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Medina MS, Alvarez NA, Sucher BJ. Getting started writing a personal diversity statement. Am J Health Syst Pharm 2024:zxae098. [PMID: 38577876 DOI: 10.1093/ajhp/zxae098] [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: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Melissa S Medina
- The University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Nancy A Alvarez
- R. Ken Coit College of Pharmacy-Phoenix Campus, The University of Arizona, Phoenix, AZ, USA
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Johnson CL, Alvarez NA, Hughes JA, McQuade BM, Fuentes DG. Why We Need to Pay Attention to Stereotype Threat. Am J Pharm Educ 2024; 88:100669. [PMID: 38367959 DOI: 10.1016/j.ajpe.2024.100669] [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: 10/05/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/19/2024]
Abstract
Although "implicit bias" has been a major focus in diversity, equity, inclusion, and antiracism educational efforts, less attention has been directed to "stereotype threat." This commentary aimed to bring increased awareness to the pharmacy academy about stereotype threat phenomena as well as explore its impact in the areas of education, with a specific focus on health professions education. In addition, potential and practical strategies are discussed to mitigate its occurrence in pharmacy education.
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Affiliation(s)
- Charisse L Johnson
- Chicago State University College of Health Sciences and Pharmacy, Chicago, IL, USA.
| | - Nancy A Alvarez
- University of Arizona, R.K. Coit College of Pharmacy, Tucson, AZ, USA
| | - Jeremy A Hughes
- Chicago State University College of Health Sciences and Pharmacy, Chicago, IL, USA
| | - Brianna M McQuade
- University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - David G Fuentes
- University of Portland School of Nursing & Health Innovations, Portland, OR, USA; American Journal of Pharmaceutical Education, Arlington, VA, USA
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Alvarez NA, Cornelison B, Obeng-Kusi M, Slack M. Understanding faculty perceptions and experiences related to climate, diversity, equity, and inclusion at a college of pharmacy: A pilot study. Curr Pharm Teach Learn 2024; 16:24-33. [PMID: 38158325 DOI: 10.1016/j.cptl.2023.12.002] [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: 01/10/2023] [Revised: 09/28/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION A climate survey was piloted to obtain an understanding of the perceptions and personal experiences of faculty for intentional planning of future meaningful, effective, and sustainable diversity, equity, and inclusion (DEI) efforts at a college of pharmacy. METHODS A 48-item, four section, online survey was developed and administered to 69 faculty between October and November 2021. Likert-like five-point scales and free-text items were included to determine an overall assessment of climate, as well as perceptions and/or personal experiences for each domain of DEI, and demographics. RESULTS Thirty-nine (57%) faculty completed the survey. For climate, every attribute had at least one respondent that observed someone make an insensitive or disparaging remark "rarely," "occasionally," and "frequently." The response pattern was similar for personal experience with insensitive remarks. For participation in diversity activities, "awareness without participation" was selected by 56% of respondents. For perceptions of diversity, "fairly" or "very" was selected by 38% to 54% of respondents. For equity, "attainable for some" to "not attainable" was identified for 15% to 26% of respondents. CONCLUSIONS These pilot climate survey results inform climate improvement as it relates to DEI and informs survey instrument refinement.
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Affiliation(s)
- Nancy A Alvarez
- Pharmacy Practice and Science, University of Arizona R. Ken Coit College of Pharmacy - Phoenix, 650 East Van Buren Street, Phoenix, AZ 85004, United States.
| | - Bernadette Cornelison
- Pharmacy Practice and Science Department, University of Arizona R. Ken Coit College of Pharmacy - Tucson, PO Box 210202, Tucson, AZ 85721, United States.
| | - Mavis Obeng-Kusi
- Pharmacy Practice and Science Department, University of Arizona R. Ken Coit College of Pharmacy - Tucson, PO Box 210202, Tucson, AZ 85721, United States.
| | - Marion Slack
- Pharmacy Practice and Science Department, University of Arizona R. Ken Coit College of Pharmacy - Tucson, PO Box 210202, Tucson, AZ 85721, United States.
