النشرة الصيدليه |
* على الصيدلي العامل في مجال خدمة الصحه والأفراد إحترام قواعد المهنه وتقدير حياة الأنسان * على الصيدلي أن يكون عادلا في معاملة جميع المرضى دون تمييز * على الصيدلي تحديث معلوماته المهنيه باستمرار ومتابعة الجديد في علم الصيدله *على الصيدلي إحترام أسرار مهنته وان لا يبوح بأي معلومات عن المريض الا بإذنه أو في الحالات النادرة التي تحتم فيها مصلحة المريض البوح ببعض المعلومات عنه * على الصيدلي تنفيذ المهام الصيدليه بحرص وتركيز * على الصيدلي أن لا يقلل من شأن مهنته ولو جزئيا ، وان يقاوم بشدة كل محاولة المساس بأستقلال مهنته * على الصيدلي إجتناب أي فعل يسيء الى مهنته أو يقلل من شأنها وان كان لا يمت للمهنه بصله واضعا في إعتباره ما للصيدله من مكان واحترام * على الصيدلي إحترام أخلاقيات مهنة الصيدله ونظام مزاولة المهنة المحلي * على الصيدلي إحترام حق المريض في حرية الأختيار ضمن الحدود الشرعيه * على الصيدلي أن يتأكد أن المبلغ الذي يتقاضاه مقابل خدماته عادل ومعقول وأن يرفض الإشتراك في أي عمل من شأنه تعريض المريض للخطر لأن ذلك مخالف لأخلاقيات المهنه * على الصيدلي أن يتأكد أن كل ما ينشره من معلومات ذات علاقه بمهنته صحيحه وموثوقه ومتمشيه مع آداب وأخلاقيات المهنــــــــه * على الصيدلي الأحتفاظ بعلاقات يسودها جو الثقه مع الجهات الإداريه التابع لها * على الصيدلي مساعدة الجهات الصحيه في جهودها لحماية الصحه بتقديم النصح وتكريس جهوده للرفع من مستوى المعايير الصحيه * على الصيدلي أن يقوم بدوره كموجه للصحه العامه * على الصيدلي أن يشارك في أنشطة الجمعيات المهنيه المحليه والعالميه والتي تهدف الى تحسين ظروف العمل والرفع من مستوى المهنه * من حق الصيدلي الإمتناع عن صرف وبيع وتموين الدواء إذا رأى أن مصلحة المريض تقتضي ذلك ، وأذا كان الدواء مكتوبا بوصفه طبيه فعلى الصيدلي تقديم المشورة للطبيب الواصف |
العدد الأول |
WARFARIN-ACETAMINOPHIN DANGEROUS INTERACTION Warfarin is commonly used to prevent clotting in cardiovascular diseases Warfarin has many drug interaction ,which may affect . is activity and leading to serious side effects. Patients on warfarin therapy easily may ingest acetaminophin ( paracetamol ) to relief pain . Acetaminophin is without bleeding side effects like aspirin , but if acetaminophin is administered with warfarin it may increase its bleeding effect . In a prospective case control study , 289 outpatients 9 mean age 70 years on warfarin therapy for at least one month ( target INR of 2.0-3.0 ) were followed within 24 hrs. of the reported INR . Case patients were identified and controls were randomly selected from patients with acetaminophen , even a regular dose of warfarin can result in dangerous hemorrhaging . although the average weekly warfarin dose was similar between the two groups , the INRs were higher in the case group whom was ingesting gr- eater amounts of acetaminophin on weekly basis . The risk for elevated INRs with concurrent acetaminophen therapy was dose dependent . The authors concluded that acetaminophen is under recognized cause of over-anticoagulation in outpatients taking warfarin . Although the authors do not propose a mechanism of action , they encourage clinic- ians to query patients about their use of acetaminophen and monitor INRs closely in patients who take high chronic doses . Editorial comments : we also encourage all colleages in pharmacies to discuss this drug interaction with their patients especially in older population. Patient education is one of patient's rights and will lead to stop purchasing similar drugs from groceries . Ref. DPIC newsletter vol. 18 may-jun 1999 . ******************************************************************************************** |
PHARMACIST QUISTION ???
