What is the relationship between photosensitizing drugs and skin cancer?

ABSTRACT: Many medications are associated with phototoxicity or photoallergy, the two types of photosensitivity. Recently, a warning related to increased skin cancer risk was added to the labeling of the popular diuretic hydrochlorothiazide. This article reviews some photosensitizing medications and describes patient education on preventing and recognizing photosensitivity reactions and skin cancer.

The cardiac effects of hydroxychloroquine in immune-mediated rheumatologic diseases.

ABSTRACT: Hydroxychloroquine, when used to treat patients with rheumatoid arthritis or systemic lupus erythematosus, has been found to reduce cardiovascular disease (CVD). The drug also has been associated with cardiac adverse reactions such as conduction abnormalities. This article reviews the reduction of CVD and the cardiac adverse reactions associated with hydroxychloroquine.

Which drug is best for a patient with type 2 diabetes and heart failure?

ABSTRACT: Heart failure is twice as common in men with type 2 diabetes than those without it and is almost five times greater in women with diabetes. Ideally, effective treatment for one condition also will help with the other; certainly, clinicians should not prescribe a medication that will potentially worsen one of the conditions, if avoiding it is at all possible. This article reviews the effects of diabetes medications on heart failure outcomes.

Subclinical hypothyroidism: To treat or not to treat?

Subclinical hypothyroidism affects 4.3% of the US population. Despite this prevalence, whether to treat or to observe patients with subclinical hypothyroidism remains controversial. Guidelines for overt hypothyroidism strongly favor treatment for symptomatic benefits, but the same benefits of levothyroxine treatment have not been proven for patients with subclinical hypothyroidism-most likely due to the asymptomatic nature of the condition. Additionally, a connection between subclinical hypothyroidism and cardiovascular complications has not been definitively established, although the evidence favors a relationship. This article describes the background, presentation, and diagnostics of subclinical hypothyroidism, treatment, and potential cardiovascular complications, so clinicians can decide if initiating treatment is best for their patients with subclinical hypothyroidism.

Bariatric surgery and type 2 diabetes.

Type 2 diabetes is primarily managed with lifestyle modifications, self-monitoring of blood glucose, and medication. The goal is to maintain A1C less than 7% in most patients and prevent damage to other organs such as the kidneys and heart. Patients who are obese and cannot achieve normal blood glucose levels despite diet, exercise, and multiple medications may be considered for bariatric surgery. The Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy have been shown to improve A1C, reduce weight, and reduce the number of medications patients need for diabetes management. Comorbidities such as hyperlipidemia and hypertension also may improve. This article describes types of bariatric surgery, proper selection of surgical candidates, patient education, and the postoperative patient management necessary for long-term success in improving blood glucose control.

Diagnosing and managing mitral regurgitation.

Mitral regurgitation is the most prevalent valvular disorder in the United States. Patient presentation varies from asymptomatic to symptoms of severe heart failure. Primary care providers often are the first to detect mitral regurgitation as a result of careful auscultation. Medical management focuses on reducing cardiac workload, combating cardiac remodeling, and treating left ventricular failure. Surgical management is reserved for severe cases.

Musculoskeletal development in patients with Down syndrome.

Down syndrome is a chromosomal aneuploidy that results in disruptions in multiple body systems, including musculoskeletal function. Early intervention to focus on bone mineral density, gait correction, agility, balance, and muscle strength is imperative in order for patients to achieve maximum potential.

Insight into scabies.

Scabies, an infectious disease caused by the scabies mite, manifests as an intensely pruritic skin rash. Children, the underprivileged, and patients with immunocompromise are at a higher risk of acquiring this contagious disease. Infectivity occurs worldwide in patients of all races, ages, and sex. The classical appearance of papular burrows between the webbed spaces of digits or along the wrists can help distinguish scabies from other dermatologic diseases. Practitioners need to be familiar with how scabies may present so that patients can be treated and taught how to prevent spread of the disease.

My patient wants to try e-cigarettes to quit smoking. What should I say?

Electronic cigarettes are popular alternatives to actual cigarettes and are often used for smoking cessation. However, concerns about their efficacy and safety have resulted in calls for tighter regulation of their use.

Polycystic ovary syndrome and chronic inflammation: pharmacotherapeutic implications.

