Medications

MKSAP: 70-year-old woman with hypothyroidism and a fractured hip

mksap

Conditions

December 2, 2010

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 70-year-old woman with hypothyroidism fell and fractured her hip. During preoperative evaluation for hip fracture repair, she mentions recent mild fatigue, which has not significantly limited performance of her daily activities, and ongoing right upper-quadrant abdominal pain after eating. She takes levothyroxine, 0.075 …

Antibiotics need to become controlled substances and regulated

WhiteCoat, MD

Meds

November 29, 2010

Antibiotics for viral infections are a big pet peeve of mine. No. Make that a huge pet peeve.

Some doctors prescribe antibiotics for coughs and stuffy noses because the patients want them. If you’re one of those patients who think that antibiotics make your coughs go away, or clear up your stuffy noses, or somehow make your sinus headaches vanish, or if you’re a doctor who prescribes antibiotics for these symptoms, …

Help patients synchronize their prescription drugs

Michael Aaronson, MD

Meds

November 12, 2010

Here’s the scenario: on the 2nd of the month, a patient with diabetes on metformin and high blood pressure on benazepril sees her family physician for a routine follow up.

The patient’s blood pressure is elevated and the decision is made to add carvedilol to help get the blood pressure to goal. The patient’s metformin and benazepril “drop” (are renewed) at the pharmacy on the 18th of every month, a date …

Arimidex price markup at major pharmacy chains

Leslie Ramirez, MD

Meds

October 22, 2010

The commonly prescribed breast cancer drug, Arimidex, was released as a generic in June 2010. The generic name is anastrozole. I called several local pharmacies last week to find out how much this medicine would cost for a one-month supply. I found some very surprising results:

Costco: $27

Walgreens (with Saver Card): $325 (without Card): $380

CVS: $361

Walmart: $347

Target: $340

These are not typos. Costco is selling a one-month supply of generic Arimidex for $27, …

Finasteride, fruit, and the matter of prostate health

Kevin

Meds

October 14, 2010

by Arnon Krongrad, MD

The noose was loose on its neck. At first I worried, but then I relaxed. This was a bottle of pomegranate juice, the antioxidant superpower. As the billboard implied, it could cheat death. Perhaps if I consumed pomegranate juice, I could cheat death.

Last week, the Federal Trade Commission charged POM Wonderful, LLC, makers of pomegranate products, with deceptive advertising. …

DTC advertising, and its history with the FDA

Ishmael Bradley, MD

Meds

September 18, 2010

Advertising is everywhere.

That should come as no surprise to anyone who has lived in modern America. It is impossible to turn on the television, ride the subway, or even sort through the daily mail without coming across an ad for a new car, a soft drink, or the latest digital toy. These advertisements have only one goal: to entice you to buy their products. This is harmless enough when these …

Most doctors don’t like prescribing pills

Melanie Lane, MD

Physician

September 3, 2010

I am a medical doctor. I am also called an allopath, someone who practices “Western medicine.”

We allopaths like data, proof, science, randomized, double-blind, placebo-controlled trials. We want to know the “mechanism of action.” We want someone to prove that yoga or medication or some procedure actually helps your depression or blood pressure or back pain and that these treatments are safe before we prescribe them. We feel more confident about …

How drug companies sell psychiatrists on their drugs

Daniel J. Carlat, MD

Meds

August 26, 2010

An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc.

In 1993, the FDA approved Neurontin for the treatment of epilepsy. This should have been a cause for celebration at Warner-Lambert, the drug company that introduced it, but the celebration was muted. The FDA had …

Creatine causing muscle cramps and how supplements may be dangerous

Orly Avitzur, MD

Meds

August 18, 2010

About a month ago, a 44-year-old insurance executive came to see me with complaints of headaches and muscle cramps. His pain was caused by the typical cluster headache located behind one eye, accompanied by one-sided tearing and nasal congestion, and often triggered by occasional wine or chocolate. The muscle cramps mainly affected the legs and seemed to worsen after exercise.

When I got the results of his lab work, I was …

Testosterone and when should low levels be treated in older men

William R. Yates, MD

Conditions

August 6, 2010

I’ve been interested in the role of testosterone in physical performance, depression and aging for many years. While at the University of Iowa, I was involved in research to detect testosterone doping, the psychological effects of testosterone and the potential for testosterone to alleviate depression in older men.

One of the difficult questions facing clinicians is when is testosterone too low in older men.

One problem with answering this question is the …

Pharmaceutical sponsored dinners have educational value

Randall S. Bock, MD

Meds

August 5, 2010

It is insulting to think that doctors who are ostensibly smart enough to save one’s life are in fact so stupid, or merely gullible enough, to be swept away by what is in actuality only a very weak potion of sales-presentation intermixed with and embedded within generally informative and pharmaceutical-balanced subject-focused medical lectures.