Q. All of the following drugs are contraindicated in breastfeeding except : A) Cyclophosphamide B) Ergotamine C) Bromocriptin D) Doxorubicin E) Digoxin F) Lithium ANSWER : Select the correct answer and clik for checking. * * * * * * * * * * * ** |
ISSUE NO. 2 | العدد الثاني |
حمى الوادي المتصدع Overview Rift Valley Fever (RVF) is a zoonosis (a disease which primarily affects animals, but occasionally causes disease in humans). RVF may cause severe disease in both animals and humans, leading to a high morbidity and mortality, and exacting substantial economic costs from loss of livestock. Since 1930, when the virus was first isolated during an investigation into an epidemic amongst sheep on a farm in the Rift Valley of Kenya, there have been damaging outbreaks in sub-Saharan and North Africa. In 1997-98, there was been a major outbreak in Kenya and Somalia, and reports of disease from Mauritania. A wide variety of mosquitoes are possible vectors for the RVF virus (cf.: greater detail below). There is, therefore, a potential for epizootics (epidemics amongst animals) and associated human epidemics consequent on the introduction of the virus into a new area. This has often been demonstrated in the past and remains a concern. The Virus, the Reservoirs, and the Vectors The virus which causes RVF is a member of the Phlebovirus genus, one of the 5 genera in the family Bunyaviridae. It is primarily spread amongst animals by the bite of infected mosquitoes. A variety of mosquitoes may act as vector for transmission of the RVF virus; in different regions a different species of mosquito may prove to be the predominant vector. In addition, the various vector species play differing roles in sustaining transmission of the virus. Aedes mosquitoes may acquire the virus from feeding on infected animals, and are capable of trans-ovarial transmission (transmission of the virus from infected female mosquitoes to offspring via eggs), so new generations of mosquitoes may hatch, already infected, from their eggs. This provides a durable mechanism for maintaining the virus in nature, as the eggs of these mosquitoes may survive for periods up to several years in dry conditions. During periods of inundation of larval habitats by rainfall, for example, in the rainy season, the eggs will hatch, and the mosquito population will increase and spread the virus to the animals on which they feed. Previously uninfected mosquitoes will feed on infected, viraemic (virus circulating in the bloodstream), animals and thus amplify and perpetuate the outbreak by transmitting the virus to the animals on which they subsequently feed. Many types of animals may be infected with RVF, and disease may be severe in many domesticated animals including cattle, sheep, camels and goats, although sheep appear to be more susceptible than cattle and goats are less susceptible. Exotic breeds, more recently introduced into an endemic area, fare worse than breeds long adapted to local conditions. Animals of different ages also differ in their susceptibility to severe illness: over 90% of lambs infected with RVF die, whereas mortality amongst adult sheep can be as low as 10%. The abortion rate amongst pregnant, infected ewes is almost 100%. An epizootic of RVF is usually first manifested as a wave of unexplained abortion amongst livestock. This may be considered the sentinel event, heralding the epidemic to follow. Transmission to Humans During epizootics, people may become infected with RVF either by being bitten by infected mosquitoes, or through contact with the blood, body fluids or organs of infected animals. Such contact may occur while involved in the care or slaughtering of infected animals, or, possibly, from the ingestion of raw milk. The virus may infect by entering either through inoculation (e.g., if the skin is broken, or through a wound from an infected knife), or it may be inhaled as an aerosol. The aerosol mode of transmission has also led to infection in laboratory workers. Clinical Features The incubation period (interval from infection to onset of symptoms) of RVF varies from two to six days. There then follows an influenza-like illness, with sudden onset of fever, headache, myalgia (muscle pain) and backache. Some patients also develop neck stiffness, photophobia (the patient finds exposure to