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The Drug Investigations - Three So Far

Nurses   (1,129 Views | 15 Replies)

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I am curious what everyone thinks about the three drugs in question now (losartan, ranitidine, and metformin), and nurses' role in questioning the continued use of them.

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1,703 Posts; 17,764 Profile Views

Well, I don't think anything about it.

Maybe you could provide some context.

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Pepper The Cat has 33 years experience as a BSN, RN and specializes in Gerontology.

2 Followers; 1,719 Posts; 24,795 Profile Views

What is a drug investigation?

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SilverBells is a BSN and specializes in Rehab/Nurse Manager.

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Not sure what you are trying to get at but if there are any concerns about continued use of any medication, it would mostly be for the providers to address.  Obviously, a nurse would have the responsibility to report any possible side effects from a medication, but ultimately, the provider is accountable for whether or not a drug should be continued. 

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hppygr8ful has 15 years experience and specializes in Psych, Addictions, Elder Care, L&D.

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I brought up this research with my Physician as I am a diabetic on metformin with family history of dementia. Still waiting to see what he does after reading the research.

https://www.neurologyadvisor.com/conference-highlights/aaic-2018/metformin-associated-with-increased-dementia-risk-in-african-americans-with-diabetes/

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4 hours ago, JKL33 said:

 

34 minutes ago, hppygr8ful said:

I brought up this research with my Physician as I am a diabetic on metformin with family history of dementia. Still waiting to see what he does after reading the research.

https://www.neurologyadvisor.com/conference-highlights/aaic-2018/metformin-associated-with-increased-dementia-risk-in-african-americans-with-diabetes/

Wow! Wasn't aware of either of these. I knew about losartan but not the ranitidine and metformin.

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dream'n has 27 years experience as a BSN, RN and specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

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What I think is that every medication has risks (known and unknown), it should simply be balanced with the benefit. 

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9 hours ago, hherrn said:

Well, I don't think anything about it.

Maybe you could provide some context.

Well, ok then! I thought everyone had heard about these, but I guess not.

Valisure expands capabilities to test medications for cancer causing contaminants implicated in recent recalls -- https://www.valisure.com/blog/valisure-news/valisure-expands-capabilities-to-test-medications-for-cancer-causing-contaminants-implicated-in-recent-recalls/

Valisure Detects NDMA in Ranitidine -- https://www.valisure.com/blog/uncategorized/detection-of-ndma-in-raniditine/

FDA Investigating Metformin for Possible Carcinogen
https://www.medscape.com/viewarticle/922248

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8 hours ago, Pepper The Cat said:

What is a drug investigation?

I suppose by "drug investigation," I meant, generally, a detailed analysis of the ingredients of those drugs. More specifically, Valisure has begun screening samples of losartan (and possibly other ARBs) from all batches of medications it dispenses for the cancer causing contaminants N-Nitrosodimethylamine (NDMA), N-Nitrosodiethylamine (NDEA), and N,N-Dimethylformamide (DMF), the chemical solvent that has been implicated in the production of these impurities. Lastly, there are ongoing investigations (finally) into generic medications that are manufactured overseas, particularly in India and China, and it’s been found that 80% of the manufacturing plants use fraudulent practices to certify that their drugs are safe.

 

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Currently the FDA can't logistically regulate/oversee overseas generic drug manufacturing. Congress should ban generic drug importation until either the FDA figures out a way to reliably and comprehensively oversee and regulate overseas generic drug manufacturing (which I don't see as a realistic possibility) or Congress should pass a law enacting a tax on all imported generic drugs that go to paying pharmacies to test every batch of drug they dispense. This would be a massive overhaul of the current pharmacy industry and would involve large upfront investment in the technology required to test the drugs and then the ongoing maintenance of those testing systems. None of that will happen, it's just what I think should happen. But hopefully the FDA will at least start being more aggressive in their oversight and get increased funding for more testing capabilities. 

Edited by eerrmm

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myoglobin has 12 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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I have several thoughts on this subject mostly related to metformin:

1.  Most studies including RCT's have shown that metormin actually reduces dementia risk in diabetic individuals.  For example this metaanalysis which looked at over ten studies (including two RCT's) came to this conclusionhttps://www.ncbi.nlm.nih.gov/pubmed/30149446 .  

2.  Metformin is one of the few chemical shown to actually extend lifespans of animals (although because of our relatively long lifespans data is not available in humans).  Other than caloric restriction (with adequate nutrition) there is probably no more reliable way to extend the lifespan of an organism than with Metformin.  

3.  Having said that the best way to treat most cases of Type II diabetes is probably a combination of progressive diet (especially a diet that minimizes simple carbohydrates), combined with exercise (a combination of both strength training and endurance exercise), and in some cases intermittent fasting.  Many clinicians view Type II diabetes as "long term" complication of metabolic syndrome due in large part to reduced insulin sensitivity (which is in turn due to long term down regulation of insulin receptors and other factors from the chronic exposure to excess insulin secondary to a diet rich in simple carbohydrates).   Under medical supervision and with sufficient compliance most cases of type II diabetes can be controlled with sufficient caloric restriction and exercise.  This is perhaps why most cases of type II diabetes are reversed when people undergo bariatric surgery as shown in this meta-analysis of studies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553790/.   

4.  Having said of that the study that you quote is troubling and bears further inquiry. 

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