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Subject:  [COPD] Drugs
   Date:  Tue, 14 Mar 2000 13:38:00 -0600
   From:  "C-Arlene Rothenberg" <Rlener1@AOL.COM>

Hi family!  Olivija wrote "I was just discussing one of my medications with a pharmacist the other day and they told me that "One of the reasons a drug may work different on different people or people who have gained a lot of weight or lost a lot of weight, is some drug dosages should be measured by weight, size and/or age and maybe other factors of the patient.  Their is also lots more variances in
drug dosage than most doctors are taking into consideration." That was a direct quote by the pharmacist (as near as I can remember)
Your friend in Pa.

I'd like to add a few things to her list.  I am a pharmacist, retired now because of the big E, but the memory still occasionally works. <G>
It's a good idea to get all your prescriptions at one source so the pharmacist has a complete list of all the meds you are taking.  Let them know if you take any herbal supplements or over-the-counter preparations.  There is always the possibility of an interaction that could cause an over/under dose.
Taking a diuretic (water pill) could flush out too much of your medication.  So could a bout of diarrhea.
So many of us are being treated for conditions that are in addition to our COPD.  Always tell your doctor what medications you are taking besides what he/she has prescribed for you.  Another point...drugs that have a long duration of action also have a longer onset of action.  Other drugs, like many of the antidepressants, need 1 to 3 weeks to build up a sufficient blood level before they become noticeably effective.  Also, very little research has been done testing drugs on the 'mature' population, but remember, as we age, our systems are wearing down.  Drugs that are detoxified and eliminated by the bowel or urinary tract are slowed down by aging livers or kidneys and
could lead to an 'overdose' of a drug.
Well, I didn't set out to write a book, but you get the idea.  Your pharmacist is a good source of information.  Talk to her/him.  Breathe easy!
Arlene in sunny warm NJ


Albuterol and Levalbuterol:  (Proventil®, Ventolin®, Xopenex™) are bronchodilators


clinical usefulness, and bacterial resistance issues associated with new treatments for respiratory tract infectionsAntibiotic Side Effects

ALLEGRA, (fexofenadine hydrochloride):ALLEGRA New Non-Sedating Antihistamine Now  Once-a-Day Allegra®   Newly Approved Drug Therapies Clinical trials Results   ALLEGRA-D®

Atrovent®, Ipratropium: is a bronchodilator

Celebrex: Celebrexrelief from the pain and inflammation associated with osteoarthritis and adult rheumatoid arthritis.

Cellcept:  CellCept® Complete Product Information
     (mycophenolate mofetil capsules)
      (mycophenolate mofetil tablets)
      CellCept® Oral Suspension
      (mycophenolate mofetil for oral suspension)
      CellCept® Intravenous
      (mycophenolate mofetil hydrochloride for injection)

Chlortrimeton: Allergy medicine (Benadryl, Chlortrimeton)
Use: Take allergy medicine to relieve sneezing, watery and itchy eyes and irritated nose and throat caused by different allergies.  Price: $6 to $13 in drugstores and supermarkets
Dosage: When taking Benadryl, take one or two tablets every four to six hours. When taking Chlortrimeton, take one tablet every
eight to 12 hours.
Side effects: May cause drowsiness
Drug interaction: Do not take the medication with bronchitis or emphysema.

Chlorambucil: (Leukeran)
After beginning chlorambucil for interstitial lung disease, your physician will follow you closely and inquire about any side effects or
problems with the medicine. You will usually begin by taking 2 mg (one tablet) per day, increasing to 4 mg (two tablets) per day
after one month. Do not take any more of the drug each day than is prescribed by your physician.
Some side effects of taking chlorambucil that you should know about include the following:
1. Chlorambucil is a drug which will lower your blood counts. Your physician will watch your blood cell counts very closely while you take this medicine.
2. Chlorambucil can cause stomach upset, such as nausea and vomiting in some cases. At the doses we use for interstitial lung
diseases, this side effect should be minimal.
3. Some rare central nervous system effects have been reported in patients taking chlorambucil. These include nervousness, tremors, twitching, and in severe cases, seizures. However, these are in patients taking higher doses than used for inter- stitial lung
4. Rarely, rash or dermatitis has been reported in patients receiving chlorambucil.
5. Increased susceptibility to infection. With the body’s immune system suppressed, you could be more likely to develop
infections. If you feel you are having any signs of infection such as fever, sore throat or muscle aches, contact your doctor.
6. Some secondary malignancies (cancers caused by taking chlorambucil) have been reported in a few patients. The
development of leukemia and other secondary malignancies have been observed in patients taking chlorambucil for non-cancerous

Ciprofloxacin: Additional information
 Ciprofloxacin is one of the drugs used in combination to treat MAC. If you are HIV+ and travelling to a country where intestinal  infection is common, discuss what drug you should take with your doctor. The risk of intestinal infections may be reduced by taking preventive drugs such as norfloxacin, ciprofloxacin, and Bactrim, though in some instances these drugs might actually worsen infection by disrupting normal intestinal bacteria. Recent Public Health Service recommendations suggest either clarithromycin or azithromycin as the first line treatment for MAC, along with at least one other drug, usually ethambutol and one of the following: ciprofloxacin or rifabutin.
Subject: Drug interactions
   Date: Wed, 15 Mar 2000 13:40:59 EST
   From: Cecil Montgomery <LMontg3322@AOL.COM>Drug description
I don't know if some of you are aware of the fact that Cipro and Tagamet each can possibly have a deadly toxic reaction if you are taking theophylline. I know this because I have been hospitalized for a toxic reaction to both. As to the reference above I don't know if she was taking theophylline or not but Cipro should never be prescribed if you are.  It is advisable to always check your drugs for interaction even though you may not be taking some of the medication that your drugs interact with. I have a pill book that I purchased at the local drug store and I always take it with me when I go to my appointments. Twice, I have reminded the DR that a particular drug, he was going to prescribe, had an interaction with other medication I am taking. Drs. like anyone else are not perfect and I have not received any problems for reminding them. One even thanked me. I just happen to see this post and brought this up because theophylline, like prednisone,
is a pretty much standard among pulmonary patients.

