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Scopolamine ref.: Davis's Drug Guide

Scopolamine (scoe-pol-a-meen)
Scopace, Transderm-Scop,
Transderm-V

Classification
Therapeutic: antiemetics
Pharmacologic: anticholinergics
Pregnancy Category C










Indications
Transdermal: Prevention of motion sickness. Management of nausea and vomiting associated with opioid analgesia or general anesthesia/recovery from anesthesia. IM, IV, Subcut: Preoperatively to produce amnesia and to decrease salivation and excessive respiratory secretions.
PO: Symptomatic treatment of postencephalitis parkinsonism and paralysis agitans. Treatment of spasticity. Inhibits excessive motility and hypertonus of GI tract in irritable colon syndrome, mild dysentery, diverticulitis, and pylorospasm. Prevention of motion sickness.

Action
Inhibits the muscarinic activity of acetylcholine. Corrects the imbalance of acetylcholine and norepinephrine in the CNS, which may be responsible for motion sickness.
Therapeutic Effects: Reduction of nausea and vomiting. Preoperative amnesia and decreased secretions. Reduction of spasms.

Pharmacokinetics
Absorption: Well absorbed following IM, subcut, and transdermal administration.
Distribution: Crosses the placenta and bloodbrain barrier.
Metabolism and Excretion: Mostly metabolized by the liver.

IM, IV, Subcut (Children): Antiemetic/anticholinergic— 6 mcg/kg or 0.2 mg/m2.
IM (Children 8–12 yr): Antisecretory—0.3 mg.
IM (Children 3–8 yr): Antisecretory—0.2 mg.
IM (Children 7 mo–3 yr): Antisecretory— 0.15 mg.
IM (Children 4–7 mo): Antisecretory—0.1 mg.

Availability (generic available)
Transdermal therapeutic system: Transderm- Scop—1.5 mg scopolamine/patch releases 0.5 mg scopolamine over 3 days, Transderm-V— 1.5 mg scopolamine/patch releases 1 mg scopolamine over 3 days. Tablets: 0.4 mg.
Injection: 0.3 mg/mL, 0.4 mg/mL.

NURSING IMPLICATIONS
Assessment
  • Assess patient for signs of urinary retention periodically during therapy.
  • Monitor heart rate periodically during parenteral therapy.
  • Assess patient for pain prior to administration. Scopolamine may act as a stimulant in the presence of pain, producing delirium if used without opioid analgesics.
  • Antiemetic: Assess patient for nausea and vomiting periodically during therapy.
Potential Nursing Diagnoses
Impaired oral mucous membrane (Indications, Side Effects) Risk for injury (Side Effects)

Implementation
PO: Administer at least 1 hr prior to exposure to travel for motion sickness. Tablets may be crushed or dissolved in water to decrease onset.

IV Administration
  • Direct IV: Diluent: Scopolamine should be diluted with sterile water for injection prior to IV administration. Concentration: Dilute dose with an equal volume of diluent. Rate: Inject slowly over 2–3 min..
  • Syringe Compatibility: atropine, butorphanol, chlorpromazine, cimetidine, diphenhydramine, droperidol, fentanyl, glycopyrrolate, hydromorphone, meperidine, metoclopramide, midazolam, morphine, nalbuphine, pentazocine, pentobarbital, perphenazine, prochlorperazine, promethazine, ranitidine, sufentanil, thiopental.
Evaluation/Desired Outcomes
  • Decrease in salivation and respiratory secretion preoperatively.
  • Postoperative amnesia.
  • Prevention of motion sickness.
  • Prevention and treatment of opioid- or anesthesia- induced nausea and vomiting.
  • Reduction in spasms.
  • Reduction in excessive GI motility.

Omalizumab ref.: Davis's Drug Guide

Omalizumab (o-ma-liz-u-mab)
Xolair
Classification
Therapeutic: antiasthmatics
Pharmacologic: monoclonal antibodies
Pregnancy Category B








Indications
Moderate to severe asthma not controlled by inhaled corticosteroids.

Action
Inhibits binding of IgE to receptors on mast cells and eosinophils; preventing the release of mediators of the allergic response. Also decreases amount of IgE receptors on basophils. Therapeutic
Effects: Decreased incidence of exacerbations of asthma.

