Esther Soler Climent.

B-Nursing
.Hepatology Unit. HGTiP. Badalona. Barcelona. Spain. esthersoler74@gmail.com

THE FIRST 4 WEEKS.

At week 4, you will have a blood test to measure the amount of virus in your blood. If the virus is undetectable means that you are responding really well, so you have many options to cure (SVR). However, it takes some time to complete the treatment. If the virus is still detectable with a low amount, the news may not be bad depending on what happens in week 12. However, if the quantity of virus in the blood is above a certain level, your doctor may recommend stopping treatment you are taking for hepatitis C.

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THE FIRST 12 WEEKS. At week 12, you will have another blood test to measure the amount of virus in blood.

Continue treatment. Depending on your response in the first 12 weeks you should stop or continue treatment only with peginterferon alpha and ribavirin for another 12 or 36 weeks.

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This medicine may affect other medicines and other medicines may affect it. Inform the team of health to visit if you are taking or have recently taken other medicines, including those not prescribed.

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Telaprevir should always be taken with food because it is important to achieve appropriate levels of medication in your body. Example of food that can be taken to improve levels of the drug: Whole milk, chocolate biscuits, toast with butter and jam, toast with cream cheese, chocolate, nuts, cheese, dried fruit, olives, etc ...

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No, not reduce your dose.

Can you chew, dissolve or break the tablets ?

No, the tablets should be swallowed whole. Do not chew, break or dissolve before swallowing. Tell your doctor if you have trouble swallowing tablets whole.

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If you find that you skipped a dose in a shorter period of 4 hours: Take the prescribed dose with food immediately. If you find deque have missed a dose after 4 hours: Skip the missed dose. Resume treatment with the next scheduled dose, without double dose to make up the missed.

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The pills should be stored in their original packaging, which must be kept tightly closed to protect from moisture.

The pack contains a bag of desiccant to keep the tablets dry. Do not remove the desiccant from the container.

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Keep out of reach and sight of children.

Telaprevir not use after the expiration date on the carton after EXP. The expiry date is the last day of that month. Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose medcatenos and do not need. This will help to protect the environment.
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Precautions in pregnancy .

As Telaprevir be administered in combination with Ribavirin and ribavirin can cause considerable damage to the fetus, all patients are women or men, must take special precautions to avoid pregnancy. Any method of contraception can fail, so you and your partner will have to use at least two effective contraception during and after treatment with Telaprevir.
Women of childbearing age and their male partners.

The anticoceptivo hormone may not be reliable during treatment. Therefore, you and your partner should use two barrier methods of contraception during treatment with Telaprevir and up to two months after completion.

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Some patients may feel faint or visual disturbances during treatment. Do not drive or operate machinery if you experience these conditions during treatment with Telaprevir. This medicine contains 2.3 milligrams of sodium per tablet which should be considered in the treatment of patients with low sodium diets. Tell your doctor if you should be careful about salt intake and a diet low in sodium.

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Patients taking this treatment often suffer from itchy skin rashes. Typically, the rash is mild or moderate. Rarely, patients may experience other symptoms, which may be a sign of a severe rash.
Your doctor should check your rash to determine the best treatment. Your doctor may interrupt treatment and treatment should not be restarted if stopped.

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If the rash worsens, or

If you develop other symptoms with the rash: Fever Fatigue Swelling of the face Swollen lymph nodes, or if your rash is spreading and has cold sores.

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Fainting Painful swelling of the joints, most commonly of the feet (gout). Vision problems. Bleeding from the anus. Swelling of the face.

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Low number of red blood cells (anemia) Nausea, diarrhea and vomiting. Inflammation of the veins of the rectum or anus (hemorrhoids), discomfort in the anus or rectum. Rash and itching of the skin

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What I can do to prevent and control the most common side effects?

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Avoid: Perfumed products Bubble bath Soap, particularly perfumed soaps. Soap-free cleansing bars, these can be drying and potentially irritating. Lanolin-based creams, lotions, ointments etc. Anything that you think you might be allergic to. (common allergy-causing agents; detergents, plants, pets, harsh chemicals in household cleaning products, rubber gloves, jewelry, feathers, grass and pollen, artificial fingernails and adhesive).

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Personal Hygiene: Dry yourself by patting your skin with a soft towel, rather than rubbing vigorously. Use mild, non-perfumed, non-deodorent soaps Or low allergy soap of soap substitute - cream, cleaning gels. Take showers or short, cool baths instead of long, hot baths. Shaving for men - if dry skin reactions occurs on your face, skip a couple of days (over a weekend?) to give your face a rest. Do not use perfumed after-shave. Shaving for women - if after shaving your legs a rash appears do not shave again until the skin has completely healed. Clothes: Wear cotton clothes where possible next to the skin, rather than wool, synthetic fibers or rough clothing. Wash clothes in mild detergent.

