The Latest News in Rheumatology
10/4/2002
Increased Fracture Risk in Patients With Inflammatory
Bowel Disease
Survey Results: Is Pain
Misunderstood?
The New Wave of
Medications
Instant Access to
Prescription Drugs: A Doctor's Office ATM
Common
Drug Interactions -- What Every Consumer Should Know
San Antonio (Reuters Health) -- Researchers from the UK and the
Netherlands reported that patients with inflammatory bowel disease (IBD) have a
significantly higher risk of fractures.
Dr. Tjeerd-Pieter van Staa (from the University of Utrecht in the
Netherlands) and colleagues conducted a study to evaluate the risk of fracture
in IBD patients. This was the first population-based study of patients with IBD
to examine fracture risk as well as the main risk factors.
Patients with Crohn's disease had a higher fracture risk than patients with
ulcerative colitis. The risk of hip fracture was increased by 86% in Crohn's
patients and by 40% in ulcerative colitis patients.
As could be assumed, the researchers found that inflammatory bowel disease
patients undergoing drug treatment or with a history of symptoms (such as
diarrhea, abnormal pain, rectal bleeding, weight loss, or anemia) had a higher
fracture risk than IBD patients without drug treatment or a history of the
above-mentioned symptoms. Yet patients who had undergone bowel surgery did not
have an increased fracture risk.
They found that fracture risk was related to disease severity as assessed by
the number of recorded symptoms, and that the use of oral corticosteroids
increased with disease severity.
Dr. van Staa and colleagues concluded that IBD patients should receive
counseling on certain lifestyles measures to help reduce bone loss and to avoid
consequent fractures.
A recent survey shows that most Americans do not know much about who suffers
from chronic pain and how it is treated, as is reported by Lisa Habib in the
WebMD Medical News online.
The American Chronic Pain Association organized a coalition of 50 medical
organizations (called the Partners for Understanding Pain) to help raise
awareness about pain.
Survey results showed that 78% of the people surveyed were afraid that they
would become addicted to pain medication. Yet pain expert Daniel Carr, MD, of
the Tufts-New England Medical Center, says that most pain medications rarely
cause addiction because they do not produce a "high"-- they merely
relieve pain.
Most people in the survey believed that most chronic pain sufferers are 65 or
older. But the Partners for Understanding Pain says that 80% of sufferers are
between 24 and 64 years old.
The majority of the people in the survey believed that a doctor can diagnose
pain problems and treat them. Carr disputes this popular notion by stating that
few medical schools teach pain management, so most doctors have little formal
training in that area.
The American Chronic Pain Association claims that more than 50 million
Americans suffer from chronic pain.
New drugs are currently being developed that can be tailored to a person's
individual genes, and scientists are coming up with means to get those drugs
into the body in other ways besides pills or shots. During the last five years,
several new drugs have been introduced that help patients avoid potential risks
associated with regular medicine use. This article can be found at the WebMD
Medical News online section, written by Jennifer Warner.
Examples of recently approved advanced drug delivery systems include:
- A long-acting systems that allows for once-a-week dosing of interferon
treatment for certain cancers and hepatitis.
- A pump that a person can swallow that slowly releases a steady, daylong
dose of the drug Ritalin (which is used to treat Attention Deficit
Hyperactivity Disorder in children).
- Controlled release wafers that can be implanted next to a cancerous tumor
and release chemotherapy directly to the tumor. This method has shown a
five-fold increase in survival rates of brain cancer patients.
- The first controlled release system for a protein: a once-a-month
injection of slow-releasing human growth hormone.
Examples of medical advances for the future:
- A skin patch system using ultrasound technology to make the skin more
permeable to allow accurate blood glucose systems without a blood sample.
The patch transmits the information by radio frequency to a small,
easy-to-carry monitor so a diabetes patient can monitor his/her insulin.
- New inhalers that use larger, but lighter microscopic drug particles to
deliver inhaled medications more effectively to the lungs. Researchers say
that a current problem with inhaled medications is that the drug particles
are so small that they stick together, and only a small percent ever make it
deep into the lungs.
- Microchips that contain as many as 100 tiny drug compartments in which
biosensors may be integrated into these chips to detect biological signals
from the body and release the drug automatically when needed.
An explanation of drugs designed with the patient in mind:
Even when a drug is given exactly as prescribed, adverse drug reactions
account for more than 100,000 deaths every year in the U.S. Some people have
genetic variations that cause them to react differently to a drug. For example,
a person's genetic makeup may cause the body to break down drugs quicker. He/she
will need a larger dose than others for the drug to work effectively.
A large number of adverse drug reactions may be prevented by advances in a
new field called pharmacogenetics. This involves understanding the role that
genes play in determining how a person will respond to a drug. Although it may
take up to 15 years for these types of medications to reach the public, Rochelle
Long (PhD, Chief of Pharmacological and Physiological Sciences at the National
Institutes of Health) estimates that it will take less time to feel the benefits
of the gene research on current dosing guidelines and new diagnostic tests.
In the near future, patients may be able to get their prescription drugs
before leaving the doctor's office, as is reported by Jean Lawrence in a WebMD
online feature.
InstyMeds and FirstFill are two systems that allow commonly prescribed
medications to be distributed from a doctor's front office or waiting room. They
are being groomed for use in emergency rooms, pharmacies, and drive-by machines
so that consumers hypothetically would be able to get their healthcare in one
place.
How does InstyMeds work?
1. A doctor discusses with the patient how to take the new medication,
potential side effects, whether the patient has any drug allergies, etc.
2. The physician writes the prescription on a Palm-Pilot like device that uses
the InstyMeds software.
3. InstyMeds automatically calculates the correct dosage based on a patient's
weight.
4. The doctor asks the patient whether he/she would like to take the
prescription to a drugstore or whether he/she would like to pick it up on the
way out of the office.
5. If wanted immediately, the doctor prints a voucher with a security code, and
the patient inserts the voucher in the InstyMeds dispenser.
6. If a patient has a copay or is paying for the medication himself, he/she uses
a credit card to take care of the fee.
7. The drug passes through three barcode checks, and comes of out of the machine
like a soda or candy bar exiting a vending machine.
8. Patients can talk to a pharmacist from a phone provided next to the machine
if they would like.
The machine holds about 35 commonly prescribed medications that are available
in different strengths and quantities, although none contain controlled
substances. It automatically reorders supplies once the machine begins emptying.
Of people who have tried the InstyMeds system, 94% say they want to use it
every time.
FirstFill has been around longer than InstyMeds, but it requires more time
and work. The doctor's staff must reach for the medication bottle, evaluate the
information on the patient's chart, enter information into a computer that the
patient is receiving a medication, wait to hear back from the system whether or
not a person is allergic to the medication, and print out a prescription label.
The nurse would also collect the payments. Like InsyMeds, FirstFill can fill the
prescription immediately or it can send the prescription directly to a drugstore
nearby. Paul Peterson, Senior Marketing Manager at FirstFill, says that this
system is more fully integrated into a patient's record than InstyMeds is.
Proponents of the ATM-like systems say that it is very accurate and
easy-to-ease. Medication errors kill 7,000 people a year, and many say that
these new systems eliminate the potential for error by printing the prescription
out instead of requiring pharmacists to decipher hard-to-read written
prescriptions for medications that often sound or look alike.
Besides medication accuracy benefits, one doctor summed up the thoughts of
many patients by saying, "When one kid is barfing, you don't want to drag
them all over to the pharmacy."
Others have criticized the systems by saying they penalize the poor who may
not have access to credit cards to pay for the medications, and that they
eliminate the important role of the pharmacist as a patient's medication
counselor.
Even the safest drugs can kill, according to an article by Daniel DeNoon
published online at WebMD Medical News.
Over-the-counter headache and fever medications are some of the safest drugs
on earth, but every year, accidental overdoses lead to tragedy.
The FDA panel lists the following common mistakes that can result in an
overdose:
- An infant gets a fever and the parents may be out of acetaminophen drops
made for infants so they substitute a product made for older children.
- Many parents expect a fever to go away completely after giving a child a
dose of acetaminophen. When the fever does not go away (as is often the
case), the parents give the child another dose too soon.
- Oftentimes, adults take numerous over-the-counter medicines for different
cold or flu symptoms. Each medication may contain a maximum or near-maximum
dose of acetaminophen.
- The doctor prescribes pain medication that contains acetaminophen. A
patient may take this medicine together with an over-the-counter remedy that
also contains acetaminophen.
"Over-the-counter drugs are still drugs. They have to be very safe to be
sold over the counter, but there is no such thing as a totally safe drug,"
says John Jenkins, MD and director of the FDA's office of new drugs.
Drug store shelves carry a wide array of products containing acetaminophen,
all of which are safe by themselves. But people who take more than one product
at a time may accidentally overdose on the medications.
Normally, the body gets rid of acetaminophen through the liver. When a person
takes too big a dose of acetaminophen, the pathway to the liver clogs up. Most
people are okay at this point because their bodies' backup system carries off
the excess drug. But when the backup system isn't working correctly (often occurring
when a person is malnourished or has an acute viral infection), the
acetaminophen begins killing liver cells, which can result in the person's
death.
Consumers may protect themselves by not exceeding the daily recommended dose,
reading the container labels for medicine ingredients, and discussing medication
combinations with a doctor or pharmacist.