Case 1: Aspirin and Diabetes

Q: LH is a 52-year-old lady who’s filling her new prescription for atorvastatin. She is contemplating taking aspirin at 81 mg day by day for her coronary heart well being. LH has hypertension and sort 2 diabetes and not too long ago discovered she has excessive ldl cholesterol. A couple of years in the past, her main care doctor (PCP) really helpful she take child aspirin day by day. LH by no means did so, however having discovered she has excessive ldl cholesterol, she is considering taking the newborn aspirin. She has no prior cardiac occasions. What ought to the pharmacist suggest to LH?

A: Aspirin remedy has advantages in addition to dangers. Primary prevention with aspirin remedy is really helpful in adults 50 years or older who’ve diabetes and at the very least 1 extra main threat issue, together with a household historical past of untimely heart problems, albuminuria, continual kidney illness, dyslipidemia, hypertension, and smoking. Prior to initiating aspirin remedy, consider sufferers for a rise of bleeding threat, akin to anemia, older age, and renal illness. Patients 70 years or older might not profit as a result of the chance of bleeding outweighs the benefits. Because LH has diabetes with dyslipidemia and hypertension, she might profit from taking 1 dose of child aspirin day by day. She ought to talk about this along with her PCP earlier than initiation, as a result of it has been greater than a 12 months because the final advice.¹

Case 2: Hypertension and NSAIDs

Q: RD is a 58-year-old man who’s searching for an arthritis therapy. His main care doctor advised him to take an OTC ache reliever, however RD has not tried this. He has hypertension (BP) and takes 2 drugs to handle this situation. RD checks his BP commonly. It is normally regular, though it could fluctuate when he’s burdened. What ought to the pharmacist suggest?

A: Because RD has hypertension and no different medical situations, it could be helpful to keep away from any nonsteroidal anti-inflammatory medicine akin to ibuprofen or naproxen, which enhance BP by lowering kidney perform and making the physique retain fluid. Study outcomes present that the typical enhance in BP is 3/2 mm Hg,2,3 though this enhance varies amongst sufferers. Therefore, it could be helpful to begin with different choices. In this case, RD can strive acetaminophen and see whether or not it relieves his arthritis. Depending on the situation of the arthritis, different choices could also be out there, akin to a prescription ache product or topical capsaicin.

Case 3: Cardiovascular Disease and Pneumococcal Vaccine

Q: GG is a 65-year-old lady who’s receiving her annual influenza vaccination. She not too long ago acquired a analysis of coronary heart failure. GG is attempting to get her immunizations up-to-date and has by no means acquired a pneumococcal vaccine. GG wish to obtain each the influenza and pneumococcal vaccines. Because there are a number of formulations, which vaccines ought to the pharmacist suggest?

A: The Advisory Committee on Immunization Practices (ACIP) modified the influenza vaccine suggestions for sufferers 65 years or older for the 2022/2023 season. Because GG is 65 years previous, she would profit from the quadrivalent adjuvanted inactivated influenza vaccine, the quadrivalent high-dose inactivated influenza vaccine, or the quadrivalent recombinant influenza vaccine. If the pharmacy doesn’t have any of those vaccines, some other age-appropriate influenza vaccines can be really helpful.⁴ For her pneumococcal vaccine, the ACIP recommends the pneumococcal 15-valent conjugate vaccine (PCV15) or pneumococcal 20-valent conjugate vaccine (PCV20) for PCV-naïve adults 65 years or older or PCV-naïve adults aged 19 to 64 years with sure underlying situations. GG can obtain the vaccine no matter her coronary heart failure analysis. If PCV15 is used, a dose of pneumococcal polysaccharide vaccine (PPSV23) ought to be administered at the very least 1 12 months later. Both vaccines can be applicable for GG, so she will determine whether or not she would really like 2 vaccines in 1 12 months or to be carried out after the PCV20 vaccine. For those that obtain the PCV15 vaccine adopted by the PPSV23 vaccine, a minimal interval of 8 weeks will be thought-about for adults who’re immunocompromised or have a cerebrospinal fluid leak or cochlear implant.⁵

Case 4: Omega-3 Fish Oil

Q: IL is a 48-year-old man who’s searching for omega-3 fish oil. He takes 10 mg of atorvastatin at bedtime. His main care doctor really helpful that IL start taking OTC omega-3 fish oil dietary supplements as a result of his triglyceride ranges are barely excessive. IL is confused about how a lot he ought to take as a result of totally different manufacturers have totally different dosing. He can also be debating growing his fish consumption as an alternative of taking a complement. What ought to the pharmacist suggest?

A: Fish oil dietary supplements sometimes present 300 mg per capsule, though doses can fluctuate primarily based on producer. Omega-3 content material by way of dietary sources, akin to fish, may fluctuate. Cold-water fatty fish akin to herring, salmon, sardines, and tuna comprise excessive quantities of omega-3 fish oil, whereas fish with a decrease fats content material akin to bass, cod, and tilapia comprise decrease ranges. The National Institutes of Health suggests consuming 1.1 to 1.6 g of omega-3 fish oil day by day as a part of a standard weight-reduction plan. To get an efficient dosage for managing hypertriglyceridemia, IL would wish to take 2 to 4 g day by day.⁶ To obtain the excessive doses of omega-3 fish oil wanted, supplementation is his most suitable choice.

About the Authors

Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP, is a scientific affiliate professor of pharmacy follow and administration on the Ernest Mario School of Pharmacy at Rutgers University in Piscataway and a transitions-of-care scientific pharmacist at Morristown Medical Center, each in New Jersey.

Ammie Patel, PharmD, BCACP, BCPS, is a scientific assistant professor of pharmacy follow and administration at Ernest Mario School of Pharmacy at Rutgers University in Piscataway and a scientific pharmacist in ambulatory care at RWJBarnabas Health in Shrewsbury and Eatontown, all in New Jersey.