Showing posts with label Considerations. Show all posts
Showing posts with label Considerations. Show all posts

Statins - Considerations

Considerations-Statins




Statins shouldn't be taken if you have severe liver disease or if blood tests suggest that your liver may not be working properly.
This is because statins can affect your liver, and this is more likely to cause serious problems if you already have a severely damaged liver.
Before starting to take statins, you should have a blood test to ensure your liver is in a relatively good condition. You should also have a routine blood test to check the health of your liver 3 months after treatment begins, and again after 12 months.

Pregnancy and breastfeeding

Statins shouldn't be taken by women who are pregnant or breastfeeding, as there's no firm evidence on whether it's safe to do so.
Contact your GP for advice if you become pregnant while taking statins.

People at an increased risk of side effects

Statins should be taken with caution if you're at an increased risk of developing a rare side effect called myopathy, which is where the tissues of your muscles become damaged and painful. Severe myopathy (rhabdomyolysis) can lead to kidney damage.
Things that can increase this risk include:
  • being over 70 years old
  • having a history of liver disease
  • regularly drinking large quantities of alcohol
  • having a history of muscle-related side effects when taking a statin or fibrate (another type of medicine for high cholesterol)
  • having a family history of myopathy or rhabdomyolysis
If one or more of these apply to you, you may need to be frequently monitored to check for complications. A lower dose of statin may also be recommended.
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
Read more about the side effects of statins.

Interactions

Statins can react unpredictably with certain other substances (known as "interacting"), potentially increasing the risk of serious side effects, such as muscle damage.
Medications that can interact with some types of statin include:
  • certain antibiotics and antifungals  
  • certain HIV medications
  • warfarin – a medication commonly used to prevent blood clots
  • ciclosporin – a medication that suppresses the immune system and is used to treat a wide range of conditions, including psoriasis and rheumatoid arthritis
  • danazol – a synthetic hormone medication used to treat conditions such as endometriosis
  • verapamil and diltiazem – types of medication called calcium channel blockers, which are used to treat various conditions affecting the heart and blood vessels
  • amiodarone – a medication sometimes used to treat irregular heartbeats
  • fibrates – medications that, like statins, help reduce cholesterol levels in the blood
If you're taking statins and need to take one of these medications, your doctor may prescribe an alternative statin or prescribe your current statin at a lower dosage. In some cases, they may recommend that you temporarily stop taking your statin.

Food and alcohol

Grapefruit juice can affect some statins and increase your risk of side effects. Your doctor may advise you to avoid it completely or only consume small quantities.
Your doctor will also ask you how much alcohol you drink before prescribing statins. People who regularly drink large amounts of alcohol are at increased risk of getting more serious side effects.
If you're prescribed a statin, you may be able to continue drinking alcohol. However, you shouldn't drink more than 14 units of alcohol a week.

Researching your medication

For full details of cautions and interactions relevant to your specific medication, check the patient information leaflet that comes with it.
If in doubt, contact your GP or pharmacist for advice.
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Laxatives - Considerations

Considerations-Laxatives




Most people can use laxatives, but not all types are suitable for everyone.
Check with a GP or pharmacist before using laxatives if you:
  • have a bowel condition, such as irritable bowel syndrome (IBS), Crohn's disease or ulcerative colitis
  • have a colostomy or ileostomy, where the small or large intestine is diverted through an opening in the abdomen
  • have a history of liver or kidney disease
  • are pregnant or breastfeeding
  • have an obstruction somewhere in your digestive system
  • have diabetes, as some laxatives can cause a rise in blood sugar
  • have difficulty swallowing
  • have a lactose intolerance, as some laxatives contain lactose
  • have phenylketonuria, a rare genetic condition where the body is unable to break down a substance called phenylalanine, as phenylalanine is found in certain bulk-forming laxatives
  • are taking opioid painkillers, such as codeine or morphine
These situations do not necessarity mean you cannot take laxatives, but certain types of laxative may be more suitable for you than others.

Children and laxatives

Always check with a GP before giving your baby or child a laxative.
Laxatives are not recommended for babies who have not been weaned.
If your unweaned baby is constipated, try giving them extra water in between feeds.
Gently massaging their tummy and moving their legs in a cycling motion may also help.
Babies who are eating solid foods may be able to use laxatives, but first make sure your baby drinks plenty of water or diluted fruit juice, and increase the amount of fibre in their diet.
If they're still constipated, a GP may prescribe or recommend a laxative.
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Hysterectomy - Considerations

Considerations-Hysterectomy




If you have a hysterectomy, as well as having your womb removed, you may have to decide whether to have your cervix or ovaries removed.
These decisions are usually made based on:
  • your medical history
  • your doctor's recommendations
  • your personal feelings
It's important that you're aware of the different types of hysterectomy and their implications.

