SYSTEMIC DRUG THERAPY

SYSTEMIC DRUG THERAPY

There are many different types of systemic medication therapy: those that treat the entire body as a whole, or those that target specific bodily systems, such as the cardiovascular, gastrointestinal, or nervous systems. Additionally, the treatment of mental health issues is systemic.

The nervous system Before medications like tacrine (which showed limited promise for enhancing cognition) was developed, treatment for Alzheimer's disease—the most common form of dementia—was purely supportive. Research shows that older people who are routinely stimulated with memory exercises retain information better than those who are not, proving that the continuous use of cognitive abilities prevents memory loss in the elderly.

" shaking palsy," as described by the English surgeon James Parkinson in 1817, is a persistent neurological illness that results in a gradual loss of motor function. Levodopa and other medications help reduce tremors, muscle rigidity, and postural instability, but no treatment has been found to stop the disease's progression. One of the several ergotamines and nonsteroidal anti-inflammatory drug formulations is effective in treating migraines, which are thought to be caused in part by aberrant neurophysiological reactions (NSAIDs). In the treatment of severe migraines, sumatriptan has dramatically better, with fewer side effects, than ergotamine or dihydroergotamine.

Mental disorders For anxiety and depression, recent developments in medication have proven significant. Although long-term use of benzodiazepines can lead to mild dependence, they have been the primary treatment for anxiety disorders since the 1960s. No matter how much alcohol you

consume, you won't experience any withdrawal symptoms when taking a drug like buspirone

(azapirone). As a result, there are also newer and safer treatments for panic disorder and OCD.

In the last few decades, significant progress has been made in the treatment and prevention of

depression. Anxiolytics such as Prozac and other SSRIs are as effective as older antidepressants

but come with fewer unpleasant side effects. Overdosing is less of a risk with these drugs,

which is important to keep in mind for patients with severe depression.

SYSTEMIC DRUG THERAPY

SYSTEMIC DRUG THERAPY

There are many different types of systemic medication therapy: those that treat the entire body

as a whole, or those that target specific bodily systems, such as the cardiovascular,

gastrointestinal, or nervous systems. Additionally, the treatment of mental health issues is

systemic.

The respiratory system

Acute bronchitis cough medications are the most commonly prescribed for respiratory

treatment. Only bacterial infections can be treated with antibiotics. Expectorants and

humidification (steam therapy) are the most common treatments for colds and flus because

they help loosen or liquefy thick mucus and soothe the inflamed mucous lining. Despite the fact

that they are frequently recommended, no clinical evidence supports the effectiveness of these

treatments. The natural defensive mechanism of coughing, which is to clear the airway of fluids

and foreign substances, is also subverted by cough suppressants, which are designed to prevent

unneeded coughing. This non-opioid cough suppressant, dextromethorphan, is readily

accessible over the counter and is nearly as effective as codeine. Antihistamines and

decongestants may be helpful if nasal congestion and postnasal discharge are present.

Asthma is a condition in which the airways become obstructed, resulting in wheezing episodes.

Using bronchodilators to treat a mild to moderate asthma episode is beneficial. Corticosteroids

or other anti-inflammatory medications like cromolyn sodium or necromil sodium must be used

for long periods of time to control recurrent attacks.

Chronic cough and shortness of breath are the first symptoms of chronic obstructive pulmonary

disease (COPD), which usually appears in old age. Some benefit can still be gained by quitting

smoking, utilizing bronchodilators, and taking antibiotics early when a superimposed infection

appears, even when the majority of the harm has already been done. When a patient's

condition is grave, supplemental oxygen therapy may be necessary.

The gastrointestinal system

Diarrhea and constipation are routinely treated with medications, which either decrease or

increase lower gastrointestinal activity. To help with constipation, there are many different

types of laxatives that can be taken in the form of stimulants (such as cascara sagrada), bulk-

forming agents (like psyllium seed) or even lubricants (like mineral oil) that can be taken in the

form of laxatives. If the cause of the diarrhea is a bacterial infection, such as traveler's diarrhea,

antibiotics must be used, or an antiparasitic medication must be used if a parasite is to blame.

Narcotics (codeine, paregoric) and nonnarcotic analogues (loperamide hydrochloride) are used

to treat diarrhea, as well as bismuth subsalicylate, a nonnarcotic analogue (Pepto-Bismol).

Antibiotics and bismuth are commonly used to treat chronic gastritis and recurrent peptic

ulcers caused by Helicobacter pylori infection. The H2-receptor antagonists (e.g., cimetidine)

and medicines that build a barrier to protect the stomach from the acid are used to treat ulcers

that are not caused by H. pylori (e.g., sucralfate). In addition to providing symptomatic relief,

anti-acids can be employed.

