RESUMO
PURPOSE: Study goal was to assess the impact of the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) Cholesterol Guidelines on patients in the fourth statin benefit group which included patients aged 40 to 75 years, without diabetes or clinical atherosclerotic cardiovascular disease (ASCVD), and have an ASCVD score ≥7.5%. These patients could benefit from treatment interventions by a pharmacist. METHODS: Patients were identified from electronic health records. A sample of 3503 patients was ascertained from having a lipid panel performed within the 12 months before November 1, 2013. Patients were excluded if we were unable to calculate 10-year ASCVD risk. RESULTS: A total of 3203 patients were included, with 2008 not on statin therapy. Of those, 1507 (75%) had a 10-year ASCVD risk score <7.5% and 501 (25%) had a score > 7.5%. Patient characteristics leading to an increase in risk included advanced age, smoker, male, and hypertension treatment. Of 2008 nonstatin patients, there were 466 (23.2%) who fit criteria for initiation of moderate- or high-intensity statin. CONCLUSION: Widespread adoption of the 2013 ACC/AHA Cholesterol Guidelines will expand prescribing rates of statins. Implementing screening strategies may help identify patients who require treatment in this fourth statin benefit group. A pharmacist can be vital in screening patients, educating patients regarding the need for medication therapy, and monitoring for adherence in these new regimens.
Assuntos
American Heart Association , Colesterol/sangue , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Guias de Prática Clínica como Assunto/normas , Adulto , Idoso , Cardiologia/normas , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sociedades Médicas/normas , Estados Unidos/epidemiologiaAssuntos
Doenças da Túnica Conjuntiva , Dabigatrana , Hemorragia Ocular , Insuficiência Renal , Tacrolimo , Idoso , Antitrombinas/administração & dosagem , Antitrombinas/efeitos adversos , Antitrombinas/farmacocinética , Fibrilação Atrial/tratamento farmacológico , Doenças da Túnica Conjuntiva/sangue , Doenças da Túnica Conjuntiva/induzido quimicamente , Doenças da Túnica Conjuntiva/diagnóstico , Doenças da Túnica Conjuntiva/terapia , Dabigatrana/administração & dosagem , Dabigatrana/efeitos adversos , Dabigatrana/farmacocinética , Interações Medicamentosas , Substituição de Medicamentos/métodos , Hemorragia Ocular/sangue , Hemorragia Ocular/induzido quimicamente , Hemorragia Ocular/diagnóstico , Hemorragia Ocular/terapia , Feminino , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/farmacocinética , Coeficiente Internacional Normatizado , Transplante de Fígado/métodos , Insuficiência Renal/sangue , Insuficiência Renal/complicações , Insuficiência Renal/diagnóstico , Tacrolimo/administração & dosagem , Tacrolimo/farmacocinética , Resultado do TratamentoAssuntos
Técnicas de Laboratório Clínico , Erros de Diagnóstico/prevenção & controle , Testes Diagnósticos de Rotina , Monitoramento de Medicamentos/métodos , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemoglobinas Glicadas/análise , Humanos , Mononucleose Infecciosa/diagnóstico , Lipídeos/sangue , Testes de Função Hepática , Sensibilidade e Especificidade , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Testes de Função TireóideaRESUMO
Pediculosis and scabies are caused by ectoparasites. Pruritus is the most common presenting symptom. Head and pubic lice infestations are diagnosed by visualization of live lice. Finding nits (louse egg shells) alone indicates a historical infestation. A "no nit" policy for schools and day care centers no longer is recommended because nits can persist after successful treatment with no risk of transmission. First-line pharmacologic treatment of pediculosis is permethrin 1% lotion or shampoo. Multiple novel treatments have shown limited evidence of effectiveness superior to permethrin. Wet combing is an effective nonpharmacologic treatment option. Finding pubic lice should prompt an evaluation for other sexually transmitted infections. Body lice infestation should be suspected when a patient with poor hygiene presents with pruritus. Washing affected clothing and bedding is essential if lice infestation is found, but no other environmental decontamination is necessary. Scabies in adults is recognized as a pruritic, papular rash with excoriations in a typical distribution pattern. In infants, children, and immunocompromised adults, the rash also can be vesicular, pustular, or nodular. First-line treatment of scabies is topical permethrin 5% cream. Clothing and bedding of persons with scabies should be washed in hot water and dried in a hot dryer.
