digitalis

DIGITALIS

·         Digitalis acts in atrial fibrillation by:- Increase in AV node refractoriness.

·         Major electrophysiological effect of digitalis is: 1) hyperpolarization

                                                                                                   2) shortening of atrial action potential

                                                                                                   3) increase in AV node refractoriness.

·         Increase in AV node refractoriness is also responsive for termination of reentrant arrhythmias involving the AV node.

·         Inhibition of Na+  K+ ATPase is responsible for inotropic action of digitalis.

 

ANTIANDROGENS:- Danazol , Cyproterone acetate , Flutamide

ANTIESTROGEN:-Clomiphene citrate , Tamoxifen citrate

ANTIPROGESTINS:-Mifepristone (RU486)

 

Even in large dosages used in malaria, quinine does not cause toxicity because :-elevates plasma alpha1 acid glycoprotein .

About quinine:-

·         It is an erythrocytic schizontocide.

·         Used for t/t of multidrug resistant strains of P.falciparum

·         Associated with a triad of dose related toxicities-  a)cinchonism b)hypotension c)hypoglycemia

TIANEPTINE

·         5 HT1 uptake enhancer

·         Atypical  antidepressants

·         Neither sedative nor stimulant

·         Other atypical antidepressants are – trazodone , mianserin

classification of OVARIAN TUMOR

1.       EPITHELIAL

·         Serous

·         Mucinous

·         Endometrioid

·         Brenner

·         Mixed

2.       SEX CORD STROMAL

·         Granulose cell

·         Theca cell

·         Fibroma

·         Sertloli Leydig cell (androblastoma , arrhenoblastoma )

·         Gyandroblastoma

3.       GERM CELL

·         Dysgerminoma

·         Endodermal sinus tumor

·         Embryonal carcinoma

·         Poly embryoma

·         Chorio carcinoma

·         Teratoma

·         Struma ovary

·         Carcinoid

4.       GONADOBLASTOMA

5.       METASTATIC TUMOR

 

HENOCH SCHOLEIN PURPURA

  • purpura in Henoch scholein purpura is due to vasculitis and not due to thrombocytopenia.
  • small and medium sized vessels involved.
  • usally seen in children (infact it is the most common small vessel vasculitis in children ).
  • vasculitis is caused by immune complex deposition.
  • most common antibody seen in these immune complexes is IgA(IgA levels are elevated.)
  • platelet count is normal
  • sr complement level is normal
 

clinical pentad of TTP

  1. Microangiopathic Hemolytic Anemia (Coomb's negative) :- Haemolysis , Fragmentation of RBC's , Increased LDH (elevated due to intravascular hemolysis)
  2. Thrombocytopenia :- ( due to consumptions of platelets)
  3. Decreased renal function:-(due to deposits in the Renal Vasculature)
  4. Disturbed NEUROLOGICAL function:-characteristically diffuse and non focal eg-confusion,aphasia,alteration in consciousness
  5. Fever
 
 
 

Advantages of PRAZOSIN

Prazosin (selective a1 blocker)
Advantages:-
------------------
  • improved carbohydrate metabolism
  • symtomatic improvement in PVD and BPH
  • favorable effect on lipid profile
  • no impairment in cardiac contractility 

PROSTAGLANDINS and their use

· PGF2a (carboprost) ---- abortifacient , postpartum hemorrhage

· Latanoprost ----- glaucoma

· PGE2 (dinoprost) ----- induction of labour , abortifacient , bronchodilator , cervical ripening

· PGE1 (alprostadil) ---- to maintain patency of ductus arteriosus , intravenous injection for impotence

· PGE1 (misoprostol) ---- gastric peptic ulcer NSAID induced

· PGI2 (epoprostinol) ---- to avoid damage to platelets , primary pulmonary hypertension

Alkaline Phosphatase-importance in bone diseases

sources of Alkaline Phosphatase-
  • bone
  • intestine
  • liver
  • placenta
importance of alkaline phosphatase in bone disesese:
-----------------------------------------------------------------------------
  • Serum alkaline phosphatse is the most valuable enzyme for assessment of bone disesases and serves as index of osteoblastic activity.
  • Increased level of alkaline phosphatase are seen in-
                         a.Pagets diseases:-level of alkaline phosphatase are higher in Pagets disease than in any other condition. (excpt hereditary hypophosphatasia).
                         b.Hyperparathyroidism:-serum alkaline phosphatase may be raised depending upon degree of involvement of bone. 

ECG

Hyperkalemia
  • narrowing and peaking of T waves
  • AV conduction  delay
  • diminution of P waves
  • prolonged PR interval and widening of QRS interval
  • sine-wave pattern
Hypokalemia
  • flattening or inversion of T waves
  • prominent U waves
  • ST segment depression
  • prolonged QU  interval
  • severe hypokalemia-prolonged PR interval, decreased voltage and widening of QRS complex
Hypermagnesemia
  • changes similar to those of hyperkalemia
Hypomagnesemia
  • changes similar to those of hypokalemia
Hypercalcemia
  • shortening of QT interval
Hypocalcemia
  • prolongation of QT interval
Uraemia
  • changes similar to those of hypocalcemia in association with hyperkalemia
Hypothermia
  • prolongs repolarization, usually with a distinct convex elevation of the J point ( Osborn Wave)
Pericarditis
  • in acute phase , there is ST segment elevation with convexity upwards diffusely in all leads except aVR and there is no reciprocal ST depression.
Digitalis effect
  • the T wave is flattened at therapeutic levels and there is no reciprocal ST depression
SAH
  • marked QT prolongations with deep , wide T wave inversions  ( CVA-T wave pattern)
WPW syndrome
  • wide QRS , short PR interval and slurring of the initial part of the QRS (delta wave) 
Pulmonary thromboembolism
  • sinus tachycardia ( most common manifestation) , S wave in lead I , a Q wave in lead III and an inverted T wave in lead III ( S1 Q 3 T3)

IMMUNOSUPPRESSANTS

             Specific T cell inhibitor (calcineurin inhibitor)---

          cyclosporine , tacrolimus

             Cytotoxic drugs(antiproliferative drugs)---azathioprine , cyclophosphamide , methotrxate , chlorambucil , mycophenolate mofetil

             Glucocorticoids----prednisolone & others

             Antibodies----muromonab cd3 , antithymocyte globulin , rho Ig

             DRUGS CAUSING CHOLESTATIC JAUNDICE---chlorpropamide , erythromycin , rifampicin , amocillin , nitrofurantoin , methimazlole , ocp's , chlorpromazine , carbamezipine , nifedipine , verapamil

             IMP. ADVERSE EFFECTS OF ORAL HYPOGLYCEMICS-----hypersensitivity ( rashes , photosensitivity , agranulocytsis , cholestatic jaundice [ only by cholrpropamide] ) ; disulfiram like effect---chlorpropamide , not safe in pregnancy [sulfonylureas ] , secreted in mmilk

             DRUGS CAUSING HEMOLYSIS IN G6PD DEF----sulfonamides , nitrofurantoin , antimalarials eg- primaquine , chloramphenicol , cotrimoxazlole , dapsone , aspirin , phenacetin , probenicid

             ABOUT BROMOCRIPTINE------bromocriptie is a dopmine analogue which decrases prolactin release , it has greater affinity on D2 receptors , increase GH release in normal indivudals but decrease the same from pituitary tumor causing acromegaly , can be used in parkinsonism , stimulates dopaminergic receptors in ctz---therefore produces emesis