nursing pharmacology
TRANSCRIPT
PHARMACOLOGY
DR.CH.PAVAN KUMARMBBS
• They are not magical spells.• Egyptian payrus - 1600bc
• Charaka - susrutha - vagabhatta• Evidence based medicine
• Definitions
Sources
• Plants• Animals• Minerals• Microbes-cephalo,pencil,tetra
• Human-hormones,ab
• Synthetic–Cellular-urokinase
–rDNA-tpa
–Hybridoma-mab
Drug compendia
• DRUG FORMULARY• PHARMACOPEIA
ROUTES• Parenteral
– Injection• im, iv, ip, ia, it, i.medullary.
– Inhalation• Best absorption
– Transdermal• BCG, SMALL POX• DERMOJET, PELLET, SIALISTIC IMPLANT..• TRANSMUCOSAL.
– transmucosal• TOPICAL
– OCUSERT,PROGESTASERT, OSMOTIC PUMP, COMPUTERISED PUMPS.
• Enteral– Advantages– disadvantages
• TRANSMUCOSAL– S.L, NASAL, RECTAL.– ENEMA
• RETENTION• EVACUATION
• TRANSDERMAL– OUTER LAYER– DRUG– POROUS MENMBRANE– ADHESIVE.
PHARMACOKINETICS
• Body does to drug• Travel of drug in the body
–ABSORPTION–DISTRIBUTION–METABOLISM–EXCRETION–INTERACTION
ABSORPTION
• Site of administration to site of action• Factors
– Disintegration or dissolution time– Formulation– Particle size-antihelminthics,steriods– Lipid solubilty– pH and ionosation– Area and vascularity– GI motility– Presence of food– Metabolism– Disease
ABSORPTION• Site of administration to site of action.• First pass metabolism• Bioavailabilty• Bioequivalence potency of two drug formulations
• TRANSPORT• Ionised – water soluble -charged• DIFFUSION• PASSIVE • ACTIVE
– For natural metabolites only
DISTRIBUTION• Plasma protien binding warfarin –
ethosuximde,lithium• Blood brain barrier
– Tight junctions,glial paint on capillaries.• Placental barrier• Tissue binding
– Adipose tissue-thiopentone– Muscle – emetine– Bone – tetracycline ,lead– Retina – chloroquine– Thyroid - iodine
METABOLISM• Biochemical alteration of the drug• Site liver,kidney,gut mucosa,lungs,blood,skin.• Result
– Inactivation or activation• Enzymes
– Phase 1 oxidation– Phase 2 more polar compound
• Enzyme induction ,inhibition
EXCRETION• Renal – Passive tubular reabsorption
• Diuretic + sod.bicarb + IV Fluids to alkalinise urine.
• SWEAT,SALIVA,MILK.• PULMONARY EXCRETION
– GA,ALCOHOL.• Fecal and biliary excretion
– Water soluble conjugates excreted in bile– Enterohepatic circulation– Action increased in chloramphenicol, tetracycline,
OCP, ERYHROMYCIN.
PHARMACODYNAMICS
• STIMULATION• DEPRESSION• IRRITATION• REPLACEMENT• ANTI INFECITVE• CYTOTOXIC• MODULATION OF IMMUNE STATUS
ACTION
• RECEPTORS– AGONIST,ANTAGONIST,PARTIAL AGONIST
• ENZYMES• ION CHANNELS• PHYSICAL ACTION• CHEMICAL INTERACTION• ALTERATION OF METABOLIC PROCESS
SYNERGISM ANTAGONISM
• ADDITIVE–NO + ETHER
• ANTAGONISM–CHEMICAL,PHYSIOLOGICAL,RECPTOR
• SYNERGISM–LEVODOPA + CARBIDOPA
ADDICTION
• PHYSICAL : TOLERANCE WITH WITHDRAWL SYMPTOMS• PSYCHOLOGICAL : COMPULSIVE DRUG SEEKING
BEHAVIOUR
DRUG DEPENDANCE
• WONT STOP EVEN WITH HARM .
• Adverse drug reactions
• Drug development• Rationale• Chemotherpy
–Quinolones–Aminoglycosides–Cotrimoxazole–Sulfonamides
ADVERSE DRUG REACTIONS• SIDE EFFECTS• TOXIC EFFECTS• INTOLERANCE = QUANTITATIVE • IDIOSYNCRASY = QUALITATIVE• ALLERGIC REACTIONS = IMMUNOLOGICAL• IATROGENIC• TERATOGENICITY• ORGANIC TOXICITY• SYSTEM DISTURBANCES
THERAPEUTIC DRUG MONITORING• TO MONITOR AND INDIVIDUALISE THE DRUG
DOSAGE
– DIGOXIN,ANTIDEPRESANTS.
THERAPEUTIC WINDOW
• INDIVIDUALISED– RANGE OF PLASMA LEVELS OF A DRUG BETWEEN
EFFICACY AND TOXICITY .
DRUG DEVELOPMENTPHASE VOLUNTEERS REMARKS
PRECLINICAL 50 SAFETY, BIOACTIVITY
PHASE I 50 SAFETY, DOSAGE
PHASE II 200 EVALUATION OF EFECTIVENESS
PHASE III 2000 CONFIRMATION ,COMMON SE.
PHASE IV POST PRESCRIPTION,POST
FDA
RARE SE.
ESSENTIAL DRUGS CONCEPT
• MINIMUM DRUGSTHAT TO BE AVAILABLE IN PHC– CORE LIST– COMPLEMENTARY LIST – SQUARE BOX - SAME EFFICAY
RATIONALE OF DRUGS
• DOSE AND DURATION• COMBINATION• ESCALATING TH EDRUGS
CHEMOTHERAPY
• Classification• Spectrum
–Narrow • penicillins gm + ve• Aminoglycosides gm- ve
–Broad• Chloramphenicol,tetracyclines
FACTORS
• Site• Concentration• Host defense• sensitivity
RESISTANCE
• Acquired • Mutation• Transfer of genetic
material• Transduction• Transformation• conjugation
FLOUROQUINOLONES• Quinolones : naoxalinic acid, lidixic acid, cinoxin.• Bactericidal,gm – ve. not very good PPB.• Flouroquinolones :• Newer trova,gatiflox,moxiflo.• MOA: DNA gyrase inhibition no positive coiling.• SPECTRUM: gm –ve.newer anaerobes
strep.pnuemoniae• PK :
– without food, PEFLOX cross BB .– microsomal enzyme inhibiton.
• ADV REACTIONS : N,V ADB, Arthropathy, Tendon Rupture.
• CONTRAINDICATIONS : pregnancy ,pediatric, not with theophylline, antiarrhythmics,
• Uses : – UTI– TYPHOID– DIARHHEA– GONORRHEA– RTI ,NUETROENIA– ORTHOPEDICS , ANTHRAX.– CHANCROID, TB.
SULFONAMIDES
• Limited role now ,bacteriostatic. • Short
– Sulfisoxazole, sulfadiazine• Intermediate
– sulfamethoxazole• Long
– Sulfamethoxypyridazine, sulfadoxine• Poorly absorbed
– sulfasalazine• Topical
– Sulfacetamide, mefenide,silver sulfadiazine
• MOA : – stop PABA to DHFA – Competitive inhibition of folica acid synthetase– Not efective in pus,blood tissue breakdown
products (rich in PABA)• Resistance :
– Mutation,alteranative pathway, low permeability• SPECTRUM:
– GRAM POSITIVE AND SOME GM –VE• PK : well absorbed, PPB,liver by acetylation
• Adverse effects : – Renal : – HSN : SJ
SYNDROME .– ANEMIA– KERNICTERUS
USES :•UNCOMPLICATED UTI•WITH PRIMETHAMINE NOCARDIA , TOXOPLASMA, CHL RES MALARIA•SECOND CHOICE FOR TRACHOMA, LGV, STREP PHARYNGITIS•TOPICAL•ULCERATIVE COLITIS
CO - TRIMOXAZOLE• Trimethoprim with
sulfamethoxazole ,bactericidal.• MOA : sulfa goes for folic acid syntetaseTrimethoprim goes for dihydro folete reductase• Resistance : mutation, plasmid.• SPECTRUM: gm + ve, gm - ve
PABA
DIHYDROFOLATETETRAHYDROFOLT
E
folic acid syntetase
dihydro folete reductase
• ADV EFF : ANEMIA, UREMIA• T 80+ S 400 ;T160 + S 800
–UTI ,PROSTATIS–RTI–BAC G ENTERITIS–TYPHOID–PNEUMOCYSTIC JIROVECII–CHANCROID
AMINOGLYCOSIDES
• Amino sugars with glycosidic linkage• Streptomyces,micromonospora
(GENTAMICIN).• Amikacin ,netilmycin semisynthetic .
• Not oral preparations• Poor CSFpenetration, ionisable, extracellular,
bactericidal, gm –ve, otonephro toxic.• Aerobic gram –ve e
coli,proteus,ps,brucella,salmonella.
• MOA : binds to 30s part of ribosomes inhibits synthesis. Postantibiotic Efect.
• RESISTANCE : enzymes,dec binding,permeabilty.• PK : im route,no PPB,BBB.• ADV EFECTS :NEPHRO OTO TOXIC,NM blockade.• CONTRAINDICATIONS :no mixing,not with loop
diureics,not for pregnant.• USES :TB,SBE,PLAGUE,TULAREMIA,UTI,TOPICAL.• NEOMYCIN : ORAL DRUG for bowel preparation,
hepatic coma.
TODAY
• PENCILLINS AND CEPHALOSPORINS• MACROLIDES AND UTI• COMPARITIVE CLASSIFICATION
BETA LACTAMS
• 1928 Sir.Alexander Fleming dicovered• Penicillium notatum,Penicillin chryosogenes.• Classification
– Natural• Penicillin G
– Semisynthetic• Acid resistant penicillin V• Penicillinase resistant methi,cloxa,oxa,naf• Aminopenicillins amoxi,ampi cillin• Antipseudomonal carboxy ureido
• MOA: inhibition transpeptidases in the peptidoglycan synthesis
• Resistance : penicillinase that opens the b lactamase ring, modification .
