test to either reject or fail to reject the null hypothesis based on the p-value. Type I and type II errors in hypothesis testing are explained. Sensitivity and specificity in diagnostic tests are introduced using an example about detecting if a car is being stolen.
This document provides an introduction to applied statistics and various statistical concepts. It discusses the normal (Gaussian) distribution, standard deviation, standard error of the mean, and confidence intervals. Examples and explanations are provided for each concept. Hands-on examples for calculating these statistics in Excel, SPSS, and Prism are also presented. The document aims to explain key statistical terms and how they are applied in data analysis.
a clinically oriented discussion of blood coagulation and related diseases and treatment. also discussing DIC, plasma fractions and anti-platelet drugs.
HMG-CoA reductase inhibitors, commonly known as statins, are the primary drugs used to treat dyslipidemia. They work by inhibiting cholesterol production in the liver, leading to increased clearance of LDL cholesterol from the bloodstream. Fibrates also effectively lower triglyceride levels by increasing fatty acid metabolism. Bile acid sequestrants function by binding bile acids in the gut, enhancing their excretion and increasing LDL receptor activity in the liver. Combination drug therapies that target multiple lipid abnormalities can provide improved treatment outcomes over single agents alone.
This document discusses various immunopharmacology drugs and their uses. It covers immunosuppressive antibodies including monoclonal antibodies used for transplantation, cancer, and autoimmune diseases. It also discusses immunosuppressive drugs classified as immunophilin ligands or cytotoxic agents that are used for transplantation and graft-versus-host disease. Common drugs discussed include cyclosporine, tacrolimus, sirolimus, mycophenolate, azathioprine, and cyclophosphamide.
The document provides guidance on rational prescription writing, including introducing the concept of "P-drugs" or personal first-choice drugs, outlining the steps in prescription writing, common abbreviations, and important instructions and information to provide to patients. It also discusses medication errors and how electronic prescribing can help reduce errors by suggesting alternative drugs. The overall goal is to teach students how to properly treat patients through skillful prescribing rather than just knowledge of drugs.
This document discusses the use of various drugs during pregnancy and lactation. It covers analgesics, antihypertensives, chemotherapeutics, central nervous system drugs, anticoagulants, endocrine drugs, antiemetics, antihistamines, and others. For each drug class or individual drug, it notes any potential risks to the fetus, such as teratogenicity, and recommendations for use during pregnancy and effects on the newborn. The overall message is that many drugs should be avoided during pregnancy if possible due to risks of harming fetal development, and careful consideration of risks and benefits is needed for drug treatment during this period.
This document discusses drug use during pregnancy and lactation. It covers principles of therapy during pregnancy and lactation, emphasizing using the lowest effective dose for shortest time. Physiologic and pharmacokinetic changes in pregnancy that affect drug distribution and metabolism are described. The fetal circulation is explained, as well as how drugs can affect the fetus. Drug categories in pregnancy from A to X are defined based on safety evidence. Common issues in pregnancy like anemia, constipation, and gestational diabetes are also covered.
This document discusses drug use during pregnancy and lactation. It covers the effects of non-therapeutic drugs like alcohol, caffeine, cigarettes, cocaine and marijuana on the fetus. It also discusses the management of selected medical conditions in pregnancy like AIDS, UTI, asthma, diabetes, hypertension and epilepsy. The final sections discuss neonatal therapeutics including vitamin K administration and treatment of ophthalmia neonatorum. It concludes with guidance on drug use during lactation, identifying drugs that are generally safe and those that require caution.
This document discusses methemoglobinemia, which is a condition caused by elevated levels of methemoglobin in the blood. Methemoglobin cannot carry oxygen, so symptoms range from cyanosis to death depending on levels. It may be congenital or acquired through medications, chemicals, and certain foods. Diagnosis involves blood tests showing abnormal hemoglobin color. Treatment focuses on reducing methemoglobin back to hemoglobin, primarily using methylene blue or ascorbic acid. The document also briefly covers cyanide poisoning, which causes tissue anoxia and can be fatal within minutes of inhalation.
This document provides guidance on proper academic writing style and conventions. It discusses things to avoid such as adjectives, negatives, long sentences, and colloquial language. It also covers proper use of punctuation like commas, semicolons, and apostrophes. Connectors are addressed to link ideas clearly. The document aims to improve clarity, precision and formality of academic writing.
This document provides an overview of the key elements of academic writing, including:
- How to structure an academic paper, with sections like the title, abstract, introduction, methods, results, discussion, and conclusion.
