March 03, 2007 Archives - Page 2 of 8 - Clinical Advisor

Print Issue: March 03, 2007

DRUG THERAPY FOR STUBBORN HIGH BP

Which class of drug should be used to treat a patient who has maximized all of his heart failure medications (amlodipine [Norvasc], ACE inhibitor, beta blocker) yet still has elevated BP?—Deborah Skinner, NP, Muskegon, Mich. Consider adding an angiotensin receptor blocker to the regimen. The combination of nitrate and hydralazine, particularly in the African-American population,…

AN UNUSUAL NEUROLOGIC COMBINATION

A 37-year-old black man who had left-sided facial paralysis was diagnosed with Bell’s palsy and given steroids and acyclovir by another clinician. (I’m not sure of the reason for the acyclovir. Maybe the clinician thought there was a possibility of some other disorder.) Later, when I examined the patient, he said he felt no better…

HERPES TESTING FOR PARTNERS?

As an obstetrician/gynecologist, am I obligated to offer testing to the male partner of a patient who has tested positive for herpes?—Fred Nichols, DO, Sparta, N.J. The clinician who first detects a sexually transmitted disease has an obligation to inform the partner, if possible (i.e., when the partner is known). This is usually done by…

DIFFERENCES BETWEEN SECOND-GENERATION SULFONYLUREAS

How do the second-generation sulfonylureas differ with regard to their blood sugar-lowering effects? I read that glimepiride is the safest of these antihypoglycemic agents, but there was no explanation as to why this is the case.—Suzannne R. Martini, FNP-C, Howell, Mich. The second-generation sulfonylureas are all equally effective at lowering blood sugar. Each sulfonylurea forms…

TREATING RESISTANT DERMATITIS

What is the best way to treat a morbidly obese man with bilateral stasis dermatitis and ulcers that are resistant to local antibiotics?—Elizabeth Oommen, MD, Hicksville, N.Y. Leg elevation and use of emollients are important first steps. If pruritus and erythema of the skin are present, a topical corticosteroid may be indicated. For the ulcers,…

DOES FLAXSEED CAUSE PROSTATE

Does dietary flaxseed oil have a role in prostate cancer?—Gerard K. Nash, DO, Amarillo, Tex. Flaxseed oil is a rich source of α-linolenic acid, an omega-3 fatty acid. In his newsletter, “Prostate Forum,” Charles E. Myers Jr, MD, a researcher at the University of Virginia Medical School, in Charlottesville, has written that some clinical studies…

SHOULD THE STATE PAY FOR ELECTIVE PROCEDURES?

Most of my patients are low-income and receive Medicaid or similar assistance. What moral and ethical responsibilities do I have to patients requesting referrals and prior authorization for such things as eyeglasses or fertility treatment, gastric bypass, and other elective procedures? I am hesitant to ask the state to pay for these things when the…

ACCURACY OF HOME BP MONITORS

Compared with arm cuffs, how reliable are home BP monitors that fit on the wrist or even the finger? And why aren’t BP readings the same in both arms?—Bernard Wolf, MD, Concord, Calif. Arm cuffs appear to be the most reliable at-home devices. Some wrist cuffs, such as one by Omron, have been validated, but…

FRUGAL FUNGAL THERAPY

Are dandruff and psoriasis caused by a fungal infection? What is the simplest, least expensive therapy for each?—Gerald Strahs, MD, Havertown, Pa. Dandruff, or seborrheic dermatitis, may be an inflammatory reaction to the normal colonizing fungal organism Pityrosporum ovale. Common first-line, inexpensive therapies include shampoos containing selenium sulfide or ketoconazole. Topical steroid preparations may also…

CLOPIDOGREL vs. ASPIRIN

Which patients should be on a regimen of aspirin or clopidogrel (Plavix)? What role does warfarin (Coumadin) play in those requiring anticoagulation therapy?—Jill Schmidt, PA-C, Belmont, Mich. Aspirin has an established role in preventing thrombotic events in cardiovascular disease. Patients with a history of MI, stroke, prosthetic valve (nonmechanical), CAD, atrial fibrillation (AF), coronary-artery stenting,…

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