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    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. Because of the presence of AF in your patient, ivabradine is not an option. However, some other tweaks can be made before considering Entresto: Diltiazem worsens exercise tolerance 4,5,7 and therefore should be discontinued. The dose of ramipril is not optimal.

    Perhaps his dose has been limited by side effects such as hyperkalemia but this should be investigated. The dose of bisoprolol is not optimal. As such, concentrate on optimizing ramipril first.

    If after this his symptoms still persist, consider adding Entresto. The plasma B-type natriuretic peptide level will need to be investigated. Also the NHYA class will need to be confirmed. One note with Entresto is it caused more symptomatic hypotension than the comparator enalapril in the trials. Clinical Resource, New Drug: Euro-K 20 would be expected to act similarly as K-Dur as K-Dur is the brand reference 2 ; however, none of the potassium chloride products are interchangeable.

    The underlying premise of the article is that inhibiting synapse formation is harmful. In other words, synapses are being formed uncontrollably or at least aberrantly , causing disease. So, while the animal studies indicate pregabalin and gabapentin do inhibit synaptogenesis, in this sense they are controlling chaos as opposed to interfering with normal development. As such, I make no claims that gabapentinoids do not or cannot cause long-term negative effects on neuropsychiatric development.

    All drugs carry risks and these risks are amplified in the pediatric population due to their intense state of development of all facets as well as the dearth of medical studies conducted in them. It always comes down to risk vs. This study by no means proves gabapentinoids are harmful to the neurodevelopment of a child or adolescent. For this reason the usual tenets of drug use apply: Jasper's Basic Mechanisms of the Epilepsies [Internet]. Adolescent intermittent alcohol exposure: Alcohol Clin Exp Res.

    Ther Adv Drug Saf. Pregabalin for the treatment of generalized anxiety disorder: Post menopausal vaginal atrophy Breast Cancer Medication History: Product monograph of course contraindicates in women with past or previous breast cancer history.

    Nonhormonal treatments remain first-line therapy. The committee found that vaginal estrogen usually has minimal systemic absorption and delivers lower doses of estrogen closer to normal menopausal levels. While acknowledging controversy about recurrence risk with the use of vaginal estrogen in women with breast cancer who are receiving aromatase inhibitors, the committee concludes that such women "may benefit" from short-term topical estrogen combined with tamoxifen, followed by a return to aromatase inhibitors.

    Current data indicate no increased risk for recurrence among women receiving tamoxifen, they write. The committee also emphasizes an individualized approach and informed decision making, in which women can thoroughly weigh the risks and benefits of vaginal estrogen in coordination with an oncologist.

    Management of symptomatic vulvovaginal atrophy: Marvelon Coversyl Plus- responded well but needs additional lowering. Suggested amlodipine instead as grapefruit interaction is not thought to be clinically significant 1. No QT prolongation for amlodipine. One resource suggests conjugated meningococcal vaccine is preferred over polysaccharide in pregnant women 2 ; however, this statement was not referenced and not found elsewhere.

    One study has been published containing reports of meningococcal conjugate vaccine exposure during pregnancy to the Vaccine Adverse Events Reporting System, in which no safety concerns were identified.

    PHAC - "the use of conjugate meningococcal vaccines in pregnancy may be considered" 9 There is no mention of polysaccharide vaccine in pregnancy so perhaps this is an endorsement of the conjugated.

    Elwood C, Immunization in pregnancy. Maternal immunization with pneumococcal 9-valent conjugate vaccine and early infant otitis media.

    Epub Oct Pneumococcal vaccination during pregnancy for preventing infant infection. Cochrane Database of Systematic Reviews , Issue 1. Meningococcal A conjugate vaccine: Safety of meningococcal polysaccharide-protein conjugate vaccine in pregnancy: Am J Obstet Gynecol ; Epub May Pneumococcal vaccines WHO position paper - - recommendations. However, norethindrone is metabolized to ethinyl estradiol EE ; when taking Micronor norethindrone 0.

    However, in a woman taking 15 mg norethindrone daily, research suggests about 25 mcg EE would be generated. The next best option is based on one very small open-label study in which medroxyprogesterone 10 mg TID taken on days 12 to 25 was as effective as norethindrone 5 mg TID taken on days 12 to 25 at reducing heavy menstrual bleeding. Theoretically, taking the MPA days before the expected onset of bleeding, as one does with norethindrone, should delay bleeding. If the wedding is not before the patient's next cycle, she could experiment beforehand.

