...marketed as Coreg CR. References Press Release, FDA Approves First Generic Versions of Coreg, U.S. Food and Drug Administration, Sep. 5, 2007 Stafylas PC, Sarafidis PA (2008). "Carvedilol in hypertension treatment". Vasc Health Risk Manag 4 (1): 23–30. doi:10.2147/vhrm.2008.04.01.23. PMC 2464772. PMID 18629377. Othman AA, Tenero DM, Boyle DA, Eddington ND, Fossler MJ (2007). "Population pharmacokinetics of S(-)-carvedilol in healthy volunteers after administration of the immediate-release (IR) and the new controlled-release (CR) dosage forms of the racemate". AAPS J 9 (2): E208–18. doi:10.1208/aapsj0902023. PMC 2751410. PMID 17614362. Vanderhoff BT, Ruppel HM, Amsterdam PB (November 1998). "Carvedilol: the new role of beta blockers in congestive heart failure". Am Fam Physician 58 (7): 1627–34, 1641–2. PMID 9824960. Kornhuber J, Muehlbacher M, Trapp S, Pechmann S, Friedl A, Reichel M, Mühle C, Terfloth L, Groemer T, Spitzer G, Liedl K, Gulbins...
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...University of Pennsylvania School of Nursing Medication Tracking Sheet Tracking Medications Across the Curriculum Major Drug Classification (s): beta blocker Generic drug name: Metoprolol Trade (Brand) name: Lopressor Normal dosage range:______25-50mg Safe dosage range: Route(s) of administration: PO once a day Drug action (s): Blocks simulation of beta1 adrenergic receptors. * Uses: * Hypertension. * Angina pectoris. * Prevention of MI and decreased mortality in patients with recent MI. * Management of stable, symptomatic (class II or III) heart failure due to ischemic, hypertensive or cardiomyopathc origin (may be used with ACE inhibitors, diuretics and/or digoxin; Toprol XL only). * * * Significant side effects: fatigue, weakness * Significant adverse reactions: CV- bradycardia, tachycardia, pulmonary edema, hypotension Significant drug/drug interactions: Drug-Drug * General anesthesia, IVphenytoin, and verapamil may cause ↑ myocardial depression. * ↑ risk of bradycardia when used with digoxin, verapamil, diltiazem, or clonidine . * ↑ hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates . * Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension...
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...Alzheimer’s disease is a wholesale loss of synapses, contact points via which nerve cells relay signals to one another and a parallel deterioration in brain function, notably in the ability to remember. Amyloid beta (Aβ) denotes peptides of 36–43 amino acids that are crucially involved in Alzheimer's disease as the main component of the amyloid plaques found in the brains of Alzheimer patients. The peptides result from the amyloid precursor protein (APP), which is being cut by certain enzymes to yield Aβ. Study has shown that Beta amyloid begins life as a solitary molecule but tends to bunch up , initially into small clusters that are still soluble and can travel freely in the brain, and finally into the plaques that are hallmarks of Alzheimer’s. The study showed for the first time that in this clustered form, beta-amyloid can bind strongly to a receptor on nerve cells, setting in motion an intercellular process that erodes their synapses with other nerve cells. Further looking into this protein and the information regarding it in various databases, the following was sequence was found out for the Beta amyloid A4 protein in Homo sapien in SWISSPROT. >sp|P05067|A4_HUMAN Amyloid beta A4 protein OS=Homo sapiens GN=APP PE=1 SV=3 MLPGLALLLLAAWTARALEVPTDGNAGLLAEPQIAMFCGRLNMHMNVQNGKWDSDPSGTK TCIDTKEGILQYCQEVYPELQITNVVEANQPVTIQNWCKRGRKQCKTHPHFVIPYRCLVG EFVSDALLVPDKCKFLHQERMDVCETHLHWHTVAKETCSEKSTNLHDYGMLLPCGIDKFR GVEFVCCPLAEESDNVDSADAEEDDSDVWWGGADTDYADGSEDKVVEVAEEEEVAEVEEE E...
