bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement of Hyperphosphatemia following Patient Education
Authors: Satoh Minori , Koizumi Akiko , Izumi Satoshi , Kugoh Yasuhiro , Kiriyama Eriko , Oguma Emiko , Furukubo Taku , Matsunaga Chiharu , Yamakawa Tomoyuki , Kadowaki Daisuke , Hirata Sumio
Published: September 2013

Background:

Patient adherence to a phosphate binder treatment regimen is crucial in the management of hyperphosphatemia. Nonadherence may be due to a lack of patient knowledge of the nature and treatment of the illness.

Objective:

To investigate the effectiveness of pharmacist-provided education regarding phosphate binders and hyperphosphatemia on serum phosphate concentration and calcium x phosphorous product in hemodialysis patients.

Methods:

A total of 398 hemodialysis patients who were prescribed phosphate binders participated in a pharmacist-run, education-based intervention session regarding phosphate binders and hyperphosphatemia. Each session was individualized on the basis of patient knowledge, assessed via a questionnaire. Particular attention was given to correcting patient misconceptions. Patients with elevated serum phosphate received additional education. Mean serum concentrations of phosphate and calcium, averaged from 4 measurements obtained at both baseline and postintervention, were compared to evaluate the efficacy of the intervention.

Results:

Postintervention, patients with the highest baseline serum phosphate concentrations (≥7.0 mg/dL) showed a significant decrease in mean ± SD serum concentrations of phosphate and calcium-phosphate product (7.4 ± 0.4 mg/dL and 72.6 ± 6.4 mg2/dL2 to 6.5 ± 0.8 mg/dL and 63.1 ± 8.4 mg2/dL2, respectively; p < 0.001). Likewise, patients with serum phosphate concentrations ranging from 6.0–6.9 mg/dL showed a significant decrease in both parameters after educational intervention (p < 0.05 and p < 0.005, respectively).

Conclusions:

An education session regarding phosphate binders and hyperphosphatemia, provided by pharmacists for hemodialysis patients, appeared effective in reducing serum phosphate concentrations and calcium x phosphorus product, thus contributing to improved patient prognoses.
Pattern of Lisdexamfetamine Ingestions Reported to Texas Poison Centers
Authors: Forrester Mathias B
Published: September 2013

Background:

Little information exists on lisdexamfetamine ingestions reported to poison centers.

Objective:

To describe the pattern of lisdexamfetamine ingestions reported during the first year of their approved use to Texas poison centers.

Methods:

The distribution of total cases of lisdexamfetamine ingestions with and without coingestants reported to Texas poison centers from July 2007–June 2008 was determined for the following selected variables: drug formulation, reported total dose ingested, patient sex and age, exposure site, and circumstances of the exposure.

Results:

Of 187 total ingestions, the total dose ingested was reported for 59% (mean 221.4 mg; range 5–3,080). Fifty-eight percent of the patients were male and 38% were aged 6–12 years. Thirty-eight percent of the ingestions occurred as a result of therapeutic error, 26% were due to general unintentional reasons, and 12% were suspected attempted suicide; 11% of the patients called the poison center due to an adverse reaction to lisdexamfetamine. Of the 133 (71%) cases without coingestants, 53% were managed on site (ie, not a healthcare facility) and 79% resulted in or were expected to result in, at most, minor effects or minimal toxicity. The most frequently reported adverse clinical effects among cases without coingestants were tachycardia (14%), agitation (14%), vomiting (6%), and nausea (5%).

Conclusions:

The majority of lisdexamfetamine ingestions reported to Texas poison centers did not involve coingestants. Of those without coingestants, most were managed on site and did not result in serious medical outcomes.
Effect of Diabetes Medications on Cardiovascular Risk and Surrogate Markers in Patients with Type 2 Diabetes
Authors: Blake Elizabeth W , Sease Julie M
Published: September 2013

Objective:

To evaluate the effect of diabetes medications on the risk of cardiovascular disease and surrogate markers.

Data Sources:

Literature was accessed through MEDLINE (1950–July 2008) and PubMed using multiple terms for diabetes, cardiovascular risk, surrogate markers, and diabetes medications. In addition, reference citations from publications were reviewed.

Study Selection and Data Extraction:

English-language articles that met the above criteria, with clinical relevance, were evaluated.

Data Synthesis:

Evidence regarding the effect of diabetes medications on cardiovascular risk is sparse, with information on their effects on surrogate markers more widely available. Recent evidence demonstrates that glycemic control alone may not reduce the risk of macrovascular events. Multiple trials were reviewed to determine the effect of diabetes medications on this risk, as well as the effect on surrogate markers (eg, blood pressure, cholesterol, body weight). Metformin and acarbose demonstrated significant reductions in macrovascular events, including myocardial infarction. Data regarding sulfonylureas, thiazolidinediones, and insulin are conflicting. Pioglitazone may reduce cardiovascular events, except heart failure, whereas rosiglitazone may increase these events. Until direct evidence can be obtained, the full effect of diabetes medications on cardiovascular risk is unknown.

Conclusions:

Current literature provides little support that diabetes medications may lower the risk of cardiovascular events while some agents may increase this risk. Of the drugs available, metformin may be the least detrimental. Current literature regarding other diabetes medications provides conflicting results on their effect on cardiovascular outcomes. In the meantime, practitioners should treat all targets of cardiovascular risk in patients with diabetes.

