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Rhabdomyolysis:  'rhabdo' if you are in the know

10/19/2012

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wildfireworld.org/2011/09/health-the-new-dirty-word-in-wildland-fire-rhabdomyolysis/

When muscle is damaged, a protein called myoglobin is released into the bloodstream. It is then filtered out of the body by the kidneys. Myoglobin breaks down into substances that can damage kidney cells.

Meds that increase risk for rhabdo
http://en.wikipedia.org/wiki/Rhabdomyolysis
"Many medications increase the risk of rhabdomyolysis. The most important ones are:[1][2][6]
  • Statins and fibrates, both used for elevated cholesterol, especially in combination; cerivastatin (Baycol) was withdrawn in 2001 after numerous reports of rhabdomyolysis.[8] Other statins have a small risk of 0.44 cases per 10,000 person-years.[9] Previous chronic kidney disease and hypothyroidism increase the risk of myopathy due to statins. It is also more common in the elderly, those who are severely disabled, and when statins are used in combination with particular other medicines, such as ciclosporin.[8][9]
  • Antipsychotic medications may cause neuroleptic malignant syndrome, which can cause severe muscle rigidity with rhabdomyolysis and hyperpyrexia
  • Neuromuscular blocking agents used in anesthesia may result in malignant hyperthermia, also associated with rhabdomyolysis
  • Medications that cause serotonin syndrome, such as SSRIs
  • Medications that interfere with potassium levels, such as diuretics"

Complications of rhabdo (besides kidney damage)
http://www.emedicinehealth.com/rhabdomyolysis/article_em.htm:
"Significant muscle injury can cause fluid and electrolyte shifts from the bloodstream into the damaged muscle cells, and in the other direction (from the damaged muscle cells into the bloodstream). As a result, dehydration may occur. Elevated levels of potassium in the bloodstream (hyperkalemia) may be associated with heart rhythm disturbances and sudden cardiac death due to ventricular tachycardia and ventricular fibrillation.

Complications of rhabdomyolysis also include disseminated intravascular coagulation, a condition that occurs when small blood clots begin forming in the body's blood vessels. These clots consume all the clotting factors and platelets in the body, and bleeding begins to occur spontaneously.

When muscles are damaged, especially due to a crush injury, swelling within the muscle can occur, causing compartment syndrome. If this occurs in an area where the muscle is bound by fascia (a tough fibrous tissue membrane), the pressure inside the muscle compartment can increase to the point at which blood supply to the muscle is compromised and muscle cells begin to die."

My experience:
I have taken care of a couple compartment syndrome patients due to rhabdo, and it is not pretty.  Surgeons have to filet the muscle open to release the pressure and leave it open until the swelling goes down.  I had to do dressing changes on the open muscle.  The poor patients were in so much pain from having me touch the dressings to their exposed muscle.  I couldn't be gentle enough to spare them pain. 

So now I want to spare anyone the pain of getting rhabdo.  Statins (cholesterol lowering drugs) can cause rhabdo.  Statins frequently cause muscle pain.  That muscle pain is the breakdown of muscle tissue. 

Before you take cholesterol lowering drugs, ask yourself the questions that the Mayo Clinic suggests in my previous post:

Weighing the risks and benefits of statins:
When thinking about whether you should take statins for high cholesterol, ask yourself these questions:

  • Do I have other risk factors for cardiovascular disease?
  • Am I willing and able to make lifestyle changes to improve my health?
  • Am I concerned about taking a pill every day, perhaps for the rest of my life?
  • Am I concerned about statins' side effects or interactions with other drugs?


Good luck.  Good health to you!


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Mayo Clinic advice on statins

10/18/2012

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google image from: www.regenexx.com
Statins are drugs given to lower cholesterol.

