Renagel 800 mg film-coated tablets - Summary of Product Characteristics (SPC) by SANOFI.Tanya's Comprehensive Guide to Feline Chronic Kidney Disease. Home >. > Hypertension. Overview. Hypertension (high blood pressure) is very common in CKD cats, and can have some very serious. It is effective, is unlikely to make blood pressure fall too. What is Hypertension? The heart pumps blood through the body via. Hypertension means the pressure (or tension). This creates. more work for the heart, and can eventually lead to damage to the blood. The adrenal gland is. This is known as. RAAS). If the RAAS is activated, these hormones make the blood vessels in the body constrict, which. The RAAS can be activated by CKD, but there is some debate as to how common activation of the RAAS is in CKD. In Feline hypertension: Part 1(2. Dr C Atkins states . Plasma. renin activity and aldosterone concentrations in hypertensive cats with. Jepson RE, Syme HM & Elliott J Journal of Veterinary Internal Medicine. However. current evidence in cats does not demonstrate the same findings, despite. Fæokromocytomer er tumorer opstået i de kromaffine celler i binyremarven, som producerer katecholaminerne adrenalin, noradrenalin og dopamin. The first line of phosphorus control is to feed foods low in phosphorus, ideally a therapeutic kidney diet. Survival of cats with naturally occurring. Duragesic (fentanyl) Transdermal System for transdermal administration is an opioid analgesic indicated for the management of pain in opioid-tolerant patients, severe. Acarbose official prescribing information for healthcare professionals. Includes: indications, dosage, adverse reactions, pharmacology and more. Glucobay 50mg tablets - Summary of Product Characteristics (SPC) by Bayer plc. Hypertension (high blood pressure) is very common in CKD cats, and can have some very serious consequences, including a stroke or blindness. More research is needed, although differences. If intraglomerular blood pressure is too high, it. On the other hand, reducing blood pressure within the kidneys can lead to a reduction in the. According to. Cornell University College of Veterinary Medicine, other conditions that may. The National Kidney & Urologic Diseases Information. Clearing House explains more about this. Feline hypertension: Part 1(2. Atkins C. . To obtain an accurate diagnosis, blood pressure needs to be measured, but unfortunately. CKD cats for hypertension, even though CKD patients are at. How Common is Hypertension? Prevalence. of systolic hypertension in cats with chronic renal failure at. Syme HM. Barber PJ, Markwell PJ & Elliott J, Journal of the American. Veterinary Medical Association 2. CKD. However, since the risk of high blood pressure developing increases as. CKD worsens, it appears that at least one third of CKD cats have high. In fact, as mentioned in Changes in systolic blood pressure over time in. Bijsmans ES, Jepson RE, Chang YM, Syme HM, Elliott J Journal of. Veterinary Internal Medicine. CKD cats is as high as 6. Elevated kidney values were an independent. Therefore if you have a. CKD cat, you should monitor blood pressure whatever the cat's age. It is. also wise to monitor blood pressure in all older cats (over the age of. Cats with. hyperthyroidism. One study. Hypertension in cats with chronic renal failure or. Kobayashi DL, Peterson ME, Graves TK, Lesser M &. Nichols CE Journal of Veterinary Internal Medicine. Therefore you need to be particularly careful if your cat has both hyperthyroidism and CKD. Using. corticosteroids may also lead to hypertension. Symptoms of Hypertension. There are a surprising number of possible symptoms of hypertension in cats. Urgent Symptoms of. These symptoms, or target organ damage (TOD) as they are referred to in. ACVIM. consensus statement: guidelines for the. Brown S, Atkins C, Bagley R, Carr A, Cowgill L, Davidson M, Egner B. Elliott J, Henik R, Labato M, Littman M, Polzin D, Ross L, Snyder P, and. Stepien R Journal of Veterinary Internal Medicine. There is more. about target organ damage. Neurological Problems. Up to 4. 