DIGESTIVE SYSTEM-PART-II-DIARRHEA

DIARRHEA-TREATMENTS

Diarrhea is a frequent disturbing physiologic event in our routine life. It is one of the body languages by which the body tries to express that some unwanted things have been ingested into it. It is an involuntary action of expelling unwanted things out by our bodies without our concern.

Hence diarrhea can be defined as an abnormal increase in the frequency and loosening of the stools.

In general, the amount of stool may increase to above 200 gm or ml/day and its water content increased to above 60% to 99%.

Diarrhea persists due to some disturbing physiologic factor prevents or blocks the absorption of the water content of the stool by the small intestine.

Classifications of Diarrhea

1.By Mechanism of Actions:-

a. Osmotic Diarrhea occurs when a nonabsorbable substance present in the foods pulls excess water into the intestinal lumen.

(e.g.)1.Overeating

2.Ingestion of nonabsorbable substances such as sorbitol, glycerin, etc.

3.Enzyme deficiencies (e.g.)Deficiency of Lactase a disaccharidase enzyme to breakdown the nonabsorbable disaccharide sugar Lactose into absorbable monosaccharides.

b.Secretory Diarrhea occurs when the intestinal wall is damaged results in increased secretion and decreased absorption of water and electrolytes by the intestine.

(e.g.)

1.Bacterial endotoxins (E.coli;Vibrio cholerae,Shigella,S.aureus)

2.Bacterial infections (Shigella, Salmonella)

3.Viral infections (Rotavirus, Norwalk virus)

4.Protozoal infections (Giardia lamblia, Entamoeba histolytica)

5.Miscellaneous causes such as inflammatory bowel disease, and medications like prostaglandins, antibiotics, colchicine, and chemotherapeutic drugs.

c.Motility Disorders occurs when there is an insufficient contact of the stool with the intestinal wall so that less water is absorbed by the intestine

(e.g.)

1.Irritable bowel syndrome, scleroderma, diabetic neuropathy, gastric/intestinal incompatibility, and vagotomy.

2. Medications that can induce motility disorders include cholinergic agents (metoclopramide, bethanechol,), digitalis quinidine, and antibiotics.

Antibiotics cause diarrhea by intestinal irritations, increased bowel motility, and destroying intestinal bacterial flora. These symptoms can be minimized by taking antibiotics after food.

2.By etiology

a.Acute Diarrhea(Less than 2 weeks)

1.Infections

A.Viral infections due to Rota and Norwalk viruses

Rotavirus usually affect children under 2 years of age. The infection onset by 1 to 2 days and lasts for 5 to 8 days. Vomiting, fever, and mild dehydration are common symptoms. There is usually no pus or blood in the stool

Norwalk virus usually affects older children and adults. It has an onset of 1to2 days and lasts for 24 to 48 hours. Mild fever, vomiting, and dehydration are the symptoms and without pus or blood in the stool.

B.Bacterial Infections

Due to the consumption of contaminated water and food and the onset occur after 8 to several days.

Toxigenic Bacteriae These includes E.coli;V.cholerae;S.aureus.which spread their endotoxins. Symptoms are excretion large watery and greasy stools leads to severe dehydration.

Invasive Bacterias such as E.coli; Shigella; Salmonella; Campylobacter; and Clostridium difficile ane invading the intestinal mucosa. This results in dysentery like diarrhea which is experienced by an extreme urgency to defecate, stomach cramping, tenesmus(a false feeling of passing stool), fever, chills, blood, or pus in the stool.

Protozoa such as G.lamblia; E.histolytica; and Cryptosporidium causes explosive foul-smelling large volume of watery stool. This is due to the extreme invasion of the intestine by destroying its villi. Symptoms are severe loss of water and extreme dehydration. Though it is self-limiting it may persist for several months until complete eradication of the organisms.

C. Diet-induced diarrhea is commonly induced by food allergies, high fiber diets, fatty or spicy foods, large amounts of stimulants like caffeine, or milk. Avoiding such foods are the best treatment

TREATMENTS

A.Non-Medical Treatments

It is most advisable normal feeding of food or milk should not be stopped as the recent researches show that a normal diet or breastfeeding during diarrhea does not make it worse and may actually improve diarrhea.

