Shifting the paradigm in the management of conditions affecting the thyroid gland

Disorders of the thyroid gland are frequently encountered in the clinical practice setting and typically fall into one of two categories, namely hypothyroidism (i.e. deficient levels of circulating thyroid hormone), or hyperthyroidism (or thyrotoxicosis) that involves abnormally high levels of thyroid hormone in the bloodstream. This article provides a high-level overview of thyroid function, the two major pathophysiological abnormalities of the thyroid gland, as well as treatment modalities aimed at managing patients with thyroid pathology

Pharmacotherapy during pregnancy, childbirth and lactation: points and principles to consider (a 2015 update)

Pregnancy, childbirth and lactation pose unique challenges in terms of drug therapy. The pregnant mother and her unborn child are exceptionally vulnerable from a physiological, clinical and ethical standpoint. This warrants careful consideration with respect to a number of important aspects, which could firstly influence the decision to opt for drug therapy, and secondly, could influence the specific agent selected for each indication. The US Food and Drug Administration has introduced changes to the content and format of information presented in prescription drug labelling to assist healthcare providers when assessing benefit versus risk, and in the subsequent counselling of pregnant woman and nursing mothers who need to take medication. This change came into effect at the end of June 2015. This article provides an overview of these important aspects.Keywords: embryo, foetus, lactation, neonate, pregnanc

The allergic scholar

Allergic diseases are on the increase globally. There has been a doubling in the number of scholars suffering from allergy-related disease in the past two decades. This article describes the predisposing factors which contribute to an increased incidence of allergies within the population. These factors include a genetic  predisposition, allergen exposure, abnormalities in the bowel flora and infection exposure. Some of these  relate to the hygiene hypothesis and the microflora hypothesis, which are discussed in this article. Treatment options for those suffering from allergic disease are also discussed, with an emphasis on asthma, anaphylaxis, allergic rhinitis and atopic dermatitis.Keywords: atopy, allergy, scholars, corticosteroids, antihistamine

Gastro-oesophageal reflux: An overview of the cost-effectiveness of pharmacotherapeutic treatment options

Gastro-oesophageal reflux disease (GORD) produces symptoms that cause great irritation to the patient. Pharmacotherapeutic management is directed at minimising these symptoms and reducing the causative factors, e.g. acid production, thereby providing relieve. Currently available agents include simple antacids and acid suppression therapy, including histamine 2-receptor antagonists, proton pump inhibitors, mucosal or cytoprotective agents, pro-motility agents. Deciding on appropriate therapy will be dependent on the diagnosis, side-effects and cost-effectiveness of the treatment.Keywords: GORD, gastro-oesophageal reflux, PPIs, proton-pump inhibitors, cost effectivenes

Cardiovascular effects and the use of nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) include the nonselective and the cyclo-oxygenase-2-specific inhibitors. These agents are used for pain associated with musculoskeletal conditions. The nonselective   anti-inflammatory drugs are still widely used, and are also freely available as over-the-counter analgesics. However, they carry the risk of serious  cardiovascular adverse effects, especially in patients who have a high,  pre-existing cardiovascular risk profile. It is imperative that physicians are aware of these risk factors and choose agents that have the best benefit-to-risk profile, while taking into consideration the patient’s individual risk profile

An overview of anti-allergic drug therapy and the histamine-1 antihistamines

Allergic disease decreases the daily quality of life of many people, and can increase the number of working days lost owing to sick leave. Associated symptoms with allergic disease depend on the origin of the disease, and can either be allergic, non-allergic and purulent, or can cause rhinitis as a result of a common cold. Treatment depends on the origin of the rhinitis. However, an antihistamine is indicated in most instances. Combination treatment includes sympathomimetic drugs (either local or systemic) and corticosteroid medication (when indicated, and in most instances, used locally). The article provides an overview of the nature and the management of allergic disease and the histamine 1 antihistamines.Keywords: anti-allergic drug therapy, H1 antihistamines, histamine receptors, allergic rhinoconjunctivitis, allergy healt

An overview of pharmacotherapy-induced ototoxicity

This article provides an overview of ototoxic medication, as well as different pharmacological and audiological monitoring strategies. Although ototoxic medications play an important role in modern medicine, they also have the capacity to do great harm and lead to significant morbidity. Physicians have to be aware of the potential effects of medication in order to identify patients who are at increased risk of developing ototoxicity. Precaution should be taken to prevent any auditory impairment that might occur through  appropriate administration and monitoring. Although some otoprotective substances have been used successfully in certain studies, further trials must be performed to assess their clinical utility. The clinical pharmacist and audiologist form an important part of the ototoxicity management healthcare team

Sublingual immunotherapy for the treatment of allergies

The treatment of allergies often involves pharmacological therapy and recommendations by healthcare workers that the allergen should be avoided. Allergen-specific immunotherapy has emerged as an alternative to effectively decrease the immunoglobulin (Ig) E:IgG4 ratio. Two routes of administration are described, namely subcutaneous immunotherapy, which has always been considered to be the gold standard of treatment, and sublingual immunotherapy, which has recently been shown to have fewer systemic side-effects and improved compliance by patients.Keywords: AIT, allergic disease, allergen-specific immunotherapy, allergic rhinitis, clinical efficacy, SCIT, SLIT, subcutaneous immunotherapy, sublingual immunotherap

A review of phosphodiesterase type 5 inhibitors

Currently, three phosphodiesterase type 5 (PDE5) inhibitors are available for clinical use in South Africa; sildenafil, vardenafil and tadalafil. The PDE  inhibitors are used in males to treat erectile dysfunction. However, sildenafil is also registered for use in the treatment of pulmonary hypertension. Newer  studies are investigating the use of these drugs for other conditions, including hypertension, ischaemia or reperfusion injury, myocardial infarction, cardiac hypertrophy, heart failure and other peripheral circulatory conditions, e.g. Raynaud’s disease. The article provides a broad overview of the mechanism of action, indications, pharmacokinetics and side-effects of these agents

Approach to asthma in adults

Asthma is a chronic inflammatory disease that causes hyper-responsiveness of the bronchial tree, with reversible airflow obstruction. The condition places a significant burden on our healthcare system. Chronic asthma can cause remodelling of the airway. Patients suffering from asthma should be aware of its signs and symptoms, as well as factors that can precipitate an asthmatic attack. Asthma is mostly classified as either acute or chronic. The diagnosis of asthma is based on identification of both a characteristic pattern of  respiratory symptoms and variable expiratory airflow limitation. Treatment is based on how the patient presents, and includes bronchodilators, inhaled corticosteroids and mast cell stabilisers. This article provides an overview of the diagnosis, characterisation and treatment of asthma.Keywords: asthma, bronchodilator, inhaled corticosteroid, β2 agonist, peak expiratory flow, spirometry, SABA, LAB