EIGHT STAR PHARMACIST
The concept of the “seven-star pharmacist” was introduced by WHO and adopted by FIP in 2000 in its policy statement on Good Pharmacy Education Practice to cover the roles of caregiver, decision-maker,communicator, manager, life-long learner, teacher and leader. The function of the pharmacist as a researcher has since been added and all these have been addressed in the competence standards.
1. Caregiver:
Pharmacists must view their practice as integrated and continuous with those of the healthcare system and other health professionals.
2. Decision-maker: The appropriate, efficacious, safe and cost-effective use of resources (for example,personnel, medicines, chemicals, equipment, procedures, practices) should be the foundation of the pharmacist’swork. Achieving this goal requires the ability to evaluate, synthesise data and information and decide upon themost appropriate course of action.
3. Communicator: The pharmacist is in an ideal position to provide a link between prescriber and patient, and tocommunicate information on health and medicines to the public and other health professionals. Communication involves verbal, non-verbal, listening and writing skills.
4. Manager: Pharmacists must be able to manage resources (human, physical and financial) and information effectively; they must also be comfortable being managed by others, whether by an employer or the manager/leader of a healthcare team.
5. Life-long-learner: It is impossible to acquire in pharmacy school all the knowledge and experience needed topursue a life-long career as a pharmacist. The concepts, principles and commitment to life-long learning must begin while attending pharmacy school and must be supported throughout the pharmacist’s career. Pharmacists should learn how to keep their knowledge and skills up to date and how to put them into practice.
6. Teacher: Every pharmacist has a responsibility to assist with the education and training of future generations of pharmacists and the public. Participating as a teacher not only imparts knowledge to others, it offers an opportunity for the practitioner to gain new knowledge and to fine-tune existing skills.
7. Leader: Leadership involves compassion and empathy as well as vision and the ability to make decisions, communicate, and manage effectively. A pharmacist whose leadership role is to be recognised must have vision and the ability to lead.
8. Researcher: The pharmacist must be able to use the evidence base (e.g., scientific, pharmacy practice, healthsystem) effectively in order to advise on the rational use of medicines in the healthcare team. As a researcher,the pharmacist is able to increase the accessibility of unbiased health and medicines-related information for thepublic and other healthcare professionals.
Platform for the young doctors and pharmacists for academics and other prospective like jobs, e-books.
Saturday, 1 August 2015
Friday, 24 July 2015
Treatment for myocardial infarction
1. Oxygen — Used to maintain blood oxygenation as well as tissue and
cardiac O2 levels.
2. Aspirin — If administered when myocardial infarction is detected,
the antiplatelet properties of aspirin may reduce the overall size of
the infarction.
3. Thrombolytic therapy — If employed in the first 1 to 4 hours following
the onset of a myocardial infarction, these drugs may dissolve
clots in coronary blood vessels and re-establish blood flow.
4. Vasodilator drugs — Intravenous nitroglycerin can increase blood
flow to the myocardium and reduce myocardial work.
5.β-Blockers — Blunt the effect of catecholamine release on the myocardium,
reduce heart rate and myocardial work.
6. Pain management — Sublingual nitroglycerin, morphine if necessary
7. Antiarrhythmia drugs — To treat and prevent a number of potentially
life-threatening arrhythmias that might arise following a myocardialinfarction.
8. ACE inhibitors — Drugs that block activation of the renin–angiotensin
system and thus reduce the negative effects of vasoconstriction
and salt and water retention on the myocardium.
Types of Drug Information Questions
ADVERSE DRUG REACTIONS
Adverse reactions
Allergies
Teratogenicity
Toxicology
DOSING
Age-specific dosing
Dosing in patients with altered organ function (liver,
kidneys)
Indication-specific dosing
DRUG ADMINISTRATION
Commercial dosage form alterations (crushing, dissolving)
Drug administration methods
Product preparation (reconstitution, admixing,
compounding)
Compatibility, stability, and storage
Timing (with or without food or enteral products)
DRUG INTERACTIONS
Drug-disease interactions
Drug-drug interactions
Drug-food interactions
Drug–laboratory test interactions
Drug-nutrient interactions
INDICATIONS AND THERAPEUTIC USE
Approved drugs
Investigational drugs
Unapproved drugs
POISONINGS
Signs and symptoms
Treatment
PRODUCT-SPECIFIC CONCERNS
Constituents (sugars, dyes, adjuvants, alcohol)
Formulations
Identification
Storage
MISCELLANEOUS
Drug use during pregnancy and lactation
Pharmacoeconomics
Product-specific assays
Veterinary drug information
Drug Administration - Formulation
Formulation
Clinically useful drugs are formulated by drug
companies into preparations that can be administered
orally. intra\"enously. or by another route. The fonnu·
lation of a drug depends on the following factors:
-The barriers that the drug is capable of passing.
