Pharmacology of Antihistamines, Antineoplastics, and Diuretics

Antihistaminic Agents

Antihistamines are drugs that inhibit the action of histamine in the human body. Histamine is a chemical substance classified as an autacoid (a local hormone released from tissue that acts at the site of synthesis).

Histamine Overview

  • Chemical Name: 2-(1H-Imidazol-4-yl)ethanamine
  • Discovery: Sir Henry Dale, 1910.
  • Synthesis: Decarboxylation of Histidine, catalyzed by Histidine Decarboxylase (HDC).
  • Storage: Primarily in mast cells and basophils, also in enterochromaffin-like (ECL) cells
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Essential Cardiology Clinical Reference and Management

1. Acute Coronary Syndrome (ACS)

Diagnosis Patterns

  • STEMI: ST elevation in contiguous leads OR new LBBB.
  • Posterior MI: ST depression V1–V3 + tall R waves.
  • Inferior MI: II, III, aVF (RCA → AV node → AV block risk).
  • Lateral MI: I, aVL, V5–V6 (LCx).
  • Wellens: Deep/biphasic T waves V2–V3 → critical LAD stenosis.
  • Troponin rise: Not always plaque rupture (can be sepsis, demand ischaemia).

STEMI Management

  • PCI if within 12h + within 120 min pathway.
  • Otherwise fibrinolysis (within 12h).
  • Repeat ECG 60–90
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Gastroenterology Clinical Essentials: Bowel and Liver Pathology

Surgical Management of Colitis

  • Ulcerative Colitis (UC): Refractory disease requires panproctocolectomy (removal of colon, rectum, and anus) with a permanent end ileostomy. UC is a continuous disease involving the rectum; leaving the rectum results in persistent active disease.
  • Ileostomy vs. Colostomy:
    • Ileostomy: Right iliac fossa, spouted, liquid output (due to lack of colonic water absorption). The spout protects skin from digestive proteases.
    • Colostomy: Left-sided, semi-solid stool, less spouted.
  • Hartmann’s
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Psychiatry Clinical Reference and Management Notes

Obsessive-Compulsive Disorder (OCD)

Core Concepts

TermDefinition
ObsessionIntrusive, unwanted thought
CompulsionRepetitive act to reduce anxiety
  • Diagnosis: Symptoms persist >2 weeks
  • Usually has preserved insight
  • SSRIs: Higher doses needed; response may take ≥12 weeks

Management

SeverityFirst-Line
Mild impairmentCBT + ERP
Severe / poor CBT responseAdd SSRI
Severe functional impairmentRefer secondary mental health

Exposure and Response Prevention (ERP)

  • Expose patient to anxiety trigger
  • Prevent compulsive behaviour

Pharmacology

DrugKey
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Gastroenterology and Hepatology Clinical Summary

1. Liver Disease: Patterns, Causes, and Associations

Chronic Liver Diseases

ConditionKey Features
HaemochromatosisFatigue, erectile dysfunction, arthralgia; ↑ ferritin, ↑ transferrin saturation, ↓ TIBC; AR; hypogonadotrophic hypogonadism; ↑ HCC risk
Wilson’s DiseaseLiver and neuro disease; ↓ caeruloplasmin, ↓ serum copper, Kayser-Fleischer rings, psychosis
PBCMiddle-aged women; ↑ IgM; anti-mitochondrial Ab (M2); treat: ursodeoxycholic acid
PSCp-ANCA+, MRCP “beading”; strong UC association;
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Endocrine Disorders: Clinical Management and Diagnostics

Thyroid

Graves’ Disease

  • Most common cause of thyrotoxicosis
  • Autoimmune: IgG antibodies against TSH receptor
  • TSH receptor antibodies positive in ~90%
  • Exophthalmos + pretibial myxoedema = specific for Graves’
  • Smoking = biggest modifiable risk factor for thyroid eye disease
  • Clubbing with hyperthyroidism → think Graves’
  • Postpartum period may trigger or worsen Graves’
  • Radioiodine contraindicated in active eye disease
  • Diffuse homogeneous uptake on radioactive iodine scan

Hyperthyroidism

  • Hyperthyroidism
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