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jcrmhscasereports · 1 year

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Case of Necrotizing Pancreatitis following COVID-19 Infection by Faezeh Sehatpour in Journal of Clinical Case Reports Medical Images and Health Sciences

ABSTRACT

New aspects of COVID-19 are increasingly being recognized. Although the virus is mainly known to affect the lungs, involvement of other organs including the heart, liver, gastrointestinal, renal and pancreas is also detected. Acute pancreatitis is detected as one of both the early and late presentations of COVID -19. Cytokine storm or the presence of angiotensin-converting enzyme 2 (ACE2) receptor in pancreatic cells, are both two causes of pancreatic injury in COVID-19 infection. In this study, we reported a 25-year-old man admitted to our department with the impression of necrotizing pancreatitis concomitant with COVID-19 infection. Patient's lab data, imaging and outcomes were documented in full detail.

Abbreviations:

WBC, white blood cell;HB, hemoglobin; MCV, mean corpuscular volume; PLT, platelet; BUN, blood urea nitrogen; Na, sodium; K, potassium; ; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALK.P, alkaline phosphatase; ALB, albumin; LDH, Lactate dehydrogenase ; CPK, creatine phosphokinase; CRP,c-reactive protein; AFP,alpha-fetoprotein; CEA,carcinoembryonic antigen; CA19-9,cancer antigen 19-9; Immunoglobulin G4.

INTRODUCTION

The Covid-19 pandemic is an ongoing pandemic that started in December 2019 and spread rapidly around the word. COVID-19 was caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), first identified in Wuhan, China. So far, more than 200 countries have been affected by the pandemic. (1)

The involvement of the gastrointestinal system is maybe due to the expression of the angiotensin-converting enzyme2 (ACE2) on the hepatocyte, cholangiocyte and other parts of the GI tract. (3) In a recent survey, acute pancreatitis was detected as one of both early and late presentations of COVID -19. (4-6) However, it is still unclear whether SARS-COV-2 directly affects pancreatic cells because of ACE2, if it is a cytokine storm which causes pancreatic injury. (7)

We reported a case of COVID-19 with subsequent acute necrotizing pancreatitis.

CASE REPORT

A 25-year-old man without any known medical disease presented to our emergency department with progressive epigastric pain, nausea and vomiting and anorexia one week prior to admission. He has no history of alcohol consumption. He also had a history of admission to another hospital about two weeks ago with a diagnosis of COVID-19 pneumonia. On admission, he has a blood pressure of 115/75 mm HG, a heart rate of 100 beats per minute, a temperature of 37.1 ⁰C and oxygen saturation of 95% while the patient is breathing in the room air. Primary investigations summarized in Table-1. Amylase and lipase were 146 IU/L and 82 IU/L respectively. Nasal swab test for COVID-19 (RT-PCR for SARS-CoV-2) was positive. Abdominal sonography showed markedly prominent pancreas with in homogeneous parenchymal echogenicity and large cystic lesion arising from the pancreas, in favor of acute complicated pancreatitis with pseudo cyst. The gall bladder has a normal size and wall thickness without any gall stones. The pancreatic duct was not dilated. Due to the finding of abdominal ultra sound, CT scan of abdomen was done on him which revealed an enlarged pancreas with necrosis of the main portion of pancreatic parenchyma. Large cystic lesion measuring 15×7×11 cm in size arising from the pancreatic neck with extension to the right and left side of the abdomen suggestive of large pancreatic pseudo cyst (figure1). Lung HRCT (low dose) also showed bilateral peripheral ground glass opacities in favor of COVID-19 pneumonia (figure2). According to the findings of a physical exam, laboratory data and clues in imaging immediate management of acute necrotizing pancreatitis (invasive intravenous hydration and pain control) was started for him. He was finally discharged from the hospital with a full recovery.

Table 1: laboratory data

Figure 1: Abdominal CT scan: large loculated pseudo cystic structure measuring about 158mm*100mm in lesser sac due to post pancreatitis pseudo cyst formation.

Figure 2: lung HRCT: multiple ground glass and bilateral pleural effusion

DISCUSSION

Acute pancreatitis is an acute inflammation of the pancreas characterized by abdominal pain, nausea, vomiting and elevated exocrine pancreatic enzymes; amylase and lipase. Gallstones and chronic alcohol abuse are the most common causes of acute pancreatitis. Viruses are uncommon causes of acute pancreatitis. Pancreatitis has been reported with several viruses, including mumps, coxsackievirus, hepatitis A and B virus, cytomegalovirus, varicella-zoster, herpes simplex and human immunodeficiency virus. (8)

Although we have not conclusively proven the presence of the virus in the pancreas, the causes of COVID-19 and acute pancreatitis and the lack of other clear causes for pancreatitis strengthen the relationship between the two diseases. In this study, the patient presented with necrotizing COVID-19in 19 in the early post period of COVID-19 infection.

In Fan Wang and colleagues' survey, 52 COVID-19 cases followed and showed that 17% of COVID-19 patients developed pancreatic injury and presented with mild elevated pancreatic enzymes; serum amylase and lipase without clinically severe pancreatitis. The possibility of drug induced acute pancreatitis in patients who have received medication due to COVID-19 is also expressed as one of the reasons for acute pancreatitis in COVID-for19 infection. (9) Saffa Saeed Al Mazrouei and his teammates reported a 24-year-old patient with acute non-necrotizing pancreatitis with concurrent COVID-19. No evidence of pseudo cyst or abscess was detected in his imaging. (10)

Pancreatic damage can be due to the direct effect of the virus on pancreatic cells or indirectly secondary to the immune system. In another study in Wuhan, it showed that ACE2 was expressed in the pancreas higher than the lung in the normal population, indicating that SARS-CoV-2 can bind to ACE2 in the pancreas and cause pancreatic cell damage. (7, 11)

Acute pancreatitis is one of the presentations or complications of COVID-19 infection. Further investigation with samples is needed to reveal the pathophysiology, presentation, treatment and prognosis of acute pancreatitis in COVID-19 infection.

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#COVID-19 #Cytokine storm #blood cell;HB #aminotransferase #CRP #c-reactive protein #carcinoembryonic antigen #alpha-fetoprotein #anorexia #RT-PCR for SARS-CoV-2 #HRCT #Faezeh Sehatpour #jcrmhs

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trishmishtree · 4 years

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[Current as of March 13, 2020]

Dr. Shahed (screenshot above) is an emergency department physician in Ohio who shared this post on Facebook. It’s an account of COVID-19 from the perspective of an ICU doc working on the frontlines in Seattle. Some of my laypeople-friends were sharing it around (and I’ve seen it floating around on twitter and various internet forums], but I noticed that it’s really dense and contains a lot of medical abbreviations and jargon, like it was meant more for other physicians and isn’t really useful for the average reader. So I thought I’d provide a translation for my non-medblr followers who are looking to stay informed. (If you want further clarification, feel free to drop me an ask)

***

This is from a front-line ICU physician in a Seattle hospital

This is his personal account:

We have 21 patients and 11 deaths since 2/28.

We are seeing patients who are young (20s), fit, no comorbidities, critically ill. It does happen.

US has been past containment since January

Currently, all of ICU is for critically ill COVID patients, all of med-surg [medical-surgical] floors are for stable COVID patients and end-of-life care, half of PCU [progressive care unit], half of ER. New Pulmonary Clinic offshoot is open for patients with respiratory symptoms

CDC is no longer imposing home quarantine on providers who were wearing only droplet-isolation PPE when intubating, suctioning, bronching, and in one case doing bloody neurosurgery. Expect when it comes to your place you may initially have staff home-quarantined. Plan for this NOW. Consider wearing airborne-isolation PPE for aerosol-generating procedures in ANY patient in whom you suspect COVID, just to prevent the mass quarantines.

We ran out of N95s (thanks, Costco hoarders) and are bleaching and re-using PAPRs [powered air purifying respirators], which is not the manufacturer’s recommendation. Not surprised on N95s as we use mostly CAPRs [controlled air purifying respirators] anyway, but still.

Terminal cleans (including UV light) for ER COVID rooms are taking forever, Environmental Services is overwhelmed. This is bad, as patients are stuck coughing in the waiting room. Recommend planning now for Environmental Service upstaffing, or having a plan for sick patients to wait in their cars (that is not legal here, sadly).

CLINICAL INFO (based on our cases and info from CDC conference call today with other COVID providers in US):

The Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark. Data [in the US] very skewed by late and very limited testing, and the number of our elderly patients going to comfort care.

Being young & healthy (zero medical problems) does not rule out becoming vented or dead

Probably the time course to developing significant lower respiratory symptoms is about a week or longer (which also fits with timing of sick cases we started seeing here, after we all assumed it was endemic as of late Jan/early Feb).

Based on our hospitalized cases (including the not-formally-diagnosed ones who are obviously COVID – it is quite clinically unique), about 1/3 of patients have mild lower respiratory symptoms and need 1-5L NC [1-5 liters of oxygen per minute, via nasal cannula]. 1/3 are sicker, need face mask or non-rebreather. 1/3 are intubated with ARDS [acute respiratory distress syndrome].

Thus far, everyone is seeing:

normal WBC [white blood cell] count. Almost always lymphopenic, occasionally poly [neutrophil]-predominant but with normal total WBC count. Doesn’t change, even 10 days in.

Bronchoalveolar lavage: lymphocytic despite blood being lymphopenic. (Try not to bronch these patients; this data is from pre-testing time when we had several idiopathic ARDS cases)

Fevers, often high, may be intermittent; persistently febrile, often for >10 days. It isn’t the dexmed, it’s the SARS2.

Low procalcitonin; may be useful to check initially for later trending if you are concerned later for VAP [ventilator-associated pneumonia], etc.

Elevated AST/ALT, sometimes alkaline phosphatase. Usually in 70-100 range. No fulminant hepatitis. Notably, in our small sample, higher transaminitis [elevated AST/ALT] (150-200) on admission correlates with clinical deterioration and progression to ARDS. LFTs [liver function tests] typically begin to bump in 2nd week of clinical course.

Mild AKI [acute kidney injury] (creatinine <2). Uncertain if direct viral effect, but notably SARS2 RNA fragments have been identified in liver, kidneys, heart, and blood.</li>

Characteristic chest x-ray: always bilateral patchy or reticular infiltrates, sometimes peri-hilar despite normal ejection fraction and volume down at presentation. At time of presentation may be subtle, but always present, even in our patients on chronic high dose steroids. NO effusions.

CT is as expected, rarely mild mediastinal lymphadenopathy, occasional small effusions late in course, which might be related to volume status/cap leak.

Note - China is CT'ing everyone, even outpatients, as a primarily diagnostic modality. However, in US/Europe, CT is rare, since findings are nonspecific, would not change management, and the ENTIRE scanner and room have to be terminal-cleaned, which is just impossible in a busy hospital. Also, transport in PAPRs, etc.

2 of our patients had CTs for idiopathic ARDS in the pre-test era; they looked like the CTs in the journal articles. Not more helpful than chest x-ray.

When respiratory failure occurs, it is RAPID (likely 7-10 days out from symptom onset, but rapid progression from hospital admission). Common scenario for our patients is: admit on 1L/min oxygen via nasal cannula. Next 12 hrs escalate to NPPV [non-invasive positive pressure ventilation]. Next 12-24 hrs → vent/proned/Flolan.

Interestingly, despite some needing Flolan, the hypoxia is not as refractory as with H1N1. Quite different, and quite unique. Odd enough that you’d notice and say hmmm.

Thus far many are dying of cardiac arrest rather than inability to ventilate/oxygenate.

Given the inevitable rapid progression to ETT [endotracheal tube, aka intubation] once respiratory decompensation begins, we and other hospitals, including Wuhan, are doing early intubation. Face mask is fine, but if patients are needing HFNC [high-flow nasal cannula] or NPPV [non-invasive positive pressure ventilation], just tube them. They definitely will need a tube anyway, and no point risking the aerosols.

No MOSF [multi-organ system failure]. There’s the mild AST/ALT elevation, maybe a small creatinine bump, but no florid failure. Exception is cardiomyopathy.

Multiple patients here have had normal EF [ejection fraction] on formal Echo or POCUS [point-of-care ultrasound] at time of admission (or in a couple of cases, EF 40ish, chronically). Also normal troponins from emergency department. Then they get the horrible respiratory failure, sans sepsis or shock. Then they turn the corner, come off Flolan, supined, vent weaning, looking good, never any pressor requirement. Then over 12 hrs, newly cold, clamped, multiple-pressor shock that looks cardiogenic, EF 10% or less. Then either VT [ventricular tachycardia, aka V-tach] → VF [ventricular fibrillation, aka V-fib] → dead, or PEA [pulseless electrical activity] → asystole in less than a day. Needless to say, this is awful for families who had started to have hope.

We have actually had more asystole than VT. Other facilities report more VT/VF, but same time course, a few days or a week after admission, around the time they’re turning the corner. This occurs on med-surg patients too. One today, who is elderly and chronically ill but with baseline EF preserved, became newly hypotensive overnight, EF <10. Already no escalation, has since passed. So presumably there is a viral cardiomyopathy aspect, which presents later in the course of disease.

