Sunday, February 7, 2010

Pharmacology...(Nota Dr Yasser n Panel Discussion)

Bismillah, Alhamdulillah diberi peluang lagi sekali untuk menghirup udara yg segar..



Hmm..insyaAllah kali ni saya cuba Tulis tentang
1. "Nota Dr Yasser" - yg sempat saya tulis masa lecture dia
2. "Panel Discussion Question" - masa ni ramai orang rak datang, lelaki ada la beberapa ketul je yg datang ..       Ni pun x dapat amik semua .. Mungkin masa ni kelaut jugak melayang...

Nota Dr Yasser
( Renin Angiotensin System )
                                                                                             --> Vasoconstriction
* Concept = Angiotensin II act on --> AT I receptor causing  --> Allow noradrenaline release
                                                                                              --> Release of aldosterone (impotant point)
                                                                                                * Bnyak lg tapi ini yg paling penting 
- Action of aldosterone is :-
  - Eliminate K+ and H+
  - Act at distal portion of distal convoluted tubules (For NaCl reabsorbtion)

* So kita kene la inihibit daripada process atas ni berlaku utk hypertensive patient
   - APa kene buat ??? ---> Bagi ACE Inhibitor

Contoh drugs :-
1. Captopril --> By acting on -SH group (can give sublingually)
2.  Enalapril --> By competition

* In comatous = Hypertensive Encephalopathy --> Give Captopril Sublingually

Case 1

Myocardiac infarction                                 
Heart Failure                  --> Give Drugs to    --> Dilate afferent (kidney)
Diabetic Nephropathy                                   -- > Dilate efferent 2x             *(To prevent albuminuria)

*Vascular Growth factor --> Can also dilate afferent and efferent nephron

Side Effect of ACE Inhibitor
1. Hyperkalaemia     --> Reduced by Diuretic (Thiazide or Loop Diuretic)
2. Cough                 
3. Brochospasm        --> Cough n Bronchospasm (Give ARBs)

Drugs Choice (Ni yang Mahal ni..)
1. Severe Hypertension  --> Captopril (sublingual) n Labetalol
2. Mild Hypertension + Pregnancy --> a-methyldopa
3. CHD --> ARBs , ACE I , carvedalol , metoprolol and Bisoprolol
                   ( minimize preload n afterload + prevent remodelling )

Drugs Contraindicated
1. Asthmatic Patient --> Avoid B-blocker and ACE I (But give Ca Channel Blocker)
2. Diabetic Patient ---> Avoid B-blocker and Diuretic (But give Ca channel blocker , ACE I or ARBs)
3. Heart Block --> Avoid B-blocker and Ca Channel blocker (But Give Nifedipine and Rennin Inhibitors)

Panel Discussion

1) How come "amiodarone" cause "Torsade de pointes"
    - Block K Channel + also another channel
* For Torsade de Pointes to happen (prolonged QT segment)
   - Ca channel is blocked --> effect electrical impulse

2) Lidocaine only effect ventricles --> Longer duration of depolarization

(Sorry lukisan buruk -pakai paint je lukis ni)

Ni la macam mana drug action on heart for angina

3) ACE I --> Prevent diabetic nephropathy = By dilates affent + dilates efferent nephron 2x

4) B-blocker in diabetic --> Patient will hypoglycemic (not aware)- as the sympathetic nerve is blocked

5) Diuretic --> minimize insulin in the body

6) B-blocker --> reset baroreceptor by
                           - First = Cold in extermities (Constrict B2)
                           - Decrease RAS

7) Cholestyramine --> increase VLDL = Increase bile salt synthesis ---> Increase VLDL (simultaneously)

8) Take BAS (Cholestyramine) + Anticoagulant --> Not Absorbed = Decrease anticoagulant

9) Digoxin --> Vagus like action --> slowing the AV conduction (use in dysrythmia)
     side effect :- (Increase in dosage)
            - Increase excitability to ventricular Muscles

9 ) Verapamil --> contraindicated in Ventricular Tachycardia (block Ca channel)

10) Patient with hepatotoxicity - we can give
          - BAS (cholestyramine)
          - Fibrates

Penambahan baikan .....

