101
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Abstract
BACKGROUND The 2013 Society of Critical Care Medicine guidelines for the management of pain, agitation, and delirium in adult intensive care unit (ICU) patients recommend intravenous opioids as first-line therapy to treat nonneuropathic pain. There is a paucity of literature describing possible benefits of utilizing specific opioids over others in ICU patients. OBJECTIVE The objective was to identify rationales for the transition from continuous infusion fentanyl to continuous infusion hydromorphone in critically ill patients. METHODS This was a single-center, prospective, observational analysis of adult ICU patients who were transitioned from fentanyl to hydromorphone. The major end point was to characterize the primary reason for transition. Minor end points included secondary reason(s) for transition, transition dosing, changes in continuous sedative requirements, and level of sedation. RESULTS Forty-six patients were included in the analysis. The primary rationale for transition was ventilator compliance (28.3%), followed by tachyphylaxis or better pain control (19.6%), and reduction in sedatives (13.0%). The most common secondary reason(s) for transition included reduction in sedatives (47.8%), opioid rotation (32.6%), and obesity (30.4). Median fentanyl rate of 100 µg/h was transitioned to 1 mg/h of hydromorphone. The percentage of patients requiring the use of continuous sedatives was decreased in the 24 hours following transition (P = .005); however, patients were more deeply sedated (P = .02). CONCLUSION Rationales for transition were to improve ventilator compliance, optimize patient-specific pharmacokinetics, and limit overall sedative exposure.
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Affiliation(s)
- Mary P Kovacevic
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Paul M Szumita
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Kevin M Dube
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeremy R DeGrado
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
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102
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Abstract
The landscape of drug information is growing, leading to information overload from various avenues, both scientific and public opinion. The completeness of these resources are not well-studied and no standardizations exist for these databases. Thus, it is not uncommon to have missing information across the drug information resources used by healthcare professionals. Such gaps in these resources may lead to fatal and nonfatal incidences if more than one resource is not consulted. To date, there have been numerous medication errors reported in the literature. In an effort to review the data found in drug information resources, we conducted a comprehensive search of the PubMed, Embase, and EBSCO electronic databases from January 2000 to January 2017, using the terms “drug information,” “medical information,” and “drug information resource.” A total of 14 articles were identified and five were included in our review, which evaluated the differences between drug information resources. Two articles evaluated pharmacogenomics information, one was infectious disease-specific, one evaluated usability as well as other factors, and the last evaluated general content. Overall, there was consistency across the articles in that they each reported on disparities in drug information among several drug information resources. Drug information keeps changing, and it is imperative that healthcare professionals have access to multiple resources to ensure the accuracy and completeness of information. We strongly encourage the standardization of drug information content on drug information resources as well as the information made available from pharmaceutical companies, as it may refine the quality of drug information provided to help prevent medication errors and adverse drug events.
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Affiliation(s)
| | - Hoang A Huynh
- The University of Arkansas for Medical Sciences College of Pharmacy, Arkansas Children's Hospital, Little Rock, USA
| | - Zhen Zhang
- Department of Pharmacy, Memorial Healthcare System, Hollywood, USA
| | - Janie Robles
- Pharmacy Practice School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, USA
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103
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Abstract
OBJECTIVE To review efficacy and safety of the glucagon-like peptide-1 receptor agonist (GLP-1 RA) semaglutide for type 2 diabetes (T2D). DATA SOURCES A literature search of PubMed/MEDLINE and EMBASE using the term semaglutide was completed through April 2018. A search of clinicaltrials.gov was also conducted. STUDY SELECTION AND DATA EXTRACTION English-language studies assessing the efficacy and/or safety of semaglutide were evaluated. DATA SYNTHESIS Semaglutide is a newly approved GLP-1 RA for the treatment of T2D. Administered once weekly at a dose of 0.5 or 1 mg, it has been compared with placebo, sitagliptin, insulin glargine, a combination of oral antidiabetic therapies, and 2 GLP-1 RAs, exenatide ER and dulaglutide, and demonstrated greater efficacy compared with these therapies. Published data from studies ranging from 30 to 104 weeks duration demonstrate efficacy with decreases in hemoglobin A1C (A1C) ranging from 1.1% to 2.2%. Studies show reductions in weight from 1.4 to 6.5 kg. Semaglutide demonstrated a reduction in the composite outcome of cardiovascular (CV) death, nonfatal myocardial infarction, or nonfatal stroke compared with placebo in patients at high risk of CV events (hazard ratio = 0.74; P = 0.02). Common adverse effects include nausea, vomiting, and diarrhea as seen with other GLP-1 RAs. Relevance to Patient Care and Clinical Practice: Semaglutide represents an attractive GLP-1 RA considering its A1C and weight reduction. It provides patient convenience and high patient satisfaction. CONCLUSIONS Semaglutide is an appealing option for the treatment of T2D as a once-weekly GLP-1 RA with established glycemic, CV, and weight benefits.
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Affiliation(s)
- Rhianna M Tuchscherer
- 1 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Angela M Thompson
- 1 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Jennifer M Trujillo
- 1 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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104
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Abstract
Adverse effects of linezolid are typically limited to diarrhea, nausea, and headache when shorter durations are used; however, as extended durations of linezolid therapy are increasingly more common, additional monitoring parameters should be considered in these patients. We describe a unique case of hypoglycemia, lactic acidosis, and pancreatitis related to an extended duration of linezolid therapy. A 52-year-old woman presented with altered mental status, abdominal pain, and hypotension following six weeks of linezolid and ertapenem therapy. Laboratory data revealed an initial blood glucose of 40 mg/dL and metabolic acidosis secondary to lactic acidosis. Finally, her abdominal pain on admission was likely related to an enlarged pancreas noted on computed tomography of her abdomen. Due to suspected linezolid toxicity, the patient received two intermittent hemodialysis sessions to remove linezolid and correct the metabolic acidosis. Given limited data on long-term monitoring of patients receiving extended durations of linezolid therapy, we suggest periodic monitoring of lactate, arterial blood gas, and blood glucose. If patients present with this triad of symptoms secondary to linezolid therapy, adverse effects should be treated with dextrose and intravenous thiamine while reserving hemodialysis for those with metabolic acidosis refractory to thiamine.
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Affiliation(s)
- Philip E Tobias
- Department of Pharmacy, Rush University Medical Center, Chicago, IL, USA
| | | | - Amy P Hanson
- Department of Pharmacy, Rush University Medical Center, Chicago, IL, USA
| | - Payal K Gurnani
- Department of Pharmacy, Rush University Medical Center, Chicago, IL, USA
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105
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Chie QT, Tam CL, Bonn G. Malaysians' Preferences and Concerns Regarding Seeking Information About Illegal Drugs. Front Public Health 2018; 6:143. [PMID: 29868548 PMCID: PMC5966702 DOI: 10.3389/fpubh.2018.00143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/30/2018] [Indexed: 11/13/2022] Open
Abstract
A brief survey asked Malaysians if they had searched for information about illegal drugs and their thoughts about the information available. Two hundred and eighty participants from four states: Selangor, Penang, Malacca, and Johor filled out a paper-and-pencil survey including both multiple choice and open-ended written questions. Quantitative analyses of closed-ended, and thematic analyses of open-ended data indicated the following: Half of participants had, at some point, actively searched for information about drug use; 28% reported searching at least once per month. Participants generally (79%) preferred to obtain information online, but 62% also reported sharing and obtaining information about drugs in face-to-face interactions with friends and others. Concerns regarding the reliability of information, such as the presence of conflicting or contradictory messages from multiple sources, was a common theme in open ended responses. Of those who searched for information, about 70% reported desiring more detailed information about different drugs, in particular about their various side effects and risks. It is suggested that drug information campaigns, particularly those aimed at university students, might better focus on providing accurate, detailed information about the risks and other issues involved in various types of drug use, rather than one-size-fits-all messages. Given the varied and confusing nature of information already available, overly simplistic anti-drug messages may be ineffective, if not counterproductive.
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Affiliation(s)
- Qiu Ting Chie
- Psychology, Universiti Tunku Abdul Rahman, Petaling Jaya, Malaysia
| | - Cai Lian Tam
- Psychology, Monash University Malaysia, Jeffrey Cheah School of Medicine and Health Sciences, Bandar Sunway, Malaysia
| | - Gregory Bonn
- Psychology, General Studies, King Fahd University of Petroleum and Minerals, Dhahran, Saudi Arabia
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106
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Abstract
Hereditary transthyretin amyloidosis is an inherited disorder that results in the gradual progressive deposit of abnormal protein called amyloid in the body's organs and tissues. There are currently no approved drugs to treat transthyretin amyloidosis, and patients may require liver transplantation for survival. There are a few drugs in development to treat hereditary transthyretin amyloidosis either by stabilizing the abnormal protein or by decreasing production of transthyretin. Both methods are being developed to slow progression of the disease.
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107
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Vishwanathan K, Dickinson PA, So K, Thomas K, Chen Y, De Castro Carpeño J, Dingemans AC, Kim HR, Kim J, Krebs MG, Chih‐Hsin Yang J, Bui K, Weilert D, Harvey RD. The effect of itraconazole and rifampicin on the pharmacokinetics of osimertinib. Br J Clin Pharmacol 2018; 84:1156-1169. [PMID: 29381826 PMCID: PMC5980546 DOI: 10.1111/bcp.13534] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 01/09/2023] Open
Abstract
AIMS We investigated the effects of a strong CYP3A4 inhibitor (itraconazole) or inducer (rifampicin) on the pharmacokinetics of the epidermal growth factor receptor-tyrosine kinase inhibitor osimertinib, in patients with advanced non-small cell lung cancer in two Phase I, open-label, two-part clinical studies. Part one of both studies is reported. METHODS In the itraconazole study (NCT02157883), patients received single-dose osimertinib 80 mg on Days 1 and 10 and itraconazole (200 mg twice daily) on Days 6-18 orally. In the rifampicin study (NCT02197247), patients received osimertinib 80 mg once daily on Days 1-77 and rifampicin 600 mg once daily on Days 29-49. RESULTS In the itraconazole study (n = 36), the geometric least squares mean (GMLSM) ratios (osimertinib plus itraconazole/osimertinib alone) for Cmax and AUC were 80% (90% CI 73, 87) and 124% (90% CI 115, 135), respectively, below the predefined no-effect upper limit of 200%. In the rifampicin study (n = 40), the GMLSM ratios (osimertinib plus rifampicin/osimertinib alone) for Css,max and AUCτ were 27% (90% CI 24, 30) and 22% (90% CI 20, 24), respectively, below the predefined no-effect lower limit of 50%. The induction effect of rifampicin was apparent within 7 days of initiation; osimertinib Css,max and AUCτ values returned to pre-rifampicin levels within 3 weeks of rifampicin discontinuation. No new osimertinib safety findings were observed. CONCLUSIONS Osimertinib can be co-administered with CYP3A4 inhibitors, but strong CYP3A inducers should be avoided if possible.
