Barts Health NHS Trust provides information about using the drug Cladribine to treat multiple sclerosis. Cladribine works by suppressing the immune system specifically lymphocytes, or white blood cells, which are implicated in MS. It has been shown to reduce relapses and disease progression in clinical trials for relapsing MS. Common side effects include headaches and nausea. Cladribine is not currently licensed for use in treating MS in the UK, but is being offered as an unlicensed treatment option.
Barts ms clinical guidance for subcutaneous cladribineBartsMSBlog
This document is a package leaflet that provides information for users of LITAK 2 mg/ml solution for injection, which contains the active substance cladribine. It is used to treat hairy cell leukemia. The document provides details about the proper use of LITAK, including dosage, administration, possible side effects and storage instructions. It summarizes that LITAK is injected subcutaneously daily for 5 days to treat hairy cell leukemia and lists very common side effects like infections, fever, and low blood cell counts.
This document outlines the consent form for patients receiving Cladribine treatment for multiple sclerosis (MS) at Barts Health NHS Trust hospitals. It details 5 points that patients must initial to confirm their understanding of and agreement to the risks and monitoring involved with Cladribine treatment. These include being informed of the risk-benefit profile of Cladribine based on clinical trials, understanding it is not a licensed treatment for MS, discussing alternative treatments, agreeing to adhere to safety monitoring protocols, and using contraception during treatment and for 6 months after.
Cases of progressive multifocal leukoencephalopathy (PML), a rare brain disease caused by the JC virus, have been reported in patients treated with the drug cladribine. PML diagnosis occurred months to years after cladribine treatment and was associated with prolonged lymphopenia in several cases. Healthcare professionals are advised to consider PML in patients with new neurological symptoms who have been treated with cladribine. Patients who develop suspected PML should discontinue cladribine treatment. Manufacturers are updating drug information materials to include this safety risk.
Information, consent sheet, safety checklist, and Litak summary of medical product characteristics concerning the use of cladribine in people with multiple sclerosis, who are not eligible for disease modifying treatment under the commissioning policies of NHS England.
Disclaimer of liability:
The material and information contained in this document is for general information purposes only. You should not rely upon the material or information on the website as a basis for making any medical, legal or any other decisions. Whilst we endeavour to keep the information up to date and correct, neither the author Klaus Schmierer, his primary employer Queen Mary University of London, or Barts Health NHS Trust, make any representations or warranties of any kind, express or implied about the completeness, accuracy, reliability, suitability or availability with respect to the information contained in this document for any purpose. Any reliance you place on such material is therefore strictly at your own risk.
Klaus Schmierer, Queen Mary University of London, and Barts Health NHS Trust will not be liable for any false, inaccurate, inappropriate or incomplete information presented in this document.
Although every effort is made to keep this document up and running smoothly, due to the nature of the Internet and the technology involved, Klaus Schmierer, Queen Mary University of London, or Barts Health NHS Trust take no responsibility for, and will not be liable for the website being temporarily unavailable due to technical issues (or otherwise) beyond its control or for any loss or damage suffered as a result of the use of or access to, or inability to use or access this website whatsoever.
To the extent not prohibited by law, in no circumstances shall Klaus Schmierer, Queen Mary University of London, or Barts Health NHS Trust be liable to you or any other third parties for any loss or damage (including, without limitation, damage for loss of health, business or loss of profits) arising directly or indirectly from your use of or inability to use, this document or any of the material contained in it.
A pharmacists mom's experience with the health care systemPASaskatchewan
This document summarizes a pharmacist's presentation about her experience with her son Logan's rare medical condition called Nephrogenic Diabetes Insipidus (NDI). The presentation details Logan's diagnosis and treatment journey, including a critical medication error that occurred during a medical procedure. The pharmacist discusses how an intravenous potassium order was written and administered incorrectly, putting Logan at risk of a potentially fatal overdose. She analyzes the multiple factors that contributed to the error and emphasizes the important role of pharmacists and technology in preventing future mistakes. The pharmacist concludes by urging healthcare professionals to truly listen to patients and families, stop unsafe situations from progressing, and continue working to make the healthcare system safer for all.
Crizotinib Capsules 200mg, 250mg Taj Pharma PILTajPharmaQC
Crizotinib 200mg/250mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Crizotinib Dosage & Rx Info | Crizotinib Uses, Side Effects Crizotinib: Indications, Side Effects, Warnings, Crizotinib -Drug Information –Taj Pharma, Crizotinib dose Taj pharmaceuticals Crizotinib interactions, Taj Pharmaceutical Crizotinib contraindications, Crizotinib price, Crizotinib Taj Pharma Crizotinib SmPC-Taj Pharma Stay connected to all updated on Crizotinib Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
Omnacortil (Prednisolone Tablets) is a corticosteroid hormone which is used to treat conditions such as arthritis, blood problems, immune system disorders, skin and eye conditions, breathing problems, cancer, and severe allergies. It decreases the immune system's response to various diseases to reduce symptoms such as pain, swelling and allergic-type reactions.
Barts ms clinical guidance for subcutaneous cladribineBartsMSBlog
This document is a package leaflet that provides information for users of LITAK 2 mg/ml solution for injection, which contains the active substance cladribine. It is used to treat hairy cell leukemia. The document provides details about the proper use of LITAK, including dosage, administration, possible side effects and storage instructions. It summarizes that LITAK is injected subcutaneously daily for 5 days to treat hairy cell leukemia and lists very common side effects like infections, fever, and low blood cell counts.
This document outlines the consent form for patients receiving Cladribine treatment for multiple sclerosis (MS) at Barts Health NHS Trust hospitals. It details 5 points that patients must initial to confirm their understanding of and agreement to the risks and monitoring involved with Cladribine treatment. These include being informed of the risk-benefit profile of Cladribine based on clinical trials, understanding it is not a licensed treatment for MS, discussing alternative treatments, agreeing to adhere to safety monitoring protocols, and using contraception during treatment and for 6 months after.
Cases of progressive multifocal leukoencephalopathy (PML), a rare brain disease caused by the JC virus, have been reported in patients treated with the drug cladribine. PML diagnosis occurred months to years after cladribine treatment and was associated with prolonged lymphopenia in several cases. Healthcare professionals are advised to consider PML in patients with new neurological symptoms who have been treated with cladribine. Patients who develop suspected PML should discontinue cladribine treatment. Manufacturers are updating drug information materials to include this safety risk.
Information, consent sheet, safety checklist, and Litak summary of medical product characteristics concerning the use of cladribine in people with multiple sclerosis, who are not eligible for disease modifying treatment under the commissioning policies of NHS England.
Disclaimer of liability:
The material and information contained in this document is for general information purposes only. You should not rely upon the material or information on the website as a basis for making any medical, legal or any other decisions. Whilst we endeavour to keep the information up to date and correct, neither the author Klaus Schmierer, his primary employer Queen Mary University of London, or Barts Health NHS Trust, make any representations or warranties of any kind, express or implied about the completeness, accuracy, reliability, suitability or availability with respect to the information contained in this document for any purpose. Any reliance you place on such material is therefore strictly at your own risk.
Klaus Schmierer, Queen Mary University of London, and Barts Health NHS Trust will not be liable for any false, inaccurate, inappropriate or incomplete information presented in this document.
Although every effort is made to keep this document up and running smoothly, due to the nature of the Internet and the technology involved, Klaus Schmierer, Queen Mary University of London, or Barts Health NHS Trust take no responsibility for, and will not be liable for the website being temporarily unavailable due to technical issues (or otherwise) beyond its control or for any loss or damage suffered as a result of the use of or access to, or inability to use or access this website whatsoever.
To the extent not prohibited by law, in no circumstances shall Klaus Schmierer, Queen Mary University of London, or Barts Health NHS Trust be liable to you or any other third parties for any loss or damage (including, without limitation, damage for loss of health, business or loss of profits) arising directly or indirectly from your use of or inability to use, this document or any of the material contained in it.