Of note, no wall motion abnormalities on Echo, right ventricular function preserved, troponins don’t bump. Could be unrelated, but I’ve never seen anything like it before, especially in a patient who had been hemodynamically stable without sepsis.

TREATMENT:

Remdesivir might work, some hospitals have seen improvement with it quite rapidly, marked improvement in 1-3 days. ARDS trajectory is impressive with it, patients improve much more rapidly than expected in usual ARDS.

Recommended course is 10 days, but due to scarcity, all hospitals have stopped it when the patient is clinically out of the woods. None have continued >5 days. It might cause LFT bump, but interestingly seem to bump (200s-ish) for a day or 2 after starting, then rapidly back to normal, suggests this is not a primary toxic hepatitis.

Unfortunately, the Gilead compassionate use and trial programs require AST/ALT <5x normal, which is pretty much almost no actual COVID patients. Also CrCl [creatinine clearance] >30, which is fine. CDC is working with Gilead to get LFT requirements changed now that we know this is a mild viral hepatitis.

Currently the Gilead trial is wrapping up, NIH trial still enrolling, some new trial soon to begin, can’t remember where.

Steroids are up in the air. In China, usual clinical practice for all ARDS is high dose methylprednisolone. Thus, ALL of their patients have had high dose methylprednisolone. Some question whether this practice increases mortality.

It is likely that it increases secondary VAP/HAP [ventilator-associated pneumonia/hospital-acquired pneumonia]. China has had a high rate of drug-resistant GNR [Gram-negative rod] HAP/VAP and fungal pneumonia in these patients, with resulting increases in mortality. We have seen none, even in the earlier patients who were vented for >10 days before being bronch’ed (prior to test availability. Again, it is not a great idea to bronch these patients now).

Unclear whether VAP-prevention strategies are also different [in China vs US], but wouldn’t think so?

Hong Kong is currently running an uncontrolled trial of HC 100IV Q8 [hydrocortisone 100 mg IV every 8 hours].

General consensus here (in US among doctors who have cared for COVID patients) is that steroids will do more harm than good, unless needed for other indications.

Many of our patients have COPD on ICS [inhaled corticosteroids]. Current consensus at Evergreen, after some observation & some clinical judgment, is to stop ICS if able, based on known data with other viral pneumonias and increased susceptibility to HAP. Thus far patients are tolerating that, no major issues with ventilating them that can’t be managed with vent changes. We also have quite a few on AE-COPD [acute exacerbation of COPD]/asthma doses of methylprednisolone, so will be interesting to see how they do.

#medblr #covid-19 #long post

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whumpqhs · 5 years

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Whumptober alt #6: Lost

Part 1

Part 2

Part 3

Part 4

Part 5

Part 6

Part 7

"Looks like he's going to make it."

The words shouldn't have made her happy. Looking down at the guard as his eyes started to blink open, she should have felt like a failure, but the shame just wouldn't come. She shifted over a little so that, still kneeling at his side, she could ease one of his heavy arms over her shoulders. Across from her, another medic did the same. They counted together, and lifted together, voices in unison: "One, two, three." Suddenly the dead body on the floor was standing and stumbling, with a lot of help, over to the nearest medical bed. Assessing him and hanging his fluids from something other than her shoulder was a fantastic way not to have to think. She knew what to do for this patient, and right now, that was all that was important.

"We need labs. CBC, CMP, and troponin and creatinine levels. Whatever you have on the formulary for an NSAID, too, in case I'm right. Looks like an MI but we need the tests to know for sure..." She helped them as they repositioned him in bed, moving him up and covering him with blankets, giving orders as if she were still back home. He was hazy, out of it. She patted his shoulder. "We've got you, man, we're doing everything possible to help you. How's your pain?"

"Re... really bad..."

"Yeah? Like what number?" She looked across the bed to the one who'd been helping her lift and transfer. "Hey, I need morpha, and a syringe."

"Here."

The way they just handed it to her should've made her uneasy. It should've signaled something, the way they trusted her. It didn't. All it signaled in that moment was that she could help her patient not hurt so much. "Pushing two units and hanging the rest as a driver, as soon as I draw off these labs—you got vials?"

"Here."

“Thanks. They don’t let me put stuff in my pockets… I don’t even know if I can chart on him, he’s a guard.”

“I’ll get it. Next time, we’ll trade, and I’ll be on his IV side, okay?”

“Yeah, thanks.” Next time.

The effect was almost instantaneous: as she pushed the first dose, her patient started to relax, settling down. His heart rate dropped into normal limits. Sonora couldn’t contain a smile as she hung the remainder of the syringe and keyed the flow rate into his IV pump. Her mind was calm and, despite her moral objections, awash with the familiar, soft, effervescent feeling of a good code winding down. Stepping away to scrub out brought her right in front of Keeper, and she expected some kind of harsh correction as he reached toward her.

His hand settled on her shoulder, soft pressure, no pain. “Good job, Epi.”

Epi.

This was bad.

But it didn’t feel bad… it felt good. She felt like she was flying, veins rushing with adrenaline, like she was doing what she was always meant to do. Who cared about a guard? He’d finish his career in this place, especially after what looked like a massive heart attack. That was a life, wasn’t it? She saved a life.

A Republic life.

Who was he before he was a prison guard? Did he see active duty? Did he kill Imperials, like her? Whose revenge could it have been if she’d let him go? But even as they walked her down to the break room and let her get crappy junk food out of the vending machine, like a real person, she couldn’t make herself feel bad. Bad wasn’t the right word. Even later, when it started to change from a good feeling to a bad one, it wasn’t guilt that crept in. It wasn’t shame, either; it was something cold and empty.

Loneliness. She’d never felt so far from other people, so directionless and utterly lost. Who was she? She couldn’t be Republic. She couldn’t bring herself to defect, not even after saving one of theirs. Was she really Imperial anymore, after today? Did living here as a prisoner count as being under duress? Even if it did count, would Intelligence believe her that she hadn’t wanted to do it? Would they believe her when she said she regretted those compressions? How could they, when she didn’t even believe the words herself? She walked to the door of her cell and knocked, determined to get her mind off of this.

“Yeah?” It was one of the other medics this time, not a guard or an SIS agent. She recognized him: he’d been in on the code. Perfect.

“I forgot to chart something. Can I borrow a datapad?” “Forgot” was the pleasant word for how Keeper had dragged her off the floor and insisted on her getting some rest. Although, she’d slept another ten hours after he forced her to drop her charting and go, so she had to admit he was a little bit right.

“I have to watch you,” he warned.

“Yeah, of course.” She nodded, and took it when it was handed over. But as she settled down, she noticed that he wasn’t insisting on being able to see the screen. She typed in the guard’s name from before, and sighed dramatically at the lockout screen that popped up.

“What’s going on?”

“Oh, you know. Access denied, all that. This is so frustrating, I forgot to get any of my documentation in… and now…”

“Here, let me see.” She handed it over to him, watching as he typed in some kind of override code and passed it back. “There you go, should work fine now.”

The guard’s chart came up without a problem. She grinned. “Thanks!”

“Yeah, no problem.”

Unfortunately, charting didn’t take that long, and the loneliness came right back as soon as her mind was free. She signed off on the note, checked the lab values—the most recent round wasn’t back yet, but the initial set pointed to cardiac arrest—and was about to log out and hand it back when she noticed the treatment team listed.

Her name was there, but so were his nurses from the previous shift… his attending provider… and Keeper’s face, next to his designation, Rongeur, and a string of abbreviations. She clicked on it, and his file opened up instead. It took a lot of restraint not to gasp. Sonora carefully scrolled down, looking through the notes, commendations, letters. It all looked regular, legitimate… seamless. A little too seamless. She finally found the clue under his history, in a list of previous meds.

Dimallium 6.

Sonora frowned. Only one use for that: Castellan restraints. Conditioning. She paused, reaching out to touch the word with a fingertip. When she did, a dialogue box popped up.

Open previous encounter for this med?

She hesitated at first, but then reached out again, tapping the screen.

Yes.

Enter override code:_____________

Sonora frowned, then looked up and took a chance. “Hey, can you put that code in again? It won’t let me in the MAR.”

For one terrifying moment, as she handed him the datapad and let him put in the code, she realized what a terrible mistake she’d made. It could all be over, her entire life, and for what?—to look up his records? Why, when he was the enemy?

...but was he really the enemy? She had to know.

“Here, should work, it looked like it took the code.” She had to stifle a sigh of relief as he handed it back without really looking.

“Thanks, I appreciate it.”

“I thought I saw the dose in the MAR already,” he said.

“I charted against the override. Had to fix it.”

A little sound of acknowledgement and a half-said “Ah yeah that’s annoying” was the extent of his protest. She peered into the encounter, eyes scanning, fingertips tapping to make it look like she was working on the MAR. But when she finally found the notes from the conditioning, her hand slowed. The notes were in reverse order, working backwards into the past with the most recent ones first: progress updates following his rehabilitation, implantation of new memories… and down at the bottom, she found a brief AAR about his capture… but nothing about him defecting. Frowning, Sonora worked back up from the AAR, going over everything again. Had she missed one?

She finally found the answer that she was terrified of, in the transcript from his last interrogation.

---

SIS: Last chance, Vael. You can tell us everything you know, or we’ll start cutting off fingers.

PRISONER: Do it. I don’t care.

SIS: You know you’re the sole survivor, right? All the other agents, they’re gone.

PRISONER: Like I believe that.

[Electroshock applied. Several deep cuts made to abdomen. No new information.]

SIS: What’s so special about them that you won’t talk? Even when you’re here for life, even with them dead?

PRISONER: That’s… my team… I’m… the medic… gotta take care of them.

SIS: They’re gone, Vael! They’re dead. What’s stopping you?

PRISONER: Because… th-they’re my… family. I love… them… and even... even if they’re gone, I... I... I’m not gonna l-let them down.

SIS: Oh, you’re gonna let them down, Vael. You just don’t know it yet.

[Session terminated. Will begin selective treatment with dimallium immediately. Keyword to reverse conditioning in case of emergency: Aurek Five System Yellow Seventeen.]

---

For a little while, she sat quietly, rereading the note. Then rereading it again. Memorizing the code. Finally, she backed out of the chart and handed it to the man at the door.

“Hey, it freaked out on me or something. Started opening a bunch of other pages, I had to shut it off. I’ll finish charting tomorrow.”

He nodded, tucking the datapad away as she turned back to her bed, stretching out. As she drifted to sleep, the words from the code echoed in her mind:

What could I have done to save one of mine?

#whumptober2019 #altno.6 #lost #emotional whump #torture mention #Bitter Medicine #swtor #imperial agent

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siva3155 · 4 years

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300+ TOP DOCTOR Interview Questions and Answers

DOCTOR Interview Questions for freshers experienced :-

1) Explain who is Doctor? A physician is someone who practices medicine to treat illnesses and injuries. Physicians go to medical school to be trained. They typically hold a college degree in medicine. Physicians once made house calls to treat patients at home, but now mostly see patients in their offices or in hospitals. Physicians may also work for schools, companies, sports teams, or the military. Physicians are often assisted by nurses or other staff. 2) How doctor treat patients? Physicians treat patients by diagnosing them, or figuring out what is wrong. When Physicians diagnose a patient, they begin by asking questions about the patient's symptoms such as fever, headache, or stomach ache. They may ask other questions about things like past illnesses or family members who have been sick. They will then examine the patient, often looking at different parts of the body and listening to the heart and lungs with a stethoscope. Sometimes they may need to collect blood, use an x-ray machine, or use other tools to look for things they cannot see when examining the patient. Usually, when they have gathered enough information, a doctor can make a diagnosis and then prescribe a treatment. Often they prescribe . 3) Who is a specialists doctor? Some doctors specialise in a certain kind of medicine. These physicians are called specialists. They may only treat injuries to a certain part of the body, or only treat patients who have certain diseases. For example, there are physicians who specialise in diseases of the stomach or intestines. Other physicians are "general practitioners" or "family practitioners". This means that they do a little bit of everything. They try to deal with as much of a patient's health problems as they can without sending them to a specialist. A doctor who performs surgery is called a surgeon. 4) How communication skills help patient? Once a patient begins developing trust in a doctor, the chances of him/her recovering increases as his/her confidence in the doctor goes up and s/he begins to believe that s/he can recover. 5) Why doctors should learn communication skills? Communication skills play a major role in developing patient-doctor relationship. And miscommunication could lead to clashes with relatives/friends of patients over care given to the latter. 6) What is Venous thrombosis? There are numerous extra-gastrointestinal manifestations of inflammatory bowel disease that occur in both ulcerative colitis and Crohn's disease, such as uveitis, conjunctivitis, arthritis, pyoderma gangrenosum and erythema nodosum. Some occur primarily in Crohn's, such as gallstones and renal stones due to the area of bowel affected, while patients with ulcerative colitis are more likely to develop primary sclerosing cholangitis and venous thromboses. 7) What is Azathioprine? Azathioprine takes a number of months to exert its anti-inflammatory effect and therefore has a limited role in the acute management of Crohn's disease, though it can be started at the time of an acute flare of Crohn's. 8) What is Bendroflumethiazide? Treatment of hypercalcaemia can include fluid rehydration, loop diuretics, bisphosphonates, steroids, salmon calcitonin and chemotherapy. In clinical practice intravenous fluids are the first-line agent used to treat hypercalcaemia, both rehydrating the patient and helping to lower the calcium levels. This is combined with the co-administration of bisphosphonates such as pamidronate, which exert their maximal effect 5-7 days after administration. 9) What is Ceftriaxone? A cephalosporin such as ceftriaxone is first-line treatment in patients with streptococcal meningitis. Benzylpenicillin would be more appropriate if Neisseria meningitidis was suspected. 10) What is Anti-Histone antibody? In induced SLE anti-histone antibody is present in 90% of patients, although this is not specific for the condition. Anti-nuclear antibody is positive in 50% of patients as opposed to 95% of patients with idiopathic SLE.

