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to 15 [10:<60 bpm), increased heart rate (48%; 100 bpm), altered blood pressure (systolic 160 mmHg: 33%; systolic> <90 mmHg: 29%; diastolic 100 mmHg: 17%) Central nervous system: Fatigue (62%), peripheral neuropathy (27%; grades 3/4: 4%), headache (15%) Endocrine & metabolic: Hyperglycemia (89%), hypocalcemia (78%), hypoalbuminemia (73%), decreased serum bicarbonate (63%), hyperkalemia (32%), weight loss (14%) Gastrointestinal: Diarrhea (47%), constipation (36%), decreased appetite (21%), vomiting (15%) Hematologic & oncologic: Lymphocytopenia (13% to 99%; grades 3/4: 9% to 77%), leukopenia (91%; grades 3/4: 32%), thrombocytopenia (84%; grades 3/4: 19%) Hepatic: Increased serum alkaline phosphatase (39%; grades 3/4: 1%) Immunologic: Immunogenicity (19%; neutralizing: 6%) Infection: Infection (81%; grades 3/4: 28%), opportunistic infection (22%), herpes zoster (14%), fungal infection (10%) Neuromuscular & skeletal: Limb pain (16%) Ophthalmic: Cataract (12%) Respiratory: Cough (34%), nasopharyngitis (25%), upper respiratory tract infection (23%), pneumonia (15% to 20%), oropharyngeal pain (10%) Miscellaneous: Fever (7% to 37%), infusion related reaction (10%; grade 3: 1%) 1% to 10%: Cardiovascular: Chest pain ( 5%), pulmonary embolism (3%) Central nervous system: Hypoesthesia ( 5%), mood changes ( 5%) Dermatologic: Night sweats ( 5%) Hematologic & oncologic: Second primary malignant neoplasm (9%), malignant neoplasm of skin (4%), solid tumor (4%), anemia (3%), malignant neoplasm (hematologic: 2%) Hepatic: Hepatotoxicity (3%) Hypersensitivity: Hypersensitivity ( 5%) Renal: Acute renal failure (3%) Respiratory: Respiratory tract infection (3%) Warnings/Precautions Concerns related to adverse effects: Hepatotoxicity: Liver enzyme elevations (AST/ALT more than 3 times ULN, total bilirubin more than 2 times ULN, and alkaline phosphatase less than 2 times ULN) have occurred. Monitor liver function tests periodically; may require treatment interruption and/or discontinuation. Infection: Infections were reported in the majority of multiple myeloma patients treated in the clinical trial, including fatal infections. Monitor for opportunistic, fungal, herpes zoster, and other infections during therapy; treat promptly if infections occur. Infusion reactions: Infusion reactions (eg, fever, chills, hypertension) have been reported; all reactions were grade 3 or lower. Bradycardia and hypotension have also occurred during infusion. The majority of infusion reactions (~70%) occurred during the first dose. Premedicate with dexamethasone, H 1 - and H 2 -blockers, and acetaminophen prior to each dose. Administer in a facility with immediate access to resuscitative measures (eg, glucocorticoids, epinephrine, bronchodilators, and/or oxygen). May require treatment interruption, infusion rate modification, and/or discontinuation. Secondary malignancy: Invasive second primary malignancies have been reported. The rate of hematologic malignancies was the same between the elotuzumab/lenalidomide/dexamethasone group versus the lenalidomide/dexamethasone group. Solid tumors and skin cancer were reported more frequently in the elotuzumab arm versus the control group. Monitor for the development of secondary malignancies. Disease-related concerns: Interference with determination of myeloma response: Elotuzumab (a human IgG kappa monoclonal antibody) may be detected on serum protein electrophoresis and immunofixation assays which monitor for endogenous M-protein. Interference with these assays by elotuzumab may affect the determination of complete response and disease progression in some patients with IgG kappa myeloma protein. Concurrent drug therapy issues: Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Dosage form specific issues: Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling. Monitoring Parameters Liver function tests (periodically); signs/symptoms of infusion reactions (monitor vital signs every 30 minutes during and for 2 hours after the end of the infusion in patients who experience an infusion reaction), infections, and second primary malignancies Pregnancy Considerations Animal reproduction studies have not been conducted. Elotuzumab is indicated for use in combination with lenalidomide. Due to its potential to cause fetal harm, lenalidomide is only available through a REMS program. Males and females of reproductive potential using this combination must be able to comply with pregnancy testing and contraception requirements for lenalidomide. Refer to the lenalidomide monograph for additional information. Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience loss of strength and energy, diarrhea, constipation, burning or numbness feeling, rhinitis, pharyngitis, lack of appetite, painful extremities, vomiting, or weight loss. Have patient report immediately to prescriber signs of infection, signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), signs of high potassium (abnormal heartbeat, confusion, dizziness, passing out, weakness, shortness of breath, or numbness or tingling feeling), severe headache, dizziness, passing out, tachycardia, bradycardia, mole changes, skin growth, vision changes, angina, mood changes, night sweats, bruising, or bleeding (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about elotuzumab Side Effects During Pregnancy Dosage Information Drug Interactions Support Group En Español 0 Reviews Add your own review/rating Drug class: miscellaneous antineoplastics Consumer resources Elotuzumab Elotuzumab Intravenous (Advanced Reading) Professional resources Elotuzumab (AHFS Monograph) Other brands: Empliciti Related treatment guides Multiple Myeloma> ] Drug Status Rx Availability Prescription only N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Elotuzumab Rating No Reviews – Be the first! No Reviews – Be the first! Not Rated – Be the first! Drug Class Miscellaneous antineoplastics Related Drugs miscellaneous antineoplastics tretinoin , Revlimid , Zytiga , Accutane , isotretinoin , irinotecan Multiple Myeloma dexamethasone , Decadron , Revlimid , cyclophosphamide , Cytoxan , Adriamycin , doxorubicin , Velcade , Doxil , vincristine , lenalidomide , Pomalyst , thalidomide , bortezomib , carfilzomib , Ninlaro , Kyprolis , melphalan , daratumumab , Thalomid , Dexasone , pomalidomide , carmustine , ixazomib , More… that each one

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pictures [1):<1) Edema 26 (3) 0 Rash (Non-Application Site) 25 (3) 5 (2) Infection 25 (3) 8 (2) Ecchymosis 19 (2) 1 (> <1) Dry Skin (Non-Application Site) 19 (2) 1 (> <1) Contact Dermatitis, vesicles (Application Site) 18 (2) 0 Paresthesia (Non-Application Site) 14 (2) 3 (> <1) Accidental Injury 22 (2) 7 (2) Pruritus (Non-Application Site) 15 (2) 2 (> <1) Sinusitis 10 (1) 2 (> <1) Halitosis 11 (1) 1 (> <1) Application Site Reaction (not otherwise specified) 11 (1) 3 (> <1) Post marketing Experience In non U.S. post marketing surveillance, the following adverse reactions have been reported during post-approval use of diclofenac sodium topical solution. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Body as a Whole: abdominal pain, accidental injury, allergic reaction, asthenia, back pain, body odor, chest pain, edema, face edema, halitosis, headache, lack of drug effect, neck rigidity, pain Cardiovascular: palpitation, cardiovascular disorder Digestive: diarrhea, dry mouth, dyspepsia, gastroenteritis, decreased appetite, mouth ulceration, nausea, rectal hemorrhage, ulcerative stomatitis Metabolic and Nutritional: creatinine increased Musculoskeletal: leg cramps, myalgia Nervous: depression, dizziness, drowsiness, lethargy, paresthesia, paresthesia at application site Respiratory: asthma, dyspnea, laryngismus, laryngitis, pharyngitis Skin and Appendages: At the Application Site: contact dermatitis, contact dermatitis with vesicles, dry skin, pruritus, rash; Other Skin and Appendages Adverse Reactions: eczema, rash, pruritus, skin discoloration, urticaria Special senses: abnormal vision, blurred vision, cataract, ear pain, eye disorder, eye pain, taste perversion 7. DRUG INTERACTIONS Drug interactions with the use of diclofenac sodium topical solution have not been studied. The following drug interactions [sections 7.1 to 7.7] are noted for oral diclofenac sodium. Aspirin When diclofenac is administered with aspirin, the binding of diclofenac to protein is reduced, although the clearance of free diclofenac is not altered. The clinical significance of this interaction is not known; however, as with other NSAIDs, concomitant administration of diclofenac and aspirin is not generally recommended because of the potential of increased adverse effects. Anticoagulants The effects of anticoagulants such as warfarin and NSAIDs on GI bleeding are synergistic, such that users of both drugs together have a risk of serious GI bleeding higher than users of either drug alone. ACE-Inhibitors NSAIDs may diminish the antihypertensive effect of angiotensin converting enzyme (ACE) inhibitors. Consider this interaction in patients taking NSAIDs concomitantly with ACE-inhibitors. Diuretics Clinical studies, as well as post marketing observations, have shown that NSAIDs can reduce the natriuretic effect of furosemide and thiazides in some patients. The response has been attributed to inhibition of renal prostaglandin synthesis. During concomitant therapy with NSAIDs, observe the patient closely for signs of renal failure [ see Warnings and Precautions (5.6) ] , as well as to assure diuretic efficacy. Lithium NSAIDs have produced an elevation of plasma lithium levels and a reduction in renal lithium clearance. The mean minimum lithium concentration increased 15% and the renal clearance was decreased by approximately 20%. These effects have been attributed to inhibition of renal prostaglandin synthesis by the NSAID. Thus, when NSAIDs, including diclofenac, and lithium are administered concurrently, observe patients carefully for signs of lithium toxicity. Methotrexate NSAIDs have been reported to competitively inhibit methotrexate accumulation in rabbit kidney slices. This may indicate that they could enhance the toxicity of methotrexate. Use caution when NSAIDs, including diclofenac, are administered concomitantly with methotrexate. Cyclosporine Diclofenac, like other NSAIDs, may affect renal prostaglandins and increase the toxicity of certain drugs. Therefore, concomitant therapy with diclofenac may increase cyclosporine's nephrotoxicity. Use caution when diclofenac is administered concomitantly with cyclosporine. Oral Nonsteroidal Anti-Inflammatory Drugs Concomitant use of oral NSAIDs with diclofenac sodium topical solution has been evaluated in one Phase 3 controlled trial and in combination