Anti -thyroid

Hyperthyroidism

1) Thioamides - carbimazole, propylthiouracil, methimazole --> block synthesis of thyroid hormone
How to start??
starts at a high daily dose of 15 - 40mg continued until the patient has normal thyroid function. Then reduced to a maintenance dose of 5 - 15mg.
Treatment is usually given for 12 - 18 months followed by a trial withdraw
SE : rashes & pruritus --> if due to carbimazole cn change to PTU
bone marrow suppression (ask patient to come if has fever,sore throat)- Monitor WBC 3monthly
PTU can also cause fulminant liver failure --> death
PTU & methimazole - use in pregnancy. PTU (1st trimester) da rest is methimazole

2) Beta blocker - adrenoreceptor blocker
treat tremor & tachycardia

3) radioactive iodine (131 - I)
MOA : incorporate into storage follicles & destroy tissue internally

4) Iodide replacement agent (pottasium iodide)
MOA : inhibit thyroglobulin proteolysis --> inh hormone release --> decrease overactivity of thyroid

Hypothyroidism

Levothyroxine (synthetic T4) , Liothyronine (synthetic T3)
MOA : actions as endogenous hormone. enter cells, convert T4 to T3, T3 enter nucleus, bind to specific receptor protein, activate the synthesis

Anti Hypertensive

1) Beta Blocker
MOA : Sympatholytic at Beta 1 & Beta 2 adrenoreceptor, inhibit NE at the synapse
Drugs : Propanolol, cardioselective Beta 1 antagonist :Metonolol, atenolol
SE : Bradycardia, bronchospasm, hallucinations, muscle weakness

2) Alpha blocker (seldom use in hypertension, use for BPH)
MOA : Alpha adrenoreceptor blocker cause vasodilatation
Drugs : Prazosin, Terazosin

3) Alpha & beta blocker (use in pre eclampsia / emergency treatment of hypertension)
MOA: Block alpha & beta adrenoreceptor & cause decrease in peripheral vascular resistance leads to reduction in BP
Drugs: Labetolol
SE : Drowsiness, bradycardia, complete heartblock, bronchoconstriction, pulmonary edema
Relative Contraindication : asthma, heart failure, any degree of heart block

4) ACEI
MOA : vasodilator as angiotensin is potent vasoconstrictor. ACEI inhibit conversion of angiotensin 1 to angiotensin II by ACE
Drugs : Captopril, enalapril
SE : hyperkalemia, dry cough, hypotension, postural hypotension, angioedema
Contraindication : Renal artery stenosis, pregnancy, impaired renal function

5) Angiotensin receptor blocker (ARB)
MOA: AT₁-receptor antagonists. Block the activation of angiotensin II AT1 receptor on vessels which directly causes vasodilatation, reduces secretion of vasopressin, reduces production and secretion of aldosterone
Drugs : losartan, valsartan, telmisartan
SE : Dizziness, headache, hyperkalemia, postural hypotension on first dose

6) Calcium channel blocker (CCB)
MOA: Block entry of calcium through calcium channel in the smooth muscle of endothelium cause it to relax & vasodilatation
Drugs:
Dihydropyridine (Nifedipine, amlodipine)
Nondihydropyridine (verapamil, diltiazem) --> reduce myocardial oxygen demand & reverse coronary spasm
SE: Dihydropyridine - reflex tachycardia, leg edemadizziness,headache
Non-dihydropyridine - arrythmias
CI ; can worse proteinuria in pt with nephropathy

7) Direct Vasodilator
MOA : at local level. Nitric oxide - potent vasodilator, enhance action of NO direct at vessels
Drugs : Hydralazine, Minoxidil, Na nitroprusside
SE : Hypotension, headache, Tachycardia, tachyphylaxis

8) Centrally acting drugs
MOA : affect on CNS & sympathetic NS
Drugs : clonidine - use or migraine
Methyldopa - safest to use in pregnancy
SE: dizzinessm postural hypotension

9) Diuretics
a) Thiazide (chlorothiazide, indapamide)
MOA: inh reabsorption of Na & K at distal tubule
SE : hypokalemia, metabolic alkalosis, hyperurecemia, hyperglycemia
CI : gout

b) Carbonic anhydrase Inhibitor (CAI) - acetazolamide - use for acute glaucoma
MOA : Inh reabsorption of NaHCO3- at proximal tubule
SE : hypokalemia, metabolic acidosis, hypersensitivity

c) Loop Diuretics - Furusemide, Bumetanide, Ethacrynic acid
MOA : Inh reabsorption of Na, Cl, K at THICK ASCENDING Loop of HenLe & increase renal blood flow by cortical vasodilatation
SE : hypokalemia, metabolic alkalosis, postural hypotension

d) Pottassium sparing - spironolactone
MOA : Aldosterone antagonist - inhibit action of aldosterone at distal tubule & collecting duct
SE : hyperkalemia, metabolic acidosis, gynecomastia

