Dementia Overview – Allison-McNutt

Overview: Gradual increase in incidence as you age 50% change after age 85 Annual screening over age 70 (AAN recommendation) 60% of dementia is Alzheimers Lewy Body Dementia (psychiatric/visual hallucinations with Parkinson's symptoms) is as prevalent as vascular dementia  5% Parkinson's < 5% frontotemporal dementia Dementia is generally progressive and acquired; increased risk when patients… Continue reading Dementia Overview – Allison-McNutt

Chronic Low Back Pain: What does and does not work (according to current evidence)

DOES WORK: Keeping moving Physical therapy or manipulation therapies Acupuncture, tai chi (clinician should emphasize possible benefits - likely enhances the placebo effect!) NSAIDs - lowest effective dose for shortest period - 1st line pharmacotherapy Can try APAP in those with NSAID contraindications, but unlikely to help Duloxetine (other SNRIs may work, but evidence lacking)… Continue reading Chronic Low Back Pain: What does and does not work (according to current evidence)

Antibiotics in Pregnancy

OK penicillins cephalosporins clindamycin erythromycin azithromycin SMX/TMP in SECOND TRIMESTER ONLY Avoid TMP in 1st trimester (folate antagonist) Avoid SMX in 3rd trimester (kernicterus risk) nitrofurantoin  Avoid in last month (risk of hemolytic anemia) CAUTION nitrofurantoin  small risk, but short courses (e.g., BV, trich) likely OK doxycycline likely OK in short courses NO fluoroquinolones tetracyclines… Continue reading Antibiotics in Pregnancy

Heparin-Induced Thrombocytopenia – Stuart

HIT occurs in 5% of patients exposed to heparin. Etiology:  Autoantibody to PF4-heparin complex. More common with UFH, in women, and with surgery. Thrombocytopenia is noted in 90%, thrombosis in 50%. Dx:  Lab:  HIT antibody testing:  PF4 antibody, IgG Clinical Dx:  Four T Score: 4 T's score [From UpToDate, 4/21/17]:  Calculating the score — The 4 T's… Continue reading Heparin-Induced Thrombocytopenia – Stuart

Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

ITP is an acquired disorder of platelets:  consider as either increased destruction or decreased production. Classified as primary (a dx of exclusion) vs secondary. Etiology:  Caused by anti-platelet IgG directed against membrane proteins of the platelets. Inciting events:  infection vs immune alteration.. Incidence:  highest in children, and increased incidence with increased age in adult. DDx:… Continue reading Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

Updated H. Pylori Regimens – Quadruple Therapy

Due to increasing resistance (~15% in some locales) of H pylori to clarithromycin, triple therapy (PPI + 2 abx) is no longer recommended.  QUADRUPLE therapy (options below) are now recommended. From Prescriber's Letter: Select an initial regimen based on prior macrolide exposure, allergies, dosing convenience, and cost. All PPIs are equally effective. Regimen Combinations Comments… Continue reading Updated H. Pylori Regimens – Quadruple Therapy

Hospital-Acquired (HAP) and Ventilator-Associated (VAP) Pneumonia Updates

Pearls from presentation 3/21/17 in FMTS by Amber, PharmD: Risk factors for MDR HAP, MRSA or Pseudomonas HAP/VAP:  IV abx within 90 d. Risk factors for MDR VAP:  prior abx within 90 d, septic shock at time of VAP, ARDS preceding VAP, ≥5 d hospitalization prior to VAP, dialysis prior to VAP onset. Antibiotic regimens: Add… Continue reading Hospital-Acquired (HAP) and Ventilator-Associated (VAP) Pneumonia Updates