NBCHT Drug Information

Transcription

1 NBCHT Drug Infrmatin USEFUL DRUG INFORMATION FOR COLON HYDROTHERAPISTS NSAIDs Nn-steridal anti-inflammatry Drugs are cmmnly prescribed fr treatment f pain and inflammatin eg. jint pain, arthritis, gut, backache, sprts injury, menstrual pain, headaches etc. As a grup f drugs, they are taken regularly by apprximately 33 millin Americans. Cmmn examples f NSAIDs are : Aspirin salsalate (Amigesic), diflunisal (Dlbid), ibuprfen (Mtrin), ketprfen (Orudis), nabumetne (Relafen), pirxicam (Feldene), naprxen (Aleve, Naprsyn,) diclfenac (Vltaren), indmethacin (Indcin), sulindac (Clinril), tlmetin (Tlectin), etdlac (Ldine), ketrlac (Tradl), xaprzin (Daypr), celecxib (Celebrex). Side effects f NSAIDs Majr side effects f NSAIDs are n the gastrintestinal system. Between10%-50% f patients experiences side effects such as abdminal pain, diarrhea, blating, heartburn, and indigestin. A smaller percentage taking NSAIDs lng- term run the risk f develping stmach and dudenal ulcers with additinal risk f cmplicatins such as bleeding r perfratin. These side effects f NSAIDs are attributed t its mechanism f actin. The bdy prduces prstaglandins, chemical agents invlved in the natural physilgical inflammatry respnse. Prstaglandins are prduced in cells by the enzyme cyclxygenase (COX). There are tw types f cyclgenase enzymes : COX-1 and COX-2. Bth enzymes prduce prstaglandins that prmte inflammatin, pain, and fever. Hwever, nly COX-1 prduces prstaglandins that supprt platelets and prtect the stmach. Cmmn anti-inflammatry drugs like aspirins and ibuprfen blck bth COX-1 and COX-2 enzymes and reduce prstaglandins thrughut the bdy. As a cnsequence, nging inflammatin, pain, and fever are reduced. Hwever by reducing prstaglandins (blcking f COX-1 enzyme) in the stmach, the prtective actin f prstaglandin n the stmach and its beneficial effects n platelets and bld cltting is cmprmised, resulting in risk f stmach ulceratin and bleeding. NBCHT Cntrlled Acts Plicy 8/11/2010 1

2 Newer NSAIDs are Cx-2 inhibitrs New generatins f NSAIDs are mre specific in actins. These drugs are uniquely different frm traditinal NSAIDs by selectively blcking the COX-2 enzyme and nt the COX-1 enzyme. By blcking nly the COX-2 enzymes which impede the prductin f prstaglandins in the bdy it reduces pain, swelling and inflammatin withut causing adverse effects in the stmach (n actin f COX-1 enzymes and thus n reductin f prstaglandin in the stmach). Selective COX-2 inhibitr such as Celebrax (celecxib) is therefre less likely t cause bleeding and ulcers. Other side effects f NSAIDs NSAIDS als causes sme cmmn side effects such as nausea, vmiting, diarrhea, cnstipatin, decreased appetite, rash, dizziness, headache, and drwsiness and edema. The mre serius side effects include kidney failure, liver failure, ulcers and prlnged bleeding after an injury r surgery. In spite f the lwer incidence f adverse effects with the use f COX-2 inhibitrs, FDA has issued guidelines regarding its use. These guidelines are based n the latest available scientific data that indicate an increased risk f cardivascular (CV) events and gastrintestinal (GI) bleeding assciated with their use. Prednisne Predinislneis a sterid. It is a life saving drug in varius medical cnditins such as brnchial asthma, anaphylaxis and shck cnditins. It is als a drug cmmnly prescribed fr chrnic health cnditins including psriasis, rheumatid arthritis, stearthritis, gut and varius inflammatry disrders. The prblem with the use f this drug is that it can aggravate sme medical cnditins such as diabetes, steprsis, hypertensin, glaucma, peptic ulcers and cause the trigger an infectin etc. Its wide clinical efficacy in many health cnditins makes it a cmmn prescriptin drug. While it is useful in the reslutin f many health prblems, it is a drug that is verused and abused. Lng term use can suppress immunity resistance and lead t fluid accumulatin as well as Cushing s syndrme. Drug interactins with ther drugs such as barbiturates, rifampicin, cyclsprine, NSAIDs, antacids and insulin can result in elevatin f drug cncentratin r enhancement f txicity f ther drugs. Any patients n prednisne (r ther frmulatin f sterids) shuld be mnitred clsely t ensure that there is a need t maintain gd therapeutic cntrl f their health cnditins while underging cln hydrtherapy. NBCHT Cntrlled Acts Plicy 8/11/2010 2

