Four Nutritional Supplement Scams To Stay Away From

Proper nutrition is one of the keys to maintaining good health but, unfortunately, the American diet isn't exactly packed full of vitamins and minerals. Many consumers, as a result, have turned to supplements as a means to offset what they lack from their diets. This enormous demand has given rise to a number of companies interested in selling various nutritional products such as shakes, meal replacement bars and pills.  

Lack Of FDA Oversight For Nutritional Supplements

 

The dietary supplement industry, however, has long benefited from a lack federal regulation when compared to medical drugs, which is why these companies can make numerous empty promises regarding the effectiveness of their products. Moreover, these supplements do not undergo rigorous testing to ensure their purity and potency, which means that consumers could be purchasing an expensive yet worthless product.

 

How To Avoid Fraud

 

Since the rules are rather loose when it comes to the supplement market, fraud comes in many forms. Some products provide modest benefits but are marketed as cure-alls, while others are part of multi-level marketing systems that look suspiciously like pyramid schemes. The worst, however, are the ones that appear legitimate but can cause serious side-effects. Here are a few examples of these common scams:

 

1. The Cure-All

 

California-based POM Wonderful is best known for its pomegranate juice products, though it also sells pills containing an extract. In May, a judge issued the company a cease-and-desist order due to a complaint filed in 2010 by the FTC, which stated that POM Wonderful engaged in false advertising by claiming that its products could prevent serious illnesses such as heart disease and prostate cancer. Unwarranted claims of this kind, unfortunately, are commonplace in the supplement industry, though this ruling suggests that the federal government has begun to pay more attention.

 

2. The "Free Trial"

 

The more exotic the plant, the more likely it will be touted as a miraculous weight loss product. Acai berry supplements supposedly help people lose weight by boosting their metabolisms, but this "proof" stems from testimonials and unknown medical experts. While acai supplements are probably a waste of money, a more serious problem has been the online scams involving these products. Central Coast Nutraceuticals, for instance, was shut down by the FTC after nearly 3,000 customers complained to the Better Business Bureau about receiving numerous credit card charges despite promises of a "free trial" period for its AcaiPure supplements.

 

3. The Pyramid Scheme

 

Multi-level marketing strategies have long been criticized for closely-resembling pyramid schemes because they offer heavy incentives for recruiting other salespeople into the program and tend to have high start-up costs. Herbalife, one of the most successful purveyors of nutritional supplements, has come under scrutiny lately after a Belgian court ruled in January that the company operated as a pyramid scheme. Although the verdict is under appeal, the company's annual reports have drawn further suspicion. In 2005, for instance, the turnover rate for its distributors was 80%, and most of these were lower-level salespeople. This high dropout rate suggests that a great deal of the company's income comes from recruitment instead of retail sales - a common characteristic of pyramid schemes.

 

4. Dangerous Medicine

 

Many pharmacy technician schools now train students to help customers understand the risks that some over-the-counter supplements pose, such as dangerous drug interactions and toxicity from high doses. Supplement companies, however, have been shown to reveal little information about the safety of their products. When agents from the Government Accountability Office (GAO) asked supplement sellers questions such as whether it was safe for people to take garlic with blood pressure medication, or if aspirin interacted with ginkgo biloba, all of them claimed that these herbal supplements were safe even though the National Institutes of Health (NIH) has stated otherwise. Whether these supplements do what they claim or not, they may carry risks that make them not worth taking.

 

Although many supplements have been shown to provide some nutritional or medicinal benefit, they are rarely as powerful as companies claim and some can be downright dangerous. Those who are interested in boosting their health with these products, then, should conduct some research and consult their doctor first before making a purchase.

 

Author byline: Young Lee writes from her hometown of Phoenix, AZ. She hopes consumers are aware of their choices when it comes to nutritional supplements.