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Alvarez NA, Gaither CA, Schommer JC, Lee S, Shaughnessy AM. Moral Distress and Moral Injury in Pharmacy and Why the Academy Needs to Care. Am J Pharm Educ 2023; 87:100610. [PMID: 37865387 DOI: 10.1016/j.ajpe.2023.100610] [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: 06/25/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 10/23/2023]
Abstract
Pharmacists and other pharmacy personnel are experiencing job stress and burnout, and in some instances, suicidal ideation and death by suicide. However, the described lived experiences of pharmacists and other pharmacy personnel are not defined by burnout. Thus, consideration of and research about whether pharmacy personnel are possibly experiencing moral distress or moral injury is necessary and urgent. The pharmacy academy is served by considering workplace conditions and lived experiences of pharmacists because of the potential, negative impact on prospective student recruitment, quality of experiential sites and preceptors, sites for clinical faculty placement, and the well-being of alumni. Understanding phenomena occurring for pharmacy personnel and determining how they impact the pharmacy academy can lend itself to the future development of solutions.
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Affiliation(s)
- Nancy A Alvarez
- University of Arizona, R. Ken Coit College of Pharmacy, Phoenix, AZ, USA.
| | | | - Jon C Schommer
- University of Minnesota, College of Pharmacy, Minneapolis, MN, USA
| | - SuHak Lee
- University of Minnesota, College of Pharmacy, Minneapolis, MN, USA
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Devraj R, Castleberry AN, Alvarez NA, Persky AM, Poirier TI. Pharmacy Leaders' Advice to Students Pursuing Leadership: A Qualitative Study. Innov Pharm 2023; 14:10.24926/iip.v14i3.5528. [PMID: 38487382 PMCID: PMC10936452 DOI: 10.24926/iip.v14i3.5528] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Leadership development is important both from a curricular standpoint and for continued advancement of the profession. Advice from current leaders in the profession may serve as a powerful motivator to students desiring to be leaders. The purpose of this qualitative study was to provide advice from experienced pharmacy leaders. METHODS Fifty-four pharmacy leaders were identified based on pre-determined, specific criteria and by using a snowball sampling method. Interviews with leaders were conducted via Zoom to learn about their leadership journey, their legacy, and advice they would give students. The interviews were transcribed, de-identified and analyzed using the inductive, modified constant comparison approach for open and axial coding. Advice themes were compared by gender and generational category. RESULTS The majority of the interviewees were male (69%), belonged to the Baby Boomer Generation (1946-1964, 59.3%), and held leadership positions in education (78%) and health systems (48%). Thirty-seven leadership advice themes were present. The topmost advice to students was to keep an open mind (35%) and to get involved in organizations (32%). Pieces of advice shared by both men and women leaders included: being open minded, getting involved in organizations, taking initiative, trying new or difficult things, and finding your passion. Keeping an open mind, and taking initiative were common across the three generations. CONCLUSION Pharmacy leaders have insightful information for students aspiring to be future leaders. Leadership advice was similar by gender and generational category. Students would benefit in developing their leadership based on advice from the lived experience of pharmacy leaders. Future studies could examine students' perspectives on leadership advice.
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Castleberry AN, Devraj R, Alvarez NA, Persky AM, Poirier TI. Pharmacy Leaders' Reflections on Leadership and Legacy. Am J Pharm Educ 2023; 87:100111. [PMID: 37852685 DOI: 10.1016/j.ajpe.2023.100111] [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: 07/15/2022] [Revised: 03/01/2023] [Accepted: 03/21/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To explore the experiences, contributions, and perceived legacy of individuals recognized as leaders in the pharmacy profession and compare these by gender and generational category. METHODS A total of 54 leaders were interviewed about their journey to leadership and the legacy they leave to the profession. Interviews were transcribed, de-identified, and qualitatively analyzed using an inductive, modified constant comparison approach for open and axial coding. Qualitative responses were quantified to allow for the comparison of themes by gender and generational category. RESULTS Common leadership themes included: humility, not expecting to be in a leadership role, taking initiative, being passionate about their work, having mentors to guide them, having a network of people around them, being a part of change, serving during a challenging time, seizing opportunities when they presented themselves, and being involved in professional organizations. The individual's clinical work (38.9%), helping to develop pharmacy as a clinical profession (33.3%), publications (29.6%), impact on students (29.6%), building programs (22.2%), involvement in organizations (20.4%), and impactful research (16.7%) were common themes noted in the legacy responses. CONCLUSION Although there are many advancements still to be made, upcoming leaders would benefit from the journey and perceived legacy of these leaders as they carry the torch to advance the practice of pharmacy.
