Side-effects of specific drug classes (for elderly)

There are a number of differences between older people and younger people that have an impact on their treatment with medicines. These are particularly apparent in very old patients:

• Older people's bodies take up and eliminate medicines from the body differently than younger patients'.
• Older people are susceptible to a wide range of diseases, including Alzheimer's disease, heart disease, bone diseases and mental illnesses.
• Older people often have more than one disease at a time, making it difficult to treat the separate diseases.
• Older people may be weaker than younger patients, making them vulnerable to disease and the risks associated with medical treatment.

Side-effects of specific drug classes:

NSAIDs

• Gastrointestinal bleeding is more common and has more serious consequences in older patients.
• NSAIDs can worsen heart failure or aggravate impaired renal function. These effects can be worse in elderly patients.
• They are best avoided, if possible, for simple pain relief in osteoarthritis (OA), etc; paracetamol should be tried instead and, if this is insufficient, try a low-dose NSAID in addition, with proton-pump inhibitor (PPI) or misoprostol cover, or substitute a low-dose opioid.
• Consider complementary therapies such as acupuncture to help with pain management.
• The co-prescription of NSAIDs and ACE inhibitors in older patients can be a recipe for disaster; their combined deleterious effect on renal cortical perfusion and function can lead to significant renal impairment in the older patient.

Hypnotics

• Hypnotics with long half-lives are a significant problem and can cause daytime drowsiness, unsteadiness from impaired balance and confusion.
• Short-acting ones may also be a problem and should only be used for short periods if essential.
• In patients prone to falls or dizziness avoid using these agents unless absolutely necessary.
• Where benzodiazepines are used to help patients overcome a crisis or transitional period, great care must be taken that they be given only for short periods, to avoid the danger of dependence and addiction.
• It is much better to take a good history of an older patient's sleep habits and suggest sleep hygiene and non-pharmaceutical measures to overcome insomnia, than to prescribe drugs, which at best will be a temporary solution.

Diuretics

• This class of drugs is often overused in the elderly and should not be used for chronic treatment of gravitational oedema where measures such as leg-raising, increased walking/leg exercises and graduated compression stockings are often sufficient.
• Where diuretics are used to treat hypertension or cardiac failure, they should be reviewed regularly, along with an assessment of the patient's state of hydration and U&Es if necessary.
• Withdrawal of diuretics requires careful monitoring and consideration of potential contra-indications to withdrawal and can be difficult to achieve. For example, patients with well-controlled heart failure can develop troublesome symptoms and blood pressure can rise significantly in hypertensive patients.

Digoxin

In the very elderly, the daily maintenance dose should be 125 micrograms. In the renally impaired, the dose should be 62.5 micrograms. 250 micrograms/day are likely to cause toxicity.

Drugs that cause bone marrow suppression

Drugs such as co-trimoxazole and chloramphenicol should only be used if there is no suitable alternative.

Anticoagulants and antiplatelet drugs

• Beware of gastrointestinal bleeding and contra-indications such as peptic ulceration which may have occurred a long time ago and been forgotten about.
• For warfarin, prescribe only when patients have a full understanding of why the drug is being taken, its dangers, correct daily dosing/timing and the importance of regular INR monitoring.

Antidepressants

• Tricyclic antidepressants commonly cause postural hypotension and confusion in the older patient; they should be used carefully.
• Serotonergic medications used for depression may cause serotonin syndrome and agitation in the older patient; this can be difficult to distinguish from some of the symptoms of depression.

Diabetic medication

• Long-acting oral hypoglycaemics such as chlorpropamide and glibenclamide should be avoided as there is a significant risk of hypoglycaemia when these agents are used in the older patient.
• Tight diabetic control must be balanced against potentially catastrophic events precipitated by hypoglycaemia, particularly in those who live alone, have a poor understanding of diabetes self-management, or who experience few warning symptoms of hypoglycaemia.

The Travelers and the Plane Tree

Two men were walking along one summer day. Soon it became too hot to go any further and, seeing a large plane tree nearby, they threw themselves on the ground to rest in its shade.
Gazing up into the branches one man said to the other: "What a useless tree this is. It does not have fruit or nuts that we can eat and we cannot even use its wood for anything."
"Don't be so ungrateful," rustled the tree in reply. "I am being extremely useful to you at this very moment, shielding you from the hot sun. And you call me a good-for-nothing!"
All of God's creations have a good purpose. Islam teaches us that we should never belittle Allah's blessings.

