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Managing Pain with Transdermal Ketoprofen
Author(s): Williams, KaCee D.
Publication: International Journal of Pharmaceutical Compounding, May/Jun 2010
Abstract: Successful treatment of acute and chronic pain has been and continues to be a challenge for physicians and pharmacists alike. This article includes a brief discussion about the differences between acute and chronic pain and discusses the use of transdermal medications for the treatment of pain.

Traditional oral drug therapies, although effective, can have detrimental side effects that prohibit their use. Compounded transdermal ketoprofen offers practitioners a viable treatment option and alternative dosage form for nonsteroidal anti-inflammatory drug therapy with decreased systemic side effects. See the full article.

Emerging Evidence for Androgen Replacement Therapy in Aging Men
Author(s): Bramwell, Bethany L.
Publication: International Journal of Pharmaceutical Compounding, Mar/Apr 2010
Abstract: The age-related changes in organ and system function of an individual increase the risk of developing certain diseases. The data presented in this article reviews current literature on the specific physiological effects of androgen deficiency in disease states and the risks and benefits of testosterone replacement therapy specifically in the areas of urologic, cardiac, and endocrine health. See the full article.

Hormonal Influences in Prostate Cancer: An Update of a Complex Subject
Author(s): Biundo, Bruce
Publication: International Journal of Pharmaceutical Compounding, Mar/Apr 2010
Abstract: Pharmacists who are involved with patients and physicians have a tremendous opportunity to serve in the realm of prostate cancer, and there are numerous compounding opportunities. For example, compounded testosterone gels can help keep testosterone levels in the mid to upper range with proper dosing and patient counseling. Also, estradiol levels can be held in check or lowered by compounding aromatase- inhibitors such as anastrazole or letrazole into the lower doses that men require, rather than their more potent versions for female patients. Nutraceuticals such as omega-3 fatty acids, vitamin D, zinc, and selenium all play an important role in prostate health, as these agents have 5a-reductase inhibiting and anti-inflammatory properties. More than anything else, we see that the pathophysiology of prostate cancer, although quite complex, is being explored at an amazing rate. The author believes that hormonal balance is critical, and that it is largely hormonal imbalance that is involved in prostate disease. See the full article.

Transdermal Dosing Considerations for Veterinarians
Author(s): Williams, KaCee D.
Publication: International Journal of Pharmaceutical Compounding, Sept/Oct 2009
Abstract: Transdermal medications are being demonstrated to be a safe and effective alternative to oral or parenteral dosing for certain medications. These medications are viable options for veterinarians and pet owners with difficult-to-treat patients. When choosing to treat an animal with a transdermal medication, it is essential to consider all of the factors that affect absorption, begin with conservative dosing, and increase dosage slowly with proper monitoring in order to achieve successful therapy with a diminished risk of unwanted side effects. See the full article.

The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy?
Author(s): Holtorf, Kent
Publication: Holtorf Medical Group, Inc., Torrance, CA, Postgraduate Medicine, Volume 121, Issue 1, Jan 2009
Abstract: Background: The use of bioidentical hormones, including progesterone, estradiol, and estriol, in hormone replacement therapy (HRT) has sparked intense debate. Of special concern is their relative safety compared with traditional synthetic and animal-derived versions, such as conjugated equine estrogens (CEE), medroxyprogesterone acetate (MPA), and other synthetic progestins. Proponents for bioidentical hormones claim that they are safer than comparable synthetic and nonhuman versions of HRT. Yet according to the US Food and Drug Administration and The Endocrine Society, there is little or no evidence to support claims that bioidentical hormones are safer or more effective.

Objective: This paper aimed to evaluate the evidence comparing bioidentical hormones, including progesterone, estradiol, and estriol, with the commonly used nonbioidentical versions of HRT for clinical efficacy, physiologic actions on breast tissue, and risks for breast cancer and cardiovascular disease.

Methods: Published papers were identified from PubMed/MEDLINE, Google Scholar, and Cochrane databases, which included keywords associated with bioidentical hormones, synthetic hormones, and HRT. Papers that compared the effects of bioidentical and synthetic hormones, including clinical outcomes and in vitro results, were selected. Results: Patients report greater satisfaction with HRTs that contain progesterone compared with those that contain a synthetic progestin. Bioidentical hormones have some distinctly different, potentially opposite, physiological effects compared with their synthetic counterparts, which have different chemical structures. Both physiological and clinical data have indicated that progesterone is associated with a diminished risk for breast cancer, compared with the increased risk associated with synthetic progestins. Estriol has some unique physiological effects, which differentiate it from estradiol, estrone, and CEE. Estriol would be expected to carry less risk for breast cancer, although no randomized controlled trials have been documented. Synthetic progestins have a variety of negative cardiovascular effects, which may be avoided with progesterone.

