Medications and Drugs

Medications and Drugs


Lovaza is an antilipemic or fat-regulating drug that is used in addition to diet to reduce triglyceride (TG, a fat-carrying particle in the blood) levels in adult patients with severe elevations in blood levels of TG (≥mg/dL). TG is composed of three fatty acids as well as glycerol, and like cholesterol, comes from either the diet or the liver. High levels of TG in the blood are associated with conditions such as obesity, insulin resistance, poorly controlled diabetes mellitus amongst others that contribute to the risk of atherosclerosis or hardening of the arteries (progressive build up of waxy plaque on the inside of blood vessels) which, in turn, is responsible for coronary artery disease (angina and heart attacks) and strokes.

The precise way in which Lovaza works is not clear; however, its proposed mechanism of action is by decreasing the amount of TG produced by the liver and increasing the removal of TG by the liver. Other drugs that reduce TG levels include fibric acids such as gemfibrozil (Lopid), nicotinic acids such as niacin (Nicobid, Nicolar, Slo-Niacin), and statins such as atorvastatin (Lipitor). Lovaza was FDA approved on November 10, 2004.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Capsules: 1 gm

STORAGE: Lovaza should be stored at 25 C (77 F) and not frozen.

PRESCRIBED FOR: Lovaza is indicated as an adjunct to diet to reduce TG levels in adult patients with severe elevations of TG (≥ 500 mg/dL). Off-label uses of Lovaza include prevention of atherosclerosis and prevention of angina, heart attacks, and strokes.

DOSING: The daily dose of Lovaza is 4 grams per day. The daily dose may be taken as a single 4 gram dose (four capsules) or as two, 2 gram doses (two capsules given twice daily). Patients should be advised to swallow Lovaza capsules whole. They should not break open, crush, dissolve, or chew Lovaza capsules.

DRUG INTERACTIONS: Taking Lovaza with an anticoagulant (blood thinner) affecting coagulation such as aspirin, nonsteroidal antiinflammatory drugs (NSAIDS) such as ibuprofen (Motrin), warfarin (Coumadin), and heparin (Hep-Lock U/P) should be monitored periodically as Lovaza may increase the risk of bleeding.

Since some drugs may increase TG levels, patients should tell their doctor or pharmacist of the following medications before using Lovaza since their doctor may want to change the doses of these medications or monitor their effects; beta-blockers such as atenolol (Tenormin), diuretics or water pills such as hydrochlorothiazide (Diuril), and vitamins/supplements (fish/flaxseed/cod liver oils).

Lovaza contains ethyl esters of omega-3 fatty acids which are obtained from the oil of several fish sources. Lovaza should therefore be used with caution in patients with known sensitivity or allergy to fish and/or shellfish.

PREGNANCY: There are no adequate and well-controlled studies in pregnant women. Lovaza should be used during pregnancy only if the potential benefit to the patient justifies the potential risk to the fetus.

NURSING MOTHERS: It is not known whether Lovaza is excreted in human milk and caution should be exercised when administering Lovaza to nursing women.

SIDE EFFECTS: Upset stomach, burping, and strange tastes in may occur. If these effects persist or worsen, patients should notify their doctor. They also should tell their doctors immediately if any of the following rare but serious side effects that suggest increased bleeding occur: easy bleeding from cuts/bruising, black/tarry stools, vomitus that looks like coffee grounds.

Reference: FDA Prescribing Information

Last Editorial Review: 11/10/2009 2:53:29 PM

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Stroke »
What is a stroke?

A stroke, or cerebrovascular accident (CVA), occurs when blood supply to part of the brain is disrupted, causing brain cells to die. When blood flow to the brain is impaired, oxygen and glucose cannot be delivered to the brain. Blood flow can be compromised by a variety of mechanisms.

Blockage of an artery

* Narrowing of the small arteries within the brain can cause a so-called lacunar stroke, (lacune=empty space). Blockage of a single arteriole can affect a tiny area of brain causing that tissue to die (infarct).
* Hardening of the arteries (atherosclerosis) leading to the brain. There are four major blood vessels that supply the brain with blood. The anterior circulation of the brain that controls most motor, activity, sensation, thought, speech, and emotion is supplied by the carotid arteries. The posterior circulation, which supplies the brainstem and the cerebellum, con...

