Newsletters, Charts & References are available online at www.RxFiles.ca ABBREVIATIONS, CALCULATIONS, COLOURS & SYMBOLS DEFINED COLOURS USED WITHIN THE CHARTS Green shading usually indicates HERBAL/LIFESTYLE related Blue shading usually indicates PEDIATRIC related Purple script usually indicates TRADE NAMES Yellow highlights CLINICAL DIFFERENCES, PRACTICE GAPS & COMMON ?’s Navy script usually indicates MAJOR TRIALS Pink script usually indicates PREGNANCY & LACTATION related Gray script usually indicates DISCONTINUED drug Purple shading usually indicates OVERVIEW/GUIDELINE approach SYMBOLS Canada (We are Canadian) Formulary Related Symbols ⊗ W $ ς ☺ Ê ⊗ k DRUGS IN PREGNANCY & LACTATION RISK CATEGORIES PREGNANCY [P] (subscript denotes trimester specific info) Safe P Safe L • Compatible in pregnancy • Compatible in breastfeeding Likely Safe P Likely Safe L • No (limited) human data – probably compatible • Compatible – maternal benefit >> embryo‐fetal risk • Human data suggest low risk • No (limited) human data – probably compatible Caution P Caution L • Human, and or animal, data suggest risk P • Hold/delay breastfeeding • No (limited) human data – potential toxicity LACTATION [L] Non‐formulary in Saskatchewan Exception Drug Status (EDS) in Saskatchewan (SK) (1‐800‐667‐2549) Not covered by NIHB (Non‐Insured Health Benefits) • Potential risk in specific trimester(s), as indicated by ‘x’ PX http://www.hc-sc.gc.ca/fnihb/nihb/pharmacy/drugbenefitlist/index.htm • Contraindicated in specific trimester(s), as indicated by ‘x’ PX Prior approval required by NIHB. Coverage for eligible First Nations & Inuit (1‐800‐580‐0950) Covered by NIHB. Found on the OTC charts (pgs 94‐97) & identified ONLY for those drugs which have SK Formulary restrictions such as EDS or non‐formulary status. Retail Cost to Consumer based on acquisition cost, markup & dispensing fee in Saskatchewan. Lowest generic price used where available. Tablet is scored. Appears as superscript, e.g. 25ς mg tablet. Tastes good Concern if drug or herbal is given Pre‐Op Avoid if patient has soybean & peanut allergy Male Female l Dose ↓ may be required for liver dysfunction Dose ↓ required for renal dysfunction 1 if 1) drug ≥ 75% renal excretion 2) toxic if accumulates 3) an active metabolite requiring dose adjustment. [CrCl <60ml/min indicates impaired renal function] Contraindicated P Contraindicated L • Contraindicated in pregnancy P • Contraindicated in breastfeeding What you’ll see in the charts: P = pregnancy risk category L = lactation risk category Colours correspond to risk categories outlined in this table. Example, warfarin: P = contraindicated 1st trimester P1 L L = compatible during lactation Unknown for Pregnancy P and/or Lactation L • No (limited) human data – no relevant animal data th Reference: Drugs in Pregnancy and Lactation. 9 ed. Briggs GE, Freeman RK, Yaffe SJ, editors. Williams and Wilkins; Philadelphia, PA: 2011. Other Pregnancy Resources: 1.Motherisk www.motherisk.org Canadian info on drugs in pregnancy & lactation 877-439-2744, 416-813-6780 2. Lexi‐comp.com 3. Individual Drug Product Monographs 4. Micromedex 5. LactMed http://toxnet.nlm.nih.gov/cgi‐bin/sis/htmlgen?LACT 6. Pregnancy Exposure Registries http://www.fda.gov/womens/registries/default.htm ABBREVIATIONS (Charts usually have footnotes to explain unique abbreviations) BID BP Bz CI CV DI Dx Twice daily Blood pressure Benzodiazepine Contraindication Cardiovascular Drug interaction Diagnosis/disease eGFR Estimated glomerular filtration rate g Generic available GI Gastrointestinal HA Headache HF Heart failure HR Heart rate HSR LFT M OD OTC Þ QID Hypersensitivity rxn Liver function tests Monitoring Daily Over the counter Porphyria Four times daily SE SCr SJS Sx Sz TID Tx Side effect Serum creatinine Stevens Johnson Sx Syndrome/symptom Seizure Three times daily Treatment CALCULATIONS CKD‐EPI IBW WHO Essential Medicines List http://www.who.int/medicines/publications/essentialmedicines/en/index.html ABW CrCl MDRD Units Most