bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistence with Medications in Glaucoma Management, Hypertension, and Dyslipidemia
Authors: Velentgas Priscilla , Sheffield Reinee , Nordstrom Beth L , Johnson Eric , Do Thy , Mentor Sherry M , Seeger John D 
Published: September 2013

Objective: To summarize pharmacy database studies of persistence with ocular hypotensives and review the literature of adherence with 2 additional classes of medication—antihypertensives and antihyperlipidemics—comparing methods used to analyze adherence in the 3 treatment areas. Data Sources: A search of MEDLINE (1990–2004) was conducted, using search terms designed to identify English-language articles describing adherence or persistence with any of the 3 drug classes of interest. Study Selection and Data Extraction: All articles identified through MEDLINE were reviewed and screened for use of an automated pharmacy database as an information source, quantitative results provided, and follow-up duration of at least 90 days. Details of methods used to estimate adherence or persistence and estimates of persistence with ocular hypotensive therapy, antihypertensives, and lipid-lowering agents were extracted. Data Synthesis: All studies describing the use of ocular hypotensives, and the majority of studies in the other treatment areas, identified inception cohorts of drug initiators. Use of survival analysis techniques to analyze adherence to medication therapy was less common in the hypertension and hyperlipidemia treatment adherence literature than in literature about glaucoma. In the treatment of hypertension, use of angiotensin II receptor antagonists or angiotensin-converting enzyme inhibitors was associated with higher levels of adherence. Statins in treatment of hyperlipidemia and topical prostaglandins as ocular hypotensive medications were also associated with higher levels of adherence. Conclusions: Findings regarding the relative superiority of specific drug classes were consistent within each therapeutic area, with less consistency in identifying other predictors of adherence. Increased use of survival analysis in future studies of persistence might improve comparability of results across studies.
Oral Bioavailability of Candesartan Cilexetil Suspension
Authors: Teng Renli , Hansson Anna-Carin , Börjesson Inger 
Published: September 2013

Background: Candesartan cilexetil is a prodrug that is converted to candesartan during absorption from the gastrointestinal tract. Candesartan is a potent, orally active, specific angiotensin II type 1 receptor antagonist that has become a well-accepted treatment for hypertension. Pediatric patients often require alternative dosage forms, as candesartan cilexetil is not yet commercially available as a liquid formulation. Objective: To determine the relative bioavailability of candesartan by comparing a candesartan cilexetil tablet (reference formulation) with an oral candesartan cilexetil suspension (test formulation). Methods: In an open-label, randomized, 2 period, 2 treatment crossover study, 24 healthy volunteers were given a 32 mg candesartan cilexetil tablet and a 32 mg candesartan cilexetil suspension with a 7 day washout period between treatments. Results: Pharmacokinetic analyses showed that the mean relative bioavailability of the candesartan cilexetil commercial 32 mg tablet compared with the suspension of 32 mg candesartan cilexetil was 93%. The 90% CIs of the plasma AUC for the tablet versus suspension (0.861 and 0.998, respectively) were well within the bioequivalence criteria of 80–125%. Administration of candesartan cilexetil suspension was associated with a 17% increase in the maximum plasma concentration (Cmax) relative to the tablet administration (643 vs 523 nM/L, respectively). The 90% CIs on the ratio of mean Cmax for the tablet and suspension were 0.738 and 0.914, respectively. Mean time to peak plasma concentrations (tmax) after suspension administration was 3.1 hours, whereas the tablet resulted in a mean tmax of 3.9 hours. No significant differences in elimination half-life were observed between the 2 formulations. Both formulations were well tolerated, and no serious adverse events were reported. Conclusions: These results demonstrate that administration of candesartan cilexetil suspension achieves an extent of absorption and tolerability that is comparable with those of orally administered candesartan cilexetil tablets.
Role of Proton Pump Inhibitors in Calcium Absorption, Bone Resorption, and Risk of Hip Fracture
Authors: Tahir Rabia , Patel Priti N 
Published: September 2013