A pharmacists mom's experience with the health care systemPASaskatchewan
This document summarizes a pharmacist's presentation about her experience with her son Logan's rare medical condition called Nephrogenic Diabetes Insipidus (NDI). The presentation details Logan's diagnosis and treatment journey, including a critical medication error that occurred during a medical procedure. The pharmacist discusses how an intravenous potassium order was written and administered incorrectly, putting Logan at risk of a potentially fatal overdose. She analyzes the multiple factors that contributed to the error and emphasizes the important role of pharmacists and technology in preventing future mistakes. The pharmacist concludes by urging healthcare professionals to truly listen to patients and families, stop unsafe situations from progressing, and continue working to make the healthcare system safer for all.
Crizotinib Capsules 200mg, 250mg Taj Pharma PILTajPharmaQC
Crizotinib 200mg/250mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Crizotinib Dosage & Rx Info | Crizotinib Uses, Side Effects Crizotinib: Indications, Side Effects, Warnings, Crizotinib -Drug Information –Taj Pharma, Crizotinib dose Taj pharmaceuticals Crizotinib interactions, Taj Pharmaceutical Crizotinib contraindications, Crizotinib price, Crizotinib Taj Pharma Crizotinib SmPC-Taj Pharma Stay connected to all updated on Crizotinib Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
Omnacortil (Prednisolone Tablets) is a corticosteroid hormone which is used to treat conditions such as arthritis, blood problems, immune system disorders, skin and eye conditions, breathing problems, cancer, and severe allergies. It decreases the immune system's response to various diseases to reduce symptoms such as pain, swelling and allergic-type reactions.
Generic Tadalafil Medications to Effectively Treat Erectile DysfunctionThe Swiss Pharmacy
Generic Tadalafil is a prescription medication which is FDA-approved to treat the following in men: erectile dysfunction (ED), a condition in which you can’t get or keep an erection, symptoms of benign prostatic hyperplasia (BPH), a prostate condition that may cause problems with urination and ED and symptoms of BPH together.
Tadalafil's effect starts working in 30 minutes and lasts for upto 36 hours. Tadalafil can also be used daily by using the 5 mg dose, so you can be ready anytime. It’s available in three strengths: 5mg, 10 mg and 20 mg. It is also available as an Oral jelly in the strength of 20 mg.
Tadalafil tablets are also indicated to improve the ability to exercise in adults with Pulmonary Arterial Hypertension (PAH).
1. Choice of anti-epileptic drugs depends on seizure type and patient needs, starting with low doses of a single drug and gradually increasing. Combination therapy may be used if seizures are not controlled.
2. Treatment should begin early and be the simplest regimen. Drugs should be gradually withdrawn after at least 3 years of seizure freedom.
3. Carbamazepine and phenytoin are first-line treatments for generalized tonic-clonic seizures, while valproate is preferred for absence seizures and myoclonic seizures.
Pradaxa (Dabigatran Etexilate Capsules) is used for prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (NVAF), with one or more risk factors, such as prior stroke or transient ischemic attack (TIA); age 75 years or greater, heart failure (NYHA Class II or higher); diabetes mellitus; hypertension.
This medicine is also used for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults
Prednisone is a steroid medication used to treat conditions caused by inflammation and reduce the immune system's response. It works by suppressing the production of antibodies to stabilize an overactive immune system. Prednisone should be taken as directed by a doctor and requires a gradual reduction in dosage before stopping to avoid withdrawal effects. Common side effects include insomnia, nausea, fatigue, and increased hunger. Those taking prednisone should avoid sources of infection and get approval from their doctor before receiving immunizations or taking other medications due to interaction risks.
Generic Finasteride 5mg Tablets are used for the treatment and control of benign prostatic hyperplasia (BPH) in patients with an enlarged prostate to cause regression of the enlarged prostate, improve urinary flow and improve the symptoms associated with BPH.
This medication is also used to reduce the incidence of acute urinary retention and the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.
Finax (Finasteride 1 mg Tablets) are used to treat male pattern hair loss by decreasing levels of DHT, a hormone that causes hair loss, helping to reverse balding and stimulate hair regrowth. Finax should be taken once daily with or without food. Side effects may include sexual dysfunction and breast changes but usually stop after discontinuing treatment. Finax is contraindicated in women and children.
The document provides guidelines for managing paracetamol poisoning through a flowchart approach. The flowchart guides medical professionals on assessing factors such as dosage, time of ingestion, and patient risk to determine appropriate treatment which may include administering activated charcoal, observing the patient, testing blood levels, or treating with intravenous N-acetylcysteine. It also provides dosing instructions for N-acetylcysteine and indicators for contacting specialist care.
Zolpiderm tartrate 5mg and 10mg tablets pil, taj pharmaceuticals.Taj Pharma
This document is a patient information leaflet for Zolpidem Tartrate 5mg and 10mg tablets produced by Taj Pharmaceuticals. It provides information on:
- What zolpidem is and what it is used for, which is the short-term treatment of insomnia.
- Contraindications and warnings for its use, including not taking it if you have breathing problems or a history of substance abuse.
- How to take zolpidem, including only taking it at bedtime for 2-4 weeks as prescribed by your doctor.
- Possible side effects and drug interactions to be aware of when taking zolpidem with other medications.
Tadalafil Dapoxetine Tablets to treat Erectile Dysfunction and Premature Eja...Clearsky Pharmacy
Tadalafil and Dapoxetine Combination medication is a combination containing Tadalafil 20mg and Dapoxetine 60mg in a single tablet.
Tadalafil Dapoxetine Tablets are used for the treatment of male erectile dysfunction as well as treatment of premature ejaculation in men at the same time.
Tadalafil is used to treat men who have erectile dysfunction (also called sexual impotence).
These medicines prevent an enzyme called phosphodiesterase type-5 from working too quickly. By controlling the enzyme, Tadalafil helps to maintain an erection after the penis is stroked by increasing blood flow to the penis.
Dapoxetine Hydrochloride is used to treat premature ejaculation in adult men aged 18 to 64 years. Dapoxetine increases the time it takes to ejaculate and can improve the control over the ejaculation.
Crisanta (Drospirenone and Ethinyl Estradiol Tablets)Clearsky Pharmacy
Crisanta (Drospirenone and Ethinyl Estradiol Tablets) is used as an oral contraceptive. This medicine is also used to treat premenstrual dysphoric disorder (PMDD) or moderate acne.
Crizotinib 200mg/250mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Crizotinib Dosage & Rx Info | Crizotinib Uses, Side Effects Crizotinib: Indications, Side Effects, Warnings, Crizotinib -Drug Information –Taj Pharma, Crizotinib dose Taj pharmaceuticals Crizotinib interactions, Taj Pharmaceutical Crizotinib contraindications, Crizotinib price, Crizotinib Taj Pharma Crizotinib SmPC-Taj Pharma Stay connected to all updated on Crizotinib Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
Megalis (Generic Tadalafil Tablets) prescription medication which is FDA-approved to treat the following in men: erectile dysfunction (ED), a condition in which you can’t get or keep an erection, symptoms of benign prostatic hyperplasia (BPH), a prostate condition that may cause problems with urination and ED and symptoms of BPH together. Megalis comes as a tablet that you swallow. It’s available in two strengths: 10 mg and 20 mg.
Tadalafil tablets are also indicated for the treatment of pulmonary arterial hypertension (PAH).
Desogestrel and ethinyl estradiol 0.15mg and 0.03mg 0.02mg tablets pil, taj p...Taj Pharma
Desogestrel and ethinyl estradiol 0.15mg/0.03mg tablets Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Desogestrel and ethinyl estradiol Dosage & Rx Info | Desogestrel and ethinyl estradiol Uses, Side Effects , Desogestrel and ethinyl estradiol 0.15mg/0.03mg tablets: Indications, Side Effects, Warnings, Desogestrel and ethinyl estradiol - Drug Information - Taj Pharma, Desogestrel and ethinyl estradiol dose Taj pharmaceuticals Desogestrel and ethinyl estradiol interactions, Taj Pharmaceutical Desogestrel and ethinyl estradiol contraindications, Desogestrel and ethinyl estradiol price, Desogestrel and ethinyl estradiol , Taj Pharma Desogestrel and ethinyl estradiol 0.15mg/0.03mg tablets - Taj Pharma . Stay connected to all updated on Desogestrel and ethinyl estradiol Taj Pharmaceuticals Taj pharmaceuticals Hyderabad. Patient Information Leaflets, PIL.
