Wednesday, December 31, 2014
Thursday, October 16, 2014
Tuesday, May 13, 2014
GOUT
Gout
is a medical condition usually characterized by recurrent attacks of acute
inflammatory arthritis- a red, tender, hot, swollen joints. Gout causes
inflammation of your joints usually in your arms or legs. However, it can
affect any of your joints, including those found in your feet and ankles,
knees, hands, fingers, wrist and elbows.
According
to the UK Gout Society, gout affects around 1 in every 100 people. It’s more common
in men, particularly those aged 30 to 60 and in older people.
Causes:
You
can develop gout if you have much uric acid in your body. Uric acid is a
chemical that everyone has in their blood. Excess uric acid is passed through
your kidneys and out of your body in your urine. However, the level of uric
acid in your blood can rise if
1) Yours
kidneys don’t pass uric acid quickly enough.
2) Your
body produces too much uric acid.
If
level of uric acid in your body is too high, it can form tiny crystals that
collect in your tissues, particularly in and around your joints and may cause
swelling and pain. These crystals tend to form at a cooler body temperature
which is why gout is more common in your fingers and toes.
Who are at risk of Gout?
1) Are
men aged of 30-60
2) Are
women who has been through the menopause
3) Eat
a diet that contains high level of purines which are found in red meat, sea
food and some other foods.
4) Drink
too much alcohol, especially beer.
5) Do
not drink enough fluid daily & become dehydrated
6) Taken
certain medicines, such as diuretics which increase the flow of urine from your
body
7) Have
a family history of gout
8) If
your kidneys do not pass enough uric acid out in your urine
9) Are
overweight, have diabetes and high blood pressure
10) Have
psoriasis ( itchy, dry & flaky skin ) which can sometimes cause your body
to produce too much uric acid
11) Are
taking certain types of cancer medicines
Diagnosis of gout:
1) Take
a sample of blood which will be sent to the laboratory to measure the level of
uric acid
2) Remove
some fluid from your swollen joints with a needle, if uric acid crystals can be
seen in your fluid so you have gout
3) May
need to have an x-ray of your joints in order to diagnose gout
Complications:
1) The
most common complication of gout is progressive joint damage which leads to
long term pain, deformed joints & eventually disability
2) Prolonged
high level of uric acid in your body can increase your risk of vascular
diseases which may lead to heart attack or stroke
3) Damage
your kidneys if uric acid crystals collect in your kidney tissues
Prevention:
1) Gout
can be prevented from reoccurring so often & so severely by making changes
to your diet and taking medicines if needed
2) Choose
to eat and to drink that cannot increase the level of uric acid in blood
3) Drink
enough water every day that will help to dilute your blood and urine, results
in lowering the level of uric acid in blood
4) Doing
regular exercise
Self-help:
There are number of steps you can take to
reduce the pain & swelling from having gout
1) Raise
and rest your joints, do not attempt any vigorous physical activity
2) Keep
your joints cool and do not cover it. Ice the affected joints by using an ice
pack or ice wrapped in a towel for about 20 minutes , at a time to reduce
swelling and bruising. Do not apply ice directly to your skin, it can damage it
3) Drink
enough water
Treatment:
There are certain medicines that can prescribe
to help to ease your pain and swelling from gout.
1) Non-steroidal
anti-inflammatory drugs ( NSAIDs ) , such as ibuprofen and naproxen which may
relieve pain and inflammation but if you have heart attack, high blood
pressure, kidney or lung disease, or over 65 so these medicines may be harmful
& do not take aspirin because it can affect your uric acid level and make
your gout last longer
2) If
NSAIDs are not suitable for you, your doctor may prescribe a medicine called
colchicines which reduces pain & swelling.
3) Third
option is steroids tablets if you cannot take NSAIDs or colchicines
4) Steroid
joint injection is recommended if you have gout in a large joint ( such as knee
joint )
REMEMBER;
ALWAYS CONSULT YOUR DOCTOR OR PHARMCIST BEFORE TAKING ANY TABLET OR MEDICINE.
