This Clinical Pharmacist series provides in-depth reviews of diseases and their management, and some other emerging areas of practice. The articles can form the basis for continuing professional development. Online modules are accessible here
Multiple myeloma: clinical features and classification
May 2012
Bone pain, renal failure, recurrent infections and anaemia are classic clinical features of multiple myeloma, a haematological malignancy that accounts for 2% of all cancer deaths in the UK
Multiple myeloma: management
May 2012
Treatment for multiple myeloma aims to control the disease, maximise quality of life and prolong survival; this can be achieved through a combination of disease-specific therapies and supportive care
Acute kidney injury: diagnosis, staging and prevention
April 2012
Prevention and early recognition of acute kidney injury can improve outcomes for those affected. Pharmacists can help to review patients whose renal function is at risk of rapid deterioration
Acute kidney injury: management
April 2012
Management of acute kidney injury depends on the underlying cause and whether the condition is the result of pre-renal, intrinsic or post-renal dysfunction. All patients should have their medicines reviewed
Gout: clinical features and diagnosis
March 2012
During an attack of gout, a person will experience excruciating pain, redness and swelling in one or more peripheral joints. The condition is caused by deposition of urate crystals in the affected jointsGout: managing gout and hyperuricaemia
March 2012
Managing gout involves alleviating the pain of an attack and preventing episode recurrence and complicationsBenign prostatic hyperplasia: clinical features and diagnosis
February 2012
For older men, benign prostatic hyperplasia is a common cause of lower urinary tract symptoms such as polyuria, incomplete bladder emptying, urinary urgency and, in severe cases, urinary retentionBenign prostatic hyperplasia: management
February 2012
Men with benign prostatic hyperplasia often experience lower urinary tract symptoms, the severity of which will determine treatment — options include lifestyle interventions, medication and surgeryStable angina: clinical features and diagnosis
January 2012
Angina is caused by myocardial ischaemia. The classic symptom of the condition is retrosternal pressure or heaviness, which can be accompanied by pain that radiates to areas such as the neck, jaw and armsStable angina: management
January 2012
Management of stable angina involves symptomatic relief of chest pain, longer-acting control of symptoms and prevention of cardiovascular complications. This article looks at NICE’s approach to angina treatment
Parkinson's disease: clinical features and diagnosis
December 2011
Tremor, bradykinesia, hypokinesia and rigidity are well known features of Parkinson’s disease, but patients also experience troublesome non-motor symptoms, such as depression, pain and insomniaParkinson's disease: management
December 2011
There is no definitive first-line treatment for managing the motor symptoms of Parkinson’s disease. Treatment choice should take into account factors such as patient age, adverse effects and comorbidities
Thyroid disorders: clinical features and diagnosis
November 2011
Appropriate thyroid function is essential for normal metabolism. Hyperthyroidism is characterised by weight loss, sweating and tremor, whereas hypothyroidism can cause weight gain, constipation and dry skin
Thyroid disorders: management
November 2011
Management of overt hypothyroidism involves replacement of thyroid hormones. For patients with hyperthyroidism, the aim is to treat the underlying condition and to relieve the associated symptoms
Intravenous fluids: principles of treatment
October 2011
Although intravenous fluids are commonly prescribed for patients in hospital, they are often overlooked by pharmacists conducting a clinical review. This article provides some tips for reviewing fluid orders
Intravenous fluids: practical aspects of therapy
October 2011
Cystic fibrosis is a common genetic disease and, although many clinical features of the condition are respiratory, it also affects the gastrointestinal tract, liver, pancreas and reproductive organs
Cystic fibrosis: pathophysiology and diagnosis
