Pharmacology

From The Archives: They’re all the ‘roid rage: origins and mechanisms of corticosteroid therapy.

April 3, 2014
From The Archives: They’re all the ‘roid rage: origins and mechanisms of corticosteroid therapy.

Please enjoy this post from the archives dated September 23, 2011

By Santosh Vardhana, MD

A 36-year-old obese male with hypertension and hyperlipidemia presents to the ER with new knee pain, swelling, and erythema. Joint aspiration reveals negatively birefringent crystals. He is started on oral prednisone.

A 26-year-old woman with lupus presents to ER with edema, hematuria, and fevers. On exam she hypertensive, febrile to 100.4C, and has periorbital and lower extremity edema. Urine dipstick reveals 2+blood and protein. She is started on IV methylprednisolone.…

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An antidote on the horizon? An update on the progress toward achieving reversibility for the new oral anticoagulants

February 21, 2014
An antidote on the horizon? An update on the progress toward achieving reversibility for the new oral anticoagulants

By Gabriel Schneider, MD

Peer Reviewed

The new oral anticoagulants (NOACs) are an appealing alternative to the burdensome vitamin K antagonists such as warfarin. These novel agents include direct thrombin inhibitors such as dabigatran (which inhibits thrombin) and factor Xa inhibitors such as rivaroxaban and apixaban (which prevent thrombin generation). Compared to warfarin, NOACs have fewer food and drug interactions, as well as a more predictable pharmacodynamic profile that serves to obviate the need for the frequent outpatient monitoring in most patients. In addition…

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What Physicians Should Know About MDMA (Ecstasy)

February 20, 2014
What Physicians Should Know About MDMA (Ecstasy)

By Loren Gorcey

Peer Reviewed

With the recent resurgence of techno music and raves in the United States, the drug MDMA, known worldwide by the name “ecstasy,” has experienced a comeback. In light of a New Year’s Eve rave in Los Angeles in 2010, where 18 MDMA-related emergency room visits and 1 death occurred, MDMA is once again becoming a problem . Locally, 4 MDMA-related emergency room visits and 2 MDMA-related deaths occurred this past summer at Electric Zoo, an annual electronic music festival in…

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From The Archives: The Polymyxins: Why am I using them all the time, and what are they?

November 21, 2013
From The Archives: The Polymyxins: Why am I using them all the time, and what are they?

Please enjoy this post from the archives dated December 8, 2010

By Jon-Emile S Kenny

Faculty Peer Reviewed

A 65-year-old female with locally advanced rectal cancer is admitted to the ICU, hypotensive and febrile. Her PICC line is removed and blood cultures drawn. Fourty-eight hours later all cultures return ESBL Klebsiella with susceptibility only to polymyxin.

I sat on the venerable call-room couch staring mindlessly at the cluttered, nauseating walls repeating the word ‘polymyxin’ like an endless antimicrobial mantra. What strange dosing it has, and…

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FROM THE ARCHIVES – Kayexalate: What is it and does it work?

November 7, 2013
FROM THE ARCHIVES – Kayexalate: What is it and does it work?

Please enjoy this post from the archives dated December 1, 2010

By Todd Cutler, MD

Faculty Peer Reviewed

A 62-year-old male is hospitalized with an acute congestive heart failure exacerbation. On hospital day three, the patient’s symptoms have significantly improved with twice daily furosemide 80mg IV. He is continued on IV diuretics and aggressive electrolyte repletion. On day five of his admission, his basic metabolic panel is significant for a creatinine of 2.3 mg/dL (increased from 1.3 on admission) and a potassium concentration of

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Corticosteroids and Prophylaxis. What complications should you try to prevent in patients on chronic corticosteroids?

October 30, 2013
Corticosteroids and Prophylaxis.  What complications should you try to prevent in patients on chronic corticosteroids?

By Robert Joseph Fakheri, MD

Faculty Peer Reviewed

A 55 year-old male is recently diagnosed with systemic sarcoidosis. The patient is started on prednisone 40mg with the plan to decrease the dose after remission of symptoms, which may take a number of months. What kind of prophylaxis should the patient receive?

