#benralizumab

[eosinophil-hate-blog]

[drpedi07]

Benralizumab Drug

Medical information for Benralizumab on Pediatric Oncall including Mechanism, Indication, Contraindications, Dosing, Adverse Effect, Interaction.

[mindblowingscience]

Safer relief for people suffering from severe asthma is a step closer with a large clinical trial finding a monocolonal antibody treatment called benralizumab can radically reduce the need for more dangerous high-dose steroid treatments. Asthma impacts almost 300 million people worldwide, around 5 percent of whom have a severe version of this respiratory disease. They face a horrifying struggle to get enough air on a daily basis, with all the associated chest tightness, coughing, panic, and frequent hospital visits.

Continue Reading.

[redashtvblog]

A Comprehensive Guide to Cough Treatment

Understanding Coughs

Coughing can be classified into two main types: acute and chronic. Acute coughs last for less than three weeks and are often caused by respiratory infections like the common cold or influenza. Chronic coughs persist for more than eight weeks and may indicate more serious underlying conditions such as asthma, chronic obstructive pulmonary disease (COPD), or gastroesophageal reflux disease (GERD).

Causes of Coughs

Coughs can result from a variety of factors, including:

Infections: Viral or bacterial infections of the respiratory tract.

Allergies: Exposure to allergens like pollen, dust, or pet dander.

Asthma: A chronic condition that inflames and narrows the airways.

Smoking: Irritation and damage to the respiratory system from tobacco use.

Environmental Irritants: Pollution, chemicals, and other irritants in the air.

GERD: Acid reflux causing irritation of the esophagus and throat.

Asthma and Coughing

Asthma is a common cause of chronic coughing. Asthma-related coughs are typically dry and persistent, often worsening at night or early in the morning. This type of cough is due to inflammation and narrowing of the airways, which triggers the coughing reflex.

Asthma Cough Treatment

Treating an asthma cough involves managing the underlying asthma condition. The primary goal is to reduce airway inflammation and prevent asthma attacks. Here are some effective strategies for asthma cough treatment:

Inhaled Corticosteroids: These medications reduce inflammation in the airways, helping to prevent asthma symptoms. Examples include fluticasone, budesonide, and beclomethasone.

Long-Acting Beta Agonists (LABAs): Often used in combination with inhaled corticosteroids, LABAs help relax the muscles around the airways, making breathing easier. Salmeterol and formoterol are common LABAs.

Leukotriene Modifiers: These oral medications help reduce inflammation and prevent asthma symptoms. Montelukast and zafirlukast are popular options.

Short-Acting Beta Agonists (SABAs): Also known as rescue inhalers, SABAs provide quick relief from asthma symptoms by relaxing the airway muscles. Albuterol and levalbuterol are widely used SABAs.

Anticholinergics: These medications help prevent the muscles around the airways from tightening. Ipratropium is a common anticholinergic used for asthma.

Biologic Therapies: For severe asthma, biologic therapies like omalizumab, mepolizumab, and benralizumab target specific molecules involved in the inflammatory process, providing relief from asthma symptoms.

Allergen Immunotherapy: Also known as allergy shots, this treatment involves gradually exposing the patient to increasing amounts of allergens to build tolerance and reduce allergic reactions.

Lifestyle Modifications: Avoiding asthma triggers, maintaining a healthy weight, and managing stress can significantly improve asthma symptoms and reduce coughing.

Asthma Treatments for Adults

Asthma can develop at any age, and managing it effectively in adults requires a comprehensive approach. Adult asthma treatments focus on both immediate relief and long-term control. Here are some key strategies:

Immediate Relief

Rescue Inhalers: Short-acting beta agonists (SABAs) like albuterol provide quick relief from asthma symptoms. They are used as needed during an asthma attack or before exercise.

Oral Corticosteroids: In severe cases, oral corticosteroids like prednisone may be prescribed for a short duration to quickly reduce inflammation and control asthma symptoms.

Long-Term Control

Inhaled Corticosteroids: These are the cornerstone of long-term asthma management, helping to reduce airway inflammation and prevent symptoms. Common examples include fluticasone, budesonide, and beclomethasone.

Long-Acting Beta Agonists (LABAs): When used with inhaled corticosteroids, LABAs provide long-lasting relief by relaxing the airway muscles. Salmeterol and formoterol are commonly prescribed LABAs.

Combination Inhalers: These inhalers contain both a corticosteroid and a LABA, providing comprehensive asthma management. Examples include fluticasone/salmeterol and budesonide/formoterol.

Leukotriene Modifiers: Oral medications like montelukast and zafirlukast help reduce inflammation and prevent asthma symptoms.

Theophylline: This oral medication helps relax the muscles around the airways, making breathing easier. It is less commonly used today due to potential side effects.

Biologic Therapies: For severe asthma, biologic therapies like omalizumab, mepolizumab, and benralizumab target specific molecules involved in the inflammatory process, providing significant relief.

Lifestyle and Home Remedies

Identify and Avoid Triggers: Keeping a diary of asthma symptoms can help identify triggers. Avoiding allergens, irritants, and respiratory infections is crucial.

Maintain a Healthy Weight: Obesity can worsen asthma symptoms, so maintaining a healthy weight through diet and exercise is important.

Quit Smoking: Smoking exacerbates asthma and can lead to severe respiratory complications. Quitting smoking is essential for effective asthma management.

