bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe Hypoglycemia from Patient Misuse of Insulin Glargine Pen
Authors: Pham Antony Q , Borno Lana T , Pham Diane A 
Published: September 2013

Objective: To report a case of severe hypoglycemia resulting from a patient's misuse of an insulin glargine pen. Case Summary: A 61-year-old male with a history of diabetes mellitus type 2 (T2DM), obesity, hypertension, end-stage renal disease, and systolic heart failure was admitted to the emergency department (ED) for severe hypoglycemia. The patient's treatment was recently switched from insulin glargine to an insulin glargine pen and had mistakenly injected the entire insulin pen. He was found lethargic and unresponsive at home and was brought into the ED with an initial blood glucose level of 11 mg/dL. He was given 6 ampules of dextrose 50% in the ED, started on a dextrose 10% infusion and was subsequently transferred to the medical intensive care unit (MICU). Throughout his stay in the MICU, the patient received a dextrose 20% infusion and a total of 11 ampules of dextrose 50% to keep his blood glucose level above 100 mg/dL. After a 6-day hospital course, the patient was stabilized and was discharged on sitagliptin. Discussion: The concern for hypoglycemia is present for any patient receiving insulin therapy. A MEDLINE search revealed the rates of hypoglycemia from insulin glargine but we found no previously described cases of severe hypoglycemia due to patient misuse of an insulin glargine pen. Our patient mistakenly injected the entire contents of the pen and became unresponsive and severely hypoglycemic. The long duration properties of insulin glargine likely prolonged the patient's hospital course. According to the Naranjo scale, the adverse reaction experienced by our patient was highly probable. Conclusions: Medication changes can be confusing for patients, and pharmacists have a unique opportunity to counsel and educate patients on the proper use of their medications, thus helping to prevent adverse events such as hypoglycemia from improper use of an insulin glargine pen.
Health Perception Changes of State Employees following a Health Screening Event
Authors: Pervanas Helen C , Silva Matthew A , Willett Kristine C , Cooper Maryann R , Durand Cheryl , Belliveau Paul , Abel Cheryl 
Published: September 2013

Background: Health screenings can identify patients at risk for chronic medical conditions. Additionally, screenings may influence behavior changes as depicted by the Health Belief Model. Objective: To examine the perceptions of state employees regarding their health and risk for medical conditions, assess whether unexpected or abnormal screening results will impact perceptions, and identify barriers to scheduling an annual physical examination. Methods: State employees participated in screenings for diabetes, dyslipidemia, and osteoporosis. Participants were asked to complete a pre- and post-survey. Pre-survey questions gathered information on demographics, chronic medical conditions, perception of overall health, and willingness to have an annual physical examination. The post-survey assessed self-health perceptions based on screening results, their risk for chronic medical conditions, and the likelihood that the screening results would encourage scheduling a provider appointment. Results: One hundred twenty-six of 128 (98.4%) employees completed the survey. Thirty-five percent of employees had cholesterol levels >200 mg/dL and 23% had T-scores less than or equal to −1.0. When asked about preexisting medical conditions, 40% of those with elevated cholesterol levels reported that they had high cholesterol, and 5% with low T-scores stated that they had osteoporosis. Following the screenings 54% and 55% responded that they were at risk for high cholesterol (p = 0.02) and osteoporosis (p < 0.001), respectively. Participants who reported having had no annual physical examination but who planned to schedule a visit as a result of their screening had a higher total cholesterol level than those who reported annual physical examinations prior to the screening (207 ± 42.6 mg/dL vs 189 ± 33.2 mg/dL; p = 0.03). Conclusions: Health screenings increased awareness of dyslipidemia and osteoporosis among state employees. Higher than normal cholesterol results influenced health perceptions and encouraged respondents to schedule a provider visit.
Comparing Medication Adherence Methods in Lipid-Modifying Therapy
Authors: Lafleur Joanne , McAdam-Marx Carrie , White George L , Lyon Joseph L , Oderda Gary M 
Published: September 2013