Corticosteroids are an effective treatment option for a number of diseases spanning many specialties. However, long-term corticosteroid treatment is marred with a number of side effects including hypertension, hyperglycemia, weight gain, adrenal suppression, osteoporosis,…

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Clinical Misinformation: The Case of Benadryl Causing Dementia

May 22, 2013
Clinical Misinformation: The Case of Benadryl Causing Dementia

By Natalie Smith, MD

Faculty Peer Reviewed

A few weeks ago I received an email from a friend I grew up with containing a link to an article she had seen online and a question as to its implications. The email was directed to me, the medical student, but was also sent to eight of our other closest friends. I clicked on the link and found a short article titled, “What drugs are known to cause memory loss?” My friend’s particular concern was based on…

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Xopenex: Is it worth the money?

August 16, 2012
Xopenex: Is it worth the money?

By Han Na Kim

Faculty Peer Reviewed

Case:

The patient is a 50-year-old woman with history of steroid-dependent, severe, persistent asthma since childhood and coronary artery disease who presented with dyspnea and URI symptoms admitted for management of asthma exacerbation. Patient received nebulized albuterol treatment every two to four hours, and on hospital day two, patient developed persistent sinus tachycardia to heart rate of 120s believed to be secondary to albuterol therapy. Given her tachycardia, would it be safer to prescribe levalbuterol rather than…

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The Placebo Effect: Can Understanding Its Role Improve Patient Care?

May 4, 2012
The Placebo Effect: Can Understanding Its Role Improve Patient Care?

By Brian D. Clark

Faculty Peer Reviewed

The ability to critically assess the validity of a clinical trial is one of many important skills that a physician strives to develop. This skill helps guide clinical decision-making, and there are a number of things that we are trained to look for to help determine the validity of any given study. Right at the top of the list of factors that go into this appraisal is that of study design, with the randomized, placebo-controlled trial serving…

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Challenges in the Treatment of TB and HIV Co-Infection

March 16, 2012
Challenges in the Treatment of TB and HIV Co-Infection

By Santosh Vardhana, MD/PhD

Faculty Peer Reviewed

Ms. T is a 32- year-old woman with no past medical history who presents with a three month history of productive cough, shortness of breath, and a twenty pound weight loss. On review of systems, she also reports night sweats. On physical exam, she is cachectic. Pulmonary exam reveals dry bibasilar inspiratory crackles. Rapid HIV test is positive, and CD4 count returns at 46. Chest X-ray reveals bilateral increased interstitial markings at the lung bases as well as…

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Ethical Considerations on the Use of Fear in Public Health Campaigns

November 23, 2011
Ethical Considerations on the Use of Fear in Public Health Campaigns

By Ishmeal Bradley, MD

Faculty Peer Reviewed 

The goal of public health is to prevent or minimize disease and injury on a population level. How to achieve this end has changed over time, though. In previous decades, communicable diseases posed the greatest health risks. Consequently, public health officials used the tools of isolation, quarantine, and (forced) vaccination to combat these threats. Today, however, the major causes of morbidity and mortality are chronic conditions, many of which are thought to be due to lifestyle behaviors. Consider obesity,…

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Medicine By Numbers: 131 Million

October 28, 2011
Medicine By Numbers: 131 Million

By Maryann Kwa, MD

Faculty Peer Reviewed

131 million: The number of times the most popular medication in the United States was prescribed in 2010.

Recently, IMS Health, a company that monitors annual sales for pharmaceutical and healthcare industries, published a list of the most prescribed medications in the United States in 2010 .

Medication Number of Prescriptions in 2010(in millions) 1. Hydrocodone/Acetaminophen 131.2 2. Simvastatin 94.1 3. Lisinopril 87.4 4. Levothyroxine sodium 70.5 5. Amlodipine 57.2 6. Omeprazole 53.4 7. Azithromycin 52.6

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