Drugs Collection

Paracetamol

2011-02-17T04:50:00.000-08:00

Paracetamol

Paracetamol relieves pain and fever in adults and children, and it is the most widely accepted medicine for this purpose. It is used mainly for its pain relief properties either as a medicine prescribed by a doctor or it can be purchased as an over-the-counter medicine both in retail pharmacies or grocers shops.
There are virtually no groups of people who should not take paracetamol, and interactions with other treatments are not a problem.
When taken at the recommended dosage, there are virtually no side-effects.
Its pain relief (analgesic) and fever relief (antipyretic) effects are similar to those of aspirin and it works in a similar, though not identical, way. Unlike aspirin, however, increasing the dose does not result in clinically useful anti-inflammatory activity. Paracetamol is therefore not of value for reducing inflammation in the treatment of chronic rheumatic diseases as are the non-steroidal anti-inflammatory drugs like aspirin. Nevertheless, paracetamol does provide useful pain relief and is considered the first line treatment in osteoarthritis.
Paracetamol can be combined with decongestant ingredients to help relieve the symptoms of the common cold, influenza and sinusitis by relieving headache, general aches, nasal congestion and fever.
Paracetamol and its combinations are mainly available as tablets for immediate consumption or for dissolving in water before consumption. It is suitable for all age groups including the very young for whom it may be used following immunisation procedures, and it is available in liquid formulations for young children.
Mechanism of action :

Over 100 years after it was first discovered, we are now learning what the mechanism of action is that makes paracetamol such an effective and useful medicine. It now appears paracetamol has a highly targeted action in the brain, blocking an enzyme involved in the transmission of pain.
As with many medicines, the effectiveness of paracetamol was discovered without knowing how it works. Its mode of action was known to be different to other pain relievers, but although it produces pain relief throughout the body the exact mechanism was not clear.
The production of prostaglandins is part of the body's inflammatory response to injury, and inhibition of prostaglandin production around the body by blocking the cyclooxygenase enzymes known as COX-1 and COX-2 has long been known to be the mechanism of action of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. However, their action in blocking COX-1 is known to be responsible for also causing the unwanted gastrointestinal side effects associated with these drugs.
Paracetamol has no significant action on COX-1 and COX-2, which left its mode of action a mystery but did explain its lack of anti-inflammatory action and also, more importantly, its freedom from gastrointestinal side effects typical of NSAIDs.
Early work (1) had suggested that the fever reducing action of paracetamol was due to activity in the brain while its lack of any clinically useful anti-inflammatory action was consistent with a lack of prostaglandin inhibition peripherally in the body.

Now, recent research (2) has shown the presence of a new, previously unknown cyclooxygenase enzyme COX-3, found in the brain and spinal cord, which is selectively inhibited by paracetamol, and is distinct from the two already known cyclooxygenase enzymes COX-1 and COX-2. It is now believed that this selective inhibition of the enzyme COX-3 in the brain and spinal cord explains the effectiveness of paracetamol in relieving pain and reducing fever without having unwanted gastrointestinal side effects.

Metronidazole ( Flagyl )

2011-02-17T04:39:00.000-08:00

Metronidazole

Trade name : Flagyl

Important information about metronidazole

Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Metronidazole will not treat a viral infection such as the common cold or flu. Do not drink alcohol while you are taking metronidazole and for at least 3 days after you stop taking it. You may have unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting.

Before taking metronidazole

Do not use this medication if you are allergic to metronidazole, or if you are in the first trimester of pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Before taking metronidazole, tell your doctor if you are allergic to any drugs, or if you have:

· liver disease;

· a stomach or intestinal disease such as Crohn's disease;

· a blood cell disorder such as anemia (lack of red blood cells) or leukopenia (lack of white blood cells);

· epilepsy or other seizure disorder; or

· nerve disorders.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication.

Metronidazole can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take metronidazole?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take the extended-release form of metronidazole (Flagyl ER) on an empty stomach, at least 1 hour before or 2 hours after eating a meal. Do not crush, chew, or break the extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time. Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Metronidazole will not treat a viral infection such as the common cold or flu.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your liver function may also need to be tested. Do not miss any scheduled visits to your doctor.

This medication can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using metronidazole.

Store metronidazole at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include nausea, vomiting, dizziness, loss of balance or coordination, numbness and tingling, or seizures (convulsions).

What should I avoid while taking metronidazole?

Do not drink alcohol while you are taking metronidazole and for at least 3 days after you stop taking it. You may have unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting.

Check the labels of any medicines or food products you use to make sure they do not contain alcohol.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Ampicillin

2011-02-17T00:51:00.000-08:00

What is this ampicillin?

Trade Name : Ampiclox

AMPICILLIN (am pi SILL in) is a penicillin antibiotic. It is used to treat certain kinds of bacterial infections. It will not work for colds, flu, or other viral infections.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

bowel disease, like colitis
heart disease
kidney disease
liver disease
seizures disorder
an unusual or allergic reaction to ampicillin, other penicillins or antibiotics, other medicines, foods, dyes, or preservatives
pregnant or trying to get pregnant
breast-feeding

How should I use this medicine?

Take this medicine by mouth with a full glass of water. Follow the directions on the prescription label. Take this medicine on an empty stomach, at least 30 minutes before or 2 hours after food. Do not take with food. Take your medicine at regular intervals. Do not take your medicine more often than directed. Take all of your medicine as directed even if you think you are better. Do not skip doses or stop your medicine early.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

allopurinol
birth control pills
chloroquine
methotrexate
probenecid
some other antibiotics like erythromycin, tetracycline

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Tell your doctor or health care professional if your symptoms do not improve or if you get new symptoms.

Do not treat diarrhea with over the counter products. Contact your doctor if you have diarrhea that lasts more than 2 days or if it is severe and watery.

This medicine can interfere with some urine glucose tests. If you use such tests, talk with your health care professional.

Birth control pills may not work properly while you are taking this medicine. Talk to your doctor about using an extra method of birth control.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
breathing problems
dark urine
fever
pain or difficulty passing urine
pain when swallowing
redness, blistering, peeling or loosening of the skin, including inside the mouth
seizures
unusual bleeding, bruising
unusually weak or tired

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

diarrhea
dizziness
headache
loss of appetite
nausea, vomiting
sore mouth, tongue
stomach upset

Amoxicillin

2011-02-17T00:43:00.000-08:00

What is amoxicillin?

Trade name : Amoxil

Amoxicillin is a penicillin antibiotic. It fights bacteria in your body.Amoxicillin is used to treat many different types of infections caused by bacteria, such as ear infections, bladder infections, pneumonia, gonorrhea, and E. coli or salmonella infection. Amoxicillin is also sometimes used together with another antibiotic called clarithromycin (Biaxin) to treat stomach ulcers caused by Helicobacter pylori infection. This combination is sometimes used with a stomach acid reducer called lansoprazole (Prevacid).

Amoxicillin may also be used for purposes not listed in this medication guide.

Important information about amoxicillin

Do not use this medication if you are allergic to amoxicillin or to any other penicillin antibiotic, such as ampicillin (Omnipen, Principen), dicloxacillin (Dycill, Dynapen), oxacillin (Bactocill), penicillin (Beepen-VK, Ledercillin VK, Pen-V, Pen-Vee K, Pfizerpen, V-Cillin K, Veetids), and others.

Before using amoxicillin, tell your doctor if you are allergic to cephalosporins such as Omnicef, Cefzil, Ceftin, Keflex, and others. Also tell your doctor if you have asthma, liver or kidney disease, a bleeding or blood clotting disorder, mononucleosis (also called "mono"), or any type of allergy.

Amoxicillin can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking amoxicillin. Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Amoxicillin will not treat a viral infection such as the common cold or flu. Do not share this medication with another person, even if they have the same symptoms you have.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking amoxicillin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Before taking amoxicillin

Do not use this medication if you are allergic to amoxicillin or to any other penicillin antibiotic, such as:

· ampicillin (Omnipen, Principen);

· dicloxacillin (Dycill, Dynapen);

· oxacillin (Bactocill); or

· penicillin (Bicillin C-R, PC Pen VK, Pen-V, Pfizerpen, and others).

To make sure you can safely take amoxicillin, tell your doctor if you are allergic to any drugs (especially cephalosporins such as Omnicef, Cefzil, Ceftin, Keflex, and others), or if you have any of these other conditions:

· asthma;

· liver disease;

· kidney disease;

· mononucleosis (also called "mono");

· a history of diarrhea caused by taking antibiotics; or

· a history of any type of allergy.

FDA pregnancy category B. Amoxicillin is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Amoxicillin can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking amoxicillin. Amoxicillin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Aspirin

2011-02-16T11:49:00.000-08:00

What is aspirin?

Aspirin is in a group of drugs called salicylates. It works by reducing substances in the body that cause pain, fever, and inflammation.

Aspirin is used to treat mild to moderate pain, and also to reduce fever or inflammation. It is sometimes used to treat or prevent heart attacks, strokes, and angina. Aspirin should be used for cardiovascular conditions only under the supervision of a doctor.

Important information about aspirin

Aspirin should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Aspirin can cause a serious and sometimes fatal condition called Reye's syndrome in children.

Stop using this medication and call your doctor at once if you have any symptoms of bleeding in your stomach or intestines. Symptoms include black, bloody, or tarry stools, and coughing up blood or vomit that looks like coffee grounds.

Avoid drinking alcohol while you are taking this medication. Alcohol may increase your risk of stomach bleeding.

Aspirin is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina). Aspirin should be used for cardiovascular conditions only under the supervision of a doctor.

Before taking aspirin

· a recent history of stomach or intestinal bleeding;

· a bleeding disorder such as hemophilia; or

· an allergy to an NSAID (non-steroidal anti-inflammatory drug) such as Advil, Motrin, Aleve, Orudis, Indocin, Lodine, Voltaren, Toradol, Mobic, Relafen, Feldene, and others.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely take aspirin:

· asthma or seasonal allergies;

· stomach ulcers;

· liver disease;

· kidney disease;

· a bleeding or blood clotting disorder;

· heart disease, high blood pressure, or congestive heart failure;

· gout; or

· nasal polyps.

If you are taking aspirin to prevent heart attack or stroke, avoid also taking ibuprofen (Advil, Motrin). Ibuprofen may make this medication less effective in protecting your heart and blood vessels. If you must use both medications, take the ibuprofen at least 8 hours before or 30 minutes after you take the aspirin (non-enteric coated form). This medication may be harmful to an unborn baby's heart, and may also reduce birth weight or have other dangerous effects. Tell your doctor if you are pregnant or plan to become pregnant while you are taking this medication. Aspirin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Pain killer

2010-12-25T09:32:00.000-08:00

Pain killer

An analgesic, also known as a painkiller, is the term used for any member of the group of drugs used to relieve pain and to achieve analgesia - painless state. Analgesic drugs act in various ways on the peripheral and central nervous system. The pain relief induced by analgesics occurs either by blocking pain signals going to the brain or by interfering with the brain's interpretation of the signals. There are several groups of pain killers and they include:
• paracetamol (acetaminophen)
• the nonsteroidal anti-inflammatory drugs (NSAIDs) such as the salicylates
• narcotic drugs such as morphine
• synthetic drugs with narcotic properties such as Tramadol …
Some other classes of drugs, which normally don’t belong to the group of pain killers, are used to treat some pain syndromes and these include tricyclic antidepressants and anticonvulsants.
It should be pointed out that some experts include aspirin and other non-steroidal anti-inflammatory drugs in the class of analgesics, because they have some analgesic properties but they primarily have an anti-inflammatory effect.