Removal of the cervix (total or radical hysterectomy)

If you have cancer of the cervix, ovarian cancer or womb (uterus) cancer, you may be advised to have your cervix removed to stop the cancer spreading.
Even if you do not have cancer, removing the cervix takes away any risk of developing cervical cancer in the future.
Many women are concerned that removing the cervix will lead to a loss in sexual function, but there's no evidence to support this.
Some women are reluctant to have their cervix removed because they want to retain as much of their reproductive system as possible.
If you feel this way, ask your surgeon whether there are any risks associated with keeping your cervix.
If you have your cervix removed, you'll no longer need to have cervical screening tests.
If you do not have your cervix removed, you'll need to continue having regular cervical screening.

Removal of the ovaries (salpingo-oophorectomy)

The National Institute for Health and Care Excellence (NICE) recommends that a woman's ovaries should only be removed if there's a significant risk of associated disease, such as ovarian cancer.
If you have a family history of ovarian or breast cancer, removing your ovaries may be recommended to prevent you getting cancer in the future.
Your surgeon can discuss the pros and cons of removing your ovaries with you. If your ovaries are removed, your fallopian tubes will also be removed.
If you have already gone through the menopause or you're close to it, removing your ovaries may be recommended regardless of the reason for having a hysterectomy.
This is to protect against the possibility of ovarian cancer developing.
Some surgeons feel it's best to leave healthy ovaries in place if the risk of ovarian cancer is small – for example, if there's no family history of the condition.
This is because the ovaries produce several female hormones that can help protect against health problems such as weak bones (osteoporosis). They also play a part in feelings of sexual desire and pleasure.
If you'd prefer to keep your ovaries, make sure you have made this clear to your surgeon before your operation.
You may still be asked to give consent to treatment for having your ovaries removed if an abnormality is found during the operation.
Think carefully about this and discuss any fears or concerns you have with your surgeon.

Surgical menopause

If you have a total or radical hysterectomy that removes your ovaries, you'll experience the menopause immediately after your operation, regardless of your age. This is known as a surgical menopause.
If a hysterectomy leaves 1 or both of your ovaries intact, there's a chance that you'll experience the menopause within 5 years of having the operation.
Although your hormone levels decrease after the menopause, your ovaries continue producing testosterone for up to 20 years.
Testosterone is a hormone that plays an important part in stimulating sexual desire and sexual pleasure.
Your ovaries also continue to produce small amounts of the hormone oestrogen after the menopause.
It's a lack of oestrogen that causes menopausal symptoms such as:
Hormone replacement therapy (HRT) is usually used to help with menopausal symptoms that occur after a hysterectomy.

Hormone replacement therapy (HRT)

You may be offered HRT after having your ovaries removed. This replaces some of the hormones your ovaries used to produce and relieves any menopausal symptoms you may have.
It's unlikely that the HRT you're offered will exactly match the hormones your ovaries previously produced.
The amount of hormones a woman produces can vary greatly, and you may need to try different doses and brands of HRT before you find one that feels suitable.
Not everyone is suitable for HRT. For example, it's not recommended for women who have had a hormone-dependent type of breast cancer or liver disease.
It's important to let your surgeon know about any such health problems you have had.
If you're able to have HRT and both of your ovaries have been removed, it's important to continue with the treatment until you reach the normal age for the menopause (51 is the average age).

Cervical screening

If your cervix is removed during a hysterectomy, you'll no longer need to have cervical screening.
If your cervix is left in place, you'll need to continue to go for regular cervical screening tests.
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Anticoagulant medicines - Considerations

ConsiderationsAnticoagulant medicines



If you're prescribed anticoagulants, always follow the instructions of your GP or another healthcare professional.
Some of the main issues you'll need to consider while taking your medication are outlined below.

Having surgery

If you're taking anticoagulants and you need to have surgery or any kind of invasive procedure, make sure that the healthcare professionals treating you are aware of your medication.
This includes procedures used to diagnose other conditions, such as an endoscopy or cystoscopy.
As anticoagulants reduce the ability of your blood to clot, there's a risk you could experience heavy bleeding if any kind of cut (incision) is made during a procedure.
You may therefore be advised to stop taking your medication before surgery.
If you're having a dental procedure, such as having a tooth removed, tell your dentist that you take anticoagulants.
You may not need to stop taking your medication, but you might need to have a blood test before the procedure to make sure your blood clots at the right speed.
Only stop taking your medication on the advice of your GP or another healthcare professional.

Pregnancy

Warfarin isn't normally given to pregnant women because it can affect the unborn baby. 
It can cause birth defects or excessive bleeding from the placenta or foetus.
It may sometimes be used in the second trimester, but should never be taken during the first trimester and should ideally be avoided in the third trimester as well.
The newer anticoagulant medications apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto) also are not recommended in pregnancy.
If you're taking any of these medications, you should make sure you use contraception when having sex to avoid becoming pregnant.
If you're on anticoagulants and find out you're pregnant or plan to start trying for a baby, speak to your GP or anticoagulant clinic about stopping or changing your prescription. 
Injections of an anticoagulant called heparin can be given while you're pregnant if necessary.