Pharmacokinetics
Absorption: 62% absorbed slowly from subcut sites.
Distribution: Enters breast milk. Metabolism and Excretion: Degraded similarly to IgG via binding degradation, reticuloendothelial system and the liver.
Half-life: 26 days.

ROUTE: Subcut

ONSET: within 1 hr

PEAK: unknown

DURATION: up to 1 yr

Contraindications/Precautions
Contraindicated in: Hypersensitivity; Acute bronchospasm.

Use Cautiously in: Chronic use of inhaled corticosteroids;
OB: Use in pregnancy only if clearly needed; enroll pregnant women with at least one exposure to omalizumab in the Xolair Pregnancy
Exposure Registry (1-866-496-5247); Lactation:
Safety not established; Pedi: Children 12 yr
(safety not established).

Adverse Reactions/Side Effects
Local: injection site reactions. Misc: allergic reactions including ANAPHYLAXIS,qrisk of malignancy.
Interactions
Drug-Drug: None noted.
Route/Dosage
Subcut (Adults and Children 12 yr): 150– 375 mg every 2–4 wk (determined by pretreatment serum IgE level and body weight).

Availability
Powder for injection: 150 mg/vial.

NURSING IMPLICATIONS
Assessment
  • Assess lung sounds and respiratory function prior to and periodically during therapy.
  • Assess allergy symptoms (rhinitis, conjunctivitis, hives) before and periodically throughout therapy.
  • Assess for allergic reactions (urticaria, tongue and/or throat edema) within 2 hr of first or subsequent injections. Observe patient following injection. Epinephrine, diphenhydramine, and corticosteroids should be available in case of anaphylaxis.
  • Monitor for injection site reactions (bruising, redness, warmth, burning, stinging, itching, hives, pain, induration, mass, inflammation). Usually occur within 1 hr of injection, last 8 days, and decrease in frequency with subsequent dosing.
  • Lab Test Considerations: Serum IgE levels will increase following administration and may persist for up to 1 year following discontinuation. Serum total IgE levels obtained <1 year following discontinuation may not reflect steady state free IgE levels and should not be used to reassess the dosing regimen.
Potential Nursing Diagnoses
Ineffective airway clearance
Implementation
  • Doses of inhaled corticosteroids may be gradually decreased with supervision of health care professional; do not discontinue abruptly.

Meclizine Ref.: Davis's Drug Guide

Meclizine
(mek-li-zeen)
Antivert, Bonamine, Bonine, Dramamine Less Drowsy Formula

Classification
Therapeutic: antiemetics, antihistamines
Pregnancy Category B

Indications
Management/prevention of: Motion sickness, Vertigo.



Action
Has central anticholinergic, CNS depressant, and antihistaminic properties. Decreases excitability of the middle ear labyrinth and depresses conduction in middle ear vestibular-cerebellar pathways.
Therapeutic Effects: Decreased motion sickness. Decreased vertigo from vestibular pathology.
Pharmacokinetics
Absorption: Absorbed after oral administration.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: 6 hr.

TIME/ACTION PROFILE (antihistaminic
effects)

ROUTE: PO 
ONSET: 1 hr 
PEAK: unknown
DURATION 8–24 hr

Contraindications/Precautions
Contraindicated in: Hypersensitivity; OB: Has caused congenital malformations (cleft palate) in animal studies.
Use Cautiously in: Prostatic hyperplasia; Angleclosure glaucoma; Lactation: Occasional use may be acceptable; prolonged use may expose infant to drug effects or may interfere with milk supply;
Pedi: Children <12 yr (safety not established);
Geri: increase sensitivity and risk of adverse reactions.

Adverse Reactions/Side Effects
CNS: drowsiness, fatigue. EENT: blurred vision.
GI: dry mouth.

Interactions
Drug-Drug: Additive CNS depression with other CNS depressants, including alcohol, other antihistamines, opioid analgesics, and sedative/ hypnotics. Additive anticholinergic effects with other drugs possessing anticholinergic properties, including some antihistamines, antidepressants, atropine, haloperidol, phenothiazines, quinidine, and disopyramide.