Manage Stress: Stress can trigger asthma symptoms, so practicing stress-reducing techniques like yoga, meditation, and deep breathing exercises can be beneficial.

Regular Monitoring: Regular check-ups with a healthcare provider are important to monitor asthma control and adjust treatment as needed.

Other Common Causes of Cough

Respiratory Infections

Respiratory infections, such as the common cold, influenza, bronchitis, and pneumonia, are frequent causes of acute coughs. Treatment often involves:

Rest and Hydration: Adequate rest and staying hydrated can help the body fight off the infection.

Over-the-Counter Medications: Cough suppressants, decongestants, and pain relievers can alleviate symptoms.

Antibiotics: For bacterial infections like pneumonia or bacterial bronchitis, antibiotics may be necessary.

Gastroesophageal Reflux Disease (GERD)

GERD can cause chronic coughing due to stomach acid irritating the esophagus and throat. Treatment options include:

Lifestyle Changes: Avoiding foods that trigger reflux, eating smaller meals, and elevating the head of the bed can reduce symptoms.

Medications: Antacids, H2 blockers, and proton pump inhibitors (PPIs) can help reduce stomach acid production and alleviate symptoms.

Chronic Obstructive Pulmonary Disease (COPD)

COPD, which includes chronic bronchitis and emphysema, is a leading cause of chronic cough. Treatment involves:

Bronchodilators: Medications that relax the airway muscles, making breathing easier.

Inhaled Corticosteroids: These reduce inflammation in the airways.

Oxygen Therapy: For severe cases, supplemental oxygen may be necessary.

Pulmonary Rehabilitation: A program of exercise and education designed to improve lung function and quality of life.

When to Seek Medical Attention

While many coughs resolve on their own, some require medical attention. Seek professional help if you experience:

Persistent Cough: A cough that lasts more than eight weeks.

Severe Symptoms: Difficulty breathing, chest pain, or coughing up blood.

High Fever: A fever above 100.4°F (38°C) that persists.

Conclusion

Coughing can be a symptom of various conditions, ranging from mild infections to chronic diseases like asthma and COPD. Understanding the underlying cause is essential for effective treatment. For those with asthma, specific asthma cough treatments and asthma treatments for adults can significantly improve symptoms and quality of life. By combining medications, lifestyle changes, and regular monitoring, individuals can manage their coughs effectively and maintain better respiratory health.

[columbianewsupdates]

Chronic Spontaneous Urticaria Market Forecast 2032: FDA Approvals, Clinical Trials, Pipeline, Epidemiology and Companies by DelveInsight | Rilzabrutinib, Remibrutinib, Benralizumab, Fenebrutinib, more

http://dlvr.it/T7T2xc

[newswireml]

Benralizumab Improves Mucus Measures in Eosinophilic Asthma#Benralizumab #Improves #Mucus #Measures #Eosinophilic #Asthma

Use of benralizumab led to significant improvements in CT mucus scores and asthma control over 2.5 years, as indicated by data from 29 individuals with eosinophilic asthma. “Mucus-plug formation in asthma may be driven in whole or in part by eosinophilic oxidation,” write Marrissa J. McIntosh, BSc, of Western University, London, Canada, and colleagues. Previous studies have shown that a single…

[biotech-news-feed]

Opinion/decision on a Paediatric investigation plan (PIP): Fasenra, Benralizumab, decision type: P: decision agreeing on a investigation plan, with or without partial waiver(s) and or deferral(s), therapeutic area: Haematology-Hemostaseology, PIP nu #BioTech #science

[weelectronicstudentreviewstuff]

AstraZeneca Pharma gets DCGI nod to market asthma drug, Benralizumab solution,

AstraZeneca Pharma gets DCGI nod to market asthma drug, Benralizumab solution,

Image Source : AP AstraZeneca Pharma gets DCGI nod to market asthma drug Drug firm AstraZeneca Pharma on Monday said it has received marketing authorisation from Drug Controller General of India for Benralizumab solution, indicated as an add-on maintenance treatment for severe asthma. AstraZeneca Pharma India Ltd has received import and market permission in Form CT-20 (marketing authorisation)…

[didanawisgi]

2020 Yale-G’s Monthly Clinical Updates According to www.uptodate.com

(As of 2020-11-12, updated in Yale-G’s 6th-Ed Kindle Version; will be emailed to buyers of Ed6 paper books)

       Chapter 1: Infectious Diseases

Special Viruses: Coronaviruses

     Coronaviruses are important human and animal pathogens, accounting for 5-10% community-acquired URIs in adults and probably also playing a role in severe LRIs, particularly in immunocompromised patients and primarily in the winter. Virology: Medium-sized enveloped positive-stranded RNA viruses as a family within the Nidovirales order, further classified into four genera (alpha, beta, gamma, delta), encoding 4-5 structural proteins, S, M, N, HE, and E; severe types: severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and novel coronavirus (2019-nCoV, which causes COVID-19). Routes of transmission: Similar to that of rhinoviruses, via direct contact with infected secretions or large aerosol droplets. Immunity develops soon after infection but wanes gradually over time. Reinfection is common. Clinical manifestations: 1. Coronaviruses mostly cause respiratory symptoms (nasal congestion, rhinorrhea, and cough) and influenza-like symptoms (fever, headache). 2. Severe types (2019-nCoV, MERS-CoV, and SARS-CoV): Typically with pneumonia–fever, cough, dyspnea, and bilateral infiltrates on chest imaging, and sometimes enterocolitis (diarrhea), particularly in immunocompromised hosts (HIV+, elders, children). 3. Most community-acquired coronavirus infections are diagnosed clinically, although RT-PCR applied to respiratory secretions is the diagnostic test of choice.              