NAZNEEN ZULFIQAR
PHARM-D, KU
LOWESTOFT, UNITED KINGDOM
Wednesday, April 30, 2014
MIGRAINE
Many
people are talking to social media sites such as twitter to share the agony of
their migraine pain, sharing the agony with other sufferers on social media
indicates a trend towards the cathartic sharing of physical pain as well as
emotional pain . Migraine poses a huge public health problem, harming mood,
productivity and overall quality of life. An estimated 12% of the western world
population suffer migraine attacks and of those 75% see reduced functionally
and 30% require bed rest.
Migraine is a chronic neurological disorder characterized
by repeated attacks of several headaches. A migraine headache causes throbbing
and pulsating pain, usually on only one side of the head. A migraine is not
simply a bad headache. A migraine is an intense headache accompanied by other
symptoms such as nausea (feeling sick), visual problems and an increased
sensitivity to light or sound.
The
intense throbbing , pulsating pain, and excruciating pain that accompanies a
migraine can be so debilitating more than 90% of sufferers are unable to work
or function normally during an attack. Around two-third of adults who
experience migraine is women. About one
in five women and one in ten men in the united state have experienced a
migraine or severe headache in the first three months and migraine ranks as one
of the top 20 most disabling medical conditions worldwide. A migraine can last
up to 72 hours and the 14 million people that suffer from chronic migraines
live in fear of their next attack, knowing that it can happen at any time,
without warning. Although, migraines are not life threatening and do not
shortens people’s life expectancies. They can significantly damage the quality
of people’s lives (Migraine Research
Foundation, 2013).
Types of migraine:
There
are 2 types of migraine:
1) Hemiplegic migraine:
People
with hemiplegic migraine experience paralysis or weakness on one side of the
body, disturbance in speech and vision, symptoms can last for several days.
a)
Familial
hemiplegic migraine (FHM ):
Is an inherited genetic migraine
disorder that causes hemiplegic migraine. If parents, siblings or child has
FHM, the chances you will have FHM are higher.
b)
Sporadic
hemiplegic migraine (SHM ):
Occur in people without the genetic
disorder and without a family history of hemiplegic migraine.
2) Ophthalmic migraine:
Also
sometime called ocular or retinal migraine are rare migraine variants
characterized by repeated instances of visual disturbances such as blind spots
or blindness on one side of the field of vision.
Migraine Aura:
Around
one in five people who experience migraine experience an aura before their
attack. An aura is a warning sign that a migraine is about to happen. People
commonly experience an aura between 20 minutes and one hour before the headache
stage of their migraine. The main symptoms of aura are visual problems such as
blurred vision (difficulty focusing), blind spots, and flashes of light or a
zigzag pattern moving from the central field of vision towards the edge. Other
aura symptoms include tingling sensation ( pins & needles ) in the face,
lips and tongue or in the arms and legs, speech problems such as slurred
speech, dizziness, a stiff neck, and a very rarely loss of consciousness.
Symptoms of Migraine:
The
main symptoms of migraine are an intense throbbing or headache often affecting
the front or one side of the head, nausea (feeling sick), and vomiting and
increased sensitivity to light and sound. The throbbing headache is often made
worse by the person moving. Other symptoms of migraine might include poor
concentration, feeling hot or cold, perspiration (sweating) and increased need
to pass urine. People might also experience stomach and diarrhea. It is common
for people t feel tired for up to two or three days after migraine.
Migraine causes:
The
exact cause of migraine is still unknown; it seems to be an electrical
disturbance in the brains of people who experience an aura before their attack,
there appear to be change in the blood vessels in the brain. People with high
blood pressure are at a high risk of experiencing migraine. Women are more than
twice as likely as men to experience migraine. This is due to hormonal factors.
Women might find that they experience a migraine just before or just after the
start of their periods.
Some
women find that oral contraception (the pills) can trigger migraine. It might
be women experience migraine as they approach the menopause or that hormone
replacement therapy (HRT) triggers migraine.
