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Antiviral Medication for Genital Herpes

Genital herpes is an infection of the genitals (penis in men, vulva and vagina in women) and surrounding area of skin. It is caused by the herpes simplex virus. Antiviral medicines such as aciclovir, famciclovir, and valaciclovir are used to treat genital herpes infection. They do not clear the virus completely from the body, so the symptoms may come back (recur). They work by stopping the virus from multiplying, which reduces the duration and severity of symptoms.

What is genital herpes?
Genital herpes is an infection of the genitals (penis in men, vulva and vagina in women) and surrounding area of skin. The buttocks and anus may also be affected. It is caused by the herpes simplex virus.
Genital herpes is usually a sexually transmitted infection. Many people who are infected with this virus never have symptoms but can still pass on the infection to others. If symptoms occur, they can range from a mild soreness to painful blisters on the genitals and surrounding area.
This leaflet just discusses antiviral medication for genital herpes. See separate leaflet called Genital Herpes for more general details on genital herpes infection.

What is antiviral medication?
There are three antiviral medicines that are currently usually used to treat genital herpes:
Aciclovir
Famciclovir
Valaciclovir
They all come in different brand names. They work by stopping the herpes virus from multiplying. They do not clear the virus from the body. If an antiviral medicine is started early in an episode of symptoms, it tends to reduce the severity and duration of symptoms during an episode of genital herpes.
It is thought that these medicines all work as well as each other when used to treat genital herpes.
Antiviral medication for a first episode of genital herpes
An antiviral medicine is commonly prescribed for a first episode of genital herpes. (A first episode of genital herpes is also called a primary episode.) A five-day course of treatment is usual but this may be extended by a few days if blisters are still forming. With a first episode of genital herpes, the sores and blisters may last from about 10 days up to 28 days. This is usual

Antiviral medication for recurrent episodes of genital herpes
Further episodes of symptoms (recurrences) tend to be milder and usually last just a few days. You usually have 7-10 days of symptoms rather than 10-28 days that can occur with a first episode. Antiviral medication is often not needed for recurrences. Painkillers, salt baths, and local anaesthetic ointment (such as lidocaine) for a few days may be sufficient to ease symptoms. However, an antiviral medicine may be advised for recurrent episodes of genital herpes in the following situations:
⦁    If you have severe recurrences. If you take a course of an antiviral medicine as soon as symptoms start, it may reduce the duration and severity of symptoms. You may be prescribed a supply of medication to have ready at home to start as soon as symptoms begin. This kind of "as needed" treatment tends to be prescribed if you are getting severe attacks of genital herpes fewer than six times a year. There are a number of different options of courses of treatment to take, ranging from one to six days in length, and with different daily regimes.
⦁    If you have frequent recurrences. You may be advised to take an antiviral medicine every day. In most people who take medication every day, the recurrences are either stopped completely, or their frequency and severity are greatly reduced. A lower maintenance dose rather than the full treatment dose is usually prescribed. A typical plan is to take a 6- to 12-month course of treatment. You can then stop the medication to see if recurrences have become less frequent. This type of continuous treatment can be repeated if necessary. This type of daily treatment tends to be prescribed if you have severe attacks of genital herpes more than six times per year.
⦁    For special events. A course of medication may help to prevent a recurrence during special times. This may be an option even if you do not have frequent recurrences but want to have the least risk of a recurrence - for example, during a holiday or during exams.
Antiviral medication for genital herpes whilst you are pregnant
A specialist will normally advise about what to do if you develop genital herpes whilst you are pregnant, or if you have recurrent genital herpes and become pregnant. This is because there may be a chance of passing on the infection to your baby.

