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UniMark Pharmaceuticals was established in 1997 and emerging in Pharmaceutical Market. It is dedicated to provide better quality of life to every person and cost effective treatment by focusing on the growing need of pharmaceutical market. Business Evolution: The basis of UniMark business evolution is marketing all over Pakistan With life saving drugs in Cardiovascular Market Anti-diabetic market Gynecology

The Human Circulatory System by Tariq

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The Human Circulatory System

UniMark Pharmaceuticals was established in 1997 and emerging in Pharmaceutical Market.It is dedicated to provide better quality of life to every person and cost effective treatment by focusing on the growing need of pharmaceutical market. Business Evolution: The basis of UniMark business evolution is marketing all over Pakistan With life saving drugs in

Cardiovascular Market

Anti-diabetic market

Gynecology

The Human Circulatory SystemIntroductionHumans and other vertebrates have a closed circulatory system:

This means that circulating blood is pumped through a system of vessels

This system consists of the heart (pump), series of blood vessels and the blood that flows through them.

Parts of the Circulatory System

Divided into three major parts:The Heart The Blood The Blood Vessels

Functions of Circulatory SystemCirculate blood throughout entire body for

Transport of oxygen to cellsTransport of CO2 away from cellsTransport of nutrients (glucose) to cellsMovement of immune system components (cells, antibodies)Transport of endocrine gland secretions

The HeartLocated near the center of your chest

Hollow structure

Composed almost entirely of muscle

About the size of your clenched fist

The Heart: StructuresFour chambersTwo atriaUpper chambersLeft and rightSeparated by interatrial septumTwo ventriclesLower chambersLeft and rightSeparated by interventricular septum Atrioventricular septum separates the atria from the ventricles727-8The Heart: Structures(cont.)

8Heart coverings

Pericardium Covers the heart and large blood vessels attached to the heartVisceral pericardium Innermost layerDirectly on the heartParietal pericardium Layer on top of the visceral pericardium

The Heart: ValvesTricuspid valve prevents blood from flowing back into the right atrium when the right ventricle contractsBicuspid valve prevents blood from flowing back into the left atrium when the left ventricle contracts Pulmonary valve prevents blood from flowing back into the right ventricle Aortic valve prevents blood from flowing back into the left ventricle

The Heart: Blood Flow

Deoxygenated blood in from bodyOxygenated blood in lungsAtria ContractVentricles ContractDeoxygenated blood out to lungsOxygenated blood out to body13The Heart: Blood Flow (cont.)Right AtriumRight VentriclePulmonarySemilunarValveLeft AtriumBicuspidValveLeft VentriclePulmonaryValveTricuspidValveAorticSemilunarValveLungsBody14The Heart: Cardiac CycleRight atrium contractsTricuspid valve opens Blood fills right ventricle

Right ventricle contractsTricuspid valve closesPulmonary semilunar valve opensBlood flows into pulmonary arteryLeft atrium contracts Bicuspid valve opens Blood fills left ventricle

Left ventricle contractsBicuspid valve closesAortic semilunar valve opensBlood pushed into aortaOne heartbeat = one cardiac cycleAtria contract and relaxVentricles contract and relax15Cardiac CycleInfluenced byExerciseParasympathetic nervesSympathetic nervesCardiac control centerBody temperaturePotassium ionsCalcium ions

The Vascular System

Blood PressureBlood pressure is the force or pressure that the blood exerts on the walls of the blood vesselsBP = CO x TPRCO= SV x HRBP = Blood PressureCO = Cardiac OutputTPR = Total Peripheral ResistanceSV = Stroke VolumeHR = Heart rate

Blood PressureForce blood exerts on the inner walls of blood vesselsHighest in arteries Lowest in veins

Systolic pressure (Normal 120mmHg)Ventricles contractBlood pressure is at its greatest in the arteries

Diastolic pressure (Normal 80mmHg)Ventricles relaxBlood pressure in arteries is at its lowestReported as the systolic number over the diastolic number(120/80mmHg) 19PRIMARY HYPERTENSIONIt is also called Essential Hypertension About 90% persons have primary hypertension, The main reasons are believed to be involves is

DietAgeObesityRaceHeredityStressSmokingSECONDARY HYPERTENSION Secondary hypertension is due toExcessive renin secretion ArteriosclerosisEndocrine Disorders

