April Welcome to College of Medicine College of comb

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					                                       Rapid Rx
                Welcome to West Winds Primary Health Centre’s email service that gives you
                         the ‘bottom line’ on advancements in pharmacotherapy.

                Provided by special guest author Lisa Nicholson – Pharmacy Resident
                    at Saskatoon Health Region Dept of Pharmaceutical Services

                                    April 1, 2009

Remember to forward your questions to me…if your question is highlighted in a
           future edition of RapidRx you will win a yummy prize!!
         Congratulations to this week’s winner – Dr. Keith Ogle from
                          Academic Family Medicine!!




                              *image may not depict actual prize.



        Remember you can access all of the RapidRx archives on the
          University of Saskatchewan College of Medicine website


                             Website of the Week
                       Therapeutics Initiative – Evidence Based Drug Therapy

                     Therapeutics Initiative, based at the University of British Columbia,

                     provides up-to-date, evidence-based, practical information on drug

                    therapy. One feature is the Therapeutics Letter – a short publication

                  that targets problematic drug issues. Another feature is the Podcasts –

                        case-based education sessions (20-30 minutes) that can be

                   downloaded to your MP3 player. Registration is free at www.ti.ubc.ca

                     and podcasts can also be downloaded for free at the iTunes store.
**New Canadian Hypertension Guidelines 2009**

                                    Background
      CHEP is the Canadian Hypertension Education Program

      CHEP provides recommendations for the diagnosis and treatment of

       hypertension in Canada


                                   What’s New?


   CHEP Theme for 2009: Hypertension in the diabetic patient

      80% of diabetics die of CVD and a recent survey showed that more

       than 2/3 of diabetics in Canada had uncontrolled BP

      CHEP recommends that all diabetics be screened and aggressively

       treated for hypertension with a combo of lifestyle and pharmacotherapy

       in order to control BP to <130/80mmHg


   Combination Therapy with ACE Inhibitors and ARBs

      CHEP now does NOT recommend the use of the combo of an ACE

       inhibitor and ARB in patients with:

        1) Uncomplicated Hypertension

        2) Ischemic heart disease in the absence of heart failure

        3) Non proteinuric chronic kidney disease

        4) Diabetes without microalbuminuria


      This is based on new studies that suggest this combo leads to an

       increased risk of adverse effects (hyperkalemia, hypotension, renal

       impairment) without any added benefit in these pt groups

      The only pts who should be considered for this combo (as there is still

       evidence for benefit) are pts with advanced heart failure or
               proteinuric nephropathy.



           Age

            CHEP specifically recommends that age not be used as a factor in

               prescribing drugs for hypertension

              New studies show clear benefits of lowering BP in the elderly (>80

               years); therefore, treat these pts similarly to other pts.

              However, use caution with frail elderly pts (esp those with postural

               hypotension) as risks of treating may outweigh the benefits.



                                       Other Important Reminders

            CHEP continues to encourage home BP measurement

            Assess BP at all appropriate visits

            Assess and manage overall CV risk in hypertensive patients

            Lifestyle modification is the cornerstone for management



           Reference: http://hypertension.ca/chep/recommendations-2009/



What’s the deal with the new Pantoprazole Magnesium (Tecta™)?

                                               Bottom Line
              Tecta™ (pantoprazole magnesium) is a new salt form of

               pantoprazole sodium (Pantoloc™ - which recently went generic)

              Tecta™ is more expensive than generic pantoprazole sodium,

               generic omeprazole and rabeprazole (Pariet™)

              Tecta™ is not currently on the provincial formulary

              There is no published information available that supports the drug

               company’s claims that Tecta™ it is clinically equivalent to
    Pantoloc™ (or other PPIs)




                                        Introduction
   Tecta™ (pantoprazole magnesium) is a new salt form of pantoprazole

    sodium (Pantoloc™) marketed by Nycomed Canada.

   Approved for sale in Canada in 2006

   Dose = 40mg once daily in the morning for most indications

   Similar treatment indications to other PPIs



                                           Cost

   Tecta™ is not currently on Sask provincial formulary

   Cost comparison (obtained from a local pharmacy Mar 23, 2009):

                   1. Tecta™ 40mg x 30 tabs = $58.04

                   2. pantoprazole (generic) 40mg x 30 tabs = $53.84

                   3. omeprazole (generic) 20mg x 30 tabs = $44.93

                   4. rabeprazole (Pariet™) 20mg x 30 tabs = $38.66



                          Evidence – Tecta™ vs. Pantoloc™

   Tecta™ was shown have similar effects to Pantoloc™ on esophagitis

    healing rates in a one UNPUBLISHED RCT in 636 pts with GERD.

   Pharmacokinetic parameters (i.e., Cmax) are not equivalent between

    the two products

   There is no long term data on adverse effect or drug interaction

    differences between the two products.




Tecta Product Monograph, Feb 09
Nycomed Canada communication, Mar 09.
         The Importance of Asthma / COPD Inhaler Technique

                      Poor inhaler technique is a very common problem

                      Improper technique leaves medication in the mouth and throat

                       instead of getting into the lungs where it is effective

                      To assess a patient’s inhaler technique, observe a demonstration by

                       the patient first, then offer suggestions for improvement

                      For examples of technique for an MDI without a spacer:

                  http://www.youtube.com/watch?v=51Zjwcx7Zbs

                  http://www.youtube.com/watch?v=9v1bWkN8f2Q

                  http://www.asthmameds.ca/pmdi.php

                      And an MDI with a spacer:

                  http://www.youtube.com/watch?v=CEUm--zy8xY&feature=related

                  http://www.youtube.com/watch?v=LScBYTATOnY&feature=related

                  http://www.youtube.com/watch?v=CpGYewU-QcQ&feature=related

                  http://www.asthmameds.ca/spacer.php

                      A Turbuhaler:

                  http://www.youtube.com/watch?v=hoivoQyooww

                  http://www.asthmameds.ca/turbuhaler.php

                      A diskus (called an accuhaler in the video)

                  http://www.youtube.com/watch?v=QMjmw2DOEuw

                  http://www.asthmameds.ca/diskus.php



If you do not want to receive this email please reply with unsubscribe typed in the subject line

                         Derek Jorgenson, BSP, PharmD
      Clinical Pharmacist, West Winds Primary Health Centre, Saskatoon SK
                             Phone: (306) 655-4270

				
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