FDA Approves A new Drug For Nocturnal Polyuria (Frequent Urination At Night)

                  FDA Approves A new Drug For Nocturnal Polyuria FDA approves a new drug for Nocturnal polyuria

FDA Approves New Drug For Nocturnal Polyuria (Frequent Urination  At Night)

Good News:US FDA  Approves A New Drug  For Nocturnal Polyuria In Adults i.e Noctiva, That Will Control Your Frequent Urination At Night.The Drug Is In Nasal Spray Form And Will Only Be used For Adult Nocturnal Enuresis.

The active ingredient in Noctiva Spray Is desmopressin acetate, is included in some other medicine, as well as an injected version for bleeding disorders. The FDA said the nasal spray version is that the first approved treatment for frequent nighttime urination.

An Official From FDA’s Center for Drug evaluation and research said during a statement on Friday said, “Today’s approval provides adults who overproduce pee at midnight with the primary FDA-approved therapeutic option tofacilitate reduce the amount of times a night they get up to urinate”. The Food and Drug Administration Further said the spray, referred to as Noctiva, isn’t approved to treat all causes of frequent nighttime urination, thus doctors should confirm the cause and best treatment for each person.

Actually The Spray Is Originally Approved For A Common Condition Caused By Uncontrolled Diabetes ,Chronic Heart Failure (CHF), Prostate And Bladder Problems.

Noctiva’s effectiveness was Checked in randomized, placebo-controlled trials in 1,045 patients 50 years elderly and older with nocturia because of nocturnal polyuria. though these trials showed alittle reduction within the average range of night-time urinations with Noctiva compared to placebo, a lot of patients treated with Noctiva were able to at least halve their range of night-time urinations, and patients treated with Noctiva had more nights with one or fewer night-time urinations.

How To Use The Spray:

The nasal spray is employed daily about half-hour before bedtime. It works by making the kidneys absorb a lot of water, that reduces the quantity of urine.

FDA’s strongest Black Box  warning :

The drug will cause hazardously low levels of sodium within the blood (Hyponatremia). alternative side effects include increased blood pressure, colds, dizziness, bronchitis, nose bleeds,And back pain.

Milford ,Pennsylvania-based Renaissance Lakewood, LLC for Serenity Pharmaceuticals, LLC Has Marketed The Noctiva Spray.

 

Why Do Medical Professionals Wear White Coats ?

Why Do Medical Professionals Wear White Coats ?

New medical students are slipping on their short white coats, a big and exciting occasion that marks the start of their careers.

The tradition of the white coat initially fashioned within the early decades of the twentieth century. Before that, doctors wore formal, black apparel instead of white. White coats are thought to have been adopted in an exceedingly aware effort to mimic lab coats and make the image of doctors as people of science and to pursue the idea of sterility in treatment that was changing into vital at that time. each aims were meant to set doctors aside from the common person and, since its adoption, the white coat stood as a standing image. It reworked an individual into the embodiment of life science — like a white knife cutting through the contaminated world of death and disease — pure and superior in her knowledge and treatments. To go together with this, as doctors advance in training, they usually receive longer and longer white coats — enhancing their status and image.

According To JRSM (Journal Of The Royal Society Of The Medicine)  “ 72 % of all hospital doctors and medical students wear white coats and most wear them bigger than 75th of the time. White coats are worn principally for straightforward recognition by colleagues and patients, to put things within the pockets and to stay clothes clean. Psychiatrists and pediatricians try and maximize rapport with patients by deliberately not carrying white coats.”

Traditionally, they were buff, however white is substitutable with innocence, being trustworthy, cleanliness and life. within the past, doctors wore their street clothes most frequently or black, reflecting the mortality and frequent deaths seen in their chosen profession.But Indeed, a number of studies have shown that the coats harbor doubtless harmful microorganism.The Intresting Question Is  If white coats are therefore unhealthy, why do doctors still wear them?

Top Prescribed Drugs

Top Prescribed DrugsThe Top Prescribed Drugs

The top filled medication treat a growing range of people with high cholesterol, thyroid disorders, high blood pressure, GERD ,Pain, Inflammation and type 2 diabetes. the other medication rounding out the highest List additionally treat high blood pressure, additionally as high cholesterol and chronic pain.

Almost 4,065,175,064 prescriptions for medications were written within the united states in 2015.Remember this is often just for USA now Lets assume For a moment how much Prescription are going to be filled within the whole world? Major studies that analyzed the financial impacts of increased therapeutic drug use on treatment outcomes and spending have come to totally different conclusions. However, it’s known that a lot of diseases may be prevented, treated effectively or cured through prescription medications.

Following Are Top Prescribed Drugs .

1)Narcotic Analgesics:

Narcotic analgesics Is The Number One Class Of Top Prescribed Drugs And  Are Used For The Treatment Of  Pain and Inflammation.In 2010, over 244,300 prescriptions were filled for these kinds of pain killers.

According To GoodRx A US Base Startup That List Drugs Prices And Sell Prescription Drugs At Discounted Rate ,Compiled A list Of “Top 10 Most Popular Prescription Drugs” According To That Firm Vicodin (Hydrocodone And Acetaminophen) Is The Top Prescribed Drug In The First Month Of 2017 .The Lisiting Is based On Claims That Are Reported In Pharmacies.Some leading narcotic analgesics include Vicodin (hydrocodone and acetaminophen), Oxycodone (oxycodone), Percocet (acetaminophen and oxycodone), codeine, morphine and Ultram (tramadol).

2)Lipid Lowering Drugs:

More than 255.4 million prescriptions for statins and other lipid-lowering medicine were filled in 2010.Lipid regulators, mainly statin drugs, are used to stop dyslipidemia (high blood cholesterol) and other cardiovascular issues and are prescribed for the interference and treatment of the many different diseases including osteoporosis and post-menopause complications.

Pfizer’s Lipitor (atorvastatin calcium) was the best marketing branded statin, followed by, alternative branded statins included Mevacor (lovastatin), Crestor (rosuvastatin calcium) by AstraZeneca  Zocor (simvastatin), Lescol (fluvastatin sodium), Vytorin (Ezetimibe/Simvastatin), Pravachol (pravastatin, sodium),  and Pitavastatin.

