Perioperative management of metformin: is there something new?

Metformin is the drug of choice in the treatment of type 2 diabetes mellitus. Diabetic patients treated with metformin, who are scheduled for surgery, have always been subjects to discussion regarding the perioperative management of metformin because of the risk of developing lactic acidosis. The article presents the basic informations about this adverse event, describes new approach to the metformin treatment in the perioperative period, and summarizes the recommendations of professional societies and expert groups.

Drug administration via feeding tubes: examples, working group.

Drug administration via feeding tubes can be associated with number of various problems. The present text provides examples of medications whose administration via a feeding tube is of high risk. Also, it informs about the existence and activities of the working group of the Czech Professional Society of Clinical Pharmacy, which pursues this matter in detail.

Cardiovascular drug utilisation and socio-economic inequalities in 20 districts of the Czech Republic.

OBJECTIVE: To analyse whether there exists a socio-economic gradient in utilisation of cardiovascular drugs at the district level in the Czech Republic. METHODS: The aggregated data on drug utilisation during the period 1997-2000, expressed in defined daily doses per 1000 inhabitants per day, were obtained from the General Health Insurance Company. Socio-economic characteristics of the districts in year 2000 (percentage of university-educated inhabitants, percentage of single-member households, number of ambulatory physicians per 10,000 inhabitants, unemployment rate and mean monthly income) were used as single unadjusted predictor variables. Partial correlation controlling for age in districts was used to analyse the relationship of cardiovascular disease (CVD) drug utilisation and several socio-economic variables. RESULTS: There were considerable differences in the utilisation of CVD drugs within the districts studied. Significantly higher utilisation of dihydropyridine Ca-channel blockers and statins was found in the districts with a higher percentage of university-educated inhabitants and more ambulatory physicians. CVD drug utilisation (nitrates, fibrates, selective beta-blockers, verapamil and diltiazem and statins) correlated significantly with the percentage of single-member households. The five socio-economic variables explained more than 60% of the variability in use of dihydropyridine Ca-channel blockers, verapamil and diltiazem, ACE inhibitors and statins. CONCLUSION: There exists a significant gradient in the utilisation of mainly newer CVD drug groups within districts of the Czech Republic that can be, at least partly, explained by social characteristics of the districts.