...Contains Nonbinding Recommendations Guidance on Ramipril This guidance represents the Food and Drug Administration's (FDA's) current thinking on this topic. It does not create or confer any rights for or on any person and does not operate to bind FDA or the public. You can use an alternative approach if the approach satisfies the requirements of the applicable statutes and regulations. If you want to discuss an alternative approach, contact the Office of Generic Drugs. Active ingredient: Form/Route: Recommended studies: 1. Ramipril Capsule/ Oral 2 studies Type of study: Fasting Design: Single-dose, two-treatment, two-period crossover in-vivo Strength: 10 mg Subjects: Normal healthy males and females, general population Additional Comments: Female subjects enrolled in the BE studies should not be pregnant, and if applicable, should practice abstention or contraception during the study. ______________________________________________________________________________ 2. Type of study: Fed Design: Single-dose, two-treatment, two-period crossover in-vivo Strength: 10 mg Subjects: Normal healthy males and females, general population Additional comments: Please see comment above. ______________________________________________________________________________ Analytes to measure (in appropriate biological fluid): Ramipril and the metabolite, ramiprilat in plasma. Bioequivalence based on (90% CI): Ramipril. If ramipril can be reliably measured, a confidence interval approach for...
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...Volume 3, number 2 What is critical appraisal? Sponsored by an educational grant from AVENTIS Pharma Alison Hill BSC FFPHM FRCP Director, and Claire Spittlehouse BSc Business Manager, Critical Appraisal Skills Programme, Institute of Health Sciences, Oxford q Critical appraisal is the process of systematically examining research evidence to assess its validity, results and relevance before using it to inform a decision. q Critical appraisal is an essential part of evidence-based clinical practice that includes the process of systematically finding, appraising and acting on evidence of effectiveness. q Critical appraisal allows us to make sense of research evidence and thus begins to close the gap between research and practice. q Randomised controlled trials can minimise bias and use the most appropriate design for studying the effectiveness of a specific intervention or treatment. q Systematic reviews are particularly useful because they usually contain an explicit statement of the objectives, materials and methods, and should be conducted according to explicit and reproducible methodology. q Randomised controlled trials and systematic reviews are not automatically of good quality and should be appraised critically. www.evidence-based-medicine.co.uk Prescribing information is on page 8 1 What is critical appraisal What is critical appraisal? Critical appraisal is one step in the process of evidence-based clinical practice. Evidencebased clinical practice...
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...Generic Name | Brand Name | alendronate tablet | Fosamax | acebutolol | Sectral | Acyclovir | Zovirax 200, 400 mg | acyclovir capsule | Zovirax | acyclovir tablet | Zovirax | afeditab CR tablet | Adalat cc | albuterol inhalation solution | Proventil/Ventolin | albuterol tablet | Proventil | albuterol tablet | Ventolin | albuterol/ipratropium inhalation solution | DuoNeb | alclometasone dipropionate cream | Aclovate | alendronate Na | Fosamax | alfuzosin hcl | Uroxatral | allopurinol | Zyloprim | allopurinol tablet | Zyloprim | alprazolam | Xanax | amiloride/HCTZ | Modurectic | aminophylline | Aminophylline | amiodarone | Cordaron | amiodarone tablet | Cordarone | amitriptyline | Elavil | amitriptyline tablet | Amitriptyline tablet | amlodipine besylate | Norvasc | anastrazole | Arimidex | antihypertensive combinations | Hyzaar | Anucort-Hc Supp | Anusol-HC (suppository) | atenolol | Tenormin | atenolol tablet | Tenormin | atenolol/chlorthalidone | Tenoretic | atenolol/chlorthalidone tablet | Tenoretic | augmented betamethasone dipropionate | Diprolene AF Cream | baclofen tablet | Lioresal | baclofen tabs | Lioresal | belladonna alkaloids/phenobarbital | Belladonna alkaloids/Phenobarbital | benazepril | Lotensin | benazepril HCTZ tablet | Lotensin HCT | benazepril tablet | Lotensin | benazepril/HCT | Lotensin-HCT | benztropine mesylate | Cogentin | benztropine tablet | Benztropine tablet | bicalutamide...
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... She lives on Christian Island and needs to take a ferry to get to the nearest hospital. She has a history of atrial fibrillation and TIA’s, and the patient also smokes 2 packs of cigarettes a day. She’s on ASA, digoxin, ramipril, metoprolol. She has an allergy to penicillin and bee stings. The patient shows a-fib on the monitor and vital signs and GCS are normal. Pupils are PEARL at 3mm. Patient name: Myrtle Bellamee Birthday: 1938/01/10 Health card number: 1284569735 VR Treatment with the Ontario Stroke Strategy The Ontario Stroke System (OSS) is a comprehensive and integrated approach that aims to decrease the incidence of a stroke and improve patient care and outcomes for those who’ve experienced a stroke. The treatment plan that Mrs Myrtle Bellamee would have been on before this incident would be a very common strategy due to her history of cerebrovascular accident (CVA) or a stroke, atrial fibrillation and her previous transient ischemic attack (TIA). She would have been on a low dose antiplatelet drug, which she currently is; she is taking acetylsalicylic acid (ASA). She would also be place on blood pressure medications to control her hearts pressure; like the similar drug she is taking, metoprolol and ramipril. To control her irregular heart of atrial fibrillation she would be prescribed digoxin which she was also on. The doctor could also have prescribed her some cholesterol...