with oral diclofenac, compared to oral diclofenac alone, resulted in a higher rate of rectal hemorrhage (3% vs. less than 1%), and more frequent abnormal creatinine (12% vs. 7%), urea (20% vs. 12) and hemoglobin (13% vs. 9%). Therefore, do not use combination therapy with diclofenac sodium topical solution and an oral NSAID unless the benefit outweighs the risk and conduct periodic laboratory evaluations. Topical Treatments Instruct patients that before applying sunscreen, insect repellant, lotion, moisturizer, cosmetics, or other topical medication to the same skin surface of the knee treated with diclofenac sodium topical solution, they must wait until the treated area is completely dry. 8. USE IN SPECIFIC POPULATIONS Pregnancy Pregnancy Category C prior to 30 weeks gestation; Category D starting 30 weeks gestation. Teratogenic Effects: There are no adequate and well-controlled studies of diclofenac sodium topical solution in pregnant women. Diclofenac sodium topical solution should not be used by pregnant women as its safe use has not been adequately determined and starting at 30 weeks gestation, diclofenac and other NSAIDs should be avoided by pregnant women as premature closure of the ductus arteriosus in the fetus may occur. Developmental studies in animals demonstrated that diclofenac sodium administration did not produce teratogenicity despite the induction of maternal toxicity and fetal toxicity in mice at doses up to 20 mg/kg/day (0.6-fold the maximum recommended human dose [MRHD] of 154 mg/day based on body surface area comparison), and in rats and rabbits at doses up to 10 mg/kg/day (approximately 0.6-fold and 1.3-fold the MRHD, respectively). Published reproductive and developmental studies of dimethyl sulfoxide (DMSO, the solvent used in diclofenac sodium topical solution) are equivocal as to potential teratogenicity. Nonteratogenic Effects: In rats, maternally toxic doses of diclofenac were associated with dystocia, prolonged gestation, reduced fetal weights and growth, and reduced fetal survival. Labor and Delivery The effects of diclofenac sodium topical solution on labor and delivery in pregnant women are unknown. In rat studies maternal exposure to diclofenac, as with other NSAID drugs, known to inhibit prostaglandin synthesis, increased the incidence of dystocia, delayed parturition, and decreased offspring survival. Nursing Mothers It is not known whether this drug is excreted in human milk; however, there is a case report in the literature indicating that diclofenac can be detected at low levels in breast milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from diclofenac sodium topical solution, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Pediatric Use Safety and effectiveness in pediatric patients have not been established. Geriatric Use Of the 911 patients treated with diclofenac sodium topical solution in seven controlled Phase 3 clinical trials, 444 subjects were 65 years of age and over. There was no age-related difference in the incidence of adverse events. Of the 793 patients treated with diclofenac sodium topical solution in one open-labeled safety trial, 334 subjects were 65 years of age and over including 107 subjects 75 and over. There was no difference in the incidence of adverse events with long-term exposure to diclofenac sodium topical solution for this elderly population. As with any NSAID, use caution in treating the elderly (65 years and older) and it may be useful to monitor renal function since they are more likely to have decreased baseline renal function. 10. OVERDOSAGE There have been no known experiences of overdose with diclofenac sodium topical solution. Symptoms following acute NSAID overdose are usually limited to lethargy, drowsiness, nausea, vomiting, and epigastric pain, which are generally reversible with supportive care. Gastrointestinal bleeding can occur. Hypertension, acute renal failure, respiratory depression and coma may occur, but are rare. Anaphylactoid reactions have been reported with therapeutic ingestion of NSAIDs, and may occur following an overdose. Manage patients using symptomatic and supportive care following an NSAID overdose. There are no specific antidotes. Emesis is not recommended due to a possibility of aspiration and subsequent respiratory irritation by DMSO contained in diclofenac sodium topical solution. Activated charcoal (60 to 100 g in adults, 1 to 2 g/kg in children) and/or osmotic cathartic may be indicated in patients seen within 4 hours of ingestion with symptoms or following a large overdose (5 to 10 times the usual dose). Forced diureses, alkalinization of urine, hemodialysis, or hemoperfusion may not be useful due to high protein binding. For additional information about overdose treatment, call a poison control center (1-800-222-1222). 11. DESCRIPTION Diclofenac sodium topical solution is a clear, colorless to faintly pink-orange solution for topical application. Diclofenac sodium topical solution contains 1.5% w/w diclofenac sodium, a benzeneacetic acid derivative that is a nonsteroidal anti-inflammatory drug (NSAID), designated chemically as 2-[(2,6- dichlorophenyl)amino]-benzeneacetic acid, monosodium salt. The molecular weight is 318.14. Its molecular formula is C 14 H 10 Cl 2 NNaO 2 and it has the following structural formula: Each 1 mL of solution contains 16.05 mg of diclofenac sodium. In addition diclofenac sodium topical solution contains the following inactive ingredients: dimethyl sulfoxide USP (DMSO, 45.5% w/w), propylene glycol, alcohol, glycerin and purified water. 12. CLINICAL PHARMACOLOGY Mechanism of Action The mechanism of action of diclofenac is similar to that of other nonsteroidal anti-inflammatory drugs. Diclofenac inhibits the enzyme, cyclooxygenase (COX), an early component of the arachidonic acid cascade, resulting in the reduced formation of prostaglandins, thromboxanes and prostacylin. It is not completely understood how reduced synthesis of these compounds results in therapeutic efficacy. Pharmacodynamics Diclofenac, the active component of diclofenac sodium topical solution has anti-inflammatory, anti-nociception, and antipyretic effects. Pharmacokinetics After topical administration to healthy human volunteers of single and multiple maximum doses of diclofenac sodium topical solution, 40 drops (approximately 1.2 mL) to each knee (80 drops total dose), the following diclofenac pharmacokinetic parameters were obtained: (see Table 2 ). Table 2: Single-Dose (80 drops) and Multiple Dose (80 drops four times daily for 7 days) Diclofenac Sodium Topical Solution Pharmacokinetic Parameters Pharmacokinetic Parameters Diclofenac sodium Normal Adults [N=18] (Age: 18-55 years) Normal Adults [N=19] (Age: 18-55 years) Single Dose Multiple Dose Four times daily for 7 days * Apparent total body clearance AUC 0-t 177.5 72.6 ng.h/mL 695.4 348.9 ng.h/mL AUC 0-inf 196.3 68.5 ng.h/mL 745.2 374.7 ng.h/mL Plasma C max 8.1 5.9 ng/mL 19.4 9.3 ng/mL Plasma T max (h) 11.0 6.4 4.0 6.5 Plasma t 1/2 (h) 36.7 20.8 79.0 38.1 Kel (h -1 ) 0.024 0.010 0.011 0.004 CL/F (L/h) 244.7 84.7 * - Absorption Diclofenac systemic exposure from diclofenac sodium topical solution application (4 times daily for 1 week) was approximately 1/3 of the diclofenac systemic exposure from the Solaraze (diclofenac topical gel) application (twice daily for 4 weeks). Distribution Diclofenac is more than 99% bound to human serum proteins, primarily to albumin. Diclofenac diffuses into and out of the synovial fluid. Diffusion into the joint occurs when plasma levels are higher than those in the synovial fluid, after which the process reverses and synovial fluid levels are higher than plasma levels. It is not known whether diffusion into the joint plays a role in the effectiveness of diclofenac. Metabolism Five diclofenac metabolites have been identified in human plasma and urine. The metabolites include 4'- hydroxy-, 5-hydroxy-, 3'-hydroxy-, 4',5-dihydroxy- and 3'-hydroxy-4'-methoxy diclofenac. The major diclofenac metabolite, 4'-hydroxy-diclofenac, has very weak pharmacologic activity. The formation of 4'-hydroxy diclofenac is primarily mediated by CPY2C9. Both diclofenac and its oxidative metabolites undergo glucuronidation or sulfation followed by bilIary excretion. Acylglucuronidation mediated by UGT2B7 and oxidation mediated by CPY2C8 may also play a role in diclofenac metabolism. CYP3A4 is responsible for the formation of minor metabolites, 5-hydroxy and 3'-hydroxy-diclofenac. Excretion Diclofenac is eliminated through metabolism and subsequent urinary and biliary excretion of the glucuronide and the sulfate conjugates of the metabolites. Little or no free unchanged diclofenac is excreted in the urine. Special Populations Pediatric: The pharmacokinetics of diclofenac sodium topical solution has not been investigated in pediatric patients. Race: Pharmacokinetic differences due to race have not been studied. Platelets The effect of diclofenac sodium topical solution on platelet function was evaluated in 10 healthy human volunteers as a sub-study of a multiple-dose pharmacokinetic study [see Pharmacokinetics (12.3) ]. Average (range) platelet aggregation time following stimulation with adenosine diphosphate, collagen, epinephrine and arachidonic acid was 101.3% (73.3 to 128.1), 99.8% (69.6 to 112.9), 109.9% (66.2 to 178.1) and 99.0% (15.5 to 126.6) of baseline value, respectively. These results indicate that there was no effect on platelet aggregation after application of the maximum clinical dose for 7 days [see Pharmacokinetics (12.3) ]. 