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.

Summative service and stakeholder evaluation of an NHS-funded community Pharmacy Emergency Repeat Medication Supply Service (PERMSS).

Abstract: Objectives Service and stakeholder evaluation of an NHS-funded service providing out-ofhours (OOH) emergency repeat medications to patients self-presenting at community pharmacies. Setting Community pharmacies across the North East of England accredited to provide this service. Participants Patients self-presenting to community pharmacies during OOH periods with emergency repeat medication supply requests. Intervention Community pharmacists assessed each request for clinical appropriateness and when suitable provide an emergency repeat medication supply, with additional pharmaceutical advice and services if required. Primary outcomes Number of emergency repeat medication supplies, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist and patient satisfaction. Results A total of 2485 patients were managed across 227 community pharmacies (15 December 2014 to 7 April 2015). Most patients presented on Saturdays, with increased activity over national holidays. Older age was associated with increased service use. Of the 3226 medications provided, 439 were classified as high risk. Patients found this service easy to access and were willing to access the community pharmacy in the future for medication-related issues. In the absence of this service, 50% of patients would have missed their medication(s) until they saw their doctor and a further 46% would have accessed an alternative service. The cost of National Health Service (NHS) service(s) for patients who would have accessed an alternative OOH service was estimated as 37 times that of the community pharmacy service provided. Community pharmacists were happy to provide this service despite increased consultation times and workload. Conclusions Community pharmacists were able to manage patients’ OOH requests for emergency repeat medication and patients were happy with the service provided. Since the service cost was favourable when compared with alternative OOH services, it would be a viable option to reduce the workload on the wider NHS.

BOOMR: Better Coordinated Cross-Sectoral Medication Reconciliation for Residential Care

Abstract: There is evidence that medication errors often arise during the transition of residents from acute care to long-term care (LTC) homes due to lapses in communication and documentation. Better Coordinated Cross-Sectoral Medication Reconciliation (BOOMR) is an integrated practice change improving medication safety during patient transitions through the health system. Our Medication Reconciliation (MedRec) redesign improved patient engagement using "the patient's story," increased quality of information, workflow efficiency and reduced unnecessary medications. Using progressive initiatives, we showed cost savings to the system proving value for quality with sustainable results since January 2015.