Ciprofloxacin: What other medicines can interact with this drug
•aluminum salts
•calcium salts
•didanosine, ddI
•iron (ferrous sulfate) preparations
•magnesium salts
•multivitamins containing iron, zinc, manganese, or calcium

Claratyne: Claratyne™ (known in the USA as Claritin) relieves symptoms associated with allergic rhinitis (hayfever), such as sneezing, runny or itchy nose, and burning or itchy eyes. Loratadine is also indicted for the relief of symptoms and signs of chronic urticaria (hives) and
other allergic skin disorders. Claratyne Decongestant contains an antihistamine and a decongestant.
DG DISPATCH - EAACI:Claritin - Faster Relief Than Allegra For Seasonal Allergic Rhinitis Claritin  More about CLARITIN®

Clarithromycin:  A Survey of the Quality of Generic Clarithromycin Products from 13 Countries

Corticosteroids:  JAMA - Vol. 287 No. 10 - March 13, 2000
Corticosteroid Therapy in Pulmonary Sarcoidosis

A Systematic Review

Shanthi Paramothayan, PhD, MRCP; Paul W. Jones, PhD, FRCP

Context  Corticosteroids are used in pulmonary sarcoidosis to reduce symptoms and minimize long-term damage. Spontaneous recovery is a common feature. Both the decision to initiate therapy and the treatment response may be influenced by disease severity, so trials need to use a randomized controlled design.

Objective  To assess the effect of oral and inhaled corticosteroids on chest radiograph results, symptoms, pulmonary function,
and long-term outcome in pulmonary sarcoidosis.

Data Sources  MEDLINE, EMBASE, CINAHL, and the Cochrane Controlled Trials Register were searched all years through December 2001. Bibliographies of review articles and retrieved articles were searched, and pharmaceutical companies and authors of identified trials were contacted for other studies. There was no language restriction.

Study Selection  Trials were randomized and included a control group. Participants were adults with histologic evidence of pulmonary sarcoidosis. Treatments included the use of oral and inhaled corticosteroids for at least 8 weeks. The search identified 150 studies; 9 met the inclusion criteria, but only 8 provided usable data.

Data Extraction  Two reviewers assessed trial quality using the Jadad score, which evaluates the quality of randomization, blinding, and reasons for withdrawal. Data were extracted and sent to primary authors for verification.

Data Synthesis  In patients with stage 2 and 3 disease, oral corticosteroids improved findings on the chest radiograph after 6 to
24 months (Peto odds ratio, 2.54; 95% confidence interval [CI], 1.69-3.81; P<.001). Forced vital capacity improved with oral corticosteroids (weighted mean difference [WMD], 4.2% predicted; 95% CI, 0.4%-7.9% predicted) and diffusing capacity also
improved (WMD, 5.7% predicted; 95% CI, 1.0%-10.5% predicted). In 2 small studies of inhaled corticosteroids, there was no effect on chest radiograph and inconsistent effects on lung function in one and only a small improvement in symptoms in the other. There were no data following corticosteroid withdrawal to assess any disease-modifying effect.

Conclusions  Oral corticosteroids improved results on the chest radiograph following 6 to 24 months of treatment and produced
a small improvement in vital capacity and diffusing capacity. Trials of inhaled corticosteroids were small and results too inconsistent to make firm conclusions concerning their efficacy. There are no data to suggest that corticosteroid therapy alters long-term disease progression.

JAMA. 2002;287:1301-1307

Cromolyn Sodium for ACE Inhibitor Cough nnCromolynCromolyn sodium is also effective for symptomatic control of both seasonal and perennial allergic rhinitis. Cromolyn sodium is able to prevent both the acute phase and late phase reactions to allergen. In general, cromolyn sodium should be administered prophylactically before exposure. Cromolyn sodium appears to be effective, but less potent than nasal corticosteroids. The safety profile of cromolyn sodium is excellen.


After beginning cytoxan for interstitial lung diseases, your physician will follow you closely and inquire about any side effects or
problems with the medicine. This drug should be taken as one dose per day in the morning. It is important to drink extra fluids whiletaking cyclophosphamide so that you will urinate more frequently. This will help to prevent possible bladder damage from the drug.  Do not take any more of the drug each day than is prescribed by your physician.
Some side effects of taking cytoxan that you should know about include the following:
1. Cytoxan is a drug which will lower your blood counts. Your physician will watch your blood cell counts very closely while you take this medicine.
2. Cytoxan can cause an inflammation in your urinary bladder called cystitis. This is caused by the drug sitting around in the bladder too long. By drinking extra fluids and urinating frequently, you can min- imize this side effect. Also, do not take your cytoxan
immediately before going to bed at night.
3. Cytoxan can cause stomach upset, such as nausea and vomiting in some cases. At the doses we use for interstitial lung diseases, this side effect should be minimal.
4. Cytoxan can cause some hair loss. Some changes in skin pigmentation may also occur.
5. Increased susceptibility to infection. With the body’s immune system suppressed, you oculd be more likely to develop infections. If you feel you are having any signs of infection such as fever, sore throat or muscular aches, contact your doctor.
6. Some secondary malignancies (cancers caused by taking Cytoxan) have been reported in a few patients. Bladder cancers are most frequently reported. Some other types of cancer have also been reported.

