Rx Note

Introduction Non-steroid anti-inflammatory drugs, or in short NSAIDs, are commonly used for their Anti-inflammatory, Analgesic (pain killer) and Antipyretic (anti-fever) effects. They can be classified into Non-selective (traditional), e.g. diclofenac, ibuprofen, mefenamic acid and naproxen. COX-2 selective, e.g. celecoxib and etoricoxib. NOTE: Different from NSAIDs, paracetamol does not have anti-inflammatory actions. Efficacy According to British National Formulary , Though differences in anti-inflammatory activity between NSAIDs are small, but there is considerable variation in individual response and tolerance to these drugs. About 60% of patients will respond to any of the NSAIDs; of the others, those who do not respond to one may well respond to another. Pain relief starts soon after taking the first dose and a full analgesic effect should normally be obtained within a week, whereas an anti-inflammatory may not be achieved (or may not be clinically accessible) for up to 3 weeks...

Introduction A bruise (also known as contusion) is an injury appearing as an area of discoloured skin that is commonly caused by blunt impact , such as a fall, trauma or bump, resulting in damage of the soft tissues, including rupture of small blood vessels (capillaries) without cuts on the skin . Older people are more prone to bruising. NOTE: A haematoma is a larger collection of blood, usually caused by surgery, injury or greater trauma. Like a bruise, haematomas will usually be reabsorbed into the body. However, depending on the size, location and cause of the haematoma, the area may need to be drained surgically or take a longer period of time to resolve. Symptoms The blunt force trauma damages capillaries beneath the skin, causing blood to leak into the surrounding tissue. Skin discolouration is initially red or pink, gradually becoming blue, green and yellow. Most bruises heal in 1 to 2 weeks, but some take longer. NOTE: The characteristic colour changes of a bruise are due to...

Introduction 8 food-types cause about 90% of food allergy reactions. Milk (mostly in children) Eggs Peanuts Tree nuts (e.g. walnuts, almonds, pine nuts, brazil nuts and pecans) Soy Wheat (and other grains with gluten, including barley, rye and oats) Fish (mostly in adults) Shellfish (mostly in adults) Case Scenario "Do you have any drug allergies?" Often, when dispensing medications to patients (especially antibiotics or NSAIDs) or clerking CP1 form , we ask patients this question. The onset of hives within a few hours of taking a new medication is easily recognized as possible drug hypersensitivity. However, many clinical presentations of drug hypersensitivity are more complex or take place in the setting of illness and/or polypharmacotherapy. For example, The patient in intensive care who develops a rash while receiving multiple medications The ambulatory with complex chronic diseases who develops a new and unexplained symptom while taking many medications. The main questio...

Introduction Plantar fasciitis is one of the most common causes of heel pain . It involves inflammation of a thick band of connective tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). Clinical Presentation Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning or after a period of inactivity . The pain typically lessens with gradually increased activity, but worsens toward the end of the day with prolonged weight bearing. The sensation of the bottom of the heel is quite painful, and the patient may complain of a burning sensation. Risk factors Peak incidence at age 40-60 years old Certain types of exercise, such as long-distance running, ballet dancing and aerobic dance Flat feet (pes planus) Obesity Prolonged walking or standing on hard surfaces Treatment Provision of education about the condition including its possible causes. Patients may have unrealistic expectations that med...

Introduction Low back pain affects 60-80% of people at some stage in their lives ( most common between the ages of 35 and 55 years) and is often recurrent . Acute back pain is generally regarded as lasting less than 6 weeks, subacute for 6-12 weeks and chronic longer than 12 weeks. Clinical Features Pain in the lower lumbar or sacral area is usually described as aching or stiffness. Depending on the cause, pain might be localized or more diffuse. In case of acute injury, the symptoms come on quickly, and there will be a reduction in mobility. Risk Factors Heavy physical work Frequent bending, twisting or lifting Prolonged static postures Smoking Obesity Physical inactivity NOTE: Low back pain can be caused by gastrointestinal problems (e.g. peptic ulcer or pancreatitis) or genitourinary conditions (e.g. kidney stones , pyelonephritis) but low back pain is not the major presenting symptom. Management Most patients (95%) who present in the pharmacy will have simple back pain that wi...

