Which Medications Can Cause Edema?

Medscape | By Mauricio Wajngarten, MD

Edema in the feet and legs is a common complaint in our practices. It can cause pain, weakness, heaviness, discomfort, limited movement, and a negative body image. Medications can contribute to edema, either alone or in combination with other health issues.

Edema is also associated with advanced age, female sex, obesity, diabetes, hypertension, pain, lack of physical activity, and mobility limitations. These factors often necessitate medication prescriptions, which can aggravate the problem. Therefore, it is important to know how to treat or prevent medication-induced edema.

There are four main causes of edema, and all can facilitate medication-induced edema. These are:

• Increased capillary pressure. Conditions such as heart failure, renal dysfunction, venous insufficiency, deep vein thrombosis, and cirrhosis can increase capillary pressure, leading to edema.
  
  
• Decreased oncotic pressure. Hypoalbuminemia, a primary cause of reduced colloid oncotic pressure, can result from nephrotic syndrome, diabetic nephropathy, lupus nephropathy, amyloidosis, nephropathies, cirrhosis, chronic liver disease, and malabsorption or malnutrition.
  
  
• Increased capillary permeability. Vascular injury, often associated with diabetes, can increase capillary permeability and contribute to edema.
  
  
• Impaired lymphatic drainage. Lymphatic obstruction is common in patients with lymphedema, tumors, inflammation, fibrosis, certain infections, surgery, and congenital anomalies. Conditions such as thyroid disorders can also cause an increase in interstitial albumin and other proteins without a corresponding increase in lymphatic flow, leading to lymphedema.

Medications That Can Cause Edema

• Calcium channel blockers (CCBs). Drugs such as nifedipine and amlodipine can increase hydrostatic pressure by causing selective vasodilation of precapillary vessels, leading to increased intracapillary pressures. Newer lipophilic CCBs (eg, levamlodipine) exhibit lower rates of edema. Reducing the dose is often effective. Diuretics are not very effective for vasodilation-induced edema. Combining CCBs with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), which induce postcapillary dilation and normalize intracapillary pressure, may reduce fluid leakage into the interstitial space. This combination may be more beneficial than high-dose CCB monotherapy.
  
  
• Thiazolidinedione (eg, pioglitazone). These increase vascular permeability and hydrostatic pressure. They work by stimulating the peroxisome proliferator–activated gamma receptor, increasing vascular endothelial permeability, vascular endothelial growth factor secretion, and renal retention of sodium and fluids. Because of other adverse effects, their use is now limited…

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We Asked 7 Doctors: How Do You Get Patients to Exercise?

Medscape | By Lou Schuler

We know exercise can be a powerful medical intervention. Now scientists are finally starting to understand why.

A recent study in rats found that exercise positively changes virtually every tissue in the body. The research was part of a large National Institutes of Health initiative called MoTrPAC (Molecular Transducers of Physical Activity Consortium) to understand how physical activity improves health and prevents disease. As part of the project, a large human study is also underway.

"What was mind-blowing to me was just how much every organ changed," said cardiologist Euan Ashley, MD, a professor of medicine at Stanford University, Stanford, California, and the study's lead author. "You really are a different person on exercise."

The study examined hundreds of previously sedentary rats that exercised on a treadmill for 8 weeks. Their tissues were compared with a control group of rats that stayed sedentary.

Your patients, unlike lab animals, can't be randomly assigned to run on a treadmill until you switch the machine off.

So how do you persuade your patients to become more active?

We asked seven doctors what works for them. They shared 10 of their most effective persuasion tactics.

1. Focus on the First Step

"It's easy to say you want to change behavior," said Jordan Metzl, MD, a sports medicine specialist at the Hospital for Special Surgery in New York City who instructs medical students on how to prescribe exercise. "It's much more difficult to do it."

He compares it with moving a tractor tire from point A to point B. The hardest part is lifting the tire off the ground and starting to move it. "Once it's rolling, it takes much less effort to keep it going in the same direction," he said.

How much exercise a patient does is irrelevant until they've given that tire its first push.

"Any amount of exercise is better than nothing," Ashley said. "Let's just start with that. Making the move from sitting a lot to standing more has genuine health benefits." 

2. Mind Your Language

Many patients have a deep-rooted aversion to words and phrases associated with physical activity.

"Exercise" is one. "Working out" is another.

