Jun
1
Clopidogrel 75 mg
June 1, 2011 | Leave a Comment
Clopidogrel (generic Plavix)
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Pharmacological Effects:
Clopidogrel - antiplatelet drugs. Effect of the drug is due to the ability of clopidogrel selectively inhibit the binding of adenosine receptors of platelets, thus inhibited the activation of a complex glycoprotein IIb / IIIa and decreases platelet aggregation. Clopidogrel increases the bleeding time. Antiplatelet action of clopidogrel is dose dependent, with use of the drug at the recommended therapeutic doses, the maximum therapeutic effect occurs within 3-7 days. Clopidogrel irreversibly blocks ADP receptors of platelets, so that they lose their ability to aggregate, the restoration of normal function was restored 7 days after drug withdrawal, as we update platelets.
After oral administration the drug is rapidly absorbed from the gastrointestinal tract. Bioavailability is about 50% and is independent of food intake. Clopidogrel - prodrug, is metabolized in the liver with the formation of the active substance - thiol metabolite of clopidogrel. The main metabolite is a carboxylic acid derivative, which determine the pharmacokinetic profile. Peak drug concentrations in plasma observed after 60 minutes after oral administration. Excreted in the urine and feces as metabolites. The half-life of about 8 hours.
Indications:
Clopidogrel is administered as a prophylactic agent in patients suffering from diseases of the cardiovascular system, in particular for the prevention of atherothrombotic events in patients with myocardial infarction, ischemic stroke and patients with peripheral artery disease.
Clopidogrel is also used in combination with acetylsalicylic acid for the treatment of acute coronary syndrome without ST segment elevation ST (in particular, patients with unstable angina or myocardial infarction without wave Q).
Clopidogrel is used in treatment of patients with acute myocardial infarction-segment elevation ST, when the patient shows thrombolytic therapy.
How to use:
Clopidogrel is taken orally. A tablet recommended to swallow whole, without chewing or crushing, drinking plenty of water. Clopidogrel does not depend on food intake. The duration of treatment and dose usually determines the physician for each patient individually.
Adult and elderly patients for the prevention of atherothrombotic events is usually prescribed for 75mg of the drug (1 tablet), 1 per day. Receiving the drug for prevention after myocardial infarction should be started a few days later, but no later than 35 days later, after suffering an ischemic stroke - after 1 week but no later than 6 months.
Patients with acute coronary syndrome without ST-segment elevation is usually prescribed 300mg once the drug (4 tablets) at the beginning of treatment, then transferred to taking 75mg of the drug 1 per day in combination with acetylsalicylic acid. Dose of acetylsalicylic acid determines the physician individually, usually it is 75-325mg per day, however, due to the increased risk of bleeding did not exceed the recommended daily dose of aspirin 100mg. Maximum therapeutic effect observed after 3 months of therapy.
In acute myocardial infarction is usually prescribed 300mg of the drug once at the beginning of treatment, then switching to the use of a drug 75mg once daily in combination with acetylsalicylic acid. When treating patients over the age of 75 years, the drug starts with 75mg of the drug 1 time per day, skipping the loading dose of the drug at the beginning of therapy. Duration of treatment for at least 4 weeks.
Data on the need for dose adjustment of the drug in patients with impaired liver function and / or kidney disease, are absent.
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Side effects:
Using the drug clopidogrel in patients noted the development of such adverse reactions:
From the blood system: thrombocytopenia, granulocytopenia, neutropenia, anemia (including aplastic anemia), in a few cases noted the development of thrombotic thrombocytopenic purpura syndrome (Moshkovitsa) and Henoch-Schonlein purpura. In addition, frequently noted the development of different localization of bleeding in patients receiving the drug clopidogrel, including gastrointestinal and nasal bleeding, as well as ocular and intracranial hemorrhage
From the gastrointestinal tract and liver: stomatitis, nausea, vomiting, indigestion, pain in the epigastric region, violations of the chair, gastritis and peptic ulcers of the stomach and duodenum. In addition, the possible elevation of liver enzymes and increased levels of bilirubin in the blood.
Allergic reactions: skin rash, itching, rash, maculopapular rash, bronchospasm, angioedema.
Other: cough, arrhythmia, pulmonary embolism, fatigue, confusion, headache, fever, myalgia, arthralgia, hematuria.
With the development of side effects should stop taking the drug and call your doctor.
In the case of bleeding, including hidden, you should contact your doctor, since the drug prolongs bleeding time and increases the risk of complications from bleeding. If the observed development of abnormal bleeding, including bleeding gums, it is necessary to conduct a study of the hemostatic system, in addition, when using the drug clopidogrel is recommended to regularly monitor liver function.