Vomiting and nausea are natural defense mechanisms that should not be ignored until the

underlying reason has been identified. They may be the result of mental illness or be brought

on by problems with the digestive or central nervous systems, drugs, or underlying health

issues (pregnancy or diabetic acidosis). The phenothiazines (e.g., Compazine) are among the

most commonly used antiemetics, although new medications are being researched to assist

reduce the vomiting associated with cancer chemotherapy.

SYSTEMIC DRUG THERAPY

SYSTEMIC DRUG THERAPY

There are many different types of systemic medication therapy: those that treat the entire body as a

whole, or those that target specific bodily systems, such as the cardiovascular, gastrointestinal, or

nervous systems. Additionally, the treatment of mental health issues is systemic.

The cardiovascular system

In the most prevalent form of arteriosclerosis, known as hardening of the arteries, cholesterol deposits

form plaques in large and medium-sized arteries, narrowing the lumen and reducing blood flow. When

the coronary arteries (which supply blood to the heart muscle) become obstructed, this narrowing

reduces the artery's capacity to deliver oxygen-rich blood to tissues. Depending on the extent of injury, a

heart attack might occur, which leads in the loss of heart muscle. Lowering blood cholesterol,

particularly the low-density lipoprotein (LDL) component, can halt or even reverse the progression of

atherosclerosis. Exercise, a low-cholesterol diet, and a healthy weight can all help lower cholesterol

levels. High-density lipoprotein (HDL) cholesterol is advantageous in that it aids in the removal of

dangerous cholesterol from the artery wall. Some medicines can enhance HDL cholesterol levels in the

blood, but avoiding smoking and increasing exercise are the most effective ways to raise the amount of

HDL cholesterol.

Angina can be caused by coronary artery narrowing, which reduces blood flow to the heart (angina

pectoris). A variety of medications, including nitroglycerin and beta blockers, can be used to treat this

disease.

Cardiotonic drugs have long been used to treat congestive heart failure (CHF). A positive inotropic

impact (affecting the force with which muscles contract) on the heart was first observed using digitalis, a

foxglove plant derivative. There are two ways to administer digoxin, the most frequent type of this drug.

Too much digitalis is poisonous and can cause cardiac arrhythmias, thus it has a narrow therapeutic

range. A patient's serum potassium levels are closely monitored since toxicity is exacerbated when the

patient's serum potassium levels are lower than normal.

In addition to decreasing the burden on the heart, drugs that dilate arterial smooth muscle and lower

peripheral resistance (vasodilators) help cure heart failure. Treatment for heart failure includes the use

of ACE inhibitors, vasodilators that suppress the angiotensin converting enzyme. Hypertensive patients

can also benefit from taking these medications.

Essential hypertension, or primary hypertension, is the most common kind of hypertension.

Approximately 5% of all hypertensive patients have secondary hypertension, which is high blood

pressure that is caused by a known underlying medical condition (e.g., kidney disease). While weight

loss, exercise, and a reduction in sodium intake are usually the first steps in treating hypertension, a

wide range of medications are available to help lower blood pressure, whether the systolic or diastolic

reading is too high. Traditionally, a single, well-tolerated medication, such as a diuretic, was the first

step in a stepped-care approach. If it doesn't work, a second drug is added and the combination is

tinkered with until the most successful regimen is discovered with the fewest adverse effects. In some

cases, a third medicine may be required for treatment.

SURGICAL THERAPY

SURGICAL THERAPY

 Major categories of surgery

1. Treating wounds

Wound heal in three ways:

1) primary intention (wound edges are brought together, as in a clean surgical wound),

2) secondary intention (the wound is left open and heals by epithelization), or

3) third intention, or delayed closing, whether they were caused by an accident or a surgical

scalpel (the wound is identified as potentially infected, is left open until contamination is

minimized, and is then closed).

The optimum procedure depends on a number of factors, including the presence of severe bacterial

contamination, the ability to identify and remove all necrotic material and foreign bodies, and the ability

to control bleeding. Clean wound edges and close opposing without putting too much strain on the

tissue are essential for normal healing to occur. The wound necessitates an adequate blood flow. The

blood supply will be compromised if the tissue is too tight and the margins can't be closed without

putting pressure on them. The edges can be pulled together more easily if the subcutaneous tissue is

removed by cutting under the skin. Skin grafts or flaps are utilized to close the wound if direct

approximation is still not achievable.