Objective: To review the influence of proton pump inhibitors (PPIs) on calcium absorption, bone remodeling, and fracture risk. Data Sources: A search via MEDLINE (1966–April 2007) was performed using the search terms proton pump inhibitors, omeprazole, calcium absorption, calcium malabsorption, bone resorption, and fracture risk. Study Selection and Data Extraction: English-language literature, including abstracts, preclinical and clinical trials, and review articles, were identified from the data sources and reviewed. Data Synthesis: Data on the effect of PPIs on calcium absorption are conflicting; however, the majority of data indicate that PPIs decrease intestinal calcium absorption, which could negatively affect bone strength. In particular, calcium carbonate may be more difficult to absorb in an environment with elevated pH due to PPI use. Data on the role of PPIs in osteoclast function are also conflicting, with one human study indicating decreased bone resorption due to inhibition of osteoclast function and another human study indicating no association between PPIs and osteoclast function. The risk of fracture with PPI use was evaluated in 2 studies, and both studies found an increased risk of fracture of 14–44% after PPI use. Conclusions: PPI use may increase a patient's risk of fracture. Additional studies are needed before causality can be established.
Barriers to Community Pharmacists' Provision of Diabetes Care Services in Iowa
Authors: Plake Kimberly S , Chesnut Renae J , Odorzynski Melissa 
Published: September 2013

Background: Pharmacists are in a unique position to provide valuable patient care services to patients with diabetes. Even though many pharmacists have developed their diabetes care knowledge base and obtained credentials, they do not provide diabetes care on a regular basis, suggesting the existence of barriers to care other than knowledge and skills. Objective: To determine the barriers limiting the provision of diabetes care services in community pharmacy settings. Methods: Community pharmacists (N = 1,337) in Iowa were surveyed regarding (1) the types of diabetes care services provided, (2) reimbursement for services provided, (3) educational needs, (4) perceived barriers to providing diabetes services, and (5) demographics. A 46 item questionnaire was developed and mailed to participants with an addressed, stamped envelope. Nonrespondents were contacted by email or phone and asked to complete the questionnaire. Respondents' perceived barriers to diabetes care were compared based on their demographic characteristics. Results: Response rate to the questionnaire was 59.2%. Approximately 30% of respondents provided at least one diabetes care service. Of those respondents, 98% offered blood glucose meter training to their patients, and 64.7% offered patient education on diabetes topics. Issues pertaining to reimbursement, workload, and available time were the most limiting barriers to providing diabetes care services to their patients. Previously documented barriers such as patient attitudes, cultural/language barriers, store layout and patient privacy, and inadequate resources and start-up funds were not considered to be limiting by the respondents in this study. Conclusions: Provision of diabetes care services is higher than reported in earlier studies. While some barriers may no longer be as limiting as they were in the past decade, inadequate reimbursement, large workload, and lack of time continue to persist as the primary barriers cited by pharmacists who are charged with providing diabetes care.
Poor Central Nervous System Penetration of Tigecycline in a Patient with Sepsis and Ventriculitis Caused by Multidrug-Resistant Klebsiella Pneumoniae
Authors: Chen Julie L , Orsini Jose , Killu Claude 
Published: September 2013

Objective: To report the use of tigecycline in a case of ventriculitis and concurrent bacteremia. Case Summary: A 57-year-old African American male with a ruptured brain aneurysm was admitted to the intensive care unit after surgical intervention and external ventricular drainage placement. His hospital course was complicated by myocardial infarction, ventilator-associated pneumonia, ventriculitis, and sepsis, with multidrug-resistant (MDR) Klebsiella pneumoniae isolated from multiple sites, including blood and cerebral spinal fluid (CSF). The patient was treated with high doses of intravenous tigecycline and gentamicin along with intrathecal gentamicin. This combination eradicated infections outside the central nervous system (CNS) within 48 hours, but it took approximately 8 days for the CSF culture to become negative. Timed serum and CSF fluid samples were collected to determine CSF penetration of tigecycline on day 12 of therapy. CSF concentrations obtained 30 minutes after the dose and at the end of the dosing interval remained below the detectable limit of 0.05 μg/mL. Discussion: Although CSF tigecycline concentrations may not represent actual CNS tissue concentrations at the site of infection, the low CSF concentrations observed in our case may be responsible for the slow CSF clearance of infection. It was not clear whether gentamicin therapy alone, administered both intravenously and intrathecally, would have achieved the same outcome and cleared the infection from the CNS in this patient. Conclusions: Until additional clinical data are available, tigecycline should not be used for the management of MDR infections associated with the CNS.
A Pilot Study Comparing Two Methods for Warfarin Management in Hospitalized Patients
Authors: Ford M Michelle , Stewart David W 
Published: September 2013

