Print Issue: September 11, 2007

CAN CRP BE USED TO MONITOR HYPERLIPIDEMIA THERAPY?

In addition to their well-known effects on lipids, statins also lower high-sensitivity C-reactive protein (hs-CRP). How helpful are hs-CRP levels in the management of hyperlipidemia in a primary-care setting where patients can have comorbid or concomitant conditions that can elevate CRP?—George Demnos, MD, Deerfield, Ill. The serum concentration of CRP (produced by the liver in…

ANTIPLATELET THERAPY AND NSAID USE

A number of my older patients who take a daily aspirin have been told in the past that they could not take a nonsteroidal anti-inflammatory drug (NSAID) as well. Is there any evidence that NSAIDs will reduce the effectiveness of aspirin? Similarly, is there any evidence that warfarin (Coumadin) therapy will be affected by NSAID…

ACE INHIBITOR AND CREATININE ON THE RISE

In a patient on an ACE inhibitor, how do you monitor serum creatinine, especially when it’s starting to rise? Do you ever stop the ACE inhibitor and change to another BP medication? How does the rising creatinine affect the glomerular filtration rate calculation when using formulas, such as the Modified Diet in Renal Disease (MDRD)…

RISING CREATININE WITH HYDROCHLOROTHIAZIDE

What workup is needed for an elderly patient who is taking 25 mg hydrochlorothiazide for his hypertension and has slowly rising creatinine levels (1.5-2.0 mg/dL)?—Thomas R. Barringer, MD, Fridley, Minn. The first issue to consider is whether the dose is excessive for that individual. A 25-mg dose may be excessive for a petite older woman,…

TREATING PITYRIASIS ROSEA WITH A MACROLIDE

What is the rationale for using a macrolide to treat pityriasis rosea (PR)?—Michelle Spencer, NP, Salt Lake City PR is a papulosquamous dermatosis. Classically, the condition presents with a single large lesion (herald patch). Within a few days to a few weeks, multiple additional smaller lesions appear along the cleavage lines (Langer’s lines). The duration…

EXERCISE-INDUCED ILLNESS AND JOINT PAIN

A 42-year-old white man complains of moderate-to-severe joint pain (usually in his knees) when under stress and after prolonged UV exposure. He is asymptomatic during the summer in Michigan where he lives. He first noticed the symptoms 10 years ago. Over the past 18 months, he has been diagnosed four times with oral thrush and…

TEENAGE METABOLIC SYNDROME

What is the best way to treat metabolic syndrome in teenagers, especially females with polycystic ovary syndrome? Should I prescribe metformin and statins when efforts to encourage exercise and a healthy diet have failed?—Jana Tomsky, MD, Walnut Creek, Calif. Metabolic syndrome presents many challenges and very few solutions. Treatment of type 2 diabetes is the…

SHOULD ALZHEIMER’S PATIENTS VOTE?

A 90-year-old former reading teacher with Alzheimer’s disease has no recent memory, so she forgets whatever has been said to her. Is it ethical for persons sent by her family to ask her to mark a voting ballot?—Joshua Grossman, MD, Johnson City, Tenn. Since the 1950s, being dead is virtually the only exclusion that can…

ALOPECIA IN WOMEN

What protocol and lab workup should be followed to diagnose alopecia in women? What are the causes and treatment? Is this a lifelong condition?—Dawn Wells, PA-C, Dallas The most common form of alopecia in women is androgenetic alopecia (Am Fam Physician. 2003;67:1007-1014). Alopecia areata, telogen effluvium, cicatricial alopecia, and traumatic alopecias are other common disorders…

AGRICULTURAL EYE PROBLEMS

Most of my patients are farmworkers exposed to high levels of pesticides, sun, and dust. A large proportion (>40%) have conjunctival injection and bilateral pterygium in each eye. What low-cost strategies are available to medically manage these eye problems? I tell patients to wear dark lenses and use lubricating eyedrops while working and recommend lavage…

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