Mrs. A is 28 weeks pregnant with gestational hypertension and proteinuria. Her fetus has normal growth but high umbilical artery resistance on Doppler.
The document discusses expectant management vs expedited delivery. For Mrs. A, expectant management is recommended up to 34 weeks given her fetus' normal growth. This involves strict maternal monitoring and interventions like corticosteroids for lung maturity.
The risks and components of expectant management are outlined, including frequent monitoring of maternal status and fetal wellbeing by tests like NST, BPP, growth scans and Doppler. Indications for earlier delivery include worsening maternal status, non-reassuring fetal testing or signs of fetal compromise.
Cognitive Behavorial Therapy for Insomnia k. Jensen f. RemillardPASaskatchewan
This document summarizes cognitive behavioral therapy for insomnia (CBT-I). It defines insomnia and discusses predisposing, precipitating, and perpetuating factors. It describes CBT-I as the first-line treatment for insomnia, focusing on addressing dysfunctional thoughts and behaviors. Key components of CBT-I include sleep hygiene, stimulus control therapy, sleep restriction therapy, and cognitive restructuring. The document outlines considerations for candidate selection and delivering CBT-I over multiple sessions, including reviewing sleep logs and assessing treatment progress.
1) Cladribine is an immunosuppressant drug that has been used to treat multiple sclerosis (MS) for many years and has been shown to be effective in reducing relapses and disease progression in clinical trials.
2) It works by suppressing lymphocytes, a type of white blood cell that is involved in MS, which lowers immune system activity that may be damaging in MS.
3) Cladribine is administered through subcutaneous injections over two 5-day treatment courses, one year apart, with monitoring of lymphocyte levels throughout treatment and follow-up.
This document discusses the importance and benefits of pharmacogenetic testing for physicians and their patients. It notes that pharmacogenetic testing can help physicians determine the right drug, dose, and timing for each individual patient to reduce adverse drug reactions and improve outcomes. Not utilizing this testing could open physicians up to legal liability issues. The document provides several case studies demonstrating how pharmacogenetic testing could have helped identify the right treatment for patients and avoided negative health consequences or legal risks for physicians. It also addresses the ease of testing, billing, and reimbursement to make the case for integrating pharmacogenetics into medical practice.
Chlorambucil 2 mg tablets smpc taj pharmaceuticalsTaj Pharma
CHLORAMBUCIL - Drug Information - Taj Pharma, CHLORAMBUCIL dose Taj pharmaceuticals CHLORAMBUCIL interactions, Taj Pharmaceutical CHLORAMBUCIL contraindications, CHLORAMBUCIL price, CHLORAMBUCIL Taj Pharma Cancer, oncologyChlorambucil 2 mg tablets SMPC- Taj Pharma . Stay connected to all updated on CHLORAMBUCIL Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Clozapine Tablets USP 25mg, 50mg and 100mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Clozapine Dosage & Rx Info | Clozapine Uses, Side Effects Clozapine: Indications, Side Effects, Warnings, Clozapine -Drug Information –Taj Pharma, Clozapine dose Taj pharmaceuticals Clozapine interactions, Taj Pharmaceutical Clozapine contraindications, Clozapine price, Clozapine Taj Pharma Clozapine SmPC-Taj Pharma Stay connected to all updated on Clozapine Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
The Committee for Medicinal Products for Human Use (CHMP) adopted a negative opinion, recommending the refusal of the marketing authorisation for the medicinal product Kynamro, intended for the treatment of certain forms of familial hypercholesterolaemia. While Kynamro was effective at reducing LDL cholesterol levels, the CHMP was concerned about its safety profile. A high proportion of patients stopped taking Kynamro due to side effects and there were concerns about liver toxicity and an increased risk of cardiovascular events. Therefore, the CHMP determined that the risks of Kynamro did not outweigh its benefits and recommended refusing its marketing authorisation.
Rituximab therapy resulted in remission in nearly half of patients with difficult-to-treat steroid-resistant nephrotic syndrome and a 95% reduction in relapse frequency in patients with steroid-dependent nephrotic syndrome. Minimal side effects were observed. Rituximab effectively depleted B-cells and showed promise as an alternative treatment for difficult cases of nephrotic syndrome. Longer-term studies are still needed to assess long-term outcomes and safety.
Generic Tadalafil Medications to Effectively Treat Erectile DysfunctionThe Swiss Pharmacy
Generic Tadalafil is a prescription medication which is FDA-approved to treat the following in men: erectile dysfunction (ED), a condition in which you can’t get or keep an erection, symptoms of benign prostatic hyperplasia (BPH), a prostate condition that may cause problems with urination and ED and symptoms of BPH together.
Tadalafil's effect starts working in 30 minutes and lasts for upto 36 hours. Tadalafil can also be used daily by using the 5 mg dose, so you can be ready anytime. It’s available in three strengths: 5mg, 10 mg and 20 mg. It is also available as an Oral jelly in the strength of 20 mg.
Tadalafil tablets are also indicated to improve the ability to exercise in adults with Pulmonary Arterial Hypertension (PAH).
1. Choice of anti-epileptic drugs depends on seizure type and patient needs, starting with low doses of a single drug and gradually increasing. Combination therapy may be used if seizures are not controlled.
2. Treatment should begin early and be the simplest regimen. Drugs should be gradually withdrawn after at least 3 years of seizure freedom.
3. Carbamazepine and phenytoin are first-line treatments for generalized tonic-clonic seizures, while valproate is preferred for absence seizures and myoclonic seizures.
Pradaxa (Dabigatran Etexilate Capsules) is used for prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (NVAF), with one or more risk factors, such as prior stroke or transient ischemic attack (TIA); age 75 years or greater, heart failure (NYHA Class II or higher); diabetes mellitus; hypertension.
This medicine is also used for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults
Prednisone is a steroid medication used to treat conditions caused by inflammation and reduce the immune system's response. It works by suppressing the production of antibodies to stabilize an overactive immune system. Prednisone should be taken as directed by a doctor and requires a gradual reduction in dosage before stopping to avoid withdrawal effects. Common side effects include insomnia, nausea, fatigue, and increased hunger. Those taking prednisone should avoid sources of infection and get approval from their doctor before receiving immunizations or taking other medications due to interaction risks.
Generic Finasteride 5mg Tablets are used for the treatment and control of benign prostatic hyperplasia (BPH) in patients with an enlarged prostate to cause regression of the enlarged prostate, improve urinary flow and improve the symptoms associated with BPH.
This medication is also used to reduce the incidence of acute urinary retention and the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.
Finax (Finasteride 1 mg Tablets) are used to treat male pattern hair loss by decreasing levels of DHT, a hormone that causes hair loss, helping to reverse balding and stimulate hair regrowth. Finax should be taken once daily with or without food. Side effects may include sexual dysfunction and breast changes but usually stop after discontinuing treatment. Finax is contraindicated in women and children.
The document provides guidelines for managing paracetamol poisoning through a flowchart approach. The flowchart guides medical professionals on assessing factors such as dosage, time of ingestion, and patient risk to determine appropriate treatment which may include administering activated charcoal, observing the patient, testing blood levels, or treating with intravenous N-acetylcysteine. It also provides dosing instructions for N-acetylcysteine and indicators for contacting specialist care.
Zolpiderm tartrate 5mg and 10mg tablets pil, taj pharmaceuticals.Taj Pharma
This document is a patient information leaflet for Zolpidem Tartrate 5mg and 10mg tablets produced by Taj Pharmaceuticals. It provides information on:
- What zolpidem is and what it is used for, which is the short-term treatment of insomnia.
- Contraindications and warnings for its use, including not taking it if you have breathing problems or a history of substance abuse.
- How to take zolpidem, including only taking it at bedtime for 2-4 weeks as prescribed by your doctor.
- Possible side effects and drug interactions to be aware of when taking zolpidem with other medications.