3) Beta-Adrenergic  Blockers:

Beta-adrenergic blocking agents or beta-blockers (plain and in combination with alternative medicine, are prescribed for the treatment of heart condition, notably high blood pressure, as well as migraines glaucoma, and  hyperthyroidism. more than 191.5 million prescriptions for beta-blockers were filled in 2010.

Commonly prescribed beta-blockers include), Normodyne, Trandate (labetalol), Coreg (carvedilol), Inderal (propranolol), Sectral (acebutolol)), Brevibloc (esmolol . ), atenolol (atenolol, Lopressor, Toprol-XL (metoprolol)and Zebeta (bisoprolol).

4)Antidepressants:

Antidepressants are one of the fastest growing categories of prescription drugs. In 2010, over 253.6 million prescriptions were filled for antidepressants, according to the IMS report.

One of the main factors driving the rise in scripts for antidepressants is that a growing range of primary care providers and others practicing outside the sector of psychological medicine are writing the prescriptions for patients who haven’t received a clinical psychiatrical diagnosing,

5)Ace Inhibitors:

Angiotensin-converting enzyme (ACE) inhibitors are utilized in the treatment of high blood pressure, scleroderma, migraines and alternative conditions. In 2010, pharmacies dispensed over 168.7 million prescriptions for ACE inhibitors.

ACE inhibitors include capoten (captopril), vasotec (enalapril), , Lotensin (benazepril),  Aceon (perindopril), zestril (Lisinopril), Univasc (Moexipril), Accupril (quinapril), Altace (ramipril) Fosinopril, Prinivil and Mavik (trandolapril).

Autonomic Nervous System Pharmacology & Adrenergic Antagonists

Autonomic Nervous System PharmacologyAutonomic Nervous System Pharmacology

Short introduction Of Nervous System:

The nervous system is divided into two;
A) Central Nervous System
B) Peripheral Nervous System
Central Nervous system composed of brain and spinal cord.While The peripheral nervous system includes neurons located outside the brain and spinal cord.i.e any nerves that enter or leave the CNS.
The Peripheral nervous system is subdivided into Two;A)Efferent B)Afferent
A)Efferent:The Efferent neurons carry signals away from brain and spinal cord to the peripheral tissues.
B)Afferent:The afferent neurons bring information from periphery to the CNS.These neurons provide sensory input to modulate the function of the efferent division through the reflex arc or neural pathways that mediate reflex action.
The efferent division further divided into;
A)Autonomic System

B)Somatic

In this Chapter we will Discuss about Autonomic Nervous system in detail.

Autonomic Nervous System Pharmacology

ANS is further classified into three
(1)Sympathetic
(2)Parasympathetic
(3)Enteric.

●Sympathetic and parasympathetic NS are working against each other.
●Under stress sympathetic Nervous system activate while in Relax position your parasympathetic nervous system activates.e.g When You are lying on your bed.
I will take advantage of Dr.Najeeb Very Famous Example.

Scenario Example : A Person walking on the road suddenly a very big dog appears behind him in a very hostile Manner.The sympathetic nervous system Will Activate & his body will prepare for fight or flight.Here his body will prepare for flight because the dog is big and dangerous but if the dog is too small your body will prepare for fight and the dog sympathetic nervous system will activate and the dog will run away.
Taking the first example we will see the sympathetic N.S of The Person.

Question: How the sympathetic N.S Will be activated?
How Adrenergic System Start ?

Note :
1)Sympathetic preganglionic fibers release acetylcholine as a neurotransmitter at neuro effector organs.Means All the neurons Coming out of CNS are cholinergic.
2)Sympathetic Postganglionic fiber release Norepinephrine as a neurotransmitter.

3)The acetylcholine release in the 2 example will act on adrenal medulla and adrenal medulla will then release Epinephrine.The epinephrine released by adrenal medulla to the general circulation will act on all the receptors in the body.

Q)How adrenergic Receptor Work?

This is very important because a lot of drugs act on this area
The main neurotransmitter here is Norepinephrine This N.E is synthesized in the nerve ending.Basically, Amino acids come from absorption of food from GIT into the General circulation.This amino acid converted into tyrosine in the blood and then taken up intracellularly into nerve ending where tyrosine converts into Dopa with the help of Tyrosine Hydroxylase enzyme.The Dopa then converted into Dopamine by an enzyme which is called Dopa decarboxylase enzyme.The Dopamine then Stored in the vesicles if not stored the dopamine is destroyed in the cytosol by MAO(Monoamine oxidase) enzyme so that’s why they are stored in the vesicles.In the vesicle, the dopamine converts into Norepinephrine if the neuron is adrenergic but if the neuron is dopaminergic the dopamine inside the vesicle will and store and will release as such.Here the neuron is adrenergic so the Norepinephrine will release in the nerve ending.
》Now the Ca+ Channels will open intracellular Calcium Level will increase.
There is a protein on the wall of vesicles which is called synaptobrevin
And the other protein on the membrane of the neuron  i.e Syntaxin.
Whenever sympathetic nervous system release Norepinephrine some of the N.E work on presynaptic membrane (alpha 2 AR)and causes inhibition of the cyclic AMP and Increase outflux of potassium (k+) from the nerve ending which control the release of N.E

How Norepinephrine Release

Q)What Happens to N.E after Using?

》There is a special reuptake mechanism and unlike cholinergic system in which the acetylcholine is destroyed by acetylcholinesterase enzyme.But in this case, the N.E is reuptake to the cell.After Reuptake there is a 50 % chance for N.E to take back by vesicle or destroyed by MAO Enzyme.
》Small Amount of N.E is methylated by an enzyme COMPT Which cause methylation some very small amount of NE comes into General circulation.

Q)How Drugs Act On This Whole System?/ Autonomic Nervous System Pharmacology

Following are some of the drugs which work on this system and show their effects.

Sympatholytic Drugs/adrenergic antagonist:

These drugs work on the above system and reduce the release of Norepinephrine.

1)Methyl Tyrosine:(CH5-Tyrosine)

The mechanism of action of methyl tyrosine is same like that of tyrosine.This drug enters into the system just like tyrosine and will work/bind on methyl hydroxylase enzyme.The enzyme will not work properly and eventually less dopamine will produce so fewer N.E will produce Less N.E means adrenergic activity decreases so this drug is sympatholytic, or adrenergic antagonist.