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...Am J Stem Cell 2012;1(3):196-204 www.AJSC.us /ISSN:2160-4150/AJSC1208001 Review Article Directed differentiation of progenitor cells towards an islet-cell phenotype Arif Abed1, Charlotte Critchlow2, Peter R Flatt3, Neville H McClenaghan3, Catriona Kelly1 The Guy Hilton Research Centre, Institute for Science and Technology, Keele University, UK; 2Keele Medical School, Keele University, UK; 3Diabetes Research Group, SAAD Centre for Pharmacy and Diabetes, University of Ulster, Coleraine, UK 1 Received August 3, 2012; Accepted November 9, 2012; Epub November 30, 2012; Published December 10, 2012 Abstract: Exogenous insulin administration and oral anti-diabetic drugs are the primary means of treating diabetes. However, tight glycaemic control, with its inherent risk of hypoglycaemia, is required to prevent the microvascular and macrovascular complications of the disease. While islet or pancreas transplantations offer a longer-term cure, their widespread application is not possible, primarily because of a lack of donor tissue, the burden of life-long immunosuppression, and eventual graft rejection. The rapid increase in the incidence of diabetes has promoted the search for alternative cell-based therapies. Here we review recent advances in the directed differentiation of both endocrine and non-endocrine progenitors towards an islet-like phenotype. Keywords: Endocrine, progenitor cells, islet cells, insulin production, diabetes mellitus The need for cell-based therapies for...
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...el páncreas exactamente en los islotes de Langerhans por su factor beta, esto ocurre cuando a través del Glut 2 membranal los detectores de glucosa encuentran una concentración más alta a lo necesario Esta hormona (la insulina) viaja por el torrente sanguíneo y afecta las células hepáticas, neuronales y musculares para que capten glucosa. La insulina se une al receptor membranal de insulina Si la concentración de glucemia es baja los RTK activan la vía PI-3 cinasa. Al final de esta vía de señalización se activa la proteincinasa B PKB que activa las vesículas de GLUT4 que se desplazan y se fusionan con la membrana para hacer que la glucosa entre en la célula. Tras eliminarse la insulina los GLUT4 sufren endocitosis y comienza la producción del glucógeno. Esto hace que se reduzca la degradación de glucosa a piruvato y este efecto es el opuesto al de la hormona glucagón que se produce en el páncreas. Existen diversos tipos de GLUT que son los receptores de glucosa en las membranas celulares, algunos ocupan ser activados mientras otros no. Por lo cual el cerebro logra captar la glucosa sin la necesidad de utilizar la insulina al usar el Glut 3 Cuando existe una falla en el metabolismo de la glucosa y la insulina se obtiene niveles altos de glucemia que deben de ser controladas con dietas muy estrictas. Esta enfermedad se conoce como “Diabetes” que existen 2 tipos: El tipo 1 es en el que las células beta casi no producen insulina, y el tipo 2 es el que la captación de la...