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Affiliation(s)
| | | | - Karen So
- Global Medicines Development / Global Clinical DevelopmentAstraZenecaCambridgeUK
| | - Karen Thomas
- Biostatistics and InformaticsAstraZenecaMacclesfieldUK
| | - Yuh‐Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, and School of MedicineNational Yang‐Ming Medical UniversityTaipeiTaiwan
| | | | | | - Hye Ryun Kim
- Yonsei Cancer Center, Division of Medical Oncology, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Joo‐Hang Kim
- CHA Bungdang Medical CenterCHA UniversityGyeonggi‐doRepublic of Korea
| | - Matthew G. Krebs
- The Christie NHS Foundation Trust, Manchester UK and Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
| | | | - Khanh Bui
- Quantitative Clinical PharmacologyAstraZenecaWalthamMAUSA
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108
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Bejan‐Angoulvant T, Genet T, Vrignaud L, Angoulvant D, Fauchier L. Three case reports of involuntary muscular movements as adverse reactions to sacubitril/valsartan. Br J Clin Pharmacol 2018; 84:1072-1074. [PMID: 29512176 PMCID: PMC5903246 DOI: 10.1111/bcp.13545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/12/2018] [Accepted: 01/28/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | - Laura Vrignaud
- Regional Center of PharmacovigilanceCHRU de ToursToursFrance
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109
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Tsuchiya M, Esashi A, Obara T, Inooka K, Mano N, Takamura C. Effect of Educational Interventions on Adverse Drug Reaction Reporting in a Cancer Institute in Japan: A Questionnaire Study. Hosp Pharm 2018; 54:93-99. [PMID: 30923401 DOI: 10.1177/0018578718769242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Limited data regarding knowledge and factors related to understanding the adverse drug reaction (ADR) reporting system of health care professionals are available in Japan. Objective: The objective of this study was to identify factors related to understanding the ADR reporting system in Miyagi Cancer Center and to find ways to increase the number and quality of ADR reports. Methods: Self-administered questionnaire surveys were administered before and after the educational meeting among health care professionals who were working in our hospital during the study period. Subanalyses restricted to nurses were also performed. Main Outcome Measure: Understanding ADR reporting system among healthcare professionals. Results: The percentage of respondents who understood the ADR reporting system in the questionnaire after the educational meeting was significantly higher than that in the questionnaire before the educational meeting. In the questionnaire after the educational meeting, multivariate logistic regression analysis found that having over 30 years of practical experience (odds ratio [OR], 3.852; 95% confidence interval [CI], 1.228-12.081 for 20-29 years, 7.695; 1.650-35.881 for over 30 years), being a physician (8.071; 1.923-33.878), being a pharmacist (18.357; 3.847-87.585), and participating in the educational meeting (5.111; 1.700-15.365) were factors associated with understanding the ADR reporting system. Multivariate logistic regression analysis of the questionnaire results before the educational meeting among nurses showed that working at outpatient departments (8.330; 3.008-23.069) was significantly and independently associated with understanding the ADR reporting system. Conclusions: The present study demonstrated that many years of practical experience, profession (physicians, pharmacists), and educational interventions were associated with good understanding of the ADR reporting system among health care professionals.
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Affiliation(s)
- Masami Tsuchiya
- Miyagi Cancer Center, Natori, Miyagi, Japan.,Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi, Japan
| | | | - Taku Obara
- Tohoku University Hospital, Sendai, Miyagi, Japan
| | | | - Nariyasu Mano
- Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Miyagi, Japan.,Tohoku University Hospital, Sendai, Miyagi, Japan
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110
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Dahn R, Walker S. New Medications in the Treatment of Acute Decompensated Heart Failure. Hosp Pharm 2018; 53:85-87. [PMID: 29581599 DOI: 10.1177/0018578717750096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute decompensated heart failure is a sudden worsening of heart failure symptoms, typically resulting in peripheral edema and dyspnea as a result of pulmonary congestion. Acute decompensated heart failure is responsible for over 1 million hospitalizations every year. Current pharmacologic therapy is limited in its options. Despite an improved survival rate, statistic still suggests that about 50% of patients die within 5 years of diagnosis. New pharmacologic agents aim to improve efficacy by targeting previously unexplored physiological pathways.
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Affiliation(s)
- Ryan Dahn
- Prescribe Right, LLC, Wildwood, MO, USA
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111
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Abstract
Adenosine is a potent endogenous mediator of vasodilation. Compounded sterile solutions of adenosine are used in cardiac catheterization lab to perform stress tests on the heart. These tests are used to determine the fractional flow reserve (FFR) and are commonly used in the management and diagnosis of cardiovascular conditions. The purpose of this study was to assess the physical and chemical stability of 2 mg/mL adenosine in 0.9% Sodium Chloride Injection, USP in polyvinyl chloride [PVC]) and polyolefin infusion bags stored at room temperature (20°C-25°C) and under refrigeration (2°C-8°C). The compounding and analytical methods used in this study were very similar to those described in the prior publications from the authors' laboratory. To ensure a uniform starting concentration of all stability samples, a batch of 2 mg/mL adenosine solution was prepared and then packaged into empty PVC and polyolefin infusion bags. These stability samples were prepared in triplicate for each bag type and storage temperature (a total of 12 samples). The infusion bag samples were assessed for stability immediately after preparation and after 1 day, 3 days, 7 days, and 14 days. At each time point, the infusion bags were first visually inspected against a light background for color change, clarity, and particulates. Aliquots were drawn from each sample at each time point for pH analysis and high-performance liquid chromatography (HPLC) analysis. Over 14 days of storage at room temperature or refrigeration, no considerable change in visual appearance or pH was observed in any bags. All samples retained 90% to 110% of the initial drug concentration. No significant degradation peaks were observed in the HPLC chromatograms.
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Affiliation(s)
| | | | | | | | - Fang Zhao
- Wegmans School of Pharmacy, Rochester, NY, USA
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112
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Ohno Y. [Quantitative Prediction of Drug-Drug Interaction Caused by CYP Inhibition and Induction from In Vivo Data and Its Application in Daily Clinical Practices-Proposal for the Pharmacokinetic Interaction Significance Classification System (PISCS)]. YAKUGAKU ZASSHI 2018; 138:337-345. [PMID: 29503426 DOI: 10.1248/yakushi.17-00191-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Drug-drug interactions (DDIs) can affect the clearance of various drugs from the body; however, these effects are difficult to sufficiently evaluate in clinical studies. This article outlines our approach to improving methods for evaluating and providing drug information relative to the effects of DDIs. In a previous study, total exposure changes to many substrate drugs of CYP caused by the co-administration of inhibitor or inducer drugs were successfully predicted using in vivo data. There are two parameters for the prediction: the contribution ratio of the enzyme to oral clearance for substrates (CR), and either the inhibition ratio for inhibitors (IR) or the increase in clearance of substrates produced by induction (IC). To apply these predictions in daily pharmacotherapy, the clinical significance of any pharmacokinetic changes must be carefully evaluated. We constructed a pharmacokinetic interaction significance classification system (PISCS) in which the clinical significance of DDIs was considered in a systematic manner, according to pharmacokinetic changes. The PISCS suggests that many current 'alert' classifications are potentially inappropriate, especially for drug combinations in which pharmacokinetics have not yet been evaluated. It is expected that PISCS would contribute to constructing a reliable system to alert pharmacists, physicians and consumers of a broad range of pharmacokinetic DDIs in order to more safely manage daily clinical practices.
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Affiliation(s)
- Yoshiyuki Ohno
- Department of Pharmacy, The University of Tokyo Hospital, Faculty of Medicine, The University of Tokyo
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113
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Abstract
The warfarin management strategy for a mechanical mitral valve patient initiated on a ritonavir-based hepatitis C treatment regimen is described. A 62-year-old male with a past medical history of hepatitis C genotype 1a and stable warfarin dose history was initiated on a concomitant Viekira Pak® (VP) regimen containing ritonavir. Prior to initiation of the VP for hepatitis C treatment, the patient was stable on a warfarin dose of 40 mg/wk for 5 months. During treatment with VP, the patient experienced a markedly decreased international normalized ratio (INR) and warfarin requirements ultimately increased 125% from baseline (90 mg/wk). Effective anticoagulation management throughout and surrounding the treatment period for hepatitis C involved frequent warfarin dose adjustments, including preemptive changes, close monitoring, and repeated use of enoxaparin to ensure adequate thrombotic prophylaxis. This is believed to be the first reported case describing the management of warfarin in a patient with hepatitis C who received VP and required a drastically increased weekly warfarin dose. The possible mechanisms suggestive of this interaction and similar case reports in the literature are discussed.
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114
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Sieg AC, Gass JA. Bivalirudin Medication Use Evaluation and Cost Savings Initiative. Hosp Pharm 2017; 52:522-526. [PMID: 29276283 DOI: 10.1177/0018578717720508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bivalirudin is a parenteral anticoagulant that elicits its effect through inhibition of both free and clot bound-thrombin. Inhibition of thrombin serves as a unique mechanism for anticoagulation when compared to heparin as thrombin serves as the final common pathway for the intrinsic and extrinsic coagulation cascades. Due to unclear benefit over heparin, concerns regarding reversibility, and most importantly cost its use as a parenteral anticoagulant varies by institution. A recent drug expenditure review within our institution noted a significant increase in the contribution bivalirudin had on the overall drug budget. In an effort to establish the rationale for the cost increase, a medication use evaluation was performed. While it was discovered that 625 out of 1364 days of bivalirudin therapy were potentially avoidable, an equally important discovery was the amount of waste that was associated with bivalirudin therapy. Calculating daily requirements for bivalirudin indicated that 60% of patients required less than 100 mg per day. Within this article, we describe a cost-savings initiative to reduce bivalirudin waste and the resulting cost-avoidance following implementation.
