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NSAIDs:
Nonsteriodal anti-inflammatory drugs (NSAIDs) is a type of medicine that reduces pain and swelling.
However,they do not prevent further joint damage. Two common NSAIDs are Aspirin and Advil. NSAIDs have analgestic and anti-inflammatory
properties. NSAIDs reduce pain when taken at low dose and relieve inflammation when taken at a higher dose. NSAIDs such as
ASA (Aspirin,Anacin etc.) and Ibuprofen (Motrin IB,Advil etc.) can be purchased without a prescription. Examples of other
NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene and Clinoril.
The various NSAIDs and Aspirin if taken in full doses usually have the same levels of anti-inflammatory effect. However,different
individuals may experience greater relief from one medication then another. Taking more than one NSAID at a time increase
the possibility of side effects,particularily stomach problems such as ulcers and (GI) bleeding. People taking these medications
should consider a stomach protectant such as misoprostol (Cytotec).
At over-the-counter,NSAIDs are among the best antidotes for arthritis pain. At prescription doses they are effective
fighters of both pain and inflammation. But this relief may come at a cost for some patients-stomach problems. Acetominophen
is not a NSAID but is a excellent analgestic (pain relieving) taken in combination by many patients but consult your physician
as to doseage. ACR recommends it for the pain of osteoarthritis. There has been some recent research on high doseage that
is adverse.
Because ulcers are a potentially harmful side effect of NSAID use, a new option was recently brought to market. The newest
class of NSAIDs called cyclooxygenase-2 (Cox-2) inhibitors are safer to the stomach.Vioxx (Rofecoxib) and Celebrex
(Celecoxib) are two such drugs. A new Cox-2 inhibitor called Baldecoxib (Bextra) was approved in 11/01
for treating RA and OA. They are designed to not interfere with Cox-1 (stomach-lining protector).
One downside of these drugs is that research has shown that they may not provide protection against heart disease as
a traditional NSAID might,so ask the doctor about the advisability of using it,along with low-dose aspirin or other heart-protective
medication, particularily,if one have heart disease or risk factors of it. Patient prone to infections should inform
their physician.
DMARDs:
Disease modifying anti-rheumatic drugs (DMARDs) may be prescribed when inflammation continues for
more than 8 weeks or when RA strikes many parts at once. DMARDs target the cells in the immune system causing the inflammation,but
do not reverse permanent joint damage. The gold standard is metrotrexate in the U.S. Gold salts,sulfasazine,,hydroxychlorine,chloroquine
and azathlopine are also employed. A DMARD is usually prescribed in addition to an NSAID or predisone.
Side effects may include mouth sores,diarrhea, and nausea dependent on medication and patient. More serious side effects
that may occur.monitored through regular blood and urine tests,include possible liver damage and excessive lowering of white
blood cell count (increasing susceptibility to certain infections) and platelet count (affecting blood clotting). The severity
will dictate the use of certain drugs or a combination of drugs. e.g., HCQ is usually prescribed for
the milder type of disease or when the disease prognosis is unclear to allow some form of joint protection while the course
of disease becomes more certain.
DMARDs are relatively slow acting with a delay of 1-6 months before a clinical respose is evident. Efficacy cannot be
predicted for the individual patient but up to two-thirds of patients may have a response to these agents. Each DMARD has
specific toxicity that requires careful monitoring. From the patient's perspective,the convience of administeration of the
drug,the requirements of the monitoring program, the cost and its monitoring,the time until expected benefit,and the frequency
and potential seriousness of adverse reactions are important considerations.
The physician should also assess patient factors such as compliance and comorbid diseases,the severity and prognosis
of the patient's disease and the physician's own confidence, training experience and knowledge in administeration of the drug.
HCQ tends to cause less toxicity or side effects than other DMARDs but may take anywhere from 3
to 6 months to take effect and even up to 12 months to reach maximum therapeutic value. It also may remain in the body for
as many as 5 years after the last pill is take.In rare cases hydroxychloroquine may damage the mascula, the fine-tuning of
the eye.