2)Reserpine: 

This Drug Work On dopamine transporter on the vesicle and Don’t let dopamine to enter into the vesicle and we know that dopamine outside the vesicle will be destroyed by MAO enzyme.There will no or less N.vesicle.So after action potential, the Nerve ending will not release N.E because of empty vesicle.This drug is called resperine.

3)Bretylium & Guanadrel:

These drugs Don’t allow the vesicle to fuse with the membrane of neuron and don’t let the vesicle to expel N.E.So Less N.E release from the neve terminal.

4)Alpha Methyl Dopa:

This drug is taken up by the transport mechanism i same like tyrosine.It is going to fool the dopa. Dopa work/bind on this Drug (Alpha methyldopa) instead of dopa decarboxylase enzyme.The drug continuously fooling this system up to the end and in the end no N.E release but instead the nerve terminal release alpha methyl N.E. so When action potential generated alpha methyl norepinephrine will release into the synaptic cleft.

Note: These drugs decrease the activity of norepinephrine but by binding direct into the normal Mechanism.These drugs don’t work on receptor.

Drugs That Block the receptor:

These drugs are also called adrenergic receptor blockers/antagonist:
These drugs also decrease the effect of N.E but by blocking the receptor on which N.E act.

Adrenergic Receptor Blockers/Antagonists

Sources: Lippincott Illustrated Reviews Pharmacology

                     Doctor Najeeb Lectures.

We Will Discuss Sympathomimetic Drugs In The Upcoming Posts.Keep Sharing Our Contents.

Ten Key Points For Using Antibiotics Wisely in Hospitals

How to use antibioics in hospital

How to use antibiotics in hospital

1)Get appropriate microbiological samples before antibiotic administration & carefully interpret the results.

(2)Avoid the utilization of antibiotics to treat fever use them to treat infection & investigate the root cause of fever before starting treatment.

3)Start empirical antibiotic treatment after taking cultures,tailoring it to the site of infection ,risk factors for multidrug resistant bacterium, & the local microbiology and susceptibility patterns.

4)Prescribe drugs at the optimal dosing and for an approximate duration, adapted to each clinical situation and patient characteristics.

5)Use antibiotic combinations only where the current evidence suggests some benefits.

6)When possible avoid antibiotics with a higher likelihood of promoting drugs resistance or hospital acquired infections, or use them only as a last resort.

7)Drain the infected foci quickly and remove all potentially infected devices.

8)Always try to de-escalate antibiotic treatment according to clinical situation and microbiological results.

9)Stop unnecessarily prescribed antibiotics once the absence of infection is likely.

10)Don’t work alone
Setup local teams with infectious diseases  specialist,clinical microbiologist,hospital pharmacist, infection control practitioner and comply with hospital antibiotic policies and guidelines.

By : Marwa Elsayed .

Drug information Specialist PGCPD, Bsc .

Drug and Poison information Center .

References : Int J Antimicrobial Agents 2016 Sept ; 48(3) 239-46 ,doi:10.1016/j.ijantimicag.2016.06.015. Epub 2016 july 25.

World’s Oldest Surgeon Who Performed 10,000 Operations

World Oldest Surgeon

Facts:

Name : Alla Ilyinichna Levushkina

Age: 89 years Old

Height: 4ft 9in

Nationality: Russian

Total Operations:10,000+

Daily Operations: 4 Daily

She is now considered one of the World’s oldest surgeon. She has performed more than 10,000 surgeries in her life But Her Hands are very stable. During part of her time serving as operating surgeon, she flew round the Russian geographical region for thirty years, treating patients living in far-flung areas of the country.A few years back she came back to her town of Ryazan, close to Moscow, and has worked at town Hospital since.And The intresting Thing Is That She Is Single and She Is Living In Apartment With Her Disable Nephew And 8 Cats .

However, medicine isn’t invariably wherever she saw her career going – she originally wished to be a geologist, reports Russian newspaper Kommersant. But she was impressed to become a doctor after reading a novel regarding doctors and went on to study at the moscow Medical Institute. Alla Specialty Is In proctology, a field of medicine that deals with bowel and rectal problems.

She said: ‘I work and everything. I even have nothing to do in retirement. Doctor – it’s not simply a profession it’s a way of life. Why else would the Dr. live, if not to work?’ I work because it’s fascinating to me, and additionally because i prefer to win. I like to help individuals accomplish remissions.‘There are people I saved a few years ago when no one else wanted to perform an operation on them. and i did that and that they are still alive and have grown up kids.’

Alla is happy with her track record – zero fatalities – and is living her childhood dream.In honour of her loyalty to the profession, Alla was recently awarded the prize for the most effective doctor in Russia.

 

6 Strangest Medical Conditions

You All Have Heard Of Crazy Disease Like Ebola,And Swine Flu That Have Been Known To Spread Like Fire.But What About Those Rare ,Extreme And Strangest Medical Conditions.Of  Thousands Of Medical Conditions We Picked Top 6 Strangest Medical Conditions .

(1)The Bark Skin Disease:

Epidermodysplasia Verruciformis(EV) is additionally named as Lewandowsky-Lutz dysplasia and “Tree Man illness,” this can be a awfully rare hereditary genetic disease.  It causes widespread HPV (Human papillomavirus) that produces tumors and lesions, which may resemble warts, across the victim’s body. they’ll be reddish-brown in color and are most typically found on the trunk, hands, extremities (both upper and lower) and face. they have been named as “bark like” growths.  Malignant tumors (carcinomas) develop on areas of the skin that are exposed to daylight, largely when the victim is between 20 and 40 years of age.

The growths are usually caused as a result of an impaired immune reaction to warts and similar growths.

(2)Progeria:

Progeria, additionally referred to as Hutchinson-Gilford progeria syndrome (HGPS), could be a rare genetic condition that causes a child’s body to age quick. most children with progeria don’t live past the age of thirteen. The disease affects both sexes and all races equally. It affects regarding one in every 4 million births worldwide. Approximately 350-400 people have progeria around the world.

Causes: 90 % of kids with progeria have a mutation on the gene that encodes for lamin A, a protein that holds the nucleus of the cell together.This protein is additionally called progerin.

