Read this Medication Guide before you start taking STELARA™ and each time before you get an injection. There may be new information. This Medication Guide does not take the place of talking with your doctor about your medical condition or treatment with STELARA™.

What is the most important information I should know about STELARA™?

STELARA™ is a medicine that affects your immune system. STELARA™ can increase your chances of having serious side effects, including:

Serious Infections: STELARA™ may lower the ability of your immune system to fight infections and may increase your risk of infections. Some people have serious infections while taking STELARA™, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses. Some people have to be hospitalized for treatment of their infection.

• Your doctor should check you for TB before starting STELARA™.
• If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with STELARA™ and during treatment with STELARA™.
• Your doctor should watch you closely for signs and symptoms of TB during treatment with STELARA™.

You should not start taking STELARA™ if you have any kind of infection unless your doctor says it is okay.

Before starting STELARA™, tell your doctor if you think you have an infection or have symptoms of an infection such as:

• fever, sweats, or chills
• muscle aches
• cough
• shortness of breath
• blood in your phlegm
• weight loss
• warm, red, or painful skin or sores on your body
• diarrhea or stomach pain
• burning when you urinate or urinate more often than normal
• feel very tired
• are being treated for an infection
• get a lot of infections or have infections that keep coming back
• have TB, or have been in close contact with someone who has TB.

After starting STELARA™, call your doctor right away if you have any symptoms of an infection (see above).

STELARA™ can make you more likely to get infections or make an infection that you have worse.

People who have a genetic problem where the body does not make any of the proteins interleukin 12 (IL-12) and interleukin 23 (IL-23) are at a higher risk for certain serious infections. These infections can spread throughout the body and cause death. It is not known if people who take STELARA™ will get any of these infections, because of the effects of STELARA™ on these proteins in your body.

Cancers:

STELARA™ may decrease the activity of your immune system and increase your risk for certain types of cancers. Tell your doctor if you have ever had any type of cancer.

Reversible Posterior Leukoencephalopathy Syndrome (RPLS):

RPLS is a rare condition that affects the brain and can cause death. The cause of RPLS is not known. If RPLS is found early and treated, most people recover. Tell your doctor right away if you have any new or worsening medical problems including:

• headache
• seizures
• confusion
• vision problems

What is STELARA™?

STELARA™ is a prescription medicine used to treat adults 18 years and older with moderate or severe psoriasis that involves large areas or many areas of their body, who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).

STELARA™ may improve your psoriasis but may also lower the ability of your immune system to fight infections. This may also increase your risk for certain types of cancer.

It is not known if STELARA™ is safe and effective in children.

It is not known if taking STELARA™ for more than 2 years is safe and effective.

What should I tell my doctor before receiving STELARA™?

Before receiving STELARA™, tell your doctor if you:

• have any of the conditions or symptoms listed in the section “What is the most important information I should know about STELARA™?”
• have recently received or are scheduled to receive an immunization (vaccine). People who take STELARA™ should not receive live vaccines. Tell your doctor if anyone in your house needs a vaccine. The viruses used in some types of vaccines can spread to people with a weakened immune system, and can cause serious problems. You should not receive the BCG vaccine during the one year before taking STELARA™ or one year after you stop taking STELARA™.
• receive phototherapy for your psoriasis.
• have any other medical conditions.
• are pregnant or planning to become pregnant. It is not known if STELARA™ will harm your unborn baby. You and your doctor should decide if you will take STELARA™.
• are breast-feeding or plan to breast-feed. It is thought that STELARA™ passes into your breast milk. You should not breast-feed while taking STELARA™ without first talking with your doctor.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• other medicines that affect your immune system.
• certain medicines that can affect how your liver breaks down other medicines.

Ask your doctor or pharmacist if you are not sure if your medicine is one that is listed above. Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.

How will I receive STELARA™?

• STELARA™ is given by injection under the skin (subcutaneous injection).
• STELARA™ should only be given by a healthcare provider as directed by your doctor.
• Your doctor will decide the right dose of STELARA™ for you and how often you should receive it.
• Be sure to keep all of your scheduled follow-up appointments.

What should I avoid while receiving STELARA™?

You should not receive a live vaccine while taking STELARA™. See “What should I tell my doctor before taking STELARA™?”

What are the possible side effects of STELARA™?

STELARA™ can increase your chances of having serious side effects. See “What is the most important information I should know about STELARA™?”

Common side effects of STELARA™ include:

• upper respiratory infections
• headache
• tiredness

These are not all of the possible side effects of STELARA™. Tell your doctor about any side effect that bothers you or that does not go away. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about STELARA™

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide.

