DOCSLIB.ORG

Which Diuretics Are Safe and Effective for Patients with a Sulfa Allergy?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Which Diuretics Are Safe and Effective for Patients with a Sulfa Allergy? From the CLINIcAL InQUiRiES Family Physicians Inquiries Network Ron Healy, MD University of Washington, Which diuretics are safe Seattle; Alaska Family Medicine Residency, Anchorage and effective for patients Terry Ann Jankowski, MLS University of Washington, Seattle with a sulfa allergy? Evidence-based answer Diuretics that do not contain a sulfonamide subsequent allergic reactions to commonly group (eg, amiloride hydrochloride, used sulfonamide-containing diuretics eplerenone, ethacrynic acid, spironolactone, (eg, carbonic anhydrase inhibitors, loop and triamterene) are safe for patients with an diuretics, and thiazides) (strength of allergy to sulfa. The evidence is contradictory recommendation: C, based on case series ® as to whether a history Dowdenof allergy to Healthand poor Media quality case-control and cohort sulfonamide antibiotics increases the risk of studies). Copyright Clinical commentaryFor personal use only Are all sulfa drugs created equal? agents and off-patent, with no company Historical bromides commonly fall by the to take up their cause, no one has been FAST TRACK wayside as better evidence becomes willing to challenge outdated package Reasonable available. Who would have thought 15 insert warnings. years ago that we would be promoting As clinicians who regularly work evidence supports beta-blockers for patients with congestive without a net, we are accustomed to what many of us heart failure? prescribing medications in less than ideal are doing: Using Likewise, with closer inspection, we circumstances. Thankfully, reasonable cheap thiazides have learned that not all sulfa drugs are evidence is available to support what many created equal. The stereospecificity due of us are already doing—using cheap for patients to the absence of aromatic amines in thiazides for patients despite a history of with a history common diuretics means they are safe sulfa allergy. for patients with known sulfa antibiotic Brian Crownover, MD, FAAFP of sulfa allergy 96 MDG Family Medicine Residency, allergies. Given that diuretics are older Eglin Air Force Base, Fla z Evidence summary hydrochlorothiazide, and indapamide). Little research has been performed Hypersensitivity reactions occur when on sulfonamide antibiotic and sulfon- the aromatic amine group is oxidized amide diuretic allergic cross-reactivity. into hydroxylamine metabolites by the What we do know is that there are 2 liver. Sulfonamides that do not contain classes of sulfonamides—those with an this aromatic amine group undergo dif- aromatic amine (the antimicrobial sul- ferent metabolic pathways, suggesting fonamides) and those without (eg, the that allergic reactions that do occur in diuretics acetazolamide, furosemide, this group are not due to cross-reactivity 488 VOL 56, NO 6 / JUnE 2007 THE JOURNAL OF FAMILY PRACtICE For mass reproduction, content licensing and permissions contact Dowden Health Media. Diuretics for patients with sulfa allergy in sulfa-allergic patients. But that point When the results were adjusted for is far from settled by the research. age, sex, history of asthma, use of medi- cations for asthma or corticosteroids, the On one side, a large cohort study adjusted odds ratio for individuals ex- shows some cross-reactivity periencing an allergy to a nonantibiotic A large retrospective cohort study us- sulfonamide in those persons with a his- ing Britain’s General Practice Research tory of allergy to a sulfonamide antibiotic Database identified 20,226 patients seen was 2.8 (95 % CI, 2.1–3.7). Of note, the from 1987 through March 1999 who adjusted odds ratio for the occurrence were prescribed a systemic sulfonamide of a penicillin allergy in a patient with a antibiotic, and then at least 60 days later history of sulfonamide antibiotic allergy received a nonantibiotic sulfonamide (eg, was significantly higher at 3.9 (95% CI, thiazide diuretic, furosemide, oral hypo- 3.5–4.3). glycemic).1 Researchers reviewed records Some limitations of the study includ- to determine whether patients described ed uncertainty of cause and effect of pre- as having an allergic reaction to a sulfon- scribed medications and subsequent reac- amide antibiotic were at increased risk of tions, possible inconsistency of physician having a subsequent allergic reaction to diagnosis and coding, and lack of precision a sulfonamide nonantibiotic. in the diagnosis of allergic reactions. There Patients were identified as being al- is also the possibility of “suspicion bias,” lergic using both narrow definitions where patients with a history of allergies (anaphylaxis, bronchospasm, urticaria, may be more closely monitored for subse- laryngospasm, or angioedema) and quent reactions than nonallergic patients. broad ones. As only 18 patients out of the 20,226 patients were reported as On the other side, small studies having an allergic reaction using the nar- reveal little risk of cross-reaction row definition, analysis was based on Researchers involved in a retrospective the broad definition. Added to the broad study of 363 hospital charts examined category were asthma, eczema, and oth- 34 patients with a self-reported history of FAST TRACK er “adverse” drug effects that were not sulfa allergy who were subsequently giv- The odds of specified by the author. en acetazolamide (a carbonic anhydrase Using this broad definition, research- inhibitor), furosemide (a loop diuretic), an allergy to ers identified allergies to sulfonamide an- or both.2 The nature of the self-reported a nonantibiotic tibiotics in 969 patients. Of this group, 96 sulfa allergic reaction was documented sulfonamide more patients (9.9%) had a subsequent reaction in 79% of the 34 patients. These re- than doubled to a sulfonamide nonantibiotic, which in- ported reactions included urticarial rash, cluded drugs from the loop and thiazide nonspecified rash, dyspnea, swelling, if the patient had diuretic classes (including bumetanide, nausea or vomiting, throat swelling, red a history of allergy chlorothiazide, furosemide, hydrochloro- eyes, and bullae. Two patients who were to a sulfonamide thiazide, indapamide, and torsemide). It given acetazolamide developed urticaria. was unclear if any patients taking a car- No allergic reactions occurred for those antibiotic bonic anhydrase inhibitor experienced patients given furosemide. an allergic reaction. For comparison pur- The researchers concluded that there poses, of the 19,257 patients who were was little clinical or pharmacological not identified as having an allergy to a evidence to suggest that a self-reported sulfonamide antibiotic, again using the sulfa allergy was likely to produce a life- broad definition, 315 (1.6%), had a sub- threatening cross-reaction with acetazol- sequent allergic reaction to a sulfonamide amide or furosemide. Small numbers and nonantibiotic, for an unadjusted odds ra- the lack of a standard definition for an tio of 6.6 (95% confidence interval [CI], allergic reaction limited the strength of 5.2–8.4). their conclusion. C O NTIN UE D www.jfponline.com VOL 56, NO 6 / JUnE 2007 489 ES i R i QU n I A small single-blind study of 28 pa- A literature review of Medline from tients with a history of fixed drug erup- 1966 to early 2004 revealed 21 case se- AL c tion to sulfonamide antibiotics examined ries, case reports, and “other articles” the usefulness of patch testing as an al- that evaluated the presence of cross-reac- ternative to controlled oral challenge test- tivity.4 When the authors of this literature CLINI ing.3 Before patch testing, a sulfonamide reviewed drilled down to diuretics, they