Learn a Drug a Day - Calcium acetate

Drug for today is calcium acetate.
What is calcium acetate indicated for?
INDICATIONS : 

• It is indicated for the control of hyperphosphatemia in end stage renal failure and does not promote aluminum absorption.
• It is used to prevent high blood phosphate levels in patients who are on dialysis due to severe kidney disease. Dialysis removes some phosphate from your blood, but it is difficult to remove enough to keep your phosphate levels balanced. Decreasing blood phosphate levels can help keep your bones strong, prevent unsafe buildup of minerals in your body, and possibly decrease the risk of heart disease and strokes that can result from high phosphate levels. 

How does calcium acetate work?
MECHANISMS OF ACTION : 
It works by : -

• inducing reduction in the dietary intake of phosphate. 
• inhibition of absorption of phosphate in the intestine with phosphate binders.
• removal of phosphate from the body by more efficient methods of dialysis.

How is calcium acetate taken?

ROUTE OF ADMINISTRATION : 

• It is taken orally as tablets. 

Dosage - Click here~ 

                       

Is there any contraindication?

CONTRAINDICATIONS : 

• It is contraindicated in patients with hypercalcemia.

Are there any possible side effects?
SIDE EFFECTS : 

• Nausea.
• Hypercalcemia. Mild hypercalcemia (Ca> 10.5mg/dl) may be asymptomatic or manifest itself as constipation, anorexia, nausea and vomiting. More severe hypercalcemia (Ca> 12mg/dl) is associated with confusion, delirium, stupor and coma. 
• Mild hypercalcemia is easily controlled by reducing the calcium acetate dose or temporarily discontinuing therapy. Severe hypercalcemia can be treated by acute hemodialysis and discontinuing calcium acetate therapy.
• Decreasing dialysate calcium concentration could reduce the incidence and severity of calcium acetate induced hypercalcemia. 
• Isolated cases of pruritus(itchiness) have been reported which may represent allergic reactions.

What precautions are necessary?

PRECAUTIONS :  

• Excessive dosage of calcium acetate induces hypercalcemia. Therefore, early in the treatment during dosage adjustment serum calcium should be determined twice weekly. Should hypercalcemia develop, the dosage should be reduced or the treatment discontinued immediately depending on the severity of hypercalcemia.
• Calcium acetate should not be given to patients on digitalis, because hypercalcemia may precipitate cardiac arrhythmias.
• Calcium acetate therapy should always be started at low dose and should not be increased without careful monitoring of serum calcium. An estimate of daily dietary calcium intake should be made initially and the intake adjusted as needed. 
• Serum phosphorus should also be determined periodically.
• The patient should be informed : 
• (i)   about compliance with dosage instructions, adherence to instructions
• (ii)  about diet and avoidance of the use of nonprescription antacids. 
• (iii) about the symptoms of hypercalcemia.

DRUG INTERACTION : 

• Calcium acetate may decrease the bioavailability of tetracyclines.

Pregnancy and breastfeeding:  

• Animal reproduction 
• studies have not been conducted with calcium acetate. It is also not known 
whether calcium acetate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Calcium acetate should be given to a pregnant woman only if clearly needed. 
• It is not known whether this drug is excreted in human milk. As a general rule, nursing should not be undertaken while the patient is on calcium acetate since it may be excreted in human milk.

WARNING : 

• Patients with end stage renal failure may develop hypercalcemia when given calcium with meals. 
• No other calcium supplements should be given concurrently with calcium acetate.
• Progressive hypercalcemia due to overdose of calcium acetate may be severe as to require emergency measures. 
• Chronic hypercalcemia may lead to vascular calcification, and other soft-tissue calcification. The serum calcium level should be monitored twice weekly during the early dose adjustment period. 
• The serum calcium times phosphate (CaXP) product should not be allowed to exceed 66. 
• Radiographic evaluation of suspect anatomical region may be helpful in early detection of soft-tissue calcification. 

