Your opinions of pseudoephedrine in stable hypertensive and diabetic patients

[Aznfarmerboi]

I got interested in the subject since almost all of us were taught to be cautioned on sympathomimetics in hypertensive and diabetic patients. However I did a review and it appears that most reports/studies show that the increase is usually 1-2 pressure units systolic and 2-3 pulses in HR only. There were almost no adverse effects reported.

With that in mind, does it really matter? I see a lot of pharmacists directing patients to nasal sprays/normal saline solutions instead once a person say they have hypertension.

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[RxWildcat]

If its controlled hypertension I usually say that a short course of PSE is OK although I typically will warn them that it could spike their BP and they'll want to monitor it a little more closely. If the person recently stroked out then of course not, but just use some common sense.

 

[Aznfarmerboi]

I heard the netti pot does wonders too... I havent read up on that though concerning side effects if there are any.

 

[RxWildcat]

netti pot side effects include: feeling like you're drowning and having snot hang out your nose, at least that was my experience

 

[confettiflyer]

Yeah I had this issue come up as well at my IPPE sites and at work, consensus (on my end) has been that so long as the pt w/ DM is normotensive and w/out any recent complications, limited use of PSE is okay. Stable hypertensive pt's get the OK, but to monitor BP closely and limit use...and to exhaust non-PSE alternatives first (ie saline).

 

[PharmDstudent]

I know pharmacists who recommend PSE if the patient's BP is controlled.

Considering that PE works on alpha receptors instead of alpha and beta receptors like PSE, I would think that PE would be safer.

I don't know if there are any studies comparing saline, PE, and PSE, but maybe they're out there. If you find any, then maybe you could use those to narrow down your choices.

 

[spacecowgirl]

I was very skeptical (and grossed out), but I have to say that the netti pot is pretty awesome. I have horrible sinus problems and it has helped along with Flonase and 2 months of abx. If I have a sinus headache, I do 2 rinses, take some ibuprofen and then I'm only moderately miserable.

 

[PharmDstudent]

I was very skeptical (and grossed out), but I have to say that the netti pot is pretty awesome. I have horrible sinus problems and it has helped along with Flonase and 2 months of abx. If I have a sinus headache, I do 2 rinses, take some ibuprofen and then I'm only moderately miserable.

Awwww... poor you! We have a patient like that. They've tried all sorts of antibiotics (as far as treatment goes), but the only that has worked for sure is frequent and lengthy normal saline rinses PRN from bulk solution bottles.

From what I know about sinusitis, your sinuses have to flow in order for the infections to stay at bay.

 

[prevacid]

some of that stuff i was taught in school is a complete joke (and this would be one of them)

if u have controlled htn, u can take sudafed, end of story

 

[confettiflyer]

PE is crap

 

[PharmDstudent]

PE is crap

I know...

I don't use it, but it works for some people.

 

[confettiflyer]

I know...

I don't use it, but it works for some people.

yeah it's one of those things i'd recommend to someone else, but no one i know. rather, i'd recommend it to a parent who has some suspicion that his/her kid is adept at converting PSE to a more marketable substance.

 

[Aznfarmerboi]

I recommend PSE over PE anytime any days. I think PE does work... but not in the dose that they recommend.

 

[PumpkinSmasher]

I recommend PSE over PE anytime any days. I think PE does work... but not in the dose that they recommend.

Those UoF professors that petitioned the FDA claim it works at 25mg q 4hrs. I will still stick with PSE regardless.

 

[aboveliquidice]

I know pharmacists who recommend PSE if the patient's BP is controlled.

Considering that PE works on alpha receptors instead of alpha and beta receptors like PSE, I would think that PE would be safer.

I don't know if there are any studies comparing saline, PE, and PSE, but maybe they're out there. If you find any, then maybe you could use those to narrow down your choices.

Doesn't PE suck in terms of comparable efficacy???

edit: I really should finish reading the post before replying... I am having another crisis of motivation.

 

[PharmDstudent]

Doesn't PE suck in terms of comparable efficacy???

edit: I really should finish reading the post before replying... I am having another crisis of motivation.

Yeah. Why don't you read the whole post before commenting? *shakes head*

If safety is an issue, then safety should be of greatest importance. I didn't say anything about comparable efficacy.



What is up with this forum lately? Geez... It must be pre-finals stress or something???

 

[Quiksilver]

I ask them if they are stable and at goal... if they are, great PSE is fantastic. i tell them that it will slightly elevate BP, and recommend non-pharmacologic ways to treat HTN while on the med to offset the effects. Not drinking/smoking/cutting down on salt should help simplify the recommendation, right?

 

[dumediat]

I ask them if they are stable and at goal... if they are, great PSE is fantastic. i tell them that it will slightly elevate BP, and recommend non-pharmacologic ways to treat HTN while on the med to offset the effects. Not drinking/smoking/cutting down on salt should help simplify the recommendation, right?

Much, much easier said than done. Usually, when HTN patients come in asking for PSE or PE, I tend to call their physician/cardiologist and ask what they think rather than telling the patient to call their own doctor (unless, of course, it's after hours). I realize that it probably isn't going to be a problem in a controlled patient, but I still don't wanna mess with it unless I'm sure.

 

[PumpkinSmasher]

Much, much easier said than done. Usually, when HTN patients come in asking for PSE or PE, I tend to call their physician/cardiologist and ask what they think rather than telling the patient to call their own doctor (unless, of course, it's after hours). I realize that it probably isn't going to be a problem in a controlled patient, but I still don't wanna mess with it unless I'm sure.

You can usually talk to the patient a little and figure out if they are a good candidate. If patient knows their blood pressure when questioned, knows their medications and roughly how long they have been on them then they give me the impression they are taking a proactive role in their health care and 3 days of some PSE is not going to make them kneel over. Depends on disease states and the information you have at hand definitely though.

