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The chart below was recently discussed at a meeting of primary care prescribing leads and advisers. It illustrates the variation in the extent to which GPs use fluticasone as opposed to the other inhaled steroids. Fluticasoje is an expensive choice with no clear advantage in general practice use. Careful interpretation is required because these scrips, although mainly for asthma, will also represent therapy for COPD. In addition we must note that the inclusion of scrips for Seretide should mean that we are recognising asthma patients treated at Step 3 and beyond of the current guidelines. Where we see scrips for fluticasone on its own then this could represent Step 2 inhaled steroid + short acting bronchodilator ; or Step 3 long acting bronchodilator + inhaled steroid + short acting bronchodilator ; or beyond. At the lower strength eg moderate asthma where a long acting bronchodilator is needed ; Seretide 50 Evohaler is promoted as having a cost advantage over separate MDIs of salmeterol plus beclometasone. Indeed it is, with Seretide 50 Evohaler costing 19.50 at 2 puffs BD for 30 days and salmeterol MDI plus generic beclometasone 100 MDI at 2 puffs BD ; costing approximately 33.54. However, at the higher strengths Seretide becomes more expensive. For instance Seretide 125 Evohaler costs 39.41 versus 39.28 for the salmeterol beclometasone constituents, and 66.98 for Seretide 250 Evohaler versus 49.96 for the salmeterol beclometasone constituents. If we look at Cornish prescribing data for all Seretide preparations for Oct-Dec 2001 we see the following: Seretide 50 Evohaler 261 scrips Seretide 125 Evohaler 517 scrips Seretide 250 Evohaler 616 scrips Seretide 100 Accuhaler Seretide 250 Accuhaler Seretide 500 Accuhaler 434 scrips 250 scrips 404 scrips equivalent monthly cost of Accuhaler 33.54 ; equivalent monthly cost of Accuhaler 39.41 ; equivalent monthly cost of Accuhaler 66.98.
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A&E 1. A&E Management Guidelines for: a ; Hypertension d ; Asthmatic Attack b ; Hyperglycaemia e ; Minor Head Injury c ; Epileptic Attack 2. Wound Management and Suture Technique Dr. Yuen Cheuk Pun, Eddie Associate Consultant, A & E Dept, QEH Sedation and Anaesthesia 1. a ; Pre-Anaesthetic Assessment b ; Common Anaesthetic Techniques The Preadmission Clinic c ; Sedation or Surgical Procedures Dr. Koo Chi Hung Senior Medical Officer, Dept of Anaesthesiology, QEH.
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Meningitis discussed on page 178. Extradural abscess usually with clinical features of acute mastoiditis. Brain abscess cerebellum or temporal lobe ; : Systemic effects of infection: Malaise, pyrexia. Raised intracranial pressure: headache, drowsiness, confusion, impaired consciousness, papilloedema, bradycardia, hypertension. Localising signs any of the following ; : - Cerebellar abscess: neck stiffness, weakness and loss of tone on same side as abscess, ataxia falling to same side ; , intention tremor with past pointing, dysdiadochokinesis, nystagmus, vertigo, for example, fluticasone mechanism of action.
20 Unique Identifier 15975036 Authors West LJ. Institution Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. lwest sickkids Title Targeting antibody-mediated rejection in the setting of ABO-incompatible infant heart transplantation: graft accommodation vs. B cell tolerance. [Review] [68 refs] Source Current Drug Targets - Cardiovascular & Haematological Disorders. 5 3 ; : 223-32, 2005 Jun. Abstract In order for ABO-incompatible organ transplantation to be performed successfully, the antibody response must be targeted. Aggressive strategies are usually required both to remove pre-existing antibodies directed at donor A B antigens and to suppress further production of antibodies. If this can be accomplished in the short-term, graft accommodation of ABO-incompatible transplants may develop upon eventual reaccumulation of antibodies as the graft acquires resistance to antibody-mediated damage. In contrast to mature individuals, very young infants lack isohemagglutinins due to a natural lag in development of immunity to T cell-independent polysaccharide antigens. This delay in maturation permits a window of safety during which infants can receive ABO-incompatible grafts without the requirement for aggressive immunosuppressive strategies. We have recently demonstrated that ABO-incompatible heart transplantation.
Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis. I. Psychotropic drugs. J Geriatr Soc 1999; 47: 309. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis. II. Cardiac and analgesic drugs. J Geriatr Soc 1999; 47: 4050. Ensrud KE, Blackwell TL, Mangione CM, et al. Central nervous system-active medications and risk for falls in older women. J Geriatr Soc 2002; 50: 162937 and advil.
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SAB PROCHLORPERAZINE. 77 SAB PROCTOMYXIN HC . 141 SAB-ANUZINC HC. 140 SAB-ANUZINC HC PLUS . 140 SAB-DICLOFENAC. 50 SAB-INDOMETHACIN . 51 SAB-NAPROXEN. 53 SAB-OPIUM & BELLADONNA. 59 SABRIL . 66 SAIZEN . SEC 3.45 SALAGEN . 17 SALAZOPYRIN . 13 SALAZOPYRIN EN-TABS. 13 SALBUTAMOL . 20 SALBUTAMOL SULFATE . 20 SALBUTAMOL SULFATE . SEC 3.45 SALMETEROL XINAFOATE. 20 SALMETEROL XINAFOATE FLUTICASONE PROPIONATE. 20 SALOFALK. 107 SALOFALK 2G 60G ; . 107 SALOFALK 4G 60G ; . 107 SANDOMIGRAN . 21 SANDOMIGRAN DS . 21 SANDOSTATIN. SEC 3.34 SANDOSTATIN LAR. SEC 3.34 SANDOZ ACEBUTOLOL . 27 SANDOZ FLUOXETINE. 69 SANDOZ GLICLAZIDE . 125 SANDOZ GLYBURIDE. 126 SANDOZ ACEBUTOLOL . 27 SANDOZ AMIODARONE. 27 SANDOZ ANUZINC HC . 140 SANDOZ ANUZINC HC PLUS. 140 and theophylline.
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Results: Neither fluticasone nor terfenadine treatment led to atrophy in the nasal mucosa by clinical or histologic observation. No significant changes from baseline were observed for any assessment of atrophy. In contrast to what would have been expected if atrophy were to occur, mean epithelial layer thickness in the fluticasone group significantly increased compared with terfenadine treatment P .03 ; . Conclusions: Treatment with intranasal fluticasone for 1 year increases the thickness of the nasal epithelium as compared with a year's treatment with terfenadine and does not lead to atrophy in the nasal mucosa. The increased thickness in the fluticasone treatment may represent repair from epithelial damage caused by chronic allergic inflammation.
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Corticosteroids Guidelines of care for the use of topical corticosteroids are available at: : aad Low Potency alclometasone crm, oint 0.05% fluocinolone acetonide soln 0.01% hydrocortisone crm 2.5% Medium Potency betamethasone valerate crm, lotion, oint 0.1% fluocinolone acetonide crm, oint 0.025% fluticasone propionate crm 0.05%, oint 0.005% hydrocortisone valerate crm, oint 0.2% mometasone crm, oint 0.1% triamcinolone acetonide crm, lotion 0.025% triamcinolone acetonide crm, lotion, oint 0.1% High Potency betamethasone dipropionate crm, lotion, oint 0.05% fluocinonide crm, gel, oint, soln 0.05% triamcinolone acetonide crm 0.5% halcinonide crm, oint, soln 0.1% Very High Potency betamethasone dipropionate augmented crm 0.05% betamethasone dipropionate augmented oint clobetasol propionate crm, gel, lotion, oint 0.05% halobetasol propionate crm, oint 0.05% Emollients ammonium lactate 12% Immunomodulators Guidelines for the treatment of atopic dermatitis are available at: : aad tacrolimus Local Analgesics lidocaine patch Rosacea metronidazole gel 0.75% sulfacetamide sulfur Scabicides and Pediculicides permethrin 5% crotamiton Miscellaneous Skin and Mucous Membrane podofilox trypsin balsam castor oil PROTOPIC ACLOVATE SYNALAR HYTONE and glimepiride.
Should improve adherence to treatment. The availability of several strengths of fliticasone in the combination product will allow corticosteroid dosing appropriate for the degree of asthma severity. J. R. B. Shapiro G, Lumry W, Wolfe J, et al: Combined salmeterol 50 g and fluticason4 propionate 250 g in the Diskus device for the treatment of asthma. J Respir Crit Care Med 161: 527-534, 2000.
