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Crohn's Dz: Pharmaceuticals


Pentasa for maintenance

symptom controlling meds
--zofran
--phenergan
--donnatal

others:
--Remicade
--6mp
--azathioprine
--Asacol
--others
--Humira could cause lymphoma

AZULFIDINE and MESALAMINE
--docs have been using over 50 yrs for IBS
--Azulfidine molecule is half aspirin-like and half like the antibiotic sulfa
--allergies to sulfa are common
--removal of sulfa-like portion resulted in meslamine, an apirin-like anti-inflam drug, FDA approved 1987
--Pentasa is MESALAMINE with a specific delivery system
--reduces a man's sperm count (why?)
--mesalamine is sold under a variety of brand names (UK: Asacol, Ipocal, Pentasa & Salofalk. US: Canasa, Rowasa, Pentasa, Asacol and Lialda)
--newest is Lialda, FDA approved January 2007 for ulcerative colitis, taken only once a day
--mesalamine is an antioxidant
--5-ASA is considered the active moiety of sulfasalazine, which is metabolized to it.
--also formulated for rectal administration as rectal suppository, suspension or enemas

PENTASA
--man-made
--mesalamine is 5-amino-2-hydroxybenzoic acid
--molecular weight = 153.14.
--taken by mouth for inflam disorders of the colon such as Crohn's disease
--common dosage 4 pills 4x daily with food, or 2x daily for maintenance dose
--if miss dose, just skip it and resume on schedule
--sometimes given in conjunction with other meds such as prednisone
--mesalamine aka 5-aminosalicylic acid, or 5-ASA
--each Pentasa capsule contains about 250 mg of mesalamine
--shelf life is 3 years
--targeted delivery: releases meds in diseased area??
--special plastic coating delays release of mesalamine until the tablets reach the ileum
--mechanism unknown
--appears to be topical rather than systemic, minimal absorbtion
--most is excreted with the stool
-"Studies have shown that Pentasa can help bring a case of Crohn's under control and help maintain a remission over time."
--manufacturere says IBS rarely goes into permanent remission, but flare-ups are reduced by CONTINUED USE of Pentasa at maintenance dose (LIFETIME INCOME FOR BIG PHARMA, TAKE NOTE)
--"no known drug interactions"
--different from Asacol (also mesalamine) is the outer coating, Asacol releases later and only works for colitis but not in ileum
--"Only stop Pentasa under your doctor's supervision."
--SE's: headaches, skin rash, blistering, peeling, itching, fever, bleeding, bruising, upset stomach, heartburn, nausea and vomiting, dizziness
--do not take if aspirin allergy or untreated peptic ulcer disease
--beware if pregnant, planning to become pregnant soon, or breast-feeding (not studied yet)
--INGREDIENTS IN 250 mg capsule: 250 mg of mesalamine, acetylated monoglyceride, castor oil, colloidal silicon dioxide, ethylcellulose, hydroxypropyl methylcellulose, starch, stearic acid, sugar, talc, and white wax. Capsule shell contains D&C Yellow #10, FD&C Blue #1, FD&C Green #3, gelatin, titanium dioxide, and other ingredients. WHAT OTHER INGREDIENTS?

LIALDA
--contains the highest mesalamine dose per tablet (1.2 g)
--Preparations that lower stool pH (such as lactulose, a laxative) will affect the binding of Mesalazine in the bowel and reduce its efficacy

ZOFRAN
--blocks the actions of chemicals WHICH??? in the body that trigger nausea and vomiting
--used to prevent nausea and vomiting that may be caused by surgery/cancer Tx (chemo/radiation)
--may also be used for other purposes not listed
--do not use if allergic to ondansetron, dolasetron (Anzemet), granisetron (Kytril), or palonosetron (Aloxi)
--beware if you have liver disease, or a personal or family history of Long QT syndrome
--contains phenylalanine
--SE's: blurred vision or temporary blindness, slow heart rate, trouble breathing, anxiety, agitation, shivering, light-headed, fainting, lowered urination, impaired thinking or reactions DON'T DRIVE
--FDA pregnancy category B (not expected to be harmful to an unborn baby) JUST LIKE THALIDOMIDE!
--take with or without food
--tablets dissolve in mouth
--take missed doses when remember unless almost time for next dose: don't double
--S/Sx of OD: sudden loss of vision, severe constipation, feeling light-headed, or fainting

