In episode 144, Mike and James finish up their discussion about headache prevention with a poignant yet stirring discussion of the use of antihypertensive and antiepileptic agents for migraine prevention. We show these drugs work and decide that they work not as antihypertensives or antiepileptics but have something to do with their ability to induce fairies to sprinkle magical dust on the brain. At the end we realise that even when it comes to fairy dust, low dose is the way to go. 

Show notes

1) Propranolol for migraines

Cochrane Library CD003225

2) Lisinopril for migraine

BMJ 2001;322:1-5

3) Candesartan for migraine

JAMA 2003;289:65-69

4) Verapamil for headache

Am J Med 1991;90:S48-S53

Headache 1989;29:425-7

5) Hypertension treatment and headaches

Circulation 2005;112:2301-6

6) Overview of pharmacological management

BMJ 2011;342:d583doi:10.1136/bmj.d583

CMAJ 2010;182:E269-E276.DOI:10.1503/cmaj.081657

In episode 143, Mike and James quickly create headaches among their listeners but fortunately just as quickly get to a discussion about the prevention of headaches with antidepressants. We find out that tricyclics work but SSRIs don’t. To prove that point we both take high doses of fluoxetine during the podcast with no effect, except the clear effect it has on the quality of the podcast. 

Show notes

Tricyclics for preventing headaches

BMJ 2010;341:c5222doi:10.1136/bmj.c5222.2

SSRIs for preventing headaches

Cochrane Library CD002919

Prophylaxis of migraine review

CMAJ 2010;182:E269-76

In episode 142, Mike and James finish off the elderly, but hopefully not literally, by discussing some key RCTs that help inform us as to a few medications that likely should be part of your discussion/armamentarium with your elderly patients. At the end Mike extols the virtues of low doses and James tells him I told you so.

Show notes

1) “Optimal” managaement of elderly patients with vascular disease

Am Heart J 2006;152:585-92

2) Drug withdrawal in the elderly

IMAJ 2007;9:430–434.

3) Withdrawing antipsychotics

JAMA 2005;294:1934-43

NEJM 2005:353:2335-41

Lancet Neurol 2009;8:151–57

PLoS Med 5(4): e76.doi:10.1371/journal.pmed.0050076

4) Testosterone

NEJM 2010; 363:109-22

5) BP in the elderly

Lancet 2000;355:865–872

Cochrane CD000028

N Engl J Med 2008;358:1887-98

Cardiol J 2009;16:379–385

Hypertens Res 2008;31:1595-601

Hypertension 2010;56:196-202

Circulation 2001;104:1923-6

6) Anticoagulation in the elderly

Lancet 2007;370:493–503

7) Rate control in the elderly with A fib

N Engl J Med 2010;362:1363-73

8) Low-dose iron

Am J Med 2005;118:1142-7

In episode 141, Mike and James whine about the Beers criteria that is used to evaluate drug use but in the end they realise that all drug use criteria are quite arbitrary and that individual drug use issues need to be dealt with individually. To that end we discuss general concepts as to how to review patients on polypharmacy.

Shownotes

1) Different drug use in the elderly criteria

Arch Intern Med 2003;163:2716-24

Pharmacother 2010;44:1968-75

Arch Intern Med 2007;167:781-7

Dtsch Arztebl Int 2010;107:543–51

2) Association of drug use criteria and bad outcomes

Ann Pharmacother 2007;41:438-8

Am J Med 2009;122,1142-9

J Am Geriatr Soc 2011;59:875-80

Ann Pharmacother 2010;44:1725-32

Age & Ageing 2008;37:673–9

Arch Intern Med 2011;171:1013-9

3) Studies of unsafe prescribing

Arch Intern Med 2009;169:1952-60

Drugs Aging 2008;25:61-70

J Gerontol A Biol Sci Med Sci 2007;62:1172-81

Arch Intern Med 2009;169:1952-1960

Drug Safety 2007;30:171-184

Drug Safety 2009;32:489-98