Comparative Drug Review Gastrointestinal Therapies Tagamet And Nexium Biology Essay

Comparative Drug Review Gastrointestinal Therapies Tagamet And Nexium Biology Essay Tagamet and Nexium have been two of the many common drugs these days, both of which are widely used in the medical treatment of major gastric acid-related disorders like peptic ulcer disease (PUD) and gastro-esophageal reflux disease (GERD), with their respective active ingredient being cimetidine and esomerprazole. In view of their similar uses in gastrointestinal therapies, this review addresses various major characteristics possessed by the two drugs and in an attempt to make a vivid comparison between them in accordance to their active ingredients, for providing information optimizing the selection of gastric acid-related drugs at different clinical conditions. Mechanism Both cimetidine and esomeprazole serve to cure gastrointestinal disorders by reducing the secretion of gastric acid, however, with different drug targets to be acted on and mechanisms to bring about their actions. Cimetidine, being a histamine H2 receptor competitive antagonist (H2RA), reversibly binds to the histamine H2 receptor on the acid-secreting parietal cell of the stomach and lead to the production of second messenger cAMP which can ultimately trigger the H+/K+-ATPase to pump more acid out of the cell. Thus, the binding of histamine released by Enterochromaffin-like (ECL) cells in the stomach to the receptors, which in turn stimulates gastric acid secretion, is inhibited. At the same time, with the blockage of the histamine H2 receptors by cimetidine, the effect of both gastrin- and acetylcholine-stimulated acid secretion would be reduced. All these result in the lowering of acidity in the stomach. Esomeprazole, being a proton pump inhibitor (PPI), acts by an entirely different mechanism. Esomerprazole is a weak-base prodrug and it accumulates in the unique, highly acidic canalicular space of the active parietal cell, where the pH is less than 2.0. At this pH, it is converted to the active form of the drug, which then covalently binds to one or more cysteines that are accessed from the luminal surface of the gastric proton pump in gastric parietal cells, the H+/K+ ATPase enzyme, the target of which esomeprazole acts on. As a result, this irreversibly inhibits the H+/K+ ATPase enzyme, whose activity is involved in the final step of gastric acid secretion Therapeutic Effectiveness Owing to their different mechanisms of action, the gastric acid-suppressive effect produced by them varies, thus leading to variation in their effectiveness for treating related diseases. In general, PPIs (e.g. esomerprazole) are more potent than H2RAs (e.g. cimetidine) because the former inhibits the H+/K+ ATPase enzyme involved in the final step of acid secretion[1], as the latter only inhibits one of the pathways involved in acid secretion. The superior acid-suppressive effect of PPI over an H2RA has been verified by comparative studies. [2-5] Because of the different mechanism of these two drugs, esomeprazole has a longer duration than cimetidine. After converted to the active form, Esomeprazole can bind reversibly to the H+/K+-ATPase. As a result, esomeprazole will not be easily enzymatically metabolized and the major factor that leading to loss of effect of esomeprazole is largely dependent on the production of new H+/K+-ATPase. This is reason why esomeprazole has a rather long duration of effect on inhibition of acid secretion. In terms of therapeutic outcomes, it has been shown that higher efficacy is found in PPI treatments than in H2RA treatments for a wide range of diseases such as peptic ulcer disease, gastroesophageal reflux disease, GI damage caused by non-steroidal anti-inflammatory drugs, and Zollinger-Ellison syndrome. [6 V13], as revealed by many studies. One of these aimed to investigate oesophagitis in which a meta-analysis of 43 therapeutic trials was conducted in patients with moderate or severe oesophagitis. The proportion of patients successfully treated was almost doubled with PPIs, and the rapidity of healing and symptom relief were about twice that with H2RAs. [14] Thus, It had confirmed the advantage of PPIs over H2RAs. [15] To sum up, up to the present stage, esomerprazole seems to be more effective and a more preferable choice than cimetidine for the treatment of most gastric acid-related diseases. Safety In fact, both cimetidine and esomeprazole are quite safe and they rarely have adverse effects that may be lethal. In a meta-analysis of 24 double-blind placebo-controlled studies, it shows negligible difference