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Am Fam Physician. 2023;107(2):130

What is the preferred pharmacologic treatment for chronic constipation in adults?

First-line pharmacologic treatment options for normal transit and slow transit constipation include bulk laxatives and osmotic laxatives. Polyethylene glycol (Miralax) is the preferred osmotic laxative over lactulose for the treatment of constipation because it is more effective and has fewer adverse effects.

What initial treatment should be considered for patients with endometriosis symptoms?

The first-line treatment for symptoms of endometriosis is combined hormonal contraceptives. Patients presenting with clinical symptoms of endometriosis can start empiric treatment and then plan for diagnostic laparoscopy if symptoms do not improve or if medication is not tolerated.

When should patients be offered a spiritual assessment?

Consider offering a spiritual assessment to patients at hospitalization, if a significant clinical decline occurs in the hospital setting, when addressing end-of-life care, or when providing psychosocial services for the treatment of substance use disorders in the hospital setting.

Does medical cannabis help chronic pain?

Noninhaled medical cannabis or cannabinoids slightly improve pain levels (number needed to treat = 10; 95% CI, 7 to 20) to decrease average pain by 1 cm more on a 10-cm visual analog scale compared with placebo for people living with chronic cancer or noncancer pain. These medications slightly improve sleep quality and physical functioning compared with placebo.

What are the most effective forms of emergency contraception?

The copper IUD (Paragard) is the most effective form of emergency contraception, with the levonorgestrel-releasing intrauterine system, 52 mg, (Mirena, Liletta) found to be similarly effective, followed by oral ulipristal (Ella); oral levonorgestrel, 1.5 mg (Plan B One-Step); and the Yuzpe method.

What treatment is recommended for immune thrombocytopenia (ITP)?

Initial treatment for ITP is corticosteroid therapy or intravenous immune globulin (human) infusion. Recurrent or unresponsive cases are treated with thrombopoietin receptor agonists or immunomodulators (e.g., rituximab). ITP is the most common cause of isolated thrombocytopenia. There is no specific laboratory test for ITP, so it is often a diagnosis of exclusion. Primary ITP is distinguished from secondary ITP by the absence of chronic medical conditions or acute infections.

Additional Online Only AFP Clinical Answers

Are over-the-counter formulas that contain antihistamines, analgesics, or decongestants effective in treating symptoms of the common cold?

Antihistamine/analgesic/decongestant combinations have some general benefits in adults and older children. However, these benefits must be weighed against the risk of adverse effects. There is no evidence of effectiveness in young children.

What adjunctive therapies are helpful for the management of schizophrenia in addition to antipsychotic medication?

Adjunctive treatments with psychosocial therapies such as cognitive behavior therapy for psychosis, psychoeducation, supported employment services, assertive community care, and family interventions should be offered.

Is a five-day or 10-day regimen of antibiotics more effective for children with community-acquired pneumonia (CAP)?

Children who clinically improve after five days of antibiotics for CAP do well whether they stop treatment or receive an additional five days of therapy, based on one randomized controlled trial.

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