bluuebunny/crossref_metadata_2025_split huggingface dataset:
Amiodarone-Induced Neuropathies and Related Neurotoxicities
Authors: Slowe Kristen K , Krikorian Susan A 
Published: September 2013

Objective: To report the frequency and symptomatic characteristics of amiodarone-induced neuropathies and related neurotoxicities. Data Sources: Literature retrieval was accessed through MEDLINE and PubMed (1950–July 2010), using the terms amiodarone, neuropathy, and neurotoxicity. In addition, reference citations from publications identified were reviewed. Study Selection and Data Extraction: All articles published in English retrieved from the data sources were assessed. Case reports, randomized trials, and retrospective medical record analyses were included in the review. Data Synthesis: The frequency and characteristics of amiodarone-induced neurologic disturbances are not well established. We reviewed 7 case reports, 8 randomized trials, and 1 retrospective record analysis. Neurologic adverse reactions associated with amiodarone therapy consistently presented as tremor, gait ataxia, peripheral neuropathy, or a combination. Amiodarone dose and duration of exposure ranged from 200 mg/day to 1200 mg/day and 21/2 months to 20 years, respectively, across case reports. Similarly, clinical trials and retrospective analysis demonstrated widely varying rates of neurotoxicity after amiodarone exposure, from 1.6% to 54%. A dose- or duration-dependent nature of amiodarone exposure and its associated neurotoxicity is difficult to substantiate, based on current literature. Nonetheless, the nature of its clinical presentation and mechanism of pathogenesis is better understood. Conclusions: A dose- or duration-dependant rise in the frequency of amiodarone-induced neurologic disturbances has not been established, due to variances in dose and duration exposure, differing study definitions of neurotoxicity, and inconsistent criteria for reporting a drug event, across relevant literature.
Evaluation of Anticoagulation Management and Chronic Disease State Control in a Pharmacist-Run Pharmacotherapy/Anticoagulation Clinic
Authors: Sease Julie M , Blake Elizabeth W , Gowan Mollie , Shealy Kayce M 
Published: September 2013

Background: The benefit of pharmacist-run clinics for anticoagulation, dyslipidemia, diabetes, and hypertension has been described in the literature as individual services. We describe a clinic model in which anticoagulation and other chronic disease states are managed concomitantly. Objective: To evaluate the control of anticoagulation, hypertension, dyslipidemia, and diabetes in anticoagulation patients enrolled in a pharmacotherapy/anticoagulation clinic. Methods: Patients seen in the pharmacotherapy/anticoagulation clinic for management of anticoagulation were included in a retrospective review. Demographic information, blood pressure measurements, and laboratory values were recorded. Initial and final results were compared and statistically analyzed. Benchmark goals were set for each parameter analyzed. Results: Between August 2007 and July 2008, 282 patients were enrolled in the clinic. While slightly increasing the average time in therapeutic range from 69.9% to 70.7%, the clinical pharmacists also managed hypertension, dyslipidemia, and diabetes, if present. Systolic (p = 0.0075; 95% CI 0.98 to 6.31) and diastolic (p = 0.004; 95% CI 1.26 to 4.33) blood pressures decreased during the study period such that the number of patients with controlled blood pressure increased to 81%. Low-density lipoprotein cholesterol measurements decreased by an average of 5.9 mg/dL (p < 0.0001; 95% CI 3.121 to 8.789), with an increase in number of patients at goal to 86%. Although not significant, mean hemoglobin A1c (A1C) values decreased an average of 0.12% (p = 0.1138; 95% CI 0.029 to 0.271), with an increase to 59% of those achieving a goal A1C. Conclusions: A pharmacotherapy/anticoagulation clinic can be considered a practice model for effective management of anticoagulation patients who require management of other chronic disease states.
Training Community Pharmacy Technicians about Their Roles in the Provision of Medication Therapy Management Services
Authors: Pattin Anthony Jamarr , Powers Mary F , Lengel Aaron J 
Published: September 2013

