Dr. B. A. Joshi, M.D.(Med) D.Ped. M.B. email@example.com Highly dedicated physician with Private Practice and Hospital experience in Internal Medicine, Cardiology and Pediatrics; experienced as Medical Advisor to Law Firms and pharmaceutical companies and Teaching Experience in Private Capacity. Ex- Part-time teaching faculty in Northeastern University, Boston, U.S.A. I am involved in teaching for medical assistance, EKG technician, medical administration etc. firstname.lastname@example.org
Medicine is ever changing Science. I urge you to confirm the information from other resources and refer to manufacturers recommendations for all dosages especially new drugs and those used infrequently.
Sample theory and rationales for MCQ from 45 teaching modules of all “Allied Health Science Courses”.
Blood Brain Barrier: Protects brain from toxic substances System is operating at the level of capillaries of brain and choroids plexus Free passage to water and lipid soluble substances Ionizable organic molecules are denied the passage Blood brain barrier becomes less efficient in presence of inflammatory process e.g meningitis So Abt reach in brain but as in flammation subside BBB tends to be restored. As that may happen while viable micro organisms persist in CSF –drug dosage should not be reduced till CSF is sterilized
Pharmacodynamics Where drug acts How drug acts Synthesis of new compounds with more specific actions and fewer adverse reaction. Structural Relationship Activity Atropine-Home atropine Procaine-Procainamide Chlorpromazine---Trifluroperazine Nicotinic acid---nicotinamide
Pharmacodynamics 1.Where drug acts 2. How drug acts Synthesis of new compounds with more specific actions and fewer adverse reaction. Structural Relationship Activity Atropine-Home atropine Procaine-Procainamide Chlorpromazine---Trifluroperazine Nicotinic acid---nicotinamide Ligand ↓ Receptor ↓ ↓ ↓ ↓ ↓ Gated ion channels G-Protein Tyrosine Kinase Gunylate Cyclase Nuclear genetic ↓ material Adenyl cyclase cyclic AMP Phospholipase C-inositoltriphosphate ↓ intracellular Ca increases
Drugs to be used with care in elderly: NSAID CNS depressant Psychotropics Antihypertensives-postural hypotension Diuretics Digoxin Nephrotoxic
Drugs causing ototoxicity Aminoglycosides Macrolides Loop diuretic Antimalarial quinine,chloroquine Anticancer drugs—Cisplatin,Bleo Chelating agent------Desferrioxamine Drugs known to cause dependence Severe Psychic and physical dependence Morphine Alcohol,Barbituates,Benzodiazepines Nicotine,Tobacco -----Psychic Dependence Cocaine,LSD,Hashish,Caffeine-coffee,tea
Effects Of Neurotransmitter Effects of Acetyl choline:- Cholinergic neurotransmitter acting on muscarnic and nicotinic receptor Muscarnic action: It decreases hear rate and force of contraction. It depresses conduction in SA node It causes dilatation of blood vessel. It contracts the smooth muscle of G.Itract,bronchial muscle and urinary bladder. It causes constriction of pupil by miosis.-reduces intraocular tension. Spasm of accommodation. Also used in glaucoma—condition where increase intraocular pressure. It increases secretion of bronchial,salivary,lacimal and gastric secrection It increases sweating.-. the increased bronchial secrection accompanied by bronchospasm causes cough.
