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    While it appears nitrofurantoin may be safe for maternal use in breastfeeding infants at least 8 days' old 1 , this infant is just on the cusp and spent his first 5 days in NICU. Based on information below, consider trimethoprim alone or cephalexin. Alternatives and safety in nursing: It's possible the calcium in the breastmilk may bind ciprofloxacin, thereby reducing exposure to the infant. Use in nursing mothers is acceptable with monitoring of the infant for diarrhea or thrush, and avoiding breastfeeding for hours after a dose to decrease the exposure.

    Bugs and Drugs app 3. Anxiety stomach problems Medication History: Currently, there is no evidence for a drug-drug interaction between Tecfidera and hemp oil. Potentially an interaction could occur and hemp oil should be used with caution.

    Tecfidera causes immunosuppression and hemp oil studies in mice have also shown some immunosuppressive properties. Safety data currently says hemp oil use is likely safe in adults, but there is no evidence to suggest efficacy in treating any condition. Depending on what the hemp oil is being used for, it may be more appropriate to consider alternative therapy. Somerville MA ; c [cited 13 Feb ]. Ogbru O, Abedin S, editors. WebMD; c [cited 13 Feb ].

    Primary progressive MS lacks effective medical treatment, potentially due to the absence of inflammation, unlike relapsing MS 1. There are currently no approved medications for PPMS however some medications have shown potential including methotrexate, rituximab, ocrelizumab, and stem cell therapy. Rituximab may delay disease progression in patients less than 51 years old with PPMS. Compared to placebo, Ocrelizumab has been associated with more neoplasms, infusion reactions, upper respiratory tract infections, and oral herpes.

    Stem cell therapy has been used experimentally in those with aggressive or unresponsive MS. The procedure includes collecting patient stem cells followed by exposure to chemotherapy to deplete the immune system, as immune system dysfunction is thought to be causing the MS damage. There is currently no approved stem cell therapy treatment for MS and there needs to be further analysis on the risks vs benefits of SC treatment.

    MS Society of Canada. Registration and login required. Disease modifying therapies in multiple sclerosis: Annals of Neurology ; Methotrexate for multiple sclerosis. Cochrane Database of Systematic Reviews , Issue 2. Rituximab in patients with primary progressive multiple sclerosis: Results of a randomized double-blind placebo-controlled multicenter trial.

    Treatment of progressive multiple sclerosis in adults. Cited 13 Feb Subscription and login required A study of ocrelizumab in participants with primary progressive multiple sclerosis [homepage on the internet]: NKA no meds Amoxicillin x 10 days, rash, sore throat persist Response: While there would be no reason to continue treatment based on the rash alone 1 , considering the continued presence of sore throat, further treatment may be warranted. Azithromycin and clindamycin are alternative treatments 2 though resistance is consdierable in Canada.

    UTD - Complications of streptococcal tonsillopharyngitis 2. UTD - Treatment and prevention of streptococcal tonsillopharyngitis 3. Bugs and Drugs 4. For both pregabalin and gabapentin, patients on peritoneal dialysis should be dosed as though CrCl References: Dialysis of Drugs 4. PVCs - not bothering her went on antibiotic in December and they flared, then resolved after antibiotic was stopped Medication History: Pantoloc, zopiclone, premarin cream, Flonase, Ditropan Response: The metoprolol is likely to further reduce heart rate and it seems important to clarify if the cardiologist is aware of the patient's resting HR.

    UTD - Ventricular premature beats 2. UTD - Major side effects of beta blockers 3. J Cardiovasc Pharmacol Ther. PDF Houston M, et al. Most studies address the switch from oral treatment to the patch. A method to switch from oral dopamine agonists to rotigotine in patients with restless legs syndrome and mild augmentation. Overnight switch from ropinirole to transdermal rotigotine patch in patients with Parkinson disease.

    Overnight switch from oral dopaminergic agonists to transdermal rotigotine patch in subjects with Parkinson disease. Outcomes from switching from rotigotine patch to alternate therapies in Parkinson's disease. Documentation of elevated dabigatran levels secondary to verapamil exists 1 ; despite this, no dose adjustment is recommended. Pantoprazole, which not only acts as a gastic protectant, may actually reduce dabigatran levels, however no dose adjustment is recommended. Oral ondansetron is typically used for chemotherapy-induced nausea and vomiting at the dose of 8 mg PO twice daily for 3 days and highly emetogenic chemo has been dosed up to 24 mg PO 30 minutes before starting treatment.

    In this case it was recognized as posterior reversible encephalopathy syndrome which describes changes in neuroimaging potentially due to impaired cerebral blood flow and endothelial dysfunction.

    The monograph describes animal studies in which dogs given oral ondansetron, at 7. In rats and mice, there was no evidence of tumourgenic effects with high-dose ondansetron taken for 2 years. Toxnet Toxicology Data Network. National Library of Medicine; [updated Oct 25; cited Feb 14]. Product Monograph not online.