of incidence of side effects between cimetidine and placebo. The most commonly reported adverse effects are diarrhea, other gastrointestinal disturbances, dizziness, tiredness, rashes and headache. Furthermore, most adverse effects of cimetidine are dose-related and as the length of treatment increases, the risk is decreased which means Cimetidine is rather secure for patients who require long-term treatment. Also, Cimetidine has significant anti-androgen effects in patient receiving high dose and this puts some male patients in fear. Adverse effects of Esomeprazole are infrequent as Cimetidine, but some of its common side effects like headache, diarrhea and skin rashes can be severe and may need to resolve on drug discontinuation. Moreover, recognized increases in the prevalence of pneumonia and Campylobacter enteritis as well as a doubling of the risk of infection with Clostridium difficile should not be overlooked due to the role of esomeprazole as a first-line drug. What should emphasize is that patients still need health care professionals careful indication as if both drugs are safe. Since esomeprazole is one of the most frequently prescribed medicine and 63% , 33% and 67% of hospital inpatients in Austria, Ireland and the United Kingdom did not meet the criteria for taking esomeprazole or other proton pump inhibitors. As a result, it is pharmacoeconomically unfavorable and improved clinical pharmaceutical care can be achieved by detailed indication by the cooperation of pharmacist and health care professionals. What is more, these two drugs are placed in the same Pregnancy Category by the US FDA and they are not advised for the pregnant women. Because of their inhibition of parietal cells, secretion of intrinsic factor is reduced. As a result, both drugs can lead to mal-absorption of Vitamin B12 which is important for maturation of Erythrocytes and DNA synthesis and thus Vitamin B12 therapy may be needed. Drug interactions They interact with a wide variety of drugs except that they both reduce absorption of acid-dependent drugs due to their effect of lowering of the stomach pH, but in fact only drugs with a narrow therapeutic index have clinical significance. The majority of interactions is due to binding of cimetidine to cytochrome P450 isoenzymes in the liver with subsequent inhibition of microsomal oxidative metabolism and increased bioavailability or plasma concentrations of drugs metabolised by these enzymes. These drugs are anticoagulants, phenytoin, theophylline, benzodiazepines, betal-blockers, lidocaine, Procainamide, ketoconazole and itraconazole. Similarly, Esomeprazole interferes with the elimination of drugs metabolized by isoenzyme CYP2C19 and to a smaller extent by CYP3A4. Therefore, it increases the plasma level of clarithromycin, amoxicillin, diazepam, phenytoin, and warfarin. In addition, esomeprazole has a potential interaction with atazanavir which is a HIV-Protease Inhibitor to treat HIV by substantially reducing the concentration of atazanavir. Conclusion Summarizing all the above mentioned features, Nexium is seemingly a better drug in terms of its potency, therapeutic effects as well as its range of application in clinical conditions, comparing to Tagamet. However, its benefits and drawbacks may be revealed in the future by research works, which should be always aware of.

America’s Change in Industry and Technology in the Early 1800s Essay

America’s ideas and beliefs have been changing over centuries of mistakes and experiments. This is the way that we formed our own government, made the right choices in subsequent decisions, and how we exhibit what kind of country we are to the rest of the world. Our nation evolved more quickly following several inventions that may seem simple or obvious in retrospect. One of America’s biggest eras of change was in the early 1800s. Jobs were moving from farms to factories. Transportation was turning certain cities into hubs of industry. The dependence on slaves was increasing on the Southern plantations. During the early 1800s, new technology and industrial methods changed the way people in America made a living. Key inventions that impacted American industry included factory production and Eli Whitney’s concept of interchangeable parts. These innovations led to mass production of manufactured items. Machine-made components, unlike parts that had been crafted individually, could replace each other in a product. Even unskilled workers could make these parts. Because of this, products became more plentiful, less expensive, and easier to repair. Cloth also became a mass-produced commodity. The thread-spinning water frame and the cloth-weaving power loom were invented at a time that people were giving up on farming the poor soil of the Northeast. In addition, steam engines and water mills increased production and decreased cost of the factories that employed townsfolk and financed cities. All of these beneficial results made manufacturing more lucrative than working on a farm. The abundance of products being made during this era called for a more efficient method of distribution. American cities developed as centers for manufacture and trade. New roads and a system of canals were built to carry the products to distant markets. Steam engine locomotives also became an important means of transportation for goods and people. Industry and housing for its workers were built around the ports and train stops. America’s expansion of transit helped cities develop as economic centers. Once the factory system became the successful business model, city life became the norm. People started to work in the artificial environment dictated by their tasks. Most people no longer woke up to the sound of the rooster signaling them to milk the cow and collect the eggs. Instead, they worked set hours in a factory, earning a regular income. However, large factories and shipping companies needed more than just manual labor. They also employed foremen, supervisors, and watchmen to keep the business secure. As a result of this division of labor, people could work more efficiently. Not every innovation was benign. Eli Whitney’s invention of the cotton gin (short for engine), which prepared cotton faster and more efficiently than by manual means, made selling cotton to the textile factories in New England even more profitable, but at a cost. Unfortunately, the increased demand for cotton by Northern factories escalated the need for slaves in the South to pick and supply larger quantities of raw materials. A negative result of the invention of the cotton gin and its role in the Industrial Revolution was that in just twenty years, the slave population rose from 697,897 to 1.2 million. Slaves and their sympathizers were hurt and upset by this growing injustice. From the start of the Industrial Revolution, new methods of production changed the jobs, income, and environment of the average American worker. Interchangeable parts, steam power, and the factory system increased production, decreased cost, and stimulated the growth of cities and transportation. America developed cities full of workers and transportation routes loaded with products. Manufacturing supported the Northern economy, while the South was still reliant on slave labor. Life in America changed greatly in the early 1800s with the country’s advancement from farming and simple trade to a modern, consumer-based economy.

Key Pieces of Sample of a Term Paper

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A Comparative Analysis on Two Leaders - Free Essay Example

Sample details Pages: 5 Words: 1517 Downloads: 7 Date added: 2017/06/26 Category Ethics Essay Type Compare and contrast essay Did you like this example? Two leaders Quality Mother Theresa Pope John Paul II Personal Values Charity Humility Selflessness Faith Voluntarism Faith Compassion Peace Unity Liberty Personal Beliefs She believed that it is our duty to care for others. She believed that Godà ¢Ã¢â€š ¬Ã¢â€ž ¢s presence could be seen in every human suffering. She believed that we get easily caught up in our own problems wherein we forget how many people around us were less fortunate. She believed that doing good things does not have to be big, as even little things with great love could be sufficient. She believed that serving other before oneself will stop the selfishness and shallowness. He believed that freedom is doing what is righteous, not by doing what we prefer. He believed that every human life is part of Godà ¢Ã¢â€š ¬Ã¢â€ž ¢s loving plan. He believed that democracy without values can become an open or thinly disguised totalitarianism. He believed on having no fear of moving into the unknown. He believed that the world is created for manà ¢Ã¢â€š ¬Ã¢â€ž ¢s service and Godà ¢Ã¢â€š ¬Ã¢â€ž ¢s glory. Personal Attitudes Selfless Loving Cheerful Humble Religious Non-bias Religious Philanthropic Determined Caring Personal Metaprograms Motivation filter Orientation filter Success indication filter Decision-making filter Convincer filter Leadership filter Energy Direction filter Performance filter Work Satisfaction filter Preferred Interest filter Abstract/Specific filter Comparison filter Challenge Response filter Time Awareness filter Focus filter Toward Motivated Both, Possibility and necessity Internal Do Automatic Self and others Both, Active and Reflective Team Player People People Abstract to specific Sameness Choice In time Others Toward motivated Both possibility and necessity Internal Do Automatic Self and others Both Active and Reflective Team player People People Abstract to specific Sameness with differences equally Choice Through time Others Quotes associated to them à ¢Ã¢â€š ¬Ã…“There is hunger, maybe not the hunger for a piece of bread but there is a terrible hunger for love.