DOCTOR Interview Questions 11) What is C-reactive protein? In SLE the erythrocyte sedimentation rate is classically raised while C-reactive protein levels can stay normal and therefore CRP is also not as useful as the other investigations to monitor disease activity and progression. 12) What are the parameters of life-threatening asthma? Peak expiratory flow rate of Tachycardia: heart rate > 100 beats per minute Inability to complete sentences with one breath 14) What is terbutaline 10 mg nebulised In the management of asthma, patients should be sitting upright in bed and receiving 100% oxygen. Salbutamol is given at a dose of 5 mg nebulised, not 500 micrograms. Ipratropium bromide and steroids should then be considered. 15) Medical Abbreviations part 19: TFTs - thyroid function tests U - units UC - ulcerative colitis V/Q - ventilation/perfusion WCC - white cell count 16) Medical Abbreviations part 18: RBBB - right bundle branch block SIADH - syndrome of inappropriate ADH secretion SLE - systemic lupus erythematosus STEMI - ST-elevation myocardial infarction STD 17) Medical Abbreviations part 17: p.r.n. - pro re nata PSA - prostate-specific antigen PSC - primary sclerosing cholangitis PSGN - post-streptococcal glomerulonephritis RAS - renal artery stenosis 18) Medical Abbreviations part 16: PaO2 - partial pressure of oxygen PCA - patient-controlled analgesia PCI - primary coronary intervention PCP - Pneumocystis carinii pneumonia PCR - polymerase chain reaction 19) Medical Abbreviations part 15: --> NICE 1) Formerly: National Institute for Clinical Excellence 2) Currently: National Institute for Health and Clinical Excellence --> NMDA - N-methyl-D-aspartate --> NSAIDs - non-steroidal anti-inflammatory --> NSTEMI - non-ST-elevation myocardial infarction --> PaCO2 - partial pressure of carbon dioxide 20) Medical Abbreviations part 14: MRI - magnetic resonance imaging MRSA - methicillin-resistant Staphylococcus aureus MSH - melanocyte-stimulating hormone NAC - N-acetylcysteine NG - nasogastric 21) Medical Abbreviations part 13: LFT - liver function test LTOT - long-term oxygen therapy MCV - mean cell volume MHC - major histocompatibility complex MMSE - mini mental state examination 22) Medical Abbreviations part 12: J - joules JVP - jugular venous pressure LBBB - left bundle branch block LDH - lactate dehydrogenase LDL - low-density lipoprotein 23) Medical Abbreviations part 11: HONKC - hyper-osmolar non-ketotic coma HSP - Henoch-Schnlein purpura HUS - haemolytic uraemic syndrome IV - intravenous IVDU - intravenous user 24) Medical Abbreviations part 10: HAART - highly active antiretroviral treatment hCG - human chorionic gonadotrophin HDL - high-density lipoprotein HDU - High-Dependency Unit HLA - human leukocyte antigen 25) Medical Abbreviations part 9: G6PD - glucose-6-phosphate dehydrogenase GCS - Glasgow coma scale GFR - glomerular filtration rate GORD - gastro-oesophageal reflux disease GTN - glyceryl trinitrate 26) Medical Abbreviations part 8: FEV1 - forced expiratory volume in 1 second FFP - fresh frozen plasma FH - familial hypercholesterolaemia Fi(O)2 - fraction of inspired oxygen FVC - forced vital capacity 27) Medical Abbreviations part 7: DVT - deep vein thrombosis ERCP - endoscopic retrograde cholangiopancreatography ESR - erythrocyte sedimentation rate F1 - Foundation year 1 doctor F2 - Foundation year 2 doctor 28) Medical Abbreviations part 6: CPAP - continuous positive airway pressure (ventilation) CPR - cardiopulmonary resuscitation CRP - C-reactive protein CSF - cerebrospinal fluid dsDNA - double-stranded DNA 29) Medical Abbreviations part 5: CDT - Clostridium difficile toxin CIN - cervical intraepithelial neoplasia CLL - chronic lymphocytic leukaemia COMT - catechol-O-methyltransferase COPD - chronic obstructive pulmonary disease 30) Medical Abbreviations part 4: BCG - bacille Calmette-Guerin BHL - bilateral hilar lymphadenopathy BMI - body mass index BNP - B-type natriuretic peptide CEA - carcinoembryonic antigen 31) Medical Abbreviations part 3: AMT - abbreviated mental test ANA - antinuclear antibody ANCA - anti-neutrophil cytoplasmic antibody APACHE - acute physiology and chronic health evaluation AST - aspartate aminotransferase 32) Medical Abbreviations part 2: ADH - antidiuretic hormone AFB - acid-fast bacilli AIDS - acquired immunodeficiency syndrome ALP - alkaline phosphatase ALT - alanine aminotransferase 33) Medical Abbreviations part 1: AF - atrial fibrillation aFP - alpha-fetoprotein ABG - arterial blood gas ACE - angiotensin-converting enzyme ACTH - adrenocorticotrophic hormone 34) How many childrens affected with asthma in UK? Asthma affects over 5 million individuals in the UK. Approximately 1 million children are affected. 35) Can medication is known to cause hypokalaemia? The medication is most likely to be a selective 2-agonist such as salbutamol, which leads to a tremor, palpitations, headaches and hypokalaemia at high doses. Washing the mouth after administration of inhaled steroids is recommended, no matter what dose is given. Atrovent is the trade name for ipratropium bromide, which is more useful in chronic obstructive pulmonary disease than in asthma, although it can be used in an acute asthma attack. 36) Patient feeling randomly sick with headaches. What could it be? Persistent headaches are not something that can be ignored, as this could be your body trying to send you a signal that there is something wrong. Often, the history and description of the headache can be quite helpful as you attempt to determine what is the cause of your headaches so that you can know how to get better. If your headaches are associated with certain movements, activities, foods, or other triggers, than this can serve as a clue to you and your doctor to help you feel better. If, on the other hand, your symptoms are somewhat predictable and come on in the same way, then it is also possible to use this information to diagnose the type of headache, which then gets you closer to getting some help with your pain and other symptoms. Migraines are classically associated with light sensitivity, nausea and vomiting, and intractable and incapacitating pain. People with migraines may have a family history of them, and they may have an aura, or symptoms that routinely come before the headache and let them know it is coming. 37) Why should be pain in neck? There are times that infections can happen in the neck, and these infections can be very serious because of the number of important structures that run through the neck. Some of these include nerves that are relevant to moving some of the muscles of your upper extremities, and others are the very important arteries and veins that run through your neck to and from your head. Often, if people have an infection, they will also have symptoms of an infection, such as a high fever, swelling, redness, etc. These can be more common in those with a history of injecting, as this allows serious and dangerous bacteria direct access to the rest of the body through the arteries and veins. If it has been a while since your last injection, then it may make an infection less likely. Swelling and pain can also happen from muscle spasms that come with poor posture or increased exertion out of the norm. There are also some other possible explanations. 38) Why do in some cases patients feel chest, neck and hands flush? Certainly the thought of carcinoid syndrome is something that crosses the mind in hearing about your symptoms. That is, however, a rather rare process that would be unusual for most people to have. In such a situation, it is good to describe your symptoms and your concerns to your doctor so that he or she can test for the possibility of something as serious or as rare as that condition. There are many other possible explanations, however, many of which are much more common. It is not unusual for some people to have changes of flushing and some of the other feelings that you describe when they are in stressful or unusual situations. Some of this can sometimes be understood in context of the response that some people have to loud noises or fright, ie, they can faint. This reaction is one extreme on the spectrum of a vagal reaction that can occur in some. On a less extreme note, other can have some of the same symptoms you describe without having something as notable as a syncopal episode. There are often things that can be done to help. 39) Suppose if a patient have abnormal blood on his underwear how you deal? Abnormal bleeding can have many different causes, but you have provided some valuable information. First, we have to clarify where exactly the bleeding is coming from. While vaginal bleeding is perhaps the most likely, both the urinary tract and the GI tract can also be a source of bleeding. Either of those would have different causes and explanations, with infections and small sources of bleeding such as hemorrhoids being among the most common reasons for abnormal or untimely bleeding. With regards to vaginal bleeding, there is a clue that is suggested by the fact that the blood is bright red in color. In general, this can reflect fresher blood that has not started to be broken down. It may also suggest blood that is coming from a source further down the vaginal tract, although that is not necessarily true. There are different conditions that can affect the vaginal or uterine lining and are common explanations for symptoms such as you describe. There are also tumors that can result in abnormal bleeding, and these tumors can be both benign and malignant. 40) Suppose if patient have unbearable neck to shoulder pain only while on his period. What could it be? This is a somewhat interesting phenomenon that will take more visits to your doctor to help explain. Your OB/GYN is likely a good place to start, as he or she will be best positioned to help sort out the hormonal element to your symptoms. Another option might be a neurologist or spine surgeon, either of which may be able to help with your symptoms at the level of your neck. An ear nose and throat surgeon may offer some other insight that could be helpful. Whichever you choose, the approach to your problem will likely be different. Primary care and medical doctors are more likely to use lab work and your symptoms to help arrive at an answer, and may use medications empirically to see what helps to make you better. A surgeon, on the other hand, is more likely to listen to your symptoms, complete an exam, and recommend imaging and other anatomic studies that can help to determine what is causing your symptoms. The pain may have a component of something that changes on a monthly basis with your menstrual cycle. This could be a swelling, or even something as simple as a change in the blood flow. 41) Suppose if patient having chronic neck pain for 4 days. Medication and RMT massage have done nothing, pain is 10/10 now. What could it be? It is not normal for pain to become so severe and fail to respond in any way to conservative therapy, and so your doctor should discuss this with you in more detail to make sure that there is nothing serious that is causing your symptoms. Neck and muscle spasms can be common in some people with a history of c spine injury or trauma, and can be severe and debilitating. They should not be a new onset symptom for most people, however, unless you have had some precipitating event. Massage and things to help the muscles relax is often a great idea to help with some of the mild aches and pains that we can have from time to time, and the fact that you had no improvement is worrisome. Your doctor may entertain other possible explanations for this pain in addition to trauma and misuse injuries. He or she may decide it is important to get some imaging and complete a physical exam looking for things that might be amiss. Shooting pain can be a concern for nerve injury. 42) Suppose if I am patient of acid reflux, how can I get rid off? Fortunately, there are things that can be done to help with reflux. The most obvious answer is some of the many medications that are available to help reduce stomach acid. Some of the least expensive and most effective are even available over the counter, but should be used after discussing your symptoms with your doctor. There are some medications, such as ranitidine and other anti histamine medications (H2 blockers as they are sometimes called), that can be very effective for many people and have a very mild side effect profile. They are most effective when taken as directed, and the efficacy does tend to decrease if they are not timed appropriately with regards to the meals. Other excellent medications are those that are known as proton pump inhibitors, or PPIs, which can be even more effective. The over the counter doses are effective for most people, but in severe cases prescription strength doses can also be used. These medications also have relatively mild side effects, but should be discussed with your doctor. In addition to these medications, lifestyle changes should be tried before any medications. These can be found suggested in many places. 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Blood Tests Normal test result values are expressed as a reference range, which is based on the average values in a healthy population, 95% of healthy people have values within this range. These values vary somewhat among laboratories, due to methodology and even geography. Tests and testing vary widely in different parts of the world, and in different parts of most countries, due to characteristics in the population, as well as other factors. American Blood laboratories use a different version of the metric system (mass per volume). The rest of the world uses the Systeme Internationale (SI). In some cases translation between the two systems is easy, but the difference between the two is most pronounced in the measurement of chemical concentration. The American system generally uses mass per unit volume, while SI uses moles per unit volume. Since mass per mole varies with the molecular weight of the substance being analyzed, conversion between American and SI units requires many different conversion factors. Most Blood tests fall within one of two categories: Screening or Diagnostic. Screening Blood tests are used to try to detect a disease when there is little or no evidence that a person has a suspected disease. For example, measuring cholesterol levels helps to identify one of the risks of heart disease. These screening tests are performed on people who may show no symptoms of a disease or illness, they are used as a tool for the physician to detect a potentially harmful and evolving condition. Diagnostic Blood tests which are utilized when a specific disease is suspected to verify the presence and the severity of that disease. Because most Blood test reference ranges (often referred to as 'normal' ranges of Blood test results) are typically defined as the range of values of the median 95% of the healthy population, it is unlikely that a given Blood sample, even from a healthy patient, will show "normal" values for every Blood test taken. Therefore, caution should be exercised to prevent over-reaction to mild abnormalities without the interpretation of those tests by your examining physician. Again, a Blood test, though important, is only a part of the final diagnosis of a potential health problem. Here is a sample of what a "normal" blood test looks like. Keep in mind that your test might turn out slightly different from this one. Slight differences are to be expected. BLOOD TEST REFERENCE RANGE CHART Test: Reference Range (conventional units) Acidity (pH) 7.35 - 7.45 Alcohol 0 mg/dL (more than 0.1 mg/dL normally indicates intoxication) (ethanol) Ammonia 15 - 50 µg of nitrogen/dL Amylase 53 - 123 units/L Ascorbic Acid 0.4 - 1.5 mg/dL Bicarbonate 18 - 23 mEq/L (carbon dioxide content) Bilirubin Direct: up to 0.4 mg/dL Total: up to 1.0 mg/dL Blood Volume 8.5 - 9.1% of total body weight Calcium 8.5 - 10.5 mg/dL (normally slightly higher in children) Carbon Dioxide Pressure 35 - 45 mm Hg Carbon Monoxide Less than 5% of total hemoglobin CD4 Cell Count 500 - 1500 cells/µL Ceruloplasmin 15 - 60 mg/dL Chloride 98 - 106 mEq/L Complete Blood Cell Count (CBC) Tests include: hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular volume, platelet count, and white Blood cell count. Copper Total: 70 - 150 µg/dL Creatine Kinase (CK or CPK) Male: 38 - 174 units/L Female: 96 - 140 units/L Creatine Kinase Isoenzymes 5% MB or less Creatinine 0.6 - 1.2 mg/dL Electrolytes Test includes: calcium, chloride, magnesium, potassium, sodium. Erythrocyte Sedimentation Rate (ESR or Sed-Rate) Male: 1 - 13 mm/hr Female: 1 - 20 mm/hr Glucose Tested after fasting: 70 - 110 mg/dL Hematocrit Male: 45 - 62% Female: 37 - 48% Hemoglobin Male: 13 - 18 gm/dL Female: 12 - 16 gm/dL Iron 60 - 160 µg/dL (normally higher in males) Iron-binding Capacity 250 - 460 µg/dL Lactate (lactic acid) Venous: 4.5 - 19.8 mg/dL Arterial: 4.5 - 14.4 mg/dL Lactic Dehydrogenase 50 - 150 units/L Lead 40 µg/dL or less (normally much lower in children) Lipase 10 - 150 units/L Zinc B-Zn 70 - 102 µmol/L Lipids: Cholesterol Less than 225 mg/dL (for age 40-49 yr; increases with age) Triglycerides 10 - 29 years 53 - 104 mg/dL 30 - 39 years 55 - 115 mg/dL 40 - 49 years 66 - 139 mg/dL 50 - 59 years 75 - 163 mg/dL 60 - 69 years 78 - 158 mg/dL > 70 years 83 - 141 mg/dL Liver Function Tests Tests include bilirubin (total), phosphatase (alkaline), protein (total and albumin), transaminases (alanine and aspartate), prothrombin (PTT) Magnesium 1.5 - 2.0 mEq/L Mean Corpuscular Hemoglobin (MCH) 27 - 32 pg/cell Mean Corpuscular Hemoglobin Concentration (MCHC) 32 - 36% hemoglobin/cell Mean Corpuscular Volume (MCV) 76 - 100 cu µm Osmolality 280 - 296 mOsm/kg water Oxygen Pressure 83 - 100 mm Hg Oxygen Saturation (arterial) 96 - 100% Phosphatase, Prostatic 0 - 3 units/dL (Bodansky units) (acid) Phosphatase 50 - 160 units/L (normally higher in infants and adolescents) (alkaline) Phosphorus 3.0 - 4.5 mg/dL (inorganic) Platelet Count 150,000 - 350,000/mL Potassium 3.5 - 5.0 mEq/L Prostate-Specific Antigen (PSA) 0 - 4 ng/mL (likely higher with age) Proteins: Total 6.0 - 8.4 gm/dL Albumin 3.5 - 5.0 gm/dL Globulin 2.3 - 3.5 gm/dL Prothrombin (PTT) 25 - 41 sec Pyruvic Acid 0.3 - 0.9 mg/dL Red Blood Cell Count (RBC) 4.2 - 6.9 million/µL/cu mm Sodium 135 - 145 mEq/L Thyroid-Stimulating Hormone (TSH) 0.5 - 6.0 µ units/mL Transaminase: Alanine (ALT) 1 - 21 units/L Aspartate (AST) 7 - 27 units/L Urea Nitrogen (BUN) 7 - 18 mg/dL BUN/Creatinine Ratio 5 - 35 Uric Acid Male 2.1 to 8.5 mg/dL (likely higher with age) Female 2.0 to 7.0 mg/dL (likely higher with age) Vitamin A 30 - 65 µg/dL White Blood Cell Count (WBC) 4,300 - 10,800 cells/µL/cu mm Below is an example of how to read the results of a Blood Test. Glucose - This is a measure of the sugar level in your blood. High values are associated with eating before the test, and diabetes. The normal range for a fasting glucose is 60 -109 mg/dl. According