Fluids in large quantities should be taken as electrolyte solution in order to prevent dehydration in acute diarrheal episodes. Oral and intravenous rehydration should be engaged as per the severity.

A homemade rehydration solution can be prepared as follows 

Sodium chloride(Table salt)     ---0.5 teaspoon

Potassium chloride                   ---0.25 tsp

Sodium bicarbonate (backing

                                    salt)      ---0.5 tsp

Glucose                                    ---2 tablespoon

Water add up to 1 liter.

Recommended dosages as follows

Adult (= or > 10 yrs)              ---2000to3000ml/day

Children (5 to 10 yrs)             ---1000to2000ml/day

Children (below 5 yrs)           ---40to75ml/kg for -  

                                                  - the first 6 hrs.or -

5 to 10 ml every 10 to 15 min for 30 min then-

15 to 20 ml every 10 to 15 mins for 30 mins then-

30 ml  every 30 minutes to complete the first 6 hours

60 ml (1/4 cup) every 30 minutes for the next 12 hours

Fluids to be avoided include hypertonic fluids such as apple juice; powdered drink mixes; gelatin water and carbonated drinks.

B.Medical Treatments

Up to date, the American FDA has allowed three agents as a category -I (i.e.safe and effective) medicines such as activated attapulgite (Aluminium and Magnesium silicates); calcium polycarbophil and loperamide.

1.Antiperistaltic drugs

These medicines acting by reducing the peristaltic movements of the gut. The frequency of the bowel movement is decreased and stool consistency is increased.

This medication is contraindicated in bacterial diarrhea as it prevents the clearance of the bacteria from the body and opens the way for the organism to enter into the system. But much information tells that this not serious and often proves no harm however care should be taken during the colitis diarrhea as it may cause serious megacolon.

Children <2 years should not be treated with these medications.

The following medicines are dispensed under prescription such as opiates related diphenoxylate/atropine (Lomotil); difenoxin/atropin(Metofen) as antiperistaltic agents.

Loperamide(Imodium); Kaopectate-II; are the nonprescription drugs.

Antiperistaltic drugs should not be used for more than 48 hours.

Side effects

1.Abdominal Pain

2.Stomach discomfort or distention

3.Drowsiness

4.Dizziness

5.Dry mouth 

Dosage

For adults 4 mg followed by 2 mg after each loose motion and not exceed 16 mg/day

For children 1 to 2 mg three times daily as per the weight and age.

2.Adsorbents

These drugs adsorb the toxins, bacteria gases, and water content of the stool on its surface of exposure. They are not absorbed systemically.

They are used only to give symptomatic relief and not a cure for severe symptoms. They should be given in large doses immediately following a loose stool.

a.Activated attapulgite. For adults a dose of 1200 mg after each stool.

For children 300 to 600 mg after each stool

Side effects are almost nill

b. Calcium Polycarbophil For adult 1 gm 1 to 4 times daily

For children 0.5 gms 1 to 4 times daily.

Side effects are nill

3.Miscellaneous

1.Bismuthsubsalicylate for an adult 2 tablets or 30 to 60ml every hour as needed to a maximum of 8 doses per day. The child's dose is half of the adult dose.

Side effects 

It can cause harmless grayish black stools or tongue and ringing in the ear.

Contraindicated in children recovering from chickenpox, or flu because of the possible Rye's syndrome.

2. Lactobacillus is used to replace the normal bacterial flora.

3. Lactase a disaccharidase they can breakdown diarrhea producing nonabsorbable disaccharides like lactose (in milk) into absorbable glucose and galactose.

The adult dose is 1 to 2 capsules taken with dairy products

4. Anticholinergics like atropine and scopolamine are producing antidiarrheal effects by slowing the bowel movements and increasing fluid absorption.

Side effects are dry mouth, blurred vision, urinary retention, and tachycardia.

