Durante mucho tiempo no había principios uniformes para la Atribución de nombres a los antibióticos https://antibioticos-wiki.es . Más a menudo se les llama por el nombre genérico o especie del producto, con menos frecuencia-de acuerdo con la estructura química. Algunos antibióticos se nombran de acuerdo con el lugar donde se asignó el producto.
Sspho
Pharmacy Update – April 2011 Issues are also available at www.SSPHO.org In this issue: -Summary of the February P&T meeting (pgs 1 - 3) Summary of February P&T Meeting Updated review of azelastine (Astelin & Astepro
limited health plan coverage of Astepro are also issues
Nasal Sprays): The Committee considered an updated
to consider (see table below) before using nasal
summary review of azelastine (Astelin & Astepro
antihistamines prior to trying a non-sedating OTC oral
Nasal Sprays by Meda). Azelastine nasal sprays are H
antihistamine or prescription nasal corticosteroid
receptor antagonists indicated for the relief of the
symptoms of seasonal allergic rhinitis. The safety and
Cost & Health Plan Coverage of Nasal Antihistamine
effectiveness of Astepro has not been established in
Sprays:
patients younger than 12 years of age. Astelin is approved for children 5-11 years old and for adults.
Health Plan
The recommended dose of both products is 1 or 2
Coverage
Azelastine (generic)
sprays per nostril twice daily. Astepro Nasal Spray
requires priming before initial use by releasing 6
sprays or until a fine mist appears. When Astepro
Azelastine (Astelin)
Nasal Spray has not been used for 3 or more days, it
must be re-primed with 2 sprays or until a fine mist
appears. Patients allergic to Splenda® or products
Azelastine (Astepro)
containing Splenda® should not use Astepro.
Astepro Nasal Spray claims to be an improvement
over the marketed Astelin Nasal Spray, due to being
Olopatadine (Patanase)
better tolerated by patients (i.e.: less bitter taste and
nasal discomfort). Astepro is comprised of unique
vehicle formulated with sorbitol and sucralose, a taste
The Committee voted unanimously to maintain
masking agent while older Astelin has a saline based
Astepro as non-formulary but they also voted
vehicle. The active ingredient, azelastine, remains the
unanimously to add the newly available generic
same and both products have the same strength,
azelastine nasal spray to the formulary.
137mcg. An advantage of intranasal antihistamines is
that they have a quick onset, at around 30 minutes.
Review of methylnaltrexone (Relistor): The
This is quicker than intranasal corticosteroids or oral
Committee was provided an executive summary
antihistamines. As such, intranasal antihistamines are
review of subcutaneous methylnaltrexone (Relistor –
Wyeth/Progenics), a selective mu-opioid receptor
Intranasal antihistamines might reduce nasal
antagonist, which is indicated for the treatment of
congestion more than oral antihistamines, but not as
opioid-induced constipation in patients with advanced
well as intranasal steroids. Like some oral
illness who are receiving palliative care when response
antihistamines, intranasal antihistamines can cause also
to laxative therapy has not been sufficient.
sedation. Despite the fact that Astepro is relatively
Methylnaltrexone (Relistor) injected subcutaneously
new, there is a new drug application (NDA) for another
every other day is effective for relief of constipation
newly formulated higher strength azelastine nasal
associated with opioid treatment in about 50% of
spray which has now been accepted by the FDA as
patients with advanced illness receiving palliative care,
complete for substantive review after initial evaluation.
without interfering with analgesia or precipitating signs
This newest product has the potential to become the
of central-nervous-system withdrawal. It appears to be
first once-a-day nasal antihistamine in the U.S.
an important advance in the treatment of such patients
Currently, Astelin and Astepro are non-formulary
items. The committee felt that although intranasal
South Shore Physician-Hospital Organization Pharmacy
antihistamines may be appropriate for PRN use and
Newsletter is published exclusively for members of South Shore
might reduce nasal congestion more than oral
Physician-Hospital Organization. Comments on its contents are
antihistamines, they don’t work as well as intranasal
encouraged. Please call Steven Golden, MD, South Shore PHO Medical Director at (781) 340-4068 or Geraldine McNamara, RN,
steroids. Like some oral antihistamines, intranasal
at (781) 340-8160. Information published in this newsletter is
antihistamines can also cause sedation. This appears to
confidential and intended for the addressee named. Any disclosure
be especially true for azelastine. The high cost and….
or unauthorized copying is strictly prohibited.
The mechanism for the delays in gastric emptying,
needle, and 2 alcohol swabs. Vials should be stored at
oral-cecal, and colonic transit time, and inhibition of
room temperature and protected from light. The
defecation associated with opiate-induced bowel
average wholesale price (AWP) for methylnaltrexone
dysfunction is the stimulation of the mu receptor.
is about $50 per single-use vial or $350 for a 7-tray kit.
