CK done!

I’ve had to pinch myself a few times in the last 2 days ‘cos it has hardly sunk in that 2ck is over!

Day 0, I was 45mins flight away from home, totally psyched up, ready as I could be and knowing that my loved ones were back home praying for me. I got up early, prayed, exercised, got dressed, made sandwiches for my breaks,  read  1 or 2 pages of MTB to wake my brain cells and had a good proteinous breakfast. On my way out of the hotel, I sat down for less than 10mins at the web station and just scrolled through week 2 of this mental map (the week with the highest number of posts), nodding along. Those highlights bounced back and forth in my brain as I did the 10mins walk to the exam centre.

Generally, the exam went very well save for the intermittent drilling noise coming from outside the window at the prometric centre. It was distracting at first but when I talked to the proctor after block 1 and learnt that there was nothing they could do about it, (not even to change my seat to one farther from the window), I told myself :” You can do this, the noise is now part of the exam and you just have to surmount it!” After that I wasn’t as bothered by the noise. 9hours went by quickly and before you knew it I was on my way back to my hotel room saying “thank you God” and telling Hubby (on the phone) how it went.

Well, the 4weeks wait is on…

I prepared for this step using U world, MTB, Kaplan Qbank, a few Kaplan videos and many online resources. One tool which was however extremely useful to me was this blog which I started about a month to the exam, when I was feeling like I needed some form of ‘decongestion’ or was it ‘info organisation’? Whatever it was, trying to put down the most important facts about each condition or concept was really helpful in consolidating what I knew well and identifying what I didn’t know  enough about. Also, the product of my mental mapping (this blog) was good for quick revision anywhere internet was available. I hope someone else will also find it useful.

To all those at the stage that I was when I started this blog, good luck!

Asthma mudra

Asthma mudra
Like aakash-vardhak (or aakaash), Prtihvi-shaamk (or surya) and Linga mudra, this mudra too can help asthmatics, enabling them to relieve an attack of asthma.
Method: Press together the finger nails of the middle fingers, keeping the other fingers gently extended.

Effects: This mudra helps to treat as well as prevent attacks of asthma.Duration: At least fifteen minutes when suffering from breathlesnes. A regular performance of this mudra for about five minutes thrice a day helps the person to jprevent future attacks of asthma..

iPad App for Education of Heart Patients After Surgery - Mayo Clinic Video

From Mayo Clinic YouTube channel: “Being in the hospital after major surgery is no fun. On top of dealing with pain, patients have uncertainty. They also have to worry about getting all the information they need to support their recovery. That’s not always easy in the hospital; things happen quickly and doctors and hospital staff are often really busy. Doctors at Mayo Clinic may have a solution to this issue. They’re giving iPads to heart surgery patients to see if a new iPad app can make hospital stays easier and more satisfying.”

Our research presented during the 2011 ACAAI meeting showed that 95% patients thought the iPad was helpful for coming to understanding of their condition:

PATIENT PERCEPTION OF A POINT-OF-CARE TABLET COMPUTER (IPADâ„¢) BEING USED FOR PATIENT EDUCATION – P318

A. Nickels*, V. Dimov, V. Press, R.Wolf, Chicago, IL.

Background:

During the fall of 2010, the Internal Medicine/Pediatrics program at University of Chicago introduced Point-of-Care Tablet Computers (iPadâ„¢) for clinical use. iPadsâ„¢ are intended to improve access to EMR, work flow, resident and patient education, and access to electronic clinical tools. The graphic display and ease of interface makes the iPadâ„¢ a potentially powerful tool to achieve these goals. This pilot study is designed to gauge the initial patient perception of the iPadâ„¢ when used for patient education.

