Migraine is broadly divided into two main categories based on the presence or absence of aura symptoms. For women who experience migraine associated with a fall in serum oestrogen levels (menstrual migraine), the migraine is almost invariably without aura. In comparison, high levels of serum oestrogen appear to be associated with migraine with aura.
While the clinical course of migraine is variable around the time of menopause, the perimenopause is the time of peak prevalence, which is followed by a reduction in prevalence in the early postmenopausal phase. The increase in prevalence of migraine is reported to be predominantly in those women who experience migraine without aura, while the prevalence is largely unchanged in women with pre-existing migraine with aura.
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The 2009 RGH E-Bulletins are archived here.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
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The first of the RGH E-Bulletins for 2010 is now out.
Recent evidence shows that the maximum risk is within the first few days after a TIA. One study has shown that for a period of 90 days after a TIA, the risk of stroke is 10.5%, with half of these patients suffering stroke within 48 hours.
Rapid initiation of treatment leads to better outcomes.
The EXPRESS observational study of specialist outpatient TIA management demonstrated that early pharmacotherapy (reducing the median delay to first prescription from 20 days to 1 day) as part of urgent assessment and treatment was associated with a significant lowering of the risk of recurrent stroke at 90 days from 10.3% to 2.1%.
Patients with TIA and associated high -grade carotid stenoses receiving early surgical intervention within two weeks have better secondary stroke prevention outcomes than those receiving later surgery.
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I have mentioned the Practical Pharmacy newsletter produced by Health Action International Africa previously.
This issue looks at adherence from a number of positions including the factors that contribute to poor adherence, ways for children to take medicine and tailoring dosage regimes.
Adherence: The degree to which patients follow medical advice and take medicines as directed. Adherence depends not only on patient’s acceptance of information about the health threat itself but also on the practioner’s ability to persuade the patient that the treatment is worthwhile and on the patient’s perception of the practitioner’s credibility, empathy, interest and concern. (WHO/MSF)
Although based on African experiences many of the examples and points made are pertinent in Australia’s ‘fourth world’, remote indigenous Australia. The current issue is below or it can also back issues can be found here
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Prasugrel (Effient®) is the latest addition to the thienopyridine class of medications (e.g. clopidogrel, ticlopidine). This drug is an irreversible antagonist of P2Y12 ADP receptor on platelets; thereby inhibiting platelet activation and aggregation.
Currently, when co-administered with aspirin, prasugrel has an approved indication in Australia for prevention of atherothrombotic events in patients with acute coronary syndromes (ACS), defined as moderate to high risk unstable angina, ST-segment elevation myocardial infarct (STEMI) or non-STEMI, who are to undergo percutaneous coronary intervention (PCI).
Download the complete bulletin: Prasugrel (133) Volume 35 (12): October 12, 2009
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