- Guidelines for writing each section, such as keeping the introduction brief, describing the methods in detail, and highlighting the main findings in the results.
- Tips for writing style, including using a cautious style, generalizations supported by evidence, and avoiding absolute statements.
More from Mohammad Hadi Farjoo MD, PhD, Shahid behehsti University of Medical Sciences (20)
Hemodialysis: Chapter 8, Complications During Hemodialysis, Part 2 - Dr.GawadNephroTube - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/FHV_jNJUt3Y
- Video recording of this lecture in Arabic language: https://youtu.be/D5kYfTMFA8E
- 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
POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptxsouravpaul769171
Theoretically, gene therapy is the permanent solution for genetic diseases. But it has several complexities. At its current stage, it is not accessible to most people due to its huge cost. A breakthrough may come anytime and a day may come when almost every disease will have a gene therapy Gene therapy have the potential to revolutionize the practice of medicine.
Chair and Presenter, Stephen V. Liu, MD, Benjamin Levy, MD, Jessica J. Lin, MD, and Prof. Solange Peters, MD, PhD, discuss NSCLC in this CME/MOC/NCPD/AAPA/IPCE activity titled “Decoding Biomarker Testing and Targeted Therapy in NSCLC: The Complete Guide for 2024.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bBb8fi. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 1, 2025.
Descoperă Bucuria Vieții Sănătoase cu Jurnalul Fericirii Life Care - Iulie 2024!
Gata să te bucuri de o vară vibrantă și plină de energie? Life Care îți vine în ajutor cu Jurnalul Fericirii din Iulie 2024, un ghid complet pentru o viață armonioasă și echilibrată.
Pe parcursul a cateva de pagini pline de informații utile și inspirație, vei descoperi:
Sfaturi practice pentru o alimentație sănătoasă:
Rețete delicioase și ușor de preparat: Bucură-te de preparate gustoase și nutritive, perfecte pentru zilele călduroase de vară.
Recomandări pentru o alimentație echilibrată: Asigură-ți aportul necesar de nutrienți esențiali pentru un organism sănătos și plin de vitalitate.
Sfaturi pentru alegeri alimentare inteligente: Învață cum să faci cumpărături sănătoase și să eviți tentațiile nesănătoase.
Trucuri pentru un stil de viață activ:
Rutine de exerciții fizice adaptate nevoilor tale: Găsește antrenamente potrivite pentru a te menține în formă și energic pe tot parcursul verii.
Idei de activități în aer liber: Descoperă modalități distractive de a te bucura de vremea frumoasă și de a petrece timp de calitate cu cei dragi.
Sfaturi pentru un somn odihnitor: Asigură-ți un somn profund și reparator pentru a te trezi revigorat și pregătit pentru o nouă zi.
Sfaturi pentru o stare de bine mentală:
Tehnici de relaxare și gestionare a stresului: Învață cum să te relaxezi și să faci față provocărilor zilnice cu mai multă ușurință.
Sfaturi pentru cultivarea optimismului și a gândirii pozitive: Descoperă cum să abordezi viața cu o perspectivă optimistă și să atragi mai multă bucurie în ea.
Recomandări pentru a te conecta cu natura: Bucură-te de beneficiile naturii asupra stării tale mentale și emoționale.
Bonus:
Oferte exclusive la produsele Life Care: Beneficiază de reduceri și promoții speciale la o gamă largă de produse pentru o viață sănătoasă.
Concursuri și premii: Participă la concursuri distractive și câștigă premii valoroase.
Jurnalul Fericirii Life Care - Iulie 2024 este mai mult decât o simplă revistă. Este un ghid complet și personalizat pentru a te ajuta să obții o viață mai sănătoasă, mai fericită și mai plină de satisfacții.
Nu rata această șansă de a te bucura de vară la maximum! Descoperă Jurnalul Fericirii Life Care - Iulie 2024 astăzi!
Comandă-ți exemplarul acum și fă un pas important către o viață mai bună!
#JurnalulFericirii #LifeCare #Iulie2024 #ViataSanatoasa #Bunastare #Fericire #Oferte #Concursuri #Premii
Exploring Alternatives- Why Laparoscopy Isn't Always Best for Hydrosalpinx.pptxFFragrant
Not all women with hydrosalpinx should choose laparoscopy. Natural medicine Fuyan Pill can also be a nice option for patients, especially when they have fertility needs.
