DR. G. C. DHAR.

NOVEMBER 2008

. FDA “BLACK BOX” WARNING TO FLUROQUINOLONES

From November 1997 through December 2007, there have been 407 reported cases of tendon rupture and 341 cases of tendinitis in patients using fluoroquinolones.

Actual number may be much higher.

FDA “BLACK BOX” WARNING TO FLUROQUINOLONES

Most common rupture was of the Achilles tendon.

High Risk Patients:

• Patients over 60 years of age.

• -Patients who had received kidney, heart, or lung transplants

• -Patients taking steroid treatment.

FDA “BLACK BOX” WARNING TO FLUROQUINOLONES

• PRACTICE SUGGESTION:• In case of tendon pain, drug must be

stopped.

• The warnings apply to tablets, capsules, and injectable formulations for systemic use.

• not to ophthalmic or otic formulations

FDA “BLACK BOX” WARNING TO FLUROQUINOLONES

REF: Published 15 July 2008, doi:10.1136/bmj.a816

Azithromycin eye drop

• Topical therapy with azithromycin 1.5% administered only twice daily for 3 days effectively eradicates most pathogenic bacteria associated with bacterial conjunctivitis.

• This new anti-infective product has the advantage of a short treatment course which could lead to an improvement in patient compliance.

Azithromycin eye drop

•Ref: PMID: 18988154 [PubMed - in process]

•Eur J Ophthalmol. 2008 Nov-Dec;18(6):858-68.

SLEEP

IN HYPERTENSIVES

Sleep duration and CV Risk in HTN

• Short sleep duration (<7.5 hrs) is an independent predictor of Cardiovascular events in patients with hypertension.

• Physicians should inquire about sleep duration in the risk assessment of patients with hypertension.

• Ref: Arch Intern Med. 2008;168(20):2225-2231.

NEW ANTI-HYPERTENSIVE!

ALISKIREN

RENIN BLOCKER

NEW ANTI-HYPERTENSIVE!

• Aliskiren approved by FDA in March 2007.• Highly effective in Diabetic Nephropathy.• When used along with Losartan, ACR is

decreased by >50% in comparison to Losartan alone.

• Available in 150mg & 300mg in tablet form.

• Ref: N Engl J Med 2008 6;358(23):2433-46

hs-CRP

?

A Simple Blood Test hs-CRP

• High level of hs-CRP is a useful marker for cardiovascular disease and predict heart attack and stroke.

• Lowering hs-CRP irrespective of other cardiovascular markers e.g. dyslipidemia effectively reduces risk of cardiovascular outcomes.

• Ref: NIH (14th November 2008)

MIXED DYSLIPIDEMIA

• Long-term fenofibric acid + statin combination therapy is generally well tolerated and resulted in comprehensive and sustained improvements in multiple lipid parameters in adults with mixed dyslipidemia.

• Ref:Journal of Clinical Lipidology; 14 Nov 2008.

DO YOU KNOW THAT

STATINS FIGHT INFECTIONS?

Statins Reduce Death Risks from Pneumonia

Statin and prognosis of pneumonia

• Eight year long study in Denmark on adult population hospitalized due to pneumonia, a significant reduction in death rate found in patients who were under prior statin therapy.

• Ref: Arch Intern Med (Oct 2008) 168: 2081-2087.

Statin in infection

• Statins have diverse immunomodulatory and antiinflammatory properties independent of their lipid-lowering ability.

• Statins offer good prognosis along with antibiotics in patients suffering from sepsis specially in patients with diabetes mellitus, those with malignancy, and those receiving steroid.

Statin in infection• Researches now under way to use statin

along with antibiotics in acute and persistent infection.

• How statins act on infection?• Statins reduce G-protein mediated

inflammation and infection.• Ref: Br J Anaesth. 2008 Jun;100(6):862. No

abstract available. • PMID: 18483119 [PubMed - indexed for

MEDLINE].

29 year old man came to you for employment physical examination.

• BMI: 39kg/M2

• FBG: 177mg/dl

• Lipid Profile: TC: 154mg/dl; HDL-C: 31mg/dl; LDL-C: 69mg/dl; TG: 271mg/dl.

skin findings reveal acanthosis nigricans, a sign of insulin resistance

syndrome.

Dx: Type 2 DM with dyslipidemia.