5. Antiinfectives The infective diarrheas can be treated by the administration of antibiotics

Ciprofloxacin                             500 mg twice/day

Doxycycline                                100mg twice/day

Norfloxacin                                 400mg twice/day

Tetracycline                                   250mg 4times/day

Septran-DS                                   1 tab 2 times/day

The above are treatments should be under a doctors supervision

 

DIGESTIVE SYSTEM-PART-1-CONSTIPATION

CONSTIPATION-TREATMENTS

Because of our modern lifestyle, our eating styles and the method of cooking are all changed. Even the natural edibles such as fruits, grains, nuts, and herbs are all grown in chemically fertilized fields. The days are modernized in such a way that everybody whether they are poor or rich has to rely on foods with slow poisonings to satisfy their hunger.

Because of this everybody becomes sick and somehow relies on medicines which are also chemicals as an added tragedy of self-poisoning. Even animals, birds are not escaped from this moral tragedy.

Simply we are self-poisoning in the name of food drinks and medicines with a moral just.No another way to escape.

Stomach distress is a common discomfort with many people in this modern world because our eatings are first dumped into this part only. Some people because of their careless eating behavior do not give respect to their stomach instead they use it as a dustbin by dumping into it mercilessly with whatever they saw and whenever they feel to munch something as fast foods. The result is stomach distress like upset, constipation, or diarrhea.

Constipation is defined as the difficult or infrequent passage of stool. Normal passage of stool must range in frequencies from 1 or 2 times daily or 2 to 3 times weekly.

Constipation may generally give a discomfort of headache, stomach bloating, or an abnormal rectal fullness.

Causes

1.Insufficient dietary fibers

2.Lack of movements

3.Poor bowel habits such as not responding to the defecatory urge, or hurried and incomplete evacuation.

4.Stress

5.Fever

6.Medicines such as opium, marijuana, nicotine, anticholinergics like antidepressants, antihistamines, phenothiazines antispasmodics, and calcium-containing antacids.

7.Pathological conditions like intestinal obstructive tumors, diabetes, and hypothyroidism.

 Diverticulitis a condition in which small pouches are formed at the bowel wall.

Counsellings

1.Normal stool frequencies

2.Duration of the constipation

3. Amount of dietary fibers taken

5.Medicines in use

6.Presence of other symptoms.

7.Chronic medical history. 

Treatments

A.Non-Medical 1.Advice to increase intake of fluids and fibers such as cereals, fruits, green vegs, potatoes

2.Increase exercise to increase bowel movements

3. Bowel training to increase regularity

B.Medical

1.Laxatives: Laxatives generally should not be taken if nausea, vomiting, or stomach pain is present.

a)Bulk Laxatives  

Bulk laxatives are natural or synthetic polysaccharides that work in both small and large intestines.

Because their onset of action is slow(24 to 72 hrs) they are better to be used as a preventive rather than as a curative.

Bulk laxatives should be taken at least with a minimum of 5 ounces of water otherwise they may cause constipation. Some bulk forms may contain sugar hence care must be taken by diabetics.

Bulk laxatives are contraindicated in obstructive bowel syndrome, intestinal tumors or Crohn's disease(a type of inflammatory disease that affects any part of the digestive system)

Examples of Bulk Laxatives 

1.Natural

a)Psyllium (The adult dose is 3.7 to 7 gms/day, child dose is 1/2 of the adult dose)

b)Malt extract (Adult 16 gms 4 times/day;child dose 16 gms 2 times/day)

2.Synthetic

a)Methylcellulose (Adult dose 1to 2 gms 1to 2 times/day; child dose 05 gms 1 to 3 times/day)

b) Polycarbophil (Adult dose 1 gm 1 to 4 times/day;child .05 gm 1 to 3 times/day)

Tetracyclines should not be taken with any calcium compounds like calcium polycarbophil.

b)Saline and Osmotic Laxatives

These laxatives work by forming an osmotic gradient to pull water into the lumen of the intestine and thereby form a bulky feeling to promote the peristalsis and motility.

These laxatives also the activity of an enzyme known as cholecystokinin a pancreatic enzyme that increases the fluid secretion of the GI tract.