13. NONCLINICAL TOXICOLOGY Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenicity studies in mice and rats administered diclofenac sodium, as a dietary constituent for 2 years resulted in no significant increases in tumor incidence at doses up to 2 mg/kg/day corresponding to approximately 0.35-and 0.7-fold (mouse and rat, respectively) of the maximum recommended human topical dose (MRHD) of diclofenac sodium topical solution (based on apparent bioavailability and body surface area comparison). In a dermal carcinogenicity study conducted in albino mice, daily topical applications of diclofenac sodium for two years at concentrations up to 0.035% diclofenac sodium (a 43-fold lower diclofenac sodium concentration than present in diclofenac sodium topical solution) did not increase neoplasm incidence. In a photococarcinogenicity study conducted in hairless mice, topical application of diclofenac sodium at doses up to 0.035% diclofenac sodium (a 43-fold lower diclofenac sodium concentration than present in diclofenac sodium topical solution) resulted in an earlier median time of onset of tumors. Mutagenesis: Diclofenac was not mutagenic or clastogenic in a battery of genotoxicity tests that included the bacterial reverse mutation assay, in vitro mouse lymphoma point mutation assay, chromosomal aberration studies in Chinese hamster ovarian cells in vitro , and in vivo rat chromosomal aberration assay of bone marrow cells. Impairment of Fertility: Fertility studies have not been conducted with diclofenac sodium topical solution. Diclofenac sodium administered to male and female rats at doses up to 4 mg/kg/day (1.4-fold of the MRHD of diclofenac sodium topical solution based on apparent bioavailability and body surface area comparison) did not affect fertility. Studies have not been conducted to determine the safety of DMSO on fertility. Animal Toxicology and/or Pharmacology Ocular Effects No adverse effects were observed using indirect ophthalmoscopy after multiple-daily dermal application to rats for 26 weeks and minipigs for 52 weeks of DMSO at twice the concentration found in diclofenac sodium topical solution. Published studies of dermal or oral administration of DMSO to rabbits, dogs and pigs described refractive changes of lens curvature and cortical fibers indicative of myopic changes and/or incidences of lens opacity or discoloration when evaluated using slit-lamp biomicroscopy examination, although no ocular abnormalities were observed in rhesus monkeys during daily oral or dermal treatment with DMSO for 9 to 18 months. 14. CLINICAL STUDIES Pivotal Studies in Osteoarthritis of the Knee The use of diclofenac sodium topical solution for the treatment of the signs and symptoms of osteoarthritis of the knee was evaluated in two double-blind controlled trials conducted in the U.S. and Canada, involving patients treated with diclofenac sodium topical solution at a dose of 40 drops four times a day for 12 weeks. Diclofenac sodium topical solution was compared to topical placebo (2.3% DMSO with other excipients) and/or topical vehicle solution (45.5% w/w DMSO with other excipients), applied directly to the study knee. In both trials, diclofenac sodium topical solution treatment resulted in statistically significant clinical improvement compared to placebo and/or vehicle, in all three primary efficacy variables pain, physical function (Western Ontario and McMaster Universities LK3.1 OA Index (WOMAC) pain and physical function dimensions) and Patient Overall Health Assessment (POHA)/Patient Global Assessment (PGA). Numerical results are summarized in Tables 3 and 4. Table 3: Change in treatment outcomes after 12 weeks of treatment in one study of efficacy of Diclofenac Sodium Topical Solution Efficacy Variable Study I Mean baseline score and mean change in efficacy variables after 12 weeks of treatment Mean Baseline score Diclofenac sodium N=154 Topical placebo * N=155 Topical vehicle N=161 * placebo formulation included 2.3% DMSO vehicle formulation included 45.5% DMSO WOMAC pain score 13 -6.0 -4.7 -4.7 (Likert 3.1, 0-20) WOMAC physical function (Likert 3.1, 0-68) 42 -15.7 -12.3 -12.1 POHA (0-4) 2.3 -1.0 -0.4 -0.6 Table 4: Change in treatment outcomes after 12 weeks of treatment in one study of efficacy of Diclofenac Sodium Topical Solution Efficacy Variable Study II Mean baseline score and mean change in efficacy variables after 12 weeks of treatment Mean Baseline score Diclofenac sodium N=164 Topical vehicle * N=162 * vehicle formulation included 45.5% DMSO WOMAC pain score (Likert 3.1, 0-20) 13 -5.9 -4.4 WOMAC physical function (Likert 3.1, 0-68) 42 -15.3 -10.3 PGA (0-4) 3.1 -1.3 -1.0 16. HOW SUPPLIED/STORAGE AND HANDLING Diclofenac Sodium Topical Solution is supplied as a clear, colorless to faintly pink-orange solution containing 16.05 mg of diclofenac sodium per mL of solution, in a white high density polyethylene bottle with a white low-density dropper cap. NDC Number & Size NDC # 51021-150-05 150 mL bottle Storage Store at 25 C (77 F); excursions permitted to 15 to 30 C (59 to 86 F) [See USP Controlled Room Temperature]. 17. PATIENT COUNSELING INFORMATION See FDA-Approved Patient Labeling ( Medication Guide and Instructions for Use ). Patient/Caregiver Instructions Inform patients of the following information before initiating therapy with an NSAID and periodically during the course of ongoing therapy. Encourage patients to read the NSAID Medication Guide that accompanies each prescription dispensed prior to using diclofenac sodium topical solution [see Medication Guide and Instructions for Use ]. Cardiovascular Effects Diclofenac sodium topical solution, like other NSAIDs, may cause serious DV side effects, such as MI or stroke, which may result in hospitalization and even death. Although serious CV events can occur without warning symptoms, instruct patients to be alert for the signs and symptoms of chest pain, shortness of breath weakness, slurring of speech, and to ask for medical advice when observing any indicative sign or symptoms. Inform patients of the importance of this follow-up [see Warnings and Precautions (5.1) ]. Gastrointestinal Effects Diclofenac sodium topical solution, like other NSAIDs, may cause GI discomfort and, rarely, serious GI side effects, such as ulcers and bleeding, which may result in hospitalization and even death. Although serious GI tract ulcerations and bleeding can occur without warning symptoms, inform patients to be alert for the signs and symptoms of ulceration and bleeding, and to ask for medical advice when observing any indicative sign or symptoms including epigastric pain, dyspepsia, melena, and hematemesis. Instruct patients of the importance of this follow-up [see Warnings and Precautions (5.2) ]. Hepatotoxicity Inform patients of the warning signs and symptoms of hepatotoxicity (e.g., nausea, fatigue, lethargy, pruritus, jaundice, right upper quadrant tenderness, and "flu-like" symptoms). If these occur, instruct patients to stop therapy with diclofenac sodium topical solution and seek immediate medical therapy [see Warnings and Precautions (5.3) ]. Adverse Skin Reactions Diclofenac sodium topical solution, like other NSAIDs, can cause serious systemic skin side effects such as exfoliative dermatitis, SJS, and TEN, which may result in hospitalizations and even death. Although serious systemic skin reactions may occur without warning, instruct patients to be alert for the signs and symptoms of skin rash and blisters, fever, or other signs of hypersensitivity such as itching, and to ask for medical advice when observing any indicative signs or symptoms [see Warnings and Precautions (5.8) ]. Advise patients to stop diclofenac sodium topical solution immediately if they develop any type of generalized rash and contact their physicians as soon as possible. Diclofenac sodium topical solution can cause a localized skin reaction at the application site. Advise patients to contact their physicians as soon as possible of they develop any type of localized application site rash. Instruct patients not to apply diclofenac sodium topical solution to open skin wounds, infections, inflammations, or exfoliative dermatitis, as it may affect absorption and reduce tolerability of the drug. Instruct patients to wait until the area treated with diclofenac sodium topical solution is completely dry before applying sunscreen, insect repellant, lotion, moisturizer, cosmetics, or other topical medication. Instruct patients to minimize or avoid exposure of treated knee(s) to natural or artificial sunlight. Weight Gain and Edema Instruct patients to promptly report to their physician signs or symptoms of unexplained weight gain or edema following treatment with diclofenac sodium topical solution [see Warnings and Precautions (5.5) ]. Anaphylactoid Reactions Inform patients of the signs of an anaphylactoid reaction (e.g. difficulty breathing, swelling of the face or throat). If these occur, instruct patients to seek immediate emergency help [see Warnings and Precautions (5.7) ]. Effects During Pregnancy Instruct patients who are pregnant or intending to become pregnant not to use diclofenac sodium topical solution [see Use in Specific Populations (8.1) and Impairment of Fertility (13.1) ]. Eye Exposure Instruct patients to avoid contact of diclofenac sodium topical solution with the eyes and mucosa. Advise patients that if eye contact occurs, immediately wash out the eye with water or saline and consult a physician if irritation persists for more than an hour. Prevention of Secondary Exposure Instruct patients to avoid skin-to-skin contact between other people and the knee(s) to which diclofenac sodium topical solution was applied until the knee(s) is completely dry. Medication Guide for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) (See the end of this Medication Guide for a list of prescription NSAID medicines.) What is the most important information I should know about medicines called Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)? NSAID medicines may increase the chance of a heart attack or stroke that can lead to death. This chance increases: with longer use of NSAID medicines in people who have heart disease NSAID medicines should never be used right before or after a heart surgery called a "coronary artery bypass graft (CABG)." NSAID medicines can cause ulcers and bleeding in the stomach and intestines at any time during treatment. Ulcers and bleeding: can happen without warning symptoms may cause death The chance of a person getting an ulcer or bleeding increases with: taking medicines called "corticosteroids" and "anticoagulants" longer use smoking drinking alcohol older age having poor health NSAID medicines should only be used: exactly as prescribed at the lowest dose possible for your treatment for the shortest time needed What are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)? NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis, menstrual cramps and other types of short-term pain Who should not take a Non-Steroidal Anti-Inflammatory Drug (NSAID)? Do not take an NSAID medicine: if you had an asthma attack, hives, or other allergic reaction with aspirin or any other NSAID medicine or pain right before or after heart bypass surgery Tell your healthcare provider: about all of your medical conditions. about all of the medicines you take. NSAIDs and some other medicines can interact with each other and cause serious side effects. Keep a list of your medicines to show to your healthcare provider and pharmacist. if you are pregnant, NSAID medicines should not be used by pregnant women late in their pregnancy. if you are breastfeeding. Talk to your doctor. What are the possible side effects of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)? Serious side effects include: heart attack stroke high blood pressure heart failure from body swelling (fluid retention) kidney problems including kidney failure bleeding and ulcers in the stomach and intestine low red blood cells (anemia) life-threatening skin reactions life-threatening allergic reactions liver problems including liver failure asthma attacks in people who have asthma Other side effects include: stomach pain constipation diarrhea gas heartburn nausea vomiting dizziness Get emergency help right away if you have any of the following symptoms: shortness of breath or trouble breathing chest pain slurred speech weakness in one part or side of your body swelling of the face or throat Stop your NSAID medicine and call your healthcare provider right away if you have any of the following symptoms: nausea more tired or weaker than usual itching your skin or eyes look yellow stomach pain flu-like symptoms vomit blood there is blood in your bowel movement or it is black and sticky like tar unusual weight gain skin rash or blisters with fever swelling of the arms and legs, hands and feet These are not all the side effects with NSAID medicines. Talk to your healthcare provider or pharmacist for more information about NSAID medicines. Call your doctor for medical advice about s ide effects. You may report s ide effects to FDA at 1- 800-FDA-1088. Other information about Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Aspirin is an NSAID medicine but it does not increase the chance of a heart attack. Aspirin can cause bleeding in the brain, stomach, and intestines. Aspirin can also cause ulcers in the stomach and intestines. Some of these NSAID medicines are sold in lower doses without a prescription (over-the-counter). Talk to your healthcare provider before using over-the-counter NSAIDs for more than 10 days. NSAID medicines that need a prescription Generic Name Trade name * Vicoprofen contains the same dose of ibuprofen as over- the- counter (OTC) NSAID, and is usually used for less than 10 days to treat pain. The OTC NSAID label warns that long term continuous use may increase the risk of heart attack or stroke. Celecoxib Celebrex Diclofenac Flector, Cataflam , Voltaren , Arthrotec (combined with misoprostol), PENNSAID (Diclofenac Sodium Topical Solution) Diflunisal Dolobid Etodolac Lodine , Lodine XL Fenoprofen Nalfon , Nalfon 200 Flurbiprofen Ansaid Ibuprofen Motrin , Tab-Profen , Vicoprofen * (combined with hydrocodone), Combunox (combined with oxycodone) Indomethacin Indocin , Indocin SR, Indo-Lemmon , Indomethagan Ketoprofen Oruvail Ketorolac Toradol Mefenamic Acid Ponstel Meloxicam Mobic Nabumetone Relafen Naproxen Naprosyn , Anaprox , Anaprox DS, EC- Naproxyn , Naprelan , Naprapac (copackaged with lansoprazole) Oxaprozin Daypro Piroxicam Feldene Sulindac Clinoril Tolmetin Tolectin , Tolectin DS, Tolectin 600 This Medication Guide has been approved by the U.S. Food and Drug Administration. Patient Instructions for Use Diclofenac Sodium Topical Solution Read the Medication Guide that comes with diclofenac sodium topical solution first. Be sure that you read, understand, and follow these Instructions for Use before you use diclofenac sodium topical solution for the first time. Important: For use on the skin only (topical). Do not get diclofenac sodium topical solution in your eyes, nose or mouth. Before you use diclofenac sodium topical solution: Apply diclofenac sodium topical solution exactly as your healthcare provider tells you. Talk with your healthcare provider or pharmacist if you are not sure. Only use diclofenac sodium topical solution to treat pain from osteoarthritis in your knee or knees. Apply diclofenac sodium topical solution on clean dry skin that does not have any cuts, infections or rashes. Use diclofenac sodium topical solution 4 times each day on your knee or knees as prescribed. Your total dose for each knee is 40 drops of diclofenac topical solution, each time you use it. If you get diclofenac sodium topical solution in your eyes, rinse your eyes right away with water or saline. Call your healthcare provider if your eyes are irritated for more than one hour. Steps for using diclofenac sodium topical solution: Step 1. Wash your hands with soap and water before and after applying diclofenac sodium topical solution. Step 2. Put 10 drops of diclofenac sodium topical solution either on your hand or directly on your knee (See Figure A ). Figure A Step 3. Spread diclofenac sodium topical solution evenly on the front, back and sides of your knee (see Figures B and C ). Repeat steps 2 and 3, three times so that your knee is completely covered with a total of 40 drops of diclofenac sodium topical solution. Figure B Figure C Step 4. If your healthcare provider has prescribed diclofenac sodium topical solution for both knees, repeat steps 2 and 3 for the other knee. After you use diclofenac sodium topical solution: Wash your hands with soap and water right away after applying diclofenac sodium topical solution. Do not touch the treated knee or allow another person to touch the knee treated with diclofenac sodium topical solution until your knee is completely dry. cover your knee with clothing until your knee is completely dry. put sunscreen, insect repellant, lotion, moisturizer, cosmetics, or other topical medicines on your knee until it is completely dry. take a shower or a bath for at least 30 minutes after you put diclofenac sodium topical solution on your knee(s). use heating pads or apply bandages to the skin where you have applied diclofenac sodium topical solution. use sunlamps and tanning beds. Protect your treated knee from sunlight. Wear clothes that cover your skin if you have to be in sunlight. How should I store diclofenac sodium topical solution? Store diclofenac sodium topical solution between 68 F to 77 F (20 C to 25 C). Keep diclofenac sodium topical solution and all medicines out of the reach of children. This Instructions for Use has been approved by the U.S. Food and Drug Administration. Brands mentioned are trademarks of their respective owners. Manufactured for: Sircle Laboratories, LLC Madison, MS 39110 METAXALL Metaxalone 800mg Tablets Lorvatus Pharmapak Description Metaxalone is available as an 800 mg, light pink to pink, capsule shaped, scored uncoated tablet. Chemically, metaxalone is 5-[(3,5- dimethylphenoxy) methyl]-2-oxazolidinone. The empirical formula is C 12 H 15 NO 3 , which corresponds to a molecular wei recognise tramping away Lorvatus Pharmapak a really

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various EC-NAPROSYN 375 (EC-naprosyn 375 mg) Generic Name: naproxen Pill with imprint EC-NAPROSYN 375 is White, Elliptical / Oval and has been identified as EC-naprosyn 375 mg. It is supplied by Genentech. EC-Naprosyn is used in the treatment of sciatica; back pain; pain; bursitis; ankylosing spondylitis (and more ), and belongs to the drug class nonsteroidal anti-inflammatory agents. Risk cannot be ruled out during pregnancy. EC-Naprosyn 375 mg is not a controlled substance under the Controlled Substance Act (CSA). Images for EC-NAPROSYN 375 Save up to 80% off prescription medications Click here for your free Discount Card EC-naprosyn Generic Name: naproxen Imprint: EC-NAPROSYN 375 Strength: 375 mg Color: White Size: 14.00 mm Shape: Elliptical / Oval Availability: Rx and/or OTC Drug Class: Nonsteroidal anti-inflammatory agents Pregnancy Category: C – Risk cannot be ruled out CSA Schedule: Not a controlled drug Labeler / Supplier: Genentech Inactive Ingredients: croscarmellose sodium povidone k90 magnesium stearate methacrylic acid – methyl methacrylate copolymer (1:1) magnesium silicate triethyl citrate sodium hydroxide water Note: Inactive ingredients may vary. More info Imprint Search Print Get help with Imprint Code FAQs . Print this page Add to My Med List More about EC-Naprosyn (naproxen) Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Images Drug Interactions Support Group Pricing & Coupons En Español 0 Reviews Add your own review/rating Generic Availability Drug class: nonsteroidal anti-inflammatory agents Consumer resources EC-Naprosyn EC Naprosyn (Advanced Reading) Other brands: Aleve , Anaprox , Naprelan , Anaprox-DS , … +3 more Professional resources Naproxen Sodium (AHFS Monograph) Naproxen Tablets (FDA) Other Formulations Naprosyn Related treatment guides Ankylosing Spondylitis Aseptic Necrosis Back Pain Bursitis … +18 more Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Copyright 2017, National Library of Medicine, Truven Health Analytics and Cerner Multum, Inc. All Rights Reserved. Drug Status Rx OTC Availability Rx and/or OTC C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA EC-Naprosyn Rating No Reviews – Be the first! 7.0 /10 No Reviews – Be the first! 7.0 Rate it! Drug Class Nonsteroidal anti-inflammatory agents maintaining

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reformatory Preservativos masculinos Posted under Guías de la Salud . Updated 1 December 2014. +Related Content El preservativo masculino El preservativo masculino es una envoltura que se usa sobre el pene durante la relación sexual. Previene el embarazo actuando como barrera y evitando que el semen masculino se vierta en la vagina y que los espermatozoides puedan penetrar en el óvulo y fecundarlo. Los preservativos disminuyen las posibilidades de que mujeres y hombres contraigan enfermedades de transmisión sexual, incluyendo el VIH. Hay decenas de formas, texturas y estilos de preservativos para elegir, algunos más efectivos que otros. Los preservativos pueden ser de latex, poliuretano o piel de cordero natural. Pueden ser o no lubricados. Algunos contienen espermicidas, otros no. Es major no usar condones con espermicida. De 100 mujeres usando preservativos Uso tipico: 14 de ellas se embarazan Uso perfecto: 3 de ellas se embarazan Importa qué tipo de preservativo uso? Si, el mejor es el de latex. Brinda la mejor protección, tanto para el embarazo, como para las enfermedades de transmisión sexual. Si eres alérgico al latex, los de poliuretano son un buen método. Ellos brindan la misma protección frente al embarazo y alguna protección frente a las ETS, pero se rompen o se deslizan más frecuentemente que los de latex. Los preservativos naturales o de piel de cordero, son efectivos frente a la prevención del embarazo, pero no son efectivos para la prevención de las ETS. Es una decisión personal usar los preservativos lubricados o no, pero la mayoría de los adolescentes los prefiere lubricados. Qué efectivo es el preservativo en el control de la fertilidad? Si la mujer usa el preservativo en cada relación sexual y sigue las instrucciones siempre, su efectividad es del 97%. Es decir que lo debe usar siempre, durante toda la relación sexual y no sólo, en el momento de la eyaculación. Esto significa que si 100 mujeres usan preservativo masculino correctamente todo el tiempo, 3 mujeres quedan embarazadas en 1 año. Es obvio que si el preservative masculino es mas efectivo contra la fertilidad cuando se