According to medical record and nurse from the Silver Jubilee Home, our

foster parent,Uncle Alan Lee Kwek Leong have to take 4 types of medicine
everyday such as Metformin 500mg,Nifedipine 10mg,Gliclazide 80mg and
Lovastatin 20mg.
Metformin 500mg
Uncle Alan has to take metformin 500mg twice a day. Metformin is
medicine for diabetes patient to help control blood sugar levels.Metformin is
for people with type 2 diabetes.
ACTION OF MEDICINE
Metformin works by restoring the proper response of the body to the insulin
which naturally produce and also decreases the amount of the sugar that
liver makes in addition with the amount of sugar that absorb by the stomach
or intestines. It is used together with better lifestyle such as a proper diet
and exercise as well as possibly take with other medication to control the
high blood sugar for both diabeties patient or the people who are at high risk
of getting diabetes. Metformin also used by women with a certain disease in
the ovaries (polycystic ovarian syndrome) or to make menstrual cycles more
regular as well as increase fertility.
INFORMATION OF DISEASE
Diabetes Mellitus is a long-term condition in which the blood sugar
level is abnormally high. There are 3 types of diabetes. First of all,
Gestational Diabetes which affects females during pregnancy; Type 1
Diabetes is when the body of the patient does not produce insulin whereas
for Type 2 Diabetes which is more common, it is a condition where the body
does not produce enough insulin for proper function.
The symptoms including frequent urination. It is normal to release
about 2 liters per day but patient has to be aware that waking at night to
urinate or urinate larger amount than usual can mean something is not right

and check up is needed because it may be due to other factor as well.Besides

that, unusual weight gain or loss, increased thirst and hunger even after
eating and having difficulties in healing of wounds such as small
cuts,infections and sores. The white blood cells become comparatively slow
to respond to infections when glucose level is too high. Eye problems can be
one of the symptoms of diabetes patients too because when the blood sugar
shifts, it can make the lens of the eyes shrink or swell which make the vision
to be blur or create little spots called floaters.
A1C test is a blood test to observe the average glucose levels in blood
for previous 3 months and periodic A1C testing is highly recommended.

DOSAGE
Patient should read the Patient Information Leaflet available before start
taking metformin as well as each refill later on and consult doctor or
pharmacist if problems occurred.
The dosage of metformin that should be taken should be based on the
medical condition, kidney function and the response to the medicine of the
patient.
Doctor may direct the patient to take a lower dose at the beginning and then
slowly increase the dose in order to lower the risk of side effects such as
upset stomach until the best dose for the patient observed.
The medicine usually orally taken 1-3 times everyday with meals as directed
as the doctor. Taking the medicine same times each day can maximize the
benefit from the medicine.
Drink plenty of fluids unless otherwise directed by the doctor.
Follow doctors instruction carefully if the patient is taking another antidiabetic drug such as chlorpropamide to either stop or continue the old drug
and starting metformin.
Check blood sugar regularly as directed by doctor and update your doctor
for the result obtained as dosage may need to change according to it.

SIDE EFFECT
Side effect of taking metformin including hives , swelling of face, lips,
tongue or throat, nausea, stomach upset, diarrhea,metallic taste in the mouth
and also difficulty in breathing.
A very serious allergic reaction to metformin is rare but if symptoms like
rash, itching, swelling as well as severe dizziness occurred , patient need to
get medical help immediately.
An overdose of metformin can cause lactic acidosis. Symptom of lactic
acidosis includes increasing sleepiness, slow heart rate , cold and numb
feeling in arms and legs, muscle pain and also feeling dizzy.
DRUG INTERACTION
Some drug should not be taken together with metformin because it can cause
serious problems, possibly lead to fatal interactions.
Alcohol
Drug for high blood pressure such as metoprolol , propranolol, glaucoma eye
drops such as timolol
Iodinated contrast agents which is used for radiography to enhance visibility)
Calcium channel blockers such as nifedipine and Amlodipine
Corticosteroids such as Betamethasone,hydrocortisone
Contraceptives such as oestrogens and progesterone

