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
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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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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SNRIs
Medications and supplements induced hypertension
Patients are often surprised when they learn they're taking medications that can INCREASE blood pressure or induced hypertension (HTN) . Check for common culprits if patients have new or worsening high blood pressure. Explain that most patients won't have a significant blood pressure increase with these medications, but some could see a 5 to 10 mmHg bump in s…
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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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Pain Management
Treating dental pain (tooth pain or toothache)
OVERVIEW ㅡ A toothache or tooth pain is caused when the nerve in the root of a tooth or surrounding a tooth is irritated. Dental (tooth) infection, decay, injury, or loss of a tooth are the most common causes of dental pain. Pain may also occur after an extraction (tooth is pulled out). Pain sometimes originates from other areas and radiates to the jaw, thus appeari…
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Rheumatology
Recommendation for safety use of chronic NSAIDs
As a clinical pharmacist, it can be challenging to navigate the various options of NSAIDs (non-steroidal anti-inflammatory drugs). While there is no evidence to indicate that one NSAID is more effective than the others, certain NSAIDs carry higher risks. Here are some tips to consider when suggesting a chronic NSAID treatment... …
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Sulfa Allergy
Fewer red flags when celecoxib (Celebrex) is given to patients with a sulfa allergy
As a clinical pharmacist, it's important to understand sulfonamide "sulfa" allergy. Many medications containing sulfonamide chemical group have labels that warn against using them in patients who have had an allergic reaction to sulfonamides in the past. There is a potential for cross-reactivity between members of a specific class (e.g, two antibiotic …
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Pain Management
NSAIDs (dose and duration) in high-CV-risk patients
All NSAIDs have a boxed warning about increased risk of CV events. Naproxen ( Naprofen ) , celecoxib ( Celebrex ) and probably ibuprofen ( Brufen ) are associated with less cardiovascular risk than other NSAIDs!.. Results from the first big study that directly compares chronic NSAIDs in high-CV-risk patients. It suggests celecoxib, naproxen, and ibuprofen all h…
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