Pharmacy and Medicine

The physician analyzes the patient's migraine history to devise an appropriate treatment program. The goals of treatment are to prevent or reduce the number of migraines (called prophylactic treatment) and to alleviate symptoms and shorten the duration of the migraine (called abortive treatment).
Prophylactic Treatment:
*Preventative medication may be prescribed for patients who have frequent headaches (3 or more a month) that do not respond to abortive treatment. Studies have shown that as many as 40% of these patients may benefit from preventative treatment.
*Using one medication (monotherapy) is tried first, but a combination of medicines may be necessary. Many of these medications have adverse side effects. If migraines become controlled, the dosage is often reduced or the drug discontinued.
*Beta blockers (e.g., propranolol [Inderal®], atenolol [Tenormin®]) are the preferred medications. These drugs produce an effect on heart rate. They should not be taken by patients with asthma and should be used with caution in patients with diabetes.
*Side effects include gastrointestinal upset, insomnia, low blood pressure (hypotension), slowed heart rate (bradycardia), and sexual dysfunction. Some beta blockers pass into breast milk and may cause problems in nursing infants.
*Antiseizure drugs such as valproic acid (Depakote®), topiramate (Topamax®), and gabapentin (Neurontin®) may be used to treat migraine.
*Side effects include nausea, gastrointestinal upset, sedation, liver damage, and tremors.
*Calcium channel blockers (e.g., verapamil, amlodipine [Norvasc®]) inhibit artery dilation and block the release of serotonin. They should not be taken by patients with heart failure or heart block.
*Side effects include constipation, flushing, low blood pressure, rash, and nausea.
*Tricyclic antidepressants (TCAs; e.g., amitryptaline [Elavil®], nortryptaline [Pamelor®], desipramine [Norpramin®]) block serotonin reabsorption and take 2–3 weeks be effective.
*Side effects include the following:
* Constipation
* Dry mouth
* Low blood pressure (hypotension)
* Increased heart rate (tachycardia)
* Urinary retention

