bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Orlistat Use in a Veteran Population: A Pharmacist-Managed Pharmacotherapy Weight-Loss Clinic versus Standard Medical Care
Authors: Graham Maqual R , Landgraf Chelsea G , Lindsey Cameron C
Published: September 2013

Objective:

To determine whether a pharmacist-managed pharmacotherapy weight-loss clinic using orlistat is beneficial in promoting weight loss and reducing cardiovascular risk.

Methods:

A retrospective review of the records of all veterans receiving orlistat was conducted. Patients were assigned to 1 of 2 treatment groups: those enrolled in the pharmacist-managed pharmacotherapy weight-loss clinic (intervention) or those receiving standard medical care (control). Changes in weight and body mass index (BMI) at 6 months were compared with baseline measures. Treatment success, defined as a weight loss of ≥5% of initial body weight, was determined. The impact of weight loss on cardiovascular risk factor reduction was compared within each group. The prevalence of adverse drug reactions was also assessed and compared.

Results:

Forty-seven patients were included in the analysis: 18 and 29 in the intervention and control groups, respectively. Intervention patients lost a mean ± SD of 5.0 ± 6.0 kg by 6 months compared with 2.2 ± 4.7 kg for the controls (p = 0.109). BMI significantly decreased for all patients independent of group assignment (intervention, p = 0.006; control, p = 0.026), yet a between-group comparison revealed no difference (p = 0.140). Five patients (28%) in the intervention group were considered treatment successes versus 4 (14%) in the control group; however, this was not a significant difference (p = 0.274). Total cholesterol and glycosylated hemoglobin were significantly decreased in intervention patients, while control patients demonstrated significant improvement only in total cholesterol. There was no difference in adverse reaction occurrence between groups (p = 0.995).

Conclusions:

Patients enrolled in the pharmacist-managed pharmacotherapy weight-loss clinic lost twice as much weight, and twice as many were considered treatment successes compared with control patients. Intervention patients demonstrated improvement in several cardiovascular risk factors.
Effectiveness of an Amiodarone Protocol and Management Clinic in Improving Adherence to Amiodarone Monitoring Guidelines
Authors: Graham Maqual R , Wright Marcia A , Manley Harold J
Published: September 2013

Objective:

To determine whether adherence to suggested monitoring parameters improved as a result of the development and implementation of an amiodarone protocol and management clinic. Adverse effects from amiodarone therapy were also evaluated to ascertain whether the Amiodarone Management Clinic (AMC) better identified adverse events as a result of improved monitoring.

Methods:

A retrospective review of charts of patients with an active amiodarone prescription was conducted. Patients were identified as enrolled in the AMC (intervention) or as receiving standard medical care (control) by nonpharmacist practitioners. Compliance with recommended monitoring parameters, including the presence of interacting medications and associated drug concentration or international normalized ratio (INR), was assessed for all patients and then compared between groups. Type and frequency of adverse effects were determined for both groups.

Results:

Two hundred twenty-five charts were reviewed; 154 and 71 patients were assigned to the intervention and control groups, respectively. One hundred one (66%) patients in the intervention group were considered compliant with thyroid function monitoring compared with 26 patients (37%) in the control group (p < 0.0001). One hundred six (69%) and 27 (38%) patients in the intervention and control groups, respectively, were deemed compliant with liver function monitoring (p < 0.0001). Intervention patients taking warfarin were more likely to have blood drawn for INR assessment; however, there was no difference in values between groups. Seventy-six patients had a documented adverse effect from amiodarone, 68 of whom were from the intervention group (p < 0.0001).

Conclusions:

Many patients receiving amiodarone are not managed according to published guidelines. Implementation of a pharmacist-managed protocol and clinic significantly improved compliance with 2 of the 3 parameters needing continuous monitoring. Although more adverse effects were documented for intervention patients, it is unclear whether the AMC actually improved the event detection rate.
Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and other Healthcare Professionals Part I
Authors: Nice Frank J , DeEugenio Deborah , DiMino Traci A , Freeny Ingrid C , Rovnack Marissa B , Gromelski Joseph S
Published: September 2013

Objective:

To provide a guide for practicing pharmacists, pharmacy technicians, and other healthcare professionals so that they are able to counsel and advise breast-feeding mothers and fellow healthcare professionals on the safety and use of common ambulatory care, analgesic, and anesthetic medications during breast-feeding.

Data Sources:

Primary texts used by the breast-feeding community were searched, as well as Micromedex, MEDLINE, PubMed, Embase, and Embase2 (1984–July 2003).

Study Selection and Data Extraction:

Multiple sources were utilized whenever available to validate the data, and primary articles were used to verify all tertiary source information. Search terms included breast feeding, lactation, nursing, and medications, as well as specific drug names.

Data Synthesis:

Concerns regarding medication use during breast-feeding have caused mothers to either discontinue nursing or not take necessary medications. Complete avoidance of medications or cessation of breast-feeding is often unnecessary. Although there are medications that can be harmful to nursing infants, breast milk concentrations of most drugs are insufficient to cause any harm.