(3)Haemolacria:

Haemolacria refers to the presence of blood within the tears. Concentrations can be so low that it may only be detected with laboratory testing, or the affected person may additionally appear to be bleeding from the eyes because of the high blood content material. It usually appears as a symptom of ailment, although it can additionally increase spontaneously in a few cases, mainly in fertile girls. studies shows that some girls produce some blood in their tears in reference to the hormone cycle, and may be blind to it due to the fact best lines are gift.

Causes:

1)Systemic Infections Associated With Bloody Tear.

2)Hemorrhagic fevers like Ebola cause Blood Vessels to burst, leading to leaks throughout the body.

3)Injuries to the eye can lead to haemolacria, as the eye or surrounding area may leak blood that mixes with the tears.

4)Tumors and other Lession inside the eye and near the tear ducts are another possible cause.

5)Researchers theorize it may be associated with extreme stress or psychological upset in these instances.

(4)Hypertrichosis:

This is a Rare  medical condition in which there’s excessive hair growth in areas that commonly don’t have hair. it’s generally referred to as the werewolf syndrome or Ambras syndrome.It can happen to any anyone despite age, gender, or race.

Causes:Unknown

(5)Proteus syndrome:

Proteus syndrome, additionally called Wiedemann syndrome (named when the German paediatrician Hans-Rudolf Wiedemann), could be a rare congenital defect that causes  overgrowth Of Different Tissues Of The Body  and atypical bone development, typically accompanied by tumors over half the body. Only 200 cases have been confirmed worldwide, with estimates that about 120 people are currently alive with the condition .

Causes: Proteus syndrome is caused by a mutation during a growth regulatory gene known as AKT1 that happens after fertilization of the embryo (somatic mutation)

(6)Hyperdontia:

Hyperdontia is an oral condition characterised by having an excess range of teeth. normal|the quality} range of primary teeth is 20 and also the standard range of permanent teeth is 32. Primary teeth are the primary set of teeth that erupt in a person’s mouth, usually by the age of 36 months, and are shed by the time the person is regarding 12 years old. Permanent teeth then take the place of the primary teeth and are sometimes absolutely erupted by the time the person reaches twenty one years older. an individual who develops more than twenty primary teeth or over 32 permanent teeth has hyperdontia. the extra teeth are observed as supernumerary teeth.

Cause: hereditary factors.

Pharmacology Mnemonics

First And Most important Thing Is What are Mnemonics And why We Use It ? Basically mnemonics are the techniques and methods that help recall and easily memorise you Large peice of information,in the form of lists ,steps ,stages and memorable words etc.

How to make Mnemonics ?

Making mnemonic is not a difficult task infact its  very easy to make mnemonics.First of all try to Pick every first word of uses or side effects etc combine that words in such a way to make a new and memorable word that is easily understandable .

Following are some of the Pharmacology Mnemonics /Pharmacology made easy Which Will help you In exams .

Pharmacology Mnemonics / Pharmacology made easy

1)Antidiarrheal Drugs

Remember (A  COOBRA)

A.Alpha 2 Agonist (Clonidine)
A.Absorbent Kaolin and Pectin)
C.Charcoal :Physically acting agent
O.Octreotide:Somatostatin
O.Opioid Agonist : Diphenoxylate +Loperamide+Diphenoxin
B.Bismuth Compound :Bismuth subsalicylate
R.Resin (Bile Acid Binding Resin):Cholesttramine
A.anticholinergic :Propatheline +Atropine

2)Migraine : Treatment Drugs

Remember This Sentence And Pick Every First Word

Pharmacotherapeutic Agents are Very Volatile  For Migraine Prophylaxis”:

P:  Pizotifen
A:  Amitriptyline
V:  Verapamil
V:  Valproic acid
F:  Flunarizine
M: Methysergide
P: Propranolol

3)Asthma Treatment

Don’t Forget ASTHMAA

A.Albuterol And Terbutaline
S.Salmeterol And Formoterol
S.Steroids:Beclomethasone
T.Theophyline  (Methylxanthines)
H.Histamine Release Blockers like Cromolyn
M.Muscarinic Antagonist ; Ipratropium
A.Antileukotrienes Like Montelukast etc
A.Anti IgE Like Omalizumab

 

4) Beneficial effects of inhibition of prostaglandin synthesis i.e. paracetamol and NSAIDs

Just Don’t Forget  (5 A’s)

A: Analgesia
A: Antipyretic
A: Anti-inflammatory
A: Antithrombotic
A: Arteriosus (NSAIDs for closure of patent ductus arteriosus)
5) RTI: drugs to treat viral respiratory infections “
Remember
RAO:
R: Rimantadine
A: Amantadine
O: Oseltamivir

6)Medication administration: short checklist TRAMP:

Before dispensing medication, ensure have correct:
T: Time
R: Route
A: Amount
M: Medication
P: Patient

7)Drugs that increase warfarin (O DEVICES)

O: Omeprazole
D: Disulfiram
E: Erythromycin
V: Valproate
I: Isoniazid
C: Ciprofloxacin and Cimetidine
E: Ethanol (acutely)
S: Sulphonamides
8)Drugs that decrease the effectiveness of warfarin (BRAS PC)
B: Barbiturates
R: Rifampicin
A: Alcohol (chronic use)
S: Sulphonylureas
P: Phenytoin
C: Carbamazepine

9)Cocaine: cardiovascular effect COcaine causes blood
vessels to
COnstrict (other local anesthetics which cause vasodilation).

10)Carbamazepine : Indications CBZ:
C: Cranial Nerve V (trigeminal) neuralgia
B: Bipolar disorder
Z: Zeisures (Seizures)

11)Sulfonamides: common characteristics SULFA:

S: Steven-Johnson syndrome/ Skin rash / Solubility low
U: Urine precipitation/ Useful for UTI
L: Large spectrum (gram positives and negatives)
F: Folic acids synthesis blocker (as well as synthesis of nucleic acids)
A: Analog of PABA
12)Tricyclic antidipressents (TCA): side effects 

Remember CAT”S

C: Cardiac (arrhythmia, MI, stroke)
A: Anticholinergic (tachycardia, urinary retention, etc)
T: Thrombocytopenia
S: Seizures
13)Bacteriocidal Antibiotics :

Remember this sentence

Penicillins & Cephalosporins Are Very Cidal For Microbes 
P.Penicillins
C.Cephalosporins
A.Aminoglycoside
V.Vancomycin
F.Fluoroquinolones
M.Metronidazole

14)Peptic Ulcer Treatment

PEPTIC ULCER

P.Proton Pump inhibitors like omeprazole,eso,lansoprazole
E.E1 Analogues like misoprostol
P.Pathogen (H.Pylori)Eradicators Like Metronidazole,Amoxicillin And Tetracycline etc
T.Tidine (H2 Blockers) Like Ranitidine ,Famotidine and Nizatidine
I.Intestinal Antacids Like Mg(OH)2NAHCO3 And Al(OH)3CACO3
C.Cholinergic Antagonist Like Pirenzipine
C.Colliodal Bismut And Sucralfate .