Background: Investigators have employed a number of different methods to calculate adherence estimates for patients taking lipid-modifying therapy (LMT), including measures with different numerator and denominator options. Although at least one method is known to correlate well with cardiovascular outcomes, most have not been evaluated in outcomes studies. Objectives: To evaluate different methods for measuring adherence, using LMT as a case example, and to determine whether estimates for adherence differ statistically and/or whether different methods can lead to different conclusions about patient adherence. Methods: Adherence ratios were calculated using 8 different methods for 12,448 patients who were in a managed-care system and were considered new starts with statin therapy. The calculated measures were compared and tested for differences. Patients were categorized as adherent by each method, using a threshold of 0.8, and the proportions of patients categorized as adherent were compared for differences between adherence calculation methods. Results: Adherence ratios calculated with like observation intervals did not vary substantially, regardless of which method for measuring medication availability was used. Those calculated with different observation intervals had substantial variability. Mean adherence ratios ranged between 0.777 and 0.798 for difference in days' observation intervals; they ranged between 0.618 and 0.630 for the predefined interval. Differences between ratios calculated using these different denominators were statistically significant (p < 0.008). Correlations between ratios were statistically significant for all comparisons (p < 0.001). Correlation coefficients ( r) were 0.64 for comparisons between ratios with different denominators versus 1.0 for comparisons with like denominators. Categorization as adherent or nonadherent differed between the methods for about 20% of patients. Conclusions: Significant differences were found to be based on observation period but not on medication availability. Studies of adherence should be interpreted with caution depending on which method is used, and particular interest should be paid to whether the choice of methods is consistent with study objectives and to the observation interval, as different methods may lead to different conclusions about patient adherence. Further research in LMT and other therapeutic areas is needed to determine which methods correlate best with positive patient outcomes, such as reductions in low-density lipoprotein cholesterol and cardiovascular events.
Identifying Physical Assessment Skills and Their Relative Importance in Faculty-Based Pharmacy Practice Settings within the Same Region
Authors: Mistry Amee D , Machado Matthew R 
Published: September 2013

Background: As pharmacy educators, it is the responsibility of the faculty to prepare student pharmacists, through education, for the variety of opportunities that will be available to them after graduation. This education can be provided by incorporating standards set forth by the Accreditation Council on Pharmacy Education (ACPE), as well as by working with fellow educators at other schools of pharmacy within the region or across the country. This article summarizes data collected regarding physical assessment skills from pharmacy practice faculty within the Northeast region. Objective: To identify how often physical assessment skills are applied and their importance to pharmacy practice faculty practicing in various pharmacy settings, to use the data collected from pharmacy practice faculty to standardize which physical assessment skills should be used for training student pharmacists, and to use the collected data to assist in the development of guidelines that highlight core competencies in physical assessment that are in accordance with ACPE Accreditation Standards and Guidelines and that student pharmacists should be able to perform upon graduation. Methods: A physical assessment survey was mailed to pharmacy practice faculty at schools of pharmacy in the Northeast region. The survey asked faculty members to rate 2 parameters for each skill: how often a skill is used at their own practice site, and the importance of that skill to teach student pharmacists to use in the future. Results: A total of 238 surveys were mailed to pharmacy practice faculty in the Northeast region; 81 surveys were returned to the primary investigator. The data collected indicated a wide spread of opinions among faculty members regarding physical assessment. Conclusions: Although physical assessment skill is a required competency set forth by the ACPE Accreditation Standards and Guidelines, there is a wide variety of skills that pharmacy practice faculty feel are important to teach student pharmacists.
Cognitive Impairment and Medication Complexity in Community-Living Older Adults: The Health, Aging and Body Composition Study
Authors: Lee David Sh , De Rekeneire Nathalie , Hanlon Joseph T , Gill Thomas M , Bauer Douglas C , Meibohm Bernd , Harris Tamara B , Jeffery Sean M 
Published: September 2013