Conclusions:

Having objective and reliable information on medications enables pharmacists, pharmacy technicians, other healthcare providers, and mothers to make educated decisions regarding drug therapy and breast-feeding.
The North Dakota Telepharmacy Project: Restoring and Retaining Pharmacy Services in Rural Communities
Authors: Peterson Charles D , Anderson Howard C
Published: September 2013

Objective:

To provide a detailed description of the North Dakota Telepharmacy Project including its overall purpose, goals, and how it works, and provide valuable information and guidelines for pharmacists and rural communities on how to successfully implement a telepharmacy program designed to serve small rural communities that have lost their pharmacy services, are about to lose their pharmacy services, or have had no pharmacy services.

Discussion:

Ten rural communities in western, northern, and central frontier counties of North Dakota including 4 central pharmacy hub sites serving 6 remote rural telepharmacy spoke sites are described. Through use of audio, video, and computer links, North Dakota has developed a successful statewide telepharmacy program to restore and retain pharmacy services to rural communities that have lost, are about to lose, or have no pharmacy services. North Dakota currently has full-service telepharmacy sites established in the communities of Beach, New England, Maddock, Rolette, and New Town. These remote telepharmacy sites are served by licensed pharmacists in central pharmacies located in Killdeer, Rugby, and Watford City. The distance from the central pharmacy site to the remote telepharmacy site ranges from 31 to 95 miles (average ∼57). The size of the remote telepharmacies ranges from 1,200 to 2,500 square feet (average ∼1,660). The remote telepharmacies are staffed by 2–3 personnel (1 pharmacy technician, 1–2 store clerks). The remote telepharmacy sites dispense 15–55 prescriptions per day (average ∼35). Hours of service of the remote telepharmacy sites are generally 9:00 am to 5:00 pm, Monday through Friday. The remote telepharmacy communities have populations ranging from 498 to 1,367 people (average ∼799). The remote communities have a medical clinic staffed 5 days a week by either a physician, physician's assistant, or nurse practitioner.

Conclusions:

Through use of telepharmacy technology, pharmacy services can be restored and retained in remote rural communities satisfying all rules and regulations of the state board of pharmacy using the same processes and procedures as traditional pharmacy practice including pharmacist drug utilization review, verification before dispensing, and patient counseling. Telepharmacy services produce the same quality of pharmacy services as the traditional mode of delivery and provide additional value-added features that are not found with traditional pharmacy practice.
Subdural Hematoma Due to Probable Warfarin–Fluorouracil Interaction
Authors: Giunta Giovanni , Velluti Francesca
Published: September 2013

Objective:

To describe the occurrence of a subdural hematoma in a woman undergoing chemotherapy with cyclophosphamide, methotrexate, and fluorouracil combined with warfarin therapy.

Case Summary:

A 60-year-old white woman with atrial fibrillation underwent radical mastectomy for primary breast cancer with histologically positive axillary lymph nodes. Following surgery, the patient received adjuvant chemotherapy with a CMF 1–8 regimen consisting of cyclophosphamide 100 mg/m2 orally on days 1–14, methotrexate 40 mg/m2 intravenously, and fluorouracil 600 mg/m2 by intravenous bolus on days 1 and 8 every 4 weeks. Warfarin 5 mg/day was administered concomitantly due to atrial fibrillation. Following the second course of concomitant therapy, the patient developed a headache, hemiparesis, and an international normalized ratio (INR) of 7.6, which was highly suggestive of a drug interaction between fluorouracil and warfarin. A computed tomography scan of the brain revealed a left parieto-occipital subdural hematoma.

Discussion:

This case emphasizes the importance of the potentially fatal drug interaction involving warfarin and fluorouracil.

Conclusions:

Several adverse interactions between warfarin and fluorouracil have been reported. Considering the severity of this interaction, close monitoring of the INR is recommended in patients receiving these agents concomitantly.
Blood Pressure Elevation with Rofecoxib in Older Adults
Authors: Eng Marty L , Rojas-Fernandez Carlos H
Published: September 2013

Objective:

To report blood pressure elevation associated with rofecoxib use in 2 older adults.

Case Summaries:

Two patients, aged 75 and 94 years, were prescribed rofecoxib for osteoarthritis pain. After the initiation of therapy, an elevation in systolic blood pressure measurement ≥17 mm Hg was observed. Upon withdrawal of rofecoxib, blood pressure in one patient returned to baseline measurements. In the second patient, sustained rofecoxib use resulted in blood pressure elevation and change in antihypertensive therapy.

Discussion:

It is well known that even a small elevation in blood pressure can significantly increase a person's risk for cardiovascular events. However, little is known about the potential magnitude of blood pressure elevation with the use of cyclooxygenase-2 inhibitors in the older adult population. In 2 older adults with osteoarthritis and hypertension, rofecoxib potentially led to a substantial elevation in blood pressure. In each case, adjustments of respective therapeutic regimens were made. The Naranjo probability scale indicates a probable relationship in both cases between the rofecoxib and blood pressure elevation.