Etanercept induces remission of polyarteritis nodosa: a case report

Abstract: Polyarteritis nodosa (PAN) is a systemic autoimmune vasculitis characterized by necrotizing inflammatory lesions of the medium-sized and small muscular arteries, preferentially at vessel bifurcations, resulting in microaneurysms formation, aneurysmal ruptures with hemorrhage, thrombosis and consequently, organs ischemia or infarction. It usually appears in middle and older age, without gender predilection (Jennette et al., 1994). PAN shows a wide variety of symptoms, including general symptoms, neurological, skin, renal, and gastrointestinal involvement. In particular, skin lesions, characterized by multiple firm waxy papules, subcutaneous nodules, livedo reticularis, ulcers and gangrene, are observed in 25–60% of patients with PAN (Cohen et al., 1980). In most of the cases, the disease is treated with glucocorticoids and cyclosphosphamide (conventional treatment). However, rituximab is the first FDA-approved drug (on April 19, 2011) for any form of vasculitis. There is no known cause or cure for vasculitis. Rituximab works by affecting the action of and eliminating B cells, which are cells of the immune system that have a number of actions. It was initially developed for treatment of a type of lymphoma, and since has been found to be effective for autoimmune diseases, including rheumatoid arthritis and now ANCA-associated vasculitis (Cohen Tervaert, 2011). Refractory patients are exposed to many complications, notably accelerated atherosclerosis. The etiologies of systemic vasculitis are yet unknown. However, dysregulation and/or enhanced expression of pro-inflammatory substances may be involved in the pathogenesis of these diseases. Tumor necrosis factor (TNF)-alpha is a pro-inflammatory cytokine produced primarily by cells of the macrophage-monocyte lineage. The biologic effects of TNF-alpha include adhesion molecule expression, synthesis of proinflammatory cytokines and chemokines, activation of immune system cells (T-cells, B-cells, and macrophages), and inhibition of regulatory T-cells; thus, it may directly participate in vascular inflammation as well as in endothelial cell death via apoptosis (Bansal and Houghton, 2010; Jarrot and Kaplanski, 2014). In addition, TNF-alpha may play a role in neutrophil “priming” inducing membrane expression of proteinase-3 or myeloperoxidase, which are subsequently recognized by ANCA (anti-neutrophil cytoplasmic antibodies) in ANCA-associated vasculitis (AAV) (Radford et al., 1999). Also, elevated levels of plasma TNF-alpha have been shown to correlate with active glomerulonephritis (a variant of vasculitis) and elevated in vitro TNF stimulated peripheral blood mononuclear cells and CD4+ T cells (Ludviksson et al., 1998). Etanercept is a fusion protein composed of 2 extracellular p75 TNF receptor domains linked by the Fc portion of human IgG1. It binds to and neutralizes biologically active TNF-alpha. It has been approved by the FDA for the treatment of rheumatoid arthritis, polyarticular juvenile idiopathic arthritis in patients aged 2 years or older, psoriatic arthritis, ankylosing spondylitis and plaque psoriasis according to the results of randomized phase III studies. The most common side-effects of etanercept are reactions at the injection site (usually redness and sometimes itching), a blocked or runny nose, nausea, mild fever, headaches, dizziness, a rash, and stomach symptoms. More serious and infrequent adverse events are heart failure, infections and skin cancers. In this report we show a case of successful treatment of refractory PAN with etanercept. A 10-year-old patient, with no remarkable medical history, affected by systemic vasculitis was treated with first-line glucocorticoids for 2 years. At relapse, he was treated with intravenous cyclophosphamide (IVCY). After three IVCY pulses, the patient's condition deteriorated with subacute polyarthritis, myalgias and livedo. Furthermore, multiple malacic lesions were observed at brain MRI (Magnetic Resonance Imaging) and signs of sensory-motor polyneuropathy were documented on electromyograms of the legs. Histological examination of neuromuscular biopsy found a vasculitis with fibrinoid necrosis confirming the diagnosis of PAN. Thus, he was initially treated with 60 mg/day of prednisolone, followed by 1000 mg/day of IVCY therapy according to the European League Against Rheumatism (EULAR) recommendations for the management of small and medium vessel vasculitis (European Vasculitis Study Group, 2009). However, he presented resistance to high dose corticosteroid and IVCY therapy, thus he was treated with high dose intravenous immunoglobulin (IVIg) therapy that, according to the literature, can show efficacy in such cases with a good safety profile (Sroa et al., 2010). After 2 months of IVIg treatment (0.4 g/kg body weight/day for 5 consecutive days every month), a partial regression of the disease was achieved. Clinical progression was observed after 6 months. Thereafter, the patient was treated with oral thalidomide (initial dosage 100 mg/day) obtaining a rapid control of signs and symptoms. The treatment was continued for 6 months with a lower daily dose (50 mg/day) until the occurrence of a severe peripheral neuropathy. Considering (i) patient age, (ii) clinical conditions, (iii) disease progression, (iv) previous treatments, and (v) scientific literature reporting involvement of TNF pathway and response to anti-TNF agents in systemic vasculitis, off-label use of etanercept (Bartolucci et al., 2002; Sonomoto et al., 2008) was proposed (25 mg subcutaneously twice a week). Interestingly, after starting the treatment, symptoms and lesions improved without adverse effects. A clinical response was registered after 2 months, with marked improvement in arthralgia, resolution of ulcerations and erythema nodosum and reduction of fatigue. He shows persistent clinical remission after 2 years of treatment. At present, the dosage has been adjusted according to age and weight and he is on treatment with etanercept 50 mg subcutaneously once a week. Our report, as few cases in literature (Feinstein and Arroyo, 2005; Brik et al., 2007; Guillevin and Pagnoux, 2007; Braun-Moscovici et al., 2008; Eleftheriou et al., 2009; Valor et al., 2013; Zoshima et al., 2013), supports a role of anti-TNF therapy in rare systemic vasculitis and, indirectly, it gives evidence that increased levels of TNF-alpha may play a critical role in the inflammatory process associated with PAN. Preliminary data suggest that other several forms of vasculitis appear responsive to TNF antagonists (Behcet's disease, Churg-Strauss vasculitis and giant cell arteritis). Despite aggressive medical management, 22.4% of patients affected by PAN die within 5 years, and of the survivors, medication-induced morbidity is frequent. Thus, there is great need of basic studies on the pathogenic mechanisms underlying these disorders as well as of treatments with high safety and efficacy. Treatment with etanercept could be considered when standard therapies are unsuccessful or contra-indicated.

