Allied Health Sciences

1. Allied Health Sciences Sample Slides

2. Dr. B. A. Joshi, M.D.(Med) D.Ped. M.B. • lisabjoshi@yahoo.comHighly dedicated physician with Private Practice and Hospital experience in Internal Medicine, Cardiology and Pediatrics; experienced as Medical Advisor to Law Firms and pharmaceutical companies and Teaching Experience in Private Capacity. Ex- Part-time teaching faculty in Northeastern University, Boston, U.S.A. I am involved in teaching for medical assistance, EKG technician, medical administration etc.

3. Medicine is ever changing Science. I urge you to confirm the information from other resources and refer to manufacturers recommendations for all dosages especially new drugs and those used infrequently.

4. Sample theory and rationales for MCQ from 45 teaching modules of all “Allied Health Science Courses”.

5. Blood Brain Barrier: • Protects brain from toxic substances • System is operating at the level of capillaries of brain and choroids plexus • Free passage to water and lipid soluble substances • Ionizable organic molecules are denied the passage • Blood brain barrier becomes less efficient in presence of inflammatory process e.g meningitis So Abt reach in brain but as in flammation subside BBB tends to be restored. • As that may happen while viable micro organisms persist in CSF –drug dosage should not be reduced till CSF is sterilized

6. Pharmacodynamics • Where drug acts • How drug acts • Synthesis of new compounds with more specific actions and fewer adverse reaction. • Structural Relationship • Activity • Atropine-Home atropine • Procaine-Procainamide • Chlorpromazine---Trifluroperazine • Nicotinic acid---nicotinamide

7. Pharmacodynamics • 1.Where drug acts • 2. How drug acts • Synthesis of new compounds with more specific actions and fewer adverse reaction. • Structural Relationship • Activity • Atropine-Home atropine • Procaine-Procainamide • Chlorpromazine---Trifluroperazine • Nicotinic acid---nicotinamide Ligand • ↓ Receptor • ↓ ↓ ↓ ↓ ↓ • Gated ion channels G-Protein Tyrosine Kinase Gunylate Cyclase Nuclear genetic • ↓ material • Adenyl cyclase cyclic AMP Phospholipase • C-inositoltriphosphate ↓ intracellular Ca increases

8. Drugs to be used with care in elderly: • NSAID • CNS depressant • Psychotropics • Antihypertensives-postural hypotension • Diuretics • Digoxin • Nephrotoxic

9. Drugs causing ototoxicity • Aminoglycosides • Macrolides • Loop diuretic • Antimalarial quinine,chloroquine • Anticancer drugs—Cisplatin,Bleo • Chelating agent------Desferrioxamine • Drugs known to cause dependence • Severe Psychic and physical dependence • Morphine • Alcohol,Barbituates,Benzodiazepines • Nicotine,Tobacco • -----Psychic Dependence • Cocaine,LSD,Hashish,Caffeine-coffee,tea

10. Effects Of Neurotransmitter Effects of Acetyl choline:- Cholinergic neurotransmitter acting on muscarnic and nicotinic receptor Muscarnic action: • It decreases hear rate and force of contraction. • It depresses conduction in SA node • It causes dilatation of blood vessel. • It contracts the smooth muscle of G.Itract,bronchial muscle and urinary bladder. • It causes constriction of pupil by miosis.-reduces intraocular tension. Spasm of accommodation. Also used in glaucoma—condition where increase intraocular pressure. • It increases secretion of bronchial,salivary,lacimal and gastric secrection • It increases sweating.-. • the increased bronchial secrection accompanied by bronchospasm causes cough.

11. Nicotinic action: • On autonomic ganglia.-Ach stimulate nicotinic receptor on autonomic ganglia-cauese release of Ach and Adrenaline from post ganglionic parasympathetic and Sympathetic nerve endings.----- resulting rise in blood pressure. Blocked by Hexamethonium,alpha bungarotoxin • It causes the contraction of Skeletal muscle at myoneural junction blocked by d-tuvocurarine , Decamethonium and succinyl choline

12. Atropine: • Anti cholinergic drug: • Plant atropa belladonna=plant alkaloid—Atropine and Hyscosine • organic ester of tropic acid • Competitive Muscarnic antagonist of Ach-All secretions are blocked-dryness of mouth • Reduced G.I secrection • Decreased secretions in nose bronchial • Sweating is reduced, hyperpyrexia • Difficulty in swallowing • it increases hear rate, tachycardia • It decrease motility and contraction of intestine-used as antispasmodic • it decrease urinary contractility so causes urinary retention • it produces mydriasis-increases intraocular pressure, relaxes cillary muscle-pupil dilated—it also produce cyclopegia-i.e can not see near object or in front of light-or called paralysis of accommodation • It relaxes smooth muscle of bronchial and G I tract. • it inhibits A-V block be of vagal activity • it is reducing secretion of rsp system-so as a pre anesthetic medication