    Product monograph for Ondansetron. Unfractionated heparin is the same as heparin 1. It is unlike low molecular weight heparins which would be ordered as the brand eg. Innohep or generic name eg. Language barrier but caller thinks a TB treatment protocol caused something with platelets Response: Risk of adrenal suppression nausea, fatigue, shortness of breath, hypotension, hypoglycemia, myalgia, fever, dizziness is low if systemic steroids are taken less than 3 weeks.

    Canadian Pharmacist's Letter ; 26 5: GeriRx Files, pg Ticagrelor, ASA, metoprolol and atorvastatin. An Ace inhibitor will likely be started in next hours. None of my references have any information about apigenin.

    Saw palmetto may inhibit 3A4 but this was not documented when mg daily was taken for 8 weeks. Saw palmetto may have cardiovascular concerns. Possibly resveratrol 1,4 and hesperidin 1 increase bleeding risk. Stinging nettle 1,4 and tribulus 1.

    None of the ingredients were considered harmful in general. Natural Medicines - DI checker 2. Natural Medicines - monographs 3. Review of Natural Products, The. Ref Online Electronic Medical Library. There is some research suggesting lysine may prevent recurrent HSV infection 3,4,13,14 and that it appears to be dose-dependent.

    All of the limitations of the former trial apply as well as methodological limitations of a survey. Success of L-lysine therapy in frequently recurrent herpes simplex infection. Sen P, Barton SE. Genital herpes and its management. Development and evaluation of a host-targeted antiviral that abrogates herpes simplex virus replication through modulation of arginine-associated metabolic pathways. Arginine inactivates human herpesvirus 2 and inhibits genital herpesvirus infection.

    Int J Mol Med. National Center for Biotechnology Information. Lysine prophylaxis in recurrent herpes simplex labialis: Lysine as a prophylactic agent in the treatment of recurrent herpes simplex labialis.

    Treatment of recurrent herpes simplex infections with L-lysine monohydrochloride. Failure of lysine in frequently recurrent herpes simplex infections. Failure of lysine in frequently recurrent herpes simplex infection. Subjective response to lysine in the therapy of Herpes simplex. J Antimicrob Chemother ; Unlike other glucocorticoids, no well-established equivalent dose to prednisone is available for oral budesonide.

    National Advisory Committee on Immunization. Update on the use of herpes zoster vaccine. Public Health Agency of Canada. Accessed Mar Treatment of active Crohn's disease with an oral slow-release budesonide formulation. Am J Gastroenterol ; N Engl J Med ; Acetaminophen, atorvastatin, gravol, docusate, labetalol, ramipril, zopiclone Response: I found that two ingredients were also referred to as lithospermum arnebia guttata or gromwell and camphor borneolum or zhang hao or bing pian and used those in my drug interaction analysis.

    The analysis of lithospermum, camphor and phellodendron showed drug interactions with acetaminophen, atorvastatin, and labetalol. Camphor is potentially hepatotoxic and should be used with caution with concomitant acetaminophen, atorvastatin, and labetalol as there may be an increase in liver enzymes and risk of developing liver damage. Phellodendron and atorvastatin should be used with caution as phellodendron might inhibit CYP3A4 enzymes, potentially increasing levels of atorvastatin and other CYP3A4 substrates.

    Natural medicines database interaction checkler: Comparison and Frequently-Asked Questions. Accessed Feb 28 How I treat with anticoagulants in Blood, 13 , Accessed February 27, These side effects may go away with time as the product is being used. If the symptoms are moderately bothersome the patient could try a saline nasal spray or an intranasal corticosteroid. Lantus product monograph Sanofi-Aventis. DHEA cream applied vaginally or to the thigh and intravaginal suppositories have shown to be effective in treating vaginal atrophy in post menopausal woman.

    DHEA is possibly unsafe when used orally for long term at higher doses; long term use of 50 to mg of DHEA daily can produce higher DHEA serum levels and potentially puts them at risk for cancer including breast cancer.

    Dupilumab does not have a notice of compliance yet. The studies were over 16 weeks therefore longer term efficacy studies are required 2. Health Canada Notice of Compliance 2. Amlodipine steady state is usually reached within days of consecutive daily dosing. Amlodipine will have significant reductions in BP at hours after first dose. Depiro Pharmacotherapy textbook - hypertension 3. Drug product database- amlodipine accel pharma.

    The drugs of choice are Ivermectin and albendazole ivermectin preferred. In fact, there is a Canadian article which addressed the fact that CLM "treatment in Canada is only available through the Special Access Program SAP of Health Canada, thus, many patients are prescribed ineffective courses of non-targeted therapy" and the importance of using the first line treatments: Management of imported cutaneous larva migrans: A case series and mini-review.

