University at Buffalo School of Pharmacy and Pharmaceutical Sciences Drug Information Response Documentation

Size: px
Start display at page:

Download "University at Buffalo School of Pharmacy and Pharmaceutical Sciences Drug Information Response Documentation"

Transcription

1 University at Buffalo School of Pharmacy and Pharmaceutical Sciences Drug Information Response Documentation Module Dates: 10/24/05-11/30/05 Name of Clerkship: Applied Pharmacotherapy Preceptor Name: Dr. Tammie Lee Demler Student Name: Maura Radliff, S. Keller Module Dates: Date of Question: 10/27/05 Date of Response: 10/30/05 Source Name & Title: Dr. Stephanie Keller Specific Question: Complete an overview of alpha-1-antogonists. Type of Questions: Short Answer Long Answer Type of Long Answer Question (please underscore): Pharmacy & Therapeutics Review / Drug Review / Newsletter / Controversial Literature Evaluation Keywords: alpha-1 blockers, overview, benign prostatic hypertrophy, BPH, hypertension, mechanism, adverse effects, safety, efficacy Data Sources: Searches of scholar.google.com and Journals at Ovid with no date limitations were performed using key search terms alpha-1 blockers, efficacy, adverse effects, terazosin, prazosin, doxazosin. Response: Background: Alpha-1 blockers are a group of medications indicated for use in hypertension or treatment of benign prostatic hypertrophy (BPH). These medications include doxazosin, terazosin, prazosin, alfuzosin, and tamsulosin. Terazosin, doxazosin, and prazosin can be used for hypertension and BPH. Tamsulosin and alfuzosin are only indicated for BPH because they have less antihypertensive effects and are more specific to the alpha-1a subtype receptors. 1 Mechanistically, these medications are selective for the alpha-1 receptors and not alpha-2 receptors. Because of this increased selectivity, the incidence of reflex tachycardia and hypotensive effects is decreased. 1 Alpha-1 receptor antagonists role in antihypertensive treatment is to block the receptors and results in smooth muscle relaxation leading to reduced blood pressure. 1 Alpha-1 receptors are also located in the prostate, prostatic urethra, and bladder neck. 1 Alpha-1a receptors are specifically involved in mediation of prostatic smooth muscle contraction which is why tamsulosin and alfuzosin target these receptors for treatment of BPH leading to increased urine flow rate and decreased symptoms. 1 Alpha-1 blockers are unique from other antihypertensive medications due to their ability to induce positive effects on lipid metabolism. 1 Patients with higher baseline

2 lipid levels taking alpha blockers have shown to have more significant effects on the lipid profile including reduction in serum total cholesterol, LDL, and triglycerides. 1 Alpha blockers have a limited adverse event profile with the most common side effect being orthostatic hypotension which is dose related. 1 It has been reported to occur with terazosin and doxazosin up to 9-10%. 1 As for alfuzosin and tamsulosin, the incidence of orthostatic hypotension is very low because of their increased selectivity for alpha-1a receptors. 1 Some other adverse effects that can occur are abdominal pain, constipation, dyspnea, peripheral edema, somnolence, and weight gain. 1 After researching further about alpha-1 blockers, it was found that new studies have been conducted in combat veterans with posttraumatic stress disorder (PTSD) to reduce the occurrence of nightmares by using prazosin. 2 It has been suggested that some neurobiological systems are controlled by alpha-1 adrenergic receptors such as stages of the sleep cycle, corticotropin releasing hormone (CRH), and stimulation of the prefrontal cortex by alpha-1 adrenergic receptors. 2 After more studies are completed, prazosin may become a new option for the treatment of PTSD related nightmares. 2 Recently, the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) compared the cardioprotective properties of doxazosin and chlorthalidone. The arm of this study was discontinued early due to the significantly higher risk of developing cardiovascular disease and heart failure in the doxazosin treatment group. For this reason, doxazosin use for hypertension treatment has declined. This has led to the current interest in reviewing this class of medications. Literature Review: ALLHAT Research Group conducted a randomized, double-blind, active controlled clinical trial in patients ( 55 years old) with hypertension and at least 1 other coronary heart disease (CHD) risk factor to compare the effect of doxazosin with chlorthalidone on the incidence of CHD for 4-8 years. CHD risk factors are previous MI or stroke, left ventricular hypertrophy by ECG, history of type 2 diabetes, current cigarette smoking, and low HDL cholesterol level. Patients were randomized to receive chlorthalidone 12.5mg-25mg per day or doxazosin 2-8mg per day. If the goal blood pressure was not reached at the maximum tolerated dosage, an open-label Step 2 agent (atenolol, reserpine, or clonidine) or an open-label Step 3 agent (hydralazine) could be added. Routine visits were scheduled every 3 months during the first year, and every 4 months after that. The primary endpoint was the composite of fatal CHD and nonfatal MI. Other outcomes also considered were all-cause mortality, combined CHD, stroke and combined CVD. However, the doxazosin treatment arm was discontinued after 4 years due to a significantly higher incidence of combined CVD events and CHF compared to the chlorthalidone treatment group. The results of the study showed that after 2 years of treatment the proportion of patients at or below blood pressure goal was 61% in the chlorthalidone group and 54% in the doxazosin group; and at 4 years, 64% were at or below blood pressure goal in the diuretic group, and 58% in the alpha-1 blocker group. The primary outcome and all-cause mortality demonstrated no significant differences between the 2 groups. However, combined CHD and stroke were higher in the doxazosin group compared to the chlorthalidone group. Also, the risk of combined CVD outcomes was 25% higher in the doxazosin treatment group (RR 1.25; 95% CI, ), which included a doubled risk for CHF. The authors concluded that it was uncertain what the CHF rate with doxazosin would be without antihypertensive drug treatment. Possible complications suggested by ALLHAT included differences in adherence of the 2 treatment groups, or how the mean systolic blood pressure was 2-3 mmhg higher in the doxazosin group which may have accounted for the increased risk of CVD. However, the study did determine that chlorthalidone is more effective than doxazosin as a first-line antihypertensive agent in older patients with hypertension and CVD risk factors. 3 Lepor et al conducted a double-blind, placebo-controlled study in 1229 men with BPH to compare the safety and efficacy of placebo, terazosin, finasteride, and the combination of both drugs. Terazosin was gradually titrated up to 10mg daily, and finasteride 5mg was administered once daily at bedtime. Patients were seen for follow-ups after 2, 4, 8, 13, 19, 26, 32, 39, 45, and 52 weeks of therapy. These routine assessments included

3 compliance, adverse effects, and vital signs. After 2, 4, 13, 26, 39, and 52 weeks, American Urological Association symptom scores, residual urinary volumes after voiding and uroflometry were determined. Hematologic analysis and studies of blood chemistry were performed at 4, 26, and 52 weeks. At 26 and 52 weeks, transrectal ultrasonography was completed; and at baseline and 52 weeks, prostate specific antigen (PSA) serum concentrations were measured. The reported adverse effect that was most common in the terazosin and combination therapy groups was dizziness. As for the finasteride and the combination treatment groups, patients reported impotence and decreased libido. The combination therapy group reported the most abnormalities in ejaculation compared to the other groups. Also, dose reductions were seen more often in the terazosin and combination therapy groups than in the finasteride and placebo groups. Symptom scores in the terazosin and combination therapy groups were significantly lower than in the placebo and finasteride treatment groups. Although finasteride and the placebo groups demonstrated significant changes from baseline, there were no differences seen between the two. The mean peak urinary flow rates at all follow-up visits were significantly higher in the terazosin and combination therapy groups than the finasteride and placebo groups. Lastly, the mean changes in prostate volume from baseline was an increase of 0.5 cm 3 in the placebo group, a decrease of 6.1 cm 3 in the finasteride group, an increase of 0.5 cm 3 in the terazosin group, and a decrease of 7.0 cm 3 in the combination therapy group. Lepor et al concluded that there were statistically significant changes between terazosin and finasteride in favor of terazosin concerning symptom scores and urinary flow rate. 4 Buzelin et al conducted a 14 week double-blind, randomized, multicenter, parallel group phase III trial in 256 patients with BPH enlargement and lower urinary tract symptoms (LUTS) to compare the efficacy and tolerability of tamsulosin with alfuzosin in the treatment of LUTS which often suggests an obstruction of the bladder and may indicate BPH. Patients were randomized to receive tamsulosin 0.4mg once daily or alfuzosin 2.5mg three times a day for 12 weeks following a 2 week placebo run-in period. At the initial assessment, a digital rectal exam to determine prostate size, an abdominal ultrasonogram or X-ray, an ECG and lab parameters were performed along with blood pressure, pulse, Boyarsky symptom score life style questionnaire and urinary free flow measurements were noted. At 2, 6 and 12 weeks of treatment, Boyarsky symptom score, urinary free flow measurements, ultrasonographic estimation of residual urine volume, and blood pressure and pulse were recorded. In addition, the final assessment at 12 weeks also included prostate size, ECG, life style questionnaire and lab determinations were noted. Primary endpoints to determine efficacy included Qmax (maximum urinary flow rate) and the total urinary symptom score measured on Boyarsky scale. The results of the study showed significant increases in Qmax relative to baseline in both treatment groups (P<0.001). However, the maximum increase in Qmax was observed at 2 weeks of treatment with tamsulosin and 2-6 weeks for alfuzosin. Also, both tamsulosin and alfuzosin showed significant decreases in Boyarsky symptom scale to a mean score of 4.1 and 3.8, respectively. No significant changes were seen in voiding and storage symptom scores between the treatment groups. Similar values for the 2 groups were also observed in patients with 30% or 3 ml/s improvement in Qmax and a 25% decrease in total symptom scores. Tamsulosin and alfuzosin were generally well tolerated and resulted in drop out rates due to adverse events of 2% and 3%, respectively. Lastly, in patients who were normotensive, statistically significant decreases were observed in alfuzosin more than tamsulosin for supine blood pressure. Buzelin et al concluded that tamsulosin has a number of advantages which make it useful for treatment of BPH including no significant decrease in blood pressure, no need for dose titration, and it is long-acting, so it can be dosed once daily. 5 Raskind et al conducted a retrospective chart review of 59 combat veterans with previous treatment-resistant chronic PTSD to determine if prazosin can reduce symptomatic distress (i.e. nightmares). The patients all had persistent nightmares even with treatment of at least one psychoactive medication (SSRIs, trazodone, sedating antihistamines, valproic acid, or benzos). The medications were continued while prazosin was being titrated and during the 8 week treatment evaluation period. Initially, prazosin was administered 1mg at bedtime for several days, increased up to 2mg, and continued to increase until nightmares improved, intolerable side effects occurred, or maximum daily dose of 20mg was attained. At baseline, postreatment, and 8 weeks after the stable dose was achieved, CAPS recurrent distressing dreams item was completed in the patients. At week 8, Clinical Global Impression-Change scale (CGI-C) score to determine change in overall PTSD severity nightmares was