    Otherwise, I find no other options. NSAIDs taken at therapeutic doses e. Safer prescribing of therapeutic norethisterone for women at risk of venous thromboembolism. UTD - Management of abnormal uterine bleeding. This is not a problem. While some anticonvulsants induce doxycycline metabolism, neither lamotrigine nor clobazam do.

    Updated Malarial Screening Tool, Jun, Raynaud's Syndrome Medication History: Typically symptoms of RP are triggered by cold or emotional stress. The other consideration is perhaps the red, hot feet are indicative of an underlying pathology also related to the RP symptoms. Agents with even less evidence include phosphodiesterase-5 PDE-5 inhibitors, prazosin and topical nitrates.

    Dosing is as follows1,3: I've searched every variation of what those names look like, and cannot find anything. Verify spelling, try to get dosage and milligram strength to help. However, the fact the receptors are related does not mean they have the same action. No precautions or contraindications are available in monographs or other literature with respect to denosumab and live vaccines. There is not enough evidence to avoid vaccination live or otherwise in patients on denosumab but at the same time, it is something to monitor in hopes of finding some more definitive information.

    Discontinuation syndrome of antidepressants is typically inversely related to half-life. Clinical Handbook of Psychotropic Drugs 3. Canadian Pharmacist's Letter; March ; Vol: Toward achieving optimal response: Those with chronic benign neutropenia do not have an increased risk of infection. UTD - Approach to the adult with unexplained neutropenia 2. UTD - Management of the adult with non-chemotherapy-induced neutropenia 3. Sulfa allergy refers to sulfonamide antibiotic or sulfonamide non-antibiotic reactions; while hypersensitivity reactions can be experienced following expsoure to sulfites and sulfates, they are not cross-sensitive to sulfa antibiotic or sulfa non-antibiotics.

    The evidence supporting PHT is based on three uncontrolled studies involving a total of 30 patients. Of the 30 patients, 16 experienced complete pain relief, 7 partial pain relief, and 6 no effect. UpToDate suggests for patients taking enzyme inducing drugs, including CBZ, to start LMG at 50 mg daily, titrating upward as needed to mg daily at week 3, mg daily at week 5, mg daily at week 6, and mg daily at week 7.

    Dilantin in the treatment of trigeminal neuralgia. Braham J, Saia A. Phenytoin in the treatment of trigeminal and other neuralgias. Anticonvulsant therapy in trigeminal neuralgia. Am J Med Sci ; Pharmaceutical Press accessed 21 Apr ; available at http: Lamotrigine lamictal in refractory trigeminal neuralgia: Cited 21 Apr Subscription and login required. This patient did not disclose the actual bleeding disorder, though her history suggests it may be antiphospholipid syndrome APS.

    Secondary thrombosis prophylaxis is usually undertaken with warfarin 5,6,8 ; whether the target INR should be 2. Following warfarin, therapies typically go to heparins or direct acting anticoagulants 6,8 , though trials are ongoing, but none have been published. Indeed, only one case report of fondaparinux for APS was found 10 ; the patient, an adolescent, was given 7.

    Otherwise, biologics such as rituximab may be considered, though immunotherapy is only considered in those who need them for other reasons e. As such, nothing revolutionary can be recommended. Perhaps the patient was not adherent with previous treatments and the requirment for two injections per day could motivate her to be adherent?

    This should be investigated for all of the agents. Again, she may be more willing to put up with these effects if it means reducing the number of injections. Prevention of Recurrent Thrombosis in Antiphospholipid Syndrome: Different from the General Population? Wells P, Forgie M. Safety and efficacy of oral direct inhibitors of thrombin and factor Xa in antiphospholipid syndrome. Epub Apr 9. Use of fondaparinux in a patient with antiphospholipid antibody syndrome and heparin-associated thrombocytopenia.

    Mean lesions at baseline: Common and Flat Warts 5. Experience with children in an outpatient clinic setting in the northeastern United States. Travel Clinic Nurses' Tool updated Jun. Dosing can start as minutes before breakfast and minutes after breakfast. The rationale to the 2 doses surrounding breakfast is that in patients with an intact gallbladder, this dosing may enhance the excretion of the pruritogens, which presumably accumulate in the gallbladder during the overnight fast.

