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Generic Name: Pioglitazone HydrochlorideActos is used to control high blood sugar in type 2 diabetes cheap metoclopramide 10 mg mastercard. Actos also reduces the production of unneeded sugar in the liver buy generic metoclopramide 10mg on-line. Actos (and the similar drug rosiglitazone maleate) can be used alone or in combination with insulin injections or other oral diabetes medications such as glipizide generic metoclopramide 10 mg without prescription, glyburide cheap 10 mg metoclopramide with amex,or metformin hydrochloride. Always remember that Actos is an aid to, not a substitute for, good diet and exercise. Failure to follow a sound diet and exercise plan can lead to serious complications, such as dangerously high or low blood sugar levels. Remember, too, that Actos is not an oral form of insulin, and cannot be used in place of insulin. Actos should be taken once a day with or without meals. If you miss a dose on one day, skip it and go back to your regular schedule. Store at room temperature in a tight container, away from moisture and humidity. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Actos. Side effects may include:Headache, hypoglycemia, muscle aches, respiratory tract infection, sinus inflammation, sore throat, swelling, tooth disorderIf Actos gives you an allergic reaction, you should not take Actos. In very rare cases, a drug similar to Actos has proven toxic to the liver. The manufacturer therefore recommends that your doctor check your liver function before you begin taking Actos and periodically thereafter. If you experience symptoms of liver problems such as jaundice (yellowing of the skin and eyes), nausea, vomiting, abdominal pain, fatigue, loss of appetite, or dark urine, report them to your doctor immediately. In rare instances, Actos causes swelling and fluid retention that can lead to congestive heart failure. If you already have this problem, you should avoid Actos. If you develop symptoms that signal the problem?such as shortness of breath, fatigue, or weight gain?you should check with your doctor immediately; the drug will probably have to be discontinued. The problem is more likely when Actos is taken in combination with insulin. Actos, by itself, will not cause excessively low blood sugar (hypoglycemia). However, when you combine it with insulin injections or some other oral diabetes drugs, the chance of hypoglycemia increases. If you begin to feel symptoms of hypoglycemia?shaking, sweating, agitation, clammy skin, or blurred vision?take some fast-acting sugar, such as 4 to 6 ounces of fruit juice. Let your doctor know about the incident; you may need a lower dose of insulin or oral medication. To make sure that your blood sugar levels stay within the normal range, get regular tests of your blood sugar and glycosylated hemoglobin (a long-term measurement of blood sugar). Contact your doctor during periods of stress due to fever, infection, injury, surgery, and the like. Dosage of your diabetes medicines may need to be changed. It is possible that Actos may reduce the effectiveness of birth control pills containing ethinyl estradiol and norethindrone. To guard against an unwanted pregnancy, be sure to use some other form of contraception. If Actos is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Actos with the following:The effects of Actos during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, tell your doctor immediately. He may switch you to insulin during your pregnancy, since normal blood sugar levels are very important for the developing baby. It is not known whether Actos appears in breast milk. The recommended starting dose of Actos is 15 to 30 milligrams once a day. If this fails to bring your blood sugar under control, the dose can be increased to a maximum of 45 milligrams a day. If your blood sugar still remains high, the doctor may add a second medication. When Actos is added to other diabetes medications, your doctor may need to lower their dosage if you develop low blood sugar. If you are taking insulin, the dose should be lowered when blood sugar readings fall below 100. The effects of a massive Actos overdose are unknown, but any medication taken in excess can have serious consequences. If you suspect an overdose with Actos, seek medical attention immediately. Generic Name: Glimepiride Human Ophthalmology DataGlimepiride tablets USP are an oral blood-glucose-lowering drug of the sulfonylurea class. Glimepiride is a white to yellowish-white, crystalline, odorless to practically odorless powder formulated into tablets of 1 mg, 2 mg, and 4 mg strengths for oral administration. Glimepiride tablets USP contain the active ingredient Glimepiride and the following inactive ingredients: lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone, and sodium starch glycolate. In addition, Glimepiride tablets USP 1 mg contain ferric oxide red, Glimepiride tablets USP 2 mg contain ferric oxide yellow and FD&C Blue #2 aluminum lake, and Glimepiride tablets USP 4 mg contain FD&C Blue #2 aluminum lake. Chemically, Glimepiride is identified as 1 - [[p - [2 - (3 - ethyl - 4 - methyl - 2 - oxo - 3 - pyrroline - 1 - carboxamido)ethyl]phenyl]sulfonyl] - 3 - (trans - 4 - methylcyclohexyl)urea. The CAS Registry Number is 93479-97-1The structural formula is:Glimepiride is practically insoluble in water. The primary mechanism of action of Glimepiride in lowering blood glucose appears to be dependent on stimulating the release of insulin from functioning pancreatic beta cells. In addition, extrapancreatic effects may also play a role in the activity of sulfonylureas such as Glimepiride.

