bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of the Pharmacist on a Multidisciplinary Psychiatry Team: Impact on Medication Adherence in a Community Setting
Authors: Carvalhana Virginia , Flak Edred 
Published: September 2013

Objective: To report the effect of pharmacist involvement in a multidisciplinary psychiatry team managing high-risk patients in the community. Case Summary: We report 3 cases of professional collaboration that highlight the role of the pharmacist as a member of the multidisciplinary psychiatry team in the successful management of high-risk patients. Regular communication between pharmacists and psychiatrists, as well as delivery of specialized pharmacy services such as dispensing of medications in controlled supply, witnessed medication consumption, and adherence monitoring, resulted in decreased use of emergency services, decreased incidents of overdose, and increased adherence to medication. Discussion: The management of psychiatric patients poses a significant challenge to healthcare providers. Poor adherence to drug therapy is often a significant barrier to treatment success and can lead to clinical and economic burdens. Professional collaboration between psychiatrists and pharmacists can aid in successful management of psychiatric patients at risk of relapse or deterioration in the community setting secondary to nonadherence and/or possible overdose. The pharmacist is often an unrecognized or underutilized member of the multidisciplinary team. The recent focus on expanding the pharmacist's scope of practice supports the involvement of pharmacists as integral members of interdisciplinary and collaborative care models. Conclusions: Interprofessional collaboration and implementation of specialized pharmacy services can increase patient adherence to medication regimens, reduce the potential for overdose, and aid in the successful management of psychiatric patients in the community setting. Although we have highlighted a small number of cases, future research is required to assess the effectiveness of such interventions on a larger scale.
Review of Serum Voriconazole Concentrations and Correlations with Adverse Events and Efficacy
Authors: Latran Michael J 
Published: September 2013

Objective: To review the available evidence regarding the monitoring of serum voriconazole concentrations in terms of efficacy and safety. Data Sources: A literature search of MEDLINE was conducted (1950–February 2009), with combinations of the following search terms: voriconazole, therapeutic drug monitoring, voriconazole serum concentrations, voriconazole levels, trough, and adverse events. Data Collection: All studies and case reports that evaluated serum voriconazole concentrations in adults were reviewed and considered for inclusion. Citations in identified articles were searched for additional information. Data Synthesis: Ten studies and case reports that evaluated serum voriconazole concentrations in terms of efficacy and safety in adults were identified and included in this review. Results from efficacy studies show an association between low serum voriconazole concentrations and disease progression. One study found that a lack of response occurred more often in patients with a serum voriconazole trough of 1 μg/mL or less (p = 0.02). Another study found that patients were more likely to fail voriconazole therapy for invasive fungal infections when serum concentrations were less than or equal to 2 μg/mL. In terms of safety, 6 studies showed an association between elevated serum voriconazole concentrations and adverse events. Conclusions: Available data suggest that serum voriconazole concentrations of 1 μg/mL or less are associated with therapeutic failures, whereas serum voriconazole concentrations of 6 μg/mL or more are associated with adverse events. Studies show that monitoring serum voriconazole concentrations may decrease the incidence of adverse events while increasing efficacy.
Measuring Persistence to Oral Hypoglycemic Agents in Type 2 Diabetic Veterans
Authors: Kim Nancy , Agostini Joseph , Justice Amy 
Published: September 2013