This Medication Guide summarizes the most important information about STELARA™. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about STELARA™ that was written for healthcare professionals. For more information, go to www.STELARAinfo.com or call 1-800-457-6399.

What are the ingredients in STELARA™?

Active ingredient: ustekinumab

Inactive ingredients: sucrose, L-histidine, and polysorbate 80.

Manufactured by Cilag AG, Schaffhausen, Switzerland for Centocor Ortho Biotech Inc. Horsham, PA 19044

Revised September 2009

This Medication Guide has been approved by the U.S. Food and Drug Administration.

U.S. License No. 1821

Source:medicinenet.com

Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs and result in nasal secretions, a barking-like cough, decreased appetite, and listless behavior. Swine flu produces most of the same symptoms in pigs as human flu produces in people. Swine flu can last about one to two weeks in pigs that survive. Swine influenza virus was first isolated from pigs in 1930 in the U.S. and has been recognized by pork producers and veterinarians to cause infections in pigs worldwide. In a number of instances, people have developed the swine flu infection when they are closely associated with pigs (for example, farmers, pork processors), and likewise, pig populations have occasionally been infected with the human flu infection. In most instances, the cross-species infections (swine virus to man; human flu virus to pigs) have remained in local areas and have not caused national or worldwide infections in either pigs or humans. Unfortunately, this cross-species situation with influenza viruses has had the potential to change. Investigators think the 2009 swine flu strain, first seen in Mexico, should be termed novel H1N1 flu since it is mainly found infecting people and exhibits two main surface antigens, H1 (hemagglutinin type 1) and N1 (neuraminidase type1). Recent investigations show the eight RNA strands from novel H1N1 flu have one strand derived from human flu strains, two from avian (bird) strains, and five from swine strains.

Why is swine flu (H1N1) now infecting humans?

Many researchers now consider that two main series of events can lead to swine flu (and also avian or bird flu) becoming a major cause for influenza illness in humans.

First, the influenza viruses (types A, B, C) are enveloped RNA viruses with a segmented genome; this means the viral RNA genetic code is not a single strand of RNA but exists as eight different RNA segments in the influenza viruses. A human (or bird) influenza virus can infect a pig respiratory cell at the same time as a swine influenza virus; some of the replicating RNA strands from the human virus can get mistakenly enclosed inside the enveloped swine influenza virus. For example, one cell could contain eight swine flu and eight human flu RNA segments. The total number of RNA types in one cell would be 16; four swine and four human flu RNA segments could be incorporated into one particle, making a viable eight RNA segmented flu virus from the 16 available segment types. Various combinations of RNA segments can result in a new subtype of virus (known as antigenic shift) that may have the ability to preferentially infect humans but still show characteristics unique to the swine influenza virus (see Figure 1). It is even possible to include RNA strands from birds, swine, and human influenza viruses into one virus if a cell becomes infected with all three types of influenza (for example, two bird flu, three swine flu, and three human flu RNA segments to produce a viable eight-segment new type of flu viral genome). Formation of a new viral type is considered to be antigenic shift; small changes in an individual RNA segment in flu viruses are termed antigenic drift and result in minor changes in the virus. However, these can accumulate over time to produce enough minor changes that cumulatively change the virus’ antigenic makeup over time (usually years).

Second, pigs can play a unique role as an intermediary host to new flu types because pig respiratory cells can be infected directly with bird, human, and other mammalian flu viruses. Consequently, pig respiratory cells are able to be infected with many types of flu and can function as a “mixing pot” for flu RNA segments (see Figure 1). Bird flu viruses, which usually infect the gastrointestinal cells of many bird species, are shed in bird feces. Pigs can pick these viruses up from the environment and seem to be the major way that bird flu virus RNA segments enter the mammalian flu virus population.