Smoking is responsible for nearly a half million deaths each year generic metoclopramide 10mg with amex. In 1992 10mg metoclopramide visa, the total economic cost of alcohol abuse was estimated at $150 billion in the U metoclopramide 10 mg visa. Drug abuse facts include the following:Cocaine use peaked in the late 1980s and early 1990s and has fallen since 10 mg metoclopramide sale. Methamphetamine is mostly abused by people aged 15 - 25. Prescription drug abuse is rising sharply particularly among teenagers. The use of "club drugs" such as ecstasy, GHB, Ketamine and LSD is on the rise, particularly among teenagers who, incorrectly, believe these drugs are harmless. Drug addiction therapy is offered as part of almost all drug treatment programs. Drug addiction therapy is critical, as drug addiction is not only a physical but psychological and behavioral issue as well. Drug addiction counseling provides a way of looking at all the effects of drug abuse. Anyone facing drug use issues should get drug addiction counseling. Drug addiction therapy can help in the following ways:Identify underlying reasons for drug useChange thoughts and behaviors around drug use, enhance motivation to changeHelp with life coping skills, particularly stress toleranceWork to repair relationships negatively affected by drug addictionCreate skills to prevent relapseDrug addiction therapy, sometimes referred to as behavioral therapy, is the most commonly used drug abuse treatment. Drug abuse therapy comes in many forms, with different techniques and goals. Drug addiction counseling may happen individually, with loved ones or in a group setting. The following types of drug addiction therapy are evidence-based as recognized by the National Institute on Drug Abuse: Cognitive Behavioral Therapy (CBT) - addresses addiction-related behaviors by identifying them and learning skills to modify them. People who received CBT have been shown to retain their treatment gains over the following year. Community Reinforcement Approach (CRA) - focuses on improving relationships, learning life and vocational skills, and creating a new social network. This is combined with frequent drug testing whereby drug-free screenings are rewarded with vouchers which are exchangeable for health-related goods. CRA has been shown to increase patient participation in drug addiction counseling and increase periods of drug abstinence. Motivational Enhancement Therapy (MET) - focuses on increasing the internal motivation towards treatment and addiction behavior change. MET is most successful at increasing patient participation in drug addiction therapy and treatment. The Matrix Model - a multi-approach system built on promoting patient self-esteem, self-worth and a positive relationship between the therapist and patient. The therapist is viewed as a teacher and coach and uses their relationship to reinforce positive change. The Matrix Model drug addiction therapy contains detailed manuals, worksheets and exercises drawing from other types of therapy. The Matrix Model has been shown effective particularly when treating stimulant abuse. The three key aspects of this type of drug addiction counseling are: acceptance of drug addiction; surrendering oneself to a higher power; active involvement in 12-step activities. FT has been shown effective, particularly in cases of alcohol addiction. Behavioral Couples Therapy (BCT) - creates a sobriety/(drug) abstinence contract for the couple and uses behavioral therapies. BCT has been shown effective at increasing treatment engagement and drug abstinence as well as decreasing drug-related family and legal problems at a 1-year follow-up. Other, more general types of drug addiction therapy are also available in the forms of psychotherapy and group therapy. Psychotherapy is an appropriate drug addiction therapy particularly when past traumatic events are involved. Places providing specific types of drug addiction therapy can found through their respective professional organizations or through substance abuse treatment centers. Drug addiction therapy is always best offered by experts in the particular form of drug addiction counseling. Some types of drug addiction therapy have certifications and professional organizations associated with them such as the National Association of Cognitive-Behavioral Therapists and the Association for Behavior Analysis. Drug addiction counseling and therapy varies in length from only a few sessions, like in the case of MET, to 12 - 16 sessions for CBT and BCT. Some drug addiction therapy lasts more than 24 weeks, as is the case with CRA and the Matrix Model. When drug addiction therapy is provided as part of a drug addiction program, the cost of the drug addiction counseling is included in the cost of the drug addiction program. Other drug addiction counseling may be offered through community services on a sliding payment scale or free-of-charge. For private drug addiction therapy sessions, one hour may cost $150 or more, with health insurance paying some or all of the cost. Drug addiction facts and drug addiction statistics have been tracked by a variety of groups in the United States and worldwide. In spite of this, drug addiction statistics are still considered inaccurate because of the way in which they are collected (self-reporting) and the limited sample size and sample type. Drug addiction statistics collected as a result of emergency room visits or entry into treatment are considered representative of people in that situation, however. Facts about drug addiction, as well as drug addiction statistics, are collected by The Substance Abuse and Mental Health Services Administration (SAMHSA). The government agency authored the National Survey on Drug Use and Health. Here are some staggering drug addiction facts, based on statistics from 2009: 23. Facts about drug addiction show cigarette usage has also declined among teens. However, recently, concern has been raised over teens smoking tobacco from a hookah pipe or cigar. When asked, 17% of 12-graders reported hookah smoking and 23% reported smoking small cigars. As the above drug addiction statistic shows, almost one-in-ten people sought treatment for substance abuse in 2009. Drug addiction facts collected in 2008 suggest the vast majority of these, over 40%, involve alcohol abuse.

