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Alzheimer’s Disease Drug

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Introduction:-
This public information leaflet provides information about drugs used to treat Alzheimer’s disease. It discusses how the drugs work, why they are prescribed, their side effects and alternative treatments. Alzheimer’s disease is only one of many possible causes for memory problems in people. The other causes are described in detail in our Help is at Hand leaflet, ‘Memory and Dementia’.

Cholinesterase Inhibitors
What are Cholinesterase inhibitors?
These are the main drugs used for Alzheimer’s disease in the United Kingdom. Three drugs are currently licensed:

Drug name….Donepezil.       Other name ….Aricept

Drug Name….Galantamine   Other Name.… Reminyl

Drug Name.…Rivastigmine  Other Name.... Exelon

There are no major differences between these drugs. They are all designed to alleviate certain symptoms of Alzheimer’s disease – for example, memory loss, apathy and anxiety. They are not a cure, though there is some evidence that they may slow the course of the illness.

What effect can these drugs have?
They can improve memory, particularly remembering new information and recall of old information. They can also have general benefits including improving alertness and motivation. It may take some months of treatment for there to be a noticeable improvement or slowing down of memory loss. Some people report improved mood and will be able to perform tasks which they had forgotten how to do such as going shopping.

What side effects are there?
The most common side effects of these drugs are nausea, loss of appetite, tiredness, diarrhoea, muscle cramps and sometimes poor sleep. These may be reduced or avoided by increasing the dose slowly, or taking the medicine after food. The side effects usually fade after a few weeks and will go away if the medicine is stopped. More information about side effects can be obtained from the doctor prescribing the treatment or by reading the leaflet that comes with the prescription.

How do they work?
Acetylcholine is a chemical that is involved in the transmission of information between certain brain cells involved in memory. In Alzheimer’s disease, these brain cells start to die and the amount of acetylcholine available to pass messages between cells is very much reduced. Memory starts to suffer. Cholinesterase Inhibitors reduce the destruction of acetylcholine and increases its levels in the brain. The increase in the amount and effectiveness of acetylcholine reduces some of the effects of Alzheimer’s disease.

How well do they work?
Research has shown that about 50-60% of people who have taken these drugs show a slight improvement or a stabilisation of their condition over a period of six months. However, in the longer term, it is not known whether the effect of these drugs will be temporary or whether they will slow the rate of decline over a longer period of time. Unfortunately not everyone benefits from these medicines, and if no improvement or stabilisation is seen in the first few months, it is recommended that they are stopped. In Britain the National Institute for Health and Clinical Excellence (NICE) has decided that these drugs are not cost effective in the early stages of Alzheimer’s Dementia and should only be given to people in moderate stages of the illness. Many people are unhappy about this decision.

How should these drugs be taken?
It is usual to start on a low dose which is gradually increased. Don’t be put off by any side effects early on in the treatment as these usually wear off after a few weeks. It is important to take the drugs every day for them to be effective.

How long should these drugs be taken?
These drugs are usually prescribed for a trial period of three to four months. If the doctor decides they are not working, he or she will recommend stopping them. If these drugs do work, there is currently no clear consensus as to how long they should continue to be prescribed. People with Alzheimer’s disease are often given a memory test called the ‘Mini Mental State Examination‘ (MMSE). Current guidelines suggest that these drugs should only be used for moderate dementia which equates to an MMSE score of between 10 and 20 out of 30. However, there is some evidence that these drugs work in earlier and later stages of the illness.

Who can prescribe these drugs?
A specialist, rather than your GP, will prescribe the medicine during the trial period. You will usually see the specialist in a hospital clinic. You may need blood tests and a brain scan to exclude any other causes for the memory loss. In some areas the specialist will continue to prescribe the drug if they conclude that it is working. In other areas the specialist may continue assessing its effectiveness but ask that the family doctor prescribes it.

Memantine
This drug, which is also known as Ebixa, has been used to treat dementia in Germany since 1989. It is thought to work by affecting glutamate, a brain chemical which is involved in learning and memory 3. In Alzheimer’s disease too much glutamate leaks out of damaged brain cells and this interferes with learning and memory. In the studies completed so far just over half the people taking Memantine show some slowing down in the progression of the dementia but this effect has only been demonstrated so far in people with more severe dementia. The main side effects of Memantine, which are usually mild, are nausea, restlessness, stomach-ache and headache.

