Wednesday, November 14, 2018

Psychedelic Babbels


Hi everyone, my name is Vicky, and I’m a pharmacist rotating through mdBriefCase for the next 5 weeks. I’m very excited to learn about the world of medical writing, and content development. This blog will be my baby for the next few weeks, and I will be chatting to you about various topics that I find interesting.

But first, a little bit about me: I’ve been a practicing pharmacist for 5 years. I started out in community pharmacy, working for independent pharmacies that emphasized on patient care. A chance encounter placed me at the outpatient transplant pharmacy in London, Ontario where I was engrossed in all things solid-organ transplant related. That was also where I developed a fondness for nephrology and thrombosis.

A couple years later, I wanted to push myself therapeutically and took on the role of inpatient orthopedic surgery pharmacist. It was a big change for me to go from the fast-paced commercial world filled with patient interaction and drugs in nice packaging, to an equally fast-paced world filled with surgeons with swagger, bleary eyed medical residents, intravenous drugs, and patients so sick that code blues were called on the regular. It was like Greys Anatomy with none of the sexiness. I loved every minute of it.

Fast forward another couple of years when I met my husband in Toronto, and we decided that long-distance was not the key to happiness and longevity. I moved back to Toronto, taking on the position of float pharmacist at Humber River Hospital. As a float pharmacist, I covered everything from ICU/emergency/ nephrology/cardiology, to rehabilitation/ internal medicine. Humber was where I started writing policies and procedures for the hospital, and developing hospital specific guidelines. While I loved working at Humber, I couldn’t quite shake the feeling that there’s more for me to learn and to take on in this world. I heard about Medical Science Liaison (MSL) through a good friend of mine, and thought it would be something I could potentially be very good at. A chance encounter placed me in contact with Paladin pharmaceuticals, which was looking for someone to be the MSL for a new transplant medication. The world came in full circle, and I’m happy to say that I will be starting a new career as a MSL with Paladin.
It’s hard to believe that 5 years went by so fast, and I’m so grateful for the opportunities that have awarded me with such rich experiences. If there are interesting tidbits and experiences that I can share, they would be:
  • Orthopedic surgeries are bloody. Nails, hammers and bone saws are regularly used.
  • On the opposite of the spectrum, open heart surgeries are delicate and long. Patients sometimes have to be chilled slowly to preserve organ function, and warmed up slowly after the surgery.
  • Kidney, heart, and liver transplant patients are very different from one another. Kidney patients are usually healthy-ish except for the fact that they need dialysis or they’ll die. Heart patients are so sick they’re at the precipices of dying by the time they receive their transplant. And liver patients all have some degree of brain damage because of the ammonia that accumulates in their blood.
  • Internal medicine is not sexy. There’s a book called House of God that took a satirical approach at internal medicine. While terms like “gomers” (stand for Get Out of My Emergency Room) and “buff and turf” are mostly tongue-in-cheek, what’s not satirical is how brutal on-call hours can be for the newly initiated. A resident on call can be awake from 6 am of day 1 all the way to 10 am of day 2. Now multiple that by 3 days a week, for 4 - 6 years.
  •   Also not satirical is the emotional toll internal medicine can have on doctors. Dark humor was something we used to get on with our day in spite of the daily tragedies. One of my favourite books, When Breath Becomes Air, written by a late neurosurgery resident who discovered that he had terminal lung cancer, has a brilliant passage on how cynical all medical professionals become. The author, Paul Kalanithi, had just been paged out of his lunch – a diet coke and ice cream sandwich – to help a 22-year-old man with major head injury. He spent an hour trying unsuccessfully to save the patient, and then:
    • “I slipped out of the trauma bay just as the family was brought in to view the body. Then I remembered my Diet Coke, my ice cream sandwich . . . and the sweltering heat of the trauma bay. With one of the ER residents covering for me, I slipped back in, ghostlike, to save the ice cream sandwich in front of the corpse of the son I could not. Thirty minutes in the freezer resuscitated the sandwich. Pretty tasty, I thought, picking chocolate chips out of my teeth as the family said its last goodbyes.”

Outside of work, I’m a prolific reader, and a dancer. Some of the most awesome experiences I’ve had in the world of dance include when I went back to China for their Olympics of Chinese dance - Tao Li Cup, and when I auditioned for So You Think You Can Dance Canada.  Come talk to me about anything anthropology, history, sociology and spirituality related. I’d love to share ideas and learn from you. 