ACPE Universal Program Numbers:

407-000-09-050-H01-P (Pharmacists); 407-000-09-050-H01-T (Technicians)
Lithium Toxicity Secondary to Lithium—Losartan Interaction
Authors: Aruna Augustine S
Published: September 2013

Objective:

To report a case of lithium toxicity following lithium and losartan coadministration in a diabetic patient.

Case Summary:

A 61-year-old white male with a history significant for bipolar disorder, hypertension, and diabetes was admitted to the Veterans Affairs Medical Center—based Nursing Home Care Unit for long-term intravenous antibiotic therapy for osteomyelitis. He developed lithium toxicity at a dose previously tolerated (1,350 mg/day) following administration of losartan 50 mg on the day before and day of evidence of toxicity. The drugs had been used concurrently prior to admission without evidence of toxicity; however, adherence to treatment could not be confirmed and concurrent dehydration may have been a contributing factor. Lithium toxicity was evidenced by irritability, tremors, confusion, and disorientation. Results of laboratory studies were significant for an elevated lithium concentration, hyponatremia, and slight elevations of serum creatinine and blood urea nitrogen. All other laboratory values were within normal limits.

Discussion:

Losartan, an angiotensin-receptor blocker (ARB), is commonly used for treatment of hypertension and heart failure as well as for renoprotection in diabetic patients. It has been shown to interact with lithium, resulting in lithium intoxication, most likely as a result of natriuresis leading to hyponatremia. Hyponatremia and a decrease in the glomerular filtration rate through the action of both angiotensin-converting enzyme inhibitors and ARBs enhance the renal tubular reabsorption of lithium, thus leading to potentially toxic serum concentrations of lithium. An objective causality assessment revealed that the interaction was probable.

Conclusions:

The temporal fashion in which the episode occurred indicated that a lithium—losartan interaction was probably the cause of lithium toxicity in this patient. Clinicians need to be aware of potential lithium—ARB interactions resulting in an increased risk of lithium toxicity associated with concurrent use of these drugs.
Topiramate for Use in Adult Migraine Prophylaxis
Authors: Sinert Molly R , Epstein Benjamin J
Published: September 2013

Objective:

To review studies comparing topiramate with placebo or other migraine prophylaxis agents in order to outline the role of topiramate in the pharmacologic prevention of adult migraine and to provide clinicians with evidence for rationale of its use.

Data Sources:

Primary studies and review articles were identified via a MEDLINE search (1960–November 2008). Search terms included topiramate, antiepileptic, anticonvulsant, migraine prophylaxis, and migraine prevention. Additional references were obtained from bibliographies of those resources.

Study Selection and Data Extraction:

All relevant information extracted from randomized, controlled studies and systematic reviews evaluating the efficacy, safety, and pharmacology of topiramate in the prevention of adult migraine were included.

Data Synthesis:

Topiramate is approved for the prevention of adult migraine. It has historically been used in the treatment of seizure disorders but received approval for migraine prophylaxis in 2004. The exact mechanism of its antimigraine effect remains unknown, but modulation of sodium channels, γ-aminobutyric acid, and glutamate activity seem to be involved, given the proposed shared pathophysiology between seizure and migraine. Two pivotal trials comparing topiramate with placebo led to approval for migraine prophylaxis in the US and a third similar trial that compared topiramate with propranolol secured licensure in Europe. Additional studies evaluated optimal dosing up to 200 mg daily and duration of therapy through 14 months. These trials demonstrated the ability of topiramate 50 mg twice daily, administered for up to 14 months, to safely reduce migraine frequency, duration, and severity. Limited information from comparative studies suggests a similar effect of topiramate and other agents, including divalproex sodium, propranolol, and timolol. The most common adverse effect observed among all trials was mild-to-moderate paresthesias that were transient in nature. Other adverse effects commonly reported include gastrointestinal upset and cognitive impairment. Adverse effects were more likely to occur during titration periods. Topiramate's safety profile appears to be as good as or better than that of other prophylactic agents.

Conclusions:

Topiramate is an appropriate first-line drug to consider for prevention of adult migraine. The efficacy and safety of topiramate in migraine prophylaxis has been well established in clinical trials and is comparable with other approved agents for this indication. When choosing among these agents, prescribers should consider the adverse effect profile, route of administration, cost, and comorbidities.

ACPE Universal Program Number:

407-000-09-052-H01-P (Pharmacists); 407-000-09-052-H01-T (Technicians)
Incidence of Cross-Sensitivity with Carbapenems in Documented Penicillin-Allergic Patients
Authors: Lager Stephanie , White Betsy , Baumann Megan , Mitchem Randall E , Jackson Ronna , Black Nicola
Published: September 2013

Background:

When carbapenems were first introduced, it was recommended to use them cautiously in patients with a penicillin allergy due to an approximately 50% potential risk of cross-sensitivity in these patients. Carbapenems have a broad spectrum of coverage and may be necessary for treatment of acutely ill patients; however, clinicians may avoid the use of carbapenems in patients with a documented penicillin allergy.

Objective:

To further define the risk of cross-sensitivity to carbapenems in patients with a penicillin allergy that has been documented in the electronic medical record or has been self-reported.

