bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Clinical Significance of the Interaction between Proton Pump Inhibitors and Clopidogrel
Authors: Weber Zachary A , Rodgers Philip T 
Published: September 2013

Objective: To determine whether the interaction between omeprazole and clopidogrel is a proton pump inhibitor (PPI) class effect or a drug-specific effect. Data Sources: A MEDLINE search for primary literature was completed (through August 2009) using the search terms proton pump inhibitors and clopidogrel. Additional data obtained from references and abstracts presented at clinical meetings were included when appropriate. Study Selection: Nine primary literature articles were identified and reviewed. This included only one prospective, double-blind, placebo-controlled, randomized trial. The remainder were prospective and retrospective cohort studies and a population-based nested case-control study. Data Extraction: Omeprazole, a CYP2C19 inhibitor, has been shown to increase the platelet reactivity index (PRI) when combined with clopidogrel (52.4% vs 39.8%; p < 0.0001), leading to an increased risk of thrombosis. This combination was also shown to cause a 25% increase in the risk of mortality or rehospitalization for acute coronary syndrome (ACS), with a significantly higher risk for each 10% increase in time on this combination therapy (odds ratio [OR] 1.07; CI 1.05 to 1.09). Conversely, combination therapy with pantoprazole or esomeprazole and clopidogrel caused a nonsignificant increase in PRI (p = 0.382) and adenosine diphosphate-induced platelet aggregation (p = 0.69 and 0.88, respectively). Similarly, the combination of pantoprazole and clopidogrel was not associated with an increased risk of myocardial infarction (OR 1.02 [0.70–1.47]) when patients were followed for 90 days following hospital discharge for ACS. One study has shown a class effect when PPIs are combined with clopidogrel, leading to an increased risk of a major adverse cardiovascular event (hazard ratio 1.51; 1.39 to 1.64). Histamine2 (H2)-receptor antagonists have not been associated with a significant interaction with clopidogrel in any study. Conclusions: The use of PPIs with clopidogrel may be warranted, based on comorbid disease states for many patients, but H2-receptor antagonists should be considered when appropriate, due to their lack of interaction with clopidogrel.
The Implementation of an Electronic Document Management System at a Drug Information Center
Authors: Wisniewski Christopher S , Pummer Tara L , Krenzelok Edward P 
Published: September 2013

Objective: To describe a method for creating an electronic document management (EDM) system at a drug information (DI) center based at an academic medical center to improve efficiency and provide increased availability through remote access. Summary: At DI centers, written materials not available electronically are often stored in file cabinets and retrieved by an individual when required. This process can be time-consuming and inefficient. Various EDM programs were evaluated and compared based on capabilities, cost of implementation and maintenance, and efficiency. Following program selection, documents were scanned onto a dedicated personal computer (PC) and organized according to a predetermined hierarchy of folders. Specialists then performed optical character recognition (OCR) and entered authors, titles, and assigned key words for each new electronic file. Results: It was determined that Adobe Acrobat software fulfilled all requirements at minimal expense. A specialist is able to scan and electronically file 72 documents (496 pages) per hour, perform OCR on 40 documents per hour, and attach titles, authors, and key words to newly scanned documents at a rate of 10 articles per hour. This EDM system is capable of storing in excess of 70,000 documents on a PC with 250 GB of hard disk space and 4 GB of random access memory, which can be accessed remotely from any computer through a secure virtual private network connection. Conclusions: Adobe Acrobat software, when combined with a high-resolution scanner, provides an inexpensive method for EDM that allows for immediate document retrieval, expansion of operations, and remote access.
Human Ingestions of Veterinary Cyclooxygenase-2 Inhibitors
Authors: Forrester Mathias B 
Published: September 2013

Background: Deracoxib and firocoxib are cyclooxygenase-2 inhibitors approved for veterinary use, but not for use in humans. Information on the outcome of human ingestions of these drugs is not readily available. Objective: To describe human ingestions of cyclooxygenase-2 inhibitors reported to poison centers. Methods: All human ingestions of deracoxib and firocoxib reported to Texas poison centers during 2003–2009 were identified, and the distribution of ingestions by demographic and clinical factors was determined. Final medical outcome was determined by poison center staff, based on adverse clinical effects that are observed or expected. Results: Of 72 total ingestions, 56.9% involved deracoxib and 43.1% involved firocoxib. One tablet or less was ingested in 87.7% of cases in which the number of tablets was known. The patients were 62.5% female, 51.4% aged 0–5 years, 6.9% aged 6–19 years, and 41.7% aged 20 years or more. The patient was managed on site in 94.4% of the cases. The distribution of cases by final medical outcome was 44.4% no effect, 18.1% not followed but judged nontoxic, 34.7% not followed but minimal effects possible, and 2.8% effects probably not related to the ingestion. Conclusions: Human ingestions of deracoxib and firocoxib reported to Texas poison centers were relatively uncommon. Such ingestions usually involved 1 tablet or less. Cases followed to known outcome did not result in serious outcomes and were frequently managed on site.
Saxagliptin: New Therapy for Type 2 Diabetes
Authors: Logan Jill K , EscañO Alisa K 
Published: September 2013