And that’s all for now. Stay tuned for the next issue!

 - Vicky

Monday, November 12, 2018

Staying Relevant in a Digital Age

At its roots, community pharmacy is a customer service field. A patient comes to a pharmacy with a prescription for the product that they need, the pharmacy prepares and packages the product, and the patient pays for the product and services. Although medications to treat or prevent disease are often valued higher than the products at a clothing store or fast food restaurant, buyers are still looking for the same things - convenience and efficiency.

Recent enhancements in automation and technology in the pharmacy field have been aimed to improve the ease of filling prescriptions. PopRx was the first application to make an appearance on the Canadian pharmacy technology scene in 2015.1 It is an app that allows people to send a picture of their prescription or medication vial to their local pharmacy and have the medication delivered to them on the same day. Other technologies have since been developed to improve accessibility. Pharmabox is an automated kiosk that sells personal care items and over-the-counter (OTC) medications that can be found in pharmacies.2



With technology disrupting the pharmacy landscape, pharmacists must come up with ways to stay relevant and avoid becoming overshadowed by the convenience of applications and automated machines. Here are thoughts on how pharmacists can add value to their services in a way that machines can't.

1. Remember our other products
Medications are not the only products sold in the pharmacy. Yes, medication is the first thing that comes to mind when you think of pharmacy, but our products go beyond technical services. Pharmacists can use their clinical knowledge to provide comprehensive medication reviews, disease screening and education, chronic disease management, smoking cessation consultations, and much more. Our cognitive services can never be replaced by technology. Instead we can use technology to grow these services, such as in the case of point-of-care testing or pharmacogenomic testing.

2. Filter information
In 2013, more than 50% of Canadians reported that they used Google searches to research or self-diagnose their symptoms.3 This number is only expected to be higher today with the widespread use of cell phones and social media. Although access to all of this information by means of technology is empowering for the public, it doesn't mean all of the information is true. In the pharmacy, I often field questions from patients asking if the latest health trends in the news or on the internet actually work or if we sell a product that Google recommended they try for their symptoms. Pharmacists shouldn't be discouraging people from using technology to research their health answers, but we should be encouraging them to let us help them decide what's factual and what's inaccurate.

3. Provide a personalized experience
Computers or automated services can't compete with the experience of face-to-face interaction. Pharmacists can provide patients with clinical services that are tailored to their needs, instead of reciting a laundry list of side effects or irrelevant information about a drug or disease that ultimately doesn't help the patient with decision-making. It's not just about having all the information, but it's also about knowing how to apply it to the patient that's in front of you. 

Having the knowledge and expertise to filter information and provide individualized clinical services for our patients is how the pharmacy profession will stay afloat amidst the rise of technology.

Chantel


References
1.     Hardy, Ian. (2015, November 24). PopRx, the "Uber of prescriptions" launches in Toronto. Accessed on October 22, 2018: https://mobilesyrup.com/2015/11/24/poprx-the-uber-of-prescriptions-launches-in-toronto/
2.     Harman, Megan. (2018, October 3). Automated Drugstore Concept 'Pharmabox' Aims to Disrupt Canadian Retailing. Accessed on October 22, 2018: https://www.retail-insider.com/retail-insider/2018/9/automated-drugstore-concept-pharmabox-plans-to-disrupt-canadian-retailing
3.     Oliveira, Michael. (2013, July 31). More than half of Canadians use 'doctor Google' to self-diagnose. Accessed on October 22, 2018: https://globalnews.ca/news/752415/more-than-half-of-canadians-use-doctor-google-to-self-diagnose/

Thursday, October 18, 2018

Are Pharmacists Ready for Recreational Cannabis?

On October 17, 2018, Canada became the second country to legalize the recreational use of cannabis.1 While the new legislation only authorizes recreational use for those 18 years or older with specific restrictions controlling the production, distribution, sale, and possession of cannabis, Canadians were still divided in their support of the legalization in the months leading up to the date.1,2


How do pharmacists feel?

Pharmacists proudly wear the title of medication experts, however 75% of Canadian pharmacists admitted to never asking about cannabis when reviewing a patient's medication to assess for drug interactions and 82% said that they don't know about the Canadian cannabis guidelines.3 Although cannabis for medical purposes has been legal since 2001, Canadian pharmacists generally feel unprepared the handle the influx of questions that will follow the legalization of recreational cannabis.3


Finding our place

Personally, I think pharmacists should embrace this new legislation as an opportunity to show the value of our profession to patients, rather than being too afraid to admit that we don't know all the answers right now. Here are some of the ways that I envision pharmacists applying their expertise to help patients using cannabis both recreationally and medically.