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115
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Hu J, Walker S. Cholesterol Ester Transfer Protein Inhibitor Review. Hosp Pharm 2017; 52:596-598. [PMID: 29276295 DOI: 10.1177/0018578717729669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Treatment of blood cholesterol is part of a strategy to lower atherosclerotic cardiovascular (ASCVD) risk. While use of HMG-CoA reductase inhibitors to modify cholesterol levels is the primary means of lowering the risk of an ASCVD event, residual risk remains. A new strategy being investigated is the use of cholesterol ester transfer protein (CETP) inhibitors to raise the levels of high-density lipoprotein cholesterol (HDL-C) and lower low-density lipoprotein cholesterol (LDL-C). While initial large-scale studies demonstrated no reduction of cardiovascular events, one CETP inhibitor, anacetrapib, has demonstrated a reduction in cardiovascular events in the REVEAL trial.
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Affiliation(s)
- Jerry Hu
- St. Louis College of Pharmacy, MO, USA
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116
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Abstract
Migraine is a common disorder affecting 12% of the U.S. POPULATION Prophylaxis is recommended for patients who experience frequent migraines. Because current drugs used for prophylaxis are not 100% effective and cause adverse effects that affect compliance, new strategies have been studied to prevent headaches. One new pharmacologic strategy is to use an inhibitor of the calcitonin gene-related peptide (CGRP). As a class, the CGRP receptor inhibitors have reduced monthly migraine days and are well tolerated. This article will briefly review CGRP inhibitors in development.
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117
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Tomita T. [Research on Insufficient Information for Pharmaceutical Products]. YAKUGAKU ZASSHI 2017; 137:1497-1504. [PMID: 29199258 DOI: 10.1248/yakushi.17-00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Several issues concerning medicines remain unclear, including the availability of known, but not easily recognizable information. This review evaluates the mechanisms of side effects and the various risk indications included in package inserts. The results can be summarized as follows. 1) Short-term exposure to gatifloxacin significantly induced insulin secretion and increased the cytosolic Ca2+ concentration of islet cells by augmenting extracellular Ca2+ influx and its release from the endoplasmic reticulum. Alternatively, there was a decline in the cellular insulin level and reactivity to sulfonylurea after prolonged exposure. The insulin depletion was greater than that produced by other fluoroquinolones. 2) The elution of di(2-ethylhexyl)phthalate (DEHP) from the infusion set could be associated with the solubilizers in the injection medicines. The package inserts of several products containing polysorbate or ethanol had no warning about DEHP. Although there was a slight correlation between polysorbate content and descriptions on package inserts, the use of DEHP-containing devices was prohibited for some products, even with limited amounts of polysorbate. Therefore, the package insert statements should be reviewed to reflect appropriately the extent of DEHP elution. 3) Risk management plan consists of strategies to minimize the potential risks of medicines. One approach could be to introduce reminders on package inserts; however, of 268 potential risks associated with 81 products, 56 were not mentioned in package inserts. Because most postmarketing pharmacovigilance plans depend on spontaneous reporting by healthcare personnel, the descriptions on package inserts should be reexamined.
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Affiliation(s)
- Takashi Tomita
- Department of Pharmaceutical Services, Hiroshima University Hospital
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118
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Gotlib D, Bostwick JR, Calip S, Perelstein E, Kurlander JE, Fluent T. Collaborative Care in Ambulatory Psychiatry: Content Analysis of Consultations to a Psychiatric Pharmacist. Psychopharmacol Bull 2017; 47:41-46. [PMID: 28936009 PMCID: PMC5601088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To determine the volume and nature (or topic) of consultations submitted to a psychiatric pharmacist embedded in an ambulatory psychiatry clinic, within a tertiary care academic medical center and to increase our understanding about the ways in which providers consult with an available psychiatric pharmacist. EXPERIMENTAL DESIGN Authors analyze and describe the ambulatory psychiatric pharmacist consultation log at an academic ambulatory clinic. All consultation questions were submitted between July 2012 and October 2014. PRINCIPAL OBSERVATIONS Psychiatry residents, attending physicians, and advanced practice nurse practitioners submitted 280 primary questions. The most common consultation questions from providers consulted were related to drug-drug interactions (n =70), drug formulations/dosing (n =48), adverse effects (n =43), and pharmacokinetics/lab monitoring/cross-tapering (n =36). CONCLUSIONS This is a preliminary analysis that provides information about how psychiatry residents, attending physicians, and advanced practice nurse practitioners at our health system utilize a psychiatric pharmacist. This collaborative relationship may have implications for the future of psychiatric care delivery.
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Affiliation(s)
- Dorothy Gotlib
- Drs. Gotlib, MD, Calip, MD, and Fluent, MD, Michigan Medicine, Department of Psychiatry, Ann Arbor, MI. Dr. Bostwick, PharmD, BCPS, BCPP, University of Michigan College of Pharmacy, Ann Arbor, MI. Dr. Perelstein, BS, Washington St. Louis School of Medicine, Department of Neurology, St. Louis, Missouri. Dr. Kurlander, MD, MS, Michigan Medicine, Division of Gastroenterology, Ann Arbor, MI
| | - Jolene R Bostwick
- Drs. Gotlib, MD, Calip, MD, and Fluent, MD, Michigan Medicine, Department of Psychiatry, Ann Arbor, MI. Dr. Bostwick, PharmD, BCPS, BCPP, University of Michigan College of Pharmacy, Ann Arbor, MI. Dr. Perelstein, BS, Washington St. Louis School of Medicine, Department of Neurology, St. Louis, Missouri. Dr. Kurlander, MD, MS, Michigan Medicine, Division of Gastroenterology, Ann Arbor, MI
| | - Seema Calip
- Drs. Gotlib, MD, Calip, MD, and Fluent, MD, Michigan Medicine, Department of Psychiatry, Ann Arbor, MI. Dr. Bostwick, PharmD, BCPS, BCPP, University of Michigan College of Pharmacy, Ann Arbor, MI. Dr. Perelstein, BS, Washington St. Louis School of Medicine, Department of Neurology, St. Louis, Missouri. Dr. Kurlander, MD, MS, Michigan Medicine, Division of Gastroenterology, Ann Arbor, MI
| | - Elizabeth Perelstein
- Drs. Gotlib, MD, Calip, MD, and Fluent, MD, Michigan Medicine, Department of Psychiatry, Ann Arbor, MI. Dr. Bostwick, PharmD, BCPS, BCPP, University of Michigan College of Pharmacy, Ann Arbor, MI. Dr. Perelstein, BS, Washington St. Louis School of Medicine, Department of Neurology, St. Louis, Missouri. Dr. Kurlander, MD, MS, Michigan Medicine, Division of Gastroenterology, Ann Arbor, MI
| | - Jacob E Kurlander
- Drs. Gotlib, MD, Calip, MD, and Fluent, MD, Michigan Medicine, Department of Psychiatry, Ann Arbor, MI. Dr. Bostwick, PharmD, BCPS, BCPP, University of Michigan College of Pharmacy, Ann Arbor, MI. Dr. Perelstein, BS, Washington St. Louis School of Medicine, Department of Neurology, St. Louis, Missouri. Dr. Kurlander, MD, MS, Michigan Medicine, Division of Gastroenterology, Ann Arbor, MI
| | - Thomas Fluent
- Drs. Gotlib, MD, Calip, MD, and Fluent, MD, Michigan Medicine, Department of Psychiatry, Ann Arbor, MI. Dr. Bostwick, PharmD, BCPS, BCPP, University of Michigan College of Pharmacy, Ann Arbor, MI. Dr. Perelstein, BS, Washington St. Louis School of Medicine, Department of Neurology, St. Louis, Missouri. Dr. Kurlander, MD, MS, Michigan Medicine, Division of Gastroenterology, Ann Arbor, MI
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Munsour EE, Awaisu A, Hassali MAA, Darwish S, Abdoun E. Readability and Comprehensibility of Patient Information Leaflets for Antidiabetic Medications in Qatar. J Pharm Technol 2017; 33:128-136. [PMID: 34860991 PMCID: PMC5998532 DOI: 10.1177/8755122517706978] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Background:The readability and comprehensibility of the patient information leaflets (PILs) provided with antidiabetic medications are of questionable standards; this issue negatively affects adherence to drug therapy, especially in patients with limited literacy skills. Objective: To evaluate the readability and comprehensibility of PILs supplied with medications used for the treatment of type 2 diabetes mellitus in Qatar. Methods: All PILs of the antidiabetic medications in Qatar were evaluated using the Flesch Reading Ease (FRE) score for readability. The Flesch-Kincaid Grade Level, Gunning-Fog Index, and SMOG Grading were used to estimate the comprehensibility of PILs in terms of school grade levels. Results: A total of 45 PILs were evaluated: 32 (71.1%) PILs of brand-name products and 13 (28.9%) for generics. Nine (20%) of the PILs were in English only; 8 (17.8%) were in English, Arabic, and French; and 28 (62.2%) were in English and Arabic. The mean FRE score was 37.71 (±15.85), and the most readable PIL had FRE score of 62. The mean scores for the comprehensibility evaluations were 10.96 (±2.67), 15.02 (±2.52), and 11.41 (±1.6) for the Flesch-Kincaid Grade Level, Gunning-Fog Index, and SMOG Grading, respectively. The most commonly used antidiabetic medication was metformin with 1372.9 (±552.9) as PILs' mean number of words. Conclusion: Only 2.2% of PILs had acceptable readability scores. All PILs could be comprehended by at least an 11th grade student, which exceeds the recommended grade level for health-related materials. Approximately 20% of these PILs were in English only and were not readable by most patients.