Cyclobenzaprine Ref.: Davis's Drug Guide

Cyclobenzaprine
(sye-kloe-ben-za-preen)
Amrix, Flexeril


Classification:
Therapeutic: skeletal muscle relaxants (centrally
acting)
Pregnancy Category B

Indications:
Management of acute painful musculoskeletal conditions associated with muscle spasm.
Unlabeled Use: Management of fibromyalgia.



Action:
Reduces tonic somatic muscle activity at the level of the brainstem. Structurally similar to tricyclic antidepressants. Therapeutic Effects: Reduction in muscle spasm and hyperactivity without loss of function.

Pharmacokinetics
Absorption: Well absorbed from the GI tract.
Distribution: Unknown.
Protein Binding: 93%.
Metabolism and Excretion: Mostly metabolized by the liver.
Half-life: 1–3 days.

TIME/ACTION PROFILE (skeletal muscle
relaxation)

ROUTE: PO
ONSET: within 1 hr
PEAK:  3–8 hr
DURATION: 12–24 hr

Full effects may not occur for 1–2 wk

Contraindications/Precautions
Contraindicated in: Hypersensitivity; Should not be used within 14 days of MAO inhibitor therapy; Immediate period after MI; Severe or symptomatic cardiovascular disease; Cardiac conduction disturbances; Hyperthyroidism.

Use Cautiously in: Cardiovascular disease; Geri: Appears on Beers list. Poorly tolerated due to anticholinergic effects; OB, Lactation, Pedi: Pregnancy, lactation, and children 15 yr (safety not established).

Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, confusion, fatigue,
headache, nervousness.
EENT: dry mouth, blurred vision. CV: arrhythmias. GI: constipation,
dyspepsia, nausea, unpleasant taste. GU: urinary retention.

Interactions
Drug-Drug: Additive CNS depression with other
CNS depressants, including alcohol, antihistamines, opioid analgesics, and sedative/ hypnotics. Additive anticholinergic effects with drugs possessing anticholinergic properties, including antihistamines, antidepressants, atropine, disopyramide, haloperidol, and phenothiazines. Avoid use within 14 days of MAO inhibitors (hyperpyretic crisis, seizures, and death may occur). Drug-Natural Products: Concomitant use of kava-kava, valerian, chamomile, or hops can increase CNS depression.

Route/Dosage
PO (Adults): Acute painful musculoskeletal conditions—10 mg 3 times daily (range 20–40 mg/day in 2–4 divided doses; not to exceed 60 mg/day) or extended-release, 15–30 mg once daily. Fibromyalgia—5–40 mg at bedtime (unlabeled).

Availability (generic available)
Tablets: 5 mg, 10 mg. Cost: Generic—5 mg, 10 mg. Extended-release capsules (Amrix): 15 mg, 30 mg.

NURSING IMPLICATIONS

Assessment
  • Assess patient for pain, muscle stiffness, and range of motion before and periodically throughout therapy.
  • Geri: Assess geriatric patients for anticholinergic effects (sedation and weakness).
Potential Nursing Diagnoses
Acute pain (Indications)
Impaired physical mobility (Indications)
Risk for injury (Side Effects)

Implementation
  • Do not confuse cyclobenzaprine with cyproheptadine.
  • PO: May be administered with meals to minimize gastric irritation.
  • Swallow extended-release capsules whole; do not open, crush, or chew.
Patient/Family Teaching
  • Instruct patient to take medication as directed; do not take more than the prescribed amount.
  • Taken missed doses within 1 hr of time ordered; otherwise, return to normal dose schedule.
Do not double doses.
  • Medication may cause drowsiness, dizziness, and blurred vision. Caution patient to avoid driving or other activities requiring alertness until response to drug is known. Advise patient to avoid concurrent use of alcohol or other CNS depressants with this medication.
  • If constipation becomes a problem, advise patient that increasing fluid intake and bulk in diet and stool softeners may alleviate this condition.
  • Advise patient to notify health care professional if symptoms of urinary retention (distended abdomen, feeling of fullness, overflow incontinence, voiding small amounts) occur. Inform patient that good oral hygiene, frequent mouth rinses, and sugarless gum or candy may help relieve dry mouth.
Evaluation/Desired Outcomes
  • Relief of muscular spasm in acute skeletal muscle conditions. Maximum effects may not be evident for 1–2 wk. Use is usually limited to 2–3 wk; however, has been effective for at least 12 wk in the management of fibromyalgia.