3 Atrvastatin (lipitr) Atrvastatin is an ral drug that lwers the level f chlesterl in the bld. It belngs t a class f drugs referred t as statins, which includes lvastatin (Mevacr), simvastatin, (Zcr), fluvastatin (Lescl), and pravastatin (Pravachl). All statins, including atrvastatin, prevent the prductin f chlesterl in the liver by blcking HMG-CA reductase, an enzyme that makes chlesterl. Statins reduce ttal chlesterl as well as LDL chlesterl in bld. LDL chlesterl is believed t be the "bad" chlesterl that is primarily respnsible fr the develpment f crnary artery disease. Reducing LDL chlesterl levels retards prgressin and may even reverse crnary artery disease. Atrvastatin als reduces the cncentratin f triglycerides in the bld and raises the cncentratins f HDL ("gd") chlesterl. High bld cncentratins f triglycerides als have been assciated with crnary artery disease. Atrvastatin has als been prven in clinical studies t prevent angina, strke, heart attack, hspitalizatin fr cngestive heart failure, and revascularizatin prcedures in individuals with crnary heart disease. It can reduce the risk f mycardial infarctin, strke, angina and revascularizatin prcedures in adults with multiple risk factrs fr crnary artery disease. Prblem with the use f Atrvastatin lies in its sides effects. This is attributed t several factrs, ne f which is DRUG INTERACTIONS. Decreased eliminatin f atrvastatin culd increase levels f atrvastatin in the bdy and increase the risk f muscle txicity frm atrvastatin. Therefre, atrvastatin shuld nt be cmbined with drugs that decrease its eliminatin. Examples f such drugs include erythrmycin (E-Mycin), ketcnazle (Nizral), itracnazle (Spranx), clarithrmycin (Biaxin), telithrmycin (Ketek), cyclsprine (Sandimmune), nefazdne (Serzne), and HIV prtease inhibitrs such as indinavir (Crixivan) and ritnavir (Nrvir). Large quantities f grape fruit juice (>1.2 liters daily) als will increase bld levels f atrvastatin. Amidarne (Crdarne), verapamil (Calan Verelan, Isptin), cyclsprine (Sandimmune), niacin (Niacr, Niaspan, Sl-Niacin), gemfibrzil (Lpid) and fenfibrate (Tricr) als may increase the risk f muscle txicity when cmbined with atrvastatin. Atrvastatin increases the effect f warfarin (Cumadin) and the bld cncentratin f digxin (Lanxin). Patients taking atrvastatin and warfarin r digxin shuld be mnitred carefully. Chlestyramine (Questran) decreases the absrptin f atrvastatin. Atrvastatin shuld be given at least tw hurs befre and at least fur hurs after chlestyramine. PREGNANCY: Atrvastatin shuld nt be taken during pregnancy because the develping fetus requires chlesterl fr develpment, and atrvastatin reduces the prductin f chlesterl. Atrvastatin shuld nly be administered t wmen f childbearing age if they are nt likely t becme pregnant. SIDE EFFECTS: Atrvastatin is generally well-tlerated. Minr side effects include cnstipatin, diarrhea, fatigue, gas, heartburn, and headache. Atrvastatin may cause liver and muscle damage. Serius liver damage caused by statins is rare. NBCHT Cntrlled Acts Plicy 8/11/2010 3