light uncomfortable) and vomiting, and in these patients the disease may be mistaken for meningitis in the early stages. The symptoms of RVF usually last from four to seven days, after which time the immune response to infection becomes detectable with the appearance of IgM and IgG antibodies, and the disappearance of circulating virus from the bloodstream. A small proportion of patients develops a much more severe disease, and this generally appears as one of several recognizable syndromes. The fever and other symptoms described above may appear in association with eye disease, which characteristically manifests itself in retinal lesions. When the lesions are in the macula, some degree of permanent visual loss will result. Another syndrome manifests itself with acute neurological disease, as meningoencephalitis (inflammation of the brain and of the tissue surrounding it). The onset of these two syndromes is usually one to three weeks after the first symptoms. RVF may also manifest itself as haemorrhagic fever. Two to four days after the onset of illness, the patient shows evidence of severe liver disease, with jaundice and haemorrhagic phenomena, such as vomiting blood, passing blood in the faeces, developing a purpuric rash (a rash caused by bleeding in the skin), and bleeding from the gums. Patients with the RVF-haemorrhagic fever syndrome may remain viraemic for up to 10 days. The proportion of patients developing these three types of complications is about 0.5-2% for eye disease, and less than 1% for meningoencephalitis and for the haemorrhagic fever syndrome. Most fatalities occur in patients who have developed one of these complications. The case-fatality rate for patients developing haemorrhagic disease is high – approximately 50%, whereas death in those with only ocular disease or meningoencephalitis is uncommon. The total case fatality rate has varied widely in the various documented epidemics, but, overall, is less than 1%. Diagnosis and Treatment The diagnosis of acute RVF may be reached by several approaches. Serological tests such as enzyme-linked immunoassay (the "ELISA" or "EIA" methods) may demonstrate the presence of specific IgM antibodies to the virus. The virus itself may be detected in blood or tissues by a variety of techniques including virus culture, antigen detection tests, and PCR, a molecular method for detecting the viral genome. The antiviral drug ribavirin has been shown to inhibit viral growth in experimental systems, but has not been evaluated in the clinical setting. Most human cases of RVF are relatively mild and of short duration, so will not require any specific treatment. For the more severe cases, the mainstay of treatment is general supportive therapy. Prevention and Control Rift Valley fever can be prevented by a sustained program of animal vaccination. Both live, attenuated, and killed vaccines have been developed for veterinary use. The live vaccine requires only one dose and produces long-lived immunity, but the presently-available vaccine may cause abortion if given to pregnant animals. The killed vaccines do not cause these unwanted effects, but multiple doses must be given to produce protective immunity. This may prove problematic in endemic areas. An inactivated vaccine has been developed for human use. This vaccine is not licensed and is not commercially available but has been used experimentally to protect veterinary and laboratory personnel at high risk of exposure to RVF. Other candidate vaccines are under investigation. The risk of transmission from infected blood or tissues exists for people working with infected animals or people during an outbreak. Gloves and other appropriate protective clothing should be worn, and care taken when handling sick animals or their tissues. Healthcare workers looking after patients with suspected or confirmed RVF should employ universal precautions when taking and processing specimens from patients. Hospitalized patients should be nursed using barrier techniques. As noted above, laboratory workers are at risk, so samples taken for diagnosis from suspected cases (human and animal) of RVF should be handled by trained staff and processed in suitably equipped laboratories. Other approaches to the control of disease involve protection from and control of the mosquito