1. Harm Reduction
Legalization will likely increase people's comfort and openness to sharing their cannabis use with  healthcare providers. Coupled with the idea of pharmacists being the most accessible healthcare provider, pharmacists are in a good position to screen for a cannabis-use disorder. Similar to principles we use in harm reduction for alcohol or opioid dependence, we can provide patients with practical tips for reducing the harms of cannabis5,6:

  • Avoid driving for 4-5 hours after use
  • Shift away from smoking to other routes (i.e. vapourizers, edibles)
  • Delay use until after 25 years old since the brain is still developing
  • Avoid frequent (daily or near-daily) use
  • Store cannabis safely and away from children

2. Drug Interactions and Managing Side Effects
Using the current understanding of cannabis drug interactions, pharmacists are able to provide evidence-based answers to patients wanting to know how cannabis fits in with their prescription and non-prescription medications. In addition to using our unique knowledge of drug metabolizing enzymes, we can use our clinical judgment to examine the significance of cannabis side effects overlapping with prescription drug side effects.

Common unwanted side effects of cannabis include uneasiness, sedation, muscle twitches, and impaired memory or confusion.6 We can help patients manage these short-term side effects by encouraging them to reduce the tetrahydrocannabinol (THC) content of the strains being used or reduce the frequency or amount of cannabis being used.6 It is important to communicate with patients that the long-term side effects of cannabis remain unknown.6

3. Filling in Knowledge Gaps
One main barrier to conducting extensive research on cannabis is that it is not widely legalized. At present, what we know about cannabis for medicinal and recreational use is based on evidence gathered from small short-term studies. Despite this, pharmacists should be knowledgeable about the current information and be willing to share it with patients. Looking to the future, legalization in Canada can create an opportunity for further research in areas that are lacking - long-term side effects, optimal strains and dosages for medical uses, and impacts of legalization on society.

If you'd like to brush up on the current evidence on cannabis and its medical use in time for the recreational legalization, consider the course Medical Cannabis IQ: The Fundamentals on Advancing Practice or other continuing education courses offered by the Canadian Pharmacists Association.


Chantel


References

  1. Government of Canada. Cannabis Legalization and Regulation. Accessed October 15, 2018: http://www.justice.gc.ca/eng/cj-jp/cannabis/
  2. Navigator. Cannabis in Canada. Accessed October 15, 2018: http://www.navltd.com/wp-content/uploads/2018/03/Cannabis-In-Canada_03_2018.pdf
  3. Pharmacy5in5. "Recreational cannabis will be legal on Wednesday". Message to Pharmacy5in5 Mailing List. October 15, 2018. Email.
  4. Government of Canada. Understanding the New Access to Cannabis for Medical Purposes Regulations. Accessed October 15: https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/understanding-new-access-to-cannabis-for-medical-purposes-regulations.html
  5. Government of Canada. Cannabis in Canada: Get the facts. Accessed October 15, 2018: https://www.canada.ca/en/services/health/campaigns/cannabis/canadians.html
  6. Grindrod, K & Beazely, M. Cannabis 101. Accessed October 15, 2018: https://uwaterloo.ca/pharmacy/sites/ca.pharmacy/files/uploads/files/cannabis_infographic_2_sided.pdf

Monday, October 15, 2018

Flu Season is Coming ... with Some Updates

"When are flu shots coming in?" is the most frequently asked question at every community pharmacy counter once Thanksgiving weekend rolls around. Although pharmacies will have to brace themselves for the increased workload and disruption to normal prescription workflow, it's great to see that so many patients understand the importance of protecting themselves and the people around them against the flu and its complications.


While flu shots are slowly making their way into community pharmacies, pharmacy students are also preparing for the extra volume of patients flu season brings. For some of us, including myself, this year's influenza vaccine will be the first vaccination we've ever administered.

On top of remembering documentation requirements, the correct process for land-marking an injection site, and procedures for anaphylactic reactions, we should also keep in mind the important update for those 65 years and older as we're handing out influenza vaccination questionnaires to patients.

What's the update? 