References :  

1. Calcium acetate by Nabi Biopharmaceuticals.

2. Calcium acetate by MedicineNet.com.

3. Calcium acetate by MIMS Malaysia. 

Learn a Drug a Day - Dobutamine

Today's drug is dobutamine.

Drug which you might familiar with its name but do you know about its indications?
INDICATIONS : 

• It is a cardiac drug.
• Positive inotrope (affects the force with which the heart muscle contracts) used in cardiovascular decompensation secondary to loss of ventricular contractility as in CHF(Congestive heart failure) or after cardiac surgery.
• Positive inotrope used in CHF patients after acute myocardial infarction. 

How does dobutamine work? 

MECHANISMS OF ACTION : 

• Dobutamine belongs to the catecholamine family and is a beta-adrenergic agonist. 
• Dobutamine directly stimulate beta-1 receptors exerting a positive inotropic effect on the myocardium resulting in increased cardiac output due to improved myocardial contractility.

PHARMACOKINETICS : 

• Onset of Action        : 1-2 mins
• Duration of Action    : 5-6 mins

How is dobutamine taken?
ROUTE OF ADMINISTRATION : 

• For IV(intravenous) use only.

Is there any contraindication?

CONTRAINDICATIONS : 

• It is contraindicated in patients with Idiopathic Hypertophic Subaortic Stenosis (IHSS - a disease characterized by marked hypertrophy of the left ventricle, involving in particular the interventricular septum and the left ventricular outflow tract.).

Are there any possible side effects?

SIDE EFFECTS : 

• Tachyarrhythmias- any disturbance of the heart rhythm in which the heart rate is abnormally increased. (atrial fibrillation patients are at increased risk), ectopy.
• Hypertension. Patients with pre-existing hypertension may show exaggerated pressor responses.
• Angina, chest discomfort, and palpitations.
• Non-cardiac related adverse effects: nausea, vomiting, paresthesias, dyspnea, headache, mild leg cramps, nervousness, and fatigue.
• Mild local pain and irritation if extravasation occurs. Infiltration can be treated with Phentolamine injection. 5 to 10 mg of phentolamine is injected subcutaneously in a pin-wheel fashion surrounding the area of infiltration. This will avoid dermal necrosis/sloughing.
• Rare hypovolemia.

What precautions are necessary? 

PRECAUTIONS : 

• During the administration of dobutamine, as with any adrenergic agent, ECG and blood pressure should be continuously monitored. In addition, pulmonary wedge pressure and cardiac output should be monitored whenever possible to aid in the safe and effective infusion of dobutamine.
• Hypovolemia should be corrected with suit-able volume expanders before treatment with dobutamine is instituted.
• No improvement may be observed in the presence of marked mechanical obstruction, such as severe valvular aortic stenosis.

DRUG INTERACTIONS : 

• Alkaline solutions, e.g. sodium bicarbonate, inactivate dobutamine.
• Anesthetics such as halothane and cyclopropane may sensitize the heart to the effects of dobutamine resulting in ventricular arrhythmias.
• Concomitant use of dobutamine and nitroprusside results in a higher cardiac output and usually lower pulmonary capillary wedge pressure(PCWP) than with either agent alone.
• Increased vasopressor effect of dobutamine when used with bretylium, guanethidine, oxytocic drugs or TCAs (tricyclic antidepresssants).

Pregnancy and breastfeeding:  

• Reproduction studies performed in rats at doses up to the normal human dose (10 mcg/kg/min for 24 h, total daily dose of 14.4 mg/kg), and in rabbits at doses up to twice the normal human dose, have revealed no evidence of harm to the fetus due to dobutamine. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
• It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when dobutamine is administered to a nursing woman. If a mother requires dobutamine treatment, breastfeeding should be discontinued for the duration of the treatment.

References : 

1. Dobutamine by ANNE ARUNDEL MEDICAL CENTER.

2. Dobutamine by RxList.

3. Dobutamine by MIMS Malaysia.

Learn a Drug a Day - Bumetanide

Sorry. It's a bit late posting today's drug - bumetanide.