BCPS 2013: Infectious Disease (Pneumonia)

Infectious Disease.  The topic that I like but loathe.  At the same time. Pneumonia

      1. Community Acquired Pneumonia (CAP) - not hospitalized 2 days or more within the past 90 days, not in a LTC facility/residence, no IV antibiotic therapy, IV chemo, or wound care in the past 30 days, or attendance at a hospital or dialysis clinic.  Must have at least two of the following symptoms:  fever or hypothermia, rigors, sweats, new cough (with or without sputum), chest discomfort, onset of dyspnea, or fatigue, pain, headache, myalgias, anorexia.CURB-65 - predictor of complicated course and whether to admit to the hospital.  Give a point for each of the following:  age > 65, comorbid illnes (DM, CHF, lung dz, renal dz, liver dz), high temp > 101F, Bacteremia, altered mental status (think elderly), immunosuppression (cancer, steroid use), High-risk etiology (S. aureus, legionella, G- bacilli, anaerobic aspiration), multilobe involvement or pleural effusion.
      2. Nosocomial Pneumonia Hospital Acquired Pneumonia (HAP) (48 hours or more after admission), Ventilator Assoc Pneumo (more than 48–72 hours after intubation), Health care Assoc Pneumo (2 or more days within 90 days of the infection) - know risk factors of nosocomial pneumonia.  Pretty common sense.
      3. CAP Organisms:  Unidentifiable (40-60%), M.pneumo, S. pneumo, H.flu, C.pneumo, viruses, S. aureus, Moraxella cat,
      4. Alcoholics - S. pneumoniae, oral anaerobes, gram negative bacilli
      5. Nursing Home - S. pneumoniae, H. influenzae, gram negative bacilli, S. aureus
      6. COPD - S. pneumoniae, H. influenzae, M. catarrhalis
      7. Postinfluenza: H. influenzae, S. aureus, S. pneumoniae
      8. Exposure to water: Legionella
      9. Poor oral hygiene: oral anaerobes
      10. HIV infection: P. jiroveci, S. pneumoniae, M. pneumoniae, Mycobacterium

HAP Organisms:  S. aureus, Pseudomonas aeruginosa, Enterobacter spp., Klebsiella pneumoniae, Candida, Acinetobacter spp., Serratia marcescens, Escherichia coli, S. pneumoniae

P. aeruginosa is transmitted by health care workers’ hands or respiratory equipment S. aureus is transmitted by health care workers’ hands Enterobacteriaceae endogenously colonize hospitalized patients’ airways (healthy people seldom have gram negative upper airway colonization) Stress changes respiratory epithelial cells so that gram-negative organisms can adhere Up to 70% of patients in the intensive care unit have gram-negative upper airway colonization, and 25% of them will become infected through aspiration

TREATMENT

CAP - duration of treatment at least five days:

Empiric nonhospitalized - prev healthy and no abx in past 3 mos - macrolide or doxy (macrolide if H.flu suspected) and if comorbidities present or recent antibiotics in past 3 months - Respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg])

-- OR -- Macrolide (or doxycycline) with high-dose amoxicillin (1 g 3 times/day) or amoxicillin/clavulanate (2 g 2 times/day) or with a cephalosporin (ceftriaxone, cefuroxime, or with cefpodoxime)

Empiric treatment of hospitalized patients with moderately severe pneumonia - Respiratory fluoroquinolone

--OR-- Ampicillin, ceftriaxone, or cefotaxime (ertapenem in select patients) plus a macrolide (or doxycycline)

Empiric treatment of hospitalized patients with severe pneumonia requiring intensive care unit treatment (may need to add other antibiotics if P. aeruginosa or MRSA is suspected)

  • Ampicillin/sulbactam plus either a respiratory fluoroquinolone or azithromycin
  • Ceftriaxone plus either a respiratory fluoroquinolone or azithromycin
  • Cefotaxime plus either a respiratory fluoroquinolone or azithromycin

Treatment duration—at least 5 days, with 48–72 hours afebrile and no more than one sign of clinical instability (elevated temperature, heart rate, or respiratory rate; decreased systolic blood pressure; or arterial oxygen saturation) before therapy d/c

Hospital Acquired Pneumonia - Treatment duration—Efforts should be made to decrease therapy duration to as short as 7 or 8 days (14 days for pneumonia secondary to P. aeruginosa).