• PK : HCl inactivates. Probenicid retains from kidney.BBB in inflammation.
• Route : oral benzyl peniciilin, i.m repository procaine,benzathine
• ADV : hypersensitivity ,local,• Jarisch Herxheimer Reaction (Syphilis).• Pnuemococci,streptococci,menigicocci,staphylococci,syphi
ls,diphthteria,anthrax.• Prophylactic : Rheumatic Fever, Gonnarea, Syphilis,
Bacterial Endocarditis
SEMISYNTHETIC PENICILLINS• Acid resistant penicillins : peniciilin V • Mild strep pharyngits,sinusitis, 550mg qid.• Penicillinase resistant penicillins : • Methicillin not for p.o• Cloxacillin for p.o• Nafcillin most potent• Cloxaciilin, Methicillin, Vancomycin,
Linezolid.
Extended Spectrum Penicillins• AMINOPENICILLINS • Ampicillin : • For gm –ve also,non penicillase resistant.• P.o qid.,renal clearance.adv : d,rash• Uses : RTI,UTI,MENIGITS,TYPHOID.SEPTICEMIA.• BACAPMICILLIN,longer acting.• Amoxicillin :• preferred.peptic ulcer with h.pylori. P.o tid.
Anti Pseudomonal Penicillins• Carboxy penicillins :
– Gm-ve,gm +ve,ps,proteus. 2-5gm qid im ,iv ,p.o .– Ticarcillin,with aminoglycosides.Severe UTI .– ADV : slat and water retention.
• Ureidopenicillins : more gm-ve.Less ADV.– Azlocillin,mezlocillin,piperacillin. i.v .– Piperacillin with b.lactamse inhibitor, 3-4gm
hid,qid iv severe ps.• Beta lactamase inhibitors :
– Amoxyclav,ampicillin sulbactum,piptaz
CEPHALOSPORINS• Mother compound :acremonium fungus CEPHALOSPORIN
A• MOA ,RESISTANCE : same• I generation : gm + ve ,cephalothin penicillase reistant, • II generation : gm –ve ,anaerobes. cefuroxime
resistant,BBB.• III generation : gm –ve, weakly for gm +ve.highly
resistant.ceftriaxone,BBB,ceftazidime against ps.• IV generation : cefime,cefipirome,no oral preparations.• V generation: Ceftobiprole, ceftaroline, ceftolozane• ADV:HSN,NEPHROTOXIC ,d, bleeding,leucopenia,
pain.DISULFIRAM LIKE REACTION.
CARBAPENEMS • Spectrum : gm +,gm -,anaerobes.• M O A : same• Imipenem : i.v with dihydropeptidase inhibitor
Cilastatin.• Uses. Penicillin res pnuemococci,with
aminolycoside in ps.• Meropenem : ,Ertapenem not for
ps. ,faropenem p.o .• Monobactams : Aztreonam gm-ve,ps. i.v .
MACROLIDES
• Erythromycin and other semisynthetics as roxithro,clarithro,azithromycin.
• Spectrum : aerobic gm+ve.• MOA : bacteriostatic and bactricidal.• Binds to 50s ribosomes (amino to 30 s).• Resistance : plasmid (enzymatic,inhibition to entry)• PK :enteric coated, not BBB,microsomal inhibitor. • ADV : Hepatitis,cholestatic Jaundice, Allergy,
cardiac ,SNHL.• Uses :atypical pn,legionnaires,croup, topical.• Roxithromycin, clarithromycin for H,pylori.• Azithral no drug interactions.• Ketolides : Modified macrolides for macrolide
res.pneumococci .ex.telithromycin for CAP.
U.T.I
• URINARY ANTISEPTICS : – NITROFURANTOIN
• bactriostatic,bactricidal.gm+ve, gm-ve, 50-100mg qid ,100mg od p.o.
– Methanime mandelate• Release formaldehyde in acidic urine,bactericidal.• Resistant chronic UTI.
• URINARY ANALGESICS– PHENOPYRIDINE
• Relieves urgency, dysuria.• Others
– Sulfa, nalidixic acid, penicillins, tetracyclines, cotrimoxazole.
Miscellaneous
• SPECTINOMYCIN– Aminoglycoside,gm-ve.for pen allergic gonnarea.
• CLINDAMYCIN– 50s ribososmal inhibition as macrolide not as aminogly– Pn.jirovecii,tooplasma,VHD.
• GLYCOPEPTIDES– VANCOMYCIN I.V
• Streptococcus orientalis for MRSA.• OTO,NEPHROTOXIC.RASH. REDMAN SYNDROME.• Pen.res.pneumo ,ps.colitis,enterococcal
endocarditis.• TEICOPLANIN i.m safer ,MRSA, ENTEROCOCCI.
• POLYPEPTIDE ABX : – Polymixin (Bacillus polymyxa), colistin (Bacillus
colistinus).– MOA : leakage of cellular contents– Uses : topical, diarr due to gm –ve in pediatrics.
• Bacitracin : Bacillus subtilis ,gm +ve, inhibits cell wall synthesis, bactericidal ,topical (bacitracin + neomycin)
• Sodium fusidate : Fusidium coccineum ,gm +ve ,bactericidal,p.o,topical.
• Mupirocin : Ps.flourescens ,bactericidal gm+ve,-ve, MRSA. Topical, intranasal.
• Fosfomycin : gm +ve,-ve, inhibits cell wall synthesis ,p.o, i.v uncoplicated UTI.
• Cycloserine : Streptomyces orchidaceus +ve ,-ve ,m.tb
CLASS M O A PK SPECTR
ADV REMARKS
F Q BACTERICIDALDNA GYRASE INHIBITION
WITH FOOD,PEFLOX CROSS BBB, ENZYME INHIBITION
-VE, ANAEROBE
ARTHROPATHY
TROVA, GATI, MOXI
UTI, TYPHOID, DIARRHEA, ANTHRX, CHANCROID, TB , Post antibiotic efect
SULFA BACTRIOSTATICFOLATE MET.
BBB,PPB +VE RENAL,SJ SYNDROME, KERNICTERUS
WITH PYRIMETHAMINE= NOCARDIA, TOXOPLASMA, CHL RES MALARIA
B LACTAMS
INHIBITS TRANSPEPTIDASE
BBB, +VE
+, -, - VE
HSN, JH REACTION, PENICILLINASES, DISULFIRAM REACTION
GONOCOCCI, SYPHILIS, MENINGOCOCCI
NH 2 GLYCO
BACTERICIDAL30 S AS TETRACYCLINES
NO BBB, PPPB +VE OTO,NEPHRO TB, SBE, UTI, PLAGUEPost antibiotic efect
MACROLIDES
BACTERICIDAL, 50SCHLORAMPHENICOL
NO BBB, ORAL ,ENZYME INHIBITION
+VE HEPATITIS, JAUNDICE, ALLERGYAnti inlam, immnomod
ATYPICAL PN, LEGIONNAIRES, CROUP, TOPICALTACROLIMUS
?• ENTERAL ROUTE CRIETERIA• FIRST PASS METABOLISM• BBB• COTRIMOXAZOLE• PREVIOUS QUESTION PAPERS
TODAY
• Broad Spectrum Antibiotics• Anti Tubercular Therapy• Anti Leprotic Therapy
Broad Spectrum Antibiotics TETRACYCLINES
• SOURCE : soil Actinomycetes• Natural : Chlor,etra,oxytetra. • Semisynthetic : demeclocycline, methacycline,
doxycycline, minocycline.• SPECTRUM : gm-ve,+ve ,anaerobes, rickettsiae,
chlamydiae, mycoplasma, protozoa• MOA :30s ribososmes, bacteriostatic• PK : oral,calcium chelation.not with iron, milk,
antacids.excreted by kidneys.doy,mino by gut.• ADV : Hepatotoxic, Nephrotoxic,
Phototxic ,Osteoodonto ,Suprainfections ,HSN, • Minocycline causes vestibular toxicity .
• Uses : doc rickettsial ,chlamydia, aty pn ,cholera ,brucellosis ,plague .
• Also for diarrhoae, STD, acne, protozoal infections .
• Contraindications : not in pregnancy,<8yrs .• Tigecycline :
– Derivative of minocycline ,for mrsa,vmrsa, – I v 100 50 mg bd– Excreted by gut.
CHLORAMPHENICOL• Source : Streptomyces venezulae• M O A : Bacteriostatic, Bactericidal . 50 s
ribosome.• Spectrum : +Ve, -Ve, Anaerobe, Rickettsiae,
Chlamydiae, Shigella, Bordetella, Cocci .• PK : PO ,BBB ,Liver .• ADV : Bone Marrow Depression, Gray Baby
Syndrome, HSN, Superinfection .• Uses : Typhoid, Bac Menigitis, Anaerobic, Rick,
Topical E/D.
Anti Tubercular Therapy
• I line :H R Z E S• II line :Ethionamide ,Thiacetazone, PAS,
Amikacin, Rifabutin, Kanamycin, Ciprofloxacin.Etc
Isoniazid : • Intra and extracelluar organisms, • Moa : inhibits mycolic acid synthesis by active
form.• PK : PO, BBB, LIVER, slow and fast acetylators • Adv : Peripheral Nueritis, Hepatitis ,Hemolysis
in G6PD def.
RIFAMPICIN• Semisynthetic der of Streptomyces mediterranei.• Bactericidal ,only drug fro persisters dormants.• Sterilizing agent .• Binds to DNA dep RNA polymerase.• Pk : oral ,bbb ,enzyme inducer .• Adv : Hepatits, Git ,Flu Like ,HSN ,Staining Of
Secretions .• Uses : TB ATYPICAL TB ,LEPROSY ,H I,RES STAPH with
VANCOMYCIN,BRUCELLOSIS with DOXYCYCLINE ,NIESSERIAE.
• Rifabutin for TB in HIV,Other Rifapentine.