Patients taking the drug clopidogrel, should inform health care workers (including dentists) of the medication.
Contraindications:
Individual hypersensitivity to the drug.
Severe liver damage, jaundice, accompanied by cholestasis.
Due to the fact that the drug contains lactose, it is not prescribed to patients with glucose-galactose malabsorption and hereditary lactase deficiency.
Clopidogrel is not used for the treatment of patients with active bleeding, including bleeding from the peptide ulcer or intracranial hemorrhage.
Clopidogrel is contraindicated during pregnancy and breastfeeding.
In connection with unproven efficacy and safety of the drug in patients under 18 years of clopidogrel should not be used in pediatrics.
Clopidogrel should be prescribed with care to patients with an increased risk of bleeding due to trauma, surgical interventions, as well as violations of the blood system.
Clopidogrel should be used with caution in patients suffering from impaired renal function and / or liver.
Do not take the drug for 7 days before the scheduled surgery.
Pregnancy:
Clopidogrel is contraindicated in pregnancy due to the fact that the safety of the drug to the fetus is not proven.
If necessary, use during lactation should solve the issue of a possible interruption of breastfeeding.
Interaction with other drugs:
The combined use of medication with acetylsalicylic acid indicated a mutual enhancement of their effect on platelet aggregation. Safety of combined treatment with these drugs for more than 12 months is not proven.
Clopidogrel should be used with caution in conjunction with heparin, but the drug clopidogrel to patients receiving heparin therapy, does not require dosage adjustment of the latter.
In the appointment of the drug to patients receiving other thrombolytic drugs, caution should be exercised.
With the simultaneous application of clopidogrel with warfarin may increase the risk of bleeding. Should not be prescribed clopidogrel for patients receiving warfarin therapy.
Clopidogrel should be prescribed with care with medications that have a high degree of association with plasma proteins.
With the simultaneous appointment of a drug with non-steroidal anti-inflammatory drugs with caution.
With the simultaneous application of the drug with antacid drugs are not observed changes in pharmacokinetic parameters of clopidogrel.
Caution must be exercised in the appointment of the drug clopidogrel patients taking inhibitors of glycoprotein IIb / IIIa.
Overdose:
In the application of excessive doses of the drug in patients there is an increase in bleeding time.
No specific antidote. In case of overdose symptomatic treatment is shown. In the case require immediate correction of the state, shows platelet transfusion.
Product:
Film-coated tablets, 10 pieces per blister, 1 or 2 blisters per carton.
Storage Conditions:
Clopidogrel is recommended that you store in a dry place away from direct sunlight at a temperature above 25 degrees Celsius.
Shelf life - 3 years.
Synonyms:
Plavix, Zilt, Agregal, Listab.
Ingredients:
1 tablet, film coated contains:
Clopidogrel bisulfate (recalculated as clopidogrel) - 75mg;
Excipients, including lactose.
Attention!
Before using the drug Clopidogrel you should consult your doctor. These operating instructions refer to a free transfer and is intended solely for information. For more information, please contact the manufacturer annotations. Buy Clopidogrel online without a prescription (no rx needed), but consult your doctor before purchasing the drug.
Aug
1
Ciclopirox
August 1, 2009 | Leave a Comment
Generic Name
Ciclopirox (sye-kloe-PERE-ox) &
Brand Names
Loprox Penlac
Type of Drug Antifungal,
Prescribed For
Fungus and yeast infections of the nails and skin, including athlete’s foot, candida, and dandruff.
General Information
Ciclopirox slows the growth of a variety of fungus organisms and yeasts and kills many others. The drug penetrates the skin, hair, hair follicles, and sweat glands. Ciclopirox nail lacquer is used for toenail and fingernail fungus infections. Ciclopirox shampoo is used for dandruff.
Cautions and Warnings
Do not use this product if you are allergic or sensitive to any of its ingredients.
Possible Side Effects
Common: burning, itching, stinging, or oozing at the application site.
Drug Interactions None known.
Usual Dose
Cream/Lotion
Adult and Child (age 10 and over): Massage into cleansed affected skin and surrounding area twice a day.
Nail Lacquer
Adult: Apply to infected nails once a day. Use in conjunction with monthly visits to a health care professional.
Child (under age 10): not recommended.
Shampoo
Adult: Wet hair and apply 1-2 tsp to the scalp. Lather and leave on hair and scalp for 3 minutes, then rinse. Avoid contact with eyes. Repeat twice weekly for 4 weeks.
Child (under age 16): not recommended.