Available as rectal enemas and suppositories work within 5 to 30 minutes and the oral preparations work within 4 days. 

A.Saline Laxatives

1.Magnesium citrate

2.Magnesium hydroxide

3.Magnesium sulfate

4.Sodium phosphate.

B.Osmotic Laxatives

1. Glycerin is available in suppositories or enema liquid.

An adult dose is 3 gm as suppository or 5 to 15 ml as an enema

A child dose is 15 gm as suppository or 2 to 5 ml as an enema

2. Lactulose is available as prescription medicine.

This may cause flatulence or cramping and must be taken with fruit juice, water, or milk.

The adult dose is 15 to 30 ml 2 to 3 times daily;

A child dose is 2.5 to 5 ml 2 to 3 times daily.

3. Sorbitol is a nonabsorbable sugar similar in efficacy and action with lactulose. It can be given orally as a 70% solution or rectally as a 25% solution. At the beginning of the first few days, sorbitol will give stomach flatulence, cramps, and pains similar lactulose but these will disappear on continued use.

An adult dose is 15ml orally (70% solution) or 120ml rectally (25% solution)

A child dose is 15 ml orally (70% solution) or 30 to 60 ml rectally (25% solution)

C.Stimulant Laxatives

These drugs work both in the small and large intestines by stimulating their motility. Their major drawback is abdominal cramping. Continuous use may produce numbness and reduced sensitivity of the bowel.

Oral preparations have the onset of action in 6 to 10 hours while the rectal preparations have the onset within 30 to 60 minutes.

1. Anthraquinone Laxatives include senna, cascara sagrada, and Castrol.

Long time use may cause melanosis coli a condition in which a dark pigmentation of the colonic mucosa occurs which disappears in 12 months after discontinuation of the drug. There are no other serious side effects.

Urine becomes colored as pink/red, brown, or yellow.

Cascara sagrada may be excreted in the milk.

a)Senna an adult dose is 300 to 1200mgs/day and for children 100 to 600mgs/day.

b)Cascara sagrada adult dose is 300 to 1000mgs/day.

2.Diphenhydramine derivatives
a)Phenolphthalin
These preparations may cause allergies in some people.
The adult dose is 60 to 200 mg/day.
alkaline urine
discoloration of the urine to pink/red, yellow or brown.
b)Bisacodyl (Dulcolax)
The tablets are enteric-coated and they should not be crushed or chewed. 
Bisacodyl should not be taken within 1 hour of ingesting antacid or milk.
3.Castor Oil
It has an onset of action within 2 to 6 hours. It works mainly at the small intestine. Hence it produces strong cathartic effects such as excess fluid and electrolyte loss. Cause dehydration. Contraindicated in pregnancy.
Adult dose 15 to 60ml
The child's dose is 5 to 15ml.
4.Emollient Laxatives
They cause surfactant effects and allow absorption of water by the stool to soften. They are very useful to heart patients to avoid them in straining to pass the hard stool.
The onset of action is very slow. (24 to 72 hours)
a)Docusate sodium
b)Docusate calcium
c)Docusate potassium
The adult dose is 100 to 300 mg/day
Child dose is 50 to 150 mg/day
Large quantity of water (8oz) water should be consumed after each dosage
This product should not be given with mineral oils as they may cause systemic absorption of mineral oils
5.Lubricant Laxatives 
Mineral oil-like liquid paraffin can be included in this category. They form fine lubrication of the bowel wall and thereby produce laxative effects.
The onset of action is 6 o 8 hours.
The adult dose is 15 to 45 ml/day
Child dose is 10 to 15 ml/day
Cautions 
1. Mineral oil may interfere with the absorption of fat-soluble vitamins like vitamin-A, D, E, and K.
2. Debilitated and dysphagia patients are at the risk of lipid pneumonitis from mineral oil aspirations.
3. Emollients like docusate should not be used concurrently as it may cause the absorption of mineral oil into the system.
4.May cause seepage
5.Should be taken in an empty stomach. 