• Pyrazinamide : –against intracellular, active in acid
ph ,unknown moa, bbb, hyperuricemia. , • Streptomycin :
– i.m ,OTO NEPHRO toxicity.optic nueritis, • Ethambutol :
–static ,inhibit mycolic acid incorporation by inhibiting arabinosyl transferases.adv:
Second line drugs :• Thioacetazone : decreases resistance.• Ethionamide :static drug ,intra and
extracellular ,peripheral nueritis.• PAS : sulfa drug, poor tolerance .• Amikacin, kanamycin, capreomycin : • Cycloserine : CNS TOXICITY• FQ, Linezolid.
• Decreases Resistance, Reduce Toxicity ,Shorten Course• Two phases intensive ,continuation.
– CAT I. • 2 H3R3Z3E3 4H3R3
– CAT II• 2H3R3Z3E3S3 OR 1H3R3Z3E3 5H3R3E3
• Resistant TB : Positive Sputum after 6months • DOTS PLUS CAT IV MDR TB :• XDR TB :• Steroid in TB :TB serositis ,miliary TB,renal TB not ileal TB.• CHEMOPROPHYLAXIS : contacts, old TB ,HIV with contact.
INH +-R• MAC : Clarithromycin + ethambutol +-rifabutin
LEPROSY• Sulfones, Rifampicin, Clofazimne, Ethionamide,
Protionamide.• Dapsone : diamonodiphenylsulfone ,MOA :as
sulfa .leprostatic.oral.adv:G6PD hem anemia, hepatits, lepra reactions.
• Uses : leprosy, p.jirovecii, dermatitis herpetiformis.• Rifampicin• Clofazimine :dye,suppress lepra reactions.reddish black
discolration .• Ethionamide ,protinamide :peripheral
nueritis,hepatotoxicity.• F Q : lepricidal ,others as Minocycline, Clarithromycin.
• Paucibacillary 6 months– D 100 / R600
• Multibacillary 24 months – D100 C50 / R600 C 300
• ROM 600 + 400 +100• CHEMOPROPHYLAXIS D100 o.d +R600 o.m ;ACEDAPSONE
i.m 10 weekly.– LEPRA I
• TUBERCULOID LEPROSY .TYPE IV HSN • STEROIDS +CLOFAZIMINE
– LEPRA II • LEPROMATOUS LEPROSY.ENL.TYPE II ,ARTHUS TYPE,• CLOFAZIMINE,CHLORQUINE, STEROIDS,
THALIDOMIDE.ASPIRIN.
• SUPERINFECTION ,CROSS RESISTANCE
Today• Antiviral Agents
• Antifungal Agents• Anti malarial agents
Antiviral agents : Antiherpes agents• Acyclovir :
– acyclovir triphosphate ,inhibits viral DNA synthesis.
– HSV 1,2,VZV,EBV.– ADV : PO rash,TOPICAL irritation, IV
nephro,nuerotoxicity.• Valacyclovir : prodrug of acyclovir• famiciclovir prodrug of peniciclovir.• Idoxuridine,trifluridine topical for HSV keratitis.• Ganiciclovir , foscarnet : CMV, acyclovir res.HSV.
Anti influenza agents• Amantidine ,rimantidine (long acting)
–Inhibit the repication influenza viruses.–Uses : influenz A 200mg od po 5 days–Prophylaxis –Parkinsonism
• Amantidine enhances dopamine release .
Anti Retroviral Agents• NRTI Zidovudine, Stavudine, Zalcita, Lamuvudine.• NNRTI Nevirapine, Efavirenz .PPB.• NtRTI Tenofovir• PI Saquinavir ,enzyme inhibitors.• FI enfuvuritide, maraviroc• Maturation inhibitor beviramat• Integrase strand Transfer I Raltegravir(RAL)
• Myelosuppression ,peripheral nueropathy, hyperuricemia, pancreatitis.
• Resistance : Acquired ,Transmitted
• HAART–2 NRTI + 1 NNRTI–2NRTI + boosted PI
• PMTCT NVP, Zidovudine• POST EXPOSURE PROPHYLAXIS
–ZIDOVUDINE 600mg 4WEEKS–LAMIVUDINE 15 mg bd 4 weeks–+/- INDINAVIR /SAQUINAVIR 800mg tid /
Miscellaneous agents• Ribavirin :
–broad spectrum antiviral agent.–Flu A,B ,RSV ,measles. Aerosol spray
/po / iv .• Interferon :
–immunomodulating, antiproliferative effects
–Myelosuppression, alopecia, cardiac, nuerotxicity.
Anti Fungal Agents• Antifungal antibiotics
– AMB,NYSTATIN, HAMYCIN, GRISEOFULVIN
• Antimetabolites– FLUCYTOSINE 5FC
• Azoles– IMIDAZOLES : CLOTRI,MICANO,
KETOCONA– TRIAZOLES : FLUCON, ITRACON,
TERACON• Misc
– TERBINAFINE, PNUEMOCANDINS• Other topical
– TOLNAFTATE, BENZOIC ACID, SEL.SULFIDE, SALICYLIC ACID.
• AMB : –Streptomyces nodosus –Candida, Histoplasma, Cryptococcus,
Coccidoides, Aspergillus, Leishmania. –Static and cidal –MOA : porosity by binding ergosterol in
mebrane. No PO.–Adv : pain,thrombophlebitis,
nephro,nuero,myelo toxicity .
• Griseofulvin : – penicillium griseofulvum , – p.o.antimitotic by binding to microtubules. – for dermatophytoses,
• Nystatin : topical oral,vaginal candidiasis.• Hamycin : topical otomycosis, cut candidiasis.• Flucytosine : cryptococcus neoformans, candida.DNA
synthesis inhibition.with AMB useful.myelosuppression. • Azole :
– dermaophytes, candida, cryptococcus, histoplasma, deep mycoses.
– MOA : inhibition of formation of ergosterol
• Ketoconazole :– po, empty stomach, adrenal gonadal suppression.
P.o,shampoo, oint.– Uses :mucocutaneous candidiasis, dermatophytosis,
cushings syndrome.• Fluconazole : bbb, cryptococcal meningitis.• Itraconazole : po,i.v ,with food.• Econazole,terconazole,…topical• Terbinafine :
– dermatophytes, candida.– Po,fungicidal, inhibits formation of ergosterol, deposits
in keratin.– Doc for systemic mycoses, onychomycosis, candidiasis,
pityriasis.
• Topical for dermatophytes, pityriasis versicolor
• Pnuemocandins : –inhibits the formation of cell wall–capsofungin ,micafungin.–For candidiasis, aspergillosis.
Anti Malarial Agents• Protozoa plasmodium• Prophylactic primaquine, pyrimethamine• Blood Shizonticides CQ, Q, MQ, HF,
pyrimethamine, artemesinin• Tissue schizonticides PQ• Gametocidal PQ, CQ, Q
• CQ : – Inhibition of heme polymerase ,po, liver, gut.– Adv : cardiac, per nueropathy, retinopathy.– Malaria, Amoebiasis, Lepra reaction, rheumatoid
arthritis• Q :
– cinchona officinalis ,Analgesisc, cardiac depressant, L.A, skeletal muscle relaxant, abortificient.
– For CQ resistant malria. Next is halofantrine.– Adv : hypoglycemia, disulfiram like reaction, cinchonism.
• MQ : CNS ADV. • Pyrmethamine : DHFR ase inhibition , malaria,
toxoplasmosis.
• Artemesinin– Artemesisa annua,qinghaosu,– Develops free radicals from heme that binds
membrane protiens of the protozoa.– Cerebral malaria,i.m, i.v, rectal, p.o .– Use :acute attacks of CQ res malaria.
• PQ : hemolysis in G6PD .• CQ SEN MALARIA
– CQ 600 0+ 300 6+ 300 24+ 300 24• CQ RES MALARIA
– Q600 TID 3DAYS + DOXYCYCLINE 100 BD 7DAYS– ARTMESININ 100BD + 50 BD 5DAYS
TODAY
ANTIPROTOZOAL AGENTS
ANTIHELMINTHIC AGENTS
ECTOPARASITIDES
ANTI CANCER AGENTS
IMMUNOSUPPRESSANTS, IMMUNO
STIMULANTS
ANTI PROTOZOAL AGENTS
• ANTIAMOEBIC DRUGS : INTRA AND
EXTRAINTESTINAL : METRO,EMETINE .
• LUMINAL : DILOXANIDE ,TETRACYCLINES,
PAROMOMYCIN <amino glyco>.
• EXTRAINTESTINAL : CQ
• METRO :– Active drug binds to DNA for inhibitionn. – PO, BBB, – Adv: hepato, nuerotoxic, metallic taste,
disulfiram like drug reaction, cimetidine enhances conc.
– Amoebiasis, Trypanosomiasis, Giardiasis, Anaerobics, H.pylori, Ps colitis, Dracunlosis, topical preparation.
• Tinid : 2g P.O OD 3days.• Emetine : ipecac,s.c, i.m, cardiotoxicity.• Diloxanide furoate : with metro 500mg tid.
• Pnuemocystosis : cotrimoxazole ,pentamidine ,atovaquone.
• Trypanosomiasis.– Suramin sodium, ighly toxic pentamidine is
best alternative.Melarsoprol, Eflornithine.• Leishmaniasis :
– Sod.Stibogluconate : i.m, i.v, carditoxic.– Others Meglumine Antimonate, Ethyl
Stibamine, Pentamidine ,Miltefosine.– Amb,ketoconazole, Allopurinol,
Paromomycin.
• Antihelminthics : – Benzimidazoles :– Thiabend, Albend, Mebend.– Binds to βtubulin inhibits the uptake of glucose.– With fatty food, PPB, 100mg po bd 3 days.– Round, pin, hook, tape.– ALBEND : better tolerable, single dose,effective against
Trichomonas, Giardia, Wuchereria. Adv . Granulocytopenia. – Pyrantel pamoate : dep.NM Blockade.– 10-15/kg od.– Oxantel pamoate.– Piperazine citrate : flaccid paralysis ,safe in pregnancy.
– Levamisole : immunomodulator.– Niclosamide : Tapeworm ,– Prizaquantel :Schistosomes, increase calcium
permeabilty to cell causing paralysis.• Nuerocysticercosis, Tapeworms,, Schistosomiasis.