Intravenous drugs are injected directly into the blood
stream. In contrast, oTal preparations must pass
through the wall of the gastrointestinal tract and
blood vessel walls before entering the bloodstream.
-The setting in which the drug will be used. An
intravenous preparation might be appropriate for a
drug which is administered during surgery, but
would be inappropriate for home administration of
aspirin
.
-The urgency of the medical situation
. The delaybefore onset of action varies between preparations of
the same drug. Emergency situations often caU for
intravenous administration of agents which might
normaUy be administered by another route.
-Stability of the drug. Drugs which are denatured by
acid are not good candidates for oral preparations
because they may be destroyed in the stomach
(stomach pH = 2).
• First Pass Effect.
Blood from the gastrointestinal tract passes
through the liver before entering any other
organs. During this first pass through the liver, a
fraction of the drug (in some cases nearly all) can be
metabolized to an inactive or less active derivative.
The inactivation of some drugs is so great that the
agents are useless when administered orally.
Thursday, 23 July 2015
FDA Approves New Prescription Acne Treatment
FDA approved Galderma Laboratories’ antibiotic-free adapalene and benzoyl peroxide 0.3%/2.5% gel (Epiduo Forte Gel) for the once-daily treatment of acne vulgaris.
“Acne is a challenging condition to manage. It can vary greatly from patient to patient, can have a significant physical and psychosocial impact on sufferers, and patients can find treatment adherence difficult to maintain,” said clinical investigator Jonathan Weiss, MD, in a press release. “For many patients, rapid results are especially important, and some acne treatments take time to show effect. We were very excited to see in the clinical trial that people using Epiduo Forte Gel saw results as early as 1 week, with efficacy continually improving through week 12.”
The most commonly reported adverse events experienced by trial participants treated with Epiduo Forte Gel were skin irritation, eczema, atopic dermatitis, and skin burning sensation. Most of the side effects associated with the drug’s use were mild and moderate in severity, a finding that Galderma considers particularly relevant to acne patients with sensitive skin.
Galderma plans to launch Epiduo Forte Gel in early September 2015, according to a manufacturer press release.
10 Things to do during every interview.
Here is a list of ten things I tell my clients before they go into an interview to do. If these are done correctly the chances of success go up dramatically.
1) Dress properly-This maybe a no brainer but there are some out there who do not wear a suit to an interview. The guideline usually is to dress as if you are going to church or court which ever you're more comfortable with. Just Because the interviewer or organization is casual, does not mean we can be.
2) Always Smile and make eye contact- When you first meet the interviewer extend your hand and make eye contact. Introduce yourself and listen for their name so that you can use it at the end the interview to thank them for taking the time to interview you.
3) Bring 2 copies of your resume- This is important that you bring a good clean copy of your resume with you on resume paper. I say bring two because usually the director is going to need to pass your resume on to his Hr department and we want him to have one as well.
4)Stay away from money- It is improper to discuss money at the first interview. If they ask you about money it is ok to say your negotiable. Money is always the last thing to discuss even if it is the first thing on your mind.
5) Do your research- This is important, you want the potential employer to know you have looked into them and it will tell you what their recent success have been and where they are going as an organization.
6)Always ask questions- The only way to hear what you want to hear is to ask questions. The questions should revolve around duties and the company. Some questions should also revolve around the research you have done prepare some questions about things you have seen on the organizations website.
7)Always speak good of the past- Never criticize a current or former employer. Your potential boss would not want you to go around bad mouthing him if you leave his organization.
8)Mentally prepare yourself- You do want to walk into an interview with an air of confidence, in your mind you should already know that you have done the research and have good questions prepared, the only thing standing in your way is the attitude you present to your interviewer. Always make sure you are enthusiastic about the opportunity and convey that to them.
