Clinical Consultant Pharmacist NS

04/09/2024

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Online or in person, we are happy to share our expertise as IWK's medication experts with our acute and primary care pharmacy partners!

07/04/2023

We are taking questions today and all weekend from 8-4. Happy Easter!

20/02/2023

We are taking questions today from 8-4! Call or text 613-406-0984 or email us at admin@rxconsultns.com. Happy Monday!

23/12/2022

For those of you working to provide our essential service this weekend, we will be available for support from 8 AM - 4 PM on December 24th, 25th and 26th. Please call if you can as access to email may be delayed. Happy Holidays!

23/11/2022

If you are running low on amoxicillin suspension (who isn't these days), there are a few things we can do before switching to an alternative antimicrobial. Amoxicillin is usually the drug of choice for many common pediatric respiratory infections including otitis media and pneumonia. Alternatives, unless specifically indicated (e.g. allergy, treatment failure), are often considered inferior due to poor oral bioavailability (i.e. cefuroxime), high resistance rates (i.e. azithromycin) and adverse effects (C. difficile associated with clindamycin). Here are a few helpful hints:

1) If possible, round doses to the nearest 250 mg to accommodate available capsule sizes (250 mg and 500 mg). The dosage range of amoxicillin is broad (check Firstline for your specific indication) and given its broad therapeutic index, if you are slightly over (within 10%) of the recommended dose, there is minimal risk of harm.

2) Amoxicillin capsules may be opened and mixed with a small amount of soft food, water or juice immediately prior to administration. PRO TIP: Try chocolate ice cream! It helps numb the tastebuds and chocolate (or raspberry) works really well to mask medicinal tastes.

3) If you are fortunate enough to have some chewable amoxicillin 250 mg tablets on hand, these are scored and can be quartered with a pill splitter. Therefore, doses may be rounded in increments of 62.5 mg (much more flexible than capsules). These tablets can also be dissolved in a small amount water or milk immediately prior to administration for those little ones who can't tolerate solids.

3) Call for help. We are more than happy to help you troubleshoot !

Here is a helpful handout on how to get alternative dosage forms into children:

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must ex...

04/11/2022

We get many peds questions (rightfully so)! This is an excellent, community-focused resource for those who are interested!

20/06/2021

To celebrate our 100th consult, we’re sharing our TOP 10 reasons for consultation. We’ve heard from you that you aren’t always sure when to call, so here are some FAQs for inspiration! We are so honored to work with you and THANK YOU for placing your trust in us. We hope to hear from you soon!

FAQs

1. Determination of individualized blood pressure targets and anti-hypertensive dose adjustments
2. Estimation of renal function (CrCl) and recommended drug dosing (metformin, DOACs)
3. Management of drug-drug and drug-disease interactions
4. Deprescribing and tapering (PPIs, gabapentin)
5. Inclusion and exclusion criteria, antimicrobial selection for uncomplicated cystitis
6. Medication use in pregnancy and lactation
7. Drug dosing in pediatrics
8. Therapeutic substitution for drug shortages or unavailability on evening and weekends
9. Prescribing under the CDSA
10. Suggested assessment, monitoring and follow-up when performing a renewal with or without an adaptation

28/05/2021

The IWK has recently adopted the Comfort Promise to do everything possible to prevent and treat pain. Part of this promise is to offer topical analgesia for all needle pokes, including immunizations. With COVID immunizations opening to adolescents, community pharmacists may be receiving questions regarding the use of topical anesthetics (e.g. EMLA, Ametop) to reduce injection pain. The IWK has some excellent resources including a handout for parents on how to apply. Check out the link below!

The IWK has officially made the Comfort Promise!

Through a collaboration with Minnesota Children’s we have committed ourselves to “do everything possible to prevent and treat pain.” The IWK has adapted Minnesota Children’s evidence-based pain management program, the Comfort Promise.

As part of our Promise, we are now recommending the following options be offered to ALL children undergoing painful needle procedures such as blood draws, IV starts💉, and immunizations:
👉Topical anesthetic cream (e.g. EMLA, Ametop)
👉Oral sucrose (24%) for infants 12 months and younger or breastfeeding/skin-to-skin🤱
👉Comfort positioning
👉Distraction🎮
As pharmacy staff in community pharmacies and hospitals, you may be uniquely placed to offer the Comfort Promise to your patients. These comfort measures are encouraged prior to immunizations, including seasonal influenza, that are routinely offered to children in community pharmacies.

You can find our parent handout on the use of topical anesthetic cream here: https://www.iwk.nshealth.ca/node/4019
We would love to hear some of your FAQs about use of topical anesthetics!

16/05/2021

There as been A LOT of talk about blood clots lately. So, what can you do when a patient with an indication for hormone replacement therapy is concerned about their risk of VTE? One underused risk-reduction strategy is to use transdermal over oral estrogens. The supportive literature is gaining steam, with the study below representing one of the largest to date in favour of transdermal delivery. While the study is retrospective and unable to prove causation, the observations are biologically plausible; hepatic first-pass metabolism of oral estrogens is postulated to induce hepatic production of coagulation factors. Most importantly, for the majority of patients, the risks of switching routes of administration is minimal. A therapeutic substitution can easily be performed from oral to an equivalent dose of transdermal estrogen. For help determining the best option for your patient, please reach out!

https://www.bmj.com/content/364/bmj.k4810

Objective To assess the association between risk of venous thromboembolism and use of different types of hormone replacement therapy. Design Two nested case-control studies. Setting UK general practices contributing to the QResearch or Clinical Practice Research Datalink (CPRD) databases, and linked...

30/04/2021

This! Thank you frontline pharmacists for ALL that you have done and will do.

We've been at this more than a year and are now in the middle of another lockdown. Throughout this time, pharmacy teams have been there to ensure we get the healthcare we need and are now playing a vital role in the delivery of the COVID-19 vaccine.

14/04/2021

Good Morning! Welcome, Pharmacy Students!

It's pharmacy student season and we just wanted to let you know that you can absolutely delegate a student to call us. Of course, we are not meant to take the place of the preceptor, so questions should be patient-specific (rather than general) in nature. It is expected that the student share their learning with their preceptor.

As always, if you have any questions, please let us know!

02/04/2021

Update!

After a year of piloting, the NSCP is transitioning the consultant service to a permanent resource!
In the meantime, keep reaching out at the contact information on our page and stay tuned for updates as the service evolves.

A reminder that we are available through the long weekend (8 AM to 4 PM daily).

Thank you to everyone who made the program a success. We can’t wait to keep working with you!

- Jaime and Emma