Nursing implication: Derm:

BEFORE: ~ Advise parents or rash, urticaria.

caregivers to check
concentrations of liquid INDICATION:Mild pain ,Fever
preparations. Errors
have resulted in serious actiON: Inhibits the synthesis of prostaglandins that
liver damage.~ Assess fever; note
presence of associated may
signs (diaphoresis, serve as mediators of pain and fever, primarily in the
tachycardia, and CNS
malaise).
DURING: ~ Adults should not take
Cont` contraindications: Paracetamol:
acetaminophen longer
than 10 days and Contraindications
children not longer than
5 days unless directed
by health care
professional.~ Advise mother or caregiver (None except hypersensitivity to paracetamol).
to take medication
exactly as directed and
not to take more than
the recommended
amount. Paracetamol: Cautions
AFTER: ~ Advise patient to consult
health care professional
if discomfort or fever is
not relieved by routine
doses of this drug or if The antidote acetylcysteine (e.g. fluimucil) must be
fever is greater than administered within 8 to 10 hours when there is
39.5°C (103°F) or lasts intoxication: i.v. infusion of 150 mg/kg in 15
longer than 3 days. minutes, then 50 mg/kg for 4 hours, and then 100
mg/kg for 16 hours in a 5% glucose solution.
EFFECTS: Hema:h em ol yti c
anemia, neutropenia,
leukopenia,
pancytopenia.
Hepa:jaundice Dose:1.2 mL
Metabolic: hypoG q 4 hr PRN,od Class:antipyretics,
GI:HEPATIC FAILURE,
HEPATOT nonopioid ,analgesics
OXICITY brand: Acetaminophen
(overdose) (Paracetamol
GU:renal failure
(high doses/chro
nic use).

Reactions journal: "In conclusion, our data show that in a cohort of patients with severe aplastic anemia receiving
immunosuppressive therapy, telomere length was not associated with response but was associated with risk of
relapse, clonal evolution, and overall survival."
Generic Name for Prednisone

Prednisone 1mg, 2.5mg, 5mg, 10mg, 20mg, 50mg; scored tabs.

Legal Classification:

Rx

Pharmacological Class for Prednisone

Glucocorticoid.

Manufacturer of Prednisone

Various generic manufacturers

Indications for Prednisone

Corticosteroid-responsive disorders.

Adults and Children:

See literature. Initially 5–60mg daily.

Contraindications for Prednisone

Systemic fungal infections. Live vaccines.

Warnings/Precautions for Prednisone

Tuberculosis. Latent amebiasis. Strongyloides infestation. Hypothyroidism. Ocular herpes simplex. Cirrhosis. Renal
insufficiency. If exposed to chickenpox or measles, consider prophylactic passive immune therapy. Ulcerative colitis
if perforation pending. Peptic ulcer. Diverticulitis. Intestinal anastomoses. Myasthenia gravis. Hypertension.
Osteoporosis. Diabetes. Kaposi's sarcoma. Supplement with additional steroids in physiologic stress. Avoid abrupt
cessation. May increase risk and mask signs of infection. May cause electrolyte imbalances, adrenocortical
insufficiency, psychotic derangements. Alternate, intermittent, or single-daily doses at 8AM minimize adrenal
suppression. Use lowest effective dose. Monitor weight, growth, fluid and electrolyte balance. Pregnancy. Nursing
mothers.

Interactions for Prednisone

Barbiturates, hydantoins, rifampin, other hepatic enyzme inducers may decrease effects. Potentiated by
ketoconazole, troleandomycin. Excretion of high-dose aspirin increased. Caution with diuretics, digoxin, aspirin in
hypoprothrombinemia. Potentiated by oral contraceptives. Monitor oral anticoagulants.

Adverse Reactions for Prednisone

HPA axis suppression, increased susceptibility to infection, glaucoma, cataracts, secondary infections, hypokalemia,
hypocalcemia, hypernatremia, hypertension, CHF, psychic disorders, myopathy, osteoporosis, peptic ulcer, dermal
atrophy, increased intracranial pressure, carbohydrate intolerance.
How is Prednisone supplied?Contact supplier.Related Disease:
Corticosteroid-responsive disorders

Mechanism of Action: Glucocorticoids are naturally occurring hormones that prevent or suppress inflammation and
immune responses when administered at pharmacological doses. At a molecular level, unbound glucocorticoids
readily cross cell membranes and bind with high affinity to specific cytoplasmic receptors. This binding induces a
response by modifying transcription and, ultimately protein synthesis to achieve the steroid's  intended action. Such
actions may include: inhibition of leukocyte infiltration at the site of inflammation, interference in the function of
mediators of inflammatory response, and suppression of humoral immune responses. Some of the net effects include
reduction in edema or scar tissue, as well as a general suppression in immune response. The degree of clinical effect
is normally related to the dose administered. The antiinflammatory actions of corticosteroids are thought to involve
phospholipase A2 inhibitory proteins, collectively called lipocortins. Lipocortins, in turn, control the biosynthesis of
potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of the precursor
molecule arachidonic acid. Likewise, the numerous adverse effectsrelated to corticosteroid use are usually related to
the dose administered and the duration of therapy.

