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MARCH 27TH, 2011
By ADMIN

MEDICATIONS FOR RA (RHEUMATOID ARTHRITIS): CYTOXAN

Generic available: no
Tablet size: 25, 50 mg
Intravenous administration possible
Dose: variable
Effective within: two weeks to three months
Cyclophosphamide is by far the most potent and dangerous of the immunosuppressive drugs used in the treatment of RA. Like azathioprine, it was first used as a form of cancer chemotherapy. Its effectiveness in the treatment of RA is undisputed, but its potentially severe side effects preclude its use in the treatment of mild or moderate RA. Cyclophosphamide is generally reserved for the treatment of unusually severe or life-threatening complications of RA such as vasculitis, Felty’s syndrome, and other complications with organ involvement. In these very serious situations the benefits of cyclophosphamide outweigh the risks.
Side effects of cyclophosphamide
Cyclophosphamide has essentially the same potential side effects as azathioprine. Because cyclophosphamide has the most potent effect on the bone marrow and immune system, the occurrence and severity of these side effects are higher than in people taking azathioprine, although the precise risk is difficult to ascertain. We do know that a low white blood cell count occurs so frequently during cyclophosphamide therapy that it is often considered an expected effect rather than a side effect. The risk of severe blood abnormalities and infection increases in proportion to the dose and length of time which cyclophosphamide is prescribed.
Unlike azathioprine, cyclophosphamide can cause cystitis or bladder inflammation. Uncomfortable urination and the appearance of blood in the urine are symptoms of cystitis.
Hair loss can occur, particularly at very high doses. The amount of hair loss is highly variable, but in almost all patients it re-grows after the treatment is discontinued.
An important concern in cyclophosphamide therapy is the long-term increased risk of bladder or blood cancers (leukemias and lymphomas). It is estimated that with long-term daily cyclophosphamide use the risk of developing these cancers nearly doubles. Because cyclophosphamide is prescribed almost exclusively for severe, unremitting RA or for life-threatening complications, this potential risk of cancer in the future is usually at a tolerable level.
*101/209/5*

MEDICATIONS FOR RA (RHEUMATOID ARTHRITIS): CYTOXANGeneric available: noTablet size: 25, 50 mgIntravenous administration possibleDose: variableEffective within: two weeks to three monthsCyclophosphamide is by far the most potent and dangerous of the immunosuppressive drugs used in the treatment of RA. Like azathioprine, it was first used as a form of cancer chemotherapy. Its effectiveness in the treatment of RA is undisputed, but its potentially severe side effects preclude its use in the treatment of mild or moderate RA. Cyclophosphamide is generally reserved for the treatment of unusually severe or life-threatening complications of RA such as vasculitis, Felty’s syndrome, and other complications with organ involvement. In these very serious situations the benefits of cyclophosphamide outweigh the risks.
Side effects of cyclophosphamide Cyclophosphamide has essentially the same potential side effects as azathioprine. Because cyclophosphamide has the most potent effect on the bone marrow and immune system, the occurrence and severity of these side effects are higher than in people taking azathioprine, although the precise risk is difficult to ascertain. We do know that a low white blood cell count occurs so frequently during cyclophosphamide therapy that it is often considered an expected effect rather than a side effect. The risk of severe blood abnormalities and infection increases in proportion to the dose and length of time which cyclophosphamide is prescribed.Unlike azathioprine, cyclophosphamide can cause cystitis or bladder inflammation. Uncomfortable urination and the appearance of blood in the urine are symptoms of cystitis.Hair loss can occur, particularly at very high doses. The amount of hair loss is highly variable, but in almost all patients it re-grows after the treatment is discontinued.An important concern in cyclophosphamide therapy is the long-term increased risk of bladder or blood cancers (leukemias and lymphomas). It is estimated that with long-term daily cyclophosphamide use the risk of developing these cancers nearly doubles. Because cyclophosphamide is prescribed almost exclusively for severe, unremitting RA or for life-threatening complications, this potential risk of cancer in the future is usually at a tolerable level.*101/209/5*

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categories Arthritis

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MARCH 17TH, 2011
By ADMIN

PATIENTS’ RESPONSES TO BDD TREATMENT DAVID: A GOOD RESPONSE TO MEDICATION PLUS COGNITIVE-BEHAVIORAL THERAPY

David was feeling desperate. A 32-year-old disc jockey, he was at the point of quitting his job. He couldn’t focus on his work because of his hair obsessions, and was often late because he couldn’t tear himself away from the mirror in the morning. Even the expensive new hairpiece he’d bought to hide his slightly receding hairline didn’t help him feel any better. “I don’t like going out in public, and I’ve given up on dating,” he said. “I don’t want to date because someone will run their fingers through my hair and know it’s a hairpiece. I can’t focus on conversations because I think people are looking at my hair. At times I stay in completely; I don’t even food shop.”
In the week before he first saw me, David missed work three times and had considered going to an emergency room because he was so panicked about his hair. “I hate myself and how I look. I’m really down on myself. I’ve even had thoughts of ending my life. I can’t live the rest of my life like this. How can you live in your own body if you can’t stand it?”
David started taking fluoxetine (Prozac) right away. He continued supportive psychotherapy (see description below) which had helped him cope a little better but didn’t diminish his BDD symptoms. As expected, the medication didn’t work immediately, and the first month of treatment was rocky. David and I considered hospitalization several times. But with the support of friends, family, and his therapist, he maintained his will to live. About a month after beginning treatment, David started to feel somewhat better. His hair preoccupation began to wane, and the thoughts were less painful. He was more willing to see his friends. He didn’t check mirrors all the time, and he sought reassurance less often. He was no longer considering suicide.
He then started CBT while continuing the medication. His CBT therapist helped him stop mirror checking and reassurance seeking. He started going out more and seeing friends. Finally, he even gave up his hairpiece. He received many compliments on his new hair style, and his self-confidence greatly improved.
*229\204\8*

