By P. Reto. Regis College. 2018.
Crawford: I would fear that viewing the problem as a "phase" might be a way to minimize the seriousness of it purchase 160 mg fenofibrate mastercard. However cheap 160 mg fenofibrate overnight delivery, many adolescents with eating disorders do recover in adulthood cheap fenofibrate 160 mg on line. Many adolescents are very concerned about body image and weight, but do not have a full syndrome. If these symptoms are interfering with everyday life, then help is needed. Bob M: Here are a few audience comments relating to what we are talking about:LDV: When my husband comes home from work and and asks the food? LMermaid: My wife has anorexia and admits this but will never, ever admit that she is depressed and this has contributed towards her not taking meds which are linked with Serotonin reuptake. Should I be convincing her she is depressed or supporting her stand? She does seem depressed to me from time-to-time, due to her eating disorder and complications stemming from it. Crawford: The medications can frequently be helpful for anorexic patients regardless of whether depression is present. And to everyone in the audience, thank you for your participation and your questions. I want to again urge you need help recovering from you eating disorder, please take it seriously. Sacker joined us to discuss the medical risks of eating disorders (anorexia and bulimia), which range from hair loss, kidney failure, electrolyte imbalance, esophageal rupture, loss of menstrual period, to heart failure. He also commented on the problems that the audience shared, including how eating disorders affect fertility and pregnant women and problems with diet pills. What if you abused ipecac syrup, or abuse diuretics, or have been abusing laxatives? To find out what these behaviors can result in, read the transcript below. Our topic tonight is "The Medical and Psychological Risks of Eating Disorders. Ira Sacker, director of the Eating Disorders Program at Brookdale Medical Center and co-author of the book, Dying To Be Thin. Sacker is also the founder of HEED, "Helping To End Eating Disorders," a support and information organization based in New York. Am I right in assuming that most people do NOT die from an eating disorder, but are more likely to suffer from different medical complications as a result of having anorexia or bulimia? Some of the medical complications of anorexia include hair loss, kidney failure, electrolyte imbalance, esophageal rupture secondary to vomiting, and loss of menstrual period, resulting in possibilities of osteoporosis and infertility. There are also cardiac complications which can result in sudden death. Sacker: Additional complications include ruptured blood vessels in eyes, all of the cardiac and renal complications, as well as multiple ulcers of the esophagus and stomach. David: If one starts engaging in disordered eating behaviors, how long does it take for medical complications to arise? David: On the average though, are we talking about a few weeks or a few months, or many months, even years before any serious medical complications arise? Sacker: Certain complications, like hair loss and loss of menstrual period, may occur rather soon, but other complications such as osteoporosis or heart and kidney disease, may not been seen at first, therefore giving the person a false sense of health. David: The reason I asked that question is because there are many people suffering from eating disorders who think "this will never happen to me. You think that you are in control initially, but then realize that you actually have no control at all. Sacker: Purging causes increased pressure which can be transmitted to the chambers of the eye. BurnhamBuggirl: How long can you go without a period before you are infertile? Sacker: The earlier the diagnosis is made, and the earlier the malnutrition is corrected, the greater the chance of full recovery of fertility. David: Can one become permanently infertile as a result of prolonged anorexia or bulimia? It is baffling to me that my body would sacrifice the protein each month. Take this as a sign from your body that it wants you to get the help you so desperately need. Sacker: If you are restricting, rather than bingeing and purging, then you are engaging in anorexic behavior. David: Some of the medical problems we are discussing tonight are explained in some detail on the Peace, Love and Hope Eating Disorders site here at HealthyPlace. David: What about the psychological problems that can result from having an eating disorder? Sacker: Some of the psychological problems include depression, isolation, mood swings, suicidal ideation, social withdrawal, feelings of rejection, unworthiness, loneliness, and obsessive compulsive behavior. David: Are some of these disorders, like depression or mood swings, a result of possibly a situation the person finds themselves in or is it because of an imbalance in the brain chemicals? Sacker: The first step is admitting that there is a problem, then you must realize that eating disorders are not all about food. Once this is accomplished, you can slowly begin to process the emotions behind the behaviors. Also, some of you are asking about whether you have anorexia or bulimia.
