It is worthwhile to check drug prices now and then (once a quarter seems about right) to see what is happening in the pharmaceutical world. When you do this, you will find some drugs that have inexplicably shot up in price. One recent example was doxycycline, which went from around ten cents a tablet to over two dollars a tablet in a couple of months.
On the other hand, drugs that we think of as expensive in the back of our minds sometimes are no longer expensive. Olanzapine (Zyprexa) is now cheaper than haloperidol. Risperidone is cheaper still.
And sometimes, a drug that is a bit more expensive than its alternative is still the most cost-effective treatment based on “the hassle factor,” meaning frequency of dosing, ease of administration, potential for diversion–that sort of thing. Drugs prescribed for outbreaks of genital herpes are like that, in my opinion. Valacyclovir can be more cost-effective than acyclovir for the treatment of recurrent genital herpes.Continue reading →
Your patient is a 29-year old male who presents to the medical clinic stating that he has been having a feeling of a racing heart off-and-on for the last couple of months. It comes and goes, maybe two or three episodes a week. They only last a few minutes. He feels odd when this happens but he does not have to stop his activities. He has noticed no pattern to these; they have happened at work (he is an inmate worker), in the middle of the night and every time in between.
His physical exam is normal including blood pressure of 124/78, regular heart rate of 68 and normal heart sounds.
A patient presents to your clinic with this rash on her arm. She reports that it began three days ago and has steadily gotten worse. Now, the rash is weeping and crusting a little bit. It hurts and itches.
She has been in jail for around 6 weeks. Her only other visits to the medical clinic in that time were for “Athlete’s Foot,” for which she was treated with anti-fungal cream, and depression for which she was prescribed citalopram. She is on no other medications.
All correctional medical people should be able to recognize scabies by sight.
Just to review, scabies is a tiny mite that burrows beneath the skin and causes intensely itchy lesions. Since the mite wanders (as little animals will do), scabies tends to spread with time, and can be passed from individual to individual. Weirdly, scabies does not cause lesions above the neck, probably because of the increased blood supply there. If you are interested, you can find more detailed information on scabies in Wikipedia.
Scabies is found commonly in correctional facilities. Both nurses and practitioners need to be able to spot scabies, hopefully before it spreads throughout a housing dorm! Continue reading →