  1. Early onset (less than 5 days) and no risk factors for multidrug-resistant organisms -  Common organisms include S. pneumoniae, Haemophilus influenzae, (MSSA), Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., and Proteus spp. -- Treatment -- Third-generation cephalosporin (cefotaxime or ceftriaxone), Fluoroquinolone (levofloxacin, moxifloxacin, ciprofloxacin), Ampicillin/sulbactam, OR Ertapenem
  2. Late onset (5 days or longer) or risk factors for MDR organisms - Common organisms include those listed above for early onset plus Pseudomonas aeruginosa, K. pneumoniae (extended spectrum β-lactamase positive), Acinetobacter spp., MRSA, and Legionella pneumophila. -- Treatment -- a.  Ceftazidime or cefepime plus aminoglycoside or fluoroquinolone (cipro-, levo-)  b.  Imipenem, meropenem, or doripenem plus aminoglycoside or fluoroquinolone (ciprofloxacin, levofloxacin), OR c.  Piperacillin/tazobactam plus aminoglycoside or fluoroquinolone (ciprofloxacin, levofloxacin)  ***Vancomycin or linezolid should be used only if MRSA risk factors (e.g., history of MRSA infection/colonization, recent hospitalization or antibiotic use, presence of invasive health care devices) are present or there is a high incidence locally (greater than 10%–15%).

Risk factors for MDR organisms -- Antibiotic therapy within the past 90 days, Hospitalization of 5 days or more, High resistance in community or hospital unit, Risk factors for health care–associated pneumonia, Immunosuppressive disease and/or therapy

A wonderful article published just last November that I love.  (Pharmacy Times)  Only thing is it doesn't go into the detail of the different antibiotics with Late vs Early Onset of Hospital Acquired.  Just CAP.  That's OK

And because guidelines haven't changed, my quizlet from last year.  Hope you enjoy:

Hemorrhoids and the Squat vs. Sit Debate

ipottyHemorrhoids are swollen and inflamed veins in the anus and rectum. Most who have hemorrhoids often experience pain, irritation, itching and bleeding.  Hemorrhoids is rare in most parts of Asia, Middle East and Africa, but common in Western countries. In America, for example, about half of the population will be affected by it before age 50 (particularly women probably due to childbirth). There is a reason why hemorrhoids is  more prevalent in the Western countries but not in Asia, Middle East and Africa: the use of sitting toilets.

The recent development of using sitting toilets rather than squat commodes was increasing the incidence of hemorrhoids among Indonesians, a doctor said on Tuesday.

Eka Ginanjar, an internist from Cipto Mangunkusumo Hospital, said Western-style toilets were more unnatural than traditional conveyances because they caused more pressure to the rectal area.

Recently, the diet lacking in fiber has been blamed; however as previously quoted, countries using the sit western toilet more are more to blame.  A 2010 Japanese study found that squatting reduced abdominal pressure and muscle strain in comparison to sitting. An Israeli study done in 2003 found similar results, and also commented on the relative lack of issues relating to hemorrhoids and constipation that use squat toilets more frequently.

But what really made me want to post about hemorrhoids and our toilets is that in my own experience (ahem! I will not admit to hemorrhoids) it seems that limiting your time on the throne is the key.  That means no iPhones, no magazines, or newspapers on the potty.  In other words DO YOUR BUSINESS and move on.  Right?

Right?

So I present to you now the CTA Digital 2-in-1 iPotty with activity seat!

Train them now and young (ages 2-4, sorry pharmacy students!) to learn to sit and sit and sit.