Tadalafil Dapoxetine Tablets to treat Erectile Dysfunction and Premature Eja...Clearsky Pharmacy
Tadalafil and Dapoxetine Combination medication is a combination containing Tadalafil 20mg and Dapoxetine 60mg in a single tablet.
Tadalafil Dapoxetine Tablets are used for the treatment of male erectile dysfunction as well as treatment of premature ejaculation in men at the same time.
Tadalafil is used to treat men who have erectile dysfunction (also called sexual impotence).
These medicines prevent an enzyme called phosphodiesterase type-5 from working too quickly. By controlling the enzyme, Tadalafil helps to maintain an erection after the penis is stroked by increasing blood flow to the penis.
Dapoxetine Hydrochloride is used to treat premature ejaculation in adult men aged 18 to 64 years. Dapoxetine increases the time it takes to ejaculate and can improve the control over the ejaculation.
Crisanta (Drospirenone and Ethinyl Estradiol Tablets)Clearsky Pharmacy
Crisanta (Drospirenone and Ethinyl Estradiol Tablets) is used as an oral contraceptive. This medicine is also used to treat premenstrual dysphoric disorder (PMDD) or moderate acne.
Crizotinib 200mg/250mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Crizotinib Dosage & Rx Info | Crizotinib Uses, Side Effects Crizotinib: Indications, Side Effects, Warnings, Crizotinib -Drug Information –Taj Pharma, Crizotinib dose Taj pharmaceuticals Crizotinib interactions, Taj Pharmaceutical Crizotinib contraindications, Crizotinib price, Crizotinib Taj Pharma Crizotinib SmPC-Taj Pharma Stay connected to all updated on Crizotinib Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
Megalis (Generic Tadalafil Tablets) prescription medication which is FDA-approved to treat the following in men: erectile dysfunction (ED), a condition in which you can’t get or keep an erection, symptoms of benign prostatic hyperplasia (BPH), a prostate condition that may cause problems with urination and ED and symptoms of BPH together. Megalis comes as a tablet that you swallow. It’s available in two strengths: 10 mg and 20 mg.
Tadalafil tablets are also indicated for the treatment of pulmonary arterial hypertension (PAH).
Desogestrel and ethinyl estradiol 0.15mg and 0.03mg 0.02mg tablets pil, taj p...Taj Pharma
Desogestrel and ethinyl estradiol 0.15mg/0.03mg tablets Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Desogestrel and ethinyl estradiol Dosage & Rx Info | Desogestrel and ethinyl estradiol Uses, Side Effects , Desogestrel and ethinyl estradiol 0.15mg/0.03mg tablets: Indications, Side Effects, Warnings, Desogestrel and ethinyl estradiol - Drug Information - Taj Pharma, Desogestrel and ethinyl estradiol dose Taj pharmaceuticals Desogestrel and ethinyl estradiol interactions, Taj Pharmaceutical Desogestrel and ethinyl estradiol contraindications, Desogestrel and ethinyl estradiol price, Desogestrel and ethinyl estradiol , Taj Pharma Desogestrel and ethinyl estradiol 0.15mg/0.03mg tablets - Taj Pharma . Stay connected to all updated on Desogestrel and ethinyl estradiol Taj Pharmaceuticals Taj pharmaceuticals Hyderabad. Patient Information Leaflets, PIL.
Mrs. A is 28 weeks pregnant with gestational hypertension and proteinuria. Her fetus has normal growth but high umbilical artery resistance on Doppler.
The document discusses expectant management vs expedited delivery. For Mrs. A, expectant management is recommended up to 34 weeks given her fetus' normal growth. This involves strict maternal monitoring and interventions like corticosteroids for lung maturity.
The risks and components of expectant management are outlined, including frequent monitoring of maternal status and fetal wellbeing by tests like NST, BPP, growth scans and Doppler. Indications for earlier delivery include worsening maternal status, non-reassuring fetal testing or signs of fetal compromise.
Cognitive Behavorial Therapy for Insomnia k. Jensen f. RemillardPASaskatchewan
This document summarizes cognitive behavioral therapy for insomnia (CBT-I). It defines insomnia and discusses predisposing, precipitating, and perpetuating factors. It describes CBT-I as the first-line treatment for insomnia, focusing on addressing dysfunctional thoughts and behaviors. Key components of CBT-I include sleep hygiene, stimulus control therapy, sleep restriction therapy, and cognitive restructuring. The document outlines considerations for candidate selection and delivering CBT-I over multiple sessions, including reviewing sleep logs and assessing treatment progress.
1) Cladribine is an immunosuppressant drug that has been used to treat multiple sclerosis (MS) for many years and has been shown to be effective in reducing relapses and disease progression in clinical trials.
2) It works by suppressing lymphocytes, a type of white blood cell that is involved in MS, which lowers immune system activity that may be damaging in MS.
3) Cladribine is administered through subcutaneous injections over two 5-day treatment courses, one year apart, with monitoring of lymphocyte levels throughout treatment and follow-up.
This document discusses the importance and benefits of pharmacogenetic testing for physicians and their patients. It notes that pharmacogenetic testing can help physicians determine the right drug, dose, and timing for each individual patient to reduce adverse drug reactions and improve outcomes. Not utilizing this testing could open physicians up to legal liability issues. The document provides several case studies demonstrating how pharmacogenetic testing could have helped identify the right treatment for patients and avoided negative health consequences or legal risks for physicians. It also addresses the ease of testing, billing, and reimbursement to make the case for integrating pharmacogenetics into medical practice.
Chlorambucil 2 mg tablets smpc taj pharmaceuticalsTaj Pharma
CHLORAMBUCIL - Drug Information - Taj Pharma, CHLORAMBUCIL dose Taj pharmaceuticals CHLORAMBUCIL interactions, Taj Pharmaceutical CHLORAMBUCIL contraindications, CHLORAMBUCIL price, CHLORAMBUCIL Taj Pharma Cancer, oncologyChlorambucil 2 mg tablets SMPC- Taj Pharma . Stay connected to all updated on CHLORAMBUCIL Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Clozapine Tablets USP 25mg, 50mg and 100mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Clozapine Dosage & Rx Info | Clozapine Uses, Side Effects Clozapine: Indications, Side Effects, Warnings, Clozapine -Drug Information –Taj Pharma, Clozapine dose Taj pharmaceuticals Clozapine interactions, Taj Pharmaceutical Clozapine contraindications, Clozapine price, Clozapine Taj Pharma Clozapine SmPC-Taj Pharma Stay connected to all updated on Clozapine Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
The Committee for Medicinal Products for Human Use (CHMP) adopted a negative opinion, recommending the refusal of the marketing authorisation for the medicinal product Kynamro, intended for the treatment of certain forms of familial hypercholesterolaemia. While Kynamro was effective at reducing LDL cholesterol levels, the CHMP was concerned about its safety profile. A high proportion of patients stopped taking Kynamro due to side effects and there were concerns about liver toxicity and an increased risk of cardiovascular events. Therefore, the CHMP determined that the risks of Kynamro did not outweigh its benefits and recommended refusing its marketing authorisation.
Rituximab therapy resulted in remission in nearly half of patients with difficult-to-treat steroid-resistant nephrotic syndrome and a 95% reduction in relapse frequency in patients with steroid-dependent nephrotic syndrome. Minimal side effects were observed. Rituximab effectively depleted B-cells and showed promise as an alternative treatment for difficult cases of nephrotic syndrome. Longer-term studies are still needed to assess long-term outcomes and safety.
This multicenter study evaluated the efficacy and safety of rituximab treatment in 57 patients with difficult-to-treat nephrotic syndrome, including 24 with steroid-dependent nephrotic syndrome (SDNS) and 33 with steroid-resistant nephrotic syndrome (SRNS). At a mean follow-up of 16-21 months, rituximab led to sustained remission in 83% of SDNS patients and 48.5% of SRNS patients. It also significantly reduced relapse rates in SDNS patients. The treatment was generally well-tolerated with few minor infusion-related reactions reported. Larger controlled trials are still needed to confirm rituximab's benefits in nephrotic
Gestational trophoblastic diseases are rare conditions arising from trophoblastic tissue that make up the placenta. There are several types including hydatidiform mole, invasive mole, choriocarcinoma, and placental site tumor. Treatment and prognosis depends on the type and stage of the disease. For example, hydatidiform mole is generally treated with suction evacuation of the uterus followed by monitoring of HCG levels, while chemotherapy is often used for invasive or metastatic diseases like choriocarcinoma. The risk of developing these conditions varies between populations and can be influenced by factors like age, diet, and blood type combinations between mother and father.
