bluuebunny/crossref_metadata_2025 huggingface dataset:
Ximelagatran: A New Era in Oral Anticoagulation
Authors: McCall Kenneth L , MacLaughlin Eric J
Published: September 2013

Objective:

To review the pharmacology, pharmacokinetics, and clinical trials of the oral direct thrombin inhibitor ximelagatran.

Data Sources:

All primary articles involving ximelagatran or its active form, melagatran, and indexed on MEDLINE or International Pharmaceutical Abstracts databases (1966–December 2002) were evaluated. Recent ximelagatran and melagatran abstracts were also obtained online from the American Society of Hematology at www.hematology.org/meeting/abstracts.cfm (2001 and 2002).

Data Synthesis:

Ximelagatran is an orally bioavailable prodrug of melagatran that directly blocks unbound thrombin and fibrin-bound thrombin. Ximelagatran displays predictable pharmacodynamic and pharmacokinetic properties with a linear dose–response relationship and low interpatient variability. These parameters allow fixed dosing of ximelagatran without routine coagulation monitoring. Ximelagatran has yet to be approved by the FDA; however, several major clinical trials have been completed. These clinical trials have revealed that an easier-to-manage ximelagatran regimen is at least as effective and has a similar safety profile as conventional therapy for prevention of venous thromboembolism (VTE). The results of studies with ximelagatran for treatment of VTE and prevention of thrombosis associated with atrial fibrillation are promising, but need further investigation.

Conclusions:

Ximelagatran possesses several advantages over warfarin including fixed dosing and the lack of coagulation monitoring, the absence of known diet or drug interactions, and a faster onset of action. Ximelagatran appears to be at least as effective as warfarin for prevention of VTE. Further research is needed with ximelagatran in the treatment of VTE and atrial fibrillation.
Using Medicaid Claims and Dosing Guidelines to Assess the Prescribing and Outcomes of Conventional Antipsychotics
Authors: Rickles Nathaniel M , Svarstad Bonnie L
Published: September 2013

Background:

While newer atypical antipsychotics are considered the treatment of choice for schizophrenia, it is important to study dosing guidelines for conventional antipsychotics as they continue to be used alone or in combination with newer agents for patients who are refractory to treatment with newer agents. Few studies have used Medicaid claims for this purpose, even though they provide a readily available and objective means of assessing dosing in relation to guidelines and outcomes of prescribing.

Objective:

To examine a new multi-method approach for studying dosing guidelines and outcomes of prescribing in Medicaid recipients receiving conventional antipsychotics.

Methods:

Data were collected from medical records, Medicaid prescription and hospital claims, and case managers in 8 county-based delivery systems in Wisconsin during a 12-month period in 1989–1990 as a part of a larger naturalistic study. Eligible patients had a primary diagnosis of schizophrenia, a prescription for oral antipsychotics, and no hospitalizations during baseline (first quarter).

Results:

Of 159 patients, 46.5%, 32.1%, and 21.4% had baseline antipsychotic doses below, above, and within the guidelines, respectively. Patients dosed above the guidelines were 4 times more likely to be hospitalized after baseline (p < 0.05) than those within the guidelines after controlling for adherence, baseline functioning, and past hospitalizations. Further analysis showed that the high-dose/hospitalization relationship was mediated or explained in part by adverse effects.

Conclusions:

The use of Medicaid claims revealed a substantial amount of prescribing outside of guidelines and an increased risk of hospitalization during the study period. Future trials are needed to compare this methodologic approach with other approaches and to determine whether current dosing patterns and outcomes have changed. This study was made possible through Rickles' National Institute of Mental Health (NIMH) Fellowship in Mental Health Services Research at the University of Wisconsin — Madison. The study obtained data from a larger project supported by NIMH grant MH-43555 to the late Dr. James Greenley and his colleagues at the University of Wisconsin — Madison. Data from this study were presented in March 2000 at the 147th Annual Meeting and Exposition of the American Pharmaceutical Association.
Review of Tech-Check-Tech
Authors: Wilson Debbie L
Published: September 2013

Objective:

To explore the legal implications of the empiric literature and relevant legal literature on tech-check-tech.

Methods:

Two reviews were made: one of the states' and US holdings' laws regarding technician credentialing and tech-check-tech, and another of the empiric literature on tech-check-tech.

Data Sources/Selection:

The International Pharmacy Abstracts database and PubMed were searched for articles using the following key words: Tech* & accuracy, Tech* & check, Tech* & error, and tech-check-tech. When searching PubMed, the term “pharmacy” was added in each search. This search was verified July 2, 2002, to ensure that no articles were missed. Full articles and meeting abstracts were included if they contained data that allowed for comparisons between pharmacists' and technicians' accuracy or error rates in checking. Primary, secondary, and tertiary sources were used. All articles included were searched on the Web of Science to find other relevant articles. The bibliographies of the included articles were also checked.

Data Synthesis:

Thirty-five of the 53 US states and holdings (66%) either license, register, certify, require Pharmacy Technician Certification Board certification, and/or have technician training or educational requirements. Four states (7.5%) allow tech-check-tech in some form. Ten empiric studies were found that investigated tech-check-tech. The error detection rate was available in only 2 of the studies and showed nearly the same rates (technicians 97%, pharmacists 94%).