Methods:

Ninety-five patients with a documented or self-reported penicillin allergy were evaluated for the risk of carbapenem cross-sensitivity. Allergy information was obtained from a patient interview by a pharmacist or from the electronic medical record. Patients were evaluated for the type of allergic reaction, time of onset, and the carbapenem administered. The primary endpoint of the study was to determine the incidence of carbapenem cross-sensitivity in patients with a penicillin allergy.

Results:

Twenty-eight patients (29%) with a penicillin allergy were interviewed about their allergy, the reaction type, and the date of onset. The other 67 patients were not interviewed due to lack of clinical services or because the patient was unable to communicate. Two (2.1%) of the 95 patients were positive for an allergic reaction to a carbapenem.

Conclusions:

This research study supports recent findings that the incidence of carbapenem cross-sensitivity is low in patients with a penicillin allergy that is self-reported or documented in the electronic medical record. The benefits of using a carbapenem in penicillin-allergic patients may outweigh the potential risks. Based on these findings, our dispensing algorithm was modified.
Clopidogrel Adherence following Percutaneous Coronary Intervention with a Drug-Eluting Stent in a VA Medical Center
Authors: Shroff Adhir , Ali Ambreen , Groo Vicki L
Published: September 2013

Background:

Antiplatelet therapy with aspirin and a thienopyridine is the standard of care for prevention of thrombosis following coronary stent implantation. Recent evidence suggests a prolonged risk of stent thrombosis; therefore, clopidogrel therapy for at least 1 year is recommended following implantation of a drug-eluting stent. Premature discontinuation of clopidogrel is a well-recognized risk factor for stent thrombosis.

Objective:

To identify the rate of adherence to clopidogrel therapy among patients who have undergone percutaneous coronary intervention (PCI).

Methods:

We queried the central Veteran Affairs (VA) pharmacy database for each patient who underwent PCI with a drug-eluting stent between September 2004 and August 2005 at a single VA medical center. Based on pharmacy refill records, patients were considered adherent to clopidogrel if they filled more than 80% of the clopidogrel prescriptions.

Results:

We observed that 20.3% of patients were nonadherent to clopidogrel therapy for the course that they were assigned. Shorter duration of therapy was the only factor that predicted increased adherence. Race, polypharmacy, marital status, prior clopidogrel use, and age did not have a significant impact on adherence. Multivariable analysis did not demonstrate any other significant relationships.

Conclusions:

In this high-risk cohort of patients who have undergone PCI, we observed a 20% incidence of nonadherence to clopidogrel therapy. Shorter duration of therapy had a significant impact on improving rates of adherence in our analysis. This observation is of particular concern given the recent recommendations to prolong antiplatelet therapy to at least 1 year following PCI with a drug-eluting stent.
Comparison of Immediate-Release and Controlled-Release Paroxetine Ingestions Reported to Texas Poison Control Centers between 2002 and 2008
Authors: Forrester Mathias B
Published: September 2013

Background:

Controlled-release (CR) paroxetine was created to improve the tolerability of immediate-release (IR) paroxetine while maintaining therapeutic benefits. There is limited information comparing the toxicity of the 2 paroxetine formulations.

Objective:

To compare the toxicity and management of paroxetine IR and paroxetine CR ingestions reported to poison control centers.

Methods:

Cases of ingestion of paroxetine that were reported to Texas poison control centers between 2002 and 2008, in which the final medical outcome and dose were known, were retrospectively reviewed. The rates for selected variables were determined for paroxetine IR and paroxetine CR and comparisons between the 2 were made by calculating the ratio of the drug's CR rate to the IR rate and 95% confidence interval. Compliance with simplified algorithms of triage management guidelines was determined for both formulations.

Results:

Included in the analysis were 405 cases of paroxetine IR ingestion and 169 cases of paroxetine CR ingestion for which a reported dose and final medical outcome were known. There were no statistically significant differences between the paroxetine CR and paroxetine IR formulations with respect to serious medical outcomes (ratio 0.69, 95% CI 0.34 to 1.31), self-harm or malicious intent (ratio 0.82, 95% CI 0.60 to 1.12), or referral to a healthcare facility (ratio 1.18, 95% CI 0.76 to 1.83). The rate of compliance with the triage algorithm for cases not already en route to or at a healthcare facility when the poison control center was contacted was 87% for paroxetine IR and 89% for paroxetine CR.

Conclusions:

The toxicity and management of paroxetine IR and paroxetine CR ingestions reported to Texas poison control centers were similar after adjusting for differences in dosage.
Eltrombopag: A Thrombopoietin Receptor Agonist for Idiopathic Thrombocytopenic Purpura
Authors: Zhu Min
Published: September 2013

Objective:

To review the pharmacology, pharmacokinetics, safety, and efficacy of eltrombopag in previously treated patients with chronic idiopathic thrombocytopenic purpura (ITP).

Data Sources:

Articles were identified through a search of the MEDLINE (1950–December 2008) database for English-language articles containing the key words eltrombopag, SB-497115, idiopathic thrombocytopenic purpura, and immune thrombocytopenic purpura. References from publications identified in this search were reviewed for relevant information. Unpublished data received from the manufacturer was also included in this review.

Study Selection and Data Extraction:

All articles identified from the data search were reviewed for relevant information. Applicable information was included in this review.

Data Synthesis:

Eltrombopag is a new oral thrombopoietic receptor agonist approved by the FDA in November 2008 as second-line treatment of chronic ITP. It stimulates human megakaryocyte differentiation and proliferation, leading to increased platelet production. Eltrombopag has been shown in clinical trials to increase platelet counts in a dose-dependent manner regardless of splenectomy status, baseline platelet counts, and concurrent ITP therapy. Available data show a statistically significant decrease in the incidence of any bleeding (World Health Organization Grades 1–4) and clinically significant bleeding (Grades 2–4). Common adverse effects are mild and typically do not lead to treatment discontinuation. Results from clinical studies demonstrated significant increase in platelet counts with minimal adverse effects.

Conclusions:

Eltrombopag treatment provides a potential new resource for clinicians to use in the pharmacotherapy of ITP. Further studies are needed to explore its long-term safety and efficacy in patients with chronic ITP.

ACPE Universal Program Number:

407-000-09-054-H01-P (Pharmacists)
An Update of Recent Trials with Vildagliptin, a Dipeptidyl Peptidase-4 Inhibitor for the Treatment of Type 2 Diabetes
Authors: Johnson John T , Golden Kish L , Braceras Rogelio
Published: September 2013

Objective:

To review the clinical efficacy and tolerability of vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, for the treatment of type 2 diabetes, based on recent Phase 3 trials.

Data Sources:

Primary literature and review articles were obtained via a MEDLINE search (2005–November 2007) using the search terms diabetes, vildagliptin, and LAF-237. Additional data from abstracts presented at clinical meetings were included when appropriate.

Study Selection:

Nine double-blind, randomized, multicenter, parallel-group trials and vildagliptin studies were identified and reviewed.

Data Synthesis:

Vildagliptin, a selective DPP-4 inhibitor, has been shown to produce clinically significant reductions in hemoglobin A1c (A1C) levels when used as monotherapy (0.6–1%) or in combination with other glucose-lowering agents (mean decrease 0.7%). Phase 3 trials indicated a 24- to 52-week sustained effect on reduction of blood glucose in patients with type 2 diabetes. The primary endpoint for all trials was change from baseline A1C. In the intent-to-treat population, baseline A1C was compared with end-of-study A1C. More than 2,500 patients with type 2 diabetes enrolled in monotherapy trials; an additional 2,119 participated in combination therapy trials. Males outnumbered females, and all groups included obese patients. The most common adverse effects reported were nasopharyngitis, headache, and dizziness. Vildagliptin was weight-neutral and produced a rate of hypoglycemia similar to that of placebo.

Conclusions:

Vildagliptin appears to be a promising agent for the management of type 2 diabetes.
Establishing the Role of the Pharmacist in the Patient-Centered Medical Home… The Opportunity is Now
Authors: Dettloff Richard W , Glosner Patricia , Moroney Susannah Motl
Published: September 2013

The patient-centered medical home (PCMH) is an approach to delivering comprehensive, continuous, coordinated care across all life stages and has been hypothesized to be one potential solution to the discrepancy between the high cost but low quality of health care in the US. Although a plethora of literature exists on how pharmacy interventions can improve the quality of patient care through medication therapy management programs, there is a paucity of data supporting pharmacists' involvement in PCMHs. Pharmacists are uniquely trained and positioned to make important contributions to PCMHs as medication care coordinators. The opportunity is now for pharmacists to establish their role within this medical setting.
The Effect of Pharmaceutical Care Programs on Blood Pressure Control in Individuals with Hypertension: A Meta-Analysis
Authors: Ni Yongbing , Chen Yongfa , Huang Wenlong
Published: September 2013

Objective:

To evaluate the effect of pharmaceutical care (PC) programs on blood pressure control in individuals with hypertension.

Methods:

Studies were retrieved by searching MEDLINE, EMBASE, Cochrane, CNKI, and CBM databases from 1999 to February 2008. Randomized controlled trials (RCTs) on the association of pharmaceutical care programs with blood pressure control in individuals with hypertension were included in this study. Moreover, the studies were selected independently by 2 authors. The analysis was conducted by using Review Manager version 4.2 software.

Results:

Five RCTs with a total of 585 patients with hypertension were included in this meta-analysis. Compared with the control group, the PC program intervention group had significantly lower endpoint systolic blood pressure (SBP) and diastolic blood pressure (DBP). Moreover, SBP and DBP were significantly improved in the intervention group relative to the control group.

Conclusions:

PC programs appear to be an effective tool in helping to control blood pressure in hypertensive patients.
Pill Burden in Low-Income Patients with Metabolic Syndrome and Diabetes
Authors: Boyd Steven T , Scott David M , Pick Amy M
Published: September 2013

Background:

While pill burden can harm or overwhelm patients, very little is known about pill burden in patients with diabetes or metabolic syndrome.

Objective:

To determine the pill burden level in low-income patients with metabolic syndrome who were enrolled in a diabetes study that was trying to achieve recommended targets of therapy.