Conclusion: Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animalderived counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. Further randomized controlled trials are needed to delineate these differences more clearly. See the full article.

Hormone Treatment Options for Males: What to Do for Men with Low Testosterone
Author(s): Biundo, Bruce
Publication: International Journal of Pharmaceutical Compounding, Jul/Aug 2009
Abstract: Male hypogonadism is a condition that is receiving increasing medical scrutiny, resulting in research producing results favorable to the consideration of maintaining physiological levels of testosterone. As healthcare professionals interested in the health and welfare of a significant portion of the population, surely compounding pharmacists are interested in what can be done for men with this condition to help these patients improve their quality of life and long-term health. This article discusses the various ways that men’s testosterone levels can be raised and provides insight into the importance of androgen-estrogen balance. See the full article.

Saliva Tests, Part 1: Clinical Use, Elements of Testing, and Guidelines for Posttreatment Interpretation
Author(s): Kells, John and Dollbaum, Charles M.
Publication: International Journal of Pharmaceutical Compounding, Jul/Aug 2009
Abstract: Saliva is an excellent medium for the measurement of the biologically active fraction of steroid hormones in the bloodstream because it is a natural ultrafiltrate of blood, and steroids not bound by carrier proteins in the blood freely diffuse into saliva. The baseline measurement of hormone levels in saliva provides an accurate assessment and can be used to identify or monitor a number of clinical conditions, including climacteric changes in perimenopausal or postmenopausal women, adrenal disorders such as Addison’s disease or Cushing’s disease, and androgen deficiency. In men and women, the age-related decrease of hormones such as testosterone and dehydroepiandrosterone can also be assessed and monitored. When compared with serum testing, saliva testing offers several advantages. Saliva collection is simple, noninvasive, stress free, painless, and safe for the patient and practitioner. The collection time for saliva testing is more controllable than that for serum testing. See the full article.

Topical Treatment of Neuropathic Pain
Author(s): Vadaurri, Vince
Publication: International Journal of Pharmaceutical Compounding, May/Jun 2008
Abstract: Pikes Peak Hospice & Palliative Care, Inc., provides care for more than 200 patients with terminal disease who reside at home, in long-term care facilities, in assisted-living facilities, or in its acute care Inpatient Unit. Over the past 4 years, its pharmacy has evolved to provide individualized compounded preparations to meet the unique and complex needs of these patients. An integral part of this evolution was development and implementation of topical treatments for pain. These patients often have multiple medical conditions and complicated health issues. Nearly 50% of patients in the care of Pikes Peak Hospice receive a topical compound to treat any of a variety of conditions, including neuropathies, muscle skeletal pain, wound pain, agitation, and anxiety. Topical compounds give practitioners another option in managing patient maladies and, in many instances, compounded topicals have proven as effective, if not more effective, than commercially available products. See the full article.

The Rectal Rocket: A Two-Day Treatment for Hemorrhoids
Author(s): Vail, Jane
Publication: International Journal of Pharmaceutical Compounding, May/Jun 2008
Abstract: Hemorrhoids, which remain one of the most common colorectal complaints, have been classified into three types: (1) internal, (2) external, and (3) internal-external (mixed). Currently, there are a variety of therapeutic options for hemorrhoids, and the severity of hemorrhoidal disease determines the proper therapy. Added to the present armamentarium of therapies is a uniquely designed suppository that is used primarily to treat internal and external hemorrhoids and also is used for the treatment of anal fissures. The Rectal Rocket, designed by compounding pharmacists Robert and Jerry Boudreaux, delivers lidocaine and hydrocortisone directly to the site of inflammation and heals injured tissue. In this interview, Robert Boudreaux, RPh, and his son, Douglas Boudreaux, PD, discuss the history, design, mode of action, and availability of this unique preparation. See the full article.

Case Report: Ketoprofen/Riboflavin/Caffeine Capsules and Progesterone Therapy for Recurrent Migraine Pain
Author(s): Fields, Shannon W.
Publication: International Journal of Pharmaceutical Compounding, May/Jun 2007
Abstract: A 40-year-old woman presented with recurrent migraine headaches. The etiology of this patien4 s migraines and known triggers were not specified. The patient, an active single mother, was in good overall health and worked as a nurse in a busy obstetric/gynecology practice. See the full article.

Clinical Nuggets and Pearls: Chronic Neuropathic Pain and Opioid Tolerance
Author(s): Jones, Marty
Publication: International Journal of Pharmaceutical Compounding, Jan/Feb 2002
Abstract: The author focuses on chronic neuropathic pain and opioid tolerance. He provides a seven-step protocol for using N-methyl-D-aspartate antagonists to reduce opioid load and an algorithm for treating chronic neuropathic pain. Side effects caused by opioids and N-methyl-D-aspartate antagonists are compared and contrasted, and a figure illustrates a map of the human dermatomes. See the full article.

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