Page 76 - Retail Pharmacy Magazine October 2020

74 CPD ACTIVITY FROM PAGE 73 also a concern in this age group.12 Topical NSAIDs have been shown to have some benefit in pain relief, mainly in patients with knee osteoarthritis. Because of minimal systemic absorption, topical NSAIDs are considerably safer than oral NSAIDs and are considered a first-line option, particularly in people with an increased risk of adverse effects.12 They may be applied to the affected area three to four times daily.11,12 Paracetamol, at a dose of 1g four to six hourly as necessary, up to a maximum of 4g daily can be used for pain. Although it has been the analgesic of choice for osteoarthritis for many years, it is no longer recommended as first-line by osteoarthritis guidelines, due to lack of efficacy.12 Role of the pharmacist Many pharmacists may be unfamiliar with Paget disease due its decreasing incidence in the population and because the primary treatment, intravenous zoledronic acid, takes place in a community infusion centre or GP surgery. However, pharmacists still have a role to play in giving reassurance and advice on how to take risedronate and how to recognise signs of adverse effects. They also have an important role in advising on the suitability of different types of analgesia, particularly for patients with pre-existing hypertension, heart failure and gastritis. Conclusion Paget disease is a condition often found by chance via X-rays for another condition or on a routine liver function test. The outlook is good for most patients, particularly if treatment is provided before any significant complications develop.4 Bisphosphonate treatment can provide a remission for many and the use of intravenous zoledronate has simplified treatment to a single, once-in-a-lifetime treatment for many people. References 1. Bone and Metabolism Expert Group. Bone and Metabolism, version2. Melbourne. Therapeutic Guidelines; 2019. At: tg.org.au 2. Britton C, Walsh J. ‘Paget disease of bone’. Australian Family Physician, 2012; 41 (3) 100-103. 3. Cundy T. ‘Paget’s disease of bone’. Metabolism, 2018 Mar 1; 80: 5-14. 4. Charles J. BMJ Best Practice. ‘Paget disease of bone’. 2019. At: bestpractice.bmj.com 5. Ralston SH, Corral-Gudino L, Cooper C, Francis RM, Fraser WD, Gennari L, Guañabens N, Javaid MK, Layfield R, O’Neill TW, Russell RG. ‘Diagnosis and management of Paget’s disease of bone in adults: A clinical guideline’. Journal of Bone and Mineral Research, 2019; 34 (4): 579-604. 6. Australian Medicines Handbook (online). Adelaide: Australian Medicines Handbook Pty Ltd;2020. At: amhonline.amh.net.au 7. Reid IR, Miller P, Lyles K, Fraser W, Brown JP, Saidi Y, Mesenbrink P, Su G, Pak J, Zelenakas K, Luchi M. ‘Comparison of a single infusion of zoledronic acid with risedronate for Paget’s disease’. New England Journal of Medicine, 2005; 353 (9): 898-908. 8. Reid IR, Lyles K, Su G, Brown JP, Walsh JP, del Pino-Montes J, Miller PD, Fraser WD, Cafoncelli S, Bucci-Rechtweg C, Hosking DJ. ‘A single infusion of zoledronic acid produces sustained remissions in Paget disease: Data to 6.5 years’. Journal of Bone and Mineral Research, 2011; 26 (9): 2261-70. 9. Wat WZ. ‘Current perspectives on bisphosphonate treatment in Paget’s disease of bone’. Therapeutics and Clinical Risk Management, 2014; 10: 977. 10.Medicinewise News, Jan 2020. NPS Medicinewise At: nps.org.au 11. Rheumatology Expert Group. Rheumatology, version 3. Melbourne. 2019. Therapeutic Guidelines. At: tg.org.au. 12.Shirley PY, Hunter DJ. ‘Managing osteoarthritis’. Australian Prescriber, 2015 Aug; 38 (4): 115. 13.Adami S, Pavelka K, Cline GA, Hosterman MA, Barton IP, Cohen SB, Bensen WG. ‘Upper gastrointestinal tract safety of daily oral risedronate in patients taking NSAIDs: A randomised, double-blind, placebo-controlled trial’. InMayo Clinic Proceedings, 2005; 80 (10): 1278-1285. Elsevier. 14.Stockleys Drug Interactions, 2015. Medicines Complete. The Royal Pharmaceutical Society. 2020. London Accreditation number: A2010RP2 (Exp. 30/09/2022). This activity has been accredited for 1 hour of Group One CPD (or 1 CPD credit) suitable for inclusion in an individual pharmacist’s CPD plan, which may be converted to 1 hour of Group Two CPD (or 2 CPD credits) upon successful completion of the associated assessment activity. 1. The primary abnormality which causes Paget disease of bone is: A) Abnormally large osteoclasts causing excessive bone resorption. B) Abnormally large osteoblasts causing increased bone formation. C) Hypocalcaemia. D) Vitamin D deficiency. 2. The imaging test recommended for diagnosis of Paget disease of bone is: A) Magnetic resonance imaging (MRI). B) Computed tomography (CT). C) X-rays. D) Radionuclide bone scans. 3. When used as a treatment for Paget disease, zoledronic acid is usually given: A) Once a year for three years. B) Once a month for three months. C) Once only. D) Once every three years. 4. Ken comes into the pharmacy and tells you he is due to have a zoledronic acid infusion next week for his Paget disease. He asks what the most common adverse effect is and what can he do about it. You reply: A) Gastritis and heartburn. Take a proton pump inhibitor. B) Osteonecrosis of the jaw. See his dentist. C) Heart failure. Watch for puffy ankles. D) Fever and flu-like symptoms. Take paracetamol. 5. The most suitable analgesic for someone with osteoarthritis of the knee secondary to Paget disease is: A) An oral NSAID. B) A topical NSAID. C) Paracetamol. D) Oxycodone.. Paget disease of bone 2 CPD CREDITS RETAIL PHARMACY • OCT 2020