vectors. Personal protection is important and effective. Where appropriate individuals should wear protective clothing, such as long shirts and trousers, use bednets and insect repellent, and avoid outdoor activity at peak biting times of the vector species. Measures to control mosquitoes during outbreaks, e.g., use of insecticides, are effective if conditions allow access to mosquito breeding sites. New systems which monitor the variations in climatic conditions are being applied to give advance warning of impending outbreaks by signalling the events which may predictably lead to increases in mosquito numbers. These will allow authorities to implement measures to avert the threatened epidemic. WHO's Role In response to the 1997-98 outbreak in northeastern Kenya and southern Somalia, WHO scientists and doctors led an international team which investigated the origins and epidemiology of the outbreak. Members of the team from WHO's headquarters and African Regional (AFRO) offices, its Kenyan and Somalian country offices, and several collaborating centres. For investigation, analysis and isolation of the virus, collaborating centres in Kenya (the Kenya Medical Research Institute), South Africa (the National Institute of Virology) and the USA (the Centers for Disease Control and Prevention) played key roles. تعريف الحالة المشتبه بها : هي حالة تعاني من الآتي : - أ- حمى غير معروفة السبب ( درجة الحرارة أكثر من 5 و 38 درجة مئوية ) لفترة تزيد عن 48 ساعة مع ارتفاع في وظائف الكبد لأكثر من ثلاث أضعاف المعدل الطبيعي أو مع ظهور يرقان . أو : ب- حمى غير معروفة السبب ( درجة الحرارة أكثر من 5 و 38 درجة مئوية ) لفترة تزيد عن 48 ساعة مصحوبة باجهاض ، نزف تحت الجلد أو نزيف ( على سبيل المثال مكان الوخز ، من الجهاز الهضمي ، زيادة نزف في الدورة الشهرية ) . أو :- فقد مفاجىء للبصر غير معروف السبب . أو :- حمى غير معروفة السبب ( درجة الحرارة أكثر من 5و38 درجة مئوية ) لفترة تزيد عن 48 ساعة ومصحوبة بدوار ، ارتباك ، فقدان احساس المكان والزمان ، نسيان ، نعاس أو نوم غير سوي ، هلوسة ، إرتجاف ، تشنجات ، أو غيبوبة أو:- وفاة غير معروفة السبب مع وجود تاريخ مرضي لحمى . * طريقة نقل العدوى : 1* لدغة بعض أنواع البعوض الناقل للمرض الكيولكس والأيدس . 2* ملامسة افرازات الحيوانات المصابة بالمرض . 3* إستنشاق الرذاذ المتطاير من أنسجة الحيوانات المصابة أو أجنتها أثناء عمل الفحص التشريحي البيطري لها . * فترة الحضانة :- فترة حضانة المرض 2-7 أيام . * فترة أنتقال العدوى : لا تنتقل العدوى مباشرة من الأنسان المريض الى السليم والبعوضة المصابة تصبح ناقلة للفيروس طيلة حياتها . * القابلية للعدوى : القابلية عامة - والعدوى البسيطة غير المشخصة يمكن أن تكون عامة - والعدوى تعطي مناعة ضد المرض . * طريقة المكافحة : أ- الإجراءات الوقائية : 1* اتخاذ الإجراءات المعروفة لاتقاء العدوى من لدغ البعوض 2* إتخاذ الإحتياطات اللازمة لوقاية الجسم من ملامسة دم الذبائح وأنسجتها 3* مكافحة المرض وسط الحيوانات الأليفة ب- المكافحة في المريض والمخالطين والبيئة : 1* الإبلاغ الفوري عن الحالات 2* العزل واتخاذ الإجراءات التحوطية نحو الدم وسوائل الجسم 3* عمل إستقصاء جيد للحالات والمخالطين لاكتشاف الحالات البسيطة بينهم ولمعرفة مصدر العدوى المحتمل . 4* مكافحة البعوض حول أماكن ظهور الحالات . 5* التوعية الصحية بطرق العدوى والمكافحة . * علاج المرض : لا يوجد علاج نوعي للمرض ويتم علاج الأعراض والمضاعفات . |
ISSUE NO. 3 | العدد الثالث |
GUIDLINES FOR THE MANAGEMENT OF SNAKE BITE |
PATIENT WITH SUSPECTED SNAKE BITE |
|
1 | snake brought and positively identified as poisonous or fang marks were clear ( CLICK ) |
2 | snake was brought and positively as non-poisonous,or no fang marks,no severe local pain, none of the expected local and systemic manifestation were detected . Observe for 4 - 8 hours to exclude misidentification . Give anti- tetanic serum and tetanus toxoid ( CLICK ) . |
DETERMINE IF SNAKE IS HAEMATOXIC OR NEUROTOXIC |
Discharge The Patient |
Give anti-tetanic serum and tetanus toxoid. Observe 24 hours . |
DETERMINE IF SNAKE IS HAEMATOXIC OR NEUROTOXIC |
Discharge The Patient |
Horned Viper Cerastes Cerasts |
Carpet Viper Echis Coloratus |
Saw Scaled Viper Echis Carinatus |
Puff Ader Bitis Arietans |
Labaratory Procedure and Expected Result if Snake is Haemotoxic |
LAB TEST | EXPECTED RESULT |
PT & APPT FIBRIN DEGRADATION PROD. FIBRINOGEN LEUKOCYTE RBC HEAMATOCRITE PLATELET Hb |
high * high * low * high low low low low |
* These parameters are not significantly changed in the case of B.arietans bite , however blood platelets are significantly reduced.
