Effects of Stress:

More Presentations from Dr.Naina Mohamed Pakkir Maideen

·       The Physiological effects of stress include…

Ø Tension Headache

Ø Back Ache

Ø Salivary secretion

Ø Diarrhoea

Ø Stomach Complaints

Ø Rapid Breathing

Ø Excessive Sweating

Ø Elevated Heart rate

Ø Increased Pulse rate

Ø Blood Pressure elevation

Ø Increased risk of Type 2 Diabetes

Ø Erectile Dysfunction

Ø Infertility

Ø Irregular menstrual cycle

Ø Weakening of Immune System

Ø Sleep Deprivation

Ø Fatigue

·       The Psychological effects of stress include…

Ø Anxiety

Ø Restlessness

Ø Depression

Ø Lack of motivation or focus

Ø Irritability or anger

Ø Sadness or depression

·       The Behavioural effects of stress include…

Ø Overeating or Undereating

Ø Angry Outbursts

Ø Smoking

Ø Alcohol or Drug abuse

Ø Social Withdrawal

Stress:

 

More Presentations from Dr.Naina Mohamed Pakkir Maideen

Stress is the human response to excessive demands (Stressor) which disturb physiological, social and psychological systems.

Ø The stress can be either Negative stress (Distress) or Positive stress (Eustress) depending on the stressor.

Ø The stressors could be either internal (Anxiety, fear and personality traits) or external (Family stressors, Social stressors, Work stressors, Change stressors, Chemical stressors, Disease stressors, Environmental stressors, etc.)

Ø There are three sorts of stress such as Acute stress, Episodic stress and Chronic stress.

Ø Acute stress occurs only at a very short period of time.

Ø Emotional symptoms of Acute stress include anger, anxiety, irritability and acute periods of depression.

Ø Physical symptoms of Acute stress include headache, pain, stomach upset, dizziness, heart palpitations, shortness of breath, hypertension and bowel disorders.

Ø The acute stress which is suffered too frequently is termed Episodic stress.

Ø The symptoms of Episodic stress include Ceaseless worrying, Longer periods of intermittent depression, anxiety disorders and emotional distress, Persistent physical symptoms similar to those found in acute stress and Coronary heart diseases, or other heart problems.

Ø Chronic stress is dangerous and unhealthy.

Ø Chronic stress is caused by long-term exposure to stressors, such as unhappy marriage, traumatic experiences, unwanted career or job, stress of poverty, chronic illnesses, relationship conflicts, political problems, and dysfunctional families.

Ø Chronic stress can induce serious illnesses like stroke, heart attack, cancer, and psychological problems such as clinical depression and post-traumatic disorder.

Ø The Physical signs and symptoms of chronic stress include Dry mouth, Difficulty in breathing, Pounding heart, Stomach ache, Headache, Diaphoresis, Frequent urination and Tightening of muscles.

Ø The Mental signs and symptoms of chronic stress include Sudden irritability, Tension, Problems with concentration, Difficulty in sleeping, Narrowed perception and Frequent feelings of fatigue.

Ø Physiological response to stress occurs as Immediate responses to stress, through the Stimulation of Sympathetic adrenomedullary system and General Adaption Syndrome.

Ø The release of Epinephrine and Norepinephrine occurs from adrenal medulla as an immediate response to stress.

Ø Stimulation sympathetic system leads to Acceleration of heart and lung action, Paling or flushing, Vasoconstriction in many parts of the body, Liberation of nutrients for muscular action, Inhibition of the lacrimation and salivation, Dilation of pupil, Relaxation of bladder, Inhibition of erection, Auditory exclusion (Loss of hearing), Tunnel vision (Loss of peripheral vision) and Shaking.

Ø The Stages of GAS include Alarm Stage, Resistance Stage and Exhaustion Stage.

Ø Psychological response to stress occurs as Direct Action and Indirect Action.

Ø Direct action to stress may occur as Freezing (Anticipation of Threat), Aggression (Fight), Escape (Flight), Learned helplessness or Hopelessness (Depression).

Ø Indirect action to stress may occur as Displacement, Repression, Denial, Projection, Rationalisation, Intellectual Isation or Reaction formation.

FDA approves Evolocumab (Repatha) to treat high cholesterol:

More Presentations from Dr.Naina Mohamed Pakkir Maideen

©   On 27^th Aug 2015, the U.S. Food and Drug Administration approved Evolocumab (Repatha) injection to treat high cholesterol.

