Overactive Bladder

Overactive bladder is a disease which can result from several different etiologies but is primarily characterized by a hyperactive bladder wherein affected individuals feel a frequent urge to urinate and may also experience spontaneous urine loss. Antimuscarinics are the traditional first-line therapy for treatment.  Any antimuscarinic should be tried for at least two weeks to … Continue reading

Pain Pathophysiology Overview

Receptors involved in pain modulation: opioid receptors alpha-2 adrenergic receptors voltage-gated calcium channels NMDA receptors Chemical mediators (sensitize neurons to pain): substance P prostaglandins bradykinin glutamate Neurotransmitters (facilitate pain modulation): norepinephrine serotonin GABA

Overview of Types of Pain

acute pain: < 1 month in duration chronic pain:  > 6 months in duration can arise from nociceptive and/or neuropathic origins Nociceptive pain:  experienced in the presence of an injury or trauma.  Can be described as sharp, dull, or achy and may either be localized or diffuse. examples include: osteoarthritis and pancreatitis. Neuropathic pain: pain … Continue reading

Risk Factors for Statin-Induced Myopathy

High statin doses People whom are frail or have a small frame Elderly Perioperative periods Untreated hypothyroidism Diabetes Renal Diseases Liver Diseases Medications:  Nicotinic Acid, Fibrates (especially gemfibrozil), CYP450 3A4 Inhibitors (for simvastatin, lovastatin, and atorvastatin)

Lifestyle Recommendations for Patients with Hyperlipidemia

Saturated fat should account for less than 7% of total calories Total fat should account for less than 25-35% of total calories Fiber:  20-30 grams daily Consume less than 200 mg of dietary cholesterol daily

Lipid Management Goals

Non-LDL Cholesterol Triglycerides < 150 mg/dL Total Cholesterol < 200 mg/dL HDL > 40 mg/dL (males) HDL > 50 mg/dL (females) Non HDL Cholesterol:  LDL goal + 30 mg/dL LDL Cholesterol LDL < 70 mg/dL:  Preexisting coronary heart disease (CHD) at high risk LDL < 100 mg/dL:   CHD (myocardial infarction, unstable or chronic stable … Continue reading

Secondary Causes of Dyslipidemia

The following can increase Low Density Lipid (LDL) cholesterol levels: Hypothyroidism Obstructive Liver Disease Nephrotic Syndrome Medications:  Progestin, Corticosteroids, Anabolic Steroids, Cyclosporine The following can increase Triglyceride (TG) levels: Diabetes Hypothyroidism Nephrotic Syndrome Chronic Renal Failure Obesity Medications:  Estrogen, Thiazide Diuretics, Beta Blockers, Corticosteroids, Atypical Antipsychotics The following can decrease High Density Lipid (HDL) cholesterol … Continue reading

Useful Websites Regarding Lipid Management

http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm National Cholesterol Education program provides national guidelines for nonpharmacologic and pharmacologic recommendations for lipid management. http://www.nhlbi.nih.gov/guidelines/cholesterol/statins.htm Clinical advisory from the American College of Cardiology, AHA and the National Heart, Lung and Blood Institute (NHLBI) on the prevention and management of statin-adverse events http://hp2010.nhlbihin.net/cholmonth/ NHLBI designed website with supportive patient education materials http://www.heart.org/HEARTORG/Conditions/Cholesterol/Cholesterol_UCM_001089_SubHomePage.jsp AHA website … Continue reading

Prickly Heat

Prickly Heat (aka heat rash aka miliaria) No major consequences or long-term effects Best treatment:  cool & dry the skin Presents as fine red to reddish pin-point sized rash Symptoms: may be asymptomatic or itching, burning, stinging               (easily treated) Anti-itching products: antihistamines, hydrocortisone, calamine, astringents, baths/soaks (oatmeal, body washes) Astringents = witch hazel & aluminum … Continue reading

Diaper Dermatitis

Diaper dermatitis (diaper rash) = due to presence of a diaper or other occlusive covering of the inguinal & genital areas Best treatment: keep baby clean & dry May occur in any age group using diapers Unlikely to be life threatening or cause permanent injury Rapid onset (within a few hours);  resolution takes a couple … Continue reading