bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Targeted Review of Smoking Cessation Aids and Their Pharmacology for the Pharmacy Technician
Authors: Rowe Stacy L , Daugherty Kimberly K 
Published: September 2013

Objective: To review the pharmacologic treatment options available for smoking cessation. Data Synthesis: Nicotine replacement therapy (NRT) has a less rapid onset than that of nicotine received from smoking; therefore, it does not cause the same pleasurable response but helps to decrease the cravings. NRT is available over the counter as a gum, lozenge, and patch. NRT is also available by prescription as a nasal spray and inhaler. Information is also provided on the dosing and adverse effect profiles of 2 non-NRT prescription products used for smoking cessation including bupropion SR and varenicline. Conclusions: It is important for pharmacy technicians to be aware of the NRT and non-NRT products available both over the counter and by prescription so that they can better work with the pharmacist to aid patients in the smoking cessation process. Current guidelines do not specify any of the medications as first line. Patients should be educated on all of the options available so that they can decide which option they think will help them succeed.
Asenapine: A Novel Atypical Antipsychotic Agent for Schizophrenia and Bipolar I Disorder
Authors: Timpe Erin M , Chopra Ritika A 
Published: September 2013

Objective: To review the literature regarding asenapine, a recently approved atypical antipsychotic, and to evaluate its safety and efficacy profile. Data Sources: Primary literature was identified by conducting a MEDLINE search (1950–June 2010). English-language articles were searched using the key words asenapine, Saphris, schizophrenia, and bipolar disorder. All data were reviewed for clinical trials evaluating the safety and efficacy of asenapine. Data were also obtained directly from the manufacturer. Study Selection and Data Extraction: English-language articles on studies conducted in humans were reviewed. Data Synthesis: Asenapine is a novel atypical antipsychotic agent available as a treatment option for patients with schizophrenia, as monotherapy for the acute treatment of bipolar I manic or mixed episodes, and as adjunctive therapy with either lithium or valproate for the acute treatment of bipolar I manic or mixed episodes. Compared with other atypical antipsychotic agents, asenapine has a favorable adverse effect profile in terms of weight gain and metabolic disorders. Multiple studies have established its efficacy and safety profile. Asenapine has been shown to be superior to placebo in 4 clinical trials in patients with schizophrenia and in 2 clinical trials in patients with bipolar I disorder. Two studies comparing asenapine with olanzapine found asenapine to be similar in efficacy, 1 found olanzapine to be more effective, and 1 trial found asenapine to be associated with more adverse effects than olanzapine. This new agent is formulated as a sublingual tablet and is administered at either 5 or 10 mg twice daily. Common adverse effects reported include extrapyramidal symptoms, somnolence, sedation, and dizziness. Conclusions: Asenapine offers a viable treatment option for the acute treatment of patients affected by schizophrenia and bipolar I disorder. Future studies are needed to compare asenapine directly against other atypical antipsychotics to determine its appropriate place in therapy.
Tapentadol: A Novel, Centrally Acting Analgesic for Moderate-to-Severe Acute Pain
Authors: Matthews Michele L , Lufkin Richard 
Published: September 2013

Objective: To review the role of tapentadol in the treatment of moderate-to-severe acute pain. Data Sources: Primary literature was retrieved by searching MEDLINE (1950–August Week 3, 2010), EMBASE (1980–Week 34, 2010), International Pharmaceutical Abstracts (1970-August 2010), and Google Scholar, A bibliographic review of published articles was also performed. Search terms included tapentadol, Nucynta, and acute pain. Study Selection and Data Extraction: Randomized controlled trials available in the English language that evaluated the efficacy and/or safety of tapentadol were included in this review. Data Synthesis: Tapentadol is a centrally acting analgesic that simultaneously activates μ-opioid receptors and inhibits the reuptake of norepinephrine in the central nervous system without affecting serotonin reuptake. We identified 6 randomized controlled trials that evaluated the use of tapentadol in over 3,000 adult patients in various acute pain models. Tapentadol was found to be superior to placebo for the management of moderate-to-severe acute pain and was found to be noninferior to oxycodone in the setting of post-bunionectomy pain and acute pain related to end-stage joint disease. Although the incidence of somnolence and dizziness was similar to that of oxycodone, tapentadol was less likely to cause nausea, vomiting, or constipation. Conclusions: Tapentadol is a novel analgesic with dual mechanisms of action that appears to be safe and effective for the management of moderate-to-severe acute pain. Future studies should focus on comparative efficacy as well as the role of tapentadol in chronic pain.
Warfarin and Supplement Interactions: Survey of Published Literature
Authors: Marino Joanna , Motz David , Shields Kelly 
Published: September 2013