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As part of a comprehensive Internet addiction treatment program purchase metoclopramide 10 mg without a prescription, these support groups should also be applied to assist clients in finding adequate support and sponsorship that enable recovery buy metoclopramide 10 mg lowest price. Finally discount 10mg metoclopramide free shipping, couples counseling may be an essential part of recovery among Internet-addicted clients whose marital and familial relationships have been disrupted and negatively influenced by Internet addiction metoclopramide 10mg low price. Kimberly Young is a clinical psychologist and Executive Director of the Center for On-Line Addiction, the first behavioral healthcare firm (since 1995) specializing in Internet-related conditions. She has written many scholarly articles and books on the subject of Internet addiction. These Internet addiction articles provide excellent insight into the problem. Articles on Internet addiction signs, symptoms, causes, treatments, impact, more. Nicotine in tobacco products is a highly addictive drug. Most smokers use tobacco regularly because they are addicted to nicotine. Addiction is characterized by compulsive drug seeking and use, even in the face of negative health consequences. It is well documented that most smokers identify tobacco use as harmful and express a desire to reduce or stop using it, and nearly 35 million of them want to quit each year. Unfortunately, only about 6 percent of people who try to quit smoking are successful for more than a month. Research has shown how nicotine affects on the brain to produce a number of effects. Of primary importance to its addictive nature are findings that nicotine activates reward pathways???the brain circuitry that regulates feelings of pleasure. A key brain chemical involved in mediating the desire to consume drugs is the neurotransmitter dopamine, and research has shown that nicotine increases levels of dopamine in the reward circuits. This reaction is similar to that seen with other drugs of abuse, and is thought to underlie the pleasurable sensations experienced by many smokers. Cigarette smoking produces a rapid distribution of nicotine to the brain, with drug levels peaking within 10 seconds of inhalation. One of the key measures of whether a substance is addictive or not is: when you stop using it, does it produce withdrawl symptoms? The symptoms include:Cognitive and attentional deficitsThese symptoms may begin within a few hours after the last cigarette, quickly driving people back to tobacco use. Symptoms peak within the first few days of smoking cessation and may subside within a few weeks. For some people with a nicotine addiction, however, symptoms may persist for months. For some people who are addicted to nicotine, the feel, smell, and sight of a cigarette and the ritual of obtaining, handling, lighting, and smoking the cigarette are all associated with the pleasurable effects of smoking and can make withdrawal or craving worse. While nicotine gum and patches may alleviate the pharmacological aspects of withdrawal, cravings often persist. Other forms of nicotine replacement, such as inhalers, attempt to address some of these other issues, while behavioral therapies can help smokers and others dealing with nicotine addiction identify environmental triggers of withdrawal and craving so they can employ strategies to prevent or circumvent these symptoms and urges. Pharmacology of nicotine: addiction and therapeutics. Effect of cigarette smoking on the blood glucose level in normals and diabetics. Reducing Tobacco Use: A Report of the Surgeon General. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000. National Institute on Drug AbuseA detailed look at nicotine addiction treatment to help you stop smoking: nicotine replacement therapies and products, medications for smoking cessation, and counseling - support groups. For others, studies have shown that pharmacological treatment combined with behavioral treatment, including psychological support and skills training to overcome high-risk situations, results in some of the highest long-term abstinence rates. Generally, rates of relapse for smoking cessation are highest in the first few weeks and months and diminish considerably after about 3 months. Behavioral economic studies find that alternative rewards and reinforcers can reduce cigarette use. One study found that the greatest reductions in cigarette use were achieved when smoking cost was increased in combination with the presence of alternative recreational activities. For most people who are trying to quit smoking, nicotine replacement therapy is useful. According to one study, nicotine replacement therapy doubles your chances of