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Monday, March 13, 2017

What Is Smoking Cissation Therapy?

Smoking Cissation Therapy:

NICE released guidance in 2008 on the management of smoking cessation. General points include:

  • Patients should be offered nicotine replacement therapy (NRT), varenicline or bupropion -
  • NICE state that clinicians should not favour one medication over another
  • NRT, varenicline or bupropion should normally be prescribed as part of a commitment to stop smoking on or before a particular date (target stop date)

Saturday, March 11, 2017

Whar are the Drugs Cause Visual Disturbance?

Drugs Causing Visual Disturbance:Cataracts

  • Steroids

Corneal opacities

  • Amiodarone
  • Indomethacin

Optic neuritis

  • Ethambutol
  • Amiodarone
  • Metronidazole

Retinopathy

  • Chloroquine
  • Quinine

Blue tinge in vision

  • Sildinafil (it might also causesnon-arteritic anterior ischemic neuropathy)

Yellow-green tinge


  • Digoxin

Saturday, March 4, 2017

What are the liver diseases caused by drugs?

Drug induced liver diseases are followings:

 

Mainly hepatocellular involvement (hepatitis):

  • Alcohol
  • Amiodarone
  • Anti-tubercular drugs: INH, Rifampicin, Pyrazinamide
  • MAOIs
  • Halothane
  • Methyldopa
  • Paracetamol
  • Sodium Valproate, Phenytoin
  • Statin

Mainly cholestatic change (hepatitis may or may not present)

  • Anabolic Steroids, testosterones
  • Antibiotics: Flucloxacillin, Co-amoxyclav, Erythromycin (erythromycin stearate causes less problem) ,Nitrofurantoin
  • Fibrates
  • Phenothiazine: Chlorpromazine, proclorperazine
  • Nifedipine (rarely)
  • Sulfonylurea

Mainly liver cirrhosis (long term use)

  • Amiodarone
  • Methyldopa
  • Methotrexate

Thursday, March 2, 2017

What are the drugs acts as Cytochrome P450 enzyme inhibitors and inducers?

P450 inhibtor drugs are following: (causing low metabolism of drugs which might cause Toxicity)
  • Acute alcohol intake
  • Allopurinol
  • Amiodarone
  • Cimetidine, omeprazole
  • Dapsone
  • Imidazoles: ketoconazole, fluconazole
  • INH
  • Macrolides [Azithro-Clarithro-Erythromycins(CYP3A4)]
  • Quinolones (ciprofloxacin)
  • QuinupristinSodium valproate
  • Spironolactones
  • SSRIs: fluoxetine, sertraline
  • Grapefruit juice (potent inhibitor of the cytochrome P450 enzyme CYP3A4. It alters metabolism of statins)
  • Protease inhibitors (ndinavir, nelfinavir, ritonavir, saquinavir)
  • Cranberry Juice (inhibitors of P450 enzyme CYP2C9; alter warfarin metabolism)
  • Verapamil

P450 inducer drugs are :


  • Antiepileptics: phenytoin, carbamazepine (note that valporate is an inhibitor)
  • Barbiturates
  • Chronic alcohol intake
  • Griseofulvin
  • Quinidine
  • Rifampicin
  • Smoking (affects CYP1A2, reason why smokers require more aminophylline)
  • St John's Wort
  • Sulfa drugs
  • Tetracycline
  • Nevirapine (NNRTI)

What is autoinduction of carbamazepime? 
 Carbamazepine is an inducer of the P450 system. This in turn increases the metabolism of carbamazepine itself.

Saturday, January 7, 2017

What are the drugs cause pulmonary fibrosis?

What are the drugs cause pulmonary fibrosis?

The Following drugs are responsible for development of pulmonary fibrosis/Lung fibrosis:

  • Cyclophophamide
  • Busulphan
  • Methysergide
  • Amiodarone
  • Methotrexate
  • Nitrofurantoin
  • Minocycline
  • Ethambutal
  • Penicillamine

What are Cyclophosphamide induced lung injuries?

Lungs injury or damage by cyclophosphamide are followings:

It causes mainly two diseases:

1. Cyclophosphamide induced lung fibrosis:

  • Genetic factors play important role in developing fibrosis in lung after exposure to the drug
  • Fibrosis is relentlessly progressive and inevitably turns into terminal respiratory failure.
  • X ray shows reticulo-nodular shadow in upper zone.
  • No effective treatment and no change after cessation of the drug after starting of the disease process

2. Acute pneumonitis due to the drug:

  • It usually present with cough, dyspnea, hypoxia and bilateral nodular opacity in upper zone.
  • It responds to cessation of drug and to corticosteroid therapy.

 

Lung injury takes place due to toxic metabolites of cyclophosphamide. Those are:

  • Hydroxycyclophosphamide
  • Acrolein
  • Phsophoramide mustard