Objective: To review published literature related to potential interactions between warfarin and common dietary supplement products. Data Sources: Tertiary databases including Micromedex, LexiComp, and Natural Medicines Comprehensive Database were used to assess drug interactions with warfarin. Searches of literature from database inception through July 2010 were conducted in MEDLINE, International Pharmaceutical Abstracts, and Iowa Drug Information Service and were restricted to the English language. The following search terms were used: warfarin, ginkgo biloba, St. John's wort, garlic, coenzyme Q10, ginger, ginseng, red clover, fish oil, dong quai, cranberry, green tea, saw palmetto, bilberry, soy, chamomile, glucosamine, chondroitin, echinacea, interactions, anticoagulation/antiplatelet, bleeding, herbals, and pharmacokinetics/pharmacodynamics. Study Selection and Data Extraction: Thirty-two English language publications were identified and analyzed. Reference lists of each of the included articles were reviewed to obtain related articles for further analysis. Data Synthesis: Quality of existing data for interactions between warfarin and commonly available dietary supplements varies greatly. The majority of information available is derived from case reports, although for some products pharmacokinetic studies have been performed to assess the effect of supplement use in patients concurrently using warfarin. Some of the data that suggest interactions with warfarin were gleaned from case reports or from an understanding of supplement mechanisms of action that would indicate such an interaction. The strength of evidence for the majority of the herbal products studied seems to be lacking and therefore it is difficult to draw firm conclusions. Conclusions: Based on the narrow therapeutic window of warfarin therapy, practitioners should be encouraged to document any potential drug interaction. However, it seems inappropriate to suggest absolute avoidance of all dietary supplements in all patients using warfarin therapy. Instead, diligent monitoring and reporting should be implemented to detect such events.
Methylphenidate for Chronic Migraine and Cluster-Type Headaches: A Case Report
Authors: Detweiler Mark B , Halling Mary H , Detweiler Jonna G 
Published: September 2013

Objective: To report the successful treatment of a case of chronic, treatment-resistant migraine and cluster headaches that started after an accidental exposure to toxic gas in a patient with recurrent major depression, hypersomnia, and chronic fatigue. Case Summary: A 50-year-old female presented with a 32-year history of recurrent major depression, hypersomnia, and chronic fatigue in addition to migraine and cluster headaches that started after accidental exposure to toxic gas during an army training exercise. The frequent and severe headaches led to discharge from the army and to the patient's being fired from multiple jobs due to repeated absences. She became depressed, with hypersomnia and chronic fatigue, spending most of the day in bed for about 2 decades. This also interfered with her partner relationship. She had received tricyclic antidepressants (TCAs), anticonvulsants, triptans, migraine agents, nonsteroidal antiinflammatory drugs, and biofeedback for the headaches, all without lasting benefit. Medications for depression had included TCAs, serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors without resolution of chronic depression. Treatment for depression and fatigue began with titration of citalopram to 60 mg daily, followed by titration of bupropion SA to 300 mg in the morning and 150 mg in the afternoon. Her mood improved; however, the hypersomnia and fatigue remained along with the chronic migraine and cluster headaches. Methylphenidate immediate release was added to reduce the hypersomnia and fatigue, and her headaches markedly decreased. The patient apparently stopped taking the prescribed methylphenidate due to medication name confusion with medroxyprogesterone, and the migraine and cluster headaches returned to their prior level of severity. Methylphenidate was retitrated to 15 mg twice/day with resolution of the chronic migraine and cluster headaches, hypersomnia, and fatigue. Discussion: The literature on the use of methylphenidate, a methyl α-phenyl-2-piperidineacetate hydrochloride, for headache treatment and prophylaxis consists of 1 other case report. Methylphenidate stimulates the central nervous system, increasing norepinephrine and dopamine levels by impeding uptake and increasing release. By augmenting dopamine and norepinephrine levels in the medial prefrontal cortex and hypothalamus, methylphenidate may modulate depression and somnolence. Methylphenidate may also alter brain stem serotoninergic action, resulting in methylphenidate-mediated analgesia, perhaps modulating headache symptoms. Conclusions: Methylphenidate may have an application as a third- or fourth-tier medication for headache treatment and prophylactic action in selected treatment-resistant cases. Response appears to be dose-related.
Ohio Physicians' Intent to Adopt Electronic Prescribing
Authors: Pinto Sharrel L , Weber Nick S 
Published: September 2013

