python3 -c " from pypdf import PdfReader reader = PdfReader('/home/daytona/workspace/attachments/43c42365-5489-4475-93e7-b6e29730bcbc/Shanbhag Pharmacology.pdf') print(f'Total pages: {len(reader.pages)}') # Print first few pages to find table of contents for i in range(0, 15): text = reader.pages[i].extract_text() print(f'--- PAGE {i+1} ---') print(text[:500]) print() "

python3 -c " from pypdf import PdfReader reader = PdfReader('/home/daytona/workspace/attachments/43c42365-5489-4475-93e7-b6e29730bcbc/Shanbhag Pharmacology.pdf') # Chapter 2: Autonomic Pharmacology - pages 46-97 (book pages), PDF pages ~57-108 # Extract pages 55-110 (0-indexed) text = '' for i in range(55, 112): page_text = reader.pages[i].extract_text() if page_text: text += f'\n\n=== PDF PAGE {i+1} ===\n' + page_text print(text[:8000]) " 2>/dev/null

python3 -c " from pypdf import PdfReader reader = PdfReader('/home/daytona/workspace/attachments/43c42365-5489-4475-93e7-b6e29730bcbc/Shanbhag Pharmacology.pdf') # Search for Autonomic/Cholinergic chapter start for i in range(50, 130): text = reader.pages[i].extract_text() if text and ('Cholinergic' in text or 'cholinergic' in text or 'AUTONOMIC' in text or 'Autonomic' in text): print(f'PDF page {i+1}: {text[:200]}') print('---') " 2>/dev/null

python3 -c " from pypdf import PdfReader reader = PdfReader('/home/daytona/workspace/attachments/43c42365-5489-4475-93e7-b6e29730bcbc/Shanbhag Pharmacology.pdf') # Chapter 2: ANS pages - PDF pages 65-117 (0-indexed 64-116) text = '' for i in range(64, 117): page_text = reader.pages[i].extract_text() if page_text: text += f'\n\n=== PDF PAGE {i+1} ===\n' + page_text with open('/home/daytona/workspace/ans_content.txt', 'w') as f: f.write(text) print(f'ANS chapter extracted: {len(text)} chars') " 2>/dev/null

python3 -c " from pypdf import PdfReader reader = PdfReader('/home/daytona/workspace/attachments/43c42365-5489-4475-93e7-b6e29730bcbc/Shanbhag Pharmacology.pdf') # Find autacoids chapter (Chapter 6, page 230) for i in range(240, 310): text = reader.pages[i].extract_text() if text and ('Histamine' in text or 'Serotonin' in text or '5-Hydroxytryptamine' in text or 'HISTAMINE' in text or 'Autacoid' in text): print(f'PDF page {i+1}: {text[:200]}') print('---') " 2>/dev/null

python3 -c " from pypdf import PdfReader reader = PdfReader('/home/daytona/workspace/attachments/43c42365-5489-4475-93e7-b6e29730bcbc/Shanbhag Pharmacology.pdf') # Chapter 6: Autacoids pages 249-270 (0-indexed 248-269) text = '' for i in range(248, 278): page_text = reader.pages[i].extract_text() if page_text: text += f'\n\n=== PDF PAGE {i+1} ===\n' + page_text with open('/home/daytona/workspace/autacoids_content.txt', 'w') as f: f.write(text) print(f'Autacoids chapter extracted: {len(text)} chars') " 2>/dev/null

mkdir -p /home/daytona/workspace/ans-notes && cat > /home/daytona/workspace/ans-notes/generate_notes.js << 'JSEOF' const { Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell, HeadingLevel, AlignmentType, BorderStyle, WidthType, ShadingType, VerticalAlign, PageBreak, TableOfContents } = require('docx'); const fs = require('fs'); // Color scheme const HEADER_BG = "1B3A6B"; // Dark blue for section headers const SUBHEAD_BG = "2E75B6"; // Medium blue for sub-headers const ALT_ROW = "D6E4F0"; // Light blue for alternating rows const WHITE = "FFFFFF"; const YELLOW_BG = "FFF2CC"; // Yellow highlight for key facts function headerCell(text, colspan = 1, bgColor = HEADER_BG) { return new TableCell({ columnSpan: colspan, shading: { fill: bgColor, type: ShadingType.CLEAR }, verticalAlign: VerticalAlign.CENTER, children: [new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text, bold: true, color: WHITE, size: 20 })] })] }); } function subHeaderCell(text, colspan = 1) { return new TableCell({ columnSpan: colspan, shading: { fill: SUBHEAD_BG, type: ShadingType.CLEAR }, verticalAlign: VerticalAlign.CENTER, children: [new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text, bold: true, color: WHITE, size: 18 })] })] }); } function dataCell(text, bold = false, bgColor = WHITE, color = "000000") { return new TableCell({ shading: { fill: bgColor, type: ShadingType.CLEAR }, verticalAlign: VerticalAlign.TOP, children: [new Paragraph({ children: [new TextRun({ text, bold, size: 18, color })] })] }); } function sectionHeading(text) { return new Paragraph({ heading: HeadingLevel.HEADING_1, spacing: { before: 400, after: 200 }, children: [new TextRun({ text, bold: true, size: 32, color: "1B3A6B" })] }); } function subHeading(text) { return new Paragraph({ heading: HeadingLevel.HEADING_2, spacing: { before: 200, after: 100 }, children: [new TextRun({ text, bold: true, size: 26, color: "2E75B6" })] }); } function note(text) { return new Paragraph({ spacing: { before: 80, after: 80 }, children: [new TextRun({ text: "★ " + text, italics: true, size: 17, color: "C00000" })] }); } function spacer() { return new Paragraph({ spacing: { before: 120, after: 120 }, children: [new TextRun("")] }); } // ============================================= // TABLE BUILDERS // ============================================= // 1. CHOLINERGIC DRUGS TABLE function cholinergicTable() { const rows = [ new TableRow({ children: [headerCell("CHOLINERGIC DRUGS (CHOLINOMIMETICS / PARASYMPATHOMIMETICS)", 4)] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Type / MOA"), subHeaderCell("Uses"), subHeaderCell("Adverse Effects")] }), // DIRECT ACTING - CHOLINE ESTERS new TableRow({ children: [headerCell("DIRECT ACTING — Choline Esters", 4, "2E75B6")] }), new TableRow({ children: [ dataCell("Acetylcholine (ACh)", true, ALT_ROW), dataCell("Muscarinic + Nicotinic agonist; rapidly hydrolysed by cholinesterases", false, ALT_ROW), dataCell("No clinical use (too short-acting)", false, ALT_ROW), dataCell("Bradycardia, bronchoconstriction, hypotension", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Bethanechol", true), dataCell("Selective M3 agonist; NOT hydrolysed by cholinesterases; no nicotinic action", false), dataCell("Postoperative urinary retention; paralytic ileus", false), dataCell("Abdominal cramps, diarrhoea, bradycardia; CI in asthma/peptic ulcer", false) ]}), new TableRow({ children: [ dataCell("Carbachol", true, ALT_ROW), dataCell("Muscarinic + Nicotinic; resistant to cholinesterases", false, ALT_ROW), dataCell("Glaucoma (eye drops)", false, ALT_ROW), dataCell("Bradycardia, bronchoconstriction", false, ALT_ROW) ]}), // DIRECT ACTING - ALKALOIDS new TableRow({ children: [headerCell("DIRECT ACTING — Alkaloids", 4, "2E75B6")] }), new TableRow({ children: [ dataCell("Pilocarpine", true), dataCell("Tertiary amine; muscarinic > nicotinic; crosses blood–brain barrier (BBB)", false), dataCell("1. Glaucoma (reduces IOP by miosis + ciliary muscle contraction)\n2. Xerostomia (dry mouth in Sjogren's)", false), dataCell("Sweating, salivation, lacrimation, GI upset; CI: asthma", false) ]}), new TableRow({ children: [ dataCell("Muscarine", true, ALT_ROW), dataCell("Pure muscarinic agonist (mushroom alkaloid)", false, ALT_ROW), dataCell("No therapeutic use; toxicological importance", false, ALT_ROW), dataCell("SLUDGE: Salivation, Lacrimation, Urination, Defaecation, GI distress, Emesis", false, ALT_ROW) ]}), // INDIRECT ACTING - ANTICHOLINESTERASES new TableRow({ children: [headerCell("INDIRECT ACTING — Anticholinesterases (AChE Inhibitors)", 4, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Type"), subHeaderCell("Uses"), subHeaderCell("Key Points")] }), new TableRow({ children: [ dataCell("Physostigmine", true), dataCell("Reversible; tertiary amine (crosses BBB)", false), dataCell("1. Atropine poisoning (antidote)\n2. Glaucoma", false), dataCell("Crosses BBB; causes central effects; caution: bradycardia", false) ]}), new TableRow({ children: [ dataCell("Neostigmine", true, ALT_ROW), dataCell("Reversible; quaternary ammonium (does NOT cross BBB); direct + indirect action on NMJ", false, ALT_ROW), dataCell("1. Myasthenia gravis\n2. Postoperative urinary retention/ileus\n3. Reversal of non-depolarizing NM blockade\n4. Curare poisoning", false, ALT_ROW), dataCell("Does NOT cross BBB; no central effects; preferred over physostigmine in MG", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Pyridostigmine", true), dataCell("Reversible; quaternary ammonium", false), dataCell("Myasthenia gravis (preferred — longer duration, twice daily SR)", false), dataCell("Less potent than neostigmine; better tolerated by MG patients", false) ]}), new TableRow({ children: [ dataCell("Edrophonium", true, ALT_ROW), dataCell("Reversible; very short action (8–10 min) — binds only anionic site", false, ALT_ROW), dataCell("1. Diagnosis of myasthenia gravis (Tensilon test)\n2. Differentiate myasthenic crisis vs cholinergic crisis\n3. Curare poisoning (rapid onset)", false, ALT_ROW), dataCell("Rapid onset, short duration (8–10 min); IV use only", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Organophosphates\n(Parathion, Malathion, Sarin)", true), dataCell("IRREVERSIBLE; phosphorylate AChE", false), dataCell("Parathion/Malathion: pesticides\nSarin/Soman: nerve agents (warfare)", false), dataCell("Toxicity = SLUDGE + BBQ (Bradycardia, Bronchospasm, Qseizures); Antidote: Atropine + Pralidoxime", false) ]}), new TableRow({ children: [ dataCell("Donepezil, Rivastigmine, Galantamine", true, ALT_ROW), dataCell("Reversible AChE inhibitors; increase CNS ACh", false, ALT_ROW), dataCell("Alzheimer's disease (cognitive enhancers)", false, ALT_ROW), dataCell("Donepezil: once daily; Rivastigmine: patch available; GI side effects common", false, ALT_ROW) ]}), ]; return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows }); } // 2. ANTICHOLINERGIC DRUGS TABLE function anticholinergicTable() { const rows = [ new TableRow({ children: [headerCell("ANTICHOLINERGIC DRUGS (ANTIMUSCARINICS)", 4)] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("MOA / Type"), subHeaderCell("Uses"), subHeaderCell("Adverse Effects / Notes")] }), // Atropine new TableRow({ children: [headerCell("ATROPINE — The Prototype Antimuscarinic", 4, "2E75B6")] }), new TableRow({ children: [ dataCell("Atropine", true, YELLOW_BG), dataCell("Non-selective competitive M1/M2/M3 blocker; alkaloid from Atropa belladonna", false, YELLOW_BG), dataCell("1. Preanaesthetic medication (dries secretions)\n2. OPC poisoning (antidote)\n3. Bradycardia (vagolysis)\n4. Peptic ulcer (rarely)\n5. Motion sickness (scopolamine preferred)\n6. Uveitis/Iritis (cycloplegia)\n7. Eye: refraction testing (mydriasis)\n8. Biliary/renal colic (antispasmodic)", false, YELLOW_BG), dataCell("Dry mouth, urinary retention, constipation, tachycardia, mydriasis, cycloplegia, blurred vision, flushing\nCI: Glaucoma, BPH, pyloric stenosis\nMnemonic: HOT as a hare, DRY as a bone, RED as a beet, BLIND as a bat, MAD as a hatter", false, YELLOW_BG) ]}), // Actions of Atropine new TableRow({ children: [headerCell("PHARMACOLOGICAL ACTIONS OF ATROPINE (Organ-wise)", 4, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Organ/System"), subHeaderCell("Receptor Blocked"), subHeaderCell("Effect"), subHeaderCell("Clinical Relevance")] }), new TableRow({ children: [dataCell("Heart", true), dataCell("M2"), dataCell("Tachycardia (initial low dose → transient bradycardia)"), dataCell("Used in sinus bradycardia, heart block")] }), new TableRow({ children: [dataCell("Eye", true, ALT_ROW), dataCell("M3", false, ALT_ROW), dataCell("Mydriasis + Cycloplegia (7–10 days)", false, ALT_ROW), dataCell("Refraction testing; CI in glaucoma", false, ALT_ROW)] }), new TableRow({ children: [dataCell("Glands", true), dataCell("M3"), dataCell("Decreased ALL secretions (except milk and bile)"), dataCell("Dryness of mouth, reduced sweating")] }), new TableRow({ children: [dataCell("GIT", true, ALT_ROW), dataCell("M3", false, ALT_ROW), dataCell("Decreased tone + motility; constipation", false, ALT_ROW), dataCell("Biliary/renal colic relief", false, ALT_ROW)] }), new TableRow({ children: [dataCell("Urinary Bladder", true), dataCell("M3"), dataCell("Detrusor relaxation → urinary retention"), dataCell("Avoid in elderly men/BPH")] }), new TableRow({ children: [dataCell("Bronchi", true, ALT_ROW), dataCell("M3", false, ALT_ROW), dataCell("Bronchodilation + dries secretions", false, ALT_ROW), dataCell("Ipratropium preferred in COPD", false, ALT_ROW)] }), new TableRow({ children: [dataCell("CNS", true), dataCell("M1"), dataCell("Anti-Parkinson effect; restlessness, delirium at high doses"), dataCell("Used in Parkinsonism (benztropine)")] }), // Atropine Substitutes new TableRow({ children: [headerCell("ATROPINE SUBSTITUTES", 4, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Selectivity"), subHeaderCell("Uses"), subHeaderCell("Key Points")] }), new TableRow({ children: [dataCell("Scopolamine (Hyoscine)", true), dataCell("Nonselective antimuscarinic; more CNS sedation"), dataCell("Motion sickness (transdermal patch), preanaesthetic medication"), dataCell("Causes sedation; longer duration than atropine")] }), new TableRow({ children: [dataCell("Homatropine", true, ALT_ROW), dataCell("Eye — M3", false, ALT_ROW), dataCell("Mydriasis for refraction (shorter duration than atropine: 1–3 days)", false, ALT_ROW), dataCell("Semisynthetic; less potent than atropine", false, ALT_ROW)] }), new TableRow({ children: [dataCell("Tropicamide", true), dataCell("Eye — M3"), dataCell("Shortest acting mydriatic/cycloplegic (4–6 hrs); preferred for refraction testing"), dataCell("Fastest onset and shortest duration")] }), new TableRow({ children: [dataCell("Cyclopentolate", true, ALT_ROW), dataCell("Eye — M3", false, ALT_ROW), dataCell("Cycloplegic refraction in children", false, ALT_ROW), dataCell("Duration 24 hrs", false, ALT_ROW)] }), new TableRow({ children: [dataCell("Ipratropium / Tiotropium", true), dataCell("M3 in bronchi (quaternary — no systemic absorption)"), dataCell("COPD, Bronchial