Rheumatology
Drug interactions with colchicine
As a clinical pharmacist, you should focus on common and serious drug interactions. Dosing and drug interactions with colchicine for acute gout are still causing confusion. We're all used to the old way of dosing colchicine for acute gout, two tabs initially then one tab every 2 hours until the pain stops, diarrhea starts, or a max of 5 tabs per day. But this c…
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Statins
Approach to STATIN intolerance
As a pharmacist, you should know how to deal with statin muscle pain . Mounting evidence suggests that statin-associated muscle pain is driven by a patient’s expectation of harm. In fact, statin-intolerant patients often rate muscle symptoms similarly with statin OR placebo. But it’s still how they feel, often leading to poor adherence. Consider this approach for pat…
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Side Effects
Kidney problems when CLARITHROmycin is combined with CCBs
As a clinical pharmacist, you will get alerts about kidney problems when clarithromycin is combined with a calcium channel blocker (amlodipine, etc). Do your part... Clarithromycin is a strong 3A4 inhibitor that can slow the metabolism of calcium channel blockers and increase their levels. This can lead to hypotension , edema, bradycardia an…
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Warfarin
DIET may interfere with warfarin therapy
As a nutrition support pharmacist, you should discuss with your patients who take warfarin ( Marevan ) about the interaction with food. Many patients are caught by surprise when fad diets or special foods interfere with their warfarin therapy . Most patients know that green leafy vegetables and other foods with high vitamin K can decrease warfarin's efficacy, (s…
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Nutrition
Stay alert to drugs that cause hyponatremia
Questions are coming up about medications-induced hyponatremia. Low sodium levels are the most common electrolyte disturbance. Symptoms are rare with mild drops below 135 mEq/L that develop over time. But severe or rapid drops in sodium below 125 mEq/L can cause coma or seizures. Plus, chronically low sodium in older patients is linked with cognitive impairment, …
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Statins
How to handle statin muscle pain?
As a pharmacist, you may know that up to 30% of statin patients get muscle pain, cramps, or weakness, usually in the larger muscles such as the thighs. You should suggest these strategies to help patients stay on the statin... Lowering the dose is often enough to reduce symptoms. Changing the statin to fluvastatin, pravastatin, or …
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Warfarin
Drug interactions between WARFARIN and many antimicrobials
Questions often come up about how to handle alerts for drug interactions between warfarin and many antimicrobials. The risk of an interaction varies, but it can be significant, especially when the antimicrobial affects warfarin metabolism. For more details, see Table (1) below . Follow these rules of thumb... TMP/SMX ( Septazole, Septrin…
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PPIs
The interaction between PPI (omeprazole) and clopidogrel, what is your recommendations?
PRODIGY has published a guideline on antiplatelet treatment. This contains a scenario on the management of gastrointestinal adverse effects. This scenario discusses how to manage a patient at high risk of gastrointestinal bleeds. Ensure that general measures to reduce risk of gastrointestinal (GI) adverse effects have been taken... Prescribing …
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Rheumatology
Avoiding serious interactions with long-term antibiotics for bone or joint infections
M ore ORAL antibiotics will be used for bone or joint infections. IV antibiotics for 6 weeks or longer used to be standard. But switching to orals after just 1 to 2 weeks is usually as effective, more convenient, and less costly. Help patients avoid serious interactions and toxicities with these long-term antibiotics. Explain that missed doses can lead to treatment f…
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