6% of cats with hypertension have neurological problems. These are. more common if blood pressure is very high, or if it has suddenly. Stroke. A cat with untreated. A stroke means that the. Symptoms of stroke include. See. below for more. There. may be the classic jerking and loss of consciousness, but being . The use of. metoclopramide (Reglan) for stomach problems or. Advantage. for fleas may lower the seizure threshold. Sometimes. cats can appear blind after seizures and you will get a negative menace. Harpsiehad. a negative menace response after his seizures and several vets were. Cat Dancer. I am really surprised how many vets. I have lost count of the number of. I've heard about who have simply been put on phenobarbital (an. In. every single one of these cases, once the cat was given appropriate blood. Muscle wasting may also be caused by metabolic acidosis. General weakness may be caused by. Such behaviour is sometimes also seen in cats. Twitching may also be caused by hightoxin levels. If your cat only twitches. Pharaoh's Shakes is a video showing a CKD. Pet MD mentions that twitching may be. Ocular Problems. Blindness, Particularly Sudden Blindness (Retinal. Detachment)Unfortunately this is a relatively common occurrence in cats with. The hypertension causes the retinas to detach, so. You may notice a. Another. option is to get your cat's attention, then drop a cotton wool ball and. Blindness may also manifest. Your cat may also walk. Even if your cat's retinas detach because of. See. below for more. Hypertension in cats and dogs. Stepien RL Presentation to the. Waltham/OSU Symposium: Small Animal Cardiology 2. Pet Place. has an article about detached retinas, including information on other. Close at the. bottom of the annoying pop- up window). Bleeding Eyes (Retinal Haemorrhage)These may also. The bleeding happens in the front chamber of the. This type of bleeding is known as hyphema. Cats. with retinal haemorrhage are not usually blind. Long Beach Animal Hospital has a. International Cat Carehas a photograph of a cat with this problem. Pet Place has some information about. Heart Problems. Hypertension can damage the heart because the increased. The most common finding is left ventricular hypertrophy. In some cases a heart. Problems), but. Blood pressure in small animals Part 2: hypertension. Carr. AP & Egner BE European Journal of. Companion Animal Practice. You may. also see lethargy in cats with neurological problems caused by. Anaemia. may also cause lethargy, as may. When to Go to the Vet. I am often asked when to seek veterinary help for these symptoms. I know it. can be expensive going to the ER or out of hours vet, especially if funds are. I personally would seek veterinary help as follows. If you think your cat has had a stroke, I would go to the vet. The sooner treatment begins, the. I would be prepared to wait. I think I would go to the ER or out of hours vet. How quickly you notice the. If my cat. appeared to have other urgent symptoms, I would go to the vet, ER or out of hours. If my cat only had milder symptoms, such as nosebleeds, I would seek a same or next. If. it was the weekend or a holiday, I would keep my cat quiet and get in to see. Keep a close eye on your cat and. ER or out of hours vet if your cat seems to be. If it was the weekend or a holiday, I. I would wait until my vet opened again, but if my cat had further. I would probably be so frightened I would go to the ER or out of. I would worry myself silly otherwise. If you cannot afford. If. your cat starts to have one seizure after the other (which fortunately is. ER or out. of hours vet as soon as possible. Other Symptoms of. Worsening Kidney Values. Since hypertension can adversely affect the kidneys, one possible symptom is a. I recommend always having blood pressure checked in any cat. Other Symptoms. These symptoms still indicate a need to test for and treat hypertension if it. ER. On the other. I would not accept an appointment a week or two into the future either. I have lost. count of the number of people who have told me their cat was doing this. I. suggested the cat should be tested for hypertension, and the cat was. Other possible. causes include. Certain medications such as. Cyproheptadine). mirtazapine (Remeron), both appetite stimulants, or. In all cases, the cat. Hg. Alternatively, red