ads bit

Pages

Tuesday, August 28, 2018

Neonatal jaundice နဲ႔ စိတ္ဝင္စားဖြယ္ရာအခ်က္မ်ား





Neonatal jaundice နဲ႔ စိတ္ဝင္စားဖြယ္ရာအခ်က္မ်ား
သတိမထားမိေလာက္တဲ့အခ်က္ေတြခ်ည္း စုၿပီး ေရးေပးထားပါတယ္။ Paediatrics (Child Health) ကို စထိေတြ႕မယ့္ FP1 ေတြေရာ FP2 ကေလးေတြပါ အက်ိဳးရွိပါလိမ့္မယ္။ အခ်င္းခ်င္း share ေပးၾကပါဦးေနာ္။ ;-)
RBC breakdown က ထြက္လာတဲ့ hemobogin ထဲက heme ကို heme oxygenase (HO) ကျဖိဳခြဲမယ္ biliverdin အဲကေန bilirubin ဆက္ျဖစ္မယ္။
Total bilirubin (TB) ကို ေသြးထဲမွာ ပံုစံ၄မ်ိဳးနဲ႔ေတြ႕ရပါတယ္...
1. unconjugated bilirubin (UC) bound to albumin
2. free or unbound bilirubin
3. conjugated bilirubin
4. conjugated bilirubin bound to albumin (δ-bilirubin)
Albumin-bound UC က အမ်ားဆံုးပါ sick or preterm newborn ေတြမွာ albumin က concentration ေရာ binding affinity ပါက်လို႔ UC တက္လာဖို႔ အႏၱရာယ္ပိုမ်ားပါတယ္။
ေသြးထဲက bilirubin ေတြကို liver ထဲပို႔... conjugate လုပ္ (UDP-glucuronyl transferase/UGT လို UGT မပါလာရင္ UC တက္ Crigler-Najjar $ လို႔ ေခၚပါတယ္)... bile ထဲ secrete လုပ္ တစ္ခ်ိဳ႕ေသာ conjugated bilirubin က enteric mucosal enzyme β-glucuronidase ေၾကာင့္ UC ျပန္ျဖစ္ အူကေန liver ဆီျပန္စုပ္သြားျပန္တယ္ (enterohepatic circulation/EHC) newborn မွာက gut flora မရွိေသးတာမို႔ conjugated bilirubin ကို urobilinogen ျဖစ္ေအာင္ reduce လုပ္တာ နည္းပါေသးတယ္... အဲဒီထဲမွာ hepatic uptake နဲ႔ conjugation က newborn မွာ ခက္ခဲေနပါေသးတယ္... ဒီေတာ့ အေၾကာင္းတစ္ခုခုေၾကာင့္သာ hemolysis မ်ားေနရင္ bottleneck effect နဲ႔ UC ေတြမ်ားေနမယ္... သူသာ albumin-binding capacity ေက်ာ္သြားရင္ free UC ေတြမ်ားလာၿပီး brain ဆီေရာက္ lipid-soluble မို႔ kernicterus ဝင္ႏိုင္။
ေမြးၿပီး ၁ပတ္ေလာက္အတြင္း ႏို႔ေကာင္းေကာင္းမဝင္ရင္ relative starvation ျဖစ္ delayed meconium pass ျဖစ္ bilirubin ကို EHC နဲ႔ ျပန္စုပ္သြားၿပီး ဝါႏိုင္တယ္ ဒါကို breastfeeding jaundice လို႔ အေခၚၾကတယ္ တစ္ကယ္က breastfeeding failure jaundice လို႔ေခၚရင္ ပိုမွန္မယ္ (ဒီ principle က လူႀကီးမွာလည္း ရွိတယ္ >24 h ေလာက္ ငတ္ေနရင္ လူႀကီးလည္း နည္းနည္းဝါႏိုင္တယ္ starvation jaundice လို႔ေခၚပါတယ္တဲ့)။ ဒီလိုမဝါေအာင္ ေမြးၿပီးစရက္ေတြမွာ ႏို႔ေသခ်ာတိုက္ဖို႔လိုမယ္ တစ္ေန႔ကို ၈ႀကိမ္ကေန ၁၂ႀကိမ္ေလာက္အထိေပါ့။
ႏို႔ပိုဝင္လာတဲ့ ေမြးၿပီး ၃ရက္ ၅ရက္ေလာက္က် အေမ့ႏို႔ထဲပါတဲ့ Pregnane-3-α,20-β-diol နဲ႔ nonesterified long-chain fatty acids က UGT ကို ပိတ္လို႔ UC တက္တတ္ျပန္ အေမ့ႏို႔ထဲလည္း β-glucuronidase ပါတတ္ၿပီး သူ႔ေၾကာင့္လည္း EHC နဲ႔ UC တက္ျပန္ ဒါကိုက် breast milk jaundice လို႔ေခၚတယ္ ကေလး ၃ပတ္ကေန လပိုင္းအထိ ၾကာေနႏိုင္တယ္ ေသခ်ာခ်င္ရင္ အေမႏို႔ ၁ရက္၂ရက္ေလာက္ျဖတ္ၾကည့္လိုက္ၿပီး formula feeding ေပးရင္ UC တစ္ဝက္ေလာက္အထိ ျပဳတ္က်သြားပါတယ္ သို႔ေသာ္ ဒီလိုႏို႔ျဖတ္တာက breastfeeding ကို ျပႆနာေပးႏိုင္လို႔ သိပ္မလုပ္ခ်င္ၾကဘူး ဒါဆို အျခား prolonged neonatal jaundice causes ေတြကို exclude လုပ္ၿပီး diagnose လုပ္လို႔ရတယ္ (hypothyroid, UTI စသည္ေပါ့) ကေလးကလည္း က်န္တာအကုန္ေကာင္းေနရမွာေပါ့။
EHC ကို ပိတ္ႏိုင္ရင္လည္း UC က်ဖို႔ရွိတယ္ orlistat ကို အဲဒီလိုသံုးႏိုင္ပါတယ္တဲ့ သူက fecal fat excretion မ်ားလာေစေတာ့ bilirubin လည္း ပါသြားမယ္ေပါ့ (UC က lipid soluble ကိုး)။ β-glucuronidase ကိုပိတ္ႏိုင္ေသာ L-aspartic acid or casein လည္း ေပးလို႔ရတယ္တဲ့။ Adsorbent ျဖစ္တဲ့ activated charcoal လည္း ေပးႏိုင္ပါတယ္။
