Cottage Health Medical Resident William Hahn, MD, discusses the effects and implications of Haloperidol and QTc Prolongation.

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Over a third of post-menopausal breast cancer patients who take aromatase inhibitors abandon their treatment, because the drug's side effects are so unbearable, according to researchers from Northwestern University. Aromatase inhibitors are typically given to patients following chemotherapy, radiation therapy, and breast cancer surgery, usually for about 5 years.

(USMLE topics) Hypercalcemia: calcium metabolism, hormonal control, etiology, diagnosis, symptoms, treatment, prognosis.

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The amount of calcium in circulation is MAINLY regulated by 2 hormones: parathyroid hormone (PTH) and calcitriol. PTH is produced in the parathyroid gland while calcitriol is made in the kidney. When serum calcium level is low, PTH is UP-regulated. PTH acts to PROMOTE calcium release from bones and REDUCE calcium loss from urine. At the same time, it stimulates production of calcitriol, which promotes absorption of calcium in the small intestine while also INcreases RE-absorption in the kidney. Together, they bring UP calcium levels back to normal. The REVERSE happens when calcium level is high. This feedback loop keeps serum calcium concentrations within the normal range.
HYPERcalcemia is generally defined as serum calcium level GREATER than 2.6 mmol/L. Because the total serum calcium includes albumin-bound and free-ionized calcium, of which only the LATTER is physiologically active, calcium levels must be corrected to account for albumin changes. For example, INcreased albumin levels produce HIGHER serum calcium values but the amount of FREE calcium may STILL be normal. On the other hand, in conditions with low blood pH, albumin binds LESS calcium; releasing MORE FREE calcium while the total serum calcium may appear normal.
Most symptoms of hypercalcemia can be attributed to the effect it has on action potential generation in neurons. High levels of extracellular calcium INHIBIT sodium channels, which are essential for DEpolarization. Hypercalcemia therefore REDUCES neuronal excitability, causing confusion, lethargy, muscle weakness and constipation. In most cases, excess calcium in the blood is a direct result of calcium release from bones as they break down, becoming weak and painful. As the kidneys try to get rid of the extra calcium, MORE water is also removed, resulting in dehydration, excessive thirst and kidney stones. Extremely high extracellular calcium may also affect cardiac action potentials, causing arrhythmias. Typical ECG findings include short QT interval, and in severe cases, presence of Osborn waves.
While hypercalcemia may result from a variety of diseases and factors, HYPERparathyroidism and cancers are responsible for about 90% of cases, with the former being by far the most common cause. In HYPERparathyroidism, PTH is OVERproduced due to benign or malignant growths within the parathyroid gland.
An existing cancer elsewhere in the body can cause hypercalcemia in 2 major ways. First, some cancer cells produce a protein similar to PTH, called PTHrP, which acts like PTH to increase serum calcium. Unlike PTH, however, PTHrP is NOT subject to negative feedback; consequently, calcium levels may keep rising unchecked. Second, cancers may spread to bone tissues, causing bone resorption or osteolysis, and subsequent calcium release into the blood.
Hypercalcemia treatment consists of lowering blood calcium levels with a variety of drugs, and addressing the underlying cause. While treatment outcome for hyperparathyroidism is generally excellent, prognosis for malignancy-related hypercalcemia is poor, possibly because it usually occurs in later stages of cancer.

Lorazepam is a medication that belongs to a class of drugs known as benzodiazepines. Benzodiazepines are a group of psychoactive drugs that have a depressant effect on the central nervous system, leading to sedation, muscle relaxation, and anxiety reduction. Lorazepam is commonly prescribed for the short-term treatment of anxiety disorders, as well as for managing symptoms of alcohol withdrawal, insomnia, and certain types of seizures.

Key points about lorazepam include:

1. Anxiolytic Effects: Lorazepam is primarily used as an anxiolytic (anxiety-reducing) medication. It works by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain. GABA inhibits the activity of nerve cells, leading to a calming and sedative effect.

2. Dosage Forms: Lorazepam is available in various forms, including tablets, oral solutions, and injectable solutions. The injectable form is often used in hospital settings to manage acute anxiety or agitation.

3. Short-Term Use: Due to the risk of tolerance, dependence, and withdrawal symptoms, lorazepam is usually prescribed for short-term use, typically not exceeding a few weeks. Prolonged or excessive use can lead to physical and psychological dependence.

4. Withdrawal: Abruptly stopping lorazepam after regular use can lead to withdrawal symptoms, including anxiety, restlessness, insomnia, muscle tension, and in severe cases, seizures. Tapering off the medication under medical supervision is usually recommended to avoid withdrawal complications.

5. Side Effects: Common side effects of lorazepam include drowsiness, dizziness, muscle weakness, and impaired coordination. Less common side effects may include memory problems, confusion, and changes in mood.

6. Precautions: Lorazepam should be used with caution in individuals with a history of substance abuse, as well as those with a history of depression or other mental health disorders. It's important to inform your healthcare provider about any medications you are taking, as lorazepam can interact with other drugs and substances, including alcohol.

