Adverse drug effects are especially problematic in the elderly because they have slowed metabolism and excretion of medications. Often such adverse reactions are caused by the use of unnecessary medications, or the use of medications in excessive doses. Adverse drug effects are a widespread problem and can lead to significant injury and even death in the elderly. Physicians, nurses, and pharmacists are all responsible for the medication regimen in the nursing home setting.
The statistics regarding adverse drug effects are shocking. In the November 2006 issue of Clinical Geriatrics, a publication of the American Geriatric Society, the following was noted:
30% more money is spent in the United States on treating adverse drug effects than on all pharmaceuticals combined.
31% of older adults use more than one pharmacy, creating challenges for a comprehensive drug review.
50% of older adults receive prescriptions from more than one prescribing clinician.
One in 12 physician visits for the elderly result in a prescription of medication that is not recommended for them.
6,900,000 elderly persons are currently taking medications not recommended for the elderly.
10.3% of all prescriptions in the United States generate an electronic safety alert to the dispensing pharmacists. Of these alerts, 88% are overridden by the dispensing pharmacist. When interviewed, some pharmacists stated they did not believe the alert was important, was not real, or that they already knew about it.
The Centers for Medicare and Medicaid Services (CMS) have taken note of the high risk of injury related to adverse drug effects. In December 2006, CMS clarified federal mandates to state surveyors regarding the appropriate use of medications in the nursing home setting under F329 of the OBRA regulations. The rules are not new, but facilities are receiving clarification as to what medications should be reduced or eliminated from residents’ medication regimens. The clarification makes facilities responsible for the medication regimen, more so than the physician, nurse practitioner, or physician’s assistant who ordered the medication. State surveyors evaluate compliance with such rulings, and will, in essence, question the facility when rules are not followed. This clarification by CMS should be referred to when questioning whether therapy is recommended for the elderly population.
The following are questions you should ask the nursing home staff or medical provider of your loved one if you suspect medications are unnecessary or causing adverse effects:
Is this medication necessary?
Is the drug contraindicated in the elderly population?
Is the resident taking the lowest effective dose of the drug?
Are medications being used to treat the side effects of other medications? For example, medications for constipation are often given to treat the side effects of certain pain medications.
Can the drug regimen be simplified?
What are the potential drug interactions of the medications currently prescribed?
American Medical Director’s Association
Centers for Medicare and Medicaid Services
Getting Covid-19 again seems to be rare but you have a still possible to get Covid-19 again after the recovery of it.
It is called reinfection. According to the knowledge from similar viruses, reinfections are expected.
This situation is also valid for vaccinated people. If you got the shot of Covid Vaccine and still virus can infect you again and thanks to the vaccine, the risk of severe illness and death decrease significantly.
There is a study called SARS-CoV-2 Immunity and Reinfection Evaluation (SIREN) which was conducted by the Department of Health and Social Care and Public Health in England. The study showed that the possibility of reinfection is decreased by 83% for at least five months due to the responses of the immune from the previous infection.
The results from the same study suggested that cases of reinfection are rare and the ratio of occurrence is fewer than 1% of about 6.600 participants who had already been infected by the COVID-19 virus.
Reinfection is a rare situation but it is significant to take precautions such as wearing masks, handwashing, and social distancing.
The pandemic of Covid-19 continues to affect our lives and thankfully vaccines are coming with hope to fight this pandemic. However, new versions of the Covid-19 virus are reported and put us in a stressful place again.
Let’s see what is the variant Of Covid-19 and how does it affect us?
The mutation is responsible for the formation of new variants of the virus and some of these variants continue to spread and some of them are disappeared.
As we know, new variants of Covid-19 are reported. One of them is detected in the UK and called B.1.1.7. It is more contagious when compared to their variants.
Last October, in South Africa, named with B.1.351 variant was determined and lastly, P.1 variant was detected passenger from Brasil at the airport in Japan.
