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Communicating Awareness of (NSAIDs) Risk Effectively (CARE) - Part III
Certified for 1 AMA PRA Category 1 Credit™
Presented by the University of Alabama School of Medicine
Division of Continuing Medical Education
| Release Date: February 27, 2009 |
Expiration Date: February 27, 2012 |
CME Information
Target Audience:
Primary care physicians
Objectives:
Upon completion of this CME activity, participants should be able to:
- Recognize the effects of NSAIDs on renal function and hypertension
- Describe the "triple whammy effect" caused by concomitant use of NSAIDs, ACE inhibitors, and diuretics, which has the potential to lead to renal failure
- List two ways to describe NSAIDs risk information to patients
- Describe a culturally sensitive model of shared medical decision-making that can be used when working with patients for whom an NSAID might be appropriate
- Describe strategies for reducing physician's own biases and for addressing biases and stereotyping in others.
Source:
Author:
Janice Weatherspoon, MD
Fellow
Department of Medicine, Division of Nephrology
University of Alabama School of Medicine, UAB
Birmingham, Alabama
Co-Editors:
Jeroan J. Allison, MD, MS
Katie Crenshaw, JD, MSEd
Carlos Estrada, MD, MS
Trudi Horton, PhD
Michael Schoen, PhD
University of Alabama School of Medicine, Division of CME
Disclosure:
Dr. Weatherspoon has disclosed an honorarium from Pfizer. Ms. Crenshaw, Dr. Horton, and Dr. Schoen have disclosed receipt of grant funding from Pfizer. The UAB Division of CME has implemented its mechanism to resolve this potential conflict of interest by validating the content contained herein. Drs. Allison and Estrada have no commercial affiliations to disclose.
This educational initiative is supported through an unrestricted educational grant from Pfizer, Inc.
Because of the nature of preliminary studies, some products mentioned are unlabeled and investigational. Dosages, indications, and methods of use of drugs mentioned in this publication may reflect the experience of the authors, clinical literature, or other resources. Therefore, please see the full prescribing information before using any licensed product mentioned.
CME Participation:
To participate in this online course for CME credit, please review the objectives before beginning the program. Complete the course and the self-assessment test before February 27, 2012 to receive CME credit. Your certificate will then be available online. This process should take approximately 1 hour.
Accreditation:
The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The University of Alabama School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
The boards of nursing in many states, including Alabama, recognize Category 1 continuing medical education courses as acceptable activities for the renewal of license to practice nursing.
Disclaimer:
Dosages, indications, and methods of use of any drug referred to in this publication may reflect the clinical experience of the authors, clinical literature, or other clinical resources. Therefore, please see the full prescribing information before using any product mentioned. UAB is an equal opportunity/affirmative action institution.
Course Introduction:
Non-steroidal anti-inflammatory drugs (NSAIDs) are some of the most commonly prescribed medications, but they frequently lead to adverse events. In addition, racial disparities exist in NSAIDs risk awareness, patient-doctor risk communication, and NSAIDs risk behavior. Provision of culturally competent care is one effective means of closing such health disparities and of delivering high-quality care to all patients.
The Division of Continuing Medical Education at UAB has developed a special series of three online courses focusing on effective strategies for discussing the risks and benefits of NSAIDs with patients from diverse backgrounds. These online courses were designed for primary care physicians and other healthcare professionals like you who aspire to excellence in all aspects of practice. Each online course is founded in scientific evidence and illustrates practical techniques you can apply immediately to your work.
Case 1:
Mr. B is a 67-year-old African-American man who presents to your office after accidentally sustaining a fall two days prior. He has a history of hypertension and congestive heart failure which has been well compensated. He denies any recent hospitalizations since his last visit.
Today, Mr. B has no complaints with the exception of right hip pain which developed following his fall. He reports while at the ER, he was given a prescription for Tylenol #3, but does not plan on filling it because he “doesn’t want to get addicted.” Current medications are unchanged since last visit and include simvastatin 20mg qhs,doxazosin mesylate 4mg qhs, metoprolol 50mg bid, furosemide 20 mg bid and fosinopril sodium 20mg bid.
On exam, his blood pressure is 132/78 mmHg, HR 66/min with trace ankle edema but is otherwise normal. Laboratory findings notable for a serum creatinine 1.6 mg/dL (baseline serum creatinine ranges between 1.4-1.7.) Urinalysis is negative.
Given his past medical history, you are concerned about initiating a nonsteroidal anti-inflammatory medication. However, Mr. B reports that he “needs something” for pain. You recommend Tylenol, but he doesn’t think it will help. Reluctantly, you prescribe Naproxen 500mg twice daily for pain management and schedule a follow-up visit in 6 months.
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