Pharmacy & Therapeutics - February 2009 - (Page 70)

NEW DRUGS Program (SCHIP) is a major step toward meeting that goal. The legislation would cost nearly $33 billion over 4.5 years and would be funded in part by a cigarette tax increase of $.61 to $1 per pack. President George W. Bush had vetoed two similar bills in 2007. The House bill would provide health insurance to an additional 4.1 million children and parents, including children and pregnant women who are legal immigrants. A total of 11 million individuals could now receive coverage. Source: Washington Post, January 15, 2009 DRUG NEWS statins plus ezetimibe in 499 patients with type-2 diabetes. An earlier study had found that adding ezetimibe to simvastatin (Zocor, Merck) boosted reductions in LDL-C levels by an additional 17%. However, over two years, the average increase in common carotid ar ter y intima media thickness (CIMT) did not differ significantly from that in the statinonly group. The findings from this study, a secondary analysis of data from SANDS, indicate that CIMT regression was similar with both treatments. The key seems to be that all of these patients were in the “aggressive goal” groups with targets as follows: LDL-C, 70 mg/dL; non–HDL-C, 100 mg/dL; and systolic blood pressure, 115 mm Hg. By contrast, CIMT progressed in the patients receiving standard therapy. Source: J Am Coll Cardiol 2008;52: 2198–2205 stable over the lifetime. Thus, limited supplies of vaccine can be reserved for people who have never been vaccinated. Source: Am J Med 2008;121:1058–1064 Drugs Benefit Elderly Patients Undergoing Surgery Elderly patients who undergo major surgery have a high risk of cardiac complications, mainly because of their age and comorbidities. Do medications help, or is age an overwhelming factor? Researchers from The Netherlands say perioperative medications have both short-term and long-term benefits. They conducted a study of 1,693 patients 65 years of age and older who had major noncardiac vascular surgery. During followup (median, 8.2 years), 619 patients died, 137 (8%) in the hospital. The most common cause of death was cardiac disease, accounting for nearly half of the deaths. The perioperative use of aspirin, beta blockers, and statins was associated with a 47%, 68%, and 65% lower risk of hospital mortality, respectively. These agents were also associated with a lower risk of death over the long term: aspirin (35%), angiotensin-converting enzyme (ACE)– inhibitors (26%), beta blockers (39%), and statins (35%). No significant interaction was noted between age and use of medications; however, the risk of overall mortality in the statin patients declined in a gradient from the youngest to the oldest. The perioperative use of statins might be beneficial, especially in the very old. Source: Arch Gerontol Geriatr 2009; 48:116–120 One Smallpox Shot For a Lifetime Smallpox immunity lasts for a lifetime after a vaccination, according to findings from the Baltimore Longitudinal Study of Aging. Of 246 participants, 209 had been vaccinated one or more times as many as 88 years before the study. Stored serum samples were available at various intervals after vaccination. Eight other participants had received smallpox in childhood, and 29 had no history of infection or vaccination. Vaccinated participants maintained antivaccinia immunoglobulin G (IgG) and neutralizing antibody titers above 3 natural logs essentially indefinitely. In 97% of the participants, the researchers found no reduction in vaccinia-specific antibody titers over the follow-up period. Those subjects who had survived smallpox infection retained antivaccinia antibody titers similar to those in vaccinated participants. Multiple vaccinations appeared to have only marginally greater efficacy than a single vaccination. It had been recommended that individuals with repeated exposure to smallpox be revaccinated every five years. However, a single vaccination appears to elicit functional antibody that remains Caffeine and Low Birth Weight Although many women reduce their caffeine intake when they are pregnant, they might not be cutting back enough. More than 100 mg of caffeine a day can restrict fetal growth. Researchers from Great Britain cite earlier studies that considered safe caffeine consumption to be as low as 141 mg/day. In other studies, more than 300 mg/day was associated with low birth weight, but the findings were inconclusive, possibly because of inaccurate estimates of caffeine consumption; for instance, some women assumed that tea and coffee were the only sources of caffeine. Caffeine is rapidly absorbed and easily crosses the placenta. Intervillous blood flow to the placenta starts to decline by as much as 25% after 200 mg of caffeine is ingested. However, the placenta and fetus don’t have cytochrome P450 1A2, a main enzyme in caffeine metabolism, so continued on page 76 Statin Effects on Diabetes Does adding ezetimibe (Zetia, Merck/ Schering-Plough) to statin therapy improve subclinical atherosclerosis? Researchers from the Stop Atherosclerosis in Native Diabetics Study (SANDS) compared statins alone with 70 P&T® • February 2009 • Vol. 34 No. 2

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Pharmacy & Therapeutics - February 2009 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/New Medical Devices Drug Forecast Pushing an Expanded Role for Pharmacists Better Asthma Management with Advanced Technology Pharmaceutical Approval Update 58th Annual Meeting, American Society of Human Genetics, 2008 American Society of Hematology, 50th Annual Meeting and Exposition 2008 San Antonio Breast Cancer Symposium Stahl’s Essential Psychopharmacology, 3rd Edition Author Guidelines

Pharmacy & Therapeutics - February 2009

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