 
 

 

WEIGHT CONTROL AND SLEEP AIDS-PART-V

SLEEP LOSS- TREATMENTS

In the previous post, we have seen a comprehensive encyclopedia of sleep and insomnia and their maps. In this emotional modern lifestyle insomnia with its various forms becomes a common problem. Even after lying in the bed getting a night of good sleep is a difficult procedure for many individuals.

Hence this post is dedicated to being guidance and treatment to tackle the problems of insomnia.

Guidances

The following general procedures are helpful to have a good hygienic sleep. The followings are the nonmedical approaches:-

1.Establishing a regular bedtime

2.Going to bed when tired and ready to sleep

3. If anxiety interferes get out of the bed and have a relaxed short walk, read some relaxing books, have a warm bath, or do some relaxing exercises.

4. Avoid hard exercises at bedtime.

5. Avoid alcohol because it will break sleep into fragments.

6. Avoid stimulants such as coffee, PPA, nicotine, and pseudoephedrine

7. Make sure that bedroom and bed are comfortable

8. Avoid small afternoon naps.

Treatments

Drug Treatments of Transient and Short term Insomnia:-

In general wakefulness and sleep, are antagonizing each other to control brain activities. Several nerve transmitters are involving in these antagonizing activities.serotonin and gamma-aminobutyric acid is the two known central neurotransmitters that slowly promote sleep.

Acetylcholine a central transmitter is maintaining REM sleep.

Catecholamines such as noradrenaline, adrenaline, and dopamine are the central neurotransmitters that cause wakefulness and antagonizing sleep.

Individuals may vary greatly in their natural levels of neurotransmitters and their sensitivity to these chemicals.

These theories are helpful to describe the actions of some medications on sleep patterns.

Hypnotics have their effects by modifying the secretions and receptor responses of serotonin, GABA, acetylcholine histamine and catecholamines

The goals of the hypnotic treatments of short term and transient insomnia are to restore day time work capacity and to eliminate the self-induction of anxiety-provoking thoughts.

The general norms of the hypnotic treatments are advising the patients not to take hypnotic drugs to more than three consecutive nights followed by one-night medicine free. This is to minimize tolerance and habit formation and to have a self-practice to control the stress that night. 

Prescription hypnotic agents

Benzodiazepines are the drugs of choice for treating transient and short term insomnia.

The mechanism of action is by acting on its receptors situated adjacent to the GABA receptors, they facilitate and enhance the actions of GABA the sleep-promoting hormone on its own receptor.

Benzodiazepines are available as follows

Short-Acting (2 to 8 hours)

1.Oxazepam

2.Clonazepam

3.Midazolam

4.Triazolam 

Intermediates (10 to 20 hours)

1.Temazepam

3.Lorazepam

4.Alprazolam

Long Actings(1 to 3 days)

1.Chlordiazepoxide

2.Diazepam

3.Flurazepam

The route of administration of benzodiazepines are both oral and by I.V or i.m. injections

Since benzodiazepines are metabolized in the liver and excreted through urine caution should be taken while using these medications during renal and liver insufficiencies. 

Many of the metabolites of benzodiazepines are very active.

Drug dependence 

Prolonged use can produce dependence.

Sudden withdrawal may cause confusion, anxiety, and agitation.

Side Effects

1.Drowsiness and confusion (the most common side effects)

2.Ataxia (dysfunctions and noncooperative nerve movements)

3.Dizziness

4.If taken with other CNS depressants benzodiazepines will cause respiratory depression and death.

Flumazenil is the antidote for benzodiazepine poisoning its effects lasts for 1 hour only and hence repeated dose is necessary for heavy poisoning.

Zolpidem

It is a newer drug and has an advantage over benzodiazepines by having minimum side effects and withdrawal symptoms.

Even though it is not a benzodiazepine it acts on the benzodiazepine receptor to produce the effects.

Side effects

1.Nightmares

2.Agitations

3.Headaches

4.GI distress

5.Dizziness

6.Daytime drowsiness

Barbiturates are less commonly prescribed to treat insomnia because of its serious and excessive respiratory depressing effects.