    Medication adherence can be a significant problem as cholestyramine can be unpalatable, and induce constipation. Rifampin rifampicin — More evidence, but still very limited: In a meta-analysis of five randomized crossover trials with 61 patients, during treatment with rifampin, 47 patients 77 percent reported complete or partial resolution of pruritus, whereas 12 patients 20 percent reported complete or partial resolution of pruritus while receiving placebo or alternative medication.

    Naltrexone is contraindicated in liver failure 14 ; - There is somewhat more evidence, however, it combines all opioid antagonists buprenorphine, nalmefene, naltrexone and naloxone ; patients have been evaluated in over 10 trials.

    I based this on McKesson pricing and added the store mark-up and dispensing fee. Evidence is based on a randomized cross-over trial of 12 patients. Imam MH et al. Pathogenesis and management of pruritus in cholestatic liver disease. Datta DV et al. Treatment of pruritus of obstructive jaundice with cholestyramine.

    The potent bile acid sequestrant colesevelam is not effective in cholestatic pruritus: The pruritus of cholestasis. Epub Oct 6. Tandon P et al. The efficacy and safety of bile Acid binding agents, opioid antagonists, or rifampin in the treatment of cholestasis-associated pruritus. Epub Mar Bunchorntavakul C, Reddy KR. Pruritus in chronic cholestatic liver disease.

    Podesta A et al. Treatment of pruritus of primary biliary cirrhosis with rifampin. Khurana S, Singh P. Rifampin is safe for treatment of pruritus due to chronic cholestasis: Browning J et al.

    Long-term efficacy of sertraline as a treatment for cholestatic pruritus in patients with primary biliary cirrhosis. Mayo MJ et al. Sertraline as a first-line treatment for cholestatic pruritus. While there appears to be no specific data, articles on rectal administration of liquids ,5 have been citing a article suggesting ml can be retained without difficulty. Palliative Care Formulary 5 2. Symptom control in cancer patients: Epub Nov 9. Pharmacokinetics of rectal drug administration, Part I.

    General considerations and clinical applications of centrally acting drugs. Practical use of rectal medications in palliative care. J Pain Symptom Manage. For more information on becoming a designated center please see the Public Health Agency of Canada website 1.

    Fluconazole has a solubility in water of 8 - 10mg per mL and is also soluble in ethanol. The injection is usually formulated in 0. Fluconazole oral liquid is available in some countries. For small doses the injection can be given orally. Unit doses can be packed into oral syringes. The potential for microbial growth was not assessed. Sterile water should be used for this preparation and a 7 day expiry date is suggested. Compatibility with flavours and syrups has not been assessed so a simple solution should be prepared as above.

    Flavour can be added to the dose just prior to administration. Refrigeration is important as an antimicrobial preservative is not included in the preparation. Silexan is simply a patented ingredient that only contains lavendar , such that interactions only apply to lavendar.

    Lavendar should be used with caution in people on antihypertensives as it may have additive hypotensive effects and in people already taking CNS depressants, especially barbiturates, benzodiazepines, and chloral hydrate. The amount of calcium in an 80 mg tablet of Lipitor regardless of brand on account of the atorvastatin calcium is 2. However, as pointed out above, this is a gross overestimation and one should not rely on atorvastatin tablets as a source of calcium.

    Cyclosporine A, when applied ophthalmically twice daily, is not quantifiable in the blood even after 12 months' use. The references for this were: Effects of nonsteroidal anti-inflammatory drugs on hemostasis in patients with aneurysmal subarachnoid hemorrhage. Effect of nonsteroid anti-inflammatory drugs on subarachnoid hemorrhage in dogs.

    Glisic E, gariner L, Josti L, et al. Am J Crit Care. Guidelines on the diagnosis and the current management of headache and related disorders. Ann Indian Acad Neurol. Pain management in neurocritical care. Safety and tolerability of gabapentin for aneurysmal subarachnoid hemorrhage sah headache and meningismus.

    Gottschalk A, Yaster M. The perioperative management of pain from intracranial surgery. Influence of COX-inhibiting analgesics on the platelet function of patients with subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. Epub May 6. Overall, there is limited evidence for using oral Ketamine for acute pain. Of note, oral ketamine for acute pain is an off-label use. While IV ketamine has an onset of action of minutes, oral ketamine has an onset of 30 minutes. CPS Monograph- ketamine 2.