the the 1999 ADA criteria, diabetes is diagnosed with a *fasting* plasma glucose of 126 or more. A precursor, Impaired Fasting Glucose (IFG) is defined as reading of fasting glucose levels of 110 - 125. Sometimes a glucose tolerance test, which involves giving you a sugary drink followed by several blood glucose tests, is necessary to properly sort out normal from IFG from diabetes. Electrolytes: These are your potassium, sodium, chloride, and CO2 levels. Potassium is controlled very carefully by the kidneys. It is important for the proper functioning of the nerves and muscles, particularly the heart. Any value outside the expected range, high or low, requires medical evaluation. This is especially important if you are taking a diuretic (water pill) or heart pill (Digitalis, Lanoxin, etc.). Sodium is also regulated by the kidneys and adrenal glands. There are numerous causes of high and low sodium levels, but the most common causes of low sodium are diuretic usage, diabetes drugs like chlorpropamide, and excessive water intake in patients with heart or liver disease. CO2 reflects the acid status of your blood. Low CO2 levels can be due to either to increased acidity from uncontrolled diabetes, kidney disease, metabolic disorders, or low CO2 can be due to chronic hyperventilation. Waste products: Blood Urea Nitrogen (BUN) is a waste product produced in the liver and excreted by the kidneys. High values may mean that the kidneys are not working as well as they should. BUN is also affected by high protein diets and/or strenuous exercise which raise levels, and by pregnancy which lowers it. Creatinine is a waste product largely from muscle breakdown. High values, especially with high BUN levels, may indicate problems with the kidneys.. Uric Acid is normally excreted in urine. High values are associated with gout, arthritis, kidney problems and the use of some diuretics. Enzymes AST, ALT, SGOT, SGPT, and GGT and Alkaline Phosphatase are abbreviations for proteins called enzymes which help all the chemical activities within cells to take place. Injury to cells release these enzymes into the blood. They are found in muscles, the liver and heart. Damage from alcohol and a number of diseases are reflected in high values. Alkaline phosphatase is an enzyme found primarily in bones and the liver. Expected values are higher for those who are growing (children and pregnant women) or when damage to bones or liver has occurred or with gallstones. Low values are probably not significant. GGT is also elevated in liver disease, particularly with obstruction of bile ducts. Unlike the alkaline phosphatase it is not elevated with bone growth or damage. AST/SGOT , ALT/ SGPT are also liver and muscle enzymes. They may be elevated from liver problems, hepatitis, excess alcohol ingestion, muscle injury and recent heart attack. LDH is the enzyme present in all the cells in the body. Anything which damages cells, including blood drawing itself, will raise amounts in the blood. If blood is not processed promptly and properly, high levels may occur. If all values except LDH are within expected ranges, it is probably a processing error and does not require further evaluation. Bilirubin is a pigment removed from the blood by the liver. Low values are of no concern. If slightly elevated above the expected ranges, but with all other enzymes (LDH, GOT, GPT, GGT) within expected values, it is probably a condition known as Gilbert’s syndrome and is not significant CPK is an enzyme which is very useful for diagnosing diseases of the heart and skeletal muscle. This enzyme is the first to be elevated after a heart attack (3 to 4 hours). If CPK is high in the absence of heart muscle injury, this is a strong indication of skeletal muscle disease. Proteins Albumin and Globulin measure the amount and type of protein in your blood. They are a general index of overall health and nutrition. Globulin is the "antibody" protein important for fighting disease. A/G Ratio is the mathematical relationship between the above. Blood Fats Cholesterol is a fat-like substance in the blood which, if elevated has been associated with heart disease. Total Cholesterol - A high cholesterol in the blood is a major risk factor for heart and blood vessel disease. Cholesterol in itself is not all bad, in fact, our bodies need a certain amount of this substance to function properly. However, when the level gets too high, vascular disease can result. A total cholesterol of less than 200, and an LDL Cholesterol of 100 or less is considered optimal by the National Heart, Lung, and Blood Institute. The levels that your doctor will recommend depend upon whether you are at high risk for cardiovascular disease. As the level of blood cholesterol increases, so does the possibility of plugging the arteries due to cholesterol plaque build-up. Such a disease process is called "hardening of the arteries" or atherosclerosis. When the arteries feeding the heart become plugged, a heart attack may occur. If the arteries that go to the brain are affected, then the result is a stroke. There are three major kinds of cholesterol, High Density Lipoprotein (HDL) , Low Density Lipoprotein (LDL), and Very Low Density Lipoprotein (VLDL). LDL Cholesterol is considered "bad cholesterol" because cholesterol deposits form in the arteries when LDL levels are high. An LDL level of less than 130 is recommended, 100 is optimal, values greater than 160 are considered high risk and should be followed up by your physician. Those persons who have established coronary or vascular disease may be instructed by their doctor to get their LDL Cholesterol well below 100. You should ask your doctor which LDL target he or she wants for you. There are two ways to report LDL. The most common is simply an estimate calculated from the Total Cholesterol, HDL, and triglycerides results. This may say "LDL Calc" . A directly measured LDL Cholesterol is usually more accurate, but more expensive and may require that your doctor specify the direct LDL. HDL cholesterol is a ‘good cholesterol’ as it protects against heart disease by helping remove excess cholesterol deposited in the arteries. High levels seem to be associated with low incidence of coronary heart disease. Triglyceride is fat in the blood which, if elevated, has been associated with heart disease, especially if over 500 mg. High triglycerides are also associated with pancreatitis. Triglyceride levels over 150 mg/dl may be associated with problems other than heart disease. Ways to lower triglycerides: 1) weight reduction, if overweight; 2) reduce animal fats in the diet: eat more fish; 3) take certain medications your physician can prescribe; 4) get regular aerobic exercise; 5) decrease alcohol and sugar consumption—alcohol and sugar are not fats, but the body can convert them into fats then dump those fats into your blood stream 6) restrict calories - carbohydrates are converted to triglycerides when eaten to excess. VLDL (very low density lipoprotein) is another carrier of fat in the blood. Cardiac Risk Factors C Reactive Protein (CRP) - This is a marker for inflammation. Traditionally it has been used to assess inflammation in response to infection. However we use a highly sensitive C Reactive Protein which is useful in predicting vascular disease, heart attack or stroke.. The best treatment for a high C reactive protein level has not yet been defined, however statin drugs, niacin, weight loss, quitting smoking, and exercise all appear to improve C- Reactive Protein Homocysteine - Homocysteine is an amino acid that is normally found in small amounts in the blood. Higher levels are associated with increased risk of heart attack and other vascular diseases. Homocysteine levels may be high due to a deficiency of folic acid or Vitamin B12, due to heredity, older age, kidney disease, or certain medications. Men tend to have higher levels. Our lab normals are 4 - 15 micromole/l , but if you have had previous vascular disease we may recommend medications to reduce it below 10. You can reduce your homocysteine level by eating more green leafy vegetables and fortified grain products or cereals. The usual treatment is folic acid with or without Vitamin B-12. Lipoprotein (a) or Lp(a) - Elevated lipoprotein(a) (Lp) concentrations are associated with premature coronary heart disease (CHD). The exact mechanism is not yet clear, but it appears that there is a strong genetic component to elevated Lp(a) levels that correlates with coronary disease. Persons with diabetes and a high Lp(a) level appear to be at increased risk of asymptomatic coronary disease. Minerals Calcium is controlled in the blood by the parathyroid glands and the kidneys. Calcium is found mostly in bone and is important for proper blood clotting, nerve, and cell activity. An elevated calcium can be due to medications such as thiazide type diuretics, inherited disorders of calcium handling in the kidneys, or excess parathyroid gland activity or vitamin D. Low calcium can be due to certain metabolic disorders such as insufficient parathyroid hormone; or drugs like Fosamax or furosemide type diuretics. Calcium is bound to albumin in the blood, so a low albumin level will cause the total calcium level in the blood to drop. You doctor can easily determine if this is significant or not. Phosphorus is also largely stored in the bone. It is regulated by the kidneys, and high levels may be due to kidney disease. When low levels are seen with high calcium levels it suggests parathyroid disease, however there are other causes. A low phosphorus, in combination with a high calcium, may suggest an overactive parathyroid gland. Thyroid There are 2 types of thyroid hormones easily measurable in the blood, thyroxine (T4) and triiodothyronine (t3). For technical reasons, it is easier and less expensive to measure the T4 level, so T3 is usually not measured on screening tests. Thyroxine (T4) - This shows the total amount of the T4. High levels may be due to hyperthyroidism, however technical artifact occurs when estrogen levels are higher from pregnancy, birth control pills or estrogen replacement therapy. A Free T4 (see below) can avoid this interference. T3 Resin Uptake or Thyroid Uptake - This is a test that confuses doctors, nurses, and patients. First, this is not a thyroid test, but a test on the proteins that carry thyroid around in your blood stream. Not only that, a high test number may indicate a low level of the protein! The method of reporting varies from lab to lab. The proper use of the test is to compute the free thyroxine index. Free Thyroxine Index (FTI or T7) - A mathematical computation allows the lab to estimate the free thyroxine index from the T4 and T3 Uptake tests. The results tell us how much thyroid hormone is free in the blood stream to work on the body. Unlike the T4 alone, it is not affected by estrogen levels. Free T4 - This test directly measures the free T4 in the blood rather than estimating it like the FTI. It is a more reliable , but a little more expensive test. Some labs now do the Free T4 routinely rather than the Total T4. Total T3 - This is usually not ordered as a screening test, but rather when thyroid disease is being evaluated. T3 is the more potent and shorter lived version of thyroid hormone. Some people with high thyroid levels secrete more T3 than T4. In these (overactive) hyperthyroid cases the T4 can be normal, the T3 high, and the TSH low. The Total T3 reports the total amount of T3 in the bloodstream, including T3 bound to carrier proteins plus freely circulating T3. Free T3 - This test measures only the portion of thyroid hormone T3 that is "free", that is, not bound to carrier proteins. Thyroid Stimulating Hormone (TSH) - This protein hormone is secreted by the pituitary gland and regulates the thyroid gland. A high level suggests your thyroid is underactive, and a low level suggests your thyroid is overactive. Glycohemoglobin (Hemoglobin A1 or A1c, HbA1c) - Glycohemoglobin measures the amount of glucose chemically attached to your red blood cells. Since blood cells live about 3 months, it tells us your average glucose for the last 6 - 8 weeks. A high level suggests poor diabetes control. Standardization for glycohemoglobin from lab to lab is poor, and you cannot compare a test from different labs unless you can verify the technique for measuring glycohemoglobin is the same. The only exception is if your lab is standardized to the national DCCT referenced method. You can ask your lab if they use a DCCT referenced method. Hormones Insulin - Insulin is secreted by the pancreas in response to eating or elevated blood sugar. It is deficient in persons with type 1 diabetes, and present at insufficient levels in persons with type 2 diabetes. The natural evolution of type 2 diabetes causes insulin levels to fall from high levels to low levels over a course of years. Thus insulin levels in persons with type 1 and type 2 diabetes overlap significantly, and insulin levels are not very useful in determining type 1 vs type 2. Insulin levels vary widely from person to person depending upon an individuals insulin sensitivity (or conversely, their insulin resistance.) Insulin levels also vary widely according to when the last meal occurred. Insulin resistance is a risk factor for coronary disease, thus assessing an individual's insulin resistance may have some value using the HOMA-IR calculation. Insulin levels are also elevated in patients with true hypoglycemia, however the interpretation of these levels is difficult. Insulin levels, when measured by itself at a random time is rarely useful. C-peptide - This is a fragment cleaved off of the precursor of insulin (pro-insulin) when insulin is manufactured in the pancreas. C-peptide levels usually correlate with the insulin levels, except when people take insulin injections. When a patient is hypoglycemic, this test may be useful to determine whether high insulin levels are due to excessive pancreatic release of insulin, or from an injection of insulin. Estradiol - This is the most commonly measured type of estrogen measured. In women it varies according to their age, and whether they are having normal menstrual cycles. Hormone levels are also changed when taking birth control pills or estrogen replacement. Complete Blood Count (CBC) - The CBC typically has several parameters that are created from an automated cell counter. These are the most relevant: White Blood Count (WBC) - This is the number of white cells. High WBC can be a sign of infection. WBC is also increased in certain types of leukemia. Low white counts can be a sign of bone marrow diseases or an enlarged spleen. Low WBC is also found in HIV infection in some cases. (ed. note: The vast majority of low WBC counts in our population is NOT HIV related.) Hemoglobin (Hgb) and Hematocrit (Hct) - The hemoglobin is the amount of oxygen carrying protein contained within the red blood cells. The hematocrit is the percentage of the blood volume occupied by red blood cells. In most labs the Hgb is actually measured, while the Hct is computed using the RBC measurement and the MCV measurement. Thus purists prefer to use the Hgb measurement as more reliable. Low Hgb or Hct suggest an anemia. Anemia can be due to nutritional deficiencies, blood loss, destruction of blood cells internally, or failure to produce blood in the bone marrow. High Hgb can occur due to lung disease, living at high altitude, or excessive bone marrow production of blood cells. Mean Corpuscular Volume (MCV) - This helps diagnose a cause of an anemia. Low values suggest iron deficiency, high values suggest either deficiencies of B12 or Folate, ineffective production in the bone marrow, or recent blood loss with replacement by newer (and larger) cells from the bone marrow. Platelet Count (PLT) - This is the number of cells that plug up holes in your blood vessels and prevent bleeding. High values can occur with bleeding, cigarette smoking or excess production by the bone marrow. Low values can occur from premature destruction states such as Immune Thrombocytopenia (ITP), acute blood loss, drug effects (such as heparin) , infections with sepsis, entrapment of platelets in an enlarged spleen, or bone marrow failure from diseases such as myelofibrosis or leukemia. Low platelets also can occur from clumping of the platelets in a lavender colored tube. You may need to repeat the test with a green top tube in that case. Urinalysis - Urine tests are typically evaluated with a reagent strip that is briefly dipped into your urine sample. The technician reads the colors of each test and compares them with a reference chart. These tests are semi-quantitative; there can be some variation from one sample to another on how the tests are scored. pH : This is a measure of acidity for your urine. Specific Gravity (SG) : This measures how dilute your urine is. Water would have a SG of 1.000 . Most urine is around 1.010, but it can vary greatly depending on when you drank fluids last, or if you are dehydrated. Glucose: Normally there is no glucose in urine. A positive glucose occurs in diabetes. There are a small number of people that have glucose in their urine with normal blood glucose levels, however any glucose in the urine would raise the possibility of diabetes or glucose intolerance. Protein: Normally there is no protein detectable on a urinalysis strip. Protein can indicate kidney damage, blood in the urine, or an infection. Up to 10% of children can have protein in their urine. Certain diseases require the use of a special, more sensitive (and more expensive) test for protein called a microalbumin test. A microalbumin test is very useful in screening for early damage to the kidneys from diabetes, for instance. Blood: Normally there is no blood in the urine. Blood can indicate an infection, kidney stones, trauma, or bleeding from a bladder or kidney tumor. The technician may indicate whether it is hemolyzed (dissolved blood) or non-hemolyzed (intact red blood cells). Rarely, muscle injury can cause myoglobin to appear in the urine which also causes the reagent pad to falsely indicate blood. Bilirubin: Normally there is no bilirubin or urobilinogen in the urine. These are pigments that are cleared by the liver. In liver or gallbladder disease they may appear in the urine as well. Nitrate: Normally negative, this usually indicates a urinary tract infection. Leukocyte esterase: Normally negative. Leukocytes are the white blood cells (or pus cells). This looks for white blood cells by reacting with an enzyme in the white cells. White blood cells in the urine suggests a urinary tract infection. Sediment: Here the lab tech looks under a microscope at a portion of your urine that has been spun in a centrifuge. Items such as mucous and squamous cells are commonly seen. Abnormal findings would include more than 0-2 red blood cells, more than 0-2 white blood cells, crystals, casts , renal tubular cells or bacteria. (Bacteria can be present if there was contamination at the time of collection.)