Methods:

A prospective chart review was performed on 145 patients enrolled in a diabetes study at Siouxland Community Health Center. Patients were considered to have metabolic syndrome if they had 3 or more of the following clinical risk factors: (1) type 2 diabetes mellitus; (2) dyslipidemia (triglycerides >150 mg/dL or high-density lipoprotein cholesterol <40 mg/dL for men and <50 mg/dL for women); (3) hypertension (blood pressure <130/80 mm Hg or receiving antihypertensive medication); and (4) obesity (body mass index >30 kg/m2). Pill burden was defined as the average number of prescribed administrations per day. Inhalers, ophthalmics, and glucose meters were counted by number of puffs, drops, or finger sticks per day. Average hemoglobin A1C (A1C) level was collected at baseline and at 12 months.

Results:

The results showed that 85.5% of patients in the diabetes study were classified as having metabolic syndrome. The total number of administrations per day was analyzed for 124 eligible patients. Patients had an average baseline pill burden of 8.5 and A1C of 8.6%. After being enrolled in the study for 12 months, patients' average pill burden endpoint increased to 13.1 and A1C was reduced to 7.0%. At the end of the study, 37.9% of patients were prescribed dual therapy for glucose control: 79% on antihypertensives, 70% on lipid-lowering agents, and 65% taking aspirin.

Conclusions:

Diabetes patients with metabolic syndrome are prescribed multiple drug therapies to control diabetes and other metabolic abnormalities. In this study, we concluded that the average pill burden was 13.1 in patients with glucose-controlled diabetes and metabolic syndrome.
Licensed Vaccines for Rotavirus Prevention in the US: A Review
Authors: Hale Katherine S , Brown Sherrill J
Published: September 2013

Objective:

To review the pharmacology, efficacy, safety, and tolerability of RotaTeq and RotaRix, 2 rotavirus vaccines.

Data Sources:

English-language articles were obtained via MEDLINE (1966-August 2009) and EMBASE (1980-August 2009) searches using the key words rotavirus vaccine, epidemiology, diarrhea, intussusception, RotaShield, RotaTeq, and RotaRix. Bibliographies of selected articles were used to identify additional sources.

Study Selection and Data Extraction:

Available published articles reporting the results of human studies of rotavirus vaccines were reviewed for inclusion in this article. Additional information regarding clinical trials and adverse events was obtained from the manufacturer's prescribing information for each vaccine.

Data Synthesis:

RotaTeq is a live, attenuated human-bovine pentavalent vaccine, and RotaRix is a live, attenuated human vaccine. Both vaccines are approved for the prevention of rotavirus infection and recommended for routine immunization in healthy infants aged 14 weeks to 8 months. The vaccines differ in virologic characteristics, but clinical trials indicate similar efficacy and safety. Each vaccine is more than 70% effective in preventing any severity of rotavirus gastroenteritis and more than 98% effective in preventing severe disease through one full season of rotavirus exposure postvaccination. Efficacy begins to wane during the second season of rotavirus exposure. Post hoc analyses of clinical trials indicated an 85–100% reduction in hospitalizations and emergency department visits following vaccination. Both vaccines have been well tolerated. Fever, vomiting, and diarrhea are the most reported adverse events. Intussusception and Kawasaki syndrome have been reported, but occurrence of these events has not been shown to be significant in comparison with the background rate for each adverse event.

Conclusions:

RotaTeq and RotaRix are effective for the prevention of rotavirus infection in the US, Europe, and Latin America. Additional studies are needed to assess their duration of protection, worldwide efficacy, effect on the reduction of healthcare resource utilization, and adverse event monitoring.
Pharmacists' Perceptions of Barriers to Implementing Medication Therapy Management and the Role of Pharmacy Technicians in Overcoming the Barriers
Authors: Bright David R , Lengel Aaron J , Powers Mary F
Published: September 2013

Background:

Recent literature supports the value of clinical pharmacy services in the outpatient setting, but pharmacists must overcome barriers to the implementation of clinical services to establish an effective and efficient program.

Objective:

To identify pharmacists' perceptions of barriers to the implementation of medication therapy management (MTM) and perceptions of collaboration with pharmacy technicians.

Methods:

Surveys were sent to all 415 community pharmacists in a supermarket pharmacy chain marketing area in Ohio. Pharmacists completed the anonymous survey to indicate their opinions regarding a series of potential barriers to the implementation of MTM, including education and training, current and desired roles of pharmacy technicians, and support from store management.

Results:

Of responding pharmacists, 16.2% reported that they had personally participated in an MTM encounter, with an average number of encounters per pharmacist of 1.4. Pharmacists reported a desire for additional training in disease states commonly addressed in MTM, MTM systems, and MTM service elements, but 50.5% felt comfortable as a provider of MTM without additional training. More than 90% of pharmacists reported that sufficient staffing and overlap affords the opportunity for 0–5 MTM encounters per week. Pharmacists reported that few technicians are trained to assist with MTM, but more than 70% of pharmacists would seek technician assistance with scheduling, billing, and patient correspondence.

Conclusions:

Although technician assistance may help to reduce pharmacist staffing and training needs, few technicians are trained for clinical support roles. Incorporation of clinical pharmacy technicians into the MTM process may improve the economics and efficiency of MTM and reduce barriers to the implementation of MTM.
Overview of the Pharmacologic Options for Rosacea
Authors: Segarra-Newnham Marisel , Karimi Sahar
Published: September 2013

Objective:

To review available therapies for rosacea.

Data Sources:

A PubMed literature search (1985-July 2009) was conducted. Search terms included rosacea, antibiotics, and treatment.