Background: Although increased patient access and reimbursement opportunities are available through medication therapy management (MTM), strategies must be employed to decrease barriers to providing MTM services in a retail pharmacy. Objective: To describe a program for training community pharmacy technicians about their role in the provision of MTM services while evaluating their attitudes about and understanding of MTM. Methods: A training program was developed for community pharmacy technicians, aimed at defining MTM and designating nonclinical skills that can be developed to decrease the burden on pharmacists who perform MTM. All pharmacy technicians within a zone of a supermarket chain were invited to participate in the training program. Immediately prior to the training program, participants completed a pretest survey. After the training program, technicians completed a posttest survey. Surveys were designed to capture technicians' understanding of MTM and their attitudes about performing functions in the MTM process. Results: Of 150 technicians available in the designated zone, 28 volunteered to complete the MTM training program and surveys. More technicians responded that they believe that they have a role in MTM services after the training program (21.4%) than did before the training program (3.6%). Posttest results, compared with pretest results, indicated that technicians strongly agreed that they can help with MTM services (p < 0.01). Posttest responses showed that more technicians agreed that MTM services are important for patients, compared with pretest responses. Conclusions: Participants indicated that they are willing to help pharmacists complete MTM cases by performing nonclinical tasks. The widespread use of MTM training programs for pharmacy technicians is necessary to evaluate effective ways to prepare pharmacy technicians to assist with the MTM process.
The Role of Antioxidant Vitamins in Cardiovascular Disease
Authors: Seefeldt Teresa M , Bennet Lunawati L 
Published: September 2013

Objective: To review the current data on the role of antioxidant vitamins in cardiovascular disease. Data Sources: Articles were obtained from a MEDLINE search covering all years. Terms used in the search included combinations of antioxidant, vitamin, vitamin E, vitamin C, beta-carotene, and cardiovascular disease. Reference lists from articles were examined for additional references. Study Selection and Data Extraction: Randomized clinical trials were selected and evaluated for study design and data obtained. Observational studies, meta-analyses, and basic science articles were also reviewed for background. Data Synthesis: The use of dietary supplements, including vitamins, minerals, and herbal products, is common among patients in the US. Vitamin E, vitamin C, and beta-carotene are all supplements with reported antioxidant activity. Because oxidative stress has been implicated in the development of cardiovascular disease, there has been significant research at the basic science level as well as observational studies and randomized placebo-controlled trials examining the potential impact of vitamin E, vitamin C, and beta-carotene in the prevention and treatment of cardiovascular disease. While basic science data and data from observational studies have identified benefit from antioxidant vitamin supplementation, randomized clinical trials have failed to support a role for antioxidant vitamin supplementation in the prevention or treatment of cardiovascular disease. Conclusions: Data from randomized clinical trials do not support the use of antioxidant vitamins in cardiovascular disease. Therefore, antioxidant vitamins should not be recommended to patients for prevention or treatment of cardiovascular disease.
A Review of Commonly Prescribed Antiviral and Antiretroviral Agents
Authors: Mansour Hanine , Inge Lisa Devito , Ferreira Jason , Unger Nathan R 
Published: September 2013