ဒါျဖင့္ unconjugated hyperbilirubinemia ကို ဘယ္လို define လုပ္ၾကလဲ... UC ≥2 mg/dL (34 µmol/L) လို႔ အၾကမ္းဖ်င္းဆိုပါတယ္။
Conjugated hyperbilirubinemia က် conjugated bilirubin >1.5 mg/dL (26 µmol/L) and ">10% of TB concentration" ပါတဲ့။
(UC တက္တဲ့ကေလးေတြမွာ 10% UC က van den Bergh test မွာ direct reacting လုပ္ႏိုင္လို႔ >10% of TB ဆိုတဲ့ cut-off ကို ထပ္ထည့္ထားတာပါ)
Unconjugated hyperbilirubinemia ျဖစ္ေစတဲ့အထဲမွာ Rh incompatibility က နာမည္ႀကီးပါတယ္။ အေမက Rh(-)ve ကေလးက Rh(+)ve ဆိုရင္ အေမ့ anti-D IgG သာရွိရင္ (subsequent pregnancies, previous fetomaternal hemorrhage စသည္ေၾကာင့္ေပါ့) ကေလး RBC ေပၚက D-antigen ကို သြား bind မယ္ WBC (Fc receptor ရွိတာကိုး) လာမယ္ Hemolysis ျဖစ္မယ္ေပါ့ Bound IgG မို႔ direct Coombs test (+)ve ပါ Rh blood group က CDE system (C,c; D,d; E,e) ဆိုေပမယ့္ D က antigenic အျဖစ္ဆံုး (ကေလးေသြး 0.1 mL နဲ႔တင္ အေမ immune response လာတယ္ေျပာတယ္)မို႔ Rh D isoimmunization လို႔ ေခၚပါတယ္။ H'lytic anemia မို႔ bone marrow stimulation ျဖစ္ immature RBCs ထြက္ (ဒီေတာ့ erythroblastosis ျဖစ္) extramedullary eryropoiesis ျဖစ္ (ဒီေတာ့ hepatosplenomegaly ဝင္) anemia သိပ္ဆိုး tissue hypoxia ျဖစ္ capillary leak ျဖစ္ generalizaed edema ျဖစ္ (anemic heart failure ေၾကာင့္လည္း ပါမယ္) effusion ေတြလည္း ျဖစ္ (pleural, pericardial, peritoneal) ဒါေၾကာင့္ hydrops fetalis ဟု ေခၚသည္။ ဗိုက္ထဲမွာက ထြက္လာသမွ် UC ကို placenta က ဒိုင္ခံရွင္းေပးေနလို႔ ေမြးေမြးခ်င္း မဝါေသး ေမြးၿပီး နာရီပိုင္းအတြင္း liver conjugation မႏိုင္ secretion မႏိုင္လို႔ တရိပ္ရိပ္နဲ႔ အဝါတက္လာမယ္။
ABO incompatibility က် အေမက 'O' ကေလးက 'A' or 'B' ဆိုပိုျဖစ္တယ္ အေမ့ဆီမွာက anti-A/B က အစကတည္းကရွိၿပီးသား ဒီေတာ့ 1st pregnancy လည္း မလြတ္ဘူး စိတ္ဝင္စားဖို႔ေကာင္းတာက အေမက A ကေလးက B (ဒါမွမဟုတ္ အေမက B ကေလးက A) ဆို က် အေမ့ဆီက anti-A/B က IgM မ်ားပါတယ္ သူက placenta သိပ္မျဖတ္ႏိုင္လို႔ HDN သိပ္ျဖစ္ေလ့မရွိ အေမ O က် anti-A/B က IgG မ်ားပါတယ္တဲ့ ဒီေတာ့ ပိုျဖစ္တယ္။ IgG က Rh incompatibility တုန္းကလိုပဲ ကေလး RBCs ကိုကပ္ WBC လာ (Fc receptor နဲ႔ပဲ) H'lysis ျဖစ္ျပန္။ A or B antigenic sites က Rh ရဲ႕ D ေလာက္ RBC ေပၚ မမ်ားဘူး တစ္ခါ A or B antigenic sites က RBC အျပင္ အျခား cells ေတြမွာလည္း ရွိေတာ့ IgG က RBC ေပၚေရာက္သြားတာ ပိုနည္းတယ္ ဒါေတြေၾကာင့္ ABO incompatibility က Rh ေလာက္မဆိုးဘူး IgG-bound RBCs က spleen မွာ pitting အလုပ္ခံရေတာ့ spherocytosis ေလးလည္း ရွိေနမယ္။
IgG နဲ႔ ကေလး RBC မေတြ႕ေအာင္တားႏိုင္ရင္ H'lysis နည္းဖို႔ရွိပါတယ္ ဒါေၾကာင္း IVIG ကို ထိုးတာရွိပါတယ္ (500-1000 mg/kg over 2 h; m/b repeated after 12 h) phototherapy ေပးရင္း အဝါမက်ရင္ ဒါမွမဟုတ္ within 2-3 mg/dL (34-51 µmol/L) of exchange level ျဖစ္လာရင္ေပါ့ Rh incompatibility ထက္စာရင္ ABO case ေတြမွာ ပို effective ျဖစ္ပါသတဲ့။
TB ≥25 mg/dL (428 µmol/L) ဒါမွမဟုတ္ high-risk baby ဆို ≥20 mg/dL (342 µmol/L) ျဖစ္ရင္ intervention ၀င္ပါတယ္။
ပထမအဆင့္ phototherapy ပါ UC ေတြကို isomerization ျဖစ္ေစၿပီး ထြက္လာတဲ့ metabolites ေတြကို bile ကေန excrete လုပ္ပါတယ္။ ေနာက္ပိုင္း LED-based မီးလံုးေတြက မပူလို႔ hyperthermia ျဖစ္မွာမပူရေပမယ့္ တစ္ခါတစ္ေလ ကေလးေအးေနမွာ သတိျပဳရပါမယ္။