This condition is very rare and generally occurs at doses higher than those required to treat rheumatoid arthritis. To
reduce toxicity the patient will receive a dose based on the patient's bodyweight. If eye toxicity should occur,the drug will
be discontinued and generally the eye problems will not get worse. HCQ has been known to cause light sensitivity,nausea and
diarrhea in some patients.
Hydroxychloroquine's (Plaquenil) time of action may be 3 to 6 months .Initially,a related drug,chloroquine,was
used,but chloroquine had more side effects. Both fell out of favor for a while. Recent studies have shown HCQ much safer then
chloroquine. The dose of Plaquenil is one or two pills (200 mg) taken taken at bed-time. It is an inexpensive DMARD easily
monitored that works well in early and mild RA. In combination with other DMARDs,plaquenil is useful for more severe types.
Monitoring involves yearly eye examinations.
Methotrexate is the most frequently prescribed DMARD. MTX is highly effective,
once the maximum dose is established. It may cause side effects,including mouth irritation,nausea,diarrhea and vomiting. Methotrexate
also inhibits a person's ability to metabolize and use folic acid,a vitamin that helps stabilize cell growth. Some of the
side effects can be countered by lowering the dose or by taking folic acid,without interfering with MTX's beneficial effects.
Injectable form of methotrexate tends to lower side effects.Because MTX is escreated by the kidneys,it should not be
used by those who are on dialysis or have suffered kidney damage If a patient have mild kidney problems they should consult
their physician. Methotrexate should not be taken with alcohol. Regular laboratory blood monitoring is required.
MTX is normally prescribed at a starting dose of 2 to 4 pills per week (5 to 10 mg). The dose can easily be individualized,with
lower doses for smaller,older patients and higher doses for younger,healthier,larger patients. The starting dose is then increased,
up to 6 to 8 pills per week (1 tablet=2.5 mg) depending upon the course of the disease. Blood tests alert the physician about
side effects .
About 50 to 80% of patients achieve effective control. Because absorption of the pill varies among patients, when
benefit is incomplete,it may be given by injection. More serious but uncommon problems with MTX include inflammation and scarring
of the liver but most patients who develop this condition have underlying medical conditions that make them susceptible to
this side effect: diabetes,alcoholisim,liver disease,hepatitis,or obesity.
Sulfasalazine: It is most often used in the treatment of milder forms of RA (HCQ included). It
appears to work like MTX--by suppressing parts of the immune system. Because sulfasalazine combines salicylates and sulfa,it
is not recommended for those allergic to sulfa compounds. The medication also causes some side effects,including gastrointestinal
distress,nausea,vomiting,rash and headaches. In rare cases it may affect the white blood cell count. Decreased sperm count
can occur but normilizes when the drug is discontinued. Routine lab monitoring is required.
Sufasalazine is usually taken as a daily dose of 2 to 3 grams. Ideally the dose is increased slowly: 500 mg daily during
week 1;1000 mg daily during week 2; 1500 mg daily during week 3; and 2 grams daily during week 4. Blood tests should be
scheduled monthly for the first 3 months,then every 3 months. SSZ begins working after 4 to 12 weeks
of therapy. It is used more in Europe.
Oral cortisone (predisone) is a steriod that reduces inflammation and swelling.
Predisone may cause side effects such as thinning of bones (osteoporosis). To avoid or lessen side effects,the physician will
administer the lowest possible dose and maintain efficacy. Usually after about six months of taking predisone,most doctors
will slowly try to reduce the dose. In time,predisone may not be necessary. It is often taken with DMARD and NSAID in combination.
Gold salts are not used frequently as in the past. When used gold salts can be taken in pill or
by injection. Side effects such as rash,mouth irritation,kidney problems and diarrhea may occur. Blood and urine are
monitored on a regular basis (every time a patient is injected). Gold normally takes 4 to 6 months to work. The benifits of
gold diminish with time,usually in a time frame somewhere between that of HCQ and MTX. When gold works,the respose is dramatic.
Approximately 30 % of patients taking gold experience side effects. The cost of monitoring is high,and gold causes many adverse
reactions.