Groups of pain killers
Simply put, analgesics are a class of drugs used to relieve pain. There are basically two kinds of analgesics:
• non-narcotics
• narcotics
Non-Narcotic Analgesics
Paracetamol
Most people already know that Paracetamol or Acetaminophen is the most commonly used over-the-counter, non-narcotic analgesic. It is extremely popular pain-reliever because it is both effective for mild to moderate pain relief. It is also relatively inexpensive. Although not too many people take this drug seriously- it is proven that, if acetaminophen is not used according to the directions, serious side effects can occur. The most common side effect is increase the risk of liver damage. The risk of liver damage with acetaminophen use is also increased by ingesting alcohol. This medication can be found in combination with other active ingredients in many cold, sinus, and cough medications.
Narcotic Analgesics
Everyone should know that there are two types of narcotic analgesics: the opiates and the opioids. What exactly are opiates? Well, they are the alkaloids found in opium. Opioids are any medication which bind to opioid receptors in the central nervous system or gastrointestinal tract.
They are used in medicine as strong analgesics, for relief of severe or chronic pain. What's interesting- there is no upper limit for the dosage of opioids used to achieve pain relief, but the dose must be increased gradually to allow for the development of tolerance to adverse effects.
There are four broad classes of opioids:
• Endogenous opioid peptides- they are normally produced in the body and include endorphins, dynorphins, enkephalins…
• Opium alkaloids – the most commons are morphine, codeine, thebaine
• Semi-synthetic opioids – most common are heroin, oxycodone, hydrocodone, dihydrocodeine, hydromorphone, oxymorphone, nicomorphine
• Fully synthetic opioids – the most common are Demerol, Methadone, Fentanyl, propoxyphene, pentazocine, buprenorphine, butorphanol, Tramadol…
Oxycodone
It is important to point out that Oxycodone is a potent and addictive opioid analgesic medication. It is synthesized from thebaine. Its name is derived from codeine because the chemical structures are very similar. Oxycodone is one of the most powerful medications for pain control that can be taken orally and it is also used in treatment of moderate to severe chronic pain. OxyContin is available in 5, 10, 20, 40, 80, and 160 mg tablets, and it is effective for 8 to 12 hours. What's most important- In the United States, oxycodone is a type II controlled substance.
Morphine
Probably everyone knows that Morphine is one extremely powerful opiate analgesic drug. It represents an active ingredient of opium. It should be pointed out that, like other opiates, morphine acts directly on the central nervous system to relieve pain. Target tissue are synapses of the arcuate nucleus, in brain. There are several side effects that could occur and the most common are:
• impairment of mental performance
• euphoria
• drowsiness
• lethargy
• blurred vision
• constipation
The most important thing there is to know about this drug is that it is highly addictive when compared to other substances. Tolerance and physical and psychological dependence develop extremely quickly.
Tramadol
Tramadol is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain. What makes it so special? Well, beside the fact that it is a synthetic agent, it also appears to have actions on the GABAergic, noradrenergic and serotonergic systems. This isn't case with other pain killers! Tramadol is available in both injectable and oral preparations. Dosages vary depending on the degree of pain experienced by the patient but it is useful to know that Tramadol is approximately 10% as potent as morphine. Oral doses range from 50–400 mg daily, with up to 600 mg daily when given IV/IM.
Codeine
Everyone should know that Codeine is a narcotic analgesic painkiller used for pain relief. The drug codeine is also used in combination medications with the drug acetaminophen, in brand names such as Tylenol, Tylenol with Codeine, Empirin and Phenaphen with Codeine, or in drug combination with aspirin. It is extremely useful for treating moderate to mild pain!
Darvocet
Darvocet is a combination narcotic analgesic painkiller used for pain relief. Other brand name drugs which contain propoxy and acetaminophen include: Propacet, and Wygesic. It is very useful for treting all kind of pains, but the problem is that there are several possible side effects related to the use of this medication!
Propoxyphene
Two medications: Darvon and PP-Cap (generic drug name propoxyphene) are narcotic analgesic painkillers used for pain relief. It is important to point out that the medication propoxyphene comes as a tablet, capsule, and liquid to take by mouth. Darvocet contains the drugs propoxyphene and acetaminophen.
Duragesic
Duragesic is a narcotic analgesic painkiller used for severe pain relief. It is important to know that Duragesic comes only as a skin patch, which contains the generic drug Fentanyl. The medication is absorbed directly from the patch when applied to the skin.
Marijuana
The debate over the use of marijuana for medical purposes has been ongoing for years. Marijuana has been hailed as a prescription for many ills and physicians once used it to stimulate appetite, relieve chronic pain, and treat asthma and migraines. Most common indications for use of Marijuana are:
• chronic pain
• migraines
• glaucoma
• Multiple sclerosis…
Many young users are saying that the addiction with marijuana isn't possible. Of course, this isn't true! Addiction is highly possible! Long-term marijuana use can lead to addiction for some people, which means that they use the drug compulsively even though it interferes with family, school, work, and recreational activities. When a person is chemically dependent on marijuana, it means that it needs to use more and more to get the same effect. Most common withdrawal symptoms are: depressed feelings, trouble sleeping and nausea.
Salicylic acid
Not too many people know that Salicylic acid is a colorless, crystalline organic carboxylic acid. Salicylic acid functions as a plant hormone because. It is important to point out that salicylic acid is toxic if ingested in large quantities. In small quantities is used as a food preservative and antiseptic in toothpaste. The medicinal properties of salicylates have been known since ancient times and everyone should know that the substance occurs in the bark of willow trees.
Aspirin can be prepared by the esterification of the phenol hydroxyl group of salicylic acid. It is often combined with bismuth and when combined the two key ingredients help control diarrhea, nausea, heartburn, and even gas. It is also very mildly anti-biotic.
Side Effects and Adverse Reactions of Opioids:
Common side effects and adverse reactions:
• nausea
• of the pupil)
• orthostatic hypotension
• urinary retention
• vomiting
• drowsiness
• dry mouth
• miosis
Less common side effects and adverse reactions:
•
• bradycardia (slow heart rate)
• tachycardia (rapid heart rate)
• raised intracranial pressure
• confusion
• hallucinations
• delirium
• hives
• itch
• hypothermia ureteric or biliary spasm
• muscle rigidity
• flushing
• respiratory depression
• fatal overdose
Pros and cons for use of pain killers
There have been debates over the addictive potential of opioids vs. the benefit of their analgesic properties, especially for treating non-malignant chronic pain, such as chronic arthritis. Although they can be extremely helpful- there are several possible lethal side effects that can occur! Some experts believe opioids can be taken safely for years with minimal risk of addiction or toxic side effects. This could happen only if taken under close supervision of doctor!

antiviral drugs

2010-12-25T08:58:00.000-08:00

List of antiviral drugs
A
• Abacavir
• Aciclovir
• Acyclovir
• Adefovir
• Amantadine
• Amprenavir
• Ampligen
• Arbidol
• Atazanavir
• Atripla (fixed dose drug)
B
• Boceprevir
C
• Cidofovir
• Combivir (fixed dose drug)
D
• Darunavir
• Delavirdine
• Didanosine
• Docosanol
E
• Edoxudine
• Efavirenz
• Emtricitabine
• Enfuvirtide
• Entecavir
• Entry inhibitors
F
• Famciclovir
• Fixed dose combination (antiretroviral)
• Fomivirsen
• Fosamprenavir
• Foscarnet
• Fosfonet
• Fusion inhibitor
G
• Ganciclovir
I
• Ibacitabine
• Imunovir
• Idoxuridine
• Imiquimod
• Indinavir
• Inosine
• Integrase inhibitor
• Interferon type III
• Interferon type II
• Interferon type I
• Interferon
L
• Lamivudine
• Lopinavir
• Loviride
M
• Maraviroc
• Moroxydine
• Methisazone
N
• Nelfinavir
• Nevirapine
• Nexavir
• Nucleoside analogues
O
• Oseltamivir (Tamiflu)
P
• Peginterferon alfa-2a
• Penciclovir
• Peramivir
• Pleconaril
• Podophyllotoxin
• Protease inhibitor (pharmacology)
R
• Raltegravir
• Reverse transcriptase inhibitor
• Ribavirin
• Rimantadine
• Ritonavir
• Pyramidine
S
• Saquinavir
• Stavudine
• Synergistic enhancer (antiretroviral)
T
• Tea tree oil
• Tenofovir
• Tenofovir disoproxil
• Tipranavir
• Trifluridine
• Trizivir
• Tromantadine
• Truvada
V
• Valaciclovir (Valtrex)
• Valganciclovir
• Vicriviroc
• Vidarabine
• Viramidine
Z
• Zalcitabine
• Zanamivir (Relenza)
• Zidovudine

Hypnotic drugs

2010-12-25T08:57:00.000-08:00

Hypnotic

drugs, including benzodiazepine receptor ligands, barbiturates, antihistamines, and melatonin receptor ligands, are useful in treating insomnia, but clinicians should consider the relative abuse liability of these drugs when prescribing them. Two types of problematic hypnotic self-administration are distinguished. First, recreational abuse occurs when medications are used purposefully for the subjective "high." This type of abuse usually occurs in polydrug abusers, who are most often young and male. Second, chronic quasi-therapeutic abuse is a problematic use of hypnotic drugs in which patients continue long-term use despite medical recommendations to the contrary. Relative abuse liability is defined as an interaction between the relative reinforcing effects (i.e., the capacity to maintain drug self-administration behavior, thereby increasing the likelihood of nonmedical problematic use) and the relative toxicity (i.e., adverse effects having the capacity to harm the individual and/or society). An algorithm is provided that differentiates relative likelihood of abuse and relative toxicity of 19 hypnotic compounds: pentobarbital, methaqualone, diazepam, flunitrazepam, lorazepam, GHB (gamma-hydroxybutyrate, also known as sodium oxybate), temazepam, zaleplon, eszopiclone, triazolam, zopiclone, flurazepam, zolpidem, oxazepam, estazolam, diphenhydramine, quazepam, tra-zodone, and ramelteon. Factors in the analysis include preclinical and clinical assessment of reinforcing effects, preclinical and clinical assessment of withdrawal, actual abuse, acute sedation/memory impairment, and overdose lethality. The analysis shows that both the likelihood of abuse and the toxicity vary from high to none across these compounds. The primary clinical implication of the range of differences in abuse liability is that concern about recreational abuse, inappropriate long-term use, or adverse effects should not deter physicians from prescribing hypnotics when clinically indicated.
Diazepam
Sedatives
Triazolam
Ramelteon
Adinazolam
Temazepam
Clonazepam
Valium advert
Benzodiazepine abuse
Diazepam v oxazepam
Lorazepam v alprazolam
Benzodiazepines ligands
Quazepam (Doral, Dormalin)
Benzodiazepine antagonists
Benzodiazepine dependence
'The Drug That Tames Tigers'
Sleep dysfunction and psychiatric illness

Antiemetic Drugs

2010-12-25T08:55:00.000-08:00

Types of Antiemetic Drugs
Antiemetics are drugs used to control nausea and vomiting. These drugs are taken before surgical operations, during bouts of sickness, or after feeling queasy and unwell. You can purchase over-the-counter (OTC) antiemetics from your local pharmacy or have them prescribed by your physician.
Bismuth Subsalicylate
1. This antiemetic can be purchases OTC under the name Pepto-Bismol or Kaopectate. It is used to treat nausea, vomiting and upset stomach. It can also be useful in treating diarrhea.
Antihistamines
2. These work by preventing motion sickness. They can be purchases OTC under the names dimenhydrinate (Dramamine) and meclizine hydrochloride (Dramamine Less Drowsy). These work better if taken before you get sick.
Promoethazine
3. This is a form of antihistamine used to treat motion sickness, allergy symptoms and effects of sedation. It is also known under the name phenergan and mepergan. It is given by your doctor as an intramuscular injection, or prescribed as a suppository or syrup.
Serotonin Receptor Antagonists
4. These drugs are used after an operation to control nausea and vomiting caused by anesthesia or pain medication. They are also used for patients undergoing chemotherapy.
Dronabinol
5. This antiemetic is also known under the name Marinol. It is used to stop anorexia in AIDS patients. Marinol is also used in cancer patients who have not responded to other forms of antiemetics.

Common Opioids

2010-12-25T08:53:00.000-08:00

Common Opioids

The locations of highly concentrated regions of opiate receptors in the body correspond well with the known effects of the drugs. Table 1 highlights the body regions with a high density of opiate receptors and the effects of activating these receptors. Opioids exert their most profound effects in specific regions of the body. Table 2 outlines the major effects of commonly used opioids.
Table 1
Location of Receptors
1. Substantia gelatinosa and
medial thalamus in brain
2. Brain Stem

3. Limbic system in
brain
4. Large Intestines Effects of Receptor Activation
Pain relief for dull, prolonged pain
(analgesia)
Cough suppression, respiratory
depression, pupil constriction
Euphoria

Constipation

Table 2

Opioid
1. Morphine

2. Codeine

3. Heroin

4. Hydromorphone

5. Oxydone

6. Fentanyl

7. Methadone

8. Naloxone
(not an opioid)
Description
Medically used for pain relief. Respiratory system
depressant. Naturally exists in opium. Activates mu
opiate receptors.
Medically used for pain relief and cough suppression.
Naturally exists in opium.
Semisynthetic drug illegally used (in the USA) for its
euphoric effect. No accepted medical uses.
Depresses respiratory system.
Semisynthetic. Used to suppress cough and reduce
diarrhea.
Semisynthetic. Medically used for pain relief, cough
suppression, and to treat diarrhea.
Synthetic. Very potent analgesic properties. Full
agonist at mu receptors. Used as an anesthetic during
surgery.
Synthetic. Weak, long lasting drug. Used to reduce
withdrawal symptoms of heroin addicts who are trying
to quit.
Semisynthetic. Strong antagonist at opiate receptors.
Used to reduce the effects of opioids and treat opioid
overdoses.

Common Antiseptics

2010-12-25T08:52:00.000-08:00

Common Antiseptics
There are different types of antiseptics available in the market which can be used and applied without a doctor's prescription. Antiseptics are used extensively in hospitals and other health care settings for a variety of topical and hard-surface applications. Even for general cleaning purposes, antiseptics are used. The basic purpose of using antiseptics is to prevent bacterial growth and infections. There are few antiseptics which have been in use for a long time. Their effectiveness is known and we are discussing these common antiseptics and their usages below:

Iodophors: Contains iodine in a complex form. This is relatively nonirritating and nontoxic. Effective against a broad range of microorganisms. Less irritating to the skin. Recommended for surgical scrub and is the best antiseptic for use in the genital area, vagina, and cervix. Iodophors are effective few minutes after application. Do not dilute them. Popular brand: Betadine.

Chlorhexidine Gluconate: Useful against a broad range of microorganisms, but the effect is minimum on tuberculosis and fungi. Remains effective for at least 6 hours after being applied. Has a good, persistent effect. If irritaion occurs, it can be reduced by hard water, creams, and natural soaps. This is also used for surgical scrub and skin prep, in the genital area, vagina, and cervix.

Iodine: This is a popular antiseptic used against a broad range of microorganisms. It acts fast but can cause skin irritation. It cannot be used for routine use in surgical scrub or on mucous membranes as it causes irritation. Because of this, when used for pre-procedure skin application, iodine must be allowed to dry and then removed from the skin using alcohol.

Alcohol: This is another popular antiseptic product. Effective against a broad range of microorganisms. It acts fast in killing microorganisms. Has a drying effect on skin and hence not recommended to be used on mucous membranes. Wash the skin before applying it. To be effective, it must dry completely. Alcohol can also be diluted for optimal killing of microorganisms.

PCMX (Para-chloro-meta-xylenol): This is fairly effective against most microorganisms. This antiseptic has a persistent effect over many hours but it is less effective than chlorhexidine and iodophors. Available in both antiseptic and disinfectant preparations. It should not be used on mucous membranes.

Hexachlorophene: Among the other antiseptics, this has the least effectiveness against most microorganisms. Has a good, persistent effect with repeated use. It is toxic to the nervous system. Occasional use cannot reduce the number of microorganisms on hands. If use of this antiseptic is discontinued after long-term use, there is chances of re-growth of bacteria, causing large-scale contamination. Not recommended for use in surgical scrub.Brand: pHisoHex.

Boric acid: Used in suppositories for treating vaginal yeast infections. Can be used in eyewashes, and as an antiviral to reduce the duration of cold sore attacks. Can be applied as creams for burns.

Hydrogen peroxide: Used to clean and deodorize wounds and ulcers. Can also be used in household first aid for scrapes, etc.