antibiotic allergy was confirmed by each found 5 case reports for cross-reactivity patient with an oral challenge of sulfa- to acetazolamide, 2 case reports for furo- methoxazole, sulfadiazine, or sulfameth- semide, 1 case series, and 2 case reports azole. Potential cross-reactivity to several for indapamide (a thiazide diuretic). nonantibiotic sulfonamides (including After reviewing the studies, the authors furosemide) was also investigated using concluded that little evidence suggested a controlled oral challenge testing of these problem with cross-reactivity either with agents. Every patient tolerated a subse- acetazolamide or furosemide and that quent oral challenge with furosemide. there may be an association of cross- reactivity between sulfonamide antibi- Literature reviews limited otics and indapamide. This study was by small numbers limited by its small numbers and lack of Two literature reviews examined the small explicit critical appraisal. number of case series, case reports, and In another literature review—in “other articles” and concluded little evi- which the main focus was cross-reac- dence supports the presence of cross-re- tivity between sulfonamide antibiotics activity between sulfonamide antibiotics and celecoxib—the authors concluded and non-sulfonamide antibiotics.4,5 These that little evidence supported definitive reviews were limited by their search crite- cross-reactivity between sulfonamide ria and lack of explicit critical appraisal. antibiotics and diuretics.5 The limita- tions of this study were similar to those of the previous study. Recommendations from others The manufacturer insert for furosemide states, under the heading “General Pre- cautions,” that “patients allergic to sul- fonamides may also be allergic to furo- semide.”6 A similar warning occurs for hydrochlorothiazide under the heading “Contraindications.”7 n References 1. Strom BL, Schinnar R, Apter AJ, et al. Absence of cross-reactivity between sulfonamide antibiotics
Load more

Recommended publications
  • National Antibiotic Consumption for Human Use in Sierra Leone (2017–2019): a Cross-Sectional Study
    Tropical Medicine and Infectious Disease Article National Antibiotic Consumption for Human Use in Sierra Leone (2017–2019): A Cross-Sectional Study Joseph Sam Kanu 1,2,* , Mohammed Khogali 3, Katrina Hann 4 , Wenjing Tao 5, Shuwary Barlatt 6,7, James Komeh 6, Joy Johnson 6, Mohamed Sesay 6, Mohamed Alex Vandi 8, Hannock Tweya 9, Collins Timire 10, Onome Thomas Abiri 6,11 , Fawzi Thomas 6, Ahmed Sankoh-Hughes 12, Bailah Molleh 4, Anna Maruta 13 and Anthony D. Harries 10,14 1 National Disease Surveillance Programme, Sierra Leone National Public Health Emergency Operations Centre, Ministry of Health and Sanitation, Cockerill, Wilkinson Road, Freetown, Sierra Leone 2 Department of Community Health, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone 3 Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva, Switzerland; [email protected] 4 Sustainable Health Systems, Freetown, Sierra Leone; [email protected] (K.H.); [email protected] (B.M.) 5 Unit for Antibiotics and Infection Control, Public Health Agency of Sweden, Folkhalsomyndigheten, SE-171 82 Stockholm, Sweden; [email protected] 6 Pharmacy Board of Sierra Leone, Central Medical Stores, New England Ville, Freetown, Sierra Leone; [email protected] (S.B.); [email protected] (J.K.); [email protected] (J.J.); [email protected] (M.S.); [email protected] (O.T.A.); [email protected] (F.T.) Citation: Kanu, J.S.; Khogali, M.; 7 Department of Pharmaceutics and Clinical Pharmacy & Therapeutics, Faculty of Pharmaceutical Sciences, Hann, K.; Tao, W.; Barlatt, S.; Komeh, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 0000, Sierra Leone 8 J.; Johnson, J.; Sesay, M.; Vandi, M.A.; Directorate of Health Security & Emergencies, Ministry of Health and Sanitation, Sierra Leone National Tweya, H.; et al.
