Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. Hypertension is when blood pressure is too high. The drugs which are used to treat hypertension are known as hypertension drugs. Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats. WHO Key Facts on Hypertension Hypertension – or elevated blood pressure – is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases. An estimated 1.13 billion people worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. In 2015, 1 in 4 men and 1 in 5 women had hypertension. Fewer than 1 in 5 people with hypertension have the problem under control. Hypertension is a major cause of premature death worldwide. Hypertension Drugs List There are several classes of hypertension drugs. Each class lowers blood pressure in a different way. 1. DIURETICS Diuretics increase urination which reduces sodium and fluid in the body. That can help lower blood pressure because it lowers blood volume. Mild hypertension can sometimes be treated using diuretics alone, although they are more commonly used in combination with other high blood pressure medications. Examples of diuretics include: Bumetanide (Bumex) Chlorthalidone (Hygroton) Chlorothiazide (Diuril) Ethacrynate (Edecrin) Furosemide (Lasix) Hydrochlorothiazide HCTZ (Esidrix, Hydrodiuril, Microzide) Indapamide (Lozol) Methyclothiazide (Enduron) Metolazone (Mykroz, Zaroxolyn) Torsemide (Demadex) One side effect of diuretics is a loss of potassium, which carry out of the body in urine along with sodium. Potassium is essential for proper muscular movement and a deficiency of this mineral can result in fatigue, weakness, leg cramps, and even problems with the heart. So often, patients on traditional diuretics advise to take their medication with a potassium-rich food, such as orange juice or a banana, or they will take a potassium supplement.Some diuretics developed to address the issue of potassium loss. These blood pressure medications are known as “potassium-sparing” diuretics. They include Amiloride (Midamor) Spironolactone (Aldactone) Triamterene (Dyrenium). Finally, there are the combination diuretics, which include a potassium-sparing agent and a traditional diuretic. These include Amiloride hydrochloride and hydrochlorothiazide HCTZ (Moduretic) Spironolactone and HCTZ (Aldactazide) Triamterene and HCTZ (Dyazide, Maxzide). 2. BETA BLOCKERS Beta-blockers lower blood pressure by acting directly on the heart. These high blood pressure medications reduce heart rate and force of pumping, as well as reduce blood volume. Beta-blockers includes Acebutolol (Sectral) Atenolol (Tenormin) Bisoprolol fumarate (Zebeta) Carvedilol (Coreg) — Combined alpha/beta-blocker Esmilol (Brevibloc) Labetalol (Trandate, Normodyne) — Combined alpha/beta-blocker Metoprolol tartrate (Lopressor) and metoprolol succinate (Toprol-XL) Nadolol (Corgard) Nebivolol (Bystolic) Penbutolol sulfate (Levatol) Propranolol (Inderal) Sotalol (Betapace) HCTZ and bisoprolol (Ziac) is a beta-blocker plus 3. ACE INHIBITORS Angiotensin is a hormone in the body that causes blood vessels to narrow. The angiotensin-converting enzyme (ACE) inhibitors decrease the production of angiotensin and, in turn, that helps lower blood pressure. Examples of ACE inhibitors include: Benazepril hydrochloride (Lotensin) Captopril (Capoten) Enalapril Maleate (Vasotec) Fosinopril sodium (Monopril) Lisinopril (Prinivil, Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril hydrochloride (Accupril) Ramipril (Altace) Trandolapril (Mavik) 4. ANGIOTENSIN II RECEPTOR BLOCKERS The hormone angiotensin narrows blood vessels, but to do its job it needs a place to bind. That’s where angiotensin II receptor blockers come in. They prevent angiotensin from binding to receptors on the blood vessels and that helps lower blood pressure. Angiotensin II receptor blockers include: Azilsartan (Edarbi) Candesartan (Atacand) Eprosartan mesylate (Teveten) Irbesartan (Avapro) Losartan Potassium (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan) 5. CALCIUM CHANNEL BLOCKERS Calcium increases the strength and force of contractions in the heart and blood vessels. Blocking its entry into smooth muscle tissue reduces this effect. Calcium channel blockers lower blood pressure by relaxing blood vessels and reducing heart rate. Examples of calcium channel blockers include: Amlodipine besylate (Norvasc, Lotrel) Clevidipine (Cleviprex) Diltiazem hydrochloride (Cardizem CD, Cardizem SR, Dilacor XR, Tiazac) Felodipine (Plendil) Isradipine (DynaCirc, DynaCirc CR) Nicardipine (Cardene SR) Nifedipine (Adalat CC, Procardia XL) Nimodipine (Nimotop, Nymalize) Nisoldipine (Sular) Verapamil hydrochloride (Calan SR, Isoptin SR, Verelan, Covera HS) 6. ALPHA BLOCKERS Alpha-blockers cause blood vessels to dilate, thereby lowering blood pressure. These medications are also used to treat prostate enlargement in men. Alpha-blockers include Doxazosin mesylate (Cardura) Prazosin hydrochloride (Minipress) Terazosin hydrochloride (Hytrin) 7. ALPHA-2 RECEPTOR AGONIST Methyldopa, formerly known under the brand name Aldomet, is one of the oldest blood pressure medications still in use. It was first introduced more than 50 years ago. Methyldopa works in the central nervous system to lower blood pressure. While its general use has declined over the years, methyldopa is considered the first-line of treatment for high blood pressure that develops during pregnancy. 8. CENTRAL AGONISTS Some hypertension medications work in the central nervous system rather than directly on the cardiovascular system. Central agonists thus have a tendency to cause drowsiness. Drugs in this class include Clonidine hydrochloride (Catapres) and Guanfacine hydrochloride (Tenex). 9. PERIPHERAL ADRENERGIC INHIBITORS There was a time when the high blood pressure medication list was very short indeed. In the 1950s, reserpine was one of the few products on the market to treat hypertension. It rarely uses due to its numerous side effects and drug interactions. The peripheral adrenergic inhibitors work in the brain to block signals that tell blood vessels to constrict. They are mostly used when other high blood pressure medications fail to solve the problem. Guanadrel (Hylorel), guanethidine monosulfate (Ismelin), and reserpine (Serpasil) are peripheral adrenergic inhibitors. 10. VASODILATORS Vasodilators relax artery wall muscles, and that causes blood pressure to drop. These drugs usually not use alone — and, in the case of Minoxidil (Loniten) — used only in severe hypertension. Hydralazine (Apresoline) Minoxidil (Loniten) are vasodilators.