    Travel Med Infect Dis. Ondansetron prolongs QT interval in a dose dependent manner, especially in doses greater than 32 mg IV. Risk of dose dependent QT prolongation is expected to be greater with faster and larger IV infusions of ondansetron. QT prolongation and torsades de pointes: Clonidine may reduce physical symptoms of withdrawal. To ensure it will be tolerated a test dose of 0. If BP Methadone and buprenorphine have shown to be superior over clonidine in treatment of supervised withdrawal as two meta-analysis showed patients were more likely to complete treatment and reduce withdrawal symptoms.

    Rx files- slow opioid taper 4. Likely dyspepsia patient said there is no actual diagnosis Response: All of the PPIs are of equal equivalence 1 ; none are superior so cost and formulation are the major decision factors. Truvada is currently the only drug indicated for PrEP in Canada. The drug is not covered on the Saskatchewan formulary for this indication so all Saskatchewan formulary patients would pay out of pocket.

    Some third party insurers are covering on a case-by-case basis but maximums and deductibles may result in incomplete coverage. The GP can prescribe. However, prescription of PrEP should include a comprehensive prevention strategy as well as routine follow-up every 3 months to monitor HIV status, adverse effects, and re-inforce prevention strategy. RxTx - Truvada 3.

    Phone communication with Pharmacist, Positive Living Saskatoon, Information is available from one observational study looking at long-term effects of tranexamic acid being used cyclically for menorrhagia. This study included women who were followed for 27 cycles of 1. The discontinuation rate was Specific adverse events reported: Ophthalmological examination of patients in long-term treatment with tranexamic acid. Patients on long-term treatment of MacroBID for 6 months or longer are at increase risk of developing chronic pulmonary reactions, including diffuse intersistial pneumonitits, pulmonary fibrosis or fatalities.

    Pulmonary fibrosis has most frequently occurred in post menopausal woman and most cases have been reversible following discontinuation of MacroBID and beginning steroid therapy. The manufacturer does not provide dosing adjustment for cephalexin however some clinicians follow the guidelines to mg every 12 to 24 hrs.

    ALS patients do have problems with thickening secretions for 3 reasons: Secretion Management in ALS http: Glaucoma diagnosed Oct 16 Medication History: Pantoprazole 40 mg daily started in Feb 16 Response: Drugs which are known to cause or exacerbate glaucoma include corticosteroids, antimuscarinic drugs antihistamines, antidepressants, antispasmodics , and topiramate.

    In another study treating patients with Zollinger-Ellison syndrome or hypersecretory conditions, 4 of 34 patients experiencd visual disturbances including blurry vision and eye floaters, appearing or worsening during pantoprazole use. Rxtx - glaucoma 3. Subcutaneous administration of Versed is an off-label use, however, it is often used this way in palliative care.

    Medication use during end-of-life care in a palliative care centre. Int J Clin Pharm. Accessed on March 2, Accessed on November 25, Yes, if blood glucose is not well-controlled with the insulin combination. The dosage of the insulins should be decreased on initiation of the Forxiga because of the possibility of hypoglycemia 1,2 and adjusted as needed. Management of persistent hyperglycemia in type 2 diabetes mellitus in UpToDate 2.

    Not known Medication History: It's metabolite,- normeperidine, is neurotoxic and its accumulation can cause seizures or other CNS side effects such as tremors and hallucinations.

    Due to slower rate of metabolism in elderly and hepatic or renal impairment, use is not recommended in this population. Canadian Pharmacists Association; Acute Pain; [updated August ; cited 03 March ]. Management of acute perioperative pain. Accessed on March 3, Lodalis colesevelam is a bile acid sequestrant used to lower cholesterol. It works by preventing reabsorption of bile acids. Once bile acids are depleted, the hepatic enzyme cholesterol hydroxylase is increased which further converts cholesterol to bile acids.

    This in turn increases demand for cholesterol in liver and increases clearance of LDL from the blood. Therefore ezetimibe should be given two hours before or 4 hours after Lodalis. Uptodate lipid lowering with drugs other than statins and fibrates. Gastroparesis Pain Medication History: Tramadol and metoclopramide may have drug interactions varying from increased sedation to increased seizures and serotonin syndrome.

    Therefore, reduced tramadol metabolism may further increase serotonergic activity with decreased opioid effect. Lexi interaction checker 4. Micromedex- tramadol and bupropion 6. Pencillin allergy Medication History: Prevacid, bismuth subsalicylate, tetracycline, metronidazole Pepto Bismol bismuth subsalicylate - 2 tabs QID for 14 days Pradaxa BID- second month filled today was on warfarin for prevention of clots and then got a clot Response: No major drug interaction between Pepto Bismol and dabigatran.