4 also administered. The results of the study showed that the CAPS recurrent distressing dreams score decreased significantly from baseline (P<0.0001). The CGI-C score for overall PTSD severity limited to nightmares showed 2 patients that markedly improved, 14 patients moderately improved, 24 patients minimally improved, and 11 patients were unchanged. None of the patients had worsening of their symptoms. Fifteen patients discontinued prazosin due to adverse effects including orthostatic dizziness, headache, and nausea. The authors of the study concluded that although this was a retrospective study, the findings are encouraging and should be further pursued in larger prospective trials. 2 Summary: After reviewing the following studies, alpha-1 antagonist s use in hypertension has declined due to the results of the ALLHAT trial, but they have demonstrated good efficacy for BPH. Doxazosin was effective at reducing blood pressure, specifically, 54% achieved at or below the goal blood pressure at 2 years and 58% at 4 years. 3 However, there was a 25% higher risk of combined CVD outcomes which included a doubled risk of CHF in the doxazosin group. 3 Due to these findings, alpha-1 antagonists should not be considered first line therapy for hypertension. With all the other antihypertensive medications available (ACEI, Beta-blockers, ARBs, and diuretics), there is no need to increase the risk of cardiovascular disease when other options are accessible. However, if the patient is not high risk and has BPH an alpha-1 antagonist such as doxazosin or terazosin can be a good choice because they can be used for both conditions, thereby decreasing the number of medications a patient is taking which can increase compliance. 6 Alpha-1 blockers can also be utilized as an addition to a patient s antihypertensive therapy, but not as a sole medication. Concerning benign prostatic hyperplasia, these medications are extremely useful in decreasing symptoms and increasing urine flow rate by causing dilation of the prostatic and urinary sphincter smooth muscle indirectly. 7 In the study carried out by Lepor et al, it demonstrated that terazosin improved symptom scores and urine flow rate significantly compared to finasteride. 4 If the antihypertensive effects are unwanted, an alpha-1a antagonist such as tamsulosin or alfuzosin can be initiated. These medications primarily target the prostate and have a low incidence of orthostatic hypotension. Lastly, new studies have been conducted suggesting another possible use for prazosin in combat veterans with PTSD and related nightmares. Although the study was retrospective, another study was done by this group of authors in a small 20 week, double-blind crossover study that further supported the hypothesis of efficacy of prazosin for nightmares and other PTSD symptoms. 8 Further research is necessary to discern if prazosin will also be effective in civilians with PTSD. Alpha-1 antagonists, originally focused on treatment of hypertension, have now gained much use in treatment of BPH patients who do not require and want surgery yet. Because of the increased risk of cardiovascular disease, alpha-1 antagonists should not be used as the sole medication in high risk hypertensive patients, but can be used as an addition to an antihypertensive regimen. Tamsulosin and alfuzosin can be used for normotensive patients with BPH to decrease the incidence of orthostatic hypotension and improve symptoms. References: 1. Clinical Pharmacology [database on the internet]. Tampa: Gold Standard Multimedia; c Available from: 2. Raskind MA, Thompson C, Petrie EC, Dobie DJ, Rein RJ, Hoff DJ, et al. Prazosin Reduces Nightmares in Combat Veterans with Posttraumatic Stress Disorder. J Clin Psychiatry 2002; 63(7): ALLHAT Collaborative Research Group. Major Cardiovascular Events in Hypertensive Patients Randomized to Doxazosin vs Chlorthalidone: The Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial. JAMA 2000; 283(15): Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CM, Gormley G, et al. The efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. NEJM 1996; 335(8):

5 5. Buzelin JM, Fonteyne E, Kontturi M, Witjes WPJ, and Khan A. Comparison of tamsulosin and alfuzosin in the treatment of patients with lower urinary tract symptoms suggestive of bladder outlet obstruction (symptomatic benign prostatic hyperplasia). British Journal of Urology 1997; 80: Gavras I and Gavras H. Benefits and side effects of blood pressure lowering treatment: what was wrong with doxazosin in the ALLHAT? Curr Control Trials Cardiovasc Med 2001, 2: Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 2003; 289: Raskind MA, Peskind ER, Kanter ED, Petrie EC, Radant A, Thompson CE. Reduction of Nightmares and Other PTSD Symptoms in Combat Veterans by Prazosin: A Placebo-Controlled Study. Am J Psychiatry 2003; 160: PLEASE BE ADVISED THAT COMMUNICATION (BOTH VERBAL AND WRITTEN) BETWEEN STUDENTS, PATIENTS, AND PROVIDERS SHOULD BE REVIEWED BY THE PRECEPTOR FOR ACCURACY AND REASONABILITY PRIOR TO IMPLEMENTATION. THE SCHOOL OF PHARMACY AND PHARMACEUTICAL SCIENCE DOES NOT ASSUME ANY LIABILITY FOR THE CLINICAL USE OF STUDENT ASSIGNMENTS. C:\Documents and Settings\Lliguicota\Desktop\PSYCHIATRY NETWORK KEYWORDS\Word Files sent by Stephanie Keller\Converted to PDF\di_review_of_alpha- 1_blockers.doc

BEST in MH clinical question-answering service

BEST in MH clinical question-answering service Best Evidence Summaries of Topics in Mental Healthcare BEST in MH clinical question-answering service Question In people with PTSD (including single and multiple event trauma) how effective is prazosin

More information

TARGETED TRANSURETHRAL MICROWAVE THERMOTHERAPY VERSUS ALPHA-BLOCKADE IN BENIGN PROSTATIC HYPERPLASIA: OUTCOMES AT 18 MONTHS