Conclusions:

These reports suggest that rofecoxib could produce greater elevation in blood pressure in older hypertensive adults than has been previously reported. Therefore, close monitoring of blood pressure for 1–2 months after initiation of rofecoxib therapy is advisable. Further study is needed to determine the true clinical significance of these findings in older hypertensive adults.
Appearance of Retinal Hemorrhages in Patients on Daily-Dose Anti-Tubercular Therapy
Authors: Sodhi Punita K , Sachdev Mahipal S , Verma Lalit K , Ratan Simmi K
Published: September 2013

Objective:

To report 2 patients who presented with retinal hemorrhages while being treated with a continuous regimen of anti-tuberculous drugs.

Case Summaries:

Two women, one suffering from tuberculous infection of the lungs and the other from disseminated Koch's, were treated with a daily regimen of anti-tuberculous therapy consisting of rifampin, isoniazid, pyrazinamide, and ethambutol. On initiation of treatment, these patients did not have any systemic or ocular disease, and hematologic investigations, kidney function tests, and liver function tests were normal. Within 2 weeks of initiation of anti-tuberculous therapy, both women had transient renal function deterioration. Additionally, each had a single episode of retinal hemorrhage. While the patients remained under treatment with the same drugs, both of these adverse effects resolved spontaneously within a short period. According to the Naranjo probability scale, this reaction was probable.

Discussion:

The renal dysfunction and retinal hemorrhages in both of our patients were most probably due to anti-tuberculous drug-induced antibodies. A continuous mode of anti-tuberculous drug administration causes immunologic tolerance due to simultaneous neutralization of drug-induced antibodies. As the antibodies were short-lived, renal impairment, thrombocytopenia, and retinal hemorrhages in both of our patients were transient.

Conclusions:

The continuous regimen of anti-tuberculous drug administration is safer than intermittent therapy. In patients receiving treatment with these drugs, hepatic, hematologic, renal, and ocular parameters should be regularly monitored.
FDA Adverse Event Reports on Use of Sibutramine: An Exploratory Analysis
Authors: Stavchansky Marcus M , Wilson James P
Published: September 2013

Objective:

To report the adverse events associated with sibutramine per the Adverse Event Reporting System (AERS) database.

Methods:

A retrospective database analysis of all domestic and foreign reports of adverse events associated with sibutramine use from September 1997 to March 2002 was conducted. Outcome measures included the total numbers of reports (initial plus follow-up), the mean age of the uniquely identified cases or patients, the number of cases reported as a serious adverse event, the length of therapy prior to serious adverse event, and the mean dose for all outcomes reported.

Results:

There were 4,898 unique reports of adverse events associated with sibutramine use representing 4,749 patients between September 1997 and March 2002 in the AERS database. Of those unique reports, there were 12,081 different adverse events associated with sibutramine use during the 56-month period. The mean ± SD age was 44.39 y ± 12.56 years, while the majority of patients were female (4,153, 87.4%). Uniquely reported outcomes totaled 740 cases, 389 (52.6%) of which were termed serious as a result of the adverse event. Death was listed in 43 (7.8%) reports as the outcome. Twenty-two of those deaths were reported as due to myocardial infarction or cardiac arrest. Many of the adverse event reports were submitted by healthcare professionals (614, 8%), with the majority of reports being periodic (90%). Sibutramine was listed as the primary suspect of the adverse event in 4,433 (83.6%) cases. The average dose of sibutramine was 15 mg, while the median length of therapy was 30 days.

Conclusions:

Although valuable information comes from the AERS database, with so many other variables (risk factors, comorbid conditions, reporting bias, multiple medications) along with the number of persons taking sibutramine (>8 million worldwide), establishing a relationship between sibutramine consumption resulting in various adverse events is difficult. Because of the various limitations of the AERS database, caution must be taken when interpreting the cases reported to the database.
Mydriasis, Hypertension, and Tachycardia Possibly Associated with Venlafaxine Augmentation of Mirtazapine
Authors: Zullino Daniele F , Cucchia Gianni
Published: September 2013

Objective:

To report a case of mydriasis and hypertension resulting from concomitant use of mirtazapine and venlafaxine.

Case Summary:

A 36-year-old man had been treated for 7 weeks with mirtazapine up to 60 mg/day without satisfactory therapeutic effects. Venlafaxine extended-release up to 150 mg/day was added with the aim to boost the antidepressant effect. After 5 days of venlafaxine treatment, the patient developed apparent mydriasis, and after 9 days of therapy, the patient's blood pressure peaked at 200/120 mm Hg. While he remained under mirtazapine therapy, both symptoms resolved within 24 hours after venlafaxine discontinuation.

Discussion:

A rise in blood pressure is a well-known phenomenon with venlafaxine. As of September 27, 2004, this is the first case of hypertension after venlafaxine augmentation of mirtazapine and the first case to report a preceding mydriasis. We propose an excess of noradrenergic activity due to the combination of venlafaxine and mirtazapine to be the most probable cause.

Conclusions:

Whereas the mirtazapine/venlafaxine combination seems a promising approach in the treatment of refractory depression, this strategy may be associated with adverse drug events not observed with either of the drugs when given alone. Mydriasis may be a good premonitory sign for hypertension.
Peanut Allergy Treatment: Past, Present, and Future
Authors: Keller Tracey A , Amsden Guy W
Published: September 2013

Objective:

To review the current and future treatments for peanut allergy.

