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for public health, preventive purposes in the early years of the epidemic. In the media and in political debate, the epidemiological category of risk group has been used to stereotype and stigmatize people already seen as outside the moral and economic parameters of the "general population."

risk practice This concept, that has replaced risk group for all but surveillance purposes by the National Academy of Sciences, shifts the emphasis away from characterizing and stigmatizing people as members of groups.

risk reduction Process by which an individual changes behavior to decrease the likelihood of acquiring an infection.

Ritalin See methylphenidate.

ritonavir A protease inhibitor manufactured by Abbott Laboratories and approved for the treatment of HIV disease. The most common adverse effects associated with ritonavir are gastrointestinal: nausea, vomiting, diarrhea, and anorexia. Circumoral and peripheral paresthesias have also been reported. Common laboratory abnormalities include elevated liver enzymes in the blood and elevated cholesterol and triglycerides. Metabolic abnormalities, redistribution of body fat, and diabetes have been associated with regimens containing protease inhibitors. Initial adverse effects associated with ritonavir may be because of high drug concentration in the blood during the first two weeks of therapy. The manufacturer recommends a dose-escalation protocol to increase tolerance. Ritonavir is a potent inhibitor of the cytochrome P450 3A4 isoenzyme, an important metabolic pathway for many common drugs. Other P450 pathways are induced by ritonavir and some drug levels are lowered. Note that all approved protease inhibitors inhibit cytochrome P450 enzymes but that ritonavir is the most potent. Thus, its clinical importance lies more in its ability to improve phar-macokinetic profiles of other protease inhibitors than its efficacy and tolerability as a single protease inhibitor as part of a triple-combination regimen. Current practice favors the use of ritonavir in combination therapy, for example, with nucleoside ana log drugs, to prevent the development of drug-resistant virus. Ritonavir enhancement is the use of ritonavir with other drugs, especially with other protease inhibitors, to increase their level in the blood. (The trade name is Norvir.)

RMP-7 A drug that allows substances to cross the blood-brain barrier.

RNA See ribonucleic acid.

Robimycin See erythromycin.

Robomox See amoxicillin.

Roferon-A See alpha interferon.

rosiglitazone A drug used in the treatment of Type II diabetes (noninsulin-dependent). It is a drug that increases the sensitivity of the body to natural insulin. Insulin is the substance the body produces to control and maintain stable blood sugar levels. Drugs that perform this function are called thiazolidinediones. They also have effects on fat metabolism. This drug had been tested in trials recently in HIV patients that are effected by lipodystrophy and other metabolic changes due to treatment with HIGHLY ACTIVE ANTI-VIRAL THERAPY (HAART). Results of these studies have been mixed, with some trial results showing no changes in abnormal body composition and other trials showing a better balance of blood sugar in the body and fewer changes in fat distribution. These studies are ongoing and results will determine the use of this type of drug in managing body composition issues in people taking HAART.

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