TARGETED TRANSURETHRAL MICROWAVE THERMOTHERAPY VERSUS ALPHA-BLOCKADE IN BENIGN PROSTATIC HYPERPLASIA: OUTCOMES AT 18 MONTHS ADULT UROLOGY TARGETED TRANSURETHRAL MICROWAVE THERMOTHERAPY VERSUS ALPHA-BLOCKADE IN BENIGN PROSTATIC HYPERPLASIA: OUTCOMES AT 18 MONTHS BOB DJAVAN, CHRISTIAN SEITZ, CLAUS G. ROEHRBORN, MESUT REMZI, MITRA

More information

Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results

Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and

More information

ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes

ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Effects of a fixed combination of the ACE inhibitor, perindopril,

More information

Treatment of nightmares with prazosin

Treatment of nightmares with prazosin Treatment of nightmares with prazosin Simon Kung, M.D. Assistant Professor of Psychiatry Philippine-Minnesotan Medical Association Annual Meeting August 9, 2014 2011 MFMER slide-1 Disclosures None Off-label

More information

Riociguat Clinical Trial Program

Riociguat Clinical Trial Program Riociguat Clinical Trial Program Riociguat (BAY 63-2521) is an oral agent being investigated as a new approach to treat chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension

More information

SR 5. W2364A_NT.XATRAL SR5 PAK/SA 5/12/05 9:47 Page 1

SR 5. W2364A_NT.XATRAL SR5 PAK/SA 5/12/05 9:47 Page 1 W2364A_NT.XATRAL SR5 PAK/SA 5/12/05 9:47 Page 1 alfuzosin SR 5 mg (Alfuzosin HCI) COMPOSITION Each sustained-release, film-coated tablet contains: Alfuzosin hydrochloride......... 5 mg Excipients... q.s.

More information

HYPERTENSION ASSOCIATED WITH RENAL DISEASES

HYPERTENSION ASSOCIATED WITH RENAL DISEASES RENAL DISEASE v Patients with renal insufficiency should be encouraged to reduce dietary salt and protein intake. v Target blood pressure is less than 135-130/85 mmhg. If patients have urinary protein

More information

Alpha-Blocker Patient Advisory ASCRS and AAO Information Statement

Alpha-Blocker Patient Advisory ASCRS and AAO Information Statement Alpha-Blocker Patient Advisory ASCRS and AAO Information Statement Alpha-blocker drugs and intraoperative floppy iris syndrome (IFIS), related complications in cataract surgery Recommendations The American

More information

Prazosin (and Other Medications) for PTSD and mtbi. Murray A. Raskind, MD. Prazosin. Questions

Prazosin (and Other Medications) for PTSD and mtbi. Murray A. Raskind, MD. Prazosin. Questions Prazosin (and Other Medications) for PTSD and mtbi Murray A. Raskind, MD Director, VISN-20 Mental Illness Research, Education, and Clinical Center Professor and Vice-Chair Dept. of Psychiatry & Behavioral

More information

Cardiovascular Risk in Diabetes

Cardiovascular Risk in Diabetes Cardiovascular Risk in Diabetes Lipids Hypercholesterolaemia is an important reversible risk factor for cardiovascular disease and should be tackled aggressively in all diabetic patients. In Type 1 patients,

More information

Testosterone; What s all the hype? KRISTEN WYRICK, LTCOL,USAFR, MC USUHS, FAMILY MEDICINE JOINT BASE LANGLEY-EUSTIS

Testosterone; What s all the hype? KRISTEN WYRICK, LTCOL,USAFR, MC USUHS, FAMILY MEDICINE JOINT BASE LANGLEY-EUSTIS Testosterone; What s all the hype? KRISTEN WYRICK, LTCOL,USAFR, MC USUHS, FAMILY MEDICINE JOINT BASE LANGLEY-EUSTIS The faces of Low Testosterone What your patients are seeing Pharmacy Industry Testosterone

More information

Study Design Of Medical Research

Study Design Of Medical Research Study Design Of Medical Research By Ahmed A.Shokeir, MD,PHD, FEBU Prof. Urology, Urology & Nephrology Center, Mansoura, Egypt Study Designs In Medical Research Topics Classification Case series studies

More information

ADULT HYPERTENSION PROTOCOL STANFORD COORDINATED CARE

ADULT HYPERTENSION PROTOCOL STANFORD COORDINATED CARE I. PURPOSE To establish guidelines for the monitoring of antihypertensive therapy in adult patients and to define the roles and responsibilities of the collaborating clinical pharmacist and pharmacy resident.

More information

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University

More information

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY Charles Jazra NO CONFLICT OF INTEREST TO DECLARE Relationship Between Atrial Fibrillation and Age Prevalence, percent

More information

Aggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost

Aggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost Aggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost Naftali Stern Institute of Endocrinology, Metabolism and Hypertension Tel Aviv -Sourasky Medical Center and Sackler

More information

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains

More information

Emergency Room Treatment of Psychosis

Emergency Room Treatment of Psychosis OVERVIEW The term Lewy body dementias (LBD) represents two clinical entities dementia with Lewy bodies (DLB) and Parkinson s disease dementia (PDD). While the temporal sequence of symptoms is different

More information

Management of High Blood Pressure in Adults Based on the Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8)

Management of High Blood Pressure in Adults Based on the Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) Management of High Blood Pressure in Adults Based on the Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) Adapted by Capital Health Plan Approved by Quality Improvement

More information

Carefully review the risks and potential, but unproven, benefits of treatment.

