Pain Management
Consider kidney risks before using an NSAID
As a hospital pharmacist, you will be asked more, which NSAID is preferred in patients with kidney disease?.. There is NOT a “safest” NSAID for the kidneys . You might’ve heard that short-acting NSAIDs (ibuprofen, etc) are least kidney toxic. But this isn’t supported by evidence. The real key is to use the lowest NSAID dose for the s…
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Pain Management
Consider the interaction between aspirin and NSAIDs
New data and talk of OTC label changes will reignite debate about whether NSAIDs reduce the cardiovascular (CV) protective effect of aspirin .. Many of us remember when FDA warned that ibuprofen may interact with aspirin . This is because aspirin binds to COX-1 to inhibit platelet aggregation and nonselective NSAIDs can compete for the same receptor. OTC ibuprofen…
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Pain Management
Bruxism (tooth grinding)
Background ㅡ Bruxism is nonfunctional jaw movement that includes clenching, grinding, clicking, and gnashing of the teeth, most commonly occurring during sleep. Prevalence in adults is 8%. Roughly 3% of patients do not resolve completely. Bruxism is classified into primary (idiopathic) or secondary (iatrogenic). Some of the common secondary causes seen in clinical …
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Pain Management
IV lidocaine is an anti-arrhythmic and also can be for pain too
As a hospital pharmacist, you will see intravenous lidocaine used to treat pain. IV lidocaine can help stop heart arrhythmias. But it also has some analgesic and anti-inflammatory effects. Expect to see lidocaine 1.5 mg/kg bolus doses for pain due to conditions such as headache, kidney stones, or trauma when other analgesics don&#…
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Sumatriptan
Acute and prophylactic medications to manage CLUSTER headaches
Patients will need your help managing CLUSTER HEADACHES. They're called "suicide headaches" because the pain is so severe. Cluster headaches almost always occur on one side of the face by the eye and cause tearing, runny or stuffy nose, and restlessness. Attacks don't last as long as a migraine. But they usually occur in clusters of weeks to months,…
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Pain Management
Management of pain in patients with renal insufficiency or end-stage renal disease on dialysis
Overview ㅡ Pain is a common problem in patients with renal insufficiency and end-stage renal disease (ESRD) and can have a significant effect on the patient’s quality of life. When assessing a patient’s pain, assess both the severity of the pain (such as on an analogue scale, 0-10) and the characteristics of the pain ( see figure 1 ). Pain is most commonly characte…
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Pregnancy and Breastfeeding
Analgesics during pregnancy and lactation
Analgesics during pregnancy ㅡ Acetaminophen ( Panadol, Novaldol ) is analgesic drug of choice for pain during pregnancy (Pregnancy category B). See, figure-1-FDA pregnancy categories prior to 2014 . Figure (1) FDA pregnancy categories. Non-steroidal anti-inflammatory drugs (NSAIDs) …
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Steroids
Oral steroid instead of NSAIDs for ACUTE gout
Corticosteroids will be used more often for ACUTE gout flares. Oral corticosteroids work as well as NSAIDs for pain during a gout attack and are a safer choice for some patients. For further information, see note on " Comparison of gout therapies ". Consider a corticosteroid instead of an NSAID for mo…
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Rheumatology
The latest recommendations for treating osteoarthritis
As a clinical pharmacist, it's essential to emphasize that exercise (such as walking and strengthening exercises) and weight loss, if needed, remain the main approaches for management. It's important to note that while oral NSAIDs like naproxen are often effective, they may not be suitable for everyone due to potential risks to the heart, stomach, and kidney…
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Rheumatology
Comparison of GOUT therapies
G out is one of the most common forms of arthritis. It occurs more often in men. During a gout attack, high uric acid levels lead to the formation of uric acid crystals in joints (usually knees, ankles, and feet; can affect elbows, wrists, and fingers). Symptoms can include pain, redness, joint swelling and limited range of motion, and fever. Gout risk factors inc…
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Pain Management
Kidney risks of non-steroidal anti-inflammatory drugs (NSAIDs)
As a pharmacist, you will see more focus on the kidney risks of non-steroidal anti-inflammatory drugs (NSAIDs). Some government and medical groups are now educating providers to avoid giving NSAIDs to patients at risk for kidney problems. Think about a patient's risk before suggesting an NSAID. It's usually okay for patients with …
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