Conclusions:

This work found no evidence suggesting that tech-check-tech should not be adopted for unit-dose cart fill in every state. The credentialing of technicians varies greatly from state to state. Tech-check-tech procedures are sparsely used in the US. Training may improve accuracy, and the average error detection rate was higher for technicians than for pharmacists.
Maintenance of Goal Blood Pressure following Conversion from Lisinopril to Fosinopril
Authors: Graham Maqual R , Allcock Nicole M , Lindsey Cameron C
Published: September 2013

Objective:

To determine whether blood pressure could be maintained for patients on lisinopril following conversion to a theorized, therapeutic dose of fosinopril. The tolerability of fosinopril was also assessed.

Methods:

Subjects receiving lisinopril were considered candidates for this prospective, observational study. Prescribing information for both lisinopril and fosinopril suggested a milligram-to-milligram equivalency. Patients taking lisinopril 10 mg/d were switched to fosinopril 10 mg/d. Blood pressures were compared at baseline and 2, 6, and 18 weeks after conversion. A goal blood pressure of <140/90 mm Hg was assigned to all patients at enrollment and used to determine goal attainment at baseline and 18 weeks. More aggressive blood pressure goals are currently recommended; thus, medical histories were reevaluated at the end of the study and new goals were assigned and assessed. Adverse effect occurrence was also compared between visits.

Results:

One hundred thirty-three subjects were enrolled. The mean dose of lisinopril prior to conversion was 15 ± 11 mg/d compared with the mean final fosinopril dose of 20 ± 14 mg/d. Both the mean systolic and diastolic blood pressures increased significantly at the 18-week visit when compared with baseline (p = 0.00007 and p = 0.015, respectively). Using a goal blood pressure of <140/90 mm Hg, there was no difference detected between the baseline and the final assessment visit (p = 0.851). A greater number of subjects were unable to achieve goal status at 18 weeks when compared with baseline after applying the newly defined goals (p = 0.003). Sixteen of the original 133 subjects discontinued fosinopril due to adverse events.

Conclusions:

When converting subjects from lisinopril to fosinopril, equivalent blood pressure may be difficult to achieve without increasing the dose of fosinopril.
Communication of Drug Affordability between Physicians and Elderly Patients
Authors: Xu K Tom , Irons Brian K
Published: September 2013

Objective:

To identify characteristics among elderly patients associated with patient–provider communications regarding affordability of medications in prescribing and dispensing.

Methods:

Telephone survey data from consumers ≥65 years old collected in the Texas Tech 5000 Survey were used. The sample size for the analyses was 2,360. Demographics, insurance, financial factors, nonfinancial factors, prescription drug use, and health status were used to identify which subgroup of elderly patients recalled communication with their providers regarding the affordability of prescriptions. Statistical analyses included bivariate analyses and a multivariate logistic regression.

Results:

Eleven percent of the respondents reported being asked by their physicians whether they could afford prescription drugs. In the multivariate analysis, gender, race, insurance coverage for prescriptions, income, number of physician visits, out-of-pocket expenditure for prescriptions, health, and physicians' participatory decision-making score were found to be associated with patient–provider communications regarding affordability of medications.

Conclusions:

Further research needs to be conducted to identify ways to improve patient–provider relationships to facilitate communication regarding affordability of medications among elderly patients. Improved communication or sensitivity to prescription affordability has the potential to increase patient medication adherence and improve clinical outcomes.
Chemotherapy-Induced Delayed Emesis: What is the Role of 5-HT3Antagonists?
Authors: Ng Kwong H
Published: September 2013

Objective:

To review the current literature assessing the efficacy of different antiemetics, with a focus on comparison between serotonin (5-HT3) antagonists and other antiemetics, in the treatment of delayed emesis induced by either cisplatin or non-cisplatin cytotoxic agents.

Data Sources:

A MEDLINE search (1966–July 2002) was performed using delayed emesis, vomiting, nausea, chemotherapy, cisplatin, moderately emetogenic, selective serotonin subtype-3 (5-HT3) receptor antagonists, metoclopramide, domperidone, corticosteroids, dexamethasone, prognostic factors, risk factors, and neurokinin-1 (NK1) receptor antagonists as key words or subject headings. Only English-language articles were identified and included. Additional references were retrieved from selected articles.

Data Synthesis:

Various antiemetic consensus guidelines have recommended the use of different pharmacologic treatment, including the use of 5-HT3 antagonists, for the prevention of chemotherapy-induced delayed emesis. In some instances, it has been suggested that combinations containing a 5-HT3 antagonist may be superior to others. Current data have been synthesized in an attempt to demonstrate the efficacy of 5-HT3 antagonists in the treatment of chemotherapy-induced delayed emesis.

Conclusions:

Dexamethasone has consistently shown its antiemetic efficacy for delayed emesis induced by cisplatin and non-cisplatin agents, whereas the role of 5-HT3 antagonists alone remains controversial. Metoclopramide has been shown to be as efficacious as 5-HT3 antagonists when combined with dexamethasone for the prevention of delayed emesis. As a result, 5-HT3 antagonists should be reserved as second-line agents to metoclopramide in addition to dexamethasone. NK1 receptor antagonists have shown some early promising results. However, many questions need to be addressed before their extensive use in clinical practice.
Case–Control Study Comparing Droperidol Plus Diphenhydramine with Conventional Treatment in Hyperemesis Gravidarum
Authors: Ferreira Ema , Bussières Jean-François , Turcotte Virginie , Duperron Louise , Ouellet Geneviève
Published: September 2013

Background:

In 1998, a protocol consisting of droperidol/diphenhydramine combination was established at Hospital Sainte-Justine to treat hyperemesis gravidarum.