Easily and fast spreading of these variants cause the number of infected people, a requirement of the health services, hospital admission, and finally to death.
Therefore, protective strategies such as physical distance, mask, hand hygiene, isolation, and quarantine limit the spreading of the Covid-19 virus and protect public health.
Current vaccines were based on the previous version of the virus. However, scientists believe that they would be effective for new types of viruses.
The first result of BioNTech/Pfizer vaccines provides protection but less effective to new variants.
Two new vaccines (from Novavax and Jannsen) to be approved sooner would provide the protection as well. Experts from Oxford-AstraZeneca explained that their vaccine is protective against to new English variant.
Experts state that although this vaccine still provides protection against severe Covid-19 diseases, it is less effective against the South African variant.
Preliminary results from Moderna also show that the vaccine is effective against the South African variant. However, experts point out that the immune response may not be strong and long-lasting in this variant.
Experts say that many different variants may emerge in the future, but even in the worst-case scenario, vaccines can be redesigned or modified within a few weeks or months.
It is stated that the flu vaccine is updated to cover new strains every year, as well as the coronavirus vaccines, can be renewed.
Northwestern Medicine scientists have used patient-derived neurons to develop and test a new strategy to treat Parkinson’s disease by mitigating the effects of harmful genetic mutations, as detailed in a study published today (Oct. 16) in Science Translational Medicine.
Some experimental treatments for genetic disorders target mutated proteins or enzymes, but this study, led by Dr. Dimitri Krainc, took a different approach. Instead of trying to fix broken enzymes, the scientists amplified healthy ones, an approach that successfully alleviated symptoms of Parkinson’s disease (PD) in human brain cells and in mouse models.
“This study highlights wild-type GCase activation as a potential therapeutic target for multiple forms of Parkinson’s disease,” said Krainc, who is chair of neurology and director of the Center for Neurogenetics at Northwestern University Feinberg School of Medicine
Parkinson’s is the second-most common neurodegenerative disorder, predominately affecting neurons in an area of the brain called the substantia nigra. These neurons are responsible for producing dopamine – a chemical messenger used to transmit signals throughout the brain — and for relaying messages that plan and control body movement.
Mutations in the gene GBA1 represent the most common genetic risk factor for PD, according to the study, and GBA1 codes for an enzyme called glucocerebrosidase (GCase) that is important for neuronal function. PD-associated mutations can disable GBA1 and produce misshapen GCase enzymes, which contribute to an accumulation of toxic proteins in dopamine-producing neurons.
As this neuronal population dies, patients experience symptoms such as tremors and slowness of movement. While some medications can offer relief for these symptoms, there is no treatment that can stop or slow the disease.
According to Krainc, drug development for patients with GBA1-linked Parkinson’s has largely focused on stabilizing mutated GCase and limiting its harmful effects. However, these treatments would be effective only in a few types of PD.
“Instead, activating wild-type GCase may be more relevant for multiple forms of PD that exhibit reduced activity of wild-type GCase,” Krainc said.
In the current study, scientists developed a new series of chemical activators that stabilized and amplified normal GCase. The activator, a small molecule that binds to GCase, improved PD-related cellular dysfunction in patient derived neurons.
Importantly, these activators worked in several varieties of PD, showing this strategy could work for a wide range of patients, Krainc said.
“Our work points to the potential for modulating wild-type GCase activity and protein levels in both genetic and idiopathic forms of PD and highlights the importance of personalized or precision neurology in development of novel therapies,” he said.
A 2017 study led by Krainc and published in Science found that some of the key pathological features of PD were only seen in human neurons and not in mouse models, further emphasizing the value of patient-derived neurons for drug development in Parkinson’s disease.
“It will be important to examine human neurons to test any candidate therapeutic interventions that target midbrain dopaminergic neurons in PD,” Krainc said.
Lena F Burbulla, Sohee Jeon, Jianbin Zheng, Pingping Song, Richard B Silverman,
A modulator of wild-type glucocerebrosidase improves pathogenic phenotypes in dopaminergic neuronal models of Parkinson’s disease.