Benifits of Sex

Sexual Health

  • When you're in the mood, it's a sure bet that the last thing on your mind is boosting your immune system or maintaining a healthy weight. Yet good sex offers those health benefits and more. That's a surprise to many people, says Joy Davidson, PhD, a New York psychologist and sex therapist. "Of course, sex is everywhere in the media," she says. "But the idea that we are vital, sexual creatures is still looked at in some cases with disgust or in other cases a bit of embarrassment. So to really take a look at how our sexuality adds to our life and enhances our life and our health, both physical and psychological, is eye-opening for many people."
  • Sex does a body good in a number of ways, according to Davidson and other experts. The benefits aren't just anecdotal or hearsay -- each of these health benefits of sex is backed by scientific scrutiny.


Sex Relieves Stress

A big health benefit of sex is lower blood pressure and overall stress reduction, according to researchers from Scotland who reported their findings in the journal Biological Psychology. They studied 24 women and 22 men who kept records of their sexual activity. Then the researchers subjected them to stressful situations -- such as speaking in public and doing verbal arithmetic -- and noted their blood pressure response to stress. Those who had intercourse had better responses to stress than those who engaged in other sexual behaviors or abstained.




Sex Lowers Blood Pressure

Another study published in Biological Psychology found that frequent intercourse was associated with lower diastolic blood pressure (the lower, or second, number in a blood pressure reading). This study focused on people living with their sex partner.
Still further research found a link between partner hugs and lower blood pressure in women.
Elevated blood pressure is a risk factor for coronary artery disease, heart attack, kidney disease, and stroke.









Sex Boosts Immunity

Good sexual health may mean better physical health. Having sex once or twice a week has been linked with higher levels of an antibody called immunoglobulin A or IgA, which can protect you from getting colds and other infections. Scientists at Wilkes University in Wilkes-Barre, Pa., took samples of saliva, which contain IgA, from 112 college students who reported the frequency of sex they had.
Those in the "frequent" group -- once or twice a week -- had higher levels of IgA than those in the other three groups -- who reported being abstinent, having sex less than once a week, or having it very often, three or more times weekly.






Sex Counts As Exercise

"Sex is a great mode of exercise," says Patti Britton, PhD, a Los Angeles sexologist and president of the American Association of Sexuality Educators and Therapists. It takes work, from both a physical and psychological perspective, to do it well, she says.
The benefits of sex as a form of exercise are many - sex can improve your cardiovascular fitness, strength, flexibility, and balance, not to mention your emotional health.

Sex Burns Calories

Thirty minutes of sex burns 85 calories or more. It may not sound like much, but it adds up: 42 half-hour sessions will burn 3,570 calories, more than enough to lose a pound. The number of calories burned during sex is about the same as the number burned by walking at 2 miles per hour.
Doubling up on the 30 minute sessions, you could drop that pound in 21 hour-long sessions.

Sex Improves Cardiovascular Health

While some older folks may worry that the efforts expended during sex could cause a stroke, that's not so, according to researchers from England. In a study published in the Journal of Epidemiology and Community Health, scientists found that the frequency of sex was not associated with stroke in the 914 men they followed for 20 years.
And the heart health benefits of sex don't end there. The researchers also found that having sex twice or more a week reduced the risk of fatal heart attack by half for the men, compared with those who had sex less than once a month.

Sex Boosts Self-Esteem

Boosting self-esteem was one of 237 reasons people have sex, collected by University of Texas researchers and published in the Archives of Sexual Behavior.
That finding makes sense to Gina Ogden, PhD, a sex therapist and marriage and family therapist in Cambridge, Mass., although she finds that those who already have self-esteem say they sometimes have sex to feel even better. "One of the reasons people say they have sex is to feel good about themselves," she tells WebMD. "Great sex begins with self-esteem, and it raises it. If the sex is loving, connected, and what you want, it raises it."

