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Am Fam Physician. 2022;105(6):588

What treatment options are available for patients diagnosed with orthostatic hypotension?

Nonpharmacologic management strategies, such as avoiding or modifying exacerbating activities, should be attempted before prescribing a medication. If nonpharmacologic management alone is insufficient, it should be used in combination with medications. First-line pharmacologic therapy should include midodrine or droxidopa (Northera) titrated to relieve symptoms. 

What type of monitoring is recommended for women with a history of postpartum thyroiditis?

Patients with a history of postpartum thyroiditis should have thyroid-stimulating hormone testing annually to evaluate for permanent hypothyroidism. 

Which imaging options are available for the noninvasive diagnosis of adenomyosis?

Diagnosis of adenomyosis is based on clinical suspicion and imaging. Transvaginal ultrasonography or pelvic magnetic resonance imaging should be used to noninvasively diagnose adenomyosis. 

What laboratory testing should be considered for patients with pruritus?

The following serologic studies should be considered when pruritus is undifferentiated after the initial evaluation: complete blood count, iron studies, renal and hepatic function tests, thyroid-stimulating hormone, and fasting glucose or A1C. 

What are the first-line treatment options for uncomplicated hepatitis C infection in adults?

Adults with hepatitis C virus (HCV) infection who meet the criteria for treatment with a simplified regimen should be treated with eight weeks of glecaprevir/pibrentasvir (Mavyret) or 12 weeks of sofosbuvir/velpatasvir (Epclusa), regardless of the HCV genotype. 

Which pharmacologic therapies are recommended for the treatment of patients with borderline personality disorder?

Psychotherapy is the first-line treatment for borderline personality disorder. However, second-generation antipsychotics, mood stabilizers, and omega-3 fatty acids are pharmacologic options for treating specific symptoms of borderline personality disorder despite low-quality evidence. 

Additional Online Only AFP Clinical Answers

What is the first-line pharmacotherapy for the prevention of cluster headaches?

First-line prophylactic therapy for cluster headache is verapamil. 

Does therapy with virtual reality decrease generalized anxiety in adults?

Virtual reality does not appear to be effective and should not be used to treat generalized anxiety disorder according to two meta-analyses and multiple randomized controlled trials. In trials including anxiety disorders such as phobias and fear of flying, virtual reality may be better than no treatment, but it is not superior to traditional behavioral therapy or cognitive behavior therapy. 

What follow-up testing is recommended for patients with microscopic hematuria who are at low risk of cancer?

According to American Urological Association guidelines, performing repeat urinalysis at six months is a reasonable alternative to imaging and cystoscopy in these patients. 

Editor's Note: Several of the answers above first appeared in the new AFP Clinical Answers email, which is sent each month to recipients of the AFP email table of contents. Sign up to receive AFP emails

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