Hypertension

There are five main classes of medicines that are used to lower blood pressure. There are various types and brands of medicine in each class. The following gives a brief overview of each of the classes. However, for detailed information about your own medication you should read the leaflet that comes inside the medicine packet.

 

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors work by reducing the amount of a chemical that you make in your bloodstream, called angiotensin II. This chemical tends to narrow (constrict) blood vessels. Therefore, less of this chemical causes the blood vessels to relax and widen, and so the pressure of blood within the blood vessels is reduced.
There are various types and brands of ACE inhibitors: captopril, cilazapril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, and trandolapril. An ACE inhibitor is particularly useful if you also have heart failure or diabetes. ACE inhibitors should not be taken by people with certain types of kidney problems, people with some types of artery problems, and those who are pregnant. You will need a blood test before starting an ACE inhibitor. This will check that your kidneys are working well. The blood test is repeated within two weeks after starting the medicine, and within two weeks after any increase in dose. Then, a yearly blood test is usual.

 

 

 

 

 

Angiotensin receptor blockers

These medicines are sometimes called angiotensin-II receptor antagonists. There are various types and brands: candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan and valsartan. They work by blocking the effect of angiotensin II on the blood vessel walls. So, they have a similar effect to ACE inhibitors (described above).

 

Calcium-channel blockers

Calcium-channel blockers affect the way calcium is used in the blood vessels and heart muscle. This has a relaxing effect on the blood vessels. Again, there are various types and brands: amlodipine, diltiazem, felodipine, lacidipine, lercanidipine, nicardipine, nifedipine, and verapamil. Calcium-channel blockers can also be used to treat angina.

'Water' tablets (diuretics)

Diuretics work by increasing the amount of salt and fluid that you pass out in your urine. This has some effect on reducing the fluid in the circulation, which reduces blood pressure. They may also have a relaxing effect on the blood vessels, which reduces the pressure within the blood vessels. The most commonly used diuretics to treat high blood pressure (hypertension) in the UK are thiazides or thiazide-like diuretics. Examples are bendroflumethiazide, chlortalidone, cyclopenthiazide, and indapamide. Only a low dose of a diuretic is needed to treat high blood pressure. Therefore, you will not notice much diuretic effect (that is, you will not pass much extra urine). You will need a blood test before starting a diuretic, to check that your kidneys are working well. You should also have a blood test within 4-6 weeks of starting treatment with a diuretic, to check that your blood potassium has not been affected. Then, a yearly blood test is usual.

 

Beta-blockers

Again, there are various types and brands of beta-blockers: acebutolol, atenolol, bisoprolol, metoprolol, oxprenolol, pindolol, propranolol, sotalol, and timolol. They work by slowing the heart rate, and reducing the force of the heart. These actions lower the blood pressure. Beta-blockers are also commonly used to treat angina, and some other conditions. You should not normally take a beta-blocker if you have asthma, chronic obstructive pulmonary disease (COPD), or certain types of heart or blood vessel problems.

ZOGA-100 (Sildnafil Citrate Tablets 100mg)

Indications & Usage:-
Sildenafil is indicated for the treatment of erectile dysfunction. The studies that established benefits demonstrated improvements in success rates for sexual intercourse compare with placebo.

Properties:-
The physiological mechanism of erection of the penis involves release of Nitric Oxide (NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic, guanosine monophosphate (cGMP), producing muscle relaxation in the corpus cavernosum & allowing inflow of blood.
Sildenafil has no direct relaxant effect on isolated human corpus cavernosum, but enhances the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5). which is responsible for degradation of cGMP in the corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by Sildenafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation & inflow of blood to the corpus cavernosum. Sildenafil at recommended doses has no effect in the absence of sexual stimulation.
Studies in vitro have shown that Sildenafil is selective for PDE5. Its effect is more potent on PDE5 than other known phosphodiesterases (>80-fold for PDE1,>1,000-fold for PDE2, PDE3 and PDE4). The approximately 4000-fold selectively for PDE’s versus PDE3 is important because that PDE is involved in control of cardiac contractility, Sildenafil is only about 10-fold as potent for PDE5 compared to PDE6, an emztme found in the retina: this lower selectivity is thought to be the basis for abnormalities related to colour vision observed with higher doses or plasma levels.

Pharmacokinetics & Metabolism:-
Sildenafil is rapidly absorbed, maximum plasma concentrations are reached within 30-120mins. 90mins after dosing, less than 0.001% of the administered dose may appear in the semen of patients.
The major circulating metabolite result from N-desmethylation of Sildenafil and is itself further metabolized. After either oral or intravenous administration, Sildenafil is excreted as metabolites predominantly in the faeces (approximately 80% administered oral dose) & to a lesser extent in the urine (approximately 13% of administered oral dose).

SAPROZOLE {Omeprazole}

INDICATION:

Saprozole is indicated in the treatment of:

Heartburns (Pyrosis)

Stress ulceration

Gastric & duodenal ulcers

Zollinger-Ellison Syndrome

Acid related disorders

Prophylaxis in long-term NSAID therapy and acid aspiration.

Saprozole can prolong the elimination of Diazepam and Phenytoin and other drugs that are metabolised by oxidation in the liver. Monitoring and possible dose reduction is recommended where necessary. No interaction with Theophylline has been reported but interactions with other drugs metabolised via Cytochrome P450 enzyme system (e.g. Warfarin) is possible. No interaction with concomitantly administered antacid has been reported.

ZERAMAX

{Clotrimazole, Betamethasone & Neomycin Sulphate cream}

Anti-fungal, Anti-bacterial and Anti-inflammatory

Clotrimazole is used to treat yeast infections of the vagina, mouth, and skin such as athlete's foot, jock itch, and body ringworm. It can also be used to prevent oral thrush in certain patients.

The primary mechanism of action of clotrimazole is against the division and growing of fungi. Clotrimazole alters the permeability of the fungal cell wall and inhibits the activity of enzymes within the cell. It specifically inhibits the biosynthesis of ergosterol and other sterols required for cell membrane production.

Betamethasone is used to treat the itching, redness, dryness, crusting, scaling, inflammation, and discomfort of various skin conditions.

Betamethasone works by Interfereing with bacterial protein synthesis by binding to 30S ribosomal subunit, causing misreading of genetic code. Inaccurate peptide sequence then forms in protein chain, causing bacterial death.

Neomycin sulfate is a broad-spectrum antibiotic agent effective against gram-negative and gram-positive organisms, prescribed topically to treat skin infections.

Neomycin works by affecting the bacteria's production of certain proteins that are necessary for their survival. It causes the bacteria to produce abnormal and faulty proteins. This ultimately kills the bacteria and clears up the infection.

Pregnancy-associated malaria

Pregnancy-associated malaria (PAM) or placental malaria is a presentation of the common illness that is particularly life threatening to both mother and developing fetus. PAM is caused primarily by infection with Plasmodium falciparum, the most dangerous of the four species of malaria-causing parasites that infect humans. During her first pregnancy,  a woman faces a much higher risk of contracting malaria and of associated complications.

Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus, and the newborn child. Malaria-associated maternal illness and low birth weight is mostly the result of Plasmodium falciparum infection and occurs predominantly in Africa. The symptoms and complications of malaria in pregnancy vary according to malaria transmission intensity in the given geographical area, and the individual’s level of acquired immunity.

WHO recommends the following package of interventions for the prevention and treatment of malaria during pregnancy:

• use of long-lasting insecticidal nets (LLINs);
• in areas of stable malaria transmission of sub-Saharan Africa, intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP);
• prompt diagnosis and effective treatment of malaria infections.

IPTp reduces maternal malaria episodes, maternal anaemia, placental parasitaemia, low birth weight, and neonatal mortality. Furthermore, all pregnant women should receive iron and folic acid supplementation as a part of routine antenatal care.

How to Help Someone Having an Asthma Attack

How to Help Someone Having an Asthma Attack

* During a bout of asthma, patients find it easier to breathe while sitting up than lying down. So help them get into a comfortable sitting position.

* Most asthma patients know what they need to do to deal with an attack. So it is best to ask them. Ask if they have an inhaler and where it is. If they don't have one, ask them if you should call for help.

Many asthma patients carry not only an inhaler, but a written instruction card as well. An asthma attack can temporarily rob the patient of his ability to speak.

In such situations, an instruction card explaining what needs to be done can be invaluable. If there is such a card, just do as it says.

* Help them use the inhaler. An inhaler is designed to deliver a specific dose of asthma medication. The medication relaxes the patient's airways and helps restore normal breathing.