 

  
 (lukisan kedua utk hari ini)

Ok..Apa yg cik "Hamba" dan ustaz "afiq fahimy"

Torsades de pointes ni boleh disebabkan oleh
  • electrolyte disorders
    • hypokalemia
    • hypomagnesemia
    • hypocalcemia

    * Disebabkan QT segment ni melibatkan dua2 "Depolarization" and "Repolarization"
       - So, both calcium and potassium ni amik peranan dalam 'Torsades de pointes' ni terjadi...                
      - Kalau fikir2 balik kenapa xleh bg Verapamil pada patient yg ada Ventricular tachycardia ???
         (hehe, lu pikiq la sendiri...assalamualaikum)

Maka datanglah sesudah mereka, pengganti (yang jelek) yang menyia-nyiakan shalat dan memperturutkan hawa nafsunya, maka mereka kelak akan menemui kesesatan,
 
kecuali orang yang bertaubat, beriman dan beramal saleh, maka mereka itu akan masuk syurga dan tidak dianiaya (dirugikan) sedikitpun, yaitu syurga 'Adn yang telah dijanjikan oleh Tuhan Yang Maha Pemurah 

kepada hamba-hamba-Nya, sekalipun (syurga itu) tidak nampak. Sesungguhnya janji Allah itu pasti akan ditepati. 

(surah maryam ayat 59 -61) 


* sedikit perkongsian, memandangkan bidang medic ni "berat" dan kita tidak cukup masa utk mencari semua tentang agama..apa kata kita cari "ilmu agama" yang mencukupi utk menambahkan iman kita kepada ALLAH..


wallahu a'lam
-islahmujahidin-

9 comments:

hamba said...

salam

i think i should tell this
from what i have understood
to make it easier to be understood

amiodarone is the potent potassium channel blocking agent

but it also has another action which is CCB, beta blocking character, and also sodium channel blocker

Torsade De Pointes happened because of the prolongation of QT interval

prolongation of QT interval is caused by the sodium channel blocking acion as the same as Quinidine and Precainamide (potent sodium channel blocker)

-hanya sedikit pen'detail'an. mintak maap kalau penulis sudah pun tahu...
hanya menambah info sahaja..

islahmujahidin said...

yup..
betul tu..
sama r ..Tp ni dalam simplified note..

-mungkin diri sendiri faham, orang lain susah nak faham kot..

hehe :D

- syukran2...

::::aFiq FahiMy:::: said...

salam,ya syaatir..

nk menziarah..
sharing ilmu.. ;)
btw..nice post~

Kpd saudari hamba:

Sy xtau klu saudari tersalah taip,
cme sy ingin perbetulkan psal Torsades da pointes..

mmg btul Torsades adlh disbbkan prolongation of QT interval..
dan prolongation of QT will cause prolongation of AP duration..

tp..
QT interval prolongation adlh disbbkan potassium (K+) channel blocking action of quinidine..

Na channel blocking action will lead to prolongation of QRS complex..n smmgnya QT interval tu pnjg gak disbbkan prolongation of QRS complex..

tp dua tu berbeza..
Na channel blocking action akn prolong depolarization phase..

tp utk K channel blocking action akn sbbkan prolongation of repolarization phase (i.e:prolong RRP)...so,dgn prolongation RRP,membrane have more tendency to be depolarise prematurely..so,Torsades berlaku..

Sbb tu procainamide less likely to cause Torsades than quinidine..sbb less efffect on K channel..bknnya terletak pd Na channel blocking effect..sbb kedua-duanya sama..

Bg amidarone..
Rarely to cause Torsades sbb dia ade Ca channel blocking effect..so dia akn shortenkan AP duration yg diprolongkan oleh K channel blocking effect..
(i.e:mcm dia neutralisekan r)..
so,less tendency to cause Torsades..

Itu saja drpd saya..maaf,ya syaatir & saudari hamba..tulis pnjang sgt..tgh semangat study~hehe..

segala kesilpan drpd sy hrp diperbetulkan...waallahua'lam

Dr. Alex said...

cayalah syahmi..
ni aku sayang syahmi nih.
hehe.
mekasih syahmi.
semoga Allah merahmati kamu.
semoga kita semua berjaya di dunia dan di akhirat.
amin ya rabb.

islahmujahidin said...

Syukran Afiq n Yim ...

hamba said...

ok, terima kasih atas pembetulan

sorry sb bagi maklumat yg salah

need to struggle more...

islahmujahidin said...

Hmm..
sorry jugak ayat terabur + lukisan xlawa

Anonymous said...

thx la bro...
bnyak yg mmbantu,
coz slalu jam tym lecture prof yaser ni..haha

benludin azhar said...

salam...

terjumpa blog ni ketika google psal metoprolol 100mg..

boleh tau side effect drug ini? FYI saya peghidap darah tinggi. before this doc bg amlo 10 mg...tukar ke meto 100mg 2 ari lepas kes 'agina'

boleh tau side effect drug nih?

tq