Dr. Louise Carrier Medical Director Geriatric Psychiatry Community Services of Ottawa Dr. Linda Gobessi Geriatric Psychiatrist Geriatric Psychiatry Community Services of Ottawa.
In order to understand the potential health plan savings from patent expirations, we can review the recent history of gastrointestinal medications. The older therapy for treating peptic ulcers and gastric acid reflux was to inhibit the action of histamine at the histamine H2 receptors of the parietal cells, thus reducing gastric acid secretion. Examples of these drugs, known as H2 Receptors, include Axid, Pepcid, Tagamet and Zantac. The newer therapy for treating such conditions employ suppressing gastric acid secretion by inhibiting the proton acid ; pump at the surface of the gastric parietal cell. These newer drugs are known as Proton Pump Inhibitors PPIs ; and include Prevacid and Prilosec. Table 1 shows the commercial drug cost history for these gastrointestinal medications for an HMO with roughly 200, 000 members. The respective generic equivalent product is shown below the brand product with data if there has been a corresponding patent expiration.
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The Study of Asthma in Canada "A Landmark survey" is a GlaxoWellcomme sponsored study on patient and physician perspectives of asthma care. The results were very interesting as to the disparity between perceived asthma control between physicians and patients. If you have not received a copy or would like an additional one, please contact your GlaxoWellcomme representative or let me know and I will do that for you centrally. GP's in Asthma Group Great Britain ; International Primary Care Respiratory Conference, Setting the Agenda for the New Century, June 9-11, 2000 I was fortunate to be the Canadian representative to this conference. It was an interesting conference that brought together Family Physicians from all over the world; Australia, New Zealand, Sweden, Norway, Denmark, Portugal, England, Scotland, Ireland, and Holland. I gave a talk there about Health Care in Canada. The conference was very well organized. There were a number of main themes, some running concordantly. These included Allergy and Rhinitis, Organization of Care, COPD, International Perspectives, Respiratory Infections, prevention, research, and medication use such as ICS in COPD and B2 use past, present, and future ; . I attended the GPIAG annual general meeting as well. They currently have 870 members. They have two 9 members who will be Professors of Primary Care Respiratory Medicine which are University appointments; Dr. David Price, the recent chair of the GPIAG and Dr. Ron Neville. They have a much larger budget and are more involved in health policy and research than we at the FPAGC ; are. One of the goals of the conference was to bring together international primary care physician leaders and to develop an ongoing relationship. To this end, the International Primary Care Respiratory Group was formed. Dr. Price reflected on how the conference had created and built momentum in the primary care respiratory arena and highlighted the excellent research and education work being carried out by the numerous primary care organizations. Positive international collaborative activities would continue the enthusiasm generated by the conference and drive it forward. It was agreed that we would continue the success of the GPIAG conference with a biannual conference, next in Europe. It will likely be the Netherlands in 2002 and Australia in 2004. The chairperson of this group will be from the country hosting the conference with the vice-chairman being from the country hosting the following international conference on a rotational basis. The conferences may be held in association with other meetings in the future When I know more about dates, I will let you know, as these will be outstanding respiratory care conferences to attend.
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Precautions adverse effects include nausea, vomiting, and aspiration if the airway is not secure; monitor for bowel sounds to minimize risk of charcoal ileus; not very effective in poisonings of ethanol, methanol, and iron salts; induce emesis before giving activated charcoal; after emesis with ipecac syrup, patient may not tolerate activated charcoal for 1-2 h; can administer in early stages of gastric lavage; without sorbitol, gastric lavage returns are black drug category: antidotes - used in the management of poisoning and overdose, prevention of toxic effects, or metabolic disorders where toxic substances accrue.
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8th National Conference on Medical Sciences 8-9 May 2003 Universiti Sains Malaysia scales to include some elements of handicap concept. Physical disability is defined as the inability to accomplish one or more ADL or IADL. Separate multiple logistic regression is used to determine the risk factors for both physical disabilities. Significant risk factors of ADL were age and total cholesterol whereas for IADL were income, diastolic blood pressure and hearing impairment. There is a strongly significant association between ADL and IADL. These findings suggest that certain sociodemographic characteristics, medical illnesses and positive health behaviour did have association with physical disability in elderly. ABSTRACT CODE O - B1 - 3.