Overdosage
Accidental ingestion may cause nausea and upset stomach. Call your local poison control center or hospital for more information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
This product can be expected to relieve symptoms within the first week of use. Follow your doctor’s directions for the complete 2-4 week course of treatment with the cream or lotion to gain maximum benefit. The nail lacquer may be used for up to 48 weeks. Stopping the medication too soon can lead to a relapse.
When using ciclopirox nail lacquer, do not apply it to any skin other than that which surrounds the infected nails, because of possible irritation. Do not apply nail polish or any other nail lacquer to infected nails while you are using this product.
Avoid using ciclopirox nail lacquer near an open flame, since the product is flammable.
Do not cover cream or lotion with a bandage.
Call your doctor if the affected area burns, stings, or becomes red after you use this product, 13y i1 your symptoms do not clear Up aher 4 weeks of treatment; by then it is unlikely that this product will be effective.
If you forget a dose of ciclopirox, apply it as soon as you remember. Do not apply more than the amount prescribed to make up for the missed dose.
Special Populations
PregnancylBreast-feeding., ciclopirox may pass to the fetus in very small amounts. In animal studies, high doses of ciclopirox given by mouth did not harm the fetus. Caution should be exercised when using ciclopirox during pregnancy.
It is unknown if ciclopirox passes into breast milk. Nursing mothers who must use this drug should consider using infant formula.
Seniors: Seniors may use this drug without special restriction.
Jul
16
Aggrenox
July 16, 2009 | Leave a Comment
Brand Name
Aggrenox
Generic Ingredients
Dipyridamole + Aspirin
Type of Drug Antiplatelet.
Prescribed For
Prevention of recurrent stroke or transient ischemic attack (TIA)— “mini-stroke.”
General Information
Stroke is often the result of a clot blocking flow in a blood vessel supplying the brain. Aggrenox helps prevent blood clot formation by reducing the “stickiness” of platelets, blood cells that stick together to form the beginnings of all clots. In one study, Aggrenox reduced the risk of stroke by over 30% compared to placebo in people who had recently had a stroke or TIA.
Cautions and Warnings
Do not use this drug if you are allergic or sensitive to any of its ingredients or any nonsteroidal anti-inflammatory drug (NSAID). People who have asthma, nasal polyps, or chronic runny nose, are likely to be sensitive to aspirin.
The aspirin in Aggrenox can cause Reye’s syndrome, a severe reaction (vomiting, lethargy, and belligerence, and possibly worsening to coma) in children under age 16.
People with a history of stomach ulcers or stomach problems should avoid Aggrenox.
People who have angina or have had a recent heart attack should be very cautious about taking this drug. It may worsen chest pain.
People with low blood pressure, liver disease, or kidney failure should be cautious about taking this drug.
People taking Aggrenox may bleed for longer amounts of time. Those with bleeding disorders should avoid Aggrenox.
Possible Side Effects
✓ Most common: headache, upset stomach, abdominal pain, nausea, and diarrhea.
✓ Common: pain, tiredness, and vomiting.
✓ Less common: convulsions, rectal bleeding, blood in the stool, hemorrhoids, back pain, accidental injuries, stomach bleeding, feeling unwell, weakness, fainting, memory loss, arthritis, joint or muscle pain, coughing, and respiratory infection.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Avoid alcohol. People who take 3 or more drinks a day while using any aspirin-containing product are more likely to develop stomach ulcers or bleeding.
• Aspirin may reduce the blood-pressure-lowering effects of angiotensin-converting enzyme (ACE) inhibitor drugs, beta blockers, and diuretics.
• Combining aspirin and acetazolamide or an NSAID can cause kidney problems.
• Aspirin can increase the blood-thinning effects of anticoagulant (blood-thinning) drugs such as warfarin. Avoid this combination.
• Aspirin can increase the effects of oral antidiabetes drugs, possibly leading to low blood sugar.
• Aspirin counteracts the uric-acid-eliminating effects of probenecid and sulfinpyrazone.
• Aspirin can increase the toxic effects of anticonvulsant drugs and methotrexate.
• Dipyridamole increases the level of adenosine in the blood and may increase cardiovascular-related side effects. The adenosine dosage may need to be adjusted when these two drugs are combined.
• Dipyridamole may interfere with cholinesterase inhibitors used to treat myasthenia gravis.
Food Interactions
Aggrenox is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
Adult: 1 capsule (200 mg of sustained-release dipyridamole and 25 mg of aspirin) morning and evening.
Child: not recommended.
Overdosage
Symptoms include a sensation of warmth, flushing, sweating, restlessness, weakness, dizziness, low blood pressure, and rapid heartbeat. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you experience blood in your stool, persistent diarrhea, or abdominal or stomach pain.
Avoid alcohol while taking this drug.
In people taking Aggrenox, minor cuts may take longer than normal to stop bleeding.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule.