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Affiliation(s)
| | - Radhika Devraj
- Southern Illinois University Edwardsville, Edwardsville, IL, USA
| | - Nancy A Alvarez
- The University of Arizona R. Ken Coit College of Pharmacy - Phoenix Campus, Phoenix, AZ, USA
| | - Adam M Persky
- The University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
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Lee JK, Collins B, Pepper E, Alvarez NA, Warholak T. Improving a Leadership Scale: Applying Rasch Analysis to Student Pharmacists' Attitudes and Beliefs About Leadership. Am J Pharm Educ 2023; 87:100063. [PMID: 37316138 DOI: 10.1016/j.ajpe.2023.100063] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Leadership development is necessary for student pharmacists to become pharmacist leaders, but no readily usable standard measurement of student attitudes toward and beliefs about leadership exists. To assess the reliability and validity evidence for using the Leadership Attitudes and Beliefs Scale (LABS-III), originally developed and validated in Malaysia, for use with student pharmacists in the United States. METHODS The 2-unit leadership course was piloted among second- and third-year students in a public college of pharmacy with a 4-year doctor of pharmacy curriculum. The participating students completed the LABS-III during the first and last classes as part of a quality improvement measure for course enhancement. Rasch analysis was then used to assess the reliability and validity evidence for the LABS-III. RESULTS A total of 24 students participated in the pilot course. The pre and postcourse surveys had 100% and 92% response rates, respectively. After Rasch analysis model fit was achieved, the item separation for the 14 nonextreme items was 2.19 with an item reliability of 0.83. The person separation index was 2.16 with a person reliability of 0.82. CONCLUSION The Rasch analysis revealed that the number of LABS-III items should be decreased and that the 3-point response scale should be used to improve functionality and use in classroom settings for PharmD students in the United States. Further research is needed to augment the reliability and validity evidence of the modified instrument for use at other United States colleges of pharmacy.
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Affiliation(s)
- Jeannie K Lee
- Student Services, R. Ken Coit College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | - Barb Collins
- Student Services, R. Ken Coit College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | - Elizabeth Pepper
- Biological Sciences Graduate Program, University of Maryland, College Park, MD, USA
| | - Nancy A Alvarez
- Academic and Professional Affairs, R. Ken Coit College of Pharmacy, Phoenix Campus, The University of Arizona, Phoenix, AZ, USA
| | - Terri Warholak
- Academic and Professional Affairs, R. Ken Coit College of Pharmacy, Phoenix Campus, The University of Arizona, Phoenix, AZ, USA; St. Louis College of Pharmacy, University of Health Sciences & Pharmacy, St Louis, MO, USA.