15) Vitamin B3 Deficiency

Pellagra

3D of pellagra

D.Dementia
D.Dermatits
D.Diarhea

16) Supra ventricular Tachycardia Treatment

Remember ABCDE
A.Adenosine
B.Beta Blockers
C.Calcium channel Blockers
D.Digoxin
E.Excitation (Vagal Stimulation)

17)Drugs Used In Gout:

Remember GOUT

G.Glucocorticoids Or NSAIDs
O.Oxidase Inhibitors :Allopurinol
U.Uricosurics :Probencid
T.Tubulin (Microtubules)Inhibitors:Colchicine

18)Anti TB Drugs

First Line Drugs

Remember RIPE
R.Rifampicin
I.Isoniazid
P.Pyrazinamide
E.Ethambutol
19) Quinolone & Fluoroquinolones Drugs

Remember (N  COLM)

N.Nalidix acid
C.Ciprofloxacin
O.Ofloxacin
L.Levofloxacin
M.Moxifloxacin
20) Side Effects of Beta Blockers

Remember All agents of this group End With OLOL

CHF
GIT Disturbances
Bradycardia
Depression
Lethargy
21) Calcium Channel Blockers
Remember
Very Nice Drugs
V.Verapamil
N.Nifedepine
D.Diltiazem

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Pharma Chapter 2 :Routes of drug administration:

Routes of drug administration

Routes of drug administration

Routes of drugs administration are the strategies that are used to administer a specific drug to a patient.They are divided into 2 main types.

1)Enteral

2)Parenteral

Enteral Routes:

Administration of drugs through the gastro intestinal tract is known as enteral route of administration.it is further divided into 3 varieties.

1)Oral

2)Sublingual

3)Rectal

(A)ORAL ROUTE:

In This method the drug is taken within the mouth so enclosed,usually with the help of some water or alternative fluid.

Benefits:

1)It is convenient.

2)it is generaly economical as compared to other routes

3)This is the most typically used method of drug administration.

Limitations/Drawbacks:

1)Some drugs are not absorbed within the git,For example gentamicin,or streptomycin.Due to which its tough to administer in oral dosage type.

2)This method needs cooperation of patient.

3)Some drugs are destroyed by digestive enzymes of stomach or intenstine e.g benzyl penicillin and insullin.

4)Vomiting may occur due to unhealthy style,smell or iritant effect of the drug on the gastric mucous membrane.example are aspirin and indomethacin, which cause irrition of the stomach mucous membrane while castor oil has bad smell and quinine has bitter taste.

5)Food reduce absorption of some medicine e.g iron and tetracycline.while sure medication absorption is increased by food.e.g Griseofulvin.

6)Certain Drugs could inhibits the motility of stomach and intestine e.g opiods and antimuscarinics.thus they will delay their own absorption which of alternative medication given long with them.

7)When two or a lot of medication are given together,they can interfer with the absorption of one another.calcium, aluminium,magnesium,and iron can decrease the absorption of tetracyclines,because they react with chemicals to form insoluble salts.

8)First pass metabolism occur in oral route due to which only a part of drug could reach into the circulation.e.g oral administration of propranolol may cause metabolism of 70th of medication by first pass metabolism and so only 30 minutes of drug reached the circulation.

(B)SUBLINGUAL ROUTE:
Some drus with high lipid solubility can be chewed and then kept under the tongue.this is causes rapid absorption of drugs from the sublingual and other blood vessels of the oral mucosa.thus a quick effect of the drug will be produced.Following Drugs can be used by sublingual route.
1)Ergotamine
2)Nitroglycerin
3)Nifedipine

ADVANTAGES/BENEFITS:
1)Patient can use the drug himself with out assistance.
2)It is economical.
3)Administration of drug by this route produces a rapid effect because it is quickly absorbed into systemic circulation.
4)As the drug join the systemic circulation directly ,first pass effect does not occur.
5)The effect of the drug given by sublingual route can be terminated by spitting the tablet or swallowing it.

LIMITATIONS/DISADVANTAGES:
1)We can’t use this method in a person suffering from nausea.
2)Cooperation of patient is essential.
3)Drug can cause irritation of the mucosa with excessive saliva formation,and thus its swallowing can occur .This will prevent aim of sublingual administration.
4)We Can’t give it to an unconscious person.

(C)RECTAL ROUTE:
Administration of All form of Drugs into the rectum is known as Rectal route while of the dosage form is solid it is called suppository,while if this is liquid then it is called enema.Rectal Route can be used for both local and systemic administration.
E.g Indomethacin a pain relieving drug, can be used in the form of suppository to produce systemic effect.while corticosteroids can be used locally into the rectum for its inflamatory conditions.
About 50% of drug administered from rectal route is absorbed into portal circulation,and other 50% is absorbed into the systemic circulation.

ADVATAGES/BENEFITS:
1.This can be use in unconcious person
2.This also can be used in uncooperative child.
3.Those who are suffering from nausea can take take drugs through this route.
4.Those drugs which cause irritation of the stomach can be given through this route .e.g Aminophylline and indomethacine

LIMITATIONS:
1.Some people are embarrased to use this route.
2.Drugs absorbed into portal circulation can undergo fiest pass.
3.It requires the cooperation of a concious person.
4.Absorption of drug can be unpredictable through this route.
5.Repeated use of this route can cause irritation of rectal mucosa.

