Parkinson's disease : Parkinson's disease (PD also known as idiopathic or primary Parkinsonism, hypokinetic rigid syndrome/HRS, or paralysis agitans) is a degenerative disorder of the central nervous system. The motor symptoms of Parkinson's disease result from the death of dopamine-generating cells in the substantia nigra, a region of the midbrain; the cause of this cell death is unknown. Tremor, rigidity, bradykinesia, and postural instability are the cardinal features of Parkinsonism and may be present in any combination. There may also be a mild decline in intellectual function. The tremor of about four to six cycles per second is most conspicuous at rest, is enhanced by emotional stress, and is often less severe during voluntary activity. Although it may ultimately be present in all limbs, the tremor is commonly confined to one limb or to the limbs on one side for months or years before it becomes more generalized. Commonly used drugs in Parkinson disease include Levodopa-Carbidopa combination, Anticholinergics (orphenadrine , procyclidine ,trihexyphenidyl ), Dopamine Agonists( Bromocriptine, Carbergoline, Ropinirole, Pramipexole and Lisuride.), COMT inhibitors (entacapone ,Tolcapone) and MAO-B inhibitors ( rasagiline,selegiline)


Hyperprolactinaemia : Hyperprolactinaemia is defined as an elevation of prolactin level above 25ng/ml in women of childbearing age and above 20ng/ml in men and post-menopausal women. It occurs in the Pituitary gland which is located at the base of the hypothalamus. Hyperprolactinaemia is a raised level of prolactin in the blood. This hormone stimulates breast epithelial cell proliferation and induces milk production. The primary action of prolactin is to stimulate lactation. However, excessive production of prolactin leads to infertility and gonadal dysfunction. Prolactin suppresses gonadotrophin-releasing hormone (GnRH), resulting in suppression of ovulation in females and reduced testosterone levels and hypogonadism in males. Medication • Most patients will be treated with a dopamine agonist. Dopamine agonists suppress prolactin in most patients, normalise gonadal function and also stop galactorrhoea. Cabergoline and bromo-criptine are both ergot-based dopamine receptor agonists. Cabergoline is the first-line treatment for prolactinomas as it has greater efficacy in suppressing prolactin secretion.


Atrial fibrillation : The ventricular rate in atrial fibrillation can be controlled with a beta-blocker or diltiazem.or verapamil. Digoxin is usually effective for controlling the rate at rest; it is also appropriate if atrial fibrillation is accompanied by congestive heart failure. If the rate at rest or during exercise cannot be controlled, diltiazem or verapamil may be combined with digoxin, but care is required if the ventricular function is diminished. In some cases, e.g. acute atrial fibrillation or paroxysmal atrial fibrillation, diltiazem or verapamil or a beta-blocker may be more appropriate than digoxin (see also Paroxysmal Supraventricular Tachycardia and Supraventricular Arrhythmias below). Anticoagulants are indicated especially in valvular or myocardial disease, and in the elderly; in the very elderly the overall benefit and risk needs careful assessment. Younger patients with lone atrial fibrillation in the absence of heart disease probably do not need anticoagulation. Aspirin is less effect than warfarin at preventing emboli but may be appropriate if there are no other risk factors for stroke; aspirin 75 mg may be used.


Atrial flutter : The ventricular rate at rest can sometimes be controlled with digoxin. Reversion to sinus rhythm (if indicated) may be achieved by appropriately synchronised d.c. shock. Alternatively, amiodarone may be used to restore sinus rhythm, and amiodarone or sotalol to maintain it. If the arrhythmia is long-standing a period of treatment with anticoagulants should be considered before cardioversion to avoid the complication of emboli. Drugs used - Digoxin, Amiodarone and Sotalol


Arrhythmia : DEFINITION Arrhythmia is defined as loss of cardiac rhythm, especially irregularity of heart-beat and is an abnormal cardiac rhythm, usually involving the change in rate or regularity and is monitored by using Electrocardiograph (ECG). PATHOPHYSIOLOGY The blood pushed from ventricles in a controlled sequence of muscle contraction. In cardiac arrhythmia, there will be disturbed in the sequence and in electrical conductivity. Arrhythmias are classified in to differentkinds depending upon the disorders of impulse generation and includes, Premature contraction - Common arrhythmia, which affect large number of people. Caffeine and stress increases the occurrence of premature beats. Tachycardia - An abnormally fast heart beats (more than 100beats/min) ,this can also lead to insufficient blood circulation. Bradycardia- An abnormally fast heart beats (more than 100beats/min). This can also lead to insufficient blood circulation. Atrial fibrillation- A rapid, irregular heart rhythm caused by abnormal electrical impulses that begins in the upper chambers of the heart.In atrial fibrillation the heart rate is even higher i.e. 500 beats/min. Atrial flutter - In atrial flutter the heart rate is 250-350 beats/min, associated with tachycardia.Commonly seen in hyperthyroidism and heart failure. Ventricular fibrillation - Life threatening condition in which the heartquivers very rapidly about 350times/min or more.This leads to rapidly fatal if not reversed by defibrillation.