OTC DRUGS

The FDA has approved two antihistamines such as Diphenhydramine and Doxylamine

These antihistamines are commonly used in cough syrups and because of their serious anticholinergic effects caution should be taken by those who have extrapyramidal effects such as tardive dyskinesia, Akathesia, and Parkinson disease. Also, it should be taken with caution by those who have Prostatic enlargement.

 

   

WEIGHT CONTROL AND SLEEP AIDS- PART IV

SLEEP AIDS

Sleep is the healthy process of the body to keep it healthier. So many healthier procedures are performed during the process of sleep, such as growth, preparation of waste products like creatinine, urea, and lactic acid to be excreted in the urine. sleep maintains our body's metabolism and growth in a normal way. The digestive system is regulated. During sleeping the workloads of all our involuntary smooth muscles like heart, lungs, and visceral organs are minimized in order to boost them with fresh energy. Sleep refreshes our nervous system. Our blood is cleaned from waste and toxic products by healthy sleep.

Sleep time and quality vary among individuals. The usual range of sleep time per night is 5 to 10 hours.

Sleep requirements are changing according to the person's age. Newborns may sleep up to 18 hours. Preteens usually fall asleep within 5 to 10 minutes with deep sleep. By adulthood, 7 to 8 hours of sleep gives good rest. In the old age, six hours may suffice. In general, according to the modern theory, it is not the length of the sleep but it is the deepness of the sleep is more important.

Polysomnography includes Electro Encephalo Gram (EEG), the Electro Oculo Gram (EOG) and the Electro Myo Gram (EMG) recordings to note the changs during sleep 

Stages

By using polysomnography the scientists discovered five stages of sleep

1.One rapid eye movement (REM) stage

2.Four nonrapid eye movement (NREM) stages.

In normal sleep, REM occupies 25% by leaving the remaining 75% in the NREM stages.

In the NREM stages, the last third and fourth stages are considered as deep sleep stages or collectively known as delta sleep stages.

Most dreams occur during the REM stage and the degree of the restfulness of sleep depending on the amount of REM stage.

Most medications used to treat sleeplessness including the OTC medicines interfere with some parts of the sleep stages especially with the REM stage.
INSOMNIA
Insomnia is the interrupted sleep cycle or insufficient sleep that results in impaired daytime performances. Insomnia must be defined more with the depth of the sleep than with the length of the sleep.
Insomnia should be diagnosed with the deficiencies in the day time performances and not the number of hours  slept as the primary determinant of the diagnosis
Occasional one or two sleepless nights or with insufficient sleep is not important to be considered as insomnia. The pathologically concerning the situation with long time sleeplessness if it contains frequent microsleeps or extreme tiredness otherwise no need to worry.
Patients after a restful night sleep if they wake up in the morning with full freshness and satisfactory and feel no need to have an afternoon nap can reassure themselves that they have no insomnia. It is not necessary to have a sleep of 8 hours. Oftentimes a simple reassurance can be a cure for insomnia.
Insomnia is of three types as follows:-
1.Transient 
In this case, if a person cannot have a night sleep in less than 7 days then it is known as transient insomnia. Causes include shift work or acute anxiety
2.Short -term
This type lasts for 1-3 weeks. Causes of short term insomnia can be usually identifiable and self-limiting such as grief, pain, noise, or a tension provoking situation.
3.Long- term  
This type of insomnia lasts for more than 3 weeks. Chronic insomnia is caused by some underlying diseases most probably such as Hyperthyroidism or Arthritis and requires a thorough diagnoses of patients' physical and mental health.

General causes of insomnia

1.Intrinsic causes 

A. Psychophysiologic insomnia is a condition in which the patient associated with increased wakefulness with the bedroom and the sleep time routine.

B. Restless legs syndrome is characterized by extremely uncomfortable sensations in the leg muscle at rest which are relieved by moving the legs up and around.

C. Sleep Apnea can be obstructive or centrally mediated. The hallmark is breathing that stops for short periods during sleep. Patients with sleep apnea should not use hypnotics or OTC medicines.