Background: Currently in health care, communication between prescribers and pharmacists routinely entails paper and a telephone. Many professional associations have strongly advocated the adoption of electronic prescribing (e-prescribing) in physicians' clinical practices to decrease medication errors and adverse drug events. However, very few physicians have adopted this technology in the US. Objective: To determine the relationship between Ohio physicians' demographics and their intention to adopt e-prescribing; assess the relationships between attitudes, subjective norms, and perceived behavioral control as applied to physicians' intention to adopt e-prescribing; and identify factors that can predict physicians' intention toward the adoption of e-prescribing. Methods: In this exploratory cross-sectional study, we used a self-administered survey. The survey was developed based on the constructs of the Theory of Planned Behavior. It was mailed to 1500 physicians currently practicing in Ohio. Demographic information about the respondents was collected. Pearson correlation was used to assess the relationship between demographics and intention to adopt e-prescribing. Multiple regression analysis was used to identify the factors predicting intention. Results: The overall survey response rate was 15.33% (N = 230). A significant weak negative correlation was found between physicians' ages (r = −0.180; p = 0.007) and their intent to adopt electronic prescribing. A statistically significant negative correlation was also found between practice type (r = −0.196; p = 0.003) and the intention to adopt electronic prescribing. Attitude was the strongest predictor of intention to adopt e-prescribing (β = 0.539; p = 0.000). Conclusions: Physicians with more positive attitudes, positive subjective norms, and positive perceived behavioral control have a stronger intention to adopt e-prescribing.
Pharmacologic Options for the Management and Prevention of Migraines
Authors: Freeland Kathryn N , Vandenberg Amy 
Published: September 2013

Objective: To review available pharmacologic options for the management and prevention of migraine headaches. Data Sources: A PubMed literature search (1985–December 2010) was conducted using the following MeSH search terms: migraine, aura, headache, triptans, ergot derivatives, NSAIDs, opioids, analgesics, antiepileptics, antidepressants, β-blockers, calcium channel blockers, and prophylaxis. Tertiary references and prescribing information for included medications were used for dosing recommendations. Study Selection and Data Extraction: English-language reviews, tertiary references, guidelines, and clinical trials of newly released medications were reviewed for inclusion. Articles using pharmacotherapy in human models were reviewed. Data Synthesis: Migraine headaches are a costly and painful problem that affects 12% of the US population. Current treatment options may be divided into either acute treatments or preventive therapy. Nonpharmacologic therapy, such as the identification of triggers and maintenance of a headache diary, is an important addition to either medication regimen. Patients experiencing mild-to-moderate migraine pain may be able to manage the pain using nonsteroidal antiinflammatory drugs or analgesics. More severe migraine pain may require the use of different medications, such as opioid pain relievers or a triptan. Patients who report frequent migraines or migraines that significantly affect their activities of daily life may become candidates for migraine prophylaxis. Agents for migraine prophylaxis include antiepileptics, β-adrenergic antagonists, antidepressants, and calcium channel blockers. Conclusions: There are several options available for both the management and prevention of migraine headaches. Choice of pharmacotherapy depends on the intensity and frequency of a patient's migraines. In addition, patients should be encouraged to avoid triggers and to keep a log of migraine symptoms in order to best manage their migraines.
Developing a Weight Management Program in a Community Setting
Authors: Mistry Amee D , Lee Karen W , Machado Matthew R 
Published: September 2013