Figure 1. What are the symptoms of swine flu (H1N1)? Symptoms of swine flu are similar to most influenza infections: fever (100F or greater), cough, nasal secretions, fatigue, and headache, with fatigue being reported in most infected individuals. Some patients also get nausea, vomiting, and diarrhea. In Mexico, many of the patients are young adults, which made some investigators speculate that a strong immune response may cause some collateral tissue damage. Some patients develop severe respiratory symptoms and need respiratory support (such as a ventilator to breathe for the patient). Patients can get pneumonia (bacterial secondary infection) if the viral infection persists, and some can develop seizures. Death often occurs from secondary bacterial infection of the lungs; appropriate antibiotics need to be used in these patients. The usual mortality (death) rate for typical influenza A is about 0.1%, while the 1918 “Spanish flu” epidemic had an estimated mortality rate ranging from 2%-20%. Swine flu in Mexico (as of April 2009) has had about 160 deaths and about 2,500 confirmed cases, which would correspond to a mortality rate of about 6%, but these initial data have been revised and the mortality rate currently in Mexico is estimated to be much lower. By June 2009, the virus had reached 74 different countries on every continent except Antarctica, and by September 2009, the virus had been reported in most countries in the world. Fortunately, the mortality rate as of October 2009 has been low but higher than for the conventional flu (average conventional flu mortality rate is about 36,000 per year; projected novel H1N1 flu mortality rate is 90,000 per year in the U.S. as determined by the president’s advisory committee). How is swine flu (H1N1) diagnosed? Swine flu is presumptively diagnosed clinically by the patient’s history of association with people known to have the disease and their symptoms listed above. Usually, a quick test (for example, nasopharyngeal swab sample) is done to see if the patient is infected with influenza A or B virus. Most of the tests can distinguish between A and B types. The test can be negative (no flu infection) or positive for type A and B. If the test is positive for type B, the flu is not likely to be swine flu (H1N1). If it is positive for type A, the person could have a conventional flu strain or swine flu (H1N1). However, the accuracy of these tests has been challenged, and the U.S. Centers for Disease Control and Prevention (CDC) has not completed their comparative studies of these tests. However, a new test developed by the CDC and a commercial company reportedly can detect H1N1 reliably in about one hour; as of October 2009, the test is only available to the military. Swine flu (H1N1) is definitively diagnosed by identifying the particular antigens associated with the virus type. In general, this test is done in a specialized laboratory and is not done by many doctors’ offices or hospital laboratories. However, doctors’ offices are able to send specimens to specialized laboratories if necessary. Because of the large number of novel H1N1 swine flu cases (as of October 2009, the vast majority of flu cases [about 99%] are due to novel H1N1 flu viruses), the CDC recommends only hospitalized patients’ flu virus strains be sent to reference labs to be identified. The CDC developed a PCR diagnostic test to detect novel H1N1 virus. Photo courtesy of the CDC

Source:medicinenet.com

BRAND NAME: Lovaza

DRUG CLASS AND MECHANISM: Lovaza is an antilipemic or fat-regulating drug that is used in addition to diet to reduce triglyceride (TG, a fat-carrying particle in the blood) levels in adult patients with severe elevations in blood levels of TG (≥mg/dL). TG is composed of three fatty acids as well as glycerol, and like cholesterol, comes from either the diet or the liver. High levels of TG in the blood are associated with conditions such as obesity, insulin resistance, poorly controlled diabetes mellitus amongst others that contribute to the risk of atherosclerosis or hardening of the arteries (progressive build up of waxy plaque on the inside of blood vessels) which, in turn, is responsible for coronary artery disease (angina and heart attacks) and strokes.

The precise way in which Lovaza works is not clear; however, its proposed mechanism of action is by decreasing the amount of TG produced by the liver and increasing the removal of TG by the liver. Other drugs that reduce TG levels include fibric acids such as gemfibrozil (Lopid), nicotinic acids such as niacin (Nicobid, Nicolar, Slo-Niacin), and statins such as atorvastatin (Lipitor). Lovaza was FDA approved on November 10, 2004.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Capsules: 1 gm

STORAGE: Lovaza should be stored at 25 C (77 F) and not frozen.

PRESCRIBED FOR: Lovaza is indicated as an adjunct to diet to reduce TG levels in adult patients with severe elevations of TG (≥ 500 mg/dL). Off-label uses of Lovaza include prevention of atherosclerosis and prevention of angina, heart attacks, and strokes.

DOSING: The daily dose of Lovaza is 4 grams per day. The daily dose may be taken as a single 4 gram dose (four capsules) or as two, 2 gram doses (two capsules given twice daily). Patients should be advised to swallow Lovaza capsules whole. They should not break open, crush, dissolve, or chew Lovaza capsules.

DRUG INTERACTIONS: Taking Lovaza with an anticoagulant (blood thinner) affecting coagulation such as aspirin, nonsteroidal antiinflammatory drugs (NSAIDS) such as ibuprofen (Motrin), warfarin (Coumadin), and heparin (Hep-Lock U/P) should be monitored periodically as Lovaza may increase the risk of bleeding.

Since some drugs may increase TG levels, patients should tell their doctor or pharmacist of the following medications before using Lovaza since their doctor may want to change the doses of these medications or monitor their effects; beta-blockers such as atenolol (Tenormin), diuretics or water pills such as hydrochlorothiazide (Diuril), and vitamins/supplements (fish/flaxseed/cod liver oils).