ears are sometimes seen in cats with. Blood in Urine. This can be. It may also indicate the. There is a condition called . Long Beach Animal Hospital mentions. Physical Exam) that blood in the urine may be a sign of. Pet Place has some information about. Close at. the bottom of the annoying pop- up window). The Pet. Checkupis a product that. Pacing or Restlessness. Sometimes. cats with hypertension will pace up and down or just act restless. This may also be a sign of. Cats on certain medications, such as. Reglan). cyproheptadine (Periactin) or. Remeron or Zistin) may also exhibit these symptoms. There are a few subtle signs you or. Unfortunately, not every vet has the equipment with which to check blood pressure. If your vet does not have the. An alternative is to. US$2. 5 or so. My vet charges about . Vets who do. home visits may be able to help, and it can be better for your cat to measure. If possible, try to give your. This would probably make humans more. Harpsie. whenever he had blood taken and it definitely made him calmer. Measuring Blood Pressure. Blood pressure. is often measured using the cat's tail, though my vet uses a front paw. It is normal to take several readings and average them out in order to. ACVIM Consensus Statement: guidelines for the. Brown S, Atkins C, Bagley R, Carr A, Cowgill L, Davidson M, Egner B. Elliott J, Henik R, Labato M, Littman M, Polzin D, Ross L, Snyder P, and. Stepien R Journal of Veterinary Internal Medicine. The average of these readings is the cat's. Do not rush taking the readings. You will. normally be told your cat has a blood pressure of x, with x being a. See. below for. information on what the number means. Since blood pressure. If possible, try to test the model you are. I bought one but never really. In such cases, a possible compromise would be to. This might cost more than taking your cat to the vet, but. Alternatively, your vet might be prepared to loan you one. The following can be purchased for home use: USAParks Medical. CKD over the years. You do need a vet's prescription. It costs about US$6. US$1. 00. 0. Vmed. Vet Dop Doppleris another brand which. CKD cats have purchased. With all. the extras, it costs about US$1. This link also has a video from Dr. Gary Norsworthy showing how to measure blood pressure. Matrix Medical sells the Critikon. Dynamap brand. The models for sale are refurbished and are therefore. If you mention you are a. Tanya's Support Group, model number 8. US$2. 00 and the XL (item. US$2. 50 with two cat- sized cuffs. Shipping for either. US$2. 0. In 2. 01. I finally heard from somebody who. FDA prescribing information, side effects and uses. Acarbose Tablets are an oral alpha- glucosidase inhibitor for use in the management of type 2 diabetes mellitus. Acarbose is an oligosaccharide which is obtained from fermentation processes of a microorganism, Actinoplanes utahensis, and is chemically known as O- 4,6- dideoxy- 4- . It is a white to off- white powder with a molecular weight of 6. Acarbose is soluble in water and has a p. Ka of 5. 1. Its empirical formula is C2. H4. 3NO1. 8 and its chemical structure is as follows: Acarbose Tablets are available as 2. The inactive ingredients are starch, microcrystalline cellulose, magnesium stearate, and colloidal silicon dioxide. Acarbose - Clinical Pharmacology. Acarbose is a complex oligosaccharide that delays the digestion of ingested carbohydrates, thereby resulting in a smaller rise in blood glucose concentration following meals. As a consequence of plasma glucose reduction, Acarbose Tablets reduce levels of glycosylated hemoglobin in patients with type 2 diabetes mellitus. Systemic non- enzymatic protein glycosylation, as reflected by levels of glycosylated hemoglobin, is a function of average blood glucose concentration over time. Mechanism of Action. In contrast to sulfonylureas, Acarbose Tablets do not enhance insulin secretion. The antihyperglycemic action of Acarbose results from a competitive, reversible inhibition of pancreatic alpha- amylase and membrane- bound intestinal alpha- glucoside hydrolase enzymes. Pancreatic alpha- amylase hydrolyzes complex starches to oligosaccharides in the lumen of the small