9)Know somebody- Always have references available to provide to your potential employer.
10)Exit with a smile- At the end of the interview shake your potential employers hand and thank him again for taking the time to interview you and reiterate how much you are interested in the position. I always say to follow up with a thank you note it is always best.
How Innovation Differs from Invention
Invention
This is usually defined as the discovery of a new item. Whether it is a new drug, device, or other piece of technology, it is unique and no similar one exists. Unfortunately, most invention comes from outside of the profession, with individuals using their skills to bring inventions to pharmacy practice. The invention should result in a patent submission because of its novelty and lack of prior art.Innovation
This term usually comes after the invention has occurred. This can either be an improvement on a current system or a process that makes things better than their current state. Innovation could also involve taking an existing idea that was implemented at 1 site and replicating it at another. Because anything unique is often considered innovative. They are improvements of an existing service, as opposed to the creation of new technology.Entrepreneurship
This term applies when someone takes a novel idea and creates a new business from it. The entrepreneur is usually the founder who gets an equity stake in the start-up company.The company could be based on an invention or innovation, but it has to have a commercial base to support it. Those who start and own an independent pharmacy would be considered entrepreneurs. Starting and running a business requires very different skills than inventing and innovating.
Some might choose to turn their invention into a business, while others might allow someone else to use their invention to start a company.
Wednesday, 22 July 2015
CAPSULES
Are solid dosage forms in which
one or more medicinal and or inert substances are enclosed within a small shell
or container generally prepared from a suitable form of gelatin. Depending upon their formulation, the gelatin
capsule shells may be hard or soft.
Characteristics:
1. May be swallowed whole by the patient
2. May be inserted into the rectum for drug release and absorption from the site
3.The contents may be removed from the gelatin shell and employed as a pre measured medicinal powder, the capsule shell being use to contain a dose of the medicinal substance.
Example: Theo-dur Sprinkle
4. Elegance
5. Ease of use
6. Portability
7. Tasteless shell to mask the unpleasant taste/odor of the drug
8. Permits physician to prescribe the exact medication needed by the patient
9. conveniently carried
10. readily identified
11. easily taken
12. tasteless when swallowed
13. commonly embossed or imprinted on their surface the manufacturer’s name and product code readily identified
14. available in variety of dosage strength
15. provide flexibility to the prescriber and accurate individualized dosage for the patient
16. packaged and shipped by manufacturers at lower cost less breakage than liquid forms
17. more stable and longer shelf life
Components Of Capsules
1. Gelatin
2. FD & C and D & C colorant
3. Sugar
4. Water - 12 to 16 % but may vary depending on the storage condition
5. Sulfur dioxide (.15%) - prevent decomposition during manufacture
6. Opaquants/Opacifying agent - titanium dioxide
H HARD GELATIN CAPSULES
A Also referred to as “DFC” Dry Filled Capsule. Manufactured into two sections, the capsule body and a shorter cap.
A A recent innovation in capsule shell design is the Snap-Fit, Coni-Snap, and Coni Snap Supro hard gelatin capsules.
CaCapsule size
F For human use, empty capsules ranging in size from 000 the largest to 5 the smallest. Generally, hard gelatin capsule are used to encapsulate between 65 mg to 1 gram.
SOFT GELATIN CAPSULES
Also referred to as as Soft ElasticCapsule. Are prepared from shells of gelatin from which glycerin or a polyhydric alcohol and as sorbitol has been added to render the gelatin elastic or plastic like.
Tthe gelatin is plasticized by the addition of glycerin, sorbitol or polyol. The shell may contain preservatives to prevent from fun
soft gelatin capsule has a seam at the point of closure of the 2 halves, and the contents can be liquid, paste or powder.
SOFT GELATIN CAPSULES
Also referred to as as Soft ElasticCapsule. Are prepared from shells of gelatin from which glycerin or a polyhydric alcohol and as sorbitol has been added to render the gelatin elastic or plastic like.
Tthe gelatin is plasticized by the addition of glycerin, sorbitol or polyol. The shell may contain preservatives to prevent from fun
soft gelatin capsule has a seam at the point of closure of the 2 halves, and the contents can be liquid, paste or powder.