    [Show full text]
  • Folic Acid Antagonists: Antimicrobial and Immunomodulating Mechanisms and Applications
    International Journal of Molecular Sciences Review Folic Acid Antagonists: Antimicrobial and Immunomodulating Mechanisms and Applications Daniel Fernández-Villa 1, Maria Rosa Aguilar 1,2 and Luis Rojo 1,2,* 1 Instituto de Ciencia y Tecnología de Polímeros, Consejo Superior de Investigaciones Científicas, CSIC, 28006 Madrid, Spain; [email protected] (D.F.-V.); [email protected] (M.R.A.) 2 Consorcio Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain * Correspondence: [email protected]; Tel.: +34-915-622-900 Received: 18 September 2019; Accepted: 7 October 2019; Published: 9 October 2019 Abstract: Bacterial, protozoan and other microbial infections share an accelerated metabolic rate. In order to ensure a proper functioning of cell replication and proteins and nucleic acids synthesis processes, folate metabolism rate is also increased in these cases. For this reason, folic acid antagonists have been used since their discovery to treat different kinds of microbial infections, taking advantage of this metabolic difference when compared with human cells. However, resistances to these compounds have emerged since then and only combined therapies are currently used in clinic. In addition, some of these compounds have been found to have an immunomodulatory behavior that allows clinicians using them as anti-inflammatory or immunosuppressive drugs. Therefore, the aim of this review is to provide an updated state-of-the-art on the use of antifolates as antibacterial and immunomodulating agents in the clinical setting, as well as to present their action mechanisms and currently investigated biomedical applications. Keywords: folic acid antagonists; antifolates; antibiotics; antibacterials; immunomodulation; sulfonamides; antimalarial 1.
    [Show full text]
  • Eslicarbazepine Acetate Longer Procedure No
    European Medicines Agency London, 19 February 2009 Doc. Ref.: EMEA/135697/2009 CHMP ASSESSMENT REPORT FOR authorised Exalief International Nonproprietary Name: eslicarbazepine acetate longer Procedure No. EMEA/H/C/000987 no Assessment Report as adopted by the CHMP with all information of a commercially confidential nature deleted. product Medicinal 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK Tel. (44-20) 74 18 84 00 Fax (44-20) 74 18 84 16 E-mail: [email protected] http://www.emea.europa.eu TABLE OF CONTENTS 1. BACKGROUND INFORMATION ON THE PROCEDURE........................................... 3 1.1. Submission of the dossier ...................................................................................................... 3 1.2. Steps taken for the assessment of the product..................................................................... 3 2. SCIENTIFIC DISCUSSION................................................................................................. 4 2.1. Introduction............................................................................................................................ 4 2.2. Quality aspects ....................................................................................................................... 5 2.3. Non-clinical aspects................................................................................................................ 8 2.4. Clinical aspects....................................................................................................................
    [Show full text]
  • The Local Use of the Sulfonamide Drugs
    THE LOCAL USE OF THE SULFONAMIDE DRUGS GEORGE CRILE Jr., M.D. Since the introduction of sulfanilamide and its derivatives, the reliance upon chemotherapy for the control of acute surgical infections has temporarily overshadowed the importance of sound surgical princi- ples and often has resulted in the administration of inefficient or inade- quate treatment. Too often, the physician fails to recognize the limita- tions of chemotherapy and vainly attempts to control the infection well beyond the optimum time for surgical intervention. Chemotherapy is very effective in controlling infections from hemo- lytic streptococcus; is moderately effective in controlling staphylococcic infections; but is of slight value when administered systemically in patients infected with the nonhemolytic streptococcus or colon bacillus. However, even in infections caused by the hemolytic streptococcus or the staphylococcus, sulfanilamide and sulfathiazole cannot replace surgery after suppuration has taken place and mechanical drainage of an abscess is required. It is in the treatment of lymphangitis and cellulitis, not in the treatment of abscesses, that chemotherapy has been of the greatest value. The work of Lockwood1 and others has indicated that the products of proteolysis in vitro interfere with the bacteriostatic and bacteriocidal powers of sulfanilamide. The presence of similar substances in undrained abscess cavities probably interferes with the destruction of the organ- isms by chemotherapy. Accordingly, the sulfonamide drugs should supplement rather than replace early and adequate surgical drainage, especially in the presence of suppuration. The local application of the sulfonamide drugs is based upon the principle that the local concentration of the drug in the tissues is ten to twenty times as high as that which can be obtained by any method of systemic administration.
