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CONTINUING PROFESSIONAL DEVELOPMENT
up to 3 times a day.20 In addition, where
appropriate, patients can use topical or
oral NSAIDs for additional pain relief.
However, in patients with comorbid
gastrointestinal, cardiovascular and
renal conditions, NSAIDs may not be
suitable.20 Intra-articular corticosteroids
may also be useful for the short-term
relief of a flare-up in symptoms,
or to treat and acute deterioration in
symptoms.20 There is limited evidence to
support non-pharmacological treatment
options for osteoarthritis, such as
topical application of cold or heat,
acupuncture, massage, taping of joints
and exercise therapy.
Six weeks later, Mrs Kelly returns to your
pharmacy for some of her prescriptions.
She mentions that she is feeling much
better, and her dizziness, heartburn
and swollen ankles have disappeared.
She is thankful that she stopped in to
speak with you, as she was unaware
that she had caused her symptoms by
taking a medicine that had not been
recommended by you or her doctor.
Mrs Kelly assures you that she will
check all her medicines with you in the
future, and says she is now considering
a dose administration aid (DAA) from
KEY LEARNING POINTS
• There are a variety of potential
causes of non-specific symptoms
such as dizziness, heartburn and
fluid retention. It is prudent that
pharmacists ascertain a detailed
patient history, to determine current
medicines, including any OTC or
• In some cases, patients start taking a
new medicine without being aware
of its potential adverse effects or drug
interactions. As such, patients should
be encouraged to discuss all of their
medicines with their pharmacist or
doctor, to ensure they are suitable for
their condition and safe for use.
1. Labuguen RH. Initial evaluation of vertigo. Am Fam
Physician 2006;73(2):244–51. At: www.aafp.org/
2. Tucci DL. Dizziness and vertigo. In: Merck Manuals
Professional Version. 2013. At: www.merckmanuals.com/
3. Lanier JB, Mote MB, Clay EC. Evaluation and management
of orthostatic hypotension. Am Fam Physician
2011;84(5):527–36 . At: www.aafp.org/afp/2011/0901/
4. Penninx BW, Pluijm SM, Lips P, et al. Late-life anemia is
associated with increased risk of recurrent falls. J Am Geriatr
Soc 2005;53(12):2106–11 .
5. Thomas DR, Cote TR, Lawhorne L, et al. Understanding
clinical dehydration and its treatment. J Am Med Dir Assoc
6. Mayo Clinic. Dehydration. At: www.mayoclinic.org/
7. Ronkainen J, Agreus L. Epidemiology of reflux symptoms
and GORD. Best Pract Res Clin Gastroenterol 2013;27:325–
8. DiMarino MC. Gastroesophageal reflux disease (GERD).
In: Merck manuals Professional Version. 2014. At: www.
9. Eberhardt RT, Raffeto JD. Chronic venous insufficiency.
10. Nesto RW, Bell D, Bonow RO, et al. Thiazolidinedione use,
fluid retention, and congestive heart failure: a consensus
statement from the American Heart Association and
American Diabetes Association. October 7, 2003.
Circulation 2003;108(23):2941–8 .
11. Blakley B, Gulati H. Identifying drugs that cause dizziness.
J Otolaryngol Head Neck Surg 2008;37(1):11–15.
12. Rossi S, ed. Australian medicines handbook. Adelaide:
Australian Medicines Handbook; 2015. At: www.amh.net.
13. Mayo Clinic. Dizziness: symptom. 2015. At: www.mayoclinic.
14. Mayo Clinic. GERD. 2015. At: www.mayoclinic.org/
15. Cho S, Atwood JE. Peripheral edema. Am J Med
16. Shoair OA, Nyandege AN, Slattum PW. Medication-related
dizziness in the older adult. Otolaryngol Clin North Am
17. Ray WA, Stein CM, Hall K, et al. Non-steroidal anti-
inflammatory drugs and risk of serious coronary
heart disease: an observational cohort study. Lancet
18. Bleumink GS, Feenstra J, Sturkenboom MC, et al.
Nonsteroidal anti-inflammatory drugs and heart failure.
19. Cannon CP, Curtis SP, FitzGerald GA, et al. Cardiovascular
outcomes with etoricoxib and diclofenac in patients
with osteoarthritis and rheumatoid arthritis in the
Multinational Etoricoxib and Diclofenac Arthritis Long-term
(MEDAL) programme: a randomised comparison. Lancet
20. Rheumatology Expert Group. Therapeutic guidelines:
rheumatology. Version 2. Melbourne: Therapeutic
Guidelines Ltd; 2010.
1. Vertigo is a common cause of
dizziness. It can be caused by:
a) A sudden drop in diastolic blood
b) Increased venous pressure.
c) Decreased cardiovascular function.
d) Malfunction of the peripheral vestibular
a) Can be associated with an increased
falls risk in the older population.
b) Can cause extreme dryness of the
mucous membranes of the mouth and
c) Can be associated with venous
d) Can cause fluid retention of the
3. Which ONE of the following
medicines has been widely
implicated in the development of
4. In the treatment of osteoarthritis:
a) Intra-articular corticosteroids are used
for long-term symptom control.
b) 1 g of paracetamol every 4–6 hours can
assist with symptom relief.
c) 1 g paracetamol modified-release only
once a day provides optimal symptom
d) There is a wide body of evidence to
support exercise therapy as a non-
pharmacological treatment option.
a) Do not suppress the formation of
b) Are the first-line treatment option for
c) Are not associated with causing fluid
d) Can suppress prostacyclin and result in
adverse cardiovascular effects.
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