– DEC : OPSONISATION, IMMOBILISING THE ORGANISM.• FILARIASIS, TROPICAL EOSINOPHILIA.
– IVERMECTIN : Streptomyces avermitilis• paralysing the worm,. W.Bancrofti, B,malyi, Ascris,
Strogyloides.Oncocerciasis, Lymp Filariasis, Strogyloidosis, Cut.Larva Migrans,scabies, Pediculosis, Ascariasis.
• Benzyl benzoate : 25 % emulsion fro scabies.• Permethrin : 5% cream • Lindane ,Gamma Benzene Hexa Chloride : • BHC 1% ,aplastic anemia,cardiac toxicity.• Crotamiton : lice and scabies ,10% cream tid
two days.• Ivermectin : 200mcg/kg .sulfur : 10 % oint.• DDT : 2%• TETMOSOSL SOAP : Monosulpiram. 5% cream • Pediculosis : Permethrin topical, Ivermectin
systemic.
ANTICANCER AGENTS• ALKYLATING AGENTS • ANTIMETABOLITES• NATURAL PPRODUCTS• MISC• HORMONES AND ANTAGONISTS• Adv :bonemarrow,alopecia,gonads,
teratogenicity, carcinogenicity.
ALKYLATING AGENTS
• CYTOTOXIC, IMMUNOSUPPRESSANT, RADIOMIMETIC.
• Alkylation of DNA to break it.• Mechlorethanamine : i.v irritant.• CPS : p.o ,causes cystitis relieved with
MESNA and acetyl cysteine.• Chlorambucil ,busulfan CML.
ANTIMETABOLITES• FOLATE ANTAGONIST : METHOTREXATE
– DHFRase inhibitor. ,cytotoxic, immunosuppressant, antiinflammatory.
– Prophylactic folinic acid .– Choriocarcinoma, acute leukemiaa, breast ca, soft
tissue sarcoma,rhe arthritis, psoriasis.• Purine analogue : 6MP ,thioguanidine, fludarabine,
cladiribine .– Inhibition of DNA .– AC.LUEKEMIA, CHORIOCARCINOMA, SOLID TUMORS,
CHRONIC LEUKEMIA, NHL.– DOSE TO REDUCEDIN ALLOPURINOL.
NATURAL PRODUCTS • ANTIBIOTICS
– Actinomycin D, Daunorubicin, doxorubicin, epirubucin, mitomycin, bleomycin
• Epipodophyllotoxins : etoposide, teniposide,• Taxanes :paclitaxel;Captothecins ;Vinca alkaloids :• Misc :procarbazine, cisplati, l asparginase, imatinib,• Hormones: gc, estrogen, progestins, androgens,• Hormone antogonists : aromatase I ,• Radiophosporous, hematopoietic growth factors, Mab• PYRIMIDINE ANALOGUES :
– 5FU : CA STOMACH,COLON, RECTUM, BREAST,OVARIES.
– CYOSINE ARABINOSIDE : AML,ALL.– GEMCITABINE :
TodaySYS : GIT• ANTISEPTICS AND DISINFECTANTS
• DRUGS IN PEPTIC ULCER• EMETICS AND ANTIEMETICS• DRUGS IN CONSTIPATION• DRUGS FOR DIARRHEA
• ANTITUSSIVES
ANTISEPTICS AND DISINFECTANTS• Disinfection : Destruction of all pathogens on
nonliving things, except spores.• If spores also lost it is sterilisation.• Antiseptic : disinfectant on living tissues.• MOA :
– OXIDATION– DENATURATION– DETERGENT LIKE ACTION– SUBSTRATE COMPETITON
CLASSIFICATION • ACIDS : BORIC,BENZOIC ACID• ALCOHOLS : ETHANOL, ISOPROPYL ALCOHOL• ALDEHYDES : FORMALDEHYDE, GLUTALDEHYDE.
– ALKYLATION OF PROTIENS.• SURFACTANTS : SOAP, CETRIMDE, • PHENOL DERIVATIVES : CRESOL, PHENOL,
CHLORHEXIDNE, CHLORXYLENOL.– DENATURES BAC PROTIEN.
• HALOGENS : IODINE, CHLORINE.– TICTURE IODINE,MANDLS PAINT, IODINE OINT.
• OXIDISING AGENTS : H2O2, KMNO4,C2H5OH.• DYES :GENTIAN VVIOLET, METH BLUE, ACRIFLAVINE.• METALLIC SALTS : Hg, AgNO3, Zn.
• VAGUS +GASTRIN +HISTAMINE• ANTACIDS : Mg(OH)2, Al(OH)2, CaCO3, NaHCO3.• H2 RECEPTOR BLOCKERS : CIMETI, RANIT,
FAMOTID, ROXATI, NIZATID.• PPI : OMEP, LANSOP, ESOMEP, PANTOP, RABEP.• ANTI MUSCARINICS : PIRENZEPINE,
TELENZEPINE.• ULCER PROTECTIVES : SUCRALFATE, BISMUTH.• OTHER ;CARBENOXOLONE, CISAPRIDE,
PROSTAGLANDINS.
PEPTIC ULCER
• ANTACIDS : DECREASES ACTTIVITY OF PEPSIN.– SYSTEMIC : SOD.BICARB.
• SHORT ACTING, REBOUND HYPERACIDITY, ALKALINISATION OF URINE.
– NON SYSTEMIC : AlOH, MgOH, Mg TRISILICATE, CAL CARBONATE.• NOT ABSORBED, DELAYED
EMPTYING,HYPOPHOSPHATEMIA AL.• OSMOTIC PURGATION MG.• LIBERATES CO2,CONSTIPATION AND
HYPERCALCEMIA.HYPERACIDITY, PEPTIC ULCER, REFLUX ESOPHAGITIS.
• H2 BLOCKERS : – COMPET INHIBITION OF H2 RECEPTORS, 70% REDUCTION
IN ACIDITY. – PK : CIMETAC NO PPB, NO BBB, ANTIANDROGENICS.
• ANTICHOLINERGICS : PIRENZEPINE.– ADJUVANT, INHIBITS SECRETION OF GASTRIN.
• PPI :– SULFENIC ACID,SULFENAMIC ACID IRREVRSIBLE BINDING– MOST EFFICACIOUS, INHIBITION OF H+ K+ ATPase PUMP. – MICROSOMAL INHIBITORS RAISES TOXICITY OF
WARFARIN, PHENYTOIN. ENTERIC COATED, LOCATES AT PARIETAL CELL CANILICULI.
– ADV REACTIONS : BAC OVERGROWTH, RED B12 ABSORPTION, INCRE GASTRIN, ATROPHIC GASTRITIS.
• ULCER PROTECTIVES : – SUCRALFATE : NO ANTACIDS, DECR ABS OF
TETRACYCLINES, DIG, PHENYTOIN, CIMETAC.– BISMUTH : CHELATES PROTIEN ,FORMS
LAYER.• CONSTIPATION, BLACK STOOLS.
• PROKINETICS :– D2 BLOCKERS METOCLOP,DOMEPERIDONE
• CARBENOXOLONE ,PROSTAGLANDINS.
THERAPY H.PYLORI PEPTIC ULCER
• PPI 20-40 BD + CLARITHROMYCIN 500 BD+
AMOXYCLAV 1gm BD/ METRO 500 TID
• PPI + METRONIDAZOLE 500 + TETRACYCLINE
500 + BISMUTH COMPUOND 525 TID
• DRUG INDUCED PEPTIC ULCER
– PPI
CLASSIFICATION• Prokinetics : Metoclopramide, Domeperidone• 5HT3 antagonists : Ondem, Grani, Dola, Tropi• Antimuscarinics : Hyoscine, Cyclizine,
promethazine (pregnancy), Diphenhydramine.
• Nueroleptics : Chlorpromazine, Prochlorperazine, Haloperidol
• Others : Cisapride, Corticosteroids.
• D2 antogonists :– METOCLOPRAMIDE : increases tone of LES,
promotes gastric emptying, BBB.– DOMEPERIDONE : CANT CROSS BBB.
• 5 HT3 ANTAGONISTS : ONDEM : In stomach, CTZ centre, vomiting caused by anticancers, radiotherapy. PONV , DRUG induced vomiting.
• Antimuscarinincs : Hyoscine ; motion sickness.• Nueroleptics : Chlorpromazine ,
Prochlorperazine. D2 blockers, CTZ receptors.
DRUGS FOR CONSTIPATION• Bulk laxatives : Bran, Plantago, Agar,
Methylcellulose, Isphagula Husk.• Fecal softeners : Docusate Sod, Liq Paraffin
Lipid Pneumonia, Anal Discomfort.• Osmotic purgatives : MgSO4, MgOH2,
NAPO4, NASO4, Mg citrate, Lactulose, Sorbitol.
• Stimulant purgatives : Phenolpthalein, Bisacodyl, Castor Oil, Senna.
ANTIDIARRHEAL MEDICATION• Fluid and electrolyte replacement :
– ORS, NaCl 3.5gm, KCl 1.5gm, sodium citrate 2.9gm, GLUCOSE 20gm in 1 ltrs of water.
– Isotonic, Hypotonic, Hypertonic Solutions.• Treatment of cause :• Antibiotics, adsorbents :Kaolin, Magnesium and
Aluminum Silicate.• Antimotilty drugs : Codeine ,Diphenoxylate,
Loperamide.• Proboitics : Lactobacillus
acidophilus ,antispasmodics(propantheline, dicyclomine) .
Antitussives• Central cough suppressants – Codeine : Constipation,drowsiness, Noscapine– Synthetic : Dextrometharphan,pholcodeine,
Antihistamines, • Pharyngeal demulscents :Vicks , Lozenges, Cough
Drops,linctuses.• Expectorants : Neb. KI , Guaiphensin,
NH4Cl ,Ipecacuanha.• Bronchodilators : • Mucolytic :Bromhexine, Acetylcysteine,
Carbocysteine.• Steam inhalation : Rehydration.
TODAY
DRUGS FOR BRONCHIAL AASTHMAPOISIONING
Bronchial aasthma• Bronchodilators :
– SYMPATHOMIMETICS :–Salbutamol,terbutaline, Salmeterol.