Background: Medication complexity is a large determinant of adherence. Few studies have explored the relationship between cognitive impairment and medication complexity. Objective: To evaluate whether cognitive impairment is associated with medication complexity for prescription and over-the-counter (OTC) medications. Methods: In this cross-sectional analysis, we studied the association between cognitive impairment and the complexity of prescription and OTC drug regimens. Baseline participants were from the Health, Aging and Body Composition study, consisting of 3075 well-functioning 70- to 79-year-old black and white men and women. Cognitive impairment was defined by having a Modified Mini-Mental State Examination score <80. The complexity of prescription and OTC (including supplements/herbals) medications was assessed using a modified version of the Medication Regimen Complexity Index (mMRCI). The mMRCI score increases with complexity of dosage forms, number of medications, pill burden, and nondaily dosing. Results: The mean (SD) age was 74 (2.9) years (n = 3055; 52% female, 41% black). The median prescription mMRCI score was 6 (range 0–66). The median OTC mMRCI score was 4 (range 0–71). Adjusting for health status, demographics, and access to care, medication complexity was lower in participants with cognitive impairment for prescription (adjusted RR 0.89; 95% CI 0.80 to 0.99) and OTC medications (adjusted RR 0.76; 95% CI 0.64 to 0.93) compared to those without cognitive impairment. The number of prescription medications was not different, but the number of OTC drugs was lower for those with cognitive impairment. Conclusions: In this cohort of well-functioning older adults, those with cognitive impairment had lower prescription complexity due to less-complex dosage forms, pill burden, or daily dosing. OTC complexity was also lower, primarily due to a lower number of OTC drugs. The results of this study show that further research on medication complexity and adherence and health outcomes in cognitively impaired individuals is warranted.
Increased Warfarin Requirements during Concurrent Dicloxacillin Therapy
Authors: Kohman Kelsey N , Dunn Rebecca L , Smith Winter J 
Published: September 2013

Objective: To report on a patient who required increased dosages of warfarin to achieve therapeutic anticoagulation while taking dicloxacillin. Case Summary: A 60-year-old woman was hospitalized for an infected lymphocele and cellulitis. Based on microbiology results, dicloxacillin 500 mg by mouth 4 times daily was initiated to complete 14 days of treatment. Concurrently, a deep vein thrombosis was diagnosed by computed tomography angiography. Enoxaparin 100 mg subcutaneously twice daily and warfarin 5 mg by mouth daily were initiated with an international normalized ratio (INR) goal of 2–3. The patient had a history of a supratherapeutic INR while on warfarin 5 mg daily. Throughout the 20-day hospitalization, her warfarin dose was steadily increased in an attempt to achieve a therapeutic INR. Required doses ranged from 7.5 to 15 mg daily. Two days after discontinuation of dicloxacillin and with administration of a 15-mg warfarin boost, the INR was therapeutic at 2.3. Enoxaparin was discontinued and the patient was discharged on warfarin 7.5 mg daily. Upon clinic follow-up 5 days after discharge, the INR was supratherapeutic at 3.3 and the warfarin dose was decreased. The patient was then lost to follow-up. Discussion: This interaction between warfarin and dicloxacillin has been described in the literature; however, the mechanism responsible remains unknown. In all cases reported, increased warfarin requirements appeared after several days of dicloxacillin therapy and slowly disappeared after dicloxacillin discontinuation. This case differs from previously reported cases because it demonstrates warfarin resistance associated with dicloxacillin and a subsequent new initiation of warfarin therapy. The Naranjo probability scale and the Horn Drug Interaction Probability Scale both rate this interaction as probable. Conclusions: Patients taking dicloxacillin who are initiated on warfarin may require a longer duration of concurrent low-molecular-weight heparin therapy, as well as higher doses of warfarin, and may take longer to achieve a therapeutic INR.
Docetaxel-Associated Paroxysmal Atrial Fibrillation in a Patient Receiving Docetaxel Plus Cyclophosphamide (TC) Therapy
Authors: Myers Leslie J , Ho Yuan Yuan G 
Published: September 2013