    ClementsPharmacokinetics and analgesic effects of i. Brit J Anaesth 53 — Balukova, Marije aan het Rot, Rudie Kortekaas. The British Journal of Psychiatry Feb , 2 4. Maren Blonk et al. Use of oral ketamine in chronic pain management: European Journal of Pain.

    Volume 14, Issue 5; May Wala Effects of norketamine enantiomers in rodent models of persistent pain. Pharmacol Biochem Behav 90 — Oye Prolonged analgesic effect of ketamine, an N-methyl-d-aspartate receptor inhibitor, in patients with chronic pain. J Pharmacol Exp Ther — Abilify 2mg Cipralex Response: Concerta 54mg is equivalent to methylphenidate SR 60mg daily qam, then mg around 2pm. Biphentin could also be tried, but would cost similar to concerta at the dose required.

    Handbook of Psychotropic Drugs, 20th edition. Only one study in humans with doses of 80mg could be found 1. This study 2 tested placebo, 20, 40, or 80mg doses in a crossover design for 7 days in cold-contact urticaria. Increasing efficacy found with increasing doses.

    No safety issues different than placebo. Could not find long-term studies for high doses like this. There are no interactions 1,2 and azithromycin is not related to sulfonamide antibiotics 3 so the client can safely receive the azithromycin. Lexicomp - Sulfonamide Antibiotic Allergy.

    Alirocumab Praluent and evolocumab Repatha may be used in patients with uncontrolled familial hypercholesterolemia or those with athersclerotic cardiovascular disease primary hyperlipidemia. The RxFiles has a great document of managing statin inolerance. Sask formulary online 5. RxTx - eCPS - respective monographs 8.

    There are several potential factors that can affect HbA1c results; certainly anything that affects erythrocytes or hemoglobin can affect HbA1c. There are several case reports of unexplainable HbA1c results that the authors have traced to a particular interfering factor. The type of assay used can be a variable for some of the factors, but not all. This article goes through all the different identified drugs and conditions that may affect HbA1c results, including iron deficiency and use of erythropoietin; it has a short paragraph on the complicated relationship between HbA1c and CKD.

    It seems the only way to really know if something might be interfering with the assay is to compare assay results to the blood glucose levels. In patients whose HbA1c is not in line with their blood glucose levels, the only suggestions I found were to rely only on blood glucose levels or check fructosamine.

    HbA1c and monitoring glycaemia. Aust Fam Phys ; 41 1: Drugs affecting HbA1c levels. Indian J Endocrinol Metab. Review of hemoglobin A1c in the management of diabetes. Drug-induced haemolysis and fast haemoglobin A1 in diabetes mellitus.

    Case report referenced in [6] 9. Cataract surgery carries a standard risk of bleeding. The ramipril 10 mg daily dose that your patient is on was the post-MI target dose for ramipril. Cardioselective beta blockers are preferred post-MI for those with asthma and DM the cardioselective beta blocker acebutolol with intrinsic sympathomimetic activity less benefit.

    So we are left with metoprolol, bisoprolol, and atenolol as preferred options in these patients at cardioselective doses. Jensen B, Reiger L.

    Drug and Dosage considerations. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. McMurray J, et al.

    The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: J Am Coll Cardiol. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: Adapalene No other medications filled recently Response: Assumption is that this is treating acne.

    Entry to market studies excluded children under the age of 12, so only post marketing data exists. Of this, the FDA has outlined ten's of serious adverse events, but no deaths attributable to adapalene. There is no evidence to suggest that it is safe to use in an 8 year old, but adapalene is poorly absorbed, and is also unlikely to cause a theoretical risk.

    Regardless, discuss side effects with the caregiver, and consider contacting the doctor for an alternate product if there are concerns surrounding the use of this product. UpToDate - Adapalene 2. FDA - Pediatric advisory committee - Adapalene. The very unsatisfying reason for the contraindication is insufficient study of leflunomide in CKD patients.

    In fact, the monograph states: No dosage adjustment is necessary for patients with severe renal impairment. The kinetics of leflunomide of five patients on hemodialysis were determined and found that removal of teriflunome was negligible 9.

    This patient is not on dialysis but this indicates to me patients with no renal function either natural or renal replacement, since it did not remove the drug are able to take leflunomide. It is important to mention this paper was strictly addressing the kinetics and made no mention of adverse effects or complications of using leflunomide in these patients.

