Pharmacology

Spotlight: A case of Metformin Associated Lactic Acidosis

May 11, 2018
Spotlight: A case of Metformin Associated Lactic Acidosis

By  Jasmine Nee and Martin Fried, MD

Peer Reviewed

LEARNING OBJECTIVES

1. What is metformin-associated lactic acidosis?
2. How does severe acidemia lead to acute kidney injury?
3. How do you treat metformin-associated lactic acidosis?

CASE SUMMARY

The patient is a 40-year-old man with alcohol dependence and type II diabetes who presented to the emergency department for alcohol intoxication. After arriving hemodynamically stable with reassuring labs, he become tachypneic, confused, and lethargic a few hours later. At this point, he admitted that he took “a …

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Insulin in a Pill: Barriers to Development of Oral Insulin

May 8, 2018
Insulin in a Pill: Barriers to Development of Oral Insulin

By Nicolas Gillingham

Peer Reviewed

Over 30 million Americans—9.4% of the population—live with diabetes, six million of whom are at least partially dependent on exogenous insulin. Insulin can be self-administered by subcutaneous injection, either classically via a syringe, an insulin pen, or using an insulin pump. However, patients with diabetes report that these daily injections can feel particularly burdensome, not to mention stigmatizing, when compared to oral medications like metformin, which is one reason why insulin carries a lower rate of adherence. What if our …

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NSAIDs: Are They All the Same?

February 1, 2018
NSAIDs: Are They All the Same?

By Vishal Shah, MD

Peer Reviewed

Nonsteroidal antiinflammatory drugs (NSAIDs) are a heterogenous group of non-opioid analgesics and anti-inflammatory agents. Their use is ubiquitous, from treating a simple tension headache to a sprained ankle. NSAIDs are available over the counter and in prescription form.

NSAID use in the United States is rising; from 2005 to 2010, prescriptions for NSAIDs increased by 41%.1 These numbers will continue to rise with the increasing population age and subsequent demand for analgesics to treat conditions related to increasing age …

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How Can You Best Address Polypharmacy in the Elderly?

December 21, 2017
How Can You Best Address Polypharmacy in the Elderly?

By Michael Nguyen

Peer Reviewed

Polypharmacy has been defined as the use of multiple unnecessary medications, the use of more medications than is clinically warranted or indicated, or the use of unnecessary, ineffective, or harmful prescribing. Problematic polypharmacy should be differentiated from appropriate polypharmacy. Consideration of overall appropriateness of therapy is more valuable than simply considering the number of medications that an older person is prescribed.

Overmedication and failure to perform prudent medication reconciliation is a growing problem in prescribing practice. In individuals over 65 …

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Should Beta Blockers be Used in Heart Failure with Preserved Ejection Fraction?

August 23, 2017
Should Beta Blockers be Used in Heart Failure with Preserved Ejection Fraction?

By Lauren Christene Strazzulla

Peer Reviewed

The lifetime risk for developing heart failure from age 55 on is 33% for men and 28.5% for women, and as the population ages, there is an increasing prevalence of this disease along with its associated health care costs . Heart failure is divisible into 2 distinct entities: those with left ventricular systolic dysfunction and those with cardiovascular compromise that does not decrease LV ejection fraction, which is termed heart failure with persevered ejection fraction (HFpEF) . While …

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The Forbidden Fruit

January 27, 2017
The Forbidden Fruit

By Varun Narendra

Peer Reviewed

Griffith Hughes was the first to describe the grapefruit in 1750, naming it the “forbidden fruit” of Barbados for unknown reasons. Centuries later, it seems as if he may have been on to something, as grapefruit juice (GFJ) has been shown potentially to interact dangerously with a list of commonly prescribed medications. This list has steadily grown to include over 85 drugs.1 Meanwhile, the Internet is rife with anecdotes of near-death experiences attributed to drug interactions with the much-maligned fruit. …

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Gamechanger? Can Pioglitazone Reduce Cardiovascular Events After a Stroke? An Analysis of the IRIS Trial

January 19, 2017
Gamechanger?  Can Pioglitazone Reduce Cardiovascular Events After a Stroke?  An Analysis of the IRIS Trial

By Johanna Hase, MD

Peer Reviewed

Welcome to Gamechangers, a series that takes a critical look at the latest in medical literature to answer one important question: would the results of this article change my practice? Featuring thorough evidence-based review as well as expert commentary, our aim is for this series to help you decide if the results of a given study are, in fact, a gamechanger

A 64 year old woman with pre-diabetes, hyperlipidemia, and hypertension on aspirin, losartan and simvastatin, recently was diagnosed …

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Lies My Patients Told Me: “I Take My Medications Every Day.”

January 15, 2016
Lies My Patients Told Me: “I Take My Medications Every Day.”

By Rebecca Sussman

Peer Reviewed

Reviewing medical evidence has become such a habit that sometimes it feels almost impossible to think independently. I’ve always been a top-down thinker; I go with my gut instinct, and then look for the evidence to support my assessment.

The problem is that very often it feels like what patients need most is not the precision of a particular etiology or the selection of a medication that is perfectly and precisely tailored to their condition and comorbidities; what they need …

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