Carefully review the risks and potential, but unproven, benefits of treatment. Hypertension This is a consensus guideline for the pharmacological management of hypertension with frailty. This information was developed by the Dalhousie University Academic Detailing Service and the

More information

Can Common Blood Pressure Medications Cause Diabetes?

Can Common Blood Pressure Medications Cause Diabetes? Can Common Blood Pressure Medications Cause Diabetes? By Nieske Zabriskie, ND High blood pressure, or hypertension, is a major risk factor for cardiovascular disease. In the United States, approximately

More information

ATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL)

ATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL) ATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL) By Prof. Dr. Helmy A. Bakr Mansoura Universirty 2014 AF Classification: Mechanisms of AF : Selected Risk Factors and Biomarkers for AF: WHY AF? 1. Atrial fibrillation

More information

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria.

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. Kidney Complications Diabetic Nephropathy Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. The peak incidence of nephropathy is usually 15-25 years

More information

Prazosin for the Treatment of Combat Related Nightmares in Military Veterans with PTSD DISCLOSURES. Learning Objectives

Prazosin for the Treatment of Combat Related Nightmares in Military Veterans with PTSD DISCLOSURES. Learning Objectives Prazosin for the Treatment of Combat Related Nightmares in Military Veterans with PTSD Jess Calohan, DNP, MN, PMHNP BC Lieutenant Colonel, United States Army Program Chair, Psychiatric Mental Health Nurse

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

Posttraumatic stress disorder

Posttraumatic stress disorder clinical consultation Prazosin clinical consultation Prazosin for treatment of nightmares related to posttraumatic stress disorder Heather R. Taylor, Maisha Kelly Freeman, and Marshall E. Cates Purpose.

More information

Prescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital

Prescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital Research Article Prescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital *T. JANAGAN 1, R. KAVITHA 1, S. A. SRIDEVI

More information

PROTOCOL SYNOPSIS Evaluation of long-term opioid efficacy for chronic pain

PROTOCOL SYNOPSIS Evaluation of long-term opioid efficacy for chronic pain P a g e 1 PROTOCOL SYNOPSIS Evaluation of long-term opioid efficacy for chronic pain Clinical Phase 4 Study Centers Study Period 25 U.S. sites identified and reviewed by the Steering Committee and Contract

More information

The PSA Test for Prostate Cancer Screening:

The PSA Test for Prostate Cancer Screening: For more information, please contact your local VA Medical Center or Health Clinic. U.S. Department of Veterans Affairs Veterans Health Administration Patient Care Services Health Promotion and Disease

More information

Primary Care Management of Male Lower Urinary Tract Symptoms. Matthew B.K. Shaw Consultant Urological Surgeon

Primary Care Management of Male Lower Urinary Tract Symptoms. Matthew B.K. Shaw Consultant Urological Surgeon Primary Care Management of Male Lower Urinary Tract Symptoms Matthew B.K. Shaw Consultant Urological Surgeon NICE LUTS Guidelines Lower Urinary Tract Symptoms (LUTS) in men. NICE Clinical Guideline 97

More information

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk Lynne T Braun, PhD, CNP, FAHA, FAAN Professor of Nursing, Nurse Practitioner Rush University Medical Center 2

More information

Overactive Bladder and/or Nocturia (Female)

Overactive Bladder and/or Nocturia (Female) Overactive Bladder and/or Nocturia (Female) Definition: Increased urinary frequency > 8 voids / day More than 1 void/night in women 80 years old Diagnosis

More information

Adrenergic, Adrenergic Blockers, Cholinergic and Cholinergic Blockers

Adrenergic, Adrenergic Blockers, Cholinergic and Cholinergic Blockers Adrenergic, Adrenergic Blockers, Cholinergic and Cholinergic Blockers Objective 1: Explain the difference between the sympathetic and parasympathetic nervous systems Autonomic Nervous System Sympathetic

More information

Guidance for Industry Hypertension Indication: Drug Labeling for Cardiovascular Outcome Claims

Guidance for Industry Hypertension Indication: Drug Labeling for Cardiovascular Outcome Claims Guidance for Industry Hypertension Indication: Drug Labeling for Cardiovascular Outcome Claims U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research

More information

4/29/2014. The Practice of Prescribing/Medical Psychology: Ethical Implications and Nightmare Sleep Management for PTSD. Disclaimer.

4/29/2014. The Practice of Prescribing/Medical Psychology: Ethical Implications and Nightmare Sleep Management for PTSD. Disclaimer. The Practice of Prescribing/Medical Psychology: Ethical Implications and Nightmare Sleep Management for PTSD CDR ANTHONY TRANCHITA DIRECTOR OF PSYCHOLOGICAL HEALTH GRAND FORKS AIR FORCE BASE, NORTH DAKOTA

More information

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING

More information

Cohort Studies. Sukon Kanchanaraksa, PhD Johns Hopkins University

Cohort Studies. Sukon Kanchanaraksa, PhD Johns Hopkins University This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

More information

LOW T NATION TESTOSTERONE INTAKE FORM NAME: DATE: ADDRESS: CITY: STATE: ZIP: CELL #: HOME #: SOC SECURITY #: DATE OF BIRTH:

LOW T NATION TESTOSTERONE INTAKE FORM NAME: DATE: ADDRESS: CITY: STATE: ZIP: CELL #: HOME #: SOC SECURITY #: DATE OF BIRTH: LOW T NATION TESTOSTERONE INTAKE FORM NAME: DATE: ADDRESS: CITY: STATE: ZIP: CELL #: HOME #: SOC SECURITY #: DATE OF BIRTH: DRIVERS LICENSE NUMBER: STATE: EMAIL ADDRESS: MARITAL STATUS: ( ) SINGLE ( )

More information

Sponsor Novartis. Generic Drug Name Secukinumab. Therapeutic Area of Trial Psoriasis. Approved Indication investigational

Sponsor Novartis. Generic Drug Name Secukinumab. Therapeutic Area of Trial Psoriasis. Approved Indication investigational Clinical Trial Results Database Page 2 Sponsor Novartis Generic Drug Name Secukinumab Therapeutic Area of Trial Psoriasis Approved Indication investigational Clinical Trial Results Database Page 3 Study

More information

ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY. Guidelines for Use of Intravenous Isoproterenol

ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY. Guidelines for Use of Intravenous Isoproterenol ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use of Intravenous Isoproterenol Major Indications Status Asthmaticus As a last resort for

More information

Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines

Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines Mitchell S.V. Elkind, MD, MS Associate Professor of Neurology Columbia University New York, NY Presenter Disclosure Information Mitchell

More information

Novartis Gilenya FDO Program Clinical Protocol and Highlights from Prescribing Information (PI)

Novartis Gilenya FDO Program Clinical Protocol and Highlights from Prescribing Information (PI) Novartis Gilenya FDO Program Clinical Protocol and Highlights from Prescribing Information (PI) Highlights from Prescribing Information - the link to the full text PI is as follows: http://www.pharma.us.novartis.com/product/pi/pdf/gilenya.pdf

More information

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,

More information

Case Study 6: Management of Hypertension

Case Study 6: Management of Hypertension Case Study 6: Management of Hypertension 2000 Scenario Mr Ellis is a fit 61-year-old, semi-retired market gardener. He is a moderate (10/day) smoker with minimal alcohol intake and there are no other cardiovascular

More information

PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION

PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION Hull & East Riding Prescribing Committee PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION For guidance on Primary Prevention please see NICE guidance http://www.nice.org.uk/guidance/cg181

More information

Hypertension and Diabetes

Hypertension and Diabetes Hypertension and Diabetes C.W. Spellman, D.O., Ph.D., FACOI Professor & Associate Dean Research Dir. Center Diabetes & Metabolic Disorders Texas Tech University Health Science Center Midland-Odessa, Texas

More information

Update and Review of Medication Assisted Treatments

Update and Review of Medication Assisted Treatments Update and Review of Medication Assisted Treatments for Opiate and Alcohol Use Disorders Richard N. Whitney, MD Medical Director Addiction Services Shepherd Hill Newark, Ohio Medication Assisted Treatment

More information

The MTOPS Study: New Findings, New Insights, and Clinical Implications for the Management of BPH

The MTOPS Study: New Findings, New Insights, and Clinical Implications for the Management of BPH european urology supplements 5 (2006) 628 633 available at www.sciencedirect.com journal homepage: www.europeanurology.com The MTOPS Study: New Findings, New Insights, and Clinical Implications for the

More information

JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates. January 30, 2014

JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates. January 30, 2014 JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates January 30, 2014 GOALS Review key recommendations from recently published guidelines on blood pressure and cholesterol management Discuss

More information

Anticoagulation For Atrial Fibrillation

Anticoagulation For Atrial Fibrillation Anticoagulation For Atrial Fibrillation New Agents In A New Era Arjun V Gururaj, MD Arrhythmia and Electrophysiology Nevada Heart and Vascular Center Disclosures Biotronik Speaker Clinical investigator

More information

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Guidelines Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Stroke/TIA Nearly 700,000 ischemic strokes and 240,000 TIAs every year in the United States Currently, the risk for

More information

1. What is the prostate-specific antigen (PSA) test?

1. What is the prostate-specific antigen (PSA) test? 1. What is the prostate-specific antigen (PSA) test? Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test measures the level of PSA in the blood. The doctor

More information

University at Buffalo School of Pharmacy and Pharmaceutical Sciences Drug Information Response Documentation. Module Dates:

University at Buffalo School of Pharmacy and Pharmaceutical Sciences Drug Information Response Documentation. Module Dates: University at Buffalo School of Pharmacy and Pharmaceutical Sciences Drug Information Response Documentation Module Dates: 10/24/05-11/30/05 Preceptor Name: Dr. Tammie Lee Demler Name of Clerkship: Applied

More information

Before, Frank's immune cells could

Before, Frank's immune cells could Before, Frank's immune cells could barely recognize a prostate cancer cell. Now, they are focused on it. Stimulate an immune response against advanced prostate cancer Extend median survival beyond 2 years

More information

Summary 1. Comparative-effectiveness

Summary 1. Comparative-effectiveness Cost-effectiveness of Delta-9-tetrahydrocannabinol/cannabidiol (Sativex ) as add-on treatment, for symptom improvement in patients with moderate to severe spasticity due to MS who have not responded adequately

More information

CLINICAL STUDY REPORT SYNOPSIS

CLINICAL STUDY REPORT SYNOPSIS CLINICAL STUDY REPORT SYNOPSIS Document No.: EDMS-PSDB-6511351:2.0 Name of Sponsor/Company Name of Finished Product Name of Active Ingredient(s) Protocol No.: CR002353 Johnson & Johnson Pharmaceutical