The Canadian Immunization Guide created by the National Advisory Committee on Immunization (NACI) details current evidence-based recommendations on the use of vaccines for disease prevention in different populations. In an update for the 2018 flu season, NACI acknowledges evidence that the high-dose trivalent inactivated vaccine (TIV) provides better protection than the standard-dose TIV against flu-related complications and hospitalizations in those aged 65 and older.1

When considering the evidence for provincial and territorial funding, NACI recommends that any of the four influenza vaccines indicated of those 65 years and older - standard-dose TIV, high-dose TIV, adjuvanted TIV, and quadrivalent inactivated vaccine (QIV) - can be used.On the other hand for individuals 65 years and older seeking to get vaccinated and clinicians who are advising individual patients, NACI recommends the high-dose TIV be offered over the standard-dose TIV.3

How will this impact community pharmacy?

Currently in Canada, Ontario is the only province to publicly fund the high-dose TIV for all adults 65 years of age or older, while Nova Scotia, Manitoba, Saskatchewan, and Prince Edward Island are only funding the vaccine for elderly people living in long-term care facilities.Ontario pharmacies will not be receiving high-dose TIV as a part of the Universal Influenza Immunization Program (UIIP) and so the vaccination will only be publicly funded if received at a physician or nurse practitioner's office, retirement home, long-term care facility, or hospital.

While sharing the demands of flu season with other healthcare providers may relieve some of the burden on Ontario pharmacies, it leaves us with a question - what should we be doing with patients 65 years and older? There isn't enough evidence to make a comparative recommendation between the high-dose TIV, adjuvanted TIV, and QIV.So should we be vaccinating patients over 65 in community pharmacies or send them straight to their doctor's office? We can't possibly expect physicians and nurses to vaccinate all Ontarians aged 65 and older, so how do we decide which patients to refer? Would turning patients away significantly delay vaccination or even discourage them from getting vaccinated?

How will you apply NACI's recommendations to patients over 65 wishing to get vaccinated in your pharmacy? Please send me your comments and experiences using the form to the right.

For more information on influenza vaccinations in older adults and how to approach vaccine hesitancy, see the Influenza in Older Adults - Ensuring Optimal Protection course offered on rxBriefCase.

I look forward to reading your comments!



Chantel

References

  1. Government of Canada. (2018, May 1). Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2018-2019. Accessed October 9, 2018: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2018-2019.html#1.1
  2. Sanofi. (2018, October 1). Sanofi aims to topple the flu as it marks National Seniors Day with a Guinness World Record attempt. Accessed October 9, 2018: https://www.newswire.ca/news-releases/sanofi-aims-to-topple-the-flu-as-it-marks-national-seniors-day-with-a-guinness-world-record-attempt-694786581.html
  3. Ontario Ministry of Health and Long-Term Care. (Updated 2018, September 19). Universal Influenza Immunization Program (UIIP). Accessed October 9, 2018: http://www.health.gov.on.ca/en/pro/programs/publichealth/flu/uiip/

Saturday, October 6, 2018

WPD - The Significance behind the Abbreviation


In 2009, the International Pharmaceutical Federation (FIP) designated September 25th as World Pharmacist Day, commonly abbreviated as WPD.1 The theme for this year is "Pharmacists: Your medication experts".Although World Pharmacist Day shares the same date as other international holidays - World Dream Day, German Butterbrot Day, and One-Hit Wonder Day - the day has a great meaning to pharmacists and pharmacy students across the world.2

The Theme

The goal of World Pharmacist Day is to encourage pharmacists to advocate for their role in healthcare and to bring awareness to their unique knowledge base. Regardless of the differing scopes of pharmacists across the world, the most fundamental responsibility is to ensure that the right patient receives the right medication. This breaks down the perception of pharmacists as "pill counters" and emphasizes that pharmacists have a role in protecting health by using their expert medication knowledge to assess the appropriateness of medications for each patient. In keeping with the idea of pharmacists as one of the most trusted professionals, this year's theme also highlights that not only do we provide current and evidence-based information about medication to patients, but also to other healthcare professionals.1,3

Past World Pharmacist Day themes, such as last year's theme "From research to healthcare: Your pharmacist is at your service", have similarly countered other publicly-held opinions of pharmacists.4 The 2017 theme reflects that pharmacists contribute to patient health not only in patient-care settings like hospital or community pharmacy, but also in diverse settings like research, industry, and education.4

The 2018 Celebrations

The president of the International Pharmaceutical Federation, Dominique Jordan, invited pharmacists across the world to spread this year's message within their communities, at work, and on social media by decorating their profile pictures with a World Pharmacist Day Twibbon.