Expected Local and Systemic Manifestation if Snake is Haemotoxic : |
|
GIVE POLYVALENT SNAKE ANTIVNOME 50 ml ( 5* 10 ml ampoles) to be diluted in 250 ml normal saline infused i.v over 30 -60 minutes.some dose can be repeated every 4 - 6 hours until definite improvment take place. Children must be giventhe same dose as adults. |
arabian cobra naja haje arabicus |
black desertcobra walterinnesia aegyptia |
mole viper atractaspis |
* mole viper atractaspis mainly cardiotoxic causing coronaryvasoconstriction and AV block |
IF SNAKE IS POSITIVELY IDENTIFIED AS ARABIAN COBRA OR WALTERINNESIA AEGYPTIA assist respiration for patients who show severe neurotoxic symptom , application tensilon test ( edrophonium ) is necessary and manage according to the result . IS BIVALENT ANTIVENOM AVAILABLE AT YOUR HOSPITAL? YES: Give bivalent antivenom NO: Double the dose of polyvalent antivenom and give as bivalent antivenom |
EXPECTED LOCAL AND SYSTEMIC MANIFESTATION IF SNAKE IS NEUROTOXIC :
|
GIVE BIVALENT SNAKE ANTIVENOM 50 ml ( 5* 10 ml ampoles) to be diluted in 250 ml normal saline infused i.v over 30 -60 minutes.more antivenome should be given if sever signs persist after 1 -2 hours. dose can be repeated every 4 - 6 hours until definite improvment take place. Children must be giventhe same dose as adults. * please note that the antivenom dose isbased mainly on titration of the symptoms until clinical manifestation disappears. |
ISSUE NO. 4 | العدد الرابع |
GUIDLINES FOR THE MANAGEMENT OF SCORPION STING |
Discharge The Patient |
GIVE SCORPION ANTIVENOM *A. crassicauda *L.quinquestriatus The two most dangerouse scorpions in saudi arabia and two of the most toxic in the world . |
Labaratory Procedure
and Expected Result Some or all of these changes can be seen in the victims |
LAB TEST | EXPECTED RESULT |
WBC BLOOD GLUCOSE. CPK LDH AMYLASE Na & Ca K BLOOD GASES ECG X-ray |
high high high high high low high acidosis changes changes |
* Cause of death : cardiac failure , circulatory collapse , or respiratory failure .
POLY VALENT SCORPION ANTIVENOM Give 5*1 ampoules polyvalent scorpion antivenom diluted in a 20 - 50 ml half normal salin, i.v . over aperiod of 20 minutes . If systemic manifestation still exists , the same dose is to be repated every 2 hours up to 4 doses , then keep under observation for atleast 24 hours , sfter recovery. * please note that the antivenom dose isbased mainly on titration of the symptoms until clinical manifestation disappears. |
ADJUNCTIVE THERAPY TO SUPPORT VITAL FUNCTION * sever pain : 0.5 ml ( max.) of 1% xylocain , infiltrated at the site of the sting . * vomiting : chloropramazine 0.5 - 1 mg/kg i.m. repeated if necessary * convulsion : diazepam i.v slowly * pulmonary oedema : O2 , furosemide and fluid restriction . * dyspnea : IPPV * hyperthermia : acetaminophen suppository * hypertension : hydralazine or nifedipin * acidosis : correct blood gases and electrolytes * shock : c.v.p line with 0.5 normal saline to keep value at 8-12 cm H2O and maintain blood pressure at a level to perfuse vital organs .( systolic B.P. between 60-70 mm Hg in children ) . * CONTRAINDICATED DRUGS ( Don't Use ) : Barbiturates , Morphine or Pethidine , Beta Blockers |
* REFERNCE :
NATIONAL ANTIVENOM & VACCINE PRODUCTION CENTER
* For further information :
National Guard Health Affairs
Tel : 252-0252 ext. 5626/ 5655 fax: 252-0188
e-mail : navpc@ngha.org
ISSUE NO. 5 | العدد الخامس |
Phenylpropanolamin
may cause Hemorrhagic Stroke Food And Drug Administration (FDA)
is taking steps to remove phenylpropanolaminePPA from all
drug products and has requested that all drug companies
discontinue marketing products containing PPA . FDA issued a public health
advisory concerning the risk of hemorrhagic stroke(
stroke is characterized by either bleeding in the brain
because of ruptured vessel or impaired blood flow to a
part of the brain when a vessel is blocked by a clot )
associated with PPA . which is an Active ingredient
used in many (OTC) preparations cough and cold
medications as a decongestant , the Ministry Of Health
has taken steps to stop marketing of the following 21
preparations that contain this Substance:
1-Pholrine pediatric syrup .
(Misr medical services) 2-Tutssal pediatric syrup.
(AlJazirah) 3-Tussal expectorant .
(AlJazirah) 4- Tussal B.T. syrup.
(AlJazirah) 5-Tussal plane syrup.
(AlJazirah) 6-Conta- flu tab.
(Smith&Kline
Beecham) 7-Noflu tab.
(Cairo comp.) 8-Rubitiussin C.F syrup.