Hepatocarcinoma today between guidelines and medical therapy. The role of sur...Gian Luca Grazi
Today more than ever, hepatocellular carcinoma therapy is experiencing profound and substantial changes.
The association atezolizumab (ATEZO) plus bevacizumab (BEVA) has demonstrated its effectiveness in the post-operative treatment of patients, improving the results that can be achieved with liver resections. This after the failure of the use of sorafenib in the already historic STORM study.
On the other hand, the prognostic classification of BCLC is now widely questioned. It is now well recognized that the indications for surgery for patients with hepatocellular carcinoma are certainly narrow in BCLC and no longer reflect what is common everyday clinical practice.
Today, the concept of multiparametric therapeutic hierarchy, which makes the management of patients with hepatocellular carcinoma much more flexible and allows the best therapy for the individual patient to be identified based on their clinical characteristics, is gaining more and more importance.
The presentation traces these profound changes that are taking place in recent years and offers a modern vision of the management of patients with hepatocellular carcinoma.
Chair, Benjamin M. Greenberg, MD, MHS, discusses neuromyelitis optica spectrum disorder in this CME activity titled “Mastering Diagnosis and Navigating the Sea of Targeted Treatments in NMOSD: Practical Guidance on Optimizing Patient Care.” For the full presentation, downloadable Practice Aids, and complete CME information, and to apply for credit, please visit us at https://bit.ly/4av12w4. CME credit will be available until June 27, 2025.
Chemical kinetics is the study of the rates at which chemical reactions occur and the factors that influence these rates.
Importance in Pharmaceuticals: Understanding chemical kinetics is essential for predicting the shelf life of drugs, optimizing storage conditions, and ensuring consistent drug performance.
Rate of Reaction: The speed at which reactants are converted to products.
Factors Influencing Reaction Rates:
Concentration of Reactants: Higher concentrations generally increase the rate of reaction.
Temperature: Increasing temperature typically increases reaction rates.
Catalysts: Substances that increase the reaction rate without being consumed in the process.
Physical State of Reactants: The surface area and physical state (solid, liquid, gas) of reactants can affect the reaction rate.
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EXPERIMENTAL STUDY DESIGN- RANDOMIZED CONTROLLED TRIALRishank Shahi
Randomized controlled clinical trial is a prospective experimental study.
It essentially involves comparing the outcomes in two groups of patients treated with a test treatment and a control treatment, both groups are followed over the same period of time. Prepare a plan of study or protocol
a. Define clear objectives
b. State the inclusion and exclusion criteria of case
c. Determine the sample size, place and period of study
d. Design of trial (single blind, double blind and triple blind method)
2. Define study population: Most often the patients are chosen from hospital or from the community. For example, for a study for comparison of home and sanatorium treatment, open cases of tuberculosis may be chosen.
3. Selection of participants by defined criteria as per plan:
Selection of participants should be done with precision and should be precisely stated in writing so that it can be replicated by others. For example, out of open cases of tuberculosis those who fulfill criteria for inclusion may be selected (age groups, severity of disease and treatment taken or not, etc.)
Randomization ensures that participants have an equal chance to be assigned to one of two or more groups:
One group gets the most widely accepted treatment (standard treatment/ gold standard)
The other gets the new treatment being tested, which researchers hope and have reason to believe will be better than the standard treatment
Subject variation: First, there may be bias on the part of the participants, who may subjectively feel better or report improvement if they knew they were receiving a new form of treatment.
Observer bias: The investigator measuring the outcome of a therapeutic trial may be influenced if he knows beforehand the particular procedure or therapy to which the patient has been subjected.
Evaluation bias: There may be bias in evaluation - that is, the investigator(Analyzer) may subconsciously give a favorable report of the outcome of the trial.
Co-intervention:
participants use other therapy or change behavior
Study staff, medical providers, family or friends treat participants differently.
Biased outcome ascertainment:
participants may report symptoms or outcomes differently or physicians
Investigators may elicit symptoms or outcomes differently
A technique used to prevent selection bias by concealing the allocation sequence from those assigning participants to intervention groups, until the moment of assignment.
Allocation concealment prevents researchers from influencing which participants are assigned to a given intervention group.
All clinical trials must be approved by Institutional Ethics Committee before initiation
It is mandatory to register clinical trials with Clinical Trials Registry of India
Informed consent from all study participants is mandatory.
A preclinical trial is a stage of research that begins before clinical trials, and during which important feasibility and drug safety data are collected.
