Transcript Allied Health Sciences

Allied Health Sciences
Sample Slides
 Dr. B. A. Joshi, M.D.(Med) D.Ped. M.B.
 [email protected]
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.
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
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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
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actions and fewer adverse reaction.
Structural Relationship
Activity
Atropine-Home atropine
Procaine-Procainamide
Chlorpromazine---Trifluroperazine
Nicotinic acid---nicotinamide
 Pharmacodynamics
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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
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Receptor
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Gated ion channels G-Protein
Tyrosine Kinase Gunylate Cyclase
Nuclear genetic
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material
Adenyl cyclase cyclic AMP
Phospholipase
C-inositoltriphosphate
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intracellular Ca increases
Drugs to be used with care in
elderly:
 NSAID
 CNS depressant
 Psychotropics
 Antihypertensives-postural hypotension
 Diuretics
 Digoxin
 Nephrotoxic
Drugs causing ototoxicity
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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:
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Anti cholinergic drug:
Plant atropa belladonna=plant alkaloid—Atropine and Hyscosine
organic ester of tropic acid
Competitive Muscarnic antagonist of Ach-All secretions are blockeddryness 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:
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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
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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.
Dosage Regime:
Name of drug
Dose
Oral absorption
Distribution
Excretion
CSF penetration
Serious
toxicity
Isoniazid
H
5-10 mg/kg
300 mg
90%
Wide
Hepatic
metabolis
m
Good
Neuro
hepato
Rifampicin
R
10mg/kg
450-600mg
90%
red color urine,
saliva and
perspiratio
n
wide
Hepatic
metabolis
m
good
hepato
Pyrazinamide
Z
15 mg/kg
1500-2000 mg
70%
wide
Hepatic
metabolis
m
excellent
Hepatic
visual
Ethambutol
E
20 mg/kg
1200-1500mg
not recommended in
children
77%
All tissue except CSF
Renal
fair
ocular
Streptomycin
S
20 mg/kg I.M
15 mg/kg I.M
upto 0.75
g
extracellular
renal
poor
Neuro
nephro
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)
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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.
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Blood Group
A
B
AB
O
Rh +ve, Rh -ve
Rh +ve, Rh -ve
Rh +ve, Rh –ve
Rh +ve, Rh –ve
Blood Group
Cells Carry Antigen
Plasma Carry Antibodies
Can Receive
Can Donate
A group
A Antigen
Antibody B
A or O
A or AB
B group
B Antigen
Antibody A
B or O
B or AB
AB group
A & B Antigen
No Antibodies of A or B
A, B, AB, O
(Universal Recipient)
AB only
O group
No Antigen
Antibodies of A & B
O
A, B, AB, O
(Universal Donor)
ADVANCED LIFE SUPPORT
SYSTEM
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Defibrillation – Synchronize defibrillation with R wave.
Ventilation
Drug therapy
Sodium bicarbonate 1meq/kg
If patient pulse less –
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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
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Herpes Acyclovir
fungal
AmphotericinB
Candidiasis
Fluconazole
CytomegaloVirus
Foscarnet
CytomegaloVirus of Eye Gianclyvir
Kaposi Sarcoma
Interferon Afa2a2b
PneumoCytisCarini Pentamedinie
Pneumonia
Trimethoprim Sulpha
methoxazole
Urokinase
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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
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*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
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*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
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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 
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LOWEST PRIORITY
LEAST LIKELY
EXCEPT
INCORRCT
UNSAFE
PRIORITY
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IMMEDIATE
BEST
MOST
PRIORITY
INITIAL
VITAL
ESSENTIAL
PLAN YOUR MCQ
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ELIMINATION
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KEY WORD
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FOCUS ON PRIMARY ISSUE.
 LEFT VENTRICAL FAILURE SIGNS ARE
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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
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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.
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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