Cytoxan is the brand name of a medication known as cyclophosphamide, and is an agent commonly used to fight
cancer. It inhibits the growth of rapidly reproducing cells in the body by interfering with the processing of their DNA.
However, because of its effects on rapidly reproducing cancer cells, it therefore also impairs the growth of those normal
body cells that rapidly reproduce, including cells of the gut, and bone marrow. This latter effect causes some depression
of white blood cell functions, and it is this effect that forms the theory behind which this drug has been used for a variety
of auto-immune conditions (conditions in which an “overactive” immune system harms the body).It also serves as well;
that is, as a general immunosuppressant. This is a potentially dangerous medication, and should only be taken under the close supervision of your physician, with blood level checks on a routine basis. Side effects are varied, and include but
are not limited to the development of malignancy after treatment, urinary bladder bleeding and/or scarring, harm to a fetus
if the patient receiving the drug is pregnant, sterility, loss of normal menstrual bleeding, cardiac problems including congestive heart failure and inflammation of the heart muscle and lining, poor wound healing, excessively low white blood cell (cells that fight infection, amongst other functions) counts, low platelet (portion of blood involved in clotting) counts, anemia, decreased resistance in fighting off infection, nausea, vomiting, diarrhea, intestinal bleeding, hair loss (“alopecia”), skin rash, lung scarring, and others. If you are experiencing a symptom that you feel may be related to the medication, visit your health care provider. He or she can determine whether thesymptom is possibly due to the drug, and determine the
best course of action to take.

First let me say that all people react and their bodies utilize these exotic drugs differently. But running through them are certain effects. I was on
Cytoxan pre transplant for six months. During that time it replaced Prednisone. It neither improved degraded my condition (IPF) as far as we can tell. But it did cause discomfort. And this discomfort can be extreme. The original use of this drug is as chemo therapy in breast cancer so you can consider that you are undergoing chemo. The main problem experienced is bladder irritation. It is constant and burning, 24 hours a day. I, in addition to that, experienced a seemingly constant low grade headache. Again whether it was attributable to the drug itself of a referred pain from the bladder caused by the drug is unclear.
I really nailed down the connection between the burning feeling and this drug when I missed a dose one day and within eight hours the condition disappeared. Suggestion? They advise drinking lots of fluids. I agree one hundred percent. Just make them check your chemical balances (hydrolytes), particularly potassium, while on this drug. And you will take a lot of water or fluids to hold down the burning. I went back on Prednisone.  Stan
Cytoxan is a very potent drug with strong side effects.  When taking it one will develop quite a bit of nausea.  One also should have regular urine examinations for blood products. It causes hemorrhagic cystitis and bladder cancers along 
with other forms of cancer.  If you get the PDR and read on it you will get a better picture.  That and some of the pharmaceutical texts on it.  I was put on this at one time.  But my doctor then did it by IV as he felt that they could help control the bad side effects better that way.  At the same time they also gave me an anti-nausea drug to help keep the stomach upset controlled.  As I have been showing advancement in my disease, this drug is again being looked at.  I am now trying Colchicine because the side effects are not near as bad.  But I have not been on it long enough to give an evaluation.

Digoxin: for heart rhythm

Diphenhydramine: (Benadryl) is one of many antihistamine agents that has both drying and sedative effects that is used to combat the symptoms of hay fever and other types of allergy. These agents work primarily be blocking the effects of histamine, which causes itching, sneezing, runny nose, and watery eyes.  Histamine can also close bronchial tubes and make breathing difficult. Single doses are absorbed
quickly and most activity is completed in one hour with distribution throughout the entire body. Most of the drug is found as a degradation product in the liver, though little is excreted in the urine. Diphenhydramine is most commonly used as an antihistaminic agent, for antiparkinsonism, and for motion sickness. Side effects include fast or irregular heartbeat, sore throat, fever, drowsiness, and cotton mouth.
Product Indications:
Temporarily relieves nasal congestion, runny nose and sneezing, itching of the nose or throat, and itchy, watery eyes due to hay fever or other upper respiratory allergies, and runny nose, sneezing, and nasal congestion associated with the common cold.
Directions For Use:
Follow dosage recommendations, or use as directed by your doctor. Adults and children 12 years of age and over: one (1) tablet every
4 to 6 hours, not to exceed 4 tablets in 24 hours. Children under 12 years of age: consult a doctor.
Do not exceed recommended dosage. If nervousness, dizziness, or sleeplessness occur, discontinue use and consult a doctor. If
symptoms do not improve within 7 days or are accompanied by fever, consult a doctor. Do not take this product, unless directed by a doctor, if you have a breathing problem such as emphysema or chronic bronchitis, heart disease, high blood pressure, thyroid disease, diabetes, or if you have glaucoma or difficulty in urination due to enlargement of the prostate gland. May cause excitability especially in
children. May cause marked drowsiness; alcohol, sedatives, and tranquilizers may increase the drowsiness effect. Avoid alcoholic beverages while taking this product. Do not take this product if you are taking sedatives or tranquilizers, without first consulting your
doctor. Use caution when driving a motor vehicle or operating machinery. Do not use any other products containing diphenhydramine
while using this product. As with any drug, if you are pregnant or nursing a baby, seek the advice of a health professional before using
this product. KEEP THIS AND ALL DRUGS OUT OF THE REACH OF CHILDREN. In case of accidental overdose, seek professional assistance or contact a Poison Control Center immediately.
Drug Interaction Precaution:
Do not use this product if you are now taking a prescription monoamine oxidase inhibitor (MAOI) (certain drugs for depression,
psychiatric or emotional conditions, or Parkinson's disease), or for 2 weeks after stopping the MAOI drug. If you are uncertain whether your prescription drug contains an MAOI, consult a health professional before taking this product.
Active Ingredients: Each tablet contains: Diphenhydramine Hydrochloride 25mg and Pseudoephedrine Hydrochloride 60mg.
Inactive Ingredients: Croscarmellose Sodium, Dibasic Calcium Phosphate Dihydrate, FD&C Blue No.1 Aluminum Lake, Hydroxypropyl Methylcellulose, Microcrystalline Cellulose, Polyethylene Glycol, Polysorbate 80, Pregelatinized Starch, Stearic Acid, Titanium Dioxide and Zinc Stearate.
Check out our Frequently Asked Questions page or call 1-800-223-0182, weekdays 9am to 5pm (EST) and mention you have visited our web site.