Conjugated hyperbilirubinemia ကို photo ျပမိရင္ photoproducts က photobilirubin II ပါ သူက brown pigments အျဖစ္ ၿပိဳကြဲပါတယ္ bile က ကန္ခ်ဖို႔ႀကိဳးစားေပမယ့္ conjugated hyperbilirubinemia ကေလးေတြက cholestasis ရွိတာမို႔ ေသြးထဲျပန္ဆန္တက္ၿပီး skin နဲ႔ urine မွာ brown-black (bronze) color ျဖစ္ပါတယ္ ထူးထူးျခားျခားျပႆနာေတာ့ မေပးပါဘူးတဲ့။
တစ္ခုသတိထားရမွာက congenital erythropoietic porphyria ရွိရင္ေတာ့ photo မျပရပါဘူး ျပမိရင္ H'lysis ပိုဆိုးမယ္ bullous lesions ေတြေပၚမယ္ ေသတဲ့အထိျဖစ္ႏိုင္ပါတယ္။
Intensive phototherapy နဲ႔မွ ၆နာရီအတြင္း TB က က်မသြားဘူးဆို exchange transfusion ကိုစဥ္းစားပါတယ္။ Blood group က O-negative ဆို ေကာင္းပါတယ္ (အေမေသြးေရာ ကေလးေသြးနဲ႔ပါ compatible ျဖစ္ၿပီးသားျဖစ္ပါတယ္) ဒါမွမဟုတ္ ABO/Rh compatible to maternal serum ပါ (အေမ့ serum နဲ႔ cross matching လုပ္ရမယ္လို႔ ဆိုလိုပါတယ္)။ ကေလးရဲ႕ blood volume ၂ဆနဲ႔ ေသြးလဲလို႔ double-volume exchange transfusion လို႔ေခၚပါတယ္ term ကေလးဆို 2×85mL/kg (170 mL/kg) preterm ဆို 2×100mL/kg (200 mL/kg) ေသြးအသြင္းအထုတ္ကို မၾကမ္းေစရပါဘူး တစ္ခါကို 10% total blood volume (TBV) မေက်ာ္ေစရပါဘူး တစ္ခါအသြင္းအထုတ္လုပ္တဲ့ေသြးကို aliquot လို႔ေခၚပါတယ္ အေကာင္းဆံုးက တစ္ခါကို 5 mL/kg or 5% of TBV ကို 2-10 minutes ၾကာေအာင္ အသြင္းအထုတ္လုပ္သင့္ပါတယ္။ Exchange တစ္ၿကိမ္လုပ္လိုက္ရင္ 85% of circulating RBCs လဲၿပီးျဖစ္တယ္ (Ig-G bound RBCs နည္းေစတယ္ေပါ့) bilirubin က ထက္ဝက္ထိက်ပါတယ္။ လဲရင္ ၅ရက္အတြင္းလွဴထားတဲ့ fresh blood ဆို ပိုေကာင္းပါတယ္ မရႏိုင္လို႔ old blood သံုးရင္ acidosis ကို correct လုပ္ဖို႔ Na bicarbonate ေပးရပါလိမ့္မယ္ (ေသြးအိတ္ထဲက citrate က alkali ထြက္လာဦးမွာမို႔ pH 7.1 အထိပဲ ညွိထားရင္ လံုေလာက္ပါတယ္)။
ေသြးမလဲခင္ ၁နာရီ ၂နာရီအလိုမွာ salt-poor albumin (1 g/kg) ေပးလိုက္ရင္ albumin က tissues ေတြထဲက UC ေတြကို ေသြးထဲဆြဲထုတ္ေပးထားလို႔ exchange transfusion ကို effective ပိုျဖစ္ေစပါတယ္ (UC 40% ေလာက္ ပိုက်တယ္ေျပာပါတယ္)။
အခုေျပာေနတဲ့ bilirubin ျပႆနာေတြက heme breakdown ကေနလာတာမို႔ အေပၚဆံုးမွာေျပာထားတဲ့ HO enzyme ကို ပိတ္လိုက္ရင္ ကိစၥျပတ္ပါတယ္ ဒီလိုေတြးၿပီး HO inhibitor ေတြထြင္လာၾကတယ္ metalloporphyrins ေတြလို႔ ေခၚပါတယ္ tin protoporphyrin, tin mesoprophyrin, zinc protoporphyrin စသည္ျဖင့္ေပါ့ သူတို႔ကို Crigler-Najjar $ မွာေတာ့ သံုးေနၾကပါၿပီ။ Non-metalloporphyrin inhibitor ေတြလည္း ရွိပါတယ္ ဥပမာ azalanstat ပါ။
---------------------
By the way စာသင္ေနပါတယ္ေနာ္... ေရစက္ဆံုတဲ့ကေလးမ်ား တက္ခ်င္ရင္ စံုစမ္းႏိုင္ပါတယ္ လူအမ်ားႀကီးမဟုတ္လို႔ လူနည္းနည္းနဲ႔ အာရံုပိုစိုက္ခ်င္တဲ့ကေလးေတြအတြက္ အဆင္ေျပပါမယ္ေနာ္။
CHILD
Final Part I: Sat, Sun (7:30-9:30AM)
Final Part II Junior: Sat, Sun (1:30-3:30PM)
Final Part II Senior: Mon, Wed (4:00-6:00PM)
အျခားဘာသာေတြလည္း သင္ပါတယ္။
3rd MB Surgery: Friday (4:30-5:30PM)
Final Part I OG: Sat, Sun (9:30-11:30AM)
လူစုမိရင္လည္း လိုက္သင္ေပးပါတယ္။
Final Part II Junior
Surgery: Tue, Thu (4:00-6:00PM)
Medicine: Tue, Thu (6:00-8:00PM)
OG: Sat, Sun (11:30AM-1:30PM)
Final Part II Senior
OG: Sat, Sun (11:30-1:30PM)
Pharmacology လည္း သင္ေနပါတယ္... စံုစမ္းႏိုင္ပါတယ္။

