RHEMATOID ARTHRITIS-PART-1

RHEUMATOID ARTHRITIS

Rheumatoid arthritis is an inflammatory chronic and systemic disease most apparently involved in the synovial joints. The inflammation can spread over extra-articular tendons and organ structures.

Criteria 

There are many criteria as follows:-

1.Morning Stiffness

Morning stiffness in any part of our body might have been experienced by somebody else especially at the knees or the feet. This may last for at least one hour.

2.Joints Swelling

At least three joints must have been experiencing swelling with fluid. The possible areas are the wrist, elbow, knee, ankle, and phalangeal (Hand and Feet Fingers) joints.

3.At least One Joint Area

At least one joint area in the hand such as the wrist, metacarpophalangeal(MCP), or proximal interphalangeal(PIP)

4.Symmetric

Simultaneous experience of arthritis in the bone joints at both sides of the body.

5.Subcutaneous Nodules(Rheumatoid nodules)

These nodules must be observed over bony prominences, extensor surfaces, or in juxta-articular regions by a physician.

6.Abnormal Presence Of Serum Rheumatoid Factor

It should be observed by a physician by any methodology

7.Radiological Changes

Bony erosions or decalcifications must be present in the hand or wrist x-ray.

Rheumatoid Arthritis (RA) is more common in women than men with a ratio of 3:1 respectively.

Occurrence

In general, the occurrence is rare (1 to 3%) in early ages, and medial at 30 to 40 years and more common at above 40 years. 

Etiological Factors

Although it is still not knowing the exact reasons yet the following might have been observed as the etiological factors.

1. A specific leukocyte antigen is often involving some inflammatory reaction if the individual is exposed to certain environment.75% whites have this antigen while 30% from the rest of the population is suffering from RA.

2. Some infectious diseases may also be as factors to precipitate RA.

Symptoms

1.Synovial swellings with inflammation, with fluid collection and edema. If left untreated the RA becomes chronic and the synovium becomes thick and boggy.

2. The thickened synovium grow inward across the cartilage results in cartilage degradation, loss of adjacent bone, and erosions.

3. The pain will produce by rub and press.

 

 

NEWS UPDATE-AGE NO BAR TO HIP SURGERY

AGE NO BAR FOR BONE SURGERIES

The news is very pleasant and induces hopes to the life expectancy of old aged people.

As the age increase the bones get weakened and more brittle.

Osteoporosis is more common in old aged people and is a hurdle to make a surgery to repair a broken hip in that age.

But now the news said regional anesthesia, better pain management, and implanting uncemented surgical parts make the procedure less risky.

There are two methods of hip repairs.1. Total hip replacement in which the whole hip bones and the ball are replaced.2.Hemiarthroplasty in which only the ball is replaced.

The first one is more complicated than the second one and holds more life expectancy.

Both can be possible at an old age but the most preferable one is hemiarthroplasty.

PART-IV-ECZEMA AND ITS CURE

ECZEMA-TREATMENTS

A medical E.Book regarding eczema and its remedies is now available for free of cost exclusively for the visitors of this blog.

The book is very useful and step by step illustrative about the causes and cure for eczema which is one of the mind throbbing skin infections of our life.

The informative book is very useful and can remain in your library of E.Book collections for reference at the time.

You can use this book to develop your fundamental medical knowledge regarding eczema and you can use this knowledge for giving presentations, delivering speeches, and debates in various medical events.

This book is very useful for medical and paramedical professionals, pharmacists, and those who are related to the medical and pharmaceutical trading and business.

To own your free copy please click the following image and follow the instructions. Thanking You.

 ECZEMA

PART-IX-CNS-STIMULANTS-Contd..-AMPHETAMINES

AMPHETAMINES

Amphetamines are central stimulants but they are frequently used as drugs of abuse. This we will see in a separate article in the other blog 'MAS PHARMACY AND HEALTH REVIEW'

Amphetamine is generally an equal mixture of the two enantiomers the Levo and dextro amphetamines

Further amphetamines are available in the market as follows:-

1.Methylamphetamine (Ritalin)

2.Methamphetamine (Methedrine or 'speed')

3.Dextroamphetamine (Dexedrine)

4.MDMA ('ecstasy')-Methylene Dioxy Meth Amphetamine

5.Bupropion

Amphetamines are chemically a derivative of the endogenous phenylethylamine.

Mechanism

Amphetamines are powerful central stimulants work by releasing norepinephrine and dopamine from their storage.

Physiology

Amphetamines by stimulating CNS through the release of catecholamines they mainly affect sleep centers of the hypothalamus which regulates the sleep cycles.

1. Amphetamine causes euphoria to the individuals who are addict to it. Euphoria is a kind of daydream or imagination of impossible thoughts associated with belief and confidence.