Benzalkonium Chloride:This is a mild antiseptic. Comes as a spray and in squirt-bottles. One of the most common antiseptic in over-the-counter f
irst aid preparations

CNS Stimulants

2010-12-25T08:51:00.000-08:00

CNS Stimulants

Stimulants (also called psychostimulants[1]) are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others. Due to their effects typically having an "up" quality to them, stimulants are also occasionally referred to as "uppers". Depressants or "downers", which decrease mental and/or physical function, are in stark contrast to stimulants and are considered to be their functional opposites. Stimulants are widely used throughout the world as prescription medicines and as illicit substances of recreational use or abuse.
Effects
Stimulants (Analeptics) produce a variety of different kinds of effects by enhancing the activity of the central and peripheral nervous systems. Common effects, which vary depending on the substance in question, may include enhanced alertness, awareness, wakefulness, endurance, productivity, and motivation, increased arousal, locomotion, heart rate, and blood pressure, and the perception of a diminished requirement for food and sleep. Many stimulants are also capable of improving mood and relieving anxiety, and some can even induce feelings of euphoria. It should be noted, however, that many of these drugs are also capable of causing anxiety,heart failure, even the ones that may paradoxically reduce it to a degree at the same time. Stimulants exert their effects through a number of different pharmacological mechanisms, the most prominent of which include facilitation of norepinephrine (noradrenaline) and/or dopamine activity (e.g., via monoamine transporter inhibition or reversal[2]), adenosine receptor antagonism, and nicotinic acetylcholine receptor agonism.
Indications: Stimulants are used both individually and clinically for therapeutic purposes in the treatment of a number of indications, including the following:
• To counteract lethargy and fatigue throughout the day while at work or while doing other activities.
• To reduce sleepiness and to keep the person awake when necessary, as well as to treat narcolepsy.
• To decrease appetite and promote weight loss, as well as to treat obesity.
• To improve concentration and focus while at work or school, especially for those with attentional disorders such as ADHD.
• Occasionally, they are also used to treat clinical depression.
Types
Caffeine
Caffeine is a mild stimulant compound that is found naturally in coffee, tea, and to a lesser degree, in cocoa or chocolate. It is included in many soft drinks, particularly energy drinks. Caffeine is the world's most widely used psychoactive drug and by far the most common stimulant. The vast majority (over 85%) of people in the United States consume caffeine on a daily basis. Few jurisdictions restrict its sale and use. Caffeine is also included in some medications, usually for the purpose of enhancing the effect of the primary ingredient, or reducing one of its side effects (especially drowsiness). Pure caffeine tablets are also widely available.
Nicotine
Nicotine is the active chemical constituent in tobacco, which is available in many forms, including cigarettes, cigars, chewing tobacco, and smoking cessation aids such as nicotine patches and nicotine gum. Nicotine is used widely throughout the world for its stimulating effects.
[edit] Amphetamines
Main article: Amphetamine
Main article: Methamphetamine

A chart comparing the chemical structures of different amphetamine derivatives
Amphetamines are a group of phenylethylamine stimulants such as amphetamine and methamphetamine. Like NDRIs, amphetamine increases the levels of norepinephrine and dopamine in the brain via reuptake inhibition; however, the more important mechanism by which amphetamines cause stimulation is through the direct release of these catecholamines from storage vesicles in cells. Amphetamines are known to cause elevated mood and euphoria as well as rebound depression and anxiety.[3]
Amphetamines are often used for their therapeutic effects; physicians occasionally prescribe amphetamines to treat major depression, where subjects do not respond well to tradition SSRI medications, and numerous studies have demonstrated the effectiveness of drugs such as Adderall in controlling symptoms associated with ADD/ADHD. In rare cases, ADD/ADHD patients who are not responding sufficiently to traditional amphetamines are prescribed Dextrorotary methamphetamine[citation needed]. Due to their availability and fast-acting effects, amphetamines are prime candidates for abuse [1].
MDMA ("Ecstasy")
Methylenedioxymethamphetamine (MDMA), known by its common street name "Ecstasy", is an illicit substance that typically comes in either tablet, capsule, or powder/crystal form. It had a medical application as a treatment for depression until 1985 when studies showed unrecoverable serotonin levels when used as daily prescription. After one year of use consisting of two tablets biweekly, the levels were stable. MDMA is said to be a cross between an amphetamine stimulant and a psychedelic hallucinogen. Notably, MDMA is also unique and very popular for its entactogenic properties. The stimulant effects of MDMA include hypertension, anorexia (appetite loss), euphoria, social disinhibition, insomnia (or enhanced wakefulness), improved energy, increased arousal, and increased perspiration, among others.
Cocaine
Cocaine is made from the leaves of the coca shrub, which grows in the mountain regions of South American countries such as Bolivia, Colombia, and Peru. In Europe, North America, and in some parts of Asia, the most common form of cocaine is a white crystalline powder. Cocaine is a stimulant but is not normally prescribed therapeutically for its stimulant properties, although it sees clinical use as a local anesthetic, particularly in ophthalmology. Most cocaine use is recreational and its abuse potential is high, and so its sale and possession are strictly controlled in most jurisdictions. Other tropane derivative drugs related to cocaine are also known such as troparil and lometopane but have not been widely sold or used recreationally.[4]
NRIs & NDRIs
These drugs inhibit the reuptake of norepinephrine and/or dopamine, resulting in increased extracellular levels and therefore enhanced neurotransmission, ultimately producing a stimulant effect. Many of these compounds are used as ADHD medications and antidepressants. The most well known NDRI is bupropion (Wellbutrin, Zyban), and the two most well known NRIs are atomoxetine (Strattera) and reboxetine (Edronax). Many of these drugs have a considerably lower abuse potential in comparison to other stimulants like the amphetamines and cocaine.
Modafinil, Adrafinil, and Armodafinil
Modafinil (Provigil/Alertec/Modavigil) is an analeptic drug approved by the (FDA) for the treatment of narcolepsy, shift work sleep disorder, and excessive daytime sleepiness associated with obstructive sleep apnea.
Modafinil, like other stimulants, increases the release of monoamines but also elevates hypothalamic histamine levels, leading some researchers to consider Modafinil a "wakefulness promoting agent" rather than a classic amphetamine-like stimulant.
Modafinil has been shown to be effective in the treatment of Attention-Deficit Hyperactivity Disorder (ADHD), depression, cocaine addiction, Parkinson's Disease, schizophrenia, shift workers' sleep disorder and disease-related fatigue.
Adrafinil is the prodrug of Modafinil, and is metabolized into it in about one hour, when taken on an empty stomach.
Armodafinil is a new version of Modafinil.
Ampakines
Recently, there have been improvements in the area of stimulant pharmacology, producing a class of chemicals known as ampakines, or eugeroics, (good arousal). These stimulants tend to increase alertness without the peripheral (body) effects or addiction/tolerance/abuse potential of the traditional stimulants. They have minimal effect on sleep structure, and do not cause rebound hypersomnolence or "come down" effects. Ampakines such as ampalex and CX717 have been developed but are still in clinical trials and have not yet been sold commercially. Another compound with similar effects to these drugs is carphedon, which is sold as a general stimulant in Russia under the brand name Phenotropil.
Yohimbine
Yohimbine is a psychoactive drug of the tryptamine chemical class with stimulant and aphrodisiac effects.
Abuse
Abuse of central nervous system stimulants is common. Addiction to CNS stimulants can quickly lead to medical, psychiatric and psychosocial deterioration. Drug tolerance, dependence, sensitisation as well as a withdrawal syndrome can occur.[5]
Testing
The presence of stimulants in the body may be tested by a variety of procedures. Serum and urine are the common sources of testing material although saliva is sometimes used. Commonly used tests include chromatography, immunologic assay and mass spectrometry.[6]

Aspirin:

2010-12-25T08:49:00.000-08:00

Aspirin:

Aspirin is one of the most commonly used drugs today for pain relief. It is a very well known analgesics, which has been in use since the 1890â€™s. The general name of Aspirin is acetylsalicylic acid. This drug was produced by Bayer in Germany. This medicine, a predominant pain killer, was the first nonsteroidal anti-inflammatory drug (NSAID) and still the most effective.
Uses of Aspirin
During the course of its application, it has been found that aspirin has a number of uses besides pain relief. Many studies have been carried out to test aspirin's abilities in various areas, including its side effects. Research is still going on in this wonder drug. Present uses of aspirin include:
• Over-the-counter pain relief. It is mainly used for headaches.
• Reduction of inflammation and swelling in injuries and athritis.
• Aspirin is also recommended to sufferers of heart attack, mini-stroke and unstable angina.
• Can reduce heart attack severity if taken at the very first sign.
• It is used to recover after cardiovascular surgery.
• Aspirin is also recommended for treatment of rheumatoid arthritis, osteoarthritis and other rheumatoid diseases.
Benefits of Aspirin
Research studies have shown the following possible benefits of Aspirin:
• Migraine treatment
• Improving gums circulation
• Combating ovarian, breast and colon cancer and reducing colorectal cancer repeating
• Cataracts prevention
• Controlling pre-eclampsia
• Improving memory and brain function
• Prevention of adult leukaemia, HIV replicating, prostrate cancer
• Increasing success rates of IVF programs

Who Cannot Use Aspirin?
Aspirin is not recommended for
• Children under 16
• Asthma Patients
• Pregnant Women
• Anyone under 20 with a fever
• Bleeding disorders patients
• Patients with persistent stomach problems
• Diabetic Patients
• Breastfeeding mothers
• Heavy alcohol drinkers
• Healthy people for more than 10 days
• G6P deficiency diseases
• People with liver or kidney disease
• People on low sodium diets
Side Effects of Aspirin
Like all medicines, there are some side effects associated with aspirin. Though most of them are acceptable risks for most patients, there are some severe risks attached which are given below:
• The use of aspirin in children and teenagers with a fever has led to the development of a potentially fatal condition called Reye Syndrome.
• Aspirin leads to nausea and vomiting in some patients. Hence it is better to take this with or just after food.
• Other side effects may be ringing in the ears, excessive bleeding, indigestion, heartburn and allergic reactions.
• Since the tablets are excreted via the kidneys, the medicine has the power to damage the kidneys and long term usage reduces renal function.

Note: So it is advisable to take aspirin under doctor's advise. Aspirin is effective when taken as directed and/or under medical supervision.

Anti-Inflammatory Drugs

2010-12-25T08:48:00.000-08:00

Anti-Inflammatory Drugs

Because most episodes of back pain have inflammation as a contributing factor, anti-inflammatory medication such as non-steroidal anti-inflammatory drugs (NSAIDs) is often an effective pain medication treatment option.
The types of NSAIDs reviewed on this page work like aspirin by limiting the formation of inflammation, but have fewer gastrointestinal side effects (such as gastritis or ulcers) than aspirin.
Most Common Types of NSAID’s
NSAIDs comprise a large class of drugs with many different options. In addition to aspirin, there are currently several types of both non-prescription (over-the-counter) NSAIDs and prescription brands of NSAIDs. The three types of NSAIDs most commonly used to treat many types of back pain and neck pain include:
• Ibuprofen (e.g. brand names Advil, Motrin, Nuprin)
• Naproxen (e.g. brand names Aleve, Naprosyn)
• COX-2 inhibitors (e.g. brand name Celebrex)
The type of NSAID recommended will usually depend on a number of factors, including the patient’s diagnosis, clinical situation and level of pain, individual risk factors, and the patient’s past experience with particular medications.
Ibuprofen (e.g. Advil, Motrin, Nuprin)
Ibuprofen was one of the original non-steroidal anti-inflammatory drugs and is available without a prescription. For patients with back problems, ibuprofen is most commonly recommended to relieve mild or moderate back pain, tenderness, inflammation, and stiffness. Common situations in which ibuprofen may be recommended include:
Article continues below
• Activity-related pain or discomfort (e.g. pain that follows sports, housework, shoveling snow, or other exertion)
• Pain related to muscle strain in the low back
• Neck stiffness related to muscle, ligament or tendon strains or damage
Ibuprofen does have some aspirin-like effects on the stomach, so people with active ulcers or sensitive stomachs should avoid ibuprofen. It is best to take ibuprofen with food to minimize the chance of stomach upset. Ibuprofen also has a mild blood thinning effect that lasts a few hours, and can reduce the effectiveness of some blood pressure medications and diuretics (water pills).
The typical recommended dose for ibuprofen is 400 mg taken every eight hours. Prescription doses can be as high as 800 mg of ibuprofen every eight hours.
Naproxen (e.g. Aleve, Naprosyn, Anaprox, Naprelan)
Naproxen is available in both non-prescription strength (e.g. brand name Aleve) and prescription strength (e.g. brand name Naprosyn). For patients with back pain, it works by reducing proteins that cause inflammation and pain in the body and is commonly recommended for treatment of back pain.
Naproxen thins the blood, so individuals taking oral blood thinners or anticoagulants should avoid naproxen, as excessive blood thinning may lead to bleeding. Naproxen also can have some adverse gastrointestinal side effects, so people with active ulcers or sensitive stomachs should avoid it. It is best to take naproxen with food to reduce the chance of upset stomach. Notably, naproxen has a potentially fatal interaction with MAOI drugs (e.g. Marplan, Nardil).
The usual adult dose is 250 to 500 mg twice daily using regular naproxen tablets.
COX-2 Inhibitors (e.g. Prescription Brand Celebrex)
This is a newer class of NSAID, which includes the brand name Celebrex. It works by stopping the chemical reaction that leads to inflammation in the body, but (unlike other NSAIDs) does not harm the chemical production of the protective stomach lining. Therefore, COX-2 inhibitors lead to a lower gastrointestinal complication rate than other NSAIDs and do not tend to produce ulcers.
Also unlike other NSAIDs, COX-2 inhibitors do not impair blood clotting, so they are considered safer for patients taking blood thinning medications, such as warfarin (e.g. Coumadin), and they may be used before or after surgery without an increased risk of bleeding.
Important new information from recent studies shows a potentially increased risk for cardiovascular events (such as heart attack and stroke) for COX-2 inhibitors, and the FDA has called for further research. Patients taking COX-2 inhibitors should meet with their physician to determine their individual risk factors for side effects and appropriate treatment options.
Other Forms of NSAID’s

In addition to the above, NSAID's come in forms other than taking it orally. For example:
• Toradol can be given as an intravenous drug, so it is useful after surgery or if the patient cannot eat.
• Flector can be given as a transcutaneous form of Diclofenac. An NSAID administered through an adhesive patch applied to the skin can be useful because it does not give the patient a large dose of the drug systematically, which can reduce gastrointestinal and other potential side effects of NSAIDs.
Effective Use of NSAIDs
It is better to use NSAIDs continuously to build up an anti-inflammatory blood level, and the efficacy is markedly lower if taken only when experiencing pain. Taking the drug regularly in the prescribed/recommended dose lets the drug build up over time in order to have an anti-inflammatory effect and allowing the area a better healing environment.
NSAIDs and the pain relief medication acetaminophen (e.g.
brand name Tylenol) work differently, so sometimes doctors recommend taking the two medications at the same time. Some people report feeling better pain relief when they take both an NSAID and acetaminophen for their pain.

Antihistamines:

2010-12-25T08:45:00.000-08:00

Antihistamines:

Over-the-counter (OTC) drugs are medicines you can buy without a doctor’s prescription. Antihistamines are used to relieve or prevent allergy symptoms. Two types of OTC antihistamines are available: first-generation and second-generation antihistamines. Both types can be useful for allergies. First-generation antihistamines are also sometimes used in OTC cold medicines.
First-Generation OTC Antihistamines
• Brompheniramine (one brand name: Dimetapp Cold and Allergy Elixir)
• Chlorpheniramine (one brand name: Chlor-Trimeton)
• Dimenhydrinate (one brand name: Dramamine)
• Diphenhydramine (two brand names: Benadryl Allergy, Nytol, Sominex)
• Doxylamine (two brand names: Vicks NyQuil, Alka-Seltzer Plus Night-Time Cold Medicine)

Second-Generation OTC Antihistamines
• Loratadine (two brand names: Alavert, Claritin)
• Cetirizine (one brand name: Zyrtec)

Note: Both types of antihistamines often are mixed with other drugs, such as pain relievers or decongestants. Many of the brand names above are for these combination medicines, which are meant to treat many symptoms at once. In general, it’s a good idea to treat just the symptoms that you have. For example, if you have only a runny nose, don’t choose a medicine that also treats headache and fever.
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Drug Recall Information
Sometimes certain medicines get taken off the market. This is called a drug recall. Generally drugs are recalled if they are unsafe for patients or if they cause serious side effects. Recently, McNeil Consumer Healthcare recalled 21 lots of its over-the-counter (OTC) medicines. Medicines recalled include certain Tylenol Extra Strength, Tylenol PM, Children's Tylenol Meltaways, Benadryl Allergy Ultratab Tablets and Motrin IB. View a complete list of the medicines that have been recalled.
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How do antihistamines work?
When your body is exposed to allergens, it releases histamines. Histamines attach to the cells in your body and cause them to swell and leak fluid. This can cause itching, sneezing, runny nose and watery eyes. Antihistamines prevent histamines from attaching to your cells and causing symptoms.

First-generation antihistamines also work in the part of the brain that controls nausea and vomiting. This is why they can help prevent motion sickness. Because one of the most common side effects of first-generation antihistamines is feeling sleepy, they are sometimes used to help people who have trouble sleeping (insomnia).
What are some common side effects of OTC antihistamines?
Healthy adults don’t usually experience side effects from antihistamines. However, side effects can be a concern for older adults or people who have health problems.

First-generation antihistamines can make you feel very sleepy. This can affect your ability to drive or operate machines. It can also make it hard for you to think clearly. Antihistamines can cause your mouth and eyes to feel dry. They can also cause abdominal pain and headaches. Second-generation antihistamines are much less likely to cause these side effects.
Could OTC antihistamines cause problems with any other medicines I take?
Antihistamines can interact with other drugs you take. If you take any of the following drugs, talk to your doctor before taking a first-generation antihistamine:
• Sleeping pills
• Sedatives
• Muscle relaxants
Antihistamines are often combined with decongestants and/or pain relievers. If you take one of these combination medicines, it’s important to understand each of the active ingredients and the interactions they may have with other medicines you’re taking.

Be sure not to take too much antihistamine. Many OTC cold and allergy medicines contain antihistamines, as do some prescription drugs. If you take more than one of these products, you may get much more antihistamine than you intend.

Second-generation antihistamines are less likely to interact with other medicines you are taking.
Who shouldn’t take antihistamines?
Talk to your doctor before using a first-generation antihistamine if you have any of the following health problems:
• Glaucoma
• Trouble urinating (from an enlarged prostate gland)
• Breathing problems, such as asthma, emphysema or chronic bronchitis
• Thyroid disease
• Heart disease
• High blood pressure
If you have kidney or liver disease, you should talk to your doctor before taking a second-generation antihistamine.

Antifungal Drugs

2010-12-25T08:44:00.000-08:00

Antifungal Drugs
Clotrimazole
Azole: a broad spectrum antifungal developed in 1967. It was one of the first azoles to be developed. Formulations are now generic in a number of countries. It is effective against Candida albicans and the dermatophytes. Its action is fungistatic or fungicidal, depending upon the concentration used. This azole drug is available in a variety of dosage forms...
Ciclopirox
Antifungal, topical. Ciclopirox olamine is a hydroxypyridone antifungal that is structurally unrelated to other antifungal agents. It was first introduced in 1975 and has been accepted and used in Europe for many years. It was approved by the FDA in 1982 for the treatment of superficial fungal infections...
Ketoconazole
Ketoconazole is an azole medication used to treat a broad spectrum of fungi It was originally developed in the late 1970's in the oral form and granted FDA acceptance in 1981. Shortly after the topical formulations were undergoing trials and proven effective. The 2% cream and 1% shampoo are now available over the counter...
Terbinafine Hydrochloride
Antifungal, allylamine -one of the first antifungals of the allylamine class, discovered in 1974. It was approved for systemic use in the UK in 1991, and for topical use in the USA in 1992. Terbinafine is an antifungal effective against Dermatophytes, Aspergillus sp., and Candida and Pityrosporum yeasts...
Itraconazole
Itraconazole is an antifungal azole. It is a synthetic triazole analogue with a wide spectrum of antifungal activity. It was first synthesized in 1980, and approved in Europe in 1987. It was approved by the FDA in 1992 for systemic mycoses, and then for onychomycoses in 1995, and for use by pulse therapy in 1997. In 2000, itraconazole was also approved to treat blastomycosis, histoplasmosis, and aspergellosis in patients intolerant of amphotericin B...
Fluconazole
Fluconazole is an antifungal azole. It is a broad spectrum antifungal, first approved in Europe in 1988 and then in America in 1990. It was the first single dose treatment approved for vaginal candidiasis. Fluconazole is an effective agent in the treatment and prophylaxis of Candidal infection...

Antidepressant

2010-12-25T08:42:00.000-08:00

Antidepressant Medications for Depression

In-depth look at antidepressants, medications for depression. How antidepressant drugs work, types of antidepressants, interactions, more.
Antidepressants are medicines used to help people who have depression. With the help of these depression medications, most people can achieve No Iframes significant recovery from depression.
Antidepressant drugs are not happy pills, and they are not a panacea. They are prescription-only drugs that come with risks as well as benefits, and should only ever be taken under a doctor's supervision. They are, however, one depression treatment option. Taking medications for depression is not a sign of personal weakness - and there is good evidence that they do help.
Whether antidepressant medication is the best treatment option depends on how severe the person's depression is, their history of illness, their age (psychological treatments are usually the first choice for children and adolescents), and their personal preferences. Most people do best with a combination of medications for depression and therapy.
For adults with severe depression, says psychiatrist, Petros Markou, M.D., there is strong evidence that antidepressants are more effective than any other treatment. If depression is mild or moderate, psychotherapy alone may be sufficient, though even in this case, short-term antidepressant drug treatment or herbal therapy can help people get to the point where they can engage in therapy and get some exercise (which is also thought to help improve mood).
"How do I get better? Well, certainly, for me in recent years it has been through antidepressant drug therapy - mainly in the beginning, because I think it's very hard to get into all that positive thinking and raise your self esteem and all those things that you're supposed to do, if your mood is so low you can't even think at all. So to take anti-depressants, and most of them are very good, they do help me to shift the mood and then work on other therapies, and work with other people that know how I feel, and all of those things that will, I know, in the end make me feel better and put that Black Dog at bay."

Leonie Manns, Depression Sufferer
How Antidepressants Work
Most antidepressants are believed to work by slowing the removal of certain chemicals from the brain. These chemicals are called neurotransmitters (such as serotonin and norepinephrine). Neurotransmitters are needed for normal brain function and are involved in the control of mood and in other responses and functions, such as eating, sleep, pain, and thinking.
Antidepressants help people with depression by making these natural chemicals more available to the brain. By restoring the brain's chemical balance, antidepressants help relieve the symptoms of depression.
Specifically, antidepressant drugs help reduce the extreme sadness, hopelessness, and lack of interest in life that are typical in people with depression. These drugs also may be used to treat other conditions, such as obsessive compulsive disorder, premenstrual syndrome, chronic pain, and eating disorders.
Typically, antidepressants are taken for 4 to 6 months. In some cases, however, patients and their doctors may decide that antidepressants are needed for a longer time.
Types of Antidepressants
There are many different kinds of antidepressants, including:
• Selective serotonin reuptake inhibitors (SSRIs)
• Tricyclic antidepressants (tricyclics)
• Others
Like most medicines, antidepressant drugs can cause side effects. Not all people get these side effects. Any side effects you have will depend on the medicine your doctor has chosen for you. Your doctor should talk to you about your medicine.
SSRI Antidepressants
SSRIs are a group of antidepressants that includes drugs such as escitalopram (brand name: Lexapro) citalopram (brand name: Celexa), fluoxetine (brand name: Prozac), paroxetine (brand name: Paxil) and sertraline (brand name: Zoloft). Selective serotonin reuptake inhibitors act only on the neurotransmitter serotonin, while tricyclic antidepressants and MAO inhibitors act on both serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body.
Selective serotonin reuptake inhibitors have fewer side effects than tricyclic antidepressants and MAO inhibitors, perhaps because selective serotonin reuptake inhibitors act only on one body chemical, serotonin. Some of the side effects that can be caused by SSRIs include dry mouth, nausea, nervousness, insomnia, headache and sexual problems. People taking fluoxetine might also have a feeling of being unable to sit still. People taking paroxetine might feel tired. People taking sertraline might have runny stools and diarrhea.
Tricyclic Antidepressants
The tricyclics have been used to treat depression for a long time. They act on both serotonin and another neurotransmitter, norepinephrine, and may also interact with other chemicals throughout the body. They include amitriptyline (brand name: Elavil), desipramine (brand name: Norpramin), imipramine (brand name: Tofranil) and nortriptyline (brand names: Aventyl, Pamelor). Common side effects caused by these medicines include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. These antidepressants can also affect a person's blood pressure and heart rate.
Other Antidepressants
Other antidepressants exist that have different ways of working than the SSRIs and tricylics. Commonly used ones are venlafaxine, nefazadone, bupropion, mirtazapine and trazodone. Less commonly used are the monoamine oxidase inhibitors (MAOIs).
Some of the most common side effects in people taking venlafaxine (brand name: Effexor) include nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased blood pressure, increased heart rate and increased cholesterol levels can also occur.
Nefazodone (brand name: Serzone) can give people headaches, blurred vision, dizziness, nausea, constipation, dry mouth and tiredness. No Iframes
Bupropion (brand name: Wellbutrin) can cause agitation, insomnia, headache and nausea. Mirtazapine (brand name: Remeron) can cause sedation, increased appetite, weight gain, dizziness, dry mouth and constipation. Some of the most common side effects of trazodone (brand name: Desyrel) are sedation, dry mouth and nausea. MAOI antidepressants like phenelzine (brand name: Nardil) and tranylcypromine (brand name: Parnate) commonly cause weakness, dizziness, headaches and tremor.
Important Warning When Taking Antidepressants
The U.S. Food and Drug Administration (FDA) ordered makers of all antidepressant medications to include a "black box warning" (the most serious warning) on their products' labeling to include warnings about increased risks of suicidal thinking and behavior, known as suicidality, in children, adolescents and young adults (ages 18 to 24) during initial treatment (generally the first one to two months).
IMPORTANT SAFETY INFORMATION – Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Antidepressants increased the risk of suicidality (suicidal thinking and behavior) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of antidepressants in children, adolescents or young adults must balance the risk to clinical need. Patients of all ages started on antidepressant therapy should be closely monitored and observed for clinical worsening, suicidality or unusual changes in behavior, especially at the beginning of therapy or at the time of dose changes. This risk may persist until significant remission occurs. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Lexapro is not approved for use in pediatric patients.
Interactions of Antidepressants
Antidepressants Can Affect Other Medications You May Be Taking
Antidepressants can have an effect on many other medicines. If you're going to take an antidepressant, tell your doctor about all the other medicines you take, including over-the-counter medicines and herbal health products (such as St. John's wort). Ask your doctor and pharmacist if any of your regular medicines can cause problems when combined with an antidepressant. When taken together, some medicines can cause serious problems.
Taking an MAOI antidepressant at the same time as any other antidepressants or certain over-the-counter medicines for colds and flu can cause a dangerous reaction. Your doctor will tell you what foods and alcoholic beverages you should avoid while you are taking an MAOI. You should not take an MAOI unless you clearly understand what medications and foods to avoid. If you are taking a MAOI and your doctor wants you to start taking one of the other antidepressants, he or she will have you stop taking the MAOI for a while before you start the new medicine. This gives the MAOI time to clear out of your body.
Another risk of antidepressants is serotonin syndrome, a drug reaction resulting from the over-stimulation of serotonin receptors. This can occur when an antidepressant is taken either with another antidepressant, with certain recreational and other drugs (see below), or more rarely, even when one antidepressant is taken alone. Symptoms include hyperactivity, mental confusion, agitation, shivering, sweating, fever, lack of coordination, seizure, and diarrhoea.
To minimise the risk of serotonin syndrome, there must be a 'washout' period of at least two weeks when switching from one antidepressant drug to another.
Drugs that may induce serotonin syndrome when taken with antidepressants (not a complete list)
• ecstasy
• cocaine
• lithium
• St John's wort (Hypericum) - herbal antidepressant
• diethylproprion - an amphetamine
• dextromethorphan - found in many cough suppressants
• Buspar (buspirone) - for anxiety
• Selgene, Eldepryl (selegiline) - for Parkinson's Disease
• anti-epileptics - Tegretol, Carbium, Teril (carbamazepine)
• analgesics - pethidine, Fortral (pentazocine), Tramal (tramadol), fentanyl
• anti-migraine drugs - Naramig (naratriptan), Imigran (sumatriptan), Zomig (zolmitriptan)
• appetite suppressants - phentermine and fenfluramine
• tryptophan - an amino acid
Which Antidepressant Drug Is Best For Me?
Because the neurotransmitters involved in the control of moods are also involved in other processes, such as sleep, eating, and pain, drugs that affect these neurotransmitters can be used for more than just treating depression. Headache, eating disorders, bed-wetting, and other problems are now being treated with antidepressants.
All antidepressant drugs are effective, but certain types work best for certain kinds of depression. For example, people who are depressed and agitated do best when they take an antidepressant drug that also calms them down. People who are depressed and withdrawn may benefit more from an antidepressant drug that has a stimulating effect.
Antidepressants Are Not A Magic Bullet
While antidepressant drugs help people feel better, they cannot solve problems in people's lives. Some mental health professionals worry that people who could benefit from psychotherapy rely instead on antidepressant drugs for a "quick fix." Others point out that the drugs work gradually and do not produce instant happiness. The best approach is often a combination of counseling and medicine, but the correct treatment for a specific patient depends on many factors. The decision of how to treat depression or other conditions that may respond to antidepressant drugs should be made carefully and will be different for different people.