Objective: To report a case of paroxysmal atrial fibrillation in a patient who was receiving a chemotherapy regimen including docetaxel plus cyclophosphamide (TC). Case Report: A 67-year-old woman was receiving TC therapy for stage IIB breast cancer. She developed symptomatic paroxysmal atrial fibrillation following chemotherapy administration. The patient presented with tachycardia-palpitations, a shaking sensation inside her body, shortness of breath, and tightness in her chest that did not radiate. Propafenone treatment was replaced with sotalol. Cycle 2 of chemotherapy was administered and symptoms of atrial fibrillation returned. Sotalol was switched to dronedarone monotherapy and the symptoms resolved. Discussion: Based on the Naranjo probability scale, chemotherapy was the probable cause of the patient's episodes of paroxysmal atrial fibrillation. Conclusions: As single agents, taxanes have minimal cardiac toxicity, although cardiac toxicity may be higher with precipitating factors. Clinicians caring for patients receiving taxane chemotherapy should be aware of the potential for docetaxel-induced paroxysmal atrial fibrillation.
Risk of Spontaneous Bruising with Concomitant Use of Nonsteroidal Antiinflammatory Drugs and Citalopram
Authors: Desilets Alicia , Willett Kristine C , Waller Dustin , Barry Ann 
Published: September 2013

Objective: To report a case of spontaneous bruising with concomitant use of nonsteroidal antiinflammatory drugs (NSAIDs) and citalopram. Case Summary: A 34-year-old white woman with a history of chronic thrombocytopenia (baseline platelet count 120–130 × 103/μL) presented to the emergency department (ED) after noticing an increase in bruising on her upper and lower extremities. When the patient was interviewed, it was found that her dose of citalopram had been recently increased from 20 to 40 mg/day and she had started ibuprofen (dose unknown) on her own to manage rib pain approximately 1 month after the citalopram dosage increase. The patient was advised to discontinue ibuprofen and was discharged. Shortly thereafter, she was started on oxaprozin 600 mg twice daily for management of trochanteric bursitis. She returned to the ED stating that bruising occurred 1 week after she was given oxaprozin. At this visit, the patient was told to discontinue oxaprozin and naproxen 440 mg twice daily was prescribed. One week later, the patient again returned to the ED with complaints of spontaneous bruising. At this point citalopram and naproxen were discontinued and she was started on acetaminophen (dose not documented) and buspirone 10 mg twice daily. No other episodes of ecchymosis have occurred in the 8 months since this change to her drug regimen. Discussion: Medications that increase the risk of bleeding should be carefully administered in patients who have a low platelet count. This patient experienced bruising when her dose of citalopram was increased and an increase in bruising when she combined an NSAID with citalopram. Selective serotonin reuptake inhibitors (SSRIs) may increase antiplatelet activity of NSAIDs and could therefore increase the risk of bruising. Use of the Horn Drug Interaction Probability Scale indicated a possible interaction with concomitant use of NSAIDs and citalopram. Conclusions: Patients who experience NSAID- and/or SSRI-related bruising should consult their providers and alternative treatments should be considered.
Urban and Suburban Community Pharmacists' Experiences with Part D—A Focus Group Study
Authors: Khan Shamima 
Published: September 2013

Background: With the enactment of Medicare Part D, the provision of drug coverage for senior citizens in the US has changed permanently. Not much is currently known about the impact of Part D on urban and suburban pharmacies. Objective: To explore community pharmacists' experiences with Medicare Part D in urban and suburban areas of New York City and adjacent Long Island. Methods: Seven focus groups were held between January 2010 and December 2010, 6 of which were held on St. John's University campus. A convenience sample of pharmacists practicing in chain and independent settings participated in the study. Participation was voluntary and anonymous. Results: Thirty pharmacists participated in the study. They reported that patients are facing challenges in reference to Part D, even 4 years after implementation of the program. Patients are often limited by their lack of computer skills, language skills, or level of education. Pharmacists also reported facing financial challenges because of “slow and low” reimbursement. Pharmacists were also dispensing more prescriptions, dealing with multiple plans, a variety of formularies, different copayments, and various prior authorization procedures. Conclusions: With regard to Medicare Part D, the challenges faced by pharmacists practicing in some of the urban and suburban areas of New York State are somewhat comparable to those faced by pharmacists practicing in rural areas. Although the financial impact has been more detrimental to independently owned pharmacies, pharmacists practicing in chain settings expressed concerns.
Tigecycline-Induced Acute Pancreatitis with Rechallenge: A Case Report
Authors: De Mesa Charles , Dajoyag-Mejia Maria A , Issac Regina , Darouiche Rabih O 
Published: September 2013

