Pharmacology

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 albuterol?…

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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 as …

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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 …

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

September 23, 2011
They’re all the ‘roid rage: origins and mechanisms of corticosteroid therapy.

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.

A 60-year-old man with HIV on HAART presents to the ER …

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Avastin and the Meaning of Evidence

September 9, 2011
Avastin and the Meaning of Evidence

By Antonella Surbone MD PhD and Jerome Lowenstein MD

The recent hearings at the Food and Drug Administration regarding the revocation of approval for the use of Avastin in the treatment of breast cancer bring into sharp focus several very important issues in medicine today.

The pharmaceutical industry, armed with powerful new tools for deciphering the signaling mechanisms and mutations responsible for the development and progression of malignancies, has developed new therapies for treating cancer and other malignancies. The cost of development of each …

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More Pills, More Problems: The Polypill Revisited

August 3, 2011
More Pills, More Problems: The Polypill Revisited

By Jonathan Leventhal

Faculty Peer Reviewed

Polypharmacy has become an integral part of daily life for millions of chronically ill patients worldwide, and rightfully so. Evidence-based studies have repeatedly demonstrated that multiple drugs are required for optimal therapeutic management in chronic diseases including diabetes, hypertension, and heart disease. A typical patient with cardiovascular disease will likely be on aspirin, a statin, an ACE inhibitor, a diuretic, a calcium channel- or beta-blocker, and possibly antidiabetic medications. Cardiovascular disease is only one area in which effective …

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