Sex Strengthens Your Well-Being

Sex, like any activity that fosters a close and loving connection to your partner, not only raises self-esteem, but strengthens your overall sense of well-being. Studies have shown that people with strong social support networks (which includes lovers) are healthier and happier than their less-connected peers.


Sex Improves Intimacy

Having sex and orgasms increases levels of the hormone oxytocin, the so-called love hormone, which helps us bond and build trust. Researchers from the University of Pittsburgh and the University of North Carolina evaluated 59 premenopausal women before and after warm contact with their husbands and partners ending with hugs. They found that the more contact, the higher the oxytocin levels.
"Oxytocin allows us to feel the urge to nurture and to bond," Britton says.
Higher oxytocin has also been linked with a feeling of generosity. So if you're feeling suddenly more generous toward your partner than usual, credit the love hormone.

Sex Reduces Pain

As the hormone oxytocin surges, endorphins increase, and pain declines. So if your headache, arthritis pain, or PMS symptoms seem to improve after sex, you can thank those higher oxytocin levels.


Oxytocin – The Love Hormone

A study published in the Bulletin of Experimental Biology and Medicine examined the response of the “love hormone” oxytocin on pain perception in an experiment with 48 volunteers. Study participants inhaled oxytocin vapor and then had their fingers pricked. Those who had inhaled oxytocin lowered their pain threshold by more than half.

Sex Reduces Prostate Cancer Risk

Frequent ejaculations, especially in 20-something men, may reduce the risk of prostate cancer later in life, Australian researchers reported in the British Journal of Urology International. When they followed men diagnosed with prostate cancer and those without, they found no association of prostate cancer with the number of sexual partners as the men reached their 30s, 40s, and 50s.
But they found men who had five or more ejaculations weekly while in their 20s reduced their risk of getting prostate cancer later by a third.
Another study, reported in the Journal of the American Medical Association, found that frequent ejaculations, 21 or more a month, were linked to lower prostate cancer risk in older men, as well, compared with less frequent ejaculations of four to seven monthly.

Sex Strengthens Pelvic Floor Muscles

For women, doing a few pelvic floor muscle exercises known as Kegel exercises during sex offers a couple of benefits. You will enjoy more pleasure, and you'll also strengthen the area and help to minimize the risk of incontinence later in life.
To do a basic Kegel exercise, tighten the muscles of your pelvic floor, as if you're trying to stop the flow of urine. Count to three, then release.


Additional Benefits of Kegel Exercises

Kegel exercises have a number of proven health benefits in addition to making sex more enjoyable. The strengthening of the pelvic floor muscles can help prevent prolapse (a slipping out of position) of the vagina, uterus, and bladder. Pelvic floor muscles may be weakened later in life as a result of childbearing, being overweight, and aging. Kegel exercises help offset the consequences of weakened pelvic floor muscles.

Sex Helps You Sleep Better

The oxytocin released during orgasm also promotes sleep, according to research.
And getting enough sleep has been linked with a host of other good things, such as maintaining a healthy weight and blood pressure. Something to think about, especially if you've been wondering why your guy can be active one minute and snoring the next.

Sex As Physical Exercise Also Promotes Sleep

The physical exercise component of sex can also help you relax and sleep better, in addition to the hormonal effects. People who get regular exercise tend to sleep better and have more restful sleep. Moreover, as we have seen in the earlier part of this slideshow, sex is a great way to get some exercise.

Summary

Take note that sex is good for you in ways you may never have imagined and that the health benefits extend well beyond the bedroom.



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Propecia

Finasteride (generic name)
Propecia (brand name)


Finasteride Oral tablet [Benign Prostatic Hyperplasia] 

What is this medicine?

  • FINASTERIDE (fi NAS teer ide) is used to treat benign prostatic hyperplasia (BPH) in men. This is a condition that causes you to have an enlarged prostate. This medicine helps to control your symptoms, decrease urinary retention, and reduces your risk of needing surgery. When used in combination with certain other medicines, this drug can slow down the progression of your disease.
  • 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:

  •     Liver disease
  •     An unusual or allergic reaction to finasteride, 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 glass of water. Follow the directions on the prescription label. You can take this medicine with or without food. Take your doses at regular intervals. Do not take your medicine more often than directed. Do not stop taking except on the advice of your doctor or health care professional.
  • 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?