Study Selection and Data Extraction:

English-language reviews, comparative clinical trials, and guidelines for treatment of rosacea were reviewed. Seven comparative trials were identified.

Data Synthesis:

Rosacea is a common dermatologic disease that affects about 10% of the adult population, usually before age 50. The etiology of the disease is unknown. There are 4 subtypes of rosacea: erythematotel-angiectatic (frequent flushing and redness), papulopustular (early telangiectasias, classic rosacea), phymatous (thickened skin with prominent pores), and ocular. Severity of each subtype is classified as mild, moderate, or severe. The goal of therapy is symptomatic control versus cure. For papulopustular rosacea, topical metronidazole is the first line of therapy. Azelaic acid is a newer preparation that patients have preferred over topical metronidazole in head-to-head trials. Topical sodium sulfacetamide/sulfur is another alternative. Systemic agents may be needed for nonresponders or patients with severe disease. Oral alternatives include a 40–mg dose of doxycycline, which costs significantly more than generic doxycycline 100 mg. The lowest effective oral dose should be used to reduce the possibility of bacterial resistance. Telangiectasias may require laser surgery.

Conclusions:

Several alternatives are available for the treatment of rosacea, depending on the subtype, severity of disease, and patient response. In addition to pharmacologic therapy, patients with rosacea need to be counseled about identification and avoidance of triggers that can exacerbate their symptoms, the use of broad-spectrum sunscreens, and the use of mild cleansers.
Autoimmune Hepatitis Induced by Interferon Beta Therapy in a Patient with Multiple Sclerosis: A Case Report
Authors: Benmousa Ali , Helmy Ahmed , Sanai Faisal M , Ghandour Zuhal M
Published: September 2013

Objective:

To report a case of a woman who had multiple sclerosis and developed autoimmune hepatitis (AIH) induced by interferon beta therapy.

Case Summary:

A 35–year-old woman with multiple sclerosis was being treated with interferon beta when she presented with fatigue and jaundice. Liver biochemistry testing revealed acute hepatitis (alanine and aspartate aminotransferase values >10 times the upper limit of normal) that was histologically consistent with AIH. Our patient had a score of 9 on the Roussel Uclaf Causality Assessment Method scale, indicating a high probability that hepatotoxicity in this case was related to interferon beta therapy. The patient had spontaneous clinical and biochemical improvement after stoppage of treatment. However, when she resumed interferon beta therapy, derangement of liver function reappeared, which again responded well to discontinuation of interferon.

Discussion:

Interferons can induce many autoimmune diseases due to their immunomodulatory effects. Autoimmune thyroid diseases and, to a lesser extent, skin and pulmonary involvement, are frequently reported during interferon alfa treatment for chronic hepatitis C. Several different forms of hepatotoxicity have also been described with interferon alfa and beta therapy, but few cases of AIH induced by interferon are reported in the literature. AIH has been described in association with interferon alfa therapy; however, this association with interferon beta therapy is extremely rare, and only a handful of cases have been described. Moreover, reports of previous cases were not rechallenged with the same medication, thereby failing to demonstrate firm evidence of causality. This is the first report of the disease reappearing upon drug rechallenge. In addition, we have shown that interferon-induced AIH can be suitably treated by drug withdrawal rather than by institution of steroid therapy.

Conclusions:

Practitioners need to be aware of the potential complication of AIH induced by interferon beta; this condition occurs independently of the typically benign enzyme elevations frequently reported with this drug.
Survey of Hospital Pharmacy Directors: Assessment of the Current State of Unit-Dose Acquisition
Authors: Mason Scott J , Meller Russell D , Thomas Lisa M , Pazour Jennifer A , Root Sarah E
Published: September 2013

Background:

Many hospitals are in the planning stage of barcode point-of-care (BPOC) implementation. One of the challenges that hospital pharmacies face in BPOC implementation is unit-dose acquisition.

Objective:

This article presents the results of a survey of hospital pharmacy directors to assess the current state of unit-dose acquisition to support bedside barcode-enabled dispensing practices.

Methods:

An online survey was administered over 2 months and was available from September to November 2008. The University of Arkansas Institutional Review Board approved the survey before it was disseminated. The survey was developed in collaboration with 2 hospital pharmacy directors. Ninety-one valid survey responses were representative in terms of the distribution of hospital size compared with previous surveys of the American Society of Health-System Pharmacists. Though there were 91 total respondents, not all provided responses to all of the survey questions. Thus, some of the figures, tables, and text refer to fewer than 91 respondents.

Results:

The results of interest to pharmacy technicians indicated that most hospitals today are able to purchase at least 40% of their medications in unit-dose packaging directly from the manufacturer. For medications that cannot be acquired in unit-dose packaging, 85% of the hospitals surveyed perform repackaging operations in-house. However, 87% of the hospitals that use a high-speed oral solid repackager only use this equipment, at most, 4 hours per day. Our survey results showed that only 8% of the hospitals surveyed used a third-party repackager to acquire unit-dose medications, compared with 85% of hospitals that are either currently using or in the planning phase of using BPOC.

