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C2H4

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Re: Medical Lecture and Lessons
« Reply #40 on: July 12, 2009, 05:13:53 AM »

Dong, the SSRIs are the first-line agents for depression, not because they are more effective than the other drug classes but because they are generally safer, with fewer side effects. Most of the TCAs I see in practice right now are either used as 2nd-line agents for refractory cases, or as sleep aids. One can OD easily with TCAs though, thus the limited use in clinical practice. I almost never see anyone on MAOIs anymore. Out of the hundreds of patients on anti-depressants that I see, probably just one or two are on MAOIs. The SNRIs have pretty much the same safety profile as the SSRIs, with the added benefit of NOT causing as much weight gain as the latter. In fact, many patients lose weight on while on this med class. The last one is Wellbutrin, which acts on NE and Dopamine (and a little bit on serotonin as well), a lot of people prefer this coz it doesn't cause the sexual side effects that's typical with SSRIs. This can be used as an adjuvant also with SSRI therapy, to counteract the weight gain side effect.

Can you discuss fish oil, dong? Very promising pud siya sa depression.
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C2H4

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Re: Medical Lecture and Lessons
« Reply #41 on: July 12, 2009, 05:18:41 AM »

The atypical anti-psychotics are considered 1st-line these days because they cause fewer extrapyramidal side effects than the older agents. Monitor carefully lang ta ani kay ga cause ni sila metabolic syndrome and less frequently, agranulocytosis (esp. with Olanzapine).

Personally, ang akong nabantayan nga common side effect with people on anti-psychotics, dong, is tardive dyskinesia. It's barely noticeable on others, but on some people, very pronounced gyud. Mao nang usually, trial and error gyud to treat this. Most people don't do too well on monotherapy anymore.

C2H4

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Re: Medical Lecture and Lessons
« Reply #42 on: July 12, 2009, 05:20:23 AM »
Keep up the good work, dodong. We are learning a lot from these medical lectures.

Lorenzo

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Re: Medical Lecture and Lessons
« Reply #43 on: July 12, 2009, 12:35:52 PM »

Hello Darling Ate Ethylene,

I'm glad you found this little niche, hehehe.

Ang primary anti-epileptic strategy namo karon is to address the situation. Initial treatment to suppress or reduce the incidence of seizures is based on the specific types of seizures. Thus tonic-clonic (grand mal) seizures are treated differently than say---absence seizures (petit mal).

The use of monotherapy is initiated w/ a single agent (phenytoin, phenobarbital, ethosuximide, valproate (valproic acid or di-velproic acid), or zonisamide, or BNZ, or GABA-PENTIN. -- we administer monotherapy until seizures are controlled or or the toxic signs occur.

If seizure conditions is refractory to monotherapeutics, a second drug may be added to the therapeutic regimen.

You are right tho, 'te, monotherapy is rare nowadays due refractory effects.


hehehe, such a sharp and intelligent lady~~~


Always,
Bran

Lorenzo

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Re: Medical Lecture and Lessons
« Reply #44 on: July 12, 2009, 12:42:28 PM »

Hahaha yes yes yes! Sharp and correct jud ka oi!
Agree ko sa imung observation 110%.

;)

I will honor your request, darling Ate.
Fish oil is also good for hyperlipidemic states. It has been medical established that increased intake of fishoil has lead to the increase of HDL (high density lipoproteins), which is good for the heart (cardiothoracic health). And increase in HDL will result in a reduction of LDL (low density lipoprotein; and ldl is correlated to atherosclerotic growth --> which leads to prothrombotic states---> which can dislodge and cause systemic embolus---> can cause visceral infarct ---> if untreated via thrombolytics and anti-platelets/anticoagulants, will lead to Death.

Since HDL outcompetes LDL for the ldl receptors in the liver, this will lead to the metabolism of ldl and prevention of its development in to cholesterol states; thereby increasing the health of the patient.

HDL = very good for pt
LDL = contraindicated for pt.

Dear Ate,
I will honor your request.
Give me a few days. lang.


Love,
Always,
Bran

Lorenzo

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Re: Medical Lecture and Lessons
« Reply #45 on: July 14, 2009, 07:30:32 AM »
Neuropharmacology: Fish Oil and Depression: An Analysis (Part 1)

Presented by: A. Lorenzo Lucino Jr.

http://www.youtube.com/watch?v=9SVzx1sPckE

Lorenzo

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Re: Medical Lecture and Lessons
« Reply #46 on: July 14, 2009, 07:33:39 AM »
[Neuropharmacology: Fish Oil and Depression (Part 2)]

Presented by: A. Lorenzo


http://www.youtube.com/watch?v=OolWJ-HrpqM


For you, Ethylene.
;)




Lorenzo

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Re: Medical Lecture and Lessons
« Reply #47 on: July 14, 2009, 08:22:42 AM »
In some instances, Ethyl, the patient responds well with monotherapy of EPA (from Fish Oil) and has positive results for depressive patients. But a dual therapy with atypical types such as: Bupropion, or mirtazapine and also: EPA(fish oil) is proven effective.

hehehe cool stuff actually, i learned alot in this mini-research.