usa todo el tiempo y siempre correctamente. Si mujeres usan el preservativo masculino, pero no lo usan perfectamente, la efectividad disminuye a un 86%. Esto significa que si 100 mujeres usan el preservative masculine, pero no lo usan perfectamente cada vez, por lo menos 12 mujeres quedarán embarazadas en un año. La mayoría de las fallas de este método, es por uso inadecuado. El empleo de los preservativos vencidos, es causa de mayor índice de ruptura. Qué efectivo es el preservativo en la prevención de las Enfermedades de Transmisión Sexual? La respuesta a esta pregunta depende de qué tipo de preservativo uses. El preservativo de latex brinda una excelente protección frente a las ETS. Los preservativos de poliuretano, brindan alguna protección frente a las ETS, aunque no es claro cuán eficaces son. Es importante recordar que los preservativos de cordero o naturales, no protegen de las ETS. La respuesta a esta pregunta depende de a cual tipo de ETS nos estamos refiriendo. Los preservativos de latex son efectivos contra las ETS que están en los fluidos sangre o semen tal como el virus VIH/SIDA, hepatitis, chlamydia y gonorrea. Los preservativos son mucho menos efectivos frente a las ETS causadas por organismos que viven en lesiones inflamadas o ulceradas de las mucosas genitales, tal como sífilis, herpes y virus del papiloma humano también llamados verrugas genitales. Dónde debo guardar los preservativos no usados? Debemos guardarlos en lugares secos, con poca luz y a temperatura ambiente. Extremo frío o calor debilitan el material. La luz solar o la humedad pueden causar mayor número de rupturas o desgarros. Los preservativos no se deben llevar en una billetera o guardar en la gaveta del auto, por más de dos semanas, porque el material se debilitará y será más propenso a que se desgarre o rompa. Cuánto tiempo los preservativos se mantienen en correcto estado? Siempre corrobore la fecha de vencimiento de la caja. Algunos están marcados con la fecha de manufactura. Se puede usar un preservativo hasta cuatro años después de la fecha de manufactura. Otros preservativos están marcados con la fecha de expiración. No se debe usar más allá de la fecha de vencimiento indicada en la etiqueta. Si no está seguro de la fecha de vencimiento del preservativo, tírelo y use uno nuevo. Nunca use un preservativo que esté frágil, quebradizo, dañado o de color inusual. Cómo usar el preservativo? Primero use un preservativo nuevo cada vez que tenga sexo vaginal, anal u oral. Tenga cuidado cuando abra un paquete de preservativos no romper o desgarrar el latex con los dientes, uñas o anillos. No desenrolle el preservativo antes de colocarlo sobre el pene, porque puede debilitar el latex y deteriorarlo al mismo tiempo y volver peligroso su uso. Puede colocarle el preservativo al hombre o colocárselo él solo. Suavemente se debe presionar el aire del extremo superior del preservativo, antes de colocarlo sobre el pene. Asegurarse haber dejado un centímetro de espacio en el fondo del preservativo, para coleccionar el semen, así este no se escurrirá por el costado lateral del mismo. Se puede usar lubricantes acuosos como glicerinas o jaleasdurante la relación, para evitar que el preservativo se rompa. Si coloca una gota de jalea lubricante dentro del fondo del preservativo, puede incrementar la sensación a la par de aumentar la seguridad. Nunca use un lubricante de base oleosa, porque debilitará el preservativo y lo hará más proclive a romperse. Ejemplo de lubricantes oleosos son lociones, vaselina o aceites para bebes. Las medicaciones para tratar infecciones micóticas en las mujeres, suelen favorecer su ruptura. Sostenga el extremo del preservativo entre los dedos pulgar e índice y colóquelo sobre la cabeza del pene. Si el pene no es circunciso, tire hacia atrás la piel del prepucio, antes de colocar el preservativo sobre él. Extraiga el exceso de aire para evitar que el preservativo estalle. Coloque el preservativo cuando el pene esté eréctil. Desenróllelo sobre todo el largo del pene eréctil. Luego que el hombre ha eyaculado, debe retirarlo cuando el pene está aún eréctil, pues el preservativo puede fácilmente escurrirse cuando éste está flácido. él deberá sostener el preservativo sobre la base del pene mientras se retira de la vagina para evitar que se derrame el semen. Suavemente enrolle el preservativo hasta la extremidad del pene para removerlo. Qué se debe hacer con un preservativo usado? Se debe envolver el preservativo usado y tirarlo a un cesto de desechos. No lo tire por el inodoro, pues puede obstruir la cañeria. Los preservativos no pueden ser usados dos veces, por lo tanto usar uno con cada relación sexual y luego descartarlo. Qué pasa si el preservativo se rompe o desgarra? Primero No desespere! El pene debe ser retirado inmediatamente. Si se va a continuar la relación sexual, usar un preservativo nuevo. La jalea o espuma anticonceptiva debe ser colocada en la vagina y la mujer no debe efectuar duchas vaginales. Las duchas vaginales pueden causar infecciones. Si está preocupada por un embarazo o por una ETS, consulte a su médico o asistente de salud. Debe pensar en efectuar una contracepción de emergencia. Con qué frecuencia se rompen los preservativos? Los preservativos raramente se rompen si son bien guardados y usados correctamente. Estudios muestran, que los de latex, se rompen solo alrededor de 0.4%4 de cada 1000 y los de poliuretano se rompen el 4% 4 de cada 100. Las parejas que usan poliuretano tienen 9 veces más posibilidades de rupturas que aquellas que usan preservativos de latex. Cuando los preservativos se rompen, usualmente es porque no se dejó el espacio para el semen en el fondo del mismo, o estaban vencidos, o fueron expuestos al sol o al calor, o fueron desgarrados por los dientes o por las uñas. También perjudica el empleo de lubricantes en base oleosa en lugar de base acuosa, que causan su ruptura. Si el preservativo se guarda y usa correctamente, es muy difícil que se rompa. Qué pasa si el preservativo se sale y no puede ser extraído de la vagina? No se asuste! Trate de alcanzarlo con el dedo y extraerlo de la vagina, en caso contrario contactarse con el médico o asistente de salud y pedir una consulta. Qué pasa si mi pareja o yo tenemos una reacción alérgica con el uso del preservativo? Algunas personas pueden tener reacción alérgica al preservativo. Esto puede deberse al espermicida o al latex. Pruebe uno libre de espermicida, lo cual se recomienda igual. Si piensa que el latex puede ser el responsable de la alergia, debe usar un preservativo masculino o femenino de poliuretano. Hable con su médico o su asistente de salud frente a cualquier duda. involved

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registration code What Is It? Alcoholism (alcohol dependence) is the most severe type of drinking problem. There is no absolute number of drinks per day or quantity of alcohol that defines alcoholism, but experts have defined a limit above which the risks of drinking increase significantly. Here are some defining characteristics of alcohol dependence: Tolerance The need to drink more and more alcohol to feel the same effects, or the ability to drink more than other people without getting drunk. Withdrawal symptoms After stopping or cutting back on drinking, symptoms are anxiety, sweating, trembling, trouble sleeping, nausea or vomiting, and, in severe cases, physical seizures and hallucinations. Desire to stop drinking, but inability to do so. Loss of control over the amount of alcohol consumed. Preoccupation with drinking. Paying less attention to other life activities. Ignoring problems, sometimes very obvious ones. A person with alcohol dependence has come to rely on alcohol physically, psychologically and emotionally. The brain adapts to the presence of alcohol and undergoes persistent changes. When alcohol use suddenly stops, the body’s accustomed internal environment changes drastically, causing symptoms of withdrawal. Alcoholism can be linked many psychological, interpersonal, social, economic and medical problems. Alcoholism can increase the risk of depression and suicide and play a role in violent crimes, including homicide and domestic violence (abuse of a spouse or child). It can lead to traffic accidents and even accidents involving intoxicated pedestrians who decide to walk home after drinking. Alcoholism also can lead to unsafe sexual behavior, resulting in accidental pregnancy or sexually transmitted diseases. Alcohol dependence increases the risk of liver disease (hepatitis and cirrhosis), heart disease, stomach ulcers, brain damage, stroke and other health problems. In pregnant women who drink alcohol, there is also the danger that the child will develop fetal alcohol syndrome, a cluster of health problems including unusually low birth weight, facial abnormalities, heart defects and learning difficulties. The lifetime chance of developing alcoholism is very difficult to determine, but it is very common. In the United States, about 1 in 16 adults have severe problems with drinking and millions more are engaged in what experts consider risky drinking. In fact, a recent analysis revealed that 30% of a representative sample of U.S. residents reported an alcohol use disorder at some time in their lives. Alcohol problems come about from a combination of biological tendencies and environmental influences. Biology. People with a family history of alcohol dependence are at greater risk for developing the illness themselves. For example, if a parent has alcohol dependence, a child has a four-times greater risk of becoming alcohol-dependent. This is partly due to inheriting genes that increase vulnerability, perhaps by governing a person’s physical responses to alcohol or the experience of intoxication. Sometimes alcohol is used to blot out feelings arising from an underlying depression or anxiety disorder. Environment. Alcohol may be a big part of a person’s social group or may have been a part of family life (sometimes quite destructively). A person may turn to alcohol to get relief from stress (which frequently backfires, because the drinking causes problems of its own). Family support and healthy friendships can reduce the risk. Symptoms Alcohol dependence can involve any of the following symptoms or behaviors: Having long episodes of intoxication Drinking alone Having work problems or financial problems caused by drinking Losing interest in food Being careless about personal appearance Having blackouts Driving drunk Hurting oneself or someone else while intoxicated Hiding liquor bottles and glasses to hide the evidence of drinking Experiencing mood or personality changes Because large amounts of alcohol can be toxic to the body (for example, the cardiovascular, gastrointestinal or nervous systems), alcoholism also may cause physical symptoms: Morning nausea or shaking Signs of malnutrition due to a poor diet Abdominal pain or diarrhea A flushed red color to the face and palms Numbness, weakness or tingling in the arms or legs Unusually frequent accidental injuries, especially falls Diagnosis Even though alcohol related disorders are very common, only a small minority of individuals recognize the problem and get help. Therefore, screening is very important, whether it is done by primary care physicians or friends and family. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) now recommends that primary care physicians ask a very simple, but specific question How many times in the past year have you had: (Men) 5 or more drinks in a day? (Women) 4 or more drinks in a day? The goal with this question is to get a quick idea whether or not the person is at increased risk for developing alcohol-related problems. The limits are different for women and men because of known differences in how alcohol is absorbed, distributed and eliminated from the body. Thus, the risk goes up for men who drink more than 4 standard drinks in a day (or more than 14 in a week); while for women, the limit is lower 3 drinks in a day (and 7 drinks in a week). Almost always, people feel nervous or defensive about their drinking, which is one reason this very common problem so often goes undetected or unaddressed. The NIAAA therefore recommends that physicians make a point of using their time with patients to educate them about drinking and its dangers. As a screening test, the single question about drinking patterns is as good as slightly more detailed ones, such as the CAGE test. CAGE questions may be easier for concerned family members and friends to ask, since they may hesitate to ask direct questions about quantity. The word “CAGE” is a device for remembering the questions (see the highlighted words): Do you worry that you might need to CUT down on drinking? Do you feel ANNOYED because other people have criticized your drinking? Do you feel GUILTY about drinking? Do you need a morning EYE OPENER drink to steady your nerves or to fight a hangover? Another screening questionnaire used by physicians is the 10-question AUDIT (Alcohol Use Disorders Identification Test) developed by the World Health Organization. Doctors often also ask whether a person has alcohol-related problems at work, at home or with the law, such as getting into fights or driving while intoxicated. The doctor may ask about physical symptoms of alcoholism. As embarrassing as the answers may be, the doctor should view drinking problems as an understandable human predicament and not a reason for their patients to feel ashamed. A physical examination can reveal signs of poor nutrition and alcohol-related liver or nerve damage. Blood tests can check for anemia, vitamin deficiencies and abnormal levels of liver chemicals. The NIAAA has a very helpful set of resources for the general public and for clinicians. They are all easily available online at . Expected Duration For most people who have alcohol dependence, the first alcohol-related life problems usually appear in the mid-20s to early 40s. Left untreated, alcoholism often persists and gets worse over time. Up to 30% of people with alcohol dependence do manage to abstain from alcohol or control their drinking without formal treatment. On the other hand, the illness can be fatal there are approximately 100,000 alcohol-related deaths per year in the United States. Prevention There is no absolute way to prevent alcoholism. Screening is important, because early detection and treatment can prevent dangerous complications. Treatment Only a minority of people with drinking problems are able to cut down and drink “in moderation.” More often, once a person has lost control of his or her drinking, the safest approach is usually to stop drinking alcohol completely. The first step in this process is recognizing the problem. The well-known phenomenon of denial, which is a common part of the illness, often turns the illness into a chronic one. Unfortunately, the longer the illness persists, the harder it is to treat. A doctor or substance abuse expert may be able to help a person look at the consequences of drinking. A nonjudgmental approach to the discussion is essential. If an individual is beginning to think about alcohol as a problem worth trying to solve, educational groups may provide support for weighing the pros and cons of drinking. It is never easy for family members and friends to identify the problem. A professional may have to help loved ones kindly, but firmly talk to the drinker about the painful impact drinking has on them. Once an individual commits to stopping drinking, the physician will look for and treat withdrawal symptoms. Depending on the amount and duration of drinking and any symptoms, detoxification (often simply called “detox”) from alcohol can be done as an outpatient, or as an inpatient in a hospital or drug treatment facility. During the withdrawal process, the doctor may prescribe a class of antianxiety drugs called benzodiazepines for a short period in order to reduce withdrawal symptoms. After weaning from alcohol, medication in some cases can help reduce cravings. Two medications that fit in this category are naltrexone (ReVia) and acamprosate (Campral). As an alternative, sometimes the drug disulfiram (Antabuse) may be prescribed. Disulfiram does not reduce craving, but it creates an incentive not to drink, because drinking alcohol while taking it causes nausea and vomiting. A drug called topiramate (Topamax), which is used to treat seizures and migraine headaches, may diminish the reinforcing effects of alcohol, but it is not yet approved for this use by the Food and Drug Administration (FDA). Also not approved by the FDA, there is limited evidence that baclofen (Lioresal), a drug used to treat muscle spasticity, could help people quit alcohol use. After detoxification, many people with alcohol disorders need some form of long-term support or counseling to remain sober. Recovery programs focus on teaching a person with alcoholism about the disease, its risks, and ways to cope with life’s usual stresses without turning to alcohol. Psychotherapy may help a person understand the influences that trigger drinking. Many patients benefit from self-help groups such as Alcoholics Anonymous (AA), Rational Recovery or SMART (Self Management and Recovery Training). It is very important to treat any other problems, such as depression or anxiety, which may contribute to the risk of drinking. If the doctor suspects that alcohol-related damage to the liver, stomach or other organs, additional tests may be necessary. A healthy diet with vitamin supplements, especially B vitamins, is helpful. When To Call a Professional Call your doctor whenever you or someone you love has an alcohol-related problem. Remember, alcoholism is not a sign of weakness or poor character. It is an illness that can be treated. The sooner treatment begins, the easier alcoholism is to treat. Prognosis About 30% of alcoholics are able to abstain from alcohol permanently without the help of formal treatment or a self-help program. For the rest, the course of the illness is very varied. Some people will go through periods where they remain sober, but then relapse. Others have a hard time sustaining any period of sobriety. It is clear, however, that the more sober days you have, the greater the chance that you will remain sober. Another motivating fact remaining sober can increase life expectancy by 15 or more years. Additional Info National Institute on Alcohol Abuse and Alcoholism (NIAAA) 5635 Fishers Lane MSC 9304 Bethesda, MD 20892-9304 Phone: 301-443-3860 (Especially “Rethinking Drinking” and “Helping Patients Who Drink Too Much.” ) National Clearinghouse for Alcohol and Drug Information (NCADI) P.O. Box 2345 Rockville, MD 20847-2345 Toll-Free: 1-800-729-6686 Fax: 240-221-4292 TTY: 1-800-487-4889 Alcoholics Anonymous World Services, Inc. P.O. Box 459 New York, NY 10163 Phone: 212-870-3400 Al-Anon/Alateen Al-Anon Family Group Headquarters, Inc. 1600 Corporate Landing Parkway Virginia Beach, VA 23454-5617 Phone: 757-563-1600 Fax: 757)-563-1655 Medical content reviewed by the Faculty of the Harvard Medical School. Copyright by Harvard University. All rights reserved. Used with permission of StayWell. Conditions optimum

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would you like All-Nite Generic Name: acetaminophen, dextromethorphan, and doxylamine (a SEET a MIN oh fen, DEX tro me THOR fan, and dox IL a meen) Brand Name: All-Nite, Contac Cold+Flu Cooling Night, Coricidin HBP Nighttime Multi-Symptom Cold, Night Time Cold/Flu, Nyquil Cold & Flu, Robitussin Peak Cold Nighttime Cold + Flu, Tylenol Cold & Cough Nighttime Cool Burst, Tylenol Warming Cough & Sore Throat Nightime Overview Side Effects Dosage Interactions Reviews More Support Group Q & A What is All-Nite (acetaminophen, dextromethorphan, and doxylamine)? Acetaminophen is a pain reliever and fever reducer. Dextromethorphan is a cough suppressant. It affects the cough reflex in the brain that triggers coughing. Doxylamine is an antihistamine that reduces the effects of the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Acetaminophen, dextromethorphan, and doxylamine is a combination medicine used to treat headache, fever, body aches, cough, runny nose, sneezing, and sore throat caused by allergies, the common cold, or the flu. This medicine will not treat a cough that is caused by smoking, asthma, or emphysema. Acetaminophen, dextromethorphan, and doxylamine may also be used for purposes not listed in this medication guide. Slideshow The Shocking Truth About Antibiotic Resistance What is the most important information I should know about this medicine? Do not use this medicine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. Do not take more of this medication than is recommended. An overdose of acetaminophen can damage your liver or cause death. Call your doctor at once if you have nausea, pain in your upper stomach, itching, loss of appetite, dark urine, clay-colored stools, or jaundice (yellowing of your skin or eyes). In rare cases, acetaminophen may cause a severe skin reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling. What should I discuss with my healthcare provider before taking this medicine? Ask a doctor before taking medicine that contains acetaminophen if you have ever had liver disease, or if you drink more than 3 alcoholic beverages per day. Do not use this medicine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include furazolidone, isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. You should not use this medication if you are allergic to