Background: Medication adherence is essential for diabetes control but difficult to measure. Persistence, the continuous refill of medications, is one measurement that could be integrated into practice, but concordance among definitions of persistence is unclear. Objective: To compare persistence patterns in the use of oral hypoglycemic agents by diabetic veterans in the first year of treatment, using 2 separate refill metrics. Methods: Eligible veterans were 18 years or older and had filled at least one prescription for any nondiabetes drug during the 6 months preceding study entry. Study entry was the date that patients first filled a prescription for oral hypoglycemic agents between January 1, 2000, and December 31, 2002. Persistence was defined as (1) total days (days' supply/study period) and (2) continuous fill (days' supply/refill interval). Results: Inclusion criteria were met by 110,554 veterans. They had a median age of 63 years, 97% were male, and most had multiple comorbidities. Most patients received only one oral hypoglycemic agent. When total days was used, median persistence at 1 year was 83%, with 45% of subjects demonstrating poor persistence (<80%). When continuous fill was used, median persistence was 0.99, and 24% had poor persistence. Both metrics decreased over time. Continuous fill produced higher persistence estimates and a substantial proportion of overpersistence (>24% of patients). The 2 measures had a kappa agreement statistic of 0.56 (95% CI 0.55 to 0.57). Conclusions: Although both metrics showed similar trajectories over time, more conservative estimates, ease of calculation, and transparency favor total days over continuous fill. Continuous fill revealed substantial overpersistence, which should be considered separately from good persistence. Explicit definitions of persistence are necessary to enhance comparisons among refill studies and provide context for clinical applications.
Ask-Advise-Refer Increases Referrals to a Smoking Cessation Group Clinic
Authors: Philbrick Ann M , Farris Karen B , Faber Ashley J , Anderson Erin A , Carmody Brenda R , Mascardo Lisa A , Jacobsen Ryan B , Reist Jeffery C , Newkirk Erin N , McDanel Deanna L 
Published: September 2013

Background: The Department of Pharmaceutical Care at the University of Iowa Hospitals and Clinics sponsors a pharmacist-managed smoking cessation group clinic. Ask-Advise-Refer is a method to refer patients to smoking cessation programs, but few data are available to support its use by pharmacists in an academic medical center outpatient pharmacy. Objective: To quantify the number of individuals asked about tobacco use, advised to quit smoking, referred, and enrolled in the pharmacist-managed smoking cessation group clinic through the hospital's 2 ambulatory care pharmacies. Methods: The Ask-Advise-Refer program was implemented and evaluated prospectively in both ambulatory care pharmacies. Patients over 18 years old who received their own prescriptions were asked about tobacco use. Pharmacists advised tobacco users to quit and surveyed their interest in quitting within the next 30 days. A pharmacist contacted interested patients by phone to provide them with more information to enroll them in the smoking cessation group clinic. A documentation form followed the prescription through the filling process. Forms used for data collection were gathered daily and information on tobacco use was entered into the dispensing system weekly. Forms also provided numerical counts for evaluating the program. Results: Of the 3,267 patients asked about smoking status, 889 of them used tobacco. Of those, 53.8% were interested in quitting in the next 30 days; 30% of these patients wanted the pharmacist to contact them. Of the patients who were contacted, 22 agreed to enroll in the clinic, and 10 attended the clinic. Conclusions: By implementing an Ask-Advise-Refer brief smoking cessation intervention at an academic medical center outpatient pharmacy, referrals and participation were increased in the pharmacist-managed smoking cessation group clinic.
Amiodarone-Induced Cutaneous Leukocytoclastic Vasculitis after Cardiac Surgery
Authors: Kaushik Prashant , Hefty Matthew , Soule Matthew R 
Published: September 2013

Objective: To remind physicians and pharmacists of the potential of amiodarone to cause leukocytoclastic vasculitis (LCV) as a potentially serious acute adverse drug reaction, and that the cornerstone of treatment for LCV is identification and removal of the etiologic agent (usually a drug such as amiodarone). Case Summary: A 70-year-old white male who underwent aortic valve replacement developed cutaneous LCV (without serious systemic involvement) 2 days after treatment with amiodarone 800 mg/day was initiated. Amiodarone was discontinued and the rash almost completely resolved within 48 hours. Amiodarone 400 mg/day was restarted 13 days later and arthralgias and palpable purpuric lesions reappeared in the same distribution, but much more extensively, within 2 days. Amiodarone was discontinued and, once again, arthralgias and skin lesions resolved within 1 week. Discussion: Photosensitivity and the development of blue/grey skin pigmentation are the most commonly and classically recognized cutaneous adverse drug reactions (ADRs) of long-term use of amiodarone. LCV, the most common small-vessel necrotizing vasculitis as an acute ADR to amiodarone, is rare, but needs to be considered in day-to-day clinical practice. The Naranjo probability scale suggested a highly probable association between LCV and the use of amiodarone in our patient. Conclusions: To the best of our knowledge, this is the first case report of LCV occurring in a post–cardiac surgery setting with the use of amiodarone. Cardiothoracic surgeons, cardiologists, other treating physicians and pharmacists should be aware of this rare but potentially serious adverse event related to amiodarone.
Pharmacy Automation and Workflow Implications: A Case Study
Authors: Silverstein Steven 
Published: September 2013

