Know Your Medication's Side Effects!

The left-hand column below lists the 10 most commonly prescribed medications in the U.S. in the order of the frequency that they are prescribed. In the right column are the most common side effects of these medications in no particular order.  See if you can match the medication with its most common side effects.  In some cases, there may be overlap in the side effects that these medications cause, but there will be at least one in the list of symptoms that is specific for that medication. 

Recognize that any of these medications can produce allergic reactions, with symptoms that include rash; hives; itching; difficulty breathing; tightness in the chest; and swelling of the mouth, face, lips, or tongue.  Additionally, almost all of these drugs can cause mild-to-moderate gastrointestinal upset, such as stomach pain, nausea, and vomiting.  This matching exercise does not include some of the more severe, but much less common, side effects of these medications.  The answers will be provided at the bottom of this page.

Medication		Side Effects
1.	Hydrocodone  (may be combined with acetaminophen as Vicodin)	a)	Dizziness; light-headedness; temporary blurred vision;  joint pain, swelling, warmth, or redness (especially of the big toe joint)
2.	Simvastatin (Zocor), a cholesterol-lowering statin drug	b)	Cough; diarrhea; dizziness; headache; tiredness; symptoms of low blood pressure (e.g., fainting, severe dizziness, light-headedness).
3.	Lisinopril (brand names include Prinivil and Zestril), a blood pressure drug	c)	Diarrhea in up to 10% of patients; gas; metallic taste in mouth; headache; nausea
4.	Levothyroxine (Synthroid), synthetic thyroid hormone	d)	Side effects in order of frequency are headache, abdominal pain, nausea, diarrhea, vomiting, and excess gas
5.	Amlodipine (Norvasc), an angina/blood pressure drug	e)	Constipation; headache; muscle pain, tenderness, or weakness
6.	Omeprazole (Prilosec), an antacid drug	f)	Blurred vision; constipation; difficulty breathing; dizziness; drowsiness; flushing; lightheadedness; mental/mood changes.
7.	Azithromycin (brand names include Z-Pak and Zithromax), an antibiotic	g)	Excessive sweating; diarrhea; fast or irregular heartbeat; fever; heat intolerance; mood changes (e.g., anxiety, irritability, nervousness); tremors; trouble sleeping
8.	Amoxicillin (various brand names), an antibiotic	h)	Allergic reactions have been reported in up to 10% of patients and have included rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue
9.	Metformin (Glucophage), a diabetes drug	i)	Lower leg swelling; fast, slow, or irregular heartbeat; facial flushing, and dizziness, particularly at higher dosages (e.g. 10 mg daily).
10.	Hydrochlorothiazide (various brand names), a water pill used to lower blood pressure, sometimes paired with a second anti-hypertensive medication	j)	Gastrointestinal side effects have included nausea, abdominal discomfort, vomiting, and diarrhea in up to 10% of patients.

It makes no difference if you are taking a prescription drug, an herbal remedy, or an over-the-counter supplement - all have the potential to cause side effects.  Odds are high that most readers are taking or have taken at least one of these medications.  In a study performed in 2002, an alarming one in four patients taking a prescription medication suffered observable side effects.  Be aware also that side effects may occur when certain medications are taken together or mixed with food or alcohol.  Be alert to the possibility that a symptom that develops after starting a new medication could be due to a medication side effect. 

To learn more about a medication's side effects, be sure and read the package insert or printed materials that come with a prescription medication or read the label of over-the-counter products.  You can also talk to your pharmacist or doctor if you have any questions regarding a drug's side effects.  While some side effects may be more of a nuisance that anything else, some can be quite serious and require immediate medical attention.

Answers:  1. f; 2. e; 3. b; 4.g; 5. i; 6. d; 7. j; 8. h; 9. c; 10. a

Understanding Viral vs. Bacterial Infections - Part 2, The Infections

Last week, we looked at how bacteria and viruses differed. Some of these differences, such as viruses being unable to cause harm unless they invade a living host, have a bearing on the nature of the infections that they cause, as well as the way that the infections that they cause are treated.