    [Show full text]
  • Xifaxan® (Rifaximin)
    Wednesday, October 14, 2015 4 p.m. Oklahoma Health Care Authority 4345 N. Lincoln Blvd. Oklahoma City, OK 73105 The University of Oklahoma Health Sciences Center COLLEGE OF PHARMACY PHARMACY MANAGEMENT CONSULTANTS MEMORANDUM TO: Drug Utilization Review Board Members FROM: Bethany Holderread, Pharm.D. SUBJECT: Packet Contents for Board Meeting – October 14, 2015 DATE: October 1, 2015 NOTE: The DUR Board will meet at 4:00 p.m. The meeting will be held at 4345 N Lincoln Blvd. Enclosed are the following items related to the October meeting. Material is arranged in order of the agenda. Call to Order Public Comment Forum Action Item – Approval of DUR Board Meeting Minutes – Appendix A Action Item – Vote on 2016 Meeting Dates – Appendix B Update on Medication Coverage Authorization Unit/Bowel Preparation Medication Post-Educational Mailing – Appendix C Action Item – Vote to Prior Authorize Tykerb® (Lapatinib), Halaven® (Eribulin), Ixempra® (Ixabepilone), Kadcyla® (Ado-Trastuzumab), Afinitor® (Everolimus), & Perjeta® (Pertuzumab) – Appendix D Action Item – Vote to Prior Authorize Orkambi™ (Lumacaftor/Ivacaftor) – Appendix E Action Item – Vote to Prior Authorize Savaysa® (Edoxaban) – Appendix F Action Item – Vote to Prior Authorize Epanova® (Omega-3-Carboxylic Acids), Praluent® (Alirocumab), & Repatha™ (Evolocumab) – Appendix G Annual Review of Constipation and Diarrhea Medications and 30-Day Notice to Prior Authorize Movantik™ (Naloxegol), Viberzi™ (Eluxadoline), & Xifaxan® (Rifaximin) – Appendix H 30-Day Notice to Prior Authorize Daraprim® (Pyrimethamine) – Appendix I Annual Review of Allergy Immunotherapies and 30-Day Notice to Prior Authorize Oralair® (Sweet Vernal, Orchard, Perennial Rye, Timothy, & Kentucky Blue Grass Mixed Pollens Allergen Extract) – Appendix J Annual Review of Non-Steroidal Anti-Inflammatory Drugs and 30-Day Notice to Prior Authorize Dyloject™ (Diclofenac Sodium) – Appendix K ORI-4403 • P.O.
    [Show full text]
  • Chloroquinoxaline Sulfonamide (NSC 339004) Is a Topoisomerase II␣/␤ Poison1
    [CANCER RESEARCH 60, 5937–5940, November 1, 2000] Advances in Brief Chloroquinoxaline Sulfonamide (NSC 339004) Is a Topoisomerase II␣/␤ Poison1 Hanlin Gao, Edith F. Yamasaki, Kenneth K. Chan, Linus L. Shen, and Robert M. Snapka2 Departments of Radiology [H. G., E. F. Y., R. M. S.]; Molecular Virology, Immunology and Medical Genetics [H. G., R. M. S.]; College of Medicine [H. G., E. F. Y., R. M. S., K. K. C.]; and College of Pharmacy [K. K. C.], Ohio State University, Columbus, Ohio 43210, and Abbott Laboratories, Abbott Park, Illinois 60064 [L. L. S.] Abstract Drugs and Enzymes. CQS (NSC 339004) was provided by Dr. R. Shoe- maker, National Cancer Institute. VM-26 (teniposide, NSC 122819) was Chloroquinoxaline sulfonamide (chlorosulfaquinoxaline, CQS, NSC obtained from the National Cancer Institute Division of Cancer Treatment, 339004) is active against murine and human solid tumors. On the basis of Natural Products Branch. DMSO was the solvent for all drug stocks. Purified ␤ its structural similarity to the topoisomerase II -specific drug XK469, human topoisomerase II␣ was from TopoGen (Columbus, OH) and LLS ␣ CQS was tested and found to be both a topoisomerase-II and a topoi- (Abbott Laboratories, Abbott Park, IL). Purified topoisomerase II␤ was a ␤ somerase-II poison. Topoisomerase II poisoning by CQS is essentially gift of Dr. Caroline Austin (University of Newcastle, Newcastle upon Tyne, undetectable in assays using the common protein denaturant SDS, but United Kingdom). easily detectable with strong chaotropic protein denaturants. The finding Filter Assay for in Vitro Topoisomerase-DNA Cross-links. The GF/C that detection of topoisomerase poisoning can be so dependent on the filter assay for protein-SV40 DNA cross-links is used to measure topoisomer- protein denaturant used in the assay has implications for drug discovery ase poisoning in vitro with purified enzymes and DNA substrates (9).