Cyclosporine like azathioprine is a type of immunosuppressant that is used
to help prevent the rejection of a transplanted organ. Cyclosporine can cause side effects ranging from excessive hair growth
and elevated blood pressure to more serious problems like kidney dysfunction. It is not recommended for those who already
have high blood pressure or kidney or liver disease. this medication is reserved for those who do not respond to other DMARDs.
Although individual DMARDs are often effective in slowing the progression of rheumatoid arthritis,they may be more effective
when combined. Combinations include the following: MTX and cyclosporine,MTX and anti-TNF therapy,and
MTX combined with HCQ and SSZ (sulfasalazine).Studies comparing DMARD combinations to individual DMARD treatment have
found that they offer increased benefits to patients while not increasing side effects or toxicity. The benefits are especially
evident after one year of treatment,in particular for triple combination therapy.
Corticosteriods(glucocorticoids) are man-made drugs that closely resemble cortisone, a hormone naturally
produced by the adrenal glands in the body. In RA,these drugs are used to treat severe inflammation that is accompanied by
severe pain and stiffness. They are also used to treat systemic RA which may affect the lining of the lungs and blood vessels.
The most common form is predisone. Low dose predisone is usually given to patients,at the start, while the DMARDs take effect
("bridge").
Corticosteriods sometimes are given as injection into one or more joints or other area of inflammation. While eliminating
some side effects,injections may have their own possible problems on the joints,if given more than a few times a year (large
joints) They are very effective and quick-acting for the short term.
Biologics are newer drugs that are becoming available for RA patients that fail to respond to conventional
treatment. The biologic response modifiers-Etanercept (Enbrel) amd Infliximab (Remicade)-
have been available for a couple of years. Both of these agents work,through different ways,to suppress an inflammatory cytokine
called tumour necrosis factor (TNF) Biologics also inhibit the damage to the joint structures that arthritis can cause. For
many people,these drugs have helped when nothing else could.
Despite the benefits of these agents,they have their downside. They must be infused (Remicade) or injected (Enbrel) and
they are expensive ($12,000-$20,000 per annum). Researchers believe that future agents,still in early development stages,may
be less expensive and can be taken orally.
Scientists have identified TNF as one of the naturally occuring hormones that activte cells responsible for the redness,heat,swelling
and pain with joint inflammation. RA patients have an excess of TNF.
Anakinra (Kineret) was approved by the FDA in 11/01 for the treatment of
RA. Anakinra works by blocking the action of another inflammatory cytokine,interleukin-1 which also plays a role in inflammation
and destruction It requires daily injections with a special injecting device.
D2E7, also known as Adalimumab (TNF inhibitor),currently going through phase 111 clinical trials,appears
to be the next biologic compound to be introduced. Ease of administeration is one of the features quoted by the development
team,Abbott Laboratories.
Pain is one symptom virtually everyone will have,regardless of which form of arthritis they have.
For that reason,analgestic (pain-reliever) medications play an important role in the arthritis treatment plan One of the most
commonly used analgestic is acetaminophen, The ACR recommends it as
a first-line option against osteoarthritis pain Unlike NSAIDs acetaminophen and other pure analgestics don't relieve inflammation.
Yet recent studies suggest acetaminophen relieves arthritis pain--even severe pain--as effectively as NSAIDs without NSAID's
risk of GI side effects. At one time acetaminophen was the only analgestic many doctors prescribed for arthritis pain. But
that is changing
A new combination drug called Ultracet,a combination of acetaminophen and tramadol was
approved for acute pain by the FDA in November 2001. Increasingly,doctors are becoming more willing to prescribe narcotic-analgestics--traditionally
reserved for severe,acute pain for their patients with chronic arthritis pain that hasn't responded to more conservative measures.
GENERIC NAME: hydrocodone/acetaminophen. BRAND NAMES: Vicodin, Vicodin ES, Anexsia, Lorcet, Lorcet Plus, ;Hydrocodone is
a narcotic pain-reliever and a cough suppressant, similar to codeine. The precise mechanism of pain relief by hydrocodone
and other narcotics is not known. Acetaminophen is a non-narcotic analgesic (pain reliever) and antipyretic (fever reducer).