Science Translational Medicine, 16 Oct 2019, Vol. 11, Issue 514.
Rare diseases represent a global problem. Until now, the lack of data made it difficult to estimate their prevalence. Created and coordinated by Inserm, the Orphanet database, which contains the largest amount of epidemiological data on these diseases taken from the scientific literature, has made it possible to obtain a global estimate. Under the coordination of Inserm US14 Director Ana Rath, these data have shown that more than 300 million people worldwide are currently living with a rare disease. The study, published in the European Journal of Human Genetics, is the first to analyze the available data on rare diseases with such precision.
Systemic sclerosis, polycythemia vera and Marfan syndrome… These are obscure conditions, which are still largely unknown by the general public and differ broadly in their clinical expression. They do have one thing in common: they are very rare.
According to the European definition, a disease is considered rare when it affects fewer than 5 in 10,000 people. Few studies have been performed by the scientific community, and there is a lack of health professional expertise and of suitable treatments. This means that the thousands of rare diseases identified over the years cause immense suffering to many patients and their families, throughout the world.
The few epidemiological studies published on the subject so far rarely use general population registries. This made it difficult to establish their exact prevalence.
Yet such figures are needed if we are to identify priorities for health and research policy, understand the societal burden of these diseases, adapt the management of patients and, more generally, promote a real public health policy for rare conditions. “Given that little is known about rare diseases, we could be forgiven for thinking that their sufferers are thin on the ground. But when taken together they represent a large proportion of the population. Although rare diseases are individual and specific, what they have in common is their rarity, and the consequences which result from that”, emphasizes Ana Rath, from Inserm US14 (Information and service platform for rare diseases and orphan drugs).
Under her leadership, study author Stéphanie Nguenguan (Inserm US14), and her colleagues, used the Orphanet database to shed light on the issue.
People with high blood pressure who take all their anti-hypertensive medication in one go at bedtime have better controlled blood pressure and a significantly lower risk of death or illness caused by heart or blood vessel problems, compared to those who take their medication in the morning, according to new research.
The Hygia Chronotherapy Trial, which is published in the European Heart Journal , is the largest to investigate the effect of the time of day when people take their anti-hypertensive medication on the risk of cardiovascular problems. It randomized 19,084 patients to taking their pills on waking or at bedtime, and it has followed them for the longest length of time – an average of more than six years – during which time the patients’ ambulatory blood pressure was checked over 48 hours at least once a year.
The researchers, who are part of the Hygia Project led by Professor Ramón C. Hermida, Director of the Bioengineering and Chronobiology Labs at the University of Vigo, Spain, found that patients who took their medication at bedtime had nearly half the risk (45% reduction) of dying from or suffering heart attacks, myocardial infarction, stroke, heart failure or requiring a procedure to unblock narrowed arteries (coronary revascularization), compared to patients who took their medication on waking.
The researchers had adjusted their analyses to take account of factors that could affect the results, such as age, sex, type 2 diabetes, kidney disease, smoking and cholesterol levels.
When they looked at individual outcomes, they found that the risk of death from heart or blood vessel problems was reduced by 66%, the risk of myocardial infarction was reduced by 44%, coronary revascularization by 40%, heart failure by 42%, and stroke by 49%.
Prof Hermida said: “Current guidelines on the treatment of hypertension do not mention or recommend any preferred treatment time. Morning ingestion has been the most common recommendation by physicians based on the misleading goal of reducing morning blood pressure levels. However, the Hygia Project has reported previously that average systolic blood pressure when a person is asleep is the most significant and independent indication of cardiovascular disease risk, regardless of blood pressure measurements taken while awake or when visiting a doctor. Furthermore, there are no studies showing that treating hypertension in the morning improves the reduction in the risk of cardiovascular disease.
“The results of this study show that patients who routinely take their anti-hypertensive medication at bedtime, as opposed to when they wake up, have better-controlled blood pressure and, most importantly, a significantly decreased risk of death or illness from heart and blood vessel problems.”  
