MKSAP: 75-year-old man with very severe COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 75-year-old man is seen for routine follow-up for very severe COPD. He has constant dyspnea and air hunger and spends most of the day in a chair. He has had no change in baseline cough and sputum production. He has had multiple COPD exacerbations that required ICU admission and intubation. He has not benefited from pulmonary rehabilitation in the past. He quit smoking 3 years ago. His medical history is also notable for hypertension, type 2 diabetes mellitus, and a myocardial infarction 3 years ago. Hi...
Source: Kevin, M.D. - Medical Weblog - February 3, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Palliative Care Pulmonology Source Type: blogs

Updated Medicare and Medicaid Drug Spending Data Released
On November 15, 2016, the Centers for Medicare and Medicaid Services (CMS) released updated Medicare and Medicaid drug spending data, to include information for calendar year (CY) 2015 through its online interactive dashboards for Medicare and Medicaid. The inclusion of the Medicaid drug spending data on the public dashboard is new this year, as is the addition of high-level (aggregated) Medicare drug rebate data. CMS noted that “there is significant growth in spending on prescription drugs, representing a significant burden.” In CY 2015, total prescription drug costs amounted to roughly $457 billion – a...
Source: Policy and Medicine - December 14, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

MKSAP: 62-year-old man is evaluated for declining exercise capacity
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique is good. He quit smoking 2 years ago. All immunizations are up to date, including influenza and pneumococcal vaccination. A chest radiograph performed 3 months ago for increased coug...
Source: Kevin, M.D. - Medical Weblog - August 13, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Pulmonology Source Type: blogs

MKSAP: 66-year-old man with polyuria and polydipsia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 66-year-old man is evaluated in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While in the emergency department, he was noted to have a random blood glucose level of 211 mg/dL (11.7 mmol/L). His HbA1c was 7.8% at the time. A repeat random fingerstick blood glucose level in office is 204 mg/dL (11.3 mmol/L). The patient reports recent polyuria and polydipsia. He has lost 6 kg (13.2 lb) over the last 3 months. He has chronic epiga...
Source: Kevin, M.D. - Medical Weblog - July 23, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Source Type: blogs

A Year in Review: FDA 2015 New Drug Approvals
The approval of first-of-a-kind drugs rose last year to forty-one, resulting in the highest level of newly approved U.S. drugs in nineteen years. The total number of new drugs approved last year was even higher at sixty-nine. The rising figures reflect an industry-wide desire to research and develop drugs for rare and hard-to-treat diseases. The newly approved drugs serve to advance medical care and the health of patients suffering from many ailments, including various forms of cancer, heart failure, and cystic fibrosis. Additionally, more than 40% of the new therapies were approved for treatment of rare or "orphan&...
Source: Policy and Medicine - January 13, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Test your medicine knowledge: 72-year-old woman with COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 year ago. She quit smoking 1 year ago. Her medications are a budesonide/formoterol inhaler, tiotropium, and an albuterol inhaler as needed. On physical examination, pulse r...
Source: Kevin, M.D. - Medical Weblog - June 27, 2015 Category: Journals (General) Authors: Tags: Conditions Pulmonology Source Type: blogs

Be kind to your doctor
Shared with permission from the FB wall of a GP Some six years ago, this lady X was brought to me. she has very bad case of Chronic Obstructive Pulmonary Disease. I still recall how she used to struggle for breath each time she came. Thank goodness she would quickly recover after nebulization as intra-muscular injection because her case would usually be a narrow decision between admitting and the risk of treating her as out-patient. After a few visits, her symptoms were controlled. Among the things I gave her was Spiriva inhaler, and off label use of Singulair, which worked pretty well on her. I remember one day on my way ...
Source: Malaysian Medical Resources - February 6, 2015 Category: Global & Universal Authors: palmdoc Tags: - Ethics Source Type: blogs

MKSAP: 72-year-old woman with severe COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 year ago. She quit smoking 1 year ago. Her medications are a budesonide/formoterol inhaler, tiotropium, and an albuterol inhaler as needed. On physical examination, pulse r...
Source: Kevin, M.D. - Medical Weblog - November 1, 2014 Category: Journals (General) Authors: Tags: Conditions Pulmonology Source Type: blogs

You Say You Want Some Revolutions? - Famed Academic Physician Dr Milton Packer's Endless Alternating Turns as Drug Company Spokesperson and FDA Advisor
Last week, we noted  we again discussed the web of conflicts of interest that is draped over medicine and health care, and seems responsible for much of our current health care dysfunction.  We have discussed examples of conflicts of interest affecting clinical research, clinical teaching, clinical care, and health care policy.  Each time I think we must have cataloged all the useful examples, a striking new one appears.Only a few days later, yet another new variant has in fact appeared. A New Kind of Revolving Door A new version of the "revolving door" apparently was first noted by Public Citizen,...
Source: Health Care Renewal - September 16, 2014 Category: Health Management Tags: Avandia Bristol-Myers-Squibb conflicts of interest FDA GlaxoSmithKline Milton Packer Novartis Pfizer revolving doors sacubitril Source Type: blogs

Unraveling An Off-Rate
Medicinal chemists talk a lot more about residence time and off rate than they used to. It's become clear that (at least in some cases) a key part of a drug's action is its kinetic behavior, specifically how quickly it leaves its binding site. You'd think that this would correlate well with its potency, but that's not necessarily so. Binding constants are a mix of on- and off-rates, and you can get to the same number by a variety of different means. Only if you're looking at very similar compounds with the same binding modes can you expect the correlation your intuition is telling you about, and even then you don't always ...
Source: In the Pipeline - October 29, 2013 Category: Chemists Tags: The Central Nervous System Source Type: blogs

Pharmalot... Pharmalittle... Good Morning
Rise and shine. Another busy day is on the way. And by all indications, this is going to be a hot one, at least in the region in which the Pharmalot corporate campus is situated. Who says summer is over? To keep cool, we plan to brew an iced glass or two of delicious stimulation. This requires foraging for the proper equipment. So while we do so, here are some items of interest to start the day. Hope you accomplish everything on your agenda and, as always, reach out if you run across anything intriguing... AstraZeneca Pays $50M To Merck For Cancer Drug (Reuters) Merck R&D Chief Tells Analysts Further R&D Changes Ar...
Source: Pharmalot - September 11, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs

Top stories in health and medicine, September 11, 2013
From MedPage Today: Pay for Performance Pays Off. Patients treated by physicians who received cash payments for adhering to treatment guidelines were more likely to show improvements in cardiovascular risk factors. Conflicting Data on Spiriva Safety. Real-world data indicating excess mortality with the mist version of tiotropium (Spiriva) was countered by further details from the TIOSPIR trial indicating no difference versus the dry powder version, which many here declared the winner in the data duel. EHRs Tied to Fewer Admissions. The use of electronic health records has the capacity to cut down on the number of eme...
Source: Kevin, M.D. - Medical Weblog - September 11, 2013 Category: Family Physicians Tags: News Cancer Pulmonology Source Type: blogs

A Boehringer Shake Up And An FDA Warning Letter Over Production Gaffes
After a string of grave and embarrassing manufacturing problems, Boehringer Ingelheim is overhauling some of its management. Late last week, Boehringer Ingelheim quietly posted on its web site that Wolfram Carius (see photo), a member of the board of managing directors who oversaw biopharmaceuticals and production, will be leaving the drugmaker next month after a 26-year career. And he will be replaced by Wolfgang Baiker, who most recently headed worldwide development (see this). His resignation occurs shortly after Boehringer received a searing warning letter from the FDA about serious production violations at a plan...
Source: Pharmalot - May 22, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs