My Canadian Pharmacy Best Medications

My Canadian Pharmacy is one of the largest and dynamically developing online pharmacies in Canada. The pharmacy was opened in 1999, and today we are one of the most popular and reliable drug-stores in the world working in the Internet.

The basic principle on which My Canadian Pharmacy service is based is, first of all, certified products. Our pharmacy has all necessary certificates of quality and registration for the entire range represented in the catalogue and cooperates exclusively with representatives of the world’s leading manufacturers and largest wholesale operators of pharmaceutical market, working according to standards of GMP, GPP and GDP.

My Canadian Pharmacy

The main specialization of the pharmacy, above others, is drugs for erectile dysfunction treatment. We offer our clients best conditions and best quality of these popular drugs. Nowadays almost all men at least once in their lives faced problem of erectile dysfunction. that is why My Canadian Pharmacy directed its activity mainly to this sphere of health. We sell Viagra, Cialis, Levitra and other similar products at the lowest prices found in the internet. But in the same time we guarantee best quality of our products and 100% effectiveness. On our website you may get acquainted with full list of medications for potency and prices for them.

One of the distinctive advantages of My Canadian Pharmacy is, of course, qualifications of specialists and level of customer service. All employees of our drug-store have high level of professionalism, regularly undergo appropriate certifications and courses.

The company always tries to offer its customers only comfortable terms of purchase, therefore My Canadian pharmacy always has special offers and regular customers are offered special loyalty program.

In addition, My Canadian Pharmacy offers visitors additional services. Thus, our pharmacists are always ready to provide visitors with comprehensive consultation on all medications registered in the product list. By visiting you can find out about availability of goods and order delivery for any drug you wish to buy.

Mission of My Canadian Pharmacy is, first of all, concern for health of the nation and the company does its best to make this mission a reality.

My Canadian Pharmacy: Advair Discus Dosage & Side Effects

My Canadian Pharmacy Advair Discus is a combined preparation containing salmeterol and fluticasone propionate, which have different mechanism of action.

Indications for Advair Discus Use

Reversible obstructive airway disease.

Systematic treatment of reversible bronchial obstructive airway diseases, including asthma in children and adults, in case if appointment of bronchodilator in combination with inhaled GCS is necessary.

The drug is intended for treatment of:

  • patients receiving effective maintenance doses of selective agonists of long-acting beta2-adrenergic receptors and inhaled glucocorticosteroids;
  • patients who, when treated with inhaled glucocorticosteroids, report symptoms of the disease;
  • patients regularly receiving bronchodilators and requiring use of inhaled glucocorticosteroids.


Basic therapy of COPD, including chronic bronchitis and pulmonary emphysema.

advair discus dosage and side effects


Hypersensitivity to any of the drug components.

Canadian Pharmacy Advair Discus Dosage and Administration

Advair Discus is intended only for inhalation.

Patients should be aware that Advair Discus should be used regularly, even in absence of asthma attacks.

Patients should undergo medical examination on regular basis to ensure that dosage chosen for them remains optimally effective, only the doctor can change it. Dosage of the drug should be adjusted to minimal effective, which provides control over symptoms of the disease. If such effective control is achieved on the background of minimal effective dosage of the drug when applied twice a day, the next step may be to transfer patient to use of a single corticosteroid. As alternative for treatment of patients who need long-acting beta2-agonists, dosage of Advair Discus can be reduced to 1 time a day if, according to doctor, control of symptoms of the disease is adequately maintained. If patient has history of nocturnal asthma attacks, this one-time dose should be taken before bedtime, if in anamnesis symptoms mainly occur in the afternoon, dosage is applied in the morning.

Amount of fluticasone propionate in chosen form of Advair Discus should correspond to severity of the disease. It should be borne in mind that fluticasone propionate for treatment of patients with bronchial asthma is effective at dosage that corresponds to half of daily dose of other inhaled corticosteroids. For example, 100 mcg of fluticasone propionate is approximately equivalent to 200 mcg of beclomethasone dipropionate (containing freons) or budesonide. If a patient requires higher recommended doses, appropriate doses of beta-agonists and / or corticosteroids should be given.

