|
Literature:
- Diabetics Should be Taking Statins
(or Gemfibrozil):
(Ivanhoe Newswire) -- New
guidelines released by the American College of
Physicians suggest controlling cholesterol is as
important as controlling blood sugar for diabetes.
Authors of the new guidelines say all people with
diabetes and any other risks for cardiovascular disease
should be taking statins, which are cholesterol-lowering
drugs.
Aimed at physicians and patients, the new guidelines
suggest all adults with type 2 diabetes, known coronary
artery disease, or a risk factor for CAD should take
statins regardless of their cholesterol levels. CAD
risk factors include
high blood pressure,
high
cholesterol, smoking, physical inactivity and obesity. Premenopausal women with diabetes and another risk
factor should be taking statins or the
non-statin drug
gemfibrozil, also known as
Lopid.
The authors say statins are extremely safe, except for
patients who have liver problems or are taking drugs
that interact with statins.
In April 2003, the American College of Physicians called
for tight control of blood pressure for diabetics.
According to the American Diabetes Association, 80
percent of people with type 2 diabetes will develop or
die from complications of heart and vessel disease.
About 65 percent of deaths among people with diabetes
are due to heart disease and stroke.
The number of people with diabetes is growing rapidly in
the United States. The American Diabetes Association
estimates 18.2 million Americans have the condition, and
an additional 1.3 million people, ages 20 and older, are
diagnosed with diabetes each year.
SOURCE: Archives of Internal Medicine, Reported
April 20, 2004 .
- Chemists Pioneer New Antibiotics And Nano-Sized
Delivery Vehicles:
University of South Florida chemists who recently
patented a new class of synthetic antibiotics for
killing drug-resistant bacteria have also developed a
better (and smaller) way of getting drugs to a target.
Using nanotechnology - the big science of making small
things - their antibiotics now can ride into bacteria
cells on nano-sized, spherical vehicles one millionth
the size of a pinhead.
"We feel that this technology will afford many benefits
down the road," explains says Edward Turos, a professor
in USF's Department of Chemistry and one of several USF
chemists working in drug discovery as a member of the
Drug Discovery Program at the H. Lee Moffitt Cancer
Center and Research Institute. “For example, patients
battling serious hospital infections may be treated with
much smaller doses of drug, potentially reducing
unwanted side effects, such as toxicity and allergic
responses, as well as the onset of further drug
resistance.”
The new synthetic antibiotics, members of a family of
antibiotics called beta-lactams, of which penicillin is
also a member, uses a new mode of action to stop
methicillin-resistant staph (MRSA) bacteria dead in
their tracks. MRSA bacteria are responsible for most of
the hospital-borne infections becoming resistant to even
the most powerful antibiotics. The new antibiotics
attack these bacteria selectively and with more power
than vancomycin, the drug now used as the last line of
resort for MRSA infections.
"Antibiotic resistance is a huge problem worldwide, and
there has been an alarming increase in antibiotic
resistance just in the past several years," advises
Turos. "What is most important is that this new class of
antibiotics acts particularly well on the nastiest
strains of staph bacteria, for which there may not be
any effective treatment."
After creating the new class of antibiotics, the next
step for the USF team was to develop a second punch - a
tiny drug delivery vehicle that could better carry the
antibiotic to the infection site and deliver less drug
more effectively. Using a process called "microemulsion
polymerization" the team created nano-sized plastic
spheres with drugs chemically bonded to their surface.
The nanoballs allow the drug to be dissolved in water,
dramatically improving performance. The nano-sized
plastic balls are many times smaller than the bacteria
cells and bacteria willingly gobble them up as potential
food. But, once inside the cell, the balls release high
concentrations of the drug where it wreaks havoc on the
internal machinery of the cell.
