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The most enduring changes are those that come from the inside. Improvements that arise from outside pressure sometimes fade away once that influence is removed, especially when the changes are hard to make.

Fosamprenavir (Lexiva, GlaxoSmithKline/Vertex) is the latest protease inhibitor (PI) approved by FDA for the treatment HIV-1 infection. A prodrug of amprenavir (APV), fosamprenavir has improved solubility and bioavailability over the parent PI, allowing for once- or twice-daily dosing and a decreased pill size and burden. In clinical trials, fosamprenavir was studied alone or boosted with ritonavir (RTV) in both HIV treatment-naïve and -experienced patients. In both patient populations, fosamprenavir decreased HIV RNA, increased CD4 cell counts from baseline, and increased the proportion of patients reaching undetectable viral loads (<400 and <50 copies/mL). Patients who received treatment with fosamprenavir demonstrated protease gene mutations different than those commonly seen with other PIs (except APV). Fosamprenavir appears to have an adverse effect profile similar to that of other PIs.

One of the primary etiologies of acute renal failure (ARF) is nephropathy secondary to the administration of radiocontrast dye. In the United States alone, the cost of ARF-related expenses is estimated at more than $8 billion per year. Since ARF contributes such a substantial burden to the cost of healthcare and may be associated with significant morbidity and mortality, initiatives to educate pharmacists, physicians, and other health-care providers about how to decrease the incidence of radiocontrast-induced ARF are warranted. It is important to identify patients at risk for developing this pathology and to play an active role in disease state prevention. This review covers the pathogenesis, signs and symptoms, and current treatment options for reducing the risk of radiocontrast-induced nephropathy. Current pharmacotherapy focuses on the use of aggressive hydration before and after the administration of a contrast agent. Clinical trials evaluating the application of periprocedural drugs are also reviewed.

For some, an investigational clinical trial can seem like the opportunity for a miracle; for others, it is an altruistic donation to science that might be used to help others. It also can be a means of receiving treatment for people with chronic conditions who have few resources, or it can be viewed cynically by critics of the pharmaceutical industry.

Later this year, U.S. Surgeon General Dr. Richard Carmona will release a report, "The Health Consequences of Smoking," and a new database of medical research, treatment and smoking prevention information. This year's report will come 40 years after Americans first learned there were significant consequences of smoking, thanks to the efforts of then-Surgeon General Dr. Luther Terry, who was appointed during the Kennedy administration.

The oral contraceptive marketplace has undergone evolutionary changes over the years. Early oral contraceptive formulations contained higher doses of estrogen and progestin, which were associated with several safety concerns. Consequently, scientists returned to the laboratories to develop lower-dose formulations that would minimize risk without compromising efficacy. To date, numerous formulations have entered the marketplace that allow for tailored dosing to meet a woman?s clinical and individual needs. In order to provide additional treatment options and create more convenient oral contraceptive regimens, monophasic, multiphasic, extended-cycle, progestin-only, and chewable regimens have emerged. This article will review the main health risks and benefits of oral contraceptives, the concept of extended-cycle regimens, and the financial implications associated with oral contraceptive use.

Memantine (Namenda, Forest) is the newest medication to receive FDA approval for the treatment of Alzheimer?s disease and the first to be approved with a moderate-to-severe indication. All previously approved Alzheimer?s disease treatments belong to the cholinesterase inhibitor class and are approved with a mild-to-moderate indication. Memantine has been used for more than 10 years in Germany and features a novel mechanism of action: N-methyl-d-aspartate (NMDA) antagonism. It has been shown to be effective in double-blind, placebo-controlled trials as monotherapy and in combination therapy with the cholinesterase inhibitor donepezil in patients with moderate-to-severe Alzheimer?s disease.