Objective:

To compare the efficacy of the droperidol/diphenhydramine combination with other conventional treatments used before implementation of this protocol in the treatment of hyperemesis gravidarum (HG).

Methods:

A nonrandomized, prospective study was conducted using a historical control of 54 patients receiving conventional antiemetic treatment and 2 study groups: 67 patients treated with intravenous droperidol 1 mg/h plus diphenhydramine 25–50 mg every 6 hours and 34 patients treated with intravenous droperidol 0.5 mg/h plus diphenhydramine 50 mg every 6 hours. Study outcomes included length of hospital stay, readmission rate, intensity of nausea and vomiting according to the National Cancer Institute scoring system, maternal body weight variation, pregnancy outcomes, and adverse effects.

Study Site:

Sainte-Justine Hospital in Montréal, Québec, a tertiary care university teaching hospital affiliated with the University of Montréal.

Study Population:

Hospitalized patients diagnosed with HG.

Results:

The 3 groups, comparable in terms of maternal characteristics, showed no difference in terms of length of stay. The readmission rate was lower in the group that received droperidol 1 mg/h compared with the other 2 groups. Overall, droperidol use was associated with a reduction in daily nausea and vomiting scores (p < 0.001). The most common adverse effects were xerostomia, drowsiness, constipation, and hypotension. Extrapyramidal reactions were observed in 20% of the droperidol patients. Birth defects occurred in 2.4% of the control group and 7.5% of the study group (p = 0.52). Drugs could be excluded as causal agents for the majority of malformations in 5 of 7 cases.

Conclusions:

Droperidol/diphenhydramine is an effective alternative for treatment of refractory HG. A large, prospective, randomized study would be required to confirm the efficacy of this treatment as well as maternal and fetal safety.
Seizure Activity after Venlafaxine Overdose
Authors: Sarandöl Asli , Taneli Bilgen
Published: September 2013

Objective:

To report the findings from the case of a patient developing first-time seizure activity following an overdose of venlafaxine.

Case Summary:

A 27-year-old man with major depression ingested 60 venlafaxine 75-mg capsules in an apparent suicide attempt. The patient experienced generalized seizure activity 9 and 11 hours after ingestion. The electroencephalogram showed a pathologic pattern, with several generalized epileptiform discharges. Venlafaxine was discontinued, and no further sequelae were observed.

Discussion:

The Naranjo probability scale indicated a probable relationship between the seizures and venlafaxine overdose. The mechanism of seizures associated with venlafaxine overdose is unclear. Neurotransmitters play an important role in seizure genesis, and hepatic damage may occur.

Conclusions:

Clinicians should be aware of proconvulsant effect and the risk of hepatocellular injury from venlafaxine overdose when prescribing this drug.
Emergency Medical Technician/Paramedic's Role in Prehospital Drug Delivery
Authors: Pearson Richard M
Published: September 2013

Objective:

To describe the role of the medical technician/paramedic and review 2 types of drug storage: the emergency department and prehospital emergency medical services (EMS).

Data Sources:

Information was obtained from personal experience, personal communication with hospitals, prehospital healthcare providers, pharmacy technicians, and pharmacists. Searches of the Internet were conducted for sites reviewing traditional drug storage systems, as well as those utilized specifically for prehospital EMS. Key words used were advanced cardiac life support, crash cart, drug security, drug storage, emergency department, and emergency medical services.

Study Selection and Data Extraction:

All articles identified from the data sources were evaluated and all information deemed relevant was included for this review.

Data Synthesis:

Emergency departments traditionally utilize crash carts for their ease of maneuverability over tiled floors and massive storage capabilities. Prehospital EMS are unable to use crash carts for drug storage and transport. Smaller, more compact types of securable and transportable drug storage units are required for prehospital EMS.

Conclusions:

The concept of bringing the emergency department to the injured is still a relatively young science. With time and experience come innovations that tailor themselves to the needed specialties. The drug box used by the emergency medical technicians/paramedics bridges that gap between the emergency department and the street.
Aripiprazole: An Antipsychotic with a Novel Mechanism of Action
Authors: Lemieux Amy A , Goldman-Levine Jennifer D , Goren Jessica L
Published: September 2013

Objective:

To evaluate aripiprazole in the treatment of schizophrenia, including a comparison of available agents, pharmacology, pharmacokinetics, assessment of clinical trials, and adverse effects.

Data Sources:

A MEDLINE search (1962–March 2003) was conducted for primary and secondary sources. Search terms included OPC-14597, aripiprazole, typical antipsychotics, atypical antipsychotics, and schizophrenia. The Review and Evaluation of Clinical Data from NDA 21-436 was accessed from the FDA Web site.

Study Selection:

All articles retrieved were evaluated, and the most appropriate studies were selected. Relevant poster presentations were included.

