Percent expected to be able to discuss medication-related problems with a pharmacist during a clinic visit. Eighty-two percent said they expect a pharmacist to interact with their clinic physician to optimize medication use, and 58% indicated that they would like a visit with the clinic pharmacist to discuss their medication needs. Many respondents expected a.
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Researchers determined that those who had adverse events also had, among other factors, a family psychiatric history, a diagnosis of symptomatic epilepsy, and a high starting dose and rapid titration schedule of topiramate.
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Tory bipolar disorder types I and II ; responded to a mean dose of 200 mg day of topiramate after 8.5 weeks of treatment. Chengappa et al.10 treated 20 patients with bipolar I disorder or schizoaffective disorder with adjunctive topiramate mean dose 210.5 mg day ; over a 5-week period. Twelve patients 60% ; responded to topiramate, and the time to response ranged from 2 to 4 weeks. Adverse events included paresthesias, anorexia, slowed thinking, fatigue, sedation, and word-finding difficulty. Fifty-five percent of patients reported no adverse effects. Only 1 patient discontinued the study prematurely because of "acute confusional states." Wooten and Kramer11 used high-dose topiramate to treat 8 patients with bipolar disorder, schizoaffective disorder, or schizophrenia. The mean dosage was 868 mg day in divided doses range, 502000 mg day ; . Sixty percent of patients responded to topiramate. One patient experienced mild paresthesia, and 2 patients experienced transient delirium at high doses 1600 and 2000 mg day ; . Kusumakar et al.9 treated 27 female patients with a DSM-IV diagnosis of bipolar I and bipolar II disorder who had been refractory to at least 2 mood stabilizers and who had a weight gain of more than 20% over the previous 24 months with topiramate 100150 mg day ; . Fifteen of the 27 patients showed significant improvement, and only 4 patients discontinued because of adverse events. Fourteen patients lost weight during the 16-week study. Nine patients experienced a weight loss of more than 5%. We describe a case series of 5 patients who were treated with topiramate either as an adjunct or as monotherapy who experienced improvement in mood symptoms as well as substantial weight loss and tramadol.
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PRODUCTS INVOLVED IN TELEPHONE ENQUIRIES Table 3 lists the most frequent products as distinct from substances ; encountered in the principal age groups. In older age groups, psychotropic drugs and analgesics predominate with newer SSRIs joining first generation tricyclic antidepressants near the top of the list. Table 3: Top five products by age groups and valaciclovir, for example, topiramate wiki.
| Topiramate adverse effectsPatients with kidney disease with or without nephrotic syndrome ; , and should generally be regarded as the drugs of first choice.42, 43 Drug therapy for hypertriglyceridemia includes a fibrate or niacin. In general, fibrates are better tolerated than nicotinic acid. Statins are indicated to lower LDL to acceptable levels in CKD patients based on efficacy and additional benefits observed in the general population, including the reduction in cardiovascular events and all-cause mortality.42 Drug-Related Problems in Chronic Kidney Disease Given the vast number of medications required to address CKD and manage the associated complications, drug-related problems are prevalent in this population.44.45 Such problems include improper drug selection, subtherapeutic dosage, overdose, adverse drug reactions, drug interactions, failure to receive a drug, and inappropriate laboratory monitoring.45 In the dialysis population, the extent of medication use, including medications administered during dialysis therapy, contributes to the potential for drug interactions, adverse reactions, and nonadherence to therapy. The effect of decreased kidney function on absorption, distribution, metabolism, and elimination of pharmacologic agents, in addition to the contribution of dialysis to drug removal, further complicates pharmacotherapy in this population. Appropriate pharmacotherapeutic management includes choice of rational agents based on the indication, a regular comprehensive review of all medications, and frequent re-evaluation to adjust regimens relative to kidney function. Another important consideration in patients with CKD is.