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...542 學術 阿茲海默失智症的食療科學證據 文/孫 瑜 邱銘章* 李明濱** 恩主公醫院神經內科 台大醫院神經內科* 台灣失智症協會理事長** 背 景 阿茲海默失智症為一逐漸腦部退化以致於喪失智 能的疾病，包括喪失智力與生活能力，年紀愈大，愈 易得病，這是現在人口結構逐漸老化的社會，必須面 對的重要議題。長久以來，就有不少研究在探討飲食 與失智症的相關性，包括食物種類與得病的相關性， 及以飲食型態來預防或延緩疾病惡化。這些飲食的研 究中，有不少建議攝取富含維他命C、E及胡蘿蔔素等 抗氧化食物來預防或改善失智症的惡化，另外維他命 B群、葉酸，不飽合脂肪酸、魚類、酒類等，都曾被 報導過可降低阿茲海默失智症的風險。不過上述這些 研究的結論常常不一致。另外，臺灣很流行的保健食 品如紅麴及銀杏也被奉為預防失智症的聖品，還有現 在很熱門的地中海飲食，這些食物對阿茲海默失智症 的預防及治療效果的科學證據仍須進一步探討。本篇 研究擬以實證醫學的方法探討飲食對失智症的防治效 果，進而希望為高齡族群提供飲食的建議。 方 法 分兩階段進行。第一階段：先以一般性回顧的方 法搜尋及整理阿茲海默失智症的完整且有臨床試驗的 飲食研究。從Pub Med中搜尋以關鍵字「nutrition」或 「diet」連結 「Alzheimer's dementia」或「Alzheimer's disease」搜尋相關的文章。並設定為回顧(review)性 文章，語言為英文或中文，起始年代不設限，搜尋至 2009年。總共找到73篇文章，其中再進一步將動物 實驗、基礎實驗及病理研究去除。如此一來，剩下33 篇，其中館際合作能找到24篇，再從中去挑選回顧性 研究中，所有收集納入分析比較的臨床試驗(含世代研 究及病例對照研究)最完整的文章，加以整理。另外也 加入我們自己團隊的研究。第二階段：是分別針對國 內常被報導的保健產品、食品及飲食型態，如紅麴、 銀杏、地中海飲食及咖哩等，用於阿茲海默失智症的 所有研究，探討其目前臨床科學性的結論為何。 結 果 以下分別就不同的飲食因素與阿茲海默失智症相 關性加以探討： 1.抗氧化飲食 阿茲海默失智症患者腦中的β類澱粉蛋白，會在 腦中形成過氧化反應，進一步造成神經元的損傷(1)，這 些腦中的氧化反應是阿茲海默失智症的是原因還是結 果，並不是很清楚，不過已有不少研究在探討以食物 中的抗氧化物質，來影響阿茲海默失智症的病程 (2) 。 常被研究的抗氧化物包括維他命E、維他命C及胡蘿蔔 素。有些研究發現阿茲海默失智症患者血中的這些抗 氧化物質濃度偏低。食物中維他命E的來源很廣，包 含蔬果、肉(牛羊豬)、魚與乳酪 (3)。維他命C的來源則 多為蔬果及胡蘿蔔 (3)。β胡蘿蔔素來源則為青菜(特別 是青花椰菜)、紅蘿蔔、水果如木瓜、蕃茄及葡萄柚等 (3) ，觀察幾個較大型的前瞻性臨床研究，其營養的介入 可分為攝取維他命及攝取富含這些維他命的飲食(多是 問卷及電訪的方式)，整理如表1 (4)。吾人可發現這些研 究的結論並不一致。不過可看出以下三點趨勢：1.以富 含維他命E、C的食物供給來減少失智症的發生，結果 是有效的多於無效的研究。2.富含維他命E、C食物對 預防失智症的證據，比以維他命E、C藥物還多(食物優 於藥物)。3.在失智症防治上，維他命E的飲食比維他命 C的證據還強。 2.維他命B群，葉酸與失智症 維他命B12或葉酸缺乏會造成神經細胞的損傷及 中樞神經病變(5)。也會造成智力的退化，這也是失智症...
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...significant improvement in other areas. 100% compliance in all areas will have positive benefits for the patient as well as for the hospital. The goal is to improve compliance in order to ensure patient safety and decrease mortality rates for surgical patients. Assessment Appropriate hair removal and normathermia are two areas that show consistent compliance. Maintaining current processes and procedures is recommended. While antibiotic selection was meeting the desired goal as set forth in the Surgical Care Improvement Project (SCIP) Inf-2, after May a significant decrease in compliance is noted. Use of prophylactic antibiotics prior to incision (SCIP Inf-1), stopping the antibiotic within 24 hrs. of surgery end time (SCIP Inf-3), beta blockers given during perioperative period (SCIP Card-2), recommended VTE prophylaxis ordered (SCIP VTE-1) and given within 24 hrs. prior through 24 hrs. after surgery (SCIP VTE-2) Corrective Action Plan The goal of the prophylactic antibiotic before and after surgery is to promote serum levels and gain bactericidal tissue. There is no known benefit for the patient to continue these antibiotics greater than 24 hrs. post-surgery (qualitymeasures.ahrq.gov, 2013). Physicians have been educated regarding the selection of antibiotics and the importance of administering the first dose within one hour of surgery (jointcommission.org, 2014). Concurrent audits to capture data in real time of these cases will help to ensure compliance by physicians...