Medication Systemic Corticosteroids Methylprednisolone Prednisolone Dosage Form Adult Dose Applies to all three cortcosteroids ; Child Dose * Inhaled Corticosteroids See Estimated Comparative Daily Dosages for Inhaled Corticosteroids ; 2, 4, 8, mg tables 0.25-2 mg kg daily in single dose in a.m. 7.5 60 mg daily in a single does in or qod as needed for control a.m. or qod as needed for control 5 mg tablets, Short-course "burst" to achieve control: Short-course "burst": 1-2 mg kg day, 5 mg 5 cc, maximum 60 mg day for 3-10 days 40-60 mg per day as single or 2 divided 15 mg 5 cc doses for 3-10 days Prednisone 1, 2.5, 5, mg tablets; 5 mg cc, 5 mg 5 cc Long-Acting Inhaled Beta-Agonists Should not be used for symptom relief or for exacerbations; use with inhaled corticosteroids ; Salmeterol Formoterol Combined Medication Fluticasnoe Salmeterol Cromolyn and Nedocromil Cromolyn Nedocromil Leukotriene Modifiers Montelukast MDL 21 mcg puff DPI 50 mg blister DPI 12 mcg single-use capsule DPI 100, 250, or 500 mg 50 mg MDI 1 mg puff Nebulizer 20 mg ampule MDI 1.75 mg puff 4 or 5 mg chewable tablet 10 mg tablet 2 puffs q 12 hours 1 blister q 12 hours 1 capsule q 12 hours 1 inhalation bid; dose depends on severity of asthma 2-4 puffs tid-qid 1 ampule tid-qid 2-4 puffs bid-qid 10 mg qhs 1-2 puffs q 12 hours 1 blister q 12 hours 1 capsule q 12 hours 1 inhalation bid; dose depends on severity of asthma 1-2 puffs tid-qid 1 ampule tid-qid 1-2 puffs bid-qid 4 mg qhs 2-5 yrs ; 5 mg qhs 6-14 yrs ; 10 mg qhs 14 yrs ; 20 mg daily 7-11 yrs ; 10 mg tablet bid and anacin.
Tion of erythrocytes; 2 ; reduces the time required for cells to enter the circulation, thereby increasing the number of circulating immature erythrocytes such as reticulocytes see Fig. 12 and 3 ; facilitates the incorporation of iron into RBCs. When the number of produced erythrocytes meets the body's tissue oxygenation needs, erythropoietin release and RBC production are reduced. Table 11 lists causes of tissue hypoxia that may stimulate the release of erythropoietin.
Followed by 52 weeks of treatment with flutixasone propionate or beclomethasone dipropionate, both administered at a dosage of 200 g twice daily using a dry powder inhaler Diskhaler ; . No specific instructions were given with respect to mouth rinsing. This was left to the investigators' discretion, according to local practice. Both formulations looked the same because of the predominance of lactose in the formulation, and any taste associated with the products would be attributable to the lactose. Treatment randomization was generated by computer using a validated computer program Patient Allocation for Clinical Trials; GlaxoSmithKline ; . Each investigator was given a block of treatment minimum block size, 4 treatments ; and provided with individually sealed envelopes containing details of the medication that corresponded to each patient's treatment number. Treatment was assigned in ascending order, starting with the lowest number. Patients visited the clinic after 2 and 4 weeks of treatment, and then at 12-week intervals for the next 48 weeks. A follow-up visit was arranged at 2 weeks after completion of treatment. No detailed assessments of compliance were made during the study. Although compliance with inhaled corticosteroid therapy is generally considered to be poor, the purpose of this study was to compare 2 inhaled corticosteroids for which it was assumed that compliance rates would be similar. However, investigators were asked to confirm whether patients were taking their medication correctly at each clinic visit. OUTCOME MEASURES The primary end point was growth velocity, measured by means of stadiometry during the 52-week treatment. Secondary end points included asthma symptom scores, -agonist use, asthma exacerbation rate, and lung function measurements. The study was powered to detect a difference in growth of 1 cm between the treatments. Based on data from a previous study, 13 if the SD of growth velocity was 2.7 cm y, it would be necessary to recruit 240 patients, ie, 120 per treatment group, to ensure a power of 80% to detect a difference of 1 cm the 5% significance level. On a daily basis, each patient recorded their daytime and nighttime asthma symptom score 0 indicates no symptoms; 1, mild; 2, moderate; and 3, severe ; , morning and evening PEF, the number of doses of as-needed albuterol administered, and concurrent medication on a diary card. This information was entered throughout the run-in Continued on next page and panadol.