What is bumetanide?
INDICATIONS : 

• It is indicated for the treatment of edema associated with congestive heart failure, hepatic and renal disease, including the nephrotic syndrome.
• It is also used to controls high blood pressure but does not cure it. 

How does bumetanide work?
MECHANISMS OF ACTION : 

• It is a loop diuretic with a rapid onset and short duration of action.
• It causes the kidneys to get rid of unneeded water and salt from the body into the urine. 
• It inhibits sodium reabsorption in the ascending limb of the loop of Henle during hydration and hydropenia.  
• It blocks chloride reabsorption in the ascending limb of the loop of Henle.
• It is somewhat more chloruretic than natriuretic. 
• Potassium excretion is also increased by bumetanide, in a dose-related fashion. 

How is bumetanide taken?
ROUTE OF ADMINISTRATION : 

• It can be administered orally and parenterally (intravenous or intramascular).
• However, it is only administered parenterally to patients in whom gastrointestinal absorption may be impaired or in whom oral administration is not practical. Parenteral treatment should be terminated and oral treatment instituted as soon as possible.

Is there any contraindication?
CONTRAINDICATIONS : 

• It is contraindicated in anuria ( passage of less than 50 ml of urine in a day, often caused by failure in the function of kidneys. ).  
• Although bumetanide can be used to induce diuresis in renal insufficiency, any marked increase in blood urea nitrogen or creatinine, or the development of oliguria during therapy of patients with progressive renal disease, is an indication for discontinuation of treatment with bumetanide.  
• It is also contraindicated in patients in hepatic coma or in states of severe electrolyte depletion until the condition is improved or corrected.  
• It is contraindicated in patients hypersensitive to this drug.

Are there any possible side effects?
SIDE EFFECTS : 
(i) Most common possible side effects : 

• muscle cramps 
• dizziness
• hypotension
• headache 
• nausea 
• encephalopathy (in patients with preexisting liver disease) 
• serious skin reactions (i.e., Stevens-Johnson syndrome, toxic epidermal necrolysis) 

(ii) Less common possible side effects : 

• impaired hearing
• itchiness
• electrocardiogram changes 
• weakness
• hives
• abdominal pain 
• arthritic pain 
• musculoskeletal pain 
• rash 
• vomiting 

What precautions are necessary?
PRECAUTIONS :  


Drug Interactions : 

(i) Drugs With Ototoxic Potential ( damage to the ear, specifically the cochlea or auditory nerve and sometimes the vestibular system)
    - Especially in the presence of impaired renal function, the use of parenterally administered bumetanide in  patients to whom aminoglycoside antibiotics are also being given should be avoided, except in life-threatening conditions.

(ii) Drugs With Nephrotoxic Potential 
     - There has been no experience with the concurrent use of bumetanide with drugs known to have a nephrotoxic potential.  Therefore, the simultaneous administration of these drugs should be avoided.

(iii) Lithium 
      - Lithium should generally not be given with diuretics because they reduce its renal clearance and add a high risk of lithium toxicity.

(iv) Probenecid 
      - Pretreatment with probenecid reduces both the natriuresis and hyperreninemia produced by  bumetanide. This antagonistic effect of probenecid on bumetanide natriuresis is not due to a direct action on sodium excretion but is probably secondary to its inhibitory effect on renal tubular secretion of bumetanide. Thus, probenecid should not be administered concurrently with bumetanide.

(v) Indomethacin 
     - Indomethacin blunts the increases in urine volume and sodium excretion seen during bumetanide treatment and inhibits the bumetanide-induced increase in plasma renin activity. Concurrent therapy with bumetanide is thus not recommended.

(vi) Antihypertensives
      - Bumetanide may potentiate the effect of various antihypertensive drugs, necessitating a reduction in the dosage of these drugs.

