[120] Routine VTE prophylaxis: Is there a net health benefit?
Prophylaxis of venous thromboembolism (VTE) with low molecular weight heparin (LMWH) is now common for hospitalized non-surgical patients in British Columbia and much of North America. This includes patients who are at very low risk for a VTE. VTE events include deep vein thrombosis (DVT), usually in the legs, which can be either symptomatic or asymptomatic, as well as pulmonary embolism … [Read more...]
[119] Epinephrine autoinjectors available in Canada
Anaphylaxis is one of the most dramatic health crises. Experiencing or witnessing this acute and serious allergy event is a powerful incentive to learn more, yet many health care professionals must act without the benefit of personal experience. The Canadian Institute for Health Information estimates that anaphylaxis makes up 8% of the approximately 171,000 annual emergency department visits for … [Read more...]
[118] Trends in utilization of proton pump inhibitors in British Columbia
The first three Therapeutics Letters focused on complaints related to the upper gastrointestinal tract, a common presentation to the primary care physician.1-3 These Letters reviewed evidence about H2-blockers, eradication of Helicobacter pylori, and drugs used for gastroesophageal reflux. However, they also raised concerns about chronic acid suppression by daily dosing of omeprazole, the first … [Read more...]
[117] Gabapentin and pregabalin: Are high doses justified?
Analgesia once seemed a relatively straightforward aspect of medicine. Recommendations in textbooks and guidelines were definitive, albeit heavily conflicted. Even recent guidelines encourage dose titration, based on an implicit, if unsupported, notion that more is likely to be better.1 Recent experiments and systematic reviews show that drugs seldom outperform placebo significantly in chronic … [Read more...]
[116] New drug for cystic fibrosis: Regulatory approval, clinical uncertainty?
A new drug for cystic fibrosis (CF) that combines lumacaftor and ivacaftor (Orkambi), was approved by Health Canada (HC) in 2016 to treat people age 12 and older with the most frequent CF genetic mutation: homozygous F508 deletion of the cystic fibrosis transmembrane regulator (CFTR) gene. This affects 50% of the Canadian CF population. In CF, mucus membranes do not release an adequate amount … [Read more...]
[115] Cannabinoids for Chronic Pain
Canada's parliament legalized the recreational use of herbal cannabis (marijuana) in October 2018. The well-publicized limitations of clinical research and well-recognized side effects such as cannabis intoxication have not deterred people from seeking out and using herbal cannabis for chronic pain in increasing numbers. This is occurring with or without a physician’s authorization.1 In fact, half … [Read more...]
[114] Shingrix: A New Vaccine for Shingles
Herpes zoster (HZ) or “shingles” occurs when the varicella zoster virus (VZV), lying latent in the sensory ganglia, becomes reactivated. An HZ outbreak typically presents as a vesicular skin eruption most characteristically forming a painful girdle around one side of the thorax. The rash and pain usually resolve over a few weeks. However, about 10% of patients with shingles develop some degree of … [Read more...]
[113] How well do you know your anticholinergic (antimuscarinic) drugs?
Anticholinergic drugs, prescribed for a variety of clinical conditions, are amongst the most frequently used prescription drugs in BC (Table 1). Also referred to as “antimuscarinics,” such drugs specifically block muscarinic receptors for acetylcholine (ACh).1 Muscarinic ACh receptors are important in the parasympathetic nervous system that governs heart rate, exocrine glands, smooth muscles, as … [Read more...]
[112] Antidepressant Withdrawal Syndrome
Antidepressant drugs are associated with drug tolerance, dependence and a discontinuation syndrome similar to other drug classes such as the opiates and benzodiazepines. The effects of stopping any antidepressant should be more precisely termed “withdrawal syndrome” instead of “antidepressant discontinuation syndrome.” What is it? Antidepressant withdrawal syndrome refers to physical and … [Read more...]
[111] Deprescribing Proton Pump Inhibitors
The first PPI was approved in Canada in 1988. Pronounced and durable reduction of stomach acid production made omeprazole a “blockbuster drug”, spawning multiple imitators. Eventually this included (as patent extensions) the single enantiomers esomeprazole and dexlansoprazole. Prescription PPIs are approved for peptic ulcer disease (PUD), gastroesophageal reflux (GERD), and non-ulcer dyspepsia. … [Read more...]
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