It seems the pendulum is always swinging back and forth with the management of COPD. Few years ago, we have pulled away from the use of high dose inhaled corticosteroids when we found its association with increased risk of pneumonia and related mortalities. Here’s my post on this topic. And thus, the treatment strategy has shifted to using more long acting bronchodilators. These bronchodilators include LABA (long acting beta agonist) and LAMA (long acting muscarinic antagonist).
I have ranted about drug shortages in the past. It is extremely frustrating that medications go on drug shortage with little warning, or when drug shortages occur, simple modification of the therapy isn’t an option.
I am happy to see some of my patients’ opioid therapies being tapered down. Last week, I went to a talk on Opioid Use Disorder. The speaker described the opioid withdrawal symptoms as “oozing from the orifices”. I agree this description wholeheartedly! When opioids are tapered too quickly, it can cause tearing eyes, runny nose and diarrhea…..
For individuals with atrial fibrillation who also require percutaneous coronary intervention, triple antithrombotic therapy with warfarin and two antiplatelet agents (e.g. Aspirin and Clopidogrel) has been the standard of care for post PCI management. However, this combination therapy is also associated with higher risk of bleeding. Recently, many research scientists have started looking at the utility of dual therapy with DOAC and a P2Y12 inhibitor such as clopidogrel or ticagrelor in the same setting. These results have finally been released for rivaroxaban and dabigatran.
I have come across few Medschecks completed in the community where I have felt slightly perplexed. Many Medscheck documentation would include a notification that a Medscheck has been completed but no issues have been identified but I could easily identify 3-4 potential issues just from glancing at the medication list. Some have not even included a personal medication record which, to my knowledge, is a requirement for the Medscheck Program.
As we celebrate the Canadian Patient Safety Week, I want to encourage everyone to take an active role in medication safety. Whether you are taking any medication or not, it is never too early to engage, to be involved and to strive for a culture to promote patient safety.
Here are 5 questions to ask about your medications:
Want to test your knowledge on medication safety as a healthcare provider or patient? Click here to find out more!
What medications may increase bleeding risk for individuals taking NOACs (non-Vitamin K oral anticoagulants)? A recent article published in JAMA aimed to address this question. Chang et al published their work on assessing the association between the use of NOACs with or without concurrent medications and risk of major bleeding.