acetaminophen (Tylenol), doxylamine, or dextromethorphan. Ask a doctor or pharmacist before taking this medicine if you have any medical condition, especially: asthma or COPD, cough with mucus, or cough caused by smoking, emphysema, or chronic bronchitis; a blockage in your stomach or intestines; liver disease, alcoholism, or if you drink more than 3 alcoholic beverages per day; kidney disease; an enlarged prostate, problems with urination; glaucoma; or if you take potassium (Cytra, Epiklor, K-Lyte, K-Phos, Kaon, Klor-Con, Polycitra, Urocit-K). It is not known whether this medicine will harm an unborn baby. Do not use cough and cold medicine without a doctor’s advice if you are pregnant. This medicine may pass into breast milk and may harm a nursing baby. Antihistamines may also slow breast milk production. Do not use cough and cold medicine without a doctor’s advice if you are breast-feeding a baby. Artificially sweetened liquid medicine may contain phenylalanine. Check the medication label if you have phenylketonuria (PKU). Always ask a doctor before giving a cough or cold medicine to a child. Death can occur from the misuse of cough and cold medicines in very young children. How should I take All-Nite (acetaminophen, dextromethorphan, and doxylamine)? Use exactly as directed on the label, or as prescribed by your doctor. Do not use for longer than recommended. Cough and cold medicine is usually taken only for a short time until your symptoms clear up. Do not take more of this medication than is recommended. An overdose of acetaminophen can damage your liver or cause death. Measure liquid medicine with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one. Stop taking the medicine and call your doctor if you still have a sore throat after 2 days, or if you have a fever, headache, rash, nausea, or vomiting. If you need surgery or medical tests, tell the surgeon or doctor ahead of time if you have taken this medicine within the past few days. Store at room temperature away from moisture and heat. Do not allow liquid medicine to freeze. What happens if I miss a dose? Since this medicine is used when needed, you may not be on a dosing schedule. If you are on a schedule, use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of acetaminophen can be fatal. The first signs of an acetaminophen overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in your upper stomach, dark urine, and yellowing of your skin or the whites of your eyes. What should I avoid while taking this medicine? Ask a doctor or pharmacist before using any other cold, allergy, pain, or sleep medication. Acetaminophen (sometimes abbreviated as APAP) is contained in many combination medicines. Taking certain products together can cause you to get too much acetaminophen which can lead to a fatal overdose. Check the label to see if a medicine contains acetaminophen or APAP. Avoid drinking alcohol. It may increase your risk of liver damage while you are taking acetaminophen, and can increase certain side effects. This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly. This medicine side effects Get emergency medical help if you have signs of an allergic reaction : hives; difficult breathing; swelling of your face, lips, tongue, or throat. In rare cases, acetaminophen may cause a severe skin reaction that can be fatal. This could occur even if you have taken acetaminophen in the past and had no reaction. Stop taking this medicine and call your doctor right away if you have skin redness or a rash that spreads and causes blistering and peeling. If you have this type of reaction, you should never again take any medicine that contains acetaminophen. Stop using the medicine and call your doctor at once if you have: severe headache, seizure (convulsions); fast, pounding, or uneven heartbeats; confusion, hallucinations, severe dizziness or drowsiness, slow or shallow breathing; tremor, restless muscle movements; little or no urinating; flu symptoms, easy bruising, unusual bleeding, pale skin, weakness, feeling light-headed; or nausea, pain in your upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes). Common side effects may include: headache, sleep problems (insomnia); upset stomach, diarrhea or constipation; dry eyes, blurred vision, dry mouth or nose; mild dizziness or drowsiness, trouble concentrating; feeling restless or excited (especially in children); or mild skin rash. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Side Effects (complete list) What other drugs will affect All-Nite (acetaminophen, dextromethorphan, and doxylamine)? Ask a doctor or pharmacist before using this medicine if you are also using any other drugs, including prescription and over-the-counter medicines, vitamins, and herbal products. Some medicines can cause unwanted or dangerous effects when used together. Not all possible interactions are listed in this medication guide. Taking this medicine with other drugs that make you sleepy or slow your breathing can worsen these effects. Ask your doctor before taking acetaminophen, dextromethorphan, and doxylamine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures. Next Side Effects Print this page Add to My Med List More about acetaminophen/dextromethorphan/doxylamine Side Effects Dosage Information Drug Interactions Support Group 1 Review Add your own review/rating Drug class: upper respiratory combinations Consumer resources Acetaminophen, dextromethorphan, and doxylamine Acetaminophen, Dextromethorphan, and Doxylamine Capsules Acetaminophen, Dextromethorphan, and Doxylamine Liquid Other brands: Vicks NyQuil Cold & Flu Nighttime Relief , Coricidin HBP Nighttime Multi-Symptom Cold , Clear Cough PM Multi-Symptom , Contac Cold + Flu (Night) Cooling Relief Liquid , … +3 more Related treatment guides Cough Cold Symptoms Where can I get more information? Your pharmacist can provide more information about acetaminophen, dextromethorphan, and doxylamine. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Copyright 1996-2012 Cerner Multum, Inc. Version: 2.03. Last reviewed: October 21, 2015 Date modified: December 03, 2017} Drug Status OTC Availability Over the counter N Pregnancy Category Not classified N/A CSA Schedule Not a controlled drug Drug Class Upper respiratory combinations Related Drugs Cold Symptoms diphenhydramine , Benadryl , Promethazine DM , chlorpheniramine , echinacea , Tussionex Pennkinetic , Banophen , Benadryl Allergy , Chlor-Trimeton , Guaifenex , Triaminic , Promethazine with Dextromethorphan , More… Cough benzonatate , acetaminophen / hydrocodone , diphenhydramine , Benadryl , Mucinex , guaifenesin , Dilaudid , Promethazine DM , hydromorphone , Lortab , codeine , Tessalon Perles , More… Acetaminophen / dextromethorphan / doxylamine Rating 1 User Review 6.7 /10 1 User Review 6.7 Rate it! Related Questions & Answers Acetaminophen/Dextromethorphan/Doxylamine – is nighttime cold medicine safe to take for someone with Read more questions} } despite the fact that

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Photo :RECALL: Libbey Bourbon Glasses

wealthy person {Dec. 1, 2017 — Ohio-based Libbey Glass Inc. has recalled nearly 230,000 of its 8-ounce Bourbon Taster Glasses over fears they may break with normal use. The glasses are clear, colorless, and have one of three logos etched on the bottom: Kentucky Bourbon Trail, Kentucky Bourbon Trail Craft Tours, or SIV. They are sold individually and in boxed sets of four at outlet stores in Shreveport, LA, and Toledo, OH, as well as at Total Wine stores nationwide. The glasses are also sold in some distillery gift shops, are used in restaurants, and were available for sale online between May 2017 and October 2017. Libbey says it has received two reports of 12 glasses breaking, but no injuries have been reported. Consumers may call Libbey at 800-982-7063 between 8 a.m. and 5 p.m. ET, Monday through Friday. The company asks consumers to stop using the glasses and return them to where they were purchased for a full refund. Commercial customers should contact Libbey directly. WebMD Article Reviewed by Hansa D. Bhargava, MD on December 01, 2017 Sources Consumer Product Safety Commission: Libbey Glass Recalls Bourbon Glasses Due to Laceration Hazard. 2017 WebMD, LLC. All rights reserved. Top Picks Manage Your Migraine What to Eat Before Your Workout Treating RA With Biologics Best Treatments for Allergies MS and Depression: How Are They Linked? Your Guide to Understanding Medicare} {Health Solutions Cancer Treatments Penis Curved When Erect Live Better With Diabetes Therapy at Home? Understand Immunotherapy Painful Knees? Survive Cold and Flu Season Bent Fingers? Immediate Pain Relief Wearable Health Lower Back Pain Relief Targeted Cancer Therapy Get Cancer Answers Managing Diabetes Smartphone Health Apps More from WebMD Tips to Better Manage Your Migraine The Stress of Caregiving Healthy Cat Tips Immunotherapy for Cancer What Inhalers Do to Your Body Could You Have Tinnitus? 8 Ways to Avoid Heart Attack Living Better With Migraine How to Prevent Meningitis in Your Teen Tips for Your Dog’s Health Diabetes Assessment Avoid Allergy Triggers Treating Advanced Prostate Cancer 5 Things That Spike Your Blood Sugar} now and again