After the wound has been thoroughly cleaned, a local anesthetic, such as lidocaine, is used and left in

place for one to two hours before the incision is sealed shut. Local anesthetic injections might be

followed by additional washing of the wound, especially if foreign material is present. Scrubbing

aggressively is essential to remove the many small pieces of debris that are embedded in the skin if the

injury was caused by a fall on gravel or asphalt. Drenching the affected area in high-pressure saline

solution will eliminate most foreign material and limit the risk of further infection. As tetanus is a

disease caused by infection with Clostridium tetani, wounds that have been contaminated must be given

proper immunizations.

Sutures are the most often used method of wound closure, but staples and sticky tissue tape may be

more suited in some cases. To seal skin wounds, silk sutures were initially used, however nylon is more

durable and less likely to trigger tissue reaction than silk. As a general rule, sutures should be as small in

diameter as possible while still ensuring that the wound edges are kept as close together as possible.

Catgut (produced from sheep intestines) or a synthetic material like polyglycolic acid are used to imitate

the deeper layers of tissue beneath the skin in order to reduce tissue response. In order to speed up

healing or prevent fluid from accumulating, the goal is to fill in any empty spaces. Open suction drains

are used to prevent the accumulation of liquid, but drains are a source of contamination and only

seldom used. Staples allow for a quicker skin closure, although they lack the precision of sutures. Tape is

a great tool if the edges can be pulled together effortlessly and tension-free. However, tape can come

loose or be removed by the patient and is less effective if there is substantial wound edema even

though it is comfortable, quick to apply and avoids the markings produced by sutures.

Depending on the location, the desired cosmetic outcome, the blood flow to the area, and the degree of

reactivity around the sutures, sutures are normally removed after 3 to 14 days. In order to avoid visible

scarring, sutures in the facial area are normally removed within three to five days of placement. Tape is

commonly used to support the wound for the time it takes to heal. If there is a lot of tension on the

wound, sutures in the trunk or leg will be removed in 7 to 10 days or even longer. The horizontal neck

incision for thyroidectomy minimizes scarring and tension by placing an incision parallel to normal skin

lines.

Dressings keep the site clean and allow drainage to be absorbed more easily. During the first 24 hours

after surgery, a surgical wound is most vulnerable to surface contamination, hence an occlusive dressing

of gauze and tape is used. Transparent semipermeable membranes allow the wound to be viewed

without the dressing being removed, thereby protecting the wound from contamination. Compression

aids healing in the same way that skin grafts do.

When a wound heals, a scar forms; the goal is to have a scar that is strong but not overly visible.

Regardless of how meticulously the incision was closed, some people develop a keloid, a dense

overgrowth of scar tissue. Irritation and migration are followed by migration and proliferation, and

finally scar formation and closure. During the first 24 hours, platelets form a clog by attaching to the

collagen revealed by blood artery injury. The platelets and fibrin combine to create a clot, and the white

blood cells enter to remove any foreign material that may have gotten into the wound. In order to

increase the amount of blood flowing to the injured region, the vessels in the area widen, which speeds

up the healing process. Fibroblasts and macrophages invade the wound during the migratory phase to

begin healing. A scab is formed when epithelial cells migrate across a blood clot and connect with

nearby capillaries to produce new blood vessels. new epithelial cells cover and connect to build new

blood vessels in the proliferative phase. Fibroblasts release collagen to promote healing strength. Late in

the healing process, the scar is remodeled, blood vessels expand, and the epithelium on the surface of

the wound heals.

Wound healing can be affected by a variety of conditions, including diabetes mellitus and drugs. If the

blood glucose level is too high, wound healing may be impaired and the wound may be more susceptible

to infection in patients with well-controlled diabetes. Wound healing can be delayed by kidney or liver

failure, malnutrition, and poor circulation caused by arteriosclerosis. Steroids, anticancer treatments,

and other medications might interfere with the body's natural healing process.