Background: Managing body weight is important for a patient's overall well-being. Developing a weight management program for patients is a basis for providing structure and assistance to patients who may not understand what is necessary to achieve a healthy body weight. Objective: To describe implementation of a pharmacist-run weight management program in a community pharmacy. Methods: From July to December 2007, we created a weight management program which was implemented in January 2008 in a community pharmacy setting by utilizing nutritional information readily available online, purchasing commercially available weight management machines, and offering counseling sessions. Results: Preliminary results show that patients have been able to decrease their weight with the assistance of this pharmacist-run program. Conclusions: A community pharmacy-based weight management program can assist patients in decreasing their total body weight and give pharmacists an opportunity to be involved in managing obesity.
Antidepressant Pharmacology: Introduction for the Pharmacy Technician
Authors: Cates Marshall E , Wensel Terri M , Waldrop Bruce A , Iranikhah Maryam M 
Published: September 2013

Objective: To review the pharmacology of antidepressants and describe clinical applications of antidepressants in the treatment of depression. Data Sources: A MEDLINE/PubMed search (1995–July 2011) was conducted for English-language articles using the terms pharmacology, antidepressant, tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, venlafaxine, desvenlafaxine, duloxetine, bupropion, trazodone, nefazodone, mirtazapine, vilazodone, efficacy, adverse effects, and drug interactions. Book chapters related to the pharmacology of antidepressants were also searched. Study Selection and Data Extraction: Articles and book chapters relevant to the pharmacology of antidepressants were reviewed. Data Synthesis: Antidepressants exert pharmacologic actions via enzyme inhibition, reuptake inhibition, receptor antagonism, and receptor partial agonism. These actions can cause both therapeutic and adverse effects. Each antidepressant possesses a unique blend of pharmacologic actions, which helps to differentiate antidepressants and aids in the understanding of their particular efficacy profiles, adverse effect profiles, and pharmacodynamic drug interaction profiles. Conclusions: There are important clinical applications of the pharmacologic properties of antidepressants. Gaining familiarity with antidepressant pharmacology will enable the pharmacy technician to develop a more thorough understanding of the drug class.
Profound Neurotoxicity and Treatment Response following One Cycle of Bortezomib Therapy in an Elderly Male with Multiple Myeloma
Authors: Eaton Ellen , Wachter Adam , Tesson Alan , Cooper April A 
Published: September 2013

Objective: To report a case of peripheral and autonomic neuropathy following one cycle of bortezomib in a patient with newly diagnosed multiple myeloma. Case Summary: A 75-year-old male who was highly functional prior to therapy rapidly became bed-bound from hypotension, syncope, and peripheral neuropathy after initiating bortezomib. Orthostatic hypotension and syncope persisted despite exclusion of infection and endocrine derangements and his receiving adequate intravenous hydration. Five weeks after this single cycle, the patient had a complete treatment response, including undetectable M-spike, improved anemia, and return to baseline renal function. An objective causality assessment revealed that an adverse drug event was probable. Discussion: Although neurotoxicity is an adverse effect of bortezomib, a MEDLINE search revealed little evidence on autonomic neuropathy, such as orthostatic hypotension and syncope. Also unique is the patient's complete treatment response following this single cycle. One explanation for the toxicities and dramatic treatment response is increased bortezomib exposure due to decreased drug metabolism. Both drug interactions and genetic polymorphisms can reduce bortezomib metabolism via effects on cytochrome P450 enzymes. Our patient was concomitantly taking 4 CYP inhibitors; amiodarone and omeprazole were longstanding, and ciprofloxacin and fluconazole were recently initiated prior to chemotherapy. Of these, fluconazole inhibits CYP2C9, 2C19, and 3A4; amiodarone inhibits CYP3A4, 1A1, 1A2, 2B6, and 2D6; ciprofloxacin inhibits CYP1A2 and 3A4; and omeprazole inhibits CYP1A2, 2C19, 2C9, 2D6, and 3A4. Similarly, genetic variables affect CYP enzymes. Genetic testing can predict response to bortezomib therapy, but pretherapy testing is not standard practice due to availability and cost, as in our patient's case. Conclusions: CYP-inhibiting drugs and many genetic polymorphisms can reduce bortezomib metabolism and increase serum concentrations of the drug, but guidelines on drug-drug interactions, monitoring, and genetic testing prior to bortezomib toxicity are needed.
Metformin-Associated Exacerbation of Chronic Pancreatitis: A Possible Adverse Drug-Disease Interaction
Authors: Wadsworth Thomas G , Kiester Jo , Thompson E Gregory 
Published: September 2013

