Clinical Consultant Pharmacist NS

We had a great question yesterday that I wanted to share (especially now that we are entering the second wave of COVID-19). A pharmacist received a prescription from a family doctor for mifegymiso, along with a prescription for a second dose of misoprostol 800 mcg buccally, to be taken 24 hours after the first dose if no bleeding occurs. As the additional dose of misoprostol was atypical, the pharmacist reached out. As we attempt to minimize physical interactions to slow... the spread of COVID-19, preventing revisits to healthcare providers (including pharmacies) is imperative. The Society of Obstetricians and Gynecologists of Canada has released a Pandemic Guideline for Medical Abortion (MA) that states: "To minimize patient visits to pharmacies, and to reduce complications, MA prescriptions [for mifegymiso] should include an additional dose of misoprostol 800 mcg so that patients have medication on hand if an additional dose is required." If a second dose of misoprostol is used, there may be an additive risk of adverse effects. You can prepare the patient for this during your counselling and prescribe supportive care (e.g. analgesics) as required. The full guideline (as well as guidelines on providing virtual care for medical abortions) can be found on the SOGC website: https://sogc.org/en/content/COVID-19/COVID-19.aspx

Exciting News! Extended Hours! We recognize that being a pharmacist is not a 9-5 job. You remain on call for patients after everyone else has gone home and we would like to do the same for you. Therefore, as of today, we are extending our hours. We will now be available 8 AM to 8 PM Monday to Friday (8 AM to 4 PM on weekends). We are also very excited to welcome a new team member, Dr. Emma Reid. ... Emma completed a Bachelor of Science in Pharmacy at Dalhousie University in 2013, followed by a hospital pharmacy residency program through the Lower Mainland Pharmacy Services in Vancouver. In 2019, she earned a Doctor of Pharmacy through the University of Alberta. She has experience caring for both hospital inpatients and outpatients, and she particularly enjoys precepting and teaching. Emma currently practices as a critical care pharmacist at the QEII Health Sciences Centre in Halifax, with special interests in research and antimicrobial stewardship. Welcome to the team, Emma! To consult Jaime or Emma, please call or text 613-406-0984. You can also reach us by e-mail at [email protected] or on Facebook.

Happy Monday! I apologize that we are having some issues with our Zoom phone line. We are working on it :) In the meantime, please call me on my cell at 613-406-0984. Have a great week!

Out of Office Good Morning, Pharmacists! I will be away from the office tomorrow, Saturday, August 8th and Thursday, August 13th. ... In other (good) news, the pilot project has been extended until (at least) August 31st. I look forward to working with you over the rest of the summer! Stay safe!

Frequently Asked Questions Can I prescribe tramadol? Technically, yes. As it does not fall under the CDSA (yet), the regulations do not preclude it. Pharmacists in Nova Scotia are licensed to prescribe for pre-specified indications, not by drug. ... The more important question is should you prescribe tramadol? By definition, pharmacists may prescribe for minor ailments...and we all know tramadol is hardly ever appropriate for minor or mild pain. However, among the more obvious opioid-like reasons to use an alternative agent, the initiation of tramadol has been associated with serious, potentially life-threatening hypoglycemia, particularly within the first 30 days of therapy (1). This effect has been observed across patient populations, including young children and patients who do NOT take diabetes medications (2). This contradicts statements in the product monograph that mostly those with pre-disposing risk factors such as diabetes, older age and renal insufficiency are at risk. Therefore, while we really shouldn’t be initiating tramadol unless circumstances are extenuating, we should be including the risk of hypoglycemia and its signs, symptoms and management in our routine counselling for patients with new prescriptions for tramadol. References (1) Fournier, J. P., Azoulay, L., Yin, H., Montastruc, J. L., & Suissa, S. (2015). Tramadol use and the risk of hospitalization for hypoglycemia in patients with noncancer pain. JAMA internal medicine, 175(2), 186-193. (2) Juba, K. M., van Manen, R. P., & Fellows, S. E. (2020). A Review of the Food and Drug Administration Adverse Event Reporting System for Tramadol-Related Hypoglycemia. Annals of Pharmacotherapy, 54(3), 247-253. https://jamanetwork.com//jamainte/article-abstract/1984243

Happy Canada Day! I am available from 8 to 4 today, so please call, text, e-mail or message me on here! Thanks for all you do