Rx Note

Introduction Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis and is transmitted primarily by inhalation . After primary infection, 90% of individuals with intact immunity control further replication control of the bacilli, which may then be cleared or enter a "latent" phase . The person remains asymptomatic, but latent disease has the potential to become active at any time. The remaining 10% of individuals develop progressive to primary tuberculosis . It most commonly affects the lungs, although it can affect other parts of the body. NOTE: In general, individuals with pulmonary and laryngeal TB are infectious (higher risk if sputum smear is positive) , whereas those with extrapulmonary TB are regarded as non-infectious. Clinical Presentation Pulmonary TB is characterized by its slow onset and initial mild symptoms. The cough is chronic in nature and sputum production can vary from mild to severe with associated haemoptysis . Other sympto...

Introduction Cough is the most common respiratory symptom and is usually self-limiting (will resolve in 3-4 weeks without the need for antibiotics). Coughing is the body's defence mechanism to clear the airways of foreign bodies and particulate matter . Questions to Ask the Patient Some important information to be gathered include Duration of the cough Duration longer than 2-3 weeks with no improvement or is getting worse suggests non-acute cause of cough and requires further investigation, such as tuberculosis , asthma , chronic bronchitis, COPD , lung cancer, heart failure and gastroesophageal reflux . Chest pain, haemoptysis (coughing up blood), shortness of breath and wheezing Suggest possible sinister pathology or severe cases of simple viral infection, and requires further investigation. Age Children or adult? If children, how many years old? Persistent nocturnal cough in children Suggests possible asthma , especially those with family history. Nature of cough Coughs can b...

Introduction Since medicines taken by breastfeeding mothers may pass into breast milk, this article explores the safe use of over-the-counter medications while breastfeeding Medicines that passed into breast milk in small quantities rarely affects breastfed babies. Pain Paracetamol is considered compatible with breastfeeding when used in usual recommended doses to treat mild pain, such as headaches, toothaches, muscular pains or to reduce fever. NSAIDs are safe to help relieve pain and inflammation, but selective NSAIDs (COX-2 inhibitors) have limited data. Of the NSAIDs, ibuprofen is considered the drug of choice. Naproxen should be used cautiously in breastfeeding women due to its long half-life and has been documented to cause prolonged bleeding, anaemia and thrombocytopenia in a breastfed infant. Cough For a dry cough , a cough suppressant such as dextromethorphan is considered safe while breastfeeding. For a chesty cough , an expectorant such as guaifenesin or a mucolytic such ...

Introduction Given the potential for teratogenic effects of certain drugs, this article explores the safe use of over-the-counter medications during pregnancy. Products containing alcohol should be avoided. Pain The use of paracetamol (acetaminophen) in recommended doses during pregnancy has not be associated with an increased risk of miscarriage or still birth. Nonetheless, paracetamol should be used at the lowest effective dose for the shortest duration of time to effectively treat the mother and protect the health of the foetus (inconclusive data on adverse events such as wheezing and asthma in early childhood, adverse effects on male reproductive development and ADHD or autism spectrum disorders) An increase in foetal death or spontaneous abortion may been seen following maternal overdose if treatment is delayed. In general, NSAIDs should be avoided in pregnancy and must be avoided after 30 weeks' gestation because of the risk of Miscarriage in early pregnancy; however, evi...