AMANTADINE
Generic Name: Amantadine
Brand Name: SYMMETREL
INTRODUCTION
Amantadine is antiviral and antiparkinonism drug.
INDICATIONS
FDA Approved for:
• Parkinson’s disease
• Influenza A infection
Off label uses:
• ADHD
• Chronic hepatitis C
DOSAGE
• 200 mg per day
Preparations:
• Tablets: 100 mg
• Oral solution: 50 mg/5 ml (480-ml)
PHARMACOLOGICAL ACTIONS
Mechanism of Action:
• It prevents the release of infectious viral nucleic acid into the host cell by interfering with the function of the transmembrane domain of the viral M2 protein.
• It may have direct and indirect effects on dopamine neurons.
• It is a weak, non-competitive NMDA receptor antagonist
Pharmacokinetics:
It is primarily excreted unchanged in the urine and has half life of 10 to 31 hours.
ADVERSE DRUG REACTIONS
Notable Side Effects
• Nausea
• Dizziness, insomnia
• Anxiety, depression
• Livedo reticularis
Life-Threatening Effects
• Congestive heart failure
• Psychosis
• Rare seizures
• Neuroleptic malignant syndrome
Drug Interactions:
• Agents with anticholinergic properties may potentiate the anticholinergic-like side effects of amantadine.
• Coadministration of thioridazine has been reported to worsen the tremor in elderly patients with Parkinson’s disease
• Coadministration of quinine or quinidine with amantadine was shown to reduce the renal clearance of amantadine by about 30%
LAB TESTS NEEDED
CPK, BUN, serum creatinine, LDH, liver function test.
CONTRAINDICATIONS
• If there is a proven hypersensitivity to amantadine
OVERDOSE
• Acute toxicity may be attributable to the anticholinergic effects of amantadine. Drug overdose has resulted in cardiac, respiratory, renal or central nervous system toxicity
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...s, delirium, anxiety, cardiac and respiratory arrest and even coma.
TAPERING AND WITHDRAWAL
It should be tapered gradually since sudden discontinuation results in withdrawal symptoms as nasal congestion, abdominal symptoms, diarrhea, muscle aches and anxiety.
SPECIAL POPULATIONS
• Cardiac impairment: It should be used with caution.
• Elderly: It should be used with caution as susceptible to adverse effects.
• Children and adolescents: Safety and efficacy has not been established.
• Pregnancy: Risk category C ( no controlled studies in humans)
• Breast Feeding: there is no study done in nursing mothers.
PRECAUTIONS
Risk of angle closure glaucoma.
Risk of urinary retention related to urethroprostatic disorders.
CLINICAL GUIDELINES AND PEARLS
• It is a weak peripheral anticholinergic agent
It has some anti secretory, antispasmodic and mydriatic effects.
Lasix is known as the “water pill” it’s a diuretic administrated orally.(1) The active ingredient of Lasix is furosemide, but also includes a number of inactive ingredients including lactose monohydrate NF, magnesium stearate NF, starch NF, talc USP, and colloidal silicon dioxide NF. (1) The peak effects of furosemide are typically seen within the first hour of two after a dose of the medication. (1). Lasix is prescribed for individuals to treat edema that may arise from congestive heart failure, liver cirrhosis or renal disease. (1) In adults, furosemide may also be taken to treat hypertension itself.(1) Furosemide comes in 20, 40, and 80mg tablets as well as oral suspensions.(2) Furosemide is absorbed rapidly from oral suspension at 50 minutes, and from tablets at 87 minutes.(2) Food may slow down the absorption of the drug and alter the bioavalibitly.(1) Furosemide binds to plasma proteins, albumin being the main plasma protein that furosemide binds to, at 91-99%, and peak plasma concentrations increase with the increase of a single dose.(2) Furosemide is excreted through the urine and the remainder is excreted in the feces. (2) The half-life for furosemide is approximately 2 hours but the diuretic effects last 6-8 hours. (2)
...clearance and volume of distribution of unbound drug increased after post menstrual age with an increase of 41% and 25% of mature values respectively. The terminal half life decreased with an increase in age. This could be accounted for by differences in body weight and increase in metabolising enzymes as the subjects mature. Ropivacaine metabolism occurs by 1st order kinetics to PPX. the fraction metabolised utilised PPX urinary amounts. Post menstrual age and body weight were required in the expression of clearance, only body weight was required for the expression of volume. Clearance of unbound PPX achieved half of its mature value at 46.5 weeks post menstrual age. There was an increase of fraction metabolised in coloured and mixed race groups aged less than 1 year. The effects of increased volume and clearance are minimal as the metabolite in excreted anyway.
