TEC: Evidence Based Therapeutics
Therapeutics Education Collaboration
Medication Mythbusters – Home of the Best Science (BS) Medicine Podcast

Episode 46: High quality information on drug safety – Special Guest Dr. Bruce Psaty

In episode 46 we speak with one of the gurus of drug safety, Dr. Bruce Psaty, to get some insight on the whole issue of identifying the good and bad things that drugs can do. We come to the conclusion that high quality information is ultimately what is needed if we are to understand what drugs can and cannot do. Both Mike and James lament on their ability to produce high quality information.

Episode 45: Practice Changing Articles – with Double the Mikes Part II

In our 45th episode, we review a few more practice changing studies with Dr Mike Kolber. We go through the renal outcomes of a large trial of ACE or ARB or together, the benefits of medical therapy to pass of renal stones and then we journey into another evidence void to review the most recent antibiotic prophylactic guidelines from NICE (UK) and the US. At the end James tries to sort out which Mike is the expert and which one is just opinion, and he can’t so he enrolls them both in an RCT without their consent.

Show Notes

1) Renal outcomes with ACE & ARB (alone or combined).

Lancet 2008;372:547-53.

Canadian Hypertension Education Program (CHEP) urges physicians NOT to combine ACE & ARB

2) Medical therapy for renal stone passage.

Ann Emerg Med 2007;50:552-63

Lancet 2006;368:1171-9

3) Antibiotic Prophylaxis for Infective Endocarditis

J Am Coll Cardio 2008;52:676-85

Heart 2008;94;930-1

Who gets prophylaxis

  • US: dental procedures with manipulation of either gingival tissue, the periapical region of teeth or perforation of the oral mucosa
    1. Prosthetic cardiac valves or prosthetic material used for cardiac valve repair
    2. Previous infective endocarditis.
    3. Congenital heart disease (CHD – see below for clarity)
    4. Cardiac transplant recipients with valve regurgitation due to a structurally abnormal valve.
  • “Patients with CHD. (Level of Evidence: B)
  • Unrepaired cyanotic CHD, including palliative shunts and conduits. (Level of Evidence: B)
  • Completely repaired congenital heart defect repaired with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure. (Level of Evidence: B)
  • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (both of which inhibit endothelialization). (Level of Evidence: B)”

Episode 44: Practice Changing Articles – with Double the Mikes

In Episode 44, we review another collection of practice changing articles and are joined by Dr. Mike Kolber. The first case and study considers the use of metformin in gestational diabetes and the trial leads to a longer discussion of the challenges of prescribing in pregnancy. The second case and study concerns the use of ondansetron for vomiting in pediatric patients. James interrupts the two Mikes frequently but never knows which one.

Show Notes

1) Metformin for gestational diabetes

NEJM 2008;358:2003-15

2) Glyburide for gestational diabetes

NEJM 2000;343:1134-8

3) Persistent pulmonary hypertension of the newborn

NEJM 2006;354:579-87

4) Risk of depression relapse in pregnancy

JAMA 2006;295:499-507

Lancet 2003;361:653–51

5) Vomiting in kids and ondansetron

Arch Pediatr Adolesc Med 2008;162: 858-65

Dosing: Ondansetron usually 1 dose: IV 0.15-0.3 mg/kg or oral 2-8 mg (range based on weight) or 1.6-4 mg (range based on age)

Episode 43: Obesity – what’s the big deal? – Part III

In episode 43, we take our last run/jog at the problem of obesity by exercising our right to talk about the benefits of increasing activity. James tells the listening audience that Mike is 5’ 6” and weighs 250 lbs and Mike demonstrates to James how to become more active by chasing him around the studio with a hockey stick – but only metaphorically speaking, as Mike lives in Edmonton and James lives in Vancouver.

Show Notes

1) Latest NEJM paper on different “diets”

NEJM 2009;369:859-73

2) Activity-related benefits – morbidity and mortality

Arch Intern Med 2007;167:2453-60

JAMA 1995; 273:1093-8

Circulation 2008;117:614-22

JAMA 2003;289:2379-86

NEJM 2002;347:716-25

3) Other activity benefits

Cochrane Database SystRev 2002:CD003404

J Gerontol A Biol Sci Med Sci 2008;63:997-1004

J Sports Med Phys Fitness 2007;47:462-7

Cochrane Database SystRev. 2008;CD004366

Cochrane Database SystRev. 2008;CD004376

4) Impact of exercise on weight

JAMA 2003;290:1323-30 JAMA 2003;289:323-30

5) Exercise versus angioplasty

Circulation 2004;109:1371-8

6) Do patients adhere?

NEJM 2002;346:393-403

7) Write a prescription for lifestyle – reminders etc

J Fam Pract 2000;49:158-68

Am J Public Health 1998;88:288-91

8) Pedometers

JAMA 2007;298:2296-2304

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