(Extra Corpreal Mechanical Oxygenation  but I have also seen writings of it with this meaning.  ECMO Extra Corpreal Membrane Oxygenation.) Basically it is a different kind of life support. I was on ECMO  for three days after my transplant.  They found that the donor lungs were not good after they had already taken my lung out.  Basically a death sentence.  The decision to put one donor lung in (I was suppose to receive a double lung) was made and to place me on ECMO.
ECMO was invented at the University of Michigan and many docs from everywhere go there to learn about it. Also many patients from other states come when their state doesn't have the technology.  If this had to happen I was in the right place. At the time, only one other
person with a transplant had ever had ECMO used on them and he was the first one at the here.  Since then I have known of two people Julie being one of them.  They are both deceased now.  I tell you that not to scare you but to show you how IMPORTANT.  Exercise and
self help are to your survival.  I was 16-17% lung function but about a two years before my transplant I stopped being in a wheel chair and got my life together.  I was very sick and it took along time and continuous effort.  But I got better (My lungs did not get better just my
ability to use the 02 I had)  this is everything.  I went to the club three days a week without fail and walked the treadmill on the off days.  I still do !!!  The docs said if I had not done this I would not of made it.
They placed the Edemas Lung in my right side,  they did a lung reduction on the left (to help me) and then places me on ECMO.  I also had about 20 different drugs going and I was kept in a coma.
ECMO (a garden size hose) was attached at my neck into my lung and out through my groin.  This circulated the blood and O2 through my lung mechnically.
ECMO although looks very complicated is really and artificial lung outside of the body.  I went to see someone on ECMO after I recovered enough I wanted to see what kept me alive.   They can also add renal to that if it is necessary. When I went back to see about it.  The tech that cared for me was there although he didn't recongise me with out being so bloat up and tubes everywhere. He showed me a woman on ECMO he told me that most people who need ECMO do not survive.  That in most cases it is used in cases of pneumonia (lots of children) and by this time many don't survive.  But some do.  We have an annual ECMO picnic to celebrate this.  The docs who invented the machine are always there.  Its fun to see others who have the scars that I do on my neck.  Not only from the ECMO but from being trached.
I hope none of you ever need it,   but if you do you should know something about it.  I never heard of it till I was recovering and my recovery took a very long time.  I was a very sick girl.
When you get false calls be glad that they are watching out for your lungs because anything can happen.   I was the model patient worked out, ate good, took supplements, attended the meetings.  Everything and yet I still went through hell.
Thank You Karen Fitchett for the above description of ECMO.


Foradil: Foradil Aerolizer (formoterol fumarate inhalation powder)

Pharmacokinetic assessment of oral ganciclovir in lung transplant recipients with cystic fibrosis. Snell GI, Kotsimbos TC, Levvey BJ, Skiba M, Rutherford DM, Kong DC, Williams TJ, Krum H Lung and Heart Transplant Service, Departments of Clinical Pharmacology, Pharmacy and Clinical Biochemistry, Alfred Hospital, Prahran 3181, Australia.
Oral ganciclovir has been used as prophylaxis and therapy against cytomegalovirus in patients with HIV infection and following organ transplantation. Oral ganciclovir has clear practical advantages over intravenous ganciclovir but has a relatively low bioavailability and this may be problematic in at-risk patients with malabsorption. The bioavailability and therefore therapeutic potential of oral ganciclovir in cystic fibrosis (CF) patients post-lung transplant (LT) might be expected to be inadequate given the high incidence of malabsorption in these patients. An 8 h pharmacokinetic study was performed in 12 CF patients 160 +/- 122 days post-transplant who had been taking 1 g oral ganciclovir tds for 3 days with food (plus normal enzyme supplements).
Mean (range) serum creatinine was 150 Imol/L (70-280). Blood was sampled at 0.5, 1, 2, 3, 4, 6 and 8 h post-final dose. Plasma was stored at -20 degrees C and later analysed by highperformance liquid chromatography. Mean peak concentration (C(max)) was 4.8 mg/L (0.96-12.8), mean minimum concentration (C(min)) was 3.6 mg (0.78-11.7) and mean area under the curve (AUC) was 35.4 mg.8 h/L (8-99). C(max), C(min) and AUC correlated significantly with one another (P < 0.001) as well as with serum creatinine and creatinine clearance (P < 0.01). When corrected for alterations in renal function, plasma oral ganciclovir levels are as predicted for other transplant populations. Three days of oral ganciclovir results in therapeutically useful plasma drug levels in the CF LT population, despite a background of general malabsorption. C(max), C(min) and AUC are highly correlated, allowing for the possibility of steady-state drug monitoring to confirm that the recommended dosing algorithm produces appropriate plasma levels.

potency is double-edged: while critical in tempering certain disease states, they can also cause a number of complications.  It is a Corticosteroid.  Corticosteroids have been in use for over 40 years.1-3 Over time they have become indispensable in controlling a variety of disease states. Currently, glucocorticoids are available in numerous formulations: oral, topical, ophthalmic solutions and ointments, oral inhalers, nasal formulations, parenteral and rectal preparations. Various complications associated with this drug class warrant caution and monitoring with each formulation. This article will address the therapeutic benefits of glucocorticoids as well as the consequences attributed to oral, topical and parenteral formulations.

