Raiyyan Tahsan

Raiyyan Tahsan
Hello I'm Raiyyan Tahsan
Brand Model and Executive

Neurology Case No 8.Parkinson Diseases Restless Leg Syndrome.  

আলামিন মেডিকেল ২য় বর্ষের স্টুডেন্ট – আমার কাছে আসছিলো- মাস খানেক আগে

তার মায়ের বয়স ৪৩ ৷ ওনার সমস্যা হচ্ছে – উনি শুইলে পা স্থীর রাখতে পারেনা– শুধু পা নাড়াচাড়া করেন

Unpleasant sensation to leg

Crawling leg

Urge to Movement of leg while lying —

মানে উনি Rest এ থাকলে ওনার পা continuously Moving হতে থাকে–

আমার কাছে ওনাকে anemic মনে হলো– আমি একটা CBC কর‍তে দিলাম, Hb 9 gm/dl আসে-

MCV, MCHC low.

আমি IDA suspect করে serum ferritin করতে দিলাম,

পরে ডায়াগনোসিস করলাম, ওনার সমস্যা

Restless leg syndrome Due To IDA..

..

এই ক্ষেত্রে চিকিৎসার জন্য আমাকে আয়রন ডেফিসিয়েন্সি এনিমিয়া কারেকশন করা লাগবে– আমি ওরাল আয়রন দিলাম

Tablet 1:-Zenifol (200mg+200mg) AS A (Ferrous Fumarate+Folic Acid) (AS A Iron & Vitamin Combined preparations).

Indications of Tablet :-Zenifol (200mg+200mg) AS A (Ferrous Fumarate+Folic Acid) (AS A Iron & Vitamin Combined preparations).

Zenifol is indicated in-

  • Prophylaxis and treatment of Iron deficiency anaemia in pregnancy.
  • Prevention of megaloblastic anaemia of pregnancy.

Pharmacology of Tablet :-Zenifol (200mg+200mg) AS A (Ferrous Fumarate+Folic Acid) (AS A Iron & Vitamin Combined preparations).

Iron is an essential constituent of the body being necessary for haemoglobin formation and for the oxidative processes of living tissues. Iron salts should only be given for the treatment and as prophylaxis of Iron deficiency anaemia. Iron deficiency anaemias are most often the result of chronic haemorrhage, nutritional deficiency, pregnancy or parasite infestation or malabsorption of iron.

A deficiency of Folic acid typically during pregnancy has long been known to cause a megaloblastic anaemia. The vitamin is not storable in the body and the combination of fetal demand during pregnancy and malnutrition can lead to a deficiency, hence anaemia. It has been observed that the rapid production of red blood cells following treatment with iron may deplete body folate if there is inadequate intake; combination of folic acid and ferrous fumerate avoids the complication. Iron and Folic acid are absorbed in the proximal small intestine particularly the duodenum. Ferrous Fumerate & Folic acid supplements replenish iron deficiency. Thereby arresting the anaemia process. Absorbed iron is taken upto the bone marrow’s tissues that form blood cells where it is used to synthesize haemoglobin.

Dosage & Administration of Tablet :-Zenifol (200mg+200mg) AS A (Ferrous Fumarate+Folic Acid) (AS A Iron & Vitamin Combined preparations).

Adults: One tablet daily. When necessary one tablet may be given twice daily. In pregnancy, it is recommended that Irolic tablet should be started at first antenatal consolation and continues for 3 months after delivery. The tablet should preferably be taken before meals; if there are gastro-intestinal disturbances, doses may be taken after meals.

Interaction of Tablet :-Zenifol (200mg+200mg) AS A (Ferrous Fumarate+Folic Acid) (AS A Iron & Vitamin Combined preparations).

The absorption of iron salts and tetracycline is diminished when they are taken concomitantly by mouth. If treatment with both drug is required, the iron salt should be administered 3 hours before or 2 hours after the tetracycline. The absorption of iron salts is also decreased in the presence of antacids or when taken with tea. Iron salts appear to reduce the effects of penicillamine. Co-trimoxazole may inhibit megaloblastic haemopoiesis. Serum anticonvulsant levels may be reduced by administration of folate.

Contraindications of Tablet :-Zenifol (200mg+200mg) AS A (Ferrous Fumarate+Folic Acid) (AS A Iron & Vitamin Combined preparations).

This is contraindicated in patients with pernicious anaemia and anaemia other than those due to iron deficiency. The nature and causes of anaemia should be established. Absorption of Ferrous Fumerate & Folic acid is inhibited by Magnesium trisillicate and Antacid containing carbonate.