13. Autonomic nervous system Autonomic nervous system is divided into two types. 1 Sympathetic: 2 Parasympathetic:

14. Respiratory Infections: • Common Respiratory microbial Pathogens: • Gram +ve Streptococcie pneumonia • Staphylococcus aureus • Enterococcus faecalis • Gram –ve E.Coli • Klebisella • Haemophilus Influenza • M.catatrall • Atypical Chlamydia pneumonia • Mycoplasma pneumonia • Legionella pneumonia • Anaerobes Clostridium perfinges • Bacteroids fragitis • Fusobacterium • Common Respiratory viruses: • Rhinoviruses-------- common cold • Corona virus -------- common cold • Respiratory Syncytial virus pneumonia • Adenoviruses common cold • Influenza A viruses influenza • Influenza B viruses influenza

15. Leukotriene modifiers • Zileuton • Dose: Single oral dose of 800 mg • Leukotriene Receptor mechanism • -----Zafirlucast Long acting • - Promiucast • Motelucast—Selective inhibitor of LTB4 Receptors • Notes: • Leukotirene Modifiers: • As mentioned earlier LTC4, D4, E4 produce critical elements of asthma. • Inhibition of 5-lipoxygenase enzyme • Useful in Aspirin induced Asthma • Allergic rhinitis • Exercise induced asthma • Cold air induced airway obstruction • Not meant to prescribe in acute attacks.

16. Dosage Regime:

17. Side Effects of Sympathomiometics 1.Metabolic -Increase in glucose, insulin, fatty acids -Decrease in potassium phosphate, calcium, magnesium2.Cardiac3.Arterial O24.Tremors5.Muscle Cramps

18. HIV / AIDS (Acquired Immune Deficiency Syndrome) • 36 million HIV +ve worldwide. • HIV is Retrovirus. • Its generic material is RNA instead of DNA. • Virus hides in cells for months or even years. • Incubation period on an average is about 10 years to cause AIDS. • Spread • Unprotected Sex. • Needles and Syringes of Infected person. • During pregnancy, birth and breast feeding. 25% Infected mothers transmit disease to new borne • Blood transfusions. • Risk to health care professionals. • Symptoms • Enlarge Lymph nodes. • Fatigue. • Pelvic Inflammation Disease. • Fever and Sweating. • Wight Loss. • Dementia. • Diagnosis • ELISA Test • Western Blot. • CD4 and CD8 count less than 200.or 14% less than total Lymphocytes. • Presence of opportunistic Infections.

19. Blood Group • A Rh +ve, Rh -ve • B Rh +ve, Rh -ve • AB Rh +ve, Rh –ve • O Rh +ve, Rh –ve

20. ADVANCED LIFE SUPPORT SYSTEM • Defibrillation – Synchronize defibrillation with R wave. • Ventilation • Drug therapy • Sodium bicarbonate 1meq/kg • If patient pulse less – • Defibrillate (200J) • If no response repeat at 360J • Start IV fluids • Ventilate with 100% oxygen • Intubate or bag mask • If pulseless continue chest compression • Epinephrine – 0.5 to 1mg IV or ETT can repeat after 3 to 6 minutes. • Lidocaine 1mg/kg bolus in two minutes. • Can repeat lidocaine bolus for ventricular tachy cardia. • Repeat defibrillation 360J • PH less than 7.15

21. Management of opportunistic infections in AIDS • Herpes - Acyclovir • fungal - AmphotericinB • Candidiasis - Fluconazole • CytomegaloVirus - Foscarnet • CytomegaloVirus of Eye - Gianclyvir • Kaposi Sarcoma - Interferon Afa2a2b • PneumoCytisCarini - Pentamedinie • Pneumonia - Trimethoprim Sulpha methoxazole

22. Urokinase • obtains from culture of human kidney cells. • Thromolysis in 60 – 90% • Within a period of 12 hrs. • Contra indication • Active bleeding • Recent C.V.A • Pregnancy • Recent surgery • Recent Trauma • Severe Uncontrolled hypertension 180/110 • Bleeding diathesis • Hemorrhagic Ophthalmic conditions • Reperfusion Arrhythmia.

23. ADENOSINE • *Supra ventricular Tachycardia. • *P.S.V.T. • *Naturally occurring nudeoside • *Inhibitors at A-V node. • *Rapid intravenous dose of 6 mg in 1-2 seconds, additional dose if necessary. • *Ultra short half life 10 seconds. • *Facial flushing. • *Is used in Pharmacological stress testing

24. DIABETES KETOACIDOSIS • *Hyperglycermia leads to glycosuria, volume depleption Tachycardia, Hypotension, kusumal respiration, acetone odor & metabolic acidosis. • *Both insulin def. And glycogen excess is necessary of DKA. • It results from: • *Increase hepatic glucose production (Gluconegenesis, and glycogenolylis) • *Impaired peripheral glucose utilization. • *Marked increase in free fatty acids from adipocytes resulting in ketone synthesis. • *Catacholamines favourss lipolysis and release of free fatty acids. • TREATMENT OF DKA. • *Confirm diagnosis (Glucose, Ketones, Metabolic acidosis) • *Assess 1). Electrolytes • 2). Acidbase status PH,HCO3, PCO2 • 3). Renal function. • *Replace fluids 2-3 litres 0.9% saline in 1-3 hours. • *10-20 units regular insulin • *10 units/hr by infusion. • *Measure onion gap (K, bicarbonate Phosphate) • *Replace K 10 meq/hr when urine output is 20 – 40 units/hr if K < 3.5 • *When blood sugar 250 mg & patient is conscious shift to SC insulin injection. • *Bicarbonate defi correction usually not necessary nor advisable.