ACCORDING TO WHO ROLE OF HOSPITAL PHARMACIST
Hospital pharmacy
Hospitals and other institutions and facilities, such as
outpatient clinics, drug-dependency treatment facilities, poison control
centres, drug information centres, and long-term care facilities, may be
operated by the government or privately. While many of the pharmacist’s
activities in such facilities may be similar to those performed by community
pharmacists, they differ in a number of ways.
Additionally, the hospital or
institutional pharmacist:
• has more opportunity to interact closely with the
prescriber and, therefore, to promote the rational prescribing and use of
drugs;
• in larger hospital and institutional pharmacies, is
usually one of several pharmacists, and thus has a greater opportunity to
interact with others, to specialize and to gain greater expertise;
• having access to medical records, is in a position to
influence the selection of drugs and dosage regimens, to monitor patient
compliance and therapeutic response to drugs, and to recognize and report
adverse drug reactions;
• can more easily than the community pharmacist assess and
monitor patterns of drug usage and thus recommend changes where necessary;
• serves as a member of policy-making committees, including
those concerned with drug selection, the use of antibiotics, and hospital
infections (Drug and Therapeutics Committee) and thereby influences the
preparation and composition of an essential-drug list or formulary;
• is in a better position to educate other health
professionals about the rational use of drugs;
• more easily participates in studies to determine the
beneficial or adverse effects of drugs, and is involved in the analysis of
drugs in body fluids;
• can control hospital manufacture and procurement of drugs
to ensure the supply of high-quality products;
• takes part in the planning and implementation of clinical
trials.
MANAGEMENT- COMMUNICATION
Communication
The
exchange of ideas, messages, or information by speech, signals, or writing.
Communication Skills
Communication
skills are the tools that we use to remove the barriers to effective
communication.
Goal
·
The
goal of communication is to convey information &
·
the
understanding of that information
from one
person or group to another person or group.
THE
COMMUNICATION PROCESS
The main
components of communication process are as follows:
1. Context
- Communication is affected by the context in which it takes place. This
context may be physical, social, chronological or cultural. Every communication
proceeds with context. The sender chooses the message to communicate within a
context.
2. Sender
/ Encoder - Sender / Encoder is a person who sends the message. A sender
makes use of symbols (words or graphic or visual aids) to convey the message
and produce the required response. Sender may be an individual or a group or an
organization. The views, background, approach, skills, competencies, and
knowledge of the sender have a great impact on the message.
3. Message
- Message is a key idea that the sender wants to communicate. It is a sign that
elicits the response of recipient. It must be ensured that the main objective
of the message is clear.
4. Medium
- Medium is a means used to exchange / transmit the message. The choice of
communication medium varies depending upon the features of communication.
5. Recipient
/ Decoder - Recipient / Decoder is a person for whom the message is
intended / aimed / targeted. The degree to which the decoder understands the
message is dependent upon various factors such as knowledge of recipient, their
responsiveness to the message, and the reliance of encoder on decoder.
6. Feedback
- Feedback is the main component of communication process as it permits the
sender to analyze the efficacy of the message. It helps the sender in
confirming the correct interpretation of message by the decoder. Feedback may
be verbal (through words) or non-verbal (in form of smiles, sighs, etc.). It
may take written form also in form of memos, reports, etc
FORMS OF COMMUNICATION:
Oral
Oral
communication makes up the bulk of business communication today. Effectively
communicating orally requires knowledge of the topic at hand, critical thinking
ability and great interpersonal skills. Those skilled with oral communication
are also typically good listeners who pay attention to verbal and nonverbal
communication clues.
Nonverbal
People
communicate nonverbally via body language and facial expressions. Eye contact,
gestures and proximity to the speaker are all examples of nonverbal
communication. It's important to pay
attention to your body language and posture when speaking or listening to
someone else.
Written
Written
communication in today's workplace commonly takes the form of email. Effective
communication and proper etiquette are no less important in electronic form
than they are on the written page. Keep business correspondence professional.
Use correct grammar, punctuation and spell check every message before sending.
Follow the same rules of etiquette in email that you would in any other
business setting. Many employees consider email the most effective form of
office communication.
COMMUNICATION BARRIERS
Communication
Barriers are the various obstacles and hurdles which arise in between of an
effective communication leading to misunderstandings and misinterpretations by
the receiver. They result in distortion of the message and the goal is never
accomplished.