(2)PARENTERAL ROUTES:

Par means besides,Renteral means gastrointestinal tract.So Administration of drugs by routes other then enteral routes are known as parenteral routes.Most often ,the term parenteral is used when a drug is given by intravenous(IV),intramuscular(IM),subcutaneous(SC) injection.Here we will use the term parenteral for any route of drug administration other than enteral (From GIT).It Can be further divided into the following three Types:
1.Injection
2.inhalation
3.Topical

1)INJECTIONS:
Here the drug is administered with the help of a special instrument know as a syringe or by an infusion apparatus.The following types of injections are commonly employed.
1.intravenous (IV)
2.intramuscular(IM)
3.Subcutaneous (SC)
4.Intradermal
5.Intrathecal
6.intra-articular

Intravenous Route:
The drug is injected into a peripheral vein.Effects of the drugs may occur immediately .intravenous administration of a drug can be done bu two methods.
A)Bolus
B)infusion
Bolus:In this method injection is made into a vein with the help a syringe,
Infusion: infusion is done with the help of an infusion apparatus.Drugs With Short Duration of action can be given by intravenous infusion.e.g Dopamine,dobutamine etc.Similarly large quantities of fluid can also be given by intravenous infusion. Eg Normal Saline or dextrose solution etc.

Advantages:
1.It is highly effective and reliable route of drug administration.
2.A large volume of drug can be given by this method.
3.Effects of the drugs occur rapidly; this route is often used in emergency conditions.
4.An irritant Drug can be injected by this route the drug will be imediately diluted by the blood,and thus its irritant effect is reduced.
5.Rate of IV infusion of the drug can be controlled according to the response of the patient.Sodium nitroprusside can be given intravenous infusion for sever hupertension,and the rate of infusion can be adjusted according to the blood pressure of the patient.

LIMITATIONS:
1.This Reguire the help of a trained person,who is familiar with technique.
2.Proper asceptic precautionhave to be observed during the procedure.
3.This method is often expensive
4.some drugs can cause irritation of the vien wall and thrombophelbitis e.g diazepam.
5.The drug is directly administered into the systemic circulation thats why serious adverse effects can occur.Hence injection should be given slowly,and response of the patient should be carefully monitored.if the ADR occur asministeration of the drug should be immediately stpped.

INTRAMUSCULAR ROUTE:
In this method the drug is directly injected into a  skeletal muscle with the help of a syringe.Commonly injection is made into one of the following skeletoal muscle;
1.Vastus lateralis
2.Gluteus maximus
3.Deltoid
Absortion of drug is more feom deltoid and vastus lateralis than from Gluteus maximus due to better blood supply of the former two skeletal muscles,Drugs in aqueous solutions are more rapidly absorbed than those in oily solutions.Action of some drugs can be prolonged by combining them with some other substances e.g the effect of penicillin can be prolonged by combining it with procaine.This will cause slow absorption of penicillin from the site of injection.Thus intramuscular injection of procaine penicillin is effective for about 24 hours.intramuscular injection of oily solutionof penicillin will also prolonged its effects due to slow absorption of the drugs from the site of injection.

Benefits/Advantages:
1.This is reliable route ,liquid preparation produce their effects in 10-30 minutes.
2.certain depot preparations can be used by this route that are effective for a prolonged period.1 intramuscular injec of medroxyprogesterone may act as contraceptivr for about three months.One intramuscular injection of benzathine penicillin may be effective for about 1 month.
3.Rate of absorption of drug is more rapid as compared to the subcutaneous route.

Limitations:
1.A person trained for the technique is required for injection.
2.Only a limited amount of drug can be used by this route.
3.some drugs may cauee irritation of skeletol muscles,eg penicillin may cause pain when administered through an intramuscular injection.
4.If ADR (Adverse drug reactions)occur after its administration it can’t be removed from the site of injection.
5.Proper aseptic precautions are essential during the procedure.

Subcutaneous Route:
Drug is inected under the skin with a syringe.absorption of drug is slow in this method as compare to intramuscular route.
Advantages:
1.It is reliable route.
2.Self injection is possible.
Disadvantes:
1.Drug may cause irritation of the subcutaneous tissue.
2.Poor absorption of drug occurs in peripheral circulatory failure.
3.Poor absorption.

2)INHALATION:
Drug is inhaled into the lungs and then its absorption occurs into the systemic circulation from alveoli.Drugs Can be inhaled by the following methods.

A)Powder inhalation:
Some drugs can be inhaled as a fine powder with the help of a special apparatus known as spinhaler.Sodium cromoglycate can be used by this method for the prevention of bronchial asthma.

B)Gas inhalation:Most of the general anaesthetics are available as a volatile liquids.Their inhalation causes rapid absorption of drugs into the blood circulation from the alveoli.There is a rapid distribution of drug from the blood into the brain .this causes loss of consciousness ,for example suh an effect is produced by halothane ,enflurane etc.

C)Aerosol Inhalation:
The drug particle in this method are suspended in a gas.Particle size of a drug is 2-5 micrometers.e.g Terbutaline,Salbutamol,Ipratropium,Corticosteroids etc can be used as aerosolfor the treatment of asthma.Drug particles are distributed uniformly in a gas that us present in a compressed form in a special appartus known as inhaler.Drug is used by inhalation from the inhaler.

ADVANTAGES:
1.Aerosoland powders affect the lungs,and they have minimum systemic effects.
2.General anaesthetic are rapidly absorbed from the lungs,and they are also excreted from the lungs,thus their administration can be easily controlled.
3.Nitrous oxide is a gas with good analgesic effect.though it does not produce full anaesthesia,it can be used by the patient himself during painful conditions e.g during labour.

DISADVANTAGES:
1.Patient may not be able to use the apparatus properly.
2.Drug can cause irritation of the bronchial tract.
3.A special Apparatus is required.
4.Obsteuction of the bronchial tree with mucous plugs may interfere with the effect of drug.

TOPICAL ROUTE:
Drug is applied locally on skin ,eye,ear,nose oral cavity urinary bladder,rectum and vigina.Drugs can be applied on the skin for local or systemic effects .eg nitroglycerin can be used in the form of an ointment or a sticking plaster on the skin to produce its systemic effects.

ADVANTAGES:
1.Patient can use it himself.
2.High local concentration of drug can be achieved usually without its systemic effects.