Migraine triggers:
There
are various factors which might trigger a migraine. Each is different and you
should try to identify which factor might apply to you and try to avoid them.
Many people find that they are able to that one of the triggers o is own but a
combination of more than one trigger can push them over their threshold and
cause an attack.
1)
Emotional
triggers:
Include stress, anxiety, excitement and
shock.
2)
Physical
triggers:
Include tiredness, irregular sleep,
tension in the neck & shoulder, eye stress (for example after using a
computer screen) and dental problem (for example teeth grinding).
3)
Dietary
trigger:
Include lack of food (dieting),
irregular meals, dehydration, alcohol, caffeine, certain food such as chocolate,
cheese, citrus fruits, certain food additives such as monosodium glutamate (
MSG ), aspartame ( a sweetener ), nitrates.
4)
Environmental
triggers:
Include bright light, loud noise, and
smoky environment.
5)
Other
triggers:
Other triggers include smoking and some
sleeping tablets.
Treatment of migraine:
1) Most
people find that lying down in a quite dark room reduces the pain of migraine.
2) Sleeping
(If you are able) can also help to treat migraine.
3) Some
people find that symptoms die down after they have vomited.
4) Some
people find that pain relief medications like paracetamol, aspirin, and
anti-inflammatory drug like ibuprofen are effective, especially if they take
them at the very first sign of an attack.
5) People
might also benefit from anti-sickness medications.
6) People
might be prescribed general strong pain relief medication such as Triptan which
is a specific migraine medication. If situation does not improve after treatment
than you might referred to a specialist migraine clinic.
Who is at risk for a
Migraine headache?
The
risk factors for migraine headache include:
1)
Age:
Most people will experience their first
migraine headache before or during adolescence
2)
Family
history:
Migraine headache can be hereditary.
More than 75% of people who suffer from migraine headache have a parent or
sibling who has migraine.
3)
Gender:
Women are three times more likely to
have migraine headaches than men. Women who have migraine headaches have more
frequent migraine compared to men who experience migraine.
.
Tips to
prevent Migraine:
1) Stay
on a regular sleep schedule
2) Eat
regularly
3) Drink
plenty of water to keep hydrated & trying to avoid stress
4) Avoid
food triggers such as caffeine, chocolate, cheese, alcohol, red wine.
5) Exercise
regularly
6) Avoid
stressful situations
NAZNEEN ZULFIQAR, PHARM-D, KU
LOWESTOFT, SUFFOLK, UNITED KINGDOM
Tuesday, April 8, 2014
FDA Advisory Panel Endorses Inhaled-Insulin Product Afrezza
A US Food and Drug Administration (FDA) advisory panel has voted in favorof MannKind's Afrezza (Technosphere insulin-inhalation system) for the treatment of both type 1 and type 2 diabetes in adults.
Votes of the Endocrinologic and Metabolic Drugs Advisory Committee in favor of Afrezza were 13-1 for type 1 diabetes and 14-0 for type 2 diabetes. One panel member left early and did not vote.
Afrezza consists of a premeal insulin powder loaded into a cartridge for oral inhalation. The company is seeking an indication as an ultrarapid-acting insulin for adults with type 1 or 2 diabetes. In type 1 patients, the indication would be for use with injected basal insulin.
Panel members cited the advantages of more rapid onset of insulin action and shorter duration, resulting in a lower risk for hypoglycemia, as well as the potential for greater acceptance of inhaled-insulin therapy for patients with type 2 diabetes who might otherwise refuse or be unable to self-inject insulin.
However, the panel did express concern about data suggesting lower glucose-lowering efficacy compared with injected short-acting insulin (aspart) in type 1 patients and about lack of long-term lung-function data beyond 2 years, as well as a possible signal for lung cancer.
Panel members presented the agency with a long list of recommendations for postmarketing studies and labeling requirements to address those issues, among others.