Treatment: 1. Mainly consists of ensuring appropriate infection control and supportive care for sepsis and acute respiratory distress syndrome. 2. In study: Chloroquine showed activity against the SARS-CoV, HCoV-229E, and HCoV-OC43 and remdesivir against 2019-nCoV. Dexamethasone may have clinical benefit.

Prevention: 1. For most coronaviruses: The same as for rhinovirus infections, which consist of handwashing and the careful disposal of materials infected with nasal sec retions. 2. For novel coronavirus (2019-nCoV), MERS-CoV, and SARS-CoV: (1) Preventing exposure by diligent hand washing, respiratory hygiene, and avoiding close contact with live or dead animals and ill individuals. (2) Infection control for suspected or confirmed cases: Wear a medical mask to contain their respiratory secretions and seek medical attention; standard contact and airborne precautions, with eye protection.

      Hepatitis A: HAV vaccine is newly recommended to adults at increased risk for HAV infection (substance use treatment centers, group homes, and day care facilities for disabled persons), and to all children and adolescents aged 2 to 18 years who have not previously received HAV vaccine.

      Hepatitis C: 8-week glecaprevir-pibrentasvir is recommended for chronic HCV infection in treatment-naive patients. In addition to the new broad one-time HCV screening (17-79 y/a), a repeated screening in individuals with ongoing risk factors is suggested.

      New: Lefamulin is active against many common community-acquired pneumonia pathogens, including S. pneumoniae, Hib, M. catarrhalis, S. aureus, and atypical pathogens.  

      New: Cefiderocol is a novel parenteral cephalosporin that has activity against multidrug-resistant gram-negative bacteria, including carbapenemase-producing organisms and Pseudomonas aeruginosa resistant to other beta-lactams. It’s reserved for infections for which there are no alternative options.

      New: Novel macrolide fidaxomicin is reserved for treating the second or greater recurrence of C. difficile infection in children.       Vitamin C is not beneficial in adults with sepsis and ARDS.    

      Chapter 2: CVD

      AF: Catheter ablation is recommended to some drug-refractory, paroxysmal AF to decrease symptom burden. In study: Renal nerve denervation has been proposed as an adjunctive therapy to catheter ablation in hypertensive patients with AF. Alcohol abstinence lowers the risk of recurrent atrial fibrillation among regular drinkers.

VF: For nonshockable rhythms, epinephrine is given as soon as feasible during CPR, while for shockable rhythms epinephrine is given after initial defibrillation attempts are unsuccessful. Avoid vasopressin use.

All patients with an acute coronary syndrome (ACS) should receive a P2Y12 inhibitor. For patients undergoing an invasive approach, either prasugrel or ticagrelor has been preferred to clopidogrel. Long-term antithrombotic therapy in patients with stable CAD and AF has newly been modified as either anticoagulant (AC) monotherapy or AC plus a single antiplatelet agent.

      Long-term antithrombotic therapy (rivaroxaban +/- aspirin) is recommended for patients with AF and stable CAD. Ticagrelor plus aspirin is recommended for some patients with CAD and diabetes.

VTE (venous thromboembolism): LMW heparin or oral anticoagulant edoxaban is the first-line anticoagulants in patients with cancer-associated VTE.

Dosing of warfarin for VTE prophylaxis in patients undergoing total hip or total knee arthroplasty should continue to target an INR of 2.5.

     Chapter 3: Resp. Disorders

Asthma: Benralizumab is an IL-5 receptor antibody that is used as add-on therapy for patients with severe asthma and high blood eosinophil counts.

Recombinant GM-CSF is still reserved for patients who cannot undergo, or who have failed, whole lung lavage.

Pulmonary embolism (PE): PE response teams (PERT, with specialists from vascular surgery, critical care, interventional radiology, emergency medicine, cardiac surgery, and cardiology) are being increasingly used in management of patients with intermediate and high-risk PE.

Although high-sensitivity D-dimer testing is preferred, protocols that use D-dimer levels adjusted for pretest probability may be an alternative to unadjusted D-dimer in patients with a low pretest probability for PE.

     Non-small cell lung cancer (NSCLC): Newly approved capmatinib is for advanced NSCLC associated with a MET mutation, and selpercatinib for those with advanced RET fusion-positive. Atezolizumab was newly approved for PD-L1 high NSCLC.

Circulating tumor DNA tests for cancers such as NSCLC are increasingly used as “liquid biopsy”. Due to its limited sensitivity, NSCLC patients who test (-) for the biomarkers should undergo tissue biopsy.

Cystic Fibrosis (CF): Tx: CFTR modulator therapy (elexacaftor-tezacaftor-ivacaftor) is recommended for patients ≥12 years with the F508del variant.

Vitamin E acetate has been implicated in the development of electronic-cigarette, or vaping, product use associated lung injury.