Nicotinic action: On autonomic ganglia.-Ach stimulate nicotinic receptor on autonomic ganglia-cauese release of Ach and Adrenaline from post ganglionic parasympathetic and Sympathetic nerve endings.----- resulting rise in blood pressure. Blocked by Hexamethonium,alpha bungarotoxin It causes the contraction of Skeletal muscle at myoneural junction blocked by d-tuvocurarine, Decamethonium and succinyl choline
Atropine: Anti cholinergic drug: Plant atropa belladonna=plant alkaloid—Atropine and Hyscosine organic ester of tropic acid Competitive Muscarnic antagonist of Ach-All secretions are blocked- dryness of mouth Reduced G.I secrection Decreased secretions in nose bronchial Sweating is reduced, hyperpyrexia Difficulty in swallowing it increases hear rate, tachycardia It decrease motility and contraction of intestine-used as antispasmodic it decrease urinary contractility so causes urinary retention it produces mydriasis-increases intraocular pressure, relaxes cillary muscle-pupil dilated—it also produce cyclopegia-i.e can not see near object or in front of light-or called paralysis of accommodation It relaxes smooth muscle of bronchial and G I tract. it inhibits A-V block be of vagal activity it is reducing secretion of rsp system-so as a pre anesthetic medication
Autonomic nervous system Autonomic nervous system is divided into two types. 1 Sympathetic: 2 Parasympathetic:
Respiratory Infections: Common Respiratory microbial Pathogens: Gram +ve Streptococcie pneumonia Staphylococcus aureus Enterococcus faecalis Gram –ve E.Coli Klebisella Haemophilus Influenza M.catatrall Atypical Chlamydia pneumonia Mycoplasma pneumonia Legionella pneumonia Anaerobes Clostridium perfinges Bacteroids fragitis Fusobacterium Common Respiratory viruses: Rhinoviruses-------- common cold Corona virus -------- common cold Respiratory Syncytial virus pneumonia Adenoviruses common cold Influenza A viruses influenza Influenza B viruses influenza
Leukotriene modifiers Zileuton Dose: Single oral dose of 800 mg Leukotriene Receptor mechanism -----Zafirlucast Long acting - Promiucast Motelucast—Selective inhibitor of LTB4 Receptors Notes: Leukotirene Modifiers: As mentioned earlier LTC4, D4, E4 produce critical elements of asthma. Inhibition of 5-lipoxygenase enzyme Useful in Aspirin induced Asthma Allergic rhinitis Exercise induced asthma Cold air induced airway obstruction Not meant to prescribe in acute attacks.
Name of drugDoseOral absorptionDistributionExcretionCSF penetrationSerious toxicity Isoniazid H 5-10 mg/kg 300 mg 90%WideHepatic metabolis m GoodNeuro hepato Rifampicin R 10mg/kg 450-600mg 90% red color urine, saliva and perspiratio n wideHepatic metabolis m goodhepato Pyrazinamide Z 15 mg/kg 1500-2000 mg 70%wideHepatic metabolis m excellentHepatic visual Ethambutol E 20 mg/kg 1200-1500mg not recommended in children 77%All tissue except CSFRenalfairocular Streptomycin S 20 mg/kg I.M15 mg/kg I.M upto 0.75 g extracellularrenalpoorNeuro nephro Dosage Regime:
Side Effects of Sympathomiometics 1.Metabolic -Increase in glucose, insulin, fatty acids -Decrease in potassium phosphate, calcium, magnesium 2.Cardiac 3.Arterial O2 4.Tremors 5.Muscle Cramps
HIV / AIDS (Acquired Immune Deficiency Syndrome) 36 million HIV +ve worldwide. HIV is Retrovirus. Its generic material is RNA instead of DNA. Virus hides in cells for months or even years. Incubation period on an average is about 10 years to cause AIDS. Spread Unprotected Sex. Needles and Syringes of Infected person. During pregnancy, birth and breast feeding. 25% Infected mothers transmit disease to new borne Blood transfusions. Risk to health care professionals. Symptoms Enlarge Lymph nodes. Fatigue. Pelvic Inflammation Disease. Fever and Sweating. Wight Loss. Dementia. Diagnosis ELISA Test Western Blot. CD4 and CD8 count less than 200.or 14% less than total Lymphocytes. Presence of opportunistic Infections.
