Diabetes Information on the Internet

(Australia—Australian Family Physician, August 1997, p. 917.) Several Web sites relate to health care issues and offer resources for those with chronic diseases. Recommendations for sources of information on diabetes mellitus include the Diabetic Gourmet (http://gourmetconnection.com/ezine/diabetic/), which offers recipes, menu suggestions and an online discussion. Diabetes.com (http://www.diabetes.com/site/) is described as targeting health professionals and well-informed patients or family members and contains updates on research and treatment strategies. Diabetes Mall (http://diabetesnet.com/index.html) has a commercial section offering books, software and other informational materials for sale, but most materials are created by those who have diabetes, including an online game called The Virtual Diabetic. The comprehensive Web site offered by the Melbourne International Diabetes Institute (http://www.idi.org.au) provides information, including statistical services and an online shop, for patients, researchers, health professionals and others.

Calcium Channel Antagonists

(Australia—Australian Family Physician, July 1997, p. 841.) Currently available calcium channel blockers belong to one of four distinct pharmacologic groups. Verapamil is a phenylalkylamine; diltiazem derives from benzothiazepines; nifedipine, nimodipine and other agents belong to the dihydropyridine group, and a new class includes the prototype drug mibefradil, a tertraline derivative. All of these drugs impair contraction of vascular and myocardial smooth muscle by preventing calcium ions from entering cells, but verapamil is highly specific for cardiac nodal tissue and the dihydropyridines are selective for peripheral vascular arterial walls. All of these agents are well absorbed by the oral route and, with the exception of amlodipine, have extensive first-pass hepatic metabolism resulting in short half-lives and the need for frequent dosing. Up to 75 percent of hypertensive patients treated with a single calcium channel blocker experience a reduction in diastolic blood pressure of at least 10 mm Hg, but the choice of this class of drugs, particularly as opposed to angiotensin-converting enzyme inhibitors, diuretics or beta-adrenoreceptor blocking agents, must be individualized. Verapamil and diltiazem are frequently used to treat supraventricular arrhythmias and angina. Nimodipine's relative selectivity for cerebral vasculature has led to its use in patients with subarachnoid hemorrhage. Important drug interactions with calcium channel blockers include verapamil–digoxin and verapamil–beta blockers (producing bradycardia and atrioventricular block), and elevated levels of verapamil or most dihydropyridines when used concurrently with cimetidine.

Treatment of Eyelid Problems

(Great Britain—The Practitioner, September 1997, p. 540.) Patients with blepharitis usually complain of irritation, burning and the sensation of a foreign body in the eye. Symptoms generally are described as worse in the mornings. Anterior blepharitis affects the lid margins and may be controlled with good hygiene and use of topical antibiotics. Posterior blepharitis affects the meibomian glands and requires treatment with hot compresses and lid massage to soften and remove secretions, plus use of systemic antibiotics, particularly doxycycline or erythromycin. A number of conditions can result in entropion (lid margin turned inward, resulting in irritation of the eye). Treatment is directed at relieving symptoms plus removing the cause and repositioning the lid. Conversely, in patients with ectropion, the everted lid exposes the globe to keratopathy, conjunctival hypertrophy and epiphoria.

Acute Migraine Therapy

(Great Britain—The Practitioner, September 1997, p. 501.) In Great Britain, three serotonin (5-hydroxytryptamine; 5-HT1) agonists are available for the treatment of migraine, and their use has markedly reduced the use of ergotamine as a leading migraine treatment. It is suggested that first-line treatment should consist of a simple analgesic of the patient's choice, with or without an antiemetic. The most commonly used antiemetic is metoclopramide, given 10 to 20 minutes before aspirin or another analgesic. In very young or older patients, domperidone should be used because of its lower associated rate of dystonic reactions. Up to one half of patients with migraine obtain relief from first-line combination therapy. Patients who do not respond to first-line therapy should be offered a 5-HT1 agonist if no contraindications are present. The prototype agent, sumatriptan, is available as a subcutaneous injection and a nasal spray, or in oral forms. Zolmitriptan, at 2.5 mg, is equivalent to 100 mg of sumatriptan and has similar efficacy and side effects. Naratriptan appears to have fewer side effects and a lower rate of headache recurrence than sumatriptan.