    However, their data were collected between and , which suggests to me they did not have problems with the drug in this population. Of course five patients is a small number. Considering the high protein binding of leflunomide Renal Drug Handbook 3. Dosing of antirheumatic drugs in renal disease and dialysis. Epub Nov Leflunomide in dialysis patients with rheumatoid arthritis--a pharmacokinetic study.

    The main reason is the way the manufacturer lists the ingredients, it is impossible to know the dosages of any one ingredient; secondly, there are just so many ingredients it would take a week and I know my response will be the same: As an example, it would be like taking a combination cold and flu product and listing like this: There are a lot of sources of caffeine in the product denoted with an asterisk in the ingredients below which is typical for weight loss products.

    One of the products also contains bitter orange, which has stimulant properties, which again, if the dose is unknown, can be potentially dangerous. Also, typical of weight loss products are laxatives, which are found in Flush.

    So people lose water weight and feel good about themselves. This is what is in the blue box: If Xyng is well tolerated then it can be consumed on an empty stomach. Cevimeline Evoxac is not available in Canada through the usual routes , nor the Special Access Programme 6 , despite the fact Lexicomp lists it avaialble in Canada.

    Cevimeline may have a lower risk of bradycardia and bronchospasm than pilocarpine due to greater selectivity for the type of muscarinic receptors found in the mouth. Canadian Pharmacist's Letter ; 26 Phone communication SAP, , May 3, Oral administration of the parenteral dexamethasone products to children has been evaluated and deemed acceptable. PMs from DPD 3. Canadian Pharmacist's Letter ; 24 Both Stockley's and lexicomp include cannabis and do not list any interactions with azithromycin.

    The regimens used in adults is what should be used for pediatrics at pediatric doses. Bugs and Drugs App 2. Purified water is prepared by distillation, ion-exchange deionization, demineralization reverse osmosis, or other methods. AHS Compounding Manual 2. Boretella holmesii has only recently be recognized as a pathogen and much is unknown about it, including transmission, clinical manifestations, need for antibacterial therapy, and if so, which antibacterial therapy.

    Clarithromycin and azithromycin were not tested. UTD - Pertussis infection: Epidemiology, microbiology, and pathogenesis 2. Epub Oct 2. Bordetella holmesii bacteremia cases in the United States, April January Prednisolone is the active metabolite of prednisone; dosing is the same for the two. One study regarding absorption of scopolamine from transdermal patches placed at sites other than postauricular has been published.

    Of the sites tested, the back was the most permeable. Reduced absorption should be expected if the location is changed. Transdermal scopolamine for prevention of motion sickness: Hydromorph contin 30mg tid Hydromorph IR 4mg qid many other medications as well Response: The patient takes mg hydromorphone daily, which is equivalent to mg morphine 1,4.

    Different equivalency tables have different values for conversion to methadone. At a daily morphine dose of mg these range from 1: These tables apparently take into account cross-tolerance though some still prefer to further reduce for incomplete cross-tolerance.

    The second line options include Cover most of the typical dental pathogens, except anaerobes, though increasing resistance. Azith mg day 1, mg day 3. Increasing resistance to the gram-negative and anaerobic activity of tetracyclines, but can be used.

    Doxycycline mg BID x d 3 - Metronidazole mg q12h: Should be added to above regimens if anaerobic pathogens suspected, typically in more severe or deep infections. Because this isn't a huge difference, it would be prudent to start with Emulgel because of its signficantly lower concentration. Allergic and pseudoallergic reactions 2. Canadian Pharmacist's Letter ; 33 1: No dose adjustment is needed when switching between the suspension and Infatabs 1,2 ; slight adjustment may be required when switching to or from Dilantin capsules.

    Pentasa tablets are composed of extended release microgranules that allow for continuous release of drug throughout the small and large intestines; the extended release nature of the granules allows for topical local distribution to the intestines. Therefore, if a tablet is split, some of the microgranules will be split thereby comprimising the coating and promoting systemic absorption, which could result in less symptom control. If the patient finds her symptoms are not controlled or needs to be increasing the dose, it could be because the tablets are being split.

    Therefore, while it seems that isosorbidemonohydrate has benefits over the shorter acting isosorbide dinitrate, isosorbidedinitrate is still effective for the relief of angina and improved exercise tolerance, and would be an acceptable alternative in the wake of a monohydrate shortage.

