Search Results
The unpleasant and subjective sensation resulting from a noxious sensory stimulus defines the phenomenon of pain. The podiatric physician is no stranger to the difficulties in achieving optimal pain therapy. Podiatric physicians must develop analgesic regimens to treat patients with acute, chronic, and postoperative pain. Because opioid therapy is the cornerstone of the pharmacologic management of acute and chronic pain, this review focuses on the prescribing of opioid analgesics to treat lower-extremity pain. The pharmacology of frequently prescribed opioids is introduced. Then, criteria for selecting appropriate opioid analgesics as found in the current medical literature are reported. Finally, a review of the literature describing legal and ethical considerations regarding the prescribing of opioid analgesics is presented. (J Am Podiatr Med Assoc 96(4): 367–373, 2006)
US Food and Drug Administration Black Box Warnings
Podiatric Implications
Podiatric Physicians have an ethical obligation to prescribe responsibly and cautiously to diminish and minimize the growth of drug adverse effects. Clinicians who prescribe, dispense, and administer medications must be vigilant in continually reviewing new Black Box Warnings for medications they use for their patients. The safe and appropriate selection of medications and prescribing strategies are presented. First, the concept and process for these FDA black box warnings are introduced. Then, to enrich the podiatric physician's body of knowledge, several FDA boxed warnings from 27 selected drug products that may be prescribed by podiatric physicians are presented graphically as a table. Finally, strategies for safe prescribing of these drugs with boxed warnings are presented.
Vancomycin
An Overview for the Podiatric Physician
An increased reliance on vancomycin to treat bacterial infections has led to the emergence of vancomycin-resistant organisms. The podiatric physician must select and use vancomycin with due caution. This article presents a general review of vancomycin’s pharmacology, pharmacokinetics, and dosing recommendations. Literature citations of clinically based evidence regarding the development and use of vancomycin nomograms are also presented. A vancomycin dosing nomogram is introduced as an effective tool for the prescribing podiatric physician. Appropriate use of the information presented may improve patient outcomes and enable the podiatric physician to treat patients with less effort and at a lower cost. (J Am Podiatr Med Assoc 94(4): 389–394, 2004)
Low-Molecular-Weight Heparins
An Overview for the Podiatric Physician
Deep venous thrombosis is a common but underdiagnosed medical condition. The epidemiologic features, economic impact, morbidity, and mortality of venous thromboembolism make it imperative that the podiatric physician be familiar with its pathogenesis as well as its pharmacologic treatment. Medical literature rooted in clinical evidence has demonstrated that low-molecular-weight heparins are safe and effective for the prevention and treatment of venous thromboembolism. The primary purpose of this article is to review the pharmacologic characteristics of low-molecular-weight heparins. Dosing recommendations for low-molecular-weight heparins as they apply to the prevention of deep venous thrombosis are presented. Finally, a dosing criteria chart is presented to assist the podiatric physician in prescribing and evaluating low-molecular-weight heparins as a therapeutic class. (J Am Podiatr Med Assoc 95(4): 383–389, 2005)
Penicillin and Cephalosporin Drug Allergies
A Paradigm Shift
Medication hypersensitivity is a constant variable that podiatric physicians face during their professional day. To avoid potential patient harm, an understanding of penicillin and cephalosporin hypersensitivities as it pertains to podiatric medicine needs to be achieved. To accomplish this, a narrative describing the signs, symptoms, and immunologic mechanisms for the basis of penicillin and cephalosporin drug hypersensitivities is presented. Second, specific medical literature serving as clinical-based evidence to support the prescribing of cephalosporins in patients with documented penicillin allergy is presented. Finally, a review of the medical and legal literature describing health-care provider liability regarding subsequent drug hypersensitivity is presented. The information contained in this review allows for the evolving paradigm that permits the prescribing of selective cephalosporins to patients with a history of penicillin allergy as long as the allergic symptoms were not serious or life-threatening. (J Am Podiatr Med Assoc 98(6): 479–488, 2008)