Goldmann, David R., and David A. Horowitz. American College of Physicians Home Medical Guide to Parkinson's Disease. New York: Dorling Kindersley Pub., 2000. Print.
People who have been diagnosed with this lifelong disease have either started to see the early signs and symptoms or have yet to recognize them. The negative impact that fatigue, loss of muscle strength and in-coordination has on the patients with Parkinson’s disease can be improved with a well-balanced exercise regimen. The three most common physical symptoms the patient will experience are tremors, rigidity, and bradykinesia. “Tremors while at rest are the most common initial symptom and are present in around 70 percent of cases at disease onset. It often presents as a pill rolli...
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But often the symptoms do not stop at acute withdrawal. After the body makes initial adjustments to the absence of drugs, the changes that have occurred in the brain still need time to revert back to their original state. During this period, a variety of symptoms known as Post-Acute Withdrawal Syndrome (PAWS) begin to occur. In the book Uppers, Downers, All Arounders, published by CNS Productions, authors Darryl Inaba and William Cohen define PAWS as “a group of emotional and physical symptoms that appear after major withdrawal symptoms have abated” (Inaba & Cohen, 2011).
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Parkinson’s disease is a chronic, progressive neurodegenerative disorder characterised by resting tremor, slowed movements, rigidity and postural instability (Casey G, 2013). It is the second most common neurodegenerative disorder after Alzheimer’s (Martin and Mills, 2012). There is a great variability in reported incidence rates, probably due to difference in diagnostic criteria and case ascertainment, with reported rates in Australia and in Western countries ranging from 8.6 to 19.0 per 100,000 population (J Macphee and D Stewart, 2012). The two main brain structures affected by Parkinson’s are the substantia nigra pars compacta, which is located in the midbrain and other parts of the basal ganglia, w...
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Most signs and symptoms of Parkinson disease correspond to one of three motor deficiencies: bradykinesia, akinesia, tremor, and rigidity. The first two qualities are usually present before tremor, but often attributed to aging by the patient and even the physician, and thus the disease is rarely diagnosed until tremor becomes evident much later. An average of 80% of the nigrostriatal neurons may have already degenerated by the time Parkinsonism is diagnosed, which complicates treatment (Fitzgerald, 130). Bra...
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Parkinson disease (PD), also referred to as Parkinson’s disease and paralysis agitans, is a progressive neurodegenerative disease that is the third most common neurologic disorder of older adults. It is a debilitating disease affecting motor ability and is characterized by four cardinal symptoms: tremor rigidity, bradykinesia or kinesis (slow movement/no movement), and postural instability. Most people have primary, or idiopathic, disease. A few patients have secondary parkinsonian symptoms from conditions such as brain tumors and certain anti-psychotic drugs.
Additionally ACE Inhibitors are excreted through the kidney by glomerular filtration and therefore may need to be adjusted due to renal impairment (Mangoni & Jackson, 2001).
... their mediation regimen closely. Many elderly patients are taking several drugs that can reduce the efficacy and increase the toxicity of one another. In order to avoid complications it is important to always educate the patients on proper usage, side effects and specific drug interactions. If a patient misses a dose they should never double up. This could increase their risk for possible overdose. Certain OTC drugs and herbal supplements can have adverse reactions and reduce the efficacy of these drugs. Patients should be advised to that alcohol or tobacco consumption may alter the absorption of the medication and should be avoided. Lab work should be completed routinely to avoid renal and liver toxicity when taking these two classes of drugs.
Acromegaly and gigantism are due to overproduction of Growth hormone (GH) usually caused by a GH-secreting pituitary adenoma— a disorder of unequal skeletal, tissue, and organ growth. The incidence of acromegaly is 5 cases per million per year and the prevalence is 60 cases per million. High GH and insulin-like growth factor-I (IGF1) levels lead to comorbidities including arthritis, facial changes, hypertension, diabetes mellitus, and heart and respiratory failure. If the condition is not diagnosed and treated early, its disabling effects leads to increase in morbidity and reduced life expectancy. The diagnosis is based on clinical features and confirmed by measuring growth hormone levels after oral glucose tolerance test and the estimation