Antiarrhythmic Drugs

2010-12-25T08:40:00.000-08:00

Antiarrhythmic Drugs
Arrhythmias or dysrhythmias are abnormal heart rhythms. Arrhythmias cause the heart to pump less effectively. Tachycardia is the medical term for a heartbeat that's too fast. Bradycardia is the term for a heartbeat that's too slow. Ventricular fibrillation is a severe cardiac arrhythmia that can result in sudden cardiac death. It's a rapid, uncontrolled contraction of the left ventricle (pumping chamber of the heart).
Some of the major types of commonly prescribed cardiovascular medications are summarized in this section. For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking; however, the AHA is not recommending or endorsing any specific products. If your prescription medication isn't on this list, remember that your healthcare provider and pharmacist are your best sources of information. It's important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects. Never stop taking a medication and never change your dose or frequency without first consulting your doctor.

Drugs used to treat cardiac arrhythmias include:
Class I — Sodium channel blockers
Disopyramide (Norpace®)
Flecainide (TambocorTM)
Lidocaine (Xylocaine®)
Lidocaine (Xylocaine®)
Mexiletine (Mexitel®)
Moricizine (Ethmozine®)
Procainamide (Procan®, Procanabid®, Pronestyl®)
Propafenone (Rythmol®)
Quinidine (Cardioquin®, Quinaglute Dura-Tabs®, Quinidex Extentabs®, Quinora®)
Tocainide (Tonocard®)

Class II — Beta blockers
Acebutolol (Sectral®)
Atenolol (Tenormin®)
Betaxolol (Kerlone®)
Bisoprolol (Zebeta®)
Carvedilol (Coreg®)
Esmolol (Brevibloc®)
Metoprolol (Toprol-XL®, Lopressor®)
Nadolol (Corgard®)
Propranolol (Inderal®)
Sotalol (Betapace®, Betapace AF®, Sorine®)
Timolol (Blocadren®)
Class III — Potassium channel blockers
Amiodarone (Cordarone®, Pacerone®)
Azimilide (StedicorTM)
Bepridil (Vascor®)
Dofetilide (Tikosyn®)
Ibutilide (Corvert®)
Tedisamil (Pulsium®)
Class IV — Calcium channel blockers
Diltiazem (Cardizem®, Tiazac®, Cartia XT®, Dilacor XR®, Diltia XT®)
Verapamil (Calan®, Covera-HS®, Isoptin® SR, Verelan®)
Miscellaneous
Adenosine (Adenocard®, Adenoscan®)
Digoxin (Lanoxin®, Digitek®)

Anti TB drugs

2010-12-25T08:38:00.000-08:00

Anti TB drugs:
TB is treated with a combination of medications along with isoniazid. Rifampin (Rifadin), ethambutol (Myambutol), and pyrazinamide are the drugs commonly used to treat active TB in conjunction with isoniazid (INH). Four drugs are often taken for the first two months of therapy to help kill any potentially resistant strains of bacteria. Then the number is usually reduced to two drugs for the remainder of the treatment based on drug sensitivity testing that is usually available by this time in the course. Streptomycin, a drug that is given by injection, may be used as well, particularly when the disease is extensive and/or the patients do not take their oral medications reliably (termed "poor compliance"). Treatment usually lasts for many months and sometimes for years. Successful treatment of TB is dependent largely on the compliance of the patient. Indeed, the failure of a patient to take the medications as prescribed is the most important cause of failure to cure the TB infection. In some locations, the health department demands direct monitoring of patient compliance with therapy.
Surgery on the lungs may be indicated to help cure TB when medication has failed, but in this day and age, surgery for TB is unusual. Treatment with appropriate antibiotics will usually cure the TB. Without treatment, however, tuberculosis can be a lethal infection. Therefore, early diagnosis is important. Those individuals who have been exposed to a person with TB, or suspect that they have been, should be examined by a doctor for signs of TB and screened with a TB skin test.

Anesthesia Drugs

2010-12-25T08:37:00.000-08:00

Anesthesia Drugs

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
Abstract
The obstetrician-gynecologist is often solely responsible for analgesia/sedation and regional blocks during office-based and outpatient procedures. The American Society of Anesthesiologists guidelines for the provision of analgesia/sedation for nonanesthesiologists provide helpful recommendations to maximize patient safety during office-based and outpatient procedures. This article provides a review of the fundamentals of sedation/analgesia, monitored anesthesia care, and local anesthetics.
Key words: Sedation/analgesia, Monitored anesthesia care, Lipid rescue, Local anesthetic toxicity, Maximum dose recommendations
• Other Sections▼
o Abstract
o Sedation/Analgesia and MAC
o Regional Blocks and Topical Anesthesia
o Conclusion