Lovaza contains ethyl esters of omega-3 fatty acids which are obtained from the oil of several fish sources. Lovaza should therefore be used with caution in patients with known sensitivity or allergy to fish and/or shellfish.

PREGNANCY: There are no adequate and well-controlled studies in pregnant women. Lovaza should be used during pregnancy only if the potential benefit to the patient justifies the potential risk to the fetus.

NURSING MOTHERS: It is not known whether Lovaza is excreted in human milk and caution should be exercised when administering Lovaza to nursing women.

SIDE EFFECTS: Upset stomach, burping, and strange tastes in may occur. If these effects persist or worsen, patients should notify their doctor. They also should tell their doctors immediately if any of the following rare but serious side effects that suggest increased bleeding occur: easy bleeding from cuts/bruising, black/tarry stools, vomitus that looks like coffee grounds.

Source:medicinenet.com

Pain is the most common reason for people to seek medical advice, pain medicine is the most frequently purchased over-the-counter (OTC) medication. Fever is one of the most common reasons that children visit the doctor. Moreover, one in five emergency room visits for children is due to fever. Since OTC medicines that are effective in treating pain also are effective at reducing fever, they will be considered together in this article.

What are the classifications of pain?

Pain can be classified as acute, chronic non-malignant, chronic malignant. Headaches are the most common cause of pain and can be considered a separate class of pain.

Acute pain

Acute pain is experienced by everyone; it is usually short in duration with an identifiable pathology, a predictable prognosis, and treatment that usually includes analgesics. Acute pain is most often due to injuries. Examples of injuries include:

• muscle soreness due to overuse, sprains or strains, or viral infections,
• tears of the ligaments,
• broken bones,
• bruises, and
• cuts.

Acute pain from such injuries can respond well to OTC pain medication. Muscle soreness also may respond well to heat and massage.

Chronic non-malignant pain

Chronic non-malignant pain often begins as acute pain, but it continues beyond the typical time expected for resolution of the problem or persists or recurs for other reasons. It is a type of pain associated with progressive, debilitating diseases such as arthritis. Treatment for chronic non-malignant pain can include OTC medications . However, because of the chronic nature of the pain, regular use of OTC medications can lead to side effects.

Chronic malignant pain

Chronic malignant pain is pain associated with advanced, progressive diseases (often fatal) such as cancer, multiple sclerosis, AIDS, and terminal kidney disease. OTC medications for pain may be useful for the management of chronic malignant pain. However, stronger prescription medications are usually necessary.

What are the types of headaches?

Headaches are the most common reason that pain medications (analgesics) are taken. Headaches can be classified into three types:

1. muscle contraction,
2. migraine or vascular, and
3. sinus.

Muscle contraction headache

A muscle contraction headache, the most common type, results from the continuous tightening of the muscles in the upper back, neck, or scalp. This type of headache often is described as a tight, pressing, or throbbing sensation of the head. It can be brought on by emotional stress and anxiety (“tension headaches”). Acute muscle contraction headaches generally respond well to OTC analgesics, but chronic muscle contraction headaches can require physical therapy or relaxation techniques

Source:medicinenet.com

NSAIDs reduce the blood pressure-lowering effects of certain high blood pressure (antihypertensive) medications, including:

• thiazide diuretics such as hydrochlorothiazide (Dyazide, Maxzide);
• beta-blockers such as propranolol (Inderal, Inderal LA), atenolol (Inderal, Tenormin), and metoprolol (Lopressor);
• angiotensin receptor antagonists such as enalapril (Vasotec), lisinopril (Zestril; Prinivil), benazepril (Lotensin), quinapril (Accupril), ramipril (Altace), and captopril (Capoten); and
• some medications that act on the brain, such as clonidine (Catapres).

NSAIDs reduce blood flow to the kidneys and reduce the action of diuretics and decrease the elimination of lithium (Eskalith) and methotrexate (Rheumatrex).

NSAIDs also decrease the ability of the blood to clot and can increase the risk of bleeding. When used with other drugs that also increase bleeding risk (for example, warfarin [Coumadin]), there is an increased likelihood of serious bleeding or complications of bleeding. Therefore, individuals who are taking drugs that reduce the ability of blood to clot should avoid the prolonged use of NSAIDs.

What about overdoses of pain relievers and fever reducers?

The American Association of Poison Control Centers reported that of all overdoses of OTC products, 66% involved acetaminophen, 19% involved ibuprofen, and 15% involved aspirin.