Objective: To evaluate the efficacy of saxagliptin for the treatment of hyperglycemia associated with type 2 diabetes. Data Sources: A MEDLINE/PubMed search was conducted of all available date ranges from 1990 through October 2009 for literature in the English language, using the search terms saxagliptin, type 2 diabetes mellitus, incretin hormones, and dipeptidyl peptidase-4 inhibitors. The manufacturer of saxagliptin (Onglyza) was contacted for clinical trial information. Study Selection: Five prospective, randomized controlled trials were reviewed. Studies were included in this review if they had examined saxagliptin and its effects on hyperglycemia. Trials examined included those on saxagliptin monotherapy and those on saxagliptin in combination with metformin, with a sulfonylurea, and with a thiazolidinedione. Data from the MEDLINE/PubMed search, as well as clinical trial data obtained from the manufacturer, were used in this review. Data Synthesis: Saxagliptin demonstrated statistically significant decreases of 0.43–0.54% in hemoglobin A1c (A1C) in the monotherapy treatment group. The A1C-lowering effects were the greatest, with a decrease of 2.5% in patients concomitantly administered metformin and saxagliptin as initial therapy. In addition to its effects on A1C, saxagliptin proved to be weight neutral and had minimal risks of hypoglycemia, with hypoglycemia seen only in the saxagliptin in combination with a sulfonylurea group. Conclusions: Saxagliptin is an effective treatment for hyperglycemia associated with type 2 diabetes. It is currently a third-line option in the American Diabetes Association treatment algorithm for type 2 diabetes and, based on the trials reviewed here, this is an acceptable place in therapy. Saxagliptin is a good option for patients with diabetes who are at high risk of hypoglycemia.
Review of Medications Used in the Treatment of Diabetes Mellitus
Authors: Laliberte Brandi K , Neumiller Joshua J 
Published: September 2013

Objective: To review the pathophysiology of diabetes mellitus and outline currently available medications used in its treatment. Data Sources: A MEDLINE/PubMed search (1966-December 2009) was conducted for English-language articles using the terms diabetes mellitus, pharmacotherapy, metformin, thiazolidinedione, sulfonylurea, meglitinide, α-glucosidase inhibitor, DPP-4 inhibitor, colesevelam, bromocriptine, exenatide, pramlintide, and insulin. Book chapters relevant to the pathophysiology and pharmacologic treatment of diabetes were also searched. Study Selection and Data Extraction: Articles and chapters pertinent to the pharmacologic management of diabetes mellitus were reviewed. Data Synthesis: Type 1 diabetes is characterized by an absolute lack of insulin production by the β-cells of the pancreas, requiring insulin therapy. Type 2 diabetes is characterized by both insulin resistance and a relative or absolute lack of insulin secretion. Because type 2 diabetes involves both insulin resistance and decreased insulin production over time, people with type 2 diabetes can be treated with a variety of drugs currently on the market. Therapies currently on the market include metformin, thiazolidinediones, sulfonylureas, meglitinides, α-glucosidase inhibitors, DPP-4 inhibitors, colesevelam, bromocriptine, exenatide, pramlintide, and insulin. Conclusions: Given the multitude of medications available for the treatment of diabetes, it is important that pharmacy technicians and pharmacists be aware of the various agents currently on the market. With a solid foundation of knowledge regarding diabetes medications, a huge impact can be made on the quality of care of the customers and patients the pharmacy serves.
Communication Training and Assessment Using Webcams
Authors: Powers Mary F , Bright David R 
Published: September 2013

Background: Communication training is a necessary and valuable component of the education of pharmacists and pharmacy technicians. Video recording students during communication exercises provides a basis for providing feedback that allows the students to improve their skills. Objective: To describe how webcams and notebook computers were used as an alternative method for recording students during communication exercises in a professional practice development laboratory in a PharmD program. Methods: P-2 pharmacy students participated weekly in 3-hour laboratory sessions in a professional practice development course and engaged in interviewing and counseling activities. This article describes the transition from VHS camcorders to webcams. Surveys were distributed to 107 students, 8 teaching assistants, and the laboratory instructor. Student perspectives, teaching assistant perspectives, and faculty perspectives for the VHS method and webcam method were evaluated and compared. Results: The majority (75%) of teaching assistants reported a perceived time savings with the webcams, and all teaching assistants and faculty perceived a benefit in providing the students with a digital recording for immediate feedback as compared with a 2-week delay in distributing VHS recordings of patient counseling sessions. More students reported having access to a computer capable of playing the digital video recording as compared with access to a VHS player (96.1% vs 39.8%; p < 0.001). Furthermore, 61.2% of students reported watching the recorded counseling session outside of class. Conclusions: Using webcams for recording pharmacy communication exercises in a pharmacy practice laboratory was demonstrated to provide a useful means for self-assessment and constructive feedback. Additionally, the technique may be useful in other laboratory courses for PharmD students.
Ramelteon Treatment of Insomnia
Authors: Singh Angela C , Hill Angela M , Ghazvini Patty , Patel Jalpa , Mahdavian Soheyla 
Published: September 2013