Overview:
A migraine headache is a throbbing or pulsating headache that is often one sided (unilateral) and associated with nausea; vomiting; sensitivity to light, sound, and smells; sleep disruption; and depression. Attacks are often recurrent and tend to become less severe as the migraine sufferer ages.
Types:
Migraines are classified according to the symptoms they produce. The two most common types are migraine with aura and migraine without aura. Less common types include the following:
* Abdominal migraine
* Basilar artery migraine
* Carotidynia
* Headache-free migraine (auro without migraine)
* Ophthalmoplegic migraine/Ocular migraine
* Status migrainosus
*Some women experience migraine headaches just prior to or during menstruation. These headaches, which are called menstrual migraines, may be related to hormonal changes and often do not occur or lessen during pregnancy. Other women develop migraines for the first time during pregnancy or after menopause.
*Migraine with aura is characterized by a neurological phenomenon (aura) that is experienced 10 to 30 minutes before the headache. Most auras are visual and are described as bright shimmering lights around objects or at the edges of the field of vision (called scintillating scotomas) or zigzag lines, castles (teichopsia), wavy images, or hallucinations. Others experience temporary vision loss. Nonvisual auras include motor weakness, speech or language abnormalities, dizziness, vertigo, and tingling or numbness (parasthesia) of the face, tongue, or extremities.
*Migraine without aura is the most prevalent type and may occur on one or both sides (bilateral) of the head. Tiredness or mood changes may be experienced the day before the headache. Nausea, vomiting, and sensitivity to light (photophobia) often accompany migraine without aura.
Abdominal migraine is most common in children with a family history of migraine. Symptoms include abdominal pain without a gastrointestinal cause (may last up to 72 hours), nausea, vomiting, and flushing or paleness (pallor). Children who have abdominal migraine often develop typical migraine as they age.
*Basilar artery migraine involves a disturbance of the basilar artery in the brainstem. Symptoms include severe headache, vertigo, double vision, slurred speech, and poor muscle coordination. This type occurs primarily in young people.
*Carotidynia, also called lower-half headache or facial migraine, produces deep, dull, aching, and sometimes piercing pain in the jaw or neck. There is usually tenderness and swelling over the carotid artery in the neck. Episodes can occur several times weekly and last a few minutes to hours. This type occurs more commonly in older people. Doppler ultrasound studies of the carotid arteries are normal.
*Headache-free migraine is characterized by the presence of aura without headache. This occurs in patients with a history of migraine with aura.
*Ophthalmoplegic migraine begins with a headache felt in the eye and is accompanied by vomiting. As the headache progresses, the eyelid droops (ptosis) and nerves responsible for eye movement become paralyzed. Ptosis may persist for days or weeks.
*Status migraine is a rare type involving intense pain that usually lasts longer than 72 hours. The patient may require hospitalization.
Incidence and Prevalence:
Migraines afflict about 30 million people in the United States. They may occur at any age, but usually begin between the ages of 10 and 40 and diminish after age 50. Some people experience several migraines a month, while others have only a few migraines throughout their lifetime. Approximately 75% of migraine sufferers are women.
Migraine Causes:
The cause of migraine is unknown. The condition may result from a series of reactions in the central nervous system caused by changes in the body or in the environment. There is often a family history of the disorder, suggesting that migraine sufferers may inherit sensitivity to triggers that produce inflammation in the blood vessels and nerves around the brain and scalp, causing pain.
Triggers:
A trigger is any stimulus that initiates a process or reaction. Commonly identified migraine triggers include the following:
* Alcohol (e.g., red wine)
* Environmental factors (e.g., weather, altitude, time zone changes)
* Exertion
* Foods that contain caffeine (e.g., coffee, chocolate), monosodium glutamate (MSG; used to enhance flavor in several processed foods and in Chinese food), and nitrates (found in processed foods, hot dogs)
* Glare, contrasting patterns
* Hormonal changes in women
* Hunger
* Lack of sleep
* Medications (over-the-counter and prescription)
* Perfume
* Stress
Signs and Symptoms:
Migraine headache pain is often described as throbbing or pulsating pain that is intensified by routine physical activity, coughing, straining, or lowering the head. The headache is often so severe that it interferes with daily activity and may awaken the person. The attack is debilitating, and migraine sufferers are often left feeling tired and weak once the headache has passed.

*A migraine headache typically begins in a specific area on one side of the head, then spreads and builds in intensity over 1 to 2 hours and then gradually subsides. It can last up to 24 hours, and in some cases, several days.
*There may be accompanying symptoms such as nausea, vomiting, sensitivity to light (photophobia), or sensitivity to sound (phonophobia). Hands and feet may feel cold and sweaty and unusual odors may be intolerable.

Diabetes is a serious disease that affects an increasingly large number of people nowadays. There are numerous people officially registered at diabetes centers from all over the world. The effects of this disease are, however of the most diverse and they may vary from minor glycemia problems to important glycemia dysfunctions that can also lead to the death of the patient in the most grave cases. There are numerous treatments for this disease but this, however, has not reduced the overall number of people affected by diabetes. Researchers are still trying to prevent its causes but most of the times people get diabetes caused by stress and by a disordered rhythm of life. And this is very difficult to control by medical methods.
Causes:One of the most important causes that lead to diabetes is the disordered nutrition system. This unhealthy nutrition regime includes abuses of many kinds: abuse of sweets and foods that include a lot of sugar, abuse of bread which also includes ingredients that contribute to raising the glycemia level and also the abuse of fat foods that also leads to high cholesterol problems. Actually high glycemia and high cholesterol usually go hand in hand, as people who suffer from one are most likely to suffer from the other as well. High glycemia is hence, the main cause for diabetes. People are advised to check their glycemia by medical analyses at least twice a year.
The other cause which does not depend on the glycemia level at all is stress. High stress leads to high glycemia on a nervous, psychical basis.

