E-drug: new Canadian GP Formulary
----------------------------------
The second edition of Drugs of Choice: A Formulary for General Practice =
is
now out. This is an evidence based book of prescribing information
organized around diagnoses/problems for which general practitioners in
Canada would initiate therapy. This edition of the book has been expande=
d
and now includes recommendations for 177 different conditions. Besides
being available as a wire-bound book there is also a disk version (for
Windows only). The price is: book or disk CAN$19.95, book and disk
CAN$24.95 + shipping and handling costs. Payment can be made by American=
Express, Amex and Visa. I have included a list of the topics covered alo=
ng
with a sample entry. Anyone interested in getting a copy should contact:=
Canadian Medical Association
Membership Services
P.O. Box 8650
Ottawa, ON
CANADA K1G 0G8
Fax: +613-731-9013
-----------------------------------------------------------------------
Cardiovascular system
Angina pectoris
Atrial fibrillation
Bacterial endocarditis-prophylaxis
Cardiovascular disease-primary prevention
Congestive heart failure
Hypertension
Hypertension and congestive heart failure
Hypertension and diabetes
Hypertension and dyslipidemia
Hypertension and ischemic heart disease
Hypertension and pregnancy
Hypokalemia-diuretic induced
Intermittent claudication
Raynaud's phenomenon
Dermatology
Acne vulgaris
Alopecia areata
Androgenic alopecia in men
Bites-cat
Bites-dog
Bites-human
Burns-first degree and small second degree
Cellulitis, uncomplicated
Dermatitis, atopic
Dermatitis, contact
Dermatitis, seborrheic
Dermatophytosis
Diabetic foot
Diaper rash
Furunculosis-acute and recurrent
Head lice
Herpes labialis
Herpes simplex, mucocutaneous
Herpes zoster
Hyperhydrosis
Impetigo, non-bullous
Pressure ulcers
Psoriasis
Rosacea
Scabies
Sunburn
Urticaria, chronic idiopathic
Varicella (chickenpox)
Venous ulcers
Warts
Ear, nose and throat
Angular cheilitis
Candidiasis, oral
Cold, common
Cough, acute
Dental abscess
Ear wax
Gingivitis
Hiccups-persistent
Motion sickness
Otitis externa
Otitis media
Pertussis
Pharyngitis
Rhinitis, allergic
Rhinitis, vasomotor
Sinusitis, acute
Ulcers, aphthous
Vestibular disorders, acute
Endocrinology
Appetite stimulation
Diabetes, insulin-dependent
Diabetes, non-insulin-dependent
Hyperlipidemia
Hyperthyroidism (Graves' disease)
Hypothyroidism
Obesity
Gastroenterology
Amebiasis (Entamoeba histolytica)
Colic, infant
Colic, recurrent biliary
Constipation
Diarrhea, acute
Diarrhea, travelers'-prophylaxis
Dyspepsia, non-ulcer
Gastroesophageal reflux disease
Gastropathy, NSAID-induced
Giardiasis (Giardia lamblia)
Hemorroids
Hepatitis A-prophylaxis
Hepatitis B-post exposure prophylaxis
Irritable bowel disease
Lactose intolerance
Nausea-vomiting
Peptic ulcer disease
Worms, intestinal
Genitourinary system
Colic, recurrent renal
Cystitis-pyelonephritis-adults
Enuresis
Epididymitis
Impotence
Prostatic hypertrophy, benign
Prostatitis
Syphilis
Urethritis
Urinary incontinence
Hematology
Anemia, iron deficiency
Anemia, pernicious
HIV
HIV infection
HIV-clostridium difficile colitis
HIV-salmonella enterocolitis
Mycobacterium avium complex (MAC)-prophylaxis
PCP (pneumocystis carinii pneumonia)-prophylaxis
Toxoplasmosis-secondary prophylaxis
Musculoskeletal system
Arthritis, osteo
Arthritis, rheumatoid
Bursitis and tendonitis
Fibromyalgia
Gout
Lyme disease-early localized disease (erythema migrans)