Background: Inpatient pharmacy automation is becoming an increasingly important component of the medication distribution process across the country. The use of pharmacy automation is perceived as a tool for increasing patient safety and pharmacy department efficiency. Adjusting pharmacy workflow requirements and staffing redefinitions is essential when implementing pharmacy automation. Objective: To evaluate the results of an acute care, community, teaching hospital's experience as the inpatient pharmacy implements a robot, medication carousel, and barcode packager, and shifts its medication distribution model from a cartless to cart fill method. Summary: Data on robot efficiency, changing pharmacy technician roles, and pharmacist time were collected over 2 years. The medication distribution process and pharmacy technician roles had to be adjusted multiple times to increase workflow efficiency. The initial shift to a cart fill distribution model, with first doses dispensed from the robot, resulted in robot efficiency of approximately 71%. When the distribution model was shifted to hybrid cart fill and cartless model, with first doses dispensed from automated dispensing cabinets, the robot efficiency improved to between 85% and 90%. Conclusions: Pharmacy automation requires proper workflow adjustments to realize the potential increased efficiency of this technology. Additionally, optimizing the medication distribution model to maximize the efficiency of staffing workflow has a significant impact on automation efficiency.
Plerixafor for Stem Cell Mobilization Prior to Autologous Stem Cell Transplant in Non-Hodgkin's Lymphoma and Multiple Myeloma
Authors: Moorman Meredith T , Baxley Allison , Borders Emily B 
Published: September 2013

Objective: To review the pharmacology, pharmacokinetics, dosage, administration, clinical efficacy, safety, and place in therapy of plerixafor, a CXCR4 receptor antagonist used to mobilize stem cells prior to hematopoietic stem cell transplantation. Data Sources: Articles were identified by searching MEDLINE (1950-August 2009) and the American Society of Hematology abstract database using the key terms plerixafor, AMD3100, hematopoietic stem cell transplant, mobilization, multiple myeloma, and non-Hodgkin's lymphoma. Additional articles were obtained by using the reference sections of articles found during the literature search. Study Selection and Data Extraction: All articles identified from the literature search were reviewed for relevant information. Appropriate information was included in this review. The search was restricted to available English-language articles, including those on both preclinical and clinical trials. Data Synthesis: Plerixafor is a CXCR4 receptor antagonist approved by the FDA to assist in the mobilization of hematopoietic stem cells in patients with non-Hodgkin's lymphoma or multiple myeloma undergoing autologous stem cell transplant. Plerixafor is used in combination with granulocyte colony-stimulating factor. Plerixafor has been compared with placebo in both Phase 2 and Phase 3 clinical trials and has been shown to allow for a greater collection of hematopoietic stem cells in fewer apheresis sessions. Plerixafor demonstrated good tolerability in clinical trials. Conclusions: Plerixafor has demonstrated efficacy and tolerability when used for stem cell mobilization in patients with non-Hodgkin's lymphoma and multiple myeloma. Further studies are warranted to determine the safety and efficacy of plerixafor in patients with malignancies other than non-Hodgkin's lymphoma or multiple myeloma who are undergoing stem cell transplant and to determine its potential use in healthy stem cell donors.
Milnacipran: A New Treatment for Fibromyalgia Syndrome
Authors: Hale Katherine S 
Published: September 2013