DISADVANTAGES:
1.Some drugs can cause allergic reaction e.g certain antimicrobials.
2.Systemic absorption of drugs can occur from the local site of application.This can produce adverse effects on various parts of the body like administration of atropine or beta blocker in the eye.use of corticosteroids on skin can cause sufficient absorptioninto the blood to produce their systemic effects.

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                     Routes Of Drug Administration

New Drugs Approved By FDA In 2016

Following are some of the New Drugs Approved By FDA , We Have Highlighted Drugs,Their Category,Indications,Month of Approval and Manufacturers.

New Drugs Approved By FDA In 2016

Drugs And CategoryIndications/UsesDate Of ApprovalManufacturer
Musculoskeletal:
a)Exondys 51 (eteplirsen)
b)Spinraza (nusinersen)
c)Zinbryta (daclizumab)
a)For the treatment of Duchenne muscular dystrophy with mutated DMD gene amenable to exon 51 skipping
b)For the treatment of spinal muscular atrophy
c) For the treatment of relapsing multiple sclerosis
a)Approved September 2016
b)Approved December 2016
c)Approved May 2016
a)Sarepta Therapeutics
b)Biogen;
c)Biogen
Nephrology:
a)Cabometyx (cabozantinib)
b)Lenvima (lenvatinib
c)Rayaldee (calcifediol)
a) For the treatment of advanced renal cell carcinoma
b)For the treatment of advanced renal cell carcinoma
c) For the treatment of secondary hyperparathyroidism in adults with stage 3 or 4 chronic kidney disease,
a) Approved April 2016
b) Approved May 2016
c)Approved June 2016
a)Exelixis
b)Eisai
c)Opko Health
Gastroenterology:
Zinplava (bezlotoxumab)
For the treatment of recurrent Clostridium difficile infection in patients receiving antibacterial treatment,Approved October 2016Merck
Genetic Disease:
Spinraza (nusinersen);
For the treatment of spinal muscular atrophy,Approved December 2016Biogen;
Hematology:
a)Afstyla (Antihemophilic Factor (Recombinant) Single Chain),
b)Idelvion (Coagulation Factor IX (Recombinant),Albumin Fusion Protein);
c)Kovaltry [Antihemophilic Factor (Recombinant)];
d)Opdivo (nivolumab);
e)Venclexta (venetoclax);
a)For the treatment of hemophillia A,
b)For the treatment of hemophilia B,
c)For the treatment of hemophillia A
d) For the treatment of classical Hodgkin lymphoma
e)For the treatment of chronic lymphocytic leukemia with 17p deletion
a)Approved May 2016
b)Approved March 2016
c)Approved March 2016
d)Approved May 2016
e)Approved April 2016
a) CSL Behring
b)CSL Behring;
c)Bayer
d)Bristol-Myers Squibb;
e)AbbVie
Hepatology (Liver, Pancreatic, Gall Bladder):
a)Defitelio (defibrotide sodium);
b)Ocaliva (obeticholic acid);
c)Vemlidy (tenofovir alafenamide);
d)Zepatier (elbasvir and grazoprevir)
a)For the treatment of hepatic veno-occlusive disease with renal or pulmonary dysfunction following HSC
b) For the treatment of primary biliary cholangitis
c)For the treatment of chronic hepatitis B
d)For the treatment of chronic HCV genotypes 1 or 4
a)Approved March 2016
b)Approved May 2016
c)Approved November 2016
d) Approved January 2016
a) Jazz Pharmaceuticals
b)Intercept Pharmaceuticals
c)Gilead Sciences
d)Merck;
Immunology:
a)Afstyla (Antihemophilic Factor(Recombinant), Single Chain); CSL
b)Descovy (emtricitabine and tenofovir alafenamide);
c)Epclusa (sofosbuvir and velpatasvir) ;
d)Odefsey (emtricitabine, rilpivirine, and tenofovir alafenamide);
e)Taltz (ixekizumab)
f)Vaxchora (Cholera Vaccine, Live, Oral);
a)For the treatment of hemophillia A,
b)For the treatment of HIV-1 infection,
c) For the treatment of hepatitis C,
d) For the treatment of HIV-1 as initial therapy,
e)For the treatment of plaque psoriasis,
f) For active immunization against Cholera,
a)Approved May 2016
b)Approved April 2016
c)Approved June 2016
d)Approved March 2016
e)Approved March 2016
f)Approved June 2016
a)CSLBehring;
b)Gilead Sciences
c)Gilead Sciences;
d)Gilead Sciences
e)Eli Lilly;
f)PaxVax;
Infections and Infectious Diseases:
a)Anthim (obiltoxaximab);
b)Descovy (emtricitabine and tenofovir alafenamide)
c)Epclusa (sofosbuvir and velpatasvir)
d)Odefsey (emtricitabine, rilpivirine, and tenofovir alafenamide)
e)Vemlidy (tenofovir alafenamide)
f)Zepatier (elbasvir and grazoprevir)
g)Zinplava (bezlotoxumab)
a)For the treatment of inhalational anthrax
b)For the treatment of HIV-1 infection
c)For the treatment of hepatitis C
d)For the treatment of HIV-1 as initial therapy
e)For the treatment of chronic hepatitis B
f)For the treatment of chronic HCV genotypes 1 or 4
g)For the treatment of recurrent Clostridium difficile infection in patients receiving antibacterial treatment
a)Approved March 2016
b)Approved April 2016
c)Approved June 2016
d)Approved March 2016
e)Approved November 2016
f) Approved January 2016
g)Approved October 2016
a)Elusys Therapeutics
b)Gilead
c)Gilead Sciences
d)Gilead Sciences
e)Gilead Sciences
f)Merck
g)Merck
Cardiology/Vascular Disease:
a)Byvalson (nebivolol and valsartan);

