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On Monday we took a look at a prescription and tried to get your opinions on this, before today being Friday. Anyway this is what we think.
Many of the adverse effects of ACE inhibitors relate to their pharmacological action and all therefore have a similar spectrum of adverse effects. ACE inhibitors induce a bothersome dry cough,it is usually not dose related, occurs more frequently in women than in men, usually develops 1 week and 6months after initiation of therapy. This adverse effect may be mediated by by accumulation in the lungs of bradykinin,substance P and/or prostaglandin.
looking at the prescriptions again, it is clear that cough is most probably due to the lisinopril. Now what options do we have, from pharmaceutical,therapeutic and economic viewpoints.
1.we can sell the drugs to the patient, keep our knowledge and keep rhinathiol money in our pocket,at least it is not o/s
2.we can send the patient back to the prescriber, to review the prescription, by so doing we cost the patient more money (T.fare,or fuel if he/she is mobile),but save his life, educate the prescriber and prevent further spending.However, the prscriber might insist on his own (if you read my meaning), and send the patient elsewhere,thereby keeping his/her ego and keeping our knowledge as well,meanwhile,we lost patient and money!!!
3. we can change the ACEI to ARB,tell the patient not to buy the rhinathiol, because he/she does not need it, and encourage him/her to see his/her prescriber and explain what the pharmacist said,a good prscriber would be your friend at once. Or better still manage the cough,how??..see below
NOTE: ACEIs induced cough can be managed with aspirin or iron supplements or thromboxane antagonist…do you know that before…i guess not,bookmark and visit us, we will learn together.
There are some lovely comments on this i saw on face book, i don’t why you do not want to put it here o,any way..
if you missed the question click the prescription
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