What happens if you take Sildenafil tablet (Viagra) for long term?

 Sildenafil tablets (Viagra), is a medication, that is widely consumed recreationally, especially among young people. In Nepal, this drug is available under various brand names, including Viagra, Zenegra, Aryagra, and Silagra. It is available in 50 mg and 100 mg doses in the market.

What is Sildenafil?

Sildenafil is a medication used for men's sexual health. It is primarily prescribed to treat Erectile Dysfunction (ED), a condition where a man has difficulty achieving or maintaining an erection.

How does it work?

Sildenafil increases blood flow to the penis, helping achieve and sustain an erection. It is particularly beneficial for men who experience ED due to diabetes, heart disease, high blood pressure, or aging.

Recreational Use

Many young people are now using this medication without a doctor's prescription for recreational purposes. Some take it to boost confidence or enhance sexual performance.

Effects of Long-Term Use

If Sildenafil is misused for a long time:

• It can reduce confidence in engaging in sexual activity without the drug.
• Users may develop a psychological dependence on the medication.
• This condition is known as Psychogenic Erectile Dysfunction, where the ability to achieve an erection without the drug is compromised.

Who Should Be Cautious While Using This Drug?

If you have any of the following conditions, consult a doctor before using Sildenafil:

✔️ Heart disease, high blood pressure, diabetes, or liver/kidney problems

✔️ Currently taking nitrate medications

✔️ Serious eye conditions

✔️ Blood disorders

👉 Do not take this medication without a doctor's prescription if you have any of these conditions.

Proper Usage Guidelines

✔️ Always follow your doctor's prescription.

✔️ Typically, a 50 mg tablet is taken one hour before sexual activity.

✔️ Do not take it more than once a day, as excessive use can be harmful.

Serious Side Effects

Seek immediate medical attention if you experience:

❗ An erection lasting more than 4 hours

❗ Headache, chest pain, blurred vision, or hearing loss

❗ Increased heart rate or feeling weak

👉 Visit a doctor immediately if you experience these symptoms.

Long-Term Risks of Using Sildenafil

1️⃣ Heart Problems: It can increase blood pressure and the risk of heart attack.

2️⃣ Vision Issues: It may cause blurred vision or even sudden vision loss.

3️⃣ Hearing Problems: It can lead to tinnitus (ringing in the ears) or sudden hearing loss.

4️⃣ Psychological Dependence: Users may lose confidence in performing without the drug.

5️⃣ Digestive Issues: Long-term use can cause acidity, gastric problems, or indigestion.

Final Message

🚨 If you are using this drug recreationally, be cautious!

👉 Improper use can have severe health consequences.

👉 Do not take Sildenafil without medical advice.

If you found this information helpful, like, comment, and share.

🙏 Thank you! 

Can we use Vitamin E Capsules directly on face and hair ? Tips to use Vitamin E Capsule

 

Nowadays, many people visit pharmacies to buy Vitamin E capsules for application on their skin and hair. But is it really appropriate to apply Vitamin E capsules directly to the skin and hair? Today, I will discuss this topic.

Before that, let’s first understand Vitamin E.

Vitamin E is also known as the "beauty vitamin" because it has antioxidant properties. It is found in abundance in dry fruits like almonds, cashews, walnuts, sunflower seeds, and sesame seeds; green vegetables like spinach, cabbage, and fenugreek leaves; and fruits like kiwi, avocado, and mangoes.

• Vitamin E helps reduce age-related skin issues like blemishes and wrinkles.
• It keeps the skin hydrated and radiant.
• It helps reduce hair fall, prevents split ends, and strengthens the hair.
• It boosts the immune system, protecting the body from infections and diseases.
• It helps balance cholesterol levels.
• It improves blood circulation, reducing the risk of heart attacks.
• It strengthens eye muscles and helps maintain clear vision.
• It aids in the faster healing of small wounds, burns, and scars.

These are the benefits of Vitamin E. If you are consuming the foods mentioned above regularly, you don’t need to take Vitamin E capsules separately. However, many people nowadays apply Vitamin E capsules directly to their skin and hair.