PATIENTS’ RESPONSES TO BDD TREATMENT DAVID: A GOOD RESPONSE TO MEDICATION PLUS COGNITIVE-BEHAVIORAL THERAPYDavid was feeling desperate. A 32-year-old disc jockey, he was at the point of quitting his job. He couldn’t focus on his work because of his hair obsessions, and was often late because he couldn’t tear himself away from the mirror in the morning. Even the expensive new hairpiece he’d bought to hide his slightly receding hairline didn’t help him feel any better. “I don’t like going out in public, and I’ve given up on dating,” he said. “I don’t want to date because someone will run their fingers through my hair and know it’s a hairpiece. I can’t focus on conversations because I think people are looking at my hair. At times I stay in completely; I don’t even food shop.”In the week before he first saw me, David missed work three times and had considered going to an emergency room because he was so panicked about his hair. “I hate myself and how I look. I’m really down on myself. I’ve even had thoughts of ending my life. I can’t live the rest of my life like this. How can you live in your own body if you can’t stand it?”David started taking fluoxetine (Prozac) right away. He continued supportive psychotherapy (see description below) which had helped him cope a little better but didn’t diminish his BDD symptoms. As expected, the medication didn’t work immediately, and the first month of treatment was rocky. David and I considered hospitalization several times. But with the support of friends, family, and his therapist, he maintained his will to live. About a month after beginning treatment, David started to feel somewhat better. His hair preoccupation began to wane, and the thoughts were less painful. He was more willing to see his friends. He didn’t check mirrors all the time, and he sought reassurance less often. He was no longer considering suicide.He then started CBT while continuing the medication. His CBT therapist helped him stop mirror checking and reassurance seeking. He started going out more and seeing friends. Finally, he even gave up his hairpiece. He received many compliments on his new hair style, and his self-confidence greatly improved.*229\204\8*

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categories Anti Depressants-Sleeping Aid

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MARCH 7TH, 2011
By ADMIN

DRUGS FOR RHEUMATOID ARTHRITIS TREATMENT: PENICILLAMINE AND GOLD

What is penicillamine?
Penicillamine (Cuprimine, Depen) is a chelating agent, which means that it binds metals in the blood and aids in their removal. It is very effective in treating RA, but it also has some toxicity, including muscle weakness, a lupus-like syndrome of the kidney (protein in the urine), and other effects on the blood counts. It is not related to the antibiotic penicillin.
This drug is modestly useful in patients with RA. It used to be the standard of care but has been replaced by newer agents.
The drug decreases the formation of antibodies, stops the white cells in their tracks, decreases the function of the T cells, and removes damaging molecules called free radicals.
Gold used to treat RA
Gold therapy is an old remedy that still has a place in the treatment of RA. In fact, many doctors feel that gold therapy can induce a complete remission of the disease.
There are injectable forms of gold and an oral form to treat RA. The oral form is less effective than the injectable form.
As with all drugs, gold therapy has its problems. It may cause mouth ulcers, rashes, protein in the urine, and, rarely, low platelets (blood-clotting particles) and a low white cell count.
The usual dose of injectable gold is a test dose of 10 milligrams, followed one week later by 25 milligrams once a week for two weeks, and then 50 milligrams weekly for up to 20 weeks. It can be given longer if the patient has a dramatic remission.
Your doctor will keep a record of your injections and test you before each new dose. The doctor will take urine and a blood count to make sure that all is well.
*36/141/5*

DRUGS FOR RHEUMATOID ARTHRITIS TREATMENT: PENICILLAMINE AND GOLDWhat is penicillamine?Penicillamine (Cuprimine, Depen) is a chelating agent, which means that it binds metals in the blood and aids in their removal. It is very effective in treating RA, but it also has some toxicity, including muscle weakness, a lupus-like syndrome of the kidney (protein in the urine), and other effects on the blood counts. It is not related to the antibiotic penicillin.This drug is modestly useful in patients with RA. It used to be the standard of care but has been replaced by newer agents.The drug decreases the formation of antibodies, stops the white cells in their tracks, decreases the function of the T cells, and removes damaging molecules called free radicals.
Gold used to treat RAGold therapy is an old remedy that still has a place in the treatment of RA. In fact, many doctors feel that gold therapy can induce a complete remission of the disease.There are injectable forms of gold and an oral form to treat RA. The oral form is less effective than the injectable form.As with all drugs, gold therapy has its problems. It may cause mouth ulcers, rashes, protein in the urine, and, rarely, low platelets (blood-clotting particles) and a low white cell count.The usual dose of injectable gold is a test dose of 10 milligrams, followed one week later by 25 milligrams once a week for two weeks, and then 50 milligrams weekly for up to 20 weeks. It can be given longer if the patient has a dramatic remission.Your doctor will keep a record of your injections and test you before each new dose. The doctor will take urine and a blood count to make sure that all is well.*36/141/5*

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categories Arthritis