Prohibited classes of substances

Anabolic steroids e.g. nandrolone
Diuretics e.g. furosemide
Erythropoitin
Peptide hormones
Narcotics & analgesics e.g. heroin, morphine
CNS stimulants e.g. amphetamine, caffeine
Beta blockers
Agents with antiestrogenic activity e.g. aromatase inhibitors

What is doping ?

Accordiong to WADA, Doping is defined as the use of an artifice, whether substance or method, potentially dangerous to athletes' health and/or capable
of enhancing their performances, or the presence in the athlete's
body of a substance, or the ascertainment of the use of a method
on the list annexed to the Olympic Movement Anti-Doping Code

Therapeutic uses of androgens

Male hypogonadism
Enhancement of Athletic Performance
Male Contraception
Catabolic and Wasting States
Angioedema
Blood Dyscrasias

Methods of contraception

Female Contraception:
Inhibition of ovulation
Prevention of fertilization
Anti-zygotic drugs
Inhibition of implantation
use of spermicidal in vagina
IUCD
Male contraception:
Direct inhibition of spermatogenesis
Indirect inhibition of spermatogenesis
Immunological techniques (vaccine)

Uses of estrogens

As oral contraceptive pills
In hormone replacement therapy (HRT)
Osteoporosis
Treatment of postmenopausal hot flushes
Treatment of postmenopausal urogenital atrophy

Emergency Contraception

Mechanism: Multiple mechanisms are likely to contribute to the efficacy of these agents, but their precise contributions are unknown Some studies have shown that ovulation is inhibited or delayed, but additional mechanisms thought to play a role include alterations in endometrial receptivity for implantation; interference with functions of the corpus luteum that maintain pregnancy; production of a cervical mucus that decreases sperm penetration; alterations in tubular transport of sperm, egg, or embryo; or effects on fertilization. However, emergency contraceptives do not interrupt pregnancy after implantation.

Regimens: High doses of diethylstilbestrol and other estrogens once were used for postcoital contraception (the "morning-after pill") but never received FDA approval for this indication. The FDA has now approved two preparations for postcoital contraception. PLAN-B is two doses of the "minipill" (0.75 mg levonorgestrel per pill) separated by 12 hours. PREVEN is two 2-pill doses of a high-dose oral contraceptive (0.25 mg of levonorgestrel and 0.05 mg of ethinyl estradiol per pill) separated by 12 hours. This is sometimes referred to as the "Yuzpe" method after the Canadian physician who pioneered its use.

The first dose of such preparations should be taken anytime within 72 hours after intercourse, and this should be followed 12 hours later by a second dose. This treatment reduces the risk of pregnancy following unprotected intercourse by approximately 60% for the Yuzpe method and 80% for levonorgestrel alone. With either preparation, effectiveness appears to increase the sooner after intercourse the pills are taken

Adverse Effects: Nausea and vomiting are the main untoward effects, No changes in clotting factors have been reported for the combined regimen, but based on concerns with combination oral contraceptives, levonorgestrel alone might be considered for women who smoke or have a history of blood clots. Emergency contraceptive pills are contraindicated in cases of confirmed pregnancy.

Antidotes

Iron- Desferoxamine
Paracetamol- N acetylcysteine
Heparin-Protamine sulfate
Warfarin- Whole blood
Organophosphates- atropine / oximes
Dhatura- Physostgimine

How Transgenic animals help in research ?

Transgenic animals enable scientists to understand the role of genes in specific diseases.
By either introducing or inactivating particular genes, researchers can often for the first time discover the root causes of diseases associated with gene defects
Transgenic animals allow more effective treatments to be developed.
Transgenic animals help test the safety of new medicines and vaccines
Because transgenic models can highlight specific characteristics such as certain mechanisms involved in the formation of tumours, they can demonstrate more clearly the possible side effects of new therapies
Their use in early toxicity trials may also serve to prevent the subsequent use of a larger number of animals in the development phase
Transgenics may spare the use of higher animals
Transgenic animals can produce biological products.
It may be possible to use transgenic animals to make rare biological products for medical treatment
Human alpha-1-antitrypsin, a protein used to treat the rare genetic disorder of alpha-1-antitrypsin deficiency, is just one example

Role of transgenic animals in drug development

First, one can test whether it is reasonable to pursue a certain therapeutic approach. For example, if the researchers want to know if a disease could be treated by reducing the amount of a certain protein or the activity of a particular enzyme, they can produce transgenic animals missing the corresponding gene ("gene-knockout animals")
If symptoms of the disease are ameliorated without serious side effects, then it might be worth the time and expense of producing a drug that would have the same effect

How Transgenic animals are made?