To clarify, the Vitamin E capsules available in pharmacies are meant for oral consumption, not for direct application to the skin and hair. If you need Vitamin E for skincare, you can use moisturizers or creams that contain Vitamin E. Similarly, for hair care, you can use shampoos and conditioners enriched with Vitamin E.

If you still want to apply Vitamin E from capsules to your skin and hair, how should you do it?

It is best not to apply Vitamin E oil directly to your skin and hair, as it may cause allergic dermatitis. Instead, mix the oil from the capsule with aloe vera, coconut oil, almond oil, or rose water before applying.

How did you find this ? If you found it helpful, please don’t hesitate to like, comment, and share. Thank you! 

Isotretinoin, Side effects, Contraindication and Precautions

 Acne, is a common issue among many young people. No matter how much treatment some receive, they never seem to improve, and they keep running to hospitals wondering how they will recover. Today, I will provide information about a medication used for acne, i.e. isotretinoin. It is not enough to just know how to take this medication; it is also important to understand the potential side effects and the situations in which it should not be used.

"Isotretinoin is a Vitamin A derivative that reduces the activity of oil-producing glands in the skin. It helps in the regeneration of the skin."

For what type of acne is this medication suitable?

1. It is suitable for those with more severe forms of acne.
2. It is also appropriate for those who have not responded to other treatments such as antibiotics or creams. However, it should only be used with a doctor's recommendation.

This medication comes in capsule form, and the dosage is 0.5 mg/kg per day. If you weigh 60 kg, you should start with 30 mg per day or 15 mg in the morning and evening. Always take isotretinoin after a meal, and make sure to drink a glass of water with it. For more severe acne, the medication should be taken for 15 to 20 weeks.

Now, let’s talk about the potential side effects:

1. Dry and cracked lips: Use lip balm for this.
2. Dry  mouth and dry eyes: Use moisturizer for the mouth and artificial tears for the eyes.
3. The skin becomes more sensitive to the sun: Use sunscreen when going out in the sun. Avoid using any kind of cleansing or waxing on your face while on this medication.
4. Hair may become thin or fall out, but this issue gradually decreases after stopping the medication.
5. Some may experience body aches as well.

In more severe cases, isotretinoin may cause:

• A decrease in high-density lipoproteins (HDLs),
• Elevated liver function tests (LFTs),
• Decreased blood levels, including hemoglobin and hematocrit. Red and white blood cell counts may decrease, while platelet count may increase. If a decrease in white blood cells is noticed, stop the medication immediately.

What precautions should be taken while on this medication? 

• Patients taking isotretinoin should not donate blood during treatment and for one month after stopping the treatment. 
• If isotretinoin is combined with tetracycline, pseudotumor cerebri (a condition with increased pressure around the brain) may occur. Therefore, isotretinoin should not be given with tetracycline. If symptoms of pseudotumor cerebri occur, stop isotretinoin immediately and refer the patient to a neurologist for further evaluation.

Who should not take isotretinoin? 

• Isotretinoin is contraindicated in pregnant women and women who may become pregnant. It has been shown to cause serious harm to a developing baby when taken during pregnancy. Women should use birth control pills or avoid sexual activity while taking isotretinoin and for some time after stopping it. Men who are taking isotretinoin should not participate in sperm donation while on the medication. 
• Those who are allergic to Vitamin A should also avoid taking this medication.

Diet for patients with hemorrhoid's/ Piles

 

INTRODUCTION:

Hemorrhoids are enlarged veins in the lower rectum and anus, commonly referred to as piles. They may result in bleeding, pain, and discomfort. Hemorrhoids can be treated with a nutritious diet to lessen their symptoms and stop them from coming again. Now, let's get going.