  • Male hormones like testosterone
  • 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.

Diabetes

Diabetes Cases Double to 347 Million Worldwide


Nearly 10 percent of adults worldwide have diabetes, and new research suggests the rate of new cases is rising rapidly. Over the past three decades, the number of adults with either type 1 or type 2 diabetes worldwide has more than doubled, jumping from 153 million in 1980 to 347 million today. (Type 1 diabetes means the body produces too little or no insulin, while type 2 is linked to excess weight or inactivity.) About 70 percent of the increase is due to an aging population—since diabetes typically hits in middle age—while the remaining 30 percent is explained by the obesity epidemic, according to a study published Monday in the Lancet. Perplexingly, the incidence rate is rising twice as fast in the United States as it is in Western Europe, though researchers don't yet understand why. "This is likely to be one of the defining features of global health in the coming decades," study author Majid Ezzati, an epidemiologist and biostatistician at Imperial College London, told The Washington Post. "There's simply the magnitude of the problem. And then there's the fact that unlike high blood pressure and high cholesterol, we don't really have good treatments for diabetes."

Common Myths and Misconceptions About Diabetes
There are many mistaken beliefs about diabetes. Sue McLaughlin, former president of healthcare and education at the American Diabetes Association, offered her opinion of what she says are the six most common myths and misconceptions about diabetes, based on an ADA survey of more than 2,000 Americans released in 2009

Tips That Will Help Keep You Out of the Hospital

Diabetics know what they will hear whenever they see their doctor: another exhortation to eat right and exercise because that's how to keep blood sugar low and under control. It's proven advice, but not enough to prevent a long list of diabetic complications from sending you to the emergency room, say diabetes experts.
[How to Find a 'Best' Hospital for Diabetes]
Diabetes-related complications, in fact, are among the most common reasons for hospitalization, according to a recent study in the Journal of Women's Health. Researchers found that in 2006, for example, diabetics hospitalized because of congestive heart failure accounted for more than 1 in every 16 discharges; diabetics with pneumonia made up another 1 in 26. Moreover, the overall rate of hospital admissions for diabetics is rising—up more than 65 percent between 1993 and 2006. And it will climb even faster if the Centers for Disease Control and Prevention's recent estimate that as many as 1 in 3 Americans, up from 1 in 10 now, will have type 1 or type 2 diabetes by 2050 holds up.

For those who already have the disease, though, there is hope. Some of these tips may help keep you healthy­—and out of the hospital:
  • Do a daily foot check. "Keeping good watch over your feet is an important aspect of good diabetes care," says Joyce Lee, a coauthor of the Women's Health study and assistant professor in the department of pediatrics and communicable diseases at the University of Michigan Hospitals and Health Centers. A high blood glucose level can cause nerve damage in the feet, and you might not feel a cut, scrape, or blister that could be the start of a deep skin infection. Data from the study indicates that young men are especially prone to such ulcerations. Applying lotion regularly and drinking lots of water can keep skin on the feet—and the rest of the body—from becoming dry and cracked, advises the National Diabetes Information Clearinghouse.

  • Coddle teeth and gums. Diabetics run an increased risk of tooth decay, inflamed gums, and gum disease because the condition increases vulnerability to bacterial infections and hampers the ability to fight them. Periodontitis, an especially severe infection that destroys gum tissue and the bone that holds teeth in place, also complicates a diabetic's life by raising blood sugar levels when hormones are released by the immune system to battle the infection, warns the American Diabetes Association. Brushing after every meal, or at least twice a day, and flossing once a day is crucial, according to the NDIC.