Data Synthesis:

Aripiprazole is a potent partial agonist/antagonist at the dopamine D2 receptor, as well as a partial agonist at the serotonin 5-HT1A receptor and an antagonist at the 5-HT2A receptor. Clinical trials were assessed for information on dosing, side effects, and adverse drug reactions.

Conclusions:

Aripiprazole appears to be superior to placebo for the treatment of schizophrenia, with a favorable adverse effect profile.
Panic Attack Associated with Imatinib Mesylate?
Authors: Malhotra Pankaj , Gupta Nitin , Varma Subhash C
Published: September 2013

Objective:

To report a case of panic attacks in an individual on imatinib mesylate.

Case Summary:

A 34-year woman developed panic attacks a few days after starting imatinib. Investigations were negative, and the panic episodes were attributed to imatinib and possible interaction with paroxetine.

Discussion:

As of January 1, 2004, this is probably the first case reporting such an adverse event with imatinib. This adverse reaction was rated as possible based on a probability scale. It could have occurred due to a pharmacokinetic interaction between imatinib and paroxetine. Other possible hypotheses are discussed.

Conclusions:

Imatinib may be associated with panic attacks as a rare adverse event in predisposed individuals. Recognition of this phenomenon can be important in preventing or treating anxiety problems in patients taking imatinib.
Hypertension Associated with Citalopram
Authors: Saǧduyu Afşin , Şentürk Vesile
Published: September 2013

Objective:

To report a case of hypertension resulting from the therapeutic use of citalopram and review previous reports in the literature.

Case Summary:

An 87-year-old white woman who had taken a single dose of citalopram 20 mg presented to the hospital on the same day with hypertension (BP 200/100 mm Hg) following a presyncopal episode and headache. Citalopram was discontinued; the hypertension resolved in 24 hours and remained stable for 8 days. She had multiple systemic illnesses, including hypertension; however, they were under control, and no electrocardiogram abnormality shown at this time was different from previous recordings. No other medical or pharmacologic cause was found for the adverse reaction.

Discussion:

The manufacturer reports hypotension and bradycardia as being infrequent adverse effects of citalopram. To our knowledge, there have been no previous reports of hypertension after the first dose of citalopram. Multiple physical illnesses and drugs used may have interfered with findings obtained in this case. However, an acute increase in blood pressure after the first dose, which had been within normal levels with antihypertensive treatment for 4 years, as well as the low drug interaction profile of citalopram suggest that this adverse drug reaction was probable according to the Naranjo probability scale.

Conclusions:

Future research should address the cardiovascular and autonomic effects of selective serotonin reuptake inhibitors, including citalopram, in the older population and in persons with any known heart disease. Citalopram should be used with care in elderly patients unless more data are obtained from well-designed studies.
Health Information Web Sites by Therapeutic Category for Healthcare Professionals
Authors: Motl Susannah E , Timpe Erin M , Robinson Melanie , Corsberg Christine , Phillips Keri
Published: September 2013

Objective:

To compile and evaluate health information Web sites to aid healthcare professionals in locating information on select therapeutic categories.

Data Sources:

Therapeutic categories were chosen based on questions that pharmacists may receive in the community and institutional setting for which they might lack adequate resources to answer. Categories included adverse drug reactions, alternative medicine, cardiology, drug dosing in renal failure, drug interactions, foreign drug identification, geriatrics, immunology/vaccines, intravenous stability/compatibility, investigational drugs, oncology, pediatrics, pregnancy/lactation, legal and regulatory, monographs/medication usage evaluations, new drug approvals, shortages, tablet/capsule identification, therapy/therapeutics, and toxicology/poisoning. Web sites were chosen by searching www.google.com , as this search engine currently indexes over 3 billion Web pages.

Data Synthesis:

Resulting Web sites were reviewed, selected, and evaluated using published criteria to assess the quality of each Web site, focusing on the authorship, disclosure, currency, and content.

Conclusions:

The top Web sites in each category are presented, with details on their quality rating, sponsor, content, and special features or directions.
Therapeutic Options in the Treatment of Clozapine-Induced Adverse Effects
Authors: Iqbal Mohammad Masud , Aneja Alka , Rahman Atiq , Megna James L , Yasmin Laila , Schwartz Thomas L , Osmany Saabry , Alam Mohammed Adnan
Published: September 2013

Objective:

To review the therapeutic options in the management of clozapine-induced adverse effects.

Data Sources:

A MEDLINE search (from 1966 to present) was conducted, and English-language studies and review articles were retrieved to review the adverse effects of clozapine and their management.

Study Selection and Data Extraction:

All studies evaluating clozapine's adverse effects, such as agranulocytosis, seizures, neuroleptic malignant syndrome, hypersalivation, weight gain, sedation, fatigue, orthostatic hypotension, eosinophilia, delirium, new-onset diabetes, constipation, nausea, tachycardia, myocarditis, and pancreatitis, and their management were included.