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...Breonna Mosely 7/17/2014 Dr. Ganser Endocrine system effects on Sleep Deprivation Deprived sleep is a universal widespread problem observed in both children and adults. It is a vital process that helps in the functioning of learning, memory processing, cellular repair, and brain development. Statistics show that the average total hours of sleep have decreased per person to less than 7 hours per night over the past 3 to 4 decades. Many people experience sleep loss due pressures at work, stress, and our day to day lifestyle. The reduced hours of nocturnal sleep have shown to lead to serious health problems such as depression, obesity, hypertension, along with many other diseases. It also affects cognitive performance and emotionality. (1) The Endocrine system is responsible for the body’s stress systems and the release of the stress hormones necessary for adaptation and survival in the environment. Sleep deprivation are associated with increases in the hypothalamic- pituitary-adrenal axis, increased levels of cortisol and autonomic sympathetic activation and increased catecholamine levels during wakefulness. Increased sympathetic levels causes an increase in heart rate and blood pressure. Just briefly waking up from sleep for only a few seconds is associated with autonomic reflex, causing a temporary rise in heart rate and BP to the level seen while awake. This is more related to disruption and discontinuity of sleep than to the duration of sleep deprivation or...
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...Hypertension and the Renin-Angiotensin-Aldosterone System Renin-Angiotensin-Aldosterone System The renin-angiotensin-aldosterone system, otherwise known as RAAS is a complex hormone system that regulates blood pressure and fluid balance in the human body. When blood volume is low, juxtaglomerular cells in the kidneys activate prorenin, which secretes renin directly into the blood stream circulation. Subsequently, a drop in blood volume additionally releases angiotensinogen from liver, in which renin converts into angiotensin I. Angiotensin I is then converted to angiotensin II through the enzyme angiotensin converting enzyme (ACE) found in the lung. Angiotensin II is a potent biological compound that causes blood vessels to constrict, resulting in an increase in blood pressure. Additionally, angiotensin II also stimulates the secretion of the hormone aldosterone from the adrenal cortex. Furthermore, thirst or antidiuretic hormone can effectively stimulates the pituitary gland, which could release corticotropin-releasing hormone stimulating the adrenal cortex and thereby releasing aldosterone. Aldosterone contributes to the RAAS system by causing the tubules of the kidneys to increase the reabsorption of sodium and water back into the blood stream. Thus, an increase in the reabsorption of water, increases the volume of fluid in the body, which increases the blood pressure. Once the blood volume and blood pressure stabilizes, these collective effects triggers a negative feedback...
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...16-08-2012 ACKNOWLEDGMENT I want to take this opportunity to thank all the PharmEvo personals for taking the time to share their expertise and knowledge of the field during our internship experience with PharmEvo. The experience was more than i could have expected and allowed me the freedom to develop and maintain individual accounts as a professional member of the team. Working for PharmEvo helped me use the knowledge i have acquired over the past four years as a university student. 1 PREPARED BY MOOSA KAZIM 16-08-2012 TABLE OF CONTENTS Overview of PharmEvo ...................................................................................... 3 Departmental Structural Chart ........................................................................... 4 Technical Services ............................................................................................. 5 Supply Chain ..................................................................................................... 6 Quality Control (QC) ......................................................................................... 7 Quality Assurance (QA)..................................................................................... 8 Quality Compliance ........................................................................................... 8 Production ......................................................................................................... 9 Regulatory Affairs .................
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...This assignment will take the form of a case study on a current patient with heart failure being nursed in a community setting. Due to confidentiality and patient privacy, the patient discussed will be referred to as John¹. John is an 82 year old gentleman who lives alone in sheltered accommodation. John’s son and daughter live close and take it in turns to visit daily. John is an ex-smoker who gave up 20 years ago, has long standing hypertension and is overweight having a BMI of 30 kg/m. John was diagnosed with heart failure a year ago after being hospitalised three times in the space of four months. Stewart (2004) feels that a diagnoses of heart failure is problematic in older patients as their symptoms can often mimic other diseases. According to the National Institute for Clinical Excellence Guidelines (NICE) 2003, hospitalisation accounts² for 70% of the £716 million pounds spent on heart failure annually. In this assignment the physiology of the heart will be discussed and how heart failure affects its performance. John’s symptoms, medication and how his condition was diagnosed will be discussed³. John’s future care and how it will be managed along with who will be involved in his care4. NICE (2003) defines heart failure as a “complex syndrome” that results from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a “physiological circulation”. Tendera5 (2005) states that heart failure...