à ¢Ã¢â€š ¬Ã‚  à ¢Ã¢â€š ¬Ã…“We think sometimes that poverty is only being hungry, naked and homeless. The poverty of being unwanted, unloved and uncared for is the greatest poverty. We must start in our own homes to remedy this kind of poverty.à ¢Ã¢â€š ¬Ã‚  à ¢Ã¢â€š ¬Ã…“The most terrible poverty is loneliness and the feeling of being unloved.à ¢Ã¢â€š ¬Ã‚  à ¢Ã¢â€š ¬Ã…“When freedom does not have a purpose, when it does not wish to know anything about the rule of law engraved in the hearts of men and women, when it does not listen to the voice of conscience, it turns against humanity and society.à ¢Ã¢â€š ¬Ã‚  à ¢Ã¢â€š ¬Ã…“Have no fear of moving into the unknown. Simply step out fearlessly knowing that I am with you, therefore no harm can befall you; all is very, very well. Do this in complete faith and confidence.à ¢Ã¢â€š ¬Ã‚  à ¢Ã¢â€š ¬Ã…“Social justice cannot be attained by violence. Violence kills what it intends to create.à ¢Ã¢â€š ¬Ã‚  Main Decision Points in their Life At the age of 18, Mother Theresa left Skopje and went to Loreta Sisters. She was unable to see her mother and sister again. After 15 years working in the Loreto School as a teacher, she realized that she had a call to take care of the sick and the dying, the hungry, the naked, the homeless. To be Godà ¢Ã¢â€š ¬Ã¢â€ž ¢s love in action to the poorest of the poor. That was the beginning of the Missionaries of Charity. She asked permission to leave Loreta Congregation and establish the new order of sisters in the streets for the poor. After his fatherà ¢Ã¢â€š ¬Ã¢â€ž ¢s death, he decided to step into priesthood wherein he illegally attended seminary classes in the secret underground seminary headed by Archbishop of Krakow. In the beginning of Pope John Paul II papacy, he firmly reaffirmed the canon law prohibiting priests to actively participate in party politics. His purpose was not to reduce Catholicismà ¢Ã¢â€š ¬Ã¢â€ž ¢s political influence but to unite the church and to reinforce moral authority. Memories and References Mother Theresaà ¢Ã¢â€š ¬Ã¢â€ž ¢s mother Dranafile had a strong personality. Her mother taught her to be good and to be helpful. Her father died at the age of 42 wherein their family was very poor. Mother Theresaà ¢Ã¢â€š ¬Ã¢â€ž ¢s mother and sister died alone because the Albanian military did not send them out the country. When he was 8yrs. old, his mother died and after four years later, his physician brother died. He lived in a disciplined way of living with routine religious observation under his fatherà ¢Ã¢â€š ¬Ã¢â€ž ¢s supervision. He was hit by a German truck which he suffered from severe concussion and shoulder injury as he was left in the road for several days. He was discovered by a passerby. Based from his experienced, he believed that God has other plans for him as a confirmation of his vocation. On the 13th of May 1981, he was gunshot and was seriously wounded by an assassin. After his recovery, he offered forgiveness from the gunmanà ¢Ã¢â€š ¬Ã¢â€ž ¢s actions. Personal Traits Compassionate Humane Determined Forgiving Determined Commited in his beliefs Personal Skills and Skills Sets Good interpersonal skills Good communication skills Had the capability to motivate and inspire other people. Multi-lingual speaker Effective peacemaker Collaborator Personal Strategies Believed in divine providence Discouraged fund raising and allows peopleà ¢Ã¢â€š ¬Ã¢â€ž ¢s time, energy, monies and skills. To understand the poor, they must know what is poverty. They did not accept government grant, no church maintenance, salary, fees, and no income of such. Used his overseas visits to resolve numerous human conflicts that may impede the harmony between countries. He personally communicates with various parties. Maintains nonviolent and calm transactions with other religions Schedule to work on the focus areas Involvement in groupwork Short term: 19/01/2015-02/02/2015 Tasks Mon Tues Wed Thurs Fri Sat Sun Discussion with classmates 10:00AM-11: 30AM 1:30PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 2:30PM 10:00AM-11: 30AM 1:30PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 