Objective: To review the pharmacology, efficacy, and tolerability of milnacipran, a dual serotonin-norepinephrine reuptake inhibitor (SNRI), in the treatment of symptoms of fibromyalgia syndrome and associated fibromyalgia pain. Data Sources: English-language articles were obtained via searches of MEDLINE (1950-January 2010), EMBASE (1980-January 2010), and International Pharmaceutical Abstracts (1970-January 2010), using the key words milnacipran, fibromyalgia, serotonin-norepinephrine reuptake inhibitors, F 2207, and pain management. Bibliographies of selected articles were used to identify additional sources. Study Selection and Data Extraction: Available published articles reporting the results of human studies of milnacipran were reviewed for inclusion in this article. Additional information regarding pharmacology, adverse events, contraindications, and precautions was obtained from the manufacturer's prescribing information. Data Synthesis: Milnacipran is a dual SNRI approved for the treatment of fibromyalgia symptoms and pain. Milnacipran is well absorbed upon oral administration, has limited first-pass elimination, has a short halflife, and is not metabolized by the cytochrome P450 enzyme group. Phase 3 clinical trials evaluating the efficacy of milnacipran demonstrated a 10–20% higher composite response rate compared with placebo in the treatment of fibromyalgia symptoms and associated pain when milnacipran was given in doses of 100–200 mg/day. Significant improvements in physical functioning, fatigue, cognition, and mental health were also noted. Milnacipran appears to have fewer anticholinergic, sedative, and cardiovascular adverse effects compared with other pharmacologic treatments of fibromyalgia. Nausea was the most commonly reported adverse event. Conclusions: Milnacipran is an effective treatment for the symptoms of fibromyalgia syndrome and associated pain. Additional studies are needed to assess comparative effectiveness with that of other pharmacologic treatments of fibromyalgia syndrome, long-term efficacy, and safety.
Iloperidone—A Second-Generation Antipsychotic for the Treatment of Acute Schizophrenia
Authors: Hale Katherine S 
Published: September 2013

Objective: To review the pharmacology, efficacy, and tolerability of iloperidone, a second-generation antipsychotic, in the treatment of acute schizophrenia in adults. Data Sources: English-language articles were obtained via MEDLINE (1966-March 2010) and International Pharmaceutical Abstracts (1970-March 2010) searches using the key words iloperidone, acute schizophrenia, atypical antipsychotics, second-generation antipsychotics, HP 873, P88–8991, P95–12113, and Fanapt. Bibliographies of selected articles were used to identify additional sources. Study Selection and Data Extraction: Available published articles reporting the results of human studies of iloperidone were reviewed for inclusion in this article. Additional information regarding pharmacology, adverse events, contraindications, and precautions was obtained from the manufacturer's prescribing information. Data Synthesis: Iloperidone is a second-generation antipsychotic approved for the treatment of acute schizophrenia in adults. Iloperidone is well absorbed upon oral administration, highly protein bound, and metabolized primarily by CYP3A4 and 2D6. Phase 3 clinical trials evaluating the efficacy of iloperidone demonstrated significantly higher response rates with iloperidone compared with placebo in the treatment of positive, negative, and cognitive symptoms associated with acute schizophrenia when the drug was given in doses up to 24 mg daily. Dizziness, dry mouth, and nausea were the most commonly reported adverse events and appear to be dose related. Additional adverse events occurring in 5% or more of patients include orthostatic hypotension, somnolence, tachycardia, fatigue, nasal congestion, and weight increase. Iloperidone should be titrated slowly over a 7-day interval to avoid the potential for orthostatic hypotension. Product labeling includes a black box warning against the use of iloperidone in dementia-related psychosis and precautions regarding QT interval prolongation. Conclusions: Iloperidone is an effective treatment for the symptoms of acute schizophrenia in adults. Additional studies are needed to assess comparative effectiveness with other pharmacologic treatments of schizophrenia, long-term efficacy, and long-term safety.
Pharmacotherapy Using Cardiovascular Agents: Focus on the Top 200 Drugs
Authors: Schnepp Adam R , Nykamp Diane 
Published: September 2013