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TOPAMAX Abbreviated Prescribing Information. Please read Summary of Product Characteristics before prescribing. Presentation: Tablets: 25, 50, 100, mg topiramate. Sprinkle Capsules: 15, 25, 50 mg topiramate. Uses: Monotherapy: Newly diagnosed epilepsy age 6 years ; : generalised tonic-clonic partial seizures, with without secondarily generalised seizures. Adjunctive therapy of seizures: partial, Lennox Gastaut Syndrome and primary generalised tonic-clonic. Conversion from adjunctive to monotherapy: efficacy safety not demonstrated. Dosage and Administration: Oral. Do not break tablets. Low dose initially; titrate to effect. Renal disease may require dose modification. Monotherapy: Over 16 years: Initial target dose: 100 mg day two divided doses; maximum 400 mg day ; . Children 6 to 16: Initial target dose: 3 6 mg kg day two divided doses ; . Initiate at 0.5 1 mg kg nightly with weekly or fortnightly increments of 0.5 1 mg kg day. Doses less than 25 mg day: Use Topamax Sprinkle Capsules. Adjunctive therapy: Over 16 years: Usually 200-400 mg day two divided doses; maximum 800 mg day ; . Initiate at 25 mg daily with weekly increments of 25 mg. Children 2 to 16: Approx. 5 - 9 mg kg day two divided doses ; . Initiate at 25 mg nightly with weekly increments of 1 3 mg kg. Sprinkle Capsules: take whole or sprinkle on small amount teaspoon ; of soft food and swallow immediately. Contra-indications: Hypersensitivity to any component. Precautions and Warnings: May cause sedation; so caution if driving or operating machinery. Contraception recommended for women of childbearing potential oral contraceptives should contain at least 50 g oestrogen ; . Acute and vardenafil.
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Comparison of `Zoladex' 3.6mg with ovarian ablation Data are available from a large, randomised trial which directly compared `Zoladex' 3.6mg with surgical ovarian ablation.12 This trial was conducted in the US by the South West Oncology Group SWOG ; , the North Central Cancer Treatment Group NCCTG ; and the Eastern Co-operative Oncology Group ECOG ; . Based on the hypothesis that medical treatment with `Zoladex' 3.6mg would be preferred if it were shown to be equivalent to or, at most, only slightly less effective than oophorectomy, with an acceptable tolerability profile, 136 evaluable premenopausal patients with ER + and or PgR + advanced breast cancer were randomised to treatment with either surgical oophorectomy n 67 ; or `Zoladex' 3.6mg, every 4 weeks n 69.
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Treatment of epilepsy remains important in helping to reduce the psychological and social sequelae which follow on from uncontrolled seizures." "There has been a long period of misdiagnosis and misclassification, with misuse of investigations and under use of optimal diagnostic tools, surgical resources and newer drugs." "Inclusion of epilepsy as one of the key disease activity markers in the 2004 General Medical Services GMS ; GP contract may prove to be a powerful motivator for primary care to improve the lot of epilepsy patients in the community." "Of the newer drugs, lamotrigine, topiramate and levetiracetam have become commonly used compounds with proven efficacy, fewer pharmacokinetic interactions and more favourable tolerability profiles than the older agents and zantac.
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Consider as an antidepressant], hydroxyzine and diphenhydramine [we will not send claims as CNS only reports as an antidyskinetic], and Strattera which will be reported on separately as an ADHD non-stimulant. Minnesota provided the drug claims for the seven anticonvulsants that may be used for mood stabilizers. This includes valproate, levetiracetam, lamotrigine, gabapentin, carbamazepine, topiramate, and oxcabazepine. Providing claims for these drugs has limited utility because these drugs are not matched for other anticonvulsant drugs to determine why the drugs are used. Currently, CNS also does not use diagnosis claims either to determine if the anticonvulsant is used for a seizure disorder. The State contract with CNS allows for 200 physicians. The contract also stipulates there is a control group. Dr. Wiberg brought up the issue of the use of a control group and the requirement to comparability that is to treat all recipients the same. Since our State attorneys wrote the contract, it should not be a problem but Dr. Reinke will confirm. The ranking is based on the dollars of the paid drug claims for those drugs associated with "hitting" on the quality indicators. We may want to consider using a ranking of only the quality indicators for second generation antipsychotics as that is the State's primary focus. Currently, there are twenty-nine indicators; seventeen are a poly pharmacy issue which is defined as using more than one drug in the same drug class at the same time. Two indicators, however, have to do with patient behavior: 1 ; discontinuance of drugs and 2 ; multiple prescribers. New indicators are being developed for opiates, bipolar disorder, ADHD, drug use in the elderly, and depression. Slides, showing the CNS analysis, were presented. Twenty nine percent of recipients received a mental health drug per quarter based on an average monthly number of 219, 118 recipients enrolled in FFS Medicaid . The mental health drug costs for these recipients accounted for 44% of the total drug expenditures for the fee-for-service FFS ; recipients. A slide showed the number of mental health drugs per patient for 60 concurrent