Recommended Advair Discus Dosage


Adults and children from 12 years:

  • one inhalation (50 mcg of salmeterol / 100 mcg of fluticasone propionate) twice a day;
  • or one inhalation (50 mcg of salmeterol / 250 mcg of fluticasone propionate) twice a day;
  • or one inhalation (50 mcg of salmeterol / 500 mcg of fluticasone propionate) twice day.

Children from 4 to 12 years:

  • one inhalation (50 mcg of salmeterol / 100 mcg of fluticasone propionate) twice a day.

There is no data on use of Advair in children under 4 years of age, so it is not recommended to use.



  • one inhalation (50 mcg of salmeterol / 500 mcg of fluticasone propionate) twice a day.


According to clinical trials, there is no information on Advair Discus overdose.

Data on overdose of both drugs are given below.

Signs and symptoms that can be expected at overdose of salmeterol:

  • tremor;
  • headache;
  • tachycardia;
  • increased systolic blood pressure.

Optimal antidotes are cardioselective β-blockers, which should be used with caution in patients with bronchospasm in anamnesis. If treatment with Advair Discus should be stopped because of overdose with beta2-agonist included in the drug, appropriate substitutive steroid therapy should be prescribed. In addition, hypokalemia may occur, therefore, need for potassium replacement therapy should be considered.

Acute overdose

Inhalation of fluticasone propionate in doses exceeding recommended levels can cause temporary suppression of adrenal function. This does not require immediate action, as function of adrenal glands is restored in a few days, which can be checked by determination of cortisol in blood plasma.

Chronic overdose

At chronic overdose with inhalation fluticasone propionate, there is a risk of suppression of adrenal function.

My Canadian Pharmacy recommends to monitor reserve function of adrenal cortex. In case of overdose with fluticasone propionate at application of Advair Discus, therapy can be continued in appropriate dosage providing symptom control.

Side Effects of Canadian Pharmacy Advair Discus

Since Advair contains salmeterol and fluticasone propionate, it is possible to expect development of adverse reactions of those types and severity characteristic for each component separately. Additional side effects at simultaneous use of 2 components of the drug are not noted. As in case of use of other inhaled medications, paradoxical bronchospasm may occur with immediate increase in manifestation of dyspnea after inhalation. In case of development of such a state, inhaled bronchodilator of fast and short action should be immediately applied. Advair Discus should be immediately withdrawn, patient should be examined and, if necessary, alternative therapy should be prescribed.

Clinical Trial Data

Salmeterol-Fluticasone Propionate

Single cases of hematomas have been reported. Usually, such side effects were noted:

  • hoarseness / dysphonia;
  • throat irritation;
  • headache;
  • candidiasis of mouth and throat;
  • palpitation.

Patients with COPD may observe pneumonia.

Post-Licensing Data

Salmeterol-Fluticasone Propionate

Infrequent skin reactions of hypersensitivity are described. There are some reports of hypersensitivity reactions that manifest themselves as angioedema (mostly facial edema and oropharynx), respiratory symptoms (dyspnea and / or bronchospasm) and very rare — anaphylactic reactions.

Single cases of anxiety, sleep disorders and behavioral changes, including hyperactivity and excitement (mainly in children), as well as individual cases of hyperglycemia, have been noted.


There are reports of pharmacological side effects of treatment with beta2-agonists, such as tremor, palpitation, headache (usually transient, severity of which decreases with regular use of the drug). In patients with higher sensitivity, cardiac arrhythmia is noted (including atrial fibrillation, supraventricular tachycardia and extrasystole). Rare — arthralgia and very rare — hypersensitivity reactions and anaphylaxis, including edema and angioedema, bronchospasm and anaphylactic shock. There are reports of irritation of mucous membrane of mouth and pharynx. Infrequently — rash, frequently — muscle spasm. There are separate reports on development of hyperglycemia.

advair discus dosage and side effectsFluticasone Propionate

Some patients noted hoarseness and candidiasis of mucous membrane of mouth and throat. Skin reactions of hypersensitivity are described, in some cases, angioedema of face and oropharynx, development of respiratory symptoms — dyspnea and bronchospasm and extremely rare — anaphylactic reactions. Reduction of frequency of development of dysphonia and candidiasis can be achieved by rinsing oral cavity and the throat with water after inhalation. Symptomatic candidiasis can be treated with antifungal drugs for topical use, without stopping reception of Advair.

Possible systemic side effects include oppression of adrenal cortex function, Cushing’s syndrome, Cushing’s symptoms, growth retardation in children and adolescents, decreased bone mineralization, occurrence of cataract and glaucoma. There are separate reports on development of hyperglycemia.

There are separate reports on development of anxiety, sleep and behavior disorders, including hyperactivity and excitement (mainly in children).

An Effective Means for Potency Restoration

Levitra is a drug in the form of pills, intended to solve problem of impotence. This drug is effective for maintaining erection at the desired level.

It is prescribed to patients who are not able to perform sexual intercourse because of instability of erection or its complete absence. Therefore, Canadian Pharmacy Levitra is designed exclusively for adult men. Use of this drug for women and children under the age of 18 is contraindicated.

levitra effective means

In those cases where a man experiences difficulties in achieving and maintaining erection, Levitra’s use to provide opportunity to perform sexual intercourse is a very effective method. Once in the body, this drug in a very short time penetrates into bloodstream. You can see the first results approximately half an hour after intake (this period depends on individual characteristics of organism and can be more or less by 5 — 15 minutes).

One dose of the drug is effective for approximately 4 — 5 hours. Level of its content in bloodstream reaches maximum in one hour after administration, then it is only maintained, and then gradually decreases to zero.

If you take Levitra from Canada medstore at the same time as fatty food, then its action is inhibited, so its effect is manifested much later, and process of removing it from the body takes approximately one hour more. Content of the drug in bloodstream is reduced by 20%. Nevertheless, this does not affect fulfillment of main function — improvement of erection. With simultaneous use of the drug with non-fatty foods, no postponement occurs.

My Canadian Pharmacy recommends to acquire the drug only in proven places, for example in our online pharmacy. Manufacturer’s instructions state that it is permissible to use Levitra in case of expressed manifestation of sexual dysfunction, but not as major medication, but as a supplement. Based on results of the studies performed, scientists found that even in case of complete impotence, in many patients there is a complete restoration of male power after one month of regular intake of this remedy.

Generic Levitra increases duration of sexual intercourse by delaying ejaculation, and with its constant intake, duration of sexual intercourse rises by several times. But it should be understood that it does not create erection on its own, but only contributes to its strengthening during general stimulation of sexual life. Like any medication, Levitra causes side effects that vary in different people both in terms of frequency of manifestation and in main symptoms.

Discomfortable feelings appear not in all patients who use this remedy. However, with advanced forms of cardiovascular disease, there is an increased risk of such side effects of Levitra as increased problems with blood vessels, brain and blood pressure. The peak of danger occurs when there is sexual intercourse and orgasm is experienced. Even this safe stimulant can serve as main cause of poor health.

In some cases, it is fraught with fainting, blood stroke or heart attack. Therefore, if there is any doubt about this, it is necessary to agree use of the drug with the doctor. In addition, Levitra Canadian Pharmacy is contraindicated at anterior optic ischemic neuropathy. If you ignore initial manifestations, then there is possibility of sharp loss of vision. In case of deterioration of vision after use of the drug, you should contact the doctor immediately: timely response provides opportunity to quickly restore normal state.

My Canadian Pharmacy Coupon Code

Nowadays it is difficult to find high-quality medications and even if we do — prices for them are unbelievable. Everyone wants to get quality for small money, but we are well aware that quality = high price.

But today you can get what you wish. My Canadian Pharmacy provides only best quality low-cost medications. We do not make money at your expense, we try to make your life and health better. That is why in our pharmacy you will never find overpriced drugs!