Aspirin overdose can occur with as little as 150 mg/kg (10,000 mg or 10 grams in the average sized male) as a single dose, or 90 mg/kg per day for at least two consecutive days. Symptoms of toxicity due to aspirin include:

• tiredness,
• ringing in the ears,
• rapid breathing,
• seizures, vomiting,
• bleeding, and
• coma.

Large doses of acetaminophen rarely cause serious problems in children. In adults, as little as 10 grams can damage the liver and the kidneys.

Overdoses of ibuprofen rarely produce important problems. Nausea, vomiting, stomach pain, tiredness, and dizziness are the most common symptoms of large doses of ibuprofen. Rarely, coma may occur.

Source:medicinenet.com

Low dose aspirin can raise levels of uric acid in the blood and may need to be avoided in patients with increased uric acid levels or gout.

Certain NSAIDs, particularly ibuprofen (Motrin, Advil), if taken just before aspirin or in multiples doses each day, can reduce the anti-platelet effects of aspirin treatment and theoretically render aspirin less effective in preventing heart attacks and ischemic strokes.

Salicylates other than aspirin

Choline salicylate (Arthropan) is available as a liquid. It is absorbed more quickly, but its onset of action is no different than that of aspirin. Some people find choline salicylate fishy tasting. Fortunately, it can be mixed with juice or soda prior to ingestion. It is less effective at reducing fevers in children than either aspirin or acetaminophen.

Magnesium salicylate (Arthriten; Backache) is as effective as aspirin at reducing pain. Patients with chronic kidney disease should avoid magnesium salicylate, since the magnesium may accumulate in the body.

Sodium salicylate (Scot-Tussin Original) and aspirin are equally effective in the long-term treatment of rheumatoid arthritis, but sodium salicylate is less effective at reducing pain or fever.

Acetaminophen

Acetaminophen comes in various oral formulations, including different types (elixirs or syrups) and flavors of liquids, capsules, tablets, caplets, and suppositories. The capsules contain tasteless granules that can be emptied onto a teaspoon containing a small amount of drink or soft food, and can then be swallowed. However, the granules should not be mixed in a glass of liquid since the granules will stick to glass itself. The amount of acetaminophen that is absorbed from rectal suppositories is about half that of the oral formulations.

Side effects of acetaminophen

Acetaminophen generally is safe to use, and few people develop side effects. In high doses, however, it can cause liver damage and doses of 4000 mg (4 grams) per day should not be exceeded.

Pregnancy/breastfeeding and acetaminophen

Acetaminophen has no known harmful effects on the mother, fetus, or infant and, therefore, can be used safely during pregnancy and breastfeeding.

Drug interactions and acetaminophen

It has been reported that patients with HIV-related diseases (such as AIDS) who take AZT (zidovudine; Retrovir) and acetaminophen are at an increased risk of developing suppression of their bone marrow. Such patients develop lower white and red blood cell and platelet counts and, therefore, are more susceptible to infection, anemia, and bleeding.

Nonsteroidal Anti-inflammatory Drugs (NSAIDS)

There are three OTC NSAIDs; ibuprofen, naproxen sodium, and ketoprofen. All have pain relieving (analgesic), fever reducing (antipyretic), and anti-inflammatory properties. Additionally, NSAIDs are more effective than aspirin or acetaminophen for menstrual cramps.

Preparations of NSAIDs

Ibuprofen is available in tablets as well as in a pediatric suspension. Naproxen sodium is available in tablets. Ketoprofen is available as tablets and capelets.

Side effects and NSAIDs

The most frequent side effect of NSAIDs is damage to the lining of the stomach and duodenum that can lead to abdominal pain, nausea, and loss of appetite. NSAIDs also can cause ulcers and bleeding from the stomach and duodenum, but less frequently and less severely than occurs with aspirin use. NSAIDs, like aspirin, affect platelets and can inhibit the formation of blood clots, and, therefore, they should be discontinued at least 3 days before surgery or dental procedures.

Because alcohol intensifies the effect of NSAIDs on bleeding, alcohol should not be taken with NSAIDs. NSAIDs also can cause kidney damage, particularly in the elderly or patients with high blood pressure, diabetes, atherosclerosis, or who take diuretic medications (“water pills”).

Patients who are allergic to aspirin should not take NSAIDs since they are likely to be allergic to NSAIDs as well. NSAIDs may cause fluid retention in persons with congestive heart failure.

The most serious side effects are kidney failure, liver failure, ulcers, and prolonged bleeding after an injury or surgery.