Objective: To review the pharmacologic properties of and uses for the most commonly prescribed antiviral agents. Data Sources: A MEDLINE/PubMed search (1966–September 2010) was conducted for English-language articles using the terms HIV, hepatitis, cytomegalovirus (CMV), herpes simplex virus (HSV), antiviral agents, antiretroviral agent, acyclovir, valganciclovir, valacyclovir, interferon, ribavirin, ritonavir, efavirenz, zidovudine, darunavir, lopinavir, tenofovir, raltegravir, lamivudine, atazanavir, and emtricitabine. Book chapters and recent guidelines pertaining to the pathophysiology or pharmacologic properties of antiviral agents were also reviewed. Study Selection and Data Extraction: Articles, chapters, and guidelines pertaining to the relevant pharmacologic agents were collected for review. Data Synthesis: Viral pathogens affect multiple organs, causing direct and indirect damage by activating an immune response. Unlike bacterial infections, which can be eradicated from the host system, viral infections are not curable. Antiviral treatments are prescribed to reduce morbidity and mortality. There are many antiviral and more than 20 antiretroviral agents currently approved by the FDA. These include acyclovir, valacyclovir, and famciclovir for HSV; ganciclovir, valganciclovir, foscarnet, and cidofovir for CMV; interferon and ribavirin for hepatitis; efavirenz, tenofovir, emtricitabine, atazanavir, darunavir, lopinavir, ritonavir, raltegravir, zidovudine, and lamivudine as first-line agents for HIV. Conclusions: Viral illnesses affect a large portion of the population. Given the multitude of drugs available, pharmacists and pharmacy technicians should be educated about common treatment options. Having a strong knowledge of commonly prescribed antiviral drugs allows these frontline professionals to make a significant impact on the quality of care that they provide to their patients and community.
Pharmacy Technicians and Immunizations
Authors: Powers Mary F , Hohmeier Kenneth C 
Published: September 2013

Objective: To provide background on immunizations and community pharmacies and identify opportunities for pharmacy technicians to assist pharmacists in providing community pharmacy-based immunization programs. Methods: Articles were identified through searches of MEDLINE/PubMed (1950–July 2010) with the following search terms: vaccination and technician, immunization and technician, vaccination and pharmacist, and immunization and pharmacist. Additionally, immunization resources from the American Pharmacists Association, the American Society of Health-System Pharmacists, and the Centers for Disease Control and Prevention were used. Results: Pharmacy technicians can help facilitate immunization programs and help reduce some of the barriers to providing superior services. Specific tasks that can be performed by pharmacy technicians include documentation, billing, assisting in the reporting of adverse events, and facilitating communication. Technicians can also take an active role in pharmacy-based immunization programs by obtaining cardiopulmonary resuscitation training and certification. Conclusions: Pharmacy technicians can help facilitate immunization programs and help pharmacists offer more robust and comprehensive immunization services.
Adverse Drug Reactions in Hospitalized Psychiatric Patients—Comparison of Data
Authors: Bowen Guy T , Sajbel Terrie A 
Published: September 2013

Objective: To compare and contrast adverse drug reaction (ADR) reporting between 2 psychiatric hospitals, as well as preventability and possible reasons that one hospital had more preventable occurrences than the other. Methods: A 3-year retrospective analysis was conducted comparing ADRs previously reported in a study from Maryland Psychiatric Hospital that were classified as probable and definite according to the modified Naranjo probability scale versus probable and definite ADR reports from the Colorado Mental Health Institute at Pueblo (CMHIP). The same study period (July 1, 2006–June 30, 2009) was used for the retrospective analysis of ADRs at both institutions. We compared the most frequently reported classes of medications and examined the number of reactions, types of reactions, and preventability. Results: Psychiatric medications were responsible for 98/145 (67.6%) ADRs at CMHIP, while 47 (32.4%) ADRs were caused by nonpsychiatric medications. At Maryland Psychiatric Hospital, 48.4% of ADRs were caused by psychiatric medications and 51.6% were caused by nonpsychiatric medications. Of the 145 ADRs reported at CMHIP, only 1 (0.7%) was classified as preventable, versus 19 (20.4%) preventable ADRs reported in Maryland Psychiatric Hospital. The classes of medications most frequently associated with ADRs at Maryland Psychiatric Hospital were cardiovascular agents, antiepileptic drugs, and second-generation antipsychotic medications; at CMHIP the medications most commonly associated with ADRs were second-generation antipsychotics, conventional antipsychotics, and mood stabilizers. Proposed reasons for differences in numbers, types, and preventability of ADRs between the institutions are that different reporting mechanisms and pharmacy medication monitoring programs, in conjunction with quality assurance programs, were used at the 2 institutions. Conclusions: Differences between 2 comparable hospitals in the number and preventability of ADRs and the classes of medications reportedly responsible for them may be due to different reporting mechanisms and monitoring programs. Pharmacy intervention programs may lead to prevention of ADRs.
Amlodipine-Induced Gingival Hyperplasia in a Child: Case Report and a Review of the Literature
Authors: Ahmad Nazia , Mullakary Jacquline , El-Chaar Gladys M 
Published: September 2013