Acetaminophen relieves pain by elevating the pain threshold. It reduces fever through its action on the heat regulating
center of the brain. Frequently, hydrocodone and acetaminophen are combined to achieve pain relief, as in Vicodin and Lortab.
For more information please see acetaminophen (Tylenol).
Among the many brands the dose of acetaminophen ranges between 500 and 750 mg, and the dose of hydrocodone ranges between
2.5 and 10 mg. Store at room temperature, sealed, light- resistant container.
Hydrocodone is prescribed for the relief of moderate to moderately severe pain. Should be taken with food.
Hydrocodone can depress breathing, and is used with caution in elderly, debilitated patients and in patients with serious
lung disease. Hydrocodone can impair thinking and the physical abilities required for driving or operating machinery.
Alcohol and other sedatives, such as Xanax, can produce further brain impairment and even confusion when combined with
hydrocodone. Hydrocodone is generally avoided in children. Hydrocodone may be habit forming. Mental and physical dependence
can occur, but are unlikely when used for short-term pain relief.
Hydrocodone is generally avoided in pregnant women. Hydrocodone is generally avoided in nursing mothers.
The most frequent adverse reactions include lightheadedness, dizziness, sedation, nausea, and vomiting. Other side effects
include drowsiness, constipation, and spasm of the ureter, which can lead to difficulty in urinating.
GENERIC NAME: tramadol ;BRAND NAME: Ultram;DRUG CLASS AND MECHANISM: Tramadol is an effective pain reliever (analgesic).
Its mode of action resembles that of narcotics, but it has significantly less potential for abuse and addiction than the narcotics.
Tramadol is as effective as narcotics in relieving pain but does not depress respiration, a side effect of most narcotics.
Tramadol is not a nonsteroidal antiinflammatory drug (NSAID), and does not have the increased risk of stomach ulceration and
internal bleeding that can occur with the use of NSAIDs.
Tablet: 50mg. Store at room temperature, sealed container. Tramadol is used in the management of moderate to moderately
severe pain. May be taken with or without food.
Tramadol can impair thinking and the physical abilities required for driving or operating machinery. Tramadol should be
avoided in patients intoxicated with alcohol, hypnotics, and narcotics. Large doses of tramadol administered with alcohol
or anesthetic agents can impair breathing.
Tramadol can increase the risk of seizure in epileptic patients, especially with simultaneous use of tricyclic antidepressants,
such as Elavil. No dosage adjustment or reduction is necessary in healthy elderly patients 65-75 years of age. Patients over
the age of 75 years, and those with liver and kidney dysfunction may need lower dosages.
The safety of tramadol in children has not been established. Tramadol may rarely be habit forming. Tramadol should
be avoided in patients with a history of opiate addiction or hypersensitivity to opiate medications. The safety of tramadol
during pregnancy has not been established. The safety of tramadol in nursing mothers has not been established.
Tramadol is generally well tolerated and side effects are usually transient. Commonly reported side effects include nausea,
constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating,
dry mouth, diarrhea, rash, visual disturbances, and vertigo.
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You And Your Medicine:
Many medicines taken by mouth may affect the digestive system. These medicines include prescription (those ordered by a
doctor and dispensed by a pharmacist) and nonprescription or over-the-counter (OTC) products.
Although these medicines usually are safe and effective, harmful effects may occur in some people. OTC's typically do not
cause serious side effects when taken as directed on the product's label. It is important to read the label to find out the
ingredients, side effects, warnings, and when to consult a doctor. 
Always talk with your doctor before taking a medicine for the first time and before adding any new medicines to those you
already are taking. Tell the doctor about all other medicines (prescription and OTC's) you are taking. Certain medicines taken
together may interact and cause harmful side effects. In addition, tell the doctor about any allergies or sensitivities to
foods and medicines and about any medical conditions you may have such as diabetes, kidney disease, or liver disease.
Be sure that you understand all directions for taking the medicine, including dose and schedule, possible interactions
with food, alcohol, and other medicines, side effects, and warnings. If you are an older adult read all directions carefully
and ask your doctor questions about the medicine. As you get older, you may be more susceptible to drug interactions that
cause side effects.