Lorenzo

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Re: Medical Lecture and Lessons
« Reply #48 on: July 14, 2009, 08:45:14 AM »
Ethy. I do have a question for you, I was talking to my pharmacology and Behav. Psychiatry instructors regarding this earlier today and one thing that i was observing was that some typical anti-depressant drugs have inductive capability of P-450 enzymes and also some have inhibitory effects of the P-450. So in the case of depressive patients that were taking warfarin or heparin to treat their CHD conditions or any CVD conditions as well as depressive states, this would impede the effect of the drug warfarin since it would be subject to hepatometabolism, or the antithesis in the case of inhibitors of the P-450 isoenzymes. I bet you see alot of prescriptions for patients with depressive states as well as HTN/coagability states with changes in dosage for the hemotastatic drugs.

When we treat patients with drugs of the SNRI class (ventafaxine, venlafaxine), these drugs have critical A/E such as:  GIT disturbance (n/v/d: nausea-vomitting-diarrhea) as well as CNS sequelae, and instances of insomnia and sexual dysfunction.

We are taught to treat depressive patients with: Atypical drug therapy and then typical drug therapy. However, my only concern is the fact that atypical drug therapy has substantial S/E that include: tremors, seizures.

My question to you, regarding this, is : Do you see much prescription of drugs such as Mirtazapine and Bupropion to treat anti-depressive states or more so of drugs such as: duloxetine and venlafaxine, Risperidone, Sertindole, Clozapine?



Thanks a bunch, darling.


C2H4

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« Reply #49 on: July 16, 2009, 07:04:57 AM »
Thanks for the post on fish oil, dong. I am getting ready for fish burps. LOL

I was intrigued by your question so I looked into our files and I was surprised actually with what I found out. We have a lot of patients on warfarin but only two were on antidepressants concomittantly. One is on prozac, the other on zoloft. Warfarin is metabolized thru CYP2C9, and prozac inhibits CYP2C9, so I was a little surprised about that. The doctor started with a really low dose though, and the warfarin dose was adjusted as well. Still, it's worrisome coz prozac has a really long half-life. Sertraline on the other hand works better w/ warfarin coz the former mostly inhibits CYP2D6 and it doesn't make that drastic of a change in PT and INR.
We don't have a lot of patients on Mirtazapine. It is not a commonly prescribed drug. That goes for nefazodone as well. Venlafaxine and Buproprion on the other hand are fast-moving drugs. Trazodone is a common prescription too, but not for depression. It's mostly used as a sleep aid. Duloxetine is popular too, for depression as well as for neuropathic pain and fibromyalgia. The SSRIs are still the most prescribed antidepressants. I believe a major factor is the price. They're really cheap, most are only $4 for a month's supply. I also think a big factor on doctor's choice of a med for a patient is what that patient's insurance would pay for. Insurance companies have a tier copay system where SSRIs have the lowest copay, then Buproprion is middle ground, Venlafaxine usually has the highest copays. A lot of companies won't pay for nefazodone or mirtazapine at all. Clozapine is very rarely dispensed, at least, in the retail setting. It is highly regulated, doctors, patients and pharmacies have to enroll and register with a national clozapine program, requiring lots of steps and paperwork, not to mention all the monitoring with bloodwork and everything. So clozapine is reserved for the really refractive cases.
As far as warfarin and antidepressants, they don't pose really severe interactions, thus they are not absolute contraindications. The doctor can prescribe any antidepressant he wants, as long as INR levels as closely monitored. But then, it also depends on what the patient is willing to pay for or what the insurance company would cover.
Hehehe, naglabad akong ulo kay nagamit nko akong utok ug gamay. I will hibernate for a while to recharge. My next post might not be for a while. Always take care, ok? Take it easy with the caffeine. mwah!

Lorenzo

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Re: Medical Lecture and Lessons
« Reply #50 on: July 16, 2009, 02:53:42 PM »
Thank you for the in-depth pharmacokinetic-pharmacodynamic explanation, Ate Ethyl.
Noted, noted.  ;)



Lorenzo

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Re: Medical Lecture and Lessons
« Reply #51 on: July 18, 2009, 01:22:26 PM »
Ate Ethyl, very true jud imung gi ingoon about SSRI's being preferred due to the cost. Thanks for bringing this to all of us to learn and to undersand.

