Niacin is one of our
options for managing cholesterol in patients with dyslipidemia. The benefits of high doses of niacin are well
established in reducing triglycerides by 20-50%, reducing LDL by 10-25%, and
increasing HDL by 10-30%. What is not
well established, however, are the clinically beneficial endpoints of
niacin.
HughesMedicine - Pharmacotherapy Pearls from the Internal Medicine Clinical Pharmacist
Sunday, December 15, 2013
Sunday, December 8, 2013
Use of dexamethasone for vasogenic edema
Vasogenic edema is a
result of a disruption of the blood brain barrier that is frequently related to
tumors. The edema can lead to increased
intracranial pressure in addition to tissue shifts and brain displacement. Injury can occur not only from this
mechanical shift but also from decreased perfusion that is associated with
elevated intracranial pressure.
Dexamethasone is a
potent, long-acting glucocorticoid which has no inherent mineralocorticoid
activity. Glucocorticoids have a number
of mechanisms for how they reduce inflammation in the body including reduction
in lymphocytes, monocytes, basophils, and eosinophils (neutrophils decrease at
the site of inflammation but increase in the blood); suppression of the
arachadonic acid cascade by inhibiting phospholipase A2 which reduces
prostaglandins and leukotrienes; inhibition of other antigen presenting cells;
vasoconstriction and decreased capillary permeability; and at large doses,
reduced production of antibodies.
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