Rituximab therapy was evaluated in 57 patients with difficult-to-treat nephrotic syndrome, including 33 with steroid-resistant nephrotic syndrome (SRNS) and 24 with steroid-dependent nephrotic syndrome (SDNS). In SRNS patients, remission was achieved in 15 out of 33 patients (45.5%) with a median time to response of 32 days. In SDNS patients, remission was achieved in 20 out of 24 patients (83.3%) with a significant reduction in relapse rates. Rituximab was generally well-tolerated with minimal infusion-related reactions and no serious adverse events reported.
Rituximab therapy was evaluated in 57 patients with difficult-to-treat nephrotic syndrome, including 33 with steroid-resistant nephrotic syndrome (SRNS) and 24 with steroid-dependent nephrotic syndrome (SDNS). In SRNS patients, remission was achieved in 15 out of 33 patients (45.5%) with a median time to response of 32 days. In SDNS patients, remission was achieved in 20 out of 24 patients (83.3%) with a significant reduction in relapse rates. Rituximab was generally well-tolerated with minimal infusion-related reactions and no serious adverse events reported.
Roundtable Expert Discussions on CML Clinical Debates: A Collaborative Video Viewpoint Series With Medscape
This video viewpoint in its original and unaltered format is for educational purposes and is current as of May 31, 2012. All materials contained herein reflect the views of the faculty, and not those of IMER, the CME provider, or the commercial supporter. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. Readers should not rely on this information as a substitute for professional medical advice, diagnosis, or treatment. The use of any information provided is solely at the user’s own risk, and all users should verify the prescribing information and all data before treating patients or employing any therapeutic products described in this educational activity.
- For the first case, the woman can have her prolactin levels checked yearly and does not need another MRI unless her prolactin levels rise above 250 μg/liter or she has clinical signs of tumor growth.
- For the second case, the man should have his prolactin levels checked yearly and repeat an MRI in 2-3 years to confirm tumor suppression and ensure prolactin levels reflect tumor size.
- Prolactinomas are usually benign and dopamine agonists are the preferred treatment to normalize prolactin levels and reduce tumor size. Long term management involves monitoring prolactin levels and imaging periodically to check for tumor changes requiring treatment modifications.
Managing pregnancy in MS – an update (Since 2016)MS Trust
Dr Peter Brex presented an update on managing pregnancy in multiple sclerosis (MS). The key points were:
1) It is important to provide pre-pregnancy counseling to understand medication management during pregnancy and establish links with local obstetric teams.
2) While there are no clinical trials of disease-modifying therapies (DMTs) in pregnancy, data from pregnancy registries can provide guidance on safety.
3) Recommended time periods for stopping various DMTs prior to conception range from 5 months to over 2 years depending on the medication.
Dasatinib is an effective first-line treatment for chronic myeloid leukemia (CML) based on results from the DASISION trial. The trial showed that dasatinib induced higher and faster rates of complete cytogenetic response and major molecular response compared to imatinib. At 5 years of follow-up, dasatinib maintained superior rates of molecular responses including deeper responses below 0.1% BCR-ABL1. Dasatinib therefore provides improved long-term outcomes for patients with newly diagnosed CML compared to standard imatinib treatment.
This document summarizes guidelines for prescribing the antipsychotic medication clozapine. It outlines indications for clozapine including treatment-resistant schizophrenia and schizophrenia with suicidal behavior. Contraindications, pharmacology, administration procedures, monitoring requirements, adverse effects, and conclusions are described. Key points include the need for pre-treatment evaluation, slow dose titration, target dosing ranges, plasma level monitoring, potential adverse effects like neutropenia and myocarditis, and long-term maintenance dosing.
This document summarizes guidelines for prescribing the antipsychotic medication clozapine. It outlines indications for clozapine including treatment-resistant schizophrenia and schizophrenia with suicidal behavior. Contraindications, pharmacology, administration procedures, monitoring requirements, adverse effects, and conclusions are described. Key points include the need for pre-treatment evaluation, slow dose titration, target dosing ranges, plasma level monitoring, neutrophil monitoring, and managing side effects like neutropenia, myocarditis, weight gain, and seizures.
1. This patient has aggressive relapsing-remitting multiple sclerosis (RRMS) based on more than 2 relapses in the past year and active lesions on MRI.
2. Treatment guidelines recommend natalizumab (Tysabri) or fingolimod (Gilenya) for aggressive RRMS, depending on JCV antibody status.
3. As this patient is JCV antibody negative, treatment with natalizumab is recommended due to its higher efficacy in reducing relapses and disability progression compared to other disease-modifying therapies.
Safe Prescribing of Second Line Combined Oral Contraceptivemeducationdotnet
Here is what I would do next:
1. Perform a urine pregnancy test
2. Send for STI screening (chlamydia, gonorrhoea)
3. Consider pelvic ultrasound to check for ectopic pregnancy
4. Discuss options for changing contraception with the patient once investigations are complete
5. Review in 1 week with results of tests
6. Consider referral to gynaecology if pregnancy or infection is detected
The differential diagnosis includes:
- Ectopic pregnancy
- Intrauterine pregnancy
- Pelvic inflammatory disease
- Cervical infection
- Endometrial pathology
- Bleeding disorder
So in summary - investigate for pregnancy and infection, discuss
The document is a patient guide about ABRAXANE for treating metastatic breast cancer. It discusses that ABRAXANE is an albumin-bound formulation of paclitaxel that does not require solvents, allowing it to be administered in 30 minutes without premedication. It highlights from a clinical trial that ABRAXANE resulted in nearly double the tumor response rate compared to solvent-based paclitaxel and that ABRAXANE has a shorter infusion time of 30 minutes compared to up to 3 hours for solvent-based paclitaxel. Common side effects discussed include low blood cell counts, numbness/tingling of hands and feet, hair loss, fatigue, and
This study evaluated the addition of brentuximab vedotin to standard chemotherapy for the treatment of pediatric anaplastic large cell lymphoma (ALCL). The results showed that brentuximab vedotin prevented relapses during therapy and resulted in efficacy that was at least as good as previous regimens, with no patients experiencing disease progression while receiving treatment. Minimal disseminated disease, as measured by quantitative RT-PCR, was found to be highly predictive of outcome, with an 89% event-free survival rate for MDD-negative patients compared to 52.6% for MDD-positive patients. The addition of brentuximab vedotin did not result in significant increased
Similar to Barts ms clinical guidance for cladribine (20)
This document summarizes a presentation by Professor David Baker on targeting B and plasma cells in central nervous system inflammatory diseases. It discusses B cell lineages and differentiation, antibodies involved in diseases like multiple sclerosis and neuromyelitis optica, and potential therapeutic targets including CD20, CD38, IL-6 receptor and CD19 expressing B cells and plasma cells. Slides provide details on B cell and plasma cell biology, locations in lymphoid and CNS tissues, their role in disease pathogenesis and current and emerging therapies.
Revised B cell covid vaccine review paperBartsMSBlog
1) Anti-CD20 monoclonal antibodies used to treat MS and other diseases cause prolonged depletion of B cells, including memory B cells important for vaccine responses. This puts individuals at higher risk for severe COVID-19 and poor antibody response to SARS-CoV-2 infection and vaccines.
2) Vaccination prior to starting anti-CD20 treatment or delaying subsequent doses to allow for B cell repopulation may optimize protective antibody responses against COVID-19. Most individuals require 12 months after treatment to reach sufficient B cell recovery levels.
3) While continuous CD20 depletion inhibits vaccine responses, memory B cell depletion is prolonged after treatment stops, supporting potential temporary treatment breaks for vaccination to boost immunity.