     Chapter 4: Digestive and Nutritional Disorders

     Comparison of Primary Biliary Cholangitis (PBC) and Primary Sclerosing Cholangitis (PSC):

     Common: They are two major types of chronic cholestatic liver disease, with fatigue, pruritus, obstructive jaundice, similar biochemical tests of copper metabolism, overlapped histology (which is not diagnostic), destructive cholangitis, and both ultimately result in cirrhosis and hepatic failure. (1) PBC: Mainly in middle-aged women, with keratoconjunctivitis sicca, hyperpigmentation, and high titer of antimitochondrial Ab (which is negative for PSC). (2) PSC: Primarily in middle-aged men, with chronic ulcerative colitis (80%), irregular intra- and extra-hepatic bile ducts, and anti-centromere Ab (+).

      CRC: Patients with colorectal adenomas at high risk for subsequent colorectal cancer (CRC) (≥3 adenomas, villous type with high-grade dysplasia, or ≥10 mm in diameter) are advised short follow-up intervals for CRC surveillance. Pembrolizumab was approved for the first-line treatment of patients with unresectable or metastatic DNA mismatch repair (dMMR) CRC.

      UC and CRC: Patients with extensive colitis (not proctitis or left-sided colitis) have increased CRC risk.

      Eradication of H. pylori: adding bismuth to clarithromycin-based triple therapy for patients with risk factors for macrolide resistance.

      Thromboelastography and rotational thromboelastometry are bedside tests recommended for patients with cirrhosis and bleeding.

      Pancreatic cancer: Screening for patients at risk for hereditary pancreatic cancer (PC): Individuals with mutations in the ataxia-telangiectasia mutated gene and one first-degree relative with PC can be screened with endoscopic ultrasound and/or MRI/magnetic retrograde cholangiopancreatography.

      Olaparib is recommended for BRCA-mutated advanced pancreatic cancer after 16 weeks of initial platinum-containing therapy.

      HCC (unresectable): New first-line therapy is a TKI (sorafenib or sunitinib) or immune checkpoint inhibitor atezolizumab plus bevacizumab, +/- doxorubicin. Monitor kidney toxicity for these drugs.

      UC: Ustekinumab (-umab) anti-interleukin 12/23 antibody, is newly approved for the treatment of UC.

      Crohn disease: The combination of partial enteral nutrition with the specific Crohn disease exclusion diet is a valuable alternative to exclusive enteral nutrition for induction of remission.

��     Obesity: Lorcaserin, a 5HT2C agonist that can reduce food intake, has been discontinued in the treatment of obesity due to increased malignancies (including colorectal, pancreatic, and lung cancers).

      Diet and cancer deaths: A low-fat diet rich in vegetables, fruits, and grains experienced fewer deaths resulted from many types of cancer.

      Note that H2-blockers (-tidines) are no longer recommended due to the associated carcinogenic N-nitrosodimethylamine.

      Gastrointestinal Stromal Tumors (GIST):

      GIST is a rare type of tumor that occurs in the GI tract, mostly in the stomach (50%) or small intestine. As a sarcoma, it’s the #1 common in the GI tract. It is considered to grow from specialized cells in the GI tract called interstitial cells of Cajal, associated with high rates of malignant transformation.

Clinical features and diagnosis: Most GISTs are asymptomatic. Nausea, early satiety, bloating, weight loss, and signs of anemia may develop, depending on the location, size, and pattern of growth of the tumor. They are best diagnosed by CT scan and mostly positive staining for CD117 (C-Kit), CD34, and/or DOG-1.

Treatment: Approaches include resection of primary low-risk tumors, resection of high-risk primary or metastatic tumors with a tyrosine kinase inhibitor (TKI) imatinib for 12 months, or if the tumor is unresectable, neoadjuvant imatinib followed by resection. Radiofrequency ablation has shown to be effective when surgery is not suitable. Newer therapies of ipilimumab, nivolumab, and endoscopic ultrasound alcohol ablation have shown promising results. Avapritinib or ripretinib (new TKI) is recommended for advanced unresectable or metastatic GIST with PDGFRA mutations.

      Anal Cancer:

Anal cancer is uncommon and more similar to a genital cancer than it is to a GI malignancy by etiology. By histology, it is divided into SCC (#1 common) and adenocarcinoma. Anal cancer (particularly SCC among women) has increased fast over the last 30 years and may surpass cervical cancer to become the leading HPV-linked cancer in older women. A higher incidence has been associated with HPV/HIV infection, multiple sexual partners, genital warts, receptive anal intercourse, and cigarette smoking. SCCs that arise in the rectum are treated as anal canal SCCs.

Clinical features and diagnosis: 1. Bleeding (#1) and itching (often mistaken as hemorrhoids). Later on, patients may develop focal pain or pressure, unusual discharges, and lump near the anus, and changes in bowel habits. 2. Diagnosis is made by a routine digital rectal exam, anoscopy/proctoscopy plus biopsy, +/- endorectal ultrasound.

Treatment: Anal cancer is primarily treated with a combination of radiation, chemotherapy, and surgery—especially for patients failing the above therapy or for true perianal skin cancers.

     Chapter 5: Endocrinology

      Diabetes (DM):       Liraglutide can be added as a second agent for type-2 DM patients who fail monotherapy with metformin or as a third agent for those who fail combination therapy with metformin and insulin.       Metformin is suggested to prevent type 2 DM in high-risk patients in whom lifestyle interventions fail to improve glycemic indices.       Metabolic (bariatric) surgery improves glucose control in obese patients with type 2 DM and also reduce diabetes-related complications, such as CVD.       Teprotumumab, an insulin-like growth factor 1 receptor inhibitor, can be used for Graves’ orbitopathy if corticosteroids are not effective. Subclinical hypothyroidism should not be routinely treated (with T4) in older adults with TSH <10 mU/L.