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Schommer JC, Gaither CA, Alvarez NA, Lee S, Shaughnessy AM, Arya V, Planas LG, Fadare O, Witry MJ. Pharmacy Workplace Wellbeing and Resilience: Themes Identified from a Hermeneutic Phenomenological Analysis with Future Recommendations. Pharmacy (Basel) 2022; 10:pharmacy10060158. [PMID: 36548314 PMCID: PMC9781627 DOI: 10.3390/pharmacy10060158] [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: 10/12/2022] [Revised: 11/12/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
This study applied a hermeneutic phenomenological approach to better understand pharmacy workplace wellbeing and resilience using respondents' written comments along with a blend of the researchers' understanding of the phenomenon and the published literature. Our goal was to apply this understanding to recommendations for the pharmacy workforce and corresponding future research. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacy personnel was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Usable responses were from those who wrote an in-depth comment detailing stories and experiences related to pharmacy workplace and resilience. There were 614 respondents who wrote such comments. The findings revealed that business models driven by mechanized assembly line processes, business metrics that supersede patient outcomes, and reduction of pharmacy personnel's professional judgement have contributed to the decline in the experience of providing patient care in today's health systems. The portrait of respondents' lived experiences regarding pharmacy workplace wellbeing and resilience was beyond the individual level and revealed the need for systems change. We propose several areas for expanded inquiry in this domain: (1) shared trauma, (2) professional responsibility and autonomy, (3) learned subjection, (4) moral injury and moral distress, (5) sociocultural effects, and (6) health systems change.
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Affiliation(s)
- Jon C. Schommer
- Department of Pharmaceutical Care & Health Systems (PCHS), College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA
- Correspondence: ; Tel.: +1-612-626-9915
| | - Caroline A. Gaither
- Department of Pharmaceutical Care & Health Systems (PCHS), College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Nancy A. Alvarez
- R. Ken Coit College of Pharmacy–Phoenix, University of Arizona, 650 East Van Buren Street, Phoenix, AZ 85004, USA
| | - SuHak Lee
- Department of Pharmaceutical Care & Health Systems (PCHS), College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - April M. Shaughnessy
- American Pharmacists Association, 2215 Constitution Avenue NW, Washington, DC 20037, USA
| | - Vibhuti Arya
- College of Pharmacy and Health Sciences, St. John’s University, 8000 Utopia Parkway, Queens, New York, NY 11439, USA
| | - Lourdes G. Planas
- College of Pharmacy, University of Oklahoma, 1110 N Stonewall, Room 243, Oklahoma City, OK 73117, USA
| | - Olajide Fadare
- College of Pharmacy, University of Iowa, 180 South Grand Avenue, Iowa City, IA 52242, USA
| | - Matthew J. Witry
- College of Pharmacy, University of Iowa, 180 South Grand Avenue, Iowa City, IA 52242, USA
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Schommer JC, Lee S, Gaither CA, Alvarez NA, Shaughnessy AM. Improving the Experience of Providing Care in Community-Based Pharmacies. Pharmacy 2022; 10:pharmacy10040067. [PMID: 35893705 PMCID: PMC9326513 DOI: 10.3390/pharmacy10040067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
This study applied a human factors and ergonomics approach to describe community-based pharmacy personnel perspectives regarding how work environment characteristics affect the ability to perform the duties necessary for optimal patient care and how contributors to stress affect the ability to ensure patient safety. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacists and pharmacy technicians was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Qualitative thematic analysis was applied for developing operational definitions and coding guidelines for content analysis of the data. The patterns of responses for the dependent variables were compared among community-based practice setting types (chain, supermarket/mass merchandiser, and independent) and work positions (manager, staff pharmacist, technician/clerk, and owner). Chi-square analysis was used for determining statistically significant differences. The findings showed that personnel working in community-based pharmacies reported undesirable work environments and work stress that affected their ability to perform assigned duties for optimal patient care and ensure patient safety. Four work system elements were identified that were both facilitators and barriers to the ability to perform duties and ensure patient safety: (1) people, (2) tasks, (3) technology/tools, and (4) organizational context. Acknowledging local contexts of workplaces, giving adequate control, applying adaptive thinking, enhancing connectivity, building on existing mechanisms, and dynamic continuous learning are key elements for applying the HFE (human factors ergonomics) approach to improving the experience of providing care in community-based pharmacies.
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Affiliation(s)
- Jon C. Schommer
- College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA; (S.L.); (C.A.G.)