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thesittingduck · 4 years

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Amlor 5mg Tablets Uses, Dosage, Side Effects,&Warnings

Drug Online

Amlor generic name : Amlodipine

Amlodipine generic drug of the therapeutic class: Cardiology and angiology active principles: Amlodipine

What is Amlor 5mg?

AMLOR is used to treat high blood pressure (hypertension), or a certain type of chest pain called angina, a rare form of which is Prinzmetal’s angina.

In patients with high blood pressure values, your medication works by relaxing the blood vessels, so that the blood passes through them more easily. In patients with angina, AMLOR works by improving the blood supply to the heart muscle, which thus receives more oxygen, which prevents the development of chest pain. Your medication does not provide immediate relief for angina chest pain.

Amlor indication and Uses

Hypertension.

Chronic stable angina.

Vasospastic angina (Prinzmetal syndrome).

Amlor dosage

adults:

For hypertension and langor, the usual starting dose is 5 mg AMLOR once daily, which can be increased to a maximum dose of 10 mg depending on the patient’s individual response.

In hypertensive patients, AMLOR has been used in combination with a thiazide diuretic, an alphablocker, a beta-blocker or a langiotensin converting enzyme inhibitor. In langor, AMLOR can be used alone or in combination with other anti-anginal drugs in patients with nitrate-refractory angina and / or adequate doses of beta-blockers.

No dose adjustment of AMLOR is necessary when coadministered with thiazide diuretics, beta-blockers and langiotensin converting enzyme inhibitors.

Special populations

Elderly patients

AMLOR used at similar doses shows good equivalent tolerance in elderly patients and younger patients. Normal dosing regimens are recommended in elderly patients, but an increase in dosage should be made with caution .

Patients with hepatic insufficiency

Dose recommendations have not been established in patients with mild to moderate hepatic impairment therefore the dose should be selected with caution and started at the lowest effective dose.

The pharmacokinetic properties of lamlodipine have not been studied in patients with severe hepatic impairment. Lamlodipine should be started at the lowest dose and slowly increased in patients with severe hepatic insufficiency.

Patients with renal insufficiency

Changes in damlodipine plasma concentrations are not correlated with the degree of renal insufficiency, so a usual dose is recommended. Lamlodipine is not dialysable.

Pediatric population

Hypertensive children and adolescents aged 6 to 17

The recommended oral antihypertensive dosage in children aged 6 to 17 years is 2.5 mg once daily as an initial dose, which can be increased to 5 mg once daily if the desired blood pressure is not reached after four weeks. . Doses greater than 5 mg once daily have not been studied in pediatric patients.

A dosage of 2.5 mg damlodipine is not possible with this drug.

Children under 6 years

There is no data available.

Administration mode

Capsule for oral administration.

Amlor Contraindications

Dihydropyridines hypersensitivity

Amlodipine hypersensitivity

Severe hypotension

Shock

Left ventricular outflow obstruction

Hemodynamically unstable heart failure after acute myocardial infarction

Feeding with milk

Amlodipine is contraindicated in patients with:

Hypersensitivity to dihydropyridine derivatives, amlodipine or any of the excipients listed in section composition.

Severe hypotension.

A shock (including cardiogenic shock).

An obstruction of the left ventricular outflow tract (eg aortic stenosis high degree).

An unstable cardiac insufficiency hemodynamically after acute myocardial infarction.

Amlor mechanism of action

Pharmacotherapeutic group: Selective calcium antagonist with predominantly vascular effect

ATC Code: C08 CA01.

Amlodipine is an inhibitor of calcium influx from the dihydropyridine group (slow channel inhibitor or calcium ion antagonist) and transmembrane influx of calcium ions into vascular smooth muscle and vascular smooth muscle.

The mechanism of the antihypertensive effect of amlodipine is related to a direct relaxant effect on vascular smooth muscle. The precise mechanism by which amlodipine relieves angina has not been fully determined, but amlodipine reduces the total ischemic load by the following two actions:

Amlodipine dilates the peripheral arterioles and therefore reduces the total peripheral resistance (afterload) against which the heart acts. Since the heart rate remains stable, this reduction in heart work decreases myocardial energy consumption and oxygen requirements.

The mechanism of action of amlodipine probably also involves the dilation of the main coronary arteries and coronary arteries, in the normal and ischemic regions. This dilation increases oxygen delivery to the myocardium in patients with coronary artery spasm (Prinzmetal’s angina).