This post is copied from the The Mayo Clinic website http://www.mayoclinic.com/health/statins/CL00010

Weighing the risks and benefits of statins When thinking about whether you should take statins for high cholesterol, ask yourself these questions:

  • Do I have other risk factors for cardiovascular disease?
  • Am I willing and able to make lifestyle changes to improve my health?
  • Am I concerned about taking a pill every day, perhaps for the rest of my life?
  • Am I concerned about statins' side effects or interactions with other drugs?
It's important to take into account not only your medical reasons for a decision, but also your personal values and concerns. Talk to your doctor about your total risk of cardiovascular disease and discuss how your lifestyle and preferences play a role in your decision about taking medication for high cholesterol.


Potentially serious side effects

  • Liver damage. Occasionally, statin use causes an increase in liver enzymes. If the increase is only mild, you can continue to take the drug. Rarely, if the increase is severe, you may need to stop taking it. Certain other cholesterol-lowering drugs, such as gemfibrozil (Lopid) and niacin (Niacor, Niaspan), increase the risk of liver problems even more in people who take statins.

    Although liver problems are rare, your doctor will likely order a liver enzyme test before or shortly after you begin to take a statin. You shouldn't need any additional liver enzyme tests unless you begin to have signs or symptoms of trouble with your liver. Contact your doctor immediately if you have unusual fatigue or weakness, loss of appetite, pain in your upper abdomen, dark-colored urine, or yellowing of your skin or eyes.

  • Muscle problems. Statins may cause muscle pain and tenderness (statin myopathy). The higher the dose of statin you take, the more likely you are to have muscle pains. In severe cases, muscle cells can break down (rhabdomyolysis- a rare condition that causes muscle cells to break down.) and release a protein called myoglobin into the bloodstream. Myoglobin can damage your kidneys. Certain drugs when taken with statins can increase the risk of rhabdomyolysis. These include gemfibrozil (Lopid), erythromycin (Erythrocin), antifungal medications, nefazodone, cyclosporine (Restasis, Sandimmune) and niacin (Niacor, Niaspan). If you take statins and have new muscle aching or tenderness, check with your doctor.
  • Increased blood sugar or type 2 diabetes. It's possible your blood sugar (blood glucose) level may increase when you take a statin, which may lead to developing type 2 diabetes. The risk is small, but important enough that the Food and Drug Administration (FDA) requires a warning on statin labels regarding blood glucose levels and diabetes. Despite this possible connection between increased blood sugar and statin use, it's still safe for most people with high cholesterol, including diabetics, to take statins. Talk to your doctor if you have concerns.
  • Neurological side effects. Some researchers have studied whether statins could be linked to memory loss or amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease. While there's little evidence that statins can cause ALS, the FDA says some people who take statins have developed memory loss or confusion while taking statins. These side effects reverse once you stop taking the medication. Talk to your doctor if you experience memory loss or confusion. Don't stop taking your statin medication before talking to your doctor.
It's important to consider the effects of statins on other organs in your body, especially if you have health problems such as liver or kidney disease. Also, check whether statins interact with any other prescription or over-the-counter drugs or supplements you take.

Keep in mind that when you begin to take a statin, you'll most likely be on it for the rest of your life. Side effects are often minor, but if you experience them, you may want to talk to your doctor about decreasing your dose or trying a different statin. Don't stop taking a statin without talking to your doctor first.


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Prevent tardive dyskinesia: don't take Reglan.  Don't give Reglan to babies or children

10/16/2012

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Tardive Dyskinesia- repetitive, involuntary, purposeless movements.  Grimacing, tongue protrusion,  lip smacking, rapid eye blinking and rapid involuntary movements of the limbs may occur.  Walking may become difficult. 

In some variant extreme cases, affected individuals lose their ability to sit still.  Tardive dyskinesia is often misdiagnosed as a mental illness or ADHD. 

The facts are all there in wikipedia. http://en.wikipedia.org/wiki/Tardive_dyskinesia  And in the FDA black label website.http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm170934.htm  And in attorney websites looking for victims to sue the makers of Reglan.
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Tardive Dyskinesia- I am imagining what it looks like. It is similar to tourettes syndrome with tics and involuntary movements.
The other morning 'tardive dyskinesia' popped into my head.  I thought, "That's weird." 