More studies are being undertaken to see how effective it is and how the drug can best be used. NICE has issued guidance that Memantine should not be routinely prescribed in Britain due to doubts about its cost effectiveness.
Other Treatments:-

Ginkgo biloba
This is a naturally occurring substance extracted from the Maidenhair tree. It has long been thought to enhance memory.

A recent study looked at the effects of Ginkgo in over 3000 people taking it for an average of 6 years. Unfortunately Ginkgo did not stop dementia developing and in a small number of people with heart problems it actually seemed to make their dementia worse.

Vitamin E
This is a natural substance found in oils from soya beans, sunflower seeds, corn and cotton seed, as well as whole-grain foods, fish-liver oils and nuts. Vitamin E has various functions in the body and acts as a natural anti-oxidant. Vitamin E deficiencies are very rare.

Some studies suggest that taking Vitamin E can slow the progression of Alzheimer’s disease. However, further research needs to be done to establish its place in the treatment of Alzheimer’s disease. It can interfere with blood clotting and should be used with caution in people with a clotting disorder and on oral anticoagulants, although it can be used with aspirin.

In 2004 a review of studies involving a total of over 136,000 patients suggested that people taking over 400 units a day may be at a small increased risk of harm. Some experts are therefore suggesting that not more than 200 units a day should be taken.

There is some evidence that a diet rich in natural Vitamin E may reduce the risk of developing Alzheimer’s disease.

Selegeline
This is a drug that is normally used in Parkinson’s disease. It is also thought to work as an anti-oxidant but has more possible side effects than the use of Vitamin E, including lowering of blood pressure, nausea, dizziness or vivid dreams. Some studies suggest it may slow the progression of Alzheimer’s but further research is needed.

Other therapies:-
Other drugs and therapies are being investigated for Alzheimer’s disease. Developments in this field are rapid and encouraging. It is important to be wary of claims for any new drugs or therapies you read about in the media. Advice should always be sought from your family doctor, specialist or a national organisation such the Alzheimer’s Society.

Dementia can be a great burden for carers and loved ones. Their health and well-being is also vital. Further information about ways in which they can help and be supported can be found in our Memory and Dementia leaflet.

Sources: http://www.rcpsych.ac.uk/mentalhealthinfoforall/olderpeople/drugtreatmentofalzheimers.aspx

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‘Ibuprofen Best’ for Child Fevers

Ibuprofen is better at alleviating childhood fever than paracetamol and should be the drug of first choice, say UK researchers.


Most symptoms of a fever in young children can be managed at home

The Bristol-based trial involving 156 children aged between six months and six years showed ibuprofen reduced temperature faster than paracetamol.

The British Medical Journal work also says alternating the two drugs could help, which some GPs already recommend.

But experts advised against this, in line with official guidance.

The concern is the relative ease with which children could receive an overdose.

Fever is very common in young children, affecting seven in every 10 preschool children each year. “Parents wanting to use medicines to treat young, unwell children with fever should be advised to use ibuprofen first”..Says Lead researcher, Dr Alastair Hay

It can be miserable for the child and cause anxiety for parents. Most fevers will settle by themselves but a few are caused by serious infections such as pneumonia.

Guidelines published last year by the National Institute for Health and Clinical Excellence (NICE) say either ibuprofen or paracetamol can be used for children unwell or distressed with fever.

But they say that, due to the lack of evidence, the two drugs should not be given together or alternated.

The researchers from the University of Bristol and the University of the West of England, recruited children who had a temperature between 37.8 and 41 degrees centigrade, due to an illness that could be managed at home.

Alternating drugs:

Children were randomised to receive either paracetamol plus ibuprofen, just paracetamol, or just ibuprofen.

The medicines were given over a 48-hour period, with the group of children on both paracetamol and ibuprofen receiving them as separate doses.

This group received one dose of paracetamol every four to six hours (maximum of four doses in 24 hours) and then one dose of ibuprofen every six to eight hours (maximum of three doses in 24 hours).

The children’s condition was followed up at 24 hours, 48 hours and at day five.

The researchers found that in the first four hours children given both medicines spent 55 minutes less time with fever compared to those given paracetamol alone.

But giving two medicines was not markedly better than just giving ibuprofen.

However, over a 24 hour period, children given both medicines experienced 4.4 hours less time with fever than those given just paracetamol, and 2.5 hours less time with fever than those just given ibuprofen.

Safety issues:

Childhood fever :-

*A normal temperature is between 36-36.8C (96.8-98.24F)

*In children, any temperature of 38C (100.4F) or above is considered high and is called a fever

*To find out if your child has a fever, place a thermometer under your child’s armpit or use a special ear thermometer

Dr Alastair Hay, consultant senior lecturer in primary health care at the University of Bristol, who led the study, said: “Doctors, nurses, pharmacists and parents wanting to use medicines to treat young, unwell children with fever should be advised to use ibuprofen first.