People with a food intolerance such as gluten intolerance should make sure their medicines do not contain fillers or additives
with gluten. Check with your doctor if you have any questions or concerns about your medicines. Follow the doctor's orders
carefully, and immediately report any unusual symptoms or the warning signs described below.
The Esophagus
Irritation
Some people have difficulty swallowing medicines in tablet or capsule form. Tablets or capsules that stay in the esophagus
may release chemicals that irritate the lining of the esophagus. The irritation may cause ulcers, bleeding, perforation (a
hole or tear), and strictures (narrowing) of the esophagus. The risk of pill-induced injuries to the esophagus increases in
persons with conditions involving the esophagus, such as strictures, scleroderma (hardening of the skin), achalasia (irregular
muscle activity of the esophagus, which delays the passage of food), and stroke.
Some medicines can cause ulcers when they become lodged in the esophagus. These medicines include aspirin, several antibiotics
such as tetracycline, quinidine, potassium chloride, vitamin C, and iron. Warning signs
- Pain when swallowing food or liquid.
- Feeling of a tablet or capsule "stuck" in the throat.
- Dull, aching pain in the chest or shoulder after taking medicines.
Precautions
- Swallow tablets or capsules while you are in an upright or sitting position.
- Before taking a tablet or capsule, swallow several sips of liquid to lubricate the throat, then swallow the tablet or
capsule with at least a full glass (8 ounces) of liquid.
- Do not lie down immediately after taking medicines to ensure that the pills pass through the esophagus into the stomach.
- Tell your doctor if painful swallowing continues or if pills continue to stick in the throat.
Esophageal Reflux
The lower esophageal sphincter (LES) muscle is between the esophagus and the stomach. The muscle allows the passage of
food into the stomach after swallowing. Certain medicines interfere with the action of the sphincter muscle, which increases
the likelihood of backup or reflux of the highly acidic contents of the stomach into the esophagus.
Medicines that can cause esophageal reflux include nitrates, theophylline, calcium channel blockers, anticholinergics,
and birth control pills. Warning signs
- Heartburn or indigestion.
- Sensation of food coming back up into the throat.
Precautions
- Avoid foods and beverages that may worsen reflux, including coffee, alcohol, chocolate, and fried or fatty foods.
- Cut down on, or preferably quit, smoking.
- Do not lie down immediately after eating.
The Stomach
Irritation
One of the most common drug-induced injuries is irritation of the lining of the stomach caused by nonsteroidal anti-inflammatory
drugs (NSAIDs).
NSAIDs can irritate the stomach by weakening the ability of the lining to resist acid made in the stomach. Sometimes this
irritation may lead to inflammation of the stomach lining (gastritis), ulcers, bleeding, or perforation of the lining.
In addition, you should be aware that stomach irritation may occur without having any of the symptoms below.
Older people are especially at risk for irritation from NSAIDs because they are more likely to regularly take pain medicines
for arthritis and other chronic conditions. Also at risk are individuals with a history of peptic ulcers and related complications
or gastritis. These individuals should tell their doctor about any of these previous conditions. Special medicines may be
needed to protect the stomach lining. Warning signs
- Severe stomach cramps or pain or burning in the stomach or back.
- Black, tarry, or bloody stools.
- Bloody vomit.
- Severe heartburn or indigestion.
- Diarrhea.
Precautions
- Use coated tablets, which may lessen stomach irritation.
- Avoid drinking alcoholic beverages while taking medicines.
- Take medicines with a full glass of water or milk or with food, which may reduce irritation.
Delayed Emptying of the Stomach
Some medicines cause nerve and muscle activity to slow down in the stomach. This slowing down causes the contents of the
stomach to empty at a slower rate than normal.
Drugs that may cause this delay include anticholinergics and drugs used to treat Parkinson's disease and depression. Warning
signs
- Nausea.
- Bloating.
- Feeling of fullness.
- Vomiting of food eaten many hours earlier.
- Pain in midabdomen.
- Heartburn or indigestion.
- Sensation of food coming back up into the throat.
Precautions
- Eat frequent, small meals.
- Do not lie down for about 30 minutes after eating.