When spring comes we all want to get something good. That’s why we offer you special discount for all products in the list to make you even happier. You may enjoy shopping in our store and spend even less money than before. Send us a request to our e-mail and you will get your My Canadian Pharmacy Coupon Code as soon as possible.


11 Signs of Latent Depression

Depression can often appear unnoticed and unrecognized. A man with hidden depression is a person who is struggling with his inner demons and tries not to show them to anybody. Such people may be on treatment or not, they can share their condition with family or not. The problem is that the world is becoming more grim when we stop trying to understand each other. We think that struggles of life are usually not hidden and that detecting them as easy as a scars from the battle.

But remember that emotional wounds are very often not easy to notice, especially for those who are not even trying to do so. Below My Canadian Pharmacy describes most common sight of hidden depression and how to react on depression of you loved ones. To learn more about this disorder and its treatment follow the link – signs of depression

Signs, Showing Depression

1. They may deliberately try to look as if they are fine and even permanently irradiate happiness and always be on in good mood.

If you think that people with depression are always sad and sullen, you’re wrong. Depression is not just a bad mood. Those who live constantly experiencing depression can learn to control their surface emotions and even seem a «happy» person from your environment. We are all different. Quite often, people with major depression control themselves and look quite positive in public, in spite of what is going on in their mind. No one wants to upset others with their problems, even if for this they have to hide their true feelings.

2. They are constantly taking some medicines.

There are serious methods of depression treatments, such as My Canadian Pharmacy medications and therapy.

But besides drugs, there are also daily habits, as lifestyle. For example, certain music, exercises, walking, everything that helps to get out of depressive black hole. Hidden depression is really awful, especially when a person is forced to deal with it alone.

3. They may have big problems with bracking up.

If you have ever been depressed, you can understand that this is a heavy burden, not only for the person who is experiencing depression, but also for the one who is next to him. Sometimes when you let someone too close and let him see your struggle and unhappiness, that person just walks away. Of course, it is hard to blame these people, but for person with depression conventional brake up could lead to constant feeling of abandonment and loneliness.

Therefore, they often hide their depression from even loved ones. After all, there is nothing more painful to realize that dark side of your soul is so terrible that even a loving person can’t look at it.

4. They make up excuses for their actions.

This can be anything from cuts on their wrists to refusing from lunch. People living with different types of depression are experiencing many difficulties which can sometimes affect normal course of their lives. In such cases, they come up with all sorts of excuses, covering results of their heartache. Most often, they do not want to admit that they are on the very edge, so they know very well how to hide their condition.

5. They can have various deviations in meal of daily regimen.

These symptoms may seem insignificant, but they have serious consequences.

Anyone who lives, trying to hide their depression, sometimes shows only slight hints of it. Excess or insufficient sleep – one of the most obvious signs of depression. The same thing depression causes with nutrition – if your loved one eats too much or too little, it is an alarming bell. Sleep and food are the most important elements of health. And these elements people are able to control on their own. Depression creates such conditions that a person can’t take control of himself. Sleep may be the only way to turn off mind and get away from pain or, on the contrary, be impossible to achieve because of obsessive thoughts. The same is with food.

6. They may have other more serious point of view on what they consume.

A person struggling with depression knows very well what and how affects his mood.

They know that alcohol is a depressant, and if drink too much, it will be impossible to cope with depressive mood and hide it. They are also well aware that caffeine and sugar raise their mood as well as antidepressants. And they know perfectly well what with what can not be mixed.

All this they know so well, because all of the above changes their mood much more than in people who are not suffering from depression.

7. They can have very clear, but difficult to understand concepts of life and death.

Not everyone with depression have suicidal thoughts. However, depression often provokes to think about meaning of life. And a man begins to frantically search for all answers to life’s questions, knowing that everything is inevitably going to death. Such frequent immersions in bearing down reflections can lead to the fact that one no longer be able to come up.

8. They are often talented and expressive.

Many of the best inspiring us artists, musicians and world leaders also suffered from this plague called «mental illness». Such depth of emotions experienced by them most often results in their work. They are able to combine in it good and bad parts of their soul and show beauty of life through shadows of those emotions that they are experiencing.

