May 18, 2007 Archives - Clinical Advisor

Print Issue: May 18, 2007

Monitoring warfarin doses

Regarding the patient who takes a 5-mg warfarin tablet five or six days a week and a half tablet the other days in order to reach a certain international normalized ratio (INR) Item 102-3), what happens if blood is drawn the day after the half tablet dose? Wouldn’t the INR be low and not a…

ONE WEEK OF BUPROPION ISN’T ENOUGH

Bupropion is a norepinepherine reuptake inhibitor/dopamine reuptake inhibitor, not a selective serotonin reuptake inhibitor (Item 100-22). Like Ms. Waldrop, I have seen nothing in the literature supporting use of any antidepressant for only seven days per month.—Sean Green, MSN, APRN, FNP-BC, Fort Worth (103-19) Contact Us at: Letters@ClinicalAdvisor.com

AGE-LIMITED HPV TESTING

We began combining human papillomavirus (HPV) testing with Pap smears a couple of years ago. Recently, Medicare refused to pay for the HPV screening. I assume that Medicare made the judgment that older women were less likely to get HPV and therefore won’t pay for testing. I have adopted the strategy that if a woman…

CT SCANS FOR ELDERLY PATIENTS WHO HAVE FALLEN?

Are there any guidelines for doing a CT scan of the head in an elderly patient with dementia who has no sign of head or other injury following a witnessed or unwitnessed fall? What is the standard of care in the nursing home/long-term-care setting?—B.R. Manjunath, MD, Augusta, Ga. Clinicians faced with calls from nursing homes…

Long-term safety of anti-obesity agents

In appropriate patients, along with diet modification, daily exercise, and proper nutrition, I frequently prescribe anti-obesity medications for 6-12 months. Are there any adverse effects of using these medications long term, i.e., three, five, or 15 years?—Gowri R. Rocco, MD, Wayne, N.J. Drug therapy may be useful when combined with diet, exercise, and behavioral modification,…

Guidelines for contact dermatitis

Are there evidence-based guidelines for using corticosteroids in treating anaphylaxis, acute allergic reactions, and severe contact dermatitis?—Patricia Hoyecki, ARNP, FP, Medford, Ore. Guidelines for the care of contact dermatitis were prepared for dermatologists on behalf of the British Association of Dermatologists (Br J Dermatol. 2001;145:877-885). The long-term intermittent use of topical corticosteroids (mometasone furoate) in…

TREATMENT OPTIONS FOR DIAPHORETIC PALMS

A 14-year-old girl has diaphoretic palms, which cause her a great deal of embarrassment. This does not appear related to stress or hormonal cycles, and she has no other medical conditions. Is there anything that can be done for her? I have read that botulinum toxin A (Botox) has been used to treat other types…

Elusive confirmation of Clostridium difficile infection

A 70-year-old woman with a history of Clostridium difficile infection returned to the clinic with abdominal pain and diarrhea. Three stool samples were negative for C. difficile and WBCs. Would you recommend treating for C. difficile with further antibiotic therapy?—Monica Cox, MSN, MPH, ARNP-BC, Jacksonville, Fla. Clostridium difficile, a spore-forming bacterium that hails from the…

STOPPING METFORMIN

To check for renal insufficiency and ward off complications, such as lactic acidosis, I calculate the creatinine clearance of my diabetic patients taking metformin (Glucophage). At what creatinine clearance should I discontinue the medication? Does this value vary with gender or age?—Ivanka Vassileva, MD, Lawton, Okla. Clinicians are now being forced to navigate through often…

Next post in Advisor Forum