Glutathione: (GSH)
Treatment of Obstructive Airway Disease With a Cysteine Donor Protein Supplement* A Case Report*
Oxidant/antioxidant imbalance can occur in obstructive airways disease as a result of ongoing inflammation. Glutathione (GSH) plays a major role in pulmonary antioxidant protection. As an alternative or complement to anti-inflammatory therapy, augmenting antioxidant protection could diminish the effects of inflammation. We describe a case of a patient who had obstructive lung disease responsive to corticosteroids, and low whole blood GSH levels. After 1 month of supplementation with a whey-based oral supplement designed to provide GSH precursors, whole blood GSH levels and
pulmonary function increased significantly and dramatically. The potential for such supplementation in pulmonary inflammatory conditions deserves further study. Key Words: glutathione • inflammation • oxidative stress • supplementation

After beginning methotrexate for interstitial lung diseases, your physician will follow you closely and inquire about any side effects or
problems with the medicine. This drug should be taken as one dose per WEEK only. Once a day of the week has been chosen for
methotrexate therapy, the drug should be given on the same day in subsequent weeks.
Some side effects of taking methotrexate that you should know about include the following:
1. Methotrexate is a drug which will lower your blood counts. Your physician will watch your blood cell counts very closely while you take this medicine.
2. Hepatotoxicity (liver damage) has been reported in patients who take methotrexate. Some blood tests are done to determine that your liver is not being adversely affected by the medicine. If you should feel unusually tired, have a decrease in appetite, or have episodes of nausea and/or vomiting, check with your doctor. You should not drink alcohol while taking methotrexate.
3. Methotrexate can cause upset stomach, such as nausea and vomiting (not associated with liver damage as above) in some cases. At the doses we use for interstitial lung diseases, this side effect should be minimal.
4. Methotrexate can cause some hair loss. Some changes in skin pigmentation may also occur.
5. Mouth sores occur occasionally with methotrexate use. If you have an unusual amount of mouth sore please check with your doctor.
6. Development of lung disease has been reported in some patients who have taken methotrexate.
7. Increased suseptibility to infection. With the body’s immune system suppressed, you could be more likely to develop infections.
If you feel you are having any signs of infection such as fever, sore throat or muscular aches, contact your doctor.

Morphine Sulfate in all forms is a prescription drug.  Morphine Sulfate Narcotic Medication Links Section
Morphine Sulfates.iOpiates - Strong Pain Mediciness.iThe primary benefical effect of morphine sulfate and Lasix in a patient
in pulmonary edema will be a reduction of preload on the heart. Preload is defined as the stretch of the ventricles before contraction.  Preload is determined by the amount of blood that is present in the ventricles at the end of diastole. During right
ventricle diastole, the heart muscle is stretched to accommodate the influx of blood from the systemic circulation.  This myocardial
stretch is a reflection of preload and ventricular compliance. Common Problems with Morphine Use

 From:  Brenda Hoilman <BJFlounder@AOL.COM>
 In a message dated 98-06-25 14:00:49 EDT, SOBnSA@AOL.COM writes:
I just received a post from a correspondent who tells of her mother's death, less than 24 hours after being admitted to a hospice. It
appears they "eased her suffering" (from emphysema and cardiac complications) with morphine.
It was suggested that I post a message about the danger of morphine, etc, in treating pulmonary patients.
Any comments, Brenda.?
Bill Horden

Hello Everyone....
I hate to even get into this, but I feel I must...for I am well aware that people do not understand this at all.  I worked in a Hospice
before and they do NOT believe in euthanasia, if that is the suggestion.  And Hospices DO NOT help people die.  They are there
to help the person who does have a terminal illness live as long as possible with as much comfort as possible.  The aim of medicating patients is to maintain the highest degree of alertness possible and still maintain some control of suffering, so that what  time they do
have can be spent with family members.  Of course, the choice of medications for a patient comes from the patient's doctor, not the organization.  And only doctors and perhaps pharmacists, only have the knowledge to decide on the "dangers of  morphine etc,  for
certain conditions".   As for the woman in the case Bill mentioned, I have no idea of the specifics, but I do know many doctors do
not even refer a patient to Hospice until they are actively dying, and they quite often die right after being admitted.
Now, about the morphine........This is one of those cases of "a little knowledge being a dangerous thing."  First of all, Morphine is not a mercy drug when given to end stage COPD patients.
Morphine does not automatically kill, and pain is not the only valid reason for giving morphine.  Though many people do not know
or understand the mechanics involved, morphine is also given to relieve very severe sob, for it is the only medication that seems to
have any effect on it in very severe stages of COPD.  And, though many do not know, nebulized morphine has been given for severe
sob for several years now.  This does not kill the relieves the sob.  And, unlike oral morphine,  there are NO reported
side effects.  It affects the nerve ending in the lungs, according to testing results.
Additionally, there is some evidence that both forms of morphine can even increase exercise tolerance.
This article describes trials for the use of oral morphine for sob and exercise tolerance
This site describes the effects of nebulized morphine.

Has anyone tried milk thistle and psyllium husk to detoxify their bodies
You might want to try molybdenum which is a trace mineral and is known to have detoxifying qualities. Purchased at health food stores.