Blood Group ARh +ve, Rh -ve BRh +ve, Rh -ve ABRh +ve, Rh –ve ORh +ve, Rh –ve Blood GroupCells Carry AntigenPlasma Carry AntibodiesCan ReceiveCan Donate A groupA AntigenAntibody BA or OA or AB B groupB AntigenAntibody AB or OB or AB AB groupA & B AntigenNo Antibodies of A or BA, B, AB, O (Universal Recipient) AB only O groupNo AntigenAntibodies of A & BOA, B, AB, O (Universal Donor)
ADVANCED LIFE SUPPORT SYSTEM Defibrillation – Synchronize defibrillation with R wave. Ventilation Drug therapy Sodium bicarbonate 1meq/kg If patient pulse less – Defibrillate (200J) If no response repeat at 360J Start IV fluids Ventilate with 100% oxygen Intubate or bag mask If pulseless continue chest compression Epinephrine – 0.5 to 1mg IV or ETT can repeat after 3 to 6 minutes. Lidocaine 1mg/kg bolus in two minutes. Can repeat lidocaine bolus for ventricular tachy cardia. Repeat defibrillation 360J PH less than 7.15
Management of opportunistic infections in AIDS Herpes -Acyclovir fungal-AmphotericinB Candidiasis-Fluconazole CytomegaloVirus-Foscarnet CytomegaloVirus of Eye-Gianclyvir Kaposi Sarcoma-Interferon Afa2a2b PneumoCytisCarini-Pentamedinie Pneumonia-Trimethoprim Sulpha methoxazole
Urokinase obtains from culture of human kidney cells. Thromolysis in 60 – 90% Within a period of 12 hrs. Contra indication Active bleeding Recent C.V.A Pregnancy Recent surgery Recent Trauma Severe Uncontrolled hypertension 180/110 Bleeding diathesis Hemorrhagic Ophthalmic conditions Reperfusion Arrhythmia.
ADENOSINE *Supra ventricular Tachycardia. *P.S.V.T. *Naturally occurring nudeoside *Inhibitors at A-V node. *Rapid intravenous dose of 6 mg in 1-2 seconds, additional dose if necessary. *Ultra short half life 10 seconds. *Facial flushing. *Is used in Pharmacological stress testing
DIABETES KETOACIDOSIS *Hyperglycermia leads to glycosuria, volume depleption Tachycardia, Hypotension, kusumal respiration, acetone odor & metabolic acidosis. *Both insulin def. And glycogen excess is necessary of DKA. It results from: *Increase hepatic glucose production (Gluconegenesis, and glycogenolylis) *Impaired peripheral glucose utilization. *Marked increase in free fatty acids from adipocytes resulting in ketone synthesis. *Catacholamines favourss lipolysis and release of free fatty acids. TREATMENT OF DKA. *Confirm diagnosis (Glucose, Ketones, Metabolic acidosis) *Assess 1). Electrolytes 2). Acidbase status PH,HCO3, PCO2 3). Renal function. *Replace fluids 2-3 litres 0.9% saline in 1-3 hours. *10-20 units regular insulin *10 units/hr by infusion. *Measure onion gap (K, bicarbonate Phosphate) *Replace K 10 meq/hr when urine output is 20 – 40 units/hr if K < 3.5 *When blood sugar 250 mg & patient is conscious shift to SC insulin injection. *Bicarbonate defi correction usually not necessary nor advisable.