intestine, while the membrane- bound intestinal alpha- glucosidases hydrolyze oligosaccharides, trisaccharides, and disaccharides to glucose and other monosaccharides in the brush border of the small intestine. In diabetic patients, this enzyme inhibition results in a delayed glucose absorption and a lowering of postprandial hyperglycemia. Because its mechanism of action is different, the effect of Acarbose Tablets to enhance glycemic control is additive to that of sulfonylureas, insulin or metformin when used in combination. In addition, Acarbose Tablets diminish the insulinotropic and weight- increasing effects of sulfonylureas. Acarbose has no inhibitory activity against lactase and consequently would not be expected to induce lactose intolerance. Pharmacokinetics. Absorption. In a study of 6 healthy men, less than 2% of an oral dose of Acarbose was absorbed as active drug, while approximately 3. C- labeled oral dose was absorbed. An average of 5. 1% of an oral dose was excreted in the feces as unabsorbed drug- related radioactivity within 9. Because Acarbose acts locally within the gastrointestinal tract, this low systemic bioavailability of parent compound is therapeutically desired. Following oral dosing of healthy volunteers with 1. C- labeled Acarbose, peak plasma concentrations of radioactivity were attained 1. The delayed absorption of Acarbose- related radioactivity reflects the absorption of metabolites that may be formed by either intestinal bacteria or intestinal enzymatic hydrolysis. Metabolism. Acarbose is metabolized exclusively within the gastrointestinal tract, principally by intestinal bacteria, but also by digestive enzymes. A fraction of these metabolites (approximately 3. At least 1. 3 metabolites have been separated chromatographically from urine specimens. The major metabolites have been identified as 4- methylpyrogallol derivatives (that is, sulfate, methyl, and glucuronide conjugates). One metabolite (formed by cleavage of a glucose molecule from Acarbose) also has alpha- glucosidase inhibitory activity. This metabolite, together with the parent compound, recovered from the urine, accounts for less than 2% of the total administered dose. Excretion. The fraction of Acarbose that is absorbed as intact drug is almost completely excreted by the kidneys. When Acarbose was given intravenously, 8. In contrast, less than 2% of an oral dose was recovered in the urine as active (that is, parent compound and active metabolite) drug. This is consistent with the low bioavailability of the parent drug. The plasma elimination half- life of Acarbose activity is approximately 2 hours in healthy volunteers. Consequently, drug accumulation does not occur with three times a day (t. Special Populations. The mean steady- state area under the curve (AUC) and maximum concentrations of Acarbose were approximately 1. Patients with severe renal impairment (Clcr < 2. L/min/1. 7. 3m. 2) attained about 5 times higher peak plasma concentrations of Acarbose and 6 times larger AUCs than volunteers with normal renal function. No studies of Acarbose pharmacokinetic parameters according to race have been performed. Acarbose Tablets did not interfere with the absorption or disposition of the sulfonylurea glyburide in diabetic patients. Acarbose Tablets may affect digoxin bioavailability and may require dose adjustment of digoxin by 1. Cmax of digoxin by 2. However, the peak plasma level of metformin was reduced by approximately 2. Acarbose Tablets due to a slight delay in the absorption of metformin. There is little if any clinically significant interaction between Acarbose Tablets and metformin. Clinical Trials. Clinical Experience from Dose Finding Studies in Type 2 Diabetes Mellitus Patients on Dietary Treatment Only: Results from six controlled, fixed- dose, monotherapy studies of Acarbose Tablets in the treatment of type 2 diabetes mellitus, involving 7. Acarbose Tablets- treated patients, were combined and a weighted average of the difference from placebo in the mean change from baseline in glycosylated hemoglobin (Hb. A1c) was calculated for each dose level as presented below: Dose of Acarbose Tablets*NChange in Hb. A1c %p- Value. 