က်ဴရွင္မဟုတ္ဘဲ Guide သေဘာမ်ိဳး study facilitator အျဖစ္လည္း သင္ပါတယ္ message ကေန စံုစမ္းပါေနာ္။



https://www.facebook.com/permalink.php?story_fbid=2085883704959966&id=100006150708554&O:-)
Posted by at No comments:
Labels:

Saturday, August 25, 2018

meloxicam 7.5 mg

What is meloxicam 7.5 mg tablet used for?
Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body. Meloxicam is used to treat pain or inflammation caused by rheumatoid arthritis and osteoarthritis in adults.

Meloxicam Uses, Dosage, Side Effects & Warnings - Drugs.com

https://www.drugs.com/meloxicam.html
Print Share

Meloxicam

Generic Name: meloxicam (mel OKS i kam)
Brand Names: Mobic, Vivlodex
Medically reviewed on December 4, 2017
More

What is meloxicam?

Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body.
Meloxicam is used to treat pain or inflammation caused by rheumatoid arthritis and osteoarthritis in adults.
Meloxicam is also used to treat juvenile rheumatoid arthritis in children who are at least 2 years old.
A Joint Effort: A Provider's Guide To Orthopedic Pain Options
Slideshow
A Joint Effort: A Provider's Guide To Orthopedic Pain Options

Important information

Meloxicam can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).
Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.
Meloxicam may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using meloxicam, especially in older adults.
Call your doctor at once if you have symptoms of stomach bleeding such as black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds.
Avoid drinking alcohol. It may increase your risk of stomach bleeding.
Ask a doctor or pharmacist before using any other cold, allergy, or pain medicine. Medicines similar to meloxicam are contained in many combination medicines. Check the label to see if a medicine contains an NSAID (non-steroidal anti-inflammatory drug) such as aspirin, ibuprofen, ketoprofen, or naproxen.
Meloxicam can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Even people without heart disease or risk factors could have a stroke or heart attack while taking this medicine.
Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).
Meloxicam may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using meloxicam, especially in older adults.
You should not use meloxicam if you are allergic to it, or if you have ever had an asthma attack or severe allergic reaction after taking aspirin or an NSAID.
To make sure meloxicam is safe for you, tell your doctor if you have:
  • heart disease, high blood pressure, high cholesterol, diabetes, or if you smoke;
  • a history of heart attack, stroke, or blood clot;
  • a history of stomach ulcers or bleeding;
  • asthma;
  • kidney disease (or if you are on dialysis);
  • liver disease; or
  • fluid retention.
Taking meloxicam during the last 3 months of pregnancy may harm the unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
Meloxicam may cause a delay in ovulation (the release of an egg from an ovary). You should not take this medicine if you are undergoing fertility treatment, or are otherwise trying to get pregnant.
Meloxicam can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.
Meloxicam is not approved for use by anyone younger than 2 years old.

How should I take meloxicam?

Take meloxicam exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger amounts or for longer than recommended. Use the lowest dose that is effective in treating your condition.
You may take meloxicam with or without food.
Shake the oral suspension (liquid) well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
If a child is taking this medication, tell your doctor if the child has any changes in weight. Meloxicam doses are based on weight in children.
If you use this medicine long-term, you may need frequent medical tests.
Store at room temperature, away from moisture and heat. Keep the bottle tightly closed when not in use.
Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.
See also: Dosage Information (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking meloxicam?

Avoid drinking alcohol. It may increase your risk of stomach bleeding.
See also: Meloxicam and alcohol (in more detail)
Avoid taking aspirin while you are taking meloxicam.
Ask a doctor or pharmacist before using any cold, allergy, or pain medication. Many medicines available over the counter contain aspirin or other medicines similar to meloxicam. Taking certain products together can cause you to get too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.