(A.H Robins)
9-Dimetapp Extan tab. 10-Dimetapp syrup.
(A.H Robins) 11-Escornade syrup. (Smith
Becham) 12-Escornade cap. 13-Contrasal S.F
adult syrup. (AlHikma) 14-Contrasal expectorant syrup .
(AlHikma) 15-Contrasal B.T. syrup.
(AlHikma) 16-Contrasal P.J pediatric syrup.
(AlHikma) 17-Contrsal P.J adult syrup.
(AlHikma) 18-Kidi Kold syrup.
(AlHikma) 19-RhinoTussal syrup.
(Mack) 20-Rhinopront syrup.
(Mack) 21-Corcidine D. tab .
(Schering) Antimicrobial
Agents Associated With Photosensitivity : Amantadin , azithromycin ,
ciprofl-oxacin , clofazimin , dapsone , dox- ycycline , erythromycin ethyl
succ- inate , griseofulvin ,
norfloxacin , ofloxacin , pyrazinamide , sulfon- amide , tetracyclines ,
trimethoprim Drugs And Breastfeeding
Research
in the United state , Canada , Europe , and other
developed countries among predominantly middle-class
population , provides strong evidence that human-milk
feeding decreases the incidence and/or severity of
diarrhea , lower respiratory infection , otitis media ,
bacterial meningitis , botulism , urinary tract infection
, and necrotizing enterocolitis , There are a number of
studies that show a possible protective effect of human-milk
feeding against sudden infant death syndrome , insulin-dependant
diabetes mellitus , crohn's disease , ulcerative colitis
, lymphoma , allergic diseases and other chronic
digestive disease .
The following questions and options
should be considered when prescribing drug therapy to
lactating women (1) Is the drug therapy really necessary?
Consultation between the pediatrician and the mother's
physician can be most useful . (2) Use the safest drug ,
for example , acetaminophen rather than aspirin for
analgesia . (3) If there is a possibility that a drug
maypresent arisk to the infant , consideration should be
given to measurement of blood concentrations
in the nursing infant. (4) Drug exposure to the nursing
infant may be minimized by having the mother takes the
medication just after she has breastfed the infant and/or
just befor the infant is due to have a lengthy sleep
period. Drugs Contraindicated during breastfeeding : Bromocriptin , Cyclophosphamide Cyclosporine , Doxorubicin ALL DRUGS OF ABUSE
INCLUDING:
Amphetamine , Cocaine , Heroin Ergotamine , lithium ,
methotrexate , Radiopharmaceuticals , lysergic acid diethylamide ( LSD) , phencyclidine ,Drug listed as compatible* with breastfeeding by American Academy of Pediatrics ( AAP) :Acetaminophen , Captopril ,Acyclovir
, Atropine , Baclofen ,
Caffeine , Carbamazepine ,Cephalosporins , Cimetidine , Clindamycin , Digoxin ,
Diltiazem, Enalapril , Erythromycin ,
Ethosuximide , Hydralazine , Ibuprofen , Minoxidil , Naproxin ,
Methyldopa, Nifedipin , Penicillin ,
Phenytoin , Prednisolone , Propoxyphene , proPylthiouracil , Pseudoephedrine , Quinidine , Quinine , Rifamicin , Senna , Spironolacton , Tolbuta
mide, Trimethoprim , Valproic acid , Verapamil , Warfarin
. * Compatibility does not
indicatethat a drug is risk-free in breastfeeding dyads ;
it suggests only that in most situation , there is
sufficient evedence to imply safety . Additional drugs
having significant evidence* for safety in breastfeeding
dyads Albuterol inhalers , Amantadine
, Azathioprine , Azithromycin , Beclomethasone inhaler ,
Cholestyramine , Clomipramine , Cromolyn sodium , Famotidine , Fluconazole ,
HeptitisA vaccin , Influenza vaccin , Insulin ,Fluvoxamin
, Heparin , Ipratropium inhaler , Levothyroxine ,
Lortadine , Metoclopramide , Nortriptyline , Nystatin ,
Omeprazole , Ondansetron , Ranitidine , Sulfamethoxazole
. * Case report data , pharmacokineetic properties , andlor pediatric use data . |
ISUUE NO. 6 | العدد السادس |
REDUCING
NSAID –INDUCED
G.I ULCERATION IS
POSSIBLE
The widespread use of
NSAIDS , including aspirin, attests to the efficacy of
these agents for relieving pain, inflammation and fever .
