sailajabyrisetty's blog

Vitamin D is gaining status in the medical and popular media. Its role in the development and maintenance of bones is well established, but there is growing research suggesting it can also reduce the risk of cardiovascular disease, cancer, and autoimmune and infectious diseases.

Codeine can be harmful and even fatal to some brestfed infants, according to new evidence from Dr. Gideon Koren, director of the Motherisk Program at the Hospital for Sick Children in Toronto. Concern regarding the safety of codeine during breastfeeding arose after a two-week old infant died of an overdose of morphine acquired from breast milk. Codeine (with acetaminophen) is often given to women to control pain following childbirth. It is most commonly prescribed for mothers whose delivery invloves a surgical episiotomy or caesarean section. The drug has been considered compatible with breast feeding, according to well-recongnized guidelines published by the American Academy of Pediatrics. Codeine is an inactive prodrug of morphine. In most people only about 10% of the drug is converted to morphine. However, Koren and colleague's research found that about 5% of women are CYP2D6 ultra-rapid metabolizers.

In September, Alcon plans to introduce Nevanac (nepafenac ophthalmic suspension 0.1%) for the management of pain and inflammation associated with cataract surgery.
Nepafenac is a nonsteroidal anti-inflammatory and analgesic prodrug. After ocular administration, it penetrates the cornea and is hydrolyzed to amfenac, a nonsteroidal anti-inflammatory drug (NSAID) that inhibit the action of cyclooxygenase, an enzyme required for prostaglandin synthesis.
Nevanac suspension shuld be shaken well before use. The recommended dosage is one drop instilled into the affected eye(s) three times daily, beginning one day prior to cataract surgery. The drops should be continued on the day of surgery and for the first two weeks after surgery.
The most common adverse effects are eye disorders (e.g., eyelid crusting, eye pain, blurred vision, foreign body sensation, eye pruritus,tearing) and headache.

Naproxen, an anti-inflammatory and analgesic, is available only with the prescription in Canada. Health Canada will consider moving it to OTC (over the counter). As it is available with out prescription in U.S, many Canadians cross the border to pick up Aleve (one of the OTC versions of naproxen) to avoid visiting the doctor and paying prescription fees.
Naproxen is also OTC in 33 other countries. Health Canada is considering nonprescription status for a daily dose of 440 mg for upto 5 days. Naproxen will be used for mild to moderate pain due to headache, muscle sprains, menstrual pain, dental extraction, and fever.

Almost all patients on chronic opioids get constipation due to decreased GI motility. Sometimes this is more uncomfortable than the pain that is being treated.
Relistor (methylnaltrexone) is an opioid antagonist like naltrexone. The methyl group keeps it from crossing into the CNS. This allows Relistor to block opioid effects in the CNS.
For now , Relistor is only for palliative care patients who are not getting relief from laxatives. It is given SC every other day, as needed. It usually works within 4 hours and most side effects are mild such as nausea, dizziness, and diarrhea.
Patients starting chronic opioids should get a stool softner plus stimulant laxative such as Senna, bisacodyl tablets.

A new National Drug Schedule change will move single-dose 'plan B' (levonorgestrel), an emergency contraceptive pill, to Schedule III from Schedule II. This means that now pharmacies may choose to move it from behind the counter to the same pharmacy self-selection area where otehr Schedule III medicines are sold. Changes to the National Schedules are automatically adopted by some provinces like Ontario, New Brunswick, Manitoba, Alberta... some provinces and territories will decide on their own thether or not to adopt the scheduling change. Women's group want plan B more accessible. They argue that consulation fees and personal questions by pharmacists are a barrier to patients getting the emergency contraceptive pill. However, some pharmacy groups don't like the change. They say pharmacists offer valuable services, such as determining when Plan B is not appropriate...and counselling on birth control and sexually transmitted infections.

What can a pharmacist do?

Pharmacist can help to ensure that unused medications are returned to the pharmacy and dispose them appropriately through hazardous waste companies. By educating patients on proper disposal, pharmacists contribute significantly to preventing medications from entering the water supply.

By discouraging inappropriate use and overuse of prescription, nonprescription and alternative medications, pharmacists can help decrease the amount of medication that is purchased and eventually discarded, or unnecessarily ingested and excreted into our environment. For example, pharmacists may counsel patients to select single-entity cough and cold preparations that target their specific symptom(s), as opposed to multi-ingredient product that contain ingredients they do not need. With new prescription, it makes sense to limit initial prescription size and determine patient tolerability, thereby minimizing drug wastage.

According to two recent reports, generic drugs are gaining an increasingly strong share of drug expenditures in Canada. According to figures released in May by the CIHI (Canadian Institute for Health Information) Canadians spent a total of $26.9 billion on drugs in 2007, with prescription drugs representing 84% of that figure.
CIHI report showed that the annual growth rate for prescribed drug spending in 2007 (7.5%) was lower than the 10.5 % average annual grwoth rate between 1997 and 2006.

Generic drugs currently comprise 49% of all prescriptons in Canada. According to IMS Health, the average cost of a brand name prescription was $64.19 in 2007, compared to an average cost of $26.07 for a generic prescription.

News from Canadian press:

Ontario patients could soon get drug prescriptions from their local pharmacists as the governing Liberals look to join other provinces and expand the prescribing powers of pharmacist, nurses and other non-physicians.

The Ministry of Health is commissioning a study which would examine whether those who have prescription authority now, like midwives, optometrists and nurse practitioners- should be able to prescribe more classes of drugs.

The study would also look at the role of pharmacists and whether they could ease pressure on the health-care system by writing prescriptions.

Ontario’s interest comes after Alberta expanded the role of its pharmacists last year, allowing them to prescribe some drugs, give drug refills and inject vaccinations.