Pharmacist's Letter: December 2009; Vol: 25, No. 12

VACCINES This is an actual Issue article. Click "Detail-Document" to read more on this subject. See "Table of Contents" for all the articles in this issue. SUBSCRIBE TODAY!      You'll see more questions caused by the current unique situation...too much H1N1 - very little testing for flu strain - too little vaccine - but enough Tamiflu.      Who should get antivirals? Experts now say start antivirals sooner, and with less hesitation...to limit flu severity and deaths.      Encourage giving antivirals as soon as possible to high-risk patients with flu symptoms...or to anyone with severe or worsening symptoms...even if it's been more than 48 hours past the flu's onset.      Advise not to wait for test results before starting Tamiflu.      Tell flu patients to call their prescriber if they don't improve within 72 hours or get worse. Most H1N1 deaths are due to viral pneumonia and acute respiratory distress syndrome.      Do antivirals reduce the vaccine's effect? Possibly...IF antivirals are given within 48 hours BEFORE or two weeks AFTER the NASAL attenuated vaccine. Recommend revaccinating...unless the patient has confirmed H1N1.      Should patients who had the flu get vaccinated? Yes, unless you know which flu the patient had. Give both H1N1 and seasonal vaccines if the strain wasn't tested...or just seasonal vaccine if patients had confirmed H1N1. Use the injectable for pregnant women.      Is it okay to give seasonal and H1N1 vaccine at the same time? Yes...but don't give two live NASAL vaccines at the same time. Give shots in opposite arms if they are being given the same day.      If you need to give two H1N1 doses, try to make both either nasal or injectable...but don't hesitate to switch types if needed due to supplies.      Is H1N1 vaccine causing adverse effects? Nothing unexpected.      How long are patients contagious? The virus can shed for 7 days or longer after symptoms start...it's highest during the fever. Explain that taking Tamiflu may not reduce the contagious period by much.      What are the options for critically ill H1N1 patients? High-dose Tamiflu, 150 mg BID for 10 days...or investigational IV antivirals... peramivir, zanamivir (Relenza). See our Detail-Document to get these.      To help with all the questions you're getting, get our patient handout, 2009 H1N1 Vaccine: Questions and Answers. View Detail-Document #251201 Copyright © 2009 Pharmacist's Letter. Illegal to reproduce and/or forward. PharmacistsLetter.com

Pharmacist's Letter: December 2009; Vol: 25, No. 12

Download This Issue's Handheld File Start reading this issue of the Letter or skip to any topic below. VACCINES too much H1N1 - very little testing for flu strain - too little vaccine - but enough Tamiflu read this article TAMIFLU more options for patients who need LIQUID Tamiflu DIABETES new warnings about Byetta and kidney failure VACCINES Gardasil and Cervarix, the two human papillomavirus vaccines OSTEOPOROSIS how long women should take a bisphosphonate for osteoporosis WOMEN'S HEALTH whether nitrofurantoin and TMP/SMX are safe to use during pregnancy CARDIOLOGY Valturna, a new combination of Diovan (valsartan) and Tekturna (aliskiren) for hypertension start beta-blockers earlier before surgery MEDGUIDES The increase in drugs with required MedGuides is causing confusion DERMATOLOGY how to choose a topical corticosteroid for skin problems HYPERTENSION new emphasis on treating hypertension in KIDS DYSLIPIDEMIA You'll hear more controversy about ezetimibe (Vytorin, Zetia) CE QUESTIONS December 2009 CE Questions Start reading this issue of the Letter or skip to any topic above.

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