Vol15no

DRUG & THERAPEUTICS LETTER
A Quarterly Bulletin from
Drug Information Unit (DIU)
Department of Clinical Pharmacology
Tribhuvan University Teaching Hospital
Institute of Medicine, Maharajgunj, Kathmandu
Vol 15 No. 1 January-March 2008
• Prescribing exercise for diabetes
• Antidepressants in pregnancy and
breast feeding
• Drug Monitoring and Toxicology
swelling of the ankles and pain in the calvesthat is not associated with muscle pain. If Laboratory
these symptoms are present, furtherinvestigation is needed before the patient Prescribing exercise for diabetes
can begin an exercise routine. Othercardiovascular risk factors that should be cholesterol and lipid profiles, resting heart circumference, family history and previous have lower rates of all cause mortality and cardiovascular heart disease. Regularexercise assists in maintaining good blood The presence of cardiovascular risk factors and other complications does not preclude a person with diabetes from undertaking an exercise prescription or identify those who should undergo cardiac stress testingbefore starting to exercise. Currently there Prescribing exercise should be considered one of the essential components ofdiabetes care. Unfortunately, it is still Stress testing allows definitive management of patients with cardiovascular diseasebefore exercise is prescribed. However, there Certain exercise intensities and modalities is no evidence that stress testing should may be contraindicated or inappropriate for be routinely performed before exercise of some people. Before prescribing an exercise moderate intensity if cardiovascular disease risk is low. Stress testing may be impractical imperative that the patient is screened and assessed for cardiovascular disease riskfactors or other conditions that may pose significant health risks. The patient should DRUG & THERAPEUTICS LETTER Vol. 15 No. 1 January - March 2008 or suffering from one of the many comorbid rheumatoid arthritis, severe osteoarthritis, osteoporosis and other joint problems.
Exercise has an insulin-type effect which High intensity exercise is contraindicated poses potential hazards for those who are in people with proliferate retinopathy due insulin dependent or take oral hypoglycemic carbohydrate intake are not modified with increases in levels of physical activity.
microalbuminuria. High impact and weight- exercise intensity and duration.As a general rule though, extra carbohydrate should be neuropathy, arthritis and osteoporosis as ingested before exercise if the session is to they are at greater risk of falls, injuries and last longer than 30 minutes or if pre- exercise blood glucose levels are less than 5.6 mmol/ L. As exercise-induced hypoglycaemia mayoccur many hours post exercise, regular lipid profiles, blood pressure and resting exercise. Alternatively, insulin dosage may cholesterol. In addition, it helps patient to also impact on exercise prescription.
recommend that aerobic activity should be Exercise may have adverse effects on those with proliferative or severe non-proliferative moderate intensity on most, if not all days retinopathy. Until the retinopathy has been stabilized, high intensity resistance and between exercise sessions. If weight loss aerobic training should be avoided due to is desired, then 60 minutes of exercise or more is recommended. It is often difficult Nevertheless, patients with either of these conditions can still benefit from regular therefore the exercise prescription should initally begin at a level the patient canmange, with the aim of gradually increasing disease can increase the risk of injury and infection in the feet. Peripheral neuropathycan also affect balance, placing the patient at greater risk of falls. Some types of exercise such as treadmill walking should be avoided.
walking, swimming or cycling. However, the type of exercise will depend on the patient’s for blisters is a must for these individuals, safety and physical activity preferences.
especially with weightbearing activities.
The effects of exercise on patients who are insulin dependent, taking oral medications DRUG & THERAPEUTICS LETTER Vol. 15 No. 1 January - March 2008 cycling, and upper limb resistance training editors. Handbook of exercise indiabetes. 2nd ed. Alexandria, VA: Conclusion
American Diabetes Association; 2002.
7. Gordon NF. The exercise prescription.
prevention and management of diabetes. It exercise in diabetes. 2nd ed. Alexandria, cardiovascular risk and improve quality of life. Both aerobic and resistance training modalities should form the cornerstone ofany exercise program. Prescribed correctlyand with adequate considerations of the Brief Information
barriers, motivators and medical concernsfacing people with diabetes, exercise can Antidepressants in pregnancy and
be an extremely safe and effective treatment breast-feeding
References
women is a common problem. In attemptingto find the best treatment options for these and more risks than with other patients.
2. Di Loreto C, Fanelli C, Lucidi P, Murdolo lactating women and therefore practice is impact of different amounts of physicalactivity on type 2 diabetes. Diabetes experience. Clinicians must consider the risk effects of the illness itself on both the intensity resistance training improvesglycemic control in older patients withtype 2 diabetes. Diabetes Care Castaneda-Sceppa C, White RD.
Physical activity/exercise and type 2 diabetes: a consensus statement fromthe American Diabetes Association.
gestational length and lower birth weight postnatal depression and breastfeeding is DRUG & THERAPEUTICS LETTER Vol. 15 No. 1 January - March 2008 postnatal depression are more likely to stop sertraline as the maternal response may be and maintain breastfeeding are less likely have difficulties with breastfeeding.
its consequences must be weighed againstthe risks of the medications to both mother and infant during the different phases of of the relative risks of the antidepressants, some neonatal effects, and different studies postnatally for feeding, neurological and respiratory difficulties. Prescription of paroxetine in higher doses cause concern.
While some perinatal psychiatrists prefer than in antenatal use, and potentially of Drug Monitoring and Toxicology Laboratory
The total number of patients who utilized Drug/Enzymes Ref. Value Total Samples Results within Results beyond Cholinesterase level 4,260-11250 224 57 167 units/litre “Drug and Therapeutics Letter” is also available now in the following websites:http:// www.teachinghospital.org.np/diu.html,http://www.iom.edu.np/diu.html Chief Editor :
Prof. Kumud Kumar Kafle
Editors:
Dr. Sanu Maiya Shakya, Dr. Satish Deo
Department of Clinical Pharmacology, Drug information Unit, Room Number :1-85 Doctors’
Room Block, TU Teaching Hospital, P.O. Box : 3578, Maharajgunj, Kathmandu.
Phone No. : 4412404 Extn 1093, E-mail : diu@healthnet.org.np

Source: http://teachinghospital.org.np/vol15no1.pdf