• Selective beta 2 agonists, tremor, palpitations, nervousness.
– METHYL XANTHINES : –Theophylline, Aminophylline.
• Bronchodilators, low therapeutic window, delirium, arrhythmia,convulsions.
– ANTICHOLINERGICS : – Ipratropium Bromide
• Muscarinic receptors
• Antiinflammatory agents – Systemic :GLucocorticoids.– Inhalational :Beclomethasone, Budesonide,
Flunisolide, Fluticasone.• Mast cell stabilisers
– Disodium Cromoglycate, Nedocromil Ketotifen.• Miscellaneous.
– Omalizumab– Anti IgE mab .
STATUS ASTHMATICUS • Nebulisation of Salbutamol and Ipratropium
Bromide R10min• Inj.Salbutamol 0.4mg i.m /s.c R/O Tachycardia• Inj.Hydrocortisone i.v 100mg stat. R8H p.o
prednisolone.• Inj.AMinophylline 250mg slow i.v in 20mins.• Mechanical ventillation• Oxygen inhalation• Antibiotics• IVF
POISIONING• Stop the source • Limit the absorption
– Vomiting, stomach wash, cathartics, washing• Supportive therapy
– C A B– COMA COCKTAIL
• NALOXONE 2mg + THIAMINE 100mg +DEXTROSE 50%• Specific therapy
– ANTOIDOTE, ANTIVENOM, ANTITOXIN– ethanol in methanol posioning. – nitrite in cyanide poisioning.
• Other measures• Diuresis, dilysis, hemoperfusion fat soluble drugs
• Gut decontamination : – emesis by ipecac, mustard powder solution luke
warm water.– Not in corrosives, petrol, unconsious
• Stomach wash :– in few hrs to few days– In all cases unless contraindicated.– Not in corrosives, petrol, FB, convulsant.
• Medicoal.– For PCM, babiturates, salicylates, antidepressants,
anticonvuksants– Not for alcohol, corrosives,heavy metals.
• Purgatives :– MgSO4, Na2SO4, fluid intake– polyethylene glycol and electrolytes in iron poisioning.
• Circulatory failure :– Foot end elevtion– Plasma expanders– Vasopressors
• Respiratory failure : – Clearance of airway– Aspiration– Intubation– Oxygen support
• Fluid and electrolyte balance :–Hyponatremia –Hypernatremia diuresis–Hypokalemia KCl –Hyperkalmia K+ sparing diuresis, Ca
gluconate–Hypocalcemia Ca gluconate
• Metabolic complications Acidosis, Convulsions
• ANTIDOTES : physical – activated charcoal chemical – KMnO4 for barirurates p , alkalies.chelators.
• UNIVERSAL ANTIDOTE–1 TANNIC ACID–2 MILK OF MANESIA–2 BURNT TOAST
ORGANOPHOSPOROUS POISIONING
• Accidental, suicidal, occuptional.• Treatment :
– Stop contamination– Reduce contamination– Supportive menagement – Inj.Atropine i.v 2mg R10min till pupillary dilation– Choineesterase reactivators
• Inj . Pralidoxime ,diacetyl monoxime • Not useul in carbamate poisioning.• Inj.PAM 1-2gm slow i.v
C V S Today
DiureticsDrugs for congestive heart failureDrugs for arrhythmia
diuretics• High efficacy diuretics
– Furosemide, torsemide .• Sulfa derivative, lop diuretic• Blocks Na+ K+2Cl- in thick ascending limb, Ca i• PK: short acting, PPB• Adv : • ↓K+, Na+, Ca2+, Mg2+• met alkalosis, dehydraton, hyperuricemia,
ototxicity , hyperglycemia, hyperlipidemia, allergy.
• Uses : edema, ARF, Ac.pul.edema., cer.edema, HTN with RENAL REPLACEMENT.
• Moderate efficacy drugs– Thiazide
• Chlorthiazide, hydrochlorthiazide• DCT, Blocks Na+ Cl- ,Ca i• PK: p.o • Adv : hypokalemia, hypercalcemia,
hyperlipidemia, hyperglycemia, impotence in men, photosensitivity.
• Uses : HTN, CHF, EDEMA, RENAL STONES, DI– Thiazide Like Drugs
• Chlorthalidone, metalazone,clopamide.
• Low efficacy drugs– K + sparing :
triamterene,amiloride,aldosterone• Aldosterone antagonist-
spironolactone.enhance Na+excretion nd reduce K+ loss .
• Adv: gynecomastia, hyperkalemia, met acidosis, rash,
• Uses : edema, HTN, ALDOSTERONISM.
– CA inhibitor :Acetazolamide• H2O + CO2 H2CO3
• H2CO3 H+ + HCO3-
– IN GLAUCOMA, EPILEPSY, MOUNTAIN SICKNESS, HYPERPHOSPHATEMIA, ALKALINISATION OF URINE, MET ALKALOSIS. REDUCTION OF CSF
– ADV :MET ACIDOSIS, RENAL STONES, HYPKALEMIA
– Osmotic diuretics : Mannitol, glycerol– Methylxanthine : theophylline
• Newer agents : tolvaptan, lixivaptan, conivaptan
CONGESTIVE HEART FAILLURE
• DIURETIC :Frusemide, Bumetanide• Vasodilators
– Hydralazine, organic nitrates, ACE inhibitors, ARB, nitroprusside, prazosin, CCB.
• Positive ionotropics : – Cardiac glycosides : digoxin, digitoxin. With a.fib.– Β adrenergic agonist : dobutamine, dopamine,
dopexamine.in renal impairment– Phosphodiesterase inhibitor :amrinone,
milironone.– Newer agents : isatrxime, levosimenden.
• Others : B blockers
Antiarrhythmics• Class I :Na+ channel blockers
– A :prolong repolariisation • Quinidine, procainamid,disopyramide.
– B Shorten repolarisation • Lignocaine, mexilitene
– C Minimal effect on repolarisation• Flecainide, propafenone.
• Class II : beta blockers: propranlol, acebutol, esmolol.• Class III : K + channel blockers :
Amiodarone,bretyllium, stalol, dofetilide, ibutilide.• Class IV Ca2+ channel blockers : Verapamil,
diltiazem.
TODAY
ANTI ANGINAL DRUGSANTIHYPERTENSIVE
HYPOLIPIDAEMICS DRUGSHEMATINICS
ANTIANGINAL • NITRATES
– NITROGLYCERIN ,ISOSRBIDE DINTRATE, MONONITRATE,
– Converted to NO ,release cGMP.– Reduction of preload, coronary dilation, inhibition
of platelet aggregation.– P.o extensive first pass. – Adv :headache, pos hypotnsion, tolerance,
dependance, acute angina.Not with sildenafil.– Uses : exrtional angina, vasospastic angina,
unstable angina, cardiac failure, MI, cyanide poisioning,esophageal spasm, biliary colic.
• CCB : • Verapamil, Diltiazem, Amlodipine, Nifedipine,
Trimetazidine.• Misc : Ranolazine
– Trimetazidine congener, – Prolong QT, headache, constipation.
• Dilate arterioles, coronaries, releases afterlod, decrease myocardial contractility,.
• Reduced workload, reduced myocardial oxygen demand.prophylactic.
• Use : vasospastic angina, exrtional angina.
• Dipyradamole ,Aspirin–Prophylactic, coronary dilator antiplatelet.
• Beta Blockers : –Propranolol, Atenolol.–Prophylactic,decreases sympathetic
stimulation.• Potassium Channel Openers : • ATPsensitive K+
–Also Acts By Releasing NO.–Nicorandil, Pinacidil.
ANTIHYPERTENSIVE• Diuretics
–Thiazides : hydrochlorthiazide, chlorthiazide, chlorthalidone, ndapamide.
–Loop diuretics : frusemide, torsemide.
–K+ sparing diuretics :spironolctone, amrinone, milirinone.
• Drugs on RAS system– ACE I
• Captopril ramipril, enalipril• P.O , renal clerance• ADV : dry cogh, hypotension, hyperkalemia,
dysguesi, angionuerotic edema, rash, teraogenicity,.
• Uses :HTN, CCF, MI, CAD, CR, scleroderma.– ARBs
• Losartan, irbesrtan, olmesartyan, valsartan.– Renin antagonists :aliskiren
• Sympatholytics : – Centrally acting drugs : clonidine, methyl
dopa • Seletive alpha 2 agonist• Adv :dryness of mucosa, parotid swelling,
constipation, impotence, rebound hypertnsion.
• Uses : opiod withrawl, DM NEPHROPATHY, PREANAESTHETIC MEDICATION.
– Ganglion blockers :trimethapan SEVRE ADV.
• Adrenergic nueron blockers : – Guanethidine, Reserpine.
• Adrenergic receptor blockers : – α block :
• Prazosin, Erazosin,doxazocin, Phenoxybanzamine, Phentolamine.
– β block : • Propranoolo, Atenolol, Emolol, Metoprolol.
– α block β block :• Labetolol, Carvedilol.
• Calcium channel blockers : –Verpamil, Nifedipine, Nicardipine,
Nimodipine, Amlodipine, Felodipine.• Vasodilators :
–Arteriodilators : Hydralazine , Minoxidil
–Venodilators : Sod.Nitroprusside
HYPOLIPIDAEMICS DRUGS
• HMG COA reductase inhibitors :• Hydroxymethyl co A inhibitors • Rte controlling enzyme in synthesis of
cholesterol.
HEMATINICS• Compounds for formation of blood.• Iron :
– RDA : 0.5 -5 mg– Source :– Absorption : 10% absorbed .
• Site : duodenum• Increased with acid, vit c,met.• Decreased with antacids , phopshate, phytate,
tetracyclines.– Transport : transferrin ,ferrritin.– Excretion :0.5 -1 mg
• Oral iron– Ferrous sulphate,fumerate,gluconate– adv : metallic taste, diarrhea constipation.
• Parenteral iron – Deep i.m z technique, slow i.v
• Indications :–Intolerance, malbsorption, non
compliance, ever deficiency.– : iron dextran, iron obitol citric acid.