WHO B.P CLASSIFICATION B.P classification according to the WHO is

Grade 1 (Mild Hypertension) SBP 140-159 or DBP 90-99 Grade 2 (Moderate Hypertension) SBP 160-179 or DBP 100-109 Grade 3 (Severe Hypertension) SBP 180 or DBP 110What is the difference between the systolic pressure and diastolic pressure?ANSWER: Systolic pressure is the result of the contraction of the ventricles increasing the pressure in the arteries. Diastolic pressure is the result of the relaxation of the ventricles lowering the pressure in the arteries.22The Heart: Cardiac Conduction SystemGroup of structures that send electrical impulses through the heart

Sinoatrial node (SA node)Wall of right atriumGenerates impulseNatural pacemakerSends impulse to AV node

Atrioventricular node (AV node)Between atria just above ventriclesAtria contractSends impulse to the bundle of HisBundle of HisBetween ventriclesTwo branches Sends impulse to Purkinje fibers

Purkinje fibersLateral walls of ventriclesVentricles contract23

Control of Blood PressureShort term control BaroreceptorsChemoreceptorsHigher centres in the brain

Long term controlRAAS systemBaroreceptorsLocated in walls of aortic arch and left and right carotid sinusMechanical stretch receptorsNeuronal circuits in brainstem compare actual value of BP provided by the baroreceptors with the set point or optimal value

Summary of the main mechanisms in blood pressure controlBaroreceptor and Chemoreceptor Reflexes

The Baroreceptor ReflexChemoreceptor Nerve ending situated in the carotid and aortic bodies control of respiration Sensitive to changes in the levels of Co2 , O2 and acidity of the blood

The relationship between stimulation of chemoreceptors and arterial blood pressureLong term Blood pressure regulationRenin-angiotensin-aldosterone system (RAAS)Anti-diuretic harmone (ADH)Atrial natriuretic peptide (ANP)Harmone released by heartSodium and water loss from the kidneyReduces blood pressure

RAAS SystemBlood supply to the heart

The heart is supplied with arterial blood by the right and left coronary arteries, which branch from the aorta immediately distal to the aortic valveThe coronary arteries receive about 5% of the blood pumped from the heart, although the heart comprises a small proportion of body weightBlood supply to the heart Venous drainage

Most of venous blood is collected into several small veins that join to form coronary sinus, which opens into right atrium

The remainder passes directly into the heart chambers through little venous channelsLarry M. Frolich, Ph.D.,Human AnatomyHeart InnervationHeart receives visceral motor innervationSympathetic (speeds up)Parasympathetic (slows down)

Electrocardiography

Alterations in Electrocardiogram

Blood A type of connective tissueRed blood cells (erythrocytes) White blood cells (leukocytes) Platelets cell fragments Plasma fluid part of bloodAverage-sized adult has 4 to 6 liters of blood Amount depends on:Size of personAmount of adipose tissueConcentrations of ionsFemales have less than males38Blood ComponentsHematocrit The percentage of red blood cellsNormal is about 45%

White cells and platelets = 1%

Plasma = 55%

39Blood Components: Red Blood CellsErythrocytes Transport oxygen throughout the bodySmall biconcave-shaped cells Hemoglobin is a pigment in RBCsOxyhemoglobin carries oxygen; bright red Deoxyhemoglobin does not carry oxygen; darker red Carries carbon dioxide, so also called carboxyhemoglobinAnemia low RBC countErythropoietin regulates production of RBCs40Blood Components: White Blood Cells GranulocytesNeutrophils (55%) destroy bacteria, viruses, and toxins in the bloodstream (phagocytes)Eosinophils (3%) get rid of parasitic infections such as worm infectionsBasophils (1%) control inflammation and allergic reactions AgranulocytesMonocytes (8%) destroy bacteria, viruses, and toxins in blood Lymphocytes (33%) provide immunity for the body 41Blood Components: White Blood Cells (cont.)WBC count normally 5000 to 10,000 cells per cubic millimeter of bloodLeukocytosis Elevated WBC countUsually due to infectionLeukopenia Low WBC countSome viral infections and other conditions42Blood Components: PlateletsFragments of cells found in the bloodstreamAlso called thrombocytes Important in the clotting process of bloodNormal count130,000 to 360,000 platelets per cubic millimeter of blood 43Blood Components: PlasmaLiquid portion of blood composed mostly of waterProteinsAlbumins Smallest plasma proteinsPull water in to help maintain blood pressureGlobulins transport lipids and fat-soluble vitaminsFibrinogen needed for blood clottingNutrientsAmino acidsGlucoseNucleotidesLipids from the digestive tractGases oxygen, carbon dioxide, and nitrogenElectrolytesWaste products

