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Primary Care

Alpha-2 receptor agonists for the treatment of posttraumatic stress disorder

Authors: Molly R Belkin, Thomas L Schwartz

Posttraumatic stress disorder (PTSD) is thought to be related to a hyperactive sympathetic nervous system. Sometimes, use of the US Food and Drug Administration (FDA)-approved medications for PTSD, the selective serotonin reuptake inhibitors (SSRIs) sertraline and paroxetine, may not lead to full remission and symptoms of hyperarousal may persist. In this article the authors review the literature on the alpha-2 receptor agonists clonidine and guanfacine for the treatment of PTSD and conclude that while the evidence base is limited, these agents might be considered useful when SSRIs fail in patients with PTSD.

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Effect of variations in treatment regimen and liver cirrhosis on exposure to benzodiazepines during treatment of alcohol withdrawal syndrome

Authors: Pavel Gershokovich, Kishor M Wasan, Charles Ribeyre, Fady Ibrahim, John H McNeill

Benzodiazepines (BDZ) are the drugs of choice to prevent the symptoms of alcohol withdrawal syndrome (AWS). Differences in treatment regimens, the choice of BDZ, as well as the presence of liver cirrhosis can substantially alter the exposure of patients to drugs used for AWS treatment so patients should be carefully monitored.

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A review of current treatment strategies for gestational diabetes mellitus

Authors: Kristi W Kelley, Dana G Carroll, Allison Meyer

Once changes in lifestyle have failed, treatment for gestational diabetes mellitus remains a matter of debate. In this article the authors review the evidence for glyburide and metformin, and discuss the role of insulin. Also, recommendations for postpartum screening and how to manage patients who are breastfeeding are described.

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A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond

Authors: Lalita Prasad-Reddy, Diana Isaacs

Many of the agents used to treat type 2 diabetes have undesirable adverse effects of hypoglycemia and weight gain. Glucagon-like peptide-1 (GLP-1) receptor agonists represent a unique approach to the treatment of diabetes. In this article the authors discuss the various GLP-1 receptor agonists available on the market, specifically focusing on their relative efficacy, safety, and clinical differences as well as their potential benefits in addition to glucose lowering in type 2 diabetes, and describe the adverse effects and toxicities seen with these agents.

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Review of the experiences from the first childhood influenza vaccination programme with a live attenuated influenza vaccine in England and Scotland

Authors: George Kassianos, Sharon White, Arlene J Reynolds, Sankarasubramanian Rajaram

In 2012, the Joint Committee on Vaccination and Immunisation recommended that the UK National Immunisation Programme for influenza be extended to include healthy children/adolescents aged 2–17 years. The extension of this new immunisation programme began in 2013–2014 and targeted children aged 2–3 years in primary care. This article describes the processes utilised in England and Scotland for programme setup, workforce management, identification and care of contraindicated patients, collection of data on vaccine uptake, communication strategies, and education of parents and children. In light of the lessons learnt from these pilot programmes, the authors make recommendations and offer practical advice to help ensure effective preparation and management of new childhood influenza vaccination programmes in other countries.

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