2.Extrinsic causes 

A. Adjustment sleep disorders are prompted by a stressful situation.

B. Inadequate sleep hygiene  is caused by a lifestyle that reduces the amount of quality sleep

C. Hypnotic, stimulant, or alcohol dependency is caused by dependence, tolerance, or over-reliance on a particular drug of abuse.

3.Circadian sleep disorders

A. Delayed sleep phase syndrome occurs in people whose natural sleep times are altered due to work.

e.g.If a person should be at work at 8 a.m but gets tired after 2 a.m. and wakes at 10 a.m.would be affected by this disorder.

B. The jet lag syndrome is a problem primarily for people who frequently travel across several time zones.

4. Psychiatric disorders

such as major depressive disorders result in poor sleep that usually improves on proper antidepressant treatments

 

 

WEIGH CONTROL AND SLEEP AID PART-III

OTC WEIGHT LOSS DRUGS

A local anesthetic like benzocaine is available on OTC as a category-1 medicine. This acts on the nerve endings in the oral cavity to produce numbness and thereby decreases the feeling of taste at the taste buds to some people.

Available for oral use as lozenge, gum, and candy

3.5mg is the dosage form available in order to keep in the mouth for some period before food.e.g.Slim Mint; Diet Aid.

Phenylpropanolamine or PPA is another OTC medicine chemically and action-wise related to amphetamine as an adrenergic agonist. e.g.Dexatrim;Acutrim;Prolamine

It is available as 37.5 mg in an immediate releasing dosage form which should be taken about. 30 min before food 

75 mg which is the maximum dose is the approved dose in sustained release dosage forms.

Since PPA is sympathomimetic drug care should be taken by the patients who have heart diseases, hypertension, diabetes, and hyperthyroidism.

When used in controlled dosage PPA is milder than amphetamines in producing side effects

Other PPA side effects are CNS stimulation such as insomnia, nervousness, and headache

PPA Drugs Interactions

1.Cold and allergic rhinitis medicines

2.Antihypertensive drugs(Antagonizing)

3.Other sympathomimetics(Synergizing)

Other OTC weight-loss medicines are Bulk Laxatives Which by producing a feeling of stomach fullness suppress the hungry. 

WEIGHT CONTROL AND SLEEP AID-PART-II

PRESCRIPTION WEIGHT CONTROL DRUGS

In the previous post, we have seen some diet formulas available in the pharmacies as OTC weight control preparations.

When you buy these slimming formulas please be careful about their contents. Because high protein is very important to protect our vital body organs and functions.

The formula branded as "Last Chance Diet" marketed in the mid 70s in U.S.caused several deaths from cardiovascular complaints and the casualties is observed due to the lack of nitrogen balance because of the product's contents of poor quality protein formula.

By keeping these important points in later years high-quality protein formulas with some proportions of carbohydrates and fat like Optifast, Medifast, and Health Management Resources(HMR) are appearing in the market. Although these products are safe and free from fatalities as they supply daily 400 to 800 calories sufficient for our body, yet maintenance of weight loss over a long term use is still in question.

Slimfast and Ultraslimfast are high-quality protein food replacement formulas that appeared in the market in later years. These proved some successes as they replace one or two main meals of the day.

Prescription Medications

1.Amphetamine

2.Methamphetamine

3.Phenmetrazine.

All the above drugs are acting as slimming drugs by suppressing the hungry. Amphetamines are indirect adrenergic agonists by releasing norepinephrine from its stores at presynaptic nerve terminals

These medicines are no more in use because of their high potency of toxicities and drug abuse.

Drugs that are marketed later are:-

1.Phendimetrazine

2.Diethylpropion

3.Phentermine

4.Fenfluramine

These drugs too show little drug abuse but are allowed to use for short term purposes such as for not more than a few (8 to 12) weeks on medical prescription only. 

Similar to amphetamines these drugs also act by indirectly agonizing the adrenergic nervous system in a lesser degree, but has other routes of action too such as through CNS by suppressing safe center in the hypothalamic ventromedial nucleus  

Fenfluramine is acting through the serotonin pathway.