Swallow Aggrenox tablets whole; do not crush or chew them.
Special Populations
Pregnancy/Breast-feeding: Pregnant women should avoid Aggrenox because of its aspirin content. Aspirin can cause bleeding problems in mother and fetus and result in a low-birth-weight infant. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Both ingredients in Aggrenox pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may need a reduced dose of Aggrenox.
Jul
15
The Prostate in Sexual Activity.
July 15, 2009 | Leave a Comment
The Prostate in Sexual Activity
The prostate is part of the male reproductive system and supplies part of the seminal fluid. It is not essential for the man’s sexuality, though, nor even for his ability to reproduce. When a man’s prostate is removed, male sexuality is not normally affected ripped fuel. His sex drive is intact, and his ability to
achieve and maintain an erection is unchanged.
SEMINAL FLUID
In fact most of the fluid you ejaculate isn’t sperm at all. Most of the fluid consists mainly of secretions from a number of glands. The largest of these glands is the prostate.
The various secretions from these glands probably serve the purpose of providing the sperm with a greater motility after they have been ejaculated, which stimulates their activity and enables them to move towards the egg. It is thought by some people that the prostate also has a lot to do with the feeling that an orgasm gives you. When a man
has an orgasm, sperm fluid from the seminal vesicles and the secretions from the prostate all mix together as semen at the top of the urethra, just below the bladder. A man gets an intensely pleasurable sensation when the semen floods down the urethra into the penis . He also gets a pleasurable feeling when the semen squirts out of the penis and into the tight region of a woman’s vagina. The prostate gland can be felt, as a man’s orgasm proceeds, to contract i-liythmically, which some people believe to be very much an integral part of the pleasure he experiences on orgasm.
What prostate fluid contains:
• Water.
• Salts.
• Minerals.
• Proteins.
• Antibodies.
• Enzymes.
• Citric acid.
• Fats buy domain fioricet tramadol .
• Prostaglandins, which are hormone-like chemicals.
PROSTATIC DISEASE
Prostatic disease can have an effect not only on the urinary system, but also on the reproductive system. The male reproductive and urinary systems are, of course, closely linked, if only because they share the same exit route - the penis - or, to be more exact, the urethra which runs through the centre of the penis. The prostate gland is the site at which the male sex hormone testosterone, which is made by the testicles, is broken down. It is here that it then forms another hormone called dihydrotestosterone (DHT). The conversion is controlled by an enzyme called 5-alphareductase. In a study conducted by Imperato-McGinley (Science, 1974), the males in an obscure tribe in the Dominican Republic are deficient in 5-alpha-reductase and are often mistaken for girls until they reach puberty. Until then, they have a very small penis and scrotum, which suddenly enlarge at puberty, along with the development of a deep voice. These males only ever develop a very small prostate gland, they never go bald, and they do not suffer from acne check.
It is this genetic deficiency in 5-alpha-reductase that has enabled researchers to comprehend the role played by dihydrotestosterone in the enlargement of the prostate gland.
Testosterone
As well as prostate enlargement, the male hormone testosterone also has several other effects on the male body.
These include the following:
• The growth of the penis.
• The growth of testes.
• The production of sperm.
• A deeper voice.
• The growth of facial and body hair.
• The male sex drive.
• Bone growth hair loss.
• Strength.
• Acne.
• Baldness.
A MAN’S GREATEST FEARS
One of man’s greatest fears on seeing a urologist and considering the prospect of a prostatectomy is what effect this will have on his sexuality. The idea of having any sexual organ tampered with by a surgeon is very frightening for most men, who worry that it may have a deleterious effect on their sex lives. Many men are so frightened that their prostate problems will affect their sex lives, particularly if they have to have an operation, that they put off going to the doctor gastroparesis caused by prozac . And even when they do eventually go to the doctor, they may be too embarrassed to discuss sexual matters. Sex is something that all too many men find difficult -if not impossible - to talk about with their doctor. But this is foolish. It is only by talking the matter over with their doctor that they will find their fears were groundless and that they can therefore be reassured.
The doctor’s role.
To make matters worse, some doctors and urologists are sometimes insensitive on this subject. It is quite wrong of them to assume that their patients are too old to be interested in sex. Sex can play an important role in the lives of many men until well into old age, and they should treat their fears as real and serious. A man who is due to have a prostatectomy should not just fret about this in secret, he should talk to his doctors about it - his GP, his consultant, his surgeon. Most importantly, the doctor should respect his fears, and him for coming to air them with him. It’s not easy for any man to do this, and if he succeeds in overcoming his reluctance to do so, the doctor should recognise what that has cost him. If the doctor reacts badly, it might have catastrophic effects: it might just send him scuttling back to his burrow, his pride injured, and he might never be able to take the risk again. Only when both doctor and patient can talk about this calmly, sensibly, realistically, will the patient be reassured that it will have no effect on his sexuality - neither on his libido, nor his ability to obtain or maintain an erection, nor on his performance.