Analgesic techniques for obstetric and gynecologic patients include local infiltration and regional blocks with or without sedation, parenteral agents and neuraxial blockade during labor, and general anesthesia for more extensive surgeries and, occasionally, for cesarean deliveries. Although the American College of Obstetricians and Gynecologists (ACOG) and the American Society of Anesthesiologists (ASA) have established goals to ensure prompt provision of anesthetic services in all hospitals providing obstetric care, ensuring such services remains a challenge, particularly in smaller hospitals or in rural locations.1 As a result, anesthesia expertise may not be available for routine labor management and, rarely, during emergency cesarean deliveries. In addition, the obstetrician-gynecologist (ob-gyn) is often solely or primarily responsible (in conjunction with nursing staff) for analgesia and sedation during office-based or outpatient procedures. This article provides a review of the fundamentals of sedation/analgesia, monitored anesthesia care (MAC), and local anesthetics.
Sedation/Analgesia and MAC
Sedation/analgesia and MAC, as distinguished by the depth of sedation attained and the level of expertise of the individual administering and monitoring the sedation, are the anesthetic techniques of choice, alone or in combination with regional blocks, for a number of outpatient and office-based obstetric and gynecologic procedures. As such, a review of ASA recommendations for the provision of sedation/analgesia by nonanesthesiologists, as well as a summary of the mechanisms, physiologic effects, dosing regimens, and peculiar characteristics of the anesthetic drugs most commonly used during intravenous (IV) sedation and MAC procedures, is in order.
In 2002, the ASA updated its recommendations for various aspects of sedation/analgesia, including preprocedure patient evaluation, monitoring, training of personnel involved, and recovery care.2 In addition to defining the various levels of sedation/analgesia (Table 1), the guideline task force underscores that the provider must be prepared to rescue patients in the event of drug-induced respiratory depression, airway obstruction, and/or cardiovascular collapse. Beyond preoperative evaluation with strict attention to airway concerns (Table 2), coexisting diseases, and nil per os status (Table 3), such preparedness involves vigilant monitoring of the patient’s response to verbal and painful stimuli, detection of hypoxia with pulse oximetry, observation and auscultation of ventilatory function with or without exhaled carbon dioxide detectors, blood pressure measurements at regular intervals, and electrocar-diographic monitoring, if indicated by the level of sedation or the patient’s cardiovascular risk factors. Supplemental oxygen, per face mask or nasal cannula, should also be provided, particularly at deeper levels of sedation. Another integral aspect of preparedness is availability of emergency airway and resuscitation equipment, as well as personnel trained in cardiopulmonary resuscitation (CPR). Often a chin-lift maneuver and/or stimulation, placement of an oral or nasal airway, or ventilation using positive pressure by face mask suffices if the patient develops airway obstruction or loses respiratory drive temporarily. However, more advanced airway protection and CPR are critically important skills, as is working knowledge of the drugs commonly administered.
Propofol
Propofol, a substituted isopropyl-phenol that increases inhibitory γ-aminobutyric acid activity, is a commonly used IV sedative-hypnotic that features a rapid onset, swift redistribution, and a relatively benign side-effect profile. Although it provides no clinically significant analgesia, propofol has antiemetic, antipruritic, and anticonvulsant properties, and effectively temporizes emergence delirium.3
Propofol produces rapid and profound decreases in consciousness that can culminate rapidly in a state of general anesthesia. At doses of 1.5 to 2.5 mg/kg IV, it induces unconsciousness within roughly 30 seconds. Doses vary dramatically, but conscious sedation can be achieved with 25 to 100 μg/kg/min. Alternatively, small intermittent boluses, titrated to effect, or administration of 0.7 mg/kg with 3-minute lockout periods are effective regimens for IV conscious sedation.4 Recovery from propofol should occur within minutes, and is generally marked by a sense of well-being.
At sedative doses of propofol, the provider should anticipate decreases in systemic blood pressure and dose-related depression of ventilation, with little to no decrease in heart rate. However, bradycardia and asystole, refractory to anticholinergics and possibly associated with decreased sympathetic activity, have been reported with propofol.5 Dose-dependent depression of ventilation, exacerbated by concomitant administration of benzodiazepines or opioids, occurs with both sedative and induction doses of propofol. As a result, supplemental oxygen should always be used during its administration. Further, clinicians well versed not only in propofol administration, but also in emergency equipment and rescue procedures should be prepared to intervene.
Propofol is a water-insoluble drug that is suspended in soybean oil and egg lecithin to create an aqueous solution. The preparation burns on injection, supports bacterial growth, and, rarely, can cause anaphylactic reactions in patients with multiple drug and/or food sensitivities.6 Selection of larger veins, prior administration of IV lidocaine, and slow administration with a generous crystalloid infusion may serve to minimize the undesirable burning sensation commonly experienced upon injection of propofol. It is recommended that unused propofol from an open vial be discarded within 6 hours.
Midazolam
Midazolam, a water-soluble benzodiazepine, is commonly used in combination with other agents for its anxiolytic, amnestic, and hypnotic properties during conscious sedation/MAC and during procedures under local or regional blocks. In contrast to diazepam, midazolam has a steep dose-response curve that necessitates careful titration to avoid oversedation, boasts a short elimination half-life of roughly 1 to 4 hours, has clinically inactive metabolites, and is painless upon injection.7 Further, it decreases analgesic requirements and diminishes agitation without cardiovascular depression. However, significant respiratory depression, particularly when used in combination with opioids, and postoperative psychomotor and cognitive impairment warrant caution during its administration. Marked variability in dose-response among patients, with the elderly particularly sensitive, is also common with midazolam. Flumazenil, a benzodiazepine antagonist, reverses midazolam’s sedative and amnestic effects, but its short duration (45–90 minutes) leads to concerns for resedation (Table 4). With regard to the obstetric population, midazolam crosses the placenta, enters fetal circulation, and may contribute to neonatal depression. A disadvantage with midazolam premedication for cesarean delivery is the potential for maternal amnesia.
Midazolam 2 mg IV administered prior to propofol sedation has proven to decrease intraoperative anxiety, recall, and discomfort without prolonging recovery from propofol.8 Patients who take benzodiazepines on a regular basis may require a higher initial dose and more frequent redosing vis-à-vis the benzodiazepine-naive patient, although the potential for respiratory impairment must be considered. Midazolam in combination with opioids leads to a marked synergistic effect that clinically decreases the dose of each required for hypnosis and analgesia and also increases the likelihood of life-threatening complications, such as hypoxemia and apnea.9 Midazolam’s duration of sedation is roughly 15 to 80 minutes, although time to complete recovery may be significantly longer.10
Fentanyl
Fentanyl, an opioid, is a common component of conscious sedation/MAC on account of its profound, short-lived analgesia and its synergistic reduction in sedative dose requirements. Compared with morphine, fentanyl is highly lipid soluble and boasts a more rapid onset, a roughly 100-fold greater potency, and a shorter duration of action. Unlike morphine, fentanyl is not associated with histamine release and, alone, seldom produces hypotension.
Low doses of fentanyl (1–2 μg/kg IV) exert a peak effect within 5 minutes and provide effective analgesia for roughly 30 minutes. Fentanyl may be redosed in 25- to 50-μg increments during conscious sedation procedures, keeping in mind that the effect-site equilibration time may be prolonged and that the concomitant administration of sedatives reduces analgesic requirements. Although fentanyl swiftly redistributes to inactive tissues, prolonged infusions or frequent redosing may lead to saturation of inactive sites and significant prolongation of action, including adverse effects.
Analgesic doses of fentanyl only minimally impact the cardiovascular system. However, bradycardia, which can result in decreases in blood pressure and cardiac output, is more common at higher doses and with concomitant administration of sedatives, such as benzodiazepines. Fentanyl causes dose-related respiratory depression, which is also more pronounced when administered in combination with sedatives. Naloxone is a pure opioid antagonist that reverses the effects of fentanyl and other opioids. Titrated in 0.04 mg IV increments every 2 to 3 minutes, naloxone can effectively reverse pruritus, nausea, respiratory depression, and other adverse opioid effects without altering analgesia. However, naloxone should be used with caution, as it may acutely reverse analgesia, precipitate withdrawal syndrome, and cause hypertension, pulmonary edema, and arrhythmias. Renarcotization may occur, requiring redosing every 30 minutes.
Remifentanil
Remifentanil, another opioid, can provide an appropriate analgesic complement to local, regional, and MAC cases due to its rapid onset and reliably rapid offset. Specifically, its effect-site equilibration time is 1 to 1.5 minutes, facilitating titration to patient comfort. Further, unlike other opioids used in clinical practice today, remifentanil is metabolized primarily by nonspecific esterases, ensuring rapid offset and minimal to no accumulation during prolonged infusions. This predictable onset and clearance reduces the risk of respiratory depression and renders remifentanil well suited for outpatient procedures. However, administration by experienced providers and vigilant monitoring of remifentanil’s inherent, potent respiratory depressant effect is paramount.11 Concomitant administration of other agents, such as midazolam, may lead to a synergistic respiratory depressant effect.
During conscious sedation and MAC, remifentanil is often administered in conjunction with propofol or midazolam via continuous infusion, at doses ranging from 0.05 to 0.25 μg/kg/min. A single slow bolus of 1 μg/kg over 30 to 60 seconds prior to a specific, short-lived stimulus, such as a regional block, has been shown to be effective, albeit not without risk of respiratory depression.12 Because the analgesic effect of remifentanil is short lived at 6 to 10 minutes, it alone is not appropriate for procedures in which postoperative pain is expected.
Ketamine
A phencyclidine derivative with inhibitory activity at the N-methyl D-aspartate receptors, among several other target receptors, ketamine is frequently used for pediatric and adult sedation, as an analgesic complement to neuraxial and general anesthesia, as an induction and maintenance agent, and for postoperative pain relief. For sedation/analgesia purposes, ketamine provides profound analgesia, albeit for somatic more than visceral pain, and amnesia without depressing ventilatory function. It also stimulates release of endogenous catecholamines and increases sympathetic nervous system outflow, thereby increasing heart rate, arterial blood pressure, and cardiac output, as well as myocardial oxygen demand. However, in patients with imminent cardiovascular collapse and limited catecholamine reserves, ketamine may cause direct myocardial depression. Although ketamine generally preserves respiratory function and causes marked bronchodilation, it stimulates copious secretions and may predispose patients to laryngospasm.
Ketamine causes a dissociative, cataleptic-like state, marked by lack of communication and a nystagmic gaze, which may make it difficult to discern depth of sedation and which may contribute to profound emergence delirium. Vigilance and preparedness to rescue a patient from cardiorespiratory collapse is therefore required during ketamine sedation, particularly in the presence of other sedatives. Finally, ketamine causes an increase in cerebral blood flow and, at least theoretically, intraocular pressure, so caution must be used when selecting the appropriate patient population for ketamine sedation.
Ketamine is available in a racemic form, although the S (+) isomer, with fewer untoward effects and far greater potency, is commonly used outside the United States. Intense analgesia at subanesthetic doses of 0.2 to 0.5 mg/kg IV occurs within 1 minute of administration and lasts approximately 20 to 60 minutes. Infusions of 10 to 100 μg/kg/min or intermittent boluses of one-third to one-half of the initial dose, titrated to effect, are effective maintenance regimens.
Dexmedetomidine
Dexmedetomidine, a highly specific α2-agonist, has gained popularity as an adjuvant to general anesthesia, a sedative for awake intubations and similar conscious sedation procedures, the sole anesthetic agent for certain surgical procedures, and as a postoperative sedative in intensive care units. An agent with anxiolytic, sedative, hypnotic, and analgesic properties, dexmedetomidine shows particular promise also for its limited impact on the respiratory system and for its stable and predictable hemodynamic effects, namely a reduction in both heart rate and blood pressure. The initial hemodynamic response to the loading dose, however, is often marked by a transient increase in blood pressure. The decrease in heart rate that ensues may be marked, requiring swift dose adjustment and/or anticholinergic treatment. Vigilance to patient monitoring must be maintained also to avoid airway obstruction related to a deeper-than-anticipated level of sedation. Atipamezole, a selective α2-adrenoceptor antagonist, rapidly reverses the sedative and cardiovascular effects of dexmedetomidine, although it is not routinely readily available.
Dexmedetomidine is generally administered via a loading dose of 0.5 to 1 μg/kg IV over 10 to 20 minutes, followed by an infusion of 0.2 to 0.7 μg/kg/h. It is available in 2-mL vials containing 100 μg/mL and requires careful dilution prior to administration.
Regional Blocks and Topical Anesthesia
Several obstetric and gynecologic procedures are currently performed under regional nerve block or with topical local infiltration, including cervical cerclage, dilatation and evacuation, and perineal infiltration, among others. As such, an intimate understanding of the mechanism, pharmacology, dosing, and toxicity of local anesthetics is indispensable for the patient provider.
Local anesthetics in use today fall into 2 broad categories, esters and amides (Table 5). Esters, which include cocaine, procaine, chloroprocaine, and tetracaine, among others, are metabolized by the enzyme pseudocholinesterase (aka, plasma cholinesterase), whereas amides, including lidocaine, mepivacaine, bupivacaine, prilocaine, and ropivacaine undergo hepatic metabolism. Levobupivacaine, the less cardiotoxic S-enantiomer of bupivacaine, has been withdrawn from the US market. Amides and their metabolites linger longer than esters, whereas clinically relevant esters are predictably and rapidly metabolized, except in the rare case of pseudocholinesterase deficiency.
Local anesthetics are often categorized by onset, potency, and duration. Onset is determined primarily by pKa, whereas potency is related to lipid solubility and duration is associated with protein binding. The addition of sodium bicarbonate in a ratio 1 mL to 10 mL of local anesthetic, which effectively increases the pH of the local anesthetic to approximate its pKa, speeds onset by roughly 3 to 5 minutes.13 With regard to potency of commonly used local anesthetics, lidocaine, mepivacaine, and chloroprocaine are considered intermediate in potency; ropivacaine and bupivacaine are highly potent.14 Chloroprocaine is of short duration; lidocaine and mepivacaine are moderate in duration; and bupivacaine has a long duration of action.
Toxicity of local anesthetics ranges from the rare allergic reaction to central nervous system (CNS) derangements and cardiotoxicity. Allergic reactions to esters can be traced to the metabolite para-aminobenzoic acid, whereas allergic reactions to amides may be due to the preservatives present in multiuse vials that are structurally similar to para-aminobenzoic acid. These rare reactions manifest as rash, urticaria, laryngeal edema, and, in extreme cases, bronchospasm and hypotension, and must be distinguished from tachycardia and hemodynamic changes associated with inadvertent intravascular injection of epinephrine-containing local anesthetics. Cross-sensitivity between esters and amides does not occur in the absence of a common metabolite or preservative, namely para-aminobenzoic acid.
Systemic toxicity from local anesthetics results from excessive plasma concentration in the blood, most often due to inadvertent intravascular injection during a nerve block. Less often, systemic absorption from the injection site culminates in toxicity. Site of injection, including vascularity of the area, dose injected, properties of local anesthetic administered, and the presence or absence of epinephrine affect the degree of systemic absorption. In descending order, the areas of highest plasma concentration from absorption include intercostal, caudal, paracervical, epidural, brachial plexus, and sciatic/femoral. The addition of epinephrine in a concentration of 5 μg/mL (1:200,000) serves to diminish this systemic absorption via vasoconstriction and has the additional benefits of decreasing blood loss and prolonging the duration of action of local anesthetics. However, it is not recommended in patients with uncontrolled hypertension, arrhythmias, or cardiovascular disease, for parturients with suspected uteroplacental insufficiency, or for administration in highly vascular areas where high systemic absorption is likely.
With regard to epinephrine, 1:200,000 means 1 g per 200,000 mL; as there are 1,000,000 μg in 1 g, 1:200,000 is equivalent to 5 μg/mL.15 Also note that epinephrine comes in different packages of 1:1000 (ie, 1 mg/mL) and 1:10,000 (ie, 0.1 mg/mL). Alternatively, it is available premixed with local anesthetic, usually in the 5 μg/mL concentration. Similarly, packaging and concentrations vary among local anesthetics. Care must be taken to review the concentration before administration and to confirm concentration in milligrams per milliliter. For example, 2% lidocaine contains 20 mg/mL, and 1.5% lidocaine contains 15 mg/mL.
Early signs of systemic toxicity range from lightheadedness, dizziness, circumoral numbness, tinnitus, slurred speech, and restlessness. Over-activity of the CNS, as manifested by twitches, tremors, and, often, tonicclonic seizures, marks the more advanced stages of neurotoxicity. Global CNS depression, culminating in unconsciousness and respiratory arrest, ultimately develops. Acidosis, hypercarbia, and hypoxia both predispose to and exacerbate CNS toxicity. Although the cardiovascular system is more resistant to local anesthetic toxicity than the CNS, at high plasma concentrations profound hypotension, dysrhythmias, and conduction blockade of the cardiac sodium channels occur. Bupivacaine, with its high lipid solubility, is particularly worrisome with regard to cardiotoxicity, reflecting its high affinity for and its slow dissociation from cardiac sodium channels, among other protein receptors. In addition, bupivacaine-induced cardiotoxicity appears highly refractory to resuscitation efforts. However, cardiotoxicity is not limited to bupivacaine, as demonstrated by case reports of adverse cardiac events with the administration of etidocaine and, rarely, mepivacaine, lidocaine, and ropivacaine, among others. Pregnancy,16 the concomitant administration of epinephrine and phenylephrine, coexisting cardiac disease, and tachycardia may lower the threshold for bupivacaine-induced cardiotoxicity. Treatment of CNS and cardiotoxicity requires immediate attention to airway, oxygenation, and ventilation and early commencement of cardiopulmonary resuscitation, as well as the timely administration of a benzodiazepine, such as midazolam, or thiopental, a barbiturate, for seizure control.
Over the past decade, a series of case reports have demonstrated the successful treatment of refractory local anesthetic-induced toxicity with IV lipid emulsion.17 Although the timing, dose, and exact mechanism are not yet agreed upon, multiple case reports have demonstrated that the administration of a loading dose of a 20% lipid emulsion (1-1.5 mg/kg IV), followed by a 0.25 mL/kg/min infusion, may serve to bind the excess lipid-soluble local anesthetics in the bloodstream. Standard therapy and cardiopulmonary resuscitation are to be continued throughout.
Although systemic reactions to local anesthetics cannot be avoided completely, several recommendations may aid in the reduction of the incidence of adverse outcomes. Limiting the total dose of local anesthetic administered, frequent negative aspirations for intravascular injection, divided dosing, and an epinephrine test dose may serve to minimize complications.18 With regard to maximum total dose, current recommendations are not evidence based, and the practitioner must take into account the site of injection, the presence or absence of epinephrine, and patient-specific factors that may influence the pharmacokinetics of the local anesthetic, including pregnancy, age, and coexisting disease.19 Although current recommendations vary from country to country and among manufacturers, broadly accepted maximum doses, applicable to systemic absorption, may serve to complement clinical acumen .
Conclusion
The gynecologist/obstetrician is often solely or primarily responsible (in conjunction with nursing staff) for analgesia/sedation and regional blocks during office-based and outpatient procedures. ASA guidelines for the provision of analgesia/sedation for nonanesthesiologists, reviewed in this article, provide helpful recommendations to maximize patient safety during office-based and outpatient procedures. A working knowledge of the drugs commonly used, including hypnotics, sedatives, analgesics, and local anesthetics, and preparedness to rescue a patient in the event of apnea, cardiovascular collapse, or local anesthetic-induced toxicity, are additional indispensable tools.