Such lectures occur usually at a private function room at a restaurant or, in conjunction with a served …

Medications that increase the risk of photosensitivity

Kevin

Meds

August 3, 2010

by Marianna Rakovitsky, RPh

Oh, Summer! The weather is warm, the sun is shining and it is the time when we try to get outside as much as possible. Summer is my favorite time of the year. I love the beach, days that are filled with light and sunshine, trips to the orchards and hanging out in the backyard. The sunshine that makes the summer such a …

The Massachusetts gift ban benefits health insurance companies

Kevin

Meds

July 23, 2010

by Edison Wong, MD

With the recent proposal to repeal the so-called Massachusetts “gift ban” (more appropriately referred to as the “interaction ban”), I asked myself who stands to gain the most from such bans?

Is it the consumers or patients? Is it the physicians or their practices? Is it the federal or state governments? Nope. Sadly, it is the insurers who gain the most, at the expense of patients.

The …

Ask your pharmacy to price match prescription drugs

Leslie Ramirez, MD

Meds

June 12, 2010

As we have established repeatedly on LesliesList.org, prescription prices can vary a lot from one pharmacy to another.

But did you know that some pharmacies will actually match a competitor’s price? This could save you a ton of cash, but you have to know how, and whom, to ask for this service. Pharmacy retail chains all have different policies. I spoke to a pharmacist recently at each of the seven top …

Demerol used to treat shivering in patients

Christian Sinclair, MD

Conditions

June 9, 2010

If you have spent anytime with a palliative care team in a hospital you will know of their efforts to essentially blacklist Demerol (meperidine) from use in the hospital.

Some hospitals have removed it or restricted it from the formulary all together. In medical culture, Demerol has been a go to opioid peri-OR and mostly favored by surgeons. The drug has been purported to be less likely to cause billiary spasm, …

Your asthma or COPD inhaler is not available, and what to do

Matthew Mintz, MD

Meds

May 28, 2010

As reported in MedPage Today, the FDA announced the end for CFC-propelled inhalers. Of the seven inhalers with deadlines for removal, only three are still being made:

Flunisolide (Aerobid Inhaler System) on June 30, 2011
Albuterol and ipratropium combination (Combivent Inhalation Aerosol) on Dec. 31, 2013
Pirbuterol (Maxair Autohaler) on Dec. 31, 2013

The reason for this is because CFC’s are harmful for the environment, and the newer inhalers have to be replaced with …

Allergy drug recommendations for patients on a budget

Leslie Ramirez, MD

Conditions

May 21, 2010

Ahhh spring.

The lovely blooms unfurling. The trees budding.

It’s enough to make a girl get tears in her eyes.

And sneezes in her nose.

And itching on her face.

Yes, it’s allergy season again — but what can you do to make yourself more comfortable without emptying your wallet?

1. Avoidance. Close the windows. Make someone else cut the grass. Stay inside. (Yes, I hate this one too- let’s move on.)

2. Neti pot or other nasal saline rinsing. LOVE …

Alternative medicine isn’t taught to doctors in medical school

Kevin

Meds

April 26, 2010

by Crystal Phend

Physicians don’t know much more about complementary and alternative medicine than their patients do, according to a new survey.

Most healthcare professionals who answered an online survey of Drug and Therapeutic Bulletin subscribers said their profession was just as poorly informed about herbal medicines (75.5%) as the general public (86.3%).

And almost half of respondents rated their own knowledge about herbal medicines as “quite” or “very” poor (36.2% and 10.4%, …

Neosporin and other OTC drugs to avoid

Edward Pullen, MD

Meds

April 12, 2010

Most people use non-prescription medications without giving much thought to the potential side effects or problems that may be associated with their use.

Here are 5 popular OTC meds you should avoid, and better alternatives. I bet most of you use one or more of these. Neosporin, Topical Vitamin E, Afrin nasal spray (or other short acting nasal decongestant sprays), daily headache medications, and sedating antihistamines.

1. Neosporin: Neosporin in the most …

Read more…

Neosporin and other OTC drugs to avoid

Your metformin may smell like dead fish

Kevin

Meds

March 1, 2010

Originally published in MedPage Today

An immediate-release form of the antidiabetic agent metformin has a dead fish odor that may cause patients to stop taking the drug, clinicians warned.

Metformin is known to cause adverse gastrointestinal effects such as diarrhea, nausea, vomiting, flatulence, distention, and abdominal pain. Those side effects “often necessitate discontinuing the drug,” a group of physicians and pharmacists …