Answer: Although “10%” isn’t listed in the package insert or in guidelines as the “limit”, it is a clinically acceptable limit to consider before starting one of these agents due to:
The annual Great American Smokeout is on Thursday, November 21st. This event, sponsored by the American Cancer Society, is held annually on the third Thursday of November (typically the week before Thanksgiving).
Readers of PharmAid can likely appreciate the past articles dedicated to the topic of tobacco cessation. Although providers continually promote tobacco cessation to their patients, the Great American Smokeout is one day dedicated to concentrating such efforts.
Smoking has been linked to at least 12 different types of cancer, and it causes roughly 3 of every 10 cancer deaths in the United States. Certain groups within the United States are known to smoke both at higher rates and more heavily than others. These same groups face inequities in daily life as well as barriers to proper healthcare. Such groups include:
It cannot be understated the importance of continuing to ask patients if this day may just be the day they choose to quit! Even if their response is, “not yet,” encourage them to consider simply going one day without using tobacco products. Doing so may provide them with the confidence that cessation may not be the impossible task they otherwise may view it to be.
Check out the Great American Smokeout’s website for information that both you and your patients may find helpful, including:
As overwhelming as tobacco cessation may seem, they stress that “You don’t have to stop smoking in one day. Start with day one.” The Great American Smokeout is intended to potentially be that day for any of the millions of Americans who are current smokers. Help them by continuing to ask if now is their time to quit, and continuing to offer them help on their journey!
Questions occasionally arise from patients as to whether or not they should repeat a dose of medication following a vomiting episode.
Colleagues at Pharmacist’s Letter have created a decision tree to help healthcare providers give appropriate guidance for patients in these circumstances.
Generally speaking, redosing is usually NOT necessary and/or recommended in the following circumstances:
Conversely, consideration should be given toward redosing in the following cases:
Vomiting occurring between 15-60 minutes after a dose should be handled on a case-by-case basis.
In situations like these, guidance can sometimes be found in package labeling. If not, look for recommendations in the package labeling in regards to missed doses. If missed doses are recommended to be skipped, avoid redosing.
Consider partnering with specialists for how to handle doses for cancer medications and immunosuppressant therapies to weigh risk/benefit scenarios and arrange for closer monitoring/follow-up, if/when warranted.
Clinical Pharmacy Practitioner in Primary Care
Mike Grunske, PharmD, BCPS
Mike Grunske is a Board-Certified Pharmacotherapy Specialist (BCPS). Mike transitioned his practice to the Clement Zablocki VA Medical Center where he has since practiced in the Primary Care Clinics as a Clinical Pharmacist Practioner. Within this role, his practice involves direct care and management of patients’ medication regimens. He has worked as an active preceptor for both pharmacy students and residents throughout his entire career. Mike is also Past-President and former Foundation Chair of the Pharmacy Society of Wisconsin (PSW).
Mike is married to a fellow PharmAid contributor (Vanessa Grunske). Together they have a teenage daughter and son. He enjoys traveling with his family, attending his kid’s cheer, baseball, and basketball events, and spending any available leftover time running and hunting.
Pharmacist at Advocate Aurora Health
Vanessa Grunske, PharmD, BCACP
Vanessa practices with Advocate Aurora Health in Milwaukee, where she sees patients at Aurora Sinai Medication Management Clinic and maintains a dispensing practice at St. Luke’s Medical Center. Board-certified in ambulatory care pharmacotherapy, her practice interests include diabetes, hypertension, smoking cessation, geriatrics, improving health literacy, and medication adherence. She particularly enjoys and spends a good share of her work hours teaching and mentoring pharmacy students, family medicine residents and pharmacy residents.
She and her husband, Mike, live in the Milwaukee area with their two teenage children. In her free time, she enjoys cooking, baking, visiting our national parks with her family or relaxing on a beautiful Caribbean beach.
Professor at Concordia University Wisconsin School of Pharmacy
Beth Buckley, PharmD, CDCES
Beth Buckley, PharmD, CDCES (Certified Diabetes Care and Education Specialist), is a Professor of Pharmacy Practice at the Concordia University Wisconsin School of Pharmacy, where she has a teaching role within all years of the curriculum with a focus on Applied Patient Care Skills Lab, Diabetes Pharmacotherapy, and electives in the areas of diabetes and wellness. Her current role is ambulatory care pharmacist where she works with a Collaborative Practice Agreement to provide chronic disease state management within a primary care clinic.
When not working, she enjoys reading, gardening, traveling with her husband, volunteering within the community, and active fun: hiking, biking, dog walking, practicing yoga, mindfulness, and living with intention and gratitude.
Disclaimer: The Wisconsin Academy of Family Physicians (WAFP) has entered into a business relationship with Pharm Aid to offer our members discounts and exclusive savings. This or other affinity program relationships presented by the WAFP in no way implies a WAFP endorsement of the program, supplier, or vendor.
