Uses and side effects of Airtec-SF

Airtec-SF is an inhaled medication, prescribed in bronchial asthma and COAD (Chronic obstructive Airway disease) patients. It is a mixture of steroid and a long acting bronchodilator. Steroid is Fluticasone. Long acting bronchodilator is Salmeterol.

Airtec-SF is available as a dry powder Airtec-SF Diskus and as an Airtec-SF HFA aerosol. Usage instructions should be taken from the healthcare professionals.

What are the common side effects of Airtec-SF?

Side effects due to the steroid Fluticasone in Airtec-SF

High doses of inhaled steroids suppress natural steroid production. Due to this suppression you may need increased doses of steroids during illnesses.

So you should not stop the medication without consulting your doctor. Also you should have a Steroid card with you all the time if you are on high dose of steroids. This card is needed inform health care professionals that you are on steroids, if you are found unconscious.

High doses of inhaled Fluticasone are associated with increased chance of having respiratory tract infections. Bone mineral density may be reduced, so patients may get osteoporosis. Hoarseness of the voice and oral fungal infections can occur with this medication.

Side effects due to Salmeterol in Airtec-SF

Palpitations, fine tremor, nervous tension and headache are the commonest side effects. Rarely nausea, increased heart rate, sleep disturbances and muscle cramps can occur.
Very rarely heart attacks, low blood pressure and allergies are reported.

What the doctor should know before prescription?

The doctor should know your complete medical history including over the counter medications you are on, before prescribing Airtec-SF. If you have,

* Hyperthyroidism
* Heart disease
* Hypertension
* Liver disease
* Diabetes mellitus

Then you need to discuss with your doctor before taking Advair. This medication is known to lower blood potassium levels. So doctors will monitor blood potassium levels in severe asthma.
Before prescribing this, the doctor should know whether you are pregnant or nursing as well.

How Airtec-SF acts?

In asthma and COAD, inflammation of the smaller airways blocks the airflow and causes symptoms. Inflammation causes edema and narrowing of the airways.

Steroids like Fluticasone reduce the airway inflammation associated with bronchial asthma. They are prescribed to treat and to prevent asthma attacks. Inhalation steroids are preferred to oral in the long term treatment, because oral steroids need to go through the blood to reach the lungs. But inhalation steroids directly go into the lungs, bypassing other organs.

Salmeterol is a long acting bronchodilator in the selective beta agonist family. They dilate already narrowed small airways in the lung and give a rapid response. Due to this bronchodilators are used to treat bronchial asthma. But longer acting (steroid) drugs are prescribed to prevent attacks.

Airtec-SF is usually indicated in patients who have a poor response to long term inhalation steroids.

Sources
BNF

Uses and side effects of Glamoxin Syrup

Glamoxin Syrup is a common prescription only broad spectrum antibiotic in the penicillin group. Its generic name is Amoxycillin. This medication is quite effective and has low side effects profile. Glamoxin acts by inhibiting bacterial cell wall synthesis.

This medication is available as capsules, tablets, suspension form for children, and injection form. Oral Glamoxin should be taken as whole with a full glass of water to minimize side effects. In addition, taking this medication with food reduces gastric side effects.  Some doctors prescribe antacids with Glamoxin to reduce gastric side effects. Before prescribing Glamoxin , your doctor should know whether you have kidney problems, liver problems, fever with red rashes, gout, leukemia or allergies to the penicillin group of antibiotics.

Common side effects of Glamoxin Syrup

 One of the most common side effects reported with Glamoxin are gastro intestinal effects (nausea vomiting and diarrhea). Usually it is not a problem to most of the patients. Some patients are allergic to beta lactam antibiotics. These patients can develop allergic rashes to Glamoxin . Certain patients can get edema in lips tongue and skin (hives) as well.