Data Sources:

Literature review was conducted via MEDLINE (1996–October 2003) using OVID and PubMed. The following terms were used: food allergy, peanut allergy, anti-IgE, antihistamine, anaphylaxis, and epinephrine.

Data Synthesis:

Peanut allergy is an immunoglobulin (Ig) E–mediated type I reaction, which is the leading cause of fatal and near-fatal food allergy. Proper diagnosis and treatment plans for patients with peanut allergy are essential. Many patients who have a known life-threatening allergy are far too often unprepared. New treatments aimed at reduction or prevention of anaphylactic reactions are in development.

Conclusions:

Education on the understanding of how to avoid peanut proteins and how to identify signs and symptoms of food allergy is the number one tool in treatment of peanut allergy. The second tool is an easily accessible physician-ordered treatment plan, which includes signs and symptoms of anaphylaxis, proper medications with dosing and administration instructions, and contact numbers. Medications must be available at all times.
Recently Approved Medicare Provisions for Prescription Drugs and Medication Management Services
Authors: Powers Mary F
Published: September 2013

Objective:

To review recent changes in Medicare affecting the practice of pharmacy.

Data Sources:

Articles were identified through searches of MEDLINE (2003–March 2004), LEXISNEXIS ACADEMIC (2003–March 2004), and LEXISNEXIS CONGRESSIONAL databases (2003–March 2004), using the key words Medicare, pharmacist, pharmacy, and drug costs. Additional references were located through review of the bibliographies of the articles cited and through searches of the Web sites for Medicare, Social Security, and the American Pharmacists Association.

Study Selection and Data Extraction:

Reports about Medicare and Medicare Part D were selected. Articles describing the history of Medicare and changes that impact pharmacy were included.

Data Synthesis:

The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MPDIMA) provides an optional prescription drug benefit for Medicare beneficiaries in 2006 as Medicare Part D. Before its full implementation, eligible Medicare beneficiaries may qualify for a temporary Medicare-approved Drug Discount Card. The prescription drug benefits will be administered by private entities. Other provisions of the MPDIMA affect pharmacy, including a provision for medication therapy management services to ensure that the covered Part D drugs are appropriately used. This will be the first time that Medicare provides for payment of pharmacist-administered patient care services.

Conclusions:

Recent changes in Medicare provide Medicare beneficiaries with optional coverage for prescription drugs. Full implementation of the Medicare prescription drug benefit will occur in 2006, with an interim Drug Discount Card available through December 2005.
Azithromycin Extravasation in a Pediatric Patient
Authors: Hey Diana M , Koontz Susannah E
Published: September 2013

Objective:

To report a case of azithromycin infiltration and extravasation in a pediatric patient.

Case Summary:

A 12-month-old African American male, between chemotherapy cycles for acute myelogenous leukemia, self-dislodged his central venous catheter. A peripheral catheter was placed in the right dorsal hand and, 2 days later, azithromycin for injection infiltrated at the infusion site. Several bullae formed in the first web space and a few areas of epidermolysis, each <2 cm wide, later appeared on the forearm. Treatment included warm compresses, adaptee dressing, topical antibiotics, splint placement, and arm elevation. Four months after the incident, there was no visible impairment or restriction to the toddler's use of the right hand or arm. The only residual finding was an area of hypopigmented skin in the dorsal web between the first and second fingers.

Discussion:

As of February 10, 2005, this is the first case published in the English-language literature describing intravenous azithromycin infiltration and extravasation. Infiltration occurs generally by 3 mechanisms. These include the catheter dislodging or causing a hole in the vessel wall, intravenous fluid irritating the vessel wall leading it to rupture or leak, or backflow of intravenous fluid through the catheter insertion site.

Conclusions:

Complications can occur secondary to intravascular therapy, including extravascular extravasation. In this case, infiltration and extravasation injury were probably related to azithromycin. Immediate detection and treatment are critical to decrease morbidity associated with infiltration events.
Atorvastatin: An Update of Recent Clinical Trial Experience
Authors: Mendys Philip M , Simpson Ross J
Published: September 2013

Objective:

To demonstrate how evaluative studies of atorvastatin have progressed from surrogate markers to more complex head-to-head clinical experiments.

Data Sources:

A search of MEDLINE was conducted (1994–April 2004), and an extensive manual review of journals was performed using the key search terms atorvastatin, coronary heart disease, and lipid-lowering therapy.

Study Selection and Data Extraction:

All articles identified from the data sources were evaluated. Studies were selected to track both sponsor-supported and non–sponsor-funded experiments designed to evaluate atorvastatin.

Data Synthesis:

Originally introduced in 1997, atorvastatin was considered to be a potent addition to the hydroxymethylglutaryl coenzyme A reductase inhibitors (statins). Atorvastatin significantly reduces low-density lipoprotein cholesterol and triglyceride levels with a starting dose of 10 mg/day. Broad acceptance and utilization of the statin class was still evolving at that time. Pfizer/W-L directed a comprehensive clinical trial program. Currently, there are >400 ongoing and completed clinical experiments with <80,000 patients involved. Along with an extensive safety record, atorvastatin will likely continue to change the way in which statin therapy is applied in various clinical settings.