• Acute iron poisioning : –pain ,hematemesis, malena, shock,
acidosis, CVS collapse–Lavage with sod.bicarb.–Deferrioxamine i.v / i.m ,correction of
acidosis and shock.
B12• DNA synthesis, RBC maturation .• RDA : 1-5µgm• SOURCE :gut flora, liver, meat, pulses.• ABSORPTION :terminal ileum .• Deficiency : Pernicious Anemia, Gasrtectomy,
Chronic Gastritis, Malabsorption, Fish Tapeworm.
• Cyanocobalamin 100µgm/ml i.m /deep s.c• Hydroxycobalamin 100, 500, 1000µgm/ml• Deficiency, nueropathy.
• DNA synthesis, RBC maturation .• RDA : 50-400µgm• SOURCE :liver ,yeast, egg .• ABSORPTION :duodenum, jejunum.• Deficiency : dietary, malabsorption, folate
inhibitors(phenytoin, MTX, OCP)• Folic cid 2-5mg/day p.o /i.m• In pregnancy 500mg p.o od• Folinic acid:
Hematopoietic growth factors• ERYTHROPOIETN
– Binds to progenitors in marrow.– Adv :HTN, thrombosis, allergy.– Uses :marrow failure, renal failure,malignancy,
HIV.• MYELOID GROWTH FACTORS
– GM –CSF, G-CSF, M-CSF– Adv :bone apin, fever, arthralgia.
• MEGAKARYOCYTE GROWTH FACTORS– Thrombopoietin ,Increases platelet productionin
cancer chemotherapy.
Oral anticoagulants p 119
• Warfarin :– Interferes synthesis of K dependant factors Ii,
VII, IX, X – Blocks ɣ dependant carboylation of glutamate– PK :PO, 99% PPB, slow onset of action, affect
loses 5 days after stopping the drug.– PT is for monitoring.– Adv : hemorrhage ,teratogenicity.
• Uses :venous thrombosis, pulm embolism, post op, post stroke ,bed ridden ,ARF, Unstable angina, heart valves.
• Contraindications :–Bleeding disorders, sever HTN,
mlignancy, bac endocarditis, liver and kidney disease, recent surgery, CVA.
Thrombolytics (fibrinolytics)• STK :
– βhemolytic streptococci– Ab s can inactivate adv : allergy, hypotension.– anistrptlase i.v bolus (long acting STK)
• UK:culture of human kidney cells.• tPA :activatesplasminogen
– Alteplase, duteplase ,reteplase rDNA tPA.– Tenectaplase binds to fibrin.
• Adv :bleeding, allergy,.• Uses : AMI, DVT, PUL EMBOLISM.• CONTRAINDICATIONS :
Plasma expanders• High molecular weight substances oncotic pressure.• Colloids :
– Dextran ,interferes with coagulation, blod grouping, cross amtching.
– Long shelf life short acting causes allergy.– Gelatin :allergy ,not interferes with hemotolgy– HES , Human albumin .– Polyvinyl pyrrolidone : histamine release, interferes
with coagulation• Uses : Severe hypovolemic shock, hypoprotienemia,
burns.
SHOCK • C / O acute sympathetic overactivity• Pallor, sweating, cold clammy skin, tchycrdia.• Hypovolemic Shock : H2O,electrolyte balance• Septic Shock : abx• Cardiogenic Shock : MI• Anaphylactic Shock : Type I HSN .adrenaline.• Nuerogenic Shock : SA, testicular trauma.
Management• Foot end elevation• Maintain BP and plasma volume.• Correcion of acid base balance.• Maintain adequate urine output.• Drotecogin alpha
– Activated protien C– Inhibition of coagulation,– Improves fibrinolysis– Inhibition of TNF aplha
TODAYCENTRAL SYMPATHOLYTICS
GENERAL ANESTHETICSLOCAL ANESTHETICS
ANTIEPILEPTICSSKELETAL MUSCLE RELAXANTSANTI PARKINSONISM DRUGS
CENTRAL SYMPATHOLYTICS109• Clonidine :
– selective α2 agonist (vasomotor centre in IV ventricle)
– Blocks release of NA, – Adv : drowsiness, dryness of eyes, prarotid
swelling, constipation, impotence– Rebound hypertension.– Use : mild hypertension ,opioid withdrawl,
diabetic nueropathy, with anaesthetics.
• αmethyl dopa:–Prodrug that forms alpha methyl
norepinephrine, alpha 2 gonist.–Renin levels fall, LVH is revetrsed
In 12 weeks of treatment.–Safe in pregnancy
GENERAL ANESTHETICS
Classification p131Stage of analgesiaStage of deliriumStage of surgical anaesthesiaStage of medullary paralysis
• Nitrous oxide :– Inhalational gas, sweetish odor, smooth induction and
recovery ,.– Diadv : light anesthesia, teratogenicity.
• Halothane :– Colorless volatile liquid, non irrtant, non inflammable– Adv :potent, smooth and rapid induction and recovery.– Disadv :
• not a good analgesic, not a good muscle relaxant.• Myocardial depressant.• Respiratory depression, hepatitis, • malignant hyperthermia.
Preanaesthetic medication• Anxiolytics, amnesia: diazepam• Preop pain relief :OPIODS
(MORPHINE , PETHIDINE)• Safer anasthesia :PROMETHAZINE,
ONDEM, METOCLOPRAMIDE• Anti acidity measures : PPI
LOCAL ANAESTHESIA
• INJECTABLE ,SURFACE ANAESTHETICS • LIGNOCAINE :
– MOA :blockad of Na+ channels.– Smaller fibers are more susceptible– Addition of vasoconstrictor as adrenaline,
phenylephrine.• Slowed absorption• Reduced sysemic toxicity
– Adv :tremors,restlessness, convulsions.cardiac depressant, allergy,.
– Use : surface ,infiltration, field block, nerve block, S.A,
ANTIEPILEPTICS P 148
• Phenytoin :–Blocks Na+ channels, poorly watersolubel,
99%PPB, enzyme inducer.–Adv :nystagus, diplopia, ataxia.–Gingival hyperplasia, perpheral
nueropathy, HSN, megaloblastic anemia, teratogenicity.
SKELETAL MUSCLE RELAXANTS P 55
• Drugs acting on peripheral NMJ– Competitive blockers
• D.tubocurarine, vecuronium, atracurium.– Depolarising blockers: SuCh .– Others :botulionum toxin
• Drugs acting centrally: diazepam, baclofen.• Drugs acting directly on muscle : dantrolene
• Competitive blockers: – blocks Nm receptors, reversible.– Adv :hypotension, histamine release, only i.m,
inv– Treatment of toxicity :neostigmine.
• Depolarising blockers : – low amount of depolarisation .– Abscense of pseudocholinesterase, rYR
recptors.• Centrally acting
– P.o, blocks spinal cord impulse transmission.• Dantrolene Ca 2+ influx at SER.
ANTI PARKINSONISM DRUGS P 154
• Drugs that increase dopamine–DA precursor :
• Levodopa–Drugs that release dopamine
• Amantadine–Dopaminergic agonists
• Bromcriptine, cabergoline, lisuride, ropinirole, pramipexole
– Inhibit dopa metabolism• MAO inhibitors
–Selegeline, rasagiline• COMT inhibitors:
–Tolcapone, entacapone.• Drugs that influence cholinergic system :
– Central anticholinergics• Benztropin, benzhexol, biperidine
– Antihistamines • Diphenhydramine, orphenadrin,
promethazine
Levodopamine• Prodrug crosses BBB, taken up by nigrostriatal
tract.• Converted to DA.• Other actions :
– Irritates CTZ– It causes postural hypotension, tachycardia
arrhythmias suppresses prolactin.• PK : PO, with food, liver, small intestine.• ADV : abnormal involuntary movements, on-off
phenomenon.
ANALGESICS , ANTIPYRETICS HYPNOTICS AND SEDATIVES
CHOLINERGICS AND ANTICHOLINERGICSCNS STIMULANTS
ANTIPSCHYCOTICS ANTI MANIACS 188
ANTI DEPRESSANTS AND ANTI ANXIETY DRUGS 191
NSAIDS• NONSELECTIVE
– SALICYLATES :ASPIRIN– PARAAMINO PHENOLS PCM– PYRAZOLINE :PHENYL BUTAZOE– INDOLE ACETIC ACID : INDOMETHACIN, ETODOLAC– ARYL ACID DER : DICLO,ACECLO, KETOROLAC– PRPIONIC ACID DER : IBU, FENO,NAPROXEN,– ANTHRANILIC ACID DER : MEFENAMIC ACID– OXICAM : PIROXICAM, MELOXICAM– ALKANONES ; NABUMETONE
• SELECTIVE : NIMUSELIDE, CELECOXIB, ETORICOXIB, ETODOLAC
• TOXICITY OF PCM : N ACETYL CYSTEINE.• TOXICITY OF ASPPIRIN : ALAKALINE
DIURESIS
• USES :ANALGESIC, FEVER, INFLAMMATORY, ARF, RA,OA,POST MI, POST STROKE, IBD,.
RHEUMATOID ARTHRITIS• NSAIDS • DMARDS
– IMMUNOSUPPRESSANTS :MTX, CPS, CS, AZT.• BIOLOGICAL AGENTS
– TNF ALPHA BLOCKERS: ETANERCEPT, INFLIXMAB.– INHIBITORS OF T CELL ACTIVATION : ABATACEPT– IL 1 ANATAGONIST : ANAKINRA– ANTI B LYMPHOCYTE ANTIBODY : RITUXIMAB– GOLD SALTS ;AURONIFIN, AUROTHIOMALTE– OTHERS :PENICILLAMINE, SULPHASALAZIN,
CHLORQUINE, HYDROXYCHLOROUINE.• ADJUVANTS :CORTICOSTEROIDS
GOUT
• ACUTE GOUT : COLCHICNE, NSAIDS• IN CHRONIC GOUT :
–URIC ACID SYNTHESIS INHIBITOR : ALLOPURINOL, FEBUXOSTAT
–URICOSURICS :PROBENICID, SULPHINPYRAZONE.
