Acetaminophen (Paracetamol) associated serious skin reactions:

 Dr.Naina Mohamed Pakkir Maideen

v FDA notified healthcare professionals and patients that Acetaminophen (Paracetamol) has been associated with a risk of rare but serious skin reactions including Stevens - Johnson syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and Acute Generalized Exanthematous Pustulosis (AGEP) which can be fatal.

v These reactions can occur with first-time or any time use of Acetaminophen (Paracetamol).

v Health care professionals should be aware of this rare risk of Acetaminophen (Paracetamol) induced serious skin reactions.

v Patients should stop taking the product immediately when they develop a rash or other skin reaction and seek medical attention right away.

Evolocumab - New Drug to Lower ‘LDL' Cholesterol:

 Dr.Naina Mohamed Pakkir Maideen

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Evolocumab is a "human monoclonal antibody".

—  It is an inhibitor of Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9).

—  PCSK9 is produced by liver and is a regulatory protein which targets LDL receptors for degradation. Hence, LDL receptors would be least available to remove LDL-C (Bad cholesterol), from the blood.

—  Inhibition of PCSK9 increases the number of LDL receptors on the surface of liver cells which leads to reduction of LDL levels in the bloodstream.

—  According to the results of a global trial, Evolocumab can further knock down cholesterol levels in people who take cholesterol-busting statin medications.

—  Evolocumab will be mostly helpful in treating people with a genetic disorder that causes them to have high cholesterol and the people with high cholesterol who can't take large doses of statins.

—  It is a very specific antibody and it seems to be very well-tolerated without any drug interactions or any side effects.

—  Evolocumab is under evaluation and once it gain U.S. Food and Drug Administration approval, the drug will be expensive.

Antibiotic Resistance:

p The ability of pathogens that works against the antibiotics is termed Antibiotic Resistance.

p Antibiotic resistance may be caused by many factors including…

Ø Overuse

Ø Misuse

Ø Availability of OTC antibiotics

Ø Healthcare Workers

Ø Hospitalized Patients

Ø Animal Feed

Ø Antibiotics in food and water

Ø Antibiotic resistance in genetically modified crops

p There are three types of Antibiotic resistance such as…

Ø Natural or inherent resistance

Ø Mutational resistance

Ø Acquired (Extrachromosomal) resistance

p Bacterial resistance may be developed by the mechanisms like…

Ø Enzymatic degradation of the drug

Ø Modification of the drug's target

Ø Reduced permeability of the drug

Ø Efflux pumping of Antibiotics

Ø Modification of Target ribosomes

Ø Alteration of Pathway

p Antibiotic resistance may be reduced by…

Ø Stop unnecessary antibiotic prescriptions

Ø Complete the course of antibiotic prescriptions

Ø Promote Vaccine recommendations

Ø Implement infection control measures, such as hand washing, isolation precautions, and immunization

Ø Improve communication, education and training.

Negative Effects of "Skipping Breakfast":

¢ Breakfast is the most important meal of the day.

¢ Skipping breakfast may leads to

—  Elevated risk of Coronary Heart Disease (CHD)

—  Disruption of Metabolism

—  Weight Gain

—  Type 2 Diabetes Mellitus

—  Impaired Lipid Level

—  Lowered concentration level

¢ The risk of Coronary Heart Disease (CHD) is elevated by impairment of insulin sensitivity and serum lipids caused by skipping of breakfast.

¢ Obesity may be induced by breakfast skipping through disruption of metabolism.

¢ Breakfast skipping may lead to weight gain due to intense eating in the afternoon.

¢ The risk of Type 2 Diabetes Mellitus is increased by insulin resistance induced by skipping of breakfast.

¢ The concentration, memory and coordination may be lowered by reduced blood supply to the brain which is caused by breakfast skipping.

¢ Anything to eat at breakfast is better than going hungry.

¢ Even “Ritual Fasting” or “Fasting Therapy” makes way for the breakfast.

¢ "Don't skip breakfast"

High Alert Medications:

More presentations from Naina Mohamed Pakkir Maideen

Ø High alert Medications (HAMs) are the drugs or medications having heightened risk of causing significant patient harm when they used in error.

Ø Hypertonic electrolytes solutions are considered as High Alert Medications due to their nature of abundant release of electrolytes in to the bloodstream.

Ø Hypertonic Calcium Chloride Injection:

·       It is indicated in Cardiac Resuscitation, Hypocalcemic Tetany, Magnesium Sulphate overdose and lead coli.

·       It is Contraindicated in Ventricular Fibrillation.

·       Overdose of Calcium Chloride 10% Injection leads to Hypercalcemia. If not treated it may cause confusion, delirium and coma followed by death.

·        Overdose of Calcium Chloride 10% Injection is treated by 4–6 L of intravenous saline over the first 24 h to treat Dehydration and by loop diuretics to enhance sodium and calcium excretion.

Ø Hypertonic Magnesium Sulphate Injection:

·       Magnesium sulphate is indicated in patients with Hypomagnesemia, Torsades de Pointes, Status Asthmaticus, Eclampsia & Pre eclampsia and Uterine Tetany.

·       Magnesium sulphate is Contraindicated in patients with Heart block, Myocardial damage and Impaired Renal function.

·       Overdose of Magnesium sulphate Injection leads to progressive weakness of respiratory muscles leading to respiratory failure. If not treated it may cause hypoxia, ischemia and cardiac arrest.

·       Overdose of Magnesium sulphate is treated by One ampoule of Calcium gluconate 1gm (10ml of 10% Solution) given intravenously for over 2-3 minutes.

Ø Hypertonic Potassium Chloride Injection:

·       It is indicated in Hypokalemia.

·       It is Contraindicated in Hyperkalemia and Renal failure.

·       Overdose of Hypertonic Potassium Chloride Injection may cause Paresthesias of the extremities, Muscular or respiratory paralysis, Mental confusion, Weakness, Hypotension, Cardiac arrhythmias, Heart block, Electrocardiographic abnormalities and Cardiac arrest.

·       Overdose of Hypertonic Potassium Chloride Injection can be treated by intravenous Dextrose Injection, USP, 10% or 25%, containing 10 units of crystalline insulin per 20 grams of dextrose and is administered 300 to 500 mL per hour.

Ø Insulins:

·       Insulin is indicated for the treatment of both Type 1 and Type 2 diabetes mellitus.

·       It is Contraindicated in Hypoglycemia.

·       Overdose of Insulin leads to hypoglycemia. If untreated it may cause impairment of brain functions, convulsions and coma followed by death.

·       Hypoglycemia and Hypokalemia caused by overdose of Insulin should be monitored.