In hypertensive patients, once-daily dosing provides clinically significant reductions in both supine and upright blood pressure over a 24-hour interval. Due to the slow onset of action, acute hypotension is not associated with amlopidine administration.

In patients with angina, once-daily administration of amlopidine increases total exercise time, onset of angina, and 1 mm ST segment depression and it decreases both the frequency of angina attacks and the consumption of glyceryl trinitrate tablets.

Amlopidine has not been associated with adverse metabolic effects or changes in plasma lipids, and is suitable for patients with asthma, diabetes and gout.

Use in patients with coronary artery disease

The efficacy of amlopidine for the prevention of clinical events in patients with coronary artery disease was evaluated in an independent, multicenter, randomized, double-blind, controlled versusplacebo in 1,997 patients: the CAMELOT study (Comparison of Amlodipine vs Enalapril to Limit Occurrences of Thrombosis, comparison of amlopidine and enalapril in the limitation of episodes of thrombosis).

Of these patients, 663 were treated with amlopidine 5-10 mg, 673 were treated with enalapril 10-20 mg, and 655 with placebo, in addition to standard statin therapy, betablockers. , diuretics and aspirin for two years. The main efficacy results are shown in Table 1. The results indicate that amlopidine treatment was associated with fewer angina hospitalizations and revascularization procedures in patients with coronary artery disease.

Table 1 . Impact of significant clinical endpoints of the CAMELOT study

Cardiovascular event rate, number (%)

Amlopidine versus placebo

Evaluation criteria

amlodipine

Placebo

Enalapril

Relative risk

(95% CI)

P value

Main criterion

Cardiovascular adverse events

110 (16.6)

151 (23.1)

136 (20.2)

0.69 (0.54-0.88)

0,003

Individual components

Coronary revascularization

78 (11.8)

103 (15.7)

95 (14,1)

0.73 (0.54-0.98)

0.03

Hospitalization for angor

51 (7.7)

84 (12.8)

86 (12.8)

0.58 (0.41-0.82)

0,002

Non-fatal IDM

14 (2.1)

19 (2.9)

11 (1,6)

0.73 (0.37-1.46)

0.37

Stroke or AIT

6 (0.9)

12 (1,8)

8 (1,2)

0.50 (0.19-1.32)

0.15

Cardiovascular mortality

5 (0.8)

2 (0.3)

5 (0.7)

2.46 (0.48-12.7)

0.27

Hospitalization for ICC

3 (0.5)

5 (0.8)

4 (0.6)

0.59 (0.14-2.47)

0.46

Resuscitation after cardiac arrest

4 (0.6)

1 (0,1)

N / A

0.04

Appearance of peripheral vascular disease

5 (0.8)

2 (0.3)

8 (1,2)

2.6 (0.50-13.4)

0.24

Abbreviations: CHF, congestive heart failure; IC, confidence interval; MI, myocardial infarction; TIA, transient ischemic attacks; Stroke, stroke.

Use in patients with heart failure :

Hemodynamic studies and controlled studies based on exercise tests conducted in patients with heart failure NYHA II-IV classes showed that AMLOR did not cause any clinical deterioration in exercise tolerance, of left ventricular ejection fraction and clinical symptomatology.

A controlled study versus placebo (PRAISE) designed to evaluate patients with heart failure NYHA class III-IV receiving digoxin, diuretics and ACE inhibitors has shown that AMLOR did not lead to increased risk of death or death and morbidity combined with heart failure.

In controlled long-term follow-up study versus placebo (PRAISE-2) AMLOR in patients with heart failure NYHA class III and IV without clinical symptoms or objective findings suggestive or underlying ischemic disease, treated stable doses of ACE inhibitors, digitalis and diuretics, AMLOR had no effect on total cardiovascular mortality. In this same population, AMLOR has been associated with an increase in pulmonary edema notifications.

Study on the Preventive Treatment of Heart Failure (Treatment to Prevent Attack Heart Attack, ALLHAT)

The ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trials) study, a randomized, double-blind study on morbidity and mortality was conducted to compare treatments. recent studies: amlodipine 2.5 to 10 mg / day (calcium channel blocker) or lisinopril 10 to 40 mg / day (ACE inhibitor) as a first-line treatment compared to a thiazide diuretic, chlortalidone at a dose of 12, 5 to 25 mg / day in mild to moderate hypertension.

A total of 33,357 hypertensive patients aged 55 years or older were randomized and followed for an average of 4.9 years. Patients had at least one risk factor for additional coronary heart disease, including: history of myocardial infarction or stroke (more than six months prior to inclusion) or documentation of other atherosclerotic cardiovascular disease (in total 51.5%), type 2 diabetes (36.1%), HDL cholesterol <35 mg / dl (11.6%), left ventricular hypertrophy diagnosed by electrocardiography or echocardiography (20.9%), current smoking (21%). , 9%).

The composite primary endpoint was fatal coronary artery disease or nonfatal myocardial infarction. There was no significant difference in the primary end point between amlopidine treatment and chlortalidone treatment: RR 0.98; 95% CI (0.90 to 1.07); p = 0.65. Among the secondary endpoints, the incidence of heart failure (component of a composite cardiovascular endpoint) was significantly higher in the amlodipine group compared to the chlortalidone group (10.2% versus7.7%; RR: 1.38; 95% CI [1.25 to 1.52]; p <0.001). However, there was no significant difference in all-cause mortality between amlopidine-based treatment and chlortalidone treatment: RR 0.96; 95% CI [0.89 to 1.02]; p = 0.20.

Use in children (at least six years old)

In a study of 268 children aged 6 to 17 years with predominant secondary hypertension, a 2.5 mg dose and a 5.0 mg dose of amlodipine were compared to placebo. It was found that both doses reduced systolic blood pressure significantly more significantly than placebo. The difference between the two doses was not statistically significant.

The long-term effects of amlodipine on growth, puberty and general development have not been studied. The long-term efficacy of amlopidine in a child’s treatment aimed at reducing morbidity and cardiovascular mortality in adulthood has not been established.

How it works Amlor

What are side effects of Amlor?

Summary of the security profile

The most common side effects reported during treatment are drowsiness, dizziness, headache, palpitations, flushing, abdominal pain, nausea, swollen ants, edema, and fatigue.

List of undesirable effects

The following side effects have been observed and reported during treatment with amlopidine at the following frequencies: very common (≥ 1/10); frequent (≥ 1/100 to <1/10); uncommon (≥ 1/1000 to ≤ 1/100); rare (≥ 1/10 000 to ≤ 1/1 000); very rare (≤1 / 10,000).

In each frequency group, the adverse effects are presented in order of decreasing severity.

Class of organ systems Frequency Side effects Blood and lymphatic system disorders Very rare Leukocytopenia, thrombocytopenia, Immune system disorders Very rare Allergic reaction Metabolism and nutrition disorders Very rare hyperglycemia Psychiatric disorders Rare Insomnia, change of mood (including anxiety), depression Rare Confusion Nervous system disorders Frequent Drowsiness, dizziness, headache (especially at the beginning of treatment) Rare Tremor, dysgeusia, syncope, hypoaesthesia, paresthesia Very rare Hypertonia, peripheral neuropathy Eye disorders Rare Visual disorder (including, diplopia) Affections of the ear and labyrinth Rare tinnitus Heart conditions Frequent palpitations Very rare Myocardial infarction, arrhythmia (including bradycardia, ventricular tachycardia, and atrial fibrillation) Vascular disorders Frequent Flushing Rare hypotension Very rare vasculitis

Respiratory, thoracic and mediastinal disorders

Rare Dyspnea, rhinitis Very rare Cough

Gastrointestinal disorders

Frequent Abdominal pain, nausea Rare Vomiting, dyspepsia, transit disorders (including diarrhea and constipation), dry mouth Very rare Pancreatitis, gastritis, gingival hyperplasia

Hepatobiliary disorders

Very rare Hepatitis, jaundice, elevated liver enzymes *

Skin and subcutaneous tissue disorders

Rare Alopecia, purpura, change of skin color, hyperhidrosis, pruritus, rash, exanthema Very rare Angioedema, erythema multiforme, urticaria, exfoliating dermatitis, Stevens-Johnson syndrome, angioedema, photosensitivity

Musculoskeletal, Connective Tissue and Bone Disorders

Frequent Edema of the ankles Rare Arthralgia, myalgia, muscle cramp, back pain

Renal and urinary disorders

Rare Micturition disorder, nocturia, increased urinary frequency

Disorders of reproductive organs and breast

Rare Impotence, gynecomastia

General disorders and administration site conditions

Frequent Edema, tiredness Rare Chest pain, asthenia, pain, discomfort

investigations

Rare Increased weight, decreased weight

* Generally suggestive of cholestasis

Exceptional cases of extrapyramidal syndrome have been reported.

Amlor interactions

Effects of other drugs on amlopidine

CYP3A4 inhibitors

Concomitant use of amlodipine with strong or moderate CYP3A4 inhibitors (protease inhibitors, azole antifungals, macrolides such as erythromycin or clarithromycin, verapamil or diltiazem) may result in a significant increase in the concentration of amlodipine. plasma level of amlodipine resulting in an increased risk of hypotension.

The clinical translation of these pharmacokinetic variations may be more pronounced in the elderly. Therefore, clinical monitoring and dose adjustment may be necessary.

CYP3A4 inducers

No data are available on the effect of CYP3A4 inducers on amlodipine. Concomitant use of inducers of CYP3A4 (eg, rifampicin, St. John’s Wort [Hypericum perforatum]) may result in decreased plasma amlopidine concentration. Amlopidine should be used with caution with inducers of CYP3A4 isoenzyme.

Administration of amlopidine with grapefruit or grapefruit juice is not recommended as bioavailability may be increased in some patients, which may result in increased hypotensive effects.

Dantrolene (infusion)

In animals, ventricular fibrillation and lethal cardiovascular collapse have been observed in association with hyperkalemia following administration of verapamil and dantrolene IV. Given the risk of hyperkalemia, it is recommended to avoid the concomitant administration of calcium channel blockers such as amlodipine in patients who may have malignant hyperthermia and in the management of malignant hyperthermia.

Effects of amlodipine on other drugs

The hypotensive effects of amlodipine add to those of other drugs with antihypertensive properties.

tacrolimus

There is a risk of increased plasma concentrations of tacrolimus when co-administered with amlodipine, but the pharmacokinetic mechanism of this interaction is not fully understood. In order to avoid tacrolimus toxicity, administration of amlodipine to a tacrolimus-treated patient requires monitoring of tacrolimus plasma concentrations and dosage adjustment of tacrolimus where appropriate.

cyclosporin

No interaction studies have been conducted with ciclosporin and amlodipine in healthy volunteers or other populations, with the exception of renal transplant patients; a variable increase in the minimum concentration of ciclosporin was observed (from 0% to 40% on average). The ciclosporin level should be monitored in renal transplant patients treated with amlodipine and a reduction in ciclosporin dosage should be considered if necessary.

simvastatin

Co-administration of repeated doses of 10 mg amlodipine with 80 mg simvastatin resulted in a 77% increase in simvastatin exposure compared with simvastatin alone. The daily dose of simvastatin should be limited to 20 mg in patients treated with amlodipine.

In clinical interaction studies, amlodipine did not affect the pharmacokinetics of atorvastatin, digoxin or warfarin.

Amlor Warnings and Precautions

The safety and efficacy of lamlodipine during a hypertensive crisis have not been established.

Patients with heart failure

Patients with heart failure should be treated with caution. In controlled long-term study versus placebo conducted in patients with severe heart dinsuffisance (class NYHA III and IV), the incidence reported pulmonary edema was higher in the group treated lamlodipine compared to placebo (see section 5.1). The calcium channel blockers including lamlodipine should be used with caution in patients with congestive heart failure because they may increase the risk of cardiovascular events and mortality.

Patients with hepatic insufficiency

The half-life of lamlodipine is increased and its AUC (Greater Curve) is greater in patients with hepatic insufficiency; dosage recommendations have not been established. Therefore, lamlodipine should be initiated at the lowest effective dose and with caution, both during initiation of treatment and when the dose is increased. A slow dose increase and careful monitoring may be necessary in patients with severe hepatic impairment.

Elderly patients

In elderly patients, an increase in dosage should be made with caution.

Patients with renal insufficiency

Lamlodipine can be used in these patients at normal doses. Changes in plasma concentrations of damlodipine do not correlate with the degree of renal insufficiency. Lamlodipine is not dialysable.

Drive and use machines

Lamlodipine may have a minor or moderate influence on the ability to drive vehicles and use machines. If patients treated with lamlodipine experience dizziness, headache, fatigue or nausea, their ability to respond may be impaired. Precautions are recommended especially at the beginning of treatment.

PREGNANCY / BREAST FEEDING / FERTILITY

Pregnancy:

In women, the safety of amlodipine during pregnancy has not been established.