asthma; Tiotropium: once daily (long-acting)"), dataCell("Minimal systemic effects; given by inhalation")] }), new TableRow({ children: [dataCell("Pirenzepine", true, ALT_ROW), dataCell("Selective M1 blocker (gastric)", false, ALT_ROW), dataCell("Peptic ulcer (reduces gastric acid)", false, ALT_ROW), dataCell("Less dry mouth/constipation than atropine", false, ALT_ROW)] }), new TableRow({ children: [dataCell("Oxybutynin / Tolterodine / Solifenacin", true), dataCell("M3 bladder selectivity"), dataCell("Overactive bladder / urge incontinence"), dataCell("Tolterodine: fewer dry mouth complaints; Solifenacin: once daily")] }), new TableRow({ children: [dataCell("Benztropine / Trihexyphenidyl", true, ALT_ROW), dataCell("Central M1 blocker", false, ALT_ROW), dataCell("Parkinson's disease (drug-induced or idiopathic); reduce tremor + rigidity", false, ALT_ROW), dataCell("Not useful for bradykinesia", false, ALT_ROW)] }), ]; return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows }); } // 3. ADRENERGIC DRUGS TABLE function adrenergicTable() { const rows = [ new TableRow({ children: [headerCell("ADRENERGIC AGONISTS (SYMPATHOMIMETICS)", 5)] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Receptors"), subHeaderCell("MOA / Type"), subHeaderCell("Uses"), subHeaderCell("Adverse Effects")] }), // CATECHOLAMINES new TableRow({ children: [headerCell("DIRECT-ACTING CATECHOLAMINES", 5, "2E75B6")] }), new TableRow({ children: [ dataCell("Adrenaline (Epinephrine)", true, YELLOW_BG), dataCell("α1, α2, β1, β2, β3", false, YELLOW_BG), dataCell("Endogenous catecholamine; secreted by adrenal medulla (80%); DOC for anaphylaxis", false, YELLOW_BG), dataCell("1. Anaphylactic shock (IM 1:1000 = 1mg/mL, 0.3–0.5 mL)\n2. Cardiac arrest (IV/intracardiac)\n3. With LA (prolongs duration, 1:100,000)\n4. Bronchial asthma (SC)\n5. Open-angle glaucoma (reduces IOP)\n6. Haemostasis (topical)\n7. Nasal decongestant", false, YELLOW_BG), dataCell("Palpitation, hypertension, anxiety, arrhythmias, cerebral haemorrhage\nCI: Hypertension, IHD, with halothane", false, YELLOW_BG) ]}), new TableRow({ children: [ dataCell("Noradrenaline (Norepinephrine)", true, ALT_ROW), dataCell("α1, α2, β1 (no β2)", false, ALT_ROW), dataCell("Endogenous NT; α > β; marked vasoconstriction; reflex bradycardia", false, ALT_ROW), dataCell("Cardiogenic/septic shock (IV infusion)\nHypotension states (ICU)", false, ALT_ROW), dataCell("Hypertension, intense vasoconstriction; extravasation causes tissue necrosis", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Dopamine", true), dataCell("D1, D2, β1 (low dose), α1 (high dose)", false), dataCell("Dose-dependent receptor selectivity:\n• Low (2–5 µg/kg/min): D1 → renal/mesenteric vasodilation\n• Medium (5–10): β1 → ↑CO\n• High (>10): α1 → vasoconstriction", false), dataCell("Cardiogenic shock, heart failure with renal impairment", false), dataCell("Nausea, tachycardia, arrhythmias at high doses", false) ]}), new TableRow({ children: [ dataCell("Dobutamine", true, ALT_ROW), dataCell("β1 > β2", false, ALT_ROW), dataCell("Synthetic; direct β1 agonist; ↑CO with minimal HR change; does NOT cause renal vasodilation", false, ALT_ROW), dataCell("Acute heart failure, cardiogenic shock; cardiac stress testing", false, ALT_ROW), dataCell("Tachycardia, arrhythmias; tolerance on prolonged use", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Isoprenaline (Isoproterenol)", true), dataCell("β1 + β2 (non-selective β)", false), dataCell("Potent β agonist; ↑HR, ↑CO, bronchodilation, vasodilation", false), dataCell("AV block (historically); severe bradycardia; Rarely used now", false), dataCell("Tachyarrhythmias, angina; largely obsolete", false) ]}), // SELECTIVE β2 AGONISTS new TableRow({ children: [headerCell("SELECTIVE β2 AGONISTS (Bronchodilators)", 5, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Duration"), subHeaderCell("MOA"), subHeaderCell("Uses"), subHeaderCell("Adverse Effects")] }), new TableRow({ children: [ dataCell("Salbutamol (Albuterol)", true, ALT_ROW), dataCell("Short-acting (SABA; 4–6 hr)", false, ALT_ROW), dataCell("Selective β2 → bronchodilation, uterine relaxation, ↑glycogenolysis", false, ALT_ROW), dataCell("Acute bronchial asthma (DOC), COPD, tocolysis (premature labour)", false, ALT_ROW), dataCell("Tremor (β2 skeletal muscle), tachycardia, hypokalaemia", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Terbutaline", true), dataCell("Short-acting (SABA)", false), dataCell("Selective β2 agonist", false), dataCell("Asthma; tocolysis (SC/oral)", false), dataCell("Same as salbutamol; tremor, tachycardia", false) ]}), new TableRow({ children: [ dataCell("Formoterol / Salmeterol", true, ALT_ROW), dataCell("Long-acting (LABA; 12 hr)", false, ALT_ROW), dataCell("Selective β2, long duration", false, ALT_ROW), dataCell("Maintenance in asthma/COPD (combined with ICS)", false, ALT_ROW), dataCell("Not for acute attacks; tolerance possible", false, ALT_ROW) ]}), // α AGONISTS new TableRow({ children: [headerCell("ALPHA (α) AGONISTS", 5, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Receptor"), subHeaderCell("MOA"), subHeaderCell("Uses"), subHeaderCell("Notes")] }), new TableRow({ children: [ dataCell("Phenylephrine", true), dataCell("α1 selective", false), dataCell("Vasoconstriction; raises BP; reflex bradycardia; active mydriasis (no cycloplegia)", false), dataCell("Nasal decongestant; pupillary dilation (no cycloplegia); hypotension in spinal anaesthesia", false), dataCell("Pure α1; no cardiac stimulation; short-acting", false) ]}), new TableRow({ children: [ dataCell("Clonidine", true, ALT_ROW), dataCell("α2 agonist (central)", false, ALT_ROW), dataCell("Stimulates central α2 → ↓sympathetic outflow → ↓BP and ↓HR", false, ALT_ROW), dataCell("Hypertension; opioid withdrawal; ADHD; menopausal flushes; migraine prophylaxis", false, ALT_ROW), dataCell("Sedation, dry mouth; rebound hypertension on sudden withdrawal", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Methyldopa", true), dataCell("False NT → α2 agonist (central)", false), dataCell("Converted to α-methylNA → acts on central α2 → ↓BP; DOC for hypertension in pregnancy", false), dataCell("Hypertension in pregnancy (DOC)", false), dataCell("Sedation, positive Coombs test, hepatotoxicity, drug fever", false) ]}), // INDIRECT / MIXED ACTING new TableRow({ children: [headerCell("INDIRECT / MIXED ACTING SYMPATHOMIMETICS", 5, "2E75B6")] }), new TableRow({ children: [ dataCell("Ephedrine", true, ALT_ROW), dataCell("α + β (indirect > direct)", false, ALT_ROW), dataCell("Releases NA + weak direct agonism; oral bioavailability; crosses BBB", false, ALT_ROW), dataCell("Hypotension due to spinal anaesthesia (IV; DOC); nasal decongestant; mild asthma (oral)", false, ALT_ROW), dataCell("Tachyphylaxis; hypertension, insomnia; plant alkaloid (Ephedra sinica)", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Amphetamine", true), dataCell("α + β indirect", false), dataCell("Releases stored monoamines (NA, DA, 5-HT); CNS stimulant", false), dataCell("ADHD; narcolepsy (dextroamphetamine)", false), dataCell("High abuse potential; psychosis, dependence; controlled drug", false) ]}), ]; return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows }); } // 4. ANTI-ADRENERGIC DRUGS TABLE function antiAdrenergicTable() { const rows = [ new TableRow({ children: [headerCell("ANTI-ADRENERGIC DRUGS (ADRENOCEPTOR BLOCKERS)", 5)] }), // Alpha blockers new TableRow({ children: [headerCell("ALPHA (α) BLOCKERS", 5, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Type / Selectivity"), subHeaderCell("MOA"), subHeaderCell("Uses"), subHeaderCell("Adverse Effects")] }), new TableRow({ children: [ dataCell("Phentolamine", true), dataCell("Non-selective α1 + α2; reversible (competitive)", false), dataCell("Blocks α receptors → vasodilation; α2 block → reflex tachycardia (nasal congestion AE)", false), dataCell("1. Diagnosis of pheochromocytoma (Regitine test)\n2. Hypertensive crisis in pheochromocytoma\n3. Control BP during surgery for pheo", false), dataCell("Postural hypotension, reflex tachycardia, nasal stuffiness", false) ]}), new TableRow({ children: [ dataCell("Phenoxybenzamine", true, ALT_ROW), dataCell("Non-selective α1 + α2; IRREVERSIBLE", false, ALT_ROW), dataCell("Irreversible covalent bond with α receptors; prolonged action", false, ALT_ROW), dataCell("Preoperative management of pheochromocytoma", false, ALT_ROW), dataCell("Prolonged postural hypotension, nasal congestion, inhibits ejaculation", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Prazosin / Terazosin / Doxazosin", true), dataCell("Selective α1 blocker", false), dataCell("Blocks postsynaptic α1 only → vasodilation; no tachycardia (preserves α2 feedback)", false), dataCell("1. Hypertension\n2. Benign prostatic hyperplasia (BPH) — relaxes bladder neck/prostate\n3. Raynaud's disease", false), dataCell("First-dose syncope (take at bedtime); postural hypotension; less tachycardia than phentolamine", false) ]}), new TableRow({ children: [ dataCell("Tamsulosin", true, ALT_ROW), dataCell("α1A selective (prostate > vasculature)", false, ALT_ROW), dataCell("Selective for α1A receptors in prostate/bladder neck; minimal BP effect", false, ALT_ROW), dataCell("BPH (preferred — minimal BP lowering)", false, ALT_ROW), dataCell("Retrograde ejaculation; minimal hypotension", false, ALT_ROW) ]}), // Beta blockers new TableRow({ children: [headerCell("BETA (β) BLOCKERS", 5, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Selectivity / Properties"), subHeaderCell("MOA"), subHeaderCell("Uses"), subHeaderCell("Adverse Effects / CI")] }), new TableRow({ children: [ dataCell("Propranolol", true, YELLOW_BG), dataCell("Non-selective β1+β2; no ISA; membrane stabilizing (MSA)", false, YELLOW_BG), dataCell("Blocks β1+β2; ↓HR, ↓CO, ↓BP, ↓renin; β2 blockade causes bronchoconstriction", false, YELLOW_BG), dataCell("1. Hypertension\n2. Angina\n3. Arrhythmias (AF, SVT)\n4. Thyrotoxicosis (controls symptoms)\n5. Migraine prophylaxis\n6. Essential tremor\n7. Anxiety (situational)\n8. IHSS\n9. Pheochromocytoma (after α-blocker)", false, YELLOW_BG), dataCell("Bronchoconstriction (CI: asthma), bradycardia, AV block, cold extremities, fatigue, masks hypoglycaemia\nMasks tachycardia of hypoglycaemia (not sweating)", false, YELLOW_BG) ]}), new TableRow({ children: [ dataCell("Metoprolol / Atenolol / Bisoprolol", true), dataCell("Cardioselective β1 (safer in asthma at low doses)", false), dataCell("Preferential β1 blockade; reduces HR and CO; less bronchoconstriction", false), dataCell("Hypertension, angina, arrhythmias, heart failure (bisoprolol/carvedilol/metoprolol reduce mortality in CHF)", false), dataCell("Less bronchospasm; mask hypoglycaemia; bradycardia; fatigue", false) ]}), new TableRow({ children: [ dataCell("Carvedilol", true, ALT_ROW), dataCell("Non-selective β + α1 blocker; no ISA; antioxidant", false, ALT_ROW), dataCell("β blockade + α1 vasodilation; reduces afterload", false, ALT_ROW), dataCell("Chronic heart failure (reduces mortality); hypertension", false, ALT_ROW), dataCell("Postural hypotension, dizziness; contraindicated in severe asthma", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Labetalol", true), dataCell("α1 + β1 + β2 blocker (ratio α:β = 1:3 oral, 1:7 IV)", false), dataCell("Combined α + β blockade; lowers BP without reflex tachycardia", false), dataCell("Hypertensive emergencies (IV); hypertension in pregnancy (safe)", false), dataCell("Postural hypotension; bronchospasm; dizziness", false) ]}), new TableRow({ children: [ dataCell("Pindolol / Acebutolol", true, ALT_ROW), dataCell("Non-selective / β1 selective WITH ISA", false, ALT_ROW), dataCell("ISA = Intrinsic sympathomimetic activity — partial agonism; less bradycardia at rest", false, ALT_ROW), dataCell("Hypertension (less suitable for angina/arrhythmia due to ISA)", false, ALT_ROW), dataCell("Less resting bradycardia, less cold extremities; not preferred in tachyarrhythmias", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Esmolol", true), dataCell("β1 selective; ultra-short acting (t½ = 9 min); metabolized by RBC esterases", false), dataCell("IV only; rapid onset; cardiac β1 blockade", false), dataCell("Perioperative hypertension/tachycardia; SVT; thyroid storm", false), dataCell("Short-acting → useful when precise titration needed; IV only", false) ]}), // CONTRAINDICATIONS TABLE new TableRow({ children: [headerCell("β-BLOCKER CONTRAINDICATIONS & PRECAUTIONS", 5, "C00000")] }), new TableRow({ children: [subHeaderCell("Contraindication"), subHeaderCell("Reason", 4)] }), new TableRow({ children: [dataCell("Bronchial asthma / COPD", true), dataCell("β2 blockade → bronchoconstriction (non-selective worse)", false, WHITE, "000000", 4)] }), new TableRow({ children: [dataCell("AV block / sick sinus syndrome", true, ALT_ROW), dataCell("↓AV conduction → complete heart block", false, ALT_ROW)] }), new TableRow({ children: [dataCell("Diabetes mellitus", true), dataCell("Masks tachycardia of hypoglycaemia (sweating still present); delays recovery from hypoglycaemia")] }), new TableRow({ children: [dataCell("Peripheral vascular disease", true, ALT_ROW), dataCell("β2 blockade → vasoconstriction → worsens ischaemia", false, ALT_ROW)] }), new TableRow({ children: [dataCell("Phaeochromocytoma (without α-blocker)", true), dataCell("Unopposed α stimulation → severe hypertension — ALWAYS give α-blocker first")] }), ]; return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows }); } // 5. SEROTONIN TABLE function serotoninTable() { const rows = [ new TableRow({ children: [headerCell("SEROTONIN (5-HT) — AGONISTS AND ANTAGONISTS", 4)] }), // Basics new TableRow({ children: [headerCell("5-HT RECEPTOR SUBTYPES (Key ones)", 4, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Receptor"), subHeaderCell("Location"), subHeaderCell("Effect