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Weather: Extreme weather conditions can worsen and cause dry skin reactions (hot and sunny, cold and windy). Wear gloves in cold weather. Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
Fluids: Drink plenty of fluids keep your body well hydrated. You should drink 2-3 quarts of nonalcoholic, non-caffienated beverages daily, unless you are instructed to restrict your fluid intake.

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Lotions and creams: Use moisturizers regularly. Moisturizers prevent water loss by layering an oily substance over the skin to keep water in or by attracting water to the outer skin layer from the inner skin layer.

Bath oils such as baby oil, mineral oil, Herbal Bath Oil, Lubriderm Bath Oil, or Neutrogena Body Oil can be applied to your wet skin after you emerge from the bath or shower.

Protect hands: Always rinse and dry hands carefully, particularly after contact with cleaning products. Wear rubber or vinyl gloves to protect hands, underneath wear thin cotton gloves. Do not wear for long periods of time. (Wash the cotton gloves frequently).

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You can moisturize with Vaseline or moisturizing creams soluble in the lips and nasal mucosa. Reinforce oral hygiene. If you have discomfort or pain in the gums must make brushing teeth and to rinse of chamomile, plantain or basil, often to avoid the accumulation of food and bad taste. To this, add a tablespoon of chamomile flowers or a spoonful of chopped dried leaf and plantain or one tablespoon of dried leaves and chopped basil in a cup of boiling water, the dose is to mouthwash 4 times a day, to improve. Avoid alcohol mouthwashes.

If you have dry mouth can chew gum or sugarless candy or pieces of fruit like pineapple or orange, they can help produce more saliva.
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Maintain good oral hygiene - brush your teeth before and after each meal. Choose and prepare foods that look and smell good to you. Eat small, frequent meals. Use plastic utensils if food tastes like metal. Eat mints (or sugar-free mints), chew gum (or sugar-free gum) or chew ice to mask the bitter or metallic taste. Substitute poultry, eggs, fish, peanut butter, beans and dairy products for red meats. Marinate meats in sweet fruit juices, wines, salad dressing, barbeque sauce, or sweet and sour sauces. Flavor foods with herbs, spices, sugar, lemon, and tasty sauces. Chilled or frozen food may be more acceptable than warm or hot food. Try tart foods such as oranges or lemonade (this may be painful if mouth sores are present). Avoid cigarette smoking. Eliminate bad odors. Eat in pleasant surroundings to better manage taste changes. Increase your fluid intake.

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There is no one magic solution for taste changes that suits everyone. Finding foods that taste appealing may be a process of trial and error. Some people who experience taste changes avoid their favorite foods to prevent the possibility of spoiling them for the future.

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Food preparation:

Try to eat small meals or snacks, every two to three hours, instead of three large meals a day (become a grazer). Don't expect to eat regular size meals. Foods that are high in protein or calories are good snacks to have handy. Examples include; milk shakes, cheese, fruits, peanut butter, nuts, crackers and juices. Eat foods that are rich in calories and nutrients. Avoid lowcalorie foods that fill you up, such as lettuce, broth and diet soda. When choosing beverages, select nutrient-dense fluids such as milk, milk shakes, juice and punch-type drinks. Avoid heavy meals, greasy or fried foods, and foods that cause gas. Examples of gas-producing foods include: beans, cauliflower, broccoli, cabbage, and carbonated drinks. Prepare food that is colorful and appealing to the eye.

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Surroundings and their effect on Lack of appetite :

Try to eat with friends or family. Make eating a social event. Often times, people will eat more when they are socializing. Try changing the time, place, and surroundings of meals. Watch your favorite TV program while you eat. Use a plate that is larger than needed and put small portions on the plate. That way the amount of food that you need to eat does not look so overwhelming.

Avoid smells that are obnoxious or bothersome to you while you are eating.
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If you aren't eating much because your mouth is dry, try increasing your non-alcoholic fluid intake to at least two liters per day; just make sure it is okay with your doctor to drink this much fluid. Also limit the amount of food you drink with meals. Liquids make you feel full. Save the liquids for between meals. Avoid toothpaste and mouthwashes that contain alcohol as this can cause further drying of your mouth. To stimulate saliva, or to make your mouth moist, try sucking on ice cubes, candies, or gum.