2. CNS stimulation reduces tiredness and fatigue, improves alertness, and cognitive ability.

3. Elevate B.P-Hypertension.

4.Elevate breathing

5. Blunts hungry.

6. Amphetamine is an aphrodisiac, a drug that stimulates sexual desire.

Clinical Use

1.To improve sleep disorders(Anti-Narcoleptic)

2.Attention Deficit Hyperactivity Disorders(ADHD) 

3.Appetite Control.

Route Of Administration

Oral

Metabolism and Kinetics

Amphetamine is well absorbed orally and 75 % is bioavailable in case of dextroamphetamine.

Amphetamine is a weak base with a pH of 9.9 and in the alkaline gut, it easily gets dissociated into the highly lipid-soluble free base and easily absorbed by the fatty gut villus.

15 to 40% are absorbed by the plasma proteins

Amphetamine is metabolized in the liver and excreted in the urine.

Amphetamine is eliminated by the body within two days of the last dosage taken.

Elimination is increased and the half-life is decreased by acid diets and vice versa.

Contraindication

Amphetamine should not be taken by those who are using MAOIs for their mobility disorders. Because MAO should not be inhibited any way if amphetamine is in usage as amphetamine is acting by releasing catecholamines from their stores which are metabolized by MAO. Inhibiting MAO will result in an excessive adrenergic crisis.

Adrenergic Crisis Treatments

Chlorpromazine a neuroleptic is the drug of choice to neutralize amphetamine poisoning as it effectively blocks the alpha-adrenergic receptors which are responsible for CNS disturbances and hypertension. 

PART-IX-CNS STIMULANTS-COFFEE AND SMOKING

CENTRAL STIMULANTS-COFFEE &SMOKING

CNS stimulants are drugs inducing increased motor activities, excitement, and decrease the feelings of tiredness.

1.METHYLXANTHINES

1.Caffeine

2.Theophylline

3.Theobromine

Theobromine is of little interest and it is mostly found in cocoa butter.

These drugs stimulate the CNS by a series of chemical and biological pathways involving an increase in cyclic guanosine monophosphate and cyclic adenosine monophosphate the two nucleotides which are increasing intracellular signaling to exhibit an increased motor activity and thereby stimulating the CNS.

Caffeine:-

 

The pharmacodynamical effects of caffeine are as follows:-

1. Centrally caffeine increases motor activity and alertness.

2.Heart and Bloodvessels-Caffeine increases heart rate (+chronotrophic) and contractility (+inotrophic)

3. Caffeine and its derivatives relax the smooth muscles of the bronchioles and dilate them to facilitate good ventilation. Hence drinking a cup of coffee would be beneficial during an attack of cold and asthma.

4. Caffeine is a weak diuretic and increases the excretion of sodium+,potassium+, and chloride-ions in the urine. Hence over a drink of coffee may lead to heavy loss of these ions.

5. Caffeine stimulates gastric secretions and thereby enhance acidity in the stomach. Hence care should be taken by those who suffer from peptic ulcers to avoid coffee drinks.

Side Effects

1.Insomnia

2.Agitation

3.Nausea and Vomiting

4.Convulsions

5.Cardiac Arrhythmias

Theophylline

 

Theophylline is already dealt with in detail in the post describes Asthma in this blog. Please refer to it.

2.NICOTINE

 

Physiology

Nicotine is having double action on the preganglionic receptors. Because of its specific actions at the preganglionic receptors the receptors are known as nicotinic receptors.

At low dosage it causes ganglionic stimulation by depolarization through acetylcholine. At high doses it causes ganglionic blockade.

At low dosage it causes arousal, relaxation, and improved attention through ganglionic stimulation.

At high doses it causes respiratory depression through medullary suppression through the ganglionic blockade.

Pharmacology

At Low Dose

Nicotine at a low dosage increases heart rate. constricting the blood vessels and thereby elevate B.P.

At High Dose:-

1. At a high dose, it slows the heart rate, dilates the blood vessels and thereby lower the B.P.

2. It causes many dysfunctions in our digestive system.

Nicotine increases acid secretions in the stomach and causes peptic and duodenum ulcers by impairing the secretions of sodium bicarbonate from the pancreas. 

Nicotine increases the stomach's susceptibility to H.pylori.

Nicotine weakens L.E.S.and thereby causes heartburn and G.E.R.D.

Nicotine causes the liver's ability to metabolize various toxic wastes and drugs ingested.

Nicotine causes Crohn's disease.

3. Nicotine causes severe urinary incontinence.

All the above effects are due to the ganglionic blockade of nicotine at high doses.

Clinical Uses

Fortunately nicotine has no therapeutic uses.

Kinetics

Nicotine is rapidly absorbed through the buccal mucosa, by inhalation, and by the skin.

Side Effects

1.Irritability

2.Tremors

3.Intestinal cramps

3.Diarrhea

4.Increased heart rate and B.P.

Withdrawal Symptoms For Addicts

1.Craving

2.Irritability

3.Restlessness

4.Anxiety

5.Stomach pain.