Gliclazide 80mg
Uncle Alan who is a patient of type 2 diabetes takes Gliclazide 80mg
twice a day. Gliclazide is one type of oral hypoglycemic which used to
control the hyperglycemia in gliclazide-responsive diabetes mellitus of
stable, mild and non-ketosis prone type 2 diabetes. The active ingredient of
this medicine is gliclazide which classified as sulphonylurea. Gliclazide
prevents accumulation of fats in arteries of the patient with type 2 diabetes.
ACTION OF MEDICINE
Gliclazide works by increasing the amount of insulin produced by the body
which helps to lower the amount of sugar in the blood. This medicine is used
when diabetes cannot be controlled by proper dietary management and
exercise or when the insulin therapy failed.
Gliclazide binds to sulphonylureas receptors (SUR-1) selectively on the
surface of the beta cells in pancreas. It provides cardiovascular protection as
it does not bind to sulphonylureas receptors (SUR-2A) in the heart.
This binding can closes the K+ ion channels which in turn decreases the
efflux of potassium from the cell that lead to depolarization of the cell
effectively.
This causes Ca2+ ion channels to open and increases the Ca2+ influx
Ca2+ then bind to and activate the calmodulin that leads to exocystosis of
insulin vesicles
Insulin vesicles release insulin.

INFORMATION OF DISEASE
Diabetes mellitus is a chronic and prolonged condition in which it
affect the body ability of the patient to use the energy found in food.
Carbohydrates and sugar found in food need to be converted into glucose
which fuels the cells in the body. It requires insulin which is a hormone in
the bloodstream that utilize the glucose to provide energy. The glucose will
then builds up in the bloodstream which in turn damage the tiny blood
vessels in kidney, heart, eyes or nervous system. Severe complication may
occur if diabetes is left untreated. Acute complications includes diabetic
ketoacidosis , nonketotic hyperosmolar coma and also serious long-term
complications such as heart disease,stroke,kidney failure, foot ulcers and
also damage to eyes and nerve. Besides that , diabetes patient may encounter
hypoglycemia in which low blood glucose and hyperglycemia when blood
glucose is too high in which both can have bad effect on patient.Diabetes
can either be does not produce enough insulin or insulin produce is not
useful for the body. Inactivity and obesity may increases the risk for diabetes
too.
DOSAGE
Dosage of gliclazide for the 80mg formulation is 40 to maximum 320mg
daily in two divided doses and take together immediately after meal while
the 30mg and 60mg modified formulation may be given at 30 to 120mg once
daily at breakfast.
The dosage may be lower at the beginning and slowly increase depending on
the effect on the patient.

Dosage may change if circumstances change such as when the patient is

having fever or infection or is about to undergo surgery.
Do not share medicine with other people as it may not be suitable for all the
diabetes patients.
Do not change the dose of medication without seeking for advice from
prescriber.
Inform doctor before taking gliclazide if the patient has an intolerance to
some sugars as gliclazide 80mg contain lactose.
SIDE EFFECT
Side effect of taking gliclazide including headache, intense hunger, feeling
sick, fatigue and low level of sugar in blood.
If left untreated, it may become severe as drowsiness, loss of consciousness
or eventually lead to coma.
Gliclazide can cause disorder in digestive, skin such as rash,redness and also
swelling of face, blood, liver that cause yellow skin and eyes and also eyes
DRUG INTERACTION
Patient is adviced to list down the medicine they are taking and show it to
pharmacists or doctor before start taking Gliclazide 80mg. Severe problems
can occurred if interaction between drugs occurred.
Examples :
Aspirin
Medicines containing alcohol
Fluconazole (used to treat fungal infections)
Tetracycline compounds (a type of antibiotic)
Chloramphenicol (a type of antibiotic),
Disopyramide (used to treat irregular heart beat)
Fibrates (used to reduce fat)
Cimetidine (used to treat stomach ulcers)

Oral contraceptives
Interaction between medicines is not necessary for the patient to stop taking
one of them but can manage the medication according to consultation of
doctors or pharmacists.