Background: The potential for medication errors in a hospital setting has led to a change from daily order writing to scheduled dosing. It has also been hypothesized that scheduled dosing may decrease the pharmacists' workload in a community teaching hospital. Objective: To evaluate the impact that scheduled warfarin dosing would have on patient safety for a pharmacist-run anticoagulation service. Methods: Two methods for managing warfarin in a pharmacist-run anticoagulation service were compared. A retrospective chart review was conducted on a random sample of 80 inpatients who received warfarin either from January 2006 through December 2006 (control/daily dosing group) or from January 2007 through March 2007 (scheduled dosing group). Patients not managed by pharmacists or with a target international normalized ratio (INR) range other than 2 to 3 were excluded. Results: A total of 35 patients met inclusion criteria; 20 patients were in the daily order (control) group and 15 were in the scheduled dosing group. A total of 7 doses were omitted in the daily dosing group, compared with none in the scheduled dosing group. Of the 7, 4 were omissions in administration and 3 were order omissions. In the control group, the dose was changed 47 times (36%) compared with 23 times (28%) in the scheduled dosing group. In the daily dosing group, 28 (22%) INRs were within the therapeutic range and 97 (78%) were in the nontherapeutic range. In the scheduled dosing group, 24 (25%) INRs were within the therapeutic range and 72 (75%) were in the nontherapeutic range. Conclusions: Scheduled dosing eliminated omission-type medication errors and was more efficient than daily dosing. The process change decreased pharmacist workload without having a negative impact on patient care.
Preadmission Predictors of Graduating Grade Point Average in a Professional Pharmacy Program
Authors: Wiest Donald B , Chumney Elinor CG , Nappi Jean M 
Published: September 2013

Background: College of pharmacy admissions committees face an important task in selecting students who will excel as practitioners. This task becomes more cumbersome as the number of applicants continues to increase. Established criteria as predictors of academic success in a pharmacy program would be valuable tools in the student admissions process. Objective: To determine which preadmission variables (eg, Pharmacy College Admission Test [PCAT] score, undergraduate grade point average [GPA], applicant interview scores) best predicted academic success for 3 consecutive college of pharmacy graduating classes. Methods: This investigation was a blinded, retrospective record review of 141 pharmacy students from the graduating classes of 2002, 2003, and 2004 at the Medical University of South Carolina. Linear regression analysis was used to model academic success (ie, graduating GPA) as predicted by demographics and preadmission performance indicators. Results: Undergraduate GPA, PCAT score, and applicant interview scores were all highly significant predictors of graduating GPA. Factors found to be not significantly related to graduating GPA were student Scholastic Assessment Test scores, education level, sex, age, and letters of reference. Conclusions: The composite PCAT, prepharmacy GPA, and applicant interview scores were significant predictors of graduation from a professional pharmacy program.
Rash and Liver Dysfunction Related to Lamotrigine Therapy
Authors: Serwetman Lea RC , Krikorian Susan A , Javedan Houman 
Published: September 2013

