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NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

Thursday, March 31, 2016

BP lowering in hypertensive urgency

ans is 
B. Inability to control the rate and extent of fall in BP
C. Reports of adverse/fatal outcome
D. Both 'B' and 'C'

thank you;

Wednesday, March 23, 2016

sore throat.-DrSudeepKC

A 22-year-old woman complains of a sore throat. On examination she has mild jaundice and an enlarged liver and spleen.
Examination of Throat

a. Anaerobic bacteria
b. Chlamydia psittaci
c. Corynebacterium diphtheriae
d. Epstein–Barr virus

D.Epstein–Barr virus right answer

EBV infects B cells of the immune system and epithelial cells. Once EBV's initial lytic infection is brought under control, EBV latency persists in the individual's B cells for the rest of the individual's life.

It is best known as the cause of infectious mononucleosis (glandular fever). It is also associated with particular forms of cancer, such as Hodgkin's lymphomaBurkitt's lymphomagastric cancer,nasopharyngeal carcinoma, and conditions associated with human immunodeficiency virus (HIV), such as hairy leukoplakia and central nervous system lymphomas.There is evidence that infection with EBV is associated with a higher risk of certain autoimmune diseases,especiallydermatomyositissystemic lupus erythematosusrheumatoid arthritisSjögren's syndrome,and multiple sclerosis.Some 200,000 cancer cases per year are thought to be attributable to EBV.

The infection develops slowly with such mild symptoms that it may initially be indistinguishable from a cold or the flu. As the condition progresses the symptoms may include:
  • sore throat that lasts two weeks or more
  • Swollen lymph nodes in the neck, armpits, and groin
  • A persistent fever (usually about 102 degrees F)
  • fatigue
  • malaise (a vague feeling of discomfort)
These symptoms can be mild or so severe that throat pain impedes swallowing and fever reaches 105 degrees F. Some people also experience a rash, eye painphotophobia (discomfort with bright light), a swollen spleen or liver infection.
Although the symptoms of infectious mononucleosis usually resolve in one or two months, the EBV remains dormant in cells in the throat and blood for the rest of the person's life. Periodically, the virus can reactivate and can be found in the saliva of infected persons. This reactivation usually occurs without symptoms of illness. EBV also establishes a lifelong dormant infection in some cells of the body's immune system.
Diagnosis is suggested on the basis of the clinical symptoms of fever, sore throat, swollen lymph glands and the age of the patient. A physical examination may reveal an enlarged liver and/or enlarged spleen. The liver and spleen may also be tender. Laboratory tests may be needed for confirmation.
Blood findings with infectious mononucleosis may include an elevated white blood cell count, an increased percentage of certain white blood cells and a positive reaction to a "monospot test." The monospot test relies on clumping of horse red blood cells by mononucleosis antibodies presumed to be in a person's serum.
antibody tests for EBV measure the presence and/or the concentration of specific EBV antibodies. Different laboratory tests can measure specific EBV antibodies. Some of these tests can be performed on a single sample of blood, while others compare different samples of blood over a period of time.
In most cases of mononucleosis, no specific treatment is necessary. The illness is usually self-limited. Since it is a viral infection and viruses do not respond to antibiotics, they are ineffective against mono. Doctors will recommend bedrest and drinking plenty of fluids.
When the patient's temperature returns to normal, he or she may gradually resume normal activities as strength returns. However, mono can be accompanied by a streptococcal infection of the throat, in which case an antibiotic will be prescribed to treat that condition.
In severe cases, corticosteroid drugs that reduce swelling are prescribed. If the spleen is swollen, the doctor may recommend avoiding strenuous activities, such as lifting and pushing, as well as any contact sports, which may cause sudden rupture of the spleen. Hospitalization is necessary if there is a serious complication, such as rupture of the spleen.

Thursday, March 17, 2016

Guidelines for the use of a statin in hypertension; DrSudeepKC

Guidelines for the use of a statin in hypertension include the following, except:

A. Following a stroke
B. Type 2 diabetic diagnosed 11 years previously
C. Primary prevention with a CVD risk of 25%
D. Target levels of LDL <2 mmol/L and total cholesterol <4 mmol/L
E. Primary prevention in an 80-year-old

ANSWER : E. Statins should be used in all cases of secondary prevention in patients with hypertension, with target levels of LDL <2 mmol/L and total cholesterol <4 mmol/L or a 30% reduction. The primary prevention benefit of statins has been shown in trials of hypertensive patients down to a CVD risk level of 6%.

This is not financially feasible; therefore the recommendation is for statin use if the CVD risk is ≥20% or established type 2 diabetes for more than 10 years. There is little evidence for the treatment of patients over 80 years old with statins.

Monday, March 14, 2016

Captopril produces greater fall in blood pressure in:

Correct ans is  : A. Diuretic treated patients

Sunday, March 13, 2016

rate limiting enzyme-DrSudeepKC

A. Renin is the correct answer

Saturday, March 12, 2016

absorbed from the stomach: -DrSudeepKC


Diclofenac sodium is a benzeneacetic acid derivative, designated chemically as 2-[(2,6-dichlorophenyl)amino] benzeneacetic acid, monosodium salt. The structural formula is:

             Structure Image
soluble in methanol, soluble in ethanol, sparingly soluble in water and practically insoluble in chloroform and in dilute acid. The n-octanol/water partition coefficient is 13.4 at pH 7.4 and 1545 at pH 5.2. Diclofenac sodium has a dissociation constant (pKa) of 4.0 ± 0.2 at 25°C in water.
Each enteric-coated tablet for oral administration contains 25 mg, 50 mg, or 75 mg of diclofenac sodium. In addition, each tablet contains the following inactive ingredients. Inactive ingredients: Black iron oxide, croscarmellose sodium, hydroxypropyl cellulose, hydroxypropyl methylcellulose, lactose (monohydrate), magnesium stearate, methacrylic acid copolymer, microcrystalline cellulose, polyethylene glycol, povidone, red iron oxide, and titanium dioxide. The 25 mg also contains: D and C Yellow #10 Aluminum Lake and pharmaceutical glaze shellac. The 50 mg also contains: Pharmaceutical glaze shellac and yellow iron oxide. The 75 mg also contains: carnauba wax, glycerol monostearate, shellac, and yellow iron oxide.