Although the role of stimulants in these adult cases is also unknown purchase 160mg fenofibrate otc, adults have a greater likelihood than children of having serious structural cardiac abnormalities 160mg fenofibrate sale, cardiomyopathy buy generic fenofibrate 160 mg on-line, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. Adults with such abnormalities should also generally not be treated with stimulant drugs [see CONTRAINDICATIONS ]. Hypertension and Other Cardiovascular ConditionsStimulant medications cause a modest increase in average blood pressure (about 2-4 mmHg) and average heart rate (about 3-6 bpm), and individuals may have larger increases. While the mean changes alone would not be expected to have short-term consequences, all patients should be monitored for larger changes in heart rate and blood pressure. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e. Assessing Cardiovascular Status in Patients being Treated with Stimulant MedicationsChildren, adolescents, or adults who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if findings suggest such disease (e. Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation. Administration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with pre-existing psychotic disorder. Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. Emergence of New Psychotic or Manic SymptomsTreatment-emergent psychotic or manic symptoms, e. If such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate. In a pooled analysis of multiple short-term, placebo-controlled studies, such symptoms occurred in about 0. Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility. Monitor growth in children during treatment with stimulants. Patients who are not growing or gaining weight as expected may need to have their treatment interrupted. Careful follow-up of weight and height in children ages 7 to 10 years who were randomized to either methylphenidate or non-medication treatment groups over 14 months, as well as in naturalistic subgroups of newly methylphenidate-treated and non-medication treated children over 36 months (to the ages of 10 to 13 years), suggests that consistently medicated children (i. In a controlled trial of ADDERALL XR in adolescents, mean weight change from baseline within the initial 4 weeks of therapy was -1. Higher doses were associated with greater weight loss within the initial 4 weeks of treatment. Chronic use of amphetamines can be expected to cause a similar suppression of growth. There is some clinical evidence that stimulants may lower the convulsive threshold in patients with prior history of seizures, in patients with prior EEG abnormalities in the absence of seizures, and very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. In the presence of seizures, ADDERALL XR should be discontinued. Difficulties with accommodation and blurring of vision have been reported with stimulant treatment. The least amount of amphetamine feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage. ADDERALL XR should be used with caution in patients who use other sympathomimetic drugs. The premarketing development program for ADDERALL XR included exposures in a total of 1315 participants in clinical trials (635 pediatric patients, 350 adolescent patients, 248 adult patients, and 82 healthy adult subjects). Of these, 635 patients (ages 6 to 12) were evaluated in two controlled clinical studies, one open-label clinical study, and two single-dose clinical pharmacology studies (N= 40). Safety data on all patients are included in the discussion that follows. Adverse reactions were assessed by collecting adverse reactions, results of physical examinations, vital signs, weights, laboratory analyses, and ECGs. Adverse reactions during exposure were obtained primarily by general inquiry and recorded by clinical investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse reactions without first grouping similar types of reactions into a smaller number of standardized event categories. In the tables and listings that follow, COSTART terminology has been used to classify reported adverse reactions. The stated frequencies of adverse reactions represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse event of the type listed. Adverse Reactions Leading to Discontinuation of TreatmentIn two placebo-controlled studies of up to 5 weeks duration among children with ADHD, 2. The most frequent adverse reactions leading to discontinuation of ADDERALL XR in controlled and uncontrolled, multiple-dose clinical trials of children (N=595) were anorexia (loss of appetite) (2. Over half of these patients were exposed to ADDERALL XR for 12 months or more. In a separate placebo-controlled 4-week study in adolescents with ADHD, five patients (2. The most frequent adverse event leading to discontinuation and considered to be drug-related (i.