44Blood: Bleeding ControlHemostasis the control of bleedingThree processes of hemostasisBlood vessel spasmPlatelet plug formationBlood coagulation

45

Platelet plug formation46Diseases and Disorders of the Cardiovascular SystemDiseaseDescriptionAnemiaThe blood does not have enough red blood cells or hemoglobin to carry an adequate amount of oxygen to the bodys cells Aneurysm A ballooned, weakened arterial wall ArrhythmiasAbnormal heart rhythmsCarditisInflammation of the heartEndocarditisInflammation of the innermost lining of the heart, including valves47DiseaseDescriptionMyocarditisInflammation of the muscular layer of the heartPericarditisInflammation of the membranes that surround the heart (pericardium)Congestive Heart FailureWeakening of the heart over time; heart is unable to pump enough blood to meet bodys needsCoronary Artery Disease (CAD)Atherosclerosis; narrowing of coronary arteries caused by hardening of the fatty plaque deposits within the arteries Diseases and Disorders of the Cardiovascular System (cont.)48DiseaseDescriptionHypertensionHigh blood pressure; consistent resting blood pressure equal to or greater than 140/90 mm HgLeukemiaBone marrow produces a large number of abnormal WBCsMurmurs Abnormal heart soundsMyocardial InfarctionHeart attack; damage to cardiac muscle due to a lack of blood supplyDiseases and Disorders of the Cardiovascular System (cont.)49DiseaseDescriptionSickle Cell AnemiaAbnormal hemoglobin causes RBCs to change to a sickle shape; abnormal cells stick in capillariesThalassemiaInherited form of anemia; defective hemoglobin chain causes, small, pale, and short-lived RBCsThrombophlebitisBlood clots and inflammation develops in a veinVaricose VeinsTwisted, dilated veins Diseases and Disorders of the Cardiovascular System (cont.)50ANSWER: Anemia is a condition in which a person does not have enough red blood cells or hemoglobin in the blood to carry an adequate amount of oxygen to body cells. The doctor has told your patient she has anemia. How would you explain this to the her?51CARSEL25 TabletsCARSEL 50 TabletsCARSEL 100 TabletsCARSEL PLUS50 TabletsCARSEL PLUS100 Tablets CARSEL

PRESCRIBING INFORMATIONCarsel has the antihypertensive effect Metoprolol Tartrate is a selective beta-1adrenoreceptor blocking agent.CARSEL PLUS has combination of Hydrochlorothiazide that has antihypertensive & diuretics action. Carsel 25,50,100 have Metoprolol Tartrate 25mg,50mg and 100 mg respectively.The 50/25 tablets contain 50mg of Metoprolol Tartrate & 25mg of Hydrochlorothiazide USP.The 100/25 tablets contain 100mg of Metoprolol Tartrate & 25mg of Hydrochlorothiazide USP.

53INDICATIONS & DOSAGEINDICATIONSDOSAGEThat is hypertension preferably in high risk patients with renal disease, heart failure or diabetes mellitus1 to 2 tablets per day in single or divides dosesStage III hypertension1 to 2 tablets per day in single or divides doses

Essential hypertension WHO grade I & II1 to 2 tablets per day in single or divides doses

PRESENTATIONFilm coated tablet, blister strip 10 tablets, available in carton pack of 30 Tablets

PRICECARSEL 25Retail Price = 60.00Rs Trade Price = 51.00RsCARSEL 50 Retail Price = 95.00Rs Trade Price = 80.75RsCARSEL 100Retail Price = 150.00RsTrade Price = 127.50Rs

CARSEL PLUSCARSEL PLUS 50Retail Price =90.00RsTrade Price = 76.50Rs

CARSEL PLUS 100Retail Price = 150.00Rs Trade Price = 127.50Rs

PRICE COMPARISON

S #Brand NameCompanyStrengthPackingPrice/ PackPrice/ Tab.1CARSELUniMark25mg50mg100mg30s60.0095.00150.002.003.175.002BETALOOC ZOKBH100mg30s480.0016.003MEPRESSORNOVARTIS 100mg200 mg30s30s187.48323.006.2010.76

MIODARONE

MIODARONEContain Amiodaronehydrochloride,which is a member of a new class ofantiarrhythmicdrugs.Theantiarrhythmiceffect ofAmiodaroneis due to:A prolongation of the myocardial cell-action potential duration and refractory period