Conclusions:

The survey found that most hospital pharmacy directors choose to repackage medications in-house, despite the high cost of repackaging equipment and a relatively low utilization of that equipment. Hospitals indicated that cost and turnaround time were the 2 issues of greatest concern when considering outsourcing unit-dose medication repackaging to a third-party repackager.
Doripenem: The Newest Addition to Carbapenem Antibiotics
Authors: Willett Kristine , Raman Kirthana , Nichols Jessica , Durand Cheryl
Published: September 2013

Objective:

To review the pharmacology, pharmacokinetics, microbiology, and clinical efficacy and safety data of doripenem for the management of complicated and nosocomial infections.

Data Sources:

Literature searches were conducted using MEDLINE (1996-September 2009, week 2) and EMBASE (1996–2009, week 38) with the term doripenem. References from articles obtained from the search were evaluated for other relevant citations.

Study Selection and Data Extraction:

All articles in English evaluating the efficacy, adverse effects, pharmacology, microbiologic spectrum of activity, and pharmacokinetic profile of doripenem were selected.

Data Synthesis:

Doripenem is the newest addition to the carbapenem class of antibiotics and has been studied for a variety of indications. It is approved by the FDA for the treatment of complicated urinary tract infections and complicated intraabdominal infections. The manufacturer is also seeking an indication for the treatment of nosocomial pneumonia. Efficacy studies evaluating doripenem's use for these indications were conducted as noninferiority studies comparing doripenem with standard treatment options. Results showed that doripenem is noninferior to levofloxacin in the treatment of complicated urinary tract infections, noninferior to meropenem in the treatment of complicated intraabdominal infections, and noninferior to both piperacillin/tazobactam and imipenem/cilastatin for the treatment of nosocomial pneumonia. The adverse effect profile for doripenem is similar to that of other carbapenems, with the most commonly reported effects being headache, nausea, diarrhea, rash, and phlebitis.

Conclusions:

Doripenem has been shown to be an effective and well-tolerated carbapenem antibiotic for the treatment of complicated urinary tract infections and complicated intraabdominal infections. It has also exhibited promising results in studies evaluating its use in patients with nosocomial pneumonia.
The Clinical Significance of the Interaction between Proton Pump Inhibitors and Clopidogrel
Authors: Weber Zachary A , Rodgers Philip T
Published: September 2013

Objective:

To determine whether the interaction between omeprazole and clopidogrel is a proton pump inhibitor (PPI) class effect or a drug-specific effect.

Data Sources:

A MEDLINE search for primary literature was completed (through August 2009) using the search terms proton pump inhibitors and clopidogrel. Additional data obtained from references and abstracts presented at clinical meetings were included when appropriate.

Study Selection:

Nine primary literature articles were identified and reviewed. This included only one prospective, double-blind, placebo-controlled, randomized trial. The remainder were prospective and retrospective cohort studies and a population-based nested case-control study.

Data Extraction:

Omeprazole, a CYP2C19 inhibitor, has been shown to increase the platelet reactivity index (PRI) when combined with clopidogrel (52.4% vs 39.8%; p < 0.0001), leading to an increased risk of thrombosis. This combination was also shown to cause a 25% increase in the risk of mortality or rehospitalization for acute coronary syndrome (ACS), with a significantly higher risk for each 10% increase in time on this combination therapy (odds ratio [OR] 1.07; CI 1.05 to 1.09). Conversely, combination therapy with pantoprazole or esomeprazole and clopidogrel caused a nonsignificant increase in PRI (p = 0.382) and adenosine diphosphate-induced platelet aggregation (p = 0.69 and 0.88, respectively). Similarly, the combination of pantoprazole and clopidogrel was not associated with an increased risk of myocardial infarction (OR 1.02 [0.70–1.47]) when patients were followed for 90 days following hospital discharge for ACS. One study has shown a class effect when PPIs are combined with clopidogrel, leading to an increased risk of a major adverse cardiovascular event (hazard ratio 1.51; 1.39 to 1.64). Histamine2 (H2)-receptor antagonists have not been associated with a significant interaction with clopidogrel in any study.

Conclusions:

The use of PPIs with clopidogrel may be warranted, based on comorbid disease states for many patients, but H2-receptor antagonists should be considered when appropriate, due to their lack of interaction with clopidogrel.
The Implementation of an Electronic Document Management System at a Drug Information Center
Authors: Wisniewski Christopher S , Pummer Tara L , Krenzelok Edward P
Published: September 2013

Objective:

To describe a method for creating an electronic document management (EDM) system at a drug information (DI) center based at an academic medical center to improve efficiency and provide increased availability through remote access.

At DI centers, written materials not available electronically are often stored in file cabinets and retrieved by an individual when required. This process can be time-consuming and inefficient. Various EDM programs were evaluated and compared based on capabilities, cost of implementation and maintenance, and efficiency. Following program selection, documents were scanned onto a dedicated personal computer (PC) and organized according to a predetermined hierarchy of folders. Specialists then performed optical character recognition (OCR) and entered authors, titles, and assigned key words for each new electronic file.

Results:

It was determined that Adobe Acrobat software fulfilled all requirements at minimal expense. A specialist is able to scan and electronically file 72 documents (496 pages) per hour, perform OCR on 40 documents per hour, and attach titles, authors, and key words to newly scanned documents at a rate of 10 articles per hour. This EDM system is capable of storing in excess of 70,000 documents on a PC with 250 GB of hard disk space and 4 GB of random access memory, which can be accessed remotely from any computer through a secure virtual private network connection.