The two main causes have the same level of gravity and of intensity. They must however be taken into consideration by anyone, as nothing is more important than health. These numerous causes are very serious but at the same time they are controllable as well. That means people have the power of controlling their daily diets and alimentation. For this, the need of an education system regarding a healthy life is vital to be done.
Symptoms:There are some important symptoms that alert high glycemia and further on, the presence of diabetes in an organism. Among these symptoms the most common and obvious are the change of metabolism and the reduction of saliva in the person’s mouth. Among the symptoms there is also the great appetite for sugar and for sweet aliments. The modification of metabolism reflects at the beginning an important loss of weight and later on there comes instability in the weight of the patient. People suffering from diabetes cannot easily maintain their standard weight. In advanced forms of diabetes people modify their weight considerably.
Regarding the reduction of saliva that most patients suffering from diabetes present, this symptom is one of the earliest ones to appear. This signals high glycemia from the very beginning of the installation of diabetes. People suffering from diabetes often feel their mouth dry especially during the night and have the need of drinking many liquids.
Also, the increased appetite for sugar and sweets is a notable symptom of diabetes, as it reflects the difficulty of saturating organism with sugar. Actually this appetite is only a sensation that some people suffering in an advanced stage of diabetes solve by injecting insulin regularly into their bodies.
Precaution:There are many precaution measures that one can take in order to avoid diabetes. One important precaution is the special attention at one’s daily diet and nutritional system. By having a balanced alimentary regime people can easily avoid diabetes and many other diseases that can derive from bad alimentation.

People are also advised to have a lot of physical exercise, as studies have shown that the ones who practice sports are less threatened by the risk of getting diabetes. This disease is characteristic for sedentary people. The lack of physical activity can easily lead to diabetes.

By a healthy diet and by physical workout people can, hence avoid getting diabetes. Also, people are advised to take theirmedical tests at least twice a year in order to become aware of the eventual problems that they may have up to that certain point.
Treatment:
There are numerous treatments found for diabetes so far. The pills taken for lowering the glycemia level are the most common treatment. They are used by people suffering from diabetes in an early stage of the disease. The pills can be usual ones that can be found in all the pharmacies, or naturist pills, the ones based on natural ingredients only. These pills are said to lower the level of glycemia from the patient’s blood. That is why they must be administrated and taken by respecting a strict schedule.
Another common treatment for diabetes is the insulin. This substance is usually injected in the organism and people who are prescribed insulin are usually suffering from and advanced form of diabetes. Insulin is prescribed when the glycemia level has reached a dangerous point. Another method of administrating insulin is the plaster method. There are special plasters in pharmacies that contain the necessary dose of insulin for a certain amount of time. Some people use plasters instead of the injection method, since the plaster method has become very popular and so easy to use.