Retrograde ejaculation
What it may well do, however, is cause him to be infertile after the operation. Even a man who has no intention of becoming a father again may find the idea of losing his potential to be a father very distressing. A man may find this emasculating, as if it were questioning his manhood. He’s only lost his ability to procreate, not his sexuality, but this can have a devastating effect on him. This is reminiscent of a woman who regrets the loss of her womb after a hysterectomy, even though she is beyond childbearing, and feels she has lost her femininity. A doctor should have the sensitivity to talk to his patient about this. Only with patience and understanding can he help
him come to terms with his feelings of fear and loss. Retrograde ejaculation will not make a man impotent, nor - in most cases - will it prevent him from having orgasms. It will, however, make the sensation of orgasm a different one - and, in all honesty, probably not as good. Some women, too, are disappointed by the new feeling of a ‘dry’ climax in their male partner. These changes in a man’s sexuality should be addressed beforehand. He should be told what to expect. A sensitive doctor will also help a couple come to terms with their new-found sexuality.
Impotence
It is possible, though by no means certain - nor even common -that prostatectomy may cause impotence Some men are frightened that it might have this effect, probably because they have heard tales of the old perineal prostate operation (which is hardly ever done nowadays) or the radical prostatectomy in which the entire prostate, including the capsule in which it is enclosed, is removed (sometimes performed for prostate cancer). In both these operations, the nerves supplying the penis were sometimes cut, which led to a man’s impotentence. The problem of impotence is therefore unlikely but it may arise. If a man is very frightened that the operation may lead to impotence, he may actually experience a kind of psychological impotence afterwards. This underlines how important it is for a man to be reassured before the operation. If a psychological problem does occur, a counsellor or sex therapist should be able to deal with it.
An excuse to avoid sex
In spite of all the evidence that prostate surgery has no effect at all on a man’s sexuality (other than retrograde ejaculation), it does occasionally seem to happen. An obvious explanation for this is that some men may use surgery as an excuse to avoid sex, which they had stopped enjoying ages ago anyway. Occasionally, if a man is not in very good health, a prostate operation - which is, after all, a major operation requiring a long convalescence period - may be enough to push his sexuality over the edge.
Generally, though, most men do not have any problems with their sex lives after the operation. In fact, a man may actually find that his sex life has greatly improved since he had his prostatectomy, if only because he now has full control of his bladder.
Jul
3
Allergy: Diagnosis and FAQs
July 3, 2009 | Leave a Comment
ALLERGIES
• Install an Aprilaire HEPA-type air filter
• Use a high-quality vacuum cleaner (Miele)
• Rinse your nasal passages with saltwater
• Try vitamin C
• Experiment with the herbs stinging nettle and butterbur
• Try Nasal Crom (cromolyn) spray to prevent allergy symptoms
• Look for loratadine, an over-the-counter antihistamine
• Ask your doctor about a steroid nasal spray
• Consider pseudoephedrine for symptomatic relief
Breathing is basic. Most of the time we take it for granted. But if your nose is congested and your sinuses are stopped up, you are miserable. For one thing, your head feels as if it’s full of cotton. Studies have found that people suffering from allergies frequently experience sleep difficulties, fatigue, poor concentration, drowsiness, irritability, delayed reaction times, memory problems, and cognitive impairment. When you are in the middle of an allergy attack it is hard to drive safely even if you are not sneezing. Making decisions or operating other kinds of machinery can also be problematic.
Paradoxically, although antihistamines are the mainstay of allergy treatment, they can also cause drowsiness, delayed reaction times, sedation, and cognitive impairment. Even the so-called second-generation nonsedating antihistamines that are so heavily advertised to consumers may not be as benign as drug companies would have you believe. When given in doses that are adequate to relieve symptoms, some of these nonsedating antihistamines may also make people drowsy and impair performance.
Research has shown that driving skills are affected with both the older and the newer antihistamines. A massive study conducted for the National Highway Traffic Safety Administration discovered that driving while drowsy—no matter what the cause—increased the risk of a crash or near crash by four to six times.
Physicians often think of allergies as more of a nuisance than a life-threatening condition. But we now realize that impairment poses huge risks if people are driving. And allergy symptoms don’t just occur in the spring and fall, when pollen is in the air. Nowadays many folks are congested all year long. At last count, 50 million people are sensitive to things like dust mites, cat dander, cockroaches, mold spores, and pollens from oak, elm, and maple trees as well as ragweed and rye, blue,and Bermuda grasses.24 Symptoms include nasal stuffiness, runny nose, itching, sneezing, and coughing. Chronic sinusitis, which may develop as a consequence of allergies, affects more than 30 million people. And asthma, which can be life threatening, often has an allergic and inflammatory component.
