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Content 7

 

The Doctor and the Pharmacist

Radio Show Articles:
December 17, 2016

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President Signs New Health Bill into Law
Long-Term Acetaminophen and NSAID Use Tied to Hearing Loss
Psychiatric Drug Use Common in U.S.
Overall Use of Illicit Substances Down Among Teens
Topical Lidocaine Could Help Make Infant Vaccines Less Painful
Asked and Answered: Sweet Solutions Are Effective for Procedural Pain Control in Neonates
Scalp-Cooling Device Limits Hair Loss from Chemotherapy
1 in 3 Long-Term Rx Opioid Users Report Dependence
New Eczema Treatment Approved
FDA Approves First Cellularized Scaffold Product to Repair Knee Cartilage

President Signs New Health Bill into Law
By the Editors
President Barack Obama signed the 21st Century Cures Act into law on Tuesday.
The sweeping new law aims to speed FDA approval of drugs and devices. It also provides funding for fighting opioid abuse and cancer research.
https://www.whitehouse.gov/the-press-office/2016/12/13/statement-press-secretary-hr-34
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Long-Term Acetaminophen and NSAID Use Tied to Hearing Loss
By Kelly Young, Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS
Regular, long-term use of acetaminophen and nonsteroidal anti-inflammatory drugs is associated with modestly elevated risk for hearing loss in women, suggests an American Journal of Epidemiology study.
Over 55,000 women aged 44–69 in the Nurses' Health Study answered questions about incident hearing loss and how often they took aspirin, acetaminophen, and NSAIDs.
During 873,000 person-years' follow-up, nearly 19,000 women said they developed hearing loss. After multivariable adjustment, regular NSAID and acetaminophen use (2 or more days per week) for more than 6 years was associated with incident hearing loss, compared with less than 1 year of use (relative risks, 1.10 and 1.09). Aspirin use showed no association.
The authors conclude: "Considering the high prevalence of analgesic use and the high probability of frequent and/or prolonged exposure in women of more advanced age, our findings suggest that NSAID use and acetaminophen use may be modifiable risk factors for hearing loss."
https://academic.oup.com/aje/article/doi/10.1093/aje/kww154/2661733/Duration-of-Analgesic-Use-and-Risk-of-Hearing-Loss
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Psychiatric Drug Use Common in U.S.
By Kelly Young, Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD
One in six U.S. adults reported filling at least one psychiatric drug prescription in 2013, according to a research letter in JAMA Internal Medicine.
Researchers used data from the 2013 Medical Expenditure Panel Survey to estimate the prevalence of psychiatric drug use among U.S. adults aged 18 to 85. Over 350,000 prescriptions from 37,000 adults were included.
Nearly 17% of adults filled at least one psychiatric drug prescription in 2013. Use was highest among white adults, at 21%, and lowest among Asians, at 5%. Women were more likely than men to use psychiatric drugs (21% vs. 12%). Use was more common among older adults — 25% of those aged 60 to 85.
The most commonly prescribed drugs were sertraline (Zoloft), citalopram (Celexa), alprazolam (Xanax), zolpidem (Ambien), and fluoxetine (Prozac).
Of those taking psychiatric drugs, 84% reported long-term use. Several of the drugs, including benzodiazepines and zolpidem, carry risk for dependence or are only recommended for short-term use.
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2592697
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Overall Use of Illicit Substances Down Among Teens
By Kelly Young, Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
Fewer adolescents are using drugs, cigarettes, and alcohol than in the past, according to results from the NIH-funded Monitoring the Future annual survey.
Over 45,000 junior high and high school students were surveyed in 2016. Among the findings:

https://www.nih.gov/news-events/news-releases/teen-substance-use-shows-promising-decline
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Topical Lidocaine Could Help Make Infant Vaccines Less Painful
By Kelly Young, Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD
Topically applied lidocaine may help ease vaccination pain in infants, according to a study in the Canadian Medical Association Journal.
Roughly 350 infants who were undergoing vaccinations in their first year of life were randomized to one of four groups:

Families who didn't receive an active intervention received a corresponding dummy intervention instead (e.g., placebo video, placebo oral solution).
The lidocaine-sucrose-video group had the lowest infant pain scores, based on facial grimacing, crying, and body movements. Scores in the video group and sucrose-video group did not differ from the placebo group.
The authors conclude: "Given that vaccination pain is iatrogenic and most infants were distressed despite the use of cointerventions, consideration should be given to adding lidocaine to reduce the burden of pain."
http://www.cmaj.ca/content/early/2016/12/12/cmaj.160542.full.pdf+html
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Asked and Answered: Sweet Solutions Are Effective for Procedural Pain Control in Neonates
By Daniel M. Lindberg, MD, Dr. Lindberg is an associate editor with NEJM Journal Watch Emergency Medicine, from which this story was adapted. Full coverage is available at the link below.
Evidence that sweet solutions improve pain for neonates during painful procedures has been compelling for more than a decade, according to a meta-analysis in Pediatrics.
Using a robust search strategy, researchers identified 168 randomized, controlled trials of oral sweet solutions for procedural pain control in neonates.
Pooled results showed that sweet solutions reduced crying time by a mean of 23 seconds and improved pain scores by a mean of 0.90 points. The cumulative results became statistically significant in 1999 for pain scores and in 2002 for crying time, yet dozens of studies have been performed since then.
Comment: At some point, it is unethical to ignore evidence that is clear and convincing. Sweet solutions improve crying time and pain scores for neonates, have virtually no untoward effects, and should be used for painful procedures. Future trials should not include a placebo arm.
http://pediatrics.aappublications.org/content/early/recent
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Scalp-Cooling Device Limits Hair Loss from Chemotherapy
By Amy Orciari Herman, Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
An experimental scalp-cooling device prevented hair loss in half of women undergoing chemotherapy for breast cancer. Findings from the industry-funded trial were presented at the San Antonio Breast Cancer Symposium.
Some 182 women with stage I-II breast cancer undergoing taxane- or anthracycline-based chemotherapy were randomized to cooling therapy or no cooling therapy. The cooling device is a two-cap system: an inner silicon cap circulates a refrigerated fluid, and an outer neoprene cap acts as an insulator. Women assigned to cooling therapy wore the device during chemotherapy, plus 30 minutes before and 90 minutes afterward.
In an interim analysis, 50% of women in the scalp-cooling group had preserved their hair, versus none in the control group. Mild side effects included headache and transient discomfort.
Lowering the scalp's temperature constricts blood vessels and decreases blood flow to the scalp, one researcher explained. This reduces the amount of chemotherapy drugs that reach the hair follicles.
The manufacturer will seek FDA clearance for the device. A similar scalp-cooling device was cleared for marketing in 2015.
https://www.bcm.edu/news/cancer/scalp-cooling-reduces-chemotherap-hair-loss
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1 in 3 Long-Term Rx Opioid Users Report Dependence
By Amy Orciari Herman, Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
One-third of patients who've taken prescription opioids for 2 months or longer report becoming dependent on or addicted to them, the Washington Post reports.
Researchers surveyed some 620 current or recent long-term opioid users. Among the other findings:

Of note, nearly 60% of respondents said that opioid painkillers have improved their lives, and roughly 70% said the pain relief benefits outweigh the addiction risks. Of those who reported being addicted, 60% said they'd sought help.
U.S. physicians wrote 240 million prescriptions for opioids in 2014, the Post reports.
https://www.washingtonpost.com/national/health-science/one-third-of-long-term-users-say-theyre-hooked-on-prescription-opioids/2016/12/09/e048d322-baed-11e6-91ee-1adddfe36cbe_story.html?utm_term=.dc3bbd1b1a0b
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New Eczema Treatment Approved
By the Editors
The FDA has approved crisaborole ointment (marketed as Eucrisa) to treat mild-to-moderate atopic dermatitis in patients aged 2 years and older.
The phosphodiesterase 4 (PDE-4) inhibitor is applied to the affected area twice daily. The FDA says its mechanism of action in treating atopic dermatitis is unknown.
Approval was based on two placebo-controlled trials comprising over 1500 patients aged 2 to 79 years. Those who used crisaborole had a greater treatment response after 4 weeks of treatment.
The most common side effect was local pain, such as stinging. Hypersensitivity reactions also may occur.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm533371.htm
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FDA Approves First Cellularized Scaffold Product to Repair Knee Cartilage
By Kristin J. Kelley, Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM
The FDA has approved a knee cartilage repair product called Maci to treat symptomatic defects of the knee in adult patients.
Maci is made of healthy cartilage taken from a patient's own knee. The patient's cells are placed onto a bioresorbable porcine-derived collagen membrane, which is implanted by a surgeon to the damaged area and then trimmed to the right shape.
Approval was based on a 2-year study of 144 patients in which treatment with Maci was compared with an alternative surgical procedure. Data from the trial (and a 3-year follow-up) demonstrated a long-term clinical benefit for patients who received the implant. Side effects included back pain, cold-like symptoms, and joint pain.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm533153.htm

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