Impatient Listener
The
listener should be patient enough to absorb the complete information and then
respond accordingly. Always jot down your points and start off with your
queries once the sender is through with the communication. Don’t jump in
between the conversation.
Misinterpretation
This can
stem from poor communication efforts by the message sender. Language and
communication differences are common as companies become more diverse.
Additionally, noises and distractions in the work environment can cause
confusion during the reception and interpretation of messages.
Low pitch and tone
Sometimes
even the pitch and tone can play a communication barrier. Your content might be
accurate and related, but if your pitch is low your information will never reach
the listeners. The tone has to be very clear and loud for delivering correct
information.
Ignoring the content
One should
lay emphasis on the content of his speech. The content has to be clear and
above all interesting. Don’t just speak; take some time to find out what you
are speaking. Don’t make your speech monotonous otherwise the listeners after
sometime will definitely fall asleep or bored.
Unorganized Thought
Unorganized
and haphazard thoughts also are instrumental in poor communication and a very
important barrier to effective communication.
Cultural level
In any
organization, an individual can never think on the same line as his boss does.
There is always a difference in their thought process.
Lack of Knowledge
Employees generally lack knowledge about the
company, its products and their jobs. This can contribute to poor production,
creativity and results within the organization. It can also lead to poor
communication and ineffective results during interactions with clients or
customers.
7Cs OF COMMUNICATION
The 7 Cs
provide a checklist for making sure that your meetings , emails
, conference calls , reports , and presentations are well constructed and clear ,so your
audience gets your message.
According
to the 7 Cs, communication needs to be:
Clear.
Concise.
Concrete.
Correct.
Coherent.
Complete.
Courteous.
1. Clear
Your
messages need to be clear if they are to be effective. When writing or speaking
to someone, be clear about your goal or message. What is your purpose in
communicating with this person? If you're not sure, then your audience won't be
sure either.
To be
clear, try to minimize the number of ideas in each sentence. Make sure that
it's easy for your reader to understand your meaning. People shouldn't have to
make assumptions on their own to understand what you're trying to say.
2. Concise
If you
want your messages to be read by busy people, make them brief. Remove all words
phrases and sentences that serve no purpose. You can also eliminate wordiness
by substituting one word for wordy, overused expressions.When you're concise in
your communication, you stick to the point and keep it brief. Make sure to
check,
Are there
any unnecessary sentences?
Have you
repeated the point several times, in different ways?
3. Concrete
When your
message is concrete, then your audience has a clear picture of what you're
telling them. There are details (but not too many) and vivid facts, Your
message is solid. You have a choice in your writing to use concrete (specific)
or abstract (vague) words. However, concrete items terms are typically mare
accurate and, in some cases, more believable.
4. Correct
Correctness
includes proposes spelling, grammar, punctuation, and format. For spelling,
punctuation and grammar.
When your
communication is correct, it fits your audience. And correct communication is
also error-free communication.
5. Coherent
When your
communication is coherent, it's logical. All points are connected and relevant
to the main topic, and the tone and flow of the text is consistent. Ideas need
to flow from on to the next through smooth transitions. You can achieve this by
outlining your messages, writing simple sentences ad focusing each paragraph on
one idea.
6. Complete
In a
complete message, the audience has everything they need to be informed and, if
applicable, take action. Make sure that you included all relevant information,
contact names, dates, times and locations etc.
7. Courteous
Your
message should be positive i.e. building goodwill and focused upon the reader.
Courteous communication is friendly, open, and honest. There are no hidden
insults or passive-aggressive tones. You keep your reader's viewpoint in mind,
and you're empathetic to their needs.
IMPORTANCE OF COMMUNICATION SKILLS:
Communication
skills are very important for all managers and leaders.
Good
communication skills allow managers and leaders to perform their role more
effectively. Their role requires that they communicate. They must communicate
many things to many people: they must communicate effectively to the team, to
their suppliers, to their customers and financiers.
So it is
important that leaders and managers are good communicators.
Communication
skills for managers and leaders consist, mainly, of six subset skills:
1. The ability to set out the goal or the
target to be hit.
2. The ability to communicate the plan of
action that, it is hoped will describe successful action, capable of achieving
the goal.
3. The ability to communicate delegated
actions: who is going to do which task?