25 mg t. Acarbose Tablets regimen was superior to lower doses, but there were no statistically significant differences from 5. Clinical Experience in Type 2 Diabetes Mellitus Patients on Monotherapy, or in Combination with Sulfonylureas, Metformin or Insulin: Acarbose Tablets were studied as monotherapy and as combination therapy to sulfonylurea, metformin, or insulin treatment. The treatment effects on Hb. A1c levels and one- hour postprandial glucose levels are summarized for four placebo- controlled, double- blind, randomized studies conducted in the United States in Tables 2 and 3, respectively. The placebo- subtracted treatment differences, which are summarized below, were statistically significant for both variables in all of these studies. Study 1 (n=1. 09) involved patients on background treatment with diet only. The mean effect of the addition of Acarbose Tablets to diet therapy was a change in Hb. A1c of . In the diet, sulfonylurea and metformin groups, the mean decrease in Hb. A1c produced by the addition of Acarbose Tablets was statistically significant at six months, and this effect was persistent at one year. In the Acarbose Tablets- treated patients on insulin, there was a statistically significant reduction in Hb. A1c at six months, and a trend for a reduction at one year. Hb. A1c (%)a. Study. Treatment. Mean Baseline. Mean change from baselineb. Treatment Differencep- Value. Placebo Plus Diet. Acarbose Tablets 1. Plus Diet. 8. 6. 9- 0. Placebo Plus SFUc. Acarbose Tablets 5. Plus SFUc. 9. 6. 4- 0. Placebo Plus Metformine. Acarbose Tablets 5. Plus Metformine. 8. Placebo Plus Insulinf. Acarbose Tablets 5. Plus Insulinf. 8. One- Hour Postprandial Glucose (mg/d. L)Study. Treatment. Mean Baseline. Mean change from baselineb. Treatment Differencep- Value. Placebo Plus Diet. Acarbose Tablets 1. Plus Diet. 29. 9. Placebo Plus SFUb 3. Acarbose Tablets 5. Plus SFUb. 31. 1. Placebo Plus Metformind. Acarbose Tablets 5. Plus Metformind. 28. Placebo Plus Insuline. Acarbose Tablets 5. Plus Insuline. 27. Figure 2. Figure 2: Effects of Acarbose Tablets (. Treatment differences at 6 and 1. Indications and Usage for Acarbose. Acarbose Tablets are indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Contraindications. Acarbose Tablets are contraindicated in patients with known hypersensitivity to the drug. Acarbose Tablets are contraindicated in patients with diabetic ketoacidosis or cirrhosis. Acarbose Tablets are also contraindicated in patients with inflammatory bowel disease, colonic ulceration, partial intestinal obstruction or in patients predisposed to intestinal obstruction. In addition, Acarbose Tablets are contraindicated in patients who have chronic intestinal diseases associated with marked disorders of digestion or absorption and in patients who have conditions that may deteriorate as a result of increased gas formation in the intestine. Precautions. General. Macrovascular Outcomes: There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with Acarbose Tablets or any other anti- diabetic drug. Hypoglycemia: Because of their mechanism of action, Acarbose Tablets when administered alone should not cause hypoglycemia in the fasted or postprandial state. Sulfonylurea agents or insulin may cause hypoglycemia. Because Acarbose Tablets given in combination with a sulfonylurea or insulin will cause a further lowering of blood glucose, it may increase the potential for hypoglycemia. Hypoglycemia does not occur in patients receiving metformin alone under usual circumstances of use, and no increased incidence of hypoglycemia was observed in patients when Acarbose Tablets were added to metformin therapy. Oral glucose (dextrose), whose absorption is not inhibited by Acarbose Tablets, should be used instead of sucrose (cane sugar) in the treatment of mild to moderate hypoglycemia. Sucrose, whose hydrolysis to glucose and fructose is inhibited by Acarbose Tablets, is unsuitable for the rapid correction of hypoglycemia. Severe hypoglycemia may require the use of either intravenous glucose infusion or glucagon injection. Elevated Serum Transaminase Levels: In long- term studies (up to 1. Acarbose Tablets doses up to 3.
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