Methods:

8 questions, physician administered, patient survey of Allergy Immunology patients or their parents. Preloaded iPads™ with education materials (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients. Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis. Results: 20 patients surveyed (11 resident/9 attending). For those survey items without 100% agreement, there was no statistically significant difference in responses based on level of training (p≥0.45). 100% [0.861, 1] of participants liked the iPad™ being used to help explain their children’s condition, 95% [0.783, 0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would like it to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was helpful for coming to understanding of their condition. Limitations of this study include a convenient sample, physician-administered survey, and observer bias.

Conclusion:

Patient perception was very positive toward the use of a Point-of-Care Tablet Computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an effect on patient perception. Confirmation of the results may be required before wider implementation.

Source:  Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.

http://www.annallergy.org/supplements

Chronic Asthma Home Remedies (cough variant asthma)

cough variant asthma

Recurring health barriers are certainly annoying to deal with. Illnesses such as cancer, asthma, diarrhea and stress deliver different degrees of symptoms and consequences. In the case of asthma, breathing is usually distorted at any unexpected time. This certain health liability can kick off at any age but it usually sets at childhood stage. It is even deemed to be the most popular chronic disease among kids, with about 15 t0 20% of the children populace getting affected. Chronic asthma home remedies can be executed to avoid undesirable attacks.

Before learning some chronic asthma home remedies, it’s appropriate to learn the rudiments of the disease, its causes and symptoms. When airways are inflamed and narrowed down, breathing becomes hard and that’s when asthma attacks. It later leads to wheezing wherein the air coming from the nose is breathed out through lessened tubes. Varied factors are considered to have caused asthma attacks like family history, immune system troubles, exposure to cigarette smoke, allergies, infections, reactions to selected foods, bodily reactions to stress and emotional trauma. Asthma could kill one if not remedied immediately.

It’s said that wheezing worsens at the maximum level when it’s dawn. When a person’s airways are limited, no ample oxygen is able to enter and get circulated through the bloodstream. That’s why a person can transform into bluish color when attacked by asthma. A severe cause to this can be very alarming and threatening, and what’s the worst part is that it could stop your heartbeat. There are many kinds of asthma, as told by medical professionals. They include adult asthma, infant asthma, childhood asthma, cough variant asthma, cardiac asthma, coughing asthma, bronchial asthma and chronic asthma. Because the basic problem with asthma as contributed by the difficulty of air to come in and out of the lungs, the quickest remedy to apply is through using the medical inhalers. The so-called bronchodilators can expand the airways. Chronic asthma home remedies are also beneficial to be administered to those experiencing asthma repeatedly for a longer time.

One of the popular chronic asthma home remedies can is done by using a nebulizer that gives in a much larger dose of asthma-intended drugs. The drugs in the nebulizer go immediately to the lungs so that’s why response can be as quick as possible. Breathing exercises can be helpful to improve the breathing mechanism of the person. Cardiovascular exercises like swimming, jogging, kickboxing, step aerobics and skipping can also provide long-term benefits to the way a person breathes. Eventually, he will be able to lessen the occurrence of asthma attacks. Also, you can get the habit of drinking herbal versions of milk and tea or perhaps eat some soup taken from drumstick leaves, pear-shaped fruits called figs, and ginkgo biloba. These have all been proven and tested to reduce the frequency of asthma occurrences.

Ian Pennington is an accomplished niche website developer and author. To learn more aboutasthma remedies, please visit At Home Asthma Care for current articles and discussions. Article Source: http://EzineArticles.com/?expert=Ian_Pennington

BETA ADRENERGIC RECEPTOR BLOCKERS

BETA ADRENERGIC RECEPTOR BLOCKERS

 