Foods to eat:

• High-fiber foods: Consuming foods high in fiber can help to soften and facilitate the passage of stool, which eases the pressure on the rectum and anus. Legumes, whole grains, fruits, and vegetables are all excellent providers of fiber.
• Water: Keeping the stool soft and avoiding constipation, which aggravates hemorrhoids, are two benefits of drinking lots of water.
• Probiotics: Probiotics are beneficial bacteria that can lessen constipation and enhance gut health. They can be found in fermented foods like kefir and yogurt.
• Lean protein: Consuming foods high in protein, such as fish, poultry, and legumes, can help you stay lean and avoid gaining weight, which can put additional strain on your anus and rectum.

FOODS TO AVOID:

• Acidic and spicy foods: These foods can aggravate the rectum and anus lining, exacerbating the symptoms of hemorrhoids. Steer clear of foods like tomatoes, citrus fruits, and spicy peppers.
• Foods that have been processed: processed foods are frequently low in fiber and high in fat, which can exacerbate hemorrhoid symptoms and cause constipation.
• Caffeine and alcohol: Caffeine and alcohol both cause the body to become dehydrated and constipated, which exacerbates hemorrhoids.

ADDITIONAL ADVICE:

• Smaller, more frequent meals should be consumed throughout the day to avoid constipation and overindulgence.
• Hemorrhoids can worsen if you hold in your stool, so don't put off using the restroom when you need to.
• Engage in regular exercise to enhance bowel movement and circulation.

SUMMARY: 

Ultimately, controlling hemorrhoid symptoms can be greatly aided by maintaining a nutritious diet. Avoiding certain foods, drinking lots of water, and eating high-fiber foods can all help prevent constipation and lessen the pressure on the rectum and anus. 

Conductometry: Principal, Instrumentation and Application

 

Conductance: flow of electricity through a electrolyte solution due to migration of ions by applying potential difference between two electrode.

-         Cathode (-ve charged) will attract cations (+ve charged)

-         Anode (+ve charged) will attract anions (-ve charged)

It is denoted by G. and is reciprocal of resistance R.

So, G= 1/R

Units of conductance is siemens (S).

Specific Conductance:

Resistance is directly proportional to the length (l) and inversely proportional to the cross-section area (a) of the conductor.

R ∝ l/a

R= ρl/a where, ρ= specific resistance

R= ρ= Specific resistance (having 1 m length and 1 m² area)

·        Specific conductance (k): reciprocal of specific resistance

(k)= 1/ ρ,

k= l/a *1/R,

K=l/a * G

Unit of specific conductance is siemens.m^-1

Equivalent conductance:

·        Conductance one gram equivalent solutions. If l=1 m, volume= 1m³ and 1 gm equivalent solution is taken then,

·        G=k

·        It is denoted by the symbol “Λ”. And its unit is siemens.m²/gram equivalent.

 

Molar conductivity:

·        Molar conductivity can also be defined as the conducting power of all the ions that are formed by dissolving a mole of electrolyte in a solution. 

Λ_m = K / C

·        Where K is the specific conductivity and c is the concentration in mole per litre.

·        The unit of molar conductivity is Siemens⋅m²⋅mol^-1.

 

Principal:

Conductometry is based in the principal of determination of changes in conductivity. Change in conductance is due to replacement of ions with each other.

Ionic conductivity is different for different ions.

 

Instrumentation:

 

Current Source:

-         Alternative current source is used.

-         High frequency alternating current generator is employed.

-         Electrical potential is applied, ions will be transferred and ultimately conductance takes place.

 

Conductivity meter:

-         Digital display

-         Calibrator

-         Power switch

 

Conductivity Cell:

-         It is made up of pyrex or quartz

-         Fitted with 2 electrodes

: cathode

: anode

 

Electrodes:

-         Electrodes are made up of platinum

^-          Area of electrode surface = 1 cm²

-         Distance between two electrode is 1 cm

-         Electrodes are plated with platinum black: to avoid polarization

: to increase the surface area

-         Coating is done through 3% chloroplatinic acid and lead acetate

 

Conductometric titration

The principle of conductometric titration is based on the fact that during the titration, one of the ions is replaced by the other and invariably these two ions differ in the ionic conductivity with the result that conductivity of the solution varies during the course of titration. The equivalence point can be located graphically by plotting the changes of conductance as a function of the volume of the added titrant.