DIAZEPAM• prodrug.• benzodiazepine receptor is an integral part of the
GABAA receptor • enhance gaba-mediated synaptic inhibition.• PK : p.o , 99%ppb,short acting, major metabolite
of diazepam, n-desmethyl-diazepam• adv :withdrawl symptoms• uses :
– antiepileptic, sedative
HYPNOTICS AND SEDATIVES• Barbiturates : amobarbital, pentobarbital, phenobarbital,
secobarbital, and sodium thiopental.• Quinazolinones : cloroqualone, diproqualone, etaqualone• Benzodiazepines : alprazolam (Xanax), lorazepam (Ativan),
diazepam (Valium), and clonazepam (Klonopin) zopiclone (Imovane, Zimovane), eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Stilnox, Stilnoct)
• Nonbenzodiazepines :• Others
– Antihistamines : diphenhydramine (Benadryl) and doxylamine,
– Antidepressants : Trazodone[2
– Antipsychotics : Chlorpromazine
ANS - Sympathetic nervous system (Adrenergic)
• Sympathetic Nervous System (adrenergic) Norepinephrine = neurotransmitter
- Drugs that mimic = adrenergic drugs, sympathomimetics, or adrenomemetics
* Adrenergic agonists - Drugs initiate a response
- Drugs that block = adrenergic blockers, sympatholytics or adrenolytics
* Adrenergic antagonists - prevent a response
ANS
• 4 types of adrenergic receptor organ cells:1. Alpha-1 = vasoconstriction of blood vessels inc. blood return to heart, inc. circulation, inc. BP2. Alpha-2 = inhibits release of norepinephrine dec. in vasoconstriction, dec. BP3. Beta-1 = inc. in heart rate & force on contraction4. Beta-2 = relaxation of smooth muscle in bronchi, uterus,
peripheral blood vesselsDopaminergic = dilate vessels, inc. in blood flow - only dopamine
activates this receptor
ANS - Parasympathetic Nervous System (Cholinergic)
• Parasympathetic or Cholinergic Nervous System Acetylcholine = neurotransmitter - Drugs that mimic = cholinergic drugs,
parasympathomimetics Cholinergic agonists - initiates a response - Drugs that block = anticholinergic, parasympatholytics Cholinergic antagonists - prevents a response
CHOLINERGICS AND
ANTICHOLINERGICS
• CHOLINERGICS :– ESTERS
• Acetyl choline, methacholine, carbachol, bethachol.
– Cholinemimetic • Pilocarpine, muscarine
– Anticholinesterases• Reversible :
–Neostigmine, physostigmine, pyridostigmine
• Irreversible :–organophosphorous
ACETYL CHOLINE• Muscarinic actions :
– Vagal stimulation– Vasodilation, decreases PVR.– Increase tone of non vascular smooth
muscle cells (peristaltic, voiding of urine, bronchospasm)
– Enhances secretion of all glands, Miotic• Nictoitnic actions :
– Persistent depolarisation, paralysis, stimulatory of ANS.
Anticholineesterases uses
• AS A MIOTIC• MYASTHENIA GRAVIS• POISIONING OF ANTICHOLINERGICS• CURARE POISIONING• POST ILEUS• ALZHEIMERS DISEASE
GLAUCOMA• Decrease formation of aqueous
• Beta blockers: Timolol, betxolol, levobunolol• Adrenergics : Apraclonidine ,dipivifrine.• Carbonic anhydrase
inhibitors :acetazolamide• Increase drainage of aqueous
• PG analogues–Latanoprost
• Cholinergic drugs–Carbochol, pilocaropine, physostigmine
ANTICHOLINERGICS P 52
• Actions :–CVS : tachycardia, reduces all
secretions, mydriatic, reduce motility.
• Uses :–As antispasmodics, as mydriatic,
as preanaesthetic medication.
ADRENERGICS • Adrenaline
– CVS : cardiac stimulant via β1– Vascular : biphasic response– Renal, mesentric, pulmonary vasoconstrictin.– Bronchodilator, relaxation of gut, spleenic
contraction, hepatic glycogenolysis, inhibition of insulin.
– Uses :• Anaphylactic shock, cardiac arrest, control
of hemorrhage
α blockers• Prazosin :
– Potent, highly selective– Decreases PVR, no significant tachycardia.– Decreases central sympathetic flow.– Inhibition of phosphodiesterase, causing vasodilation– Decrese LDL cholesterol.– Relaxes urinary bladder neck causing voiding of
urine.– ADV : first dose phenomenon :hypotension.– Headache, dizziness.– Uses :
• HTN, peripheral vascular disease, CCF, BPH.
β blockers• Propranolol :
–Non selective blocker–CVS : decrease HR,force, CO,
bronchoconstriction, decreased secretion of aqueous, blocks lipolysis, glycogenolysis,
–ADV : bradycardia, CCF, cold extremities, insomnia, depression, fatigue, rebound hypertension,
CNS STIMULANTS196
• Respiratory stimulants (analeptics)–Doxapram, nikethaide
• Psychomotor symptoms–Amphetamine, cocaine,
methylxanthine• Convulsants
–Leptazol, strychnine
CORTICOSTEROIDS• CYTOPLASMIC RECEPTORS ,DRUG RECEPTOR COMPLEX
ENTERS THE NUCLEUS AND REGULATE PROTIEN SYNTHESIS.
• HIGH FIRST PASS ,99%PPB,• SHORTACTING : HYDROCORTISON P 318• INTERMEDIATE ACTING : PREDNSIOLONE• LONGACTING :DEXAMATHASONE,
BETAMARETHASONE.• ADV :cushings, hyperglycaemia, infection,
osteoporosis, avscular necrosis, peptic ulcerarion, mental, cataract, glaucoma, delayed wound healing,HPA axis suppressioon.
uses• Acute adrenal insufficiency, rheumatod
arthritis, allergy,bronchial aasthma, collagen vascular diseases, eye,renal, skin,git,liver, hematology.
• Mineralocorticoids :• Promote water retntion by mineral corticoid
receptor at DCT,promotes loss of potassium loss.
• Fludrocortisone• Aldosterone deficiency disease.
Diabetes mellitus• Insulin• Banting,best• Actions :
– metabolism of glucose and uptake. inhibits glucose storage.
– inhibition of lipid breakdown , forms triglycerides.promotes protien synthesis.
• DM, BURNS, HYPOKALEMIA, ANOREXIA NERVOSA.
• Adv :– Hypoglycaemia, allergy, lipodystrophy, edema.
• Table 40.1 338
SULFONYUREAS
I INSULIN RELEASE, I TISSUE SENSITIVITY
HYPOGLYCEMIACHOLESTATIC JAUNDICE
BIGUANIDES DEC HEPATIC GLUCONEOGWENESISINC SENSITIVITY
DIARHHEA, METALLIC TASTE,LACTIC ACIDOSIS
MEGLITINIDE INSULIN RELEASE HYPOGLYCAEMIA
THIAZOLIDONEDIONES
INC GLUCOSE TRANSPORT DEC HEPATIC GLUCONEOGENESIS
WEIGHT GAIN, EDEMA,
ALPHA GLUCOSIDASE INHIBITORS
DEC CARBOHYDRATE ABSORPTION
FLATULENCE, DIARHOEA, ABDOMINAL DISTENTION.
• AMYLIN ANALOGS :–INHIBITS GLUCAGON SECRETION,
DELAYS GASTRIC EMPTYING, SUPPRESS APETITE.
• GLUCAGON LIKE PEPTIDE ANALOGS :–EXENATIDE, LIRAGLUTIDE.
• DIPEPTIDYL PEPTIDASE INHIBITORS: –SITAGLIPTIN,INHIBITOR OF INCRETIN
INHIBITOR. PRAMLINITIDE,
• Calcium : – Tissue excitability.– Secretion of glands – Cardiac muscular contraction.– Essential for coagulation– Increased by paratharmone, decreaed by
calcitonin– Normal level 9-11mgdl
• Adv :constipation– Uses : calcium def, osteoporosis, rickets,
anatacid, placebo.
• Phosphorous :• RDA : 1000mg
–Formation of bones and teeth–phosphorylation reasctions–component of nuceli, cytoplasm, –phosphate buffering system–enzymatic reactions
• Vitamin D :• Fat soluble vitamin , • Actions :• RDA : 10mg• Uses :
–Prophylaxis ,nutrional rickets, osteoprosis, hypoparathyroidism.
• Calcitonin parafollicular cells of thyroid.• bisphosphonates
VACCINATION
• Active immunisation– Toxoids – component – Live attenuated– Inactivated– Polyaccharides– live
• Initial dose• booster
Passive immunisation• Anti sera• Immunoglobulins• Primary immunisation and
secondary immunisation
Lead posioning
• HEAVY METAL, SINDOR, SURMA.• Fatal dose :10-70gm• c/o metallic taste, abdominal pain, irratability,
lead pasy, lead lines, lead encephalopathy, pallor, basophilic stippling of wbc.
• plumbism• Also with thiamine, stomacvh wash
Arsenic poisioning
• m/c poisioning ,HOMICIDAL• Fatal dose : 200-300mg arsenic trioide,gas• Moa :binds to sulphhydryl groups of enzymes• Deposits in bone,hair.• C/o pigmentation, mees lines,
hyperkeratosis, • Chelstion by BAL,DMSA, PENICILLAMINE,
ESTROGEN
• Replacement therapy• Post menopusal symptoms• Senile vaginits• Osteoporosis• Oral contraceptives• Dysmenorrhea• Dysfunctional uterine bleeding• Carcinoma prostate
SERM ‘S
TamoxifenOrmeloxifene
Clomiphene citrate
Combined contraceptives• Coc
– Monophasic– Biphasic– Triphasic
• Minipill pop• Postcoital pill
– Diethylstilbestrol 25mg/day od 5 days– COC ee 50mg + levonorgesterol 0.75mg stat
and 12 hrs after
HYPOTHALAMUS
GnRH
FSH LH
OVARY
Anterior pituitary
Progesterone inhibits mid cycle
LH release,inhibit ovulation
OESTROGEN PROGESTERONE
Estrogen inhibits FSH release, decreases follicle dev
Inhibit passage of ovumNot favourable for implantationThicken cervical mucus
Anabolics 333
• Synthetic androgens with higher anabolic activity and low androgenic activity–Catabolic states–Osteoprosis–Growth stimulationabuse in athletes
• Methandienone, stanazolol.