"I often tell them they just have to start moving," said Chris Raynor, MD, an orthopedic surgeon based in Ottawa, Ontario. "Don't think about it as working out. Think about it as just moving. Start with something they already like doing and work from there."

3. Make It Manageable

This also applies to patients who're injured and either waiting for or recovering from surgery.

"Joints like motion," said Rachel Frank, MD, an orthopedic surgeon at the University of Colorado Sports Medicine, Denver, Colorado. "The more mobile you can be, the easier your recovery’s going to be."

That can be a challenge for a patient who wasn't active before their injury, especially if they're fixed on the idea that exercise doesn't matter unless they do it for 30-45 minutes at a time.

"I try to break it down into manageable bits they can do at home," Frank said. "I say, 'Look, you brush your teeth twice a day, right? Can you do these exercises for 5 or 10 minutes before or after you brush your teeth?'"…

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NAHC-NHPCO Alliance Names New CEO

McKnight’s Home Care / By Adam Healy
 
After a lengthy search, the NAHC-NHPCO Alliance named Steven Landers, MD, MPH, to become its chief executive officer. 
 
Landers most recently served as president and CEO of Senior Life Group, and he has also held roles such as director of home care at the Cleveland Clinic and president and CEO of the Visiting Nurse Association Health Group. He has also held past appointments to the boards of directors of the National Association for Home Care and Hospice, American Academy of Home Care Medicine, the Partnership for Quality Home Health, and the Research Institute for Home Care (formerly the Alliance for Home Health Quality and Innovation).
 
“I’ve had the opportunity in my career to see the healthcare industry from many vantage points, and in this new role with The Alliance, I will use all that I have learned to make a difference for our members as we continue to expand to meet the growing public needs for our care,” Landers said Monday in a statement.
 
Landers’ appointment is an important step in the merger between NAHC and the National Hospice and Palliative Care Organization. Bill Dombi, who currently leads NAHC as CEO, disclosed in May that he plans to retire at the end of 2024. Both he and Ben Marcantonio, CEO of the NHPCO, were ineligible to head the merged organization.
Ken Albert, chair of the transition board for the two organizations, remarked in a statement Monday on the value Landers brings to the merged association.
 
“Providing leadership around policy and advocacy efforts is critical to our mission at The Alliance,” Albert said. “Throughout his career, Dr. Landers served the field as an effective policy advocate, shaping policy at both the state and federal levels. We are thrilled to welcome him as our inaugural CEO, and I know he will build an extraordinary team to offer value for our members.”  

Judge Strikes Down FTC Noncompete Ban Nationwide

Healthcare Dive | By Ryan Golden and Rebecca Pifer

A Texas federal judge [last] Tuesday stuck down the Federal Trade Commission’s ban on noncompete agreements in employment contracts, holding that the ban violates the Administrative Procedure Act and exceeds the agency’s statutory authority.

The ruling, which applies nationwide, comes just 15 days before the ban was set to take effect on Sept. 4.

Judge Ada Brown of the U.S. District Court for the Northern District of Texas had already ruled against FTC last month, when she preliminarily enjoined the noncompete ban — but only with respect to the case’s plaintiffs.

Brown’s Aug. 20 decision, however, sets the regulation aside entirely, as the APA “does not contemplate party-specific relief,” she wrote.

The decision is a win for the U.S. Chamber of Commerce, the largest business lobby in the nation, which brought the suit along with a tax firm.

It’s more of a mixed bag for the healthcare industry. The noncompete ban was expected to help physicians, nurses and other medical workers locked into restrictive contracts by making it easier to change jobs and potentially cause wages to increase.

Roughly 35% to 45% of doctors are bound by noncompetes, according to the American Medical Association.

However, there were lingering questions about the ban, including whether the FTC had legal authority to promulgate it, whether it would apply to nonprofit hospitals and how it would affect M&A activity, physician shortages and recruitment efforts, especially for smaller regional systems.

Powerful hospital lobby the American Hospital Association, which strongly opposed the ban, cheered the judge’s decision.

“The rule was a breathtaking assertion of regulatory power ... made worse by the fact that the Commissioners did not attempt to understand the disruptive impact it would have on hospitals, health systems, and the patients they serve,” AHA general counsel Chad Golder said in a statement shared with Healthcare Dive.

Meanwhile, the FTC is “seriously considering” an appeal, FTC spokesperson Victoria Graham said.

Graham noted that Brown’s decision does not stop regulators from going after overly restrictive noncompetes through case-by-case enforcement.

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