Meloxicam side effects

Get emergency medical help if you have signs of an allergic reaction to meloxicam: sneezing, runny or stuffy nose; wheezing or trouble breathing; hives; swelling of your face, lips, tongue, or throat.
Get emergency medical help if you have signs of a heart attack or stroke: chest pain spreading to your jaw or shoulder, sudden numbness or weakness on one side of the body, slurred speech, feeling short of breath.
Stop using meloxicam and call your doctor at once if you have:
  • the first sign of any skin rash, no matter how mild;
  • shortness of breath (even with mild exertion);
  • swelling or rapid weight gain;
  • signs of stomach bleeding - bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;
  • liver problems - nausea, upper stomach pain, itching, tired feeling, flu-like symptoms, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
  • kidney problems - little or no urinating, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath;
  • low red blood cells (anemia) - pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; or
  • severe skin reaction - fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Common meloxicam side effects may include:
  • upset stomach, nausea, vomiting, heartburn;
  • diarrhea, constipation, gas;
  • dizziness; or
  • cold symptoms, flu symptoms.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)

Meloxicam dosing information

Usual Adult Dose of Meloxicam for Osteoarthritis:
Initial dose: 7.5 mg orally once daily
Maintenance dose: 7.5 mg orally once daily
Maximum dose: 15 mg orally daily
Usual Adult Dose of Meloxicam for Rheumatoid Arthritis:
Initial dose: 7.5 mg orally once daily
Maintenance dose: 7.5 mg orally once daily
Maximum dose: 15 mg orally daily
Usual Pediatric Dose for Juvenile Rheumatoid Arthritis:
Greater than or equal to 2 years: 0.125 mg/kg orally once daily

Maximum dose: 7.5 mg orally daily

There was no additional benefit demonstrated by increasing the dose above 0.125 mg/kg once daily in clinical trials.

What other drugs will affect meloxicam?

Ask your doctor before using meloxicam if you take an antidepressant such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone. Taking any of these medicines with an NSAID may cause you to bruise or bleed easily.
Tell your doctor about all your current medicines and any you start or stop using, especially:
  • cyclosporine;
  • lithium;
  • methotrexate;
  • sodium polystyrene sulfonate (Kayexalate);
  • a blood thinner (warfarin, Coumadin, Jantoven);
  • heart or blood pressure medication, including a diuretic or "water pill"; or
  • steroid medicine (such as prednisone).
This list is not complete. Other drugs may interact with meloxicam, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use meloxicam only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 1996-2018 Cerner Multum, Inc. Version: 12.03.
Medical Disclaimer
 
Posted by at No comments:
Labels:

duloxetine 30 mg

 
What is duloxetine 30 mg used for?
Duloxetine is used to treat depression and anxiety. In addition, duloxetine is used to help relieve nerve pain (peripheral neuropathy) in people with diabetes or ongoing pain due to medical conditions such as arthritis, chronic back pain, or fibromyalgia (a condition that causes widespread pain).
home depression center >  depression a-z list > 

duloxetine (Cymbalta, Irenka)

https://www.emedicinehealth.com/drug-duloxetine/article_em.htm

Brand Names: Cymbalta, Irenka

Generic Name: duloxetine


What is duloxetine (Cymbalta, Irenka)?

Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). Duloxetine affects chemicals in the brain that may be unbalanced in people with depression.
Duloxetine is used to treat major depressive disorder in adults. Duloxetine is also used to treat general anxiety disorder in adults and children who are at least 7 years old.
Duloxetine is also used in adults to treat fibromyalgia (a chronic pain disorder), or chronic muscle or joint pain (such as low back pain and osteoarthritis pain).
Duloxetine is also used to treat pain caused by nerve damage in adults with diabetes (diabetic neuropathy).
Duloxetine may also be used for purposes not listed in this medication guide.

What are the possible side effects of duloxetine (Cymbalta, Irenka)?

Get emergency medical help if you have signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have:
  • a light-headed feeling, like you might pass out;
  • vision changes, eye pain or swelling, eye redness;
  • easy bruising, unusual bleeding;
  • painful or difficult urination;
  • a seizure;
  • a manic episode--racing thoughts, increased energy, reckless behavior, feeling extremely happy or irritable, talking more than usual, severe problems with sleep;
  • liver problems--right-sided upper stomach pain, itching, dark urine, jaundice (yellowing of the skin or eyes);
  • low levels of sodium in the body--headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady; or
  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
Older adults may be more sensitive to the side effects of this medicine.
Common side effects may include:
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about duloxetine (Cymbalta, Irenka)?

Do not take duloxetine within 5 days before or 14 days after you have used an MAO inhibitor, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine.
Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.
Do not stop using duloxetine without first talking to your doctor.

What should I discuss with my healthcare provider before taking duloxetine (Cymbalta, Irenka)?

You should not use duloxetine if you are allergic to it.
Do not take duloxetine within 5 days before or 14 days after you have used an MAO inhibitor, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. A dangerous drug interaction could occur.
Some medicines can interact with duloxetine and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.
To make sure duloxetine is safe for you, tell your doctor if you have ever had:
Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using duloxetine. Your family or other caregivers should also be alert to changes in your mood or symptoms.
It is not known whether duloxetine will harm an unborn baby. However, duloxetine may cause problems in a newborn if you take the medicine during the third trimester of pregnancy. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.
If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of duloxetine on the baby.
Duloxetine can pass into breast milk, but effects on the nursing baby are not known. Tell your doctor if you are breast-feeding.
Duloxetine is not approved for use by anyone younger than 18 years old.