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...GENERIC NAME:LABETALOL - ORAL (luh-BET-uh-lol) BRAND NAMES: Normodyne, Trandate DRUG CLASS AND MECHANISM: Labetalol is a drug that is used for treating high blood pressure. Nerves from the adrenergic nervous system travel from the spinal cord to arteries where they release norepinephrine. Norepinephrine attaches to adrenergic receptors on arteries and causes the arteries to contract, narrowing the arteries, and increasing blood pressure. Labetalol blocks receptors of the adrenergic nervous system. When labetalol attaches to and blocks the receptors, arteries expand, resulting in a fall in blood pressure. GENERIC AVAILABLE: Yes PRESCRIPTION: Yes PREPARATION: Tablets: of 100, 200 and 300 mg; Injection: 5 mg/ml STORAGE: Tablets should be stored between 2-30 C (36-86 F). PRESCRIBED FOR: Labetalol is used alone or in combination with other drugs to reduce blood pressure. DOSING: The recommended starting oral dose of labetalol is 100 mg twice daily and the dose can be increased by 100 mg twice daily every 2-3 days based on the response of the blood pressure. Usual maintenance doses are 200-400 mg twice daily. Patients with severely high blood pressure may require 1.2 to 2.4 g daily. Stopping or changing the dose of the drug should be directed by a physician because serious side effects may occur. The initial intravenous dose of labetalol is 20 mg injected over 2 minutes. Additional injections of 40 or 80 mg may be administered every 10 minutes as needed up to a total dose...
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...Beta-blockers xxxx Collin College HPRS 1310-WW1 April 15, 2012 The first beta-blocker drug approved by the FDA in 1967 was developed by Sir James Black, an accomplishment for which he was awarded the Nobel Prize in Medicine in 1988 (Stapleton, 1997). Sir Black took a different approach to the treatment of angina pectoris—instead of using drugs to increase the amount of oxygen delivered to the heart, Black sought to find a drug that could reduce the amount of oxygen required by the heart. The drugs in this classification are subdivided into two categories: non-selective and selective (cardioselective). Major drugs in the non-selective beta-blocker category include carteolol, nadolol, penbutolol, pindolol, propranolol, sotalol, and timolol. Major drugs in the cardioselective category include acebutolol, atenolol, betaxolol, esmolol, metroprolol, and nebivolol. Some others, including carvedilol and labetalol also have alpha-adrenergic blocking effects, but are outside the scope of this paper. (Vallerand, 2013; Turley, 2010) Beta-blockers are prescribed for the treatment of hypertension, angina pectoris, cardiac arrhythmias, hypertrophic subaortic stenosis, prevention of myocardial infarction, congestive heart failure, migraine headaches, and glaucoma. (Vallerand, 2013; Hodgson & Kizior, 2013) Beta-blockers work to compete with sympathetic neurotransmitters1 for beta1 and beta2 adrenergic receptor sites. Beta1 receptors are found in cardiac muscle, and beta2 receptors...