when stimulated"), subHeaderCell("Clinical Relevance")] }), new TableRow({ children: [dataCell("5-HT1A", true), dataCell("Brain (raphe nuclei); presynaptic autoreceptor"), dataCell("↓Anxiety, ↓depression"), dataCell("Target for buspirone (anxiolytic); antidepressants")] }), new TableRow({ children: [dataCell("5-HT1B/1D", true, ALT_ROW), dataCell("Cranial blood vessels, trigeminal nerve terminals", false, ALT_ROW), dataCell("Vasoconstriction of dilated cranial vessels; ↓neuropeptide release", false, ALT_ROW), dataCell("TARGET for TRIPTANS in migraine", false, ALT_ROW)] }), new TableRow({ children: [dataCell("5-HT2A", true), dataCell("Smooth muscle, platelets, brain"), dataCell("Vasoconstriction, platelet aggregation, bronchoconstriction"), dataCell("Target for atypical antipsychotics; cyproheptadine; ketanserin")] }), new TableRow({ children: [dataCell("5-HT3", true, ALT_ROW), dataCell("CTZ, gut, vagal afferents", false, ALT_ROW), dataCell("Nausea, vomiting, ↑GI motility", false, ALT_ROW), dataCell("TARGET for ondansetron/granisetron (antiemetics)", false, ALT_ROW)] }), new TableRow({ children: [dataCell("5-HT4", true), dataCell("GIT"), dataCell("↑GI motility, prokinesis"), dataCell("Target for metoclopramide (partial), mosapride")] }), // 5-HT AGONISTS new TableRow({ children: [headerCell("5-HT AGONISTS / SEROTONERGIC DRUGS", 4, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Receptor"), subHeaderCell("Uses"), subHeaderCell("Notes / AEs")] }), new TableRow({ children: [ dataCell("Sumatriptan", true, YELLOW_BG), dataCell("5-HT1B/1D agonist (selective)", false, YELLOW_BG), dataCell("Acute migraine attack (DOC for moderate-severe migraine)", false, YELLOW_BG), dataCell("Oral, SC (fastest), nasal; t½ = 2 hr; chest tightness, flushing, paresthesia\nCI: IHD, hypertension, PVD, pregnancy; Do NOT combine with ergots (within 24 hrs)", false, YELLOW_BG) ]}), new TableRow({ children: [ dataCell("Other Triptans\n(Rizatriptan, Zolmitriptan, Eletriptan, Frovatriptan, Naratriptan)", true), dataCell("5-HT1B/1D agonist", false), dataCell("Acute migraine (oral; some also nasal — zolmitriptan)", false), dataCell("Frovatriptan/Naratriptan: longer t½ (less headache recurrence); better oral bioavailability than sumatriptan", false) ]}), new TableRow({ children: [ dataCell("Buspirone", true, ALT_ROW), dataCell("5-HT1A partial agonist", false, ALT_ROW), dataCell("Generalized anxiety disorder (GAD); no dependence", false, ALT_ROW), dataCell("Slow onset (2–4 weeks); no sedation, no dependence; not for panic attacks", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("SSRIs (Fluoxetine, Sertraline, Paroxetine, etc.)", true), dataCell("Block 5-HT reuptake transporter (SERT) → ↑synaptic 5-HT", false), dataCell("Depression, anxiety disorders, OCD, panic disorder, PTSD", false), dataCell("Sexual dysfunction, GI upset, insomnia; serotonin syndrome risk with MAOIs; safe in pregnancy (sertraline preferred)", false) ]}), // 5-HT ANTAGONISTS new TableRow({ children: [headerCell("5-HT ANTAGONISTS", 4, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Receptor Blocked"), subHeaderCell("Uses"), subHeaderCell("Key Notes")] }), new TableRow({ children: [ dataCell("Ondansetron / Granisetron / Tropisetron", true, YELLOW_BG), dataCell("5-HT3 antagonist", false, YELLOW_BG), dataCell("1. Chemotherapy-induced nausea/vomiting (CINV) — DOC\n2. Postoperative N&V\n3. Radiation-induced vomiting", false, YELLOW_BG), dataCell("Well tolerated; headache, constipation; preferred over metoclopramide in CINV", false, YELLOW_BG) ]}), new TableRow({ children: [ dataCell("Cyproheptadine", true), dataCell("5-HT2A + H1 antagonist (dual)", false), dataCell("1. Carcinoid syndrome (controls flushing/diarrhoea)\n2. Postgastrectomy dumping syndrome\n3. Allergic conditions (antihistamine effect)\n4. Appetite stimulant (weight gain)", false), dataCell("Sedation, dry mouth, weight gain; also useful in serotonin syndrome", false) ]}), new TableRow({ children: [ dataCell("Ketanserin", true, ALT_ROW), dataCell("5-HT2A + α1 antagonist", false, ALT_ROW), dataCell("Hypertension (antihypertensive)", false, ALT_ROW), dataCell("Dual mechanism; useful in Raynaud's disease", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Methysergide", true), dataCell("5-HT2A/2C antagonist", false), dataCell("Prophylaxis of migraine (no longer commonly used)", false), dataCell("Long-term use → retroperitoneal/pulmonary/cardiac fibrosis; drug holiday mandatory", false) ]}), new TableRow({ children: [ dataCell("Atypical Antipsychotics\n(Clozapine, Olanzapine, Risperidone, Quetiapine)", true, ALT_ROW), dataCell("5-HT2 + D2 blockade", false, ALT_ROW), dataCell("Schizophrenia, bipolar disorder", false, ALT_ROW), dataCell("5-HT2 blockade reduces EPS compared to typical antipsychotics", false, ALT_ROW) ]}), // ERGOT ALKALOIDS new TableRow({ children: [headerCell("ERGOT ALKALOIDS", 4, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("MOA"), subHeaderCell("Uses"), subHeaderCell("AEs / Notes")] }), new TableRow({ children: [ dataCell("Ergotamine", true, YELLOW_BG), dataCell("Partial agonist at 5-HT1B/1D + α-adrenergic agonist; vasoconstriction of cranial vessels", false, YELLOW_BG), dataCell("Acute migraine (oral/sublingual/rectal); combined with caffeine (Cafergot)", false, YELLOW_BG), dataCell("Ergotism: peripheral vasospasm, gangrene, uterine contraction\nCI: pregnancy, PVD, IHD, hypertension\nDo NOT combine with triptans (within 24 hrs)", false, YELLOW_BG) ]}), new TableRow({ children: [ dataCell("Ergometrine (Ergonovine)", true), dataCell("Partial agonist at 5-HT2A; α-adrenergic agonism; potent uterotonic", false), dataCell("Postpartum haemorrhage (IM/IV); active management of 3rd stage of labour", false), dataCell("Nausea, vomiting, rise in BP; minimal vasoconstrictive effect compared to ergotamine", false) ]}), new TableRow({ children: [ dataCell("Bromocriptine", true, ALT_ROW), dataCell("Semisynthetic ergot; D2 agonist → ↓prolactin", false, ALT_ROW), dataCell("1. Parkinsonism\n2. Hyperprolactinaemia / galactorrhoea\n3. Acromegaly", false, ALT_ROW), dataCell("Nausea, postural hypotension; lung fibrosis with long use", false, ALT_ROW) ]}), ]; return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows }); } // 6. HISTAMINE TABLE function histamineTable() { const rows = [ new TableRow({ children: [headerCell("HISTAMINE RECEPTORS AND EFFECTS", 4)] }), new TableRow({ children: [subHeaderCell("Receptor"), subHeaderCell("Location"), subHeaderCell("Effect when stimulated"), subHeaderCell("Pharmacological Significance")] }), new TableRow({ children: [ dataCell("H1", true, YELLOW_BG), dataCell("Smooth muscle (bronchi, gut, uterus), endothelium, CNS", false, YELLOW_BG), dataCell("Bronchoconstriction, ↑capillary permeability, pruritus, pain, vasodilation (↓BP)", false, YELLOW_BG), dataCell("Blocked by H1-antihistamines; involved in allergy, anaphylaxis", false, YELLOW_BG) ]}), new TableRow({ children: [ dataCell("H2", true), dataCell("Gastric parietal cells, heart", false), dataCell("↑Gastric acid secretion, ↑HR (weak)", false), dataCell("Blocked by H2-blockers (ranitidine, famotidine, cimetidine) — peptic ulcer treatment", false) ]}), new TableRow({ children: [ dataCell("H3", true, ALT_ROW), dataCell("Presynaptic autoreceptor (brain, lung, skin)", false, ALT_ROW), dataCell("↓Histamine synthesis and release", false, ALT_ROW), dataCell("Modulates histamine levels; agonists ↓histamine", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("H4", true), dataCell("Mast cells, eosinophils, leukocytes", false), dataCell("Chemotaxis, cytokine secretion", false), dataCell("Role in inflammation; target for future allergy drugs", false) ]}), ]; return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows }); } function antihistamineTable() { const rows = [ new TableRow({ children: [headerCell("H1-ANTIHISTAMINES — CLASSIFICATION AND COMPARISON", 5)] }), new TableRow({ children: [subHeaderCell("Feature"), subHeaderCell("1st Generation"), subHeaderCell("2nd Generation"), subHeaderCell("Examples"), subHeaderCell("Key Points")] }), // General comparison new TableRow({ children: [ dataCell("Cross BBB?", true, ALT_ROW), dataCell("YES (lipophilic) → sedation", false, ALT_ROW), dataCell("NO (hydrophilic, P-gp efflux) → non-sedating", false, ALT_ROW), dataCell("", false, ALT_ROW), dataCell("2nd gen preferred for daytime use", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Anticholinergic effects", true), dataCell("YES — dry mouth, urinary retention, blurred vision, constipation", false), dataCell("MINIMAL", false), dataCell("", false), dataCell("1st gen cause more side effects", false) ]}), new TableRow({ children: [ dataCell("Duration of action", true, ALT_ROW), dataCell("4–6 hours (most)", false, ALT_ROW), dataCell("12–24 hours (longer)", false, ALT_ROW), dataCell("", false, ALT_ROW), dataCell("2nd gen: once or twice daily dosing", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Anti-emetic / Anti-vertigo", true), dataCell("YES (promethazine, dimenhydrinate, cyclizine)", false), dataCell("NO (most have no anti-emetic effect)", false), dataCell("", false), dataCell("1st gen used for motion sickness/vertigo", false) ]}), new TableRow({ children: [ dataCell("Local anaesthetic action", true, ALT_ROW), dataCell("YES (diphenhydramine)", false, ALT_ROW), dataCell("NO", false, ALT_ROW), dataCell("", false, ALT_ROW), dataCell("Diphenhydramine: topical LA", false, ALT_ROW) ]}), // First generation list new TableRow({ children: [headerCell("1ST GENERATION H1-BLOCKERS", 5, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Special Properties"), subHeaderCell("Uses"), subHeaderCell("AEs"), subHeaderCell("Notes")] }), new TableRow({ children: [ dataCell("Diphenhydramine", true, ALT_ROW), dataCell("Sedating; LA action; anticholinergic", false, ALT_ROW), dataCell("Allergy, motion sickness, insomnia, cough suppressant (antitussive)", false, ALT_ROW), dataCell("Sedation, dry mouth, blurred vision, urinary retention", false, ALT_ROW), dataCell("Prototype first-gen antihistamine", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Dimenhydrinate", true), dataCell("Diphenhydramine + 8-chlorotheophylline", false), dataCell("Motion sickness (oral)", false), dataCell("Sedation, dry mouth", false), dataCell("Combination product", false) ]}), new TableRow({ children: [ dataCell("Promethazine", true, ALT_ROW), dataCell("Strong sedative, antiemetic, anticholinergic, antipsychotic (phenothiazine)", false, ALT_ROW), dataCell("Motion sickness, preanaesthetic, antiemetic, allergic reactions", false, ALT_ROW), dataCell("Marked sedation, extrapyramidal effects (rare)", false, ALT_ROW), dataCell("Most sedating; avoid in children <2 yrs (risk of respiratory depression)", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Chlorpheniramine (CPM)", true), dataCell("Less sedating among 1st gen; potent H1 blocker", false), dataCell("Allergic rhinitis, urticaria, drug reactions; common cold preparations", false), dataCell("Mild sedation, dry mouth", false), dataCell("Available in most OTC preparations (e.g., with paracetamol)", false) ]}), new TableRow({ children: [ dataCell("Cyclizine / Meclizine", true, ALT_ROW), dataCell("Anti-emetic, anti-vertigo", false, ALT_ROW), dataCell("Motion sickness, N&V of pregnancy (meclizine); vertigo", false, ALT_ROW), dataCell("Sedation, dry mouth", false, ALT_ROW), dataCell("Meclizine: low teratogenic risk; preferred in pregnancy N&V", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Cinnarizine", true), dataCell("H1 blocker + Ca2+ channel blocker (in vestibular cells)", false), dataCell("Vertigo (Meniere's disease), motion sickness, peripheral vascular disease", false), dataCell("Sedation, weight gain, extrapyramidal effects (rare)", false), dataCell("Calcium channel blocking in vestibular cells → relieves vertigo", false) ]}), new TableRow({ children: [ dataCell("Cyproheptadine", true, ALT_ROW), dataCell("H1 + 5-HT2A blocker; appetite stimulant", false, ALT_ROW), dataCell("Allergy; carcinoid syndrome; appetite stimulant (underweight children)", false, ALT_ROW), dataCell("Sedation, dry mouth, weight gain", false, ALT_ROW), dataCell("Dual H1 + 5-HT2A antagonist; useful in serotonin syndrome", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Hydroxyzine", true), dataCell("H1 blocker + anxiolytic (histamine + CNS)", false), dataCell("Anxiety, pruritus, preoperative sedation", false), dataCell("Sedation, dry mouth", false), dataCell("No dependence; used in generalized anxiety", false) ]}), // Second generation list new TableRow({ children: [headerCell("2ND GENERATION H1-BLOCKERS", 5, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug"), subHeaderCell("Properties"), subHeaderCell("Uses"), subHeaderCell("AEs"), subHeaderCell("Notes")] }), new TableRow({ children: [ dataCell("Cetirizine", true, YELLOW_BG), dataCell("Non-sedating (mild sedation possible); active metabolite of hydroxyzine", false, YELLOW_BG), dataCell("Allergic rhinitis, urticaria, atopic dermatitis, conjunctivitis", false, YELLOW_BG), dataCell("Mild sedation (compared to others in gen 2), dry mouth (minimal)", false, YELLOW_BG), dataCell("Most widely used 2nd gen; once daily", false, YELLOW_BG) ]}), new TableRow({ children: [ dataCell("Levocetirizine", true), dataCell("R-enantiomer of cetirizine; more potent, less sedating", false), dataCell("Allergic rhinitis, urticaria", false), dataCell("Less sedating than cetirizine", false), dataCell("Preferred over cetirizine in pilots/operators of heavy machinery", false) ]}), new TableRow({ children: [ dataCell("Loratadine", true, ALT_ROW), dataCell("Non-sedating; minimal anticholinergic", false, ALT_ROW), dataCell("Allergic rhinitis, urticaria, eczema", false, ALT_ROW), dataCell("Headache; minimal sedation", false, ALT_ROW), dataCell("OTC in many countries; once