12 Drugs Every Emergency Pharmacist Should Know
An emerging field of practice for pharmacists is emergency medicine. Emergency Pharmacist deals with emergency drugs. The Centers for Disease Control and Prevention (CDC) states that there were 130.4 million visits to the emergency department (ED) in 2013. Following below are the key role of an emergency pharmacist. Direct Patient Care Rounds Medication Order Review Medication Therapy Monitoring Patient Care Involving High-Risk Medications and Procedures Resuscitation ( Pharmacists prepare medications for immediate administration) Medication Procurement and Preparation Medication Information Documentation Emergency drugs may be divided into two categories. The first category is drugs that are essential and should be part of every emergency drug kit. The second category consists of drugs that are useful but are optional depending on the practitioner’s training in emergency medical procedures and whether sedation and general anesthesia are used for behavior and anxiety management. Thus, emergency drug kits will vary from office to office. 1. Acetylcysteine MOA: Replenishes glutathione stores serves as glutathione substitute and enhances sulfate conjugation of acetaminophen (Tylenol) PO Dose: 140 mg/kg x 1, then 70 mg/kg q 4 hours x 17 doses (72 hours total) IV Dose: 150 mg/kg in 200ml D5W over 1 hour, 50 mg/kg in 500ml D5W over 4 hours, 100 mg/kg in 1 liter D5W over 16 hours (21 total hours, may need to continue until LFTs and APAP level normalize) Emergent Indications: Acetaminophen (Tylenol) overdose Where you’ll get in Trouble: Hypersensitivity reaction (stop infusion, switch to PO or slow infusion rate), while rare, you can also see hypersensitivity with PO as well, Preg B 2. Atropine MOA: Direct anticholinergic Dose: Organophosphate/carbamate toxicity: 1-6 mg IV q 3-5 minutes PRN, until dry secretions (can double dose each time until adequate response achieved) Peds Bradycardia: 0.02 mg/kg IVx1; 0.5 mg maximum single dose; 1 mg max cumulative dose Adult bradycardia: 0.5 mg IV, 3 mg max cumulative dose Emergent Indications: Organophosphate/carbamate toxicity, bradycardia Where you’ll get in Trouble: Hyperthermic patients, tachydysrhythmias, Preg C 3. Diazepam MOA: Enhances inhibitory effects of GABA Dose: 2-10 mg PO/IV/IM q 6 hours PRN Emergent Indications: Seizure abortion, alcohol withdrawal, agitation, muscle spasm Where you’ll get in Trouble: Respiratory depression, hypotension, Preg D 4. Diltiazem MOA: Inhibits calcium influx in myocardium > vascular smooth muscle; prolongs AV nodal conduction Dose: 0.25 mg/kg IV x1; may give 0.35 mg/kg IV x1 after 15 minutes; continuous infusion 5-15 mg/hr Emergent Indications: Stable Afib with RVR, stable SVT Where you’ll get in Trouble: Latrogenic hypotension, bradycardia, Preg C 5. Epinephrine MOA: Alpha and beta-receptor agonist Dose: ACLS: 1 mg 1:10,000 IV PALS: 0.01 mg/kg 1:10,000 IV Anaphylaxis: 0.1-0.5 mg 1:1,000 IM/SQ (IM preferred) Peds anaphylaxis/asthma: 0.01 mg/kg 1:1,000 IM/SQ (max single dose 0.3 mg) Hypotension refractory to IVF: 1-10 mcg/min IV Emergent Indications: Anaphylaxis, ACLS arrest, PALS/NRP arrest, severe asthma Where you’ll get in Trouble: Dosing errors (10 fold errors), tissue necrosis (needs to administer via central venous line), dysrhythmias, Preg C 6. Esomeprazole MOA: Inhibits parietal cell hydrogen-potassium ATPase (PPI) Dose: 80 mg IV bolus followed by 8 mg/hour Emergent Indications: Upper GI bleed (non-variceal) Where you’ll get in Trouble: Fairly benign when used acutely, Preg B 7. Furosemide MOA: Inhibits Na and Cl reabsorption in the distal renal tubule and ascending loop of Henle Dose: The usual dose in ED 20-40 mg IV, reassess, increase to desired effect (maximum single dose 200mg) Emergent Indications: Pulmonary edema, CHF exacerbation, hyperkalemia (if making urine) Where you’ll get in Trouble: Volume depletion, hypokalemia, metabolic alkalosis, ototoxicity, Preg C 8. Fomepizole MOA: Inhibits alcohol dehydrogenase Dose: 15 mg/kg IV loading dose, then 10 mg/kg q 12 hours x 4 doses, then 15 mg/kg q 12 hours until ethylene glycol levels < 20 mg/dL and patient asymptomatic with normal pH Emergent Indications: Methanol or ethylene glycol toxicity Where you’ll get in Trouble: Fairly safe, Preg C 9. Glucagon MOA: Stimulates cAMP production independent of the beta receptor, increases gluconeogenesis and glycogenolysis Dose: Beta-blocker/Ca channel blocker toxicity: 3-10 mg IV loading dose, then 1-10 mg/hour IV continuous infusion if responsive to loading dose Hypoglycemia: 1 mg IV/SQ/IM Emergent Indications: Beta-blocker toxicity Ca channel blocker toxicity, hypoglycemia Where you’ll get in Trouble: Anaphylactoid reaction, can cause hypotension, emesis (aspiration risk in the altered patient), Preg B 10. Heparin MOA: Binds to antithrombin III thereby potentiating inactivation of thrombin and factors IX, Xa, XI, XII; prevents fibrinogen → fibrin; preferential inactivation of thrombin over other clotting factors Dose: Venous thromboembolism: 80 units/kg IV x 1, then 18 units/kg/hour ACS or Afib: 60 units/kg IV x 1, then 12 units/kg/hr Emergent Indications: Thromboembolism; ACS (enoxaparin preferred for NSTEMI) Where you’ll get in Trouble: Bleeding (protamine may be given for reversal), dosing errors, Preg C 11. Insulin Regular MOA: ↑ peripheral glucose uptake increased inotropy, shifts potassium intracellularly Dose: Hyperkalemia: 5-10 units IV x 1 CCB overdose: 1 unit/kg bolus given with 25 grams of dextrose if initial BG < 250 mg/dL; then initiate insulin drip at 0.1 – 1 unit/kg/hr titrated to SBP along with 0.5 g/kg/hr of dextrose titrated to maintain BG 100 – 200 mg/dL DKA/HHS: 0.1 unit/kg bolus followed by continuous infusion 0.1 unit/kg/hour Emergent Indications: Hyperkalemia, DKA/HHS, CCB overdose Where you’ll get in Trouble: Hypokalemia, hypoglycemia, only regular insulin can be given IV, Preg B 12. Sodium Bicarbonate MOA: Increases serum bicarbonate (increases buffer stores) Dose: Hyperkalemia or metabolic acidosis: 50 mEq IV x 1 (1 amp = 50 mEq) TCA toxicity: 1-2 mEq/kg IV bolus to achieve a serum pH of 7.45-7.55 and QRS narrowing; effective serum alkalinization unlikely with continuous infusion Salicylate toxicity: 3 amps (150mEq) in 1 liter D5W given as 10-20 ml/kg bolus, then 2-3ml/kg/hr; goal urine pH 7.5-8.0 Emergent Indications: Hyperkalemia, TCA toxicity, salicylate toxicity, metabolic acidosis Where you’ll get in Trouble: caution in CHF, overshooting into metabolic alkalosis, hypernatremia, Preg C
Medicines To Be Avoided During Pregnancy
Doctors usually tell women to avoid medicines during pregnancy, if possible, especially during the first 3 months. That is when a baby’s organs form. Early in the first trimester, many women don’t yet know that they are pregnant. While the science is very limited (pregnant women are generally not included in medication safety studies) there are a handful of medications that are considered category X drugs, or drugs that should not be taken in women who are or may become pregnant. Which Medicines Can I Take During Pregnancy? Before prescribing any medicine, your doctor or midwife will look at whether the risk of taking medicine is higher than the risk of not treating your illness. It can be hard to know if a medicine is safe for your baby. Most medicines are not studied in pregnant women, because researchers worry about how the medicines might affect the baby. If you are planning a pregnancy, talk to your doctor or midwife about any medicines you are taking, including over-the-counter ones. In general, doctors say it is usually safe to take Acetaminophen (such as Tylenol) for fever and pain. Penicillin and some other antibiotics. HIV medicines. Allergy medicines (A few). Over-the-counter cold medicines (A Few). Some medicines for high blood pressure. Most asthma medicines. Some medicines for depression. Some medicines for heartburn. Which Medicine I Should Not Use During Pregnancy? Some of the over-the-counter medicines that increase the chances of birth defects are: Bismuth subsalicylate (such as Pepto-Bismol). Phenylephrine or pseudoephedrine, which is decongestants. Avoid medicines with these ingredients during the first trimester. Cough and cold medicines that contain guaifenesin. Avoid medicines with this ingredient during the first trimester. Pain medicines like aspirin and ibuprofen (such as Advil and Motrin) and naproxen (such as Aleve). The risk of birth defects with these medicines is low. Some of the prescription medicines that increase the chances of birth defects are: The acne medicine isotretinoin (such as Accutane). This medicine is very likely to cause birth defects. It should not be taken by women who are pregnant or who may become pregnant. ACE inhibitors, such as benazepril and lisinopril, which lower blood pressure. Some medicines to control seizures, such as valproic acid. Some antibiotics, such as doxycycline and tetracycline. Methotrexate, which is sometimes used to treat arthritis. Warfarin (such as Coumadin), which helps prevent blood clots. Lithium, which is used to treat bipolar depression. Alprazolam (such as Xanax), diazepam (such as Valium), and some other medicines used to treat anxiety. Paroxetine (such as Paxil), which is used to treat depression and other conditions. I hope this will help you. Please share it with people you care about.