Department of Pharmaceutical and Medicinal Chemistry, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria. 2 National Institute for Pharmaceutical Research and Development Idu, Abuja, Nigeria and potassium.
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Following negotiations, Gilead and Board Staff agreed that Gilead would propose to sell Viread in Canada at an average price not to exceed $15.1250 per 300 mg tablet. Board Staff recommended that it was appropriate for the Board to conclude that it would not have sufficient grounds to make an order under section 83 of the Act with respect to Viread, taking into consideration the factors set out in section 85 of the Act. The Board received one submission in response to its Notice and Comment from the Canadian Treatment Action Council CTAC ; . There were no submissions from the Ministers of Health in the provinces and territories. Gilead and Board Staff filed written submissions in response to the submission from CTAC and pravachol.
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Anongnud Sasok. Development of clinical nursing practice guideline for increasing drug compliance in schizophrenic patients. Bangkok : Mahidol University, 2005. 171 p. R E33770 ; Jarunya Sanguanpour. Development of clinical nursing practice guidelines for a psychoeducational program for patients with epilepsy. Bangkok : Mahidol University, 2005. 85 p. R E33768 ; Jaruwan Heapthamai. The development of a clinical nursing practice guideline for a psycho-educational program for caregivers of schizophrenic patients. Bangkok : Mahidol University, 2006. 96 p. R E34078 ; Manee Sakunpunphuk. Clinical nursing practice guideline for post extubation care in infant patients. Bangkok : Mahidol University, 2006. 142 p. R E34219 ; Mayuree Moonsawade. Clinical nursing practice guideline for promoting self-care ability of persons with hypertension. Bangkok : Mahidol University, 2005. 170 p. R E33756 ; Nuchjaree Kidjawan. The development of a clinical nursing practice guideline for prevention and management of perineal dermatitis in neurological patients with incontinence. Bangkok : Mahidol University, 2005. 117 p. R E33401 ; Prawida Patanun. The development of a clinical nursing practice guideline for post suicide attempt adults. Bangkok : Mahidol University, 2005. 107 p. R E33767 ; Samruay Nawarak. The development of clinical nursing practice guideline for managing pain in patients with cancer. Bangkok : Mahidol University, 2006. 182 p. R E34069 and prednisone.
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The first study to prospectively investigate insulin pump therapy in diabetic pre-school aged children was published in 2004.5 This controlled clinical trial enrolled 42 patients, of whom 37 completed six months of therapy. Compared with multiple daily injections MDI ; , pump therapy was not associated with differences in blood sugar control, severe hypoglycemia, or episodes of diabetic ketoacidosis. Pump therapy appeared to be safe and was well tolerated. Parental satisfaction with CSII was high, and nearly all families chose to continue to use an insulin pump after completion of the study. Two additional prospective controlled trials of insulin pump therapy in children less than six years of age were subsequently performed.6, 7 In the first, CSII was compared with a conventional insulin regimen consisting of MDI over a period of 12 months.6 Overall metabolic control, diabetes quality of life, and incidence of hypoglycemia were similar in the two groups. None of the subjects experienced diabetic ketoacidosis. Similar to the previous study, all of the patients elected to continue to use CSII after the study ended. In the other study, similar results were reported, and again, all of the patients elected to continue on CSII after completion of the study.7 Although the above studies involved small numbers of patients treated for short periods of time, the results from these prospective clinical trials are remarkably consistent. Contrary to what is often believed by the lay public, use of an insulin pump does not necessarily improve glycemic control in very young children.8 The lack of improvement in diabetes control from CSII in the very young child suggests that justification for this approach may come from lifestyle concerns rather than a medical imperative. The widespread preference for insulin pumps on the part of parents of young diabetic children is striking.Although and premarin.