In some ways, the infections caused by bacteria and viruses are alike. They can each cause similar symptoms such as fever, coughing, vomiting, diarrhea, fatigue, and cramping. They are both capable of causing short-lived acute infections as well as chronic infections, that untreated, can last a lifetime. Also, viruses and bacteria lend themselves to preventive measures, such as the use of vaccines.

Bacterial infections occur when harmful bacteria enter the body. Often this happens because the organism takes advantage of a situation, such as a break in the skin or a compromised immune system. This is called an "opportunistic" infection. Some of the most common types of bacterial infections are caused by:

• Staph (Staphylococci) are bacteria that are commonly found on the skin or in the nose of healthy individuals. Some types of Staph bacteria can cause serious infections of the skin, heart, lungs, or blood stream. A particularly serious type of Staph infection is called MRSA (methicillin-resistant Staphylococcus aureus). MRSA does not respond to the typical antibiotics used to treat Staph infections.
  
• Strep (Streptococci) infections include "strep throat"; a common skin infection in children called impetigo; toxic shock syndrome; and a form of pneumonia.
  
  
• H. flu (Haemophilus influenza), despite its name, does not cause the flu. At one time, it was mistakenly considered to be the cause of influenza until it became apparent that the flu was caused by a virus. It is one of the most common causes of middle ear infections (otitis media) in children.
  
  
• E. coli (Escherichia coli) bacteria commonly live in the gastrointestinal tract of humans and even serve useful purposes, such as producing Vitamin K. A disease-producing strain of E. coli can cause food poisoning if transmitted through improperly cooked hamburger, or other food products.
  
  
• There are many other infections caused by bacteria including tuberculosis, pelvic inflammatory disease, Lyme disease, tetanus, and bacterial pneumonia.

An antibiotic is usually needed to treat bacterial infections. Antibiotics either kill bacteria, or interrupt their ability to multiply. This gives the body's defenses an opportunity to take over and fight the infection. The names of antibiotics that are effective against different strains of bacteria include the penicillins (e.g. ampicillin), cephalosporins (e.g. Keflex), tetracyclines (e.g. Vibramycin), quinolones (e.g. Cipro) and macrolides (erythromycin).

Vaccines may also be available to prevent bacterial infections. Effective vaccines have been developed for a number of bacterial infections including diphtheria, tetanus, whooping cough, meningococcal meningitis, pneumococcal pneumonia, and typhoid fever.

Viral infections include the common cold, influenza, measles, AIDS, hepatitis A & B, rabies, chicken pox and shingles. In contrast to bacteria, viruses must invade a living cell to reproduce. Once inside the host cell, the virus's genetic material (DNA or RNA) takes control of the cell and forces it to replicate the virus. The infected cell eventually dies, releasing the new viruses which go on to infect other cells. Viral infections are generally more difficult to treat than bacterial infections because the virus "hides" inside normal, living cells protecting them from treatment with antibiotics.

Because of the overlap in symptoms, it can be difficult for someone to know if a condition, such as diarrhea is being caused by a bacteria or virus. When the diagnosis is uncertain, doctors can usually tell which is responsible with a careful history and physical examination. Sometimes, special testing, such as a "culture test" to grow the specific organism, may also be used.

Many viral infections, such as the common cold, do not presently have a treatment that is directed against the virus. In particular, the antibiotics used for treating bacterial infections, are ineffective against viruses. Fortunately, many viral infections are "self-limited" and the body's immune system is able to fight off the infection. A few anti-viral drugs are available such as the ones used in treating a human immunodeficiency virus (HIV) infection, seasonal influenza, and cold sores. Another type of antiviral drug, called interferon, enhances the body's immune response to the viral infection.

Most viruses attack specific areas of the body, such as the liver, genitals, or respiratory tract. In some instances the infected cell loses control of its normal function and develops into cancer. Examples of this include cervical cancer following an infection with the human papilloma virus (HPV) and liver cancer developing from a chronic hepatitis B infection.