Pregnancy/breastfeeding and NSAIDs

NSAIDs are safe for use during the first or second trimesters of pregnancy, but should not be taken during the third trimester because they can:

• prolong labor and delay birth,
• increase bleeding in the mother following birth, and
• can cause cardiac (heart) and vascular (blood vessels) complications in the newborn.

Nevertheless, use of NSAIDs during any portion of pregnancy should be approved by the treating doctor. Ibuprofen and naproxen sodium also are safe for use by nursing mothers. Due to insufficient data, ketoprofen is not recommended for use by nursing mothers.

Source:medicinenet.com

Side effects of aspirin

Aspirin prevents platelets from their natural ability to stick together and form blood clots. On the one hand, this effect can be used beneficially, such as to prevent the blood clots that cause heart attacks or strokes. On the other hand, by preventing blood clots, aspirin can have the detrimental effect of promoting bleeding. Therefore, aspirin should not be used by people who have diseases that cause bleeding (such as hemophilia and severe liver disease) or diseases in which bleeding may occur as a complication (such as stomach ulcers). Moreover, since the effect of aspirin on platelets lasts for many days, people should not take aspirin for at least seven days before surgical or dental procedures because of the increased risk of bleeding after the procedures.

In patients at risk for bleeding, acetaminophen can be an excellent alternative to aspirin since acetaminophen does not have an effect on platelets, blood clots, or bleeding.

Like aspirin, other NSAIDs affect platelets, but the duration of the effect is less than with aspirin. Two aspirin-related, salicylate-containing products (salsalate and choline magnesium trisalicylate) have no effect on the platelets, but they are available only by prescription.

Serious side effects of aspirin occur infrequently. However, they may occur and generally tend to be more frequent with higher doses. Therefore, it is advisable to use the lowest effective dose to minimize side effects.

The most common side effects of aspirin involve the gastrointestinal system. Aspirin can cause ulcers of the stomach and duodenum (first part of the small intestine), abdominal pain, nausea, gastritis (inflammation of the stomach), and even serious gastrointestinal bleeding from ulcers. Sometimes, ulcers of the stomach and bleeding occur without any abdominal pain, and the only signs of bleeding may be bloody or dark stools or weakness.

Although many people claim to be “allergic” to aspirin, most describe their “allergy” as abdominal pain or heartburn. These common side effects are not allergies, but rather reflect the irritating effects of aspirin on the lining of the stomach. True allergy to aspirin is a rare and serious condition in which a patient can develop swelling of tissues, spasm of the airways (bronchospasm) that causes difficulty breathing, and even anaphylaxis, a life-threatening condition. Clearly, patients with a history of allergy to aspirin should not take aspirin. Since aspirin is related chemically to the other NSAIDs, patients who are allergic to the other NSAIDs, such as ibuprofen (Motrin) and naproxen (Aleve), should also not take aspirin.

Pregnancy/breastfeeding and aspirin

Regular aspirin consumption during pregnancy has been associated with side effects in the pregnant mother, including bleeding and complications during labor. It is unclear if aspirin taken in the first two trimesters poses a risk to the fetus. However, when taken during the third trimester, aspirin may increase the risk of bleeding in the newborn. Nevertheless, for certain mothers with diseases that are associated with a high risk for blood clotting during pregnancy and miscarriage, aspirin is actually recommended in low doses for prevention. Although very little aspirin is secreted into breast milk, most authorities recommend that nursing mothers avoid using aspirin. A woman should consult with her health care practitioner before taking any medications while pregnant or breastfeeding.

Viral infections in children and aspirin

Because aspirin causes Reye’s syndrome (a potentially fatal liver disease that occurs almost exclusively in persons under the age of 15 years), aspirin should not be given to children when a viral infection is suspected.

Drug interactions and aspirin

Aspirin may interact with other medications and cause undesirable side effects. For example, high doses of aspirin can increase the activity of valproic acid (Depakene; Depakote), an effect which can cause drowsiness or behavioral changes.

High doses of aspirin also can enhance the effect of some blood sugar-lowering medications used to treat diabetes, including glyburide (Diabeta), glipizide (Glucotrol), and tolbutamide (Orinase), which can possibly lead to hypoglycemia (low blood sugar). Blood sugar levels may need to be more closely monitored in this setting.

Source:medicinenet.com

Migraine or vascular headaches are due to dilation (widening) of blood vessels in the head. An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches. Migraine headaches affect children as well as adults. Before puberty, boys are affected more than girls by migraine headaches. However, as a child nears adolescence, girls are affected more than boys. An estimated 6% of men and up to 18% of women will experience a migraine headache. Although many patients use the expression “migraine” to describe any particularly painful headache, many of these are actually muscle contraction headaches. OTC medications for pain may be quite effective for treating migraine headaches. However, prescription medications that are specifically formulated for treating or preventing migraines are often necessary.