accurate for CKD estimation: http://www.kidney.org/professionals/kdoqi/gfr_calculator.cfm Ideal Body Weight (kg) Males= 50kg + 0.906 (Height in cm ‐ 152.4cm). Females = 45.5kg + 0.906 (Height in cm ‐ 152.4cm) Adjusted Body Weight (kg) = {Ideal body weight (IBW) + 0.4 (Actual body weight‐IBW)} Creatinine clearance (ml/min) Male={(140‐age) x ABW weight in kg }/ {SCr in umol/l x 0.814} Female= 0.85 x CrCl male Or: Creatinine clearance (ml/sec/70kg)={(140‐age) x 1.5 [ x 0.85 if female]/ {SCr in umol/l} } eGFR = accurate, but need PDA with MedCalc to do the calculation. www.hdcn.com www.kidney.org To convert SI units to conventional (cholesterol x 38.6=mg/dL; glucose x 18=mg/dL; Uric acid x 0.017 = mg/dL; Vit D x 0.4=ng/ml) DISCLAIMER: The content of this newsletter represents the research, experience and opinions of the authors and not those of the Board or Administration of Saskatoon Health Region (SHR). Neither the authors, nor Saskatoon Health Region, nor any other party who has been involved in the preparation or publication of this work warrants or represents that the information contained herein is accurate or complete, and they are not responsible for any errors or omissions or for the result obtained from the use of such information. Any use of the newsletter will imply acknowledgment of this disclaimer and release any responsibility of SHR, its employees, servants or agents. Readers are encouraged to confirm the information contained herein with other sources. © Copyright 2013 – Saskatoon Health Region (SHR). 139 Evidence Based Medicine (EBM)………………………………….…………i CARDIOLOGY 5yr CVD Risk Assessment Tool………………………………….………….. 1 Antihypertensives ACE Inhibitors & ARBs…...…..……….………...…………..……... 2 Beta Blockers…...…………………………...………………....…….. 3 Calcium Channel Blockers……..…………….……………..…….... 4 Diuretics & Misc. Antihypertensives…...….……………………... 5 Antihypertensives Summary - Guidelines & Trials..………….... 6-9 Antiplatelets & Antithrombotics.…..………………...….……………..….. 10-11 new Atrial Fibrillation………………...……………………...……...…….……… 11a-c Heart Failure………………...……………………..……...………….…….… 12-13 Lipid Landmark Trials..……...……………………..……...……….….....… 14 Lipid Lowering Agents.……...……………………….…...………….……… 15 MI: Post Myocardial Infarction.……....……………………..………..………16 QT Prolongation & Torsades de Pointes..……....……...……………………17 Landmark Outcome Trials: Glycemic Control & Prevention…………30a Lipids/ASA/BP………………………………30b new Overview & Approach to Type 2 Diabetes…………………………………30c new Obesity Weight Loss: Drugs…………………………………………………… 31 Weight Loss: Herbal Products.……...…...………………………… 32-33 Thyroid: Hypo & Hyperthyroid Chart……………………………………34-35 new Women’s: Hirsutism, idiopathic…..……..……...…..……………………… 36 GASTROINTESTINAL Crohn’s & Ulcerative Colitis……...………...…………...…………..………37-39 GERD & Peptic Ulcer Disease: Evidence & Chart ……..……..……...… 40-41 H. pylori ……..……..……...……………….……...…..……..……..……...… 42 Irritable Bowel Syndrome.……………….……...……….………...…………43 44-45 Nausea & Vomiting Management.………...…...……….………...………… Various OTC (see OTC GI: Dyspepsia, Constipation, Diarrhea) DERMATOLOGY GENITOURINARY EENT (Eye/Ear/Nose/Throat) INFECTIOUS DISEASES Acne Treatment…………..….……..………...…………………………..….. 18-19 Topical Corticosteroids…………..………..………...…………………...….. 20 Various OTC (see OTC Acne, Fungal, Dermatitis, Plantar Warts & Head Lice ) Glaucoma (Topical Treatments).………..………...………….………...……21 Intranasal Corticosteroids………..……..….………...………...…………… 22 Various OTC (see OTC Congestion, Cough, Cold & Allergy ) ENDOCRINE & METABOLIC Andropause: Testosterone Replacement…...………...…………...………23 Diabetes Anti-hyperglycemic (Hypoglycemics)……………………………… 24-25 Glucose: Self-Monitoring Blood Glucose (SMBG) Tips……………26 Insulin Pen Delivery Devices……..………………………………… 27 Insulin Management: Chart & Clinical Tips………………………28-29 Disclaimer/Copyright Statement p.139 46 Erectile Dysfunction……...…………….………...……….……...…………… Sexual Dysfunction……...……………….………...…….……...……………47 Urinary Incontinence……….………………….………...