Data Synthesis:

Clozapine, an atypical antipsychotic that has been proven effective and comparable, as well as superior, to conventional antipsychotics in treatment-resistant schizophrenia, is also being used in the treatment of a wide variety of other psychiatric conditions, including suicidal ideation, tardive dyskinesia, and affective disorders such as depression, bipolar disorders, and schizoaffective disorder. Although clozapine exhibits a markedly low incidence of extrapyramidal symptoms compared with similar medications, it has other adverse effects, some of which are potentially life threatening, requiring careful monitoring. The adverse effects of clozapine range from benign drooling, weight gain, nausea, and constipation, to life-threatening agranulocytosis, seizures, and neuroleptic malignant syndrome (NMS). Mandatory periodic white blood cell monitoring has resulted in dramatic reduction in mortality due to clozapine-induced agranulocytosis, promoting high adherence by patients. Prompt diagnosis and treatment of adverse effects of clozapine has also been effective in reducing complications, including mortality due to other serious adverse effects such as NMS and seizure. Other adverse effects are comparatively benign and can be managed effectively.

Conclusions:

Clozapine has a wide variety of adverse effects, some of which are potentially life threatening. Clinicians should be aware of possible severe complications and emergency management. Differentiating between minor and major adverse effects and initiating appropriate intervention is essential for a positive therapeutic outcome when prescribing clozapine.
Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and other Healthcare Professionals Part III
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 antiinfectives, vaccines, antiepileptics, benzodiazepines, psychotherapeutic drugs, and radiopharmaceuticals during breast-feeding.

Data Sources:

Primary texts used by the breast-feeding community ( Medications and Mothers' Milk, Drugs in Pregnancy and Lactation, Drugs and Human Lactation) were searched, as well as Micromedex, MEDLINE, PubMed, EMBASE, and EMBASE2 (1984–February 2004).

Study Selection/Data Extraction:

Multiple sources were used wherever 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 drugs 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.
When Prescription Drugs Go Over-the-Counter: Where are the Boundaries?
Authors: Boothby Lisa A , Doering Paul L , Jaco VIT
Published: September 2013

Objective:

To determine local pharmacists' willingness to recommend/allow the use of OTC ibuprofen when prescription-strength ibuprofen had been prescribed for symptomatic relief of rheumatoid arthritis, to examine the evidence-based medicine supporting the use of ibuprofen for rheumatoid arthritis treatment, and to determine the impact this evidence has for nonprescription ibuprofen drug labeling.

Methods:

Sixty community pharmacies in the southeastern US were surveyed via the “shopper” method. Then a literature search was conducted using MEDLINE (1966–June 2003), International Pharmaceutical Abstracts (1970–June 2003), Current Contents (1966–June 2003), Lexis-Nexis (2001–2003), and Cochrane Database of Systematic Reviews (2000–June 2003). Articles that examined the efficacy and safety of low-dose ibuprofen (<400 mg every 4–6 h not to exceed 1200 mg/day) were reviewed. Clinical practice guidelines were obtained to determine the standard of care for rheumatoid arthritis treatment.

Results:

All pharmacists stated that it was completely acceptable to substitute OTC ibuprofen for the prescription formulation. Little to no counseling occurred at the point of service. These recommendations do not coincide with clinical practice guideline recommendations for the use of nonsteroidal antiinflammatory drugs versus disease-modifying antirheumatic drugs for long-term rheumatoid arthritis treatment.

Conclusions:

Results of this survey and literature review suggest the need for nonprescription educational initiatives regarding the role of nonprescription analgesics geared toward pharmacists. Clarification from the FDA as to the role of nonprescription drug therapy for chronic disease states is needed.
Valacyclovir and Postherpetic Neuralgia
Authors: Segarra-Newnham Marisel , Tagoff Shari S
Published: September 2013

Objective:

To describe the role of valacyclovir in the treatment of acute herpes zoster pain and its effect in postherpetic neuralgia.

Data Sources:

A literature search was conducted on MEDLINE (1980–October 2003). Search terms included valacyclovir, postherpetic neuralgia, treatment, acyclovir, and valacyclovir.

Study Selection and Data Extraction:

Articles describing use of valacyclovir in the treatment of herpes zoster, with focus upon alleviation of acute zoster pain and postherpetic neuralgia, and articles describing use of valacyclovir for this indication in comparison with other antivirals were evaluated.

Data Synthesis:

Four studies discussing the use of valacyclovir in the treatment of herpes zoster with focus on herpetic pain and postherpetic neuralgia were identified. All of these studies reported that valacyclovir is an effective treatment for herpes zoster and alleviates associated pain significantly faster than acyclovir, presumably due to its greater bioavailability. Valacyclovir likely results in a higher adherence rate than acyclovir because it is dosed 3 versus 5 times daily. Interestingly, the severity of pain was not significantly different between the 2 treatments, only the duration. Finally, one study showed that valacyclovir is equally as effective as famciclovir in alleviating pain associated with herpes zoster.

Conclusions:

Valacyclovir 1 g given orally 3 times a day for 7 days is effective in the treatment of herpes zoster. It is superior to acyclovir 800 mg given orally 5 times a day for 7 days and equivalent to famciclovir 500 mg given orally 3 times a day for 7 days in alleviating acute zoster pain and postherpetic neuralgia.
Improved Stability of Treprostinil Sodium with Proper Vial Puncture Technique and Adapter Use
Authors: Phares Kenneth R , Wade Michael , Weiser William E , Miller Stephen P , Pan Wei
Published: September 2013

Background:

Treprostinil sodium has an expiration date of 14 days following initial vial puncture.

