Commentary by David Hatcher, MSIII (reviewed by Neil Shapiro, MD Editor-In-Chief, Clinical Correlations)
C.M. is a 68 year-old retired Caucasian male with a past medical history significant for coronary artery disease, hyperlipidemia, HTN, and a 30 pack year history of smoking. His drug regimen consists of a beta-blocker, an ace inhibitor, a statin, and aspirin.
Patients like C.M. are now more common than ever before. He has already had one heart attack, and he has multiple risk factors for…
Is there evidence to support the use of Lantus® (human insulin analog glargine) administered Q12h in Type 1 Diabetes?
Commentary by Kathy Lee, Pharmacy Resident
The goal of diabetes management is to reduce the risk of long-term complications by maintaining near-normal glycemic control, in addition to reducing other risk factors. Patients with type 1 diabetes have an absolute deficiency in insulin and require exogenous insulin replacement. Lantus®, human insulin analog glargine, is the only long-acting insulin that exhibits a “peakless” action profile with…
Commentary by Robert Leonard PharmD, Pharmacy Resident New York Harbor Healthcare System
On November 20, 2007 the FDA announced mounting evidence linking varenicline (Chantix®) therapy for smoking cessation with suicidal ideation and erratic and aggressive behavior. The announcement comes in response to post-marketing case reports submitted to the FDA by the makers of Chantix®, Pfizer Inc. Early review of the cases reveal new onset of depressed mood, suicidal thoughts, and changes in emotions or behaviors within days to weeks of starting Chantix® therapy.…
Commentary by Helen Kourlas PharmD, Pharmacology Section Editor
On October 16th the FDA announced the approval of raltegravir (Isentress®) for the treatment of Human Immunodeficiency Virus (HIV)-1 infection in combination with other antiretroviral agents. The use of raltegravir is recommended for patients who have HIV-1 strains resistant to multiple antiretroviral medications. Raltegravir belongs to a new pharmacologic class of antiretrovirals called HIV integrase strand transfer inhibitors. Integrase is one of the three enzymes necessary for the HIV-1 virus to replicate, and integrase inhibitors can…
Commentary by Kathy Lee, Pharm.D. Pharmacy Practice Resident
On October 18 2007, the FDA announced the approval of labeling changes to erectile dysfunction (ED) drugs in the class known as phosphodiesterase type 5 (PDE-5) inhibitors. This includes drugs Cialis®, Levitra®, Viagra®, as well as Revatio®, a PDE-5 inhibitor indicated for pulmonary arterial hypertension (PAH). The label revisions draw attention to the potential risk of sudden hearing loss, sometimes associated with vestibular symptoms such as tinnitus, vertigo, and dizziness. Based on 29 postmarketing reports of…
Commentary by Helen Kourlas, PharmD and John Papadopoulas, PharmD, Pharmacology Section Editors
The sulfonylureas are members of a class of substituted arylsulfonylureas that have been used clinically since the 1950s. These agents are usually divided into two categories or generations. First generation agents include acetohexamide, chlorpropamide, tolazamide, and tolbutamide (the first widely utilized agent). The more potent second-generation agents include glimepiride, glipizide, and glyburide.
Sulfonylureas acutely lower plasma glucose by stimulating the release of insulin. The primary mechanism is through binding to…
Commentary by Helen Kourlas, PharmD
On September 17th 2007, the FDA issued an advisory warning healthcare professionals to avoid the use of higher than recommended doses of haloperidol, marketed as Haldol, Haldol Decanoate and Haldol Lactate. In addition to this warning, the FDA also emphasized that the injectable form of haloperidol is only approved to be administered as an intramuscular injection. Common off – label intravenous administration of haloperidol has led to numerous case reports of QT prolongation, Torsades de Piontes (TdP) and…
Commentary by Helen Kourlas, PharmD
Beta-adrenergic receptor antagonists, commonly known as beta-blockers (B-blockers) have been used for decades to treat hypertension, ischemic heart disease and some arrhythmias – and more recently to treat congestive heart failure. (1,2) Typically, B receptors are located in the heart (B1) and in peripheral vessels (B2) and the binding of catecholamines (epinephrine, norepinephrine and dopamine) to B1 receptors produce positive chronotropic and inotropic effects, while the binding of the B2 receptors produce a vasodilatory response in the peripheral…
Commentary By Susan Morey PharmD, Pharmacy Practice Resident
Approximately 3% of patients who use sulfonamide antibiotics develop an allergic reaction, with the most common being the development of a maculopapular rash. (1, 2, 3) Sulfonamides are chemical compounds which contain a SO2NH2 moiety and can be divided into 3 groups based on their structure. (1, 2) The first group, the sulfonylarylamines includes the sulfonamide antibiotics. The second group, the nonsulfonylarylamines, includes carbonic anhydrase inhibitors (CAI), cyclooxygenase 2 (COX-2) inhibitors, loop diuretics, thiazides, and…
-Commentary by Susan Morey, PharmD. Pharmacy Practice Resident
A true allergy to penicillin is known to occur in less than 10% of patients exposed to penicillin. 1, 2 The cross-reactivity to cephalosporins has been reported to be approximately 8% to 18% in patients with a documented penicillin allergy. True allergic, type I reactions are IgE mediated, with a spectrum of presentation ranging from urticaria to severe anaphylactic shock.1, 2
The beta-lactam ring has been implicated as the structure responsible for cross-reactivity…
Welcome to our first blog commentary. One of the purposes of the blog is to generate discussion about issues in health care. This “Clinical Commentary” section is an invitation to our housestaff and faculty to submit their own thoughts and viewpoints on current issues. The views expressed in this section are soley those of the authors and do not necessarily represent the views of Clinical Correlations.
Commentary by Gregory Mints MD and Nirav Shah MD, MPH
The meta-analysis of Rosiglitazone’s effect on cardiovascular events…
Commentary by Seagram Villagomez MD, Chief Resident
Since its approval in 1999, nearly 1 million Americans have used the thiazolidinedione (TZD) rosiglitazone (Avandia – GlaxoSmithKline) for the treatment of Type 2 Diabetes. However, in a drug class which seems plagued by concerns, the safety profile associated with rosiglitazone has been brought to question. Previously, troglitazone (Rezulin) was pulled off the market secondary to hepatoxicity, while muraglitazar was not approved by the FDA given adverse cardiovascular events during early clinical trials. In a…