days. CNS stated that the 60% on 1 mental health drug is pretty typical of other state Medicaid program where CNS has done analysis. The greatest concern is when patients are on five or more mental health drugs. There were 1, 920 on "5" drugs; 650 on "6" drugs; 215 on "7" drugs; 59 on "8" drugs; 18 on "9" drugs; and 9 on "10" mental health drugs. The State could consider individual case review for these. Next, slides were presented showing drug utilization per drug class for all ages. Keith Schafer, CNS, stated Minnesota has a higher percent of poly pharmacy than any other State in the Midwest that uses CNS [Michigan, S Dakota, N Dakota, Arkansas, Missouri, Wisconsin, Indiana, Kansas]. There was a discussion of how the mix of recipients in FFS programs in Minnesota has a higher number of disabled. Pam Victor, CNS, stated that 33% of people with mental health drugs are taking a second generation antipsychotic as compared to 20-25% in other states; the pupm [per user per month] cost is correspondingly higher for mental health drugs at $307 [Minnesota] compared to $220 to $250 range for most other states. The next highest state is $275 compared to Minnesota's $307. The number of recipients on two or more 2nd generation antipsychotics is twice as high in Minnesota with the corresponding 2nd generation cost of $202.94 compared to $112 to $160 in other States. Therefore, the choice of Minnesota to focus on the 2nd generation antipsychotics makes very good sense. Slides showing drug class use by age categories[ 0-17 yrs; 0-4 yrs; 18 to 64 yrs, and 64 years] were briefly discussed. Pam Victor, CNS, stated that there are only 15% of children in Minnesota FFS compared to other states with less managed care where there are 25-30% children. Dr. Reinke noted that age could be one of the parameters used for our first mailing. Focusing on the Top 100 physicians "hitting" on the quality indicators, would account for 43.8% of the mental health drug dollars of the outliers. Focusing on the Top 200 will account for 58.9% of outlier dollars. Keith Schafer pointed out the effect of diminishing return, with the Top 400, you would only pick up another 10% of the outlier dollars. This program will target the Top 200 where we will see the greatest effect and ceclor.
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Expectation that they give up the drug may present them with what seems to be an impossible choice. Some chemically-involved victims seek help from, or are mandated into, substance abuse treatment programs. Often, intakes to treatment programs do not include an assessment for adult domestic violence. Victims therefore often remain unidentified as they participate in the treatment program. Even when they identify domestic violence, substance abuse treatment providers often still assume that victims must be abstinent before they can address their safety- related concerns. Imagine, then, a victim of domestic violence who is still in a relationship with an abusive partner, engaging in a recovery program, keeping a regular schedule of treatment programming and appointments, abstaining from alcohol or other drug use, attending AA meetings, working the program, getting self-focused, and practicing emotional detachment. Her abusive partner might respond in the following ways. Increased violence and coercion Abusers are typically very resistant to their partners' attempts toward independence of any kind. Abusers may respond to their partners' recovery efforts by re-establishing their control through the use of intensified violence and coercion. Sabotage Some abusers will actively sabotage their partners' recovery. Sabotage can take many forms. An abuser may renege on child care, preventing the victim from keeping appointments or going to meetings. He may keep alcohol in the house, saying he's "not the one with the problem." He may restrict access to the resources the victim needs in order to comply with her treatment plan: transportation, child care, and health insurance. The abuser may use emotional manipulation: "I know your recovery program is important to you, but I'm getting concerned about the kids. Your being away from them so much is really taking its toll on them." The abuser may make accusations of infidelity regarding the victim's relationship with self-help group members. Abusers may also coerce the victim into using substances and celecoxib.
Female ZDF rats were gavaged with Topifamate and pair fed with controls each day at 4 pm. Cannulated rats were permitted to feed without any restrictions ad libitum ; . Daily Topirqmate treatments caused food intake reduction lasting 1-2 days recovering fully by day 6 of treatment. All groups of rats experienced the same reductions in body weight regardless of surgical state with full weight regained by day 7 A ; . Basal blood glucose levels were significantly lower in Topirramate treated animals compared to controls B ; . OGTT were performed with a 50% glucose solution 2 grams per kg ; , and results from Control and Topiramae treated ZDF rats are seen in Figure C data represent MEAN SEM, n 5-6 ; and indicate lower glucose levels in Topuramate treated rats compared to Controls P 0.05.
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Impairing efficacy of migraine prophylactics and that once-daily dosing is preferable 82. The formal evidence-base for efficacy is good for beta-blockers 83, 84, valproate 85 and topiramtae 86, 87, adequate for amitriptyline 88 but poor for other prophylactic drugs. The following recommendations are based on this evidence coupled with expert clinical experience.