    Each of these agents possess the potential to cause bleeding. Their combined use would seem to increase that potential. Recommended monitoring for increased signs of bleeding. Increase monitoring diligence for signs and symptoms of bleeding if these agents are used concomitantly. Pepto Bismol, PPI, metronidazole and tetracycline. Lexidrug interaction checker 2. Stockleys drug interaction checker 3.

    Rxfiles h pylori testing and eradication 5. Acid suppressing medications have a limited role in the treatment of infants with regurgitation. They are not valuable in treating children less than one year of age with uncomplicated GER "happy spitters". When pharmacotherapy is chosen as a treatment, or for a limited trial, a PPI is generally preferred over histamine type 2 receptor antagonists H2RA.

    Post marketing reports of severe skin reactions associated with Accutane, like Stevens-Johnson syndrome, toxic epidermal necrolysis, and erthema have been reported. A Roche global safety database as of reported 66 incidences of severe skin reactions in adults and children worldwide, however there are approximately 16 million medication users. To manage the photosensitivity you can trial a decreased dose of Accutane or apply hydrocortisone cream to a small area to see if it helps reduce the redness and itchiness.

    Potential consequences of abrupt discontinuation or large dose reduction of an antipsychotic include discontinuation syndrome flu-like , psychosis, and movement disorders. Clinical Handbook of Psychotropic Drugs, 20th Ed, pg There are some interactions with grapefruit juice and calcium channel blockers however none were recognized with amlodipine.

    Stockleys drug interaction checker 2. Food and Drug interactions book. Topical steroids may be used in treating mild-moderate contact dermatitis.

    If skin irritation occurs with fentanyl patches, steroidal sprays have been used; wait 1 minute after spraying before applying the new patch. However they can be used as a last resort. Alprazolam Cyclobenzaprine Ranitidine Response: No interactions identified 2. Lexi-drug interaction checker 2. Stockleys drug interaction checker. In disorders with excess absorption via diet or intestinal disorder it may be more important to reduce oxalate content in diet.

    An association of oxalates and vulval pain was found involving a woman with vulvodynia. She presented with high levels of oxalate in her urine. Her symptoms resolved and oxalate levels declined after starting a low-oxalate diet and calcium citrate to remove oxalate from the body.

    In the US, a low oxalate diet is widely used for treatment of vulvodynia. Up to date- prevention of recurrent calcium stones in adults 2. Uptodate — primary hyperoxaluria 3.

    Vulval pain society- http: Shortage is estmated to be resolved April 6th. Referred to Amantadine shortages document. Schedule II means a pharmacist needs to be involved in discussion with the patient. The fact your patient is tolerating amitriptyline is reassuring. Ann Allergy Asthma Immunol. Proton pump inhibitors PPIs may decrease serum mycophenolate acid levels, depending on the product used.

    Stockleys Drug Interactions 2. Lexicomp Drug Interaction Checker 3. Intestinal parasite - dientamoeba fragilis, blastocytis hominis Medication History: Tried Vermox and Combantrin Response: Bugs and Drugs app 2. There is no equivalent dose of opioids and marijuana.

    Tapering of high dose opioid can be considered before starting marijuana as there may potentially be additional CNS depression with the combination. Butrans Patch for Weekly Application for converting opioids to Butrans patches which may be of some assistance. Health Canada drug product database- buprenorphine 2. Pharmacists Letter- Medicinal Marijuana 5. Serum salicylate levels are reduced by steroids; however the main concern is following steroid withdrawal in those taking moderate to high doses of ASA.

    Stockleys Drug interactions 2. There is no difference in terms of bioavailability or onset of action between the two products. Lexidrugs - Ondansetron 3. Canadian Pharmacist's Letter ; 20 Treatment of eosinophilic esophagitis EoE consists of: As the esophagus may be inflamed, PPIs will confer protection to potential acid exposure. In a randomized study patients received esomeprazole 40 mg for 8 weeks along with swallowed fluticasone; treated patients experienced significant improvement in symptoms of dysphagia regardless of GERD status.

    Most patients receive swallowed fluticasone which is administered using an MDI without a spacer. The medication is sprayed into the mouth and swallowed; the patient should not eat or drink for 30 minutes after administration. Adults should use mcg twice daily. If treatment is not beneficial, the dose may need to be increased or the patient can be switched to oral viscous budesonide budesonide nebules mixed with sucralose [4].

    Budesonide can also be administered using a nebulizer and having the patient swallow the accumulated liquid. Patients generally continue with treatment for 8 weeks and if relapse is an issue afterwards a maintenance dose or dietary changes may be considered. It may reduce the burden of allergy and risk of anaphylaxis however there is the possibility that the immunotherapy may trigger the EoE as seen in mice. Further research is needed to determine safety and efficacy. Esophageal dilation will relieve dysphagia but not improve the underlying inflammation.

