November 03, 2006 Archives - Page 3 of 6 - Clinical Advisor

Print Issue: November 03, 2006

NEW STREP THERAPY

Q: Is cephalexin (Keflex) an acceptable therapy for strep throat?—Charles Liang, DO, Bloomington, Ill. A: Yes. First-line therapy for streptococcal pharyngitis continues to be penicillin or its derivatives, but there are good data to support the use of oral cephalosporins, such as cephalexin. Controversy exists over which are better — pencillins or cephalosporins. Even though…

STUNNING STINGS

Q: Some of my patients have told me about a clinician who treats insect/spider bites or stings with a stun gun, basically shocking the area around the bite. Is there any medical evidence or support for this type of treatment?—Nancy L. Kimbrow, MD, Keene, Tex. A: This interesting approach to treating spider bites was reviewed…

VASOPRESSIN OR EPINEPHRINE IN ADVANCED CARDIAC LIFE SUPPORT?

Q: Please comment on the use of vasopressin and epinephrine in current advanced cardiac life support (ACLS) protocols. Based on recent studies, is there any evidence that one is more efficacious than the other?—Andrew Obermeier, PA-C, Venice, Fla. A: This past summer, the American Heart Association, the American College of Cardiology, and the European Society…

FEELING THE PAIN OF RENAL LESIONS

Q: What are the pain referral patterns in patients with renal cell carcinoma?—Carlton J. Lewis, DO, Lufkin, Tex. A: Patients with renal cell carcinoma are generally asymptomatic until their tumors are large and/or metastatic. They then may present with a variety of symptoms related to hematuria, mass disease in the abdomen and flank, or sites…

MUSCLE PAIN IN HYPERLIPIDEMICS

Q: What alternatives are there for hyperlipidemic patients with increased complaints of muscle pain due to statin use? Do you see good results with ezetimibe (Zetia)?—G. Arthurs, FNP, Chester, N.Y. A: Has the patient tried more than one statin? Generally speaking, not all statins are alike. Specifically, the degree of myalgia-type side effects (with or…

Synera- Oxygen-activated patch turns up the heat on pain

Company: Endo Pharmacologic class: Topical anesthetic Active ingredients: Lidocaine 70 mg, tetracaine 70 mg; topical patch. Indication: Local dermal analgesia for superficial venous access and superficial dermatologic procedures (e.g., excision, electrodesiccation, shave biopsy of skin lesions). Pharmacology: Synera is a topical patch that contains a eutectic mixture of lidocaine, an amide-type local anesthetic, and tetracaine,…

Polymyalgia rheumatica (PMR)

Dr. Alper is medical director of clinical reference products for EBSCO Publishing, Inc., in Ipswich, Mass., and editor-in-chief of DynaMed (www.dynamicmedical.com), a database of comprehensive updated summaries covering nearly 2,000 clinical topics. Ms. Meskimen is a clinical instructor, University of Missouri-Columbia, and a reviewer for DynaMed. Description • Nonarticular rheumatic disorder resulting in muscle pain…

When thyroid hormone levels are insufficient

The key to managing hypothyroidism is establishing the primary cause and determining whether the disorder is persistent or transient. This statistic may surprise you: Hypothyroidism is the second most common endocrine disorder (after diabetes) encountered in primary care. Failure to produce sufficient amounts of thyroid hormone occurs in children and adults and increases in frequency…

Managing cirrhosis in a primary-care setting

Although most patients with the disease are treated by specialists, diagnosis and regular management of symptoms often fall to the primary-care clinician. Cirrhosis is the 12th-highest cause of death in the United States and the fifth leading cause of mortality in patients 45-54 years old.1 Annually, the disease is responsible for 421,000 hospitalizations and 27,000…

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