What is it?  Well folks, it is a training toilet that features an adjustable docking station for an iPad and a clear cover to prevent smudges and other mishaps (probably urine and feces) to the attached device.  Fold the lid down and becomes a play seat for regular activities!  Brilliant (not!)

Why kids want it?  Because learning to poop like a civilized person is boring, but iPads aren't.  Yep.  That's the marketing right there.  It's boring to wait so sit and play.  Are you imagining yourself at work right now on the throne with your iPhone out?2-in-1 ipotty

Why parents want it for them?  By starting up an engaging, interactive app, tots are less likely to get fidgety and try to leave before the job is done.

Aren't we setting up these guys for a lifetime of sitting and playing = hemorrhoids?  (insert big laugh here)

If you want one... (not me!) check them out:

Maybe they will come up with an adult version soon.

 

What Does a Pharmacy Technician Do?

A pharmacy technician is the biggest help to a pharmacist.  See, I used to be a pharmacy technician once.  PharmacyTechnician.jpeg Pharmacy technicians assist the pharmacist in filling prescriptions.  I know that initially the first thought is retail pharmacy and the retail pharmacy technician who stands behind the counter, rings you up and asks you if you have any questions before you leave the pharmacy.  Technicians do a lot more.  They are usually in charge of inventory.  They also become certified which is a designation that allows them to do a lot more under the supervision of a pharmacist.

A pharmacy technician assists pharmacists with formulating, labeling, and dispensing medications, along with maintaining patient profiles and inventory. Unlike a pharmacist, a pharmacy technician does not attend pharmacy school, and his or her job is usually restricted. The required qualifications for this job vary from state to state.  You don't necessarily have to go to a tech school to become one, either.  All you need is a willing pharmacist to train you and the ability to take the certification test.  You could decide to go to school just to get your foot in the door.

In a hospital, a pharmacy technician fills carts (today normally on the floors with the nurses) and answers phones.  They mix and compound IV medications including chemotherapy.  They fill crash carts for codes.  They fill and keep records for narcotics.  Essentially they do a lot and the job can be very fulfilling.

The market has changed quite a bit over the years and it seems pharmacist positions are declining while technician jobs are stable.  I hope this continues for technicians although I would like to see pharmacist positions to rise as well.

The salary of a pharmacy technician can be anywhere from $10-20/hour depending on where you live.  Hospitals tend to pay for more experience whereas retail pays less.  This is usually the reverse for licensed pharmacists... at least early on in a pharmacist career.

 

BCPS 2013: ADHD Pediatrics (Stimulants: Amphetamines)

250px-StratteraIronically enough I could stand to use an amphetamine this morning as I am struggling to wake up.  Caffeine will have to suffice.  Have you started studying yet?  I really think it's time if you want to make it a more enjoyable experience rather than cramming as I did last year.  It just doesn't work for an old 40 year-old brain like myself.  That's right.  I'm turning 40 today.  I cannot believe it.  Ask anyone around me though, (ok maybe this is just a hope I have) I still am youthful.  Perhaps it's the young toddler almost kindergartner and 2 1/2 year-old I have.  Perhaps it's my mindset.  Whatever it is, I hope it sticks around the next 40 years.  

Amphetamine-containing products in ADHD

1.  Adderall - mixed amphetamine salts immediate release

2.  Adderall XR - mixed amphetamine salts extended release:  indicated for the treatment of ADHD in children 6 years and older.  50/50 immediate release and extended release beads.  Duration 10-12 hours.  Once daily dosing.  Can sprinkle on applesauce.

3.  Vyvanse - Lisdexamfetamine dimesylate (say that one three times fast!):  prodrug, designed for less abuse, duration 10 hours, no clinical superiority over other amphetamine-containing meds.

