Australian Prescriber最新文献

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterised by developmentally inappropriate levels of hyperactivity, impulsivity and/or inattention, with substantial impact on functioning. Stimulants (methylphenidate, dexamfetamine, lisdexamfetamine) are the main pharmacological treatment for children and adolescents with ADHD and are highly effective at reducing core ADHD symptoms. Non-stimulants such as atomoxetine, clonidine and guanfacine can also be useful in some patients.

Most patients with non-valvular atrial fibrillation (AF) or acute venous thromboembolism (VTE) can be treated with a direct-acting oral anticoagulant (DOAC); currently available DOACs are apixaban, rivaroxaban and dabigatran. Warfarin is the first-line oral anticoagulant for valvular AF in patients with mechanical heart valves or rheumatic mitral stenosis. Apixaban and rivaroxaban are first-line oral anticoagulants for cancer-associated VTE, and for AF or VTE in patients with body mass index over 35 kg/m² or actual body weight over 120 kg. All DOACs require dose adjustment in people with moderate kidney impairment. Routine laboratory measurement of drug concentrations or relevant coagulation function assays is not required for safe and effective use of DOACs; however, there are situations when it may be beneficial, including emergency scenarios requiring normal haemostasis and where excessive or inadequate anticoagulation is suspected.

Gestational diabetes is common and increasing in prevalence in Australia. New Australasian consensus recommendations released in June 2025 include higher diagnostic thresholds for gestational diabetes and guidance on early pregnancy screening. Women with risk factors for hyperglycaemia in pregnancy are recommended to have glycated haemoglobin (HbA1c) measured in the first trimester. Women with a previous history of gestational diabetes or a first-trimester HbA1c of 6.0 to 6.4% should undergo a pregnancy oral glucose tolerance test (POGTT) before 20 weeks gestation. All pregnant women without early gestational diabetes or existing diabetes should undergo a POGTT at 24 to 28 weeks gestation. Insulin remains the mainstay of pharmacological therapy. Metformin may have a role, but its use should be evaluated on an individual basis. Other non-insulin antihyperglycaemic therapies are contraindicated in pregnancy. Gestational diabetes is a significant risk factor for the development of type 2 diabetes and cardiovascular disease, and long-term surveillance is indicated.

Cumulative exposure to ultraviolet radiation drives skin cancer and photo-ageing across all skin types, including people with darker skin. Visible light radiation plays a key role in the pathogenesis of pigmentary conditions. Intense childhood exposure to ultraviolet radiation is a critical risk factor for development of melanoma later in life. Effective sun protection requires a daily, multifaceted approach when the ultraviolet index is 3 or higher. This includes the correct application of broad-spectrum sunscreen with a sun protection factor of 50+ in conjunction with protective clothing, a broad-brimmed hat, sunglasses, and seeking shade. Some medicines may be photosensitising and patients using these medicines should be advised to adopt stricter sun protection measures. There are many myths about sunscreens that may be barriers to sunscreen use, including concerns about endocrine disruption and nanoparticle toxicity. When counselling patients on sun protection, it is important to offer practical, evidence-based advice that extends beyond sunscreen use alone. The goal is to empower patients to incorporate sun safety into their daily routines.