- Tell your doctor if symptoms continue. Your doctor may consider changing your dosage of the medicine or trying a new medicine.
The Intestine
Constipation
Constipation can be caused by a variety of medicines. These medicines affect the nerve and muscle activity in the large
intestine (colon). This results in the slow and difficult passage of stool. Medicines also may bind intestinal liquid and
make the stool hard.
Medicines that commonly cause constipation include antihypertensives, anticholinergics, cholestyramine, iron, and antacids
that contain mostly aluminium. Warning sign
- Constipation that is severe or disabling or that lasts several weeks.
Precautions
- Drink plenty of fluids.
- Eat a well-balanced diet that includes whole grains, fruits, and vegetables.
- Exercise regularly.
- Take laxatives only under a doctor's supervision.
Diarrhea
Diarrhea is a common side effect of many medicines. Diarrhea is often caused by antibiotics, which affect the bacteria
that live normally in the large intestine.
Antibiotic-induced changes in intestinal bacteria allow overgrowth of another bacteria, Clostridium difficile (C.
difficile), which is the cause of a more serious antibiotic-induced diarrhea.
The presence of C. difficile can cause colitis, an inflammation of the intestine in which the bowel "weeps" excess
water and mucus, resulting in loose, watery stools. Almost any antibiotic may cause C. difficile-induced diarrhea,
but the most common are ampicillin, clindamycin, and the cephalosporins. Antibiotic-induced colitis is treated with another
antibiotic that acts on C. difficile.
Diarrhea also can be a side effect of drugs that do not cause colitis but that alter the movements or fluid content of
the colon. Colchicine is a common cause of drug-induced diarrhea. Magnesium-containing antacids can have the effect of laxatives
and cause diarrhea if overused. In addition, the abuse of laxatives may result in damage to the nerves and muscles of the
colon and cause diarrhea. Warning signs
- Blood, mucus, or pus in the stool.
- Pain in the lower abdomen.
- Fever.
Precautions
- If diarrhea lasts for several days, consult your doctor.
The Liver
The liver processes most medicines that enter the bloodstream and governs drug activity throughout the body. Once a drug
enters the bloodstream, the liver converts the drug into chemicals the body can use and removes toxic chemicals that other
organs cannot tolerate. During this process, these chemicals can attack and injure the liver.
Drug-induced liver injury can resemble the symptoms of any acute or chronic liver disease. The only way a doctor can diagnose
drug-induced liver injury is by stopping use of the suspected drug and excluding other liver diseases through diagnostic tests.
Rarely, long-term use of a medicine can cause chronic liver damage and scarring (cirrhosis).
Medicines that can cause severe liver injury include large doses of acetaminophen (and even in small doses when taken with
alcohol), anticonvulsants such as phenytoin and valproic acid, the antihypertensive methyldopa, the tranquilizer chlorpromazine,
antituberculins used to treat tuberculosis such as isoniazid and rifampin, and vitamins such as vitamin A and niacin.
Warning signs (for liver injury)
- Severe fatigue.
- Abdominal pain and swelling.
- Jaundice (yellow eyes and skin, dark urine).
- Fever.
- Nausea or vomiting.
Precautions
- If you have ever had a liver disease or gallstones, you should discuss this with your doctor before taking any medicines
that may affect the liver or the gallbladder.
- Take these medicines only in the prescribed or recommended doses.
Glossary of Medicines
The following glossary is a guide to medicines used to treat many medical conditions. The glossary does not include all
medicines that may affect the digestive system. If a medicine you are taking is not listed here, check with your doctor. Acetaminophen
Acetaminophen relieves fever and pain by blocking pain centers in the central nervous system.
Examples of brand names include Tylenol, Panadol, and Datril. Antacids
Antacids relieve heartburn, acid indigestion, sour stomach, and symptoms of peptic ulcer. They work by neutralizing stomach
acid.
Aluminum hydroxide antacids include Alu-Tab and Amphojel; calcium carbonate antacids include Tums, Alka Mints, and Rolaids
Calcium Rich; magnesium antacids include Mylanta and Maalox. Antibiotics
Antibiotics destroy or block the growth of bacteria that cause infection.