    [Show full text]
  • Chapter 25 Mechanisms of Action of Antiepileptic Drugs
    Chapter 25 Mechanisms of action of antiepileptic drugs GRAEME J. SILLS Department of Molecular and Clinical Pharmacology, University of Liverpool _________________________________________________________________________ Introduction The serendipitous discovery of the anticonvulsant properties of phenobarbital in 1912 marked the foundation of the modern pharmacotherapy of epilepsy. The subsequent 70 years saw the introduction of phenytoin, ethosuximide, carbamazepine, sodium valproate and a range of benzodiazepines. Collectively, these compounds have come to be regarded as the ‘established’ antiepileptic drugs (AEDs). A concerted period of development of drugs for epilepsy throughout the 1980s and 1990s has resulted (to date) in 16 new agents being licensed as add-on treatment for difficult-to-control adult and/or paediatric epilepsy, with some becoming available as monotherapy for newly diagnosed patients. Together, these have become known as the ‘modern’ AEDs. Throughout this period of unprecedented drug development, there have also been considerable advances in our understanding of how antiepileptic agents exert their effects at the cellular level. AEDs are neither preventive nor curative and are employed solely as a means of controlling symptoms (i.e. suppression of seizures). Recurrent seizure activity is the manifestation of an intermittent and excessive hyperexcitability of the nervous system and, while the pharmacological minutiae of currently marketed AEDs remain to be completely unravelled, these agents essentially redress the balance between neuronal excitation and inhibition. Three major classes of mechanism are recognised: modulation of voltage-gated ion channels; enhancement of gamma-aminobutyric acid (GABA)-mediated inhibitory neurotransmission; and attenuation of glutamate-mediated excitatory neurotransmission. The principal pharmacological targets of currently available AEDs are highlighted in Table 1 and discussed further below.
    [Show full text]
  • Acetazolamide
    Cambridge University Press 978-0-521-68716-4 - The Epilepsy Prescriber’s Guide to Antiepileptic Drugs Philip N. Patsalos and Blaise F. D. Bourgeois Excerpt More information the epilepsy prescriber’s guide to antiepileptic drugs ACETAZOLAMIDE A Therapeutics Chemical name and structure: Acetazolamide, N-(5-(aminosulfonyl)-1,3,4-thiadiazol-2-yl)-aceta- mide, is a white to faintly yellowish white odorless crystalline powder with a molecular weight of 222.25. Although a sulfonamide compound, it is unlike sulfonamide anti- biotic compounds. It does not contain an arylamine group at the N4-position, which contributes to allergic reactions associated with sulfonamide antibiotics. The structure of acetazolamide bears some similarity to that of zonisamide. Its empirical formula is C4H6N4O3S2. NN O CH3 CNH SO2NH2 S THERAPEUTICS Brand names: r Acetadiazol; Acetak; Albox; Apo-Acetazolamide; Azol r Carbinib; Cetamid r Diamox; Diamox Sequals; Diamox Sustets; Diluran; Diural; Diuramid r Evamox r Fonurit r Glaupax r Huma-Zolamide r Ledamox; Lediamox r Medene r Optamide r Renamid r Stazol; Synomax r Uramox r Zolmide Generics available: r Yes Licensed indications for epilepsy: r Adjunctive treatment of generalized tonic–clonic and partial seizures (UK-SPC) r Adjunctive treatment of atypical absences, atonic, and tonic seizures (UK-SPC) r Intermittent therapy of catamenial seizures (UK-SPC) Licensed indications for non-epilepsy conditions: r Adjunctive treatment of glaucoma (UK-SPC; FDA-PI) r Prevention or amelioration of symptoms associated with acute mountain sickness (FDA-PI) 1 © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-68716-4 - The Epilepsy Prescriber’s Guide to Antiepileptic Drugs Philip N.