#.Americans are buzzing about the FDA’s recent decision to reverse the ban on Ephedra and ephedrine supplements in the United States.
#.Known as the “world’s oldest medicine” ... Ephedra has been used for thousands of years for its variety of healing properties.
#.While ephedra is not a cure-all, it has been successfully used in treating hundreds of afflictions, including some that may surprise you. When the average person hears the word “Ephedra” they may think of two things; weight loss and banned.
#,Yet there are millions of people who have safely used ephedra to burn fat and lose weight, who were devastated when the U.S. Food and Drug Administration imposed a ban on ephedra in early 2004.
#.The FDA claimed a high death rate attributed to the use (or misuse) of ephedra and ephedrine — the main “active” ingredient in the ephedra plant. However, further research showed that only five of these deaths could be attributed to ephedra use, so the ban was lifted.
#.To put the number of adverse events into perspective, consider that over 12 million people were reportedly using ephedra during 1999, without any harmful side-effects.
#.Ephedra has thermogenic "fat-burning" qualities, which means it can be used to speed up your body metabolism. This natural increase in metabolism, is what results in virtually effortless weight loss and has earned ephedra the nickname “miracle fat burner.”
#.Unlike other weight loss products on the market — ephedra helps the body retain lean muscle mass. The thermogenic qualities of ephedra also improve the body’s ability to eliminate toxins (through urine and sweat), which can reduce unnecessary water retention.
#.What you may not know is that the ephedra plant has been used to treat a number of respiratory and circulatory conditions, including asthma, allergies (such as hay fever) and the common cold.
#.Ephedrine — or the synthetic equivalent called pseudoephedrine — can be found in many over-the-counter cold and allergy medications, including Sudafed. Ephedra is a vasodilator, meaning it relaxes (or dilates) blood vessels, which allows blood to flow more easily, and allows nasal passages to open wider.
#.In Chinese medicine, ephedra has been used for thousands of years to increase blood flow and improve circulation... Athletes have used ephedra for centuries, since it helps build muscle and burn fat.
#.Many people report increased energy and stamina while using ephedra, which increases overall athletic performance. And Ephedra is generally considered safe when adhering to the recommended doses.
#.Since ephedra is a very powerful and effective supplement, you should check with your physician before using ephedra if you have any of the following conditions:
* Anxiety
* High blood pressure
* Glaucoma
* Heart disease
Contraindication:
Do not take ephedra if you are pregnant or lactating. Check with your physician before beginning any weight loss program.

Crohn's disease is generally characterized by the formation of ulcers (open sores) anywhere in the small and large intestines (commonly known as the colon). Ulcerative colitis on the other hand is characterized by formation of ulcers mainly in the lower portions of the large colon. The differentiating feature is between Crohn’s disease and ulcerative colitis is the area that is affected by these two disorders. While Crohn's disease does not affect the rectum or may only affect the regions around the rectum, the ulcers associated with ulcerative colitis often begin at the rectum and extend to the other regions of the large intestine (especially the lowermost regions). Another distinguishing feature between these two disorders lies in the curability. While surgery can cure ulcerative colitis in most instances, there is no cure for Crohn’s disease (only symptoms can be treated effectively).
Treatment:
Crohn’s disease and ulcerative colitis are chronic disorders that persist for a long duration. However, effective treatment can generally result in complete recovery from the symptoms of IBD and the individual can lead a normal life.
Anti-inflammatory drugs and drugs to suppress the body’s immune system are generally the first line of treatment of mild to moderate IBD. These help in reduction of the inflammation in the colon and thereby decrease other associated symptoms.
Administration of medications that belong to the group of anti-diarrheals, laxatives, and pain relievers are also commonly advised for individuals suffering from mild to moderate forms of IBD. Antibiotic medications may be advised if any underlying infection is suspected or identified during the diagnostic procedures.
A well balanced diet that supplies adequate amounts of calories, vitamins, minerals and other essential nutrients should be consumed to prevent the occurrence of malnutrition. Adequate consumption of water and other fluids is also advised.
Severe cases of IBD may require hospital admission for appropriate care and prevention of complications. Surgery may be advised in some severe cases of ulcerative colitis wherein removal of the affected portion can often cure the condition. However, a similar result cannot be obtained with Crohn’s disease and hence, surgery is reserved as a last option for treatment of Crohn’s disease.