9. They are often looking for meaning of something.

Everyone wants to have a purpose in life. We want to be sure that everything we do, we do for the good. Be sure that we are moving in the right direction.

And people with latent depression also want it all, but with greater thirst and despair. Feelings of inadequacy and fear of what is happening is not new to those whose hearts and minds are under yoke of depression. And very often these people want to somehow compensate their internal fragility and vulnerability.

Therefore, they can change directions in which are moving much more often and be incredibly passionate about finding true happiness.

10. Sometimes they can show their pain and give a slight hint on the fact that they need help.

Even a person who has already adapted to depression and knows how to live with this burden sometimes needs help. But these cries of despair from people who always look strong are easy to overlook. Sometimes it is simply too dangerous for them to be alone, even if they claim otherwise. And if suddenly they managed to open up and tell what is happening to them, remember – it is one of the most important points, namely those moments create robust and reliable bridge in your relationship, because it is impossible to constantly torture yourself and hide true feelings in front of best friend or loved one.

11. They are looking for love and support, as well as all people.

Not showing to world your inner demons does not mean dishonesty.Facts about depression

People live concealing their depression to gain protection. Protection for their hearts and hearts of people who surround them. We live in a world that forces us to hide anything that looks ugly and surly. But we are not obliged to do so. And the best thing you can do for people with depression is to understand that they need love and support, as well as every person on this earth.

Never turn your back on a person who is in struggle with himself. Cry when you want. Lend a helping hand, even when the door was slammed in front of you. Open your soul, despite fear of being misunderstood. If we continue to ignore the bad and the good will pass unnoticed.

Harm of Smoking and Benefit of Nicotine

Can Nicotine be Useful?

Why do people smoke? What makes them consciously shorten their lives, day after day, experiencing smoking harmful effects of body  and poisoning their body? The answer is known to everyone – habit. However, what we call just a bad habit has long been added to International Classification of Diseases as «tobacco addiction». Necessity for such action was associated with severe social consequences of smoking that can shorten life of smoker for more than 15 years and show thereby that harm of smoking is a very dangerous thing.

The irony is that majority of smokers (according to My Canadian Pharmacy statistics on smoking harm, about 70%) consider that main component that is detrimental to health is nicotine to which they are addicted. While most harm of smoking is caused not by nicotine, but products of tobacco leaf combustion, in other words – cigarette smoke. Recent research have shown that low doses of nicotine are not only harmless, but can even be beneficial to organism. Further experiments have shown that people who smoke tobacco have very low risk of developing of Parkinson’s and Alzheimer’s diseases; they are much less likely to obtain sepsis (blood infection), herpes infection, ulcerative colitis. From this perspective, harm of smoking seems to be not so harmful. Moreover, drugs are being developed on the basis of nicotine, mainly – skin patches.Facts about Smoking

15 Kinds of Cancer for Smokers

However, all said above does not justify smoking, because in addition to nicotine smoker gets about 5000 hazardous substances from cigarette smoke! The most dangerous of them are carcinogens which contribute to development of malignant tumors (cancer). Therefore, harm of smoking caused by these carcinogens, is the strongest. To date, there are about 15 different types of cancer that are caused by smoking. For example, smoker’s chances of getting lung cancer 15 – 30 times higher than in non-smoker. Cancer of genitourinary system, oropharynx, esophagus and stomach affects smokers 4 – 5 times more often than non-smokers.

It is sad that non-smokers are inhaling tobacco smoke that smokers exhale (the so-called passive smoking), receives the same carcinogens, but in smaller doses. Unfortunately, risk of cancer is also increased in passive smokers, including children. Therefore, harm of smoking in such passive way, as simply being in a closed room with smoking people can be nothing less than active smoking.