A first episode of genital herpes whilst you are pregnant
If you develop a first episode of genital herpes within the final six weeks of your pregnancy, or around the time of the birth, the risk of passing on the virus to your baby is highest. In this situation there is about a 4 in 10 chance of the baby developing a herpes infection. The baby may develop a very serious herpes infection if he or she is born by a vaginal delivery.
Therefore, in this situation your specialist is likely to recommend that you have a caesarean section delivery. This will greatly reduce the chance of the baby coming into contact with the virus (mainly in the blisters and sores around your genitals). Infection of the baby is then usually (but not always) prevented.
However, if you decide against a caesarean section and decide to opt for a vaginal birth, the specialist is likely to recommend that you be given antiviral medication (usually aciclovir). This is given into your veins (intravenously) during your labour and birth. They may also suggest that antiviral medication be given to your baby after he or she is born.
As long as there are two months between your catching the virus and giving birth to your baby, a normal vaginal delivery is likely to be safe for the baby. This is because there will be time for your body to produce protective proteins called antibodies. These will be passed on to the baby through your bloodstream to protect it when it is being born. The specialist may advise that you should be treated with antiviral medication at the time of infection. This helps the sores to clear quickly. In addition, your doctor may advise that you should take antiviral medication in the last four weeks of pregnancy to help prevent a recurrence of herpes at the time of childbirth. Antiviral medicines such as aciclovir have not been found to be harmful to the baby when taken during pregnancy.
If you have recurrent genital herpes and become pregnant
If you have recurring episodes of genital herpes, the risk to your baby is low. Even if you have an episode of blisters or sores during childbirth, the risk of your baby developing a serious herpes infection is low. This is because you pass on some antibodies and immunity to the baby during the final two months of pregnancy.
For most women with recurrent genital herpes, it is felt to be safe to have a normal vaginal delivery. This is even the case if you have a recurrence whilst giving birth. However, you and your specialist will weigh up the pros and cons of vaginal delivery vs caesarean section. If you do have a recurrent episode when you go into labour, you should discuss your options with your specialist and together decide the best way that your baby should be delivered.
Often antiviral medication will be advised in the last four weeks running up to childbirth. This may help to prevent a recurrence of blisters during childbirth. Again, your specialist will be able to advise on the pros and cons.
In summary
A first episode of herpes around the time of birth can be serious for the baby and a caesarean section is usually advised. In any other situation - an earlier primary infection or a history of recurrent episodes - the risk to the baby is low and your specialist will advise on possible options. This may include taking antiviral medication, as well as the type of delivery method.

Are there any side-effects from antiviral medicines?
Most people who take antiviral medication get no side-effects, or only minor ones. Feeling sick (nausea), being sick (vomiting), diarrhoea, and tummy (abdominal) pain, as well as skin rashes (including photosensitivity and itching) are the most common side-effects.
Read the leaflet inside the medication packet for a full list of possible side-effects.
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:

It is helpful if you have your medication - and/or the leaflet that came with it - with you while you fill out the report.

Further reading & references
2014 UK National Guideline for the Management of Anogenital Herpes; British Association for Sexual Health and HIV (2014)
Management of Genital Herpes in Pregnancy; British Association of Sexual Health and HIV and Royal College of Obstetricians and Gynaecologists (Oct 2014)
Herpes simplex - genital; NICE CKS, September 2012 (UK access only)
British National Formulary; NICE Evidence Services (UK access only)
Caesarean section; NICE Clinical Guideline (November 2011)

Allopurinol (Pirai atritis atau tofaseus kronis)    

Hepatitis B Immunisation

People at increased risk of contracting hepatitis B should be immunised. The hepatitis B vaccine can also be used to prevent infection if, for example, you have had a needlestick injury and you are not immunised. Some people need blood tests to check if they are immune. See your practice nurse if you think you need this vaccine.

What is hepatitis B?
Hepatitis B is an infection caused by the hepatitis B virus. The infection mainly affects the liver. However, if you are infected, the virus is present in body fluids such as blood, saliva, semen and vaginal fluid. In the UK it is estimated that about 1 person in 200 to 1000 is infected with the hepatitis B virus. It varies widely depending on the part of the UK studied. It is much more common in other countries. It is most common in sub-Saharan Africa and East Asia.
If you are infected with the hepatitis B virus, the initial symptoms can range from no symptoms at all to a severe illness. After this initial phase, in a number of cases the virus remains in the body long-term. These people are called carriers. Some carriers do not have any symptoms but can still pass on the virus to other people. About 1 in 4 carriers eventually develop a serious liver disease such as cirrhosis. In some cases liver cancer develops after a number of years. See separate leaflet called Hepatitis B for more details of the disease.
If you are pregnant and are infected with the hepatitis B virus, you can pass it on to your baby as the baby is being born. Vaccinations for the baby can prevent this happening. So all pregnant women in the UK are offered testing for hepatitis B during each pregnancy. If the test is positive, the baby can be protected.
How is hepatitis B passed on?
The hepatitis B virus is passed from person to person in one of these ways:

Who needs hepatitis B immunisation?
Anyone who is at increased risk of being infected with the hepatitis B virus should consider being immunised. This includes:
Workers who are likely to come into contact with blood products, or are at increased risk of needlestick injuries, assault, etc. For example:

People who change sexual partners frequently (in particular, sex workers).
People who live in close contact with someone infected with hepatitis B. (You cannot catch hepatitis B from touching people or normal social contact. However, close regular contacts are best immunised.) People who regularly receive blood transfusions (for example, people with haemophilia).
People with certain kidney or liver diseases.
People who live in residential accommodation for those with learning difficulties. People who attend day centres for people with learning difficulties may also be offered immunisation.
Families adopting children from countries with a higher risk of hepatitis B, when the hepatitis B status of the child is unknown. (It is, however, advisable for the child to be tested for hepatitis B.)
Foster carers or if you live with foster children.
Prison inmates. Immunisation against hepatitis B is now recommended for all prisoners in the UK.
Travellers to countries where hepatitis B is common. In particular, those who place themselves at risk when abroad. The risk behaviour includes sexual activity, injecting drug use, undertaking relief work and/or participating in contact sports. Also, if you may need a medical or dental procedure in these countries and the procedure may not be done with sterile equipment.
Babies who are born to infected mothers.
The immunisation schedule
You need three doses of the vaccine for full protection. The second dose is usually given one month after the first dose. The third dose is given five months after the second dose.
One to four months after the third dose you may need to have a blood test. You may need one if you are at risk of infection at work, especially as a healthcare or laboratory worker or if you have certain kidney diseases. Your doctor will be able to advise you if you need a blood test. This checks if your body has made proteins to protect you (antibodies) against the hepatitis B virus. If you have, you will not be able to get it (ie you are immune.)
You may then need a booster dose five years later. There is no need for a blood test before or after this.
The schedule is the same for the combined hepatitis A and B vaccine which is also available.
Rapid immunisation schedule
A schedule of giving three doses more quickly than usual may be used in some situations. That is, three doses with each dose a month apart. An even quicker schedule is also sometimes used. That is, the second dose given seven days after the first and the third dose given 21 days after the first.
These rapid schedules may be used if you are at very high risk of infection and need to be immune as soon as possible. For example, if you are soon to travel abroad, are new to prison or are sharing needles to inject drugs. However, a more rapid schedule may not be as effective for long-term immunity unless a fourth dose is given 12 months after the first dose. Your doctor will advise on the best schedule for your circumstances.

Are there any side-effects from hepatitis B immunisation?
Side-effects are uncommon. Occasionally, some people develop soreness and redness at the injection site. Rarely, some people develop a mild high temperature (fever) and a flu-like illness for a few days after the injection.

What if I come into contact with hepatitis B and am not immunised?
Seek medical attention as soon as possible if you have been at risk from a possible source of infection and you are not immunised. For example, if you have a needlestick injury or have been bitten by someone who may have hepatitis B.
You should have an injection of immunoglobulin as soon as possible. This is an injection which contains antibodies against the virus. It gives short-term protection. You should also start a course of immunisation. The hepatitis B vaccine is very effective at preventing infection if given shortly after contact with hepatitis B. Even if you have had the hepatitis B vaccine and are at risk of infection (for example, by having unprotected sex or sharing contaminated needles), you should ask your doctor for advice. You may be advised to have a booster vaccine or even an injection of immunoglobulin.
Babies who are born to infected mothers should have an injection of immunoglobulin as soon as possible after they are born. They should also be immunised. The first dose of vaccine is given within the first day after birth. This is followed by three further doses at 1 month, 2 months and 12 months of age. At 12 months, immunised babies have a blood test to check that the vaccine has worked.

Who should not receive the hepatitis B vaccine?

The vaccine may be given if you are pregnant or breast-feeding and immunisation against hepatitis B is necessary.

