Kathy Maxwell Community Pharmacist Hillpark Care Chemist Manurewa Pharmacists Role Pharmacists are the scientist the medicine adviser the clinical practitioner the social carer ID: 912897
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Slide1
Getting the most out of your Arthritis medicines & your Pharmacist
Kathy MaxwellCommunity PharmacistHillpark Care Chemist, Manurewa
Slide2Pharmacist’s Role
Pharmacists are the scientist, the medicine adviser, the
clinical practitioner
, the social carer
, the medicine maker, the
medicine supplier
, the
manager, the business person and the unremarkable character. (List from 43 pharmacists in UK) A student pharmacist described us as a link between chemical and health science.
Slide3Pharmacist’s Role
For me its all about people. Your Pharmacist plays a major role in your careNew Zealand Community Pharmacists
LTC
– helping with adherenceWhat is adherence?
– it is an agreed plan between a health professional and the patient
Slide4What do we want medicines to do?
Manage symptoms especially pain and without side effectsPrevent damage to jointsMaintaining Joint function
Slide5What do we want medicines to do?
Management requires continual review and ongoing lifestyle modifications.This is a general presentation and if you have any concerns about what I say please feel free to ask me any questions you may have.
Slide6Making the most of your medicines
Medication is an important element in arthritis management, together with lifestyle measures and other therapies.Take them at the right time and in the right wayLook out for side effects or signs that you aren’t getting any better (or getting worse)
Slide7Making the most of your medicines
If you need medicines regularly make sure you always have enough of your medicines. Your community pharmacist can help you with reminder servicesCompliance packs
A phone call to say you need a new script
Slide8Questions to ask about your medicines
What am I taking this medicine for?Does this new prescription mean I should stop taking any other medicines?How long and when should I take my medicine?
Slide9Questions to ask about your medicines
Are there any food, drinks, or other medicines to avoid while I’m taking this medicine? Why is that important?What are the potential side effects? What should I do if I think I have a side effect?What should I do if I miss a dose?
Slide10Questions to ask a health professional
If you are thinking about stopping a medicine, or not taking a medicine you have been prescribedYou are finding it difficult to take a medicine as it was prescribed
You are worried or concerned about side effects that you are experiencing
You find it difficult to remember to take your medicines
Slide11Health Literacy
“a person’s ability to obtain, process and understand basic health information and services in order to make informed and appropriate health decisions”
Slide12What your Pharmacist can do
Help you to understand your medicines so that you can make decisions about your treatment.What they do?How to use them?Discuss your experiences of taking or not taking medicines, your views about what medicines mean to you and how medicines affect your daily life.
Slide13What your Pharmacist can do
Look for ways for you to get, take or use your medicines that fit in with your daily life.If you have any problems with your medicines help you to find solutions that you find acceptable.
Slide14Types of medications used in Arthritis
Analgesics Non-steroidal anti-inflammatory drugs (NSAIDs) Cox-2 inhibitors Corticosteroids Disease-modifying anti-rheumatic drugs (DMARDs)
Biologic response modifiers (BRMs).
Slide15NSAIDs – Making safer choices
What is bpac? NSAIDs ( Non Steroidal Anti-
Inflammatories
) can be associated with serious adverse effects in susceptible patientsParacetamol
is the first choice as an analgesic
Slide16NSAIDs – Making safer choices
Naproxen (up to 1000mg per day) or ibuprofen (up to 1200mg per day) are recommended as first line NSAIDs based on cardiovascular riskLowest effective dose, for the shortest possible time.Your age and the condition being treated needs to be considered
Slide17How NSAIDs work
The cyclo-oxygenase (COX-1 and COX-2) enzymes produce prostaglandins (Pg) following the metabolism of omega-6-polyunsaturated fatty acid (arachidonic acid).
Pg are chemical messengers that mediate inflammation, fever and the sensation of pain.
Analgesic and anti-inflammatory effects of NSAIDs are produced through the prevention of Pg production by inhibition of COX activity.
Slide18Cox-1 and Cox-2 – The difference
Cox-1 are widely distributed in the body, but concentrated in the cells of the stomach, kidneys and endothelium and in plateletsPg catalysed by COX-1 activity control renal perfusion, promote platelet aggregation and provide gastroprotection by regulating mucous secretion. Inhibition of COX-1 can cause adverse GI effects.
Slide19Cox-1 and Cox-2 – The difference
COX -2 is induced by inflammation and is present in macrophages, leukocytes and synovial cells.Pg formed via COX-2 activity mediate pain, inflammation, fever and inhibit platelet aggregationNSAIDs that inhibit both COX -1 and 2 are called Non-Selective NSAIDs, while those that inhibit COX-2 enzymes are termed COX-2 inhibitors
Slide20NSAIDs and COX inhibition
Ibuprofen, naproxen and diclofenac
are non-selective, however
diclofenac inhibits more COX-2 than Cox-1
Meloxicam – low dose mainly inhibits COX-2, as dose increases then COX-1 is increasingly inhibited. Funded with Special Authority.
Celecoxid
and
etoricoxib – COX 2 inbibitors. Not funded.
Slide21Adverse Effects of NSAIDs
Cardiovascular COX-2 were developed because of less GI, but found that COX-2 activity blocks platelet aggregation (opposite to Aspirin) so more chance of a MIGastrointestinalincreased risk with long acting formulations
Renal failure
Block COX-2 then reduce blood flow to kidneyProblem in dehydration
Bigger problem in diabetesHypersensivity
reactions
Slide22Paracetamol
Compared to NSAIDs Minimal GI toxicityLittle effect on blood pressureNo association with MI
No interaction with the anti-platelet effect of aspirin.
Slide23All medicines have risks and benefits
Risks
Benefits
Slide24Reducing the Risk of NSAID use
Make sure that if you buy OTC products they don’t contain NSAIDsConsider risk factors CV Disease, CKD, duodenal ulcersWatch for other products that may interact with NSAIDs
ACE inhibitors, diuretics,
warfarin,
dabigatran, aspirinTalk to your medical team
Slide25Cardiovascular Risk Factors
Previous Cardiovascular eventHeart Failure (double risk – Triple Whammy)Increase systolic blood pressure 2-3 mmHg
Slide26Gastrointestinal Complications
GI risks double with NSAIDs (COX-1 produces protective gastric mucous)Take NSAIDS with food or milk so stomach is not emptyMay take a PPI prophylactically
regularly
Slide27Complementary Therapies
Likely EffectiveGlucosamine sulphate (osteoarthritis)SAMe (osteoarthritis)
Possibly Effective (Selection)Acupuncture (osteoarthritis)
Avocado (osteoarthritis)
Beta-carotene (osteoarthritis)Borage (Rheumatoid arthritis)Bromelain
(osteoarthritis)
Fish Oil (Rheumatoid arthritis)
NZ Green Lipped Mussel (Osteo and Rheumatoid arthritis)
Slide28What can your Pharmacist offer you?
Clinically researched informationPut you in contact with support mechanismsSuggest some lifestyle options to help you manage betterSomeone to talk with around your condition
Referral onto other health professionals such as physiotherapists
How to prevent gout attacks?Condition information
Slide29Thank you