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...Selección de distribuciones de probabilidad Para llevar a cabo una simulación usando variables aleatorias como tiempos entre llegadas o tiempos de servicio, es necesario especificar su distribución de probabilidad. Una vez que las distribuciones de probabilidad han sido especificadas, la simulación a través del tiempo generará variables aleatorias a partir de estas distribuciones. Las distribuciones de probabilidad más usadas en simulación pueden ser divididas de la siguiente manera: 1. Distribuciones Continuas. 2. Distribuciones Discretas. 3. Distribuciones Empíricas. Distribuciones continuas 1. Uniforme. Usada como un primer modelo para una cantidad que oscila aleatoriamente entre “a” y “b” y de la que se conoce muy poco. La distribución U(0,1) es esencial para generar variables aleatorias de las otras distribuciones. La figura 1 muestra dicha gráfica. Parámetros: a,b en donde a<b Rango: [a,b] Fig. 1 GRÁFICA DE LA DISTRIBUCIÓN UNIFORME 2. Exponencial. Tiempos entre llegadas de “clientes” a un sistema que ocurren a un tasa constante. Parámetros: en donde >0 Rango: [0, ] Fig. 2 GRÁFICA DE LA DISTRIBUCIÓN EXPONENCIAL 3. Gamma. Tiempo para cumplir alguna tarea. Por ejemplo, tiempo de servicio de clientes o reparación de una máquina. Parámetros: , en donde > 0 Rango: [0, ] Fig. 3 GRÁFICA DE LA DISTRIBUCIÓN GAMMA 4. Weibull. Tiempo para completar alguna tarea (la función densidad es muy parecida a...
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...Antiarrhythmics Antiarrhythmia drugs are used to treat abnormal heart rhythms resulting from irregular electrical activity of the heart. There are many different types of antiarrhythmic drugs. Examples include: * Tambocor (flecainide) * Procanbid (procainamide) * Cordarone (amiodarone) * Betapace (sotalol) In addition, there are other types of heart drugs that can be used to treat arrhythmias, including: Read the Do You Know Which Symptoms Signal a Heart Attack in Women? article > > * Beta-blockers such as metoprolol or Toprol XL, which reduce the heart's workload and heart rate. * Calcium channel blockers such as Calan, which also reduces the heart rate. There are also a variety of drugs used by the doctor in an emergency situation to control or convert an abnormal heart rhythm. Why Do I Need to Take an Antiarrhythmia Drug? Your doctor has determined that you have an abnormal heart rhythm that would be best treated with drugs alone or in addition to a procedure, such as putting in an implantable cardioverter defibrillator (ICD). Because these drugs only control abnormal heart rhythms, not cure them, you may have to take them for life. Can I Take Other Drugs While Taking Antiarrhythmics? If you are taking an antiarrhythmic, talk to your doctor before taking any other drugs (prescription or over-the-counter), herbal remedies, or supplements. Are There Side Effects Associated With Antiarrhythmics? Yes, antiarrhythmics do have side effects...
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...VERY IMPORTANT,because you may get a drug you've never heard of it, but will be able to recognize it's category, and the most common side-effects. Once you've done that you should definitely know at the very least these, their side-effects, dangerous drug interactions, safe dosage ranges, etc. Digitalis, Lasix, Nitro, Clozaril, Lithium, Theophylline, Aspirin, Nardil (know all the MAOI's since there are only a couple), Cogentin, know never to mix a MAOI with an SSRI or other antidepressants, Tylenol, Dilantin, Mag Sulfate, and the major cardiac drugs. helps for better memorization coumadin is highly protein bound. so an increase in protein intake will decrease the effectiveness KCL must be diluted and administered no faster than 20 mEq/hr long-term use of rocephin can cause over-growth of organisms such as Candida albicans Periorbital edema is indicative of post-strept glomerulonephritis After birth, the infant of a diabetic mother is often hypoglycemic epigastric pain can be indicative of an impending seizure variable decelerations indicate a problem with cord compression Clients stered on Disulfiram (Antabuse) must avoid any form of alcohol Tetany is the major sign of hypoparathyroidism nervousness and insomnia suggest an overdose of thyroid hormone replacement therapy remember ELAIN for drugs that can be admin via endotracheal tube (epinephrine, lidocaine, atropine, isuprel, and narcan) ASA can cause hemorrhage during a sickle cell crisis Normal...
