In episode 38 we try to go over 8 new studies in one podcast but only get half-way there. We cover 2 inhaled anticholinergic studies, one new glucose lowering trial and the latest smoking cessation RCT. Mike and James wax poetically about a variety of issues and demonstrate clearly their well-honed technique of how not to stay foccussed, succint and to-the-point which explains why we only got to half the studies.

Show Notes

1) Inhaled anticholinergics – for better or worse?

Tiotropium given for 4 years on-top of existing therapy – no increase in mortality and fewer myocardial infarctions

N Engl J Med 2008;359:1543-54

Inhaled anticholinergics increases risk of cardiovascular death – but not total mortality

JAMA 2008;300:1439-1450

2) VADT – trial – the third study showing either no benefit or harm from aggressively lowering blood glucose – glycated hemoglobin level reduced from 8.4% to 6.9%

N Engl J Med 2009;360:129-39

3) Varenicline for smoking cessation Varenicline verus transdermal nicotine

Thorax 2008;63:717-24

Evidence showing 0.5 mg BID of varenicline is as effective as 1 mg BID

FDA document

In Episode 37, we again review listener questions and comments around such diverse topics as Bell’s Palsy, viruses that break bones, glucose monitoring, glitazones and COPD. Both James and Mike give diverse answers with diverse meanings that even they don’t really understand.

Show Notes

1) The third study showing either no benefit or harm from aggressively lowering blood glucose – glycated hemoglobin level reduced from 8.4% to 6.9%

NEJM 2009;360:129-39

2) Studies of monitoring blood sugar in type 2 diabetics showing no benefit and increased depression scores

BMJ 2007;335:132

BMJ 2008;336:1177-80

3) Beta-blockers and thiazides do appear to increase the chance of developing diabetes

Am J Cardiol 2007;100:1254–62

4) 10-year follow-up of intensive glucose control in Type 2 diabetes

NEJM 2008;359:1577-89

5) COPD guidelines recommending inhaled steroids as one of the first line inhalers

Ann Int Med 2007;147:639-53

In episode 36, we take up where we left off in episode 35 by reviewing eight more (not ten) old drugs that hopefully you are still using – if not, get with the progam – in your day-to-day practice. Dr Bob joins us yet again for this episode and provides us with some great clinical experience and finally some reasonable humour. Mike tries to deliver some useful clinical pearls and James tries to keep things flowing smoothly – neither have tremendous success.

Show Notes

Nortriptyline

1) Chronic headache JAMA. 2001;285:2208-2215

2) Smoking cessation Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2007, Issue 1

Fluoxetine

1) Weight loss in diabetics Arch Intern Med 2004;164:1395-1404

Metformin

1) Metformin’s contraindications should be contraindicated CMAJ 2005;173:502-504

Colchicine

1) Gout – uptake of colchicine into leukocytes Clin Pharmacol Ther 1993;54:360-7

2) Does colchicine work? The results of the first controlled study in acute gout Aust NZ J Med 1987;17:301-4 Br J Clin Pharmacol 1988;26:488-9

3) Pericarditis Arch Intern Med 2005;165:1987-91

4) Osteoarthritis Arth Care Res 2002;47:280-4 Osteoarthritis Cartilage 2002; 10:247-52

5) Cirrhosis NEJM 1988;318:1709-13

Vitamin B12

1) Oral vs IM Vitamin B 12 Fam Pract 2006;23:279-85

Iron

1) Low dose (15 and/or 50 mg) is as good as high doses (150mg) Am J Med 2005; 118: 1142-7

Nitroglycerin

1) Tennis elbow Am J Sports Med 2003;31:915-20

2) Acute pulmonary edema Amer J Emerg Med 1999;1716:571-4

3) Anal/bum fissures Lancet 1997;349:11-4

4) Raynaud’s Lancet 1982;1:76-7

In this first episode of the New Year (Episode #35) we review nine (not ten) old drugs that should, in most circumstances, still likely play an important role in your day-to-day prescribing and recommendations. Dr Robert Rangno again joins us for this episode and provides us with some great clinical experience and some mediocre humour. Mike and James, as usual laugh about a variety of things that in hindsight really aren’t all that funny.

Show Notes

Chlorpheniramine

1) Editorial on antihistamines

CMAJ 1997;157:37-8

2) Tolerance to the sedative effects of 100 mg of diphenhydramine occurs within 3 days

J Clin Psychopharmacol 2002:22:511–15

Thiazides

1) ALLHAT JAMA 2002;288:2981-97

2) ACE inhibitors no better than thiazides in diabetics

Arch Intern Med 2005;165:1401-9

Spironolactone

1) RALES/CHF study New Engl J Med 1999;341:709-17

2) Spironolactone for resistant hypertension

AJH 2003;16:925–30 Journal of Hypertension 2007;25:891-4

3) Polycystic ovarian disease

J Clin Endocrinol Metab 2004;89:2756-62

Reserpine

1) Potentially useful agent

Clin Pharmacol Therap 1996;60:368–73

2) Treatment of diastolics of 115-129 mmHg – VA Study JAMA 1967;202:1028-34 (NO LINK – Archived)

Amoxicillin

1) Once daily amoxicillin for Strep throat

Arch Disease Childhood 2008;93:474-8

Pediatrics 1999;103:47-51

Doxycycline

1) No appreciable resistance to doxycycline, including pneumococcus

Chest 2004;125:1913

Arch Int Med 1999;159:266-70

2) Community acquired MRSA

Antimicrob Agents Chemother 2007;51:2628-30

Clin Infect Dis 2005;40:1429-34

3) Low dose (20 mg twice daily) for acne

Arch Dermatol 2003;139:459-64

Sulfa drugs

Allergy to penicillin increases your risk of reacting to sulfa drugs

N Engl J Med 2003;349:1628-35

Nitrofurantoin

Still good for bladder infections

British Journal of General Practice 2002;52:729-34