Conclusions:

The experimental and clinical trial data with atorvastatin demonstrate a broad database supporting how atorvastatin impacts cardiovascular risk. As studies within the atorvastatin clinical program continue, we will undoubtedly gain additional insight on how patients can benefit from statin therapy.
Allergic Cross-Sensitivity between Penicillin and Carbapenem Antibiotics
Authors: Greanya Erica D , Chua Doson
Published: September 2013

Objective:

To review the literature evaluating the cross-hypersensitivity between carbapenem and penicillin antibiotics.

Data Sources:

Primary literature was accessed through MEDLINE (1980–June 2004), EMBASE (1980–December 2004), International Pharmaceutical Abstracts, PubMed, and references of reviewed articles. Key search terms were carbapenem, imipenem, meropenem, ertapenem, drug hypersensitivity, and penicillin allergy.

Study Selection and Data Extraction:

All articles describing clinical studies involving the use of carbapenem antibiotics in patients allergic to penicillin were reviewed.

Data Synthesis:

Four studies assessed carbapenem hypersensitivity in penicillin-allergic patients. Original estimates deemed the cross-reactivity to be 50% based on skin testing in a small number of patients; however, 3 more recent retrospective analyses indicate the overall incidence to be approximately 10%. The retrospective nature and presence of confounding factors in the more recent studies make it difficult to apply the lower estimates of carbapenem cross-sensitivity to a general patient population. The majority of cross-reactivity reactions reported was the development of a rash or hives.

Conclusions:

With minimal data available, the incidence of allergic reaction to carbapenem antibiotics in patients with self-reported penicillin allergy is likely less than the original skin test–determined estimates of 50%. However, caution should be used in patients with previously reported anaphylactic reactions to penicillin. A detailed allergy history is important in determining the clinical consequences of the potential cross-reactivity of carbapenem antibiotics in penicillin-allergic patients.
Thrombosis Secondary to Medroxyprogesterone in Patient at Risk for Thromboembolism
Authors: Ward Michael C , King Devin A , Link Mirranda , Gloria Rodel R , Taylor James R , Weitzel Kristin Wiisanen
Published: September 2013

Objective:

To report a case in which a young woman receiving medroxyprogesterone acetate injections developed deep vein thrombosis (DVT) after prolonged travel.

Case Summary:

An obese 27-year-old African American woman who had been receiving medroxyprogesterone acetate injections 150 mg intramuscularly every 3 months for 6 years experienced DVT after a 56-hour car ride. The patient's known risk factors for DVT included immobility, obesity (140 kg), and medroxyprogesterone acetate therapy. Family and personal history for thrombotic events were denied. Tests were performed after detection of the DVT to assess the patient for anticoagulation defects; results revealed an unidentified underlying protein S deficiency. All other test results were within normal limits.

Discussion:

Based on the Naranjo probability scale, it is possible that the DVT experienced by our patient was due to medroxyprogesterone acetate. Although she did have other risk factors for DVT, her underlying protein S deficiency was diagnosed after the thrombosis. Literature describing the relationship between the injectable form of contraception and thrombosis is limited. Therefore, this report reviews protein S deficiency, the relationship between oral contraceptives (OCs) and thrombosis, the influence of immobility on thrombosis development, and the clinical implications of evaluating patients for underlying inherited clotting abnormalities before initiating OCs.

Conclusions:

When considering whether to prescribe contraceptives, clinicians should assess the patient's risk factors for thrombosis, such as family or personal history. Although generally not recommended, prescreening tests may be considered if there is a positive family or personal history.
Management of Benign Prostatic Hyperplasia
Authors: Thapa Sraddha , Kourlas Helen
Published: September 2013

Objective:

To review the physiology and pathophysiology of benign prostatic hyperplasia, as well as current medical strategies for the management of the disease.

Data Sources:

A MEDLINE search (1992–September 2004) was conducted using benign prostatic hyperplasia (BPH), α-receptor antagonists, and 5 α-reductase inhibitors as MeSH search terms to identify clinical trials and review articles.

Study Selection/Data Extraction:

Primary literature and tertiary review articles evaluating the safety and efficacy of pharmacotherapeutic options in the management of benign prostatic hyperplasia were retrieved and included.

Data Synthesis:

Pharmacotherapeutic management of symptoms associated with benign prostatic hyperplasia has become the hallmark of therapy. Therapeutic agents evaluated include α-adrenergic antagonists (prazosin, terazosin, doxazosin, alfuzosin, tamsulosin) and 5-α-reductase inhibitors (finasteride, dutasteride). α-Adrenergic antagonists are more popular for therapy of BPH. This group of drugs is generally the first line of therapy, with growing popularity of tamsulosin and alfuzosin due to their decreased incidence of adverse effects.

Conclusions:

Understanding the pathophysiology of the disease can play an integral part in the selection of a pharmacotherapeutic agent. Patients who require pharmacologic intervention can benefit greatly by the number of agents available.
Duloxetine in the Treatment of Stress Urinary Incontinence
Authors: Osborne Kristie L , Davis Steven M
Published: September 2013

Objective:

To review the available literature regarding the use of duloxetine in the treatment of stress urinary incontinence.

