Treatment for myocardial infarction

1. Oxygen — Used to maintain blood oxygenation as well as tissue and
cardiac O2 levels.

2. Aspirin — If administered when myocardial infarction is detected,
the antiplatelet properties of aspirin may reduce the overall size of
the infarction.

3. Thrombolytic therapy — If employed in the first 1 to 4 hours following
the onset of a myocardial infarction, these drugs may dissolve
clots in coronary blood vessels and re-establish blood flow.

4. Vasodilator drugs — Intravenous nitroglycerin can increase blood
flow to the myocardium and reduce myocardial work.

5.β-Blockers — Blunt the effect of catecholamine release on the myocardium,
reduce heart rate and myocardial work.

6. Pain management — Sublingual nitroglycerin, morphine if necessary

7. Antiarrhythmia drugs — To treat and prevent a number of potentially
life-threatening arrhythmias that might arise following a myocardialinfarction.

8. ACE inhibitors — Drugs that block activation of the renin–angiotensin
system and thus reduce the negative effects of vasoconstriction
and salt and water retention on the myocardium.

ADRs

Introduction to ADRs

Adverse drug reactions (ADRs), also known as ‘side effects’, ‘adverse
drug events’, or ‘drug misadventures’, are a frequent cause of morbidity in hospital and the community. They have a significant cost both financially and in terms of quality of life. 
Few studies of ADRs have been carried out in the community so the effect on primary care is harder to assess, but studies in the hospital environment have shown the following.

• ADRs occur in 10–20 % of patients in hospital.
• ADRs are responsible for 5 % of admissions to hospital.
• ADRs might be responsible for 1 in 1000 deaths in medical wards.
• ADRs are the most common cause of iatrogenic injury in hospital
patients.

The World Health Organization (WHO) defines an ADR as follows:
‘ a drug-related event that is noxious and unintended and occurs at doses used in
humans for prophylaxis, diagnosis or therapy of disease or for the modification
of physiological function .’

However, this definition does not take into account the following
scenarios, all of which can also cause ADRs:
• overdose (including prescribing or administration errors)
• therapeutic failure
• drug interactions
• drug withdrawal.

Pharmacists have an important role in identifying, reporting, and preventing
ADRs.

Terminology in liver disease

Hepatocellular injury
Damage to the main cells of the liver (hepatocytes)

Hepatitis
 Inflammation of the liver, a type of hepatocellular injury. Could
be caused by viruses, drugs, or other agents, or could be
idiosyncratic.

Cirrhosis
 Chronic, irreversible damage to liver cells, usually caused by
alcohol or hepatitis C. If the remaining cells cannot maintain
normal liver function (compensated disease), ascites, jaundice,
and encephalopathy can develop (decompensated disease).

Cholestasis 
Reduction in bile production or bile fl ow through the bile
ducts.

Liver failure 
Severe hepatic dysfunction where compensatory mechanisms
are no longer suffi cient to maintain homeostasis. Could be
acute and reversible, or irreversible (e.g. endstage cirrhosis).

Anaphylaxis

Symptoms and signs of anaphylaxis

Anaphylaxis is defined as an immediate systems hypersensitivity event produced

by IgE-mediated release of chemicals from mast cells and basophils.
Theoretically, prior exposure to the agent is required and the reaction is
not dose- or route-related, but in practice anaphylaxis to injected antigen
is more frequent, severe, and rapid in onset than following exposure to
oral or topical antigen.
Agents which commonly cause anaphylaxis include:
• drugs — e.g. penicillins, aspirin
• insect stings — e.g. wasp and bee venoms
• food — e.g. nuts.
Urticaria and angioedema are the most common symptoms
and absence of these suggests that the reaction may not be anaphylaxis.
Airways oedema, bronchospasm, and shock are life-threatening and
immediate emergency treatment is usually required.
The onset of symptoms following parenteral antigen (including stings) is
usually within 5–30min. With oral antigen, there is often a delay. Symptoms
usually occur within 2h, but may be immediate and life-threatening.
A late-phase reaction may also occur with recrudescence of symptoms
after apparent resolution. Recurrence is a fairly frequent phenomenon
and healthcare workers should be aware of this. Patients should not be
discharged too quickly as they may require further treatment.
End-of-needle reactions
Some patients may experience an anaphylactic-like reaction during rapid
intravenous (IV) drug administration. This is known as an end-of-needle
reaction. Initial symptoms may suggest anaphylaxis, but in fact this is a
vasopressor effect and can be distinguished from anaphylaxis as bradycardia
occurs which is rare in anaphylaxis. Skin symptoms are also rare
in end-of-needle reactions. Stopping or slowing down the infusion or
injection usually leads to resolution of symptoms,and administration at a
slower rate usually avoids a repeat event.
Signs and symptoms of anaphylaxis
F Urticaria
R Angioedema
E Dyspnoea, wheeze
Q Nausea, vomiting, diarrhoea, cramping abdominal pain
U Flush
E Upper airway oedema
N
T
R Headache
A Rhinitis
R Substernal pain
E Itch with no rash
Seizure

Facts about Kidney Disease

1. The incidence kidney failure (or chronic Kidney disease) has doubled the last 15 years.

2. It is estimated that currently there are over 1 million people worldwide who are alive on dialysis or with a functioning graft.

3. Diabetes is an important cause of kidney failure and diabetes is five times more common in the Asians when compared to the white population

4. Another lifestyle related disorder - hypertension is an important cause of kidney failure and it too has seen a global increase in its incidence. Asians again are twice more prone to develop this condition in comparison to the white population.

5. Almost 66% kidney failure occurs due to hypertension or diabetes.

6. There are approximately 7.85 million people suffering from chronic kidney failure in India.

7. It is estimated that there are between 11 to 30 million people with chronic Kidney disease or other evidence of kidney disease in USA.

8. In the United States the cost of treating patients with renal replacement therapy will be US $28 billion by the year 2013. It is estimated that over 600 000 patients will require treatment.

9. In India 90 % patients suffer from kidney disease are not able to afford the cost of treatment.

10. The crisis of kidney shortage is a global phenomenon and it is worst in Asian countries.

Peptic Ulcer Disease- A review