JustCare

Author: Jonathan Block

  • After a heart attack, multiple drugs can affect quality of life

    After a heart attack, multiple drugs can affect quality of life

    Elderly nursing home patients prescribed a multitude of medications following a heart attack may live longer compared to those given just one prescription drug, but it can come at a cost: It may negatively impact their quality of life.

    Researchers examined claims data from nearly 4,800 nursing home residents, most of whom were white women with an average age of 84. The study looked at deaths, hospitalizations and decreased ability to manage daily activities after the residents were prescribed one of four kinds of medications after leaving the hospital following a heart attack. Those medications were beta blockers, blood thinners, blood pressure drugs and statins.

    Results, published in Circulation: Cardiovascular Quality and Outcomes, showed that residents prescribed three or four medications after hospital discharge were less likely to die within 90 days compared with those prescribed just one medication. The death risk between those taking one or two prescription drugs did not differ.

    Additional analysis found that, with the exception of blood thinners, greater prescription drug use was associated with a 30% increase in functional decline.

    “Since using more medications may interfere with older adults’ ability to do their daily activities, more medications should not be taken by older adults who wish to maintain their independence and daily functioning rather than live longer,” lead author Andrew R. Zullo, PharmD, PhD, an assistant professor at the Brown University School of Public Health, said in a statement. “Using more medications after a heart attack does not simply improve all health outcomes.”

    This article originally appeared in Medshadow.org

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  • PPIs found to increase risk of kidney failure

    PPIs found to increase risk of kidney failure

    Routine use of proton pump inhibitors, common over-the-counter medications used to treat acid reflux, can increase the risk of kidney failure four-fold.

    Researchers examined health data on more than 190,000 patients over a 15-year period in a retrospective study. None of the patients had existing kidney disease at the start. Researchers compared patients who were eventually given a PPI and those who weren’t ever given one. Common PPIs include Prevacid (lansoprazole), Prilosec (omeprazole) and Nexium (esomeprazole).

    Results, published in Pharmacotherapy, found that those on a PPI had a 20% increased risk of chronic kidney disease compared with those not on the drug. In addition, those on a PPI were four times as likely to experience kidney failure. The study authors noted that the risks were highest in those 65 and older.

    Although PPIs are only meant for short-term use, overuse of the medications are as high as 70% of patients.

    Lead author David Jacobs, PharmD, PhD, assistant professor of pharmacy practice at the University of Buffalo School of Pharmacy and Pharmaceutical Sciences, noted that doctors need to be educated on the dangers of overuse of PPIs and deprescribing initiatives developed.

    Last month, a study that analyzed adverse events reports sent to the FDA found that PPIs were associated with an increased risk of kidney disease.

    This story first appeared on Medshadow.org.

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  • More men at low risk for prostate cancer wait and see about treatment

    More men at low risk for prostate cancer wait and see about treatment

    An increasing number of men at low risk of developing prostate cancer are choosing a wait-and-see approach in lieu of treatment options such as radiation or surgery.

    In 2010, 14.5% of men with low-risk prostate cancer used a wait-and-see approach, also known as active surveillance. By 2015, that figure was 42.1%, according to new research published in JAMA. Over the same period, the rate of men in this group having their prostate gland removed declined from 47% to 31%, while those who received radiation therapy declined from 38% to 26%.

    Among men with intermediate risk, the active surveillance rate increased from 5.8% to 9.6% over the time period. The percentage of men in this group having either their prostate removed or having radiation only hardly declined. Among men with high risk, the rate of active surveillance remained the same, at about 2% over the period. Having a prostatectomy increased from 38% to 43%, while radiation therapy decreased from 60% to 55%.

    The results of the study are not all that surprising, considering that in 2010 the National Comprehensive Cancer Network changed its guidelines, recommending active surveillance for men at low risk or those with a short life expectancy.

    Prostate cancer is the second most common cancer among men worldwide. Last year, 1.3 million new cases were diagnosed.

    This article originally appeared in Medshadow.org

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  • Do you really need that antibiotic?

    Do you really need that antibiotic?

    According to a new study in BMJ, nearly one-quarter of antibiotic prescriptions filled by those with private insurance were not medically justified, leading to concerns about antibiotic overuse, antibiotic resistance and adverse events, the last particularly in children.

    Researchers looked at insurance recording for 19 million children and adults (ages 18 to 64) for 2016. About 7.6 million of those – about 40% — filled at least one antibiotic prescription. However, in 23% of those cases, the medications were not medically justified. About 36% were determined to be potentially appropriate and 28% did not have a diagnosis associated with it.

    Researchers found that antibiotics are most often overprescribed for bronchitis and the common cold, conditions caused by viruses and which antibiotics are ineffective against.

    “Despite decades of quality improvement and educational initiatives, providers are still writing antibiotic prescriptions for illnesses that would get better on their own,” lead author Kao-Ping Chua, MD, PhD, a researcher and pediatrician at University of Michigan C.S. Mott Children’s Hospital and the UM Institute for Healthcare Policy and Innovation, said in a statement. “Antibiotic resistance is one of the greatest threats to public health in the world, and the large number of antibiotics that providers prescribe to patients is a major driver of resistance.”

    A study conducted by the Centers for Disease Control and Prevention (CDC) last year found that antibiotics are the leading cause for emergency room visits due to drug adverse events in children.

    Chua also cited CDC statistics that every year in the US, 2 million people suffer from antibiotic-resistant infections and 23,000 die.

    The study found that the rate of antibiotic prescriptions is 805 per 1,000 people. National data indicate that around 270 million antibiotic prescriptions are filled every year.

    This article originally appeared in Medshadow.org

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  • Talk to your doctor before taking a cold medicine

    Talk to your doctor before taking a cold medicine

    With cold and flu season in full swing, people with high blood pressure that is not controlled well or who have heart disease need to be careful with over-the-counter cold medicines, as they may cause a spike in blood pressure.

    Many cold medicines contain decongestants and nonsteroidal anti-inflammatory drugs (NSAIDs), both of which can raise blood pressure. Examples of decongestants are pseudoephedrine and phenylephrine. Some NSAIDs are Advil (ibuprofen) and Aleve (naproxen).

    “People with uncontrolled high blood pressure or heart disease should avoid taking oral decongestants,” Sondra DePalma, a physician assistant at UPMC Pinnacle in Pennsylvania, told American Heart Association News. “And for the general population or someone with low cardiovascular risk, they should use them with the guidance of a healthcare provider.”

    Guidelines released last year by the American Heart Association and the American College of Cardiology dealing with high blood pressure management say that decongestants should be used for as short a time as possible, and to try alternatives such as nasal saline or antihistamines.

    Regarding NSAIDs, guidelines say to use Tylenol (acetaminophen) or topical NSAIDs as other options.

    Healthcare professionals also say if your cold symptoms are mild or moderate, rest and drink plenty of fluids. Avoiding dehydration can help reduce body aches and may reduce the need for decongestants.

    This article was originally published in Medshadow.org

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  • Higher risk of car accidents for people on multiple meds

    Higher risk of car accidents for people on multiple meds

    While it’s no surprise that many older adults take a lot of different medications, many of those drugs can potentially increase their risk of getting into an automobile accident.

    A new report from the AAA Foundation for Traffic Safety found that nearly 50% of active older drivers used seven or more medications. An analysis of 3,000 older drivers that also monitored the drugs they were taking found that about 20% of the meds should be avoided because of limited therapeutic benefit and/or potential to cause excess harm. These drugs are on a list known as the Beers Criteria.

    These inappropriate drugs include benzodiazepines such as Xanax (alprazolam) and Valium (diazepam), as well as first-generation antihistamines. These medications can cause blurred vision and confusion and can impact coordination, increasing a driver’s crash risk by as much as 300%, according to AAA.

    Some of the most commonly prescribed medications in this age group can affect driving ability. For example, 73% of respondents said they took a heart medication, and 70% said they took a central nervous system drug, such as a pain medication, stimulant or anti-anxiety drug.