Noncompetitive- and -adrenergic inhibition Class III of antiarrhythmicdrugs . 60PRESENTATIONPresented in Alu-Alu packing of 30 TabletsPriceRetail Price = 331.50 Trade Price = 390.00PRICE COMPARISON

S #Brand NameCompanyStrengthPackingPrice/ PackPrice/ Tab.1MIOARONEUniMark200mg30s390.0013.002CARDARONESanofi aventis200mg30s464.1415.43SEDACORONEBIO PHARMA200 mg50s585.8412.00 ANGIPRO 75Aspirin is acetylsalicylic acid and is antithromoltic, analgesic, antipyretic and anit-inflammatory agent.The enteric coated Angipro 75 is designed to resist disintegration in the stomach, but to dissolve in a better neutral to alkaline environment of the duodenum. MECHANISM OF ACTIONAspirin as anti-platelet drug blocks thromboxane A2 sysnthesis from arachidonic acid in plateletsAspirins mode of action as an anti-inflammatory and anti-rheumatic agent may be due to inhibition of synthesis and release of prostaglandins.

INDICATIONS ANGIPRO 75 (enteric coated Aspirin) is indicated for:

Angina PectorisMyocardial InfarctionMyocardial infarction prophylaxisTransient Ischemic AttacksProphylactic use of ANGIPRO is also recommended to avoid the chances of thrombo embolic disordersANGIPRO 75 is also indicated in condition requiring chronic or long-term aspirin therapy for pain and inflammation, e.g. rheumatoid arthritis, Juvenile rheumatoid arthritis, PRICE

M.R.P. Rs.. 30.00RsTRADE PRICE25.50Rs

PRICE COMPARISON

Brand NameCompanyStrengthPackingPrice/ PackPrice/ Tab. ANGIPRO UniMark75 mg30s30.001.00LOPRINEHIGHNOON75mg30s33.001.10APISCOTSCOTMANN75 mg30s30.001.00DOLOPRINPACIFIC PHARMA75mg30s30.001.00ASCARDAtco75mg30s33.001.10

NIGLYS SR2.6/6.4mgGlyceryl TrinitrateSustained release pellets Mode of action Glyceryl trinitrate has dilator properties on vascular smooth muscle in virtually all vascular beds.The beneficial effects in therapeutic doses and the effects seen with overdose are attributable to the physiologic consequences of systemic venous and arteriolar vasodilatation.The cardiac preload, systemic blood pressure and systemic vascular resistance all show a progressive decrease.

NIGLYS, relaxes smooth muscle including vascular smooth muscle, and reduces systolic blood pressure. It is thought that the anti-anginal effect mainly depends on reducing myocardial oxygen demand by means of peripheral vasodilatation , which causes decreased venous return permitting a reduction in left ventricular volume and energy expenditure.Indications1-Prophylaxis and treatment of angina2- Left ventricular failure. 3-Control of hypertension during cardiac surgery.4-Congestive cardiac failure unresponsive to usual therapy. 5- IHD, CHD PRESENTATION Niglys is available in capsules form as 2.6 mg and 6.4 mg sustained release pellets.

Packing

Niglys 2.6mg = 30s capsules Niglys 6.4mg = 30s capsules PRICE COMPARISON

S #Brand NameCompanyStrengthPackingPrice/ PackPrice/ Tab.1Niglys SRUniMark2.6 mg30s110.003.602Niglys SRUniMark6.4mg30s150.005.003Angiocard SRHighnoon//Biogenics2.5 mg30s119.843.994Angiocard SRHighnoon//Biogenics6.5mg30s142.594.755NitromintMedipex2.6 mg60s221.973.706NitromintMedipex6.4mg30s168.005.607CardnitAtco2.6 mg30s106.003.508CardnitAtco6.4mg30s130.004.309SustacSearle2.6 mg30s157.225.2410SustacSearle6.4mg30s185.806.1911NitroscotScottman2.6 mg30s130.004.3312NitroscotScottman6.4mg30s160.005.33

(UNIPLATE)Clopidogrel It is an oral,thienopyridineclassantiplatelet agent used to inhibit blood clots incoronary artery disease,peripheral vascular disease, andcerebrovascular disease.Mode of actionClopidogrel is aprodrug, the action of which may be related to an ADP receptor onplatelet cell membranes. The drug specifically and irreversibly inhibits theP2Y12subtype of ADP receptor, which is important in activation of platelets and eventual cross-linking by the proteinfibrin.[1]Platelet inhibition can be demonstrated two hours after a single dose of oral clopidogrel, but the onset of action is slow, so that a loading-dose of 300mg is usually administered.PRICE(1X10S)