How should I take duloxetine (Cymbalta, Irenka)?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
You may take duloxetine with or without food.
Do not crush, chew, break, or open an extended-release capsule. Swallow it whole.
It may take 1 to 4 weeks before your symptoms improve. Keep using the medication as directed. Do not stop using duloxetine without first talking to your doctor. You may have unpleasant side effects if you stop taking this medicine suddenly.
Store at room temperature away from moisture and heat.
Posted by at No comments:
Labels:

Aluminium hydroxide

Aluminium hydroxide

From Wikipedia, the free encyclopedia
Jump to navigation Jump to search
Aluminium hydroxide
Unit cell ball and stick model of aluminium hydroxide
Sample of aluminium hydroxide in a vial
Names
Preferred IUPAC name
Aluminium hydroxide
Systematic IUPAC name
Aluminium(3+) trioxidanide
Other names
Aluminic acid
Aluminic hydroxide
Aluminium(III) hydroxide
Aluminium hydroxide
Aluminum trihydroxide
Hydrated alumina

Orthoaluminic acid
Identifiers
3D model (JSmol)
ChEBI
ChEMBL
ChemSpider
DrugBank
ECHA InfoCard 100.040.433
KEGG
PubChem CID
RTECS number BD0940000
UNII
Properties[1][2]
Al(OH)3
Molar mass 78.00 g/mol
Appearance White amorphous powder
Density 2.42 g/cm3, solid
Melting point 300 °C (572 °F; 573 K)
0.0001 g/100 mL
3×10−34
Solubility soluble in acids and alkalis
Acidity (pKa) >7
Isoelectric point 7.7
Thermochemistry[3]
−1277 kJ·mol−1
Pharmacology[4]
A02AB01 (WHO)
  • US: B (No risk in non-human studies)
Hazards
Safety data sheet External MSDS
GHS pictograms GHS-pictogram-exclam.svg
H319, H335
P264, P261, P280, P271, P312, P304+340, P305+351+338, P337+313
NFPA 704
Flammability code 0: Will not burn. E.g., waterHealth code 1: Exposure would cause irritation but only minor residual injury. E.g., turpentineReactivity code 0: Normally stable, even under fire exposure conditions, and is not reactive with water. E.g., liquid nitrogenSpecial hazards (white): no codeNFPA 704 four-colored diamond
0
1
0
Flash point Non-flammable
Lethal dose or concentration (LD, LC):
LD50 (median dose)
 >5000 mg/kg (rat, oral)
Related compounds
Other anions
 None
Related compounds
 Sodium oxide,
aluminium oxide hydroxide
Except where otherwise noted, data are given for materials in their standard state (at 25 °C [77 °F], 100 kPa).
☒ verify (what is ☑☒ ?)
Infobox references
Aluminium hydroxide, Al(OH)3, is found in nature as the mineral gibbsite (also known as hydrargillite) and its three much rarer polymorphs: bayerite, doyleite, and nordstrandite. Aluminium hydroxide is amphoteric in nature, i.e., it has both basic and acidic properties. Closely related are aluminium oxide hydroxide, AlO(OH), and aluminium oxide or alumina (Al2O3), the latter of which is also amphoteric. These compounds together are the major components of the aluminium ore bauxite.

Nomenclature

The naming for the different forms of aluminium hydroxide is ambiguous and there is no universal standard. All four polymorphs have a chemical composition of aluminium trihydroxide (an aluminium atom attached to three hydroxide groups).[5]
Gibbsite is also known as hydrargillite, named after the Greek words for water (hydra) and clay (argylles). The first compound named hydrargillite was thought to be aluminium hydroxide, but was later found to be aluminium phosphate; despite this, both gibbsite and hydrargillite are used to refer to the same polymorphism of aluminium hydroxide, with gibbsite used most commonly in the United States and hydrargillite used more often in Europe. In 1930, it was referred to as α-alumina trihydrate to contrast it with bayerite, which was called β-alumina trihydrate (the alpha and beta designations were used to differentiate the more- and less-common forms respectively). In 1957, a symposium on alumina nomenclature attempted to develop a universal standard, resulting in gibbsite being designated γ-Al(OH)3, bayerite becoming α-Al(OH)3, and nordstrandite being designated Al(OH)3. Based on their crystallographic properties, a suggested nomenclature and designation is for gibbsite to be α-Al(OH)3, bayerite to be designated β-Al(OH)3, and both nordstrandite and doyleite are designated Al(OH)3. Under this designation, the α and β prefixes refer to hexagonal, close-packed structures and altered or dehydrated polymorphisms respectively, with no differentiation between nordstrandite and doyleite.[5]

Properties

Gibbsite has a typical metal hydroxide structure with hydrogen bonds. It is built up of double layers of hydroxyl groups with aluminium ions occupying two-thirds of the octahedral holes between the two layers.[6][7]
Aluminium hydroxide is amphoteric. In acid, it acts as a Brønsted-Lowry base by picking up hydrogen ions and neutralizes the acid, yielding a salt:[8]
3HCl + Al(OH)3 → AlCl3 + 3H2O
In bases, it acts a Lewis acid by taking an electron pair from the hydroxide ions:[8]
Al(OH)3 + OH– → Al(OH)4–

Polymorphism

Four polymorphs of aluminium hydroxide exist, all based on the common combination of one aluminium atom and three hydroxide molecules into different crystalline arrangements that determine the appearance and properties of the compound. The four combinations are:[5]
All polymorphs are composed of layers of octahedral aluminium hydroxide units with the aluminium atom in the centre and the hydroxyl groups on the sides, with hydrogen bonds holding the layers together. The polymorphisms vary in how the layers stack together, with the arrangements of the molecules and layers determined by the acidity, presence of ions (including salt) and the surface of the minerals the substance forms on. Under most conditions, gibbsite is the most chemically stable form of aluminium hydroxide. All forms of Al(OH)3 crystals are hexagonal.[5]

Production

Virtually all the aluminium hydroxide used commercially is manufactured by the Bayer process[9] which involves dissolving bauxite in sodium hydroxide at temperatures up to 270 °C (518 °F). The waste solid, bauxite tailings, is removed and aluminium hydroxide is precipitated from the remaining solution of sodium aluminate. This aluminium hydroxide can be converted to aluminium oxide or alumina by calcination.
The residue or bauxite tailings, which is mostly iron oxide, is highly caustic due to residual sodium hydroxide. It was historically stored in lagoons; this led to the Ajka alumina plant accident in 2010 in Hungary, where a dam bursting led to the drowning of nine people. An additional 122 sought treatment for chemical burns. The mud contaminated 40 square kilometres (15 sq mi) of land and reached the Danube. While the mud was considered non-toxic due to low levels of heavy metals, the associated slurry had pH of 13.[10]

