Australian Prescriber最新文献

Psoriasis is an immune-mediated inflammatory disease with a genetic predisposition. Although manifesting predominantly as a hyperproliferative skin disorder, psoriasis is a systemic disease associated with a range of comorbidities including arthritis, cardiovascular disease and depression. Educating the patient that psoriasis is chronic and that there are possible comorbidities is paramount. Patients with a limited number of plaques and no systemic symptoms may be managed with intermittent use of topical therapies. Those with more extensive or debilitating disease may require phototherapy or systemic medicines such as methotrexate or one of the newer targeted therapies. Newer systemic therapies, including oral medicines and injectable biologics, can only be used following unsuccessful treatment with traditional therapies such as methotrexate and phototherapy. Biologic therapies for psoriasis offer the possibility of near-complete symptom resolution in people with psoriatic disease.

Opioid dependence is a chronic condition that can lead to significant harm if left untreated. People who experience opioid dependence and the treatments themselves are highly stigmatised. Person-centred trauma-informed services are critical to therapeutic engagement and effectiveness. Buprenorphine and methadone are highly effective, evidence-based medicines for opioid dependence. In recent years, long-acting injectable buprenorphine has emerged as a safe and effective treatment option, offering flexible weekly or monthly dosing. The long-term treatment of opioid dependence can be undertaken in primary care settings. General practitioner and nurse practitioner prescribing, and community pharmacist dispensing, are essential for ongoing care. Australian jurisdictions have differing regulations that guide the prescribing of medicines for opioid dependence. Health professionals should be familiar with their local jurisdiction's guidelines as well as the national guidelines. Drug and alcohol telephone services are available in each jurisdiction and can provide advice to health professionals.

Androgenetic alopecia, commonly referred to as male or female pattern hair loss, is a prevalent condition encountered in clinical practice. It is important to identify potential underlying causes and differentiate it from other forms of hair loss, which may require referral to a dermatologist for management. Pharmacological treatments for female pattern hair loss include minoxidil (topical and oral) and antiandrogens such as spironolactone. For male pattern hair loss, minoxidil and 5-alpha-reductase inhibitors (e.g. finasteride, dutasteride) can be used. Combination therapy is commonly employed, with clinical improvement typically requiring a minimum of 6 months. Supplements and other treatments have varying levels of evidence, and counselling is important to help patients make informed decisions about their management.

Pharmacogenomic testing provides information on whether a patient possesses gene variants that can influence drug exposure or response. It can be used as part of clinical decision-making to personalise drug therapy. Pharmacogenomic testing can help identify patients at higher risk of serious adverse drug reactions or therapeutic failure, and sometimes it can explain unexpected adverse effects or poor efficacy in patients already on drug therapy. As drug responses are influenced by many factors, pharmacogenomic test results must always be interpreted in the clinical context of the patient. At the time of writing, tests for thiopurine methyltransferase (TPMT) (azathioprine, mercaptopurine, thioguanine) and human leucocyte antigen B*57:01 (abacavir) are Medicare-rebated. Pharmacogenomic testing is also recommended for several other drugs, such as allopurinol and clopidogrel, but these do not currently attract a Medicare rebate.

[This corrects the article DOI: 10.18773/austprescr.2024.055.].