    [Show full text]
  • Kinetic and Mechanistic Study of the Reaction Between Methane Sulfonamide (CH3S(O)2NH2) and OH
    Atmos. Chem. Phys., 20, 2695–2707, 2020 https://doi.org/10.5194/acp-20-2695-2020 © Author(s) 2020. This work is distributed under the Creative Commons Attribution 4.0 License. Kinetic and mechanistic study of the reaction between methane sulfonamide (CH3S.O/2NH2) and OH Matias Berasategui, Damien Amedro, Achim Edtbauer, Jonathan Williams, Jos Lelieveld, and John N. Crowley Division of Atmospheric Chemistry, Max-Planck-Institut für Chemie, 55128 Mainz, Germany Correspondence: John N. Crowley ([email protected]) Received: 8 November 2019 – Discussion started: 28 November 2019 Revised: 30 January 2020 – Accepted: 3 February 2020 – Published: 4 March 2020 Abstract. Methane sulfonamide (MSAM), CH3S.O/2NH2, The main organosulfur trace gases in the marine boundary was recently detected for the first time in ambient air over the layer are dimethyl sulfide (CH3SCH3, DMS) and its oxi- Red Sea and the Gulf of Aden where peak mixing ratios of dation products dimethyl sulfoxide (DMSO), dimethyl sul- ≈ 60 pptv were recorded. Prior to this study the rate constant fone (DMSO2), methyl sulfonic acid (MSA), and methyl for its reaction with the OH radical and the products thereby sulfinic acid (MSI) for which atmospheric lifetimes with re- formed were unknown, precluding assessment of its role in spect to their degradation by the OH radical vary between the atmosphere. We have studied the OH-initiated photo- hours (DMS) and several weeks (DMSO2). oxidation of MSAM in air (298 K, 700 Torr total pressure) Recently, the first detection of methane sulfonamide in a photochemical reactor using in situ detection of MSAM (CH3S.O/2NH2, MSAM) in ambient air was made during and its products by Fourier transform infrared (FTIR) absorp- the Air Quality and Climate Change in the Arabian Basin tion spectroscopy.
    [Show full text]
  • Farrukh Javaid Malik
    I Farrukh Javaid Malik THESIS PRESENTED TO OBTAIN THE GRADE OF DOCTOR OF THE UNIVERSITY OF BORDEAUX Doctoral School, SP2: Society, Politic, Public Health Specialization Pharmacoepidemiology and Pharmacovigilance By Farrukh Javaid Malik “Analysis of the medicines panorama in Pakistan – The case of antimicrobials: market offer width and consumption.” Under the direction of Prof. Dr. Albert FIGUERAS Defense Date: 28th November 2019 Members of Jury M. Francesco SALVO, Maître de conférences des universités – praticien hospitalier, President Université de Bordeaux M. Albert FIGUERAS, Professeur des universités – praticien hospitalier, Director Université Autonome de Barcelone Mme Antonia AGUSTI, Professeure, Vall dʹHebron University Hospital Referee Mme Montserrat BOSCH, Praticienne hospitalière, Vall dʹHebron University Hospital Referee II Abstract A country’s medicines market is an indicator of its healthcare system, the epidemiological profile, and the prevalent practices therein. It is not only the first logical step to study the characteristics of medicines authorized for marketing, but also a requisite to set up a pharmacovigilance system, thus promoting rational drug utilization. The three medicines market studies presented in the present document were conducted in Pakistan with the aim of describing the characteristics of the pharmaceutical products available in the country as well as their consumption at a national level, with a special focus on antimicrobials. The most important cause of antimicrobial resistance is the inappropriate consumption of antimicrobials. The results of the researches conducted in Pakistan showed some market deficiencies which could be addressed as part of the national antimicrobial stewardship programmes. III Résumé Le marché du médicament d’un pays est un indicateur de son système de santé, de son profil épidémiologique et des pratiques [de prescription] qui y règnent.
