In Episode 120, Mike and James, in an attempt to truly make this a PREMIUM podcast, elicit Tina Korownyk to yet again help us unravel the mysteries of medicines. In this podcast, we report on two new studies that look at two old therapies for cough and cold symptoms (Vapor Rub and Zinc). We learn that despite coughs and colds being a very common condition, effective therapies are definitely not common.

Show notes

1) Vapor Rub for children with nocturnal cough and cold symptoms

Pediatrics 2010;126:1092-9 

2) Zinc systematic review

Cochrane Library

HI Everyone – sorry for the hit and miss approach to podcasts over the last month or so. Over the last few weeks we had some technological challenges and Mike and I have also needed to spend time getting ready for our Annual Drug Therapy Course here in Vancouver – April 1 and 2. We have had a great response and a couple of weeks we had to put a stop to registration because we can’t fit any more people in the ballroom at the hotel – a great problem to have. Nonetheless, their should be a premium podcast posted either Wednesday or Thursday this week (and what a perfect time to become a Premium Subscriber) but we may need to take another week or so off after the course. I also have not had time to personally respond to a number of questions and comments that have been left on the website but we will get to the questions in a future podcast. For those of you who are coming to Vancouver, I very much looking forward to meeting you and while we will be busy, please try to catch up with us and say hello. THANKS.

In episode 119, Mike and James tackle a few final issues of atrial fibrillation – rate vs rhythm control, anticoagulation in the elderly, what do with high INR numbers, and short-term warfarin interruption. They outline the details in such a clear and succint manner that they decide all you have to do is follow their guidelines but as they really don’t like guidelines it really is unclear what you should do.

Show notes

1) Rate vs rhythm meta-analyses

Arch Intern Med. 2005;165:258-62

European Heart Journal 2005;26:2000–6

Br J Clin Pham 2005;60:347-54

2) Strict versus lenient rate control

N Engl J Med 2010;362:1363-73

3) Other info on atrial fibrillation

N Engl J Med 2008;358:2667-77

Circulation 2006;114;e257-e354

4) Anticoagulation of the elderly

Circulation 2007;115:2689-96

Lancet 2007;370:493–503

5) High INR and Vitamin K

Ann Intern Med. 2009;150:293-300

Chest 2008;133:160–98S

6) Short-term warfarin interruption

Arch Intern Med 2008;168:63-69

Circulation 2006;114;e257-e354

Chest 2008;133;299S-339S

In episode 118, James and Mike continue their discussion of atrial fibrillation by going into details about the evidence for treating patients with atrial fibrillation and how to make decisions between ASA/warfarin/dabigatran and also what it means to be in or out of the INR therapeutic range. At the end James gives Mike a well deserved, but late, Christmas present, and both their hearts skip a beat – but not enough to require anticoagulation.

Show notes

1) Canadian Cardiovascular Society 2010 Atrial Fibrillation Guidelines

2) Warfarin vs ASA in afib

Ann Intern Med 2007;146:857-67

Heart 2008;94:1607-1613

2) Time in therapeutic range

Can Fam Phys 2005; 51:384-5

Can Fam Phys 2003; 49:181-4

Family Practice 2004; 21:612–6

J Manag Care Pharm 2009:15:244-52

3) Event rates by INR range

CMAJ 2008;179(3):235-44

4) Clopidogrel and ASA in atrial fibrillation 

Lancet 2006;367:1903-12

NEJM 2009;360:2066-78  

NEJM 2009;360:2127-9