Objective: To summarize pharmacologic agents available to treat cardiovascular diseases, including heart failure, hypertension, and hyperlipidemia. Data Sources: Drugs used in the management of cardiovascular disease were identified from a list of the top 200 drugs of 2008 by number of prescriptions dispensed. Relevant articles were obtained via a MEDLINE search (2000-March 2010) using the key words pharmacy technician, hypertension, heart failure, hyperlipidemia, β-blocker, ACE inhibitor, angiotensin receptor blocker, diuretic, calcium-channel blocker, clonidine, HMG-CoA reductase inhibitor, ezetimibe, fenofibrate, niacin, clopidogrel, warfarin, isosorbide mononitrate, and digoxin. In addition, evidence-based practice guidelines, monographs, package inserts, and other secondary sources were reviewed. Study Selection and Data Extraction: Relevant information regarding dosages, trade/generic names, pharmacology, and adverse effects associated with common agents to treat cardiovascular disease was included. Data Synthesis: Despite falling mortality rates, cardiovascular disease continues to be the leading cause of death in the US and is a significant cause of morbidity. Pharmacy technicians should be familiar with the basic pharmacology of the most commonly prescribed medications. Selected agents used to treat heart failure and hypertension from the following classes of drugs were reviewed: β-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics, calcium-channel blockers, and a centrally acting agent. Additionally, common drugs used to treat hyperlipidemia, including hydroxymethylglutaryl coenzyme A reductase inhibitors, cholesterol absorption inhibitors, fibric acids, and niacin, were reviewed. Antiplatelet agents, selected vasodilators, warfarin, and digoxin were also reviewed. Conclusions: Drug therapy is the key to successful management of cardiovascular disease. Health-care providers, including knowledgeable pharmacy technicians, can assist patients in the proper use of agents in the treatment of cardiovascular diseases.
Effect of Pharmaceutical Care Programs on Glycemic Control in Patients with Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials
Authors: Li Xin , Mao Mao , Ping Qineng 
Published: September 2013

Background: Diabetes mellitus is a common disease that has an increasing influence on the health of human beings. While the role of pharmaceutical care (PC) programs in the treatment of patients with diabetes mellitus is well established, there is little research that quantitatively and comprehensively assesses the impact of PC programs on glycemic control in diabetics. Objective: To evaluate the effect of PC programs on glycemic control in patients with diabetes mellitus. Methods: Publications on PC programs and randomized controlled trials (RCTs) of glycemic control were retrieved by searching MEDLINE, Embase, Cochrane, Elsevier, Chinese Biomedicine Database, and Chinese Journal Full-Text Database databases from January 1996 through February 2010. Data were extracted by 2 reviewers independently, based on their correlation with this project, and then evaluated with meta-analysis. The meta-analysis was conducted using STATA version 10.1. Begg-Mazumdar's funnel plot was generated to determine the potential impact of publication bias. Results: Fourteen RCTs, with a total of 1770 patients with diabetes mellitus, were included in this meta-analysis. Pharmacists were involved in all of these PC interventions. The average ± SD study period of included trials was 9.5 ± 4.1 months. Drug counseling, drug therapy management, lifestyles education, self-monitoring, and recommendations of drug therapy changes were the most frequently used interventions. All of the trials reported the reduction of hemoglobin A1c (A1C) as the primary clinical outcome of PC intervention. Compared with the usual-care control groups, the PC intervention groups had significant reduction in A1C levels (weighted mean difference −0.68; 95% CI-1.03 to −0.34; p = 0.000). Conclusions: PC programs delivered separately or in combination by pharmacists and other health professionals can lead to an improvement in glycemic control. The incorporation of PC programs into disease management should be strongly considered.
The Role of Statins in the Prevention and Treatment of Alzheimer's Disease
Authors: Desilets Alicia R , Koslowski Danielle A , Dunican Kaelen C 
Published: September 2013

Objective: To review the role of statins (3-hydroxy-3-methylglutaryl coenzyme A [HMG-CoA] reductase inhibitors) in the prevention and treatment of Alzheimer's disease (AD). Data Sources: Literature was retrieved from EMBASE (1980–2010, week 22) and MEDLINE (1950-May 2010, week 4), using the key words statins, HMG-CoA reductase inhibitors, and Alzheimer's disease, as well as a bibliographic review of published articles. Study Selection and Data Extraction: All clinical trials that involved humans, were published in the English language, and evaluated statins in the prevention and/or treatment of AD were included in this review. Data Synthesis: Recent studies have evaluated the use of statins in the prevention and treatment of AD; results from these studies are conflicting. One randomized, placebo-controlled trial found that statins may improve the ADAS-Cog (Alzheimer's Disease Assessment Scale on Cognition) by 0.1–1.8 points in patients with AD during the first 6 months of treatment. Alternatively, another randomized controlled trial found that atorvastatin did not provide benefit on the ADAS-Cog. Although many of the prevention trials did find potential benefit with statin use, these trials were observational. Conclusions: Due to insufficient evidence of benefit in both the prevention and treatment of AD, statins cannot be recommended at this time.