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THE SAFETY OF TULATHROMYCIN ADMINISTRATION IN GOATS. KE Washburn, WT Bissett, VR Fajt, FJ Clubb, GT Fosgate, MC Libal, KE Smyre, KL Cass. Texas A&M University, College of Veterinary Medicine, College Station, TX. The objective of our study was to determine if the administration of tulathromycin to goats at ten times the label dose for cattle and swine results in adverse effects. Ten goats were enrolled in the study and randomly assigned to treatment or control groups with five animals each. Tulathromycin or an equivalent volume of saline was administered subcutaneously to treatment and control groups, respectively. Samples were obtained from both groups prior to and at pre-determined times following administration for hematology, serum chemistry, urinalysis, genotoxicity analysis and fecal floatation. In addition, goats were observed daily for clinical evidence of adverse effects post-dosing over a seven-day study period. All goats survived until the end of the study, and although all goats in the tulathromycin treated group experienced periods of transient pain following administration, laboratory data and clinical observations indicated no significant differences in parameters of clinical relevance between treatment and control goats. Overall, findings were similar to those of previously performed safety studies performed in cattle and swine. However, the numbers of changes in genomic material were significantly greater for treatment goats as compared to controls. No significant gross or microscopic lesions were observed in either group upon post-mortem examination that could have been attributed to tulathromycin administration. In conclusion, this study suggests that administration of tulathromycin to goats at ten times the label dose for cattle and swine results in clinically mild and transient effects. Further studies are needed to explore potential long-term effects in light of the genotoxicity results.
MCELROY, ARNOLD, SHAPIRA, ET AL. measures included blood pressure and fasting measurements of blood glucose, insulin, and lipids. At every treatment period visit, we assessed all efficacy measures except for blood tests, waist-to-hip ratio, and percent and total body fat, which were obtained at the week 14 treatment period visit or the last visit if the patient terminated the study prematurely ; . We assessed the following safety measures: adverse events, clinical laboratory data, physical examination findings, and vital signs. TABLE 1. Baseline Characteristics of Patients With Binge Eating Disorder Randomly Assigned to 14 Weeks of DoubleBlind Treatment With Topiramate or Placebo Treatment Group Characteristic Topiramate N 30 ; Mean SD 40.9 5.3 4.3 N Mood disorder diagnosis Current Lifetime and colchicine.
Figure 4: Effects of toplramate treatment on the frequency of spontaneous seizures after Lipilo-induced SE. Saline-vehicle animals not represented ; received lithium and saline instead of pilocarpine; they did not develop SE. Lipilo-DZP and LipiloTPM animals were subjected to lithiumpilocarpine SE and received for 7 days two daily injections of DZP or 10, 30 or 60 mg kg TPM, respectively and were observed by video monitoring for 4 weeks after the occurrence of the first spontaneous seizure. All animals showed spontaneous recurrent seizures. Although Lipilo-TPM animals exhibited a tendency to exhibit more frequent seizures than Lipilo-DZP rats, the difference was not statistically significant. Values represent means S.D!
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Ne of the great tragedies in life is how rarely we appreciate what we have until it's gone. That is certainly true of the late Senator Paul Wellstone of Minnesota, who died Oct. 25 in a plane crash. Wellstone, 58, was a partisan Democrat, a New Deal liberal in a time when the party mainstream was moving to the right. On his first trip to the White House on the eve of the Gulf War, he reportedly assailed former President George H. W. Bush with antiwar arguments, prompting the former president to turn to an aide and ask, somewhat unceremoniously, "Who is this chickens.?" The question was to be repeated often in the 12 years Wellstone served in Washington. According to the Congressional Quarterly, no other member of the Senate was on the losing side of so many 99-to-1 or 98-to-2 votes, and no other member voted more consistently against the Bush administration. A few days before his death, Wellstone was one of 23 senators--the only one in a close re-election fight--to vote against a resolution authorizing President George W. Bush to take unilateral action against Iraq. ; "He was the Mr. Smith who went to Washington, a down-to-earth public servant filled with enthusiasm for people and a love of life, someone who stood up vocally and passionately every time for a core set of principles and values, " recalled former Democratic Vice President Al Gore, who described him as "the ideal elected official. He loved his job because it was the best way he could serve the people of his state and his country." Gore characterized the late senator as "by far the biggest and most energetic champion of quality health coverage for all Americans who need it. We worked with him closely on this issue, and on behalf of the mental health community his passing leaves us with an irreplaceable loss, " he said. Senator Pete Domenici, a republican from New Mexico, was Wellstone's friend. The two worked tirelessly on the mental health parity bill pending in Congress. In the days following Wellstone's death, Domenici could not bring himself to comment on the tragedy. "Everyone liked him--it's pathetic he's dead, " he said. Democratic Senator Edward M. Kennedy of Massachusetts was in Minnesota for a rally the day of the tragedy and passed the evening with bereft Wellstone supporters, see sidebar. ; "The nation will miss his enormous ability to reach out, touch and improve the lives of the people he served so brilliantly, " Kennedy said. From the start, Wellstone's support came from the people--from those concerned about health care and the environment, from rural activists, union members and his former students at Carleton College where he taught political science. They hit the streets and phone lines during his 1990 campaign touting the little guy Wellstone stood only 5 feet 5 inches tall ; in the big green bus as the one for whom to vote. The son of Russian Jewish immigrants, Wellstone was raised in Arlington, VA, and was a champion wrestler at the University of North Carolina in Chapel Hill, where he earned both a bachelor's degree and a doctorate. Few believed the Minnesota "newcomer" would prevail against Rudy Boschwitz, the well-heeled, two-term republican incumbent. Wellstone surprised everyone. He won the race with a 52 percent majority and four years later scored another victory. He was trying for a third win when his plane crashed, 11 days before the November election. The morning of the tragedy, Wellstone, his wife, Sheila who was usually at her husband's side ; and their adult daughter, Marcia Markuson, were headed to Eveleth for the funeral of Martin Rukavina, a longtime, for example, topiramate mood stabilizer.