b)Yosprala (aspirin and omeprazole);
a)For the treatment of hypertension
b)For the prevention of cardiovascular and cerebrovascular events
a)Approved June 2016
b)Approved September 2016
a)Allergan
b)Aralez Pharmaceuticals
Family Medicine:
a)Byvalson (nebivolol and valsartan)
b)Onzetra Xsail (sumatriptan nasal powder)
c)Soliqua 100/33 (insulin glargine and lixisenatide injection)
d)Xultophy 100/3.6 (insulin degludec and liraglutide injection)
a)For the treatment of hypertension
b)For the treatment of migraine
c)For the treatment of inadequately controlled type II diabetes,
d)For the treatment of inadequately controlled type II diabetes
a)Approved June 2016
b)Approved January 2016
c)Approved November 2016
d) Approved November 2016
a)Allergan
b)Avanir
c)Sanofi Aventis
d)Novo Nordisk;
Vaccines :
Vaxchora (Used Against Cholera, Live, Oral)
For active immunization against Cholera,Approved by FDA in June 2016PaxVax
Pulmonary/Respiratory Diseases:
a)Bevespi Aerosphere (glycopyrrolate and formoterol fumarate)
b)Cinqair (reslizumab)
c)Tecentriq (atezolizumab)
a)For the treatment of chronic obstructive
pulmonary disease
b)For the treatment of severe asthma,
c)For the treatment of urothelial carcinoma and metastatic non-small cell lung cancer,
a)Approved April 2016
b)Approved March 2016
c)Approved May 2016
a)AstraZeneca
b)Teva Pharmaceuticals
c)Genentech
Neurology:
a)Briviact (brivaracetam)
b)Carnexiv (carbamazepine)
c)Exondys 51 (eteplirsen)
d)Nuplazid (pimavanserin)
e)Onzetra Xsail (sumatriptan nasal powder)
f)Spinraza (nusinersen)
g)Troxyca ER (oxycodone + naltrexone)
h)Zinbryta (daclizumab)
a) For the treatment of partial onset seizures related to epilepsy,
b)replacement therapy when oral administration is not feasible, in adults with seizures,
c)For the treatment of Duchenne muscular dystrophy with mutated DMD gene amenable to exon 51 skipping
d)For the treatment of hallucinations and delusions associated with Parkinson’s disease,
e)For the treatment of migraine
f)For the treatment of spinal muscular atrophy
g)For the management of severe pain
h) For the treatment of relapsing multiple sclerosis
a)Approved February 2016
b)Approved October 2016
c)Approved September 2016
d)Approved April 2016
e)Approved January 2016
f)Approved December 2016
g)Approved August 2016
h)Approved May 2016
a)UCB
b)Lundbeck
c)Sarepta Therapeutics
d)Acadia Pharmaceuticals
e)Avanir;
f)Biogen
g)Pfizer;
h) Biogen
Obstetrics/Gynecology (Women’s Health):
a)Intrarosa (prasterone vaginal inser t)
b)Rubraca (rucaparib)
a)For the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy, due to menopause
b) For the treatment of advanced ovarian cancer in women with deleterious germline or somatic BRCA mutation
a)Approved November 2016
b) Approved December 2016
a)Endoceutics
b)Clovis Oncology
Oncology:
a)Cabometyx (cabozantinib)
b)Keytruda (pembrolizumab)
c)Lartruvo (olaratumab)
d)Lenvima (lenvatinib)
e)Opdivo (nivolumab)
f)Opdivo (nivolumab)
g)Rubraca (rucaparib)
h)Sustol (granisetron)
i)Syndros (dronabinol oral solution)
j)Tecentriq (atezolizumab)
k)Venclexta (venetoclax)
a)For the treatment of advanced renal cell carcinoma
b)For the treatment of head and neck squamous cell cancer
c)For the treatment of soft tissue sarcoma
d)For the treatment of advanced renal cell carcinoma,
e)For the treatment of classical Hodgkin lymphoma
f)For the treatment of recurrent or metastatic squamous cell carcinoma of the head and neck,
g)For the treatment of advanced ovarian cancer in women with deleterious germline or somatic BRCA mutation,
h)For the prevention of chemotherapy-induced nausea and vomiting
i)For the treatment of anorexia associated with AIDS and nausea and vomiting associated with cancer chemotherapy
j) For the treatment of urothelial carcinoma and metastatic non-small cell lung cancer,
k)For the treatment of chronic lymphocytic leukemia with 17p deletion
a)Approved April 2016
b)Approved August 2016
c)Approved October 2016
d)Approved May 2016
e) Approved May 2016
f)Approved November 2016
g)Approved December 2016
h)Approved August 2016
i)Approved July 2016
j)Approved May 2016
k)Approved April 2016
a) Exelixis
b)Merck
c)Eli Lilly
d)Eisai
e)Bristol-Myers Squibb
f)Bristol-Myers Squibb
g)Clovis Oncology
h)Heron Therapeutics
i)Insys Therapeutics
j)Genentech
k) AbbVie
Ophthalmology:
a)Humira (adalimumab)
b)Xiidra (lifitegrast)
a)For the treatment of uveitis,
b)For the treatment of dry eye disease,
a)Approved July 2016
b)Approved July 2016
a)Abbvie
b)Shire
Pediatrics/Neonatology:
a)Exondys 51 (eteplirsen)
b)Kovaltry [Antihemophilic Factor (Recombinant)]
c)Spinraza (nusinersen)
a)For the treatment of Duchenne muscular dystrophy with mutated DMD gene amenable to exon 51 skipping
b)For the treatment of hemophillia A
c)For the treatment of spinal muscular atrophy
a)Approved September 2016
b)Approved March 2016
c)Approved December 2016
a)Sarepta Therapeutics
b)Bayer
c)Biogen;
Pharmacology/Toxicology:
a)Sustol (granisetron)
a)For the prevention of chemotherapy-induced nausea and vomitinga)Approved August 2016a)Heron Therapeutics
Psychiatry/Psychology:
a)Nuplazid (pimavanserin)
a)For the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis,a)Approved May 2016a)Acadia Pharmaceuticals
Endocrinology:
a)Adlyxin (lixisenatide)
b)Soliqua 100/33 (insulin glargine and lixisenatide injection)
c)Xultophy 100/3.6 (insulin degludec and liraglutide injection)
a)For the treatment of type II diabetes
b)For the treatment of inadequately controlled type II diabetes
c) For the treatment of inadequately controlled type II diabetes
a)Approved July 2016
b)Approved November 2016
c)Approved November 2016
a)Sanofi Aventis
b)Sanofi Aventis
c)Novo Nordisk
Urology:
Tecentriq (atezolizumab)
For the treatment of urothelial carcinoma and metastatic non-small cell lung cancApproved May 2016Genentech