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Ivermectin is an antiparasitic drug.^[7] After its discovery in 1975, its first uses were in veterinary medicine to prevent and treat heartworm and acariasis.^[9] Approved for human use in 1987,^[10] it is used to treat infestations including head lice, scabies, river blindness (onchocerciasis), strongyloidiasis, trichuriasis, ascariasis and lymphatic filariasis.It works through many mechanisms to kill the targeted parasites,^[11] and can be taken by mouth, or applied to the skin for external infestations.

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Rituximab is a monoclonal antibody used primarily in the treatment of certain types of cancers and autoimmune diseases. A 500 mg injection is a common dosage for treating various conditions.

Key Points:

1. Uses:

   • Rituximab is used for:
     • Non-Hodgkin lymphoma (NHL): Often as part of combination chemotherapy regimens.
     • Chronic lymphocytic leukemia (CLL): Used alone or in combination with other treatments.
     • Rheumatoid arthritis: In combination with methotrexate for patients who have not responded adequately to other therapies.
     • Granulomatosis with polyangiitis (Wegener’s granulomatosis) and microscopic polyangiitis.

2. Mechanism of Action:

   • Rituximab targets the CD20 protein found on the surface of B cells, leading to the destruction of these cells. This action helps in reducing the number of malignant B cells in certain cancers and in modulating the immune response in autoimmune diseases.

3. Dosage:

   • The dosage may vary based on the specific condition being treated and the patient's body surface area. For many conditions, a common regimen involves an initial dose followed by additional doses after a certain period.

4. Administration:

   • Rituximab is administered via intravenous (IV) infusion. The infusion rate may be adjusted based on the patient’s tolerance.

5. Side Effects:

   • Common side effects may include:
     • Infusion reactions (fever, chills, nausea)
     • Fatigue
     • Headache
     • Skin rash
   • Serious side effects can include:
     • Infections (due to immunosuppression)
     • Severe allergic reactions
     • Heart problems (such as arrhythmias)

6. Precautions:

   • Patients should be screened for infections before starting treatment, as rituximab can increase the risk of serious infections.
   • Regular monitoring during treatment is essential, especially for signs of infusion reactions and infections.

7. Pregnancy and Nursing:

   • Rituximab is generally not recommended during pregnancy due to potential risks to the fetus. Women should use effective contraception during treatment.
   • The safety of breastfeeding while on rituximab is not well established and should be discussed with a healthcare provider.

8.  

Sertraline (Zoloft) is a medication used for depression, panic disorders, obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). Sertraline is thought to work by balancing serotonin, a naturally occurring chemical messenger that affects mood and emotions. Sertraline is an SSRI  (serotonin reuptake inhibitor) that increases serotonin levels between neurons (nerves) by blocking serotonin from being absorbed. Serotonin is sometimes called 5-hydroxytryptamine (5-HT).

The original sertraline brand name is Zoloft, which was FDA-approved on December 30, 1991, and it is now also available as a generic medicine.

It is available as sertraline 50mg tablets, 25mg tablets, 100mg tablets, 150mg capsules, 200mg capsules, and an oral solution of 20 mg/mL.

Amitriptyline is a tricyclic antidepressant used to treat symptoms of depression (FDA approved), and amitriptyline is used off-label for insomnia, migraine prevention, ADHD, eating disorders, bipolar disorder, anxiety, psychotic disorders, and some types of pain

Armodafinil may be used to improve wakefulness in adults who are very sleepy due to narcolepsy, obstructive sleep apnea (OSA), or shift work disorder (SWD).

• Armodafinil is taken in combination with other treatments for sleep disorders.
• Use of armodafinil does not replace using your CPAP machine or other treatments that your doctor has prescribed for OSA. Continue to use these treatments.
• Armodafinil is not a cure. It may help the sleepiness caused by these conditions, but it may not stop all your sleepiness and does not take the place of getting enough sleep. Follow your doctor’s advice about good sleep habits and using other treatments.

Armodafinil's mechanism of action is thought to involve dopamine transporter (DAT) inhibition, although the exact way it works for sleep disorders is not known. While similar to stimulants like amphetamine and methylphenidate, armodafinil has a different chemical structure. Armodafinil belongs to the drug class called CNS stimulants. 

Armodafinil is classified as a Schedule IV (4) controlled substancedue to its potential for misuse and dependence. Misuse is illegal and harmful and you should always keep it in a safe place and never share it with others. Tell your doctor if you have a history of substance abuse.

Armodafinil gained FDA approval on June 15, 2007, under the brand name Nuvigil. Armodafinil is available as a generic and as the brand Nuvigil.

Armodafinil is a purified version of Provigil

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RH GCSF (Recombinant Human Granulocyte Colony-Stimulating Factor) is an injection used to stimulate the production of white blood cells (specifically neutrophils) in the bone marrow. A typical dose might be 300 mcg, depending on the specific indication and patient needs.

Key Points:

1. Uses:

   • Primarily used to:
     • Prevent or treat neutropenia (low white blood cell counts) caused by chemotherapy or radiation therapy.
     • Support patients undergoing bone marrow transplantation.
     • Treat certain conditions like severe chronic neutropenia.

2. Mechanism of Action:

   • RH GCSF binds to the GCSF receptor on hematopoietic progenitor cells in the bone marrow, promoting the proliferation, differentiation, and activation of neutrophil precursors, leading to increased production of neutrophils.

3. Dosage:

   • The dosage may vary based on the indication and the patient’s medical condition. A typical dose for many indications is around 300 mcg, administered subcutaneously or intravenously.

4. Administration:

   • It is usually given as a subcutaneous injection, but intravenous administration may also be employed depending on the clinical setting.

5. Side Effects:

   • Common side effects may include:
     • Bone pain
     • Fever
     • Fatigue
     • Injection site reactions (redness, swelling)
   • Serious side effects can include splenic rupture or allergic reactions.

6. Precautions:

   • Patients should be monitored for signs of spleen enlargement or rupture, especially if they experience abdominal pain.
   • Regular blood tests may be necessary to monitor white blood cell counts and overall response to treatment.

7. Pregnancy and Nursing:

   • The safety of using RH GCSF during pregnancy and breastfeeding should be discussed with a healthcare provider, as data on its effects in these populations is limited.

8. Consultation:

   • Regular follow-up appointments are important to assess treatment effectiveness and manage any side effects.

Bortezomib is a proteasome inhibitor used primarily in the treatment of certain types of cancer, particularly multiple myeloma and some forms of lymphoma. A 2 mg injection is a common dosage form for this medication.