2) This program is accredited for 0.5h CE/#CME for #pharmacists #nurses #physicians in 🇺🇸🇨🇦🇬🇧🇪🇺 and is supported by educational grants from Sanofi-Genzyme and GW Pharma. It is intended for health care professionals. See https://t.co/F9LsuViSoe for prior programs & earn credit.
— MultipleSclerosis_CME (@ms_cme) October 25, 2021
4) . . . as only 1.1 per 100,000 of population & significantly lower compared to other 🇪🇺 countries. In 2019 @EANeurology concluded that there were “not enough neurologists to serve the number of patients with neurological disease”.
— MultipleSclerosis_CME (@ms_cme) October 25, 2021
6) In 2018 the Multiple Sclerosis Trust @MSTrust conducted a survey mapping #multiplesclerosis #nurse provision in 🇬🇧. Concluded an average of 1 nurse per 379 people with MS in UK with 69% of people living in areas where MS nurse caseload was not sustainable. pic.twitter.com/G6FluXSwFc
— MultipleSclerosis_CME (@ms_cme) October 25, 2021
8) There has been a rapid increase in available DMTs over the last decade resulting in an increase pressure on MS services to safely deliver & monitor these treatments https://t.co/0z3TCQMsPT pic.twitter.com/zHR5V8kAmu
— MultipleSclerosis_CME (@ms_cme) October 25, 2021
10) There is a need to diversify roles within the team & adopt a multidisciplinary team (MDT) approach to MS care if we are to improve access to treatment & support for pts on DMTs. #Pharmacists are the specialists in drug therapy & can add value to MS care pic.twitter.com/9jbbY2oJIP
— MultipleSclerosis_CME (@ms_cme) October 25, 2021
12) POLL: do you have a specialist MS pharmacist on your team?
a. Yes Full-time
b. yes but part-time
c. no – we don’t need one
d. no – but we would like one!— MultipleSclerosis_CME (@ms_cme) October 25, 2021
14) …drug interactions, arranging & interpreting monitoring blood tests. Specialty pharmacists also work behind the scenes on managing the DMT supply options, overseeing funding arrangements, writing SOPs & guidelines, & leading on clinical governance & drug safety.
— MultipleSclerosis_CME (@ms_cme) October 25, 2021
16) During the #COVID19 era, pharmacists have been an essential resource for info on vaccination – counselling our patients as data rapidly evolves. For a deep dive, see tweetorial by @GavinGiovannoni, still available for credit at https://t.co/fIjvnqS2Dq. pic.twitter.com/lozUmMRSOy
— MultipleSclerosis_CME (@ms_cme) October 25, 2021
18) Mark your answer and return tomorrow for the correct answer and more education. Follow us and stay up to date on optimal management of #multiplesclersosis! @SKriegerMD @mssociety @mssocietyuk @MSSocietyCanada @KlausSchmierer @TheNeuroAcademy @joelamathews @DrNadiaChaudhri
— MultipleSclerosis_CME (@ms_cme) October 25, 2021
20) Re yesterday's poll: Tough question, but best answer is d. For pts already on a B cell depleting drug there is really no good time to get a COVID booster. B cells remain low for avg 62 weeks after 3 cycles of drug. The interval between infusion & vaccine is unlikely … pic.twitter.com/4QwPZNZ6Vg
— MultipleSclerosis_CME (@ms_cme) October 26, 2021
22) #Pharmacists help to tease out the likelihood of drug interactions. When anticipating side effects or drug interactions it is useful to go back to basics & consider mode of action, metabolism & clearance of a drug.
— MultipleSclerosis_CME (@ms_cme) October 26, 2021
24) Answer – via lungs. 60% of a dose of DMF is eliminated through exhalation of CO2. Only 0.9% eliminated via liver, making interactions with other hepatically metabolised drugs unlikely. Currently no reported drug-drug interactions with DMF.
— MultipleSclerosis_CME (@ms_cme) October 26, 2021
26) Case example: Patient presenting to pharmacy with recurrent thrush. Has tried several topical remedies. Pharmacist establishes that pt is also taking fingolimod, then refers pt to his GP for a review & considerations of more prolonged oral treatment. pic.twitter.com/Nqmqm4nbM0
— MultipleSclerosis_CME (@ms_cme) October 26, 2021
28) Make sure to explore what herbal supplements MS patients may be taking? There are a large number of herbal or complementary medicines that purport to have benefit for PwMS. It is important to include questions about these when taking a patient drug history from your patient.
— MultipleSclerosis_CME (@ms_cme) October 26, 2021
30) Many PwMS take cannabis or preparations containing cannabidiol (CBD). #CBD inhibits cytochrome P450 enzymes involved in the metabolism of many commonly prescribed meds. Concomitant use of CBD and these drugs may increase the serum levels of the drugs and risk adverse events. pic.twitter.com/em9GV4rX6z
— MultipleSclerosis_CME (@ms_cme) October 26, 2021
32) Pharmacists have extensive expertise in drug metabolism and clearance. This has ramifications for sequencing and switching MS DMTs. How long does it take for one to wear off and the next to become effective? These nuances are important for managing this chronic condition.
— MultipleSclerosis_CME (@ms_cme) October 26, 2021
34) Mark your response and return tomorrow for a wrap-up and your link to grab 0.5h CE/#CME from @academiccme! @VictoriaLLV1 @drorlagray @WePharmacists @amyharbour7 @PharmSumrah @monicacmarta @delthomas123 @dr_niall @the_MSBlog @DullPharmacist @neurology_live @BruceWarner
— MultipleSclerosis_CME (@ms_cme) October 26, 2021
36) Yesterday's poll? The answer: 26 days. It takes approx. 4.5 half-lives for a drug to reach negligible levels. So for ocrelizumab the drug is cleared in 4.5 x 26 = 117 days or 16 weeks, …
— MultipleSclerosis_CME (@ms_cme) October 27, 2021
38) Pharmacists also often have opportunities to advise #PwMS on issues around the use of DMTs in the context of family planning, pregnancy & breast feeding. See our earlier #tweetorial on this subject–still available for credit!–at https://t.co/GLjXsscwGg.
— MultipleSclerosis_CME (@ms_cme) October 27, 2021
40) Let me close with an invite to #physicians #nurses #patients reading this #tweetorial, to read “A Day in the Life of an MS pharmacist”https://t.co/BIEkoTKvCb
— MultipleSclerosis_CME (@ms_cme) October 27, 2021
42) And with that, I bid you farewell and best wishes in managing your #PwMS. This is @RayDorsey7 and @SKriegerMD and I hope that you FOLLOW US for more education on managing #multiplesclerosis. And right now you can claim your CE/#CME credit at https://t.co/Niw2CANeRj
— MultipleSclerosis_CME (@ms_cme) October 27, 2021