"The delivery of pharmaceutical agents that are
water-insoluble to targets within the human body has
always been a challenge," says Turos, whose work is
funded by the National Institutes of Health. "Many
potentially valuable drugs that look promising are,
unfortunately, not very soluble in water and their
clinical uses are greatly restricted because they are
unable to get into the bloodstream.”
The new drug delivery vehicles that improve drug
solubility may open the door to revolutionary changes in
medicine, particularly in the detection and treatment of
infectious diseases.
“We hope to soon be able to design and custom-prepare
nano-sized delivery vehicles of different shapes and
sizes and tailor their function to a wide variety of
applications in the biomedical and nanotechnology
fields," concludes Turos.
This story has been adapted from a news release issued
by University Of South Florida, Reported
2003-09-24
- Is There Any Difference in the Clinical Effectiveness
Between Dexamethasone Acetate and Dexamethasone Sodium
Phosphate in Asthma?
Question :
Is there a difference in potency/clinical response to dexamethasone acetate or dexamethasone sodium phosphate
with respect to either one's effect on treatment of
acute asthmatic attack in outpatient settings? In
addition, is there any proven role of nebulized
budesonide for acute asthmatic attack in the emergency
department setting?
Ranjit Shah, MD:
Response from Michael A. Kaliner, MD
Michael A. Kaliner, MD, Professor of Medicine, George
Washington University School of Medicine, Washington,
DC; Section Chief, Allergy, Washington Hospital Center,
Washington, DC.
Dexamethasone is an extremely potent corticosteroid with
many undesirable side effects. Because of its potency
and side-effect profile, I do not recommend its use in
asthma management. Instead, prednisone is an effective
molecule with a much better side-effect profile. If a
patient needs oral corticosteroids for management of
acute disease, I would recommend using prednisone either
2040 mg once daily or 20-30 mg twice daily until the
attack is controlled, along with short-acting
bronchodilators and continued inhaled corticosteroids.
Once the attack is controlled, then a taper of
prednisone is appropriate.
I do not use standardized "dose packs" for any patients,
as each asthma attack requires individualization of the
dose given, the length of the time when corticosteroids
are required, and the speed of the taper. Patients are
much better served with an individual dose regimen than
with a standardized dose pack.
There have been a few studies of the role of inhaled
corticosteroids in acute asthma, and these studies have
generally shown small, but reproducible beneficial
effects.[1-3] Although there are no rigorous studies of
nebulized budesonide, they should be considered for the
management of asthma. Inhaled corticosteroids are
generally effective 4-12 hours after administration, and
studies have shown some benefit. Nebulized budesonide
has proven to be an excellent treatment for a range of
asthmatic patients. Thus, I think that the addition of a
dose of nebulized budesonide in an acute setting
wouldn't hurt, and may help a little. At the very least,
patients would have some corticosteroids in their airway
to influence their asthma the next day, after leaving
the emergency department.
Medscape Allergy & Clinical
Immunology. 2005; 5 (1): ©2005 Medscape
- Dexamethasone sodium phosphate
Generic Name: Dexamethasone sodium phosphate
Product Name: Dexamethasone Sodium Phosphate Injection
USP (DBL)
Indication:
Dexamethasone sodium phosphate is used for the treatment
of adrenal insufficiency, a condition where the adrenal
glands do not produce enough adrenal hormones (cortisol
and aldosterone). It is effective in replacing the
cortisol deficiency, but must be used in combination
with another agent (a mineralocorticoid) to replace the
aldosterone.