    Treatment of Eosinophilic Esophagitis 2. Emerging Therapeutic Options for Eosinophilic Esophagitis. Management of benign esophageal strictures 4. Oral viscous budesonide is effective in children with eosinophilic esophagitis in a randomized, placebo-controlled trial. Carbamazepine is an enzyme inducer that may increase estrogen metabolism, thereby reducing its effectiveness; however, this is not relevant for locally applied estrogen used for menopausal vaginits.

    Stockleys Drug Interaction Checker 2. Lexicomp Drug Interaction Checker: Not available Medication History: Diversion colitis is characterized by inflammation of the defunctionalized, bypassed colon following surgery. Most patients with diversion colitis are asymptomatic, but in a small proportion of patients, symptoms can significantly impact quality of life.

    Bacterial metabolism results in SCFA synthesis. SCFA are absorbed by the lumen which then supplies fuel to mucosal cells, modulates fluids and electrolytes, enhances colonic motility and mucosal blood flow, and production of inflammatory cytokines. The enemas must be compounded and consist of sodium acetate 60 mmol , sodium propionate 30 mmol , and sodium n-butyrate 40 mmol with additional sodium chloride 22 mmol.

    This yields a similar osmolality to plasma and pH is adjusted to 7. The enema is instilled twice daily for 6 weeks at a dose of 60 mls. Frequency may be reduced if improvement occurs. In one randomized crossover trial of 10 patients with IBD and colectomy, SCFA enema use for 3 weeks was not shown to improve inflammation compared to placebo.

    However these patients had severe inflammation which may have been due to IBD. Uptodate- Diversion Colitis 2. Pathophysiology, clinical presentation and management of diversion colitis: A review of current literature. International Journal of Surgery. There is minimal data for melatonin supplementation during breastfeeding and effects are relatively unknown. Briggs in Pregnancy and Lactation 2. The common guidelines for statin therapy, such as that of the American College of Cardiology do not mention how to manage low LDL, but some articles have explored targeting lower LDLs to assess if there is a greater benefit with more aggressive treatment.

    This patient would have been put on a statin following the heart attack, as this would be considered clinical atherosclerotic cardiovascular disease. A systematic review of RCTs of statin therapy found no association between being treated with statins and cognitive decline; the LDL numbers of the study were not disclosed but it did include participants on higher intensity statin therapy. Do Statins Impair Cognition? Journal of General Internal Medicine. Journal of the American College of Cardiology.

    Kastelein, MDc, John B. The American Journal of Cardiology. Can LDL cholesterol be too low? Possible risks of extremely low levels.

    Journal of Internal Medicine. How quickly after ingestion does antidote therapy need to be instituted ie: They found that delaying the antidote more than 6 hours increased rates of death OR prolonged renal insufficiency and associated morbidity significantly composite end-point, odds ratio of 3.

    They do not conclude that giving the antidote within 6 hours is optimal it could be within hours, for example , but delaying more than 6 hours definitely leads to more harm. Is oral alcohol a good option? This is not definitive, however: This World Health Organization suggests fomepizole is likely more cost-effective depending on regional costs of acquisition and staffing 6.

    Oral ethanol dosing protocols suggested for both pediatric and adult: O Another protocol 1 basically the same, slightly lower dose: The loading dose is 0. For both modalities, blood ethanol levels must be monitored hourly and adjusted accordingly, and both require patient monitoring in an ICU setting. Treatment of ethylene glycol poisonings 2. UpToDate, treatment of ethylene glycol poisoning 3. Epub Dec Reddy's - inventory Response: UpToDate - Teratogenicity, pregnancy complications, and postnatal risks of antipsychotics, benzodiazepines, lithium, and electroconvulsive therapy.

    Accessed on-line 08Sep 3. There is no indication to titrate statin doses. RxTx - Post-myocardial Infarction 4. Treatments for molluscum in immunocompetent children with the most evidence include: It is applied with the blunt end of cotton swab to lesion only in the office.

    Application is painless and does not cause bleeding. The area can be washed with soap and water within hours. The agent causes small blisters at the lesion site.

    If lesions persist, treatment can be repeated in weeks. This solution can be applied at home once or twice daily 3—4 days per week for up to 4—6 weeks. Pain, burning, erosions, pruritus and bleeding may occur. In the methods it described 4: Treatment was to be discontinued if inflammation occurred.

    UTD - Molluscum contagiosum 3. Pediatr Dermatol May-Jun;23 3: Common and Flat Warts. As per Canadian Immunization Guidelines, Canadians 50 years of age and older with no known history of varicella infection are still eligible for herpes zoster vaccination. Patients should not obtain lab confirmation - there are no known safety concerns of herpes zoster vaccine in healthy patients susceptible to varicella virus.

