Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Penicillamine is an antirheumatic drug used to
treat patients with active rheumatoid arthritis. It also is classified as a
metal binding (chelating) agent used for treating
Wilson's disease, a genetic
disease that causes excessive copper to accumulate in the body. The mechanism of
action of penicillamine in rheumatoid arthritis is unknown but it may be related
to reduction of collagen formation. (Collagen is a type of tissue that forms a
part of scar tissue that results from inflammation) and suppression of the
immune system. In patients with rheumatoid arthritis, penicillamine appears to
slow the progression of the disease (specifically deformities of the joints) and
improve function. For this reason it is considered a disease modifying
anti-rheumatic drug (DMARD). Penicillamine binds copper, iron, mercury, lead, and
cystine which then are excreted in the urine, and this mechanism is important in
treating several nonrheumatic diseases including Wilson's disease. The FDA
approved penicillamine in December 1970.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Capsules: 125 and 250 mg; Tablets: 250 mg.
STORAGE: Penicillamine should be stored at room temperature, 15 to 30 C (59
to 86 F).
PRESCRIBED FOR: Penicillamine is used to treat active rheumatoid arthritis
that has not responded to other drugs. Penicillamine also is used to promote
copper excretion from the body in patients with Wilson's disease and is useful
for preventing cystine kidney stones in individuals with cystinuria. It has been
used in the treatment of lead poisoning.
DOSING:
Penicillamine should be taken on an empty stomach, at least one hour
before meals or two hours after meals 1-4 times daily. The usual adult dose is
125-750 mg daily. Some patients may require up to 1 g daily administered in 4
doses.
Wilson's disease is treated with 750-1.5 g daily in 4 doses.
Cystinuria
is treated with 1-4 g daily in 4 doses.
DRUG INTERACTIONS: Penicillamine should not be taken by patients who are also
taking gold [gold sodium
thiomalate; aurothiomalate (Myochrysine),
auranofin (Ridaura),
aurothioglucose (Solganal)], antimalarial
[hydroxychloroquine (Plaquenil)],
phenylbutazone (Butazolidine), or cytotoxic drugs
[cyclophosphamide (Cytoxan),
azathioprine (Imuran, Azasan),
methotrexate (Rheumatrex,
Trexall)]
because these drugs also affect the bone marrow and kidney and when combined
with penicillamine can seriously reduce bone marrow and kidney function.
The
absorption of penicillamine is reduced by iron (ferrous sulphate), magnesium and
aluminum salts (for example, antacids) because they form unabsorbable complexes
with penicillamine in the intestine. Administration of penicillamine and iron
containing products or antacids should be separated by 2 hours.
PREGNANCY: Penicillamine should not be taken by
pregnant women unless it is
for a life-threatening condition, because of potential harm to the fetus.
NURSING MOTHERS: Penicillamine should not be used by
nursing mothers because
of potential adverse effects in the infant.
One in every 20 people develop a kidney stone at some point in their life. A kidney stone is a hard mineral and crystalline material formed within the kidney or urinary tract. Kidney stones symptoms and signs are, blood in the urine and pain in the abdomen, flank (lower back), or groin. A number of different conditions can lead to kidney stones including: gout, hypercalciuria, people with inflammatory bowel disease, kidney disease, and hypoparathyroidism. Some medications also increase the risk of kidney stones.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Pulmonary fibrosis is scarring throughout the lungs. Pulmonary fibrosis can be caused by many conditions including chronic inflammatory processes, infections, environmental agents, exposure to ionizing radiation, chronic conditions, and certain medications. Symptoms include shortness of breath, coughing, and diminished exercise tolerance. Treatment options are dependent on the type of pulmonary fibrosis; lung transplant and/or medications are optons.
Genetic disease is a disorder or condition caused by abnormalities in a person's genome. Types of genetic inheritance include single inheritance (for example, cystic fibrosis, sickle cell anemia, Marfan syndrome, and hemochromatosis), multifactoral inheritance, chromosome abnormalities (for example, Turner syndrome, and Klinefelter syndrome), and mitochondrial inheritance (for example, epilepsy and dementia).
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal antiinflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.
Eosinophilic fasciitis is a skin disease that causes thickening and inflammation of the skin and fascia. Symptoms include redness, warmth, and hardening of the skin, as well as occasional tissue and joint pain. Treatment for eosinophilic fasciitis aims to eliminate inflammation through the use of aspirin, NSAIDs, and cortisone. Aggressive forms of eosinophilic fasciitis may require the use of immune suppression medications.
Lead-based paint and lead contaminated dust are the main sources of exposure for lead in U.S. children. Lead-based paints were banned for use in housing in 1978. All houses built before 1978 are likely to contain some lead-based paint. However, it is the deterioration of this paint that causes a problem. Approximately 24 million housing units have deteriorated leaded paint and elevated levels of lead-contaminated house dust. More than 4 million of these dwellings are homes to one or more young children. Lead poisoning is entirely preventable. The key is stopping children from coming into contact with lead and treating children who have been poisoned by lead.
Eosinophils are a particular type of white blood
cells, usually representing a small percentage (less than 8% of
the total white blood cell population). The number
of these cells (eosinophil count) increases in certain illnesses, including allergies,
asthma, Addison's disease, sarcoidosis, parasite infections, drug
reactions, and connective tissue diseases (such as rheumatoid
arthritis and scleroderma).
What is fascia?
The fascia is a lining tissue under the skin that covers a
surface of underlying tissues. When the fascia is inflamed, the condition is
referred to as "fasciitis."
What is eosinophilic fasciitis?
Eosinophilic fasciitis is a specific disease of the skin that leads to
inflammation and thickening of the skin and fascia underneath.
In patients with eosinophilic fasciitis, the involved fascia ...
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