Sinus headache

A sinus headache is caused by inflammation or an infection or blockage of one or more sinuses. The pain often is limited to the area around the eyes or the forehead. The pain may occur upon awakening, and may decrease in intensity after the person stands or sits up for a period of time. In addition to analgesics, OTC decongestants can be effective to help drain the sinuses.

What causes fever?

Most fevers last only a few hours or days and are not dangerous; however, they may cause a great deal of discomfort. A rectal temperature of greater than 101.8 F (38.8 C), an oral temperature of more than 100 F (37.8 C), or an armpit temperature of greater than 99 F (37.2 C) is considered significantly abnormal. Fevers are usually due to viral or bacterial infections; however, they also can be due to cancers, injury to tissue (for example, heart attacks), hyperthyroidism, other illnesses in which there is inflammation, and dehydration. Additionally, many different drugs have been reported to cause “drug fever.”

Harmful effects of fever (for example, dehydration, changes in consciousness, seizures, or coma) are likely to occur at temperatures above 106 F. Lower fevers can be dangerous in persons with heart disease, since fever increases the effort required by the heart to pump blood.

Two percent to four percent of children between the ages of 6 months and 5 years (usually before age 3) with high fevers will experience febrile seizures; though these seizures generally last no more than 15 minutes. Moreover, children who experience febrile seizures have a higher risk of developing epilepsy later in life.

What are the different classes OTC pain relievers and fever reducers?

The three classes of OTC analgesic/antipyretic medications are:

• Salicylates: aspirin (also called acetylsalicylic acid or ASA), choline salicylate, magnesium salicylate, and sodium salicylate;
• Acetaminophen
• Nonsteroidal antiinflammatory drugs (NSAIDs): ibuprofen, naproxen sodium, and ketoprofen. (Aspirin is also an NSAID, but it is considered separately from the other NSAIDs because it has some unique properties.) Each of these drugs is discussed in detail below.

In most circumstances, these medications all have very similar abilities to relieve pain and fever. Their onset of action (the interval from the time of ingestion to the start of pain relief) also are similar. Naproxen sodium may have a somewhat longer duration of pain relief (analgesia) than the other NSAIDs or aspirin. At high doses, salicylates and NSAIDs suppress inflammation and are, therefore, particularly useful in treating inflammatory diseases, such as arthritis. Acetaminophen does not have anti-inflammatory actions.

Many OTC analgesics are available in combination with other drugs. There is some evidence that caffeine and antihistamines enhance the effects of analgesics. Thus, caffeine increases the pain-relieving effects of aspirin and ibuprofen, and the antihistamines orphenadrine and phenyltoloxamine enhance the pain-relieving effects of acetaminophen. Combinations of decongestants with analgesics are logical only when nasal or sinus congestion are present, such as with sinus headaches.

Aspirin

Aspirin can damage the lining of the stomach and duodenum, thereby causing abdominal pain, bleeding, and/or ulcers. As a result, 1 in 5 persons who take aspirin in a dose of 2.5 grams per day or more develops ulcers and about 1 in 6 will lose enough blood from gastrointestinal bleeding to develop anemia. In an attempt to reduce the potential for these complications, some aspirin-containing tablets have been coated with a special coating that prevents the tablet from dissolving until it is past the stomach and duodenum. These “enteric-coated” aspirin products may reduce the frequency of abdominal pain, but not the bleeding or ulcers. Moreover, the onset of pain relief is delayed with enteric-coated aspirin because it takes more time for the tablets to dissolve.

Source:medicinenet.com

Pain is the most common reason for people to seek medical advice, pain medicine is the most frequently purchased over-the-counter (OTC) medication. Fever is one of the most common reasons that children visit the doctor. Moreover, one in five emergency room visits for children is due to fever. Since OTC medicines that are effective in treating pain also are effective at reducing fever, they will be considered together in this article.

What are the classifications of pain?

Pain can be classified as acute, chronic non-malignant, chronic malignant. Headaches are the most common cause of pain and can be considered a separate class of pain.

Acute pain

Acute pain is experienced by everyone; it is usually short in duration with an identifiable pathology, a predictable prognosis, and treatment that usually includes analgesics. Acute pain is most often due to injuries. Examples of injuries include:

• muscle soreness due to overuse, sprains or strains, or viral infections,
• tears of the ligaments,
• broken bones,
• bruises, and
• cuts.