Objective: To report a case of rash and liver dysfunction associated with lamotrigine treatment. Case Summary: An 81-year-old woman with a history of bipolar disorder presented to the emergency department with complaints of fever, chills, nausea, and headache. Two weeks prior to presentation, liver enzymes were normal. Lamotrigine 50 mg/day and sustained-release bupropion 200 mg/day were started after discontinuation of citalopram. The patient had previous exposure to bupropion and documented rash with exposure to penicillin and sulfa. On admission, laboratory tests revealed slightly elevated liver enzymes and slightly low serum albumin. All medications were continued. On hospital day 3, a diffuse maculopapular rash developed on the patient's chest, abdomen, neck, and upper extremities, which was pruritic and warm to the touch. Both lamotrigine and bupropion were discontinued. Liver enzymes increased to more than 3 times the upper limit of normal, and serum albumin decreased. Liver function tests improved on day 6, and the rash resolved. Discussion: Predictive risk factors associated with lamotrigine-induced rash and liver dysfunction include rapid dose titration, previously reported rash with other medications, age, and concurrent interacting medications. More serious adverse effects, such as Stevens–Johnson syndrome and fulminant hepatic failure, have also been associated with lamotrigine treatment. If rash appears at any time during treatment, lamotrigine must be discontinued. According to the Naranjo probability scale, an association between lamotrigine and rash and liver dysfunction could be considered probable in this case. Conclusions: A faster than recommended dose titration may lead to lamotrigine-induced adverse effects such as rash and liver dysfunction in patients with risk factors.
Effects of Preoperative Abciximab and Eptifibatide on Bleeding Indices in Coronary Artery Bypass Graft Patients
Authors: Stewart David W , Kincaid Edward H , Kon Neal D , Reichert Marc G 
Published: September 2013

Background: Glycoprotein (GP) IIb/IIIa antagonists are used routinely for the treatment of acute coronary syndrome and to prevent thromboses during percutaneous coronary interventions. It is not uncommon for patients who initially require a GP IIb/IIIa inhibitor to eventually receive a surgical intervention. Objective: To compare the difference in bleeding indices in patients who undergo coronary artery bypass grafting (CABG) after receiving either eptifibatide or abciximab. Methods: A retrospective chart review was completed on all adults who received abciximab or eptifibatide within 24 hours prior to undergoing CABG. Patients were excluded if they had received a dose of warfarin within 96 hours prior to the procedure or if they had an incomplete medical record, an off-pump procedure, a known hypercoagulable disorder, or hemophilia. A total of 54 patients were included and preoperative data, including doses of anticoagulant and antiplatelet agents, were recorded. Intraoperative and postoperative data collected for analysis included hemoglobin level, chest tube output, and the amount of blood products transfused for 24 hours postprocedure. Results: There was a statistically significant difference between the eptifibatide and abciximab groups in the amount of fresh frozen plasma (mean ± SD, 21 ± 31 vs 187 ± 125 mL, respectively; p < 0.05) and platelets (212 ± 81 vs 433 ± 118 mL, respectively; p < 0.01) transfused during the intraoperative period. However, when the total amount of blood products transfused intraoperatively (769 ± 243 vs 1395 ± 316 mL, respectively; p = 0.47) was evaluated, no significant difference was detected. Likewise, markers for bleeding that were collected during the 24-hour postoperative window (immediate and 24-h postoperative hemoglobin and total 24-h chest tube output) were not significantly different. Conclusions: Although there is an increased risk of bleeding when abciximab or eptifibatide is administered prior to CABG, no significant difference in the total amount of blood products used was detected between the 2 agents in this study.
Dietary Vitamin K in Oral Anticoagulation Patients: Clinician Practices and Knowledge in Outpatient Settings
Authors: Dennis Vincent C , Ripley Toni L , Planas Lourdes G , Beach Paige 
Published: September 2013

