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What’s New in the Medicine Cabinet? Mike Spieker, M.D. Naval Hospital Bremerton

What’s New in the Medicine Cabinet? Mike Spieker, M.D. Naval Hospital Bremerton. Congratulations, Stealers!. Which ones to Prescribe?. Mohler FPM 13(6); 2006 More efficacious? (NNT) Clinical advantage? Cost savings? Improve safety?. Which ones to Prescribe?. S afe T olerable

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What’s New in the Medicine Cabinet? Mike Spieker, M.D. Naval Hospital Bremerton

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  1. What’s New in the Medicine Cabinet? Mike Spieker, M.D. Naval Hospital Bremerton

  2. Congratulations, Stealers!

  3. Which ones to Prescribe? • Mohler FPM 13(6); 2006 • More efficacious? (NNT) • Clinical advantage? • Cost savings? • Improve safety?

  4. Which ones to Prescribe? • Safe • Tolerable • Effective • Price • Simple • STEPS

  5. OTCs • Theraflu • Zaditor / Alaway • Orlistat • Antehelios

  6. Ketotifen • Zaditor • Alaway • Antihistamine • Mast Cell stabilizer

  7. OTC Orlistat

  8. Obesity • Orlistat • Alli • ½ strength Xenical • Rimonabant • Acomplia • ? Tobacco • ? Pot • ? Cholesterol

  9. Anthelios • Ecamsule • marketed in Europe and Canada • OTC Sunscreen – UVA and UVB • First sunscreen approved in 18 years by FDA

  10. New Generics - Here • sertraline • simvastatin • pravastatin • fluticasone • venlafaxine • finasteride

  11. New Generics – Soon! • zolpidem • clopidogrel • ramipril • amlodipine • aldendronate • esomeprazole • meloxicam

  12. Women’s Health • Boniva • Angeliq • Implanon • Seasonique • Yaz • Loestrin-24 FE

  13. Q 3 months • Parenteral (IV) • No studies to show fewer fx • BMD: “Not inferior” • Adverse: $$

  14. Zoledronic Acid • Zometa/Reclast • Hypercalcemia • Pagets, Cancers • HORIZON • Phase III • Annual infusion • 7736 patients • 70% spine, 40% hip RRR

  15. Angeliq • Estradiol/dropirenone • Menopausal symptoms • Potassium sparing • Hypertension benefit • $197/3 months • No head to head

  16. Implanon • Etonogestrol • Single rod • Three year duration • Pearl index • 0.38 pregnancies /100 women years • Wholesale cost $523

  17. The question is not: “Should the current 21/7-day OC be altered?” but instead “How is the 21/7-day OC to be altered?”

  18. Pill Contraceptives • Seasonique • Yaz • LoEstrin Fe 1/20 • LoEstrin 24 Fe thewelltimedperiod.blogspot.com

  19. Cost Comparisons

  20. Tekturna (aliskiren) • Hypertension • New Drug Class • Direct renin inhibitor • QD dosing • Alone or combo

  21. Lucentis (ranibizumab) • Wet Macular degeneration • Injectable Q4 weeks • 95% arrested at 12 months • 1/3 improved at 24 months $1950/mo

  22. Overall Males: 33% Females: 39% • Hispanic Males: 45% Females: 53% • African American Males: 40% Females: 45% • White Males: 27% Females: 31% Lifetime diabetes risk of people born in USA in 2000

  23. Januvia & Galvus • Januvia – sitagliptin $4.86/day • Incretin breakdown inhibitors • Increases insulin • Decreases glucagon • Add to metformin or glitazone • .64-.81% decrease A1c • Galvus – vidagliptin • Byetta – exenatide • Incretin mimetic

  24. Exubera • 5 M in US use insulin • Tested in both DM I & II • 2 years; 3500 patients • Difference in A1c < 0.5% versus injected • Rapid onset • Pulmonary issues? • Video

  25. Exubera • Meal time only • Smokers – NO • Inhaler concerns • Cough • PFT • Insulin Antibody • Patients prefer the “insulin bong” • NEJM

  26. Generex Oral-lyn • Rapid mist device • Oral absorption • Not inferior • NDA in USA still 18 months

  27. Vivitrol • Monthly for ETOH abuse • Naltrexone 380 mg IM* • Opiod receptor antagonist

  28. Chantix • Smoking cessation • Equals = Zyban 22% @ 1 yr • Titrate to 1 mg BID • $2/tab • $300+ for 12 wks • No nicotine replace • Quitline 1-800 QUITNOW

  29. Cyanokit • Cyanokit • Cyanide • Duodote • Nerve agents • Insecticides • Replaces Mark I

  30. Flector • NSAID patch - diclofenac • for acute pain due to strains, sprains, and contusions.

  31. Emsam • Selegiline patch • Moderate to Severe Depression • MAOI • Tyramine foods • Cost: $430/month

  32. Gardasil RotaTeq Zostavax Adacel Boostrix Pentacel Vaccines Vaccine Economic Evaluation

  33. New Devices

  34. BLACK BOX DRUGS • Quinine – thrombocytopenia • Tequin

  35. In the Pipeline - NDAs

  36. Pristiq (desvenlafaxine) • Depression & hot flashes • Major metabolite of Effexor (venlafaxine). • Comparable efficacy and tolerability • Off-label • fibromyalgia • neuropathic pain

  37. Amyloid β drugs • Alzheimers ala HIV • Aβ inhibiotrs • Protease inhibitors • Vaccine patch • Immune stimulant

  38. Evamist

  39. Arcoxia (etoricoxib)

  40. Gestiva • Progesterone • Preterm delivery • Orphan drug • Approvable

  41. Neupro (rotigotine) • Dopamine agonist • Parkinson’s • Restless legs • “approvable”

  42. Best New Drug Name • Provenge (BLA) • Zingo (NDA) • Topical anesthetic • Altabax • Topical antibiotic

  43. CHCS changes • Read • NNT

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