1. Nifedipine 10mg
Uncle Alan is taking this medication because he has
hypertension .
Working action
Nifedipine is a calcium channel blocker(CCBs) ,It relaxes the
blood vessel and muscles of the heart .It is not only used to
treat hypertension but also to treat angina (chest pain ) .
(CCBs) works by blocking the calcium ion from flowing into
the muscle cells surrounding the arteries that supplies blood to
the heart and also other arteries .Contraction of muscle cells is
driven by the inflow of calcium ion ,therefore when the calcium
channels are blocked ,the muscle cells will not contract causing
the muscle to relax and dilate .By doing this nefedipine
increases the flow of blood to the heart .When the muscle
relaxes this actually reduces the pressure exerted by the blood
and it the pressure is reduced against which the heart must
pump blood and function .Nifedipine also slows down the
conduction of electric current that travels through the heart .
USES

 Nifedipine should not be used by an individual if he/she has a

severe coronary artery disease .Before using this medication
doctors consultation is mandatory or The individual had a heart
attack within two weeks before the day of consumption .
During consumption of this medication , blood pressure is
advised to be checked regularly .
Uncle Alan was prescribed to take 10 mg of nifedipine .Correct
dosage should be taken according to the doctor .
Side effects
In multi dose adverse drug reaction will most likely occur
simultaneously
Swelling of ankle , weakness ,flushing , Constipation ,dizziness
and headaches .
Upper stomach pain and jaundice
Heartburn ,Nousea
Muscle cramps and tremors
Cough ,stuffy nose and wheezing
Pounding heart beats
Dosage
Is 10 mg capsule orally taken 3 times a day .The effective dose
is usually 10-20 mg which is taken 3 times a day daily. Patients with
coronary artery spasm will only respond to higher dose or frequent
consumption .In those cases 20- 30 mg 3 to 4 times a day .Rarely
there will be patients who take more than 120 mg . More than 180 mg
is highly not recommended .

Drug interaction
Grape fuit juice
o Grape fruit or juice should not be taken after
consumption of nefidipine doubles the AUC (area under
curve ) and Cmax (Peak concentration ) with no change
in half life .
o It increases the level of nifedipine in blood
o It increases the bioavailability of nifedipine
o It interfere with nifedipine and inhibits nifedipine
metabolism ,slows down the rate of gastric emptying .
Beta-adrenergic blocking agents
o Certain beta blocking agents may cause congestion of
heart failure ,severe hypotension and exacerbation of
angina

Hypertension
This is a disease which also reffered to as high blood pressure ,It is a
condition in which the arteries have persistent high blood pressure .Blood
pressure is the force of the blood which exerts aginst the blood vessel
walls .The higher the pressure , the harder the heart has to pump blood .The
normal level of blood pressure for a person is below 120/80 .120 is the
systolic measurement and 80 represent the diastolic measurement .Blood
pressure between 120/80 to 139/89 is known as pre hypertension .Blood
pressure of 140/90 or above than that is known as
hypertension .Hypertension can be classified in to essential or
secondary .Essential hypertension is the term for high blood pressure with
unkown cause .Secondary is the term for high blood pressure with a known
direct cause .The symptoms of hypertension which includes severe
headaches ,fatigue or confusion ,dizziness ,nausea ,chest pain and
etc .Hypertension can be treated with several classes of drugs which includes
ACE inhibitors ,ARB drugs ,beta-blockers ,diuretics ,calcium channel
blocker ,alpha-blockers and peripheral vasodilators .

Lovastatin
This medication is taken due to the fact that uncle Alan has
Cholesterol .
Drug Description
This medication is a cholesterol lowering agent , which is isolated
from a strain of Aspergillus terreus .lovastatin, which is an inactive
lactone, It is hydrolyzed to the corresponding - hydroxyacid form.
This is a principal metabolite and an inhibitor of 3-hydroxy-3methylglutarylcoenzyme A (HMG-CoA) reductase.The enzyme
converts HMG-CoA to mevalonate .This is an early limiting step in
the biosynthesis of cholesterol .
Lovastatin is [1S-[1(R*),3,7,8(2S*,4S*), 8a]]-1,2,3,7, 8,8ahexahydro-3,7-dimethyl-8-[2-(tetrahydro-4-hydroxy-6-oxo-2H-pyran2-yl)ethyl]-1-naphthalenyl 2-methylbutanoate.

