MedicoTips.Com

Patiromer is a relatively new potassium binder and studies showed it is superior to Kayexalate which has been conventionally used to lower potassium in hyperkalemia due to various causes, especially renal failure. Patiromer works by binding to free potassium available the intestine and prevent its absorption into the bloodstream. It releases positive calcium ions which are absorbed instead of potassium if needed. As free potassium readily combines to the Patiromer, thus less potassium is available for absorption, this results in a decrease in potassium blood potassium level. Patiromer is not absorbed by the gut, thus it has no systemic side effects. The side effects are mainly related to the gut. Another advantage of Patiromer over Kayexalate is that it can be given in heart failure, hypertension, and CKD etc. Kayexalate has high sodium content and this can be potentially harmful in case of heart failure, hypertension and even in advanced chronic kidney disease. Anothe...

Azithromycin a widely used broad-spectrum antibiotic used to treat community-acquired pneumonia or respiratory tract infections. It is observed that azithromycin if given with statins, may cause severe rhabdomyolysis which may lead to an acute renal shutdown. A case reported by Dr Gaurav Alreja shows a possible interaction of azithromycin with simvastatin, A 73 years old male who was given azithromycin for bronchitis, he was taking simvastatin. He presented in emergency with the acute weakness of all extremities, he was found to have abnormal renal function tests with elevated creatinine. Simvastatin was stopped, and he was started on supportive management, bicarbonate was replaced, his renal function improved, and two months later he was again started on simvastatin without recurrence of symptoms. This gives us an indication that probably the azithromycin was responsible for the acute severe rhabdomyolysis and resultant acute renal failure when was given along with the statin. So...

Sometimes it becomes difficult to choose a drug in those patients who have multiple co-morbidities. That is are suffering from more than one disease and physician needs to choose a few out of many drugs to avoid drug-drug interactions. Anti-epileptic drugs, or the drugs which are used to treat seizures, do interact with other drugs.  Carbamazepine, phenytoin, phenobarbital, oxcarbazepine, topiramate and primidone are enzyme inducers. Enzyme inducers decrease the efficacy of a drug which is metabolized by the induced enzymes because more concentration of the enzyme will be available and the drug will be quickly metabolized and removed from the system.  Valproic acid, felbamate, rufinamide, and stiripentol, on the other hand, are enzyme inhibitors.  Therefore, we can't give these drugs to a patient who is taking a drug for any medical problem which is metabolized by the liver enzymes (eg cytochrome p450 enzyme system).  The anti-epileptic drugs which are not ...

Brilinta contains Ticagrelor as an active ingredient. It is an antiplatelet drug and works by inhibiting the platelet activation. Inhibition of platelet activation decreases the risk of blood clot formation and thus, cardiovascular problems. Indications of Brilinta (Ticagrelor) Ticagrelor is indicated in ACS (Acute coronary syndrome) that is unstable angina, ST elevation or non ST-elevation myocardial infarction . It has been compared with clopidogrel and it has been observed that Brilinta (Ticagrelor) is more effective in preventing cardiovascular deaths and ischemic stroke . It also prevents stent thrombosis in post-angioplasty patients. Warning and Side effects of Brilinta. Brilinta (Ticagrelor) Shouldn’t be used if a patient has Recently undergone major surgery or had serious trauma or accident. History of intracranial bleed Active bleed (e.g. active peptic ulcer bleed) Severe hepatic impairment Allergy or hypersensitivity to any of its ingredients. Warnings and Side effe...

Hyperthyroidism is a condition in which thyroid gland starts to secrete an increased amount of thyroxine in the blood. This, in turn, produces several effects in the body, including, palpitations, weight loss, increased appetite, heat intolerance, sleeplessness, generalized weakness and abortions. There are various causes that are responsible for this increased production of thyroxine by the thyroid gland. We will not go into this detail in this article but have explained it in a separate article, the link of which is stated below. Thyroid Diseases, an overview Hyperthyroidism in pregnancy should be treated, because it may result in fetal abnormalities. The thyroid hormone T3 and T4 crosses the placenta in small amounts. The amount of diffusion across the placenta decreases with the age of the pregnancy. But still, it may cross in significant amounts. The thyrotropin-releasing hormone and thyroid stimulating immunoglobulins (which are responsible for maternal hyperthyroidism) and be...

Alprazolam is available in the market with the trade names of Xanax, Alp and many others. It belongs to a class of drugs called benzodiazepines. Xanax is generally used to manage anxiety, stress and panic attacks. It shouldn’t be used to treat psychosis. Xanax (alprazolam) should be sold under prescription only. In developed countries, it is strictly sold under prescription but unfortunately, in many developing countries, it is being sold as an over-the-counter drug. A person can get Xanax by asking the medical storekeeper to give him some sleeping pills. He takes them, uses them according to his own wishes and when after some time, one tablet doesn’t work he adds one more. This is a very wrong practice. Alprazolam (Xanax) is not Paracetamol (acetaminophen) that can be used anywhere anytime. Many individuals do not know the proper usage of Xanax (alprazolam). Especially in developing countries where there is a lack of education and also due to the heavy flow of the patients to governme...