Data Sources:

Clinical trials were obtained through a PubMed search (1966–December 2004) with the key words duloxetine, urinary incontinence, and stress.

Data Synthesis:

This article analyzes 5 clinical studies comparing duloxetine with placebo. The randomized, double-blind, multicenter trials were performed in the US and throughout the world and had strict inclusion criteria to enroll only patients with confirmed stess urinary incontinence. All trials showed a statistically significant decrease in incontinence episode frequency of 50–60% for duloxetine compared with a placebo response of 27–40%.

Conclusions:

Duloxetine appears to be an effective treatment for stress urinary incontinence. Additional trials comparing duloxetine with pelvic floor muscle training would better define duloxetine's place in therapy.
Risk for Osteoporosis and Antiresorptive Therapies in Patients with Crohn's Disease
Authors: Makhzoum Josette , Jobin Gilles , Dagenais Pierre , Makhzoum Sylvie , Perreault Sylvie
Published: September 2013

Background:

The risk of osteoporosis is greater in patients with inflammatory bowel disease (IBD) because of several related risk factors such as the prolonged use of corticosteroids, the malabsorption of calcium and vitamin D following small-bowel disease or small-bowel resections, and the inflammatory process resulting from the illness. A reduction in bone mineral density (BMD) has been reported in 30–75% of patients with IBD (Crohn's disease or ulcerative colitis). An evaluation of the risk factors of osteoporosis should be performed to identify those in need of antiresorptive drug therapies (ART) and/or calcium and vitamin D supplements.

Objective:

To determine whether patients with Crohn's disease at risk for osteoporosis or already having decreased BMD were identified as such and treated with appropriate therapy.

Methods:

A cross-sectional study was performed among 54 white patients with Crohn's disease who attended a gastroenterology specialized clinic between January and March 2002. All patients with Crohn's disease having an outpatient medical visit were asked to participate in the study. Patients who agreed to the study were questioned for Crohn's disease activity index (CDAI) and osteoporosis risk factors such as nutrition, lifestyle, and corticosteroid therapy. Serum bone-specific markers and nutritional status were assessed. BMD test of the lumbar vertebrae (L2–L4) and the nondominant hip were assessed with dual-energy X-ray absorptiometry if the participants did not have a BMD test in the year prior to the study. ART and calcium/vitamin D use were assessed through a questionnaire and on community pharmaceutical drug services in the 2 year period prior to the evaluation.

Results:

Mean age and CDAI severity score were 41.5 years and 145, respectively. None of the patients was evaluated for BMD in the year prior to the study. Osteopenia at the nondominant hip and/or lumbar vertebrae was seen in 29 patients. Eighty-two percent of patients with a T score under −2 SD had not been exposed to ART; 84% of patients with more than 4 risk factors for osteoporosis and a T score less than −1.5 SD had not received ART. Moreover, 88% of patients with a T score less than −1.5 SD and receiving corticosteroid therapy had not been treated with ART.

Conclusions:

The presence of osteoporosis risk factors and osteopenia had not been recognized and treated in our population. Adequate osteoporosis management should be implemented in patients with Crohn's disease to reduce the occurrence of osteoporotic fractures.
A Survey of the Medication Error Experiences of Pharmacy Technicians
Authors: Kennedy Amanda G , Aiken Cheryl A
Published: September 2013

Background:

Little is known about pharmacy technicians and their experiences with medication errors in community pharmacies.

Objective:

To document the opinions and self-reported experiences of medication errors in a sample of community pharmacy technicians.

Methods:

A telephone survey of one self-identified pharmacy technician from each Vermont community pharmacy was conducted between August and October 2004. Surveys were administered using a standard script. Descriptive statistics were used to summarize quantitative data, and qualitative data were organized into similar categories.

Results:

Of 128 operating community pharmacies, 72 (56.3%) responded by providing a technician interview. Approximately 70% of technicians reported receiving training in medication errors. Nearly all (93.1%) respondents stated they had come into contact with prescribing errors; 62.7% of technicians cited illegible prescriptions or poor handwriting as examples. Two-thirds (66.7%) of all respondents stated they personally had detected a medication error. Only 2 (2.8%) technicians responded that they had ever completed a medication error report; both submitted the report to their corporate reporting programs.

Conclusions:

Most technicians are aware of medication errors in their practice, and the majority had personally detected errors. However, nearly one-third of technicians responded that they had never received any training in medication errors. Further research exploring pharmacy technicians' level of training, job experience, and understanding of and ability to report medication errors in a larger, more diverse sample is warranted.
Stability of Omeprazole Sodium and Pantoprazole Sodium Diluted for Intravenous Infusion
Authors: Carpenter Jane F , McNulty Margaret A , Dusci Leon J , Ilett Kenneth F
Published: September 2013

Background:

Proton-pump inhibitors are often administered by intravenous infusion to raise intragastric pH and prevent rebleeding following endoscopic treatment of bleeding ulcers. Currently, the manufacturers of omeprazole and pantoprazole injections recommend that infusions prepared by dilution in NaCl 0.9% should be used within 12 or 3 hours, respectively. Administration at the ward level would be facilitated if these drugs were known to be stable for up to 24 hours.