Following points high.
EXPERIMENTAL STUDY DESIGN- RANDOMIZED CONTROLLED TRIAL
Agents used in anemias hematopoietic growth factors
2. By
M. H. Farjoo M.D., Ph.D.
Shahid Beheshti University of Medical Science
Agents Used in Anemias;
Hematopoietic Growth Factors
3. Agents Used in Anemias;
Hematopoietic Growth Factors
Introduction
Iron
Folic Acid
Vitamin B12
Pyridoxine
Hematopoietic Growth Factors
Effect of Drugs on blood cells
Novel Treatments
6. Iron
Excess iron is stored as ferritin, consisting of ferric
hydroxide covered by apoferritin.
The serum ferritin is in equilibrium with storage ferritin, so
the serum ferritin is used to estimate iron stores.
Healthy people lose 1-2 mg iron daily but menstruating
women lose 30 mg of iron with each menstrual period.
Thus, many premenopausal women have iron deficiency.
Iron deficiency anemia in men and postmenopausal women
should be evaluated for occult GI bleeding.
7. Oral ferrous sulfate is the treatment of choice for iron
deficiency.
All iron salts are absorbed to approximately the same
extent.
Oral and parenteral iron have the same efficacy (if GI
tract absorption is normal).
The effectiveness of treatment is made only 3–4 weeks
after the start of treatment.
Ascorbic acid (≥200 mg) increases the absorption of
iron by at least 30%, but increases the incidence of side
effects.
Iron
8. Iron
In iron deficiency, 25% of oral iron is absorbed and 50-
100 mg of iron is incorporated into hemoglobin daily.
Therefore, 200-400 mg of iron should be given daily to
correct iron deficiency most rapidly.
Adverse effects of oral iron include nausea, epigastric
discomfort, abdominal cramps, constipation, and
diarrhea.
They can be overcome by lowering the daily dose or
taking the tablets with meals or changing the iron salt.
23. Parenteral Iron
Parenteral iron is used:
In those who require hemodialysis and erythropoietin.
After gastrectomy or small bowel resection
IBD involving the proximal small bowel
Malabsorption syndromes
24. Parenteral Iron
Parenteral iron bypasses regulatory systems and can
deliver more iron than can be safely stored.
Large IV dose of iron improves hematologic status
faster than oral iron for 1–3 weeks.
However, the final response is no better than that seen
with oral iron.
Iron stores is estimated by serum ferritin and the
transferrin saturation.
26. Parenteral Iron
Iron dextran is given by deep IM injection or IV
infusion.
IV infusion is most common rout and for IM injection
Z track technique should be used.
Local reactions and possibility of malignant change at
the site of injection, make IM injection inappropriate
except when the IV route is inaccessible.
27. Parenteral Iron
It rarely causes anaphylaxis and death, so a small test
dose should always be given before IM or IV doses.
For test, 25 mg of dextran is infused over a period of
15 minutes, and the patient is observed for 1 hr.
Use iron dextran with extreme caution in patients
with rheumatoid arthritis or during the acute phase of
an inflammatory illness.
29. Iron sucrose appears to be better tolerated and to
cause fewer adverse events than iron dextran
This agent is FDA-approved for iron deficiency in
chronic kidney disease.
Chronic use has the potential to cause renal
tubulointerstitial damage.
Parenteral Iron
33. Acute Iron Toxicity
Adults tolerate large doses of oral iron but 10 tablets of
any iron salt can be lethal in children (12 to 24 months).
Toxicity causes vomiting, abdominal pain, and bloody
diarrhea.
Of particular concern are pallor or cyanosis, lassitude,
drowsiness, and hyperventilation due to acidosis.
If death does not occur within 6 h, there may be a
transient period of apparent recovery, followed by death
in 12–24 h (because of acidosis).
With early treatment, the mortality can be reduced from
45% to about 1%.
34. Acute Iron Toxicity (Cont’d)
Whole bowel irrigation should be performed.
Deferoxamine (iron-chelating agent) is given
systemically to bind absorbed iron and to promote its
excretion in urine and feces.
Activated charcoal, does not bind iron and is NOT
effective.
Appropriate supportive therapy for GI bleeding,
metabolic acidosis, and shock must also be provided.
39. Chronic Iron Toxicity
Chronic toxicity (hemochromatosis) results when
excess iron is deposited in the heart, liver, and
pancreas.