This document summarizes a presentation on selective B cell depletion therapies for managing highly active relapsing multiple sclerosis (MS). The presentation discusses:
- Drugs available that selectively deplete B cells including rituximab, ocrelizumab, and ofatumumab.
- Benefits of B cell depletion therapies like avoiding hospital visits during COVID-19, minimal monitoring requirements, and long-term efficacy from short-term treatment.
- Ocrelizumab as the preferred treatment based on its safety profile and 2020 sales of $4.6 billion.
- Professor David Baker presented on targeting CNS plasma cells in multiple sclerosis. He discussed B cell and plasma cell biology, the role of oligoclonal bands and autoantibodies in MS pathology, and evidence that antibodies are involved in MS disease mechanisms.
- Baker described current disease-modifying therapies that target B cells and plasma cells, but noted many may not effectively reach and deplete cells in the central nervous system. Effective treatment of MS may require targeting plasma cells and their niches directly within the CNS.
1. Professor David Baker presented on whether ocrelizumab and cladribine should be treated like alemtuzumab in terms of COVID-19 risk.
2. Alemtuzumab causes long-term CD4 and CD8 T cell depletion and is associated with an increased risk of lung infections. Cladribine and ocrelizumab do not cause similar long-term lymphopenia.
3. Cladribine maintains T cell levels within normal ranges and has minimal monitoring requirements compared to alemtuzumab which requires frequent monitoring and hospital visits due to risks of cytokine release syndrome.
This document describes the development of a cell-based assay to detect neutralizing antibodies against the drug alemtuzumab, which is used to treat multiple sclerosis. Researchers generated a stable CHO cell line expressing human CD52 and used it to detect anti-alemtuzumab antibodies in serum from an MS patient treated with alemtuzumab. The assay involves measuring inhibition of alemtuzumab-Alexa 488 binding to the CHO-CD52 cells by antibodies in patient serum. This assay provides a quantitative method for routine screening of serum from patients treated with alemtuzumab to detect neutralizing antibodies.
- CD20 B cell therapies like ocrelizumab work in multiple sclerosis through several mechanisms including direct inhibition of T cells, increasing regulatory T cells, blocking antigen presentation, and directly inhibiting B cells. While MS is considered a T cell-mediated disease, B cells can induce the proliferation and activation of pathogenic T cells. CD20 therapies may work by depleting this pathogenic B cell population. However, the mechanisms are not fully understood as CD20 therapies do not fully deplete long-lived plasma cells in the central nervous system.
This document summarizes a presentation given by Professor David Baker on B cell therapy for multiple sclerosis. It discusses B cell subsets, the role of B cells in the pathogenesis of MS, response to different therapies as a key experiment to understand biology, and repopulation characteristics of immune cells after treatment. It also provides diagrams on immune cell differentiation and repopulation, the two compartment model of treating inflammatory lesions in MS, phenotypes seen in active MS lesions, and types of monoclonal antibodies used as treatments.
The document provides guidelines for reporting animal research studies in a transparent manner. It outlines the ARRIVE guidelines, which include 10 essential items that should be reported in research papers involving animal subjects. The guidelines aim to improve reproducibility, transparency and quality of reporting. They include reporting the study's objectives and design, the animals used, experimental procedures, and the statistical analysis to allow rigorous assessment of the study. Adhering to these guidelines can help improve communication of research findings.
This document provides guidance on reading and understanding medical research papers. It discusses the key elements of clinical trial papers and science papers, and emphasizes the importance of reading papers to gain knowledge and the ability to critically evaluate research. It also reviews guidelines for reporting clinical trials and animal studies, and provides tips on analyzing data and interpreting various types of charts, graphs, and statistics commonly found in medical research papers.
This study evaluated the efficacy and safety of tabalumab in treating relapsing-remitting multiple sclerosis (RRMS). 210 patients with RRMS were randomized to receive either tabalumab (4, 12, 40, or 120 mg every 4 weeks or 4 or 120 mg every 12 weeks) or a placebo. The primary outcome was the number of new or enlarging MRI lesions over 24 weeks. Treatment with tabalumab did not significantly reduce MRI lesions compared to placebo. Adverse events were more common with tabalumab but were generally mild. The study found that tabalumab was not effective for reducing disease activity in RRMS.
This document discusses the history and biology of medical cannabis in the UK. It provides key dates in the UK regarding cannabis cultivation, medical use, and legislation. It then covers the biology of the endocannabinoid system and cannabinoid receptors. The remainder discusses evidence for using cannabis to treat MS symptoms like spasticity through its effects on the endocannabinoid system and inhibitory neurotransmission. It also discusses the use of Sativex and different policies around medical and recreational cannabis internationally.
The European Medicines Agency announced that Medday Pharmaceuticals withdrew its application for marketing authorization of Qizenday, a medicine containing biotin intended to treat progressive multiple sclerosis. After evaluating the company's submission and responses to questions, the Committee for Medicinal Products for Human Use had concerns about the robustness of effectiveness data, uncertainties regarding safety, and the need for more information on how the body processes biotin. At the time of withdrawal, the Committee's provisional opinion was that the benefits of Qizenday did not outweigh its risks for treating progressive multiple sclerosis. The company withdrew the application based on this opinion. Patients currently taking Qizenday in clinical trials or compassionate use programs
Cases of progressive multifocal leukoencephalopathy (PML), a rare brain disease caused by the JC virus, have been reported in patients treated with the drug cladribine. PML diagnosis occurred months to years after cladribine treatment and was associated with prolonged lymphopenia in several cases. Healthcare professionals are advised to consider PML in patients with new neurological symptoms who have been treated with cladribine. Patients who develop suspected PML should discontinue cladribine treatment. Manufacturers are updating drug information materials to include this safety risk.
This document summarizes a debate about whether B cells or T cells are the key pathogenic cell in multiple sclerosis (MS). It provides evidence from MS therapies, animal models, and human data that memory B cells may drive MS pathology. Studies show that effective MS treatments like alemtuzumab, rituximab, and ocrelizumab strongly deplete memory B cells and reduce relapse rates. Memory B cell levels are also higher in the cerebrospinal fluid of patients during MS relapses. While T cells outnumber B cells in MS lesions, B cells may have an important role in antigen presentation and driving inflammation. Genetic studies also link MS risk genes to B cell functions. Overall, the document argues that
This document summarizes a debate between David Baker (for) and Heinz Weindl (against) the proposition that "The Key Pathogenic Cell in MS is a B cell and is Independent of Antigen-Presentation to T cells." Baker argues that B cells, not T cells, are the key pathogenic cells in MS. He notes that treatments targeting B cells like ocrelizumab are effective, while T cell-targeted treatments have failed. He also argues that animal models showing T cell dependence are suboptimal. Weindl counters some of Baker's evidence and interpretations. The document provides details on B cell subsets and their roles, effects of MS treatments on memory B cells, and evidence from pathology.
This document summarizes a debate between David Baker-For and Heinz Weindl-Against on whether B cells or T cells are the key pathogenic cell in multiple sclerosis (MS). It provides evidence from animal models, response to various MS therapies, and B cell and T cell biology to argue that memory B cells, not T cells, are the primary driver of MS pathology. Graphics show that treatments which reduce memory B cells in the blood correlate with decreased relapse rates and lesions in MS patients. The document concludes that while T cells may facilitate the disease, memory B cells are the main culprit in destroying myelin in MS.
This document provides the schedule for the Scientific Programme of a conference on Wednesday, October 25th, 2017. It includes 10 teaching courses held in different halls from 8:30-10:00, 10:30-12:00, and 12:30-14:00 on various topics related to multiple sclerosis (MS) research and treatment. There are also several parallel sessions, young scientific investigator sessions, nurses' sessions, and hot topic sessions scheduled throughout the day focused on specific areas of MS science.
This document provides an overview of current antibody treatments for multiple sclerosis. It discusses several approved treatments including natalizumab, daclizumab, alemtuzumab, their mechanisms of action in treating MS, and their efficacy and side effects based on clinical trial results. Key side effects discussed include progressive multifocal leukoencephalopathy (PML) with natalizumab, skin reactions and hepatic events with daclizumab, and infusion reactions, infections, and secondary autoimmunities with alemtuzumab.