I remembered learning about tardive dyskinesia in my psych class in nursing school.  It happens to patients who are on long term psych meds.  I recognized it in a few patients in the lock-down unit of a nursing home I once worked at when I was a CNA.  That was a long time ago.

Why did tardive dyskinesia pop into my head today?    I googled it.

I saw an attorney website claiming that Reglan causes tardive dyskinesia and would anyone like to sue the makers of Reglan?  Call that attorney.  That's weird, i gave Reglan all the time as nurse to patients in the hospital.  It was standard.  I wondered if it was likely my patients were affected.

I found more websites, like the FDA website that reports Reglan is highly linked to tardive dyskinesia.  I read that tardive dyskinesia is permanent.  You can stop taking Reglan, but the tongue protrusions, grimacing and involuntary movements don't go away.  That is sad.  Socially debilitating. 

Then I found a slew of sites that blew my mind!

Women are advised to take Reglan to increase breast milk!  What?!!

Does it get into the breastmilk?   Yes, one site said, but not more than is normally given to babies with reflux.  

What?!!!  Reglan is given to babies?

No, no, no!  Is it worth the risk of permanent neurological damage to have more breast milk?  There are herbs and stress reduction techniques that can increase breast milk.  There are gentler ways to deal with infant reflux.   Why give prescription chemicals to a baby that risk permanent damage?  Why even give a small dose?  Why even give for a shorter time than it takes to get permanent damage? 

If it takes 12 weeks to get noticeable permanent damage, less than 12 weeks does not cause any damage at all?  It doesn't make sense.  Any dose for any length of time begins to cause changes in the brain that are noticeable and permanent after only 12 weeks.  It doesn't sound safe to me.  Tardive dyskinesia occurs in a large enough portion of the population that the FDA has made black box warnings.  Feeble warnings.  Warnings that no one is even aware of.

How many babies and children already have tardive dyskinesia but are misdiagnosed?  

Maybe it is not many...but if it is you or your precious little one, it is one too many.
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How prescription drugs cause sudden death

10/3/2012

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If you would like to understand how prescription drugs can cause sudden death, keep reading.  It is a little technical, but I think you can get it.  Please let me know if you would like more detail.  :-)   

 Most healthcare professionals are not aware: There are many drugs that induce QT prolongation and torsades de pointes!  Government agencies are aware:

US National Library of Medicine  and the National Institutes of Health said this:
  • Drug induced QT prolongation and torsades de pointes are an increasing public health problem
"If torsades de points is rapid or prolonged, it can lead to ventricular fibrillation and sudden cardiac death."  
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767957/  


What is QT prolongation and torsades de points?
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To understand torsades, you have to learn a little physiology: 

Electricity causes the heart to beat.  EKGs show a picture of the electricity that moves through the heart. 

The waves and dips on a normal EKG strip each have a letter name: the P wave, the QRS complex and the T wave.

Measuring the intervals between the segments gives an idea of how efficiently each electrical impulse moves through the heart. 

As an ICU nurse I measured and documented the PR interval, the QRS complex and the QT interval on every patient every four hours while they were in the ICU.

If the electricity does not move fast enough or gets blocked, the heart does not beat properly. 

Sometimes slowed or blocked pathways cause fatal heart rhythms.  One of the fatal heart rhythms is torsades de pointes.

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Torsades is a crazy heart rhythm that is not sustainable.  It is too fast for blood to adequately fill the chambers and get pumped out to the body.  In torsades, the head and heart do not get supplied with fresh blood and oxygen.  Within minutes fainting and death occur.   

Long QT syndrome is when the resting phase of the heart is elongated.  A long QT interval puts a person at risk for torsades.  Some people are born with long QT syndrome. 

Some drugs have been found to prolong the QT interval.  This can be dangerous for someone who already has a long QT.  A prolonged QT interval can develop into torsades de pointes, which can cause sudden death.  The chances of a drug-induced fatal heart rhythm are very small in normal healthy adults.  But the elderly, children and babies are more susceptible to drug-induced QT prolongation.  

Some drugs affect the normal beating of the heart and we don't even know it.