Medication is so important that in case the patient doesn't have his or her inhaler available, most doctors say that it is ok to use someone else's. Nothing else you can do has nearly the same effect as taking the right medication.

In general, you should give two to four puffs of the inhaler and then wait for about five minutes for the next dose.

Position the mouthpiece of the inhaler between the patient's lips. Let him know when you are about to give a puff so that he can breathe in at the same time.

Wait for several seconds before you deliver another puff. Or until he lets you know he is ready for the next one.

You can use a spacer to help the person inhale the medicine over the course of several breaths, instead of one breath. This device sits between the inhaler and the person's mouth and can hold the medicine in place between breaths.

If a spacer is not available, you can make one by rolling up some paper to create a tube.

* Once you've given medication, observe the patient for several minutes. Is it getting easier for him to breathe?

* If it appears that they are not responding to the medication within ten minutes, call an ambulance. And continue to deliver about four puffs of medication every five minutes while waiting for the ambulance.

The medication will help prevent the asthma attack from getting worse even if it doesn't seem to provide immediate relief.

* Stay calm throughout the episode. This will help the patient remain calm as well. If he panics, it will worsen the asthma attack and make it far more difficult for him to breathe.

So talk to him calmly, to reinforce the feeling that everything is under control. This is vitally important.

Being aware of these asthma treatment basics will help you deal effectively with many emergency situations.

How Is Smoking Related to Diabetes?

Diabetes is a group of diseases in which blood sugar levels are higher than normal. Most of the food a person eats is turned into glucose (a kind of sugar) for the body’s cells to use for energy. The pancreas, an organ near the stomach, makes a chemical called insulin that helps glucose get into the body’s cells. When you have diabetes, your body either doesn't make enough insulin or can't use the insulin very well. Less glucose gets into the cells and instead builds up in the blood.

There are different types of diabetes. Type 2 is the most common kind of diabetes in adults and accounts for about 90–95% of all diagnosed cases. Fewer people have type 1 diabetes, which most often develops in children, adolescents, or young adults.

Type 1 diabetes used to be called juvenile-onset diabetes. It is usually caused by an auto-immune reaction where the body’s defence system attacks the cells that produce insulin. The reason this occurs is not fully understood. People with type 1 diabetes produce very little or no insulin. The disease may affect people of any age, but usually develops in children or young adults. People with this form of diabetes need injections of insulin every day in order to control the levels of glucose in their blood. If people with type 1 diabetes do not have access to insulin, they will die.

Type 2 diabetes used to be called non-insulin dependent diabetes or adult-onset diabetes, and accounts for at least 90% of all cases of diabetes. It is characterised by insulin resistance and relative insulin deficiency, either or both of which may be present at the time diabetes is diagnosed. The diagnosis of type 2 diabetes can occur at any age. Type 2 diabetes may remain undetected for many years and the diagnosis is often made when a complication appears or a routine blood or urine glucose test is done. It is often, but not always, associated with overweight or obesity, which itself can cause insulin resistance and lead to high blood glucose levels. People with type 2 diabetes can often initially manage their condition through exercise and diet. However, over time most people will require oral drugs and or insulin.

How Is Smoking Related to Diabetes?
Smoking increases your chance of having type 2 diabetes. No matter what type of diabetes you have, smoking makes your diabetes harder to control.
For example, smoking as well as use of other tobacco products (such as snuff) can interfere with how your insulin works (a situation called "insulin resistance"). Snuff is finely ground tobacco that can be dry, moist, or in tea bag-like pouches.
If you have diabetes and you smoke, you are more likely to have serious health problems from diabetes. Smokers with diabetes have higher risks for serious complications, including:
• Heart and kidney disease
• Poor blood flow in the legs and feet that can lead to foot infections, ulcers, and possible amputation (removal of a body part by surgery, such as toes or feet)
• Retinopathy (an eye disease that can cause blindness)
• Peripheral neuropathy (damaged nerves to the arms and legs that causes numbness, pain, weakness, and poor coordination)
If you are a smoker with diabetes and decide to quit smoking or using any type of tobacco product, the health benefits begin right away. People with diabetes who quit have better control of their blood sugar levels. Studies have shown that insulin resistance can start to decrease 8 weeks after quitting. And recovery from surgery can happen faster.