  • Go easy on salt. Sodium and high blood pressure go hand in hand, and high blood pressure multiplies a diabetic's already elevated risk of cardiovascular and kidney diseases, says Om Ganda, director of the lipid clinic at the Joslin Diabetes Center in Boston. The landmark DASH study by researchers at the National Heart, Lung, and Blood Institute of the National Institutes of Health, published in 2001 in the New England Journal of Medicine, showed that cutting down on salt dramatically reduced blood pressure even in those on a healthy diet rich in veggies, fruit, and low-fat dairy­. The American Heart Association says that 1,500 milligrams of salt—about two-thirds of a teaspoon—should be the daily limit; the average American consumes two to three times as much. Cutting back on salt isn't just a matter of reaching for the shaker less often, unfortunately. Prepared foods tend to be salt-heavy: One large fast-food taco or egg-and-sausage biscuit has close to the AHA's recommended limit. Even unlikely suspects such as a half cup of low-fat cottage cheese or a smallish cinnamon-raisin bagel will kick in almost a third of the recommended total. For diabetics, zeroing in on the number next to sodium on nutritional labels is a survival skill.

AMOXICILLIN

AMOXICILLIN

What is amoxicillin?
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.

CONTRAINDICATIONS:
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.


PREGNANCY CATEGORY:
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.
  • The amoxicillin chewable tablet may contain phenylalanine. Talk to your doctor before using this form of amoxicillin if you have phenylketonuria (PKU).

How should I take amoxicillin?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.
You may take amoxicillin with or without food.
  •  Shake the oral suspension (liquid) well just before you measure a dose. Measure the liquid with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
  • You may place the liquid directly on the tongue, or you may mix it with water, milk, baby formula, fruit juice, or ginger ale. Drink all of the mixture right away. Do not save any for later use.
  • The chewable tablet should be chewed before you swallow it.
  • Do not crush, chew, or break an extended-release tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.
  • To be sure this medicine is helping your condition and is not causing harmful effects, your blood will need to be tested often. Your liver and kidney function may also need to be tested. Visit your doctor regularly.
  • If you are being treated for gonorrhea, your doctor may also have you tested for syphilis, another sexually transmitted disease.
  • If you are taking amoxicillin with clarithromycin and/or lansoprazole to treat stomach ulcer, use all of your medications as directed. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor's advice.
  • 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.
  • This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using amoxicillin.

How To Lose Weight

With the world, as a whole, said to be struggling with an "obesity epidemic," it is perhaps no wonder that the weight loss industry is now quoted as being worth tens of billions of dollars a year. We seem to be bombarded on almost a daily basis by new diets, exercise programmes and magazine pictures of celebrities showing off their 'amazing new body.' For those people looking to improve their overall health and lose weight, we will go through some of the reasons for losing weight and some of the methods to help you intentionally do it.

People can lose weight for many reasons, perhaps intentionally through exercise training for a sports event, for health reasons, just to look better, or unintentionally as may occur because of an underlying disease. Weight loss refers to the loss of body fat (adipose tissue), fluid and/or lean mass. Lean mass are parts of your body without fat, such as bone mineral deposits, tendons, connective tissue and muscle.

People intentionally lose weight to:
  • Become fitter
  • Become healthier
  • To look better
  • To be eligible for a competition - such as a boxer who needs to lose a few pounds to be able to stay a middle weight, for example, or a racehorse jockey.
  • To improve their job prospects - in some professions there is a limit on how much you can weigh
Overweight or obese people may lose weight for therapeutic reasons. By losing weight they reduce their risk of developing diabetes, hypertension (high blood pressure), osteoarthritis, some cancers, and heart disease.

An obese or overweight individual with diabetes type 2 will usually have less severe symptoms if they can bring their weight down to normal levels for their height and age.

Negative Energy Balance - in order to lose weight you need to be exerting more energy than you are consuming, this is called a negative energy balance. If you are in a state of negative energy balance, your body will seek out stores of energy, such as fat or muscle to make up for the shortfall - it will start using up your excess weight. In extreme cases, however, when the individual has little fat, more muscle and lean tissue will be used up.

Sports - some sportsmen and sportswomen will try to lose weight even though doctors would say their bodyweight is ideal. In some cases it might be to get better speeds, or as mentioned above, to be within a weight classification for a competition.

Losing too much weight - if you become underweight there are also certain health risks. Your chances of developing infections might increase, there is a risk of osteoporosis, reduced muscle mass and strength, and problems regulating your body temperature. There may even be a higher risk of death if your weight goes down a lot.