        Chapter 6: Hematology & Immunology

       Anticoagulants: Apixaban is preferred to warfarin for atrial fibrillation with osteoporosis because it lowers the risk of fracture. Rivaroxaban is inferior to warfarin for antiphospholipid syndrome.

      Cancer-associated VTE: LMW heparin or oral edoxaban is the first-line anticoagulant prophylaxis.

      NH-Lymphoma Tx: New suggestion is four cycles of R(rituximab)-CHOP for limited stage (stage I or II) diffuse large B cell non-Hodgkin lymphoma (DLBCL) without adverse features. New suggestions: selinexor is for patients with ≥2 relapses of DLBCL, and tafasitamab plus lenalidomide is for patients with r/r DLBCL who are not eligible for autologous HCT.

      Chimeric antigen receptor (CAR)-T (NK) immunotherapy is newly suggested for refractory lymphoid malignancies, with less toxicity than CAR-T therapy. Polatuzumab + bendamustine + rituximab (PBR) is an alternative to CAR-T, allogeneic HCT, etc. for multiply relapsed diffuse large B-C NHL.

      Refractory classic Hodgkin lymphoma (r/r cHL) is responsive to immune checkpoint inhibition with pembrolizumab or nivolumab, including those previously treated with brentuximab vedotin or autologous transplantation.

      Mantle cell lymphoma: Induction therapy is bendamustine + rituximab or other conventional chemoimmunotherapy rather than more intensive approaches. CAR-T cell therapy is for refractory mantle cell lymphoma.

      AML: Gilteritinib is a new alternative to intensive chemotherapy for patients with FLT3-mutated r/r AML.

      Oral decitabine plus cedazuridine is suggested for MDS and chronic myelomonocytic leukemia.  

      Multiple myeloma (MM): Levofloxacin prophylaxis is suggested for patients with newly diagnosed MM during the first three months of treatment. For relapsed MM: Three-drug regimens (daratumumab, carfilzomib, and dexamethasone) are newly recommended.

      Transplantation: As the transplant waitlist continues to grow, there may be an increasing need of HIV-positive to HIV-positive transplants.

      Porphyria:       Porphyria is a group of disorders (mostly inherited) caused by an overaccumulation of porphyrin, which results in hemoglobin and neurovisceral dysfunctions, and skin lesions.       Clinical types, features, and diagnosis:  I. Acute porphyrias: 1. Acute intermittent porphyria: Increased porphobilinogen (PBG) causes attacks of abdominal pain (90%), neurologic dysfunction (tetraparesis, limb pain and weakness), psychosis, and constipation, but no rash. Discolored urine is common. 2. ALA (aminolevulinic acid) dehydratase deficiency porphyria (Doss porphyria): Sensorimotor neuropathy and cutaneous photosensitivity. 3. Hereditary coproporphyria: Abdominal pain, constipation, neuropathies, and skin rash. 4. Variegate porphyria: Cutaneous photosensitivity and neuropathies.  II. Chronic porphyrias: 1. Erythropoietic porphyria: Deficient uroporphyrinogen III synthase leads to cutaneous photosensitivity characterized by blisters, erosions, and scarring of light-exposed skin. Hemolytic anemia, splenomegaly, and osseous fragility may occur. 2. Cutaneous porphyrias–porphyria cutanea tarda: Skin fragility, photosensitivity, and blistering; the liver and nervous system may or may not be involved.  III. Lab diagnosis: Significantly increased ALA and PBG levels in urine have 100% specificity for most acute porphyrias. Normal PBG levels in urine can exclude acute porphyria.       Treatment: 1. Acute episodes: Parenteral narcotics are indicated for pain relief. Hemin (plasma-derived intravenous heme) is the definitive treatment and mainstay of management. 2. Avoidance of sunlight is the key in treating cutaneous porphyrias. Afamelanotide may permit increased duration of sun exposure in patients with erythropoietic protoporphyria.

 Chapter 7: Renal & UG

Membranous nephropathy (MN): Rituximab is a first-line therapy in patients with high or moderate risk of progressive disease and requiring immunosuppressive therapy.

      Diabetes Insipidus (DI): Arginine-stimulated plasma copeptin assays are newly used to diagnose central DI and primary polydipsia, often alleviating the need for water restriction, hypertonic saline, and exogenous desmopressin.

      Prostate cancer: Enzalutamide (new androgen blocker) is available for metastatic castration-sensitive prostate cancer. Cabazitaxel, despite its great toxicity, is suggested as third-line agent for metastatic prostate cancer. Either early salvage RT or adjuvant RT is acceptable after radical prostatectomy for high-risk disease.

      UG cancers: Nivolumab plus ipilimumab is suggested in metastatic renal cell carcinoma for long-term survival.

      Enfortumab vedotin is suggested in locally advanced or metastatic urothelial carcinoma. Maintenance avelumab is recommended with other chemotherapy in advanced urothelial bladder cancer. Pyelocalyceal mitomycin is suggested for low-grade upper tract urothelial carcinomas.