Neoral Sandimmun-Neoral®: All about this medication


Omeprazol: Prilosec


Pheudophedrine:  pseudophedrine (over the counter Sudafed) Oral decongestant
Action: mimics sympathetic nervous system, constriction of nasal mucous membranes
Side effects: anxiety, tachycardia, hypertension
Nsg. Imp: monitor cardiovascular effects, advise not to take more than 4 days

Prednisone: it is all here

Propulsid® (cisapride): cisaprideancisapride / Propulsid&trade
What can you tell me about Propulsid prescribed along with asthma medications?
Some of the drugs listed as NOT to be taken together with Cisapride (Propulsid)   are: (Cisapride being the generic name)
amitriptyline (ELAVIL);
bepridil (VASCOR);
clarithromycin (BIAXIN);
fluconazole (DIFLUCAN);
indinavir (CRIXIVAN);
itraconazole (SPORANOX);
ketoconazole (NIZORAL)
maprotiline (LUDIOMIL)
nefazodone (SERZONE)
procainamide (PROCANBID)
prochlorperazine (COMPAZINE)
promethazine (PHENERGAN)
ritonavir (NORVIR)
sotalol (BETAPACE
sparfloxacin (ZAGAM)
troleandomycin (TAO)
warfarin (COUMADIN)

Subject: [COPD] Prednisone
   Date: Sat, 8 Apr 2000 11:31:50 EDT
   From: Bill Horden <SOBnSA@AOL.COM>

Following is a message I recently posted to the Chronic Lung Disease Firm. It got considerable reaction there and is offered
here for your consideration:

Many of us can remember when penicillan was the "wonder drug" and every kindly family doctor in the country prescribed
it for everything from A to Z.  The end results were that many organisms developed resistance to the medication and many
patients found out they were allergic to it.

I suspect that prednisone is being used similarly: as a shotgun approach to inflamatory diseases, with too little regard for such tragic, irreversible side-effects as cataracts and diabetes, or the less-deadly but equally stubborn cosmetic problems of fat deposition on the face, body, and legs.

Yes, I use a prednisone inhaler (220 mcg/puff) twice a day, but I would think seriously about staying with any doctor who
put me on any oral dosage for more than a seven-day duration. At the very least, I'd get a second and third opinion.

Bill Horden



Rapamune: Rapamune (R) Sirolimus) Therapy Safely Allows Early Elimination of Cyclosporine In Kidney Transplant Patients CHICAGO, May 16 00 /PRNewswire/ -- Rapamune(R) (sirolimus), a new medication for preventing organ rejection in kidney transplant patients, allows doctors to eliminate cyclosporine, a standard component of typical multi-drug regimens, at an early treatment stage. According to new clinical data, presented today at Transplant 2000, the First Joint Meeting of the American Society of Transplant Surgeons and the American Society of Transplantation in Chicago, this novel approach utilizing Rapamune as a primary immunosuppressive agent resulted in significantly improved kidney function, significantly decreased blood pressure and no increase in the rate of acute rejection as compared to cyclosporine therapy.

"The use of Rapamune as primary therapy will allow physicians to achieve low levels of acute rejection and, importantly, improve kidney function compared to patients treated with cyclosporine-based therapy," said lead investigator Thomas Gonwa, M.D. of Baylor University Medical Center in Dallas, who presented the data.  "Reducing exposure to cyclosporine in kidney transplant patients translates into minimized treatment-related toxic side effects that damage patients' kidneys.  This has been a long-standing goal in the medical therapy of these patients and represents a real
opportunity to improve long term outcomes in the field of organ transplantation."

The findings presented by Dr. Gonwa were drawn from an ongoing study in the United States and Europe, involving 247 patients who underwent kidney transplantation.  Patients were randomly assigned to receive the standard full-dose of cyclosporine plus 2 mg/day of Rapamune (Group A patients) or a reduced-dose of cyclosporine plus Rapamune (Group B patients).  All patients were administered corticosteroids, which is standard protocol in immunosuppressive therapy.  During the third month after transplantation, those patients in Group B who had not experienced an episode of acute rejection had their cyclosporine dosage tapered and then eliminated.

The study's primary endpoint was to assess kidney function after six months.  The findings demonstrated that kidney function was significantly better in Rapamune-treated patients who underwent cyclosporine elimination (Group B), compared to patients who continued to receive full-dose cyclosporine (Group A), as demonstrated by serum creatinine levels.  Measuring creatinine, a metabolic waste product normally filtered and excreted by the kidney into the urine, is a standard method of assessing kidney function. Higher levels of serum creatinine in the blood mean the kidney is not properly filtering the creatinine and this correlates with impaired kidney function and potentially, loss of the kidney itself.

Cyclosporine's role in causing kidney damage has been known since the drugs introduction.  Cyclosporine achieves its immunosuppressive effects by
inhibiting calcineurin, an important enzyme in the body's normal immune response.  Calcineurin inhibitors such as cyclosporine and tacrolimus,
another immunosuppressant, produce well-documented adverse events such as kidney damage (nephrotoxicity), tremor (neurotoxicity) and high blood pressure (hypertension).(1)  Rapamune has a unique mechanism of action that does not involve calcineurin, and therefore the kidneys are not exposed to the toxicities observed with traditional calcineurin inhibitor based drug regimens.

In addition to better renal function, patients randomized to undergo cyclosporine elimination versus those randomized to receive full-dose cyclosporine had less high blood pressure and less unwanted hair growth (hirsutism).

Another measure of kidney function, glomerular filtration rate (GFR), confirmed that Group B patients, who were tapered off cyclosporine while on
Rapamune therapy, fared significantly better than the patients who received full-dose cyclosporine.  A GFR measure assesses how well the kidneys'
"filter", the glomerulus, is functioning.  A higher GFR corresponds to better function, as was observed in the Group B patients.

After both two months and six months, there was no significant difference in the rate of acute rejection between the two treatment groups.  Patient
survival and graft survival were also comparable at six months and did not show a statistical difference.