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Doug's mother was distraught when she brought him, age 8 months. Her doctor only seemed sympathetic with her purpose to keep the baby's temperature down the next time he catches a cold. But her doctor had referred her to the county social worker. She had been completely honest with her doctor, because she was that kind of trusting person. Since her baby had only experienced one seizure which was during a fever ; , she didn't see why her beautiful first born child should be on medicine "the rest of his life". She wanted her baby to be perfect. But the social worker had called her, talked about "the law" and being an unfit mother. She was all apart. The baby was supposed to be on PhenobarbitalTM twice a day. Our tests showed Doug had Ascaris plus lead toxicity. He was also getting home made strawberry and grape juice. She promised to put the three cats outdoors, keep the baby off the floor, keep Doug's fingernails short and always wash his hands before eating. The parasites were easily killed. The lead was spo.
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Comment Dissemination is a rare manifestation of infection with S schenckii. A search of the readily available English literature identified 253 cases of disseminated sporotrichosis. There are 2 types of disseminated sporotrichosis--systemic and cutaneous. Usually, patients with systemic disease also have disseminated cutaneous lesions; however, fewer than 1% of patients with disseminated cutaneous lesions also have systemic involvement.10 Patients with disseminated cutaneous involvement typically present with extensive disease in which lesions occur far from the initial inoculation site. Moreover, patients with disseminated skin lesions often have and should be thoroughly checked for ; internal involvement. Excluding our case, to our knowledge, only 10 cases of disseminated cutaneous sporotrichosis without internal disease have been reported.3, 11-14 Smith et al15 reported only 1 of 3 cases of disseminated cutaneous disease limited to the skin. A case report by Kurosawa et al16 involved a patient with the human immunodeficiency virus HIV ; . However, this patient later developed systemic dissemination to the eye. Disseminated sporotrichosis often is associated with immunodeficiency, the primary cause of which is impairment of the host's cell-mediated immunity.17 Our patient was taking 2 immunosuppressive medications. He also had diabetes mellitus, which may have contributed to his decreased immune.
INDICATIONS AND USAGE Epilepsy TOPAMAX topiramate ; Tablets and TOPAMAX topiramate capsules ; Sprinkle Capsules are indicated as adjunctive therapy for adults and pediatric patients ages 2-16 years with partial onset seizures, or primary generalized tonic-clonic seizures, and in patients 2 years of age and older with seizures associated with Lennox-Gastaut syndrome. Migraine TOPAMAX topiramate ; Tablets and TOPAMAX topiramate capsules ; Sprinkle Capsules are indicated for adults for the prophylaxis of migraine headache. The usefulness of TOPAMAX in the acute treatment of migraine headache has not been studied. CONTRAINDICATIONS TOPAMAX is contraindicated in patients with a history of hypersensitivity to any component of this product. WARNINGS Metabolic Acidosis Hyperchloremic, non-anion gap, metabolic acidosis i.e., decreased serum bicarbonate below the normal reference range in the absence of chronic respiratory alkalosis ; is associated with topiramate treatment. This metabolic acidosis is caused by renal bicarbonate loss due to the inhibitory effect of topiramate on carbonic anhydrase. Such electrolyte imbalance has been observed with the use of topiramate in placebocontrolled clinical trials and in the post-marketing period. Generally.
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