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A classic physical finding is called Murphy's sign that is found by placing the patient in a supine position and palpating the right upper quadrant. Murphy's sign is present if the patient's ability to inspire air is restricted by severe pain. Cystitis Bladder Infection ; Cystitis is a common cause of abdominal pain particularly in women. It usually affects the lower abdominal quadrants. Diverticulitis A diverticulum is a sac that develops in the wall of the large intestine. Diverticulitis occurs when a sac becomes inflamed and infected. Occasionally, the sac will rupture, bleed or cause obstruction and lead to abdominal pain. Because this is a common source of inflammation, a patient may report a history of flare-ups. Most people over the age of 50 have had a few diverticula. Ectopic Pregnancy An ectopic pregnancy is a fetal implantation outside the uterus, most typically in the fallopian tube. In a fallopian implantation, a rupture can occur usually between 2-12 weeks. Always consider the possibility of ectopic pregnancy in females of childbearing age with lower abdominal pain. Complaints can include severe right or left lower quadrant or unilateral abdominal pain. It may be described as cramping and radiating to the right or left shoulder an example of referred pain ; . Ask about missed or irregular menstrual cycles or spotting and history of ectopic pregnancy or pelvic inflammatory disease. Esophagitis Esophagitis is inflammation of the lower esophagus usually caused by acid that regurgitates due to a weak cardiac sphincter, the gate between the lower esophagus and stomach. It is often associated with peptic ulcer disease. Patients with esophagitis may report a history of hiatal hernia or esophageal reflux and often take antacid medications like Pepcid, Zantac, Prilosec and Axid. Symptoms may mimic those of myocardial infarction or angina. The pain associated with esophagitis is commonly felt as a burning substernal chest pain that increases when the patient lies down and can be relieved with antacids and cool liquids. The patient may also describe a bitter or foul taste in the mouth. Food Poisoning Food poisoning can be caused by many different bacteria and toxins. A common form of food poisoning is staphylococcal food poisoning. In this type of illness, the patient usually presents with an abrupt onset of severe nausea, cramps, vomiting and sometimes diarrhea. Typically the suspect food was ingested up to six hours prior to onset of the symptoms. Ask about the symptoms of others who may have eaten the same food. This ailment is usually self-limiting but the patient may need treatment for nausea, vomiting and dehydration. Intestinal Flu "Intestinal flu" is a general term for a self-limiting intestinal problem that usually and
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Than the effect of missing one dose in a seven- to 10-day antibiotic regimen and would have little impact on the overall outcome of antibiotic therapy. A significance rating of 5 is given to this unlikely interaction because the reaction is, at most, mild in severity. Nevertheless, because alternative local anesthetics are available, the use of procaine for local anesthesia with patients receiving sulfonamide therapy should be avoided when feasible. Amide local anesthetics with inhibitors of metabolism. After absorption, amide local anesthetics such as lidocaine and mepivacaine are broken down primarily in the liver. The metabolic reactions usually involve dealkylation of the terminal nitrogen of the local anesthetic, then oxidation, hydrolysis, conjugation or a combination of these. Elimination half-lives for amide local anesthetics used in dentistry are relatively short, ranging from 1.5 to 3.5 hours, and peak plasma concentrations usually are seen within 45 minutes of administration. For drugs such as dental anesthetics that undergo hepatic metabolism and have short metabolic half-lives, hepatic blood flow is the rate-limiting variable in drug elimination.7 Because local anesthetic toxicity follows systemic uptake of the local anesthetic from the injection site, avoidance of elevated blood concentrations of local anesthetics always has been recommended. Limiting the total dose and using vasoconstrictors are two common means of avoiding local anesthetic toxicity. Some concern exists that impaired hepatic function, stemming from chronic liver disease or concomitant drug therapy, may decrease the rate of local anesthetic elimination, resulting in an elevation of peak plasma concentrations. This concern is most significant with multidose or steady-state infusion therapies, such as when intravenous lidocaine is used to manage cardiac arrhythmias. The peak plasma drug concentration after a single administration of a local anesthetic is determined primarily by the rate of systemic absorption and tissue distribution. Figure 2 illustrates a computer-simulated plasmatime curve after the administration of one cartridge of 2 percent lidocaine, 1: 100, 000 epinephrine