KNH 188 September 3 Lecture 3 Outline

KNH 188 September 3 Lecture 3 Outline - Lecture 3 Thursday...

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Unformatted text preview: Lecture 3 Thursday 3 September: Summary Part I. Three Things to Remember about “side effects” First, all drugs have them Second, they are dose dependent Third, they are relative to what you want #1 Every Drug Has “Side Effects”: Even Placebos Placebo: L. “to please” a harmless substance given to patient to control for non-specific effects of receiving medication (psychological?) #2 Side effects are dose dependent “Dosis Facit Venenum” Paracelsus (1493-1541) Two Examples of side effects of…. Example 1: Cerebral Edema: Consequences Causes Cerebral Edema…. Water Intoxication Hyponatremia, Cerebral Edema, and Non-cardiogenic Pulmonary Edema in Marathon Runners. Avus, Varon & Arieff. Ann Internal Med. 2000; 132: 711-714 Example 2: Retrolental Fibroplasia Abnormal replacement of the sensory retina by fibrous tissue and blood vessels, resulting in blindness. Causes Retrolental Fibroplasia… Oxygen Toxicity Effects: Blindness caused by inadequate development of the capillaries in the lens and retina of the eye (premature infants). Pulmonary edema #3 Effects & Side Effects are Relative: What Do You Want? Side Effects: The Expected & Unexpected. Four examples: Example # 1: Prozac Example In 1985, the controversial antidepressant drug Prozac was marketed in Belgium, and in 1988 it was introduced in the United States. By 1999 sales of Prozac exceeded $28 billion. Eli Lilly was deriving one quarter of its sales from Prozac. Prozac & Side Effects Prozac Fifteen percent of approximately 4000 patients who received fluoxetine in North American clinical trials discontinued treatment due to an adverse event. These included: a. Anorexia b. tremor nervousness c. Sexual problems-decreased libido & delayed ejaculation Prozac: New Treatment Targets Prozac: Antibulimic Appetite Suppressant Antidepressants used to treat premature ejaculation include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac). American Society for Reproductive Medicine Example #2 Minoxidil (Loniten): Treatment for Hypertension Minoxidil should be reserved for the treatment of severe hypertension resistant to other drugs. Non-therapeutic Effects and Toxicities: Reflex sympathetic stimulation and sodium and fluid retention. Headache. Palpitations. Sweating. Flushing. Hypertrichosis. New use based on a side effect: Minoxidil (Rogaine): Treatment for Hair Loss Rogaine for Men Triple Pack. Rogaine Products containing Minoxidil. They have been medically proven to regrow hair. Without doubt, the most active hair care product available over the counter. Example #3 Sildenafil: Example Hemodynamic Effects in Men With Severe Coronary Artery Disease Howard C. Herrmann, M.D., Gene Chang, M.D., Bruce D. Klugherz, M.D., and Paul D. Mahoney, M.D. New Eng. J. Med Volume 342:1622-1626, June 1, 2000, Number 22 Coronary flow reserve …increased about 13 percent in both groups of arteries combined after the administration of sildenafil Sildenafil: A New Role Sildenafil citrate, marketed as Viagra® was approved as a drug for treating male erectile dysfunction (ED) by the US Food and Drug Administration on 27 March 1998. Side Effect: Vasodilation; hypotension Example #4: Testosterone Enanthate Main Effect: Increased muscle size, & strength Side effect: a common scare tactic “Makes you sterile” Users average about 20 million sperm/ml vs 84 million/ml in nonusers Oral Contraceptive Pill For Men May Only Be Five Years Away The pill is made up of a combination of the male sex hormone testosterone and desogetrel, a synthetic steroid which temporarily inhibits sperm production. Main Effect: Male Contra-ceptive & paradoxically used to treat infertility-rebound effect Side Effects: acne; weight gain (surprise!) Part II. Continuation of “Why are we here” the background for the belief that factors other than Continuation traditional medicine is instrumental in our health and longevity. Ok, so there is a large interest in Lifestyle & PA (for good reason). So what are we supposed to Ok, accomplish as individuals and a Nation? individuals Nation Will one size fit all? That is, do all groups (all Americans) have the same health issues? Will the goals we set as a Nation be suitable for all of the variety of ethnic, geographic and goals socioeconomic groups in the USA? socioeconomic National Health Objectives 2010 If these objectives can be achieved it may reduce the economic cost of health problems present in the country. The rationale is that the Nation as a whole will be strengthened by achieving these the objectives. objectives. http://www.healthypeople.gov/document/default.htm Goal 1: Increase Quality & Years of Life Goal The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy all increase and improve their quality of life. and quality Goal 2: Eliminate health disparities The second goal of Healthy People 2010 is to eliminate health disparities among The eliminate segments of the population. What is meant by health disparities? A look at differences across countries can illustrate this point? Why do they live so long in Japan? Hard to tell, since there are so many differences Why Hard between Japan and the USA. Literally comparing apples and oranges. Japan is faily between homogenous WE ARE NOT. homogenous What are some of the health issues that distinguish the various ethnic and socioeconomic groups in the U.S.A.? socioeconomic For Example… What is the # 1 killer in the U.S.A.? Top ten killers in the USA Some Disparities: Leading Causes of Death Morbidity and Mortality Weekly Report for January 14th * 2001 Stats 2001 Factors involved in health disparities among various demographic groups in the United States. United What makes these groups different? What differences exist in the USA? Sources of Health Disparities Income Education (proxy for income) see next figure Gender Race & Ethnicity Geographical Location Sexual Orientation Health Status & Income: One Source of Disparity Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Statistics. National Health Interview Survey. 1995. Educational Level & Income Worst health-Highest poverty rate. Why? Higher Income: What does it allow? Gender aka Sex (the noun) Cancer's Geography in the USA Cancer's *Some questions from material to date: *Some What is Olympic style weightlifting? Specifically what lifts or movements is competition based on? based What athletic capabilities or skills are required in these lifts besides strength (duh)? Who was John Ziegler, M.D. and what did he do? * Please do not ask me the answers to these questions. I will only confirm your answers. Please ...
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