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

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 Abciximab

Abciximab is a prescription only anti - platelet drug. It is prescribed to prevent ischemic problems in the heart, before angiogram and short term prevention of heart attacks in patients with unstable angina. It is a platelet glycoprotein iib/iiia inhibitor. Nausea, vomiting and increased bleeding tendency are the commonest problems. Commonest brand name is Reopro® by Lilly pharmaceuticals.

 Overview

Heart attacks and ischemic problems are caused by the blockade of the arteries that supply the heart (coronary arteries). This is mainly caused by the formation of blood clots within the arteries.
 Inhibition of platelet glycoprotein iib and iiia prevent platelet aggregation. Platelet aggregation is required for the blood clot formation.'

This medication is only available as intravenous injections. It is usually used by experts in specialized units.

 What doctors should know before prescribing Abciximab?

If the patient has active internal bleeding, underwent major surgery/intracranial surgery within last two months, stroke within last two years, brain cancer, arteriovenous malformation or aneurism, severe uncontrolled hypertension, reduced platelet counts or vasculitis then doctors won’t prescribe Abciximab.

 Abciximab should not be used in breast feeding as well. The doctor should know whether the patient is pregnant or not. If the patient has kidney or liver disease, then discuss it with the doctor before prescribing Abciximab.

 What doctors do before prescribing Abciximab?

Doctors will do several blood tests before and after starting Abciximab. They are Prothrombin time, Activated clotting time, Activated partial thromboplastin time, blood hemoglobin level and blood hematocrit. These tests measure the blood clotting tendency in the patient. If the tendency is less, then the patient is not suitable for Abciximab. Doctors use this drug cautiously in elderly patients.

 What are common side effects?

Increased bleeding following a wound or increased spontaneous bleeding is the main problematic side effect. Other than that some patients can have nausea and vomiting.

 Reduced blood pressure is another side effect. This will manifest as faintish ness, dizziness and lightheadedness.

 Reduced heart rate can occur in certain patients. Some patients can complain chest pain. Back pain is another troublesome side effect. Headache can occur with certain patients.

 Irritation and pain in the injection site is another common adverse effect.

 What are the rare side effects?

Cardiac tamponade can occur rarely. Breathing difficulty and respiratory distress can occur very rarely.

 Allergic reactions such as hives, edema of the tongue and lips can occur rarely in some patients. Sometimes a life threatening complication called anaphylactic shock can occur. Widespread hives, shortness of breath and pallor is characteristic. Patients with this condition need urgent medical help.
 Sources
BNF

Uses and side effects of Faximab

Faximab is a prescription only anti - platelet drug. It is prescribed to prevent ischemic problems in the heart, before angiogram and short term prevention of heart attacks in patients with unstable angina. It is a platelet glycoprotein iib/iiia inhibitor. Nausea, vomiting and increased bleeding tendency are the commonest problems. Other commonest brand name is Reopro® by Lilly pharmaceuticals.

 Overview

Heart attacks and ischemic problems are caused by the blockade of the arteries that supply the heart (coronary arteries). This is mainly caused by the formation of blood clots within the arteries.
 Inhibition of platelet glycoprotein iib and iiia prevent platelet aggregation. Platelet aggregation is required for the blood clot formation.

This medication is only available as intravenous injections. It is usually used by experts in specialized units.

 What doctors should know before prescribing Faximab?

If the patient has active internal bleeding, underwent major surgery/intracranial surgery within last two months, stroke within last two years, brain cancer, arteriovenous malformation or aneurism, severe uncontrolled hypertension, reduced platelet counts or vasculitis then doctors won’t prescribe Faximab.

 Faximab should not be used in breast feeding as well. The doctor should know whether the patient is pregnant or not. If the patient has kidney or liver disease, then discuss it with the doctor before prescribing Faximab.

 What doctors do before prescribing Faximab?

Doctors will do several blood tests before and after starting Faximab. They are Prothrombin time, Activated clotting time, Activated partial thromboplastin time, blood hemoglobin level and blood hematocrit. These tests measure the blood clotting tendency in the patient. If the tendency is less, then the patient is not suitable for Faximab. Doctors use this drug cautiously in elderly patients.

 What are common side effects?

Increased bleeding following a wound or increased spontaneous bleeding is the main problematic side effect. Other than that some patients can have nausea and vomiting.

 Reduced blood pressure is another side effect. This will manifest as faintish ness, dizziness and light headedness.

 Reduced heart rate can occur in certain patients. Some patients can complain chest pain. Back pain is another troublesome side effect. Headache can occur with certain patients.

 Irritation and pain in the injection site is another common adverse effect.

 What are the rare side effects?

Cardiac tamponade can occur rarely. Breathing difficulty and respiratory distress can occur very rarely.

 Allergic reactions such as hives, edema of the tongue and lips can occur rarely in some patients. Sometimes a life threatening complication called anaphylactic shock can occur. Widespread hives, shortness of breath and pallor is characteristic. Patients with this condition need urgent medical help.