M.R.P.130.00RsTRADE PRICE110.00RsBrand NameCompanyStrengthPackingPrice/ PackPrice/ Tab.UNIPLATEUniMark75 mg10s130.00.0013.00LOWPLATPHARM EVO75 mg

10s140.0014.00NO-CLOTCCL75mg10s140.0014.00CLOTNILLBH75 mg

10s130.0013.00OGRELBOSCH75 mg

10s120.0012.00PIDOGRELHIGH NOON75 mg10s100.0010.00PLAVIXS.AVENTIS75mg28s3360.00120.00KOLMARK 10/20(Tablets)Generic name: Atorvaststin CalciumMode of actionKOLMARK is a selective, competitive inhibitor of HMG-CoA reductase, the rate-limiting enzyme that converts 3-hydroxy-3- methylglutaryl-coenzyme A to mevalonate, aprecursor of sterols, includingcholesterol. KOLMARK lowers plasma cholesterol and lipoprotein levels by inhibiting HMG-CoA reductase and cholesterol synthesis in the liver and by increasing the number of hepatic LDL receptors on the cell surface to enhance uptake andcatabolismof LDL; KOLMARK also reduces LDL production and the number of LDL particlesINDICATIONSPrevention of Cardiovascular Diseasein adult patients without clinically evident coronaryheart disease, but with multiple risk factors for coronary heart disease such as age, smoking,hypertension low HDL-C, or a family history of early coronary heart disease, kolmark is indicated to:Reduce the risk ofmyocardial infarctionReduce the risk ofstrokeReduce the risk for revascularization procedures andanginan patients withtype 2 diabetes, and without clinically evident coronary heart disease, but with multiple risk factors for coronary heart disease such asretinopathy,albuminuria, smoking, or hypertension, KOLMARK is indicated to:Reduce the risk of myocardial infarctionReduce the risk of stroke

patients with clinically evident coronary heart disease, KOLMARK is indicated to:Reduce the risk of non-fatal myocardial infarctionReduce the risk of fatal and non-fatal strokeReduce the risk for revascularization proceduresReduce the risk of hospitalization for CHFReduce the risk of anginaHyperlipidemiaa. LDL-C remains 190 mg/dL orb. LDL-C remains 160 mg/dL PRICE(1X10S)KOLMARK 10

M.R.P.125.00RsTRADE PRICE..106.25Rs

KOLMARK 20

M.R.P.180.00 RsTRADE PRICE..153.00 Rs

PRICE COMPARISON

Brand NameCompanyStrengthPackingPrice/ PackPrice/ Tab.KOLMARKUniMark10 mg20mg10s125.00180.0012.5018.00FOPSECMERCK10mg20mg10s130.0022.0013.0022.00LIPIREXHIGHNOON10mg20mg10s

130.00230.0013.0023.00LIPIGETGETZ10mg20mg

10s

150.00250.0015.0025.00MONOSOR 20/40(Isosorbide-5-mononitrate) Tablets

MODE OF ACTIONIt is of Synthetic origin and belongs to Nitrates. It belongs to EDRF (NO) agonist pharmacological group on the basis of mechanism of action and also classified in Antianginal Agents and Visosorbide-5-mononitrate is organic nitrate esters commonly used in the treatment of angina pectoris, myocardial infarction, congestive heart failure. Organic nitrate esters have a direct relaxant effect on vascular smooth muscles, and the dilation of coronary vessels improves oxygen supply to the myocardium. The dilation of peripheral veins, and in higher doses peripheral arteries, reduces preload and after-load, and thereby lowers myocardial oxygen consumption. asodilators pharmacological group.INDICATIONSIsosorbide 5-Mononitrate is primarily indicated in conditions likeCongestive heart failure,Prevention and treatment of scurvy,Prophylaxis of angina.PRICEMONOSOR 20(2x10s)M.R.P..77.00RsTrade Price65.45 Rs

MONOSOR 40 (2x10s)M.R.P123.00RsTrade Price104.55 Rs

PRICE COMPARISON

Brand NameCompanyStrengthPackingPrice/ PackPrice/ Tab.MONOSORUniMark20mg40mg20s77.00123.003.856.15MONISMAPPLE20mg40mg20s

77.00123.003.856.15ELANTONATCO20mg40mg

50s

191.90308.283.856.17MONOTRATEPFIZER20mg40mg

20s

72.30111.243.625.60