What is so scary about these statistics is that they keep going up. No one knows why, but it appears that more people are suffering than ever before.
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Conclusions
Allergies don’t get the respect they deserve. When you complain about your congestion, most friends and family members will barely sympathize. But allergies can slow you down and make you dangerous behind the wheel. Finding the right treatment to ease your symptoms without causing worse problems is a challenge. Combining several options, including environmental control, may be the most effective solution for solving this common problem.
• Use a HEPA-type air filter and a dehumidifier to remove allergens from the air you breathe and make the environment inhospitable for the three Ms of allergy—mold, mildew, and mites.
• Get a high-quality vacuum cleaner that won’t spew dust and dirt back into the air. Miele models rank high on our list.
• Wash your nasal passages with saline. A neti pot will help.
• Consider an herbal approach such as stinging nettle (Urtica dioica) or butterbur (Petasites hybridus). Men with prostate enlargement may find nettles especially helpful since some OTC allergy medicines may make this condition worse.
• The natural products quercetin and bromelain may help stabilize mast cells and prevent histamine release.
• Cromolyn (NasalCrom) is an OTC remedy that also stabilizes mast cells. It should be used preventively before exposure to allergens occurs. Cromolyn does not cause drowsiness.
• Oral antihistamines can control symptoms, but they may also make you dangerous on the highways. Even nonsedating products may interfere with driving ability. Generic loratadine (Claritin) is now available without a prescription.
• Among prescription allergy medicines, steroid nasal sprays offer the most effective symptom relief with a minimum of side effects. The cost is significant, since they are available only by prescription. One generic variety (flunisolide) is less expensive than brand-name products like Flonase and Rhinocort AQ.
• Pseudoephedrine can be surprisingly effective at controlling allergy symptoms. Beware of side effects such as insomnia, nervousness, high blood pressure, and irregular heart rhythms.
Jul
1
Drugs for Diabetes Treatment
July 1, 2009 | Leave a Comment
Diabetes
Diabetes mellitus is a deficiency caused by a lack of insulin, a specftffchormone secreted by the islet cells of the pancreas, or by a failure of the insulin-release mechanism. As a result of that insulin deficiency, carbohydrates and fats are not fully metabolized. Glucose accumulates in the circulation and causes a diuresis, so that polyuria and thirst are troublesome complications. Insulin-dependent diabetes, which occurs mainly in children and young adults, can be controlled by injections of insulin. Soluble insulin is used for rapid treatment and in emergencies, but stabilized patients can be controlled by one of the longer-acting forms of insulin such as insulin-zinc-suspension.. Insulin was once obtained from pigs or cattle, but human types of insulin are now available and used to an increasing extent.
In middle age, a non-insulin-dependent type of diabetes may develop. In such patients, the natural secretion of insulin still occurs, but the insulin is not released according to metabolic requirements. Release can, however, be induced by treatment with the orally active hypoglycaemic agents referred to as the sulphonylureas, represented by chlorpropamide. The sulphonylureas are most effective in mature patients who are already stabilized on low doses of insulin, or who do not respond to purely dietary control. Patients receiving less than 20 units of insulin daily can usually be transferred directly to an oral drug, but in other cases the transfer should be carried out over a few days.
For those patients who do not respond to the sulphonylureas, an alternative is the biguanide metformin. The mode of action differs, as it functions mainly by increasing the peripheral utilization of glucose. Guar gum has some antidiabetic properties, possibly mediated by interfering with the absorption of carbohydrates, and may be a useful supplementary treatment. Oral therapy with any antidiabetic drug is not suitable for juvenile or unstable diabetics.
Diabetic emergencies may cause hypoglycaemia which may also result in coma. The former requires treatment with i.v. soluble insulin, preferably by an i.v. pump system, failing which the insulin should be given by i.m. injection. Hypoglycaemic coma, which may be due to an overdose of insulin, can be treated with the i.v. infusion of 50% glucose solution, or by the injection of glucagon 1 m by any route. (Diazoxide is used in the control of chronic hypoglycaemia which is due to the overproduction of insulin. It has no place in the emergency treatment of diabetic coma.)