In animal studies, reproductive toxicity has been observed at high doses (see section 5.3 ).

Use during pregnancy is recommended only if no safer alternatives are available and when the disease itself poses greater risks to the mother and fetus.

feeding:

It has not been established whether amlopidine is excreted in breast milk. The decision to continue or discontinue breastfeeding or to continue or discontinue amlodipine therapy should be considered in consideration of the benefit of breastfeeding for the child and the benefit of amlopidine treatment for the mother.

Fertility:

Reversible biochemical changes in the spermatozoa head have been reported in some patients treated with calcium channel blockers. There is insufficient clinical data regarding the potential effect of amlopidine on fertility. In a rat study, adverse effects were detected on male fertility (see section 5.3 ).

What should I do if I miss a dose?

If you forget to take AMLOR 10 mg, capsule:

Do not worry. If you forget to take one capsule, skip the dose completely. Take the next dose according to the normal rhythm. Do not take a double dose to make up for the dose you forgot to take.

What happens if I overdose from Amlor ?

If you take more AMLOR 10 mg capsule than you should:

Taking too many capsules can lead to a sometimes dangerous drop in your blood pressure. You may feel dizzy, dizzy, faint or weak. If the blood pressure falls too much, a shock may occur. Your skin may become cold and clammy and you may lose consciousness. Consult a doctor if you have taken too many AMLOR capsules.

What is Forms and Composition Amlor?

COMPOSITION

What does AMLOR 10 mg capsule contain?

Active substance

Amlodipine besylate: 13.889 mg

Amlodipine equivalent quantity: 10,000 mg

For one capsule

Other components

The capsule shell contains: gelatin, black iron oxide, yellow iron oxide, titanium dioxide.

The printing ink on the capsule shell contains: shellac, black iron oxide.

NOT’s

Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:

general information:

Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles

Additional information:

General explanation about dealing with the medicine: how to take the medicine, the doses and times of it, the start and duration of its effectiveness, the recommended diet during the period of taking the medicine, the method of storage and storage, recommendations in cases for forgetting the dose and instructions to stop taking the drug and take additional doses.

Special warnings:

For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.

Side effects:

It treats possible side effects and drug interactions that require attention and its effect on continuous use.

The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.

The post Amlor 5mg Tablets Uses, Dosage, Side Effects,&Warnings appeared first on Drug Online.

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colinfitzpatrick · 4 years

Text

Amlor 5mg Tablets Uses, Dosage, Side Effects,&Warnings

Drug Online

Amlor generic name : Amlodipine

Amlodipine generic drug of the therapeutic class: Cardiology and angiology active principles: Amlodipine

What is Amlor 5mg?

AMLOR is used to treat high blood pressure (hypertension), or a certain type of chest pain called angina, a rare form of which is Prinzmetal’s angina.

Amlor indication and Uses

Hypertension.

Chronic stable angina.

Vasospastic angina (Prinzmetal syndrome).

Amlor dosage

adults:

For hypertension and langor, the usual starting dose is 5 mg AMLOR once daily, which can be increased to a maximum dose of 10 mg depending on the patient’s individual response.

No dose adjustment of AMLOR is necessary when coadministered with thiazide diuretics, beta-blockers and langiotensin converting enzyme inhibitors.

Special populations

Elderly patients

Patients with hepatic insufficiency

Dose recommendations have not been established in patients with mild to moderate hepatic impairment therefore the dose should be selected with caution and started at the lowest effective dose.

Patients with renal insufficiency

Changes in damlodipine plasma concentrations are not correlated with the degree of renal insufficiency, so a usual dose is recommended. Lamlodipine is not dialysable.

Pediatric population

Hypertensive children and adolescents aged 6 to 17

A dosage of 2.5 mg damlodipine is not possible with this drug.

Children under 6 years

There is no data available.

Administration mode

Capsule for oral administration.

Amlor Contraindications

Dihydropyridines hypersensitivity

Amlodipine hypersensitivity

Severe hypotension

Shock

Left ventricular outflow obstruction

Hemodynamically unstable heart failure after acute myocardial infarction

Feeding with milk

Amlodipine is contraindicated in patients with:

Hypersensitivity to dihydropyridine derivatives, amlodipine or any of the excipients listed in section composition.

Severe hypotension.

A shock (including cardiogenic shock).

An obstruction of the left ventricular outflow tract (eg aortic stenosis high degree).

An unstable cardiac insufficiency hemodynamically after acute myocardial infarction.

Amlor mechanism of action

Pharmacotherapeutic group: Selective calcium antagonist with predominantly vascular effect

ATC Code: C08 CA01.

Amlopidine has not been associated with adverse metabolic effects or changes in plasma lipids, and is suitable for patients with asthma, diabetes and gout.

Use in patients with coronary artery disease

Table 1 . Impact of significant clinical endpoints of the CAMELOT study

Cardiovascular event rate, number (%)

Amlopidine versus placebo

Evaluation criteria

amlodipine

Placebo

Enalapril

Relative risk

(95% CI)

P value

Main criterion

Cardiovascular adverse events

110 (16.6)

151 (23.1)

136 (20.2)

0.69 (0.54-0.88)

0,003

Individual components

Coronary revascularization

78 (11.8)

103 (15.7)

95 (14,1)

0.73 (0.54-0.98)

0.03

Hospitalization for angor

51 (7.7)

84 (12.8)

86 (12.8)

0.58 (0.41-0.82)

0,002

Non-fatal IDM

14 (2.1)

19 (2.9)

11 (1,6)

0.73 (0.37-1.46)

0.37

Stroke or AIT

6 (0.9)

12 (1,8)

8 (1,2)

0.50 (0.19-1.32)

0.15

Cardiovascular mortality

5 (0.8)

2 (0.3)

5 (0.7)

2.46 (0.48-12.7)

0.27

Hospitalization for ICC

3 (0.5)

5 (0.8)

4 (0.6)

0.59 (0.14-2.47)

0.46

Resuscitation after cardiac arrest

4 (0.6)

1 (0,1)

N / A

0.04

Appearance of peripheral vascular disease

5 (0.8)

2 (0.3)

8 (1,2)

2.6 (0.50-13.4)

0.24

Abbreviations: CHF, congestive heart failure; IC, confidence interval; MI, myocardial infarction; TIA, transient ischemic attacks; Stroke, stroke.

Use in patients with heart failure :

Study on the Preventive Treatment of Heart Failure (Treatment to Prevent Attack Heart Attack, ALLHAT)

Use in children (at least six years old)

How it works Amlor

What are side effects of Amlor?

Summary of the security profile

The most common side effects reported during treatment are drowsiness, dizziness, headache, palpitations, flushing, abdominal pain, nausea, swollen ants, edema, and fatigue.

List of undesirable effects

In each frequency group, the adverse effects are presented in order of decreasing severity.

Respiratory, thoracic and mediastinal disorders

Rare Dyspnea, rhinitis Very rare Cough

Gastrointestinal disorders

Frequent Abdominal pain, nausea Rare Vomiting, dyspepsia, transit disorders (including diarrhea and constipation), dry mouth Very rare Pancreatitis, gastritis, gingival hyperplasia

Hepatobiliary disorders

Very rare Hepatitis, jaundice, elevated liver enzymes *

Skin and subcutaneous tissue disorders

Musculoskeletal, Connective Tissue and Bone Disorders

Frequent Edema of the ankles Rare Arthralgia, myalgia, muscle cramp, back pain

Renal and urinary disorders

Rare Micturition disorder, nocturia, increased urinary frequency

Disorders of reproductive organs and breast

Rare Impotence, gynecomastia

General disorders and administration site conditions

Frequent Edema, tiredness Rare Chest pain, asthenia, pain, discomfort

investigations

Rare Increased weight, decreased weight

* Generally suggestive of cholestasis

Exceptional cases of extrapyramidal syndrome have been reported.

Amlor interactions

Effects of other drugs on amlopidine

CYP3A4 inhibitors

The clinical translation of these pharmacokinetic variations may be more pronounced in the elderly. Therefore, clinical monitoring and dose adjustment may be necessary.

CYP3A4 inducers

Administration of amlopidine with grapefruit or grapefruit juice is not recommended as bioavailability may be increased in some patients, which may result in increased hypotensive effects.

Dantrolene (infusion)

Effects of amlodipine on other drugs

The hypotensive effects of amlodipine add to those of other drugs with antihypertensive properties.

tacrolimus

cyclosporin

simvastatin

In clinical interaction studies, amlodipine did not affect the pharmacokinetics of atorvastatin, digoxin or warfarin.

Amlor Warnings and Precautions

The safety and efficacy of lamlodipine during a hypertensive crisis have not been established.

Patients with heart failure

Patients with hepatic insufficiency

Elderly patients

In elderly patients, an increase in dosage should be made with caution.

Patients with renal insufficiency

Lamlodipine can be used in these patients at normal doses. Changes in plasma concentrations of damlodipine do not correlate with the degree of renal insufficiency. Lamlodipine is not dialysable.

Drive and use machines

PREGNANCY / BREAST FEEDING / FERTILITY

Pregnancy:

In women, the safety of amlodipine during pregnancy has not been established.

In animal studies, reproductive toxicity has been observed at high doses (see section 5.3 ).

Use during pregnancy is recommended only if no safer alternatives are available and when the disease itself poses greater risks to the mother and fetus.

feeding:

Fertility:

What should I do if I miss a dose?

If you forget to take AMLOR 10 mg, capsule:

Do not worry. If you forget to take one capsule, skip the dose completely. Take the next dose according to the normal rhythm. Do not take a double dose to make up for the dose you forgot to take.

What happens if I overdose from Amlor ?

If you take more AMLOR 10 mg capsule than you should:

What is Forms and Composition Amlor?

COMPOSITION

What does AMLOR 10 mg capsule contain?

Active substance

Amlodipine besylate: 13.889 mg

Amlodipine equivalent quantity: 10,000 mg

For one capsule

Other components

The capsule shell contains: gelatin, black iron oxide, yellow iron oxide, titanium dioxide.

The printing ink on the capsule shell contains: shellac, black iron oxide.

NOT’s

Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:

general information:

Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles

Additional information:

Special warnings:

For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.

Side effects:

It treats possible side effects and drug interactions that require attention and its effect on continuous use.

The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.

The post Amlor 5mg Tablets Uses, Dosage, Side Effects,&Warnings appeared first on Drug Online.

from Drug Online https://bit.ly/3gmYSBX via Edrug Online

#medicines #including Allergy Medicines #Anemia #Antibiotic Medicines #Colds & Flu Medicines #Cough Me

0 notes

thesittingduck · 4 years

Text

Amlodipine 5mg Tablets (Amlor) Uses, Dosage, Side Effects,&Warnings

Drug Online

Amlor generic name : Amlodipine

Amlodipine generic drug of the therapeutic class: Cardiology and angiology active principles: Amlodipine

What is Amlor 5mg?

AMLOR is used to treat high blood pressure (hypertension), or a certain type of chest pain called angina, a rare form of which is Prinzmetal’s angina.

Amlor indication and Uses

Hypertension.

Chronic stable angina.

Vasospastic angina (Prinzmetal syndrome).

amlodipine dosage

Dosage:

adults:

For hypertension and langor, the usual starting dose is 5 mg AMLOR once daily, which can be increased to a maximum dose of 10 mg depending on the patient’s individual response.

No dose adjustment of AMLOR is necessary when coadministered with thiazide diuretics, beta-blockers and langiotensin converting enzyme inhibitors.

Special populations

Elderly patients

Patients with hepatic insufficiency

Dose recommendations have not been established in patients with mild to moderate hepatic impairment therefore the dose should be selected with caution and started at the lowest effective dose.

Patients with renal insufficiency

Changes in damlodipine plasma concentrations are not correlated with the degree of renal insufficiency, so a usual dose is recommended. Lamlodipine is not dialysable.

Pediatric population

Hypertensive children and adolescents aged 6 to 17

A dosage of 2.5 mg damlodipine is not possible with this drug.

Children under 6 years

There is no data available.

Administration mode

Capsule for oral administration.

amlodipine mechanism of action

Pharmacotherapeutic group: Selective calcium antagonist with predominantly vascular effect

ATC Code: C08 CA01.

Amlopidine has not been associated with adverse metabolic effects or changes in plasma lipids, and is suitable for patients with asthma, diabetes and gout.

