Australian Prescriber最新文献

Triple antithrombotic therapy or 'triple therapy' describes the combination of 3 oral antithrombotic medications - an anticoagulant drug (warfarin, apixaban, rivaroxaban or dabigatran) and 2 antiplatelet drugs (usually aspirin plus clopidogrel). Most commonly, triple therapy is indicated for patients who require both dual antiplatelet therapy following coronary stent insertion for acute coronary syndrome and long-term anticoagulation for atrial fibrillation. Current evidence supports shorter durations of triple therapy to mitigate bleeding risks without compromising ischaemic protection. Recent guidelines advocate up to 1 week of triple therapy for most patients, extending up to 1 month for those at high ischaemic risk. In practice, the approach to antithrombotic therapy is individualised by the patient's cardiologist, balancing bleeding and ischaemic risks. General practitioners and pharmacists have an important role in supporting patients in their step-down plan to dual therapy with the oral anticoagulant drug and one of the antiplatelet drugs, and then ongoing monotherapy with the oral anticoagulant drug.

Device-assisted therapies for Parkinson disease include apomorphine continuous subcutaneous infusion, levodopa continuous intestinal gel infusion, levodopa continuous subcutaneous infusion and deep brain stimulation. These therapies have a role in managing motor fluctuations and dyskinesias in people with advanced Parkinson disease when symptoms are inadequately controlled with oral and transdermal treatments. Subcutaneous infusion of apomorphine or levodopa are the least invasive device-assisted therapies. Levodopa intestinal infusion is delivered via a surgically placed intestinal tube. Deep brain stimulation involves implanting electrodes into specific target regions of the basal ganglia to modulate brain activity. Selecting an appropriate device-assisted therapy depends on individual factors such as age, comorbidities, symptom severity and patient preferences. Initiation and management require neurologist and multidisciplinary involvement, typically in a specialist movement disorder centre. Primary care clinicians play a crucial role in ongoing support and management for people using these therapies, including monitoring and managing adverse effects and communicating with movement disorder services.

Drugs can affect the fetus in various ways, with the timing of exposure during pregnancy a key factor in determining both if and how a drug will impact a developing fetus. The exclusion of women of childbearing age from clinical trials, and the challenges in conducting large epidemiological studies, have resulted in a paucity of data on the fetal and maternal safety of drugs in pregnancy. In some patients, the benefits of drug treatment may outweigh the potential risks to the fetus. It is important for prescribers to assess and communicate the benefits and risks in the context of the individual patient. The Australian categorisation system for prescribing drugs in pregnancy was implemented to guide prescribers; however, it has shortcomings and lessons can be learned from the systems of other countries. Obstetric drug information services and other evidence-based resources are available to provide guidance to healthcare professionals and consumers on the use of drugs in pregnancy and breastfeeding.

Reporting adverse events (adverse drug reactions) associated with medicines and vaccines assists with identifying previously unrecognised side effects and other safety concerns. Reporting adverse events to the Therapeutic Goods Administration is mandatory for sponsors (pharmaceutical companies), and strongly encouraged but voluntary for healthcare professionals and consumers. Adverse events should be reported even when causality is uncertain, as reports may contribute to identification of a safety signal for new or uncommon events. Suspected adverse events associated with new medicines and vaccines (registered in the last 5 years), and medicines included in the Black Triangle Scheme, should be prioritised for reporting. For other medicines, serious adverse events and unexpected adverse events should be prioritised. The Therapeutic Goods Administration analyses adverse event reporting data and uses signal detection methods to identify and evaluate emerging safety signals, which may lead to regulatory actions and communication to address safety issues.