Chapter 8: Rheumatology

Janus kinase (JAK) inhibitors (upadacitinib, filgotinib) are new options for active, resistant RA and ankylosing spondylitis.

Graves’ orbitopathy: new therapy–teprotumumab, an insulin-like growth factor 1 receptor inhibitor.

Chapter 9: Neurology & Special Senses

Epilepsy: Cenobamate, a novel tetrazole alkyl carbamate derivative that inhibits Na-channels, provides a new treatment option for patients with drug-resistant focal epilepsy. A benzodiazepine plus either fosphenytoin, valproate, or levetiracetam is recommended as the initial treatment of generalized convulsive status epilepticus.

Migraine: Lasmiditan is a selective 5H1F receptor agonist that lacks vasoconstrictor activity, new therapy for patients with relative contraindications to triptans due to cardiovascular risk factors.

      Stroke: New recommendation for cerebellar hemorrhages >3 cm in diameter is surgical evacuation.       TBI: Antifibrolytic agent tranexamic acid is newly recommended for moderate and severe acute traumatic brain injury (TBI).

      Ofatumumab is a new agent that may delay progression of MS.

 Chapter 10: Dermatology

 Minocycline foam is a new topical drug option for moderate to severe acne vulgaris.

       Melanloma: Nivolumab plus ipilimumab in metastatic melanoma has confirmed long-term survival. With sun-protective behavior, melanoma incidence is decreasing.

       New: Tazemetostat is suggested in patients with locally advanced or metastatic epithelioid sarcoma (rare and aggressive) ineligible for complete surgical resection.

       Psoriasis: New therapies for severe psoriasis and psoriatic arthritis: a TNF-alpha inhibitor (infliximab or adalimumab, golimumab) or IL-inhibitor (etanercept or ustekinumab) is effective. Ixekizumab is a newly approved monoclonal antibody against IL-17A. Clinical data support vigilance for signs of symptoms of malignancy in patients with psoriasis.

     Chapter 11: GYH

      Breast cancer:        Although combined CDK 4/6 and aromatase inhibition is an effective strategy in older adults with advanced receptor-positive, HER2-negative breast cancer, toxicities (myelosuppression, diarrhea, and increased creatinine) should be carefully monitored. SC trastuzumab and pertuzumab is newly recommended for HER2-positive breast cancer.

      Whole breast irradiation is suggested for most early-stage breast cancers treated with lumpectomy. Accelerated partial breast irradiation can be an alternative for women ≥50 years old with small (≤2 cm), hormone receptor-positive, node-negative tumors.

      Endocrine therapy is recommended for breast cancer prevention in high-risk postmenopausal women.

      Uterine fibroids: Elagolix (oral gonadotropin-releasing hormone antagonist) in combination with estradiol and norethindrone is for treatment of heavy menstrual bleeding (HMB) due to uterine fibroids.

      Chapter 12: OB

      Table 12-6: Active labor can start after OS > 4cm, and 6cm is relatively more acceptable but not a strict number.

      Table 12-7: Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria, or of hypertension and significant end-organ dysfunction with or without proteinuria, in the last half of pregnancy or postpartum. Once a diagnosis of preeclampsia is established, testing for proteinuria is no longerdiagnostic or prognostic. “proteinuria>5g/24hours” may only indicate the severity.

      Mole: For partial moles, obtain a confirmatory hCG level one month after normalization; for complete moles, reduce monitoring from 6 to 3 months post-normalization.

      Chapter 14: EM

SHOCK RESUSCITATION

Emergency treatment—critical care!

“A-B-C”: Breathing: …In mechanically ventilated adults with critical illness in ICU, intermittent sedative-analgesic medications (morphine, propofol, midazolam) are recommended.

 Chapter 15: Surgery

      Surgery and Geriatrics: Hemiarthroplasty is a suitable option for patients who sustain a displaced femoral neck fracture.

    Chapter 16: Psychiatry

     Depression: Both short-term and maintenance therapies with esketamine are beneficial for treatment-resistant depression.

Schizophrenia: Long-term antipsychotics may decrease long-term suicide mortality.

Narcolepsy: Pitolisant is a novel oral histamine H3 receptor inverse agonist used in narcolepsy patients with poor response or tolerate to other medications. Oxybate salts, a lower sodium mixed-salt formulation of gamma hydroxybutyrate is for treatment of narcolepsy with cataplexy.

     Chapter 17: Last Chapter

PEARLS—Table 17-9:  Important Immunization Schedules for All (2020, USA)

Vaccine                 Birth       2M          4M          6M          12-15M                 2Y         ��4-6Y       11-12Y       Sum

HAV                                                                                       1st                          2nd (2-18Y)                            2 doses

HBV                      1st           2nd                        3rd (6-12M)                                                                             3 doses

DTaP                                    1st            2nd         3rd          4th (15-18M)                        5th                             + Td per 10Y

IPV                                       1st           2nd         3rd (6-18M)                                         4th                             4 doses

Rotavirus                            1st           2nd                                                                                                         2 doses

Hib                                       1st           2nd         (3rd)       (3-4th)                                                                    3-4 doses

MMR                                                                                    1st                                         2nd                              2 doses

Varicella                                                                              1st                                         2nd                        + Shingles at 60Y

Influenza                                                            1st (IIV: 6-12Y; LAIV: >2Y                (2nd dose)               1-2 doses annually

PCV                                     1st           2nd         3rd          4th                                                                        PCV13+PPSV at 65Y

MCV (Men A, B)                                                                                                                                1st         Booster at 16Y

HPV                      9-12Y starting: <15Y: 2 doses (0, 6-12M); >15Y or immunosuppression: 3 doses (0, 2, 6M).