Oral contraceptives prevent conception/pregnancy due to their following effects on a woman’s body. 1. Oral contraceptive pills contain Estrogen and a Progestogen. The most commonly used Estrogen in oral contraceptive pills is  Ethinyl Estradiol while the commonly use Progestogens are Norethindrone, Levonorgestrel, Desogestrel and Norgestimate. You can see their names written in the leaflet that is supplied along with the pill pack.  2. Oral contraceptives inhibit ovulation. they inhibit the release of the egg from the ovaries and without the egg, the male sperm can’t produce a baby. Oral contraceptives inhibit ovulation by manipulating the normal hormonal responses and blood level of a female. Hypothalamus secretes a hormone called Gonadotropin-releasing hormone (GnRH). This acts on the anterior pituitary and causes the release of FSH and LH. FSH reaches the ovaries via blood where it causes follicle maturation and development. It also signals the release of Estrogen from...

Hepatotoxicity:- Hepatotoxicity implies chemical-induced liver damage. Drug-induced hepatic injury is the most frequent reason used for the withdrawal from the market of an approved drug, and it also accounts for more than 50 per cent of the cases of acute liver failure in the United States today. More than 75 per cent of cases of idiosyncratic (a dose of a drug induces an unexpected allergic reaction) drug reactions results in liver transplantation or death. Drug Metabolism In Liver: - Biotransformation is the biochemical modification of pharmaceutical substances by living organisms, usually through specialized enzymatic systems, Liver is central to the metabolism of virtually every foreign substance. Most drugs and xenobiotics are lipophilic (lipid soluble) , enabling them to cross the membranes of intestinal cells. (the more a substance is lipophilic more it is diffused)  Drugs are rendered more hydrophilic by biochemical processes in the hepatocyte, yielding water-...

Role of the innate immune system NAPQI induce liver damage trigger activation and inflammatory responses of the innate immune system causing the production of inflammatory mediators, including cytokines, chemokines, and reactive oxygen and nitrogen species that contribute to the progression of liver injury. Some of these mediators, such as IFN-, Fas, or Fas ligand, are directly involved in causing liver damage. Mutant mice lacking these factors are resistant to APAP hepatotoxicity.APAP hepatotoxicity leads to the activation of KC.KC activation results in the release of pro-inflammatory mediators which are TNF( directly induce tissue damage), IL-12 and IL-18, activators of NK and NKT cells. KC may also play a protective role. They are a source of IL-10 and IL-6, important in counteracting inflammatory responses and stimulating liver regeneration. Role Of Adaptive Immune System Clinical Signs: Following are the clinical characteristics which show involvement of the adaptive immune sy...

1. Analgesics Aspirin has recently been recognized as potentially hepatotoxic. Almost all reported cases have occurred in children and young adults with connective tissue disorders such as Still's disease, rheumatoid arthritis and systemic lupus erythematosus, and females have been affected more often than males. Aspirin has been involved in the great majority of cases. About 50 % of patients with juvenile rheumatoid arthritis have evidence of some degree of liver injury as shown by elevation of plasma aminotransferases during conventional high-dosage aspirin therapy. Another drug in this category includes gabapentin which shows hepatotoxicity as one of its side effects. 2. Anti-Tuberculosis Drugs Hepatotoxicity is one of the most important adverse drug reactions associated with anti-tuberculosis drugs that may limit their use. Previous studies showed transient elevations of serum hepatocellular enzymes (e.g. alanine aminotransferase and aspartate aminotransferase) in approxima...

Liver Injury:  Liver injury is defined as rising in either (a) ALT level more than three times of upper limit of normal (ULN) (b) ALP level more than twice ULN (upper limit normal) (c) total bilirubin level more than twice ULN when associated with increased ALT or ALP. Liver damage is further characterized into hepatocellular (predominantly initial Alanine transferase elevation)  cholestatic (initial alkaline phosphatase rise) types. Specific histo-pathological patterns of liver injury from drug-induced damage are discussed below. Zonal Necrosis : This is the most common type of drug-induced liver cell necrosis where the injury is largely confined to a particular zone of the liver lobule. It may manifest as a very high level of ALT and severe disturbance of liver function leading to acute liver failure. Drugs include: Paracetamol, carbon tetrachloride Hepatitis: In this pattern hepatocellular necrosis is associated with infiltration of inflammatory cells. ...