4 Methtrexate Methtrexate is an example f an extremely txic drug prescribed fr treatment f varius cancer. It is als indicated in treatment f rheumatid arthritis and psriasis. There are numerus side effects such as stmatitis, nausea, malaise, fatigue, headache etc as well as infectins due t immune suppressin. Serius adverse reactins include: bne marrw suppressin, liver, lung and kidney txicity. Unexpected severe (smetimes fatal) bne marrw suppressin, aplastic anemia and gastrintestinal txicity have been reprted with cncmitant administratin f methtrexate (usually in high dsage) alng with sme nnsteridal antiinflammatry drugs (NSAIDs). It is thus imprtant fr cln hydrtherapists t be aware that any patients n methtrexate therapy shuld be handled with care and t ensure that their health cnditins are stable befre prceeding with cln hydrtherapy. Plavix (clpidgrel) Plavix is a drug prescribed t keep the platelets in yur bld frm cagulating (cltting) s as t prevent unwanted bld clts that can ccur with certain heart r bld vessel cnditins. Plavix is used t prevent bld clts after a recent heart attack r strke, and in peple with certain disrders f the heart r bld vessels. Because f this drug actin, Plavix may cause bleeding prblem even frm a minr injury. It can present as bleeding within the digestive tract stls are black and/r vmit is cffee grund clr. These are signs f bleeding in yur digestive tract. Avid drinking alchl while taking Plavix. Alchl may increase the risk f bleeding in yur stmach r intestines. Clients intending t underg any type f surgery r dental wrk shuld infrm their surgen r dentist abut the use f Plavix. They will need t stp using the medicine fr at least 5 days befre having surgery, t prevent excessive bleeding. While taking Plavix, avid taking aspirin r ther NSAIDs (nn-steridal anti-inflammatry drugs) unless under dctr's advice. NSAIDs include ibuprfen (Mtrin, Advil), naprxen (Aleve, Naprsyn), diclfenac (Vltaren), diflunisal (Dlbid), etdlac (Ldine), flurbiprfen (Ansaid), indmethacin (Indcin), ketprfen (Orudis), ketrlac (Tradl), mefenamic acid (Pnstel), melxicam (Mbic), nabumetne (Relafen), pirxicam (Feldene), and thers. If clients are taking Plavix (clpidgrel), be aware f the increase risk f bleeding in such clients and advise them t seek treatment accrdingly, if there are warning signs f any bleeding prblems. NBCHT Cntrlled Acts Plicy 8/11/2010 4

5 Warfarin (cumadin) Warfarin (cumadin) is a drug prescribed t prevent cltting especially in cases at risk f suffering frm thrmbsis r high risk f emblism. These can be cases f strkes, heart disease, peripheral arterial disrders r atrial fibrillatin. There may als be side effects such as nausea, abdminal discmfrt and hypersensitivity t warfarin. The imprtance thugh is the risk f haemrrhage in such cases during any prcedure r injury. Due t the pssibility f bleeding frm haemrrhids r prblem f rectal bleed during cln hydrtherapy sessin, it is imprtant fr a cln hydrtherapist t be aware f this prblem in patients taking warfarin. Digxin Digxin is a very useful drug in the treatment f varius heart cnditins. Derived frm the fxglve plant, its medicinal prperties have been dcumented since the late 18 th century. Digxin is recmmended fr use in treatment f heart prblems such as atrial fibrillatin, cngestive heart failure (CHF) etc. In spite f its usefulness, ne prblem with digxin lies in its narrw therapeutic windw leading t risk f drug txicity. (ie. a very small range f dsage befre it manifests txicity which can be serius and fatal). Apprximately 0.4% f all hspital admissins are related t digitalis txicity. Of peple in nursing hmes, 10 t18% develp this txicity. Accrding t a large study published in 1990, definite digxin txicity ccurred in 0.8% f patients with heart failure treated with digxin. One f the mst cmmn precipitating cause f digitalis intxicatin is the lack f ptassium stres in the bdy. This ccurs ften in patients with heart failure as a result f diuretic therapy and secndary hyperaldsternism. Anther cause is drug interactins. A number f drugs are knw t ptentiate digxin txicity. These include the fllwing: Quinidine Erythrmycin Verapamil, diltiazem, nifedipine Captpril Antichlinergic drugs Ibuprfen Amidarne Therapist managing clients wh have heart disease r atrial fibrillatin, shuld take a detailed drug histry and advise clients t seek medical attentin. NBCHT Cntrlled Acts Plicy 8/11/2010 5

6 Lasix (Frusemide) Lasix is a very useful drug t prevent the bdy frm absrbing t much water. It is generally prescribed fr cngestive heart failure, liver disease, r kidney disrders. Side effects f Lasix may include: dry muth, thirst, nausea, vmiting; feeling weak, drwsy, restless, r light-headed; fast r uneven heartbeat; muscle pain r weakness; urinating less than usual r nt at all; easy bruising r bleeding, unusual weakness; a red, blistering, peeling skin rash; hearing lss; r stmach pain, lw fever, lss f appetite, dark urine, clay-clred stls, jaundice (yellwing f the skin r eyes). Clients n Lasix shuld be referred t the referring Health Care practitiner prir t the sessin. Carvedill (Creg) Carvedill (Creg) is a prescriptin medicine prescribed cmmnly fr treatment f hypertensin and cngestive heart failure. It belngs t a class f drugs knwn as the beta blckers. There are a number f knwn side effects. These include : Dizziness Lw bld pressure Diarrhea High bld sugar Increase in weight Slw heart rate Nausea Insmnia Drp in bld pressure when standing frm either a sitting r lying-dwn psitin. Due t the pssibility f drug interactin with a large number f drugs including heart medicatin, anti-depressants, NSAIDs etc, a careful drug histry must als be taken frm clients. NBCHT Cntrlled Acts Plicy 8/11/2010 6