Alcoholism is a disease that can be seen through drinking-related arrests or job loss purchase fenofibrate 160mg, but they tend to happen late in the disease fenofibrate 160 mg with visa. These signs include:An increasing tolerance to the effects of alcohol discount fenofibrate 160 mg with mastercard. You may have heard the expression that someone can "hold their liquor. A growing preoccupation with or interest in drinking. Also drinking alone or drinking before an activity where there will be drinking. We now know that these can be part of the definition of alcoholism. This symptom, called denial, is almost always present in the disease of alcoholism. Later, difficulties in relationships, on the job, or with the law often occur. Other signs and symptoms closely matching the definition of alcoholism are:Hiding alcohol or sneaking drinksGulping the first few drinksWanting to drink more, or longer, than the rest of the crowdLosing control of drinking, leading to attempts to control it ("going on the wagon")It is very important to seek help early as alcoholism is a disease. As the disease progresses, severe health problems can occur in almost every body system. If you want to learn more about the signs and definition of alcoholism, consult your healthcare provider or look in the yellow pages for "alcoholism" or "alcoholism treatment. These are meetings for people who have a family member with a drinking problem. DSM IV - American Psychiatric AssociationNational Institute on Alcohol Abuse and AlcoholismFor more in-depth information on signs-symptoms, causes and treatment of alcoholism, click the "next" article below. For information on: Alcoholics: What is an alcoholic? Alcohol Abuse: Determining if you have a drinking problem and what do to about it. Effects of Alcohol: short and long-term, physical and psychological. Because drinking alcohol is woven into so many aspects of society in the United States, alcoholism symptoms can sometimes be overlooked. This first of the warning signs of alcoholism that should be carefully noted is: Does drinking cause problems in your life? If the answer to this is yes, then you have a problem with alcohol and it may be an alcoholism symptom. Tolerance is one of the defining symptoms of alcoholism. Tolerance to alcohol is when more and more alcohol is needed to achieve the same effect. For example, if a person finds that alcohol relaxes them, one of the warning signs of alcoholism is that the person needs more and more alcohol to feel relaxed. The second of the defining symptoms of alcoholism is the experience of alcohol withdrawal when not drinking. Withdrawal is negative physical symptoms that appear when not drinking alcohol. For example, one of the warning signs of alcoholism is when a person needs a drink first thing in the morning just to "get going". Alcoholism symptoms around withdrawl: may make a person extremely irritable, angry or depressed. Other alcoholism signs and symptoms related to withdrawal include:Symptoms of alcoholism include behaviors around the compulsive need to drink. The alcoholism signs and symptoms can generally be seen at home, at work and in daily life. Common warning signs of alcoholism include:Gulping drinks or ordering doubles to become intoxicated more quickly, to feel good or just to feel normalGiving up other activities such as sports or hobbies due to drinkingAlcohol becoming the main focus of daily life and taking up a lot of time and attentionAlcoholism screening test to help determine if you have a drinking problem, alcoholism or alcohol addiction. Answering these alcoholism test questions will take only a few minutes, and will generate personalized results based on your age, gender and drinking patterns. Your responses are completely confidential and anonymous. How many drinks containing alcohol do you have on a typical day when you are drinking? How often do you have six or more drinks on one occasion? How often during the last year have you found it difficult to get the thought of alcohol out of your mind? How often during the last year have you found that you were not able to stop drinking once you had started? How often during the last year have you been unable to remember what happened the night before because you had been drinking? How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? How often during the last year have you had a feeling of guilt or remorse after drinking? Have you or someone else been injured as a result of your drinking? The AUDIT questionnaire was developed by the World Health Organization (1993) to screen for harmful or hazardous drinking patterns. A score of 8 or more is suggestive of problem drinking.
When blood glucose concentrations are normal or elevated discount fenofibrate 160mg with mastercard, GLP-1 and GIP increase insulin synthesis and release from pancreatic beta cells by intracellular signaling pathways involving cyclic AMP purchase fenofibrate 160mg without a prescription. GLP-1 also lowers glucagon secretion from pancreatic alpha cells cheap 160 mg fenofibrate visa, leading to reduced hepatic glucose production. By increasing and prolonging active incretin levels, sitagliptin increases insulin release and decreases glucagon levels in the circulation in a glucose-dependent manner. Sitagliptin demonstrates selectivity for DPP-4 and does not inhibit DPP-8 or DPP-9 activity in vitro at concentrations approximating those from therapeutic doses. Metformin is an antihyperglycemic agent which improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Its pharmacologic mechanisms of action are different from other classes of oral antihyperglycemic agents. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. Unlike sulfonylureas, metformin does not produce hypoglycemia in either patients with type 2 diabetes or normal subjects (except in special circumstances [see Warnings and Precautions ]) and does not cause hyperinsulinemia. With metformin therapy, insulin secretion remains unchanged while fasting insulin levels and day-long plasma insulin response may actually decrease. In patients with type 2 diabetes, administration of sitagliptin led to inhibition of DPP-4 enzyme activity for a 24-hour period. After an oral glucose load or a meal, this DPP-4 inhibition resulted in a 2- to 3-fold increase in circulating levels of active GLP-1 and GIP, decreased glucagon concentrations, and increased responsiveness of insulin release to glucose, resulting in higher C-peptide and insulin concentrations. The rise in insulin with the decrease in glucagon was associated with lower fasting glucose concentrations and reduced glucose excursion following an oral glucose load or a meal. Sitagliptin and Metformin hydrochloride Co-administrationIn a two-day study in healthy subjects, sitagliptin alone increased active GLP-1 concentrations, whereas metformin alone increased active and total GLP-1 concentrations to similar extents. Co-administration of sitagliptin and metformin had an additive effect on active GLP-1 concentrations. Sitagliptin, but not metformin, increased active GIP concentrations. It is unclear what these findings mean for changes in glycemic control in patients with type 2 diabetes. In studies with healthy subjects, sitagliptin did not lower blood glucose or cause hypoglycemia. Cardiac ElectrophysiologyIn a randomized, placebo-controlled crossover study, 79 healthy subjects were administered a single oral dose of sitagliptin 100 mg, sitagliptin 800 mg (8 times the recommended dose), and placebo. At the recommended dose of 100 mg, there was no effect on the QTc interval obtained at the peak plasma concentration, or at any other time during the study. Following the 800-mg dose, the maximum increase in the placebo-corrected mean change in QTc from baseline at 3 hours postdose was 8. This increase is not considered to be clinically significant. At the 800-mg dose, peak sitagliptin plasma concentrations were approximately 11 times higher than the peak concentrations following a 100-mg dose. In patients with type 2 diabetes administered sitagliptin 100 mg (N=81) or sitagliptin 200 mg (N=63) daily, there were no meaningful changes in QTc interval based on ECG data obtained at the time of expected peak plasma concentration. The results of a bioequivalence study in healthy subjects demonstrated that the Janumet (sitagliptin/metformin HCl) 50 mg/500 mg and 50 mg/1000 mg combination tablets are bioequivalent to co-administration of corresponding doses of sitagliptin (JANUVIA) and metformin hydrochloride as individual tablets. The absolute bioavailability of sitagliptin is approximately 87%. Co-administration of a high-fat meal with sitagliptin had no effect on the pharmacokinetics of sitagliptin. The absolute bioavailability of a metformin hydrochloride 500-mg tablet given under fasting conditions is approximately 50-60%. Studies using single oral doses of metformin hydrochloride tablets 500 mg to 1500 mg, and 850 mg to 2550 mg, indicate that there is a lack of dose proportionality with increasing doses, which is due to decreased absorption rather than an alteration in elimination. Food decreases the extent of and slightly delays the absorption of metformin, as shown by approximately a 40% lower mean peak plasma concentration (C), a 25% lower area under the plasma concentration versus time curve (AUC), and a 35-minute prolongation of time to peak plasma concentration (T) following administration of a single 850-mg tablet of metformin with food, compared to the same tablet strength administered fasting. The clinical relevance of these decreases is unknown. The mean volume of distribution at steady state following a single 100-mg intravenous dose of sitagliptin to healthy subjects is approximately 198 liters. The fraction of sitagliptin reversibly bound to plasma proteins is low (38%). The apparent volume of distribution (V/F) of metformin following single oral doses of metformin hydrochloride tablets 850 mg averaged 654 a 358 L. Metformin is negligibly bound to plasma proteins, in contrast to sulfonylureas, which are more than 90% protein bound. Metformin partitions into erythrocytes, most likely as a function of time. At usual clinical doses and dosing schedules of metformin hydrochloride tablets, steady-state plasma concentrations of metformin are reached within 24-48 hours and are generallyC]sitagliptin oral dose, approximately 16% of the radioactivity was excreted as metabolites of sitagliptin. Six metabolites were detected at trace levels and are not expected to contribute to the plasma DPP-4 inhibitory activity of sitagliptin. In vitro studies indicated that the primary enzyme responsible for the limited metabolism of sitagliptin was CYP3A4, with contribution from CYP2C8. Intravenous single-dose studies in normal subjects demonstrate that metformin is excreted unchanged in the urine and does not undergo hepatic metabolism (no metabolites have been identified in humans) nor biliary excretion. Following administration of an oral [C]sitagliptin dose to healthy subjects, approximately 100% of the administered radioactivity was eliminated in feces (13%) or urine (87%) within one week of dosing.