Statins
Coenzyme Q10 for STATIN intolerance
As a community pharmacist, patients will ask you more about Coenzyme Q10 for STATIN intolerance. Statin intolerance is present in about 9% of statin-treated patients, according to a recent meta-analysis. This finding is getting a lot of attention and is likely to increase interest in supplements that might help limit statin-induced muscle pain and weakness . Be prepa…
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Side Effects
How to REVERSE bleeding due to Pradaxa or Xarelto
As a hospital pharmacist, the new oral anticoagulants are bringing up questions about how to reverse bleeding due to Pradaxa or Xarelto . Antidotes for Pradaxa (dabigatran) or Xarelto (rivaroxaban) are NOT available in many hospitals, like vitamin K for warfarin . But there are things you can do. Stopping the anticoagulant and w…
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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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Side Effects
Manage the side effects of antipsychotics
AS A PHARMACIST, you may be asked to help manage oral antipsychotic side effects in patients with schizophrenia. Second-generation or atypical antipsychotics [risperidone ( Apexidone, Risperdal )] are often tried before first-generation or typical medications [haloperidol ( Halonace, Safinace )]. But efficacy is mostly similar and side effects can overlap. …
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Trimethoprim
Think carefully before prescribing Septazole with potassium-boosting drugs
AS A PHARMACIST, you will hear more about possible harm when TMP/SMX ( Bactrim, Septrin, Septazole , etc) is combined with medications that increase potassium ( ACEIs , spironolactone , etc). This interaction is more risky than previously thought and is popping up on more drug interaction software . Trimethoprim decreases urinary excre…
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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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Side Effects
How to handle drug-induced edema
Questions come up about how to handle drug-induced edema. Peripheral edema often prompts clinicians to jump straight to a workup for thromboembolism or heart, renal, or hepatic failure. But first look for medications that can cause it... Dihydropyridine calcium channel blockers ( amlodipine, etc ) cause dose-dep…
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Side Effects
Amphotericin B–related nephrotoxicity
Amphotericin B is a polyene antifungal agent that acts by binding directly to ergosterol on the fungal cell membrane, resulting in disruption of membrane integrity and cell death. Amphotericin B has activity against a very wide range of clinically important yeasts and molds. Resistance to amphotericin B is rare. Amphotericin B has been the gold standard for t…
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Side Effects
How to treat peripheral edema due to dihydropyridine calcium channel blockers
One of the most ADVERSE EFFECT caused by calcium channel blockers (CCD), dihydropyridine (e.g., amlodipine, etc) is peripheral edema. It's dose-dependent. Incidence of peripheral edema may be > 80% with high doses. Major cause of CCB nonadherence. Mechanism is thought to be arteriolar dilatation. The resulting pressure gradient between arteriole and venule ca…
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Side Effects
Pay attention when quinolones used in diabetic patients
Stronger WARNINGS will lead to more concerns about quinolone risks . Quinolone labels already caution about hypo- and hyperglycemia, and certain CNS effects such as agitation, nervousness, or confusion. Now FDA will require warnings of hypoglycemic coma especially in the elderly, renal impairment, or in combination with …
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Side Effects
Using of potassium binders when ACEIs or ARBs cause hyperkalemia
New Rx Lokelma will pique interest in the role of potassium binders to treat CHRONIC high potassium due to ACEIs or ARBs. Think of Lokelma (sodium zirconium cyclosilicate) as most similar to sodium polystyrene sulfonate ( Kayexalate , etc) for hyperkalemia. Both exchange sodium to bind potassium. Lokelma also exchanges hydrogen. But Lokelma may cause fewer GI side e…
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TMP/SMX
Trimethoprim/sulfamethoxazole (TMP/SMX) in combination with drugs that increase potassium
As a pharmacist, you should be be careful when use of trimethoprim/sulfamethoxazole ( Bactrim, Septrin, etc) in combination with drugs that increase potassium like angiotensin converting enzyme inhibitors (ACEI) , angiotensin receptor blockers (ARBs) or spironolactone. Remmember that trimethoprim/sulfamethoxazole labeling has a precaution about hyperkalemia, and …
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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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