OBJECTIVE: To examine the relationship between polycystic ovary syndrome (PCOS), cardiovascular risk factors, cardiovascular disease (CVD), and chronic inflammation and analyze data regarding pharmacologic therapies that are recommended to reduce CVD risk in PCOS and the impact of those therapies on chronic inflammation. DATA SOURCES: A search of MEDLINE (1950-October 2011) was conducted to identify clinical studies pertaining to the identification and treatment of CVD and chronic low-grade inflammation in PCOS. Search terms included polycystic ovary syndrome, cardiovascular disease, inflammation, metformin, thiazolidinedione, and statin. Bibliographies of these studies and review articles were also examined. STUDY SELECTION AND DATA EXTRACTION: English-language clinical studies evaluating the effect of metformin, thiazolidinediones, and statins on inflammatory markers, endothelial function, adhesion molecules, fibrinolysis, cytokines, and adipokines in PCOS were included. DATA SYNTHESIS: Women with PCOS have an increased prevalence of many cardiovascular risk factors including obesity, android fat distribution, insulin resistance, impaired glucose tolerance, diabetes, dyslipidemia, hypertension, and metabolic syndrome. Markers of chronic low-grade inflammation, which are associated with an increased risk of CVD, are also elevated in PCOS. Clinical guidelines recommend the use of insulin sensitizers and statins to prevent CVD in some patients with PCOS. Current literature indicates that each of these medication classes has beneficial effects on inflammation, as well. Although there are currently no studies to determine whether these treatments decrease CVD in PCOS, it can be hypothesized that drugs impacting chronic inflammation may reduce cardiovascular risk. Some studies show that metformin, thiazolidinediones, and statins have beneficial effects on inflammatory markers in PCOS; however, the data are inconsistent. CONCLUSIONS: There is insufficient information to recommend any pharmacologic therapies for their antiinflammatory effects in PCOS in the absence of other indications such as diabetes and dyslipidemia.

Implementation of a pharmacist-run telephonic insulin titration service.

OBJECTIVES: To describe an insulin titration-by-phone service conducted by pharmacists and to discuss the effects of this service on patient care and outcomes in the first year of its existence. SETTING: An academic family medicine department in which pharmacists practice in nondistributory roles, from March 2009 through March 2010. PRACTICE DESCRIPTION: Pharmacy services within the department include a chronic disease medication therapy management clinic as well as consultation in various other primary care and specialty clinics. Fourth-year student pharmacists complete advanced pharmacy practice experiences at this site as well. PRACTICE INNOVATION: Based upon a need identified by department providers (physicians and physician assistants), an insulin titration-by-phone service was implemented by two faculty pharmacists. Patients were referred into this service by their primary care provider (PCP) and were called by one of the pharmacists on a regular basis. Pharmacist recommendations for insulin dose adjustments were made based on patient reported self-monitored glucose values. PCP approved recommendations and the patient was notified of changes. MAIN OUTCOME MEASURE: Decrease in glycosylated hemoglobin (A1C ) within 9 months of referral to the service when compared with baseline. RESULTS: Analysis included 76 patients. The mean decrease in A1C was 1.55% (SD 2.31; P <0.001). The largest decrease in A1C (1.4%) was seen in the first 3 months after referral. Seven patients achieved an A1C ≤7% ( P = 0.007). Forty-one patients had a decrease in A1C of at least 1% during the first 9 months after their referral ( P <0.001). CONCLUSION: The implementation of a pharmacist-run insulin titration-by-phone service resulted in improvements in A1C that were most pronounced in the first 3 months after referral.

Impact of a pharmacistdeveloped protocol on the cardiac monitoring of methadone in chronic noncancer pain management.

Objectives: To describe the roles of pharmacists in a chronic pain management clinic (PMC) and to discuss the impact of a pharmacist-developed protocol on monitoring for rate-corrected QT interval prolongation with methadone when used for chronic noncancer pain.Setting: An academic family medicine department with an affiliated PMC in which pharmacists practice, from 2005 to 2008.Practice description: Pharmacy services in the PMC included taking medication histories and reconciling the medication record at each visit, assessing the efficacy and safety of drug therapy, making therapeutic recommendations to the two PMC physicians, and counseling patients on their drug regimens. These services were provided by faculty pharmacists and by student pharmacists completing their advanced pharmacy practice experiences at the site.Practice innovation: Based on a need identified in a medication use evaluation performed by the pharmacists, a protocol was developed with the objective of increasing the rates of cardiac monitoring in high-risk patients prescribed methadone in all of the department's clinics.Main outcome measure: Rates of electrocardiogram (ECG) monitoring pre- and postprotocol were compared to determine the impact of the protocol.Results: A 19% absolute (136% relative) increase occurred in the proportion of high-risk patients who had an ECG performed (P = 0.02). The proportion of high-risk patients from the PMC who had an ECG increased by 20% (absolute; 27% relative; P = 0.005), with no significant change in the other clinics.Conclusion: The implementation of a pharmacist-developed protocol resulted in improvements in monitoring practices. The improvement was most pronounced in the PMC, which uses pharmacists in the patient care process. This suggests that the involvement of pharmacists in the application of the protocol may be more important than the existence of a protocol.

Cardiovascular risks and benefits with oral drugs for Type 2 diabetes mellitus.

Type 2 diabetes mellitus affects approximately 321 million people worldwide. It is estimated that about half of these patients will die from cardiovascular complications. In spite of these statistics, medications for diabetes are approved based not on outcomes, but on surrogate markers such as blood glucose or glycosylated hemoglobin. In recent years, however, the safety of diabetes medications has come under scrutiny, and more studies are being undertaken to determine the effect(s) of the medications on actual outcomes. In this review the authors review available study results for all of the currently approved classes of oral medications for Type 2 diabetes, and discuss the possible mechanisms for the findings. More studies are necessary for many of these classes, however, to make definitive recommendations regarding their cardiovascular effects.