Slipper Orchids

My favorite type of orchid is the lady slipper orchid because of their strange appearance. They are like no other types of flowers and have pouch-shaped lips. The mostly terrestrial and lithophytic slipper orchids include four genera—Paphiopedilum, Phragmipedium, Cypripedium and Selenipedium. But most Cypripedium and Selenipedium are not plants for the beginner because they can be quite difficult to grow under cultivation unless you live in temperate regions with Cypripedium growing wildly in your back yard!

You can readily buy Paphiopedilum at fancy grocery stores, and if you can’t find them, find a fancier store where women shop with little dogs in their bag! While these types of flowers come in girlie soft pink, eye-catching yellow, innocent white and other soft colors, many of them are dark red, brown and green with hairy and warty petals. The infamous Paphiopedilum sanderianum from Borneo has lateral sepals (the side petals) that can hang down 3 feet (1 meter) long! This highly sought-after plant can cost hundreds of dollars. But there are plenty of wonderful Paphiopedilum plants out there that don’t cost an arm and a leg.

Dendrobium Orchids

Another type of orchid you can grow at home is what I call the “Thai restaurant orchids.” These types of orchids are Dendrobium hybrids and can be found at Thai restaurants that decorate their tables with freshly-cut flowers. They come in many colors (white, green, purple, pink, yellow and more) and require a fairly warm environment. In fact, they could loose their leaves in the winter when the ambient temperature drops below 60°F (15°C) or so. But the “Thai restaurant orchid” is really just one small group of hybrids within the Dendrobium genus. Dendrobium is actually one of the largest orchid genera.

Dendrobium species live as epiphytes and lithophytes in New Guinea, Southern China, Thailand, Japan, Australia, New Zealand, Tahiti and more. As a result, it’s hard to generalize how to care for these types of orchids. Some of them require cool nights of 50 to 59°F (10 to 15°C) while some of them require warm temperatures in the 80s°F (27°C). That’s why it’s so important to understand their natural environment so that you can make them happy.

The Professor

As usual life was hectic for me. Every day, I had to leave in a hurry to reach my office on time by 9:00 am. It was already 8:00 am; I just woke up from my slumber. In a hurry I got freshen up and dressed, ready to leave for office by 20 minutes without having my breakfast. It was a common routine for me; life was full of fixed schedule just like a pendulum moving to and fro.
I stood near the road, waved towards a passing auto, no luck. After 5minutes an auto stood by and I saw a young driver with a black t-shirt and blue denim, quite unusual for an auto driver. Without wasting my time in bargaining I boarded the auto. Another passenger was already seated, a woman in her mid-forties with little make ups, marks of talc near her neck, big rounded spectacles with a hand bag with few books. I guessed she was a professor from the imprint on her bag "Bangalore University."
After 5 minutes, the auto stopped and a woman came to seat near "The professor." Within an instant, the professor strongly opposed to the driver that woman cannot seat near her, or go in the auto.
The lady seemed like a daily laborer, with stains of dirt and dust across her sari, she looked feeble but her hand full of scratches and stiffness proved her strenuous works for a living. She had some masonry tools, dusty and old.
I was left aback when "The professor" said she cannot sit with her.
She can't sit in the auto. "This is my vehicle, I decide who will go or not" said the angry driver.
I will pay the full fare, replied the professor lady.
My anger was nearly out of control. Suddenly I spoke with a burst. "What the hell are you, Human or devil? Being a teacher is this what you teach your children? You think you are civilized? I think you are the most uncivilized one. You call yourself educated, but what is the use of the education. I think you are an uneducated fool."
The professor lady got angry and said to the driver, "I will pay the full fare, just leave this guy here."
The driver was equally angry: "Just get down; I don't need your bloody money. You are a curse to humanity."
With a few angry murmurs, the so called professor of a college with no such thing called humanity in her for a fellow woman, got down angrily.
The laborer lady got up and put her things at the back of the auto and sat down.
Unaware of the pace of time, I was fighting for a person's rights, fundamental rights. I was satisfied, even though it was already late.
I was just getting down from the auto paying my fare, when I heard a low voice saying "Thank You."
You must not lose faith in humanity. Humanity is an ocean; if a few drops of the ocean are dirty, the ocean does not become dirty. - Mohandas K. Gandhi

Effects of illegal drugs in pregnancy

If a parent has drug problems it affects their child at every stage, from pregnancy onwards.Almost all drugs pass through the placenta to reach your baby and have some effect on her.

Drugs in your body may reduce the amount of oxygen that can reach your baby. Early in pregnancy, some drugs may affect your baby's development. Your baby may not grow as well as expected in your uterus (womb).