II. Beta Adrenergic Receptor Blockers

A. Introduction

1. Cardiovascular effects of Beta Blockers

a. Since catecholamines have positive inotropic and chronotropic effects on the heart, beta blockers slow the heart rate, and decrease myocardial contractility. When sympathetic activation is low, these drugs have modest effects. However, when sympathetic activation is high, such as during exercise and stress, beta blockers attenuate the expected increase in heart rate, and diminish cardiac output. Blockade of vascular Beta 2 receptors results in increased total peripheral resistance. Blood flow to most organs other than the brain is reduced. With long term use total peripheral resistance returns toward normal by unclear mechanisms. Beta blockers tend to decrease the capacity to work. Exercise performance is impaired less by selective Beta 1 blockers. Beta blockers have important effects on cardiac rhythm and automaticity. They reduce the sinus rate, decrease the rate of depolarization of ectopic pacemakers, and slow conduction in the atria and AV node. Lots more on this topic during lectures on antiarrhythmic drugs. Beta blockers do not lower blood pressure in normal man, however they do reduce blood pressure in hypertensive man. The mechanism of this effect has not been satisfactorily explained. Chronic prophylactic therapy with a beta blocker in patients who have had a myocardial infarct appears to help prevent the recurrence of a second fatal myocardial infarct.

2. Pulmonary effects of Beta Blockers

a. Beta blockade usually has little effect on pulmonary function in normal man, however in asthmatics they can cause life threatening bronchoconstriction. Although Beta 1 selective blockers may be less likely to cause respiratory problems in asthmatics, these drugs should be used with great caution, if at all in patients with bronchospastic disease since even relatively selective blockers have some affinity for the beta 2 receptor.

3. Metabolic effects of Beta Blockers

a. Catecholamines promote glycogenolysis and mobilize glucose in response to hypoglycemia. Non-selective Beta blockers adversely effect recovery from hypoglycemia in insulin dependent diabetics. Nonselective Beta blockers must therefore be used with great caution in diabetics. A selective Beta 1 blocker is usually preferable in this case. Beta blockers (Beta 3 receptor) attenuate the lipolytic response to sympathetic nervous system activation which is an important energy source for exercising muscle. Selective beta 1 antagonists may cause these effects less fequently than non-selective antagonists.

 

B. Pharmacology of Nonselective Beta Blockers

1. Propranolol

a. After oral administration, propranolol is almost completely absorbed, but undergoes extensive first pass metabolism in the liver. The extent of clearance by the liver varies radically across patients however and results in as much as a 20 fold difference in plasma concentration of the drug after oral administration to different persons. This has obvious significance in patients with liver disease. 90% of the drug in the circulation is bound to plasma proteins. When used as an antihypertensive agent, the full response on the blood pressure may not develop until after several weeks of administration. Abrupt withdrawal of propranolol after chronic therapy can lead to the develpment of withdrawal symptoms. Side effects include GI distress (relatively unopposed parasympathetic nervous system), and CNS effects such as nightmares, insomnia, and depression.

2. Nadolol

a. Nadolol is a nonselective beta blocker with a long duration of action. Nadolol is poorly lipid soluble, and incompletely absorbed from the GI tract. Interindividual variability in its bioavailability is less than with propranolol. It is not extensively metabolized, and is excreted intact in the urine. As such kidney disease is a cause for concern, and may result in an accumulation of nadolol. Because nadolol is poorly lipid soluble, it is thought that there will be lower concentrations of nadolol in the brain, and this may contribute to a lower incidence of CNS side effects seen with this drug.

3. Timolol

a. It is a nonselective blocker with a short duration of action. It is well absorbed from the gut and is subject to moderate first pass metabolism. It is metabolized by the liver and only a small fraction is excreted by the kidney in unchanged form. Timolol is an example of a beta blocker which is used in glaucoma to reduce the rate of synthesis of aqueous humor. The ocular form of timolol is well absorbed into the circulation and adverse effects can occur in patients with asthma or congestive heart failure.

b. Other new drugs with similar mechanisms of action include Bopindol, Carteolol, oxprenolol, penbutolol, sotalol etc etc

 