The most important advantages of this method are that it can be used for determination of:

– turbid and highly coloured solutions,

– very dilute solutions,

– reaction which is not complete and where there is no suitable indicator, e.g. reaction between weak acid and weak base.

 

Precaution to be considered in conductometric titrations:

1. Upon carrying on titration the titrant used should be at least 10 times concentrated as the solution to be determined, e.g. on determination of 0.01 M hydrochloric acid the titrant sodium hydroxide should be at least 0.1 M. By this way dilution that takes place during titration is minimum and this is necessary because conductivity decreases with dilution.

2. Avoid the presence of ions which will not take part in the reaction, such as the presence of buffer or concentrated acids. These ions will increase the initial conductivity and its change during the titration will be comparatively small and can not be accurately observed.

3. The method is suitable for detection of end point in neutralization, complexation and precipitation reactions but not redox reaction, as there is no electron transfer at the electrode surface.

 

Some typical conductometric titration curves are:

1. Strong Acid with a Strong Base, e.g. HCl with NaOH

Before NaOH is added, the conductance is high due to the presence of highly mobile hydrogen ions. When the base is added, the conductance decreases due to the replacement of hydrogen ions by the added cation as H⁺ ions react with OH^- ions to form undissociated water.

This decrease in the conductance continues till the equivalence point. At the equivalence point, the solution contains only NaCl. After the equivalence point, the conductance increases due to the high conductivity of OH-ions.

Fig: Conductometric titration of strong acid (HCl) vs. strong base (NaOH).

2. Strong Acid with a Weak Base, e.g. HCl with dilute ammonia

Initially the conductance is high and then it decreases due to the replacement of H+. But after the endpoint has been reached, the graph becomes almost horizontal, since the excess aqueous ammonia is not appreciably ionised in the presence of ammonium chloride (Fig. 2).

Conductometric titration of strong acid (HCl) vs. weak base (NH4OH).

3. Weak Acid with a Strong Base: e.g. CH3COOH with NaOH

Initially a slight decrease in the conductance is caused by binding a small amount of hydrogen ions, originating from dissociation of acetic acid, into water molecules. Next, the gradual conductance increase is connected with the substitution of the weakly dissociated acetic acid by the well dissociated sodium acetate. After the equivalence point has been reached, the conductance increases significantly due to the increasing concentration of OH ions (Fig. 3).

Conductometric titration of weak acid (CH3COOH) vs. strong base (NaOH).

4. Weak Acid with a Weak Base: e.g. CH3COOH with dilute ammonia

Initially a slight decrease in the conductance is caused by binding a small amount of hydrogen ions originating from dissociation of acetic acid and next an increase is observed because of well dissociated salt - ammonium acetate formation. After the equivalence point the conductance increases but much less (Fig. 4).

Conductometric titration of weak acid (CH3COOH) vs. weak base (NH4OH).

Application of Conductance measurement

• They are used to determine the purity of water by checking the pollution levels of various water bodies.
• Conductometric titration is also used to examine the alkalinity of freshwater bodies and the salinity of seawater.
• Conductometry is also used in the food industry by microbiologists in order to trace microorganisms. 
• The application of conductometric titration is also found in the pharmaceutical industry. It is used to check the basicity of organic acids and to detect antibiotics.
• It is used to determine the purity of distilled water or its freshness by examining the chemical equilibrium in ionic reactions.

Advantages of conductometric titration

Some of the main advantages of such titration are given:

1.     It is quite difficult to select suitable indicators for the titration of colored solutions. In such cases, conductometric titration can be carried out.

2.     Titration of very diluted solution and weak acids versus weak bases can not be carried out in volumetric titration but titration of such acid bases can be carried out quite easily with the help of conductometric titration.

3.     In a volumetric titration, special attention is needed near the endpoint to detect the color change but in this titration, no such special care is required near the endpoint.