Serious side effects of Glamoxin Syrup

 Very rarely patients can develop another life threatening complication called anaphylactic reaction (shock). This is characterized by sudden faintish ness, low blood pressure, and pallor. In an anaphylactic reaction, drug should be discontinued immediately, and patient should seek emergency medical help. Rarely some patients have reported skin peeling off from the body and erythema multiforme.

Rarely patients can develop a condition called antibiotic associated colitis. This is common to most of the broad spectrum antibiotics. It is characterized by severe foul smelling diarrhea with gross blood and mucus, and abdominal cramps. Antibiotic associated colitis is caused by toxins released by a bacteria called clostridium difficile. It is a bacterium in normal intestinal flora. Broad spectrum antibiotics like Glamoxin disrupt normal intestinal flora and allow overgrowth of bugs like clostridium difficile.

Amoxicillin Rash

Some patients can develop rashes, even without an allergic history to Penicillin antibiotics. These are sometimes called Amoxicillin rashes. It is a rash with a red patch and a skin elevation. This appears usually 3-14 days after initiation of therapy. It usually begins on trunk, and spreads out to involve most of the body. In most patients’ rash subsides in 6 – 14 days even with the drug. It will settle usually in seven days once the drug is discontinued.  Incidence of Amoxicillin rash is higher with several viral infections. It is especially common in Infectious Mononucleosis Infection (Glandular fever), and in lymphatic leukemia. Increased incidence of rash is also reported in patients who are taking both Amoxicillin and Allopurinol for gout.

Other side effects of Glamoxin

Very rarely patients can develop convulsions due to CNS toxicity. Especially in high doses with renal impairment. Doctors will reduce the dose, if you have renal impairment. Reduced effectiveness of Oral Contraceptive Pill is a debatable drug interaction. It is usually consider as a safe Drug in pregnancy and lactation.

Sources
British National Formulary 58th edition. www.bnf.org

Symptoms, complications and treatment of Abruptio placentae

Placental abruption is separation of the placenta from inner wall of the uterus that occurs before the onset of labor. Main symptoms of placental abruption are vaginal bleeding, severe abdominal pain and reduced fetal movements. It should be suspected in any woman who develops vaginal bleeding in the last three months of pregnancy.

It is one of the leading cause of vaginal bleeding and maternal death in the last three months of pregnancy (third trimester) and It can occur in any 9 mothers out of 1000. In addition to the maternal problems, this can seriously affect the fetus.This has around 20 – 40 % death rate for the fetus, even in the best units in the world, and accounts for around 6% maternal deaths.

Placental Abruption is more common in African American women in USA. Increased risk is observed in women less than 20 years and more than 35 years.

What causes it?

Multiple risk factors are identified like smoking prior and during pregnancy. Cocaine abuse is another risk factor.

Abdominal trauma is a well known cause of Placental Abruption. Especially by road traffic accidents. It can occur due to wearing of seat belts in the mid abdomen. Lower seat belt should extend across pelvis to prevent placental abruption.

Other more common causes are previous placental abruption, prolonged rupture of membranes, chorioamnionitis (infection in fetal membranes), hypertension in pregnancy, maternal age >35 and low socioeconomic status.There is also a relationship with thrombophilia (Increased blood clot formation) according to some literature.


What are the symptoms?

Symptoms are mainly vaginal bleeding (80%), severe abdominal pain, uterine contractions, uterine hardness and low fetal movements. During the clinical evaluation, doctors try to differentiate this with placental previa (placenta is situated lower than normal) and the normal labour.

What is a concealed hemorrhage?

Sometimes blood is pooled between placenta and the uterus. So the patient is only having a severe abdominal pain without vaginal bleeding. Rarely low fetal movements are the only presenting symptom.

The doctor will detect low blood pressure, high pulse rate, abdominal tenderness and reduced fetal heart sounds. Prolonged reduced fetal heart sounds usually carry a bad prognosis for the fetus.

What are the tests patient must undergo?