September 2011Intravenous fluid therapy can be used to replace large fluid losses or to maintain fluid status when oral intake is insufficient; appropriate prescribing requires an understanding of basic fluid physiology
Cystic fibrosis: pharmacological management
September 2011The pharmacological management of patients with cystic fibrosis largely focuses on maintaining lung function; however, other aspects of care, such as managing pancreatic insufficiency, are also important
Stroke: classification and diagnosis
July/August 2011
Slurred speech, facial droop and arm weakness — it is critical that all healthcare professionals are alert for these signs of stroke to ensure that patients displaying them receive treatment quickly
Stroke: acute management
July/August 2011Time is of the essence when treating stroke. Therefore, patients should be transferred immediately to a hyperacute stroke unit for management, which will depend on the type and severity of the stroke
Stroke: long-term management
July/August 2011Dry mouth, depression and spasticity are common sequelae of stroke. Managing these problems and preventing further vascular events are the main considerations in the long-term care of stroke patients
Invasive fungal infections: causes and diagnosis
June 2011
The increasing use of immunosuppressant medicines means that the number of invasive fungal infections is on the rise. Pharmacists should be able to identify the patients at risk of such infections
Invasive fungal infections: management
June 2011Choosing the most suitable antifungal for a sick patient is not easy. Pharmacists should be aware of the factors influencing this choice and the side effects and monitoring requirements of each drug
Liver disease: pathophysiology
May 2011The functions of the liver are wide ranging and include synthesis of clotting factors and metabolism of drugs and bilirubin; symptoms of liver disease relate to the liver’s inability to perform these function
Liver disease: managing the complications
May 2011Complications of liver disease include the development of clotting disorders, ascites and portal hypertension
Liver disease: alcohol and the liver
May 2011Alcohol consumption can be a major contributing factor in the development of liver damage; abstinence is the mainstay of treatment for alcoholic liver disease, but therapies such as thiamine also have a role
Lung cancer: diagnosis and staging of disease
April 2011Early detection of lung cancer can improve treatment outcomes. Pharmacists should take an active role in raising people’s awareness of lung cancer signs and symptoms and ensure prompt referral to GPs
Lung cancer: treatment
April 2011First-line treatment for non-small cell lung cancer is surgery; but many patients are not suitable and, for these patients, management may involve radiotherapy, chemotherapy or newer targeted therapies
Inflammatory bowel disease: clinical features and diagnosis
March 2011Inflammatory bowel disease is an umbrella term for two conditions — ulcerative colitis and Crohn's disease. Although these affect the bowel, up to 40% of sufferers experience extraintestinal symptoms
Inflammatory bowel disease: management
March 2011Management of inflammatory bowel disease depends on the site and severity of the inflammation and patient adherence. Surgery might be required if IBD is severe or does not respond to medical therapy
Schizophrenia: clinical features and diagnosis
February 2011Schizophrenia is a chronic mental health condition characterised by a distortion of perceptions and thinking. It is thought to be caused by a combination of biological, social and psychological factors
Schizophrenia: long-term management
February 2011Although effective for the treatment of schizophrenia, antipsychotics have considerable adverse effects, ranging from the metabolic syndrome to extrapyramidal reactions — striking a balance can be tough
Chronic kidney disease: clinical features and renal replacement therapies
January 2011Chronic kidney disease is a growing health problem. Identification of patients in the early stages of the disease allows steps to be taken that slow progression to renal failure requiring dialysis or transplantation
Chronic kidney disease: managing the complications
January 2011Anaemia and metabolic bone disease are complications of chronic kidney disease that can appear relatively early in the course of the condition. What is the best way to manage these complications?