 

Adverse Effects of Amphetamine-containing products:  appetite loss, insomnia, abdominal pain, and nervousness, hypertension worsening, tic disorder worsening.  *Recent labeling change warns of association with sudden cardiac death (potential) so IS NOT RECOMMENDED FOR PATIENTS WITH KNOWN STRUCTURAL HEART DEFECTS.  Routine eletrocardiography is not recommended unless history and physical exam suggest cardiac disease.  And, don't withhold if you can't get an electrocardiogram or assessment by a pediatric cardiologist (if otherwise healthy).

 

Nonstimulant medications in ADHD

1.  Strattera - Atomoxetine Potent inhibitor of NE reuptake, once or twice daily dosing, **considered first line therapy for children with an active substance abuse problem, comorbid anxiety, or tics.

Adverse Effects - dyspepsia, decreased appetite, weight loss, and fatigue, can cause liver injury but don't monitor liver enzymes, *doesn't exacerbate tics (imagine a question like this:  kid has tics what is the best choice for ADHD), and don't forget black box warning that a lot of SSRIs have for suicidal ideation in children and teens.  AND Please don't forget CYP2D6 with atomoxetine.

2.  Antidepressants - Non-FDA label approved treatment - Bupropion and Imipramine/Nortriptyline

Bupropion obviously contraindicated in seizure disorder.  Can use immediate or extended release.

Imipramine and Nortriptyline - electrocardiogram to start and after each dose increase and desipramine used with extreme caution due to reports of sudden death.

3.  Alpha-Adrenergic Receptor Agonists - Clonidine and Guanfacine

Clonidine - KAPVAY - ADHD in 6-17 year olds (clonidine extended release), use in combo with methylphenidate lessons tics

May be more effective for hyperactivity than for inattention

adverse effect:  SEDATION

Guanfacine - Intuniv - extended release for 6-17 year olds.  Shown to improve comorbid tic disorder.  Less sedating with a longer DOA than clonidine.  Can have rebound hypertension with abrupt d/c of extended release product.

The Best Health Blogs You Must Read in 2013

health blogs1.  Health Beat by Maggie Mahar - Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the healthinsurance.org blog and she’ll continue to write on both websites. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex Gibney.

Before she began writing about health care, Mahar was a financial journalist and wrote for Barron’s, Time Inc., The New York Times and other publications. (Her first book, Bull: A History of the Boom and Bust 1982-2003(Harper Collins, 2003) was recommended by Warren Buffet in Berkshire Hathaway’s annual report. For more on her books, click here.

In an earlier career, Mahar was an English professor at Yale University where she taught 19th and 20th century literature.

2.  HealthBlawg  - David Harlow is a seasoned health care attorney and consultant recognized as an accomplished, innovative and resourceful thought leader in health care law, strategy and policy.  His experience in both the public and private sectors over the past twenty-five years affords him a unique perspective on legal, policy and business issues facing the health care community.

3.  But Doctor I Hate Pink - Breast Cancer? But Doctor, I hate pink is a brutally honest, laugh out loud funny, raw account of navigating life with metastatic breast cancer. Breast cancer is not all pink ribbons and fun runs and survivorship memorabilia, and Ann tells it like it is, what it's like to live life when you know you are going to die.

4.  The Health Care Blog - You can think of us as a little bit like the Huffington Post with a focus on medicine, science and the business of medicine.  Since passage of the Obama administration’s health reform law, we’ve paid close attention to the Affordable Care Act, tracking the implications of the landmark legislation for the industry and consumers, as well as the looming legal battle over the law’s future in Washington.

5.  Health Care Informatics - Mark Hagland's blog about informatics.

6.  Simply Healthy - Marta Montenegro has been inspiring people to live healthy lives by giving them the tools and strength to find one’s inner athlete. Inspired by her father’s last words to her, “Find your victory,” she dedicated herself to living a healthy lifestyle and sharing her personal journey with others. Her personal website MartaMontenegro.com combines health and fitness advice, first-person stories, and tips on nutrition, beauty and fashion.

