April 13, 2007 Archives - Page 3 of 8 - Clinical Advisor

Print Issue: April 13, 2007

URINATION WOES

A 50-year-old man who had problems with urgency as well as frequent and difficult urination for the past 10 years recently experienced some relief with tamsulosin (Flomax). Time between urinations, which had ranged from 20 to 90 minutes, has doubled, and much of the straining is gone. Ultrasounds show increasing prostate size, from 30 cc…

RATIONALE FOR VARYING WARFARIN DOSES

From time to time, I see a patient whose cardiologist has prescribed anticoagulation therapy with warfarin (Coumadin), but the doses vary, for example, 5 mg daily for five or six days, then a half tablet for the other day or two. That doesn’t make any sense to me. There are so many dosing options available…

THYROXINE’S EFFECT ON ANTISEIZURE MEDICATION

How does thyroxine suppress antiseizure medication?—Jules G. Minkes, DO, Miami The interaction among thyroxine, seizures, and anticonvulsants is complex. It has been known for quite some time that thyroid hormone lowers the seizure threshold in humans and can cause seizures in patients with Graves’ disease (Epilepsia. 1980;21:91-96). Thyroxine therapy for hypothyroidism has also been shown…

DOES TYPE OF MI AFFECT INSTRUCTIONS FOLLOWING ANGIOPLASTY?

Is there any difference in discharge instructions following percutaneous coronary intervention (PCI) for ST-elevated MI (STEMI) vs. non-STEMI (NSTEMI)? Both cases featured mild hypokinesis of the affected myocardium.—Simona Leszinsky, PA-C, Oak Park, Mich. The recommendations would be similar. Antiplatelet therapy would be the same for both NSTEMI and STEMI. Although only mild impairment of left…

FONDAPARINUX REDUCES THE CHANCES OF THROMBOEMBOLISM IN HOSPITALIZED PATIENTS

Level 2: Mid-level evidence Fondaparinux (Arixtra) may prevent symptomatic and asymptomatic venous thromboembolism in bedridden hospital patients with an acute illness (BMJ. 2006;332:325-329; full-text available online without charge at www.bmj.com/cgi/content/full/332/7537/325. Accessed March 15, 2007). This finding is based on a trial with 849 medical inpatients aged 60 years and older who were randomized to fondaparinux…

EARLY FEEDING AFTER GI SURGERY MAY REDUCE MORTALITY AND LENGTH OF HOSPITAL STAY

Level 2: Mid-level evidence For the treatment of colonic ileus, delaying feeding until after return of bowel function does not appear necessary. Based on a Cochrane review with limited evidence, early feeding after GI surgery may actually reduce mortality and length of hospital stay (Cochrane Database Syst Rev. 2006[4]:CD004080). The systematic review included 13 randomized…

METHYLPHENIDATE MAY NOT BE EFFECTIVE FOR ADHD IN YOUNG CHILDREN

Level 2: Mid-level evidence Methylphenidate (Ritalin, Concerta, Daytrana, others) appears to have little or no effect in preschool children with attention-deficit hyperactivity disorder (ADHD), based on a randomized trial with a high dropout rate and small differences (J Am Acad Child Adolesc Psychiatry. 2006;45:1284-1293). The study enrolled 303 stimulant-naïve children aged 3-5.5 years with a…

RALOXIFENE REDUCES BREAST CANCER RISK BUT INCREASES RISK OF STROKE

Level 1: Likely reliable evidence Raloxifene (Evista) reduced the risk of breast cancer and vertebral fracture but increased the risk of fatal stroke and venous thromboembolism, based on the results of the Raloxifene Use for the Heart (RUTH) trial with 10,101 postmenopausal women older than 55 years who had coronary heart disease (CHD) or multiple…

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