American Pharmacists Association

About: American Pharmacists Association is a other organization based out in Washington D.C., District of Columbia, United States. It is known for research contribution in the topics: Pharmacist & Pharmacy. The organization has 2413 authors who have published 1969 publications receiving 30470 citations. The organization is also known as: APhA & American Pharmaceutical Association.

Pharmacist and physician satisfaction and rates of switching to preferred medications associated with an instant prior authorization program for proton pump inhibitors in the North Carolina Medicaid program.

Abstract: BACkgRouNd: Proton pump inhibitors (PPIs) are among the highest expen diture drugs covered by health care plans. during fiscal year 2001-2002, Medicaid programs nationwide spent nearly $2 billion on PPIs. Although the costs of individual PPIs vary widely, there is little variation in therapeu tic effectiveness. on June 1, 2007, the North Carolina Medicaid program implemented an “instant approval” option simultaneously with a prior authorization (PA) program for PPIs with the goal of managing costs and maintaining high-quality care. Preferred PPIs included generic omepra zole and Prilosec oTC. This instant approval process (IAP) was expected to impose less administrative burden than is typically associated with PA programs by permitting physician and nonphysician prescribers to either write the PA criteria directly on a prescription form or use “M d Easy,” a preprinted form that could be faxed by the prescriber to the dispensing pharmacy. A previous study found that from the prescriber’s perspective the IAP reduced practice-related administrative burden and was associated with a reduced gap in PPI therapy when compared with traditional PA. oBJECTIvE: To evaluate the acceptability and effectiveness of this IAP for PPIs as assessed by the outcome measures of (a) pharmacist satisfaction with the IAP; (b) physician and pharmacist satisfaction with the M d Easy form; and (c) utilization rates for preferred PPIs, comparing medical prac tices that used the Md Easy form with practices that did not. METhodS: A cross-sectional design was used to assess pharmacist and physician satisfaction. A stratified random sample of 240 pharmacies was selected from 1,561 North Carolina pharmacies with claims in the Medicaid claims data file during state fiscal year 2006. Additionally, a stratified random sample of 240 medical practices was selected from 1,045 primary care practices serving Medicaid beneficiaries during 2006. Surveys were administered to pharmacists using either in-person interviews or selfadministered questionnaires and to physicians using a mailed questionnaire with follow-up to nonrespondents. An interrupted time series analysis was used to evaluate the effect of the Mform on switching to preferred PPIs using paid Medicaid claims of surveyed practices from calendar year 2007. Practices that reported both using the IAP and receiving the M d Easy form were defined as M d Easy users. Monthly market share data were ana lyzed using log negative binomial regression models to account for autocor relation in the time series data. RESulTS: The pharmacy survey was completed by 202 (84.2%) pharmacies selected for participation. of 198 permanently employed pharmacists, 140 (70.7%) reported experience with the IAP for PPIs. More than two-thirds (68.6%) of the pharmacist respondents with IAP experience indicated that the IAP is better (34.3%) or much better (34.3%) than traditional PA with R ESEAR C H respect to overall administrative burden of phone calls, faxes, patient inter actions, and doctor contacts. Surveys were completed by 171 (71.3%) of selected physician practices, of which 56 (32.7%) reported experience with the Md Easy forms. of practices that recalled receiving the Mforms, 52 of 56 (92.9%) reported that the forms “very much” or “somewhat” helped prevent gaps in PPI therapy; 54 of 55 (98.2%) reported that they helped identify patients affected by Medicaid PPI PA; and 100% reported that they helped physicians to follow PA requirements. Immediately after implementation of the IAP and M d Easy form, the observed market share of preferred PPIs increased by 4.1 times (95% CI = 3.57-4.62). From May to June 2007, the preferred PPI market share increased by 64.0 percentage points, from 19.3% to 83.3% (< 0.001), for practices that reported using the IAP and receiving the M d Easy form (n = 56) and by 55.4 percentage points, from 21.8% to 77.2% (< 0.001), for practices that either (a) report ed not receiving the M d Easy form (n = 25) or (b) reported not using the IAP (n = 84) or (c) did not respond to the survey item asking about the M Easy form (n = 4). The overall increase in preferred PPI market share after implementation of the IAP was 1.29 times higher for practices that used the Md Easy form than for those that did not based on negative binomial regression modeling; this difference approached statistical significance (95% CI = 1.00-1.68; P = 0.053). CoNCluSIoN: This study suggests that an IAP for PPIs using either hand written prescriptions or a preprinted form is an effective alternative to traditional PA. The IAP was associated with an increase in market share for preferred PPIs and was perceived by pharmacists as less administratively burdensome than traditional PA. Additional studies are needed to determine sustainability and the applicability to other prescription drugs.

Comparison of two concentrations of amphotericin B bladder irrigation in the treatment of funguria in patients with indwelling urinary catheters

Abstract: The efficacy of amphotericin B bladder irrigation at two concentrations was studied. Patients with funguria (> or =15,000 colony-forming units of yeast per milliliter of urine), an indwelling urinary catheter, and a physician order for amphotericin B continuous bladder irrigation were randomly assigned to receive 10 or 50 mg of amphotericin B per liter of sterile water as a continuous irrigation for 72 hours at the rate of 42 mL/hr. Before the bladder irrigation began, the indwelling catheter was changed to a three-way catheter. Repeat urine cultures were performed 24 hours after the irrigation was discontinued. A total of 28 patients were enrolled from November 1993 to May 1995. The rate of eradication of the infection was 100% in the 50-mg/L group and 67% in the 10-mg/ L group. Subject enrollment was stopped prematurely because all the treatment failures occurred in the 10-mg/L group. Dose was the only variable significantly associated with outcome. Bladder irrigation with amphotericin B was more effective when the drug concentration was 50 mg/L rather than 10 mg/L.