At QTDrugs.org I found:  "AZCERT is an independent non-profit research and education organization that supports CredibleMeds, an educational program to improve therapeutic outcomes and reduce adverse events caused by drug interactions and drugs that cause heart arrhythmias."   They have studied patients born with long QT syndrome to find out which drugs are safe and which can be fatal for congenital long QT syndrome.  In the process, they have found hundreds of drugs which have risks for QT prolongation,  possible risks and risks under certain conditions.

What does this mean?  Many of the drugs we think are completely harmless have been linked with QT prolongation!  That means these drugs prolong the resting phase of the heart.  These drugs have the potential to change the heart rhythm.  Millions of healthy people take these drugs and don't notice a thing.  At risk are the elderly and the very young and those who have long QT syndrome to begin with.
I pulled these familiar drugs from the 'high risk' for TorsadesdePoint list:

Erythromycin Erythrocin®

Azithromycin Zithromax®

Haloperidol Haldol®

Droperidol Inapsine®

Thioridazine Mellaril®

Pentamidine NebuPent®

Disopyramide Norpace,

Pimozide Orap®

Amiodarone Pacerone®

Amiodarone Cordarone®,

Pentamidine Pentam®

Procainamide Pronestyl®

Cisapride Propulsid®
 
Quinidine Quinaglute®

Terfenadine Seldane®

Mesoridazine Serentil®

Flecainide Tambocor®

Chlorpromazine Thorazine


I pulled these from the 'possible' risk of torsades list:

Famotidine Pepcid®

Oxytocin Pitocin®

Venlafaxine Effexor®

Escitalopram Lexapro®

Levofloxacin Levaquin®

Lithium Lithobid®

Lithium Eskalit


I pulled these familiar drugs from the 'risk of torsades under certain conditions' list:

Diphenhydramine Benadryl® Antihistamine / Allergic rhinitis, insomnia Risk of QT increase/torsades in overdosages

Diphenhydramine Nytol® Antihistamine / Allergic rhinitis, insomnia Risk of QT increase/torsades in overdosages

Paroxetine Paxil® Anti-depressant / depression

Sertraline Zoloft® Anti-depressant / depression

Fluoxetine Prozac® Anti-depressant / depression

Fluoxetine Sarafem® Anti-depressant / depression

Fluconazole Diflucan® Anti-fungal /Drug interaction risk- metabolic inhibitor. Can also increase QT at high doses - 800 mg/day

Amitriptyline Elavil® Tricyclic Antidepressant / Risk of TdP with overdosage

Ciprofloxacin Cipro® Antibiotic / bacterial infection Drug interaction risk - metabolic inhibitor

Trimethoprim-Sulfa Septra® or Bactrim® Antibiotic / bacterial infection Also available in DS (double strength)

Clomipramine Anafranil® Tricyclic Antidepressant

Desipramine Pertofrane® Tricyclic Antidepressant / Risk of TdP with overdosage

Doxepin Sinequan® Tricyclic Antidepressant

Imipramine Norfranil® Tricyclic Antidepressant / TdP risk with excess dosage

Itraconazole Sporanox® Anti-fungal / fungal infection Drug interaction risk - metabolic inhibitor

Ketoconazole Nizoral® Anti-fungal / fungal infection Prolongs QT & Drug interaction risk - metabolic inhibitor.