It leads to organ failure and death and occurs in:
Inherited hemochromatosis (excessive iron absorption)
Receiving many transfusions over long periods
(Thalassemia major).
Oral deferasirox is used for chronic iron overload,
and is as effective as deferoxamine.
42. A 62-year-old woman, whose serum ferritin concentration was 3583 ng/ml (normal
range, 30 to 300). Liver is seen as a darkened organ (Panel A).
After 32 phlebotomies within14 months (total blood volume removed, 16 liters), the
serum ferritin concentration was 606 ng/ml (Panel B).
she is currently being treated with phlebotomy. The disease is genetic.
Hemochromatosis
45. Folic Acid
Folic acid is required for the synthesis of amino acids
and DNA.
Only 5-20 mg of folates are stored in the liver.
Megaloblastic anemia can develop within 1-6 months
after the intake of folic acid stops.
Oral drug is well absorbed even in malabsorption
syndromes.
1 mg folic acid orally daily is sufficient for full
recovery in almost all patients.
46. Folic Acid
Folic acid deficiency is seen in:
Alcohol dependence and liver disease (poor diet and
diminished hepatic storage)
Pregnancy and hemolytic anemia (increased folate
requirement)
Malabsorption syndromes
Renal dialysis (dialysis removes folates)
Some drug ingestion: methotrexate, trimethoprim and
pyrimethamine (inhibit dihydrofolate reductase)
51. Vitamin B12
The dietary source of vitamin B12 is meat (especially
liver), egg, and dairy products.
B12 is stored in the liver with a storage pool of 3000-
5000 mcg.
Daily requirements are 2 mcg, it would take 5 years
for megaloblastic anemia to develop.
52. Vitamin B12
The most common causes of vitamin B12 deficiency
are:
Pernicious anemia (defective secretion of intrinsic
factor)
Partial/total gastrectomy (intrinsic factor secreting
cells removed)
Abnormality in the distal ileum
54. Patients with sideroblastic anemia have impaired
hemoglobin synthesis.
Pyridoxine corrects sideroblastic anemias associated
with isoniazid and pyrazinamide, which act as
vitamin B6 antagonists.
Vitamin B6 (Pyridoxine)
64. Erythropoietin
Recombinant human erythropoietin (Epoetin alfa) is
produced in a mammalian cell expression system.
It is not cleared by dialysis.
Darbepoetin alfa (not yet in Iran) is a derivativee with
2 to 3 times longer half-life.
65. Erythropoietin
An inverse relationship exists between the hematocrit
level and erythropoietin level.
The most important exception is in the anemia of chronic
renal failure.
These patients are most likely to respond to exogenous
erythropoietin.
Failure to respond to erythropoietin is due to concurrent
iron or Folate deficiency.
66. Erythropoietin
In primary bone marrow disorders and nutritional and
secondary anemias, endogenous erythropoietin is
already high.
Erythropoietin therapy in these conditions is not usually
beneficial.
But in selected patients, erythropoietin may be useful
for primary bone marrow disorders and secondary
anemias.
They are patients who have disproportionately low
serum erythropoietin levels for their degree of anemia.
67. Erythropoietin
Erythropoietin is also used for:
Anemia by zidovudine in HIV and anemia of
prematurity.
To accelerate erythropoiesis after phlebotomies for
autologous transfusion for elective surgery.
For treatment of iron overload (hemochromatosis).
Erythropoietin is banned by the international olympic
committee.
Its side effects includes hypertension and thrombotic
complications.
69. Epoetin (beta) Injection 4000 IU/0.3 ml
Price in Iran: 110,000 Toman
It seems there is no
significant difference between
efficacy of epoetin beta and
epoetin alfa
70. Myeloid Growth Factors
Myeloid growth factors consist of:
G-CSF: Granulocyte Colony-Stimulating Factor
(Filgrastim)
GM-CSF: Granulocyte-Macrophage Colony-
Stimulating Factor (Sargramostim, Molgramostim)
G-CSF and GM-CSF are used for treating some kinds
of neutropenia
71. G-CSF
The most important role of G-CSF in transplantation is
mobilization of peripheral blood stem cells (PBSCs).
Splenic rupture is a rare but serious complication of G-
CSF.
Pegfilgrastim, has a much longer half-life than
filgrastim.
Pegfilgrastim is injected once per myelo- suppressive
chemotherapy cycle instead of daily for several days.
75. Other Applications
Studies show that G-CSF and GM-CSF are safe for
leukemia (AML).