Periodic Table as a Part Tobacco Smoke

Tobacco smoke is rich not only with carcinogens. Harm of smoking is aggravated by the fact that composition of inhaled tobacco smoke can contain almost the entire periodic table:

  • mercury;
  • lead;
  • aluminum;
  • copper and even arsenide (poison);
  • ammonia (used in toilet cleaners);
  • acetone (solvent for varnishes);
  • DDT (highly toxic insecticide);
  • formaldehyde (preservative used in morgues);
  • methanol (used in rocket fuel production);
  • naphthalene (poison for moths);
  • vinyl chloride (plastic).

Incredibly strong harm of smoking is manifested in the fact that all of this stuff on a daily basis settles in smoker’s lungs, chokes them and constantly poisoning causes pulmonary insufficiency, early disability and premature death.

What Else?

Interesting facts were discovered after opening of radioactive polonium-210 in tobacco smoke composition. Harm of smoking from its use is very strong. Doctors have estimated that smoker who smokes 20 cigarettes daily, during one year receives radiation exposure equal to (attention!) 300 X-rays of lungs! Practically, Chernobyl in your home!

What more can you expect from smoking? Firstly harm of smoking manifests itself in diseases of heart and blood vessels. At average, risk of premature death at the age of 40 – 60 years from heart attack in tobacco smokers is three times higher than in non-smoker. And this was caused mainly by high doses of nicotine and not only components of tobacco smoke.

Smokers Turns into Vegetable

If you draw a grotesque image of a smoker who suffered the whole harm of smoking and experienced all harmful effects of smoking, it would be blind, deaf, bald, wrinkled man (cataract, early baldness, premature wrinkles and deafness caused by smoking) with amputated leg (after suffering thromboarteritis) suffering from shortness of breath (lung emphysema), covered with scabs and unable to produce offspring (smoking often causes psoriasis, violation of sperm formation, reduced erection). However, such a bleak picture, fully expressing harm of smoking, has already been drawn by the World Health Organization on its website. There you can «enjoy» little monster and in several languages read about his illnesses.

Smoking Changes DNA

Epigenetic changes in DNA caused by smoking cover more than 7000 genes.

It is well known that DNA is subjected to chemical modifications that do not change sequence of genetic text, but still influence activity of genes. Special enzymes leave methyl marks on some nitrogenous bases – genetic letters that make up DNA, then activity of those genes that have received methyl labels changes. This method of regulating genetic activity is called epigenetic; and epigenetic marks often occur in response to some environmental factors – such as in response to certain lifestyle and habits.

Several dozens of researchers, led by Stephanie London from National Institute of Environmental Health Sciences, told in «Circulation: Cardiovascular Genetics» how smoking affects epigenetic state of human DNA.

In general, such studies are numerous, but this time we are talking about meta-analysis, when results of several works on the same subject are collected and analyzed at once, and as a result we can tell how various articles conform with each other, how reliable the data are and whether, based on all the results, it is possible to formulate, confirm or refute some hypothesis.

Stephanie London and her colleagues took 16 studies which contained results of epigenetic research of about 16 000 people, some of whom smoked, while others gave up some time ago, and others have never smoked. The task was to compare in these three groups points of DNA methylation – whether there is difference, where, how much, etc.

It turned out that smoking alters epigenetic status of more than 7,000 genes – that is, about one-third of all the genes that are in our genome. If a person quits smoking cold turkey, majority of these changes comes to naught during five years, that is, in the sense of epigenetic modifications, genes go back to «before smoking» state. However, there are some areas in DNA that even after we quit smoking remain with methyl «nicotinic» marks and such long-lasting marks can stay in their place for about thirty years.

It is known that epigenetic modifications may cause many diseases (especially vigorously scientists study in this sense cancer and metabolic disorders). From a practical point of view, analysis of how and where DNA of former smoker is methylated, will allow to predict whether or not there is something to fear of and whether it is necessary to take some measures prevent smoking, even though a long time ago, from presenting, due to stable epigenetic modifications, any unpleasant surprises.

Facts about Smoking

However, it should be made clear that relationship between DNA methylation and one or another disease is not always understood and not necessarily all modifications of these 7000 genes are associated with something bad. On the other hand, the scale of epigenetic changes (and length of some of them) is impressive, so probably molecular biologists will deal here with cause-and-effect relationships, it would be reasonable to quickly get rid of nicotine addiction.