    Only if lab confirmation of varicella virus has been obtained in the past for other reasons would one vaccinate with two doses of univalent varicella vaccine. There are liquid sodium phosphate solutions marketed for laxative use and contain 4. Dieticians of Canada phosphorus content of foods available.

    UpToDate - Evaluation and treatment of hypophosphatemia 2. Phone communication with , Novartis Customer Service, , Mar 31, Platelets usually highest was 5. I found but one case report of hydroxyurea HU -associated hyperkalemia in a patient with polycythemia vera. While the authors describe normalization of potassium levels with discontinuation of the HU, they do not provide any information about how the condition was subsequently managed.

    There have been three cases reported via MedEffect 3 ; however, all of these seem to be tumour lysis syndrome as other metabolic abnormalities hyperuricemia, hyperphosphatemia, hypocalcemia were present, which is typical of tumour lysis syndrome.

    No reason to believe any of the other drugs would be a causative factor, whether by interaction or adverse effect profile was found. There is a decent amount of information regarding pseudohyperkalemia in patients with myeloproliferative disorders.

    Because it is possible furosemide was affecting potassium simultaneously, if simultaneous plasma and serum samples can be ordered, pseudohyperkalemia can easily be ruled in or out. Should this be a true hyperkalemia,low dose Kayexalate sodium polystyrene sulfonate — SPS is reasonable to try. They followed these patients for a mean 14 months; baseline potassium was 6. Some did experience nausea but this subsided with continued use. It is best to use the sorbitol-free product 19 , which is powder.

    Hyperkalaemia associated with hydroxyurea in a patient with polycythaemia vera. Eur J Clin Pharmacol. MedEffect Adverse Drug reaction database 4. UTD - Tumor lysis syndrome: Definition, pathogenesis, clinical manifestations, etiology and risk factors 5. UTD - Prognosis and treatment of essential thrombocythemia 6.

    Renal complications in oncohematologic patients. J Invest Med ; 57 8: UTD - Treatment and prevention of hyperkalemia in adults Clinical utility of patiromer, sodium zirconium cyclosilicate, and sodium polystyrene sulfonate for the treatment of hyperkalemia: Pseudohyperkalemia in patients with increased cellular components of blood.

    Am J Med Sci. When is a high potassium not a high potassium? J R Soc Med. Pseudohyperkalemia occurring in a patient with chronic renal failure and polycythemia vera without severe leukocytosis or thrombocytosis. The tip of the iceberg. Am J Case Rep. Epub Jun Secondary prevention of hyperkalemia with sodium polystyrene sulfonate in cardiac and kidney patients on renin-angiotensin-aldosterone system inhibition therapy.

    Epub Nov 6. That said, if she has some 0. Geri RxFiles, pg 2. The threshold dose of prednisone considered sufficient to interfere with immune response such that Zostavax should not be given or prednisone started after Zostavax is 20 mg once daily.

    The only information available is from an abstract in which ampicillin rectal suppository was compared to amoxicillin suspension administered rectally. There was less perianal irritation in the amoxicillin group 5. J Int Med Res. Clinical evaluation of rectally administered ampicillin in acute otitis media. There is no need to discontinue breastfeeding if using topical fluorouracil on small areas. Hale - Medications and Mothers' Milk. No drug interactions between evolocumab and adalimumab were identified.

    However, given the total amount of endogenous IgG of 50— g, the usual dose of most mAbs of The possibility of additive immunosupppression was considered; however while adalimumab does cause immunosuppression, 4 the target of evolocumab, PCSK9, is not involved in the immune system and there is no indication evolocumab affects the immune system. ECPS - Humira 5. Epub Jul Pharmacokinetics interactions of monoclonal antibodies. The Risperdal Consta Kit should be stored under refrigeration, however, if there is no refrigeration available, it can be stored at room temperature References: Risperdal Consta Drug Product Monograph.

    The hairline, neck, temples, and forehead may be infested in infants and geriatric patients. In these populations, permethrin should also be applied to the scalp and face, sparing the eyes and mouth.

    UpToDate, treatment of scabies. Rare cases of hypertrichosis have been associated with topically applied minoxidil. The laboratory investigation excluded hyperandrogenism and thyroid dysfunction.

    Topical minoxidil should be used with caution in children. Hypertrichosis is a common side effect of topical minoxidil treatment in women. Although usually localized to the face, it may occasionally involve limbs and other body areas. Systemic absorption of the drug is typically minimal with topical therapy, with 1. However, hypotheses on the pathogenesis of the diffuse hypertrichosis reaction routinely include systemic absorption, as well as high sensitivity of the follicular apparatus to minoxidil.

    These effects included sinus tachycardia, sensation of palpitation and dizziness. The efficacy of topical minoxidil in alopecia areata has never been definitively proven. The possibility of systemic absorption contraindicates, in some reasearchers opinion, this treatment in young children, who can develop serious cutaneous or systemic side effects. Infantile generalized hypertrichosis caused by topical minoxidil. Minoxidil induced hypertrichosis in a 2 year-old child.