Objective:

To determine whether omeprazole and pantoprazole diluted for infusion in NaCl 0.9% or dextrose 5% are sufficiently stable to allow preparation of 24 hour infusion bags.

Methods:

Intravenous 500 mL bags of NaCl 0.9% or dextrose 5% containing 200 mg of either omeprazole or pantoprazole were prepared. While stored at 22 °C, samples were withdrawn at intervals up to 10 days, and pH and drug content were measured. ANOVA was used to compare drug concentrations at preparation with those after storage.

Results:

The pH of the infusions did not alter by more than 0.2 units over 48 hours, but decreased subsequently. The measured concentrations of both omeprazole and pantoprazole decreased during storage. The decrease in concentration was greater in dextrose 5% than in NaCl 0.9% and was related to storage time. However, for both drugs, the mean decrease did not exceed 6% over the first 48 hours.

Conclusions:

Infusions of omeprazole or pantoprazole can be maintained for up to 48 hours without significant loss of active drug content. Maintaining the same bag for 48 hours may provide cost savings compared with the present practice of replacing bags more frequently.
Use of Pharmacy Database to Investigate Patterns of Physician Practice as Related to Patient Outcomes
Authors: Cerrito Patricia B , Cerrito John C
Published: September 2013

Background:

It has been observed that physicians vary considerably in their dose prescribing in the cardiac catheterization laboratory.

Objective:

To investigate the relationship between heparin dose and patient outcome and demonstrate the effectiveness of data mining in investigating variation in physician practice.

Methods:

The pharmacy database containing information about heparin dose prior to angioplasty was merged with a clinical database containing information about patient weight and length of hospital stay. The data were analyzed using data mining and kernel density estimation.

Results:

Cardiologists practice differing methods for administering heparin doses. This variability has impact on patient length-of-stay. Patients receiving heparin doses greater than 80 mg/kg stayed in the catheterization lab longer than patients receiving less (p < 0.001). This was independent of the number of vessels treated during angioplasty.

Conclusions:

Length of stay related to angioplasty is significantly related to physician decisions concerning the heparin dose prescribed. Data mining is an effective tool that can be used to exploit the pharmacy database for research into physician practice.
Reasons Why Herbal Users Do or Do Not Tell Their Physicians about Their Use: A Survey of Adult Ohio Residents
Authors: Shah Bupendra K , Lively Buford T , Holiday-Goodman Monica , White Donald B
Published: September 2013

Background:

Several studies have reported lack of patient–physician communication regarding herbal use. However, reasons for this lack of communication are not well understood.

Objective:

To determine, explore, and identify reasons for lack of patient–physician communication about herbal use.

Methods:

Using a cross-sectional design, a systematic sample of 1,000 adult Ohio residents was surveyed through a 29 item questionnaire. Survey items were adapted from earlier instruments evaluating complementary and alternative use. Descriptive and univariate statistics were run using SPSS version 10.0.

Results:

Of 210 usable responses, almost half (47.6%) of the participants reported that they were either currently using herbal products or had used them in the past, with 1 in 16 using herbal products daily. Forty-eight percent of these respondents indicated that they had never had a discussion with their physician about using herbal medicines. A similar percentage (45%) of individuals using herbal agents had not told their physicians about any of the products they used. The top 3 reasons for informing physicians of herbal use were that the physician needs to be aware of all of the products used, the physician may know whether herbals work, and the physician understands the interactions of herbals with prescribed drugs. The main reason that patients did not supply the information was that the physician did not ask them about it.

Conclusions:

Many patients do not inform their physicians about their use of herbal products unless asked. Physicians and other healthcare providers should therefore integrate inquiry about herbal product use as part of medication history.
The Role of Technicians in Managing Computerized Drug–Drug Interaction Alerts in Community Pharmacies and the Relationship to Pharmacist Managers' Attitudes
Authors: Murphy John E , Malone Daniel C , Skrepnek Grant H , Armstrong Edward P , Abarca Jacob , Grizzle Amy J , Rehfeld Rick A , Woosley Raymond L
Published: September 2013

Background:

Community pharmacies are where identification and prevention of drug–drug interactions (DDIs) typically occur. Technicians have been shown to play some role in the initial screening of DDIs in community pharmacies.

Objectives:

To examine the role of technicians in the management of DDI alerts in community pharmacies and the possible relationship to the attitudes of pharmacy managers toward DDI alerts.

Methods:

A national survey of pharmacist managers in 3,000 community pharmacies was conducted. Data collected included demographics, workload issues, handling of DDIs, and pharmacists' attitudes toward computerized DDI alerts.

Results:

Of questionnaires returned, 736 could be used. Technicians were more often allowed or sometimes allowed to override lower level DDI alerts without prior review by a pharmacist. However, some pharmacies (2.1%) allowed or sometimes allowed technicians to override interactions with the highest potential clinical significance. Stores with the highest use of technology were less likely to allow technicians to override insignificant interactions. Stores that allow technicians to override clinically significant interactions were less confident in their program's ability to provide meaningful alerts and more likely to agree that alerts are a waste of time and that the volume of alerts makes differentiating important from unimportant DDIs more difficult.