    The AAA Foundation said prior research found that less than 18% of older drivers say they received a warning from their doctor that their medication could impact their driving ability.

    This article was originally published on Medshadow.

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  • If you take supplements, beware of potentially serious supplement-drug interactions

    If you take supplements, beware of potentially serious supplement-drug interactions

    Millions of seniors that take herbal supplements in addition to prescription drugs may be at risk for potentially serious supplement-drug interactions.

    Researchers in the UK polled older adults 65 and older, finding that about one-third of them take at least one supplement in addition to their regular medications. Based on an evaluation of those supplements and drugs, researchers say that one-third of that group are at risk for potentially serious adverse events, they reported in the British Journal of General Practice.

    Some of the adverse events are a risk of bleeding, an increase in blood sugar concentration and reducing the effectiveness of the medication an individual is taking.

    Researchers identified three supplement-drug combinations they say pose a “significant” hazard: calcium and the underactive thyroid drug levothyroxine; peppermint and Prevacid (lansoprazole), which is used for acid reflux; and St. John’s wort and amlodipine, a blood pressure-lowering medication. In the first combination, the efficacy of levothyroxine can be reduced by calcium. Antacids like Prevacid can eat away at protective coatings on peppermint oil pills, potentially leading to nausea and heartburn. And St. John’s wort can reduce the levels of amlodipine in the blood.

    Other potentially serious combinations include fish oil pills and bisoprolol, a beta blocker, as well as glucosamine, a supplement used for arthritis relief, and the diabetes drug metformin. The first combination can lead to a potentially unsafe lowering of blood pressure, while the second can increase blood sugar.

    The study authors conclude that doctors should ask senior patients about supplement use to potentially avoid interactions with medications.

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    This article originally appeared in medshadow.org.

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  • Don’t overlook marijuana-prescription drug interactions

    Don’t overlook marijuana-prescription drug interactions

    Middle-aged and older adults are increasingly using marijuana. As these groups tend to take more medications, marijuana-drug interactions are overlooked.

    When I think of a typical marijuana user, I admit I tend to stereotype. I see a young person, at home or with friends, smoking a large joint and having a good time. I don’t picture a grandma toking. Yet new research indicates that older people, in fact, are using cannabis more and more.

    A new study found that the number of middle-aged and older adults using marijuana is on the rise. The analysis, based on the National Survey on Drug Use and Health, found that about 9% of adults between 50 and 65 had used cannabis in the last year, and about 3% of those 65 and older had. In 2013, those figures were, respectively, 7% and 1.4%.

    Laws allowing for marijuana use – either recreationally or for medical purposes – are on the rise and can explain the increase. There is some medical evidence that marijuana can be used for a variety of medical conditions, such as pain, nausea from chemotherapy, multiple sclerosis, epilepsy and seizures, and this may also help to explain the increase in the older population.

    Why Worry?

    So what’s the big deal, you might ask? Since older people tend to take multiple medications, there is a risk of marijuana potentially interacting with those drugs and undermining their effectiveness. Yet because marijuana research is limited in the US, thanks to strict restrictions from the government, it’s hard to know exactly what those impacts are.

    If older individuals – or any people, for that matter – are using marijuana for medical purposes, hopefully their doctors are aware of the medications being taken. However, if you are using marijuana and your doctors don’t know, you should tell them as soon as possible. They may be aware of potential marijuana-drug interactions.

    Despite the lack of research on marijuana-drug interactions, there are certain classes of drugs that don’t mix well with cannabis. Because marijuana is very calming on the body, taking drugs that have sedating effects is a big no-no. For example, taking benzodiazepines such as Valium (diazepam) and Xanax (alprazolam), which are used for anxiety and insomnia, or muscle relaxants can lead to central nervous system depression. The same goes with using cannabis and alcohol.

    Cannabidiol (CBD), one of the chemicals found in marijuana, is a big culprit for problems. Why? It can inhibit an enzyme in the liver that is used to break down medicines. When this happens, the medication ends up staying in the body longer, which can enhance the effects of drugs. CBD can even slow the breakdown of statin medications, used to lower cholesterol. That can increase the chances of side effects associated with statins, such as muscle pain.

