Niraparib-A new anticancer drug

Niraparib,(Zejula) formerly known as MK-4827, is an orally active and potent poly (ADP-ribose) polymerase, or PARP, inhibitor. A Phase 1/2 monotherapy study has been completed in more than 100 patients with advanced solid tumors. Based upon the results of the Phase 1/2 study and published data from other trials of PARP inhibitors, TESARO is evaluating niraparib at a dose of 300 milligrams once daily in two Phase 3 studies.

Niraparib is a prescription medicine used for the maintenance treatment of adults with ovarian cancer, fallopian tube cancer, or primary peritoneal cancer, when the cancer comes back. Niraparib is used after the cancer has responded (complete or partial response) to treatment with platinum-based chemotherapy. It is not known if Niraparib is safe and effective in children.

Mechanism of Action of Niraparib (Zejula)

PARP is a family of proteins involved in many functions in a cell, including DNA repair, gene expression, cell cycle control, intracellular trafficking and energy metabolism. PARP proteins play key roles in single strand break repair through the base excision repair pathway.

PARP inhibitors have shown activity as a monotherapy against tumors with existing DNA repair defects, such as BRCA1 and BRCA2, and as a combination therapy when administered together with anti-cancer agents that induce DNA damage.

Side effects of Niraparib (Zejula)

Symptoms of low blood cell counts (low red blood cells, low white blood cells, and low platelets) are common during treatment with Niraparib, but can be a sign of serious bone marrow problems, including MDS or AML. Symptoms may include:

1.     Weakness

2.     Fever

3.     Feeling tired

4.     Weight loss

5.     Shortness of breath

6.     Blood in urine or stool

7.     Frequent infections

8.     Bruising or bleeding more easily

High blood pressure common in treatment with Niraparib

High blood pressure is common during treatment with Niraparib, and can become serious. Your healthcare provider will check your blood pressure and heart rate monthly for the first year and as needed thereafter during your treatment with Niraparib.

Clinical Studies of Niraparib

The drug was evaluated in clinical studies involving 553 people with any of these recurring cancers who had had their tumors shrunk by at least two doses of platinum-based chemotherapy. The average progression-free survival of certain women given Niraparib was 21 months, compared with 5.5 months among women who took a placebo, the FDA said.

Cough-A respiratory disorders

A cough is a common reflex action that clears the throat of mucus or foreign irritants. Coughing to clear the throat is typically an infrequent action, although a number of conditions can cause more frequent bouts of coughing.

1.    A cough that lasts for less than three weeks is an acute cough.

2.    A cough that lasts between 3 and 8 weeks, improving by the end of that period, is a subacute cough.

3.    A persistent cough that lasts more than eight weeks is a chronic cough.

Causes of cough

A cough can be caused by several conditions, both temporary and permanent.

Clearing the throat cause of cough

A cough is a standard way of clearing the throat. When your airways become clogged with mucus or foreign particles such as smoke or dust, a cough is a reflex reaction that attempts to clear the particles and make breathing easier.

Usually, this type of coughing is relatively infrequent, but coughing will increase with exposure to irritants such as smoke.

Viruses and bacteria are causes of cough

The most common cause of a cough is a respiratory tract infection, such as a cold or flu. Respiratory tract infections are usually caused by a virus and may last from a few days to a week. Infections caused by the flu may take a little longer to clear up and may sometimes require antibiotics.

Smoking is causes of cough

Smoking is another common cause of coughing. A cough caused by smoking is almost always a chronic cough with a distinctive sound. It’s often known as “smoker’s cough.”

Asthma is causes of cough

A common cause of coughing in young children is asthma. Typically, asthmatic coughing involves wheezing, making it easy to identify. Asthma exacerbations should receive treatment using an inhaler. It’s possible for children to grow out of asthma as they get older.

Drugs for Cough

1. Pharyngeal Demulcents

Lozenges, cough drops, linctuses containing Syrup, Glycerine, Liquorice.

2. Expectorants (Mucokinetics)

(a) Bronchial secretion enhancers: Sodium or Potassium citrate, Potassium iodide, Guaiphenesin (Glyceryl guaiacolate), balsum of Tolu, Vasaka, Ammonium chloride.

(b) Mucolytics:  Bromhexine, Ambroxol, Carbocisteine, Acetylcysteine.

3. Antitussives (Cough centre suppressants)

(a) Opioids: Codeine, Pholcodeine, Ethylmorphine.

(b) Nonopioids: Noscapine, Dextromethorphan, Chlophedianol.