Objective:

To extend the expiration date of treprostinil sodium after initial vial entry and determine its stability after daily versus every 3-day vial entry. Stability and compatibility of treprostinil sodium with a Clave connector device was assessed.

Methods:

An initial study considered treprostinil vials punctured daily without regard to proper vial puncture technique. A second study considered treprostinil sodium vials punctured every 3 days with proper technique. Vials in these studies were stored in a stability chamber at 25 °C and 60% relative humidity up to 30 days. Treprostinil stability was assessed with a Clave connector adapter up to 84 days with the vials inverted. Vials were analyzed for treprostinil and m-cresol content, pH, appearance, particulate matter, and sterility.

Results:

Initial data indicated 14 days as the expiration date after initial vial entry and daily vial puncture. The parameter influencing stability was particulate matter, which was significantly reduced with proper vial puncture technique and vial entry every 3 days. Particulate matter counts remained low up to 84 days using a Clave adaptor and withdrawal every 7 days. Other stability parameters were acceptable throughout the stability study.

Conclusions:

These data indicate that the number of vial entries influenced treprostinil stability rather than time after initial vial entry. Two methods were identified to extend the expiration date of treprostinil sodium after initial vial puncture: proper vial puncture technique and use of a Clave adapter to withdraw the vial contents.
A Complex Interaction between Clozapine and Phenytoin
Authors: Shad Mujeeb U
Published: September 2013

Objective:

As of July 9, 2004, to report the first case of potential pharmacodynamic and pharmacokinetic interactions between clozapine and phenytoin occurring simultaneously in a patient.

Case Summary:

A 60-year-old African American female treated with clozapine and phenytoin developed neutropenia after the clozapine dose was increased from 650 to 900 mg/day. The neutropenia resolved after phenytoin was discontinued, and the clozapine dose was decreased from 900 to 300 mg/day without any significant change in clozapine levels.

Discussion:

Neutropenia can be explained on the basis of a potential pharmacodynamic interaction between clozapine and phenytoin. However, neutropenia did not occur until the clozapine dose was increased from 650 to 900 mg/day, corresponding to an increase in clozapine levels from 90 to 114 ng/mL. Neutropenia resolved after phenytoin was discontinued, even though the clozapine concentrations achieved after phenytoin discontinuation (137 ng/mL) were almost the same as those when phenytoin was coadministered (114 ng/mL). This finding suggests that neutropenia was precipitated not only by an increase in the clozapine dose, but also by the concomitant use of phenytoin. On the other hand, the decrease in clozapine concentrations can be explained on the basis of a pharmacokinetic interaction between clozapine and phenytoin. Phenytoin has the potential to decrease clozapine concentrations by inducing the activity of CYP1A2, which provides a primary metabolic pathway for clozapine.

Conclusions:

Concomitant use of phenytoin may not only decrease clozapine concentrations and compromise its efficacy, but can also precipitate neutropenia. Although based on a single case report, these findings warrant caution when coadministering clozapine and phenytoin.
Erythropoietin for Prevention and Treatment of Anemia in the Intensive Care Unit
Authors: Deal Eli N , Marken Patricia A , Manley Harold J , Garvin Cory G
Published: September 2013

Objective:

To evaluate and summarize the data on erythropoietin (EPO) use to prevent anemia in intensive care unit (ICU) patients.

Data Sources:

A literature search was performed using MEDLINE (1966–December 2003) using the key words erythropoietin, intensive care unit, anemia, and critically ill.

Data Synthesis:

Attempts to decrease the complications associated with anemia in ICU patients have recently focused on EPO use. Two comprehensive studies found that EPO significantly reduced the cumulative number of blood transfusions as compared to that of placebo. The assessing outcomes found no difference between the groups with respect to mortality rates, ventilation days, or length of stay.

Conclusions:

Available trials demonstrate reduced blood transfusions in ICU patients when EPO is administered. However, this result has not carried over as a defined clinical benefit. EPO use should be reserved for patients with longer hospital stays who are at risk for frequent blood transfusions as a comprehensive blood conservation strategy in the ICU.
Prevalence of Smoking and Attitude toward Smoking Cessation among Community Pharmacists, Saudi Arabia
Authors: Al-Arifi Mohammed Nasir
Published: September 2013

Background:

Although the percentage of the population that smokes has declined in the US and other countries, it is increasing in Third World countries. In Saudi Arabia, despite warnings on every packet of cigarettes indicating health hazards related to smoking, this habit is increasing rapidly, particularly among the younger population.

Objective:

To assess the prevalence and risk factors of smoking among community pharmacists and explore their attitudes toward issues related to smoking cessation.

Methods:

A survey was conducted in November 2003 in community pharmacies in Riyadh City, Saudi Arabia. Community pharmacies were randomly selected from the Ministry of Health Registers List. A self-administered questionnaire was used for data collection.

Results:

The survey revealed a 19.9% prevalence rate of cigarette smoking among community pharmacists. Lung diseases, including cancer, and cardiovascular diseases were mentioned as the main risk factors of cigarette smoking. The majority of the surveyed pharmacists agreed with banning smoking in common places, and they are willing to support patients who want to quit smoking. They also believe that the pharmacist can play a positive role in smoking cessation.

