The Cardiovascular Risk Associated with the Use of Long Acting Bronchodilators

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).

Continue reading The Cardiovascular Risk Associated with the Use of Long Acting Bronchodilators


Falling Stars

November is Fall Prevention Month. I wrote a post last year that I think is still relevant today. Here are things to consider when doing a medication review for fall prevention. #fallprevention


We pay a lot of attention to falls in the elderly population. When someone has sustained a fall, it usually signals a decline in clinical status. A fall often results in injuries, bone fractures, loss of mobility, independence, and eventually death.

While most people point to psychotropic drugs as the culprit of falls, there are many other factors to consider when completing a fall risk assessment pertaining to medications.

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Medscheck – Useless or Useful?

I recently read on Twitter from a physician who felt Medscheck was a waste of his time. After several comments from others who have shown support for the program, he backtracked his comment to say there may be value to others but he didn’t feel it has added value to his practice.

Continue reading Medscheck – Useless or Useful?

10 Warning Signs in Dementia

World Alzheimer’s Day is coming soon – Sept 21, 2017.  After spending several years in geriatrics, I can’t help but feel compelled to do something every year. Check here for a post I wrote last year on Dementia.

This year, I have decided to be a little more creative by sharing a video on the 10 warning signs in dementia as described in Alzheimer Society Canada. Often family members don’t see the signs early enough. When treatments are started early, there is usually a greater chance in slowing the disease progression.

If you like my video, please comment, like or share. Thank you for checking out my post!

Who is at risk of B12 Deficiency?

It isn’t uncommon that I see a patient admitted to nursing home with advanced dementia and a very low level of vitamin B12. I always wonder how much of vitamin B12 deficiency may be contributing to the progression of dementia, even though it isn’t the cause. I am not a big fan of any vitamin supplements but Vitamin B12 is one where I would advocate supplementation where indicated.

Continue reading Who is at risk of B12 Deficiency?

High Alert Medications – Do you know what they are?

High alert medications are medications that may be associated with heightened risk and safety concerns in an event of a medication incident or error. Hence, there is a need to provide more awareness and education to all care providers handling these medications. It is also important to understand their unique needs and monitoring requirements.

However, there are way more medications than one can remember. As such, ISMP Canada has developed three specific lists of High Alert Medications pertaining to three different types of settings:

  1. Acute Care Settings
  2. Community & Ambulatory Healthcare Settings
  3. Long Term Care Settings

Of the three settings, the list for acute care settings has the most drug categories and specific drugs. See the attached highalertmedications_ acute care settings for more details.

In community and ambulatory healthcare settings, the following are consider high risk medications / categories:

Slide1In long term care settings, the following are considered high risk medications or categories:


These lists have been designed to help different healthcare organizations to determine which medications may require special safeguards to reduce the risk of errors.

Some examples of strategies include:

  • Standardizing the process for medication use including ordering, storage, preparation and administration.
  • Improve access to information
  • Limit access to high alert medications
  • Use auxillary label and automated alerts
  • Employ redundancies (automated or independent double check if necessary)

These strategies may or may not be the solution to minimize the risk of errors. It is important that each organization develops its own unique strategies or action plans to manage the risks of handling high alert medications in the organization.

Have you thought about what high alert medications you deal with everyday? Are sufficient safeguards implemented to protect your patients?

Thank you for reading my post.