July 17, 2008 Archives - Page 4 of 7 - Clinical Advisor

Print Issue: July 17, 2008

Add a bisphosphonate to raloxifene?

A healthy, asymptomatic woman with a stable bone mineral density of -2.5 on dual energy x-ray absorptiometry (DEXA) has been taking raloxifene (Evista) for seven years along with calcium and vitamin D. She also exercises regularly. Should bisphophonates be added to the Evista? Or should the Evista be stopped and the bisphosphonates used alone for…

Role of D-dimer in suspected thromboembolism

D-dimer testing is now routinely done in the emergency department. How should the results be interpreted in the setting of a patient presenting with possible thromboembolism?—Erik L. Schuls, MD, Gastonia, N.C. The very high sensitivity and negative predictive value of certain D-dimer assays make them useful to help rule out thromboembolism in patients with a…

Cardiac parameters at odds

When evaluating a patient’s risk of vascular disease, primary-care clinicians often use the cholesterol/HDL ratio, while cardiologists use the LDL level. What should one do if the cholesterol/HDL ratio is favorable, but the LDL is high?—Melvin L. Edwards, MD, Ann Arbor, Mich. The usual reason the ratio is favorable is that the HDL is high.…

Incontinence during sleep

A 53-year-old white woman reports that during the past year she has had three episodes of urinary incontinence during rapid-eye-movement (REM) sleep. She reports that she wakes up and can recall dreams (she does not have night terrors). A neurologic exam, MRI, and electroencephalogram (EEG) were normal. A urologist found normal urodynamics. She has no…

Oral vs. SC diabetes medications

Is exenatide (Byetta) so much more effective than sitagliptin (Januvia) that exenatide is worth the discomfort of subcutaneous injections?—Kashif Memon, MD, Vernal, Utah Clinical trials conducted by Amylin Pharmaceuticals, Inc., and Eli Lilly and Company showed that Byetta provided a mean 2.1% reduction in hemoglobin A1c (HbA1c) in poorly controlled patients (HbA1c >9.0%) over the…

The effects of long-term opioid use

Besides the obvious physical and psychological aspects of dependency and addiction, is there any research documenting the effect of using long-term opioids (to treat chronic pain) on the body?—Michelle Simpsom, MSN, APRN-BC, Leonard, Mich. An excellent review of opioid research reveals that patients may experience hyperalgesia, a heightened sensitivity to painful stimuli, endocrine dysfunction, and…

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