The Hygia Project is composed of a network of 40 primary care centres within the Galician Social Security Health Service in northern Spain. A total of 292 doctors are involved in the project and have been trained in ambulatory blood pressure monitoring, which involves patients wearing a special cuff that records blood pressure at regular intervals throughout the day and night. The Hygia Chronotherapy Trial is unusual in monitoring blood pressure for 48 hours, rather than the more usual 24 hours.
Between 2008 and 2018, 10,614 men and 8,470 women of Caucasian Spanish origin, aged 18 or over, who had been diagnosed with hypertension by means of ambulatory blood pressure monitoring, were recruited to the trial; they had to adhere to a routine of daytime activity and night-time sleep, which means that it is not possible to say if the study findings apply to people working night shifts.
Doctors took the patients’ blood pressure when they joined the study and at each subsequent clinic visit. Ambulatory blood pressure monitoring over a 48-hour period took place after each clinic visit and at least once a year. This gave doctors accurate information on average blood pressures over the 48 hours, including how much blood pressure decreased or ‘dipped’ while the patients were asleep.
During a median (average) of 6.3 years follow-up, 1752 patients died from heart or blood vessel problems, or experienced myocardial infarction, stroke, heart failure or coronary revascularization. Data from ambulatory blood pressure monitoring showed that patients taking their medication at bedtime had significantly lower average blood pressure both at night and during the day, and their blood pressure dipped more at night, when compared with patients taking their medication on waking. A progressive decrease in night-time systolic blood pressure during the follow-up period was the most significant predictor of a reduced risk of cardiovascular disease.
Prof Hermida concluded: “The findings from the Hygia Chronotherapy Trial and those previously reported from the Hygia Project indicate that average blood pressure levels while asleep and night-time blood pressure dipping, but not day-time blood pressure or blood pressure measured in the clinic, are jointly the most significant blood pressure-derived markers of cardiovascular risk. Accordingly, round-the-clock ambulatory blood pressure monitoring should be the recommended way to diagnose true arterial hypertension and to assess the risk of cardiovascular disease. In addition, decreasing the average systolic blood pressure while asleep and increasing the sleep-time relative decline in blood pressure towards more normal dipper blood pressure patterns are both significantly protective, thus constituting a joint novel therapeutic target for reducing cardiovascular risk.”
The Hygia Project is currently investigating what the best blood pressure levels should be while asleep in order to reduce cardiovascular risk most effectively in the THADEUS Trial (Treatment of Hypertension During Sleep). 
Limitations of the Hygia Chronotherapy Trial include that it requires validation in other ethnic groups; the question of whether the same results would be seen in shift workers also requires investigation; and patients were not assigned to specific hypertension medication classes or specific lists of medications within each class – their treatment was chosen by their doctors according to current clinical practice.
- “Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial”, by Ramón C. Hermida et al. European Heart Journal. doi:10.1093/eurheartj/ehz754
2. Hygia Project, “Asleep blood pressure: significant prognostic marker of vascular risk and therapeutic target for intervention”, by Ramón C. Hermida et al. European Heart Journal, 2018;39:4159-4171, doi:10.1093/eurheartj/ehy475
3. Systolic blood pressure is the pressure in the arteries as the heart contracts to eject blood out into them. Diastolic blood pressure is the pressure in the arteries between heart beats when the cardiac muscles relax.