4. The ability to give corrective critical
feedback to the people who are not performing in the proper manner and, in
addition, to be able to get them to correct their performance and get
"back on track".
5. The ability to give praise and appreciation
to those who are doing a good job.
6. The ability to communicate the need for
constant change, adaptation, refinement and flexibility to the conditions,
whilst still remaining faithful to the overall goal and plan.
What are STEROID HORMONES
They
are grouped on the basis of the receptors they bind.
vGlucocorticoids
vMineralocorticoids,
vProgesterone
vAndrogens
vEstrogens
•The
natural steroid hormones are generally synthesized from cholesterol in the
gonads and adrenal glands.
•
These forms of hormones are lipids.
•They
can pass through the cell membrane as
they are fat-soluble, and then bind to steroid hormone receptors which may be
nuclear or cytosolic
depending on the steroid hormone, to bring about changes within the cell.
•Steroid
hormones are generally carried in the blood bound to specific carrier proteins
such as SHBPs and CHBPs.
•Further
conversions and catabolism occurs in the liver, in other "peripheral"
tissues, and in the target tissues.
•A
variety of synthetic steroids and sterols have also been contrived.
•Most
are steroids, but some non-steroidal molecules can interact with the steroid
receptors because of a similarity of shape.
•Some
synthetic steroids are weaker, and some much stronger, than the natural
steroids whose receptors they activate.
Examples
Of Synthetic Steroids
ØGlucocorticoids: alclometasone, prednisone,dexamethasone,
ØMineralocorticoid: fludrocortisone
ØVitamin
D: dihydrotachysterol
ØAndrogens: apoptone, oxandrolone, oxabolone, testosterone, nandrolone
(also known as anabolic steroids)
ØEstrogens:
diethylstilbestrol (DES)
ØProgestins: danazol, norethindrone, medroxyprogesterone acetate, 17-Hydroxyprogesterone caproate.
Some
steroid antagonists:
ØAndrogen:
cyproterone
acetate
ØProgestins: mifepristone, gestrinon
Thursday, 18 June 2015
ADRs
Introduction to ADRs
Adverse drug reactions (ADRs), also known as ‘side effects’, ‘adverse
drug events’, or ‘drug misadventures’, are a frequent cause of morbidity in hospital and the community. They have a significant cost both financially and in terms of quality of life.
Few studies of ADRs have been carried out in the community so the effect on primary care is harder to assess, but studies in the hospital environment have shown the following.
• ADRs occur in 10–20 % of patients in hospital.
• ADRs are responsible for 5 % of admissions to hospital.
• ADRs might be responsible for 1 in 1000 deaths in medical wards.
• ADRs are the most common cause of iatrogenic injury in hospital
patients.
The World Health Organization (WHO) defines an ADR as follows:
‘ a drug-related event that is noxious and unintended and occurs at doses used in
humans for prophylaxis, diagnosis or therapy of disease or for the modification
of physiological function .’
However, this definition does not take into account the following
scenarios, all of which can also cause ADRs:
• overdose (including prescribing or administration errors)
• therapeutic failure
• drug interactions
• drug withdrawal.
Pharmacists have an important role in identifying, reporting, and preventing
ADRs.
Adverse drug reactions (ADRs), also known as ‘side effects’, ‘adverse
drug events’, or ‘drug misadventures’, are a frequent cause of morbidity in hospital and the community. They have a significant cost both financially and in terms of quality of life.
Few studies of ADRs have been carried out in the community so the effect on primary care is harder to assess, but studies in the hospital environment have shown the following.
• ADRs occur in 10–20 % of patients in hospital.
• ADRs are responsible for 5 % of admissions to hospital.
• ADRs might be responsible for 1 in 1000 deaths in medical wards.
• ADRs are the most common cause of iatrogenic injury in hospital
patients.
The World Health Organization (WHO) defines an ADR as follows:
‘ a drug-related event that is noxious and unintended and occurs at doses used in
humans for prophylaxis, diagnosis or therapy of disease or for the modification
of physiological function .’
However, this definition does not take into account the following
scenarios, all of which can also cause ADRs:
• overdose (including prescribing or administration errors)
• therapeutic failure
• drug interactions
• drug withdrawal.
Pharmacists have an important role in identifying, reporting, and preventing
ADRs.
