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The Food and Drug Administration (FDA) convened a joint meeting of 3 advisory committees in June 2009 to review and propose recommendations for reducing the incidence of acetaminophen-induced liver injury. The committee voted in favor of 7 of the 9 recommendations that will be taken to the FDA for executive review and action. The actions supported by the committee represent potentially sweeping changes to both over-the-counter and prescription acetaminophen-containing products. This article reviews the committee process, previous FDA actions on acetaminophen, and implications of the recommendations made for the orthopedic practitioner.

Despite the news of aid from chondroitin sulfate, recent research has questioned its efficacy in treating osteoarthritis.

An orthopedist can play a critical role in corticosteroid induced osteoporosis management by identifying at-risk patients and selecting appropriate prophylactic measures. This article is part two in a two-part series on osteoporosis. Part one appeared in the July 2008 issue of ORTHOPEDICS.

Between 30% and 50% of American women will endure a clinical fracture during their lifetime due to the loss of bone mineral density that occurs with menopausal estrogen loss. This article is part one in a two-part series on osteoporosis. Part two will appear in the August 2008 issue of ORTHOPEDICS.

Approximately half of orthopedic surgeons reported operating on at least 1 patient with known HIV infection. Knowledge of postexposure prophylaxis guidelines may prevent HIV transmission and avert unnecessary exposure to antiretroviral agents.

Drug allergies are specific to characteristics of the medication's chemical structure.

Although reports are rare, lactose-containing medications may cause patient discomfort and subsequently affect medication adherence.

Supplemental glucocorticoid therapy is a topic widely debated in the medical field. Patients present with various signs, symptoms and etiologies making diagnosis of the condition elusive. There is wide inter-patient variability in cortisol response during stress so defining normal response concentrations of cortisol is difficult. Deficiency of cortisol in acutely ill patients increases the potential of morbidity and mortality. Despite the conflicting evidence, if cortisol deficiency is identified, supplemental treatment with glucocorticoids is advocated. One aspect agreed on by all is the need for continued investigations in the requirement of supplemental glucocorticoids.

The use of contrast media in diagnostic procedures is a potential risk for the development of acute renal failure. To reduce the occurrence of contrast-induced nephropathy, assessment and subsequent minimization of risk factors is important. If risk factors are present, consider discontinuing concomitant nephrotoxic drugs, limiting exposure to contrast media or using an alternative imaging technique. Additionally, adequate intravenous hydration is universally recommended and should be employed in all patients.

While patient-controlled analgesia and intermittent intravenous opioids are primarily used for pain control, transdermal drug delivery is a possible adjuvant treatment.

By understanding bariatric surgery procedures performed and the need for additional medication management, optimal outcomes can be achieved in these patients.

Pharmacogenomics is developing at a rapid pace. Though ethical and financial considerations still exist, physicians should familiarize themselves with this evolving science.

Although antimicrobials are effective in preventing postoperative surgical infection, there is substantial room for improvement in their use.

Heparin and low molecular weight heparin agents are frequently administered to postoperative orthopedic patients. In patients with a history of heparin-induced thrombocytopenia, alternative anticoagulant agents to heparin for prophylaxis and treatment must be considered. Unfortunately, the data is limited in this patient population. Upon transitioning from heparin-induced thrombocytopenia treatment with direct thrombin inhibitors, argatroban, or lepirudin, careful consideration must be taken to avoid further thrombotic complications.

The potential risk for heparin-induced thrombocytopenia should be suspected in postoperative patients who develop thrombocytopenia in the presence of heparin and low-molecular weight heparin agents.

Patients undergoing orthopedic surgery are at increased risk for infection, and antimicrobial use continues to be required. Antimicrobial selection, however, is an important consideration given the increasing incidence and severity of C. difficile infection described in the literature. When choosing antimicrobials for prophylaxis and treatment, evaluate patients for risk factors that may predispose them to C. difficile infection. Patients receiving multiple antibiotics or broad-spectrum antibiotics, women, patients with concurrent proton pump inhibitor use, and those with renal failure are at increased risk. Choice of antibiotics should be evaluated for their potential or likelihood to cause C. difficile infection. When a number of these risk factors are present, avoiding the use of high-risk antibiotics may be warranted.

Once-daily aminoglycoside dosing is effective in treating gram-negative infections, including those associated with bones and joints.

Because many obese patients and patients with underlying renal dysfunction require surgical intervention, it is important to examine the dosage recommendations and monitoring required with low-molecular-weight heparins.

Increased claims of hypersensitivity reactions are being reported due to the inability to differentiate between the terms "allergic reaction" and "adverse effect."