COPD: clinical features and diagnosis
December 2010Chronic obstructive pulmonary disease is an incurable condition affecting millions of people worldwide
COPD: management
December 2010For patients with chronic obstructive pulmonary disease, inhaled medicines are the mainstay of treatment
Atrial fibrillation: clinical features and classification
November 2010Atrial fibrillation is not a benign condition — it increases mortality and can cause considerable symptoms. Classification and treatment are based on the temporal pattern of the arrhythmia
Atrial fibrillation: management
November 2010Treatment of atrial fibrillation usually involves controlling ventricular rate or restoring sinus rhythm. Equally important is thromboembolic risk assessment and prescription of an anticoagulant if required
Eating disorders: Clinical features and diagnosis
October 2010Eating disorders are common psychiatric conditions in young women and have a substantial impact on physical health and psychosocial well-being. Early identification is essential to improve outcomes
Eating disorders: Management
October 2010Although psychosocial therapies are the treatment of choice for eating disorders, some patients will need medicines
Atopic eczema: Clinical features and diagnosis
September 2010Atopic eczema can have a substantial impact on a patient’s daily living. Assessment should focus on both physical and quality-of-life aspects of the disease to ensure optimal management
Atopic eczema: Management
September 2010The education of patients and their carers on avoiding trigger factors, using emollients effectively and adopting a stepped management plan is essential for successful treatment of eczema
Burns: clinical features and prognosis
July 2010There are many causes of burns. Patients with complex burns should be referred to a specialist burns unit
Burns: management
July 2010Timely and appropriate management of burns can improve the outcome for victimsAsthma: the condition and its diagnosis
June 2010Wheeze, shortness of breath, cough and chest tightness are classic symptoms of asthma — a condition that can be fatal. Before appropriate treatment can be selected an accurate diagnosis must be made
Asthma: treatment and monitoring
June 2010Asthma treatment plans should take into account patients’ goals and preferences
Rheumatoid arthritis: Features, causes and diagnosis
May 2010Social and financial independence can be lost when a person develops severe rheumatoid arthritis. Prompt diagnosis and treatment can improve outcomes for patients and reduce costs to society
Rheumatoid arthritis: Management
May 2010Evidence in support of early and aggressive pharmacological intervention in rheumatoid arthritis continues to be gathered. DMARDs, corticosteroids and biologics are the main drugs in the armoury
Adult myeloid leukaemias: Pathogenesis, clinical features and classification
April 2010Acute and chronic myeloid leukaemias and the myelodysplastic syndromes affect the formation of blood cells in the bone marrow. Genetic factors are linked to the development and prognosis of these diseases
Adult myeloid leukaemias: Current and future treatments
April 2010Acute myeloid leukaemia is treated with chemotherapy and, if appropriate, stem cell transplantation. For those with chronic myeloid leukaemia, therapy has been transformed by tyrosine kinase inhibitors
Epilepsy: clinical features and diagnosis
March 2010
When an individual experiences a seizure it is important to identify the underlying cause. Repeated seizures may constitute a diagnosis of epilepsy. The type of seizures will dictate how the epilepsy is treated.
Epilepsy: pharmacological treatment and monitoring
March 2010
Although treatment with antiepileptic drugs can stop seizures recurring, close monitoring of side effects is crucial.
Organ transplantation: donation and surgery
February 2010
For over 50 years those who experience vital organ failure have had a chance to live relatively normal lives thanks to transplant surgery. However, the shortfall between recipients and donors continues to rise.
Organ transplantation: immunosuppression
February 2010
Patients who tolerate a transplanted organ without the need for pharmacological intervention are few and far between. Several immunosuppressants can be used to reduce the risk of organ rejection.
Hepaptitis B: diagnosis and monitoring
January 2010Some 350 million people across the world are infected chronically with hepatitis B. Despite global control of the disease being achievable through widespread vaccination, this has not yet been attained.
Hepatitis B: management
January 2010When a decision has been made to treat a patient with chronic hepatitis B (CHB) infection, choosing the most appropriate treatment depends largely on whether he or she has compensated or decompensated cirrhosis.
Type 2 diabetes: pathophysiology and clinical features
December 2009
Some 2.6 million UK residents have diabetes and this number is rising. These people are at increased risk of heart disease, blindness and limb amputation. Early detection of the condition is essential.
Type 2 diabetes: management
December 2009
The aim of type 2 diabetes treatment is to maintain a patient’s HbA1c level below 6.5%. To ensure there is a range of treatment options, NICE has updated its guidance to include newer medicines.
Multiple sclerosis: symptoms and diagnosis
November 2009It is not fully known why people develop multiple sclerosis. There is evidence that the disease process, characterised by demyelination of nerves in the central nervous system, has an autoimmune component.
Multiple sclerosis: treatment
November 2009Treatments for multiple sclerosis can be split into three categories: those that alleviate symptoms of the disease, those used to limit the duration of a relapse and those that can slow disease progression.
HIV infection: pathology and disease progression
October 2009UK HIV infection rates continue to increase and the proportion of undiagnosed infection remains a problem. Undiagnosed individuals are at risk of developing advanced disease and infecting others. Transmission can occur sexually, parenterally or from mother to child and current prevention strategies target these routes.
HIV infection: combination antiretroviral therapy
October 2009Since the advent of combination antiretroviral therapy in the mid-1990s HIV-infected individuals are now living longer with improved quality of life. Medication adherence is vital for successful treatment.