    Rabeprazole is enteric coated because it is unstable in acidic media and undergoes pH-dependent decomposition especially rapidly below pH ; therefore it should not be crushed. DPD - apo-rabeprazole monograph 2. There are no drug interactions or contraindications for getting zostavax after having the prolia injection. Unlike other live vaccines, because HZ vaccine is not used for eliciting a primary immune response, it is reasonable to consider HZ vaccine in people receiving low dose immunosuppressive therapy.

    Prolia is used with caution in patients with impaired immune systems or using concomitant immunosuppressive therapy; may be at increased risk for serious infections.

    Olopatadine comes in a nasal spray called Patanase 0. It is used for seasonal allergic rhinitis at 2 sprays in each nostril twice daily.

    Has patient tried taking iron with a meal to decrease GI side effects? IM generally not recommended as it is painful, stains the buttocks, and has variable absorption and case reports of sarcoma 1 IV Dexiron is the cheapest and most convenient form of IV Iron.

    Dexiron and Venofer not available for another couple of weeks. Dexiron and the other option Venofer are not available from the manufacturer for at least a few weeks. Escitalopram is predicted to increase the exposure to nortriptyline. The serotonin syndrome has, rarely, been seen in patients given SSRIs with tricyclics.

    Nortriptyline has been associated with QT prolongation or torsade de pointes mainly in overdose but an effect is not established, whereas escitalopram has some risk of prolonging the QT interval. Some consider that concurrent use might increase the risk. Since both citalopram and escitalopram are thought to be among the SSRIs least likely to alter the metabolism of other drugs, escitalopram is likely the best choice among the SSRI's to use with someone also taking nortriptyline.

    Monitor concurrent use for tricyclic toxicity dry mouth, sedation, confusion , and adjust the dose if necessary. Some suggest a small initial SSRI dose. Increasing age, female sex, cardiac disease, and some metabolic disturbances notably hypokalaemia predispose to QT prolongation: Escitalopram and citalopram are considered weak inhibitors of CYP2D6.

    The tablets are film-coated 1 and immediate release. Phone communication with AST medical information, question originally emailed to: Morphine IR can be crushed 2.

    ISMP do not crush 3. Manufactuer call to Purdue Pharma. For low-dose aspirin, there are not any specific recommendations for monitoring, beyond what a patient would already have done. Diabetics, also on diuretics , other NSAIDs -- these populations likely already have renal function testing done, so low dose ASA would not impact this. If a person has no risk factors for compromised renal function, then extra testing would not be necessary based on just being on ASA 81mg.

    Monograph for ASA 81mg 2. One resource that has fairly comprehensive list of metabolites is drugbank. Florinef is known to be stable up to 30 days at room temperature. Phone communication with Julia, Paladin Labs, 07 Apr Furosemide is available as an oral solution. Clearly it has a slower onset of effect minutes for diuresis compared to 5 minutes for IV. Ethacrynic acid is a loop diuretic available as injectable DIN It has a higher risk of ototoxicity than other loops and should be avoided in those with CrCl Unfortunately, the ethacrynic acid is the only other IV diuretic available in Canada.

    Ottawa Hospital Parenteral drug Manual 5. A placebo double-blind pilot study of dextromethorphan for problematic behaviors in children with autism. An update on its utility for neurological and neuropsychiatric disorders. Spiriva, salbutamol, statin, Lantus, metformin, amlodipine clarithromycin mg BID x 7 days, 10 days ago with prednisone not sure if hospitalized Response: If it is strongly felt the etiology is bacterial, amoxicillin-clavulanate is a better choice in this complicated patient.

    Herath SC, Poole P. Prophylactic antibiotic therapy for chronic obstructive pulmonary disease COPD. Cochrane Database of Systematic Reviews , Issue Surgeon wants to know what can use for breakthrough? Monograph - Plus - CIs - alkalosis, where disteneion may be due to partial or complete gastric obstruction. While it is not stated in monographs, it would seem the reason for the contraindication of antacids in patients with intestinal obstruction may be due to risk of bezoar formation, which has been reported in earlier literature.

    Possibly bezoar formation can be monitored during dilatations. Small bowel obstruction caused by a medication bezoar: Intestinal obstruction from medication bezoars. Small bowel obstruction from an antacid bezoar: The reason for enteric coated ASA is to reduce dyspepsia.

    When taken during a suspected MI, it is preferred to chew ASA for faster absorption; certainly chewables are easier to chew and taste better. The next best option in this case would be a regular tablet though enteric coated can be used if it's all that's available - it may be more difficult to chew. The risk of GI bleed is a systemic effect of ASA and is not reduced by use of enteric coated products. As stated above, enteric coated products serve to reduce dyspepsia, but not reduce GI bleeding.

