What are Anticholinergics?

Anticholinergic drugs “slow the activity of the stomach and intestinal tract, thus reducing the likelihood of cramping and also reducing acid secretion.” This drug also decreases or completely stops contractions occurring in the bladder and the ability of the bladder to work to its optimum best is increased. Anticholinergics often are sold under the names oxybutynin (Ditropan) and hyosyamine (Levsinex). Anticholinergics are best prescribed for youngsters who either the doctor has deemed as having a small capacity for the bladder to work or else children who due to bladder contractions throughout the daytime hours, suffer from incontinence. There is a beneficial formula that can be used to estimate what a normal or average volume in regards to the bladder is in kids. This formula is simply the child’s age plus two and this will equal the ounces in urine.

Anticholinergics are not the best choice for children who wet their bed at night on an occasional basis but instead for those who wet the bed at night and those who have problems with wetting in the daytime (otherwise known as incontinence). In some cases there are children who fail to gain results from taking desmopressin acetate (DDAVP) in regards to bed wetting therefore their doctors decide to try them on a trial basis on both DDAVP and an anticholinergic. The most common scenario for this is a child who has bladder capacity that is limited in regards to other children. The combination of these two drugs works for some kids and not others. The way the two drugs work in concert is that the DDAVP decreases the amount of urine that the child voids in the night while the anticholinergic increases the amount of urine that the bladder is able to hold. By working together, the two drugs help prevent nocturnal enuresis by disallowing the bladder to become too full throughout a child’s sleeping hours.

For children who have daytime voiding problems and who are six years or older, the anticholinergic prescribed is usually oxybutynin (Ditropan XL) and it is to be taken once a day only. Another kind of anticholinergic known as hyoscamine is available as a capsule and it has a long acting capacity. Hyosyamine needs to be administered twice a day except for children who just have problems with isolated bed wetting and in that case it is taken only once a day, before bedtime.

Anticholinergics do have a few side effects that parents and their children must be aware of. Flushing of the face and dry mouth are the two most common symptoms. It is best to not spend too much time in the direct sunlight while taking this drug as it can cause facial flushing to be worse. In the unfortunate case of an overdose of an anticholinergic, hallucinations and blurred vision can result.

The most recent anticholinergic to appear on the market is called tolterodine (Detrol) and this one is believed to be the safest of them all as well as to exhibit the least possibility of side effects. Detrol is more particular when it comes to how it goes to work on the functioning of the bladder. The Food and Drug Administration (FDA) has yet to give its seal of approval for this medication to be used in children under the age of twelve years.

Tests, Investigations and medications for heart problems

The following tests may reveal a heart attack and the extent of heart damage:

• Electrocardiogram (ECG) – usually repeated over several hours
• Echocardiography
• Coronary angiography

The following tests may show the by-products of heart damage and factors indicating you have a high risk for heart attack:

• Troponin I and troponin T
• CK and CK-MB
• Serum myoglobin

A heart attack is a medical emergency! Hospitalisation is required and intensive care is usually needed. When admitted, continuous ECG monitoring is started immediately. Life-threatening arrhythmias, (unstable heart rhythms) are the leading cause of death in the first few hours of a heart attack so it’s essential patients are closely monitored.

The goals of treatment for heart attacks are to stop its progression by reducing demands on the heart so it can heal, and prevent complications.

Medications and fluids are inserted directly into a vein using an intravenous (IV) line. Various high tech monitoring devices are also used to monitor the hearts status. A urinary catheter is sometimes inserted into a patient’s bladder to closely monitor fluid status

Oxygen is usually given, even if blood oxygen levels are normal. This ensures oxygen is readily available for the tissues of the body and assists in reducing the workload on the heart.

Pain Control

Intravenous nitro-glycerine or other similar type medicines are given for pain and to reduce oxygen requirements for the heart. Morphine and similar medicines are very effective pain killers usually prescribed for those suffering a heart attack.

Blood Thinning Medications

Thrombolytic therapy

If the ECG recorded during acute chest pain shows a change called "ST-segment elevation," clot-dissolving (thrombolytic) therapy should be initiated within 6 hours of beginning of chest pain. The initial therapy is administered as an IV infusion of streptokinase or tissue plasminogen activator, and is followed by an IV infusion of heparin. Heparin therapy usually lasts for 48 to 72 hours. Additionally, warfarin taken orally is often prescribed to prevent further development of clots.

Thrombolytic therapy is not appropriate for people who have had:

• A major surgery, organ biopsy, or major trauma within the past 6 weeks
• Recent neurosurgery
• Head trauma within the past month
• History of GI (gastrointestinal) bleed
• Brain tumour
• Stroke within the past 6 months
• Current severely elevated high blood pressure

Thrombolytic therapy can also be complicated by significant bleeding.

Emergency coronary angioplasty may be required to open blocked coronary arteries. This procedure can be used instead of thrombolytic therapy or in cases where Thrombolytics should not be used. Often the re-opening of the coronary artery after angioplasty is ensured by implantation of a small device called a stent! Emergency coronary artery bypass surgery (CABG) may be required in some cases.

Platelets collecting and accumulating is the initial event often leading to clot formation. So a cornerstone of therapy for a heart attack is antiplatelet medication. This medication can prevent the collection of platelets at the site of injury in a blood vessel wall (like a crack in an atherosclerotic plaque) and is very useful. One antiplatelet agent widely used is the common aspirin! Two other important antiplatelet medications are ticlopidine (Ticlid) and clopidogrel (Plavix).

Other Medications

Beta-blockers (like metoprolol, atenolol, and propranolol) are used to reduce the workload of the heart.

ACE Inhibitors (like ramipril, lisinopril, enalapril, or captopril) are used to prevent heart failure.

Factors affecting heart disease

Include

• Smoking
• High Blood Pressure
• Diet
• Stress
• Family History

The following sections deal with various aspects of your life-style which you may need to give greater consideration to. Advice is also offered to substantially reduce the risk of worsening heart disease.

Read each section carefully and seriously consider what changes should apply to you – and think about carrying them out!