Propranolol is one of the most commonly prescribed drugs in private practice. Apart from Angina Pectoris, there are a dozen other conditions where this drug is used. More the reason, a family physician should not be caught with the patient blaming him for a bad side effect of the drug which should have been foreseen by the doctor before prescribing it.
My method of prescribing is as follows:
I. If a patient has a history of
i. Chronic asthma
ii. Raynaud’s phenomenon
iii. Hands and feet become cold in his/
her AC office,
I shall not prescribe propranolol.
II. On Clinical Examination
If the pulse rate of the patient is around 56 to 60 or BP is 95/70 mmHg (very common in Indian women), I would avoid using propranolol.
III. While recording the routine ECG if I find evidence of
i. Bundle branch block,
ii. First degree heart block (increased PR interval),
iii. Sinus bradycardia,
I shall avoid starting propranolol.
IV. Many smokers do not reveal their smoking habits and the history of smoker’s cough. Thus if I find SPO2 (Pulse Oximetry) even slightly low and symptoms of
cough/dyspnoea and evidence of COPD (which can also be confirmed by peak flow reading), I would not prescribe propranolol to such patients.
WHAT WORKS FOR OSTEOARTHRITIS?
In order to control pain, improve function, and alter the disease process, patients with osteoarthritis should be managed with a combination of methods, say Hunter and Felson. Non-pharmacological management such as weight loss, physical therapy, and knee braces should be tried before drug treatment, and surgery should be considered only when effective medical treatment has failed. The authors review diagnosis and investigation and summarise current knowledge about epidemiology and management of this common joint disease.
BMJ, 2006; 332 : 639. |
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