Nortriptyline Pamelor® Tricyclic Antidepressant

Protriptyline Vivactil® Tricyclic Antidepressant

Ritonavir Norvir® Protease inhibitor / HIV

Solifenacin VESIcare® / treatment of overactive bladder

Trazodone Desyrel® Anti-depressant / insomnia

Trimipramine Surmontil® Tricyclic Antidepressant
US National Library of Medicine
National Institutes of Health
Drug induced QT prolongation and torsades de pointes: key points
  • Drug induced QT prolongation and torsades de pointes are an increasing public health problem
  • Antiarrhythmic drugs, non-sedating antihistamines, macrolides antibiotics, antifungals, antimalarials, tricyclic antidepressants, neuroleptics, and prokinetics have all been implicated in causing QT prolongation and/or torsades de pointes
  • Co-administration of multiple drugs, especially with other QT prolonging drug(s) and/or hepatic cytochrome P450 CYP3A4 isoenzyme inhibitors, must be avoided, [drugs that impair the liver...which is most cholesterol lowering drugs]
  • The risk of QT prolongation is increased in females, patients with organic heart disease (for example, congenital long QT syndrome, myocardial infarction, congestive heart failure, dilated cardiomyopathy, hypertrophic cardiomyopathy, bradycardia), hypokalaemia [low potassium,  which happens when a person has is dehydrated or has diarrhea]   and hepatic impairment
  • The treatment of drug induced torsades de pointes includes identifying and withdrawing the offending drug(s), replenishing the potassium concentration to 4.5–5 mmol/l, and infusing intravenous magnesium (1–2 g). In resistant cases, temporary cardiac pacing may be needed
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Adverse Drug Reactions

10/3/2012

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This is not to scare you.  This is to inform you so you can know the risks (if you want to know them) and make better decisions that you are happy with. 

If you don't want to know the risks, you better leave right now, ha ha!

I am building this site to inform you about harmful drug reactions that the drug companies don't want you to know about. 

Most doctors are too busy to be able to properly discuss all the problems with the meds they are prescribing.  Sometimes patients who know about all the possible side effects will probably experience them just by the placebo effect, so it's better if we don't bring it up.  Right?

Well I am bringing it up. 

I hope you will come back as I develop the list.

Here are a few adverse reactions to get started with:

NSAIDS: Non-steroidal anti-inflammatory drugs  such as most arthritis medications, and ibuprophen (and aspirin) are so highly linked to severe gastrointestinal bleeding that it has developed its' own disease name: NSAID Gastropathy

Oral contraceptives and Hormone Replacement Therapy are highly linked to blood clots, strokes and heart attacks, but we already know that, right?

Statins: cholesterol lowering drugs are highly linked to liver problems like hepatitis, severe muscle degeneration and early dementia

Macrolide antibiotics like Erythromycin is linked to hepatitis and long QT syndrome. 

Pepcid, Effexor, Zoloft, Paxil and many antidepressants are linked with QT prolongation under certain conditions.

The QT interval is the resting phase of the heart rhythm. Prolongation of the QT interval elongates the resting phase of the heart.  Congenital long QT syndrome is when someone is born with a long QT interval.  It is linked to torsades de pointe, which is an unsustainable heart rhythm.  QT prolongation and the chances of a drug-induced fatal heart rhythm are very small in healthy adults.  But the elderly, children and babies are susceptible.   Many of these drugs affect the normal beating of the heart and we don't even know it.

What does this mean?  Many of the drugs we think are completely harmless have been linked with QT prolongation!  That means these drugs prolong the resting phase of the heart. Many of these drugs affect the normal beating of the heart and we don't even know it!

These drugs have the potential to change the heart rhythm.  Millions of healthy adults take these drugs and don't notice a thing.  At risk are the elderly and the very young and those who have long QT syndrome to begin with. 

Who knows how many babies on Propulsid for reflux died not from SIDS, but from a prolongated QT?  Or how many of the elderly on Propulsid for GERD died not from a sudden heart attack but from drug-induced torsades?  Those stats will never be known.  No one reports it, if it can be explained as SIDS or a heart attack.  For years there hasn't been a way to report it.  Doctors hate to think a harmless drug they prescribed everyday could cause sudden death.  Drug companies squash that information.

To ease your mind, millions and millions of people take these drugs and don't instantly die.  The statistics show that the drugs are relatively safe compared to the millions of people who take them.  
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Adverse Drug Reactions

10/3/2012

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Adverse drug reactions are unintended, harmful reactions to medicines.  According to the world Health Organization, adverse drug reactions are among the leading causes of death in many countries.  


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    Adverse Drug Reactions

    Adverse drug reactions are unintended, harmful reactions to medicines. 

    According to the world Health Organization, adverse drug reactions are among the leading causes of death in many countries.

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