The growth factors even increase neutrophil recovery
and reduce infection rates and days of hospitalization.
Both G-CSF and GM-CSF have FDA approval for
treatment of patients with AML.
76. Megakaryocyte Growth Factors
Megakaryocyte growth factors consist of:
Thrombopoietin (Not in Iran)
Interleukin-11 (Not in Iran)
Eltrombopag
Romiplostim
They are used in cirrhotic patients who have low
thrombopoietin levels.
79. Clinical uses of hematopoietic growth factors
and similar agents
81. Hemolysis
A number of drugs can cause hemolysis by various
mechanisms:
Drug-induced thrombotic microangiopathy (DITMA)
Immune (antibody-mediated) hemolysis
Oxidative damage (G6PD deficiency)
Methemoglobinemia
84. Unsafe Substances in G6PD deficiency
Medicines and other substances likely to be UNSAFE in moderate-to-
severe G6PD deficiency*[1-3]
Medications
Dapsone (diaminodiphenyl sulfone)
Methylene blue (methylthioninium chloride)
¶
Nitrofurantoin, nifuratel, and nitrofurazone (nitrofural)
Δ
Phenazopyridine (pyridium)
Primaquine
Rasburicase
Chemical exposures and foods
Fava beans
Henna compounds (black and red Egyptian)
Naphthalene (mothballs, lavatory deodorant)
Phenylhydrazine
"RUSH" (isobutyl nitrate, amyl nitrate)
86. Medications that May Cause Methemoglobinemia
Amino salicylic acid (also called PABA)
Clofazimine and Dapsone (for leprosy)
Chloroquine
Local anesthetics even in sprays and creams,
(benzocaine, lidocaine, and prilocaine)
Metoclopramide
Methylene blue*
Nitroglycerin
Phenazopyridine
Primaquine
Rasburicase
Sulfonamides
87. Causes of Drug Induced Splenomegaly
Hematologic (hypersplenic) states
Acute and chronic hemolytic anemias, all etiologies
Following use of recombinant human G-CSF
89. Drug-induced Neutropenia and
Agranulocytosis
The risk is low and independent of dose, and is very
rare in doses <10 mg/day.
Risk factors for agranulocytosis include:
Patients with infectious mononucleosis
Concomitant use of probenecid and captopril.
Underlying autoimmune disease
Combination therapy with an ACEI and interferon
90. Drug-induced Neutropenia and
Agranulocytosis
Drugs cause neutropenia or agranulocytosis by:
Antibodies (PTU)
Direct toxic effects (Clozapine)
Immune destruction occurs days to weeks after
beginning the drug, with explosive symptoms.
Rechallenge is associated with a prompt recurrence
even with low doses.
91. Drug-induced Neutropenia and
Agranulocytosis
With direct toxicity, the time course is slower than
immune mediated.
Most cases present within the first 6 months and
usually within the first 3 months of drug treatment.
The neutropenia is asymptomatic or insidious.
Rechallenge requires both a latent period and high
drug doses before recurrence is observed.
In both subtypes, neutropenia resolves 1-3 weeks after
cessation of the drug.
92. Drug-induced Neutropenia and
Agranulocytosis
The diagnosis should be suspected if a patient
develops fever, mouth sores, or gingival inflammation.
Differential diagnosis is viral infection and nutritional
deficiency (copper or vitamin B12 deficiency).
The most common agents in agranulocytosis are:
clozapine, thionamides, sulfasalazine, and
trimethoprim-sulfamethoxazole
93. Risk of drug-induced immune thrombocytopenia
(DITP) from a new drug is rare.
Patients present within two weeks of drug exposure
with platelet count < 20,000 / microL and / or
bleeding.
Thrombocytopenia develops within hours if
previously exposed, or within 1-2 weeks for a new
drug.
After drug discontinuation, platelets return to normal
in a week.
Thrombocytopenia
94. Causes of Drug Induced Thrombocytopenia
Drug-induced
Heparin (NOTE: special case, also can cause thrombosis)
Phenytoin, Carbamazepine, Valproic acid
Sulfonamides (trimethoprim-sulfamethoxazole)
Amiodarone
Cimetidine, Ranitidine
Acetaminophen, Ibuprofen, Naproxen
Furosemide
Beta-lactam antibiotics (penicillins, cephalosporins)
Vancomycin
MMR vaccine
Food and beverages
Walnuts
Certain herbal teas
Alcohol
Nutrient deficiencies (vitamin B12, folate, copper)