daily", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Desloratadine", true), dataCell("Active metabolite of loratadine; more potent", false), dataCell("Allergic rhinitis, urticaria, skin allergies", false), dataCell("Minimal; headache", false), dataCell("Once daily; more potent than loratadine", false) ]}), new TableRow({ children: [ dataCell("Fexofenadine", true, ALT_ROW), dataCell("Active metabolite of terfenadine; NO cardiac toxicity; truly non-sedating", false, ALT_ROW), dataCell("Allergic rhinitis, urticaria; preferred in pilots, athletes", false, ALT_ROW), dataCell("No cardiac toxicity; no sedation; headache", false, ALT_ROW), dataCell("Safest 2nd gen; no QT prolongation; P-gp substrate (avoid grapefruit juice)", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("Azelastine", true), dataCell("Topical H1 blocker + anti-inflammatory", false), dataCell("Allergic rhinitis (nasal spray); allergic conjunctivitis (eye drops)", false), dataCell("Bitter taste (nasal spray)", false), dataCell("Available as nasal spray and eye drops", false) ]}), new TableRow({ children: [ dataCell("Rupatadine", true, ALT_ROW), dataCell("H1 + PAF (platelet-activating factor) antagonist", false, ALT_ROW), dataCell("Allergic rhinitis, urticaria", false, ALT_ROW), dataCell("Mild sedation", false, ALT_ROW), dataCell("Dual mechanism (H1 + PAF antagonism)", false, ALT_ROW) ]}), ]; return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows }); } // 7. MIGRAINE TABLE function migraineTable() { const rows = [ new TableRow({ children: [headerCell("TREATMENT OF MIGRAINE", 4)] }), // Pathophysiology new TableRow({ children: [headerCell("PATHOPHYSIOLOGY OF MIGRAINE (Brief)", 4, "2E75B6")] }), new TableRow({ children: [ dataCell("Step 1: Trigger (stress, food, hormones, etc.) activates cortical spreading depression", false, ALT_ROW), dataCell("Step 2: Abnormal dilation of cranial blood vessels", false, ALT_ROW), dataCell("Step 3: Release of inflammatory neuropeptides (CGRP, substance P) around trigeminal nerve endings", false, ALT_ROW), dataCell("Step 4: Vasodilation + neurogenic inflammation → throbbing headache, photophobia, nausea", false, ALT_ROW) ]}), // Acute treatment new TableRow({ children: [headerCell("DRUGS FOR ACUTE MIGRAINE ATTACK", 4, "2E75B6")] }), new TableRow({ children: [subHeaderCell("Drug / Class"), subHeaderCell("MOA"), subHeaderCell("Notes"), subHeaderCell("Contraindications")] }), new TableRow({ children: [ dataCell("TRIPTANS (5-HT1B/1D agonists)\nSumatriptan (DOC), Rizatriptan, Zolmitriptan, Naratriptan, Frovatriptan, Eletriptan, Almotriptan", true, YELLOW_BG), dataCell("1. Constrict dilated cranial blood vessels\n2. ↓Release of inflammatory neuropeptides\n3. Inhibit trigeminal neurovascular transmission", false, YELLOW_BG), dataCell("• Drugs of choice (DOC) for moderate-severe acute migraine\n• Sumatriptan: fastest SC/nasal; oral t½ = 2 hr\n• Naratriptan/Frovatriptan: longer t½, less headache recurrence\n• Do NOT give within 24 hr of ergot derivatives\n• Not for hemiplegic or basilar migraine", false, YELLOW_BG), dataCell("IHD, hypertension (uncontrolled), peripheral vascular disease, pregnancy, history of stroke, within 24 hrs of ergot use", false, YELLOW_BG) ]}), new TableRow({ children: [ dataCell("ERGOTAMINE\n(Cafergot = Ergotamine + Caffeine)", true), dataCell("Partial agonist at 5-HT1B/1D + α agonist → cranial vasoconstriction", false), dataCell("Moderate migraine; caffeine enhances GI absorption and adds analgesic effect; given early in attack", false), dataCell("Pregnancy, PVD, IHD, hepatic/renal disease; do NOT combine with triptans (24 hrs washout)", false) ]}), new TableRow({ children: [ dataCell("NSAIDs\n(Ibuprofen, Naproxen, Aspirin, Diclofenac)", true, ALT_ROW), dataCell("COX inhibition → ↓prostaglandins → ↓inflammation and sensitization", false, ALT_ROW), dataCell("Mild-moderate migraine; first-line for simple migraine; aspirin + metoclopramide = effective combination", false, ALT_ROW), dataCell("Peptic ulcer, renal impairment, bleeding disorders; avoid aspirin in children", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("PARACETAMOL (Acetaminophen)", true), dataCell("Central COX inhibition (?) + TRP channel modulation", false), dataCell("Mild migraine; safe option; often combined with codeine or caffeine", false), dataCell("Safe in pregnancy; avoid overdose (hepatotoxicity)", false) ]}), new TableRow({ children: [ dataCell("ANTIEMETICS\n(Metoclopramide, Prochlorperazine, Domperidone)", true, ALT_ROW), dataCell("D2 antagonists → ↓nausea/vomiting; also enhance GI absorption of analgesics (metoclopramide)", false, ALT_ROW), dataCell("Combined with analgesics; metoclopramide IV is very effective; also treats gastric stasis of migraine", false, ALT_ROW), dataCell("Extrapyramidal effects (metoclopramide, especially in young females); avoid in tardive dyskinesia", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("OPIOIDS\n(e.g., Tramadol)", true), dataCell("µ-opioid receptor agonist", false), dataCell("Only when triptans and NSAIDs fail; avoid routine use", false), dataCell("Dependence potential; rebound headache with chronic use; last resort only", false) ]}), // Prophylaxis new TableRow({ children: [headerCell("PROPHYLAXIS OF MIGRAINE — Mnemonic: ABCD", 4, "C00000")] }), new TableRow({ children: [subHeaderCell("Drug Class (ABCD)"), subHeaderCell("Drugs"), subHeaderCell("MOA"), subHeaderCell("Notes")] }), new TableRow({ children: [ dataCell("A — Antidepressants (TCAs)", true, YELLOW_BG), dataCell("Amitriptyline (most evidence)", false, YELLOW_BG), dataCell("Central serotonin and NA reuptake inhibition; lowers pain threshold", false, YELLOW_BG), dataCell("Useful especially when migraine + depression/insomnia coexist; take at night", false, YELLOW_BG) ]}), new TableRow({ children: [ dataCell("B — Beta-Blockers", true), dataCell("Propranolol (DOC for prophylaxis), Metoprolol, Timolol, Atenolol, Nadolol", false), dataCell("Reduce vasoreactivity; ↓β-adrenergic tone; ↓cortical spreading depression", false), dataCell("Propranolol most effective; CI in asthma, bradycardia, diabetes; used when migraine + hypertension", false) ]}), new TableRow({ children: [ dataCell("C — Ca2+ Channel Blockers (CCBs)", true, ALT_ROW), dataCell("Flunarizine (DOC), Verapamil, Nifedipine", false, ALT_ROW), dataCell("Block Ca2+ channels → prevent vasoconstriction/spreading depression", false, ALT_ROW), dataCell("Flunarizine: 10 mg/day; also useful in basilar migraine; AE: weight gain, depression", false, ALT_ROW) ]}), new TableRow({ children: [ dataCell("D — Drugs (Anticonvulsants + others)", true), dataCell("Valproate (Sodium valproate), Topiramate, Gabapentin", false), dataCell("Valproate: GABA-ergic effect; Topiramate: Na+ channel blockade + GABA enhancement + AMPA inhibition", false), dataCell("Valproate and Topiramate FDA-approved for migraine prophylaxis; CI: valproate in pregnancy (teratogenic)", false) ]}), new TableRow({ children: [ dataCell("Other prophylactic agents", true, ALT_ROW), dataCell("Methysergide (5-HT2A/C antagonist), Clonidine (α2 agonist), Pizotifen (5-HT2/H1 blocker), CGRP antibodies (Erenumab, Fremanezumab)", false, ALT_ROW), dataCell("Methysergide: retroperitoneal fibrosis on long-term use (drug holiday required)\nCGRP monoclonal antibodies: newest preventive treatment (SC monthly)", false, ALT_ROW), dataCell("Prophylaxis indicated when ≥2–3 attacks/month or significant functional impairment; treatment given for 3–6 months", false, ALT_ROW) ]}), ]; return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows }); } // ============================================= // DOCUMENT ASSEMBLY // ============================================= const doc = new Document({ creator: "Orris AI", title: "ANS and Autacoids — Exam Notes (Shanbhag Pharmacology)", description: "Comprehensive exam-oriented table notes based on Shanbhag Pharmacology", sections: [{ children: [ // TITLE new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 200, after: 400 }, children: [ new TextRun({ text: "ANS & AUTACOIDS", bold: true, size: 52, color: "1B3A6B" }), new TextRun({ break: 1, text: "Exam-Oriented Table Notes", bold: true, size: 30, color: "2E75B6" }), new TextRun({ break: 1, text: "Based on Shanbhag Pharmacology (4th Edition)", italics: true, size: 22, color: "595959" }), ] }), // ====== SECTION 1: CHOLINERGIC ====== sectionHeading("SECTION 1: CHOLINERGIC & ANTICHOLINERGIC DRUGS"), subHeading("1A. Cholinergic Drugs (Cholinomimetics / Parasympathomimetics)"), note("Muscarinic receptors: M1 (CNS/gastric), M2 (heart), M3 (smooth muscle/glands/eye)"), note("Nicotinic receptors: NN (ganglia + adrenal medulla), NM (neuromuscular junction)"), note("SLUDGE mnemonic for cholinergic excess: Salivation, Lacrimation, Urination, Defaecation, GI distress, Emesis"), spacer(), cholinergicTable(), spacer(), subHeading("1B. Anticholinergic Drugs (Antimuscarinics)"), note("Atropine poisoning mnemonic: HOT as a hare, DRY as a bone, RED as a beet, BLIND as a bat, MAD as a hatter"), note("Atropine is NOT cycloplegic when applied topically via eye drops in patients with normal IOP — it blocks ALL muscarinic subtypes"), note("Atropine vs Phenylephrine for mydriasis: Atropine = passive mydriasis + cycloplegia; Phenylephrine = active mydriasis (NO cycloplegia)"), spacer(), anticholinergicTable(), spacer(), new Paragraph({ children: [new PageBreak()] }), // ====== SECTION 2: ADRENERGIC ====== sectionHeading("SECTION 2: ADRENERGIC & ANTI-ADRENERGIC DRUGS"), subHeading("2A. Adrenergic Agonists"), note("Catecholamines (Adrenaline, NA, Dopamine, Dobutamine, Isoprenaline): Rapid onset; IV/injection route; NOT orally active; rapidly metabolized by MAO + COMT"), note("Non-catecholamines (Ephedrine, Amphetamine, Salbutamol): Oral bioavailability; longer duration; not metabolized by MAO/COMT"), note("VMA (Vanillylmandelic Acid): main metabolite of catecholamines in urine; normal = 4–8 mg/24 hrs; elevated in pheochromocytoma"), spacer(), adrenergicTable(), spacer(), subHeading("2B. Anti-Adrenergic Drugs (Adrenoceptor Blockers)"), note("Phentolamine TEST: Inject phentolamine IV → if systolic BP drops >35 mm Hg (diastolic >25 mm Hg) = positive for pheochromocytoma"), note("β-blockers in CHF: Carvedilol, Bisoprolol, Metoprolol (extended release) — started at LOW doses; they reduce mortality in stable CHF"), note("Propranolol is the ONLY β-blocker used for migraine prophylaxis and essential tremor"), spacer(), antiAdrenergicTable(), spacer(), new Paragraph({ children: [new PageBreak()] }), // ====== SECTION 3: SEROTONIN ====== sectionHeading("SECTION 3: AUTACOIDS — SEROTONIN & DRUGS ACTING ON SEROTONERGIC SYSTEM"), subHeading("5-Hydroxytryptamine (5-HT / Serotonin): Receptors, Agonists and Antagonists"), note("5-HT is synthesized from tryptophan (amino acid); stored mainly in enterochromaffin cells of gut (90%), platelets, and brain"), note("5-HT3 is the ONLY ionotropic (ligand-gated ion channel) serotonin receptor; all others are G-protein coupled"), note("Serotonin Syndrome: excess 5-HT (e.g., SSRIs + MAOIs) → agitation, tremor, clonus, hyperthermia; treat with cyproheptadine + supportive care"), spacer(), serotoninTable(), spacer(), new Paragraph({ children: [new PageBreak()] }), // ====== SECTION 4: HISTAMINE & MIGRAINE ====== sectionHeading("SECTION 4: AUTACOIDS — HISTAMINE, ANTIHISTAMINES & TREATMENT OF MIGRAINE"), subHeading("4A. Histamine Receptors and Effects"), note("Histamine synthesis: decarboxylation of histidine; stored in mast cells and basophils in storage granules"), note("Histamine liberators: morphine, d-tubocurarine, radiocontrast media, bee/wasp venom, strawberries"), note("Betahistine: histamine analogue (H1 agonist + weak H3 antagonist); used for vertigo in Meniere's disease"), spacer(), histamineTable(), spacer(), subHeading("4B. H1-Antihistamines: 1st vs 2nd Generation"), note("MOA of all H1-blockers: COMPETITIVE antagonism at H1 receptors"), note("H1-blockers do NOT affect gastric acid secretion (that is H2); they do NOT block H2 receptors"), note("Cardiotoxicity: Terfenadine and Astemizole (1st gen withdrawn) caused QT prolongation/Torsades; replaced by fexofenadine and cetirizine"), spacer(), antihistamineTable(), spacer(), subHeading("4C. Treatment of Migraine"), note("Migraine phases: Prodrome → Aura (in 15–20%) → Headache (4–72 hrs; unilateral, throbbing, with N&V, photo/phonophobia) → Resolution"), note("Triptans are DOC for moderate-to-severe migraine; NSAIDs + antiemetics for mild-moderate attacks"), note("Prophylaxis mnemonic: ABCD — A=Amitriptyline, B=Beta-blockers (propranolol), C=Calcium channel blockers (flunarizine), D=Drugs (valproate, topiramate)"), note("Never combine triptans and ergots within 24 hours — risk of severe vasospasm"), spacer(), migraineTable(), spacer(), // Footer note new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 400 }, children: [ new TextRun({ text: "Notes compiled from Shanbhag Pharmacology (4th Edition) by Tara V Shanbhag & Smita Shenoy", italics: true, size: 16, color: "595959" }) ] }) ] }] }); Packer.toBuffer(doc).then(buffer => { fs.writeFileSync('/home/daytona/workspace/ans-notes/ANS_Autacoids_Exam_Notes.docx', buffer); console.log('Document created successfully!'); }).catch(err => { console.error('Error:', err); process.exit(1); }); JSEOF echo "Script written"

cd /home/daytona/workspace/ans-notes && npm install docx 2>&1 | tail -5 && node generate_notes.js

ls /home/daytona/workspace/ans-notes/node_modules/docx 2>/dev/null && echo "docx installed" || echo "not installed"

cd /home/daytona/workspace/ans-notes && timeout 90 node generate_notes.js 2>&1

ls -lh /home/daytona/workspace/ans-notes/ANS_Autacoids_Exam_Notes.docx && python3 /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/workspace/ans-notes/ANS_Autacoids_Exam_Notes.docx 2>/dev/null || echo "Validation not available, file created"