Pharmacy students at the University of Toronto embraced the theme by participating in a social media competition that involved completing the sentence "I am a future pharmacist and I am an expert in ____" and posting a photo on social media holding up the message. Outside of the University of Toronto pharmacy world, a simple search of "World Pharmacist Day 2018" or "WPD 2018" on Facebook, Twitter, or Instagram pulls up a long list of pharmacists, patients, and organizations from across the world celebrating the impact of pharmacists.


The Impact

Appreciation days, whether they are for bringing awareness to pharmacists or the best one-hit wonders, are meant to get the conversation started and serve as a platform for more questions and opportunities to advocate in the future. From my experience participating in Pharmacy Awareness Month last March where I spoke to patients about the expanded scope of Ontario pharmacists, many people were unaware of some of the things their pharmacists could do for them. Although I didn't have an extensive conversation about it with every patient, I'm sure I left the door open for them to ask their pharmacist about it at their next visit or ask their friends or family if they've had experience with it. 

Judging by the number of likes, comments, and shares of WPD 2018 social media posts and pictures, the campaign must be working to get people engaged and talking about the role of pharmacists.

Hope you had a happy World Pharmacist Day!

Chantel

References:
  1. International Pharmaceutical Federation. World Pharmacist Day. Accessed on October 2, 2018: https://www.fip.org/worldpharmacistsday
  2. Days of the Year. Browse all the weird holidays on ... 25th, September 2018. Accessed on October 2, 2018: https://www.daysoftheyear.com/days/2018/09/25/
  3. Marotta, Ryan. (2018, February 9). Pharmacists Remain Among Most Trust and Ethical Professionals. Accessed on October 2, 2018: https://www.pharmacytimes.com/news/pharmacists-remain-among-most-trusted-and-ethical-professionals
  4. International Pharmaceutical Federation. Diversity of profession to be focus of World Pharmacist Day 2017. Accessed on October 2, 2018: https://www.fip.org/www/index.php?page=news_publications&news=newsitem&newsitem=242

Friday, September 28, 2018

The New Pharmacy Student on the Block (Five)

Hi Everyone!

My name is Chantel Asamoah and I am 4th year Pharmacy Student doing block 5 of my APPE (Advanced Pharmacy Practice Experience) here at mdBriefCase.

APPE is a time for pharmacy students to put together everything we've learned over 3 years of school and apply it in real-life practice as a pharmacist. Although mdBriefCase will be my only non-direct patient care (NDPC) placement, I'm excited to learn about the impact that pharmacists can have in non-traditional settings. We all tend to envision the role of a pharmacist as binary - either a community pharmacist or a hospital pharmacist. Or at least that's how I saw it before I started pharmacy school. But there's so much more you can do with a PharmD degree - industry, education, consulting, public health, government, the list goes on!

Before coming to mdBriefCase, my placements included  Michael Garron Hospital (MGH) in general medicine, respirology and oncology, a community placement at a No Frills pharmacy, and a "study" block - which I used as an opportunity to visit Chicago with one of my best friends. I can say that there was at least one thing I learned from each of my previous blocks that has positively influenced the way I will practice as a pharmacist or how I think of the patients I will work with in the future.

  1. Block 1 General Medicine Unit at MGH - a common task for pharmacy students during a hospital setting is discharge prescription counseling. During this rotation at MGH, I was asked to provide discharge counseling to a deaf patient through a sign-language interpreter. It was such an eye-opening experience because I couldn't imagine how the patient would have dealt with all the changes to his medications and understood how/why he needed to start taking new medications. It really got me to start thinking about how language barriers can prevent people from accessing the health information that they need, and as a pharmacist, I should be mindful of these barriers and always have strategies to help. These can include providing written information or asking if I could call a family member that speaks English to translate.
  2. Block 2 Respirology and Oncology Unit at MGH - during my 5-weeks, one patient that I was interviewing was experiencing an excruciating migraine and didn't have any of her medications from home, which are usually effective. She had to resort to laying in her hospital bed with her eyes closed, lights off, and with an ice pack on her forehead. None of the medications she was getting in the hospital were helping, but she remembered receiving something in the emergency room years ago that helped, but she couldn't remember the name. Although it would have been easier and less time-consuming for me to give the Advil some more time to work, I looked through all the records of her previous hospital admissions to find the name of this specific medication that helped years ago. I didn't get to see her or find out if it was helpful because she was discharged over the weekend, but I'm glad I didn't just take the easy way out in the interest of time.
  3. Block 3 No Frills Pharmacy - being a familiar face in a community pharmacy allows you the opportunity to building lasting patient relationships. During this placement, I became involved in the care of a patient who was recently prescribed insulin for the first time. While he was very happy to have me review his medications and progress with him every week, he lacked the confidence to start an injectable medication that would get his diabetes under control, after years of struggling with it. It required a lot of motivational interviewing on my part before he was finally able to make that leap. Sometimes, people just need someone to take the time to listen to their fears and motivate them to reach their goals.
  4. Block 4 "Study" Block/Chicago Trip - if you've ever been to Chicago, you know that the city has a lot of culture (and good food)! Learning about the culture of the city made all of the tourist sitesand experiences much more meaningful. This reminded me why it is important for us to make an effort to at least try to understand our patient's culture or where they're coming from.