Microbial Bioassay: An Easy Guide
A microbial bioassay is a testing procedure in which the biological activity of a substance or product to stimulate or inhibit the growth of a microbial test organism is estimated. In contrast to common physical or chemical methods, a microbial bioassay results in detailed information on the true activity of a substance. Over the last decade, this type of assays has become increasingly important for quality control and product development. Types of Microbial Bioassay There are two types of microbial bioassay as per USP. Cylindrical Plate Assay Turbidimetric Assay Cylindrical Plate Assay This method depends upon the diffusion of antibiotics through a solidified agar layer in a Petri dish to an extent that the growth of microorganisms is prevented in a circular area known as the zone of inhibition, around the cavity containing antibiotic solution. Turbidimetric Assay The turbidimetric method is a method to determine the antimicrobial potency of an antibiotic, based on the measurement of the inhibition of growth of a microbial culture in a fluid medium. The inhibition of the growth of a test organism is photometrically measured as changes in the turbidity of the microbial culture. Procedure In this article, I will discuss in detail the procedure of the cylindrical plate method of microbial bioassay. Reagents Buffer pH 8.0 Dissolve 1.70gm of KH2PO4 and 0.491gm of NaOH in distilled water and make volume to 500ml with distilled water. Adjust pH with 0.1N NaOH or 0.1N HCl if required. Sterilize this buffer in the autoclave for 15 minutes at 121 C and 15 PSI pressure. Preparation of Innoculum Grow pure organism Staphylococcus epidermidis ATCC 12228 for 18 hours in Antibiotic Agar # 1 pH 6.6 ± 0.1 at 32 — 35°C. This growth is transferred with 3ml sterile saline to the surface of 250ml Antibiotic Agar # 1 pH 8.3 ± 0.1 and incubate it for 24 hours at 32 — 35°C. Prepare the stock suspension by collecting the surface growth in 50ml of sterile saline. Preparation of Standard Dilutions The quantity (mg) of standard is calculated as below and weighed exactly to prepare standard stock solution of 1000 IU / ml. 100,000/ T1 Where T1 = Std. concentration in IU /mg Place the weighed Standard in a 100ml volumetric flask. Add approx. 80ml of sterile phosphate buffer solution pH 8.0 ± 0.1. Mix with a magnetic stirrer and make-up the volume to 100ml with sterile phosphate buffer solution pH 8.0 ± 0.1. Make standard high and standard low dilution as follows. i- Standard High: 1ml stock solution volume to 50 ml with sterile phosphate buffer pH 8.0 (i.e. 20 IU / ml). ii- Standard Low: 0.5ml stock solution volume to 50ml with phosphate buffer pH 8.0 (i.e. 10 IU / ml). Preparation of Sample Dilutions Dissolve equivalent sample powder in 100ml sterile phosphate buffer pH 8.0. Filter stock sample solution after 30 minutes stirring before proceeding for dilutions. Prepare sample high and low dilutions as in case of standard. Preparation of Media Plates Prepare Antibiotic Agar # 1 as directed by the manufacturer in 200ml quantity. Adjust pH to 8.3 ± 0.1 and then divide it into 150ml and 50 ml in the separate flask and then autoclave them. Give base layer by pouring 21 ml each into six sterilized Petri plates with the help of sterile wide tip 25ml pipette let it solidify. Add 0.2ml of prepared organism suspension to 50ml of prepared media while at 45°C swirl to mix suspension evenly and give seed layer of 4ml with the help of a 5ml wide tip sterile pipette. Leave the plates for solidification of the seed layer. Make four cavities 6 — 8 mm with the help of a sterilized borer and spatula and mark as SL, SH, STL, STH. S = Sample ST = Standard L = Low Dosage H = High Dosage Fill cavities by pouring 100µl of prepared low dilution (1 IU / 100µl) and High dilution (2IU / 60ml). Incubation Allow the transferred solution to absorb in the media for 1 — 2 hours then incubate the plates in the incubator at 36 — 37.5°C for 18 hours. Observations After incubation period observe the plates for zones of inhibition Measure the zones on zone magnifier with the help of vernier caliper. Four out of six plates should give reproducible results. Calculations Calculate the content as follows. Potency (%) = Antilog (SH + SL) — (STH + STL) ____________________ x 0.301 (SH – SL) + (STH – STL) x 100
Important Drug Interactions of the High Alert Drugs
High-alert drugs are drugs that bear a heightened risk of causing significant patient harm when they are used in error. High-alert drugs carry a significant risk of causing serious injury or death to patients when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients. For years, the Institute for Safe Medication Practices (ISMP) has published a list of high-alert medications for acute care settings. ISMP gives the following strategies to reduce the risk of errors and minimize harm. Standardizing the ordering, storage, preparation, and administration of these medications Improving access to information about these drugs Limiting access to high-alert medications Using auxiliary labels and automated alerts Employing redundancies High Alert Drugs The following medicines should ‘ring alarm bells’ as having important interactions: Warfarin Statins Macrolide Antibiotics Calcium Channel Blockers Azole antifungals SSRIs – fluoxetine Amiodarone Digoxin Rifampicin, Isoniazid Antiepileptic medicines – particularly carbamazepine, phenytoin; less so valproate Important Drug Interactions of High Alert Drugs Warfarin Monitor INR and patient closely when adding metronidazole, ciprofloxacin, cotrimoxazole, clarithromycin, doxycycline, fluconazole, azathioprine, rifampicin, isoniazid, carbamazepine, phenytoin, sulfasalazine, amiodarone Adjust dose of warfarin, at the outset, when adding these drugs Switch to LMWH or UFH Atorvastatin Do not use with verapamil, clarithromycin, itraconazole, fluconazole, ciclosporine Monitor CPK levels Switch to rosuvastatin (with warfarin, atorvastatin may be better) when adding any of