Dexamethasone is also useful for the symptomatic
treatment of the following diseases:
- collagen diseases (eg: lupus, polyarteritis nodosa,
giant cell arteritis)
- pulmonary disorders (eg: status asthmaticus, chronic
asthma, sarcoidosis)
- blood disorders (eg: leukaemia, idiopathic
thrombocytopenic purpura, autoimmune haemolytic anaemia)
- rheumatic diseases (eg: rheumatoid arthritis,
osteoarthritis)
- skin diseases (eg: psoriasis, pemphigus, various types
of dermatitis)
- ulcerative colitis
- cerebral oedema
- laryngeal oedema associated with acute non-infective
laryngitis
- eye disorders (eg: allergic conjunctivitis, keratitis,
allergic corneal marginal ulcers, chorioretinitis, optic
neuritis
- neoplastic states (eg: cerebral neoplasms,
hypercalcaemia associated with cancer)
The 120mg/5ml vial of Dexamethasone Sodium Phosphate for
Injection USP is specifically designed for use in shock,
including excessive blood loss during surgery.
Action:
Dexamethasone is a hormone similar to those produced by
the adrenal glands, called glucocorticoids. It is very
powerful, having 25-30 times the activity of
hydrocortisone, another well-known glucocorticoid.
Dexamethasone is used in the treatment of adrenal
insufficiency, where it replaces hormones that are not
being produced for one reason or another. In this
situation, it can be curative. All other uses of
Dexamethasone (antiinflammatory, anti-allergy and
metabolic actions) are for symptom relief and do not aim
to cure disease.
Dose Advice:
Dexamethasone Sodium Phosphate for Injection USP is for
intravenous or intramuscular injection when systemic
effects are required, or intrasynovial or soft tissue
injection for local effects.
IV and IM administration:
- dosage requirement depends on severity and nature of
disease being treated
- doses range from 0.5-24mg daily
- duration of treatment is dependent on clinical
response and dosage should be adjusted to minimum
required as soon as possible
- gradual withdrawal of therapy is necessary
- IV Dexamethasone is generally reserved for patients
who cannot take it orally, or for use in an emergency
situation
Shock:
- usual dose is 2-6mg/kg as a single IV injection,
followed by:
- 3mg/kg/day as continuous infusion
- 120mg/5ml vial may be diluted with sodium chloride or
glucose for intravenous infusion
- solution for infusion should be used as soon as
possible, or stored for no longer than 24 hours at
2-8??C
- high dose therapy should continue only until the
patient is stable (48-72 hours maximum)
Cerebral oedema:
- initial dose of 10mg IV followed by 4mg IM every six
hours
- treatment should continue until signs of oedema
subside (12-24hours)
- reduce dosage after 2-4 days and withdraw over 5-7
days
- 2mg IV or IM 2-3 times daily can be used for
maintenance of patients with cerebral malignancy
Intrasynovial and soft tissue injection:
- dose depends on area and degree of inflammation
- large joints: 2-4mg
- small joints: 800mcg-1mg
- tendon sheaths: 400mcg-1mg
- soft tissue infiltration: 2-6mg
- joints should be injected once every 2-3 weeks while
bursa can be injected once every 3-5 days
Common side effects:
Most side effects associated with Dexamethasone are seen
when high doses are administered for long periods of
time. The following minor effects are seen:
Skin changes:
- thin fragile skin
- increased sweating
- stretch marks
- easy bruising
- increased hair growth
- acne
General effects:
- menstrual irregularities
- muscle weakness
- restlessness
- anxiety
- trouble sleeping
- headache
- increased appetite/weight gain
- hiccups
- nausea and vomiting
- diarrhoea
Uncommon side effects:
The following are some more effects that may be seen
with high dose, long term therapy:
- suppression of natural adrenal hormone secretion
- increased requirements for hypoglycaemic medications
in diabetics
- development of diabetes
- growth suppression in children
- osteoporosis
- muscle and joint problems
- impaired wound healing
- abdominal distension
- ulcerative oesophagitis
- burning or tingling, especially in perineal area
- glaucoma (changes in vision, trouble seeing, eye
discomfort)
- cataracts
- euphoria
- mental disturbance (behaviour changes, unusual
thoughts)
- convulsions
- vertigo
The following are symptoms that may indicate allergy and
should be immediately reported to your doctor:
- allergic dermatitis
- hives
- widespread purple rash
- itching
- swelling in face or hands
- swelling or tingling in mouth or throat
- chest tightness
- trouble breathing
↑Top
-
Prednisone:
Generic Name: Prednisone
Product Name: Sone
Indication:
Prednisolone is used in the following situations:
- Anti-inflammatory treatment in acute attacks of gout;
- rheumatoid arthritis;
- Autoimmune diseases to suppress an overactive immune
system.