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...Chronic kidney diseaseFrom Wikipedia, the free encyclopedia Jump to: navigation, search Chronic kidney disease Classification and external resources Uremic frost on the forehead and scalp of a young man who presented with complaints of chronic anorexia and fatigue with blood urea nitrogen and serum creatinine levels of approximately 100 and 50 mg/dL respectively. ICD-10 N18 ICD-9 585.9 585.1-585.5 403 DiseasesDB 11288 MedlinePlus 000471 eMedicine article/238798 MeSH D007676 Chronic kidney disease (CKD), also known as chronic renal disease (CRD), is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are non-specific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis.[1] It is differentiated from acute kidney disease in that the reduction in kidney function must be present for over 3 months. Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a lower glomerular filtration rate and as a result a decreased capability of the kidneys...
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...Ethics in There were a number of nursing priorities identified, the patient also has hypertension. The key priority for nursing care with this patient is her learning about disability and the potential communication barriers that may occur. The patient’s hypertension is well controlled with medication for these reasons. So we will focus this assignment around communication barriers with people with learning disabilities, the importance of good communication between the multi-disciplinary team within the unit. So it is important that we explore any issues with consenting to the procedure as it is imperative that the patient is fully aware of the procedure and understands the possible risks and complications. So it is mandatory that we introduced ourselves to the patient stating that we was a student nurse and gained verbal consent to carry on with the assessment, as a student nurse you must respect patient’s wishes at all times, if they do not wish for a student to carry out the assessment this must be respected, the patient wishes out way the need for the student to gain experience (NMC 2005). In accordance with the NMC 2008 where it states that nurses must protect and promote dignity all pre-assessments are carried out in a private room (NMC 2008). My mentor made aware by the reception staff before that the patient has learning disabilities. I ensured that short sentences and the appropriate language. Also ensure that the patient was given the time to process what was being...
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...survival rate. This shows that ace inhibitors are effective. This could be because as the ACE inhibitors reduce the blood pressure, less strain is put on the blood vessels and therefore less damage will occur within the blood vessels. As a result, less damage is caused to the vessels and the risks of heart attacks and a stroke is reduced. ACE inhibitors can therefore help individuals with atherosclerosis reduce these risks. {2} Evaluation of graph {3} We can also compare the reliability of this data {3} by comparing the data with other sources. For example, by looking at the graph below {4} we can see the effectiveness of the ACE inhibitors on patients with CHD (coronary heart disease). {4} this graph shows patients taking an ACE inhibitor (Ramipril) and the event rate in comparison to patients taking a placebo. Graph {4} clearly shows how effective an ace inhibitor is on the prevention of heart attacks and strokes. Therefore this evidence supports the graph {3} which provides similar evidence on the effectiveness of ACE inhibitors and shows that they are effective when reducing blood pressure. The source is reliable and contains valid data as the graph was obtained from a website which belonged to a college of cardiology whom do in-depth research in cardiology and atherosclerosis and ACE inhibitors. Implications of ACE inhibitors: An economical implication of ACE inhibitors would be that they may be quite expensive if you need to take them longitudinally and some may not be able...
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...TOP 200 DRUGS FOR 2009 WITH CLASSIFICATION, ROUTE, AND USE GENERIC | BRAND | CLASS | MAJOR USE | SCHEDULE | ROUTES | atorvastatin | Lipitor | HMA-CoA reductase inhibitor | hypercholesterolemia | not controlled | PO | amoxicillin | Amoxil, Trimox | Penicillin antibiotic | infection | not controlled | PO | hydrochlorothiazide | Microzide | Thiazide Diuretic | Hypertension/edema | not controlled | PO | azithromycin | Zithromax | macrolide antibiotic | infection | not controlled | PO, IV | metformin | Glucophage, Glucophage XR | antidiabetic | Type 2 Diabetes | not controlled | PO | atenolol | Tenormin | beta blocker (B1) | hypertension/angina/acute M.I. | not controlled | PO, IV | Simvastatin | Zocor | HMG-CoA Redctase inhibitor | hypercholesterolemia | not controlled | PO | alprazolam | Xanax, Xanax XR | benzodiazepeine | anxietty/panic disorder | schedule 4 | PO | furosemide | Lasix | loop diuretic | edema/hypertension | not controlled | PO, IV | zolpidem | Ambien, Ambien CR | anxiolytic/hypnotic | insomnia | schedule 4 | PO | potassium chloride | K-Dur, Klor-Con, Micro-K | posassium supplement/electrolyte | hypokalemia | not controlled | PO, IV | sertraline | Zoloft | selective serotonin reuptake (SSRI) | major depression/ocd/panic disorder | not controlled | PO | montelukast | Singulair | leukotriene inhibitor | asthma maintenence | not controlled | PO | escitalopram | Lexapro | selective serotonin reuptake inhibitor (SSRI) | major depression/anxiety...