these drugs Clarithromycin Do not use with atorvastatin, digoxin, warfarin, dabigatran, rivaroxaban, apixaban, colchicine, phenytoin, carbamazepine and drugs that prolong QT interval May use azithromycin or another antibiotic in patients taking any of these drugs Itraconazole, Fluconazole Do not use with atorvastatin, dabigatran, rivaroxaban, apixaban, digoxin Use carefully with warfarin, carbamazepine, phenytoin, rifampicin Digoxin Do not use with clarithromycin, itraconazole, ciclosporine, verapamil, diltiazem Use carefully with diuretics, amiodarone, rifampicin, phenytoin, carbamazepine Rifampicin, Isoniazid Use carefully with hepatotoxic drugs Use carefully with phenytoin, carbamazepine, warfarin, digoxin, calcium channel blockers, oral contraceptives, corticosteroids, sulfonylureas, macrolide antibiotics, azole antifungals Carbamazepine, Phenytoin Do not use with clarithromycin, oral contraceptive pills Use carefully with warfarin, itraconazole, isoniazid, rifampicin Amiodarone Use carefully with digoxin, warfarin, carbamazepine, phenytoin, and drugs that prolong QT interval Sildenafil Do not use with nitrates Allopurinol Do not use with azathioprine For Further Information Please Subscribe [email-subscribers-form id=”1″]
HAAD Exam Preparation Guide: Tips for UAE Healthcare Professionals
Do you want to practice in the United Arab Emirates (UAE)? A professional license is a mandatory requirement to practice within a profession in UAE. To get a license you must pass the HAAD exam. I tried to cover everything from what is the HAAD exam? what do you have to study for the exam? Who should take the exam? Tips for the Exam Test and actionable steps that you can take to pass your HAAD exam. To make it easy, I have created a table of contents to help you navigate through our ultimate guide to prepare for the HAAD exam. Table of Contents What is the HAAD Exam? HAAD Exam Syllabus What is the ESS (Examination & Evaluation System)? Who should take the HAAD Exam? Tips for Exam Day Exam Preparation Timeline Exam Day Happening Before the exam day How to Register for the HAAD exam? Requirements of HAAD exam Cost of the HAAD exam Recommended Books for HAAD What is the HAAD Exam? HAAD (Health Authority of Abu Dhabi) is a professional license exam conduct by Abu Dhabi Authority. There are different specialties of exams depending on the student’s profession. The major areas which HAAD covers include Doctors in Abu Dhabi must obtain specific licenses from HAAD depending on whether they are interns, general practitioners, specialists, consultants or resident doctors. Pharmacists need to take a different exam on the basis of their specialization’s, The HAAD classifies pharmacists into clinical pharmacists, community pharmacists, and pharmacy technician. Nurses too must obtain their licenses from HAAD depending on whether they are applying to be registered nurses, registered midwives, nurse practitioners, mental health nurses, pediatric nurses, community nurse or assistant nurses. HAAD Exam Syllabus Pharmacist HAAD Syllabus 1. Professional and Ethical Practice Self-management Commitment to Quality Fulfills their legal and regulatory obligations as a Pharmacist and employer Demonstrate ongoing learning 2. Dispensing medicines Manage the dispensing process Adheres to legal and ethical requirements of UAE prescriptions Promote and contribute to the optimal use of medicines Communicate effectively Provide clinical and pharmaceutical services Provide medicines and health information and education 3. Manage work issues and relationships Manage work Manage problems Communicate effectively in the workplace Work effectively with others 4. Clinical competence Clinical governance Continuing professional development (CPD) Health and safety Prescribing guidelines Code of ethics Environmental protection Consumer and Data protection Evidence-based practice Action and uses of drugs Quality Assurance Responding to adverse drug reactions Triage Adverse effects of medicines Drug interactions Counseling requirements Optimizing patients’ drug therapy Health promotion and disease prevention Pharmaceutical Calculations Nurse HAAD Syllabus 1. Management of Nursing Care Promotes patient optimum health and wellbeing Promotes an environment that maximizes patient safety Promotes patient physiological and psychological integrity 2. Professional and Ethical Practice Demonstrates professional behavior when working with people Upholds and contributes to the maintenance of professional nursing standards Actively contributes to collaborative working relationships with members of the interdisciplinary healthcare team 3. Professional Development Demonstrate a commitment to the development of self Demonstrates a commitment to the development of others Demonstrates a commitment to the development of the profession 4. Clinical competence: Geriatric medicine, most notably diabetes, rheumatoid arthritis, cataracts, Alzheimers and dementia. First Aid and CPR Clinical Application of Laboratory Tests Pain Management Cardiac Dysrhythmias: Interpretation, Treatment, and Nursing Management Drugs of Abuse and Mental Health Issues Clinical Application of: Pharmacological Concepts Nursing Management of Human Resources Trauma/Critical Care Nursing Women’s Health Issues Computing and Nursing Informatics Ethical Challenges in Health Care Informatics Dying and Death Emergency Care and Safety What is the ESS (Examination & Evaluation System)? Each type of professional can apply for the fully online Examination & Evaluation System (EES), in their own country, thus reducing costs and time, all fees can even be paid electronically. All health-care professionals including doctors, technicians, dentists, pharmacists, and traditional practitioners; especially outside the UAE can now apply online for a medical license to work in the UAE. Who Should Take the HAAD Exam? Central Sterile Services Department (CSSD) – someone who performs decontamination services, mainly in a hospital setting. Dental technician – someone who aids a dentist performing their job. Dietician – someone who works with food and nutrition. Emergency Medical Services (EMS) – emergency care, paramedicine, medical assessment. GP Dentist. Medical imaging – this is mainly radiography. Medical practitioner – this is mainly a doctor. Medical laboratory technician – laboratory sciences, hematology. Nursing – similar to NCLEX Exam. Optometry – ophthalmology. Pharmacist – very similar to the NAPLEX Exam. Physiotherapy Tips For Exam Day When you arrive at the test center, there are some initial steps you will need to complete before sitting down for the exam: You will be required to “Check-In” at the reception desk in the Test Centre where you will present your two forms of valid, original identification. The test center staff will verify your appointment time, your identity, and they will take a photo of you and collect your signature on an electronic signature pad. The Candidate Rules that contain the terms conditions for sitting the exam will be given to you. It is your responsibility to read and understand the terms and conditions of sitting at the Health Authority of Abu Dhabi examination. The Test Centre Administrator will provide you with a locker and key to store all of your personal belongings after check-in. You may not bring any personal belongings into the testing room. This includes but is not limited to the following: Mobile telephones Blue Tooth headphones PDAs Handbags Books Paper Drinks and food of any kind Medicines Pens, pencils, markers Exam Preparation Timeline Prepare – practice makes perfect, make sure you practice from as many sources as possible. Remember you can learn from as many books as possible but the most effective way to make sure this stays in your brain is to use it, do as many HAAD Exam questions as possible. Dedicate – make sure you dedicate enough time to the exam, on average students take at least two months to prepare often reserving at least 15 hours per week to make
Serial Dilutions: An Easy Learning Guide
Dilution is the process of making a solution weaker or less concentrated. In microbiology, serial dilutions (log dilutions) are used to decrease a bacterial concentration to a required concentration for a specific test method, or to a concentration which is easier to count when plated to an agar plate. I have created this guide to provide a better understanding of dilutions and should be used as a guideline, not a replacement for laboratory procedures. Types of Dilutions Log Dilutions A log dilution is a tenfold dilution, meaning the concentration is decreased by a multiple of ten. To complete a tenfold dilution, the ratio must be 1:10. The 1 represents the amount of sample added. The 10 represents the total size of the final sample. For example, a sample size of 1 ml is added to 9 ml of diluent to equal a total of 10 ml. Example: 1:10 dilution – if the concentration is 1,000 CFU, a one log dilution will drop the concentration to 100 CFU. Multiple Dilutions Multiple dilutions are required to decrease the sample concentration by multiple logs. If the concentration is 35,000 CFU/ml (104), and 35 CFU/ml is the target concentration, the following serial dilutions can be performed. Serial Dilution A serial dilution is the stepwise dilution of a substance in a solution. Usually, the dilution factor at each step is constant, resulting in a geometric progression of the concentration in a logarithmic fashion. Purpose of Serial Dilution Like I mention above A serial dilution is a series of sequential dilutions used to reduce a dense culture of cells to a more usable concentration. Each dilution will reduce the concentration of bacteria by a specific amount. Requirements Sterile Normal Saline Desired Strain (Bacterial culture) Multiple tubes with a screw cap MicroPipette Agar (Tryptic Soy Agar, Selective media) Broth (Tryptic Soy Broth) Precautions Clean and sterilize your work area. Use either disposable inoculation loop or a metal loop that can be heat sterilized to inoculate plates, slants and liquid tubes. If using a metal loop, be sure to cool the loop by touching the sterile cooled liquid media. Procedure Make dilution in the 1st tube by taking 2ml normal saline in a tube and inoculate the desired culture in it. Label 10 tubes and plates as 1,2,3……..,10. Add 9 ml in each test tube. After this, transfer 1 ml (known volume) of the culture from the previously made dilution into the 1st tube having 9ml normal saline. From 1st tube transfer 1ml (known volume) in 2nd test tube and repeat steps till 10th test tube. Discard 1ml from the 10th test tube. After making dilutions, pour 100ul with a pipette from 1st test tube into the respective plate. Repeat this procedure until the 10th plate. After following these steps, pour media TSA or desired media into the plates and let them solidify. Incubate at 35° ±2 in case of bacterial culture and for fungus incubate at 23°±2. Results Observe after 24 hours. Calculations Dilutions are useful in science when making solutions or growing an acceptable number of bacterial colonies to count. There are three formulas used to work microbiology dilution problems: finding individual dilutions, finding serial dilutions, and finding the number of organisms in the original sample. To find a dilution of a single tube, use the formula: sample/(diluent + sample). The sample is the amount you are transferring into the tube, and the diluent is the liquid already in the tube. When you transfer 1 ml into 9 ml, the formula would be 1/(1+9) = 1/10. This could also be written as 1:10. After you have calculated the individual dilutions for each tube, multiply the dilutions when using serial dilutions. Serial dilutions are the culmination of a number of diluted tubes used in order to get smaller dilutions. When a sample diluted 1/100 is added to a sample diluted 1/10, the final dilution would be: (1/100) x (1/10) = 1/1000. Example of Calculation Let’s think through a practice dilution: You will make several dilutions of a bacterial stock culture. For some dilutions, you will add 10µl of the more concentrated solution to 990µl of sterile diluent in a microfuge tube. For others, you will add 100µl of the more concentrated solution to 900µl of sterile diluent. Following is a graphic representation of these dilutions: How did we get to those dilution values? Here is an example: 10µl of sample put into 990µl of diluent gives: 10µl divided by (990 + 10) µl total volume = 10/1000 = 1/100 = 10-2 You plate (put subsamples onto nutrient agar) the following dilutions: (A) 10µl of the 10-3 dilution (B) 100µl of the 10-5 dilution (C) 100µl of the 10-6 dilution (D) 100µl of the 10-7 dilution You incubate the plates for 24 hours, after which you obtain the following results: Plate Colonies on Plate A too many to count B) 685 C) 52 D) 4