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Stelara™ (ustekinumab) Injection

Stelara™ (ustekinumab) Injection



Stelara™ introduction

Read this Medication Guide before you start taking STELARA™ and each time before you get an injection. There may be new information. This Medication Guide does not take the place of talking with your doctor about your medical condition or treatment with STELARA™.

What is the most important information I should know about STELARA™?

STELARA™ is a medicine that affects your immune system. STELARA™ can increase your chances of having serious side effects, including:

Serious Infections: STELARA™ may lower the ability of your immune system to fight infections and may increase your risk of infections. Some people have serious infections while taking STELARA™, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses. Some people have to be hospitalized for treatment of their infection.

* Your doctor should check you for TB before starting STELARA™.
* If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with STELARA™ and during treatment with STELARA™.
* Your doctor should watch you closely for signs and symptoms of TB during treatment with STELARA™.

You should not start taking STELARA™ if you have any kind of infection unless your doctor says it is okay.

Before starting STELARA™, tell your doctor if you think you have an infection or have symptoms of an infection such as:

* fever, sweats, or chills
* muscle aches
* cough
* shortness of breath
* blood in your phlegm
* weight loss
* warm, red, or painful skin or sores on your body
* diarrhea or stomach pain
* burning when you urinate or urinate more often than normal
* feel very tired
* are being treated for an infection
* get a lot of infections or have infections that keep coming back
* have TB, or have been in close contact with someone who has TB.

After starting STELARA™, call your doctor right away if you have any symptoms of an infection (see above).

STELARA™ can make you more likely to get infections or make an infection that you have worse.

People who have a genetic problem where the body does not make any of the proteins interleukin 12 (IL-12) and interleukin 23 (IL-23) are at a higher risk for certain serious infections. These infections can spread throughout the body and cause death. It is not known if people who take STELARA™ will get any of these infections, because of the effects of STELARA™ on these proteins in your body.

Cancers:

STELARA™ may decrease the activity of your immune system and increase your risk for certain types of cancers. Tell your doctor if you have ever had any type of cancer.

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Medications and Drugs

Medications and Drugs


DRUG CLASS AND MECHANISM: FluMist is a nasal vaccine that protects against infection with the influenza virus or the "flu." FluMist contains live influenza virus that has been weakened so that it causes minimal or no symptoms. When FluMist is inhaled, the body responds to the weakened viruses in FluMist by developing antibodies that fight influenza viruses. These antibodies protect against later infections by the naturally-occurring influenza virus. FluMist is effective only against the strains of influenza virus that are included in it, and the strains of virus change from year to year. FluMist has no effect on the flu once infection has begun. FluMist should be given shortly before the flu season begins to allow time for antibodies to be produced and for protection throughout the entire flu season. FluMist does not prevent 2009 H1N1 (swine flu) virus infection. The FDA approved FluMist in June 2003.

PRESCRIPTION: Yes.

GENERIC AVAILABLE: No.

PREPARATIONS: Intranasal Spray: prefilled single use intranasal spray, 0.2 ml

STORAGE: FluMist should be stored refrigerated between 2-8 C (35-46 F).

PRESCRIBED FOR: FluMist is used for preventing influenza virus infections (flu) in individuals 2 to 49 years of age.

DOSING: Children 2 to 8 years of age who have not previously received. FluMist should be given 2 doses of 0.2 ml one month apart. Children 2 to 8 years of age, who previously received FluMist and adults 9 to 49 years of age, should be given 1 dose (0.2 ml) each season. FluMist is administered by inhaling through the nose and is not given by injection. Half of a single dose (0.1 ml) should be inhaled into each nostril while in a standing position.

Since FluMist contains viruses that are likely to cause the flu in the upcoming season, FluMist developed for previous seasons will not be effective and should not be used.

DRUG INTERACTIONS: Children 5 to 17 years of age who are receiving aspirin therapy should not be given FluMist because of the association between aspirin, influenza infection and Reye's syndrome.

Use of FluMist together with antiviral drugs that are active against the influenza virus has not been evaluated. Since there is a potential for these agents to reduce the effectiveness of FluMist (by preventing infection with the weakened viruses in FluMist), such antiviral agents should not be administered until 2 weeks after FluMist therapy, and FluMist should not be administered until 48 hours after antiviral therapy is discontinued.

PREGNANCY: FluMist should not be given to pregnant women.

NURSING MOTHERS: Use of FluMist during breast feeding has not been adequately evaluated, and it is not known whether FluMist is excreted in breast milk.