 

A review on COMMUNITY PHARMACY PRACTICE IN NEPAL: CURRENTLY PROVIDED BY PHARMACIES

 

ABSTRACT

Objective: The aim of this review was to assess the current community pharmacy practice in Nepal.

Methods: Studies were identified through searches in Hinari, PubMed and Google scholars between the years 2010 to 2019.

Result: The study conducted at Pokhara reveals that about half of the community pharmacies were run by the non-pharmacist personnel. About a quarter of pharmacies were providing services such as the administration of injections, wound dressing, and laboratory and consultation services in addition to medicine dispensing and counseling services. Similarly, study conducted at Bara and Parsa of Nepal showed that more than half of the antibiotic were dispensed without prescription. Research in Kathmandu valley showed that among the variabilities of services that a Community Pharmacy would convey Blood Pressure Measurement was seen as the most common one.

Conclusion: Overall, this review article concluded that there is noble initiation for providing quality of pharmaceutical services at the Nepalese Community Pharmacy despite of having strong policy. If the regulatory body become strong and handover the all the right to the pharmacist rather than orientation holder, this would ultimately lead to rational use of medication at the community level and patients get benefited.

Keywords: Nepal, Clinical pharmacy, Community Pharmacy, Health care, Pharmaceutical care, Pharmacy practice

INTRODUCTION

Community pharmacies are being recognized rapidly in many parts of the world as a source of professional medical advice.(1) It is a unique combination of service and business, where pharmaceuticals are sold (business), and information is provided about the use of medicines and the prevention and treatment of diseases (services). Community pharmacies are in most cases the first point of contact used by millions of people seeking health care every day. These community pharmacists could play a significant role in the self-management of minor illness by using over-the-counter (OTC) medicines, and hence improve the overall health of their communities(2).

In Nepal, “Community Pharmacy” is a professional term and often referred to as a medical shop or store (Aushadhi pashal) or a retail pharmacy and here the professional role of pharmacists is not well established. Moreover, people consider community pharmacists as chemists or medicine traders(3). Consumers' behavior in purchasing medicine from medical stores is similar to buying food items or general commodities from a grocery store. In developing countries like Nepal, the majority of people reside in rural areas where healthcare facilities are scarce. Thus, community pharmacies have become the most favored place for those seeking healthcare for general ailments(4), Furthermore, consultation is easier and cheaper. However, the problem is non-professionals, i.e., non-pharmacists, who operate community pharmacies, especially in rural areas. (5).

OBJECTIVE

-          To describe the current status of Nepalese community pharmacies and community pharmacist practice.

-          To discuss future directions for community pharmacy service development in Nepal that may lead to an enhanced primary care role in the context of the recent healthcare reforms.

METHODOLOGY

Studies were identified through searches in Hinari, PubMed and Google scholars using a combination of search terms, namely: ‘Nepal, Nepalese, community pharmacy, retail pharmacy, pharmacist, clinical pharmacy, pharmaceutical care, primary healthcare’. Articles were limited to those in English published between 2010 and 2019, and pertaining to Nepal. Additional articles were identified through the cross-referencing of articles and books.  Articles which reveals the ideas about the current practice of community pharmacy, were selected and reviewed.

RESULT AND DISCUSSION

A study conducted at Pokhara of western Nepal concerning pharmacy practice identified that close to a half the studied premises were operated by legally recognized pharmaceutical personnel, whereas the rest was run by people who didn't have the legal authority to operate pharmacies independently. About a quarter of pharmacies were providing services such as the administration of injections, wound dressing, and laboratory and consultation services in addition to medicine dispensing and counseling services. Almost two-thirds of patients visiting the pharmacies were dispensed medicines without a prescription. Tetanus Toxoid, Depot-Medroxy Progesterone Acetate, and Diclofenac were the most commonly-used/administered injections. Most of the generated waste was disposed of in a municipal dump without adhering to the proper procedures for the disposal of hazardous waste  (6).

