Respiratory and Allergy
Simplify Recommendations for Managing COPD
As a clinical pharmacist, implementing updated guidance will prompt inquiries into the optimal treatment approaches for COPD. There aren’t big changes, but it can be tough to assess if patients are on optimized therapy. Consider these rules of thumb... ✅ Ensure that all patients with COPD have a short-acting bronchodilator (alb…
قراءة المزيد
Respiratory and Allergy
Which LONG-acting bronchodilator to use first-line for COPD
As a clinical pharmacist, you will hear debate over which long-acting bronchodilator to use first-line for COPD. Guidelines suggest either tiotropium ( Spiriva ) or a long-acting beta-agonist (salmeterol, formoterol) for persistent symptoms. Both types of bronchodilators improve COPD symptoms, but tiotropium seems to work better to prevent exacerbations. …
قراءة المزيد
Respiratory and Allergy
Chronic azithromycin to PREVENT COPD exacerbations
As a hospital pharmacist, you will see some patients taking chronic azithromycin to PREVENT recurrent COPD exacerbations. Preventing acute COPD exacerbations is a BIG deal. Each exacerbation worsens lung function and quality of life, plus the 30-day mortality rate is higher after a severe COPD exacerbation than a heart attack. …
قراءة المزيد
Respiratory and Allergy
Treating serious STREP infections
As a clinical pharmacist, The uptick in severe cases will raise questions about how to treat Group A strep . We generally think of this bug causing strep throat, or skin infections. Most cases are mild, or some patients are asymptomatic carriers. But there’s a rise in serious infections, such as necrotizing fasciitis and toxic shock syndrome. The increase may be due…
قراءة المزيد
URTI
Cough and Cold symptoms management updates
As a community pharmacist, you should always be aware of the latest developments in the treatment of coughs and colds. This year’s spike in respiratory viruses will have patients asking which OTC to take for cough and cold symptoms. Continue to emphasize nondrug options like fluids, cool-mist humidifiers, ice chips for sore throat,…
قراءة المزيد
Smoking Cessation
Chantix (CHAMPIX) for smoking cessation
CHANTIX also known as CHAMPIX in the EU and other countries (varenicline) is the latest option for smoking cessation. It's the first PARTIAL nicotine agonist. It binds to nicotine receptors, but stimulates them less than nicotine. This partial nicotine effect helps ease withdrawal symptoms. But having the drug on board also BLOCKS some of the pleasurable effects…
قراءة المزيد
URTI
OTC cough medications
As a community pharmacist, patients will ask you how to manage acute cough due to the common cold. There still isn't good evidence for or against using OTC or prescribed medications for acute cough due to a cold. But patients often want to take something. So continue to suggest trying nondrug options first: fluids, cool-mist humidifiers, etc... …
قراءة المزيد
Steroids
Re-evaluate when SHORT-term steroid use is needed
New concerns will raise questions about when it's appropriate to use SHORT courses of oral corticosteroids in adults. We know long-term steroid use can lead to adverse effects, such as osteoporosis and weight gain . And using a steroid for just a few days can cause hyperglycemia , insomnia, etc. Now evidence links steroid use for just one week to a slightly high…
قراءة المزيد
Steroids
Give single dose dexamethasone for pediatric asthma exacerbations
More children will get just ONE or TWO doses of dexamethasone for asthma exacerbations. We're seeing a shift away from the typical 3- to 5-day course of prednisone or prednisolone to a 1- to 2-day course of dexamethasone. Dexamethasone is longer acting and may cause less vomiting. Plus new evidence suggests that a SINGLE dose of dexam…
قراءة المزيد
Respiratory and Allergy
The link between asthma and GERD
Is there a link between asthma and GERD ? Gastroesophageal reflux (GERD) is common among patients with asthma but often causes mild or no symptoms. Some asthma patients are given a PPI , even if they don't have typical GERD symptoms such as heartburn ... That's because even patients without overt GERD symp…
قراءة المزيد
Respiratory and Allergy
Quick guide of pneumonia
P neumonia is an inflammatory condition of the pulmonary parenchyma caused by an infection. The symptoms, treatment, and morbidity associated with the infection vary by the setting in which it is acquired. A classification system for pneumonia has been adopted by the Infectious Disease Society of America (IDSA) and the American Thoracic Society (ATS) as below (see t…
قراءة المزيد
Respiratory and Allergy
Don't automatically add empiric anaerobic coverage for aspiration pneumonia
A SPIRATION PNEUMONIA is difficult to diagnose and differentiate from other aspiration syndromes, community-acquired pneumonia , and hospital-acquired pneumonia . Aspiration pneumonia is linked to a higher mortality rate (29.4%) compared to community-acquired pneumonia (11.6%). Choice of antibiotics will depend on where the pneumonia developed ( e.g., community, h…
قراءة المزيد
Steroids
Consider using steroids for community acquired pneumonia (CAP) patients
As a clinical pharmacist, you'll see more push to use steroids for patients hospitalized with community-acquired pneumonia (CAP) . The thought is that inflammation in the lungs causes a lot of pneumonia symptoms. We've heard about this controversial topic for a while. Some small trials show a benefit, while others do not. To date, guidelines still don'…
قراءة المزيد
Respiratory and Allergy
Recommendations for using beta-blockers in patients with COPD or asthma
Alerts still pop up when beta-blockers are used in patients with COPD or asthma , but these shouldn't always raise a red flag. Many of us were taught to avoid beta-blockers in these patients because of concerns about bronchoconstriction. But cardioSELECTIVE options (metoprolol [ Seloken Zoc ], bisoprolol [ Concor ], nebivolol [ Nebilet ], etc) don't cause mo…
قراءة المزيد
Respiratory and Allergy
Approach to asthma
Overview ㅡ Chronic inflammatory disorder of airways that causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. Causes may be due to genetic factors or environmental exposures (see "Risk Factors" - table 1) . Table (1). Pathophysiology and risk factors of asthma …
قراءة المزيد
Social Plugin