    Make sure the last tablet is given at 7pm to ensure a drug free interval. After reviewing the abstracts of 4 trials, the following can be concluded about the comparative efficacy between isosorbide dinitrate and isosorbidemononitrate: Comparison of the effects of a controlled-release formulation of isosorbidemononitrate and conventional isosorbide dinitrate on exercise performance in men with stable angina pectoris.

    Isosorbidemononitrate and isosorbide dinitrate retard in the treatment of coronary heart disease: Curr Med Res Opin ; Micromedex comparative efficacy 8. Hemodynamic effects of oral isosorbidemononitrate and dinitrate in ischemic heart failure.

    Clin Cardiol ; Comparative clinical trial of isosorbide 5-mononitrate and sustained-release isosorbide dinitrate in ischaemic heart disease. Health Canada has approved Narcan nasal spray 2 though it is not available through wholesalers at this this time and there is no projected timeline though in the fall of , the projected timeline was Spring [1].

    Previous research for Opioid toxicity lectures; Nov, ; in lecture slides 2. Phone communication with Adapt pharma , May 11 Equi-Analgesic dose gabapentin to pregabalin is considered approx 6: Both were well tolerated.

    Gabapentin to pregabalin therapy transition: Substitution of gabapentin therapy with pregabalin therapy in neuropathic pain due to peripheral neuropathy. The only potential risks is QT prolongation between Seroquel and azithromycin. Doses can be repeated every minutes as needed. Forms for Health Canada need to be submitted by prescribing physicians.

    Caller to contact Cannimed. Cotrimox daily x 2months perindopril 4 mg daily Response: It seems that the interaction would be dose-dependent as the interaction is additive. There is no direct evidence risk is lower when using single strength versus double strength. MD is aware of interaction and plans to check potassium weekly suggested day for the first one.

    Canadian Pharmacist's Letter ; 22 1: Pilocarpine — A systematic review of the literature identified nine randomized trials that studied pilocarpine in the postradiation setting.

    The review concluded that approximately 50 percent of patients with xerostomia benefit from oral pilocarpine following RT.

    Continuous treatment with doses greater than 2. Typical pilocarpine dose for xerostomia is 5—10 mg TID po. Lifelong therapy is required. These include sweating, headaches, tachycardia, hypertension, flushing, and increased bowel and bladder motility. Pilocarpine should be avoided in patients with uncontrolled asthma, acute angle glaucoma, or known hypersensitivity to pilocarpine.

    Canadian Pharmacist's Letter ; 22 2: A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: A randomized phase III prospective trial of bethanechol to prevent radiotherapy-induced salivary gland damage in patients with head and neck cancer.

    No, neither the Sanis doxycycline capsules nor tablets have ingredients that are sources of gluten. Phone communication with Sanis medical information, Sulforaphane and indolecarbinol are essentially the broccoli in the supplement; both of these are molecules derived from broccoli. There is marginally more information regarding indolecarbinol in that it is considered possibly safe at doses of mg daily for up to 3 months or mg daily for up to 15 months.

    Somerville MA ; c [cited 16 May ]. Sulforaphane and Other Nutrigenomic Nrf2 Activators: Oxid Med Cell Longev. While eye drops can genearlly be used in the ear, ear drops should not be used in the eye because they may not be isotonic, appropriate pH, or preserved. Canadian Pharmacist's Letter; October ; Vol: I started by going to erowid.

    Unfortunately, all of the posts were from the early s when the fentanyl patches were reservoir and the gel could be extracted then heated. As for published journals, I only found an analysis of heated fentanyl and a few case reports. One case reported alveolar proteinosis as a result of smoked fentanyl patches; for some reason, this study is not available to me so I only had the limited information from the abstract.

    The other two case reports simply report on overdoses in which contents of reservoir fentanyl patches had been smoked. Potential biomarkers of smoked fentanyl utilizing pyrolysis gas chromatography-mass spectrometry.

    Pulmonary alveolar proteinosis as a reaction to fentanyl patch smoke. Fentanyl-related deaths in Ontario, Canada: Toxicological findings and circumstances of death in cases J Analyt Toxicol ; 30 8: Marquardt K, Tharatt S.

    Inhalation abuse of fentanyl patch. Clin Toxicol ; 32 1: Abstract only 1. Her quality of living has increased fold. She is calm, playful and happy. No more screaming and crying while running around the house, no hair loss, no more lesions and marks on her skin.

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