Pressure is the most critical factor in the development of pressure ulcers; high pressure applied constantly for two hours produces irreversible tissue ischemia and necrosis. Malnutrition, fecal and urinary incontinence, fractures, and a low serum albumin may be additional risk factors. Frequent turning and mobilization of patients, relieving pressure and allowing tissue reoxygenation, are the most effective means of prevention and treatment (PS Goode and RM Allman, Med Clin North Am, 73:1511, Nov 1989).

The FDA has approved Jentadueto XR (Boehringer Ingelheim/Lilly), a once-daily extended-release formulation of the dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin and the biguanide metformin, for oral treatment of type 2 diabetes. Linagliptin and metformin have been available for years in a twice-daily immediate-release combination (Jentadueto). Once-daily extended-release formulations combining metformin with the DPP-4 inhibitors saxagliptin (Kombiglyze XR) and sitagliptin (Janumet XR) are also available.

The FDA has approved venetoclax (Venclexta – Abbvie/Genentech), an oral selective BCL-2 inhibitor, for treatment of chronic lymphocytic leukemia (CLL) in patients with a 17p deletion who have received at least one prior therapy. The 17p deletion is associated with a poor prognosis in patients with CLL; it is prevalent in about 20% of patients with relapsed CLL. Venetoclax is the fi rst BCL-2 inhibitor to become available in the US.

Primary hypothyroidism is usually the result of Hashimoto's (autoimmune) thyroiditis, thyroidectomy, or radioactive iodine therapy. Treatment of hypothyroidism with replacement doses of thyroid hormone is usually lifelong. Levothyroxine (LT4; synthetic thyroxine; Synthroid, and others) is the drug of choice.1

Metformin (Glucophage, and others) is generally preferred as the first-line agent for treatment of type 2 diabetes, but most patients subsequently require treatment with more than one drug. Many combination products have been marketed; the latest of these combines saxagliptin with extended-release (ER) metformin as Kombiglyze XR.

Linagliptin (Tradjenta) and metformin (Glucophage, and others) are now available as a fixed-dose combination (Jentadueto – Boehringer Ingelheim/Lilly) for oral treatment of type 2 diabetes in adults. Metformin is generally the preferred first-line agent for treatment of type 2 diabetes, but most patients eventually require treatment with multiple drugs. Linagliptin is a dipeptidyl peptidase-4 (DDP-4) inhibitor like sitagliptin (Januvia) and saxagliptin (Onglyza). Both sitagliptin and saxagliptin are also available in fixed-dose combinations with...

Two new fixed-dose combinations are now available for management of type 2 diabetes. Metaglip (Bristol-Myers Squibb), a combination of metformin and glipizide, is approved for initial therapy or as second-line treatment when control is not adequate on metformin or a sulfonylurea alone. Avandamet (GlaxoSmithKline), a combination of metformin and rosiglitazone, is approved by the FDA only as second-line therapy for patients who are not well controlled on metformin alone, or are already taking both metformin and rosiglitazone. Glucovance (Bristol-Myers Squibb), a combination of metformin and...

Dronedarone (Multaq - Sanofi-Aventis) has been approved by the FDA for oral treatment of atrial fibrillation and flutter. Amiodarone (Cordarone, and others) is the most effective drug for this indication, but has considerable toxicity.

For patients with diabetes poorly controlled with a single oral drug, addition of a second drug with a different mechanism can be helpful. A fixed-dose combination (Actoplus met - Takeda) of two widely used antihyperglycemic drugs, the thiazolidinedione pioglitazone (Actos) and the biguanide metformin (Glucophage, and others), has been approved by the FDA for management of type 2 diabetes. It is indicated for patients already being treated with both pioglitazone and metformin or as second-line therapy for those not adequately controlled with either metformin or pioglitazone alone....

Sitagliptin (Januvia) and metformin (Glucophage, and others) are now available in a single tablet (Janumet - Merck) for treatment of type 2 diabetes. The combination is approved by the FDA for use in patients not adequately controlled by sitagliptin or meformin alone or in those already taking both drugs. Metformin is also available in combination with the thiazolidinediones pioglitazone and rosiglitazone and with the sulfonylureas glipizide and glyburide.