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Affiliation(s)
| | | | | | - Sara Darwish
- Hamad General Hospital, Hamad Medical
Corporation, Doha, Qatar
| | - Einas Abdoun
- Hamad General Hospital, Hamad Medical
Corporation, Doha, Qatar
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Abstract
Quetiapine, an atypical antipsychotic used in the intensive care unit (ICU) to manage delirium, has a possible adverse effect of corrected QT (QTc) interval prolongation. The objective of this analysis was to describe the impact of quetiapine on QTc interval prolongation in critically ill patients. This was a single-center, prospective cohort analysis of ICU patients who received quetiapine between October 2015 and February 2016. The major end point was the incidence of QTc prolongation greater than 60 milliseconds above baseline during therapy. Minor end points included median change in QTc interval and incidence of Torsades de Pointes (TdP). Univariate and multivariable analyses were performed to determine variables associated with higher risk of QTc prolongation. During the study period, 103 patients were enrolled in the analysis. QTc interval prolongation greater than 60 milliseconds occurred in 14 (13.6%) patients. The median change in QTc interval was 20 milliseconds. There were no cases of TdP. On multivariable analysis, the only variable associated with higher incidence of QTc prolongation was administration of a concomitant medication known to prolong the QTc interval ( P = .046). QTc prolongation was relatively uncommon among critically ill patients utilizing quetiapine. Patients receiving concomitant medications known to prolong the QTc interval may be at an increased risk.
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Affiliation(s)
- Kevin M Dube
- 1 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeremy DeGrado
- 1 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Paul M Szumita
- 3 Critical Care, Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
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Abstract
OBJECTIVE To review the safety and efficacy of obiltoxaximab, a monoclonal antibody indicated for the treatment of Bacillus anthracis inhalational anthrax in adult and pediatric patients. DATA SOURCES A MEDLINE (1946 to May, week 1, 2017) and EMBASE (1980 to 2017, week 19) search was performed using the search terms obiltoxaximab OR ETI-204 OR Anthim AND anthrax. STUDY SELECTION AND DATA EXTRACTION All English-language clinical studies in both animal and human models assessing the safety and efficacy of obiltoxaximab were included. DATA SYNTHESIS A total of 5 articles have been published on clinical studies examining safety and efficacy of obiltoxaximab. Efficacy studies in 2 animal models, New Zealand White rabbits and cynomolgus macaques, showed higher rates of survival post-anthrax exposure when obiltoxaximab was administered. Safety studies in healthy human volunteers showed that it was tolerated, with a relatively low incidence of adverse events. CONCLUSION Based on these clinical studies and the implausibility of conducting a trial in infected individuals, obiltoxaximab is a safe and efficacious addition to the anthrax antitoxin armamentarium to protect against and treat inhalational anthrax.
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Affiliation(s)
- Audrey W Hou
- 1 Sanofi Genzyme/MCPHS University, Cambridge, MA, USA
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Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a common pathogen in infants with cystic fibrosis (CF). The use of palivizumab prophylaxis for RSV infection as the standard of care for infants with CF remains controversial. OBJECTIVE To evaluate the efficacy of palivizumab in reducing the incidence of RSV hospitalization in children with CF who are younger than 2 years. METHODS Four electronic databases (PubMed, Embase, CINAHL, and CENTRAL) were searched from inception until January 31, 2017, for clinical studies investigating the use of palivizumab in infants with CF aged less than 2 years. The primary outcome was hospitalization rate due to RSV infection. Secondary outcomes included hospitalization for respiratory illness, length of hospital stay, safety (adverse effects), and cost-effectiveness of palivizumab prophylaxis. RESULTS The review included a total of 10 studies (six cohort studies, two before-and-after studies, one cross-sectional study, and one randomized controlled trial) involving 3891 patients with CF. Seven studies reported that palivizumab prophylaxis had a positive impact on the rate of RSV hospitalization. Five studies (n=3404) reported that palivizumab prophylaxis significantly reduced the rate of hospitalization due to RSV infection compared to no prophylaxis. One study (n=5) demonstrated patients with CF who received palivizumab had no RSV hospitalization. Another study showed infants with CF receiving palivizumab (n=117) had a lower risk of hospitalization for RSV infection compared with premature infants (gestational age < 35 completed weeks) who received palivizumab (n=4880). CONCLUSIONS Evidence from the literature suggests that palivizumab may have a potential role in reducing RSV hospitalization in children aged less than 2 years with CF. Given the lack of overall data, additional research is warranted to better understand the efficacy and safety of prophylactic palivizumab in infants with CF.
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Affiliation(s)
- Kok Pim Kua
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor Darul Ehsan, Malaysia.,Department of Pharmacy, Petaling District Health Office (Ministry of Health Malaysia), Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor Darul Ehsan, Malaysia
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Avasarala J, Jain S, Urrea-Mendoza E. Approach to Fingolimod-Induced Lymphopenia in Multiple Sclerosis Patients: Do We Have a Roadmap? J Clin Pharmacol 2017; 57:1415-1418. [PMID: 28543950 DOI: 10.1002/jcph.945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 04/17/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Jagannadha Avasarala
- Department of Medicine, Division of Neurology, USC School of Medicine, Greenville Health System, Greenville, SC, USA
| | - Sandip Jain
- Department of Medicine, Division of Neurology, USC School of Medicine, Greenville Health System, Greenville, SC, USA
| | - Enrique Urrea-Mendoza
- Department of Medicine, Division of Neurology, USC School of Medicine, Greenville Health System, Greenville, SC, USA
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125
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Caraci F, Enna SJ, Zohar J, Racagni G, Zalsman G, van den Brink W, Kasper S, Koob GF, Pariante CM, Piazza PV, Yamada K, Spedding M, Drago F. A new nomenclature for classifying psychotropic drugs. Br J Clin Pharmacol 2017; 83:1614-1616. [PMID: 28401576 DOI: 10.1111/bcp.13302] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/06/2017] [Accepted: 03/26/2017] [Indexed: 12/01/2022] Open
Abstract
The Neuroscience-based Nomenclature (NbN) for psychotropic drugs was developed as an alternative to the current Anatomical Therapeutic Chemical (ATC) indication-based classification in order to provide more precise designations for this drug class. The ATC nomenclature for psychotherapeutics is limited in that it fails to specify either pharmacological domains or mechanism of action and also does not describe all the potential uses of a particular agent. The disconnect between the drug classification and its clinical use is not very useful for scientific purposes and is confusing for patients and caregivers, often leading to a misunderstanding of the intended effects of the prescribed medication and, most importantly, to low treatment adherence. The NbN classifies psychopharmacological agents on the basis of contemporary scientific information on their pharmacology and mechanisms of action so as to provide physicians clear alternatives when selecting or altering therapeutic regimens. The classification of each psychotropic drug includes four additional dimensions: approved indications; efficacy and side effects; practical note; neurobiology. By emphasizing the pharmacology and the molecular mechanism of action, NbN provides a vehicle for clinicians and basic scientists to improve the understanding and clinical use of this important drug class.
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Affiliation(s)
- Filippo Caraci
- Department of Drug Sciences, University of Catania, Catania, Italy.,Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Sam J Enna
- Department of Molecular and Integrative Physiology, Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph Zohar
- Department of Psychiatry, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Giorgio Racagni
- Department of Pharmacological and Biomolecolar Sciences, University of Milan, Milan, Italy
| | - Gil Zalsman
- Geha Mental Health Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, New York, USA
| | - Wim van den Brink
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Siegfried Kasper
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel, 18-201090, Vienna, Austria
| | - George F Koob
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Baltimore, Maryland, USA.,National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Pier Vincenzo Piazza
- Inserm U1215, Neurocentre Magendie, Physiopathology of Addiction Group, Bordeaux, France.,Université de Bordeaux, Bordeaux, France
| | - Kiyofumi Yamada
- Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan
| | - Michael Spedding
- Spedding Research Solutions SAS, 6 Rue Ampere, Le Vesinet, 78110, France
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.,Unifarm Research Centre, Catania, Italy
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Hauser K, Koerfer A, Niehaus M, Albus C, Herzig S, Matthes J. The prescription talk - an approach to teach patient-physician conversation about drug prescription to medical students. GMS J Med Educ 2017; 34:Doc18. [PMID: 28584866 PMCID: PMC5450434 DOI: 10.3205/zma001095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 01/31/2017] [Accepted: 02/15/2017] [Indexed: 06/07/2023]
Abstract
Background: Medication communication from physicians to patients often is poor, by this among others enhancing the risk of non-adherence. In this context, a neglect regarding the prescription talk has been complained. Aim of the project: In a newly developed elective medical students work on physician-patient conversations dealing with drug prescription. Essential aspects related to an effective and safe drug treatment are combined with steps of shared decision-making. Together with a tutor, students develop a (model) conversation guide that might be tailored according to individual needs and views. Description/Methods: In a one-week course 3rd-5th year medical students treat a paper case according to problem-based learning. This is accompanied by a one-hour lecture and literature provided on an online learning platform (ILIAS). During a workshop, aspects of drug treatment and patient participation are integrated into a guide for a prescription talk. At the end of the week the students are invited to apply the (if need be individualized) guide in a simulated physician-patient communication with an actor. The conversation is evaluated using a checklist based upon the (model) conversation guide. Results: Informal and formalized feedback indicate high acceptance and satisfaction of participants with this elective. The checklist turned out to be of acceptable to good reliability with mostly selective items. Portfolio entries and written evaluation suggest that participants' positions and attitudes are influenced.