SIDE EFFECTS: The most common side effects of FluMist are cough, runny nose, nasal congestion, sore throat, headache, restlessness, muscle aches, tiredness or weakness and fever. Hypersensitivity reactions have also been reported. FluMist should not be administered to individuals with asthma because it may increase wheezing.

Reference: FluMist Prescribing Information, 2009

Last Editorial Review: 11/23/2009

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Are You Seeking Better Seizure Control?
Vimpat
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Important Safety Information

Vimpat (lacosamide) is a medicine that is used with other medicines to treat partial onset seizures in patients 17 years of age and older with epilepsy. Vimpat is generally well-tolerated, but may not be for everyone. Ask your doctor if Vimpat is right for you. Antiepileptic drugs, including Vimpat, may cause suicidal thoughts or actions in a very small number of people, about 1 in 500. Call your healthcare provider right away if you have new or worsening symptoms of depression, any unusual changes in mood or behavior, or suicidal thoughts, behavior, or thoughts about self harm that you have never had before or may be worse than before. Please see additional patient information in the Medication Guide at the end of the full prescribing information. This information does not take the place of talking with your healthcare provider about your condition or your treatment. Please see additional Patient Safety Information
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Swine Flu »
What is swine flu (novel H1N1 influenza A swine flu)?

Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs and result in nasal secretions, a barking-like cough, decreased appetite, and listless behavior. Swine flu produces most of the same symptoms in pigs as human flu produces in people. Swine flu can last about one to two weeks in pigs that survive. Swine influenza virus was first isolated from pigs in 1930 in the U.S. and has been recognized by pork producers and veterinarians to cause infections in pigs worldwide. In a number of instances, people have developed the swine flu infection when they are closely associated with pigs (for example, farmers, pork processors), and likewise, pig populations have occasionally been infected with the human flu infection. In most instances, the cross-species infections (swine virus to man; human flu virus to pigs) have remained in local areas and ha...

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Medications and Drugs

Medications and Drugs


Acetaminophen belongs to a class of drugs called analgesics (pain relievers) and antipyretics (fever reducers). The exact mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before a person feels it. It reduces fever through its action on the heat-regulating center of the brain. Specifically, it tells the center to lower the body's temperature when the temperature is elevated. The FDA approved acetaminophen in 1951.

PRESCRIPTION: No.

GENERIC AVAILABLE: Yes.

PREPARATIONS: Liquid suspension, chewable tablets, coated caplets, gelcaps, geltabs, and suppositories. Common dosages are 325, 500 and 650 mg.

STORAGE: Store tablets and solutions at room temperature 15°-30°C (59°-86°F). Suppositories should be refrigerated below 27°C (80°F).

PRESCRIBED FOR: Acetaminophen is used for the relief of fever as well as aches and pains associated with many conditions. Acetaminophen relieves pain in mild arthritis but has no effect on the underlying inflammation, redness, and swelling of the joint. If the pain is not due to inflammation, acetaminophen is as effective as aspirin. It is as effective as the non-steroidal antiinflammatory drug ibuprofen (Motrin) in relieving the pain of osteoarthritis of the knee. Unless directed by physician, acetaminophen should not be used for longer than 10 days.

DOSING: The oral dose for adults is 325 to 650 mg every 4 to 6 hours. The maximum daily dose is 4 grams. The oral dose for a child is based on the child's age, and the range is 40-650 mg every 4 hours.

When administered as a suppository, the adult dose is 650 mg every 4 to 6 hours. For children, the dose is 80-325 mg every 4 to 6 hours depending on age.

DRUG INTERACTIONS: Acetaminophen is metabolized (eliminated by conversion to other chemicals) by the liver. Therefore drugs that increase the action of liver enzymes that metabolize acetaminophen [for example, carbamazepine (Tegretol), isoniazid (INH, Nydrazid, Laniazid), rifampin (Rifamate, Rifadin, Rimactane)] reduce the levels of acetaminophen and may decrease the action of acetaminophen. Doses of acetaminophen greater than the recommended doses are toxic to the liver and may result in severe liver damage. The potential for acetaminophen to harm the liver is increased when it is combined with alcohol or drugs that also harm the liver.

Cholestyramine (Questran) reduces the effect of acetaminophen by decreasing its absorption into the body from the intestine. Therefore, acetaminophen should be administered 3 to 4 hours after cholestyramine or one hour before cholestyramine .