More information

Guidelines for the management of hypertension in patients with diabetes mellitus

Guidelines for the management of hypertension in patients with diabetes mellitus Guidelines for the management of hypertension in patients with diabetes mellitus Quick reference guide In the Eastern Mediterranean Region, there has been a rapid increase in the incidence of diabetes

More information

Treatment of Hypertension: JNC 8 and More

Treatment of Hypertension: JNC 8 and More PL Detail-Document #300201 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER February 2014 Treatment of

More information

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering

More information

ABOUT XARELTO CLINICAL STUDIES

ABOUT XARELTO CLINICAL STUDIES ABOUT XARELTO CLINICAL STUDIES FAST FACTS Xarelto (rivaroxaban) is a novel, oral direct Factor Xa inhibitor. On September 30, 2008, the European Commission granted marketing approval for Xarelto for the

More information

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG

More information

Special Communication

Special Communication Clinical Review & Education Special Communication 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National

More information

New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine

New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine New Cholesterol Guidelines: Carte Blanche for Statin Overuse Rita F. Redberg, MD, MSc Professor of Medicine Disclosures & Relevant Relationships I have nothing to disclose No financial conflicts Editor,

More information

Combination Antihypertensive Therapy: When to use it Diabetes

Combination Antihypertensive Therapy: When to use it Diabetes Combination Antihypertensive Therapy: When to use it Diabetes George L. Bakris, MD, F.A.S.N., F.A.S.H. Professor of Medicine Director, ASH Comprehensive Hypertension Center The University of Chicago Medicine

More information

Hypertension and Heart Failure Medications. Dr William Dooley

Hypertension and Heart Failure Medications. Dr William Dooley Hypertension and Heart Failure Medications Dr William Dooley Plan Heart Failure Acute vs. chronic Mx Hypertension Common drugs used Method of action Choice of medications Heart Failure Aims; Short term:

More information

Isabella Sudano & Franco Muggli

Isabella Sudano & Franco Muggli Swiss Hypertension Guidelines Isabella Sudano & Franco Muggli CoLaus, Swisshype ESC 2005 Dokumentenname Datum Seite 1 European Journal of Cardiovascular Prevention and Rehabilitation 2009 Guideline...

More information

Using an EMR to Improve Quality of Care in a National Network

Using an EMR to Improve Quality of Care in a National Network Using an EMR to Improve Quality of Care in a National Network James M. Gill, MD, MPH Associate Professor of Family Medicine Senior Scientist in Health Policy Jefferson Medical College, Philadelphia, PA

More information

Benign Prostatic Hyperplasia: A Case-Based Approach

Benign Prostatic Hyperplasia: A Case-Based Approach Benign Prostatic Hyperplasia: A Case-Based Approach Benign Prostatic Hyperplasia: A Case-Based Approach Release Date: December 15, 2003 Expiration Date: December 14, 2006 Target Audience: Physicians, pharmacists,

More information

Comparison/Control Groups. Mary Foulkes, PhD Johns Hopkins University

Comparison/Control Groups. Mary Foulkes, PhD Johns Hopkins University This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

More information

Urinary Incontinence FAQ Sheet

Urinary Incontinence FAQ Sheet Urinary Incontinence FAQ Sheet Are you reluctant to talk to your doctor about your bladder control problem? Don t be. There is help. Loss of bladder control is called urinary incontinence. It can happen

More information

A list of FDA-approved testosterone products can be found by searching for testosterone at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/.

A list of FDA-approved testosterone products can be found by searching for testosterone at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/. FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke

More information

7. Prostate cancer in PSA relapse

7. Prostate cancer in PSA relapse 7. Prostate cancer in PSA relapse A patient with prostate cancer in PSA relapse is one who, having received a primary treatment with intent to cure, has a raised PSA (prostate-specific antigen) level defined

More information

The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT?

The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT? AACE 23 rd Annual Scientific and Clinical Congress (2014) Syllabus Materials: The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT? JoAnn E. Manson, MD, DrPH, FACP, FACE Chief, Division

More information

ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE

ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE I- BACKGROUND: Coronary artery disease and stoke are the major killers in the United States.

More information

FAQ About Prostate Cancer Treatment and SpaceOAR System

FAQ About Prostate Cancer Treatment and SpaceOAR System FAQ About Prostate Cancer Treatment and SpaceOAR System P. 4 Prostate Cancer Background SpaceOAR Frequently Asked Questions (FAQ) 1. What is prostate cancer? The vast majority of prostate cancers develop

More information

Oral Zinc Supplementation as an Adjunct Therapy in the Management of Hepatic Encephalopathy: A Randomized Controlled Trial

Oral Zinc Supplementation as an Adjunct Therapy in the Management of Hepatic Encephalopathy: A Randomized Controlled Trial Oral Zinc Supplementation as an Adjunct Therapy in the Management of Hepatic Encephalopathy: A Randomized Controlled Trial Marcus R. Pereira A. Study Purpose Hepatic encephalopathy is a common complication

More information

Cardiovascular Effects of Drugs to Treat Diabetes

Cardiovascular Effects of Drugs to Treat Diabetes Cardiovascular Effects of Drugs to Treat Diabetes Steven E. Nissen MD Chairman, Department of Cardiovascular Medicine Cleveland Clinic Disclosure Consulting: Many pharmaceutical companies Clinical Trials:

More information

Statins and Risk for Diabetes Mellitus. Background

Statins and Risk for Diabetes Mellitus. Background Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration

More information

High Blood Cholesterol

High Blood Cholesterol National Cholesterol Education Program ATP III Guidelines At-A-Glance Quick Desk Reference 1 Step 1 2 Step 2 3 Step 3 Determine lipoprotein levels obtain complete lipoprotein profile after 9- to 12-hour

