Aust Prescr
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Obesity is a major public health issue with significant health and financial costs. Almost one in three Australian adults are living with obesity Bariatric surgery can have a role in the management of obesity. There is evidence for its effectiveness in preventing or reversing chronic health conditions The type of bariatric surgery can significantly impact the absorption, distribution, metabolism or elimination of orally administered drugs. Some changes can be predicted from pharmacokinetic and physiological effects, but management should be individualised The effect of weight loss itself after bariatric surgery may require drug doses to be altered A review of the patient's medicines and ongoing follow-up are important before and after surgery to ensure optimal outcomes.
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Osteoporosis, osteopenia and minimal trauma fractures are becoming increasingly common in the ageing population. Fractures cause increases in morbidity and mortality and have a significant financial impact on the healthcare system and society Addressing risk factors for osteoporosis early may prevent or delay the onset of fractures and use of drugs. Calcium and vitamin D supplementation may benefit people with a high risk of deficiency (e.g. institutionalised older people) but may not be required in people without risk factors. ⋯ All patients will need ongoing monitoring and most will require some long-term therapy once started Raloxifene may be considered in women who do not tolerate first-line antiresorptive drugs. Romosozumab is a new anabolic treatment for osteoporosis and, together with teriparatide, is subsidised as second-line therapy for individuals with severe disease and multiple fractures. Specialist referral should be considered for patients who sustain fractures while undergoing osteoporosis therapy.
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Autosomal dominant polycystic kidney disease is the most common genetic kidney disease affecting adults. Approximately 60% of patients develop kidney failure by 60 years of age due to slowly expanding kidney cysts. A healthy lifestyle and rigorous control of blood pressure slow kidney cyst growth. ⋯ Tolvaptan, a vasopressin receptor antagonist, slows kidney cyst growth and the decline in the estimated glomerular filtration rate by 1 mL/minute/1.73 m2 per year. It is indicated in patients with chronic kidney disease who are at high risk of progression to kidney failure. Chronic kidney pain is common and can be managed with analgesics, and input from pain specialists if refractory.
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Erectile dysfunction is one of the most common male sexual dysfunctions. The diagnosis can usually be made by a detailed history and examination. Men with erectile dysfunction benefit from multimodal management strategies. ⋯ Providing simple and clear instructions is critical to realise the full benefits of these drugs. Those with severe vascular disease or a history of pelvic surgery may not respond to phosphodiesterase-5 inhibitors. Anxiety or unrealistic expectations can also result in a poor response.