©   Evolocumab is the second PCSK9 (Proprotein Convertase Subtilisin Kexin type9) inhibitor.

©   Evolocumab (Repatha) is approved to treat adult patients with…

Ø Heterozygous familial hypercholesterolemia (HeFH)

Ø Homozygous familial hypercholesterolemia (HoFH)

Ø Who require additional lowering of LDL cholesterol (i.e Whose cholesterol is not controlled by diet and Statin treatment)

©    The recommended dose of Evolocumab for adults, is 140 mg every two weeks or 420 mg once a month.

Mechanism of Action:

©   Evolocumab (Repatha) binds to a protein called Proprotein Convertase Subtilisin Kexin type 9 (PCSK9) and inhibits its binding to low density lipoprotein receptors (LDLR) at the surface of hepatocytes. When PCSK9 binds to cell surface LDLR, lysosomal degradation of LDLR occurs. But, inhibition of PCSK9 binding to LDLR by Evolocumab prevents the lysosomal degradation and increases the number of LDLR available to clear LDL particles leading to lowering of LDL cholesterol.

Adverse Drug Reactions:

©  The most common ADRs noted in the clinical trial participants being treated with Evolocumab, include Nasopharyngitis, Upper respiratory tract infection, Flu like symptoms, Back pain, Redness, pain, or bruising  at the injection site and Allergic reactions (Rash and hives).

FDA approves Flibanserin (Addyi) to treat Hypoactive Sexual Desire Disorder (HSDD):

 

More Presentations from Dr.Naina Mohamed Pakkir Maideen

Ø On 18^th Aug 2015, The U.S. Food and Drug Administration approved Flibanserin (Addyi) to treat acquired, generalized Hypoactive Sexual Desire Disorder (HSDD) in premenopausal women.

Ø Flibanserin (Addyi) is the first FDA-approved treatments for sexual desire disorders in men or women.

Proposed Mechanism of Action:

Ø Flibanserin activates 5-HT_1A receptors in the prefrontal cortex and improves the balance between excitatory (Dopamine and Norepinephrine) & inhibitory (Serotonin) neurotransmitter systems, at prefrontal cortex leading to regulation of sexual response.

Adverse Drug Reactions:

Ø The most common ADRs noted in the clinical trial participants being treated with Flibanserin, include Dizziness, Somnolence (Sleepiness), Nausea, Fatigue, Insomnia and Dry mouth.

Drug Interactions:

Ø Flibanserin can interact significantly with Alcohol, CYP3A4 Inhibitors, CYP3A4 Inducers, CYP2C19 Inhibitors, Digoxin or other P-gp Substrates and Other CNS Depressants.

Contraindications:

Ø Alcohol consumption

Ø Concomitant use of CYP3A4 Inhbitors such as Macrolide Antibiotics (Erythromycin, Clarithromycin, Telithromycin, etc.), Azole Antifungals (Ketoconazole, Fluconazole, Itraconazole, etc.), Antiretroviral protease inhibitors (Saquinavir, Ritonavir, Indinavir, Nelfinavir, Amprenavir, etc.), Ciprofloxacin, Verapamil, Grapefruit juice, etc.

Ø Hepatic Impairment

                             

FDA approves Alirocumab (Praluent) to treat high cholesterol:

More Presentations from Naina Mohamed Pakkir Maideen

©  On 24^th July 2015, the U.S. Food and Drug Administration approved Alirocumab (Praluent) injection to treat high cholesterol.

©   Alirocumab is the first PCSK9 (Proprotein Convertase Subtilisin Kexin type9) inhibitor.

©   Alirocumab(Praluent) is approved to treat adult patients …

Ø With Heterozygous familial hypercholesterolemia (HeFH)

Ø Who require additional lowering of LDL cholesterol (i.e Whose cholesterol is not controlled by diet and Statin treatment)

©    The usual starting dose of Alirocumab is 75 mg/2 weeks.

Mechanism of Action:

©   Alirocumab (Praluent) binds to a protein called Proprotein Convertase Subtilisin Kexin type 9 (PCSK9) and inhibits its binding to low density lipoprotein receptors (LDLR) at the surface of hepatocytes. When PCSK9 binds to cell surface LDLR, lysosomal degradation of LDLR occurs. But, inhibition of PCSK9 binding to LDLR by Alirocumab prevents the lysosomal degradation and increases the number of LDLR available to clear LDL particles leading to lowering of LDL cholesterol.