 

CNS DEPRESSANTS-PART-VIII-LOCAL ANESTHETICS

LOCAL ANESTHETICS

Local anesthetics are partial anesthetics that do not anesthetize the entire body. This is particularly useful for carrying out a surgical operation at a particular area of the body which can easily be desensitized without affecting the rest of the body. Also they are useful to reduce the pain impulses at an injured part of the body such as tooth pain.

TYPES OF LOCAL ANESTHETICS

In general there are two types of local anesthetics divided by their chemical structure. Structurally there are two portions in their molecule such as lipophilic (Affinity for fat) and hydrophilic (Affinity for water). There are two types of local anesthetics available determined by the bond linking the hydrophilic part to the lipophilic part.

They are either esters or amides

Esters

1.Cocaine

2.Benzocaine

3.Procaine

4.Tetracaine

Amides

1.Lidocaine (Xylocaine,or Lignocaine)

2.Mepivacaine

3.Bupivacaine

4.Prilocaine

Mechanism

Local anesthetics block the nerve conduction of pain impulses by inhibiting the voltage-gated sodium channels of the nerve cell membrane.

Small unmyelinated nerves that conduct pain,  heat, and autonomic activity are affected first.

With increasing concentration Pain fibers(A and C fibers) sensory(A-fibers) fibers followed by motor fibers(A-fibers) which are myelinated get affected.

Metabolism

Esters are more electrophilic and more rapidly metabolized by blood and tissue esterases and hence they have a shorter half-life and less toxic.

Amides are less electrophilic and slowly metabolized in the liver and hence they have a longer half-life and more toxic.

Clinical Indications

1.For surface anesthesia

2.Nerve blocks

3.Spinal and Epidural anesthesia

4. Lidocaine is also used as an antiarrhythmic systemically

With Epinephrine

To increase the duration of action of local anesthetics epinephrine is added which blocks the area to be anesthetized by vasoconstriction effects and thereby reduces the systemic absorption and enhances the local anesthetic actions.

Side Effects

1. Systemic effects will result in high doses and long time continuous use.

Cardiovascular effects like Depression of myocardial contraction(negative inotropic)

and hypotension.

But on the contrary cocaine causes systemic vasoconstriction and hypertension.

2.Lightheadedness(Headache)

3.Sensory disturbances

4.Convulsions

5. At high dose coma and death can occur.

CNS-PART-VII-ANESTHETICS-Contd...

ANESTHETICS-Contd...

DISSOCIATIVE AGENTS AND HALLUCINOGENS

These agents are employed as adjuncts with the inhalation agents to attain anesthesia rapidly. These agents are psychotic products and induce withdrawal symptoms, through hallucinations and delusions. They are usually given by I.V.routes.

1.PROPOFOL (Diprivan)

This drug is clinically used for the induction of anesthesia.

Pharmacology:-

This drug is very similar to the opioid thiopental as high-fat solubility. Hence it easily crosses the blood-brain barrier to produce ultrafast CNS effects. Higher affinity and readily distribute into highly vascularised tissues like the brain followed by rapid redistributing back into the blood. Hence its onset of action is ultra-fast with a short duration of action.

Benefits Over Thiopental

1. Ultra-fast in the induction of anesthesia similar to thiopental but recovery is very sooner than thiopental.

2.Less nausea and vomiting

3.No cumulative effect or delay in recovery even after a prolonged infusion.

Metabolism and Kinetics

Metabolized by liver-enzymes like CYP-450-2-B6 through glucuronidation and extrahepatic enzymes present in kidneys. The metabolism is very faster than that of thiopental. Usually the I.V. anesthetics are not eliminated through lungs. The metabolites are excreted in the urine.

Side Effects

1.Hypotension

2.Negative inotropic effects(Weaken the muscle contractions especially that of the heart)

3.The pain of injection.

KETAMINE

Ketamine because of the prominent cardiovascular support it is mostly used in relieving the patients from fear of surgery and radiotherapies and post-operative traumas.

It is very useful in relieving traumas of children during dressing changes of burns and radiological procedures.

Ketamine is a dissociative agent to produce anesthesia associated with catatonia, amnesia, and analgesia without actual loss of consciousness.

Pharmacology

Ketamine's cardiovascular support during anesthesia is accounted for by its sympathetic stimulant action. Ketamine causes an increase in catecholamine releases and thereby causes a series of sympathomimetic effects such as increased heart rate, B.P, and cardiac output.

Warning:-

Ketamine should not be given as an analgesic in patients with head injuries as it increases cerebral blood flow oxygen consumption and intracranial pressure.

Side Effects

1.Disorientation

2.Sensory and perceptual illusions

3.Vivid and unpleasant dreams.

The side effects can be minimized or nullified by the concomitant or 5 to 10 minutes prior administration of diazepam

Routes of Administration:-

1. Intra muscularly

2.Intra venously.