7.  Runblogger - The best running blog out there (running is health right?) and you can read more about the author.

8.  Wall Street Journal Health Blog - Great resource from the WSJ.

9.  Jay Parkinson + MD + MPH - If I had gone to medical school instead of pharmacy school, THIS is the kind of doctor that I would want to be.  Love this blog.

After completing a residency in pediatrics and one in preventive medicine at Johns Hopkins, I started a practice for my neighborhood of Williamsburg, Brooklyn in September 2007. People would visit my website; see my Google calendar; choose a time and input their symptoms; my iphone would alert me; I would make a house call; they'd pay me via Paypal; and we'd follow up by email, IM, videochat, or in person.

Fast Company calls me The Doctor of the Future. I've got a startup called Sherpaa. Read more about me here.

10.  NPR's Shots - fascinating daily information about health around the world

 

So there is my top ten list of blogs I enjoy at the moment.  Hope you enjoy!

BCPS 2013: ADHD Pediatrics (Stimulants: Methylphenidates)

adhdThe DSM-5 will not be out until later this year (hopefully).  So, the criteria for ADHD in the DSM-IV-TR:

DSM-IV Criteria for ADHD

 

I. Either A or B:

Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level: Inattention

    • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
    • Often has trouble keeping attention on tasks or play activities.
    • Often does not seem to listen when spoken to directly.
    • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
    • Often has trouble organizing activities.
    • Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
    • Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
    • Is often easily distracted.
    • Is often forgetful in daily activities.

    Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: Hyperactivity

  • Often fidgets with hands or feet or squirms in seat when sitting still is expected
  • Impulsivity
  • Often blurts out answers before questions have been finished.
  • Often has trouble waiting one's turn.
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)
  • Often gets up from seat when remaining in seat is expected
  • Often excessively runs about or climbs when and where it is not appropriate (adolescents/adults feel restless)
  • Often has trouble playing or doing leisure activities quietly
  • Is often on the go or often acts as if driven by a motor
  • Often talks excessively

II. Some symptoms that cause impairment were present before age 7 years.

III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).

IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.

V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Based on these criteria, three types of ADHD are identified:

IA. ADHD, Combined Type: if both criteria IA and IB are met for the past 6 months

IB. ADHD, Predominantly Inattentive Type: if criterion IA is met but criterion IB is not met for the past six months

IC. ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion IB is met but Criterion IA is not met for the past six months.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

In late October 2011, the American Academy of Pediatrics (AAP) released new guidelines for the diagnosis and treatment of ADHD, updating guidelines that dated back to 2000 and 2001. The biggest change is that the guidelines were expanded to include recommendations for children and adolescents ages 4 to 18. The previous guidelines included children ages 6 to 12.

There are two recommended forms of treatment for ADHD, medication and behavior therapy. The new guidelines recommend starting with a course of behavior therapy in preschool age children (ages 4-5) and adding medication if necessary. For older children, they recommend a combination of medication and behavior therapy.

Treatment Options: Combination of pharmacotherapy and behavioral therapy is more beneficial compared

with either intervention alone.

Stimulant medications: Some children with ADHD respond better to one stimulant type than another; therefore, both methylphenidate- and amphetamine-containing products should be tried before stimulant treatment is deemed a failure.

a. Methylphenidate-containing products: “Ramp effect” = behavioral effects are proportional to the

rate of methylphenidate absorption into the central nervous system

Treatment

**Combination therapy with behavioral therapy and medication is better than either alone.

Stimulant Medications (amphetamine or methylphenidate try both before deeming stimulants a failure)

Adverse Effects of this category:  (a) Headache, stomachache, loss of appetite, and insomnia  (b) Use with caution in patients with glaucoma, tics, psychosis, and concomitant monoamine oxidase inhibitors (c) Insomnia

Methylphenidate immediate release (Ritalin)

  • A 50:50 racemic mixture of l-threo and d-threo isomers of methylphenidate
  • The short duration of action requires two or three doses daily.

