1. Vitamin A and its derivatives (isotretinein, Accutane and etretinate)Women who are pregnant should not take regular vitamins. Too many vitamins can harm your baby. For example, very high levels of vitamin A have been linked with severe birth defects.Significant risk of spontaneous abortion [20] and risk of many significant anomalies2. ACE inhibitors (May cause fetal hypotension, kidney damage in the fetus when used in II and III trimester, decrease in the amount of amniotic fluid and deformities of face, limbs and lungs)3. Anticoagulants- warfarinDuring 1st Trimester- defects like nasal hypoplasia and a depressed nasal bridge; termed as Fetal warfarin SyndromeDuring 2nd and 3rd Trimester-risk of fetal malformations
4. Anti-thyroids (Methimazole, Carbimazole) -Overactive and enlarged Thyroid gland.
5. Anticonvulsants-Carbamazepine (Risk of birth defects)
                                 Sodium valproate (Increased risk cleft palate and abnormalities of the heart, face, skull, hands or …

Basics of Oral Anti-diabetic drugs

The sulfonylureas and meglitinides increase the secretion of insulin by the pancreas. _ Metformin inhibits glucose production by the liver and decreases insulin resistance. _ The alpha-glucosidase inhibitors delay absorption of glucose by the intestine. _ The thiazolidinediones decrease insulin resistance.
_ The dipeptidyl peptidase 4 inhibitors promote the release of insulin from the pancreas after eating a meal.
It is necessary to know before starting these drugs that all the diabetes drugs have the potential to cause side effects and lifestyle changes have benefits to your health beyond controlling blood sugar, most doctors will recommend you try diet and lifestyle modifications first — before you try a drug.
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FDA Adds 8 Drugs to Watch List

1. Cetirizine HCl       =========>    Oculogyric crisis
2. Codeine sulfate=========>Respiratory depression or arrest resulting in death in children taking                                                        codeine who are CYP2D6 ultra-rapid metabolizers 3. Fluoroquinolone =========> Retinal detachment 4. Olmesartan medoxomil =========>Malabsorption resulting in severe diarrhea and weight loss 5. Proton pump inhibitors =========>Pneumonia
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Acetaminophen produces its analgesic effect by inhibiting the same cyclooxygenase, prostaglandin H2 synthase, that is the target of NSAID and aspirin. However, acetaminophen blocks this enzyme at its peroxidase catalytic rather than at the cyclooxygenase catalytic site. Therefore, the acetaminophen-mediated inhibition is sensitive to changes in the tissue peroxide levels; higher concentrations of peroxide in activated leukocytes and platelets block the effect of acetaminophen on inflammation and platelet thrombosis. However, acetaminophen is able to inhibit prostaglandins in the central nervous system, thus providing relief of pain and fever. Therefore, acetaminophen is not an NSAID or anti-thrombotic agent.

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Ultram is the Generic form of Ultram. ULTRAN ® (tranadol hydrochloride tablets) is a prescription medication indicated for the management of moderate to moderately severe pain. ULTRAM received U.S. Food and Drug Administration (FDA) approval in March, 1995. Ultram has been prescribed to more than 55 million patients worldwide and ULTRAM has been prescribed to more than 21 million patients in the United States alone.

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Tenecteplase versus Alteplase for Acute Ischemic Stroke

Intravenous alteplase is the only approved treatment for acute ischemic stroke. Tenecteplase, a genetically engineered mutant tissue plasminogen activator, is an alternative thrombolytic agent.
Tenecteplase was associated with significantly better reperfusion and clinical outcomes than alteplase in patients with stroke who were selected on the basis of CT perfusion imaging.


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“Gatifloxacin can cause severe hyperglycemia”

A 65-year-old woman with no history of diabetes, developed hyperglycemia, after taking Gatifloxacin. She was admitted to the hospital with a one day history of abdominal cramps, nausea, and vomiting. Her blood glucose was 1,121 mg/dL (normal range 70 to 100 mg/ dL). She had a history of high BP, transient ischemic attacks, hyperlipidemia and renal failure. The patient was receiving Gatifloxacin 200 mg daily for 9 days empirically for bronchitis, which was started during a prior hospitalization. After admission, she responded well to an insulin infusion combined with subcutaneous doses of regular insulin. (Ann Pharmacother.2005; 39(7):1349–1352)
Reports of hypoglycemia with other fluoroquinolones have been documented, but only Gatifloxacin is reported to cause severe hyperglycemia

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