……………………48-49 Adult Vaccines.……………………………………………….…………………50 51-53 Antifungals.……………………………..…………………………….………… Anti-Infectives for Common Infections………………………….………… 54-55 Anti-Infectives Oral.……………………………………………….………… 56-57 new 57a-d Hepatitis: B,C.…………………………….………………..………...………… Human Immunodeficiency Virus (HIV)…….……………..……………… 58-59 Influenza..…….…………………………………………………..…………… 60 Malaria Prophylaxis……..………..…….…………………………………… 61 Pneumonia: Community Acquired…….......…….………………………..…62 Pneumonia: Fine Severity Risk or CURB-65 or CRB-65….……..………63 Urinary Tract Infections in Adults...………..…………………………….. 64 MUSCULOSKELETAL & CONNECTIVE TISSUE Back Pain Treatment Options…………...…….………….………….......… 65 Chronic Non-Cancer Pain .…….…………….…………………………........ 66-67 Gout………………………………………………………….………………….. 68 NSAIDs & Other Analgesics (see OTC Pain Relief Chart) ………….……69 Opioids ……...……..……………….………………………………….……..... 70 new Opioids, Pain Approaches: Acute vs Palliative vs CNCP ……...……..…70a-b Osteoporosis ………..……..………………………………………….……...... 72-73 Pediatric Pain Treatment Considerations………..…………………………71 74 Rheumatoid Arthritis: DMARDs .……..……………………..………….…… NEUROLOGY Alzheimer’s/Dementia ……...……………………..……....…………………. 75-77 77a Anticholinergic Drug List……..……………………..…………….…….…..… new Elderly/Long Term Care: Pearls for Prescribing.…………….……………77b Essential Tremor & Restless Legs Syndrome…….….………….…………78 Multiple Sclerosis……….………….………………………..…………………79 Migraine: Acute & Prophylaxis……….………….…...………………………80-81 Parkinson’s……….………….………………………..…………………………82-83 Seizures: Antiepileptics…….………...……………..…………………………84-85 new PSYCHIATRY Attention Deficit Hyperactivity Disorder (ADHD).……………….…….. 98-99 Anxiety Disorders Antianxiety Agents..…………….……...………….……………….…100 Benzodiazepines……...……………….……...….……………….……101 Bipolar Disorder: Mood Stabilizers………….……...…………………..... 102-3 Depression Antidepressants……...……………….……...…….……………….… 104-5 Antidepressant Drug Interactions….…….……………….……...…106 Hypersexuality Treatment Options………….……....……...………....... 107 Schizophrenia: Antipsychotics..……………….…...……………………… 108-9 Sleep Disorders: Sedatives.……………….……...………………….......... 110-11 RESPIRATORY Asthma & COPD Pharmacotherapy…..……..……...……………….……...……………112-13 Inhalational Devices.……………….……...……………………....... 114 SMOKING CESSATION Smoking Cessation Chart…….……………….……...…………………….. 115 OBSTETRICS & GYNECOLOGY Contraception 86-87 Oral Contraceptive …….……....……………..……………………..… 88 Other Hormonal Birth Control ………..…………………..………… Menopause Postmenopausal Herbal Therapy………………….……...…………89 Postmenopausal Drug Therapy………..………………….……...…90 new Peri-Pregnancy Drug Considerations…………….……...……………… 91a-b OVER THE COUNTER (OTC) & HERBAL MEDICATIONS Cold-fX, Glucosamine & Lakota Herbal Products………….....……………91 OTC Herbal Drug Interactions……...………………………………………………92-93 Congestion; Cough; Cold; Allergy…………………………………….…….. 94 GI: Dyspepsia, Constipation & Diarrhea; Pain relief……………………. 95 Acne; Fungal; Dermatitis……………………………………………….……. 96 Plantar Warts; Head Lice & Vitamins……………...…………………...… 97 Disclaimer/Copyright Statement p.139 MISCELLANEOUS Cannabinoids: Overview.……………….……...………….………...…....... 116 Canadian Health Agencies & Regulatory Environment.……...…......... 117 CKD Anemia Landmark Trials…….…….………….……...…………..…………118-19 120 Erythropoetin Comparison…….……...……………….……...……………… Iron Replacement…….……...………………………….……...……………. 121 Phosphate Binder…….……...………………………….……...……………. 121a-b new Palliative Care………….………………..…...…………………..…….......... 121c-d Patient Safety: Medication Issues…...…………………..…..................... 122 RxFiles Program, Academic Detailing Overview……..…...................... 123 Substance Abuse Chart……….………..…...…………………..…............. 124-5 Transplantation Chart…………..…...…………………..…....................... 126-7 INDICES Newsletters & Q&A’s…………..…...…...……………..….......................... 128 Drug, Disease & Trial…………..…...…...……………..…......................... 129-38 Abbreviations & Symbols…………..….....………………..….................... 139