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Cost Effectiveness / Yield / Medical Economics
 
When to Chew (Sublingual) a Tablet of Nifedipine
O P Kapoor
 

The following are the indications when a family physician can effectively advise a chewed tablet of sublingual nifedipine. It must be kept in the emergency bag.

  1. A patient of angina pectoris, who avoids taking GTN tablet or spray before exertion because of severe headache and fainting like symptoms, should be advised nifedipine
  2. Patients having difficulty in swallowing due to motility disorder of oesophagus, will need frequent administration of GTN spray. In such cases, nifedipine can be used as a substitute every time in liberal dose of 5-20 mg.
  3. Finally, one of the best treatments for a spasm of anal sphincter (occurring due to severe pain of anal fissure) is local application of GTN ointment 0.2%. Tab. nifedipine can also be used. Remember that this is much cheaper than an injection of botulin toxin.
 

To Scan or Not to Scan in Headache

Some patients with primary headaches may need imaging

Should patients ever have a scan to reassure all parties involved?

Most often the reassurance the patient seeks is a diagnosis, or an explanation of the problem, which, given the increased understanding of primary headache, is now possible in most instances.

It should be made clear to the patient why this is being done, particularly with primary headache - if the patient wants an explanation he or she will be back with the normal scan seeking that explanation. Failing to provide one could understandably cause anxiety in a patient.

Peter J Goadsbye, BMJ, 2004; 329 : 469-70.