Objective: To report a case of tigecycline-induced acute pancreatitis. Case Summary: A 50-year-old African American man with spinal cord injury was hospitalized on 2 occasions for recurrence of an infected pressure ulcer requiring systemic antibiotic therapy. Bone and tissue cultures from his initial hospitalization grew multidrug resistant (MDR) Acinetobacter baumanii sensitive to tigecycline. He was treated with intravenous tigecycline on these 2 occasions (50-mg infusions every 12 hours), each of which resulted in significant elevation in serum amylase (to 615 U/L and 715 U/L) and lipase (to 325 U/L and 616 U/L) levels. On each occasion, the pancreatic enzymes became normal after discontinuing tigecycline. Discussion: Tigecycline is the first FDA-approved drug in the class of antibiotics called glycylcyclines, which are developed from tetracyclines to afford broad coverage against certain resistant gram-positive and gramnegative bacteria. It is recommended for patients at least 18 years of age for treatment of complicated intraabdominal infections, community-acquired bacterial pneumonia and complicated skin and skin structure infections caused by susceptible organisms. Tigecycline-induced pancreatitis is a rare adverse event. Review of the literature yielded only 6 prior documented cases (5 adult and 1 pediatric cases). Although the pediatric case demonstrated rechallenge, the patient concurrently received other antibiotics that are known to cause pancreatitis. Conclusions: This is the first report, to our knowledge, of pancreatitis associated with monotherapy with tigecycline, and this relationship was confirmed upon rechallenging our patient with tigecycline. An objective causality assessment revealed that the adverse-drug-associated event was definite.
Dextromethorphan Abuse: A Literature Review
Authors: Gershman Jennifer A , Fass Andrea D 
Published: September 2013

Objective: To review dextromethorphan abuse patterns from 2002–2012 and emphasize the pharmacist's role in prevention, education, and sales surveillance. Data Sources: A literature search was conducted through PubMed (2002-November 2012), EMBASE (2002-November 2012), and International Pharmaceutical Abstracts (2002-November 2012), using the search term dextromethorphan abuse. The Drug Enforcement Administration and National Association of Boards of Pharmacy websites were searched for dextromethorphan abuse and legislative updates. The search was limited to a 10-year period to identify the most current case reports and studies. Study Selection and Data Extraction: The limits used were studies/case reports evaluating humans and published in the English language. Only studies and case reports that assessed dextromethorphan abuse were included in the review. Eight studies and 9 case reports met the inclusion criteria. Data Synthesis: Case reports and studies demonstrate that there are patterns associated with dextromethor phan abuse. A study using data reported to the National Poison Data System identified Coricidin as the most (65.5%) commonly abused dextromethorphan product until 2006; its abuse has decreased since that time (p < 0.0001). The most common abuse effects and toxicities cited in studies and case reports include agitation, confusion, central nervous system depression, tachycardia, hypertension, lethargy, psychosis, hallucinations, mydriasis, dizziness, and cardiotoxicity. One study identified that 96% of samples tested positive for other substances in addition to dextromethorphan. Coingestion of other substances is also common among dextromethorphan abusers. Conclusions: Case reports and studies demonstrate that there are patterns associated with dextromethorphan abuse. It is difficult to identify dextromethorphan as the causative agent of abuse effects because of coingestion of other substances. Studies should examine the pharmacist's role and the association between dextromethorphan sales restrictions and abuse patterns.