- Correspondence: ; Tel.: +1-612-626-9915
| | - SuHak Lee
- College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA; (S.L.); (C.A.G.)
| | - Caroline A. Gaither
- College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA; (S.L.); (C.A.G.)
| | - Nancy A. Alvarez
- R. Ken Coit College of Pharmacy—Phoenix, University of Arizona, 650 East Van Buren Street, Phoenix, AZ 85004, USA;
| | - April M. Shaughnessy
- American Pharmacist Association, 2215 Constitution Avenue NW, Washington, DC 20037, USA;
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Sobeski LM, Schumacher CA, Alvarez NA, Anderson KC, Bradley B, Crowe SJ, Merlo JR, Nyame A, Rivera KS, Shapiro NL, Spencer DD, Dril E. Medication access: Policy and practice opportunities for pharmacists. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Adwoa Nyame
- American College of Clinical Pharmacy Lenexa Kansas USA
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Alvarez NA. Leading our communities in patient care. J Am Pharm Assoc (2003) 2018; 58:343-345. [DOI: 10.1016/j.japh.2018.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Alvarez NA. Treat the patient and not the number: A call to care. J Am Pharm Assoc (2003) 2017; 57:431-434. [DOI: 10.1016/j.japh.2017.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Victor TW, Alvarez NA, Gould E. Opioid Prescribing Practices in Chronic Pain Management: Guidelines Do Not Sufficiently Influence Clinical Practice. The Journal of Pain 2009; 10:1051-7. [DOI: 10.1016/j.jpain.2009.03.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 03/24/2009] [Accepted: 03/25/2009] [Indexed: 12/21/2022]
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Gammaitoni AR, Alvarez NA, Galer BS. Safety and tolerability of the lidocaine patch 5%, a targeted peripheral analgesic: a review of the literature. J Clin Pharmacol 2003; 43:111-7. [PMID: 12616661 DOI: 10.1177/0091270002239817] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The safety, tolerability, and efficacy of the lidocaine patch 5% (Lidoderm), a targeted peripheral analgesic with an FDA-approved indication for the treatment of postherpetic neuralgia, has been well established. Recent case reports and studies have suggested potential efficacy in other neuropathic and nonneuropathic pain conditions. Several pharmacokinetic studies have demonstrated minimal systemic absorption with 12-, 18-, and 24-hour/day dosing. Mean maximum plasma concentrations have shown the lidocaine patch to possess a minimal risk for systemic toxicities or drug-drug interactions. The most common adverse events generally involve mild skin reactions. There have been no drug-drug interactions noted in clinical trials. Recent evidence suggests that extended application does not result in A-beta-mediated sensory loss at the application site, which is particularly important in patients who already have a degree of sensory loss due to their underlying condition. The lidocaine patch provides a treatment option that carries a relatively low systemic adverse event and drug-drug interaction risk burden, even with continuous application of up to four patches per day.
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Abstract
The pharmacokinetics, safety, and tolerability of four topical lidocaine patches 5% continuously applied for 72 hours and changed every 12 or 24 hours were examined. In this randomized, prospective, multiple-dose, open-label pharmacokinetic study, lidocaine patches were applied to healthy men and women for three consecutive days. Ten subjects received four lidocaine patches every 24 hours (group 1), and 10 subjects received four patches every 12 hours (group 2). Serial samples of venous blood were obtained to determine pharmacokinetic data. Overall tolerability and safety were assessed, and skin sensory testing was conducted to determine whether local anesthetic activity was produced. The mean maximum plasma lidocaine concentrations at steady state with lidocaine patches applied in groups 1 and 2 were 186 and 225 ng/mL, respectively, compared with the reported mean maximum plasma concentration of 130 ng/ml. with the labeled dosage (12 hr/day). The area under the concentration-time curve for one dosage interval at steady state was 3550 and 4506 ng.hr/mL for groups 1 and 2, respectively. No loss in sensation at the application site was reported. No patient had edema, and most cases of erythema were very slight. No systemic adverse events were judged to be related to the patches. Continuous application for 72 hours of four lidocaine patches 5%, changed every 12 or 24 hours, produced plasma lidocaine concentrations that remained well below those that typically produce antiarrhythmic effects or toxicity. Mild application-site erythema occurred in most patients, but no systemic adverse reactions were judged to be related to the patches. No loss in sensation at the application site was reported.
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