This shows that Community pharmacies in Pokhara offer a wide range of services but the lack of qualified staff and adequate infrastructure may be compromising the quality of the services offered, while lack of strong policy making agency may be another reasons.

The study conducted at two district of Nepal i.e. Bara and Parsa, among 161 community pharmacies, 25% were not registered and most of them were located in rural areas. It was typical (66.5%) to dispense antibiotics without prescription and most (91.4%) of the staffs involved in dispensing were non-pharmacists. Additionally, the study revealed common practices of replacing one brand of antibiotic with other brands (66%), dispensing incomplete courses of antibiotics (73%), and not giving any advice regarding antibiotic use (39%) or completion of a full course of therapy (80%).(5), which demonstrate the various components related to the irrational dispensing of antibiotics in the community.

Community Pharmacy Practice at three district of Katmandu Valley was conducted where the overall compliance with Good Pharmacy Practice indicators for Kathmandu, Bhaktapur and Lalitpur districts were found to be 12.81 (55.69%), 11.13 (48.39%) and 12.99 (56.48%). Among the variabilities of services that a Community Pharmacy would convey Blood Pressure Measurement was seen as the most common one. And the others services that pharmacies have provided were declining in the order of wound dressing, tetanus injection, Glucose detection and finally Rabies for all three districts. The 90% of Pharmacies of Lalitpur provide Blood pressure measurement service, while 80% of Kathmandu and 78% of Bhaktapur. Lalitpur district was superior on additional pharmacy service as depicted in the graph except for wound dressing service which was lead by Bhaktapur district with 83%(7). Overall, it shows that all districts glumly failed to comply with the standards set by GPP. Pharmacies seemed to profit oriented rather than providing quality of health services.

The survey conducted at community pharmacy of Kathmandu valley revealed the availability of the essential medicines was not 100%. High competition and high price variation were seen in medication like metformin 500 mg (254.6%) and atorvastatin 10 mg (327.6%). The study showed that maximum (54.7%) brands were manufactured in Nepal. (8)This overall suggest that pharmacies were not concern about the rational use of medication by providing essential medicine at affordable price.

CONCLUSION

Overall, this review article concluded that there is noble initiation for providing quality of pharmaceutical services at the Nepalese Community Pharmacy despite of strong policy and lack of competency among the pharmacist. If the regulatory body become strong and handover the all the right to the pharmacist rather than orientation holder, this would ultimately lead to rational use of medication at the community level and patients get benefited. This may uplift the respect to the pharmacy profession more than the word “medicine dispenser”.

REFERENCES

1.         Fang Y, Yang S, Zhou S, Jiang M, Liu J. Community pharmacy practice in China: past, present and future. International Journal of Clinical Pharmacy. 2013;35(4):520-8.

2.         Saini R, Rai A. Text Book of Community Pharmacy. New Delhi (India): New Age International. 2012.

3.         Bhuvan K, Alrasheedy AA, Ibrahim MIM. Do community pharmacists in Nepal have a role in adverse drug reaction reporting systems? The Australasian medical journal. 2013;6(2):100.

4.         Miller R, Goodman C. Performance of retail pharmacies in low-and middle-income Asian settings: a systematic review. Health policy and planning. 2016;31(7):940-53.

5.         Ansari M. Evaluation of community pharmacies regarding dispensing practices of antibiotics in two districts of central Nepal. PloS one. 2017;12(9):e0183907.

6.         Gyawali S, Rathore DS, Adhikari K, Shankar PR, KC VK, Basnet S. Pharmacy practice and injection use in community pharmacies in Pokhara city, Western Nepal. BMC health services research. 2014;14(1):190.

7.         Shrestha R, Ghale A. Study of good pharmacy practice in community pharmacy of three districts of Kathmandu valley, Nepal. International Journal. 2018;4(10):240.

8.         Shrestha R, Ghale A, Chapagain BR, Gyawali M, Acharya T. Survey on the availability, price and affordability of selected essential medicines for non-communicable diseases in community pharmacies of Kathmandu valley. SAGE open medicine. 2017;5:2050312117738691.