Ultra sound examination, is the best form of investigation. But it is dependent on the experience of the radiologist. In addition, negative ultra sound scan does not exclude placental abruption.

Management can continue only with the clinical judgement of the doctor. Possible ultra sound scan findings consistent with placental abruption include seeing a retroplacental clot (Blood clot between placenta and uterine wall), expanding hemorrhage  and reduced fetal heart beat.

Fetal Cardiotocograph is a chart of fetal heart rate over time. It can reliably detect fetal compromise. In placental abruption Cardiotocograph will show reduced heart rate for longer time.

 How placenta abruption is treated?

It depends on the degree of placental abruption. Treatment includes watchful waiting in mild abruptions, and caesarian section if the baby is alive. But if the mother is stable and baby has died vaginal delivery is the preferred option.

What are the complications?

Intra uterine fetal death is the most devastating complication other than the maternal death. Prolonged bleeding is the main cause of maternal deaths. Maternal death may be the outcome of disseminated intravascular coagulation (wide spread clot formation, which leads to consumption of clotting factors in blood) as well.

Termination of the pregnancy is the only treatment option in most of the time. It has to be done even the baby is premature to save the life of mother. Sometimes Hysterectomy (Removal of uterus) is the only option available to save the mother's life.

Further reading/Sources
1. www.emedicine.com
2. Obstetrics by Ten Teachers  by Christoph Lees

Uses and side effects of Abreva

Abreva is an over the counter topical antiviral drug. It is used in Herpes simplex infection. Abreva significantly shortens the recovery time of cold sores associated with a Herpes simplex infection. Its generic name is Docosanol. It is available as a topical cream. Side effects are usually rare.

Cold sores are caused by Herpes simplex viral infection. This virus resides inside the nerves. Once the patient’s immunity is lowered, virus reactivates and causes cold sores.  So this illness is a recurrent and troublesome. Usually it cannot be treated completely. It usually spreads through close physical contact and by sharing clothes.

What are the things you should know before using Abreva?

Abreva can be applied to face, skin, lips or genitalia. It should be applied after cleaning the area with water and soap. It should also be applied with a clean hand. It should be applied five times a day. You should not share this medication with anyone, because disease can spread through it. Do not apply this medication to eyes or inside the mouth.

When to inform your doctor before using Abreva?

It is important to discuss with your doctor if you are pregnant or breast feeding before using Abreva. If you are taking other drugs including other over the counter drugs, then you should consult your doctor before taking this preparation. If you have any medical condition that needs long term medications, then you should consult your doctor before taking Abreva as well.

If you have following conditions inform your doctor before taking this medication.

* Kidney disease
* Diabetes
* Liver disease

If the skin surrounding the blisters are becoming increasingly red then you should inform your doctor. It may be a sign of secondary bacterial infection that may need antibiotics.

What are the serious side effects that need immediate medical help?

Sometimes serious allergic reaction called anaphylactic reaction can occur. It is characterized by widespread hives, itchiness, difficulty in breathing, chest tightness and edema of lips and tongue. If you develop these features, urgent medical help must be sought.

What are the other side effects?

Sometimes less significant allergic reactions (hives, itchiness and edema of the lips) can occur. You should discuss with your doctor if you develop allergic reactions.

Skin irritation in and around the applied area is also a common side effect. Some patients can get headache with this medication. But it can be controlled with over the counter pain killers such as Acetaminophen.

Sources
BNF

Overview of common drugs prescribed for nausea and vomiting

Nausea and vomiting are very common symptoms in the day to day illnesses everyone get. Sometimes they can be symptoms of serious illnesses. Even though, it is a common symptom, it can become very troublesome one too. But there are effective drugs for this troublesome symptom. Some drugs are over the counter and others are prescription only.

