Aust Prescr
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Long-term treatment with warfarin is recommended for patients with atrial fibrillation at risk of stroke and those with recurrent venous thrombosis or prosthetic heart valves. Patient education before commencing warfarin - regarding signs and symptoms of bleeding, the impact of diet, potential drug interactions and the actions to take if a dose is missed - is pivotal to successful use. ⋯ Regular monitoring of the anticoagulant effect is required. Evidence suggests that patients who self-monitor using point-of-care testing have better outcomes than other patients.
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Post-traumatic stress disorder occurs in people exposed to life-threatening trauma. GPs may be seeing more patients with post-traumatic stress disorder as military personnel return from overseas deployments. The condition can present in various ways. ⋯ Usually 8-12 sessions are needed for a therapeutic effect. If drug treatment is needed, selective serotonin reuptake inhibitors are the first line. Other drugs used in post-traumatic stress disorder include antipsychotics, anticonvulsants and prazosin.
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The combined oral contraceptive pill is an effective contraceptive method which can also offer other benefits. However, other contraceptive options should be discussed. If the pill is the chosen method, prescribe a pill with the lowest effective dose of oestrogen and progestogen. ⋯ They are effective if taken correctly, have a relatively low risk of venous thromboembolism, and are listed on the Pharmaceutical Benefits Scheme. The pill is usually taken in a monthly cycle. Some women may prefer an extended pill regimen with fewer or no inactive pills.
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When assessing vitamin D status, measure serum 25-hydroxyvitamin D concentration as this reflects total body vitamin D reserves. Recent Australasian guidelines outline who should be tested for vitamin D deficiency, who should be treated and when repeat testing should be performed. ⋯ Measurement can be repeated after three months of repletion, and thereafter less frequently unless new risk factors for vitamin D deficiency arise. When interpreting vitamin D pathology reports, practitioners should be aware that some laboratories quote reference limits which are based on overseas rather than Australian guidelines.