Conclusions:

Although pharmacists who participated in this survey were fully aware of the health hazards related to smoking, we found that their activities in promotion of smoking cessation were far from exemplary. Based on these findings, there is a need to put more emphasis on pharmacists to devote time for anti-smoking counseling.
Atypical Antipsychotics and Diabetes: Discussion and Monitoring Recommendations
Authors: Suehs Brandon T , Bettinger Tawny L , Hall Catherine S
Published: September 2013

Objective:

To discuss the relationship between atypical antipsychotics (AAPs) and diabetes and to report new monitoring recommendations for patients being prescribed AAPs.

Data Sources:

Articles were identified through searches of MEDLINE and PubMed (1966–March 2004). Search terms included hyperglycemia, diabetes, glucose, atypical antipsychotics, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. Only articles published in the English language were included in the search. Additionally, bibliographies of articles cited were used to identify additional articles.

Study Selection and Data Extraction:

All available articles identified by the data sources were reviewed and those deemed relevant to the review were included.

Data Synthesis:

Information pertaining to diabetes/hyperglycemia risk in case reports and submissions to the Medwatch system prompted the FDA to require labeling changes for all AAPs. The exact relationship between AAPs and diabetes remains unclear. The association is clouded by the fact that patients with schizophrenia are, in general, at higher risk for diabetes mellitus. Sedentary lifestyle and poor dietary intake are 2 possible contributing causes of diabetes in patients with schizophrenia. Weight gain or other metabolic effects of AAPs may put patients at further risk of developing diabetes. The American Diabetes Association, American Psychiatric Association, American Association of Clinical Epidemiologists, and North American Association for the Study of Obesity have released a joint consensus statement addressing some of the concerns related to AAP use.

Conclusions:

Because of the apparent increased risk of diabetes in patients taking AAPs, monitoring weight, fasting blood glucose, blood pressure, and lipids should be a part of the baseline assessment and ongoing care.
Incidence of Acute Renal Failure Associated with Milrinone
Authors: Amin Kamal , Bastani Bahar
Published: September 2013

Background:

Milrinone is a phosphodiesterase type III inhibitor with positive inotropic and vasodilatory effects used in patients with severe congestive heart failure (CHF).

Objectives:

To determine the incidence rate of acute renal failure (ARF) associated with milrinone therapy.

Methods:

Medical records of 116 patients with cardiomyopathy/severe CHF who received milrinone were reviewed from January 1993 to January 1996. Twenty-nine patients were excluded, resulting in 87 patients, 4 of whom received milrinone twice.

Results:

During a 3-year period, 11 of 91 milrinone therapies became complicated with ARF (incidence 12%). The patients' age (mean ± SD) was 52.3 ± 13.6 years, baseline serum creatinine (SCr) was 1.6 ± 1.0 mg/dL, milrinone dose was 0.47 ± 0.16 μg/kg/min, and mean duration of therapy was 6.5 ± 10.6 days. Fourteen treatments were <24 hours, 2 (14%) of which were complicated with ARF; of the remaining 77 treatments (≥24 h), 9 (11.7%) were complicated with ARF. Their peak SCr was 3.2 ± 1.5 mg/dL and time to peak SCr was 4.9 ± 2.8 days. There was no significant difference in the incidence of ARF in patients who received therapy for <24 hours versus ≥24 hours; in the prevalence rate of diabetes mellitus, hypertension, coronary artery disease; or in baseline SCr, milrinone dose, and duration of therapy between patients who did and did not develop ARF.

Conclusions:

We found a 12% incidence of ARF in patients receiving milrinone therapy for severe CHF, which in the absence of an appropriate control group could be the aggregate effects of milrinone therapy and severe CHF.
Analyzing a Health-System's Use of Unfractionated Heparin to Ensure Optimal Anticoagulation
Authors: Jellinek Samantha P , Cohen Victor , Likourezos Antonios , Goldman William M , Lashley Eustace L
Published: September 2013

Background:

Although unfractionated heparin (UH) dosing nomograms have proven to be superior to standard dosing, the latter remains the mainstay at our institution. We hypothesize that the incorporation of technology integrated with a decision support algorithm will facilitate the use of a UH nomogram by clinicians.

Objective:

To critically appraise the steps involved with the use of UH, create a decision support algorithm to aid in the management of UH, and determine whether the use of this algorithm can improve achievment of rapid and safe anticoagulation compared with the current standard of care.

Methods:

We analyzed the steps involved with the use of UH and subsequently reviewed the medical literature for risk factors for bleeding that patients may harbor when initiating UH. Based on this information, we designed a computerized physician order entry (CPOE), factor-based, weight-adjusted decision support algorithm with the primary goal of minimizing the risk of bleeding while optimizing and ensuring optimal anticoagulation. We compared the CPOE strategy with our current standard of care.

Results:

The CPOE factor–based dosing strategy significantly improved the rates and decreased the time to achieving an initial activated partial thromboplastin time (aPTT) that was ≥60 seconds compared with the control group. At the time of first aPTT measurement, the CPOE factor-based group achieved a 92.9% therapeutic rate compared with the standard heparin dosing group, which achieved a 60.8% therapeutic rate (p < 0.01).

Conclusions:

The institution of a CPOE factor-based dosing strategy in collaboration with pharmacists' interventions optimizes anticoagulation treatment with UH.
Fatal Acute Pancreatitis in a Patient Chronically Treated with Candesartan
Authors: Gill Christopher J , Jennings Anne E , Newton Jeffrey B , Schwartz David E
Published: September 2013

Objective:

To summarize a case of acute pancreatitis in a patient receiving the angiotensin II receptor blocker (ARB) candesartan.

Case Summary:

A previously healthy 75-year-old white man presented with acute pancreatitis complicated by anuric renal failure, respiratory failure, circulatory collapse, and died within 24 hours despite resuscitation efforts. He had been receiving candesartan 32 mg/day for more than one year with no apparent adverse effects.

Discussion:

In recent years, angiotensin-converting enzyme (ACE) inhibitors have been linked with sporadic cases of acute pancreatitis. Recent case reports suggest a similar association between pancreatitis and the related drug class of ARBs. Animal data indicate that the renin–angiotensin system plays an important role in pancreatic hemodynamics and exocrine function and is activated in the setting of acute pancreatitis. Because both ARBs and ACE inhibitors affect angiotensin II, we hypothesize that a common pathophysiologic mechanism might apply to both ARB- and ACE inhibitor–induced pancreatitis.

Conclusions:

Although acute pancreatitis appears to be a rare complication of both ARBs and ACE inhibitors, the catastrophic outcome in this case mandates that clinicians be aware of this adverse effect. Further research into the role of the renin–angiotensin system in the pathogenesis of acute pancreatitis appears warranted.
Fluoroquinolone- and Methicillin-Resistant Staphylococcus Aureus: Insights from the Antimicrobial Resistance Management Program
Authors: Gums John G , Epstein Benjamin J
Published: September 2013

Background:

Staphylococcus aureus is a frequent cause of infections involving the bloodstream, skin and soft tissue, and lungs in hospitalized patients. These isolates are often multidrug resistant and represent a major therapeutic challenge.

Objective:

To explore the susceptibilities of S. aureus to nafcillin/oxacillin, a surrogate for methicillin resistance, and the fluoroquinolones and determine whether a relationship might exist between fluoroquinolone use and the prevalence of methicillin-resistant S. aureus (MRSA).

Methods:

To date, 353 institutions throughout the US and Puerto Rico have enrolled in the Antimicrobial Resistance Management (ARM) Program, and data have been submitted on nearly 5 million isolates of S. aureus. Isolates submitted from 1990 through 2002 were reviewed for sensitivity to nafcillin/oxacillin, clindamycin, erythromycin, and the fluoroquinolones ciprofloxacin and levofloxacin.

Results:

From 1990 through 2002 inclusive, susceptibility to nafcillin/oxacillin nationally was 64.9% (n = 360,460), ranging from 62.2% in the North Central and Northeast US to 72.8% in the Southwest. Nationally, S. aureus isolates were more resistant to levofloxacin (41.4%, n = 123,868) than ciprofloxacin (38.7%, n = 256,178). The greatest change in susceptibility of S. aureus to nafcillin/oxacillin and ciprofloxacin occurred concurrently from 1998 to 2002, which may implicate fluoroquinolone use with increasing rates of MRSA infection.

Conclusions:

Resistance to methicillin and the fluoroquinolones has increased in concert during the past 5 years. Collectively, data from the ARM Program, along with several other investigations, support a role of fluoroquinolone use in the emergence of MRSA. These observations, along with increasing resistance among gram-positive and gram-negative pathogens, underscore the need for judicious use of fluoroquinolones.
The Economic and Psychosocial Impact of Migraine before and after Diagnosis and Treatment
Authors: Weitzel Kristin Wiisanen , Levin Gary M
Published: September 2013

Background:

Migraine headache is associated with significant costs. Many patients with migraine do not receive appropriate care. Correct diagnosis of migraine is often elusive, which may impact patient care.

Objective:

To determine the economic and disability burdens that patients with migraine experience before treatment and after diagnosis and treatment.

Methods:

This survey was administered to patients in a community pharmacy. Eligible patients were 18–40 years of age with diagnosed migraine who had prescriptions for an ergotamine, triptan, or combination product containing acetaminophen, isometheptene, and dichloralphenazone. Main outcome measures included pre- and postdiagnostic comparison of patient disability measures, migraine medication use, migraine-related patient costs, and physician office visit characteristics and diagnostic testing.

Results:

Forty-nine patients completed the study (mean ± SD age 38 ± 14 y, 90% female). The average age of symptom onset was 24 ± 13 years, with first presentation to physician at age 28 ± 12 and diagnosis made at age 31 ± 12 years. The mean number of physicians visited was 2.3 ± 4.7, comprising 5.3 ± 7.8 office visits before diagnosis. After diagnosis and treatment, significantly fewer patients experienced attacks lasting ≥16 hours and reported missing ≥5 days of work/month from migraine symptoms. Patients also reported significantly increased effectiveness at work when experiencing symptoms after diagnosis and treatment.

Conclusions:

This study demonstrated that migraine often eludes formal diagnosis and diagnosis is difficult for the primary care physician to make without expensive tests and/or consultation. Patient outcomes were greatly improved after a formal diagnosis followed by appropriate treatment.