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Suggestions while Prescribing in Certain Illnesses OP Kapoor |
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I would like to clear certain misconceptions in the minds of the family physicians, while treating certain illnesses.
- Bronchial Asthma
a. Although the family physicians have more or less stopped giving injections to a patient of asthma as in the olden days, the prescription of tablets and syrups continues. Even these should be replaced by inhalers.
b. The doctors often prescribe Salbutamol inhalers to be taken as many as 3-5 times a day. Salbutamol inhaler is like a GTN tablet for angina and is to be used only for an occasional attack of asthma.
c. For patients of chronic asthma, the treatment is a course of steroid tablets. Steroid inhalers are initiated for prevention of asthma attacks.
- Angina Pectoris
a. GTN is to be placed sublingually just before the patient is expecting anginal pain.
b. Beta-blocker is the drug given to reduce the number of anginal attacks.
- Gout
a. Patients should not be given Allopurinol during the attack of gout. The attack will subside with large dose of NSAID group of drugs only. It is after the attack settles down that the patient should be called and advised in detail to take Allopurinol life time, in case he is getting frequent attacks of gout.
- Rheumatoid Arthritis
In Rheumatoid Arthritis, NSAID group of drugs should be given only for pain relief. These drugs do not cure the root cause of the aetiology of the illness. To achieve that, only DMARD type of drugs like Methotrexate should be given to every patient till remission occurs.
HOMOCYSTEINE LOWERING AFTER ACUTE MYOCARDIAL INFARCTION
Observational reports have found that lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Treatment with folic acid and vitamin B12, with or without vitaminB6, lowers plasma homocysteine levels. In the NORVIT trial in patients after myocardial infarction, such therapy did not decrease the rate of recurrent infarction, stroke, and sudden death.
N Engl J Med, 2006; 354 : 1556, 1578, 1629. |
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| Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008 |
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