Dabigatran Use in a Postoperative Coronary Artery Bypass Surgery Patient with Nonvalvular Atrial Fibrillation and Heparin-PF4 Antibodies

Abstract: OBJECTIVE:To present a case of dabigatran use for nonvalvular atrial fibrillation in a patient from a population for whom it has not been studied. Postoperative coronary artery bypass patients have significant bleeding risk and potential to develop heparin-induced thrombocytopenia (HIT).CASE SUMMARY:A 70-year-old male with a history of paroxysmal atrial fibrillation in sinus rhythm prior to surgery developed atrial fibrillation on postoperative day 2 after coronary artery bypass surgery. Because of thrombocytopenia, anticoagulation to decrease stroke risk with atrial fibrillation was initiated with dabigatran 150 mg orally twice daily beginning on postoperative day 4. Later on postoperative day 4, after dabigatran was administered, the patient's HIT screening test was positive for heparin/PF4 antibodies; however, he was not clinically diagnosed with HIT. Heparin was not used postoperatively and transition dosing from dabigatran to warfarin was started on postoperative day 8, the day of discharge. At the t...

Dermatologic Cross-Sensitivity between Diltiazem and Amlodipine:

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Real-Life Frequency of New-Onset Thrombocytopenia during Linezolid Treatment.

Abstract: Background: Thrombocytopenia is a well-recognized adverse effect of linezolid; however, the frequency of this adverse effect during therapy has been variable across previous studies, and the associated risk factors are unclear. Objectives: To identify the real-life frequency of new-onset thrombo -cytopenia due to linezolid and to determine the associated risk factors. Methods: A retrospective observational cohort study was conducted among consecutive inpatients at a tertiary care hospital who received linezolid for a minimum of 5 days between January 2013 and August 2017. Data were extracted from electronic medical records obtained from a hospital database. Thrombocytopenia was defined as platelet count less than 100 × 109/L or a 50% reduction from baseline (i.e., before linezolid initiation). Risk factors were identified by comparing the characteristics of patients who experienced the adverse effect during linezolid therapy with those of patients who did not experience the adverse effect. Continuous data were analyzed with the t test and categorical data with the 2 test. Results: A total of 102 patients were included (38 women, 64 men; overall mean age 50 years, standard deviation [SD] 21). The mean duration of linezolid therapy was 14 (SD 10) days. Thrombocytopenia occurred in 18 patients (17.6%). Risk factors for the development of thrombocytopenia included mean duration of therapy (22 [SD 18] days versus 12 [SD 7] days; p = 0.023), renal replacement therapy (17% versus 4%; p = 0.032), renal impairment (61% versus 32%; p = 0.021), and concomitant administration of unfractionated heparin (50% versus 21%; p = 0.013). Conclusions: The real-life frequency of new-onset of thrombocytopenia in patients receiving linezolid for a minimum of 5 days was 17.6%. Risk factors for linezolid-induced thrombocytopenia included prolonged duration of therapy, renal impairment, and concomitant unfractionated heparin. RESUME Contexte : La thrombopenie est une reaction indesirable bien connue, induite par le linezolide; cependant, la frequence de cette reaction indesirable pendant le traitement hvariait d’une etude a l’autre et on ignore quels sont les facteurs de risque associes a cet antibiotique. Objectifs : Decouvrir la frequence reelle des nouveaux cas de thrombopenie causes par le linezolide et determiner les facteurs de risque qui lui sont associes. Methodes : Une etude de cohorte observationnelle retrospective a ete menee aupres de patients hospitalises consecutivement dans un hopital de soins tertiaires, qui ont recu du linezolide pendant au moins cinq jours entre janvier 2013 et aout 2017. Les donnees ont ete tirees des dossiers medicaux electroniques provenant d’une base de donnees d’un hopital. La thrombopenie a ete definie comme un taux de plaquettes de moins de 100 × 109/L ou comme une reduction de 50 % de leur valeur initiale (c’est-a-dire, avant l’amorce du traitement au linezolide). Les chercheurs ont etabli les facteurs de risque en comparant les caracteristiques des patients ayant subi la reaction indesirable pendant leur traitement au linezolide avec les caracteristiques des patients n’ayant pas subi cet effet indesirable. Les donnees continues ont ete analysees a l’aide d’un test t et les donnees categoriques a l’aide d’un test de 2. Resultats : Au total, 102 patients ont ete admis (38 femmes, 64 hommes; âge moyen de 50 ans, ecart-type de 21). La duree du traitement au linezolide etait de 14 jours (ecart-type de 10). Dix-huit patients (17,6 %) ont souffert de thrombopenie. Parmi les facteurs de risque de thrombopenie, on comptait la duree moyenne du traitement (22 jours [ecart-type de 18] contre 12 jours [ecart-type de 7]; p = 0,023), le traitement de suppleance renale (17 % contre 4 %; p = 0,032), l’insuffisance renale (61 % contre 32 %; p = 0,021) et l’administration concomitante d’heparine non fractionnee (50 % contre 21 %; p = 0,013). Conclusions : La frequence reelle de nouveaux cas de thrombopenie parmi les patients recevant du linezolide pendant un minimum de 5 jours etait de 17,6 %. Parmi les facteurs de risque de thrombopenie associes au linezolide, on mentionne l’allongement de la duree du traitement, l’insuffisance renale et l’administration concomitante d’heparine non fractionnee.