“If more sustained symptom control over a 24-hour period is wanted, giving both medicines alternately is better than giving one on its own.

“However, parents should keep a careful record of when doses are given to avoid accidentally giving too much.”

He said he thought it would be appropriate for NICE to review its guidance in light of the new study, saying the current guidance was too cautious.

In an accompanying editorial in the BMJ, Dr Anthony Harnden from the University of Oxford, warned of the relative ease with which children could receive an overdose.

He said that a “more complicated alternating regimen of paracetamol and ibuprofen may be less safe than using either drug alone”.

A spokeswoman for NICE said the 2007 guidance recommended that more research should be conducted on the effectiveness and safety of alternating doses of paracetamol and ibuprofen in reducing fever in children who remain febrile after the first fever-reducing medicine.

She said: “Any newly published research will need to be thoroughly assessed by independent experts as part of the process of updating clinical guidelines.

“This is essential to ensure that any new evidence is of the highest standards before any potential updates can be made to existing guidance.”

Professor Steve Fields, chairman of the Royal College of General Practitioners, advised parents and carers of children with fever to follow the NICE guidance.

“We believe parents should keep it simple. We do not see at this moment any need to change the advice.

“However, this paper does demonstrate that using ibuprofen initially is more effective at reducing temperature and may demonstrate that using both ibuprofen and paracetamol together could have a positive effect.”

“We believe parents should keep it simple. We do not see at this moment any need to change the advice ” … Says Professor Steve Fields, chairman of the Royal College of General Practitioners

Sources: BBC NEWS: 2nd. Sept.’08

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Hysterectomy

A hysterectomy is a major surgical procedure. It always involves removal of the uterus, but can also include the removal of other parts of the genital tract.

..

Are there different types of hysterectomy?

Yes. A total hysterectomy is the most common operation and this means removal of the uterus and cervix (neck of the womb).

A sub-total hysterectomy means the removal of the body of the uterus, leaving the cervix behind.

A radical hysterectomy involves the removal of the uterus, cervix, a small portion of the upper part of the vagina and some soft tissue from within the pelvis.

Why is it carried out?

A hysterectomy can help to ease many gynaecological complaints. These include:

* Heavy or very painful periods

* Fibroids: Swellings of abnormal muscle that grow in the uterus, and can cause heavy or painful periods, or problems with urination.

* Prolapse: Where the uterus, or parts of the vaginal wall, drops down.

* Endometriosis: A condition where the cells which line the uterus are found outside the uterus in the pelvis. This can cause scarring around the uterus, and may cause the bladder or rectum to ‘stick’ to the uterus or fallopian tubes.

* Various forms of cancer, including cancer of the cervix, uterus, fallopian tubes, or ovaries.

In most cases – except for cancer – the procedure is usually only used as a last resort.

How is the operation carried out?

The most common method is to cut through the lower abdomen, usually leaving a six-inch scar.

However, doctors may opt in some instances to remove the uterus through the vagina.

Are there any risks?

No operation is risk-free, especially surgery as major as a hysterectomy.

However, the vast majority of women undergo the procedure without any complications.

Obesity can make surgery more tricky, and increase the risk of post-operative complications, such as heavy bleeding.

There is also a small risk of damage to the bladder, or the tubes that carry urine from the kidneys to the bladder.

An uncommon – but serious – complication is the development of a blood clot in the veins of the leg.

Is it a common procedure?

Up to one in five women will undergo a hysterectomy during their lifetime so it is a relatively common operation.

Over 40,000 hysterectomies were carried out in the UK in 2004/2005.

The NHS drug and treatment watchdog, the National Institute for Health and Clinical Excellence (NICE), warned in January 2007 that too many women were ‘suffering in silence’ from heavy periods because they feared having to have a hysterectomy.

NICE stressed that drugs and minor surgery could often be effective alternative treatments.

What impact does it have on sex?

A woman who has had a hysterectomy should be able to enjoy a satisfying sex life – in fact many women report that their level of sexual pleasure improves following the surgery.

Provided the surgery goes well, it should be possible to resume a normal sex life about six weeks after the operation.

You may click to see:->Hysterectomy Surgical Procedure

>Medical Encyclopedia:Hysterectomy

Sources: BBC NEWS: February 12,2007

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