25. INTERFERONS • INTERFERON • 3 or 5 million on alt. Days or daily depending on indication, protocol & combination used • INTERFERON B • INTERFERON • Action • Antiviral, antitumor acivity • Inhibits RNA & DNA viruses • Antiproliferative effect on normal and malignant cells • Suppresss antibody formation through effect on B lymphocytes • Inhibits onset of delayed hypersensitivity • Side effects • Flu-like syndrome • Myelosuppression, coma, MI • Nausea, vomiting • Hyper tension and hypotension • Arrhythmias, seizures, confusion • Taste disturbances • Thyroid, lupus and hemolytic anemia • Uses • Chronic hepatitis B, C, D andG: with or without antivirals like Ribavirin or Lamivudine • Condylomata acuminata • Kaposi’s sarcoma • CML, hairy cell leukemia, NHL, multiple myelomam, renal cell carcinoma

26. KEY WORDS - LOWEST PRIORITY • LEAST LIKELY • EXCEPT • INCORRCT • UNSAFE PRIORITY • IMMEDIATE • BEST • MOST • PRIORITY • INITIAL • VITAL • ESSENTIAL PLAN YOUR MCQ • ELIMINATION • KEY WORD • FOCUS ON PRIMARY ISSUE.

32. LEFT VENTRICAL FAILURE SIGNS ARE RALES,SHORTNESS OF BREATH,PAROXYMAL NOCTURENAL DYSPNEA. • RTSIDED FAILURE-----NECK VEINS, EDEMA DISTETION OF ABDOMENAND ENLRGE LIVER/ • COMBINATION OF SIGNS SUGGEST GLOBAL FAILURE. • BETA ADRENERGIC BLOCKERS WORK THROUGH ACTIONS OF ENDOGENIOUS NEURO HORMONAL SYSTEM. • 3 TYPES • 1THOSE THAT ARE RELATIVELY SELECTIVE TO BETA 1 RECEPTOR (METOPROLOL) • 2SELECTIVE TO BETA 1 &BETA 2 RECEPTOR(PROPANOLOL,BUCINDOLOL) • 3.SELECTIVE TO BETA1, BETA2, &ALPHA1 RECETOR.(CARVIDOL)

33. SMALL FOR GESTATIONAL AGE (S.G.A.) • IN UTERUS HYPOXIA CAUSES RELEXATION OF ANAL SPHINCTER WITH PASSAGE OF MECONIUM INTO AMNIOTIC FLUID. • NEW BORN EMERGENCY • HYPOGLYCEMIA • RESPIRSTORY DISTRESS • TRANSIENT TACHYPNOEA OF NEW BORN. • MECONIUM ASPIRATION SYNDROME • IN SEVERE ASTHAMA NO WHEEZING SOUNDS MAY BE HEARD BECAUSE OF DECREASED IN AIRFLOW. • DIMINISHED BREATH SOUNDS ARE INDICATIVE OF OBSTRUCTION AND RESPIRATORY FAILURE. IN HYPER PARATHYROIDISM Ca INCRESES & FORM RENAL STONES & NENCE PLENTY OF FLUIDS & MORBIDITY SHOULD BE ENCOURAGED.

34. BEHEVIOR THERAPY • REALITIY THERAPY • SHORT TERM DYNAMIC PSYCHOTHERAPY. • PSYCHOANGLYTIC THERAPY • PSYCHODERMA • COMMUNICATION:- • THERAPEUTIC COMMUNICATION TECHNIQUS REDIRECTS PT’S FEEDING BACK IN ORDERTO VALIDATE WHAT PT IS SAYING • GIVE PT THE OPPERTUNITS TO VERBALIZE. • PT EXPERIENCE NUMEROUS EMOTIONAL AND BEHAVIRO OR FOLLOWING SERIOUS ILLNESS • OPEN ENDED STATEMENT GIVES PT OPPORTUNITY TO EXPRESS • THERAPEUTIC COMMUNICATION TECHNIQUE OF REFLECTION, AND CLARIFIES AND ENCOURAGES FURTHER EXPRESSION OF PATIENTS FEELINGS • RESPONDING TO THE FEELING EXPRESSED BY PT IS AN EFFECTIVE COMMUNICATION

35. LEARN AT LISA WE CAN BECAUSE WE THINK WE CAN LIFESTYLE ACADEMY (INTERNATIONAL) ALLIED HEALTH SCIENCE DIVISION ORGANIZERS FOR LECTURES, SEMINARS AND WORKSHOPS PRESIDENT & COURSE DIRECTOR DR. B.A. JOSHI MD (MED) DPED MB www.learnatlisa.com