Methylnaltrexone is a peripherally acting selective mu-
The annual cost of treatment with Relistor can range
opioid receptor antagonist. It is a quaternary derivative
of naltrexone, unlike naloxone. The addition of the
Methylnaltrexone appears effective in the therapy of
methyl group at the amine in the naltrexone ring results
opioid-induced constipation and will likely be useful
in a compound with greater polarity and lower lipid
for patients failing to respond to traditional laxative
solubility, thus preventing it from crossing the blood-
regimens. Activity has not been as clearly
brain barrier. This allows the drug to block peripheral
demonstrated in postoperative bowel dysfunction.
receptor opioid effects without affecting the central
Since Relistor is a prescription product and has a very
narrow indication, it is likely to be used only by
Approval of Relistor was based on two randomized,
palliative care patients with advanced illness.
double-blind trials in terminally ill patients with
Although impressed by the clinical data and
constipation caused by opioid therapy. In the first trial,
acknowledging the appropriate use of the drug in
a bowel movement occurred within 4 hours after a
hospitals and extended care environments, the
single subcutaneous dose of methylnaltrexone 0.15
Committee voted unanimously to classify Relistor as
mg/kg, methylnaltrexone 0.3 mg/kg or placebo in 62%,
non-formulary on the SSPHO outpatient formulary.
58% and 14% of patients, respectively. In the second
trial 133 patients were randomized to receive
Review of combination dutasteride 0.5 mg and
methylnaltrexone 0.15 mg/kg or placebo every other
tamsulosin hydrochloride 0.4 mg (Jalyn): The
day for 2 weeks. About 50% of patients who received
Committee was provided an executive summary
methylnaltrexone had a bowel movement within 4
review of the combination product dutasteride 0.5 mg
hours compared to 15% of those who received placebo.
and tamsulosin hydrochloride 0.4 mg (Jalyn
A bowel movement occurred within 24 hours after
manufactured by GSK). In combination as a 5α-
each of the 7 doses in the trial in 55-66% of patients
reductase inhibitor and alpha adrenergic antagonist,
injected with methylnaltrexone and in 29-39% of those
Jalyn is indicated for the treatment of symptomatic
injected with placebo. These rates of response persisted
benign prostatic hyperplasia (BPH) in men with an
throughout the study and during a 3-month open-label
Each of the two drugs utilizes a different
In clinical trials, adverse effects associated with
mechanism of action to improve lower urinary tract
methylnaltrexone included abdominal pain, flatulence,
symptoms (LUTS) in patients with BPH. Tamsulosin
diarrhea, nausea and dizziness. One patient died with
works by antagonizing alpha-1 adrenoreceptors in the
severe diarrhea and dehydration. Treatment with
human prostate. The smooth muscle relaxation
methylnaltrexone did not appear to diminish the
improves urinary flow rate and BPH symptoms.
analgesic effect of opioids or precipitate non-
Dutasteride is a 5α-reductase inhibitor which exerts its
gastrointestinal signs of opioid withdrawal. The usual
effects by blocking the conversion of testosterone to
dosage of methylnaltrexone is 8 mg injected
dihydrotestosterone. Dihydrotestosterone is the agent
subcutaneously in the abdomen, thigh or upper arm
responsible for the enlargement of the prostate gland.
every other day as needed (maximum is one dose per
5α-reductase is present in two forms in the body, type
24 hours) for patients 38 to <62 kg, or 12 mg for
1 and type 2. Type 1 is primarily found in the
patients 62-114 kg. For all other patients, the
reproductive tissues and type 2 is present in the skin
recommended dosage is 0.15 mg/kg. According to the
and liver. Dutasteride is a competitive and specific
manufacturer, patients with creatinine clearance
inhibitor of both types 1 and 2. The individual
<30mL/min should reduce their dosage by half. The
pharmacokinetic properties of dutasteride and
subcutaneous formulation for use in opioid-induced
tamsulosin are maintained whether given separately or
constipation received FDA approval in April 2008.
