Friday, January 6, 2017

A Case of the Cramps - Review of eCME

To mix up the blog a bit, I’ve decided to review an eCME this time around! After looking through the rxBriefCase directory, the Role of Antispasmodics in the Self-Treatment of Abdominal Cramping and Pain caught my attention.

Based on the learning objectives alone, this topic was already interesting and relevant to my practice. At the community pharmacy I work at, patients commonly ask about gastrointestinal (GI) issues and how to optimally manage them. This program provided a comprehensive overview of functional GI disorder (with a focus on IBS), and increased my confidence in recommending an antispasmodic. Due to the sensitive nature of the condition, I also appreciated the counselling suggestions found throughout the program.

After completing the session, key learning points included:
-        The pathophysiology of functional GI disorder is multifaceted, and includes genetics, psychosocial factors, visceral hypersensitivity, inflammation and changes to bacterial flora
-        Patients with “red flags” (e.g. dysphagia, weight loss >3 kg within 6 months) should be referred to a physician
-        GI diseases can severely impair quality of life, due to the unpredictable nature of symptoms and associated emotional distress
-        Therapies for functional GI disorder are not curative, but mainly target patient-specific symptoms, such as diarrhea, constipation, abdominal cramps and pain 
-        Compared to placebo, loperamide is no more effective at reducing pain, bloating or global symptoms of IBS, and may worsen nighttime abdominal pain
-        Non-prescription antispasmodic therapies (i.e. hyoscine butylbromide, dicyclomine hydrochloride) are effective and well tolerated for abdominal pain and cramps, with a low incidence of anticholinergic side effects

As practice shifts towards pharmacy-based, minor ailments programs, pharmacists are well equipped to embrace the challenges of assessing, educating and treating a number of expanded health conditions. In line with this philosophy, this CME was an excellent illustration of how pharmacist involvement can positively impact the lives of patients with chronic, GI disease.