Uses

One of the major uses of aluminium hydroxide is as a feedstock for the manufacture of other aluminium compounds: speciality calcined aluminas, aluminium sulfate, polyaluminium chloride, aluminium chloride, zeolites, sodium aluminate, activated alumina, and aluminium nitrate.[7]
Freshly precipitated aluminium hydroxide forms gels, which are the basis for the application of aluminium salts as flocculants in water purification. This gel crystallizes with time. Aluminium hydroxide gels can be dehydrated (e.g. using water-miscible non-aqueous solvents like ethanol) to form an amorphous aluminium hydroxide powder, which is readily soluble in acids. Aluminium hydroxide powder which has been heated to an elevated temperature under carefully controlled conditions is known as activated alumina and is used as a desiccant, as an adsorbent in gas purification, as a Claus catalyst support for water purification, and as an adsorbent for the catalyst during the manufacture of polyethylene by the Sclairtech process.[citation needed]

Fire retardant

Aluminium hydroxide also finds use as a fire retardant filler for polymer applications in a similar way to magnesium hydroxide and mixtures of huntite and hydromagnesite.[11][12][13][14][15] It decomposes at about 180 °C (356 °F), absorbing a considerable amount of heat in the process and giving off water vapour. In addition to behaving as a fire retardant, it is very effective as a smoke suppressant in a wide range of polymers, most especially in polyesters, acrylics, ethylene vinyl acetate, epoxies, PVC and rubber.[16]

Pharmaceutical

Under the generic name "algeldrate", aluminium hydroxide is used as an antacid in humans and animals (mainly cats and dogs). It is preferred over other alternatives such as sodium bicarbonate because Al(OH)3, being insoluble, does not increase the pH of stomach above 7 and hence, does not trigger secretion of excess acid by the stomach. Brand names include Alu-Cap, Aludrox, Gaviscon or Pepsamar. It reacts with excess acid in the stomach, reducing the acidity of the stomach content,[17][18] which may relieve the symptoms of ulcers, heartburn or dyspepsia. Such products can cause constipation, because the aluminium ions inhibit the contractions of smooth muscle cells in the gastrointestinal tract, slowing peristalsis and lengthening the time needed for stool to pass through the colon.[19] Some such products (such as Maalox) are formulated to minimize such effects through the inclusion of equal concentrations of magnesium hydroxide or magnesium carbonate, which have counterbalancing laxative effects.[20]
This compound is also used to control hyperphosphatemia (elevated phosphate, or phosphorus, levels in the blood) in people and animals suffering from kidney failure. Normally, the kidneys filter excess phosphate out from the blood, but kidney failure can cause phosphate to accumulate. The aluminium salt, when ingested, binds to phosphate in the intestines and reduce the amount of phosphorus that can be absorbed.[21][22]
Precipitated aluminium hydroxide is included as an adjuvant in some vaccines (e.g. anthrax vaccine). One of the well-known brands of aluminium hydroxide adjuvant is Alhydrogel, made by Brenntag Biosector.[23][full citation needed] Since it absorbs protein well, it also functions to stabilize vaccines by preventing the proteins in the vaccine from precipitating or sticking to the walls of the container during storage. Aluminium hydroxide is sometimes mistakenly called "alum", which properly refers to aluminium potassium sulfate.[citation needed]
Vaccine formulations containing aluminium hydroxide stimulate the immune system by inducing the release of uric acid, an immunological danger signal. This strongly attracts certain types of monocytes which differentiate into dendritic cells. The dendritic cells pick up the antigen, carry it to lymph nodes, and stimulate T cells and B cells.[24] It appears to contribute to induction of a good Th2 response, so is useful for immunizing against pathogens that are blocked by antibodies. However, it has little capacity to stimulate cellular (Th1) immune responses, important for protection against many pathogens,[25] nor is it useful when the antigen is peptide-based.[26]

Potential adverse effects

In the 1960s and 1970s it was speculated that aluminium was related to various neurological disorders, including Alzheimer's disease.[27][28] Since then, multiple epidemiological studies have found no connection between exposure to aluminium and neurological disorders.[29][30][31]

References


  • For solubility product: "Archived copy". Archived from the original on 15 June 2012. Retrieved 2012-05-17.

  • For isoelectric point: Gayer, K. H.; Thompson, L. C.; Zajicek, O. T. (September 1958). "The solubility of aluminum hydroxide in acidic and basic media at 25 ?c". Canadian Journal of Chemistry. 36 (9): 1268–1271. doi:10.1139/v58-184. ISSN 0008-4042. Retrieved 2017-07-01.

  • Zumdahl, Steven S. (2009). Chemical Principles (6th ed.). Houghton Mifflin Company. ISBN 0-618-94690-X.

  • Black, Ronald A.; Hill, D. Ashley (2003-06-15). "Over-the-Counter Medications in Pregnancy". American Family Physician. 67 (12): 2517–2524. ISSN 0002-838X. Retrieved 2017-07-01.

  • Karamalidis, AK; Dzombak DA (2010). Surface Complexation Modeling: Gibbsite. John Wiley & Sons. pp. 15–17. ISBN 0-470-58768-7.

  • Wells, A.F. (1975), Structural Inorganic Chemistry (4th ed.), Oxford: Clarendon Press

  • Evans, KA (1993). "Properties and uses of aluminium oxides and aluminium hydroxides". In A. J. Downs. Chemistry of aluminium, gallium, indium, and thallium (1st ed.). London; New York: Blackie Academic & Professional. ISBN 9780751401035.