Side Effects of Tablet :-Zenifol (200mg+200mg) AS A (Ferrous Fumarate+Folic Acid) (AS A Iron & Vitamin Combined preparations).

Side effects of iron and folic acid preparations which have been reported include nausea, vomiting, gastro-intestinal symptoms, constipation and diarrhea.

Precautions & Warnings of Tablet :-Zenifol (200mg+200mg) AS A (Ferrous Fumarate+Folic Acid) (AS A Iron & Vitamin Combined preparations).

Administration of Irolic during the first trimester of pregnancy may be undesirable. Very few pregnant women are not protected by physiological doses of folic acid. If anaemia is developed despite prophylaxis with Irolic, patient should be investigated further. Some post-gastrectomy patient show poor absorption of Fe. Care is needed when treating patients with peptic ulcer.

Overdose Effects of Tablet :-Zenifol (200mg+200mg) AS A (Ferrous Fumarate+Folic Acid) (AS A Iron & Vitamin Combined preparations).

Patients who have taken an overdose should have gastric lavage performed, if possible within four hours of the overdosage occurring. In addition patients should have such symptomatic treatment as appears necessary. In order to eliminate excess free iron, a chelating agent such as desferrioxamine should be administered as soon as possible. Giving milk and/or 5% solution of sodium bicarbonate by mouth will be helpful in the meantime.

Therapeutic Class of Tablet :-Zenifol (200mg+200mg) AS A (Ferrous Fumarate+Folic Acid) (AS A Iron & Vitamin Combined preparations).

Iron & Vitamin Combined preparations

OR

Tablet 2:-Hemofix 33 mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

Indications of Tablet :-Hemofix 33 mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

 

Hemofix is indicated in the treatment of iron deficiency anemia.

Pharmacology of Tablet :-Hemofix 33 mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

 

Ferrous ascorbate, a synthetic molecule of ascorbic acid and iron. Iron replenishes the iron stores in your body and corrects iron deficiency anemia. Vitamin C (ascorbate) is added to enhance the absorption of iron in the body.

Dosage & Administration of Tablet :-Hemofix 33 mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

 

Adult & Elderly: One tablet a day before or after meal (food independent absorption) or as directed by the physician. In more severe cases, two tablets a day may be required as prescribed by the physician.

Pediatric patients: Safety and effectiveness in pediatric patients have not been established.

Contraindications of Tablet :-Hemofix 33 mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

 

It is contraindicated in hemosiderosis, hemochromatosis, hemolytic anemia.

Side Effects of Tablet :-Hemofix 33 mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

 

The treatment of a neurotic patient was interrupted because of nausea and regurgitation. In pregnant women, the incidence of pyrosis and chronic constipation is slightly increased.

Precautions & Warnings of Tablet :-Hemofix 33 mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

 

Oral iron preparations may aggravate existing peptic ulcer, regional enteritis and ulcerative colitis. Iron compounds taken orally can impair the absorption of tetracycline antibiotics. Antacids given concomitantly with iron compounds decrease iron absorption.

Overdose Effects of Tablet :-Hemofix 33 mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

 

The chance of poisoning is rare in adults with iron overdose.

Therapeutic Class of Tablet :-Hemofix 33 mg (AS A Ferrous Ascorbate AS A Oral Iron preparations).

 

Oral Iron preparations

আর একটা Tablet দিলাম-

Ropinirole.

Tablet 3.- Perkirol 0.25 mg (AS A Ropinirole AS A Antiparkinson drugs).

0+0+1 (one hour before bed time) 3 days

Then-

0+0+2 (one week)

Then-

Perkirol 1 mg

0+0+1 continue.. (৩ মাস) এর পর ফলো আপ-

Indications of Tablet:- Perkirol 0.25 mg (AS A Ropinirole AS A Antiparkinson drugs).

Perkirol is indicated for the treatment of the signs and symptoms of idiopathic Parkinson’s disease. It is also indicated for the treatment of moderate-to-severe primary Restless Legs Syndrome (RLS).

Pharmacology of Tablet:- Perkirol 0.25 mg (AS A Ropinirole AS A Antiparkinson drugs).