Friday, 12 June 2015
Terminology in liver disease
Hepatocellular injury
Damage to the main cells of the liver (hepatocytes)
Hepatitis
Inflammation of the liver, a type of hepatocellular injury. Could
be caused by viruses, drugs, or other agents, or could be
idiosyncratic.
Cirrhosis
Chronic, irreversible damage to liver cells, usually caused by
alcohol or hepatitis C. If the remaining cells cannot maintain
normal liver function (compensated disease), ascites, jaundice,
and encephalopathy can develop (decompensated disease).
Cholestasis
Reduction in bile production or bile fl ow through the bile
ducts.
Liver failure
Severe hepatic dysfunction where compensatory mechanisms
are no longer suffi cient to maintain homeostasis. Could be
acute and reversible, or irreversible (e.g. endstage cirrhosis).
Anaphylaxis
Symptoms and signs of anaphylaxis
Anaphylaxis is defined as an immediate systems hypersensitivity event produced
by IgE-mediated release of chemicals from mast cells and basophils.Theoretically, prior exposure to the agent is required and the reaction is
not dose- or route-related, but in practice anaphylaxis to injected antigen
is more frequent, severe, and rapid in onset than following exposure to
oral or topical antigen.
Agents which commonly cause anaphylaxis include:
• drugs — e.g. penicillins, aspirin
• insect stings — e.g. wasp and bee venoms
• food — e.g. nuts.
Urticaria and angioedema are the most common symptoms
and absence of these suggests that the reaction may not be anaphylaxis.
Airways oedema, bronchospasm, and shock are life-threatening and
immediate emergency treatment is usually required.
The onset of symptoms following parenteral antigen (including stings) is
usually within 5–30min. With oral antigen, there is often a delay. Symptoms
usually occur within 2h, but may be immediate and life-threatening.
A late-phase reaction may also occur with recrudescence of symptoms
after apparent resolution. Recurrence is a fairly frequent phenomenon
and healthcare workers should be aware of this. Patients should not be
discharged too quickly as they may require further treatment.
End-of-needle reactions
Some patients may experience an anaphylactic-like reaction during rapid
intravenous (IV) drug administration. This is known as an end-of-needle
reaction. Initial symptoms may suggest anaphylaxis, but in fact this is a
vasopressor effect and can be distinguished from anaphylaxis as bradycardia
occurs which is rare in anaphylaxis. Skin symptoms are also rare
in end-of-needle reactions. Stopping or slowing down the infusion or
injection usually leads to resolution of symptoms,and administration at a
slower rate usually avoids a repeat event.
Signs and symptoms of anaphylaxis
F Urticaria
R Angioedema
E Dyspnoea, wheeze
Q Nausea, vomiting, diarrhoea, cramping abdominal pain
U Flush
E Upper airway oedema
N
T
R Headache
A Rhinitis
R Substernal pain
E Itch with no rash
Seizure
ATOMIC EMISSION SPECTROSCOPY
Technique
is also known as OPTICAL
EMISSION SPECTROSCOPY (OES)
- The
study of radiation emitted by excited atoms and
monatomic ions
- Relaxation of atoms in the excited state results in
emission of light
- Produces line spectra in the UV-VIS and the
vacuum UV regions
Used for qualitative identification of elements present
in the sample
- Also for quantitative analysis from ppm levels to percent
- Multielement technique
- Can be used to determine metals, metalloids, and some
nonmetals simultaneously
Emission wavelength and energy are related by
ΔE = hc/λ
- Does not require light source
- Excited atoms in the flame emit light that reaches the detector
(luminescence)
Techniques Based on Excitation Source
- Flame Photometry (flame OES)
- Furnace (Electrical Excitation)
- Inductively Coupled Plasma (ICP)
monatomic ions
- Relaxation of atoms in the excited state results in
emission of light
- Produces line spectra in the UV-VIS and the
vacuum UV regions
Used for qualitative identification of elements present
in the sample
- Also for quantitative analysis from ppm levels to percent
- Multielement technique
- Can be used to determine metals, metalloids, and some
nonmetals simultaneously
Emission wavelength and energy are related by
ΔE = hc/λ
- Does not require light source
- Excited atoms in the flame emit light that reaches the detector
(luminescence)
Techniques Based on Excitation Source
- Flame Photometry (flame OES)
- Furnace (Electrical Excitation)