However , it is now well recognized that a significant
disadvantage of NSAIDS use is an increased risk of
gastroduodenal ulcers. Strategies to minimize
these events include: avoiding NSAIDS , using the lowest
effective dose , avoiding certain concomitant medications
(e.g. corticosteroids ) or use of one of the new
generation of highly selective cyclo-oxygenase type 2 (cox-2)
inhibitor NSAIDS . For patients who are at high risk of
developing adverse gastric events (e.g. the elderly and
those with a prior history of ulcer) , pharmacological
prophylaxis may be appropriate and possiblycost effective. The prostaglandin
misoprostol and proton pump inhibitor omeprazole are the
most promising agents for prevention of gastroduodenal
ulcers. The annual death rate
among patients with rheumatoid and osteoarthritis due to
serious adverse consequences of gastroduodenal ulceration
( perforation and haemorrhage ) has been estimated to be
as high as 16500 in US alone .Overall, the relative risk
for severe gastroduodenal complications is approximately
3 to 10 times greater for NSAIDS users than non-users
depending on the NSAID being used. Even low dose aspirin increases the relative risk of ulcer haemorrhage or perforation 2 to 4 fold. Many strategies for damage prevention : a topical effect and a systemic effect. The first step in
preventing NSAID-induced gastroduodenal ulceration is to
carefully asses the need for NSAID Therapy. Wherever
possible , non NSAID analgesic (e.g. paracetamol should
be used .If treatment with NSAID is necessary the lowest
possible effective dose should be as there is evidence to
suggest that the development of ulcers is dose related.
High gastric acidity
contributes to NSAIDS injury in the stomach and
duodenal bulb.
Increasing the gastric
mucosal PH can prevent G.I damage , presumably by
increasing the time for mucosal repair. The proton pump
inhibitor, omeprazol (losec) has been shown to reduce
ulcer rate by up to 80 % compared with no treatment.
Misoprostol provides
cytoprotetion Intragastric prostaglandins
exert various protective effects including :stimulating
the section of bicarbonate and mucous, increasing the
resistance of the surface epithilium to injury and
preserving intravascular blood flow. Co-administration of
an exogenous prostaglandin such as misoprostol with NSAIDS
would be expected to be beneficial. Chemoprophylaxis for high
risk patients Various risk factors have been
identified which predispose to the development of a
serious gastrointestinal event. Probably the most
important of these advanced age (<60 years ) . It has
been suggested that for patient < 1 risk factor
consideration should be given to the administration. Of
preventive treatment, either misoprostol or omeprazole.
Other anti-ulcer agents such as histamin H2 antagonists
was limited to protection against duodenal ulcers in a
large comparative trial with omeprazole and sucralfate
has been shown to be ineffective. Ref. www.medscape.com (
drug&ther perspect 2000) PHARMACIST
SAVE LIVES LIKE SUPERMAN Every day pharmacists save
the lives of patients by many ways like to check wrong
prescription ( names and doses , side effects) and drug
interactions that some time doctor cannot judge.
One patient came to
pharmacy with a prescription and the doctor prescribed
for him danol . When the pharmacist checked the diagnosis
was peptic ulcer ( danol is the drug which
is used for different diagnosis ). The pharmacist
discussed with the doctor . Actually he wanted to write denol
which is used for peptic ulcer , by mistake of alphabet
he wrote this drug (i.e. A & E ) .