Taking illegal drugs may cause problems later on in your pregnancy, too, as they can affect how well the placenta works. There is a risk that the placenta may come away from the side of your uterus, sometimes causing severe bleeding. This is called placental abruption. Placental abruption is a serious condition and, because of the bleeding it causes, it can be life-threatening for you and your baby.

Your baby may have withdrawal symptoms if you regularly take certain drugs during your pregnancy. Your baby may need to stay in hospital, so nurses and doctors can check her for signs of withdrawal, and give her treatment.

Here is what we know so far about the effects of illegal drugs:

Cannabis (marijuana)

Cannabis is the most widely used illegal drug. Taking cannabis during pregnancy might make your baby unsettled and more easily startled after he is born. In the longer term, it could cause behaviour and learning problems for your baby as he grows older.

Smoking cannabis also exposes your baby to the risks related to smoking. If you smoke, you are more likely to go into premature labour. There's also a higher chance that your baby will be born with a low birth weight and other complications, and it increases the risk of cot death. (CDC 2013)

Speed (amphetamines) and crystal meth (methamphetamine)

It's best for your baby if you stop taking speed or crystal meth before you get pregnant. You can still quit if you are pregnant, but to be safe, you should stop taking these drugs with medical help in a drug treatment programme. Stopping suddenly could be harmful for you or your baby and could cause miscarriage.

Taking speed or crystal meth can make the following more likely:

• a complication where the placenta can't carry enough oxygen and nutrients to your baby, called placental insufficiency
• the placenta separating from your uterus (placental abruption)

These drugs can affect your baby's growth in the uterus, making her smaller than expected for your stage of pregnancy and increasing the chance of premature birth.

Some babies may have withdrawal symptoms but there are not many studies on this problem.

We also lack full information about the lasting effects of these drugs as your child grows up. But it's possible that children exposed to these drugs in the uterus may not develop and learn as well as other children their age.

Ecstasy

There's a lot of concern about the long-term side-effects of taking ecstasy. But there's very little research on the way that it can affect your pregnancy or your baby. Ecstasy may have an effect on your baby's motor development (co-ordination and movement). There is limited evidence that it could cause birth defects, but we don't know for sure.

Cocaine and crack cocaine

Taking cocaine or crack during pregnancy may increase your risk of having a miscarriage, and of placental abruption later in pregnancy.

Using cocaine while you are pregnant can slow down your baby's growth in the uterus. It may also increase the risk of your baby having problems with learning and behaviour when he is older.

Heroin and strong painkillers

Heroin has serious risks for your baby. The same kind of problems can happen if you are regularly using related painkillers (opioids) like morphine or Tramadol during pregnancy. You may not realise that you can become addicted to strong painkillers.

If you use heroin or other opioids, it is vital to get treatment as soon as you can. Trying to quit on your own could be dangerous for you and your baby. It could cause a miscarriage or premature birth, or your baby could be stillborn. The safest way to quit is with medical help, as part of a drug treatment programme.

During pregnancy, heroin and other opioids can slow down your baby's growth and have an effect on how her brain grows. These drugs can also make it harder for your baby to breathe just after she is born.

The Shepherd

Once upon a time, there lived in Basra an old man whose only occupation was caring for and loving his only son who was a handsome young man. The old man invested all his money on his son's education. The young man went away for a few years and acquired an education at a well known university under the great scholars of that age.
The day had arrived for the son to return from his studies and the old man waited at the door for his son. When the son came and met his father, the old man looked into his eyes and felt great disappointment. "What have you learnt my son?" he asked, "I have learnt everything there was to be learnt, father", he said. "But have you learnt what cannot be taught?" asked the father. "Go, my son and learn what cannot be taught", said the old man.
The young man went back to his master and asked him to teach him what cannot be taught. "Go away to the mountains with these four hundred sheep and come back when they are one thousand", said the master.
The young man went to the mountains and became a shepherd. There for the first time he encountered a silence. He had no one to talk to. The sheep did not understand his language. In his desperation, he would talk to them but they would look back at him as if to say he was stupid. Slowly but surely he began to forget all his worldly knowledge, his ego, his pride and he became quiet like the sheep and great wisdom and humility came to him.
At the end of two years when the number of sheep had grown to one thousand, he returned to his master and fell on his feet. "Now you have learnt what cannot be taught," said the master.

Note: It is interesting to note that the prophets of Allah (SWT) at some time in their lives, generally before Nubuwwat (Prophethood), tended to sheep and other such animals.

Man is the only creature that refuses to be what he is. - Albert Camus
Monkeys are superior to men in this: When a monkey looks into a mirror, he sees a monkey. - Malcolm de Chazal