Objective: To provide an overview of the use of ramelteon for the treatment of insomnia. Data Sources: A literature review was conducted through PubMed using the terms ramelteon, insomnia, treatment, adverse events, elderly, and melatonin. Additionally, reference citations from publications identified were reviewed. Data from 1982 to 2009 were gathered. Study Selection and Data Extraction: All articles in English that were identified from the data sources were evaluated. Data Synthesis: Long-term clinical trials of ramelteon have demonstrated that it is effective and safe, causing minimal adverse effects and no potential for abuse. Additionally, discontinuation of ramelteon does not result in rebound insomnia, which makes it an ideal agent for the management of insomnia in the elderly population. Conclusions: Ramelteon offers a safe and effective new therapeutic option for patients experiencing transient or chronic insomnia.
Improved Stability in INR with Coumadin for a Patient Requiring Very Low Warfarin Doses
Authors: Anderson Douglas C , Poulos Phillip , Scoggins Bernard P 
Published: September 2013

Objective: To describe a patient who required very low doses of warfarin but who could not achieve therapeutically stable anticoagulation until treatment was switched from generic to branded warfarin. Case Summary: A 53-year-old male with a history of hypertension, coronary artery disease, heart failure, and mild renal insufficiency was diagnosed with atrial fibrillation during a routine examination. Anticoagulation was started with warfarin 5 mg daily. The patient presented to the anticoagulation clinic 2 days later with an international normalized ratio (INR) of 5.4 and no signs or symptoms of bleeding. Warfarin was held for 3 days until the INR was <3. Warfarin was then restarted at 2.5 mg daily. Over the next week his INR rose to 4.8; warfarin was again held and restarted at 1.5 mg/day. Although the warfarin dose was eventually titrated to 6.5 mg/wk, the INR never stabilized and the patient only had consecutive therapeutic INRs twice in 1 year and only one 3-month period with therapeutic INRs not requiring any dosage adjustments. The decision was made to switch from the generic product to Coumadin to try to improve stability. Several dosage adjustments were made over the 6 weeks following the switch before the INR was stabilized with 7 mg/wk. Subsequent INRs ranged from 2.0 to 2.2 in the 3 months after the switch, during which time INRs were measured at least weekly. Over 14 months after the switch, the patient did not have an INR outside of the therapeutic range. Discussion: Many patients are able to take generic warfarin without problems. However, case reports have documented occasional patients who have had problems after switching to a generic product. Large cohorts have been switched to generic warfarin without experiencing significant changes in therapeutic control. However, 1 cohort study found that patients who required very low warfarin dosages had significant changes in their INR after switching to a generic product. Conclusions: Patients who require very low warfarin dosages to consistently maintain therapeutic anticoagulation may experience less therapeutic stability while on a generic product.
Community Pharmacy Use Patterns of Women with HIV and Women at Risk for HIV in the San Francisco Bay Area
Authors: Cocohoba Jennifer M , Hsu Tracy , Greenblatt Ruth M. 
Published: September 2013

Background: Community pharmacies play a key role in the care of patients when dispensing antiretroviral therapy. Objective: To determine factors associated with the use of multiple dispensing pharmacies to obtain medications in a population of HIV-positive and at-risk women and to determine whether use of multiple pharmacies was associated with immunologic or virologic changes for the subset of HIV-positive women. Methods: A survey on community pharmacy use was distributed to participants in the Women's Interagency HIV Study, San Francisco site, from 2004–2007. Poisson, linear, and logistic regression methods were used to determine associations between specific patient characteristics and use of multiple dispensing pharmacies and associations between multiple pharmacy use and CD4+ cell count or viral load changes. Results: There was a trend toward an association between HIV status and use of multiple pharmacies (IRR 1.23; 95% CI 1.00 to 1.51; p = 0.05). In multivariable analyses of HIV-positive women, use of additional pharmacies (over the primary pharmacy) during the study period was not associated with statistically significant changes in CD4+ count or viral load. Conclusions: HIV-positive participants may tend to use multiple pharmacies more frequently than their HIV-negative counterparts do, though this practice does not appear to be associated with poorer immunologic or virologic outcomes. Further studies should be conducted to determine whether different patient patterns of community pharmacy use affect HIV treatment outcomes.
Roles of Intravenous Iron Therapy in Various Patient Settings
Authors: Nguyen Timothy V , Wang Amy , Kim Sara S 
Published: September 2013