Pregnancy and breastfeeding:   

• There are no adequate and well-controlled studies in pregnant women.  A small investigational experience in the United States and marketing experience in other countries to date have not indicated any evidence of adverse effects on the fetus, but these data do not rule out the possibility of harmful effects. Bumetanide should be given to a pregnant woman only if the potential benefit justifies the potential risk to the fetus. 
• It is not known whether this drug is excreted in human milk. As a general rule, nursing should not be undertaken while the patient is on bumetanide since it may be excreted in human milk.

WARNING :

Bumetanide is a potent diuretic which,  if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required, and dose and dosage schedule have to be adjusted to the individual patient's needs.

References : 
1. Bumetanide by Validus Pharmaceuticals LLC 
2. Bumetanide by Medline Plus

Learn a Drug a Day - Colchicine

Today's drug is colchicine.

First of all, what is colchicine?
INDICATIONS : 

• Colchicine is an anti-gout agent.
• It is specifically indicated for treatment and relief of pain in attacks of acute gouty arthritis. ( sudden,  severe pain in one or more joints caused by abnormally high levels of uric acid in the blood)
• It is also used to treat familial Mediterranean fever (FMF; an inborn condition that causes episodes of fever, pain, and swelling of the stomach area, lungs, and joints) in adults and children 4 years of age and older. 
• It is not a pain reliever and cannot be used to treat pain that is not caused by gout or FMF.
• It is also used as prophylaxis to prevent attacks of gout.

How does colchicine work? 

MECHANISMS OF ACTION : 

• it exerts its effect by reducing the inflammatory response to the deposited urate crystals and also by diminishing phagocytosis in joints. It inhibits lactic acid production by leucocytes, thereby interrupting urate deposition and inflammatory response that sustains the acute gout attack and therefore helps to reduce pain and tenderness.

How is colchicine taken? 

ROUTE OF ADMINISTRATION : 

• It is taken orally as tablets. 
• It should be taken with or after food to reduce stomach upset. 
• It should also be taken with plenty of water.  
• Grapefruit or grapefruit juice should not be taken during treatment with colchicine.

( I'm not including dosage here because i think dosage varies from situation to situation and it's very confusing. And i think even if i included here, most of you would just ignore as we're not ready to memorize all the dosages! xD haha! but i heard senior said that we need to memorize all the dosage exactly in coming semesters!! GOOD LUCK to all of us... xD For those who are interested in dosages, you can go this link. )

Are there any possible side effects?

SIDE EFFECTS : 

(i) Most common possible side effects: 

• Nausea, vomiting, stomach pain and diarrhoea. These may be reduced if colchicine is taken with food, before bed or by eating little and often. If patient is sick, suggest them sticking to simple foods such as dry toast, and drink plenty of liquid. If patient experiences nausea, vomiting or diarrhoea during treatment for an acute attack, ask he/she to stop taking the medicine.
• Loss of appetite. 
• Patients older than 65 may be at increased risk of gastrointestinal bleeding.  

(ii) Less common or rare possible side effects: 

There are some rare but potentially serious side effects with colchicines. If patient experiences any of 

these side effects, refer he/she to doctor straight away.  

• Skin rash, fever or hair loss.    
• Severe diarrhoea with bloody or black tarry stools. 
• Difficulty in passing urine or blood in urine. 
• Confusion or convulsions. 
• Numbness or weakness in the fingers and toes.
• Bleeding, mouth ulcers or infection associated with low blood cell counts. This is more likely when colchicine is taken in high doses for acute gout or taken for a long time. 

Other rare side effects include headache, dizziness, difficulty sleeping, seizures, tremor, 

shortness of breath and muscle weakness.  

Very rarely, death has occurred when colchicine has been taken in overdose.

(iii) Long term possible side effects: 

• Muscle inflammation may occur and is more common in people with reduced kidney or liver function taking long term colchicine.

What precautions are necessary? 

PRECAUTIONS : 

Ask patients if they have : 

(i) Ulcers or serious gastrointestinal conditions. 

(ii) Kidney and liver diseases.

     - Colchicine should be used with caution if kidney or liver function is significantly reduced. 

