Tuesday, June 15, 2021

PEBC Exam: The Management of Multiple Sclerosis

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Overview of Multiple Sclerosis

Multiple Sclerosis (MS) is a progressive and potentially disabling disease of the central nervous system (brain and spinal cord). The hallmark of MS is the destruction of the protective myelin sheath around nerve fibers by the immune system resulting in the impairment of communication between the brain and the rest of the body.

Symptoms of MS depend on the degree of nerve damage. Some patients with severe Multiple Sclerosis may lose the ability to walk independently while others may experience long periods of remission without any new symptoms. Unfortunately, there is no cure for MS. All available treatments help lessen the frequency of relapses and potentially delay the progression of physical disability. Canada has the fifth highest worldwide prevalence of MS, affecting 240 out of every 100,000 people. Relapsing-remitting MS (RRMS) is the most common type of MS, affecting 85 to 90 percent of patients.

Common symptoms may include:

  • Numbness/weakness of limbs and/or trunk affecting typically on one side of the body at a time
  • Unsteady gait, tremors, or lack of coordination
  • Electric-shock sensations occurring with certain neck movements, mostly bending the neck forward known as Lhermitte sign
  • Memory impairment

Vision symptoms may include:

  • Partial or complete loss of vision often with pain affecting typically one eye at a time
  • Blurred vision
  • Double vision

Treatments

For many years, there were limited treatments available in Canada and they were all given by intramuscular or subcutaneous injection. Recently, three new oral drugs have been approved by Health Canada; these more patient-friendly oral drugs have changed the landscape of Multiple Sclerosis treatment in Canada.

 

Summary of MS Drugs in Canada

Name

Drug Administration

Interferon   beta-1a (Avonex or Rebif)

Injection

Interferon   beta-1b (Betaseron or Extavia)

Injection

Glatiramer   acetate (Copaxone)

Injection

Natalizumab (Tysabri)

Infusion

Alemtuzumab (Lemtrada)

Infusion

Fingolimod (Gilenya)

Oral

Dimethyl fumarate (Tecfidera)

Oral

Teriflunomide (Aubagio)

Oral


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Tuesday, April 6, 2021

Free PEBC Exam Preparation Tips

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PEBC Exam Preparation Tips

As a practicing pharmacist or pharmacy technician in Canada, you are expected to be actively engaged in the community you serve to inform and educate. Here is an overview of the key elements of an effective education session in a community.

Step 1: Identify the learning needs of participants. Examples: weight management, smoking cessation, drug therapy compliance, diabetes management, blood pressure control…

Step 2: Identify an educational method that is appropriate for the participants. Examples: scenarios, show and tell, Q&As…

Step 3: Use appropriate communication techniques to deliver the educational session. Examples: live, videos, web-based, prints such as flyers, articles, booklet…

Step 4: Assess the outcomes of the education session against the previously identified learning needs. Examples: ask questions, encourage verbal feedback, written quiz, surveys…

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Saturday, February 27, 2021

PEBC Exam Tips and More

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Cytisine is a new smoking cessation drug approved by Health Canada in August 2017 as a natural health product (NHP) which acts as a partial agonist of the α4β2 nicotinic acetylcholine receptor responsible for the central effects of nicotine. Cytisine is available without a prescription. Here is the detailed dosing regimen of Cytisine in smoking cessation.


Wednesday, February 3, 2021

Free PEBC Exam Practice Questions

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Cytisine is a natural health product approved in August 2017 by Heath Canada as a smoking cessation aid. It works by blocking the effects of nicotine to reduce cravings and withdrawal symptoms. How would you counsel a patient to take cytisine during the first 3 days of treatment?

A. Take 1 capsule once daily with a corresponding reduction of the number of cigarettes smoked
B. Take 1 capsule 2 times daily every 6 hrs with a corresponding reduction of the number of cigarettes smoked
C. Take 1 capsule 3 times daily every 4 hrs with a corresponding reduction of the number of cigarettes smoked
D. Take 1 capsule 6 times daily every 2 hrs with a corresponding reduction of the number of cigarettes smoked
E. Take 1 capsule as needed with a corresponding reduction of the number of cigarettes smoked

Answer: D

Cytisine is a new smoking cessation drug approved by Health Canada in August 2017 as a natural health product (NHP) which acts as a partial agonist of the α4β2 nicotinic acetylcholine receptor responsible for the central effects of nicotine. Cytisine is available without a prescription. Contraindications include arterial hypertension, advanced atherosclerosis, and pregnancy or breastfeeding. The adverse effects reported with Cytisine are largely gastrointestinal (dyspepsia and nausea) and sleep disturbance, which are self-limiting.

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Friday, December 4, 2020

Free PEBC Exam Practice Questions

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Lennox-Gastaut syndrome (LGS) is a severe form of childhood epilepsy that is defined by generalized multiple types seizures, slowness of intellectual growth, and a specific electroencephalogram disturbance. Which of the following cannabinoids is indicated for the treatment of seizures associated with Lennox-Gastaut syndrome?

A. Nabiximols

B. Nabilone

C. CBD

D. Cannabis

E. THC

Answer: C

THC and CBD are the two primary substances found in cannabis. Nabiximols (Sativex) is extracted THC/CBD used to treat advanced cancer pain, Multiple Sclerosis neuropathic pain or spasticity; Nabilone (Cesamet) is THC analog used to treat severe nausea and vomiting due to cancer chemotherapy, AIDS-related anorexia, palliative pain, and neuropathic pain.

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Thursday, February 13, 2020

PEBC Exam Practice Questions

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A 55-year-old patient with Type 2 diabetes mellitus is non-compliant with medication and diet recommendations. The simplest and informative way to assess for past non-compliance and long-term glycemic control would be to perform which of the following tests?

A. Fasting blood glucose test
B. Glucose tolerance test
C. Glycated hemoglobin test
D. Urine ketone test

Answer: C

Glycated hemoglobin or A1C test identifies the three-month average plasma glucose concentration. The test is limited to a three-month average because the maximum lifespan of a red blood cell is 120 days.

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Sunday, December 15, 2019

PEBC Practice Questions

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Parathyroid hormone (PTH) is a peptide hormone produced by the parathyroid gland. Which of the following statements is NOT correct regarding the biological functions of PTH?

  1. Stimulates the activation of vitamin D in kidneys
  2. Increases the level of calcium in blood by stimulating the activity of osteoblasts
  3. Enhances the reabsorption of calcium in kidneys
  4. Increases the level of phosphate in blood by stimulating the activity of osteoclasts
  5. Inhibits the reabsorption of phosphate in kidneys

Answer: B
The level of calcium in blood is increased due to the stimulation of osteoclasts; osteoclasts are bone-resorbing cells.

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