2:30PM 10:00AM-11: 30AM 1:30PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 2:30PM 10:00AM-11: 30AM 1:30PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 2:30PM WORK (5:00PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Library research 3:20PM-4:20PM 3:20PM-4:20PM WORK (5:00PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 9:00PM) WORK (5:00PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Internet research 3:20PM-5:00PM WORK (5:00PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 9:00PM) WORK (5:00PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Discussion with colleagues while at work 5:00PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 9:00PM WORK (5:00PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 9:00PM) WORK (5:00PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Long term: 09/02/2015-01/11/2015 Tasks Mon Tues Wed Thurs Fri Sat Sun Contribute at least 3 ideas in group activity 10:30AM- 11:30AM 1:30PM- 2:20PM 10:30AM- 11:30AM 1:30PM- 2:20PM WORK CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Speak in front of the class as the group representative 10:30AM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 11:30AM 1:30PM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 2:30PM 10:30AM à ¢Ã¢â€š ¬Ã¢â‚¬Å" 11:30AM WORK CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Do handover about clientà ¢Ã¢â€š ¬Ã¢â€ž ¢s status and make suggestions to improve cares 5:00PM- 9:00PM 5:00PM- 9:00PM 5:00PM- 9:00PM CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Improve self-confidence Short term: 19/01/2015- 15/02/2015 Tasks Mon Tues Wed Thurs Fri Sat Sun Read inspirational quotes such as our daily bread 8:30AM-8:45AM 8:30AM-8:45AM 8:30AM-8:45AM 8:30AM-8:45AM 8:30AM-8:45AM 8:30AM-8:45AM WORK (5:00PM- 9:00PM) 8:30AM-8:45AM CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Have a encouraging conversation with tutor / classmate 12:00NN- 1:00PM SDL 12:00NN- 1:00PM 12:00NN- 1:00PM 12:00NN- 1:00PM WORK (5:00PM- 9:00PM) WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Working with workmates with various style / strategies in work WORK (5:00PM- 9:00PM) SDL WORK (5:00PM- 9:00PM) WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Long-term: 16/02/2015- 16/08/2014 Tasks Mon Tues Wed Thurs Fri Sat Sun Go to church to pray and attend mass for spiritual support 3:00PM- 3:30Pm 3:30PM- 4:00PM 3:30PM- 4:00PM WORK (5:00PM- 9:00PM) 11:00AM- 12:15PM Communicate with family overseas to ask for advices and encouragement through viber or facebook messenger WORK (5:00PM- 9:00PM) 2:00PM- 3:00PM 6:00PM-7:00PM 6:00PM-7:00PM 10:00PM- 11:00PM 12:00NN- 2:00PM WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Permanent job as nurse for residency Short term: 09/12/2014- 09/01/2015 Tasks Mon Tues Wed Thurs Fri Sat Sun Look for CAP providers in NZ aside from prospect school (EIT) 10:00AM- 11:00AM 4:00PM- 5:00PM 4:00PM- 5:00PM WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Make an inquiry about CAP program in one of CAP providers through emails / phone calls SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) 1:00PM- 3:00PM 4:00PM- 5:00PM 4:00PM- 5:00PM SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) 10:00AM- 11:00AM WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Completion of documents required for CAP school such as JP of documents and medical SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) 12:30PM-1:00PM 12:00NN-1:00PM 10:00AM-10:30AM WORK (5:00PM-9:00PM) WORK (5:00PM- 9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Submission of requirements to school SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) 10:00AM- 12:00AM 4:00PM- 5:00PM 4:00PM- 5:00PM SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) WORK (5:00PM-9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Long term: 09/01/2015- 27/07/2015 Tasks Mon Tues Wed Thurs Fri Sat Sun Attend school in AGI to complete Level 6 and submission of portfolios and course works SCHOOL (9:00AM-3:00PM) SDL SCHOOL (9:00AM-3:00PM) SCHOOL (9:00AM-3:00PM) SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Inquire to fellow colleagues at work about possible school for CAP WORK (5:00PM-9:00PM) WORK (5:00PM-9:00PM) WORK (5:00PM-9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Advance searching in the internet for places with job vacancies for nurses 12:00NN- 1:00PM 4:00PM- 5:00PM 4:00PM- 5:00PM 4:00PM- 5:00PM SCHOOL (9:00AM-3:00PM) WORK (5:00PM-9:00PM) 1:00PM- 2:00PM WORK (5:00PM-9:00PM) CHURCH (11:00AM- 12:15PM) WORK (2:45PM- 11:15PM) Don’t waste time! 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