iForumRx.org

Drug Treatment for Agitation in Alzheimer’s Disease: A Conundrum

Managing behavioral health in persons withdementia is an enormous and growing problem. Most patients with Alzheimer's disease (AD) have challengingneuropsychiatric symptoms such as agitation. These symptoms are distressing andoften overwhelming for caregivers often resulting in institutionalization andincreased healthcare utilization. Several medications are used off-labelto treat these symptoms including antidepressants, antipsychotics,anticonvulsants, anxiolytics and cholinesterase inhibitors.   But manyregulatory bodies, professional associations, and patient advocacy groups havepromoted initiatives to decrease the inappropriate use of medications andencourage the use of alternatives, particularly behavioral interventions. The combination of dextromethorphan hydrobromideand quinidine sulfate (Nuedexta) has been recently studied for the off-labeltreatment of agitation in Alzheimer’s disease.  A patient-centered, systematic, andevidence-based approach should be considered when addressing the behavioral and psychological symptoms of dementia.

Crossing the Periprocedural Bridge in Patients with Atrial Fibrillation

For over two decades LMWHs have been routinely used to provide therapeutic coverage in patients who must temporarily stop warfarin. Current guidelines suggest using injectable anticoagulants during warfarin interruption (aka bridging) in patients with atrial fibrillation based on patients’ risk of arterial thrombosis. Using the CHADS₂ score to assess risk, the guidelines recommend (grade 2C) bridge therapy if the CHADS₂ score is 5 or higher and not bridging if the CHADS₂ score is 2 or lower. But what about patients with a CHADS₂ score of 3 or 4?

Reconsidering Strategies for Insulin Intensification

Basal, prandial, NPH, ultra-long, inhaled, 70/30, 75/25, 50/50, U-100, U-200, U-300, and U-500 insulin … the list of options for patients with diabetes requiring insulin continues to expand. Current guidelines for glycemic management of patients with type 2 diabetes provide specific recommendations for the initiation of insulin therapy, but not insulin intensification. The recently published LanScape study provides a foundation for making evidence-based clinical decisions.

TEXT ME — Text Messaging to Promote Behavior Change

With over 75% of people using mobile phones worldwide, text messaging might be a simple, cost-effective platform to encourage lifestyle changes. Several healthcare-related applications and mobile phone text messaging systems have already been designed; yet, very few have undergone rigorous testing to confirm clinical benefit.  The investigators of the Tobacco, Exercise, and Diet Messages (TEXT ME) trial designed a text message-based intervention to encourage lifestyle modifications and evaluated its impact on cardiovascular risk in patients with established CHD. The TEXT ME study provides robust findings to support a simple, inexpensive intervention to modify cardiovascular risk … at least over the short term.

Pulling Ahead After a SPRINT – Evidence for Lower Blood Pressure Goals

The debate over the intensity of blood pressure (BP) lowering for patients with hypertension has been going on for decades.  Additional fuel to the fire was recently added with the early halt and publication of the Systolic Blood Pressure Intervention Trial (SPRINT).  So “how low should you go” for patients with high BP? Do lower BP goals reduce CV outcomes and death, particularly in patients at high risk?  Do they cause greater adverse effects? Or perhaps even worsen CV outcomes? These questions were examined in SPRINT.

Televised Medical Talk Shows – Is There Truth in Edutainment?

Televised medical talk shows have become a daily viewing ritual for millions around the world. The Dr Oz Show is so popular that it earned him the title “America’s Doctor”, attracting massive numbers of followers as did the show The Doctors.   To what extent are the recommendations and claims made by medical shows supported by evidence? 

Preventing Gestational Diabetes with Myo-Inositol: Ready for Prime Time?

With increased emphasis on disease prevention, gestational diabetes (GDM) is worthy of more attention. The incidence is on the rise not only in the United States (U.S.) but worldwide. Complications of GDM such as preeclampsia, cesarean delivery, neonatal hypoglycemia, macrosomia, and birth trauma negatively impact maternal and fetal health. Is a readily available, non-prescription dietary supplement the answer? Recent investigations have examined the use of myo-inositol for GDM prevention, with positive results. 

An Aspirin a Day to Prevent Colon CA

Several studies have evaluated the correlation between low-dose aspirin and NSAID use and the development of colorectal cancer. In 2007, the U.S. Preventive Services Task Force (USPSTF) recommended against the use aspirin for the prevention of colorectal cancer in most adults. However, there is mounting evidence that daily, long-term aspirin use may prevent colorectal cancer in patients aged 50-69. Could something as simple as an aspirin a day prevent colon CA?

The Heart of the Matter – Is EMPA-REG a Game Changer for Diabetes Management?

The Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) study sought to determine the effects of empagliflozin on cardiovascular morbidity and mortality in patients with type 2 diabetes at high risk for CVD. Does the evidence from the EMPA-REG OUTCOME study coupled with the other benefits of SGLT2 inhibitors (reduction in weight and blood pressure, mild adverse effects) make empagliflozin the preferred second-line agent from the treatment of type 2 diabetes? 

Taking a CHANCE on Clopidogrel Plus Aspirin to Prevent Stroke Recurrence

The CHANCE (Clopidogrel in High risk patients with Acute Non-disabling Cerebrovascular Events) trial investigators examine whether patients who have a TIA or mini-stroke should receive aspirin AND clopidogrel to reduce the risk of recurrent stroke.