So, the choice is still yours: to smoke or not to smoke? To suffer from harm of smoking or not? To draw inspiration in the world around us or in tobacco smoke? Tobacco or health? Life or death?


My Canadian Pharmacy about Prevalence and Determinants of Nutritional Changes in Chronic Obstructive Pulmonary Disease: Disscusion

nutritional depletionWhile still common, the incidence and severity of the nutritional depletion in our nonhospitalized population is lower than reported in hospitalized patients. We found 26.7 percent with weight loss greater than 5 percent in the past year, 32.8 percent with TSF percent less than 60 percent of standard, 5 percent with В W percent less than 60 percent of standard, and 53.4 percent with a mild decrease in MAMC percent of less than 90 percent of standard.

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My Canadian Pharmacy about Prevalence and Determinants of Nutritional Changes in Chronic Obstructive Pulmonary Disease: Results

caloric requirementPrevalence

The mean of the nutritional parameters for the population indicates general depletion (Table 1). The BW percent appears to be the most severely affected. Based on estimated daily caloric requirement determined from basal energy expenditure, there appears to be adequate caloric intake for a healthy population. However, analysis of the estimated calorie needs based on resting Vo2 indicate less adequate caloric intake, with nine of 49 (18 percent) ingesting 80 percent or less. My Canadian Pharmacy offer various vitamins and medicament to treat such disorders effectively anf quick – Separate analysis of the 16 individuals with weight loss 5 percent or greater in the previous years indicates more severe abnormalities in the anthropometric parameters.

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The Prevalence and Determinants of Nutritional Changes in Chronic Obstructive Pulmonary Disease

Weight lossWeight loss is a common phenomenon in patients with chronic obstructive pulmonary disease (COPD). The incidence of significant weight loss may be as high as 71 percent in the COPD patient population. A sustained weight loss has been associated with a poor prognosis. Recent surveys of nutritional status in hospitalized patients with COPD have found other measurements, such as weight for height, triceps skinfolds (TSF), and mid-arm muscle circumference (MAMC), to be significantly less than the normal standards.

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My Canadian Pharmacy: The Control of Nausea and Vomiting in Patients Receiving Cancer Chemotherapy

chemotherapyOver the past 5 years, clinical trials with several antiemetics have led to greatly improved methods in the control of emesis associated with chemotherapy. To be able to take advantage of this work, clinicians must be familiar with the following: 1) the differing types of emesis; 2) the various patterns of emesis produced by different chemotherapeutic agents; 3) the activities, applications, toxicities, dosages, routes of administration and schedules of at least 3 or 4 antiemetic agents; and 4) the ability to take a proper patient emetic history and to be able to act upon the findings. Thus, improvement in the control of emesis, while likely for nearly all patients, is possible only when considerable clinical skills are acquired and used.

There appear to be several emetic syndromes in patients receiving chemotherapy. These problems may be caused by different mechanisms and therefore may require separate approaches. Acute chemotherapy-induced emesis is the most common type of emesis, and to date no method other than alteration of the chemotherapy schedule or pharmaceutical control has been shown to be effective or have preclini-cal physiologic bases for possible effectiveness. Although anticipatory emesis can be a very disturbing problem for patients, it must be realized that: 1) this is a problem that affects a minority of the patients; 2) it can be prevented by proper antiemetic drug treatment with initial course of chemotherapy; and 3) even with effective treatment for patients with anticipatory emesis, the problem is likely to return if the acute chemotherapy-induced emesis is not properly controlled. Delayed emesis is a poorly studied phenomenon in which emesis can begin 1 to 4 days after chemotherapy—even in patients in whom the emesis was well-controlled on the day of treatment. This primarily appears to be a problem for some patients treated with higher doses of cis-platin. All emesis occurring in patients given chemotherapy should not be attributed to these agents. Several other conditions (such as intestinal obstruction or gastritis) or agents (specifically pain medications) can lead to nausea and vomiting; interventions other than the selection of antiemetic should be considered in these instances.

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