Ropinirole is a non-ergoline dopamine agonist. Ropinirole has the highest affinity at the D3 receptors, which are concentrated in the limbic areas of the brain and may be responsible for some of the neuropsychiatric effects. The exact mechanism of action of ropinirole as a treatment for Parkinson’s disease is unknown, however, it is believed to be related to its ability to selectively stimulate dopamine D2 receptors within the caudate-putamen system in the brain. This system affects body movement. Negligible affinity is seen for ropinirole at α2 adrenoreceptors in the periphery and 5HT-1 receptor. Ropinirole has no affinity at the D1-like receptors, benzodiazepine or GABA receptors. The precise mechanism of action of ropinirole as a treatment for Restless Legs Syndrome is unknown, however, it is believed to be related to its ability to stimulate dopamine receptors.

Dosage & Administration of Tablet:- Perkirol 0.25 mg (AS A Ropinirole AS A Antiparkinson drugs).

Dosing for Parkinson’s disease: The recommended starting dose for Parkinson’s disease is 0.25 mg three times daily. Based on individual patient therapeutic response and tolerability, if necessary, the dose should then be titrated with weekly increments as described below. Maximum recommended total daily dose of 24 mg (8 mg three times daily).

  • Week 1: 0.25 mg 3 times daily. Total Daily Dose 0.75 mg
  • Week 2: 0.5 mg 3 times daily. Total Daily Dose 1.50 mg
  • Week 3: 0.75 mg 3 times daily. Total Daily Dose 2.25 mg
  • Week 4: 1 mg 3 times daily. Total Daily Dose 3 mg

Dosing for Restless Legs Syndrome: The recommended adult starting dose for RLS is 0.25 mg once daily 1 to 3 hours before bedtime. After 2 days, if necessary, the dose can be increased to 0.5 mg once daily, and to 1 mg once daily at the end of the first week of dosing, then as shown below as needed to achieve efficacy. Titration should be based on individual patient therapeutic response and tolerability, up to a maximum recommended dose of 4 mg daily.

  • Days 1 and 2: 0.25 mg, 1 to 3 hours before bedtime, to be taken once daily
  • Days 3-7: 0.5 mg, 1 to 3 hours before bedtime, to be taken once daily
  • Days 2: 1 mg, 1 to 3 hours before bedtime, to be taken once daily
  • Days 3: 1.5 mg, 1 to 3 hours before bedtime, to be taken once daily
  • Days 4: 2 mg, 1 to 3 hours before bedtime, to be taken once daily
  • Days 5: 2.5 mg, 1 to 3 hours before bedtime, to be taken once daily
  • Days 6: 3 mg, 1 to 3 hours before bedtime, to be taken once daily
  • Days 7: 4 mg, 1 to 3 hours before bedtime, to be taken once daily

Interaction of Tablet:- Perkirol 0.25 mg (AS A Ropinirole AS A Antiparkinson drugs).

Because Perkirol is a dopamine agonist, it is possible that dopamine antagonists such as neuroleptics (phenothiazines, butyrophenones, thioxanthenes) or metodopramide may reduce the efficacy of Perkirol.

Contraindications of Tablet:- Perkirol 0.25 mg (AS A Ropinirole AS A Antiparkinson drugs).

It is contraindicated in patients known to have a hypersensitivity to Ropinirole.

Side Effects of Tablet:- Perkirol 0.25 mg (AS A Ropinirole AS A Antiparkinson drugs).

The most common side effects of Perkirol include fainting, drowsiness, hallucinations, dizziness, nausea or vomiting, uncontrolled sudden movements, leg swelling, fatigue, confusion, headache, upset stomach, abdominal pain or discomfort, increased sweating etc.

Pregnancy & Lactation of Tablet:- Perkirol 0.25 mg (AS A Ropinirole AS A Antiparkinson drugs).

Pregnancy category C. There is no adequate and well-controlled studies in pregnant women. It should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus. Ropinirole inhibits prolactin secretion in human and could potentially inhibit lactation.

Precautions & Warnings of Tablet:- Perkirol 0.25 mg (AS A Ropinirole AS A Antiparkinson drugs).

Patients treated with Perkirol have reported falling asleep while engaged in activities of daily living. Dopamine agonists in clinical trials and clinical experience appear to impair the systemic regulation of blood pressure, with resulting orthostatic hypotension.

Therapeutic Class of Tablet:- Perkirol 0.25 mg (AS A Ropinirole AS A Antiparkinson drugs).

Antiparkinson drugs

আলহামদুলিল্লাহ উনি ১ মাসের মধ্যে এই সমস্যা একবারি কমে গেলো উনি ভালো আছেন—-

General Queries:-

1.Sir IDA jodi na paoa jeto tahole next investigation ki hoto?

Answer is:secondary cause evaluate korte hobe….in that case

Raiyyan Tahsan Date:-25-01-2025 Saturday Time:-3-44-55 PM

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top