1 AUGUST 2011

The latest edition of Australian Prescriber is out now and looks at the following topical issues:

The workload of being a patient

Clinicians caring for patients, particularly those with chronic illnesses, need to deal with the increasing workload patients face when looking after themselves, according to Professor Victor Montori of the Mayo Clinic in the USA. He writes that current practice guidelines increasingly carry a message of ‘treat to target’, which assumes that achieving particular targets (such as a certain blood pressure or blood glucose) will lead to better outcomes for the patient. This approach, however, requires the patient to do more intensive self-monitoring and self-management, and make time for more treatments, investigations, and visits to health professionals than they have the capacity to do.

Metabolic effects of antipsychotics

Antipsychotic medications remain the cornerstone of treatment for a number of psychiatric illnesses, however for some of the newer antipsychotics, obesity and other risk factors for cardiovascular and metabolic disease are a problem. Early detection and intervention are crucial, according to Professor Tim Lambert of the University of Sydney, especially as smoking, physical inactivity and unhealthy eating are commonly associated with psychosis. Lifestyle interventions can help, but should they fail, additional strategies could be considered including switching antipsychotics (in consultation with a psychiatrist), medication for metabolic illness, patient counselling to promote adherence, or bariatric surgery.

Managing atrial fibrillation

Atrial fibrillation is the most common sustained cardiac arrhythmia, and there is a range of treatment options, but each has limitations. Dr Himabindu Samardhi, Dr Maria Santos, Dr Russell Denman, Dr Darren Walters, and Professor Nicholas Bett of Prince Charles Hospital, Brisbane, discuss current management options, examining the assessment of stroke risk, drug and device-based therapies for preventing stroke, rate control and rhythm control. According to the authors, newer antithrombotic regimens, including dabigatran and rivaroxaban, may offer an alternative to warfarin.

Pharmaceutical excipients

Excipients have been defined as inert substances used as vehicles and diluents for drugs, however they have the potential to cause adverse effects in sensitive individuals. Alison Haywood of Griffith University and Beverley Glass of James Cook University write that excipients can play many important roles including improving the stability of a medicine or enhancing safety, but may also be responsible for a range of adverse reactions. Identifying such reactions, and finding appropriate information on which excipients are in medicines (e.g. the Consumer Medicines Information leaflet) will assist in ensuring a safe outcome for the patient.

To read the full articles and more visit www.australianprescriber.com

Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published by NPS, an independent, not-for-profit organisation for quality use of medicines funded by the Australian Government Department of Health and Ageing. Australian Prescriber is published every two months, in hard copy that is distributed to health professionals free of charge, and online in full text at www.australianprescriber.com