(iii) taking other medicines, such as :  

• cyclosporin – this is a medicine used to suppress the immune system
• erythromycin – this is an antibiotic used to treat bacterial infection; 
• clarithromycin – this is an antibiotic used to treat bacterial infection. It can be used to treat Helicobacter pylori, which is the bacteria that can cause stomach ulcers.

 - Colchicine should be used carefully if taken at the same time as: 

• acidifying and alkalinising agents, such as ammonium chloride, ascorbic acid (vitamin C) or sodium bicarbonate
• verapamil, diltiazem and amiodarone
• anti-fungal treatments such as ketoconazole
• medicines to help to sleep
• anticoagulants such as warfarin
• antithyroid medicines

- Aspirin can be used safely in the low doses taken for prevention of heart attack and 

stroke. Patient with gout should avoid taking aspirin in all other circumstance as at 

higher doses it can raise the uric acid level.   

- Colchicine can usually be taken safely with anti-inflammatory drugs (NSAIDs), as long 

as patient's kidney function is reasonably normal. 

- The simple pain reliever, paracetamol, and combined medicines such as Panadeine and Panadeine Forte, can be used while taking colchicine provided patient take them as directed. 

More drug interaction of colchicine ---> click Mee! 

Alcohol:   

•  Alcohol can trigger an attack of gout.  When taking colchicine, keep alcohol intake to a minimum i.e. 1-2 standard drinks, once or twice a week.  Drinking a lot (more than 6-8 standard drinks) on one occasion, even if infrequently, is strongly discouraged.  In some cases total abstinence from alcohol is recommended.  
• In addition to alcohol, other things that may trigger an acute gout attack include dehydration, diuretics and stopping colchicine treatment.

Pregnancy and breastfeeding:   

• Colchicine is not often used by women who may wish to get pregnant.  The effects of colchicine during pregnancy have not been well studied, so it is not clear if colchicine causes birth defects. 
•  If patient is pregnant or is considering having a child, she should discuss this with her doctor before beginning this medication.

Okie.. done with today's chochicine.. =) 

Please kindly drop some comments if u think there's something to be added or somewhere to be improved. Ur comments are much appreciated.. Thank you! 

References : 

1. Colchicine by Australian Rheumatology Association.

2. Colchicine by Medline Plus.

3. Colchicine by MIMS Malaysia. 

Learn A Drug A Day

Being a pharmacy student, we should start learning about drug, their indication, side effects, etc day by day instead of learning or memorizing them in one shot as told by Ms.Saras. Seriously, there is no extra free time for us (or i should say just me xD) to learn about them during our semester, when so many reports, assignments, quizzes are going on. 

Thus, i think it's best to learn them during holidays when i finally have so much free time. x) 

So, now i would like to introduce you all < Learn A Drug A Day> in my blog..

I would start posting a drug and its related information such as indication, side effects, etc everyday if possible xD 

Hey, friends and all the pharmacy students out there, let's learn a drug a day together with me! x) 

死傻婆!

11/5/2012

考完试的第二天~

就和我的傻婆

疯狂购物去~

我们差不多半年不见了~

也幸好我考完试了~

才能见这傻婆一面

在她去新加坡之前

和她逛最后一次街！

要和谢谢她

其实主要是我有很多东西买

她是陪我逛、买和给我意见的~

还请了我吃早餐和蛋糕！

以后我工作了，一定会请回你的！

当天我们聊得超多东西

总是有聊不完的话题

我们逛了一整个下午

都快累死了

还好要买的东西都买完~

算Mission Completed x) 

逛完了我们又到会Sg.Wang吃千层蛋糕

和上次一样 xD 

哈哈~看样子很好吃

其实吃起来没有很好吃啦~

xP 

吃饱了

我们还在那里自拍等我们的男友到 

自拍的时候

超搞笑的咯！ 

哈哈~

但至少为我们留下了很多美好好笑的回忆~

虽然没有Post 在FB album

其实我也很稀饭这张

看我美丽的傻婆 

To ：Annie Sha Po

傻婆，是我们称号对方的方法

被你叫傻婆一点也不生气

叫你傻婆也是一点也不奇怪

xD

不懂为什么我的好姐妹都要到新加坡去发展

我老婆去了

现在到你 

说真的

真的超级无敌不舍得你！

你真的是我最最最好的Shopping Kaki !!

