Pharmacy & Therapeutics - March 2009 - (Page 130) NEW DRUGS arrived in the ED and was followed throughout their hospital stay, including discharge drugs and follow-up. Patients received better care for ACS, spent fewer days in the hospital, and received appropriate medications when the critical-care pathway was used. At discharge, patients were informed about the importance of complying with their prescribed regimens. The study authors also ensured that the patients’ health plans would allow them easy access to cardiac therapies. Staff members were educated about key elements of the guidelines, which had been established by the American College of Cardiology and the American Heart Association. Research was provided by funding from Sanofi-Aventis, Bristol-Myers Squibb, and the Kaleida Health Foundation. Source: Am Heart J 2009;157(1):61–68 DRUG NEWS cence, the molecular basis of the syndrome, the effect of environment or toxins in promoting the syndrome, the role of drugs in insulin resistance, prehypertension, early vascular changes, elevated triglyceride levels, low HDL-C levels; leptin and weight regulation, prenatal and neonatal environments; and prevalence of the syndrome in different racial and ethnic groups. Sources: Circulation 2009;119:628– 647; Associated Press, February 17, 2009 through pain, and therapy during pregnancy. Source: J Pain 2009;10:113–130.e22 Adolescents Might Not Need Cholesterol Drugs After All Fewer than 1% of American teenagers are likely to need cholesterol drugs to ward off future heart problems, according to a recent study. This news may be reassuring in light of the prevalence of childhood obesity. In 2008 the American Academy of Pediatrics issued guidelines urging physicians to consider cholesterol drugs for more children (as young as eight years of age) if they had high levels of low-density lipoprotein-cholesterol (LDLC) as well as obesity and hypertension. However, newer research suggests that many children might not need to take cholesterol drugs. Researchers studied data from about 10,000 children from 1999 to 2006. Of those, about 2,700 in the 12- to 17-year-old group were assessed for LDL-C levels. From 5% to 7% of these youths had elevated LDL-C. Only 0.8% of this group fit the Academy’s profile of patients needing treatment with cholesterol-lowering drugs. After the academy guidelines were published, however, many people had thought large numbers of children were going to need to take medications for long periods of time. Abdominal obesity, insulin resistance, and hyperinsulinemia are the common characteristics of youth with the metabolic syndrome. Although most of these young patients tend to be overweight or obese, not all overweight or obese children progress to the syndrome, type-2 diabetes, or cardiovascular disease. More research is needed to determine whether the metabolic syndrome can actually predict future disease. The researchers advocate studies to examine phenotypes in childhood and adoles- Preventing Postoperative Pain In Older Adults The long-held belief that acute postoperative pain is merely a symptom, that it resolves while the patient is healing, and that it is not harmful relegates the relief of acute pain to a low priority in the minds of many medical personnel. A study from New York City suggests that aggressively managing pain after surgery might lead to a reduction in the incidence of chronic postoperative pain. The study, which evaluated an interdisciplinary pain-management program, showed that effective pain control resulted in better rehabilitation for older adults after surgery. The intervention consisted of daily pain assessments by nursing and physical therapy staff members, an analgesic protocol including guidelines for treating opioid side effects for physicians; and informing all clinical staff members of patients’ pain each day. Patients were interviewed about their pain ever y day, and they under went physical performance testing on the fourth and seventh days. They were contacted by telephone every six weeks for 24 weeks after hospital discharge to assess pain and walking ability. Compared with usual-care patients, those in the intervention group reported less pain at rest and with physical therapy; were less likely to have moderate to very severe pain at discharge and during Monitoring Opioids For Non-cancer Pain The American Pain Society and the American Academy of Pain Medicine have released the first comprehensive guidelines to assist practitioners in prescribing opioids for patients experiencing chronic non-cancer pain. The use of long-term opioid therapy for chronic non-cancer pain has grown substantially. An expert panel has concluded that chronic opioid therapy can be effective for carefully monitored patients. However, opioids are also associated with potentially serious adverse effects and outcomes related to their potential for abuse. The panel addressed such topics as patient selection, risk stratification, informed consent, management plans, initiation and titration of therapy, methadone, patient monitoring, dose escalations, high-dose therapy, rotating opioids, discontinuing therapy, adverse effects, safety during driving and work, break- 130 P&T® • March 2009 • Vol. 34 No. 3
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.