Introduction Crepitus refers to popping, cracking or clicking sounds that originate from a joint. These noises are commonly felt in the knees, but they can occur in any joint. Causes Often, it can be harmless. The sound itself simply indicates air bubbles forming and bursting in the joint fluid, which can happen even in healthy joints. However, when it is associated with pain, inflammation or discomfort, this can indicate an underlying medical condition , such as Osteoarthritis Meniscus tears Ligament injuries Tendonitis Patellofemoral pain syndrome Baker's cyst Management Joint noises themselves do not necessarily indicate a serious problem and do not require treatment. However, if you have crepitus along with pain, swelling or discomfort, it is important seek immediate medical attention for evaluation. They can determine the underlying cause and recommend appropriate treatment, which may involve Rest Ice application NSAIDs Physical therapy Surgery (in certain cases) External Link...

Introduction Systemic lupus erythematosus (SLE or commonly referred to as lupus) is an autoimmune disease associated with autoantibody production, primarily affects young women, with a female-to-male ratio of 10:1. The disease predominantly occurs in people age 15-45 years and it is more common in women of African-American and Asian descent. Symptoms Systemic lupus erythematosus can involve almost any organ and may present in different ways. Fatigue is common, but does not help distinguish SLE from other diseases. Arthritis and cutaneous manifestations [e.g. malar rash ("butterfly rash") and photosensitivity] are most common, but renal, hematologic and neurologic manifestations contribute largely to morbidity and mortality. Triggering Factors Factors such as sunlight, certain drugs and viral infection are known to trigger SLE, but the underlying cause is not fully understood. Drugs that include lupus include Methimazole Propylthiouracil Methyldopa Minocycline Procainamide Hy...

Introduction Trigger finger (also called stenosing flexor tenosynovitis) is a condition that causes pain, stiffness and a sensation of locking or catching when the digit is flexed and extended . The patient may present with a digit locked in a particular position, most often flexion (bent position), which may require gentle, passive manipulation into full extension. It can occur in one or more fingers in each hand and can be bilateral. Risk Factors The cause of trigger finger is most frequently unclear , although patients often attribute it to overuse or repetitive movements. Trigger finger is most common among women in the fifth or sixth decade of life . The prevalence of trigger finger is also higher among patients with diabetes mellitus , rheumatoid arthritis , or conditions that cause systemic deposition of protein such as amyloidosis. Treatment The goals of treatment of trigger finger are to alleviate pain and to allow smoother movement of the finger with flexion and extension. ...

Introduction Menorrhagia is excessive (heavy) menstrual blood loss (i.e. blood loss of 60-80 ml or more period, compared with average loss of 30-40 ml), which occurs over several consecutive cycles. NOTE: A period normally lasts 2-7 days, with the average period being 5 days long. Medicine-Induced Menstrual Bleeding Occasionally, medicines can change menstrual bleeding patterns. Anticoagulants Monoamine oxidase inhibitors Phenothiazines Steroids Tamoxifen Thyroid hormones Management Oral tranexamic acid reduces the volume of menstrual blood loss by about 50% through its antifibrinolytic effect , which increases blood clotting. It provides symptomatic relief but does not resolve underlying causes. Dosage varies, according to the heaviness and duration of bleeding: 1 to 1.5 g 3 or 4 times daily for the first 3-5 days of each cycle. Although tranexamic acid is available as an OTC medication in oversea, it is a prescription medication at Malaysia ( Group B poison ). The use of NSAID (...

Introduction Photosensitivity induced by exogenous agents refers to a process in which chemicals or drugs that are ingested or applied to the skin promote a photosensitivity reaction when the individual is exposed to sunlight. In one study , photosensitivity was responsible for approximately 20% of adverse drug reactions in elderly . Photosensitivity reactions can be classified according to the underlying mechanism or pathogenesis of the reaction into either Phototoxicity Most common form Results from direct tissue or cellular damage following ultraviolet (UV) irradiation of a phototoxic agent that has been ingested or applied to the skin. Phototoxicity can occur in any individual in whom the threshold concentration of the chemical or drug has been reached . Appear as an exaggerated sunburn . Typical photosensitivity reactions may result in the development of erythema, oedema and papules, and in severe cases, may also progress to the development of plaque-like urticarial lesions and p...