 Although troublesome, vomiting is a natural defense against the toxins and germs. To induce vomiting, the brain has two dedicated parts. First one is called the Chemoreceptor trigger zone (CMTZ) and other is the vomiting centre. CMTZ detects certain chemicals in blood and sends the signal to the vomiting centre to induce vomiting. In addition to receiving impulses from CMTZ, the vomiting centre receives other inputs from various brain areas, including inner ear (cause for motion sickness). Some drugs acts on CMTZ and others acts directly on the vomiting centre. Few other drugs act in less understood ways.

 Usually doctors prescribe these drugs, when the diagnosis is sure. In addition, doctors usually do not prescribe vomiting medications in intestinal obstruction.

 Promethazine (Avomine 25mg®)

This is an anti histamine medication, that acts on the Vomiting centre. It is an effective in motion sickness as well as in other causes of vomiting. But the side effects are really troublesome E.g. drowsiness, dry mouth and blurred vision. This is an over the counter medication in some countries.

Metoclopramide (Emenil 10mg®)

This is a prescription only drug in Dopamine receptor antagonist family. This medication acts on CMTZ and in the gastrointestinal system. This drug inhibits CMTZ and increases the gastro intestinal transition. Main side effect is abnormal movements called the extra pyramidal symptoms. They are caused by widespread dopamine blockade inside the brain.

Domperidone (Domstal®)

This is a similar drug to Metoclopramide. But drug concentration in brain is low after administration. So abnormal movements are very much less. In USA this drug is not yet approved.

 Chlorpromazine (Largactil®) and Haloperidol

These drugs are primarily used in psychotic disorders, but they are effective in stopping vomiting as well. Due to their calming effect, it is used in patients with terminal illnesses. Action and side effects are similar to Metoclopramide.

 Dolasetron (Anzemet®), Granisetron (Kytril®) and Ondansetron (Zofran®)

 These prescription only drugs act on the serotonin receptors in brain and especially on the CMTZ. They are mainly used in cancer patients following chemotherapy.

 Aprepitant (Emend®) and Fosaprepitant (Ivemend®)

 These drugs act on Neurokinin 1 receptors. They are prescribed in cancer chemotherapy with other anti emetics medications.

Steroid Dexamethazone is also used in vomiting associated with cancer chemotherapy. Another drug used in vomiting in the condition called meniere’s disease is Betahistidine (Serc®).

 Sources
British National Formulary

Uses and side effects of Calnif Retard tablets

Calnif Retard is a prescription medication used to control hypertension, and to treat angina. Its generic name is Nifedipine. It is in the dihydropyridine calcium channel blocker class. Calnif Retard is administered orally. In addition, sublingual preparations are also available.

Although Calnif Retard is the drug of choice for treating and preventing prinzmetal angina (chest pain due to coronary artery spasm), it is associated with increased mortality with acute myocardial infarctions and unstable angina (acute coronary syndromes). So doctors are using this medication cautiously for patients who had acute coronary syndromes.

This is a delayed release preparation of Nifedepine, therefore it can be taken once daily. Usual dose is 20mg daily.

Cautions in using Calnif Retard
This medication should be discontinued, if ischemic chest pain occurs or existing pain worsens. Doctors use this drug cautiously in patients with poor cardiac reserve, heart failure, severe hypotension, elderly patients, patients with diabetes mellitus, and hepatic impairment. In addition, this drug should not be used for cardiogenic shock, advanced aortic stenosis, porphyria, and myocardial infarctions (Heart attack).

Common side effects of Calnif Retard 

Common side effects are gastro intestinal disturbances, hypotension (reduced blood pressure), palpitations, headache, dizziness, lethargy, and lack of energy.

Less commonly tachycardia (increased heart rate), syncope, and nasal congestion are reported. Certain patients can get shortness of breath, anxiety, sleep disturbance, migraine, and pins and needles (parasthesia). Few patients complain of sleep disturbances. Can aggravate or start migraine episodes with this medication. Some patients complain passing increased amount of urine and passing increased amount in night. Few patients complain erectile dysfunction with Calnif Retard . Certain number of patients can have bleeding from the nose, muscle pain, joint swelling, and visual disturbances.