Inotropics and cardiotonics are medications that increase the strength of the muscle contractions that pump blood from the heart. Until recently, the inotropic drug digitalis was the main medical treatment for heart failure.
Digitalis
A drug derived from the foxglove plant that has been used to treat heart disease for more than 300 years - makes the heart's contractions stronger, may reduce heart size, and can lessen the frequency or severity of some heart arrhythmias. Digitalis has not been shown to improve survival of heart patients, but it does relieve symptoms and may reduce hospitalizations. Many experts now prescribe drugs proven to prolong life, such as an ACE inhibitor or beta-blocker before digitalis is tried. Digitalis may be useful, however, especially if used in combination with other agents for patients with:
* Systolic dysfunction characterized by a low ejection fraction, or EF (the percentage, or fraction, of blood pumped out of the heart with each beat)
* Heart failure and atrial fibrillation, a rapid, irregular heartbeat arising in the upper chamber. Digoxin (Lanoxin) is the most commonly prescribed form of digitalis.
A research study reported that low-dose digoxin may be as effective as higher doses for some patients with mild to moderate heart failure . If side effects exist, but are mild, patients may be able to continue digitalis.
In one study, it was found that patients who stopped taking digoxin after using it in combination with ACE inhibitors were at risk for worsening heart failure.
While most medications are generally safe when taken as prescribed, all have potential side effects, and some can be dangerous. Digitalis, for example, can cause abnormal heart rhythms that may be life-threatening. Blood tests may be needed to monitor its levels in the blood. Digitalis, many other medications and some non-prescription substances also can interact with other drugs. It is important that your healthcare provider knows every medication you are taking. You also should not discontinue a medication without consulting with your healthcare provider, and report any worrisome side effects or symptoms immediately.
Common Inotropic and Cardiotonic Drugs:
* Amrinone (Inocor®)
* Digitoxin (Crystodigin®)
* Digoxin (Lanoxin®, Lanoxicaps®)
* Dobutamine (Dobutrex®)
* Milrinone (Primacor®)
Root Of Administration:
Some drugs may be administered intravenously (IV), which means they are infused continuously through an IV tube, or catheter, into a vein. Dobutamine, for example,may be administered in the home with a device called a portable infusion pump.
Treating heart failure at an early stage offers the best chance for a longer and better quality life. Three classes of medications have been the standard treatments for heart failure: ACE inhibitor and angiotensin receptor blocker (Renal-Angiotensin System blockers); diuretics and digitalis.

1.Introduction:
The statins (or HMG-CoA reductase inhibitors) are a class of drugs that lower cholesterol levels in people with or at risk of cardiovascular disease.
They lower cholesterol by inhibiting the enzyme HMG-CoA reductase, which is the rate-limiting enzyme of the mevalonate pathway of cholesterol synthesis. Inhibition of this enzyme in the liver results in decreased cholesterol synthesis as well as increased synthesis of LDL receptors, resulting in an increased clearance of low-density lipoprotein (LDL) from the bloodstream. The first results can be seen after one week of use and the effect is maximal after four to six weeks.
2.Mechanism Of Action:
Statins act by inhibiting the enzyme HMG-CoA reductase, the enzyme controlling the first committed step of sterol (cholesterol) synthesis, in the liver. Because statins are similar to HMG-CoA on a molecular level they take the place of HMG-CoA in the enzyme and reduce the rate by which it is able to produce mevalonate, the next molecule in the cascade that eventually produces cholesterol, as well as a number of other compounds.
Inside the liver cell, other enzymes of the protease class sense the decreased level of cholesterol produced. In response, they cleave a protein called "membrane-bound sterol regulatory element binding protein", which then responds by migrating to the nucleus to increase production of various other proteins and enzymes, including the LDL receptor. The LDL receptor then relocates to the cell membrane of the liver cell, and binds to passing low density lipoprotein and very low density lipoprotein particles (both containing cholesterol in the undesired form). LDL and VLDL enter the liver and are digested.
3.cholesterol related actions:Statins exhibit action beyond lipid-lowering activity in the prevention of atherosclerosis. Researchers hypothesize that statins prevent cardiovascular disease via four proposed mechanisms:
1.Improve endothelial function
2.Modulate inflammatory responses
3.Maintain plaque stability
4.Prevent thrombus formation
4.Examples:Atorvastatin,Cerivastatin,Fluvastatin,Lovastatin,Mevastatin,Simvastatin etc.
5.Adverse Efeect:myalgias, muscle cramps,rhabdomyolysis.
Drug Interection:Combining any statin with a fibrate, another category of lipid-lowering drugs, increases the risks for rhabdomyolysis.