Acute pain from such injuries can respond well to OTC pain medication. Muscle soreness also may respond well to heat and massage.

Chronic non-malignant pain

Chronic non-malignant pain often begins as acute pain, but it continues beyond the typical time expected for resolution of the problem or persists or recurs for other reasons. It is a type of pain associated with progressive, debilitating diseases such as arthritis. Treatment for chronic non-malignant pain can include OTC medications . However, because of the chronic nature of the pain, regular use of OTC medications can lead to side effects.

Chronic malignant pain

Chronic malignant pain is pain associated with advanced, progressive diseases (often fatal) such as cancer, multiple sclerosis, AIDS, and terminal kidney disease. OTC medications for pain may be useful for the management of chronic malignant pain. However, stronger prescription medications are usually necessary.

What are the types of headaches?

Headaches are the most common reason that pain medications (analgesics) are taken. Headaches can be classified into three types:

1. muscle contraction,
2. migraine or vascular, and
3. sinus.

Muscle contraction headache

A muscle contraction headache, the most common type, results from the continuous tightening of the muscles in the upper back, neck, or scalp. This type of headache often is described as a tight, pressing, or throbbing sensation of the head. It can be brought on by emotional stress and anxiety (“tension headaches”). Acute muscle contraction headaches generally respond well to OTC analgesics, but chronic muscle contraction headaches can require physical therapy or relaxation techniques.

Source:medicinenet.com

For those who are willing to commit to working in rural or inner city health care, several programs offer tuition, tuition with living expenses or loan repayment. The Rural Recruitment and Retention Net-work, and the National Rural Health Association (see both in chapter 3) and the Rural Information Center (800-633-7701) can be contacted for specific information and guidance. Visit www.nal.usda.gov/ric/ to find out more about these programs. Contact your state department of health, the Rural Assistance Center www.raconline.org or the National Health Service Corps www.bphc.hrsa.gov/. The NHSC also has information on loan-repayment programs for health care workers in inner-city areas.

Assistance is available to minority students through programs offered by institutions such as the Indian Health Service. Visit their web site at www.ihs.gov .http://www.bphc.hrsa.gov/ Contact the financial aid office of your college or of the nearest medical school.

The United States Armed Services offers abundant educational opportunities. If you enlist for several years they will train you for many health care or computer-related careers. Their Tuition Assistance Program currently pays up to $4,500 per year for full-time active duty members. Eligible College Fund Program enlistees receive up to $65,000 toward college tuition, when combined with the Montgomery G.I. Bill, and upon honorable discharge. Registered nurses who enlist, in addition to loan repayment or sign-up bonuses, may work towards a degree as a nurse practitioner or physician assistant. Students who have their pre-med degree can arrange to have their medical or dental school paid for. Call your local recruiter to get details on education programs or visit the U.S. Army’s web site at www.todaysmilitary.com/.

There are many programs available for those who take the time to seek them out. Contact local hospitals that are short staffed and other medical providers to ask about tuition assistance programs. Directories with hospital contact information are described in Chapter 3. Many employers offer tuition assistance to current employees who show initiative and maintain good grades. It is amazing just how many programs are available especially when demand for workers is high and com-petition is fierce between recruiters and medical facilities in general.

There are also magnet schools that specialize in health care training in cities like Los Angeles and Baltimore. The Chicago Public Schools has a program to encourage minorities to go into medicine and the AMA has a “Doctors Back to School” program, sending physicians to speak in schools to get young people interested in medical careers.

The federal government started offering student loan payoff incentives for new hires in 2004 and since then have paid out over 100 million to employees to pay off their loans. They will pay up to $10,000 a year for six years for a total of up to $60,000, quite a benefit to say the least. Visit http://federaljobs.net to explore federal job options. Uncle Sam employs over 100,000 medical workers at VA facilities nationwide and at other agencies such as Health and Human Services, etc. The all new 10th edition of The Book of U.S. Government Jobs explains where the jobs are, what’s available, and how to get one. A section is devoted to recruitment incentives including the student loan payoff program, cash incentives, and relocation reimbursement.

Locate programs that you find attractive through the use of the resources listed in this chapter and in all of the other resource sections located throughout this book. Don’t forget to contact occupational associations to find out what information they may have concerning scholarships and tuition assistance programs. The more contacts you make the more programs you will uncover in your research.

To explore health care jobs with the federal government or to investigate special emphasis hiring programs obtain a copy of the author’s Book of U.S. Government Jobs – 9th edition, available at libraries, bookstores or from the publisher. This book can be purchased through our toll free service with all major credit cards at 1-800-782-7424 (Orders Only) or order online.