Hypersensitivity reactions can occur with some patients. They are hives, rashes, and itchiness, and yellowish discoloration of the body. Rarely follwoing side effects are reported. They include loss of appetite, swelling of the gums, mood abnormalities, hyperglycemia, and male infertility.
Photosensitivity reactions also reported.

Difficulty in swallowing, intestinal obstruction, and intestinal ulcers has been reported. Increased sizes of the breasts, even in males can occur. Very rarely nifedipine causes agranulocytosis (recution in all blood cells).

Pregnancy

This medication can inhibit labor. So your doctor may not prescribe this medication during the pregnancy.

Breast feeding

Amount in milk is too small to be harmful. But manufactures are advising doctors to avoid using this medication , unless indicated.

Drug interactions of Calnif Retard

Patients should avoid taking grape fruit juice while taking this medication. Grapefruit juice can increase plasma concentration of Calnif Retard . In addition, anti tuberculosis medication, Rifampicin reduces plasma concentration of this drug. Calnif Retard  can cause severe drop in the blood pressure, if co administered with beta blockers such as Tenormin.

Side effects can be reduced, if taken wholly with full glass of water without crushing or breaking the capsules.

Sources
AHFS Drug Information
British National Formulary www.bnf.org

Uses and side effects of Alesa Gel

Alesa Gel is a topical acne medication developed by Glenmark Pharmaceuticals Ltd.. It is a combination of benzoyl peroxide and the antibiotic Clindamycin. Benzoyl peroxide is used as a treatment for comodones seen in acne. Clindamycin is effective in infected acne.

What is Acne?

Acne is a popular skin lesion. They can be classified into commodonal acne and infected acne. Acanya gel is effective for the both types. Acne is formed by the blockade of sebaceous glands with dead cells, dirt and dust. Human sebaceous glands are situated near the sweat glands. Face contains lot of sebaceous glands. They secrete a type of oily substance onto the skin called sebum. Blocked sebaceous glands are called Commodones.  Sebaceous glands are usually more active after puberty. Benzoyl peroxide is effective for commodones. Clindamycin is effective in acne infected with bacteria.

What are the dangerous side effects?

The most serious side effect is allergic reactions and anaphylactic shock. If you developed wide spread hives, pallor, shortness of breath, chest tightness and edema of lips then you must stop the application of Alesa Gel gel and seek immediate medical advice.

Another rather uncommon side effect is watery and blood stained diarrhea. If present stop the medication and seek medical advice.

What are the common side effects of Alesa Gel ?

Skin irritation is a common side effect. Skin irritation can be manifested as redness, burning, stinging or peeling. You must stop the medication and seek medical advice if irritation is more severe.

How to minimize side effects?

Use as exactly as prescribed by your doctor. Do not apply more to get quick results. Do not use it longer than prescribed. Wash your face with mild soap before applying. Make sure you wash your hands before applying Alesa Gel . Avoid accidental application into the eyes and mouth. It must not be applied on broken or damaged skin.

Avoid using other skin products that are known to cause skin irritation such as harsh soap, shampoos, hair removing preparations and skin products with alcohol. To minimize skin irritation avoid exposure to UV light or direct sunlight. You can use sun screen with minimum SPF 15 and without PABA, if you are going out.

Benzoyl peroxide can also bleach clothes and hair, so avoid contact with them.

What the doctor should know before prescribing Alesa Gel ?

Since Alesa Gel  is a topical preparation, side effects and problems are minimal, but occasionally antibiotics can be absorbed and can cause serious side effects. The doctor should know if the patient has following conditions.

* Inflammation of the intestines
* Ulcerative colitis
* Severe antibiotic associated colitis
* Liver disease

The doctor must know whether you are pregnant or breast feeding, because this medication can harm your unborn baby.

Sources
British National Formulary