total dose of 36 milligrams, elimination half-life of 90 minutes, volume of distribution of 84 liters and peak concentration at 30 minutes ; .15, 16 A twofold increase in lidocaine's metabolic half-life value to 180 minutes ; increases the peak concentration from 0.34 micrograms mL to 0.37 g mL. When lidocaine's half-life is adjusted to 15 hours a tenfold increase that is well beyond the impairment seen with severe liver disease ; , the peak blood concentration is increased only 21 percent 0.41 micrograms mL ; . Changes in hepatic metabolic function, and subsequently lidocaine's elimination half-life, cause only a minimal elevation of the peak blood concentrations after single-dose anesthetic therapy. The adverse drug interactions described here result from changes in liver amidase activity, decreased hepatic blood flow or both. Although these reactions have been well-documented, their significance after single-dose anesthetic therapy is usually insignificant clinically. Cimetidine. Cimetidine Tagamet, SmithKline Beecham ; is a histamine H2-receptor antagonist known to inhibit the hepatic oxidative enzymes needed for the metabolism of many drugs, including lidocaine. When the elimination of lidocaine is slowed, blood concentrations after steady-state infusion may increase as much as 50 percent.17 Following administration for dental anesthesia, blood concentrations of lidocaine during its terminal elimination phase may remain elevated for an extended period. This inhibition is not seen with other histamine H2-receptor antagonists such as ranitidine Zantac, Glaxo Wellcome ; or famotidine Pepcid, Merck & Co. Inc. ; .18, 19 Classic local anesthetic overdose reactions theoretically are possible, particularly when high doses of lidocaine are used or when reinjection is necessary. However, as illustrated in Figure 2, peak blood concentrations of lidocaine after a single dose of lidocaine for dental anesthesia therapy are increased only minimally. Increased risk of lidocaine toxicity after administration of a single dose for dental anesthesia resulting from coadministration of cimetidine is unlikely and unreported. A significance rating of 5, therefore, is applicable. Propranolol. It has been reported that following intravenous infusion of lidocaine, the -adrenergic blocker propranolol Inderal, Wyeth-Ayerst ; can decrease hepatic blood flow 11 percent and reduce the clearance of lidocaine by as much as 40 percent.20 As with the previously discussed drug interaction with cimetidine, lidocaine blood concentrations may remain ele545 and
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As time ticks by, the burning in my throat subsides, the weight on my chest lightens, but I get a headache from the nitroglycerin tablet. The nurse gives me Tylenol. A short time passes, three more cardiac patients arrive in Urgent Care. The place is buzzing as one of the nurses tell me it's the end of her shift. A different nurse arrives. A lab tech draws blood. I lay on the gurney and wait. The Cardiologist arrives and asks me the usual questions about my health and lifestyle. I walk almost daily and practice yoga several times a week. I'm a semi-vegetarian - I don't eat red meat. I don't smoke, don't drink, don't take drugs. I'm surprised by his next comment. "If I met you on the street and you told me your symptoms, I'd think you were having a bad case of heartburn and tell you to take a Pepcid, but your EKG looks strange, so I faxed it to my boss." What? You faxed it to your boss? What's going on? I remember hearing that July is the worse time to be in the hospital because the new interns arrive. This doctor looks young. I wonder how long he's been on the job. "We'll wait and see what your enzymes look like when we get your blood test results. In the meantime, just lay here and relax." He pats my hand and leaves without another word. I close my eyes and rest. I feel more like my normal self although I'm still tired. Jim and I sit and wait for the blood test results. The young Cardiologist walks in an hour later. "Good news. Your enzyme levels are normal, but in cases like this, we always take a second blood test six hours later, so we are going to move you to an observation room in the hospital. If your blood test comes back normal, which I suspect it will, we'll give you a stress test and send you home." Oh goody. Normal enzyme levels. I haven't a clue what that means, but laying in the hospital for six hours just to be sure isn't that bad. "Do you think I should call Connie?" I ask Jim. Connie, my sister, is a nurse in Illinois and I always call her when I have a medical question. "Maybe we should wait and get the results of the second blood test before calling anyone. We don't want to worry anyone needlessly, " he says. I agree. I've been caring for my mother, who has Alzheimer Disease. Also, two weeks ago, I returned from Pittsburgh where my mother-in-law was put on hospice with congestive heart failure and respiratory failure. Neither side of the family needed to worry about me right now. I'm holding my own. 2.