Leukotriene Modifiers to Prevent Aspirin-Provoked Respiratory Reactions in Asthmatics

Abstract: OBJECTIVE:To evaluate the use of leukotriene modifiers in preventing aspirin-provoked respiratory reactions in asthmatics.DATA SOURCES:Clinical literature accessed through MEDLINE (1965–February 2001). Key search terms included aspirin, asthma, leukotriene, and treatment.DATA SYNTHESIS:Aspirin-sensitive asthmatics experience a wide variety of symptoms, ranging from rhinitis to life-threatening bronchospasms, after the ingestion of aspirin or nonsteroidal antiinflammatory drugs (NSAIDs). The relationship between aspirin sensitivity, asthma, and nasal polyps was first reported in 1922. The exact mechanism of these reactions is not clearly understood. Four studies investigated the use of leukotriene modifiers to prevent aspirin-provoked respiratory reactions. The efficacy of these agents ranged from complete inhibition to no blockade.CONCLUSIONS:Patients who experience aspirin-sensitive asthma should be cautious when taking aspirin and NSAIDs, despite treatment with leukotriene inhibitors.

Case–Control Study Comparing Droperidol Plus Diphenhydramine with Conventional Treatment in Hyperemesis Gravidarum

Abstract: Background: In 1998, a protocol consisting of droperidol/diphenhydramine combination was established at Hospital Sainte-Justine to treat hyperemesis gravidarum. Objective: To compare the efficacy of the droperidol/diphenhydramine combination with other conventional treatments used before implementation of this protocol in the treatment of hyperemesis gravidarum (HG). Methods: A nonrandomized, prospective study was conducted using a historical control of 54 patients receiving conventional antiemetic treatment and 2 study groups: 67 patients treated with intravenous droperidol 1 mg/h plus diphenhydramine 25-50 mg every 6 hours and 34 patients treated with intravenous droperidol 0.5 mg/h plus diphenhydramine 50 mg every 6 hours. Study outcomes included length of hospital stay, readmission rate, intensity of nausea and vomiting according to the National Cancer Institute scoring system, maternal body weight variation, pregnancy outcomes, and adverse effects. Study Site: Sainte-Justine Hospital in Montreal, Quebec, a tertiary care university teaching hospital affiliated with the University of Montreal. Study Population: Hospitalized patients diagnosed with HG. Results: The 3 groups, comparable in terms of maternal characteristics, showed no difference in terms of length of stay. The readmission rate was lower in the group that received droperidol 1 mg/h compared with the other 2 groups. Overall, droperidol use was associated with a reduction in daily nausea and vomiting scores (p < 0.001). The most common adverse effects were xerostomia, drowsiness, constipation, and hypotension. Extrapyramidal reactions were observed in 20% of the droperidol patients. Birth defects occurred in 2.4% of the control group and 7.5% of the study group (p = 0.52). Drugs could be excluded as causal agents for the majority of malformations in 5 of 7 cases. Conclusions: Droperidol/diphenhydramine is an effective alternative for treatment of refractory HG. A large, prospective, randomized study would be required to confirm the efficacy of this treatment as well as maternal and fetal safety.