Items in AFP with MESH term: Drug Therapy, Combination

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Pharmacologic Treatment of Psychotic Depression - Cochrane for Clinicians


Alternative Therapies for Traditional Disease States: Osteoarthritis - Article

ABSTRACT: Americans spend more on natural remedies for osteoarthritis than for any other medical condition. In treating osteoarthritis, glucosamine and chondroitin sulfate, two of the molecular building blocks found in articular cartilage, are the most commonly used alternative supplements. In randomized trials of variable quality, these compounds show efficacy in reducing symptoms, but neither has been shown to arrest progression of the disease or regenerate damaged cartilage. Although few clinical trials on S-adenosylmethionine exist, preliminary evidence indicates that it relieves pain to a degree similar to that of nonsteroidal anti-inflammatory drugs but with fewer side effects. Clinical trials of dimethyl sulfoxide offer conflicting results. Neither ginger nor cetyl myristoleate has proven clinical usefulness.


Drug-Eluting Coronary Artery Stents - Article

ABSTRACT: Many advances have been made in the percutaneous treatment of coronary artery disease during the past 30 years. Although balloon angioplasty alone is still performed, the use of coronary artery stents is much more common. Approximately 40 percent of patients treated with balloon angioplasty developed restenosis, and this was reduced to roughly 30 percent with the use of bare-metal stents. However, restenosis within the stent can occur and is difficult to treat. Drug-eluting stents were developed to lower the rate of restenosis, which now occurs in less than 10 percent of patients treated with these stents. There have been concerns about abrupt thrombosis within drug-eluting stents occurring late after their implantation, leading to acute myocardial infarction and death. Recent studies have alleviated, but not completely dispelled, these concerns. Strict adherence to dual antiplatelet therapy with aspirin and a thienopyridine is required after stent placement, and the premature discontinuation of therapy is the most important risk factor for acute stent thrombosis. Adequate communication between cardiologists and primary care physicians is essential not only to avoid the premature discontinuation of therapy, but also to identify, before stent placement, those patients in whom prolonged antiplatelet therapy may be ill-advised. Elective surgery following stent placement should be delayed until the recommended course of dual antiplatelet therapy has been completed.


Combination Therapy for Postmenopausal Osteoporosis - FPIN's Clinical Inquiries


Addition of Long-Acting Beta Agonists for Asthma in Children - Cochrane for Clinicians


Diagnosis and Treatment of Urethritis in Men - Article

ABSTRACT: Symptoms of urethritis in men typically include urethral discharge, penile itching or tingling, and dysuria. A diagnosis can be made if at least one of the following is present: discharge, a positive result on a leukocyte esterase test in firstvoid urine, or at least 10 white blood cells per high-power field in urine sediment. The primary pathogens associated with urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae. Racial disparities in the prevalence of sexually transmitted infections persist in the United States, with rates of gonorrhea 40 times higher in black adolescent males than in white adolescent males. Recent studies have focused on identifying causes of nongonococcal urethritis and developing testing for atypical organisms, such as Mycoplasma genitalium and Ureaplasma species. Less common pathogens identified in patients with urethritis include Trichomonas species, adenovirus, and herpes simplex virus. History and examination findings can help distinguish urethritis from other urogenital syndromes, such as epididymitis, orchitis, and prostatitis. The goals of treatment include alleviating symptoms; preventing complications in the patient and his sexual partners; reducing the transmission of coinfections (particularly human immunodeficiency virus); identifying and treating the patient’s contacts; and encouraging behavioral changes that will reduce the risk of recurrence. The combination of azithromycin or doxycycline plus ceftriaxone or cefixime is considered first-line empiric therapy in patients with urethritis. Expedited partner treatment, which involves giving patients prescriptions for partners who have not been examined by the physician, is advocated by the Centers for Disease Control and Prevention and has been approved in many states. There is an association between urethritis and an increased human immunodeficiency virus concentration in semen.


Postexposure Prophylaxis Against Human Immunodeficiency Virus - Article

ABSTRACT: Family physicians often encounter situations in which postexposure prophylaxis (PEP) with antiretroviral medications against human immunodeficiency virus (HIV) may be indicated. When the exposure source's HIV status is unknown and testing of the source is possible, use of a rapid HIV test kit may facilitate decision making at the point of care. When PEP is given, timing and duration are important, with data showing PEP to be most effective when initiated within 72 hours of exposure and continued for four weeks. Although two-drug PEP regimens are an option for some lower risk occupational exposures, three-drug regimens are advised for nonoccupational exposures. Sexual assault survivors should be given three-drug PEP regardless of assailant characteristics. In complicated situations, such as exposure of a pregnant woman or when a source is known to be infected with HIV, expert consultation is advised. In most cases, PEP is not indicated after an accidental needlestick in the community setting. Health care volunteers working abroad, particularly in areas of high HIV prevalence or where preferred PEP regimens may not be readily available, often choose to travel with personal supplies of PEP. Patients presenting for care after HIV exposure should have baseline testing for HIV antibodies, and follow-up HIV antibody testing at four to six weeks, three months, and six months after exposure.


Treating Diabetic Peripheral Neuropathic Pain - Article

ABSTRACT: Diabetic peripheral neuropathic pain affects the functionality, mood, and sleep patterns of approximately 10 to 20 percent of patients with diabetes mellitus. Treatment goals include restoring function and improving pain control. Patients can realistically expect a 30 to 50 percent reduction in discomfort with improved functionality. The main classes of agents used to treat diabetic peripheral neuropathic pain include tricyclic antidepressants, anticonvulsants, serotonin-norepinephrine reuptake inhibitors, opiates and opiate-like substances, and topical medications. Physicians should ask patients whether they have tried complementary and alternative medicine therapies for their pain. Only two medications are approved specifically for the treatment of diabetic peripheral neuropathic pain: pregabalin and duloxetine. However, evidence supports the use of other therapies, and unless there are contraindications, tricyclic antidepressants are the first-line treatment. Because patients often have multiple comorbidities, physicians must consider potential adverse effects and possible drug interactions before prescribing a medication.


Valve Disease and Diet Pills-Where Do We Stand? - Editorials


The Calcium Channel Antagonist Controversy - Editorials


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