Prednisone is the most commonly-prescribed oral corticosteroid. The drug is metabolized in the liver to its active
form, prednisolone. Relative to hydrocortisone, prednisone is roughly 4 times as potent as a glucocorticoid.
Prednisone is intermediate between hydrocortisone and dexamethasone in duration of action. Prednisone is used in
many conditions, including allograft rejection, asthma, systemic lupus erythematosus, and many other inflammatory
states. Prednisone has very little mineralocorticoid activity, so it is not used in the management of adrenal 
insufficiency unless a more potent mineralocorticoid is administered concomitantly. Prednisone was first approved
by the FDA in 1955.

Rebamipide:

Effects:

BACKGROUND: Rebamipide, a gastro-protective drug, acts on stimulation of prostaglandin and mucus

glycoprotein synthesis, inhibition of reactive oxygen species, inflammatory cytokines, and neutrophils activation.

OBJECTIVE: To investigate the effect of rebamipide (mucosta) on healing of gastric ulcer caused by various
etiologies.

MATERIAL AND METHOD: Thirty patients with gastric ulcer underwent gastric antral and body biopsies for
histopathology. Group classifications depended on H. pylori status using CLO test, histology or urea breath test and
history ofNSAIDs taking. All patients received rebamipide 100 mg, three times a day, for 8 weeks. The symptoms
and adverse effects were assessed in 4 weeks and 8 weeks after prescription. At the end of the present study, an
endoscopy was repeated to evaluate ulcer healing and biopsy for gastric inflammation grading.

RESULTS: According to the ulcer cause, there were seven patients with H. pylori+ NSAIDs+, nine patients with H.
pylori + NSAIDs-, three patients with H. pylori - NSAIDs +, and 11 patients with H. pylori - NSAIDs-. The ulcers
were completely healed in most patients with a history of NSAIDs use. There was a significant improvement of
symptom scores from baseline in all groups (5.9 vs. 0.6, p < 0.001). The improvement of gastric inflammation
scores were favorable in NSAIDs users (2.38 vs. 1.75, p = 0.011). All patients were satisfied as there were few
adverse effects.

CONCLUSION: Rebamipide is effective and well tolerated for treatment of gastric ulcers especially those caused by
NSAIDs, as it promotes the improvement of gastric inflammation scores, clinical symptoms, and ulcer healing.
Indication & Dosage
Oral
Peptic ulcer, Gastritis
Adult: 100 mg tid, in the morning, evening and before bed.
Contraindications
Lactation.
Special Precautions
Pregnancy, elderly and children.
Adverse Drug Reactions
Rash, pruritus, constipation, diarrhoea, nausea.
Mechanism of Action
Rebamipide is a mucosal protective agent and is postulated to increase gastric blood flow, prostaglandin
biosynthesis and decrease free oxygen radicals.
MIMS Class
Antacids, Antireflux Agents & Antiulcerants

Shorter Biological Marker Length in Aplastic Anemia Patients Linked to Higher

Relapse, Death Rates
Severe aplastic anemia is characterized by life-threatening cytopenias (blood cell count
below normal), but this condition can be treated by bone marrow transplantation or
immunosuppressive drugs. In older patients, and when an appropriate matched sibling
donor is not available, immunosuppression can be effective, although relapse and
clonal evolution (the appearance of chromosome abnormalities in bone marrow cells
that accompany hematologic malignancy) can occur in many patients, according to
background information in the article. Recently, target cell abnormalities have been
identified as risk factors in bone marrow failure. "Mutations in telomerase complex
genes resulting in extremely short telomeres have been described in some patients with
apparently acquired severe aplastic anemia," the authors write. Telomeres, a structure
at the end of a chromosome that shortens with each cell division, function as protective
caps to prevent erosion of genomic DNA during cell division. Genetic factors and
environmental stressors can shorten the length of the telomere.

Phillip Scheinberg, M.D., of the National Institutes of Health, Bethesda, Md., and
colleagues conducted a study to determine the effect of telomere attrition in acquired
severe aplastic anemia by measuring telomere length prior to immunosuppressive
therapy. The study included 183 patients with severe aplastic anemia who were treated
from 2000 to 2008. The pretreatment leukocyte (white blood cells involved in defending
the body against infectious disease) age-adjusted telomere length of patients with
severe aplastic anemia enrolled in immunosuppression protocols was analyzed for
correlation with clinical outcomes.

One hundred and four patients (57 percent) responded to immunosuppressive therapy.
The researchers found that there was no correlation between telomere length
(measured pretreatment) and the probability of response to the therapy. The response
rate for patients in the first quartile (shortest telomere lengths) was 56.5 percent; in the
second quartile, 54.3 percent; in the third quartile, 60 percent; and in the fourth quartile,
56.5 percent. Additional analysis demonstrated that telomere length was associated
with relapse, clonal evolution, and mortality. Telomere length was inversely correlated
with the probability of disease relapse. The probability of clonal evolution was higher in
patients in the first quartile (24.5 percent) than in quartiles 2 through 4 (8.4 percent).

"Survival between these 2 groups differed, with 66 percent surviving 6 years in the first
quartile compared with 83.8 percent in quartiles 2 through 4," the researchers write.

Reaction: