The American journal of geriatric pharmacotherapy
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Am J Geriatr Pharmacother · Aug 2008
Comparative StudyRisk of hospitalizations/emergency department visits and treatment costs associated with initial maintenance therapy using fluticasone propionate 500 microg/salmeterol 50 microg compared with ipratropium for chronic obstructive pulmonary disease in older adults.
Cost-effective treatments for chronic obstructive pulmonary disease (COPD) are needed to reduce the burden on the Medicare system. ⋯ Compared with the IPR cohort, the FSC 500/50 cohort was 45% less likely to have a COPD-related exacerbation event and had similar medical costs. FSC 500/50 was a more effective initial maintenance therapy than IPR for this Medicare population, and, despite the $260 increase in COPD-related pharmacy costs, there was no significant difference in COPD-related medical costs.
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Am J Geriatr Pharmacother · Aug 2008
Comparative StudyComparison of estimated glomerular filtration rate with estimated creatinine clearance in the dosing of drugs requiring adjustments in elderly patients with declining renal function.
The National Kidney Foundation's practice guidelines for chronic kidney disease recommend using the Modification of Diet in Renal Disease (MDRD) equation for calculating the estimated glomerular filtration rate (GFR). ⋯ Although an MDRD equation may be useful for estimating GFR, the CG(CrCl)-Eq should still be used for drug dosage adjustments. The CG(CrCl)-Eq may require a slight "adjustment factor" to be applied using serum creatinine values measured by newly established assay procedures.
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Am J Geriatr Pharmacother · Aug 2008
Case ReportsMegestrol acetate-associated adrenal insufficiency.
Megestrol acetate (MA) is commonly used to promote weight gain in malnourished elderly patients. Although adrenal insufficiency has been reported as an adverse effect of MA, this association is not well recognized in clinical practice. ⋯ This case of adrenal insufficiency in an elderly woman was probably related to MA use. Clinicians should be alert to the possibility of this adverse effect when considering use of MA therapy.