Notes from Canadian Pharmacists Letter - Jan 2017
- new study suggesting all NSAIDs have equal risk when used in pts with CV disease
- only looked at celebrex 200mg total daily dose
- traditionally naproxen is supposed to be the safest in CV disease, up to 500mg BID
- celebrex still preferred if GI risk factors (even in concurrent CV disease)
pts on chronic suboxone, if also have pain issues (and non-opioid adjuncts not helping), you can divide the suboxone dose out to q6-8h to improve its analgesic effects
- new Canadian guidelines for prevnar/pneumovax in >65 y/o… give both, prevnar first is better.
- See guidelines for timelines depending on when/what is given first, etc
- Prevnar not covered unless immunocompromise, may change
- give Tdap to pregnant moms after week 26. This is being done in the US but not in Canada yet
- transfers immunity to the fetus.
- many cases of pertussi (whooping cough) in newborns, but they don’t get tdap until week 8
- calcium supps + CV risk may be overblown; stay less than recommended daily max
- 1g a day for women <=50, men <=70, 1200mg otherwise
- max 2500 < 50y/o, 2000mg <50
- ca supps likely don’t cause dementia
- quinolones in kids: no joint damage or tendon rupture actually observed. (original data was in beagels)
- may still cause joint or muscle pain
beta-blockers & PPIs should be tapered to stop safely (eg in palliation)
- biologics can have “biosimilars” - not a generic version, but should work the same
- infliximab already has one (Inflectra)
- now etanercept has one (Brenzys) -> $200 less /month but doesn’t have all the indications
- no washout needed to switch and dosing is the same
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