7. Elderly and Special Populations: The effects of lorazepam can be more pronounced in the elderly population, leading to increased sedation and risk of falls. Dosage adjustments may be necessary for older adults. Pregnant and breastfeeding women should consult their healthcare providers before taking lorazepam, as it can potentially affect the developing fetus or infant.

8. Medical Supervision: Lorazepam should be taken under the supervision of a medical professional who can monitor its effects, adjust the dosage, and guide the discontinuation process when necessary.

It's important to note that lorazepam and other benzodiazepines are not recommended for long-term use due to the potential for dependence and other adverse effects. If you have concerns about anxiety or any other medical condition, it's advisable to consult a healthcare provider who can recommend appropriate treatment options based on your individual needs.

Chlorphenamine is an antihistamine used in treating allergies from insect bites.

Filming location: Morriston, Swansea, Wales, Great Britain.

Date: Tuesday 29th July 2025

Bisacodyl is a stimulant laxative used to treat constipation and for bowel preparation before medical procedures. Here are some key points about its pharmacology:

Mechanism of Action
Stimulant Laxative: Bisacodyl acts directly on the colonic mucosa, stimulating sensory nerve endings in the walls of the intestine and rectum. This induces parasympathetic reflexes, resulting in increased peristaltic contractions of the colon and promoting defecation.

Water and Electrolyte Secretion: It increases the secretion of water and electrolytes into the intestinal lumen, which helps soften the stool and facilitates bowel movements.

Pharmacokinetics
Absorption: Approximately 5% of bisacodyl is absorbed after oral administration.

Distribution: It is distributed locally in the intestines.

Metabolism: Bisacodyl is hydrolyzed by intestinal enzymes and bacteria in the bowel to its active desacetyl forms.

Excretion: The drug is primarily excreted in the stool, with a small amount excreted in the urine.

Onset of Action: The onset of action varies depending on the form of administration:

Oral tablets: 6-12 hours

Suppositories: 15-60 minutes

Enema: 5-20 minutes

Clinical Uses
Constipation: Bisacodyl is used to relieve occasional constipation.

Bowel Preparation: It is used for bowel evacuation prior to radiological examinations and surgical procedures.

Side Effects
Common side effects of bisacodyl include:

Abdominal discomfort

Abdominal cramps

Diarrhea

Rectal irritation

Precautions
Contraindications: Bisacodyl should not be used in individuals with hypersensitivity to the drug, intestinal obstruction, severe dehydration, or acute surgical abdominal conditions.

Special Precautions: Use with caution in patients with nausea, vomiting, or abdominal pain. Prolonged use can lead to dependence.

Bisacodyl is a valuable medication for managing constipation and preparing patients for gastrointestinal procedures, offering effective relief with a well-defined mechanism of action and pharmacokinetic profile.

#Bisacodyl #Dulcolax

What is Cyclobenzaprine (Fexmid)? What is Cyclobenzaprine used for?


Cyclobenzaprine is a muscle relaxant used to relieve muscle spasms resulting from injuries or other musculoskeletal conditions. It works by acting on the central nervous system to produce its muscle relaxant effects, rather than directly on the muscles themselves.

How Does Cyclobenzaprine Work?

Cyclobenzaprine works by blocking nerve impulses (or pain sensations) that are sent to your brain. It helps to relax muscles, providing relief from pain, stiffness, and discomfort.

Uses of Cyclobenzaprine

Cyclobenzaprine is primarily prescribed for short-term use to treat muscle spasms associated with acute, painful musculoskeletal conditions. It is often used in conjunction with rest and physical therapy.

Dosage and Administration

The typical starting dose for adults is 5 mg taken three times a day. Depending on the response, the dose may be increased to 10 mg three times a day. The extended-release capsule form is usually taken once daily. Cyclobenzaprine should not be used for more than 2-3 weeks without a doctor's guidance. Always follow your doctor's dosing instructions and do not adjust your dose without consulting them.

Side Effects and Precautions

Common side effects include drowsiness, dry mouth, dizziness, and fatigue. Serious side effects can include irregular heartbeats, chest pain, or signs of serotonin syndrome such as agitation, hallucinations, and rapid heart rate. If you experience severe side effects, seek medical attention immediately. Cyclobenzaprine can interact with other medications, so inform your doctor about all the medicines and supplements you are taking.

Important Safety Information

Avoid drinking alcohol while taking Cyclobenzaprine, as it can enhance drowsiness and increase the risk of serious side effects. Be cautious when driving or operating machinery until you know how the medication affects you. Do not use Cyclobenzaprine if you have certain conditions like heart block, congestive heart failure, or if you have recently had a heart attack. Always discuss your health conditions and any concerns with your healthcare provider.

Conclusion

Cyclobenzaprine can be highly effective for managing muscle spasms when used responsibly and under a doctor's guidance. Always discuss your treatment plan with your healthcare provider to ensure safe and effective use.

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