Chapter 17 HYQ answer 22: No routine prostate cancer screening (including PSA) is recommended and answer “G” is still correct–PSA

screening among healthy men is not routinely done but should be indicated in a patient with two risk factors.

[mcatmemoranda]

Notes from the asthma lecture the fellows reviewed today:

Fraction of exhaled NO (FeNO) drops with use of ICS.

FEV1 improves by 200 mL and FVC improves by 12% in pts with asthma after they are given bronchodilator (albuterol) during PFTs.

Peak Expiratory Flow (PEF) decrease by 15% after exercise = exercise induced asthma.

Aspirin-Exacerbated Respiratory Disease (AERD) = nasal polyps

Obese asthma pts have reduced lung volume. The pt we're seeing now is obese and you can see how all his weight is compressing his lungs on CT.

LABAs (salmeterol, formoterol) shouldn't be used without inhaled corticosteroids. The other day, I was listening to an OnlineMedEd video on pharmacology for lung diseases and I'm pretty sure Dustyn said that if you give a LABA without an ICS, it increases risk of mortality.

8 to 12 mg/dL is the therapeutic window for theophylline. I reviewed a question about theophylline just last night.

30 to 700 IU/mL serum IgE and no response to other meds is the indication for use of omalizumab. People can have anaphylaxis from omalizumab, so you have to make sure they're actually candidates for treatment with omalizumab before you give it.

IL-5 inhibitors (mepolizumab) and IL-5 receptor inhibitors (benralizumab) stop eosinophils.

Bronchial thermoplasty applies heat to smooth muscle in bronchioles to decrease narrowing of airways. Never heard of this treatment.

Type 2 low asthma involves IL-17 and IL-8. IL-8 summons neutrophils.

[pediadoc7-blog]

Benralizumab Drug Information

Medical information for Benralizumab including Mechanism, Indication, Contraindications, Dosing, Adverse Effect, Interaction. To know more about Benralizumab read this article https://www.pediatriconcall.com/drugs/benralizumab/1060

[bidhuan]

Mengenal Injeksi Otomatis Dosis Tunggal Benralizumab Untuk Asma Berat Pada Anak

Mengenal Injeksi Otomatis Dosis Tunggal Benralizumab Untuk Asma Berat Pada Anak

Farmasetika.com – Fasenra (Benralizumab) adalah obat yang telah disetujui oleh FDA (Food and Drug Administration) pada Mei 2019 sebagai obat yang dapat digunakan dalam terapi jangka panjang penyakit asma berat dengan kelainan sel eosinofil yang diderita oleh pasien berumur 12 tahun ke atas.

Asma berat

Pada pasien asma berat, sel eosinofil sendiri merupakan salah satu jenis sel darah putih yang…

[lucadezzani]

Top Pharma News of the Week - September 10th

Top Pharma News of the Week – September 10th

All The Most Important Pharmaceutical News Stories Of The Week – September 2018 – Week # 2 Cablivi™ (caplacizumab) approved in Europe for adults with acquired thrombotic thrombocytopenic purpura (aTTP)

September 3, 2018

The European Commission has granted marketing authorization for Cablivi™ (caplacizumab) for the treatment of adults experiencing an episode of acquired thrombotic thrombocytopenic…

[redashtvblog]

What Are the Best Asthma Treatments?

Asthma, a chronic respiratory condition characterized by inflammation and narrowing of the airways, can significantly impact quality of life. Fortunately, there are numerous effective asthma treatments available to help manage symptoms and improve breathing. This guide will explore the best asthma treatments, including those specifically for adults, treatments targeting asthma cough, and the role of yoga in asthma management.

Asthma Treatment: An Overview

Asthma treatment typically involves a combination of medications and lifestyle adjustments to control symptoms and prevent flare-ups. The primary goal is to maintain normal activity levels and avoid asthma attacks.

Medications

Inhaled Corticosteroids Inhaled corticosteroids are the cornerstone of long-term asthma management. They work by reducing inflammation in the airways, making them less sensitive to triggers. Common inhaled corticosteroids include fluticasone, budesonide, and beclomethasone. These medications are usually taken daily to keep asthma under control.

Long-Acting Beta Agonists (LABAs) LABAs, such as salmeterol and formoterol, are often prescribed in combination with inhaled corticosteroids. They help to relax the muscles around the airways, preventing symptoms like wheezing and shortness of breath.

Leukotriene Modifiers These oral medications, including montelukast and zafirlukast, help reduce inflammation and prevent airway constriction. They are particularly useful for people who experience asthma symptoms triggered by allergies.

Theophylline Theophylline is an oral medication that helps to open up the airways by relaxing the muscles around them. It is typically used as an add-on treatment for people who do not respond adequately to inhaled corticosteroids and LABAs.

Biologics Biologics are a newer class of medications that target specific molecules involved in the inflammatory process of asthma. Examples include omalizumab, mepolizumab, and benralizumab. These are usually prescribed for severe asthma that does not respond to standard treatments.