Acetaminophen doses greater than 2275 mg per day may increase the blood thinning effect of warfarin (Coumadin) by an unknown mechanism. Therefore, prolonged administration or large doses of acetaminophen should be avoided during warfarin therapy.

PREGNANCY: Acetaminophen is used in all stages of pregnancy and is the drug of choice for short-term treatment of fever and minor pain during pregnancy.

NURSING MOTHERS: Acetaminophen is excreted in breast milk in small quantities. However, acetaminophen use by the nursing mother appears to be safe.

SIDE EFFECTS: When used appropriately, side effects with acetaminophen are rare. The most serious side effect is liver damage due to large doses, chronic use or concomitant use with alcohol or other drugs that also damage the liver. Chronic alcohol use may also increase the risk of stomach bleeding.

Reference: FDA Prescribing Information

Last Editorial Review: 9/21/2007

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Fever »
What is a fever?

Fever refers to an elevation in body temperature. Technically, any body temperature above the normal oral measurement of 98.6 F (37 C) or the normal rectal temperature of 99 F (37.2 C) is considered to be elevated. However, these are averages, and your normal temperature may actually be 1 F (0.6 C) or more above or below the average of 98.6 F. Body temperature can also vary up to 1 F (0.6 C) throughout the day.

Thus, fever is not considered medically significant until body temperature is above 100.4 F (38 C). Fever serves as one of the body's natural defenses against bacteria and viruses which cannot live at a higher temperature. For that reason, low fevers should normally go untreated, unless accompanied by troubling symptoms.

Also, the body's defense mechanisms seem to work more efficiently at a higher temperature. Fever is just one part of an illness, many times no more important than the presence of other symptoms such as cough, ...

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Sinus Infection

Sinus Infection



A sinus is a hollow, air-filled cavity. For the purposes of this article, a sinus will referred to those hollow cavities that are in the skull and connected to the nasal airway by a narrow hole in the bone (ostium). Normally all are open to the nasal airway through an ostium. Humans have four pair of these cavities each referred to as the:

1. frontal sinus (in forehead),
2. maxillary sinus (behind cheeks),
3. ethmoid sinus (between the eyes), and
4. sphenoid sinus (deep behind the ethmoids).

The four pair of sinuses are often described as a unit and termed the "paranasal sinuses." The cells of the inner lining of each sinus are mucus-secreting cells, epithelial cells and some cells that are part of the immune system (macrophages, lymphocytes, and eosinophils).

Functions of the sinuses include humidifying and warming inspired air, insulation of surrounding structures (eyes, nerves), increasing voice resonance, and as buffers against facial trauma. The sinuses decrease the weight of the skull.


What is a sinus infection?

A sinus infection occurs when a pathogenic organism (virus, bacterium, or a fungus) grows within a sinus and causes intermittent blockage of the sinus ostium. Drainage of mucus and pus often occur when the blockage is relieved. The drainage usually goes from the nasal passages to the throat or out the nostrils. Such infections also cause inflammation (an influx of immune cells and swelling of the sinus tissue) of one or more sinuses. This adds to blocking the openings of the sinuses and causes discomfort.

Inflammation of the air cavities within the passages of the nose (paranasal sinuses) is referred to as sinusitis. Sinusitis can be caused by infection, but can also be caused by allergy and irritation of the sinuses.

Sinusitis is one of the more common conditions that can afflict people throughout their lives. Sinusitis commonly occurs when environmental pollens irritate the nasal passages, such as with hay fever. Sinusitis can also result from irritants, such as chemicals or the use and/or abuse of over-the-counter (OTC) nasal sprays, and illegal substances that may be snorted through the nose. About 30 million adults have "sinusitis."

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Next: What causes sinus infections? »
Sinus Infection - Effective Treatments
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Exercise-Induced Asthma »
What Is Exercise-Induced Asthma?

Like it sounds, exercise-induced asthma is asthma that is triggered by vigorous or prolonged exercise or physical exertion. Most people with chronic asthma experience symptoms of asthma during exercise. However, there are many people without chronic asthma who develop symptoms only during exercise.

Why Does Exercise Induce Asthma?

During normal breathing, the air we take in is first warmed and moistened by the nasal passages. Because people tend to breathe through their mouths when they exercise, they are inhaling colder and drier air.

In exercise-induced asthma, the muscle bands around the airways are sensitive to these changes in temperature and humidity and react by contracting, which narrows the airway. This results in symptoms of exercised-induced asthma, which include:

* Coughing with asthma
* Tightening of the chest
* W...

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