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Affiliation(s)
- Katarina Hauser
- Universität zu Köln, Zentrum für Pharmakologie, Institut II, Köln, Deutschland
| | - Armin Koerfer
- Uniklinik Köln, Klinik und Poliklinik für Psychosomatik und Psychotherapie, Köln, Deutschland
| | - Mathilde Niehaus
- Universität zu Köln, Humanwissenschaftliche Fakultät, Lehrstuhl für Arbeit und Berufliche Rehabilitation, Köln, Deutschland
| | - Christian Albus
- Uniklinik Köln, Klinik und Poliklinik für Psychosomatik und Psychotherapie, Köln, Deutschland
| | - Stefan Herzig
- Universität zu Köln, Zentrum für Pharmakologie, Institut II, Köln, Deutschland
- Universität zu Köln, Rektorat, Köln, Deutschland
| | - Jan Matthes
- Universität zu Köln, Zentrum für Pharmakologie, Institut II, Köln, Deutschland
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Ting CY, Abd Wahab MS, Lee KS, Tan RTH, Ming LC. A Cross-Sectional Study on the Use of, Preference for, and Perceived Reliability of Mass Media for Drug-Related Information Among the General Public in Sarawak. Ther Innov Regul Sci 2017; 51:212-220. [PMID: 30231729 DOI: 10.1177/2168479016674041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Because of the large size of Sarawak and the high proportion of people residing in rural areas in this Malaysian state, disseminating drug-related information there can be challenging. It is, therefore, important to recognize the type of mass media for drug-related information that are salient to the people of Sarawak. This study was aimed at identifying the use of and the preferences for mass media to obtain drug-related information among the public in Sarawak. We also aimed to recognize the media perceived as the most reliable for drug-related information. METHODS This was a cross-sectional study using a self-administered questionnaire carried out from September to October 2013. Survey respondents were recruited from 4 divisions in Sarawak: Kuching, Sibu, Miri, and Bintulu. RESULTS A total of 433 completed questionnaires were obtained at the end of the study period. All respondents had access to common mass media such as television (89.8%, 389/433), radio (68.6%, 297/433), and the Internet (66.1%, 286/433). Among all respondents, television (71.4%, 309/433) was noted as the most preferred media for drug-related information. Compared with rural respondents, urban respondents were significantly more likely to have access to and prefer the Internet to obtain drug-related information. On the other hand, rural respondents were more likely to have access to and prefer radio for such information compared to their urban counterparts. CONCLUSIONS Television can be an important and attractive choice of mass media in a quality use of medicines (QUM) campaign. The Internet can be used to disseminate drug-related information in urban areas, whereas radio can be used in a QUM campaign targeting the rural public.
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Affiliation(s)
- Chuo Yew Ting
- 1 Pharmaceutical Services Division, Sarawak State Health Department, Malaysia
| | - Mohd Shahezwan Abd Wahab
- 2 Vector-borne Diseases Research Group (VERDI), Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Kah Seng Lee
- 3 Pharmaceutical Services Division, Ministry of Health, Petaling Jaya, Selangor, Malaysia
| | - Robin Tiow-Heng Tan
- 4 Pharmaceutical Services Division, Malacca State Health Department, Malaysia
| | - Long Chiau Ming
- 2 Vector-borne Diseases Research Group (VERDI), Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia.,5 Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Australia
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128
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Borja-Hart N, Hohmeier KC. Availability of drug information on community pharmacy websites in Tennessee. Int J Pharm Pract 2017; 25:244-247. [PMID: 28181321 DOI: 10.1111/ijpp.12350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 01/05/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study reports the availability and type of drug information resources on community pharmacy websites in Tennessee. METHODS A list of pharmacies was obtained from the Tennessee Board of Pharmacy. All community pharmacies located in Tennessee with a website were evaluated. Community pharmacy websites that listed a drug information resource were further analysed into pharmacy type and drug information provider. KEY FINDINGS One hundred and sixty-nine websites were evaluated. Thirty-six websites listed a drug information resource. Fifty per cent of those sites used the drug information provider RxWiki. Other providers included drugs.com, First Data Bank, A.D.A.M., RxList, Gold Standard Multimedia and Express Scripts. CONCLUSION Community pharmacy websites are underutilized as a provider for credible drug information for the public.
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Affiliation(s)
- Nancy Borja-Hart
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, College of Pharmacy, Nashville, TN, USA
| | - Kenneth C Hohmeier
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, College of Pharmacy, Nashville, TN, USA
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Leceta A, Sologuren A, Valiente R, Campo C, Labeaga L. Bilastine in allergic rhinoconjunctivitis and urticaria: a practical approach to treatment decisions based on queries received by the medical information department. Drugs Context 2017; 6:212500. [PMID: 28210286 PMCID: PMC5299972 DOI: 10.7573/dic.212500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Bilastine is a safe and effective commonly prescribed non-sedating H1-antihistamine approved for symptomatic treatment in patients with allergic disorders such as rhinoconjunctivitis and urticaria. It was evaluated in many patients throughout the clinical development required for its approval, but clinical trials generally exclude many patients who will benefit in everyday clinical practice (especially those with coexisting diseases and/or being treated with concomitant drugs). Following its introduction into clinical practice, the Medical Information Specialists at Faes Farma have received many practical queries regarding the optimal use of bilastine in different circumstances. DATA SOURCES AND METHODS Queries received by the Medical Information Department and the responses provided to senders of these queries. RESULTS The most frequent questions received by the Medical Information Department included the potential for drug-drug interactions with bilastine and commonly used agents such as anticoagulants (including the novel oral anticoagulants), antiretrovirals, antituberculosis regimens, corticosteroids, digoxin, oral contraceptives, and proton pump inhibitors. Most of these medicines are not usually allowed in clinical trials, and so advice needs to be based upon the pharmacological profiles of the drugs involved and expert opinion. The pharmacokinetic profile of bilastine appears favourable since it undergoes negligible metabolism and is almost exclusively eliminated via renal excretion, and it neither induces nor inhibits the activity of several isoenzymes from the CYP 450 system. Consequently, bilastine does not interact with cytochrome metabolic pathways. Other queries involved specific patient groups such as subjects with renal impairment, women who are breastfeeding or who are trying to become pregnant, and patients with other concomitant diseases. Interestingly, several questions related to topics that are well covered in the Summary of Product Characteristics (SmPC), which suggests that this resource is not being well used. CONCLUSIONS Overall, this analysis highlights gaps in our knowledge regarding the optimal use of bilastine. Expert opinion based upon an understanding of the science can help in the decision-making, but more research is needed to provide evidence-based answers in certain circumstances.
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Affiliation(s)
- Amalia Leceta
- Medical Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Ander Sologuren
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Román Valiente
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Cristina Campo
- Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
| | - Luis Labeaga
- Medical Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
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130
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Abstract
Shortages and sudden price increases of certain drugs may both occur emergently, with little to no warning, and they can have a dramatic impact on patient care. Little data are available linking drug shortages and price increases. Many of the same characteristics that may make medications susceptible to shortages can also place them at risk for sudden price increases. These characteristics include unapproved drugs, off-patent sole-source medications, and infrequently used medications. We reviewed drug shortage data from the University of Utah Drug Information Service to demonstrate how frequently these characteristics occurred and resulted in higher drug prices. Clinicians can use drug shortage management principles to mitigate the impact of sudden price increases for patients and health care organizations.
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Affiliation(s)
- Erin R Fox
- Department of Pharmacy, University of Utah Health Care, Salt Lake City, Utah
| | - Linda S Tyler
- Department of Pharmacy, University of Utah Health Care, Salt Lake City, Utah
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131
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Send AFJ, Peters-Klimm F, Bruckner T, Haefeli WE, Seidling HM. A randomized controlled trial to assess the effect of a medication plan containing drug administration recommendations on patients' drug knowledge after 2 months. J Clin Pharm Ther 2016; 42:69-74. [PMID: 27796035 DOI: 10.1111/jcpt.12476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 10/03/2016] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Patients' drug administration errors are often promoted by poor drug knowledge resulting from inadequate oral or written information. It has previously been shown that a medication plan enhanced with graphical and textual information on drug handling (enhanced medication plan) proved to immediately increase patients' drug knowledge. This study aimed to evaluate the effect of the enhanced medication plan on drug knowledge in outpatients after 2 months (intervention group) compared to patients with a simple medication plan with standard information (control group). METHODS We recruited patients using ≥5 drugs in four family practices in Germany. After inclusion, patients' knowledge on handling of their drugs was assessed using three questions from a standardized catalog. Thereafter, patients were randomized to the intervention or control group. After 2 months, drug knowledge was reassessed with three different questions from the same standardized catalog. RESULTS AND DISCUSSION Of 120 enrolled patients, 75% of participants in the control group (42/60 patients) and 78% of participants in the intervention group (46/60; P = 0·71) completed the study. Baseline drug knowledge was similar in both groups (43·7% vs. 40·6% correct answers). After 2 months, patients' drug knowledge showed an absolute increase of 23·2% in the intervention group (P < 0·01) and was unchanged in the control group (46·0%; P = 0·70). WHAT IS NEW AND CONCLUSION The enhanced medication plan outperformed the effect of a simple medication plan and persistently increased the fraction of correct answers of polypharmacy patients. This demonstrates that the enhanced medication plan may be a useful tool in promoting drug knowledge.
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Affiliation(s)
- A F J Send
- Cooperation Unit Clinical Pharmacy, Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - F Peters-Klimm
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - W E Haefeli
- Cooperation Unit Clinical Pharmacy, Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - H M Seidling
- Cooperation Unit Clinical Pharmacy, Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
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132
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Dickinson R, Raynor DK, Knapp P, MacDonald J. Do Patients Use a Headline Section in a Leaflet to Find Key Information About Their Medicines? Findings From a User-Test Study. Ther Innov Regul Sci 2016; 50:581-591. [PMID: 30231767 DOI: 10.1177/2168479016639080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the European Union (EU), all medicines are mandated to be provided with a patient information leaflet (PIL). Many patients express concerns about the length and complexity of some PILs, and this can be a disincentive for patients to read the PILS. In order to address this, the UK's regulatory body (Medicine and Healthcare products Regulatory Agency [MHRA]) suggested leaflets might include a headline section-information presented prominently at the beginning of a leaflet that summarizes key safety messages about a drug. OBJECTIVE To explore the extent to which readers used a headline section in a PIL, using a form of diagnostic testing called user-testing, which examines how readers find and understand key information. METHODS The study used a cross-sectional design to user-test a PIL with a headline section in a target sample of 20 participants. Participants were provided with an exemplar PIL, and the performance of the PIL was evaluated by a questionnaire and semistructured interview. RESULTS The results showed that a headline section was used just over one-third of the time (39%); 90% of participants used the headline section to find information when they initially began the user-test. The qualitative findings suggested that the participants valued the presence of the headline section. CONCLUSION The research suggests there does not appear to be any negative impact from including a headline section in a PIL, and it is a technique that is highly valued by the consumers of medicines information.