Background: Dietary vitamin K is a recognized variable associated with oral anticoagulant therapy. However, current practices of dietary education and instruction regarding vitamin K, as well as factors influencing related decision-making, are unknown. Research has examined healthcare providers' ability to identify a meal containing vitamin K, but the ability to classify portions of specific vegetables according to vitamin K content has not been evaluated. Objective: To characterize dietary evaluation and instructional methods provided to patients receiving warfarin therapy, assess factors influencing instructional methods, and evaluate clinician knowledge of vitamin K content for specific vegetable portions. Methods: A cross-sectional online survey of US healthcare providers involved with management of outpatient oral anticoagulation therapy was conducted. Results: One hundred twenty-two responses were received. Seventy-four percent of respondents collected initial dietary history from all patients and 52% asked all patients for dietary history at follow-up visits. Taking a verbal dietary history from all patients was significantly associated with larger clinic size and managing patients in person. Eighty-two percent of respondents reported providing dietary vitamin K education to all patients. Low patient literacy was a common factor influencing instruction to avoid foods high in vitamin K. Overall mean score reflecting the ability to classify vegetable portions by vitamin K content was 64.6 ± 10.9%. Conclusions: Acquisition of dietary history by anticoagulation providers is not always completed at initial and follow-up patient visits. Provision of patient education at initial visits is relatively high. Patient factors such as low literacy may influence a clinician's decision to provide a specific method of dietary instruction, including avoidance of foods high in vitamin K. Clinicians are least likely to correctly identify vegetable portions containing vitamin K in the range of 10–99 μg and should consider portion size when assessing dietary history.
Medications for Extensively Drug-Resistant Tuberculosis: Back to the Future?
Authors: Ashby Charles R , Jodlowski Tomasz Z , Sym Donna 
Published: September 2013

Objective: To reexamine the existing medications for the potential treatment of extensively drug-resistant tuberculosis (XDR-TB), based on susceptibility data, and to identify potential future medications from the literature. Data Sources: Relevant information was identified through a search of MEDLINE (1966–November 2007), PubMed (1955–November 2007), American Search Premier (1975–November 2007), International Pharmaceutical Abstracts (1960–November 2007), Science Citation Index Expanded (1996–November 2007), Cochrane Databases (publications archived until November 2007), and various tertiary sources as listed in the references, using the terms extensively drug-resistant tuberculosis (XDR-TB), ethambutol, pyrazinamide, para-aminosalicylic acid, cycloserine, linezolid, diarylquinoline, nitroimidazopyran, fluoroquinolones, β-lactams, new treatments, and ethionamide alone or in combination regimens. Study Selection and Data Extraction: After identification of the relevant information, the data presented in this article were selected based on clinical relevance and value of information. Data Synthesis: Based on susceptibility data, pyrazinamide, ethambutol, para-aminosalicylic acid, cycloserine, and ethionamide may be used for the treatment of tuberculosis. However, due to the emergence of XDR-TB, many of these agents are no longer successful treatment regimens. We have found limited data supporting potential future use of β-lactams, clarithromycin, and linezolid in resistant TB infections. TMC207, nitroimidazopyran, and SQ109 compounds may also prove to be viable options in the near future for treatment of tuberculosis, especially in cases with resistance to mainstay medications. Conclusions: Extensively resistant tuberculosis appears to be a potentially catastrophic disease if allowed to spread. Due to its resistance profile, very few potentially effective agents are available, calling attention to this growing problem.
Pharmacy and Public Policy: Evolution of the Legal and Regulatory Framework for Generic Interchange
Authors: Fink Joseph L 
Published: September 2013

The past 40 years have seen a movement in the profession of pharmacy to modify the strictures on professional judgment and professional service to patients emanating from antisubstitution laws, both statutes and regulations, at the state level of government. The shift of responsibility for preparing final dosage forms more and more from the community pharmacist to the pharmaceutical industry led the brand name pharmaceutical manufacturers to form an organization to seek enactment of restrictions on the ability of pharmacists to select the brand of medication to be dispensed. Beginning in 1970, the American Pharmaceutical Association sought to change these laws, and through that decade, coalitions were formed with a variety of groups to effect the modifications. A variety of public policy issues were presented for consideration as part of this movement, with the states adopting a variety of approaches, with all jurisdictions eventually restoring to pharmacists the ability to make professional judgments in the area of drug product selection. This initiative within the profession was a highlight of the past century and may have built the confidence of pharmacists to seek other modifications in public policy related to the legal and regulatory framework within which they practice. This article was adapted from a presentation before the American Society for Pharmacy Law 31st/American Pharmaceutical Association 153rd Annual Meeting, San Francisco, CA, March 18, 2006.