2. Surgical extirpation

In the treatment of cancer or other damaged or contaminated organs, the term "extirpation" refers to

the removal or eradication of an organ or tissue to its whole. All malignant tissue must be removed,

which usually entails removing both the visible tumor and any nearby tissue that may contain tiny tumor

expansions. A complete cure is guaranteed unless the cancer spreads through the lymphatic system,

which is the primary method of cancer dissemination. Therefore, it is common practice to remove

nearby lymph nodes at the same time that the tumor is surgically removed. The results of a node biopsy

will reveal whether or not the cancer has spread to other parts of the body (spread). Using this

information, doctors can determine if more treatment is necessary, such as radiation therapy or

chemotherapy. Palliative surgery, which offers pain relief but does not remove the tumor entirely, may

be an option if removing the tumor completely is not possible. In the early stages of breast cancer,

radical surgery may not be the best option. No more benefit has been proven in early breast cancer than

a lumpectomy (removal of tumor only) followed by radiation treatment to the area, but the patient's

psychological anguish is typically enhanced by this procedure. In recent years, however, advancements

in breast reconstruction techniques have reduced the severity of the trauma associated with a

mastectomy.

3. Reconstructive surgery

To replace tissue that has been severely damaged or removed during surgery or trauma, reconstructive

surgery is often required. If the wound cannot be closed properly, a skin graft may be required. Split-

thickness skin grafts are employed when a substantial region of skin needs to be replaced. In spite of the

fact that this type of graft has a higher survival rate and a faster healing rate than other grafts, their

appearance is visually unappealing. For tiny defects, such as those on the face or hands, a full-thickness

skin graft (epidermis and dermis) is performed, and skin from the ear or neck is most commonly

employed. A skin flap is necessary for exposing bone, nerve, or tendon. Both a local flap and a free flap

can be utilized to cover the defect, depending on how much tissue is available in the location where the

wound is located. Using nearby tissue (skin and subcutaneous tissue) rotated to cover a scar from skin

cancer removal is an example of a local flap. When the required amount of tissue isn't accessible locally,

like in a lower-leg injury caused by a car bumper, a free flap is employed. There are a variety of flaps that

can be employed depending on the amount of tissue needed and the blood supply available. A sufficient

blood supply is required to feed both the split flap and the wound edge.

Additional tissue can be generated using tissue expanders, which can be utilized to conceal a deformity.

Reservoirs are implanted under the skin of a neighbouring area using inflatable plastics. To stretch the

overlaying skin and cover the defect, saltwater is injected into the reservoir for several weeks.

Medical issues that can necessitate reconstructive surgery include but are not limited to: Implanting

prosthetic devices, such as artificial heart valves, pacemakers, joints and blood arteries, or bones, can be

necessary in some cases.

Replace sick tissue with a prosthetic device. Because they are created of a substance that does not

provoke rejection, they often perform better than donated tissue. Early in the 16th century, the first

attempts at creating artificial limbs were made. An aortic aneurysm graft, developed by American

surgeon Michael DeBakey and his colleagues in 1954, was one of the earliest prosthetic devices used in

cardiovascular medicine to replace dilated vessels that risk rupture and death. Later, grafts consisting of

identical materials were used to replace damaged arteries in the body. Metal joints and heart valves are

two further examples of prosthetic devices (e.g., hip, knee, or shoulder).

4. Transplantation surgery

The discovery of immunosuppressive cyclosporine in the early 1970s dramatically enhanced the success

of organ transplantation. It has since been created a variety of immunosuppressive medications such as

prednisone, macrolide lactone, and antibodies that have been shown to be effective in the treatment of

autoimmune diseases (e.g., muromonab-CD3 and basiliximab).

Transplant surgeries involving the kidney are among the most common. Living relatives frequently

donate their kidneys in order to increase the chances of a transplant recipient's long-term survival.

Identical twins have the best chance of surviving. There is also the utilization of cadaver transplants.

Ninety percent or more of grafts survive one year. Approximately 50 percent of grafts fail after 8 to 11

years, although some can endure for decades. However, the chances of a successful transplantation

decline rapidly with time, thus kidneys removed from living donors must be implanted within 24 hours

at the latest. They can be kept for up to 72 hours.

Success rates with this operation are steadily rising, and it can be performed for up to six hours. To

reduce the chance of rejection, blood and tissue types are closely matched. The donor and donated

organs should be the same size as the receiver and the recipient's organ, and the time between the

declaration of death and the procurement of the organ should be as short as feasible.

End-stage liver disease can be treated by a liver transplant in some patients. The mortality rate following

surgery ranges from 10% to 20%, depending on the patient's age and health. All survivors need long-

term immunosuppressive treatment.

