Monitoring drug therapy
The effects of drugs vary significantly between individuals, and monitoring is essential to ensure the desired effect is achieved. Wherever possible, therapeutic effects should be monitored directly, using a measure that captures how the patient feels, functions or survives (a ‘clinical endpoint’). In practice, it is often not feasible to use a clinical endpoint to guide therapy, particularly for preventive treatments. The next best option is to use a surrogate endpoint: a measure that predicts whether the clinical endpoint will be achieved. (Source: Medicine)
Source: Medicine - November 13, 2023 Category: Internal Medicine Authors: Andrew W. Hitchings Tags: Clinical pharmacology Source Type: research
Adverse drug reactions and interactions
This article summarizes some of the key facts about ADRs and DDIs and explores aspects relating to their prevention, diagnosis and management in clinical practice. (Source: Medicine)
Source: Medicine - November 11, 2023 Category: Internal Medicine Authors: Gurpreet S Jutley, Mark Pucci, Robin E Ferner, Jamie J Coleman Tags: Clinical pharmacology Source Type: research
How to appraise clinical trials
Treatment decisions should be based on high-quality data, ideally obtained from randomized controlled trials. However, randomized trials are not immune from bias and other important limitations. Critical appraisal of such studies must consider both the methodological rigour of the study and the applicability of the results to routine clinical practice. Readers should work systematically through trial reports to establish the aims of the study and consider whether the methods used are able to provide an unbiased answer. (Source: Medicine)
Source: Medicine - November 10, 2023 Category: Internal Medicine Authors: Y.K. Loke, K. Mattishent Tags: Clinical pharmacology Source Type: research
Polypharmacy and deprescribing
Polypharmacy is a common issue in clinical practice, with 20% of adults given ≥5 regular medications. It particularly impacts elderly individuals and those with multiple morbidities, and is worsened by single-disease, guideline-driven prescribing and service pressures. Although sometimes appropriate, it can also be problematic, associated with a range of adverse outcomes in cluding hazardous prescribing, excess treatment burden, poor quality of life, higher health service use, and increased morbidity and mortality. (Source: Medicine)
Source: Medicine - November 10, 2023 Category: Internal Medicine Authors: Rupert A. Payne Tags: Clinical pharmacology Source Type: research
The emergency treatment of poisoning
Poisoning is a common presentation in emergency care and can occur in many situations. It is important to understand the priorities in the care of poisoned patients, the key principles in toxicology and the value of clinical signs and symptoms. Clinicians face challenges when dealing with uncertainty in undifferentiated patients, which can be minimized through appropriate self-directed learning. There is also value in departmental planning to avoid significant logistical issues. The future direction of emergency treatment of poisoning is likely to see improvements in primary prevention, reductions in protocol variation and...
Source: Medicine - November 10, 2023 Category: Internal Medicine Authors: Chris Humphries, Michael Eddleston, James Dear Tags: Clinical pharmacology Source Type: research
Clinical pharmacology of biological medicines
This article focuses on monoclonal antibodies, which are large, complex molecules, produced using living organisms, that target specific antigens. They differ from the traditional chemical drugs in having distinct pharmacokinetic and pharmacodynamic characteristics. This article discusses the different clinical applications and challenges of their use, providing an overview of the recent advances in this field. (Source: Medicine)
Source: Medicine - November 10, 2023 Category: Internal Medicine Authors: Mostafa Meshaal Ahmad Tags: Clinical pharmacology Source Type: research
Pharmacodynamics and pharmacokinetics for the prescriber
Pharmacodynamics is the study of how drugs have effects on the body. This is typically by interacting with receptors located in cell membranes or in the intracellular fluid, although there are many other types of drug target. The relationship between the drug dose and its effect is described mathematically by the dose –response curve. Drugs acting at the same receptor (or tissue) differ in the size of the response they can achieve (efficacy) and the amount of drug required to achieve it (potency). (Source: Medicine)
Source: Medicine - November 10, 2023 Category: Internal Medicine Authors: Simon RJ Maxwell Tags: Clinical pharmacology Source Type: research
Prescribing medicines for patients with renal impairment
Renal impairment is common worldwide and poses a significant challenge to safe drug prescribing. As renal function falls, drug clearance decreases and exposure to free drug often increases, leading to increased risks of toxicity and adverse drug reactions. There is also a risk of therapeutic failure as some drugs become less effective when renal function declines or dose reductions are excessive. Polypharmacy is common in this patient group, increasing the risk of drug interactions. It is therefore important that prescribers have a good understanding of the altered pharmacokinetics seen in renal disease and understand the ...