    Canadian Pharmacist's Letter; November ; Vol: Lantus Insupen Needles 32G 4mm Response: The resounding consensus is needle length has no effect. I have outlined some strategies to manage and information that I gathered from these references. There is conflicting information about what angle to hold the pen, but there are several other suggestions. Strategies to reduce leakage - Leave pen in for 10 seconds to prevent leakage 1,2 - After removing needle, place finger on site for seconds 1 - Always remove the needle from the pen after injection ; leaving the needles attached can cause air to enter the cartridge and it will take longer to inject the insulin 1 or affect the dose 2 - Try injecting at degree angle rather than 90 1 o however, another says: Everything you wanted to know about injecting insulin.

    Post CVA several years lives at home. Had significant urinary retention post stroke and now continent on tamsulosin. Booked for cataract extraction and was told to be off it for a month.

    In the case of a patient established on tamsulosin therapy and requiring cataract surgery, mitigating factors lie largely with the surgeon.

    Switching to a less selective alpha-antagonist would seemingly be a good compromise of risk reduction and maintenance of control of lower urinary tract symptoms LUTS ; however, there is no evidence to support this strategy. Other drugs used for LUTS include other alpha-1 blockers, 5-alpha-reductase inhibitors, antimuscarinics in combination with alpha-1 blockers and tadalafil.

    The effects of tamsulosin on the iris have been reported to occur even several years after discontinuation,2, likely because some of the effects are irreversible. However, it needs to be mentioned the estimate of the hazard ratio of tamsulosin compared to other alpha blockers has been wide from study to study which could be because in most studies either the tamsulosin cohort was significantly larger than the others or the cohort in general was small.

    Unfortunately, the only research to address this is a small case series published in abstract only. I realize this leaves you in a difficult position. There is also a good chance his use of tamsulosin will complicate the surgery. The research to date suggests likely not on both of these last points, but it is too limited to make conclusions. Hopefully with this information you, your patient and the surgeon can reach a best-fit solution.

    Ferri's Clinical Advisor , Know the Risks, Avoid the Complications. Prospective masked comparison of intraoperative floppy iris syndrome severity with tamsulosin versus alfuzosin. Epub Dec 4. Expert Opin Drug Saf. Intraoperative floppy iris syndrome IFIS: How to avoide intraoperative floppy iris syndrome. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg ; Intraoperative floppy-iris syndrome associated with alpha1-adrenoreceptors: J Cataract Refract Surg.

    Jan Teper S, Dobrowolski D, et al. Complications of cataract surgery in patients with BPH treated with alpha 1A-blockers. Cent European J Urol. Can switching tamsulosin to alfuzosin prevent intra-operative floppy iris syndrome in patients with benign prostate hypertrophy?

    Product monograph from DPD. It is possible the nystatin was not used optimally. Nystatin should be used for days 1,3,6 until 2 days after the infection has cleared. If the mother does not have symptoms, there is no need to switch from the suspension.

    Dynamed - Oral candidiasis in infants 4. Canadian Pharmacist's Letter ; 32 SickKids drug handbook 6. Bugs and Drugs 7. BNF for children CHF, AF, aortic valve stenosis. EF and NYHF class not available Never smoked, lived healthy all his life, ran until his hip replacement and then biked well into his 70's. Renal damage may occur by the same mechanism, owing to renal CYP metabolism. Overdose during pregnancy has been associated with fetal death and spontaneous abortion.

    Very high levels of acetaminophen can cause lactic acidosis and altered mental status by uncertain mechanisms, probably involving mitochondrial dysfunction. Acetaminophen is rapidly absorbed, with peak levels usually reached within 30— minutes.

    Absorption may be delayed after ingestion of sustained-release products [Tylenol Extended Release, Tylenol Arthritis] or with co-ingestion of opioids or anticholinergics. Volume of distribution Vd is 0. The elimination half-life is 1—3 hours after a therapeutic dose but may be greater than 12 hours after an overdose see also Table II— Children younger than 10—12 years appear to be less susceptible to hepatotoxicity because of the smaller contribution of CYP to acetaminophen metabolism.

    In contrast, the margin of safety may be lower in patients with induced CYP microsomal enzymes because more of the toxic metabolite may be produced.

    High-risk patients include alcoholics and patients taking inducers of CYP2E1, such as isoniazid. Fasting and malnutrition may also increase the risk for hepatotoxicity, presumably by lowering cellular glutathione stores. Chronic toxicity has been reported after daily consumption of supratherapeutic doses.

    Please enter User Name Password Error: Please enter Password Forgot Username? Use this site remotely Bookmark your favorite content Track your self-assessment progress and more! Otherwise it is hidden from view. About MyAccess If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

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