Nursing Week’s Articles: 07/13/2009 – 07/22/2009
Use of dexamethasone and prednisone in acute asthma exacerbations in pediatric patients
Canadian Family Physician, 07/15/09
Shefrin AE et al. – Short courses of systemic corticosteroids are indicated in the treatment of moderate and severe asthma exacerbations as well as mild exacerbations unresponsive to increased doses of beta-agonist therapy and inhaled corticosteroids. Prednisone (1 to 2 mg/kg daily for 5 days) and dexamethasone (0.3 to 0.6 mg/kg daily for 1 to 5 days) are appropriate choices, with some evidence suggesting that dexamethasone might be better tolerated and requires shorter duration of therapy. Side effects of short corticosteroid treatments appear minimal and clinically insignificant. More studies are needed to ascertain the optimal dose, duration, and choice of systemic steroids, especially in the ambulatory care setting.
Osteoarthritis: Managing without surgery
APCToday, 07/16/09
Crosby J – Osteoarthritis (OA) is a common, almost expected, part of getting old. Some patients require no treatment or have symptoms that are easily controlled with over-the-counter analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) and lifestyle modifications. Others are so debilitated that surgery is the only way to go. Where does that leave elderly patients in between—those who don’t make good surgical candidates or find little relief from basic interventions and want to “try everything” before surgery? The best way to answer this question is to utilize the STEPS (Safety, Tolerability, Efficacy, Price, and Simplicity) format, a helpful mnemonic for an objective way to evaluate drugs or medical therapies. The recommendations, strength of recommendation (SOR) ratings, and summaries that follow are presented in this format, and draw upon recent reviews, focused studies, and scholarly analysis provided by the Osteoarthritis Research Society International (OARSI). The interventions are divided into 3 categories: over-the-counter remedies, nonpharmacologic interventions, injections/prescription drugs.
The CATIE and CUtLASS Studies in Schizophrenia: Results and Implications for Clinicians.
CNS Drugs, 07/16/09
Naber D et al. – CATIE and CUtLASS suggest that SGAs do not live up to all the previous expectations. However, even if most of these advantages are debatable, the lower risk of tardive dyskinesia and the better subjective effects should be strong enough reasons to favour these drugs.
Methods
* CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness)
* CUtLASS (Cost Utility of the Latest Antipsychotic drugs in Schizophrenia Study).
* 1493 patients participated in CATIE, an 18-month, double-blind trial comparing the SGAs olanzapine, quetiapine, risperidone and ziprasidone with the FGA perphenazine.
* If efficacy or tolerability was insufficient, patients were re-randomized to a medication other than the one they previously received.
* In CUtLASS, a 12-month open-label trial, 277 patients were randomized to receive an FGA or a SGA.
Results
* Improvement of psychopathology and of quality of life was only moderate.
* Overall, 74% of patients discontinued study medication before 18 months, and the median time to discontinuation was 4.6 months. from olanzapine (time to discontinuation 9.2 months), the other SGAs did not differ from each other or from perphenazine.
Glucose Control and Cardiovascular Disease in Type 2 Diabetes
Annals of Internal Medicine, 07/21/09
Kelly TN et al. – This review of 5 large trials found that, compared with conventional control, intensive glucose control reduced the risk for some cardiovascular disease (such as nonfatal myocardial infarction), did not reduce the risk for cardiovascular death or all–cause mortality, and increased the risk for severe hypoglycemia. Health care providers should focus their efforts on combining elements of lifestyle modification, glucose control that minimizes hypoglycemia, blood pressure reduction, and lipid lowering to optimally curtail the risk for CVD in patients with type 2 diabetes.