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Affiliation(s)
| | - David K Raynor
- 1 School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Peter Knapp
- 2 Department of Health Sciences, University of York and the Hull York Medical School, York, United Kingdom
| | - Jan MacDonald
- 3 Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
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Bahri S, Lee KS, Adenan MA, Murugiah MK, Khan TM, Neoh CF, Long CM. Dikir Farmasi: folk songs for health education. Arts Health 2016; 8:272-278. [PMID: 27695527 PMCID: PMC5020322 DOI: 10.1080/17533015.2016.1182195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/08/2016] [Indexed: 11/06/2022]
Abstract
In an effort to enhance public awareness, we develop Dikir Farmasi as an innovative approach to deliver health information. Dikir Farmasi combines the elements of dikir barat (a type of traditional folk song rhythm) and traditional sketches which are popular in the state of Kelantan, Malaysia. These sketches and dikir barat rhythmic songs, with lyrics touch on issues such as drug abuse and regulation are presented in an entertaining and humorous way. Health promotion messages are disseminated using Dikir Farmasi in the form of compact disks, video compact disks, stage performance, exhibition, social media, printed media (signboard, brochure and flyer).
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Affiliation(s)
- Salmah Bahri
- Pharmaceutical Services Division, Ministry of Health Malaysia, Petaling Jaya, Malaysia
| | - Kah Seng Lee
- Pharmaceutical Services Division, Ministry of Health Malaysia, Petaling Jaya, Malaysia
| | - Mohammad Aswady Adenan
- Kelantan State Health Department, Pharmaceutical Services Division, Kota Bharu, Malaysia
| | - Muthu Kumar Murugiah
- Penang State Health Department, Pharmaceutical Services Division, Penang, Malaysia
| | | | - Chin Fen Neoh
- Faculty of Pharmacy, Department of Pharmacy Practice, Universiti Teknologi MARA (UiTM), Puncak Alam, Malaysia
| | - Chiau Ming Long
- Faculty of Pharmacy, Department of Pharmacy Practice, Universiti Teknologi MARA (UiTM), Puncak Alam, Malaysia
- Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Hobart, Australia
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134
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Hincapie AL, Cutler TW, Fingado AR. Incorporating Health Information Technology and Pharmacy Informatics in a Pharmacy Professional Didactic Curriculum -with a Team-based Learning Approach. Am J Pharm Educ 2016; 80:107. [PMID: 27667844 PMCID: PMC5023978 DOI: 10.5688/ajpe806107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 12/09/2015] [Indexed: 06/06/2023]
Abstract
Objective. To incorporate a pharmacy informatics program in the didactic curriculum of a team-based learning institution and to assess students' knowledge of and confidence with health informatics during the course. Design. A previously developed online pharmacy informatics course was adapted and implemented into a team-based learning (TBL) 3-credit-hour drug information course for doctor of pharmacy (PharmD) students in their second didactic year. During a period of five weeks (15 contact hours), students used the online pharmacy informatics modules as part of their readiness assurance process. Additional material was developed to comply with the TBL principles. Online pre/postsurveys were administered to evaluate knowledge gained and students' perceptions of the informatics program. Assessment. Eighty-three second-year students (84% response rate) completed the surveys. Participants' knowledge of electronic health records, computerized physician order entry, pharmacy information systems, and clinical decision support was significantly improved. Additionally, their confidence significantly improved in terms of describing health informatics terminology, describing the benefits and barriers of using health information technology, and understanding reasons for systematically processing health information. Conclusion. Students responded favorably to the incorporation of pharmacy informatics content into a drug information course using a TBL approach. Students met the learning objectives of seven thematic areas and had positive attitudes toward the course after its completion.
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Affiliation(s)
- Ana L. Hincapie
- University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Timothy W. Cutler
- University of California-San Francisco School of Pharmacy, San Francisco, California
| | - Amanda R. Fingado
- University of California-San Francisco School of Pharmacy, San Francisco, California
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135
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Abstract
OBJECTIVE The purpose of this study was to determine how well patients could correctly recognize and comprehend the various information items in over-the-counter (OTC) medications package leaflets in Saudi Arabia. METHODS Leaflets from 20 most commonly sold OTC medications were examined by experts to evaluate the leaflet layout, language, and content. The same leaflets were also evaluated by patients who had their medicines dispensed at 2 hospitals and 8 community pharmacies in Al Kharj, Saudi Arabia. A questionnaire was used for the patients' examination. RESULTS A total of 479 questionnaires were included in the study. Each package leaflet was examined by at least 20 participants. The results indicate poor comprehensibility, for many items, particularly items regarding "drug interactions" and "contraindications." CONCLUSION The participants had some difficulty recognizing and comprehending certain information items in the package leaflets that are supplied with OTC medications in Saudi Arabia.
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Affiliation(s)
- Sinaa Alaqeel
- 1 Clinical Pharmacy Department, King Saud University, Riyadh, Saudi Arabia
| | - Nahed Al Obaidi
- 2 Pharmacy services Department, King Khalid Hospital, Al Kharj, Saudi Arabia
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136
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Abstract
Good medicines information is critical to medical practice. Choose high-quality, pre-appraised sources first and make sure they are current. Select the information that is most relevant to the needs of your particular patient. Take the time to become familiar with the features of the resources you use. Australian Medicines Handbook, Therapeutic Guidelines, Australian Prescriber and NPS MedicineWise cover most routine clinical practice needs.
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Affiliation(s)
- Richard O Day
- Clinical Pharmacology and Toxicology, St Vincent's Hospital, UNSW Medicine, Sydney
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137
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Wittman D, Kovera C, Sullivan M, Rumore MM. Incorporating a Drug Information Consult into a Pharmacy Practice Course to Build Literature Search and Evaluation Skills Through a 3-Stage Model. J Pharm Pract 2016; 30:306-312. [PMID: 27207995 DOI: 10.1177/0897190016637793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Pharmacy students need to be equipped with skills to research and evaluate literature to effectively apply evidence-based medicine (EBM) in practice. To prepare them, a 3-stage approach to writing a drug information consult (3sDIC) was incorporated into a pharmacy course. The primary objective was to assess students' abilities to retrieve and analyze literature pursuant to a drug information consult. Secondary objectives were to examine feasibility of faculty participation and continuation of the assignment. DESIGN Ninety students were given a clinical scenario about a patient. The assignment consisted of 3 stages incorporating use of the Population, Intervention, Comparison intervention, Outcome (PICO) method and modified systematic approach (MSA) for stage 1, evaluation of primary literature to write a draft for stage 2, and stage 3, the final consult. All 3 stages were reviewed and graded by faculty. ASSESSMENT All students completed the 3sDIC, with no grade failures. The rubric employed by faculty was effective, providing students the opportunity to improve the consult. The 3sDIC was found to be feasible with adequate faculty support. CONCLUSION The 3sDIC, although not a substitute for a complete drug information course, demonstrated a streamlined approach for Pharmacy year 2 (P2) students to acquire and develop drug information skills.
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Affiliation(s)
- Deborah Wittman
- 1 Department of Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA
| | - Craig Kovera
- 1 Department of Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA.,2 Janssen Pharmaceutical Companies of Johnson & Johnson, Raritan, NJ, USA
| | - Maureen Sullivan
- 1 Department of Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA
| | - Martha M Rumore
- 3 Department of Social, Behavioral & Administrative Pharmacy, Touro College of Pharmacy, New York, NY, USA
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138
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García-Molina Sáez C, Urbieta Sanz E, Madrigal de Torres M, Vicente Vera T, Pérez Cárceles MD. Computerized pharmaceutical intervention to reduce reconciliation errors at hospital discharge in Spain: an interrupted time-series study. J Clin Pharm Ther 2016; 41:203-8. [PMID: 26916590 DOI: 10.1111/jcpt.12365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/25/2016] [Indexed: 01/01/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE It is well known that medication reconciliation at discharge is a key strategy to ensure proper drug prescription and the effectiveness and safety of any treatment. Different types of interventions to reduce reconciliation errors at discharge have been tested, many of which are based on the use of electronic tools as they are useful to optimize the medication reconciliation process. However, not all countries are progressing at the same speed in this task and not all tools are equally effective. So it is important to collate updated country-specific data in order to identify possible strategies for improvement in each particular region. Our aim therefore was to analyse the effectiveness of a computerized pharmaceutical intervention to reduce reconciliation errors at discharge in Spain. METHODS A quasi-experimental interrupted time-series study was carried out in the cardio-pneumology unit of a general hospital from February to April 2013. The study consisted of three phases: pre-intervention, intervention and post-intervention, each involving 23 days of observations. At the intervention period, a pharmacist was included in the medical team and entered the patient's pre-admission medication in a computerized tool integrated into the electronic clinical history of the patient. The effectiveness was evaluated by the differences between the mean percentages of reconciliation errors in each period using a Mann-Whitney U test accompanied by Bonferroni correction, eliminating autocorrelation of the data by first using an ARIMA analysis. In addition, the types of error identified and their potential seriousness were analysed. RESULTS AND DISCUSSION A total of 321 patients (119, 105 and 97 in each phase, respectively) were included in the study. For the 3966 medicaments recorded, 1087 reconciliation errors were identified in 77·9% of the patients. The mean percentage of reconciliation errors per patient in the first period of the study was 42·18%, falling to 19·82% during the intervention period (P = 0·000). When the intervention was withdrawn, the mean percentage of reconciliation errors increased again to 27·72% (P = 0·008). The difference between the percentages of pre- and post-intervention periods was statistically significant (P = 0·000). Most reconciliation errors were due to omission (46·7%) or incomplete prescription (43·8%), and 35·3% of which could have caused harm to the patient. WHAT IS NEW AND CONCLUSION A computerized pharmaceutical intervention is shown to reduce reconciliation errors in the context of a high incidence of such errors.