    [Show full text]
  • DIURETICS Diuretics Are Drugs That Promote the Output of Urine Excreted by the Kidneys
    DIURETICS Diuretics are drugs that promote the output of urine excreted by the Kidneys. The primary action of most diuretics is the direct inhibition of Na+ transport at one or more of the four major anatomical sites along the nephron, where Na+ reabsorption takes place. The increased excretion of water and electrolytes by the kidneys is dependent on three different processes viz., glomerular filtration, tubular reabsorption (active and passive) and tubular secretion. Diuretics are very effective in the treatment of Cardiac oedema, specifically the one related with congestive heart failure. They are employed extensively in various types of disorders, for example, nephritic syndrome, diabetes insipidus, nutritional oedema, cirrhosis of the liver, hypertension, oedema of pregnancy and also to lower intraocular and cerebrospinal fluid pressure. Therapeutic Uses of Diuretics i) Congestive Heart Failure: The choice of the diuretic would depend on the severity of the disorder. In an emergency like acute pulmonary oedema, intravenous Furosemide or Sodium ethacrynate may be given. In less severe cases. Hydrochlorothiazide or Chlorthalidone may be used. Potassium-sparing diuretics like Spironolactone or Triamterene may be added to thiazide therapy. ii) Essential hypertension: The thiazides usually sever as primary antihypertensive agents. They may be used as sole agents in patients with mild hypertension or combined with other antihypertensives in more severe cases. iii) Hepatic cirrhosis: Potassium-sparing diuretics like Spironolactone may be employed. If Spironolactone alone fails, then a thiazide diuretic can be added cautiously. Furosemide or Ethacrymnic acid may have to be used if the oedema is regractory, together with spironolactone to lessen potassium loss. Serum potassium levels should be monitored periodically.
    [Show full text]
  • Topiramate Is More Effective Than Acetazolamide at Lowering
    University of Birmingham Topiramate is more effective than acetazolamide at lowering intracranial pressure Scotton, William J; Botfield, Hannah F; Westgate, Connar Sj; Mitchell, James L; Yiangou, Andreas; Uldall, Maria S; Jensen, Rigmor H; Sinclair, Alex J DOI: 10.1177/0333102418776455 License: Creative Commons: Attribution (CC BY) Document Version Publisher's PDF, also known as Version of record Citation for published version (Harvard): Scotton, WJ, Botfield, HF, Westgate, CS, Mitchell, JL, Yiangou, A, Uldall, MS, Jensen, RH & Sinclair, AJ 2018, 'Topiramate is more effective than acetazolamide at lowering intracranial pressure', Cephalalgia. https://doi.org/10.1177/0333102418776455 Link to publication on Research at Birmingham portal Publisher Rights Statement: William J Scotton, Hannah F Botfield, Connar SJ Westgate, James L Mitchell, Andreas Yiangou, Maria S Uldall, Rigmor H Jensen, and Alex J Sinclair, Topiramate is more effective than acetazolamide at lowering intracranial pressure, Cephalalgia, First Published June 13, 2018; https://doi.org/10.1177/0333102418776455. Checked 02/07/2018. General rights Unless a licence is specified above, all rights (including copyright and moral rights) in this document are retained by the authors and/or the copyright holders. The express permission of the copyright holder must be obtained for any use of this material other than for purposes permitted by law. •Users may freely distribute the URL that is used to identify this publication. •Users may download and/or print one copy of the publication from the University of Birmingham research portal for the purpose of private study or non-commercial research. •User may use extracts from the document in line with the concept of ‘fair dealing’ under the Copyright, Designs and Patents Act 1988 (?) •Users may not further distribute the material nor use it for the purposes of commercial gain.
    [Show full text]