Side effects

1.Restlessness

2.Insomnia

3.Tremors

4.Tachycardia

5.Diarrhea

6.Nausea

7.Dry mouth 

8.Mydriasis

9.Drug abuse

In general, all the side effects are very similar to adrenergic stimulations and hence patients with cardiac arrhythmias and other cardiovascular problems should seek medical advice

For Long Term Uses

At last, a modified fenfluramine known as Dexfenfluramine is allowed by the FDA for chronic treatment of obesity on prescription. The drug suppresses the appetite and carbohydrate cravings by increasing the availability of serotonin in the brain which is safer than norepinephrine  

WEIGHT CONTROL AND SLEEP AIDS-PART-1

OBESITY TREATMENTS (OTC)-PART-1

Obesity is best defined as the surplus body fat that causes an increase in body weight by 20% of an individual's normal weight to be according to his height and BMI

People with overweight with a large abdomen are more likely in worse health than people who have fat distributed around their hips and limbs.

Waist measurement ratios of greater than0.95% in men and 0.80% women are with a greater chance of death rates.

Causes 

There is a medical belief that obesity is caused by ingesting more calories to the body than that the body can able to use it. The excess calories would be deposited as fat on the abdomen, hip, and limb.

Elevated Body Weight SetPoint

Some people who have this set point when they try to lose weight by fasting or low-calorie intake a compensatory adjustment in metabolism results in regaining their weight back. Hence even if these people are taking less food or fasting they cannot lose their instead it may increase.

Heredity

Another point is heredity which is an important factor as a cause of obesity. Anyone member of the family was obese the gene will be carried out to his or her descendants.

Food cues

Obese people are more responsive to food cues such as taste, smell, and sight of food.

Pathology

Many studies show that obesity can cause hypertension, diabetes mellitus, and osteoarthritis.

Women who gained 30 to 50 kg weight by her age at 18 may have a minimum 25% chance of getting a heart attack.

People who are 20% or more above their ideal body weight are having more chances to suffer the following disorders;-

1.Amenorrhea

2.CHF

3.Cancers of cervix,endometrium,colon,gallbladder,prostate and uterus.

4.Coronary Heart diseases such as Angina and MI

5.Diabetes Mellitus

6.Fatty liver

7.Gallbladder disease

8.Hirsutism

9.Hypertension

10.Hypertriglyceridemia

11.Respiratory tract infections

12.Varicose veins

The risks of obesity can be better determined by the ideal weight and the Body Mass Index(BMI)

The BMI can be easily calculated by the following formulas

1. Weight in kgs is divided by the squared height in meters

2. Weight in pounds multiplied by 700 is divided by squared height in inches

Researches show that the overall risk of developing heart disease is related to BMI as follows:-

1.BMI of 25 or less--Low risk

2.BMI of 25 -30  - Low to Moderate

3.BMI above 30-- High

Programs

1. A weight loss goal of 1-2 lbs per week is appropriate

2. To lose 1lb per week can be achieved by expending 3500 by work or decrease calorie intake by 3500 during that week.

3. For example, a patient who normally intakes 4000 calories per day must decrease his daily intake by 500 calories per day so that in one week he can decrease his calorie intake by 7x500=3500.

Balanced diets with calories derived from carbohydrates, protein, and fat are optimal. The fat calorie intake should be minimized by 30 % from less than 10% saturated fat.

Fat contains 9 calories per gram

Carbohydrates and proteins contain 6 calories per gram.

Fewer calorie diets (300-800) can help but with proper intake of proteins in order to maintain the Lean Body Mass.

During this procedure, patients should watch for electrolyte imbalance, postural hypotension, and ECG abnormalities

Formula Diets are available at OTC of the pharmacies such as Slimfast  which contains high proteins.

These preparations are instructed to take full mealtime by replacing it. When you replace the full meals once or twice per day by these formula diets your body gets the least calories per day. Most of these preparations contain high-quality proteins with no carbohydrates and fats.

Exercises are also can help to shed some weight.