Cilostazol

Availability:
50mg, 100 mg tablets

ACTIONS:
Inhibitions of Isoenzyme which results in vasodilatation and inhibition of platelet aggregation induced by colagen or arachidonic acid.

THERAPUTIC EFFECTS:
Increase skin temperature of the extremities and improves claudication. Effectiveness is indicated by increased ability to walk further without claudication.

USES:
Intermittent claudication.

CONTRAINDICATIONS:
Congestive heart disease. Concurrent therapy with clopidogrel has not been studied for safety or efficacy. Pregnancy and lactation.



CAUTIOUS USE
:
Safety and efficacy in children <18y are not esteblished.


ROUTE AND DOSAGE:
Adult: PO 100mg b.i.d. 0.5 h before or 2 h after meals, may need to reduce to 50mg b.i.d. with contaminat ketoconazole, itraconazole, erythromycin, dilitiazem or omeprazole

PREGNANCY CATEGORY (US FDA):
Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Cancer drug reverses Alzheimer's in mice

Cancer drug reverses Alzheimer's in mice

A cancer drug has succeeded in reversing Alzheimer's disease in its early stages in mice, according to a new study.
The drug, bexarotene, is designed to reduce levels of amyloid beta, the protein whose presence in the brain has been most closely tied to the development of Alzheimer's.
In a new study, mice treated with bexarotene saw their amyloid beta levels drop 25 percent within six hours and, importantly, they showed a corresponding improvement in their cognitive function.
"The data we provide here really suggest that Alzheimer's could be, in the early stages, a reversible disease," said study author Paige Cramer, a doctoral student in neuroscience at Case Western Reserve School of Medicine.
The researchers used mice that had a mouse model of Alzheimer's disease. After the researchers administered varying doses of bexarotene, they measured levels of amyloid beta in the brain and tested the mice for their abilities in maze running, nest building, smell, and fear conditioning, which is a type of learning.
"They did a lot of different tests of learning and memory and they saw an effect on every single one of them," said Michael Sasner, a research scientist and associate director at the Jackson Laboratory in Bar Harbor, Maine.
Bexarotene is already approved by the Food and Drug Administration for the treatment of cutaneous T-cell lymphoma, a type of skin cancer, and so it may be able to proceed through clinical trials more quickly than drugs not already known to be safe to administer to people.
The study appears in the Feb.10 issue of the journal Science.

A new way to target Alzheimer's
Sasner, who was not involved with the new study, said it overcomes some of the weaknesses of previous Alzheimer's work, in which only one or two tests of cognitive improvement were conducted.
Bexarotene is not the first attempted Alzheimer's treatment to target amyloid beta. But past research has aimed at removing the plaques that amyloid beta can form in the brain, which has not shown any effect on the disease itself.
The difference now, researchers say, is in a better understanding of amyloid beta and the various forms it can exist in. Rather than focusing on the plaques, researchers now think it is the active, soluble form of the protein that is at work in Alzheimer's.
While there are various views on the causes of Alzheimer's, "the predominant view right now is that it's the soluble forms of amyloid beta that are causing the impaired brain function," Cramer said. "Plaques are just sinks, just tombstones that gather amyloid beta."
Bexarotene works by promoting the production of another protein, called Apolipoprotein E, which binds to and clears amyloid beta from the brain.
"This paper lends a lot to the mechanism of how ApoE may be involved in Alzheimer's," Cramer said.

Hurdles remain
It remains to be seen whether the benefits of bexarotene in mice would translate to humans.
"Because we're using an FDA-approved drug, this allows us to translate these basic science findings to the clinic; that's our next goal," Cramer said.
Figuring out the correct dosing presents another challenge. Researchers found that in one case, giving bexarotene over several doses appeared to be less effective than giving it once. Cramer said the reason may be that the drug degrades itself within the body.
Cramer said she and Gary Landreth, the senior investigator on the study, hope to begin a preliminary trial this year, in which they will look for the same changes in beta amyloid levels in humans. If successful, the testing would move to clinical trials.
Bexarotene is currently sold as Targretin; patents on that drug will expire in April.
"There's a long way to go to prove this treatment in humans, but it seems like an exciting thing to follow up on," Sasner said.

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