Download Getting the Most out of your arthritis meds & your Pharmacist

Getting the most out of your
Arthritis medicines & your
Pharmacist
Kathy Maxwell
Community Pharmacist
Hillpark Care Chemist, Manurewa
Pharmacist’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.
Pharmacist’s Role
For me its all about people. Your Pharmacist plays a
major role in your care
New Zealand Community Pharmacists
• LTC
– helping with adherence
• What is adherence?
– it is an agreed plan between a health professional and the
patient
What do we want medicines
to do?
• Manage symptoms
– especially pain and without side effects
• Prevent damage to joints
• Maintaining Joint function
What 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.
Making 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 way
• Look out for side effects or signs that you aren’t getting
any better (or getting worse)
Making 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
services
- Compliance packs
- A phone call to say you need a new script
Questions 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?
Questions 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?
Questions to ask a health
professional
• If you are thinking about stopping a medicine, or not
taking a medicine you have been prescribed
• You 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
Health Literacy
“a person’s ability to obtain, process and understand
basic health information and services in order to make
informed and appropriate health decisions”
What 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.
What 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.
Types 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).
NSAIDs – Making safer choices
• What is bpac?
• NSAIDs ( Non Steroidal Anti-Inflammatories) can be
associated with serious adverse effects in susceptible
patients
• Paracetamol is the first choice as an analgesic
NSAIDs – 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 risk
• Lowest effective dose, for the shortest possible time.
• Your age and the condition being treated needs to be
considered
How 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.
Cox-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 platelets
– Pg 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.
Cox-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 aggregation
NSAIDs that inhibit both COX -1 and 2 are called
Non-Selective NSAIDs, while those that inhibit COX-2
enzymes are termed COX-2 inhibitors
NSAIDs 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.
Adverse 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 MI
• Gastrointestinal
– increased risk with long acting formulations
• Renal failure
– Block COX-2 then reduce blood flow to kidney
– Problem in dehydration
– Bigger problem in diabetes
• Hypersensivity reactions
Paracetamol
Compared to NSAIDs
–
–
–
–
Minimal GI toxicity
Little effect on blood pressure
No association with MI
No interaction with the anti-platelet effect of aspirin.
All medicines have risks and
benefits
Benefits
Risks
Reducing the Risk of NSAID use
• Make sure that if you buy OTC products they don’t
contain NSAIDs
• Consider risk factors
– CV Disease, CKD, duodenal ulcers
• Watch for other products that may interact with
NSAIDs
– ACE inhibitors, diuretics, warfarin, dabigatran, aspirin
• Talk to your medical team
Cardiovascular Risk Factors
• Previous Cardiovascular event
• Heart Failure (double risk – Triple Whammy)
• Increase systolic blood pressure 2-3 mmHg
Gastrointestinal Complications
• GI risks double with NSAIDs (COX-1 produces
protective gastric mucous)
• Take NSAIDS with food or milk so stomach is not empty
• May take a PPI prophylactically regularly
Complementary Therapies
• Likely Effective
– Glucosamine sulphate (osteoarthritis)
– SAMe (osteoarthritis)
• Possibly Effective (Selection)
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–
–
–
–
–
–
Acupuncture (osteoarthritis)
Avocado (osteoarthritis)
Beta-carotene (osteoarthritis)
Borage (Rheumatoid arthritis)
Bromelain (osteoarthritis)
Fish Oil (Rheumatoid arthritis)
NZ Green Lipped Mussel (Osteo and Rheumatoid arthritis)
What can your Pharmacist offer
you?
• Clinically researched information
• Put you in contact with support mechanisms
• Suggest some lifestyle options to help you manage
better
• Someone to talk with around your condition
• Referral onto other health professionals such as
physiotherapists
• How to prevent gout attacks?
• Condition information
Thank you