SKIN SURGICAL TECHNIQUES

SKIN SURGICAL TECHNIQUES

1. Laser surgery

At short distances, a laser beam can generate significant heat by emitting a very intense

monochromatic, nondivergent beam of light. Laser photocoagulation (also known as laser

welding) is used to stop bleeding in the gastrointestinal tract after a peptic ulcer. It is also used

to repair a surgically detached retina. Lasers can be used to cure pigmented tumors, erase

tattoos, or coagulate a hemangioma since they are absorbed by pigmented lesions (a benign but

disfiguring tumor of blood vessels). To treat superficial bladder cancer, laser surgery can also be

paired with transurethral ultrasound-guided laser-induced prostatectomy (TULIP). The

treatment of glaucoma and cervix and vulva diseases, including cancer in situ and genital warts,

are more recent applications.

2. Cryosurgery

Cryosurgery is a technique in which tissue is vaporized under extremely low temperatures.

Liquid nitrogen can be used to treat warts, precancerous skin lesions (actinic keratoses), and tiny

cancerous lesions on the skin. Extraction of central nervous system abnormalities (including

difficult to reach brain tumors) and treatment of some heart conduction problems are other

possible uses.

3. Stereotactic surgery

For deep lesions in the brain that cannot be reached otherwise, stereotactic surgery is a

valuable neurosurgical technique that allows the use of cold (as in cryosurgery), heat, or

chemicals to find and treat them. One of the advantages of this technique is that it keeps the

head immobile in a "halo frame," which aids in the precise location of the lesion or area that

needs treatment.

High-intensity radiation is also focused using stereotactic techniques on specific parts of the

brain in order to treat tumors or eliminate arteriovenous malformations. With the patient under

local anesthetic, a single burr hole in the skull is all that is needed to guide fine-needle aspiration

biopsies of brain lesions with this approach. Additionally, stereotactic fine-needle biopsy can be

utilized to examine breast lesions that are not palpable but are found by mammography.

4. Minimally invasive surgery

New technology that uses a small incision to insert a rigid or flexible endoscope to enable

internal video imaging is replacing traditional open surgical techniques. Treatments such as

endoscopic procedures (endoscopy) are frequently used to treat the nasal sinus, intervertebral

discs, fallopian tubes (including the uterus), shoulders, and knee joints. Even while endosurgery

has several advantages over conventional surgery, it can be more expensive and have a greater

rate of complications.

5. Trauma surgery

One of the most common reasons of lost life expectancy is trauma. Surgeons are now able to

save more lives than ever before thanks to the rapid advancement of medical technology and

instrumentation. Adult respiratory distress syndrome, multiorgan failure, kidney failure, sepsis,

and other life-threatening conditions can now be treated in the intensive care unit thanks to a

variety of life-supporting monitoring and technology.

Radiation therapy and other nonsurgical treatment options

1. Radiation therapy

electromagnetic waves (e.g., X-rays) or particles, such as electrons, neutrons, or protons, are

examples of ionizing radiation. Free radicals and oxidants are formed when cells come into

contact with tissue, resulting in cell death. Radiation may typically retain organ structure and

function while causing less harm than surgery when done correctly. Depending on the tumor's

radiosensitivity and the surrounding healthy tissues, a specific kind of radiation is applied. By

depositing their energy at a higher depth with high-energy sources such as linear accelerators,

these treatments not only cure deep-seated tumors but save the skin as well. Alternatively,

numerous beams of radiation can be directed at the deep tumor, providing a lesser dosage to

the rest of the body. Some skin malignancies can be treated with low-intensity electron beam

radiation.

2. Hyperthermia

More sensitive than healthy tissue to temperatures about 43 degrees Celsius (109.4 degrees

Fahrenheit). Tumor centers, where blood supply is low and radiation is ineffective, are more

sensitive to heat than the rest of the tumor. Microwaves or ultrasound can be used to heat a

tumor. Hyperthermia, a kind of nonionizing radiation treatment, may improve the effects of

radiation and chemotherapy.

3. Photodynamic therapy

Photodynamic treatment is another non-ionizing radiation therapeutic method (PDT). To use

this method, a light-absorbing chemical is injected into the body, and only the cancer cells retain

it. Laser beams of the proper wavelengths are used to destroy the cells. Tumors of the bronchi,

bladder, skin, and peritoneal cavity can be treated using PDT.

4. Extracorporeal shock wave lithotripsy

"Extracorporeal shock wave lithotripsy" refers to the use of shock waves to disintegrate stones

in the urinary system, most commonly the kidney or upper ureter (ESWL). The urethra and

bladder are the final destinations for the resulting stone pieces or dust particles.

The patient is given a general, regional, or even local anesthesia before the shock wave is

administered to the flank above the kidney. Stones of this size don't need to be submerged in

water; shock waves are instead conveyed through the skin by use of a water-filled rubber bulb.

Endoscopes are used to remove stones that are too big to be handled this way.