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...In: Other Topics Mock Code Cardiopulmonary Arrest PNCI - Learner Robert Johnson Age: 60 Weight: 70 kg Base: Stan D. Ardman Patient History Past Medical History: Hypertension well-controlled by medication, hypercholesterolemia and obesity; minor car accident three weeks ago in which he sustained whiplash Allergies: No known drug allergies Medications: Lopressor (metoprolol), Zocor (simvastatin) Code Status: Full Code Social/Family History: Married with two adult children who live locally; Does not smoke, drink or use illicit drugs Handoff Report Situation: The patient is a 60-year-old male in room 425 on the Orthopedic Unit who is recovering from an anterior-posterior interbody fusion of L4 – L5 performed two days ago. His has had an uneventful recovery. He is in his room eating breakfast. Background: Hypertension, hypercholesterolemia and obesity. The hypertension has been well controlled by his medication. He is wearing a soft neck collar for support following a minor car accident three weeks ago in which he sustained whiplash. The patient has no known drug allergies and is awake and alert. Assessment: Vital signs: HR 87, BP 128/62, RR 18, SpO2 has been 98% on room air, Temp 37.1oC Cardiovascular: No telemetry; HR regular Respiratory: Clear in both lung fields GI: Advanced to full liquid diet and tolerating it well GU: Voiding clear, yellow urine Extremities: Pink, warm and with adequate turgor; Movement is strong in all...
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...is using drugs called Benzodiazepines (BZs). These are the most common type of drug to relieve stress and anxiety issues. They work by slowing down the Central Nervous System activity. GABA, the hormone responsible for anxiety relief naturally in the human body is enhanced by the BZs. The BZs will also help to reduce the serotonin activity in the brain, which is the neurotransmitter which causes stimulation, and reduces anxiety as a result. Benzodiazepines have a number of effects that all lead to the reduction of stress in people without much effort. The other type of drug that could be used to treat stress and anxiety issues are Beta Blockers (BBs). When the body detects stress, the SNS is activated which leads to raised heart rate, which leads to higher blood pressure which can lead to Chronic Heart Disease, heart attack, stroke etc. The Beta Blocker is taken then and it acts by reducing activity of adrenaline and noradrenaline and also binds to the receptors of the heart and other areas of the body stimulated by arousal. As a result of blocking these receptors, it is therefore harder to stimulate them and so the heart beat is slowed, and therefore lower blood pressure. An advantage of drugs is that they work very quickly and are effective in reducing stress almost immediately. Their use can be therefore be justified, provided that the stressor is a short-term one rather than a long-term one. Another advantage is that drugs are also relatively inexpensive compared to psychological...
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...Creative Change in Healthcare Mary Ofili HSC 587 May 19, 2014 Lanny A. Kope Creative Change in Healthcare Change in any organization, especially healthcare is a given constant, frequent and always almost inevitable. Several factors may lead to these changes and sometimes, these factors are internal and other times they are external. In the United States, the economy determines the interactions between the cost of healthcare and the way hospitals deliver care to the patients. The current persistent economic downturn continues to force Medicare to look closely at how hospitals are reimbursed and to cut reimbursement rates. With the overhaul of the healthcare system, hospitals have to evaluate how to deliver care to the patients with limited financial resources. Therefore, Medicare expects hospitals to bear the cost of any adverse outcome caused by any changes within the hospital environment. For examples, hospitals are no longer reimbursed for the cost of diabetic ulcer treatment acquired while the patient is in the hospital. The quality of the expected result is much higher while the reimbursement is much lower. Hospitals have to look closely at how the nursing staff delivers care to the patients. The traditional bedside nursing is staffed by three levels of nurses. Certified Nurse’s Assistant (CNA), Licensed Vocation Nurse (LVN), and the Registered Nurse (RN). Other levels of nurses such as Nurse Practitioners and other advanced practice nurses are not included in the...
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