Conclusions:

Pharmacy technicians play a limited role in the management of DDI alerts, but could be used to help ensure that a patient's profile of medications is up-to-date and determine whether the patient had already been receiving the combination without notable problem.
An Audit of Lipid Management in Patients with Diabetes in an Academic Internal Medicine Practice
Authors: Adigun Adegboyega Q , Lloyd Benjamin J , Donato Anthony A
Published: September 2013

Background:

There is increasing pressure from health insurers that clinicians meet nationally accepted standards of care for patients with diabetes. How quality improvement initiatives will be implemented in the ambulatory care setting remains unclear.

Objective:

To conduct an audit of lipoprotein management in patients with diabetes in a single academic internal medicine practice, using low-density lipoprotein cholesterol (LDL-C) as the primary measurement, and compare results to nationally reported data.

Methods:

A retrospective, cross-sectional study involving all patients with diabetes seen in an internal medicine faculty practice from January 1, 2004, to December 31, 2004, was performed. Data collected included results of lipid tests performed within the past year, medications to lower cholesterol, and markers of diabetes control.

Results:

Two hundred eight patients with diabetes were eligible for the study. Forty-two percent were at the LDL-C goal of less than 100 mg/dL. Sixty-five percent were taking a hydroxymethylglutaryl coenzyme A reductase inhibitor (statin), while 6.6% were taking 2 or more lipid-lowering drugs. Twenty-four patients (12%) had high LDL-C levels (>130 mg/dL) but were not taking lipid-lowering agents; these patients were older compared with the population with an LDL-C level at the goal (mean ± SD 66 ± 15 vs 59 ± 15 y; p < 0.05) and less likely to have coronary artery disease (8.7% vs 33%; p < 0.05). Thirty-six percent of patients were above the goal LDL-C despite use of statins at moderate or higher doses.

Conclusions:

Achieving goal LDL-C levels remains a challenge, even in this era of powerful, proven pharmacotherapy. Strategies to improve lipid management may need to address issues of patient acceptance of and adherence to cholesterol-lowering drug therapy. Audits are helpful to compare practice data with accepted benchmarks, but confounders must be considered if the audit data are used for high-stakes decisions.
Epinephrine versus Vasopressin in Adult Cardiac Arrest: Role of Agonal Respirations and Patient Age
Authors: Rottenberg Eric M
Published: September 2013

A review of the literature regarding the use of vasopressin versus epinephrine in the treatment of out-of-hospital cardiac arrest recommends initially administering 1 mg of epinephrine, followed by alternating doses of vasopressin 40 IU and epinephrine 1 mg every 3 minutes in adults, regardless of the initial electrocardiographic rhythm. The American Heart Association—Emergency Cardiac Care Committee (AHA—ECCC) adopted this position in its recent recommendations. However, further research is required to determine whether epinephrine should always be the initial agent regardless of the initial cardiac rhythm or whether other factors need to be considered. A review of evidence that may have been overlooked by the AHA-ECCC argues for the need to consider the presence of spontaneous agonal (“gasping”) respirations and patient age before determining which vasopressor to use first.
Chronic Stable Angina: Angiotensin-Converting Enzyme Inhibitor Therapy and/or Calcium-Channel Blocker Therapy—When is it Indicated?
Authors: Marrs Joel C , Saseen Joseph J
Published: September 2013

Objective:

To discuss outcomes data assessing the use of angiotensin-converting enzyme (ACE) inhibitors and calcium-channel blockers (CCBs) in the prevention of cardiovascular events in patients with chronic stable angina that have been published since the 2002 American College of Cardiology/American Heart Association (ACC/AHA) updated guidelines for the treatment of chronic stable angina.

Data Sources:

A MEDLINE search (2002–April 2006) identified 60 primary, review, and meta-analysis articles. The inclusion criteria were: patients with stable coronary artery disease, chronic stable angina, or coronary heart disease; evaluation of long-term therapy with either ACE inhibitor or CCB therapy; prospective, randomized, controlled clinical trials; cardiovascular events as the primary endpoint of the study; and date of publication after the 2002 ACC/AHA guidelines.

Study Selection and Data Extraction:

All articles identified from the literature search were evaluated, and all clinical trials deemed relevant were included in this review. Six randomized trials met inclusion criteria and evaluated the utility of ACE inhibitor and CCB therapy in reducing cardiovascular events in patients with coronary artery disease and/or chronic stable angina.

Data Synthesis:

Patient populations, background therapy, and the study endpoints of all 6 trials varied. However, all primary endpoints assessed cardiovascular events. Two of the 3 ACE inhibitor trials demonstrated a significant reduction in the primary endpoint and 1 of the 3 CCB trials demonstrated a significant reduction in the primary endpoint.

Conclusions:

Newer evidence cumulatively supports the addition of an ACE inhibitor to standard antianginal pharmacotherapy to reduce the risk of cardiovascular events. However, benefit is influenced by severity of illness and use of additional cardiovascular risk reduction pharmacotherapy. The level of supporting evidence for ACE inhibitor therapy in chronic stable angina is higher than that cited in the 2002 ACC/AHA guidelines. Newer evidence evaluating the use of CCBs to prevent cardiovascular events in patients with stable coronary artery disease is controversial and remains consistent with the 2002 guidelines.