Treating Crohn’s Disease
Treating Crohn’s Disease
Budesonide is one of the glucocorticoid steroids, a class of steroids which takes its name from two facts: they play an important role in the body’s metabolism of glucose; and they are produced in the adrenal cortex. In addition to being naturally-occurring, this important substance is also available in a number of therapeutic preparations. Sold under various brand names, budesonide preparations have been approved for use in treating several health conditions. Therapeutic Uses These preparations are most frequently used to treat asthma and allergies with respiratory symptoms, such as hay fever. Nasal polyps (“nasal polyposis”) can be treated (and in some cases prevented) with budesonide. However, it is also used as a Crohns treatment. Crohn’s disease (also called “regional enteritis”) is one form of inflammatory bowel disease (“IBD”). In addition to being used as a Crohns treatment, a new budesonide preparation is being tested to determine its efficacy as a treatment for ulcerative colitis. Brand Names AstraZeneca sells budesonide preparations under various brand names. Rhinocort, which is called Rhinosol in Denmark, is AstraZeneca’s budesonide nasal inhalant. The company’s oral budesonide inhalant is sold as Pulmicort (called Budicort in Israel). Symbicort is an AstraZeneca inhalant which combines budesonide with formoterol. The same preparation is sold in Brazil by Eurofarma, under the name Noex. Budesonide is marketed by Prometheus Laboratories as an enema or a time-release capsule, both of which are called Entocort. The same company also sells Entocort EC, which is an immediate-release budesonide capsule. Budesonide capsules are typically taken in one of two treatment courses: either 9 mg per day for a total of 2 months; or 6 mg per day for a total of 3 months. Pharmacological Characteristics Compared to other corticosteroids, the body metabolizes budesonide quickly. When used as a Crohns treatment, the substance is most effective in the ileum and right colon. Treating Crohn’s Disease . And, because it has very little impact on pituitary, hypothalamus and adrenal gland function, a patient does not need to gradually decrease the dosage before discontinuing budesonide. Side Effects Budesonide’s side effects are typically milder than those seen with similar medications. They can include the following: Dry mouthCoughingSore throatNasal irritation and/or nose bleedsChange in mucus colorDizziness or lightheadednessMuscle crampsRashNausea In rare cases, one or more of the following side effects can occur: Facial swellingSevere acneWhite areas in the oral cavityRespiratory difficultyIrregular menstruation The occurrence of any of these side effects should be immediately reported to the patient’s physician. A very small number of children taking budesonide have exhibited behavioral changes. Potential Drug Interactions and Contraindications Several drug interactions are possible with budesonide, including interactions with the following medications: ErythromycinClarithromycinTelithromycinNefazodoneIndinavirRitonavirKetoconazoleNelfinavirItraconazol Furthermore, budesonide may be contraindicated if you suffer from tuberculosis, hypertension, diabetes, osteoporosis or glaucoma. Before taking budesonide, patients must tell their physicians if they are pregnant or planning to become pregnant. Finally, patients taking budesonide must avoid being near anyone with measles or chicken pox – especially if they have not been immunized against those conditions.
Fmgemciexam
Fmgemciexam
in Case Study
Cleft lip and cleft palate
Eminn
Eminn
in General
This is a 29-year-old previously healthy woman with pyoderma gangrenosum immediately after thyroidectomy.
This is a 29-year-old previously healthy woman with pyoderma gangrenosum immediately after thyroidectomy.
This is a 29-year-old previously healthy woman with pyoderma gangrenosum immediately after thyroidectomy.The lesion arised on her collar, upper sternal and upper right thoracal area on the lower side of her cervical incision side.The clinical and histopathologic findings were consistent withPG Colonoscopy were negative for Crohn's disease ulcerative colitis.Dissemination of the ulcer did not respond to topical therapies but responded well to oral prednisone (80 mg/d) and oral cyclosporin (4 mg/kg per day) and was eventually repaired by skin grafting.During the 2 months, the prednisone dose had been gradually reduced to 10 mg/d and cyclosporin A (1 mg/kg per day), thereby decreasing the risk of nephrotoxicity, hypertension, hepatotoxicity and other side effects of the drug.By the16th-week visit, cyclosporin was discontinued.Treatment of PG has focused on the identification and control of the underlying systemic disease and immunosuppression and treatment of secondary infection.The ideal mode of therapy for PG varies according to the type and severity of the disease presentation.The course of the disease is unpredictable and the response to therapy variable from patient to patient.For patients with ulcers that are rapidly progressive, prompt control of the process is essential to provide pain relief, avoid secondary bacterial infections, and minimize the degree of scarring.Because of cyclosporine's proven efficacy and rapid response, many have advocated its use earlier in the course of the disease as first-line theraphy
Andy Wells
Andy Wells
in Case Study
Radial Keratotomy
Radial Keratotomy
A 41-year-old woman presented to the ophthalmology clinic with vision that had been deteriorating during the preceding 20 years. Her subjective refraction showed that a hyperopic shift had occurred since her current corrective lenses had been prescribed. Her best corrected visual acuity was 20/25 in both eyes. Slit-lamp examination revealed features that suggested that radial keratotomy had been performed: a clear central cornea with 16 corneal incisions extending from the periphery. Because radial keratotomies are performed manually, the incisions are neither perfectly radial nor symmetric. The patient confirmed that she had undergone this surgery for the treatment of myopia 23 years before presentation. At the time of the procedure, she had had no immediate complications. Radial keratotomy was frequently performed in the 1980s and 1990s to correct myopic refractive errors. However, the procedure is associated with a number of complications. Overlapping or excessively central incisions may lead to reduced visual acuity, and corneal scarring is associated with glare and halos. Patients are at risk for progressive hyperopia and, in rare cases, owing to reduced corneal biomechanical strength, globe rupture with minimal trauma. The patient received a new prescription for corrective lenses and was advised of the importance of protective eyewear. At a 6-month follow-up visit, her vision had not deteriorated further. Sahib Y. Tuteja, B.Sc. Manchester Medical School, Manchester, United Kingdom Muralidhar Ramappa, M.D. LV Prasad Eye Institute, Hyderabad, India source: nejm.org
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