quitting smoking. When used properly, all forms of nicotine replacement products appear to be about equally effective. Keep in mind, however, if you are pregnant or have heart disease, nicotine replacement therapies may not be right for you. Several nicotine replacement therapies can be obtained without a prescription. Nicotine chewing gum (Nicorette, others) is one medication approved by the Food and Drug Administration (FDA) for the treatment of nicotine dependence. Nicotine in this form acts as a nicotine replacement to help smokers quit smoking. The success rates for smoking cessation treatment with nicotine chewing gum vary considerably across studies, but evidence suggests that it is a safe means of facilitating smoking cessation if chewed according to instructions and restricted to patients who are under medical supervision. Nicotine lozenge (Commit) is a tablet that dissolves in your mouth and, like nicotine gum, delivers nicotine through the lining of your mouth. The lozenges are also available in 2- and 4-milligram doses. The recommended dose is one lozenge every couple of hours for six weeks, then gradually increasing the intervals between lozenges over the next six weeks. Another approach to smoking cessation is the nicotine transdermal patch (Nicoderm CQ, Nicotrol, Habitrol, others), a skin patch that delivers a relatively constant amount of nicotine to the person wearing it. Both nicotine gum and the nicotine patch, as well as other nicotine replacements such as sprays and inhalers, are used to help people fully quit smoking by reducing withdrawal symptoms and preventing relapse while undergoing behavioral treatment. The nicotine in this product, sprayed directly into each nostril, is absorbed through your nasal membranes into veins, transported to your heart and then sent to your brain. This device is shaped something like a cigarette holder. You puff on it, and it gives off nicotine vapors in your mouth. You absorb the nicotine through the lining in your mouth, where it then enters your bloodstream and goes to your brain, relieving nicotine withdrawal symptoms. There are other medications to help you in your efforts to quit smoking, but they should be used in conjunction with a behavior modification program. One tool in treating tobacco and nicotine addiction is the antidepressant medication bupropion, that goes by the trade name Zyban. This is not a nicotine replacement, as are the gum and patch.

Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks) in these patients revealed a risk of death in the drug-treated patients of between 1 buy discount metoclopramide 10mg on line. Over the course of a typical 10-week controlled trial buy 10 mg metoclopramide amex, the rate of death in drug-treated patients was about 4 buy metoclopramide 10mg line. Although the causes of death were varied order metoclopramide 10mg on line, most of the deaths appeared to be either cardiovascular (e. ZYPREXA (olanzapine) is not approved for the treatment of patients with dementia-related psychosis (see WARNINGS ). ZYPREXA (olanzapine) is a psychotropic agent that belongs to the thienobenzodiazepine class. The chemical designation is 2-methyl-4-(4-methyl-1-piperazinyl)-10H-thieno[2,3-b] [1,5]benzodiazepine. The molecular formula is CS, which corresponds to a molecular weight of 312. The chemical structure is:Olanzapine is a yellow crystalline solid, which is practically insoluble in water. ZYPREXA tablets are intended for oral administration only. Inactive ingredients are carnauba wax, crospovidone, hydroxypropyl cellulose, hypromellose, lactose, magnesium stearate, microcrystalline cellulose, and other inactive ingredients. The color coating contains Titanium Dioxide (all strengths), FD&C Blue No. ZYPREXA ZYDIS (olanzapine orally disintegrating tablets) is intended for oral administration only. Each orally disintegrating tablet contains olanzapine equivalent to 5 mg (16 emol), 10 mg (32 emol), 15 mg (48 emol) or 20 mg (64 emol). It begins disintegrating in the mouth within seconds, allowing its contents to be subsequently swallowed with or without liquid. ZYPREXA ZYDIS (olanzapine orally disintegrating tablets) also contains the following inactive ingredients: gelatin, mannitol, aspartame, sodium methyl paraben and sodium propyl paraben. ZYPREXA IntraMuscular (olanzapine for injection) is intended for intramuscular use only. Each vial provides for the administration of 10 mg (32 emol) olanzapine with inactive ingredients 50 mg lactose monohydrate and 3. Hydrochloric acid and/or sodium hydroxide may have been added during manufacturing to adjust pH. Olanzapine is a selective monoaminergic antagonist with high affinity binding to the following receptors: serotonin 5HT=4 and 11 nM, respectively), dopamine D=7 