Approximately 10 million patients with traumatic wounds are treated in US emergency departments annually. The practice of wound cleansing or antiseptic management has a dichotomous history anchored in tradition and science. The merits of antiseptic fluid irrigation of traumatic wounds have received little scientific study. The purpose of this article is to critically evaluate the potential harm to patient outcome by the use of antiseptics on acute wounds. First, animal and cell culture data that describe the effects of topical antiseptics on wound healing are offered. Second, human case studies are presented to illustrate the potential harm of the indiscriminate use of antiseptics. Finally, data from previously published reviews are presented and evaluated for clinically based evidence to justify the current practice of antiseptic use in acute traumatic wounds. (J Am Podiatr Med Assoc 95(2): 148–153, 2005)
Painful peripheral neuropathy is a common complication of diabetes mellitus that can affect almost every tissue of the body. In the absence of a curative therapy for this disorder, pharmacologic or nonpharmacologic tools, or a combination of both, can be used to provide relief of symptoms. This article reviews medications currently used to manage painful diabetic neuropathy. The pathogenesis of painful diabetic neuropathy is described as a basis for understanding medication selection. The literature describing the pharmacologic properties of medications used to treat painful diabetic neuropathy is also reviewed. Comparisons of medication dosages, frequencies, and adverse effects are offered to help with selection of the most appropriate agent for each individual patient. (J Am Podiatr Med Assoc 97(5): 394–401, 2007)
Fracture Healing
An Appraisal of the Effects of Frequently Prescribed Medications
Background
Recognizing the existence of adverse drug effects of frequently prescribed drugs can empower a clinician with knowledge to avoid dangerous adverse effects that may result in hazardous, negative patient outcomes on either fracture healing or bone health. Pharmacovigilance reports have described the influence of medications, allowing for bone health to be quite unpredictable.
Methods
First, mechanisms found in the medical literature of potential drug adverse effects regarding fracture healing are presented. Second, the 100 most frequently prescribed medications in 2010 are reviewed regarding adverse effects on fracture healing. These reported adverse effects are evaluated for medical causation. Last, a data table describing the 100 reviewed medications and their reported effects on fracture healing is provided.
Results
The actual number of different medications in the review was 72. Reported drug adverse effects on bone and fracture healing occurred with 59 of the 72 drugs (81.9%). These adverse effects are either described as a definitive statement or represented by postmarketing case reports. Thirteen of the 72 review drugs (18.1%) did not have any description of the possible effects on bone health. A total of 301 cases reports describing delayed union, malunion, and nonunion of fractures represent 31 of the 72 medications reviewed (43.1%).
Conclusions
This review offers the health-care provider information regarding potential adverse drug effects on bone health. Empowered with this information, clinicians may assist their patients in maximizing pharmacologic outcomes by avoiding these reported harmful adverse effects.
Background: Many health-care providers may overlook or be unaware of most drug-to-drug interactions. Recognizing the existence of drug interactions with cigarette smoking and alcohol ingestion can empower a clinician with knowledge to avoid dangerous interactions that may result in hazardous, negative patient outcomes. Cigarette smoking and alcohol use can reduce the efficiency of certain drugs or make drug therapy more unpredictable.
Methods: This review offers the physician information regarding prescription drug interactions with cigarette smoking and alcohol use. First, mechanisms found in the medical literature of potential drug interactions in cigarette smokers and alcohol drinkers are presented. Second, the 100 most frequently prescribed medications in 2006 are reviewed regarding cigarette smoking effects and alcohol effects as cited in the medical literature. Lastly, a table of these 100 medications and any reported effects of cigarette smoking or alcohol consumption on each drug is provided.
Results: The actual number of different medications reviewed was 78. Drug interactions resulting from the effects of cigarette smoking occurred with 33.3% of the drugs (n = 26), and drug interactions resulting from the effects of alcohol consumption occurred with 76.9% of the drugs (n = 60). Finally, resource information regarding smoking cessation and alcohol abuse recovery is summarized so that physicians may empower their patients to avoid potential drug-interaction events.
Conclusions: Cigarette smoke and alcohol may interact with medications through pharmacokinetic or pharmacodynamic mechanisms. Engaging in both of these social activities can reduce the efficiency of certain drugs or can make drug therapy unpredictable. This review offers the health-care provider information regarding potential prescription drug interactions. Empowered with this information, clinicians may assist their patients to maximize pharmacologic outcomes by avoiding these reported harmful interactions. (J Am Podiatr Med Assoc 99(1): 81–88, 2009)