Insulin zinc (IZS) Human Ultratard
(crystalline) Humulin Zn
Protamine zinc Hypurin Protamine Zinc
Soluble insulin
Insulin zinc (IZS) (amorphous)
Isophane insulin (a complex
with protamine)
Biphasic insulin
Biphasic isophane insulin (a complex with protamine)
Insulin zinc (IZS) (amorphous)
Insulin zinc (IZS) (amorphous
Human Actrapid Human Velosulin Humulin S Hypurin Neutral Velosulin
Insulin Lispro*
Semitard MC Hypurin Isophane Pork Insulatard Human Insulatard Humulin I Rapitard MC Pork Mixtard Human Mixtard Humulin M1-5 Semitard MC
beef 5-8 human-pyr human-emp human-prb beef
pork
humalog
pork 18-24 beef
pork
human-pyr human-prb beef & pork pork
human-pyr human-prb beef/pork
beef 24-36 beef/pork human-pyr human-prb
human-pyr 24-36 human-prb
beef
glibenclamide Daonil, Semi-Daonil, Euglucon
gliclizide Diamicron
glimepiride Amaryl
glipizide Glibenese, Minodiab
gliquidone Glurenorm
tolazamide Tolanase
tolbutamide Rastinon
biguanide
metformin Glucophage
acarbose Glucobay
guar gum Guarem
Iroglitazone* Romozin
Note: This new drug, an insulin enhancer, has recently been withdrawn pending investigations of reports of liver damage.
Jul
1
Drugs for Cough Treatment
July 1, 2009 | Leave a Comment
Cough
Cough is an explosive exptiation of air from the lungs, and is a protectiv-e–! mechanism to expel excessive exudate or foreign bodies from the respiratory tract,
but other irritant factors may also stimulate the cough reflex. Productive cough
should not be suppressed without good cause, such as when the patient finds
cough exhausting or prevents sleep, but suppression may then have the
undesirable effect of causing retention of sputum. On the other hand, suppression
of the dry, useless or unproductive cough may have corresponding advantages.
Many soothing and demulcent preparations represented by simple linctus have
been used for the symptomatic relief of cough, and another traditional remedy is
steam inhalation, assisted by the addition of Friar’s balsam and menthol.
Expectorant products such as ammonia and ipecacuanha mixture are also used,-,—,–.
even though pharmacological proof of their efficacy may be lacking. Cough
suppressants, represented by codeine, have a central depressant action on the
cough centre, but effective doses may have the disadvantage of causin
Extended use should be avoided because of the possible risk of
habituation. The treatment of severe cough in terminal lung cancer is with more potent cough suppressants such as diamorphine or methadone.
Approved names Brand names
codeine linctus Galcodine
pholcodine linctus
Table 9 Cough suppressants.
Galenophol, Pavocol D, Pholcomed
Jul
1
Drugs for Cancer Treatment
July 1, 2009 | Leave a Comment
The treatment of cancer is difficult because cancer cells are cells that have escaped from the controls that govern normal cell growth and differentiation of function. As a result, uncoordinated growth may develop rapidly, and cancer cells may migrate and invade other tissues. Any anti-cancer drug is therefore likely to damage normal cells, particularly actively growing cells such as those of the bone marrow, and the dose of a cytotoxic agent is often a compromise between that having the desired anti-cancer action and that causing toxicity.
The drugs used in the treatment of cancer can be divided into four main groups, which attack the cells at different points. The alkylating agents interfere with the replication and function of DNA, modify protein synthesis, and have correspondingly wide effects. The antimetabolites interfere with cell metabolism by combining with cell enzymes, or by forming abnormal proteins, or otherwise inhibiting normal development. The cytotoxic antibiotics have an action similar to that of the antimetabolites, but they also have radiomimetic properties, and combined radiotherapy may increase the risks of damage to normal cells. These antibiotics, with the exceptions of dactinomycin and bleomycin, also have undesirable cardiotoxic properties, and dosage requires careful control. Amsacrine is a synthetic cytotoxic agent with some of the properties of the antibiotic group. Some recently introduced drugs include docetaxel, gemcitabine, letrozole, paclitaxel, raltitrexed and topotecan.
The vinca alkaloids are a class apart, as they are plant substances, and act at the metaphase stage of cell division. They are used mainly in acute leukaemias and some lymphomas. Vincristine is almost free from any depressive effects on bone marrow function, vinblastine has some degree of myelosuppressive activity but is less neurotoxic. Vindesine occupies an intermediate position. Etoposide is a synthetic drug with some of the properties of the vinca alkaloids. Other and unclassified cytotoxic agents include the platinum complexes carboplatin and cisplatin, used mainly in ovarian cancer, and the enzyme crisantaspase used in acute lymphoblastic leukaemia. Some cancers are hormone dependent, and the symptoms may be controlled by suitable hormone antagonists. Breast cancer for example may respond to aminoglutethimide, anastrozole, formestane, letrozole and toremifene. Prostatic cancer can be treated with anti-androgens such as fosfesterol, bicalutamidc, cyproterone and flutamide. Certain hormone analogues such as buserelin, goserelin, leuprorelin and triptorelin are also used in cancer of the prostate. A distressing side-effect of high-dose cytotoxic chemotherapy was severe and intractable nausea and vomiting, which could be so intense that patients have been known to refuse further anti-cancer treatment. The problem has since been resolved by the introduction of potent antierneties of the ondansetron type.