Source: Medicine - November 10, 2023 Category: Internal Medicine Authors: Iain M MacIntyre Tags: Clinical pharmacology Source Type: research
Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - November 10, 2023 Category: Internal Medicine Tags: Self-assessment/cpd answers Source Type: research
Writing prescriptions: how to avoid common errors
Prescribing medicines is the primary tool used by most healthcare systems to cure illness, relieve symptoms and prevent future disease. Prescribing is probably the most complex intellectual task that doctors undertake, requiring the formulation of an appropriate treatment regimen from the many thousands available, taking into account the infinite variation in the patients they encounter. Not surprisingly, suboptimal prescribing is common and represents an obvious target for quality improvement in healthcare. (Source: Medicine)
Source: Medicine - November 10, 2023 Category: Internal Medicine Authors: Simon R.J. Maxwell Tags: Clinical pharmacology Source Type: research
Pulmonary sarcoidosis
Sarcoidosis can occur after genetically susceptible individuals interact with unidentified environmental antigens. Diagnosis requires clinical evaluation, chest radiography, lung function testing, judicious tissue biopsy (endobronchial ultrasound being a preferred method) and exclusion of other granulomatous disease. No long-term systemic therapy is usually needed for the common presentation of L öfgren syndrome (bilateral hilar lymphadenopathy, erythema nodosum, transient iritis). Individuals whose disease needs treatment early after diagnosis have increased mortality risk. (Source: Medicine)
Source: Medicine - November 9, 2023 Category: Internal Medicine Authors: Marcus W. Butler, Michael P. Keane Tags: INTERSTITIAL lung disease and systemic disease presenting in the lung Source Type: research
Diffuse parenchymal lung disease
s are a heterogeneous group of disorders characterized by inflammation and fibrosis of the pulmonary interstitium. They are collectively referred to as interstitial lung diseases (ILDs), although this term is a misnomer as it includes disorders that also affect the alveolar space. Many of these entities are of unknown cause and little is understood about their pathogenesis. However, the classification, prognosis and treatment of ILDs continue to evolve as our understanding of the disease process improves. (Source: Medicine)
Source: Medicine - November 9, 2023 Category: Internal Medicine Authors: Christine Fiddler, Helen Parfrey Tags: INTERSTITIAL lung disease and systemic disease presenting in the lung Source Type: research
Managing pleural malignancy
Pleural malignancy is a growing problem, with malignant pleural effusions (MPEs) affecting 70 per 100,000 people every year. Around 15% of all cancer patients are diagnosed with pleural malignancy during their cancer journey, and they are treated by general and respiratory physicians alike. MPEs usually indicate advanced or aggressive disease, with median survival typically 6 –12 months. Symptoms can be debilitating, so effusion management and symptom control form key aspects of care. Management options for MPE have grown in recent years, and important differences in the benefits and disadvantages of the various methods...
Source: Medicine - October 31, 2023 Category: Internal Medicine Authors: Geraldine A. Lynch, Anna Bibby, Nick A. Maskell Tags: Pulmonary oncology Source Type: research
Idiopathic pulmonary fibrosis and progressive fibrotic interstitial lung disease
Interstitial lung diseases (ILDs) represent a spectrum of disorders affecting the lung parenchyma. The most common of the idiopathic interstitial pneumonias is idiopathic pulmonary fibrosis (IPF), characterized by progressive lung fibrosis, lung function decline, symptom burden and early mortality. The precise aetiology of IPF remains unknown and there are currently no curative treatment options; management strategies focus on symptom control and slowing disease progression with antifibrotic medication. (Source: Medicine)
Source: Medicine - October 28, 2023 Category: Internal Medicine Authors: Philip Evans, Elen Rowlands, Ben Hope-Gill Tags: Interstitial lung disease and systemic disease presenting in the lung Source Type: research
Occupational interstitial lung disease
Interstitial lung diseases (ILDs) are a diverse group of lung parenchymal diseases. They cover a spectrum of inflammatory to fibrotic pathologies. Many ILDs are labelled idiopathic, meaning there is no recognized cause, but many can be triggered by environmental and occupational exposures. Occupational ILD can present as many different ILD subtypes, including hypersensitivity pneumonitis, granulomatous disease (e.g. chronic beryllium disease), pneumoconiosis (silicosis) and usual interstitial pneumonia (typically asbestosis). (Source: Medicine)
Source: Medicine - October 28, 2023 Category: Internal Medicine Authors: Christopher C. Huntley, Kimberley Nettleton, Vicky C. Moore, Gareth I. Walters Tags: Interstitial lung disease and systemic disease presenting in the lung Source Type: research