So pharmacist saved the
life of patient from fatal action of the drug . Some times pharmacist detect serious
illness that required hospitalization , one lady came for
cough syrup. Pharmacist detected that patient has sever
illness and he informed her doctor who admitted her in
hospital and was diagnosed as a case of CHF. One mother came with child for
laxative , but child was feeling abdominal pain , so,
pharmacist sent him to doctor where he was operated for
acute appendicitis. So , Pharmacist should check the
drug , dose , side effects , and interaction. So , all
prescriptions should be passed through pharmacists who
are super hero or super heroins of the pharmacy PEANUTS
ALLERGY MAY BE TRIGGED BY BREAST FEEDING some moms should
avoid peanuts products while nursing mother to her It is
proved that some proteins from peanuts can be transmitted
through lactating baby by breast feeding. These proteins cause allergic
reaction in babies who are exposed to peanuts allergy. So
children should not be exposed to peanuts until after age
of 3 if parents or other family member , have a history
of Br. Asthma , allergies or eczema such mother should
not include peanut in their diet if they are on breast
feeding . |
ISSUUE NO. 7 | العدد السابع |
PRUDENT VANCOMYCIN USE There
have been several reports of the rapid increase in the
incidence of infection and colonization with vancomycin
resistant enterococci (VRE) which have become world wide
problem. Several
factors have been associated
with VRE
and these include: A. Prior
exposure to vancomycin and multi-antimicrobial therapy. B. Severe
underlying disease or immunosuppression. C. VRE
gastrointestinal colonization. D. Transmission of
microorganisms from patient to patient either via direct
contact or indirectly via hands of personnel or
contaminated patient care equipment or environmental
surfaces. E. Prolonged
hospital stay. F. Physical
location in the hospital. There is the
growing concern that if vancomycin is not use cautiously,
the vancomycin resistant genes present in VRE may be
transferred to other gram-positive microorganisms such as
staphylococcus aureus. The following are
some of the recommended measures by the US hospital infection
control practices advisory committee (HICPAC) for the
prudent vancomycin use. A. Situations in
which the use of vancomycin is appropriate or acceptable: 1. Serious infection with
beta-lactam-resistant gram-positive organisms. 2. Infections with gram-positive
organisms in patient with serious allergy to beta-lactam
antimicrobial agents. 3. When antibiotic-associated
colitis(AAC) fails to respond to metronidazole therapy or
if AAC is severe and potentially life-threatening. 4. Prophylaxis, as
recommended by the American Heart Association, for
endocarditis in certain situations. 5.
Prophylaxis for major surgical procedures
involving implantation of prosthetic materials or devices
at institutions with high rates of infections due to
methicillin resistant Staphylococcus aureus (MRSA) or
methicillin-resistant S. epidermidis (prophylaxis should
be discontinued after maximum of two doses). B. Situations in which
the use of vancomycin should be discouraged: 1.
Routine surgical prophylaxis other than in a patient with
life-threatening allergy to beta-lactam antimicrobial
agents. 2.
Empiric therapy for a febrile neutropenic patient,
unless there is strong evidence that patient has an
infection due to gram-positive microorganisms, and
prevalence of infections due to MRSA in the hospital is
substantial. 3.
Treatment in response to a single blood culture for
coagulase- negative staphylococcus, if other blood
cultures drawn in the same time frame
are negative. 4. Continued empiric use
for presumed infections in patients whose culture are
negative for beta-lactam resistant gram-positive
microorganisms. 5. System or local prophylaxis for
infection or colonization of indwelling central or
peripheral catheters. 6. Selective
decontamination of the digestive tract. 7. Eradication of MRSA
colonization. 8. Primary treatment of
AAC. 9. Routine prophylaxis of
low birth-weight infants. 10. Routine prophylaxis for
patients on continuous ambulatory peritoneal dialysis or
hemodialysis. 11. Treatment of infections
due to beta-lactam-sensitive gram-positive microorganisms
in patients with renal failure (for dosing convenience) 12. Use of vancomycin
solution for topical application or irrigation. Reference: Hospital
Infection Control practices advisory committee (HICPAC) PHENYLPROPANOLAMINE
(PPA) IN THE NEWS AGAIN The Pharmacy Bulletin
of March 2001 highlighted the issue of
Phenylpropanolamine (PPA) causing Haemorrhagic
stroke and the recommendation of food and drug
administration (FDA) regarding the use of pharmaceutical
preparation containing PPA. However, recent studies
both in the U.K & U.S.A. on causing haemorrhagic
stroke have been associated with factors such as smoking
status, hypertension, race and level of education. The committee on safety
of medicines (CSM) of the medicines control agency (MCA)
reports that the evidence of the link between PPA and
haemorrhagic stroke was weak and that the benefits of PPA
as used in the U.K still outweigh the risks. However it warns that: 1. Patient with
hypertension, hyperthyrodism heart disease or those
taking mono-amine oxidase inhibitors should not receive
PPA products. 2. All patients should not
exceed the stated dose. ONE
ALPHA DROPS (alphacalcidol) ACCIDENTAL
OVERDOSE . Alfacalcidol is indicated
in all conditions where there is a disturbance of
calcium metabolism due to 1- alpha hydroxylation. These
include renal osteodystrophy, hyperparathyroidism (with bone disease), neonatalhypocalcaemia,
hypoparathyroidism, and vitamin D- dependent rickets. There have been |