Drug Therapy

  • A 71-year-old woman with shock and a high INR
    Raja Y. Zaghlol, MD, Michael E. Tierney, MD, BMedSc, Louay Y. Zaghlol and Ayman A. Zayed, MD, MSc, FACE, FACP
    Cleveland Clinic Journal of Medicine April 2018, 85 (4) 303-312; DOI: https://doi.org/10.3949/ccjm.85a.17031

    She presents with an acute change in mental status, blood pressure 80/40 mm Hg, pulse 130, INR 6.13.

  • Deprescribing: When trying for less is more
    Brian F. Mandell, MD, PhD
    Cleveland Clinic Journal of Medicine March 2018, 85 (3) 179-180; DOI: https://doi.org/10.3949/ccjm.85b.03018

    We should periodically revisit the goals and rationale for all prescribed medications.

  • Methemoglobinemia in an HIV patient
    Riva Raiker, MD, William C. Lippert, MD, MPH and Romil Chadha, MD, MPH, FACP, SFHM
    Cleveland Clinic Journal of Medicine March 2018, 85 (3) 186-187; DOI: https://doi.org/10.3949/ccjm.85a.17004

    He had restarted his home dapsone prophylaxis, but his dyspnea worsened and his urine became dark.

  • Alzheimer dementia: Starting, stopping drug therapy
    Luke D. Kim, MD, FACP, CMD and Ronan M. Factora, MD, FACP, AGSF
    Cleveland Clinic Journal of Medicine March 2018, 85 (3) 209-214; DOI: https://doi.org/10.3949/ccjm.85a.16080

    It is reasonable to consider discontinuing therapy when a patient has progressed to advanced dementia.

  • Medication management in older adults
    Luke D. Kim, MD, FACP, CMD, Kenneth Koncilja, MD and Craig Nielsen, MD, FACP
    Cleveland Clinic Journal of Medicine February 2018, 85 (2) 129-135; DOI: https://doi.org/10.3949/ccjm.85a.16109

    Some drugs may become unnecessary or even dangerous as the patient ages. Periodic medication review is needed.

  • Finding balance: Optimizing medication prescribing in older patients
    Kelly C. Sponsler, MD and Amanda S. Mixon, MD, MS, MSPH, FHM
    Cleveland Clinic Journal of Medicine February 2018, 85 (2) 136-137; DOI: https://doi.org/10.3949/ccjm.85a.17087

    More than one-third of older adults in the United States take 5 or more medications. Consider deprescribing.

  • Preventing cardiovascular disease in older adults: One size does not fit all
    Ariela R. Orkaby, MD, MPH, Oyere Onuma, MD, MSc, Saadia Qazi, DO, MPH, J. Michael Gaziano, MD, MPH and Jane A. Driver, MD, MPH
    Cleveland Clinic Journal of Medicine January 2018, 85 (1) 55-64; DOI: https://doi.org/10.3949/ccjm.85a.16119

    The balance of risk and benefit may differ considerably for 2 patients of the same age if one is fi t and the other is frail.

  • Frailty and cardiovascular disease: A two-way street?
    Emer Joyce, MD, PhD
    Cleveland Clinic Journal of Medicine January 2018, 85 (1) 65-68; DOI: https://doi.org/10.3949/ccjm.85a.17075

    Frailty may be both a cause and a consequence of cardiovascular disease.

  • Toward understanding chronic kidney disease in African Americans
    Brian F. Mandell, MD, PhD
    Cleveland Clinic Journal of Medicine November 2017, 84 (11) 824-825; DOI: https://doi.org/10.3949/ccjm.84b.11017

    African Americans respond differently to some treatments than the white male patients who participated in the clinical trials.

  • Fever after recent travel
    Habib Rehman, MBBS, FRCPC, FRCPI, FRCP (GLAS), FACP
    Cleveland Clinic Journal of Medicine November 2017, 84 (11) 840-846; DOI: https://doi.org/10.3949/ccjm.84a.16046

    The patient had been taking a TNF-alpha inhibitor and had recently returned from Mexico.

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