Conclusions:

Adobe Acrobat software, when combined with a high-resolution scanner, provides an inexpensive method for EDM that allows for immediate document retrieval, expansion of operations, and remote access.
Human Ingestions of Veterinary Cyclooxygenase-2 Inhibitors
Authors: Forrester Mathias B
Published: September 2013

Background:

Deracoxib and firocoxib are cyclooxygenase-2 inhibitors approved for veterinary use, but not for use in humans. Information on the outcome of human ingestions of these drugs is not readily available.

Objective:

To describe human ingestions of cyclooxygenase-2 inhibitors reported to poison centers.

Methods:

All human ingestions of deracoxib and firocoxib reported to Texas poison centers during 2003–2009 were identified, and the distribution of ingestions by demographic and clinical factors was determined. Final medical outcome was determined by poison center staff, based on adverse clinical effects that are observed or expected.

Results:

Of 72 total ingestions, 56.9% involved deracoxib and 43.1% involved firocoxib. One tablet or less was ingested in 87.7% of cases in which the number of tablets was known. The patients were 62.5% female, 51.4% aged 0–5 years, 6.9% aged 6–19 years, and 41.7% aged 20 years or more. The patient was managed on site in 94.4% of the cases. The distribution of cases by final medical outcome was 44.4% no effect, 18.1% not followed but judged nontoxic, 34.7% not followed but minimal effects possible, and 2.8% effects probably not related to the ingestion.

Conclusions:

Human ingestions of deracoxib and firocoxib reported to Texas poison centers were relatively uncommon. Such ingestions usually involved 1 tablet or less. Cases followed to known outcome did not result in serious outcomes and were frequently managed on site.
Saxagliptin: New Therapy for Type 2 Diabetes
Authors: Logan Jill K , EscañO Alisa K
Published: September 2013

Objective:

To evaluate the efficacy of saxagliptin for the treatment of hyperglycemia associated with type 2 diabetes.

Data Sources:

A MEDLINE/PubMed search was conducted of all available date ranges from 1990 through October 2009 for literature in the English language, using the search terms saxagliptin, type 2 diabetes mellitus, incretin hormones, and dipeptidyl peptidase-4 inhibitors. The manufacturer of saxagliptin (Onglyza) was contacted for clinical trial information.

Study Selection:

Five prospective, randomized controlled trials were reviewed. Studies were included in this review if they had examined saxagliptin and its effects on hyperglycemia. Trials examined included those on saxagliptin monotherapy and those on saxagliptin in combination with metformin, with a sulfonylurea, and with a thiazolidinedione. Data from the MEDLINE/PubMed search, as well as clinical trial data obtained from the manufacturer, were used in this review.

Data Synthesis:

Saxagliptin demonstrated statistically significant decreases of 0.43–0.54% in hemoglobin A1c (A1C) in the monotherapy treatment group. The A1C-lowering effects were the greatest, with a decrease of 2.5% in patients concomitantly administered metformin and saxagliptin as initial therapy. In addition to its effects on A1C, saxagliptin proved to be weight neutral and had minimal risks of hypoglycemia, with hypoglycemia seen only in the saxagliptin in combination with a sulfonylurea group.

Conclusions:

Saxagliptin is an effective treatment for hyperglycemia associated with type 2 diabetes. It is currently a third-line option in the American Diabetes Association treatment algorithm for type 2 diabetes and, based on the trials reviewed here, this is an acceptable place in therapy. Saxagliptin is a good option for patients with diabetes who are at high risk of hypoglycemia.
Review of Medications Used in the Treatment of Diabetes Mellitus
Authors: Laliberte Brandi K , Neumiller Joshua J
Published: September 2013

Objective:

To review the pathophysiology of diabetes mellitus and outline currently available medications used in its treatment.

Data Sources:

A MEDLINE/PubMed search (1966-December 2009) was conducted for English-language articles using the terms diabetes mellitus, pharmacotherapy, metformin, thiazolidinedione, sulfonylurea, meglitinide, α-glucosidase inhibitor, DPP-4 inhibitor, colesevelam, bromocriptine, exenatide, pramlintide, and insulin. Book chapters relevant to the pathophysiology and pharmacologic treatment of diabetes were also searched.

Study Selection and Data Extraction:

Articles and chapters pertinent to the pharmacologic management of diabetes mellitus were reviewed.

Data Synthesis:

Type 1 diabetes is characterized by an absolute lack of insulin production by the β-cells of the pancreas, requiring insulin therapy. Type 2 diabetes is characterized by both insulin resistance and a relative or absolute lack of insulin secretion. Because type 2 diabetes involves both insulin resistance and decreased insulin production over time, people with type 2 diabetes can be treated with a variety of drugs currently on the market. Therapies currently on the market include metformin, thiazolidinediones, sulfonylureas, meglitinides, α-glucosidase inhibitors, DPP-4 inhibitors, colesevelam, bromocriptine, exenatide, pramlintide, and insulin.

Conclusions:

Given the multitude of medications available for the treatment of diabetes, it is important that pharmacy technicians and pharmacists be aware of the various agents currently on the market. With a solid foundation of knowledge regarding diabetes medications, a huge impact can be made on the quality of care of the customers and patients the pharmacy serves.