Resistant hypertension? Time to consider this fourth-line drug

Resistant hypertension? Time to consider this fourth-line drug For most adults with resistant hypertension, spironolactone is superior to doxazosin and bisoprolol as an adjunct to triple therapy. Practice changer: When a triple regimen of an ACE inhibitor or ARB, calcium channel blocker, and a thiazide diuretic fails to achieve the target blood pressure, try adding spironolactone

Yeast infection in pregnancy? Think twice about fluconazole

Yeast infection in pregnancy? Think twice about fluconazole. This study's findings regarding the risk of miscarriage may mean it's time to forego fluconazole in favor of topical azoles as first-line treatment. Practice changer: Avoid prescribing oral fluconazole in early pregnancy because it is associated with a higher rate of spontaneous abortion than is topical azole therapy. Stength of recommendation: B: Based on a large cohort study performed in Denmark

Treating migraines : it's different for kids

Treating migraines: Its different for kids. Certain medications used for migraine prevention in adults do not perform the same way in children and adolescents and can actually cause harm. PRACTICE CHANGER: Do not prescribe amitriptyline or topiramate as preventive therapy for migraine in children; both drugs are no better than placebo for this population and are associated with increased rates of adverse events.Authors: Matthew Hawks, MD; Anne Mounsey, MD Nellis AFB Family Medicine Residency, Las Vegas, Nev (Dr. Hawks); Department of Family Medicine, The University of North Carolina, Chapel Hill (Dr. Mounsey

Consider these medications to help patients stay sober

Naltrexone can help prevent relapse in recently detoxified patients with alcohol use disorder. The evidence for acamprosate is not quite as strong. Practice changer: Consider prescribing oral naltrexone (50 mg/d) for patients with alcohol use disorder who wish to maintain abstinence after a brief period of detoxification

A spoonful of honey helps a coughing child sleep

When a parent brings in a child (ages 1-5 years) with cough, runny nose, and other symptoms of a viral upper respiratory infection (URI), recommend that honey be given at bedtime. Stength of recommendation: A: Based on a well-designed, randomized controlled trial (RCT)

Mediterranean diet: Higher fat but lower risk

"For patients at high risk for cardiovascular disease, a Mediterranean diet may be the best bet."Counsel patients at high risk for cardiovascular disease and stroke to follow a Mediterranean diet, which is associated with a 30% risk reduction

Injection may be the best bet for young athletes' knee pain

Consider giving dextrose/lidocaine injections to adolescents with Osgood-Schlatter disease (OSD) that persists despite physical therapy. Stength of recommendation: A: Based on one well-designed, randomized controlled trial (RCT)

Does niacin decrease cardiovascular morbidity and mortality in CVD patients?

Q: Does niacin decrease cardiovascular morbidity and mortality in CVD patients? A: No. Niacin doesn't reduce cardio- vascular disease (CVD) morbidity or mortality in patients with established disease (strength of recommendation [SOR]: A, meta-analyses of randomized controlled trials [RCTs] and subsequent large RCTs). Niacin may be considered as mono-therapy for patients intolerant of statins (SOR: B, one well-done RCT).Authors: Peter Lazzopina, MD; Anne Mounsey, MD University of North Carolina Family Medicine Residency, Chapel Hill; Lara Handler, MSLS University of North Carolina, Chapel Hil

Which treatments work best for hemorrhoids?

Excision is the most effective treatment for thrombosed external hemorrhoids (strength of recommendation [SOR]: B, retrospective studies). For prolapsed internal hemorrhoids, the best definitive treatment is traditional hemorrhoidectomy (SOR: A, systematic reviews). Of nonoperative techniques, rubber band ligation produces the lowest rate of recurrence (SOR: A, systematic reviews)

Need an add-on to metformin? Consider this

Review of: Ou SM, Shih CJ, Chao PW, et al. Effects of clinical outcomes of adding dipeptidyl peptidase-4 inhibitors versus sulfonylureas to metformin therapy in patients with type 2 diabetes mellitus. Ann Intern Med. 2015;163:663-672.1.Need an add-on to metformin? Consider this. Sulfonylureas have been the preferred add-on therapy to metformin for T2DM, but a study finds that DPP-4s have lower risks of death, CV events, and hypoglycemia. Practice changer: Consider a dipeptidyl peptidase-4 inhibitor before a sulfonylurea for patients with type 2 diabetes mellitus who require therapy in addition to metformin