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HEALTHPLUS PARTNERS MEDICAID ; FORMULARY UPDATE The HealthPlus Partners Medicaid ; Formulary Quick-Check document contains recommendations for selected medication categories. Here is a complete summary of all HealthPlus Partners Medicaid ; Formulary changes approved in the second quarter of 2007: Formulary Status Changes The following medications were ADDED to the formulary: Amitiza lubiprostone ; Boniva ibandronate ; Brovana arformoterol ; Byetta exenatide ; with prior authorization required Chantix varenicline ; with duration limits Desferal deferoxamine mesylate ; Elmiron pentosan polysulfate sodium ; Exjade deferasirox ; Fosamax alendronate ; Fosrenol lanthanum carbonate ; PhosLo calcium acetate ; Premarin vaginal cream conjugated estrogens ; Ranexa ranolazine ; Renagel sevelamer ; Restasis cyclosporine ophth emulsion ; Revatio sildenafil ; with prior authorization required Sensipar cinacalcet ; Suboxone buprenorphine naloxone ; Symlin pramlintide ; with prior authorization required Thalomid thalidomide ; Tracleer bosentan ; Zemplar paricalcitol ; Zyvox linezolid ; The following medications are now generically available and are on the formulary: Ambien zolpidem ; Inderal LA propranolol ; Lamisil Tablets terbinafine ; Lotrel amlodipine benazepril ; Mavik trandolapril ; Nimotop nimodipine ; Norvasc amlodipine ; Omnicef cefdinir ; Toprol XL metoprolol ; Univasc moexipril ; Uniretic moexipril hctz ; Vantin cefpodoxime ; The following medications are non-formulary and were added to the Prior Authorization Program: Rhinocort Aqua budesonide ; Veramyst fluticasone furoate ; Vyvanse lisdexamfetamine dimesylate ; Prior Authorization Update Prior authorization currently applies for new start members AND will also apply to members who are currently receiving the following medications: Formulary Drugs Crestor, Lescol XL, Lipitor Non-Formulary Drugs Advicor, Altoprev, Caduet, Pravigard PAC Lexapro and acetaminophen and fluticasone.
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RESPIRATORY and PULMONARY AGENTS CLARITIN; loratadine acetylcysteine ADVAIR DISKUS; fluticasone salmeterol ALBUTEROL; albuterol sulfate ALLEGRA; fexofenadine hcl aminophylline BENADRYL; diphenhydramine hcl chlorpheniramine maleate clemastine fumarate cromolyn sodium cyproheptadine hcl dexchlorpheniramine maleate ELIXOPHYLLIN; theophylline anhydrous flunisolide guaifenesin GUAIFENESIN W PHENYLEPHRINE; guaifenesin phenylephrine hcl GUAIFENESIN W PSEUDOEPHEDRINE; guaifenesin p-ephed hcl ipratropium bromide metaproterenol sulfate midodrine hcl PHENADOZ; promethazine hcl terbutaline sulfate THEOCAP; theophylline anhydrous theophylline anhydrous THEOCHRON; theophylline anhydrous ADRENELIN CHLORIDE NASAL; epinephrine ASTELIN; azelastine hcl ATROVENT HFA; ipratropium bromide BECONASE AQ; beclomethasone dipropionate EPIPEN; epinephrine EPIPEN JR.; epinephrine GASTROCROM; cromolyn sodium INTAL; cromolyn sodium NASACORT AQ; triamcinolone acetonide REVATIO; sildenafil citrate RHINOCORT AQUA; budesonide SEREVENT DISKUS; salmeterol xinafoate SINGULAIR; montelukast sodium SPIRIVA; tiotropium bromide TWINJECT; epinephrine G ; - Generic only is covered. Brand-name listed for reference only. 30.
In conclusion, our data refutes the assertion that mometasone furoate has negligible systemic bioavailability and a lower potential for systemic adverse effects compared with other inhaled corticosteroids. Clinicians therefore need to be aware that mometasone furoate has the potential for producing similar adrenal suppression to that of fluticasone propionate at medium to high doses.
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