Substance misuse: prevalence, dependence and harm
September 2009
Over a third of adults in the UK are believed to have used illicit drugs at some point in their lives. Long-term drug misuse is associated with dependence, along with physical, mental and social harms.
Substance misuse: harm reduction and treatment
September 2009
A solid evidence base is now established for the treatment of substance misuse and for several interventions that reduce the harm it can cause. Pharmacists’ involvement in offering both is essential.
Substance misuse: emerging drug trends
September 2009
Special K, liquid ecstacy, super E, ice. Pharmacists in city areas may have heard these mentioned. Rather than admit, or maintain, ignorance it is worth learning about some of the newer drug trends.
Paediatric meningitis: clinical features and diagnosis
July/August 2009
Fever, headache, photophobia and neck stiffness — these are the classic symptoms of meningitis. But in children, young ones particularly, signs can be variable and non-specific, or may well be absent.
Paediatric meningitis: treatment of bacterial infection
July/August 2009Children who develop bacterial meningitis must be treated swiftly to limit the risk of permanent neurological damage. Determining the right treatment depends on identifying the infecting organism.
Gene therapy: science and technology
June 2009
How to get genetic material into human cells is one of the challenges facing scientists researching gene therapies.
Gene therapy: applications
June 2009Several disease areas are at the centre of gene therapy research. This article looks briefly at what is on the horizon.
Osteoporosis: features of disease and diagnosis
May 2009Fractured hips are the cause of around a fifth of admissions to UK orthopaedic wards. Osteoporosis, literally porous bones, contributes to many of these traumas, from which some patients never recover.
Osteoporosis: treatment and risk assessment
May 2009Several guidelines exist for the identification and treatment of osteoporosis. Patients diagnosed with the condition should be prescribed bisphosphonates, if suitable, in the first instance.
Acne: causes and clinical features
April 2009Acne vulgaris is a chronic skin condition which involves inflammation of the pilosebaceous unit — the hair follicle and the sebaceous gland. It affects the areas where there are most sebaceous glands, that is the face, chest and upper back and shoulders.
Acne: treatment
April 2009The objectives of acne treatment are to reduce the numbers of lesions and their impact on the patient and to prevent or minimise long-term scarring.
Heart failure: clinical features and diagnosis
March 2009Heart failure is a complex syndrome resulting from structural or functional cardiac disorder. The syndrome is characterised by symptoms and signs of breathlessness, fatigue and fluid retention. Many risk factors cause heart failure, including coronary artery disease, hypertension, congenital heart disease, arrhythmias, alcohol and some medicines.
Heart failure: management
March 2009Heart failure is a complex syndrome requiring multiple interventions to optimise outcomes. Drug therapy, in particular with ACE inhibitors and beta-blockers, is the mainstay of treatment for most patients and significantly reduces mortality and morbidity.
Bipolar affective disorder: symptoms and diagnosis
February 2009Bipolar affective disorder (BPAD) is a chronic relapsing-remitting condition associated with episodes of hypomania, mania and depression. During the course of the illness, recurrent episodes can be in the same pole or fluctuate between poles. It is a common condition, affecting 1–2% of the population.
Bipolar affective disorder: long-term management
February 2009
Long-term medication has a vital role in reducing the frequency and severity of acute episodes of both mania and depression in patients with bipolar affective disorder. Additionally, treatment has been shown to reduce patients’ risk of suicide.
Bipolar affective disorder: treatment of acute relapses
February 2009Pharmacological therapy is the main treatment option for patients with bipolar affective disorder (BPAD). Medicines used for maintenance treatment of BPAD, such as mood stabilisers or antipsychotics, are often used to treat acute episodes of BPAD.
Skin and soft tissue infection: diagnosis and management
January 2009Skin and soft tissue infections (SSTIs) encompass a broad range of infections with a variety of risk factors and causes. Careful assessment of risk factors, severity markers and co-morbidities will inform the most appropriate therapy.
Skin and soft tissue infection: focus on meticillin-resistant S aureus
January 2009Meticillin-resistant Staphylococcus aureus skin and soft tissue infections are an increasing challenge for clinicians and healthcare organisations.