Neuroleptic Drugs

2010-12-25T08:35:00.000-08:00

Neuroleptic Drugs
The agents inflicted upon Alexandria are known by a variety of designations, including major tranquilizers, antipsychotics, and neuroleptics. These words are synonyms. The original ones, including Thorazine and Mellaril, are called phenothiazines, and sometimes that term is used too loosely to designate the entire group. In psychiatry, the term neuroleptic is now preferred. Neuroleptic was coined by jean Delay and Pierre Deniker, who first used the drug in psychiatry, and means "attaching to the neuron." Delay and Deniker intended the term to underscore the toxic impact of the drug on nerve cells (see chapter 4).
List of Neuroleptics
The public identifies most psychiatric drugs by their trade names-the proprietary trademarks under which the companies own and market them. With generic names in parentheses, a list of trade names of neuroleptics in use today includes Haldol (haloperidol), Thorazine (chlorpromazine), Stelazine (trifluoperazine), Vesprin (trifluopromazine), Mellaril (thiorldazine), Prolixin or Permitil (fluphenazine), Navane (thiothixene), Trilafon (perphenazine), Tindal (acetophenazine), Taractan (chlorprothixene), Loxitane or Daxolin (loxapine), Moban or Lidone (molindone), Serenfil (mesoridazine), Orap (pimozide), Quide (piperacetazine), Repoise (butaperazine), Compazine (prochlorperazine), Dartal (thiopropazate), and Clozaril (clozapine).(1)
The antidepressant Asendin (amoxapine) turns into a neuroleptic when it is metabolized in the body and should be considered a neuroleptic. Etrafon or Triavil is a combination of a neuroleptic (perphenazine) and an antidepressant (amitriptyline), and it combines the impact and the risks of both.
The neuroleptics are the most frequently prescribed drugs in mental hospitals, and they are widely used as well in board-and-care homes, nursing homes, institutions for people with mental retardation, children's facilities, and prisons. They also are given to millions of patients in public clinics and to hundreds of thousands in private psychiatric offices. Too often they are prescribed for anxiety, sleep problems, and other difficulties in a manner that runs contrary to the usual recommendations. And too often they are administered to children with behavior problems, even children who are living at home and going to school.
The Numbers of Patients Treated
No one knows the total numbers of neuroleptic drugs taken by patients each year, but estimates are possible. While the overall number of beds in state hospitals is down, annual admissions are up from the 1950s, and most of the several hundred thousand patients admitted each year are diagnosed as schizophrenic. Nearly all of these are prescribed neuroleptics. Hundreds of thousands more are getting them through outpatient clinics. Well over a million people a year are treated with neuroleptics on the wards and in the clinics of state mental health systems.
Additional millions more are receiving neuroleptics or antipsychotics through sources outside the state mental hospital system and long-term clinics. Of the estimated two million patients in nursing homes, many of them are on neuroleptics. Add to these patients the tens of thousands being treated with these drugs in private psychiatric hospitals, and in the psychiatric and medical wards of general hospitals, plus the tens of thousands in institutions for people with retardation, the untold thousands in board-and-care homes, still more in prisons, and hundreds of thousands in private practice-and the total swells to many millions. Even homeless people in shelters are sometimes forced to take them.
The National Prescription Audit provided by the FDA reported twentyone million prescriptions for neuroleptics in 1984. These figures are drawn from retail pharmacies and therefore do not include patients in institutions or patients dispensed medications directly from clinics. Of course, many patients obtain more than one prescription a year, but the figures suiz2est that at least several million individuals are obtaining neuroleptics rrom retail pharmacies each year.
That huge numbers of people are treated with neuroleptics is confirmed by the figures occasionally released by the pharmaceutical companies. The first neuroleptic was chlorpromazine, whose trade name is Thorazine. In a 1964 publication entitled Ten Years'Experience with Thorazine, the manufacturer, Smith Kline and French, estimated that fifty million patients had been prescribed chlorpromazine in the first decade of use (1954 to 1964). The figure probably was worldwide. In recent years, haloperidol, sold by McNeil Pharmaceutical under the trade name Haldol, has become the most prescribed neuroleptic. In a letter to attorney Roy A. Cohen dated August 13, 1987, McNeil's director of medical services, Anthony C. Santopolo, provided a glimpse at Haldol's escalating use. The figures for patients first treated with Haldol grew from 600,000 in 1976 to 1,200,000 in 1981.(2)
Overall, the estimate I made in my 1983 medical book, Psychiatric Drugs, of five to ten million persons per year in America being treated with neuroleptics probably remains valid today. The sheer size of these numbers should motivate us to learn everything we can about the impact of these agents on the brain and the mind.
The Clinical Impact of the Neuroleptics
Textbooks of psychiatry and review articles claim that the neuroleptics have a specific antipsychotic effect, especially on the so-called positive symptoms of schizophrenia, such as hallucinations and delusions, marked incoherence, and repeatedly bizarre or disorganized behavior.
Meanwhile, very little is written in professional sources about the apathy, disinterest, and other lobotomylike effects of the drugs. Review articles tend to give no hint that the medications are actually stupefying the patients and that life on a typical mental hospital ward is listless at best. And so we must turn to the earliest research reports on the drugs. The pioneers, eager to show the potency of their new discovery, were far more candid and graphic in describing the effects to doctors as yet unfamiliar with them.
The Nature of Lobotomy - To grasp what the pioneers said about the neuroleptic effect, it's important first to understand the lobotomy effect to which it is compared. This link contains the history and description of the surgical lobotomy.
The Birth of Chemical Lobotomy - Reports from the Drug Pioneers & How Neuroleptics Produce Lobotomy - In 1952, the first shot in the "revolution in psychiatry" was fired in Paris by the two pioneers Delay and Deniker. They published their findings on chlorpromazine (Thorazine) in French in Congres des Medecins Alienistes et Neurologistes de France. Read the straightforward description of the apathy and lack of initiative typical of lobotomy.
The neuroleptics also are used in tranquilizer darts for subduing wild animals and in injections to permit the handling of domestic animals who become vicious. The veterinary use of neuroleptics so undermines the antipsychotic theory that young psychiatrists are not taught about it.(3)
The Fundamental Principle of Psychiatric Treatment
The brain-disabling principle applies to all of the most potent psychiatric treatments-neuroleptics, antidepressants, lithium, electroshock, and psychosurgery. The principle states that all of the major psychiatric treatments exert their primary or intended effect by disabling normal brain function. Neuroleptic lobotomy, for example, is not a side effect, but the sought-after clinical effect. It reflects impairment of normal brain function.
Conversely, none of the major psychiatric interventions correct or improve existing brain dysfunction, such as any presumed biochemical imbalance. If the patient happens to suffer from brain dysfunction, then the psychiatric drug, electroshock, or psychosurgery will worsen or compound it.
If relatively, low doses produce no apparent brain dysfunction, the medication may be having no effect or producing a placebo effect. Or, as frequently happens, the patient is unaware of the impact even though it may be significant. Anyone familiar with the behavior of people drinking alcohol knows how easily a slightly intoxicated person may deny being impaired or even claim to be improved. Most people coming off cigarettes become abruptly aware of missing the sedative and tranquilizing effects that previously were taken for granted.
Iatrogenic (Treatment-Caused) Helplessness
Brain dysfunction, such as a chemical or surgical lobotomy syndrome, renders people much less able to appreciate or evaluate their mental condition. Surgically lobotomized people often deny both their brain damage and their personal problems. They will loudly declare, "I'm fine, never been better," when they can no longer think straight. Sometimes they deny that they have been operated on, despite the dime-size burr holes in their skulls palpable beneath their scalp. Superficially, the denial looks so sincere that prolobotomists cite it to justify the harmlessness of the treatment.
Even without the production of brain dysfunction, the giving of drugs or other physical interventions tends to reinforce the doctor's role as an authority and the patient's role as a helpless sick person. The patient learns that he or she has a "disease," that the doctor has a "treatment," and that the patient must "listen to the doctor" in order to "get well again." The patient's learned helplessness and submissiveness is then vastly amplified by the brain damage. The patient becomes more dutiful to the doctor and to the demoralizing principles of biopsychiatry. Denial can become a way of life, fixed in place by brain damage.
Suggestion and authoritarianism are common enough in the practice of medicine but only in psychiatry does the physician actually damage the individual's brain in order to facilitate control over him or her. I have designated this unique combination of authoritarian suggestion and brain damage by the term iatrogenic helplessness. Iatrogenic helplessness is key to understanding how the ma'or psychiatric treatments work .
There is little or no reason to anticipate a physical treatment in psychiatry that will control severely disturbed or upset people without doing equally severe harm to them. If psychosurgery, electroshock, or the more potent psychiatric drugs were refined to the point of harmlessness, they would approach uselessness. In biopsychiatry, unfortunately, it's the damage that does the trick.
Clarifying a Confusing Point
Whether or not some psychiatric patients have brain diseases is irrelevant to the brain-disabling principle of psychiatric treatment. Even if someday a subtle defect is found in the brains of some mental patients, it will not change the damaging impact of the current treatments in use. Nor will it change the fact that the current treatments worsen brain function rather than improving it. If, for example, a patient's emotional upset is caused by a hormonal problem, by a viral inflammation, or by ingestion of a hallucinogenic drug, the impact of the neuroleptics is still that of a lobotomy. The person now has his or her original brain damage and dysfunction plus a chemical lobotomy.
Claims for Curing Specific Schizophrenic Symptoms
But what about claims that the treatments reduce psychiatric symptoms, such as so-called hallucinations and delusions? Gerald Klerman was the major figure in transforming the image of the neuroleptics from nonspecific flattening agent to antipsychotic medication. Klerman was an avid advocate of biopsychiatry from early in his career and went on to become director of NIMH. Klerman's research findings were published in various places, including Alberto DiMascio and Richard Shader's 1970 compendium The Clinical Handbook of Psychopharmacology.
Klerman found that the four most improved "symptoms," in descending order, were combativeness, hyperactivity, tension, and hostility. In short, the drugs subdue and control people. Hallucinations and delusions the cardinal symptoms of schizophrenia - ran a poor fifth and sixth.(4)
Since drugged patients become much less communicative, sometimes nearly mute, it's not surprising that they say less about their hallucinations and delusions. Had the investigators paid attention, they would have noticed that the patients also said less about their religious and political convictions as well as about their favorite hobby or sport. There's no wild cheering for the home team on the typical psychiatric ward. Furthermore, the drugs cause so much discomfort (see chapter 4) that patients often stop saying what they believe to avoid getting larger doses and to bring a more speedy end to the treatment. As many ex-patients have told me, "I learned right away I'd better shut up or I'd get more of that stuff." What's astonishing is that despite investigator bias and the global inhibition produced by the drugs, communications labeled hallucinations and delusions continued to be recorded.
Klerman vociferously claimed that his research confirmed an antipsychotic effect, and few, if any, people bothered to check his data.
They Who Are Different from Us
After I described the lobotomizing effect of the neuroleptics during a 1989 debate with an internationally known psychiatrist, the opposing doctor admitted that he himself had taken "one small dose of neuroleptic" and then experienced an overwhelming and unbearable sense of "depression" and "disinterest." But he went on to say that his patients, because of their "abnormal brains," underwent no such lobotomy effect. Unlike normal people, the patients supposedly felt better because the drug "harmonized" their biochemical abnormalities. This was not the first time I'd heard this argument made by a psychiatrist.
The outrage expressed by ex-patients in the audience contradicted his assertions about the harmlessness of the medications. So does the clinical literature cited in this and the next chapter.
What does it say about professionals when they argue that their patients are so different from themselves? Biopsychiatry lives by the principle that its patients are so different from other humans that almost anything can be done to them, including surgical, electrical, and chemical lobotomy. By contrast, the ethical helping person assumes that those seeking help possess the same human sensitivities as anyone else, including the therapist.
Drugs and Adjustment
Life in a mental hospital is so inhibited, constrained, and suppressed that patients might seem better adjusted when heavily drugged. As already noted in chapter 2, D. L. Rosenhan describes in the January 19, 1973, Science that even the most highly regarded mental hospitals are humiliating and oppressive places, even for normal volunteers masquerading as patients. Typical state hospitals, where many drug studies are conducted, are intimidating and frightfully violent. In Erving Goffman's phrase, these "total institutions" also stigmatize and demean their inmates. His analysis in Asylums (1961) helps us understand why a drugged patient would seem better adjusted than a drug-free person in such a setting; the chemically lobotomized patient fits better into the social role of mental patient, with its obedience to authority, conformity, lack of dignity, acceptance of mundane routines, and restricted opportunities for self-expression. Similarly, books and stories by former patients in all kinds of psychiatric facilities almost always describe them as wholly suppressive and demoralizing.(5) To say that patients behave better in a mental hospital when they are drugged is more a commentary on the requirements of being an inmate than on the allegedly beneficial qualities of drugs.
Unfortunately, the patient may face an equally suppressive life situation after discharge from the hospital. Board-and-care homes and nursing homes are at least as boring and stifling as psychiatric hospitals. Often they offer nothing but a bed, a TV, and perhaps a local park bench. Again, it is no surprise that patients might seem to adjust better to them when drugged. Indeed, most drug-free people would want to take flight rather than to waste away in a facility that offers nothing in the way of rehabilitation, recreation, or social life.
Nor is life necessarily less stultifying when the patient returns home to his or her family. As we saw in chapter 2, the families of children labeled schizophrenic are, at their best, unable to relate to their overwhelmed offspring. At their worst they are outright abusive. Typically the parents are overinvolved and unrelentingly critical of their son or daughter. Again, it's no surprise that drugged offspring might seem better adjusted to life in these families, while drug-free ones might continue to be resentful, rebellious, and difficult to control.
Drug experts and psychiatric textbooks that tout neuroleptics almost never concern themselves with the living conditions to which they are asking or forcing the drugged patient to adjust.

Hypoglacemic grugs

2010-12-25T08:34:00.000-08:00

NON-INSULIN DRUGS TO LOWER BLOOD GLUCOSE
Over the past few years more and more medications have become available to help control blood glucose.

I discuss insulin options here.

On this page I first list the available classes of non-insulin medications, their main pros and cons, then I discuss the approach to selecting the "best" medicine:

Sulfonylureas
These drugs work by stimulating the pancreas to make insulin.

Here's what's good about sulfonylureas:
• They are very effective at bringing down elevated blood glucose levels.
• They're inexpensive.
Here's what's bad about sulfonylureas:
• They lose their effectiveness faster than most other classes of blood-glucose lowering medicine. Therefore, within a few years of taking this type of medicine it won't be of much benefit to you.
• They tend to cause weight gain.
• They not uncommonly cause episodes of hypoglycemia. (This is especially true of glyburide, hence glyburide is, for most people, not as good a sulfonylurea to use as the other types.)
These are the most commonly used types of sulfonylureas:
• Gliclazide
• Glimepiride
• Glyburide (also known as glibenclamide)

Metformin
Metformin isn't actually the name of the class - the class is called biguanides - but since metformin is the only drug in the class I'm taking a small liberty here.

Metformin works primarily by reducing how much glucose the liver releases.

Here's what's good about metformin:
• It is quite effective at bringing down elevated blood glucose levels.
• It does not cause weight gain.
• There is some evidence that it may reduce the risk of heart attack (or maybe even some types of cancer).
• For women with certain types of infertility (particularly PCOS), it may improve fertility.
• It's inexpensive
Here's what's bad about metformin:
• It can cause nausea, abdominal cramps, and diarrhea. (This, however, is not usually a problem if the dose is started low and only slowly increased.).
• It should not be used if you have advanced kidney failure.
Metformin is considered the best initial medication to treat type 2 diabetes in almost all cases. (The one most significant exception being if your blood gluocse is extraordinarily elevated in which case you should be immediately placed on insulin.)

Glinides
These drugs work by stimulating the pancreas to make insulin.

Here's what's good about glinides:
• They are reasonably effective at bringing down elevated blood glucose levels.
Here's what's bad about glinides:
• They are not as powerful as many other medications.
• They need to be taken before each meal.
• They can cause hypoglycemia.
These are the two available glinides:
• Repaglinide (GlucoNorm)
• Nateglinide (Starlix)

Alpha-glucosidase Inhibitors
These drugs work by slowing down absorption of glucose from the intestine.

Here's what's good about alpha-glucosidase inhibitors:
• They don't cause hypoglycemia.
• They are very safe with serious side-effects being almost unheard of.
Here's what's bad about alpha-glucosidase inhibitors:
• They tend to cause lots of flatulence. (Less of a problem if started in a low dose and only gradually increased.)
• They are not very potent at lowering blood glucose levels.
The most commonly used alpha-glucosidease inhibitor is acarbose (GlucoBay).

Thiazolidinediones (TZDs)
These drugs work primarily by increasing the amount of glucose taken up by muscle and fat cells.

Here's what's good about TZDs:
• They are quite effective at bringing down elevated blood glucose levels.
• They tend not to lose their effectiveness as quickly as most other medications used to lower blood glucose.
Here's what's bad about TZDs:
• They cause weight gain.
• They increase the risk of heart failure.
• They increase the risk of osteoporosis.
• Depending on the particular TZD, they may adversely affect your cholesterol levels.
These are the two available TZDs:
• Pioglitazone
• Rosiglitazone
Because of the risk of adverse effects of TZDs - and in particular, the perceived risks of rosiglitazone - TZDs are being used less and less often.

DPP-4 Inhibitors
These drugs work by stimulating the pancreas to make insulin and reducing how much glucose the liver releases.

Here's what's good about DPP-4 inhibitors:
• Data available so far suggests these drugs seldom have adverse effects and are remarkably safe.
• They do not cause weight gain.
• They do not cause hypoglycemia.
Here's what's bad about DPP-4 inhibitors:
• They are not as potent as a number of other available drugs
These are the available DPP-4 inhibitors:
• Saxagliptin (Onglyza)
• Sitaliptin (Januvia)
• Vildagliptin (this one is not available in Canada)

GLP-1 Analogues
These drugs work by stimulating the pancreas to make insulin, reducing how much glucose the liver makes, slowing down how quickly the stomach empties food into the intestine, and by reducing appetite.

Here's what's good about GLP-1 analogues:
• They are very effective at reducing blood glucose levels.
• They lead to weight loss in most people.
Here's what's bad about GLP-1 analogues:
• They often cause nausea and vomiting. (But this tends to go away within a few weeks if you can put up with it until then.)
• They are expensive (up to $300 per month in Canada).
• They are given by injection.
These are the available GLP-1 analogues:
• Liraglutide (Victoza)
• Exenatide (Byetta) - this is not available in Canada

Another type of drug called pramlintide (Symlin) is available in some countries, but not in Canada. It is given by injection and is used in certain people with diabetes who are also taking insulin therapy.