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Affiliation(s)
| | - E Urbieta Sanz
- Department of Hospital Pharmacy, Queen Sofia Hospital, Murcia, Spain
| | | | - T Vicente Vera
- Department of Cardiology, Queen Sofia Hospital, Murcia, Spain
| | - M D Pérez Cárceles
- Department of Legal Medicine, Regional Campus of International Excellence 'Campus Mare Nostrum', School of Medicine, University of Murcia, Murcia, Spain
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139
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Randhawa AS, Babalola O, Henney Z, Miller M, Nelson T, Oza M, Patel C, Randhawa AS, Riley J, Snyder S, So S. A Collaborative Assessment Among 11 Pharmaceutical Companies of Misinformation in Commonly Used Online Drug Information Compendia. Ann Pharmacother 2016; 50:352-9. [PMID: 26917822 PMCID: PMC4871169 DOI: 10.1177/1060028016635196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Online drug information compendia (ODIC) are valuable tools that health care professionals (HCPs) and consumers use to educate themselves on pharmaceutical products. Research suggests that these resources, although informative and easily accessible, may contain misinformation, posing risk for product misuse and patient harm. Objective: Evaluate drug summaries within ODIC for accuracy and completeness and identify product-specific misinformation. Methods: Between August 2014 and January 2015, medical information (MI) specialists from 11 pharmaceutical/biotechnology companies systematically evaluated 270 drug summaries within 5 commonly used ODIC for misinformation. Using a standardized approach, errors were identified; classified as inaccurate, incomplete, or omitted; and categorized per sections of the Full Prescribing Information (FPI). On review of each drug summary, content-correction requests were proposed and supported by the respective product’s FPI. Results: Across the 270 drug summaries reviewed within the 5 compendia, the median of the total number of errors identified was 782, with the greatest number of errors occurring in the categories of Dosage and Administration, Patient Education, and Warnings and Precautions. The majority of errors were classified as incomplete, followed by inaccurate and omitted. Conclusion: This analysis demonstrates that ODIC may contain misinformation. HCPs and consumers should be aware of the potential for misinformation and consider more than 1 drug information resource, including the FPI and Medication Guide as well as pharmaceutical/biotechnology companies’ MI departments, to obtain unbiased, accurate, and complete product-specific drug information to help support the safe and effective use of prescription drug products.
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Affiliation(s)
| | | | - Zachary Henney
- Cubist Pharmaceuticals Inc, Global Medical Affairs, Lexington, MA
| | | | - Tanya Nelson
- Janssen Scientific Affairs, LLC, Raritan, NJ, USA
| | | | | | | | | | | | - Sherri So
- Novo Nordisk Inc, Plainsboro, NJ, USA
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140
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O'Sullivan TA, Phillips J, Demaris K. Medical Literature Evaluation Education at US Schools of Pharmacy. Am J Pharm Educ 2016; 80:5. [PMID: 26941431 PMCID: PMC4776298 DOI: 10.5688/ajpe8015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/21/2015] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine how medical literature evaluation (MLE) is being taught across the United States and to summarize methods for teaching and assessing MLE. METHODS An 18-question survey was administered to faculty members whose primary responsibility was teaching MLE at schools and colleges of pharmacy. RESULTS Responses were received from 90 (71%) US schools of pharmacy. The most common method of integrating MLE into the curriculum was as a stand-alone course (49%). The most common placement was during the second professional year (43%) or integrated throughout the curriculum (25%). The majority (77%) of schools used a team-based approach. The use of active-learning strategies was common as was the use of multiple methods of evaluation. Responses varied regarding what role the course director played in incorporating MLE into advanced pharmacy practice experiences (APPEs). CONCLUSION There is a trend toward incorporating MLE education components throughout the pre-APPE curriculum and placement of literature review/evaluation exercises into therapeutics practice skills laboratories to help students see how this skill integrates into other patient care skills. Several pre-APPE educational standards for MLE education exist, including journal club activities, a team-based approach to teaching and evaluation, and use of active-learning techniques.
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Affiliation(s)
| | - Jennifer Phillips
- Midwestern University Chicago College of Pharmacy, Chicago, Illinois
| | - Kendra Demaris
- Hilo Medical Center and Hilo College of Pharmacy, University of Hawaii, Hilo, Hawaii
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141
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Abstract
OBJECTIVE To review the antihyperglycemic effect of ranolazine in type 2 diabetes mellitus (T2DM). DATA SOURCES An EMBASE search was conducted between January 1966 through December 2015 using the search termsranolazine, diabetes, andhemoglobin A1C(A1C). Additional references were identified from a review of literature citations. A search of clinicaltrials.gov was conducted to identify unpublished studies assessing ranolazine in diabetes. STUDY SELECTION AND DATA EXTRACTION All English-language observational and randomized controlled trials assessing the effects of ranolazine on A1C were evaluated. DATA SYNTHESIS Four published and 3 unpublished trials were identified. In all except 1 study, ranolazine 750 to 1000 mg twice daily was associated with a statistically significant decrease in A1C compared with placebo (placebo-corrected change in A1C: -0.28 to -0.7). In the trial in which a significant difference was not observed, patients assigned to ranolazine received a lower maintenance metformin dose compared with patients not assigned to ranolazine. A greater percentage of patients randomized to ranolazine achieved an A1C<7% compared with the placebo group (41.2%-59% vs 25.7%-49%). Ranolazine was not associated with an increase in the incidence of hypoglycemia and was well tolerated overall. The mechanism for lowering of A1C has not been determined. CONCLUSIONS Ranolazine therapy may decrease A1C among patients with T2DM without an increase in hypoglycemia. For patients with T2DM and chronic stable angina, ranolazine may be of use given its utility in cardiovascular disease and benefit in A1C lowering.
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142
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Bicalho MD, Soares DB, Botoni FA, Reis AM, Martins MA. Drug-Induced Nephrotoxicity and Dose Adjustment Recommendations: Agreement Among Four Drug Information Sources. Int J Environ Res Public Health 2015; 12:11227-40. [PMID: 26371029 DOI: 10.3390/ijerph120911227] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 08/17/2015] [Accepted: 08/31/2015] [Indexed: 11/16/2022]
Abstract
Hospitalized patients require the use of a variety of drugs, many of which individually or in combination have the potential to cause kidney damage. The use of potentially nephrotoxic drugs is often unavoidable, and the need for dose adjustment should be evaluated. This study is aimed at assessing concordance in information on drug-induced nephrotoxicity and dose adjustment recommendations by comparing four drug information sources (DRUGDEX®, UpToDate®, Medscape® and the Brazilian Therapeutic Formulary) using the formulary of a Brazilian public hospital. A total of 218 drugs were investigated. The global Fleiss’ kappa coefficient was 0.265 for nephrotoxicity (p < 0.001; CI 95%, 0.211–0.319) and 0.346 for recommendations (p < 0.001; CI 95%, 0.292–0.401), indicating fair concordance among the sources. Anti-infectives and anti-hypertensives were the main drugs cited as nephrotoxic by the different sources. There were no clear definitions for qualitative data or quantitative values for dose adjustments among the four information sources. There was no advice for dosing for a large number of the drugs in the international databases. The National Therapeutic Formulary offered imprecise dose adjustment recommendations for many nephrotoxic drugs. Discrepancies among information sources may have a clinical impact on patient care and contribute to drug-related morbidity and mortality.
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143
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Abstract
Lithium toxicity results in a range of gastrointestinal and neurologic signs and symptoms and can ultimately be fatal. Serum lithium levels may be unreliable when evaluating patients for toxicity, since levels may not be elevated in patients on chronic lithium therapy. Serum lithium levels may also be artificially elevated if blood is collected in a tube containing lithium heparin. We present a case of a woman on chronic lithium therapy whose lithium level was artificially elevated due to blood collection in an incorrect tube.
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Affiliation(s)
- Lisa S Richman
- NewYork-Presbyterian Hospital-Columbia, University Medical Center, Department of Pulmonary, Allergy and Critical Care Medicine, New York, NY, United States
| | - Amy L Dzierba
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY, United States
| | - Kathleen A Connolly
- NewYork-Presbyterian Hospital-Columbia, University Medical Center, Department of Pulmonary, Allergy and Critical Care Medicine, New York, NY, United States
| | - Paula M Bryan
- NewYork-Presbyterian Hospital-Columbia, University Medical Center, Department of Pulmonary, Allergy and Critical Care Medicine, New York, NY, United States
| | - Subani Chandra
- NewYork-Presbyterian Hospital-Columbia, University Medical Center, Department of Pulmonary, Allergy and Critical Care Medicine, New York, NY, United States
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144
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Gregory PJ, Jalloh MA, Abe AM, Hu J, Hein DJ. Characterization of Complementary and Alternative Medicine-Related Consultations in an Academic Drug Information Service. J Pharm Pract 2015; 29:539-542. [PMID: 25952592 DOI: 10.1177/0897190015579450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To characterize requests received through an academic drug information consultation service related to complementary and alternative medicines. METHODS A retrospective review and descriptive analysis of drug information consultations was conducted. RESULTS A total of 195 consultations related to complementary and alternative medicine were evaluated. All consultation requests involved questions about dietary supplements. The most common request types were related to safety and tolerability (39%), effectiveness (38%), and therapeutic use (34%). Sixty-eight percent of the requests were from pharmacists. The most frequent consultation requests from pharmacists were questions related to drug interactions (37%), therapeutic use (37%), or stability/compatibility/storage (34%). Nearly 60% of complementary and alternative medicine-related consultation requests were able to be completely addressed using available resources. Among review sources, Natural Medicines Comprehensive Database, Clinical Pharmacology, Micromedex, and Pharmacist's Letter were the most common resources used to address consultations. CONCLUSION Utilization of a drug information service may be a viable option for health care professionals to help answer a complementary and alternative medicine-related question. Additionally, pharmacists and other health care professionals may consider acquiring resources identified to consistently answering these questions.