Breastfeeding

You can usually take warfarin while you're breastfeeding, but you should discuss this with your GP or midwife first. 
Heparin is also safe to take while you're breastfeeding.
Apixaban, dabigatran and rivaroxaban aren't recommended if you're breastfeeding because it's not clear if they're safe for the baby.
If you're on anticoagulants and are breastfeeding or planning to breastfeed, speak to your GP, anticoagulant clinic or midwife to find out if you need to change your prescription.

Avoiding injury

Taking anticoagulant medicines can make you more prone to bleeding if you're injured.
Try to avoid minor injuries and cuts and grazes by:
  • taking care when brushing your teeth and shaving (consider using a soft toothbrush and an electric razor)
  • using insect repellent to avoid insect bites or stings 
  • using protection when gardening, sewing or playing sports 
Your GP or anticoagulant clinic may advise you to avoid contact sports because of the risk of excessive bleeding.

Other medications and remedies

If you're taking anticoagulants, you should speak to your GP, anticoagulant clinic or pharmacist before taking any other medication, remedy or supplement.
This includes prescription medicines, medicines bought over the counter without a prescription (such as aspirin), and any herbal remedies (such as St John's Wort).
Some treatments can stop anticoagulants working or can increase the effect they have, which can be dangerous.
Some of the medicines that can affect anticoagulants include certain:
For a full list of medicines that you should avoid, check the patient information leaflet that comes with your medicine.

Food and drink

It's important to have a healthy, balanced diet that includes lots of fruit and vegetables if you're taking anticoagulants.
But you should avoid making frequent changes to the amount of green vegetables you eat and cranberry juice you drink if you're taking warfarin.
Foods with a lot of vitamin K, such as leafy green vegetables, chickpeas and liver, can interfere with how warfarin works. 
You can still include these in your diet while taking warfarin, as the clinic will adjust your dose accordingly, but it's important to be consistent in the amount you eat.
Do not drink cranberry juice while you're taking warfarin. It can increase the blood-thinning effect of warfarin.
You should also seek advice before taking supplements containing vitamin K.
The effect of warfarin is also affected by alcohol. If you're taking warfarin, do not drink more than 1 or 2 alcoholic drinks a day and never binge drink.  
These food and drink restrictions don't usually apply if you're taking apixaban, dabigatran and rivaroxaban, but you should check with your GP, anticoagulant clinic or pharmacist if you're not sure.
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Antibiotics - Considerations

ConsiderationsAntibiotics



There are some important things to consider before taking antibiotics.

Penicillin

Don't take one of the penicillin-based antibiotics if you've had an allergic reaction to them in the past. People who are allergic to one type of penicillin will be allergic to all of them.
People with a history of allergies, such as asthma, eczema or hay fever, are at higher risk of developing a serious allergic reaction (anaphylaxis) to penicillins, although cases are rare.
Penicillins may need to be used at lower doses and with extra caution if you have:

Pregnancy and breastfeeding

Most penicillins can be used during pregnancy and breastfeeding in the usual doses.
Tell your healthcare professional if you're pregnant or breastfeeding, so they can prescribe the most suitable antibiotic for you.

Cephalosporins 

If you previously had an allergic reaction to penicillin, there's a chance that you may also be allergic to cephalosporins.
Cephalosporins may not be suitable if you have kidney disease, but if you need one you will probably be given a lower than usual dose.
If you're pregnant or breastfeeding, or have acute porphyria, check with your doctor, midwife or pharmacist before taking cephalosporins.

Aminoglycosides

Aminoglycosides are normally only used in hospital to treat life-threatening conditions such as septicaemia, as they can cause kidney damage in people with pre-existing kidney disease. 
They're only used during pregnancy if your doctor believes they're essential.

Tetracyclines

The use of tetracyclines isn't usually recommended unless absolutely necessary in the following groups:
  • people with kidney disease – except doxycycline, which can be used 
  • people with liver disease 
  • people with the autoimmune condition lupus – which can cause skin problems, joint pain and swelling, and fatigue (feeling tired all the time) 
  • children under the age of 12 
  • pregnant or breastfeeding women 

Macrolides

You shouldn't take macrolides if you have porphyria – a rare inherited blood disorder.
If you're pregnant or breastfeeding, the only type of macrolide you can take is erythromycin (Erymax, Erythrocin, Erythroped or Erythroped A) unless a different antibiotic is recommended by your doctor. 
Erythromycin can be used at the usual doses throughout your pregnancy and while you're breastfeeding.
Other macrolides shouldn't be used during pregnancy, unless advised by a specialist.

Fluoroquinolones

Fluoroquinolones aren't normally suitable for women who are pregnant or breastfeeding.
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