4. Labetolol

a. It is an example of a nonselective beta blocker which also blocks alpha 1 receptors. It also inhibits uptake of NE from the synaptic cleft (a cocaine-like effect). Its pharmacokinetics are like those of Propranolol discussed above, ie well absorbed, highly metabolized and very variably so on first pass through liver, mainly metabolized by liver. It is used in the treatment of pheochromocytoma and hypertensive emergency, where its alpha 1 effects promote vasodilation and hypotension, while its beta 1 effect helps reduce reflex tachycardia.

b. Other new drugs with a similar mechanism of action include Carvedilol, Medroxalol, Bucindolol

 

C. Pharmacology of Selective Beta Blockers

 

1. Metaprolol

a. It is a selective Beta 1 antagonist, whose pharmacokinetics are like propranolol.

2. Atenolol

a. It is also a selective Beta 1 antagonist. It is a poorly lipid soluble drug. About half of an oral dose is absorbed, but most of this reaches the systemic circulation ie there is no first pass metabolism in the liver. As a result, peak concentrations of this drug in the plasma are not so variable across patients. It is excreted unchanged in the urine. It has a somewhat longer duration of action than metaprolol.

3. Esmolol

a. it is a selective Beta 1 antagonist with a very very short duration of action. It is given by iv infusion. It has a half life of about 8 minutes in plasma, and is metabolized by plasma esterases. It is used only for the treatment of atrial tachycardia.

b. Other new drugs with a similar mechanism of action include Bisoprolol, Nebivolol, Betaxolol

 

D. Toxic Effects of Beta Blockers

 

1. Patients with impaired cardiac function have high levels of sympathetic activation of the heart to provide support for cardiac performance. In these patients, beta blockers may provoke an acute incident of congestive heart failure. In fact use of beta blockers in heart failure was once contraindicated.

a. Despite this fact, beta antagonists are currently being used for the treatment of mild to moderate degrees of congestive heart failure. Not all beta blockers are equally efficacious, however metoprolol appears to be useful. The mechanisms which underly this beneficial effect are poorly understood at this time.

2. Arrhythmias, especially bradyarrhythmias .

3. Bronchoconstriction, especially in asthmatics

4. CNS effects include sleep disturbances & depression

5. Metabolic effects include delayed recovery from insulin induced hypoglycemia.

 

E. Drug Interactions

 

1. Drugs that induce hepatic drug metabolizing enzymes will reduce the plasma concentrations of beta blockers that are extensively metabolized by the liver. These include barbiturates, many miscellaneous sedative hypnotic drugs, phenytoin (diphenylhydantoin), as well as smoking.

 

F. Therapeutic Uses of Beta Blockers

 

1. Used as Antihypertensives especially in mild cases where they are less likely than other agents to provoke postural hypotension.

2. In the treatment of ischemic heart disease

a. In angina, beta blockers reduce cardiac work and oxygen consumption. This reduces the frequency of anginal episodes.

b. Long term prophylactic use of nonspecific beta blockers helps prevents the recurrence of a fatal second myocardial infarct in patients who survived an initial attack. The mechanism of this effect is not known.

3. In the treatment of mild to moderate degees of congestive heart failure, chronic treatment with certain beta-1 blockers prolong the life expectancy.

4. Beta blockers are antiarrhythmics. More in other lectures. Here, only mentioned their ability to block atrial tachycardia.

5. In glaucoma, beta blockers decrease the rate of synthesis of aqueous humors.

6. Many of the signs and symptoms of hyperthyroidism are due to sympathetic nervous system activation. Beta blockers reduce these symptoms.

7. Beta blockers are useful in the prophylaxis of migraine, but not in treatment.

Chris" Cause

Hey thanks for stopping by to check out Bella’s asthma page. Thankfully her asthma seems to be under control for sometime now. Lets keep it that way! Just wanted to drop a line to redirect you to beth’s blog about Chris Jr and his, or shall I say, OUR autism. It certainly affects everyone in the house. But if you get a chance stop by and join the mailing list! http://mysensoryman.blogspot.com/

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