10) Renin inhibitor - Aliskiren
MOA : act on the Juxtaglomerular cells of kidney, which produce renin in response to decreased blood flow
SE : hyperkalemia, hypotension, angioedema

DAY 1 - Be Strong~

Tomorrow Is The Day. Today is My last day to recap most that Ive studied before. Please pray that I make it this time. There is a limit to a person's strength.

But for now, I just want to do my best, prepare the best that I can, be positive, be SUPER happy, MEGA happy, have INFINITE happiness & the rest I leave it to Allah. Human has so much limitations. Just live with it & be happy with it.

Allah knows best for me. I always believe Allah will definitely help those who ask for his help & those inneed~

Akhir kata. benarlah kata-kata Allah (Always believe in his promises) =)

Warna Warni 2010

Tiba-tiba tengah stadi, teringat kepada kemeriahan sanak saudara apabila berkenduri. Ini yang membawa saya kepada entry ini. Warna Warni 2010 pastinya membawa seribu kenangan.

Terutamanya kepada saya dan pastinya kepada saudara mara sebelah saya & suami juga. Agenda paling hangat adalah majlis perkahwinan yang dilangsungkan sepanjang tahun ini =)

Pembuka tirai 2010. Perkahwinan saya dan suami pada tanggal 1hb & 2hb Januari
Venue: Bandar Baru Bangi & Saujana Utama

Seterusnya perkahwinan Iwan dan Ila - September 2010
Venue : Melaka & Sg Besar

Penutup tirai 2010. Perkahwinan Kapten Fizi & Shida - November 2010
Venue : Sg Besar
Sayang, hanya ada satu gambar sahaja. Huhu~ Selebihnya ada di rumah pula~

Seronok melihatkan gambar-gambar ini. Teringat betapa gembiranya saya pada ketika itu. Eh, tak bermakna sekarang saya tidak gembira. Gembira juga~ hehe

DAY 3 - THE ROAD

With just a glimpse (5months ago), the road seems to be rough & bumpy with no ends to it.....

Yeah, definitely the journey requires a lot of works & sacrifices.........

Need to juggle between so many things~


But I chose to be happy & enjoy the things that I did till the very end~

Always be grateful of what I have & make the best of it....SMILE~


KAU RAHMATILAH KAMI YA ALLAH~ AKU REDHA DENGAN KETENTUANMU~

DAY 4 - WiLL I ?

Will I be able to fit perfectly into the glass slippers?

As this is my last chance to achieve my childhood dream. Pray hard it wont fall & break into pieces like the other side of my delicate slippers. Help me through ya Allah~

I wonder how it feels when it does.....

Dear Liyana.....

only 3 days left...use the time wisely....

May Allah help me along the way...

Lend me your strength, Ya Allah~

KeLetiHaN~

Hati tenanglah dikau, setenang awan di langit~

Sangat bersyukur setiap hari kerana Allah sangat memudahkan urusan saya. Positiviti yang saya ada sangat-sangat membantu & makin sampai kepenghujung, terbit pula rasa sayang nak tinggalkan lecturer2 & UIA.

Dalam semangat untuk meneruskan saki-baki perjuangan, mula merasakan kepenatan yang mula melanda diri. Sebelum ini ada study group, jadinya bila kita penat, kawan-kawan yang tolong ajar & turn kita mendengar & bergilir-gilir dalam berkongsi ilmu. Tetapi sekarang tidak lagi, semuanya harus diusahakan sendiri & hanya kepada Allah saya memohon pertolongan.

Manusia kudratnya sangat terbatas. Apabila kita menginginkan sesuatu, memang kita menggunakan kudrat kita, tetapi siapa yang membenarkan setiap otot-otot kita ini berfungsi??Siapa yang membenarkan sel-sel otak kita memainkan peranan??Semuanya daripada ALLAH kan~

Jadinya, have fun & teruskan usaha & bergembiralah dengan apa yang kamu ada =)

Sikit-sikit kan lama-lama jadi bukit~ hehe

"Ya Allah~ kau lembutkanlah hati examiner2ku nanti~ "