This is why i love Pharmacists. ;)

Muah 8)

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Re: Medical Lecture and Lessons
« Reply #52 on: July 20, 2009, 01:16:07 PM »
Let us proceed further to the discussion of Virology, a subset of Microbiology.

One topic that I want to share here is the concept of Pox Viridae (Pox Viruses), this is the 2nd largest viralgroup, next only to herpes viruses. It contains DNA and RNA. It is brick-shaped ; it is a double stranded DNA , which is enveloped. And there are over 10,000 viruses particles produced from each affected cell and one big particle.

So let me share some Epidemiology of Small Pox:

Pox Viridae do not cause chickenpox; chicken pox is caused by the herpes viridae varicella zoster (VZV). Do note that Pox Viridae Used to cause Small Pox.

Why do we say 'Used' to cause small pox? Answer: That last case of small pox was in 1977. Small Pox is the only major viral agent that has been eradicated from the face of the Earth.

For more than 3 thousand years this highly contagious virus spread via the respiratory tract; causing pox skin lesions and death. A concerted vaccination and surveillance program conducted by the World Health Organization brought this tyranny to an End.

Small pox was the agent that was responsible for the ERADICATION of the Native Americans in North America and Central-South America.

The Small Pox Virus has been eradicated by Medical Science.
Completely.

:)

Lorenzo

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Re: Medical Lecture and Lessons
« Reply #53 on: August 14, 2009, 01:07:03 PM »
The following will be covered in later lectures:

1) Anti-Viral Drugs

2) Anti-Cancer Drugs

3) Basis of Vaccination & Lab Testing

4) Psychological Behavioral Problems: Schizophrenia, Manic Depression, Depression (General): and Treatment Modes.


Cheers.

AsPo

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« Reply #54 on: August 17, 2009, 12:35:09 PM »
dONG LORENZ,,,unsa ning LUPUS desease.is it fatal.nagsearch ko naa may mga sub.is this can tranmit to anay one?thanks dong.heres my E mail,lina_cc@yahoo.com.thanks
"Let thy words be few"

Lorenzo

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Re: Medical Lecture and Lessons
« Reply #55 on: August 17, 2009, 01:59:01 PM »
Catalina,

I will answer your question here.
Lupus or otherwise known as SLE (systemic lupus ereythematosus) isn't a viral or bacterial disease that can be transmitted via aerosol.

It is an immunological defecit. Its a hypersensitivity disease; Type III Hypersensitivity. It is a result of your body being unable to recognize self antigens; as a result, the body's human immune system (innate and adaptive) will target and attack the self antigens; it can lead to systemic damage.

There is no cure to this; as it is a genetic disease; a result of the antigen presenting cell's inability to recognize the 'self' antigen.

What we can do; is suppress the immune system to hinder the damage and prevent further systemic prolapse.

The adverse effect, of course, is bacterial and viral infection as a result of drug-induced immuno suppression.


If you have further questions, you can reach me vis-a-vis:
branlorenzo@gmail.com



AsPo

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« Reply #56 on: August 17, 2009, 05:08:24 PM »
dong thanks so much for the explanation,

Lorenzo

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« Reply #57 on: August 20, 2009, 11:39:08 AM »
The pleasure is mine, Catalina.

Hope all is well.

Lorenzo

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« Reply #58 on: August 20, 2009, 11:50:31 AM »
Hi Guys,

I recently presented a Medical Case Review on: Schizophrenia and Psychotic Disorders , the mode of treatment, diagnosis, and relations recently this month.

As a member of the AMSA (American Medical Students' Association), we, medical student members, are required and opted to present a case that has our interest.

In ever so much interest in the mode of psychotic diseases and treatment of psychotic diseases, which has been fueled by this year's Medical Pharmacology and Psychiatric Behavioral Science classes, I have grown quite interested into the diseases that have plagued human mental health and psychological disturbances.

In understanding the chemical and hormonal imbalances, the pathway deviations, and the methodology that is implemented to correct the neuropathology.

So, I presented on Schizophrenia, a disastrous and severe psychotic disorder, a result of excessive dopaminergic activity and inhibition of inhibitory pathways.

I will post some clips of my presentation; as I was recorded and filmed during my presentation. :)

I thank my friends and medical staff for the recording, as it has been quite rewarding watching it again.

I hope and trust all of you will enjoy it as well.

A learning experience pood.


All the best,
Bran Lorenzo
M.D & Ph.D Candidate
SJUSOM' 2012

Lorenzo

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« Reply #59 on: September 01, 2009, 06:11:14 AM »
A brief overview of the H1N1 Viral Strain, popularly known by the news media as 'Swine Flu'.

http://www.youtube.com/watch?v=DcbH_x3nChA

Enjoy and if you have any questions, feel free to ask.



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