Most people who have a cardiovascular disease (for example, angina, peripheral arterial disease, or a previous heart attack, transient ischaemic attack (TIA) or stroke) tak
ASPIRIN - TO PREVENT BLOOD CLOTS
What does aspirin do?
Aspirin is a medicine that has been used for many years as a painkiller. However, it has another action to lower the risk of forming a blood clot in the arteries of the heart (coronary arteries) or brain. This lowers the risk of having a heart attack or stroke.
How does aspirin work?
Aspirin helps to prevent blood clots forming. A blood clot may form in a blood vessel (artery) if a lot of platelets stick on to some atheroma (see below). A clot in an artery may stop blood flowing to the tissues further down. If a blood clot forms in an artery in the heart or brain, it may cause a heart attack or stroke.
Atheroma patches are like fatty lumps that develop in the inside lining of some arteries. This mainly occurs in older people and is sometimes called hardening of the arteries.
Platelets are tiny particles in the blood, which help the blood to clot when a blood vessel is cut. Platelets sometimes stick on to atheroma inside an artery.
Low-dose aspirin reduces the stickiness of platelets. This helps to stop platelets sticking to a patch of atheroma and forming a blood clot.
What is the dose of aspirin to prevent blood clots?
The usual dose to prevent blood clots is 75 mg each day. This is a lot less than the dose for pain relief. Taking more than the recommended dose does not make aspirin work any better to prevent blood clots, but increases the risk of side-effects developing. Therefore, stick to the dose recommended by your doctor, which is usually 75 mg daily.
If you take low-dose aspirin to prevent blood clots and you need to take painkillers (for example, for headaches) it is best to take paracetamol rather than a higher dose of aspirin.
Who should take low-dose aspirin to prevent blood clots?
People with known cardiovascular diseases
Cardiovascular diseases are diseases of the heart or blood vessels. However, in practice, when doctors use the term cardiovascular disease they usually mean diseases of the heart or blood vessels that are caused by atheroma. Patches of atheroma are like fatty lumps that develop in the inside lining of some blood vessels (arteries). These diseases include heart attack, angina, stroke, transient ischaemic attack (TIA) and peripheral arterial disease. If you have, or have had, any of these diseases, you will normally be advised to take low-dose aspirin to help to prevent further problems or complications.
Taking aspirin when you have a cardiovascular disease, to reduce the risk of future cardiovascular diseases, is known as secondary prevention. For people with cardiovascular diseases there is a lot of benefit from taking aspirin. Several studies involving thousands of people have proved that the risk of having a heart attack or stroke is much reduced in these people if they take aspirin. For example, the risk of having a non-fatal heart attack is reduced by about a third. The risk of having a non-fatal stroke is reduced by about a quarter. The risk of dying is reduced by about a sixth.
Note: taking aspirin is not a substitute for preventing atheroma from developing. If possible, you should also reduce any risk factors. For example, do not smoke, do some regular physical activity, eat a healthy diet, and keep your weight in check.
Why doesn't everyone take aspirin to prevent blood clots?
There is a small risk of developing serious side-effects with aspirin (see below). For people with a cardiovascular disease, studies have shown that the benefits of taking aspirin far outweigh the small risk of side-effects. But, for people who do not currently have a cardiovascular disease, on average, even the small risk of side-effects from aspirin is greater than the benefit relating to blood clots. (However, see below about protecting against cancer.)
What about people with a high risk of developing a cardiovascular disease?
Everybody has some risk of developing atheroma that may cause one or more of the above cardiovascular diseases. Patches of atheroma are like fatty lumps that develop in the inside lining of some blood vessels. However, certain risk factors increase the risk. These include:

In the past, people at a high risk of developing a cardiovascular disease were recommended to take aspirin. This is called primary prevention. That is, aiming to prevent a disease occurring before it happens. However, there have been some recent studies which have not shown much benefit of taking aspirin in those people with an increased risk of cardiovascular disease (including those with diabetes or high blood pressure). In addition, aspirin treatment can cause serious side-effects in a small number of users. Therefore, to prevent heart attacks and strokes, the risks of taking aspirin outweigh any benefits for people who do not have a cardiovascular disease.
But, again, see below regarding preventing cancer.
Are there any side-effects from low-dose aspirin?
Most people do not have any side-effects with low-dose aspirin.
The most serious possible side-effects that affect a small number of people include the following:
Bleeding in the stomach or gut. This is more common if you have a stomach or duodenal ulcer. It is also more likely if you take a steroid medicine or an anti-inflammatory medicine (such as ibuprofen) as well. As a rule, it is best to avoid taking both aspirin and these other medicines. If you develop upper tummy (abdominal) pains, pass blood or black stools (faeces), or bring up (vomit) blood, stop taking the aspirin. Then see your doctor as soon as possible or go to the nearest casualty department.