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anticipating {Alzheimer’s Community Design What to Look for in an Alzheimer’s Community By John Zeisel, Ph.D Editor s Note: The following recommendations are courtesy of John Zeisel and is excerpted from I m Still Here by John Zeisel, Ph.D . All rights reserved. Copyright John Zeisel, 2009. What Kind of Design is Best for an Alzheimer’s Community ? Look for homelike environments. People living with Alzheimer s at home are already in a residential setting. Residential quality in assisted living and similar group residences for people living with Alzheimer s can reduce symptoms. By this I mean homelike rooms that are not too big, with regular shape and familiar decor on the walls. There is little doubt that the territorial imperative, also linked to oxytocin, is centered at “home” for all living creatures. It is not surprising, therefore, to find that research shows reductions in both verbal and physical agitation in such settings. Integrating All Five Senses in Designing an Alzheimer ;s Community Look for environments that are designed so that people living with Alzheimer s glean the same information about the environment from what they see, hear, touch, and smell. Such settings are understood best. All living creatures employ all their senses simultaneously to understand their surroundings. If a kitchen is intended to be the social hub of a group, the more it looks, feels, sounds, and smells like a social hub the more it will be used that way. If a garden is to be used frequently, it needs to be inviting, highly visible through a window, and accessible through an easily located and unlocked door. The more fragrant, flowering plants there are, the more it feels like a garden. Each of us naturally develops coping strategies that triangulate our sensory awareness to compensate for diminished sight, hearing, or other sensory loss as we age. This is also true for people living with Alzheimer s disease. Research shows that where people have multiple sensory cues to understand the environment in which they live, verbal agitation and psychotic symptoms are reduced. Fostering Independence & Empowerment Look for settings that are designed to enable people living with Alzheimer s to do by and for themselves things that foster independence, as much as possible. For example, walking is much easier when simple, inconspicuous rails to lean on are incorporated into a setting for support. The more the lean rail looks like a wide residential chair rail instead of an institutional grab bar, the better. Bathroom doors that are highly visible with a readable sign, with toilet seats high enough for even those with weak legs to sit down and get up easily, ensure more frequent independent use. Safe, secure gardens with doors that enable views outside also invite independent use. Our minds naturally provide us with awareness of how our bodies relate to the environment, a process called proprioception, and maintaining a sense of control over our environment leads to a greater sense of empowerment. In sum, wherever you and your partner live, if you find these eight characteristics, you will find a designed physical environment that profoundly influences how people living with Alzheimer s feel, behave, and function. About the Author: John Zeisel, Ph.D has a background in design, which is how he first entered into the world of Alzheimer s and dementia care. His book I m Still Here covers design principles that make a lasting impact on the daily lives of Alzheimer s patients and also touches upon other aspects of providing care, safety and understanding to those with Alzheimer s. His work gives readers insight into how to view those with Alzheimer s disease and gives real-world examples of how to find new venues for communication, mainly via art appreciation and expression. Zeisel champions the idea that people with Alzheimer s are very much in the present, but need to have their environment and audience structured to allow them to be able to share their thoughts and emotions. Besides tailoring the environment, Zeisel points out how caregivers, both professional and family, can ensure that apathy or agitation is alleviated or eradicated. He gives his audience the tools to be nothing short of a social anthropologist for the Alzheimer s community at large. Widgets Assisted Living Costs Near You Compare pictures, pricing, options. Get Information Assisted Living Costs Near You Reference (optional) Who needs care? — Choose One — Parent(s) Relative(s) Friend(s) Myself Spouse Patient/Client Job Other Where are you looking for care? Your e-mail address Let’s get started 1 2 Paying with Medicaid only By submitting this form, you agree to’s Privacy Policy , Terms of Use and Agreement to be Contacted by Telephone . 1 2 READ THESE NEXT: Alzheimer’s and Wandering: What You Need to Know How to Find the Alzheimer’s Care Facility That is Right for You} {Top Cities for Assisted Living Assisted Living in Inver Grove Heights Assisted Living in Lake Alfred Dementia and Alzheimer’s Care in Oklahoma City Assisted Living in Lawrence, KS Assisted Living in Daleville, VA Memory Care in Littleton Find Memory and Alzheimer’s Care Near You Find Assisted Living Near You} really unusual

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Photo :The Problem with Healthy Food Porn

reduce As any Instagram lover can attest, unhealthy foods (think: greasy macaroni and cheese, sugar-filled cake pops, and pretty much anything wrapped in bacon) get a lot more Internet time than do healthy ones. A new website from Bolthouse Farms (a company that sells products like smoothies, juices, dressings, and carrots) is out to change that. The aptly named tracks 24 food-related hashtags half healthy, half not so much in real-time. Why? So you can see how many people are sharing them at any given moment. Today s hashtags include #candy, #melon, #pie, and #kale, among others. MORE: How Checking Out Instagram Affects Your Diet When we checked for this article, a whopping 71.6 percent of food porn being shared online was of the unhealthy variety, according to the site. And it was a particularly sad day for #beets, which were coming in dead last (among the items tracked by the site), with only 342,815 moment-by-moment shares. Meanwhile, #pizza was rocking the Internet will more than 9 million shares. MORE: The Food Lover s Diet While the site doesn t go so far as to tease out healthy #snacks, #burgers, and other foods from the grease-soaked kind (check out these healthy snack ideas and six bikini-friendly burgers ), the site s a pretty good reminder that we seriously need to rehab our food porn problem. After all, fruits and veggies can be beautiful, too! (The site goes as far as to encourage visitors to start posting more pictures of healthful foods to make every #FoodPorn count and change the imbalance. ) Want to do your part? Try these easy tips to make veggie dishes look food-porn worthy . You won t be able not to share them. MORE: 8 Healthy-Eating Instagram Accounts You Should Follow nutrition news at this time

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Photo :Sugar-Sweetened Beverages

kit Sugar-Sweetened Beverages Posted under Health Guides . Updated 11 December 2017. +Related Content What is a sugar-sweetened beverage? A sugar-sweetened beverage is a drink that has sugar added to it. This includes: Soft Drinks/Soda (Coca-Cola, Mountain Dew, Sprite) Sports Drinks (Gatorade, Power-aid) Sweetened Iced Tea (Arizona, Lipton) Sweetened coffee drinks (Bottled iced coffees, coffee drinks ordered with sugar or flavoring syrups) Energy Drinks (Monster, Red Bull) Fruit juice or punch What is the problem with sugar-sweetened beverages? Sugar-sweetened beverages contain a lot of calories and sugar and often provide little to no nutrition for your body. Some beverage companies add vitamins to make you think that the drink is healthy when in reality it has just as much sugar as other sugar-sweetened drinks. In addition to high amounts of sugar, these beverages also have a lot of calories. Even though you take in a lot of calories when you have a sugar-sweetened drink, you likely do not feel full afterwards compared to how you would feel from eating a healthy snack that has the same amount of calories. The added calories from these beverages can lead to weight gain and diseases such as type II diabetes. How much sugar is recommended in one day? The American Heart Association recommends consuming less than 25 grams of added sugar per day. Often, sugar-sweetened beverages contain more than this amount causing people to take in much more than the recommended amount of added sugar in a day. Added sugar is sugar that has been added to something like to sweeten a beverage instead of naturally-occurring types of sugar that you would find in milk or a piece of fruit. How much sugar is in this drink? To figure out how much sugar is in a beverage, first look at the Nutrition Facts Label. Next to sugar, there will be a number in grams (g). Take that number and divide it by 4 to find the number of teaspoons of sugar in that drink. For reference, a sugar cube or packet, like you would find in a coffee shop, are both 1 teaspoon of sugar. As an example, think about a 20 ounce bottle of Coca-Cola. This drink has 65 grams of sugar in the whole bottle. 65 / 4 = 16.25 teaspoons (or packets) of sugar! That means that this one bottle of Coca-Cola is more than double the recommended amount! What about 100% fruit juice? Juice, especially 100% fruit juice, can be confusing because it seems like a healthy choice. It is true that with 100% fruit juice there is no added sugar. However, 100% fruit juice contains just as much sugar as other sugar-sweetened beverages. If you think about drinking apple juice versus eating an apple, eating the apple is the healthier alternative. Why? When juice is made, fiber, vitamins, and minerals that are naturally present in the fruit are often lost. Juice is a condensed version of fruit. Eight ounces of orange juice contains about 4 oranges. Eating 4 oranges would take some time because you would need to peel them, chew, and swallow. Not to mention that you would likely feel full after eating 4 oranges! Eight ounces of juice, however, would not take long to drink, and your body would absorb it very quickly so you would likely feel hungry soon afterwards. The fiber and naturally present vitamins and minerals make whole fruits a better choice than fruit juice. Other juices, fruit punch, or smoothies that are not 100% fruit juice often have additional sugar added in. What are alternatives to sugar-sweetened beverages? Instead of drinking a sugar sweetened beverage, try drinking water! If you want to add a bit of flavor, think about a sugar-free flavoring such as Crystal Lite or Mio, or adding real fruit such as berries, watermelon, or lemon to your water. If you enjoy the carbonation in beverages, try seltzer or sparkling water instead. You can even try a splash of 100% juice in seltzer for some extra flavoring. Sparkling water is often naturally flavored and contains zero calories or sugar. Drinking low-fat dairy or dairy alternatives (such as soy milk) can help you meet your calcium and protein needs. It can be tough to cut back on sugar-sweetened beverages, especially if you are used to drinking a lot of them each day. Try to cut back on these beverages one at a time so you can make a long-term change. The following tables lists how much sugar is in some popular drinks Beverage Grams of Sugar Teaspoons of Sugar Soda Coca-Cola (20 oz) 65 16.25 Mountain Dew (20 oz) 77 19.25 Sprite (20 oz) 64 16 Sports Drinks Gatorade (24 oz) 42 10.5 Powerade (20 oz) 34 8.5 Vitamin Water (20 oz) 32 8 Sweetened Tea Arizona Iced Tea with Lemon (23 oz) 69 17.25 Lipton Citrus Green Tea (20 oz) 32 8 Sweetened Coffee Dunkin Donuts Iced Coffee Original ready to drink (13.7 oz) 45 11.25 Starbucks Carmel Frappuccino ready to drink (13.5 oz) 46 11.5 Energy Drinks Monster Energy (16 oz) 50 12.5 Red Bull (8.3 oz) 27 6.75 Juice Minute Maid Apple Juice (15.2 oz) 49 12.25 Naked Strawberry Banana Fruit Smoothie (15.2 oz) 44 11 Simply Fruit Punch Juice (11.5 oz) 35 8.75 Tropicana Pure Premium Original Orange Juice (16 oz) 44 11 Tags: sugar , sugar-sweetened beverages involved

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