Vacation, neither. That scared me, Andy, and it made me lean in for an even closer look at my good girl. What I saw scared me even more. The way she'd changed her clothes, for instance. Not just one sweater for another, or a skirt for a dress; she'd changed her whole style of dressin, and all the changes were bad. You couldn't see her shape anymore, for one thing. Instead of wearin skirts or dresses to school, she was mostly wearin Aline jumpers, and they was all too big for her. They made her look fat, and she wasn't. At home she'd wear big baggy sweaters that came halfway to her knees, and I never saw her out of her jeans and workboots. She'd put some ugly rag of a scarf around her head whenever she went out, somethin so big it'd overhang her brow and make her eyes look like two animals peerin out of a cave. She looked like a tomboy, but I thought she'd put paid to that when she said so-long to twelve. And one night, when I forgot to knock on her door before I went into her room, she just about broke her legs gettin her robe offa the closet door, and she was wearin a slip - it wasn't like she was bollicky bare-ass or nothin. But the worst thing was that she didn't talk much anymore. Not just to me; considerin the terms we were on, I coulda understood that. She pretty much quit talkin to everybody, though. She'd sit at the supper-table with her head down and the long bangs she'd grown hangin in her eyes, and when I tried to make conversation with her, ask her how her day had gone at school and things like that, all I'd get back was 'Umkay' and 'Guesso' instead of the blue streak she used to talk. Joe Junior tried, too, and run up against the same stone wall. Once or twice he looked at me, kinda puzzled. I just shrugged. And as soon as the meal was over and the dishes was warshed, out the door or up to her room she'd go and
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Prozac fluoxetine ; . Barr Laboratories received six months' exclusivity for its 20mg fluoxetine capsule and entered the market immediately after the patent on Lilly's blockbuster antidepressant, Prozac, expired on Aug. 2, 2001. The impact of the Prozac patent expiration was significant, with generics controlling greater than 75% of overall fluoxetine prescriptions three months after their introduction. The full financial impact of generic fluoxetine will not be seen until February 2002, when multiple generics enter the market. Prozac had $2.2 billion in U.S. sales in 2000. Pelcid famotidine ; . The FDA approved generics by multiple manufacturers in April 2001 to compete with Merck's H-2 blocker, which had $755 million in U.S. sales in 2000. Generics for Pepciid now represent greater than 85% of all famotidine prescriptions. Mevacor lovastatin ; . In July, Merck won a court-ordered six-month patent extension for its cholesterol-reducing drug Mevacor by submitting to the FDA a supplemental new drug application based.
ORAP .21 ORFADIN .27 orphenadrine aspirin caffeine .23 ORTHO EVRA .26 ORTHO TRI-CYCLEN LO .26 OVIDE .41 oxaprozin .5 OXSORALEN-ULTRA .39 oxybutynin .32 oxybutynin ext-rel .32 oxycodone.6 oxycodone ext-rel.6 oxycodone acetaminophen.6 OXYTROL.32 PACERONE.15 paclitaxel.12 PANCRELIPASE .31 pancrelipase delayed-rel.31 PANGESTYME.31 PANOKASE .31 PANRETIN .41 papain urea oint, spray .41 PARCOPA.21 PARNATE .19 paroxetine HCl.20 PATANOL.41 PAXIL susp .20 peg 3350 electrolytes .31 PEGANONE .19 PEGASYS.34 PEG-INTRON.34 penicillin inj .7 penicillin VK.8 PEPCID susp.30 pergolide .21 permethrin 5% .41 perphenazine .21 phenazopyridine .32 phenytoin inj .19 phenytoin sodium extended.19 PHOSLO .28 PHOTOFRIN .13 pilocarpine .32, 43 pindolol.16 PLAN B .26 PLARETASE.31 PLAVIX .33 PLEXION SCT.41 podofilox soln .41 53.
NoRPace cR See disopyramide phosphate eR nortriptyline . NoRvasc NovoliN 70 30 . NovoliN N NovoliN R Novolog . Novolog MiX 70 30 . NulYTelY . NuTRoPiN . nystatin . nystatin traimcinolone . nystatin susp . octreotide . ocuFloX . See ofloxacin ofloxacin . omeprazole DR oMNiceF . oXisTaT . oXsoRaleN-ulTRa oxybutynin . oxycodone . oxycodone acetaminophen . oxycodone eR 12hr . oXYcoNTiN . See oxycodone eR 12hr PaRNaTe . paroxetine . PaTaNol . PaXil . See paroxetine PaXil cR PaXil oral susp . PeDiaZole . See erythromycin sulfisoxazole Peg-iNTRoN 10, 20 peg 3350 and electrolytes . peg 3500 packets . penicillin v potassium . PeNTaM . See pentamidine PeNTasa PePciD . See famotidine PeRcoceT . oxycodone acetaminophen PeRiDeX . chlorhexidine gluconate.
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