How to Pass NAPLEX On Your First Try
How to study and pass NAPLEX? This is the question that arises in every graduate who wishes to become a registered pharmacist in the U.S. Especially for non-U.S. resident graduates who really suffer from respect to time and money. To pass NAPLEX is not that easy but you have to act smartly for good preparation. The NAPLEX. The North American Pharmacist Licensure Exam. It is the one test that every single pharmacy graduate has to pass in order to practice. Let us try to understand the background and composition of NAPLEX. NAPLEX Background The NAPLEX. The North American Pharmacist Licensure Exam evaluates the candidate’s knowledge of the practice of pharmacy. It is one of the procedures that the board of pharmacy uses to asses candidate competence to practice as a pharmacist. For beginners, I would recommend you visit the NAPLEX page on the NABP website. This is the official website of the National Association of Board of Pharmacy. You can find the latest information about registration costs and test availability. Before you get started I would recommend you download the NAPLEX Application Bulletin. You can find the updated bulletin on the NABP website. This bulletin guides each and everything which a candidate must know about NAPLEX. NABP keeps on updating the bulletin that is why I am not sharing the link over here. For all of you download the latest bulletin from the NABP website. It is a comprehensive guide of around 53 pages. Read the whole of it carefully. Make sure to focus on what to bring to the test center and type of IDs acceptable. Registration should match with your ID. Do not choose an ID which contradicts with your application name, for example, if someone register as John Mike Abraham and his ID is John Abraham. NAPLEX Test Composition The NAPLEX test consists of 250 questions. Out of 250 questions, 50 are the experimental base. These experimental questions are added for evaluation for use in future NAPLEX and hence do not affect your score. These experimental questions are mixed throughout the test so there is no way to guess which question is real or which is experimental. Let us see the test composition of NAPLEX. Multiple Choice Questions We all are familiar with these types of questions. In these questions, you have to select only the most appropriate answer. The best way to attempt these questions is to eliminate the irrelevant options and narrow down the options to 1 or 2. Multiple Response Questions A multiple response question is basically a multiple choice question: The questions allow participants to select multiple alternatives, and more than one of these can be correct. Multiple response questions are normally more difficult to answer compared to multiple-choice questions. The best way to handle these types of questions is to deal with each answer option as a true or false statement. Ignore everything else, and just evaluate each choice individually. This helps to reduce the “overwhelm” the multiple response questions can bring. Constructed Response These are fill in the blank questions. The example in the bulletin involves a calculation where you have to fill in the answer with the nearest whole number. Ordered Response For these questions, you have to highlight, drag, and order answer options in a particular order (such as highest to lowest). The example in the candidate bulletin involves the potency of topical corticosteroids. Hot Spot This is where you have a diagram where you have to use your computer mouse to identify something on the diagram (example in the bulletin is HIV life cycle). Just knowing what types of questions are possible decreases anxiety and therefore helps you prepare best. Remember one of the best ways to get ready for the exam is to practice, practice, practice, and practice some more. There are lots of sample questions on AccessPharmacy available for you to prepare. Keep working hard! Test time is just around the corner. NAPLEX Becoming Clinical Oriented You’ve probably heard that the NAPLEX has been getting more “clinical” over the years. This is true. There are more scenario-based questions where you are given a clinical case and asked to interpret questions about it. Don’t let your ego convince you that you don’t need to study that much. You need to prep for this exam like it’s the most important one you’ll take in your life (because quite possibly, it is). The goal of the NAPLEX is to make sure you can practice pharmacy without killing someone. You are more likely to get asked about a rare (but potentially fatal) side effect than you are to get asked about the 4th line of therapy in a patient with refractory hypertension and Stage 4 CKD. Remember that, and remember it well. Especially if you’re someone who is prone to talking yourself out of the answers you’ve picked. How Long to Study For NAPLEX? Depending on how intensely you study, I think you can prep for the NAPLEX in 2 – 4 weeks on average. Can you do it in less (or more) time? Yes, but it really just depends on your study style. Outside of the $575 you’re spending to take the exam, the NAPLEX is also one of the only things standing between you and a decent income. Waiting 45 days for a second attempt is only costing you money. Plus if you’re doing a residency, most programs require that you pass the NAPLEX so you can complete the “distribution” requirement of their program. Fail the NAPLEX more than once, and you may have a difficult conversation with your residency program director. So, my best advice is to study for the NAPLEX for as long as it takes you to feel over-prepared. Best to leave nothing to chance with so much at stake. For most people, this should be achievable in 2 – 4 weeks. My Recommended NAPLEX Preparation Guides RxPrep RxPrep offers everything you need in a NAPLEX review book. At more than 1000 pages, RxPrep is