Dexmethylphenidate (Focalin)

  • Only d-threo isomer, thought to be the active enantiomer of methylphenidate
  • l-Threo isomer hasn't been shown to hinder the effectiveness or increase the adverse effects of methylphenidate
  • Recommended doses are half those of racemic methylphenidate immediate release
  • Short duration of effect requires two or three doses daily
  • Offers no proven pharmacoeconomic benefit over other methylphenidate immediate release products (i.e., Ritalin and generics)

Methylphenidate sustained/extended release (Metadate ER, Ritalin SR)

  • Duration of action may be up to 8 hours, but must use two doses daily for afternoon control
  • May be used in place of methylphenidate immediate-release BID dosing regimen after dose titration with IR product

Methylphenidate (OROS) (Concerta)

  • Indicated for the treatment of ADHD in children 6 years and older
  • Tablet contains osmotic agents and a rate-controlling membrane with a laser-drilled hole for release
  • Outer capsule contains 22% of drug (immediate release) and tablet core contains the remainder released over 10 hours
  • Do not crush or divide
  • Duration of effects is 10-12 hours (behavioral)
  • Once daily dose with/without food

Dexmethylphenidate ER (Focalin XR)

  • Uses spheroidal oral drug absorption system polymer-coated beads
  • Bimodal drug release
  • Faster onset than methylphenidate (OROS), but shorter duration of action.  Afternoon symptom control isn't as good as with methylphenidate (OROS) Concerta.

Methylphenidate modified release (Metadate CD)

  • Treatment for children 6 and older
  • Capsule contains 30% immediate-release beads and 70% extended-release beads (slowly released about 4 hours after ingestion)
  • Duration of behavioral effects is 6–8 hours probably need afternoon coverate
  • Once-daily dosing; capsule may be opened and sprinkled on applesauce

Methylphenidate extended release (Ritalin LA)

  • Indicated for the treatment of ADHD in children 6 years and older
  • Uses spheroidal oral drug absorption system polymer-coated beads
  • Contains 50/50 immediate/extended release to mimic BID methylphenidate immediate release
  • Efficacy can wane later in the day requiring methylphenidate IR coverage for late-day symptoms
  • Once daily dosing can sprinkle on applesauce

Methylphenidate transdermal system (Daytrana)

  • Apply to hip 2 hours before effect is needed; recommended to remove 9 hours after but can wear up to 16 hrs
  • Duration of effect is about 3 hours after removing the patch
  • Dose may be titrated weekly to desired effect
  • Can swim or exercise while wearing

Amphetamine containing continued tomorrow...

BCPS 2013: Pediatric Seizures

wpid-Photo-Feb-3-2013-1021-PM.jpg

Pediatric Seizures

Partial - VPA, CBZ, PHT PB, gabapentin, lamotrigine, tiagabine, topiramate, oxcarbazepine, zonisamide, levetiracetam

Generalized:

Tonic-clonic - VPA, CBZ, PHT Lamotrigine, topiramate, zonisamide, levetiracetam

Myoclonic - VPA Topiramate, zonisamide, levetiracetam

Absence - Ethosuximide, VPA Lamotrigine, zonisamide, levetiracetam

Lennox-Gastaut - VPA, topiramate, lamotrigine Rufinamide, clobazam, felbamate, zonisamide

Infantile spasms - ACTH Vigabatrin, lamotrigine, tiagabine, topiramate, VPA, zonisamide

Know the adverse effects and pharmacokinetics interactions of the medications listed above. Think about a scenario. Teen girl has acne, overweight, and seizures. Phenytoin should immediately be crossed of the list because of its side effect profile. Which drugs affect birth control pills effectiveness?

What type of seizure does ACTH cover? What type of seizure does ethosuximide cover?

I will start adding my Flashcards to these topics this week.