Selecting The "Best" Medicine To Lower Your Blood Glucose
What is the "best" medicine to lower your blood glucose? Heck, beats me. Why? Well, because there is no "best" medicine. What is best for you may be entirely different from what's best for your neighbour or your cousin or...

Basically, you, in parnership with your health care team, need to look at your specific situation and make a collective decisiion as to what the best choice is for you as an individual. Having said that, there are guidelines written by diabetes associations to help health care providers in their decision-making. These guidelines are typically distilled down to an algorithm, or series of steps which can be followed. The Canadian Diabetes Association algorithm appropriately obliges health care providers to look at the characteristics of each particular class of drug when making decisions, rather than being a "thou shalt do this" approach. Here is the CDA algorithm
As you can see, lifestyle therapy is in the forefront of therapy.
For most people with newly diagnosed type 2 diabetes who require blood glucose-lowering medication, metformin is the best initial choice. Insulin, however, is preferred if your blood glucose levels are exceptionally high; especially if you are unwell from your high blood glucose.

If despite lifestyle and metformin therapy your blood glucose levels are still above target, then you will need additional blood glucose-lowering medication. The various choices are listed in the preceding algorithm (except for GLP-1 analogue therapy as this was not yet available in Canada when the table was designed) with some of their main advantages and disadvantages.

If after a few months your blood glucose readings are still above target then you will need additional medication.

One of the single greatest shortcomings in treating elevated blood glucose in people living with type 2 diabetes is undue delay in adding aditional blood glucose-lowering medications. You and your health care team should be striving for you to achieve target blood glucose control within 6 to 12 months of your diagnosis.

HYPERLIPIDEMIA Drugs

2010-12-25T08:31:00.000-08:00

HYPERLIPIDEMIA Drugs

Simvastatin is a cholesterol-lowering drug. Your doctor may prescribe Simvastatin in addition to a cholesterol-lowering diet if your blood cholesterol level is too high, and if you have been unable to lower it by diet alone. In people with high cholesterol and heart disease, Simvastatin reduces the risk of heart attack, stroke and "mini-stroke" (transient ischemic attack) and can stave off the need for bypass surgery or angioplasty to clear clogged arteries.

You can find an extensive list of recent scientific research abstracts about ZOCOR here

MEVACOR (generic name: Lovastatin)

Lovastatin is used to reduce the amounts of LDL (bad) cholesterol and total cholesterol in your blood. These actions are important in the prevention of heart disease and hardening of th

Diuretic Drugs

2010-12-25T08:30:00.000-08:00

Diuretic Drugs
A class of drugs, named diuretic drugs is used to get rid of excess water in the body. Know more on diuretic drugs, their types, uses etc, in this article.

Diuresis is a condition in which body loses water through excess urination. Diabetes mellitus is a disease which causes diuresis. However, there are certain other diseases in which the fluid retention in body becomes a problem. In such cases, body must lose excess water and fluid content. Losing of water is recommended in cases of hypertension, congestive heart failure, kidney diseases etc. Diuretic drugs or 'water pills' are mainly used for the purpose of elimination of water from the body. Diuretic drugs prevent the reabsorption of certain substances like sodium, chlorine, so that these substances are eliminated along with excess water.

Types of Diuretic Drugs
Different diuretic drugs have different working mechanism. Some diuretic drugs impede the kidney's ability to absorb sodium, which leads to loss of sodium through the urine. However, water is required to eliminate sodium from the body, hence loss of sodium also results in loss of water. This types of diuretic drugs are known as high ceiling diuretics or loop diuretic drugs. The second category of diuretic drugs, known as thiazide diuretics wok by eliminating sodium, as well as chlorine, along with lots of water. Potassium sparing diuretics are the type of diuretic drugs which block the exchange of sodium for potassium. Due to this mechanism, some amount of potassium is retained, hence the name.

Uses of Diuretic Drugs
Diuretic drugs may be recommended as a single acting drug or in combination with other diuretic drugs. Although, the purpose of all diuretics is same, that is expulsion of water from body, the choice of diuretic is greatly influenced by the underlying medical disorder. For instance, patients suffering from congestive heart failure are often prescribed loop diuretics. The reason is that loop diuretics are very powerful and offer maximum water loss. The reduction of fluid in blood, reduces pressure on the heart, so that its efficiency of pumping blood is increased. However, these drugs do little to lower blood pressure. In that case, thiazide diuretics are more effective hypertension medications. They bring about the loss of sodium, chlorine and water which helps in lowering of blood pressure. Thus, thiazide are the most recommended diuretic drugs for hypertension. Potassium sparing diuretics are helpful for congestive heart failure patients. However, these drugs are to be given in combination with loop diuretics and thiazide diuretics.

Diuretic Drugs List
The most popular diuretic drugs names include-
• Loop Diuretics: Bumetanide (Bumex) and Furosemide (Lasix)
• Thiazide Diuretics: Hydrochlorothiazide (HydroDIURIL, Esidrix), Chlorothiazide (Diuril) and Chlorthalidone (Hygroton).
• Potassium Sparing Diuretics: Amiloride (Midamor) and Triamterene (Dyrenium).
• Combination Diuretics: Dyazide and Maxzide (combination of Thiazide Diuretic Hydrochlorothiazide and Potassium sparing Diuretic Triamterene).
Side Effects of Diuretic Drugs
The most obvious side effect of diuretic drugs is frequent urination. The loss of electrolytes such as sodium, chlorine results in electrolyte imbalance in the body. It also results in extreme weakness, fatigue, dehydration, excessive thirst etc. Blurred vision, confusion are some other side effects of diuretic drugs. Other diuretics side effects include fever, sore throat, cough, ringing in the ears, unusual bleeding or bruising, rapid and excessive weight loss etc. In rare cases, skin rash may develop. Loss of potassium may result in loss of appetite, nausea, vomiting or muscle cramps. In certain rare cases, potassium sparing diuretics may induce breast enlargement in men and women alike. Irregular menses, excess growth of hair are some other side effects of potassium sparing diuretics.

Diuretic drugs should be strictly taken under the guidance of a medical practitioner only. Your body may take a little while to get used to these drugs. If you experience any of the above side effects, call your doctor right away.

Common Antibiotics

2010-12-25T08:28:00.000-08:00

Common Antibiotics

Penicillin Group. Penicillin G, the most popularly used antibiotic because it is the cheapest, safest, and most effective antibacterial treatments available. Although penicillins are extremely safe, patients can occasionally develop an immune reaction to them and become allergic. In such cases the availability of alternative antibiotics is critical.
• Penicillin G and V remain the drugs of choice for treating many gram-positive bacterial infections. Penicillin G and V are used to treat infections caused by gram-positive Staphylococcus pyogenes (strep throat), and Streptococcus pneumoniae (respiratory tract infections). These are also used to treat the sexually transmitted diseases gonorrhea and syphilis. Penicillin V is similar in its activity to penicillin G, but because it is not destroyed by stomach acid it is a better drug for oral dose.
Methicillin was the first penicillin to have activity against the staphylococcus strains that were resistant to penicillin G.
• Ampicillin and amoxycillin are similar antibiotics with a broader spectrum of activity than earlier penicillins, it is active against common gram-negative bacteria as well as gram positive bacteria. But they are not active against penicillin G-resistant staphylococci. Both are effective on oral administration and are active against the gram-negative bacterium Escherichia coli (a common cause of urinary tract infections), Haemophilus influenzae (an important cause of ear infections and meningitis in infants), and Salmonella typhi (responsible for typhoid fever).
• Carbenicillin was the first penicillin synthesized to possess useful activity against Pseudomonas aeruginosa. This bacterium is normally only responsible for infections in hospitalized patients and had proved particularly difficult to treat.
Cephalosporin Group - injectable forms of this group are generally broad-spectrum, bactericidal agents that are restricted to hospital use for the treatment of serious infections.
Tetracycline Group - are broad-spectrum antibiotics that have been used to treat a wide range of infections, are orally active, and are bacteriostatic. It is used in the treatment of gonorrhea (caused by Neisseria gonorrhea) and urinary tract infections caused by Escherichia coli. Drugs belonging to this group can cause pigmentation of the teeth in childre

Beta lactum antibiotics are chemicals that contain the 4-membered beta lactum ring. They are produced by the fungus molds Penicillium and Cephalosporium. These antibiotics inhibit the last step in the bacterium's cell wall synthesis. Beta lactum antibiotics are useful against Gram-positive bacteria. Around 300-500 people die each year from an allergy to a beta lactum antibiotic. There are several kinds of beta lactum antibiotic:
• Natural Penicillins are produced by fermentation of the fungus Penicillium notatum chrysogenum. They include Pencillin G and Penicillin V. They will kill streptococcus, gonococcus and staphylococcus. They are usually not effective against Gram-negative rod-shaped bacteria.
• Cephalolsporins are similar to penicillins and are made from a species of Cephalosporium. They are used as penicillin substitutes, and in surgical prophylaxis.
Semisynthetic penicillins were first used in 1959. A mold produces the main part of the molecule, which is then altered chemically. These antibiotics are usually constructed to have certain advantages over natural penicillins. Sometimes, chavulanic acid is added to a synthetic penicillin to extend the life of the drug. Here are some types of semisynthetic penicillin:
• Amoxycillin and Ampicillin are useful not only on Gram-positive bacteria, but also on some Gram-negative bacteria.
• Clavamox, also called augmentin, is prepared by adding chavulanic acid to amoxycillin. Clavulanic acid is made from Streptomyces clavuligerus.
Bacitracin is an antibiotic produced by a Bacillus species. It prevents the growth of the cell wall. Because of its high toxicity, it is not systemically used. It is used in topic antibiotics, and to sterilize the bowel before surgery, since it is not absorbed by the digestive tract.
Polymyxin is an antibiotic produced by Bacillus polymyxis. It works by inhibiting cell membrane growth. It is rather toxic to humans, so is therefore usually used only as a topical antibiotic. Occasionally, it is used to treat urinary tract infections, however it must be used under close hospital supervision, for it will easily damage the kidney and other organs.
Tetracyclines are a family of eight antibiotics, all products of Sptromyces. Some of these can now be produced synthetically. Tetracyclines block protein synthesis on isolated ribosomes. It concentrates in certain types of ribosomes possesed only by bacteria, so it is not toxic to the animal. Because of their extremely low toxicity, they were overused in the medical community, and now there is widespread resistance to tetracyclines. However, they are still useful in treatment of some diseases, such as Lyme disease. Some examples of tetracyclines are:
• Tetracycline
• Chlortetracycline
• Doxycycline is a semisynthetic tetracycline.
Chloramphenicol is produced by Streptomyces venezuelae. It works by inhibiting translation during protein synthesis. It is effective against both Gram-positive and Gram-negative bacteria. It is currently produced by chemical synthesis. Chloramphenicol causes aplastic anemia in a small percentage of patients, and ever since that was discovered, chloramphenicol has been used very little in non life-threatening situitions.
Macrolides are produced by Streptomyces erythreus. Their chemical structures contain large lactone rings linked through glycoside bonds with amino sugars. Macrolides are inhibitors of protein synthesis. They are effective against Gram-positive bacteria and most Gram-negative bacteria, Neissera, Legionella, and Haemophilus, but not Enterobacteriaceae. The most important macrolides are:
• Erythromycin
• Oleandomycin
Aminoglycosides are products of Spectromyces griseus. They are protein synthesis inhibitors binding to bacterial ribosomes to prevent the initiation of protein synthesis. They can be used against a wide variety of both Gram-positive and Gram-negative bacteria. Aminoglycoside usage has been limited because prolonged use has been found to cause kidney damage and injury to the auditory nerves, leading to deafness. Some examples of Aminoglycosides are:
• Streptomycin has its primary use for treating tuberculosis patients.
• Gentamicin is used against many strains of Grma-positive and Gram-negative bacteria, including Pseudomonas aeruginosa
• Kanamycin is a complex of three different antibiotics. It is effective against many gram-positive bacteria, including penicillin-resistant staphlococci, even at low concentrations.
• Tombramycin, along with gentamicin, are the principal antibiotics used for treatments against Pseudomonas infections.
Nalidixic acid is a synthetic chemotheraputic agent effective against Gram-negative bacteria. It binds to DNA gyrase enzyme (topoisomerase) and inhibits DNA duplication. It is a member of a group of compounds called the quinolones. It is mainly used in the treatment of urinary tract infections, and will kill several types of Gram-negative bacteria such as E. coli, Enterobacteriaceae aerogenes, K. pneumoniae, and Proteus species, which are common causes of urinary tract infections. It is not effective against Pseudomonas aeruginosa, and Gram-positive bacteria are usually resistant.
Rifamycins are produced by Streptomyces mediterranei. They inhibit transcription in eubacterial RNA polymerase. A synthetic derivative of rifamycin is:
• Rifampicin is active against Gram-positive and Gram-negative bacteria. It is often used against Mycobacterium tuberculosis. It has a greater effect on the bacteria that causes tuberculosis than most other antibiotics. It has replaced isoniazid as the front-line drug to treat tuberculosis, especially where isoniazid resistance is present. It is also used to meningitis, caused by Neisseria meningitidis. It can be taken orally.
Sulfonamides were introduced in 1935 by Domagk. He discovered that these chemicals could cure mice with beta-hemolytic Streptococci infections. Sulfonamides are derived from the compound sulfanilamide. They are effective against Streptococcus pneumoniae, beta-hemolytic streptococci, and E. coli. The sulfonamides are used in treatment for urinary tract infections caused by E. coli and in treatment of meningococcal meningitis. Some examples of sulfonamides are:
• Prontosil
• Gantrisin
• Trimethoprim
Isoniazid (INH) is primarily used in the treatment of tuberculosis. It works by inhibiting synthesis of mycolic acid. It is usually given together with rifampicin. It prevents the growth of bacteria resistant to rifampicin.
Paraaminosalicylic acid (PAS), is a chemotheraputic agent once used as the primary agent in tuberculosis treatment. Paraaminosalicylic acid is an anti-folate. It is used only as a secondary anti-tuberculosis agent, having been replaced by ethambutol.
Ethambutol, a chemotheraputic agent used in the treatment of tuberculosis, works by inhibiting the incorporation of mycolic acids into the mycobacterial cell wall.