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Australian Journal of Pharmacy : April 2005
ucation Her pneumococcal vaccination status is not known. Venlafaxine may exacerbate hypertension but at the low dose with good BP control this is not a problem. Doris is not taking low-dose aspirin probably due to her previous peptic ulcer perforation. Hypertension control: Her blood pressure last week was 125/80mmHg which is within recommended guidelines. She is currently continent but is rather concerned about taking her fluid tablet. The use of indapamide 1.5mg controlled release may be more suitable and also offers a lower risk of hypokalaemi.6 Osteoarthritis pain: The use of paracetamol increasing from 2 bd to regularly 2 qid is likely to assist Doris. She is also keen to undertake some gentle exercises provided by the physiotherapist as well as explore the hydrotherapy pool. Doris’ weight is within ideal range (weight 58kg, height 160cm; body mass index =23kg/m2 ). Osteoporosis? Although not listed as a problem it seems likely that Doris may have reduced bone density. Her history shows low vitamin D (measured as 25-hydroxycholecaliferol). This may have been caused by a dietary deficiency or lack of sunlight or hypoparathyroidism. She is also taking calcium supplements. Consideration could be given to a bisphosphonate given her recent fracture weighing up possible gastrointestinal effects, and relatively small potential benefit at age 90. Regular temazepam: Doris is not keen to cease her nightly sleeping tablet but may be prepared to try some sleep hygiene measure if she can have her ‘sleeper’ if she is still awake one to two hours after settling. CPE POINTS Additional pain relief could be obtained by substituting one or more doses of paracetamol with a paracetamol/codeine combination. Doris does have some problems with constipation so this would need to be checked. The option of using Tramadol for additional pain relief is not recommended as Doris is taking venlafaxine. Tramadol would have a cumulative effect on serotonin metabolism possible causing a serotonin syndrome.6 Involvement of Doris in the activities of the hostel assists her to self-manage her OA pain. Monitoring: No pathology results were available. It is suggested that regular urine and electrolytes, including serum creatinine, plus calcium and D2 levels be routinely measured. The introduction of the new RMMR offers pharmacists a better opportunity to communicate effectively with the GP and be an established member of the healthcare team as the ‘medication managers’ . References available on request Members of the Australian College of Pharmacy Practice and Management may gain half (0.5) a credit point by either answering questions directly online at www.acpp.edu.au or forwarding the answers to: ACPP, PO BOX 7007, CANBERRA BC ACT 2610 by the 25th of the month following the month of issue. All but one of the following statements are true. Which statement is false? Answers will be listed on www.acpp.edu.au in due course. 1. (a) Osteoarthritis is the most common type of arthritis in Australia. (b) More women than men are affected with osteoarthritis. (c) Inflammation is the main contribution to osteoarthritis. (d) Joint replacement surgery may be an option. (e) Nutritional factors may play a part in progression of OA. 2. (a) Education of patients may assist with pain management. (b) Weight reduction may assist osteoarthritis. (c) Exercise may assist osteoarthritis. (d) Exercise will only make osteoarthritis worse. (e) Exercise may include hydrotherapy as well as walking. 3. (a) Paracetamol should be used prn. (b) Paracetamol can be used regularly up to 4g per day in most people. (c) NSAIDs should be used regularly to control osteoarthritis pain. (d) Paracetamol and warfarin may increase INR. (e) Paracetamol and warfarin may decrease INR. THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 APRIL 2005 ? 283 4. (a) The VIGOR study compared rofecoxib with naprosyn. (b) Rofecoxib was withdrawn due to increased risk of heart attacks and strokes. (c) Celecoxib has not been shown to have risks of heart attacks. (d) Meloxicam has less COX-2 inhibition than celecoxib. (e) GI Risks are increased when low dose aspirin is taken with COX-2 inhibitors. 5. (a) RMMRs can be claimed for by any pharmacist. (b) RMMRs can be done routinely as well as a Comprehensive Medical Assessment. (c) A post-review discussion of the GP with the pharmacist Is mandatory following a RMMR unless minor changes are recommended or a EPC case conference is planned. (d) Only new residents can have a RMMR. (e) Some residents in Aged Care Homes may self medicate.