每次和你逛街都超开心！

买超多东西~

而且要买的东西一定会买到！

你总是会给我意见~

帮我挑选~

真的很喜欢和你逛街！

没想到这次是第二次

也是最后一次了~

（在KL啦！）

你去新加坡了

我们就没什么机会一起逛街了~！

啊~好失望哦！

傻婆，和你相处是非常开心的事

我们什么都说

总是有很多话题

在NS Camp 里面一样

出来了也一样

很怀念我们在NS Camp一起生活

一起共万难

互相照顾的日子

真的很谢谢你在Camp 里面一路来的照顾

就像我大姐姐般

提醒我这个那个

记得我们一起刷牙

一起包着Sarong洗澡

一起泡杯面

一起泡蘑菇汤

一起烫衣服

一起睡觉

一起看杂志

一起聊天日子~

全部的全部都是我们美好的回忆

是你让我在NS的日子

过得一点也不孤单

是你让我在NS的日子

充满了色彩！ 

你是其中一个让我没后悔去NS的理由~

能认识到你这么一个好姐妹

真的很感激~ 

真的是我们的缘分！

虽然我开学了

都超忙

我们几乎没什么联络

但是你还是记得我的生日

为我准备了礼物

还为我设计了生日卡

真的让我非常感动！

虽然少联络

但我们一见面

还是有聊不完的话题

一点也没有生疏过~！

这就是所谓的好姐妹~

在这茫茫人海中

要找一个志同道合又合得来的朋友

不容易~

很感谢上天让我认识了你这个傻婆好姐妹！

*huG* 

虽然很舍不得你去新加坡

虽然很不想你去

但是还是会祝福你的 =) 

去了新加坡

虽然我们没什么机会见面

但绝对不能忘了我！

永远要想念我这个好姐妹

oK? 

我们一定要保持联络~

真的不想失去一个想你那么好的姐妹！

你有机会再上来KL

一定要找我出来！

我有机会去新加坡

也一定会去找你！

去到新加坡

要好好照顾自己！

也希望你和你的老公要一直幸福下去！

傻婆，真的很爱你！

* Ji Mui FOREVER *

Birthday Celebration Replacement Dinner

20/11/2011

两个2011的日子~
和底儿约会去~
=D
其实是补回我生日的晚餐
^^

我们去了The Garden~
先去吃了Snowflake
最爱taroball 了~
Wee~ =D

之后就去会The Garden看戏~
看了~

哈哈~原本是24号才上映的~
不懂为什么有几场~
我们就去看了~
我们看Premium Class de~

不错~
蛮好笑的~
这个可爱搞笑的猫猫~
就像我的Dear~
咔咔！

看完戏就去吃晚餐了 =)
去了Alexis~
Dear 说Derrick 说这里的Steak不错喔~
但是都不管我事~
我都不吃牛肉！
咔咔 xD

Drinks
Strawberry Milkshake & Apple Juice

Starter
Deep Fried Calamari Ring
Like!
Nice =D

Main Course
Mine
Roast Terragon Chicken
Not bad~

Dear's
I Dunno how it tastes like...
as i don't eat steak...
i just ate the french fried..
LOL xD

Dessert
Tiramisu
Different style from the ordinary tiramisu~
Kind of special~
it doesn't really taste bitter ~
it has cheese within summore~
It tastes nice for me =)

It's end of our date after the dinner
=D

哈哈~很Rojak下咯~
又英文又华语 xD

好啦~想说~
很久没有和底儿约会了~
至从开学底儿又工作了~
我们就很少时间了~
还好现在假期~
终于有空~
又可以尽情地玩了！
开心^^
底儿~十二月我们要常去约会哦！
咔咔 xD

谢谢底儿今天的晚餐和电影哦~
爱你 :P