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Affiliation(s)
| | | | - Andrew M Abe
- Pharmacy Practice, University of Kansas, Lawrence, KS, USA
| | - James Hu
- Pharmacy Practice, Creighton University, Omaha, NE, USA
| | - Darren J Hein
- Pharmacy Practice, Creighton University, Omaha, NE, USA
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145
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Abstract
OBJECTIVE To describe and evaluate the available evidence assessing the role of tacrolimus in the management of patients with myasthenia gravis (MG). DATA SOURCES A literature search of MEDLINE (1946 to September 2014) and EMBASE (1947 to September 2014) was performed using the terms 'tacrolimus' and 'myasthenia gravis'. Citations of retrieved articles were examined for relevance. STUDY SELECTION AND DATA EXTRACTION The search was limited to prospective clinical trials focused on clinical outcomes in patients with generalized MG. Case reports, retrospective evaluations and non-English articles were excluded. DATA SYNTHESIS A total of 12 studies met inclusion criteria, of which seven articles evaluated tacrolimus in steroid-dependent patients and two examined the utility of tacrolimus in patients failing corticosteroids and cyclosporine. Other studies evaluated early initiation of tacrolimus after thymectomy, effectiveness of tacrolimus in de novo MG and the effectiveness of tacrolimus post-thymectomy in thymoma patients versus nonthymoma. A total of eight trials showed statistically significant improvements in quantitative MG score (QMGS) and postintervention status criteria - Myasthenia Gravis Foundation of America (PSC-MGFA). Of the trials examining steroid reduction with tacrolimus, two reported high rates of complete withdrawal; however, the most robust trial was unable to detect a difference in mean steroid dose. Long-term effects of tacrolimus (up to 5 years) were assessed in eight trials, which consistently showed positive effects on QMGS or reduction in adjunct therapies. CONCLUSIONS There is limited yet promising information to suggest a beneficial role for tacrolimus in reducing QMGS and corticosteroid burden in patients with refractory symptoms or new-onset MG. Long-term use appears to be safe in this population.
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Affiliation(s)
- Jennifer L Cruz
- Drug Information, Geriatric Research and Education Clinical Center, Durham VA Medical Center, 508 Fulton Street (119), Durham, NC 27705, USA
| | - Marissa L Wolff
- Geriatrics, Geriatric Research and Education Clinical Center, Durham VA Medical Center, Durham, NC, USA
| | - Adam J Vanderman
- Geriatrics, Geriatric Research and Education Clinical Center, Durham VA Medical Center, Durham, NC, USA
| | - Jamie N Brown
- Pharmacy Service, Durham VA Medical Center, Durham, NC, USA
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146
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Dowse R, Ramela T, Barford KL, Browne S. Developing visual images for communicating information aboutantiretroviral side effects to a low-literate population. Afr J AIDS Res 2015; 9:213-24. [PMID: 25860626 DOI: 10.2989/16085906.2010.530172] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The side effects of antiretroviral (ARV) therapy are linked to altered quality of life and adherence. Poor adherence has also been associated with low health-literacy skills, with an uninformed patient more likely to make ARV-related decisions that compromise the efficacy of the treatment. Low literacy skills disempower patients in interactions with healthcare providers and preclude the use of existing written patient information materials, which are generally written at a high reading level. Visual images or pictograms used as a counselling tool or included in patient information leaflets have been shown to improve patients' knowledge, particularly in low-literate groups. The objective of this study was to design visuals or pictograms illustrating various ARV side effects and to evaluate them in a low-literate South African Xhosa population. Core images were generated either from a design workshop or from posed photos or images from textbooks. The research team worked closely with a graphic artist. Initial versions of the images were discussed and assessed in group discussions, and then modified and eventually evaluated quantitatively in individual interviews with 40 participants who each had a maximum of 10 years of schooling. The familiarity of the human body, its facial expressions, postures and actions contextualised the information and contributed to the participants' understanding. Visuals that were simple, had a clear central focus and reflected familiar body experiences (e.g. vomiting) were highly successful. The introduction of abstract elements (e.g. fever) and metaphorical images (e.g. nightmares) presented problems for interpretation, particularly to those with the lowest educational levels. We recommend that such visual images should be designed in collaboration with the target population and a graphic artist, taking cognisance of the audience's literacy skills and culture, and should employ a multistage iterative process of modification and evaluation.
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Affiliation(s)
- Ros Dowse
- a Rhodes University , Faculty of Pharmacy , PO Box 94 , Grahamstown , 6140 , South Africa
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147
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Mamen AV, Håkonsen H, Kjome RLS, Gustavsen-Krabbesund B, Toverud EL. Norwegian elderly patients' need for drug information and attitudes towards medication use reviews in community pharmacies. Int J Pharm Pract 2015; 23:423-8. [PMID: 25801503 DOI: 10.1111/ijpp.12184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 02/01/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Medication use review (MUR) is a community pharmacy service in several countries. Knowledge about what patients want from such a service is limited. The aim of this study was therefore to investigate Norwegian elderly patients' need for drug information and their attitudes towards MURs. METHODS In Norway's two largest cities, 162 patients (72% women; mean age: 78.9 years) who used at least one prescription drug were recruited from 18 senior centres. They were interviewed personally with a structured questionnaire (29 closed and 4 open-ended questions). KEY FINDINGS The average number of prescription drugs used was 4.4. Seventy per cent also used over-the-counter drugs. The main source of drug information was the general practitioner (GP) followed by package inserts and pharmacy staff. For drug-related problems, 62% would contact the GP compared with 24% who preferred the pharmacist. Fifty per cent remembered no information when collecting prescriptions. However, 56% wanted to know more about their medication and 55% were interested in a MUR. The main topics they wished to address were effect/side effects and interactions. Lack of privacy was reported to be a major obstacle in the current situation. CONCLUSIONS This study shows that community pharmacies in Norway play a minor role regarding drug information to elderly polypharmacy patients. The GP is both their main information source and whom they contact for drug-related problems. However, half of the patients would like to know more about their medication. More than half were positive towards taking part in a MUR.
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Affiliation(s)
- Anette Vik Mamen
- Research Group on Social Pharmacy/Centre for Pharmacy, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Helle Håkonsen
- Department of Social Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Reidun L S Kjome
- Research Group on Social Pharmacy/Centre for Pharmacy, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Else-Lydia Toverud
- Department of Social Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
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148
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Abstract
Thrombocytopenia can occur from a variety of etiologies. Drug-induced thrombocytopenia is known to occur with beta-lactam medications, but often in the setting of prolonged use. We describe 2 patients who developed rapid-onset thrombocytopenia from piperacillin/tazobactam. Other causes of immediate thrombocytopenia were excluded. These cases describe a rare presentation of rapid-onset thrombocytopenia in a commonly used medication.
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Affiliation(s)
- Shamsuddin Shaik
- Department of Internal Medicine, St Luke's University Hospital, Bethlehem, PA, USA
| | - Haseeb A Kazi
- Department of Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Peter T Ender
- Section of Infectious Diseases, St Luke's University Hospital, Bethlehem, PA, USA
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149
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Davis LE. A workshop series using peer-grading to build drug information, writing, critical-thinking, and constructive feedback skills. Am J Pharm Educ 2014; 78:191. [PMID: 25657378 PMCID: PMC4315213 DOI: 10.5688/ajpe7810191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/03/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To utilize a skills-based workshop series to develop pharmacy students' drug information, writing, critical-thinking, and evaluation skills during the final didactic year of training. DESIGN A workshop series was implemented to focus on written (researched) responses to drug information questions. These workshops used blinded peer-grading to facilitate timely feedback and strengthen assessment skills. Each workshop was aligned to the didactic coursework content to complement and extend learning, while bridging and advancing research, writing, and critical thinking skills. ASSESSMENT Attainment of knowledge and skills was assessed by rubric-facilitated peer grades, faculty member grading, peer critique, and faculty member-guided discussion of drug information responses. Annual instructor and course evaluations consistently revealed favorable student feedback regarding workshop value. CONCLUSION A drug information workshop series using peer-grading as the primary assessment tool was successfully implemented and was well received by pharmacy students.
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Affiliation(s)
- Lindsay E Davis
- Midwestern University College of Pharmacy, Glendale, Arizona
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Lu Y, Branstad R, Karim RM, Asinger RW. Consideration of clinical variables for choosing new anticoagulant alternatives to warfarin for the management of non-valvular atrial fibrillation. J Clin Pharm Ther 2014; 39:628-36. [PMID: 25252149 DOI: 10.1111/jcpt.12207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/21/2014] [Indexed: 12/19/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Patients with non-valvular atrial fibrillation (NVAF) are at risk for stroke and systemic embolism (SSE), and this risk can be decreased with adjusted-dose warfarin. Warfarin, however, is cumbersome to use and requires at least monthly laboratory monitoring. Three new oral anticoagulants (NOACs) that are less cumbersome have been approved as alternatives to warfarin for SSE prevention in NVAF. Selecting a patient-specific alternative to warfarin can be confusing for pharmacists and clinicians. This review details clinical parameters to consider when choosing an alternative to warfarin for a specific patient and summarizes them in a Comparison Table. METHODS Using available clinical evidence from pivotal trials, US FDA- and Health Canada-approved prescribing information and post-marketing observations, this review provides a summary of important clinical variables for clinicians to consider when choosing patient-centred anticoagulant alternatives to warfarin for prevention of SSE in NVAF. RESULTS AND DISCUSSION Dabigatran, rivaroxaban and apixaban are approved alternatives to warfarin for primary and secondary prevention of SSE in patients with NVAF. Additionally, apixaban has also been compared to aspirin in patients with NVAF that were considered unsuitable for vitamin K antagonist therapy. Prospective consideration of age, weight, hepatic function, renal function and drug interactions are important clinical parameters to consider when selecting patient-centred alternatives to adjusted-dose warfarin. WHAT IS NEW AND CONCLUSION Several NOACs are now alternatives to warfarin for SSE prevention in NVAF but require providers to make a shift in strategy from tailoring anticoagulant dose based on anticoagulant effect to selection of the anticoagulant based on clinical variables that affect anticoagulant exposure. These variables and their interactions should be considered in choosing an alternative to warfarin and are summarized in a simple table comparing the new anticoagulants.
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Affiliation(s)
- Y Lu
- Hennepin County Medical Center, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA
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