Adverse Drug Reactions:

©  The most common ADRs noted in the clinical trial participants being treated with Alirocumab, include Nasopharyngitis, Itching, swelling, pain, or bruising at injection site, Flu like symptoms, Urinary tract infection, Diarrhea, Bronchitis, Myalgia, Muscle spasms, Sinusitis, Cough and Allergic reactions.

FDA approves Entresto (A new Heart Failure Drug):

More Presentations from Naina Mohamed Pakkir Maideen

©  On 07^th July 2015, the U.S. Food and Drug Administration approved Entresto tablets for the treatment of heart failure.

©  Entresto is a crystalline complex composed of 2 molecular moieties…

Ø Sacubitril (Neprilysin inhibitor )

Ø Valsartan (Angiotensin Receptor Blocker)     

Mechanism of Action:

©  Sacubitril blocks the degradation of endogenous vasoactive peptides (ANP, BNP, bradykinin, and Adrenomedullin), by inhibiting Neprilysin enzyme.

©  Valsartan decreases vasoconstriction and sodium retention by blocking the binding of Angiotensin II to the AT 1 receptors (Vascular smooth muscle and the adrenal gland).

Adverse Drug Reactions:

©  The most common ADRs noted in the clinical trial participants being treated with Entresto include Hypotension, Hyperkalemia, Cough, Dizziness and Renal Impairment.

Contraindications:

©  Entresto is contraindicated in patients taking Aliskiren and ACEIs and in patients with a history of angioedema related to previous ACE inhibitor or ARB therapy.

Drug Interactions:

©  Entresto may interact significantly with drugs such asACE Inhibitors, Aliskiren, ARB, Potassium-sparing diuretics, NSAIDsandLithium.

Pregnancy:

©  Use of Entresto should be discontinued as soon as possible, if pregnancy is detected.

Lactation:

©  Use of Entresto or Breastfeeding should be discontinued.

FDA approves Cangrelor (A new Antiplatelet drug):

More presentations from Naina Mohamed Pakkir Maideen

©  On 22.06.15, The U.S. Food and Drug Administration approved Cangrelor (Kengreal) which is a new intravenous antiplatelet drug could be used with Percutaneous coronary intervention (PCI) for the treatment of stable angina or acute coronary syndromes (ACS, or myocardial infarction (MI) and unstable angina (UA)).

©  Cangrelor (Kengreal) is an intravenous (IV), direct acting, reversible competitive inhibitor of P2Y12 receptor.

Mechanism of Action:

©  Cangrelor blocks P2Y12 receptors of Platelet cell membranes causing inhibition of release of ADP and other mediators such as TxA2 and inhibition of activation of Glycoprotein IIb/IIIa which result in to the inhibition of Platelet activation and aggregation.

Adverse Drug Reactions:

©  The ADRs such as Dyspnea, Vomiting, Nausea, Headache and Hypotension have been noted with Cangrelor use.

Contraindications:

Cangrelor is contraindicated in patients with significant active bleeding and patients with known hypersensitivity (e.g., anaphylaxis) to cangrelor.

Pharmacogenetics:

More Presentations from Dr.Naina Mohamed Pakkir Maideen

*      Pharmacogenetics is the study of influences of a gene on therapeutic and adverse effects of drugs.

*       Primaquine induced hemolysis in patients with G6PD (Glucose-6-Phosphate Dehydrogenase ) deficiency, was the first pharmacogenetic discovery.

*      The term Pharmacogenetics was coined by Vogel in 1959.

*      Two main divisions of Pharmacogenetics include…

Ø Drug-disposition Pharmacogenetics

Ø Drug-target Pharmacogenetics

*      Drug-Disposition Pharmacogenetics deals with the pharmacokinetics of a drug.

*      Drug-Target Pharmacogenetics deals with the pharmacodynamics of a drug.

*      Pharmacogenetic Studies include…

Ø Candidate-gene studies

Ø Genome-wide association study (GWAS)

*      The Candidate-gene approach, tests how frequent an allele or a set of alleles in patients who have a better (or worse) drug response.

*      The role of common genetic variations in disease or drug response surveyed by Genome-Wide Association Study (GWAS).

