Pharmacology

Statin Pleiotropy: Unique Roles for a Common Medication

April 26, 2007
Statin Pleiotropy: Unique Roles for a Common Medication

By: Melissa Freeman, MD, PGY1

For over a decade now, statins, or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, have facilitated millions of patients in the management of their atherosclerosis. Statins are known for their ability to reduce hepatic lipoproteins, up-regulate hepatic LDL receptors, and increase apoprotein E- and B-containing lipoproteins. They have become a household name in the genre of lipid-lowering and a touted hero in cardiovascular risk reduction amongst physicians. Excitingly, research has found that statins may be valuable in disease…

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First Direct Renin Inhibitor Approved for Hypertension

March 29, 2007
First Direct Renin Inhibitor Approved for Hypertension

Commentary By: Josh Olstein, PGY-3

Earlier this month the FDA approved Tekturna (aliskiren) the first drug in a novel class of antihypertensives that work by directly inhibiting renin. While Novartis has yet to release pricing information, don’t expect to see this new addition on the Bellevue or VA formulary any time soon.

The idea of treating hypertension by blocking the actions of renin has been toyed with by pharmaceutical companies for over twenty years with little success. Aliskiren is the first agent…

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Does the Overuse of Macrolides Lead to Antibiotic Resistance?

March 12, 2007
Does the Overuse of Macrolides Lead to Antibiotic Resistance?

Commentary By: Danise Schiliro, PGY-3

Although intuitively we always worry about creating drug resistance when using antibiotics, there is a surprising lack of well done studies that show a clear causal effect of antibiotic use on the development of subsequent drug resistance. A recent study in Lancet may however lead us to re-evaluate our use of macrolides in everyday practice.

Azithromycin and clarithromycin are two of the most commonly used macrolides for treating respiratory infections. Azithromycin has a long half-life, making it convenient for once…

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More Breaking News: Rosiglitazone Linked to Fractures

March 6, 2007
More Breaking News: Rosiglitazone Linked to Fractures

Commentary By: Cara Litvin PGY-3

The FDA recently informed physicians of a report issued by GlaxoSmithKline acknowledging that Avandia (rosiglitazone) has been linked to increased fractures in females (1). The report stems from a review of the safety data from ADOPT (A Diabetes Outcome and Progression Trial) (2), which was a recently published randomized trial of 4,360 patients designed to compare glycemic control with rosiglitazone relative to metformin and glyburide monotherapies. In the published study, there were no unexpected adverse events reported, although…

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A Bad Break for the Purple Pill…

January 8, 2007
A Bad Break for the Purple Pill…

Commentary By Josh Remick, PGY-2

In the December 27th 2006 issue of JAMA, Yang et al. reported the results of a nested case-control study of United Kingdom patients entitled “Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture.” Using the General Practice Research Database (GPRD), a computerized medical record system used by several of the general medical practices in the UK, new hip fracture cases were found in patients at least 50 years old (n=13,556) and matched them with…

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Do Statins Get Along With Hepatitis C?

January 4, 2007
Do Statins Get Along With Hepatitis C?

A 53 year old male with chronic hepatitis C and type 2 diabetes is found to have a moderately elevated cholesterol.

1. Is it safe to start a statin?

2. Do statins have any effect on viral replication?

Comentary By Ed Bini, M.D. Associate Professor/Director Gastroenterology and Hepatology Research

The many benefits of statins far outweigh the risks associated with this class of medications. However, statins are known to have the potential to cause hepatotoxicity. The most common form of statin-induced hepatotoxicity is elevations in…

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FDA Warns of Methadone Dangers When Used for Chronic Pain

December 12, 2006
FDA Warns of Methadone Dangers When Used for Chronic Pain

Last week, the FDA issued a public health advisory regarding the use of methadone (trade name Dolophine) for chronic pain. Death and life threatening side effects have been reported in patients newly starting methadone treatment and patients who have switched to methadone after taking other narcotics for pain control.  According to the advisory, prescribing methadone is complex and should only be used when moderate to severe pain is not relieved by other non-narcotic pain relievers.

Although pain relief from a…

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