Rheumatology
How long patients should take bisphosphonates
As a clinical pharmacist, you will hear more controversy about how long patients should take bisphosphonates (alendronate, etc) for osteoporosis. Many patients get put on a bisphosphonate to prevent fractures and are left on them indefinitely. But long-term use may be associated with problems, jaw osteonecrosis and atypical femur fractures. …
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SNRIs
Cymbalta for lower back pain
Cymbalta (duloxetine) will be used more for chronic musculoskeletal pain in the lower back or due to osteoarthritis . Cymbalta is already approved for neuropathic pain . Plus, it's approved for chronic musculoskeletal pain, so physicians are hearing more about this use, too. Some antidepressants do have analgesic effects, especially tricyclics (amitriptyline, …
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Vitamin D Supplements
Take MORE vitamin D and LESS calcium!
As a nutrition support pharmacist, people are asking you if they should take MORE vitamin D and LESS calcium. This follows some recommendations by many experts... According to Vitamin D , some experts recommend that adults get 1000 IU/day of vitamin D instead of just 400 IU/day. They say that vitamin D is MORE important than calcium for bone health and has o…
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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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Rheumatology
Caffeine may worsen rheumatoid arthritis
As a clinical pharmacist, you should always be aware of drug interactions. There's concern that caffeine might reduce the efficacy of methotrexate for rheumatoid arthritis ... Methotrexate decreases inflammation by increasing adenosine levels. Caffeine might cause a problem, because it's an adenosine receptor ANTAGONIST. It's goi…
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Rheumatology
Supplements for OSTEOarthritis
As a community pharmacist, you will get questions about supplements for osteoarthritis. Guidelines don’t recommend any oral supplements for most patients with osteoarthritis , due to limited evidence. But some people swear by them or want to give them a try, especially if topical or oral NSAIDs aren’t an option. Help sort through the ple…
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Vitamin D Supplements
Vitamin D deficiency in adults
Introduction ㅡ Vitamin D deficiency is characterized by hypocalcemia and/or hypophosphatemia and rickets in children and osteomalacia in adults. When interpreting a vitamin D level, you are really asking, “Is this vitamin D level adequate to meet my patient’s needs?” The problem is that some patients may have a greater or lesser need for vitamin D than others. We…
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Vitamin D Supplements
Clinical points on VITAMIN D supplements in adults
RECENT DATA WILL BRING MORE CLARITY ABOUT THE ROLE OF VITAMIN D SUPPLEMENTS IN ADULTS. The year 2019 wasn't good for the sunshine vitamin (vitamin D). That's because randomized trials showed that vitamin D supplements don't benefit heart disease, various types of cancer, or diabetes, despite years of promising observational data. Plus most evidence sugge…
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Steroids
Help patients stick with METHOTREXATE for rheumatoid arthritis
New guidelines will lead to questions about treating rheumatoid arthritis , especially with the plethora of medication options. For more information, see topic on Overview of rheumatoid arthritis . Which medication is first-line ? Recommend sticking with oral methotrexate 7.5 mg once weekly for most patients. Generally ad…
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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
Recommend allopurinol instead of febuxostat for most chronic gout patients
AS A PHARMACIST, you'll hear about an advocacy group pushing for withdrawal of the gout med febuxostat ( Uloric, Xanthistop ) due to concerns it increases mortality. FDA adds Boxed Warning for increased risk of death with gout medicine Uloric (febuxostat), available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-boxed-warning-increased-ri…
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Rheumatology
Allopurinol or febuxostat for chronic gout?
As a pharmacist, you’ll get questions about managing chronic gout due to continued debate over whether to aim for a target uric acid level. We know to consider a chronic medication to lower uric acid when gout causes problems such as tophi or 2 or more acute gout flares/year. But there’s not much evidence on the best way to titrate medications. Some “treat to target”…
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