This document provides an overview of current and emerging antibody treatments for multiple sclerosis (MS). It discusses approved therapies like natalizumab, alemtuzumab, and daclizumab. Natalizumab works by inhibiting lymphocyte binding to endothelial cells. Alemtuzumab depletes CD52+ lymphocytes. Daclizumab antagonizes CD25-mediated T cell activation. Emerging therapies discussed include ofatumumab, ustekinumab, and secukinumab which target CD20, IL-12/IL-23, and IL-17A respectively. The document also reviews the mechanisms of action, efficacy data, safety issues like PML risk, and ongoing clinical trials of these antibody treatments for MS.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Phone Us ❤8107221448❤ #ℂall #gIRLS In Dehradun By Dehradun @ℂall @Girls Hotel...
Barts ms clinical guidance for cladribine
1. Barts Health NHS Trust: Newham University Hospital, The London Chest Hospital,
The Royal London Hospital, St Bartholomew’s Hospital and Whipps Cross Hospital.
BartsMS Patient Information Sheet Cladribine, drafted by Drs Monica Marta & Niall MacDougall, reviewed & edited by
Drs Klaus Schmierer, Sharmilee Gnananpavan, Benjamin Turner and Professor Gavin Giovannoni, 22 October 2015.
Scheduled review October 2016
BartsMS Patient Information Sheet
Cladribine for treatment of people with multiple sclerosis
Introduction
You have been given this information sheet as your neurologist would like to offer you Cladribine as a
treatment of your MS. Please read this information and then discuss any questions you may have
with your neurologist and/or MS Specialist Nurse.
Background
Cladribine has been used over many years as a therapy for people with MS (pwMS)1,2
. Cladribine
works through suppression of a specific proportion of the immune system, the lymphocytes (white
blood cells). There is plenty of evidence that this type of cells is important in MS, and that lowering
the number of lymphocytes circulating in the blood can be beneficial for pwMS. Clinical trials have
shown that Cladribine is an effective and generally safe treatment for pwMS1-6
. Despite this
favourable evidence, however, Cladribine has so far only been licensed for pwMS in Russia and
Australia, whilst this is not the case for the UK, EU, or the USA. Cladribine does have a license, since
1993, for treatment of people with ‘hairy cell leukaemia’. For further information on licensing, see
‘About unlicensed medicines’ below.
In clinical trials for relapsing MS, Cladribine has been shown to significantly reduce the number of
relapses3-5
and the rate of disease progression3,4
. After 96 weeks observation and following two
courses of treatment, 45% of pwMS on Cladribine showed no signs of disease activity (no relapses, no
disease deterioration and no new manifestations on MRI brain) compared to only 12% of pwMS who
were given a placebo4
. There is also, albeit as yet inconclusive, evidence that Cladribine may be useful
in pwMS who have progressive forms of MS1,2,6
.
How does Cladribine work?
Cladribine lowers the number of a sub-group (lymphocytes) of the white cells in the blood, thereby
partially suppressing the immune system. As MS has many features of an auto-immune disease,
where the immune system attacks the brain, Cladribine may reduce the damage caused by MS
through its effect on lymphocytes.
How is Cladribine given?
Cladribine can be given by infusion in a vein or as subcutaneous injection (injection under the skin).
There is also an oral version of (Cladribine tablets; Movectro), however these tablets are currently not
available. At Barts Health, we therefore use Cladribine subcutaneous injections. These injections are
usually very well tolerated, and usually do not cause any injection site reactions. Should this
nevertheless occur, please inform your care team immediately.
2. Barts Health NHS Trust: Newham University Hospital, The London Chest Hospital,
The Royal London Hospital, St Bartholomew’s Hospital and Whipps Cross Hospital.
BartsMS Patient Information Sheet Cladribine, drafted by Drs Monica Marta & Niall MacDougall, reviewed & edited by
Drs Klaus Schmierer, Sharmilee Gnananpavan, Benjamin Turner and Professor Gavin Giovannoni, 22 October 2015.
Scheduled review October 2016
During the 1st
week of treatment we administer Cladribine on days 1, 2 and 3. Four weeks later we
check your lymphocyte count in the blood to decide whether you should be given another 1, 2, 3 or –
rarely – no further injection(s) in week 5. The reason for this dosing scheme is that by checking your
lymphocytes at week 4 we try to avoid suppressing this cell type any further than what is considered a
safe level (i.e. a lymphocyte count no lower than 0.5 x 109
/L)).
We will then check your white cell counts after another 4 weeks, and then every 3 months until your
2nd
treatment cycle is due, which is regularly one year after the 1st
injection of Cladribine. Your
lymphocytes will then be re-checked, and the 2nd
course of treatment given in the same way as the
1st
. Following this 2nd
course of Cladribine treatment a further course will only be given if signs of new
disease activity are emerging (relapses, significant deterioration without relapse, or new lesions on
MRI).
What side effects does Cladribine have?
Cladribine has a number of possible side effects. Most of these side effects have been described in
people receiving Cladribine for treatment of leukaemia, and we have therefore attached to this
information sheet the summary of product characteristics of Cladribine (Litak) when used in people
with Leukaemia (Appendix 1).
N = 430N = 435
3. Barts Health NHS Trust: Newham University Hospital, The London Chest Hospital,
The Royal London Hospital, St Bartholomew’s Hospital and Whipps Cross Hospital.
BartsMS Patient Information Sheet Cladribine, drafted by Drs Monica Marta & Niall MacDougall, reviewed & edited by
Drs Klaus Schmierer, Sharmilee Gnananpavan, Benjamin Turner and Professor Gavin Giovannoni, 22 October 2015.
Scheduled review October 2016
The table above (Table 3), extracted from the pivotal phase III trial of Cladribine3
in people with
relapsing MS, gives a more realistic overview of the side effects in pwMS. Please ask one of the team if
there is anything you do not understand. Regarding the important difference in the rate of neoplasms
(benign and malignant), and particularly malignancies (0 cancers in pwMS on placebo versus 3 in
pwMS treated with Cladribine)3
, it is important to remember this difference does not enable drawing
any definite conclusion about whether there is an increased risk of cancer when taking Cladribine;
indeed current evidence does not support an increased risk of cancer with Cladribine compared to all
other (licensed) disease modifying treatments for pwMS7
.
Who should not take Cladribine?
• Anyone with known hypersensitivity to Cladribine.
• Women who are pregnant or breastfeeding.
• Anyone younger than 18 years of age.
• People with moderate or severe renal impairment (creatinine clearance ≤ 50 ml/min), or
moderate to severe hepatic impairment.
• Patients using other myelosuppressive medicinal products.
• Anyone with an active infection.
Cladribine and previous cancer
In the treatment of people with leukaemia Cladribine has been associated with the return or re-
occurrence of previously diagnosed cancers. If you have had cancer, or a potentially precancerous
condition, such as an abnormal cervical smear you should discuss this with your doctor before
treatment with Cladribine.
How does cladribine affect pregnancy and fertility?
Cladribine may cause serious birth defects when administered during pregnancy.
Women of childbearing potential must use effective contraception during treatment with Cladribine
and for 6 months after the last Cladribine dose.
Men being treated with Cladribine should not father a child for at least 6 months after the last
Cladribine dose. Men should use adequate contraception and consider cryoconservation (freezing) of
sperm prior to treatment due to a potential risk of infertility following Cladribine treatment.
How does cladribine affect breastfeeding?
We do not know if Cladribine is excreted in human milk, however theoretical considerations suggest it
may do so and as a result there is the potential for serious adverse reactions in nursing infants if they
were exposed to Cladribine. Mothers must not breast feed until 6 months after the last dose of
Cladribine.
Please inform your doctor if you have or have had:
• Liver or kidney problems
4. Barts Health NHS Trust: Newham University Hospital, The London Chest Hospital,
The Royal London Hospital, St Bartholomew’s Hospital and Whipps Cross Hospital.
BartsMS Patient Information Sheet Cladribine, drafted by Drs Monica Marta & Niall MacDougall, reviewed & edited by
Drs Klaus Schmierer, Sharmilee Gnananpavan, Benjamin Turner and Professor Gavin Giovannoni, 22 October 2015.