PHENERGAN
--is promethazine, available under other brand names too
--an antihistamine, blocks release of histamine from mast cells in Th2 response
--used to treat allergy: itching, runny nose, sneezing, itchy/watery eyes, hives, skin rashes
--prevents motion sickness
--treats nausea and vomiting or pain after surgery
--also used as a sedative or sleep aid, and other purposes
--mild SE's: dizziness, drowsiness, sleepiness, or confusion; blurred vision, dry mouth;
ringing in your ears; mild nausea, vomiting; increased sensitivity to sunlight.
--SE's (GET HELP): twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs are early signs of dangerous side effects, shallow breathing, weak pulse; hallucinations (seeing or hearing things); nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or fever, muscle stiffness, confusion, fast or uneven heartbeat, sweating, fainting.
--do not give to young children, can cause repiratory distress
--OD SE's: severe drowsiness, dizziness, dry mouth, large pupils, flushing, nausea, vomiting, shallow breathing, and fainting, may impair your thinking or reactions NO DRIVING
--AVOID ALCOHOL
--many drug interactions
--BEWARE if you have: epilepsy, sleep apnea, glaucoma, stomach ulcer or digestive obstruction, bone marrow disorder; problems with urination; high BP, heart or liver disease.
--FDA pregnancy category C "may be harmful to an unborn baby"
--not known if it gets into breast milk
--BEWARE if over 60 years of age
--take with a full glass of water, with or without food
--if miss dose take when remember but don't double if it's time for next dose
--BEWARE DRUG INTERACTIONS (LIST NOT COMPLETE): sedatives or anxiety medicines such as alprazolam (Xanax), diazepam (Valium), chlordiazepoxide (Librium), temazepam (Restoril), or triazolam (Halcion); antidepressants such as amitriptyline (Elavil), doxepin (Sinequan), nortriptyline (Pamelor), fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil);
narcotic pain medicines such as meperidine (Demerol), morphine (MS Contin, MSIR), propoxyphene (Darvon, Darvocet), hydrocodone (Lortab, Vicodin), oxycodone (Percocet, Percodan), fentanyl (Duragesic), codeine (Fiorinal, Fioricet, Tylenol #3); phenobarbital (Luminal), amobarbital (Amytal) or secobarbital (Seconal); an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam); or atropine (Donnatal, and others), belladonna, clidinium (Quarzan), dicyclomine (Bentyl), glycopyrrolate (Robinul), hyoscyamine (Anaspaz, Cystospaz, Levsin, and others), methscopolamine (Pamine), and scopolamine (Transderm-Scop).

DONNATAL = phenobarbital and belladonna!!
--contains phenobarbital (barbiturate) and belladonna alkaloids
--phenobartibal slows the CNS activity, reduces muscle spasms in GI and urinary tracts, reduces fluid secretions from certain glands or organs WHICH ONES??
--phenobarbital "may be habit-forming"
--p is most widely used anticonvulsant worldwide and the oldest still in use
--has sedative and hypnotic properties but, as with other barbiturates, has been superseded by the benzodiazepines for these indications
--belladonna alkaloids in this med: atropine, hyoscyamine, and scopolamine
--this combo: belladonna alkaloids and phenobarbital: used to treat IBS & intestinal ulcers
--DO NOT TAKE WITH POTASSIUM SUPPLEMENT unless doc sez
--must report other drugs due to many drug interactions, particularly anything that makes you sleepy (cold or allergy meds, narcotics, sleeping pills, muscle relaxers, seizure, depression & anxiety meds)--YOU MIGHT GET SO SLEEPY that you die
--SE: impaired thinking/reactions
--DON'T DRIVE and avoid alcohol
--SE's common in older adults: constipation, dry mouth, problems with urination, agitation, confusion, or severe memory problems !!!
--take liquid with full glass of water
--OD: headache, dizziness, nausea, vomiting, dry mouth, blurred vision, hot or dry skin, trouble swallowing, feeling excited or agitated
--avoid becoming overheated or dehydrated during exercise and in hot weather because this drug decreases perspiration and you could get heat stroke
--DO NOT TAKE if you are allergic to atropine, hyoscyamine, scopolamine, or phenobarbital
--CI's: enlarged prostate, urination problems; GI blockage; paralytic ileus; active bleeding; severe ulcerative colitis or toxic megacolon; myasthenia gravis; a hiatal hernia or reflux disease or porphyria.
--BEWARE IF YOU HAVE a colostomy or ileostomy;
liver disease; kidney disease; glaucoma; a thyroid disorder; heart disease, high blood pressure, congestive heart failure; a heart rhythm disorder; or ulcerative colitis or stomach ulcer.
--FDA pregnancy category C--may be harmful to an unborn baby
--belladonna alkaloids and phenobarbital can slow breast milk production

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