The authors describe a study in which “bipolar families,” compared with families without a serious mental illness, incurred much higher medical costs, visited physicians more often, had more hospital stays, and spent more money on prescription drugs.
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P&T® Journal contents for January 2008
Second-generation atypical antipsychotic drugs carry a lower risk of extrapyramidal symptoms and tardive dyskinesia compared with conventional agents, but they are not without their dangers. The case report of a 46-year-old patient demonstrates the point that the newer agents should be used according to their FDA-approved indications, when possible, and that patients using aripiprazole, an “atypical atypical” agent, need to be carefully monitored.
Although the “vaccine revolution” has resulted in products that can prevent illness and reduce costs of disease, the authors raise several concerns: who will pay for these improvements, how these advances will alter treatment, how cost and efficacy will be balanced, and how to choose the right product.
Presentations cover a number of clinical trials of cardiac agents, including clopidogrel versus prasugrel; an investigative thrombin receptor antagonist; a niacin/simvastatin combination; warfarin dosing versus genotype-guided dosing; clopidogrel eptifibatide, and bivalirudin; and eptifibatide versus abciximab.
Topics include nilotinib (Tasigna Capsules) for the treatment of chronic myelogenous leukemia (CML), raltegravir (Isentress) for patients with HIV-1 infection, and ixabepilone (Ixempra), combined with capecitabine (Xeloda), for use in metastatic or locally advanced breast cancer.
We know you’re as sick of the word “change” as we are, but like many clichés, it serves its purpose. Oh, and by the way, P&T is going digital.
Use and Outcomes of Antifibrinolytic Therapy in Patients Undergoing Cardiothoracic Surgery at 20 Academic Medical Centers in the United States
Given the association between the use of aprotinin (Trasylol) and an increased risk of adverse events among cardiothoracic surgery patients, in contrast to a lack of elevated risk for aminocaproic acid and tranexamic acid, the authors suggest that hospitals examine their current patterns of use and perhaps restrict aprotinin for these patients to prevent major blood loss.
Evaluation of the Management of Acute Venous Thromboembolism and Its Outcomes: One Institution’s Experience
The authors describe a study in which they sought to determine whether standard practice guidelines for the care of patients with VTE were being followed at their VA center.
Presentations cover lenalidomide (Revlimid) in the treatment of multiple myeloma, eculizumab (Soliris) for paroxysmal nocturnal hemolysis, RAD001 (Everolimus) for lymphoma, the use of deferasirox (Exjade) in patients with iron overload, and dasatinib (Sprycel) and nilotinib (Tasigna) for chronic myelogenous leukemia.
Topics include sapropterin dihydrochloride tablets (Kuvan) for reducing phenylalanine levels in patients with phenylketonuria; nebivolol (Bystolic) for hypertension; and a starch infusion (Voluven) to prevent decreased blood volume during surgery.
Presentations cover a short course of treatment with capecitabine (Xeloda), docetaxel (Taxotere), and trastuzumab (Herceptin); a study of the aromatase inhibitors letrozole (Femara) and zoledronic acid (Zometa) and their effect on bone loss; the aromatase inhibitors and tamoxifen (Nolvadex); and a trial of capecitabine plus ixabepilone (Ixempra) compared with ixabepilone monotherapy.
Topics include two new agents: ciclesonide (Alvesco Inhalation Aerosol) for the maintenance treatment of asthma and etravirine (Intelence) for adults with HIV infection. A new indication for colesevelam (Welchol) to improve glycemic control in type-2 diabetes is also discussed.
The authors conducted a study to determine whether patients who were not using insulin were following guidelines for self-monitoring of blood glucose. After a new software package was implemented at their institution, the reduced number of excess test strips led to cost savings and improved compliance.
Continuing Education Credit
The authors describe the pathophysiology and pharmacotherapy of a common complication of diabetes that causes significant morbidity and mortality.
Topics include Medicare Part D, informatics, and the paper edition of P&T.
Health Care & Law
Dr. Field presents the case for and against the FDA’s proposed new limits for pharmaceutical manufacturers in marketing and promoting off-label uses of drugs.
Presentations cover comparisons of daptomycin (Cubicin for Injection) and vancomycin (Vancocin) for skin infections and recombinant human thrombin versus bovine-derived thrombin for controlling hemostasis during surgery.
Topics include desvenlafaxine (Pristiq) for major depressive disorder in adults; rilonacept (Arcalyst) in treating inflammatory syndromes; and levocetirizine (Xyzal Oral Solution) for symptoms associated with allergic rhinitis and hives.
Continuing Education Credit
The authors discuss current and investigational therapies for this debilitating illness, the adverse events associated with its treatment, and some protocols for preventing stroke and infection.