Risks vs Benefits
Technosphere insulin begins working within 12 to 15 minutes, peaks by 30 minutes, and is essentially cleared by 180 minutes. Current rapid-acting insulins, in contrast, peak at about 1 hour and remain in the circulation up to 5 hours.
In a pivotal trial involving 353 patients with type 2 diabetes inadequately controlled on 1 or more oral agents, Afrezza was superior to placebo in lowering HbA1c at 24 weeks, with a week-24 treatment difference of -0.40 (P< .0001). However, in a pivotal study of 344 patients with type 1 diabetes, Afrezza had significantly inferior HbA1c reduction compared with premeal injections of insulin aspart, although the difference remained within the prespecified noninferiority margin.
Rates of severe hypoglycemia were 43% lower among the type 1 patients with premeal Afrezza compared with aspart injections.
Cough was the most common adverse event, occurring in 27% of all the study subjects and leading to discontinuation in 3%. Small decrements in forced expiratory volume in 1 second (FEV1) of about 40 to 60 mL were noted within the first 3 months and persisted for the 2 years of follow-up, although there wasn't further progression.
Because of the risk for bronchospasm in patients with underlying lung disease, including chronic obstructive pulmonary disease (COPD) and asthma, the product would be contraindicated in those groups, and the label would include recommendations for screening of patients for these conditions before starting them on Afrezza and possibly for periodic ongoing monitoring of lung function as well.
A total of 4 cases of lung cancer occurred in patients who had used Afrezza, 2 during the trial in smokers, and 2 others, both squamous-cell tumors, at 2.6 and 3.8 years after the end of the trial in nonsmokers. An oncologist on the panel, Liz Szabo, MD, from the National Cancer Institute, called that "unusual" and advised that more data be collected.
Pulmonologist James K. Stoller, MD, of the Cleveland Clinic Foundation, voted yes for both type 1 and type 2 because he was "extremely impressed by the unmet need and the advantages of this drug for subsets of individuals." Nonetheless, he said he remained concerned about the potential for the product's use in patients with unrecognized COPD and expressed skepticism about the extent of adherence to a label recommendation for spirometry.
"I think we sometimes take solace that the labeling indications will inform against risk, but I am highly concerned that would not be the case in clinical practice, regardless of what it says in the label." Because of that, he advised that the contraindication include ever-smokers as well as current smokers.
Acting committee chair Robert J. Smith, MD, an endocrinologist at Brown University, Providence, Rhode Island, raised the concern that MannKind had not done a study in which Afrezza was added to basal insulin in type 2 patients, whereas basal insulin is typically introduced first in clinical practice.
Nonetheless, he also voted yes for both type 1 and type 2 patients. "Perhaps the strongest motivation for me is that an inhaled form of insulin represents a drug that will serve some patients who are not effectively served by currently available forms of insulin. I am convinced enough by the efficacy data to believe that there are at least some subgroups of patients that will substantially benefit."
However, Dr. Smith added, "I think it's quite possible that there are other subgroups, and perhaps even a majority of type 1 diabetes patients, who would do better in terms of glucose control on injected rather than this form of insulin."
He also said he voted yes because "the data about potentially serious adverse events are not strong enough that I feel it's imperative to resolve those questions before the drug might be marketed, but I think there are a number of potential concerns about adverse effects that are very, very important to follow up postmarket."
FDA advisory panel members are vetted for conflicts of interest and are given temporary waivers for participation if necessary. No waivers were issued for this meeting
Source:
Tanveer Hussain MS, IRPH
Clinical Pharmacist, VA HVHCS
Castle Point, NY
Sunday, April 6, 2014
Health Tips
BE ACTIVE.
Physical activity of at least 2½ hours a week will help you to:
1.Maintain weight
2.Reduce high blood pressure
3.Reduce risk for type 2 diabetes, heart attack, stroke, and several forms of cancer
5.Reduce arthritis pain and associated disability
6.Reduce risk for osteoporosis and falls
7.Reduce symptoms of depression and anxiety
DR I SYED.
Subscribe to:
Posts (Atom)