Submission of an IV form for postoperative ileus and
The CombAT study (funded by GSK) was primarily
an oral form for use in opioid-induced constipation in
used in the evaluation of Jalyn. The study was an
patients with chronic pain is anticipated in the near
international, double-blind, randomized, and parallel
group controlled trial in men with moderate to severe
Relistor is covered by BCBSMA and Tufts at tier-2,
symptoms and an increased risk of disease progression.
and by HPHC at tier-3. It is available as individual
The trial compared combination therapy of dutasteride
single-use vials containing 12 mg/0.6 mL, or as a 7-
0.5 mg/day with tamsulosin 0.4 mg/day to the same
tray kit. Each tray within the kit contains a 12 mg/0.6
doses of each agent individually. The primary
mL single-use vial, a 1 mL syringe with retractable
endpoint was time to first event of acute urinary
retention (AUR) or BPH related prostatic surgery. The
hydrochloride 500 mg and as repaglinide 2 mg /
secondary endpoints included time to first BPH clinical
metformin hydrochloride 500 mg. It is indicated as an
progression, change in IPSS score and BPH related
adjunct to diet and exercise to improve glycemic
health status (IPSS Q8), IPSS score improvement of
control in adults with type-2 diabetes mellitus who are
25% and >3 point improvement, urinary flow rate as
already treated with a meglitinide and metformin, or
measured by Qmax, and change in prostate volume.
who have inadequate glycemic control on a meglitinide
The investigators found that combination therapy was
significantly superior to tamsulosin monotherapy but
The results of a bioequivalence study in healthy
not dutasteride monotherapy at reducing the relative
subjects demonstrated that repaglinide 1 mg/metformin
risk of AUR or BPH related surgery. Combination
500 mg and repaglinide 2 mg/metformin 500 mg
therapy was also significantly superior at reducing
combination tablets are bioequivalent to
BPH clinical progression and provided greater
coadministration of corresponding doses of repaglinide
Safety and tolerability were relatively consistent
In clinical studies, repaglinide add-on to metformin
between all treatment groups. At 24 months adverse
resulted in statistically significant improvements in
effects were more common in the combination group
hemoglobin A1c and fasting plasma glucose levels
but most were not serious enough to result in
compared with the monotherapy arms. However, the
discontinuation. The discontinuation rate of all groups
repaglinide add-on to metformin group had a higher
was under 5%. The most common adverse effects
incidence of hypoglycemia than the repaglinide
shown were impotence, decreased libido, breast
disorders, ejaculation disorders, and dizziness.
Ejaculation disorders occurred more frequently during
Cost Comparison & Health Plan Coverage:
The normal dosage of Jalyn is one capsule (0.5 mg
dutasteride / 0.4 mg tamsulosin) taken once daily 30
minutes after the same meal each day. The capsule
metformin Tier 1
should be swallowed whole and not chewed, crushed,
Prandimet N/C
or opened. No dosage adjustment is needed in renal
impairment. Dosing in end stage renal disease has not
been studied. No recommendation can be made in
At this time, there is no generic PrandiMet available
hepatic impairment due to absence of data. No dosage
in the US, as the patent on PrandiMet does not expire
adjustment is necessary in elderly patients.
until 2018. Although the patent for Prandin expired in March 2009, there are also no generic versions of
Cost Comparison & Local Health Plan Coverage:
Prandin available in the US. It will likely be decided in the courts whether generic versions of PrandiMet
Cost/month
will be allowed before 2018. Currently both Prandin
and metformin are SSPHO formulary drugs, so
Prandimet represents a potential addition to formulary.
The cost of Prandimet is actually less than the cost of
the two individual drugs; however, local health plan
coverage is quite poor at present and thus the
Committee voted unanimously to classify Prandimet as
After considering the current data available and
given the poor health plan coverage of Jalyn, despite
its somewhat favorable present cost, the Committee
Review of combination pioglitazone & metformin
voted unanimously to classify Jalyn as non-formulary.
extended-release tablets (Actoplus Met XR): The
The cost of generic tamsulosin is expected to continue
Committee was provided an executive summary
review of the combination product pioglitazone &
metformin extended-release tablet (Actoplus Met XR ).
Review of combination repaglinide & metformin
Approved in May of 2009, Actoplus Met XR is the
(Prandimet): The Committee was provided an
first oral antidiabetic fixed-dose combination
executive summary review of the combination product
medication approved with the extended-release form of
repaglinide & metformin (Prandimet). Prandimet is a
metformin. Actoplus Met XR is available as:
fixed-dose combination of the fast-acting secretagogue
pioglitazone/metformin extended-release tablets 15
repaglinide (Prandin) and insulin sensitizer, metformin,
mg/1000 mg strength tablets and 30 mg/1000 mg.
for the treatment of type-2 diabetes. Prandimet is
Actoplus Met XR is indicated as an adjunct to diet and
available as: repaglinide 1 mg / metformin
exercise to improve glycemic control in adults with
type 2 diabetes mellitus who are already treated with
the market however, the cost of the combo agents will
pioglitazone and metformin or who have inadequate
be significantly higher. The Committee voted
glycemic control on pioglitazone alone or metformin
unanimously to classify Actoplus Met XR as non-
Pioglitazone is a thiazolidinedione that acts primarily by decreasing insulin resistance and is used
Pharmacy News Clips
in the management of type II diabetes. Pharmacologic
studies indicate that it improves sensitivity to insulin in
Poison Control Warning: Using Bath Salts to Get
muscle and adipose tissue and inhibits hepatic
High {extracted from Prescribers Letter; March 2011; Vol.