Over the past century, immunizations have become an effective way to prevent viral infections. In fact, the first vaccine that was developed was used to prevent the viral illness, smallpox. Other viral diseases with effective vaccines include polio, measles, chickenpox, influenza, hepatitis A & B, and human papillomavirus (HPV) infections.

Understanding Viral vs. Bacterial Infections - Part 1, The Microbes

Microbes are microscopic living organisms, such as bacteria and fungi. Although often categorized as microbes, viruses are very different. In fact, since viruses are unable to grow or reproduce unless they enter a living cell, viruses are sometimes not considered to be living creatures at all. In order to compare and contrast viral and bacterial infections, it is first necessary to gain an understanding of the microbes themselves.

Bacteria - Bacteria first appeared on the Earth billions of years ago. Through a process known as photosynthesis, they are thought to have helped produce the oxygen environment that is essential to animal life. A distinguishing feature of bacteria is that they have only one cell. Although one type of bacteria can be seen with the naked eye, most are so small that thousands could fit in the eye of a needle. There are many of types of bacteria, but most of them are of one of three different shapes- rods (bacilli), spheres (cocci), or spirals (spirilla). Within the human body, there are approximately ten times as many bacteria as there are human cells, a majority of these located on the skin and in the bowel.

A typical bacterium (the singular of bacteria) has a rigid cell wall that contains a fluid called cytoplasm within the cell. Floating in the cytoplasm is the nucleoid or genetic material of the bacterium (DNA and RNA) that allows the bacterium to reproduce itself. Some bacteria even have threadlike structures called flagella that provide propulsion.

Some people think of bacteria only in terms of being "germs", or harmful microorganisms that invade our bodies and cause disease. And in fact, many serious infectious diseases including tuberculosis, strep throat, tetanus, Lyme disease, and gonorrhoea are caused by bacteria. The disease causing varieties, however, constitute only one percent of all bacteria. Most bacteria are harmless, and a few are even beneficial to humans. For example, Lactobacillus acidophilus is a bacterium that lives in the intestines and helps us to digest food and protects against "bad" bacteria that can cause disease. Another type of bacteria in the gut provides us with Vitamin K.

In addition to their role in human health and disease, bacteria have a number of other functions. Bacteria are involved in the break down of garbage and production of compost from vegetation. Bacteria are also used in making healthy foods like yogurt and cheese. Bacteria that digest and dissolve hydrocarbons have even been used to clean up oil spills.

Viruses - As compared to bacteria, viruses are much less complex. For one thing, an average bacterium is hundreds of times larger than most viruses. Instead of being even one-celled like bacteria, viruses are considered to be non-cellular, meaning that they consist of a packet of genetic material (DNA or RNA) carried in a shell called the capsid.

The most distinguishing feature of viruses is that without the benefit of a living host, viruses are essentially dormant, meaning that they are unable to multiply or to cause any harm. When viruses encounter appropriate host cells, however, they are able to release their genetic material into the cell. Once inside, the viral genetic material takes over the host cell’s normal functioning with its own set of instructions. This shuts down the usual cell functions and directs it to produce new virus particles. In this way, the virus becomes a "parasite" on the cell with the host cell doing the work under the instructions of the virus.

Another important distinction is that unlike bacteria, most viruses do cause disease. They exist for one purpose only which is to reproduce, and in the process, they take over and ultimately destroy host cells. Viruses have evolved to infect every form of life, from animal to plant-life. In fact, the first virus to be discovered, the tobacco mosaic virus, affects the tobacco plant, rather than humans.

Viral illnesses can range from relatively mild to fatal. The common cold, influenza, cold sores, and chicken pox are viral illnesses that typically "run their course". Hepatitis B and AIDS are chronic viral illnesses that can ultimately be fatal. Rabies and Ebola are viral infections that can rapidly cause death. One of the worse aspects of viral infections is that certain viruses are capable of triggering the development of cancer. For example, along with being a well-known cause of cervical cancer, the human papilloma virus (HPV) has become the leading cause of throat cancer in this country.

With this background on the nature of viruses and bacteria, next week we'll look at the differences in the infections that are caused by these microbes.