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Try artificial tears, available as either drops or ointment. Ointments last longer, but are thicker and can cause blurred vision for a short time after they were implemented in the eye. Do not smoke. Avoid indirect consumption of snuff, direct wind and air conditioning. Use a humidifier, especially in winter. Blink more often purposely and relax the eyes.
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Should be included in the daily diet high fiber foods like fruits, vegetables, bran, nuts and bread, among others, to prevent constipation. In the case of hemorrhoids, it is essential to pay attention to anal hygiene, cleaning the entire area carefully to avoid scratching or rubbing the hemorrhoid to help prevent infection.

Use soft toilet paper or cleaning anal by warm bath.

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Plan ahead and organize your work: Change storage of items to reduce trips or reaching Delegate when needed Combine motions and activities and simplify details

Schedule rest: Balance periods of rest and work Rest before fatigue Frequent, short rests are beneficial

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Decreased physical activity, which may be the result of illness or of treatment, can lead to tiredness and lack of energy. Scientists have found that even healthy athletes forced to spend extended periods in bed or sitting in chairs develop feelings of anxiety, depression, weakness, fatigue, and nausea. Regular moderate exercise can prevent these feelings, and help a person feel energetic and stay active. Even during therapy, it is often possible to continue exercise.
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A good exercise plan starts slowly, allowing your body time to adjust. It is important that you do something to exercise the whole body on a regular basis. Regular means every day, or, at least every other day. The right kind of exercise never makes you feel sore, stiff, or exhausted. Any kind of exercise is O.K. Walking, stationary bike, or swimming (if the immune system is O.K.) are examples of types of exercise.

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Even more dangerous than doing no exercise is exercising only occasionally and doing too much, too fast.
If you experience soreness, stiffness, exhaustion, or feel out of breath as a result of your exercise, you are overdoing it.

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Do not eat or exercise within 2 hours of bedtime Make the room dark If you have an electronic clock, or one with an illuminated face, turn the face away from you. Use the bed only for sleeping (not for watching TV or reading) Keep a consistent sleep schedule. Make sure you go to bed each night and wake up each morning, at the same time. Minimize daytime naps. If you must take a nap, do not sleep for more than an hour at a time. Longer naps will make you feel more tired, and may contribute to sleep problems such as insomnia.

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If it's okay with your doctor, try some mild to moderate exercise during the day. For example, take a twenty- minute walk most days of the week.
If you are drinking a lot of caffeine, try to slowly cut down and avoid drinking caffeine in the evening. If pain is causing difficulty sleeping, make sure you are taking prescribed medications as recommended.

If your sleep problems are becuase you are worried or anxious about your health, talk with your health care provider or social worker, and/or become involved with a support group.
Try to listen to relaxing music or partake in activities that help you feel less tense (i.e. singing, praying, cooking, painting, reading, etc.). If you are feeling depressed, notify your health care provider.

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Behavioral - Cognitive Relaxation Techniques There are several relaxation techniques that have been helpful in treating insomnia. Some of these can be done by one-self. Others may require a tape, CD or technician to facilitate.

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Abdominal breathing is also known as diaphragmatic breathing. The diaphragm is a large muscle located between the chest and the abdomen. When it contracts it is forced downward causing the abdomen to expand. This causes a negative pressure within the chest forcing air into the lungs. The negative pressure also pulls blood into the chest improving the venous return to the heart. This leads to improved stamina in both disease and athletic activity. Like blood, the flow of lymph, which is rich in immune cells, is also improved. By expanding the lung's air pockets and improving the flow of blood and lymph, abdominal breathing also helps prevent infection of the lung and other tissues. But most of all it is an excellent tool to stimulate the relaxation response that results in less tension and an overall sense of well being.
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Place one hand on your chest and the other on your abdomen. When you take a deep breath in, the hand on the abdomen should rise higher than the one on the chest. This insures that the diaphragm is pulling air into the bases of the lungs. After exhaling through the mouth, take a slow deep breath in through your nose imagining that you are sucking in all the air in the room and hold it for a count of 7 (or as long as you are able, not exceeding 7)

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 Slowly exhale through your mouth for a count of 8. As all the air is released with relaxation, gently contract your abdominal muscles to completely evacuate the remaining air from the lungs. It is important to remember that we deepen respirations not by inhaling more air but through completely exhaling it. Repeat the cycle four more times for a total of 5 deep breaths and try to breathe at a rate of one breath every 10 seconds (or 6 breaths per minute). At this rate our heart rate variability increases which has a positive effect on cardiac health.

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In general, exhalation should be twice as long as inhalation. The use of the hands on the chest and abdomen are only needed to help you train your breathing. Once you feel comfortable with your ability to breathe into the abdomen, they are no longer needed.

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If you have questions ask for information. If you need to contact us: + 34 xxxxx hepatologiacanruti@gmail.com FAX: +34 xxxxx

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