Objective: To provide clinical information on intravenous iron products and their role in chronic kidney disease (CKD), dialysis, oncology, critical illness, and heart failure. Data Sources: Intravenous iron products information, national clinical practice guidelines, and the latest primary literature available were reviewed. PubMed and MEDLINE databases were searched from January 2000-December 2009. Study Selection and Data Extraction: All FDA-approved intravenous iron products information, available national clinical practice guidelines, and primary literature were included. Data Synthesis: Iron deficiency is common in patients with CKD, dialysis, oncology, critical illness, and heart failure. Routine supplementation with intravenous iron therapy is indicated in patients with CKD, including those receiving dialysis; however, its role in oncology, critical illness, and heart failure is not clearly defined. Assessing patients for iron deficiency, evaluating their status, and knowing the risks of adverse events are important in determining the roles of intravenous iron therapy in each setting. If patients are initiated on intravenous iron, they must be closely monitored for signs and symptoms of adverse drug reactions, as well as clinical worsening. Additionally, intravenous iron must be discontinued upon resolution of iron deficiency. Conclusions: The importance of intravenous iron therapy is well established in patients with CKD, including those receiving dialysis, who have iron deficiency. Its roles in oncology, critical illness, and heart failure should be assessed on a case-by-case basis.
Overview of Chemotherapy and Nine Commonly Prescribed Chemotherapeutic Medications
Authors: Smith Tara L , Carter Chenita W 
Published: September 2013

Objective: To briefly review cancer treatment and describe 9 commonly prescribed chemotherapeutic agents currently approved by the FDA: anastrozole, bicalutamide, capecitabine, erlotinib, imatinib, imiquimod, lenalidomide, letrozole, and temozolomide. Data Sources: Literature retrieval was accessed through PubMed (2000-June 2010) and Ovid (2000-June 2010), using search terms of chemotherapy and chemotherapy safety. Reference citations from publications identified were reviewed. Individual drugs were researched by generic name, using drug-dosing literature as referenced. Study Selection and Data Extraction: Articles in English and relating to chemotherapeutic handling and safety were identified and evaluated for content relevant to the drugs being reviewed. Data Synthesis: Oral and topical chemotherapy agents are being prescribed more frequently for patients with cancer as part of their out-patient treatment protocols. Since many drugs are dispensed for patients to self-administer at home, it is important for health-care workers—and patients taking these drugs—to know the safest way to handle them. Pharmacy personnel should be familiar with these agents to provide proper patient counseling on how to take the drug, what adverse effects to expect, and other drugs that may need to be taken concomitantly (ie, antiemetics). Conclusions: Oral and topical chemotherapy medications are being used more frequently in chemotherapeutic protocols for patients to self-administer at home. It is important to understand how these drugs work as well as important facts that need to be relayed to patients regarding adverse effects, handling, and exposure.
Pharmacists' Perceptions of the Value of Technician Certification through a Nationally Accredited Certification Program
Authors: Desselle Shane P , Schmitt Michael R 
Published: September 2013

Background: There has been considerable debate over the appropriate credentialing of pharmacy technicians; however, there have been no previous attempts to ascribe the value associated with national certification. Objective: To assess pharmacists' perceptions of the skills, knowledge, and attitudes gained by technicians from the certification process and toward pharmacy technician certification in general. Methods: A self-administered questionnaire was mailed to a random sample of pharmacists from 6 states. These states were selected primarily due to criteria regarding their regulations on technician certification so that pharmacists had the opportunity to work with both certified as well as noncertified technicians. The questionnaire contained items to elicit respondents' perceptions of the impact of certification on technicians' skills, knowledge, and attitudes, as measured on Likert-type scales. There were additional items related to overall perceptions of the certification process. Unpaired t-tests, 1-way analyses of variance, and Wilcoxon ranked-sign tests were conducted. Results: Analyses were conducted on 609 usable responses among the 795 returned. Certification was reported to have a moderate contribution toward myriad technician skills, knowledge, and attitudes in ambulatory and acute care settings. Pharmacists in ambulatory care settings, with greater familiarity with the Pharmacy Technician Certification Examination, were more positive (p < 0.01) about the impact of certification. Certification of technicians was viewed as a more valuable source of training and education than prior nonpharmacy work experience, completion of a vocational training program, or a 4-year college degree (p < 0.001) and equal to prior pharmacy work experience in another setting (p = 0.73). A vast majority of pharmacists supported mandatory certification and standardized education requirements to sit for a national certification examination. Conclusions: Pharmacists view certification as a valuable means of enhancing technician competence. Combinations of pedagogic approaches and experiential education may further improve technician proficiency and enhance patient care.