To add a gene, called a transgene, to the normal chromosome set of an animal, researchers remove a one-cell embryo (the fertilized oocyte) from the oviduct of a pregnant animal and inject a cloned segment of DNA, including a gene of interest, into the male pronucleus.
The researcher then puts the embryo into the oviduct of a surrogate pregnant female who will carry the transgenic animal to term

What are transgenic animals

Neither science nor society may be ready for the direct manipulation of the human genome, but a technique for directing the genetic make-up of animals is being used in some of the most exciting biomedical research today
This technique involves inserting a foreign gene into the chromosome of an animal
The animal, called transgenic, then expresses that gene along with its normal genes
Transgenic animals are animals whose hereditary properties have been permanently modified by the introduction of recombinant DNA into their germ cells
In animals, transgenesis either means transferring DNA into the animal or altering DNA already in the animal.

Therapeutic query

A patient receiving prednisolone for one year developed oral thrush. He stopped taking prednisolone & took ketoconazole. After 24 hrs, he developed weakness, abdominal pain, fever, nausea, vomitting, diarrhoea, confusion & hypotension. A lot of fluid & electrolytes were supplemented but the condition got deteriorated.

1. What was the cause of symptom to patient ?

2. What should be the line of management in such case ?

3. What are the precautions to prevent it ?

Androgenic Alopecia (Male pattern baldness)

Clinical Features: Miniaturization of hairs along the midline of the scalp
Recession of the anterior scalp line in men and some women

Pathogenesis:Increased sensitivity of affected hairs to the effects of testosterone

Increased levels of circulating androgens (ovarian or adrenal source in women)

Treatment: If no evidence of hyperandrogen state, then topical minoxidil; finasteridea; hair transplant

Etiology of alopecia

I. Nonscarring alopecia
A. Primary cutaneous disorders
1. Androgenetic alopecia
2. Telogen effluvium
3. Alopecia areata
4. Tinea capitis
5. Traumatic alopeciaa

B. Drugs
C. Systemic diseases
1. Lupus erythematosus
2. Secondary syphilis
3. Hypothyroidism
4. Hyperthyroidism
5. Hypopituitarism
6. Deficiencies of protein, iron, biotin, and zinc
II. Scarring alopecia
A. Primary cutaneous disorders
1. Cutaneous lupus (chronic discoid)
2. Lichen planus
3. Folliculitis decalvans
4. Linear scleroderma (morphea)
5. Central centrifugal cicatricial alopecia
B. Systemic diseases
1. Lupus erythematosus
2. Sarcoidosis
3. Cutaneous metastases

Conjunctivitis

This is the most common cause of a red, irritated eye.This usually occurs in rainy season in tropical countries. This is also known as eye flu. It is contagious. It spread by close contact with infected cases. Pain is minimal, and the visual acuity is reduced only slightly. The most common viral etiology is adenovirus infection. It causes a watery discharge, mild foreign-body sensation, and photophobia. Bacterial infection tends to produce a more mucopurulent exudate. Mild cases of infectious conjunctivitis are usually treated empirically with broad-spectrum topical ocular antibiotics, such as sulfacetamide 10%, polymixin-bacitracin-neomycin, or trimethoprim-polymixin combination

Tocolytics

The drugs which relax the uterine smooth muscles are known as tocolytics.

Indications:

To delay or postpone labor

Arrest threatened abortion

Dysmenorrhoea

Delaying the labor is needed to allow foetus to mature, to initiate glucocorticoid therapy for foetal lung maturation, to transfer the mother in labor to a centre with proper facilities

The drugs used are

1. Selective beta 2 adrenergic agonist e.g. ritodrine, isoxsuprine

2. calcium channel blockers (CCB) e.g. nifedipine

3. Magnesium sulfate (i.v.)

4. Oxytocin antagonist, Atosiban

5. Misc. drugs e.g. nitrates, prgesterone, PG synthesis inhibitors (NSAIDS) , general anaesthetics (halothane) etc

Antidiabetic drugs

Antidiabetic drugs can be classified in various ways like hypoglycemics & euglycemics

Hypoglycemics drugs

Insulin

Sulfonylureas

Meglitinide

Euglycemic drugs are

Biguanides

Thiazolidinediones

Alpha glucosidase inhibitors

Oral hypoglycemic drugs

Sulfonylureas which can be further divided into first & second generation drugs e.g. Glipizide, Gliclazide

Biguanides e.g. metformin

Thiazolidinediones e.g. rosiglitazone, pioglitazones

Alpha glucosidase inhibitors e.g. Acarbose & Miglitol

Meglitinide/ Phenylalanine analogues e.g. Repaglinide, Nateglinide

Parenteral drugs e.g. insulin