Action:
Corticosteroids alter genes within the body's cells to
reduce the body's normal inflammation and immune
responses.
Dose Advice:
Adults:
Autoimmune and inflammatory disease control:
- The initial recommended dose is 1-2 mg per kg per day.
- This dose may then be reduced according to the
patient's clinical response.
Rheumatoid arthritis:
- 5-10 mg once daily.
Acute gout:
- The initial recommended dose is 20-50 mg once daily
for 3-5 days.
- This dose is then reduced gradually over 7-10 days.
Children:
Autoimmune disease:
- The initial recommended dose is 2 mg per kg per day.
- The dose is then reduced over 2 months to the minimum
dose required to sustain remission.
- The chronic use of corticosteroids in children may
retard bone growth and growth and development needs to
be monitored carefully.
Prednisone is safe to used during pregnancy and
breastfeeding.
Common side effects:
- Heartburn
- Increased susceptibility to infections such as thrush
- Masking of signs of infection
- Acne
- Osteoporosis and bone fractures
- Muscle weakness
- Increased appetite
- Delayed healing of wounds
- Thin fragile skin
- Reduced growth in children
- Cessation of menstruation
- Psychotic episodes
- Depression
- Bruising
Uncommon side effects:
- Burning and tingling sensation in the genital area
- Death of bone in the hip, ankle and shoulder
- Fractures of the vertebral bodies
Diseases treated by this drug:
Cerebral Lymphoma
Hypoadrenalism (includes Addison's disease) (Hypoadrenalism
)
- What's Old is New Again - Antibiotic
Protects Nerves By Removing Excess Glutamate:
For release: Monday, February 07, 2005
Overview A new study shows that a common antibiotic used
to treat bacterial infections increases survival rates
and delays nerve damage in a mouse model for amyotrophic
lateral sclerosis (ALS). The antibiotic works by
activating or "turning on" the gene encoding the
glutamate transporter in neurons. This finding may lead
to new drug treatments for ALS and other
neurodegenerative diseases.
A new study shows that a common antibiotic used to treat
bacterial infections increases survival rates and delays
nerve damage in a mouse model for amyotrophic lateral
sclerosis (ALS). The antibiotic works by activating or
"turning on" the gene encoding the glutamate transporter
in neurons. This finding may lead to new drug treatments
for ALS and other neurodegenerative diseases.
Jeffrey Rothstein, M.D., Ph.D., director of the Robert
Packard Center for ALS Research at Johns Hopkins
University in Baltimore, Maryland , and his colleagues
reported the beneficial effects of the antibiotic
ceftriaxone in a mouse animal model of ALS in the
January 6, 2005, issue of Nature.* Ceftriaxone
treatment, started at the onset of the disease in the
mouse model, delayed the loss of neurons and muscle
strength while increasing survival time. The study was
funded in part by the National Institute of Neurological
Disorders and Stroke (NINDS).
The initial focus on antibiotics for ALS resulted from
the NINDS-led Drug Screening Consortium, an effort in
which 27 investigators, including Dr. Rothstein,
screened 1040 existing drugs to assess their potential
to treat a variety of neurodegenerative disorders.
Co-sponsored by The ALS Association and two Huntington's
disease groups, the purpose of this cooperative drug
screening approach was to use rapid technology to find
new uses for existing drugs. Ceftriaxone was one of the
drugs that showed promise for ‘crossing-over' into
neurodegenerative diseases.