(c) Antihistamines: Chlorpheniramine, Diphenhydramine, Promethazine.

4. Adjuvant Antitussives

Bronchodilators: Salbutamol, Terbutalin.

Peptic ulcers:

Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum.

Causes of Ulcers:

No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Most ulcers are caused by an infection with a type of bacteria called Helicobacter pylori (H. pylori).

Factors that can increase risk for Peptic ulcers:

1.    Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen, ibuprofen, and many others available by prescription; can frequently cause ulcers.

2.    Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output (seen in Zollinger-Ellison syndrome)

3.    Excessive drinking of alcohol

4.    Smoking or chewing tobacco

5.    Serious illness

6.    Radiation treatment to the area

Diagnosis of Peptic Ulcers

Doctor may recommend a procedure called an upper endoscopy. It involves inserting a small, lighted tube (endoscope) through the throat and into the stomach to look for abnormalities. This procedure is usually given if you are having severe or recurring symptoms of ulcers.

Drugs for Peptic Ulcer

1. Gastric acid secretion inhibitors

(a) H2 antihistamines: Cimetidine, Ranitidine,Famotidine, Roxatidine

(b) Proton pump inhibitors: Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole, S (-) Pantoprazole, Rabeprazole, Dexrabeprazole.

(c) Anticholinergics: Pirenzepine, Propantheline, Oxyphenonium

(d) Prostaglandin analogues: Misoprostol

2. Gastric acid neutralizers (Antacids)

(a) Systemic: Sodium bicarbonate, Sod. citrate

(b) Nonsystemic: Magnesium hydroxide Mag. trisilicate, Aluminium hydroxide gel, Magaldrate, Calcium carbonate

3. Ulcer protectives

Sucralfate, Colloidal bismuth subcitrate (CBS)

4. Anti-H. pylori drugs

Amoxicillin, Clarithromycin, Metronidazole, Tinidazole, Tetracycline

Ablation: Doctor burns off the tiny parts of your heart that are causing the abnormal beats. She threads a thin tube, called a catheter, through a blood vessel in your leg or groin up to your heart.

Energy travels through the tube. It burns off the areas of tissue that cause the abnormal signals. Scars form in the burned areas and block any abnormal electrical signals.

After some ablation procedures, you'll need a pacemaker to keep your heart in rhythm.

B-type Natriuretic Peptide (BNP) blood test: 

BNP is a substance secreted from the heart in response to changes in blood pressure that occur when heart failure develops or worsens. BNP blood levels increase when heart failure symptoms worsen, and decrease when the heart failure condition is stable. The BNP level in a person with heart failure -- even someone whose condition is stable -- is higher than in a person with normal heart function. BNP levels do not necessarily correlate with the severity of heart failure.

Types of Heart Failure

Systolic dysfunction (or systolic heart failure):It occurs when the heart muscle doesn't contract with enough force, so there is less oxygen-rich blood that is pumped throughout the body.

Diastolic dysfunction (or diastolic heart failure): It occurs when the heart contracts normally, but the ventricles do not relax properly or are stiff, and less blood enters the heart during normal filling.

Ejection Fraction in Heart failure

A calculation done during an echocardiogram, called the ejection fraction (EF), is used to measure how well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present. 

Heart Failure

Heart failure does not mean the heart has stopped working. Rather, it means that the heart's pumping power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently. As a result, the kidneys may respond by causing the body to retain fluid (water) and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested, and congestive heart failure is the term used to describe the condition.

Conditions that overwork the heart: Conditions including high blood pressure, valve disease, thyroid disease, kidney disease, diabetes, or heart defects present at birth can all cause heart failure. In addition, heart failure can occur when several diseases or conditions are present at once.

Causes of Heart Failure

Heart failure is caused by many conditions that damage the heart muscle, including:

Coronary artery disease: Coronary artery disease (CAD), a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.

Heart attack: A heart attack occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that does not function properly.

Cardiomyopathy: Damage to the heart muscle from causes other than artery or blood flow problems, such as from infections or alcohol or drug abuse.

Painkillers Causes Heart Attack Risk

Nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of a heart attack by 20 to 50 percent, compared with not using them, researchers found. The increased risk of heart attack associated with NSAIDs was seen at any dose taken for one week, one month or more than one month. And the risk rose with higher doses, the study found.

NSAIDs are extensively used to treat pain and inflammation from long-term situation, such as arthritis and other joint diseases. a lot of public also take them for short-term problems, such as menstrual cramps, fever from a cold or flu or the intermittent backache or headache.