More information

PSA Screening for Prostate Cancer Information for Care Providers

PSA Screening for Prostate Cancer Information for Care Providers All men should know they are having a PSA test and be informed of the implications prior to testing. This booklet was created to help primary care providers offer men information about the risks and benefits

More information

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. abcd Clinical Study for Public Disclosure This clinical study synopsis is provided in line with s Policy on Transparency and Publication of Clinical Study Data. The synopsis which is part of the clinical

More information

HYPERCHOLESTEROLAEMIA STATIN AND BEYOND

HYPERCHOLESTEROLAEMIA STATIN AND BEYOND HYPERCHOLESTEROLAEMIA STATIN AND BEYOND Andrea Luk Division of Endocrinology Department of Medicine & Therapeutics The Chinese University of Hong Kong HA Convention 4 May 2016 Statins reduce CVD and all-cause

More information

Male New Patient Package

Male New Patient Package Male New Patient Package The contents of this package are your first step to restore your vitality. Please take time to read this carefully and answer all the questions as completely as possible. Thank

More information

Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL

Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL www.goldcopd.com GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR DIAGNOSIS, MANAGEMENT

More information

Lifestyle-based Adrenal Dysfunction

Lifestyle-based Adrenal Dysfunction Assessing Adrenal Function Primary FDM Testing Glandular vs. Lifestyle Adrenal problems Glandular-based Adrenal Problems Lifestyle-based Adrenal Dysfunction http://www.fmtown.com 1 Causes of Adrenal Dysfunction

More information

Diabetic Nephropathy

Diabetic Nephropathy Diabetic Nephropathy Kidney disease is common in people affected by diabetes mellitus Definition Urinary albumin excretion of more than 300mg in a 24 hour collection or macroalbuminuria Abnormal renal

More information

Care Manager Resources: Common Questions & Answers about Treatments for Depression

Care Manager Resources: Common Questions & Answers about Treatments for Depression Care Manager Resources: Common Questions & Answers about Treatments for Depression Questions about Medications 1. How do antidepressants work? Antidepressants help restore the correct balance of certain

More information

Erectile Dysfunction (ED)

Erectile Dysfunction (ED) Information from your Patient Aligned Care Team What is Erectile Dysfunction or ED? Erectile dysfunction (also known as impotence) is the inability to get and keep an erection firm enough for sex. Having

More information

MANAGEMENT OF PROSTATE ENLARGEMENT/BPH

MANAGEMENT OF PROSTATE ENLARGEMENT/BPH MANAGEMENT OF PROSTATE ENLARGEMENT/BPH J E S S I C A E. P A O N E S S A, M. D. A S S I S T A N T P R O F E S S O R D E P A R T M E N T O F U R O L O G Y S U N Y U P S T A T E M E D I C A L U N I V E R

More information

Hypertension Guidelines

Hypertension Guidelines Overview Hypertension Guidelines Aim to reduce Blood Pressure to 140/90 or less (140/80 for diabetics), adding drugs as needed until further treatment is inappropriate or declined. N.B. patients do not

More information

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented National Quality Strategy Domain: Community / Population Health 2016 PQRS OPTIONS F INDIVIDUAL MEASURES:

More information

Drugs for MS.Drug fact box cannabis extract (Sativex) Version 1.0 Author

Drugs for MS.Drug fact box cannabis extract (Sativex) Version 1.0 Author Version History Policy Title Drugs for MS.Drug fact box cannabis extract (Sativex) Version 1.0 Author West Midlands Commissioning Support Unit Publication Date Jan 2013 Review Date Supersedes/New (Further

More information

Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.

Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40. A.D.A.M. Medical Encyclopedia. Prostate cancer Cancer - prostate; Biopsy - prostate; Prostate biopsy; Gleason score Last reviewed: October 2, 2013. Prostate cancer is cancer that starts in the prostate

More information

Guidelines for Cancer Prevention, Early detection & Screening. Prostate Cancer

Guidelines for Cancer Prevention, Early detection & Screening. Prostate Cancer Guidelines for Cancer Prevention, Early detection & Screening Prostate Cancer Intervention Comments & Recommendations For primary prevention, it has been suggested that diets low in meat & other fatty

More information

PHENYLEPHRINE HYDROCHLORIDE INJECTION USP

PHENYLEPHRINE HYDROCHLORIDE INJECTION USP PRESCRIBING INFORMATION PHENYLEPHRINE HYDROCHLORIDE INJECTION USP 10 mg/ml Sandoz Canada Inc. Date of Preparation: September 1992 145 Jules-Léger Date of Revision : January 13, 2011 Boucherville, QC, Canada

More information

ORAL MEDICATIONS FOR MS! Gilenya and Aubagio

ORAL MEDICATIONS FOR MS! Gilenya and Aubagio ORAL MEDICATIONS FOR MS! Gilenya and Aubagio Champions against MS 4/20/13 Alexandra Goodyear, MD Stanford University Oral Medications Since 2010, 3 new oral medications for MS: Gilenya 2010 Aubagio 2012

More information

KELLI DEWITT WHITEHEAD, RN, MS, ARNP

KELLI DEWITT WHITEHEAD, RN, MS, ARNP CIRRICULUM VITAE KELLI DEWITT WHITEHEAD, RN, MS, ARNP Associated Urologist, PA 341 Wheatfield, Suite 180 Sunnyvale, TX 75182 972-270-8859 EDUCATION Master of Science, Family Nurse Practitioner University

More information