In a previous study of kidney transplant patients, Rapamune was combined with corticosteroids and azathioprine and compared to the standard triple-drug regimen of cyclosporine, corticosteroids and azathioprine.  It was found that the rate of acute rejection, as well as graft and patient survival was similar; however, the patients who received Rapamune had better kidney function than those treated with cyclosporine.(2)

Rapamune (sirolimus) oral solution received marketing approval from the United States Food and Drug Administration (FDA) in September 1999 for the prevention of acute kidney transplant rejection, and is pending approval by the European Medicines Evaluation Agency (EMEA).  A tablet formulation is currently under review by the FDA with an anticipated approval later this year.

Baylor University Medical Center in Dallas operates as one of the nation's largest not-for-profit medical centers, caring for more than 400,000 people each year.  Opened in 1903 as a 25-bed hospital, Baylor University Medical Center is a major patient care, teaching and research center for the
Southwest.  Baylor University Medical Center joined Baylor Health Care System in 1981, and serves as the system's flagship hospital.
(1)   Kreis et al., page 2, first full sentence: "The significant nephrotoxicity ..."; cites references 3-5.
(2)   Groth et al., Sirolimus-based therapy in human renal transplantation: similar efficacy and different toxicity compared with cyclosporine.
Transplantation 1999; 76: 1036. SOURCE  Baylor University Medical

Rhinocort: Nasal corticosteroids (kor-ti-ko-STER-oids) are cortisone-like medicines. They belong to the family of medicines called steroids.  The nasal spray is one of the most effective treatments for sinus congestion.
1. budesonide nasal - budesonide nasal. Pronunciation: byoo DES oh nide Brand: Rhinocort.
What is the most important information I should know about budesonide nasal?. Do not use more of this medication than is prescribed for you. Too much may cause serious side effects.Use budesonide nasal on a regular basis for best results
2. Conditions & Concerns: Allergies  Treatment and Management. The first principle of treatment, if at all
possible, is to avoid exposure to the allergens to which one is sensitive. For example, if one is allergic to grass pollen, remaining indoors between the hours of five and ten in the morning may be helpful. It is during these hours that the pollen count is the highest.

Use: Take if suffering from cough and nasal congestion.
Price: $4 to $6 in drugstores and supermarkets
Dosage: Take two teaspoons every four hours and do not exceed six doses in 24 hours.
Side effects: May cause drowsiness
Drug interaction: Do not take with prescription drugs for depression or with alcohol, or for cough associated with smoking,
asthma, chronic bronchitis or emphysema.

Salmeterol (Serevent®)is a slow-acting bronchodilator

Corticosteroids:  Corticosteroids are anti-inflammatory medications for the treatment of allergic conditions, asthma
and other diseases. They are NOT the same as anabolic steroids, used by athletes to increase muscle tissue.
This is what National Jewish Medical and Research Center says about Corticosteroids

Use: Take Sudafed if suffering from nasal congestion, cough or itchy eyes.
Price: $4 to $8 in drugstores and supermarkets
Dosage: Take two tablets every four to six hours and do not take more than four doses in 24 hours.
Side effects: Sudafed can cause nervousness, dizziness and drowsiness.
Drug interaction: Do not take it if you are diabetic or taking prescription drugs for depression.

Theophylline: is a bronchodilator, Why do I need a blood test when taking theophylline?   Theophylline  is a bronchodilator drug used primarily to treat asthma.  Theophylline should be taken at a dosage that maintains a "therapeutic level" in the bloodstream, the level at which it is believed to have maximal beneficial effect.  Like many other medicines, one can overdose on theophylline, leading to needless discomfort, damage, or death.
If your doctor doesn't schedule periodic tests for theophylline, coumadin, red blood cell count, sugar, etc., you might question him/her about it, especially if you have any abnormal symptoms.
Subject: Re: [COPD] Drugs
   Date: Tue, 14 Mar 2000 14:45:57 EST
 I just read the section on Theophylline in the Pharmocopeia.  It looks to me like you are experiencing something similar to Caffeine withdrawal since the 2
are related chemically.  Both are Xanthine derivatives.
Additional information on Theophylline.  It interacts with so many other medications.  Some medications increase the clearance of Theophyllne which results in an underdose.   Others decrease the clearance resulting in the Theophylline remaining in the system for a longer time.  This means that additional doses produce an additive effect, i.e. overdose.  This is one of several reasons for the importance of doing regular blood levels.   The therapeutic window is very narrow.
In addition, clearance in healthy adults older than 60 is 30% lower than in healthy younger adults.  And, of course, we are not exactly pictures of health <G>.  Without a dosage adjustment, severe toxicity can result.

Theophylline, aminophylline, caffeine and analogues for acute ischaemic stroke
 Update On Theophylline
Therapeutic Drug  Monitoring
Chemical Profile for THEOPHYLLINE
Theophylline for the 21st century

THYMOGLOBULIN:  Thymoglobulin vs Atgan

Tiotropium: Tiotropium for COPDto Thymoglobulin for treatment of rejectionfor

Tobi: Tobi is tobramycin that has had the preservatives removed, to make it purer specifically for inhalation use. the old tobramycin was originally made for IV use that we all reconstituted for inhalation. that contained preservatives that were abrasive to the lungs.  tobi is made by Pathogenesis.

TOBRAMYCIN: is an aminoglycoside class antibiotic.  Others in this class include gentamicin, streptomycin, amikacin, kanamycin, and neomycin.  They are called batericidal agents because they interfere with the baterial reproduction.  Aminoglycosides are highly toxic and require close blood
monitoring. I am not surprised by your intolerance since they can have some serious side effects.
         There are other antibiotics that also prevent baterial reproduction and some are quite powerful.  The best known group are the fluoroquinolones or
quinolones which include Ciprio (cipriofloxacin), Levaquin (levofloxcin), and Avelox (moxifloxacin) to name a few.  Lincosamides are another group
that affect reproduction of bacteria; Cleocin (clindamycin) is a member of this group.
         Most of these drugs are short term dosages that wipe out most bacteria from our bodies (good and bad bacteria).  You should discuss with your
doctor alternatives to the tobramycin if you are having side effects severe enough to prevent you from completing a course.