gluconeogenesis. It decreases insulin resistance in the
27 (3)} "Bath salts" abuse is making headlines. In the
periphery and in the liver resulting in increased insulin-
U.S., poison control centers are receiving record high
dependent glucose disposal and decreased hepatic
phone calls related to "bath salts" abuse and lawmakers
glucose output. In addition, pioglitazone may have
are in the process of, or have already, banned "bath
effects at the peroxisome-proliferator-activated
The "bath salts" being abused are not really bath
Metformin is an antihyperglycemic agent that
salts. These are designer stimulants being packaged as
improves glucose tolerance in patients with type 2
"bath salts" and are sold in smoke shops, convenience
diabetes by lowering both the basal and postprandial
stores, gas stations, truck stops, etc., and online. The
plasma glucose. Metformin decreases hepatic glucose
salts come in small packets or jars with brands such as
production, decreases intestinal absorption of glucose,
Cloud 9, Ivory Wave, Vanilla Sky, Purple Wave,
and improves insulin sensitivity by increasing
Blizzard, Blue Silk, etc. There are over 40 name
peripheral glucose uptake and utilization.
brands noted so far. Some street names include
In bioequivalence studies of Actoplus met XR 15
"meow-meow," "drone," "bubbles," and "MCAT."
mg/1000 mg and 30 mg/1000 mg, the area under the
The substances are available as white, tan, or brown
curve (AUC) and maximum concentration (Cmax) of
powders and are selling for about $20 to $50 per 50 mg
both the pioglitazone and the extended-release
packet. In addition to "bath salts," these products are
metformin components following a single dose of the
marketed as bath crystals, plant food, insect repellant,
combination tablet were bioequivalent to pioglitazone
and herbal incense. Some plant foods are packaged as
(Actos 15 mg and 30 mg) concomitantly administered
capsules and are intended to be opened for use.
with extended-release metformin (Fortamet) 1000 mg
Bath salts or plant foods are not subject to
tablets under fed conditions in healthy subjects.
regulation. These products masquerading as bath salts
Patients should be informed that Actoplus met XR
mainly contain powerful stimulants such as 3,4-
must be swallowed whole and not chewed, cut, or
crushed, and that the inactive ingredients may
methylmethcathinone (mephedrone) and are being
occasionally be eliminated in the feces as a soft mass
snorted, smoked, injected, and even mixed with water
as beverages. At this time, these products do not show
Cost Comparison & Local Health Plan Coverage:
These stimulants produce effects that are similar to methamphetamine, ecstasy, and cocaine and can
induce rapid heart rate, visual hallucinations, paranoia,
and psychosis, as well as suicidal or homicidal
metformin
thoughts. The psychosis can cause extreme violent and combative behavior. Self-injurious behavior is also
common. There are reports of self mutilation, suicides,
Actoplus
and homicides linked to "bath salts" highs.
There are no specific treatment recommendations
Actoplus
since health care providers cannot be sure of the
substances contained in the "bath salts." In general,
supportive care such as fluids and benzodiazepines for chemical sedation or physical restraints for severe
Presently, there is no generic Actos, Actoplus Met, or
combativeness, agitation, and hallucinations are
Actoplus Met XR available in the US (despite the fact
that the patent for Actos was due to expire in January
A ban of "bath salt" products containing MDPV
2011). The costs of the Actos’ combination products
went into effect in the U.K. in April, 2010. In the U.S.,
are presently about equal to that of the individual
some states, such as Florida and Louisiana, have
drugs; and, local health plans cover the combo’s at the
same level as Actos. Once generic pioglitazone hits
Medications for ADHD: Everything You Wanted To Know but Were Unable There are over 25 FDA approved medications for ADHD at this time. In general we divide medications into two classes: stimulants and non-stimulants. This can be confusing to families when they hear the word stimulant and they think of a medication as stimulating their child who may need to calm down, focus, and be more in control.
bergportal.ch - Merkblatt Bergkrankheiten SNOWBOARDTOUREN . NET Akute Bergkrankheit (AMS, acute mountain sickness ) Höhenhirnödem (HACE, high altitude cerebral edema ) Höhenlungenödem (HAPE, high altitude pulmonary edema )? 1. Klinik Vorkommen: ab Schlafhöhen über 2500m Höhe (HAPE) bzw. Aufenthalt von mehr als 6h über 2500m (AMS / HACE) • AMS / Akute Bergkrankh