Night leg cramps
Osteoporosis, prevention and treatment
Pain, acute-lower back
Pain, acute-miscellaneous, soft tissue or musculoskeletal
Strains and sprains
Neurology
Bell's palsy
Dementia
Epilepsy-generalized convulsive and absence seizures
Epilepsy-partial and secondarily generalized seizures
Essential tremor, benign
Headache, tension
Ischemic stroke and transient ischemic attacks
Meningococcal prophylaxis
Migraine
Neuralgia, post-herpetic
Neuralgia, trigeminal (tic douloureux)
Neuropathy, painful diabetic
Parkinson's disease
Restless legs syndrome
Torticollis
Obstetrics and gynecology
Cervicitis
Contraception
Contraception, oral-combination therapy
Dysfunctional uterine bleeding
Dysmenorrhea
Mastalgia-cyclical and noncyclical
Mastitis
Menopausal symptoms
Pelvic inflammatory disease
Pre-eclampsia-primary prevention
Pregnancy-antiemetics
Pregnancy-preconception supplements
Pregnancy-vitamin supplementation
Premenstrual syndrome
Vaginitis
Ophthalmology
Blepharitis
Conjunctivitis, allergic
Conjunctivitis, bacterial
Dry eyes
Palliative care
Anorexia-cachexia
Bowel care for patients on opioid analgesics
Pain control
Tumour-related nausea
Psychiatry and behaviour
Alcohol dependence
Anorexia nervosa
Attention-deficit hyperactivity disorder
Bulimia nervosa
Depression
Generalized anxiety disorder (GAD)
Insomnia
Mania
Obsessive-compulsive disorder
Panic disorder
Schizophrenia
Social phobia
Substance abuse-alcohol withdrawal
Substance abuse-benzodiazepine withdrawal
Substance abuse-tobacco
Respiratory system
Asthma
Bronchitis, acute
Chronic airflow limitation
Pneumonia-community-acquired, adults
Pneumonia-community-acquired, children
Pneumonia, nursing home
Tuberculosis prophylaxis
------------------------------------------------------------------------
DYSPEPSIA, NON-ULCER
DRUGS OF CHOICE
An empiric trial of antacids is warranted if symptoms are mild or of a
chronic nature. Symptom relief may be better with liquid preparations th=
an
with tablets.
SECOND-LINE THERAPIES<1,2,3>
Divide patients into two groups
1. Burning or pain
H-2 antagonists
cimetidine 400 mg, BID $0.27/d=
ay
or
ranitidine 150 mg, BID $0.81/d=
ay
or
famotidine 20 mg, BID $1.26/d=
ay
or
nizatidine 150 mg, BID $1.68/d=
ay
2. Bloating, fullness or heaviness
Prokinetic agents
metoclopramide 5-10 mg, QID (ac and hs) $0.22-0=
=2E23/day
or
domperidone 10 mg, QID (ac and hs) $0.71/d=
ay
or
cisapride 10 mg, QID (ac and hs) $2.27/d=
ay
ADDITIONAL INSTRUCTIONS AND NOTES
*Up to 60% of patients have considerable improvement of symptoms during
placebo treatment.
*Randomized trials have not demonstrated a benefit from antacids compared=
to placebo.<1,4>
*Although patients are typically divided into subgroups based on
predominant symptoms, there is no convincing data indicating that this
strategy identifies responders to a particular type of treatment.
*Although dyspepsia is a chronic condition often persisting for years the=
re
are no long-term trials of any treatment regimen.
*There is no evidence of a causal relation between H. pylori and nonulce=
r
dyspepsia.<5>
*Consider referral for additional investigation for non-responders or if
warning symptoms are present (weight loss, bleeding, vomiting).
REFERENCES
1. Holtmann G, Talley NJ. Functional dyspepsia: current treatment
recommendations. Drugs 1993;45:918-930.
2. Halter F, Miazza B, Brignoli R. Cisapride or cimetidine in the
treatment of functional dyspepsia: results of a double-blind, randomized=