American family physician
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American family physician · Sep 1997
ReviewNew drugs for schizophrenia: an update for family physicians.
The prognosis in patients with schizophrenia is worsened the longer the duration of psychosis before institution of effective antipsychotic therapy and the greater the number of psychotic relapses. Use of traditional antipsychotic medications has been limited by their substantial side effects and failure to achieve long-term control of symptoms in some cases. New "atypical" antipsychotic drugs show promise for the treatment of resistant cases of schizophrenia and improvement in patient tolerance and compliance. ⋯ However, they are associated with induction of neuroleptic malignant syndrome, and clozapine can produce fatal agranulocytosis. Atypical antipsychotic drugs on the market currently include clozapine, risperidone and olanzapine. Use of these medications in selected patients who do not benefit from, or cannot tolerate, traditional agents is an important step in improving the lives of patients with schizophrenia.
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Successful pain management requires knowing the type of surgical procedure that has been performed as well as patient characteristics that may influence the choice of analgesic. The risk of morbidity is increased in patients with certain underlying conditions such as unstable angina if they do not receive adequate postoperative analgesia. Frequent assessment of pain severity using techniques such as visual analog scales can help optimize pain control. ⋯ The use of two or more analgesic techniques together produces better pain relief than a single medication or administration route. A team approach can lessen the amount of postoperative pain. Family physicians should aggressively treat postoperative pain and actively support hospital postoperative pain treatment programs.
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American family physician · Sep 1997
ReviewSurgical patients with heart disease: summary of the ACC/AHA guidelines. American College of Cardiology/American Heart Association.
The evaluation and management of heart disease in patients about to undergo noncardiac surgery begins with a careful history and physical examination, including an assessment of clinical risk for perioperative myocardial infarction and/or death. Patients can be categorized into major, intermediate, minor or low clinical risk groups, based on clinical markers such as past myocardial infarction, congestive heart failure, angina or diabetes. Additional evaluation includes estimation of surgery-specific risk, prior coronary evaluation and/or revascularization, and level of functional capacity. ⋯ Perioperative medical therapy relies heavily on the use of beta blockers. Postoperative cardiac surveillance must be tailored to the individual patient. The use of pulmonary arterial catheters, the type of anesthesia and the assessment of long-term cardiac risk are also discussed in this summary of the ACC/AHA Guidelines.