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...All of the following medications are gluten free unless otherwise noted Generic drugs can be produced from many manufacturers and not all manufacturers use the same fillers or excipients. When there is a generic drug listed the manufacturer will be in the parenthesis. This does not imply that these are the only gluten free manufacturers but that these were the only ones checked. ANALGESICS/NONSTEROIDAL Acetaminophen w Codeine (Teva) Advil Aleve Alka Seltzer Gold Alka Seltzer Heartburn Relief Anaprox Anaprox DS Arthrotec Aspirin Enteric Coated 325mg (Leiner,code #44/227, Watson) Aspirin 81mg chewable (Watson) Avinza Baby aspirin (Walgreens, Perrigo) Bancaps HC Bufferin-all products EXCEPT Bufferin regular 325mg tablet which does contain some gluten Butazolidin Carisoprodol (Watson, West-Ward) Cataflam Celebrex Clinoril Cyclobenzaprine (Mylan, Schein, Watson) Daypro Demerol Durabac Ecotrin (all strengths) Endocet Endodan Esgic (all forms) Excedrin Extra Strength Excedrin Migraine Feldene-contains gluten Fioricet / with Codeine Fiorinal Fiorinal caps-generic (West-Ward) Fiorinal tabs-generic (West-Ward) Fiorinal with Codeine Flexeril Flubriprofen (Novapharm) Hydrocodone/APAP all strengths (Mallinckrodt, Watson) Ibuprofen (Amneal, Pharm. Formulations) Indocin Indomethacin (Novapharm) Ketoprofen XR (Andrx) Lodine (tabs/caps/XL) Lorcet 10/650 Lorcet Plus Lortab (all forms) Motrin Childrens DF Conc. Drops Mobic Morphine IR tabs (Roxane) Morphine Sulfate Ext Release Tab (Endo) Motrin...
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...The Management of Hypertension Allison A. Torbert, Pharm.D. Roberta M. Skoronski, Pharm.D. Clinical Instructors UW School of Pharmacy Objectives • Explain the classification and goals of therapy in the treatment of hypertension based on JNC VI recommendations • Describe nonpharmacologic and pharmacologic treatment approaches • Recognize patients with hypertension and comorbid conditions in order to optimize therapy • Develop an approach to manage hypertensive patients Prevalence • Approximately 50-60 million Americans have HTN defined as: systolic BP (SBP) 140 mm Hg or > diastolic BP (DBP) 90 mm Hg or > • • • • Incidence increases with age Blacks > whites Men > women Greater in less educated, lower socioeconomic groups hard disk\course\728-721\htn.ppt 1 Classification of Blood Pressure for Adults Age 18 & Older* Category Optimal+ Normal High-normal Hypertension++ Stage 1 Stage 2 Stage 3 Systolic (mm Hg) < 120 < 130 130-139 140-159 160-179 > 180 & & & & & & Diastolic (mm Hg) < 80 < 85 85-89 90-99 100-109 > 110 *Not taking antiHTN drugs & not acutely ill. When SBP & DBP fall into different categories, highest classification should be used. Isolated systolic HTN defined as SBP > 140 and DBP < 90 and staged appropriately. In addition to classifying accordingly, clinicians should specify presence or absence of target organ disease & additional risk factors + Optimal BP with respect to CV risk is < 120/80; unusually low BP’s should be evaluated...
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...Holistic Account of Care for a Patient or Client with Complex Needs What are complex needs? Who has them? It could be argued that everyone's needs are complex and as such, complex needs have been difficult to define (Rosengard et al., 2007). This essay intends to use literature to outline a systematic and holistic approach to care of a patient's complex needs. The nursing process and its framework of assessment, planning, implementation and evaluation will be utilised to provide a patient centred approach (Castledine, 2011). Rankin and Regan (2004) described complex needs as being a framework rather than a label that determines service eligibility. The needs of people include breadth (range of need) and depth (severity); these factors have to be taken into account when providing holistic care. Holistic care is defined as an approach which takes into consideration the physical, mental and social factors in an illness, rather than just the disease itself (Martin, 2010). The person this essay will centre around gave informed consent to have their notes consulted with the intention to write this essay, in line with the Nursing and Midwifery Council's (NMC) The Code (2008). There are seven elements to informed consent; competence to decide, voluntariness to decide, disclosure of information, recommendation of a plan, understanding of the disclosure and recommendation, decision of the plan and authorising of the plan (Beauchamp & Childress, 1994 pp. 145-146). In line with the...
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