|Year : 2017 | Volume
| Issue : 1 | Page : 78-79
Drug dialogues – medication news and new medications
|Date of Web Publication||17-Feb-2017|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Drug dialogues – medication news and new medications. Curr Med Issues 2017;15:78-9
Source: CMC pharmacy bulletin, a publication of the pharmacy service (DISH), CMC, Vellore.
Ibuprofen intake may be linked to low lung cancer risk
The regular use of ibuprofen by individuals with a history of smoking may lower the risk of lung cancer, according to new findings presented at the IASLC 17th World Conference on Lung Cancer in Vienna, Austria. Previous studies have shown that chronic inflammation appears to increase the risk of lung cancer, and medications that reduce inflammation have, in turn, been shown to reduce this risk. But until now, few studies have examined the association between lung cancer and non-steroidal anti-inflammatory drugs (NSAIDs).
Investigators examined data from 10,735 participants in the Third National Health and Nutrition Examination Survey (NHANES III) between 1988 and 1994. Prospective data from the survey showed ibuprofen intake among adults with a past or current smoking history was associated with a 48% reduction in the risk of dying from lung cancer. There were no statistically significant effects seen with aspirin and acetaminophen.
Ceftriaxone with lansoprazole: A deadly combination
Combined treatment with the antibiotic ceftriaxone and the proton pump inhibitor lansoprazole can lead to an in-creased risk of drug-induced arrhythmia, a study has found. The research found that patients who received both drugs together were more likely to experience drug-induced long QT syndrome (LQTS), a potentially fatal condition, than those who received either drug alone. The study found that a greater proportion of patients who received the ceftriaxone/lansoprazole combination had a QT interval of at least 500 ms, a clinically relevant threshold. They found further support for their findings in laboratory experiments. They used patch-clamp electrophysiology to examine the effects of the drugs on cells expressing the hERG channel (involved in the heart's electrical activity and is frequently blocked by drugs that cause LQTS). The team showed that, although ceftriaxone had no effect on the channel,
when added in the presence of lansoprazole it resulted in a dose-dependent drop in current. The researchers reported their findings in the Journal of the American College of Cardiology (online, 10th October 2016).
Non-statin hypolipidaemic therapies as effective as statin
The relative benefits of non-statin cholesterol-lowering treatments, including diet, have similar benefits to statins in reducing the risk of heart attack and stroke, a large meta-analysis (49 trials, 312,175) has revealed. The use of statin and non-statin therapies achieved similar relative risks of major vascular events. Reporting in JAMA (online, 27 Sep 2016), the researchers say that the key seems to be the rate at which LDL-C is reduced rather than the treatment chosen. The authors recommend that statins should be the first treatment chosen, when tolerated, given the large reduction in LDL-C they produce, their low cost, excellent safety record and proven clinical benefit. But their research raises the possibilityh that other interventions - specifically diet, bypass surgery, ezetimibe and bile acid sequestrants - may provide additional options to get the same clinical benefit.
Hormonal contraception linked with an increased risk of depression
Women who use hormonal contraception have an increased risk of depression, according to researchers in Denmark. The authors based at the University of Copenhagen, found an increased risk of being treated with an antidepressant for the first time among users of different types of hormonal contraception (including combined oral contraceptives and progestogen-only pills), with the highest rates among adolescents. The researchers, reporting in JAMA Psychiatry (online, 28 September 2016), say their findings suggest that healthcare professionals should be made aware of the risk of depression, which they describe as “this relatively hitherto unnoticed adverse effect of hormonal contraception”.
Saline nasal drops effective for chronic nosebleeds
Squirting a simple saline solution into the nostrils twice a day could alleviate chronic nosebleeds just as effectively as any one of three medication sprays, a study shows. A total of 121 people were randomly assigned to receive bevacizumab, estriol, tranexamic acid, or a saline placebo nose spray to squirt into their nose twice a day for 12 weeks. Over the 12-week period, most participants' bleeding severity scores dropped, regardless of whether they had been assigned to one of the three medications or the saline spray.
SSRIs taken in pregnancy may impair speech in offspring
A significant rise in the risk of speech and language disorders was found among children born to mothers prescribed selective serotonin reuptake inhibitors (SSRIs) during pregnancy, a study published in JAMA Psychiatry has found.
The observational cohort study involving 56,340 Finnish children, investigated whether maternal use of SSRIs during pregnancy would influence the speech, language, motor or scholastic abilities of offspring. After following the children for 14 years, the authors found that the children of mothers who were prescribed SSRIs were at 37% higher risk for a speech/language disorder than those of mothers with depression but not given SSRIs and 63% higher risk than children of mothers who had no psychiatric diagnosis. There was no difference among groups in motor or scholastic abilities.
5 Drugs / 5 Point Learning – DIURETICS
Thiazides and related diuretics
(Hydrochlorothiazide, indapamide, metolazone)
- They inhibit sodium reabsorption at the beginning of the distal convoluted tubule and are moderately potent diuretics
- Given early in the day so that the diuresis does not interfere with sleep
- They are used to reduce blood pressure
- Chlorthalidone and indapamide are the preferred diuretics in the management of hypertension
- Hypertension treated with higher doses of thiazides, can cause hypokalaemia, which in turn can aggravate hypertension and also lead to diabetes.
- They are used in pulmonary oedema due to LVF and also in patients with CHF
- They act in the thick ascending limb and can lead to excretion of up to 20-25 percent of filtered sodium
- Hearing problems are rarely seen with high dose IV loop diuretic therapy
- Frusemide and torasemide have similar properties; both act within one hour of oral administration and diuresis is complete within 6 hours and hence can be given twice daily without interfering sleep
- Loop diuretics can exacerbate diabetes and gout.
Potassium sparing diuretics
(Amiloride, eplerenone, spironolactone, triamterene)
- They have relatively weak natriuretic activity, leading to the maximum excretion of only 1 to 2 percent of filtered sodium and are weak diuretics
- They cause retention of potassium and are therefore given with thiazide or loop diuretics as a more effective alternative to potassium supplements
- Concomitant administration with an ACE inhibitor or an ARB can cause severe hyperkalaemia
- Spironolactone is used in the treatment of oedema and ascites caused by cirrhosis of the liver
- Potassium-sparing diuretics are not usually necessary in the routine treatment of hypertension, unless hypokalaemia develops.
- Mannitol is a non-reabsorbable sugar alcohol that inhibits sodium and water reabsorption in the proximal tubule
- Used to treat cerebral oedema and raised intra-ocular pressure
- Not generally used in oedematous states, since initial retention of the hypertonic mannitol might precipitate pulmonary oedema
- It can crystallize when exposed to low temperature (<20oC)
- Should be stored between 20 and 30oC.
Carbonic Anhydrase Inhibitors
- Acetazolamide is a weak diuretic and is little used for its diuretic effect
- The main indication is in oedematous patients with metabolic alkalosis
- Used orally in the management of angle-closure glaucoma and to minimize rises in IOP associated with ocular surgery
- Should be avoided in sulfa allergy
- Concomitant use with high dose aspirin may result in severe acidosis and increase CNS toxicity.
Source: Source: CMC Pharmacy Bulletin, a publication of the Pharmacy Service (DISH), CMC, Vellore.
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