Use in patients with coronary artery disease

Table 1 . Impact of significant clinical endpoints of the CAMELOT study

Cardiovascular event rate, number (%)

Amlopidine versus placebo

Evaluation criteria

amlodipine

Placebo

Enalapril

Relative risk

(95% CI)

P value

Main criterion

Cardiovascular adverse events

110 (16.6)

151 (23.1)

136 (20.2)

0.69 (0.54-0.88)

0,003

Individual components

Coronary revascularization

78 (11.8)

103 (15.7)

95 (14,1)

0.73 (0.54-0.98)

0.03

Hospitalization for angor

51 (7.7)

84 (12.8)

86 (12.8)

0.58 (0.41-0.82)

0,002

Non-fatal IDM

14 (2.1)

19 (2.9)

11 (1,6)

0.73 (0.37-1.46)

0.37

Stroke or AIT

6 (0.9)

12 (1,8)

8 (1,2)

0.50 (0.19-1.32)

0.15

Cardiovascular mortality

5 (0.8)

2 (0.3)

5 (0.7)

2.46 (0.48-12.7)

0.27

Hospitalization for ICC

3 (0.5)

5 (0.8)

4 (0.6)

0.59 (0.14-2.47)

0.46

Resuscitation after cardiac arrest

4 (0.6)

1 (0,1)

N / A

0.04

Appearance of peripheral vascular disease

5 (0.8)

2 (0.3)

8 (1,2)

2.6 (0.50-13.4)

0.24

Abbreviations: CHF, congestive heart failure; IC, confidence interval; MI, myocardial infarction; TIA, transient ischemic attacks; Stroke, stroke.

Use in patients with heart failure :

Study on the Preventive Treatment of Heart Failure (Treatment to Prevent Attack Heart Attack, ALLHAT)

Use in children (at least six years old)

How it works Amlor

What are side effects of amlodipine?

Summary of the security profile

The most common side effects reported during treatment are drowsiness, dizziness, headache, palpitations, flushing, abdominal pain, nausea, swollen ants, edema, and fatigue.

List of undesirable effects

In each frequency group, the adverse effects are presented in order of decreasing severity.

Respiratory, thoracic and mediastinal disorders

Rare Dyspnea, rhinitis Very rare Cough

Gastrointestinal disorders

Frequent Abdominal pain, nausea Rare Vomiting, dyspepsia, transit disorders (including diarrhea and constipation), dry mouth Very rare Pancreatitis, gastritis, gingival hyperplasia

Hepatobiliary disorders

Very rare Hepatitis, jaundice, elevated liver enzymes *

Skin and subcutaneous tissue disorders

Musculoskeletal, Connective Tissue and Bone Disorders

Frequent Edema of the ankles Rare Arthralgia, myalgia, muscle cramp, back pain

Renal and urinary disorders

Rare Micturition disorder, nocturia, increased urinary frequency

Disorders of reproductive organs and breast

Rare Impotence, gynecomastia

General disorders and administration site conditions

Frequent Edema, tiredness Rare Chest pain, asthenia, pain, discomfort

investigations

Rare Increased weight, decreased weight

* Generally suggestive of cholestasis

Exceptional cases of extrapyramidal syndrome have been reported.

amlodipine interactions

Effects of other drugs on amlopidine

CYP3A4 inhibitors

The clinical translation of these pharmacokinetic variations may be more pronounced in the elderly. Therefore, clinical monitoring and dose adjustment may be necessary.

CYP3A4 inducers

Administration of amlopidine with grapefruit or grapefruit juice is not recommended as bioavailability may be increased in some patients, which may result in increased hypotensive effects.

Dantrolene (infusion)

Effects of amlodipine on other drugs

The hypotensive effects of amlodipine add to those of other drugs with antihypertensive properties.

tacrolimus

cyclosporin

simvastatin

In clinical interaction studies, amlodipine did not affect the pharmacokinetics of atorvastatin, digoxin or warfarin.

Amlor Warnings and Precautions

The safety and efficacy of lamlodipine during a hypertensive crisis have not been established.

Patients with heart failure

Patients with hepatic insufficiency

Elderly patients

In elderly patients, an increase in dosage should be made with caution.

Patients with renal insufficiency

Lamlodipine can be used in these patients at normal doses. Changes in plasma concentrations of damlodipine do not correlate with the degree of renal insufficiency. Lamlodipine is not dialysable.

Drive and use machines

Amlor and PREGNANCY / BREAST FEEDING / FERTILITY

Pregnancy:

In women, the safety of amlodipine during pregnancy has not been established.

In animal studies, reproductive toxicity has been observed at high doses (see section 5.3 ).

Use during pregnancy is recommended only if no safer alternatives are available and when the disease itself poses greater risks to the mother and fetus.

feeding:

Fertility:

What should I do if I miss a dose?

If you forget to take AMLOR 10 mg, capsule:

Do not worry. If you forget to take one capsule, skip the dose completely. Take the next dose according to the normal rhythm. Do not take a double dose to make up for the dose you forgot to take.

What happens if I overdose from Amlor ?

If you take more AMLOR 10 mg capsule than you should:

What is Forms and Composition Amlor?

COMPOSITION

What does AMLOR 10 mg capsule contain?

Active substance

Amlodipine besylate: 13.889 mg

Amlodipine equivalent quantity: 10,000 mg

For one capsule

Other components

The capsule shell contains: gelatin, black iron oxide, yellow iron oxide, titanium dioxide.

The printing ink on the capsule shell contains: shellac, black iron oxide.

NOT’s

Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:

general information:

Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles

Additional information:

Special warnings:

For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.

Side effects:

It treats possible side effects and drug interactions that require attention and its effect on continuous use.

The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.

The post Amlodipine 5mg Tablets (Amlor) Uses, Dosage, Side Effects,&Warnings appeared first on Drug Online.

from Drug Online https://bit.ly/2MvmHuE via Edrug Online from faculty of medicine https://bit.ly/2XDApSB via Faculty of Medicine

#medicines #including Allergy Medicines #Anemia #Antibiotic Medicines #Colds & Flu Medicines #Cough Me

0 notes

colinfitzpatrick · 4 years

Text

Amlodipine 5mg Tablets (Amlor) Uses, Dosage, Side Effects,&Warnings

Drug Online

Amlor generic name : Amlodipine

Amlodipine generic drug of the therapeutic class: Cardiology and angiology active principles: Amlodipine

What is Amlor 5mg?

AMLOR is used to treat high blood pressure (hypertension), or a certain type of chest pain called angina, a rare form of which is Prinzmetal’s angina.

Amlor indication and Uses

Hypertension.

Chronic stable angina.

Vasospastic angina (Prinzmetal syndrome).

amlodipine dosage

Dosage:

adults:

For hypertension and langor, the usual starting dose is 5 mg AMLOR once daily, which can be increased to a maximum dose of 10 mg depending on the patient’s individual response.

No dose adjustment of AMLOR is necessary when coadministered with thiazide diuretics, beta-blockers and langiotensin converting enzyme inhibitors.

Special populations

Elderly patients

Patients with hepatic insufficiency

Dose recommendations have not been established in patients with mild to moderate hepatic impairment therefore the dose should be selected with caution and started at the lowest effective dose.

Patients with renal insufficiency

Changes in damlodipine plasma concentrations are not correlated with the degree of renal insufficiency, so a usual dose is recommended. Lamlodipine is not dialysable.

Pediatric population

Hypertensive children and adolescents aged 6 to 17

A dosage of 2.5 mg damlodipine is not possible with this drug.

Children under 6 years

There is no data available.

Administration mode

Capsule for oral administration.

amlodipine mechanism of action

Pharmacotherapeutic group: Selective calcium antagonist with predominantly vascular effect

ATC Code: C08 CA01.

Amlopidine has not been associated with adverse metabolic effects or changes in plasma lipids, and is suitable for patients with asthma, diabetes and gout.

Use in patients with coronary artery disease

Table 1 . Impact of significant clinical endpoints of the CAMELOT study

Cardiovascular event rate, number (%)

Amlopidine versus placebo

Evaluation criteria

amlodipine

Placebo

Enalapril

Relative risk

(95% CI)

P value

Main criterion

Cardiovascular adverse events

110 (16.6)

151 (23.1)

136 (20.2)

0.69 (0.54-0.88)

0,003

Individual components

Coronary revascularization

78 (11.8)

103 (15.7)

95 (14,1)

0.73 (0.54-0.98)

0.03

Hospitalization for angor

51 (7.7)

84 (12.8)

86 (12.8)

0.58 (0.41-0.82)

0,002

Non-fatal IDM

14 (2.1)

19 (2.9)

11 (1,6)

0.73 (0.37-1.46)

0.37

Stroke or AIT

6 (0.9)

12 (1,8)

8 (1,2)

0.50 (0.19-1.32)

0.15

Cardiovascular mortality

5 (0.8)

2 (0.3)

5 (0.7)

2.46 (0.48-12.7)

0.27

Hospitalization for ICC

3 (0.5)

5 (0.8)

4 (0.6)

0.59 (0.14-2.47)

0.46

Resuscitation after cardiac arrest

4 (0.6)

1 (0,1)

N / A

0.04

Appearance of peripheral vascular disease

5 (0.8)

2 (0.3)

8 (1,2)

2.6 (0.50-13.4)

0.24

Abbreviations: CHF, congestive heart failure; IC, confidence interval; MI, myocardial infarction; TIA, transient ischemic attacks; Stroke, stroke.

Use in patients with heart failure :

Study on the Preventive Treatment of Heart Failure (Treatment to Prevent Attack Heart Attack, ALLHAT)

Use in children (at least six years old)

How it works Amlor

What are side effects of amlodipine?

Summary of the security profile

The most common side effects reported during treatment are drowsiness, dizziness, headache, palpitations, flushing, abdominal pain, nausea, swollen ants, edema, and fatigue.

List of undesirable effects

In each frequency group, the adverse effects are presented in order of decreasing severity.

Respiratory, thoracic and mediastinal disorders

Rare Dyspnea, rhinitis Very rare Cough

Gastrointestinal disorders

Frequent Abdominal pain, nausea Rare Vomiting, dyspepsia, transit disorders (including diarrhea and constipation), dry mouth Very rare Pancreatitis, gastritis, gingival hyperplasia

Hepatobiliary disorders

Very rare Hepatitis, jaundice, elevated liver enzymes *

Skin and subcutaneous tissue disorders

Musculoskeletal, Connective Tissue and Bone Disorders

Frequent Edema of the ankles Rare Arthralgia, myalgia, muscle cramp, back pain

Renal and urinary disorders

Rare Micturition disorder, nocturia, increased urinary frequency

Disorders of reproductive organs and breast

Rare Impotence, gynecomastia

General disorders and administration site conditions

Frequent Edema, tiredness Rare Chest pain, asthenia, pain, discomfort

investigations

Rare Increased weight, decreased weight

* Generally suggestive of cholestasis

Exceptional cases of extrapyramidal syndrome have been reported.

amlodipine interactions

Effects of other drugs on amlopidine

CYP3A4 inhibitors

The clinical translation of these pharmacokinetic variations may be more pronounced in the elderly. Therefore, clinical monitoring and dose adjustment may be necessary.

CYP3A4 inducers

Administration of amlopidine with grapefruit or grapefruit juice is not recommended as bioavailability may be increased in some patients, which may result in increased hypotensive effects.

Dantrolene (infusion)

Effects of amlodipine on other drugs

The hypotensive effects of amlodipine add to those of other drugs with antihypertensive properties.

tacrolimus

cyclosporin

simvastatin

In clinical interaction studies, amlodipine did not affect the pharmacokinetics of atorvastatin, digoxin or warfarin.

Amlor Warnings and Precautions

The safety and efficacy of lamlodipine during a hypertensive crisis have not been established.

Patients with heart failure

Patients with hepatic insufficiency

Elderly patients

In elderly patients, an increase in dosage should be made with caution.

Patients with renal insufficiency

Lamlodipine can be used in these patients at normal doses. Changes in plasma concentrations of damlodipine do not correlate with the degree of renal insufficiency. Lamlodipine is not dialysable.

Drive and use machines

Amlor and PREGNANCY / BREAST FEEDING / FERTILITY

Pregnancy:

In women, the safety of amlodipine during pregnancy has not been established.

In animal studies, reproductive toxicity has been observed at high doses (see section 5.3 ).

Use during pregnancy is recommended only if no safer alternatives are available and when the disease itself poses greater risks to the mother and fetus.

feeding:

Fertility:

What should I do if I miss a dose?

If you forget to take AMLOR 10 mg, capsule:

Do not worry. If you forget to take one capsule, skip the dose completely. Take the next dose according to the normal rhythm. Do not take a double dose to make up for the dose you forgot to take.

What happens if I overdose from Amlor ?

If you take more AMLOR 10 mg capsule than you should:

What is Forms and Composition Amlor?

COMPOSITION

What does AMLOR 10 mg capsule contain?

Active substance

Amlodipine besylate: 13.889 mg

Amlodipine equivalent quantity: 10,000 mg

For one capsule

Other components

The capsule shell contains: gelatin, black iron oxide, yellow iron oxide, titanium dioxide.

The printing ink on the capsule shell contains: shellac, black iron oxide.

NOT’s

Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:

general information:

Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles

Additional information:

Special warnings:

For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.

Side effects:

It treats possible side effects and drug interactions that require attention and its effect on continuous use.

The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.

The post Amlodipine 5mg Tablets (Amlor) Uses, Dosage, Side Effects,&Warnings appeared first on Drug Online.

from Drug Online https://bit.ly/2MvmHuE via Edrug Online

#medicines #including Allergy Medicines #Anemia #Antibiotic Medicines #Colds & Flu Medicines #Cough Me

0 notes