You can call PCP but 2 hours when they get back to you the patient will be gone.

 

[Quiksilver]

Much, much easier said than done. Usually, when HTN patients come in asking for PSE or PE, I tend to call their physician/cardiologist and ask what they think rather than telling the patient to call their own doctor (unless, of course, it's after hours). I realize that it probably isn't going to be a problem in a controlled patient, but I still don't wanna mess with it unless I'm sure.

Have you spent any time outside a classroom? I want to know how many cardiologists you've talked to in a community setting to consult about using PSE. Do you write a SOAP note for them as well?

much easier said then done comrade. By the way, eating healthier and drinking less is often not unreasonable for a patient to do for a couple days, especially focusing on the fact that that will help the body fight off their sinus infection. They are more likely to do this on the short term to help get better anyways.

You can usually talk to the patient a little and figure out if they are a good candidate. If patient knows their blood pressure when questioned, knows their medications and roughly how long they have been on them then they give me the impression they are taking a proactive role in their health care and 3 days of some PSE is not going to make them kneel over. Depends on disease states and the information you have at hand definitely though.

You can call PCP but 2 hours when they get back to you the patient will be gone.

thank you. a quick assessment of simply asking where they fall in the BP range shows how much they care. There is more to getting the answer to your question.

 

[confettiflyer]

Have you spent any time outside a classroom? I want to know how many cardiologists you've talked to in a community setting to consult about using PSE. Do you write a SOAP note for them as well?

I know right....this sounds like stupid crap you learn in school that is completely disconnected from the real world.

 

[aboveliquidice]

Yeah. Why don't you read the whole post before commenting? *shakes head*

If safety is an issue, then safety should be of greatest importance. I didn't say anything about comparable efficacy.



What is up with this forum lately? Geez... It must be pre-finals stress or something???

sometimes - I just can't bring myself to read the entire thread... and it is definitely finals -

...and are you giving me attitude??? cause if you are - I like it

 

[dumediat]

Have you spent any time outside a classroom? I want to know how many cardiologists you've talked to in a community setting to consult about using PSE. Do you write a SOAP note for them as well?

much easier said then done comrade. By the way, eating healthier and drinking less is often not unreasonable for a patient to do for a couple days, especially focusing on the fact that that will help the body fight off their sinus infection. They are more likely to do this on the short term to help get better anyways.

I know right....this sounds like stupid crap you learn in school that is completely disconnected from the real world.

Geez, harsh...of course I don't always talk to the actual doctor, but I do at least try to get an idea from the nurse what their last BP was. Working at a slow pharmacy, you have time to do things like that. Or, on clinical rotations while counseling patients, you can just check the chart and page the resident.

The only reason I call is because, in my experience, people just tend to tell you what you want to hear so they can take the pill. Of course, the patients that tend to come into my store are ones that don't respect our opinions much...I guess it depends on the caliber of patient.

I think you guys need to chill out...I'm just putting in my 2 cents...

 

[PharmDstudent]

sometimes - I just can't bring myself to read the entire thread... and it is definitely finals -

...and are you giving me attitude??? cause if you are - I like it

What a rat! Commenting without reading- that should be an SDN felony or something!


I'm giving you a tiny dose of at-ti-tude.

Nah. It was just getting pretty snarky around here...

 

[Quiksilver]

Geez, harsh...of course I don't always talk to the actual doctor, but I do at least try to get an idea from the nurse what their last BP was. Working at a slow pharmacy, you have time to do things like that. Or, on clinical rotations while counseling patients, you can just check the chart and page the resident.

The only reason I call is because, in my experience, people just tend to tell you what you want to hear so they can take the pill. Of course, the patients that tend to come into my store are ones that don't respect our opinions much...I guess it depends on the caliber of patient.

I think you guys need to chill out...I'm just putting in my 2 cents...

We are talking about a community setting. I know in the hospital that it is easier to find blood pressure then the actual patient. I also know if you wanted to know, you can call a nurse and they will tell you it. However, since blood pressure is monitored pretty frequently, most likely the doctors will recognize the rise in BP and adjust HTN doses accordingly. They might not recognize that there is an interaction, but they will know HTN= bad.

Back to the community setting,
The fact is, most people don't know what their blood pressure usually is, most people don't know what is ideal and what is their goal in lowering blood pressure. I think if they have an answer of what their BP is and that they are regularly taking their medications, that is good enough for me. Furthermore, if they ask for a recommendation and I am asking them these questions, obviously its important for them to answer truthfully to the best of their knowledge, because remember, the patient wants to feel better! No reason to lie about blood pressure right?

Just like you critiqued my opinion, I critiqued yours. That really clearly means that I have to "chill out" though, right? Its only fair that you open yourself up to that. Its not my fault that it still sounds impractical. yes you are getting the best information possible from his MD. however in medicine as you know, sometimes getting that info is impossible for whatever reason and you are forced to make a decision in not the best of circumstances. the trick is to use as much of the little information that you have.

 

[dumediat]

Just like you critiqued my opinion, I critiqued yours. That really clearly means that I have to "chill out" though, right? Its only fair that you open yourself up to that. Its not my fault that it still sounds impractical. yes you are getting the best information possible from his MD. however in medicine as you know, sometimes getting that info is impossible for whatever reason and you are forced to make a decision in not the best of circumstances. the trick is to use as much of the little information that you have.

Well, to be fair I didn't question whether you have any practice experience, but meh..I was just giving my opinion (like the topic says) that I wouldn't give it to a HTN patient without an OK from the MD. So, if I can't get the info from the MD, I would say to the patient, "No, you can't take it without your MD saying it's OK."