Myleran
carmustine BiCNU
chlorambucil Leukeran
cyclophosphamide Endoxana
estramustine Estracyt
ifosfamide Mitoxana
lomustine CCNU
melphalan Alkeran
mustine Mustine
thiotepa Thiotepa
treosulphan Treosulfan
cladribine Leustat
gemcitabine mercaptopurine methotrexate
thioguanine Lanvis
cytarabine Alexan, Cytosar
fludarabine Fludara
fluorouracil Fluoro-Uracil, Efudix
Gemzar Puri-Nethol
Maxtrex
raltitrexed Tomudex
bleomycin Bleomycin
dactinomycin Cosmegen
daunorubicin DaunoXome
doxorubicin Doxorubicin
epirubicin Pharmarubicin
idarubicin Zavedos
mitomycin Mitomycin C
mitozantrone Novantrone
vinblastine Velbe
vincristine Oncovin
vindesine Eldesine
vinorelbine Navelbine
aldesleukin
amsacrine
bicalutamide
carboplatin
dacarbazine
Proleukin
Amsidine
Casodex
Paraplatin
DTIC
cisplatin Cisplatin
docetaxel Taxotere
etoposide
Vepesid
hydroxyurea
Hydrea
iritotecan
Campto
letrozole
Ferrara
octreotide
Sandostatin
paclitaxel
Taxol
pentostatin
Nipent
procarbazine
Natulan
razoxane
Razoxin
topotecan
Hycamptin
tretinoin
Vesanoid
aminoglutethimide
Orimeten
anastrozole
Armidex
buserelin
Suprefact
Cyprostat
Drogenil
flutamide
Lentaron
formestane
goserelin
Zoladex
tamoxifen
Torero
torasemide
Casodex
Emblon, Nottam, Notwadex, Tamofen
bicalutamide
cyproterone
Jul
1
Drugs for Bell’s Palsy Treatment
July 1, 2009 | Leave a Comment
Bell’s palsy
Bell’s palsy is a unilateral facial paralysis, characterizedby sudden onset and pain, usually behind the ear. The cause is unknown, but the symptoms are thought to be due to local swelling and a compression of the facial nerve. Patients should be reassured that the paralysis is unrelated to stroke and spontaneous recovery usually occurs after some weeks. Corticosteroids are effective if the condition is diagnosed early, and prednisolone is given initially in doses of 60-80 mg daily, decreasing by 10 mg every 2 days for about a week. As the palsy may prevent closure of the affected eye, local treatment with artificial tears or liquid paraffin may be required.
Approved names Brand names
hypromellose Tears Naturelle
(artificial tears) Isopto Alkaline & Plain
prednisolone Deltacortril, Deltastab, Precortisyl, Prednesol
liquid paraffin
Lacri-Lube
polyvinyl alcohol
Hypotears
Jul
1
Drugs for Anxiety Treatment
July 1, 2009 | Leave a Comment
Anxiety
Anxiety states may manifest themselves in a variety of ways from a general sense of uneasiness to acute panic attacks. The symptoms may also vary widely, from a minor physical disturbance such as dryness of the mouth and sweating of the hands and ‘butterflies in the stomach’ to breathlessness, hyperventilation and lightheadedness. Emotional stress often precipitates anxiety, and drug treatment is useful when the cause of the stress is ill-defined or cannot be removed. Such treatment should always be regarded as a short-term measure, as the prolonged use of anxiolytics involves the risks of dependence and the problems of eventual withdrawal. For such short-term treatment of severe anxiety, a benzodiazepine such as diazepam is often the drug of choice, but other drugs such as buspirone are also in use. Some of the potent antipsychotic agents are also given in small doses for the relief of anxiety. The beta-blockers are occasionally useful in controlling some of the symptoms of anxiety, when the possibility of stress can be anticipated, as in public speaking or performance.
Approved name Brand name Daily dose range
alprazolam Xanax 750-1500.Lig
bromazepam Lexotan 3-18 mg
ch lord iazepoxide Librium 30-100 mg
clorazepate Tranxene 7.5-22.5 mg
diazepam Atensine, Valium 5-30 mg
lorazepam Ativan 2.5-10 mg