Refered from http://www.rxlist.com/mevacor-drug.htm

Side effect
Allergic reaction which includes (hives,rash ,itching ,swelling of
mouth and etc)
Burning numbness :tingling
Chest pain
Decreased urination
Memory problem
Muscle Pain
Severe stomach and back pain
And many more
Dosage
Adult doses
Recommended dose is 20mg as a start
Range of dose is from 10-80mg in single or divided dose
Maximum dose recommended is 80 mg
Extended release formulation as an initial dose :20,40 or 60 mg once a
day
Maintenance dose is from 10 -60 mg once a day at bedtime .
Doses should be taken according to doctors prescription
Individualized according to recommended goal
Cholesterol levels should be monitored periodically

Pediatric doses
Usually for pediatric dose for heterozygous familial
hypercholesterolemia for aged between 10-17 is 10mg which should
be taken 10 mg once a day as an intial stage .
For maintenance 10-40 mg once a day
Extended release is not recommended for pediatric patients .

Precautions
It is strongly recommended that liver function test should be
performed prior to intial therapy for patients with a history of liver
disease .This test is also recommended fot all patients prior to use of
40mg or more daily .It is also very strongly recommended that the
patient should consult a doctor before consumption of medication
according to the dosses .

Uses
Lovastatin should be used with a proper diet .This is to lower
LDL and raise HDL in blood .This medication should be taken orally
by mouth .Dosage should be taken according to doctors
prescription .Avoid eating grape fruit while using this medication as it
will increase the amount of the medication in bloodstream unless
directed by a doctor or pharmacist .This medication should be
continued until the doctor says that it can be stopped .It is also
important to follow a healthy diet and exercising .

Interactions
Interactions With Lipid-Lowering Drugs That Can Cause Myopathy When
Given Alone
Myopathy risk increases by this drug ,as it is not a strong CYP3A4
inhibitors ,but may cause myopathy when given alone .
CYP3A4 Interaction
Lovastatin metabolized by CYP3A4 but it has no CYP3A4 inhibitor
activity ,this is expected not to affect the plasma concentration of
other drugs metabolized by CYP3A4.Strong inhibitors of CYP3A4
are : itraconazole, ketoconazole, posaconazole, voriconazole,
clarithromycin, telithromycin, HIV protease inhibitors and etc .
Grape fruit juice reduces the elimination of lovastatin and increase the
risk of myopathy .
Other drug interaction
Amiodarone
The myophaty risk is increaded when amiodarone is used
concomitantly with a loosely related member of the HMG-CoA reductase
inhibitor .
Cyclosporine
Myopathy risk is also increased when cyclosporine is co administered .

Hyperlipidemia
Hyperlipidemia is a condition in which body has high lipid
levels .Which also means high cholesterol and high triglyceride levels .High
lipid levels can cause an acceleration in the atherosclerosis ,or also known as
hardening of arteries .As you grow older a sticky substance called plaque
starts to form in the arteries .When the plaque builds up it causes the arteries
to become narrow and stiff .which will eventually reduce the blood
flow .Atherosclerosis increases risk to many disease which includes heart
disease ,stroke ,and etc .
Hyperlipidemia is caused by maintaining an improper lifestyle .Where
lifestyle contributors are not exercising , obesity , over eating ,and so
on .The cause for this disease could also be due to genetics .Blood test is
required to be taken to diagnose this disease because this disease usually will
not have any symptoms .Most blood test measure the LDL in blood (Low
Density Lipoprotein ) ,HDL (High Density Lipoprotein ) and sometimes
both . Normally LDL should be less than 130 mg/dL,HDL greater than
40mg/dL (men) or 50 mg/dL (women) ,total cholesterol level less than
200mg/dL and triglyceride less than 200mg/dL .

Reference
http://www.ncbi.nlm.nih.gov/pubmed/15811168
http://www.drugs.com/nifedipine.html
http://www.patient.co.uk/medicine/nifedipine
http://www.rxlist.com/procardia-drug/warnings-precautions.htm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594209/?page=1
http://www.webmd.com/drugs/2/drug-10981/procardiaoral/details/list-interaction-details/dmid-132/dmtitleselected%20calcium%20channel%20blockers-selected%20betablockers/intrtype-drug
http://www.medicalnewstoday.com/articles/150109.php
http://www.rxlist.com/mevacor-drug/side-effects-interactions.htm
http://www.drugs.com/dosage/lovastatin.html
http://www.news-medical.net/health/What-is-Hyperlipidemia.aspx
http://www.vascularweb.org/vascularhealth/Pages/hyperlipidemia.asp
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