Archive for March, 2006

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Acne treatment

Friday, March 17th, 2006

Acne treatment should be commenced early as possible to prevent scarring. Patients should be counseled that an improvement may not be seen for at least a couple of months. The choice of treatment depends on whether the acne is predominantly inflammatory or comedonal and its severity.

Mild to moderate acne is generally treated with topical preparations and response most cases. Systemic treatment with oral antibiotics is generally used for moderate to severe acne or where topical preparations are not tolerated or are ineffective or where application to the site is difficult.

Severe acne, acne unresponsive to prolonged courses of oral antibiotics, scarring, or acne associated with psychological problems calls for early referral to a consultant dermatologist who may prescribe isotretinoin for administration by mouth.

   

Tretinoin is  a vitamin A derivative used to treat acne  and its isomer isotretinoin are useful in treating comedonal acne but patients should be warned that some redness and skin peeling might occur initially but settles with time. Several months of treatment may be needed to achieve an optimal response and the treatment should be continued until no new lesions develop.  USE OF THIS MEDICINE IS NOT RECOMMENDED if you have a history of eczema.

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Oral contraceptives pills

Tuesday, March 7th, 2006

Oral contraceptives pills containing an oestrogen and a progestogen are the most effective preparations for general use. These preparation is called combined oral contraceptives.

There are several advantages of combined oral contraceptives over most other contraceptive methods.

Oestrogen and a progestogen preparations are reliable as well as reversible. As an additional advantage they reduced dysmenorrhoea, menorrhagia, premenstrual tension. Combined oral contraceptive also reduced symptoms of fibroids, functional ovarian cysts, risk of ovarian cancer, endometrial cancer and pelvic inflammatory disease.

What to do with missed pill?
The critical time for loss of contraceptive protection is when a pill is omitted at the beginning or end of a cycle. If a woman forgets to take a pill, it should be taken as soon as she remembers, and the next one taken at the normal time. If the delay is 24 hours or longer with any pill (especially the first in the packet) the pill may not work. As soon as she remembers, she should continue taking the pill normally. However, she will not be protected for the next 7 days and must either not have sex or she should use another method of contraception such as a condom. If these 7 days run beyond the end of the packet, the next packet should be started at once, omitting the pill-free interval.
Emergency contraception is recommended if more than 2 combined oral contraceptive tablets are missed from the first 7 tablets in a packet.

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Inhaled corticosteroids in asthma

Saturday, March 4th, 2006
Inhaled corticosteroids are recommended for prophylactic treatment of bronchial asthma if
1. Patients are using a beta2 agonist more than 3 times a week
2. If symptoms disturb sleep more than once a week
3. Patient has suffered exacerbations in the last 2 years requiring a systemic corticosteroid or a nebulised bronchodilator.
Beclometasone dipropionate (beclomethasone dipropionate), budesonide and fluticasone propionate are common inhaled corticosteroids.
  Inhaled corticosteroids have considerably fewer systemic side effects than oral corticosteroids.

Cfc-Free Inhalers

Chlorofluorocarbon (CFC) propellants in pressurised aerosol inhalers are being replaced by hydrofluoroalkane (HFA) propellants. Patients receiving CFC-free inhalers should be reassured about the efficacy of the new inhalers and the aerosol may feel and taste different.

CANDIDIASIS

Candidiasis is reported site effect after inhaled corticosteroids in asthma. It can be reduced by using spacer. Candidiasis responds to antifungal lozenges without discontinuation of therapy—rinsing the mouth with water (or cleaning child’s teeth) after inhalation of a dose may also be helpful.

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DIABETES and INSULIN

Friday, March 3rd, 2006

Insulin is a hormone used to treat diabetes.
The aim of insulin treatment is to achieve the best possible control of blood glucose concentration without making the patient obsessional and to avoid disabling hypoglycaemia. This needs a close co-operation between the patient and the medical team. Good control always reduces the risk of acute problems and help to reduces long term complications. Mixtures of insulin preparations may be required and appropriate combinations have to be determined for the individual patient.

There are 3 main types of insulin preparations:

  • Short duration insulin - a relatively rapid onset of action. (soluble insulin, insulin lispro and insulin aspart)

  • Intermediate action insulin - (isophane insulin and insulin zinc suspension)

  • Long acting insulin - (crystalline insulin zinc suspension)

It is very come these type of insulin use together. It can be combinations like…..

Short-acting insulin mixed with intermediate-acting insulin.
Short-acting insulin -before evening meal.
Intermediate-acting insulin - at bedtime.
Short-acting insulin - three times daily.
Intermediate-acting insulin - at bedtime.
Intermediate-acting insulin with or without short-acting insulin - once daily either before breakfast or at bedtime suffices for some patients with type 2 diabetes who need insulin, sometimes in combination with oral hypoglycaemic drugs.

Additional attension might be needed if you are usuing drug such as dexfenfluramine, fenfluramine, a monoamine oxidase inhibitor (MAOI), salicylates, oral anti-diabetes medicines, or a beta-blocker (propranolol).

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Proton pump inhibitors

Thursday, March 2nd, 2006

The proton pump inhibitors omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole inhibit step in gastric acid production by blocking the hydrogen-potassium adenosine triphosphatase enzyme system or ‘proton pump’ of the gastric parietal cell. Proton pump inhibitors are effective short-term treatments for pepetic ulcers(gastric and duodenal ulcers) they are also used in combination with antibacterials for the eradication of Helicobacter pylori.

Proton pump inhibitors should be used with caution in patients with liver disease , in pregnancy and in breast-feeding.

The most common Side effects are diarrhoea, feeling or being sick, constipation,  abdominal pain and headaches. They can also cause allergic reactions, itching, dizziness, swollen ankles, muscle and joint pain, blurred vision, depression and a dry mouth.

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AMOXICILLIN or Amoxycillin

Thursday, March 2nd, 2006

This medicine is a penicillin group antibiotic used to treat certain bacterial infections.

Better absorbed when given by mouth, producing higher plasma and tissue concentrations. Amoxicillin is used for endocarditis prophylaxis
Some medicines or medical conditions may interact with this medicine. Maculopapular rashes commonly occur with amoxicillin but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; broad-spectrum penicillins should not therefore be used for ‘blind’ treatment of a sore throat. Rashes are also common in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.

Dose

by mouth, 250 mg every 8 hours, doubled in severe infections; child up to 10 years, 125 mg every 8 hours, doubled in severe infections

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