Scheduled review October 2016
• Infections (if you suffer from an infection, this will be treated before you start using
Cladribine).
• Any signs of infections (such as flu-like symptoms or fever) during or after
treatment
Effects on ability to drive and use machines
Cladribine may influence your ability to drive and use machines in case certain adverse reactions with
a potential impact on performance occur. Thus, we recommend you do not drive whilst being treated
with Cladribine. Possible side-effects that may impair driving ability include dizziness and drowsiness,
which may occur due to anaemia.
5. Barts Health NHS Trust: Newham University Hospital, The London Chest Hospital,
The Royal London Hospital, St Bartholomew’s Hospital and Whipps Cross Hospital.
BartsMS Patient Information Sheet Cladribine, drafted by Drs Monica Marta & Niall MacDougall, reviewed & edited by
Drs Klaus Schmierer, Sharmilee Gnananpavan, Benjamin Turner and Professor Gavin Giovannoni, 22 October 2015.
Scheduled review October 2016
About unlicensed (off-label) medicines8
Before a medicine can be sold in the UK, a marketing authorisation (formerly product licence) from
the MHRA is required. The MHRA will only issue a marketing authorisation if clinical trials have shown
that:
• the medicine successfully treats the condition it was developed for
• the medicine's side effects are acceptable, and
• the medicine meets high safety and quality standards
What is an unlicensed (off-label) medicine?
Prescribing a medicine licensed for condition A to treat somebody with condition B is called “off-label
prescribing”. For example, some medicines to treat depression (“condition A”) are used to treat pain
(“condition B”). A company holding the license of a medicine to treat condition A must not market
the drug for treatment of condition B (unless the medicine also has a license for condition B).
Most medicines are licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) to
ensure that they provide benefit and are acceptably safe. Adverse effects from medicines can be
minor, but they can also be serious. To assess whether a medicine is acceptably safe, its benefits are
compared with the possible adverse effects it could cause. Significant and/or frequent side effects
may be acceptable for a medicine used to treat a life-threatening condition, but not in a medicine
used to treat a minor illness.
Wherever possible, doctors should prescribe medicines within their licensed indication. However, if a
doctor thinks a medicine will be effective in treating your condition despite not being licensed to treat
that condition, they may yet prescribe it.
Examples for prescribing a medicine off-label include:
• There is no available licensed medicine
• There may be a special clinical need that cannot be met by a medicine licensed for their
condition – for example, they are allergic to an ingredient, or cannot swallow tablets
• The medicine has undergone clinical trials and is waiting for approval from regulators such as
the MHRA
• Despite the availability of licensed medicine(s) your doctor thinks an off-label medicine is the
better for the treatment of your condition
• You may have agreed to receive an unlicensed medicine as part of a clinical trial
Doctors should inform you if they are prescribing a medicine to you ‘off-label’.
About licensing of Cladribine
Oral Cladribine (Movectro) is licensed in Russia and Australia for the treatment of pwMS. However,
the manufacturer (Merck) stopped supplying Movectro to these countries in 2011. In September
2015, Merck published a letter of intent to re-apply to the European Medicines Agency (EMA) for
6. Barts Health NHS Trust: Newham University Hospital, The London Chest Hospital,
The Royal London Hospital, St Bartholomew’s Hospital and Whipps Cross Hospital.
BartsMS Patient Information Sheet Cladribine, drafted by Drs Monica Marta & Niall MacDougall, reviewed & edited by
Drs Klaus Schmierer, Sharmilee Gnananpavan, Benjamin Turner and Professor Gavin Giovannoni, 22 October 2015.
Scheduled review October 2016
marketing authorisation of Cladribine in pwMS9
. Currently, Cladribine is not licensed in the UK, EU or
USA for treatment of pwMS.
However, Cladribine has been licensed since 1993 for the treatment of people with ‘hairy cell
leukaemia’. The reasons for refusal of a license for Cladribine as a treatment for pwMS by the EMA in
2010/11 are complex and include the concern about a possible cancer risk (as mentioned above, more
recent evidence suggests there is no increased cancer risk compared to other disease modifying
treatments for pwMS7
), the risk of lowering lymphocyte count too low, and (in 2011) insufficient
phase III clinical trial evidence of efficacy.
Will Cladribine become a licensed treatment for pwMS?
We are unable to predict whether Cladribine will be licensed in Western Europe and/or the US for
treatment of pwMS. The neurologists at BartsMS are encouraged by the evidence that Cladribine is an
effective and safe treatment for MS1-7,10
, and are working towards Cladribine becoming a licensed
drug for pwMS11-12
.
References:
1) Sipe, et al. Cladribine in treatment of chronic progressive multiple sclerosis. Lancet 1994;344:9-13.
2) Beutler, et al. The treatment of chronic progressive multiple sclerosis with cladribine. Proceedings of the National
Academy of Sciences of the United States of America 1996;93:1716-20.
3) Giovannoni, et al. A placebo-controlled trial of oral cladribine for relapsing multiple sclerosis. The New England
Journal of Medicine 2010;362:416-26.
4) Giovannoni, et al. Sustained disease-activity-free status in patients with relapsing-remitting multiple sclerosis
treated with cladribine tablets in the CLARITY study: a post-hoc and subgroup analysis. Lancet Neurol
2011;10:329-37.
5) Stelmasiak, et al. Effect of parenteral cladribine on relapse rates in patients with relapsing forms of multiple
sclerosis: results of a 2-year, double-blind, placebo-controlled, crossover study. Mult Scler J 2009;15:767-70
6) Rice GPA, et al. Cladribine and progressive MS. Clinical and MRI outcomes of a multicenter controlled trial.
Neurology 2000;54:1145–55.
7) Pakpoor, et al. No evidence for higher risk of cancer in patients with multiple sclerosis taking cladribine. Neurol
Neuroimmunol Neuroinflamm 2015;2:e158
8) http://www.gmc-uk.org/guidance/ethical_guidance/14327.asp
9) http://news.merck.de/N/0/1C517A71C016A43BC1257EBC006B50C3/$File/CladribineEng.pdf
10) Leist, et al. Effect of oral cladribine on time to conversion to clinically definite multiple sclerosis in patients with a
first demyelinating event (ORACLE MS): a phase 3 randomised trial. Lancet Neurol 2014;13:257-67.
11) http://multiple-sclerosis-research.blogspot.com/2015/12/cladribine4ms.html
12) https://twitter.com/KlausSchmierer
Appendix 1: Record of the discussion about licensed disease modifying drugs for people with
multiple sclerosis
Appendix 2: Cladribine (Litak) summary of product characteristics
7. Barts Health NHS Trust: Newham University Hospital, The London Chest Hospital,
The Royal London Hospital, St Bartholomew’s Hospital and Whipps Cross Hospital.
BartsMS Patient Information Sheet Cladribine, drafted by Drs Monica Marta & Niall MacDougall, reviewed & edited by
Drs Klaus Schmierer, Sharmilee Gnananpavan, Benjamin Turner and Professor Gavin Giovannoni, 22 October 2015.
Scheduled review October 2016
Appendix 1: Record of the discussion about licensed disease modifying drugs for people with
multiple sclerosis
Patient MRN/name:
BartsMS team member:
Record of the discussion about licensed disease modifying drugs for people with multiple sclerosis
Currently licensed disease modifying treatments for people with MS are the following:
• Interferon beta-1a (Avonex, Rebif)
• Interferon beta-1b (Betaferon, Extavia)
• Glatiramer acetate (Copaxone)
• Dimethyl fumarate (Tecfidera)
• Teriflunomide (Aubagio)
• Fingolimod (Gilenya)
• Natalizumab (Tysabri)
• Alemtuzumab (Lemtrada)
Following a discussion of the subject’s eligibility for these drugs, and their benefits and risks, please
state here the reason(s), if and as applicable, why the patient rejects treatment with any of these
medicines
State here the reason, if and as applicable, why the prescribing clinician supports treatment with
Cladribine instead of a licensed DMT