Objective: To report a case of metformin-associated exacerbation of chronic pancreatitis and examine this possible drug-disease interaction. Case Summary: A 59-year-old woman with chronic pancreatitis (CP) experienced a severe exacerbation of her characteristic chronic abdominal pain 3 weeks after initiation and titration of metformin therapy; the exacerbation resolved upon discontinuation of metformin. The patient presented to the emergency department experiencing nausea and severe right upper quadrant abdominal pain with radiation to the right flank. Persistent abdominal pain, which had been a primary feature of CP, was previously mild and easily controlled with oral analgesics. Laboratory studies ruled out acute pancreatitis and were significant only for elevated glucose (168 mg/dL). Subsequently, she was given intravenous pain and nausea medications and discharged to home. The pain and nausea shortly returned and continued for 3 more days, at which point she telephoned her gastroenterologist, who advised that she discontinue metformin because of possible adverse reaction. Within a few days of discontinuing metformin, the nausea resolved and abdominal pain gradually returned to baseline level. Discussion: Metformin is not generally known to cause or exacerbate pancreatitis, although cases of acute pancreatitis associated with metformin therapy have been reported in the literature. No cases involving chronic pancreatitis have been reported. Consequently, metformin's prescribing guidelines do not contain precautions or contraindications for patients with chronic pancreatitis. Use of the Naranjo probability scale for assessment of this case revealed that the adverse drug effect was possible, reflecting the symptomatic resolution upon discontinuation while accounting for the lack of causative certainty, previous conclusive case reports, as well as the presence of possible nondrug causes. Conclusions: To our knowledge, this is the first case describing metformin-associated exacerbation of chronic pancreatitis. Although this occurrence may be rare, cautionary consideration, education, and monitoring should accompany initiation of metformin therapy in select patients with chronic pancreatitis.
Dofetilide Overdose—A Case of Unintentional Ingestion Due to Misinterpretation of the Dose
Authors: Iyer Praneet S , Neufeld Robert J , Giambra Theresa , Norgard Nicholas B 
Published: September 2013

Objective: To report a case of unintentional overdose of dofetilide due to patient misinterpretation of the prescribed dose. Case Summary: A 50-year-old white male unintentionally ingested dofetilide 5000 μg instead of the prescribed dose of 500 μg because of a simple mathematical calculation error. The patient was given activated charcoal in the emergency department and also received 1 dose of magnesium sulfate 2 g and 1 dose of potassium chloride 80 mEq by mouth. He was admitted to the intensive care unit for cardiac monitoring for 1 day and was discharged when his QT/QTc interval was stable. Discussion: During recent years, studies have focused on errors that occur while medications are in the control of health care professionals. As health care delivery shifts from inpatient to outpatient settings, the burden of proper medication use also shifts from providers to patients. Low health literacy and lack of understanding of instructions have been cited as important root causes of medication errors in the outpatient setting. Effective communication with patients who have limited health literacy offers the potential to improve their understanding about their medical problems and treatments. Dofetilide, a class III antiarrhythmic agent, is highly regulated due to safety concerns. The drug is efficacious in the maintenance of normal sinus rhythm in patients with atrial fibrillation. Cardiac toxicity is of utmost concern when treating dofetilide overdose. The mainstay of treatment focuses on supportive care and prevention of drug absorption. Conclusions: Medication errors will not cease to occur unless patients understand their dosing instructions and health care responsibilities. This case highlights the need for the monitoring of patient understanding, especially when drugs with high safety risk are being used.