05 Vitamins For Good Hair Growth
Good hair growth is a sign of a good health. On average, hair tends to grow between 0.5 and 1.7 centimeters per month. This is equivalent to around 0.2 to 0.7 inches. Bone marrow, which is the soft substance present inside the bones, is the only part of the body that grows faster than hair. Like any other part of your body, hair needs a variety of nutrients to be healthy and grow. In fact, many nutritional deficiencies are linked to hair loss. While factors such as age, genetics and hormones also affect hair growth, optimal nutrient intake is key. Stages of Hair Growth The stages of hair growth are as follows: Each follicle contains a hair root, which is made of cells of protein. As blood circulates around the body, it delivers oxygen and nutrients to the protein cells, which they need to multiply. The protein cells multiply, they build hair, which pushes up through the skin. The hair grows out of the skin, it passes an oil gland. This lubricates the hair with the oil it needs to stay soft and shiny. By the time the hair is long enough to come through the skin, it is dead. As a new hair grows underneath, it pushes the dead hair out of the skin. The hair then falls out or is shed. Below are 5 vitamins that may be important for hair growth. Vitamin A All cells need vitamin A for growth. This includes hair, the fastest growing tissue in the human body. Vitamin A also helps skin glands make an oily substance called sebum. Sebum moisturizes the scalp and helps keep hair healthy. Diets deficient in vitamin A may lead to several problems, including hair loss. While it’s important to get enough vitamin A, too much may be dangerous. Studies show that an overdose of vitamin A can also contribute to hair growth. Sweet potatoes, carrots, pumpkins, spinach, and kale are all high in beta-carotene, which is turned into vitamin A. Vitamin A can also be found in animal products such as milk, eggs, and yogurt. Cod liver oil is a particularly good source. Your hair needs vitamin A to stay moisturized and grow. Good sources include sweet potatoes, carrots, spinach, kale, and some animal foods. Vitamin B Family One of the best-known vitamins for hair growth is a B-vitamin called biotin. Studies link biotin deficiency with hair loss in humans. Although biotin is used as an alternative hair-loss treatment, those who are deficient have the best results. However, deficiency is very rare because it occurs naturally in a wide range of foods. There’s also a lack of data about whether biotin is effective for hair growth in healthy individuals. Other B-vitamins help create red blood cells, which carry oxygen and nutrients to the scalp and hair follicles. These processes are important for hair growth. You can get B-vitamins from many foods, including whole grains, almonds, meat, fish, seafood and dark, leafy greens. Additionally, animal foods are the only good sources of vitamin B12. So if you’re following a vegetarian or vegan diet, consider taking a supplement. B-vitamins help carry oxygen and nutrients to your scalp, which aids in hair growth. Whole grains, meat, seafood, and dark, leafy greens are all good sources of B-vitamins. Vitamin C Free radical damage can block the growth and cause your hair to age. Vitamin C is a powerful antioxidant that helps protect against the oxidative stress caused by free radicals. In addition, your body needs vitamin C to create a protein known as collagen — an important part of the hair structure. Vitamin C also helps your body absorb iron, a mineral necessary for hair growth. Strawberries, peppers, guavas and citrus fruits are all good sources of vitamin C. Vitamin C is needed to make collagen and can help prevent hair from aging. Good sources include peppers, citrus fruits, and strawberries. Vitamin D Low levels of vitamin D are linked to alopecia, a technical term for hair loss. Research also shows that vitamin D may help create new follicles — the tiny pores in the scalp where new hair can grow. Vitamin D is thought to play a role in hair production, but most research focuses on vitamin D receptors. The actual role of vitamin D in hair growth is unknown. That said, most people don’t get enough vitamin D and it may still be a good idea to increase your intake. Your body produces vitamin D through direct contact with the sun’s rays. Good dietary sources of vitamin D include fatty fish, cod liver oil, some mushrooms, and fortified foods. Vitamin D’s actual role in hair growth is not understood, but one form of hair loss is linked to deficiencies. You can increase vitamin D levels through sun exposure or by eating certain foods. Vitamin E Similar to vitamin C, vitamin E is an antioxidant that can prevent oxidative stress. In one study, people with hair loss experienced a 34.5% increase in hair growth after supplementing with vitamin E for 8 months. The placebo group had only a 0.1% increase. Sunflower seeds, almonds, spinach and avocados are all good sources of vitamin E. Suggested Multivitamin Brands For Hair Growth Hairfluence (USA) Order Now Organic Hair Skin and Nails Vitamins for Women Order Now Biotin Order Now Conclusion All of the above vitamins are essential for good hair growth. Balance diet always keeps everything good. If you like this article do not forget to comment and share it with your friends.