    There is also evidence that marijuana can impact the effectiveness of antidepressants. This is because marijuana may speed up metabolism of the antidepressant in the body. As a result, a person may need higher doses in order to get the same effect from the antidepressant.

    More research is needed not only on the benefits and risks of marijuana as a medical treatment, but on cannabis-drug interactions. The trend in older people using marijuana makes the research all the more urgent. It’s time for the federal government to loosen restriction of cannabis research.

    This article was originally published in medshadow.org

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  • Aspirin may not help to prevent heart problems

    Aspirin may not help to prevent heart problems

    People who are at a moderate risk of developing cardiovascular disease who take a low-dose aspirin daily do not have fewer heart problems compared to those who don’t take anything, according to a new study.

    Researchers enrolled more than 12,500 people aged 55 and older (men) or 60 and older (women) considered to be at moderate risk of cardiovascular disease because of high cholesterol, high blood pressure or smoking. Half were given a low dose (100 mg) of aspirin daily, while the others were given a placebo. Patients were followed for an average of five years. The study was sponsored by Bayer, which manufactures brand-name aspirin.

    Results, published in the Lancet, showed aspirin did not help to prevent a first heart attack or stroke any more than a placebo.

    About 4% in each group suffered a heart issue after five years. Study author J. Michael Gaziano, MD, of Brigham and Women’s Hospital in Boston, said one reason the rate of cardiovascular events was so low is that many of the patients were taking cholesterol and hypertension drugs that may have already been helping to cut cardiovascular risk.

    Results also showed gastrointestinal bleeding events were higher in the aspirin group. Dr. Jane Armitage, University of Oxford, worked on the study and told the Associated Press that if you are healthy, it’s not worth taking a daily aspirin. Low-dose aspirin is still recommended for people who have had a heart attack or other cardiovascular event, as studies have shown it is effective in preventing another one from happening.

    This article originally was published on Medshadow.org

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  • At-home cancer test is largely unhelpful

    At-home cancer test is largely unhelpful

    If you could take a test and have it determine whether you are at an elevated risk for developing breast cancer, who wouldn’t want to know such valuable information? And what if you could do it in the comfort of your home, without a prescription? That’s the crux behind 23andMe’s at-home genetic test, which the FDA just approved.

    While at first glance the test seems like a real breakthrough and a new tool in the fight against cancer, the reality is that its impact will likely be more muted. And even worse, it could give some people a false sense of security and others a cause to worry for no good reason.

    One of the test’s biggest appeals is that it is easy. Spit in a small tube, then send it back to 23andMe, which will examine the saliva for variants in 2 genes, BRCA1 and BRCA2. The presence of those variants is associated with a significantly higher risk of breast and ovarian cancer in women, and breast and prostate cancer in men, according to the company.

    Before you go to 23andMe’s website to order a test, there are a few things you should know. The variants that are associated with the higher risk of cancers are most common in those of Ashkenazi Jewish descent. So if you are not an Ashkenazi Jew, there’s little reason for you to have the test done. Second, it only tests for 3 mutations that may cause cancer, even though there are far more, a point not lost on the FDA.

    “The test only detects three out of more than 1,000 known BRCA mutations,” the agency said in a news release. This means a negative result does not rule out the possibility that an individual carries other BRCA mutations that increase cancer risk.”

    A larger problem I see with this kind of test is that it eliminates the role of a physician to properly interpret the results and provide guidance for the patient. Many who have the test done and find they don’t have the mutations may get a false sense of security that they won’t get breast or ovarian cancer. On the other hand, those who find they do have the mutations may needlessly worry – having the mutation does not guarantee you will get cancer.

    While the decision to have any genetic test is up to the individual, this new at-home variety brings with it a host of caveats. A test can tell you a lot of things, but not everything, which is why it’s best to meet with a doctor when it comes to any serious health issues.

    This article first appeared on Medshadow.org. You can find it here.

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