I'll be sure to share the experience at mdBriefCase that most greatly shaped who I am as a pharmacist and person by the end of this rotation. Stay tuned for my upcoming projects (a critical appraisal presentation, eNewsletter, MedSchoolForYou mini-module) and weekly blog posts! 

Chantel  

Tuesday, August 28, 2018

Heart Burn: Are we treating for too long?


Heart burn is a common phenomenon that can be characterized by a burning sensation in the throat, and chest. Heartburn is relatively easy to treat with a variety of OTC and prescription products. Proton Pump inhibitors (PPIs) are the premier drug class for treating heart burn, and have had a reputation for being benign drugs, until recently.

New evidence is emerging about long term use of PPIs showing correlations between opportunistic infections, pneumonia, and malabsorption of nutrients.1,2 The current recommendation for PPIs for heartburn is 8 weeks, but the reality is many patients surpass this time-frame.

Health care providers should be striving to limit PPI therapy duration in patients to avoid these complications until more information is available.

Difficulty Ceasing?

In patients that have surpassed the recommended 8-week therapy duration, there are two main barriers that make it difficult to terminate therapy.

One of the barriers stopping PPIs therapy cessation is patient preference. Most patients are not optimistic about stopping their PPI therapy, because of how well they work.

The second barrier that causes issues with cessation of PPI therapies is the perceptions of health care providers.  PPIs have been available since 1988, and many healthcare professionals view them as safe drugs. Since most health care professionals view them as harmless, they are less likely to intervene with patients using PPIs long term.


Who does this affect the most?

Although long durations of PPI therapy should be a concern for all patients, it is especially troublesome in older adults. Older adults are more prone to infection, and are more likely to suffer from nutritional deficiencies. Long term PPI use in older adults also adds an extra layer of issues due to drug interactions. To limit this potential harm, it is important to always address any PPI use in older adults.


What can we do?

The best way to decrease complications of long term PPI use in heartburn patients is to play a more active role in product selection, and therapy duration discussions.

Tips:

1) Recommend lifestyle interventions such as exercise, weight loss, and limiting meals before bed.3

2) Consider other drug classes first before PPIs when dealing with mild & moderate cases of heartburn.

3) Discuss with patient and prescribers expected duration of therapy prior to PPI initiation.

4) Investigate any patient prescribed PPIs for longer than 8 weeks and discuss possible taper options.

5) Attempt to taper patients on long term PPIs at least once a year using a combination of life style modifications and other drugs to help.

Quick Tip: Never stop a PPI abruptly due to risk of rebound hyperacidity.

Although PPIs are used mostly to treat minor ailments, it is important to remember the associated risk with long term use. 

Hopefully these tips will be helpful for everyone, because I am signing off.
I hope you have enjoyed my posts & are excited for the next student blogger.

Sincerely,

Derick Oduro

References:

1) Trifan, Anca, et al. “Proton Pump Inhibitors Therapy and Risk of Clostridium Difficile Infection: Systematic Review and Meta-Analysis.” Advances in Pediatrics., U.S. National Library of Medicine, 21 Sept. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5643276/. 

2) Heidelbaugh, Joel J. “Proton Pump Inhibitors and Risk of Vitamin and Mineral Deficiency: Evidence and Clinical Implications.” Advances in Pediatrics., U.S. National Library of Medicine, June 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC4110863/. 

3) Ness-Jensen E, Lindam A, Lagergren J et al. Weight loss and reduction in gastroesophageal reflux. A prospective population-based cohort study: the HUNT study. Am J Gastroenterol 2013;108(3):376-82.