Postgraduate medicine
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Postgraduate medicine · Jan 2013
Inattention symptoms predict level of depression in early childhood.
To investigate the potential bidirectional relationships between severity of inattention and depression across early childhood. ⋯ Child inattention is a risk factor for increased levels of child depression. Pediatricians and clinicians who assess children's inattention symptoms also need to investigate symptoms of depression. This study makes a case for treating children's inattention symptoms at preschool and early childhood, before emotional problems become more severe.
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Postgraduate medicine · Jan 2013
ReviewPrimary care considerations of the pharmacokinetics and clinical use of extended-release opioids in treating patients with chronic noncancer pain.
Extended-release (ER) opioid analgesics are associated with prolonged analgesia and greater stability in pain relief compared with immediate-release formulations. Due to the pharmacokinetic (PK) characteristics of ER opioids and additional clinical advantages, the use of ER opioids for patients with moderate-to-severe chronic noncancer pain has increased. ⋯ In addition, the development of ER opioids with abuse-deterrent features marks an important milestone in potentially reducing abuse and may be factored into the clinical decision-making process. This article provides a comprehensive review of the PK and clinical effects of ER opioids and discusses novel ER opioid formulations that may limit abuse potential.
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Postgraduate medicine · Jan 2013
ReviewNovel oral anticoagulants for stroke prevention in patients with atrial fibrillation: dawn of a new era.
Atrial fibrillation (AF) is an important cause of ischemic stroke and is the underlying cause of > 20% of all strokes, with increasing age being a risk factor. Until recently, warfarin was the only available oral anticoagulant used to decrease this risk in patients with AF. However, there are several disadvantages of warfarin use, such as the requirement for monitoring the international normalized ratio, its wide range of drug-food interactions, and its narrow therapeutic index. ⋯ The US Food and Drug Administration has approved a direct thrombin inhibitor (dabigatran) and 2 factor Xa inhibitors (rivaroxaban and apixaban) for stroke prevention in patients with nonvalvular AF. There are several other new oral anticoagulant agents on the horizon, including the factor Xa inhibitor edoxaban. This review article discusses the pharmacological properties, clinical trial data, and practical issues associated with the use of these novel oral anticoagulants.
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Postgraduate medicine · Jan 2013
ReviewAntiplatelet drug use in patients with non-ST-segment elevation acute coronary syndromes.
Patients with unstable angina pectoris/non-ST-segment elevation myocardial infarction have an acute coronary syndrome. These patients should be treated with dual antiplatelet therapy with the use of aspirin plus either clopidogrel, prasugrel, or ticagrelor, depending on the clinical circumstances. ⋯ Platelet glycoprotein IIb/IIIa inhibitors should not be used as part of triple antiplatelet therapy if there is an increased risk for bleeding or in non-high-risk patients, such as those with a normal baseline cardiac troponin level, those without diabetes, and those aged ≥ 75 years for whom potential benefit may be significantly offset by the potential risk for bleeding. Clinical trial data do not support the use of intravenous cangrelor or oral vorapaxar in the treatment of patients with acute coronary syndromes.
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Postgraduate medicine · Jan 2013
ReviewA review of antithrombotic therapy for transcatheter aortic valve replacement.
Aortic stenosis (AS) is a common valvular pathological finding in older adults. A latent period followed by rapid progression after the onset of symptoms can result in a high rate of death if left untreated. Aortic valve replacement (AVR) remains the standard of care for patients with severe symptomatic AS; however, due to comorbidities and age, patients may be ineligible for surgical AVR. ⋯ Intravenous unfractionated heparin titrated to target activated clotting times during the procedure and dual antiplatelet therapy before and after TAVR with aspirin and clopidogrel may be used. However, it is unclear which antithrombotic regimen may provide optimal protection for early and late thrombotic events in patients who undergo TAVR. This review evaluates the current guidelines, trials, and registry data discussing antithrombotic regimens for TAVR.