- Inductively Coupled Plasma (ICP)
FLAME
ATOMIC EMISSION SPECTROSCOPY
-
Known as Flame
OES
-
Also called flame photometry
-
Solutions containing metals (or some nonmetals) are
introduced
into a flame
-
Very useful for elements in groups 1A and 2A
INSTRUMENTATION
OF FLAME OES
- No
external lamp is needed
-
Flame serves as both the atomization source and the
excitation
source
Main Components
-
Burner assembly
-
Flame
-
Wavelength selection device
-
Detector
Burner Assembly
- The
most commonly used is the Lundegarth or the premix burner
- Is
the heart of the emission spectrometer
-
Nebulizer introduces sample aerosol into the base of the flame
-
Free atoms are formed and excited in flame
-
Excited free atoms emit radiant energy
-
Only about 5% of the aspirated sample reach the flame
General Process in Flame
-
Liquid samples enter nebulizer
-
Sample droplets of liquid enter flame
-
Fine solid particles form
-
Particles decompose to free atoms
-
Excited atoms form
-
Excited atoms relax and emit radiation
-
Oxidation of atoms occur
Nebulizers commonly used
-
Pneumatic
and
-
Cross-flow
Wavelength Selection Device
Two
wavelength selectors used
- Monochromators
and
- Filters
Monochromators
-
Diffraction grating is used as the dispersion element
Filters
-
Good for detection of alkali metals due to simple spectrum
-
Material is transparent over a narrow spectral range
-
Desired radiation passes through filter and others are absorbed
- One
element is determined at a time (single channel)
Multichannel
Flame Photometers
- Two
or more filters are used simultaneously
-
Each filter transmits its designated radiation
-
Detector is PMT
-
Permits the use of internal standard calibration
Detectors
- PMT
-
Solid-state detectors (CCD, CID)
- PDA
Flame Excitation Source
- Two
gases (fuel and oxidant) are used
- Oxidant: air or nitrous oxide
- Fuel: acetylene (commonly used),
propane, butane, natural gas
-
Increase in flame temperature increases emission intensity
of
most elements (exception: Na, K, Li)
Each
element emits different characteristic wavelength of light
-
Emission lines are characterized by wavelength and intensity
Emission
intensity depends on
- Analyte element concentration in sample
-
Rate of formation of excited atoms in flame
-
Rate of introduction of sample into flame
-
Flame composition
-
Flame temperature
S = kN
S =
intensity
k =
proportionality constant
N =
number of atoms in the excited state
-
Increasing temperature increases N
-
Atomic emission spectrometry is very sensitive to temperature
-
Temperature must be carefully controlled for quantitative analysis
Elements
with emission lines at shorter wavelengths give weak
emission
intensity at low temperature
-
High-temperature nitrous oxide-acetylene flame is used for
such
elements
-
High-energy electrical or plasma excitation sources may
also
be used
-
Ratio of fuel to oxidant also affects emission intensity
- The
highest temperature is achieved when stoichiometric
mixture
is used
INTERFERENCE
Two
Classes
- Spectral interference
and
- Nonspectral
interference
Spectral
Interference
Two
types
Background
Radiation
- Broad band emission by excited
molecules and radicals in flame
Overlapping
emission lines
- Emission by different elements of
the same wavelength as
the analyte
element
Nonspectral Interference
Chemical
Interference
- Occurs if anions that combine
strongly with analyte
element
are present in sample
Excitation
Interference
- Result of collisions between
unexcited atoms of an element with
excited atoms of a different
element in sample
Ionization
Interference
- Occurs when atoms ionize in flame
and cannot emit atomic λs
APPLICATIONS
OF FLAME OES
- For measurement of alkali metals in clinical samples such as
serum and urine
- Excellent method for qualitative determination of multiple
elements in sample
- Characteristic emission lines of analyte are compared
with literature (appendix 7.1)
- Also used for quantitative analysis (application of Beer’s Law)
- Deviation from linearity is generally observed at
high concentrations
- More free atoms are liberated in
organic solvents than
in aqueous solutions
-
Implies emission intensity is relatively higher in
nonaqueous
solutions
-
Atomization is exothermic and rapid in organic solvents
-
Atomization is endothermic and relatively slow in aqueous
solutions
-
External calibrations and standard addition methods are used
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