4. Treatment of Hypertension During Sleep (THADEUS), https://clinicaltrials.gov/ct2/show/NCT03457168
Balversa (erdafitinib); Janssen Oncology; For the treatment of locally advanced or metastatic urothelial carcinoma , Approved April 2019
Bavencio (avelumab) plus Inlyta (axitinib) ; Merck and Pfizer; For the first line treatment of advanced renal cell carcinoma, Approved May 2019
Cyramza (ramucirumab) ; Eli Lilly; For the treatment of hepatocellular carcinoma with elevated alpha-fetoprotein (AFP), Approved May 2019
Herceptin Hylecta (trastuzumab and hyaluronidase-oysk); Halozyme; For the treatment of HER2-overexpressing breast cancer, Approved February 2019
Inrebic (fedratinib); Celgene; For the treatment of myelofibrosis, Approved August 2019
Keytruda (pembrolizumab) ; Merck; For the treatment of recurrent esophageal cancer with PD-L1 expressing tumors , Approved July 2019
Keytruda (pembrolizumab); Merck; previously treated metastatic small cell lung cancer, Approved June 2019
Keytruda (pembrolizumab); Merck; For the treatment of stage III non-small cell lung cancer, Approved April 2019
Keytruda (pembrolizumab); Merck; For the treatment of advanced renal cell carcinoma, Approved April 2019
Keytruda (pembrolizumab) plus Lenvima (lenvatinib); Merck and Eisai; For the treatment of advanced endometrial carcinoma , Approved September 2019
Nubeqa (darolutamide); Bayer; For the treatment of non-metastatic castration-resistant prostate cancer, Approved July 2019
Piqray (alpelisib) ; Novartis; For the treatment of HR+, HER2-negative, PIK3CA-mutated advanced or metastatic breast cancer, Approved May 2019
Polivy (polatuzumab vedotin-piiq) ; Genentech; For the treatment of diffuse large B-cell lymphoma, Approved June 2019
Rozlytrek (entrectinib); Genentech; For the treatment of ROS1-positive non-small cell lung cancer and NTRK Gene Fusion-Positive Solid Tumors, Approved August 2019
Tecentriq (atezolizumab); Genentech/Roche; For the treatment of extensive-stage small cell lung cancer , Approved March 2019
Tecentriq (atezolizumab); Genentech/Roche; For the treatment of triple negative breast cancer, Approved March 2019
Turalio (pexidartinib); Daiichi Sankyo; For the treatment of symptomatic tenosynovial giant cell tumor, Approved August 2019
Venclexta (venetoclax) plus Gazyva (obinutuzumab); Genentech and AbbVie; For the treatment of chronic lymphocytic leukemia or small lymphocytic lymphoma , Approved May 2019
Xpovio (selinexor) ; Karyopharm Therapeutics; For the treatment of adults with relapsed or refractory multiple myeloma , Approved July 2019
Pharmaceutical wholesale products provide savings to clients and customers. Whether you’re in pharmaceutical retail, pharmaceutical supply or home health care, providing the best quality products and services at reasonable prices is the goal.
Health care is expensive for consumers and pharmaceutical suppliers. A trusted pharmaceutical wholesaler keeps costs low, inventory high and gives better buying power to clients. Pharmaceutical wholesalers also provide products for the pharmaceutical retailer. With everything from pain relievers to motor oil available in pharmacies, it’s important to get the best product prices for your retail pharmacy. Wholesale vitamins are big sellers. Pharmacies compete with big box stores, vitamin shops and health food stores for consumer dollars. Getting customers to think of the pharmacy first when purchasing vitamins is a challenge.
Home health care providers rely on wholesale pharmacy supplies for medical equipment, wound care and sterile fields. Wholesale surgical gloves, sterile syringes, bandages and other supplies save patients money.
Pharmaceutical wholesale suppliers will:
- Provide savings on pharmaceutical supplies for pharmaceutical retailers.
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Purchase wholesale pharmacy supplies for retail pharmacy shops
Whether for an independent pharmacy or a part of a pharmacy chain, wholesale pharmacy supplies just make sense as a way to increase revenue and save money.
Purchase medical wholesale supplies to save customers money
Medical supply costs add up quickly for chronically ill patients. Regular purchasers of diabetic testing supplies, insulin syringes, arthritis treatments, joint support devices and incontinence supplies need every opportunity to save money.
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Find a pharmaceutical wholesaler that also deals in wholesale vitamins
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