Diclofenac sodium delayed-release tablets are a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory, analgesic, and antipyretic activities in animal models. The mechanism of action of diclofenac sodium delayed-release tablets, like that of other NSAIDs, is not completely understood but may be related to prostaglandin synthetase inhibition.
Diclofenac is 100% absorbed after oral administration compared to IV administration as measured by urine recovery. However, due to first-pass metabolism, only about 50% of the absorbed dose is systemically available. Food has no significant effect on the extent of diclofenac absorption. However, there is usually a delay in the onset of absorption of 1 to 4.5 hours and a reduction in peak plasma levels of less than 20%.

The apparent volume of distribution (V/F) of diclofenac sodium is 1.4 L/kg.
Diclofenac is more than 99% bound to human serum proteins, primarily to albumin. Serum protein binding is constant over the concentration range (0.15-105 µg/mL) achieved with recommended doses.
Diclofenac diffuses into and out of the synovial fluid. Diffusion into the joint occurs when plasma levels are higher than those in the synovial fluid, after which the process reverses and synovial fluid levels are higher than plasma levels. It is not known whether diffusion into the joint plays a role in the effectiveness of diclofenac.
Five diclofenac metabolites have been identified in human plasma and urine. The metabolites include 4’-hydroxy-, 5-hydroxy-, 3’-hydroxy-, 4’,5-dihydroxy- and 3’-hydroxy-4’-methoxy diclofenac. In patients with renal dysfunction, peak concentrations of metabolites 4’-hydroxy- and 5-hydroxy-diclofenac were approximately 50% and 4% of the parent compound after single oral dosing compared to 27% and 1% in normal healthy subjects. However, diclofenac metabolites undergo further glucuronidation and sulfation followed by biliary excretion.
One diclofenac metabolite 4’-hydroxy-diclofenac has very weak pharmacologic activity.
Diclofenac is eliminated through metabolism and subsequent urinary and biliary excretion of the glucuronide and the sulfate conjugates of the metabolites. Little or no free unchanged diclofenac is excreted in the urine. Approximately 65% of the dose is excreted in the urine and approximately 35% in the bile as conjugates of unchanged diclofenac plus metabolites. Because renal elimination is not a significant pathway of elimination for unchanged diclofenac, dosing adjustment in patients with mild to moderate renal dysfunction is not necessary. The terminal half-life of unchanged diclofenac is approximately 2 hours.
The pharmacokinetics of diclofenac sodium delayed-release tablets has not been investigated in pediatric patients.
Pharmacokinetics differences due to race have not been identified.
Hepatic metabolism accounts for almost 100% of diclofenac sodium delayed-release tablets elimination, so patients with hepatic disease may require reduced doses of diclofenac sodium delayed-release tablets compared to patients with normal hepatic function.
Diclofenac pharmacokinetics has been investigated in subjects with renal insufficiency. No differences in the pharmacokinetics of diclofenac have been detected in studies of patients with renal impairment. In patients with renal impairment (inulin clearance 60-90, 30-60, and less than 30 mL/min; N=6 in each group), AUC values and elimination rate were comparable to those in healthy subjects.

Monday, March 7, 2016

In the typical patient who is poisoned by iron::DrSudeepKC

In the typical patient who is poisoned by iron:

iron tonic

a. Hypoglycemia initially occurs then hyperglycemia secondary to pancreatitis.
b. Gastrointestinal hemorrhage is commonly seen secondary to liver dysfunction and coagulation abnormalities.
c. Lactic acidosis is rarely seen in the toxic patient.
d. Strictures may develop late in poisoning causing gastric outlet obstruction or bowel obstruction.
e. The iron accumulates in the bone and may cause pathologic fractures.

The answer is d. Direct caustic effects on the bowel by iron can result in early gastric and small bowel hemorrhage, which can result in hypovolemia and shock.

Late strictures may present as gastric outlet or bowel obstruction. As toxic amounts of iron enter the mitochondria and disrupt oxidative phosphorylation, lactic acidosis occurs.

Hyperglycemia is often seen early, but later hepatic failure results in hypoglycemia. Iron does not accumulate in the bone.

Sunday, March 6, 2016

Conjunctivitis is commonly associated with:-DrSudeepKC

Conjunctivitis is commonly associated with:

a. Hand-foot-and-mouth disease.
b. Fifth disease.
c. Rubeola (measles).
d. Mononucleosis.
e. Reye’s syndrome.

The answer is c. Viruses are the most frequent cause of conjunctivitis and adenovirus is the most frequent virus implicated. Other diseases may present with conjunctivitis as part of their clinical syndrome.

These include Kawasaki disease, measles (rubeola), and seasonal allergies. Measles, caused by a paramyxovirus, begins with a prodrome of gradually increasing fevers and URI symptoms (cough, coryza, conjunctivitis).

The prodrome is followed 2–4 days later with the appearance of a maculopapular rash that appears first on the head and spreads inferiorly to the trunk and extremities (including the palms and soles). Koplik spots, white papules on an erythematous base, on the buccal mucosa are pathognomonic.