nM), and adrenergic (alpha) 1 receptors (K=19 nM). Olanzapine binds weakly to GABA, BZD, and (beta) adrenergic receptors (KThe mechanism of action of olanzapine, as with other drugs having efficacy in schizophrenia, is unknown. The mechanism of action of olanzapine in the treatment of acute manic episodes associated with Bipolar I Disorder is unknown. Antagonism at receptors other than dopamine and 5HTwith similar receptor affinities may explain some of the other therapeutic and side effects of olanzapine. Olanzapine is well absorbed and reaches peak concentrations in approximately 6 hours following an oral dose. It is eliminated extensively by first pass metabolism, with approximately 40% of the dose metabolized before reaching the systemic circulation. Food does not affect the rate or extent of olanzapine absorption. Pharmacokinetic studies showed that ZYPREXA tablets and ZYPREXA ZYDIS (olanzapine orally disintegrating tablets) dosage forms of olanzapine are bioequivalent. Olanzapine displays linear kinetics over the clinical dosing range. Its half-life ranges from 21 to 54 hours (5th to 95th percentile; mean of 30 hr), and apparent plasma clearance ranges from 12 to 47 L/hr (5th to 95th percentile; mean of 25 L/hr). Administration of olanzapine once daily leads to steady-state concentrations in about one week that are approximately twice the concentrations after single doses. Plasma concentrations, half-life, and clearance of olanzapine may vary between individuals on the basis of smoking status, gender, and age ( see Special Populations ). Olanzapine is extensively distributed throughout the body, with a volume of distribution of approximately 1000 L. It is 93% bound to plasma proteins over the concentration range of 7 to 1100 ng/mL, binding primarily to albumin and (alpha) 1 -acid glycoprotein. Metabolism and Elimination -- Following a single oral dose of 14 C labeled olanzapine, 7% of the dose of olanzapine was recovered in the urine as unchanged drug, indicating that olanzapine is highly metabolized. Approximately 57% and 30% of the dose was recovered in the urine and feces, respectively. In the plasma, olanzapine accounted for only 12% of the AUC for total radioactivity, indicating significant exposure to metabolites. Both metabolites lack pharmacological activity at the concentrations observed. Direct glucuronidation and cytochrome P450 (CYP) mediated oxidation are the primary metabolic pathways for olanzapine. In vitro studies suggest that CYPs 1A2 and 2D6, and the flavin-containing monooxygenase system are involved in olanzapine oxidation. CYP2D6 mediated oxidation appears to be a minor metabolic pathway in vivo, because the clearance of olanzapine is not reduced in subjects who are deficient in this enzyme. ZYPREXA IntraMuscular results in rapid absorption with peak plasma concentrations occurring within 15 to 45 minutes. Based upon a pharmacokinetic study in healthy volunteers, a 5 mg dose of intramuscular olanzapine for injection produces, on average, a maximum plasma concentration approximately 5 times higher than the maximum plasma concentration produced by a 5 mg dose of oral olanzapine. Area under the curve achieved after an intramuscular dose is similar to that achieved after oral administration of the same dose. The half-life observed after intramuscular administration is similar to that observed after oral dosing. The pharmacokinetics are linear over the clinical dosing range. Metabolic profiles after intramuscular administration are qualitatively similar to metabolic profiles after oral administration. Renal Impairment -- Because olanzapine is highly metabolized before excretion and only 7% of the drug is excreted unchanged, renal dysfunction alone is unlikely to have a major impact on the pharmacokinetics of olanzapine. The pharmacokinetic characteristics of olanzapine were similar in patients with severe renal impairment and normal subjects, indicating that dosage adjustment based upon the degree of renal impairment is not required. The effect of renal impairment on metabolite elimination has not been studied. Hepatic Impairment -- Although the presence of hepatic impairment may be expected to reduce the clearance of olanzapine, a study of the effect of impaired liver function in subjects (n=6) with clinically significant (Childs Pugh Classification A and B) cirrhosis revealed little effect on the pharmacokinetics of olanzapine. Age -- In a study involving 24 healthy subjects, the mean elimination half-life of olanzapine was about 1. Race -- In vivo studies have shown that exposures are similar among Japanese, Chinese and Caucasians, especially after normalization for body weight differences. Dosage modifications for race are, therefore, not recommended.

By Q. Spike. Boston College.