Objective: To increase awareness of amlodipine-induced gingival hyperplasia in children, as well as review whether a dose-related relationship exists. Case Summary: A 9-year-old girl with a past medical history of membranous nephropathy and hypertension presented with failure to thrive and inability to gain weight. She had a history of allergy to enalapril. On admission, she was found to have gingival hyperplasia. A review of her medication profile found amlodipine and azathioprine to be possible agents for this adverse reaction. The child's mother noticed this adverse effect after an increase in amlodipine dosage. We recommended substituting the angiotensin receptor blocker losartan for amlodipine; however, the nephrologist feared a cross-reactivity with enalapril and decided to continue amlodipine therapy. A follow-up call after hospital discharge revealed that the patient could no longer eat by mouth and that her gums bled upon brushing. Discussion: We reviewed the possible role of azathioprine in causing our patient's gingival hyperplasia. Due to the timeliness of this occurrence and the possibility of a dose-related response, we selectively reviewed the literature associated with amlodipine in children. A PubMed search and subsequent review of the literature revealed 1 study in rats that showed a relationship between amlodipine dose/plasma concentration and gingival hyperplasia. In humans, this relationship was reported with other calcium channel blockers, but not with amlodipine and not in a child. The Naranjo probability scale revealed a possible adverse reaction of gingival hyperplasia associated with amlodipine. Conclusions: To our knowledge, this is the first report of a possible dose-related occurrence of gingival hyperplasia in a child receiving amlodipine.
Warfarin Inhibition in a Patient Taking Complementary and Alternative Medicine Products
Authors: Pence Alicia , Gregory Philip J 
Published: September 2013

Objective: To report a case of a decreased international normalized ratio (INR) in a patient taking warfarin in addition to multiple complementary and alternative medicine (CAM) products. Case Summary: A patient on warfarin with a target INR of 2–3 presented to the clinic with an INR of 1.1. Approximately 3 months earlier, the patient had started taking several CAM products, including omega-3 fatty acids, butcher's broom, and hawthorn berry; aloe vera juice was added approximately 6 weeks later. She was not asked to discontinue these products; instead, the warfarin dose was increased to eventually achieve a stable INR of 2.5. Discussion: An objective causality assessment suggests that this interaction was probably related to use of one of the CAMs. However, it is unclear which of these caused the decreased INR. The most likely causative agent was aloe. Conclusions: Patients do not need to discontinue CAM products while taking warfarin. However, these products need to be taken in consistent doses. Any substantial changes in intake of these substances can necessitate a change in anticoagulant therapy.
Cerebrovascular Events and Use of NuvaRing
Authors: Wilhoite Jessica E , Place Amanda J 
Published: September 2013

Objective: To report 2 cases, occurring within 1 month at a single institution, in which young women experienced a cerebrovascular event while using the hormonal contraceptive product NuvaRing (etonogestrel/ethinyl estradiol vaginal ring). Case Summary: The first patient presented to the emergency department (ED) with a 10-day history of right frontal headache. A computed tomography (CT) scan and magnetic resonance imaging showed evidence for right postcentral and cortical venous thrombosis. A hypercoagulable workup identified a heterozygous factor V Leiden mutation. The second patient presented to the ED with a same-day history of left frontotemporal headache extending into her left jaw and neck, numbness and clumsiness of right hand and right foot, and inability to make a comprehensible sentence. A CT angiogram showed occlusion of the internal and external carotid arteries. A hypercoagulable workup indicated no evidence of a thrombophilic disorder and a transesophageal echocardiogram indicated no cardioembolic source, resulting in a final diagnosis of a spontaneous carotid artery dissection. Both patients reported recent use of NuvaRing. The medication was discontinued during the hospital stay. Discussion: The use of hormonal agents for contraception carries a well-known risk of venous thrombosis; however, the impact this therapy has on the risk of arterial thrombosis and ischemic brain events is less understood. We found no previous reports of an ischemic brain event in association with NuvaRing use. The Naranjo probability scale indicated a possible relationship between the ischemic events and NuvaRing exposure in both patients. Conclusions: Risk factors should be evaluated appropriately prior to initiating any form of combined hormonal contraceptives, oral or vaginal, in young women.
Comparison of Pediatric Levalbuterol and Albuterol Exposures Reported to Texas Poison Centers
Authors: Forrester Mathias B 
Published: September 2013

Background: Levalbuterol is R-albuterol, which is the active isomer and accounts for the therapeutic activity of albuterol. The effects of S-albuterol are often the opposite of those of levalbuterol, and the effects of levalbuterol may be diminished in the presence of S-albuterol. Objective: To compare exposures among young children to levalbuterol and albuterol that were reported to poison centers. Methods: Cases included levalbuterol and albuterol exposures among patients age 0–5 years reported to Texas poison centers during 2000–2009. The distribution of total cases for each medication was determined for selected characteristics. For cases not involving other substances and where a final medical outcome was known, the distribution of each medication was determined for outcome and management site of the exposure and most common clinical effects and treatments. Comparisons were made by calculating the rate ratio (RR) and 95% confidence interval. Results: There were a total of 1,012 levalbuterol and 4,338 albuterol exposures. Other substances were involved in 11.8% of levalbuterol and 6.6% of albuterol exposures (RR 1.77, 95% CI 1.42 to 2.20). No effect was reported in 84.0% of levalbuterol and 71.9% of albuterol exposures (RR 1.17, 95% CI 1.03 to 1.32), and 91.7% of levalbuterol and 73.1% of albuterol exposures were managed on site (RR 1.26, 95% CI 1.11 to 1.41). The most common adverse clinical effects were reported more frequently among albuterol exposures. The most frequent treatments of levalbuterol and albuterol exposures were, respectively, dilution 59.5% and 42.0% (RR 1.42, 95% CI 1.22 to 1.64), food 18.9% and 12.8% (RR 1.48, 95% CI 1.12 to 1.94), single-dose activated charcoal 0.3% and 10.1% (RR 0.03, 95% CI 0.00 to 0.15), and cathartic 0.0% and 4.6% (RR 0.00, 95% CI 0.00 to 0.22). Conclusions: Among exposures involving children aged 0–5 years that were reported to Texas poison centers, levalbuterol was more likely to include other substances, have less serious outcomes, and be managed on site when compared to albuterol.
Drug Shortages and the Role of the Pharmacy Technician: A Review
Authors: Mangan Michelle N , Powers Mary F 
Published: September 2013

Objective: To increase pharmacy technicians' awareness of national drug shortages, enabling them to understand why drug shortages occur and how they can help ameliorate the effects that a drug shortage may have in their workplace. Data Sources: Articles were identified through searches of MEDLINE and PubMed (1950 through July, 2011) using the following search terms: drug shortages, drug shortages and legislation, drug shortages and law, and drug shortages and safety. Additionally, resources on drug shortages from the American Society of Health-System Pharmacists, the FDA, and the Institute for Safe Medication Practices were used. Study Selection and Data Extraction: Articles describing drug shortages, drug shortages and legislation, and managing drug shortages in the health care setting were included. Data Synthesis: The effects of drug shortages on pharmacy departments and the health care system as a whole can place significant strain on pharmacists. Pharmacy technicians can play a key role in the initial management of a drug shortage by being responsible for such tasks as validating shortage details and duration with manufacturers, determining the institution's current stock and history of use of a medication, and remaining up-to-date on current drug shortages to help keep patients and other health care professionals informed. Conclusions: Pharmacy technicians are a valuable resource for pharmacists in the management of drug shortages and can work with pharmacists to perform operational and assessment tasks after a drug shortage has been identified.