How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:
The side-effect.
The name of the medicine which you think caused it.
The person who had the side-effect.
Your contact details as the reporter of the side-effect.
It is helpful if you have your medication - and/or the leaflet that came with it - with you while you fill out the report.
Other antiplatelet medicines used to prevent blood clots
As mentioned earlier, platelets are tiny particles in the blood, which help the blood to clot. There are other medicines which have a similar effect on reducing platelets from sticking together. They work in slightly different ways, acting on different chemicals, but with the similar end result of preventing blood clots. They include clopidogrel, prasugrel, dipyridamole and ticagrelor.
As a rule, aspirin is usually the preferred medicine. Sometimes, one of these other medicines is used if there is a problem with using aspirin. Sometimes, aspirin plus another antiplatelet medicine are taken together. The situations when this is mainly advised is when there is a particularly high risk of developing a blood clot. For example, for a certain period of time after having a heart attack, a stroke or a TIA, and during certain surgical procedures to the heart or coronary arteries.
ASPIRIN - TO PREVENT CANCER
A study published in 2010
In 2010 a large study by Rothwell and colleagues was published that had looked into the effect of aspirin on preventing cancer. The study looked at the rates of cancer in about 25,000 people. The study compared those who had taken aspirin against those who had not over a number of years. The results showed that a small daily dose of aspirin - 75 mg - reduced the risk of developing a number of common cancers. This includes cancers of the bowel, lung, prostate and oesophagus.
This study showed that the reduction in risk with taking aspirin varies for each type of cancer. However, overall, for a middle-aged person who takes aspirin for a number of years, the reduced rate of developing cancer seemed to be about 20-25%. However, you have to remember - this is a relative reduction in risk and not an absolute reduction. For example, if you have a 5 in 100 risk of developing a disease, that is an absolute risk. If a treatment reduces the risk of developing that disease by 20%, your risk goes down to a 4 in 100 risk (as 20% of 5 is 1).
The absolute risk of developing a particular cancer varies depending on the type of cancer, your age (the risk goes up the older you get), and if you have certain risk factors. For example, lung cancer is much more common in smokers.
One example: the rough overall risk of developing bowel cancer is about 4 in 100 (8 in 200). In this study, aspirin was found, on average, to reduce the risk of developing bowel cancer by about 40%. This would reduce the absolute risk to about 2.5 in 100 (5 in 200), as 40% of 4 is just over 1.5.
And, as mentioned above, aspirin causes side-effects in some people. For example, the overall risk of bleeding in the gut, caused by aspirin, is about 1 in 1,000 per year. Of these, about 1 in 20 are fatal bleeds. So, over a 20-year period, 1 in 1,000 people taking low-dose aspirin are likely to die from a fatal bleed. But, remember too, the risk of bleeding varies depending on things such as if you have a history of a peptic ulcer, are taking certain other medicines, etc (detailed earlier).
Other research studies
A further study in 2012 published by Rothwell and colleagues was even more encouraging. It concluded that the benefits of aspirin to prevent cancer were even greater than their initial study suggested. Also, that the benefits kicked in within just a few years. Other studies have added weight to the evidence that taking a daily low dose of aspirin significantly reduces the risk of developing cancer. Some studies even suggest that aspirin may help to treat and prevent the spread of certain cancers once they have developed. Some of these studies are cited at the end of this article.
How does aspirin prevent cancer?
It is not clear. Aspirin may have some effect on preventing the development of cancer cells.
So, should I take aspirin?
If you have a cardiovascular disease - generally, yes (with exceptions and cautions as described earlier).
For others, some doctors now recommend that all people aged about 45-50 should consider taking a low daily dose of aspirin for about 20-25 years. This is because of the benefits in preventing cancer in addition to preventing blood clots. When all factors are taken into consideration, people aged about 45-50 who take aspirin for 20-25 years have, on average, an overall reduction in dying at any given age by about 10%. As the risk of bleeding due to aspirin increases greatly over the age of 75, the situation should be reviewed at age 70-75. For example, many people at this age will have developed cardiovascular disease. In this situation, it is usual to continue to take aspirin. But, if you do not have a cardiovascular disease, you may be advised to stop the aspirin, as the balance of benefit to risk may then have changed.
It is also useful to remember that the overall effect of taking aspirin is based on statistics of a community of people. It is impossible to say if you as an individual are likely to benefit - just that the odds of you developing cancer go down. A useful quote is from Dr Ike Iheanacho, the editor of the Drug and Therapeutics Bulletin (a respected medical journal). He said that the reduction in risk due to aspirin would be a 'sizeable benefit' from society's point of view. But he goes on to say:
" ... let's not forget that the drug can cause major internal bleeding and this can kill. If you're going to advise people to take aspirin, you have to factor in potential harms to give them a balanced view of the potential effects of treatment."
In short, in every case, the benefit has to be balanced against the risk. Aspirin is not a total preventer of blood clots or of cancer. It simply reduces the risk, and that risk varies from person to person.

ALPRAZOLAM

Nama dagang :Tylonic, Reucid, Zyloric

Sediaan : Tablet
Kelompok obat : Antipirai (gout)
Mekanisme kerja : Menghambat xiantin oksidase sehingga menyebabkan menurunnya produksi asam urat.
Indikasi : Pirai atritis atau tofaseus kronis, pirai skunder karena tumor, batu ginjal urat.
Kontraindikasi : penyakit hati, suspensi sumsum tulang, wanita hamil dan menyusui.
Efek Samping : Mual, muntah, diare, nyeri perut, sakit kepala, pusing.
Indikasi obat : Mempegaruhi efek antikoagulan. Diuretik menurunkan efeknya.penggunaan yang lama bersama preparat besi tidak diperkenankan.