  • Boundless (2016-07-26). "Basic and Amphoteric Hydroxides". Boundless Chemistry. Retrieved 2017-07-02.

  • Hind, AR; Bhargava SK; Grocott SC (1999). "The Surface Chemistry of Bayer Process Solids: A Review". Colloids Surf Physiochem Eng Aspects. 146: 359–74. doi:10.1016/S0927-7757(98)00798-5.

  • "Hungary Battles to Stem Torrent of Toxic Sludge". BBC News Website. 5 October 2010.

  • Hollingbery, LA; Hull TR (2010). "The Fire Retardant Behaviour of Huntite and Hydromagnesite - A Review" (PDF). Polymer Degradation and Stability. 95 (12): 2213–2225. doi:10.1016/j.polymdegradstab.2010.08.019.

  • Hollingbery, LA; Hull TR (2010). "The Thermal Decomposition of Huntite and Hydromagnesite - A Review" (PDF). Thermochimica Acta. 509: 1–11. doi:10.1016/j.tca.2010.06.012.

  • Hollingbery, LA; Hull TR (2012). "The Fire Retardant Effects of Huntite in Natural Mixtures with Hydromagnesite" (PDF). Polymer Degradation and Stability. 97 (4): 504–512. doi:10.1016/j.polymdegradstab.2012.01.024.

  • Hollingbery, LA; Hull TR (2012). "The Thermal Decomposition of Natural Mixtures of Huntite and Hydromagnesite" (PDF). Thermochimica Acta. 528: 45–52. doi:10.1016/j.tca.2011.11.002.

  • Hull, TR; Witkowski A; Hollingbery LA (2011). "Fire Retardant Action of Mineral Fillers" (PDF). Polymer Degradation and Stability. 96 (8): 1462–1469. doi:10.1016/j.polymdegradstab.2011.05.006.

  • Huber Engineered Materials. "Huber Non-Halogen Fire Retardant Additives" (PDF). Retrieved 2017-07-03.

  • Galbraith, A; Bullock, S; Manias, E; Hunt, B; Richards, A (1999). Fundamentals of pharmacology: a text for nurses and health professionals. Harlow: Pearson. p. 482.

  • Papich, Mark G. (2007). "Aluminum Hydroxide and Aluminum Carbonate". Saunders Handbook of Veterinary Drugs (2nd ed.). St. Louis, Mo: Saunders/Elsevier. pp. 15–16. ISBN 9781416028888.

  • Washington, Neena (2 August 1991). Antacids and Anti Reflux Agents. Boca Raton, FL: CRC Press. p. 10. ISBN 0-8493-5444-7.

  • Bill, Robert L. (2016-09-01). Clinical Pharmacology and Therapeutics for Veterinary Technicians - E-Book. Elsevier Health Sciences. p. 105. ISBN 9780323444026.

  • Plumb, Donald C. (2011). "Aluminum Hydroxide". Plumb's Veterinary Drug Handbook (7th ed.). Stockholm, Wisconsin; Ames, Iowa: Wiley. pp. 36–37. ISBN 9780470959640.

  • Lifelearn Inc. (2010-11-01). "Aluminum Hydroxide". Know Your Pet. Retrieved 2017-06-30.

  • "About Brenntag Biosector - Brenntag". www.brenntag.com. Retrieved 19 April 2018.

  • Kool, M; Soullié T; van Nimwegen M; Willart MA; Muskens F; Jung S; Hoogsteden HC; Hammad H; Lambrecht BN (2008-03-24). "Alum adjuvant boosts adaptive immunity by inducing uric acid and activating inflammatory dendritic cells". J Exp Med. 205 (4): 869–82. doi:10.1084/jem.20071087. PMC 2807488 Freely accessible. PMID 18362170.

  • Petrovsky N, Aguilar JC (2004). "Vaccine adjuvants: current state and future trends". Immunol Cell Biol. 82 (5): 488–96. doi:10.1111/j.0818-9641.2004.01272.x. PMID 15479434.

  • Cranage, MP; Robinson A (2003). Robinson A; Hudson MJ; Cranage MP, eds. Vaccine Protocols - Volume 87 of Methods in Molecular Medicine Biomed Protocols (2nd ed.). Springer. p. 176. ISBN 1-59259-399-2.

  • "Alzheimer's Myth's". Alzheimer's Association. Retrieved 2012-07-29.

  • Khan, A (2008-09-01). "Aluminium and Alzheimer's disease". Alzheimer's Society. Retrieved 2012-03-08.

  • Rondeau V (2002). "A review of epidemiologic studies on aluminum and silica in relation to Alzheimer's disease and associated disorders". Rev Environ Health. 17 (2): 107–21. doi:10.1515/REVEH.2002.17.2.107. PMC 4764671 Freely accessible. PMID 12222737.

  • Martyn CN, Coggon DN, Inskip H, Lacey RF, Young WF (May 1997). "Aluminum concentrations in drinking water and risk of Alzheimer's disease". Epidemiology. 8 (3): 281–6. doi:10.1097/00001648-199705000-00009. JSTOR 3702254. PMID 9115023.

    1. Graves AB, Rosner D, Echeverria D, Mortimer JA, Larson EB (September 1998). "Occupational exposures to solvents and aluminium and estimated risk of Alzheimer's disease". Occup Environ Med. 55 (9): 627–33. doi:10.1136/oem.55.9.627. PMC 1757634 Freely accessible. PMID 9861186.

    External links

    Posted by at No comments:
    Labels:
    Subscribe to: Posts (Atom)