Statins (or HMG Co-A reductase inhibitors) are the most effective class of cholesterol-lowering medications, also significantly reducing the risk of developing cardiovascular disease in those patients at high risk.
Between 2004 and 2009, the number of patients diagnosed with high cholesterol has doubled, with statins currently the most prescribed of all drugs, in both quantity and cost, on the Pharmaceutical Benefits Scheme in Australia.
In late February 2012, the U.S. Food and Drug Administration (FDA) approved safety label changes for this class of medication. The expansion of advice on the risks of statins relating to memory loss and increased risk of type two diabetes was reported widely in the Australian mainstream media, resulting in concern amongst patients.
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Postural hypotension is defined as a drop in systolic blood pressure of 20mmHg or diastolic blood pressure of 10mmHg within three minutes of standing. Not only is postural hypotension dangerous because of an increased risk of falls, but it is also a risk factor for stroke and myocardial infarction.
Postural hypotension is commonly experienced in the elderly, due to decreased baroreceptor activity, reduced salt and water conservation, increased arterial stiffness, diastolic dysfunction, and also reduced parasympathetic response.
The elderly are also more likely to be affected by diseases that are associated with postural hypotension, such as Parkinson’s disease and diabetes. Likewise, they are also more likely to be taking medications that can contribute to postural drop, including diuretics, antihypertensives, alpha adrenergic blockers, antipsychotics, and vasodilators.
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Ticagrelor is an oral antiplatelet drug that is a reversible, direct-acting inhibitor of the adenosine diphosphate receptor P2Y12: it has a more rapid onset and produces more pronounced platelet inhibition than clopidogrel. Unlike clopidogrel and prasugrel which are prodrugs, ticagrelor does not need to be metabolised to become biologically active.
The efficacy of ticagrelor was studied in the PLATO study, a multi-centre, double-blinded and randomized trial,comparing ticagrelor (180 mg loading dose, 90 mg twice daily thereafter) and clopidogrel (300 – 600 mg loading dose, 75mg daily thereafter) for the prevention of cardiovascular events in 18,624 patients admitted to the hospital with an acute coronary syndrome, with or without ST-segment elevation. All patients also received aspirin at a dose of 75 – 100 mg daily unless not tolerated.
At 12 months, the findings of the PLATO study were that ticagrelor in combination with aspirin lowered the incidence of a composite outcome of death from vascular causes, MI or stroke more than the
combination of clopidogrel and aspirin. There were slightly more strokes among the group taking ticagrelor compared to those taking clopidogrel, but this was not a statistically significant difference.
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Bullous Pemphigoid (BP) is the most common autoimmune, blistering disease encountered in the western countries. The prevalence is approximately equally for both genders, and although more common in the elderly this condition can occur in younger adults and children.
The clinical presentation involves the appearance of tense blisters on normal-looking or erythematous skin, with mucous membranes involved in about 50% of cases. The degree of associated itch can range from none, through to intense itching, and this may precede the appearance of the blisters by weeks, or in some cases, years.
Bullous Pemphigoid is generally self-limiting and usually remits within five years. Given that most people affected are elderly, with many co-morbidities and a susceptibility to drug-interactions and adverse drug effects, treatment is aimed at arresting the disease progression, reducing itch and the healing of blisters
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