Best Treatment for Asthma

The best treatment for asthma is highly individualized, depending on the severity of the condition, triggers, and patient preferences. A comprehensive asthma management plan typically includes both long-term control and quick-relief medications.

Personalized Asthma Action Plans

Creating a personalized asthma action plan with the help of a healthcare provider is crucial. This plan outlines daily treatment, how to handle worsening symptoms, and what to do in an emergency. It should be reviewed and updated regularly to ensure it remains effective.

Environmental Control

Managing environmental triggers is also a key component of effective asthma treatment. Common triggers include pollen, dust mites, pet dander, mold, smoke, and air pollution. Steps to control these triggers include using air purifiers, maintaining cleanliness, avoiding smoking, and using hypoallergenic bedding.

Asthma Cough Treatment

Asthma cough treatment focuses on controlling the persistent cough that can be a symptom of asthma. This type of cough is often dry and can occur at any time, but it is frequently worse at night or early in the morning.

Quick-Relief Inhalers

Quick-relief inhalers, such as albuterol, are often used to treat asthma cough. These inhalers provide fast-acting relief by relaxing the muscles around the airways, making it easier to breathe and reducing coughing.

Cough Suppressants

While not a primary treatment for asthma, cough suppressants can sometimes be used in conjunction with asthma medications to provide temporary relief from a persistent cough. However, they should be used with caution and under the guidance of a healthcare provider.

Managing Underlying Inflammation

To effectively treat an asthma cough, it is essential to manage the underlying inflammation in the airways. This is typically achieved with inhaled corticosteroids and other anti-inflammatory medications.

Asthma Treatments for Adults

Asthma treatments for adults often require a tailored approach, as adult-onset asthma can present different challenges compared to childhood asthma.

Combination Inhalers

Combination inhalers that contain both an inhaled corticosteroid and a LABA are frequently prescribed for adults. These inhalers provide both long-term control and relief from symptoms.

Oral Corticosteroids

In cases of severe asthma exacerbations, short courses of oral corticosteroids like prednisone may be necessary. These medications help to quickly reduce airway inflammation and prevent worsening of symptoms.

Bronchial Thermoplasty

Bronchial thermoplasty is a non-drug procedure used to treat severe asthma. It involves heating the inside of the airways with a special device to reduce the amount of smooth muscle, which decreases the ability of the airways to constrict. This procedure can lead to long-term improvement in asthma symptoms and quality of life.

Lifestyle Modifications

For adults with asthma, lifestyle modifications can play a significant role in managing symptoms. Regular exercise, maintaining a healthy weight, avoiding smoking, and managing stress are all important factors.

Yoga for Asthma

Yoga for asthma has gained popularity as a complementary therapy. The practice of yoga can help improve respiratory function, reduce stress, and enhance overall well-being.

Breathing Exercises (Pranayama)

Pranayama, or yogic breathing exercises, are particularly beneficial for people with asthma. Techniques such as diaphragmatic breathing, alternate nostril breathing, and deep breathing can help improve lung function and reduce the frequency of asthma attacks.

Yoga Postures (Asanas)

Certain yoga postures can also aid in asthma management. Postures that open up the chest and improve lung capacity, such as the Fish Pose (Matsyasana), Bridge Pose (Setu Bandhasana), and Cobra Pose (Bhujangasana), are highly recommended. These postures help to expand the chest and improve airflow.

Stress Reduction

Yoga is known for its stress-reducing benefits, which can be particularly helpful for asthma patients, as stress is a common trigger for asthma symptoms. Regular yoga practice can help calm the mind and reduce the likelihood of stress-induced asthma attacks.

Integrating Yoga into Asthma Treatment

Integrating yoga into a comprehensive asthma treatment plan can provide additional benefits. However, it is essential to consult with a healthcare provider before starting any new exercise regimen. A qualified yoga instructor can also provide guidance on the most appropriate practices for individuals with asthma.

Conclusion

Asthma treatment encompasses a range of medications and lifestyle strategies aimed at controlling symptoms and preventing flare-ups. The best treatment for asthma is tailored to the individual's specific needs and may include inhaled corticosteroids, LABAs, leukotriene modifiers, biologics, and lifestyle modifications.

For adults, combination inhalers, oral corticosteroids, bronchial thermoplasty, and lifestyle changes are effective strategies. Addressing asthma cough requires both quick-relief and long-term control medications.

Yoga offers a complementary approach to asthma management, with breathing exercises, specific postures, and stress reduction techniques contributing to overall respiratory health. By combining medical treatments with holistic practices like yoga, individuals with asthma can achieve better control over their condition and improve their quality of life. Always work with healthcare providers to develop a comprehensive, personalized asthma action plan that includes both conventional and alternative treatments for optimal results

[christopherporreca01]

BRIEF-Astrazeneca says Benralizumab receives Positive EU CHMP opinion Nov 10 (Reuters) - ASTRAZENECA PLC: * BENRALIZUMAB POSITIVE CHMP IN EOSINOPHILIC ASTHMA * ‍ANNOUNCED THAT CHMP OF EUROPEAN MEDICINES AGENCY HAS ADOPTED POSITIVE OPINION, RECOMMENDING MARKETING AUTHORISATION OF BENRALIZUMAB​ Source text for Eikon: Further company coverage: (Bangalore.newsroom@thomsonreuters.com) Our Standards:The Thomson Reuters Trust Principles. Source link