Uterine stimulants
• Oxytocin ,ergometrine, pg (dinoprost, carboprost, misoprost)
• Hormone of posterior pituatary• Uterus : contracts pregnant uterus• Mammry gland : milk ejection, • Pk :oxytocinase• Uses :induction, pph, milk ejection, abortion.
TOCOLYTICS332
• Adrenergic agonists : Salbutamol Terbutaline, Isoxsuprine .
• Misc : Ethyl Alcohol,CCB, Magnesium Sulfate.• Uses :delays premature labour• Inhibits uterine contraction in threatened
abortion.• dymenorrhea
• Papaver somniferum • opioid analgesic drug. It is the main psychoactive
chemical in opium. • addiction; tolerance and psychological depende• PK:PO,PPB, BBB.• Adv :• Contraindications :
– acute respiratory depression– renal failure– chemical toxicity– raised intracranial pressure, including head injury– Biliary colic.[13]
IMIPRAMINE
• tricyclic antidepressant (TCA) of the dibenzazepine group.
• Reuptake inhibiton of nuerotransmitters• Metabolism
–Within the body, imipramine is converted to desipramine, another TCA.
PETHIDINE
• synthetic opioid analgesic of the phenylpiperidine class
• analgesic effects by acting as an agonist at the μ-opioid receptor
• analgesic in labour and delivery , pain control in diverticulitis
• Adv : dizziness, diaphoresis, urinary retention,
HEPARIN
• Can not be found in circulating blood• Heparan sulphate, heparin like molecule is found
on endothelial cells .• Heparan sulphate has anticoagulant activity.• MOA : Antithrombin inhibitor,• Unfractionated , low mol heparin.• Pk : i.v ,s.c,• Uses : dvt,pe, cad, • Adv :hemorrhage, throbocytopenia, osteoprosis,
196
Class Representative
Thioamides
propylthiouracil
methylthiouracil
methimazole
carbimazole
Iodides KI, NaI
Radioactive iodine β-adrenoceptor blockers
131I propranolol
Antithyroid drugs
● Drugs
calcitonin
• Neural crest derivatives • thyroid medullary C cells that produce calcitonin, a
calcium-lowering hormone. • antagonist to PTH• inhibition of osteoclast-mediated bone resorption
and secondarily by stimulation of renal calcium clearance
• analgesic effects directly on cells in the hypothalamus and related structures
• Paget's disease, hypercalcemia of malignancy
PARATHARMONE
• maintain the extracellular fluid (ECF) calcium
concentration within a narrow normal range
• directly on bone and kidney and indirectly on
the intestine
• regulated by the concentration of serum
ionized calcium.
Prostanoids Therapeutic UsesUterine Stimulation
• Dinoprostone (PGE2): Prostin E2 vaginal suppositories used to induce abortion between 12th -20th gestational weeks
Prostin E2 oral tablets for elective induction of labbour/obliged induction because of HTN, toxemia, intrauterine death
• Treatment of duration ≤ 18 hrsProstin E2 vaginal gel used for induction of
labour at term or near term (I-2 mg intravaginal, repeated Q 6hrs according to response)
Prostanoids Therapeutic UsesUterine Stimulation
• Carboprost (15-methyl PGF2α)• Used by IM route for induction of abortion
between 12th -20th gestational weeks• Used at a dose of 250 μg every 1-3 hrs• Dinoprost (PGF2α)• Injection form for intra-amniotic
administration• Used to induce labour or abortion
Prostanoids Therapeutic UsesGIT
• Misoprostol is a synthetic methyl ester analogue of PGE1
Used to prevent drug-induced gastric ulceration during NSAIDs, corticosteroid or anticoagulant therapy
It can be used alone or in combination with antacids for duodenal ulcer treatment
Not used for pregnant women or whom are planning pregnancy
Prostanoids Therapeutic UsesPlatelet Aggregation
• Epoprostenol (PGI2):• It is used as a heparin replacement in some
hemodialysis patients• Used to prevent platelet aggregation in
extracorporal circulation systemsImpotence
Alprostadil (PGE1) was used by in jection into corpora cavernosa to maintain erection
Replaced by PDE-V inhibitors
Leukotriens Therapeutic Importance
LTs have no therapeutic uses, but LTs antagonists have
Anti-asthma medications: 5-Lipoxygenase Inhibitors, e.g., zileutinLeukotriene-receptor antagonists;
montelukast, & zafirlukast
204
Vitamins
• Vitamins are organic (carbon) compounds needed for normal function, growth and maintenance.
• Vitamins are cofactors, they don’t do anything by themselves.
• They are not a source of calories.
205
The Nature of Vitamins
• Organic cofactors – what is a cofactor?– Water analogy, scissor analogy
• Physiological role – specific metabolic function• Prevents disease – unlike “supplements” which
may promote “some thing” or have general metabolic effect
(ex. Omega 3s, fibers)
• Natural = Synthetic (except Vitamin E)
206
The Nature of Vitamins
• Nutritional Value lost by:– Light– Heat– Oxidation– Bacteria– Enzymes– Insects– (Nutritional value of baby
food must be assured.)
Effect of packaging on nutrient loss in milk.
207
Fat Soluble Vitamins• A – orange, carotenoids, vision, antioxidant- used as color and
antioxidant
• D – we make it with sunlight, deficiency causes rickets, in milk, regulates Ca:P ratios
• E – tocopherols, antioxidants, role in preventing stroke, cancer, heart disease- used as antioxidant
• K – contributes to blood clotting factor
208
Vitamin A
• Carrotinoids Used in food industry as a colorant (orange) (label friendly)
• Antioxidant (label friendly)• Stored in liver• Important for sight
– Deficiency causes ~500,000 cases of “night blindness” worldwide
• Genetically engineered rice with high Vitamin A can prevent night blindness
• Carrotenosis
209
Vitamin D• Also known as calciferol due to its role in calcium
absorption
• Main role is to maintain calcium and potassium levels
• It is the only fat soluble vitamin that we can make- in the presence of sunlight
• Can be made from cholesterol
210
Vitamin D
• Can be stored in fat tissues (as can all fat soluble vitamins)• Elderly and shut ins are at risk- not enough sunlight• We get vitamin D form fortified milk and cereal• Toxicity is very dangerous
– Occurs only from excess supplementation– Can lead to calcium deposits in kidneys, heart and blood
vessels
211
Vitamin D
Rickets can be caused by lack of sunlight, but also from insufficient calcium. Vitamin D linked to calcium absorption.
(Rickets reported in NYC.)
212
Vitamin E
• A family of eight naturally occurring compounds• Used as an anti-oxidant in foods• Since aging is considered an “oxidation” reaction, many
“anti-oxidants” are used as dietary supplements• Deficiencies are not well understood• Role is stroke, cancer, heart, and immune response• Americans spend $300 million per year on vitamin E
supplements
213
Vitamin K • Contributes to synthesis of seven blood clotting factors
• Can be reactivated to continue biological action
• Works as a cofactor for an enzyme that makes two bone proteins
214
Water Soluble Vitamins
• Relatively cheap to add to food
• Only Vitamin C is used for its functionality
215
Water Soluble Vitamins• B1, thiamine• B2, riboflavin• B6, pyridoxamine• B12
• Biotin • Panothenic acid • Niacin• Folacin• Vitamin C
Water Soluble Vitamins• Vitamin B1
– Thiamine– Involved in carbohydrate metabolism– Helps body metabolize glucose, affects central nervous
system– Deficiency causes Beri beri (Singlese, “I can’t, I can’t”)
• B2- riboflavin– Energy metabolism
217
Water Soluble Vitamins
• B6 - Pyridoxamine– Neurotransmitter, co-enzyme in over 100
reactions
• B12 – – Development of red blood cells– Lack of it makes one anemic– Hard for vegans to get
218
Water Soluble Vitamins
• Biotin – – Involved in fatty acid synthesis– Deficiency causes skin disease and hair loss
• Panthothenic acid– Found in many foods– Essential for metabolism of carbohydrates,
protein, alcohol and fat
219
Vitamin C
• Ascorbic acid• Very inexpensive to add to food, marketing
tool. Antioxidant• Deficiency leads to bleeding gums,
hemorrhages • High in citrus fruits, limes, (Limeys)
220
Niacin (B3)
• Energy metabolism• Disease – pellagra – The Four D’s
– Dermatitis– Diarrhea– Dementia– Death
ZINC :
• Good sources: shellfish, beef and other red meats• Absorption :In small intestine• EXCRETION :Primarily in fecal material
– Unabsorbed Zn– Secreted Zn (endogenous sources)
• From pancreatic and intestinal sources• age-related macular degeneration• Acrodermatitis enteropathic• Gastroenteritis3• ANTI DANDRUFF• SUNLOTION
Dermatology• Keratolytics : issolve intercellular cement
substance.peeling.• Salicylic acid, lactic acid, propylne glycol, urea,
podophyllum resin,benzyl peroxide.• Sunscreens :
– UVA : PHOTOAGING ,PHOTOXICITY, – UVB: BURNS AND TANNING– UVC :SKIN CANCER
• REFLECTS : CALAMINE, TITANIUM DIOXIDE.• ABSORPTION : SALICYLATES, BENZOPHENONES .
ANTIMICROBIALS :TOPICAL ANTIFUNGALSTOPICAL ANTIVIRALS :ACYCLOVIRTOPICAL GLUCOCORTICOIDSACNE:CLINDAMYCIN, ERYTHROMYCIN, +-METRORETINOIDS :EISOTRETIONOIN, RETINOIN.PSORIASIS :TOPICAL ETRETINATE, CALCIPOTRIOL, MMUNOSUPPRESSANTS, ANTIPROLIFERATIVE AGENTS,
PATHOLOGY
• OLD QUESTION PAPERS BOOK .
• HOLIDAYS MENTION.