Hundreds of antibiotics are available, including penicillins (Amoxil, Amcil, and Augmentin), clindamycin, cephalosporins
(Keflex and Ceclor), tetracyclines (Minocin, Sumycin, and Vibramycin), quinolones (Cipro), and sulfa drugs (Bactrim). Anticholinergics
This class of medicines affects the nerve cells or nerve fibers and includes drugs for depression, anxiety, and nervousness.
Examples of anticholinergics include propantheline (Pro-banthine) and dicyclomine (Bentyl). Examples of antidepressants
include amitriptyline (Elavil and Endep), and nortriptyline (Aventyl and Pamelor).
Medicines for relieving the symptoms of Parkinson's disease also are in this category. Examples include levodopa (Dopar)
and carbidopa and levodopa combination (Sinemet). Anticonvulsants
These medicines control epilepsy and other types of seizure disorders. They act by lessening overactive nerve impulses
in the brain.
Examples of this class of medicines include phenytoin (Dilantin) and valproic acid (Dalpro). Antihypertensives
Antihypertensives lower high blood pressure. They act by relaxing blood vessels, which makes blood flow more easily.
Examples of antihypertensives include methyldopa (Aldomet) and clonidine hydrochloride (Catapres). Antituberculins
These drugs for tuberculosis limit the growth of bacteria or prevent tuberculosis from developing in people who have a
positive tuberculin skin test.
Brand names include INH, Dow-Isoniazid, Rifadin, and Rimactane. Calcium channel blockers
These medicines for angina (chest pain) and high blood pressure affect the movement of calcium into the cells of the heart
and blood vessels, relax blood vessels, and increase the flow of blood and oxygen to the heart.
Examples of calcium channel blockers include diltiazem (Cardizem), nifedipine (Procardia), and verpamil (Isoptin). Chlorpromazine
This tranquilizer relieves anxiety or agitation.
Examples of brand names include Thorazine and Ormazine. Colchicine
This medicine eases the inflammation from gout and prevents attacks from recurring. Iron
Iron is a mineral the body needs to produce red blood cells. Iron supplements are used to treat iron deficiency or iron-deficiency
anemia. Laxatives
Many forms of laxatives are available for relieving constipation.
Common brand names of laxatives include Phillips' Milk of Magnesia, Citroma, Epsom salts, Correctol, and ExLax. Nitrates
These drugs for angina (chest pain) relax blood vessels and increase the flow of blood to the heart.
Examples of generic and brand names include isosorbide dinitrate (Iso-Bid and Isonate) and nitroglycerin (Nitro-Bid and
Nitrocap). Nonsteroidal anti-inflammatory drugs (NSAIDs)
These drugs block the body's production of prostaglandins, substances that mediate pain and inflammation. NSAIDs relieve
the pain from chronic and acute inflammatory conditions, including arthritis and other rheumatic conditions, and pain associated
with injuries, bursitis, tendinitis, and dental problems. NSAIDs also relieve pain associated with noninflammatory conditions.
Generic and brand names of NSAIDs include aspirin (Bayer and Bufferin), ibuprofen (Advil, Nuprin, and Motrin), tometin
(Tolectin), naproxen (Naprosyn), and piroxicam (Feldene). Potassium chloride
Potassium is a vital element in the body. Potassium supplements help prevent and treat potassium deficiency in people taking
diuretics. Quinidine
This medicine often is used to correct irregular heartbeat.
Brand names of quinidine include Quinalan and Quiniglute. Theophylline
This medicine eases breathing difficulties associated with emphysema, bronchitis, and bronchial asthma. The medicine works
by relaxing the muscles of the respiratory tract, which allows an easier flow of air into the lungs.
Examples of brand names include Theo-Dur, Theophyl, and Bronkodyl. Vitamins
Vitamins serve as nutritional supplements in people with poor diets, in people recovering from surgery, or in people with
special health problems.
- Niacin helps the body break down food for energy and is used to treat niacin deficiency and to lower levels of
fats and cholesterol.
- Vitamin A is necessary for normal growth and for healthy eyes and skin.
- Vitamin C is necessary for healthy function of cells
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