The potentially therapeutic properties of ceftriaxone
for ALS have little to do with its antibiotic effects
but instead result from its ability to increase the
number of glutamate transporters. Glutamate transporters
are proteins that vacuum up the excitatory
neurotransmitter glutamate. Normally, glutamate acts to
excite nerves so that electrical signals can travel from
one to the next. Too much glutamate has a toxic effect
on nerve cells and has been implicated in
neurodegenerative diseases such as ALS, Huntington's
disease, Alzheimer's disease, epilepsy and stroke.
Removing glutamate through the transporter prevents
nerve damage caused by excessive amounts of glutamate.
"Increasing the glutamate transporter expression and
removing the excess glutamate is essentially like
turning on a fan to clear a smoke-filled room," says Dr.
Rothstein.
As part of the Drug Screening Consortium, Dr. Rothstein
found that 15 drugs from the penicillin family, named
beta lactams, increased glutamate transport in cultures
of spinal cord slices and therefore increased removal of
this excitatory neurotransmitter. Because this class of
antibiotics can increase removal of excess glutamate,
researchers hypothesized this could lead to better drug
treatment therapies for neurodegenerative disorders like
ALS.
"We're very excited by these drugs' abilities," says Dr.
Rothstein. "These studies show for the first time that
drugs, not just genetic engineering, can increase the
numbers of specific transporters in brain cells. Because
we study ALS, we tested the drugs in a mouse model of
that disease, but this approach could be valuable to
other conditions. It has potential applications in
numerous neurologic and psychiatric conditions that
arise from abnormal control of glutamate."
As a result of these recent findings, the NINDS will
fund a multi-center clinical trial in ALS patients that
is slated to start in spring 2005. The
placebo-controlled clinical trial will determine the
safety and efficacy of long-term ceftriaxone treatment
in patients with ALS. "The discovery of new uses for
antibiotics in ALS validates the drug screening approach
as a rapid and effective method of finding new uses for
existing drugs," says Jill Heemskerk, Ph.D., NINDS'
program director for the screening program. "There are
currently no effective drugs for these diseases, and the
study of compounds identified by this approach will
provide desperately needed inroads into this uncharted
territory," added Dr. Heemskerk.
ALS and other neurodegenerative diseases are currently
poorly understood, lack successful treatments and cause
progressive disability in affected patients. Dr.
Rothstein and others in the field believe that having
the ability to selectively target the glutamate
transporter will be a powerful tool not only for
treating neurodegenerative diseases but also for
developing an important new class of drugs. Since
long-term antibiotic treatment could lead to antibiotic
resistance or toxic side-effects, researchers are
working to develop novel, less toxic drugs that are more
selective in removing excess levels of glutamate. Future
research will also test other beta-lactam antibiotics
that may be more effective. If successful, these drugs
will shed new light on treatments for neurodegenerative
disorders and help to prevent nerve damage and death in
patients.
The NINDS is a component of the National Institutes of
Health within the Department of Health and Human
Services and is the nation's primary supporter of
biomedical research on the brain and nervous system.
References:
*Rothstein JD, Patel S, Regan MR, Haenggel C, Huang YH,
Bergles DE, Jin L, Dykes Hoberg M, Vidensky S, Chung DS,
Vang Toan S, Bruijn LI, Su Z-Z, Gupta P, Fisher PB. "b-Lactam
antibiotics offer neuroprotection by increasing
glutamate transporter expression." Nature, January 6,
2005, Vol. 433, pp.73-77.
**Miller TM, Cleveland DW. "Treating neurodegenerative
disease with antibiotics." Science, January 21, 2005,
Vol. 307, pp. 361-362.
By Michelle D. Jones-London, Ph.D.
Date Last Modified: Wednesday, March 09, 2005
-
Gemfibrozil
-
Gemfibrozil
-
Cefixime
-
Atorvastatin & Gemfibrozil
-
Dexamethasone 1
-
Dexamethasone 2
↑
Top
|