INTERFERONS INTERFERON 3 or 5 million on alt. Days or daily depending on indication, protocol & combination used INTERFERON B INTERFERON Action Antiviral, antitumor acivity Inhibits RNA & DNA viruses Antiproliferative effect on normal and malignant cells Suppresss antibody formation through effect on B lymphocytes Inhibits onset of delayed hypersensitivity Side effects Flu-like syndrome Myelosuppression, coma, MI Nausea, vomiting Hyper tension and hypotension Arrhythmias, seizures, confusion Taste disturbances Thyroid, lupus and hemolytic anemia Uses Chronic hepatitis B, C, D andG: with or without antivirals like Ribavirin or Lamivudine Condylomata acuminata Kaposi’s sarcoma CML, hairy cell leukemia, NHL, multiple myelomam, renal cell carcinoma
KEY WORDS - LOWEST PRIORITY LEAST LIKELY EXCEPT INCORRCT UNSAFE PRIORITY IMMEDIATE BEST MOST PRIORITY INITIAL VITAL ESSENTIAL PLAN YOUR MCQ ELIMINATION KEY WORD FOCUS ON PRIMARY ISSUE.
LEFT VENTRICAL FAILURE SIGNS ARE RALES,SHORTNESS OF BREATH,PAROXYMAL NOCTURENAL DYSPNEA. RTSIDED FAILURE-----NECK VEINS, EDEMA DISTETION OF ABDOMENAND ENLRGE LIVER/ COMBINATION OF SIGNS SUGGEST GLOBAL FAILURE. BETA ADRENERGIC BLOCKERS WORK THROUGH ACTIONS OF ENDOGENIOUS NEURO HORMONAL SYSTEM. 3 TYPES 1THOSE THAT ARE RELATIVELY SELECTIVE TO BETA 1 RECEPTOR (METOPROLOL) 2SELECTIVE TO BETA 1 &BETA 2 RECEPTOR(PROPANOLOL,BUCINDOLOL) 3.SELECTIVE TO BETA1, BETA2, &ALPHA1 RECETOR.(CARVIDOL)
SMALL FOR GESTATIONAL AGE (S.G.A.) IN UTERUS HYPOXIA CAUSES RELEXATION OF ANAL SPHINCTER WITH PASSAGE OF MECONIUM INTO AMNIOTIC FLUID. NEW BORN EMERGENCY HYPOGLYCEMIA RESPIRSTORY DISTRESS TRANSIENT TACHYPNOEA OF NEW BORN. MECONIUM ASPIRATION SYNDROME IN SEVERE ASTHAMA NO WHEEZING SOUNDS MAY BE HEARD BECAUSE OF DECREASED IN AIRFLOW. DIMINISHED BREATH SOUNDS ARE INDICATIVE OF OBSTRUCTION AND RESPIRATORY FAILURE. IN HYPER PARATHYROIDISM Ca INCRESES & FORM RENAL STONES & NENCE PLENTY OF FLUIDS & MORBIDITY SHOULD BE ENCOURAGED.
BEHEVIOR THERAPY REALITIY THERAPY SHORT TERM DYNAMIC PSYCHOTHERAPY. PSYCHOANGLYTIC THERAPY PSYCHODERMA COMMUNICATION:- THERAPEUTIC COMMUNICATION TECHNIQUS REDIRECTS PT’S FEEDING BACK IN ORDERTO VALIDATE WHAT PT IS SAYING GIVE PT THE OPPERTUNITS TO VERBALIZE. PT EXPERIENCE NUMEROUS EMOTIONAL AND BEHAVIRO OR FOLLOWING SERIOUS ILLNESS OPEN ENDED STATEMENT GIVES PT OPPORTUNITY TO EXPRESS THERAPEUTIC COMMUNICATION TECHNIQUE OF REFLECTION, AND CLARIFIES AND ENCOURAGES FURTHER EXPRESSION OF PATIENTS FEELINGS RESPONDING TO THE FEELING EXPRESSED BY PT IS AN EFFECTIVE COMMUNICATION
LEARN AT LISA WE CAN BECAUSE WE THINK WE CAN LIFESTYLE ACADEMY (INTERNATIONAL) ALLIED HEALTH SCIENCE DIVISION ORGANIZERS FOR LECTURES, SEMINARS AND WORKSHOPS PRESIDENT & COURSE DIRECTOR DR. B.A. JOSHI MD (MED) DPED MB www.learnatlisa.com