*      Pharmacists can take a lead in application of pharmacogenetics in clinical practice, since they are experts in pharmacokinetics and pharmacodynamics.

*      Health-care providers will increasingly need to take pharmacogenetics into consideration when prescribing medications.

TIPS for Healthy Hajj

More from Naina Mohamed, PhD

General Health TIPS for Hajj Pilgrims:

§    Maintain personal hygiene

§    Take bath regularly

§    Wash hands with soap and water

§    Cover nose and mouth while sneezing

§    Use always a face-mask

§    Change face face-mask every 6 hourly

§    Eliminate waste in trash only

§    Avoid spitting on floor

TIPS for Hajj Pilgrims with Chronic diseases:

§    Assess the health condition with a doctor before setting out for Hajj

§    Take sufficient medications

§    Keep medications in a proper storage conditions

§    Take medicines on time

§    Follow doctors’ and pharmacists’ instructions

§    Put on a wrist strap containing information such as name, age, disease, treatment, address and contact details

§    Inform fellow pilgrims about your disease and medications

§    Avoid making too much effort

§    Head to the nearest health center, if needed

Shaving and Hair-cutting TIPS for Hajj Pilgrims:

§    Never choose street barbers

§    Insist on using disposable shavers

§    Never share hair brush, sponges, etc. with others

§    Ask the barber to wash his hands before shaving or hair-cutting

TIPS to avoid Heat Exhaustion and Sunstrokes during Hajj:

§    Drink enough liquids (Water, Juices, Soups, etc.)

§    Avoid longer exposure to the sun

§    Use an umbrella

§    Avoid making excessive effort

§    Take sufficient rest after making every hajj ritual

§    Wear light and loose clothes

§    The signs and symptoms of heat exhaustion and sunstrokes include high body temperature, headache,  dizziness, nausea, fatigue, thirst and muscle cramps

TIPS to get protection from Food poisoning during Hajj:

§    Wash fruits and vegetables before eating

§    Check the expiry of canned foods and drinks before buying

§    Never buy uncovered food

§    Wash hands before and after preparing food

§    Wash hands before and after eating

§    Eat foods immediately after cooking

§    Avoid storing foods in buses for long

TIPS to avoid Nausea and Vomiting during Hajj:

§    Do not eat and drink too much

§    Avoid fatty foods

§    Drink enough fluids to avoid dehydration

§     Consult the doctor if vomiting is severe and persisting

TIPS to prevent Diarrhea during Hajj:

§    Avoid fatty foods

§    Check the cleanliness of foods

§    Cook the food properly

§    Do not buy from street vendors

§    Wash hands every now and then

§    Drink much liquid to avoid dehydration

§    Visit the nearest health center if diarrhea persists

TIPS to prevent Constipation during Hajj:

§    Drink enough liquid

§    Avoid cheese and dairy products

§    Eat more fresh fruits and vegetables

§    Eat more prunes which have lots of fiber

§    Avoid caffeinated drinks

§    Consume bulky agents such as fenugreek, flaxseed

TIPS to prevent Dermatological diseases during Hajj:

§    Maintain personal hygiene

§    Take bath regularly

§    Use powder and moisturizing cream when needed

§    Walk using long steps to avoid exfoliation

§    Keep thigh area clean and dry

TIPS to prevent Respiratory diseases during Hajj:

§    Use always a face-mask

§    Change face face-mask every 6 hourly

§    Cover nose and mouth while sneezing or coughing

§    Do not drink ice cold water

§    Keep away from the A/C while sweating

TIPS to prevent Tuberculosis (TB) during Hajj:

§    Use always a face-mask

§    Change face face-mask every 6 hourly

§    Avoid overcrowded places

§    Cover nose and mouth while sneezing or coughing

§    Wash hands every now and then

§    Keep residences well ventilated

§    Inform the Hajj mission doctor, if a fellow hajj coughing all the time

TIPS to prevent Xerophthalmia (Dryness of Eyes) during Hajj:

§    Use sunglasses

§    Consult with oculist before using contact lenses

§    Use moisturizing eye drops after consulting with oculist

General TIPS to perform Hajj:

§    Do not ignite fire inside the tents

§    Do not sleep on the pavements and roadsides

§    Do not get on top of buses or vehicles

§    Do not bump on others

§    Visit nearest health facility if required

§    Follow the directions issued by authorities

§    Do not slaughter the sacrifice on roads

Use the designated toilets only