TROVAN: (trovafloxacin/alatrofloxacin)public health advisory.
Xenotransplantation:HHS Issues Revised Draft Guideline on Xenotransplantation Safety


Zyvox: April 18, 2000 (Washington) -- The government approved a vital new weapon in the battle against drug-resistant bacteria today,
a drug called Zyvox described as the first entirely new type of antibiotic in 35 years.

QUESTION: What's the deal with grapefruit and medications? My doctor recently prescribed a new medication and told me that one of my favorite beverages -- grapefruit juice -- was off limits.

ANSWER:  There are several chemical processes our bodies use to break down medications. One of the most important is called the cytochrome p450 system.  Grapefruit juice slows this system down. This means that those medications dependent
on that system are not being processed at the intended rate, possibly resulting in higher blood levels of the drug that are unsafe.

If you are taking any of the "statins" or cholesterol-lowering medications and as well beta-blockers or calcium channel blockers for blood pressure, grapefruit juice is off limits. Some hospitals have even eliminated grapefruit juice as a beverage option to eliminate the risk. Talk to your doctor or pharmacist if you have any questions.

ACQUIRING MEDICATIONS(at reduced cost or free)

Free Medications if needy
Tx related expenses not necessarily covered by insurance
$5.98 each$Asthama World has Albuterol Inhalers
Patient Resources for Clinical Trials Listing
1999-2000 Prescription Drug Patient Assistance Programs
Free Prescription Medicine is Available to those who Qualify
 $5.00 Rebate on Allegra (good through 12-31-2000)
Free and Low Cost Prescription Drugs
 search for prices on meds from Canada    and here 
SeniorScrips - Another alternative for cheaper meds
Reduced or No-Cost Prescription Drug Programs


Subject:  Patient Assistance Programs
   Date: Sat, 7 Oct 2000 09:32:06 -0400
   From: Rich Sagall <>

I am the webmaster of NeedyMeds .  This site contains information on the
patient assistance programs offered by over 165 companies. We have data on nearly 1000 drugs. All the
information is available for free and is regularly updated.

I believe our information will be of interest to those who access your site. I hope you will consider establishing
a link to NeedyMeds.

Please feel free to contact me if you have any questions.

Rich Sagall, M.D.
2000 Poverty Guidelines - U.S. Department of Health and Human Services
Those of you that need help with your pharmaceuticals that are made by Glaxo such as Flovent, Beclovent, Ventolin,
Serevent, etc.  Call Glaxo at 1-888-825-5249.  Then get the patient assistance program which I believe would be
pushing #2 on your phone.  If you do not get proper help then call Laurie Humphrey at 1-800-5GLAXO-5, Extension
#32469, and she will see to it that you are taken care of.  She is in Marketing and respiratory division there as the
Exec. assistant to the VP.
Glaxo has business all over the world, and this is only for people in the United States.  People that need assistance
that are not in the states will have to get other numbers to call.  What you are interested in applying for is called the
"indigent patient program".  Good luck to all of you that need help.  Remember, Albuterol is just the generic
form of Ventolin.  Your doctor could be writing you a prescription forVentolin.  Other drugs that you may be
taking could also be replaced by a Glaxo drug.  Let me know how you are doing.

Subject:  Re: [COPD] prescriptions drugs
   Date:  Fri, 17 Mar 2000 23:11:18 -0800
   From: Toni <trowlan@DSWEBNET.COM>

Hello all,

I thought I'd share a bit of information about prescription drugs and where to seek help if you can't afford them.  This information is a booklet I received when I was accepted for free prescriptions.  The most part of the 16 prescriptions I take will be paid for.  So if there are those of you out there that could use the help contact this company as the book has most of
the companies and what they provide. request booklet below

Directory of Prescription Drug Patient Assistant Programs.

address to :

Pharmaceutical Research and Manufacturers of America
1100 Fifteenth Street, N.W.
Washington, DC 20005

Take Care and Breath easy
Toni from Oregon

Are generic and brand-name drugs equally as good? Click here to find out.

 Life-saving, health-enhancing prescription drugs are expensive, and some seniors and others suffering from chronic illness
struggle to pay for them. Current Medicare plans don't cover most prescription drugs, and experts say that supplemental
insurance plans, such as Medigap, often don't go far enough in making up the difference. Congress is currently considerin
proposals to add prescription drug coverage to Medicare, but meanwhile, seniors are left searching for other options.
Answers to lots of your questions and concerns Answered here.
Guide to Buying Prescription Drugs Online
 Alternative to Cyclosporine-base Immunotherapy.
 Internet Drug Index
Accolate Warning
Drug benefits patients with emphysema
 know about drugs
 Avoiding Adverse Drug Reactions
 Medical Encyclopedia A to Z
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 Commonly Used MDI's1
 Medscape Pharmacists Errors/Adverse Drug Reactions
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Drug Delivery has New Approaches
Medications, safety tips and health-system pharmacists
 Drug Reduces Ventilation Times
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 Drugstore - Dr. Koop
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Orphan Designated and Approved drugs
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Effects of Diet on Drug Absorption
Glutathione (GSH)
Cutting Pills
The Benefits of Glutathione (GSH)
 Effect of nebulised morphine on patients
 Patient Resources for Clinical Trials Listing
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 Index of Safty-Related Drug Labeling Change
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 Inhaled Morphine and COPD
 Use of Metered Dose Inhalers and Devices
 Inhaler Boot Camp
 International Pharmaceutical Aerosol Consortium
 What FDA says about new drug testing
Poison Reference




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last edited 2-13-2002